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Obi Y, Raimann JG, Kalantar-Zadeh K, Murea M. Residual Kidney Function in Hemodialysis: Its Importance and Contribution to Improved Patient Outcomes. Toxins (Basel) 2024; 16:298. [PMID: 39057938 PMCID: PMC11281084 DOI: 10.3390/toxins16070298] [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: 04/30/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 07/28/2024] Open
Abstract
Individuals afflicted with advanced kidney dysfunction who require dialysis for medical management exhibit different degrees of native kidney function, called residual kidney function (RKF), ranging from nil to appreciable levels. The primary focus of this manuscript is to delve into the concept of RKF, a pivotal yet under-represented topic in nephrology. To begin, we unpack the definition and intrinsic nature of RKF. We then juxtapose the efficiency of RKF against that of hemodialysis in preserving homeostatic equilibrium and facilitating physiological functions. Given the complex interplay of RKF and overall patient health, we shed light on the extent of its influence on patient outcomes, particularly in those living with advanced kidney dysfunction and on dialysis. This manuscript subsequently presents methodologies and measures to assess RKF, concluding with the potential benefits of targeted interventions aimed at preserving RKF.
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Affiliation(s)
- Yoshitsugu Obi
- Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jochen G. Raimann
- Renal Research Institute, New York, NY 10065, USA;
- Katz School of Science and Health, Yeshiva University, New York, NY 10033, USA
| | - Kamyar Kalantar-Zadeh
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA 90822, USA;
- The Lundquist Institute at Harbor, UCLA Medical Center, Torrance, CA 90502, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
| | - Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
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Screening Cases of Suspected Early Stage Chronic Kidney Disease from Clinical Laboratory Data: The Comparison between Urine Conductivity and Urine Protein. Biomedicines 2023; 11:biomedicines11020379. [PMID: 36830916 PMCID: PMC9953103 DOI: 10.3390/biomedicines11020379] [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] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: Chronic kidney disease (CKD) affects more than 800 million global population. Early detection followed by clinical management is among the best approaches for the affected individuals. However, a sensitive screening tool is not yet available. (2) Methods: We retrospectively reviewed 600 patients aged >20 years with a full range of estimated glomerular filtration rate (eGFR) for clinical assessment of kidney function between 1 January 2020, to 30 April 2021, at the Taichung Veterans General Hospital, Taichung, Taiwan. With stratified sampling based on the level of eGFR, participants were evenly grouped into training and validation sets for predictive modeling. Concurrent records of laboratory data from urine samples were used as inputs to the model. (3) Results: The predictive model proposed two formulae based on urine conductivity for detecting suspected early-stage CKD. One formula, P_male45, was for used male subjects aged ≥45 years, and it had a prediction accuracy of 76.3% and a sensitivity of 97.3%. The other formula, P_female55, was used for female subjects aged ≥55 years. It had a prediction accuracy of 81.9% and a sensitivity of 98.4%. Urine conductivity, however, had low associations with urine glucose and urine protein levels. (4) Conclusion: The two predictive models were low-cost and provided rapid detection. Compared to urine protein, these models had a better screening performance for suspected early-stage CKD. It may also be applied for monitoring CKD in patients with progressing diabetes mellitus.
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Kaka N, Sethi Y, Patel N, Kaiwan O, Al-Inaya Y, Manchanda K, Uniyal N. Endocrine manifestations of chronic kidney disease and their evolving management: A systematic review. Dis Mon 2022; 68:101466. [PMID: 35965104 DOI: 10.1016/j.disamonth.2022.101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) shows a wide range of renal abnormalities including the excretory, metabolic, endocrine, and homeostatic function of the kidney. The prognostic impact of the 'endocrine manifestations' which are often overlooked by clinicians cannot be overstated. METHODS AND OBJECTIVES A systematic review was attempted to provide a comprehensive overview of all endocrine abnormalities of CKD and their evolving principles of management, searching databases of PubMed, Embase, and Scopus and covering the literature between 2002 and 2022. RESULTS The endocrine derangements in CKD can be attributed to a myriad of pathologic processes, in particular decreased clearance, impaired endogenous hormone production, uremia-induced cellular dysfunction, and activation of systemic inflammatory pathways. The major disorders include anemia, hyperprolactinemia, insulin resistance, reproductive hormone deficiency, thyroid hormone deficiency, and serum FGF (Fibroblast Growth Factor) alteration. Long-term effects of CKD also include malnutrition and increased cardiovascular risk. The recent times have unveiled their detailed pathogenesis and have seen an evolution in the principles of management which necessitates a revision of current guidelines. CONCLUSION Increased advertence regarding the pathology, impact, and management of these endocrine derangements can help in reducing morbidity as well as mortality in the CKD patients by allowing prompt individualized treatment. Moreover, with timely and appropriate intervention, a long-term reduction in complications, as well as an enhanced quality of life, can be achieved in patients with CKD.
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Affiliation(s)
- Nirja Kaka
- GMERS Medical College, Himmatnagar, Gujarat 382007, India
| | - Yashendra Sethi
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neil Patel
- GMERS Medical College, Himmatnagar, Gujarat 382007, India.
| | | | | | | | - Nidhi Uniyal
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
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Elsherbiny NM, Said E. Editorial: Insights in renal endocrinology: 2021. Front Endocrinol (Lausanne) 2022; 13:1003683. [PMID: 36204106 PMCID: PMC9530823 DOI: 10.3389/fendo.2022.1003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nehal M. Elsherbiny
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
- *Correspondence: Nehal M. Elsherbiny,
| | - Eman Said
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
- Faculty of Pharmacy, New Mansoura University, New Mansoura, Egypt
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Sudharson S, Kokil P. An ensemble of deep neural networks for kidney ultrasound image classification. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105709. [PMID: 32889406 DOI: 10.1016/j.cmpb.2020.105709] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic kidney disease is a worldwide health issue which includes not only kidney failure but also complications of reduced kidney functionality. Cyst formation, nephrolithiasis or kidney stone, and renal cell carcinoma or kidney tumor are the common kidney disorders which affects the functionality of kidneys. These disorders are typically asymptomatic, therefore early and automatic diagnosis of kidney disorders are required to avoid serious complications. METHODS This paper proposes an automatic classification of B-mode kidney ultrasound images based on the ensemble of deep neural networks (DNNs) using transfer learning. The ultrasound images are usually affected by speckle noise and quality selection in the ultrasound image is based on perception-based image quality evaluator score. Three variant datasets are given to the pre-trained DNN models for feature extraction followed by support vector machine for classification. The ensembling of different pre-trained DNNs like ResNet-101, ShuffleNet, and MobileNet-v2 are combined and final predictions are done by using the majority voting technique. By combining the predictions from multiple DNNs the ensemble model shows better classification performance than the individual models. The presented method proved its superiority when compared to the conventional and DNN based classification methods. The developed ensemble model classifies the kidney ultrasound images into four classes, namely, normal, cyst, stone, and tumor. RESULTS To highlight effectiveness of the proposed approach, the ensemble based approach is compared with the existing state-of-the-art methods and tested in the variants of ultrasound images like in quality and noisy conditions. The presented method resulted in maximum classification accuracy of 96.54% in testing with quality images and 95.58% in testing with noisy images. The performance of the presented approach is evaluated based on accuracy, sensitivity, and selectivity. CONCLUSIONS From the experimental analysis, it is clear that the ensemble of DNNs classifies the majority of images correctly and results in maximum classification accuracy as compared to the existing methods. This automatic classification approach is a supporting tool for the radiologists and nephrologists for precise diagnosis of kidney diseases.
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Affiliation(s)
- S Sudharson
- Department of Electronics and Communication Engineering, Indian Institute of Information Technology, Design and Manufacturing, Kancheepuram, Chennai 600127, India
| | - Priyanka Kokil
- Department of Electronics and Communication Engineering, Indian Institute of Information Technology, Design and Manufacturing, Kancheepuram, Chennai 600127, India.
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Nasir N, Raji S, Mustafa F, Rizvi TA, Al Natour Z, Hilal-Alnaqbi A, Al Ahmad M. Electrical detection of blood cells in urine. Heliyon 2019; 6:e03102. [PMID: 31909269 PMCID: PMC6938827 DOI: 10.1016/j.heliyon.2019.e03102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
Available methods for detecting blood in the urine (hematuria) can be problematic since results can be influenced by many factors in patients and in the lab settings, resulting in false positive or false negative results. This necessitates the development of new, accurate and easy-access methods that save time and effort. This study demonstrates a label-free and accurate method for detecting the presence of red and white blood cells (RBCs and WBCs) in urine by measuring the changes in the dielectric properties of urine upon increasing concentrations of both cell types. The current method could detect changes in the electrical properties of fresh urine over a short time interval, making this method suitable for detecting changes that cannot be recognized by conventional methods. Correcting for these changes enabled the detection of a minimum cell concentration of 102 RBCs per ml which is not possible by conventional methods used in the labs except for the semi-quantitative method that can detect 50 RBCs per ml, but it is a lengthy and involved procedure, not suitable for high volume labs. This ability to detect very small amount of both types of cells makes the proposed technique an attractive tool for detecting hematuria, the presence of which is indicative of problems in the excretory system.
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Affiliation(s)
- Nida Nasir
- Department of Electrical Engineering, College of Engineering, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Shaima Raji
- Department of Electrical Engineering, College of Engineering, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Farah Mustafa
- Department of Biochemistry, College of Medicine & Health Sciences, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Tahir A Rizvi
- Department of Microbiology and Immunology, College of Medicine & Health Sciences, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Zeina Al Natour
- Department of Electrical Engineering, College of Engineering, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Ali Hilal-Alnaqbi
- Department of Mechanical Engineering, College of Engineering, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Abu Dhabi Polytechnic, Abu Dhabi, 1114999, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Mahmoud Al Ahmad
- Department of Electrical Engineering, College of Engineering, United Arab Emirates University (UAEU), Al Ain, 15551, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
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El-Gendy AA, Elsaed WM, Abdallah HI. Potential role of estradiol in ovariectomy-induced derangement of renal endocrine functions. Ren Fail 2019; 41:507-520. [PMID: 31216906 PMCID: PMC6586115 DOI: 10.1080/0886022x.2019.1625787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Menopause is an important physiological event associated with structural and functional changes in the kidneys. An animal model of bilateral ovariectomy was used to study the effects of estrogen depletion, replacement and antiestrogen on renal structure and endocrine function. Sixty female rats were divided into six groups; group I was the control group, the remaining five groups underwent ovariectomy: group II received no treatment. The other groups received estradiol in group III, tamoxifen in group IV, estradiol followed by tamoxifen in group V and tamoxifen followed by estradiol in group VI. Serum creatinine, blood urea nitrogen, and endocrine functions of kidney were measured. Tissue samples were examined both microscopically for beta estrogen receptors and ultrastructurally for cell changes. Groups II, IV & VI showed a significant increase in creatinine, blood urea nitrogen, renal malondialdehyde, renal erythropoietin, plasma renin and plasma prostaglandin E2 and a significant decrease in renal antioxidants and serum vitamin D3. Groups III &V had a significant decrease in creatinine, blood urea nitrogen, renal malondialdehyde and renal erythropoietin with an increase in renal antioxidants, plasma prostaglandin E2 and serum vitamin D3. Histopathological and ultrastructural examinations revealed atrophic tubular changes in group II. The changes were less marked in groups III &V and more extensive in groups IV & VI. Estrogen receptor beta staining showed progressively increased expression in the absence of estrogen. Structural and most endocrine functions of the kidney were significantly affected by estradiol deficiency. Estradiol replacement exhibited a protective effect on renal tissue and endocrine functions.
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Affiliation(s)
- Ahmed A El-Gendy
- a Department of Medical Physiology, Faculty of Medicine , Taibah University , Madinah , Saudi Arabia.,b Department of Medical Physiology, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Wael M Elsaed
- c Department of Anatomy & Embryology, Faculty of Medicine , Taibah University , Madinah , Saudi Arabia.,d Department of Anatomy & Embryology, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Hesham I Abdallah
- c Department of Anatomy & Embryology, Faculty of Medicine , Taibah University , Madinah , Saudi Arabia.,e Department of Anatomy & Embryology, Faculty of Medicine , Ain Shams University , Cairo , Egypt
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Abstract
The care of patients with acute kidney injury (AKI) has been limited due to the lack of effective therapeutics that can either prevent AKI during high-risk situations or treat AKI once established. A revolution in the scientific understanding of the pathogenesis of AKI has led to the identification of potential therapeutic targets. These targets include pathways involved in inflammation, cellular repair and fibrosis, cellular metabolism and mitochondrial function, oxidative stress, apoptosis, and hemodynamics and oxygen delivery. Many compounds are entering early-phase clinical trials. In addition, efforts to better describe sub-categories of AKI (through endo-phenotyping) hold promise to target therapies more effectively based upon pathways that are operative in the pathogenesis. These advances bring optimism that the care of patients with AKI will be transformed with the hope of better outcomes.
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Affiliation(s)
- Matthew Hulse
- Divison of Critical Care, Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Mitchell H Rosner
- Division of Nephrology, Department of Medicine, University of Virginia Health System, 135 Hospital Drive, Suite 1031, Charlottesville, VA, 22908, USA.
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Ghoshal A, Damani A, Salins N, Deodhar J, Muckaden MA. Economics of Palliative and End-of-Life Care in India: A Concept Paper. Indian J Palliat Care 2017; 23:456-461. [PMID: 29123355 PMCID: PMC5661351 DOI: 10.4103/ijpc.ijpc_51_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Only a few studies have assessed the economic outcomes of palliative care in India. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy compared to best supportive care. At present, there is no definite health-care system followed in India. Medical bankruptcy is common. In situations where patients bear most of the costs, medical decision-making might have significant implications on economics of health care. Game theory might help in deciphering the underlying complexities of decision-making when considered as a two person nonzero sum game. Overall, interdisciplinary communication and cooperation between health economists and palliative care team seem necessary. This will lead to enhanced understanding of the challenges faced by each other and hopefully help develop ways to create meaningful, accurate, and reliable health economic data. These results can then be used as powerful advocacy tools to convince governments to allocate more funds for the cause of palliative care. Eventually, this will save overall costs and avoid unnecessary health-care spending.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - M A Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
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Affiliation(s)
- Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Andhra Pradesh, India
| | - Manash P Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, Assam, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E., Karnal, Haryana, India
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Vijayan A, Li T, Dusso A, Jain S, Coyne DW. Relationship of 1,25 dihydroxy Vitamin D Levels to Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury. ACTA ACUST UNITED AC 2014; 5. [PMID: 26295008 DOI: 10.4172/2161-0959.1000190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Calcitriol [1,25(OH)2D] plays a central role in endocrine regulation of bone and mineral metabolism. Low 1,25(OH)2D levels in chronic kidney disease (CKD) are associated with increased cardiovascular morbidity and mortality. However, the role of 1,25(OH)2D in acute kidney injury (AKI) is unclear, with very limited data. This pilot study examined the relationship between 1,25(OH)2D levels in critically ill patients with AKI and clinical outcomes. METHODS Plasma 1,25(OH)2D, intact parathyroid hormone (iPTH), 25-OH Vitamin D (VitD), calcium and phosphorus were measured in 34 patients with AKI without pre-existing chronic kidney disease and 12 healthy controls. RESULTS The mean 1,25(OH)2D levels were significantly lower in patients with AKI compared to controls, (42±5.6 pg/mL vs. 76.1±5.3 pg/mL, P <0.0001). The mortality in patients with AKI was 30%. 1,25(OH)2D levels were higher in non-survivors than survivors (62±41.4 pg/mL vs. 33.7±24.2 pg/mL respectively, P = 0.046) and serum phosphorus was also higher in non-survivors (6.2±2.1 mg/dL vs. 4.6±1.6 mg/dL, P = 0.019). However, on multivariate regression analysis, accounting for age and APACHE II score, higher levels of 1,25(OH)2D was not associated with mortality in critically ill patients with AKI. CONCLUSION Mineral metabolism is dysregulated within days of acute renal injury in critically ill patients. On univariate analysis, high levels of calcitriol were associated with adverse clinical outcome in AKI. This association was not apparent after adjusting for age and APACHE II. Large controlled studies are needed to confirm these results, and determine if higher 1,25(OH)2D mediates worse outcomes in AKI.
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Affiliation(s)
- Anitha Vijayan
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Tingting Li
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Adriana Dusso
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Sanjay Jain
- Renal Division, Washington University in St. Louis, St. Louis, MO
| | - Daniel W Coyne
- Renal Division, Washington University in St. Louis, St. Louis, MO
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, Haryana, India
| | - Tushar Bandgar
- Department of Endocrinology, K.E.M. Hospital, Mumbai, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, India
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