Since 1972, many victims of endstage renal disease (ESRD) have received treatment under a unique Medicare entitlement. This book presents a comprehensive analysis of the federal ESRD program: who uses it, how well it functions, and what improvements are needed. The book includes recommendations on patient eligibility, reimbursement, quality assessment, medical ethics, and research needs. Kidney Failure and the Federal Government offers a wealth of information on these and other topics: The ESRD patient population. Dialysis and transplantation providers. Issues of patient access and availability of treatment. Ethical issues related to treatment initiation and termination. Payment policies and their relationship to quality of care. This book will have a major impact on the future of the ESRD program and will be of interest to health policymakers, nephrologists and other individual providers, treatment site administrators, and researchers.

The kidney is innervated with efferent sympathetic nerve fibers reaching the renal vasculature, the tubules, the juxtaglomerular granular cells, and the renal pelvic wall. The renal sensory nerves are mainly found in the renal pelvic wall. Increases in efferent renal sympathetic nerve activity reduce renal blood flow and urinary sodium excretion by activation of α1-adrenoceptors and increase renin secretion rate by activation of β1-adrenoceptors. In response to normal physiological stimulation, changes in efferent renal sympathetic nerve activity contribute importantly to homeostatic regulation of sodium and water balance. The renal mechanosensory nerves are activated by stretch of the renal pelvic tissue produced by increases in renal pelvic tissue of a magnitude that may occur during increased urine flow rate. Activation of the sensory nerves elicits an inhibitory renorenal reflex response consisting of decreases in efferent renal sympathetic nerve activity leading to natriuresis. Increasing efferent sympathetic nerve activity increases afferent renal nerve activity which, in turn, decreases efferent renal sympathetic nerve activity by activation of the renorenal reflexes. Thus, activation of the afferent renal nerves buffers changes in efferent renal sympathetic nerve activity in the overall goal of maintaining sodium balance. In pathological conditions of sodium retention, impairment of the inhibitory renorenal reflexes contributes to an inappropriately increased efferent renal sympathetic nerve activity in the presence of sodium retention. In states of renal disease or injury, there is a shift from inhibitory to excitatory reflexes originating in the kidney. Studies in essential hypertensive patients have shown that renal denervation results in long-term reduction in arterial pressure, suggesting an important role for the efferent and afferent renal nerves in hypertension. Table of Contents: Part I: Efferent Renal Sympathetic Nerves / Introduction / Neuroanatomy / Neural Control of Renal Hemodynamics / Neural Control of Renal Tubular Function / Neural Control of Renin Secretion Rate / Part II: Afferent Renal Sensory Nerves / Introduction / Neuroanatomy / Renorenal Reflexes / Mechanisms Involved in the Activation of Afferent Renal Sensory Nerves / Part III: Pathophysiological States / Efferent Renal Sympathetic Nerves / Afferent Renal Sensory Nerves / Conclusions / References

It is a commonly held belief that athletes, particularly body builders, have greater requirements for dietary protein than sedentary individuals. However, the evidence in support of this contention is controversial. This book is the latest in a series of publications designed to inform both civilian and military scientists and personnel about issues related to nutrition and military service. Among the many other stressors they experience, soldiers face unique nutritional demands during combat. Of particular concern is the role that dietary protein might play in controlling muscle mass and strength, response to injury and infection, and cognitive performance. The first part of the book contains the committee's summary of the workshop, responses to the Army's questions, conclusions, and recommendations. The remainder of the book contains papers contributed by speakers at the workshop on such topics as, the effects of aging and hormones on regulation of muscle mass and function, alterations in protein metabolism due to the stress of injury or infection, the role of individual amino acids, the components of proteins, as neurotransmitters, hormones, and modulators of various physiological processes, and the efficacy and safety considerations associated with dietary supplements aimed at enhancing performance.

Advances in itch research have elucidated differences between itch and pain but have also blurred the distinction between them. There is a long debate about how somatic sensations including touch, pain, itch, and temperature sensitivity are encoded by the nervous system. Research suggests that each sensory modality is processed along a fixed, direct-line communication system from the skin to the brain. Itch: Mechanisms and Treatment presents a timely update on all aspects of itch research and the clinical treatment of itch that accompanies many dermatological conditions including psoriasis, neuropathic itch, cutaneous t-cells lymphomas, and systemic diseases such as kidney and liver disease and cancer. Composed of contributions from distinguished researchers around the world, the book explores topics such as: Neuropathic itch Peripheral neuronal mechanism of itch The role of PAR-2 in neuroimmune communication and itch Mrgprs as itch receptors The role of interleukin-31 and oncostatin M in itch and neuroimmune communication Spinal coding of itch and pain Spinal microcircuits and the regulation of itch Examining new findings on cellular and molecular mechanisms, the book is a compendium of the most current research on itch, its prevalence in society, and the problems associated with treatment.

Continuous Renal Replacement Therapy provides concise, evidence-based, bedside guidance for the management of critically ill patients with acute renal failure, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice.

Cardiovascular, respiratory, and related conditions cause more than 40 percent of all deaths globally, and their substantial burden is rising, particularly in low- and middle-income countries (LMICs). Their burden extends well beyond health effects to include significant economic and societal consequences. Most of these conditions are related, share risk factors, and have common control measures at the clinical, population, and policy levels. Lives can be extended and improved when these diseases are prevented, detected, and managed. This volume summarizes current knowledge and presents evidence-based interventions that are effective, cost-effective, and scalable in LMICs.