bluuebunny/crossref_metadata_2025 huggingface dataset:
P0233ISOLATED MICROHEMATURIA IN ADOLESCENTS IS NOT ASSOCIATED WITH RENAL OR URINARY TRACT CANCER IN MIDDLE AGE
Authors: Leiba Adi , Fishman Boris
Published: June 2020

Background and Aims

Chronic or persistent isolated microhematuria (microhematuria without proteinuria) is not as benign as originally thought. It has been associated with an almost 20-fold risk of developing ESRD ( End Stage Renal Disease) in adulthood. It is still unclear if this chronic glomerular bleed increases the risk of renal or urinary tract tumors, secondary to ongoing irritation and inflammation. This is a valid question, especially as an adult with long standing isolated “glomerular” microhematuria can appear with an event of macrohematuria. In order to answer these questions, we studied the association between adolescent microhematuria and renal or urinary tract tumors in adulthood.

Method

A retrospective study based on a cohort of 2,172,866 Jewish adolescents (60% men) aged 16-19 who underwent a mandatory physical examination between ages of 16 and 19 years from 1967 to 2007 prior to their conscription. Urothelial Transitional cell carcinoma (TCC) and Renal cell carcinoma (RCC) incidence through December 31, 2012 was identified by linkage to the national cancer registry. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for RCC and TCC among adolescents who were diagnosed with persistent asymptomatic isolated hematuria after comprehensive medical evaluation. The models were adjusted for: Sex, age, year of birth, socio-economic status, BMI, years of education and country of origin.

Results

Over a median of 22 years (interquartile range of 13-31 years) of follow-up, 2007 and 1112 incident cases of TCC and RCC, respectively, occurred amongst the study population. Persistent hematuria was not associated with TCC with crude HR 1.15 (95% CI, 0.37-3.57) and adjusted HR of 1.08 (95% CI, 0.35-3.36), nor with RCC with crude HR 1.11 (95% CI, 0.28-4.457) and adjusted HR of 0.93 (95% CI, 0.23-3.75).

Conclusion

Isolated persistent microhematuria, while carrying a small risk of kidney disease progression, is not associated with either renal or urinary tract tumors. Screening guidelines among these patients should follow the general age and sex- matched approach.
P0234LOW URINARY CITRATE LEVELS ARE NOT SPECIFIC OF AUTOSOMAL POLYCYSTIC KIDNEY DISEASE (ADPKD) AND ARE PRESENT WHEN RENAL FUNCTION IS IMPAIRED IN ALL NEPHROPATIES
Authors: Borrego-Utiel Francisco-Jose , Merino Garcia Enoc , Herrera Isidoro , Moriana Dominguez Clara , Camacho Reina Victoria , Ocaña Perez Esther , García Cortés Maria José
Published: June 2020

Background and Aims

In polycystic kidney disease (PKD) it is frequently found a reduction in urinary citrate that is related with degree of renal impairment but it is unknown if this alteration is specific or if it is also present in other nephropathies. Recently it has been suggested that urinary citrate could be a marker of covert metabolic acidosis and reflects acid retention in chronic kidney disease (CKD). Our aim was to compare urinary citrate in PKD with other renal diseases and to show its relation with serum bicarbonate and excretion of uric acid and calcium.

Method

We determined citrate, calcium and uric acid in 24-hour urine in patients with PKD and with other nephropathies with varied degree of renal impairment followed in a outpatient clinic of nephrology.

Results

We included 291 patients, 119 with glomerular diseases, 116 with PKD, 21 with other nephropathies, and 35 patients with normal renal function. Urinary citrate was higher in women (Females 309±251 mg/gCr vs. males 181±145 mg/gCr, p<0.001) and in patients with normal renal function (normal 380±210 mg/gCr; PKD 203±166 mg/gCr; glomerular 279±282 mg/gCr; p<0,001). PKD patients showed similar values of urinary citrate to patients with glomerular diseases and with other nephropathies. We observed a progressive reduction in urinary citrate parallel to degree of renal impairment, in a comparable way among patients with PKD and glomerular diseases. We did not observe a relationship between urinary citrate and serum bicarbonate levels. Calcium and uric acid elimination in ADPKD patients was similar to other nephropathies and lower to patients with normal renal function. However, serum uric acid was significantly higher in glomerular patients than other nephropathies after adjust with glomerular filtration rate and sex.

Conclusion

Hypocitraturia is not specific of PKD but it is also present in all nephropathies. Urinary citrate are related to degree of renal impairment and it is not related with serum bicarbonate. We think that it could be interesting to study urinary citrate as a marker of renal function and its role as prognostic factor of renal deterioration.
P0237COMPARISONS OF CLINICAL FEATURES IN GITELMAN SYNDROME PATIENTS WITH DIFFERENT URINARY CALCIUM EXCRETIONS
Authors: Zhang Lei , Zhao Bingbin , Peng Xiaoyan , Wang Ying , Chen Limeng
Published: June 2020

Background and Aims

Hypocalciuria is considered typical in Gitelman syndrome (GS). However, a few GS cases diagnosed by gene testing presented as normocalciuria have been reported in recent years. Our study is to observe the clinical features in GS patients with different urinary calcium excretions, and investigate the value of urinary calcium excretion in the clinical classification for GS.

Method

GS cases from the National Rare Diseases Registry System of China (NRSC) (2016-2018) with SLCl2A3 gene screened in Peking Union Medical College Hospital were collected. The features of urinary calcium excretion were analyzed, and the phenotypes of patients with hypocalciuria were compared to those with normocalciuria. Hydrochlorothiazide (HCT) test was performed and the maximal increasement of chloride excretion fraction (△FECl) was calculated to evaluate the extent of NCC dysfunction.

Results

A total of 83 genetically proven GS patients was included, with the mean age at diagnosis of 31.0±13.0 years, and the male/female ratio was 1.4:1. Among them, 53 (63.9%) patients had hypocalciuria. The ratio of urinary calcium/creatine was significantly lower in patients with hypocalciuria (0.08±0.06mmol/mmol) compared to those with normocalciuria (0.47±0.28mmol/mmol), with a P value of <0.001. Age, gender, estimated glomerular filtration rate, blood pressure, alkalosis, and serum and urinary electrolytes including potassium, magnesium, natrium, chloride, and phosphorus were all comparable between patients with hypocalciuria and normocalciuria. Based on a standardized symptom questionnaire, fatigue (52.8% vs. 76.7%, P=0.03) and polyuria (9.4% vs. 30.0%, P=0.02) were less frequently reported in hypocalciuria patients, while all the other clinical symptoms were comparable. Sixteen patients in each group underwent HCT test, and the △FECl value was comparable between patients with hypocalciuria and normocalciuria (median, 0.54% vs. 0.83%, P=0.88), both of which indicated a blunt response to HCT (<2.86% according to our previous study).

Conclusion

The results show that 63.9% of the GS patients in this study had hypocalciuria. There is no definite relationship between urinary calcium excretion, phenotype and the extent of NCC dysfunction.
P0242SUBGROUP EFFICACY ANALYSIS OF SODIUM ZIRCONIUM CYCLOSILICATE (SZC) IN HYPERKALAEMIC HAEMODIALYSIS PATIENTS IN THE DIALIZE STUDY
Authors: McCafferty Kieran , Fishbane Steven , Spinowitz Bruce , Rastogi Anjay , Ford Martin , Guzman Nicolas
Published: June 2020

Background and Aims

Patients with end-stage renal disease have severely reduced renal potassium excretion and many require haemodialysis (3 days/week) to maintain normal serum potassium (sK+). The phase 3b DIALIZE study (NCT03303521) showed that sodium zirconium cyclosilicate (SZC) reduces predialysis sK+ after the long interdialytic interval and is well tolerated in haemodialysis patients with hyperkalaemia. This post-hoc analysis of the DIALIZE data assessed the efficacy of SZC in patient subgroups.

Method

The DIALIZE study randomised 196 patients 1:1 to placebo (n=99) or SZC (n=97). The study consisted of an 8-week treatment period, comprising a 4-week SZC dose titration phase followed by a 4-week evaluation phase. The starting dose of SZC was 5 g orally once daily on non-dialysis days (4 days/week) for the 4-week dose titration phase (titrated in 5 g increments to a maximum of 15 g) to achieve predialysis sK+ 4.0–5.0 mmol/L. Patients maintained a stable SZC dose for the 4-week evaluation phase (SZC 5, 10 or 15 g). Here, we assessed the proportion of treatment responders, i.e. those who during the 4-week evaluation phase achieved predialysis sK+ of 4.0–5.5 mmol/L during ≥3 of 4 haemodialysis treatments after the long interdialytic interval and who did not require potassium-lowering rescue therapy. Treatment responders were stratified by patient subgroups: sex, country, race, age (years), baseline weight (kg) and baseline sK+ (mmol/L).

Results

For patients receiving SZC, at baseline 59% were male, mean age was 55.7 years, 52% were white, 11% were Black or African American and 34% were Asian, and mean predialysis sK+ was 5.8 mmol/L. Using a predialysis sK+ range of 4.0–5.5 mmol/L, 69.1% (n=67/97) of SZC patients and 19.2% (n=19/99) of placebo patients were deemed treatment responders. Response to SZC was generally consistent across patient subgroups vs placebo for sex, country, race, age, baseline weight and baseline sK+, with some variation between subgroup subcategories (Table).

Conclusion

Our results suggest that SZC is generally effective across all groups of haemodialysis patients with hyperkalaemia. SZC responder rates for some patient subgroup subcategories were limited by low patient numbers.
P0251PERCUTANEOUS ANGIOPLASTY OF RENAL ARTERY STENOSIS IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING HEMODIALYSIS
Authors: Abu amer Nabil , Dinour Dganit
Published: June 2020

Background and Aims

Atherosclerotic renal artery stenosis (RAS) is a common disease, associated with significant morbidity and mortality. Several studies have shown that percutaneous angioplasty with stenting (PTA/S) is not superior to medical treatment. The benefit of endovascular intervention among acute kidney injury (AKI) patients requiring hemodialysis secondary to RAS has not been studied. We investigated the effects of PTA/S in patients with atherosclerotic RAS, specifically those who presented with AKI indicated for hemodialysis.

Method

We collected data between 2003 and 2019. We defined a subgroup of patients who presented with AKI and underwent the procedure after starting hemodialysis. Data collected included demographic parameters, medical background, indication for intervention, technical procedure parameters and complications and long term data including dialysis treatment and mortality. Patients who underwent PTA/S due AKI with dialysis were categorized as responders or non-responders based on improvement in kidney function and weaning off dialysis.

Results

We identified 109 PTA/S performed in 92 patients. Technical success was 97% and complication rate was 15.5%. Creatinine and blood pressure improved in 8.9% and 32% respectively, based on predetermined criteria. A subgroup of 11 patients underwent PTA/S for hemodialysis-dependent AKI. 8 patients (73%) improved kidney function and discontinued dialysis. The average time on dialysis was 17 days (range 3-35 days) to PTA/S and 22 days (range 3-42 days) to recovery of kidney function, which occurred 6.5 days (range 1-24 days) after PTA/S. two of the 8 patients required long term hemodialysis after 12 and 22 months post procedure. Only two cases were reported with mild complications (pseudo-aneurysm and brachial hematoma). Factors associated with response to PTA/S include a higher baseline eGFR, less proteinuria, larger kidney size and better contrast enhancement on imaging.

Conclusion

In patients with hemodialysis dependent AKI, PTA/S should be considered as a rescue treatment and may recover kidney function even after prolonged time on dialysis.
P0256RESEARCH OF GUT MACROBIOTA IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Olimxanova Kamila
Published: June 2020

Background and Aims

Currently, it is estimated that the intestinal microbiota has hundreds of species of bacteria. It is known that intestinal dysbiosis contributes to the development of many diseases, such as obesity, diabetes mellitus, cardiovascular diseases, including CKD. The question of the relationship between bacterial contamination and the process of endogenous inflammation in patients with chronic kidney disease of the pre-dialysis stages is not completely clear. The aim of the study the composition of the intestinal microbiota in fecal samples and the level of inflammatory markers (CRP, IL-6, leukocytes) in patients with pre-dialysis stages of CKD.

Method

60 patients with CKD of the pre-dialysis stages (C2-C4) were examined. The diagnosis of CKD was made on the basis of clinical, instrumental, and laboratory data. To study the relationship between the composition of the intestinal microbiota and inflammation in patients with CKD, we studied markers of inflammation such as CRP and IL-6. CRP was determined in blood serum by a highly sensitive method on a Humareader Single analyzer, IL-6 by enzyme-linked immunosorbent assay on a solid-phase analyzer. eGFR was calculated using the formula CKD-EPI-2011. The control group consisted of 30 healthy subjects. Statistical processing was carried out using methods of variation statistics. The results were processed using Microsoft Exel 2002 & Statistica 6.0.

Results

The average age of patients was 59 years. Of these, 25 women (40%) and 35 (60%) men. The estimated glomerular filtration rate varied from 30 to 60 ml / min / 1.73 m2, which corresponded to the indicators of the pre-dialysis stages of CKD. Analysis of intestinal microbiota showed a deficiency of Bifidobacterium bacteria (<108 CFU), and an increase in the number of Escherichia (> 108 CFU) in patients with CKD of the pre-dialysis stages. According to the results of the study, in the group of patients with CKD, the level of inflammatory markers was higher (CRP-55%, IL-6-60%, leukocytes 62%) than in the control group (CRP-45%, IL-6-40%, leukocytes 38% ) However, in men, the IL-6 index was higher than in women. In patients with CKD with obesity, the titer of pathogenic bacteria and their spectrum showed the worst results, although unreliable.

Conclusion

All examined patients had dysbiosis of the 2nd degree. At the same time, an imbalance of the intestinal microbiota is combined with an increased level of CRP, IL-6, and white blood cells.
P0259PARAPROTEIN-RELATED RENAL LESIONS IN NEWLY DIAGNOSED MULTIPLE MYELOMA: CLINICAL AND PATHOLOGICAL CHARACTERISTIC OF 51 PATIENTS WITH KIDNEY BIOPSIES
Authors: Lin Zishan , Yu Xiaojuan , Wang Suxia , Cen Xinan , Zhou Fude , Zhao Minghui
Published: June 2020

Background and Aims

Renal involvement is common in multiple myeloma (MM). In this study, we examined kidney biopsy findings in patients with newly diagnosed MM (NDMM) and correlated them with clinical characteristics and survival.

Method

Renal pathological findings were retrospectively studied in 56 patients with NDMM. Clinical and laboratory data as well as outcomes were collected from 51 patients with paraprotein-related renal lesions in NDMM. Patients were categorized according to the with or without myeloma cast nephropathy (MCN).

Results

Among 56 patients with NDMM, 51 had paraprotein-related renal lesions, of which MCN was the most common lesion in 31 patients (60.8%), followed by amyloidosis in 12 patients (23.5%) and light chain deposition disease (LCDD) in 8 patients (15.7%). Five patients had nonparaprotein-associated lesions, of which minimal change disease was the most common diagnosis, seen in 3 patients (60%). Patients with MCN had significantly higher serum creatinine levels, a lower eGFR, a higher percentage of requiring dialysis at diagnosis, a higher incidence of progressing to end-stage renal disease (ESRD), lower hemoglobin levels, a lower percentage of albumin in urine protein, a higher level of serum albumin and were more likely to have a detectable M-spike but less likely to have a detectable monoclonal whole immunoglobulin than patients without MCN. Compared with patients with MCN, the median overall survival time of patients without MCN was significantly longer (not reached vs 39 months (95% CI: 9–69 months); P=0.047; Fig.1). According to the multivariate analysis, the independent predictors of overall survival were the number of myeloma casts (HR: 1.12, 95% CI: 1.07-1.25; P=0.014) and male sex (HR: 4.99, 95% CI: 1.36-18.38; P=0.016).

Conclusion

Patients with MCN suffer from more serious and more urgent renal damage and can also present with high-grade albuminuria but without hypoalbuminemia. The number of myeloma casts and male sex are independent predictors of overall survival.
P0272COMPARATIVE GUT MICROBIOME DIFFERENCES BETWEEN FERRIC CITRATE AND CALCIUM CARBONATE PHOSPHATE BINDER TREATMENT IN HEMODIALYSIS PATIENTS
Authors: Wu Ping-Hsun , Lin Yi-Ting , Liu Po-Yu , Kuo Mei-Chuan , Chiu Yi wen
Published: June 2020

Background and Aims

Gut microbiome alteration increases uremic toxin levels inducing chronic inflammation and leading morbidity and mortality in patients with chronic kidney disease. Phosphate-binding agents may potentially change the composition of the gut microbiota. However, the limited clinical study investigates the microbiome difference between iron-containing and calcium-containing phosphate binders. The aim of this study was to compare the microbiota composition in hemodialysis patients treated with ferric citrate or calcium carbonate.

Method

The stool microbiota was investigated in hemodialysis patients with ferric citrate used (n=8) and calcium carbonate used (n=46) by 16S rRNA next-generation gene sequencing profiling. The altered microbiota between two different phosphate binders was analyzed. Differences in the microbial composition of the two patient groups were assessed using linear discriminant analysis effect size.

Results

Hemodialysis patients with calcium carbonate used revealed significantly reduced microbial species diversity (Shannon index and Simpson index) and increased microbial dysbiosis index compared with ferric citrate users. Compared to patients taking calcium carbonate, a distinct microbial community structure in patients taking ferric citrate, with an increased abundance of Bacteroidetes phylum and decreased abundance of phylum Firmicutes. In comparison between two phosphate binder users, members of the order Lactobacillales were prominent in calcium carbonate therapy, including family Streptococcaceae and genus Streptococcus. In contrast, taxa of the genus Ruminococcaceae, Flavonifractor, and Cronobacter were enriched in ferric citrate phosphate binder users.

Conclusion

The fecal microbiota was richer and more diverse in the ferric citrate group than in the calcium carbonate group. Hemodialysis patients with ferric citrate used were associated with differences in the gut microbiome composition compared to calcium carbonate users.
P0274A NOVEL METHOD FOR THE ASSESSMENT OF RENAL BIOPSY WITH THE ACTIVATABLE FLUORESCENT PROBE
Authors: Iyama Takuji , Takata Tomoaki , Mae Yukari , Taniguchi Sosuke , Ida Ayami , Ogawa Masaya , Yamamoto Marie , Fukuda Satoko , Isomoto Hajime
Published: June 2020

Background and Aims

Renal biopsy is one of the most important procedures in nephrology. The histological analysis of biopsy tissues is important for the diagnosis and prognosis assessment of renal diseases, as well as determining the treatment strategy. It is necessary to obtain biopsy specimens containing renal cortex for such purpose. Although renal biopsy is the undisputed diagnostic procedure, there always is a need to weigh the benefits against the potential complications. A novel activatable fluorescent probe that reacts with a peptide, which is highly expressed in the renal cortex, has been developed. We evaluated the feasibility of this probe for assessing renal biopsy specimens.

Method

The fluorescent probe was firstly applied to renal proximal tubular cells in order to evaluate the fluorescent emission. Then the probe was applied to mouse kidneys ex vivo. Finally, it was applied to human biopsy specimens (n=12). Fluorescent images were acquired using commercially available digital camera equipped with optical interference filter. Fluorescent intensities were quantified and the intensities in cortex and medulla were compared.

Results

We observed fluorescent emission from the renal proximal tubular cells immediately after the administration of the fluorescent probe. The fluorescent intensity gradually increased with time. The fluorescence signal was detected in the mouse kidneys ex vivo without markedly affecting the tissue morphology. The probe on human biopsy specimens also emitted fluorescent and the fluorescent could be detected in all the patients examined. In addition, the cortico-medullary junction could be identified in the fluorescent image (Figure). The fluorescent intensities in renal cortex were remarkably stronger than in medulla.

Conclusion

Renal biopsy specimens can be assessed by fluorescent image using this activatable fluorescent probe. This novel fluorescent probe is useful in clinical nephrology.
P0279DIABETIC KIDNEY DISEASE VERSUS CHRONIC KIDNEY DISEASE IN ADULTS WITHOUT DIABETES MELLITUS: A RENAL SURVIVAL ANALYSIS
Authors: Stefan Gabriel , Petrescu Ligia , Stancu Simona , Mircescu Gabriel
Published: June 2020

Background and Aims

Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease, but the decline in kidney function varies considerably between chronic kidney diseases (CKD), and determinants of renal function loss, early in the course of the disease, are still a matter of debate.

Method

We retrospectively examined the renal outcome at 31 July 2017 of 309 CKD patients (age 59.1 (50.1-68.6) years; 60% male; eGFR 32.7 (21.7-44.8) mL/min) admitted in our hospital during January 2007-December 2012 with a median follow up time of 7.2 (95%CI, 6.8-7.6) years. Only patients who had at least 3 admissions and who were alive during the study period were included. CKD was defined as the presence of an eGFR <60ml/min/1.73m2 or the presence of albuminuria >30mg/g creatinine for more than 3 months. The primary endpoint was renal survival defined as renal replacement therapy (RRT) initiation. Factors affecting renal survival were evaluated in a Cox proportional hazard model.

Results

DKD (24%), glomerular (GN, 24%), tubulo-interstitial (TIN, 27%) and vascular nephropathies (VN, 25%) were the causes of CKD. Patients with DKD (66.8 (56.5-72.2) years) and VN (68.5 (59.7-76.2) years) were older than those with GN (50.3 (37.4-59.0) years) and TIN (55.6 (45.8-61.8) years). Moreover, the highest cardiovascular comorbidity score was found in patients with VN and DKD (p<0.001). Median eGFR decline was -1.23 ( -3.39 – 0.35) mL/min/year; 29% of the patients had CKD progression of >3mL/min/year and 14% had rapid progression (>5mL/min/year). Patients with GN had the lowest eGFR (26.8 (19.1-38.9) versus DKD 36.2 (23.4-47.7), VN 34.9 (22.4-51.0), TIN 32.4 (21.8-44.8) mL/min, p<0.001), the fastest eGFR decline (-3.1 versus DKD -1.9, VN -1, TIN -1,2 mL/min/year, p 0.5) and the highest proteinuria (2.7 versus DKD 1.4, VN 0.4, TIN 0.6 g/24h, p<0.001). During follow up, 29% of the studied patients started RRT; mean renal survival time for the entire cohort was 7.4 (95%CI, 7.0-7.8) years. CKD cause (versus DKD p=0.04, Figure 1), lower eGFR (HR 0.89 (95%CI, 0.85-0.93)), elevated albuminuria (HR 1.4 (95%CI, 1.2-1.7)), higher total serum cholesterol (HR 1.00 (95%CI, 1.00-1.01)) and elevated mean arterial blood pressure (HR 1.03 (95%CI, 1.00-1.06)) were associated with RRT initiation in the Cox regression model.

Conclusion

Patients with DKD and VN had similar poorer renal survival as compared with GN and TIN. Earlier referral to the diabetic renal clinic and intensive management of the modifiable risk factors (albuminuria, hypercholesterolemia, hypertention) are necessary to retard progression of CKD and, subsequently, prolong renal survival.
P0301FIT FOR PURPOSE VALIDATION OF A CLINICAL ASSAY FOR THE DETECTION OF SERUM LEVELS OF GALACTOSE-DEFICIENT IMMUNOGLOBULIN A1 (GD-IGA1) IN PATIENTS WITH IGA NEPHROPATHY (IGAN)
Authors: Sponton Laura , Jin Hulin , Fluck Markus , Suzuki Yusuke , Kao Amy
Published: June 2020

Background and Aims

Analysis of serum or plasma from patients with IgA nephropathy (IgAN) has confirmed the presence of elevated levels of circulating immune complexes containing Gd-IgA1 (Czerkinsky 1986). New sensitive and reasonably specific noninvasive tests are emerging to guide the therapeutic strategy that is applicable to all stages of IgAN (Suzuki 2014).

Here we are reporting the fit for purpose validation of an ELISA method for the quantitative determination of Gd-IgA1 in human serum samples to support biomarker investigations in clinical studies of Merck KGaA, Darmstadt.

Method

The assay was developed based on a commercially available immunoassay kit. The dynamic range of the calibration curve was determined from 1.56 ng/mL (LLOQ) to 100 ng/mL (ULOQ). With a minimum required dilution of 200-fold and standard assay volume of 50.0 μL, the range of the method in matrix was from 312 ng/mL to 20, 000 ng/mL.

In assay validation phase, multiple validation parameters were evaluated, which included minimum required dilution (MRD), calibration curve, matrix effect, Intra- & Inter run accuracy & precision, selectivity, and parallelism. Additional validation parameters include sample stability (short/long term, freeze-thaw) and batch-to-batch comparison.

Results

All samples measured for intra & Inter - assay precision, accuracy, fulfilled the specifications according to the acceptance criteria. The selectivity was assessed using blank serum matrix from 10 individuals: the result indicated that matrix components in serum did not interfere with the detection of Gd-IgA1. Parallelism assessment was performed successfully for both samples from healthy donors and IgAN patient samples up to dilution factor (DF) 3200 (serum samples from healthy donors were determined up to DF 1600). All DF-corrected results within the assay range were determined with %CV ≤ 30.0%. Batch to batch comparison was assessed successfully based on the known shelf life of the kit. Short term stability using QC samples were given for up to 24hrs at room temperature. Freeze-thaw stability was given for up to 3 cycles at -20°C±5°C and -75°C±15°C.

The investigations were performed according to general guidelines for method validation and applicable regulations. The results of investigated validation parameters fulfilled the requirements and recommendations, generally accepted for bioanalytical projects.

Conclusion

The present validation qualified the method for the quantitative determination of Gd-IgA1 in human serum samples from clinical studies.
P0304POINT OF CARE ULTRASOUND IN NEPHROLOGY: THE SOONER THE BETTER!
Authors: Gliga Mirela Liana , Gliga Mihail Gheorghe , Chirila Cristian , Lie-Ungurean Raluca-Maria , Chirila Paula
Published: June 2020

Background and Aims

Point of care ultrasound (POCUS) is performed at the bedsite of the patient by de treating clinician. In nephrology a particular situation is related to severly ill patients, immobilized with elevated creatinine, which can not be deffered to imaging investigations such as CT scan or MRI. Using a small portable device, important clinical problems can be solved in no time.

Method

We examined 360 out of 670 patients admitted to the nephrology departament in a period of one year. They were severely ill due to following pathologies: 35 severe sepsis with hypotension, 53 decompensated heart failure, 24 stroke, 248 with renal failure and acido-basic or electrolitic disturbances. Evaluation was made using a portable US device with a 10 MHz linear probe and 3.5 MHz convexe probe with abdomen and thoracic software. Diameter of inferior vena cava (IVC), respiratory collapse of IVC, effusions in pleura, pericardium or peritoneum, liver dimensions, kidneys and spleen were described.

Results

31 out of 35 patients with hypotension had collapsed IVC, diameter less than 1cm, PPV 88.5%; 48 from 53 heart failure had enlarged IVC with reduced respiratory collapse, PPV 90.6% and 201 from 248 renal failure patients had kidney changes, 81.04%. As compared with standard diagnostic tools (echocardiography, native CT scan and clinical examination, Sensitivity was over 98% in all cases.

Conclusion

POCUS is a very usefull test for the rapid bed-site examination of kidney patients, were a rapid decision has to be made using a portable device. Sensitivity of the method proved to be comparable as with standard diagnostic tools.
P0305DIAGNOSTIC VALUE OF TGF-B-1 AND ANG II EXCRERION IN URINE IN CHILDREN WITH VESICOURETERAL REFLUX DEPENDING ON THE THERAPEUTIC APPROACH
Authors: Zaicova Natalia , Sudareva Tatiana , Dlin Vladimir , Sinitsina Lilia , Korsunskiy Anatolii
Published: June 2020

Background and Aims

to determine the diagnostic value of profibrogenic cytokines of transforming growth factor (TGF-β1) and angiotensin II (AngII) in urine to detect the severity of tubulointerstitial fibrosis in children with vesicoureteral reflux (VUR) depending on the therapeutic approach.

Method

117 patients aged 3 to 16 years (mean age 10.2 ± 4.5, 70.1% of girls) with VUR were examined. The control group consisted of 20 healthy children. All children underwent a complete nephrological examination. The levels of TGF-β1 and AngII were determined in morning urine using the ELISA method and counted for urine creatinine. To identify the severity of the lesion of the renal parenchyma, a static DMSA scintigraphy was performed.

Results

depending on the therapeutic approach, the children were divided into 2 groups: 1 gr. - children on conservative treatment (63.2%), 2 gr. - children, after surgical correction of VUR (36.8%). In each group, 3 subgroups were identified depending on the development of tubulo-interstitial fibrosis according to DMSA: A subgr. - without signs of sclerosis (15.4%), B subgr. - 1-2 foci (44.74%) and C subgr - > 3-4 foci of sclerosis (40.1%). All patients with VUR had a high urinary excretion of TGF-β1/Cr and AngII/Cr when compared with the control group (p<0.05). Regardless of the therapeutic approach, in subgroups A (without foci of sclerosis) and B (1-2 foci of sclerosis), patients had a statistically significantly lower level of excretion of these cytokines when compared with patients from subgroup C (p <0.05). No significant difference was found in the urinary excretion of TGF-β1/Cr and AngII/Cr depending on the therapeutic approach.

Conclusion

we established a reliable dependence of the excretion of TGF-β1/Cr and AngII /Cr in the urine on the severity of tubulo-interstitial fibrosis according to DMSA scintigraphy in children with VUR. At the same time, we did not note the dependence of the excretion of TGF-β1/Cr and AngII/Cr in the urine on the method of the therapeutic approach. Therefore, the study of the excretion of TGF-β1/Cr and AngII/Cr in the urine as non-invasive markers can be used as a criterion for the progression of nephropathy in VUR, regardless of treatment methods.
P0309IMPACT OF ACUTE KIDNEY INJURY ON CLINICAL COURSE AND TREATMENT RESPONSE IN PATIENTS WITH MINIMAL CHANGE NEPHROTIC SYNDROME
Authors: Okushima Hiroki , Iwata Yukimasa , Takatsuka Taisuke , Yoshimura Daisuke , Kawamura Tomohiro , Ueda Yoshiyasu , Shoji Tatsuya , Hayashi Terumasa
Published: June 2020

Background and Aims

Minimal change nephrotic syndrome (MCNS) has acute onset and is occasionally complicated with acute kidney injury (AKI) in its clinical course. Few studies concerning factors associated with AKI and impact of AKI on clinical course and response to treatments are available to date. Thus, we assessed the prevalence of and factors associated with AKI and its effect on clinical course in MCNS patients.

Method

Single center retrospective cohort study was conducted on 72 biopsy-proven MCNS patients presented to Osaka General Medical Center, between January 2006 and December 2016. Multivariate logistic regression analysis and Cox proportional hazards analysis were used to assess contributing factors to AKI and its effect on the duration until remission.

Results

Median age was 58 years and 50% were male. At first presentation, the mean albumin and total cholesterol were 1.7±0.5g/dl and 402±118mg/dl, respectively. The mean urinary protein and eGFR were 12.8±8.2g/gCr and 60.1±29.4ml/min/1.73m2, respectively. A total of 29 patients (40%) had AKI and 10 of them needed renal replacement therapy (RRT). Corticosteroid and cyclosporine A were used in 66 (91%) and 3 (4%) patients, respectively for initial treatment and 3 patients (4%) received neither. 67 patients (93%) achieved complete remission (CR) with a median duration of 18 days after treatment, while 20 of those relapsed during the median follow-up period of 38 months. Logistic regression analysis revealed that older age, lower albumin, and higher urinary protein were significantly associated with AKI. Furthermore, patients with AKI had longer duration to CR induction compared with those without AKI (Log-rank test: p=0.03). Cox proportional hazards analysis showed that older age and RRT induction were associated with the delay of CR.

Conclusion

AKI occasionally occurs in patients with MCNS and need for RRT is associated with the delay of CR.
P0310FLUID OVERLOAD AND MARKERS OF CARDIOVASCULAR DAMAGE IN SEVERE NEPHROTIC SYNDROME
Authors: Matyjek Anna , Rymarz Aleksandra , Niemczyk Stanisław
Published: June 2020

Background and Aims

One of the major symptoms of severe nephrotic syndrome is fluid retention. Fluid overload can induce cardiovascular damage. NT-proBNP (N-terminal pro-brain natriuretic peptide) and hsTnT (high sensitivity troponin T) are well known markers of this disorder. The aim of the study was to evaluate the association between volumes of body water compartments and markers of cardiovascular damage in patients with severe nephrotic syndrome (SNS) defined as nephrotic range proteinuria and hypalbuminaemia ≤ 2.5 g/dl.

Method

40 patients with SNS and eGFR >30 ml/min/1.73m2 formed the study group (SNSG) and 40 healthy volunteers without SNS matched according to age, sex, height, body mass and kidney function formed the control group (CG). In all participants serum creatinine, serum albumin concentration, daily proteinuria, hsTnT and NT-proBNP were measured. Body water compartments such as extracellular water (ECW), intracellular water (ICW), total body water (TBW), overhydration (OH) were assessed using Body Composition Monitor, Fresenius Medical Care. For statistical analysis Spearman’s correlation coefficients, chi2 or Mann-Whitney U tests were used (Statistica v 13.1).

Results

SNSG included 28 males (70%) and 12 females. Median age was 55 years (IQR 30-65), the mean daily proteinuria was 10.5 ±5.0 g. The characteristics of the study parameters in two groups are described in the table.

Significantly higher hsTnT (18 vs 6 ng/l, p=0.0001) and NT-proBNP (294.8 vs 47.1 pg/ml, p=0.0003) levels were observed in the severe nephrotic syndrome group in comparison (SNSG) to CG.

In SNSG extracellular water was significantly higher (20.9 ±5,2 vs 17.4 ±3.3 L, p=0.001) and intracellular water (ICW) was significantly lower (18.9 ±5.2 vs 21.4 ±4.8 L, p=0.034) in comparison to CG. Interestingly total body water (TBW) did not differ between the groups (39.8 ±8.6 vs 38.8 ±7.7 L, p=0.603). Also overhydration which is a derivative of ECW, was higher in SNSG (OH: 4.2 vs 0.3 L, p<0.0001) than in CG. Significant, positive correlation was observed between OH and NT-proBNP (R=0.56, p<0.0001) as well as hsTnT (R=0.60, p<0.0001). We did not observed significant correlation between ECW and NT-proBNP or hsTnT.

Conclusion

In the severe nephrotic syndrome group fluid retention was associated with the increase in ECW and the decrease in ICW whereas TBW was the same in both groups. Such constellation can indicate for intracellular underhydration which was not describe so far. Overhydration, which is a derivative of ECW, positively correlated with markers of cardiovascular damage and can be important for patients with resistant SNS and can influence their prognosis.
P0311INFECTION-RELATED GLOMERULONEPHRITIS IN ADULTS: TIME FOR A DEFINITIVE PARADIGM SHIFT?
Authors: Salviani Chiara , Zappa Mattia , Jeannin Guido , Gaggiotti Mario , Tardanico Regina , Fisogni Simona , Cancarini Giovanni , Scolari Francesco
Published: June 2020

Background and Aims

The recent decades have witnessed significant changes in the epidemiology and clinical course of infection-related glomerulonephritis (IRGN). We analyzed the clinicopathological features and long-term outcome of adult patients with biopsy-proven IRGN followed in a large Italian referral centre.

Method

We included patients with biopsy-proven IRGN diagnosed from 2000 to 2018. Clinical and laboratory findings, histological features, possible risk factors and therapy were assessed for both renal and patient outcome.

Results

Forty-one patients met the inclusion criteria (male:female ratio 3:1, mean age 61±16 years). Smoke habit (47.2%), alcoholism (30.6%), and diabetes (27.5%) were the most common risk factors. The most frequently identified sites of infection were skin, lung and heart (Table 1). Staphylococci spp. accounted for 76.5% of positive cultures (Figure 1). Hypocomplementaemia emerged in 48.5% of cases. The most frequent histologic patterns were diffuse proliferative (56.0%) and membranoproliferative (29.3%) glomerulonephritis. Haemodialysis was required by 22.5% of patients at inception. Two thirds of patients developed chronic kidney disease; half of them reached end-stage renal disease (ESRD). By multivariate analysis ESRD was associated with diabetes (HR 13.7; 95% CI, 1.6-121.0; p=0.018), crescents (HR 25.2; 95% CI, 2.7-235.7; p=0.005), and interstitial fibrosis (HR 31.0; 95% CI, 3.3-287.3; p=0.003). Male gender (HR 12.7; 95% CI, 10.8-14.6; p=0.008) hypertension (HR 40.8; 95% CI, 38.6-43.1; p=0.001), gross haematuria (HR 11.8; 95% CI, 9.4-14.2; p=0.047), need for haemodialysis at onset (HR 16.3; 95% CI, 14.7-17.8; p<0.0001), and interstitial infiltrate (HR 13.3; 95% CI, 11.6-15.0; p=0.003) significantly affected survival. Corticosteroids did not affect prognosis.

Conclusion

While traditionally considered a “benign” disease with a favorable course in children, IRGN is a potentially severe disease in adults, particularly when a background of major comorbidities and older age are present. A significant proportion of patients does not recover renal function, with a remarkable risk of ESRD.
P0319DEPRESSIVE BURDEN, QUALITY OF LIFE AND CAREGIVER BURDEN IN END STAGE RENAL DISEASE - A PARADIGMATIC SHIFT IN HOLISTIC MANAGEMENT
Authors: Khan Abdul waheed , Khan Shahbaz ali , Ray Deepak Shanker , Prasad Swetanka , Khan Shagufta , Deshpande Aruna
Published: June 2020

Background and Aims

Depressive illness is not only common in patients of End Stage Renal Disease (ESRD) but also an independent risk factor for morbidity and mortality. The relation between depressive illness, Quality of Life and caregiver burden in this vulnerable group is complex. We attempted to study these 3 important psychosocial domains in patients of ESRD on hemodialysis, peritoneal dialysis as well as those ESRD patients who were not on any dialysis yet

Method

A cross sectional analytical comparative controlled design was done to compare 3 domains of depressive burden, quality of life and caregiver burden in 3 group of patients – ESRD patients on hemodialysis, ESRD patients on peritoneal dialysis and ESRD patients not on any dialysis

Statistical methods used - χ2 statistic or Fisher‘s exact test for categorical variables and comparison of group means. ANOVA was used for continuous variables where more than 3 groups were compared. Correlational analysis done using Spearman’s correlation coefficient . A p-value of <0.05 was considered significant. SPSS 20.0 was used

Results

Depressive symptoms were present significantly across all 3 groups of ESRD. Depressive disorder was significantly higher in the Hemodialysis group (HD) as compared to peritoneal dialysis (PD) group( p=0.038). Mean QOL was significantly higher for PD. Caregiver burden was higher in the HD group.

The study brought out the huge burden of depressive symptoms and depressive illness in patients on ESRD across all 3 group of patients and the significantly higher burden of depressive illness and lower QoL and higher caregiver burden in the hemodialysis group. This assumes significance because the majority of our ESRD patients are on HD

Conclusion

This depressive burden is the hidden factor behind poor Quality of Life as well as poor overall satisfaction as well as treatment outcome in our patients of ESRD whether or not on dialysis. Apart from the inherent factors related to the illness or the type of dialysis, sociodemographic factors seem to play a role in QoL and CG burden in the hemodialyis group. To address this hidden depressive burden comprehensively, we recommend closer cooperation between nephrologist, psychiatrist and psychosocial workers to improve the overall treatment outcome in ESRD patients.
P0323REVERSIBLE RENAL FUNCTION DECLINE ASSOCIATED WITH NIRAPARIB
Authors: Lazareth Helene , Delanoy Nicolas , Raphaël COHEN , Boissier Emilie , Alexandre KARRAS , Thervet Eric , Courbebaisse Marie , Pallet Nicolas
Published: June 2020

Background and Aims

Inhibitors of poly-ADP-ribose-polymerase-1 (PARP) are prescribed for the treatment of metastatic breast and ovarian cancers. Clinical data trials suggest that niraparib may not have adverse effects on the kidney.

Method

We present a descriptive case series of renal function parameters of all the patients who received niraparib for maintenance treatment of recurrent ovarian cancer in a tertiary care center. Twenty patients received niraparib for the first time between april 2018 and march 2019 in the Georges Pompidou European Hospital, Paris, France. Four patients were excluded from the analysis because of lack of repeated serum creatinine (Scr) measurements during the first 4 months following niraparib introduction.

Results

The patients ranged in age from 51 to 82 years. All patients were women with high grade serous ovarian carcinoma. Personal medical history of hypertension was present in 68% and diabetes in 18% of patients. All patients received carboplatin and 90% received bevacizumab as maintenance treatment after first-line chemotherapy. Niraparib was introduced on average 3 years (range 2 to 9 years) after the diagnosis of cancer, at a dosage of 200 mg/day in all patients. The median Scr at baseline was 84 μmol/l (range 62 to 114 µmol/l). All patients experienced an increase in Scr level over the 3 months following niraparib introduction. The average max Scr increase was 1.35 times baseline (median Scr 117µmol/l, range 88 to 155 µmol/l, p<0.0001 compared to baseline values), and 3 patients (18%) developed stage 1 KDIGO Acute Kidney Injury/Disease (Scr increase > 1.5-2 fold baseline). None of the cases had biochemical signs of tubular or glomerular injury. Urinary creatinine clearance was higher than urinary clearance of 51Cr-EDTA, making interaction with tubular creatinine secretion unlikely. Kidney biopsy was performed in one patient who developed albuminuria. Microscopic examination identified mild tubular atrophy and interstitial fibrosis without inflammatory lesion Immunofluorescence analysis did not show immune deposits. Mesangiolysis was found in some glomeruli, typical of bevacizumab effects. Niraparib was interrupted in all but 1 patient (95%), because of haematological toxicity (n=7), tumoral progression (n=7) or gastro-intestinal toxicity (n=1). Average Scr level returned to baseline (82 µmol/l, range 62 to 107 µmol/l) over the 2 months following discontinuation.

Conclusion

Niraparib is associated with a systematic and significant increase in Scr (+35%) without obvious sign of tubular or glomerular injury. Renal dysfunction is mainly reversible after discontinuation. Decline of renal function under treatment may not be an incentive to stop treatment automatically. Physicians prescribing this agent should be aware of this complication.
P0325FREQUENCY AND PREDICTORS OF NON URINARY INFECTIONS AMONG THE ADULT PATIENTS WITH STERILE PYURIA ATTENDED IN NEPHROLOGY DEPARTMENT OF BSMMU, BANGLADESH
Authors: Md Ismail Hossain , Hamid Dr A H Hamid ahmed , Tanzin Dr Mirza Sumaiya Tanzin , Islam Rafi Nazrul
Published: June 2020

Background and Aims

Urinalysis is a test commonly ordered, especially when the patient has a febrile illness. In most cases it provides useful information, but it can sometimes be misleading. A significant proportion of patients with acute febrile illness have transient pyuria without bacteuria. Identification and management of such cases could be improved by better predictive models.To determine predictors of non urinary infections in adult patients with sterile pyuria and to develop a preliminary predictive model.

Method

This cross sectional study was done in the department of Nephrology, BSMMU, during the period of September 2016 to August 2017. All adult patients with sterile pyuria were included in the study. A total number of 233 cases who had urinary WBCs >5 per high power field (HPF) with a negative culture were selected as sample by convenient sampling technique. We performed detailed clinical and laboratory investigations to identify potential causes of the sterile pyuria. Patients were then divided into two groups, those with causative factors within the urinary tract and those with causative factors outside of the urinary tract. Logistic regression was used to create a model to predict causative group.

Results

Most 196(84.1%) patients were found to have disorders related to urinary tract (Group A) and 37(15.9%) patients had infections outside of the urinary tract (Group B). Significant proteinuria and urinary casts were more common in Group A, while urinary WBCs>20/hpf and microscopic hematuria were more common in Group(B). All of these differences were statistically significant (p<0.05). In the logistic regression model patients with sterile pyuria with fever (OR 32.9) and/or pyuria with urinary WBC>20/HPF (OR 2.14) were more likely to involvement outside of the urinary tract. Those with urinary tract symptoms (OR 0.28) and/or proteinuria (OR 0.20) were more likely to have renal and urinary tract involvement.

Conclusion

In patients attended to the nephrology department, sterile pyuria was more likely to have its origin in the urinary tract if there were urinary tract symptoms and/or proteinuria and less likely if there was fever or urinary WBCs >20/hpf.

Figure: Diagnosis of the study population (n=233)

Figure : Bar diagram shows renal status of the study population

P=0.047

P value reached from chi square test

Multivariable logistic regression analysis for infections outside the urinary tract