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Burgmaier K, Kilian S, Arbeiter K, Atmis B, Boyer O, Buescher A, Dursun I, Erger F, Fila M, Galiano M, Gokce I, Haeffner K, Haffner D, Hooman N, Klaus G, König J, Lange-Sperandio B, Marlais M, Massella L, Mekahli D, Miklaszewska M, Miloševski-Lomić G, Obrycki L, Ranchin B, Seitz B, Stabouli S, Tabel Y, Taranta-Janusz K, Weber LT, Weitz M, Wühl E, Yilmaz A, Dötsch J, Schaefer F, Liebau MC. A risk score to predict kidney survival in patients with autosomal recessive polycystic kidney disease at the age of two months. Kidney Int 2025; 107:903-915. [PMID: 39922379 DOI: 10.1016/j.kint.2025.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 01/04/2025] [Accepted: 01/09/2025] [Indexed: 02/10/2025]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a severe hepatorenal fibrocystic disorder. Its rareness and the variability of disease courses have been major obstacles for the establishment of clinical trials on treatment of kidney disease in ARPKD. In this observational study we characterized kidney disease progression in a very large cohort of up to 658 patients with the clinical diagnosis of ARPKD and identified risk factors associated with rapid kidney disease progression. The estimated probability of kidney failure by the age of 20 years was 50.1% (95% confidence interval 42.2%‒57.0%), with earlier kidney failure in specific subgroups. Mean yearly estimated glomerular filtration rate decline after the first year of life was 1.3 ml/min per 1.73 m2 during childhood and adolescence in the overall cohort, ranging from 0.5 to 2.2 ml/min per 1.73 m2 in various subgroups. Furthermore, we developed prediction models for the relative risk of early kidney failure to be applied at the age of two months in daily clinical life. The finally chosen predictor set for a score based on a Cox model encompassed five factors: gestational age at oligo- or anhydramnios, gestational age at birth, functional genotype, serum creatinine (mg/dl) as well as documentation of arterial hypertension at the age of two months. The derived simple prognostic score showed good prediction performance, especially in the first three years of life. It reliably identified patients who are not at risk of early kidney failure and may be helpful to identify patients at risk of more rapid disease progression that could benefit from novel therapeutic interventions.
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Affiliation(s)
- Kathrin Burgmaier
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Cologne, Germany; Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Samuel Kilian
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Klaus Arbeiter
- Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Bahriye Atmis
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkiye
| | - Olivia Boyer
- Pediatric Nephrology and Kidney Transplantation, Hôpital Necker Enfants Malades, MARHEA, Institut Imagine, Université Paris Cité, Paris, France
| | - Anja Buescher
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Ismail Dursun
- Department of Pediatric Nephrology, Erciyes University, Faculty of Medicine, Kayseri, Turkiye
| | - Florian Erger
- Institute of Human Genetics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Cologne, Germany; Center for Rare Diseases, University Hospital Cologne and University of Cologne, Cologne, Germany
| | - Marc Fila
- Pediatric Nephrology Unit, Centre Hospitalier Universitaire Arnaud de Villeneuve-Université de Montpellier, Montpellier, France
| | - Matthias Galiano
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ibrahim Gokce
- Division of Pediatric Nephrology, Research and Training Hospital, Marmara University, Istanbul, Turkiye
| | - Karsten Haeffner
- Department of Internal Medicine IV, Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Nakysa Hooman
- Department of Pediatric Nephrology, Ali-Asghar Children Hospital, Ali-Asghar Clinical Research Development Center (AACRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Guenter Klaus
- KfH Center of Paediatric Nephrology and Department of Pediatric Nephrology, Marburg Kidney Research Center, Philipps University, Marburg, Germany
| | - Jens König
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Bärbel Lange-Sperandio
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universitaet, Munich, Germany
| | - Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, UK
| | - Laura Massella
- Division of Nephrology, Bambino Gesú Children's Hospital-IRCCS, Rome, Italy
| | - Djalila Mekahli
- PKD Research Group, Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, the Children's Memorial Health Institute, Warsaw, Poland
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Centre de référence maladies rénales rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Barbara Seitz
- KfH Center of Pediatric Nephrology, Children's Hospital Munich Schwabing, Munich, Germany
| | - Stella Stabouli
- First Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Yilmaz Tabel
- Department of Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | | | - Lutz Thorsten Weber
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Cologne, Germany
| | - Marcus Weitz
- Department of General Pediatrics and Haematology/Oncology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Alev Yilmaz
- Pediatric Nephrology Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Jörg Dötsch
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University Hospital Cologne and University of Cologne, Cologne, Germany; Center for Family Health, University Hospital Cologne and University of Cologne, Cologne, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Max Christoph Liebau
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Cologne, Germany; Center for Rare Diseases, University Hospital Cologne and University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University Hospital Cologne and University of Cologne, Cologne, Germany; Center for Family Health, University Hospital Cologne and University of Cologne, Cologne, Germany; West German Center for Child and Adolescent Health (WZKJ), Partner site Cologne, Department of Pediatrics, Cologne, Germany.
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Alzarka B, Charnaya O, Gunay-Aygun M. Diseases of the primary cilia: a clinical characteristics review. Pediatr Nephrol 2025; 40:611-627. [PMID: 39340573 DOI: 10.1007/s00467-024-06528-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024]
Abstract
Ciliopathies encompass a broad spectrum of diseases stemming from dysfunction of the primary (non-motile) cilia, present on almost all cells in the human body. These disorders include autosomal dominant and recessive polycystic kidney diseases, nephronophthisis, and multisystem ciliopathies such as Joubert, Meckel, Bardet-Biedl, Alström, oral-facial-digital syndromes, and skeletal ciliopathies. The majority of these ciliopathies are associated with fibrocystic kidney disease resulting in progressive kidney dysfunction. In addition, many ciliopathies are associated with extra-renal manifestations including congenital hepatic fibrosis, retinal dystrophy, obesity, and brain and skeletal anomalies. The diagnoses may be challenging due to their overlapping clinical features and molecular heterogeneity. To date, over 190 genes encoding proteins that localize to the primary cilia have been identified as disease-causing. This review will discuss the clinical features of the most frequently encountered disorders of primary cilia.
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Affiliation(s)
- Bakri Alzarka
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Olga Charnaya
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meral Gunay-Aygun
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
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3
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Inoki Y, Nishi K, Osaka K, Kaneda T, Akiyama M, Sato M, Ogura M, Ide K, Kamei K. Complications and prognosis of patients diagnosed with autosomal recessive polycystic kidney disease in neonatal period. CEN Case Rep 2024; 13:181-187. [PMID: 37875772 PMCID: PMC11144170 DOI: 10.1007/s13730-023-00827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023] Open
Abstract
There are no clinical guidelines for performing nephrectomy in patients with autosomal recessive polycystic kidney disease (ARPKD). Few reports have described the clinical course of ARPKD diagnosed in the neonatal period in detail. Here, we report seven patients diagnosed with ARPKD and treated at our center during the neonatal period. Two died within 48 h of life due to pulmonary hypoplasia. Of the remaining five patients, three had anuria and required for kidney replacement therapy (KRT) within one week after birth, whereas two with a milder phenotype survived without KRT. All three patients who received KRT underwent unilateral nephrectomy and peritoneal dialysis (PD) catheter placement. To prevent fluid leakage, PD was initiated 7-14 days after catheter placement. However, peritoneal leakage occurred in two patients, resulting in peritonitis and discontinuation of PD; one who required long-term hemodialysis contracted a catheter-related bloodstream infection as well as developed subdural and epidural hematomas. Meanwhile, two patients underwent a second nephrectomy within 6 weeks after birth; one developed severe persistent hypotension and neurological complications, while the other died of bacteremia that may have resulted from cholangitis diagnosed on day 67 of life. A severe clinical course, life-threatening adverse events, and severe neurological sequalae may occur in patients with ARPKD who receive KRT in neonatal period.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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Burgmaier K, Broekaert IJ, Liebau MC. Autosomal Recessive Polycystic Kidney Disease: Diagnosis, Prognosis, and Management. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:468-476. [PMID: 38097335 DOI: 10.1053/j.akdh.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 12/18/2023]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is the rare and usually early-onset form of polycystic kidney disease with a typical clinical presentation of enlarged cystic kidneys and liver involvement with congenital hepatic fibrosis or Caroli syndrome. ARPKD remains a clinical challenge in pediatrics, frequently requiring continuous and long-term multidisciplinary treatment. In this review, we aim to give an overview over clinical aspects of ARPKD and recent developments in our understanding of disease progression, risk patterns, and treatment of ARPKD.
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Affiliation(s)
- Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany; Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Ilse J Broekaert
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Max C Liebau
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany; Center for Family Health, Center for Rare Diseases and Center for Molecular Medicine Cologne, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
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5
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Liebau MC. Early clinical management of autosomal recessive polycystic kidney disease. Pediatr Nephrol 2021; 36:3561-3570. [PMID: 33594464 PMCID: PMC8497312 DOI: 10.1007/s00467-021-04970-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a rare but highly relevant disorder in pediatric nephrology. This genetic disease is mainly caused by variants in the PKHD1 gene and is characterized by fibrocystic hepatorenal phenotypes with major clinical variability. ARPKD frequently presents perinatally, and the management of perinatal and early disease symptoms may be challenging. This review discusses aspects of early manifestations in ARPKD and its clincial management with a special focus on kidney disease.
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Affiliation(s)
- Max Christoph Liebau
- Department of Pediatrics and Center for Molecular Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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6
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Burgmaier K, Ariceta G, Bald M, Buescher AK, Burgmaier M, Erger F, Gessner M, Gokce I, König J, Kowalewska C, Massella L, Mastrangelo A, Mekahli D, Pape L, Patzer L, Potemkina A, Schalk G, Schild R, Shroff R, Szczepanska M, Taranta-Janusz K, Tkaczyk M, Weber LT, Wühl E, Wurm D, Wygoda S, Zagozdzon I, Dötsch J, Oh J, Schaefer F, Liebau MC. Severe neurological outcomes after very early bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD). Sci Rep 2020; 10:16025. [PMID: 32994492 PMCID: PMC7525474 DOI: 10.1038/s41598-020-71956-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
To test the association between bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD) and long-term clinical outcome and to identify risk factors for severe outcomes, a dataset comprising 504 patients from the international registry study ARegPKD was analyzed for characteristics and complications of patients with very early (≤ 3 months; VEBNE) and early (4–15 months; EBNE) bilateral nephrectomies. Patients with very early dialysis (VED, onset ≤ 3 months) without bilateral nephrectomies and patients with total kidney volumes (TKV) comparable to VEBNE infants served as additional control groups. We identified 19 children with VEBNE, 9 with EBNE, 12 with VED and 11 in the TKV control group. VEBNE patients suffered more frequently from severe neurological complications in comparison to all control patients. Very early bilateral nephrectomies and documentation of severe hypotensive episodes were independent risk factors for severe neurological complications. Bilateral nephrectomies within the first 3 months of life are associated with a risk of severe neurological complications later in life. Our data support a very cautious indication of very early bilateral nephrectomies in ARPKD, especially in patients with residual kidney function, and emphasize the importance of avoiding severe hypotensive episodes in this at-risk cohort.
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Affiliation(s)
- Kathrin Burgmaier
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Martin Bald
- Department of Pediatric Nephrology, Klinikum Stuttgart, Olga Children's Hospital, Stuttgart, Germany
| | | | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Florian Erger
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michaela Gessner
- Department of General Pediatrics and Hematology/Oncology, Children's University Hospital Tuebingen, Tuebingen, Germany
| | - Ibrahim Gokce
- Division of Pediatric Nephrology, Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Jens König
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | | | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Djalila Mekahli
- Department of Development and Regeneration, PKD Research Group, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Lars Pape
- Department of Pediatrics II, University Hospital Essen, Essen, Germany.,Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ludwig Patzer
- Children's Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Alexandra Potemkina
- Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Gesa Schalk
- Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Raphael Schild
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital for Children Institute of Child Health, UCL, London, UK
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, SUM in Katowice, Katowice, Poland
| | | | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Lutz Thorsten Weber
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Donald Wurm
- Department of Pediatrics, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Simone Wygoda
- Clinic for Children and Adolescents, Hospital St. Georg, Leipzig, Germany
| | - Ilona Zagozdzon
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Jörg Dötsch
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Max Christoph Liebau
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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