bluuebunny/crossref_metadata_2025 huggingface dataset:
MO164NOVEL PARAMETERS TO ASSESS ENDOTHELIAL DYSFUNCTION BY PULSE WAVE ANALYSIS
Authors: Mueller Niklas , Müller Sandra , Streis Joachim , Reuter Stefan , Pavenstädt Hermann Josef , Felderhoff Thomas , Busch Veit
Published: May 2021

Background and Aims

Pulse wave morphology changes under the high flow condition of reactive hyperaemia. We hypothesized, that those alterations may be able to indicate endothelial dysfunction.

Method

We recorded digitized pulse waves measured tonometrically with the SphygmoCor® device of 64 persons, 41 kidney transplant recipients and 23 healthy individuals, under normal conditions (NC) and under reactive hyperaemia (RH). Using matlab®, we calculated novel parameters, which had a temporal relationship with 3 charactereristic points (PO) of the normalized pulse wave, namely the maximum of the antegrade wave (1), the diacrotic notch (2) and the first diastolic inflection point (3). The following parameters were calculated: Mean slope between PO 1 and 2 (λ2), area under the curve (AUC) in the systole (Asys), AUC between PO 1 and 3 (A13), AUC between PO 1 and 2 (A12) and AUC between PO 2 and 3 (A23). Parameters were analyzed as their difference under reactive hyperaemia and under normal conditions. Also the maximum of the instantaneous difference of normalized pulse waves under NC und RH (Dmax) was analyzed. Endothelial function was evaluated by duplex sonography using ROC-analysis of peak systolic and end-diastolic flow difference under NC and RH.

Results

ROC-assessment of endothelial dysfunction as indicated by systolic peak flows demonstrated AUCs of 0.733 for λ2 (p=0.002), 0.751 for Dmax (p< 0.001), 0.698 for Asys (p=0.006), 0.648 for A13 (p=0.077), 0.678 for A12 (p=0.027) and 0.732 for A23 (p=0.001). For the diastole the values were 0.753 for λ2 (p=0.003), 0.733 for Dmax (p=0.002) 0.670 for Asys (p=0.038), 0.566 for A13 (p=0.495), 0.664 for A12 (p=0.091) and 0.722 for A23 (p=0.015) respectively.

Conclusion

Pulse wave analysis under the condition of reactive hyperaemia probably is useful to assess endothelial function in kidney transplant recipients.
MO169FUNCTIONAL STATE OF THE KIDNEYS IN PATIENT AFTER CORONARY REVASCULARIZATION
Authors: Muminov Shavkat , Saipova Durdona
Published: May 2021

Background and Aims

The aim of the study was to study the functional state of the kidneys in patients with coronary artery disease in the long-term period after coronary revascularization.

Method

There were 160 patients with coronary artery disease under observation who underwent re-endovascular procedures (RE). The average age of the patients was 56.6 ± 1.27 years. The study included patients with an eGFR of at least 60 ml / min, determined by the serum creatinine concentration. A dynamic determination of the serum creatinine concentration was carried out to isolate patients in whom the postoperative REB was complicated by contrast-induced nephropathy (CIN). In the present study, CIN was defined as an increase in serum creatinine concentration by 25% 24 or more hours after REB. In the future, all patients underwent dynamic determination of serum creatinine concentration in terms of 3 months - 1 year -2 years. Patients received standard therapy for coronary artery disease: antiplatelet therapy (in the case of stenting of coronary arteries - double therapy), bisoprolol, valsartan, atorvastatin.

Results

The results of the study showed that during 2 years of follow-up after coronary revascularization, a progressive decrease in eGFR was observed. So, by the 3rd month, eGFR decreased by -17.39 ± 1.17%, by the end of the 1st year - by -43.62 ± 1.28%, by the end of the second year of observation - by -46.50 ± 1.79%. At the same time, the decrease in eGFR was significantly more pronounced in the group of patients who had CIN in the early period after endovascular intervention (37 patients): (-39.82 ± 2.02% by the end of the 3rd month, -54.61 ± 2.94% by the end of the 1st year and -60.10 ± 3.99% by the end of the 2nd year of observation versus -10.65 ± 0.57%, -40.32 ± 1, 27% and -42.41 ± 1.85% in patients with CIN-, respectively, p <0.001 for intergroup comparisons of the relative dynamics of eGFR at all three time points).

Conclusion

Thus, the present study has demonstrated that in patients with coronary artery disease after revascularization, there is a significant decrease in the glomerular filtration function of the kidneys as early as 3 months after the endovascular procedure. CKD progression continues for at least 2 years after revascularization. One of the predictors of CKD progression is the development of CIN in the early period after endovascular intervention.
MO173SPONTANEOUS RENAL ARTERY DISSECTION (SRAD): IS IT REALLY SO RARE?
Authors: Catapano Fausta , Galaverni Maria Cristina , NIcoletti Simone , Mancini Elena
Published: May 2021

Introduction.

Spontaneous Renal Artery Dissection (SRAD) is a rare and often unrecognized clinical entity, which only accounts for 1-2% of all arterial dissections. Due to its rarity, it may be difficult to diagnose and treat.

Methods.

All patients affected by SRAD and admitted in our Unit in the last year were included.

Results.

Five patients presented with renal infarction due to SRAD were admitted in our Unit in 2020. Patient Characheristics are shown in Table 1. At onset, all suffered from abdominal pain and high blood pressure. In all patients renal function was normal. Abdomen computed tomography angiography (CTA) was diagnostic in all patients (Figure 1). They were treated with antihypertensive drugs and systemic anticoagulation followed by oral anticoagulants. At 3 month-follow-up, all patients became normotensive and partial or total renal artery recanalization were found (Figure 2).

Conclusions.

In our experience, SRAD seems to be not very rare in young and healthy patients with minimal comorbidities. Abdomen CTA is one of the “gold standard” non invasive diagnostic method. In patient treated with conservative medical therapy renal outcome is favourable. More studies are necessary to find underlying causes.
MO176IS IT REALLY INDICATED TO INCREASE FLUID INTAKE IN ELDERLY PATIENTS DURING SUMMER MONTHS?
Authors: Cases Corona Clara Maria , Arroyo Santayana Adrian , Acedo Juan Manuel , Casas Maria Luisa , Dominguez Torres Patricia , Diaz Enamorado Yunayka , Landaluce-Triska Eugenia , Tato Ribera Ana , Fernandez Juarez Gema Maria
Published: May 2021

Background and Aims

Thirst mechanism is essential to maintain an adequate osmolarity and homeostasis. During summer heat waves, there is an increased morbidity and mortality in elderly patients that has led to generally recommend an increase in fluid intake in all elderly patients beyond thirst stimulation, even in those independent patients with free access to water.

The aim of this study was to observe the differences in calculated serum osmolarity (cOsm) between young, elderly and very elderly patients who were neither institutionalized nor hospitalized, in different seasons throughout the year.

Method

We conducted a retrospective cross-sectional study in outpatients between 18-104 years old that had undergone a blood test between July 2019 and January 2020, in which serum osmolarity could be calculated. Patients with serum creatinine above 1.5 mg/dl were excluded.

Results

The study included 45236 blood samples from 41132 patients, 56.1% were female. 50% of patients were between 18 and 65 years old, 45.4% were between 65 and 85 years old and 4.6% were >85 years old. The mean cOsm in patients between 18-65 years was 288.3 mOsm/kg, compared to 289.8 mOsm/kg in those between 65- 85 years old (p<0.0001). In patients >85 years, mean cOsm was 289.4 mOsm/kg.

When comparing cOsm between different seasons of the year, cOsm in summer months was about 1 mOsm/kg higher than in autumn-winter (288.9 mOsm/kg vs 287.8 mOsm/kg in young patients, p=0.0001; 290.5 mOsm/kg vs 289.4 mOsm/kg in elderly patients, p=0.0001). In the very elderly (>85 years) the difference was smaller and non-significant (289.6mOsm/kg vs 289.1mOsm/kg).

Conclusion

Under physiologic conditions, patients >65 years have a slightly higher calculated serum osmolarity than younger patients, nevertheless staying within normal range. These differences only increase in 1 mOsm/kg during the summer months. Therefore, it is not indicated to force an increase in fluid intake in the elderly or very elderly population under physiologic conditions.
MO185THE GUT MICROBIOME-DERIVED METABOLITE TRIMETHYLAMINE N-OXIDE AS A POTENTIAL BIOMARKER IN LUPUS NEPHRITIS PATIENTS
Authors: Salah Mohamed , Shemies Rasha Samir , Elsherbeny Mona , Enein Asmaa
Published: May 2021

Background and Aims

Both human and animal studies suggest that the gut microbe-derived metabolite Trimethylamine N-oxide (TMAO) is strongly associated with several autoimmune disease including Rheumatoid arthritis and psoriatic arthropathy. TMAO has been previously studied as a discriminator between SLE patients and healthy volunteers with higher reported TMAO levels in the SLE group; this suggests that gut microbiota may enhance TMAO generation in response to disease severity. The aim of this study was to investigate the diagnostic and prognostic validity of TMAO as a potential biomarker in lupus nephritis patients. To the best of our knowledge this is the first study to investigate the gut microbe-derived metabolite Trimethylamine N-oxide (TMAO) in patients with lupus nephritis correlating to the criteria of disease severity.

Method

A total of 90 subjects were included in this cross-sectional study and divided into 3 equivalent groups; group I (lupus nephritis patients (LN)), group II (SLE patients without nephritis (NN)), and group III (healthy controls). Serum Trimethylamine Levels were assessed, compared between the study groups and correlated to the clinical, laboratory and Histo-pathological criteria obtained from kidney biopsies of the included patients.

Results

Unpredictably, TMAO levels were found to be significantly higher in healthy controls compared to the total SLE population (p=0.003), and to LN, and NN groups individually (p=0.01). There was no significant statistical difference of TMAO levels between (NN) and (LN) patients (p=0.62). TMAO levels correlated to Anti-dsDNA titres (p=0.02) and Red Blood Cells count (p=0.02) among LN patients while they haven’t shown any correlations to the other studied clinical-laboratory and histopathological factors.

Conclusion

Contrary to the results of the previous studies, TMAO levels were found to be higher in healthy controls rather than SLE patients and did not discriminate between LN and NN patients as well as did not show significant correlation to most studied criteria of disease severity. The possible confounding effect of the dietary pattern and ingested drugs on the gut microbiome underestimate the diagnostic and prognostic utility of TMAO as a potential marker in different diseases. Further studies considering the dietary pattern of the included patients are still warranted.
MO191MANAGEMENT OF HYPERKALAEMIA TO FACILITATE RAASI THERAPY IN PATIENTS WITH HEART FAILURE IN A BESPOKE UK CLINIC
Authors: Ali Ibrahim , Kalra Philip A
Published: May 2021

Background and Aims

Best practice for treatment of patients with chronic heart failure involves beta-blockers and renin-angiotensin-aldosterone system inhibitors (RAASi) such as ACE inhibitors (ACE-i), angiotensin receptor blockers (ARB), mineralocorticoid antagonists (MRA) and neprolysin inhibitor/ARB. However, use of these agents, and optimisation of their dosage, is frequently limited by hyperkalaemia, the incidence of which is increased by the co-prevalence of chronic kidney disease (CKD). Management of patients in a bespoke Hyperkalaemia Clinic can be advantageous in facilitating optimal use of RAASi.

Method

A Hyperkalaemia Clinic was opened in July 2019 in this tertiary renal centre within an NHS trust that hosts 4 district hospital heart failure services. Referrals of patients with left ventricular systolic dysfunction whose RAASi could not be optimised because of hyperkalaemia were encouraged from heart failure specialist nurses and cardiologists. Management of the patients incorporated commencement of patiromer at 8.4g daily and increases in RAASi was usually devolved to the referring team. This report describes the activity and short-term outcomes of the first 17 months after opening of the clinic (follow up until 1st January 2021).

Results

34 patients with systolic heart failure and problems with RAASi-associated hyperkalaemia were referred to the clinic. Mean age was 74 (range 44-88) years, 28% had stage 3a, 28% 3b and 8% stage 4 CKD. ACE-I or ARB were being used in 73% of patients at referral, 73% were using beta blockers and 50% MRA with loop diuretic use in 70%. At first visit 64% had normokalaemia, and 36% serum potassium 5.4-6.0 mmol/L. During follow-up, 6 (18%) patients discontinued patiromer due to gastrointestinal side effects, 3 no longer required the binder because of decrease in RAASi use and 2 patients died (one each from stroke and sepsis). One patient was switched to an alternative potassium binder. As of 1st January 2021, patiromer was still being administered to 22 (65%) patients, 8 of which had received this for >12 months; all patients remained normokalaemic and none of them required magnesium supplementation. An increase in RAASi therapy had occurred in only 12 (35%) patients.

Conclusion

Our experience demonstrates the relative simplicity of managing hyperkalaemia via a bespoke clinic in cardio-renal patients. As this was nephrology-led, optimised management was dependent upon the assertive and collaborative involvement of the referring heart failure teams who helped with biochemical monitoring and alteration of RAASi therapy. However, less than half of the patients benefitted from an increase in RAASi therapy after normalisation of serum potassium, and there was definitely scope for improving this component of the care pathway via more direct multi-disciplinary interaction with the heart failure teams.
MO129COMPARATIVE EFFECTIVENESS OF SGLT2I VERSUS DPP4I ON CARDIOVASCULAR AND RENAL OUTCOMES IN ROUTINE-CARE SETTINGS
Authors: Fu Edouard , Trevisan Marco , Lanka Vivekananda , Clase Catherine M , Xu Yang , Dekker Friedo W , Van Diepen Merel , Carrero Juan Jesus
Published: May 2021

Background and Aims

While clinical trials have demonstrated the efficacy of SGLT2 inhibitors on preventing cardiovascular and renal damage, few studies have expanded this evidence to routine-care settings.

Method

We compared clinical outcomes of adults who started SGLT2i or DPP4i therapy in Stockholm, Sweden, during 2013-2019. The primary outcome was a composite of cardiovascular (CV) death and hospitalization for heart failure (HF). Secondary outcomes included major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction, stroke), all-cause mortality and the rate of eGFR decline (eGFR slope). Propensity score weighted Cox regression was used to balance 55 variables and estimate intention-to-treat hazard ratios with 95% confidence intervals. Differences in eGFR slope were calculated with linear mixed models.

Results

We identified 7136 individuals starting SGLT2i and 13,618 starting DPP4i therapy. Median age was 64 years (37% women) and median eGFR 86 ml/min/1.73m2. During median follow-up of 2.1 years, 211 individuals developed the primary outcome, 269 experienced MACE and 178 died. After propensity score weighting, patients starting SGLT2i therapy were at lower risk for the composite of CV death/HF hospitalization (HR 0.71; 95% CI 0.53-0.94) compared with DPP4i, and showed a tendency towards lower MACE (0.84; 95% CI 0.67-1.04) and all-cause mortality (0.85; 95% CI 0.62-1.18). There were a median of 4 (interquartile range: 2-8) eGFR measurements during follow-up per patient to estimate their eGFR slopes. In adjusted models, new users of SGLT2i had a slower rate of kidney function decline compared with DPP4i (eGFR slope difference of 0.43 (95% CI 0.15-0.72) ml/min/1.73m2 per year). Results for the primary outcome were consistent across 7 pre-specified subgroups, including eGFR (eGFR ≥60: HR 0.79 [95% CI 0.57-1.08]; eGFR <60: HR 0.62 [0.38-0.99], p-value for interaction 0.40).

Conclusion

In patients undergoing routine care, initiation of SGLT2i was associated with fewer cardiovascular outcomes and less rapid kidney function decline compared with DPP4i initiation.
MO193EFFICACY AND SAFETY OF SINGLE DOSE RITUXIMAB IN STEROID-DEPENDENT OR FREQUENTLY RELAPSING MINIMAL CHANGE DISEASE IN A CHINESE MEDICAL CENTER
Authors: Li Chao , Xia Peng , Li Hang , Qin Yan , Chen Limeng , Li Xuemei , Li Xuewang
Published: May 2021

Background and Aims

The purpose of our study was to evaluate efficacy and safety of single dose rituximab in steroid-dependent or frequently relapsing minimal change disease during one-year follow-up.

Method

Twenty patients with corticosteroid-dependent (n=12) or frequently relapsing (n=8) idiopathic minimal-change diseases were hospitalized between August 2018 and July 2019 in the tertiary hospital. They received a single-dose rituximab (1g) concomitantly with their corticosteroid and immunosuppressors. The side effects of RTX were also recorded.

Results

We included 20 patients (15 males and 5 females). The mean age of onset renal disease was 21±9 years old. The included patients were steroid dependent, of whom 8 patients were frequently relapse. All patients had been received steroid in the past. 14 patients had been treated with calcineurin inhibitors (n=13, 65%) or mycophenolate mofetil (n=1, 5%). The baseline serum albumin was 33±10g/L, and serum creatinine was 76±38μmol/L, and 24-hour urine protein was 0.22 (0.06, 6.07) g/d. B-cell depletion (CD19+B cell<5/μL) was achieved after RTX infusion within one week. The average frequency of administered RTX was 1.47 times per person per year. We observed B cell reconstitution (CD19+B cell>20/μL) in 8 cases (35%) after the first dose of RTX. During follow-up (15.5±7.0 months), 19 patients achieved complete remission, while one patient was resistant to treatment. However, five relapse episodes were recorded during tapering steroids or after stopping steroids. Compared with the year before rituximab treatment, the per-patient average number of relapses decreased from 1.4±0.6 to 0.4±0.7 during 1 year of follow-up. After rituximab, the per-patient prednisone maintenance median dose decreased from 0.28 mg/kg (0.17, 0.46) to 0mg/kg (0, 0.07) (P<0.001). Furthermore, the mean estimated GFR was stable (from 117±26 to 120±17 ml/min per 1.73m2, P>0.05). There were three cases of mild infusion reaction (manifested as skin itching and rash) and two cases of infection (one case each of pneumocystis pneumonia and skin infection caused by actinomycetes).

Conclusion

Single-dose of RTX effectively prevented relapse and reduced the need for steroid in steroid-dependent or frequently relapsing minimal change disease.
MO195ATYPICAL HEMOLYTIC UREMIC SYNDROME IN LUNG TRANSPLANTATION: TREATMENT WITH ECULIZUMAB, OUR EXPERIENCE
Authors: Berzal Rico Raquel , Cavero Escribano Teresa , Aunon Pilar , Frías González Aida , Aubert Lucia , Sandino Pérez Justo , Cordero García-Galán Lucía , Rivero Martínez Marta , Andrés Belmonte Amado , Praga Manuel
Published: May 2021

Background and Aims

Atypical haemolytic uremic syndrome (aHUS) is a clinical entity characterized by acute kidney injury, thrombocytopenia and microangiopathic hemolytic anemia. There are several cases of AHUS in non-renal solid organ transplants described in the literature, included lung transplant. Kidney and patient survival are compromised by this complication because of the lack of an effective treatment. Eculizumab is C5 complement factor specific blocker already administered in another kind of secondary aHUS with encouraging results

Method

We analys six lung transplants in a retrospective single-center study between 2018-2020 who developed an aHUS and were treated with eculizumab. Clinical and analytical data were collected along the follow-up. Principal outcome was to explore haematologycal and renal response after treatment with eculizumab.

Results

We included a total of six patients (83% were female) with a median age of 57 years at the time of transplantation. Aetiologies of lung transplantation were chronic obstructive pulmonary disease in 2 patients, interstitial lung disease in another 2, and cystic fibrosis in the remaining two. Induction and maintenance immunosuppressive therapy were based on tacrolimus, mycophenolate and prednisone in all cases. Baseline serum creatinine after lung transplantation was 1.1 mg/dl (0.9-2.4). Two patients developed an aHUS in the immediate post-transplant, one of them died because of surgical complications. Another four patients developed an aHUS 59 months (33-95) after transplantation. Previously of thrombotic microangiopathy, three patients were on treatment with everolimus instead of mycophenolate and two lung transplants have cytomegalovirus reactivation. At the aHUS onset, median serum creatinine was 4mg/dl (2.4-5-7) and acute dialysis was performed in 50% of patients. Median hemoglobin was 7.2g/dl (6.9-7.7), platelet count was 32x1000/µL (17-58), and DHL was 1343 U/L (581-1597) at the start of eculizumab despite having treated the trigger. After a median of 6 doses of eculizumab, the five surviving patients had haematologycal and renal response. No patients underwent chronic dialysis. Serum creatinine was 2.2 mg/dl (1.7-2.3), hemoglobin 9.8 g/dl and platelet count 159x1000/µL at the end of follow-up.

Conclusion

AHUS is a critical complication in lung transplantation, shortly related with immunosuppressive therapy. Patients are at risk of end stage renal disease. Eculizumab treatment appears promising.
MO196KIDNEY INVOLVEMENT IN WALDENSTROM MACROGLOBULINEMIA AND IGM MONOCLONAL GAMMOPATHY
Authors: Cardoso Fernandes Sara , Gomes Ricardo , Messias Ana , Do Sacramento Marques Da Costa Bernardo , Góis Mário , Viana Helena , Ferreira Ana Carina , Nolasco Fernando
Published: May 2021

Background and Aims

Renal manifestations of IgM gammopathy are less common than those seen in patients with multiple myeloma. However, a wide spectrum of kidney diseases has been described in previous publications. We aim to characterize kidney involvement in patients with Waldenström Macroglobulinemia and IgM-secreting B cell lymphoproliferative disorders.

Method

We retrospectively studied 7 patients with a circulating monoclonal IgM and renal histology showing evidence of monoclonal immunoglobulin deposits or lymphomatous infiltration. Demographic, clinical and laboratory data were collected.

Results

Of the 7 patients studied, four (57%) were male and the median age was 68 years old (range 41-79). Among the 7 patients, 5 met criteria for Waldenström Macroglobulinemia after bone marrow biopsy; none of them had hyperviscosity syndrome. Four patients presented with nephrotic syndrome and all had impaired renal function and hypertension. Four patients had microscopic hematuria and only one patient showed no proteinuria. Mean serum creatinine levels were 2.9mg/dL. Renal biopsy showed different patterns of renal injury, including typical intracapillary monoclonal deposits disease (5 patients), membranoproliferative glomerulonephritis with cryoglobulinemia (1 patient), AL-amyloidosis (1 patient) and interstitial lymphoplasmacytic infiltration with CD20+ lymphocytes associated with minimal change disease. Follow-up data were obtained in 4 patients: 3 underwent chemotherapy but only one achieved complete remission and 2 progressed to end-stage renal disease.

Conclusion

Although rare, Waldenström Macroglobulinemia and IgM gammopathy are responsible for diverse manifestations of renal disease. A prompt diagnosis is of utmost importance in order to ensure early start of therapy, which should be directed at the underlying hematologic disorder, to improve renal survival.
MO199DENOSUMAB: NOVEL APPROACH TO TREATMENT OF OSTEOPOROSIS IN RENAL DISEASE
Authors: Greco Rosita , Mollica Agata , Zincone Francesco , Papalia Teresa
Published: May 2021

Background and Aims

Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor kappa-B ligand (RANKL), an osteoclast differentiating factor. It inhibits osteoclast formation, decrease bone resorption, increase bone mineral density (BMD), and reduce the risk of fracture. There is no restriction of its use in patients with renal disease, for whom biphosphonates are considered controindicated. The aim of our study was to evaluate the effectiveness in reducing facture risk and safety of Denosumab in patients with Osteoporosis and renal disease.

Method

This is a prospective analysis of 17 patients with Osteoporosis (average T-score below -2.5) admitted to our Nephrology Department for CKD in the last four years. in Vasculitis, Renal Allograft Recipients. Patients with severe Hyperparatiroidism were excluded. We estimated creatinine clearance (eGFR) using Cockcroft-Gault and classified levels of kidney function using the modified National Kidney Foundation classification of CKD. All patients were adequately supplemented with calcium and vitamin D before and while taking Denosumab 60 mg every 6 months. The primary endpoint is the change in bone mineral density (BMD) at one and two years. Secondary endpoints include changes in bone mineral metabolism parameters (Ca, P, PTHi, 25-OH VitD), incidence of fractures, and renal/allograft fuction at one and two years.

Results

The mean age was 52.5±4 years and 8/17 (47%) were females. N.13 patients (76.5%) were renal transplant recipients (RTR) on standard triple immunosoppression including steroids (prednisone 5 mg/day), CNI and MMF, with average eGFR 65.7±12.5 ml/min. N.2 patients (11.75%) were in hemodialysis. N.2 patients (11.75%) with Anca Vasculitis on steroid therapy and average eGFR 35.6±7.2 ml/min. All patients enrolled were with a BMD T-score of greater than -4.0 and less than -2.5. Only 2 patients had a history of fractures confirmed by a radiology report. Baseline parameters: calcium 9.8±0.32 mg/dl, phosphate 3.9±0.8 mg/dl, PTHi 137±91.0 ng/L, 25-OH VitD 18.3±8.9 ng/mL. From baseline at 1 month there were an increase in PTH and a decrease in calcemia in only 2 transplant recipients (CKD II and IV), that improved with an increased dose of Vit D. There were no significant difference in baseline bone mineral metabolism parameters to year 1 and 2 in all other patients. We found no difference in eGFR and proteinuria from baseline to 1 and 2 years in RTR and ANCA vasculitis. Significant improvement in T-score was observed at 1 year and 2 years (< -1) in all patients. No one discontinued therapy for adverse events.

Conclusion

Denosumab may have advantages in patients with kidney dysfunction, because not excreted by the kidney and there is no need for dose adjustment. This prospective study showed a significant improvement in osteoporosis (at Dexa mean T-score ≤ -1), but particular attention should be paid to ensuring that patients are calcium and Vitamin D replete.
MO202RITUXIMAB TREATMENT IN NEPHROLOGY
Authors: Malki abidi Mouna , Barbouch Samia , Mariem Hajji , Mesbahi Tasnim , Harzallah Amel , Gorsane Imen , Hafedh Hedri , Kaaroud Hayet , Goucha Rym , Ben hmida Fethi
Published: May 2021

Background and Aims

The B cells have a central role in the pathogenesis of several renal pathologies. Rituximab, a monoclonal antibody directed against the CD20 receptor expressed on the surface of B cells is an interesting alternative to conventional treatments of kidney pathologies.

Method

We conducted a descriptive retrospective study of the use of rituximab in nephrology patients.

Results

We collected 25 patients including 12 women and 13 men. The mean age was 33,5 [16-55] years. The rituximab was indicated for an extramembranous glomerulopathy in 6 patients, a focal segmental glomerulosclerosis in 4 patients, a minimal change disease in 4 patients, a lupus nephritis in 5 patients, and a granulomatosis with polyangiitis in 2 patients. Four kidney transplant patient received rituximab for the treatment of antibody mediated rejection in 3 cases and large cell lymphoma in 1 case.

The average time between the diagnosis of the renal disease and starting treatment with rituximab was of 76 +/- 46,5 months. And it was of 16 [ 0,7 ; 59,8] months after transplantation in kidney transplant recipients.

Side effects have been observed in 11 cases (44%). A favorable response has been obtained in 10 cases (40 %), within an average of 2,27 months, with at least one relapse in 4 cases. The follow-up time was 36,33 +/- 31,67 months.

Conclusion

Rituximab has been shown to be helpful in several cases of kidney disease. It may reduce the need for maintenance immunosuppression and help in some cases that are refractory to other therapies.
MO206MALE SEX IS ASSOCIATED WITH IN-HOSPITAL DEATH IN NON-DIALYSIS CKD PATIENTS WITH COVID-19
Authors: Coca Armando , Burballa Carla , Centellas Pérez Francisco Javier , Acosta-Ochoa Isabel , Arenas María Dolores , Pérez Martínez Juan , Fidalgo Veronica , Pascual Julio , Ortega Cerrato Agustin
Published: May 2021

Background and Aims

Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) can lead to significant organ injury. CKD has been associated with increased mortality in previous epidemics, and male sex has been correlated with worse outcomes during COVID-19 in the general population. Our aim was to describe the differential effect of sex as a risk factor for in-hospital mortality among non-dialysis CKD subjects.

Method

Multicenter, observational cohort study including 136 adult patients with CKD and 136 age- and sex-matched controls who required admission for COVID-19 in three academic hospitals in Spain. Viral infection was confirmed by real-time RT-qPCR and/or serologic testing in all cases. Disease severity on admission was classified according to the WHO—China Joint Mission Report on COVID-19. The presence of CKD was defined as sustained eGFR <60 and >15 ml/min/1.73m2 within the 6 months prior to COVID-19 hospitalization. Demographic and clinical data were gathered from medical records. Outcomes were recorded during the following 28 days after admission. We applied Cox proportional hazards models, adjusted for age, sex, hypertension, diabetes and severe or critical disease at presentation.

Results

Due to the matched design, no differences were found regarding age and sex between cohorts. CKD patients suffered more frequently from hypertension and diabetes and presented higher 28-day mortality after hospital admission due to COVID-19 compared with age- and sex-matched controls (40.4 vs. 24.3%; P=0.004). In adjusted Cox regression analysis among CKD patients, only age (HR: 1.087, 95% CI: 1.047-1.128) and male sex (HR: 1.883, 95% CI: 1.045-3.391) were independent predictors of 28-day mortality. Comparatively, among patients without CKD, only age acted as an independent predictor for 28-day mortality (HR: 1.082, 95% CI: 1.033-1.133). None of the variables included in adjusted regression was able to predict ICU admission in any of the cohorts.

Conclusion

Male sex is associated with increased mortality, but not with ICU admission, after hospitalization due to COVID-19 among non-dialysis CKD patients. That effect was not observed among hospitalized controls without CKD.
MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC
Authors: Herrero Berron Juan Carlos , Lentisco Carolina , Oliet Aniana , Suso Andrea , Onate Alonso Irene , Sanchez Maria , Camacho Rosa , Mon Carmen , Ortiz Milagros , Ortega Olimpia
Published: May 2021

Background and Aims

Due to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit.

Objective

To analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital.

Method

Retrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up.

Results

Of 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult.

Conclusion

The eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.
MO131THE SHRUNKEN PORE SYNDROME IS ASSOCIATED WITH POOR PROGNOSIS AND LOWER QUALITY OF LIFE IN HEART FAILURE PATIENTS- THE HARVEST-MALMÖ STUDY
Authors: Xhakollari Liana , Grubb Anders , Jujic Amra , Bachus Erasmus , Nilsson Peter M , Leosdottir Margret , Christensson Anders , Magnusson Martin
Published: May 2021

Background and Aims

The cardiorenal syndrome was studied in heart failure (HF) patients with respect to the “Shrunken pore syndrome” (SPS) that is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatin C/eGFRcreatinine-ratio.

Method

373 patients hospitalized for HF were retrieved from the HeARt and brain failure inVESTigation trial (HARVEST-Malmö). We used CKD-EPI formulas for estimated glomerular filtration rate (eGFR). Presence of SPS was defined as eGFRcystatinC ≤60% of eGFRcreatinine. In Cox regression multivariate models, associations between SPS, risk of death and risk of 30-day re-hospitalization were studied. Associations between SPS and impaired quality of life (QoL) were studied using multivariate logistic regressions.

Results

SPS was associated with all-cause mortality (124 events; hazard ratio (HR) 2.35; confidence interval (CI95%) 1.17-4.71; p=0.016 and with 30-day re-hospitalization (70 events; HR 1.82; CI95% 1.04-3.18; p=0.036). Analyses of QoL, based on a Kansas City Cardiomyopathy Questionnaire overall score <50, revealed that SPS was associated with increased risk of low health-related QoL (odds ratios (OR) 2.15 (CI95% 1.03-4.49; p=0.042).

Conclusion

The results of this observational study show for the first time an association between SPS and poor prognosis in HF. Further studies are needed to confirm the results in HF cohorts and experimental settings to identify pathophysiological mechanisms.
MO216PRELIMINARY STUDY OF THE GLYMPHATIC SYSTEM IN CKD
Authors: Buonincontri Veronica , Viggiano Davide , Capasso Giovambattista
Published: May 2021

Background and Aims

The glymphatic system is a network of extracellular spaces between neurons, glial cells, and capillaries that promotes the elimination of soluble molecules from the brain. Its dysfunction is probably relevant for neurodegenerative diseases such as Alzheimer's disease (AD). It is widely accepted that cognitive impairment accompanies chronic kidney disease (CKD). CKD is also a risk factor for dementia. However, the role of the glymphatic system in this process is unknown. A recent method to study the glymphatic system in human subjects has been proposed based on Diffusion Tensor Imaging (DTI) data and water diffusion calculation along with perivascular spaces. This approach is based on calculating a diffusion index named ALPS and showed that the glymphatic flow is reduced in MCI.

Method

To analyze the role of glymphatic system in CKD patients, we took advantage of the Alzheimer's Disease Neuroimaging Initiative (ADNI). ADNI is a longitudinal multicenter study helping researchers to monitor Alzheimer's disease and Mild Cognitive Impairment (MCI) progression. This database has a cohort of control patients and MCI patients, among which several patients with CKD stage II-III were identifiable from the creatinine values. Patients with Alzheimer's disease were excluded for this study. Among the control and MCI patients, we identified 12 CKD patients and pair-matched 12 non-CKD patients comparable for age, gender, and MoCA score. Magnetic resonance data with DTI sequences were retrieved for all patients, and the glymphatic system was characterized by the ALPS index. Tensor values were calculated using the FSL software; the diffusion values were calculated on tensor images using the ImageJ software. Differences in ALPS between CKD and non-CKD patients with and without MCI were tested.

Results

Analysis of DTI data confirmed that control patients without CKD had lower ALPS values when MCI was present compared to the non-MCI patients, suggesting a reduction of water diffusion in the glymphatic system. However, the presence of CKD had a different effect: in the absence of MCI, CKD did not modify ALPS values compared to non-CKD patients. At variance, in patients with MCI, CKD resulted in a significant increase of water diffusion in the glymphatic system compared to the controls.

Conclusion

In this preliminary study, MCI and CKD exerted opposite effects on the diffusion of water within the glymphatic system: MCI was accompanied by a reduction of water diffusion whereas CKD by an increased diffusion in the glymphatic spaces.

It is possible that small modification of water balance in CKD may be responsible for the increased diffusion of water in glymphatics in CKD. Further studies are needed to verify whether this unexpected phenomenon may modify cognitive function with a mechanism rather different from Alzheimer's disease.
MO218ALTERNATING EPISODES OF TRUE HYPERKALEMIA AND PSEUDOHYPERKALEMIA IN ADULT SICKLE CELL DISEASE - A NEPHROLOGIST'S DILEMA
Authors: Onuigbo Macaulay , Sherman Sarah , Tan Heng
Published: May 2021

Background and Aims

To illustrate the phenomenon of alternating true hyperkalemia and pseudohyperkalemia in adult sickle cell disease.

Method

Case Report

Results

Sickle cell disease (SCD) predisposes the patient to recurrent episodes of acute painful hemolytic crisis. Sickle cell nephropathy (SCN) is not uncommon in adult patients. The presence of sickled erythrocytes in the renal medullary vessels is the hallmark of the disease and renal manifestations include renal ischemia, microinfarcts, renal papillary necrosis and renal tubular abnormalities with variable clinical presentations. Furthermore, acute hemolytic crisis can be complicated by sepsis. Hemolysis, specifically, intravascular hemolysis, can produce hyperkalemia. Additionally, reduced glomerular filtration rate from SCN predisposes to hyperkalemia. Pseudo-hyperkalemia was first reported by Hartmann and Mellinkoff in 1955 as a marked elevation of serum potassium levels in the absence of clinical evidence of electrolyte imbalance. In pseudohyperkalmia, simultaneously estimated serum potassium exceeds plasma potassium by >0.4 mmol/L. This is often associated with moderate to severe thrombocytosis or leukocytosis. Clearly, hyperkalemia is a potentially lethal condition. At the same time, the institution of inappropriate treatment of pseudo-hyperkalemia leading to hypokalemia is also equally potentially lethal. We describe a 40-yo African American male patient with sickle cell anemia who exhibited alternating episodes of hyperkalemia and pseudo-hyperkalemia, during consecutive hospital admissions. Pseudohyperkalemia was associated with severe thrombocytosis complicating sepsis. EKG was normal despite measured serum potassium of 6.7 mmol/L (Figure).

Conclusion

We believe that this is the first report of adult SCD demonstrating alternating cycles of true hyperkalemia and pseudo-hyperkalemia at different times. We must draw attention to the new availability of the new potassium binders, Patiromer and sodium zirconium cyclosilicate. We would advocate for caution in the use of these potent potassium binders and to always give consideration to the presence of pseudo-hyperkalemia under appropriate clinical scenarios. We posit that providers managing adult patients with sickle cell disease must be aware of such a phenomenon to avoid the dangers of overtreatment of episodes of pseudo-hyperkalemia in such patients.
MO629XANTHINE OXIDASE INHIBITOR ATTENUATES RENAL OXIDATIVE STRESS AND ENDOTHELIAL DYSFUNCTION THROUGH THE INHIBITION OF VEGF-NADPH OXIDASES IN DIABETIC NEPHROPATHY
Authors: Hong Yu Ah , Yang Keum-Jin , Choi Wonjung , Chang Yoon-Kyung , Park Cheol Whee , Kim Suk Young
Published: May 2021

Background and Aims

Xanthine oxidase (XO) is one of major source of reactive oxygen species, and a XO inhibitor, febuxostat has been reported to the protection of kidney diseases. We investigated whether febuxostat exerts renoprotective effects against diabetic nephropathy (DN).

Method

Eight-week Male C57BL/6 mice were divided into four groups: Control group (Cont), Febuxostat control group (FEB), streptozotocin treated group (STZ) and a febuxostat and STZ-treated diabetes group (STZ+FEB). STZ was used to induce diabetes (50 mg/kg/day, 5 days), and 5 mg/kg of febuxostat was treated to experimental mice for 8 weeks.

Results

STZ-treated diabetic mice were significantly decreased in serum and kidney XO levels, serum cystatin C and albuminuria by febuxostat treatment. Febuxostat treatment decreased renal hypertrophy and mesangial matrix expansion in STZ-treated diabetic mice. Febuxostat treatment suppressed the expression of vascular endothelial growth factor (VEGF)1 and 3, NADPH oxidase (NOX)1, 2, and 4, and the levels of their catalytic subunit mRNA in in STZ-treated diabetic mice. Febuxostat treatment was accompanied by the downregulation of Akt phosphorylation, followed by the suppression of transcription factor forkhead box O3a phosphorylation and the enhancement of endothelial nitric oxide synthase. Finally, febuxostat improved oxidative stress and resulted in decreased 8-hydroxy-2'-deoxyguanosine and kidney malondialdehyde levels, and increased superoxide dismutase activity in STZ-treated diabetic mice.

Conclusions

Febuxostat attenuated DN by modulating oxidative stress and endothelial function through VEGF–NADPH oxidase signaling pathway.
MO630SNOGO-B IS AN IMPORTANT CONTRIBUTOR TO GLOMERULAR ENDOTHELIAL CELL STABILITY AND VASCULAR REMODELLING INTERVENING ON VEGFA/VEGFR2 SIGNALLING
Authors: Ricciardi Carlo Alberto , Long David , Gnudi Luigi
Published: May 2021

Background and Aims

Nogo-B is an endoplasmic reticulum protein present as a full length and circulating soluble isoform (sNogo-B) corresponding to the first ∼200aa of the N-terminus. Nogo-B is expressed in glomerular endothelial cells (GECs) and is downregulated in the diabetic glomeruli; its repletion, ameliorates diabetic glomerulopathy. However, the precise biological role of Nogo-B and its soluble form in GEC is not well understood.

We hypothesise that sNogo-B could modulate VEGFA/VEGFR2 signalling, and vascular remodelling resulting in improved GECs health and vascular remodelling (vessel repair/new vessel formation). We predict that this effect may be mediated by changes in VEGFA/VEGFR2 signalling; a critical signalling pathway which regulates blood vessel function in physiology and disease.

Method

For this experiment we used human conditionally immortalised GECs. Cells were used after differentiation at 37°. GECs were infected with adenovirus vector expressing sNogo-B or identical vector lacking sNogo-B cDNA (control vector). Cells were serum starved (4 hours, FBS 2%) and exposed to VEGFA (50 ng/ml) for 5’ 10’ 15’ min and VEGFR2 phosphorylation assessed with western immunoblotting.

Results

VEGFA-Mediated VEGFR2 phosphorylation was upregulated in wild-type GECs after 15 min VEGFA incubation (P<0.05) n=4. sNogo-B overexpression upregulated the sNogo-B protein level in the supernatant by 10 fold and prevented VEGFA/VEGFR2 phosphorylation in human immortalized glomerular endothelial cells(P<0.05).

Conclusion

sNogo-B prevents the VEGFA mediated VEGFR2 phosphorylation in GECs. Upregulation of VEGFA/VEGFR2 signalling has been implicated in diabetic glomerulopathy. sNogo-B inhibition of VEGFA/VEGFR2 signalling opens new investigations looking at the potential role of sNogo-B as therapeutic target in diabetic nephropathy.
MO631XANTHINE OXIDASE INHIBITOR AMELIORATES HIGH GLUCOSE-INDUCED OXIDATIVE STRESS BY ACTIVATING AMPK VIA THE ACTIVATION OF PURINE SALVAGE PATHWAY IN GLOMERULAR ENDOTHELIAL CELLS
Authors: Hong Yu Ah , Yang Keum-Jin , Choi Won Jung , Chang Yoon-Kyung , Park Cheol Whee , Kim Suk Young
Published: May 2021

Background and Aim

Oxidative stress plays a crucial role in the pathogenesis of diabetic nephropathy (DN). Xanthine oxidase (XO) contribute to reactive oxygen species (ROS) production, and XO inhibitor, febuxostat has been reported to the protection of kidney diseases. However, the mechanism of renoprotective effects for febuxostat remained unclear. We investigated the renoprotective mechanism associated with purine salvage pathway of febuxostat against DN.

Method

Glomerular endothelial cells (GEnCs) exposed to high glucose (HG) were treated with or without febuxostat for 72 hours, and then the changes of purine salvage pathway and the phosphorylation of 5' AMP-activated protein kinase (AMPK) and its related signaling pathway were evaluated.

Results

Cell survival was significantly decreased in HG-treated GEnCs, and febuxostat treatment enhanced cell survival in a dose-dependent manner. The expressions of xanthine/hypoxanthine, and the levels of xanthine oxidoreductase were significantly increased in HG-treated GEnCs, and these findings were attenuated by febuxostat. The AMP/ATP ratio was inhibited in in HG-treated GEnCs and enhanced by febuxostat treatment. Febuxostat treatment enhanced phosphorylation of AMPK, peroxisome proliferator-activated receptor (PPAR)-α, PPAR-gamma coactivator (PGC)-1α, and dephosphorylation of the Forkhead box O (FoxO)3a in HG-treated GEnCs. Febuxostat treatment also suppressed NADPH oxidase expressions and their catalytic subunits and oxidative stress in HG-treated GEnCs. AMPK inhibition using small interfering RNA blunted the antioxidative effects of febuxostat in HG-treated GEnCs.

Conclusions

Febuxostat attenuated HG-induced oxidative stress through the activation of purine salvage pathway and AMPK–PGC-1α–NADPH oxidase signaling.