However, it is vital that physicians with a broader practice are aware of many aspects of renal disease and this is the niche for which this book has been so well designed. Most people with renal disease present first to other physicians only going on to see a nephrologist after initial evaluation and management. Furthermore, the presence of renal disease influences best clinical care in many other settings as exemplified by the range of topics in this volume.

I congratulate Dr OP Kalra for having the vision to see the need for this book, and for assembling an impressive faculty of contributors including highly respected leaders throughout Indian nephrology.

The content of this book has been ideally chosen to provide education and advice about renal disease to non-specialist physicians and I am sure that it will be widely read and appreciated by physicians throughout India.

The first three chapters by Dr Kasi Visweswaran, Dr SC Tiwari and Dr M Thomas Mathew are devoted to assessment of renal function, renal reserve and approach to a patient with proteinuria and haematuria. These are followed by guidelines for management of fluid and electrolyte and acid base problems by Dr NP Singh and Dr VK Vijayan. The approach to a patient with nephrotic syndrome, acute glomerulonephritis and rapidly progressive renal failure has been elucidated by Dr KL Gupta, Dr Ashok Kirpalani and Dr OP Kalra. Dr K Tripathi has authored the chapter on pregnancy and renal disease and Dr Alan Almeida on drug induced renal disease. The diagnosis and management of urinary tract infection has been covered by Dr Kalra himself and Dr PP Varma and Dr Ivor Katz have provided their expertise on tuberculosis and HIV infections in patients with kidney diseases. Preventive strategies for diabetic nephropathy have been discussed by Dr OP Kalra. Acute renal failure which constitutes a common medical emergency in the general hospitals and in the intensive care units has been well covered by Dr HS Kohli and the preventive aspects of this condition have been covered by Dr OP Kalra and Dr AK Bhalla.

Several experts have dealt with various aspects of chronic kidney disease. Dr Sanjay Agarwal has attempted to explore the magnitude and epidemiology of chronic kidney disease in our country. The challenges faced by treating physicians and the approach to management of various complications and manifestations of chronic renal failure have been described in separate chapters by several experts. Dr RG Singh has applied his knowledge to hypertension in chronic renal disease and Dr DS Rana to management of renal osteodystrophy. Various aspects of anemia of chronic renal disease have been discussed by Dr V Sakhuja, coagulopathy in chronic renal disease by Dr Nandini Mukherjee, nutritional requirements of patients by Dr RK Sharma, management of dyslipidemia by Dr AK Das, infections amongst patients with renal disease by Dr Ramadas Pisharody and management of hyperglycemia amongst these patients by Dr SV Madhu.

The high risk of cardiovascular problems and their management has been highlighted by Dr Mohan Rajapurkar. One chapter by Dr Sham Sunder has been devoted to hazards of commonly used analgesics and another one for a quick reference on modification of drug doses in patients with renal disease by Dr Sandeep Mahajan. Currently available therapeutic modalities for management of end stage renal failure have been adequately elucidated by Dr Amit Gupta. Since it is not unusual for patients with renal stones or enlarged prostrate to present to a physician, medical management of these two conditions has been covered by Dr Sanjay Gupta. Use of vaccines in patients with chronic kidney disease, the role of smoking in kidney disease and pre-operative evaluation have been described by Dr S Agarwal, Dr OP Kalra and Dr Rajeshwari.

Dr MK Mani has shared his experience on the role of primary care physician in prevention of chronic kidney disease and Dr Vijay Kher has elaborated the therapeutic interventions for prevention of progression of chronic kidney disease. Dr V Jha has focused attention on the frequent dilemma faced by a physician “when should he refer the patient to a specialist”?

All topics are well referenced and the book represents a massive effort in presenting complicated renal problems in a simplified manner by various experts who all need to be congratulated. The impressive achievement is a tribute to the energy, zeal and competence in academic medicine of the editor, Dr OP Kalra. Most internists, physicians, residents and nephrologists will benefit by possessing a copy of this valuable document.

The book covers a vast range of topics such as assessment of renal function, fluid, electrolyte, acid base balance and various renal diseases. Common renal disorders such as urinary tract infection, glomerular diseases, hypertension and diabetic renal disease, etc. have been discussed in great detail. Several distinguished authors in the field of nephrology from all over the country have contributed chapters in the book. A great emphasis has been laid on prevention and treatment of various renal diseases.

Dr OP Kalra has done a wonderful job in conceptualizing, planning and finally bringing out this book with input from galaxy of leading authors in the field of Nephrology and Internal Medicine from all over the country. I whole-heartedly congratulate Dr Kalra for accomplishing this mammoth task.

Therefore it is imperative that prevention of chronic kidney disease and its early detection should be followed by aggressive management which can contribute significantly in reducing the burden of this disease.

The Indian College of Physicians dedicated to the cause of continuing education with the aim of preventing this serious disorder decided to bring out a monograph for the medical profession so that they are better prepared to stall this disease. This responsibility of bringing out the book was entrusted to Prof OP Kalra, Principal and Head of Nephrology Department at University College of Medical Sciences and GTB Hospital, New Delhi.

Prof OP Kalra has put in a lot of effort in bringing out this book and has very carefully selected the subject matter and the contributors who are the leading specialists in their own field not only nationally, but also internationally. The chapters have been well written and cover areas of early diagnosis and aggressive management so that chronic renal failure could be averted/delayed.

I am confident that this book shall be very useful to the medical community at large. Prof OP Kalra and his team of contributors deserve all the praise for executing this job in a very efficient and concise manner.

Appropriate management of end stage kidney failure entails massive financial burden on the individual, family, overcrowded tertiary care hospitals and the whole country. In addition, lack of adequate facilities for dialysis and transplantation further compounds the problem. Despite various efforts, cadaveric renal transplant programme is still in infancy in India. Due to lack of adequate funding by the government and insurance agencies and low per capita income, less than 10 percent of the patients with end stage renal disease are able to avail definitive form of renal replacement therapy. In a country, where prevention and treatment of various infectious diseases such as malaria, tuberculosis, dengue fever, etc. take priority, not enough funds are left for management of various non-communicable diseases especially chronic kidney diseases. Hence various preventive strategies remain the only option for decreasing the burden of disease due to chronic kidney disease.

I am grateful to the Faculty Council of Indian College of Physicians to give me an opportunity to bring out this book, which will help in providing guidelines for prevention and management of various renal diseases. The book covers a wide range of topics pertaining to renal medicine. Larger section of the book has been devoted to various aspects of conservative management of chronic kidney disease. I am extremely grateful to various eminent authors in the field of nephrology and general medicine from all over the country and abroad who have given valuable contribution for this book. I am extremely grateful to Dr RK Singal, Dr YP Munjal, Dr SK Bichile, Dr AK Das, Dr AK Agarwal, and Dr Sandhya Kamath for their continued support and guidance in this endeavour.

I am thankful to Prof John Feehally, Secretary General, International Society of Nephrology for his valuable suggestions and continued inspiration during the execution of this job. I am highly indebted to my teachers especially Prof KS Chugh and Prof V Sakhuja for their unstinted support and constructive criticism. I am extremely thankful to Prof SC Tiwari, Prof RK Sharma, Prof Vijay Kher, Dr DS Rana and Dr AK Bhalla for their valuable suggestions. I am thankful to Dr AK Agarwal, Head, Department of Medicine, Dr RML Hospital, Dr Sandeep Mahajan, Associate Professor of Nephrology, AIIMS, New Delhi, Dr Anil Yadav, Chief Medical Officer, Division of Nephrology and Dr Alpana Raizada, Lecturer, Department of Medicine at University College of Medical Sciences, Delhi for helping me in compilation of this book. This book is a humble attempt to fill the lacuna due to non-availability of any book on renal medicine by various Indian authors. Besides internists and general physicians, the book also tends to meet the aspirations of undergraduate and postgraduate students of medicine and young nephrologists.

I am thankful to the staff of Jaypee Brothers Medical Publishers headed by the dynamic Chairman and Managing Director, Shri Jitender P Vij for their technical expertise, experience and all possible help. I gratefully acknowledge the excellent secretarial assistance provided Mr Sumeet Arora and Mr Anil Kumar, who have been working overtime for this endeavour.