Preface

I have been practicing nephrology for forty-five years. During this time the incidence and prevalence of diseases that can result in advanced renal failure has steadily increased. Fortunately, simultaneous advances in dialysis and transplantation have kept pace to allow prolonged life support with dialysis or a "second chance" after successful transplantation. Renal diseases are often difficult to manage because they can be explosive and require early intervention. There is often "no going back" to baseline, only stabilization – the sooner the better.

Renal diseases are not as common as other medical problems in outpatient practice. Primary care providers may not have been exposed to these explosive or silent problems during their training. This collection of reports attempts to serve as insight on the types of renal diseases that can cause permanent damage. Included are reports from different authors from around the world to emphasize specific and accurate diagnosis of these diseases by renal biopsy. These reports describe the various techniques available to make the benefits outweigh risk. These techniques result in a quick, same-day, outpatient procedure to get the diagnosis to allow specific treatment.

Renal diseases are often difficult to distinguish from each other when first trying to understand their pathophysiology. The result is inability to tailor therapy to an individual patient without exact diagnosis. Renal biopsy allows for the determination of which vital renal structure is being attacked: glomeruli, tubules, interstitium, or vasculature. Renal biopsy demonstrates what part of the glomeruli is affected, which immune mechanism is causing the pathophysiology, and the percent of glomeruli that have become totally obsolescent due to the disease processes. Renal biopsy by real-time ultrasound has never been safer. It is a vital tool necessary to obtain the initial diagnosis, but also repeat biopsy may be necessary to follow the progress of therapy. Finally, in renal transplant patients who have been given a "second chance", renal biopsy allows for detection of rejection even before clinical or common laboratory tests reveal its presence to allow early and effective intervention and control.

### **Edward T. Zawada Jr. M.D. M.A.C.P.**

Professor and Chairman Emeritus, Department of Internal Medicina, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota

> Nephrologist and Intensivist, Shasta Critical, Care Specialists, Redding, California
