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You can see the tram tracking or splitting of the basement membranes here
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Appel, Columbia
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,
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WHO Classification I:normal glomeruli II:pure mesangial alterations III:focal segmental glomerulonephritis IV:diffuse proliferative glomerulonephritis V:membranous glomerulonephritis VI: sclerosing glomerulonephritis
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Diabetic nephropathy Diabetic nephropathy has become the single most common cause of ESRD in the Western world Patients with type 2 DM do poorly on dialysis and have an excess mortality An interdisciplinary approach is needed for these patients, and nephrologists must deal with a spectrum of co-morbidities (CVD, stroke, peripheral vascular disease, retinopathy) besides nephropathy
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How do microvascular complications, including renal disease, develop? High glucose induces generation of reactive oxygen species Proteins modified by glucose, i.e. Amadori products, and advanced glycation products (AGEs) play a pivotal role TGF- is crucial in the development of renal hypertrophy and ECM accumulation Later, irreversible changes such as interstitial fibrosis and glomerulosclerosis develop Concomitant with renal hypertrophy, hyperfiltration and intra-renal hypertension develop
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RPGN Superimposed on primary renal disease: IgA, membranous, MPGN, hereditary nephritis Associated with infectious, systemic diseases Has non-specific symptoms, insidious onset Diagnosis according to primary disorder: ANCA, post-infectious, Goodpasture syndrome Usually requires aggressive therapy
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