Tubulointerstitial and Cystic Disease of the Kidney

The book contains eight chapters dealing with the pathology of tubulointerstitial disease of the kidney and also a detailed update of the pathology of human renal cystic disease. Emphasis is placed on the prognostic importance of recognizing tubulointerstitial damage and discussed in detail are the present knowledge of the mechanisms of this damage and the possible reasons for the apparent disparity between the extent of glomerular damage and progression to chronic renal failure. The book is of equal relevance to renal physicians, scientists working in renal medicine research, and pathologists. In keeping with current trends in pathology, the histopathological discussion is supplemented by morphometric and molecular biology techniques.

Over recent years, much renal research has focused on the pathology of the glomerulus, where many primary renal insults occur. However, nearly thirty years have passed since Risdon's study made the apparently anomalous observation that the extent of damage to the tubulointerstitial compartment is the major determinant of renal outcome in a variety of human glomerular diseases. This volume covers various aspects of tubulointerstitial disease, and starts with an update on cystic disease of the kidney, by Drs. WILSON and FALKENSTEIN, which includes recent experimental data on the altered properties of cystic epithelium. My own chapter gives an overview of the mechanisms of tubulo interstitial damage in progressive renal disease and includes a dis cussion of the possible role of cytokines, vasoactive peptides and peptide growth factors found over the last few years to be secreted by renal tubular cells. These comments are expanded in the contribution by Dr. WOLF and Professor NEILSON, who provide a detailed account of the cellular biology of tubulointerstitial growth. The earliest studies from the 19608 attempted to correlate histo morphometry of the tubulointerstitium with renal outcome. Dr. KHAN and Professor SINNIAH provide us with an update on mor phometric methods as applied to the kidney using new techniques. Similar techniques are employed by Dr. IVANYI and Professor OLSEN who give a detailed stereomorphological account of tubulitis both in acute allograft rejection, where its- recognition is central to the diagnosis, and in other forms of tubulointerstitial disease."

The subject matter of this book underlines the prognostic importance of recognition of the tubulointerstitial damage to the histopathologist involved in the routine evaluation of renal biopsy material.