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Renal medicine is largely a disappointing discipline for the practicing physician. Although dialysis and transplantation can nowadays successfully substitute for renal function when kidneys have failed, there are almost no effective treatments for chronic glomerular diseases. Large-scale clinical trials have investigated ways to protect what is left of renal mass after injury or to retard inexorable progression toward renal failure, but there are no well-designed studies with sufficient statistical power concerning the specific treatment of glomerulonephritis. This may be due partly to insufficient knowledge of the mechanism (or mechanisms) of the glomerular injury and partly to the relative rarity of
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