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Dr Martin's explanation of the physiologic consequences of diabetic nephropathy is correct. However, this does not change the fact that the clinical course of diabetic nephropathy accelerates in the terminal few months of the disease. This is based on a clinical observation of patients and the rapidly progressive changes that occur in the measurements of renal function.
Goldstein HH. Diabetic Nephropathy-Reply. JAMA. 1977;237(8):765–766. doi:10.1001/jama.1977.03270350025007
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