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Patients frequently report prolonged recovery times after physical exertion, degraded sleep architecture, thinning skin, osteopenia, and a generalized reduction in vitality

This is done using the direct Coombs antiglobulin test, in which the patient's red cells are mixed with sera containing antibodies that are specific for human immunoglobulin or complement

Impaired kidney function is also associated with increased IGFBP levels (e.g., IGFBP-1, -2, -3, -4, and -6) (75, 77) and IGFBP-3 protease activity, which subsequently increases low-molecular-weight IGFBP-3 fragments (78), most likely due to a compromised renal IGFBP-clearance ( Figure 4 )

doi: 10.1074/jbc.M112.382473