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The diagnosis must be consistent with the biopsy justification recorded in the operative note

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Chronic oral administration of high doses of levocarnitine to patients with severe renal impairment or end stage renal failure (ESRD) and dialysis may induce an accumulation of the potentially toxic metabolites trimethylamine (TMA) and trimethylamine-N-oxide (TMAO) , as these metabolites are normally excreted in the urine