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He X, Ren F, Wang Y, Zhang Z, Zhou J, Huang J, Cao S, Dong J, Wang R, Wu M, Liu J. Acoustofluidic-based microscopic examination for automated and point-of-care urinalysis. LAB ON A CHIP 2024; 24:3679-3689. [PMID: 38904306 DOI: 10.1039/d4lc00408f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Urinalysis is a heavily used diagnostic test in clinical laboratories; however, it is chronically held back by urine sediment microscopic examination. Current instruments are bulky and expensive to be widely adopted, making microscopic examination a procedure that still relies on manual operations and requires large time and labor costs. To improve the efficacy and automation of urinalysis, this study develops an acoustofluidic-based microscopic examination system. The system utilizes the combination of acoustofluidic manipulation and a passive hydrodynamic mechanism, and thus achieves a high throughput (1000 μL min-1) and a high concentration factor (95.2 ± 2.1 fold) simultaneously, fulfilling the demands for urine examination. The concentrated urine sample is automatically dispensed into a hemocytometer chamber and the images are then analyzed using a machine learning algorithm. The whole process is completed within 3 minutes with detection accuracies of erythrocytes and leukocytes of 94.6 ± 3.5% and 95.1 ± 1.8%, respectively. The examination outcome of urine samples from 50 volunteers by this device shows a correlation coefficient of 0.96 compared to manual microscopic examination. Our system offers a promising tool for automated urine microscopic examination, thus it has potential to save a large amount of time and labor in clinical laboratories, as well as to promote point-of-care urine testing applications in and beyond hospitals.
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Affiliation(s)
- Xin He
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Feng Ren
- The Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Yangyang Wang
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Zhiyuan Zhang
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Jiming Zhou
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Jian Huang
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Shuye Cao
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Jinying Dong
- The Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Renxin Wang
- State Key Laboratory of Dynamic Testing Technology, North University of China, Taiyuan, Shanxi, 030051, China
| | - Mengxi Wu
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
| | - Junshan Liu
- State Key Laboratory of High-performance Precision Manufacturing, Dalian University of Technology, Dalian, 116024, China.
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian, Liaoning, 116024, China
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Li M, Chang D, Zhao Y, Wu L, Tan Y, Zhao M, Tang SCW, Chen M. Urinary renal tubular epithelial cells and casts as predictors of renal outcomes in patients with biopsy-proven diabetic nephropathy. J Nephrol 2024:10.1007/s40620-024-01995-8. [PMID: 39031241 DOI: 10.1007/s40620-024-01995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/20/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Urine sediment examination is a time-tested and non-invasive diagnostic tool. This study investigated the characteristics of urine sediment and its association with severity and renal outcomes in diabetic nephropathy (DN) patients. METHODS A total of 201 biopsy-proven diabetic nephropathy patients (according to the pathological classification of diabetic nephropathy proposed by the Renal Pathology Society in 2010) who underwent manual urine sediment microscopic examination were included. We compared the clinicopathological characteristics of diabetic nephropathy patients with and without urinary renal tubular epithelial cells (RTECs) or renal tubular epithelial cell casts. The predictive value of urinary renal tubular epithelial cells or renal tubular epithelial cell casts for renal outcomes in diabetic nephropathy was analyzed. RESULTS Fifty of 201 (24.9%) diabetic nephropathy patients had renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment. Diabetic nephropathy patients with renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment had a significantly higher level of proteinuria [6.0 (3.1, 9.7) vs. 3.6 (1.8, 6.8) g/24 h, p = 0.001], higher serum creatinine [227.9 (151.6, 338.1) vs. 177.0 (104.4, 288.4) μmol/L, p = 0.016] and lower estimated glomerular filtration rate (eGFR) [25.8 (15.8, 44.8) vs. 35.7 (19.9, 65.0) mL/min/1.73 m2, p = 0.025] than those without. Cox regression analysis demonstrated that the presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts was independently associated with the development of end-stage kidney disease (ESKD) in diabetic nephropathy patients [HR 1.670, 95% CI (1.042, 2.676), p = 0.033]. Adding the presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts to the predictive model could improve the effectiveness of the model for predicting the risk of ESKD within one year after renal biopsy. CONCLUSIONS The presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts was associated with more severe kidney injury and worse renal outcomes in patients with diabetic nephropathy, thus perhaps providing a noninvasive biomarker for predicting diabetic nephropathy.
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Affiliation(s)
- Mengrui Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Dongyuan Chang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
- Institute of Nephrology, Peking University, Beijing, China.
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China.
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.
| | - Yiyang Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Liang Wu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Ying Tan
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
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Yuan M, Liu XL, Tan Y, Yu F, Zhao MH. Urinary Modified C-Reactive Protein is Closely Associated with Tubulointerstitial Lesions in Lupus Nephritis. Mediators Inflamm 2023; 2023:6107911. [PMID: 37545739 PMCID: PMC10403327 DOI: 10.1155/2023/6107911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Modified C-reactive protein (mCRP) is known to be involved in the upregulation and amplification of the local inflammatory response. This study investigated the circulating and local levels of mCRP and their relevance to clinicopathological features in patients with lupus nephritis. Methods Ninety-five patients with renal biopsy-proven lupus nephritis and 30 normal controls were enrolled in this study. Plasma and urinary mCRP were screened by enzyme-linked immunosorbent assay (ELISA). The renal deposition of mCRP was detected by immunohistochemistry and immunofluorescence staining. A human proximal tubular epithelial cell line (HK2 cells) was incubated with purified IgG from lupus nephritis, and the production of CRP by HK2 cells was further evaluated. Results Plasma and urinary levels of mCRP increased significantly in patients with lupus nephritis compared with normal controls (P = 0.013, P < 0.001, respectively). The urinary mCRP levels were associated with interstitial inflammatory cell infiltration (r = 0.514, P < 0.001) and interstitial fibrosis (r = 0.270, P = 0.008). The ROC-AUC of the urinary mCRP levels for diagnosing tubulointerstitial lesions was 0.766. The urinary mCRP levels were closely associated with poor outcomes (HR: 1.204, 95% CI: 1.029-1.409, P = 0.020). However, no correlations were found of the plasma mCRP levels with clinicopathological data or the prognosis of lupus nephritis. CRP was mostly deposited in the renal tubules in patients with lupus nephritis, and the expression of CRP was significantly correlated with tubulointerstitial lesion indices. Immunofluorescence staining showed that mCRP could colocalize with IgG in tubules. Lupus nephritis-derived IgG could induce CRP production by HK2 cells. Conclusion Urinary mCRP levels were significantly increased, and urinary mCRP might be a biomarker for tubulointerstitial lesions in patients with lupus nephritis. Renal CRP could be produced by tubular epithelial cells after stimulation by lupus nephritis-derived IgG, and the local presence of mCRP might play a critical role in the development of tubulointerstitial lesions.
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Affiliation(s)
- Mo Yuan
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- School of Medicine, Yunnan University, Kunming, China
- Department of Pathology, Affiliated Hospital of Yunnan University, Second People's Hospital of Yunnan Province, Kunming, China
| | - Xiao-ling Liu
- MOE Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Ying Tan
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Yu
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Ming-hui Zhao
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Navarro D, Fonseca NM, Ferreira AC, Barata R, Góis M, Sousa H, Nolasco F. Urinary Sediment Microscopy and Correlations with Kidney Biopsy: Red Flags Not To Be Missed. KIDNEY360 2023; 4:32-40. [PMID: 36700902 PMCID: PMC10101572 DOI: 10.34067/kid.0003082022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Urinary sediment is a noninvasive laboratory test that can be performed by an automated analyzer or manually by trained personnel. Manual examination remains the diagnostic standard because it excels at differentiating isomorphic from dysmorphic red blood cells and identifying other urinary particles such as renal tubular epithelial cells (RTECs), lipids, crystals, and the composition of casts. This study aimed to investigate the prevalence of a complete profile of urinary sediment particles and its associations with histologic lesions on kidney biopsy, regardless of diagnosis. METHODS This was a single-center, observational retrospective study of 131 patients who had contemporary manual urinary sediment evaluation and kidney biopsy. A comprehensive set of urinary particles and histologic lesions were quantified, and their associations were analyzed. RESULTS In our samples, we found an elevated frequency of findings suggestive of proliferative kidney disease and a low frequency of particles evoking urologic damage. The association of histologic lesions and urinary particles was explored with a multivariate model. We identified urinary sediment characteristics that independently correlated with the presence of some histologic lesions: urinary lipids with mesangial expansion (OR=2.86; 95% confidence interval [95% CI], 1.3 to 6.3), mesangial hypercellularity (OR=2.44; 95% CI, 1.06 to 5.58), and wire loops and/or hyaline deposits (OR=2.89; 95% CI, 1.13 to 7.73); Urinary renal tubular epithelial cells with endocapillary hypercellularity (OR=3.17; 95% CI, 1.36 to 7.39), neutrophils and/or karyorrhexis (OR=4.51; 95% CI, 1.61 to 12.61), fibrinoid necrosis (OR=4.35; 95% CI, 1.48 to 12.74), cellular/fibrocellular crescents (OR=5.27; 95% CI, 1.95 to 14.26), and acute tubular necrosis (OR=2.31; 95% CI, 1.08 to 4.97). CONCLUSIONS In a population of patients submitted to kidney biopsy, we found that the presence of some urinary particles (renal tubular epithelial cells, lipids, and dysmorphic erythrocytes), which are seldom reported by automated analyzers, is associated with active proliferative histologic lesions. In this regard, manual urinary sediment evaluation may help to shape the indications for performing a kidney biopsy.
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Affiliation(s)
- David Navarro
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
| | - Nuno Moreira Fonseca
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ana Carina Ferreira
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Rui Barata
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
| | - Mário Góis
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Helena Sousa
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Fernando Nolasco
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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Han Q, Zhang Y, Jiao T, Li Q, Ding X, Zhang D, Cai G, Zhu H. Urinary sediment microRNAs can be used as potential noninvasive biomarkers for diagnosis, reflecting the severity and prognosis of diabetic nephropathy. Nutr Diabetes 2021; 11:24. [PMID: 34193814 PMCID: PMC8245546 DOI: 10.1038/s41387-021-00166-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with both diabetes mellitus (DM) and kidney disease could have diabetic nephropathy (DN) or non-diabetic renal disease (NDRD). IgA nephropathy (IgAN) and membranous nephropathy (MN) are the major types of NDRD. No ideal noninvasive diagnostic model exists for differentiating them. Our study sought to construct diagnostic models for these diseases and to identify noninvasive biomarkers that can reflect the severity and prognosis of DN. METHODS The diagnostic models were constructed using logistic regression analysis and were validated in an external cohort by receiver operating characteristic curve analysis method. The associations between these microRNAs and disease severity and prognosis were explored using Pearson correlation analysis, Cox regression, Kaplan-Meier survival curves, and log-rank tests. RESULTS Our diagnostic models showed that miR-95-3p, miR-185-5p, miR-1246, and miR-631 could serve as simple and noninvasive tools to distinguish patients with DM, DN, DM with IgAN, and DM with MN. The areas under the curve of the diagnostic models for the four diseases were 0.995, 0.863, 0.859, and 0.792, respectively. The miR-95-3p level was positively correlated with the estimated glomerular filtration rate (p < 0.001) but was negatively correlated with serum creatinine (p < 0.01), classes of glomerular lesions (p < 0.05), and scores of interstitial and vascular lesions (p < 0.05). However, the miR-631 level was positively correlated with proteinuria (p < 0.001). A low miR-95-3p level and a high miR-631 level increased the risk of progression to end-stage renal disease (p = 0.002, p = 0.011). CONCLUSIONS These four microRNAs could be noninvasive tools for distinguishing patients with DN and NDRD. The levels of miR-95-3p and miR-631 could reflect the severity and prognosis of DN.
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Affiliation(s)
- Qiuxia Han
- School of Medicine, Nankai University, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, First Medical Center of Chinese PLA General Hospital, Tianjin, China.,Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Youcai Zhang
- Department of Nephrology, Jiaozuo People's Hospital, Jiaozuo, China
| | - Tingting Jiao
- Department of Nephrology, Jiaozuo People's Hospital, Jiaozuo, China
| | - Qi Li
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiaonan Ding
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Dong Zhang
- School of Medicine, Nankai University, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, First Medical Center of Chinese PLA General Hospital, Tianjin, China. .,Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing Key Laboratory of Kidney Disease Research, Beijing, China.
| | - Guangyan Cai
- School of Medicine, Nankai University, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, First Medical Center of Chinese PLA General Hospital, Tianjin, China.,Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Hanyu Zhu
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing Key Laboratory of Kidney Disease Research, Beijing, China.
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