Intended for healthcare professionals

Clinical Review Recent advances


BMJ 2000; 320 doi: (Published 08 January 2000) Cite this as: BMJ 2000;320:98
  1. C R V Tomson, consultant renal physician (
  1. North Bristol NHS Trust, Richard Bright Renal Unit, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB

    Most doctors qualify with a knowledge that the kidney is an important organ, that the diseases affecting it are complex, and that renal physiology is difficult to understand. Once in clinical practice confusion persists particularly over which patients should be referred and when and, for instance, over whether angiotensin converting enzyme inhibitors are uniquely effective at preventing progressive renal failure or contraindicated in renal failure. Much of this confusion is now unnecessary. Recent advances have clarified some aspects of renal physiology: now the teachers understand them there is more hope of explaining them to students. Knowledge of the various types of glomerulonephritis is not necessary in deciding when a patient should be referred: this decision is becoming increasingly important as the potential for prevention of progressive renal disease increases.


    This is an unsystematic review of those areas of nephrology in which there have been recent advances, selected for a general readership. Space precludes coverage of advances in renal transplantation. I have relied on personal files, recent articles in the journals of international nephrology societies, Medline searches, and discussions with colleagues.

    Recent advances

    Identification of the genetic basis for some rare disorders has led to increased understanding of normal renal physiology and opened up the possibility of new treatments for hyperparathyroidism and hyponatraemic states

    Major advances have occurred in the understanding of the pathogenesis of IgA nephropathy and adult polycystic kidney disease, but as yet these have not led to breakthroughs in the treatment of these conditions

    The reduction of proteinuria by antihypertensives slows the progression towards end stage renal failure of many types of renal disease—angiotensin converting enzyme inhibitors may have particular value in reducing proteinuria unless systemic blood pressure is lowered far enough

    Although only a small proportion of affected patients benefit from renal revascularisation, the high frequency of renal artery …

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