The Medical clinics of North America
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Med. Clin. North Am. · Sep 2023
ReviewLower-Extremity Vascular Ulcers: Assessment and Approaches to Management.
Healing of skin wounds of the lower extremities can be complicated by concomitant vascular disease. Dysfunction of the arterial, venous, and/or lymphatic systems can compromise the healing of skin ulcers of the legs, creating a burden for patients from painful, draining wounds and placing patients at risk for infection, amputation, and even death. Insights into vascular pathophysiology and an understanding of the processes of wound healing permit an evidence-based approach to patients with vascular leg ulcers. Clinical trials have demonstrated opportunities to improve the care of patients with vascular leg ulcers, thereby reducing morbidity and mortality and easing patients' burdens.
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Chronic kidney disease (CKD) is a progressive condition which is defined by decreased kidney function evidenced by a glomerular filtration rate (GFR) less than 60 mL/min per 1.73 m2 or markers of kidney damage, or both, for at least 3 months, regardless of the underlying cause. The 5 stages of CKD are based on the estimated GFR. ⋯ Predialysis education helps patients make informed decisions and opt for a modality conducive with their lifestyle/values. It has also been associated with improvement in measurable outcomes such as delayed initiation of dialysis, cardiovascular complications, and mortality.
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Nephrotic syndrome (NS) is a key clinical entity for the internist to recognize and understand. A wide range of infectious, metabolic, malignant, and autoimmune processes drive nephrosis, leading to a syndrome defined by proteinuria, edema, and hypoalbuminemia. ⋯ Proteinuria leads to a cascade of clinical complications characterized by fluid accumulation, kidney inflammation, and dysregulation of coagulation and immunity. In this article, the authors review the clinically important etiologies of NS that should inform an initial clinical evaluation.