[The missions of a Nephrology Department in the year 2000]

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) Improve teaching: education of students and of physicians at the University must be more effective to allow a better diagnosis of acute renal failure and therefore its prevention, and a rapid histological examination of renal tissue 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 undertaken at the University Hospitals. New experimental procedures can endow the artificial kidney with most of the metabolic functions of normal kidney. This method has not been tested yet in men. 3) The xenografts are very interesting approaches because of the lack of organs, however there are major obstacles including insufficient knowledge of the mechanisms of hyperacute graft rejection, of the possibility of transmission of anthropozoonoses from animals to humans, and of gene mutation of virus that usually are not pathogenic in man; finally studies on the adaptation of the xenograft, which possess different biological parameters, to the human milieu, should be considered. 4) Cell therapy or gene therapy are currently under investigation. The major difficulties are to assess that the vector used to transfer the 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 diseases because they would help in defining the individual susceptibilities to develop nephropathies.