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10-20% of these patients experience a progressive loss of kidney function over time, eventually leading to end-stage renal disease (ESRD), which generally means that glomerular filtration rate (GFR) drops to less than 10% and the patient needs hemodialysis (31)

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The inability of bb0238∆IM isolates to persist in mice and be acquired by feeding ticks is likely because the loss of BB0238-BB0323 interactions interferes with the mutual stability and levels of both proteins