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By Michael Boulton-Jones MB, B.CHIR, MRCP (auth.)

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The ability to acidify and concentrate the urine gradually returns to near normal, so the patient has no long-term serious renal sequelae of the episode of A TN. Statistics of ATN A very real disappointment has been the failure over the last 10 to 15 years to improve significantly the prognosis of patients presenting with A TN. The introduction of parenteral nutrition and the use of early dialysis have been shown to improve survival, and yet half the patients continue to die. g. hyperkalaemia. However, most patients die with uncontrolled infection, and uraemia depresses almost all defensive mechanisms which, although improved by adequate nutrition and frequent dialysis, apparently remain incapable of eradicating advanced infection.

Thus, if a high dose IVU is performed and scars are present in the kidney, a diagnosis of chronic pyelonephritis is made, but if the outline is smooth and the patient has proteinuria, then chronic glomerulonephritis is the chosen diagnosis. Since there is no possibility of making a more accurate assessment and since it is usual for common things to occur commonly, a common diagnosis is chosen, thus fulfilling the axiom. Table 12 is taken from the European data summarized by Wing (1977). Chronic Glomerulonephritis Chronic glomerulonephritis should not be regarded as a single disease.

However, some patients do appear to lose one function first, particularly when the tubules are predominantly involved in the disease process as happens with analgesic nephropathy or renal tubular acidosis. These patients may develop a sodium losing state or marked acidosis while the GFR is well maintained. The effect Introduction 51 of renal failure on the endocrine function of the kidney also has important consequences for the patient and contributes largely to anaemia, renal osteodystrophy and hypertension, which are discussed later.

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