The future of university renal care

To evaluate the new therapies in acute or chronic renal failure, to improve teaching and to develop basic research, will be the goals of the Nephrolog y Units in the future, in the hospitals and in the universities as well. The treatment of acute renal failure : 1) Evaluate new methods of dialysis that should be less aggressive than hemodialysis, such as hemodiafiltration , in order to decrease the hemodynamic risks of an elder population. 2) Imp rove teaching : education of students and of physicians at the University m ust be more effective to allow a better diagnosis of acute renal failure an d therefore its prevention, and a rapid histological examination of renal t issue that constitutes the basis of etiopathogenic treatment of glomerular and/or vascular nephropathies. The treatment of chronic renal failure : 1) Improve and develop the present therapy. automated peritoneal dialysis at home should be developed. 2) The evaluation of new techniques of hemodialysis in the patient can only be un dertaken at the University Hospitals. New experimental procedures can endow the artificial kidney, with most of the metabolic functions of normal kidn ey. This method has not been tested yet in men. 3) The xenografts are very interesting approaches because of the lack of organs, however there ave maj or obstacles including insufficient knowledge of the mechanisms of hyperacu te graft rejection, of the possibility of transmission of anthropozoonoses front animals to humans, and of gene mutation of virus that usually are not pathogenic in man; finally studies on the adaptation of the xenograft, whi ch possess different biological parameters, to the human milieu, should be considered. 4) Cell therapy or gene therapy are currently under investigati on. The major difficulties are to assess that the vector used to transfer t he gene is absolutely harmless to man and to restrict the gene delivery to the cells of interest. The molecular genetics determinants should be essential to prevent kidney d iseases because they would help in defining the individual susceptibilities to develop nephropathies.