bluuebunny/crossref_metadata_2025 huggingface dataset:
MO146RENAL FUNCTION MEDIATES THE EFFECT OF FLUID EXCESS ON LUNG CONGESTION IN PATIENTS WITH HFREF
Authors: Popa Raluca , Sascau Radu , Statescu Cristian , Vasiliu Vlad , Neamtu Andreea , Bucur Andreea , Kanbay Mehmet , Siriopol Dimitrie
Published: May 2021

Background and Aims

Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Pulmonary congestion is considered the leading cause for hospital admissions and death among patients with HF. The aim of this study is to investigate if the effect of fluid status, as assessed by bioimpedance spectroscopy (BIS) on lung congestion is mediated by renal function, inflammation or cardiac function.

Method

This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction (LVEF) below 45% was required for inclusion (HFrEF).

Mediation is the process through which an exposure causes disease. We hypothesized that some of the total effect of extracellular water (ECW) to intracellular water (ICW) (as assessed by bioimpedance) ratio on lung congestion (as assessed by lung ultrasonography) is mediated by C-reactive protein (CRP), left atrium volum index (LAVI) or estimated glomerular filtration rate (eGFR) – the mediators.

Results

Our study included 153 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 ml/min/1.73m2. The mean median value for CRP was 25.6 (IQR 9.0-56.4) mg/L.

Figure 1 depicts the structural equation models with the calculated magnitude of the direct and indirect effects of ECW/ICW on the B-lines number in our population. In this model, the fluid status has both direct and indirect effects on lung congestion. Specifically, it has a direct effect on LAVI and eGFR, which in turn have a direct effect on the number of B-lines. Therefore, the indirect effect mediated by LAVI and eGFR accounts for a significant proportion of 27.6% of the total effect of ECW/ICW on lung congestion

Although ECW/ICW has a direct effect on inflammation, this doesn’t have any effect on renal function or lung congestion.

Conclusion

We show that eGFR and LAVI partly mediate the effect of ECW/ICW on lung congestion in patients with HFrEF. While the deleterious effects of fluid overload on lung congestion have long been recognized, this study provides evidence for a relationship of significant magnitude linking fluid overload with decreased eGFR and increased LAVI, which in turn lead to elevations in the B-lines number.

This work was supported by a grant of the Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1.1-PD-2016-0287, within PNCDI III and by a grant of the “Grigore T. Popa” University of Medicine and Pharmacy, contract number 27505/2018.
MO151CLINICAL COURSE AND OUTCOMES OF COVID-19 PATIENTS WITH BIOPSY-PROVEN GLOMERULAR AND TUBULAR KIDNEY DISEASE. LOW HEMOGLOBIN LEVELS AS A RISK FACTOR FOR MORTALITY
Authors: León Román Juan , García Carro Clara , Agraz Irene , Toapanta Néstor , Vergara Arana Ander , Gabaldon Alejandra , Torres Rodriguez Irina , Bury Roxana , Baldallo Cinthia , Seron Micas Daniel , Soler María José
Published: May 2021

Background and Aims

COVID-19 infection is responsible for respiratory infection with variable clinical expression from its asymptomatic form to severe pneumonia associated with acute respiratory distress syndrome and death. Risk factors related to higher mortality are age over 65 years, cardiovascular, pulmonary and kidney disease, hypertension, and diabetes. There is limited scientific literature on COVID-19 infection and previous kidney disease, specifically in patients with glomerular and tubular kidney disease. The aim of this study was to determine general characteristics, analytical parameters and clinical evolution of patients with kidney disease who have undergone kidney biopsy and who presented infection or high suspicion of infection by COVID-19. Identify mortality and associated risk factors.

Method

we studied patients with high clinical suspicion of infection or confirmed infection by COVID-19 from March 2020 to May 15, 2020 of all patients who underwent percutaneous renal biopsy at the Vall d'Hebron Hospital between January 2013 and December 2019.

Results

39 of the 553 patients have been diagnosed with COVID-19 infection since March 2020. The average age was 63±15 years and 48.7% were male. Hypertension was present in 79.5% of patients, chronic kidney disease without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older patients (p=0.01), patients with hypertension (p=0.005), immunosuppression (p=0.01), use of RAS-blocking drugs (p=0.04) and gastrointestinal symptoms (p=0.02) were more likely to be tested for COVID-19. 22 patients required hospitalization and 15.4% died. In the bivariate analysis, mortality was associated with older age (p=0.03), cardiovascular disease (p=0.05), chronic obstructive pulmonary disease (COPD) (p=0.05) and low hemoglobin levels (p=0.006). Adjusted Cox regression showed that low hemoglobin levels (10.12±1.89g/dL) at admission had 1.81 greater risk of mortality [1.04-3.13; p=0.04].

Conclusion

Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, use of RAS-blocking drugs, immunosuppressed patients and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.
MO155RENAL DAMAGE IN COVID-19: RESULTS FROM A COHORT STUDY IN 1,280 PATIENTS
Authors: Chebotareva Natalia , Berns Svetlana , Berns Angelina , Androsova Tatyana , Moiseev Sergey
Published: May 2021

Background and Aims

The development of acute kidney injury in COVID-19 patients is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19; however, these data are still controversial.

Method

A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 disease was confirmed by RT-PCR through a nasopharyngeal swab and typical images from a computed tomography scan in all patients. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We finally assessed the acute kidney injury (AKI) incidence and mortality defined by the survival status at discharge.

Results

In 648 (50.6%) of the patients with COVID-19, proteinuria was evidenced. Haematuria was detected in 77 (6%) patients, and leukocyturia was detected in 282 (22%) hospitalized patients. AKI was determined in 371 (29%) patients, and 10 (2.7%) of them required dialysis. Independent AKI risk factors were age >65 years, augmentation of CRP, ferritin and increase in aPTT values as a result of consumption coagulopathy. A total of 162 (12.7%) of the 1,280 hospitalized patients and 111 (30%) of the 371 patients with AKI did not survive. The hazard ratio for mortality 3.96 [CI 95% 2.828 – 5.542] for patients with AKI vs. No-AKI.

Conclusion

AKI was determined in 29% patients, in 2.7% of them severe kidney injury required dialysis. Risk factors for AKI in COVID-19 patients are old age, the inflammatory response, the severity of lung involvement and DIC. The same factors and arterial hypertension were found to increase risk of mortality.
MO157HYPONATREMIA AND DISEASE SEVERITY IN LEPTOSPIROSIS
Authors: Cavalcante Meneses Gdayllon , Andrade de Carvalho Gomes Pedro Eduardo , Studart Galdino Gabriela , Bezerra da Silva Junior Geraldo , Coelho Lopes Nicole , Costa Martins Alice Maria , Brasil Gadelha Farias Luis Arthur , De Francesco Daher Elizabeth
Published: May 2021

Background and Aims

Hyponatremia is associated with severe complication in tropical diseases and may be associated with higher mortality. The aim of this study was to investigate the association between hyponatremia and disease severity in patients with leptospirosis.

Method

This is a retrospective study including patients with confirmed diagnosis of leptospirosis admitted to three reference hospitals in Fortaleza, northeast Brazil, in the period from 1985 to 2018. Demographic, clinical and laboratory data were analyzed, and the incidence of unfavorable outcomes were investigated: acute kidney injury (AKI) – defined according to KDIGO criteria, hemodialysis need and death. Patients were divided in groups according to the levels of sodium at hospital admission (< or ≥135mEq/L). Statistical analysis was done with the SPSS program version 23.0.

Results

A total of 319 patients were included. Hyponatremia was found in 163 cases (51%) at hospital admission. Patients’ mean age was 37±15 years, and 84% were male. The group with hyponatremia had higher frequency of some symptoms and signs, such as disorientation (8.1% vs 1.3%, p=0.047) and jaundice (76% vs 54%, p<0.001). Higher levels of urea (130±80 vs 94±34mg/dL, p<0.001) and creatinine (4.3±2.7 vs 3.0±2.6mg/dL, p<0.001) were observed at hospital admission, as well as maximum levels of bilirubins, in the group with hyponatremia (p<0,05). Median lower levels of platelets during hospital stay were observed in the group of hyponatremia (45 [26 – 110] vs 73 [42 – 157] x103/µL p=0.001). A higher frequency of complications was also observed in the group with hyponatremia: hemodialysis need (38% vs 20%, p<0.001) and AKI stage 3 (71% vs 46%, p=0.002). There was no difference regarding mortality rate between the two groups (14.1% vs 10.1%, p=0.281).

Conclusion

Hyponatremia in patients with leptospirosis, at hospital admission, is associated with worse prognosis and can be an important parameter to guide clinical care in this group of patients.
MO159CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Vodošek Hojs Nina , Ekart Robert , Bevc Sebastjan , Piko Nejc , Hojs Radovan
Published: May 2021

Background and Aims

Cardiovascular mortality is high in chronic kidney disease (CKD) patients. Recognizing patients with higher cardiovascular risk might help in their treatment. CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF). However, it is also useful in predicting outcome in different cardiovascular conditions, independent of the presence of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in cardiovascular mortality in CKD patients.

Method

Eighty-seven non-dialysis CKD patients from our outpatient clinic were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed for assigned time or until their death. Mean follow-up time was 1696.45±564.60 days.

Results

Descriptive statistics of our patients are presented in table 1. During follow-up 11 patients suffered from cardiovascular death. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular mortality (HR: 2.19, CI: 1.42-3.37, p=0.001). In multivariate Cox regression analysis in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, haemoglobin, high sensitivity CRP and intact PTH were included, CHA2DS2-VASc score was an independent predictor of cardiovascular mortality (HR: 2.04, CI: 1.20-3.45, p=0.008) (table 2).

Conclusion

CHA2DS2-VASc score is a simple and quick way to identify cardiovascular risk in CKD patients.
MO161DIABETIC NEPHROPATHY AS AN ADDITIONAL FACTOR CAUSES DISTURBANCES IN T CELL IMMUNITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Sampani Erasmia , Lioulios Georgios , Dimitriadis Chrysostomos , Mitsoglou Zoi , Daikidou Dimitra Vasileia , Tsouchnikas Ioannis , Asouchidou Despoina , Fylaktou Asimina , Papagianni Aikaterini , Stangou Maria
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) and Diabetes Mellitus (DM), are chronic inflammatory conditions, and may both affect T-cell immunity. However, our knowledge about alterations of specific T cell subpopulations, as well as the further modifications occurring after dialysis initiation, is limited. The present study aimed to investigate the changes of T lymphocyte subtypes in CKD patients due to Diabetic Nephropathy (DN-CKD) and compare to nonDN-CKD patients. Furthermore, the effect of dialysis, was also estimated in both groups.

Method

In 30 DN-CKD, 30 nonDN-CKD patients and 25 healthy individuals, cytometric analysis of T cell subpopulations was performed, including CD4+, CD8+, CD4+CD28null, CD8+CD28null, Natural Killer cells and Tregs. Measurements were performed at the day started (T0) on either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) and repeated six months later (T6).

Results

At time T0, CD4+, NK cells and Tregs were significantly reduced (p=0.001, p=0.01, p<0.0001, respectively), while CD28null cells were increased (p=0.005) in CKD patients compared to controls. CD4CD28null and CD8CD28null (%) cells were increased in DN-CKD compared to nonDN-CKD (p=0.03, p=0.02, respectively). At time T6, a significant increase in total CD28null cells were noticed in DN patients (p=0.05) but not in nonDN patients. More interestingly, DN-CKD patients who started on HD showed a significant increase in CD4CD28null cells [from 30(14-100) to 52.7(15-203), p=0.02], CD8CD28null cells [from 130(47-400) to 212(25-1192), p=0.02] and NK cells [from 137(56-275) to 266(103-456), p=0.01], while those DN-CKD started on CAPD showed a significant reduction in the percentage of CD4CD28null cells [from 9.8(2.9-19.8) to 6.9(1.3-+18), p=0.05].

Conclusion

Patients with CKD due to DN are more likely to have impaired T cell immunity, mainly regarding CD28null cells, which further deteriorates after initiation of HD. Instead, CAPD method seems to ameliorate those changes.
MO162IMPACT OF THE IMMUNOSUPPRESSIVE TREATMENT, X-RAY EXPOSITION AND RENAL PATHOLOGY ON OVARIAN RESERVE IN YOUNG WOMEN
Authors: Julia Rasała , Anna Ciszewska , Król Małgorzata , Kusztal Mariusz , Katarzyna Kościelska-Kasprzak , Tukiendorf Andrzej , Kanafa Maciej , Hanna Augustyniak-Bartosik , Mazanowska Oktawia , Magdalena Krajewska
Published: May 2021

Background and Aims

Cyclophosphamide treatment and X-ray exposition in the area of the ovaries are proven to be the gonadotoxic factors in childbearing age women. Anti-Müllerian hormone (AMH) is regarded as a biomarker for ovarian reserve.

Method

The study included 167 consecutive premenopausal women attending Nephrology Clinic who gave informed consent and met exclusion criteria (past ovarian surgical procedure, PCOS, eGFR <30ml/min, irregular menstrual cycles). Clinical (renal pathology, smoking, X-rays exposition, eGFR standardized MDRD4, contraceptives) and demographic characteristics, as well as previous and current immunosuppressive therapies were recorded. Serum AMH levels were measured by Beckman Coulter’s Gen II enzyme linked immunosorbent assay (ELISA) kit; AMH levels were classified as low or normal/above age-adjusted reference levels (published norms).

Statistical analysis included both regressive and non-regressive relationships between the studied clinical features. Due to the presumption of the remaining non-regression relationships between clinical factors, an original taxonomic method by Marczewski & Steinhaus was used instead of general linear modeling. Based on patient age, eGFR, renal pathology an ‘optimal’ segregation of patients was performed following the created classification tree (dendrogram).

Results

Median age of the patients was 33 (range 18-44). Median AMH concentration was 2,66 ng/ml; AMH levels were classified in 64 females as low (median 1,015) and in 103 as normal/above age-adjusted reference (median 4,04). Sixty one patients were treated with cyclophosphamide in the past and 45 underwent kidney transplantation. 92 women suffered from glomerulonephritis, 44 from lupus nephritis, 12 from interstitial kidney disease, 5 from ADPKD and 14 from other kidney diseases.

Age, eGFR, pregnancies in the past as well as being the kidney transplant recipient were the coefficients strongly correlated with AMH level. Presence of lupus nephritis was correlated with lower levels of AMH in comparison to other renal diseases and in contrast to cyclophosphamide. X-ray exposition measured in cumulative lifetime dose was not correlated with AMH levels.

Conclusion

Although previous researchers suggested cyclophosphamide to be the strong gonadotoxic factor, our statistical analysis approach shows that lupus as the disease often treated with cyclophosphamide may be the lowering ovarian reserve factor itself. Further studies on this subject are still necessary.
MO168MANAGEMENT OF ANTICOAGULANT RELATED NEPHROPATHY: SLOVENIAN CASE SERIES AND REVIEW OF CURRENT KNOWLEDGE
Authors: Večerić-Haler Željka , Belčič Mikič Tanja , Kojc Nika , Frelih Maja , Ales Rigler Andreja
Published: May 2021

Background and Aims

Anticoagulant-related nephropathy is a recently recognized form of acute kidney injury associated with previously underdiagnosed kidney damage in addition to (usually) excessive anticoagulation. It occurs in patients receiving warfarin as well as those receiving direct oral anticoagulants.

Method

We collected and analyzed cases of Slovenian patients with pathohistologically documented anticoagulant-related nephropathy associated with all types of anticoagulant treatment from the first case in 2014 to 2020. We also performed an analysis of previously documented cases of anticoagulant-related nephropathy in the global literature (PubMed) in the period from their first mention until recently.

Results

In Slovenia, 13 patients with anticoagulant-related nephropathy have been histologically verified so far. All patients were diagnosed with concomitant underlying renal disease, and 80% had IgA nephropathy, which was disproportionately mild according to the degree of renal function impairment. After supportive measures and reversal of excessive anticoagulation, 8 of 13 patients were further treated with corticosteroids, resulting in significant improvement in renal function. During the follow-up period, a total of one steroid-treated patient died due to infectious complications and one patient progressed to end-stage renal failure. In the worldwide literature, we found 46 case reports or case series of patients with anticoagulant-related nephropathy. Failure of restitution of renal function with the need for maintenance dialysis was reported much more frequently compared to the results of our cohort (up to 67% vs. 8.3%)

Conclusion

To our knowledge, the Slovenian cohort of patients with histologically established anticoagulant-related nephropathy is the largest reported series to date that received corticosteroid therapy in addition to conservative measures. Our results indicate that steroids have a beneficial effect, likely exerted via suppression of hemoglobin-associated oxidative stress and inflammation. However, considering the polimorbidity of these patients, the benefit of additional steroid therapy must be weighed against the potential risks of side effects, especially life-threatening infections.
MO127CLEARED PODOCYTES AND NORMAL KIDNEY FUNCTION IN CLASSICAL FABRY MALES 15 YEARS AFTER START OF ENZYME REPLACEMENT THERAPY AT YOUNG AGE*
Authors: Tøndel Camilla , Riisnes Idunn , Leh Sabine , Larsen Kristin Kampevold , Skrunes Rannveig , Marti Hans-Peter , Svarstad Einar
Published: May 2021

Background and Aims

Fabry nephropathy may progress to kidney failure despite enzyme replacement therapy (ERT) when the treatment is initiated at a relatively late stage of the disease. This study evaluates long term effects of agalsidase in serial kidney biopsies and functional measurements in men with classical Fabry disease that commenced ERT at a young age.

Method

Six male Fabry patients with a median age of 20 years (range 7-30 years) at start of ERT were monitored over a median time of 15 years (range 14.5-17.0 years). The patients were treated with an agalsidase dose of 1.0 mg/kg/every other weak (eow) for 8.3 years (range 5-12 years) and with an agalsidase dose of 0.2-0.5 mg/kg/eow for 7.6 years (range 3-10 years). Kidney biopsies were evaluated with the scoring system of the International Study Group of Fabry Nephropathy (ISGFN) using both plastic embedded and paraffin embedded tissue with scoring of podocyte globotriaocylceramide (Gb3) in semithin toluidine blue sections (maximum score 4.0) and scoring of vacuolization in PAS-sections (maximum score 3.0). ISGFN composite score consists of both tissue scores giving a maximum score of 7.0. Renal function was evaluated with measurement of glomerular filtration rate (GFR) with iohexol clearance (mGFR) and urinary albumin creatinine ratio (uACR). Values are given in median (range).

Results

Kidney biopsies at baseline contained 24 (13-42) evaluable glomeruli and had an ISGFN composite score of 7.0 (6.9-7.0). After 15 years the ISGFN composite score had decreased to 0.56 (0-4.29), scored in 24 (9-52) evaluable glomeruli. At baseline mGFR was 106 (86-113) ml/min/1.73 m2 and after 15 years mGFR decreased to 97 (73-134) ml/min/1.73 m2. uACR was 5.6 (0.1-13.6) mg/mmol at baseline and had after 15 years increased to 10.0 (1.0-107) mg/mmol. The youngest patient had significant proteinuria with uACR 107 mg/mmol due to a chronic C3-glomerulonephritis superimposed on Fabry disease. Median uACR without this patient was at 15 years 5.8 (1.0-17.7) mg/mmol. The two youngest patients had no Gb3 visible (ISGFN composite score of 0) in their last biopsy and mGFR was normal in both. In all patients the reduction of podocyte-Gb3 was higher on an agalsidase dose of 1 mg/kg/eow; change composite score -4.66 (-7.9 to -1.8), compared to on an agalsidase dose of 0.2-0.5 mg/kg/eow; change composite score -0.15 (-5.1 to + 1.0).

Conclusion

Initiation of ERT at a relatively young age may clear the long living kidney cells of Gb3 and protect the kidneys from significant functional loss over a very long time period. The reduction of Gb3 in podocytes is higher on high dose compared to low dose of agalsidase.
MO172HYPONATREMIA IN PATIENTS WITH COVID19
Authors: Castillo-Rodríguez Esmeralda , Villa Daniel , Álvarez Nadal Marta , Regueiro Toribio Paula , Fernandez Lucas Milagros
Published: May 2021

Background

Among laboratory abnormalities described in the context of SARS-COV-2 infection, hyponatremia seem to be the most common. The mechanism of this sodium disbalance is not well known.

Aims

Characterize the incidence, etiology and prognostic value of sodium disbalance in patients with COVID19.

Method

Observational pilot study with 37 patients admitted to Hospital Ramon y Cajal in Madrid, Spain, between March and April 2020, with a confirmed diagnosis of COVID19. Patients were followed until discharge or death. Clinical and laboratory data were collected at admission and before the clinical outcome. Variables were analyzed comparing hyponatremic vs eunatremic patients.

Results

Distribution of patients according to their serum sodium was as follows: 16 patients with hyponatremia (44%), 19 with normal serum sodium (51%) and 2 with hypernatremia (5%). The average sodium level in hyponatremic patients was 130 ±3.2 mmol/l, median urine sodium was 36 ±3.2 mmol/l (only 6 urine sample available). Hyponatremia was associated with dyspnea at admission and with higher levels of LDH, neutrophil cells account and C reactive protein. However, no worse prognostic was associated with lower serum sodium. All patients recover sodium levels at discharge treated with salt supplementation and free water intake.

Conclusion

mild hyponatremia is a common electrolyte disorder associated with COVID19. Sing as low urine sodium and recover with water and salt ingestion, point toward hydrosaline dehydration instead of SIADH as most common origin of hyponatremia.
MO177RENAL PROXIMAL TUBULAR DISORDER AND RENAL FUNCTION LOSS IN HIV-INFECTED PATIENTS TREATED WITH TENOFOVIR DISOPROXIL FUMARATE
Authors: Zhao Bingbin , Shi Xiaoxiao , Ma Tiantian , Li Jiaying , Xia Peng , Yu Yang , Lv Wei , Chen Limeng
Published: May 2021

Background and Aims

Tenofovir disoproxil fumarate (TDF), as the most common antiviral drug, can cause both proximal tubular transportation dysfunctions and eGFR decline. The relationship between them is not clear due to lack of clinical data from large cohorts, especially in the Chinese population. In this study, we summarized the characteristics of proximal tubular injuries and eGFR decline in the cohort of HIV-infected patients treated with TDF, and explore the the impact of tenofovir on tubular transporters in vitro.

Method

We enrolled HIV-infected patients treated with TDF, who were regularly followed up in our hospital from Sep 1, 2001 to August 31, 2019. Their baseline and follow-up clinical data were collected. Proximal tubular dysfunction was defined as meeting two or more of the following criteria: hypophosphatemia, hypouricemia, low carbon dioxide binding capacity, positive urine glucose with normal plasma glucose level, and positive urine protein. Rapid deterioration of renal function was defined as the annual decline rate of eGFR exceeding 5ml/min/1.73m2. We also used human renal proximal tubular epithelial cell line (HK2) to further investigate the impact of tenofovir on transporters including SGLT2, NaPi-IIa, and URAT1 through immunofluorescence.

Results

A total of 375 HIV-infected patients receiving TDF were enrolled, mainly males (90.1%), with a median follow-up duration of 34(17, 58) months. The most common clinical manifestations were proteinuria (20.3%) and hypophosphatemia (12.3%). The prevalence of proximal tubular injury was 6.7%, which was significantly associated with low body weight, but was not associated with age, TDF course, baseline viral load, or baseline CD4+ T lymphocyte count. Their eGFR levels at the end of the follow-up were significantly lower than the baseline levels (104.6±15.2 vs. 110.6±14.2 ml/min/1.73m2, P<0.001). The average annual decline rate of eGFR was 5.0± 22.7 ml/min/1.73m2, and 23.6% of our patients had an annual decline rate of eGFR exceeding 5 ml/min/1.73m2. Rapid deterioration of renal function (≥ 5 ml/min/1.73m2 per year) was significantly associated with female but not related to proximal tubular dysfunction in multivariate logistic regression analysis. In vitro, the survival rate of HK2 cells was more than 95% when treated with tenofovir with a concentration of 1μmol/L for 48h. The expression levels of transporters (SGLT2, URAT1, and NaPi-IIa) were declined under the condition.

Conclusion

Among the HIV-infected Chinese patients treated with TDF, 6.7% had proximal tubular dysfunction and 23.6% showed accelerated annual decline rate of eGFR (≥ 5 ml/min/1.73m2 per year).
MO181ULTRASOUND ASSESSMENT OF KIDNEY SIZE AND ITS CORRELATION WITH BODY MASS INDEX IN HEALTHY VOLUNTEERS WITHOUT RENAL DISEASE
Authors: Mohammed Nazma , Latief Muzamil , Parry Manzoor , Yadla Manjusha
Published: May 2021

Background and Aims

Renal length as well as renal cortical thickness has been closely related to creatinine clearance in patients with chronic kidney disease. Our primary aim was to establish a normal range of values for kidney length in our adult population with normal renal function.

Method

This was a prospective observational study. Ultrasonographic assessment of renal parameters in 499 healthy volunteers between 18 to 80 years of age was done. Volunteers with any known renal condition or any co-morbidity were excluded from the study population. Correlation between body mass index (BMI) and renal parameters was assessed.

Results

Out of 499 volunteers 327 (65%) were males and 172(35%) were females. 17.8% volunteers were less than 30 years of age, 51.5% volunteers were in the age group of 30-60 years and 30.7 % were above 60 years of age. Mean BMI in males was 25.20 ± 3.96 kg/m2 whereas mean BMI in females was 24.08 ± 3.28 kg/m2. In males the mean cortical thickness in right kidney was 13.68+/- 2.47 mm and in left kidney cortical thickness was 13.94 ± 2.6 mm. In females right kidney cortical thickness was 12.63 ± 1.91 mm and left kidney cortical thickness was 13.40 ± 2.37 mm. In the present study the right mean renal length was 9.9 ± 40cm and left renal length was 10.19 ± 0.97cm. In our study, there was positive correlation BMI with renal length.

Conclusion

Size of kidney has significant ethnic and geographic basis and there is a positive correlation between BMI and kidney size in our study population.
MO128RETINOL BINDING PROTEIN (RBP) - NEW BIOMARKER OF KIDNEY INJURY IN MULTIPLE MYELOMA PATIENTS*
Authors: Woziwodzka Karolina , Malyszko Jolanta , Banaszkiewicz Małgorzata , Koc- Żorawska Ewa , Dumnicka Paulina , Jurczyszyn Artur , Batko Krzysztof , Tisończyk Joanna , Gołasa Paulina , Krzanowski Marcin , Zorawski Marcin , Małyszko Jacek , Drozdz Ryszard , Krzanowska Katarzyna
Published: May 2021

Background and Aims

The aim of the study was to analyse the utility of retinol binding protein (RBP) in case of renal impairment in MM patients and investigate its relationship with acclaimed parameters of renal failure and markers of MM stages.

Method

We recruited 73 patients (35 women, 38 men, in age range of 29-90 years, mean 70 ± 10 years) with multiple myeloma (MM), including 6 (8%) with smoldering MM, 40 (55%) with International Staging System (ISS) stage I, 15 (21%) with ISS II and 12 (16%) with ISS III. The majority of patients (65, 89%) received at least one treatment scheme. Thirty patients (41%) received maintenance treatment at recruitment. Median eGFR based on serum creatinine (CKD-EPICr) equaled 67 (range 9 – 117) ml/min/1.73 m2.

Results

Significant correlation was observed between RBP and the ordered variable describing MM stage from smoldering myeloma to ISS III (R=0.36; p=0.002). There were no differences between patients in CR, PR, SD and PD at the time of samples’ collection. Patients who were on maintenance treatment at recruitment tended to have higher serum RBP (median 42.6 versus 37.7 mg/l), however, the difference was not statistically significant (p=0.068). The patients who received steroid treatment had significantly higher RBP concentrations. There were no such association with other medications. There was no association between RBP and the number of previous treatment lines (p=0.8). Serum RBP did not differ between men and women (p=0.7) and did not correlate with age (p=0.6).

Significant correlations were found between RBP and serum creatinine, cystatin C and eGFR values calculated based on creatinine and/or cystatin C (Table 1). In multiple regression, serum creatinine or cystatin C and the treatment with steroids were associated with RBP independently of ISS stage (Table 2).

Moreover, RBP correlated with β2-microglobulin, LDH, leukocyte count, α-klotho, FGF-23, GDF-15, uNGAL and uIGFBP-7, however, only the associations with β2-microglobulin and sTfR were independent of serum creatinine in multiple regression (Table 1).

Baseline serum RBP concentration was significantly correlated with eGFR after a median of 19 months follow-up (range 1-24 months) (R=-0.35; p=0.003), however, the correlation was not independent of baseline serum creatinine ((beta ± SE: 0.06 ± 0.10; p=0.5). To the contrary, baseline serum cystatin C (beta ± SE: -0.36 ± 0.13; p=0.009) predicted final eGFR independently of baseline serum creatinine.

Conclusion

RBP may be useful marker in renal damage in patients with chronic kidney injury among patients with MM. This can lead to noninvasive biomarker-targeted diagnostic interventions and contribute to early beginning of treatment that may improve life expectancy quality of life in MM.
MO182CRYSTALLINE LIGHT CHAIN CAST NEPHROPATHY IS ASSOCIATED WITH EARLY MORTALITY IN PATIENTS WITH MULTIPLE MYELOMA
Authors: Lin Zishan , Zhang Xu , Yu Xiaojuan , Wang Suxia , Cen Xinan , Zhou Fude , Zhao Minghui
Published: May 2021

Background and Aims

Light chain cast nephropathy is the most common paraprotein-associated kidney lesion in patients with multiple myeloma (MM). Rarely, light chain cast nephropathy could show crystalline appearance in patients with multiple myeloma, also known as crystalline light chain cast nephropathy. We here report the first retrospective study of crystalline light chain cast from a single centre.

Method

All native kidney biopsies were retrospectively studied in the Peking University First Hospital from 2000 to 2020. Newly diagnosed MM patients with were enrolled. Patients with light chain cast nephropathy at least one cast with crystalline appearance were identified as crystalline light chain cast nephropathy (Figure 1, n = 8), others were identified as ordinary light chain cast nephropathy (n = 18).

Results

The cohort of crystalline light chain cast nephropathy consisted of 6 men and 2 women with a median age of 59.5 (range, 41-73) years. All patients suffered from advanced multiple myeloma (1 with ISS staging II, 7 with ISS staging III) and acute kidney injury with a median eGFR of 5.59 (range, 2.27-26.04) mL/min/1.73m2. All patients except 1 required emergency dialysis at admission. Microhematuria was presented in 3 patients. Median proteinuria was 2.13 (rang, 0.83-3.59) g/24h and median serum albumin was 38.2 (30.7-46.7) g/L. No one presented with nephrotic syndrome. Monoclonal immunoglobulin, detected in all patients on serum protein immunofixation electrophoresis, was λ alone in 5 patients, κ alone in 1 patient, IgG λ in 1 patient, IgA λ in 1 patient.

The 8 patients were followed up with a median time of 8 (range, 2-24) months. Three patients received VAD chemotherapy and 5 patients received bortezomib based regimens. At the time of last follow-up, 2 of 7 patients who needed emergency dialysis got rid of dialysis and the rest remained dialysis-dependent. Five patients died with a median time of 5 (range, 2-19) months, 2 patients achieved partial remission and 1 patient achieved complete remission.

There was no significant difference in clinical features, treatments and main outcomes between crystalline light chain cast nephropathy patients and ordinary light chain cast nephropathy patients (Table 1). However, crystalline light chain cast nephropathy patients had higher early mortality than ordinary light chain cast nephropathy patients (50.0% vs 11.1%, p = 0.03).

Conclusion

Crystalline light chain cast nephropathy patients usually presented with acute kidney injury requiring emergency dialysis. Although various types of monoclonal immunoglobulin were detected, there was a dominance of the λ isotype. Compared to ordinary light chain cast nephropathy patients, crystalline light chain cast nephropathy patients had higher early mortality.
MO184ANTICOAGULANT THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION
Authors: Abdullaev Sherzod , Igamberdieva Rano , Sharapov Olimkhon
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) significantly alters the pharmacokinetics of drugs, which in practice complicates the selection of adequate anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and CKD. At the same time, in the vast majority of patients with AF and CKD, ACT is required to prevent life-threatening thromboembolic complications. In such an environment, maintaining a balance between the effectiveness and safety of ACTs is extremely important.

Aim is evaluation of the efficacy and safety of the use of direct oral anticoagulants (OAC) in CKD stages 1-3 in combination with AF.

Method

The study included 93 patients (38 men and 55 women) aged 41 to 86 years with CKD stages 1-3 and AF receiving therapy with OAC (rivaroxaban) and vitamin K antagonists (warfarin). The observation period was 12 months.

Results

An analysis of 75 patients with CKD of various stages and AF receiving rivaroxaban was performed, the control group consisted of 18 patients taking warfarin. The average CHA2 DS2-VASc score in the OAC group was 4.1±1.8 points, in the warfarin group - 4.2±1.3 points. There were also no significant differences between the groups in terms of the average score on the HAS-BLED scale (risk of developing hemorrhagic complications): 2.3±0.94 points in the OAC group, 2.5±0.6 points in the warfarin group. Among the comorbidities in the OAC group, 93.2% of patients had arterial hypertension (AH), 24.5% had type 2 diabetes mellitus (DM); in the warfarin group, 94.3% of patients had hypertension and 16.8% had type 2 diabetes. In 23.9% of patients in the OAC group, minor bleeding was recorded. The largest number of hemorrhagic complications occurred in patients with stage 3 CKD: 18.9% of bleeding, which significantly (p<0.05) exceeds the number of bleeding in patients with a more pronounced decrease in renal function. In 33.3% of patients with diabetes, hemorrhagic complications were recorded, which is significantly (p<0.05) more than in the group of patients without diabetes - 21.4%. The greater number of hemorrhagic complications is most likely due to a more pronounced progression of the decline in renal function compared with patients without diabetes: 71.4% of patients with diabetes showed a decrease in GFR by an average of 16.6 ml/min/1.73 m2 for 12 months, which is significantly more (p<0.05) than in patients without diabetes (an average of 5.7 ml/min/1.73 m2).

Conclusion

In patients with CKD stages 1-3 with non-valvular AF, the use of OAC is most effective and safe in preventing thromboembolic complications. At the same time, the progression of CKD against the background of diabetes when taking anticoagulants occurs faster than in its absence, regardless of the specific anticoagulant. Patients with AF, DM and CKD are more likely to have hemorrhagic complications, which requires more frequent monitoring and monitoring of the functional state of the kidneys.
MO187NON-STEROIDAL ANTI-INFLAMMATORY DRUG PRESCRIPTION IN THE YOUNG-OLD AND VERY- OLD: TYPE, ROUTE AND BURDEN OF CARDIOVASCULAR RISK FACTORS
Authors: Lim Cynthia , Choo Jason , Kwek Jia Liang , Abdul Kadir Hanis , Tan Ngiap Chuan
Published: May 2021

Background and Aims

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular and kidney adverse effects, especially in older adults. However, NSAIDs are still frequently prescribed to some at-risk groups. We aimed to evaluate the burden of traditional cardiovascular risk factors and pattern of NSAID prescription in the very-old and young-old.

Method

Cross-sectional study of older adults who received prescriptions over 3 years from a large healthcare cluster in Singapore. Individuals aged 65-79 years were the “young-old” and those ≥80 years were the “very-old”. Prescriptions and traditional cardiovascular risk factors were retrieved from electronic records.

Results

Among 197,932 older adults (including 41,079 very-old), 49.9% received at least 1 NSAID prescription. Topical NSAIDs were more frequently prescribed among the 19,979 very-old with NSAID prescriptions (91.5% versus 82.9% of the young-old), while oral non-selective (22.1% versus 38.5%) and selective NSAID (15.1% versus 24.9%) were less frequently prescribed compared to the young-old (all p<0.001). The very-old with NSAID prescriptions were more likely to have diabetes (38.2% vs. 32.8%), hypertension (19.3% vs. 14.0%), chronic kidney disease (51.4% vs. 23.6%) and cardiovascular disease (7.0% vs. 3.8%) than the young-old with NSAID prescriptions (all p<0.001).

Table 1 shows that among the very-old, the odds of receiving oral non-selective NSAIDs was significantly lower in those with cardiovascular disease, while the odds of receiving oral COX II inhibitors was significantly higher in female and hypertension. Among the young-old, the odds of receiving oral non-selective NSAID was lower in those with cardiovascular disease, diabetes and chronic kidney disease, while the odds of receiving oral COX II inhibitors was higher in female, hypertension, cardiovascular disease and lower in diabetes and chronic kidney disease.

Conclusion

This study highlights that NSAIDs were frequently prescribed among older adults with comorbidities that may predispose to NSAID-associated adverse events. Physician education and policies are required to avoid potentially inappropriate prescriptions.
MO188RECONSIDERING THE EDELMAN EQUATION: IMPACT OF INDIVIDUAL TOTAL BODY CATION CONTENT AND BODY WEIGHT
Authors: Oppelaar Marjet , Vuurboom Mart , Wenstedt Eliane , Vogt Liffert , Olde Engberink Rik
Published: May 2021

Background and Aims

Treatment of dysnatremias is guided by formulas that are based on the Edelman equation, including Adrogue-Madias’ and others. Edelman’s equation is the result of a unique study in which serum sodium concentration ([Na+]), total body exchangeable sodium (Nae+) and potassium (Ke+) and total body water (TBW) were measured in a highly heterogeneous population. Because these observations resulted from steady state observations, the equation might not account for the recently uncovered highly dynamic Na+ body compartment where Na+ is temporarily stored and released without affecting TBW. Various factors that influence this Na+ body compartment have been identified and we questioned as to what extent these factors affect associations between serum [Na+] and [Nae+Ke]/TBW.

Method

We performed a post-hoc analysis of original data published by Edelman. In the linear regression model, effects of sex, edema (y/n), age and body weight (>/< median split) were examined. Serum [Na+] was calculated by multiplying serum water [Na+] of the original data set by 0.93. Using piecewise regression, we analyzed differences in slope and y-intercept for the regression between serum [Na+] and increasing values of (Nae+Ke)/TBW, in which the clinical characteristics from the subgroups were included as interaction factors .

Results

Data was available for 85 measurements in 82 patients; 57 males and 25 females. The median age (range) age was 58 (27-90) years and median weight (range) was 59.6 (36.4 – 168.2) kilograms. Median serum [Na+] (range) was 131.4 (103.4 – 150.2) mmol/L. The association between serum [Na+] and (Nae+Ke)/TBW was different for high and low weight categories (figure 1A). Sex, age or presence of edema did not alter the relationship. Piecewise regression showed a significant decrease in slope in the regression between serum [Na+] and (Nae+Ke)/TBW above 149 mmol/L (Nae+Ke)/TBW (figure 1B).

Conclusion

Edelman equation’s coefficients are significantly affected by weight and total body cation content. In subjects with a low weight and low total body cation content, the Edelman equation seems to adequately predict the course of serum [Na+]. However, the clinical use of the Edelman-based formulas may be hampered in subjects with higher weight and higher total body cation content, which may reflect increased tissue Na+ storage. Our analysis underlines the importance of further research into the role of osmotically inactive Na+ storage in osmoregulation.
MO189OUTCOMES OF AN ACCELERATED CITRATE ANTIGOAGULATED MEMBRANE SEPARATION PLASMA EXCHANGE ALGORITHM
Authors: Halpin Michael , Chen Bonny , Singer Richard
Published: May 2021

Background and Aims

Plasma exchange is a standard therapy for some anti glomerular basement membrane disease and some types of renal transplant rejection. As with other extracorporeal therapies, anticoagulation is usually required. This study assessed the safety, efficacy and Calcium flux of an accelerated algorithm for regional citrate anticoagulation in membrane-based plasma exchange.

Method

This was an observational study in patients receiving citrate anticoagulated, membrane-based, plasma exchange at the Canberra Hospital between July 2017 and May 2020. Data was collected prospectively using an electronic medical record and compared to data from our previously published algorithm which had used a slower blood pump speed.

Results

There were 134 plasma exchange sessions performed during the observational period. Circuit clotting occurred in 4 sessions and 1 session was affected by symptomatic hypocalcaemia. A systemic ionised calcium <0.96 mmol/L was seen in 19.4% of sessions, which was a similar frequency to that seen in our previous algorithm. A systemic ionised Ca <0.81 mmol/L occurred in 4 sessions (all asymptomatic). This hypocalcaemia occurred towards the end of the sessions, after switching from albumin to fresh frozen plasma replacement fluid. Median treatment time was 135 minutes, compared to 219 minutes in our previously published algorithm. Mean net Ca gain/session was 7.7 ± 2.3 mmol.

Conclusion

An accelerated algorithm for regional citrate anticoagulation achieves substantial time savings while maintaining efficacy and safety. The 4 episodes of systemic ionised calcium <0.81 mmol/L may have been due to recirculation of infused citrate but, probably more likely, are due to the additional citrate load imposed by use of fresh frozen plasma in these sessions. Future algorithms need to better account for the citrate load present in fresh frozen plasma.
MO190NORMATIVE DATA FOR GLOMERULAR FILTRATION RATE IN HEALTHY KIDNEY DONOR POPULATION
Authors: Bhoyar Ashish , Bhargava Vinant , Gupta Ashwani , Gupta Anurag , Tiwari Vaibhav , Bhalla A K , Malik Manish , Rana Devinder Singh
Published: May 2021

Background and Aims

Glomerular filtration rate (GFR) is estimated traditionally from 24-hour urinary creatinine clearance. Creatinine is mainly filtered by glomerulus. The collection of 24-hour urinary sample is a difficult task with many patients fail to collect all the urine samples. As measuring GFR is cumbersome, expensive, and not easily available in all centers, various equations are developed for estimating GFR from creatinine like MDRD, CKD EPI creatinine. GFR obtained from serum creatinine shows wide variation as muscle mass and dietary protein intake are important determinants of serum creatinine concentration. Literature shows very few studies with GFR estimation with reference to age in Indian population. Hence, this study is planned to develop age specific nomogram for GFR in healthy kidney donor population as well as to study agreement between GFR obtained by 99m Tc DTPA three sample method and GFR estimated by 24-hour urinary creatinine. The aim of this stidy was to develop age-specific nomogram GFR in healthy kidney donor population and to study the agreement between the GFR measured by Technetium-99m diethylene triamine pentaacetic acid (99m Tc DTPA) and 24-hour urinary creatinine method.

Method

This study was conducted at Sir Ganga Ram hospital, New Delhi. All healthy individuals aged more than 20 years and less than 65 years, undergoing evaluation as prospective kidney donor at our hospital were the part of this study. GFR was measured by 99m Tc DTPA clearance using 3 sample method. GFR measured by DTPA method was used to develop nomogram. Creatinine Clearance was calculated from 24-hour urinary creatinine by formula U x V/P where, U is urinary creatinine level, P is plasma creatinine level and V is total volume of urine. Nomogram was developed with respect to these 3 Age groups; namely, 20 to 40 years, 40 to 50 years and 50 to 65 years

Results

Total 100 kidney donors were included in this study. Enrolled subjects were divided into 3 age groups; 20 to 40 years (n=28), 40 to 50 years (n=46) and 50 to 65 years (n=26). Majority of the donors were females (n=80). The agreement between GFR obtained by 99m Tc DTPA and 24-hour urinary creatinine clearance methods was 92.6 vs. 94 ml/min, 80.4 vs. 76 ml/min and 76.3 vs. 70 ml/min in respective age groups.

Conclusion

In the younger age group (20 to 40 years), there is better agreement in GFR measured by 99m Tc DTPA method and 24-hour urinary creatinine clearance methods.