bluuebunny/crossref_metadata_2025 huggingface dataset:
MO787USE OF THE PREVENTIVE HAEMOSTASIS IN SURGICAL COMPLICATIONS OF VASCULAR ACCESS
Authors: Corciulo Simone , Covella Bianca , Rossi Luigi , Lomonte Carlo
Published: May 2021

Background and Aims

Arteriovenous fistula (AVF) is currently the recommended vascular access type and its preservation is required to ensure a safe treatment for HD patients. Nevertheless, reinterventions are often needed to treat life threatening complications such as eschars, aneurysms, high flow.These surgical procedures are at high risk of bleeding, time-consuming and technically demanding. Here we describe our approach by using preventive hemostasis to treat different types of AVF complications, such as aneurysmectomy, high flow fistula correction, ulcerectomy.

Method

The technique consists of a few steps. First, regional anesthesia is performed by brachial plexus nerve block and intravenous antibiotic prophylactic therapy is administered. Then, an inflatable tourniquet is placed on the arm, proximally to the elbow joint, after wrapping the site with a soft gauze to prevent postoperative discomfort and bruising due to accidental pinch of the skin. The arm is then elevated to allow passive exsanguination and a 5” Esmarch bandage is applied from the hand to the tourniquet cuff. The methodical application of the Esmarch bandage requires an assistant to hold the arm properly in the upright position. Once the bandage is applied, the tourniquet is inflated to complete the exsanguination of the extremity. The inflation pressure has to be adapted to patient systolic pressure, generally a 'suitable' pressure for an upper limb tourniquet is 250-300 mmHg. Lastly, the Esmarch bandage is unwrapped and, after sterile surgical draping, it is possible to proceed to skin incision.

Results

From Jan 2019 to Dec 2020, we enrolled 9 patients with AVF complications treated with the preventive emostasis. The mean age of the patients was 62 years (range, 45-80 years). Table 1 shows types of AVFs and complications, performed revisions, outcomes, short and long term complications. The tourniquet average time of application was 29 + 7,7 min. Preventive hemostasis ensures absence of blood loss, even during high flow access revision. In one patient, a moderate subcutaneous hemorrhage occurred 8 hours after the end of the surgical procedure, requiring further revision. No vascular or soft tissue complications were reported except for temporary dysesthesias.

Conclusion

Our experience shows that preventive haemostasis offers several advantages for surgeons and patients, allowing a clear operative field and avoidance of application of clamps, prevents blood loss, and reduce the need for blood transfusion. Furthermore, reperfusion injury risk is minimized. The only complication occurred suggests the recommendation to suture skin incision after removing the tourniquet to reduce risk of postoperative bleeding. In conclusion, the technique is reliable and safely applicable to surgical treatment of vascular access complication.
MO766EARLY ARTERIOVENOUS FISTULA FAILURE PREDICTION WITH ARTIFICIAL INTELLIGENCE: A NEW APPROACH WITH CHALLENGING RESULTS
Authors: Ibeas Jose , Monill-Raya Núria , Macias Edwar , Rubiella Carolina , Vallespin Joaquim , Merino Jana , Criado Eva , Guitart Josep , Vicario Jose , Morell Antoni , Serrano Javier
Published: May 2021

Background and Aims

The native arteriovenous fistula is considered the vascular access of preference, since it is directly related to major survival, reduced complications, mortality, and costs. Still, its proper maintenance remains a challenge for nephrologists. A previous study from our group, which used the data of 117 arteriovenous fistulas, led to identify in the multivariable analysis age and vein diameters as predictive factors for early failure. On the other hand, Artificial Intelligence has been established as a tool to identify relationships between variables at deep levels, which might be unseen with more conservative methods like classic statistics. Therefore, through a Machine Learning technique known as Random Forest, the aim is to evaluate the same comorbidity, biological and Doppler ultrasound variables data to identify those with a major relation with the early failure of the native arteriovenous fistula.

Method

Retrospective cohort study, gathering the same data of the previous study (from 2011 to 2015): survival, ultrasound mapping (morphology and hemodynamics), comorbidities (blood pressure, severe arteriopathy, diabetes, Charlson’s Index), and laboratory (haemoglobin, calcium, phosphorus, PTH, ferritin, PCR). Different Artificial Intelligence algorithms were tested, but the most suited one for the study's aim turned out to be Random Forest. A model was trained, dividing the data in two sets, training and validation, with an 80/20 ratio. The algorithm used 100 decision trees, with a maximum individual depth of 3 levels. The training was made with the variables that represented the 100%, 95%, 90% and 85% of impact in the fistula's maturation from a theresold according to Gini’s Index.

Results

Age 65.7 (32-88) years, male 59.8%. Hypertension 86.7%, diabetes 50.7% and vascular disease 41.3%. The trained model obtained provided the following results in the evaluation: accuracy 0.82, precision 0.86, AUROC 0.85, F1 0.86 (balance between precision and predictive value). The most relevant variables by decision order were age, phosphorous, PTH, ferritin and calcium. Morphologic and hemodynamic variables such as the vessels diameter, Peak Systolic Velocity, Charlson’s Index or PCR, were also found to be relevant, but in a minor level.

Conclusion

In comparison with classic statistics, Machine Learning techniques might create a change of paradigm in predictive models for the patency of the vascular access for Haemodialysis. Even though the Artificial Intelligence-based model provided the same relevance for age in maturation failure as traditional models, other findings stand out, like the major participation of variables related with mineral metabolism or inflammation, rather than ultrasound based ones.
MO769COMPARISON OF HEMODIALYSIS CONNECTORS CAPS VS ANTIMICROIAL BARRIER CAPS IN CENTERAL LINE-ASSOICATED BLOOSTREAM INFECTION RATES FOR HEMODIALYSIS PATIENTS
Authors: Hemeyer Connie , Moreland Marshall , Olson Elsa , Fitzpatrick Peter , Hickson Latonya
Published: May 2021

Background and Aims

Central line-associated bloodstream infections (CLABSI) lead to increased morbidity and mortality in hemodialysis-dependent patients and are costly to treat. Devices such as hemodialysis connector caps (Tego) and antimicrobial barrier caps (ClearGuardHD) represent promising interventions to reduce CLABSIs. The aim of this study was to assess the efficacy of these devices in reducing CLABSIs in hemodialysis patients who use tunneled dialysis catheters at outpatient dialysis units in a healthcare system.

Method

In a retrospective review of a quality improvement project, we compared cumulative 6-month CLABSI infection rates before and after transition from Tego connectors to ClearGuardHD caps. CLABSI events, reported to National Healthcare Safety Network (NHSN), were expressed as CLABSI events per 100 patient-months. All adult patients (age >18 years) receiving hemodialysis via a tunneled central catheter were included in the study from February 2018-August 2020. The study cohort was comprised of 13 outpatient dialysis units in a healthcare system with locations throughout the Northern Midwest and Southeastern United States. The date of change from Tego to ClearGuardHD was phased throughout the different units over the study period with events recorded 6 months pre- and post-intervention. Patients receiving home dialysis therapies were excluded from the study.

Results

The cumulative 6-month CLABSI event rate decreased by 75.7%; Tego (0.465/100 patient-months) vs. ClearGuardHD caps (0.113/100 patient-months). A total of 17 CLABSI occurrences were reported within 3,654 patient-months with Tego use. However, only 4 CLABSI occurrences were reported within 3,527 patient-months during ClearGuardHD use.

Conclusion

ClearGuardHD caps reduced the rate of CLABSI among hemodialysis patients and are superior to Tego connectors. These findings support prior studies. Implementation of ClearGuardHD caps may help eliminate CLABSI-associated morbidity among individuals requiring maintenance hemodialysis therapy.
MO243STUDY ON THE EFFECT AND MECHANISM OF NOVEL REGULATORY T CELL (CD4+CD126LOWFOXP3+ TREG) IMMUNOTHERAPY IN LUPUS NEPHRITIS*
Authors: Xu Zhenjian , Chen Junzhe , Xu Anping
Published: May 2021

Background and Aims

Our previous study found a new regulatory T cell subpopulation, CD4+CD126lowFoxp3+ regulatory T cells (CD4+CD126lowFoxp3+ Treg). This cell can maintain a stable immune regulatory function in the inflammatory state. Through in vivo and in vitro experiments, we have confirmed that CD4+CD126lowFoxp3+ Treg has an immunotherapeutic effect on T cell-mediated mouse models of autoimmune diseases such as colitis and collagen-induced arthritis (CIA). Further experimental studies showed that CD4+CD126lowFoxp3+ Treg could reduce the kidney injury caused by autoantibodies and prolong the survival time of lupus mice. However, the mechanism of CD4+CD126lowFoxp3+ Treg immunotherapy in lupus nephritis is not clear. The purpose of this study was to explore the mechanism of CD4+CD126lowFoxp3+ Treg immunotherapy in mice with lupus nephritis.

Method

In vitro experiments

CD4+CD126lowFoxp3+ Treg or CD4+CD126lowFoxp3+ Treg pretreated with PD-1 inhibitor were co-cultured with T or B lymphocytes of lupus mice under different in vitro culture condition. The expression levels of Akt and mTOR of Treg in each group were measured under immunoinflammatory conditions. To observe the effects and differences of Treg groups on the activation, proliferation and differentiation of T or B cells and other immunomodulatory effects.

In vivo experiments

CD4+CD126lowFoxp3+ Treg (2 × 106/mouse) and CD4+CD126lowFoxp3+ Treg (2 × 106/mouse) pretreated with PD-1 inhibitor and PBS were injected into NZM2328 lupus mice, respectively. After cell injection, urine protein was measured weekly. Autoantibody expression in lupus mice was measured every two weeks. The effects of Treg on the proliferation and differentiation of T/B cells in lupus mice were observed. The therapeutic effects of Treg on lupus mice were observed.

Results

Compared with CD4+CD126lowFoxp3+ Treg, the expression of Akt and mTOR increases in PD-1 inhibitors pretreatment cells. The activation, proliferation and differentiation functions of T or B lymphocytes of lupus mice were significantly weakened by immunosuppression of PD-1 inhibitors pretreated Treg in vitro, indicating that CD4+CD126lowFoxp3+ Treg may inhibit Akt-mTOR signaling pathway through PD-1 in in vitro.

Compared with CD4+CD126lowFoxp3+ Treg, the activation, proliferation and differentiation functions of T or B lymphocytes of lupus mice were significantly weakened by immunosuppression of PD-1 inhibitors pretreated Treg in vivo. And its therapeutic effect on lupus mice was ineffective, indicating that CD4+CD126lowFoxp3+ Treg may inhibit Akt-MTOR signaling pathway through PD-1 in vivo.

Conclusion

CD4+CD126lowFoxp3+ Treg may inhibit the Akt-mTOR signaling pathway by expressing PD-1, and maintain stable immunomodulatory function in the inflammatory state, thus producing immunotherapeutic effect on lupus nephritis mice.
MO252PLA2R -VE MEMBRANOUS GLOMERULONEPHRITIS PATIENTS SHOWS MORE EFFECTIVE RESPONSE THAN PLA2R +VE ON TACROLIMUS PLUS LOW DOSE PREDNISOLONE THERAPY*
Authors: Jaiswal Akhilesh Kumar , Prasad Narayan , Agarwal Vikas , Behera Manas Ranjan
Published: May 2021

Background and Aims

PLA2R is an autoantigen present in glomerular podocytes of Membranous Nephropathy (MN) patients. Several drugs have been tried which included nonspecific anti-proteinuric agents; corticosteroids, alone or with alkylating agents; cyclosporine; intravenous Ig; mycophenolate mofetil; and rituximab. There is no standard therapy for patients with frequent relapsing or steroid-dependent MN. We propose the efficacy of low dose Tacrolimus (TAC) plus prednisolone and associated changes in anti-PLA2R in adult IMN.

Method

Total 101 membranous nephropathy patients were treated with combination of prednisolone 1mg/kg alt-day) and Tac 0.1mg/kg/day (trough 6-10 ng/ml first 6M and 4-6 ng/ml for next 3M) then both taper by 1/3 every month up to 12M. Out of 101 patients; 15 diabetic; 7 lupus; 1HBV and 1 ankylosing spondylitis patients were excluded. Finally; 77 Patients were followed and evaluated for the anti-PLA2R level at baseline; 3M; 6M; 12M and end of follow-up (17-61 ; median 38 months). CR; PR; relapse; and side-effects were recorded.Of the 77 patients; at 3M 60(77.92%; CR-37; PR-23); at 6M 61(79.22%; CR-53; PR-8); at 12M 53(68.86%; CR-47; PR-6) achieved remission. Eight (10.38%) relapsed and 16(20.77%) showed no response at 12M. At end of follow-up; out of 54 responsive patients 37(68.51%; CR-36; PR-1) remained in remission and 17(31.48%) patients relapsed.

Results

Out of 77 patients; 51 (66.3%) were anti-PLA2R positive. Remission rate was significantly low in PLA2R+ve than PLA2R-ve (36/51 vs 24/26; p=0.03) at 3M; (36/51 vs 25/26; p=0.009) at 6M and (31/51 vs 22/26; p=0.03) at 12M. PLA2R level was decreased by 60.38% and 77.56% at 3M and 6M respectively (1A & 1B). There were significant correlations between PLA2R level and 24h proteinuria at baseline; 3M and at 6M (1C). During therapy 4 patients develop cutaneous tenia; 1 osteonecrosis of the femur head; 1 corpus tunnel syndrome; 4 onset diabetes; 3 tremor; and 14 patients experienced GI symptoms. The eGFR was decreased significantly (p=0.003) by 26.5% at the end of therapy and was normalized after stopping Tac; and 5 non-responsive patients had doubling of serum creatinine and progressively deteriorated eGFR. To note; 4 females had pregnancy and successful delivery in our cohort of patients.

Conclusion

PLA2R+ve patients showed poor response compare to PLA2R-ve patients. Remission with Tacrolimus and prednisolone therapy is comparable to historical Ponticelli (Pred plus CYP) regimen. Successful pregnency was ovserved on Tac based regimen.
MO259LYMPHOPENIA AT ANCA-GLOMERULONEPHRITIS DIAGNOSIS IS CORRELATED WITH SEVERITY AND RENAL PROGNOSIS
Authors: Wacrenier Samuel , Riou Jeremie , Jourdain Pierre , Guibert Fanny , HENRY NICOLAS , Assia DJEMA , Coindre Jean Philippe , Crochette Romain , Cousin Maud , Croue Anne , Jean François SUBRA , Piccoli Giorgina , Jean François AUGUSTO , Brilland Benoit
Published: May 2021

Background and Aims

Lymphopenia is commonly observed in various autoimmune diseases, such as systemic lupus erythematosus, where it has been associated with disease activity or prognosis. However, in ANCA-associated vasculitis (AAV) only few, small-scale studies have been targeted to this issue. Research has not yet focused on ANCA-glomerulonephritis (ANCA-GN) patients. Thus, the aim of this study was to analyze the association between lymphocyte counts and outcomes in a large cohort of ANCA-GN patients.

Method

We used the Maine-Anjou AAV registry that retrospectively gathers data on consecutive patients affected by AAV in four French Nephrology Centers, recorded since January 2000. We analyzed clinical, biological, and histological data at diagnosis of ANCA-GN. Biological data, including lymphocyte counts, were collected before the administration of any immunosuppressive treatment. Risk factors for end-stage kidney disease (ESKD) were analyzed. Event-free survival was also assessed.

Results

Among the 145 patients included in the study, 53 (37%) patients presented with lymphopenia at ANCA-GN diagnosis. Lymphopenic patients were older (72 [63–79] vs 66 [56–73] years old, p = 0.010), had a lower renal function at baseline (eGFR 13 mL/min vs 26 mL/min, p = 0.002), and a higher proteinuria (1.86 [1.21–3.52] g/g vs 1.30 [0.75–2.65] g/g, p = 0.042). There was a trend for a higher BVAS (18 [14–22] vs 15 [12–20], p = 0.076) in lymphopenic patients. Therapeutic management between the two groups was similar. There was no difference in relapse rate between the two groups but lymphopenic patients were more likely to require kidney replacement therapy (51% vs 25%, p = 0.003) and were more likely to die (34% vs 17%, p = 0.039). Lymphopenia was correlated with histological lesions and especially with the percentage of sclerotic glomeruli (p = 0.0027). ESKD-free survival and overall survival were lower in lymphopenic patients (p < 0.0001 and 0.0051 respectively). In multivariate Cox analysis, lymphopenia, but not death, was an independent risk factor for ESKD (HR 4.47 (95% confidence interval: [2.06–9.72], p < 0.001).

Conclusion

Lymphopenia correlates with severity of ANCA-GN at diagnosis and predicts poor renal outcome. In this view, lymphopenia could be used as a simple and cost-effective biomarker to assess renal prognosis at ANCA-GN diagnosis.
MO262THE SINGLE-CELL TRANSCRIPTOMICS OF HUMAN IGA NEPHROPATHY
Authors: Zhong Yong , Xiao Xiangcheng
Published: May 2021

Background and Aims

The exact molecular mechanisms underlying IgA nephropathy (IgAN) remains incompletely defined. Therefore, it is necessary to further elucidate the mechanism of IgA nephropathy and find novel therapeutic targets.

Method

Single-cell RNA sequencing (scRNA-seq) was applied to kidney biopsies from 4 IgAN and 1 control subjects to define the transcriptomic landscape at the single-cell resolution. Unsupervised clustering analysis of kidney specimens was used to identify distinct cell clusters. Differentially expressed genes and potential signaling pathways involved in IgAN were also identified.

Results

Our analysis identified 14 cell subsets in kidney biopsies from IgAN patients, and analyzed changing gene expression in distinct renal cell types. We found increased mesangial expression of several novel genes including MALAT1, GADD45B, SOX4 and EDIL3, which were related to proliferation and matrix accumulation and have not been reported in IgAN previously. The overexpressed genes in tubule cells of IgAN were mainly enriched in inflammatory pathways including TNF signaling, IL-17 signaling and NOD-like receptor signaling. Moreover, the receptor-ligand crosstalk analysis revealed potential interactions between mesangial cells and other cells in IgAN. Specifically, IgAN with overt proteinuria displayed elevated genes participating in several signaling pathways which may be involved in pathogenesis of progression of IgAN.

Conclusion

The comprehensive analysis of kidney biopsy specimen demonstrated different gene expression profile, potential pathologic ligand-receptor crosstalk, signaling pathways in human IgAN. These results offer new insight into pathogenesis and identify new therapeutic targets for patients with IgA nephropathy.
MO265LONGITUDINAL CHANGE IN PROTEINURIA AND KIDNEY OUTCOMES IN C3 GLOMERULOPATHY
Authors: Caravaca-Fontán Fernando , Goicoechea de Jorge Elena , Praga Manuel
Published: May 2021

Background and Aims

The association between a change in proteinuria over time and its impact in kidney prognosis has not been analyzed in C3 glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure.

Method

Retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the GLOSEN group. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modeling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure.

Results

The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13–41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (HR: 0.79; 95%CI:0.56–0.97; p<0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up.

Conclusion

The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.
MO277THE RATIO OF NEUTROPHIL TO LYMPHOCYTE AS A POTENTIAL MARKER OF CLINICOPATHOLOGICAL ACTIVITY FOR SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Han Qianqian , Liang Peifen , Li Jiajia , Liu Bo , Hu‘an’g Rong , Yang Qiongqiong
Published: May 2021

Background and Aims

The ratio of neutrophils to lymphocytes (NLR) is a novel inflammatory factor that is elevated in systemic lupus erythematosus (SLE) and related to disease activity. However, the relationship between NLR and renal pathological manifestations in patients with lupus nephritis (LN) has not been studied.

Method

In this retrospective study, 240 SLE patients were recruited. 186 patients with renal involvement and 124 LN patients underwent renal biopsy. In the meanwhile, control groups included 125 chronic kidney disease (CKD) patients and 125 healthy volunteers. Patients with SLE disease activity 2000 (SLEDAI-2K) >9 and ≤ 9 were defined as severely active and mildly active, respectively. Clinical parameters and pathological data were collected. The correlations between NLR and clinicopathological features were analyzed.

Results

The NLR of SLE group was significantly higher than that of the sex-age matched control groups. Patients with nephritis had higher NLR levels than those without nephritis [2.88(1.81,4.32) vs. 2.43(1.55,3.90), P=0.044; Figure 1]. Increased NLR was observed in severely active group compared to mildly active group [3.00(1.84,4.28) vs.2.36(1.61,3.51), P=0.020; Figure 1]. NLR was significantly positively related with SLEDAI score (r=0.131, P=0.043), Renal SLEDAI score (r=0.173, P=0.023), C-reactive protein (CRP; r=0.213, P=0.002), 24-hour urine protein (r=0.274, P<0.001; Figure 2A), renal activity index (AI; r=0.192, P=0.033), cellular crescents (r=0.274, P=0.006) and tubular atrophy (r=0.226, P=0.011), and negatively correlated with serum albumin (r=-0.187, P=0.004; Figure 2A). Based on the receiver operating characteristic (ROC) curve, the best NLR cut-off value to predict severe activity and cellular crescents was 2.19 and 3.16, respectively. The ability of NLR to differentiate severely active from mildly active SLE was stronger than CRP and weaker than C3 (Figure 3A). The ability of NLR to predict cellular crescents was better than C3, but not superior to SLEDAI and RSLEDAI. Interestingly, the ROC fitted by NLR and RSLEDAI had a higher AUC and sensitivity [AUC=0.75(0.66,0.84), sensitivity=82.6%, specificity=63.6%; Figure 3B].

Conclusion

NLR was a non-invasive and potential inflammatory factor to evaluate clinical and renal pathological activity in patients with SLE.
MO278IMMUNOSUPPRESSIVE THERAPY VERSUS SUPPORTIVE CARE IN IGA NEPHROPATHY PATIENTS WITH STAGE 3 AND 4 CHRONIC KIDNEY DISEASE
Authors: Stefan Gabriel , Stancu Simona , Zugravu Adrian Dorin , Petre Nicoleta , Mircescu Gabriel
Published: May 2021

Background and Aims

The use of immunosuppressive therapy for IgA nephropathy (IgAN) patients with stage 3 or 4 chronic kidney disease (CKD) is controversial.

Method

We performed a monocentric retrospective study on 83 consecutive IgAN patients (age 41 [33-56] years, 72% male, eGFR 36.1 [25.4-47.5] mL/min) with stage 3 or 4 CKD and proteinuria ≥ 0.75g/day who received uncontrolled supportive care (Supp) (n=36), corticosteroids (CS) (n=14) or CS combined with monthly pulses of cyclophosphamide (CS+CFM) (n=33) between 2010-2017. Patients were followed until composite endpoint (doubling of serum creatinine, ESKD (dialysis or renal transplant) or death, whichever came first) or end of study (May 2018).

Results

Patients were followed for a median of 29 (95%CI 25.2, 32.7) months, and 12 (15%) patients experienced the composite endpoint.

There were no differences between the three studied groups regarding age (Supp 46 [33.5-61.0] vs CS 40 [33-47] vs CS+CFM 41 [34-48] years), eGFR (Supp 37.7 [27.5-49.2] vs CS 40.3 [32.5-54.6] vs CS+CFM 31.5 [22.7-44.3] mL/min), proteinuria (Supp 1.9 [1.4-3.5] vs CS 1.3 [1.0-1.7] vs CS+CFM 1.7 [1.1-2.9] g/g creatinine), MESTC score (Supp 2.5 [1.5-4.0] vs CS 2 [0-2] vs CS+CFM 3 [2-3]), hypertension (Supp 94% vs CS 86% vs CS+CFM 94%) and therapy with renal angiotensin system inhibitors (Supp 83% vs CS 64% vs CS+CFM 67%).

Mean renal survival time for the entire cohort was 81.0 (95%CI 73.1, 89.0) months; we found similar renal survival time between the three groups (Supp 79.0 (95%CI 66.5, 91.6) vs CS 69.3 (95%CI 47.7, 91.0) vs CS+CFM 73.7 (95%CI 66.0, 81.4) months, p=0.4).

In univariate and multivariate Cox regression analysis adjusted for IgAN progression factors, immunosuppressive therapy was not associated with better renal survival when compared to supportive therapy (Table 1).

Conclusion

Within the limitation of a retrospective study, we found no benefit from immunosuppressive therapy in patients with IgAN with stage 3 and 4 CKD as compared to supportive care.
MO287REAL WORLD COMPARISON OF THE PREDICTIVE UTILITY OF INTERNATIONAL IGA RISK PREDICTION SCORE AND KIDNEY FAILURE RISK EQUATION IN IGA NEPHROPATHY PATIENTS
Authors: Mohammed Sophia , Chinnadurai Rajkumar , Ponnusamy Arvind
Published: May 2021

Background and Aims

IgA nephropathy is the most prevalent cause of glomerular disease worldwide. The international IgA risk prediction (IgAN) score is a well validated tool to predict the risk of 50% decline in eGFR or end stage renal disease (ESRD) at five years after biopsy in patients with IgA nephropathy. Also, the four variable kidney failure risk equation (KFRE) is another validated tool used to predict the two- and five-year risk of progression to ESRD of all cause chronic kidney disease (CKD 3-5).

Our aim is to compare the predictive utility of IgAN score and the KFRE in a real-world cohort of Caucasian patients with long-term follow-up data.

Method

All available patients with biopsy-proven IgA nephropathy in our centre between January 2001 and December 2013 were included in this observational study. Baseline (biopsy date) data relevant to the scores including demographics, laboratory and the histopathological features were collated at the time of biopsy. Follow up data on renal functions and renal outcome (50% decline in eGFR or reaching ESRD) were collected until an arbitrary end date 31/12/2018.

Results

We had a total of 115 patients recorded over this 13-year period. The median age of our cohort at time of biopsy was 41 years. Men represented 71% of the cohort. At baseline 84% were hypertensive and 11% diabetic. 77% were on a renin-angiotensin blocker, with 53% being on a statin. Out of the 115 patients, 74 were eligible to undergo analysis. The percentage risk of reaching the endpoint (50% decline in eGFR or reaching ESRD) was calculated at 2 years and 5 years for all patients. These results can be seen in table 1 and 2. At 2 years, 7 patients had reached the endpoint: 2 patients had a >50% decline in eGFR, 3 patients received RRT and 2 patients underwent transplantation. At 5 years, 14 patients had reached the endpoint: 3 patients had a >50% decline in eGFR, 6 patients received RRT and 5 underwent transplantation.

Conclusion

Our data suggests that the KRFE tool underpredicts the risk of reaching endpoint, compared to the IgAN. Our study has helped to compare the two tools, but further statistical validation is required using a larger cohort.
MO291RITUXIMAB IS EFFECTIVE AND SAFE IN ADULTS WITH STEROID-DEPENDENT NEPHROTIC SYNDROME: A LONG-TERM, SINGLE-CENTER EXPERIENCE
Authors: Patella Gemma , Comi Alessandro , Coppolino Giuseppe , Comi Nicolino , Fuiano Giorgio , Andreucci Michele , Bolignano Davide
Published: May 2021

Background and Aims

Steroid-dependent nephrotic syndrome (SDNS) may require a prolonged multi-drug therapy with risk of drug toxicity and renal failure. Rituximab (RTX) treatment has been found to be helpful in reducing the steroid dosage and the need for immunosuppressants (ISs), but little data are currently available regarding very long-term outcomes in adults. We herein describe a long-term, single-center experience of RTX use in a large series of adults with SDNS.

Method

We studied 23 adult patients with SDNS (mean age 54.2±17.1 y; 65% male; BMI 28.5±4.7), mostly consequent to membranous (47.8%) or focal glomerulonephritis (30.2 %) who were eligible to start a RTX regimen. Before entering the RTX protocol, proteinuria and eGFR were 7.06±3.87 g/24h and 65.9±28.2 ml/min/1.73 m2, respectively; albumin and CD19/CD20 ratio were 2.9±0.9 g/L and 0.99±0.01 respectively; the mean number of ISs was 2.39±0.89 and the mean annual rate of relapses was 2.2±0.9.

Results

Patients were followed over a mean follow-up of 64 months (range: 12-144). After RTX (mean dose: 1202.1±372.4 mg) the rate of relapses was virtually nullified (p<0.001). eGFR remained roughly stable (62.1±19.8 ml/min/1.73 m2, p=NS), while proteinuria, albumin, CD19/CD20 and BMI all significantly improved (p ranging from 0.01 to 0.001). The mean number of additional ISs was also reduced (0.44±0.12; p<0.001) and RTX enabled discontinuation of steroids in 13/23 (56.5%) patients. No major adverse events related to therapy were recorded.

Conclusion

Findings from this large case-series with a remarkable very long follow-up reinforce the role of RTX as an efficient and safe weapon to improve outcomes in adult patients suffering from SDNS.
MO298A SPECIFIC TUBULAR APOA-I DISTRIBUTION IS ASSOCIATED TO FSGS RECURRENCE AFTER KIDNEY TRANSPLANTATION
Authors: Jacobs Cachá Conxita , Puig Gay Natàlia , Vergara Ander , Gabaldon Alejandra , Sellares Joana , Villena Yolanda , Agraz Irene , Seron Micas Daniel , Moreso Francesc , Soler María José , López Hellín Joan
Published: May 2021

Background and Aims

A major complication primary focal segmental glomerulosclerosis (FSGS) is its recurrence after kidney transplantation that happens in 30 to 40% of the patients. The diagnosis of this relapses is not always easy as the histological lesions are not highly specific and appear after the proteinuria increase. Currently, there are no accurate biomarkers to detect FSGS recurrence. Our group identified a modified form of Apolipoprotein A-I (ApoA-I), named ApoA-Ib, specifically present in urine of recurrent FSGS patients after kidney transplantation. Aberrant forms of ApoA-I have also been described in urine of native primary FSGS patients and have associated this feature to a prominent staining of ApoA-I at the apical membrane of the tubular cells. In this study we aim to analyze the ApoA-I distribution in kidney allograft biopsies of recurrent FSGS patients.

Method

We detected ApoA-I by immunohistochemistry in kidney allograft biopsies of patients with FSGS relapse after kidney transplantation (urinary ApoA-Ib positive) and in kidney allograft biopsies of patients with a disease different from FSGS in the native kidney (No-FSGS, urinary ApoA-Ib negative).

Results

In ApoA-Ib positive recurrent FSGS patients, ApoA-I was prominently localized at the brush border of the tubular cells while in the No-FSGS patients ApoA-I was found along the cytoplasm of the tubular cells (Figure 1).

Conclusion

The localization of ApoA-I at the brush border of the tubular cells is a specific feature of primary FSGS in relapse. This suggests that ApoA-I staining in kidney biopsies, coupled with ApoA-Ib measurement in urine, could be used as a diagnostic tool of primary FSGS relapse after kidney transplantation due to its highly specific tubular distribution.
MO248P-GLYCOPROTEIN EXPRESSING IL-17A+IFN-GAMA+ TH17/1 CELLS ARE REFRACTORY TO GLUCOCORTICOID IN NEPHROTIC SYNDROME*
Authors: Jaiswal Akhilesh Kumar , Prasad Narayan , Agarwal Vikas
Published: May 2021

Background and Aims

Th17 cells are critical effectors mediating the autoimmunity in nephrotic syndrome (NS). Elevated IFN-γ has also been involved in NS; however, it remains unclear to what extent Th1 cells contribute to glucocorticoids resistance in NS. P-glycoprotein (P-gp) effluxes glucocorticoids outside the cells and selectively expressed differentially on T cell subtypes. In this study, we investigated the role of P-gp and cellular source of IFN-γ and assessed its contribution to glucocorticoids resistance in NS.

Method

We analyzed the frequency of pathogenic IL-17A+IFN-γ+ Th17/1 lymphocytes and P-gp expression on their surface by flow cytometry in SSNS (n = 32; mean age: 9.06 ± 5.84) and SRNS (n = 28; mean age: 11.29 ± 3.73) patients. We also included 15 age- and sex-matched healthy controls. All patients were of biopsy proven minimal change disease and all patients were treated with steroids. All patients were recruited as per the criteria of ISKDC.

Results

We found a significant IL-17A+IFN-γ+ Th17/1 population (P < 0.001) in steroid resistant NS (SRNS) as compared to steroid sensitive NS (SSNS) patients. IL-12 and IL-23 are significantly higher in SRNS as compared to SSNS patients which are require for transition of pathogenic Th17 cells to IFN-γ producers. Of the IL-17A+IFN-γ+ Th17/1 population 95.8% cells were expressed P-gp on their surface in SRNS; however only 30.1% cells expressed P-gp in SSNS group (Figure 1). We also observed that P-gp expression correlate positively with IL-17A+IFN-γ+ Th17/1 population (r= 0.739, p< 0.001) significantly.

Conclusion

The above findings clearly show that higher expression of P-gp on IL-17A+IFN-γ+ Th17/1 cells associated with steroid resistance in nephrotic syndrome through both IL-17A and IFN-γ.
MO302ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN ADULTS: A TUNISIAN SINGLE CENTER EXPERIENCE
Authors: El Meknassi Imen , Sanda Mrabet , Yosra Guedri , Dorsaf Zellema , Awatef Azzabi , Wissal Sahtout , Salma Toumi , Asma Fradu , Sabri Ferdaous , Ben Amor Samira , Abdellatif Achour
Published: May 2021

Background and Aims

Acute post-infectious glomerulonephritis (APIGN) is a reactive immunological disease. Its prevalence in industrialized countries is declining contrasting with developed ones. It is uncommon in adults but the prognosis may be reserved. The aim of our study was to evaluate the epidemiological, clinical and histological features of APIGN as well as its prognosis.

Method

A retrospective and descriptive study was conducted in our department. Were included all cases of histologically proven APIGN between December 2006 and December 2017.

Results

We had collected 38 cases. The mean age was 37.7 ± 17.8 years. The sex ratio was 1.92. Twelve (31.6%) patients were diabetic and four of them had already a chronic kidney disease (CKD). APIGN was preceded by an infection in 27 cases with an average interval of 10 ± 5 days. The most common site of infection was the respiratory tract (15 cases). At presentation, 27 patients had nephritic syndrome and 13 had nephrotic-range proteinuria. Hematuria was observed in 97.4%, peripheral edema in 84.2% and hypertension in 73.7% of cases. Most patients (78.9%) had acute kidney injury and 10 (26.3%) patients required dialysis. Renal biopsy had shown benign acute glomerulonephritis in 31 cases and malignant form in 7 cases. An underlying nephropathy was found in 12 cases with mostly a diabetic nephropathy. Corticosteroids were used in 3 cases of benign APIGN and 5 cases of malignant form. During the follow-up, CKD was noted in 14(36.8%) patients including 7(18.4%) patients who progressed to end-stage renal disease. Poor prognostic factors were diabetes, the presence of an underlying nephropathy in the biopsy, acute kidney injury and the need for dialysis.

Conclusion

The APIGN is uncommon in adults, yet its prognosis may be reserved with progression to CKD.
MO309SARS COV2 INFECTION COMPLICATING CRYOGLOBULINEMIC VASCULITIS WITH RENAL INVOLVEMENT
Authors: Bouafif Hanene , Mariem Hajji , Barbouch Samia , Hafedh Hedri , Gorsane Imen , Ben Hmida Fethi , Ben abdallah Taieb
Published: May 2021

Background and Aims

Cryoglobulinaemic vasculitis (CV) leading to clinically apparent skin lesions, and in some cases also to internal organ involvement such as renal involvement. The SARS Cov2 infection in this field is very serious and in the case of our patient the outcome was fatal.

The aim of this work is to highlight the particularities of CV in this case

Case presentation

We report a case of a 62-year-old woman followed since 2014 for CV type 1 IgG Lambda revealed by vascular purpura and nasal septal perforation. the etiological assessment was negative. Hepatitis C virus serology was negative. A corticosteroid therapy at a dose of 1 mg/kg/day was started with partial improvement. Then the cyclophosphamide at a dose of 150 mg/d was added with a fairly good clinical result but stopped for hemorrhagic cystitis.

Chlorominophene was started at a dose of 6 mg/d and then reduced to 4 mg/d for leuconeutropenia but the peripheral arterial manifestations (acrocyanosis of the limbs and ears) were not treated.

The evolution was marked by the appearance of renal failure (creatinine 482.33 umol/l) associated with proteinuria at 1.32 g/24h. An outbreak of cryoglobulinemia was suspected.

Plasma exchange was discussed as a therapeutic alternative and the patient was scheduled for a renal biopsy.

However, the patient became febrile with the appearance of a dry cough and the presence of a biological inflammatory syndrome (CRP at 72). A SARS-CoV-2 PCR was completed which was positive. Therefore, she was put on antibiotic therapy (Azythromycin and Cefotaxime) associated with vitamin therapy and anticoagulant treatment.

The patient was stable in terms of respiration and hemodynema, but her renal function worsened and progressed well under hydration. In addition, she presented with a slippage syndrome and she was died

Conclusion

The natural history of CV is not predictable and strongly depends on concomitant diseases and complications and response to treatment. The SARS Cov2 infection can complicate its evolution. There is no association has been described between them to our knowledge
MO319BEDSIDE URINE SEDIMENT EXAMINATION IN IMMUNOGLOBULIN A NEPHROPATHY PATIENTS PERFORMED BY NEPHROLOGISTS
Authors: Popova Anna , Racenis Karlis , Saulite Anna Jana , Vasilvolfa Aiga , Petersons Aivars , Cernevskis Harijs , Kuzema Viktorija
Published: May 2021

Background and Aims

Urine sediment microscopy is mostly abandoned by nephrologists nowadays, however it is an important diagnostic tool in kidney and urinary tract diseases. The aim of this study is to emphasize the benefits of urine microscopy performed by a nephrologist.

Method

A prospective cohort study at Pauls Stradins Clinical University Hospital Nephrology center included patients with histologically confirmed diagnosis of IgA nephropathy from 1st January 2020 till December 2020. Appropriately collected urine samples were examined using manual microscopy within an hour after sample collection and by automated urinalysis. Samples were centrifuged at 4000 rpm for 4 minutes, the supernatant urine was carefully decanted, 1 - 1,5  ml of the left urine was mixed by gentle agitation and placed on a standard glass slide with a cover slip. Sample examination was performed using low (magnification x10) and high power (magnification x40) using brightfield microscopy with a minimum of 10 fields.

Results

A total of 37 patients (24 men, mean age 42.7 ± 10.9 years) were included in the study. 59.5 % of patients (n = 22) had hematuria based on automated urine sediment analysis and 62.2 % (n = 23) of patients had hematuria based on manual urine microscopy. 45.9 % of patients (n=17) had dysmorphic erythrocytes, 13.5 % of patients (n = 5) had isomorphic red blood cells (RBC) and 40.5 % of patients (n = 15) did not have RBC in urine samples by manual urine microscopy. 54.2 % (13/24) of men and 30.8 % (4/13) of women had dysmorphic RBC in urine.

Conclusion

Manual urine sediment examination was more sensitive than automated analysis. Majority of IgA nephropathy patients have active urine sediment with hematuria and dysmorphic RBC. Manual microscopy remains an effective and reliable method that can be easily and quickly performed by nephrologists.
MO322VENOUS THROMBOEMBOLISM AND NEPHROTIC SYDROME: A FAMOUS BUT STILL SURPRISING COUPLE
Authors: Ruosi Carolina , Cavasso Michele , Caprio Francesca , Giuliana Sofia , Perna Alessandro , Orefice Giuseppe , Perna Alessandra , Simeoni Mariadelina
Published: May 2021

Background

Venous thromboembolism (VTE) is a multifactorial disorder, accounting for high morbidity and mortality rates, due to a complex interplay of several variables classifiable as inherited (mutated Leiden V factor, prothrombin, protein C, protein S and antithrombin) and acquired (lupus anticoagulants, pregnancy, major surgery procedures, cancer and inflammatory diseases) risk factors.

The association of VTE with the nephrotic syndrome, particularly deep vein and renal vein thrombosis (DVT and RVT, respectively) is tightly established. This risk is particularly high in patients with idiopathic membranous nephropathy. In fact, thromboembolic events occur with a frequency between <10% and 45% in this disease. The reason(s) underlying the hypercoagulable status in nephrotic patients are not clearly understood. Multiple hemostatic abnormalities have been described, including decreased levels of antithrombin and plasminogen (due to urinary losses), increased platelet activation, reduced plasminogen activation, overproduction of fibrinogen and factors V and VIII as a compensatory response to hypoalbuminemia. The risk of thrombosis seems to be related to the severity and duration of the nephrotic status and seems to be particularly increased with serum albumin concentrations ≤2.0 g/dl (20 g/L).

Case report

We report the case of a 28 year-old male with nephrotic syndrome due to membranous nephropathy positive for serum anti-phospholipase-A2 receptor antibody. The patient was asymptomatic for VTE, but abdominal ultrasound showed endoluminal obstruction of both renal veins. Abdominal Computer Tomography confirmed the extensive bilateral renal vein thrombosis and also revealed an extension of the thrombosis to the inferior cava vein and the left common iliac vein. He was treated with low-molecular weight heparin for six months. According to our internal protocol, a complete Thrombophilia Molecular Study was performed and showed a normal Leiden V factor, but a rare homozygous mutation of the G20210A gene encoding for prothrombin. The prevalence of this is less than 5% in the general population, but is highly variable with ethnicity. The G20210A mutation confers a mildly increased thrombotic risk that is amplified by the presence of other risk factors, such as nephrotic syndrome.

Conclusions

In our case report, the association of a nephrotic syndrome secondary to a primitive membranous glomerulonephritis and the mutation in homozygous of the G20210A prothrombin, a rare mutation associated with a high thrombotic risk, led to a severe VTE in an still asymptomatic 28-year-old patient. Based on this experience, we would highlight the importance of the genetic screening for polymorphisms associated with inherited thrombophilia in nephrotic patients complicated with VTE.
MO103PREDICTION OF CARDIOVASCULAR OUTCOMES WITH PERIDIALYTIC, INTRADIALYTIC, SCHEDULED INTERDIALYTIC AND AMBULATORY BP RECORDINGS IN HEMODIALYSIS PATIENTS
Authors: Iatridi Foteini , Theodorakopoulou Marieta , Loutradis Charalampos , Karpetas Antonios , Bikos Athanasios , Alexandrou Maria Eleni , Tsouchnikas Ioannis , Mayer Christopher , Haidich Anna-Bettina , Papagianni Aikaterini , Sarafidis Pantelis
Published: May 2021

Background and Aims

Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysis subjects due to high accuracy and strong associations with outcomes. The agreement and prediction of averaged intradialytic BP readings and home BP readings with ABPM and clinical outcomes is not known. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular outcomes and mortality in this population.

Method

We prospectively followed for 49.1±25.6 months 242 hemodialysis patients with valid 48-hour ABPMs to examine the association of pre-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings, scheduled interdialytic BP (the average of out-of-dialysis day readings at 8:00 am and 8:00 pm) and 44-hour ambulatory BP with outcomes. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary revascularization procedure or peripheral revascularization procedure.

Results

Cumulative freedom from the primary end-point was significantly lower with increasing 44-hour SBP (group 1, <120 mmHg, 64.2%; group 2, ≥120 to <130 mmHg 60.4%, group 3, ≥130 to <140 mmHg 45.3%; group 4, ≥140 mmHg 45.5%; logrank-p=0.016). Similar were the results for intradialytic (logrank-p=0.039), intradialytic plus pre/post-dialysis (logrank-p=0.044), and scheduled interdialytic SBP (logrank-p=0.030), but not for pre-dialysis SBP (logrank-p=0.570). With group 1 as the reference group, the Hazard Ratios of the primary end-point showed a gradual increase with higher BP levels with all BP metrics, except pre-dialysis SBP. An inverse association of DBP levels with outcomes was shown with all BP metrics.

Conclusion

Averaged intradialytic and scheduled home BP measurements (but not pre-dialysis readings) display similar patterns of prognostic associations with 44-hour ambulatory BP in hemodialysis patients and represent valid metrics for hypertension management in these individuals.
MO106A PROSPECTIVE STUDY ON ANXIETY AND BLOOD PRESSURE LEVELS IN HAEMODIALYSIS PATIENTS DURING COVID-19 PANDEMIC
Authors: Eren Sadioğlu Rezzan , Aktar Merve , Duman Berker , Kutlay Sim , Sengul Sule , Keven Kenan , Nergizoglu Gökhan , Ateş Kenan , Ertürk Şehsuvar
Published: May 2021

Background and Aims

Coronavirus Disease-19 (COVID-19) pandemic has currently been one of the leading causes of psychosocial stress worldwide. We hypothesized that possible changes in anxiety status might affect blood pressure in haemodialysis (HD) patients during COVID-19 pandemic.

Method

Seventy one prevalent HD patients were included in this prospective study. Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI) were applied to assess psychological status of the patients. Peridialysis blood pressure measurements were performed and average of 6 consecutive HD sessions’ pre-dialysis systolic blood pressure measurements were used for statistical analyses. All assessments were performed both at the beginning (March) and after ending (June) of the partial lock-down, which was officially instituted by the Government in parallel with the status of the pandemic in Turkey.

Results

Mean age (±SD) was 59.2±14.8 years and 52% of the patients were female. Dose of medications including antihypertensives, dry weight, interdialytic weight gain, and Kt/Vurea were stable during the study period. STAI-state score was higher in March than that in June (44.6±12.6 vs 42.3±11.5, respectively, p=0.047), whereas HADS-anxiety, HADS-depression, and STAI-trait scores were not different. Pre-dialysis systolic blood pressure was significantly higher in March than in June (127.9±20.3 vs 124.8±22.8 mmHg, respectively, p=0.029). Change in state anxiety score from March to June was remarkable particularly in patients not taking a beta-blocker (49.3±9.6 to 43.8±11.1, p=0.001) and in patients younger than the median age of 64 years (48.6±12.8 to 45.3±12.5, p=0.029). Change in blood pressure level from March to June was found to be significant only in patients not taking a beta-blocker (123.4±20.2 to 118.2±20.6 mmHg, p<0.001), while did not reach a statistically significant level in the others.

Conclusion

Our findings, though need to be confirmed by further studies, revealed an association between a higher state of anxiety and a higher blood pressure level in HD patients in COVID-19 pandemic era, which was remarkable particularly in patients not taking a beta-blocker.