bluuebunny/crossref_metadata_2025 huggingface dataset:
P0224THE POSSIBLE LINK BETWEEN UNDETERMINED CHRONIC KIDNEY DISEASE (CKDU) AND ACUTE INTERSTITIAL NEPHRITIS (AIN) IN THE DRY ZONE REGIONS OF SRI LANKA
Authors: Premarathne Shakila , Nanayakkara Nishantha , Chandrajith Rohana , Rathnayake R M S K , Rathnathunga Neelakanthi , Badurdeen Zeid , Abeysundara Hemalika , Elladeniya Nalaka , Guruge Kumudumali , Madushan Sudath , Samrasiri Udaga , Hewavitharane H P M
Published: June 2020

Background and Aims

An environmental nephropathy which is widely known as Chronic Kidney Disease of uncertain aetiology (CKDu) has been reported in dry zone of Sri Lanka and few other tropical countries. It is already become a major public health problem resulting immense social, economic and health impacts. In recent past, symptomatic presentation of CKDu with tubulitis (CKDuT)/ Acute Interstitial Nephritis indicating activity (AIN) has been reported from Sri Lanka and Central America. The AIN is a nonspecific response of kidney to an injurious agent. Usually the responsible aetiology is obvious in AIN, but not in CKDu cases, however, believed to be a sequel of interstitial nephritis. The aim of this study was to identify the occupational exposures or risk factors associated in AIN cases.

Method

In a two years of a comprehensive investigation, 60 individuals who reported with AIN were investigated. Once a case is reported, a home visit was carried out and behavioural pattern associated risk factors were assessed by a structured questionnaire in which working behaviours and conditions, spraying of agrochemical, usage of Personal Protective Equipment (PPE) and probable exposed environmental conditions were considered.

Results

Majority of AIN patients were male (90:10%) with the mean age of (44 ± 1.2) ranging from 26 - 62years. Among the study group, 53% were full time farmers while 77% of were doing farming either full time or part time. 55% of patients applied agrochemicals by themselves. 52% of individuals have used Personal Protective Equipment (PPE). 12% of individuals were sand miners while 7% and 5% were full time masons or labourers. 2% were engaged both farming and mason as full time employment. 15% were doing other employment except the above. Smoking, alcohol consumption and betel chewing were reported in the group as 50%, 57% and 72% respectively. Majority of patients were reported from Girandurukotte (17%), Wilgamuwa (32%) and Mahiyanganaya (35%) regions where CKDu are widely reported. Study indicated that there was no any significant pattern of AIN incidents over the study period.

Conclusion

Mean age of reported CKDuT were at least ten years younger than the mean age of CKDu. Comparatively higher number of sex ratio has been found in CKDuT indicating the male dominance. Some of the demographic features of AIN patients were similar with CKDu patients and both CKDu and AIN patients are engaged in farming either full time or part time.
P0231PREGNANCY AND DELIVERY OUTCOMES IN PATIENTS WITH COMPLEMENT GENE VARIANT MEDIATED THROMBOTIC MICROANGIOPATHY
Authors: Haninger Natalja , Gaggl Martina , Aigner Christof , Renate Kain , Prohaszka Zoltán , Böhmig Georg A , Leah Charlotte Piggott , Raute Sunder-Plassmann , Sunder-Plassmann Gere , Alice Schmidt
Published: June 2020

Background and Aims

In pregnancy and the postpartum period, complement gene variant mediated thrombotic microangiopathy (P-cTMA) can be life threatening for the mother and the child. We describe pregnancy and delivery outcomes of pregnancies a) before cTMA manifestation, b) complicated by P-cTMA, and c) after first manifestation of cTMA in such women.

Method

This study provides an update of patients enrolled in the Vienna TMA Cohort (VTC) as of January 2020. Demographic and clinical data were retrieved from the electronic and paper-based health care records of our institution and from the Austrian Mother-Child Health Passport. Pregnancy outcomes include live births (full term, moderate to late preterm, very preterm, extremely preterm) or deaths (miscarriage, foetal death, stillbirth, neonatal death). Among delivery outcome we ascertained spontaneous vaginal delivery; Caesarean section, gestational age, birth weight and birth weight categories, birth height, head circumference, Apgar scores, admission to a neonatal intensive care unit, and the presence of malformations.

Results

We recorded 58 pregnancies (41 live births/21 women, including one set of twins; 4 abortions and 1 stillbirth in 3 women without live births; 1 ongoing pregnancy; successful pregnancies: 40/57=70%) of 25 women (mean age [years] at first pregnancy 28.2±7.4, at cTMA manifestation 33.2±16.5). Currently 6 women have a kidney transplant and 4 have died (each death not related to pregnancy). Detailed pregnancy outcomes are shown in Figure 1. Table 1 indicates delivery outcomes of 41 live births. 6/8 neonates of pregnancies complicated by cTMA were female. Caesarean sections (female: 11/19, 58%; male: 9/24, 38%; p=0.11), preterm deliveries (female: 7/19, 37%; male: 5/24, 21%; p=0.09), and low birth weight (female: 6/19, 32%; male: 3/24, 13%; p=0.02) were more frequent among 43 pooled live births and stillbirths with known sex.

Conclusion

Overall, pregnancy and delivery outcomes were poor in pregnancies complicated by cTMA as compared to pregnancies before or after cTMA manifestation. The rate of Caesarean section, preterm delivery, and low birth weight was somewhat higher among female as compared to male neonates and stillbirths. Furthermore, neonatal female gender should be explored as risk factor for cTMA manifestation.
P0235LOW SERUM 3-METHYL HISTIDINE LEVEL IS ASSOCIATED WITH AORTIC STIFFNESS IN HEMODIALYSIS PATIENTS
Authors: Chang Yu-Chi , Tang Chi-Chong , Hsu Bang-Gee
Published: June 2020

Background and Aims

3-methyl histidine (3MH) is a non-proteinogenic amino acid and an index of muscle breakdown. Subclinical protein malnutrition is an independent association with arterial stiffness. The aim of this study was to evaluate the relationship between serum 3MH levels and carotid-femoral pulse wave velocity (cfPWV) values in chronic hemodialysis patients.

Method

Fasting blood samples and baseline characteristics were obtained from 136 chronic hemodialysis patients. Serum 3MH was performed with high-performance liquid chromatography and mass spectrometry. Aortic arterial stiffness was defined as cfPWV values >10 m/s according to the ESH-ESC 2013 guidelines.

Results

Among 110 chronic hemodialysis patients, 45 patients (40.9%) were in the aortic arterial stiffness group. When compared to those in the control group, the aortic arterial stiffness group had high prevalence of diabetes mellitus (p < 0.001), hypertension (p = 0.006), older age (p = 0.002), higher systolic blood pressure (p = 0.016), and lower serum 3MH level (p = 0.001). Multivariable logistic regression analysis of the factors significantly associated with aortic arterial stiffness revealed that serum 3MH levels (odds ratio (OR): 0.791, 95% confidence interval (CI): 0.691–0.906, p = 0.001) was the independent predictor of aortic arterial stiffness in chronic hemodialysis patients. Multivariable forward stepwise linear regression analysis also showed that logarithmically transformed 3MH level (log-3MH, β = -0.322, adjusted R2 change = 0.127, p < 0.001) was an independent predictor of cfPWV values in chronic hemodialysis patients. The area under the receiver-operating characteristic (ROC) curve indicates the diagnostic power of 3MH at predicting aortic stiffness of chronic hemodialysis patients was 0.691 (95% CI: 0.595-0.775, p = 0.0002).

Conclusion

Serum-free 3MH level is negatively associated with aortic arterial stiffness in chronic hemodialysis patients.
P0241ACUTE KIDNEY INJURY AFTER NEPHRECTOMY: A NEW NOMOGRAM TO PREDICT POSTOPERATIVE RENAL FUCTION
Authors: Xu Lingyu , Li Chenyu , Guan Chen , Zhang Yue , Xu Yan
Published: June 2020

Background and Aims

Acute kidney injury (AKI) due to nephrectomy is associated with adverse prognosis. The study aimed to develop a nomogram based on preprocedural features for early prediction of AKI and to assess the prognosis in patients after nephrectomy.

Method

The study included a development cohort of 1111 patients and an additional validation cohort of 356 patients who underwent nephrectomy. Stepwise and logistic regression analyses were used to evaluate the association between predictors and AKI. Incorporating all independent predictors, a nomogram for postoperative AKI was developed and validated. Patients were followed up for 5 years to assess renal fuction, acute kidney disease (AKD), chronic kidney disease (CKD), hospital readmission and death were key prognostic outcomes we focused on.

Results

Radical nephrectomy (odds ratio (OR) = 3.57, p < 0.001), aspirin (OR = 1.79, p = 0.008), systolic blood pressure (OR = 1.41, p = 0.004), triglyceride (OR = 1.26, p = 0.024) were independent risk factors for postoperative AKI, while albumin (OR = 0.72, p = 0.031) was a protective factor for postoperative AKI. Patients with a higher estimated glomerular filtration rate (eGFR) (60-90 ml/min/1.73 m2, OR = 0.41, p = 0.004; ≥ 90 ml/min/1.73 m2, OR = 0.37, p < 0.001) were less prone to AKI than those with a lower eGFR (< 15 ml/min/1.73 m2). These predictors were all included in the final nomogram to calculate the probability of postoperative AKI. The incidence of AKD and CKD were 27.12% and 18.64% in AKI group, which were much higher than those in no AKI group (p < 0.001).

Conclusion

The nomogram had excellent predictive ability and might have significant clinical implications for the early detection of AKI in patients undergoing nephrectomy.
P0243WOMEN WORKERS THAT DO NOT HAVE A WATER BOTTLE AT THE WORKPLACE HAVE HIGHER PREVALENCE OF URINARY TRACT SYMPTOMS AND INFECTION
Authors: NERBASS FABIANA , Santo Cintia , Fialek Edilaine , Calice-Siva Viviane , Vieira Marcos
Published: June 2020

Background and Aims

Hydration and toilet behavior at work are associated with urinary tract symptoms (UTs) and infection (UTI) in women. We aimed to evaluate the association between self-reported hydration habits, water access and toilet adequacy at work with UTs and UTI in female workers from five dialysis clinics in Southern Brazil.

Method

All women employed were invited (n=258), and 69.4% (n=179) agreed to participate. For this analysis, we included female workers employed for at least 12 months who were not pregnant or breastfeeding in the last year. Weekly work shift varied from 30 to 42 hours, divided into five or six weekdays. Participants answered an online questionnaire comprising questions regarding UTs (burning feeling; frequent or intense urge to urinate; bloody urine; lower abdomen pain) and UTI episodes in the last year; usual daily beverage intake, usual urine frequency and color according to urine color chart; water access and toilet adequacy perception at work. Workers were divided into two groups according to the employee permission in having a water bottle (WB) at the workplace. Administrative and multidisciplinary staff are allowed (WB group) and nurse staff can not have (non-WB group) due to infection control regulation in dialysis rooms.

Results

We included 133 women (age=36.9±9.5 years old). Self-reported usual daily beverage intake= 6.6±2.9 cups/day (∼1320 ml); daily urine frequency= 5.1±2.1; urine color chart score= 3.0±1.2. At least one UTs was reported by 53% (n=70) and UTI episode by 34% (n=45) in the last year. Participants with UTs had a lower urine frequency (4.7±2.3 versus 5.5±1.7 times/day; P=0.03) and a higher urine color score (3.3±1.2 versus 2.6±1.1;P=0.002). Non-WB workers (N=66/49.6%) reported a lower beverage intake (6.0±2.6 versus 7.3±3.0 cups/day;P=0.01), had a higher prevalence of UTs (65% versus 45%; P=0.02) and UTI (42% versus 25%; P=0.04). Among non-WB participants, 47% considered that the distance to water supply from the workplace spot impairs adequate hydration, and 39% answered that the number of toilets available also as a barrier. A higher prevalence of UTs was reported by these subgroups that perceived environment infrastructure barriers (77% versus 54%; P=0.04 and 92% versus 47%; P<0.001, respectively). Non-WB who responded that toilet hygiene impairs hydration (11%) had a higher prevalence of UTI (86% versus 37%; P=0.03). No significant association between work environment perception and urinary problems was found in the WB group.

Conclusion

Lower urine frequency and darker urine color were associated with UTs in this population. Workers who do not have a water bottle at the workplace reported a lower beverage intake, higher UTs and UTI prevalence. Non-WB participants that perceived work barriers to adequate hydration had a higher prevalence of urinary problems.
P0257CLINICOPATHOLOGICAL SPECTRUM OF KIDNEY INVOLVEMENT IN MONOCLONAL GAMMOPATGY
Authors: Mayssa Hadj Brahim , Ben salem Meriem , Amal Ouni , Insaf Handous , Manel Bensalah , Ahmed Letaief , Mouna Hammouda , Sabra Aloui , Amine Boukadida , Habib Skhiri
Published: June 2020

Background and Aims

The occurrence of kidney diseases associated with a monoclonal gammopathy is increasingly recognized.Renal biopsy and evaluation by light microscopy, electron microscopy and immunofluorescence,in association with adequate clinical examination are essential in accurate diagnosis. The objective of our study is to describe the types of kidney damage secodary to monoclonal gammopathies and to study its renal prognosis.

Method

It is a monocentric RETOSPECTIVE DESCRIPTIVE STUDY carried out in the nephrology department of CHU FATTOUMA BOURGUIBA MONASTIR spread over a period of 7 years from January 2012 to December 2018.

Results

we collected 40 cases of monoclonal gammopathies. The median age was 61 years.The sex ratio was 0,9. the circumstances of discovery were dominated by renal failure. it revealed the diagnosis in 77.5% of cases. the renal presentation proteinuria in 70%, microscopic hematuria in 12.5%, edematous syndrome in 27.5% and nephrotic syndrome in 37,5%. The mean creatinine level was 500 umol / L and proteinuria at 4,3 g / 24 h with a maximum rate of 17.5 g / 24h. the electrophoresis of serum proteins showed the presence of a monoclonal peak in 90% of the cases in the gamma zone. The plasmocytosis was less than 10% in 15% of cases and more than 60% in 22,5% of the cases. Radiology showed bone localizations in 32,5% of cases. These gammopathies were classified as Multiple myeloma in34 patients, POEMS in one case and 5 MGRS. Kidney biopsy was performed in 10 patients showing cast nephropathy, AL amyloidosis and vasculites(endocapillary glomerulonephritis with hyaline thrombi in all vessels and double contour appearance of the glomerular basement membrane) in respectively 12,5%, 7,5% and 2,5% of cases. the main indications were rapidly progressive renal failure, unexplained acute renal failure and nephrotic syndrome. The renal involvement retained was a myeloma tubulopathy in 28 patients, 3 of whom were confirmed histologically . AL amyloidosis was found in 5 patients and the confirmation was histological. Type 1 cryoglobulinemia was diagnosed in only one patient. Glomerular nephropathy remained undetermined in 6 patients whose PBR was indicated but not made in the presence of hemostasis disorders. The chemotherapy was started in 34 patients based on bortezomide-thalidomide-dexamethasone in 30% of cases. An autograft of the bone marrow was done in one patient. Hemodialysis was required in 15 patients. The renal function was improved in 42.5% of the cases and a passage on chronic hemodialysis in 10% of cases. 10% of patients have achieved complete hematological remission.

Conclusion

Patients with MG can develop a large variety of related renal lesions.Renal involvement darkens the prognosis hence the need for adequate care .
P0261NARRATIVE NEPHROLOGY: A BIO-PSYCHO-SOCIAL APPROACH WITH CDK PATIENTS
Authors: Lombardi Marco , Toccafondi Alessandro , Caraccia Umberto , Mari Leonardo , Dattolo Pietro Claudio
Published: June 2020

Background and Aims

Poor medication adherence in CKD patients can reach up to 80%. Non-adherence is associated with high mortality and morbidity and it is a negative criterion for the inclusion in the transplant waiting list. Poor adherence increases also the costs for health care in terms of diagnostic procedures, dialysis in emergency, etc. Therefore, to increase patients’ adherence to medical treatments is one of the priority of clinical nephrology.

According to the WHO adherence behaviors are associated to several factors (e.g. organization of health services, doctor-patient relationship, patients’ psychosocial factors). The most efficacy interventions descried in the literature to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients.

In the last years, narrative evidenced-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting adherence to treatments.

Aim of this clinical project is to obtain the best control of the evolution of chronic kidney disease through a multidisciplinary approach of narrative medicine.

Method

Within the pre-dialysis service of the Division of Nephrology and Dialysis Firenze 2, it has been integrated the clinical care for CKD patients with a protocol based on a narrative medicine approach (Fig.1).

The clinical protocol is composed by the following procedures:

Results

This project begun around 2 months ago. In this period 15 patients were met, collecting stories by 12 of them (80%). Most of the stories were rich of contents and useful from a medical point of view. None patients refuse the medical consultation at the presence of psychologist, and 5 of them asked for psychotherapy sessions. In line with the literature, 30% of patients presented symptoms of depression. Due to logistic reasons we are going to start the pharmacy counseling intervention at the end of January. All patients were grateful to have been included in this protocol. In the following months we will be able to assess the impact of this protocol in terms of medical outcome.

Conclusion

To promote an active role of patients in taking care of themselves and follow medical prescriptions, it has been implemented a clinical protocol based on narrative medicine approach in which the biological, psychological and social needs of patients are considered and discussed with them. The empirical results obtained in these first months indicate a positive response from patients in terms of wish to write the experience with the disease and to receive the medical visit with the nephrologist at the presence of a psychologist.
P0262DIAGNOSIS OF PNEUMOCYSTIS PNEUMONIA BY METAGENOMIC NEXT-GENERATION SEQUENCING IN PERIPHERAL BLOOD OF PATIENTS WITH KIDNEY DISEASE
Authors: GU Peng , XU Shutian , JIANG Xue , CHAO Zhouyu , ZHOU Yun , LI Zhe , LI Shijun
Published: June 2020

Background and Aims

Pneumocystis jirovecii is an opportunistic infectious pathogen that can cause pneumocystis pneumonia in HIV patients. The kidney transplant recipients and patients with kidney diseases receive immunosuppressive therapy, PCP is not uncommon in such patients, but early etiological diagnosis is difficult. Metagenomic next-generation sequencing (mNGS) has higher sensitivity for pathogen identification in a variety of infections. In this study, mNGS was used to detect peripheral blood samples of patients with kidney disease complicated with PCP, and to evaluate the diagnostic value of mNGS in peripheral blood for the etiology of PCP.

Method

From August 2018 to December 2019, We collected 37 cases with kidney disease complicated with pulmonary infection and clinically diagnosed with PCP after receiving immunosuppressive therapy. mNGS was used to analyze the pathogen types and sequences in peripheral blood samples to evaluate the detection efficiency to PCP. To compare the efficacy of mNGS and traditional clinical diagnosis (fungal G combined with lactate dehydrogenase detection) of PCP. In addition, patients with Bacterial/fungal pneumonia or viral pneumonia were mNGS positive controls.

Results

37 peripheral blood samples were collected from 37 patients, results for all samples were obtained within 72 hours. Pneumocystis jirovecii was detected by mNGS in 35 of the 37 samples, with a sensitivity of 94.59%, specificity of 100%. 31 patients had mixed infection. Cytomegalovirus (CMV) was detected in 19 of the 37 cases (51.4%), epstein-barr virus (EBV) was detected in 6 cases, herpes simplex virus (HSV) was detected in 5 cases, and Torquetenovirus was detected in 8 cases. There were 8 cases of bacterial infection, including 2 cases of staphylococcus, 2 cases of acinetobacter, 1 case of klebsiella pneumoniae, 1 case of escherichia coli, and 4 cases of other uncommon bacteria. There were 33 patients with positive fungal G test and elevated lactate dehydrogenase (BG/LDH), and 4 patients with multiple negative fungal G test .The sensitivity of BG/LDH was 89.19%, the specificity was 56.0%.

Conclusion

mNGS has obvious advantages over the traditional method of diagnosing PCP. It has the characteristics of accuracy, simplicity and noninvasiveness, and is of great value for the early diagnosis of PCP.
P0268A COMPARATIVE STUDY OF CYCLOPHOSPHAMIDE, THALIDOMIDE AND DEXAMETHASONE (CTD) VERSUS BORTEZOMIB AND DEXAMETHASONE (BDEX) IN AL AMYLOIDOSIS: A REAL-WORD STUDY IN CHINESE PATIENTS
Authors: Sun Shiren , Liu Baojian , Wang Yan , Bai Ming
Published: June 2020

Background and Aims

Amyloid light-chain (AL) amyloidosis is a plasma cell dyscrasia characterized by the deposition of misfolded immunoglobulin light chains. The prognosis of AL patients is poor. About 70% of patients have renal involvement and one third of patients would progress to dialysis. Cyclophosphamide, thalidomide and dexamethasone (CTD) and bortezomib and dexamethasone (BDex) have shown great efficacy in patients with AL amyloidosis, especially in Chinese patients. But which option is more suitable for Chinese patients is unclear.

Method

We retrospectively evaluated 81 AL patients who received CTD (n = 42) or BDex (n = 39) and used Mayo stage 2012 to match 26 pairs of patients.

Results

In the whole cohort, the overall hematologic responses were 86% vs 91% in the CTD and BDex groups, including a complete response of 56% vs 71%, higher than most of the previously reported chemotherapies. One- and two-year overall survival (OS) was 90.2% and 81.7% with CTD regimen, and 87.6% and 82.7% with BDex regimen. After matching by Mayo stage 2012, BDex regimen showed the advantage in the depth and speed of hematologic response over CTD regimen, but there were no statistically significant differences in OS both based on the ITT analysis (P = 0.24) and 6-month landmark analysis (P = 0.48). Cardiac response was similar, while there was a trend for higher renal response in patients treated with BDex (68% vs 44%, P = 0.09). Additionally, we found that if the patients were limited to Mayo stage III or worse, BDex regimen was associated with improved survival (P = 0.009). Overall toxicities were manageable in both regimens. Severe hematologic toxicities and diarrhea should get more attention in patients treated with BDex.

Conclusion

This is the first comparison of BDex versus CTD in patients with AL amyloidosis. These results indicated that CTD and BDex regimens can be active and safe chemotherapy for Chinese patients, but BDex regimen is superior to CTD in achieving more rapidly and deeper clonal response, as well as in improving OS in selected patients.This conclusion is significant because we confirmed BDex regimen may be an optimal option in treating Chinese patients with AL amyloidosis. The definite advantages on long-term prognosis need to be verified in the further studies.
P0271SERUM VASCULAR ENDOTHELIAL GROWTH FACTOR-D LEVEL CORRELATES WITH RENAL FUNCTION AND ALBUMINURIA IN PATIENT WITH DIABETIC CHRONIC KIDNEY DISEASE
Authors: Kim Hyeongwan , Chong Jong Hwan , Park Woong , Park Sung Kwang , Kim Won
Published: June 2020

Background and Aims

Biomarkers associated with chronic kidney disease (CKD) may play a crucial role in patients with diabetic kidney diseases. Vascular endothelial growth factor (VEGF)-C and VEGF-D are lymphangiogenic growth factors. It has been well demonstrated that there is lympnagiogenesis in fibrotic kidney disease in human. Previously, we showed that renal VEGF-C and VEGF-D are involved in lymphangiogensis in renal fibrosis model. Recent studies have shown a relationship between sodium load and serum VEGF-C levels in hypertensive patients. Lymphatic endothelial proliferation has been detected in diabetic nephropathy. Thus, serum VEGF-C level has been introduced as a candidate marker of chronic kidney disease. However, until now, there have been few report about serum VEGF-D in patients with diabetic CKD. Thus, we evaluated the relationships between serum VEGF-D and renal function and albuminuria of diabetic CKD.

Method

We divided diabetic CKD patients into four groups: CKD stage 3, CKD stage 4, and CKD stage 5 (without dialysis). Total forty two Asian patients with diabetic CKD (14 patients with CKD stage 3, 14 patients with CKD stage 4 and 14 patients with CKD stage 5) and seven healthy controls without diabetes mellitus have been enrolled in this study. In this cross-sectional study, we performed comparative analysis with serum level of VEGF-D in patients with each group. We measured the levels of VEGF-D through the multiplexing using Luminex® technology.

Results

The serum levels of VEGF-D were higher in the CKD 3, CKD 4 and CKD 5 group compared with the control group (25.9±5.6 pg/ml in control group, 60.3±9.7in stage 3, 62.9±8.5 in stage 4, and 66.5±8.0 in stage 5). However, there was not a significant difference between CKD stage III or IV and CKD stage V in serum levels of VEGF-D. Serum VEGF-D level were negatively correlated with estimated glomerular filtration rate and positively correlated with serum creatinine. At GFR level ≥60 ml/min per 1.73 m2, serum VEGF-D were biomarkers in ROC analysis. There was a positive correlation between serum VEGF-D level and albuminuria in patient with diabetic CKD. We also found that serum VEGF-D level also correlated with urine protein-to-creatinine ratio in patient with diabetic CKD.

Conclusion

Serum VEGF-D is correlated with renal function in patients with diabetic CKD. VEGF levels in the serum correlate to the severity of proteinuria and albuminuria in diabetic CKD patients. Further large-scale studies are required to confirm these findings.
P0273THE EFFECT OF END STAGE RENAL DISEASE AND RENAL REPLACEMENT THERAPY ON B LYMPHOCYTE SUBPOPULATIONS
Authors: Daikidou Dimitra Vasileia , STANGOU MARIA , Sampani Erasmia , Nikolaidou Vasiliki , Asouchidou Despoina , Dimitriadis Chrysostomos , Lioulios Georgios , Pella Eva , Anastasiou Aikaterini , Fylaktou Asimina , Papagianni Aikaterini
Published: June 2020

Background and Aims

End-stage renal disease (ESRD) is linked to immunodeficiency, which makes a significant contribution to morbidity and mortality. Disturbances in innate and adaptive immunity have been described in patients on dialysis, although their association with the therapy itself is yet to be defined. The present study aimed to assess the impact of dialysis on B cell subpopulations

Method

B cells (CD19+) and their subsets B1a (CD19+CD5+), naive (CD19+CD27−), memory (CD19+CD27+), (CD19+BAFFR+) and (CD19+IgM+), were quantified using flow-cytometry of in the peripheral blood of ESRD patients, the first day on dialysis (T0), and repeated 6 months later (T6). The results were compared to age-matched healthy control group. Exclusion criteria were age <18 or>75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months

Results

Pre dialysis ESRD patients had reduced lymphocyte count (1527±646μ/L vs. 2459±520μ/L, p<0.001) and B cell (CD19+) count (82.7±59.5μ/L vs. 177.6±73.8μ/L, p<0.001) compared to controls, whereas the percentages of B cell subsets were not particularly affected, except for B1a subset which presented a significant increase (4.1±3.6% vs. 0.7±0.7% p<0.001). In 17 patients who had a follow-up sample 6 months later, the percentage of most subsets was reduced (CD19+CD5+: 1.02±0.8% from 3.6±4.6%, p=0.015, Naive: 40±22.3% from 61±17.4%, p=0.001, CD19+BAFF+:75.8±12.6% from 82.1±9.1%, p=0.04,), apart from memory B cells percentage, which was increased (49.4±52.1% from 32,9±35,5%, p=0.01) and CD19+ IgM+ percentage, which was unaffected .

Conclusion

A significant reduction of almost all subsets of B cells was noticed in patients with ESRD on pre-dialysis stage. Furthermore, the initiation of renal replacement therapy may be linked to further alterations in B cells subpopulations, especially at their early stages.
P0277PATIENTS WITH PYELONEPHRITIS PRESENTING ONLY WITH LOWER URINARY TRACT SYMPTOMS
Authors: Rehman Fazal , Umair Farrukh
Published: June 2020

Background and Aims

The rate of acute pyelonephritis (APN) is assessed at almost 9– 11 cases for every 10,000 tenants. Its prevalence is more in developing countries and among those having low socioeconomic status. The demographics of the population in our region is different from the western population with multiple factors such as delayed presentation to hospital, varying socioeconomic status, malnutrition and lack of knowledge about basic treatment leads to increased morbidity and mortality as compared to western population. To the best our knowledge this will be the first study of its kind to describe the frequency of pyelonephritis without upper urinary tract symptoms in hospital setting.

AIM To determine the frequency of pyelonephritis in patients presenting only with low urinary tract symptoms, at a tertiary care hospital, Karachi.

Method

Study is conducted at a tertiary care hospital charts and files were reviewed from 01-11-2018 to 28-02-2019 for all the patients having diagnosis of APN from medical record files.

Results

In our study total five hundred and twenty-one (n=521) patients were included (n=492 (94%) of the participants were suffering from pyelonephritis. Approximately, 22.8% of the patients showed absence of both flank pain and costo-vertebral tenderness but were diagnosed with pyelonephritis on the basis of CT/MRI as presented. While 27% of the patients reported both upper urinary tract symptoms and were also positive on CT-MRI. It is also witnessed that 24% and 16% of the patients either reported flank pain or costo-vertebral tenderness respectively. Insignificant association between gender, age, comorbid with pyelonephritis. While, the total leucocytes count was significantly related with CT/MRI.

Conclusion

Our study showed significant number of patients having pyelonephritis in the absence of any upper tract symptoms. Ignoring the diagnosis as serious can lead to under treatment, possibility of higher rate of re-admissions or poor selection of initial antibiotics. Whereas, other side of the spectrum haunts with higher investigation cost of imaging and broad spectrum use of antibiotic for every patient presenting with just urinary tract infection in Emergency department. A balance should be devised to equilibrate the balance between two extremes.
P0281THE EFFECT OF DIRECT ANTIVIRAL AGENTS ON GLOMERULAR FILTRATION RATE
Authors: Sarhan Iman , Elsharabasy Reem , Ahmed Fatma , Hassan Mohamed
Published: June 2020

Background and Aims

HCV infects 170 million individuals approximately worldwide. The kidney is a major component of the HCV clinical syndrome. This viral infection imposes itself as a cause of kidney disease, a major risk in hemodialysis units and a significant threat in kidney transplantation. In 2011, direct acting antivirals (DAA) had been developed, which represented a huge boom in the treatment of HCV. Some doubtful data suggest possibility of association between some DAA administration and AKI occurrence, but larger prospective studies are recommended for confirming this suggestion.

Method

Retrospective cohort study of 118 adult HCV infected patients with normal baseline kidney functions (GFR ≥ 60ml/min) were included. Patients coinfected with HBV and those with impaired kidney functions at beginning of treatment were excluded. Patients were divided into 3 groups according to their DAA-combination treatment regimen. Patients’ eGFR were measured at baseline, at the end of treatment and one year later.

Results

Our results showed that patients who received Sofosbuvir/Daclatasvir/Ribavirin, their pre-treatment eGFR Mean ± SD. was (86.15±16.37). Post treatment eGFR showed an insignificant change after end of treatment (84.73±17.41) and 1 year after treatment (82.0±18.07) (P-value: 0.998 and 0.220 respectively). Those who received Sofosbuvir/Daclatasvir, their pretreatment eGFR Mean ± SD was (94.60±19.32). Post treatment eGFR showed an insignificant change after end of treatment (89.39±18.39) and 1 year after treatment (89.17±20.27). (P-value: 0.156 and 0.097 respectively). As for patients who received Sofosbuvir/Simeprevir, their pretreatment eGFR Mean ± SD was (92.71±15.11). Post treatment eGFR showed an insignificant change after end of treatment (88.36±16.27) and 1 year after treatment (89.01±15.72). (P-value: 0.620 and 0.676 respectively).

Conclusion

The new direct antiviral agents (sofosbuvir, daclatasvir and simeprevir) are effective and safe regarding glomerular filtration rate in patients with normal renal function. However, a meticulous monitoring of kidney function is mandatory during the use of these medications to early detect any untoward side effects.
P0282SARCOIDOSIS WITH RENAL INVOLVEMENT: APPROACH TO DIAGNOSIS AND MANAGEMENT
Authors: Chemli Imen , Ben salem Meriem , Letaief Ahmed , Hammouda Mouna , Aloui Sabra , Ben Salah Manel , Skhiri Habib
Published: June 2020

Background and Aims

Renal involvement in sarcoidosis is rare. It is most often the consequence of calcium metabolism disorders, interstitial granulomatous damage or secondary glomerular damage. It can progress to kidney failure in around 3% of cases.

In this study, we determined the clinical presentation of sarcoidosis with renal involvement and we described the histological lesions. We report our experience about the management and the follow-up.

Method

we analyzed all cases of renal failure caused by sarcoidosis in our department during the period of 13 years (2006-2019). There were five patients (one man and four women) at the time of diagnosis. The middle age was 53.8 years.

Results

The renal involvement was revealing in 60% of the cases. The extrarenal localizations were: pulmonary (100%), cutaneous (knotty erythema 20%), ocular (dry eye syndrome (60%) and anterior uveitis (20%)), the reticuloendothelial system (adenitis (20%) and medullary (20%)), exocrine glands (sialadenitis (40%), nasal (20%), nervous (optic neuritis 20%)). The middle renal clearance (eGFR) at the time of diagnosis of renal involvement was 33ml / min / 1.73 m. Moderate proteinuria was observed in four patients (median: 0.99 g / 24 hours), aseptic leukocyturia in one patient. No patient had microscopic hematuria. Hypercalcemia was noted in 60% of patients with hyper calciuria (median: 3 mmol / kg / 24 hours). Nephrolithiasis was noted in only one patient. No cases of nephrocalcinosis was noted. Renal biopsy showed tubulointerstitial nephropathy with granulomatous in 2 cases (40%), absence of granuloma in one case, extra-membranous glomerulonephritis in one patient and moderate interstitial fibrosis with tubular atrophy in two patients, fibrous andarteritis in a single case. A granuloma without caseous necrosis was objectified on the osteo-medullary biopsy in a single case. All patients received oral corticosteroids (Prednisone: 1 mg / kg / day for 4 patients; 0.5 mg / kg / day for one patient) associated with the treatment of hypercalcemia (hydration and diuretics). The follow-up varied from 2 to 156 months with an median of 56.4 months. 3 patients improved their renal function with a middle clearance : M0: 29 ml / min, M1: 42 ml / min, M3: 68 ml / min, M6: 67 ml / min, M12: 95 ml / min. A non-recovery of renal function was noted in only one patient. An end-stage renal disease was observed in two patients. A renal and extrarenal (lymph node) relapse was noted in a single patient with an interval of 7 years after the initial presentation.

Conclusion

Renal involvement in sarcoidosis is probably underestimated. Treatment is based on corticosteroid, which must be introduced early to prevent progression to renal failure.
P0285A COMPARISON OF URINE MICROSCOPY AND CULTURE IN HIV-INFECTED AND NON HIV-INFECTED INDIVIDUALS IN THE ANTI-RETROVIRAL ERA
Authors: Madela EIY , Assounga Alain
Published: June 2020

Background and Aims

Urinary tract infection is among the most common causes of sepsis presenting in hospitals. The aim was to collect data to enable empirical treatment of urinary tract infections in HIV negative and positive nephrology patients while waiting for urine culture results in order to reduce hospital stay. Our aim is also to assess incidence and antimicrobial susceptibility of urinary tract infections in HIV negative and positive patients.

Method

A retrospective chart review of nephrology patients admitted from January to December 2014 in Nephrology ward and the first consecutive 200 outpatients seen in Nephrology clinic in 2014 at Inkosi Albert Luthuli Central Hospital was conducted. Information was gathered with the use of a data collection sheet and urinary tract infection was based on urine culture results. All data was analysed using Statistical Package for Social Sciences version 23. Percentages of basic characteristics were calculated between groups. Logistic regression analysis was used to identify factors associated with positive urine culture.

Results

There were 654 patients in the study, 514 (79%) were HIV negative and 139 (21%) were HIV positive. The incidence of UTI in nephrology patients was 9%, 10.1% in inpatients and 6.5% in outpatients. 22% were HIV positive (p value 0.883, 95% CI 0.550-2.003). 19% had Diabetes mellitus, 15% had Systemic Lupus Erythematosus and 5% were post renal transplant patients. Escherichia coli and Klebsiella pneumonia were the common causes of urinary tract infection at 40.7% and 15.3% respectively with 22% cases on extended beta lactam resistance.

Conclusion

There was no statistically significant difference on the incidence and anti-microbial isolates between HIV infected and HIV negative nephrology patients with urinary tract infection. Hence, empirical treatment for UTI should remain the same in the 2 groups. Escherichia coli and Klebsiella pneumoniae were the most commonly cultured organisms in both groups. There is microbial resistance to commonly used antibiotics. Constant assessment of anti-microbial sensitivity of urinary tract infections is of paramount importance.
P0289MULTI-PARAMETRIC RENAL MAGNETIC RESONANCE IMAGING IN EARLY KIDNEY TRANSPLANTATION
Authors: Gillis Keith , Rankin Alastair , Allwood-Spiers Sarah , Woodward Rosemary , Roditi Giles , Radjenovic Aleksandra , Kuehn Bernd , Patel Rajan , Mark Patrick
Published: June 2020

Background and Aims

Existing methods of investigating renal transplant dysfunction do not provide reliable information regarding diagnosis nor prognosis. Multi-parametric magnetic resonance imaging (MRI) may provide novel biomarkers for evaluation of transplant dysfunction. We aim to determine how MRI parameters change over the first year of transplantation, and how these relate to future renal function.

Method

Patients receiving a kidney transplant attended for study visits at 6, 26 and 52 weeks post operatively, comprising measurement of clinical and biochemical parameters, together with research multi-parametric MRI. Imaging measurements comprised kidney volume, arterial spin labelling (ASL) perfusion, T1 relaxation time, T2*, apparent diffusion coefficient (ADC) and fractional anisotropy (FA). Imaging was performed at 3.0 Tesla using a Siemens MAGNETOM Prisma system. Regions of interest were drawn in whole kidney (WK), cortex (Cx) and medulla (Md) (figure 1).

Results

20 patients were included: 16 were male, with age 55.5±12.8 years, baseline eGFR 54.0±23.6 ml/min/1.73m2, and blood pressure 146/80 ± 15/15 mmHg. 14 received deceased, and 6 received live, donor transplants. Patients were all managed with tacrolimus, mycophenolate and low dose prednisolone, following induction therapy with either basiliximab or anti-thymocyte globulin.

6 week ADC was 1.69±0.14 in WK, 1.65±0.08 in Cx, and 1.67±0.10 ×10-3 mm2/s in Md. FA was 0.19±0.04 in WK, 0.14 ± 0.04 in Cx and 0.22 ± 0.10 in Md. T2* was 57.6±9.4 in WK, 63.9±8.7 in Cx and 45.0±8.0 ms in Md. Over the 3 visits there was reduction in FA (p=0.008) and medullary T2* (p<0.001). There was no significant change over 12 months in any other MRI parameter.

Over 1 year the median change in eGFR was -2ml/min/1.73m2. There was correlation between baseline eGFR and the following variables: volume (r=0.29, p=0.04), whole kidney ADC (r=0.36, p=0.01), cortical ADC (r=0.46, p=0.001), representative cortex ADC (r=0.48, p<0.001) and medullary ADC (r=0.29, p=0.04). There was no correlation between eGFR and other imaging biomarkers. There was correlation between baseline whole kidney ADC (r=0.54, p=0.02), cortical ADC (r=0.49, p=0.03), and renal function at 12 months.

Conclusion

Diffusion weighted MRI measurements correlate with eGFR and may allow improved prognostication regarding future renal function. Certain MRI parameters including FA and R2* vary depending on time point of transplantation which may reflect changes in transplant microstructure in the early postoperative period. Multi-parametric MRI provides a novel method of evaluating renal transplants non-invasively and may allow more accurate prediction of future transplant function than existing biochemical measures.
P0293FRACTIONAL EXCRETION OF TOTAL PROTEIN IS AN ACCURATE INDICATOR OF PROTEINURIA IN NPHROTIC PATIENTS
Authors: Takahashi Shori , Shimizu Shoichi , Saito Hiroshi , Morohashi Tamaki , Morioka Ichiro , Hamada Riku
Published: June 2020

Background and Aims

Urinary total protein/creatinine ratio (U-TP/Cr) is a simple and useful indicator of proteinuria. And it had been shown to correlate well with 24-hour urinary protein test (24hr UPT). However, U-TP/Cr is not always accurately reflecting the degree of proteinuria, especially in cases with heavy proteinuria.

Proteinuria in nephrotic syndrome could be defined as the result of changed sieving coefficient (SC) of plasma total protein through the glomerular capillary wall. Therefore, we studied fractional excretion of total protein (FETP; total protein clearance/creatinine clearance %) instead of directly unmeasurable SC. The accuracy of the FETP was verified by 24hr UPT in comparison with U-TP/Cr.

Method

Sixty-three serum and urine samples were collected from 35 pediatric patients with various age (age: 3 − 20 y; mean: 10.3 y, 22 male, 13 female) with hypoproteinemia (TP≦ 5.0 mg/dL), heavy proteinuria (FETP≧ 0.01%), and normal GFR (creatinine clearance ≧ 100 ml/min). The correlations between 24hrUPT and U-P/Cr and FETP were studied using samples obtained the same time and the superiority was statistically examined.

Results

Mean±SE of 24hUPT, U-TP/Cr and FETP (%) were 5.53±0.71 (g/day), 10.23±1.26 (g/gCr), and 0.12±0.016 (%) respectively. R values for the correlation between 24hrUPT and U-TP/Cr and 24hr UPT and FETP were 0.64 and 0.86 respectively. FETP showed a statistically better correlation with 24hrUPT than with U-TP/Cr (P: 0.0001).

Conclusion

FETP is an accurate indicator of 24hr UPT for nephrotic patients under conditions of heavy proteinuria and hypoproteinemia in comparison with UTP/CR.
P0302NEUTROPHIL TO LYMPHOCYTE AND PLATELET TO LYMPHOCYTE RATIO IN PATIENTS UNDERGOING KIDNEY TRANSPLANT
Authors: Velasco Ramirez Sandra Fabiola , Flores Fonseca Milagros Melissa , Ramirez Anguiano Ana Cristina , Cueto Casilla Martha Rosa , Diaz Burke Yolanda , Baltazar Rodriguez Luz Margarita , Villalvazo Osoria Priscila Berenice , Ruiz Cruz Norma Cecilia , Medina Perez Miguel , Gomez Navarro Benjamin
Published: June 2020

Background and Aims

Inflammation plays a central role before and after a kidney transplant recipients (KTR). Despite survival improvement, several factors are associated with poor outcomes after transplantation. In search of a cost effective inflammatory marker neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) have shown a prognostic value. Therefore, the objective of this study was to determine the association of NLR and PLR and acute kidney allograft dysfunction as markers of inflammatory state in KTR.

Method

A single center, retrospective study. Our study group included 41 KTR with acute kidney allograft dysfunction from our center at Centro Medico Nacional de Occidente, Jalisco, Mexico. NLR and PLR were collected and evaluated 1 month prior KT, at the time, 6 months and one year after transplantation. Statistical analysis: Data were expressed as the mean ± SD, median and range or frequency, as appropriate. Intergroup comparisons were performed with a chi-squared test for categorical variables and Student’s t test or the Mann-Whitney test for continuous variables. Putative associations between clinical factors, biological factors and mortality were assessed in univariate and multivariate Cox models. Statistical analyses were performed using SPSS v26.0 (IBM Corporation, NY, USA); p < 0.05 was considered statistically significant.

Results

Mean age was 29.54 ± 7.32 years, and 56% were women. Of those patients, all received living donor kidney transplantation. All patients in the study groups received standardized immunosuppressive regimen consisting of calcineurin inhibitors, mycophenolate mofetil and steroids. Median serum creatinine levels after KT were between 1.11 ± 0.36 mg/dl. The median NLR and PLR levels were significantly higher in the study group, with a median of 3.34 (1.83 –5.14) and 8.65 (343.47 – 360.59), not statistically associated. The best set of predictors in multiple regression analysis of higher levels of NLR were serum albumin (r = -0.432; p = 0.007) and C reactive protein (r = 0.641; p = 0.002). The best set of predictors in multiple regression analysis of higher levels of PLR were hematocrit (r = -0.313; p = 0.055) and serum glucose (r = 0.360; p = 0.026).

Conclusion

Our data showed that higher values of NLR and PLR are associated with inflammatory markers, leading to the conclusion that this finding must be confirmed with larger, prospective and controlled follow up.