Volume 81 (2014), No. 3/2014(March)
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Obituary
Stanley Shaldon
K.-M. Koch and H. H. Malluche
Page No. 151
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (151)
Stanley Shaldon
K.-M. Koch and H. H. Malluche
Original
The predictive value of urinary UPIb mRNA levels in VUR and recurrent urinary tract infections
Ipek Kaplan Bulut, Sevgi Mir, Afig Berdeli, and Betul Sozeri
Page No. 152
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (152-158)
The predictive value of urinary UPIb mRNA levels in VUR and recurrent urinary tract infections
Ipek Kaplan Bulut1, Sevgi Mir1, Afig Berdeli2, and Betul Sozeri1
1Department of Pediatric Nephrology, and 2Department of Pediatrics, Molecular Medicine Laboratory, Ege University Faculty of Medicine, Izmir, Turkey
Background: Vesicoureteral reflux (VUR) is a risk factor for progressive kidney damage especially when it is accompanied by urinary tract infections (UTIs). Uroplakins (UPs) are integral proteins found in the structure of urothelium. In the present study, we evaluated the usefulness of urinary UPIb messenger ribonucleic acid (mRNA) levels as an early and noninvasive diagnostic tool for VUR and as an indicator for predisposition to UTI. Methods: Urinary UPIb mRNA levels were determined in patients experiencing their first UTI episode (n = 28) or recurrent UTI (n = 31) as well as patients having UTI with VUR (n = 30). These results were compared to a control group (n = 26). Results: The UPIb mRNA values among patients diagnosed with their first UTI were lower, but not statistically different, than those in the control group. The UPIb mRNA levels of patients with recurrent UTI and UTI with VUR were significantly lower than those observed in control individuals. Conclusion: Urine UPIb levels may be useful for predicting the risk of recurrent UTI in patients diagnosed with their first UTI and may also be considered as a noninvasive screening test for VUR.Correspondence to:
Ipek Kaplan Bulut, MD
Ege University Faculty of Medicine
Department of Pediatric Nephrology
35100 Izmir, Turkey
Email: [email protected]
Original
The impact of glucose load on left ventricular mass in peritoneal dialysis patients
Kamal Hassan, Fadi Hassan, Dunia Hassan, Shadia Hassan, Rabia Edgem, Smadar Moshe, and Shadi Hassan
Page No. 159
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (159-165)
The impact of glucose load on left ventricular mass in peritoneal dialysis patients
Kamal Hassan1,2, Fadi Hassan3, Dunia Hassan4, Shadia Hassan3, Rabia Edgem2, Smadar Moshe2, and Shadi Hassan5
1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, 2Nephrology and Hypertension Department, Peritoneal Dialysis Unit, Western Galilee Hospital, Nahariya, 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 4The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, and 5Internal Medicine Department, Carmel Medical Center, Haifa, Israel
Background: Cardiovascular (CV) complications are the main cause of morbidity and mortality in peritoneal dialysis (PD) patients. Left ventricular hypertrophy (LVH) is a well-known major CV risk factor. Aim: To evaluate the impact of peritoneal glucose load on left ventricular mass (LVM) in PD patients. Methods: In this cross sectional study the glucose load and LVM were evaluated in 43 stable patients on maintenance PD for 24 – 78 months. Glucose load was calculated using a unique peritoneal glucose load index (PGLI) referred to g/kg/day glucose given in the daily PD prescription. LVM index (LVMI) was calculated using the Devereux et al. formula. Results: The PGLI was positively correlated with HbA1c and LVMI (p < 0.001). Patients with PGLI > 3 g/kg/day had higher HbA1c and LVMI compared to those with PGLI ≤ 3 g/kg/day (p < 0.001). Conclusions: Higher PGLI values were associated with worse glycemic control and increased LVMI. Efforts should be made to minimize the PGL. All other risk factors that may contribute to the development of LVH in PD patients should be identified and treated. Additional multicenter, randomized control trials are needed to determine the target objectives of PGLI.Correspondence to:
Kamal Hassan, MD
Western Galilee Hospital – Nahariya
POB 21, Nahariya 22100, Israel
Email: [email protected] or Kamal.Hassan@ naharia.health.gov.il
Original
Long-term outcomes in idiopathic nephrotic syndrome: from childhood to adulthood
Piotr Skrzypczyk, Małgorzata Pańczyk- Tomaszewska, Maria Roszkowska-Blaim, Zofia Wawer, Beata Bieniaś, Małgorzata Zajączkowska, Katarzyna Kiliś- Pstrusińska, Anna Jakubowska, Marta Szczepaniak, Monika Pawlak-Bratkowska, and Marcin Tkaczyk
Page No. 166
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (166-173)
Long-term outcomes in idiopathic nephrotic syndrome: from childhood to adulthood
Piotr Skrzypczyk1, Małgorzata Pańczyk-Tomaszewska1, Maria Roszkowska-Blaim1, Zofia Wawer1, Beata Bieniaś2, Małgorzata Zajączkowska2, Katarzyna Kiliś- Pstrusińska3, Anna Jakubowska3, Marta Szczepaniak4, Monika Pawlak-Bratkowska4, and Marcin Tkaczyk4
1Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, 2Department of Pediatric Nephrology, Medical University of Lublin, Lublin, 3Department of Pediatric Nephrology, Medical University of Wroclaw, Wroclaw, and 4Nephrology Division, Department of Pediatrics and Immunology, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
Background: The aim of the study was to assess idiopathic nephrotic syndrome (INS) relapse rate, co-morbidities, and social status of adults diagnosed with INS in childhood. Material and methods: A written questionnaire was sent to 118 adults treated for INS in childhood. In 61 (51.7%) responders (aged 26.0 ± 6.2 years, range 18 – 51.5 years), we used available medical records to evaluate age at the onset of INS, number of INS relapses below 18 years of age, response to corticosteroids (CS), renal biopsy findings, and immunosuppressive treatment as well as questionnaire to evaluate the number and treatment of INS relapses above 18 years of age, co-morbidities, age at menarche, marital status, offspring, educational status, and occupation. Results: In the group of 61 responders, median age at the onset of INS was 3 (range 1.3 – 14.0) years, median number of INS relapses at < 18 years of age was 5 (1 – 20). Steroid-sensitive nephrotic syndrome (SSNS) was diagnosed in 37 (60.7%) patients, steroid-dependent nephrotic syndrome SDNS in 18 (29.5%) patients, and steroid-resistant nephrotic syndrome (SRNS) in 6 (9.8%) patients. Mesangial proliferation was the most common pattern in renal biopsy (35.7%). All patients received CS, 15 were treated with methylprednisolone pulses, 13 with cyclophosphamide, 11 with chlorambucil, 2 with cyclosporine, and 21 with levamisole. All patients achieved remission and had normal renal function at the age of 18. In adulthood, INS relapsed in 10 (16.4%) patients, including 5 (13.5%) patients with SSNS, 4 (22.2%) with SDNS, and 1 (16.7%) with SRNS (p = 0.72). Median number of relapses was 2 (range 1 – 11). Patients with relapses at > 18 years of age had more (p < 0.005) relapses at < 18 years of age. Hypertension was diagnosed in 8 (16.1%), overweight in 14 (23.0%), obesity in 3 (4.9%), and bone fractures in 12 (19.7%) patients. Five patients had height < 3rd percentile, including 4 with INS onset at < 3 years of age. One patient had growth retardation before the treatment. No myocardial infarctions, strokes, severe infections, or malignancies were reported. Mean age at menarche was 12.9 ± 1.4 years, 37 (60.7%) patients were in a steady relationship/ married, 1/18 (5.6%) patients treated with cytostatic agents and 12/43 (24/7%) patients not treated with cytostatic agents had offspring (p < 0.05). Elementary education was reported by 4 (6.6%), secondary education by 32 (52.5%), and higher education by 25 (40.9%) patients, and 34 (55.7%) patients were professionally active. None of the 6 patients with SRNS developed end-stage renal disease. Conclusions: 1. High number of INS relapses in childhood is a risk factor for recurrences in adulthood. 2. INS relapses in childhood do not preclude active professional life in adulthood.Correspondence to:
Piotr Skrzypczyk, MD
Department of Pediatrics and Nephrology
Medical University of Warsaw
24 Marszalkowska St, 00-576 Warsaw, Poland
Email: [email protected]
Original
Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis
Paul J. Der Mesropian, John S. Kalamaras, George Eisele, Kenneth R. Phelps, Arif Asif, and Roy O. Mathew
Page No. 174
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (174-184)
Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis
Paul J. Der Mesropian1, John S. Kalamaras2, George Eisele3, Kenneth R. Phelps4, Arif Asif3, and Roy O. Mathew3,4
1Department of Medicine, Department of Nephrology, University at Buffalo, Buffalo, 2Department of Epidemiology & Biostatistics, University at Albany, 3Department of Medicine, Division of Nephrology, Albany Medical Center, and 4Department of Medicine, Division of Nephrology, Albany Stratton VA Medical Center, Albany, NY, USA
Aim: To compare long-term outcomes in CA-AKI to HA-AKI. The hypothesis was that renal and patient survival would be better in CA-AKI than in HA-AKI. Methods: Retrospective cohort analysis of patients hospitalized from 2004 to 2005, in Upstate New York Veterans Affairs hospitals. The groups: CA-AKI (n = 560), HA-AKI (n = 158), or No AKI (NA) (n = 2,320). Risk, injury, failure, loss, and end-stage kidney (RIFLE) criterion was used to define AKI. Primary outcomes: doubling of serum creatinine, endstage renal disease (ESRD), death, and a composite of the three. Secondary outcomes: de novo chronic kidney disease (CKD), recovery of renal function, and re-admission rate. The cumulative incidence of outcomes was determined over a period of 3 years after discharge. Results: CA-AKI was 3.5 times as prevalent as HA-AKI. In comparison to patients with HA-AKI, those with CA-AKI had better estimated glomerular filtration rate (71.3 vs. 61.1 mL/min/1.73 m2, p < 0.001) and lower prevalence of CKD (42.3 vs. 51.9%, p = 0.03) at baseline. More patients with CA-AKI than HA-AKI met RIFLE failure criterion (43.8 vs. 29.1%, p < 0.001). By 3 years, no differences were found for the individual primary and secondary outcomes tested (all p > 0.05). Conclusions: CA-AKI was found to be considerably more common than HA-AKI and had similar long-term consequences.Correspondence to:
Roy O. Mathew, MD
113 Holland Avenue, Mail Code 111K
Albany, NY 12208, USA
Email: [email protected]
Original
Renal tubular dysfunction in patients with primary Sjögren syndrome
Guilherme B. Duffles Amarante, Maria Clara Zotin, Eduardo Rocha, Alvimar Gonçalez Delgado, Maurilo Leite Jr., and Carlos Perez Gomes
Page No. 185
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (185-191)
Renal tubular dysfunction in patients with primary Sjögren syndrome
Guilherme B. Duffles Amarante, Maria Clara Zotin, Eduardo Rocha, Alvimar Gonçalez Delgado, Maurilo Leite Jr., and Carlos Perez Gomes
Division of Nephrology, Universidade Federal do Rio de Janeiro, Brazil
Primary Sjögren’s syndrome (pSS) is an important cause of renal tubular dysfunction in adults, mainly due to acquired type 1 distal renal tubular acidosis (RTA 1) and concentration defects (CD). This cross-sectional study evaluated renal tubular function of patients with pSS, by detecting proximal tubular injury (through measurements of urinary β2 microglobulin and albumin), RTA 1 (through an acidification protocol using furosemide and fludrocortisone), and CD (through water deprivation test, WDT). A total of 25 patients with pSS were evaluated and despite a preserved renal function (eGFR 92.5 ± 26.3 mL/min/1.73 m2), 24% were diagnosed as RTA 1. On the other hand, CD was diagnosed in 28% of the patients who presented worse renal function (eGFR 68.6 ± 27.7 mL/min/1.73 m2). Increased β2 microglobulin was found in 16% of the patients, and all of them had impaired renal function (eGFR 39.5 ± 11.9 mL/min/1.73 m2). These data showed a high prevalence of tubular dysfunction, mainly RTA 1 and CD, in patients with pSS, and suggest that patients with this disorder should be evaluated by the acidification protocol used in this study and WDT for proper diagnosis. Proximal tubular injury was less common, and probably associated with worsening of renal function.Correspondence to:
Carlos Perez Gomes, MD, PhD
R. Antonio Basilio 505, 101, Tijuca
Rio de Janeiro, RJ, 20511-190, Brazil
Email: [email protected]
Editorial
Chronic kidney disease and the aging population
Marcello Tonelli and Miguel Riella
Page No. 192
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (192-197)
Chronic kidney disease and the aging population
Marcello Tonelli and Miguel Riella; ; for the International Society of Nephrology (ISN) and the International Federation fo Kidney Foundations (IFKF)
Nephrology Education
LDL-apheresis dramatically improves generalized calciphylaxis in a patient undergoing hemodialysis
Masao Iwagami, Yasuhiro Mochida, Kunihiro Ishioka, Mochida Oka, Hidekazu Moriya, Takayasu Ohtake, Sumi Hidaka and Shuzo Kobayashi
Page No. 198
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (198-202)
LDL-apheresis dramatically improves generalized calciphylaxis in a patient undergoing hemodialysis
Masao Iwagami, Yasuhiro Mochida, Kunihiro Ishioka, Mochida Oka, Hidekazu Moriya, Takayasu Ohtake, Sumi Hidaka, and Shuzo Kobayashi
Department of Nephrology, Immunology, and Vascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
We present the first documented case of generalized calciphylaxis that dramatically improved after low-density lipoprotein-apheresis (LA) in a patient undergoing long-term hemodialysis. Calciphylaxis was diagnosed by skin biopsy and was manifest as painful ulcers on the right leg, left buttock, and glans penis. Skin perfusion pressure (SPP), which has recently been used as an indicator of impaired capillary perfusion in distal lesions of the lower extremities, was markedly reduced. The ulcers continued to worsen despite general wound care, correction of levels of calcium × phosphate product, hyperbaric oxygen therapy, and use of bisphosphonate, antiplatelet therapy, and vasodilators. Because LA is known to exert favorable effects on peripheral arterial disease through improved hemorheology, anti-inflammatory action, vasodilation, and angiogenesis, we introduced LA to produce the same effects on calciphylaxis. LA dramatically increased SPP and promoted ulcer healing, demonstrating that LA can be a useful treatment option for calciphylaxis.Correspondence to:
M. Iwagami, MD
Department of Nephrology, Immunology, and Vascular Medicine
Shonan Kamakura General Hospital
1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
Email: [email protected]
Nephrology Education
Molecular mediators of favism-induced acute kidney injury
Rosa María García-Camín, Montserrat Goma, Rosa García Osuna, Alfonso Rubio-Navarro, Irene Buendía, Alberto Ortiz, Jesús Egido, Félix Manzarbeitia, Julio Leonel Chevarria, María Constanza Gluksmann and Juan Antonio Moreno
Page No. 203
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (203-209)
Molecular mediators of favism-induced acute kidney injury
Rosa María García-Camín1, Montserrat Goma2, Rosa García Osuna1, Alfonso Rubio-Navarro3, Irene Buendía3, Alberto Ortiz3, Jesús Egido3, Félix Manzarbeitia4, Julio Leonel Chevarria1, María Constanza Gluksmann1, and Juan Antonio Moreno3
1Department of Nephrology, Hospital de Palamós, Girona, 2Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, 3Department of Nephrology, IIS-Fundación Jiménez Díaz, Universidad Autonoma de Madrid, and 4Department of Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
Intolerance to fava beans in subjects with glucose-6-phosphate-dehydrogenase deficiency (favism) may lead to severe hemolytic crises and decreased renal function. Renal biopsy findings exploring the molecular mechanisms of renal damage in favism have not been previously reported. We report a case of favism-associated acute kidney injury in which renal biopsy showed acute tubular necrosis and massive iron deposits in tubular cells. Interestingly, iron deposit areas were characterized by the presence of oxidative stress markers (NADPH-p22 phox and heme-oxigenase-1) and macrophages expressing the hemoglobin scavenger receptor CD163. In addition, iron deposits, NADPH-p22 phox, hemeoxigenase- 1 and CD163 positive cells were observed in some glomeruli. These results identify both glomerular and tubular involvement in favism-associated acute kidney injury and suggest novel therapeutic targets to prevent or accelerate recovery from acute kidney injury.Correspondence to:
Juan Antonio Moreno, MD
Department of Nephrology
IIS-Fundación Jiménez Díaz
Avenida Reyes Católicos 2, 28040, Madrid, Spain
Email: [email protected]
Nephrology Education
Thrombotic thrombocytopenic purpura due to anti-ADAMTS13 antibodies in multiple myeloma
Hubert Yao, Matthieu Monge, Marianne Renou, Caroline Lecaque, Maïté Jauréguy, Claire Presne, Raïfah Makdassi and Gabriel Choukroun
Page No. 210
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (210-215)
Thrombotic thrombocytopenic purpura due to anti-ADAMTS13 antibodies in multiple myeloma
Hubert Yao, Matthieu Monge, Marianne Renou, Caroline Lecaque, Maïté Jauréguy, Claire Presne, Raïfah Makdassi, and Gabriel Choukroun
Nephrology, Internal Medicine, Dialysis and Transplantation Department, Hôpital Sud – CHU Amiens, and UMR 1088 INSERM, University Jules Verne Picardie, Amiens – France
Context: Thrombotic thrombocytopenic purpura (TTP) is a particularly serious form of thrombotic microangiopathy (TMA) due to the risk of multiple organ dysfunction. Several etiological factors such as infection, auto-immune disease, certain medications and cancers have been associated with TTP. Clinical cases: A 74-year-old hypertensive woman with a history of thromboembolic disease was hospitalized for acute kidney injury (AKI) associated with pneumonia. Initial investigations were suggestive of Pneumocystis jirovecii infection and myeloma cast nephropathy. Several days later, the patient presented features of TTP. Von Willebrand factor-cleaving protease activity was less than 5% with a high level of IgG antibody directed against ADAMTS13. Treatment consisted of monthly 4-day cycles of dexamethasone and melphalan in combination with plasmapheresis and resulted in a favorable outcome. Three years after ceasing treatment, the patient presented no signs of hemolysis, but required chronic hemodialysis. Conclusion: The association of TMA, especially TTP, and multiple myeloma is exceptional. The authors report such a case that induced irreversible renal damage, but with stable clinical and laboratory parameters with a follow-up of 4 years.Correspondence to:
Gabriel Choukroun, MD, PhD
Nephrology, Internal Medicine, Dialysis and Transplantation Department
CHU Amiens – Hôpital Sud, Avenue René Laennec
80054 Amiens Cedex 1, France
Email: [email protected]
Nephrology Education
Goodpasture’s syndrome with concomitant immune complex mixed membranous and proliferative glomerulonephritis
Vesna Jurčić, Alenka Vizjak, Andreja Aleš Rigler, Jera Jeruc, Jörgen Wieslander and Dušan Ferluga
Page No. 216
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (216-223)
Goodpasture’s syndrome with concomitant immune complex mixed membranous and proliferative glomerulonephritis
Vesna Jurčić1, Alenka Vizjak1, Andreja Aleš Rigler2, Jera Jeruc1, Jörgen Wieslander3, and Dušan Ferluga1
1Institute of Pathology, Faculty of Medicine, University of Ljubljana, 2Clinical Department of Nephrology, University Clinical Center, Ljubljana, Slovenia, and 3Department of Nephrology, Lund University Hospital, Lund, Sweden
Classical Goodpasture’s (GP) syndrome is a monophasic illness characterized by pulmonary hemorrhage and rapidly progressive glomerulonephritis with linear IgG deposition along the glomerular and distal tubular basement membrane and estructive necrotizing diffuse extracapillary crescentic glomerulonephritis. The majority of patients have circulating anti-glomerular basement membrane (GBM) antibodies, detectable with standard anti-GBM ELISA. Concurrence of GP syndrome with proliferative glomerulonephritis has only rarely been described. In this report, for the first time we describe in a 21-year-old woman GP syndrome with 50% crescentic sclerosing glomerulonephritis with linear immunofluorescence characteristic of anti-GBM pathogenesis, combined with mixed membranous and membranoproliferative glomerulonephritis with granular immunofluorescence and subepithelial, mesangial and subendothelial deposits characterizing immune complex pathogenesis. The clinical picture was also unusual for GP syndrome, manifesting a recurrent but non-progressive course, nephrotic syndrome, normal renal function and low values of anti-GBM antibodies, identified only by novel more sensitive techniques.Correspondence to:
Dr. Vesna Jurčić, MD, PhD
Institute of Pathology, Faculty of Medicine
University of Ljubljana
Korytkova 2, 1105 Ljubljana, Slovenia
Email: [email protected]
Nephrology Education
Outflow failure caused by mesothelial cell lining sheet wrapping in a patient with peritoneal dialysis
Seok Hui Kang, Dong Shik Lee and Jong Won Park
Page No. 224
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (224-227)
Outflow failure caused by mesothelial cell lining sheet wrapping in a patient with peritoneal dialysis
Seok Hui Kang1, Dong Shik Lee2 and, Jong Won Park1
1Department of Internal Medicine, and 2Department of Surgery, Yeungnam University Hospital, Daegu, Korea
A 60-year-old male was admitted to our hospital due to nausea and poor oral intake. He had received distal pancreatectomy due to a traffic accident 15 years ago, and therefore, had a midline abdominal scar. Peritoneal dialysis (PD) was selected for renal replacement therapy. PD catheter was inserted by a surgical method with left paramedian incision under local anesthesia. Initially, dialysate flow was good, but outflow failure developed on postoperative day nine. Even after the use of laxatives and a fibrinolytic agent to correct the catheter obstruction, the problem was not resolved. Therefore, we performed an open laparotomy. When PD catheter was examined during laparotomy, a single thick band (0.6 cm × 36 cm), without blood vessels was wrapped around it. One of the ends of this band originated from the jejunum and the other was attached on the most proximal side hole of the catheter. A band was removed surgically, and then the PD catheter was repositioned in the abdominal cavity. On post-revision Day 7, PD started again and dialysate flow was good. The pathologic finding was consistent with mesothelial cell lining sheet. Considering its location and the history of a major abdominal operation, the adhesive band or sheet may be the cause in this case.Correspondence to:
Jong-Won Park, MD
Department of Internal Medicine
Yeungnam University Hospital
317-1 Daemyung-Dong, Nam-Ku, 705-717, Daegu, Korea
Email: [email protected]
Letter
Letter to the article: Association of C1q deposition with renal outcomes in IgA nephropathy Clin Nephrol. 2013; 80: 98-104.
Hamid Nasri
Page No. 228
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 – Letter to the editor
Letter to the article: Association of C1q deposition with renal outcomes in IgA nephropathy Clin Nephrol. 2013; 80: 98-104.
Hamid Nasri
Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, Iran
Correspondence to:
Prof. Hamid Nasri
Department of Nephrology
Division of Nephropathology
Isfahan University of Medical Sciences
Isfahan, Iran
Email: [email protected]
Obituary
Stanley Shaldon
ERA-EDTA
Page No. 230
Abstract
Clinical Nephrology, Vol. 81 – No. 3/2014 (230)
Stanley Shaldon
ERA-EDTA
