bluuebunny/crossref_metadata_2025 huggingface dataset:
MO474PCSK9 LEVELS AND MARKERS OF INFLAMMATION, OXIDATIVE STRESS AND ENDOTHELIAL DYSFUNCTION IN A POPULATION OF NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS: IS THERE AN ASSOCIATION?
Authors: Ntounousi Evangelia , Tellis Konstantinos , Pavlakou Paraskevi , Duni Anila , Liakopoulos Vassilios , Papagianni Aikaterini , Tselepis Alexandros
Published: May 2021

Background and Aims

Proprotein convertase subtilisin / kexin 9 (PCSK9) plays an important role in lipid metabolism while available literature regarding its involvement in the pathogenesis of atherosclerosis and in the expression of genes associated with apoptosis and inflammation is constantly increasing. Patients with chronic kidney disease (CKD) experience disproportionately increased cardiovascular morbidity and mortality due to dyslipidemia, accelerated atherosclerosis, inflammation, oxidative stress and other risk factors. In the present cross-sectional study, we investigated the possible association of serum PCSK9 levels with markers of inflammation, oxidative stress and endothelial damage in patients with CKD.

Method

Ninety-two patients with CKD stage II-ΙV (eGRF CKD-EPI 47.3 ±25.7ml/min/1,73m2, mean age 66 years, 51 men) were included. Plasma PCSK9 levels were correlated with comorbidities (arterial hypertension; diabetes mellitus, history of cardiovascular disease), renal function indices (eGFR, proteinuria – UPR/24h), lipid parameters (LDL-cholesterol, HDL-cholesterol, triglycerides, Lp (a), APO-A1, APO-B), as well as soluble biomarkers of inflammation, oxidative stress and endothelial damage (hs-CRP, fibrinogen, 8-epiPGF2a, ox-LDL, IL-6, TNF-α, sICAM-1, sVCAM-1).

Results

The mean plasma value of PCSK9 was 278.1ng/ml. PCSK9 levels showed direct correlation with serum triglycerides (p = 0.03), Lp(a) (p = 0.01), and sICAM-1 levels (p = 0.03). There was no significant correlation between PCSK9 levels and indices of renal function, other lipid profile parameters, inflammatory markers or co-morbidities. Multiple regression analysis showed a significant effect of the Lp(a) on PCSK9 levels, for each unit of higher Lp(a), an increase by 3.082 is expected (95% CI: 0.935 - 5.228, p=0.006). At the same time, patients receiving statins are expected to have on average 63.8ng/ml higher PCSK9 values compared to patients not receiving statins (95% CI: 14.6 - 113.5 p=0.012).

Conclusion

Plasma levels of PCSK9 in non-dialysis CKD patients are correlated with endothelial dysfunction and lipid metabolism parameters. Statin intake increases PCSK9 levels significantly in this patient population. PCSK9 levels are not correlated with the severity of kidney disease. Major prospective studies are necessary to investigate the role of PCSK9 in the atherosclerotic cardiovascular outcome in CKD
MO475PREDICTION OF CARDIORENAL SYNDROME BY ARTIFITIAL INTELLIGENCE
Authors: Tasic Danijela , Djordjevic Katarina , Galovic Slobodanka , Milovancevic Milos , Kocic Gordana , Radenkovic Sonja , Dimitrijevic Zorica , Jancic Nina , Vrecic Tamara , Jovanovic Andriana
Published: May 2021

Background and Aims

Potassium excretion is a secretory phenomenon and levels are often abnormal in patients with heart failure. An abnormal sodium serum level is the most common electrolyte disorder and independent predictor of readmission for heart failure and post discharge death. Since different factors could affect balance of Potassium in Cardiorenal syndrome, in this study soft computing was used to predict most important factors for the detection of the severity of systolic heart failure by ejection fraction (EF), and a subclinical phase of the cardiorenal disease by EPI creatinine-cystatin C formula (Chronic Kidney Disease Epidemiology Collaboration).

Method

The balance of potassium in Cardiorenal syndrome is analyzed by soft computing approach namely adaptive neuro fuzzy inference system or ANFIS.

Results

The clinical group consisted of 79 patients, 40 of whom were men (50.63%) and 39 of whom were women (49.37%), in the average age of 70.72 ± 9.26 years. After comparing serum electrolytes (Na+, K+) did not differ significantly in the clinical group from those of the control group. The tested biomarkers showed significantly higher values in the clinical group than in the control group: BNP (p<0.001), cystatin C (p<0.001). Figures 1 and 2 shows flowcharts of the used inputs and outputs and how they are implemented in the ANFIS networks. There are two ANFIS networks since there are two outputs. ANFIS networks shold determine which input has the strongest influence on the given outputs nased on root mean squre errors or prediciton accuracy.Based on the training error (trn) one can determine the inputs influence on the given output. Checking error (chk) is used to track the results validity. In other words the checking errors could track training error. It was found that BNP (pg/mL) has the most influence on the - EPI creatinine-cystatin C formula. Serum sodium (Na) has the most influence on the ejection fraction (EF).

Conclusion

Serum sodium-potassium disturbances are associated with advanced heart failure and reduced prognosis. ANFIS is suitable for nonlinear systems with highly redundant data. Although there are encouraging advances around this unsolved clinical problem, further investigation should consider the progressive inclusion of patients with advanced renal impairment to allow a better understanding of cardiorenal syndrome. The result of our research shows that if the values of BNP and Na significantly deviate from normal values, it is expected that EPI creatinine-cystatin C formula and EF indicate impaired organ function and that such patients are candidates for hospital treatment.
MO442ACUTE ADVERSE EFFECTS OF LOW POTASSIUM ON HEART AND KIDNEY*
Authors: Saritas Turgay , Chen Lu , Babler Anne , Rix Anne , Reimer Katharina C , Jansen Jitske , Su Xiao-Tong , Kerker Andrew S , Cuevas Catherina A , Menzel Sylvie , Kuppe Christoph , Boor Peter , Falke Lucas , Bleilevens Christian , McCormick James , Floege Jürgen , Ellison David H , Kramann Rafael
Published: May 2021

Background and Aims

Chronic hypokalemia causes kidney fibrosis with cystic lesions and arterial hypertension. In contrast, potassium-rich diet lowers blood pressure. The acute effects of hypo- and hyperkalemia on heart and kidney are not well understood.

Method

Wild-type mice were fed with low (LK), normal (NK) and high (HK) potassium diet for 4 and 20 days. Kidneys were examined for site of acute injury, inflammation and fibrosis. Blood analysis of electrolytes and kidney parameters were analyzed. Echocardiography and ECG were used to assess heart function. Further, KCNJ10 knockout mice were used to investigate kidney damage in a genetically induced hypokalemia model.

Results

Proximal tubule injury as detected by KIM-1+ staining and yH2AX+ DNA-damage was observed after 4 and 20 days of LK diet. Injury was associated with strong Ki-67+ proliferation of proximal tubule cells. No injury was detected in mice on NK and HK diet. After 20 days of LK diet, F4/80+ inflammation and aSMA+ extracellular matrix accumulation, typical for fibrosis, were observed. LK mice developed polyurie, volume depletion, loss of body weight and high BUN. Lower cardiac output and signs of myocardial stress was seen in echocardiography and ECG. Consistent with WT mice on LK diet, KCNJ10 knockout mice developed same pattern of kidney injury. Nine months after deletion of KCNJ10, cysts were observed in the proximal tubule in outer medzulla.

Conclusion

Acute hypokalemia causes kidney injury and myocardial stress. Cystic lesions originate from late proximal tubule. Hypokalemia should be corrected rapidly to stop progression into kidney fibrosis.
MO480FGF-23 AND LOW BIRTH WEIGHT: IS THERE ANY ASSOCIATION?
Authors: Balmukhanova Altynay , Kabulbayev Kairat , Batyrbayeva Dinara , Shepetov Abay
Published: May 2021

Background and Aims

According to Barker’s theory and Brenner’s hypothesis, persons were born with low birth weight (LBW) have a higher risk of CKD due to low nephron number. Also, it is well known that mineral-bone disorder (MBD) is one of the most serious complications of CKD. Views on the pathogenesis of CKD-MBD have changed considerably since Fibroblast growth factor 23 (FGF-23) was discovered. It is thought that FGF-23 increases as the nephron mass reduces. Therefore, we aimed to determine if there is an association between LBW and FGF-23.

Method

We conducted a cross-sectional study on 56 children with CKD stages 1-4. There were approximately equal numbers of participants in each stage. The mean age was 8.9 ±4.9 years old. We measured the concentration of FGF-23 (C-terminal) in serum by a sandwich enzyme-linked immunosorbent assay (ELISA) kit (Biomedica Medizinprodukte GmbH, Austria). The exclusion criteria: tubulopathy, active inflammatory, infectious, oncological and bone diseases, renal transplant, as well as taking steroids, calcium, and vitamin D. The informed consent was obtained from the parents. The study was conducted in accordance with the Declaration of Helsinki and approved by the Local Ethical Committee. FGF-23 concentration more than 1.5 pmol/l was considered as abnormal. Statistical analysis was performed using GraphPad Prism 9.0.0 (San Diego, USA)

Results

Mineral-bone disorder was diagnosed as CKD complication in 20 (35.7%) children. LBW was revealed in 14 (25%) patients. The median (IQR) eGFR among patients with normal birth weight was 65.23 (31.23-84.73) ml/min/1.73m2, among LBW – 68.93 (24.59-98.9) ml/min/1.73m2, so there were no differences in kidney function between the two groups (p=0.64). The median (IQR) level of serum FGF-23 in patients with normal birth weight was 1.75 (0.68- 2.5) pmol/l, in LBW children was 1.85 (0.78 -3.1) pmol/l. Analysis of serum level of FGF-23 in relation to weight at birth revealed no statistical differences in patients with LBW and those with normal birth weight (p=0.719), and the Spearman rank correlation was insignificant as well (r=-0.08, p=0.560).

Conclusion

FGF-23 is an important biomarker of CKD-MBD. FGF-23 does not depend on the birth weight although LBW is considered as a risk factor for CKD. However, further investigations and studies in this area are needed to make the right conclusions regarding the association between this bone biomarker and birth weight.
MO611CARDIOPULMONARY RESERVE EXAMINED WITH CARDIOPULMONARY EXERCISE TESTING IN INDIVIDUALS WITH AND WITHOUT CHRONIC KIDNEY DISEASE; A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Pella Eva , Theodorakopoulou Marieta , Boutou Afroditi , Alexandrou Maria Eleni , Bakaloudi Dimitra , Boulmpou Aristi , Papadopoulos Christodoulos , Papagianni Aikaterini , Sarafidis Pantelis
Published: May 2021

Background and Aims

Patients with chronic kidney disease (CKD) often present with reduced physical activity and exercise performance due to a number of factors relevant to co-existing disturbances of the cardiac, nervous and muscular systems. Cardiopulmonary exercise testing (CPET) is widely applied in daily clinical practice used for clinical evaluation of exercise intolerance and related symptoms (i.e. dyspnea, fatigue), as well risk stratification, and other applications in several medical fields.

Method

This is a systematic review and meta-analysis of studies which used CPET technology in adult patients with CKD to examine cardiopulmonary reserve in individuals with versus individuals without CKD. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases; manual search of article references and of grey literature was also performed. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies.

Results

From an initial 4944 literature records, we identified 29 studies fulfilling the inclusion criteria; of these, 25 studies with complete data including 2213 participants were included in final meta-analysis. Peak oxygen uptake (VO2peak) was significantly lower in CKD patients compared to controls without CKD (standardized-mean-difference, SMD:-1.40, 95%CI[-1.68, -1.13]) (Figure). Oxygen consumption at anaerobic threshold (VO2AT) (SMD:-1.06, 95%CI[-1.34, -0.79]), maximum workload (weighted-mean-difference, WMD:-58.26, 95%CI[-74.14, -42.38]) and respiratory exchange ratio (RER) (WMD:-0.02, 95%CI[-0.05, 0.01]) were also impaired in CKD patients compared to non-CKD individuals. In 3 studies comparing patients with CKD versus patients with heart failure without CKD VO2peak was higher in the former (WMD:6.60, 95%CI[3.02, 10.18]). Sensitivity analyses confirmed the robustness of these findings.

Conclusion

VO2peak and other commonly analyzed CPET variables were lower in CKD patients compared to controls, indicating reduced functional cardiopulmonary reserve in the former. In contrast, CKD patients performed better when compared patients with heart failure.
MO619GOODRENAL: HOLISTIC PATIENT CARE INTRADIALYSIS PROGRAM IN HEMODIALYSIS THROUGH A VIRTUAL HEALTH PLATFORM
Authors: Segura-Ortí Eva , Clyne Naomi , Garcia-Testal Alicia , Kouidi Evangelia , Van Craenenbroeck Amaryllis , Avesani Carla , Mesa-Gresa Patricia , Lozano-Quilis José Antonio , Lindholm Bengt , Moscoso Paula , Reboredo Maycon Moura , Lauer Andreas
Published: May 2021

Background and Aims

There is wide evidence that weak points of the care of end-stage Chronic kidney disease (CKD) patients in hemodialysis include three aspects that are suitable for intervention: exercise, nutrition and psychological support. Evidence shows that exercise for patients on hemodialysis results in increased functional capacity and strength and improved health-related quality of life and survival. Additionally, earlier studies have shown the benefits of psychological interventions and the positive effect of educational programs on nutritional status for patients on hemodialysis. Despite the well-known benefits of exercise, these programs are not being implemented in the routine clinical care of hemodialysis patients. Thus, the GoodRENal project aims to promote a healthy lifestyle among hemodialysis patients using a holistic pedagogical approach that, addressing adult learners, combines exercise, nutrition and psychological well-being as well as cognitive functioning.

Method

GoodRENal is a project funded by the European Community, Erasmus + program (336.327 euros). The project will last 3 years, from September 2020 to August 2023 and the Partners of the consortium include institutions from five European countries: Spain (Universidad CEU Cardenal Herrera, Hospital de Manises, Univesitat de Valéncia, Universitat Politécnica de Valéncia), Sweden (Skane University Hospital and Karolinska Institutet), Greece (Aristotles University of Thessaloniki) and Belgium (Katholieke Universiteit Leuven). Other supporting institutions are located in the UK, Chile and Brazil.

Results

The project will develop a virtual platform comprising three aspects of care: physical activity/exercise, nutrition, psychological well-being/cognition. In summary, the project outputs will be: 1. A didactic content on a modular platform with an educational program for integrated treatment in patients on hemodialysis; 2. A guideline to promote a healthy lifestyle among patients on hemodialysis for healthcare providers; 3. A guideline to promote a healthy lifestyle among patients on hemodialysis for patients, and their formal- and non-formal carers. At the present stage exploratory questionnaires regarding physical activity/exercise-nutrition-psychological well-being/cognition have been developed in consensus with all the partners. Data from this first exploratory study regarding needs and barriers of the stakeholders (patients, health professionals, carers) will be presented at the ERA-EDTA congress.

Conclusion

GoodRENal aims at improving the overall health, and thus the health-related quality of life, of patients on hemodialysis through a holistic and pedagogical approach that will target especially improvements of patient reported outcomes including quality of life.
MO225CMV ENCEPHALITIS IN A SLE FLARE
Authors: Marouço Catarina , Carvalho Dulce , Ribeiro Francisco , Magriço Rita , Nolasco Fernando
Published: May 2021

Background and Aims

Cytomegalovirus (CMV) infection is an opportunistic pathogen in immunocompromised patients and its management is well described after solid organ/bone marrow transplant or in HIV patients. Although less common, since Systemic Lupus Erythemathous (SLE) is a chronic auto immune disease often requiring intense immunosuppression to induce remission of disease exacerbation, SLE patients are also prone to it. Besides complicating the course of the disease, it may be a life-threatening infection. Due to the heterogeneity of SLE manifestations, usually is difficult to distinguish between a SLE flare and CMV active infection, making the diagnose challenging. It has also been described in the literature as an exacerbating SLE factor.

We report the case of an Asian, 27-year-old woman, with a recent SLE diagnosis that was admitted with a SLE flare while developing a CMV encephalitis. She was previously admitted due to a nephrotic syndrome. Immunological studies revealed an ANA title of 1:640 and a positive anti dsDNA Ab with diminished C3 and C4 levels, nephrotic range proteinuria and a diagnose of SLE was made. Renal biopsy revealed class IV lupus nephritis. She started high dose intravenous methylprednisolone (3 pulses of 500mg) and mycophenolate mofetil (MMF) at a dose of 2g per day. She was discharged taking 60 mg of oral prednisolone and the same dose of MMF. Two weeks after being discharged, she was readmitted due to worsening anaemia (Hb 6.8 g/dL), thrombocytopenia (Pl 27 000/µL) and deteriorating renal function with a sCr of 5.5 mg/dL with de novo haematuria. It was admitted a severe SLE flare and she was given another 3 pulses of 500mg I.V methylprednisolone and cyclophosphamide (CYC) was started (1 pulse of 500mg I.V). At the same time, she started to complain of myalgias and malaise, generalized hypotonia, developed fever, leukopenia with neutropenia and seizures. Serum CMV viremia was 71 000 copies and CMV polymerase chain reaction was positive in cerebrospinal fluid. She was started on I.V Ganciclovir, CYC was suspended and clinical improvement was observed.

Conclusion

Studies about the risk of different treatment drugs and other risk factors on the development of CMV disease in SLE are lacking. These studies will be useful for establishing guidelines on the institution of prophylaxis or pre-emptive treatment of CMV infection in SLE patients. Protocols for screening and prevention in this population should be implemented to account for this emerging problem. Given the rising prevalence of CMV infection in the past few years, the authors recommend that patients recently diagnosed with SLE while taking high doses of corticosteroids, which appears to be a risk factor for CMV reactivation, should be routinely tested for CMV viremia.

There should be a low threshold for suspicion, hence treatment should be started as soon as possible given the high morbidity and mortality in severe cases.
MO226A NEW DIAGNOSTIC TOOL FOR CKD PATIENTS: CONTRAST-ENHANCED ULTRASONOGRAPHY. A SINGLE CENTER EXPERIENCE
Authors: Gliga Mirela Liana , Chirila Cristian , Chirila Paula , Gomotarceanu Adriana , Torok Imola , Gliga Mihail Gheorghe
Published: May 2021

Background and Aims

Contrast-enhanced ultrasonography (CEUS) is a minimally invasive diagnostic tool available for diagnosing microvascular disturbances in tumors and many vascular pathologies. Unlike other radiological contrast agents, it is completely harmless for CKD patients and therefore it is used for the safe diagnosis of many diffuse or focal pathologies.

Method

We used CEUS examination in 50 CKD patients for the following pathologies: 10 atypical cysts, 15 liver focal lesions, 2 splenic focal lesions, 3 renal infarcts, 12 kidney focal lesions and 8 other organ involvements.

Examination was made using a VOLUSON E8 machine (GE Medical System Kreztechnik GmbH Tiefenbach 15, Austria) with a 3.5 MHz convex array abdominal transducer. 2.4 ml of microbubble contrast-agent was administered intravenously and recording of the results were made for 3-5 minutes after injection.

Results

Depending on the organ vascular characteristics, contrast enhancement and/or wash-out were suggestive for the final diagnosis. In liver lesions there are three phases and in kidneys, spleen, gallbladder, adenopathies there are two vascular phases. We obtained a very good positive predictive value and sensitivity in detecting malignant lesions.

Conclusion

According to The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound they are used both for hepatic and Non-Hepatic Applications. Being non-invasive and non-irradiating it could be the main diagnostic examination in CKD population in the future.
MO227RELATIONSHIP BETWEEN KIDNEY DAMAGE AND COGNITIVE FUNCTIONS IN PATIENTS WITH GLOMERULOPATHIES
Authors: Borriello Gianmarco , Viggiano Davide , Capasso Giovambattista
Published: May 2021

Background and Aims

Mild Cognitive Impairment (MCI) has been found to be highly prevalent amongst patients with Chronic Kidney Disease (CKD). In this cohort, the prevalence of MCI was estimated to be between 30% and 63%. Mild cognitive impairment is an intermediate state between normal aging and dementia. An individual suffering from MCI has difficulty in remembering, sustaining attention, or decision making which can negatively affect their daily lives.

The aim of this study was to verify the role of different glomerular diseases diagnosed by kidney biopsy on the MCI through a retrospective study.

Method

We recruited 45 patients with bioptic diagnosis of the following glomerular diseases: Focal Segmental Glomerulo Sclerosis (FSGS), minimal change disease (MCD), membranous glomerular disease (MG), IgA nephropathy. The renal function was analyzed using clinical variables, while Cognitive functions using the MoCA test. Patients were divided into two groups based on 24h proteinuria.

Results

The MoCA score was directly correlated to the uric acid levels (R=0.13; p=0.03). The MoCa score in the group with higher proteinuria levels was significantly lower than those of the group with lower proteinuria levels (p = 0.03). Finally, the MoCA score in subjects with FSGS or MCD is significantly higher compared the other groups (p<0.05).

Conclusion

Our data suggest that serum uric acid and proteinuria in glomerular diseases influence cognitive functions. Interestingly, uric acid plays a neuroprotective role, as low levels of uric acid reduce the MoCA score. This result agrees with previous observations of a protective role of uric acid on dopamine neurons. Conversely, the extent proteinuria seems to negatively affect cognitive functions, suggesting a role of the endothelial dysfunction. Finally, glomerulopathies with a lower degree of inflammation (FSGS, MCD) have minor impact on cognitive functions.
MO229PROFILE OF TUBERCULOSIS AND ITS MANAGEMENT IN CHRONIC KIDNEY DISEASE
Authors: Datta Divya , Prabhu Ravindra Attur , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Nagaraju Shankar Prasad , Bhojaraja Mohan V , Khader Nisha Abdul
Published: May 2021

Background and Aims

Estimates of Tuberculosis(TB) burden indicate an estimated incidence and mortality of 199 and 32 respectively per 100000 in our country. Risk factors for acquiring TB disease include HIV infection, Diabetes Mellitus, Tobacco consumption and undernutrition. We retrospectively studied profile of TB in Chronic Kidney disease(CKD) in our population.

Method

Retrospective case record based study of consecutive TB patients visiting a Tertiary care hospital attached to a Medical College diagnosed by standard methods to demonstrate TB bacilli in sputum or affected tissue. CKD was diagnosed based on estimated Glomerular filtration rate less than 60 ml/min/m2 for at least three months. Pattern of TB and adverse drug effects were studied. Statistical analysis was done on SPSS version 20

Results

Over ten months, of 746 TB patients seen, 41(5.4%) had CKD, Stage 3b,4 and 5 in 7/41(17.1%), 11(26.8%), 23(56.1%) respectively. Among CKD 24(58.5%) had Diabetes Mellitus, 1(2.4%) HIV and 37(90.2%) hypertension. Pattern of TB is shown in table 1. Adverse drug reactions were significantly higher in CKD 24/41(54.5% vs 17% in non CKD, P < 0.05). Mortality in CKD was 3/41(7.3%) and not significantly higher on multivariable analysis than in those without CKD.

Conclusion

In this retrospective survey of TB patients CKD constituted 5.4%, was associated with more adverse drug reactions but did not impact on mortality. Pulmonary TB was the common pattern in CKD.
MO233RENAL ARTERY STENOSIS: DO NOT FORGET INHERITED THROMBOPHILIA
Authors: Omrane Marwa , Ben Ariba Yosra , Ouertani Imen , Labidi Jannet
Published: May 2021

Background and Aims

Inherited thrombophilia can be defined as a genetically determined predisposition to develop thromboembolic complications. Inherited prothrombotic risk factors include antithrombin deficiency, protein C and protein S deficiencies, activated protein C resistance due to Leiden factor V mutation, inherited hyperhomocysteinemia, prothrombin G20210A variant, dysfibrinogenemia and elevated factor VIII levels.

Method

We report the case of a patient with history of bilateral renal artery stenosis who presented with renal artery bypass thrombosis related to an inherited thrombophilia.

Results

We report a case of 40-year-old male patient who presented with extremely high blood pressure and hypokalemia without other biological abnormalities. The duplex ultrasound showed bilateral renal stenosis with chronic occlusion of the right renal artery and a tight stenosis of the left renal artery estimated at 50%. Renal angiography confirmed the bilateral stenosis, associated to a small right kidney. Renal scintigraphy with DMSA showed normal left renal function and right renal function estimated at 2%. The therapeutic decision was to perform an aorto-renal bypass surgery by the saphenous vein.After renal artery bypass the blood pressure improved markedly, maintaining this result at 12 months follow-up at clinical examination and duplex ultrasound. One year later, the patient presented with high blood pressure. The duplex ultrasound showed a stenosis of the bypass with a double stenosis of the left aorto renal bypass on renal angioscanner. The patient underwent angioplasty of the venous bridge with implantation of 2 stents with improvement of blood pressure after angioplasty. Six months later, the patient presented an unbalanced blood pressure, the ultrasound control with a vascular Doppler showed a stenosis at the stent. The antihypertensive treatment was increased, a thrombophilia balance was requested concluding a combined protein C and protein S deficiency.

Conclusion

An etiological assessment should be carried out systematically in the event of thrombosis occurring before the age of 40 or in the case of iterative venous or arterial thrombosis. A genetic study where appropriate and a family screening are then recommended.
MO239ORAL FUNGAL INFECTION IN ESRD PATIENTS
Authors: Nedunchezhiyan MohanKumar , Anjum Afza , Shenoy Nandita , Nayak Rohith
Published: May 2021

Background and Aims

Chronic Kidney Disease is an increasing health alarm worldwide with systemic signs like hematologic changes, bone metabolic error, and compromised immune status presenting to a dental practitioner with oral complications. Hence a study was done to assess the oral health condition, cytological changes, and presence or absence of candida in patients with chronic renal disease undergoing dialysis aged between 30 to 65 years and controls in South India.

Method

A cross sectional study was conducted among 80 adults with CKD and controls, attending KMC and MCODS, Mangalore. Oral manifestations and oral hygiene were assessed; Cytological smears were taken for morphometric analysis of buccal mucosal cells from the subjects. Oral smears were cultured to check for the growth of fungal species in subjects and controls. Statistical analysis was done using SPSS Version 13. Chi square test was used to compare categorical variables between the groups.

Results

There was a significant difference in oral hygiene status and cytological changes in patients with CKD. Oral Fungal Infection was found in 32% of our patients on dialysis and oral lesions, defined as clinical signs associated with OFI such as erythematous oral stomatitis, membranous candidiasis, or angular cheilitis, were found in 37% of the patients with OFI, while 5% of the patients without findings of fungal infection presented oral lesions associated with OFI (p=0.0002). Furthermore, patients with self-reported mouth dryness were three times more likely (p=0.02) to be diagnosed with OFI.

Conclusion

Hemodialysis patients are found to have significantly more OFI than controls. Oral dryness and dental plaque formation also seem to be at risk of developing OFI. Detection of oral lesions associated with OFI should be combined with a histopathological diagnosis before antifungal treatment. The prevalence of oral candida in these cases is alarming and can be a predictor of a poor prognostic index. As medicine advances, oral health care professionals should have a holistic approach to the management of patients with complex medical problems especially to diseases of the renal system as it is pivotal in maintaining a stable internal environment and homeostasis.
MO134COVID-19-ASSOCIATED KIDNEY INJURY IS CHARACTERIZED BY ACUTE TUBULAR NECROSIS AND CAPILLARY CONGESTION WITH EVIDENCE FOR SARS-COV-2 IN THE NEPHRON
Authors: Bouquegneau Antoine , Erpicum Pauline , Grosch Stéphanie , Habran Lionel , Hougrand Olivier , Huart Justine , Krzesinski Jean-Marie , Misset Benoit , Hayette Marie-Pierre , Delvenne Philippe , Bovy Christophe , Kylies Dominik , Huber Tobias B , Puelles Victor , Delanaye Pierre , Jouret François
Published: May 2021

Background and Aims

Kidney damage has been reported in COVID-19 patients. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial.

Method

We consecutively performed 16 immediate (≤3h) post-mortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from 5 patients who died from sepsis and were free from COVID-19 were used as controls. Samples were methodically evaluated by 3 pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (nCoV2019 N-Protein), fluorescent in situ hybridization (nCoV2019-S) and electron microscopy.

Results

The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were males (68.7%). Proteinuria was observed in 53.3% of cases, while acute kidney injury occurred in 60% of cases. Acute tubular necrosis of variable severity was found in all cases, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus control samples. Congestion in glomerular and peri-tubular capillaries was respectively observed in 56.3 and 87.5% of patients with COVID-19 compared to 20% of controls, with no evidence of thrombi. The nCoV2019 N-Protein was detected in proximal tubules and also at the basolateral pole of scattered cells of the distal tubules in 9/16 cases. In situ hybridization confirmed these findings. RT-PCR of kidney total RNA detected SARS-CoV-2 N gene in one case. Electron microscopy did not show typical viral inclusions.

Conclusion

Our immediate post-mortem kidney samples from patients with COVID-19 highlight a congestive pattern of acute kidney injury, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest that SARS-CoV-2 is present in various segments of the nephron.
MO242RECTAL ADENOCARCINOMA IN TUBEROUS SCLEROSIS: A CASE REPORT
Authors: Omrane Marwa , Babchia Amel , Jaballah Raja , Mahersia Afef , Saidane Olfa
Published: May 2021

Background and Aims

Tuberous sclerosis (TS) is an autosomal dominant genetic disorder that is characterized by a neurocutaneous syndrome. Usually, the disease is diagnosed in childhood but there are frustrates form of tuberous sclerosis with or without genetic mutation.

Method

This clinical case is about a women with tuberous sclerosis on hemodialysis who is diagnosed a colonic polyposis and a rectal adenocarcinoma.

Results

We report the case of a 64-year-old patient with no particular family history, followed for renal failure discovered at the end stage with TS. She was treated with intermittent hemodialysis. During his follow-up, she presented melena stools and she reported lightheadedness when standing. Physical examination revealed conjunctival pallor. The patient’s heart rate was normal; her blood pressure was 120/80 mmHg supine and 120/70 mmHg standing. There was no distention or peritoneal irritation. The hemoglobin level was 78 g/L; three weeks previously, it had been stable at 106 g/L. The platelet count, prothrombin time and partial thromboplastin time were all normal. The patient was admitted to hospital. Two units of packed red blood cells were transfused. Gastroscopy was performed and it was normal. Colonoscopy revealed a fixed, circumferential rectal tumor at 6 cm and multiple colorectal polypes. Rectal biopsy confirmed a moderate to poorly differentiated adenocarcinoma of large bowel type. Computed tomography scan showed no metastases. She was operated and actually she is receiving chemotherapy cures.

Conclusion

In the literature, there is a case of invasive rectal adenocarcinoma in a 17-year-old girl with TS. We do not yet have enough data on the other types of polyps encountered. In the two small series described, the prevalence of colonic polyps is high unlike cancer which could be an isolated event. In view of all these data, it seems judicious to us to carry out a national register of patients with TS and to specify the prevalence of digestive disorders in order to organize a systematic screening if it is high, in the same way as the familial polyposis as well as to confirm or refute the hypothesis of the link between polyposis of TS and colorectal cancer.
MO137DIFFERENCES IN GUT MICROBIOTA PROFILES AND FUNCTIONS BETWEEN END-STAGE KIDNEY DISEASE AND HEALTHY POPULATIONS
Authors: Wu Ping-Hsun , Lin Ting-Yun , Ho Hsiu J , Tseng Ching-Hung , Lin Yi-Ting , Liang Shih-Shin , Lee Hei-Hwa , Kuo Mei-Chuan , Hung Szu-Chun , Chiu Yi-Wen , Wu Chun-Ying
Published: May 2021

Background and Aims

Patients with end-stage kidney disease (ESKD) are characterized by altered gut microbiota, impaired intestinal barrier function, and experienced gut microbiota-derived metabolites related to systemic complications. However, limited studies evaluated the microbial diversity and function in ESKD patients previously.

Method

Compared to age- and gender-matched subjects without kidney disease, 82 ESKD patients in the discovery cohort and 58 ESKD patients in the validation cohort were investigated for the microbial richness, biodiversity, gut dysbiosis, microbial composition differences, and the functional changes by gut metabolic module analysis. Bacterial derived free form protein-bound uremic toxins were analyzed by mass spectrometry and their association with microbial richness in ESKD patients was determined.

Results

Compared to controls, an increased α-diversity and distinct β-diversity were found in ESKD (Figure). The increase in α-diversity was correlated with protein-bound uremic toxins, particularly hippuric acid. A higher microbial dysbiosis index (MDI) was found in ESKD patients with the following enriched genera: Facealibacterium, Ruminococcus, Fusobacterium, Dorea, Anaerovorax, Sarcina, Akkermansia, Streptococcus, and Dysgonomonas. MDI at the genus level successfully differentiated between ESKD and controls in the discovery cohort (area under the curve [AUC] of 81.9%) and the validation cohort (AUC of 83.2%). Regarding functional enrichment analysis with gut metabolic modules, ESKD subjects presented with gut microbial function of increased saccharide and amino acid metabolism compared with matched controls.

Conclusion

An enriched but dysbiotic gut microbiota was presented in ESKD patients, in which the bacteria that were present increase amino acid metabolism linked to the production of protein-bound uremic toxins.
MO138ASSOCIATION OF NT-PROBNP WITH OBESITY IN CKD PATIENTS
Authors: Lin Ting-Yun , Hung Szu-Chun
Published: May 2021

Background and Aims

Obesity is associated with lower circulating levels of N-terminal pro-BNP (NT-proBNP) both in the general population and in patients with heart failure. In asymptomatic patients with CKD, NT-proBNP levels are generally elevated. The prevalence of obesity is markedly increasing among patients with CKD. However, whether obesity affects NT-proBNP levels and thresholds for increased risk of clinical outcomes is unclear.

Method

We examined the associations between NT-proBNP and obesity in 408 stage 3–5 CKD patients (268 men and 140 women; mean age 65±13 years) free of heart failure at baseline, who were categorized into 3 groups according to body mass index (BMI; kg/m2) as normal (<24.0), overweight (24.0–27.9), and obese (≥28.0). Multivariate Cox proportional hazards models were used to compare the risk associations of NT-proBNP with the composite of ESKD (needing chronic dialysis or kidney transplantation) or all-cause mortality across BMI categories.

Results

NT-proBNP levels were significantly lower in obese patients than in normal weight and overweight subjects (P <0.001). Within each CKD stage, NT-proBNP levels decreased with increasing BMI. In a multivariate analysis, NT-proBNP was inversely associated with obesity, as well as BMI and its fat and lean body mass components (all P <0.001), independent of demographics, comorbidities, and severity of CKD. During a median follow-up of 2.2 years, 117 patients progressed to ESKD and 46 patients died. Overall, higher NT-proBNP levels were independently associated with ESKD or death (HR, 1.52; 95% CI, 1.22–1.89). Specifically, higher NT-proBNP levels were consistently associated with poor outcomes in all BMI categories (P for interaction = 0.096).

Conclusion

Obese CKD patients have significantly lower NT-proBNP levels. Nevertheless, BMI category did not modify the relationship between NT-proBNP and clinical outcomes. Increased risk may be seen at relatively lower levels of NT-proBNP in obese CKD patients.
MO140INDOXYL SULFATE INDUCES THE APOPTOSIS OF THE DIFFERENTIATING NEURONS BY ENHANCING OXIDATIVE STRESS AND CLINICAL COGNITIVE IMPAIRMENT
Authors: Hou Yi-Chou , Lu Kuo-Cheng , Huang Chuen-Lin , Lin Yuh-Feng , Chen Ruei-Ming
Published: May 2021

Background and Aims

Indoxyl sulfate (IS) is a protein-bounded uremic toxin involving the multi-organ dysfunction, including neurologic system. It has been noticed that IS could induce the oxidative stress within brain by activating the inflammation mediated by astrocyte, and its concentration was associated with cognitive impairment. It has been noticed that the neuronal progenitor cells with differentiating abilities could replace the damaged neuron. The damage of IS on the progenitor cells with differentiating ability is still lacking. The aim of the study is to investigate the IS mediated cell damage on differentiating neuronal progenitor cells

Method

The study was divided into 2 parts: clinical investigation and in vitro study. The clinical investigation collected 36 participants (12 health controls and 24 ESRD patients with cognitive impairment by MMSE<=24). The in vitro study used the human neuroblastoma cell line SH-SY5Y cells with differentiating protocol by retinoic acid (RA, with concentration 10%). Indoxyl sulfate was given at concentration at 0, 25, 50 and 100μM at initiation of retinoic acid given and the 7 days after retinoic acid was given. Microscopic morphology, MTT assay, annexin V-PI dual stain, and western blotting for cleaved-caspase 3, Bax, Bcl-2 and oxidative stress (DCFCA) were measured.

Results

Among the 36 participants, the concentration of IS was higher in the ESRD patients with cognitive impairment (43365.26±24291.55 vs 5212.00±14621.82 mg/dL, p=0.00). The serum concentration of IS was negatively correlated with the total MMSE score (r=-0.446, p=0.006) and the categories of MMSE (orientation to time: r=-0.537, p=0.001, calculation: r=-0.541, p=0.001; recall: r=-0.402,p=0.014). In in vitro study, the cell viability was not influenced in undifferentiated and differentiated (retinoic acid treated for 7 days) SH-SY5Y cells. When IS during the initiation of RA treatment, the cell viability decreased 3 hours after IS was given. The annexin-V-PI dual stain demonstrated that the early apoptotic cells with annexin-V stained increased in IS treated cell with dose-dependent manner. The caspase 8 and cleaved caspase 3 increased at 6 hours after IS treated when RA given. The Bax increased after IS treated at 6 hours. The Bax/Bcl2 ratio increased at the IS concentration 50μM. The DCFCA increased after IS treated at 1 hour with dose-dependent manner, and the cell viability was rescued by N-acetylcystein.

Conclusion

The serum IS was negatively correlated the MMSE and predictive to cognitive impairment in our cohort with 36 participants (12 health control and 24 ESRD patients with MMSE <=24). The in vitro study demonstrated that IS induced differentiating SH-SY5Y cells apoptosis by activating caspase-dependent cell death after generating oxidative stress.
MO142A SINGLE-CENTER CASE SERIES OF 150 PATIENTS WITH RENAL FANCONI SYNDROME
Authors: Shi Xiaoxiao , Wang Ying , Li Jiaying , Chen Zhixin , Ma Tiantian , Wen Yubing , Ye Wei , Qin Yan , Li Xuemei , Yu Yang , Chen Limeng
Published: May 2021

Background and Aims

Renal Fanconi syndrome (RFS) is characterized by generalized dysfunctions of renal proximal tubular (PT) transport. The causes of FS can be inherited or acquired, the latter of which mostly includes drugs, heavy metals, monoclonal light chains (LC), and primary Sj gren’s syndrome (pSS). We intended to observe the clinico-pathological features of RFS with different etiologies.

Method

From January 2012 to September 2018, all the patients diagnosed as RFS in our hospital were enrolled. Their clinicopathological records were retrospectively reviewed. The diagnosis of RFS was defined as existence of ≥ 3 of the following five items alone or ≥ 2 items combined with an evidence of PT damages in kidney pathology: (I) normoglycemic glycosuria; (II) generalized aminoaciduria; (III) hypophosphatemia and hyperphosphaturia; (IV) hypouricemia and hyperuricosuria; (V) proximal RTA.

Results: 1.

Clinical characteristics

We identified 150 RFS patients, with an average age of (45.9±14.2) years old and male: female ratio 1.3:1. They presented with different degrees of PT dysfunctions and the most common were hypophosphatemia (83.2%) and aminoaciduria (80.6%). Their mean eGFR levels were 76.3 (4.5-188.6) ml/min/1.73m2 with 73.5% had proteinuria.

2. Renal pathological features

47 RFS patients received kidney biopsy and the most common pathological diagnosis was interstitial nephritis. They all presented with different degrees of proximal tubule atrophy, defective brush border, interstitial edema and fibrosis.

3. Etiology-related clinicopathologic features

The most common causes of our RFS were LC (14.0%), drugs (13.3%), and pSS (9.3%). Compared to pSS associated RFS, LC associated RFS patients showed a higher prevalence of bone involvement, more severe proteinuria and less severe hypokalemia (P < 0.05) despite similar eGFR levels. Specific renal pathological features were seen in different etiology groups, including crystalline formation and increased lysosomes in PT cells under electron microscope in LC associated RFS, and CD21 positive ectopic germinal center formation in renal interstitum in parts of the pSS associated RFS.

Conclusion

We identified 150 RFS with different etiologies and they showed etiology-specific patterns of PT dysfunctions and renal pathologic changes.
MO144OVERLAP SYNDROME OF ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS AND IGG4-RELATED DISEASE: DISTINCT CLINICOPATHOLOGIC CLUES FOR PRECISE DIAGNOSIS
Authors: Liang Peifen , Han Qianqian , Liu Bo , Yang Qiongqiong
Published: May 2021

Background and Aims

Both antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and IgG4-related disease (IgG4-RD) are multi-system inflammatory disorders. The coexistent of both diseases present the possibility of a new overlap syndrome which leads to different treatment and outcome. In this study, we aim to investigate the possibility and clinicopathologic clues to the diagnosis of this overlap syndrome.

Method

A case of a 67-year-old man in our hospital who exhibited the clinicopathologic characteristics of both AAV and IgG4-RD was presented. The serial alterations in serum parameters and treatment response of the case were followed up for the next 15 months. Then, a systematic literature review of the overlap syndrome was performed on PUBMED database from 1976 until January 2020.

Results

Forty-two patients fully met both AAV and IgG4-RD criteria in the literature. The median age was 60 years ranged from 31 to 73 years at diagnosis. Twenty-eight (66.7%) patients were men. Serum IgG4 concentration increased in 41 (97.6%) patients (median:395 mg/dl; range:177-876mg/dl). Forty-one patients (97.6%) tested positive for ANCA with 37 (90.2%) patients showing a specificity for MPO. Kidney histology of 23 (69.7%) patients presented pauci-immune necrotizing or crescentic glomerulonephritis and IgG4-relative tubulointerstitial nephritis. Glucocorticoids combined with cyclophosphamide therapy was commonly prescribed with a high remission rate within 3 months. Four common clinicopathologic features of the overlap syndrome were identified from the case and literature.

Conclusion

AAV may overlap with IgG4-RD while presenting atypical manifestations. Four common clinicopathologic characteristics could be used as specific clues to the diagnosis of overlap syndrome.
MO145CAROTID PLAQUE THICKNESS COMPARED WITH SEVERITY OF CAROTID AND CORONARY ARTERY CALCIFICATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3
Authors: Saurbrey Bjergfelt Sasha , Soerensen Ida Maria Hjelm , Hjortkjaer Henrik Oeder , Landler Nino Emanuel , Freese Ballegaard Ellen Linnea , Biering-Sørensen Tor , Kofoed Klaus F , Lange Theis , Feldt-Rasmussen Bo , Hegaard Sillesen Henrik , Christoffersen Christina , Bro Susanne
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) accelerates both atherosclerosis and arterial calcification. The aim of the present study was to explore whether maximal carotid plaque thickness (cPT max) was increased in patients with CKD stage 3 compared to controls and associated with cardiovascular disease and severity of calcification in the carotid and coronary arteries.

Method

The study group consisted of 200 patients with CKD stage 3 from the Copenhagen CKD Cohort and 121 age- and sex-matched controls. cPT max was assessed by ultrasound and arterial calcification by computed tomography scanning.

Results

Carotid plaques were present in 58% of patients (n=115) compared with 40% of controls (n=48), P=0.002. Among participants with plaques, cPT max (median, interquartile range) was significantly higher in patients compared with controls (1.9 (1.4-2.3) versus 1.5 (1.2-1.8) mm, P=0.001. Cardiovascular disease was present in 9.4% of patients without plaques (n=85), 23.2% of patients with cPT max 1.0-1.9 mm (n=69) and 34.8% of patients with cPT max >1.9 mm (n=46), P=0.001.

Carotid and coronary calcium scores >400 were present in 0.0% and 4.0%, respectively, of patients with no carotid plaques, in 19.1% and 24.2% of patients with cPT max 1.0-1.9 mm, and in 47.5% and 52.6% of patients with cPT max >1.9 mm, P<0.001.

Conclusion

This is the first study showing that cPT max is increased in patients with CKD stage 3 compared to controls and closely associated with prevalent cardiovascular disease and severity of calcification in both the carotid and coronary arteries.