bluuebunny/crossref_metadata_2025 huggingface dataset:
P0523PROTECTIVE ROLE OF REGULATORY B CELLS ON THE RENAL TISSUE REPAIRMEN AFTER ISCHEMIA REPERCUSSION INJURY
Authors: Yunosuke Yokota , Kodama Goh , Itou Sakuya , Nakayama Yosuke , Komatsu Nobukazu , Mizoguchi Atsushi , Fukami Kei
Published: June 2020

Background and Aims

Acute kidney injury (AKI), even if followed by renal recovery, is a risk factor for the future development of chronic kidney disease (CKD) and end- stage renal disease. It has been postulated that interleukin-10 (IL-10)-producing Regulatory B cells (Breg) play an important role for the tissue repairment in several tissues and organs. Basically, protective role of Breg has been reported in inflammatory bowel disease. In the kidney, it has been shown that IL-10 suppresses renal function decline and improves renal prognosis in IRI model, a typical model of AKI. However, the identity of Breg in the kidney and their origin have not been clarified. Further, how the Breg works during the transition from AKI to CKD is not known. Therefore, first we investigated whether Breg existed in renal tissue on the progression from AKI to CKD in IRI model mice. Further, we performed splenectomy, and examined the renal injury, Breg, and plasma IL-10 levels in this model.

Method

To examine the existence of Breg in the kidney of IRI model, we used 8-10 weeks-old GFP / IL-10 mice based on C57BL / 6J mice. They are reporter mice for IL-10 producing cells, and can visualize IL-10 producing cells under a fluorescence microscope without fluorescent immunostaining. We prepared following three groups, sham, IRI (unilateral), and IRI + SN (splenectomy) groups. Mice were anesthetized with chloral hydrate (4 g/kg,, intraperitoneal). After making a midline incision, exposed a blood vessel of the left renal pedicles and clamped it for 30 min by clips. one day, 7 days, and 14 days after the surgery, mice were sacrificed, and renal function and plasma IL-10 levels as well as tissue damages by PAS and Masson’s Trichrome staining were assessed. Tissue IL-10-producing cells were detected by flow cytometry.

Results

There was no difference of plasma IL-10 levels and renal tubulointerstitial injury in IRI group and IRI+SN group on day 1 after IRI. However, on day 7 and day 14, plasma IL-10 levels became gradually higher in IRI group, and SN decreased the increase in IL-10 levels. Tubulointerstitial injury was induced by IRI and SN further worsened tubular damages. Serum Cr and BUN levels were not different in three groups due to normal right kidney. On day 1, number of IL-10-producing B cells increased in the spleen and renal medulla in IRI group confirmed by flow cytometry, which was completely diminished by SN, suggesting that origin of the infiltrated Breg might be spleen, thereby being involved in the protective role in IRI injury in the kidney.

Conclusion

We report for the first time that Breg might be recruited from spleen by AKI, which may be one of the mechanisms to prevent the progression to CKD.
P0530A NOVEL LNCRNA(LRAN9884) PROMOTES AKI VIA MAINTAINING MINCLE-DEPENDENT M1 MACROPHAGE PHENOTYPE
Authors: Zhang Yingying , Yu Chen
Published: June 2020

Background and Aims

Macrophages are key inflammatory cells and play a critical role in renal inflammation in acute kidney injury (AKI). M1 inflammatory macrophage and M2 anti-inflammatory macrophage act reverse role. Phenotype of macrophages is highly flexible and can be changed over time. However, the underlying mechanism of M1 and M2 macrophage phenotype switching during AKI is still largely unclear. In our previous study, we identified a novel lncRNA (LRNA9884) might contribute to inflammation according to modifying macrophages. The present study was designed to uncover the pathogenic role and the underlying mechanism of LRNA9884 in cisplatin-induced AKI.

Method

Expression level and pattern of LRNA9884 were examined in cisplatin-induced AKI mice. The regulatory mechanisms of LRNA9884 was investigated in cultured bone marrow–derived macrophages (BMDMs) in vitro by silencing or overexpressing of LRNA9884. Flow Cytometer, fluorescence in situ hybridization (FISH) and other multiple molecular biological techniques were applied to figure out the role of LRNA9884 under acute kidney injury.

Results

LRNA9884 was significantly upregulated in the kidney of cisplatin-induced mice and was associated with the progression of the renal inflammation by using RT-PCR and ISH assay. FISH assay with immunoﬂuorescence co-staining detected that LRNA9884 was largely expressed in the nucleus of macrophage in cisplatin-induced mice kidney compared with the sham group at day 1 after AKI injury. LRNA9884 was remarkedly induced by TNF-α (10ng/ml) in BMDMs as time- and dose- dependent. Western blot and RT-PCR showed that silencing of LRNA9884 effectively inhibited upregulated of macrophage-inducible C-type lectin (Mincle) and iNOS induced by TNF-α. More importantly, we identified that LRNA9884 maintained M1 macrophages phenotype by triggering mincle production at transcriptional level as evidenced by ChIP assay.

Conclusion

LRNA9884 is a mincle-dependent lncRNA that highly-expressed in macrophages under AKI development. Targeting of LRNA9884 effectively blocked the inflammatory response via promoting the transition M1 macrophage to M2 macrophage phenotype. This study will shed new lights on the understanding of pathological role of novel LRNA9884 in AKI.
P0546EARLY, BUT NOT LATE, CONTRALATERAL NEPHRECTOMY OVERCOMES PROGRESSION TO CKD AFTER UNILATERAL ISCHEMIC INJURY
Authors: Moonen Lies , Cuesta-Apausa Cristina , Lopez-Hernandez Francisco J , Martinez Salgado Carlos , D'Haese Patrick , Vervaet Benjamin
Published: June 2020

Background and Aims

It is increasingly clear that acute kidney injury (AKI) can result in the development of chronic kidney disease (CKD) in humans. Murine renal unilateral ischemia-reperfusion injury (UIRI) models this AKI-to-CKD progression in the injured kidney in the presence of its healthy counterpart (Le Clef et al, Plos One 2016). In mice, we and others demonstrated that contralateral nephrectomy (Nx), when performed shortly after UIRI (i.e. 3 days), is able to significantly attenuate the progression to CKD. Although non-translatable, Nx can be considered an experimental therapeutic intervention that incites inherent physiological recovery mechanisms in the kidney. Here, we investigate in rats to what extent contralateral Nx is able to attenuate or revert CKD progression when performed well beyond the acute injury phase, i.e. with increased Nx delay time after UIRI.

Method

AKI was induced in male Wister rats by left UIRI for 60 min at 35°C core body temperature after which contralateral Nx was performed 3, 10 or 20 days later, or no Nx was performed. Control animals underwent sham-UIRI and sham-Nx 3 days later. Renal function was assessed by serum creatinine and transcutaneous GFR measurement 24h and 72h after Nx and weekly thereafter. Rats were euthanized 11 weeks after Nx. Kidneys were weighed and histology was evaluated by PAS stain for overall morphology and Sirius Red stain for interstitial fibrosis.

Results

When no Nx was performed, renal function of the injured kidney decreased 44% compared to control animals at week 11. Nx at day 3 induced full functional recovery from week 5 after Nx on, whereas Nx at day 10 and 20 both lead to a persistent 20% loss of renal function at week 9 after Nx (p<0.05). Nx at day 3 was able to attenuate renal atrophy and fibrotic tubulointerstitial expansion. Nx at day 10 and 20 were less efficient and led to 1.6 (p>0.05) and 2.6 (p<0.05) fold increase of tubulointerstitial area compared to controls. Nx at day 3 and 10 induced a significant increase in renal mass-to-body weight ratio compared to control from 2.9±0.1 mg/g (control) to 4.6±0.4 mg/g (day 3) and 4.8±0.3 mg/g (day 10) respectively. When Nx was performed at day 20 or no Nx was performed, renal mass-to-body weight ratio did not differ significantly from control animals, however, parallel with renal function, histopathology was considerably worse.

Conclusion

Early contralateral Nx after UIRI rescues renal function and morphology, whereas delayed Nx does not allow full recovery of the injured kidney. There was no additional functional loss when Nx was performed on day 20 versus day 10, though, histopathology aggravated. These results imply that a damaged kidney loses its intrinsic (compensatory) recovery potential over time and that an early intervention is crucial for averting CKD outcome after AKI.
P0547THE DELETION OF AKT1 ATTENUATES RENAL FIBROSIS AND TUBULAR EPITHELIAL-MESENCHYMAL TRANSITION DURING ACUTE KIDNEY INJURY TO CHRONIC KIDNEY DISEASE PROGRESSION
Authors: Ye Byung Min , Kim Il Young , Kim Min Jeong , Lee Soo Bong , Lee Dong Won , Song Sang Heon , Seong Eun Young
Published: June 2020

Background and Aims

Acute kidney injury (AKI) is an underestimated, yet important risk factor for the development of chronic kidney disease (CKD), which is characterized by the tubulointerstitial fibrosis and tubular epithelial-mesenchymal transition (EMT). Akt has been reported to be involved in renal fibrosis and EMT. Thus, we investigated the role of Akt1, one of the three Akt isoforms, in the murine model of AKI to CKD progression.

Method

We subjected the wild type and Akt1−/− mice to unilateral ischemia-reperfusion injury (UIRI). UIRI was induced by clamping the left renal artery for 30 min followed by reperfusion. After 6 weeks of UIRI, the renal fibrosis and EMT were assessed by histology, immunohistochemistry, and western blot.

Results

After 6 weeks after UIRI, we found that Akt1, not Akt2 or Akt3, was activated in UIRI-kidney. The tubulointerstitial fibrosis was significantly alleviated in Akt1−/− mice compared with the wild type (WT) mice. Besides, the deletion of Akt1 decreased the expression of the vimentin and α-SMA and increased the expression of E-cadherin, indicating the suppression of tubular EMT. However, there was no difference in the activity of TGF-β1/Smad signalling, which is the potent inducer of renal fibrosis and EMT, between WT mice and Akt1−/− mice. The deletion of Akt1 also increased the GSK-3β activity and decreased the expression of β-catenin, Snail, and twist1.

Conclusion

Our findings demonstrate that the deletion of Akt1 attenuates the renal fibrosis and tubular EMT independently of TGF-β1/Smad signalling during the AKI to CKD progression. Akt1 may be the therapeutic target against the AKI to CKD progression.
P0548PAC-MEDIATED AKI PROTECTION IS CRITICALLY MEDIATED BUT DOES NOT EXCLUSIVELY DEPEND ON CELL-DERIVED MICROVESICLES
Authors: Patschan Daniel , Schwarze Katrin , Ritter Oliver , Patschan Susann , Müller Gerhard Anton
Published: June 2020

Background and Aims

Acute Kidney Injury (AKI) significantly worsens the prognosis of hospitalized patients. In recent years, cell-based strategies have been established as reliable option for improving AKI outcomes in experimental AKI. Own studies focused on so-called Proangiogenic Cells (PACs). Mechanisms that contribute to PAC-mediated AKI protection include production / secretion of extracellular vesicles (EV). In addition, the cells most likely act by paracrinic processes (secretome). The current study evaluated whether AKI may be preventable by the administration of either PAC-derived EV and / or the secretome alone.

Method

AKI was induced in male C57/Bl6N mice (8-12 weeks) by bilateral renal ischemia (IRI - 40 minutes). Syngeneic murine PACs were stimulated with either melatonine, Angiopoietin-1 or -2, or with Bone Morphogenetic Protein-5 (BMP-5) for one hour, respectively. The four mediators were chosen since previous own studies showed improved PAC-mediated AKI protection after cell preconditioning with these substances. PAC-derived EV and the vesicle-depleted supernatant were subsequently collected and i.v. injected post-ischemia. Mice were analyzed 48 hours later.

Results

IRI induced significant kidney excretory dysfunction as reflected by higher serum cystatin C levels. The only measure that improved AKI was the injection of EV, collected from native PACs. The following conditions worsened post-ischemic renal function even further: EV+Ang-1, EV+BMP-5, EV+melatonin, and EV+secretome+Ang-1.

Conclusion

Together, our data show that PAC-mediated AKI protection substantially depends on the availability of cell-derived EV. The secretome, either collected from native or preconditioned cells does not prevent mice from ischemia-induced dysfunction. However, since previous data showed improved AKI-protection by PACs after cell preconditioning with certain mediators (Ang-1 and -2, melatonine, BMP-5), other than exclusively vesicle-dependent mechanisms must be involved in PAC-mediated AKI protection. We suggest, that the mere presence of intact cells in the post-ischemic tissue is necessary for improving functional and structural outcome parameters under certain conditions.
P0549ESSENTIAL ROLES OF TESTOSTERONE IN MALE KIDNEY MATURATION AND REPAIR AFTER INJURY
Authors: Sato Yuki , Uchino Eiichiro , Kitai Yuichiro , Oguchi Akiko , Yanagita Motoko
Published: June 2020

Background and Aims

The newborn kidneys are structurally and functionally immature. They mature after birth to adapt to extra-uterine life, yet the comprehensive changes of the kidney have not been defined. We investigated the structural and functional changes in the kidney after weaning and examined the effect of testosterone in this maturation process in male mice.

Method

We performed phenotypic analysis of male mouse kidneys as well as those subjected to castration utilizing a combination of histological analysis, bulk transcriptome analysis, charged metabolite analysis by CE-TOFMS and brush border membrane vesicles LC-MS/MS analysis.

Results

Bulk transcriptome analysis of postnatal 3 and 8 week male kidneys showed the gene sets enriched in 8w included those associated with metabolic process and transporters in proximal tubule, and structural analysis revealed proximal tubule elongation and hypertrophy in 8 weeks. Most differentially expressed genes (DEGs) identified above were induced between postnatal day 28 and 40, a period of testosterone surge, and were closely correlated with DEGs between adult male and female kidneys. These structural and gene expression changes during maturation were mostly cancelled by castration before testosterone surge. Proximal tubules expressed androgen receptor, and some of these DEGs were upregulated or downregulated by the administration of testosterone in cultured proximal tubules. Consistent results with DEGs were also confirmed at protein levels and related metabolites in vivo. For instance, induction of cystine transporter SLC7A13 expression as well as the increase in cysteine and cysteine-glutathione disulphide-Divalent in the kidney were confirmed during this period. Fatty acid β-oxidation enzymes were also increased during this period. Some of the down-regulated genes across puberty were reactivated after injury and returned to the basal levels with repair.

Conclusion

Proximal tubules are the main site of maturation after weaning, and acquire the abilities to absorb and metabolize a variety of filtered substances and to increase energy metabolism, which were mainly driven by testosterone.
P0569ACUTE KIDNEY INJURY AFTER LUNG TRANSPLANTATION: INCIDENCE, RISK FACTORS AND OUTCOMES IN A MONOCENTRIC RETROSPECTIVE COHORT STUDY
Authors: Gandolfo Maria Teresa , Bellincioni Cecilia , Morlacchi Letizia Corinna , Rossetti Valeria , Blasi Francesco B , Messa Piergiorgio
Published: June 2020

Background and Aims

Acute kidney Injury (AKI) occurs in more than 50% of patients after lung transplantation (LTx). Our aim was to describe the incidence, risk factors and outcomes associated with AKI after LTx in a retrospective monocentric cohort study.

Method

We studied all recipients of LTx (> 16 years of age) occurring at Ospedale Maggiore Policlinico Milano between Jan 1st 2015 and Dec 31st 2017. AKI was defined according to KDIGO classification, eGFR was calculated according to CKD (Chronic Kidney Disease) Epidemiology Collaboration formula and CKD was defined by an eGFR< 60 ml/min per 1.73 m2. Chi square, Fisher exact test, t.-test and logistic regression were used to define risk factors for AKI in the early post-surgical period and for CKD at 1 and 2 years after LTx. AKI-related survival was estimated using Kaplan Meyer model.

Results

Of 78 LTx patients enrolled in our Center, 50% of patients was affected by cystic fibrosis. Median age at transplant was 43 years (27-55); median follow- up was 31 months (20-40). Survival rate was 80.77% at 1 year, 69.23% at 2 years and 66.67% on Dec 31st 2019 (last follow-up).

AKI occurred in 42 (53.85%) patients within the first week after LTx, respectively grade I and II in 12 each (15.38%) and grade III in 18 (23.08%) patients.

Pre-transplant low albumin levels and hypertension were independently associated with AKI at univariate and multivariate (p= 0.0018 and 0.0004 respectively) analysis. Pre-transplant low albumin levels, pre-transplant ECMO-use, hypertension, ECMO-use during transplant surgery were associated with severe AKI in univariate analysis but only pre-transplant hypertension and ECMO-use during transplant surgery were independently associated in the multivariate one (p=0.0266 and 0.0463 respectively).

Survival was significantly reduced in patients affected by AKI (p=0.035); this observation became strongly significant when only mild and moderate (grade I and II) AKI was considered (p=0.0071).

CKD was diagnosed in 38.09% of patients at 1 year and 35.18% at 2 years.

While numerous risk factors were related to the occurrence of CKD at 1 and 2 years after LTx at univariate analysis, only grade III AKI remained independently associated with CKD at multivariate analysis (p= 0.0081 for 1 year-CKD, p=0.0154 for 2 year-CKD).

Conclusions

In our population, AKI after LTx occurred in about half of the patients and was predicted by history of hypertension, low albumin levels and hemodynamic instability during the surgery. Mild-moderate AKI, often clinically underestimated, was strongly associated with reduced survival. Severe forms of AKI were predictive of occurrence of CKD.
P0570THE INCIDENCE, RISK FACTORS OF ACUTE KIDNEY DISEASES AND DISORDERS AND ITS IMPACT ON CHRONIC KIDNEY DISEASE IN PATIENTS AFTER RADICAL CYSTECTOMY
Authors: Ge Shengnan , Tang Ying , Chen Junzhe , Yu Wenjuan , Xu Anping
Published: June 2020

Background and Aims

Acute kidney injury (AKI) is a widely-discussed complication associated with the radical cystectomy which is the gold standard for the management of invasive bladder cancer. Until now, few studies investigate the new criteria named Acute Kidney Diseases and Disorders(AKD) as the complication of radical cystectomy. In this study, we evaluated the incidence, risk factors of AKD and evaluate its impact on chronic kidney disease (CKD) in patients after radical cystectomy.

Method

A total of 279 patients who underwent radical cystectomy at Sun Yat-sen Memorial Hospital, Guangzhou, China, from January 2006 to June 2019 were evaluated, including 168 patients for Robotic-assisted Laparoscopic Radical Cystectomy (RLRC) and 111 patients for Laparoscopic Radical Cystectomy(LRC). AKD was diagnosed according to the classification scheme proposed in the 2012 KDIGO guideline. Logistic regression modeling was used to explore risk factors of AKD, while risk factors associated with CKD in AKD patients were investigated using Kaplan-Meier analysis, respectively.

Results

The overall incidence of AKD after radical cystectomy was 34.1% (95 out of 279) ,the incidences differ significantly between the RLRC and LRC groups (67 [39.9%] vs 28 [25.2%], P=0.011). Among 279 patients, risk factors associated with postoperative AKD included RLRC (OR 2.067, 95%CI 1.188 to 3.595, P=0.010), Age (years) (OR 1.046, 95%CI 1.018 to 1.074, P=0.001), baseline eGFR<60(ml/(min.1.73m2) (OR 2.662, 95%CI 1.355 to 5.230, P=0.004), Further subgroup analysis identified age, operation time<250(min) as important risk factors of AKD in RLRC patients but not in LRC patients. Of 211 patients with a preoperative estimated glomerular filtration rate (eGFR) of > 60 ml/min/1.73 m2, CKD developed in 16.0% (21/ 131) of patients in the non-AKD group and 36.3% (29/ 80) of patients in the AKD group. Kaplan-Meier analysis(shown in figure 1) identified that AKD is associated with higher CKD rates in those patients (P <0.001).

Conclusion

One-third of bladder cancer patients developed AKD after after radical cystectomy. RLRC, Age, baseline eGFR <60(ml/(min.1.73m2) were independent risk factors for postoperative AKD in all patients. Occurance of AKD could increase the risk of new-onset CKD in the long run. Though the use of RLRC is now well established, we should be aware that it may increase the risk of postoperative AKD, especially for patients who are old and with lower eGFR .Besides, we should try to improve the management of those AKD patients with aim toward preventing further development of CKD.
P0574IS PERIPROCEDURAL BLOOD LOSS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION A RISK FACTOR FOR CONTRAST-INDUCED ACUTE KIDNEY INJURY ?
Authors: Rao Indu Ramachandra , Paramasivam Ganesh , Prabhu Ravindra Attur , Nagaraju Shankar Prasad , Devasia Tom , Rangaswamy Dharshan , Shenoy Srinivas Vinayak , V B Mohan
Published: June 2020

Background and Aims

Contrast-induced acute kidney injury (CI-AKI) is a significant concern with the use of intraarterial contrast agents, especially in percutaneous coronary interventions (PCI) in which higher contrast volumes are used. Presence of anemia is a risk factor for CI-AKI and is a component of various risk-prediction models. However, the impact of periprocedural hemoglobin (Hb) drop following PCI on CI-AKI is not known, despite the fact that significant blood loss is fairly common in patients undergoing PCI. The aim of this study was to examine whether periprocedural Hb drop is a risk factor for development of CI-AKI following PCI.

Method

This was a single-center, retrospective study of patients admitted for elective or primary PCI at our center between January 2015 and December 2018. Patients with baseline eGFR <15mL/min/1.73m2 were excluded. CI-AKI was defined as per the KDIGO 2012 guidelines as an increase in serum creatinine by at least 0.3 mg/dl, or 1.5-1.9 times the baseline values within 48 hours after administration of contrast media. Periprocedural Hb drop was defined as fall in Hb by at least 1g/dL below baseline values within 48 hours following PCI.

Results

A total of 6418 patients were included. Baseline characteristics of the study population are shown in table 1. Overall incidence of CI-AKI in our study was 7.6% (n=490), of which 3.9% (n=19) required dialysis. Higher incidence of CI-AKI was seen in those with baseline eGFR < 60 ml/min/1.73m2 (16.4%) and a pre-procedural Mehran score >11 (33%). Peri-PCI Hb drop was seen in 49.9% (n=3203), with a drop >2g/dL in 18.5% (n=1185). On multivariate logistic regression analysis (Table 2), it was found that periprocedural Hb drop >2g/dL was independently associated with CI-AKI (OR 1.49, 95% CI 1.18-1.88, P=0.001). Furthermore, in those with periprocedural blood loss, the risk of CI-AKI was increased by 1.3 times for each 1g/dL drop in Hb (OR 1.30, 95% CI 1.14-1.49, P<0.001). Additionally, apart from traditional risk factors, hypertension was independently associated with development of CI-AKI (Table 2).

Conclusion

Periprocedural blood loss was associated with a higher risk of CI-AKI after PCI. Moreover, risk of CI-AKI increased with increasing severity of blood loss. Whether measures to minimize blood loss, like using a transradial approach, staging complex procedures and close monitoring of anticoagulation/antiplatelet regimens, will help reduce risk of CI-AKI needs to be studied.
P0577CLINICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOME FOR 1798 CONSECUTIVE PATIENTS WITH ACUTE KIDNEY INJURY
Authors: Montgomerie Christina , Spaak Jonas , Evans Marie , Jacobson Stefan H
Published: June 2020

Background and Aims

Acute kidney injury (AKI) is a common condition occurring in about 15% of all hospitalized patients. AKI have different pathophysiological etiologies; prerenal, renal or postrenal. Patients who recover from AKI have a higher long-term risk of end-stage kidney disease and death. However, most AKI studies include critically ill patients treated at intensive care units; less is known about general AKI patients treated at the nephrology ward. The aim of this large single center study was to report differences in laboratory findings and short-term hospital outcomes in relation to cause of AKI in consecutive patients admitted to a nephrology department.

Method

All patients diagnosed with AKI between 2009 and 2018 and admitted to the nephrology department at Danderyd University Hospital, Stockholm, Sweden, were included. Relevant laboratory and physiological measures were registered, including length of stay, procedures, etiology and level of AKI. AKI was defined as a first s-creatinine (sCr) >130 µmol/L (1.47 mg/dL) at admission, or an increase in sCr by 30% from previous stable out-patient value. These criteria were set at the beginning of the study based on clinical knowledge and clinical practice at the time. Patients on dialysis treatment were excluded. Patients were followed until either discharge or death, whichever came first.

Results

In 1798 patients with AKI, the majority (n=851) had combined type, followed by prerenal (n=668), renal (n=175), and postrenal (n=104) etiology. Patients with renal AKI were younger, had longer duration of stay, and had higher bicarbonate levels on admission (Table 1). The most common cause of renal AKI was interstitial nephritis. Patients with prerenal AKI had lower S-Cr, blood pressure and higher Hb upon admission. 58% of the patients recovered with an at least 30% decrease in sCr from baseline during their stay. Most of these were patients with prerenal AKI followed by combined AKI. There was no statistically significant difference in mortality between the four etiologies of AKI.

Conclusion

This study provides data from a large, contemporary AKI patient cohort under nephrology care. Both patient characteristics and short-term outcomes differ substantially in patients of variable AKI etiology. These findings have important implications for prognostic evaluation upon admission and further resource planning.
P0581HIPERKALEMIA IN COMMUNITY-ADQUIRED ACUTE KIDNEY INJURY. ASSOCIATED FACTORS AND CLINICAL CONSEQUENCES
Authors: Peña Porta Jose Maria , Castellano Calvo Almudena , Coscojuela Otto Ana , Tomás latorre Alejandro , Ferreras Gascó José Antonio , Alvarez Lipe Rafael
Published: June 2020

Introduction and Aims

Hyperkalemia (hyperK) is an analytical alteration that frequently occurs in the context of acute kidney injury (AKI) adding morbidity to the patient. We know little about the associated factors and the clinical consequences of this complication in patients with community-acquired acute kidney injury (CA-AKI). The aim of present study was to analyze the predisposing factors and the clinical consequences of the hiperK in patients with CA-AKI.

Method

The present study is based on a cohort of patients with CA-AKI admitted to the Nephology Service of a third level hospital from January 2010 to February 2015. Hyperkalemia was defined by the laboratory of our hospital as potassium levels above 5.1 meq / L

Results

A total of 308 patients were included in the final analyses. The mean age was 73,22±13,95 years. 58,4% were men. Charlson comorbidity index (CCI) was 7,16 ±2,7 points. The mean of drugs ingested daily was 7,81±3,66 and the length of stay 12,25±11,69 days. In view of the Etiology of AKI, 69,5% prerenal AKI and 30,5% non-prerenal ones. 212 patients had a history of previous chronic kidney disease (CKD) (68.8%). Hemodialysis (HD) was required in 54 patients (17.15%). 38 patients (12.3%) died during hospital stay. HyperK occurred in 173 cases (56,2 %). Mean potassium was 5,45±1,41 meq/L (95% IC 5,29-5,61) (range 2.65-9.70). There was a significant correlation between potassium and pH (r = - 0.328; p <0,001) as well as between K and CCI (r= 0,284; p <0,001). There was an association between hyperK and intake of potassium-sparing diuretics (p<0,001); ACEI/ARB (p=0,003) and beta blocker (p<0,001). There was no association with CKD nor NSAID intake. Using a multiple linear regression model the equation that predicted serum potassium level was: K = 36,44 – (4,4 x pH) + 0,98 (if intake of potassium-sparing diuretics) + (0.10 x CCI). Potassium level did not influence the length stay. Patients with HyperK required HD in a higher proportion (23.7 vs. 9.6%; p 0.01) and also had higher mortality during hospital stay (15.6 vs. 8.1%; p 0.048). After a follow-up of 971±702 days after hospital discharge, Kaplan-Meier survival curves showed a significant difference (Log Rank (Mantel-Cox): Chi-square 20,1; p< 0,001) between patients with hyperK and patients that did not present it.

Conclusion

HyperK occurred in just over half of our patients. The potassium level was significantly determined by the previous comorbidity, pH and the intake of potassium-sparing diuretics. HyperK patients required HD and died in a greater proportion during hospital stay than the others. Mortality after discharge was higher in patients who presented hyperK during hospital stay. Appropriate measures must be taken to correct hyperK early in patients with CA-AKI.
P0588TUBULAR EPITHELIUM INJURY BIOMARKERS AND SURVIVAL AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Smirnov Kirill , Dobronravov Vladimir , Smirnov Alexei
Published: June 2020

Background and Aims

In our recent study we have shown, that some tubular epithelium injury molecular biomarkers (MBMs) may be used for acute kidney injury (AKI) prediction in a specific category of patients, receiving hematopoietic stem cell transplantation (HSCT). Here we aimed to determine the value of this MBMs for the evaluation of the mortality following HSCT.

Method

90 HSCT recipients (46 males, 44 females) were enrolled. All-cause mortality was registered along 1 year of posttransplant period. MBM’s (calbindin, clusterin, IL-18 (interleukin-18), KIM-1 (kidney injury molecule-1), GST-π (glutathione S-transferase- π), MCP-1 (monocyte chemoattractant protein-1)) relative concentration increase was determined in alive and deceased patients after HSCT. MBM’s associations with death risk were estimated in multivariate models adjusted for clinical factors related to the prognosis (AKI, progression of the underlying disease, incomplete HLA compatibility, etc.).

Results

It was found that the relative increase in the concentrations of some MBMs was significantly higher in the group of deceased HSCT recipients (Figure). In multivariate models the associations of KIM-1, MCP-1, and calbindin with mortality were not reliable (data not shown). As for clusterin, this relationship was reliable and independent of other significant clinical factors, including overt AKI (HR=1,085 (1,034-1,139; p=0,001).

Conclusion

Urinary MBMs, taking into account their independent association with posttransplant all-cause mortality risk, may become a useful tool not only for AKI prediction, but also for HSCT prognosis evaluation.
P0593INCIDENCE AND IMPACT OF ACUTE KIDNEY INJURY (AKI) IN A THIRD LEVEL HOSPITAL
Authors: Aguilera Morales Wenceslao , Lara Ruiz Alfonso , Díaz Díez Irene , Almenara Tejederas Marina , Salgueira Lazo Mercedes
Published: June 2020

Background and Aims

The AKI index is increasing, reaching 22% in hospitalized patients. Despite the negative impact it implies, in daily practice its management remains suboptimal and there is little awareness of the problem. Aims: Know the incidence of AKI in a Third-level hospital; its impact on mortality, average stay and associated costs.

Method

Descriptive cross-sectional study of data extracted from CMBDA corresponding to a third level hospital during 2016-17. We analyze: hospitalization episodes, referral assistance units, AKI episodes at discharge, stays and exitus. To calculate associated costs, we use as reference the costs/day-hospitalization per Healthcare Unit in SAS according to BOJA-Number 218 (14nov2016). We compare groups according to presence/no AKI. Limitations: These data may be underestimated since the diagnosis of AKI may be present and not reported upon discharge; Nor do we include dialysis costs.

Results

56,816 revenues were produced; 3,589 reported AKI (incidence: 6.31%). Patients with AKI add 42,801 stays; Average stay of 18.4 days in 2016, 16.4 in 2017, compared to 6.6 and 8.7 days respectively when FRA is not associated (p <0.01). The estimated costs associated with the FRA were 22,815,558 euros, with a cost / episode of 6023 euros, compared to 3523 euros in patients without FRA. The overall associated mortality AKI was 23.2% vs 11% in the rest (p <0.01). Average stay, costs and mortality vary widely according to the Assistance Units, the impact being especially worrying in Surgical Units (table).

Conclusion

The incidence of AKI in our hospital lower than that referred to in the literature probably responds to inadequate registration in discharge reports. Despite the limitations, our data demonstrate the impact of the diagnosis of AKI in hospitalized patients, doubling the average stay, costs and mortality. These differences are accentuated in some Assistance Units, being especially alarming in Surgical Units.
P0599THE LYSOSOMAL URINE ENZYMES ACTIVITY IN CHILDREN AFTER ACUTE KIDNEY INJURI
Authors: Lavrenchuk Olga , Korol Lesya , Migal Ludmila , Bagdasarova Ingretta
Published: June 2020

Background and Aims

The urgency of the problem of acute kidney injury (AKI) in children is due to the high risk of chronic kidney disease (CKD) as an outcome. Lysosomal enzymes in urine are considered to be informative markers of renal parenchyma damage. The aim of study was to determine the activity of lysosomal enzymes β-galactosidase (GAL) and N-acetyl-β-D-glucosamynidase (NAG) in urine as markers of CKD progression in children after AKI.

Method

41 children were examined after AKI with achieving self-diuresis and clinical improvement. The functional state of the kidneys was evaluated by the glomerular filtration rate (Schwartz GFR), the level of albuminuria. Urine enzyme activity was determined and cross-linked to mmol urinary creatinine. The control (reference) group consisted of 28 children who were conditionally healthy, without kidney disease.

Results

The NAG activity was 8 times higher level than in the reference group of healthy children (87/46;193 vs. 15/11;18, p<0.001), and GAL was elevated in 3 times either (34/22;45 vs. 10/6;13, p<0.001) in patients with a disease period of up to 2 years after AKI. In patients with follow-up period 2 or more years enzyme activity levels decreased, but remained 4 times higher (NAG: 49/31;109, p <0.001 compared to control; GAL: 35/25;44, p <0.001 compared to control). The high levels of enzyme activity was documented in 73.2% of patients after one year of follow up, but the GFR decrease was found in 22.0%, and albuminuria - only in 34.1%.

Conclusion

The urine activity of NAG and GAL in children is an informative marker for diagnosing recovery after AKI or CKD progression with renal function decline. This method is non-invasive, inexpensive, and simple to conduct.
P0602CLINICAL PATTERN, RENAL RECOVERY AND PATIENT OUTCOMES AFTER ACUTE KIDNEY INJURY IN ADULTS IN AN EMERGING COUNTRY
Authors: Subbiah Arunkumar , Agarwal Sanjay Kumar
Published: June 2020

Background and Aims Acute Kidney Injury (AKI) is an important determinant of outcome in hospitalized patients. Further, there is a risk for development of Chronic Kidney Disease (CKD) in the future. Though the long-term impact of AKI has been studied in developed countries, there is a paucity of data in this area from the Indian subcontinent. This single-centre study aimed to assess the pattern, clinical spectrum, short-term and long-term outcomes of AKI.

Method In this prospective observational cohort study, detailed demographic and clinical data at presentation, during hospital stay and follow-up at 1, 3, 6 and 12 months after discharge were obtained prospectively for a cohort of patients with AKI. Both community (CAAKI) and hospital acquired AKI (HAAKI) were included. Patient with pre-existing CKD were excluded. Outcome variables examined were in-hospital mortality, renal function at discharge and on follow-up after discharge from hospital.

Results In our study cohort with 476 patients, majority of the cases were CAAKI (395, 83%). The mean age at presentation was 44.8 ± 18.7 years. Medical causes (84%) contributed to the majority of AKI while the remaining were due to surgical (10%) and obstetrical (6%) causes. Sepsis (176/476; 36.9%) was the most common cause of AKI. The most common source for sepsis was respiratory (41%) followed by urological source (18.7%). The in-hospital mortality rate for patients with AKI was 38%. Age >60 years (HR = 1.51; 95% CI, 1.11 – 2.07), oliguria (HR = 1.48; 95% CI, 1.05 – 2.10), need for ventilator (HR = 2.45; 95% CI, 1.36 – 4.41) and/or inotropes (HR = 14.4; 95% CI, 6.28 – 33.05) were predictors of mortality. At discharge, 146 (30.7%) patients had complete renal recovery, while 149 (31.3%) had partial renal recovery. Oliguria (p < 0.001), hypoalbuminemia (p = 0.001) and need for renal replacement therapy (RRT) (p = 0.01) were significantly associated with partial recovery. Of the 295 patients on follow-up at discharge, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 33 (11.2%) were lost to follow up; 47(15.9%) patients developed CKD of which 6 (2%) were dialysis dependent. Elderly patients, higher AKIN stage with oliguria and those requiring RRT were more likely to develop CKD. Among these, the need for in-hospital RRT was the single most important factor predicting the risk of CKD (OR 1.77, 95% CI, 1.12-2.78).

Conclusion In conclusion, our data shows that AKI in hospitalized patients still has high mortality in emerging countries like India. Though a fairly good percentage of cases recovered, there is a definite risk of CKD development, especially in patients who required RRT during hospitalization.
P0603INFLUENCE OF FERRITIN VALUES IN THE PORGNOSIS OF ACUTE KIDNEY INJURY
Authors: Díez Pablo , Fernández Ramos Andres , Muñoz Ramos Patricia , Sanz Sainz Marta , Santos Sánchez-Rey Begoña , Ruano Pablo , Quiroga Borja
Published: June 2020

Background and Aims

Acute Kidney Injury (AKI) is one of the most frequent causes of hospitalization and many factors have been associated to its prognosis and recovery. The role of iron in AKI physiopathology and its influence is not well known. Recent studies have shown that elevated levels of catalytic iron are associated with higher mortality in patients with AKI, however, catalytic iron is not available in usual clinical practice. Ferritin, especially abundant in the liver, is the primary intracellular iron storage protein. A small amount is secreted to the circulation and is an indirect marker of total body iron deposits. In this study we analyze the influence of iron, with ferritin values, in the prognosis of AKI.

Method

We developed a retrospective, single-center study that enrolled patients with AKI, hospitalized in our center between 2013 and 2014 with iron metabolism values in the first 72 hours after admission. At baseline, we collected demographic information, comorbidities, reason for admission and iron metabolism values (ferritin, transferrin, transferrin saturation index and serum iron). We analyzed variables associated with low and high ferritin values and its impact in AKI long-term prognosis using univariate and multivariable Cox regression.

Results

Of the 1731 analyzed patients, 833 (48.1%) had ferritin records. The mean age was 78±14 years and 48% of the patients were women. The most frequent comorbidity was hypertension (76%), followed by chronic kidney disease (46%), dyslipidemia (44%), heart failure (31%), diabetes mellitus (29%) and atrial fibrillation (27%). The most frequent reason for admission was infection (35%) followed by AKI (19%). Ferritin values differed significantly according age (p<0.0001), sex (p=0.024), diabetes (0.012), hypertension (p=0.002), neoplasia (p=0.016), reason for admission (p=0.018), baseline CKD-EPI (0.012) and lactate at admission (p<0.0001). During the hospitalization, 165 (20%) patients died. Factor associated to mortality were ferritin>500 ng/ml (p=0.013), lactate at admission (p<0.001), age (p=0.045), hypertension (p=0.014), dyslipidemia (p<0.001), ischemic heart disease (p=0.006), chronic kidney disease (p=0.001), baseline CKD-EPI (p=0.01), atrial fibrillation (p=0.005), neoplasia (p=0.023), Barthel index (p<0.001) and hemoglobin (p=0.006) and bicarbonate (p=0.012) at admission. Multivariate logistic regression demonstrated that ferritin levels over 500 ng/mL was an independent predictor of mortality (1.6 [1,1-2,3] HR [CI 95%]) (p=0.013).

Conclusion

Ferritin values higher than 500 ng/mL independently predicts mortality in patients admitted with AKI.
P0605ACUTE KIDNEY INJURY AFTER MAJOR ABDOMINAL SURGERY
Authors: Milinkovic Marija
Published: June 2020

Background and Aims

We analyzed the incidence of acute kidney injury (AKI) after major abdominal surgery, as well as demographic, clinical, laboratory and surgical factors that might have contributed in it's development.

Method

Retrospective data analysis of 83 pts who underwent major abdominal surgery at the emergency surgery department (intraperitoneal approach, hospitalization longer than 48 hours, surgery duration over one hour). Demporaphic data, comorbidities, biochemical parameters (blood count, serum concentrations of nitrogenous substances, electolytes etc), type of surgery, intraoperative characteristics (duration of surgery, blood pressure, use of vasoactive substances), postoperative complications including AKI, defined as serum creatinine concentrations increase of 0.3mg/dl and more or reduction in diuresis, as well as intrahospital mortality.

Results

The mean age of the patients was 60.9 ± 12.9 years. A total of 45 (54.2%) patients were male. AKI was registered in 15 (18.1%) patients with an average age of 69.5 ± 9.2 years, of which 8 (53.3%) were male. The average duration of surgery in the group of patients with AKI was 2.5 ± 0.8 hours, and the most common operations performed in this group involved reconstruction of the small and large intestine. The total intrahospital mortality was 10.8% and in the AKI group 33.3%.

Conclusion

Patients with AKI were significantly older, with more comorbidities and more frequent surgery that involved resection of the small and large intestine. The development of AKI was accompanied by a higher mortality rate. Given the specific pathophysiological mechanisms in abdominal surgery, further study of the factors responsible for the development of AOB is required to contribute to the development of preventive protocols and to reduce the rate of this serious postoperative complication.
P0606OUTCOME OF CANCER PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS
Authors: Isaranuwatchai Suramath , Worawichawong Supanat
Published: June 2020

Background and Aims

Recent advances in treatment of cancer lead to improvement in mortality among cancer patients. However, data regarding outcomes of cancer patients with acute kidney injury (AKI) requiring dialysis were scarce. We conducted this study to see the difference in mortality and other outcomes between cancer and non-cancer patients who had AKI requiring dialysis.

Method

We reviewed medical record of previous 18 months in our institute. Patients with age at least 18 years with acute kidney injury requiring dialysis were included in our study. Primary outcome was mortality at 30 days. Renal recovery and chronic kidney disease (CKD) after AKI events were also recorded.

Results

A total of 61 patients were included in our study; 28 patients had no cancer and 33 patients had cancer. Of cancer patients, 81.8% had advanced stage cancer. Modality of dialysis was continuous renal replacement therapy in 36.1%. Mortality at day 30 was not significantly different between cancer patients and non-cancer patients (57.6% vs. 53.6%, P = 0.754). Of alive patients, renal recovery among cancer patients and non-cancer patients was also not significantly different (69.2% vs. 50.0%, P = 0.310). CKD after episodes of AKI was also not significantly different between cancer patients and non-cancer patients (42.8% vs. 77.8%, P = 0.302).

Conclusion

This is the first study to compare mortality between cancer and non-cancer patients who had AKI requiring dialysis. We found no significant difference regard to mortality between AKI patients requiring dialysis with and without cancer. Renal recovery and CKD development were also not significantly different between two groups. More studies in nephro-oncology field are required for better treatment in cancer patients.
P0613POSTPARTUM ACUTE RENAL FAILURE AND VITAMIN D STATUS A MULTICENTER STUDY OF RISK FACTORS
Authors: Mohamed Cherif Tehir
Published: June 2020

Background and Aims

The postpartum AKI is a particular pathological and chronological entity, which remains a public health problem in Algeria.

The main objective was to describe the epidemiological, clinical and evolutionary profile of postpartum AKI and secondarily to evaluate the impact of Vit D status on: The severity of AKI (using AKIN Classification 2012), the use of the RRT and the Delays and quality of recovery of renal function.

Method

This is an observational, descriptive, prospective and multicentric study performed in two University hospital centers situated in East of Algeria (Annaba and Setif).

All patients admitted to ICU for postpartum complications over a 4 year (2014 to 2018) were included.

Results

Among the 538 pathological post partums identified in the two basins of life 179 (33.28%) presented AKI, the average age is 32.9 years and the average delivery time is 33.88 weeks.

AKI was defined by the KDIGO AKIN classification, the proportion of severe AKI requiring RRT was 34 (18.9%) and the incidence of CKD was 6.7 % with dialysis dependence for 1.11%.

Preeclamptic pathology is in the most commen cause of postpartum AKI (72.3%). However, it is not associated in univariate analysis with the occurrence and severity of AKI.

Associated factors (p <0.05) in univariate and multivariate analysis are: the HELLP syndrome, especially when associated with postpartum hemorrhage (PPH) and acute fatty liver of Pregnancy.

Maternal mortality is dramatically high 20% especially in severe stage of AKI. Absolute deficiency of vitamin D (25OH D) < 10ng/ml is correlated with the severity of the AKI.

Conclusion

The postpartum AKI is inexorably linked to pre-eclamptic pathology and its complications. The frequency of maternal and fetal deaths should prompt new strategies including early detection and closer surveillance, especially of women at risk. A particular attention should be given to vitamine D sttatut during Pregnancy