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A randomized field trial of No eligible health outcomes ACINDES: a child-centered training model for children with chronic illnesses (asthma and epilepsy) buy 5mg oxybutynin otc. J Urban Health 2000;77:280–97 Tinkelman D buy oxybutynin 2.5mg cheap, Wilson S generic oxybutynin 5 mg visa. Asthma disease management: regression to the mean or better? No eligible health outcomes Am J Manag Care 2004;10:948–54 Tolomeo C, Savrin C, Heinzer MM. Impact of asthma self-management on pediatric No eligible health outcomes emergency department visits and hospitalizations. J Asthma Allergy Educ 2010;1:61–70 Turcotte DA, Alker H, Chaves E, Gore R, Woskie S. Healthy homes: in-home environmental Wrong study design asthma intervention in a diverse urban community. Am J Pub Health 2014;104:665–71 von Sengbusch S, Müller-Godeffroy E, Häger S, Reintjes R, Hiort O, Wagner V. Mobile Wrong study design diabetes education and care: intervention for children and young people with type 1 diabetes in rural areas of northern Germany. Diabet Med 2006;23:122–7 Wade SL, Walz NC, Carey J, McMullen KM, Cass J, Mark E, et al. A Randomized trial of No eligible economic teen online problem solving: efficacy in improving caregiver outcomes after brain injury. Trauma-focused cognitive No eligible health outcomes behavioral therapy for youth: effectiveness in a community setting. Psychol Trauma 2014;6:555–62 Weiss B, Han S, Harris V, Catron T, Ngo VK, Caron A, et al. An independent randomized Ineligible population clinical trial of multisystemic therapy with non-court-referred adolescents with serious conduct problems. J Consult ClinPsychol 2013;81:1027–39 Weng HC, Yuan BC, Su YT, Perng DS, Chen WH, Lin LJ, et al. Effectiveness of a nurse-led No eligible health outcomes management programme for paediatric asthma in Taiwan. J Paediatr Child Health 2007;43:134–8 Wensley D, Silverman M. Peak flow monitoring for guided self-management in childhood Ineligible intervention asthma: a randomized controlled trial. Am J Respir Crit Care Med 2004;170:606–12 Wesseldine LJ, McCarthy P, Silverman M. Structured discharge procedure for children No eligible health outcomes admitted to hospital with acute asthma: a randomised controlled trial of nursing practice. Arch Dis Child 1999;80:110–14 Williams SG, Brown CM, Falter KH, Alverson CJ, Gotway-Crawford C, Homa D, et al. Ineligible intervention Does a multifaceted environmental intervention alter the impact of asthma on inner-city children? J Natl Med Assoc 2006;98:249–60 Wilson SR, Yamada EG, Sudhakar R, Roberto L, Mannino D, Mejia C, et al. Occupational Ineligible intervention and environmental lung disease. A controlled trial of an environmental tobacco smoke reduction intervention in low-income children with asthma. Chest 2001;120:1709–22 Wong SS, Nathan AM, de Bruyne J, Zaki R, Mohd Tahir SZ. Does a written asthma action Ineligible intervention plan reduce unscheduled doctor visits in children? Indian J Pediatr 2013;80:590–5 Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Mauras N, et al. Randomized No eligible economic trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes outcomes in adolescents. Diabetes Care 2007;30:555–60 Zatzick D, Russo J, Lord SP, Valery C, Wang J Berliner L et al. Collaborative care intervention Ineligible population targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents a randomized clinical trial. JAMA Pediatrics 2014;168:532–9 110 NIHR Journals Library www. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that 111 suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. S d y ( fi hor O t he r a nd ye a of e line T C e a lh ili ion p b lica ion) ou nt y com p le t ion e s ign e xcl d e d e a e s ofe ffe ct i e ne s ou com e s os A th e rlye t l U S A U ncle ar lus te rR T / S s th ma- re late d QoL vis its and os pitalis ations I nte rve ntion cos ts and ( minimum, ( me as ure not s pe cif ie d ) and d ire ct me d icalcare cos ts maximum, numbe rof d ays with as th ma us e d to calculate cos t pe r s ymptoms s ymptom- f re e d ay B arth olome w e t l U S A T Ye s unctionals tatus S os pitalis ation and vis its o cos ts re porte d 2 and s ymptoms ( U s h e rwood S ymptom Que s tionnaire ) B ird e t l us tralia Quas i- e xpe rime ntal / S QoL( P A QLQ f or vis its , os pitalad mis s ions os pitals e rvice participants ag e d ye ars ) and os pitalbe d - d ays cos ts ( includ ing pre s e ntations , ad mis s ions and be d - d ays ) B razile t l anad a Quas i- e xpe rime ntal / S umbe rof as th ma attacks S ch e d ule d ph ys ician vis its , o cos ts re porte d e me r e ncyoruns ch e d ule d ph ys ician vis its and h os pitalis ations B rown e t l U S A T / S umbe rof s ymptom- f re e M e d icalvis its f oracute o cos ts re porte d d ays and QoL( P A QLQ as th ma e xace rbations s ymptom s ubs cale ) B rowning e t l U K nR T / S S ymptoms P R S ) and lobal Le ng th of os pitals tay o cos ts re porte d f unctioning S ) B ruzze s e e t l U S A T / S QoL( P A QLQ) , numbe rof cute me d icalvis its , o cos ts re porte d s ymptom d ays , ni t vis its , os pitalis ations and awake ning s and d ays with us e of controlle rme d ication activityre s triction as a re s ult of as th ma B ryant- S te ph e ns e t l U S A T / S aytime and ni t- time vis its , os pitalis ations and I nte rve ntion cos ts 2 coug ing and wh e e zing me d ication us ag e B utz e t l and U S A lus te rR T Ye s QoL( P A QLQ) and as th ma os pitalis ations , vis its , I nte rve ntion cos ts W alke re t l s ymptom s e ve rity pre ve ntative vis its , s pe cialty care vis its and as th ma me d ication us e S d y ( fi hor O t he r a nd ye a of e line T C e a lh ili ion p b lica ion) ou nt y com p le t ion e s ign e xcl d e d e a e s ofe ffe ct i e ne s ou com e s os B utz e t l U S A T / S umbe rof s ymptom d ays / vis its , clinician vis its , o cos ts re porte d ni ts , activitylimitation and os pitalis ations and as th ma s ymptom s e ve rity ph armacy- bas e d as th ma me d ication us e B yf ord e t l U K T Ye s S uicid alid e ation ( S I Q) , f amily I npatie nt d ays , d aypatie nt e alth s e rvice cos ts , and arring ton e t l f unctioning and d ays , inte ns ive care d ays , e d ucation cos ts , s ocial 1 e pis od e s of s e l arm outpatie nt atte nd ance , s e rvice s cos ts , re s id e ntial G P vis its , s ch oold octor care cos ts , voluntary contacts , P N contacts , s e rvice s and inte rve ntion couns e lling s e s s ions , cos ts e d ucation contacts , s ocial s e rvice s contacts and voluntarys e rvice contacts B yf ord e t l U K T Ye s lobalf unctioning os pitalis ations , outpatie nt T otalh e alth s e rvice s and ood ye re t l oN O S C S and contacts , d aypatie nt cos ts ( inte rve ntion cos ts , 2 d e pre s s ive s ymptoms contacts , vis its , os pitals e rvice cos ts , ( C S - R and M F Q) , communitycare contacts , communityh e alth s e rvice s uicid alityand s e l arm, voluntarys e ctorcontacts , cos ts and me d ication) , and QoL Q- 5 QA LYs private s e ctorcontacts and e d ucation cos ts , s ocial s ocials e rvice s contacts s e rvice s cos ts , voluntary s e ctors e rvice s cos ts , private s e ctorand s ocial s e rvice s cos ts B yf ord e t l U K T Ye s ating d is ord e rs ymptoms os pitalis ations , outpatie nt T otalcos ts e alth s e rvice and owe rs e t l and s e ve rity( M R O S , appointme nts , d aypatie nt cos ts , s ocials e rvice s cos ts , 2 and lobalf unctioning contacts , contacts , e d ucation cos ts and ( H oN O S C s e l f - rate d and communitycontacts and voluntary/ private s e ctor clinician rate d ) , d e pre s s ive s ocials e rvice s contacts cos ts ) s ymptoms ( M F Q) and f amily f unctioning C alvo e t l S pain T Ye s S ymptoms ( P A S S ) and os pitalad mis s ions , vis its o cos ts re porte d g lobalf unctioning S ) and antips ych otic us ag e C ano- G arcinuñ o e t l S pain, uba T / S QoL( P A QLQ S panis h os pitalad mis s ions o cos ts re porte d 2 and U rug uay ve rs ion) and numbe rof as th ma attacks S d y ( fi hor O t he r a nd ye a of e line T C e a lh ili ion p b lica ion) ou nt y com p le t ion e s ign e xcl d e d e a e s ofe ffe ct i e ne s ou com e s os C ars we lle t l U K T / S ailys ymptom s core V is its to s ur e ry os pital I nte rve ntion cos ts ( cos t of vis its and f amilypractitione r nurs e ) and me d ication h ome vis its cos ts C e lano e t l U S A T Ye s s th ma s ymptom d ays vis its and os pitalis ations o cos ts re porte d C an e t l U S A T / S QoL( P A QLQ) , s ymptom- f re e vis its , os pitalis ations , o cos ts re porte d d ays and s ymptom d iary uns ch e d ule d vis its f or s core as th ma and me d ication us e C an e t l U S A T / S QoL( P A QLQ) , s ymptom- f re e vis its , os pitalis ations , o cos ts re porte d d ays and lung f unctioning uns ch e d ule d acute vis its and me d ication us e C ris tie e t l U K lus te rR T Ye s ypog lycae mic e pis od e s , linic utilis ation/ contacts I nte rve ntion cos ts and QoL( P e d s QL e ne raland with d iabe te s nurs e e alth s e rvice cos ts d iabe te s s pe cif ic) , and s pe cialis ts and d iabe te s be h aviourand we ll- be ing te ams , and os pitalis ations ( S D Q) , QA LYs C icutto e t l anad a lus te rR T Ye s QoL( P A QLQ) U r e nt h e alth - care vis its o cos ts re porte d ( includ ing vis its , walk- in clinic and s ame - d ay ph ys ician vis its ) and f ollow- up vis its C icutto e t l anad a lus te rR T Ye s QoL( P A QLQ) visits, unsch e d ule d o cos ts re porte d ph ysicianof f ice visits, walk- in clinics and unsch e d ule d communityclinicvisits C larke t l ina lus te rR T / S umbe rof s ymptom d ays os pitalis ations , vis its o cos ts re porte d and me d icine s us e C owie e t l anad a T / S i t- time as th ma vis its , os pitalis ations o cos ts re porte d s ymptoms ( f re que ncy and ( includ ing numbe rof QoL( P A QLQ) ad mis s ions and numbe r of patie nts ad mitte d ) , me d ication us ag e and numbe rof inte ns ive care ad mis s ions S d y ( fi hor O t he r a nd ye a of e line T C e a lh ili ion p b lica ion) ou nt y com p le t ion e s ign e xcl d e d e a e s ofe ffe ct i e ne s ou com e s os D omino e t l U S A T Ye s e pre s s ion s ymptoms S e rvice us e T otalh e alth - care cos ts 2 M arch e t l [ S - R ( us e d to calculate os pitalis ation, primarycare , [inte rve ntion cos ts T , 2 and d e pre s s ion- f re e d ays and oth e rme d icalvis its , s ch ool me d ication, me d ication and T re atme nt f or QA LYs ) and S ] bas e d s e rvice s and criminal manag e me nt, ad junctive A d ole s ce nts with re s pond e rs tatus jus tice courts ) s e rvice and attrition D e pre s s ion S tud y s uicid alid e ation ( S I Q- Junior pre ve ntion s e rvice s , time T e am, i S ch oolV e rs ion) , QoL and trave l and ad d itional ( P Q- LS - Q) , e alth and s ocial e alth - care s e rvice s cos ts f unctioning oN O S C and ( s e rvice , time and trave l) ] re mis s ion rate D onald s on e t l U S A T Ye s S uicid alid e ation ( S I Q) and os pitalis ations and o cos ts re porte d 2 d e pre s s ive s ymptoms me d ication us e ( includ ing ( C S - D pe rce ntag e of ad ole s ce nts taking me d ication and th e numbe rof s e s s ions taking me d ication) D oug e rtye t l anad a T / S iabe te s - re late d ad ve rs e os pitalis ations , clinic vis its , e alth s e rvice cos ts 1 and e ve nts ( e. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that 127 suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Delivering Healthcare Through Managed Clinical Networks (MCNs): Lessons From the North order oxybutynin 5mg line. Southampton: National Institute for Health Research Service Delivery and Organisation; 2010 cheap oxybutynin 5 mg without prescription. Process Improvement and Lean Thinking: Using Knowledge and Information to Improve Performance oxybutynin 2.5 mg on line. Connecting Knowledge and Performance in Public Services. Dent M, Bourgeault IV, Denis JL, Kuhlman E, editors. The Routledge Companion to Professions and Professionalism. The Routledge Companion to Professions and Professionalism. The System of Professions: An Essay on the Division of Expert Labour. The enabling role of social position in diverging from the institutional status quo: evidence from the UK NHS. Agency at the managerial interface: public sector reform as institutional work. Understanding radical organisational change: bringing together the old and new institutionalism. Imison C, Curry N, Holder H, Castle-Clarke S, Nimmons D, Appleby J. Greenhalgh T, Humphrey C, Hughes J, Macfarlane F, Butler C, Pawson R. A realist evaluation of whole-scale transformation in London. Fitzgerald L, Ferlie E, Addicott R, Baeza J, Buchanan D, Gerry M. Service improvement in healthcare: understanding change capacity and change context. Theory building from cases: opportunities and challenges. Institutional work: refocusing institutional studies of organizations. Institutional Work: Actors and Agency in Institutional Studies of Organizations. Managing the rivalry of competing institutional logics. The Institutional Logics Perspective: A New Approach to Culture, Structure and Process. A tale of three discourses: the dominant, the strategic and the marginalized. Challenging Operations: Medical Reform and Resistance in Surgery. In Bryman A, Collinson D, Jackson B, Grint K, Uhl-Bien M, editors. National Improvement and Leadership Development Board. Developing People – Improving Care: A National Framework for Action on Improvement and Leadership Development in NHS-Funded Services. London: National Improvement and Leadership Development Board; 2016. Leadership and strategic change under conditions of ambiguity. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. The New Institutionalism in Organisational Analysis. Institutional entrepreneurship by elite firms in mature fields: the big five accounting firms. Institutional contradictions, praxis, and institutional change: a dialectical perspective. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 103 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

D discount 2.5mg oxybutynin mastercard, O n electron m icroscopy the deposits m em branoproliferative glom erulonephritis type I (Fig trusted 5mg oxybutynin. H epatitis C viral antigen has been docum ented in the globulin in the capillary lum ina and appearing as hyaline throm - circulating cryoglobulins discount 5 mg oxybutynin otc. M em branous glom erulonephritis with bi (H T)are observed (arrows), often with num erous m onocytes a m esangial com ponent also has been infrequently described in in m ost capillaries. B, Im m unofluorescence m icroscopy discloses patients infected with the hepatitis C virus. H owever, m ore recent data indi- cate that this form of glom erulonephritis is a feature of hepatitis C virus infection rather than hepatitis B virus infection. In con- trast, m em branous glom erulonephritis, often with m esangial deposits and variable m esangial hypercellularity, is the glom eru- lopathy that is a com m on accom panim ent of hepatitis B virus infection. H epatitis B virus surface, core, or e antigens have been identified in the glom erular deposits. The m orphology of the glom erular capillary walls is sim ilar to the idiopathic form of m em branous glom erulonephritis. A, Som e degree of m esan- gial widening with increased cellularity occurs in m ost affected patients. B, Sim ilarly, on im m unofluorescence, uniform granular capillary wall deposits of im m unoglobulin G (IgG), com plem ent C3, and both light chains are disclosed (IgG). It som etim es is C very difficult to identify m esangial deposits in this setting. C, In addition to the expected capillary wall changes, electron m icro- FIGURE 4-5 (see Color Plate) scopy discloses deposits in m esangial regions of m any lobules H epatitis B virus infection. Several glom erulopathies have been (the arrow indicates m esangial deposits; the arrowheads indicate described in association with hepatitis B viral infection. This trend is now Tbeing reversed, owing to new imaging techniques and to sub- stantial progress in the understanding of host-parasite relationships, of mechanisms of bacterial uropathogenicity, and of the inflammatory reaction that contributes to renal lesions and scarring. French epidemiologic studies evaluated its annual incidence at 53,000 diagnoses per million persons per year, which represents 1. In the United States, the annual number of diagnoses of pyelonephritis in females was estimated to be 250,000. The incidence of UTI is higher among females, in whom it commonly occurs in an anatomically normal urinary tract. Conversely, in males and children, UTI generally reveals a urinary tract lesion that must be identified by imaging and must be treated to suppress the cause of infection and prevent recurrence. UTI can be restricted to the bladder (essentially in females) with only superficial mucosal involvement, or it can involve a solid organ (the kidneys in both genders, the prostate in males). Clinical signs and symptoms, hazards, imaging, and treatment of various types of UTIs differ. Such various forms of UTI explain the wide spectrum of treatment modalities, which range from ambulatory, single-dose antibiotic treatment of simple cystitis in young females, to rescue nephrectomy for pyonephrosis in a diabetic with septic shock. This chapter categorizes the various forms of UTI, describes progress in diagnostic imaging and treatment, and discusses recent data on bacteriology and immunology. Urinary tract infection (UTI) cannot be identified sim ply by the presence of bacteria in a voided specim en, as m icturition flushes saprophytic urethral organism s along with the urine. Thus a certain num ber of colony- form ing units of uropathogens are to be expected in the urine sam ple. M idstream collection is the m ost com m on m ethod of urine sam pling used in adults. W hen urine cannot be studied without delay, it m ust be stored at 4ºC until it is sent to the bacteriology laboratory. The urine test strip is the easiest m eans of diagnosing UTI qualitatively. Sim ultaneous detection of the two is highly suggestive of UTI. This test is 95% sensitive and 75% specific, and its negative A B C predictive value is close to 96%. The test does not, however, detect such bacteria as Staphyloccocus saprophyticus, a strain responsible for som e 3% to 7% of UTIs. Thus, treating UTI sole- FIGURE 7-1 ly on the basis of test strip risks failure in about 15% of sim ple Urine test strips. N orm al urine is sterile, but suprapubic aspira- com m unity-acquired infections and a m uch larger proportion of tion of the bladder, which is by no m eans a routine procedure, UTIs acquired in a hospital. N orm al values for a m idstream specim en are less than or equal to 105 Escherichia coli organism s and 104 leuko- cytes per m illiliter.

B buy oxybutynin 5 mg with mastercard, M icroscopic view of the xanthogranulom atous coli buy discount oxybutynin 5 mg. CT scan of the right kidney showed replacem ent of the renal tissue buy 5mg oxybutynin otc. This part of the lesion is m ade of lipid structures com posed tissue by several rounded, low-density areas and detected an of innum erable clear droplets. Spectrum of renal malakoplakia M ononuclear cells Interstitial Inflammation (nonspecific) nephritis von Hansemann M egalocytic Persistent cells interstitial inflammation (prediagnostic) nephritis Ca2+ M ichaelis-Gutmann Defective (M G) bodies M alakoplakia cell function (diagnostic) B Destuctive granulomas Fibrosis teroid therapy for autoimmune disease. In 13% of the published cases, xanthogranulomatous "pseudosarcoma" malakoplakia involved a transplanted kidney. Lesions can involve the kidney, the bladder, or the ureter and form pseudotumors. B, Histologically, malakoplakia is distinguished by large, pale, periodic acid–Schiff–positive macrophages (von Hanse- FIGURE 7-41 mann cells) containing calcific inclusions (M ichaelis-Gutmann bodies). M alakoplakia (or malacoplakia), like xanthogranulo- The larger ones are often free in the interstitium. M alakoplakia, an matous pyelonephritis, is also a consequence of abnormal macrophage unusual form of chronic tubulointerstitial nephritis, m ust be recog- response to gram-negative bacteria, A. M alakoplakia occurs in associ- nized by early renal biopsy and can resolve, provided treatm ent ation with chronic UTI. In more than 20% of cases, affected per- consisting of antibiotics with intracellular penetration is applied for sons have some evidence of immunosuppression, especially corticos- several weeks. Textor ypertension and parenchymal disease of the kidney are closely interrelated. M ost primary renal diseases eventually disturb H sodium and volume control sufficiently to produce clinical hypertension. Both on theoretical and practical grounds, many authors argue that any sustained elevation of blood pressure depends ultimately on disturbed renal sodium excretion, ie, altered pressure natriuresis. Hence, some investigators argue that a clinical state of hypertension represents de facto evidence of disturbed (or “reset”) renal function even before changes in glomerular filtration can be measured. M any renal insults further induce inappropriate activation of vasoactive systems such as the renin-angiotensin system, adrenergic sympathetic nerve traffic, and endothelin. These mechanisms may both enhance vasoconstriction and act as mediators of additional tissue injury by altering the activity of inflammatory cytokines and promoters of inter- stitial fibrosis. Arterial hypertension itself accelerates many forms of renal disease and hastens the progression to advanced renal failure. Recent studies have firmly established the importance of blood pressure reduction as a means to slow the progression of many forms of renal parenchymal injury, particularly those characterized by massive proteinuria. Over the long term, damage to the heart and cardiovascular system resulting from hypertension represents the major causes of morbidity and mor- tality for patients with end-stage renal disease. Here are illustrated the roles of renal parenchymal disease in sustaining hypertension and of arterial pressure reduction in slowing the progression of renal injury. As discussed, parenchymal renal disease may refer to either unilateral (uncommon) or bilateral conditions. M any unilateral PARENCHYMAL DISEASE RELATED abnorm alities, such as congenital m alform ations, renal agenesis, reflux nephropathy, and TO HYPERTENSION stone disease, do not com m only produce hypertension. H owever, som e unilateral lesions can produce blood pressure elevation. Data for each of these are based prim arily on dem onstrating unilateral secretion of renin and resolution with unilateral nephrectom y. It Renal artery stenosis should be em phasized that unilateral renal disease does not reduce the overall glom erular Atherosclerosis and fibromuscular lesions (Chapter X) filtration rate beyond that expected in patients with a solitary kidney. It follows that addi- Small vessel disease tional reductions in the glom erular filtration rate m ust reflect bilateral renal injury. Vasculitis Atheroembolic renal infarction Thrombosis and infarction Traumatic injury Renal fracture Perirenal fibrosis (“Page” kidney) Radiation injury Arteriovenous malformation or fistulas Other diseases Renal carcinoma Enlarging renal cyst Multiple renal cysts Renin-secreting tumors (rare) FIGURE 2-2 Angiogram and nephrogram of a persistent fractured kidney. The kidney damage shown here produced hypertension in a young woman 2 years after a motor vehicle accident. M easurement of renal vein renins confirmed unilateral production of renin from the affected side. Blood pressure control was achieved with blockade of the renin-angiotensin system using an angiotensin II receptor antagonist (losartan). M any traumatic injuries to the kidney produce temporary hypertension when a border of viable but underperfused renal tissue remains. Prevalence of Hypertension in Chronic Renal Disease FIGURE 2-3 Prevalence of hypertension in chronic renal parenchym al disease. This 70 association is most evident with glomerular diseases, including diabetic nephropathy (DN) and membranoproliferative glomerulonephritis 60 (M PGN), in which 70% to 80% of patients are affected. M inimal 50 change nephropathy (M CN) is a notable exception. Tubulointerstitial 40 disorders such as analgesic nephropathy, medullary cystic diseases, and chronic reflux nephropathies are less commonly affected.