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Pulmonary Hypertension in Chronic Hemodialysis Patients at Aristide Le Dantec University Hospital

Open Journal of Nephrology 2022年第1期12卷 93-100页

作者： Maria Faye ahmed Tall Lemrabott Niakhaleen Keita Moustapha Faye Romina Ghassani Mansour Mbengue Bacary Ba Seynabou Diagne abdou Niang El Hadj Fary Ka Nephrology Department Aristide Le Dantec University Hospital Dakar Senegal Cheikh Anta Diop University Dakar Senegal Nephrology Department Dalal Jamm Hospital Dakar Senegal

Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p = 0.015), as well as dilation of the inferior vena cava (p = 0.048).

关键词： Pulmonary Hypertension Chronic Hemodialysis Patients Transthoracic Doppler Ultrasound Dakar

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Pathological Fractures in Chronic Hemodialysis Patients in a Teaching Hospital in Senegal: Prevalence and Associated Risk Factors

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Open Journal of Nephrology 2023年第3期13卷 211-219页

作者： ahmed Tall Lemrabott Baratou Coundoul Niakhaleen Keita Maria Faye Moustapha Faye Mansour Mbengue Bacary Ba Seynabou Diagne abdou Niang El Hadji Fary Ka Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Department of Nephrology Dalal Jamm National Hospital Center Dakar Senegal Dialysis Center National Hospital Center of Pikine Pikine Senegal

Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are available on the subject in sub-Saharan Africa. The objective of this work was to evaluate the prevalence of pathological fractures in our chronic hemodialysis patients, to analyze their clinical aspects and to determine the factors associated with their occurrence. Patients and Methods: We conducted a retrospective, descriptive and analytical study over 9 years (January 1, 2011, to December 31, 2020) based on the medical records of chronic hemodialysis patients at the CHU Aristide Le Dantec. The diagnosis of pathological fracture was retained in front of any fracture occurring spontaneously or following minimal trauma and confirmed by X-ray. Results: Nineteen cases of pathological fractures were collected with a hospital prevalence of 19.39%. The mean age was 53.32 ± 13.94 years with a sex ratio of 0.36. The average seniority in dialysis was 84.16 ± 29.88 months. Among these patients, one had had 3 episodes of fractures and another 6 episodes. The circumstances of occurrence of the fractures were the fall in 63% of the cases, spontaneously in 37% of the cases. The predominant site of fractures was the femoral neck (47.38% cases). Female gender (p 5 years (p = 0.049), gait disturbances prior to the fracture (p = 0.001), positive CRP (p = 0.028) and the presence of vascular calcifications (p = 0.002) were significantly associated with the occurrence of pathological fractures. Conclusion: This study has identified the factors associated with the occurrence of pathological invoices in hemodialysis patients in our context. These fractures are often associated with the lack of regular biological follow-up due to the low socioeconomic level of our patients.

关键词： Pathological Fractures CKD-MBD Hyperparathyroidism Osteomalacia Adynamic Bone Disease Chronic Hemodialysis

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Quality of Life of Patients on Peritoneal Dialysis in Dakar: A Senegalese Single Centre Experience

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Open Journal of Nephrology 2016年第2期6卷 37-42页

作者： Kane Yaya Cisse Mouhamadou Moustapha Seck Sidy Mohamed Lemrabott ahmed Tall Faye Maria Hounsounou Christian Diallo Kalilou Ka El Hadji Fary Niang abdou Diouf Boucar Nephrology and Internal Medicine Department of Assane Seck University Ziguinchor Senegal Nephrology Department of Teaching Hospital Aristide Le Dantec Dakar Senegal Nephrology Department of Gaston Berger University Saint-Louis Senegal

Introduction: Measuring the quality of life (QOL) in recent years has become an indispensable tool in monitoring patients suffering from chronic diseases. We conducted this study to assess QOL of patients undergoing peritoneal dialysis in Dakar, and to identify associated factors. Patients and Methods: This is a cross-sectional study which was carried out from 10 to 30 June, 2011 in the peritoneal dialysis unit at university hospital in Dakar. We included all patients with end-stage renal disease (ESRD) of any age, who were on PD since at least six months and who gave their consent. The QOL was assessed using the Kidney Disease Quality of Life Short-Form 1.2 (KDQoL-SF). Results: Sixteen patients were included with a mean age of 50.25 ± 13.48 years and a sex-ratio of 1.27. Considering SF-36, the overall mean score (SMG) was 60.11 ± 15.96 with a Mean Physical Component Summary Scale of 53.66 ± 16.98 and a Mental Component Summary Scale of 70.85 ± 6.14. Concerning the KDQoL-SF, the global mean score was 61.83 ± 19.35 with a mean physical score of 50.55 ± 16.52 and a mean mental score of 62.52 ± 21.53. The mean dialysis specific dimension score was 62.52 ± 21.53 and the mean mental health score was 85.93 ± 12.06. Age, weight, level of instruction and social support were correlated with a worse QOL. Conclusion: This study showed an alteration of our PD patients’ QOL, particularly in their physical health. However, the number of patients included in the study is not enough to permit a formal conclusion.

关键词： Quality of Life Peritoneal Dialysis Dakar

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Acute Renal Failure in the Elderly in the Nephrology Department of Aristide Le Dantec Hospital in Senegal: About 45 Cases

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Open Journal of Nephrology 2023年第4期13卷 451-463页

作者： Arlette Géraldine Nguea Ndjame Ameth Dieng Vincent Ebenezer Ngamby Mamadou Coume El Hadji Fary Ka Maria Fall ahmed Tall Lemrabott Mouhamadou Moustapha Cisse abdou Niang Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Central Hospital of Yaoundé Yaoundé Cameroon Health Sciences Training and Research Unit University of Thiès Thiès Senegal Regional Hospital of Thiès Thiès Senegal Faculty of Medicine Pharmacy and Odontology Cheikh Anta Diop University Dakar Senegal National University Hospital of Fann Dakar Senegal Aristide Le Dantec Hospital Dakar Senegal Dalal Jamm National University Hospital of Guédiawaye Dakar Senegal

Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.

关键词： Acute Renal Failure Elderly Epidemiology

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Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

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World Journal of Gastrointestinal Endoscopy 2022年第6期14卷 402-415页

作者： Hussein Hassan Okasha Abeer Abdellatef Shaimaa Elkholy Mohamad-Sherif Mogawer Ayman Yosry Magdy Elserafy Eman Medhat Hanaa Khalaf Magdy Fouad Tamer Elbaz ahmed Ramadan Mervat E Behiry Kerolis Y William Ghada Habib Mona Kaddah Haitham Abdel-Hamid Amr Abou-Elmagd ahmed Galal Wael A Abbas ahmed Youssef Altonbary mahmoud El-Ansary Aml E abdou Hani Haggag Tarek Ali Abdellah Mohamed A Elfeki Heba ahmed Faheem Hani M Khattab Mervat El-Ansary Safia Beshir Mohamed El-Nady Department of Internal Medicine and Hepatogastroenterology Kasr Al-Aini HospitalsCairo UniversityKasr Al-Aini HospitalsCairo UniversityCairo 11451Egypt Department of Endemic Diseases Cairo UniversityCairo 11451Egypt Department of Tropical Medicine and Gastroenterology Minia UniversityMinia 61511Egypt Department of Internal Medicine Kasr Al-Aini HospitalsCairo UniversityCairo 11562Egypt Department of Gastroenterology Armed forces College of MedicineCairo 11451Egypt Endoscopy and Internal Medicine Consultant at Dr/ahmed Galal Endoscopy Center Alexandria 35516Egypt Department of Internal Medicine Faculty of MedicineAssuit UniversityAssuit 71111Egypt Department of Gastroenterology and Hepatology Mansoura UniversityMansoura 35511Egypt Department of Gastroenterology and Hepatology Theodor Bilharz Research InstituteCairo 11451Egypt Department of Microbiology and Immunology Faculty of Medicine for girls Al-Azhar UniversityCairo 11451Egypt Department of Internal Medicine Faculty of MedicineAin shams UniversityCairo 11451Egypt Department of Internal Medicine Bani-suef UniversityBani-suefBani-suef 62511Egypt Department of Pathology Faculty of MedicineCairo UniversityCairo 11451Egypt Department of Clinical Pathology Faculty of MedicineCairo UniversityCairo 11451Egypt Department of Environmental Medicine&Clinical Pathology National Research CentreCairo 11451Egypt

BACKGROUND Pancreatic cystic lesions(PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant *** To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen(CA)19-9, CA72-4], carcinoembryonic antigen(CEA), serine protease inhibitor Kazal-type 1(SPINK1), interleukin 1 beta(IL1-β), vascular endothelial growth factor A(VEGF-A), and prostaglandin E2(PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign *** This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound(EUS) and EUS-fine needle aspiration(EUS-FNA) for characterization and sampling of different *** The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance(59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively(P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance(P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic *** EUS examination of cyst morphology with cytopathological analysis and cyst fluid ana

关键词： Pancreatic cystic neoplasm Mucinous cystic neoplasm Intraductal papillary mucinous neoplasm Mucin stain Amylase

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Tuberculosis among Chronic Hemodialysis Patients: A Senegalese Single Center Experience

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Open Journal of Nephrology 2015年第4期5卷 117-122页

作者： Mouhamadou Moustapha Cisse Rachid El Kabouss Yaya Kane Sidy Mouhamed Seck ahmed Tall Lemrabott Maria Faye El Hadji Fary Ka Ansoumana Diatta abdou Niang Boucar Diouf Nephrology Department of Teaching Hospital Aristide le Dantec Dakar Senegal Department of Nephrology Assane Seck University Ziguinchor Senegal Department of Nephrology Gaston Berger University Saint Louis Senegal

Summary: Tuberculosis is a common infectious disease in chronic hemodialysis due to alteration of the immune system associated with chronic kidney disease. The objectives of this study are to determine the prevalence of tuberculosis in chronic hemodialysis patients and to identify its diagnostic and therapeutic difficulties. Methods and patients: This was a descriptive retrospective study over a period of 20 years (1994-2014). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Aristide Le Dantec University Teaching Hospital in Dakar which clinical symptoms and laboratory favor tuberculosis. Results: Of 258 chronic hemodialysis patients treated in Hospital Aristide Le Dantec hemodialysis center, 29 cases (11.4%) of tuberculosis disease are diagnosed. The mean age is 43.21 ± 12.48 years, and the sex-ratio is 0.8. The median time to onset of tuberculosis after initiation of hemodialysis is 22.86 ± 28.86 months. The diagnosis of tuberculosis is sure only in 17% of cases. Extra-pulmonary sites are found in 79% of cases. The average duration of treatment is 9.39 ± 1.64 months (6 - 13 months). Various treatment protocols are adopted. Mortality is 21%, 50% due to disseminated tuberculosis. Conclusion: The diagnosis of tuberculosis in the chronic hemodialysis patients is often difficult due to the atypical symptoms, the frequency of extra-pulmonary location and the lack of evidence of sure diagnosis.

关键词： Tuberculosis Hemodialysis Dakar

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Renal Cortical Necrosis: An Unusual Complication of <i>Plasmodium malariae</i>Malaria

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Open Journal of Nephrology 2015年第4期5卷 99-104页

作者： ahmed Tall Lemrabott Mouhamadou Moustapha Cissé Sidy Mohamed Seck Elhadji Fary Ka Maria Faye Aliou Ndongo Cherif Dial Younoussa Keita Khodia Fall abdou Niang Boucar Diouf Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Faculty of Medicine Gaston Berger University Saint-Louis Senegal Anatomo-Pathology Laboratory Grand-Yoff General Hospital Dakar Senegal

Renal cortical necrosis (RCN) is anecdotal in malaria. To our knowledge, RCN secondary to Plasmodium malariae has not yet been published. We report a case of severe malaria complicated by RCN. A 29 year old Senegalese patient was transferred to our department for anuria in a context of severe malaria. The diagnosis was RCN secondary to a severe Plasmodium malariae malaria. Physical examination showed anuria, anaemic syndrome, haemorrhagic syndrome and a generally impaired condition. There was a normocytic normochromic anaemia aplastic, thrombocytopenia leukocytosis of 11.580/mm3, serum creatinine of 12.45 mg/dl and blood urea of 252 mg/dl. The Plasmodium malariae had been shown to thick blood film with high parasite density. The molecular study was able to confirm the infestation of this parasite. Treatment consisted of four haemodialysis sessions and antimalarial molecules. Initial evolution was favourable with a recovery through diuresis and a partial improvement in renal function. Given the persistence of impaired renal function, a renal biopsy was performed. This confirmed the RCN. At last consultation, he had no symptoms and his last glomerular filtration rate (GFR) was 30 mL/min/1.73 m2.

关键词： Renal Cortical Necrosis Plasmodium malariae Acute Kidney Injury Malaria

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Prevalence and the Risk Factors of Renal Insufficiency in the City of Saint Louis in Senegal

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Open Journal of Nephrology 2015年第3期5卷 83-90页

作者： ahmed Tall Lemrabott Mouhamadou Moustapha Cisse Elhadji Fary Ka Sidy Mohamed Seck Maria Faye Moussa Sarr Ngoné Diaba Gaye Alassane Mbaye abdou Niang Boucar Diouf abdoul Kane Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Faculty of Medicine Gaston Berger University Saint-Louis Senegal Department of Cardiology Grand-Yoff General Hospital Dakar Senegal

Background: The true scale of renal insufficiency (RI) in Sub-Saharan Africa remains unknown due to the lack of national registries. The aim of this study is to describe the epidemiological characteristics of renal insufficiency in urban areas in Saint Louis of Senegal. Materials and Methods: It is an observational, cross-sectional and descriptive study. The study was conducted during 27 days starting from 3 to 30 May 2010. All senegalese residents of Saint Louis (older than 15 years at the time of the study) in whom creatinine clearance was performed were included in the study. The sampling method used was a systematic random sampling, stratified cluster. The survey was designed by an expert comitee based on STEPS survey of the World Health Organization. RI was defined as a glomerular filtration rate (GFR) 2. Results: Among 1424 people initially selected a final selection of 1416 was made. The sex ratio was 0.45. The mean age was 43.4 ± 17.8 years. The overall prevalence of renal insufficiency according to MDRD (Modification of diet in renal disease) formula was 181 cases or 12.7%. The mean age of the people with renal insufficiency was 47.6 ± 17.4 years. Renal insufficiency was correlated to height blood pressure (p = 0.01) and Physical inactivity (p = 0.0001). The prevalence of renal insufficiency was higher in diabetics (71.4%) and obese people (66.6%) than in non-diabetics (64.9%) and non-obese people (56.5%), although the difference was not statistically significant. Dyslipidemia and smoking were not correlated to the risk of occurrence of IR. Conclusions: This study reports the increasing magnitude of RI and its risk factors in the city of Saint Louis in Senegal. It is imperative to establish à national prevention strategies to avoid the dizzying growth of this scourge.

关键词： Renal Insufficiency Risk Factors GFR Saint-Louis Senegal

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Hyperuricemia in Patients with Chronic Renal Failure in the General Hospital of National Reference of N’Djamena (Chad)

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Open Journal of Nephrology 2017年第1期7卷 9-18页

作者： Guillaume Mahamat Abderraman Ibrahim Hamat Zeinabou Maiga Moussa Tondi ahmed Tall Lemrabott Maria Faye Cisse Mouhamadou Moustapha Kossi Akomola Sabi Ka Elhaj Fary Ka Niang abdou Diouf Boucar Hemodialysis Unit H&#244pital Général de Référence Nationale (HGRN) N’Djamena Tchad Medical Department FSS/ Université Abdou Moumouni de Niamey Service de Néphrologie et Hémodialyse H&#244pital National Lamordé de Niamey Niamey Niger Nephrology service H&#244pital Aristide Le Dantec de Dakar Dakar Sénégal Nephrology and Hemodialysis Service CHU SO Lomé Lomé Togo

Introduction: Hyperuricemia is defined as a level of serum uric acid greater than or equal to 70 mg/l (420 μmol/l) in men and 60 mg/l (360 μmol/l) in women. Several studies have shown that it is a risk factor or a factor of progression of chronic kidney disease. Recent experimental and epidemiological data correlate the association of hyperuricemia with chronic kidney disease (CKD), arterial hypertension and cardiovascular diseases, thus raising the question of the usefulness of therapeutics in the prevention of renal diseases. The objective of this study is to seek a link between chronic kidney disease and hyperuricemia. Materials and Methods: This is a descriptive and analytical study conducted at hemodialysis unit and cardiology service of General Hospital of National reference of N’Djamena (Chad) from 1th January to 1th October 2013 (10 months). We included all chronic kidney disease patients hospitalized in hemodialysis unit and cardiology service who presented associated hyperuricemia. Results: There were 712 CKD patients who were hospitalized. Among them, there were 108 patients who were included in the study and who had hyperuricemia as a prevalence of 15.20%. The average age of patients was 35.5 years and the sex ratio was 3/1. The age group between 40 to 60 years represented 54.6%. There were 41.7% of traders. Hypertensive patients accounted for 49.1%;association of diabetes and hypertension was noted in 12.90%. Renal insufficiency was moderate in 43.5% of patients. Hyperuricemia was present in more than 90% of patients. Profession, age, hematuria, proteinuria and hypertension were statistically positively related to hyperuricemia. Treatment consisted of prescribing allopurinol in 84% of patients. In more than 11% of patients the progression was unfavorable. Conclusion: The implication of hyperuricemia in chronic kidney disease has been proved in several recent studies. However, randomized studies at very long scales have to be carried out to conclude from

关键词： Component Formatting Style Styling

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Idiopathic Adult Nephrotic Syndrome: A Clinicopathological Study and Response to Steroid in a Sub-Saharan African Country

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Open Journal of Nephrology 2016年第2期6卷 61-65页

作者： Maria Faye ahmed Tall Lemrabott Mouhamadou Moustapha Cisse Jean De Dieu Nzambaza Cherif Mouhamed Dia Sidy Mohamed Seck Khodia Fall Moustapha Faye Elhadji Fary Ka abdou Niang Boucar Diouf Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Anatomo-Pathology Laboratory Grand-Yoff General Hospital Dakar Senegal Faculty of Medicine Gaston Berger University Saint-Louis Senegal

Introduction: Idiopathic nephrotic syndrome represents 25% to 30% of glomerulonephritis in adults. These glomerulonephritides are responsible of about the half of chronic kidney failure examined as well in United States as in Europe or Africa. The aim of this study was to determine the anatomoclinic, therapeutic and progression patterns of idiopathic nephritic syndrome in Dakar. Patients and Methods: It is a retrospective ten-year study in the nephrology department of Aristide Le Dantec Hospital. Patients with idiopathic nephrotic syndrome were included. We analyzed anatomoclinic, therapeutic and progression data of idiopathic nephrotic syndrome. Results: On 202 patients with nephrotic syndrome, 156 (77%) were primitive. The mean age was 29.7 ± 12 years with a sex ratio of 2.4. Edema was found in 98 patients (62.8%) and hypertension in 63 patients (40%). The mean proteinuria was 6.8 ± 4.8 g/24h. Histologic lesions found at renal biopsy were focal segmental glomerulosclerosis in 71 patients (45.5%), minimal change disease in 68 patients (43.5%) and membranous nephropathy in 8 patients (5%). 134 patients (85.8%) received steroids alone, 12 patients (7.6%) received cyclophosphamide and 4 patients (2.5%) azathioprine in association with steroids. 44 patients (28.2%) reached remission. The factors of poor prognosis were: age, above 40 years, proteinuria above 10 g/24h, existence of renal failure at admission, absence of use of steroids therapy. Conclusion: This study shows that idiopathic nephrotic syndrome is frequent in our country with a prevalence of 77%. The most common lesion found at the renal biopsy is the focal segmental glomerulosclerosis. Remission is found only in 28% which is very low. 33% of patients progress towards chronic kidney disease due to the lack of early diagnosis and the use of traditional medicine.

关键词： Idiopathic Nephrotic Syndrome Focal Segmental Glomerulosclerosis Minimal Change Disease Membranous Glomerulonephritis

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