bluuebunny/crossref_metadata_2025 huggingface dataset:
MO192ASYMPTOMATIC HYPERURICEMIA AS A RISK FACTOR OF OUTCOME IN CARDIORENAL PATIENTS
Authors: Mumajesi Suela , Idrizi Alma , Imeraj Matilda , Cadri Vilma , Pasko Nevi , Strakosha Ariana , Thereska Nestor , Barbullushi Myftar
Published: May 2021

Objective

The purpose of the study was to evaluate the impact of asymptomatic hyperuricemia on long-term outcome including death, rehospitalization in cardiorenal patients.

Introduction

Hyperuricemia is associated with progression of kidney failure, cardiovascular diseases and cardiorenal syndrome, which represents a significant health burden. There is a growing interes on evaluation of serum acid levels(SUA) as a risk factor in cardiorenal syndrome, because of the evidences that xanthine oxidase inhibitors are satisfactorily useful on cardio and renal protection.

Materials and Methods

This was a descriptive cross–sectional study. A two-years follow up was conducted to determine the outcome in cardiorenal patients. Each patient went through clinical examination with a standard valuation including the determination of uric acid levels. 139 patients (pts) with chronic kidney disease stage 3 from whom 119 had cardiorenal syndrome were included in the study. Statistical analysis was performed by χ2 test, Fisher's exact test and binary logistic regression.

Results

Hyperuricemia was founded in 65.5% of pts determined by acid uric levels higher then 7.2 mg/dl and had a strong assosiation with cardiorenal syndrome,p=0.03.The average age was 56.7 ± 12.5 years. Males were 62.2%% pts, p=0.031. Bivariate analysis revealed a strong relationship between hyperurcemia and cardiovascular components: hypertension p=0.047, diabetes mellitus p=0.021, sex p=0.03, death p=0.051 and rehospitalization in 18 pts, p=0.02. Subsequently binary logistic regression showed that higher acid uric levels even there were not statistically correlated with mortality, were a significant predictor for all-cause death (Odds Ratio [OR] 4.2, 95% confidence interval [CI] 0.87–20.35, p = 0.073).

Conclusions

Asymptomatic hyperuricemia was common and had a powerfull significant association with cardiorenal syndrome.Higher SUA was unconventionally associated with long-term adverse outcomes in these patients, so our efforts should be focused in immediate identification and treatment of this old forbidden marker.

Key words

chromic kidney disease, cardiovascular disease, etc
MO194COVID-19 INFECTION IN PATIENTS RECEIVING IMMUNPSUPPRESSIVE THERAPY: EXPERIENCE OF A NORTH AFRICAN NEPHROLOGY CENTER
Authors: Houli Rawnak , Barbouch Samia , Nadia Cherni , Mariem Hajji , Sakay Amira , Ben hamida Fethi , Amel Harzallah , Ben abdallah Taieb
Published: May 2021

Background and Aims

Since its outbreak in December 2019,novel coronavirus disease 2019 (COVID-19) has become one of physicians top concerns worldwide. Special attention is payed to immunocompromised patients with whom the virus is feared to be more aggressive . Our aim was to assess outcomes in patients receiving immunosuppressive therapy who presented with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2) infection.

Method

we monitored patients undergoing immunosuppressive regimens who presented with SARS- CoV-2 infection during a four months period from September to December 2020 in the Nephrology department of Charles Nicolle’s Teaching Hospital. The diagnosis was made through nasopharyngygeal swabs. Kidney transplant patients were not included.

Results

we identified 9 patients who presented a confirmed SARS-CoV-2 infection (details are shown in figure 1). Age varied from 32 to 67 years. Gender ratio was 0,8. Six patients had hypertension and one patient had diabetes. Seven patients suffered from chronic kidney disease stage 4 (2 patients) and stage 5 (5 patients). Active smoking was noted in 4 patients. Indications for immunosuppressive therapy were vasculitis (5patients) , lupus nephritis (1 patient) , scleroderma (1patient), cryoglubulinemia (1 patient) and multiple myeloma (1 patient). Therapies used included corticosteroids alone (2 patients) or in association with cyclophosphamide (6 patients) and in one case bortezomib.COVID-19 symptoms included fever (6 patients), fatigue (7 patients), joint pain (3 patients), dry cough (all patients)and diarrhea ( one patient). Medium duration under immunosuppressive treatment was of 42,1 days when COVID-19 diagnosis was made Among the patients, six had a mild COVID-19 presentation and displayed favorable outcomes; whereas the remaining three had severe symptoms requiring high dose oxygen and died. As for the renal outcomes, we observed no detioration of kidney function following the COVID-19 infection in any of the patients .All of the patients were treated with antibiotics, heparin and vitamins.

Conclusion

SARS- CoV-2 infection is a serious condition that can threaten prognosis especially in patients receiving immunosuppressive drugs responsible for a weaker immune response. Further work on a larger group of patients is necessary to establish whether this group is more prone to contract the COVID-19 infection and have poorer outcomes.
MO197KIDNEY FUNCTION AT THE EARLY ON ADMISSION HAS NO CORRELATED WITH DISEASE SEVERITY AND MORTALITY IN COVID-19 PATIENTS WHO ARE TREATED IN ISOLATION ROOM OF MUHAMMADIYAH HOSPITAL PALANGKARAYA INDONESIA
Authors: Tanod Darryl Virgiawan
Published: May 2021

Background and Aims

Covid-19 easily to infected and spread between person to person with different mortality rates. Affected by several factors, including the comorbid factors that are different in each patients . One of the comorbid factors currently being discussed is the function of the kidneys which can affect the severity of disease and mortality in people with Covid-19. The purpose of this study was to determine whether early kidney function in Covid-19 patients who were treated in hospital isolation rooms Muhammadiyah Palangkaraya has an effect on degrees of severity and mortality.

Method

This study was a retrospective observational study conducted at a Covid-19 referral hospital. The data were taken from the electronic health records of the hospital from July – December 2020. A 38 male and female patients, with mild and severe disease. Kidney function is known by calculating the eGFR value at the time of patients initial admission using serum creatinin through venous blood test then calculated using the formula CKD-EPI calculator. Independent Sample T-test statistical was perform to see the correlation between eGFR and the degree of severity and mortality of Covid-19 patients.

Results

In this study, a total of 38 patients consist of 15 (39.47%) men and 23 (60.52%) women who suffered from mild Covid-19 were 11 (28.94%) people, and severe 27 (71.05%) people. There were 5 patients who died (13.15%) and 33 (86.84%) who were alive. It was found that there was no correlation between the patient's baseline eGFR and the patient's mortality rate (p = 0.98), while the eGFR with the degree of severity was also not correlated (p = 0.89).

Conclusion

In this study, there was no correlation between initial kidney function in admission Covid-19 patients with the severity of Covid-19 and mortality rates. Other comorbid factors apart from renal function, early management and optimal treatment are thought to affect severity and mortality of these patients regardless of initial renal function at the time the patient was treated.
MO198IMPACT OF KIDNEY FUNCTION ON THE EVOLUTION OF MONOCLONAL GAMMOPATHIES OF UNCERTAIN SIGNIFICANCE
Authors: Gil Giraldo Yohana , Muñoz Ramos Patricia , Sanchez Ana , Cabrera Alicia , Quiroga Borja
Published: May 2021

Background and Aims

Monoclonal gammopathies of uncertain significance (MGUS) are very prevalent, but neoplastic transformation barely reaches 1% per year. Renal involvement in the course of a MGUS is a risk factor for complications. The objective of our study is to determine the prognosis of MGUS that present renal deterioration during their evolution.

Method

In the present retrospective cohort study, MGUS cases from our center were included. Baseline epidemiological and comorbidity data were collected (including renal function and hematological parameters). At 6 and 12 months, data on renal function and proteinuria were collected. During the follow-up, fatal events and the need for renal replacement therapy (RRT) were recorded as a combined endopoint. Associated factors to this combined endpoint were evaluated.

Results

One hundred twenty patients (47% women, age 81±9 years.) with diagnosis of MGUS were included. Of these, 61 (51%) had renal involvement at the time of diagnosis and 16 (13%) had an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73m2 during follow up.

Associated factors with presenting eGFR less than 60 ml/min/1.73m2 were hypertension (p=0.001), peripheral vascular disease (p=0.05), age (p=0.05), Charlson comorbidity index (p<0.001), β2microglobulin (p = 0.002), baseline proteinuria (p <0.001) and baseline renal function (p <0.001).

During follow-up (median 41 [20-60] months), 34 patients (28%) presented the combined event (8 required RRT and 28 died). The presence of an eGFR less than 60 ml /min/1.73m2 during the first year of follow-up was associated with the combined event (p = 0.028) (Figure 1). In a multivariate model adjusted for age, sex and baseline CKD, the presence of a determination of eGFR lower than 60 ml/min/1.73m2 was an independent predictor for the combined event (HR 3.9 [95% CI 1.4-11.3], p = 0.009). In patients without chronic kidney disease at baseline, 13 (22%) combined events were reported. The incidence of a determination of eGFR lower than 60 ml/min/1.73m2 was associated with the combined event during follow-up (p = 0.012). In a multivariate model adjusted for age and Charlson index, presenting an eGFR lower than 60 ml/min/1.73m2 was an independent predictor for the combined event (HR 6.7 [95% CI 1.7-26.7], p = 0.007) (Figure 2)

Conclusion

Among patients with MGUS, the presence of eGFR lower than 60 ml/min/1.73m2 is independently associated with a higher incidence of RRT and/or mortality.
MO130GLOMERULAR FILTRATION RATE IS THE MAIN PREDICTOR OF URINE OUTPUT IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD) PATIENTS TREATED WITH TOLVAPTAN
Authors: Borrego-Utiel Francisco-Jose , Merino Garcia Enoc , Garnica Alvarez Maria Luisa , Moriana Dominguez Clara
Published: May 2021

Background and Aims

Tolvaptan was approved to treat autosomal dominant polycystic kidney disease (ADPKD) to slow the rate of kidney growth and renal function decline. Tolvaptan blocks the V2 vasopressin receptor in renal collecting ducts and distal nephron causing intense polyuria. Few authors have analyzed what factors influence the volume of diuresis in patients taking tolvaptan.

Method

We have analyzed the influence of solute excretion and glomerular filtration rate, besides age and gender as predictors of urine output, using multivariable analysis. In concret, we have searched the importance of osmolar excretion as predictor of volume of diuresis.

Results

We studied 24 h-urine samples from 18 ADPKD patients on treatment with tolvaptan, who had received the three doses: 45/15, 60/30 and 90/30 mg. Each patient was represented once per dose, for a total of 54 urine samples (Table 1). Tolvaptan increased urine volume, which was roughly doubled, and roughly halved urine solute concentrations expressed by volume and calculated osmolality. By contrast, solute concentrations expressed as ratios with creatinine remained constant as did osmolality corrected with urinary creatinine, indicating that there was no change in solute excretion after tolvaptan.

Urine volume was correlated with serum creatinine (Rho= -0.36, p= 0.008), urinary creatinine (Rho = -0.29, p = 0.034) and GFR-MDRD4 (Rho = 0.44, p= 0.001). Urine volume was correlated with calculated daily osmolar excretion in Osm/day (Rho = 0.76, p <0.001). Urine volume was not correlated with calculated urinary osmolality in mOsm/Kg (Rho= -0.04, p= 0.77) or as urinary osmolality/creatinine ratio (Rho= 0.23, p= 0.1). Correlation of urine volume with osmolar excretion was lost when urine volume was removed from the predictor variable. Urine volume was additionally not correlated with urinary urea o sodium concentrations nor their solute/creatinine ratios, and although it was correlated with urinary potassium concentration (Rho = -0.33, p=0.014), it was not correlated with potassium/creatinine ratio.

We also performed a linear regression analysis searching predictors of urine volume. Only GFR and the osmolality/creatinine ratio were significant predictors of urine volume (urine volume= 55.35 x GFR + 4.74 x Osmolality/Cr; r2= 0.41, p<0.001) but individual solute assessments or tolvaptan dose did not predict urine volume.

Conclusions

Therefore, urine volume after initiating tolvaptan in patients with ADPKD is influenced mainly by the degree of renal function. There might also be a contribution of urinary solute load but it can not be studied using total solute excretion due to collinearity. We propose that the urinary solute/creatinine ratio and osmolality/creatinine ratio should be used to search for predictors of urine output in patients on tolvaptan.
MO203ALTERATIONS IN T REGULATORY CELLS IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS
Authors: Sampani Erasmia , Fylaktou Asimina , Stangou Maria , Vagiotas Xaralampos , Kasimatis Efstratios , Nikolaidou Vasiliki , Daikidou Dimitra Vasileia , Antoniadis Nikolaos , Papagianni Aikaterini
Published: May 2021

Background and Aims

Disturbances in T cell immunity are frequently seen in patients with end stage renal disease (ESRD), and the effect of long term hemodialysis (HD) is still obscure, though extremely important, especially regarding T regulatory cells (Tregs, CD4+CD25+FoxP3+) which seem to have a central role in immune response and tolerance after renal transplantation. In the present study, we assessed the possible effect of HD vintage on Treg population.

Method

Cytometric analysis was performed in 66 patients with ESRD on HD, in order to estimate CD4+ and CD4+CD25+FoxP3+ subtypes. According to HD vintage, patients were classified into two groups, group A: recently commenced on HD, and group B: on long term HD (≤12months and >12months, respectively).

Results

In all 66 patients there was a negative correlation between time on HD and lymphocyte count, both percentage (r=-0.34 p=0.005) and absolute lymphocyte number (r=-0.42 p<0.001) as well as CD4+ cells frequencies (r=-0.25 p=0.042) and total numbers (r=-0.41 p=0.001).

Twenty eight patients (42%) were included in group A (HD vintage 9±3 months) and 38 (58%) in group B, (HD vintage 99±41 months). Compared to group A, patients in group B, showed a significant reduction in percentage of Tregs on total lymphocytes (2.6±1.3% vs 1.9±0.9%, respectively, p<0.019) as well as absolute number of Tregs (34±14 μ/L vs. 21±11 μ/L, respectively, p<0.001).

Conclusion

Long term HD may act as an additional factor reducing lymphocyte count, especially Tregs in ESRD patients. This result, apart from direct affecting immunity of patients, is mostly important for those preparing for renal transplantation, or being on the waiting list.
MO207END-OF-LIFE CARE IN NEPHROLOGY INPATIENTS - ARE WE GETTING IT RIGHT?
Authors: Mateus Catarina , Martins Ana Rita , Cacheira Eunice , Gaspar Maria Augusta
Published: May 2021

Background and Aims

Average life expectancy have been continuously increasing within the general population and, equally so, within Nephrology patients. End-of-life (EOL) care is part of non-oncologic palliative care provided by Nephrology. The aim of our study is to evaluate the quality of EOL care provided in Nephrology, and to determine potential areas of improvement.

Method

Retrospective single-centre analysis of all nephrology and kidney transplant inpatients dying between January 2019 and June 2020. Clinical records were reviewed for evidence of recognition of end of life, resuscitation plans, acute interventions in the 48 hours previous to death, comfort care plans and symptoms evaluation.

Results

A total of 83 patients were included. 19.6% of patients had chronic kidney disease, 60.2% were in haemodialysis, 14.5% were kidney transplanted patients and 3.6% had acute kidney injury. 89.2% of the admissions were for acute events, 5% for symptom control and 4.8% for diagnosis.

In 72.3% of admissions, EOL was recognised. Most patients were unable to discuss EOL plans (67.5%), and the family was informed of the prognosis in only 61.4% of the cases.

At the time of dead: only 62.7% of patients had a clear resuscitation plan, 44.6% were on antibiotics and 26.5% died with nasogastric tube. Within 48h of death: invasive interventions were still being given in 42.2%, blood samples were taken in 69.9%; imaging was performed in 36.1% and 48.2% had a haemodialysis session. Comfort measure were provided to 53% and only 60.2% had evidence of symptom evaluation. 44.6% stopped invasive measures in the last 48h.

Recognition of EOL was associated with having a clear resuscitation plan (p<0.001), comfort measures (p<0.001), evidence of symptom evaluation (p=0.004), stopping invasive measures (p<0.001), having less imaging (p=0.270) and discussing prognosis with the family (p<0.001). Despite recognition of EOL, there was no difference in dying with nasogastric tube (p=0.404) or dying on antibiotics (p=0.134).

In a multivariable analysis (binary logistic regression), EOL recognition was associated with a clear resuscitation plan (Exp(B) 0.088, (CI 95%: 0.018-0.419) p=0.002), with discussion of prognosis with family ( Exp(B) 0.061 (CI 95%: 0.011-0.337) p=0.001), and with reduced body mass index (Exp(B) 0.870, (CI 95%: 0.763-0.991), p=0.037,); in a model adjusted to the age.

Conclusion

In our cohort, patient for whom EOL was recognized had better EOL care. In conclusion, there are still areas in which EOL care can be improved. Palliative care should be an investment area for training within the Nephrology core curriculum and awareness for EOL care is needed.
MO210SERUM LEVELS OF PLASMINOGEN ACTIVATOR UROKINASE RECEPTOR AND CARDIOTROPHIN-LIKE CYTOKINE FACTOR 1IN PATIENTS WITH NEPHROTIC SYNDROME
Authors: Chebotareva Natalia , Vinogradov Anatoliy , Cao Wenjing , Gindis Alla , Alentov Igor , Sergeeva Natalia
Published: May 2021

Background and Aims

The pathogenesis of primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) remains unknown to date. Some circulating permeability factors are discussed. This work assessed molecule candidates for permeability in serum samples of patients with nephrotic syndrome (NS).

Method

Forty-one patients with chronic glomerulonephritis (CGN) were included in our study. Seventeen patients had FSGS, 7 patients had MCD, 5 patients had membranoproliferative glomerulonephritis (MPGN), 6 patients had IgA nephropathy, and 6 patients had membranous nephropathy (MN). The laboratory data were compared with the clinical and histological features of nephritis. Serum levels of uPAR and CLCF-1 were measured by ELISA.

Results

The serum levels of plasminogen activator urokinase receptor (uPAR) were higher in FSGS patients before treatment than in patients with other morphological forms (MCD, IgA nephropathy, MN and MPGN). The levels of uPAR in serum did not correlate with daily proteinuria, serum creatinine/eGFR, arterial hypertension, the number of sclerosed glomeruli or tubulointerstitial fibrosis. No correlations were found between the levels of cardiotrophin-like cytokine factor 1 (CLCF-1) in serum and creatinine levels/glomerular filtration rate, the percentage of sclerosed glomeruli or the severity of tubulointerstitial fibrosis. There were no significant differences between the histological variants of nephritis. However, we found correlations between CLCF-1 levels and proteinuria (Rs = 0. 397, p = 0.015) and triglycerides levels (Rs = 0. 475, p = 0.003).

Conclusion

The data indicate an increase in the serum uPAR levels of FSGS before treatment. CLCF-1 levels in serum do not depend on histological forms of CGN, kidney function or immunosuppressive treatment, but they correlate with proteinuria and serum lipids in patients with NS.
MO213GOOD PRACTICES FOR DIALYSIS EDUCATION, TREATMENT AND EHEALTH: A SCOPING REVIEW
Authors: Van Eck van der Sluijs Anita , Vonk Sanne , Bonenkamp Anna , Van Jaarsveld Brigit , Abrahams Alferso C
Published: May 2021

Background and Aims

Recommendations regarding dialysis education and treatment are provided in various (inter)national guidelines, which should ensure that these are applied uniformly in nephrology and dialysis centers. However, there is much practice variation which could be explained by good practices: practices developed by local health care professionals, which are not evidence-based. Because an overview of good practices is lacking, we performed a scoping review to identify and summarize the available good practices for dialysis education, treatment and eHealth.

Method

Embase, Pubmed, and the Cochrane Library databases were searched for relevant articles using all synonyms for the words ‘kidney failure’, ‘dialysis’ and ‘good practice’. Relevant articles were structured according to the categories dialysis education, dialysis treatment or eHealth, and assessed for content and results.

Results

Nineteen articles (12 for dialysis education, 3 for dialysis treatment, 4 for eHealth) are identified. The good practices for education endorse the importance of providing complete and unbiased predialysis education, assisting PD patients in adequately performing PD, educating HD patients on self-management, and talking with dialysis patients about their prognosis. The good practices for dialysis treatment focus mainly on dialysis access devices and general quality improvement of dialysis care. Finally, eHealth is useful for HD and PD and affects both quality of care and health-related quality of life.

Conclusion

The results of our scoping review can inspire nephrological health care professionals to change their practices and these good practices could be used in addition to guidelines. It is important to increase the attention for local good practices, because they can truly support health care professionals and can improve outcomes and quality of life for patients, even if they are not evidence-based.
MO215DEPRESSIVE DISORDER IN LUPIC PATIENTS WITH LUPUS NEPHRITIS: DATA FROM A POPULATION OF 67 PATIENTS WITH BIOPSY PROVEN LUPUS NEPHRITIS
Authors: Stroie Anna Mirela , Paul Balanescu , Penescu Mircea , Geanina Eugenia Beldea
Published: May 2021

Background and Aims

Systemic lupus erythematosus is a multi-organ, multi-systemic autoimmune disease with significant burden on generally young patients. Renal involvement is relatively frequent, recent studies cite a prevalence of 15-60% of patients, and 25% develop end-stage renal disease after 10 years of disease onset. We studied the incidence of depressive disorders in a population of 67 patients with biopsy proven lupus nephritis. Data about depression in patients with renal involvement of lupus is still scarce. We identified variables associated with the development of depressive disorders in lupus patients.

Method

We concluded a single center transversal study to assess the incidence of depressive disorder in patients with biopsy proven lupus nephritis. We used the self-report Beck Depression/ Anxiety Inventory (BDI/ BAI), 1961/ 1990, translated in Romanian and validated in the Romanian population to diagnose depression. We also wanted to identify risk factors associated with depression in such patients. We used EpiInfo for the statistical analysis and data was extracted from medical records.

Results

We included in the study patients diagnosed with systemic lupus erythematosus, and had renal biopsy between January 2008 – December 2018. Patients were followe-up until May 2020. Beck Depression/Anxiety Inventory was administered a single time during the follow-up visit between (March 2019 – May 2020). In our study group, 58 patients were female (86.5%). Median age at diagnosis of lupus disease was 29 years (min 10 years, max 62 years). Median duration of the disease until the self-assessment inventory was 10 years (min 1.5 years, max 30 years). Median duration of corticosteroid treatment was 10.1 years (min 1.58 years, max 29). 1 patient had class I, 2 had class II, 12 had class III, 32 had class IV, 12 had class V, 1 had class VI, 1 had classes III+V, 1 had classes IV+V of lupus nephritis (ISN classification of lupus nephritis). 13 patients had normal scores of the Beck Inventory (0-9 points), 7 had mild depression (10 - 15 points), 37 had moderate depression (16- 23 points), 10 had severe depression (24-63 points). We identified female gender (p=0.009), duration of corticosteroid therapy (p=0.036), duration of the lupic disease (p=0.036) to be independently associated with depression development. Other variables, such as creatinine levels at the moment of the assessment, duration of maintenance therapy with mycofenolate mofetil or azathioprine, proteinuria, inflammatory markers were not associated significantly with depression.

Conclusion

We identified clinical variables associated with depression development in patients with lupus nephritis. The study brings data useful for the clinician, helping doctors focus on the variables that predict depression in lupus patients and making screening for depressive disorders more focused on the patients with risk factors.
MO217ASSOCIATION BETWEEN SERUM VITAMIN-D LEVEL WITH LUNG INVOLVEMENT AND OUTCOME IN COVID-19 PNEUMONIA
Authors: Abrishami Alireza , Dalili Nooshin
Published: May 2021

Background and Aims

Vitamin D deficiency has been reported as a key factor in the development of infectious diseases such as respiratory tract infections and inflammatory processes like acute respiratory distress syndrome. However, the impact of vitamin D on the severity and outcome of COVID-19 is still not fully known. Herein, we aimed to evaluate the prognostic role of serum vitamin D concentration on the extent of lung involvement and final outcome in patients with COVID-19.

Method

Seventy-three subjects with confirmed diagnosis of COVID-19 were investigated in this study. The patients had been admitted to our academic hospital from February 28, 2020 to April 19, 2020. Demographic and clinical data, serum 25(OH)D levels, and findings of initial chest computed tomography were recorded. Linear and binary logistic regression, cox regression and ROC curve tests were used for statistical analysis.

Results

The mean age of patients was 55.18 Å} 14.98 years old; 46.4% were male. Mean serum 25(OH)D concentration was significantly lower in the deceased (13.83 Å} 12.53 ng/ mL compared with discharged patients (38.41 Å} 18.51 ng/mL) (P < 0.001). Higher levels of 25(OH)D were associated with significantly less extent of total lung involvement (β = − 0.10, P = 0.004). In addition, vitamin D deficiency [25(OH) D < 25 ng/mL] was associated with a significant increase in the risk of mortality (hazard ratio = 4.15, P = 0.04).

Conclusion

This study suggests that serum vitamin D status might provide useful information regarding the clinical course, extent of lung involvement and outcome of patients with COVID-19. However, further studies with larger sample size are needed to confirm these findings.
MO220MID TERM E GFR AND ITS IMPACT ON ADVERSE PREGNANCY OUTCOMES- IMPORTANCE OF GESTATIONAL HYPERFILTERATION
Authors: Kaul Anupma , Pandey Amita
Published: May 2021

Background and Aims

The hemodynamic adaptation plays a crucial role in maintaining gestation, the clinical significance of midterm renal hyperfiltration on pregnancy outcomes is unknown. The present study was retrospective study among all pregnant ladies whose midterm eGFR wascompared with their baseline and its change from baseline was considered as a surrogatemarker for Mid term hyperfilteration among women without underlying evidence of CKD tofurther evaluate its value as a prognostic factor of the eGFR during gestation

Method

All pregnant females aged 18-50 years whose pre gestational baseline serum creatinine was available and had a singleton pregnancy were included in the study .The study was conducted from January 2015 till December 2018 in a tertiary care Institute in Northern India . MRH was represented by the highest eGFR, which was calculated using the Chronic Kidney Disease Epidemiology Collaboration method. An adverse pregnancy event was defined by the composition of preterm birth (gestational age <37 weeks), low birth weight (<2.5 kg), and preeclampsia.

Results

Total of 1045 pregnancies were evaluated to study. Among them, 15 , 305, 680, and 45 mothers had midterm eGFR levels of 60–90, 90–120, 120–150, and ≥150 ml/min per 1.73 m2, respectively. The adjusted odds ratio and associated 95% confidence interval (95% CI) of an adverse pregnancy outcome for eGFR levels below and above the reference level of 120–150 ml/min per 1.73 m2 were 1.97 (95% CI, 1.34 to 2.89; P<0.001) for ≥150 ml/min per 1.73 m2; 1.57 (95% CI, 1.23 to 2.00; P<0.001) for 90–120 ml/min per 1.73 m2; and 4.93 (95% CI, 1.97 to 12.31; P<0.001) for 60–90 ml/min per 1.73 m2. Moreover, among mothers without baseline CKD, women with adverse pregnancy outcomes had less prominent MRH than those without (P<0.001)

Conclusion

There was an unique relationship between the midterm eGFR and adverse pregnancy outcomes, and the optimal range of midterm eGFR levels was 120–150 ml/min per 1.73 m2. In those females without evident functional renal impairment, the absence of prominent MRH could be a significant risk factor for poor pregnancy outcomes
MO632FIRST PLACE IN MORTALITY DUE TO DIABETES IN EUROPE BRINGS TO ALERT OF MULTIDISCIPLINARY TREATMENT IN ALBANIA. ROLE OF NEPHROLOGISTS
Authors: Likaj Erjola , Shehaj Larisa , Idrizi Alma , Barbullushi Myftar
Published: May 2021

Background and Aims

Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and assent in our modest hemodialytic population in 1990. Changing of lifestyle and nutrition, increase in longevity, aging population, and stress have brought to increase of this morbid condition. Nowadays, with a galloping rise, we have a prevalence of 11,1 % of DM in the adult population and nearly 22% of hemodialysis patients whose primary diagnosis is diabetes. Despite this, data of EUROSTAT put us in the first place for mortality due to diabetes. It's time to act!

Method

We analyzed the number of diabetic patients in Albania second the IDF data and the number of diabetic nephropathy patients hospitalized during this decade in our Departement of Nephrology according the Statistical Department of UHC "Mother Theresa".

Results

In 2010 there were 4.5% diabetics in the adult population in Albania and in 2019 there were 9%, so doubling of numbers. Diabetic nephropathy is increasing too and now is our everyday clinical practice challenge, in 2010 there were 54 patients hospitalized for DN and its complications and in 2019 this number increased to 164 patients. Diabetics on hemodialysis are now more and more present with their problems and difficulties that need not only nephrologists but a multidisciplinary approach. Diabetic nephropathy in 2011 had only 11,3% of the hemodialytic pie and now is reaching 17,2% of the primary cause of ESRD in our hemodialytic population, regarding ERA EDTA registry, but our 2020 numbers rise to 22%. We are below the European and North American data but in incident patients it is becoming the second predominant cause of renal failure, after the hypertensive nephrosclerosis, reaching 25%-27%. Mortality in this population is a crucial point, we stand first in Europe with 110 deaths/ million inhabitants despite the reimbursement range is three-fold compared to 10 years ago An increasing number is translated into increased problems especially in vascular access, cardiovascular problems, diabetic foot problems, glycemic control, etc.

Conclusion

Nephrology Units and Hemodialysis Units too are being invaded by diabetics Caring about the glycemic levels, type of hypoglycemia drugs, time and dosage, eating or not during the hemodialysis session, are every session challenges. Cardiovascular problems with frequent hypotensions, coronary heart disease, and cardiac heart failure are other difficult to manage fields. But the most important and continuous care is that of vascular access, the "Achille's Heel" of our patients. Results from our studies reveal diabetes like the second cause of arteriovenous fistulas failure, after the age of patients so we are reinforcing the whole medical chain for referring patients in the fourth stage of CKD for the creation of permanent vascular access, especially diabetics.
MO622IMPAIRED PROTEIN-BOUND UREMIC TOXIN EXCRETION SUGGESTS TUBULAR DYSFUNCTION IN DIABETIC NEPHROPATHY
Authors: Gerritsen Karin , Ahmed Sabbir , Sparidans Rolf , Mihaila Silvia , Broekhuizen Roel , Goldschmeding Roel , Nguyen Tri , Masereeuw Rosalinde
Published: May 2021

Background and Aims

Kidney tubular damage is an important prognostic determinant in diabetic nephropathy (DN) (1). Proximal tubular secretion is a vital homeostatic function that is responsible for excretion of waste, such as protein bound uremic toxins (PBUTs) that are minimally eliminated via glomerular filtration. PBUTs are potentially harmful waste products of endogenous metabolism that are efficiently excreted by tubular secretion via organic anion transporters (OATs). Currently available diagnostic methods cannot accurately detect tubular dysfunction. We hypothesize that renal PBUT clearance may be a sensitive tubular function marker. Here, we measured PBUTs in long-term streptozotocin (STZ)-induced murine diabetic nephropathy (DN), which was characterized by severe tubular atrophy and interstitial fibrosis (2).

Method

Diabetes mellitus was induced in C57Bl/6 mice by a single intraperitoneal injection of 200 mg/kg STZ which resulted in substantial kidney damage after 6 months evaluated by histopathology and conventional markers (2). Indoxyl sulfate (IS), hippuric acid (HA), kynurenic acid (KA), kynurenine (Kyn), p-cresol glucuronide (pCG), p-cresol sulfate (pCS) and indole acetic acid (IAA) were measured in plasma and urine after 6 and 8 months by LC-MS/MS.

Results

Among the PBUTs with the highest OAT affinity, viz. IS, HA and KA, plasma concentrations were 2.2-, 2.3- and 1.5-fold higher (p=0.005, 0.0006, 0.03; Fig 1A-C) after 6 months and 1.9-, 2.1- and 2-fold higher (p=0.008, 0.0005, 0.001; Fig 2A-C) after 8 in DN, and urinary excretions (normalized for plasma concentrations) were 3.3-, 2.3- and 3.0-fold lower (p=0.012, 0.16, 0.03; Fig 1G-I) after 6 months and 2.5-, 1.6-, 2.3-fold lower (p=0.028, 0.046, 0.0005; Fig 2G-I) after 8 months in DN. Other PBUTS, viz. IAA, Kyn, pCS and pCG, were not significantly affected.

Conclusion

Our findings suggest that OAT function is compromised in murine long-term DN. Renal clearance of IS, HA and KA may be a marker of tubular function in DN. Future studies should focus on correlations with histology and validation in other species.
MO626EFFECTS OF RAMIPRIL IN LUNG AND KIDNEY ANGIOTENSIN CONVERTING ENZYME 2 (ACE2) EXPRESSION IN A TYPE 2 DIABETIC MURINE MODEL: LESSONS FOR COVID-19 INFECTION
Authors: Vergara Arana Ander , Jacobs Cachá Conxita , Molina Mireia , Dominguez Pamela , Benito Begoña , Bermejo Sheila , Seron Micas Daniel , Soler Romeo Maria Jose
Published: May 2021

Background and Aims

Angiotensin converting enzyme 2 (ACE2) is one of the components of the renin-angiotensin system (RAS) that mainly degrades angiotensin II to angiotensin-(1-7). ACE2 is predominantly expressed in the kidney and the heart, but it has been evidenced in type 2 alveolar lung cells, where it acts as a receptor for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this context, a controversy arose as to whether the use of RAS blockers could increase ACE2 lung expression and the risk infection by COVID-19. This study aimed to investigate the effect of an ACE inhibitor (Ramipril) on ACE2 expression in experimental diabetes.

Method

12 weeks old diabetic db/db mice (n=7) were given ramipril (8 mg/Kg/day) during 8 weeks or the respective vehicle. db/m (n=7) vehicle-treated non-diabetic mice were included as controls. ACE2 mRNA expression and enzymatic activity were studied in kidney, heart and lung samples of these animals to identify if the diabetic condition or treatment with ramipril modulated ACE2 expression.

Results

In vehicle-treated diabetic db/db animals, ACE2 mRNA expression was significantly increased in the kidney (p<0.001) and ramipril treatment reversed this effect (p=0.026). In the heart, ACE2 expression decreased in db/db when compared to db/m littermates (p=0.035) and ramipril had no effect. We found no differences in ACE2 gene expression in the lung. Besides, ACE2 enzymatic activity was increased in the kidney (29%) and also in the lung (16%) of db/db mice when compared to controls. Ramipril treatment decreased ACE2 activity a 19% in the lung and had no effect in the kidney when compared to untreated db/db (see figure). In the heart, ACE2 activity tended to decrease in db/db mice (29%) when compared to db/m and ramipril increased ACE2 activity (18%) but did not exceed the cardiac ACE2 activity of the db/m.

Conclusion

ACE2 is increased in the kidney and the lung, and decreased in the heart of diabetic mice. Ramipril treatment restores ACE2 levels. The results suggest that ACE inhibitors do not increase ACE2 expression and the activity decrease exerted in the lung may be protective against COVID-19 infection.
MO645BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH TYPE 2 DIABETES MELLITUS WITH AND WITHOUT DIABETIC NEPHROPATHY
Authors: Valentinova Monova Daniela , Shumnalieva Russka , Monov Simeon
Published: May 2021

Background and Aims

Diabetes mellitus and osteoporosis are both common human diseases. Diabetic nephropathy is characterized by the presence of pathological quantities of urine albumin excretion, diabetic glomerular lesions, and loss of glomerular filtration rate in diabetics. Little evidence has been reported on relationships between BMD and albuminuria.

The aim of this study is to compare the bone mineral density (BMD) in postmenopausal women with type 2 diabetes mellitus (T2DM) with and without diabetic nephropathy.

Method

We retrospectively analyze the BMD of the lumbar spine and femur using dual-energy X-ray absorptiometry in 84 postmenopausal women with T2DM with (39) and without (45) diabetic nephropathy. The serum levels of calcium, phosphorus, total alkaline phosphatase, and urine albumin excretion were measured in all participants. Diagnosis of albuminuria was based on albumin-creatinine ratio (ACR).

Results

Age, body mass index (BMI) and time since menopause were not significantly different between the two groups. The T-scores of basal BMD at L4 were significantly lower in patients with diabetic nephropathy (-0,94 ± 0,40) compared to patients without nephropathy. No significant differences in serum creatinine were detected between two groups of patients. Our data suggest that ACR was negatively associated with lumbar spine and femoral neck BMD.

Conclusion

Our results suggest that postmenopausal women with diabetic nephropathy have a lower BMD and are at increased risk of osteoporosis in the lumbar spine compared with postmenopausal women without diabetic nephropathy. ACR was negatively associated with lumbar spine and femur neck BMD. One of the explanations that has been proposed for the association between albuminuria and osteoporosis is that albuminuria is associated with reduced bone blood flow, resulting in a decreased rate of bone remodeling and the development of osteoporosis.
MO646PATHOLOGICAL PROGNOSTIC FACTORS IN DIABETIC NEPHROPATHY: A RETROSPECTIVE STUDY
Authors: Sannier Aurélie , Maisons Valentin , Bobot Mickael , Vrtovsnik Francois , Jourde-Chiche Noemie , Barba Christophe , Daniel Laurent , Rioux-Leclercq Nathalie , Vigneau Cécile , Halimi Jean-Michel , Chemouny Jonathan
Published: May 2021

Background and Aims

Kidney Biopsies (KB) performed in patients with Type-2 diabetes (T2D) usually aim at differentiating diabetic nephropathy (DN) from other kidney diseases. However, KB could also help refining patients’ prognosis, both in terms of renal survival, and in terms of patient survival. In 2010, the Renal Pathology Society developed a pathological classification of DN, but the prognostic value of the described items , is still imperfectly documented. We aimed to assess the prognostic performances of these items to predict renal and patient survival.

Method

Native KBs with diabetic and/or hypertensive nephropathy (DN/HN) performed in patients with T2D in four French centers were analyzed and scored according to the classification developed by the Renal Pathology Society. Clinical and biological data was collected from the patients’ records. Survival analyses were performed for renal survival (time to first dialysis or preemptive transplantation) and death after dichotomization of continuous data). For each of the analyses, we first established a model comprising clinical data only. We then assessed the benefit of adding each of the pathological item to the clinical model. Finally, we performed a backward stepwise analysis to identify items predictive of renal and/or patient survival.

Results

We analyzed 165 biopsies with DN/HN from patients with T2D and with at least 12 months of follow-up (unless they reached an endpoint during the first year). Among them, 73 (44%) were male, 155 (94%) had hypertension, 53 (34%) hematuria, 22 (15%) had proliferative diabetic retinopathy (DR), 33 (23%) had non-proliferative DR, 90 (62%) had no DR (20 had missing data). Mean (SD) age was 63 (11), median [IQR] eGFRCKD-EPI was 29 [18;45] ml/min/1.73m², urinary protein-to-creatinine ratio was 0.38 [0.14;0.83] g/mmol, HbA1c was 7 [6.2;8.2] % and diabetes duration before KB was 10 [5;19] years. The median [IQR] follow-up was 33 months[18;57]. During the follow-up, 43 (26%) patients died and 69 (42%) required renal replacement therapy (RRT). The percentage of ischemic glomeruli, and presence of more than one area of arteriolar hyalinosis (ah=2), were predictive of renal survival and improved the predictive value of the model when added to clinical parameters. Presence of at least one convincing Kimmelstiel–Wilson lesion (nodular glomerulosclerosis or Class III DN) was predictive of death and similarly improved the predictive model (See figure).

Conclusion

Pathological findings on KB, as classified by the Renal Pathology Society, carry significant prognostic value in patients with T2D and DN/HN. Vascular lesions (presence of arteriolar hyalinosis and less than 7% of ischemic glomeruli) predicted the need for RRT, while nodular glomerulosclerosis was predictive of death.
MO648SERUM SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR IN PATIENTS WITH DIABETIC KIDNEY DISEASE
Authors: Lupusoru Gabriela Elena , Ailincai Ioana-Georgiana , Sorohan Bogdan Marian , Andronesi Andreea Gabriella , Lupusoru Mircea , Andronesi Danut , Manda Dana , Caragheorgheopol Andra , Ismail Gener
Published: May 2021

Background and Aims

Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease worldwide, associated with significant cardiovascular morbidity and mortality. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker associated with inflammation, endothelial dysfunction and kidney disease. There is a lack of studies that investigate the role of suPAR in patients with DKD. Our aim was to assess the level of serum suPAR and to evaluate its association with kidney function, proteinuria and histological lesions in patients with DKD.

Method

We performed a cross-sectional study on 75 patients with DKD evaluated in our department between 2019 and 2020. Inclusion criteria were: age> 18 years, diagnosis of type 1 or type 2 diabetes mellitus, DKD and absence of malignancy, autoimmune disease, infectious disease and liver disease. Demographical, clinical and laboratory parameters were collected at the time of admission. A subset analysis was performed on 28 patients with biopsy- proven diabetic nephropathy (DN) to investigate the association of serum suPAR with histological lesions. Kidney function was evaluated based on serum creatinine and estimated with CKD-EPI formula, proteinuria was reported as 24h proteinuria and albumin/creatinine ratio (ACR) and serum suPAR levels were measured with a solid-phase ELISA kit. The detection range of the kit was 12 -360 pg/ml (7.8- 500).

Results

Among the 75 patients, mean age was 57.9±12.2 years, male was the dominant gender (65.3%), mean BMI was 30.7±5.5 kg/m2, most patients had hypertension (97.3%) and 22.7% were active smokers. Sixty six out of 75 patients (88%) had type 2 diabetes and the median duration of diabetes was 180 months (120- 240). Median values of estimated glomerular filtration rate (eGFR), 24h proteinuria and ACR were 24.3 ml/min (15- 36), 4.8 g/24h (1.9- 7.1) and 2000 mg/g, respectively. Median serum level of suPAR at the time of evaluation was 2857.2 pg/ml (1916.4- 3700.1). Its level was positively correlated with duration of diabetes (r= 0.278, p= 0.01), eGFR (r= 0.634, p< 0.001), 24h proteinuria (r= 0.490, p< 0.001), ACR (r= 0.524, p< 0.001) and negatively correlated with urine specific gravity (r= -0.284, p= 0.01). In the subset analysis on 28 patients with biopsy-proven DN, median suPAR level was 2474 pg/ml (1782-3745) and was positively correlated with DN class (r= 0.493, p=0.008) and interstitial fibrosis and tubular atrophy (IFTA) score (r= 506, p=0.006), but not with interstitial inflammation, arteriolar hyalinosis or arteriolosclerosis.

Conclusion

Our study showed a high serum level of suPAR in patients with DKD and its association with duration of diabetes, urinary specific gravity, kidney function and proteinuria. We also found a positive correlation with severity of glomerular lesions and IFTA.
MO649DIAGNOSTIC TESTS OF NOVEL URINARY BIOMARKERS TO IDENTIFY EARLY STAGES OF NEPHROPATHY IN NON HYPERTENSIVE TYPE 2 DIABETIC MELLITUS
Authors: Mahapatra Himansu , Kulshreshtha Bindu , Goyal Dr Parul , Chirkara Anubhuti , Khanna Tripti , Singh Anamika , Arora Arpita , Prasad Gupta Yadunandan , Sekhar Venkatesan
Published: May 2021

Background and Aims

Activation of RAS and tubulointerstitial damage might be seen in pre-albuminuria stage of diabetic nephropathy. Here, diagnostic tests of urinary Angiotensinogen, Cystatin C, Neutrophil gelatinase associated lipocalin and IL 18 have been studied in pre-microalbuminuria diabetic patients.

Method

Total 952 Diabetic screened for Nephropathy (e-GFR ≥120&ACR≥30), among them 120 cases were followed up for one year. At one year they were classified in to Hyperfiltration43, Normoalbuminuria29 and Microalbuminuria48 groups. Another 63 Diabetes without nephropathy were included as controls. Hypertension, on ACEI/ARB, e-GFR<60ml/min/1.73m2 and all Macroalbuminuria conditions were excluded. All were subjected to urine protein, ACR, HbA1c,e-GFR, along with urinary bio markers(IL-18, Cystatin-C, NGAL and Angiotensinogen). Comparative analysis of all groups, Diagnostic tests, correlation and logistic regression were analysed.

Results

Urinary IL18/Cr, Cystatin /Cr. and Angiotensiogen /Cr. levels were higher in groups of hyper filtration (13.47, 12.11 & 8.43mg/g), Normoalbuminuria (9.24,11.74&9.15mg/g) and microalbuminuria(11.59,14.48&10.24mg/g) than controls(7.38,8.39&1.26mg/g) but not NGAL/Cr. in all groups. High levels were significant in all except Cystatin/Cr. & IL18/Cr. in normoalbuminuria group. The AUC, sensitivity and specificity of Angiotensinogen (0.9, 90% and 80%) ACR (0.69, 40% and 100%) and e-GFR (0.6,37 and 100%)respectively. AUC of other biomarkers viz, IL 18/cr. Cystatin/Cr and NGAL/Cr. were 0.65, 0.64 and 0.51 respectively. Angiotensinogen/Cr and IL18/Cr showed correlation with log albuminuria r-0.3 p 0.00 and r-0.28 p 0.00 respectively; NGAL with log e-GFR (r-0.28 p0.00).Multivariate logistic analysis showed Odds of contracting nephropathy is 7.5 times having higher values of Log Angio/Cr.

Conclusion

Urinary Angiotensinogen has higher diagnostic value than ACR and e-GFR followed by IL 18 and Cystatin to diagnose DN at the pre-albuminuric stages but not urinary NGAL.