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Dietary Patterns for Promoting Kidney Health. 促进肾脏健康的饮食模式。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-07-27 DOI: 10.1159/000517670
Maria Luisa Pereira de Melo, Ilana Nogueira Bezerra, Nayara de Souza Gomes Cabral, Rafaelle de Azevedo Santiago, Clarisse Vasconcelos de Azevedo

Chronic kidney disease (CKD) is considered a public health problem and part of the growing burden of noncommunicable diseases. Many studies have searched for ways to reduce the risk of complications and death. One possible approach to modify the course of this disease is the adoption of healthy dietary habits. Previous studies have suggested that healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet, the vegetarian diet, and a diet adhering to the Healthy Eating Index, are associated with improved renal health. In this chapter, we reviewed the scientific literature and presented the potential role of dietary patterns in the prevention of CKD, contributing to dietary strategies for promoting kidney health. We found that nutritional planning plays an important role in kidney health maintenance and in the protection of kidneys from further damage. The DASH, Mediterranean, and vegetarian dietary patterns can be viable strategies for CKD prevention. However, individualized nutritional monitoring is necessary for individuals with overt kidney disease. Randomized, controlled, and prospective studies focusing on nutritional interventions applied to renal patients undergoing conservative and dialytic treatment and to the general population are necessary to assess habits that can prevent the occurrence and worsening of kidney disease.

慢性肾脏疾病(CKD)被认为是一个公共卫生问题和非传染性疾病日益增长的负担的一部分。许多研究都在寻找降低并发症和死亡风险的方法。改变这种疾病病程的一个可能方法是采用健康的饮食习惯。先前的研究表明,健康的饮食模式,如停止高血压的饮食方法(DASH)、地中海饮食、素食饮食和坚持健康饮食指数的饮食,与改善肾脏健康有关。在本章中,我们回顾了科学文献,并提出了饮食模式在预防CKD中的潜在作用,为促进肾脏健康的饮食策略做出贡献。我们发现营养计划在维持肾脏健康和保护肾脏免受进一步损害方面起着重要作用。DASH,地中海和素食饮食模式可以是CKD预防的可行策略。然而,个体化营养监测对于有明显肾脏疾病的个体是必要的。对接受保守和透析治疗的肾病患者和普通人群进行营养干预的随机、对照和前瞻性研究,对于评估可以预防肾脏疾病发生和恶化的习惯是必要的。
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引用次数: 0
Stroke and Chronic Kidney Disease. 中风和慢性肾脏疾病。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517698
Dearbhla M Kelly, Eoin M Kelleher, Manish M Sood

Chronic kidney disease (CKD) is strongly associated with the full spectrum of cerebrovascular disease including ischaemic and haemorrhagic stroke, small vessel disease, and vascular cognitive impairment. Shared conventional vascular risk factors such as age, hypertension, and diabetes mellitus may account for many of these associations, but novel renal-specific risk factors such as uraemia-related coagulopathy or endothelial dysfunction have also been proposed. In this chapter, we will explore the impact of CKD on stroke risk, mechanisms, and outcomes. We will also outline potential challenges and inequities in stroke care delivery and research for these patients along with some strategies to help improve stroke prevention and management for this high-risk group.

慢性肾脏疾病(CKD)与全谱脑血管疾病密切相关,包括缺血性和出血性中风、小血管疾病和血管性认知障碍。常见的血管危险因素,如年龄、高血压和糖尿病,可能解释了许多这些关联,但新的肾脏特异性危险因素,如尿毒症相关凝血功能障碍或内皮功能障碍也被提出。在本章中,我们将探讨CKD对卒中风险、机制和结果的影响。我们还将概述这些患者在中风护理和研究方面的潜在挑战和不公平,以及一些有助于改善这一高危群体中风预防和管理的策略。
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引用次数: 3
Prescription Drug Overdose, Depression, and Other Mental Disorders in the Context of Kidney Disease. 处方药过量,抑郁和其他精神障碍在肾脏疾病的背景下。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517700
Ramon Róseo Paula Pessoa Bezerra de Menezes, Tiago Lima Sampaio, Alice Maria Costa Martins, Renata de Sousa Alves, Emanuel Paula Magalhães

Clinical Background: Mental disorders, especially depression, are associated with several comorbidities in the kidneys. Depression is the psychiatric disorder that mostly affects individuals with chronic kidney disease (CKD) and end-stage kidney disease. Epidemiology: The mainly prescribed drugs involved in overdose cases are opioids, benzodiazepines, and antidepressants. Antidepressants are the main psychiatric drugs that lead to kidney injury, mainly the second-generation ones. However, the prevalence of depression in dialysis patients varies from 22.8 to 39.3%. Therefore, psychiatric patients have 1.5-3 times more hospitalization compared to patients having only CKD. Challenges: Randomized clinical studies should be encouraged. Studies have shown an association between depression and progression of kidney disease. The mechanisms are not completely clear, but changes on neurotransmitter release and endocrine functions appear to be related to it. Additionally, the use of antidepressant and other psychoactive drugs can induce kidney injury. Hyponatremia induced by second-generation antidepressant drugs is an important feature and can be a risk factor for elderly or patients with comorbidities such as cerebral edema, brain damage or coma. Besides this class, drugs used for anxiety and bipolar disorders or sympathomimetic drugs of abuse can trigger acute kidney injury, possibly due to endothelial dysfunction and thromboembolic and ischemic events. Prevention and Treatment: The early detection of renal impairment and the prescription of nephroprotective strategies has been a clinical challenge. Some studies aim to describe the biochemical mechanisms involved and develop clinical management strategies for these patients. This chapter brings attention to this topic, discussing the major mechanisms and clinical features of kidney injury associated with mental illness, and the most relevant clinical strategies.

临床背景:精神障碍,尤其是抑郁症,与肾脏的几种合并症有关。抑郁症是一种精神障碍,主要影响慢性肾脏疾病(CKD)和终末期肾脏疾病患者。流行病学:过量病例中涉及的主要处方药是阿片类药物、苯二氮卓类药物和抗抑郁药。抗抑郁药是导致肾损伤的主要精神药物,主要是第二代抗抑郁药。然而,透析患者抑郁的患病率从22.8%到39.3%不等。因此,精神病患者的住院率是单纯CKD患者的1.5-3倍。挑战:应该鼓励随机临床研究。研究表明,抑郁与肾脏疾病的进展之间存在关联。其机制尚不完全清楚,但神经递质释放和内分泌功能的变化似乎与此有关。此外,使用抗抑郁药和其他精神药物可引起肾损伤。第二代抗抑郁药物引起的低钠血症是一个重要特征,对于老年人或有脑水肿、脑损伤或昏迷等合并症的患者可能是一个危险因素。除此之外,用于焦虑和双相情感障碍的药物或滥用的拟交感神经药物可引发急性肾损伤,可能是由于内皮功能障碍和血栓栓塞和缺血事件。预防和治疗:肾脏损害的早期发现和肾保护策略的处方一直是一个临床挑战。一些研究旨在描述所涉及的生化机制,并为这些患者制定临床管理策略。本章讨论了精神疾病肾损伤的主要机制和临床特征,以及最相关的临床策略。
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引用次数: 0
Air Pollution and Kidney Diseases: PM2.5 as an Emerging Culprit. 空气污染与肾脏疾病:PM2.5是新出现的罪魁祸首。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517710
Yu An, Zhi-Hong Liu

Clinical Background: As a result of modern industrialization, air pollution has become a potential contributor to global burden of noncommunicable diseases, such as cardiovascular disease, respiratory disease, and kidney disease. Epidemiology: Emerging epidemiological evidence has demonstrated that exposure to ambient air pollution is associated with an increased risk for the development and progression of chronic kidney disease (CKD) and CKD-related mortality. Exposure to PM2.5, even at relatively low concentrations, is a risk factor for a lower estimated glomerular filtration rate and a faster decline in glomerular filtration rate. It has been estimated that the global burden of CKD attributable to PM2.5 is 6.95 million incident cases of CKD per year. Low- and middle-income countries in the Eastern Mediterranean and South-East Asia regions experienced the highest urban air pollution levels, thus facing a heavier burden of related disease. Challenges: Despite a growing awareness of kidney damage related to air pollution, large gaps still exist between the exact toxicological effect of particles on the kidney and the increasing prevalence of air pollution-related kidney diseases. Considering the geographic variation of air pollution, more longitudinal studies in different parts of the world are urgently needed, especially in those most affected countries. Prevention and Treatment: Air pollution control should be regarded as a high priority in urban plan and policy making. Actions are required to narrow gaps in knowledge and clean air, thus preventing air pollution-related kidney disease.

临床背景:由于现代工业化,空气污染已成为全球非传染性疾病负担的潜在因素,如心血管疾病、呼吸系统疾病和肾脏疾病。流行病学:新出现的流行病学证据表明,暴露于环境空气污染与慢性肾脏疾病(CKD)的发生和进展以及CKD相关死亡率的风险增加有关。暴露于PM2.5,即使浓度相对较低,也是肾小球滤过率估计较低和肾小球滤过率下降较快的一个危险因素。据估计,全球每年由PM2.5引起的CKD负担为695万例。东地中海和东南亚区域的低收入和中等收入国家的城市空气污染程度最高,因此面临着更沉重的相关疾病负担。挑战:尽管人们越来越认识到空气污染对肾脏的损害,但颗粒对肾脏的确切毒理学影响与空气污染相关肾脏疾病的日益流行之间仍然存在很大差距。考虑到空气污染的地理差异,迫切需要在世界不同地区进行更多的纵向研究,特别是在受影响最严重的国家。防治:空气污染控制应被视为城市规划和政策制定的重中之重。需要采取行动缩小知识差距和清洁空气,从而预防与空气污染有关的肾脏疾病。
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引用次数: 7
Regional and Racial Disparities in HIV-Related Kidney Disease. hiv相关肾脏疾病的地区和种族差异
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517702
Matthew Sinclair, Christina M Wyatt

Clinical Background and Epidemiology: Worldwide, an estimated 38 million people are living with HIV infection. The classic kidney disease of HIV infection, commonly known as HIV-associated nephropathy, is a collapsing form of focal segmental glomerulosclerosis that almost exclusively affects individuals of African descent with advanced HIV disease. People living with HIV are also at risk for immune-complex kidney diseases, antiretroviral nephrotoxicity, and kidney disease due to co-infections and comorbidities. Challenges: The burden of HIV-related kidney disease is greatest in traditionally disadvantaged populations in resource-limited settings in sub-Saharan Africa and the Caribbean and among minority populations in the United States and Europe. Factors contributing to these disparities include a higher prevalence of HIV infection, limited access to optimal antiretroviral therapy, and genetic susceptibility to kidney disease. Treatment and Prevention: Current treatment guidelines recommend the initiation of life-long antiretroviral therapy in all people living with HIV to prevent AIDS and non-AIDS complications, including kidney disease. People living with HIV who progress to end-stage kidney disease despite treatment are candidates for dialysis and kidney transplant, including the possibility of accepting organs from HIV-positive donors in some settings. Although HIV prevention is currently the only definitive solution, expanding access to antiretroviral therapy, dialysis, and kidney transplantation in people living with HIV are important intermediate steps to address the global burden of HIV-related kidney disease.

临床背景和流行病学:全世界估计有3800万人感染艾滋病毒。HIV感染的典型肾脏疾病,通常被称为HIV相关肾病,是一种局灶节段性肾小球硬化的塌陷形式,几乎只影响患有晚期HIV疾病的非洲裔个体。由于合并感染和合并症,艾滋病毒感染者也面临免疫复杂性肾脏疾病、抗逆转录病毒肾毒性和肾脏疾病的风险。挑战:在撒哈拉以南非洲和加勒比地区资源有限的传统弱势群体以及美国和欧洲的少数群体中,艾滋病毒相关肾脏疾病的负担最大。造成这些差异的因素包括艾滋病毒感染率较高,获得最佳抗逆转录病毒治疗的机会有限,以及对肾脏疾病的遗传易感性。治疗和预防:目前的治疗指南建议在所有艾滋病毒感染者中开始终身抗逆转录病毒治疗,以预防艾滋病和非艾滋病并发症,包括肾病。尽管接受了治疗,但进展为终末期肾病的艾滋病毒感染者可以进行透析和肾移植,包括在某些情况下接受艾滋病毒阳性供体器官的可能性。尽管艾滋病毒预防是目前唯一确定的解决方案,但扩大艾滋病毒感染者获得抗逆转录病毒治疗、透析和肾移植的机会是解决艾滋病毒相关肾脏疾病全球负担的重要中间步骤。
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引用次数: 1
Sepsis and Kidney Injury. 败血症和肾损伤。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517701
Jay L Koyner

Clinical Background: Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in hospitalized patients. Epidemiology: Recent standardized, separate consensus definitions of sepsis and AKI have informed the epidemiology of these 2 distinct processes. While there is no consensus definition specific to sepsis-associated AKI, several studies have utilized the combined definitions of these two syndromes to identify those patients at the highest risk for adverse outcomes. Challenges: Prevention of sepsis-associated AKI is difficult in part because patients will often present for medical care with the sepsis-associated AKI already clinically apparent. Additionally, for those that do not have AKI on presentation the ability to detect injury early is limited by the imperfect current gold standard biomarkers serum creatinine and urine output. Prevention and Treatment: Despite these challenges, there has been increased investigation of novel biomarkers of AKI. Additionally, there has been intense investigation into the ideal care of patients with sepsis, AKI as well as sepsis-associated AKI. While there are limited specific therapeutic options outside of antibiotics for infections, several studies have investigated the use of care bundles to treat these syndromes. While there is continued investigation into novel therapeutics and the use of dialysis and extracorporeal modalities, these trials have failed to revolutionize clinical care. This review summarizes the current state of sepsis-associated AKI care and discusses strategies to improve care.

临床背景:临床感染及其最严重的形式败血症和感染性休克通常与肾功能改变有关。这种急性肾损伤(AKI)与住院患者发病率和死亡率增加相关。流行病学:最近对败血症和AKI的标准化、单独的共识定义为这两个不同过程的流行病学提供了信息。虽然对于败血症相关AKI没有统一的定义,但一些研究利用这两种综合征的联合定义来确定那些不良结局风险最高的患者。挑战:预防败血症相关性AKI是困难的,部分原因是患者通常会在临床上已经出现败血症相关性AKI的情况下就诊。此外,对于那些在表现时没有AKI的患者,早期发现损伤的能力受到目前不完善的金标准生物标志物血清肌酐和尿量的限制。预防和治疗:尽管存在这些挑战,对AKI的新型生物标志物的研究已经增加。此外,对脓毒症、AKI以及脓毒症相关AKI患者的理想护理也进行了深入的研究。虽然除了抗生素之外,针对感染的特定治疗选择有限,但有几项研究调查了使用护理包治疗这些综合征的情况。虽然对新的治疗方法和透析和体外模式的使用进行了持续的研究,但这些试验未能彻底改变临床护理。本文综述了败血症相关AKI护理的现状,并讨论了改善护理的策略。
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引用次数: 4
Sickle Cell Disease and the Kidney: Pathophysiology and Novel Biomarkers. 镰状细胞病与肾脏:病理生理学和新的生物标志物。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517703
Romélia Pinheiro Gonçalves Lemes, Marilia Rocha Laurentino, Luan Rebouças Castelo, Geraldo Silva Junior

Clinical Background: Renal involvement in sickle cell disease (SCD), called sickle cell nephropathy (SCN), includes several renal manifestations, such as renal acidification defect, distal nephron dysfunction, renal papillary necrosis, and proteinuria related to glomerular injury, leading to end-stage renal disease. Epidemiology: Many patients with SCD have a defect in urinary concentration, a problem caused by the destruction of the renal medulla that initiates in childhood. The presence of proteinuria in SCD is age-related and starts as microalbuminuria in adolescence and progresses to macroalbuminuria. Proteinuria is responsible for the progression to chronic kidney disease in some patients with SCD with glomerular filtration rate (GFR) decreased due to interactions between various processes involving the vascular, glomerular, tubular, and interstitial compartments of the kidney. Challenges: Renal complications are hardly identifiable in the early stages, as serum creatinine increases only in the final stages of SCN. Subnormal GFR and elevated serum creatinine levels develop only when there is significant proteinuria. Prevention and Treatment: The identification of biomarkers of early, non-invasive kidney injury, and their inclusion in clinical practice will contribute to the identification of the mechanisms involved in the development of renal syndromes, facilitating the development of more effective strategies in the prevention and treatment of SCD.

临床背景:镰状细胞病(SCD)累及肾脏,称为镰状细胞肾病(SCN),包括几种肾脏表现,如肾酸化缺损、远端肾单位功能障碍、肾乳头状坏死和肾小球损伤相关的蛋白尿,导致终末期肾脏疾病。流行病学:许多SCD患者都有尿浓度缺陷,这是由儿童期开始的肾髓质破坏引起的问题。SCD中蛋白尿的存在与年龄有关,从青春期的微量白蛋白尿开始,发展为大量白蛋白尿。蛋白尿是一些SCD患者进展为慢性肾脏疾病的原因,肾小球滤过率(GFR)由于涉及肾脏血管、肾小球、小管和间质室的各种过程之间的相互作用而降低。挑战:肾脏并发症在早期很难识别,因为血清肌酐只有在SCN的最后阶段才会升高。GFR亚正常和血清肌酐水平升高仅在有显著蛋白尿时发生。预防和治疗:识别早期、非侵入性肾损伤的生物标志物,并将其纳入临床实践,将有助于确定肾脏综合征发生的机制,促进制定更有效的预防和治疗SCD的策略。
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引用次数: 2
Heart Disease and the Kidneys. 心脏病和肾脏。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-24 DOI: 10.1159/000517704
Ricardo Pereira Silva, Camilo Diógenes
Clinical Background: The heart can cause kidney disease, and the kidney can cause heart disease. As an example of the first situation, we can mention dilated cardiomyopathies, which can lead to renal failure of the pre-renal type due to the state of renal hypoflow. As an example of the second situation, we can remember that renal failure is a risk factor for cardiovascular diseases, such as coronary heart disease, due to the acceleration in the process of atherosclerosis that it promotes. Epidemiology: In this chapter, we will address what we consider to be the two main aspects of the interrelationships between heart and kidney disease that are "cardiorenal syndrome (CRS)" and "chronic kidney disease (CKD) and coronary heart disease (CHD)." Challenges: For CRS, we discuss its epidemiology, types, pathophysiological mechanisms common to CRS types 1, 2, 3 and 4 and pathogenesis of CSR type 5. Treatment: For "CKD and CHD" we discuss the association of CKD and CHD in community-based populations, traditional risk factor in CKD, non-traditional risk factor in CKD, reduced risk of CHD in patients with CKD, statin treatment, hypertension treatment, anti-platelet aggregation therapy, treatment of CHD in patients with CKD and prognosis of CHDF in CKD patients.
临床背景:心脏可引起肾脏疾病,肾脏可引起心脏疾病。作为第一种情况的一个例子,我们可以提到扩张型心肌病,由于肾低流量状态,可导致肾前型肾功能衰竭。作为第二种情况的一个例子,我们可以记住,肾功能衰竭是心血管疾病的一个危险因素,比如冠心病,因为它促进了动脉粥样硬化过程的加速。流行病学:在本章中,我们将讨论心脏和肾脏疾病之间相互关系的两个主要方面,即“心肾综合征(CRS)”和“慢性肾脏疾病(CKD)和冠心病(CHD)”。挑战:针对CRS,我们讨论了CRS 1、2、3、4型的流行病学、类型、常见的病理生理机制以及CRS 5型的发病机制。治疗:在“CKD和CHD”中,我们讨论了CKD和CHD在社区人群中的相关性,CKD的传统危险因素,CKD的非传统危险因素,CKD患者的冠心病风险降低,他汀类药物治疗,高血压治疗,抗血小板聚集治疗,CKD患者的冠心病治疗以及CKD患者的预后。
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引用次数: 0
The Future of Nephrology and Public Health. 肾脏病学和公共卫生的未来。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-03 DOI: 10.1159/000517714
Geraldo Silva Junior, Giovani Gadonski, Alejandro Ferreiro Fuentes, Masaomi Nangaku, Giuseppe Remuzzi, Claudio Ronco

The study of kidney diseases has been described since the Hippocratic era, but nephrology as a medical specialty dates from the mid-20th century. Despite all interesting aspects of nephrology, there is a lack of interest by young physicians for the specialty worldwide. Great discoveries have been made throughout the years, leading to great achievements in diagnosis, classification, and treatment of kidney diseases. There is a current interest in the search for novel biomarkers for early detection of kidney dysfunction, and, in the future, there will be novel diagnostic tests for kidney diseases. There have been significant improvements in dialysis and transplant techniques, and novel modalities are being studied, including new renal replacement therapy modalities, such as the wearable artificial kidney. Another trend in the contemporary world, and one that should increase in the future, is the increasing patient connectivity, using novel technologies that will allow access to healthcare and improve outcomes.

肾脏疾病的研究从希波克拉底时代就开始了,但肾脏学作为一门医学专业可以追溯到20世纪中期。尽管肾脏病学有很多有趣的方面,但全世界的年轻医生对这一专业缺乏兴趣。多年来取得了重大发现,在肾脏疾病的诊断、分类和治疗方面取得了巨大成就。目前人们对寻找新的生物标志物来早期检测肾功能障碍很感兴趣,在未来,将会有新的肾脏疾病诊断测试。透析和移植技术有了显著的进步,新的治疗模式正在研究中,包括新的肾脏替代治疗模式,如可穿戴人工肾脏。当今世界的另一个趋势,也是未来应该会增加的趋势,是越来越多的患者连接,使用新的技术,可以获得医疗保健并改善结果。
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引用次数: 0
Snakebite-Associated Kidney Injury. 蛇咬所致肾损伤。
4区 医学 Q3 Medicine Pub Date : 2021-01-01 Epub Date: 2021-08-04 DOI: 10.1159/000517725
Polianna Albuquerque, Sandra Mara Mota

Snakebite-related acute kidney injury (AKI) is mainly caused by bites from the Viperidae family which are common snakes worldwide. It is a frequent and potentially fatal clinical complication. Coagulation abnormalities are usually present and are most likely to contribute to AKI development. A better comprehension of AKI pathogenesis following the toxicsyndrome may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment. This chapter highlights the main studies about snakevenom-related AKI, the most common snakes around the world, and the respective mechanisms of AKI.

蛇咬伤相关急性肾损伤(AKI)主要是由世界范围内常见的蛇科毒蛇咬伤引起的。这是一种常见且可能致命的临床并发症。凝血异常通常存在,并且最有可能导致AKI的发展。更好地了解毒性综合征后AKI的发病机制可以改善初级卫生保健提供者对患者的管理,从而实现早期诊断和治疗。本章重点介绍了蛇科相关AKI的主要研究,以及世界上最常见的蛇类及其各自的AKI机制。
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引用次数: 1
期刊
Contributions to nephrology
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