bluuebunny/crossref_metadata_2025 huggingface dataset:
#2867 EARLY DETECTION OF VASCULAR ACCESS STENOSIS USING NEPHROFLOW
Authors: Sanchez Soledad Pizarro , Toaza Alejandra Elizabeth Collantes , Picasso Maria López , Garcia Eleno Burgos , Saico Saul Pampa , Alexandru Simona , Suarez Laura García-Puente
Published: June 2023

Background and Aims

The monitoring programs for vascular access make it possible to detect access dysfunction and indicate the need to perform an imaging test to confirm the presence of stenosis and proceed with its treatment. Measurement of arteriovenous fistula (AVF) flow using biosensors is a simple and reproducible method of vascular access assessment. AVF flow (QA) drops below 500 ml/min or a reduction of more than 25% in previous flow are considered predictors of stenosis and/or thrombosis. A stenosis with a high risk of thrombosis is defined as that which presents a decrease of more than 50% in the vascular lumen and a stenosis/prestenosis Peak Systolic Velocity ratio > 2, with additional criteria (residual diameter < 2 mm and/or QA (ml/ min) < 500 (native AVF) or and/or decrease in QA > 25% if QA < 1,000 ml/min.

Method

We performed AVF flow measurement using the NephroFlow biosensor in prevalent hemodialysis patients.

Results

Sixty-one patients were studied, all with native or prosthetic AVF. Of which 42 men and 19 women. The distribution of AVFs was: 38 brachiocephalic (62%), 16 radiocephalic (26%) and 6 brachial-axillary prostheses (10%) 1 brachial-basilic (2%). The data was collected for 24 months. The mean follow-up time for the AVF was 16 months. In 17 patients (30%), flow was detected below 25% compared to previous controls or a decrease in QA <500 ml/min. In these patients, echo-doppler was performed, showing in 15 cases stenosis with a high risk of thrombosis that was treated with angioplasty. In 1 patient, echo-doppler detected only insufficiency of the artery, and no stenosis was observed in fistulography. In 1 patient, there was a significant drop in flow (from 830 to 451 ml/min), which later recovered 650 ml/min with ultrasound without significant alterations, so an endovascular procedure was not performed. During the study period, 1 fistula thrombosis occurred in a patient who had already detected a drop in flow but could not repair it in time. At the end of the study, of the 61 patients analyzed, 51 patients continued with the technique and the flows remained stable or even increased. In the other 10 patients, 9 left due to transplantation or death and 1 patient had a new thrombosis and the AVF could not be repaired.

Conclusion

In hemodialysis units, the measurement of AVF flow using biosensors should be protocolized together with Doppler ultrasound to achieve better monitoring of vascular access, managing to detect and treat early stenosis with a high risk of thrombosis.
#3250 RENAL HAEMODYNAMIC PARAMETERS IN DIABETIC NEPHROPATHY
Authors: Malidretos Pavlos , Anagnostou Nikolaos , Palaiologos Dimitrios , Tanou Kalliopi , Koutroumpas Georgios
Published: June 2023

Background and Aims

Diabetic nephropathy is the leading cause of chronic kidney disease in modern world. Timely diagnosis is of paramount importance, especially after the recent introduction of novel therapies. The presence of an already altered renal haemodynamic profile was investigated in all patients referred with suspected diabetic nephropathy, upon their initial presentation to our renal department.

Method

During the past seven years, from January 2015 to December 2022, 578 patients were referred to the Renal Department for ultrasound assessment. Additionally to their standard assessment, they underwent renal ultrasound and triplex examination. Diabetic nephropathy (DN) was diagnosed in 149 patients. A group of patients with an estimated GFR> 60 ml/min, without diabetic nephropathy, was randomly selected from the same pull of patients for comparison reasons (control group). Renal haemodynamics assessment, including renal arteries, aorta and intrarenal resistive indexes (RI) of both kidneys, estimated glomerular filtration rate (CKDEPI) and 24h albuminuria, were evaluated in all patients.

Results

The mean age of the patients was 72.5 ±10.4 vs 65.8 ±6.9 years, for the DN and control group respectively. Renal length was comparable in both groups, renal diameter of left kidney was 10.61 ±1.28 vs. 10.59 ±1.44 cm and renal diameter of right kidney was 10.53 ±1.38 vs. 9.85 ±2.89 cm for DN group and control respectively. The estimated GFR was significantly lower in the DN group, 42.1±23.6 vs. 82.7 ±11.3 ml/min (p<0.05). Both renal arteries presented higher velocity values in the DN group, 53.4 ±22.2 vs. 21.7 ±28.9 cm/sec (p<0.0001) and 52.4 ±23.9 vs. 24.8 ±32.3 (p<0.0001), for the left and right renal artery. DN patients showed RI values above upper normal limit of 0.70, being at the same time significantly higher compared to control group, 0.73 ±0.06 vs. 0.61 ±0.17 (p<0.0001) and 0.72 ±0.06 vs. 0.59 ±0.20 (p<0.0001), for the left and right kidney respectively.

Conclusion

The presence of significantly increased renal artery velocity in diabetic nephropathy patients compared to control patients has not been described earlier to the best of our knowledge. It represents a new finding that is mainly attributed to the presence of arteriopathy. Evaluation of renal haemodynamics using triplex ultrasound, represents a non – invasive, readily available, inexpensive examination. When performed at initial patient presentation, constitutes an invaluable tool, timely assisting to diagnosis and treatment of diabetic patients.
#3293 ESTRADIOL REPLACEMENT MITIGATED BLOOD PRESSURE ELEVATION VIA SUPPRESSION OF NCC IN ANGIOTENSIN II-INFUSED OVARIECTOMIZED FEMALE RATS
Authors: Kim Yang-Gyun , Lee Sang-Ho , Moon Ju-Young , Jung Su Woong , Park Jihoon , Jin In Tae , Joo Yoosun , Cho Minhae
Published: June 2023

Background and Aims

Female rats excrete more urine sodium than male rats with similar blood pressure (BP). However, it is not clear whether the sex difference in pressure natriuresis is conserved in menopausal rats. We assessed whether the natriuretic response and renal sodium transporter activity in ovariectomized female rats infused with angiotensin II (ANGII) could be affected by estrogen supplementation.

Method

Six-week-old female Sprague-Dawley rats (n=30) were ovariectomized (OVX, n =20) or sham-operated (n=10) (−4 weeks, −4W). After 2 weeks, subcutaneous estradiol was administered to half of the OVX rats (n=10) for 4 weeks (-2W∼2W). ANGII was infused via the osmotic minipump in 60% of the rats for 2 weeks (0W∼2W). Six groups (female saline: FS, female ANGII: FA, OVX saline: OS, OVX ANGII: OA, OVX estradiol saline: OES, OVX estradiol ANGII: OEA) were sacrificed after 2 weeks of the ANGII infusion (2W). We also analyzed human data from the Korean Genome and Epidemiology Study (KoGES).

Results

ANGII-induced BP elevation was highest in the OA group, followed by the FA and OEA groups. Urine sodium tended to increase after ANGII infusion in FA and OEA but decreased in OA. Western blot results showed that cortical phosphorylated sodium chloride cotransporter (pNCC) tended to be augmented by ANGII treatment in FA and OA, but mitigated in OEA. Cortical ANGII type 2 receptor (AT2R) expression was significantly higher in estradiol-treated OVX rats than in OVX rats, irrespective of ANGII infusion. Similarly, the enhanced pNCC in ANGII-treated distal convoluted tubular cells was reversed by estradiol treatment. In KoGES data, urine sodium was significantly lower in postmenopausal women than in premenopausal women, despite the higher BP.

Conclusion

Estradiol reversed BP elevation and augmented the natriuretic response in ANGII-infused OVX rats and distal tubular cells via suppression of pNCC and increase of AT2R.
#3418 DISAPPEARANCE OF GLOMERULAR C3 DEPOSITION MIGHT BE A PROGNOSTIC MARKER IN MEMBRANOUS NEPHROPATHY AFTER TREATMENT
Authors: Cho Byoung-Soo , Jung Sung Min , Cho Won Hee , Lee Hyunsoon
Published: June 2023

Background and Aims

Membranous nephropathy (MN) is the most common cause of nephrotic syndrome (NS) in adults. In about 80% is primary and remaining 20% are secondary due to medications or other diseases. Treatment of primary MN remains controversial, and the prognosis is still difficult to predict despite the introduction of anti phospholipase A2 receptor (PLA2R) antibody. We evaluated pathological changes for predicting prognosis in patients of MN after methyprednisolone (MPD) pulse therapy.

Method

We performed 1,649 renal biopsies at the OPD during last 9 years, of which 31 subjects were MN. We performed follow up biopsy who showed normal urinary findings after treatment with MPD pulse therapy in 11 subjects of MN. Indications of the initial biopsy in MN were oral steroid resistant NS (9 subjects), massive proteinuria associated with hematuria (2 subjects). Among the 11 subjects of MN, 3 subjects were lupus nephritis (LN), 8 subjects were primary MN. One cycle of MPD consist of 10-20 mg/kg (max 1.0 g)/day for 3 consecutive days, performing every 10 to 14 days. Mean MPD pulse therapy were done 13 cycles

Results

Among the 11 cases of MN, male to female ratio was 6 to 5. Age distribution from 1 year old to 61years old (mean 40.8 y/o), Mean spot urine protein to creatinine before treatment was 4,182.5 mg/g and 189.4 mg/g after treatment. 9 subjects showed glomerular C3 deposition were noted at the initial biopsy and 2 subjects showed no C3 deposition. After treatment glomerular C3 deposition were disappeared in 8 subjects, and showed no relapse during 5.3 years follow up. However, 3 subjects who showed glomerular C3 deposition were lupus nephritis, relapsed during follow up period.

Conclusion

MPD pulse therapy might be still promising therapeutic modality in conventional oral steroid resistant MN. Although further larger number of studies are mandatory, disappearance of glomerular C3 deposition might be a prognostic marker for treatment response, instead of disappearance of proteinuria in MN.
#3859 THE TREND OF RENAL REPLACEMENT THERAPY IN N. MACEDONIA FROM 2015 TO 2020: DATA FROM THE ERA-EDTA ANNUAL REGISTRY
Authors: Gjorgjievski Nikola , Stojanoska Ana , Dzekova-Vidimliski Pavlina , Cibrev Dragan , Bushljetik Irena Rambabova- , Trajcheska Lada , Karanfiolvski Vlatko , Andreevska Galina Severova- , Markovska Zhaklina Shterjova- , Taneska Aleksandra Canevska , Petronijevikj Zvezdana , Pushevski Vladimir , Dejanov Petar , Nikolov Igor , Spasovski Goce
Published: June 2023

Background and Aims

Kidney Failure (KF) is treated with three modalities of renal replacement therapy (RRT): kidney transplantation (Tx), hemodialysis (HD), and peritoneal dialysis (PD). Our study aimed to present the trend of RRT in N. Macedonia from 2015 to 2020.

Method

The epidemiological retrospective study analyzed the patients with kidney failure by gender, age, etiology of kidney disease, and modality of RRT. The data were processed from the annual reports of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). The study patients were divided into group 1 (prevalent) with patients on the RRT at the current year, group 2 (incidence at Day 1) with patients on the RRT with a duration of at least 1 day, and group 3 (incidence at Day 91) with patients on the RRT with a duration beyond 91 days.

Results

A total of 10395 patients were analyzed with a mean age of 59.2 ± 9.5 years (median 60.4 years), of which 60.2% were male. From 2015 to 2019, there was an increasing trend in all groups, and most patients were reported in 2019. In group 1, 1598 patients were registered in 2015, and 1762 patients were registered in 2020, which is an increasing trend of 10.3%. The number of patients in group 2 was increasing every following year, with the highest growth in 2019 up to 12.1%, compared to 2018. The number of patients in group 3 also showed significant growth from 253 patients in 2015 to 324 patients in 2019, but there was a decrease of 16.4% in 2020 (271 patients). Deviations are observed in 2020, with a decrease in the number of patients in group 1 and group 3, as well as a slowdown in the growth dynamics of patients in group 2, which might be associated with the start of the SARS-CoV-2 pandemic. According to the modality, most of the patients (84.7%) were on HD in 2015 and 85.9% in 2020. The most frequent age group of patients was from 45 to 64 years, from 36.3% to 49.4%. There was an increasing trend of patients from older age groups (over 64 years) and male patients. The increasing number of patients from the age group 75+ years was also noted in all groups. Etiology of kidney disease: hypertension (25.8%) and diabetes mellitus (17.4%) were the leading causes of KF in patients requiring RRT.

Conclusion

The study showed a constantly increasing trend of patients with KF requiring RRT. The largest number of patients were men, aged from 45 to 64 years. Hypertension and diabetes mellitus were the leading causes of KF, and most of the patients were treated with HD.
#4067 HYPOXIC PRECONDITIONING FOR THE IMPROVEMENT OF THE REGENERATIVE CAPACITY OF MESENCHYMAL STEM CELLS AND ITS APPLICATION IN HYPERTENSIVE KIDNEY DISEASE
Authors: Sohi Gurparneet Kaur , Farooqui Naba , Mohan Arjunmohan , Eirin Alfonso , Lerman Lilach , Herrmann Sandra
Published: June 2023

Background and Aims

Autologous mesenchymal stem/stromal cells (MSCs) have emerged as a therapeutic option for many chronic diseases. Hypertensive kidney disease (HKD) might impair MSCs’ reparative ability by altering important biomolecular properties of the cell, but the characteristics of this impairment are unclear. In our previous pre-clinical studies, hypoxic preconditioning (HPC) enhanced MSC angiogenesis and reduced senescence through global gene and protein expression. Thus, we hypothesize that HPC would improve human MSCs by enhancing their functionality and angiogenesis, creating an anti-inflammatory and anti-senescence environment in MSCs from healthy control (HC), hypertensive patients (HTN), and hypertensive kidney disease patients (HKD).

Method

Human MSCs were collected from abdominal subcutaneous fat tissue biopsy of HC, HTN, and HKD patients (n=12 each). Samples were collected from healthy volunteers with no history of hypertension or kidney disease (HC), patients diagnosed with hypertension controlled with antihypertensive drugs (HTN), and hypertensive patients with eGFR<60 mL/min/1.73 m2 (HKD). MSCs were harvested and cultured in Normoxic (20% O2) or Hypoxic (1% O2) conditions for 24-48 hours. MSC functionality was measured by migration and proliferation. Angiogenic and inflammatory secretome in conditioned media was assessed along with MSC senescence by senescence-associated beta-galactosidase (SA-beta-gal) activity. In addition, transcriptome analysis using RNA-sequencing (n=3/group) and quantitative PCR (qPCR) were performed to evaluate gene expression.

Results

At baseline, Normoxic HTN-MSCs interestingly had higher proliferation compared to HC. HC-MSC subjected to HPC showed increased proliferation (Figure 1A). SA-β-gal activity tended to decrease after HPC, particularly in the HC group (P = .06). HPC did not affect the release of the pro-angiogenic protein VEGF from MSCs, but increased EGF in HC-MSC, and decreased HGF in HC and HKD MSCs. HPC upregulated the pro-angiogenetic genes, inflammatory gene, and a few senescence genes (Figure 1F).

Conclusion

HPC has a more favorable functional effect on HC- than on HKD-MSC, reflected in increased proliferation and EGF release, and tends to decrease senescence, whereas it has little effect on HTN or HKD MSCs. These observations may assist in developing novel therapeutic strategies to improve the regenerative capacity of MSCs in patients with hypertensive kidney disease.
#4391 SALT SENSITIVITY AND HYPERTENSIVE NEPHROPATHY: A LINK TO BE DISCOVERED
Authors: Lanzani Chiara Livia , Simonini Marco , Citterio Lorena , Zagato Laura , Gonzalez Luz Maria , Tunesi Francesca , Contursi Marianna , Maiucchi Paola , Manunta Paolo
Published: June 2023

Background and Aims

Sodium sensitivity is defined as a change in blood pressure depending on sodium intake, which is present in about 30% of the adult population. According to blood pressure variation in salt load test we can classify the population in 3 categories: sodium sensitive (SS), sodium resistant (SR), inverse sodium sensitivity (ISS), based on, respectively, an increase, a non-significant variation or a decrease in the blood pressure values following the administration of sodium. It is reported that SS subjects have, independently from other risk factors, an increased risk of cardiovascular diseases. Moreover, SNPs located in genes related with Na+ metabolism, aldosterone synthesis and tubular sodium reabsorption in the kidney are related to salt sensitivity phenotype. The aim of this study is to analyze the relationship between sodium sensitivity and the development of hypertensive kidney damage in patients with primary hypertension.

Method

A cohort of 712 naïve hypertensive patients were classified for salt-sensitivity using acute saline test (NaCl 308 mEq / 2h / iv).127 patients (follow-up > 5 years- median 11) were selected for the present analysis (SS, n = 40; 0 SR, n = 46; RSS, n = 41). We analyzed annual decline of the eGFR (CDK-EPI) (Delta-eGFR) and development of microalbuminuria (MicrAlb) as renal outcome. Moreover, genetic polymorphism involved in salt sensitive hypertension has been investigated.

Results

No differences in Delta-eGFR was observed among the groups. However, SR subjects develop earlier microalbuminuria (P = .002) even with an adequate pressure control. Genotypes analysis revealed: polymorphism in CYP11B2 and NEDD4L to be protective against decline in eGFR. For microalbuminuria HSD3B1 and ADD3 seem to be a risk factors, whereas KL, PKD and TRPC6 polymorphism result protective factors.

Conclusion

Unexpectedly these finding suggests that SR patients are more at risk of developing hypertensive nephropathy than other groups of patients. Moreover genotypes associated with salt sensitivity play different and complex role in kidney damage in hypertension. Improvement in salt sensitivity testing and standardization will be needed to allow all this pathophysiological knowledge to be translated in a clinical setting.
#4485 CLINICAL CASE OF MOSAICISM IN ADPKD PATIENT
Authors: Marzano Nenzi , Corradi Valentina , Caprara Carlotta , Rigato Matteo , Giuliani Anna , Gastaldon Fiorella , Ronco Claudio , Zanella Monica
Published: June 2023

Background and Aims

Autosomal Dominant Polycystic Kidney Disease (ADPKD) it's mainly characterized by renal involvement with progressive bilateral development of renal cysts and volumetric increase of the kidneys, responsible for the progressive loss of renal function that leads to chronic kidney disease (CKD) and the need of renal replacement therapy. There are some cases (doubtful, uncertain) in which it is necessary to perform genetic testing to achieve a definitive diagnosis. It looks like in ADPKD patients, mosaicism could modulate the clinical course of the disease. Mosaicism is characterized by few cell populations with different genomes. In these special cases the diagnosis is very difficult and the genetic analysis could be an important and helpful tool. With this report, we want to highlight the importance of the use of several diagnostic methods in those ‘atypical’ cases where otherwise the analysis would have been negative from a first molecular approach.

Method

A 47 years old woman came to our attention with typical picture of ADPKD, arterial hypertension and chronic kidney disease CKD (3b). She had no ADPKD family history, but since she had a son, genetic testing was performed. According to our workflow, first level analysis includes Next Generation Sequencing (NGS). Second level analysis, performed to investigate other genes and large rearrangement, was based on Multiplex Ligation-dependent Probe Amplification (MLPA) analysis of PKD1 and PKD2 genes, using Salsa MLPA ProbeMix P352 PKD1PKD2 kit and ProbeMix P351 PKD1 kit ©MRC Holland.

Results

NGS did not detect the presence of any genomic variants. Therefore, second-level genetic analysis (several approaches), showed a large deletion in heterozygosis of the portion comprising the 3-33 exons of PKD1 gene in mosaic in percentage close to the resolution limits of the used technique (25-30%). The same analysis was confirmed in another laboratory.

Conclusion

We concluded that the identified large deletion, without establishing the real borders due to MLPA technical restrictions, was present as mosaicism. The variant is not reported, but due to the type of mutation and the clinical picture of the patient, it is to be considered as likely pathogenic. A stepwise genetic approach might be useful in those cases where standard methods do not allow to reach a definitive diagnosis.
#4639 AN OBSERVATIONAL STUDY OF MICRO-VASCULAR COMPLICATIONS OF POST- TRANSPLANT DIABETES MELLITUS IN RENAL TRANSPLANT RECIPIENTS
Authors: Kaul Anupma , Momin Indrajeet , Prasad Narayan , Bhaduaria Dharmendra
Published: June 2023

Background and Aims

The worldwide incidence of PTDM ranges between 2.5% and 20%. Although there is a good knowledge of PTDM pathogenesis, there is still uncertainty about its proper long-term management. DR, DKD and DSPN are microvascular complications frequently seen in type 1 and 2 DM. Few data are available regarding these complications in patients with PTDM. It remains unclear if the progression of chronic diabetic complications in transplant recipients is similar to that of patients with other types of diabetes. The study was conducted to assess micro-vascular complications in renal transplant recipients with ≥5 years duration of PTDM

Method

This is a retrospective and prospective observational study of PTDM patients conducted between November 2018 to December 2020, at a tertiary care hospital. All renal transplant recipients on follow up at the institute with ≥ 5 years duration of PTDM were included in the study. Patient characteristics and laboratory values were noted from patient files and electronic records. Fundus evaluation was done by direct ophthalmoscopy. If graft kidney biopsy was done for clinical indications, it was included in evaluation. DSPN was assessed through MNSI and 10-g Semmes-Weinstein monofilament examination.

Results

115 patients with PTDM duration ≥ 5 years were included in the study. Mean PTDM duration was 8.7 ± 3.0 years. None presented findings of diabetic retinopathy at fundus examination by direct ophthalmoscopy. 37.4% patients had DSPN which was associated with PTDM duration (p value < 0.03, 95% CI, 1.53 to 29.17). The mean eGFR was 59.2 ± 21.8 ml/min/1.73 m 2, 53.9% patients had eGFR ≥ 60 ml/min/1.73 m2. 35.7% patients had proteinuria ≤ 300 mg/day. 23 (20%) patients with PTDM duration ≥ 5 years underwent graft kidney biopsy, 4 biopsies were reported as de-novo DKD, 6 biopsies were reported as suggestive of DKD. The patients with DKD had mean PTDM duration of 143.3±52.4 months, mean eGFR 44.8 ±21.8 of and a median proteinuria of 2653 mg (IQR 2758). In secondary analysis of the 23 biopsied patients PTDM duration was associated with DKD development (p value = 0.03, 95% CI, 0.93 to 0.99).

Conclusion

The initiation of microvascular complications does not seem to be as accelerated as previously supposed. DR may not be as strongly associated with de-novo DKD in PTDM patients as seen in type 1 and type 2 diabetes mellitus. PTDM seems to be a unique type of diabetes, and its consequences may be milder than expected in type 1 and type 2 diabetes.
#4641 RISK FACTORS FOR RRT RESTART AFTER CESSATION OF CRRT: A MULTICENTER STUDY
Authors: Shin Chungjoh , Min Ji Won
Published: June 2023

Background and Aims

Acute Kidney Injury occurs frequently in patients admitted to the Intensive Care Unit (ICU) and continuous renal replacement therapy (CRRT) is a commonly used treatment modality in these patients. Restart of renal replacement therapy (RRT) after initial discontinuation of CRRT is also frequently needed. The purpose of this study is to identify clinical characteristics and biomarkers influencing the restart of RRT after the cessation of CRRT, and to build a predictive model using these parameters.

Method

This multicenter retrospective study includes 891 patients who were treated using CRRT from July 2012 to December 2020 in the ICU of 3 academic hospitals. The primary end point observed was the restart of RRT during hospitalization. Baseline characteristics were compared between the no restart and restart RRT groups. Using univariate analysis and logistic regression, a prospective index was developed, and receiver operator characteristic (ROC) curve analysis was performed to confirm the predictivity of the prognostic index.

Results

Restart of RRT was needed in 632 (71.2%) patients. Compared to patients that did not restarting, patients in the restart RRT group demonstrated higher age, higher BMI, higher baseline serum creatinine (Cr), lower urine output, longer ICU admission, and more comorbid conditions (HTN, DM, HF, ischemic heart disease). In the multivariate analysis, five parameters demonstrated independent influence on restart of RRT: HTN, Cr, ICU admission duration, BMI, and mean blood pressure. The prognostic index, which was calculated from these variables, showed a satisfactory potential to predict the restart of RRT after discontinuation of CRRT. ROC analysis revealed an area under the curve of 0.738 (95% CI, 0.703-0.773, p<0.001).

Conclusion

We found that 5 of the 40 parameters observed in our study were independent risk factors for the restart of RRT during admission and we successfully developed a prognostic index based on these variables to predict the restart of RRT after discontinuation of CRRT.
#4691 LAPAROSCOPIC NEPHRECTOMY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Sharapov Olimkhon , Abdullaev Sherzod
Published: June 2023

Background and Aims

At the present, discussions continue on the indications and timing of performing kidney nephrectomy in patients with autosomal dominant polycystic kidney (ADPK) disease who are on the waiting list for kidney transplantation. Large sizes of kidneys, traumatic access, accompanying these operations cause a high incidence of postoperative complications, mortality and aggravate the severity of patients. The aim of the presented study was to find the preferred algorithm for preparing patients for kidney transplantation.

Method

The results of the nephrectomy of polycystic kidneys were analyzed in 28 patients (mean age 49±1.5 years, 16 men, 12 women), which were conditionally divided into two groups. The first group included 13 patients (46.4%) with open surgery using median laparotomy and lumbotomy, in the second group - 15 (53.6%) - laparoscopic nephrectomy. Surgical interventions for patients in both groups receiving renal replacement therapy dialysis, performed according to emergency and planned indications.

Results

The average duration of laparoscopic and open surgical interventions was 149±14 and 132±15 min, respectively. The maximum size of deleted polycystic-altered kidneys in the first group was 21.3±4.21 cm, in the second group it was 20.5±3.3 cm. The incidence of postoperative complications in the 1st and 2nd groups was 6 cases (46.1%) and 2 cases (13.3%), respectively. There was one fatal outcome (7.69%) in the 1st group as a result of septic complications. the average postoperative bed-day in the first group was 12-13 (12.7 ± 1.1), in the second - 8-9 (8.6±0.5). Patients after laparoscopic interventions are activated on the 2nd-3rd day (2.8±0.14), after open operations - on the 4th-5th (4.43±0.32).

Conclusion

The incidence of postoperative complications after laparoscopic nephrectomy in patients with ADPK does not exceed 13.3%. The use of laparoscopic technologies makes it possible to expand the possibilities of using nephrectomy for the treatment and preparation of patients with polycystic kidney transplantation.
#4946 PREVALENCE OF CHRONIC KIDNEY DISEASE IN WOMEN OF REPRODUCTIVE AGE AND OBSERVED BIRTH RATES
Authors: Vrijlandt Willemijn , De Jong Margriet , Prins Jelmer , Bramham Kate , Vrijlandt Patrick , Janse Roemer J , Mazhar Faizan , Carrero Juan Jesus
Published: June 2023

Background and Aims

Women of reproductive age with chronic kidney disease (CKD) are recognised to have decreased fertility and a higher risk of adverse pregnancy outcomes, such as hypertensive diseases, preterm birth and longer hospital stays. How often CKD afflicts women of reproductive age and how many pregnancies are affected is not well known. This study aimed to evaluate the burden of CKD and associated birth rates in an entire region.

Method

This was a retrospective cohort study including women of childbearing age in Stockholm during 2006–2015. We estimated the prevalence of CKD by the presence of an ICD-10 diagnosis of CKD, a single estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or history of maintenance dialysis. By linkage with the Swedish Medical Birth Register we identified births during the subsequent three years from study inclusion and evaluated birth rates. For CKD prevalence, we reported overall counts and the age-averaged prevalence to adjust for the uneven age distribution in the cohort. A linear regression model was fitted to identify the increase in prevalence and 95% confidence interval (CI) per additional year in age. Birth rate was calculated per 1000 person years. All analyses were performed using R version 4.2.1.

Results

We identified 817,730 women in our region, of whom 55% had at least one creatinine measurement. A total of 3938 women were identified as having CKD, providing an age-averaged CKD prevalence of 0.50%. Women with probable CKD showed a lower birth rate 3 years after the index date (35.7 children per 1000 person years) than the remaining women free from CKD (46.5 children per 1000 person years).

Conclusion

As many as 0.50% of individuals in this cohort had CKD, defined on the basis of at least one eGFR<60 ml/min1.73 m2 test result, dialysis treatment (i.e. CKD stages 3–5) or an ICD-10 diagnosis of CKD. This prevalence is lower than previous estimates. Women with CKD had a lower birth rate than those without CKD, illustrating the challenges of this population to successfully conceive. Future research should be done to identify impeding factors.
#5189 THE ASSOCIATION BETWEEN CD86 +1057G>A POLYMORPHISM AND ACUTE KIDNEY ALLOGRAFT REJECTION AMONG EGYPTIAN PATIENTS
Authors: Elsayed Moatasem , Shokeir Ahmed , Wafa Ehab , Sobh Mohamed
Published: June 2023

Background and Aims

T-cell mediated immune response is crucial in kidney transplantation and plays an important role in allograft rejection. . CD86 is a costimulatory molecule that participates in the regulation of T-cell lymphocytes activation. Single nucleotide polymorphisms (SNPs) located in this gene have been studied with inconsistent results. The aim of the study was to examine the association between (rs1129055:G/A) polymorphism in the CD86 gene and the development of acute renal allograft rejection among Egyptian patients.

Method

In this non- concurrent cohort study, we included a group of 50 kidney transplant recipients diagnosed by acute allograft rejection (AR) (which was defined by clinical diagnosis, elevated serum creatinine >30% of basal line in the absence of other pathology including infection, urinary tract obstruction, allograft artery stenosis or calcineurin toxicity and responded to treatment by immunosuppression and was confirmed by positive biopsy that was graded according to BANFF classification) and another matched group of 50 kidney transplant recipients without AR and all of the 100 patients were genotyped by direct sequencing for CD 86 polymorphism (rs1129055:G/A) by TaqMan genotyping assay.

Results

The genotypic frequencies of CD 86 rs1129055 SNP in the acute rejection group were 72% GG, 28% AG and 0% AA while in the no rejection group it were 66% GG, 30% AG and 4% AA. The AA genotype and A allele at position +1057 in the CD86 gene were more frequent in patients without AR (4% and 23.4%, respectively) compared with those showing an AR (0% and 16.2%, respectively). The odds of acute rejection weren`t statistically significant either in dominant or recessive model (P = 0.665 and 0.475 respectively).

Conclusion

These results suggest that AA genotype and A allele of CD86 +1057G>A polymorphism may provide a nonsignificant protection against acute kidney allograft rejection among Egyptian patients.
#5384 IMPROVEMENTS IN QUALITY OF LIFE (QOL) OF HEMODIALYSIS PATIENTS AFTER THE PANDEMIA; IT IS NOT WHAT IT SEEMS TO BE
Authors: Berdud-Godoy Isabel , Hernández María Teresa , Ortego Sofia , Pérez Alicia Sobrino , Bello Abraham Rincon , Andrada Clarencio Cebrián , Shkolenko Kateryna , Samaniego Diana , Such Ramón Devesa , Salvador Maria Eva Baró
Published: June 2023

Background and Aims

Patients on hemodialysis (HD), are a clinically vulnerable population. We analyzed changes in the results of the KDQOL™-36 questionnaire carried out in 2019 vs 2021, during Covid-19 pandemic. We have related the results to demographic and analytical parameters, BCM, modality and dose of dialysis, in addition to having suffered a COVID-19 infection.

Method

This is a retrospective, observational analysis performed in 47 clinics from Fresenius Medical Care (FMC) Spain. As part of our Healthcare Quality Improvement Program, HRQoL measurements were assessed using the KDQOL™-36 questionnaire. This questionnaire evaluates Physical and Mental Composite Scores (PCS and MCS, respectively) and three disease-specific scales: Effects, Burden and Symptoms dimensions (EKD, BKD, SKD). We focused our analysis in 1000 patients who completed both surveys in 2019 and 2021 in order to analyze differences.

We compared results of both surveys by Wilcoxon test. Improvement between 2019 and 2021 was calculated for each QoL Score. We categorized patients based on QoL evolution (improvement vs worsening) and analyzed the relationship between QoL improvement and different variables by univariate and multivariate logistic regression. Non-normal variables were categorized.

Results

The results are presented in detail in the figures section.

Conclusion

Except for the PCS, there were an improvement in QoL results in 2021 vs 2019. Women presented a worse evolution in EKD, MCS and SKD scores. In our study, having COVID-19 infection did not seem to be a factor associated with changes in quality-of-life in 2021. Patients on OL-HDF presented an improvement on the SKD scale compared to those treated with conventional therapy. Higher lean tissue index was related with improvement in PCS scale. Age was related with better EKD scale evolution as CCI above 5 was related with MSC Improvement. BKD scale evolution was related with HD vintage.
#5526 COMPLEMENT C3 EXERTS DIRECT PRO-FIBROTIC EFFECTS ON KIDNEY TUBULES
Authors: Manzéger Anna , Bencs Rita , Fazekas Krisztina , Stepanova Ganna , Kokeny Gabor
Published: June 2023

Background and Aims

Renal complement expression has been observed in both experimental and human kidney diseases. We have previously reported massive tubular C3 expression in fibrotic TGF-beta1 transgenic mice (Nephrol Dial Transpl 2015, 30; S3:FP301). Still, little is known whether this intra-renal complement is only an inflammatory marker of renal fibrosis or also exerts direct pro-fibrotic effects in the pathogenesis. In the present study we aimed to investigate the effect of C3a receptor activation in murine primary tubular epithelial cells.

Method

Primary tubular epithelial cells (TEC) were isolated from kidneys of four weeks-old male C57Bl6 mouse. The cells were grown in DMEM/12 medium supplemented with 2% FBS and recombinant 5 ng/ml EGF, and characterized for epithelial and mesenchymal markers. Verified TEC between P4 and P10 passages were used for the experiments. TEC cells were seeded on 6-well plates and treated for 24 hours with PBS (CTL, n=3), 100 nM C3a receptor agonist peptide (C3aR, n=3) or 10 ng/ml recombinant TGF-beta1 (TGFb, n=3). Then, mRNA and protein expressions were assessed and evaluated using Kruskal-Wallis test (p<0.05).

Results

TGF-beta induced a 2-fold Col1a1 and 1,6-fold Tgfb1 mRNA expression, accompanied by 4-fold Egr2 but did not affect Ccl2 or C3 mRNA expression. In contrast, C3aR group depicted 1,6-fold C3 and 1,8-fold Ccl2 mRNA expression, an only 1,6-fold Egr2 but a 2-fold Col1a1 and 1,5-fold Tgfb1 mRNA expression. Despite the similar Tgfb1 mRNA overexpression in TGFb and C3aR groups, marked TGFB1 protein overexpression (15-fold) was only observed in TGF-beta treated cells but not in the C3aR group.

Conclusion

Our study data indicate that renal complement C3 production can exert autocrine / paracrine direct pro-fibrotic effects on tubular epithelial cells unrelated to TGF-beta protein levels. Therefore, local C3 overexpression might play a significant pathogenetic role in kidney fibrosis.
#5536 CIRCULATING LEVELS OF COPEPTIN, GROWTH DIFFERENTIATION FACTOR 15 (GDF15) AND INTERLEUKIN 6 (ILA-6) IN PATIENTS WITH ADVANCED KIDNEY DISEASE
Authors: Gutiérrez Paulo García , Garrote Pablo Sánchez , Varas Carmen Martin , Iglesias Pedro , Gomez Juan Jose Diez , Silvestre Mardomingo Monchi , Garcia Leonardo Calle , Gomez Astrid Rodriguez , Santos-Alonso Carlos , Luis Maria Jose Fernandez-Reyes
Published: June 2023

Background and Aims

The search for new serum biomarkers of cardiovascular risk and mortality in patients with CKD is relevant to improve the monitoring of these patients. Copeptin is a glycopeptide that is released equimolarly with arginine-vasopressin. GDF-15 is a cytokine involved in macrophage activation processes and is a marker of response to oxidative stress, and IL-6 as a marker of systemic inflammation. Objective: To study the serum levels of copeptin, GDF-15 and IL-6 in patients with advanced CKD.

Method

Cross-sectional study in 32 patients with advanced CKD. In all patients, the estimated glomerular filtration rate (eGFR) was determined by CKD-EPI, the albumin/creatinine ratio (CrAI) and the serum concentrations of copeptin (immunofluorescence, Thermo Fisher), GDF-15 (chemiluminescence, Roche Diagnostics International) and IL-6 (Siemens Healthineers). Results were compared to laboratory reference values (RVs) for copeptin (VN<4.2 pmol/L) and IL-6 (VN<4.4 pg/mL). The VR of GDF-15 (708±227 pg/ml) corresponds to own data from 10 Blood Bank donors. Results for copeptin and GDF-15 (normal distribution) are shown as mean ± SD. IL-6 results (without normal distribution) as median and interquartile range.

Results

In CKD we observed an increase in copeptin (26.9±22 pmol/l, 90% >4.2 VR) and GDF-15 (4703±2683 pg/ml p<0.0001 vs. control population). Median IL6 3.2 pg/ml (IQR: 2.7-5.1, 35% >4.4 VR). We did not find differences in the levels of copeptin, GDF-15 or IL-6 based on age, sex and presence or absence of diabetes. A significant correlation was found between GDF15 levels and eGFR (r=-0.54 p<0.002).

Conclusion

Serum levels of copeptin and GDF-15, but not IL6, are increased in CKD patients. Our data suggest a significant inverse relationship between GDF15 and eGFR. More studies are needed to know the possible role of GDF-15 on the progression of kidney damage and cardiovascular complications in patients with CKD.
#5576 SYSTEMATIC REVIEW AND META-ANALYSIS OF THE SAFETY AND EFFICACY OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS FOR THE MANAGEMENT OF POSTPARTUM PAIN
Authors: Jain Arunima , Heath Lauren , Tian David , Siritharan Sai , Natali Florensia , Jayasekara Mudith , Thurgate Lauren , Seeho Sean , Delaney Anthony , Mather Amanda
Published: June 2023

Background and Aims

Effective pain management is critical for postpartum recovery. While commonly prescribed, systematically-reviewed data regarding efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) are limited. Moreover, guidelines suggest avoiding NSAIDs in women with hypertensive disorders of pregnancy (HDP) due to risks of hypertension and adverse events (AE). However, these AE have not been consistently observed in cohort studies and randomised controlled trials (RCTs) following postpartum NSAID use. This systematic review aims to provide further insight into the postpartum safety and efficacy of NSAIDs.

Method

A systematic review of eight databases and four clinical trial registries was conducted in July 2020 (PROSPERO Protocol CRD42020196054). RCTs which assessed the safety and/or efficacy of NSAIDs in postpartum women after the year 2000 were included. The primary outcome was incidence of hypertension, with secondary outcomes categorised into three groups: hypertension, secondary safety and efficacy. Data were tabulated and analysed using R (version 4.0.2). Due to heterogeneity in study design, NSAIDs were analysed in a single group and compared with other medications (including paracetamol, opioids, and local anaesthetics) grouped based on mechanism to facilitate meta-analysis. Risk of bias was assessed using the RoB 2 tool with a plan to assess quality of evidence for the primary outcome.

Results

12,172 records were identified with the inclusion of 92 RCTs. Eight studies, with four that included women with HDP, reported hypertension-related data (Table 1). The primary outcome was included in one RCT. Secondary safety outcomes such as acute kidney injury or eclampsia were not reported. The odds of nausea, vomiting and sedation were similar between groups. NSAIDs were effective when compared with placebo, as assessed by mean differences (MD) in visual assessment scores (VAS) at 12 hours (MD -1.57, 95% confidence intervals (CI) -2.47 to -0.66), 24 hours (MD -0.82, 95% CI -1.42 to -0.22) and need for additional analgesia (odds ratio 0.17, 95% CI 0.05 to 0.61). There were no significant differences in VAS between NSAIDs and other comparators at 12 and 24 hours. Further interpretation of results is limited due to heterogeneity in intervention and comparator groups, inclusion criteria and reported outcomes.

Conclusion

Our study confirms the efficacy of NSAIDs for postpartum pain, but current data are inconclusive regarding the risk of developing hypertension. Available data do not demonstrate trends toward AE although further research is required to determine long term, clinically-relevant outcomes to guide decision making.
#5987 EPIDEMIOLOGICAL AND CLINICAL PROFILE OF PATIENTS REQUIRING EMERGENCY HEMODIALYSIS
Authors: Hatem Mhenni , Khadhar Meriam , Sarra Hadded , Jerbi Mouna , Gaied Hanene , Aoudia Raja , Goucha Rim
Published: June 2023

Background and Aims

Dialysis can be either programmed or performed in an emergency context, which complicates the management of patients. Our objective was to study the indications as well as the epidemiological, clinical and biological elements of dialysis emergencies.

Method

This is a retrospective study conducted over a period of 5 months from March 2022 to September 2022 in the nephrology department of the Mongi Slim Hospital La Marsa including patients having had emergency hemodialysis sessions

Results

We collected a total of 32 cases with an average age of 65 years, ranging from 30 years to 93 years and a sex ratio at 1.06.

The majority of patients were transferred from the emergency department (69%) and secondarily from the nephrology (6%) and cardiology (6%) departments. Sixty-five percent of the patients had arterial hypertension, 53% were diabetic, 37% had chronic kidney disease, 28% had cardiovascular complications, and 41% had an active infection with a biological inflammatory syndrome.

Emergency hemodialysis was indicated for severe metabolic acidosis in 50% of the cases, threatening hyperkalemia in 41% of the cases, uremic syndrome in 28% of cases, anuria in 28% of cases, and acute lung edema resistant to medical treatment in 19% of cases. Indeed, 47% of the patients had a single dialysis emergency and 53% of them were dialyzed for several interrelated indications.

The vascular approach was mainly femoral catheter in 84% of the cases followed by arteriovenous fistula in 13% and jugular catheter in 3%. The average session duration was 3.5 hours with good hemodynamic tolerance for the majority of patients. Five patients required a blood transfusion.

Conclusion

Severe metabolic acidosis and threatening hyperkalemia were the main indications for emergency hemodialysis. Unfortunately, the majority of our patients were dialyzed via a femoral catheter. It is therefore recommended to insist on the necessity of early preparation of patients for dialysis as early as stage 4 of chronic kidney disease if the patient obviously chooses hemodialysis as the preferred method of epuration.
#6213 RISK FACTORS FOR END-STAGE RENAL DISEASE IN IGA NEPHROPATHY
Authors: Sahar Bouassida , Khadhar Meriam , Sarra Hadded , Jerbi Mouna , Hanen Gaied , Raja Aoudia , Rym Goucha
Published: June 2023

Background and Aims

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerular nephropathy worldwide and one of the principal causes of chronic kidney disease. The presentation of this nephropathy is different between ethnic groups. The aim of our work is to describe the clinical, biological, and pathological symptoms of maghrebian patients diagnosed with IgAN.

Method

We conducted a retrospective descriptive study over 46 years from 1975 and 2021. This study included 213 patients with renal biopsy-proven IgAN whose clinical, biological, and pathological data were assessed and classified according to the Oxford classification.

Results

The mean age of the patients was 34.48 [15-80] with male predominance (sex ratio=1.77). Thirty-nine patients had a family history of kidney disease. 109 patients (51%) had hypertension. The median proteinuria was 2.6 g/24 h [0-46.17 g/24 h]. Nephrotic proteinuria(>3 g/24h) was found in 98 patients (46%). The initial median glomerular filtration rate was 33.9 ml/min/1,73 m²SC. At the end of the follow-up, it was 23.7 ml/min/1.73 m²SC. Renal biopsy was performed in all the cases. The lesions observed in optical microscopy were mesangial proliferation M1 (63.8%), endocapillary proliferation E1(8.5%), glomerulosclerosis S1 (71.4%), interstitial fibrosis or tubular atrophy T1-T2 (72.8%) and crescents C1 (16.9%). Fifty-two percent of the patients were treated with ACE inhibitors or ARAII.47.9% of our population reached end-stage kidney disease and required dialysis. Only 23 patients (10.8%) had a kidney transplant.

Conclusion

The treatment of IgA nephropathy is based on early diagnosis, hence the need for a screening strategy to prevent the discovery of this nephropathy in an advanced stage.