bluuebunny/crossref_metadata_2025 huggingface dataset:
P1798MYCOPHENOLIC ACID TROUGH CONCENTRATION AND DOSE ARE ASSOCIATED WITH HEMATOLOGIC ABNORMALITIES BUT NOT REJECTION IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Jung Hee-Yeon , Lee Sukyung , Jeon Yena , Lim Jeong-Hoon , Choi Ji-Young , Cho Jang-Hee , Park Sun-Hee , Kim Yong-Lim , Kim Chan Duck
Published: June 2020

Background and Aims

Little is known regarding the safe fixed dose of mycophenolic acid (MPA) for preventing biopsy-proven acute rejection (BPAR) in kidney transplant recipients (KTRs). We investigated the correlation of MPA trough concentration (MPA C0) and dose with renal transplant outcomes and adverse events.

Method

This study included 79 consecutive KTRs who received MPA with tacrolimus (TAC) and corticosteroids. The MPA C0 of all the enrolled KTRs was measured, which was determined monthly by using particle-enhanced turbidimetric inhibition immunoassay for 12 months, and clinical data were collected at each time point. The clinical endpoints included BPAR, any cytopenia, and BK or cytomegalovirus infections.

Results

No differences in MPA C0 and dose were observed between KTRs with or without BPAR or viral infections under statistically comparable TAC concentrations. MPA C0 was significantly higher in patients with leukopenia (P = 0.021) and anemia (P = 0.002) compared with those without cytopenia. The MPA dose was significantly higher in patients with thrombocytopenia (P = 0.002) compared with those without thrombocytopenia. MPA C0 ≥ 3.5 µg/mL was an independent risk factor for leukopenia (adjusted odds ratio [AOR] 3.80, 95% confidence interval [CI] 1.24–11.64, P = 0.019) and anemia (AOR 5.90, 95% CI 1.27–27.51, P = 0.024). An MPA dose greater than the mean value of 1188.8 mg/day was an independent risk factor for thrombocytopenia (AOR 3.83, 95% CI 1.15–12.78, P = 0.029). However, an MPA dose less than the mean value of 1137.3 mg/day did not increase the risk of BPAR.

Conclusion

Either a higher MPA C0 or dose was associated with an increased risk of cytopenia, but neither a lower MPA C0 nor dose was associated with BPAR within the first year of transplantation. Hence, a reduced MPA dose with TAC and corticosteroids might be safe in terms of reducing hematologic abnormalities without causing rejection.
P1803EFFICACY, SAFETY AND IMPACT ON RENAL FUNCTIONALITY OF ACETAZOLAMIDE TREATMENT IN PATIENTS WITH PMM2-CDG (AZATAX CLINICAL TRIAL)
Authors: Serano Guimaré Mercedes , Arango Sancho Pedro , López Baez Víctor , Codina Sampera Elena , Calzada Baños Yolanda , Vinuesa Jaca Ana , Hernández Zúñiga Lina , Madrid Aris Álvaro
Published: June 2020

Background and Aims

Deficit of phosphomanomutase-(PMM2-CDG) is the most frequent congenital N-glycosylation defect, producing cerebellar syndrome with intellectual deficit and “stroke-like” episodes. It has been associated with renal alterations such as proteinuria, diffuse cortical hyperechogenicity and malformations. We evaluated efficacy, safety and renal repercussion of acetazolamide as a new therapeutic tool.

Method

First clinical trial in phase II including PMM2-CDG patients (5-21-years). First phase: 6 months treatment group with acetazolamide. Second phase: 5 weeks randomized withdrawal in responders (acetazolamide vs placebo), assessing renal functionality and effects of this medication. Dosing acetazolamide by 8 to 30mg/kg/day in 2-3 doses. Controls were performed at 3, 6, 14, 25 and 30 weeks determining acid-base balance, ionogram, renal function (creatinine) and Pr/Cr, Ca/Cr index and B2-microglobulin in first morning urine. All patients underwent in a bone densitometry study and renal ultrasound.

Results

24 patients were included (mean age 12.3 ± 4.5 years). Bicarbonate levels and plasma pH were significantly lower at week 25(p <0.001). 13 patient needs to reduce acetazolamide dose due to excessive metabolic acidosis or asthenia. They showed a decrease in sodium (p=0.06), potassium (p<0.001) and serum calcium(p=0.030), although maintained in low normality limit with a decrease in protein loss(p=0.019) and increase in calcium/creatinine index(p=0.025) without B2-microglobulin alterations. The previously ultrasound renal described findings; the cortical hyperechogenicity was observed in 8.4% without renal dysfunction or associated nephrocalcinosis. One patient presented microlithiasis and another, symptomatic renal lithiasis. Densitometric study 69% of patients presented values in the range of osteopenia at the end of trial (-0.9 to -4.9SD, average of -2.36SD).

Conclusion

The efficacy of acetazolamide in the neurological symptoms of PMM2-CDG, due to an enzymatic stimulation mechanism mediated by acidosis, generates the possibility of chronic treatment with the drug in this group of patients, with possible renal adverse effects associated with long-term, overshadowing the skeletal and renal prognosis.
P1805UNEXPECTD COMPLEMENT GENES ABNORALITIES IN CHILDREN WITH SECONDARY HEMOLITIC UREMIC SYNDROME
Authors: Cirillo Luigi , Becherucci Francesca , Guzzi Francesco , Errichiello Carmela , Buti Elisa , Vaglio Augusto , Materassi Marco , Romagnani Paola , Roperto Rosa Maria
Published: June 2020

Background and Aims

Secondary hemolytic-uremic syndrome (HUS) is currently defined in the absence of genetic defects in complement genes (primary or atypical HUS, aHUS) or Shiga-toxin producing E. Coli infection (STEC-HUS). However, the role of complement genes abnormalities in secondary HUS is still a matter of debate as results coming from studies performed in adults are controversial. Moreover, genetic defects of complement regulation have been recently described in children with STEC-HUS, thus challenging the current HUS classification. The identification of a role of complement genes abnormalities in these patients could have important clinical implications for diagnosis and treatment. In this study, we assessed the presence of complement genes abnormalities in children with secondary HUS.

Method

We describe a case series of pediatric patients diagnosed with secondary HUS. All patients were screened for the presence of ADAMTS13 auto-antibody and ADAMTS13 deficiency. We performed next-generation sequencing for a panel of complement genes reported in association with aHUS (CFH, CFI, MCP, C3, FB, and THBD). Copy number variations and hybrid genes assessment were included in the analysis.

Results

Four patients aged 1-4 years with a diagnosis of sporadic secondary HUS were included in the study. HUS was secondary to glomerulopathy, cobalamin deficiency, bone marrow transplantation, and pneumococcal pneumoniae. Two out of four patients showed hypocomplementaemia (both C3 and C4). Diarrhea was a common clinical feature in all patients at onset, and none of these patients showed neurologic involvement. Renal replacement therapy was required in two patients at onset. Only one patient did not recover kidney function, and subsequently underwent kidney transplantation. Next-generation sequencing showed genetic abnormalities in all the patients (Table 1). All but one genetic variants have already been described in association with atypical HUS. Interestingly, haplotypes in CHF and MCP were present in three patients, all of Caucasian ethnicity.

Conclusion

According to the current HUS classification, complement abnormalities are diagnostic of aHUS. However, results coming from pediatric cohorts of STEC-HUS patients already claimed a role for genetic background also outside the aHUS spectrum, suggesting that the current terminology lacks both specificity and suggestion of cause. In this case series, complement genes abnormalities were present in all patients. Whether confirmed in larger cohorts, these findings would support the role of genetic background even in secondary HUS, suggesting the need for a revision of the current HUS classification, in agreement with the pathogenic mechanisms, in order to tailor the optimal treatment.
P1807COMPARISON BETWEEN INFERIOR VENA CAVA DIAMETER, BIOIMPEDANCE SPECTROSCOPY AND CLINICAL CRITERION FOR DRY WEIGHT ESTIMATION IN HEMODIALYZED CHILDREN
Authors: Askiti Varvara , Malakasioti Georgia , Servos George , Grigoriadou Georgia , Mitsioni Andromachi
Published: June 2020

Background and Aims

The determination of dry weight (DW) in children on chronic hemodialysis (HD) remains problematic. No method has been shown superior for DW assessment in the few pediatric studies exploring the utility of inferior vena cava expiratory and inspiratory diameter diameter (IVCDe, IVCDi) and BIS against clinical criteria. We aimed to compare the performance of IVCD, BIS and clinical judgement in DW prediction in hemodialyzed children.

Method

IVCD and BIS were measured serially pre and post the midweek HD session. IVCDi, IVCDe and IVC contractility index (IVCCI) associations with: (1) BIS estimated (BIS-relOH) and (2) clinically assessed hydration status (OHc) based on deviation from DW were explored. The interpretation of IVC measurements was based on previously published pediatric reference values. The level of agreement between the three tools in fluid overload recognition was studied.

Results

Fifty-two sets of measurements were undertaken in 13 patients (median age 11 years). OHc and BIS-relOH were positively associated to each other (r=0,5, p<0,05) and to IVCDi (r=0,4, r=0,5, p<0,05) and IVCDe (r=0,4, r=0,6, p<0,05). A negative association between IVCCI and relOH-BIS was observed (r= -0,4, p<0,05). There was a poor agreement between the three methods in identification of fluid overload; out of 28 clinically overloaded patients, BIS identified only 7 whereas IVCD none (Cohen’s k <0).

Conclusion

IVCD measurements alone are not reliable for accurate fluid status prediction in hemodialyzed children as they seem to underestimate fluid overload compared to BIS and clinical criteria. Further studies are warranted to explore the applicability of new technologies for DW assessment of dialysis patients.
P1809EARLY URINARY SYSTEM COMPLICATIONS IN CHILDREN WITH HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Gurbanov Anar , Gülhan Bora , Kuşkonmaz Barış , Okur Fatma Visal , Uçkan Çetinkaya Duygu , Ozdemir Gulsah , Taş Nesrin , Çelegen Kübra , Ozaltin Fatih , Duzova Ali , Topaloglu Rezan
Published: June 2020

Background and Aims

Urinary system complications after hematopoietic stem cell transplantation (HSCT) cause severe morbidity and mortality. The aim of the study is to investigate the incidence and risk factors of urinary system complications in patients who had HSCT during their childhood.

Method

Patients who had HSCT between January 2010-2019 with a minimum follow-up period of 6 months were included in the study. Data regarding urinary system complications were collected from the medical records of the patients. pRIFLE and KDIGO classification systems were used for the definition of acute kidney injury (AKI).

Results

167 patients (108 males and 59 females) with allogeneic (n=165) and autologous (n=2) HSCT were investigated for renal complications. In cohort, HSCT was performed in 41 patients (%24.6) secondary to malignant diseases and in 126 patients secondary to non-malignant diseases. Hemorrhagic cystitis (HC) developed in 28 patients (16.8%) after HSCT. The mean age of the patients with and without HC was 14.6±5.6 years and 10.5±6 years, respectively (p=0.044). Among patients with HC, 17 had concomitant viral infection. Presence of viral infection, gender, disease group, history conditioning regime, total body irradiation, acute graft-versus-host disease and veno-occlusive disease (VOD) did not have any effect on the development of HC in logistic regression analysis. In cohort, 126 patients (75.4%) developed AKI according to KDIGO classification (stage 1; 55 patients, stage 2; 36 patients, stage 3; 35 patients). The mean period of development of AKI after HSCT was 34±22 days. The risk of AKI (according to KDIGO) was higher in patients who had HSCT secondary to malignant diseases and/or who developed viral infections after HSCT (p=0.034 and p=0.013, respectively). Among patients, 71 patients (%42.5) developed AKI according to pRIFLE classification. The risk of AKI (according to pRIFLE) was higher in patients who had HSCT secondary to malignant diseases, who developed viral infections and/or who developed VOD during follow-up (p=0.043, p=0.001 and p=0.006, respectively). One patient developed thrombotic microangiopathy after HSCT. None of the patients had nephrotic syndrome during follow-up period.

Conclusion

Patients who had HSCT secondary to malignant disease, history of viral infections and/or VOD had higher risk of AKI and should be closely monitored.
P1823THE ROLE OF FGF-23 IN CKD PROGRESSION IN CHILDREN
Authors: Balmukhanova Altynay , Kabulbayev Kairat , Kanatbayeva Assiya , Alpay Harika , Balmukhanova Aigul , Shepetov Abay
Published: June 2020

Background and Aims

Chronic kidney disease (CKD) is considered a global medical and public health issue. CKD takes a special place among non-infectious diseases because of its prevalence (6-20% according to different surveys and studies) and is associated with a poor life quality, complications and high risk of mortality. In recent years, there have been new biomarkers requiring more research in this area. One of these biomarkers is Fibroblast growth factor-23 (FGF-23) which is found as a bone derived hormone and might be a predictor of progression. However, the role of FGF-23 in CKD progression in children has not been adequately studied, especially on the early stages. Nowadays, the study of FGF-23 in children and the question of the clinical importance of this marker are relevant. Therefore, the aim of our study was to establish the role of FGF-23 in CKD progression in children.

Method

A prospective study was conducted on 73 children with different stages of CKD and 14 healthy individuals (control group) matched by age and gender. There were approximately equal numbers of patients in study groups. An average age was 9.61±1.05 years. Exclusion criteria: active inflammatory, bone, infectious, oncological, immunological diseases, taking steroids and vitamin D supplements. Laboratory measurements included all common clinical and biochemical indicators. Serum concentration of intact FGF-23 was assessed by using the ELISA method (Biomedica Medizinprodukte GmbH, Austria). Statistical analysis was conducted in MS Excel 2016 and SPSS 18.0.

Results

The normal range of FGF-23 for this kit was 0.1-1.5 pmol/l. The average value of FGF-23 in the control group was 0.69±0.12 pmol/l. Further studies in the groups with different stages of CKD revealed that FGF-23 concentration gradually rose in parallel with stages of CKD, and it reached the maximum on the last stage. It should be noticed that the level of FGF-23 concentration on the first stage of CKD was normal (0.73±0.14 pmol/l) and the comparison with healthy individuals revealed no significant differences. What is remarkable, despite the fact that the average value of the second stage patients was normal (1.36±0.2 pmol/l), there was a statistically significant difference with the control group (p=0.008). The levels of FGF-23 on the next stages were 2.52±0.52 pmol/l, 5.42±1.61 pmol/l, and 12.16±1.55 pmol/l, respectively. The differences were considerable and proved by statistical analysis (p<0.01).

Conclusion

Our study showed that there is an upward trend of FGF-23 as CKD progresses from early to advanced stages. The results on the second and third stages indicate that FGF-23 should be considered as one of early biomarkers of CKD progression in children. Thus, there is a need for more studies in this area.
P1824RETROSPECTIVE STUDY FOR THE ANALYSIS AND EVOLUTION OF RENAL FUNCTION IN A COHORT OF PATIENTS AFFECTED BY THE NEPHRONOPHTHISIS COMPLEX
Authors: Arango Sancho Pedro , López Baez Víctor , Codina Sampera Elena , Calzada Baños Yolanda , Vinuesa Jaca Ana , Hernández Zúñiga Lina , Madrid Aris Álvaro
Published: June 2020

Background and Aims

Determine evolution of renal function in nephronophthisis patient cohort, prognosis and variability of clinical presentation.

Method

Retrospective observational study to determine evolution of renal function in our cohort(n=13) between 4.5-20 years affected by different syndromes associated with nephronophthisis complex in last 20 years. We compared clinical-analytical parameters to diagnosis with current ones, including needs for kidney transplantation and results of genetics.

Results

Chronic-Kidney-Disease (CKD) prevalence at diagnosis was between 0.9-8.5 years (mean 5.3 years), staging of CKD was: 30.7% stage 2, 15.38% stage 3a and 1 patient stage 3b. 23.07% in stages 4 and 5. 69.23% needs first kidney transplantation and even a second one 15.38%. The average age at first transplantation was 6.04 years(2-11.67 years). The mean age to enter in renal replacement therapy program was 1.3 years(0.1-3.67 years). Among non-transplant, from diagnosis to present its being 0.5-7.25 years(median, 4.24 years). Most frequent symptom at the onset of the disease was delay in weight gain and height(84.61%) and also in cognitive development(53.84%), followed by polyuria-polydipsia(46.15%) and other signs/symptoms such as ataxia, pigmentary retinitis, hepatic insufficiency or skeletal alterations. In fact, in up to 54% of cases, renal involvement was a casual finding. Even with this, the most frequent form of presentation was purely renal(38.46%), followed by Joubert's Syndrome(30.77%), RHYNS(15.38%), Senior-Loken(7.7%) and Maizner-Saldino(7.7%). Currently, calculated glomerular filtration rate ranges between30.2-90.21 ml/min/1.73 m2 among recipient, with majority in the CKD stages: 3a(56%) and in between 30-128 ml/min/1.73 m2 among non-transplant patients, with predominance CKD 2 (50%).

Conclusion

The prognosis of renal function in the short-medium term in nephronophthisis is unfortunate. The possible initial symptomatic renal silence, the need (>50%) of multidisciplinary management and the frequency of CKD advanced to the diagnosis make necessary the knowledge of the disease and its possible associations, as well as its active search.
P1826ASSESSMENT OF GROWTH PARAMETERS OF CHILDREN IN LONG TERM FOLLOW UP WITH DIFFERENT RELAPSING COURSE OF NEPHROTIC SYNDROME
Authors: Sharma Sonia
Published: June 2020

Background and Aims

Childhood Nephrotic syndrome has its peak onset in the age group 2-4 years, and that is also a period of significant height growth. Corticosteroids and chronic diseases are known to have long term effects on growth parameters of these children. Hence we assessed and compared the growth of children with Infrequent relapsing (IFRNS) and remission (R) as group 1, Frequent -relapsing (FR), and steroid - dependent (SD) as group 2 and steroid -resistant (SR) as group 3.

Method

This retrospective single center study collected data from medical records of children presented in a pediatric nephrology clinic in a tertiary care center in New Delhi. Nephrotic children, aged 1-18 years with regular follow up in the period of 2014 to 2019 were included. Basic demographic details including age at onset and age at last follow up in clinic, sex, anthropometry details at last follow up were recorded. We traced initial height at nephrotic syndrome onset to assess growth velocity but were unavailable at the moment so excluded from analysis. Also, children completed less than 1 year follow up, and compliance issues were excluded. Z scores (standard deviation score) for weight, height and BMI were calculated. Initial comparison of three groups as FR/SDNS, IFRNS/R and SRNS was done. But in the second comparison, we combined FR/SD and SR children in one group as Difficult nephrotic syndrome (DNS) group. Anova Kruskal-Wallis test was used to find significance in three groups in table 1. Subsequent analysis was done by the non-parametric statistic method Mann-Whitney Test to assess significance in subgroups of boys and girls.

Results:

27 IFR/R nephrotic children, 36 FR/SD, and 15 SRNS were compared as in Table1. D-NS and IFRNS-R for boys and girls ratio (11; 16) & (18; 32) followed for a median period of 18 (max 46; 12), 24.6 (57.6; 12), and 32 (50;12) months respectively.

Conclusion

Linear growth (height) is the most affected parameters in children in SRNS and FR/SD nephrotic syndrome. Effect is more significant in girls then in boys as they showed improvement in . No difference in weight and BMI is seen on applied statistics in two groups.
P1827SIMPLE METHOD OF RENAL BIOPSY WITHOUT ADMISSIN IN CHILDREN
Authors: Cho Byoung-Soo , Yun Hyaejin , Jung Sungmin , Lee Hyun-soon
Published: June 2020

Background and Aims

Renal biopsy is an essential procedure for diagnosis and prognosis of the glomerular diseases, however needs a lot of skill and experience to do and usually requires admission for a couple of days, unless sometimes needs an embolization, transfusion, nephrectomy etc. We have an experience of more than 3,000 cases of renal biopsy without major complications such as bleeding, embolization, nephrectomy etc.. Recently we performed 309 cases of renal biopsies, whose age is under 20 year old, at the OPD level without admission.

Method

Before renal biopsy we checked bleeding tendencies and blood thinning agents were hold for more than 1 week. Kidney biopsy was done under local lidocain anesthetic at biopsy site and IV ketamine in uncooperative children. Biopsy needle was inserted under the ultrasound guide(GE LogiQ E9) at the lower pole of the kidney. We checked renal hematoma, AV-fistula formation etc. by ultrasound 3 times every one hour until go home. Biopsy materials were sent to H.S.Lee’s pathology lab. All patients went home in 6 hours after procedure. As far as we know, our clinic is the world’s first time try doing kidney biopsy at OPD plus pathology together, although some kidney pathology reading centers are available in some place.

IF results were reported by on-line on the day of kidney biopsy after 5 hours and LM and EM were reported by on-line within two days. All cases went home after 6 hours of procedure.

Results

We performed 309 cases of renal biopsy at OPD level without any major complications, of which 43 cases were follow up renal biopsies. No major complications were noted such as bleeding, AV fistular, embolization, nephrectomy etc.. Male to female ratio was 1.24. Age distribution was from 2 to 20 year-old.

Biopsy results were as follows; mesangial proliferative glomerulonephritis 82 cases(26.51%), IgA nephropathy 81 cases(26.2%), mild focal nonspecific glomerulonephritis 45 cases(14.6%), HSP 23 cases(7.4%), focal segmental glomerulosclerosis 17 cases(5.5%), podocyte disease 13 cases (4.2%), Alport’s syndrome 10 cases(3.2%), minor glomerular change 10 cases (3.2%), MPGN 8 cases (2.6%), membranous nephropathy 6 cases(1.9%), and Lupus nephritis, C1q nephropathy, C3 nephropathy, obesity related nephropathy were 11 cases respectively and others include acute PSGN, chronic tubulointerstitial nephritis.

Conclusion

OPD level percutaneous renal biopsy in children is no more a dangerous procedure if performed exactly at lower pole of the kidney, with close follow up for 6 hours by ultrasound examination.
P1830HEMODIALYSIS IN CHILDREN:NINE YEARS OF EXPERIENCE OF ALBANIAN CHILDREN HEMODIALYSIS CENTER
Authors: Xhango Ornela , Xhepa Rezar , Shtiza Diamant
Published: June 2020

Background and Aims

Hemodialysis is one of the modalities of renal replacement therapies, which is required for patients with serious acute or chronic renal dysfunction, in consequence, with uremic toxicity and derangement of electrolytes and acid-base balance.

We started provided an hemodyalisis treatment for children in Albania, for the first time about nine years ago. We want to show you our modest experience and some statistical data about the only centre of the hemodialysis for children in Albania.

Method

All patients who received hemodyalisis treatment between September 2010 and September 2019, were enrolled in the study.

Results

55 children with acute or chronic injury received hemodyalisis treatment over 9 years; 28 females and 27 males, aged from 6 months to 17 years old. 29 cases had acute kidney injury (14 of them due to HUS). 23 of AKI cases are completely recovered. 5 cases had fatal outcome, one left with renal sequelae. Of 26 children with chronic kidney disease, 13 of them underwent live-related renal transplantation, 3 children are left to continue their treatments abroad, one child actually is in CAPD, 2children died, the others continue the dialysis treatments. 14 children came from Kosovo.

Conclusion

Despite the limited experience, our hemodialysis center has successfully handled cases not only from Albania, but also from Kosovo.
P1833HOW DO WE DEFINE HYPERCALCIURIA IN 24 HR URINE?
Authors: Choi Hyowon , Namgoong Mee Kyung
Published: June 2020

Background and Aims

Hypercalciuria can clinically present itself as gross hematuria, microscopic hematuria, dysuria or abdominal pain without urinary lithiasis. It is also one of main metabolic causes of urinary lithiasis in children. In Nelson pediatrics, hypercalciuria is defined by a 24 -hour urine for calcium excretion>4mg/kg/day. A spot urine calcium creatinine ratio of >0.2, is considered abnormal in older children and adolescents. Both of them are not a standardized detect in children. Fasting and postprandial spot urinary calcium creatinine ratios may not detect hypercalciuria so accurately, that a 24-hour urine is preferred. In addition, 24hr urine collection is frequently under- or over-collected, which leads to an inadequate sampling hard to pick up which one the more accurate calculating methodology for the hypercalciuria detection with 24hr urine is. In this study, we evaluated the comparisons of 24 hr urine calcium creatinine ratio(Ca/Cr), 24hr urine calcium excretion(mg/kg)(Ca/Kg) and CCCR in school aged children.

24-hour urine for calcium excretion>4mg/kg/day

24-hour urine calcium creatinine ratio of >0.2

Calcium creatinine clearance ratio(CCCR); (24-hour U-calcium/P-total calcium) / (24-hour U-creatinine/P-creatinine), as known as fractional excretion of calcium(FeCa)

Method

We enrolled 250 normal kidney function patients who’s age is 7 to 18 year, was able to collect 24 hr urine in a single hospital unit. We conducted 24 hr urine collection, serum calcium creatinine levels on the same day from January 2007 to December 2019. We analyze of each values. We used SPSS. 25.0

Results
P1843NEPHROLOGICAL THEMATOLOGY IN PUBLICATIONS DIACHRONICALLY APPEARING IN THE PUBMED BIBLIOGRAPHICAL DATABASE
Authors: Stefanidis Ioannis , Diamandopoulos Athanasios
Published: June 2020

Background and Aims

Nephrology is a medical specialty, which in the last 50 years experienced very important scientific developments, which formally revolutionized clinical practice, namely renal biopsy, renal replacement therapy and transplantation. In addition understanding pathogenesis and clinic of renal disease also improves steadily, resulting in renewal of definitions, classifications and therapeutics in nephrology. In this context publications with nephrological content are also expanding. The aim of this bibliography-study was to analyze the publications, related to nephrology specific keywords, as they appear in the PubMed database.

Method

Certain nephrology related keywords were applied: “nephrology”, “acute renal failure”, “renal biopsy”, “hemodialysis”, “peritoneal dialysis” and “renal transplantation” were applied as terms in PubMed. Instead of renal kidney was used as an alternative term.

Results

Nephrology as a term appears 141573 times in the database and beginning from 1946 its appearance is expanding in the last three decades. The term “acute renal failure” is found for the time in 1932 in one publication and in a total number 92278 of publications. Renal biopsy appears from 1943 in a total number of 15506 publications. Hemodialysis appears in 182730 citations for the first time in 1915 in human application. Peritoneal dialysis appears in 32266 citations for the first time in 1901 and 1946 in human application. One publication on renal transplantation appears in 1946 and the total number of publications related to renal transplantation is 106075.

Conclusion

According to the above findings there is a clear expansion of nephrological publications in the last decades. In addition, hemodialysis remains still the most frequent term used in nephrology related publications. Historical analysis the PubMed database is very useful as a tool to understand the research and publication trends in nephrology, as we approach to the new era of precision medicine.
P1844QUOTATIONS FROM AHRUN AL-QASS RELATED TO THE GENITOURINARY SYSTEM DISEASES IN RHAZES'S LIBER CONTINENS
Authors: ACIDUMAN Ahmet , AŞKİT Çağatay
Published: June 2020

Background and Aims

Ahrun al-Qass “the priest”, one of the last Alexandrian physicians before the Islamic era and probably a contemporary of Paul of Aegina, composed an enormous Medical Pandect (Kunnāsh fī al-Tibb) containing 30 books. This work is considered to have been originally written in Greek and later to have translated into Syriac. It became one of the important sources of medicine throughout the Islamic world after having been translated from Syriac into Arabic by Māsarjawayh. Some fragments of this lost work have survived in Kitāb al-Hāwī/Liber Continens. The purpose of this study is to present the Ahrun’s fragments related to the genitourinary system diseases existing in Rhazes’s abovementioned work and to introduce them to the history of medicine in the English language.

Method

The quotations from Ahrun related to the genitourinary system diseases in the 10th book of Kitāb al-Hāwī, entitled as “fī amrāḍ al-kulā wa majārī al-bawl wa ghayrihā” are identified via the Arabic and Latin text. Consequently, they are compared to each other and translated into English.

Results

The quotations, in which Rhazes mentioned Ahrun’s name, are related to the genitourinary system diseases such as kidney ulcers, kidney and bladder stones and their treatment, urinary retention, diabetes, involuntarily flow of sperm and its treatment. Some of these quotations also have Rhazes’s comments.

Conclusion

In this study, fragments of Ahrun al-Qass related to the genitourinary system diseases and Rhazes’s comments on them in Liber Continens are discussed and registered to the literature in the field of history of medicine in the English language.
P1846HISTORY OF ARTIFICIAL INTELLIGENCE AND ITS APPLICATION IN NEPHROLOGY
Authors: Tasic Danijela , Milovancevic Milos , Djordjevic Katarina , Galovic Slobodanka , Dimitrijevic Zorica , Mitic Branka , Glogovac Stevan
Published: June 2020

Background and Aims

The application of artificial intelligence and neural networks in medicine is used to help solve problems that cannot be handled by the classical approach. The common name “cybernetics” encompassed the fields of management, information technology and biomedicine, but these disciplines continued to evolve independently due to the explosion of new knowledge. Over time, the development of neural networks has been turbulent and is now widely used in various fields of medicine and even in nephrology.

The aim of the paper is to analyze the history of the development of artificial intelligence and its application in nephrology.

Method

Data were collected from books, magazines, encyclopedias and databases.

Results

Basic research on cybernetics and medicine was done by Golgi and Kelley doctors after Isaak Newton and Hermann von Helmholtz. The first theoretical mathematical models were derived in 1943 by Warren Mc Culloch and Walter Pitts. A few years later, a more contemporary contribution to the development of neural networks was given by Norbert Wiener and John von Neumann because they thought that research into biomedicine based on human brain function would be very interesting. In addition, in 1948 Norbert Wiener was the first to publish a work explaining the term cybernetics. At that time, the first experiments were made and new theories in the field of artificial intelligence were put forward by Marvin Misnki. The first training of neurons and the basis of all methods for training neurons was described by the Canadian Donald O Hebb. After the first successful neurocomputer in 1957, on which Rosenblatt worked, scientists have perfected various models of neural networks to this day. So far, mostly retrospective studies have been done in clinical nephrology, transplantation and dialysis with the help of algorithms used in neural networks.

Particularly complex nephrologic patient relationships as well as assistance with timely implementation of new good clinical practice guidelines, patient prediction in at least the next month, and patient selection for palliative care are just some segments in nephrology that require the introduction of such tools into daily clinical practice with the aim of sensitive patient populations have better treatment outcomes, with physicians having more comprehensive insight and control over the mass of data.

Conclusion

Today‘s application of artificial intelligence in nephrology is based on retrospective research. The dizzying rise in technological development so far will allow the use of cybernetics and available tools based on neural network algorithms to enable and improve the nephrologists’ dedication and effectiveness.
P1853FIVE YEARS PROSPECTIVE, OBSERVATIONAL, INTERNATIONAL STUDY ON THE IMPACT OF DECISION-MAKING TOOLS FOR CHOICE OF RENAL REPLACEMENT THERAPY MODALITY
Authors: Marrón Belén , Pearce Suzanne , Ostrowski Janusz , Munteanu Dan , Torok Marietta , Roesch Michael , Martín Claudia , Kochman Pawel , Orosz Attila , García Marrón Jaime , Macário Fernando
Published: June 2020

Background and Aims

Decision-Making Tools (DMTs) are still not widely used but are considered the Gold Standard to ensure patients are well informed to choose renal replacement therapy (RRT) modality.

To analyze the impact of a structured modality information program (via DMTs) on RRT modality choice and start.

Method

All 2014-2017 predialysis patients (pts) with CKD G4-G5 and those starting unplanned dialysis without a prior information process underwent a DMTs process for RRT choice and were followed up to Dec.31st, 2018. DMTs included values evaluation, RRT information with different tools, staff deliberation support and patient modality choice. Results shown as percentage of pts who reached a certain stage over the total number of pts under evaluation.

Results

2012 pts (mean age 61 y.) from 48 clinics (cl.) in Poland (PL, 19 cl., 980 pts), Romania (RO, 12 cl., 351 pts), Hungary (HU, 10 cl., 341 pts), Germany (DE, 6 cl., 292 pts) and Argentina (AR, 1 cl., 48 pts) underwent DMTs. Staff considered PD contraindicated in 29% of pts, hence optimal candidates for HD/PD were 1408 pts. (mean age 60y. and 46% prone for a home therapy). Early referral (≥3 m. in clinic before DMT started): 51%. Aids used included written information (97% of pts), DVD in 27% and HD/PD utility visits in 49%. Relatives’ participation in the process was 82%. Most pts (91%) considered the program useful whilst 64% of staff felt that this program was better than the prior one. PD choice (35%) varied among countries: 15% (RO), 30% (PL), 36% (HU), 62% (DE) and 98% (AR). For pts who had started dialysis by study closure (n=948), PD as chronic RRT was 31% (9% after an unplanned HD start); 13% (RO), 27% (PL), 34% (HU), 54% (GE) and 83% (AR).

Conclusion

Use of DMTs at the time of RRT modality choice complies with patient empowerment and decision sharing (patients-relatives-staff). PD choice and take-on varied among countries. Most patients who chose PD were chronically ascribed to PD representing at least one third of the suitable patients for both dialysis modalities.
P1855ONLINE PATIENT/CAREGIVER EDUCATION ON HYPERKALEMIA CAN IMPROVE KNOWLEDGE AND COMPETENCE AS WELL AS PROMPT REAL LIFE CHANGES
Authors: Larkin Amy , Blatherwick Don
Published: June 2020

Background and Aims

Managing hyperkalemia with a strict diet is limiting and difficult for patients. We sought to measure the impact of online education for patients/caregivers on knowledge and confidence as well as prompting change in daily life.

Method

The patient/caregiver education was designed as 2 online, interactive activities. Both were comprised of text and integrated visuals; the second also included a patient commentary video. Demographic questions were asked prior to starting the education. A knowledge question was asked both before and after the activity to assess learning gains, as well as intent to change and confidence questions at the end. Absolute improvements were calculated for pre/post questions. The activities launched in April and May of 2019, and data collected through October 2019.

Results

To date, 98,462 learners have participated in the patient/caregiver activity.

Activity 1: High Potassium: Causes and reasons to Treat

Participants: 60,060

Completers of all questions (included in outcomes analysis): 7,262

Demographics: 59% female; 49% white, non-Hispanic; 66% over the age of 54; 16% have hyperkalemia, 75% were interested in learning more about the condition

Knowledge changes: 13% improvement in understanding what causes hyperkalemia (46% pre to 59% post)

Intent-to-act: 66% plan to talk to an HCP about next steps for treating hyperkalemia

Confidence changes: 82% reported increased confidence understanding why it’s important to treat hyperkalemia

Activity 2: It’s Complicated: How to Manage High Potassium and Heart Failure

Participants: 38,402

Completers of all questions (included in outcomes analysis): 3,816

Demographics: 60% female; 63% white, non-Hispanic; 69% over the age of 54; 58% were interested in learning more about the condition and 25% have this condition

Knowledge changes: 13% improvement in recognizing how potassium levels effect the heart (76% pre to 89% post)

Intent-to-act: 64% plan to talk to their healthcare provider about a plan to manage my hyperkalemia

Confidence changes: 82% reported increased confidence understanding how important is it to manage my heart failure and hyperkalemia

Conclusion

The metrics and outcomes gathered in this assessment are a strong indicator that these patient/caregiver-focused online educational activities improved knowledge and confidence, and prompted intent to act by patients/caregivers related to hyperkalemia.
P0516DCR2 PROMOTES RENAL FIBROSIS BY ACCELERATING TUBULAR CELL SENESCENCE AFTER ISCHEMIA REPERFUSION INJURY
Authors: Chen Jia , He Yani
Published: June 2020

Background and Aims

Cell senescence of renal tubular epithelial cells (RTECs), which is involved in renal fibrosis, is a key event in the progression of acute kidney injury (AKI). However, the underlying mechanism remains unclear. This study aims to investigate the role and mechanism of decoy receptor 2 (DcR2) in renal fibrosis and cell senescence of RTECs.

Method

KSP-creDcR2f/f mouse (Tubular DcR2 KO) and Ischemia-Reperfusion (I/R) Injury models were constructed. The models were divided into moderated (ischemia 20min) and severe (ischemia 35min) injury. The expression of renal DcR2, senescent markers (P16, P21, SA-β-gal) and senescent phenotype (IL-6, TGF-β1) were detected. Furthermore, wild type (WT) mice and KSP-creDcR2f/f mice were used to compare the degree of renal tissue and functional damage and the senescence of renal tubular cells after I/R injury. In vitro, knockdown and overexpression experiments were performed by transfected DcR2 siRNA or overexpressed adenovirus in hypoxia-reoxygenation stimulated mouse primary RTEC. The cell senescence and phenotype markers were further detected.

Results

The levels of Scr, BUN and urinary DcR2 and renal injury scores were significantly increased in I/R group at the early stage (1d) of renal injury compared with sham group. Renal fibrosis was observed in the later stage (21-42d) in severe injury. DcR2 was mainly expressed in renal tubules, and the percentage of tubular DcR2 was increased after I/R injury. DcR2 was co-expressed with P16 and SA-β-gal, and urinary DcR2 levels were related to senescent makers, suggesting that DcR2 was associated with cell senescence. The renal function and renal injury scores were lower in KSP-creDcR2f/f mice than that of WT after renal reperfusion. And the area of renal fibrosis was significantly decreased in KSP-creDcR2f/f mice compared with WT, indicating DcR2 inhibited renal fibrosis. Furthermore, the expression of senescent phenotype were suppressed in tubular DcR2 KO mice after I/R injury, suggesting that DcR2 could promote the senescence of renal tubule cells.

Conclusion

DcR2 promotes renal fibrosis by accelerating tubular cell senescence after ischemia-reperfusion Injury, suggesting that DcR2 may be a potential intervention target during the progression of AKI.
P0872EFFECT OF PARATHYROID HORMONE OSCILLATIONS ON BONE HEALTH: FROM OSTEO-ANABOLISM TO CATABOLISM
Authors: Cherif Alhaji , Kotanko Peter
Published: June 2020

Background and Aims

In patients with chronic kidney disease or primary hyperparathyroidism, chronically elevated parathyroid hormones (PTH) levels exert catabolic effects on the bone. In contrast, PTH oscillations (as seen in healthy subjects) or daily application of teriparatide (a form of PTH consisting of the N-terminal 34 amino acids; it is used to treat osteoporosis) promote bone formation. These differential responses have important clinical and therapeutic implications. Although the anabolic effects of PTH (and teriparatide) cycling are widely accepted, the underlying osteo-anabolic dynamics are not well understood.

Method

A recently developed mechanistic physiology-based model quantitating the interrelations of osteoclasts, osteoblasts and osteocytes on bone remodeling is used (Cherif et al., ΝΔΤ 2018, 33 (συππλ. 1): 165–166). The model incorporates cell-to-cell signaling pathways (i.e., RANK-RANKL-OPG), intracellular pathways, cytokines (i.e. TGFβ), PTH, sclerostin, and endocrine and paracrine feedbacks. Using the validated model, we explore the effect of altered PTH (teriparatide) administration regimen (e.g., dosing frequency and amplitude) on bone catabolism and anabolism, respectively.

Results

As in previous studies, the model accurately predicts differential responses of osteo-anabolic and catabolic effects of continuously and intermittently elevated PTH (teriparatide) levels, respectively. In addition, we observe that intermittent administration of PTH with a high frequency and amplitude induces bone catabolism similar to that seen in pathologies with continuously elevated PTH (i.e. primary or secondary hyperparathyroidism). We see a more than 3-fold change from baseline in osteoclastic over osteoblastic activities, resulting in a bone efflux of calcium and phosphate. Low PTH frequency with high dosing amplitude induces both osteoclastic and osteoblastic activities, but the net result is bone anabolism. Further, Fig. 1 shows a nonlinear region where high osteoblastic activities exceed osteoclastic resorption. These findings suggest the existence of optimal PTH (teriparatide) frequency-amplitude combinations that enhance anabolic gains, beyond which there can be a detrimental effect on bone.

Conclusion

Our results suggest that both frequency and amplitude of PTH (teriparatide) cycling affect the balance of osteo-catabolic and -anabolic effects. Understanding the underlying mechanism of differential osteo-anabolic and -catabolic responses induced by intermittent and continuous levels of PTH, respectively, may provide new therapeutic options for patients and minimize unintended consequences of intervention protocols.
P0876THE ROLE OF TRPM7 IN VASCULAR CALCIFICATION: COMPARISION BETWEEN PHOSPHATE AND UREMIC TOXIN
Authors: Lee Chien-Te , Ng Hwee-Yeong
Published: June 2020

Background and Aims

Vascular calcification is a common complication in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality. Pathogenesis of vascular calcification in CKD is multiple and phenotypic transformation of vascular smooth muscle cell (VSMC) is of critical importance. TRPM7 is a magnesium channel that regulate magnesium transport. The role of TRPM7 in VSMC transformation during vascular calcification is not clear. We aim to investigate the effects of phosphate and indoxyl sulphate on the expression of TRPM7 in VSMC and 2-APB, the TRPM7 blocker was used to evaluate the alteration of calcification-related molecules.

Method

Human aortic smooth muscle cells (HASMC) were used and treated either with phosphate (3.3mM) or indoxyl sulphate (500uM) for 7 days. 2-APB, a channel blocker of TRPM7 was added simultaneously in blocking experiment. Cells were then examined grossly and alizarin red solution was employed for calcification staining assessment. For calcification process study, cells were harvested for gene expression and protein abundance analysis.

Results

Gross examination did not find evidence of cell death during experiment on both treatments. Alizarin staining revealed apparent calcification in phosphate-treated HASMC but it was unremarkable in indoxyl sulphate. Phosphate treatment induced significant increase in RUNX2(151±35.8% of control), BMP2(124±10.1%), BMP7(155±9.3%), vitamin D receptor (VDR, 138±21%), calcium sensing receptor (CaSR, 185± 39%) and TRPM7(172±33.7%, all p< 0.05), but DKK1 and sclerostin were not changed. The addition of 2-APB prevented the increase of RUNX2(107±31.2%), BMP2(80±4.9%), BMP7(72±32.9%), VDR (94±43.2%), CaSR (83±17%) and TRPM7(118±23.9%). Indoxyl sulphate treatment was associated with decrease in TRPM7 (45±22%, p<0.05), but increase in BMP2(136±10.4%), VDR (154±53.5%) were noted. There were no significant alterations in CaSR (108±43.7%) and sclerostin (110±27.1%). Co-administration with 2-APB partially reduced the increase in RUNX2(158±55.1%), VDR (149±35.9%). The abundance of BMP2/7were not changed. TRPM7 was decreased significantly (33±23.1%).

Conclusion

We concluded that both phosphate and indoxyl sulphate induced calcification in VSMC but it was less in indoxyl sulphate. TRPM7 was upregulated by phosphate but decreased in indoxyl sulphate treatment. Blocking TRPM7 with 2-APB can prevent phosphate-induced calcification but partially attenuated calcification during indoxyl sulphate administration.