The modern medical textbook continues to defy exaggerated rumors of its impending demise. Blissfully ignorant of cost containment and prudent diets, it keeps gaining weight and becoming more expensive. This particular renal textbook has more than 3500 pages, weighs 18 lb, and costs $195. It represents the fourth reincarnation of "Strauss and Welt," which in 1963 constituted an agreeable piece of carry-on luggage for the few devotees of the budding discipline of nephrology. The current edition, by contrast, is a time bomb that threatens to ultimately explode into the size of an Encyclopedia Britannica . Its dinosaurian proportions also make it more vulnerable to early obsolescence—especially since most of the sections appear to have been written around 1985. Inherent in the nature of these multiauthor encyclopedias is a considerable amount of overlap. Subjects recur like thoughts in a dream—so that, for example, acquired renal cystic disease first appears on page 570