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Systemic Diseases of the Kidney (including Diabetes)
Allan B. Schwartz, MD, is professor of medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine. He introduces his case-based lecture with a list of ten kidney diseases associated with systemic diseases such as diabetes and systemic lupus erythematosus, and follows each case with multiple choice questions and single answers. Among Dr. Schwartz's case presentations is an extensive review of diabetic nephropathy, which accounts for over 40% of patients presenting with end-stage renal disease (ESRD). He notes that blood pressure control and Angiotensin-converting (ACE) inhibitors result in a lesser incidence of nephropathy, and continues with a discussion of histopathologic changes in diabetic nephropathy, glomerular mesangial expansion, and the risk factors for diabetic nephropathy which include hypertension, poor glycemic control, and ethnicity. ESRD, says the author, is caused mainly by hypertension and diabetes and he cites the American Diabetes Association's guidelines for management of ESRD ... and also those of the Irbesartan Diabetic Nephropathy Trial which concluded that "Irbesartan is renal-protective in patients with ... overt diabetic nephropathy." The lecture continues with a discussion of the histopathology of primary AL amyloidosis followed by a five-part question on what causes secondary amyloidosis. Dr. Schwartz explains how the treatment for each form of amyloidosis is different ... before turning to the World Health Organization's classifications of lupus nephritis and the monitoring and clinical course of that disorder. The lecture concludes with case presentations on malignant hypertensive retinopathy, kidney and electrolyte abnormalities in pregnancy, renal microthromboses, and drug-use and HIV-associated nephropathy. |
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