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The initial clinical sign of cadmium-induced renal lesions is tubular proteinuria, usually detected as increased urinary excretion of low-molecular-weight proteins (such as -2-microglobulin, or alpha-1 macroglobulin) or tubular enzymes such as N -acetyl-/-glucaminidase (NAG)

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2 Nonetheless, tobacco use remains the leading cause of preventable death in the United States, accounting for 430,000 deaths annually