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Stages Of Diabetic Nephropathy Medscape

[full Text] Tubulointerstitial Disease In Diabetic Nephropathy | Ijnrd

[full Text] Tubulointerstitial Disease In Diabetic Nephropathy | Ijnrd

SC Diabetologia Aziendale ASL 2 Olbia, Hospital San Giovanni di Dio, Olbia, Italy Abstract: Diabetes mellitus is the major cause of end stage renal disease (ESRD). We cannot predict which patient will be affected. ESRD patients suffer an extremely high mortality rate, due to a very high incidence of cardiovascular disease. Several randomized, prospective studies have been conducted to quantify the impact of strict glycemic control on morbidity and mortality, and have consistently demonstrated an association between strict glycemic control and a reduction in ESRD. Within the past 20 years, despite the implementation of treatments that were presumed to be renoprotective, diabetes mellitus has continued to rank as the leading cause of ESRD, which clearly indicates that we are still far from understanding the mechanisms involved in the initiation of ESRD. Progressive albuminuria has been considered as the sine qua non of diabetic nephropathy, but we know now that progression to diabetic nephropathy may well happen in the absence of initial microalbuminuria. The search for new biomarkers of early kidney damage has received increasing interest, since early identification of the pathways leading to kidney damage may allow us to adopt measures to prevent the development of ESRD. Most of these biomarkers are deeply influenced by environment, genetics, sex differences, and so on, making it extremely difficult to identify the ideal biomarker to target. At present, there are no new drugs that come close to providing the solutions we desire for our patients (ie, reducing complications). Even when used in combination with standard care, renal complications are, at best, only modestly reduced, at the considerable expense of additional pill burden and exposure to serious off-target ef Continue reading >>

Diabetic Nephropathy: Diagnosis, Prevention, And Treatment

Diabetic Nephropathy: Diagnosis, Prevention, And Treatment

Diabetic Nephropathy: Diagnosis, Prevention, and Treatment Jorge L. Gross, MD; Mirela J. de Azevedo, MD; Sandra P. Silveiro, MD; Lus Henrique Canani, MD; Maria Luiza Caramori, MD; Themis Zelmanovitz, MD Stages, Clinical Features, and Clinical Course Diabetic nephropathy has been didactically categorized into stages based on the values of urinary albumin excretion (UAE): microalbuminuria and macroalbuminuria. The cutoff values adopted by the American Diabetes Association[ 14 ] (timed, 24-h, and spot urine collection) for the diagnosis of micro- and macroalbuminuria, as well as the main clinical features of each stage, are depicted in Table 1 . There is accumulating evidence suggesting that the risk for developing diabetic nephropathy[ 15 , 16 , 17 , 18 ] and cardiovascular disease[ 19 , 20 ] starts when UAE values are still within the normoalbuminuric range. Progression to micro- or macroalbuminuria was more frequent in patients with type 2 diabetes with baseline UAE above the median (2.5 mg/24 h).[ 15 ] After 10 years of follow-up, the risk of diabetic nephropathy was 29 times greater in patients with type 2 diabetes with UAE values >10 g/min.[ 16 ] The same was true for patients with type 1 diabetes.[ 17 ] This favors the concept that the risk associated with UAE is a continuum, as is the case with blood pressure levels.[ 21 ] Possibly, values of UAE lower than those currently used for microalbuminuria diagnosis should be established. Although microalbuminuria has been considered a risk factor for macroalbuminuria, not all patients progress to this stage and some may regress to normoalbuminuria.[ 22 ] The initial studies in the 1980s demonstrated that ~80% of microalbuminuric type 1 diabetic patients progressed to proteinuria over a period of 6-14 years.[ 3 , 4 , 5 ] Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

By Bozidar Vujicic, Tamara Turk, Zeljka Crncevic-Orlic, Gordana orevic and Sanjin Racki Submitted: January 17th 2012Reviewed: May 23rd 2012Published: November 14th 2012 Department of Nephrology and Dialysis, Clinical Hospital Centre Rijeka, Rijeka,, Croatia Department of Nephrology and Dialysis, Clinical Hospital Centre Rijeka, Rijeka,, Croatia Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Hospital Centre Rijeka, Rijeka,, Croatia Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Hospital Centre Rijeka, Rijeka,, Croatia Department of Pathology and Pathologic Anatomy, Faculty of Medicine, University of Rijeka, Rijeka,, Croatia Diabetes mellitus (DM) is the most frequent cause of chronic kidney failure in both developed and developing countries [ 1 ]. Diabetic nephropathy, also known as Kimmelstiel-Wilson syndrome or nodular diabetic glomerulosclerosis or intercapillary glomerulonephritis, is a clinical syndrome characterized by albuminuria (>300 mg/day or >200 mcg/min) confirmed on at least two occasions 3-6 months apart, permanent and irreversible decrease in glomerular filtration rate (GFR) ( Table 1) , and arterial hypertension [ 2 ]. The syndrome was first described by a British physician Clifford Wilson (1906-1997) and American physician Paul Kimmelstiel (1900-1970) in 1936 [ 3 ]. Decline in glomerular filtration rate (ml/min/year) Decline in glomerular filtration rate in various stages of type 1 and type 2 diabetes. Available: Accessed 2012 May 14 Diabetic nephropathy is a chronic complication of both type 1 DM (beta cell destruction absolute lack of insulin) and type 2 DM (insulin resistance and/or decreased secretion of insulin) [ 4 ]. There are five stages in the development of diabetic nephropathy. Stage I: Hypertro Continue reading >>

Diabetic Nephropathy: Early Clues, Effective Management

Diabetic Nephropathy: Early Clues, Effective Management

Diabetic Nephropathy: Early Clues, Effective Management By MELISSA B. BLEICHER, MD and STANLEY GOLDFARB, MD In the Western world, diabetic nephropathy is the leading cause of progression to end-stage renal disease (ESRD). Moreover, the incidence of diabetic nephropathy is increasing. Because both the risk of the serum creatinine level doubling and the risk of proteinuria developing increase with the duration of the disease, the longer lifespan of patients with diabetes is resulting in a growing incidence of diabetic nephropathy.1 For example, in 2003 the United States Renal Data System (USRDS) listed diabetic nephropathy as the cause of ESRD in 43% of patients in whom dialysis was initiated.2 This was a 238% increase over the percentage of patients who started dialysis in 1990 in whom diabetic nephropathy was the cause of ESRD. Part of this sizable increase may result from improved treatments for diabetes-associated coronary artery disease and the consequent greater survival of patients with that complication. In this article, we discuss strategies for identifying patients at greatest risk for diabetic nephropathy, the most effective approaches to risk factor modification, and treatment of early-stage nephropathy. We also describe settings in which consultation with a nephrologist is warranted. Overt diabetic nephropathy is defined as the presence of diabetes and albuminuria of more than 300 mg/d (Table 1) on at least 2 occasions that are separated by 3 to 6 months.3 Table 1 Categorization of urinary albumin excretion Mogensen and colleagues4 described the natural history of kidney involvement in type 1 diabetes by dividing the progression into 5 stages ( Figure ). Stage 1 is characterized by a paradoxically elevated glomerular filtration rate (GFR) (hyperfiltration) a Continue reading >>

Pathogenetic Mechanisms Of Diabetic Nephropathy

Pathogenetic Mechanisms Of Diabetic Nephropathy

Abstract Diabetes is the leading cause of ESRD because diabetic nephropathy develops in 30 to 40% of patients. Diabetic nephropathy does not develop in the absence of hyperglycemia, even in the presence of a genetic predisposition. Multigenetic predisposition contributes in the development of diabetic nephropathy, thus supporting that many factors are involved in the pathogenesis of the disease. Hyperglycemia induces renal damage directly or through hemodynamic modifications. It induces activation of protein kinase C, increased production of advanced glycosylation end products, and diacylglycerol synthesis. In addition, it is responsible for hemodynamic alterations such as glomerular hyperfiltration, shear stress, and microalbuminuria. These alterations contribute to an abnormal stimulation of resident renal cells that produce more TGF-β1. This growth factor upregulates GLUT-1, which induces an increased intracellular glucose transport and d-glucose uptake. TGF-β1 causes augmented extracellular matrix protein deposition (collagen types I, IV, V, and VI; fibronectin, and laminin) at the glomerular level, thus inducing mesangial expansion and glomerular basement membrane thickening. However, low enzymatic degradation of extracellular matrix contributes to an excessive accumulation. Because hyperglycemia is the principal factor responsible for structural alterations at the renal level, glycemic control remains the main target of the therapy, whereas pancreas transplantation is the best approach for reducing the renal lesions. Diabetic nephropathy is a clinical syndrome characterized by the occurrence of persistent microalbuminuria in concomitance with insulin- or non–insulin-dependent diabetes. This nephropathy has a long natural history in type 1 diabetes. Initially, Continue reading >>

Diabetic Nephropathy Treatment & Management

Diabetic Nephropathy Treatment & Management

Approach Considerations Several issues are key in the medical care of patients with diabetic nephropathy. [20, 21] These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases. A meta-analysis from the Cochrane Database shows a large fall in blood pressure with salt restriction, similar to that of single-drug therapy. [22] All diabetic patients should consider reducing salt intake at least to less than 5-6 g/d, in keeping with current recommendations for the general population, and may benefit from lowering salt intake to even lower levels. Reducing dietary salt intake may help slow progression of diabetic kidney disease. Renal replacement therapy may be necessary in patients with end-stage renal disease (ESRD). A 2012 post-hoc analysis of the data merged from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial and the Irbesartan Diabetic Nephropathy Trial (IDNT) in 1177 patients demonstrated that a low-sodium diet (24-h urinary sodium/creatinine ratio (mmol/g) < 121) enhanced the renoprotective and cardioprotective effect of angiotensin receptor blockers (losartan or irbesartan) in type 2 diabetic patients with nephropathy. Compared with higher sodium intake groups, the patients in the low-sodium group had better renal (by 43%) and cardiovascular (by 37%) outcomes. These improved outcomes in the low-sodium group underscore the importance of recent calls for population-wide intervention to reduce dietary salt intake, particularly in patients with diabetes and nephropathy treated with angiotensin receptor blockers. [23] Continue reading >>

Definition Of Kimmelstiel-wilson Syndrome

Definition Of Kimmelstiel-wilson Syndrome

home / medterms medical dictionary a-z list / kimmelstiel-wilson syndrome definition Medical Definition of Kimmelstiel-Wilson syndrome Kimmelstiel-Wilson syndrome: Diabetic nephropathy (kidney disease).Kimmelstiel-Wilson syndrome is a kidney condition associated withlong-standing diabetes . It affects the network of tiny blood vessels (themicrovasculature) in the glomerulus, a key structure in the kidney that iscomposed of capillary blood vessels and which is critically necessary forthe filtration of the blood. Features of Kimmelstiel-Wilson syndrome includethe nephrotic syndrome with excessive filtration of protein into the urine(proteinuria), high blood pressure (hypertension), and progressivelyimpaired kidney function. When severe, Kimmelstiel-Wilson syndrome leads to kidney failure , end-stage renal disease, and the need for chronic kidney dialysis or a kidney transplant. The disorder is named for Paul Kimmelstein(1900-70), a German-born pathologist in the U.S., and Clifford Wilson(1906-), an English physician. It is also known as Kimmelstiel-Wilsondisease or intercapillary glomerulonephritis. Continue reading >>

The Pathogenesis Of Diabetic Nephropathy

The Pathogenesis Of Diabetic Nephropathy

Held PJ et al. (1991) The United States Renal Data Systems 1991 annual data report: an introduction. Am J Kidney Dis 18: 1-16 Makino H et al. (1996) Phenotypic modulation of the mesangium reflected by contractile proteins in diabetes. Diabetes 45: 488-495 Mauer SM et al. (1984) Structural-functional relationships in diabetic nephropathy. J Clin Invest 74: 1143-1155 Nielsen S et al. (1997) The clinical course of renal function in NIDDM patients with normo- and microalbuminuria. J Intern Med 241: 133-141 Raile K et al. (2007) Diabetic nephropathy in 27,805 children, adolescents, and adults with type 1 diabetes: effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex. Diabetes Care 30: 2523-2528 Remuzzi G et al. (2002) Clinical practice. Nephropathy in patients with type 2 diabetes. N Engl J Med 346: 1145-1151 Steinke JM et al. (2005) The early natural history of nephropathy in type 1 diabetes: III. Predictors of 5-year urinary albumin excretion rate patterns in initially normoalbuminuric patients. Diabetes 54:2164-2171 Ziyadeh FN (2004) Mediators of diabetic renal disease: the case for TGF- as the major mediator. J Am Soc Nephrol 15 (Suppl 1): S55-S57 Ichinose K et al. (2007) Recent advancement of understanding pathogenesis of type 1 diabetes and potential relevance to diabetic nephropathy. Am J Nephrol 27: 554-564 Raptis AE and Viberti G (2001) Pathogenesis of diabetic nephropathy. Exp Clin Endocrinol Diabetes 109 (Suppl 2): S424-S437 Singh DK et al. (2008) Mechanisms of disease: the hypoxic tubular hypothesis of diabetic nephropathy. Nat Clin Pract Nephrol 4: 216-226 Ziyadeh FN and Wolf G (2008) Pathogenesis of the podocytopathy and proteinuria in diabetic glomerulopathy. Curr Diabetes Rev 4: 39-45 Wolf G and Ziyadeh FN (1999) Molecular me Continue reading >>

Diabetic Nephropathy - Topic Overview

Diabetic Nephropathy - Topic Overview

What is diabetic nephropathy? Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage. What causes diabetic nephropathy? The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney failure. Certain things make you more likely to get diabetic nephropathy. If you also have high blood pressure or high cholesterol, or if you smoke, your risk is higher. Also, Native Americans, African Americans, and Hispanics (especially Mexican Americans) have a higher risk. What are the symptoms? There are no symptoms in the early stages. So it's important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed. As your kidneys are less able to do their job, you may notice swelling in your body, most often in your feet and legs. How is diabetic nephropathy diagnosed? The problem is diagnosed using simple tests that check for a protein called albumin in the urine. Urine doesn't usually contain protein. But in the early stages of kidney damage-before you have any symptoms-some protein may be found in your urine, because your kidneys aren't able to filter it out the way they should. Finding kidney damage early can keep it from getting worse. So it's important for people with diabetes to have regular testing, usually every year. How is it treated? The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. These medicines include: Angiotensin-converting enzyme 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 >>

Medscape's Urology Medpulse (ulg)

Medscape's Urology Medpulse (ulg)

Benign Prostatic Hypertrophy and the Role of Alpha-Adrenergic Blockade Alpha blockade still has a role in hypertension and BPH Alpha-Adrenergic Blockade and Its Role in Hypertension Should the latest state-of-the-art advances always relegate the established standard-of-care to the history books? Carcinoma Extent in Prostate Needle Biopsy Tissue in the Prediction of Whole Gland Tumor Volume in a Screening Population This analysis demonstrates that several preoperative variables are related significantly to whole gland total tumor volume in multivariate analysis. Nature of the Virus Associated with Endemic Balkan Nephropathy A coronavirus was present in the primary cell cultures from patients with the endemic nephropathy. Genital herpes is one of the most common sexually transmitted infections in the US and elsewhere. Asymptomatic, subclinical, and unrecognized infections are much more common than clinical disease, and this has implications for treatment. Get the latest information on treatment and prevention from the Genital HER2 Expression Has Prognostic Importance in Advanced Bladder Cancer It may be worthwhile to test bladder tumors for HER2/neu expression, according to oncologists who have found that expression provides prognostic information for advanced urothelial carcinoma. Holmium Laser Lithotripsy Treats Urolithiasis During Pregnancy The treatment appears to be safe and effective in all stages of pregnancy. Brachytherapy Causes Iatrogenic Shedding of Prostate Cancer Cells Brachytherapy can result in the iatrogenic shedding of prostate cancer cells, which may increase the risk of metastatic deposits and systemic failure. Infection With C. Trachomatis May Protect Against Prostate Cancer Men with Chlamydia trachomatis infection appear to have a reduced risk of pro Continue reading >>

Progressive Renal Decline: The New Paradigm Of Diabetic Nephropathy In Type 1 Diabetes

Progressive Renal Decline: The New Paradigm Of Diabetic Nephropathy In Type 1 Diabetes

Progressive Renal Decline: The New Paradigm of Diabetic Nephropathy in Type 1 Diabetes Research Division of Joslin Diabetes Center and Department of Medicine, Harvard Medical School, Boston, MA Corresponding author: Andrzej S. Krolewski, andrzej.krolewski{at}joslin.harvard.edu. Diabetes Care 2015 Jun; 38(6): 954-962. On the basis of extensive studies in Joslin Clinic patients over 25 years, we propose a new model of diabetic nephropathy in type 1 diabetes. In this model, the predominant clinical feature of both early and late stages of diabetic nephropathy is progressive renal decline, not albuminuria. Progressive renal decline (estimated glomerular filtration rate loss >3.5 mL/min/year) is a unidirectional process that develops while patients have normal renal function. It progresses at an almost steady rate until end-stage renal disease is reached, albeit at widely differing rates among individuals. Progressive renal decline precedes the onset of microalbuminuria, and as it continues, it increases the risk of proteinuria. Therefore, study groups ascertained for microalbuminuria/proteinuria are enriched for patients with renal decline (decliners). We found prevalences of decliners in 10%, 32%, and 50% of patients with normoalbuminuria, microalbuminuria, and proteinuria, respectively. Whether the initial lesion of progressive renal decline is in the glomerulus, tubule, interstitium, or vasculature is unknown. Similarly unclear are the initiating mechanism and the driver of progression. No animal model mimics progressive renal decline, so etiological studies must be conducted in humans with diabetes. Prospective studies searching for biomarkers predictive of the onset and rate of progression of renal decline have already yielded positive findings that will help to devel Continue reading >>

Iga Nephropathy | Niddk

Iga Nephropathy | Niddk

What is immunoglobulin A (IgA) nephropathy? IgA nephropathy, also known as Bergers disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues. IgA is an antibodya protein made by the immune system to protect the body from foreign substances such as bacteria or viruses. Most people with IgA nephropathy receive care from a nephrologist, a doctor who specializes in treating people with kidney disease. How does IgA nephropathy affect the kidneys? IgA nephropathy affects the kidneys by attacking the glomeruli. The glomeruli are sets of looping blood vessels in nephronsthe tiny working units of the kidneys that filter wastes and remove extra fluid from the blood. The buildup of IgA deposits inflames and damages the glomeruli, causing the kidneys to leak blood and protein into the urine. The damage may lead to scarring of the nephrons that progresses slowly over many years. Eventually, IgA nephropathy can lead to end-stage kidney disease, sometimes called ESRD, which means the kidneys no longer work well enough to keep a person healthy. When a persons kidneys fail, he or she needs a transplant or blood-filtering treatments called dialysis. More information is provided in the NIDDK health topic, Glomerular Diseases Overview . The glomeruli are sets of looping blood vessels in nephronsthe tiny working units of the kidneys that filter wastes and remove extra fluid from the blood. Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the bodys immune system harming the kidneys. People with IgA nephropathy have an increased blood level of IgA that contains less of a special sugar, galactose, than normal. This galactose-deficient IgA is considered foreign by Continue reading >>

Diabetic Nephropathy & Retinal Microaneurysm: Causes & Diagnoses | Symptoma.com

Diabetic Nephropathy & Retinal Microaneurysm: Causes & Diagnoses | Symptoma.com

. nephropathy [ n-frop ah-the ] 1. any disease of the kidneys. adj., adj nephropath ic. 2. any disease of the kidneys; see also nephritis . [medical-dictionary.thefreedictionary.com] Kidney Disease , Kidney Disease, Diabetic , Kidney Diseases, Diabetic Spanish trastorno renal asociado con diabetes mellitus , Nefropata diabtica NEOM , Enfermedad renal [fpnotebook.com] Epidemiology Kidney damage in type 1 diabetes is the largest cause of chronic kidney disease in the working age group. [ 1 ] Kidney disease in people with type 2 diabetes [patient.info] 6 mg/dL) in diabetic nephropathy. diabetic nephropathy Diabetic kidney disease The constellation of renal changes attributed to DMeg Armanni-Ebstein lesion, arterionephrosclerosis [medical-dictionary.thefreedictionary.com] , Diabetes with renal manifestations (disorder) , Nephropathy - diabetic , Diabetic nephropathies , -- Diabetic Kidney Disease , Diabetic nephropathy , Diabetic renal disease [fpnotebook.com] Abnormal serum creatinine in type 2 diabetes is often due to renal arterial disease and/or diuretic therapy for cardiac failure rather than to diabetic nephropathy. [patient.info] Diabetic retinopathy may develop in type 1 or type 2 diabetes. [virginiamason.org] Retinal Exams Reset There are 1 products that match your selections below You have 1 results [welchallyn.com] S, Hofer TP, Hayward RA: Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus. [care.diabetesjournals.org] Diabetic retinopathy is retinal damage that occurs from long-term diabetes and from diabetes that has not been adequately controlled. [virginiamason.org] Retinal Exams Retinoscopes Autorefractor Ophthalmoscopes, Binocular Indirect Ear Exam Otoscopes, MacroView Otoscopes, Traditional Otosc Continue reading >>

Preventing Progression And Complications Of Renal Disease

Preventing Progression And Complications Of Renal Disease

Preventing Progression and Complications of Renal Disease Authors : Sidney Kobrin, MD, and Shreeram Aradhye, MD, Hospital of the University of Pennsylvania (BUT...Altered for this venue by C. Newman) A comprehensive, practical approach to managing renal failure and its complications, with a focus on slowing the rate of progression. [Hospital Medicine 33(11):11-12, 17-18, 20, 29-31, 35-36, 39-40, 1997. 1997 Quadrant HealthCom, Inc.] In this new age of managed health care, generalists have had to assume increasing responsibility for managing problems previously tackled by specialists. Although timely referral to and collaboration with a nephrologist is vital in caring for patients with renal disease, it is important for the primary care physician to be familiar with measures aimed at preventing the progression and complications of renal failure. The number of patients with end-stage renal disease (ESRD) is rising rapidly in the United States. The cost of providing renal replacement therapy for these patients is about $12 billion per year. Early recognition of renal disease and appropriate interventions to delay its progression may decrease both human suffering and the financial costs associated with ESRD. Primary care physicians usually treat patients with diabetes and hypertension, the two leading causes of ESRD in this country. Since most patients with early renal failure are asymptomatic, awareness and vigilance on the part of the primary care physician are essential for the early diagnosis, appropriate referral, and collaborative management of these patients. The clinical management of the patient with progressive renal failure may be divided into several components: (1) early recognition of renal failure; (2) monitoring the progression of renal failure; (3) detectio Continue reading >>

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