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Concurrently, elevated renal venous pressurestemming from right ventricular dysfunction or tricuspid regurgitationand angiotensin II-mediated efferent arteriolar constriction reduce the glomerular filtration rate (GFR), fostering glomerulosclerosis and tubular atrophy, which are hallmarks of acute kidney disease (AKD) and chronic kidney disease (CKD)

And a classic sign of severe B12 deficiency is a sore, inflamed, smooth beefy-red tongue