Nephrology in the 21st century

Although prophecy in science is extremely dangerous no great progress in xe notransplantation may be expected in the next ten years. In contrast introd uction of less dangerous immunosuppressive strategies and induction of tran splant-specific tolerance seems likely. Thanks to better prophylaxis and th erapy a declining incidence of endstage renal failure due to diabetic and h ypertensive nephropathy respectively can be expected. Progress in the field of fibroblast pathophysiology will be followed by improvement of therapy o f fibrotizing nephropathies. Genetherapy will be available for the treatmen t of selective congenital and acquired nephropathies, although unexpected a dverse effects of these new therapeutic strategies may emerge. Finally than ks to progresses in renal pathophysiology, better therapeutic results may b e expected in the treatment of disease caused by abnormalities of the homeo static role of the kidneys.