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2013| November-December | Volume 23 | Issue 6
Online since
October 24, 2013
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ORIGINAL ARTICLES
Accuracy of spot urine protein creatinine ratio in measuring proteinuria in chronic kidney disease stage 3 and 4
R Nayak, RA Annigeri, V Vadamalai, R Seshadri, S Balasubramanian, BS Rao, PC Kowdle, MK Mani
November-December 2013, 23(6):428-433
DOI
:10.4103/0971-4065.120340
PMID
:24339521
We studied the accuracy of spot urine protein creatinine ratio (SpUr-PCR) to assess 24 h urine protein excretion (24 h-UP) in patients with chronic kidney disease (CKD). A total of 100 proteinuric CKD patients of stages 3 and 4 were studied. 24 h urine was collected to measure 24 h-UP and creatinine. A random day time urine sample was analyzed to measure the PCR. A formula to estimate 24 h creatinine excretion was derived from linear regression analysis and a correction factor was introduced to assess whether this improves the accuracy of the SpUr PCR in predicting 24 h-UP. Accuracy of the SpUr-PCR was assessed by Pearson's correlation, regression analysis, and Bland Altman analysis. Mean age was 51.85 ± 12 years and 81% of the patients were male. SpUr-PCR predicted 24 h-UP with good accuracy (
r
= 0.86 on a data transformed to a logarithmic scale,
P
< 0.001) and there was a good agreement between these two measures of proteinuria. However, SpUr-PCR was inaccurate in the subgroup with nephrotic range proteinuria (
r
= 0.35,
P
= 0.062), but when a correction factor for 24-h urine creatinine (24 h-UCr) was introduced, the accuracy of SpUr-PCR improved significantly in this group (
r
= 0.45,
P
= 0.013). Introduction of the correction factor improved the degree of agreement between these two measures in women, but not the correlation. Overall, SpUr-PCR accurately predicted 24 h-UP. Adding a correction factor for 24 h-UCr improved correlation in the subgroup of patients with the nephrotic range proteinuria and the degree of agreement in female patients, and hence may be used in expressing proteinuria measured by SpUr-PCR to improve its accuracy in them.
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271
1
REVIEW ARTICLE
Current practice of conventional intermittent hemodialysis for acute kidney injury
H Schiffl, SM Lang
November-December 2013, 23(6):395-402
DOI
:10.4103/0971-4065.120324
PMID
:24339514
The use of conventional intermittent hemodialysis (IHD) represents a mainstay of supportive care of patients with acute kidney injury (AKI). However, a number of fundamental questions regarding the optimal management of IHD remain unanswered after more than six decades of renal replacement therapy (RRT). This review summarizes current evidence regarding the timing of initiation of intermittent hemodialysis, the comparative outcomes (mortality and recovery of renal function), the prescription of the intensity of this therapy and discontinuation of dialysis. The way conventional IHD is performed has an impact on the outcome of sick patients with AKI. The value of regular education and training of those who provide IHD cannot be emphasized enough. However, we must be realistic in our expectations that no mode of RRT
per
se
will substantially alter the excessive mortality of critically ill-patients with AKI.
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493
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CASE REPORTS
Distal renal tubular acidosis and amelogenesis imperfecta: A rare association
P Ravi, TS Ekambaranath, S Ellil Arasi, E Fernando
November-December 2013, 23(6):452-455
DOI
:10.4103/0971-4065.120345
PMID
:24339526
Renal tubular acidosis (RTA) is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I) is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI) represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previously asymptomatic presented with the hypokalemic paralysis and on work-up found out to have type I RTA. The discoloration of teeth and enamel was diagnosed as AI.
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ORIGINAL ARTICLES
Elevated human chorionic gonadotropin levels in patients with chronic kidney disease: Case series and review of literature
S Soni, MC Menon, M Bhaskaran, KD Jhaveri, E Molmenti, V Muoio
November-December 2013, 23(6):424-427
DOI
:10.4103/0971-4065.120339
PMID
:24339520
Women are often subjected to serum human chorionic gonadotropin (HCG) testing prior to diagnostic and therapeutic interventions. A positive result leads to further testing to rule out pregnancy and avoid possible fetal teratogenicity. The impact of chronic kidney disease (CKD) on HCG testing has not been studied. We report a series of 5 women out of 62 with CKD, who had a positive HCG test on routine pre-transplant screening at a single transplant center. We analyzed their case records retrospectively. Despite aggressive investigation, their elevated HCG levels remained unexplained. The positive test contributed to delays in transplantation and increased overall cost of treatment.
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2,592
111
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Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome
A Iyengar, N Kamath, KD Phadke, M Bitzan
November-December 2013, 23(6):419-423
DOI
:10.4103/0971-4065.120338
PMID
:24339519
Cyclosporine A (CyA) is an effective agent for the treatment of glucocorticoid-dependent idiopathic nephrotic syndrome (GCDNS), but costs are prohibitive in resource-poor societies. The objectives of this study were to evaluate the efficacy and safety of reducing the dose of CyA by co-administering ketoconazole. A prospective study targeting children 2-18 years of age with GCDNS in remission with CyA monotherapy was conducted. CyA dose was reduced by 50% and ketoconazole was added at 25% of the recommended therapeutic dose, and the drug levels and therapeutic and adverse effects (AE) were monitored. Continued combined therapy after completion of the 4-week trial period was offered. Ten patients (median age 9.5 years, range 3.0-16.0 years) were enrolled in the study. At week 4, the CyA dose was 2.2 ± 0.7 mg/kg/day compared with 5.6 ± 0.9 mg/kg/day at enrolment (
P
< 0.0001). No AE were noted. All patients continued ketoconazole treatment for at least 3 months. CyA drug cost savings were 61%, and approximately 60% with ketoconazole cost included. The combination of an expensive immunosuppressive drug with a cheap metabolic inhibitor reduced the treatment costs by> 50% without increased adverse events or drug monitoring needs. This intervention demonstrates how access of patients with limited resources to needed drugs can be improved by interference with physiological drug elimination.
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2,454
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1
Granulomatous interstitial nephritis: Our experience of 14 patients
GD Naidu, R Ram, G Swarnalatha, M Uppin, AK Prayaga, KV Dakshinamurty
November-December 2013, 23(6):415-418
DOI
:10.4103/0971-4065.120336
PMID
:24339518
Granulomatous interstitial nephritis (GIN) is a rare condition. Drugs, infections, immune processes, and foreign body reaction are the main causes. We identified a total of 14 patients with GIN during a period of 13 years in 2798 renal biopsies. There were 8 males and 6 females in the age range of 20-70 (mean 35 ± 12) years. The serum creatinine at presentation was 6.7 ± 3.8 (range: 2.3-14.7) mg/dl. In nine patients tuberculosis was the causative agent. Drugs (
n
= 2) and Wegener's granulomatosis (
n
= 1) were other etiologies. Systemic lupus erythematosis (SLE) and Immunoglobulin A nephropathy (IgAN) were seen in one patient each. Patients with tuberculosis were treated with antituberculous therapy and three of them improved. Four out of six patients who required dialysis at presentation remained dialysis dependent, one of whom underwent renal transplantation. Two patients progressed to end stage renal disease after 7 years and 9 years each. The patients with drug induced GIN had improvement in renal function after prednisolone treatment. Patients with SLE, and Wegener's granulomatosis responded to immunosuppression. Patient with IgAN was on conservative management. Finally, six patients were on conservative management for chronic renal failure.
[ABSTRACT]
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2,276
177
3
Efficacy of basiliximab induction in poorly matched living donor renal transplantation
S Gundlapalli, M Rathi, HS Kohli, V Jha, A Sharma, M Minz, V Sakhuja
November-December 2013, 23(6):409-412
DOI
:10.4103/0971-4065.120332
PMID
:24339516
Non-depleting antibody induction has the best safety profile in transplant recipients without an increased risk of infection or malignancy. This observational study was performed in intermediate immunologic risk live donor renal transplants to assess basiliximab efficacy in patients on tacrolimus, mycophenolate, and prednisolone immunosuppression. A total of 46 patients on basiliximab induction were compared to risk matched 56 controls at the end of 6 and 12 months post-transplant. An additional cost of approximately Rs. 100,000/patient was incurred by the basiliximab group. The incidence of biopsy proven acute rejection in the control group (12.5%, 6 months and 20.5%, 1 year) and the basiliximab group (13%, 6 months and 18.9%, 1 year) was similar. At 6 months, there was a non-significant trend toward more steroid sensitive rejections and better glomerular filtration rate preservation in the basiliximab group (83.3%, 71.9 ml/min) versus the control group (28.6%, 62.2 ml/min). However, this difference was lost at 1 year (70.1 ml/min vs. 67.6 ml/min). The incidence of infections was similar and none of the patients had a malignancy. Death censored graft survival (94.6% basiliximab and 94.8% control) and the mean number of hospitalizations for all reasons at the end of 1 year were not different among the two groups. In our study, basiliximab induction did not confer an additional advantage in the intermediate risk live donor transplants in patients on tacrolimus and mycophenolate based triple drug immunosuppression.
[ABSTRACT]
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2,138
212
2
CASE REPORTS
Chronic type B aortic dissection in association with Hemolyticuremic syndrome in a child
DN Gera, PP Ghuge, S Gandhi, AV Vanikar, JD Shrimali, VB Kute, HL Trivedi
November-December 2013, 23(6):456-459
DOI
:10.4103/0971-4065.120346
PMID
:24339527
Aortic dissection (AD) is a potentially life-threatening medical emergency usually encountered in the elderly. Here, we report a 9-year-old child who was incidentally detected to have asymptomatic chronic type B dissecting aneurysm of aorta when he presented with relapse of Hemolytic uremic syndrome (HUS) without any genetic abnormalities like Marfan or Ehler-Danlos syndrome. To the best of our knowledge, this is the first case of AD associated with HUS in a child without any known associated genetic or inherited risk factors.
[ABSTRACT]
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2,237
76
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ORIGINAL ARTICLES
Emphysematous pyelonephritis: Outcome with conservative management
RA Bhat, I Khan, I Khan, N Palla, T Mir
November-December 2013, 23(6):444-447
DOI
:10.4103/0971-4065.120343
PMID
:24339524
Emphysematous pyelonephritis is a life-threatening condition characterized by necrotising gas forming infection of the renal parenchyma. We describe eight patients seen over a period of 2 years, 62.5% males and 37.5% females with age range between 21 and 65 years. About 75% patients had diabetes mellitus. Six patients were managed conservatively. One patient required nephrectomy with percutaneous drainage and one patient died without surgical intervention.
[ABSTRACT]
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2,082
165
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Influence of steroid maintenance on the outcomes in deceased donor kidney transplant recipients experiencing delayed graft function
B Tangirala, RJ Marcus, SM Hussain, KK Sureshkumar
November-December 2013, 23(6):403-408
DOI
:10.4103/0971-4065.120328
PMID
:24339515
Delayed graft function (DGF) is a risk factor for poor long-term graft and patient survival after kidney transplantation. The aim of our study was to explore the beneficial effect of steroid maintenance on outcomes in deceased donor kidney (DDK) transplant recipients with DGF. Using organ procurement and transplant network/United network of organ sharing (OPTN/UNOS) database, we identified adult patients who developed DGF following DDK transplantation performed between January 2000 and December 2008. They received induction with rabbit antithymocyte globulin (r-ATG), alemtuzumab or an interluekin-2 receptor blocker (IL-2B) and were discharged on a calcineurin inhibitor (CNI)/mycophenolate (MMF) based immunosuppression with or without steroids. Adjusted graft and patient survivals were compared between steroid versus no steroid groups for each induction modality. Median follow-up was 29.6 months for the 10,058 patients who developed DGF. There were 5624 patients in r-ATG (steroid,
n
= 4569, no steroid,
n
= 1055), 819 in alemtuzumab (steroid,
n
= 301, no steroid,
n
= 518) and 3615 in IL-2B (steroid,
n
= 3380, no steroid,
n
= 235) groups. Adjusted graft survivals were similar for steroid versus no-steroid groups in patients who received r-ATG (HR: 0.98, 95% CI 0.85-1.13,
P
= 0.75), alemtuzumab (HR 0.88, 95% CI 0.65-1.19,
P
= 0.41), and IL-2B (HR 1.01, 95%CI 0.78-1.30,
P
= 0.96) inductions. The adjusted patient survivals were also similar in r-ATG (HR: 1.19, 95% CI 0.96-1.46,
P
= 0.19), alemtuzumab (HR: 0.89, 95% CI: 0.57-1.39,
P
= 0.96), and IL-2R (HR: 1.07, 95% CI: 0.77-1.49,
P
= 0.96) groups. Our study failed to show any significant graft or patient survival benefits associated with steroid addition to CNI/MMF regimen in DDK recipients with DGF. This may be related to the early immunogenic and non-immunogenic allograft damage from DGF with long-term consequences that are unaltered by steroids.
[ABSTRACT]
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2,006
122
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Anti-C reactive protein antibodies in Indian patients with systemic lupus erythematosus
V Pradhan, A Rajadhyaksha, K Yadav, P Surve, M Patwardhan, N Dhavale, P Pandit, K Ghosh
November-December 2013, 23(6):434-437
DOI
:10.4103/0971-4065.120341
PMID
:24339522
Systemic lupus erythematosus (SLE) is characterized by over production of autoantibodies. C-reactive protein (CRP) is a phylogenetically highly conserved plasma protein that participates in the systemic response to inflammation. Anti-CRP antibodies might have biological functions of pathogenetic interest in SLE. We evaluated anti-CRP antibodies in Indian SLE patients and their association with anti-dsDNA antibodies and complement levels (C3 and C4). One hundred SLE patients diagnosed according to the American College of Rheumatology criteria were included. Disease activity was assessed using SLE disease activity index (SLEDAI). Anti-CRP autoantibodies were detected by enzyme linked immunosorbent assay. Anti-dsDNA antibodies were detected by indirect immunofluroscence test (Euroimmun Lubeck, Germany). High sensitivity CRP and complement levels (C3, C4) were detected using a Nephelometer. (BN ProSpec, Dade Behring, Germany). Anti-CRP antibodies were detected in 26% of SLE patients. Mean age of disease onset among anti-CRP positives was 22.4 ± 7.5, and 26.6 ± 9.3 years among anti-CRP negatives (
P
> 0.05). Anti-dsDNA positivity was significantly higher among anti-CRP positives (32.7%) as compared to anti-CRP negatives (16%) (
P
= 0.00519). No statistically significant difference was observed in SLEDAI scores of anti-CRP positive group and anti-CRP negative group (
P
> 0.05). We observed a positive correlation between anti-CRP antibodies and anti-dsDNA antibodies.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,017
105
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CASE REPORTS
Successful renal transplantation from a brain-dead deceased donor with head injury, disseminated intravascular coagulation and deranged renal functions
PP Ghuge, VB Kute, AV Vanikar, MR Gumber, DN Gera, HV Patel, PR Shah, PR Modi, VR Shah, HL Trivedi
November-December 2013, 23(6):448-451
DOI
:10.4103/0971-4065.120344
PMID
:24339525
Deceased donors (DDs) with the brain death due to head injury are the major source of organs for transplantation. The incidence of post-head injury disseminated intravascular coagulation (DIC) ranges from 24% to 50%. Many centers do not accept organs from donors with DIC due to increased risk of primary graft non-function and/or high chances of morbidity/mortality. We performed two successful renal transplants from a DD with head injury with DIC and deranged renal function. One of the recipients developed transient thrombocytopenia, but there was no evidence of DIC or delayed graft functions in either of the recipients. Over a follow-up of 1 month, both are doing well with stable graft function and hematological profile. Thus, a carefully selected DD with severe DIC even with deranged renal function is not a contraindication for organ donation if other risk factors for primary non-function are excluded. This approach will also help in overcoming organ shortage.
[ABSTRACT]
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1,882
92
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LETTERS TO EDITOR
Hydatid cyst of urinary bladder
FA Ganie, OH Dar, A Kaleem, S Hassan, M Gani
November-December 2013, 23(6):462-463
DOI
:10.4103/0971-4065.120348
PMID
:24339529
[FULL TEXT]
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[PubMed]
1,727
68
-
IMAGES IN NEPHROLOGY
Cystic partially differentiated nephroblastoma: A rare renal tumor
MK Mittal, B Sureka, M Sinha, BB Thukral
November-December 2013, 23(6):460-461
DOI
:10.4103/0971-4065.120347
PMID
:24339528
[FULL TEXT]
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1,467
81
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COMMENTARY
Interleukin receptor antagonist induction in kidney transplantation: Is it worth the price?
V Kher
November-December 2013, 23(6):413-414
PMID
:24339517
[FULL TEXT]
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[PubMed]
1,311
140
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LETTERS TO EDITOR
Is bullous skin lesion a risk factor for renal amyloidosis in patients with familial Mediterranean fever?
G Sargin, A Alp, H Akdam, H Akar, Y Yenicerioglu
November-December 2013, 23(6):469-470
DOI
:10.4103/0971-4065.120355
PMID
:24339536
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,295
73
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Pseudohyperphosphatemia in Waldenstrom's Macroglobulinemia
SD Amalnath, B Dubashi
November-December 2013, 23(6):465-466
DOI
:10.4103/0971-4065.120351
PMID
:24339532
[FULL TEXT]
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[CITATIONS]
[PubMed]
1,196
57
1
Peritonitis due to nontuberculous mycobacterium
R Ram, G Diwakar Naidu, G Swarnalatha, KV Dakshinamurty
November-December 2013, 23(6):464-465
DOI
:10.4103/0971-4065.120350
PMID
:24339531
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,174
65
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Aplastic anemia, membranous nephropathy and mercury
J Rooney
November-December 2013, 23(6):467-468
DOI
:10.4103/0971-4065.120353
PMID
:24339534
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,124
53
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Guidewire fragmentation complicating hemodialysis catheter insertion
R Haldar, S Samanta, S Samanta
November-December 2013, 23(6):468-469
DOI
:10.4103/0971-4065.120354
PMID
:24339535
[FULL TEXT]
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1,071
92
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Prospective analysis of utility and feasibility of ambulatory blood pressure monitoring service in a pediatric nephrology set up
R Sinha
November-December 2013, 23(6):463-464
DOI
:10.4103/0971-4065.120349
PMID
:24339530
[FULL TEXT]
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1,093
66
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Utility of renal allograft biopsy: An audit of 80 allograft biopsies
M Mubarak
November-December 2013, 23(6):466-467
DOI
:10.4103/0971-4065.120352
PMID
:24339533
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,061
85
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ORIGINAL ARTICLES
Contribution of
GSTM1
,
GSTT1
, and
MTHFR
polymorphisms to end-stage renal disease of unknown etiology in Mexicans
BE Gutiérrez-Amavizca, R Orozco-Castellanos, R Ortíz-Orozco, J Padilla-Gutiérrez, Y Valle, N Gutiérrez-Gutiérrez, G García-García, M Gallegos-Arreola, LE Figuera
November-December 2013, 23(6):438-443
DOI
:10.4103/0971-4065.120342
PMID
:24339523
Oxidative stress is increased in chronic kidney disease, owing to an imbalance between the oxidative and antioxidant pathways as well as a state of persistent hyperhomocysteinemia. The enzymes glutathione S-transferases (GSTs) and methylenetetrahydrofolate reductase (
MTHFR
) are implicated in the regulation of these pathways. This study investigates the association between polymorphisms in the Glutathione S-transferase Mu 1 (
GSTM
1), glutathione S-transferase theta 1 (
GSTT
1), and
MTHFR
genes and end-stage renal disease (ESRD) of unknown etiology in patients in Mexico. A Case-control study included 110 ESRD patients and 125 healthy individuals.
GSTM
1 and
GSTT
1 genotypes were determined using the multiplex polymerase chain reaction (PCR). The
MTHFR
C677T polymorphism was studied using a PCR/restriction fragment length polymorphism method. In ESRD patients,
GSTM
1 and
GSTT
1 null genotype frequencies were 61% and 7% respectively.
GSTM
1 genotype frequencies differed significantly between groups, showing that homozygous deletion of the
GSTM
1 gene was associated with susceptibility to ESRD of unknown etiology (
P
= 0.007, odds ratios = 2.05, 95% confidence interval 1.21-3.45). The
MTHFR
C677T polymorphism genotype and allele distributions were similar in both groups (
P
> 0.05), and the CT genotype was the most common genotype in both groups (45.5% and 46.6%). Our findings suggest that the
GSTM
1 null polymorphism appears to be associated with the ESRD of unknown etiology in patients in Mexico.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
874
65
1
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© Indian Journal of Nephrology
Published by Wolters Kluwer -
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Online since 20
th
Sept '07