bluuebunny/crossref_metadata_2025 huggingface dataset:
P0210ASSOCIATIONS BETWEEN CHANGES IN RENIN ACTIVITY AND ALDOSTERONE LEVELS AND CHANGES IN KIDNEY FUNCTION AFTER TREATMENT FOR PRIMARY ALDOSTERONISM: A LARGE MULTICENTER COHORT STUDY IN JAPAN
Authors: Kobayashi Yusuke , Yano Yuichiro , Haze Tatsuya , Hatano Yu , Tamura Kouichi , Naruse Mitsuhide , JRAS study group JPAS/
Published: June 2020

Background and Aims

Greater reduction in estimated glomerular filtration rate (eGFR) after treatment for primary aldosteronism (PA) reflects improvement of glomerular hyperfiltration associated with PA and leads to better patient outcomes. However, little is known regarding the mechanisms underlying eGFR reduction after treatment for PA.

Method

We analyzed data from the nationwide PA registry in Japan. Patients were assigned to adrenalectomy (n=419) and mineralocorticoid receptor (MR) antagonist (n=674) groups. We assessed associations between changes in BP, plasma renin activity and aldosterone levels, and eGFR after treatment for both groups.

Results

Reduction in eGFR after treatment was greater in the surgical compared to MR antagonist treatment group (median -11.0; 95% CI, -12.2 to -9.8 ml/min/1.73 m2 vs. -3.5; 95% CI, -4.3 to -2.7 ml/min/1.73 m2; p <0.001). In a multivariable linear regression, the adjusted betas (95% confidence interval) for change in eGFR after treatment for each standard deviation higher level of plasma renin activity and aldosterone were -2.12 (-4.10, -0.14) and 2.41 (1.20, 3.62) ml/min/1.73 m2, respectively, in the adrenalectomy group, and -0.65 (-1.28, -0.02) and –0.64 (-2.04, 0.76) ml/min/1.73 m2, respectively, in the MR antagonist group. Plasma renin activity Change in mean arterial pressure after treatment was not associated with change in eGFR in either group.

Conclusion

Changes in plasma renin activity and aldosterone levels but not BP, after treatment for PA were associated with greater reductions in eGFR. Post-treatment improvements in glomerular hyperfiltration may be attributable to suppressed MR activity within the kidneys, not to reductions in systemic blood pressure. It is important for clinicains not only to treat PA, but also to confirm adequate suppressed MR activity after treatment for correction of glomerular hyperfiltration.
P0211GLOMERULAR HYPERFILTRATION AND CANCER: A NATIONWIDE POPULATION-BASED STUDY
Authors: Kim Yaerim , Yoon Jeongsoo , Paek Jin Hyuk , Park Woo Yeong , Jin Kyubok , Han Seungyeup , Joo Kwon Wook , Kim Dong Ki
Published: June 2020

Background and Aims

Glomerular hyperfiltration is associated with all-cause mortality. Herein, we evaluated the association between glomerular hyperfiltration and the development of malignant disease, the most common cause of death, in an Asian population.

Method

We retrospectively reviewed the National Health Insurance Service database of Korea for people who received national health screenings from 2012 to 2013. Glomerular hyperfiltration was defined as the 95th percentile and greater after adjusting for age and sex. We performed a multivariate Cox regression analysis using glomerular hyperfiltration at the first health screening as the exposure variable and cancer development as the outcome variable to evaluate the impact of glomerular hyperfiltration on the development of malignant disease.

Results

A total of 1,953,123 examinations who followed-up for 4.9 years were included in this study. Among the 8 different site-specific malignant disease categories, digestive organs and female genital organs showed a significant associations between glomerular hyperfiltration and malignancy. The population with glomerular hyperfiltration showed an increased risk for stomach cancer (adjusted hazard ratio [aHR], 1.27), colorectal cancer (aHR, 1.23), and liver or intrahepatic malignancy (aHR, 1.40). In addition, the risk for uterine and ovarian cancer was significantly increased in the population with glomerular hyperfiltration (aHR, 1.36).

Conclusion

Glomerular hyperfiltration was associated with an increased risk for the development of malignant diseases in specific organs, such as the stomach, colorectum, uterus, and ovary. Glomerular hyperfiltration needs to be considered a significant sign of the need to evaluate the possibility of hidden adverse health conditions, including malignancies.
P0216CHECK POINT INHIBITORS AND CANCER. RENAL ADVERSE EVENTS: CASE SERIES
Authors: González Nuez Selene , Pérez Suárez Germán , Ramírez Puga Ana , Rodríguez Abreu Delvys , Fernández Granados Saulo Jesús , Esparza Martín Noemí , García Cantón César
Published: June 2020

Background and Aims

The treatment of cancer with check point inhibitors (CPI) has demonstrated significant benefits. CPI initiate antitumor immunity through negative regulatory components in T cells. However, these agents are associated with adverse events related to the immune system that can affect several organs. Initially, a low incidence of renal adverse events was reported, although recent data suggest an incidence between 9.9% and 29%. The objective of the study was to describe a case series that presented renal dysfunction related to CPI treatment.

Method

11 patients were studied retrospectively (67% males, mean age 69 ± 13 years), diagnosed with Neoplasms (9 advanced lung cancer, 7 of them metastatic and 2 metastatic melanomas) treated with CPI, who developed renal dysfunction. 5 patients with lung cancer were treated with Pembrolizumab, 3 with Nivolumab and 1 with Pembrolizumab + Ipilimumab combination. Patients with melanoma received Pembrolizumab. In 55% of the cases, immunotherapy was used as first line of antitumor treatment. Demographic and clinical-analytical data were collected, as well as the evolution of renal function.

Results

The median plasma creatinine prior to receiving treatment with CPI was 0.9 mg/dl [0.67-1.5]. The maximum creatinine reached after treatment with CPI was 2.5 mg/dl [1.8-7.5] with Pembrolizumab, 5.4 mg/dl [3-6.7] with Nivolumab and 4.3 mg/dl with the combination Pembrolizumab + Ipilimumab. Renal dysfunction occurred in the fifth cycle of treatment with Pembrolizumab and in the third cycle with Nivolumab and Pembrolizumab + Ipilimumab.

All patients received steroids (1mg/kg) and CPI were permanently discontinued in 3 patients with Pembrolizumab (43%), 1 with Nivolumab (33.3%) and 1 with Pembrolizumab + Ipilimumab (100%). Renal biopsy was performed in 4 patients who initially did not respond to steroids, resulting in acute tubulo-interstitial nephritis (ATIN), 1 of them with granuloma formation and worse renal evolution.

All patients recovered renal function partially or totally, except 1 treated with Pembrolizumab who remained with advanced kidney disease. Tumor progression was observed in 3 patients and 2 died.

Conclusion

CPI have demonstrated significant clinical benefits in the regression and prolonged stabilization of many tumors. The main cause of renal dysfunction after the use of CPI in our patients was the ATIN, with a good initial response to steroids and drug suspension. The presence of granulomas in renal biopsy confers a poor prognosis. It is an increasingly frequent entity in clinical practice, and because of its complicated management, it requires a multidisciplinary approach.
P0220EFFECTIVENESS OF SODIUM ZIRCONIUM CYCLOSILICATE (SZC) IN HAEMODIALYSIS PATIENTS WITH SEVERE HYPERKALAEMIA IN THE DIALIZE STUDY
Authors: Ford Martin , Fishbane Steven , Spinowitz Bruce , Rastogi Anjay , Guzman Nicolas , McCafferty Kieran
Published: June 2020

Background and Aims

Patients with severe hyperkalaemia require urgent intervention to avoid serious adverse outcomes and mortality. The phase 3b DIALIZE study (NCT03303521) showed that sodium zirconium cyclosilicate (SZC) reduces predialysis serum potassium (sK+) after the long interdialytic interval and is well tolerated in haemodialysis patients with hyperkalaemia. This post-hoc analysis of the DIALIZE data assessed the efficacy of SZC in patients with severe hyperkalaemia (defined as sK+ ≥6.0 mmol/L) at baseline.

Method

The DIALIZE study randomised 196 patients 1:1 to placebo (n=99) or SZC (n=97). The study consisted of an 8-week treatment period, comprising a 4-week SZC dose titration phase followed by a 4-week evaluation phase. The starting dose of SZC was 5 g orally once daily on non-dialysis days (4 days/week) for the 4-week dose titration phase (titrated in 5 g increments to a maximum of 15 g on non-dialysis days) to achieve predialysis sK+ 4.0–5.0 mmol/L. Patients maintained a stable dose of SZC for the 4-week evaluation phase (SZC 5, 10 or 15 g). Here, treatment response was defined as achievement of predialysis sK+ of 4.0–5.5 mmol/L during ≥3 of 4 haemodialysis treatments after the long interdialytic interval during the 4-week evaluation phase and not requiring potassium-lowering rescue therapy. Rates of response were compared between those patients with and without baseline severe hyperkalaemia (sK+ ≥6 mmol/L and <6 mmol/L, respectively). The sK+ measurement on Visit 1 (Day –7) was used as the baseline value.

Results

At baseline, 88 patients had sK+ ≥6 mmol/L (SZC n=46, placebo n=42) and 106 patients had sK+ <6 mmol/L (SZC n=49, placebo n=57); data were missing for two SZC patients. The overall proportion of treatment responders (irrespective of treatment and dose) in patients with baseline sK+ ≥6 mmol/L and <6 mmol/L was 44.3% and 43.4%, respectively. The proportion of treatment responders was greater with SZC compared with placebo in patients with baseline sK+ ≥6 mmol/L and sK+ <6 mmol/L (Figure). For patients receiving SZC, the proportion of treatment responders was consistent in those with baseline sK+ ≥6 mmol/L (67.4%) compared with those with baseline sK+ <6 mmol/L (71.4%; Figure).

Conclusion

Our results suggest that SZC is effective in haemodialysis patients with severe hyperkalaemia.
P0239THE EFFECT OF CHRONIC KIDNEY DISEASE AND DIALYSIS MODALITIES ON THE EXPRESSION OF T REGULATORY (CD4+CD25+FOXP3+) AND NATURAL KILLER (CD56+CD16+ ) CELLS
Authors: Sampani Erasmia , STANGOU MARIA , Daikidou Dimitra Vasileia , Asouchidou Despoina , Nikolaidou Vasiliki , Memmos Evangelos , Giamalis Panagiotis , Dimitriadis Chrysostomos , Fylaktou Asimina , Papagianni Aikaterini
Published: June 2020

Background and Aims

Tregs regulate immune responses and maintain self-tolerance, while Natural Killer cells (NK) are cytotoxic lymphocytes critical for both adaptive and innate immunity. The presence of chronic kidney disease (CKD) is often characterized by disturbances in immune responses, including dysregulation between tolerance and cytotoxicity. Aim of the present study was to evaluate the influence of CKD on the Tregs (CD4+CD25+FoxP3+) and NK cells, as well as the effect of hemodialysis (HD) and peritoneal dialysis (PD) on these subtypes.

Method

A total of 40 CKD Stage V patients and 15 healthy volunteer subjects were recruited into our study. Peripheral Tregs and NK cells were isolated from whole blood samples using flow cytometry, and the results were compared to those of age and gender matched controls. The immunologic profile of CKD patients was repeated 6 months after HD initiation (n=20) and PD (n=20) in order to investigate the effect of different dialysis methods.

Results

Patients with CKD had significantly reduced populations of CD4+CD25+ FoxP3+ Tregs (47.5± 28.8 vs 71.5±24.7) p=0.01, while there was no difference in NK cells between patients and controls (16.4±8.1% vs. 13.4±9.1%), p=NS, respectively. There were no differences between patients started on HD or PD in terms of clinical and laboratory parameters. Frequencies and total numbers of Tregs were significantly reduced after 6 months of HD, from 7.6±2.1% to 5.2±2.3%, p=0.009, and from 53.6±26K/μL to 36.9±19K/μL, p=0.02, respectively, while showed no differences on PD patients, from 5.3±3.3% to 5.6±2%, p=NS and 33.2±27K/μL to 45.6±28K/μL, p=NS, respectively. NK cells were increased in HD patients, not reaching statistical significance (245±156K/μL to 261±128K/μL). Frequencies of NK cells were positively correlated with CRP (r=0.56, p=0.009) and Intimal media thickness (IMT) (r=0.48, p=0.03)

Conclusion

The results of our study show that initiation of hemodialysis (HD) seems to reduce the expression of CD4+CD25+FoxP3+ T cells while peritoneal dialysis (PD) doesn’t seem affect this cell population. The immune alterations observed in hemodialysis patients may have a clinical impact on chronic inflammation and atheromatosis.
P0240ACQUIRED THROMBOTIC THROMBOCYTOPENIC PURPURA IN HIV POSITIVE PATIENTS SUCCESSFULLY TREATED WITH CAPLACIZUMAB: ABOUT TWO CASES
Authors: Baes Dulciane , Nicolazzi Paul , Moulonguet Florence , Simphal Philippine , Hazzan Marc , Maanaoui Mehdi , Provôt François
Published: June 2020

Background and Aims

Acquired thrombotic thrombocytopenic purpura (aTTP) is a thrombotic microangiopathy still nowadays associated with a high risk of death. Standards of care included at first the association of plasmatic exchanges, Rituximab and steroids. The emergence of Caplacizumab, a nanobody targeting the A1 receptor of Von Willebrand Factor (VWF), significantly changed the prognosis of the disease. Thrombocytopenia is frequent in HIV positive patients, and aTTP is frequently considered. Prevalence of HIV positive in aTTP patients ranges from less than 1% in western countries, up to more than 50% in African countries. The pathophysiology still remains partially understood, leading to the development of autoantibodies targeting the ADAMTS13 metalloprotease. For now, no specific recommendations are available, and standards of care consist in treating HIV positive patient the same as other aTTP patients. We present the first description of two HIV positive patients, successfully treated with caplacizumab.

Method

We report there two cases of black women, respectively aged 31 (Patient 1) and 52 years old (Patient 2), both positive for HIV for several years. The first one had stopped any antiviral treatment few months ago, and had a positive blood viral load of 110764 copies/ml. Her CD4+ rate was 30/mm3. The second one was under antiviral medication, with a negative viral load and a CD4+ rate of 295/mm3. Both were admitted in our department because of low platelet levels and hemolysis, associated with inflammatory triggers. Bacteriema for Streptococcus mitis was discovered on admission in Patient 1 and Patient 2, who had a long-term follow-up for Still disease, presented with a flare-up.

Results

Both patients had positive anti-ADAMTS13 autoantibodies (Patient 1: titer 42 UI/ml, Patient 2: 45 UI/ml), with undetectable ADAMTS-13 activities. They were treated with plasmatic exchanges until platelets levels reached over 150 G/L, steroids 1.5 mg/kg/j, Rituximab 375 mg/m2 at day 1, 4 and 8 and finally caplacizumab 10 mg before the 2nd plasmatic exchange and every day until the ADAMTS13 activity reached over 20%. Antiviral therapy and antibiotics were initiated in Patient 1 and antiviral therapy was maintained in Patient 2. The evolution was promptly favorable with normalization of platelets levels at Day 4 in Patient 1, and Day 15 in Patient 2. Patient 1 stopped caplacizumab at Day 12 and Patient 2 at day 17, when ADAMTS 13 reached over 20%. None of them relapsed after treatment, with a respective follow-up of 4 and 2 months.

Conclusion

Caplacizumab seems to be a safe and efficient treatment for aTTP in HIV positive patients.
P0245PERCUTANEOUS RENAL BIOPSY IN FRAIL AND HIGH RISK PATIENTS
Authors: Roccatello Dario , Fenoglio Roberta , Kamgaing Joelle , De Simone Emanuele , Del Vecchio Giulio , Ferro Michela , Quattrocchio Giacomo , Rabajoli Gianluca , Concas Maria Rosaria
Published: June 2020

Background and Aims:

Many patients with End Stage Kidney Disease do not undergo percutaneous kidney biopsy (KB) and do lack a definite diagnosis. Whether KB is beneficial in the extreme patients’ categories, i.e., age >75 years and very late referrals with kidney disease requiring renal replacement therapy at the first evaluation, remains controversial. Aim: To analyse the benefit/risk balance in terms of therapeutic options and general outcome of KB procedure in these borderline categories.

Method

Files for all biopsies performed in our Centre between 2013 and 2019 (# 903 inpatients’ native kidney) were retrospectively analysed with special focus on histological diagnosis, biopsy complications, and post-biopsy patient’s outcome. Two groups of high risk patients were identified 1. >75 years old patients, and 2. patients requiring dialysis at the first clinical evaluation. A rigorous protocol of screening of the bleeding risks was adopted.

Results

Of the 903 biopsies, 217 cases (24%) had group 1, and 92 (10%) group 2 criteria. Group 1: mean age 80 years (range 75-92), main histological diagnoses: ANCA associated vasculitis (AAV) (12,4%); membranous nephropathy (MN) (11,5%), diabetic nephropathy (10,1%), IgA glomerulonephritis (IgAGN) (9,2%), cast nephropathy (9,2%), renal amyloidosis (9.2%), focal segmental glomerulosclerosis (FSGS - 7,8 %). Group 2: mean age 60 years (range 20-92), most frequent histological diagnosis: AAV (26,1%); cast nephropathy (19,6 %), nephroangiosclerosis (9,8%), IgAGN (7,6 %), diabetic nephropathy (6,5%), renal amyloidosis (5,4%); FSGS (4,3%). Five major complications (2,3%), including AV fistula with spontaneous resolution in 4 patients and 1 case of severe bleeding requiring arterial embolization, and 14 minor complications (6,5%), including post biopsy haematomas <2cm in 12 patients and haematuria in 2 patients were observed in group 1. Only 1 (1%) major complication (AV fistula) and 4 minor complications (4,3%), including post biopsy <2cm haematomas in group 2 were identified in group 2. Histological diagnosis conditioned or changed treatment strategy in 71% of elderly patients (group 1), and 63% of patients in dialysis (group 2). Dialysis discontinuation was achieved in 30 out of 92 patients (36,6%) with a sparing of over 1 million euro/year.

Conclusion

Given its high diagnostic value (especially in patients who are willing to be transplanted), the prognostic significance (and the assessment of the extent of the renal sclerotic changes), and the potential impact on the treatment policy, indications to percutaneous kidney biopsy in elderly and dialysis patients should be probably revised.
P0247PREGNANCY IN WOMEN WITH NEPHROTIC-RANGE PROTEINURIA
Authors: Svetitsky Shuli , Lightstone Liz
Published: June 2020

Background and Aims

The adverse effects of chronic kidney disease on pregnancy and pregnancy on renal function have been described, but the effect of severe proteinuria in early pregnancy is not known. The aim of this study was to evaluate the obstetric and renal outcomes of pregnant women with severe proteinuria manifesting in early pregnancy.

Method

We retrospectively assessed the records of over 400 women with renal disease who were cared for during pregnancy in Queen Charlottes and Chelsea hospital and identified women with nephrotic range proteinuria in early pregnancy. Their records were reviewed and outcomes were compared to women with CKD and little or no proteinuria in early pregnancy.

Results

The study included 99 women with renal disease, of these 37 with severe proteinuria, and 62 patients who had mild or no proteinuria. The baseline GFR and blood pressure in the groups was similar. There were significantly more women with glomerular diseases in the group with proteinuria. The group with severe proteinuria had significantly higher rates of delivery by C-section, and prematurity including severe prematurity (<34 weeks). They had lower average birth weight and more babies born with very low birth weight. Their renal outcomes were poorer, with a lower eGFR at 3 years and a higher rate of advanced CKD and renal replacement therapy.

In the women with proteinuria, the level of scarring on renal biopsy was found to be a significant predictor of several poor outcomes, including premature birth and developing advanced kidney disease.

Conclusion

Severe proteinuria early in pregnancy is associated with lower birth weight, greater prematurity and poorer renal function in the long term.

Physicians treating these women must be aware that they are at a higher risk of complications than women with renal disease without severe proteinuria.
P0248HEPARIN-INDUCED THROMBOCYTOPENIA (HIT): A POSSIBLE CAUSE OF VENOUS THROMBOEMBOLISM IN ACTIVE SYSTEMIC VASCULITIS
Authors: Boni Francesca , Gregorini Alessandra Gina , Salviani Chiara , Merelli Sara , Portesi Nicola , Martini Giuliana , Alberici Federico , Scolari Francesco
Published: June 2020

Background and Aims

Increased incidence of venous thromboembolism in active phase of vasculitis has been found by several authors. Examining large cohorts of patients, the underlying mechanisms still remain unclear. Patients with active vasculitis are not rarely exposed to heparin mainly because of dialysis, plasmafiltration or ECMO. In the high inflammatory context of active vasculitis, as in major surgery, heparin exposure could promote the formation of anti-PF4/heparin antibodies and induce HIT.

Method

Description of cases with active vasculitis and HIT observed in our cohort of ANCA-associated vasculitis patients from 1994 to 2019. Review of cases reported in the literature.

Results

We observed 18 patients with systemic vasculitis and HIT (10 M and 8 F, median age: 69.5 yo). Fourteen had ANCA antibodies, one patient had both ANCA and anti-GBM antibodies (double positive), two had positive anti-GBM antibodies, one had negative ANCA and anti-GBM antibodies. Among 15 patients with positive ANCAs, 13 had anti-MPO antibodies and 2 anti-PR3 antibodies (Fig. 1).

All patients were exposed to heparin, 10 because of plasmafiltration and dialysis, 8 for dialysis alone. Mean platelet count nadir was 76100/mm3 (range 23000-197000/mm3).

In all patients PF4–heparin antibody immunoassay was strongly positive (optical density >1 in 13 patients).

The most frequent manifestations were thrombocytopenia and repeated clotting of the extracorporeal circuit and dialyzer with thrombosis of the hemodialysis catheter (6/18 patients). Four patients developed deep vein thrombosis almost invariably in the site of the hemodialysis catheter. Pulmonary embolism was observed in only one patient (Fig. 2).

To our knowledge, only 11 cases of HIT in patients with vasculitis have been reported in literature (Table I). Detailed data are available for 7 patients (6 M and 1 F, median age 69.6 yo). Three patients had anti-PR3 antibodies, 2 anti-MPO antibodies, 1 both ANCA anti-MPO and anti-GBM antibodies (double positive), 1 only anti-GBM antibodies. Mean platelet count nadir was 45625/mm3 (range 17000-131000/mm3). Three out of 11 patients developed repeated clotting of the extracorporeal circuit and dialyzer, 2 patients had deep vein thrombosis in the site of the hemodialysis catheter, and one patient had also leukopenia and subarachnoid hemorrhage. Six patients were asymptomatic and developed only thrombocytopenia.

Conclusion

When patients with active systemic vasculitis develop venous thromboembolism and thrombocytopenia after exposure to heparin, or repeated coagulation of the extracorporeal circuit and dialyzer or plasma-filter, HIT should be included in the possible differential diagnosis, and Platelet factor 4–heparin antibody tests should be performed.
P0252TROPONIN T AND LEFT ATRIAL VOLUME INDEX ARE ASSOCIATED WITH THE OCCURRENCE OF NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4-5
Authors: Hakamäki Markus , Hellman Tapio , Lankinen Roosa , Koivuviita Niina , Pärkkä Jussi , Kallio Petri , Kiviniemi Tuomas , Airaksinen Juhani , Järvisalo Mikko , Metsarinne Kaj Peter
Published: June 2020

Background and Aims

Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and often co-existing conditions. However, little is known on the prevalence and incidence of AF in patients with CKD stage 4-5.

Method

We prospectively recruited 210 consecutive non-dialysis patients with CKD stage 4-5 between 2013 and 2017. Follow-up data on AF occurrence as well as baseline medical history, laboratory tests and echocardiography were collected.

Results

At baseline, mean age was 62 years, 73/210 (34.8%) of the participants were female, mean estimated glomerular filtration rate was 12.8ml/min and 41/210 (19.5%) patients had a prior diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF was detected in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition, most commonly severe infection or surgery, and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age >60 years (HR 4.27, CI95% 1.57-11.64, p<0.01), elevated troponin T (TnT) >50ng/l (HR 3.61, CI95% 1.55-8.37, p<0.01) and left atrial volume index (LAVI) >30ml/m2 (HR 4.82, CI95% 1.11-21.00, p=0.04) independently predicted the occurrence of new-onset AF. Furthermore, the predictive effect of the covariates was cumulative (Figure 1).

Conclusion

The incidence rate of AF was remarkably high in this prospective study on patients with CKD stage 4-5. Elevated TnT and increased LAVI are associated with the occurrence of new-onset AF in patients with severe CKD.
P0290THERAPEUTIC PLASMAPHERESIS EXPERIENCE DUE TO NEPHROLOGICAL INDICATIONS
Authors: Baloglu İsmail , Serin Hatice Ozge , Tonbul Halil Zeki , Selcuk Nedim Yılmaz , Turkmen Kultigin
Published: June 2020

Background and Aims

Therapeutic plasma exchange (PEX) has an increasingly long list of indications in recent years, in addition to immunosuppressive therapies in many life-threatening immune activations, it provides significant improvements in mortality and morbidity. In this study, we aimed to investigate the laboratory and clinical effects of PEX performed with nephrologic indication in our clinic.

Method

The records of 67 patients (36 females, 31 males; mean age, 45.7±15.8 years) who underwent PEX with nephrological indication between 2012 and 2017 in our clinic were retrospectively reviewed. Characteristics of the patients such as, indications of PEX, laboratory values and number of PEX sessions were recorded. In addition, clinical responses were also evaluated.

Results

When a total 398 PEX sessions were examined, the most common indication (40.3%) was acute humoral rejection after renal transplantation, followed by granulomatosis with polyangiitis (19.4%) and thrombotic microangiopathy (9%), respectively. The average of the PEX sessions was 5.94. There was a statistically significant increase in the bicarbonate value when the arterial blood gas of the patients was evaluated after PEX (p=0.002). However, no significant difference was observed in the pH and ionized calcium values (p=0.135, p=0.969, respectively) (Table 1).

When all the patients were evaluated, there was no significant change in hemoglobin values (p=0.174), but platelet values decreased significantly (p=0.011) after PEX. However, when the patient group admitted with thrombotic microangiopathy was examined, it was observed that platelet count increased and LDH level decreased significantly (p=0.063, p=0.028, respectively).

When the serum creatinine values of all patients were evaluated, a significant decrease was observed in the serum creatinine values after PEX (p=0.001). In addition, after 2 years following PEX treatment, 70.1% of patients were still alive and 12.5% of patients undergoing PEX for acute humoral rejection were undergoing on hemodialysis treatment.

Conclusion

According to the results of our study, patients should be followed up especially for acid-base and electrolyte changes after PEX. In addition, therapeutic PEX might be effective in terms of improving morbidity and 2 year-mortality of these patients.
P0308IMPACT OF MAJOR SURGICAL OPERATIONS ON CLINICAL OUTCOME IN DIALYSIS PATIENTS
Authors: Eren Sadioğlu Rezzan , Kumru Şahin Gizem , Kutlay Sim , Şengül Şule , Keven Kenan , Nergizoglu Gökhan , Ateş Kenan , Duman Neval , Ertürk Şehsuvar
Published: June 2020

Background and Aims

We aimed to study the impact of major surgical operations on clinical outcome in patients with end-stage kidney disease treated with haemodialysis (HD) or peritoneal dialysis (PD).

Method

We retrospectively evaluated the records of all patients on HD and PD, who had been treated for at least 3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory parameters, data on all major surgical operations were recorded.

Results

Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. The mean age (±SD) was 58.3±14.5 years, 48% were female and 28% had diabetes mellitus. Forty-seven patients (23%) had a major surgical operation. The operation types were cardiovascular in 14 patients, orthopaedic in 11, gastrointestinal in 8, genitourinary in 6, parathyroidectomy in 5 and brain, pulmonary and breast in 1 patient each. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study population, 59 patients (29%) died during the study period. In Kaplan-Meier analysis (Figure), mean (95% CI) survival time in operated patients was 43 months (37 to 49 months), while it was 49 months (46 to 52 months) in the others (p=0.023). Fifteen out of 23 deaths (65%) among the operated patients occurred in the first month after surgery. Severe perioperative complications (arrhythmias, hypervolemia, hypotension, bleeding, acute coronary syndrome, respiratory failure and cerebrovascular event) were recorded in 17 (36%) of the operated patients, of whom 16 died (p=0.001). Although did not reach a significant level, mortality rate tended to be higher after emergent operations than that after elective operations. Cox regression analyses revealed that age (RR 1.033, 95% CI 1.010-1.057, p=0.005), diabetes (RR 2.581, 95% CI 1.474-4.521, p=0.001), preoperative C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, p<0.0001) and having a major surgical operation (RR 1.868, 95% CI 1.068-3.268, p=0.028) were the independent predictors of mortality.

Conclusion

Although prospective studies with a higher patient number are needed to confirm, our study shows that, in addition to age, diabetes and inflammatory status, having a major surgical operation is an independent risk factor for mortality in dialysis patients. The prevention and management of perioperative complications properly may result in more favourable outcomes in these patients.
P0312ALTERATIONS IN THE PROGRESS OF LYMPHOCYTE APOPTOSIS IN PRE- AND POST- DIALYSIS END STAGE RENAL DISEASE PATIENTS
Authors: Daikidou Dimitra Vasileia , STANGOU MARIA , Sampani Erasmia , Asouchidou Despoina , Nikolaidou Vasiliki , Dimitriadis Chrysostomos , Lioulios Georgios , Pella Eva , Anastasiou Aikaterini , Fylaktou Asimina , Papagianni Aikaterini
Published: June 2020

Background and Aims

Lymphocyte apoptosis, as a programmed mechanism of lymphocyte death, is essential in maintaining homeostasis and balance between inflammatory and immune reactions. Disturbances in the apoptotic progress, leading to fragmented lymphocytes, “late apoptotic” cells, may result in immunodeficiency, oncogenesis, atheromatosis, etc. Aim of the present study was to investigate the lymphocyte apoptotic progress in End Stage Renal Disease (ESRD) and the effect of dialysis.

Method

The study included patients on ESRD; measurements were performed at the first day of dialysis (T0) and repeated 6 months later (T6), while being on dialysis. Total lymphocytes and B lymphocytes (CD19+) were gated and stained with Annexin V to detect apoptotic cells; early and late apoptotic cells were quantified. The results were compared to age-matched healthy control group.

Results

ESRD patients had reduced lymphocyte and B cell count, 1550±592μ/L vs. 2692±690μ/L, p<0.001 and 120.4±80μ/L vs. 321.7±184.7μ/L, p=0.002, respectively, compared to controls. There was an increase in total lymphocytes and B cells, being on later apoptotic stages (LAS) in ESRD-T0 compared to controls, 0.3±0.8% vs. 0.06±0.1%, and 0.04±0.08% vs. 0.01±0.03%, respectively, although differences did not reach statistical significance. After 6 months on dialysis, a reduction was noticed in the population of lymphocytes on LAS, 0.18±0.2% from 0.34±0.8%, while there was an increase of B cells on LAS, 0.1±0.2% from 0.02±0.07, with subsequent alterations in total numbers of apoptotic cells were also evident

Conclusion

Late apoptotic changes affecting total and particularly B lymphocytes happen in ESRD, and initiation of dialysis seem to cause further alterations, which may be implicated in the increased morbidity and mortality of disease
P0315SUCCESFUL TREATMENT OF A STRETOCOCCUS-PNEUMONIAE-ASSOCIATED HAEMOLYTIC URAEMIC SYNDROME BY A SHORT COURSE OF ECULZIMAB
Authors: Frimmel Silvius , Hinz Michael , Henschel Joerg , Mitzner Steffen , Koball Sebastian
Published: June 2020

Background and Aims

Hemolytic uraemic syndrome (HUS) is a known rare complication of Streptococcus pneumonia infections (SP-HUS) and is characterized by microangiopathic hemolytic anemia, thrombocytopenia and renal failure. In adults it is associated with a higher mortality than HUS due to other etiologies.

Method

Case Report

Results

A 33-years old female patient with a history of alcohol abuse was referred to hospital with hypotension and symptoms of infection, including high fever and diarrhea, which had occurred since three days. On admission the patient presented with septic shock and was transferred to the intensive care unit. There she showed signs of hemolytic uraemic syndrome, including severe thrombocytopenia (11 Gpt/l), schistocytosis, elevated lactate-dehydrogenase (LDH; max. 2300 U/l), low haptoglobine (<0,3g/l) and acute anuric renal failure with need of continuous renal replacement therapy. Severe confusion and necrotic lesions of the extremities completed the clinical picture. Plasma exchange (PE) was initiated under suspected thrombocytopenic thrombotic purpura (TTP). Under PE the clinical situation did not ameliorate and signs of severe HUS persisted. A total of four PE were realized, TTP was excluded by Factor VIII-ADAMTS13-activity above the diagnostic limit. In the peripheral blood cultures Streptococcus pneumonia was detected, and antimicrobial was deescalated from piperacillin/tazobactam to penicillin G. Under the clinical picture of a persistent severe pneumococcal associated HUS, without clinical benefit of PE, we decided to start therapy with eculizumab, a monoclonal anti-C5-antibody, approved for the therapy of aHUS and with anecdotical evidence of efficacy in SP-HUS. We started with 1200 mg of ECZ, followed by doses of 900 mg weekly with a total of four doses. Under therapy thrombocyte count normalized, renal function ameliorated and dialysis could be discontinued, the levels of haptoglobin and LDH normalized. The patient could be referred to a rehabilitation clinic, where renal function normalized and no further signs of hemolysis were seen three months after discontinuation of therapy under monitoring. The forefoot remained necrotic with need of surgery in future, the ischemic lesions of the hands completely disappeared.

Conclusion

Eculizumab could provide a therapeutic option of pneumococcal associated HUS. Therapy could be safely discontinued after 1 month under strict monitoring of signs of HUS. Further studies are required to document the benefit of complement blockade therapy in severe forms of SP-HUS.
P0316RELATION OF RENAL ULTRASONOGRAPHIC MEASUREMENTS WITH BODY HEIGHT
Authors: Spasovska Vasilova Adrijana , Trajcheska Lada , Milenkova Mimoza , Canevska Aleksandra , Kabova Angela , Stojanoska Ana , Pushevski Vladimir , Rambabova Bushljetikj Irena , Nikolov Igor , Severova- Andreevska Galina , Pavleska Kuzmanoska Svetlana , Petronijevic Dzvezdana , Gerasimovska Kitanovska Biljana , SELIM GJULSEN , Sikole Aleksandar , Ristovska Vesna , Spasovski Goce
Published: June 2020

Background and Aims

Kidney size has been found to be correlated with anthropometric features and is different among different ethnicities. In this study, we used ultrasonography for measurement of kidney volumes in healthy individuals and evaluated the relationships with body height, age and gender.

Method

We conducted a cross-sectional observational study and evaluated 108 healthy individuals whose serum creatinine level was within reference range. Patients’ medical clinical and laboratory records were reviewed. Age, gender and height were recorded. Pearson correlation coefficients were used to evaluate the strength of association between ultrasonographic parameters with each other and with other parameters, and were expressed as r2. Variations in left and right renal dimensions between various age groups were compared using a one-way analysis of variance, followed by a post-hoc Tukey's test.

Results

Subjects’ age ranged from 16 to 84 years and the mean age was over 50 years. There was an equal distribution among genders. Strong and positive correlations were seen for the measured length, parenchyma thickness and also for both total and parenchymal volumes with subjects’ height for both kidneys. The strongest correlations were observed for the left and right kidney length and also for the right kidney parenchymal volume (r=0.536, p=0.001; r=0.469, p=0.001; r=0.44, p=0.001). On the opposite, most of the relations with age were negative, but week and insignificant. When we divided the study subjects into three age groups and compared them for the height, there was no significant difference among them. Regarding the parenchymal and total kidney volumes of both kidneys, the different age groups showed similar findings in the ultrasonographic measurements. The mean calculated volumes were slightly declining with age and showed the largest values in the first group of patients under 30 years and lowest values in patients over 70 years old. Ultrasonographic measurements were also compared among the two genders. Both (men and women) showed similar age (53.55 ± 18.22 vs. 50.79 ± 18.13 p= 0.430, respectively). As for the height, men were significantly taller than women (1.734 ± 0.007 vs.1.637 ± 0.005, p= 0.001). The kidney length, volume and parenchymal volumes of both kidneys were significantly larger in men.

Conclusion

Renal length and volume are strongly correlated with body height. This relation must be considered in clinical decisions on further investigations regarding kidney disease progression.
P0321OUR EXPERIENCE OF PATIROMER (VELTASSA) USE AND POTENTIAL COST-BENEFITS AT SOUTH TYNESIDE AND SUNDERLAND NHS FT, U.K
Authors: Coates James , Hinchliffe William
Published: June 2020

Background and Aims

Patiromer is a new medication used to manage hyperkalaemia and acts as a bowel cation-exchange polymer with a simpler dosing and more favourable side effect profile than existing agents. In May 2018, South Tyneside and Sunderland NHS Foundation Trust (STSFT) implemented a protocol for the use of Patiromer in managing chronic hyperkalaemia to enhance options for managing cardio-renal patients in clinic. Conditional on our successful formulary application, was an audit against the protocol aiming to understand utility. Our second aim was to identify potential cost-benefits of patiromer. In particular, we were interested in preventing hospital admissions, bed days saved, temporary venous lines and dialysis sessions. It is important to note this analysis is subject to interpretation based on likely outcome should patiromer not have been given.

Method

To be eligible, patients had to have eGFR <30 and either a potassium >5.5 precluding the use of RAASi/MRAs or a recurrent potassium >6. Using electronic patient record system, we investigated 49 patients commenced on patiromer between October 2018 and October 2019.

Results

Only 14% of the incident prescriptions were in clinic with over half starting at a higher than UK licensed dose (once daily). The distribution of hyperkalaemia was varied as defining hyperkalaemia onset is challenging and what we found as more emergency use. We also identified the following clinical savings: 12 fewer bed days, 15 temporary lines and a minimum of 25 dialysis sessions avoided. Interestingly, we also found that in 2 cases, physicians utilised patiromer and avoided a referral to the renal team. Furthermore, we identified 11 uses of patiromer in the conservative/palliative setting allowing patients to withdraw from dialysis and to prevent discussions on commencing renal replacement therapy for concerns around hyperkalaemia. It would also provide a quality of life benefit avoiding recurrent cannulation to facilitate the standardised medical management of hyperkalaemia.

Conclusion

In conclusion, whilst this may not demonstrate an objective cost benefit, it does show the versatility of patiromer use in clinical practice. We have found an emphasis on usage in the inpatient setting to avoid dialysis and its attendant costs, rather than where its evidence base originates: as a renin-aldosterone blockade enabler in the outpatient setting. We have demonstrated awareness of adhering to the protocol criteria, whilst understanding the pitfalls of the protocol and why the medication has been administered out with of it, especially with regards to dosing. We wish to share our experience with clinicians and raise awareness of their growing armamentarium.
P0332DIAGNOSTIC, THERAPEUTIC AND EVOLUTIONARY FEATURES OF KIDNEY DISEASE IN MULTIPLE MYELOMA
Authors: Breik Nessrine , Samia Barbouch , Najjar Mariem , Fattoum Safa , Ben Nsira Sawsen , Azaiez Seif , Harzallah Amel , Karoui Syrine , Gorsane Imen , Benhmida Fethi , Ounissi Monther , Benabdallah Taieb
Published: June 2020

Background and Aims

Multiple myeloma (MM) is a malignant disease of plasma cells. It’s is characterized by clonal proliferation of malignant plasma cells producing monoclonal proteins and causing organ damage. Kidney injury is a common complication of multiple myeloma. Multiple pathogenic mechanisms can contribute to kidney injury in the patient with myeloma, some of which are the result of nephrotoxic monoclonal immunoglobulin and some of which are independent of paraprotein deposition.

Method

We conducted a retrospective study, from January 1974 to June 2019, including all cases of multiple myeloma with renal impairment treated in our Department. The objective of this study is to analyze the epidemiological and clinico-biological characteristics of MM with renal impairment and to identify the predictive factors of mortality.

Results

We collected 196 cases. The average age was 63.47 years (31-86 years) with a male predominance (sex ratio 1.27). The circumstances of discovery was dominated by asthenia, anorexia and weight loss in 150 cases (76.5%). Renal involvement was present at the time of diagnosis of myeloma in 138 patients (70.4%) with an average serum creatinine level of 686.42 μmol/l (92-2960 μmol/L). The average hemoglobin level was 8.05 ± 2.4 g/dl. The average 24-hour proteinuria was 2.62 ± 2.11 g/24h. The renal biopsy puncture was performed in 48 patients (24.4%), revealing myelomatous tubulopathy in 16.32% of cases, AL amyloidosis in 5.1% of patients, Randall disease in 3.06% of patients, nodular glomerulosclerosis in 1% of cases and membranous nephropathy in one patient. In our series, 170 patients received chemotherapy. Of the patients, 25.5% required hemodialysis at the time of diagnosis of MM. In our series, 66.83% progressed to the end stage renal disease, 25.5% were in partial remission and 2.05% in total remission. The causes of death were dominated by infectious complications (14.97%). The average renal survival was 4 months. The prognostic factors correlated with poor renal survival were tobacco (p = 0.01), serum uric acid> 600 μmol/l (p = 0.04) and 24-hour proteinuria> 5g/24h (p = 0.009).

Conclusion

Renal involvement is frequent in multiple myeloma. The spectrum of renal lesions is heterogeneous, and it determines the management and prognosis of MM so the factors associated with renal recovery should be studied further.
P0334HEMOLYTIC UREMIC SYNDROME: CLINICAL PRESENTATION, LABORATORY FINDINGS, MANAGEMENT AND OUTCOMES
Authors: Al Salmi Issa , Metry AbdelMasiah , Hannawi SUAD
Published: June 2020

Background and Aims

Hemolytic-uremic syndrome (HUS) is a disease that has been described as a triad of hemolytic anemia, thrombocytopenia and renal impairment. There are two types of HUS, typical and atypical. HUS remains a leading cause of acute renal injury in children and is increasingly recognized as a cause of renal failure in adults. In our study we evaluated the demographic features, clinical characteristics, management and outcome of HUS.

Method

This is a descriptive study evaluating all cases of Hemolytic Uremic Syndrome (HUS) that have been admitted at Royal Hospital (RH) Oman in the period between 2008 and 2017.

Results

Thirty-six patients identified. The mean age (SD) of 10.68 (14.07) years.

Eighteen (50%) presented with abdominal pain, nausea, vomiting and diarrhea, 9 (25 %) with hypertension, 23 (64 %) with acute kidney injury (AKI), 6 (16.67%) with seizure, 2 (5.56%) with confusion and 1 (2.78%) with cerebrovascular accident (CVA).

Twenty-one (58.33 %) diagnosed as typical HUS of which 19 with Shiga toxin producing Escherichia Coli (STEC) HUS and 2 had post Streptococal HUS.

Six (16.67%) diagnosed with aHUS, 2 (5.56%) with HELLP, 2 (5.56%) with G6PD, 3 (8.33%) with Autoimmune hemolytic anemia (AIHA ), one (2.78%) with congenital TTP and 1 (2.78%) with post partum HUS.

Twenty three (63.89%) needed renal replacement therapy (RRT), while remaining 13 (36.11%) did not require RRT.

Eleven (30.56%) received plasma exchange, 5 (13.89%) received Eculizumab while 2 (5.56%) received plasma infusion and 1 (2.78%) patient received Rituximab.

The majority 22 (61.11%) had partial recovery after treatment, 5 (13.89 %) had compelte recovery and 3 (8.33% ) ended with end stage kidney disease (ESKD) and 1 (2.78%) died from hypertensive crises.

Conclusion

The study results showed that HUS population were mostly due to Shiga toxin producing Escherichia Coli (STEC). It showed that HUS population were young, mostly male and only 25% have known medical comorbidities at time of presentation. Also, the majority presented with AKI requiring dialysis, of which PD was main stay of therapy. The duration of RRT and recovery time was almost a month period.