bluuebunny/crossref_metadata_2025 huggingface dataset:
MO099: Elastography in the Assessment of Chronic Kidney Disease: A Meta-Analysis
Authors: Maralescu Felix-Mihai , Chiodan Milena , Sircuta Alexandru , Schiller Adalbert , Petrica Ligia , Bob Flaviu
Published: May 2022

BACKGROUND AND AIMS

We require an imagistic quantitative technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in the last years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic.

METHOD

The databases of PubMed, Medscape and Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (KSWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results and outcome data were all collected from each study according to a set protocol.

RESULTS

We found 33 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of KSWS between studies, we found increased heterogeneity Q = 513.133; DF = 10; P < .001, I2 (inconsistency) = 98.12% (95% CI for I2 97.52–98.57%). With a standardized mean difference of –0.216, patients with CKD have a lower KSWS than healthy controls. A positive association between KSWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, P < .001), Q = 73.3, DF = 5, P < .001, I2 = 93.18% (95% CI for I2 87.86–96.18). The pooled area under the ROC curve for KSWS to predict mild renal disease was 0.831 (95% CI, P < .001), Q = 28.32, DF = 6, P = .0001, I2 = 78.8% (95% CI for I2 56.37–89.72).

In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve values are used to compare distinct characteristics (differentiating KSWS between mildly and moderately impaired kidneys, between non-diabetic, prediabetic and diabetic patients, or KSWS between CKD and control group), therefore not being suitable for further evaluation.

CONCLUSION

The results show that patients with CKD have a lower KSWS than healthy controls. It remains a viable method for monitoring the progression of CKD but because the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity more research is needed to determine which factors actually influence KSWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice.
MO100: Alectinib-Induced Reversible Acute Kidney Injury
Authors: Conceição Suse , Moreira Fonseca Nuno , Navarro David , Ribeiro Francisco , Nolasco Fernando
Published: May 2022

BACKGROUND AND AIMS

Alectinib is a second generation anaplastic lymphoma kinase (ALK) tyrosine inhibitor approved for ALK-positive lung adenocarcinoma. This drug may be associated with acute kidney injury, mainly causing acute tubular necrosis. Usually inducing a reversible chronic increase of serum creatinine that improves after dose reduction or suspension. Severe renal impairment is a very rare adverse effect.

METHOD

We report a case of 85-year-old male patient diagnosed with ALK-positive lung adenocarcinoma for which alectinib was started with a good neoplasm response. He was admitted to our hospital due to acute kidney injury, presenting with anasarca, anuria, hyperkalemia and metabolic acidosis which required emergency dialysis support.

RESULTS

Alectinib was discontinued, and the patient recovered from kidney function. However, subsequent re-administration of alectinib (1 month thereafter) caused a new episode of acute kidney injury, requiring new transitory dialysis therapy with new recovering kidney function after drug suspension.

CONCLUSION

This case is unusual due to its severe renal presentation. Thus far, there have only been two similar cases reported. Our case report shows an uncommon and severe adverse effect of alectinib, where it is found that there exists a temporal relation between alectinib exposure and acute kidney injury. Furthermore, the patient recovered from kidney function after drug discontinuation. Frequent monitoring of renal functions is important, as it allows for drug dosage adjustment, which can prevent severe AKI and reduce the morbidity of these frail patients.
MO120: Kidney Biopsy—Safety at Neprology Gold Standard
Authors: Marques Filipe , Silva Onassis , Outerelo Cristina , Lopez Noélia , Fernandes Paulo , Nogueira Estela , Jorge Sofia , Gameiro Joana , António Lopes José
Published: May 2022

BACKGROUND AND AIMS

Percutaneous renal biopsy is a fundamental technique for the diagnosis of numerous renal pathologies. However, it is an invasive technique that requires operator experience and is associated with adverse outcomes. Bleeding complications such as haematuria or perirenal hematoma are frequent, but generally self-limiting, and may rarely be severe to the point of culminating in hypovolemic shock or death. The objectives of this study are to identify the rate of adverse outcomes and potential predictors of adverse outcomes related to the procedure.

METHOD

A retrospective analysis of patients undergoing native kidney biopsy at a tertiary centre, between 2015 and 2019 was carried out, based on the demographic and clinical characteristics of the population, analyses (creatinine at admission, pre-procedure and post-procedure blood counts) and control at 24 h after biopsy) and imaging methods (renal ultrasound 24 h after biopsy).

RESULTS

A total of 176 patients were selected, with a mean age of 48.1 ± 17.6 years. They were mostly caucasian (80.1%) and there was a predominance of females (55.7%). Approximately 46.6% had arterial hypertension, although all had their blood pressure controlled at the time of the biopsy. Mean pre-biopsy creatinine value was 2.0 ± 1.7 mg/dL. Mean pre-biopsy haemoglobin value was 12.1 ± 2.0 g/dL and 24 h post-biopsy 11.8 ± 2 .0 g/dL. There was an overall complication rate of 30.1%, corresponding to 5 cases of haematuria, 36 minor hematomas and 8 major hematomas. There were no deaths and there was no need for surgical intervention to control the bleeding. The only predictor of post-biopsy complications was age, with younger patients having fewer complications (43.9 ± 16.2 versus 50.0 ± 17.9, P = .036). There was no correlation between pre-biopsy creatinine or haemoglobin values and the occurrence of complications, nor was there a greater number of complications in hypertensive patients.

CONCLUSION

Although bleeding complications were relatively frequent in this sample, serious events were rare, as this reinforces the safety of this procedure (which provides valuable information about the prognosis and decision of the therapy to be instituted). The presence of arterial hypertension and the pre-biopsy creatininemia value did not increase the risk of complications related to the procedure.
MO126: A ‘Point Prevalence’ Pain Study over 2 Days in Three Dialysis Units in the West of IRELAND
Authors: Gorey David , Lappin David , Murphy David , Reilly Leona , Mannion Eileen , Kennedy Grace , Waldron Dympna
Published: May 2022

BACKGROUND AND AIMS

Point prevalence studies are observational studies, without intervention, and involve collecting data, in patients in multiple care units, at a specific time. It provides no information on outcomes but provides information on how common a problem is, and current management. This type of study can be an ongoing program consisting of multiple research collection days, each performing multiple, independent studies simultaneously. The point prevalence studies are purely observational, and no intervention is required by the study protocol.

The aim of the study is to understand prescribing patterns of analgesia to dialysis patients and incidence of pain among them.

METHOD

This project is a prospective, observational, multicentre, 2-day, point prevalence study of three chronic dialysis units on the prevalence of pain in all patients in receipt of dialysis. Data were gathered regarding analgesia prescribed to patients and whether patients reported pain to the haemodialysis (HD) staff.

RESULTS

A total of 164 patients were audited, with an average age of 67.8 years.

Approximately 19.5% of dialysis patients presenting reported pain. The average age of these patients was 70 years. The most common cause was MSK (34%) then cramps (31%), vascular access pain (16%), ‘other’ (13%) and vascular wounds (6%). Approximately 12.5% of those patients with pain were reviewed by a doctor.

Approximately 50% of the patients are prescribed analgesia. This varied amongst dialysis units with 52% and 26% of patients in the two public units prescribed analgesia and 70% of patients in the private unit. Types of analgesia prescribed to HD patients were paracetamol (75.46%), neuropathic agent (20.12%), codeine (6), tramadol (4), tapentadol (3), pure opioid (4), buphenorphine patch (3) and lidocaine patches (2).

CONCLUSION

This shows a significant impact of pain amongst dialysis patient presenting daily to dialysis units. A prospective research study is planned using a novel Pain App specifically developed for HD patients. This may be structured as a Cluster Clinical trial to compare and contrast outcomes in different centres.
MO129: Influence of Menstrual Situation on the Risk of Incident Microalbuminuria in School Workers: Miyagi Karoshi Prevention Study
Authors: Munakata Masanori , Hattori Tomomi , Konno Satoshi , Kubota-Nakayama Fumie , Inoue Nobutaka , Nakamura Tomohiro , Hozawa Atsushi
Published: May 2022

BACKGROUND AND AIMS

It has been recognized that menstrual situation impairs diagnostic accuracy of proteinuria. However, it is not fully understood how menstrual situation affects the degree of urinary albumin excretion, a well-known marker of endothelial damage. Moreover, there may be no report examining the dose–response relationship between contaminated blood and the risk of incident microalbuminuria.

METHOD

We studied 735 female school staffs (40.6 ± 11.2 years) who participated in the Miyagi Karoshi Prevention study. Urinary albumin excretion adjusted for creatinine (UAE) from morning spot urine sample was examined together with annual health check-up in 2019 and 2020. Menstrual situation was confirmed by a questionnaire at the time of examination. First of all, we examined the odds ratio for microalbuminuria of menstruation by means of logistic regression analysis using baseline data of 703 subjects with normo-albuminuria (NA) and 32 subjects with micro-albuminuria (MA). Next, we examined the dose–response relationship between urine blood category of − (n = 49), ± (n = 13 ), + (n = 22), 2+ (n = 13), 3+ (n = 47) and UAE or frequency of MA in 144 non-diabetic, non-hypertensive subjects without chronic kidney disease who were menstrual and non-menstrual situation in either year.

RESULTS

Age and BMI were similar between MA and NA groups, while frequency of menstruation (31.2 versus 15.4%, P < .05), hypertension, or BP ≧ 140/90 mmHg or use of antihypertensive medications (34.4 versus 10.0%, P < .001) and diabetes, or HbA1c ≧ 6.5% or use of antidiabetic medications (9.4 versus 2.3%, P < .05) was higher in MA than in NA group. Multivariate logistic regression analysis has shown that MA was significantly associated with menstruation (OR 2.65: 95% CI 1.17–53.99) and hypertension (OR 4.41: 1.69–11.51). UAE was dose-dependently increased with an increase in urine blood category (P < .001). Frequency of MA in each urine blood category was 0.0, 4.5, 0 and 17.0% (P = .001), respectively.

CONCLUSION

Contamination of blood into urine dose-dependently increases UAE in menstruated women. The diagnosis of MA may be possible even in menstrual situation if urine blood category is 2+ or lower.
MO132: Gait Speed in Predialysis Chronic Kidney Disease Patients: A Cross-Sectional Study from the Role of AST120 in Sarcopenia Prevention in Pre-Dialysis Chronic Kidney Disease Patients
Authors: Chul Kim Jun , Han Miyeun , Heon Song Sang , Kim Su-Hyun , Cha Ran-Hui , Hui Kang Seok , Suk An Won
Published: May 2022

BACKGROUND AND AIMS

Gait speed (GS) is an important measure of functional ability. The aim of this study was to investigate the factors associated with GS in patients with chronic kidney disease with respect to sarcopenic component, plasma uremic or inflammatory markers and quality of life.

METHOD

The RolE of AST120 in sarCOpenia preVEntion in pRe-dialYsis chronic kidney disease patients is a 48-week, randomized controlled, parallel group, open-label, multicentre trial to determine the role of AST-120 in patients with chronic kidney disease. A total of 150 study participants were recruited from six general hospitals in South Korea. The participants were classified into four groups according to GS: ≤0.8, 0.8–1.0, ≤1.0–1.3 and ≥1.3 m/s. Linear regression analysis was performed to identify the factors associated with GS.

RESULTS

The mean GS was 1.06 ± 0.3 m/s. The mean age of the total population was 65.0 ± 10.8 years, and 97 (64.7%) were males. The group with a GS ≤ 0.8 m/s was the oldest and had the highest proportion of participants with low education level and medical aid. The levels of albumin, creatinine, eGFR and proteinuria did not differ between the groups. Participants with a GS ≤ 0.8 m/s showed the lowest level of physical component scale (PCS) and mental component scale (MCS). The levels of IS, TNF-α and myostatin were not different between the groups; however, the level of IL-6 showed a higher trend in the lower GS group. HGS and GS showed weak correlations with one another (R2 = 0.066, P < .001); however, GS and the SMI were not significantly associated (R2 = 0.016, P = .119).

In the multivariate linear regression analysis adjusted for age, sex, diabetes, and estimated glomerular filtration rate, medical aid (β = –18.4, P = .007), handgrip strength (β = 0.85, P = .031), interleukin-6 level (β = –13.2, P = .001), haemoglobin (β = 2.84, P = .041), MCS (β = 0.45, P < .001) and PCS (β = 0.51, P < .001) were significantly associated with GS. Specifically, physical functioning, role limitation due to physical health problems and bodily pain in PCS, role limitation due to emotional problems, vitality and social functioning in MCS were statistically significantly correlated with GS. In the kidney disease-specific scale, symptom/problem, work status, cognitive function, quality of social interactions, social support and overall health rating in kidney disease were statistically significantly correlated with GS in the multivariate analysis.

CONCLUSION

GS is associated with handgrip strength, interleukin-6 and various components of quality of life including MCS and PCS.
MO135: Efficacy and Safety of Bortezomib Combined with Autologous Stem Cell Transplantation in the Treatment of MGRS
Authors: Zhao Liang , Ren Guisheng , Guo Jinzhou , Xu Weiwei , Hong Liu Zhi , Huang Xianghua
Published: May 2022

BACKGROUND AND AIMS

To evaluate the efficacy and safety of bortezomib combined with autologous stem cell transplantation (ASCT) in the treatment of monoclonal gammopathy of renal significance (MGRS).

METHOD

The clinicopathologic data of 16 patients with non-AL MGRS who received bortezomib combined with ASCT in Jinling Hospital of Nanjing University School of Medicine from February 2012 to June 2021 were retrospectively analysed.

RESULTS

Twelve patients were male and four were female, with a median age of 49 years, a median serum creatinine was 1.71 mg/ dL (1.45,  2.09) and a median eGFR wad 42.1 mL/min/1.73 m2 (29.0, 51.6). Renal pathological types included seven patients were light chain deposition disease, two patients were heavy chain deposition disease, one patient was light and heavy chain deposition disease, five patients were light chain proximal tubulopathy and one patient was proliferative glomerulonephritis with monoclonal immunoglobulin deposition. Sixteen patients received bortezomib-based induction therapy with a median three courses before transplantation. Stem cells were successfully collected from all patients and CD34 + cell counts were 4.4–13.55 × 106/kg (8.77 ± 3.29 × 106/kg). All patients had successful haematopoietic reconstitution, and a median time of achieving granulocyte count of 500/L was 10 (9, 10) days, and a median time of achieving platelet count of 20 000/L was 12 (11, 13) days. The major treatment complications during transplantation were mucositis (87.5%), diarrhoea (62.5%), fever (56.3%), and nausea and vomiting (18.8%); the other rare complications were acute kidney injury, skin rashes and liver function damage. Haematologic responses were achieved in 15 patients (93.8%), with 10 patients (62.5%) achieved complete responses, 3 patients (18.8%) achieved very good partial responses, 2 patients (12.5%) achieved partial responses, and 1 patient had no haematologic responses. Before treatment with ASCT, seven patients (43.8%) achieved partial response, of which four achieved complete response after ASCT, and one patient did not achieve hematologic response but achieved complete response after ASCT. A total of 12 patients (75%) achieved renal response before ASCT and 14 patients (87.5%) achieved renal response after ASCT. The median follow-up time was 43.5 months. One patient died during the follow-up due to infection, and one patient developed end-stage renal disease during the follow-up. Three patients relapsed, with a median time of 49 months.

CONCLUSION

Our data demonstrated that ASCT is a safe and effective treatment for rigorously selected non-AL MGRS patients, with few serious treatment complications and high haematological and organ response rates.
MO140: Lower Serum 25-Hydroxyvitamin D Levels are Associated with Peripheral Arterial Stiffness in Patients with Non‑Dialysis Chronic Kidney Disease Stage 3–5
Authors: Liao Tsung-Yu , Boey Han-Bin , Lai Yu-Hsien , Wang Chih-Hsien , Hsu Bang-Gee
Published: May 2022

BACKGROUND AND AIMS

Vitamin D deficiency is associated with a higher mortality and incidence of cardiovascular disease. High brachial-ankle pulse wave velocity (baPWV) is independently associated with an increased risk of cardiovascular events, cardiovascular mortality and all-cause mortality in atherosclerotic cardiovascular disease patients. The aim of this study was to evaluate the relationship between serum 25-hydroxyvitamin D levels and baPWV in patients with CKD stage 3 to 5.

METHOD

Fasting blood samples and baseline characteristics were obtained from 180 CKD stage 3 to 5 patients. A commercial enzyme-linked immunosorbent assay was used to measure 25-hydroxyvitamin D levels. Automatic pulse wave analyzer (VaSera VS-1000) to measure baPWV values and both sides of baPWV value which is greater than 18.0 m/s was determined as peripheral arterial stiffness (PAS).

RESULTS

A total of 73 (40.6%) participants were assigned to the PAS group with baPWV of >18 m/s in CKD patients. There were more patients with diabetes mellitus (P = .036), old age (P < .001), higher systolic blood pressure (P < .001), diastolic blood pressure (P = .015), high serum intact parathyroid hormone (iPTH) (P = .009), elevated C-reactive protein (P < .001) and lower 25-hydroxyvitamin D (P < .001) levels in the PAS group compared with the control group in CKD participants. A multivariate logistic regression analysis discloses that 25-hydroxyvitamin D [odds ratio (OR): 0.895, 95% confidence interval (CI): 0.828–0.968, P = .005] and old age (OR: 1.140, 95% CI: 1.088–1.194, P < .001) were independently associated with PAS in in patients with CKD stage 3 to 5. Moreover, according to a multivariate forward stepwise linear regression analysis, OPN level is positively associated with cfPWV. By receiver operating characteristic (ROC) curve analysis, the area under the receiver operating characteristic curve of 25-hydroxyvitamin D level was 0.684 (95% CI: 0.611–0.751, P < .001) for predicting PAS in patients with CKD stage 3 to 5.

CONCLUSION

Lower serum 25-hydroxyvitamin D levels and older age were associated with PAS measured by baPWV in patients with CKD stage 3 to 5.
MO142: Urinary Hemopexin As a Marker of Lupus Activity Among Egyptian SLE Patients with Proliferative Lupus Nephritis
Authors: Sabry Alaa , Mahmoud Rasha
Published: May 2022

BACKGROUND AND AIMS

To assess the role of urinary hemopexin in prediction of active lupus nephritis (LN) and correlate its level with disease activity and ability to predict response to induction therapy in Egyptian SLE patients with nephritis.

METHOD

A cohort case-control hybrid study included patients diagnosed as LN and were recruited during 1 year from the from nephrology department in Mansoura University Hospital (from year 2017 to 2018). Forty-four patients (2 males and 42 females) and 22 control subjects were included. They were divided into three groups. Group I : patients with active LN, group II : SLE patients without LN and group III: healthy control. All participants were subjected to full history taking, Laboratory investigations such as ANA, anti-dsDNA, serum C3, C4, 24-h urinary protein, serum and urinary creatinine and urinary haemopexin. Renal biopsies were done in those with LN if not contraindicated. Patients received induction therapy according to the KDIGO guidelines. Urinary haemopexin was repeated after 6 months of induction therapy in LN patients.

RESULTS

Urinary hemopexin was statistically higher in LN cases (11.85) IU/L compared to SLE without nephritis (4.84) IU/L and (3.63) IU/L in heathy subjects. There was a positive correlation between urinary haemopexin and proteinuria. Its level also significantly decreased after induction therapy.

CONCLUSION

Haemopexin level is higher in LN than SLE without nephritis and its level decreases after immune suppression. Its level correlates with disease activity However, it cannot replace the role of renal biopsy.
MO148: CT-Guided Native Kidney Biopsy by Interventional Nephrologists
Authors: Mohamed Amine Rahil , Michel Marc Jean , Deprele Carole , Bisaccia Vincent , Baudoin Ophelie , Delay Agnes , Legrand Eric
Published: May 2022

BACKGROUND AND AIMS

Histopathology of renal parenchyma is the key diagnostic in the treatment of kidney diseases by nephrologists. Most nephrologists perform renal biopsy using percutaneous ultrasound-guided technic. Generally, this act is very simple for the majority of patients, but when the kidney size is small or the patient has an extreme obesity, this act could be a real challenge with more risk of complications. In Annonay Hospital (North Ardeche, France) all percutaneous renal biopsies are performed by a CT guidance technic. We report a retrospective study of 123 patients who have had a CT-guided kidney biopsies by interventional nephrologists.

METHOD

Between January 2016 and June 2021, 123 CT-guided native kidney biopsies were performed by interventional nephrologists at Annonay Hospital in North Ardeche in France. A total of 77 men and 46 women were introduced in this retrospective study. The mean age was 64 years (1933–1990); the mean BMI was 26.54 (47–129 kg). In our facility, all renal biopsies were performed by CT guidance technique. The patient was installed in the prone position. Preliminary CT images at 5-mm axial slices covering the entire length of the kidney are obtained. A metallic mark is placed at the right side of the back to localize the entrance skin site, the lower pole cortex and to calculate the depth between the skin and the target. A local anesthetic agent is then injected following the calculating depth. A 16-gauge core biopsy is introduced following exactly the calculating depth and the position of the needle tip is confirmed on CT. Once two samples are acquired, the needle is removed and postprocedure images are obtained to assess for perinephric haemorrhage.

RESULTS

Renal parenchyma was obtained in all patients (100%); over 123 biopsies, 121 presented between 1 to 48 glomerulus (98.37%), 2 biopsies presented a medulla tissue (1.62%), 97 patients (78%) presented a perinephric haemorrhage no more than 1 cm in postprocedure images and 15 patients presented a macroscopic hematuria (12.19%). One patient required renal embolization for a rapid expansive perinephric haemorrhage with severe pain.

CONCLUSION

The CT-guided renal biopsy is a precise and rapid technique to have a renal parenchyma with a failure rate bordering 0%, but the cost and the radiations rate should be compared with the other methods.
MO153: Study of the Relationship between Atrial Fibrillation and The Functional State of the Kidneys in Patients with CHF
Authors: Karimdjanova Guzal
Published: May 2022

BACKGROUND AND AIMS

Chronic heart failure (CHF) is one of the most significant medical, economic and social problems of the 21st century. According to epidemiological studies, the prevalence of CHF in the USA and Western Europe ranges from 1.9% to 2.5% (Rosamond W. et al. 2007; Neumann T. et al. 2009), and this figure is steadily increasing.

  The problem of cardiorenal relationships in patients with CHF occupies one of the leading places in clinical medicine in recent years. Research results indicate that even the earliest subclinical renal dysfunction is an independent risk factor for the development of cardiovascular complications (CVC) and death, as well as recurrent events in patients with CVD [1].

 The aim of our study was to identify clinical, laboratory and instrumental differences between patients with CHF and permanent AF or persistent sinus rhythm (SR), as well as to study the relationship between AF and the functional state of the kidneys.

METHOD

80 patients (44 men, 36 women) with CHF aged 40 to 75 (mean age 62 ± 12 years) with CHF were examined. The exclusion criteria from the study were primary pathology of the kidneys, renal vessels and urinary tract, endocrine and oncological pathology. CHF was diagnosed and assessed according to the National Recommendations of the SHFS, RSC and RSMSP for the diagnosis and treatment of CHF (fourth revision), 2013

RESULTS

Among the examined patients, a persistent (>1 year) form of AF occurred in 48.7% of patients. Sinus rhythm was observed in 51.3% of patients. Table 2 shows the characteristics of the main clinical manifestations in patients with CHF according to the presence/absence of AF. GFR was lower in patients with AF than without AF (57.6 ± 15.3 versus 68.2 ± 17.6 ml/min/1.73 m2 respectively, p < 0.001) (Figure 1), in patients with CHF FC I, GFR was 84.3 ± 7.44 ml/min/1.73 m2, with CHF FC II 76.2 ± 16.34 ml/min/1.73 m2, with CHF FC III 62, 8 ± 7.3 ml/min/1.73 m2, with CHF FC IV 57.6 ± 5.1 ml/min/1.73 m2.

CONCLUSION

A feature of clinical symptoms in patients with chronic heart failure and atrial fibrillation, in contrast to patients with sinus rhythm, was a more pronounced edematous syndrome, and the echocardiographic picture was an increased size of the left atrium and right ventricle.

 In patients with CHF who have CKD, mitral regurgitation is more often observed, the latter, as is known, due to volume overload, leads to remodeling of the left atrium.
MO156: The Choice of Empiric Antimicrobial Agent and its Association with Outcomes in Kidney Transplant Recipients with Urinary Sepsis
Authors: Królicki Tomasz , Bardowska Klaudia , Kudla Tobiasz , Królicka Anna , Letachowicz Krzysztof , Mazanowska Oktawia , Krajewski Wojciech , Poznański Paweł , Krajewska Magdalena , Kamińska Dorota
Published: May 2022

BACKGROUND AND AIMS

Efficient antibiotic therapy remains the cornerstone of successful sepsis treatment. Urinary sepsis, which remains the most common sepsis type in kidney transplant recipients (KTRs), is characterized by high prevalence of multidrug-resistant (MDR) bacterial strains, often limiting the choice of antimicrobial agents. The primary aim of this study was to elucidate the efficiency of primary empiric antimicrobial therapy in KTRs hospitalized for urosepsis, depending on the antibiotic choice.

METHOD

All primary urosepsis cases in KTRs hospitalized in 2014–2019 in the Transplantation Department of the Wroclaw Medical University Hospital were included retrospectively as the study group (n = 101). A total of 100 random KTRs hospitalized for primary urinary tract infection (UTI) were set as control group. The primary endpoint was the need for antibiotic change after 3 days of completed empiric treatment (due to lacking clinical response or proven antibiotic resistance). All patients were treated according to SSC guidelines with delay in antibiotic administration of no more than 1 h after the diagnosis of sepsis.

RESULTS

In the urosepsis and UTI groups, the need for antibiotic change after 3 days of treatment equaled 45.6% and 11%, respectively. Patients with urosepsis and inappropriate antibiotic therapy were at increased risk of death (OR = 10.1 with P = .021), need for acute renal replacement therapy (OR = 4.73 with P = .012) and non-recovery from AKI (OR = 3.18 with P = .031). Similar but not statistically significant trend was observed in the UTI group for lacking recovery from AKI (OR = 1.64 with P = .636). In both groups, the length of hospital stay was significantly longer in patients who did not receive appropriate empiric antimicrobial drug. Following antimicrobial agents were associated with appropriate successful treatment rates in the urosepsis and UTI groups: ciprofloxacine (0% versus 63%), amoxiciline with clavulonic acid (16.7% versus 89%), piperaciline with tazobactam (57% versus 60%), cefuroxime (67% versus 100%), third generation cephalosporines (76% versus 92%) and carbapenemes (100% versus 100%).

CONCLUSION

A delay in successful antibiotic therapy, caused by inappropriate choice of antimicrobial agents, for the treatment of urosepsis in KTRs is associated with detrimental kidney graft outcomes. Ciprofloxacine and amoxiciline with clavulonic acid should not be used for empiric therapy of urosepsis in this patient cohort. The development of urosepsis in KTRs as compared to non-septic UTI is associated with greater risk of antibiotic resistance among causative microorganisms and increased risk of antimicrobial failure.
MO157: Evaluating the Effect of SGLT2 Inhibitors on Proteinuria and Glomerular Filtration Rate in Non-Diabetic Patients with Proteinuria
Authors: Afrooghe Arya , Nematollahi Niloofar , Sadat Hakemi Monir , Nassiri Amirahmad
Published: May 2022

BACKGROUND AND AIMS

Proteinuria is strongly associated with the risk of CKD progression in non-diabetic and diabetic patients. SGLT2 inhibitors, as a promising new class, may provide protective effects for the kidney. Even though various studies have been conducted in this area, especially in diabetic patients, little information is available about how SGLT2 inhibitors affect proteinuria, kidney function or blood pressure in non-diabetic patients. Due to the lack of adequate information in previous studies, in this study, we investigated the effect of SGLT2 inhibitors on protein excretion and glomerular filtration rate (GFR) in patients with proteinuria.

METHOD

The present study was conducted as a single-group clinical trial (before and after). Thirty patients with proteinuria were enrolled. In addition to conventional treatment, empagliflozin 10 mg daily was administered. Height, weight, body mass index (BMI), GFR content, systolic and diastolic blood pressure, proteinuria and side effects in patients at the study's beginning and end were evaluated and recorded. In the end, the data were collected and analysed statistically.

RESULTS

In the present study, 30 patients with proteinuria were followed for 13.26 ± 5.90 weeks. The mean proteinuria of patients decreased significantly during the follow-up period (from an average of 1007.9 mg at the beginning of the study to 672.33 mg at the end (P < .05)). There was no significant difference in serum creatinine levels and glomerular filtration levels (P > .05). However, there was a significant decrease in blood pressure (systolic and diastolic) (P < .05). BMI and patients' weight were decreased compared to the beginning of the study, but this difference was not statistically significant (P > .05). Hypoglycaemia or hypokalemia did not occur in any of the patients. In 10% of patients, temporary dysuria was seen. Also, urinary tract infection was recorded in one patient (3.3%). In 3.3% of patients, the drug was discontinued due to intolerance.

CONCLUSION

The results of this study demonstrated that administration of empagliflozin significantly decreases proteinuria in non-diabetic patients with chronic kidney disease. However, further studies are recommended in this area.
MO162: Renal Function During Long-Term Use of Oral Anticoagulants in Patients with Atrial Fibrillation
Authors: Abdullaev Sherzod , Igamberdieva Ranokhon
Published: May 2022

BACKGROUND AND AIMS

Long-term oral anticoagulant should be recommended in patients with atrial fibrillation (AF) and CHA2DS2VASc score ≥ 1 for stroke prevention. Warfarin and different direct oral anticoagulants are metabolized differently by the kidney. The impact on renal function during long-term use of oral anticoagulants in the patients with AF remains unclear. The aim of our study was to compare rivaroxaban's and warfarin's impact on the decline in renal function in patients with AF.

METHOD

This study included patients with non-valvular AF from 2016 to 2020, mainly through the medical history of the Republican nephrology inpatient departments. Baseline estimated glomerular filtration rate (eGFR), follow-up eGFR and the change in eGFR between 2-year eGFR and baseline eGFR were compared between different anticoagulants after propensity score matching. The primary study endpoint was acute kidney injury (AKI). A total of 289 patients were enrolled (n = 131 rivaroxaban, n = 158 warfarin) in this study, and the mean observation time was 2.9 ± 0.8 years.

RESULTS

During the observation period, there was a significantly higher incidence of AKI during follow-up in the warfarin group than in the rivaroxaban group before and after propensity score matching (before: warfarin versus rivaroxaban: 8.9% versus 4.6%, P < .001; after: warfarin versus rivaroxaban: 8.2% versus 3.8%, P < .001). The change in eGFR between 2-year eGFR and baseline eGFR did not differ between the warfarin and rivaroxaban groups after propensity score matching (warfarin versus rivaroxaban: − 1.31 ± 20.31 versus –1.82 ± 16.23 mL/min/1.73 m2, P  =  .452).

CONCLUSION

During the mean observation time of 2.9 ± 0.8 years, warfarin was associated with a higher incidence of AKI compared with rivaroxaban. The decline in renal function did not differ among warfarin and rivaroxaban groups.
MO164: Is there a Place for the Resistivity and Pulsatility Index in Diabetic Nephropathy?
Authors: Liana Gliga Mirela , Chirila Cristian , Gliga Mihail , Tilea Ioan , Chirila Paula
Published: May 2022

BACKGROUND AND AIMS

Resistivity index (RI) and pulsatility index (PI) are important Doppler ultrasound (US) parameters for the evaluation of intrarenal haemodynamics. One of the pathogenetic mechanism in diabetic nephropathy (DKD) is the arteriolar hyalinosis and the interlobar arteries were proved as hallmarks for distal vasoconstriction or dilatation. Therefore, Doppler parameters are commonly used in the early detection of intrarenal vasoconstriction. We compared the results of colour Doppler parameters RI and PI in type 2 diabetic nephropathy (DKD) with hypertensive (HT) patients with proteinuria and tried to assess the risk for the disease progression.

METHOD

A total of 141 patients with DKD and 146 hypertensive patients were examined using an Esaote MyLab X8 eXP Ultrasound device following a precise protocol by a single examiner. All patients had proteinuria values 300–500 mg/24 h. RI and PI were measured in the interlobar arteries on three levels for each kidney, and a mean was calculated. All patients were age and sex matched and had eGFR over 45 mL/min/1.73 m2. GraphPad Prism program was used, and correlation indices were calculated.

RESULTS

Mean RI values were 0.71 for ND group (SD = 0.06; 95% CI), 0.66 for HT group (SD 0.06; 95% CI); t-test was highly significant (P < .05). Mean PI values were 1.27 for ND group (SD = 0.33; 95% CI), 1.04 for HT group (SD = 0.24), t-test was also highly significant between the two groups with P values under.05. Cut-off values for RI in DKD were above 0.72. PI values were higher with age in diabetic patients. PI and RI were highly significant in case of patients with more than 5 years from the onset of diabetes.

CONCLUSION

RI can be considered a suggestive parameter for the presence of DN. PI alongside RI correlated with the duration of diabetes, age and incipient DN. We recommend the use of RI in the early evaluation of DKD. Although Doppler US examination is time-consuming, it can be easily performed in non-obese and compliant patients.
MO188: Elevated Serum Soluble Urokinase-Type Plasminogen Activator Receptor Level is Linked to Aortic Stiffness in Chronic Haemodialysis Patients
Authors: Lin Wei-Chen , Lai Yu-Hsien , Hsu Bang-Gee
Published: May 2022

BACKGROUND AND AIMS

Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with inflammation and contributing in the pathogenesis of atherosclerosis. Aortic stiffness is associated with aging-associated vascular diseases and is also an independent risk factor of cardiovascular morbidity and mortality. We evaluated the association between serum suPAR and aortic stiffness in patients with chronic haemodialysis (HD).

METHOD

A total of 135 patients with HD were enrolled in this study. Carotid–femoral pulse wave velocity (cfPWV) was measured using the SphygmoCor system. Patients with cfPWV >10 m/s were defined as the aortic stiffness group. Serum suPAR levels were measured using a commercial enzyme-linked immunosorbent assay kit.

RESULTS

Fifty-five HD patients (40.7%) had aortic stiffness and higher percentages of diabetes (P = .001), hypertension (P = .039), were of older age (P = .007) and had higher systolic blood pressure (P = .025), serum glucose level (P = .019), C-reactive protein (P = .039) and suPAR levels (P < .001) compared to control group. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum suPAR [odds ratio (OR): 1.910, 95% confidence interval (CI): 1.485–2.458, P < .001] and age (OR: 1.040, 95% CI: 1.001–1.080, P = .048) were independently associated with aortic stiffness in patients with chronic HD. After multivariable forward stepwise linear regression analysis also noted that serum suPAR level (β = 0.442, adjusted R2 change = 0.250, P < .001) was positively associated with with cfPWV values in HD patients.

CONCLUSION

Serum suPAR level is positively associated with cfPWV values and is a biomarker for aortic stiffness in patients with chronic HD.
MO206: HLA Frequency in A Spanish Transplant Patients Cohort With ANCA-Associated Vasculitis
Authors: Martin Irene , Mínguez Toral Irene , Castillo Rodriguez Esmeralda , Viera Ramírez Elizabeth , Jimenez Sara , Ferreira Marta , Elias Triviño Sandra , Gañan Israel , Galeano Cristina , Fernandez Lucas Milagros
Published: May 2022

BACKGROUND AND AIMS

ANCA-associated vasculitis (AAV) is an autoimmune disease that causes end-stage renal disease in ∼20%–25% of patients who develop kidney failure with progression to end-stage kidney disease with requirement of renal replacement therapy. Previous studies have found a genetic association between some major histocompatibility complex (MHC) loci, like the locus DPB1*0401, and AAV. We conducted a retrospective observational unicentric study with the objective to identify other possible loci related to AAV.

METHOD

As MHC determination is not usually done in patients with AAV, we looked for patients with AAV included in the kidney transplant list with a complete classic HLA allele determination registered (A, B, C, DR, and DQ). Only 14 patients with diagnosis of AAV included in the kidney transplant list from August 1993 to December 2020 in our hospital centre fulfilled this inclusion criterion. To the statistical analysis, we compared the observed proportion to the theoretical one using a normal test, since the groups in our sample included at least five subjects. We also use a continuity correction factor to approach to a binomial test.

RESULTS

The highest allele frequency in our cohort were the HLA B*51and the haplotype HLA DRB1*04-DQB1*03:02. We identified a B*51 frequency of 42.8% (6/14 patients) in our AAV register, while its population frequency in Spain is 15%, difference = 27.86% [Confidence interval (CI) 1.93%–53.78%] P = .01. We detected a DRB1*04 frequency of 57.1% (8/14 patients) in our cohort, while the population frequency of DRB1*04 and its associated loci DQB1*03:02 is 22%, difference = 35.14% (CI 9.22%–61.07%) P < .05.

CONCLUSION

HLA B*51 and the haplotype DRB1*04-DQB1*03:02 are alleles more frequent in patients with AAV than general population. This could translate a genetic predisposition of people with these alleles to develop AAV.
MO215: Intrarenal Single Cell Sequencing of MPO-Anca Associated Glomerulonephritis Patients Reveal Novel Targetable Treatment Options
Authors: Zhong Yong , Ooi Joshua
Published: May 2022

BACKGROUND AND AIMS

The etiopathogenesis underlying myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (MPO-ANCA-GN) remains incompletely understood. Furthermore, there are only limited treatment options and treatment resistance of MPO-ANCA-GN is still a common problem.

METHOD

To identify new targeted treatment options, intrarenal single-cell RNA sequencing (scRNA-seq) was applied to 11 kidney biopsies from MPO-ANCA-GN patients and 2 health kidney tissues to define the transcriptomic landscape at single-cell resolution. Intrarenal scRNAseq was also applied to a pre-clinical mouse model of MPO-ANCA-GN to show that this model of disease can be used to trial new targeted treatments.

RESULTS

We found that kidney endothelial cells in MPO-ANCA-GN patients displayed increased expression of several genes, including CD9 and SPARC, which were closely related to parietal epithelial hyperplasia and crescent formation. NF-κB pathway activation was confirmed in a variety of kidney cells in MPO-ANCA-GN patients. Kidney infiltrating immune cells of MPO-ANCA-GN patients were mainly enriched in inflammatory pathways including TNF signalling, IL-17 signalling and NOD-like receptor signalling. These findings were similar in our pre-clinical mouse model of MPO-ANCA-GN. Furthermore, there was an overexpression of inflammasome-related genes (AIM2, IFI16) in MPO-ANCA-GN patients. Treatment resistance was associated with increased infiltration of CD8+ T cells and elevated expression of SPARC, LAMA4, IL33 and CFL1 in mesangial cells when compared with patients who achieved remission after induction therapy.

CONCLUSION

These results offer new insight into the pathogenesis of MPO-ANCA-GN, treatment resistance and identify new therapeutic targets for MPO-ANCA-GN that can be tested in a pre-clinical model of disease.
MO220: Comparison of the Effects of Hydroxychloroquine and Glucocorticosteroids on Immunological Parametrs in Patients with IGA Nephropathy
Authors: Komissarov Kirill , Nizheharodava Darya , Pilotovich V. , Zafranskaya Maryna
Published: May 2022

BACKGROUND AND AIMS

Current treatment strategies of IgA nephropathy (IgAN) primarily involve blood pressure control, renin–angiotensin–aldosterone system inhibitors (RAASIs), and glucocorticosteroids (GCs), which are recommended when the supporting therapies fail to reduce proteinuria (PU) levels below 1 g/day. Hydroxychloroquine (HCQ) is considered to have an immunomodulatory rather than an immunosuppressant effect. The immune pathways targeted by HCQ are not fully investigated during treatment of IgAN. The aim of this study was to compare effects of HCQ and GCs on immunological parameters in patients with IgAN.

METHOD

32 IgAN patients aged 32.0 (26.7 ÷ 36.0) y.o., male/female ratio as 24/8 with PU > 1 g/day and estimated glomerular filtration rate (eGFR) 78 (61; 103) mL/min were divided into three treatment groups: RAASIs (n = 12); HCQ (n = 10); GCs Pozzi protocol (n = 10). The changes in clinical and immunological parameters were analyzed 6 months after treatment. Phenotypic and functional markers of peripheral blood lymphoid cells were identified by flow cytometry method (Cytoflex, «Beckman Coulter», USA). The concentrations of total immunoglobulins (Ig) class M, G, A and E were determined by ELISA method («VectorBest», Russia). Statistical analysis was done using Statistica 8.0.

RESULTS

After 6 months of treatment HCQ has shown effectiveness in decreasing of PU (P < .001), haematuria level (P <.01) as well as the same effect was noted in the other treatment groups after 6 months course. The renal function was stable in all investigated groups during follow up. There were no any adverse effects of the treatment.

The decrease of potential cytotoxic γδTCR+Т-cells (P <.01) and CD3 + 56 + TNK-cells (P < .01) numbers in peripheral blood (Fig. 1) as well as the reduction of IgM (P < 0.05) and IgG (P < .05) serum levels (Table 1) were established in patients receiving HCQ. While GCs treatment resulted in CD3 + T-cells (P < .05) suppression (Fig. 1) mainly due to CD3 + CD4 + T-helpers down-regulation (P < .05) but stimulation of cytotoxic CD3 + CD8 + T-cells (P < .05) (data not shown) and increasing of IgE level (P < .05) (Table 1). It was not revealed any influence of RAASIs treatment either on the number of lymphoid cells populations (Fig. 1) or Ig levels.

CONCLUSION

This study demonstrates different ways of pathogenic treatment in IgAN. HCQ has exhibited an immunomodulatory action on the effector mechanisms of cellular cytotoxicity via minor lymphoid T-cells populations reduction as well as on productive phase of humoral immunity via IgM and IgG levels decreasing. While GCs have suppressed CD3 + T-cell and supported IgE-mediated autoinflammation.
MO225: A Past Medical History of Autoimmune Disease Predicts a Future With Fewer Relapses in Patients With ANCA Vasculitis
Authors: Lionaki Sophia , Marinaki Smaragdi , Fragkioudaki Sofia , Bellos Ioannis , Kalaitzakis Emmanuel , Kalogeropoulos Petros , Sardeli Angeliki , Liapis George , Boletis Ioannis
Published: May 2022

BACKGROUND AND AIMS

To explore the frequency and impact of an autoimmune disease past-medical history (PMH) in the clinical picture and outcomes of patients with ANCA-associated vasculitis (AAV).

METHOD

This is a retrospective study of patients with biopsy-proven AAV, >16 years old, with detailed information about their PMH. Outcomes of interest included remission, treatment resistance, relapse, end-stage kidney disease (ESKD), and death.

RESULTS

215 patients with biopsy-proven AAV and available information regarding their PMH were studied. A total of 65 (30.2%) of them had a history of autoimmune disease prior to PIV diagnosis. The mean age overall was 53.9 years. One hundred and five patients (48.8%) were positive for PR3-ANCA, 101(47.2%) for MPO-ANCA, and 9(4.2%) were negative ANCA. Granulomatosis with polyangiitis was diagnosed in 79 (36.7%), microscopic polyangiitis in 101(47.0%) and renal-limited vasculitis in 35 (16.3%) individuals. Remission rate was similar among patients with and without a PMH of autoimmune disease. Time-to-event analysis indicated that the relapse-free survival was significantly longer in patients with PMH of autoimmune disease (148.2 versus 52.8 months, P-value < .001). After adjusting for covariates, autoimmune disease history was associated with significantly lower risk of relapse {HR 0.31, [95% confidence interval (CI) 0.14–0.69]}, which remained significant in males, patients ≥ 60 years old and those with C/PR3-ANCA, kidney and lung involvement.

CONCLUSION

Patients with a PMH of autoimmune disease, prior to AAV diagnosis, experienced significantly fewer relapses after achievement of remission, compared with patients without such a history, underlining the importance of individualization of maintenance immunosuppressive therapy, given the different etiopathogenetic settings the disease was developed.