Most doctors qualify with a knowledge that the kidney is an important organ, that the diseases affecting it are complex, and that renal physiology is difficult to understand. Once in clinical practice confusion persists particularly over which patients should be referred and when and, for instance, over whether angiotensin converting enzyme inhibitors are uniquely effective at preventing progressive renal failure or con-traindicated in renal failure. Much of this confusion is now unnecessary. Recent advances have clarified some aspects of renal physiology: now the teachers understand them there is more hope of explaining them to students. Knowledge of the various types of glomerulonephritis is not necessary in deciding when a patient should be referred: this decision is becoming increasingly important as the potential for prevention of progressive renal disease increases.
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