Volume 88 (2017), No. 5/2017(November)
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Editorial Comment
Urinary creatinine excretion in AKI – just another look
Frieder Keller
Page No. 229
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (229-230)
Urinary creatinine excretion in AKI – just another look
Frieder Keller
Nephrology, Department of Internal Medicine 1, University Hospital, Ulm, Germany
Correspondence to:
Prof. Frieder Keller
Nephrology, Department of Internal Medicine 1
University Hospital
Albert-Einstein-Allee 23, 89070 Ulm, Germany
Email: [email protected]
Original
Pretreatment with paricalcitol attenuates level and expression of matrix metalloproteinases in a rat model of renal ischemia-reperfusion injury
Sibel Ersan, Asli Celik, Mehmet Tanrisev, Isil Kose, Zahide Cavdar, Mehtat Unlu, Ayse Kocak, Cemre Ural, Banu Yilmaz, and Timur Kose
Page No. 231
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (231-238)
Pretreatment with paricalcitol attenuates level and expression of matrix metalloproteinases in a rat model of renal ischemia-reperfusion injury
Sibel Ersan1, Asli Celik2, Mehmet Tanrisev1, Isil Kose3, Zahide Cavdar4, Mehtat Unlu5, Ayse Kocak4, Cemre Ural4, Banu Yilmaz1, and Timur Kose6
1Izmir Tepecik Research and Training Hospital, Department of Nephrology, 2Dokuz Eylul University Hospital, Department of Laboratory Animal Science, 3Izmir Tepecik Research and Training Hospital, Department of Anesthesiology and Reanimation, 4Dokuz Eylul University Hospital, Institute of Health Sciences, Department of Molecular Medicine, 5Dokuz Eylul University Hospital, Department of Pathology, and 6Ege University Hospital, Department of Biostatistics, Izmir, Turkey
Background: Ischemia-reperfusion injury (IRI) is a leading cause of acute kidney injury (AKI). The inflammatory response that drives IRI involves upregulation of matrix metalloproteinases (MMPs), which results in proteolytic degradation of renal microvascular matrix. Evidence suggests a potential protective role of active vitamin D on ischemic injury by downregulating MMPs. In the present study, we aimed to determine the expression and level of MMP-2 and MMP-9 in renal IRI model and the potential beneficial effect of paricalcitol on both level and expression of MMPs and tubular injury caused by IRI. Materials and methods: 20 Wistar albino rats were divided into three groups: sham-operated, ischemia-reperfusion, and paricalcitol-pretreated. IRI model was induced by bilateral clamping of renal arteries for 45 minutes followed by 24 hours of reperfusion. The analysis of serum creatinine and levels of MMPs were performed after 24 hours of IRI. The effects of paricalcitol on the quantity and expression of MMP-2 and MMP-9 in renal tubular epithelial cells were investigated by enzyme-linked immunosorbent assay and immunohistochemistry, respectively. The pathological examinations were performed to score tubular damage by light microscopy. Results: Creatinine levels decreased in the paricalcitol group, although this was not proven to be significant. Rats in the paricalcitol group showed significant decrease in both level and expression of MMPs and in tubular injury scores as compared to the IRI group. Conclusion: Paricalcitol may attenuate renal tubular injury caused by IRI by decreasing both level and expression of MMPs. Further studies are required to investigate the interplay between activated vitamin D and MMPs in AKI.
Correspondence to:
Sibel Ersan, MD
Izmir Tepecik Research and Training Hospital
Department of
Nephrology
Izmir, Turkey
Email: [email protected]
Original
Urinary calcium excretion and bone turnover in osteoporotic patients
Amr El-Husseini, Amit Chakraborty, Qingcong Yuan, Saqib Inayatullah, Heather Bush, and B. Peter Sawaya
Page No. 239
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (239-247)
Urinary calcium excretion and bone turnover in osteoporotic patients
Amr El-Husseini1#2, Amit Chakraborty1, Qingcong Yuan3, Saqib Inayatullah1, Heather Bush3, and B. Peter Sawaya1
1Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA, 2Division of Nephrology, Mansoura University, Mansoura, Egypt, and 3Department of Statistics, University of Kentucky, Lexington, KY, USA
Introduction: It is well documented that patients with osteoporosis (OP) have high incidence of hypercalciuria (HC). However, the mechanism of HC in patients with OP is not well established. It is thought to be the result of high bone turnover (HBT) with excessive bone resorption. OP also frequently presents with low bone turnover (LBT). At this time, it is not clear whether OP with LBT is also associated with hypercalciuria. Purpose: The purpose of this study is to evaluate urinary calcium excretion in osteoporotic patients with HBT and LBT. Materials and methods: This is a retrospective study of 132 patients with osteoporosis who underwent bone biopsy at the University of Kentucky between January 2010 and December 2012. Based on bone biopsy results, patients were divided into HBT or LBT groups. Demographic data, medical history, bone mineral density, serum creatinine, calcium, phosphorus, estimated glomerular filtration rate (eGFR), filtered calcium load, fractional excretion of calcium and phosphorus, 25-hydroxy vitamin D levels, and 24-hour urinary calcium excretion and creatinine were obtained from the patients’ medical records. Also, intact parathyroid hormone (iPTH), serum osteocalcin, bone-specific alkaline phosphatase, N-telopeptide of type I collagen, and urine pyridinium levels were measured. Results: Hypercalciuria was present in approximately half of the patients in both the HBT and LBT groups. Patients with HBT OP were significantly younger than those with LBT OP (p = 0.013). There was no difference between HBT and LBT patients in 24-hour urinary calcium excretion, serum creatinine, calcium, phosphorus, eGFR, filtered calcium load, and fractional excretion of phosphorus. Mean values of serum osteocalcin and serum N-telopeptide of type I collagen were significantly lower in the LBT compared to the HBT group (p = 0.000 and 0.0152, respectively). There was a significant correlation between filtered calcium load and urinary calcium excretion in HBT patients but not in patients with LBT. Fractional excretion of calcium significantly correlated with urinary calcium excretion in both groups. There was no correlation between kidney function and 24-hour urinary calcium excretion. There was no correlation between dual-emission X-ray absorptiometry T-scores and 24-hour urinary calcium excretion. Conclusion: HC is frequently present in patients with OP regardless of the underlying bone turnover status. This may suggest the presence of a bone-derived renal calcium regulating factor(s). Further studies are needed to understand the exact mechanism and the potential consequences of HC in OP patients.
Correspondence to:
Prof. B. Peter Sawaya,
Division of Nephrology, Bone and Mineral Metabolism
University of Kentucky
800 Rose Street, Room MN-560
Lexington, KY 40536-0298, USA
Email: [email protected]
Original
Switching temporary hemodialysis catheters to long-term catheters: exchange versus de-novo placement, any difference in line infection?
Maen aboul Hosn, Zeina Nasser, Elias Elias, Walid Medawar, Majida Daouk, Jamal Hoballah, and Fady Haddad
Page No. 248
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (248-253)
Switching temporary hemodialysis catheters to long-term catheters: exchange versus de-novo placement, any difference in line infection?
Maen aboul Hosn1, Zeina Nasser2, Elias Elias3, Walid Medawar4, Majida Daouk4, Jamal Hoballah2, and Fady Haddad2
1Division of Vascular Surgery, University of Iowa Health Care, Iowa City, IA, USA, 2Division of Vascular and Endovascular Surgery, 3Division of Neurosurgery, Department of Surgery, 4Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Background: Shifting from a short-term catheter to a long-term one is done either by removing the old catheter and placing a new long-term one via fresh new puncture site, or by replacing the old catheter with a long-term one over a guidewire. Aim: We aimed to describe our technique in changing a temporary line to a long-term catheter (LTC) over a guidewire and to determine the incidence of line-related infections following this procedure. Materials and methods: A retrospective pilot study was conducted between 2005 and 2010 at the American University of Beirut Hospital. We compared the first group (A), which consisted of 20 patients who underwent exchange of a short-term dialysis catheter with a tunneled one over a guidewire using our technique, to a second group (B) of 60 patients who underwent de-novo LTC placement. The two groups were matched by age, with a follow-up of at least 1 month. Results: The technical success rate of the catheter-conversion procedure was 100%. Our results revealed no significant difference of catheter duration between the two groups, with median duration of 6.5 vs. 4.0 days for group A and group B, respectively (p = 0.21). Moreover, there was also no significant mean time difference between any infection and long term catheter (LTC) insertion among the two groups (p = 0.31). Furthermore, there was no difference of catheter infection between the two groups (p = 0.1). Conclusion: We concluded that there was no difference in terms of side effects or risk of infection in the guidewire group when compared to standard technique.
Correspondence to:
Fady Fayez Haddad, MD, FACS
Associate Professor of Clinical Surgery
Division of Vascular and Endovascular Surgery
American University of Beirut Medical Center
PO Box 11-0236 Riad el Solh, Beirut 1107 2020 Lebanon
Email: [email protected]
Original
Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study
David T. Gilbertson, Yan Hu, Yi Peng, Bradley J. Maroni, and James B. Wetmore
Page No. 254
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (254-263)
Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study
David T. Gilbertson1, Yan Hu1, Yi Peng1, Bradley J. Maroni2, and James B. Wetmore1
1Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, and 2Akebia Therapeutics, Inc., Cambridge, MA, USA
Background: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. Materials and methods: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primary payer on October 1, 2012. Based on 25th and 75th percentiles, monthly hemoglobin values were categorized as low, intermediate, or high. Six variability categories were created by patterns during the 6-month observation period. Stable categories were: always-low, alwaysintermediate, always-high; variable patterns were: varying between low and intermediate, intermediate and high, low and high (mostvariable). Cox proportional hazard models were used to assess the association between hemoglobin variability and all-cause mortality or major adverse cardiac events (MACE). Results: The 25th and 75th hemoglobin percentiles were 10.2 and 11.5 g/dL, respectively, in 2012, vs. 11 and 12.5 g/dL in 2004. ESA doses were lower in all categories in 2012 and transfusion rates higher, particularly for always-low patients. Hemoglobin variability decreased modestly: in 2004, 6.0% were always-intermediate, vs. 9.5% in 2012. In 2012, more patients were always-high and fewer were most-variable. Mortality hazard ratios (HRs) were higher for patients with any low hemoglobin: always-low (HR, 95% CI: 2.07, 1.84 – 2.31), varying between low and intermediate (1.37, 1.29 – 1.45), and most-variable (1.23, 1.16 – 1.31); the pattern was similar for MACE. Conclusions: In 2012 vs. 2004, hemoglobin levels decreased, the range of levels narrowed, and variability decreased modestly; transfusions increased. The highest risk of mortality and MACE appeared to occur in patients with persistently low, rather than highly variable, hemoglobin levels.Correspondence to:
David T. Gilbertson, PhD
Chronic Disease Research Group
Minneapolis Medical Research Foundation
701 Park Avenue, Suite S4.100, Minneapolis, MN 55415, USA
Email: [email protected]
Original
Survey among nephrologists in Germany: current practice and management of pregnant women on dialysis
Johannes Duffner, Lena Schulte-Kemna, Barbara Reister, Ulla Ludwig, Frieder Keller, Rene van Erp, and Bernd Schröppel
Page No. 264
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (264-269)
Survey among nephrologists in Germany: current practice and management of pregnant women on dialysis
Johannes Duffner, Lena Schulte-Kemna, Barbara Reister, Ulla Ludwig, Frieder Keller, Rene van Erp*, and Bernd Schröppel*
Section of Nephrology, Internal Medicine, University Hospital, Ulm, Germany
Background: To assess the experience and practice patterns of nephrologists in Germany with regard to the care of pregnant women on dialysis. Methods: The 26-item internet survey sent by email asked for demographic information, subjective proficiency, maternal and fetal complications, treatment approaches and goals. Results: Of the 2,015 surveys sent out, 200 (10%) were available for evaluation. 38% of respondents never provided care, whereas 62% treated at least one pregnant patient on dialysis. In 306 total reported cases of pregnant women on dialysis, 58% became pregnant while on maintenance dialysis, and 42% developed dialysis-dependent renal failure in the course of pregnancy. For women on peritoneal dialysis (PD), only 22% of the nephrologists would continue PD until delivery, while 78% would convert to hemodialysis either immediately or shortly before delivery. 40% of the respondents reported complications in either mother or child. 45% of the respondents routinely provided prenatal counseling, and 2/3 of the nephrologists did not routinely perform fetal monitoring. While we found a significant difference in self-reported proficiency between nephrologists having and those not having treated pregnant women on dialysis, only 40% of all physicians felt confident in treating pregnant women on dialysis. Conclusions: Our survey demonstrates that the practice of nephrologists in treating pregnant women on dialysis differs significantly. These findings highlight the need for European guidelines to standardize the care of pregnant dialysis patients.
*These authors contributed equally.Correspondence to:
Bernd Schröppel, MD,
Section of Nephrology, Internal Medicine
University Hospital
Albert-Einstein-Allee 23, 89081 Ulm, Germany
Email: [email protected]
Original
The spectrum of biopsy-proven secondary glomerular diseases: A cross-sectional study in China
Ping Wang, Lijun Tang, Jing Yao, Hong Su, Yipeng Liu, Xianglei Kong, Wenbin Li, Meiyu Cui, Qing Sun, Junhui Zhen, and Dongmei Xu
Page No. 270
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (270-276)
The spectrum of biopsy-proven secondary glomerular diseases: A cross-sectional study in China
Ping Wang1*, Lijun Tang1*, Jing Yao2, Hong Su1, Yipeng Liu1, Xianglei Kong1, Wenbin Li1, Meiyu Cui1, Qing Sun3, Junhui Zhen4, and Dongmei Xu1
1Department of Nephrology, Qianfoshan Hospital, Shandong University,
2The Blood Purification Center, Shandong Veterans General Hospital,
3Department of Pathology, Qianfoshan Hospital, Shandong University, and 4Department of Pathology, School of Medicine, Shandong University, Jinan, China
Aims: The distribution of the spectrum of chronic kidney disease (CKD) has been found to vary with time. Limited information is available regarding the changing spectrum of secondary glomerular diseases (SGDs). To further investigate changes in the spectrum of SGDs, we performed a cross-sectional study. Methods: From June 2010 to May 2015, 5,935 patients from 37 hospitals in Shandong Province were involved in this study. The study was divided into five periods according to 1-year intervals. The patients were divided into four age groups. Results: Of the 5,935 patients with qualified specimens, 1,038 (17.5%) were diagnosed with a SGD. Lupus nephritis (LN) (27.6%) was the most frequently identified SGD, followed by Henoch-Schönlein purpura glomerulonephritis (HSPN) (21.7%) and diabetic nephropathy (DN) (21.6%). The prevalence rate of DN demonstrated an increasing trend, and this condition became the leading cause of renal biopsy in period 3 (29.3%). The proportion of patients with hepatitis B virus-associated nephritis (HBVAN) decreased from 14.7% in period 2 to 5.1% in period 5 (p < 0.001). The proportion of patients with amyloidosis nephropathy (AN) increased from 2.2% in period 1 to 7.0% in period 5 (p = 0.088). The prevalence rate of DN was 0.6% in pediatric patients and 40.7% in elderly patients (p < 0.001). Conclusions: In our study, SGD was the second leading cause of renal biopsy. The distribution of the spectrum of SGD varied with time and age. Given the possibility of a detection bias, larger prospective cohort studies are needed in the future.
*These authors contributed equally to this work.Correspondence to:
Dongmei Xu, PhD
Department of Nephrology, Qianfoshan Hospital
Shandong University
No.16766, Jingshi Road, Jinan 250014, People’s Republic of China
Email: qianyixdmgmail@
163.com
Nephrology Education
Familial antiglomerular basement membrane disease in zero human leukocyte antigen mismatch siblings
Andrea Angioi, Wisit Cheungpasitporn, Sanjeev Sethi, An De Vriese, Nicola Lepori, Thomas Schwab, and Fernando Fervenza
Page No. 277
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (277-283)
Familial antiglomerular basement membrane disease in zero human leukocyte antigen mismatch siblings
Andrea Angioi1#2, Wisit Cheungpasitporn1, Sanjeev Sethi3, An De Vriese4, Nicola Lepori1#2, Thomas Schwab1#5, and Fernando Fervenza1
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA, 2Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Cagliari, Italy, 3Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA,
4Division of Nephrology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium, and 5The William J von Liebig Center for Transplantation and Clinical Regeneration, Rochester, MN, USA
Reported cases of familial Antiglomerular basement membrane (anti-GBM) disease are extremely rare. The single gene mutations that may play a role in the development of familial anti-GBM disease are currently unidentified. While human leukocyte antigen (HLA)-DR15 is known to be associated with an increased risk of anti-GBM disease, HLA types in patients with familial anti-GBM disease have never been reported. We present a case of a 65-year-old woman with rapidly-progressive glomerulonephritis and pulmonary involvement, consistent with Goodpasture’s syndrome. Two of her 15 siblings also had a history of anti-GBM disease during adolescence and both received a kidney transplant. Our patient and her siblings were smokers and had also had exposure to kerosene, a low-viscosity hydrocarbon. HLA testing was performed and showed identical HLA typing (0 of 6 HLA mismatch) as one of her brothers with anti-GBM disease. Interestingly, they both had HLA-DR15. Despite severe acute kidney injury requiring hemodialysis, the patient responded well to the standard therapy with cyclophosphamide, plasmapheresis, and systemic corticosteroids. At her 3-month follow-up visit, the patient’s kidney functions had recovered, and hemodialysis was discontinued. Concluding, we illustrate an extremely rare familial anti-GBM disease involving 3 siblings with potential links of HLA-DR15 and environmental triggers with the development of familial anti-GBM disease.
Correspondence to:
Dr. Fernando C. Fervenza
Division of Nephrology and Hypertension,
Mayo Clinic, Rochester, MN, USA
Email: [email protected]
Nephrology Education
Potential pitfalls in estimating renal injury by KDIGO, overcome by measuring creatinine clearance in acute kidney injury
John Mellas
Page No. 284
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (284-291)
Potential pitfalls in estimating renal injury by KDIGO, overcome by measuring creatinine clearance in acute kidney injury
John Mellas
Nephrology and Hypertension Specialists, Division of Clinical Nephrology Research, St. Louis, MO, USA
Acute kidney injury (AKI) is a common and serious condition frequently encountered in hospitalized patients. The severity of kidney injury is defined by the KDIGO criteria which attempt to establish the degree of renal impairment. These criteria do not measure actual creatinine clearance (K) but rather represents static measures of a dynamic process in AKI and are fraught with potential for false positives and negatives results. This paper, presented in an educational format, uses a new, unique, simple, and accurate method for estimating actual K in AKI utilizing urine creatinine excretion over an established time interval. Patient examples are provided to highlight the use of this method and its advantage over KDIGO, which has inherent shortcomings, while often incorrectly classifying the extent of renal injury in the patient with AKI. These cases highlight where KDIGO staging may over- or underestimate the actual degree of renal injury in patients with AKI. The present paper provides the practitioner with a useful tool to estimate real-time K in AKI with enough precision to predict the severity of the renal injury. It is the author’s belief that this simple method, or others like it, improve on KDIGO for estimating the degree of renal impairment in AKI, and allow a more accurate estimate of K. Methods to measure creatinine clearance in AKI have the potential to improve care for patients with this condition.Correspondence to:
John Mellas, MD
Nephrology and Hypertension Specialists, Director
Division of Clinical Nephrology Research
10004 Kennerly Road, St. Louis, MO, 63017, USA
Email: johnmellas56@
gmail.com
Nephrology Education
Renal histology and MRI findings in a
37-year-old Japanese patient with autosomal recessive polycystic kidney disease
Yusuke Ito, Akinari Sekine, Daisuke Takada, Junko Yabuuchi, Yuta Kogure, Toshiharu Ueno, Keiichi Sumida, Masayuki Yamanouchi, Noriko Hayami, Tatsuya Suwabe, Junichi Hoshino, Naoki Sawa, Kenmei Takaichi, Keiichi Kinowaki, Takeshi Fujii, Kenichi Ohashi, Hiroaki Kikuchi, Shintaro Mandai, Motoko Chiga, Takayasu Mori, Eisei Sohara, Shinichi Uchida, and Yoshifumi Ubara
Page No. 292
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 (292-298)
Renal histology and MRI findings in a
37-year-old Japanese patient with autosomal recessive polycystic kidney disease
Yusuke Ito1, Akinari Sekine1, Daisuke Takada1, Junko Yabuuchi1, Yuta Kogure1, Toshiharu Ueno1, Keiichi Sumida1, Masayuki Yamanouchi1, Noriko Hayami1, Tatsuya Suwabe1, Junichi Hoshino1, Naoki Sawa1, Kenmei Takaichi1#3, Keiichi Kinowaki2, Takeshi Fujii2, Kenichi Ohashi2#4, Hiroaki Kikuchi5, Shintaro Mandai5, Motoko Chiga5, Takayasu Mori5, Eisei Sohara5, Shinichi Uchida5, and Yoshifumi Ubara1#3
1Nephrology Center, 2Department of Pathology, 3The Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Kanagawa, 4Department of Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, and 5Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
A 37-year-old Japanese man with a serum creatinine level of 2.5 mg/dL and hepatomegaly was admitted to our hospital for investigation of renal failure. Magnetic resonance imaging (MRI) showed hepatomegaly with small cystic lesions that had high signal intensity on T2-weighted images. There was no splenomegaly, and the kidneys were nearly normal in size with a few small cystic lesions. Renal biopsy revealed that interstitial fibrosis and tubular atrophy affected 60% of the cortex. There was cystic tubular dilation, mainly affecting the distal loop of Henle and distal tubules, since immunohistochemical staining of the dilated tubules was positive for cytokeratin 7 and Tamm-Horsfall protein but was negative for aquaporin 3 and CD10. Immunofluorescence microscopy and electron microscopy did not demonstrate any immune deposits. Genetic analysis identified two different heterozygous missense variants of PKHD1, while the patient’s asymptomatic parents were each heterozygous for a single PKHD1 mutation. Accordingly, autosomal recessive polycystic kidney disease (ARPKD) due to compound heterozygous PKHD1 mutation was diagnosed. The renal biopsy findings of this patient may be nonspecific, but they were different from the typical renal histology of infantile ARPKD. In conclusion, the renal features of adult-onset ARPKD may differ from those of infantile disease.
Correspondence to:
Akinari Sekine, MD,
Nephrology Center, Toranomon Hospital Kajigaya
1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
Email: akinari-s@
toranomon.gr.jp
Letter to the Editor
Comment to: Differences in characteristics and outcomes between community- and hospital-acquired acute kidney injury: A systematic review and meta-analysis. Clinical Nephrology, 2017; 88: 167-182
Cheng Xue, Chenchen Zhou, and Jing Xu
Page No. 299
Abstract
Clinical Nephrology, Vol. 88 – No. 5/2017 – Letters to the editor
Comment to: Differences in characteristics and outcomes between community- and hospital-acquired acute kidney injury: A systematic review and meta-analysis. Clinical Nephrology, 2017; 88: 167-182
Cheng Xue1, Chenchen Zhou2, and Jing Xu1
1Kidney institute of CPLA, Division of Nephrology, Changzheng hospital, Second Military Medical University, Shanghai, and 2Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
and Response by
Ryota Inokuchi, Yoshitaka Hara, Hideo Yasuda, Noritomo Itami, Yoshio Terada, and Kent DoiCorrespondence to:
Cheng Xue, MD
Department of Nephrology
Shanghai Changzheng Hospital
Shanghai 200003, China
Email: [email protected]
