Growth plate alterations in chronic kidney disease
AbstractGrowth retardation is a major feature of chronic kidney disease (CKD) of onset in infants or children and is associated with increased morbidity and mortality. Several factors have been shown to play a causal role in the growth impairment of CKD. All these factors interfere with growth by disturbing the normal physiology of the growth plate of long bones. To facilitate the understanding of the pathogenesis of growth impairment in CKD, this review discusses cellular and molecular alterations of the growth plate during uremia, including structural and dynamic changes of chondrocytes, alterations in their process of m...
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Energy and protein requirements for children with CKD stages 2-5 and on dialysis –clinical practice recommendations from the Pediatric Renal Nutrition Taskforce
We describe how to achieve the dietary prescription for energy and protein using breastmilk, formulas, food, and dietary supplements, which can be incorporated into everyday practice. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clin ical judgment. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

The pathogenesis and management of renal scarring in children with vesicoureteric reflux and pyelonephritis
AbstractBacterial urinary tract infections (UTIs) are one of the most common reasons for children to be admitted to hospital. Bacteria infect and invade the bladder (the lower urinary tract) and if the infection disseminates to the upper urinary tract, significant inflammation in the kidneys may arise. Inflammation is a double-edged sword: it is needed to clear bacteria, but if excessive, kidney tissue is injured. During injury, nephrons are destroyed and replaced with deposition of extracellular matrix and a renal scar. In this review, we explore the pathogenesis of UTIs and discuss the risk factors that result in dissemi...
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Steroid therapy in children with IgA nephropathy
AbstractIgA nephropathy (IgAN) is one the most common primary glomerulonephritis in children and adolescents worldwide, with 20% of children developing end-stage kidney disease (ESKD) within 20  years of diagnosis. There is a need for treatment guidelines, especially for steroids in children with primary IgAN, since the STOP-IgA trial casts doubts on the use of steroids in adults with intermediate risk. Pediatricians are prone to prescribe steroids in addition to renin–angiotensin syste m blockade (RASB) when proteinuria is>  0.5 g/l, eGFR deteriorates 
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Prognostic role of acute kidney injury on long-term outcome in infants with hypoxic-ischemic encephalopathy
ConclusionsAKI might be a reliable indicator of death or long-term disability in infants with HIE receiving TH, but the absence of AKI does not guarantee a favorable long-term outcome. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation
AbstractAfter pediatric kidney transplantation BK polyomavirus (BKPyV) infections are associated with an increased risk of graft loss by BKPyV-associated nephropathy (BkPyVAN). However, suitable prognostic markers for the individual outcome of BKPyV infections are missing and the management of therapeutic interventions remains a challenge to the success of pediatric kidney transplantation. This review gives an overview on current diagnostic and therapeutic strategies in the field of BKPyV infections after pediatric kidney transplantation. Methods determining the individual immune response to BKPyV are described and their u...
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis —clinical practice recommendation from the Pediatric Renal Nutrition Taskforce
We present CPRs for the dietary intake of Ca and P in children with CKD stages 2 –5 and on dialysis (CKD2-5D), describing the common Ca- and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo- and hypercalcemia and hyperphosphatemia. T he statements have been graded, and statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. These C...
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Treatment of hyperphosphatemia: the dangers of aiming for normal PTH levels
AbstractSecondary hyperparathyroidism is part of the complex of chronic kidney disease-associated mineral and bone disorders (CKD-MBD) and is linked with high bone turnover, ectopic calcification, and increased cardiovascular mortality. Therefore, measures for CKD-MBD aim at lowering PTH levels, but there is no general consensus on optimal PTH target values. This manuscript is part of a pros and cons debate for keeping PTH levels within the normal range in children with CKD, focusing on the cons. We conclude that a modest increase in PTH most likely represents an appropriate adaptive response to declining kidney function i...
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones
ConclusionsPediatric nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

A boy with IgA vasculitis and anuria: Answers
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 17, 2020 Category: Urology & Nephrology Source Type: research

Ofatumumab rescue treatment in post-transplant recurrence of focal segmental glomerulosclerosis
ConclusionsOfatumumab may be a therapeutic option for post-transplant FSGS recurrence in patients who respond poorly to rituximab. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Quality improvement in pediatric nephrology —a practical guide
AbstractImproving quality of care delivery is an important focus for all practicing physicians. Frontline clinicians are in a great position to identify clinical problems and find innovative solutions. The current review describes the method used for quality improvement based on theModel for Improvement, a structural framework to guide improvement work. At its basis are three fundamental questions:What are we trying to accomplish? How will I know that a change will lead to improvement? And what changes could we make that will result in improvement? This preparation phase aims to identify and understand the problem, choose ...
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Risk factors for complications of percutaneous ultrasound-guided renal biopsy in children
AbstractBackgroundPercutaneous ultrasound-guided renal biopsy (PURB) is an invasive but essential procedure in establishing the histologic diagnosis of pediatric renal diseases. Large studies which describe PURB complications and its contributory risk factors are scarce in the pediatric literature.MethodsPatients who underwent real-time PURB from September 2011 to August 2017 were retrospectively reviewed. Data pertaining to clinical characteristics, histologic diagnosis and biopsy-related complications were collected. In addition, the risk factors for complications were also analyzed.ResultsOverall, 183 patients (109 fema...
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Kidney and organoid single-cell transcriptomics: the end of the beginning
AbstractSingle-cell RNA sequencing (scRNA-seq) technologies are increasingly being applied to reveal cellular heterogeneity in kidney development and disease. In just the last year, multiple scRNA-seq datasets have been generated from kidney organoids, developing mouse and human kidney, adult kidney, and kidney cancer. The data generated enables a much deeper understanding of biological processes within and between cells. It has also elucidated unforeseen cell lineage relationships, defined the presence of off-target cell types in kidney organoids, and revealed a diverse inflammatory response in a human kidney allograft un...
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Functional roles of Grainyhead-like transcription factors in renal development and disease
AbstractProper renal function relies on the tightly regulated development of nephrons and collecting ducts. This process, known as tubulogenesis, involves dynamic cellular and molecular changes that instruct cells to form highly organized tubes of epithelial cells which compartmentalize the renal interstitium and tubular lumen via assembly of a selective barrier. The integrity and diversity of the various renal epithelia is achieved via formation of intercellular protein complexes along the apical –basal axis of the epithelial cells. In recent years, the evolutionarily conserved family of Grainyhead-like (GRHL) trans...
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Renal aspects of metabolic acid –base disorders in neonates
AbstractAcid –base homeostasis is one of the most tightly regulated systems in the body. Maintaining the acid–base balance is particularly challenging for preterm infants and growing neonates. The kidney, which represents the crucial ultimate line of defense against disturbances of acid–base balance, under goes a complex maturation process during the transition from a fetal to an extra-uterine environment. This review article summarizes the physiology of acid–base regulation by the immature human kidney and discusses disorders of acid–base balance, such as metabolic acidosis, respiratory acido...
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

A rare cause of chronic hyponatremia in an infant: Answers
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

An uncommon case of arthrogryposis, renal dysfunction, and cholestasis (ARC) syndrome and review of the renal involvement: Questions
AbstractArthrogryposis, renal dysfunction, and cholestasis syndrome is a rare autosomal recessive disorder caused by mutations in the VPS33B and VIPAR genes. Most cases are fatal within the first year of life. Here we describe one of the two oldest patients with arthrogryposis, renal dysfunction, and cholestasis syndrome. This is a 12-year-old Hispanic female, from a non-consanguineous parents, diagnosed with an incomplete phenotype of arthrogryposis, renal dysfunction, and cholestasis syndrome with arthrogryposis and renal tubular dysfunction but without cholestasis. At 11 years of age, she was found to have impaired rena...
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

An uncommon case of arthrogryposis, renal dysfunction, and cholestasis (ARC) syndrome and review of the renal involvement: Answers
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Utilisation of kidneys from deceased donors at increased risk of infectious disease transmission: a step in the right direction
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

A rare cause of chronic hyponatremia in an infant: Questions
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Correction to: C3 levels and acute outcomes in Shiga toxin –related hemolytic uremic syndrome
Due to an unfortunate error during the processing of the article, the spelling of the second author name was incorrect. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - January 2, 2020 Category: Urology & Nephrology Source Type: research

Colostomy in children on chronic peritoneal dialysis
ConclusionAlthough feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Serial measurement of electrolyte and citrate concentrations in blood-primed continuous hemodialysis circuits during closed-circuit dialysis
ConclusionsFor closed-circuit dialysis using an RBC solution, the formula [dialysate flow rate (mL/min)  × time of dialysis (min)]/extracorporeal volume (mL) would be a better parameter to estimate efficacy, compared with other metrics. Additionally, the citrate concentration can be readily estimated from the ionized calcium concentration during closed-circuit dialysis. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

ABO-incompatible pediatric kidney transplantation without antibody removal
AbstractBackgroundBecause of the severe shortage of suitable deceased donors, ABO-incompatible living donor kidney transplantation (ABOi LDKT) is performed even in pediatric recipients in Japan. We performed pediatric ABOi LDKT using rituximab without anti-A/B antibody removal.MethodsThirteen pediatric recipients (mean age 7.4, range 3.4 –15.7, four females) whose baseline anti-A/B IgG titers were ≤ × 64 underwent ABOi LDKT without antibody removal and splenectomy between July 2013 and April 2017 at Toho University. Mycophenolate mofetil (MMF) was initiated on day − 10. Rituximab (...
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Alport syndrome: deducing the mode of inheritance from the presence of haematuria in family members
AbstractThe diagnosis of Alport syndrome is suspected when an individual has haematuria or renal failure, together with a hearing loss; haematuria or renal failure, and a family history of Alport syndrome; or a pathognomonic Alport feature, such as lenticonus, fleck retinopathy, a lamellated glomerular basement membrane (GBM), or a GBM that lacks the collagen IV α3α4α5 network. The diagnosis of Alport syndrome is optimally confirmed by the demonstration of a mutation in theCOL4A5 gene or two mutationsin trans in theCOL4A3 orCOL4A4 genes. In practice, genetic testing for Alport syndrome is not widely avail...
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Clinicopathological features of C3 glomerulopathy in children: a single-center experience
ConclusionsComplement and genetic studies are now routinely recommended for patients with a histopathological diagnosis of C3G. Careful interpretation of these studies and their prognostic and therapeutic implications in conjunction with biopsy findings is needed to further understand the pathophysiology of this rare disease in children. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

The European Society for Paediatric Nephrology study of pediatric renal care in Europe: comparative analysis 1998 –2017
ConclusionsThe 20-year follow-up analysis of pediatric renal care services in European countries revealed that pediatric nephrology has become a well-established subspecialty in pediatrics and nephrology in 2017. The ESPN will continue its efforts to further improve pediatric renal care for European children by harmonizing remaining disparities of renal care services. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Catch-up growth in children with chronic kidney disease started on enteral feeding after 2 years of age
AbstractBackgroundEnteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age.MethodsRetrospective study of pre-transplant, pre-pubertal children (
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Cardiovascular risk factors in children on dialysis: an update
AbstractCardiovascular disease (CVD) is a life-limiting comorbidity in patients with chronic kidney disease (CKD). In childhood, imaging studies have demonstrated early phenotypic characteristics including increases in left ventricular mass, carotid artery intima-media thickness, and pulse wave velocity, which occur even in young children with early stages of CKD. Vascular calcifications are the signature of an advanced phenotype and are mainly found in adolescents and young adults treated with dialysis. Association studies have provided valuable information regarding the significance of a multitude of risk factors in prom...
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Metabolic requirements of the nephron
AbstractThe mammalian kidney is a complex organ that has several metabolically active cell types to aid in waste filtration, salt-water balance, and electrolyte homeostasis in the body. These functions are done primarily through the nephron, which relies on strict regulation of various metabolic pathways. Any deviations in the metabolic profile of nephrons or their precursor cells called nephron progenitors can lead to renal pathologies and abnormal development. Metabolism encompasses the mechanisms by which cells generate intermediate molecules and energy in the form of adenosine triphosphate (ATP). ATP is required by all...
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?
AbstractMany critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children. Augmented renal clearance is often overlooked due to the lack of reliable methods to ...
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Genetic studies of focal segmental glomerulosclerosis: a waste of scientific time?
AbstractMany genetic causes of focal segmental glomerulosclerosis (FSGS) have been described. A paradox is that the science in the molecular biology, which generally appears of high quality, is not mirrored by a similarly critical analysis of the renal pathology. FSGS has been applied to such a wide range of conditions that it can reasonably be said to have no useful meaning. Attempts to refine the term have been largely ignored. Study of 252 papers on genetic causes of FSGS found various clinical features. Many papers took the reported diagnosis without question. Few papers reported a pathological review, almost half repo...
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Factors influencing the timing of initiation of renal replacement therapy and choice of modality in children with end-stage kidney disease
ConclusionsOur study found that the decision-making process in ESRD is multifactorial and involves not only medical factors, but also assessment of social factors, quality of life, and patient/family preference. Bettering our understanding of this decision-making process will positively impact patients and families through more informed decision-making. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Lymphadenopathy, splenomegaly, intermittent neutropenia, and acute kidney injury: Answers
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

A child with urosepsis and a bladder with a halo: Answers
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Lymphadenopathy, splenomegaly, intermittent neutropenia, and acute kidney injury: Questions
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

A child with urosepsis and a bladder with a halo: Questions
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 9, 2019 Category: Urology & Nephrology Source Type: research

Correlation of urine protein/creatinine ratios to 24-h urinary protein for quantitating proteinuria in children
ConclusionsUPCR showed strong correlation and consistency with 24HUPr for evaluating levels of proteinuria in children. UPCR
Source: Pediatric Nephrology - December 7, 2019 Category: Urology & Nephrology Source Type: research

Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry
AbstractBackgroundHigh prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated.MethodsThis retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant.ResultsAt discharge and 3 years post-transplant, arterial hypertension ...
Source: Pediatric Nephrology - December 7, 2019 Category: Urology & Nephrology Source Type: research

A role for OCRL in glomerular function and disease
ConclusionTaken together, this work suggests a previously under-appreciated role for OCRL in glomerular function and highlights the importance of investigating tubular function in patients with persistent proteinuria. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

A cross-sectional study on uric acid levels among Chinese adolescents
ConclusionsThe studied adolescent population showed sUA level and hyperuricemia prevalence which are even higher than those of adults in China. The epidemic of youth hyperuricemia may pose a future threat of gout attacks and other hyperuricemia-related diseases, which alarms the public, health professionals and health policy makers to prepare the future health challenges. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

Management of antenatal hydronephrosis
AbstractAntenatal hydronephrosis (AHN) is the most frequently detected abnormality by prenatal ultrasonography. Differential diagnosis of AHN includes a wide variety of congenital abnormalities of the kidney and urinary tract ranging from mild abnormalities such as transient or isolated AHN to more important ones as high-grade congenital vesicoureteral reflux or ureteropelvic junction obstruction. It is well known that the outcome depends on the underlying etiology. Various grading systems have been proposed for the classification of AHN on prenatal and postnatal ultrasonography. Mild isolated AHN represents up to 80% of c...
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

Membranous nephropathy: diagnosis, treatment, and monitoring in the post-PLA2R era
AbstractMembranous nephropathy (MN) is an immune complex-mediated cause of the nephrotic syndrome that can occur in all age groups, from infants to the very elderly. However, nephrotic syndrome in children is more frequently caused by conditions such as minimal change disease or focal segmental glomerulosclerosis, and much less commonly by MN. While systemic conditions such as lupus or infections such as hepatitis B may more commonly be associated as secondary causes with MN in the younger population, primary or “idiopathic” MN has generally been considered a disease of adults. Autoantibodies both to the M-type...
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

Twin gestation and the burden of adult cardio-renal disease
AbstractThe rate of twin births has increased by nearly 80% in recent decades largely due to advanced reproductive technologies. Twins are often born preterm and/or growth restricted which are independently associated with impaired renal and vascular development. Many preterm and twin infants are surviving into adulthood, albeit with an increased burden of chronic health conditions. Twinning as a research tool offers the unique opportunity to investigate the impact of genetics versus the environment on clinical outcomes. This educational review will focus on delineating our current understanding of the renal and cardiovasc...
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

A rare cause of steroid resistant nephrotic syndrome in a child: Questions
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

A rare cause of steroid-resistant nephrotic syndrome in a child: Answers
(Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 6, 2019 Category: Urology & Nephrology Source Type: research

A no-nonsense approach to hereditary kidney disease
AbstractThe advent of a new class of aminoglycosides with increased translational readthrough of nonsense mutations and reduced toxicity offers a new therapeutic strategy for a subset of patients with hereditary kidney disease. The renal uptake and retention of aminoglycosides at a high intracellular concentration makes the kidney an ideal target for this approach. In this review, we explore the potential of aminoglycoside readthrough therapy in a number of hereditary kidney diseases and discuss the therapeutic window of opportunity for subclasses of each disease, when caused by nonsense mutations. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 5, 2019 Category: Urology & Nephrology Source Type: research

Long-lasting chronic high load carriage of Epstein-Barr virus is more common in young pediatric renal transplant recipients
ConclusionsCHL was frequent, long lasting, and occurred mainly in young transplant recipients. The absence of PTLD suggests that monitoring of EBV DNA to guide immunosuppression was effective. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 4, 2019 Category: Urology & Nephrology Source Type: research

Mode of initial renal replacement therapy and transplant outcomes in the chronic kidney disease in children (CKiD) study
ConclusionCKiD subjects undergo PKT more often compared to nationally-reported rates, and are more likely to receive a kidney transplant within 1  year of starting dialysis. African-American race and lower household-income are associated with decreased access to PKT. (Source: Pediatric Nephrology)
Source: Pediatric Nephrology - December 3, 2019 Category: Urology & Nephrology Source Type: research