By Meguid El Nahas, Adeera Levin
Continual Kidney sickness (C.K.D.) is speedily turning into a world healthcare challenge with an predicted 10% of the overall inhabitants affected. for this reason, it truly is changing into more and more vital that basic care physicians and basic physic, in addition to aspiring nephrologists, have an organization knowing of C.K.D. in addition to entry to the major info. functional and highly-accessible, this ebook offers a finished consultant to the knowledge and administration of sufferers with C.K.D. . It bargains either basic care physicians and non-nephrology experts an creation to and insights into the ailment. The emphasis is on useful information and a targeted method of a few key themes within the fi
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Example text
These interventions also have the added advantage of reducing CVD risk. This is a very important goal of the management of patients with diabetic kidney disease as CVD constitute the major cause of morbidity and mortality. Intensive multifactorial intervention It is important to appreciate that the ultimate goal of reducing the complications of DM, including DKD and CVD, depends on a multifactorial approach relying of maximizing glycaemia control (HbA1c ~7%), reducing blood pressure (<125/75mmHg), the use of a statin to reduce hypercholesterolaemia as well as cessation of smoking.
On the other hand, nephritic syndrome with haematuria, reduced kidney function, hypertension, and oedema is often seen in association with acute GN (post-infectious) (see ‘Practical approach to glomerulonephritis’) or crescentic/rapidly progressive GN. The latter is characterized by a rapidly declining kidney function, hence the label of rapidly progressive GN. The prognosis of GN is often a function of the severity and persistence of heavy proteinuria, hypertension as well as the level of renal functional impairment at presentation.
Patients with rapidly progressive GN, whether it is idiopathic or secondary to an underlying vasculitis, should be treated early and aggressively with a combination of immunosuppressive agents, including steroids and cyclophosphamide, and occasionally, plasma exchange in those with Goodpasture’s syndrome, lung haemorrhage as well as patients with AASV and advanced renal insufficiency (serum creatinine >600umol/L or those who are dialysis-dependent). Combination therapy with steroids and pulse intravenous cyclophosphamide has also been advocated for the management of severe lupus nephritis.