Recent advances: Nephrology

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Abstract
Methods This is an unsystematic review of those areas of nephrology in which there have been recent advances, selected for a general readership. Space precludes coverage of advances in renal transplantation. I have relied on personal files, recent articles in the journals of international nephrology societies, Medline searches, and discussions with colleagues. Recent advances Identification of the genetic basis for some rare disorders has led to increased understanding of normal renal physiology and opened up the possibility of new treatments for hyperparathyroidism and hyponatraemic states Major advances have occurred in the understanding of the pathogenesis of IgA nephropathy and adult polycystic kidney disease, but as yet these have not led to breakthroughs in the treatment of these conditions The reduction of proteinuria by antihypertensives slows the progression towards end stage renal failure of many types of renal disease—angiotensin converting enzyme inhibitors may have particular value in reducing proteinuria unless systemic blood pressure is lowered far enough Although only a small proportion of affected patients benefit from renal revascularisation, the high frequency of renal artery stenosis in patients with atherosclerosis mandates regular monitoring of renal function if angiotensin converting enzyme inhibitors are used