The American journal of medicine
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Measurement of glycosylated hemoglobins in diabetic patients has been available to clinicians for about five years. Such measurements correlate with mean serum glucose determinations over time; therefore, they have stimulated a number of studies to determine (1) if these assays are useful in diagnosing diabetes, (2) the clinical utility of determinations of minor hemoglobins in monitoring diabetic control, and (3) the relationship of glucose "control" (as indicated by concentrations of glycosylated hemoglobins) to abnormalities or "sequelae" of the diabetic state. High concentrations of glycosylated hemoglobins are highly specific for diabetes, and positive findings provide a useful diagnostic test. ⋯ These abnormalities include abnormalities of the erythrocyte, leukocyte, platelet, and coagulation cascade and hormonal profiles in juvenile-onset diabetes and diabetes in pregnancy. In addition, correlation have been reported between certain risk factors or abnormalities, associated with vascular disease and concentrations of minor hemoglobins, including lipid profiles microvascular disease as reflected by retinal changes and quadriceps capillary basement membrane thickening, and macrovascular disease as reflected by pulse volume recordings. These studies have led to a reevaluation of the role of glucose "control" in contributing to diabetic sequelae, and, thus, have stimulated new approaches to the management of diabetes.
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Renal insufficiency, with serum creatinines ranging from 2.3 to 13.4 mg/dl, was observed in 15 patients with the minimal change nephrotic syndrome. Recovery of renal function occurred in association with diuretic therapy in 13, eight of whom subsequently underwent steroid-induced remission of the nephrotic syndrome. ⋯ Glomerular filtration rate (Cinulin) was reduced out of proportion to renal plasma flow (CPAH) as evidenced by remarkably low filtration fractions ranging from 0.03 to 0.095. The invariable association between diuresis and recovery of renal function, the recurrence of renal failure when fluid reaccumulated and the finding of markedly depressed filtration fractions lead us to postulate that renal failure in minimal change nephrotic syndrome may be due to a reversible alteration in glomerular hemodynamics which is related to fluid retention and associated intrarenal edema.