Acute Kidney Injury in Real Time: Prediction, Alerts, and Clinical Decision Support
Broad adoption of electronic health record (EHR) systems has facilitated acute kidney injury (AKI) research in 2 ways. First, the detection of AKI based on changes in serum creatinine has largely replaced the sensitive but nonspecific administrative coding of AKI that predominated in earlier studies. Second, the ability to implement real-time AKI interventions such as alerts and best-practice advisories has emerged as a promising tool to fight against the harmful sequela of AKI, which include short-term adverse outcomes as well as progression to chronic kidney disease, dialysis, and death. In this review, we discuss the cu...
Source: Nephron - August 2, 2018 Category: Urology & Nephrology Source Type: research

Contents Vol. 139, 2018
Nephron 2018;139:I –VI (Source: Nephron)
Source: Nephron - July 31, 2018 Category: Urology & Nephrology Source Type: research

Clinical Management of Chronic Kidney Disease Patients in Italy: Results from the IRIDE Study
Conclusions: This is the first Italian prospective study performed with a large cohort of CKD patients over a 3-year period. Considering the multifactorial burden of diseases associated with CKD patients, the need for greater attention to CKD and related disorders is paramount.Nephron (Source: Nephron)
Source: Nephron - July 17, 2018 Category: Urology & Nephrology Source Type: research

Delayed Graft Function: The AKI of Kidney Transplantation
With the growing wait list of individuals waiting for kidney transplantation, there has been renewed interest in the quality and function of donor organs. In particular, concern about the development of delayed allograft function (DGF) after transplantation continues to lead to the avoidance of donor organs offered to a transplant center. DGF is associated with worse short-and long-term outcomes and associated with higher rejection rates. There are no FDA-approved therapies to mitigate the ischemic injury that occurs. Risk factors include both donor and recipient characteristics, although their prediction is not precise. W...
Source: Nephron - July 13, 2018 Category: Urology & Nephrology Source Type: research

Ventilator-Induced Kidney Injury: Are Novel Biomarkers the Key to Prevention?
Mechanical ventilation is associated with significant increases in the risk of acute kidney injury (AKI). The rate of AKI due to mechanical ventilation and the associated mortality remain unacceptably high. Preventative and therapeutic strategies are clearly lacking. Ventilator-induced kidney injury is believed to occur due to changes in hemodynamics that impair renal perfusion, neurohumoral-mediated alterations in intra-renal blood flow, and systemic inflammatory mediators generated by ventilator-induced lung injury. The risk of injury to the kidney by these mechanisms may be modified by open lung protective ventilation w...
Source: Nephron - July 11, 2018 Category: Urology & Nephrology Source Type: research

Appendix I Acronyms and Abbreviations used in the Annual Report
Nephron 2018;139:363 –368 (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Appendix J Laboratory Conversion Factors
Nephron 2018;139:369 –370 (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Appendix K Renal Centre Names and Abbreviations used in the Figures and Data Tables
Nephron 2018;139:371 –372 (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Severe Solute Depletion in Patients with Hyponatremia Due to Diuretics Despite Biochemical Pictures Similar Than Those Observed in the Syndrome of Inappropriate Secretion of Antidiuretic Hormone
Conclusion: We therefore suggest that diuretic induced hyponatremia with an SIADH-like biochemical profile, should be treated mainly by solute ­repletion.Nephron (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Expanding Phenotype of Nephronophthisis-Related Ciliopathy: an Elderly Patient with Homozygous < b > < i > RPGRIP1L < /i > < /b > Mutation
Nephronophthisis-related ciliopathies (NPHP-RC) are autosomal recessive disorders characterized by renal corticomedullary cysts with the extrarenal symptoms. Typically, patients with NPHP-RC reach end-stage kidney disease (ESKD) before the age of 30 years. We herein report a Japanese woman with NPHP-RC who had unusually delayed progression to ESKD after 6 decades. She exhibited liver dysfunction at the age of 23 years. She also showed mild renal dysfunction at the age of 43 years. Ultrasonography revealed bilateral multiple renal cysts with loss of corticomedullary differentiation. Her liver and renal functions gradually d...
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Effect of Sucroferric Oxyhydroxide on Fibroblast Growth Factor 23 Levels in Hemodialysis Patients
Conclusions: Treatment of hyperphosphatemia with sucroferric oxyhydroxide was effective in patients on hemodialysis, resulting in decreased serum FGF-23 levels and a reduction in the required dose of saccharated ferric oxide.Nephron (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Trace Albumin in the Urine Dipstick Test is Associated with Coronary Artery Calcification in Korean Adults
Conclusion: Even a trace level of albumin in the urine dipstick test was associated with subclinical CAC in Korean adults. Low-grade dipstick albuminuria should not be overlooked.Nephron (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Proteomic Analysis for Identification of Biomarkers that Predict Severe Acute Kidney Injury
The search for acute kidney injury (AKI) biomarkers has identified a number of urine proteins that can be used to predict the presence of AKI but has struggled to identify proteins that are prognostic for severe AKI. In this review, we discuss 2 currently available biomarkers and the designs of the studies in which they were identified and relate this to the AKI characteristics they predict clinically. We discuss recent advances in mass spectrometry and sample preparation, which have improved the ability to identify low abundance proteins as well as the ability to characterize more of the protein by mass spectrometry. We s...
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Optogenetics in Understanding Mechanisms of Acute Kidney Injury
Background: No approved pharmacological agents are available for the treatment and prevention of acute kidney injury (AKI). The nervous system has been reported to play an important role, directly or indirectly via the immune system, in the pathophysiology of AKI. Neuromodulation, such as vagus nerve stimulation and pulsed ultrasound, is emerging as an innovative therapeutic treatment for various diseases including AKI. However, lack of effective methods to selectively stimulate or inhibit neurons has hampered the complete understanding of the roles of the nervous system in AKI because electrical stimulation is nonspecific...
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Prelims
Nephron ;139:I –XIV (Source: Nephron)
Source: Nephron - July 10, 2018 Category: Urology & Nephrology Source Type: research

Immunomodulatory and Kidney-Protective Effects of the Human Chorionic Gonadotropin Derivate EA-230
The systemic inflammatory response following infectious or non-infectious insults is related to morbidity (including acute kidney injury) and mortality. Pregnancy is associated with immunotolerance and an increased glomerular filtration rate. EA-230, a linear tetrapeptide (Alanine-Glutamine-Glycine-Valine), derived from the β-chain of the human chorionic gonadotropin hormone, has shown immunomodulatory and renoprotective properties in several pre-clinical animal models of systemic inflammation. Furthermore, an excellent safety profile of EA-230 was observed in phase 1 studies in humans, and the immunomodulatory effect...
Source: Nephron - July 6, 2018 Category: Urology & Nephrology Source Type: research

Iron Homeostasis Pathways as Therapeutic Targets in Acute Kidney Injury
Background: Iron is critical for fundamental biologic functions such as cell division and mitochondrial electron transport. However, by the virtue of its ability to donate electrons, iron is probably the most effective oxidant in biologic systems.Summary: To avoid damage from iron-mediated oxidative injury or ferroptosis, multiple defense mechanisms exist including iron binding proteins and robust glutathione-dependent intracellular pathways. Hepcidin, through its ability to sequester iron within macrophages and induce H-ferritin, serves as an endogenous protective molecule against ferroptosis.Key Messages: Recent studies ...
Source: Nephron - July 6, 2018 Category: Urology & Nephrology Source Type: research

Dyskalemia in Chronic Kidney Disease: How Concerned Should We Be?
Context: The widespread use of diuretics, potassium supplements, and medications that block renin angiotensin system puts the chronic kidney disease (CKD) population at high risk for dyskalemia, both hyperkalemia and hypokalemia. The optimal potassium level in a CKD patient is unknown.Subject of review: Two recent studies found conflicting results on the association of dyskalemia with outcomes. The Renal Research Institute CKD study [Clin J Am Soc Nephrol 2010; 5: 762 –769] found increased mortality and incidence of end-stage renal disease (ESRD) with mild to moderate hypokalemia, whereas hyperkalemia was not signifi...
Source: Nephron - July 4, 2018 Category: Urology & Nephrology Source Type: research

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease
Conclusion: The K+ in the CKD study will demonstrate if K+ supplementation has a renoprotective effect in progressive CKD, and whether alkali therapy has additional beneficial effects.Nephron (Source: Nephron)
Source: Nephron - June 29, 2018 Category: Urology & Nephrology Source Type: research

The Microbiome and Acute Kidney Injury
Acute kidney injury (AKI) is a major clinical problem in native and transplanted kidneys. Bidirectional interaction between gut microbiota and kidney tissue or the “colo-renal” system is being recognized as an important modulating factor in AKI. Gut microbes appear to have a complex but yet poorly understood communication with renal cellular and molecular processes that affect normal kidney function and response to injury. There have been major recent adva nces in the study of the microbiome that provide an opportunity to apply this knowledge to improve our understanding and treatment of patients with AKI. This...
Source: Nephron - June 29, 2018 Category: Urology & Nephrology Source Type: research

Cell Death Pathways Drive Necroinflammation during Acute Kidney Injury
Renal tubules represent an intercellular unit and function as a syncytium. When acute tubular necrosis was first visualized to occur through a process of synchronized regulated necrosis (SRN) in handpicked primary renal tubules, it became obvious that SRN actually promotes nephron loss. This realization adds to our current understanding of acute kidney injury (AKI)-chronic kidney disease (CKD) transition and argues for the prevention of AKI episodes to prevent CKD progression. Because SRN is triggered by necroptosis and executed by ferroptosis, 2 recently identified signaling pathways of regulated necrosis, a combination t...
Source: Nephron - June 29, 2018 Category: Urology & Nephrology Source Type: research

Patterns of Erythropoiesis-Stimulating Agent Use in European Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study
Conclusion: A variety of short- and long-acting ESAs are commonly used in European HD facilities to maintain hemoglobin at remarkably similar levels with each ESA type. The availability of numerous ESA options for managing anemia has allowed European providers to optimize anemia management according to the particular circumstances of each patient.Nephron (Source: Nephron)
Source: Nephron - June 26, 2018 Category: Urology & Nephrology Source Type: research

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures
Background: Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients ’ outcome.Summary: According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrea...
Source: Nephron - June 26, 2018 Category: Urology & Nephrology Source Type: research

Thrombomodulin and Endothelial Dysfunction: A Disease-Modifier Shared between Malignant Hypertension and Atypical Hemolytic Uremic Syndrome
Thrombomodulin (TM) is an endothelial glycoprotein that is present in all blood vessels. Five percent of all patients with atypical hemolytic uremic syndrome (aHUS) have mutations in the gene coding for TM, with a peak presentation in young children. Mutations often translate into quantitative and qualitative abnormalities of this endothelial glycoprotein. Outcome of the TM-associated aHUS is relatively poor with frequent relapses after transplantation despite its membrane-bound character. We observed a woman presenting with malignant hypertension (MHT) and associated kidney, brain, cardiac, and hematological involvement w...
Source: Nephron - June 25, 2018 Category: Urology & Nephrology Source Type: research

What is the Role of Soluble Urokinase-Type Plasminogen Activator in Renal Disease?
Context: Soluble urokinase-type plasminogen activator ­(suPAR) is an inflammatory signal with pleiotropic biological effects depending on context and post-translational modifications. Recently, [Hayek, et al: Nat Med 2017; 23: 945–953] it has been found that there is a link between suPAR and renal disease in several guises, and a key question is whe ther it is a driver or a marker of renal disease, and if so of which types of kidney damage.Subject of Review: Circulating suPAR has been postulated to cause acute proteinuric kidney disease, specifically focal segmental glomerulosclerosis (FSGS), though both the anim...
Source: Nephron - June 15, 2018 Category: Urology & Nephrology Source Type: research

Trajectory of Estimated Glomerular Filtration Rate Predicts Renal Injury in Children with Multicystic Dysplastic Kidney
Conclusion: All the children with MCDK who developed renal injury had eGFR trajectory of increase followed by decline. Renal injury followed the peak eGFR by 3 years on average. This observation is in agreement with the hyperfiltration theory and underscores the importance of following eGFR trajectory closely.Nephron (Source: Nephron)
Source: Nephron - June 7, 2018 Category: Urology & Nephrology Source Type: research

Study on Dialysis Session Length and Mortality in Maintenance Hemodialysis Patients: The Q-Cohort Study
Conclusion: Our results suggest that HD ≥5 h has a more favorable effect on mortality than HD #x3c; 5 h.Nephron (Source: Nephron)
Source: Nephron - June 7, 2018 Category: Urology & Nephrology Source Type: research

Influence of Intradialytic Aerobic Training in Cerebral Blood Flow and Cognitive Function in Patients with Chronic Kidney Disease: A Pilot Randomized Controlled Trial
Conclusions: Intradialytic aerobic training improves cognitive impairment and cerebral blood flow of patients in HD, suggesting a possible mechanism improving cognitive impairment by physical training in HD. These data still need to be confirmed by major trials.Nephron (Source: Nephron)
Source: Nephron - June 7, 2018 Category: Urology & Nephrology Source Type: research

Treatment Based on Cinacalcet Reduces Oxidative Stress in Hemodialysis Patients with Secondary Hyperparathyroidism
Conclusions: (1) Six-month treatment based on cinacalcet seems to reduce oxidative stress markers in maintenance hemodialysis patients with sHPT. (2) This benefit may be related rather to the direct action of cinacalcet than to the serum PTH concentration decrease.Nephron (Source: Nephron)
Source: Nephron - June 7, 2018 Category: Urology & Nephrology Source Type: research

MicroRNAs in Acute Kidney Injury
Background: It is increasingly recognised that improved diagnosis, prognosis and treatment of acute kidney injury (AKI) requires an understanding of distinct underling cellular and molecular mechanisms (endotypes) that may distinguish overtly similar clinical AKI presentations. One important avenue of research is the post-transcriptional regulation of gene expression in response to kidney injury mediated by microRNAs.Summary: This mini-review summarises the use of microRNAs as diagnostic and prognostic biomarkers in AKI. The contribution of microRNAs to the pathophysiology of AKI will be highlighted along with the potentia...
Source: Nephron - June 5, 2018 Category: Urology & Nephrology Source Type: research

Quantitative Large-Scale Three-Dimensional Imaging of Human Kidney Biopsies: A Bridge to Precision Medicine in Kidney Disease
Kidney biopsy remains the gold standard for uncovering the pathogenesis of acute and chronic kidney diseases. However, the ability to perform high resolution, quantitative, molecular and cellular interrogation of this precious tissue is still at a developing stage compared to other fields such as oncology. Here, we discuss recent advances in performing large-scale, three-dimensional (3D), multi-fluorescence imaging of kidney biopsies and quantitative analysis referred to as 3D tissue cytometry. This approach allows the accurate measurement of specific cell types and their spatial distribution in a thick section spanning th...
Source: Nephron - June 5, 2018 Category: Urology & Nephrology Source Type: research

Tubular Recovery after Acute Kidney Injury
Background: A significant portion of patients who are affected by acute kidney injury (AKI) do not fully recover due to largely unclear reasons. Restoration of tubular function has been proposed to be a prerequisite for glomerular filtration rate (GFR) recovery.Summary: Proximal tubular cells dedifferentiate during the tubular injury phase, which is required for subsequent cell proliferation and replacement of lost epithelial cells. Experimental studies indicate that some cells fail to redifferentiate and continue to produce growth factors (e.g., transforming growth factor β) that can induce fibrosis. Preclinical stud...
Source: Nephron - May 31, 2018 Category: Urology & Nephrology Source Type: research

Risk Prediction Models for Acute Kidney Injury in Critically Ill Patients: Opus in Progressu
Acute kidney injury (AKI) is a complex systemic syndrome associated with high morbidity and mortality. Among critically ill patients admitted to intensive care units (ICUs), the incidence of AKI is as high as 50% and is associated with dismal outcomes. Thus, the development and validation of clinical risk prediction tools that accurately identify patients at high risk for AKI in the ICU is of paramount importance. We provide a comprehensive review of 3 clinical risk prediction tools that have been developed for incident AKI occurring in the first few hours or days following admission to the ICU. We found substantial hetero...
Source: Nephron - May 31, 2018 Category: Urology & Nephrology Source Type: research

Necroptosis in Acute Kidney Injury
Conclusion: There is broad consistency suggesting a role for necroptosis in AKI, but some studies report divergent evidence potentially relating to the specific model used and the time point of analysis.Mlkl-deficient mice are currently the most specific and reliable experimental tool to study necroptosis in vivo (in kidney disease). The clinical potential of necroptosis inhibition in AKI is to be evaluated, but conceptual problems in AKI definitions and in complex clinical scenarios remain a concern.Nephron (Source: Nephron)
Source: Nephron - May 31, 2018 Category: Urology & Nephrology Source Type: research

Toll-Like Receptor 3 Signaling Contributes to Regional Neutrophil Recruitment in Cultured Human Glomerular Endothelial Cells
Conclusion: These findings support a role for glomerular antiviral innate immunity in the pathogenesis of GN. Intervention of glomerular TLR3 signaling may therefore be a suitable therapeutic strategy for treating GN in the future.Nephron (Source: Nephron)
Source: Nephron - May 29, 2018 Category: Urology & Nephrology Source Type: research

A de novo < b > < i > KCNA1 < /i > < /b > Mutation in a Patient with Tetany and Hypomagnesemia
Mutations in theKCNA1 gene encoding the voltage-gated potassium (K+) channel Kv1.1 have been linked to rare neurological syndromes, episodic ataxia type 1 (EA1) and myokymia. In 2009, aKCNA1 mutation was identified in a large family with autosomal dominant hypomagnesemia. Despite efforts in establishing a genotype-phenotype correlation for the wide variety of symptoms in EA1, little is known on the serum magnesium (Mg2+) levels in these patients. In the present study, we describe a new de novoKCNA1 mutation in a Polish patient with tetany and hypomagnesemia. Electrophysiological and biochemical analyses were performed to d...
Source: Nephron - May 29, 2018 Category: Urology & Nephrology Source Type: research

Improving Translation from Preclinical Studies to Clinical Trials in Acute Kidney Injury
This article reviews many issues that have limited this and the potential future perspectives in AKI prevention and treatment.Summary: Preclinical models of AKI should closely mimic the complexity of human AKI, considering the importance of several comorbidities in determining the clinical course and outcomes in the human disease. Moreover, studies should test novel interventions in models where AKI is already established, instead of focusing only at primary prevention. AKI definitions and endpoints in animal studies should be similar to those applied in clinical studies; in particular, AKI biomarkers should be implemented...
Source: Nephron - May 29, 2018 Category: Urology & Nephrology Source Type: research

Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study
Conclusions: The GBD study highlights the prominent gender disparities in CKD prevalence among 195 countries. The nature of these disparities, however, is complex and must be interpreted cautiously taking into account all possible circumstances.Nephron (Source: Nephron)
Source: Nephron - May 29, 2018 Category: Urology & Nephrology Source Type: research

The Renin –Angiotensin System, Not the Kinin–Kallikrein System, Affects Post-Exercise Proteinuria
Conclusion: The results indicated Ang II up-regulation, not bradykinin elevation, plays a role in post-exercise proteinuria.Nephron (Source: Nephron)
Source: Nephron - May 18, 2018 Category: Urology & Nephrology Source Type: research

Safety of Iohexol Administration to Measure Glomerular Filtration Rate in Different Patient Populations: A 25-Year Experience
Conclusion: Iohexol administration for GFR measurement is a safe procedure, even in repeated investigations in the same subject, that should be adopted in clinical research and, when needed, also in clinical practice.Nephron (Source: Nephron)
Source: Nephron - May 17, 2018 Category: Urology & Nephrology Source Type: research

Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine
Conclusions: VA-AKI can manifest with a precipitous rise in sCr shortly after a high cumulative dose of vancomycin. True toxic tubular injury overrepresented by the sCr rise is postulated.Nephron 2018;139:1 –12 (Source: Nephron)
Source: Nephron - April 27, 2018 Category: Urology & Nephrology Source Type: research

Erratum
Nephron 2018;139:112 (Source: Nephron)
Source: Nephron - April 26, 2018 Category: Urology & Nephrology Source Type: research

MicroRNA-10b Promotes Apoptosis via JNK Pathway in Clear Cell Renal Cell Carcinoma
Conclusion: We suggested a tumour suppressor function of miR-10b in tumourigenesis of ccRCC via proliferation suppression and apoptosis induction, and the latter was mediated by the JNK pathway activation.Nephron (Source: Nephron)
Source: Nephron - April 19, 2018 Category: Urology & Nephrology Source Type: research

Office Visit: Kidney Transplantation of a Dreamer
This editorial describes a patient who was cared for by the author. The patient developed end-stage kidney disease in the United States at the age of 17 but was denied kidney transplantation due to lack of insurance because of her immigration status. With the enactment of the Deferred Action for Childhood Arrivals (DACA) program, the patient was able to obtain a job and health insurance. The patient then received a kidney transplant when she was 27 years, after undergoing peritoneal dialysis for 10 years. The editorial describes how the DACA program improves the care of undocumented immigrants to the United States who are ...
Source: Nephron - April 19, 2018 Category: Urology & Nephrology Source Type: research

The Use of Low-Calcium Hemodialysis in the Treatment of Hypercalcemic Crisis
Conclusion: Hypercalcemic crisis is a life-threatening condition and should be managed immediately.Nephron (Source: Nephron)
Source: Nephron - April 19, 2018 Category: Urology & Nephrology Source Type: research

Accuracy of Acid-Base Diagnoses Using the Central Venous Blood Gas in the Medical Intensive Care Unit
Conclusions: In critically ill adult patients, central VBG may be used to detect and diagnose acid-base disturbances with reasonable diagnostic accuracy, even in shock states, compared to the ABG. This study supports the use of central VBG for diagnosis of acid-base disturbances in critically ill patients.Nephron (Source: Nephron)
Source: Nephron - April 12, 2018 Category: Urology & Nephrology Source Type: research

The Impact of Preexisting Chronic Kidney Disease on the Severity and Recovery of Acute Kidney Injury
Conclusion: Taken together, reduced nephron mass have a negative effect on the repair process that is partially mediated by the disruption of the cell cycle regulation.Nephron (Source: Nephron)
Source: Nephron - April 12, 2018 Category: Urology & Nephrology Source Type: research

Abstracts of the 30th Meeting of the European Renal Cell Study Group (ERCSG)
Nephron 2018;139:83 –111 (Source: Nephron)
Source: Nephron - April 12, 2018 Category: Urology & Nephrology Source Type: research

The Burden of Untreated Hepatitis C Virus Infection in Renal Patients in the United Kingdom
Nephron (Source: Nephron)
Source: Nephron - April 5, 2018 Category: Urology & Nephrology Source Type: research

Modest Impact of Serial Measurements of Acute Kidney Injury Biomarkers in an Adult Intensive Care Unit
Conclusion: Serial measurement of AKI biomarkers used in clinical models could contribute to the prediction of AKI outcomes in a heterogeneous cohort of adult mixed ICU patients, although its reliability seemed to be modest.Nephron (Source: Nephron)
Source: Nephron - April 3, 2018 Category: Urology & Nephrology Source Type: research