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In the absence of cardiometabolic diseases, is age an independent factor in assessing renal health and filtration? A pilot study 在没有心脏代谢疾病的情况下,年龄是评估肾脏健康和滤过的独立因素吗?一项初步研究
Q4 Medicine Pub Date : 2021-07-14 DOI: 10.34172/jnp.2022.17224
Jeffrey S. Forsse, D. Buckley, Ahmed Ismaeel, Kathleen E. Adair, R.L.N Torres, Catherine Lowry, Anurag Dhillon, P. Koutakis
Introduction: Serum creatinine (sCr) is conventionally used to characterize the progressive decline in renal filtration (RF). Assessment of RF and renal health (RH) is traditionally believed to be agedependent. However, in the absence of cardiometabolic disease (CMD), this may not be the case. Objectives: The purpose of this study was to determine the magnitude of age as an influencing factor independent of CMD with novel markers of RH/RF in a single health assessment. Patients and Methods: Fifty-four participants (n = 27 men; n = 27 women; age 33.4 ± 12.5 years; BMI 26.5 ± 5.5; SBP 120 ± 10.4; DBP 77.7 ± 6.7; CHOL 174 ± 30) free of CMD were recruited to assess sCr, urine creatinine (uCr), cystatin C (CyC), and urine epidermal growth factor (uEGF) to calculate estimates of RH/F via uEGF/uCr ratio (uEGFR), eGFR - modification of diet in renal disease (MDRD), CKD-EPI, and sCr/CyC eGFR. Results: There were no significant differences between age groups (20s, 30s, 40s, 50s) in biomarkers and estimates of RH/RF, sCr (P=0.91), uEGF (P=0.46), CyC (P=0.13), CyC eGFR (P= 0.10), MDRD (P=0.12), CKD-EPI (P=0.80), and sCr/CyC eGFR (P=0.12). Post-hoc analysis revealed uEGFR was the only significantly different variable between 40s and 50s age groups (P= 0.02). Conclusion: Changes in RH/RF appear to be independent of age in the absence of CMD. Indicating RH/RF could potentially be maintained in adulthood and throughout the older adult years with the continued absence of CMD.
简介:血清肌酐(sCr)通常用于表征肾滤过(RF)的进行性下降。传统上认为RF和肾脏健康(RH)的评估与年龄有关。然而,在没有心脏代谢疾病(CMD)的情况下,情况可能并非如此。目的:本研究的目的是确定年龄作为独立于CMD的影响因素的大小,并在单一健康评估中使用新的RH/RF标记物。患者和方法:54名参与者(n = 27名男性;N = 27名女性;年龄33.4±12.5岁;Bmi 26.5±5.5;收缩压120±10.4;DBP 77.7±6.7;招募无CMD的CHOL 174±30),评估sCr、尿肌酐(uCr)、胱抑素C (CyC)和尿表皮生长因子(uEGF),通过uEGF/uCr比值(uEGFR)、eGFR -肾脏疾病饮食改变(MDRD)、CKD-EPI和sCr/CyC eGFR计算RH/F。结果:不同年龄组(20岁、30岁、40岁、50岁)在RH/RF、sCr (P=0.91)、uEGF (P=0.46)、CyC (P=0.13)、CyC eGFR (P= 0.10)、MDRD (P=0.12)、CKD-EPI (P=0.80)和sCr/CyC eGFR (P=0.12)的生物标志物和估计值方面无显著差异。事后分析显示,uEGFR是40岁和50岁年龄组之间唯一显著不同的变量(P= 0.02)。结论:在没有CMD的情况下,RH/RF的变化似乎与年龄无关。表明RH/RF可能在成年期和整个老年期保持,并持续没有CMD。
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引用次数: 1
Membranoproliferative glomerulonephritis in β-thalassemia intermedia; a case report β-地中海贫血中膜增生性肾小球肾炎;病例报告
Q4 Medicine Pub Date : 2021-07-02 DOI: 10.34172/jnp.2022.17186
M. Shafiee, Seyed Alireza Zomorodian, S. Owji, J. Roozbeh Shahroodi, M. Torabi Jahromi
Introduction: β-thalassemia intermedia reduces the body’s ability to produce adult hemoglobin and causes anemia. In contrast to β-thalassemia major, β-thalassemia intermedia patients do not require lifelong transfusion and are often independent of blood transfusion until young age. Moreover, chronic hypoxia and iron overload may cause tubular and glomerular dysfunction in patients with thalassemia. Case Presentation: We report a 21-year-old female with β-thalassemia intermedia (β-TI) presenting with generalized edema and proteinuria and showed membranoproliferative glomerulonephritis (MPGN) after renal biopsy. Conclusion: The possibility of occurrence of MPGN in patients with thalassemia should be considered. To our knowledge, it is the first case of thalassemia that was reported with MPGN and, more investigation is required to assess the association of thalassemia and MPGN.
导语:β-地中海贫血会降低机体产生成人血红蛋白的能力,导致贫血。与重度β-地中海贫血相比,中度β-地中海贫血患者不需要终身输血,通常直到年轻时才需要输血。此外,慢性缺氧和铁超载可能导致地中海贫血患者肾小管和肾小球功能障碍。病例介绍:我们报告了一位21岁的女性β-地中海贫血(β-TI),表现为全身性水肿和蛋白尿,并在肾活检后显示膜增生性肾小球肾炎(MPGN)。结论:应考虑地中海贫血患者发生MPGN的可能性。据我们所知,这是首例伴有MPGN的地中海贫血病例,需要更多的调查来评估地中海贫血与MPGN的关系。
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引用次数: 0
Intradialytic hypertension prevalence and predictive factors: A single centre study 透析中高血压患病率和预测因素:一项单中心研究
Q4 Medicine Pub Date : 2021-06-05 DOI: 10.34172/jnp.2022.17206
R. Prabhu, B. Naik, M. Bhojaraja, I. Rao, S. Shenoy, S. Nagaraju, D. Rangaswamy
Introduction: Intradialytic hypertension (IDH) is associated with significant vascular and cardiac adverse outcomes. Objectives: This study was performed to know the prevalence and factors predicting IDH. Patients and Methods: A single-center cross-sectional observational study at a tertiary care hospital. After ethics committee approval and informed consent, all patients over 18 years on twice weekly hemodialysis were included, those on peritoneal dialysis and acute kidney injury excluded. Primary outcome was prevalence of IDH based on three definitions and secondary outcome was predictive factors. IDH was defined as ≥10 mm Hg surge in systolic blood pressure (SBP) between pre-and postdialysis in 4 of 6 successive sessions or >15 mm Hg rise in mean arterial pressure (MAP) between start and end of dialysis or symptomatic rise in blood pressure requiring intervention. SBP and MAP were measured on standardized monitors before, hourly and 30 minutes post dialysis. Results: Of 136 patients, prevalence of intra-dialytic hypertension was 78/136 (57%), 33/136 (24%), 15/136 (11%) based on systolic rise, rise in MAP and symptomatic rise in BP respectively. Among those with systolic rise, diabetes mellitus (P= 0.03), undernourishment (P=0.03), inter-dialytic weight gain >3 kg (P< 0.001) and dialysis vintage > 3 years (P< 0.001) were significantly associated with IDH. Conclusion: IDH prevalence varied from 11 to 57% with different definitions. Diabetes mellitus, under nutrition, inter-dialytic weight gain >3 kg and dialysis vintage >3 years predicted IDH.
引言:透析内高血压(IDH)与显著的血管和心脏不良后果有关。目的:本研究旨在了解IDH的患病率和预测因素。患者和方法:一项在三级护理医院进行的单中心横断面观察性研究。在伦理委员会批准和知情同意后,所有18岁以上每周两次血液透析的患者都被纳入,腹膜透析和急性肾损伤的患者除外。根据三个定义,主要结果是IDH的患病率,次要结果是预测因素。IDH定义为连续6次透析中有4次透析前后收缩压(SBP)激增≥10毫米汞柱,或透析开始和结束之间平均动脉压(MAP)升高>15毫米汞柱或需要干预的症状性血压升高。SBP和MAP在透析前、透析后每小时和透析后30分钟在标准化监测仪上测量。结果:在136例患者中,根据收缩压升高、MAP升高和症状性血压升高,透析内高血压的患病率分别为78/136(57%)、33/136(24%)和15/136(11%)。在收缩压升高的患者中,糖尿病(P=0.03)、营养不良(P=0.03。结论:IDH的患病率在11%至57%之间,有不同的定义。糖尿病、营养不足、透析间体重增加>3kg和透析年限>3年可预测IDH。
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引用次数: 0
Everolimus induced pulmonary thromboembolism after kidney transplantation; a case report 依维莫司诱发肾移植术后肺血栓栓塞;病例报告
Q4 Medicine Pub Date : 2021-06-05 DOI: 10.34172/jnp.2022.11
F. Saddadi, Mohammad Hassan Fallahkohan
Choice of maintenance immunosuppressive therapy after renal transplantation is important for graft survival. However, complication may also occur. Venous thromboembolic event with the mTOR inhibitor (mTORi) everolimus is a rare but life-threatening complication. Here we describe a renal transplant recipient who developed pulmonary thromboembolism.
肾移植术后选择维持性免疫抑制治疗对移植物存活很重要。然而,并发症也可能发生。mTOR抑制剂依维莫司引起的静脉血栓栓塞事件是一种罕见但危及生命的并发症。在这里,我们描述了一名肾移植受者出现肺血栓栓塞。
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引用次数: 1
COVID-19 and renal involvement; evolving role of thromboinflammation, vascular and glomerular disease in the pathogenesis COVID-19与肾脏受累;血栓炎症、血管和肾小球疾病在发病机制中的演变作用
Q4 Medicine Pub Date : 2021-06-01 DOI: 10.34172/jnp.2021.23
Tella Sadighpour, M. Mubarak, Parastoo Sabaeifard, Sanam Saeifar, F. Kenari
Coronavirus disease 2019 (COVID-19), the currently prevailing pandemic that has besieged the whole world, is caused by a novel coronavirus, named as, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially, there was a focus on respiratory disease, which was and is the most predominant presentation. However, with increasing spread of the infection and consequent increasing knowledge and experience about the disease, it has become apparent that the virus has wide-ranging effects on other organs and systems, including heart, blood, kidney and gastrointestinal tract. A variety of mechanisms are involved in viral damage of these organs. Blood vessels, particularly the microvasculature, and blood clotting systems are also frequently targeted by the virus, especially in severe cases. This review narrates the available evidence on the mechanisms underlying hypercoagulability and thrombotic tendency in COVID-19 disease. © 2021 The Author(s);Published by Society of Diabetic Nephropathy Prevention.
目前席卷全球的新型冠状病毒病2019 (COVID-19)是由一种新型冠状病毒引起的,名为“严重急性呼吸综合征冠状病毒2型”(SARS-CoV-2)。最初,重点是呼吸系统疾病,这是最主要的表现。然而,随着感染的日益蔓延以及随之而来的对该疾病的知识和经验的增加,该病毒显然对其他器官和系统产生广泛影响,包括心脏、血液、肾脏和胃肠道。病毒对这些器官的损害涉及多种机制。血管,特别是微血管和血液凝固系统也经常是病毒的目标,特别是在严重的情况下。本文综述了COVID-19疾病中高凝性和血栓倾向的现有证据。©2021作者;由糖尿病肾病预防学会出版。
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引用次数: 2
Coronavirus disease 2019 (COVID-19) in a kidney transplant recipient; case report 肾移植受者的冠状病毒病2019 (COVID-19)病例报告
Q4 Medicine Pub Date : 2021-05-29 DOI: 10.34172/jnp.2022.09
M. T. Kurian, S. Rabbani, A. C. Thomas, N. Javed
Patients with kidney transplants are at greater risk of contracting COVID-19 because of long-term immunosuppression and may end up with severe disease with adverse outcome. The experiences of COVID-19 management in kidney transplant recipients are limited. This is a case of COVID-19 in a 45-year-old patient with a second renal transplant on triple immunosuppressive therapy who was successfully treated for COVID-19, septic shock, acute kidney injury and was discharged with a stable graft function. The patient presented with mild COVID-19 symptoms but later went into septic shock followed by acute kidney injury due to a secondary bacterial infection. The patient was successfully managed using antivirals, corticosteroids, reducing the dose of immunosuppressants initially, then discontinuing all the immunosuppressants in view of septic shock and finally reinstating the immunosuppression gradually on clinical improvement. This case report may serve as a reference for treating immunocompromised kidney transplant recipients having COVID-19. However, more data and experiences are needed for optimization of treatment of kidney transplant recipients with COVID-19.
肾移植患者因长期免疫抑制而感染新冠肺炎的风险更大,并可能最终患上严重疾病并产生不良后果。肾移植受者新冠肺炎管理经验有限。这是一例新冠肺炎病例,患者为45岁,接受三重免疫抑制治疗的第二次肾移植患者,成功治疗了新冠肺炎、感染性休克、急性肾损伤,出院后移植功能稳定。该患者表现出轻微的新冠肺炎症状,但后来因继发性细菌感染而感染性休克,随后急性肾损伤。该患者使用抗病毒药物、皮质类固醇进行了成功治疗,最初减少了免疫抑制剂的剂量,然后在感染性休克的情况下停止使用所有免疫抑制剂,最终在临床好转后逐渐恢复免疫抑制剂。本病例报告可作为治疗新冠肺炎免疫功能低下肾移植受者的参考。然而,需要更多的数据和经验来优化新冠肺炎肾移植受者的治疗。
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引用次数: 1
Prevalence and clinical presentation of COVID-19 infection in hemodialysis patients 血液透析患者COVID-19感染的流行及临床表现
Q4 Medicine Pub Date : 2021-05-18 DOI: 10.34172/jnp.2022.07
A. Kenarkoohi, M. Maleki, B. Ghiasi, Elham Bastani, I. Pakzad, M. Bonyadi, A. Abdoli, S. Falahi
Introduction: Hemodialysis (HD) patients are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objectives: The aim of this study was to evaluate the prevalence and clinical symptoms of SARS-CoV-2 infection in HD patients. Patients and Methods: This is a single-center study conducted at HD center, in Ilam, Iran. The study was included 87 HD patients to be tested. SARS-CoV-2 infection was diagnosed with confirmed test by rRT-PCR (real-time reverse transcription polymerase chain reaction) assay. Results: Around 35.63% of HD patients were diagnosed as COVID-19 infection; most of them were male (74.4%). Dyspnea (58.1%) and cough (45.2%) were the most common symptoms among HD cases with SARS-CoV-2 infection. Diabetes (16.1%) and hypertension (19.4%) were the most coexisting medical illnesses. About 12.9% of patients needed ICU care. Additionally, 16.1% of our patients died, which all of them were male. Conclusion: This study showed a high prevalence of COVID-19 among our HD group, accompanied by mild symptoms. The HD population is probably among the most sensitive and high-risk groups for COVID-19 because of advanced age, comorbidities disease, low-immune function and frequent required visits, and patient overload in HD centers. Preventive measures should be taken in order to minimize the virus transmission in dialysis centers.
血液透析(HD)患者感染严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)的风险增加。目的:本研究的目的是评估HD患者SARS-CoV-2感染的患病率和临床症状。患者和方法:这是一项在伊朗Ilam HD中心进行的单中心研究。这项研究包括87名HD患者进行测试。采用实时逆转录聚合酶链反应(rRT-PCR)法确诊SARS-CoV-2感染。结果:约35.63%的HD患者被诊断为COVID-19感染;以男性居多(74.4%)。呼吸困难(58.1%)和咳嗽(45.2%)是HD合并SARS-CoV-2感染患者最常见的症状。糖尿病(16.1%)和高血压(19.4%)是最常共存的内科疾病。约12.9%的患者需要ICU护理。此外,16.1%的患者死亡,全部为男性。结论:本研究显示我们的HD组中COVID-19患病率高,伴有轻度症状。HD患者可能是对COVID-19最敏感和高风险的人群之一,因为他们年龄大、合并症、免疫功能低下、需要频繁就诊,以及HD中心的患者负担过重。应采取预防措施,尽量减少病毒在透析中心的传播。
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引用次数: 5
The effect of proton-pump inhibitor and ranitidine on the reduction of serum magnesium level and blood pressure in chronic hemodialysis patients with hypotension; a doubleblind clinical trial 质子泵抑制剂和雷尼替丁对慢性血液透析低血压患者血清镁水平和血压的影响;双盲临床试验
Q4 Medicine Pub Date : 2021-05-18 DOI: 10.34172/jnp.2022.17212
S. Mohammadi Kebar, S. Hoseininia, F. Pourfarzi, Elham Saeedi, S. Matin
Introduction: Hypomagnesaemia secondary to the use of proton-pump inhibitor (PPI) is associated with the reduction of blood pressure. Objectives: To determine the effect of PPI and ranitidine on the reduction of serum magnesium level and blood pressure in chronic hemodialysis patients with hypotension. Patients and Methods: In this double-blind randomized clinical trial, 44 hemodialysis patients who met the requirements entered the study. First, blood sample was taken from each of the patients and their serum magnesium level as well as their blood pressure was checked and recorded. Then, the patients in the intervention group received daily doses of ranitidine placebo (150 mg) and pantoprazole (40 mg) and those in the control group received daily doses of pantoprazole placebo (40 mg) and ranitidine (150 mg) for three months. After the intervention, blood samples were taken again in order to assess the patients’ serum magnesium level. The obtained data were fed into SPSS Software and analyzed. Results: The mean age of the patients was 60.14±12.98 years. Moreover, 63.6% of the total patients were female. In the group of patients who had received pantoprazole, diastolic pressure reduced significantly at the end of the study as compared to the beginning of the study. Moreover, in the patients receiving pantoprazole indicated a significant reduction of magnesium at the end of the study as compared to the beginning of the study. Conclusion: In this study, a significant relationship was also observed between the use of PPI and hypomagnesemia in hemodialysis patients. Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20150808023559N19; https://en.irct.ir/trial/42478, ethical code# IR.ARUMS. REC.1398.295).
引言:使用质子泵抑制剂(PPI)继发的低镁血症与血压降低有关。目的:观察PPI和雷尼替丁对慢性血液透析低血压患者血清镁水平和血压的降低作用。患者和方法:在这项双盲随机临床试验中,44名符合要求的血液透析患者进入研究。首先,从每位患者身上采集血样,检查并记录他们的血清镁水平和血压。然后,干预组患者接受每日剂量的雷尼替丁安慰剂(150 mg)和泮托拉唑(40 mg),对照组患者接受为期三个月的每日剂量的泮托拉唑安慰剂(40 mg。干预后,再次采集血样,以评估患者的血清镁水平。将获得的数据输入SPSS软件中进行分析。结果:患者平均年龄为60.14±12.98岁。此外,63.6%的患者为女性。在接受泮托拉唑治疗的患者组中,与研究开始时相比,研究结束时的舒张压显著降低。此外,在接受泮托拉唑治疗的患者中,与研究开始时相比,研究结束时镁含量显著降低。结论:在本研究中,PPI的使用与血液透析患者的低镁血症之间也存在显著关系。试验注册:试验方案在伊朗临床试验注册中心获得批准(标识符:IRCT20150808023559N19;https://en.irct.ir/trial/42478,道德规范#IR.ARUMS.REC.1398.295)。
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引用次数: 0
A survey on lymphocyte T CD3, CD4 and CD8 in peripheral blood of kidney transplant recipients using mycophenolic acid 应用霉酚酸对肾移植受者外周血淋巴细胞T CD3、CD4和CD8的影响
Q4 Medicine Pub Date : 2021-04-10 DOI: 10.34172/JNP.2021.41
Thi Mai Dung Do, Phan Hai An Ha, Van Dong Le, Quang Thuan Huynh
Introduction: Immunological monitoring could indirectly measure the suppressive effects of the drugs and provide early guidance on necessary preventive interventions in transplant recipients. Objectives: Our goal was to determine whether mycophenolic acid (MPA) modulates peripheral blood lymphocyte T in kidney transplant recipients. Patients and Methods: We assessed T lymphocytes CD3, CD4 and CD8 in peripheral blood in 30 donors and 35 recipients one day before and 10 days after transplantation using Becton Dickinson’s direct immune fluorescent light. Results: Comparisons showed that the number of T lymphocytes CD3+, CD4+, CD8+ in peripheral blood of transplant recipients were lower than donors (TCD3 was 1690.31±503.45 versus 2280.73± 522.48; TCD4 was 549.51 ±211.72 cell/µL versus 766.37± 341.72 cell/µL and CD8 was 1134.37 ±431.07 cell/µL versus 1523.4± 349.23 cell/µL with P<0.001; P=0.001 and P= 0.0002 respectively). Additionally, post-transplantation lymphocytes TCD4 decreased in 10/35 of recipients and increased in 22/35 of recipients (P=0.036). Conclusion: The T lymphocytes CD3, CD4 and CD8 in peripheral blood should be monitored at multiple post-transplant times to make early predictions of transplant rejection during follow-up treatment.
免疫监测可以间接测量药物的抑制作用,为移植受者必要的预防干预提供早期指导。目的:我们的目的是确定霉酚酸(MPA)是否调节肾移植受者外周血淋巴细胞T。患者和方法:应用Becton Dickinson直接免疫荧光灯检测30例供体和35例受者移植前1天和移植后10天外周血T淋巴细胞CD3、CD4和CD8。结果:移植受者外周血T淋巴细胞CD3+、CD4+、CD8+数量低于供者(TCD3分别为1690.31±503.45和2280.73±522.48;TCD4分别为549.51±211.72 cell/µL和766.37±341.72 cell/µL, CD8分别为1134.37±431.07 cell/µL和1523.4±349.23 cell/µL, P<0.001;P=0.001和P= 0.0002)。移植后淋巴细胞TCD4在10/35的受者中降低,22/35的受者中升高(P=0.036)。结论:应在移植后多次监测外周血T淋巴细胞CD3、CD4和CD8,以便在后续治疗中早期预测移植排斥反应。
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引用次数: 0
The resolution of immunofluorescent pathological images affects diagnosis for not only artificial intelligence but also human 免疫荧光病理图像的分辨率不仅影响人工智能的诊断,也影响人类的诊断
Q4 Medicine Pub Date : 2021-04-02 DOI: 10.34172/JNP.2021.26
Kensaku Takahashi, S. Kitamura, Kazuhiko Fukushima, Yizhen Sang, Kenji Tsuji, J. Wada
Implication for health policy/practice/research/medical education: We examined how the image resolution affects the diagnosis not only artificial intelligence but also nephrologists in this study. The differences between human and artificial intelligence is specificity on diiferent resolution image diagnosis. The resolution of images might be important for not artificial intelligence but human on the point of specificity. Please cite this paper as: Takahashi K, Kitamura S, Fukushima K, Sang Y, Tsuji K, Wada J. The resolution of immunofluorescent pathological images affects diagnosis for not only artificial intelligence but also human. J Nephropathol. 2021;10(3):e26. DOI: 10.34172/jnp.2021.26. ARTICLE INFO
对卫生政策/实践/研究/医学教育的启示:在这项研究中,我们不仅研究了图像分辨率对人工智能的影响,还研究了肾脏病学家的影响。人类和人工智能的区别在于不同分辨率图像诊断的特异性。在特异性方面,图像的分辨率可能对人类而不是人工智能很重要。请引用本文:Takahashi K,Kitamura S,Fukushima K,Sang Y,Tsuji K,Wada J.免疫荧光病理图像的分辨率不仅影响人工智能的诊断,也影响人类的诊断。肾脏病理学杂志。2021年;10(3):e26。DOI:10.34172/jnp.2021.26。文章信息
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引用次数: 2
期刊
Journal of Nephropathology
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