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Mohamed ON, Ibrahim SA, Saleh RK, Issa AS, Setouhi A, Rabou AAA, Mohamed MR, Kamel SF. Clinicopathological characteristics and predictors of outcome of rapidly progressive glomerulonephritis: a retrospective study. BMC Nephrol 2024; 25:103. [PMID: 38500101 PMCID: PMC10949592 DOI: 10.1186/s12882-024-03532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Globally, there are regional and time-based variations in the prevalence, etiology, and prognosis of rapidly progressive glomerulonephritis (RPGN). Prognosis of RPGN is poor, with a higher risk of death and end stage renal disease (ESRD) even with immunosuppressive medications. In the Middle East and North Africa, the studies on this disease are very limited. Therefore, we determined the predictors of outcome of RPGN. METHODS We retrospectively assessed 101 adult patients over age of 18, diagnosed with RPGN based on renal biopsy illustrating crescents in ≥ 50% of the glomeruli. Patients who had crescents in their renal biopsies that were < 50% and those who refused to consent to a renal biopsy were excluded. We categorized the patients into 3 groups based on immunohistochemistry; type I, type II and type III. Then, depending on renal loss, we divided them into ESRD and non-ESRD groups. The clinical history and physical examination were retrieved. Additionally, 24-hour urine protein, urine analysis, renal function tests, serum albumin, complete blood count, antinuclear antibodies, anti-double stranded DNA antibodies, ANCA antibodies and serum complement levels were checked. Each patient underwent a kidney biopsy for immunohistochemistry and light microscopy. The percentage of crescentic glomeruli, number of sclerosed glomeruli, tertiary lymphoid organ (TLO), neutrophil infiltration, endocapillary or mesangial hypercellularity, interstitial fibrosis with tubular atrophy (IFTA) were analyzed. Primary outcomes (remission, ESRD and mortality) and secondary outcomes were assessed. RESULTS Type II was the most frequent cause of RPGN (47.5%), followed by type III (32.7%) and type I (19.8%). 32 patients (31.7%) died during follow up, whereas 60 patients (59.4%) developed ESRD. In 41 patients (40.6%), remission occurred. Oliguria, serum creatinine, and need for HD at presentation were significantly increased in ESRD group compared to non-ESRD group (P < 0.001 for each). Mesangial proliferation, IFTA, TLO formation, sclerotic glomeruli and fibrous crescents were also significantly increased in ESRD group in comparison to non-ESRD group (P < 0.001 for each). Glomerulosclerosis (P = 0.036), and IFTA (P = 0.008) were predictors of ESRD. Infections (P = 0.02), respiratory failure (P < 0.001), and heart failure (P = 0.004) were mortality risk factors. CONCLUSION Type II RPGN was the most common. Infection was the most frequent secondary outcome. Oliguria, glomerulosclerosis, the requirement for hemodialysis at presentation, IFTA and TLO formation were predictors of ESRD. Respiratory failure, heart failure and infections were significant predictors of mortality.
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Affiliation(s)
- Osama Nady Mohamed
- Department of Internal Medicine, Faculty of medicine, Minia University, Minia, Egypt.
| | | | - Rabeh Khairy Saleh
- Department of Pathology, Faculty of medicine, Minia University, Minia, Egypt
| | - Ahmed S Issa
- Department of Radiology, Faculty of medicine, Minia University, Minia, Egypt
| | - Amr Setouhi
- Department of Cardiology, Faculty of medicine, Minia University, Minia, Egypt
| | - Ayman Ahmed Abd Rabou
- Department of Clinical Pathology, Faculty of medicine, Minia University, Minia, Egypt
| | - Mahmoud Ragab Mohamed
- Department of Internal Medicine, Faculty of medicine, Minia University, Minia, Egypt
| | - Shaimaa F Kamel
- Department of Internal Medicine, Faculty of medicine, Minia University, Minia, Egypt
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Zhang P, Yang X, Gao CL, Wu W, Xia ZK. Crescentic glomerulonephritis in children: short-term follow-up predicts long-term outcome. Front Pediatr 2023; 11:1206168. [PMID: 37691769 PMCID: PMC10485554 DOI: 10.3389/fped.2023.1206168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023] Open
Abstract
Background Crescentic glomerulonephritis (CrGN) is a relatively rare but severe condition in childhood with the clinical feature of rapidly progressive glomerulonephritis (RPGN). The aim of this study is to investigate the clinicopathological features and prognosis of CrGN in children. Methods We retrospectively analyzed the clinical and laboratory data, renal pathological results, treatment, and outcome of 147 CrGN in two Chinese pediatric nephrology centers. Results Among the 147 children, there were 22 cases of type I (15.0%), 69 cases of type II (46.9%), and 56 cases of type III (38.1%). The mean percentages of crescents in CrGN I, II, and III were 85.3%, 68.7%, and 73.6%, respectively. The children with type I CrGN presented with more severe clinical manifestations and pathological lesions. The 3-month cumulative renal survival rates of types I, II, and III CrGN were 66.3%, 93.6%, and 75.6%, respectively. The 1-year cumulative renal survival rates of types I, II, and III CrGN were 56.9%, 85.3%, and 73.1%, respectively, and the 5-year cumulative renal survival rates of types I, II, and III CrGN were 33.8%, 73.5%, and 47.1%, respectively. The Kappa Consistency Test between the 3-month and 1-year total renal survival (82.1% vs. 74.7%) of the children was 0.683 (P < 0.001), and between the 1-year and 5-year total renal-free survival (78.3% vs. 69.1%) of the children was 0.476 (P < 0.001). The Bowman's Capsule Rupture (BCR), crescent, interstitial inflammation, and interstitial fibrosis/tubular atrophy (IF/TA) score were predictors of end-stage kidney disease (ESKD) risk but BCR showed better predictive value for ESKD than interstitial inflammation score (P = 0.027) and IF/TA score (P = 0.047). Conclusion Patients with type I tended to have the worst renal survival rates. The three-month renal prognosis could partially reflect the 1-year renal prognosis, and the 1-year mortality rate could partially reflect the 5-year mortality rate of children with CrGN.
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Affiliation(s)
- Pei Zhang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiao Yang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chun-lin Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wei Wu
- Department of Pediatrics, Longgang District Center Hospital of Shenzhen, Shenzhen, China
| | - Zheng-kun Xia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Alsuheili AZ, Alhozali H, Bukhari AA, Khan MA, Alzahrani AS, Abualnaja SK, Al Zahrani RA. Clinico-Pathological Outcomes of Patients With Crescentic Glomerulonephritis: A Single-Center Study. Cureus 2023; 15:e38777. [PMID: 37303404 PMCID: PMC10249912 DOI: 10.7759/cureus.38777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Background Crescentic glomerulonephritis (CrGN) is a pathological description of rapidly progressive glomerulonephritis (RPGN). It is characterized by renal failure and is associated with a grave prognosis. This study aimed to investigate the clinical outcomes of patients diagnosed with crescentic glomerulonephritis at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Method This retrospective study included patients with CrGN who underwent treatment at the nephrology department at KAUH from June 2021 to August 2022. We collected and analyzed data from 56 patients diagnosed with CrGN on the basis of renal biopsies between 2002 and 2015. Result The study included 17 cases of CrGN. The mean age of patients at the time of diagnosis was 18.06 ± 13.49 years. The distribution of histological findings showed that cellular crescents (94.1%) and interstitial fibrosis and tubular atrophy (IFTA) (76.5%) were the most commonly observed histological findings. The most common underlying etiology was lupus nephritis (41.2%). Regarding the lab results, the mean serum creatinine level at admission was 378.88 ± 273.27 μmol/L, proteinuria was 1.53 ± 1.23 and glomerular filtration rate (GFR) level was 36.94 ± 45.08 mL/min. The factors associated with poor renal outcome were IFTA (P=0.01), phosphate level before discharge, serum creatinine level before and after discharge (P=0.032), and GFR level after discharge (P=0.001). Conclusion Crescentic glomerulonephritis is an important cause of acute kidney injury due to its potential to result in severe glomerular injury. In our study, 12 out of 17 patients experienced poor renal outcomes, which were associated with a high risk of morbidity and mortality. Therefore, early detection and treatment of CrGN is crucial in order to manage the disease.
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Affiliation(s)
| | - Hanadi Alhozali
- Faculty of Medicine, Department of Medicine, Nephrology Unit, King Abdulaziz University Hospital, Jeddah, SAU
| | - Ayar A Bukhari
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mohammad A Khan
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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Su X, Song R, Li S, Guo W, Guo X, Qiao X, Wang L. Outcomes and risk factors in patients with crescentic glomerulonephritis: a multicenter cohort study. J Nephrol 2023; 36:1027-1035. [PMID: 36786975 DOI: 10.1007/s40620-022-01550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/03/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patients with crescentic glomerulonephritis have a poor prognosis despite immunosuppressive therapy. This study investigated the clinicopathologic features, outcomes, and risk factors in Chinese patients with crescentic glomerulonephritis. METHODS The multicenter cohort study included consecutive individuals with crescentic glomerulonephritis and a minimum follow-up of 1 year after biopsy, observed from January 2013 to December 2020. Primary outcome was the occurrence of death or end stage kidney disease (ESKD) for surviving patients. Multivariable adjusted Cox proportional hazards model was applied. RESULTS Of 109 patients enrolled, 73 (67%) suffered primary outcomes, including 39 deaths, and 34 ESKDs among the 70 surviving patients, with a mean follow-up of 26 months. All 26 patients with over 90% glomeruli with crescents reached a primary outcome. Patients with type III crescentic glomerulonephritis had the worst prognosis for primary outcomes (HR, 95% CI for type I vs. type III: 0.29, 0.14-0.58; type II vs. type III: 0.44, 0.22-0.91) and a significantly faster rate of eGFR decline after adjusting for baseline variables. In patients with 75%-100% glomeruli with crescents, the risk of a primary outcome increased nearly fourfold (HR 3.96; 95% CI 2.17-7.23) compared with patients with 50-75% glomeruli with crescents after adjusting for baseline variables. Type of crescentic glomerulonephritis and percentage of cellular and total glomeruli with crescents were independent risk factors for early primary outcomes (within 6 months). CONCLUSIONS This study provides new insights into crescentic glomerulonephritis, including a description of the worst outcomes occurring in patients with type III crescentic glomerulonephritis, and suggests that the quantification of the percentage of crescents may be of use for guiding therapeutic decisions, due to their role in identifying the risk of primary outcomes.
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Affiliation(s)
- Xiaole Su
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Runxia Song
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Sijia Li
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Wenjuan Guo
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Xiaojiao Guo
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Xi Qiao
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Lihua Wang
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No. 382, Wuyi Road, Xinghualing Distirct, Taiyuan, China.
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Histopathological prognostic factors in ANCA-associated glomerulonephritis. Autoimmun Rev 2022; 21:103139. [PMID: 35835443 DOI: 10.1016/j.autrev.2022.103139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are a group of multisystemic autoimmune diseases characterized by necrotizing inflammation of small vessels. Kidney involvement is frequent in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), and accounts for a significant proportion of the morbidity and mortality related to these diseases. Despite improvement in therapeutic management of ANCA-glomerulonephritis (ANCA-GN), end-stage kidney disease (ESKD) still occurs in up to 30% of affected patients within 5 years following diagnosis. Thus, identifying patients for whom aggressive immunosuppressive therapy will be more beneficial than deleterious is of great importance. Several clinical, biological and histological factors have been proposed as predictors of ESKD. The kidney biopsy is essential not only for the diagnosis, but also for evaluating renal prognosis. In this review, we discuss the prognostic value of renal lesions at the diagnosis of ANCA-GN by analyzing each compartment of the nephron. We also review existing ESKD risk classification in ANCA-GN and finally propose an example of a standardized pathology report that could be used in routine practice.
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Chen Z, Xu J, Wu J, Xue C, Ruan M, Mei C, Mao Z. Prognostic analysis of crescentic glomerulonephritis with acute kidney injury: a single-center cohort with 5-year follow-up. Int Urol Nephrol 2022; 54:2375-2383. [PMID: 35157218 DOI: 10.1007/s11255-022-03111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Crescentic glomerulonephritis (CrGN) represents a severe form of glomerular injury that results in high rates of renal failure. This study aimed to investigate the influence of potential clinical and pathological factors on renal outcomes of CrGN; and the relationship between 3-month and 5-year follow-up as well. METHODS The cohort enrolled patients diagnosed of biopsy proven CrGN with acute kidney injury(AKI) from January 1, 2010, to January 1, 2018 in Shanghai Changzheng Hospital and followed up for 5 years. RESULTS A total of 56 patients were included, among whom 11 patients (19.6%) had type I, 12 (21.4%) had type II, and 33 (58.9%) had type III CrGN. Patients with type II CrGN tended to have a lower crescent score, less renal tubular damage, and lower serum creatinine than the other two types. Three-month cumulative renal survival rates of types I, II, and III CrGN were 45.5%, 66.7%, and 48.5%, respectively. Five-year cumulative renal survival rates of types I, II, and III CrGN were 27.2%, 83.3%, and 36.4%, respectively. The Kappa Consistency Test between 3-month and 5-year outcomes was 0.573(P < 0.001). Cox regression model showed that in-hospital dialysis was an indicative renal survival factor in 3 months (HR 15.670, 95% CI 2.987-82.210, P = 0.001). It also showed that the crescent score had an unfavorable effect for renal survival in 5 years (HR 1.750 95% CI 1.018-3.009, P = 0.043). CONCLUSIONS Clinical manifestations and outcomes varied by different CrGN types. Three-month outcomes could partially reflect the 5-year outcomes. Severity of crescents was an independent risk factor for renal survival in CrGN.
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Affiliation(s)
- Zewei Chen
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jing Xu
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jun Wu
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Cheng Xue
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Mengna Ruan
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Lim JH, Han MH, Kim YJ, Jeon Y, Jung HY, Choi JY, Cho JH, Kim CD, Kim YL, Lee H, Kim DK, Moon KC, Park SH. Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort. Kidney Res Clin Pract 2021; 40:77-88. [PMID: 33789384 PMCID: PMC8041633 DOI: 10.23876/j.krcp.20.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) is a common cause of rapidly progressive glomerulonephritis and requires prompt and proper immunosuppressive therapy to improve renal prognosis. This study aimed to evaluate the predictive value of two different classifications for renal outcomes in Korean AAGN patients. Methods Ninety-two patients who were diagnosed with AAGN at two tertiary hospitals between 2004 and 2018 were retrospectively analyzed retrospectively. The histopathologic classification according to glomerular pathology and the clinicopathologic classification according to normal glomeruli ratio, degree of interstitial fibrosis/tubular atrophy, and baseline renal function were evaluated using the Cox proportional hazards model. Results Forty-five patients (48.9%) progressed to end-stage kidney disease (ESKD) during the observation period. The mean age was 61.0 ± 15.3 years, and most patients had myeloperoxidase-ANCA (93.5%). In the histopathologic classification, the best renal survival occurred in the focal class, whereas the sclerotic class had the worst renal survival (sclerotic class vs. focal class; adjusted hazard ratio [aHR], 5.05; 95% confidence interval [CI], 1.32–19.31; p = 0.018). The mixed class had intermediate renal outcomes (mixed class vs. focal class; aHR, 4.23; 95% CI, 1.23–14.58; p = 0.022). In the clinicopathologic classification, the high-risk group had poor renal outcomes compared with the low-risk group (aHR, 6.56; 95% CI, 1.25–34.26; p = 0.026), but renal outcomes did not differ between the low- and medium-risk groups. Conclusion In Korean AAGN patients, histopathologic and clinicopathologic classifications had predictive value for renal outcomes, especially in the sclerotic class or the high-risk group with higher risk of progression to ESKD despite treatment.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Jin Kim
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
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