The kidney in progressive systemic sclerosis (scleroderma).
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Biomedical subjects
Publications and source records attributed to C C Dichoso.
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A 28-year old patient with malignant hypertension developed endstage renal failure necessitating chronic maintenance hemodialysis for seven months and transplantation of a renal allograft that was rejected within a month. After this, with continued control of the hypertension, the patient's own kidneys gradually resumed function and achieved anendogenous creatinine clearance of 30 ml/min. She has not required further dialysis for more than nine months. Recovery of sufficient renal function to maintain homeostasis, one year after onset of uremia, indicates the prolonged antihypertensive treatment period that may be necessary to reverse the renal arteriolar changes associated with malignant hypertension. This experience further underlines the necessity of moderation in the use of nephrectomy in the management of severe hypertension.
Any elevations in levels of blood urea nitrogen and/or serum creatinine do not necessarily indicate structural renal disease. Conversely, blood urea nitrogen or serum creatinine values, which appear to be within the range of normal, do not by themselves rule out significant reduction in glomerular filtration rate. Any interpretation of the blood levels of these two substances must be done with the awareness that a variety of extrarenal factors can affect them. The blood urea nitrogen to serum creatinine ratio can be a valuable tool in the determination or renal functional and structural integrity.
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