Steddon S et al. (Eds; 2006) Oxford Handbook of Nephrology and Hypertension. Oxford: Oxford University Press

The Oxford Handbook series is much loved by medical students and junior doctors alike. You will find a “cheese and onion” (as it has come to be known) in the pocket of nearly every medical student and junior doctor in the UK. The Oxford Handbook of Nephrology and Hypertension is the newest member of the series, and is aimed at everyone who has day-to-day contact with renal patients—including junior doctors, renal nurses and dieticians. Our first impression of this little flexicover handbook is very positive, with its bright and distinctively colored cover and clear layout throughout. The content is very well organized, and divided into twelve independent chapters, starting with ‘Clinical assessment of the renal patient’. We particularly like the section on urine microscopy in this chapter. Illustrations of the different urinary cast types would be a welcome addition to future editions.

The second chapter deals with acute kidney injury (AKI), and we believe it is written by an intensivist who has an interest in nephrology. This chapter introduces the most up-to-date criteria for defining AKI—the RIFLE criteria.1 The emphasis is on management of the condition, and the author offers a pragmatic approach to managing different kinds of AKI, based on cause. The chapters on chronic kidney disease (CKD) and hypertension are particularly useful to general practitioners. With reporting of estimated glomerular filtration rate having been introduced recently in most of the UK, patients with hitherto ‘undiagnosed’ CKD can now be identified more easily. Most patients with stage 3 CKD are managed in the primary care setting, and the chapter on CKD provides up-to-date information on managing the complications of this disease, including detailed coverage of anemia and renal bone disease. The extensive chapter on the management of hypertension covers all aspects from causes and pathogenesis to a practical summary of available treatments, and provides references to the most recent and influential trials (ALLHAT2 and ASCOT3). We believe these two chapters will be invaluable to general practitioners in their day–to-day practice.

The book is very easy to read and follow, covering just enough physiology to improve readers’ understanding of essential points, but without excessive detail. The authors have clearly sought to make the book as reader-friendly as possible. There are plenty of tables and diagrams throughout and most of the information is in bullet-point form rather than paragraphs. The liberal use of symbols makes the book read more like a set of notes than a textbook. In the words of their apt quote from Mark Twain, the authors have managed to avoid writing a book that “everyone wants to have read, but no-one wants to read.”

Junior doctors (house officers, senior house officers and registrars in the UK; interns and residents in the US) would benefit most from this book. It explains the different forms of renal replacement therapies beautifully, from the theory of dialysis to the practical aspects of writing dialysis prescriptions and inserting dialysis catheters. Protocols for the management of acute and chronic complications of dialysis (such as clotted vascular accesses, dialysis catheter-associated infections and peritonitis) are also included. Chapters 6 and 7 provide a concise and clear overview of a wide range of primary renal diseases as well as systemic diseases that affect the kidneys, with 1–2 pages devoted to each condition. The most useful part of the book for nephrologists is perhaps the appendices. This section contains useful information that we don’t normally carry around in our heads; for example, factors to use when converting electrolyte concentrations from mg/dl to mmol/l and vice versa. Also provided is a list of useful websites for nephrology journals and associations. The diagrams of glomerular and tubular physiology in the appendices are beautifully drawn, and would come in very handy for teaching medical students and junior doctors.

Overall, the authors have achieved the apparently impossible with this handbook: coverage of the full scope of nephrology in a pocket-size book. The book provides practical advice for the day-to-day management of nephrological conditions and hypertension, and we would recommend this little gem to everybody who works at the ‘coal face’, either in a renal unit or general practice.