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Grading Of Diabetic Nephropathy

Chronic Kidney Disease

Chronic Kidney Disease

stage 5:<15 (or dialysis): end-stage kidney disease (ESKD) The same publication 1suggests that chronic kidney disease can also be broadly classified by treatment type: Gadolinium contrast has been associated with nephrogenic systemic fibrosis (NSF) in the setting of chronic kidney disease. The threshold that is a contraindication for administration of gadolinium contrast is institution dependent and also depends on the dose and type of contrast agent being used, but a GFR of 20-30 ml/min is considered a contraindication and a GFR of 30-60 ml/min usually necessitates a smaller dose. Dialysis is a contraindication. Radiopaedia is free thanks to our Supporters & Advertisers There are no specific imaging features for CKD, and the diagnosis is based on clinical and laboratory findings. Radiological exams, especially ultrasound, are performed in most of the cases for aetiological investigation (e.g. renal artery stenosis , polycystic kidney disease, hydronephrosis , etc.) and treatment follow-up. Ultrasound with Doppler examination of intrarenal vessels is usually performed in patients with CKD, and it is common to have a normal exam. Typical B-mode findings of a long-standing severe CKD (especially stage 5) are 2: reduced renal cortical thickness <6 mm 6 Abnormal Doppler findings in these patients are 2: Radiopaedia is free thanks to our Supporters & Advertisers Stage 3 CKD patients are reported to be 20 times more likely to die of a cardiovascular event than to reach end-stage renal disease 3.The chronic vascular disease is a common CKD associated complication and deserves particular attention 1.An extensive study evidenced that treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia should be the target treatment to red Continue reading >>

Value Of Adding The Renal Pathological Score To The Kidney Failure Risk Equation In Advanced Diabetic Nephropathy

Value Of Adding The Renal Pathological Score To The Kidney Failure Risk Equation In Advanced Diabetic Nephropathy

Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Value of adding the renal pathological score to the kidney failure risk equation in advanced diabetic nephropathy * E-mail: [email protected] (MY); [email protected] (TW) Affiliations Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan, Nephrology Center, Toranomon Hospital, Tokyo, Japan, Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan, Okinaka Memorial Institute for Medical Research, Tokyo, Japan Roles Data curation, Formal analysis, Methodology, Supervision, Validation Affiliations Nephrology Center, Toranomon Hospital, Tokyo, Japan, Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan, Okinaka Memorial Institute for Medical Research, Tokyo, Japan Roles Supervision, Writing review & editing Affiliations Nephrology Center, Toranomon Hospital, Tokyo, Japan, Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan, Okinaka Memorial Institute for Medical Research, Tokyo, Japan Roles Supervision, Writing review & editing Affiliations Nephrology Center, Toranomon Hospital, Tokyo, Japan, Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan, Okinaka Memorial Institute for Medical Research, Tokyo, Japan Affiliation Department of Pathology, Toranomon Hospital, Tokyo, Japan Affiliation Department of Pathology, Toranomon Hospital, Tokyo, Japan Continue reading >>

Presentation, Pathology And Prognosis Of Renal Disease In Type 2 Diabetes

Presentation, Pathology And Prognosis Of Renal Disease In Type 2 Diabetes

Abstract Objective Non-diabetic renal disease (NDRD) is common in patients with type 2 diabetes (T2D), but the relationship between its presentation and prognosis is unknown. Research design and methods In a retrospective cohort study, we compared renal and patient survival among 263 patients with T2D who had native renal biopsies between 2002 and 2008 from three Auckland hospitals in New Zealand. The presence of diabetic nephropathy (DN), NDRD or mixed (DN and NDRD) was determined from biopsy. We examined clinical associations according to NDRD etiologies and mode of presentation—acute (defined by acute kidney injury (AKI)) or non-acute. Patients were followed until end-stage renal disease, death or December 2015. Survival was compared using Log-rank test. Results 94 (36%) patients had DN, 72 (27%) had NDRD, and 97 (37%) had mixed pathologies. Obesity-related focal segmental glomerulosclerosis was the most common NDRD (46%) in patients with non-acute presentations, whereas interstitial nephritis or immune-complex glomerulonephritides were the most prevalent in those with acute presentations (60%). DN was commonly associated with AKI (p<0.001). The prevalence of DN increased with diabetes duration (p<0.001), but NDRD was still found in 55% of subjects with ≥14 years T2D. NDRD was strongly associated with the absence of retinopathy (p<0.001). Renal survival was best in the NDRD group (p<0.001). Among those with DN, renal prognosis was worse in those with more advanced DN lesions and those with an acute presentation (p<0.001). The proportion of all-cause mortality was similar in all three groups, but overall survival was poorest in the DN group (p=0.025). Conclusions Renal disease in patients with T2D is heterogeneous. The renal prognosis differs markedly according to Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Diabetic nephropathy (diabetic kidney disease) (DN)[1] is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years. [2] Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney).[3] Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time.[4] Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration.[5] The status of DN may be monitored by measuring two values: the amount of protein in the urine - proteinuria; and a blood test called the serum creatinine. The amount of the proteinuria is a reflection of the degree of damage to any still-functioning glomeruli. The value of the serum creatinine can be used to calculate the estimated glomerular filtration rate (eGFR), which reflects the percentage of glomeruli which are no longer filtering the blood.[citation needed] Treatment with an angiotensin converting enzyme inhibitor (ACEI) or angiotensi Continue reading >>

A Pathological Scoring System To Predict Renal Outcome In Diabetic Nephropathy

A Pathological Scoring System To Predict Renal Outcome In Diabetic Nephropathy

Original Report: Patient-Oriented, Translational Research A Karger OLA /Global Kidney Academy Blog article A Pathological Scoring System to Predict Renal Outcome in Diabetic Nephropathy Hoshino J.a, b Mise K.a Ueno T.a Imafuku A.b Kawada M.b Sumida K.a Hiramatsu R.b Hasegawa E.b Yamanouchi M.b Hayami N.a Suwabe T.a Sawa N.b Hara S.a Fujii T.d Ohashi K.d, e Ubara Y.a-c Takaichi K.a-c 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa 213-8587 (Japan) Background: With the association between diabetic nephropathy (DN) and renal outcome being increasingly clear, we aimed at creating a new DN pathological scoring system that could predict the renal outcome. Methods: We studied 205 patients with DN confirmed by renal biopsy, sometime between March 1985 and January 2010, who met the inclusion criteria. Renal biopsy included clinical parameters and Tervaert classifications. Hazard ratios (HRs) for death-censored end-stage renal disease (ESRD) were estimated by adjusted Cox proportional-hazards regression. The overall pathological risk score (D-score) was calculated by summing the products of beta coefficient and bootstrap-inclusion fractions, its predictive utility evaluated by Kaplan-Meier methods and c-statistics for a 10-year risk of ESRD. Results: The D-scores of glomerular classes 1, 2A, 2B, 3, and 4 were, respectively, 0, 3, 4, 6, and 6. Those of interstitial fibrosis and tubular atrophy classes 0, 1, 2, and 3 were 0, 7, 9, and 11, and those of interstitial inflammation classes 0, 1, and 2 were 0, 3, and 4, respectively. The D-score of hyalinosis class 2 was 3 and that of arteriosclerosis class 2 was 1. So, a patient's D-score could be 0-25. HRs for ESRD in patients with D-score 14, 15-18, 19-21, and 22-25 were, respectively, 1.00 (reference) 16.21 (95% confidence interval (CI) Continue reading >>

Classification And Differential Diagnosis Of Diabetic Nephropathy

Classification And Differential Diagnosis Of Diabetic Nephropathy

Copyright © 2017 Chenyang Qi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Diabetic nephropathy (DN) is a major cause of end-stage renal disease throughout the world in both developed and developing countries. This review briefly introduces the characteristic pathological changes of DN and Tervaert pathological classification, which divides DN into four classifications according to glomerular lesions, along with a separate scoring system for tubular, interstitial, and vascular lesions. Given the heterogeneity of the renal lesions and the complex mechanism underlying diabetic nephropathy, Tervaert classification has both significance and controversies in the guidance of diagnosis and prognosis. Applications and evaluations using Tervaert classification and indications for renal biopsy are summarized in this review according to recent studies. Meanwhile, differential diagnosis with another nodular glomerulopathy and the situation that a typical DN superimposed with a nondiabetic renal disease (NDRD) are discussed and concluded in this review. 1. Introduction Diabetic nephropathy (DN) caused by diabetes mellitus is one of the major causes of end-stage renal failure worldwide [1]. Clinically, microalbuminuria is an important index to assess the progression of DN [2]. However, it is not accurate to evaluate the severity or prognosis simply based on the degree of proteinuria. It is now well recognized that not all diabetic patients who develop renal function failure have massive albuminuria [3]. Therefore, nephrologists and endocrinologists should be aware of the significance of pathological c Continue reading >>

Classification Of Diabetic Nephropathy 2014

Classification Of Diabetic Nephropathy 2014

Classification of Diabetic Nephropathy 2014 The Japanese Diabetes Society Department of Medicine, Division of Metabolism and Biosystemic Science, Asahikawa Medical University The Japanese Diabetes Society Department of Internal Medicine, Division of Diabetes, Endocrinology Metabolism, Jikei University School of Medicine The Japanese Diabetes Society Department of Diabetology Endocrinology, Kanazawa Medical University The Japanese Diabetes Society Department of Medicine, Diabetes Center Tokyo Women's Medical University School of Medicine The Japanese Diabetes Society Health Care Center, Kitasato University Japanese Society of Nephrology Okayama University Hospital Japanese Society of Nephrology Nephrology and Hypertension, Department of Internal Medicine, St. Marinna University School of Medicine Japanese Society of Nephrology Health Administration Center, Niigata University Japanese Society of Nephrology Division of Nephrology, Department of Laboratory Medicine, Kanazawa University Japanese Society of Nephrology Center for the Advancement of Higher Education, Tohoku University Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital The Japanese Society for Dialysis Therapy Department of Metabolism, Endocrinology, Molecular Medicine Faculty of Internal Medicine, Osaka City University Graduate School of Medicine The Japanese Society for Dialysis Therapy Department of Nephrology, Tokyo Medical University The Japanese Society for Dialysis Therapy Division of Nephrology, Department of Internal Medicine, Wakayama Medical University The Japanese Society for Dialysis Therapy Department of Nephrology, Yabuki Hospital The Japanese Society for Dialysis Therapy Department of Medicine IV, Tokyo Women's Medical University Japan Society of Metabolism a Continue reading >>

Nkf Kdoqi Guidelines

Nkf Kdoqi Guidelines

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETIC KIDNEY DISEASE CKD in patients with diabetes may or may not represent DKD. In the absence of an established diagnosis, the evaluation of patients with diabetes and kidney disease should include investigation into the underlying cause(s). 1.1 Patients with diabetes should be screened annually for DKD. Initial screening should commence: 5 years after the diagnosis of type 1 diabetes; (A) or Measurements of urinary ACR in a spot urine sample; (B) Measurement of serum creatinine and estimation of GFR. (B) 1.2 An elevated ACR should be confirmed in the absence of urinary tract infection with 2 additional first-void specimens collected during the next 3 to 6 months. (B) Microalbuminuria is defined as an ACR between 30-300 mg/g. Macroalbuminuria is defined as an ACR > 300 mg/g. 2 of 3 samples should fall within the microalbuminuric or macroalbuminuric range to confirm classification. 1.3 In most patients with diabetes, CKD should be attributable to diabetes if: in the presence of diabetic retinopathy, (B) in type 1 diabetes of at least 10 years' duration. (A) 1.4 Other cause(s) of CKD should be considered in the presence of any of the following circumstances: (B) Rapidly increasing proteinuria or nephrotic syndrome; Signs or symptoms of other systemic disease; or >30% reduction in GFR within 2-3 months after initiation of an ACE inhibitor or ARB. DKD, traditionally termed diabetic nephropathy, is a clinical diagnosis that historically has been based on the finding of proteinuria in a person with diabetes. This definition is independent of such markers of CKD as pathological change or a decreased GFR, and it initially Continue reading >>

Clinical Implications Of Pathologic Diagnosis And Classification For Diabetic Nephropathy

Clinical Implications Of Pathologic Diagnosis And Classification For Diabetic Nephropathy

Volume 97, Issue 3 , September 2012, Pages 418-424 Clinical implications of pathologic diagnosis and classification for diabetic nephropathy The usefulness of renal pathologic diagnosis in type II DM (diabetes mellitus) remains debate. We grouped the pathologic diagnoses as pure DN (diabetic nephropathy), NDRD (non-diabetic renal disease), and NDRD mixed with DN (Mixed). We classified pure DN as the criteria suggested by Tervaert. We compared the accuracy of clinical parameters to predict DN and usefulness of pathology to predict renal prognosis. Among 126 enrolled patients, there were 50 pure DN, 65 NDRN, and 11 Mixed. The sensitivity and specificity for predicting DN with the presence of retinopathy were 77.873.6% and, with a cut-off value of 7.5 years of diabetic duration, the sensitivity and specificity were 64.567.2%. ESRD (end stage renal disease) occurred in 44.0% of DN, 18.2% of Mixed, and 12.3% of NDRD (p<0.001). Among pure DN, Class IV showed the lowest estimated glomerular filtration rate (eGFR). We estimated the 5-year renal survival rate as 100.0% in Classes I and IIa, 75.0% in Class IIb, 66.7% in Class III, and 38.1% in Class IV (p=0.002). Nephropathy of type II DM was diverse and could not be completely predicted by clinical parameters. The renal pathologic diagnosis was a good predictor for renal prognosis in type II DM. Continue reading >>

Jcm | Free Full-text | Renal Biopsy In Type 2 Diabetic Patients | Html

Jcm | Free Full-text | Renal Biopsy In Type 2 Diabetic Patients | Html

J. Clin. Med. 2015, 4(5), 998-1009; doi: 10.3390/jcm4050998 Eugenia Espinel, Irene Agraz, Meritxell Ibernon, Natalia Ramos, Joan Fort and Daniel Sern * Nephrology Department, Hospital Universitari Vall dHebron, Autonomous University of Barcelona, Passeig de la Vall dHebron 119-129, 08035 Barcelona, Spain Author to whom correspondence should be addressed; Tel.: +34-93-274-62-19; Fax: +34-93-274-62-04. Academic Editors: Desire Luis and Juan F. Navarro-Gonzlez Received: 27 March 2015 / Accepted: 28 April 2015 / Published: 18 May 2015 : The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients. diabetic nephropathy; type 2 diabetes; kidney biopsy; histology Diabetes mellitus (DM) represents one of the most important health problems worldwide. Over the last years, the global prevalence of typ Continue reading >>

Pathologic Classification Of Diabetic Nephropathy

Pathologic Classification Of Diabetic Nephropathy

Pathologic Classification of Diabetic Nephropathy *Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology, University of Erlangen-Nuernberg, Erlangen, Germany; Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California; Department of Histopathology, Hammersmith Hospital, London, United Kingdom; Department of Pathology, University of Maryland, Baltimore, Maryland; Renal Immunopathology Center, San Carlo Borromeo Hospital, Milan, Italy; **Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Pathology, Sendai-Shaho Hospital, Sendai City, Japan; Department of Pathology, Hpital Necker, Universit Ren Descartes, Paris, France; Department of Medicine, Columbia University, New York, New York; and Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York Dr. Antien L. Mooyaart, Department of Pathology, Building 1, L1-Q, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Phone: 0031715266574; Fax: 0031715266952; E-mail: a.l.mooyaart{at}lumc.nl Although pathologic classifications exist for several renal diseases, including IgA nephropathy, focal segmental glomerulosclerosis, and lupus nephritis, a uniform classification for diabetic nephropathy is lacking. Our aim, commissioned by the Research Committee of the Renal Pathology Society, was to develop a consensus classification combining type1 and type 2 diabetic nephropathies. Such a classification should discriminate lesions by various degrees of severity that would be easy to use internationally in clinical practice. We divide diabetic nephropathy into four hierarchical glomerular lesions with a separate evaluation for degrees of interstitial and Continue reading >>

Histological Classification Of Diabetic Nephropathy

Histological Classification Of Diabetic Nephropathy

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Histological classification of diabetic nephropathy Published by Garry Flynn Modified over 2 years ago Presentation on theme: "Histological classification of diabetic nephropathy" Presentation transcript: 1 Histological classification of diabetic nephropathy 2 Overview Introduction Pathological classification of DN Conclusions Early attempts Recent renal pathology society classification (international consensus) Progressive class I - IV Conclusions 3 Introduction Diabetic nephropathy (DN) is a major cause of ESRD The incidence of DM is rising rapidly Pathologic classifications Exist for several kidney diseases e.g. lupus nephritis, focal segmental glomerulosclerosis, and IgA nephropathy, yet There is no uniform classification for DN till recently DM- Diabetes mellitus 4 Introduction (Contd) Classification schemes lead to Better communication between renal pathologists and clinicians Provide logistical structure for prognostic and interventional studies Improve clinical management and efficiency J Am Soc Nephrol 2004;15: 5013 In 1959, Gellman et al. first reported an overview and clinical correlation of findings on renal biopsies from patients with DN Before their study, the renal pathology in patients with DM was only described at autopsy Gellman proposed an elaborate systematic evaluation Examining glomeruli, tubules, arterioles, and the interstitium that was unsuitable for practical use Medicine (Baltimore) 1959;38: 32167 Attempts were made to categorize patterns seen in DN after type 2 DM Gambara et al.* and Fioretto et al.** made basic distinctions between Typical and atypical DN as well as Other glomerular diseases superimposed on DN Although such schemes Continue reading >>

A New Classification Of Diabetic Nephropathy 2014: A Report From Joint Committee On Diabetic Nephropathy

A New Classification Of Diabetic Nephropathy 2014: A Report From Joint Committee On Diabetic Nephropathy

A new Classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy 1Department of Medicine, Asahikawa Medical University, Hokkaido, Japan 2Jikei University School of Medicine, Tokyo, Japan 3Kanazawa Medical University, Ishikawa, Japan 4Tokyo Women's Medical University, Tokyo, Japan 6Okayama University Hospital, Okayama, Japan 7St. Marianna University School of Medicine, Kanagawa, Japan 10Tohoku University Hospital, Miyagi, Japan 11Osaka City University Graduate School of Medicine, Osaka, Japan 13Wakayama Medical University, Wakayama, Japan 15Kagawa Nutrition University, Saitama, Japan 16Kawasaki Medical School Hospital, Hiroshima, Japan 17Kyoto University Hospital, Kyoto, Japan * Correspondence Masakazu Haneda, Tel.: +81-166-68-2454, Fax: +81-166-68-2459, E-mail address: [email protected] Joint Committee on Diabetic Nephropathy members are in Appendix 2. Author information Article notes Copyright and License information Disclaimer Received 2014 Nov 12; Revised 2014 Nov 17; Accepted 2014 Nov 17. Copyright 2014 Japan Diabetes Society, Japanese Society of Nephrology, Japanese Society for Dialysis Therapy, and Japan Society of Metabolism and Clinical Nutrition. Journal of Diabetes Investigation published by Asian Association of the Study of Diabetes (AASD) and Wiley Publishing Asia Pty Ltd This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. This article has been cited by other articles in PMC. The Joint Committee on Diabetic Nephropathy has revised its Classification of Diabetic Nephropathy (Classifi Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Definition and Causes Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality. Prevalence and Risk Factors Diabetes has become the primary cause of end-stage renal disease (ESRD) in the United States, and the incidence of type 2 diabetes mellitus continues to grow in the United States and worldwide. Approximately 44% of new patients entering dialysis in the United States are diabetics. Early diagnosis of diabetes and early intervention are critical in preventing the normal progression to renal failure seen in many type 1 and a significant percentage of type 2 diabetics. In the United States, approximately 20.8 million people, or 7.0% of the population, are estimated to have diabetes, with a growing incidence. Roughly one third of this population, 6.2 million, is estimated to be undiagnosed with type 2 diabetes. The prevalence of diabetes is higher in certain racial and ethnic groups, affecting approximately 13% of African Americans, 9.5% of Hispanics, and 15% of Native Americans, primarily with type 2 diabetes.1, 2 Approximately 20% to 30% of all diabetics will develop evidence of nephropathy, although a higher percentage of type 1 patients progress to ESRD. Pathophysiology and Natural History The common progression from microalbuminuria to overt nephropathy has led many to consider microalbuminuria to define early or incipient Continue reading >>

Classification System For Diabetic Nephropathy May Advance Patient Care

Classification System For Diabetic Nephropathy May Advance Patient Care

Classification System for Diabetic Nephropathy May Advance Patient Care Authors: News Author: Nancy Fowler Larson This article is intended for primary care clinicians, endocrinologists, nephrologists, and other specialists who care for patients with diabetes. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Describe guidelines for renal biopsy to classify diabetic nephropathy. Describe the new classification system for diabetic nephropathy. As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Nancy Fowler Larson has disclosed no relevant financial relationships. Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships. Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California Disclosure: Dsire Lie, MD, MSEd, has disclosed the following relevant financial relationship: Served as a nonproduct speaker for: Continue reading >>

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