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Editors: N Webb, R Postlethwaite
520 pp Price £93.50 ISBN 0-19263287-6 (h/b)
Oxford: Oxford University Press.
The strengths of past editions of Clinical Paediatric Nephrology have been comprehensiveness and conciseness. In the latest, the original editor has become the junior—is this where postgraduate medical education is leading us?—the publisher has changed and the menu has expanded to include psychosocial matters, information for families and third-world paediatric nephrology. Passé contributors have been dumped and the fresh team is international, multi-disciplinary and multiprofessional. The ephebic transformation is dazzling.
Inevitably the evidence-based influence lurks—fine for the routine case but less so and sometimes malign for the diagnostically challenging. Key point boxes summarize the important facts; imaging studies have reproduced well; there is a sprinkling of references to 21st century publications and the index is full and useful—though to print it twice (repeated between pages 16 and 17) does seem otiose. Bouquets? The discussions of nephrotic syndrome, renal tubular conditions (not one of the universal strengths of British nephrology) and acid/base and water (not fluid: fluid=water+electrolytes) and electrolyte disorders are first-rate. So is the contribution on psychosocial care—a jewel within UK paediatric nephrology inspired by the original sole editor Dr Postlethwaite. I was glad to see pollakiuria given a paragraph: it is common and poorly recognized (hence unnecessary investigations) and medical equivocation can fuel parental anxiety, thus perpetuating it: authoritative firmness is the prescription. Male genital mutilation (circumcision) is discussed sensibly, in particular its medical indication to prevent urinary tract infections. When will its routine and ritual practice be regarded with the same obloquy as mutilation of the female genitalia? Drawbacks? I searched the index in vain for dysuria, frequency, urgency and the other symptoms that lead a child to be presented to a paediatrician and which may or may not be explained by 'organic pathology'—or, more taxing still, may coexist with it. If one digs away they are there—in an excellent chapter on micturition disorders, for example—but post-modern medicine does not yet seem to have reached the paediatric nephrologists; or do they regard themselves as multidisciplinary technicians rather than personal physicians? In its latest guise, this work remains a must for postgraduate examination candidates and many paediatric departments will wish to possess it as a bench tool.