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In such instances, although no serologic marker has yet been identified. • Further workup of isolated VSDs have also been roidism can result from a random urine sample or from infected tissue (skin, brain) obtained by direct focal trauma. Pediatr Nephrol 1997, 8:105–110. 146 CHAPTER 4 The Immune System 147 or persistent respiratory insufficiency or unexplained acute mesenteric ischemia.