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HIV-associated Nephropathy
HIV-associated nephropathy (HIVAN) refers to kidney disease developing in association with infection by human immunodeficiency virus, the virus that causes AIDS. The most common, or "classical", type of HIV-associated nephropathy is a collapsing focal segmental glomerulosclerosis (FSGS), though other forms of kidney disease may also occur. Regardless of the underlying histology, kidney disease in HIV-positive patients is associated with an increased risk of death. Cause HIVAN may be caused by direct infection of the kidney cells by HIV, with resulting kidney damage through the viral gene products. It could also be caused by the release of cytokines during HIV infection. Usually occurs only in advanced HIV disease and approximately 80% of patients with HIVAN have a CD4 count of less than 200. HIVAN presents with nephrotic syndrome and progressive kidney failure. Despite being a cause of chronic kidney failure, kidney sizes are usually normal or large. Pathology Abnormalities involv ...
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Kidney Disease
Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an Inflammation, inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to nephritic syndrome and nephrotic syndrome respectively. Kidney disease usually causes a loss of Assessment of kidney function, kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where Kidney dialysis, dialysis or a Kidney transplantation, kidney transplant is the only treatment option. Chronic kidney disease is defined as prolonged kidney abnormalities (functional and/or structural in nature) that last for more than three months. Acute kidney disease is now termed acute kidney injury and is marked by the ...
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HAART
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load. Treatment has been so successful that in many parts of the world, HIV has become a chronic condition in which progression to AIDS is increasingly rare. Anthony Fauci, former head of the United States National Institute of Allergy and Infectious Diseases, has written, "With collective and resolute action n ...
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Biopsies
A biopsy is a medical test commonly performed by a surgeon, an interventional radiologist, or an interventional cardiologist. The process involves the extraction of sample cells or tissues for examination to determine the presence or extent of a disease. The tissue is then fixed, dehydrated, embedded, sectioned, stained and mounted before it is generally examined under a microscope by a pathologist; it may also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. An incisional biopsy or core biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous or inflammatory conditions. Hist ...
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Stellenbosch University
Stellenbosch University (SU) (, ) is a public research university situated in Stellenbosch, a town in the Western Cape province of South Africa. Stellenbosch is the oldest university in South Africa and the oldest extant university in Sub-Saharan Africa, which received full university status in 1918. Stellenbosch University designed and manufactured Africa's first microsatellite, SUNSAT, launched in 1999. Stellenbosch is organised in 139 departments across 10 faculties offering bachelor's (Education in South Africa#Higher education and training system, NQF 7) to doctoral degrees (NQF 10) in the English and Afrikaans language. Across five campuses in the Western Cape, the university is home to 32,000 students. The students of Stellenbosch University are nicknamed "Maties". The term probably arises from the Afrikaans word "tamatie" (meaning tomato, and referring to the maroon sports uniforms and blazer colour). An alternative theory is that the term comes from the Afrikaans colloq ...
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Tygerberg Hospital
Tygerberg Hospital is a tertiary public hospital located in Parow. The hospital was officially opened in 1976 and is the largest district general hospital in the Western Cape and the second largest hospital in South Africa, with the capacity for 1899 beds. It acts as a teaching hospital in conjunction with the Stellenbosch University Stellenbosch University (SU) (, ) is a public research university situated in Stellenbosch, a town in the Western Cape province of South Africa. Stellenbosch is the oldest university in South Africa and the oldest extant university in Sub-Sahara ...'s Health Science Faculty. To become a patient at Tygerberg, a person must be referred by a primary or secondary health care facility. Over 3.6 million people receive health care from Tygerberg, either directly or via its secondary hospitals, such as Paarl and Worcester Hospital. During the normal working day there are about 10,000 people on hospital grounds. Services A full range of general speciali ...
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Ciclosporin
Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken Oral administration, orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephrotic syndrome, eczema, and in organ transplants to prevent transplant rejection, rejection. It is also used as eye drops for keratoconjunctivitis sicca (dry eyes). Common side effects include high blood pressure, headache, kidney problems, increased hair growth, and vomiting. Other severe side effects include an increased risk of infection, liver problems, and an increased risk of lymphoma. Blood levels of the medication should be checked to decrease the risk of side effects. Use during pregnancy may result in preterm birth; however, ciclosporin does not appear to cause birth defects. Ciclosporin is believed to work by decreasing the function of lymphocytes. It does this by forming a complex with cyclophilin to block the phosphatase act ...
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Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Some common naturally occurring steroid hormones are cortisol (), corticosterone (), cortisone () and aldosterone () (cortisone and aldosterone are isomers). The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone. The etymology of the '' cortico-'' part of the name refers to the adrenal cortex, which makes these steroid hormones. Thus a corticosteroid is a "cortex steroid". Classes * Glucocorticoids such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti ...
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Angiotensin Receptor Blockers
Angiotensin II receptor blockers (ARBs), formally angiotensin II receptor type 1 (AT1) antagonists, also known as angiotensin receptor blockers, angiotensin II receptor antagonists, or AT1 receptor antagonists, are a group of pharmaceuticals that bind to and inhibit the angiotensin II receptor type 1 (AT1) and thereby block the Vasoconstriction, arteriolar contraction and sodium retention effects of renin–angiotensin system. Their main uses are in the treatment of hypertension (high blood pressure), diabetic nephropathy (kidney damage due to diabetes mellitus, diabetes) and congestive heart failure. They ''selectively'' receptor antagonist, block the activation of the Angiotensin II receptor type 1, AT1 receptor, preventing the Ligand (biochemistry), binding of angiotensin#Angiotensin II, angiotensin II compared to ACE inhibitors. ARBs and the similar-attributed ACE inhibitors are both indicated as the first-line antihypertensives in patients developing hypertension along with ...
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Angiotensin Converting Enzyme Inhibitors
Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a class of medication used primarily for the treatment of high blood pressure and heart failure. This class of medicine works by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart. ACE inhibitors inhibit the activity of angiotensin-converting enzyme, an important component of the renin–angiotensin system which converts angiotensin I to angiotensin II, and hydrolyses bradykinin. Therefore, ACE inhibitors decrease the formation of angiotensin II, a vasoconstrictor, and increase the level of bradykinin, a peptide vasodilator. This combination is synergistic in lowering blood pressure. As a result of inhibiting the ACE enzyme in the bradykinin system, the ACE inhibitor drugs allow for increased levels of bradykinin which would normally be degraded. Bradykinin produces prostaglandin. This mechanism can explain ...
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Chronic Kidney Disease
Chronic kidney disease (CKD) is a type of long-term kidney disease, defined by the sustained presence of abnormal kidney function and/or abnormal kidney structure. To meet criteria for CKD, the abnormalities must be present for at least three months. Early in the course of CKD, patients are usually asymptomatic, but later symptoms may include pedal edema, leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications can relate to hormonal dysfunction of the kidneys and include (in chronological order) Hypertension, high blood pressure (often related to activation of the renin–angiotensin system), renal osteodystrophy, bone disease, and anemia. Additionally CKD patients have markedly increased Cardiovascular disease, cardiovascular complications with increased risks of death and hospitalization. CKD can lead to kidney failure, end-stage kidney failure requiring kidney dialysis or kidney transplantation. Causes of chronic kidney disease include diabetic ne ...
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AIDS
The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, preventable disease. It can be managed with treatment and become a manageable chronic health condition. While there is no cure or vaccine for HIV, Management of HIV/AIDS, antiretroviral treatment can slow the course of the disease, and if used before significant disease progression, can extend the life expectancy of someone living with HIV to a nearly standard level. An HIV-positive person on treatment can expect to live a normal life, and die with the virus, not of it. Effective #Treatment, treatment for HIV-positive people (people living with HIV) involves a life-long regimen of medicine to suppress the virus, making the viral load undetectable. Treatment is recommended as soon as the diagnosis is made. An HIV-positive person who has an ...
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FSGS
Focal segmental glomerulosclerosis (FSGS) is a histopathologic finding of scarring Sclerosis (medicine), (sclerosis) of Glomerulus (kidney), glomeruli and damage to renal podocytes. This process damages the filtration function of the kidney, resulting in protein presence in the urine due to protein loss. FSGS is a leading cause of excess protein loss—nephrotic syndrome—in children and adults in the US. Signs and symptoms include proteinuria and edema. Kidney failure is a common long-term complication of the disease. FSGS can be classified as primary, secondary, or genetic, depending on whether a particular toxic or pathologic stressor or genetic predisposition can be identified as the cause. Diagnosis is established by renal biopsy, and treatment consists of glucocorticoids and other immune-modulatory drugs. Response to therapy is variable, with a significant portion of patients progressing to end-stage kidney failure. An American epidemiological study 20 years ago demonstrated ...
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