bluuebunny/crossref_metadata_2025 huggingface dataset:
MO105: Study of 45 Cases of Membranous Nephropathy from a Kidney Biopsy Record at the Level of the Nephrology Department in Marrakech
Authors: Mikdam Najoua
Published: May 2022

BACKGROUND AND AIMS

Membranous nephropathy is the most common cause of nephrotic syndrome in adults. However, the epidemiological data of this disease are not yet sufficiently known in our country. The aim of our study was to determine the clinical, biological and histological profile of MN and to evaluate its therapeutic approaches and evolutive aspects.

METHOD

We conducted a single-centre retrospective study in the nephrology department of the University Hospital Center Mohammed VI, over a period of 3 years (2016–2019) including 45 cases of MN confirmed by renal biopsy, with a minimum follow-up of 6 months. All patients were started on supportive therapy and then reassessed at 6 months. The nature of the next treatment was determined on an individual basis according to the risk of progression of each patient. The primary endpoint of the study was to obtain a remission of nephrotic syndrome. Complete remission was defined as proteinuria <0.3 g/day, and normal renal function partial remission was defined as proteinuria of 0.3–3 g /day and a stabilization of creatininemia.

RESULTS

The mean age of the patients was 45.24 ± 10.98 years. The clinical presentation was dominated by edematous syndrome found in 75.8% of cases. Systemic manifestations were found in 50% of cases. Nephrotic syndrome was objectified in 66.67% of cases. The histological study showed a predominance of the stage 3 in 56.7% of cases. Membranous lupus nephritis was found in 20.1% of cases, viral hepatitis B in 3% of cases, secondary syphilis in 3% of cases and primary MN in 73.9% of cases. Anti-PLA2R antibodies were positive in four patients with primary MN. After a minimal 6-month follow-up, we achieved remission in 74% of patients. Eighteen patients received aetiopathogenic treatment. Total remission was found in 48% of patients, partial in 39.4% of patients and an aggravation was noted in 15.1% of the cases progressing towards end-stage renal failure.

CONCLUSION

The evolution of membranous nephropathy is highly variable, but it remains a considerable cause of end-stage renal failure; hence, the need for rapid and continuous management is high in order to achieve remission and reduce the morbimortality related to membranous nephropathy.
MO113: Estimation of Hypocalcaemia, Hypoalbuminemia and Hypomagnesaemia Prevalence in Patients with COVID-19 and its Relationship with Clinical Manifestations and Disease Progression
Authors: Hashemi Samaneh , Salmanzadeh Shokrollah , Mobarak Sara , Yahyavi Sahzabi Reza , Hazbehnejad Alireza , Noorshahi Nooshin , Hashemi Fatemeh , Maghsudi Fatemeh
Published: May 2022

BACKGROUND AND AIMS

Electrolyte abnormalities are common among patients with coronavirus disease 2019 (COVID-19). This study aims to investigate the electrolyte changes in severe and non-severe COVID-19 patients. Hypocalcaemia, hypomagnesaemia and hypoalbuminemia and their relationship with the severity of symptoms and prognosis will also be determined.

METHOD

We enrolled 270 COVID-19 patients. Serum tests were taken from each patient on the day of admission to check the level of variables. Thereon, calcium, magnesium and phosphorus levels were measured twice a week and albumin levels were measured once a week. Variables such as PTH and 25 (OH) D were measured once at the beginning of the study. Other laboratory results like complete blood count, C-reactive protein and clinical data such as arterial blood oxygen levels, length of stay in the ICU and the treatment regimen were extracted from patients' medical records and history. Finally, patients were categorized as mild, moderate, severe and critical group based on the severity of the disease. The data analyses were carried out via SPSS software (version 21.0).

RESULTS

Of 270 patients, 135 people (50%) were men. The mean age of patients was 46.7 years. Based on the severity of the disease, 91 patients had mild disease, 90 patients presented with moderate disease, 54 patients were in severe condition and 35 patients were critical. Hypocalcaemia (Ca 2+ ≤8.6 mg/dL) was detected in 49 patients (18.1%) on admission. The mean of serum magnesium, phosphorus and albumin levels on admission was 2.2 ± 0.22 mEq/L, 3.39 ± 0.79 mg/dL and 4.49 ± 0.66g/dL, respectively. Phosphorus level was lower than 2.63 mg/dL in 11 patients (4.07%) and 43 patients (15.92%) had hypoalbuminemia. The mean 25(OH) D level was 32.92 ± 10.29 μg/L; therefore, 182 patients (67.40%) fall within the normal range (>30 μg/L).

CONCLUSION

Patients with mild and moderate disease tend to develop hypocalcaemia, hypoalbuminemia and hypomagnesaemia more often than severe and critical COVID-19 patients during treatment. 25(OH) D deficiency rate was higher in the moderate group. Patients with hypocalcaemia during treatment had higher mortality than other patients. We recommend electrolytes be measured at initial presentation and serially monitored during hospitalization in order to establish timely and appropriate corrective actions and prevent the serious complications of the disease.
MO124: Intradialytic Symptomatology is Largely Patient-Specific in both Haemodialysis and Haemodiafiltration: A Randomized Cross-Over Trial between Four Intermittent Dialysis Modalities
Authors: Wijngaarden Gertrude , Rootjes Paul A , de Roij van Zuijdewijn Camiel , Nubé Menso J , Grooteman Muriel
Published: May 2022

BACKGROUND AND AIMS

Standard haemodialysis is associated with a considerable burden of intradialytic symptoms. Although haemodialysis with cool dialysate is associated with less intradialytic discomfort in general, the incidence of cold sensations increases significantly. Whether treatment with online post-dilution high-volume haemodiafiltration [target convection volume (CV) ≥23 L/session] reduces adverse intradialytic symptoms and provokes cold sensations is unknown.

METHOD

We performed a randomized controlled cross-over trial in 40 prevalent dialysis patients, who were subjected to two haemodialysis modalities: standard haemodialysis [sHD; dialysate temperature (Td) of 36.5°C] and cool haemodialysis (cHD; Td 35.5°C) and two haemodiafiltration modalities: low-volume haemodiafiltration (lvHDF, CV 15 L/1.73 m2/session, Td 36.5°C) and high-volume haemodiafiltration (hvHDF, CV ≥23 L/1.73 m2/session, Td 36.5°C). Every dialysis modality lasted 2 weeks. Intradialytic symptoms were evaluated after the last session of each dialysis modality, with a slightly modified Dialysis Symptom Index (mDSI). Intradialytic thermal sensations were scored on the Visual Analogue Scale Thermal Perception (VAS-TP) before and after 1 and 3 h of each treatment session. Patients were trained to use the mDSI and VAS-TP, in order to reduce incidental stress and unwanted learning responses due to the trial environment. Repeated measures analysis of variance (ANOVA) and one-way ANOVA were used to measure potential differences in intradialytic symptoms between the dialysis modalities (intraindividual differences) and to assess potential interindividual differences in intradialytic symptoms. Linear mixed models with an interaction term between time and modality were used to determine differences in rate of change of VAS-TP between the four modalities. When appropriate, stratified models were fitted subsequently.

RESULTS

With the exception of cold sensations during cHD (P = .01), intradialytic symptoms did not differ between modalities, but varied markedly between patients (P < .05 in 11/13 items, Table 1). While the VAS-TP score remained unaltered in sHD, lvHDF and hvHDF, patients felt significantly more cold sensations during cHD (P = .007)(Figure 1). Stratified models showed a decrease of 0.43 points/h on the VAS-TP scale (P = .007) in the first hour of cHD and remained unaltered thereafter [+0.10 points/h (P = .20)]; thermal perception remained unaltered [0.04 points/h (P = .77)] in the other modalities.

CONCLUSION

Intradialytic symptomatology was, except for the symptom feeling cold, by and large similar in all modalities, but it varied markedly between patients. Hence, adverse intradialytic symptoms seem largely patient-specific. Patients experienced more cold sensations during cool HD, but not during haemodiafiltration.
MO154: Enteric Budesonide in IGAN Nephropathy: A Real World Clinical Practice
Authors: López Martínez Marina , Agraz Irene , Bermejo Sheila , Moreso Francesc , Garcia Carro Clara , Alejandra Gabaldón M , Vergara Ander , Ramos Terrada Natalia , Azancot María A , Bolufer Cardona Mónica , Bestard Oriol , José Soler Romeo Maria
Published: May 2022

BACKGROUND AND AIMS

The gut–kidney axis seems to have a principal role in immunoglobulin A nephropathy (IgAN) development [1], leading to new treatment approaches. Enteric budesonide, a glucocorticosteroid that release the active drug in the distal ileum, has proved proteinuria reduction and estimated glomerular filtration rate (eGFR) benefit [1, 2]. Moreover, systemic steroid therapy implies severe adverse events that budesonide seems to avoid [1, 3]. Therefore, we aim to evaluate the effect of budesonide treatment in our cohort of patients affected by IgAN.

METHOD

We retrospectively selected 17 patients, from 19 to 74 years, which were treated with enteric budesonide. All of them, except for a patient with Henoch-Schönlein purpura and microhaematuria, had a renal biopsy-confirmed primary IgAN. Twelve were patients with native kidney disease and five were patients with kidney transplant. Three with native kidney disease were excluded due to the lack of therapeutic compliance. The median dose of budesonide was 9 mg/day for the whole period of treatment. Twelve were already treated with renin-angiotensin system (RAS) blockade, which was continued throughout the follow-up period. During the follow-up (maximum 2 years), creatinine, proteinuria measured as change in urine protein creatinine ratio (UPCR) and haematuria were assessed.

RESULTS

Baseline characteristics are shown in Table 1. Overall, the median reductions of UPCR at 3, 6, 12 and 24 months were of 33.08%, 54.62%, 15.38% and 15.38%, respectively. At 6 months, the median UPCR was reduced from baseline 1.3 g/g [IQ range (25%–75%): –0.58 to –4.22] to 0.59 g/g [IQ range (25%–75%): –0.17 to –0.85], P = .028. The creatinine remained stable at 6 months, with baseline median 1.57 mg/dL [IQ range (25%–75%): –1.03 to to 2.03], and creatinine at 6 months with median 1.42 mg/dL [IQ range (25%–75%):  –1.01 to –1.93]. Five patients (35.7%) did not have haematuria when budesonide was started, which remained stable at 6 months. No corticosteroid-related side effects were observed. No differences were found between patients with native disease or transplant kidney.

CONCLUSION

Enteric budesonide reduced proteinuria in patients with IgAN nephropathy. Our results suggest that enteric budesonide may represent a new approach to treatment of IgAN in both patients with native and kidney transplant.
MO178: Renal Function Impairment in Diabetic Patients after Intravitreal Injection of Anti-Vascular endothelial Growth Factor
Authors: Rivero Martínez Marta , Fernandez Maria , Berzal Raquel , Frías González Aida , Cordero Lucia , Gonzalez Celia , Hernandez-Velasco Paul , Gutierrez Eduardo , Pascual Julio , Morales Enrique
Published: May 2022

BACKGROUND AND AIMS

Intravitreal administration of vascular endothelial growth factor (VEGF) inhibitors is the treatment of a wide variety of retinal diseases. Kidney damage caused by systemic administration is widely known. However, there is not enough information in the literature on the renal effect of these drugs after intravitreal injection. The aim of the study is to analyse the effect of intravitreal anti-VEGF on kidney function in diabetic patients.

METHOD

A prospective cohort study of diabetic patients with and without chronic kidney disease (CKD) who received intravitreal anti-VEGF from January 2018 to December 2019. Clinical and analytical parameters were analysed. The follow-up time was 24 months.

RESULTS

We included 45 patients (55.6% male) with a mean age of 74.4 ± 11.5 (50–91) years. Approximately 64.4% of patients had CKD [estimated glomerular filtration rate (eGFR) <60 mL/min]. The types of anti-VEGF used were: bevacizumab 57.8% and ranibizumab 42.2%. The average number of doses administered was 7.6 ± 4.8 (1–22). The initial eGFR was 48.7 ± 25.3 mL/min and the Alb/Cr ratio 145 (49.45) mg/g. A significant decrease in the eGFR was observed at 6, 12 and 24 months (Table 1). There was a significant increase in proteinuria at 12 and 24 months. This drop in eGFR was independent of the presence of CKD, the anti-VEGF type or the number of doses. After the admistration of the first dose, five patients (17.2%) in the CKD group required renal replacement therapy (mean time 22 ± 12 months).

CONCLUSION

A significant decrease in eGFR and an increase in proteinuria are observed after administration of anti-VEGF in diabetic patients. For this reason, a close monitoring of renal function is needed to establish an early diagnosis and management of possible complications.
MO190: Experiences of Being a Living Kidney-Donor-Perceived and Measured Stress Levels before and after Kidney Donation
Authors: Andersson Helen , Lennerling Annette , Eriksson Svensson Maria
Published: May 2022

BACKGROUND AND AIMS

Living kidney donation is the preferred kidney replacement therapy considering graft function and survival rates. To donate a kidney is a life-changing experience, and there is a diverse spectrum of emotions connected to this process. The aim of this study was to investigate kidney donors' perceived and measured stress levels before and after donation. Furthermore, to investigate if the level of perceived stress could be linked to the degree of metabolic stress measured using saliva cortisol, serum glucose and insulin levels.

METHOD

A prospective observational study including 83 patients (46 ± 10.9 years, 63% women), who donated a kidney at Sahlgrenska University Hospital, Gothenburg, during 2009–2010. Three self-rating surveys concerning stress (Everyday Life Stress Scale), vital exhaustion (Maastricht Questionnaire of vital exhaustion) and depressive symptoms (Depressive Mood Scale) were answered on the day before surgery, and then 2 and 6 months after kidney donation (see score details, Table 1). Blood samples of insulin, glucose and saliva cortisol were collected at the same time points. Statistical analyses were carried out to investigate changes over time, potential gender differences, and correlations between laboratory data and survey results.

RESULTS

Kidney donors generally scored low in self-rating stress mean 15.5 and depression symptom scales mean 10.8 pre-donation. The Maastricht's questionnaire showed a trend toward significant gender difference at 2 months; women mean score was 32.1 ± 9.3 and men 35.8 ± 6.9,  P = .092. At 6 months, there was a significant gender difference in self-reported vital exhaustion, where women scored higher 36.9 ± 7.1 than men 30.7 ± 11.6;  P = .037 and a near significant difference on the Depressive Mood Scale, 12.2 ± 12.5 versus 6.4 ± 8.2 at 6 months; P = .058. No significant difference over time in experienced well-being (Everyday Life Stress Scale) was found, 15.6 ± 8.2 vs 14.3 ± 7.6,  P = .554. Data are displayed in detail in Table 1 and Figure 1. No correlations between metabolic stress measured as salivary cortisol (morning, noon and evening) and HOMA-IR, and perceived stress were found.

CONCLUSION

Kidney donors self-reported stress level and depressive symptoms did not change pre-donation to 6 months after donation. However, women reported more feelings of exhaustion and stress than men did at 6 months post-donation. In the future, a more structured psychosocial follow-up of kidney donors after at least 6 months is suggested.
MO209: Baseline Characteristics of Adults Enrolled in the Ongoing Phase 3 Randomized, Double-Blind, Active-Control Trial of Sparsentan For the Treatment of Immunoglobulin A Nephropathy (PROTECT)
Authors: Wong Muh , Barratt Jonathan , Komers Radko , Mercer Alex , Rosenberg Noah
Published: May 2022

BACKGROUND AND AIMS

Immunoglobulin A nephropathy (IgAN) is the most common glomerular disease worldwide. Despite optimized standard of care treatment, up to 40% of individuals with IgAN develop kidney failure requiring dialysis or kidney transplantation, consequently seriously affecting their quality of life and mortality. Treatments that reduce proteinuria and risk of kidney disease progression are urgently needed for IgAN. Sparsentan is a novel Dual Endothelin Angiotensin Receptor Antagonist (DEARA) being investigated for IgAN. The Phase 3 PROTECT study is examining the potential long-term antiproteinuric and nephroprotective potential and safety of sparsentan compared with an active control, angiotensin receptor blocker (ARB) irbesartan, in adults with IgAN. Here we report the baseline characteristics for all patients enrolled in the PROTECT trial.

METHOD

PROTECT is an ongoing, global, Phase 3, multicenter, randomized, double-blind, parallel-group, active controlled study designed to evaluate the efficacy and safety of sparsentan versus the active control irbesartan in adults with IgAN with overt proteinuria despite receiving maximized treatment with an angiotensin-converting enzyme inhibitor (ACEi) and/or ARB. The study duration is 270 weeks: a double-blind period of 114 weeks followed by an open-label extension period of up to 156 weeks. The primary efficacy endpoint is the change from baseline in urine protein/creatinine ratio (UP/C) based on a 24-h urine sample at Week 36. Key inclusion and exclusion criteria are shown in Table 1. Patients took their last dose of maximized standard-of-care treatment with ACEi and/or ARB therapy the day before randomization. Patients were randomized 1:1 to sparsentan or irbesartan (target dose 400 and 300 mg/day, respectively), stratified by screening eGFR and urine protein excretion values. The blinded and aggregated baseline characteristics of all the patients enrolled in the PROTECT trial are summarized descriptively.

RESULTS

A total of 406 patients from clinical sites in 18 countries, including sites in North America, Europe and Asia Pacific, were enrolled in PROTECT and 404 patients were included in the primary analysis population. Selected demographic and clinical characteristics are reported in Table 2.

CONCLUSION

PROTECT is the largest interventional trial testing a novel drug to date in IgAN. Patients with IgAN enrolled in the PROTECT trial display demographic and clinical characteristics consistent with those previously reported in the broader high-risk IgAN patient population. The presentation despite implementation of optimized standard of care treatment demonstrates the burden of IgAN and the unmet need for novel therapies in this patient population.
MO211: Variability of Proteinuria in Nephrotic Syndrome: GC1008 PH2 Trial in FSGS
Authors: Lin Julie , Hariri Ali , Accomando Beverly
Published: May 2022

BACKGROUND AND AIMS

Treatment-resistant primary focal segmental glomerulosclerosis (FSGS) is a rare glomerulopathy associated with nephrotic range proteinuria (>3.5 g/24 h). Treatment goals are reduction in proteinuria, which can delay progression to end-stage renal disease. Lack of quality repeated measures data for proteinuria in nephrotic patients is an important methodological limitation in current clinical trials research.

METHOD

We examined the 24-h urine collections (traditionally considered to be the gold standard for proteinuria assessment) compared with average of two consecutive first morning spot urine protein/creatinine (Up/c) ratio results for the patients in the placebo arm (n = 10)of this randomized, double-blind placebo-controlled study (3:3:2 allocation for 1 mg/kg, 4 mg/kg, and placebo treatment groups). Patients received randomized treatment for 112 days and were followed double-blind to 252 days. First morning Up/c was obtained from first morning spot urine collections for all visits; 24-h timed collections were performed for Day 1 and Day 112 visits. For first morning Up/c, the average of two collections at each study time point was used for analysis.

RESULTS

Median age was 42 years, 40% female, 20% black, median eGFR 60 mL/min/1.73 m2 with median Up/c 6.4 g/g (NCT01665391). Correlation coefficient between 24-h timed collection and averaged spot Up/c was r = 0.63 (P = .004). For 24-h timed urines, between subject SD = 2.015 g/24 h and within subject SD = 7.328 g/24 h. For averaged first morning spot Up/c, between subject SD = 2.5 g/g and within subject SD = 2.3 g/g.

CONCLUSION

In clinical trials subjects with nephrotic syndrome from biopsy-proven FSGS on stable doses of ACEi/ARB medications, 24-h timed collections do not provide additional useful data beyond average of two first morning spot Up/c. These data suggest that labour intensive, cumbersome timed 24-h urine collections should not be performed in clinical trials of nephrotic syndrome patients. Importantly, these data should allow for more precise power and sample size estimates for future interventional clinical trials of nephrotic syndrome.
MO214: Health-Related Quality of Life Among Patients With Anca Vasculitis
Authors: Nic an Riogh Eithne , Gogarty Eoin , Reedy Brian , Verrelli Alyssa , Elhassan Elhussein , Scott Jennifer , White Arthur , Little Mark
Published: May 2022

BACKGROUND AND AIMS

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a debilitating disease that can have a significant impact on a patient's quality of life. The aim of this study was to assess the longitudinal quality of life amongst those diagnosed with AAV using the EQ-5D instrument, which allows for calculation of quality-adjusted life years (QALYs.)

METHOD

A total of 343 patients with AAV participated in this study, of which 191 (55.7%) were male, resulting in 2746 episodes. The EQ-5D-5L standardised instrument was used to evaluate health-related quality of life in the domains of mobility, self-care, usual activities, pain/discomfort, anxiety/depression and to generate a summary index score. Overall health was also rated using a visual analogue scale (0–100). EQ-5D questionnaires were completed during routine nephrology clinic attendances and through a vasculitis patient support smartphone app. We used a random effects model to control for multiple entries relating to individual patients.

RESULTS

A lower quality of life was seen amongst those with AAV (median index value 0.80, overall population average 0.856). The mean visual analogue scale score was 75.6 ± 17.3 (overall population average 82.8, Fig. 1). Patients’ pain and discomfort level (mean 1.95) was most affected while self-care (mean 1.33) was least affected (Fig. 1). An increase in BVAS tightly correlated with a reduction in quality of life. Using the random effects model, the index score was seen to decrease with increasing age with a 2.7% reduction in index score per decade. A 7% reduction in index score was seen during periods of disease activity compared with periods of remission. Patients with end-stage kidney disease requiring dialysis had an 8% reduction in index score. A reduced quality of life was seen following COVID-19 lockdown with a 5% reduction in index score seen. Using a median survival rate of 6.16 years for patients with small vessel vasculitis, we calculated the QALYs for this population as 4.9 years.

CONCLUSION

We have defined for the first time the EQ-5D index value over the full disease course in patients with AAV. Notably, we have identified a reduction in quality of life during periods of disease activity. Other studies have demonstrated a reduction in quality of life during active disease using the AAV–PRO questionnaire and the Medical Outcomes Study Short Form-36. A decrease in work productivity has also been noted. Previously reported mean index values of 0.72 and 0.76 were lower than our observed values, although both are significantly reduced compared with population norms. In conclusion, this research highlights the negative impact of AAV on patients’ lives.
MO231: Comparison of Dominant and Non-Dominant C3 Deposition in Primary Glomerulonephritis
Authors: Ryu Jiwon , Jun Chin Ho
Published: May 2022

BACKGROUND AND AIMS

Alternative complement pathway (AP) dysregulation plays a key role in glomerulonephritis (GN) and is associated with C3 deposition. Herein, we examined pathological and clinical differences between cases of primary GN with C3-dominant (C3D-GN) and non-dominant (C3ND-GN) deposition.

METHOD

We extracted primary GN data from the Korean GlomeruloNEphritis sTudy (KoGNET). C3D-GN was defined as C3 staining two grades greater than C1q, C4 and immunoglobulin via immunofluorescence analysis. Data between groups were age- and sex-matched (each group, n = 61).

RESULTS

The C3D-GN group exhibited higher serum creatinine (P = .027), greater prevalence of estimated glomerular filtration rates < 60 mL/min/1.72 m2 (P = .009), higher C-reactive protein levels (P = .003) and lower serum C3 levels (P = .018). Serum albumin, urine protein/creatinine ratio, number of patients who progressed to end-stage renal disease and mortality were comparable between groups. Interstitial fibrosis and tubular atrophy were greater in the C3D-GN group (P = .0027 and .005, respectively) than in the non-C3GN group. C3 deposition was dominant in the former group (P < .001), in parallel with increased subendothelial deposition (P = .003).

CONCLUSION

Greater progression of renal injury and inflammation occurred in patients with C3D-GN than with C3ND-GN, potentially owing to AP dysregulation.
MO237: Rituximab in Treatment of Minimal Change Disease and Primary Focal Segmental Glomerulosclerosis in Adults-Single Center Experience
Authors: Zagorec Nikola , Horvatic Ivica , Kasumović Dino , Toric Luka , Šenjug Petar , Galešić Ljubanović Danica , Galesic Kresimir
Published: May 2022

BACKGROUND AND AIMS

Rituximab (RTX) showed some efficacy in treatment of minimal change disease (MCD) and primary focal segmental glomerulosclerosis (pFSGS) [1]. The results of its off-label use and as steroid-sparing agent were especially promising in steroid-dependent, frequently relapsing or steroid-resistant forms of MCD and pFSGS in adults [2].

METHOD

All patients treated with RTX in Department of Nephrology and Dialysis, University Hospital Dubrava, Zagreb, were retrospectively reviewed. Complete remission (CR), steroid-resistant nephrotic syndrome (SRNS), steroid-dependent nephrotic syndrome (SDNS), multidrug-resistant SRNS (MDR-SRNS) and calcineurin inhibitor (CNI)-resistant SRNS were defined according to KDIGO 2021 [3].

RESULTS

Of 82 patients treated with RTX, 11 patients had biopsy proven MCD and pFSGS. Table 1 summarizes relevant demographic, clinical and treatment data. RTX was applied in five patients with SDNS, four patients with MDR-SRNS, one patient with CNI-resistant SRNS and one patient with active hepatitis C and newly onset MCD as a first line therapy. Median follow-up after initial diagnosis and RTX application was 122.9 (range 30–219) and 20 (range 3–117) months, respectively. All patients were initially treated with steroids, and RTX was the drug most commonly applied after treatment with CNI and cyclophosphamide (CYC). Median proteinuria at the time of RTX application was 10 g/day (range 2.5–16.7), 10 patients had preserved kidney function and only 1 patient with collapsing FSGS (case 11) had severe acute kidney injury. Mean cumulative dose of RTX for induction was 1700 mg and short course of steroids was used concomitantly in 10 cases (except case 5). CR was achieved in seven cases (six cases of MCD and one case of MDR-FSGS). Three of seven patients with CR to RTX experienced relapse of disease. Time to relapse was 6, 15 and 40 months in case 5, 3 and 11, respectively. Repeated RTX application led to CR in all three cases. CR persisted in five patients even after the steroids cessation. There were no serious adverse effects of RTX administration in our cohort.

CONCLUSION

RTX showed respectable efficacy in our cohort of adults with SDNS-MCD and in case of MDR collapsing FSGS. Although statistical comparison was not performed because of small number of patients, it seems that RTX is more effective in group of SDNS than MDR-SRNS. In our cohort, patients with relapse of RTX-sensitive disease responded to repeated application. Role of RTX in treatment of MCD and pFSGS should be evaluated in randomized clinical trials.
MO271: A Single Dose of Lithium Protects Against Renal Injury Following Bilateral Ureteral Obstruction
Authors: Heloisa Massola Shimizu Maria , Aparecido Volpini Rildo , Carolina de Braganca Ana , Moura Nascimento Mariana , Bernardo Desiree , Canale Daniele , Carlos Seguro Antonio
Published: May 2022

BACKGROUND AND AIMS

Obstructive nephropathy decreases renal blood flow (RBF) and glomerular filtration rate (GFR). Glycogen synthase kinase 3β (GSK3 β), an apoptotic enzyme, is increased in a model of unilateral obstruction. Treatment with a single dose of lithium, a selective inhibitor of GSK3β, accelerated recovery of renal function in models of cisplatin and ischemia-reperfusion induced acute kidney injury (AKI). The aim of this study was to evaluate the efficacy of a single dose of lithium in the treatment of AKI induced by bilateral ureteral obstruction (BUO)

METHOD

Adult male Wistar rats were divided in four groups: (i) sham (sham operated); (ii) lithium: rats treated with lithium chloride 80 mg/Kg BW Intraperitonially (IP); (iii) BUO during 24 h; (iv) BUO during 24 h and treated with the same dose immediately after ureteral desobstruction. The rats were anesthetized 48 h after desobstruction to measure inulin clearance and renal blood flow. At the end of the clearance experiments, the rats were euthanized and the kidneys were removed to measure GSK3 β renal expression.

RESULTS

As described in the Table 1, BUO showed markedly reduction of GFR and RBF associated with an increase of GSK3β. A single dose of lithium administration ameliorated all these alterations.

CONCLUSION

Lithium treatment attenuated renal dysfunction in this model of BUO-associated AKI by improving inulin clearance. These therapeutic effects were due to an inhibition of renal expression of GSK3β. This may be a new therapeutic approach for BUO-induced AKI.
MO272: Effect of the Hollow Fiber Diameter and Membrane Surface Area of the Polymethyl Methacrylate Membrane Filter Used in Continuous Renal Replacement Therapy on the Lifetime of the Filter
Authors: Kurihara Yoshitaka , Kobayashi Yuta , Ushiroda Yosuke , Ueki Shunichi , Tsukao Hiroshi , Kobayashi Kozue , Kokubo Kenichi , Kubota Masaru , Kobayashi Hirosuke
Published: May 2022

BACKGROUND AND AIMS

When polymethyl methacrylate (PMMA) membranes are used in renal replacement therapy, inflammatory cytokines and other substances are removed by adsorption. However, these filters are also prone to clogging and the filter lifetimes are likely to be short. In the present study, we investigated the effects of the hollow fiber inner diameter and membrane area of PMMA membranes on the filter lifetime and protein removal performance using an in vitro continuous hemofiltration (CHF) experimental model with porcine blood.

METHOD

Three filters with different hollow fiber inner diameters and membrane areas were used: CH-1.0N (membrane area, 1.0 m2; hollow fiber inner diameter, 200 µm), CH-1.0W (prototype: 1.0 m2; 240 µm), and CH-1.8W (1.8 m2; 240 µm). Blood samples from one pig were divided into three portions, and in vitro CHF experiments for each filter were performed at QB = 100 mL/min and QS = QF = 10 mL/min. The pressure changes, total protein concentration in the blood, and total protein amount in the filtrate were measured during the experiments. From the results of the pressure changes, the time for the TMP to reach 200 mmHg (corresponding to the time when the membrane pores were clogged) and the time for the pressure drop through the filter to reach 200 mmHg (corresponding to the time when the hollow fibers were clogged) were calculated as the filter lifetime for comparative evaluation.

RESULTS

The time for the TMP to reach 200 mmHg was significantly longer with CH-1.8W than that with CH-1.0N or CH-1.0W (Friedman test, P < .05, n = 15). The time for the pressure drop through the filter to reach 200 mmHg was significantly longer with CH-1.8W than that with CH-1.0N or CH-1.0W (Friedman test, P < 0.05, n = 15). The results suggest that an increased membrane surface area is an essential factor for extending the filter lifetime. The total protein adsorption was significantly higher for the CH-1.0W and CH-1.8W filters than for the CH-1.0N filter (two-way ANOVA and post hoc Tukey test, P < 0.01, n = 15). Thus, the membranes with larger hollow fiber inner diameters (CH-1.8W and CH-1.0W) adsorbed more protein.

CONCLUSION

A larger membrane area contributes to a longer filter lifetime, whereas increase in the hollow fiber inner diameter does not. On the other hand, the protein removal performance, especially the adsorption performance, was higher for membranes with larger hollow fiber inner diameters.
MO274: Vancomycin Adsorption During In Vitro Model of Hemoperfusion with Mini-Module of HA380 Cartridge
Authors: Lorenzin Anna , de Cal Massimo , Sorbo David , Ronco Claudio , Zanella Monica
Published: May 2022

BACKGROUND AND AIMS

Septic shock is one of the most frequent causes in Intensive Care Unit (ICU) admission and is related to a very high risk of mortality. About one-third of patients with sepsis develops AKI which contributes to a worsening prognosis. AKI due to sepsis is the result of a dysregulated host immune response to infection, with the production of inflammatory mediators and cytokines that cause haemodynamic alterations, endothelial damage, apoptosis and, finally, immunoparalysis. The new Jafron HA380 cartridge has been specifically designed for use in clinical conditions characterized by cytokine storm such as sepsis. Given the growing application of these devices in cases of septic AKI in ICU, an unsolved problem is whether these polymers adsorb drugs, including antibiotics.

In vitro experiments were conducted to determine its adsorption capacity toward Vancomycin antibiotic.

METHOD

In vitro circulation was performed using a dedicated testing platform Galileo. A customized cartridge was built assembling mini-module components scaled in dimension toward HA380 and filled with 75 g of HA380 beads (25% of the regular size cartridge). Peristaltic pump was set at 250 mL/min. we performed two circulation containing extremely high quantity of Vancomycin (5 g in 500 mL and 10 g in 1000 mL) for 300 minutes. Samples were collected every 20 minutes. Vancomycin concentrations were measured.

The adsorption isotherm was represented using the equation: Massadsorbed = RR × Massinjected, where the RR in the Vancomycin removal ratio.

RESULTS

In vitro circulation confirms the affinity of beads material in binding Vancomycin molecules. The kinetics of vancomycin adsorption shows a rapid decay of the concentration in the first part of the experiments, after which we can observed a plateau (Fig. 1a). A total of 4500 mg of the 5000 mg were adsorbed in the end of the experiment (RR = 94%), of which 90% in the first 40 minutes (RR = 87%); after this period the curve became flat and the adsorption phenomenon negligible (Fig. 1b).

In the experiment with 10 000 mg, after 60 minutes of rapid adsorption (RR = 55%), the curve reached a plateau converging to a RR higher than 60% (Fig.). The sorbent beads were able to bind 6100 mg toward 10 000 mg injected. This amount saturated the mini-module binding sites.

CONCLUSION

The application of HA380 mini-modules allowed to determine the amount of Vancomycin necessary to reach the saturation of the sorbent material. Based on the obtained results, we estimated that the cartridge HA380 could retain more than 24 g of Vancomycin during HP circulation. Further investigation is needed to validate our results and to better understand HA380 performance in clinical practice.
MO280: Osteoblast-Specific Deletion of MEMO1 in Mice Severely Impairs the Expression of FGF23
Authors: Moor Matthias , Bartos Katalin
Published: May 2022

BACKGROUND AND AIMS

Memo deletion in mice caused a bone disease with diminished osteoblast and osteoclast biomarkers in serum [1], resembling the alterations occurring in adynamic bone disease in humans with renal failure, as well as those found in Klotho-deficient mice [2]. In addition, FGFR signaling is impaired in Memo-deficient osteoblasts [1]. We previously detected lower Fgf23 expression in cultured Memo-deficient osteoblasts, as the expression of FGF23 by bone cells requires autocrine or paracrine FGFR/Klotho signaling [3]. Here, we demonstrate that Memo1 in osteoblasts is required for Fgf23 expression in murine bone.

METHOD

Exon 2 of the Memo1 gene was deleted in the osteoblast–osteocyte lineage in Memo fl/fl mice using a Cre recombinase under the Col1a1 promotor to obtain osteoblast-specific knockout (obKO) mice. Memo obKO and Cre-negative littermate control mice were genotyped by tail genomic DNA. Organs were studied by microcomputed tomography, by qPCR and Western blot. Memo obKO and littermate control mice were challenged with acute kidney injury.

RESULTS

Memo obKO were viable without changes in gross anatomy. Weight at weaning age was transiently impaired in male but not in female Memo obKO compared with littermate controls (Fig. 1A). Memo1 expression was blunted in the femur of Memo obKO (Fig. 1B), whereas it remained comparable to controls in kidney (Fig. 1B) and liver tissues. Micro-CT revealed no differences between genotypes in trabecular or cortical bone of vertebrae, femur and tibia (Table 1). FGF23 gene expression by qPCR was undetectable in the femur of Memo obKO mice (Fig. 1C). Western blotting revealed a decrease of FGF23 protein in females and a tendency to lower expression in males of the Memo obKO genotype.

CONCLUSION

These findings demonstrate a role of Memo in the osteoblast–osteocyte lineage in contributing to the normal expression of FGF23. These data expand previous findings of FGFR-Klotho dependent regulation of FGF23 expression by the bone.
MO286: MIR-155 Deficiency Protects Renal Tubular Epithelial Cells from Telomeres and Genomic DNA Damage in Cisplatin-Induced Acute Kidney Injury
Authors: Yin Qing , Wang Bin , Liu Bicheng
Published: May 2022

BACKGROUND AND AIMS

Cisplatin nephrotoxicity is an important cause of acute kidney injury (AKI), limiting cisplatin application in cancer therapy. Growing evidence had suggested that genome instability, telomere dysfunction and DNA damage were involved in the tubular epithelial cells (TECs) damage in cisplatin-induced AKI (cAKI). However, the exact mechanism is largely unknown.

METHOD

We subjected miR-155-/- mice and wild-type controls, as well as human proximal tubule cells, to cisplatin-induced AKI models. We assessed kidney function and injury with standard techniques and measured telomere by the fluorescence in situ hybridization.

RESULTS

Our study demonstrated that miR-155 deficiency significantly improved renal function and attenuated pathological damage and mortality during cAKI. Furthermore, miR-155 inhibition reduced cisplatin-induced TECs apoptosis, genome instability, telomere dysfunction and DNA damage both in vivo and in vitro. The miR-155 inhibition mediated protective effects may be caused by increasing expression of telomere repeat binding factor 1 (TRF1) and cyclin-dependent kinase 12 (CDK12), thereby limiting the telomere dysfunction and the genome DNA damage in cAKI.

CONCLUSION

We demonstrated that inhibition of miR-155 ameliorates AKI involving the targeting and regulation of TRF1 and CDK12, indicating a novel regulatory mechanism and elucidating a potential target for cisplatin-induced AKI treatment.
MO299: Profile Of COVID-19 Patients who Developed Acute Kidney Injury in Intensive Care: Multicentre Study
Authors: Afifi Rania , Maazouzi C , Medkouri G , Elkhayat Ss , Mtioui N , Zamd M , Ramdani B , Benghanem M
Published: May 2022

BACKGROUND AND AIMS

The SARS-COV-2 acute respiratory distress fyndrome, which is the source of the infection known as coronavirus disease (COVID-19), spread rapidly, causing a pandemic that not only severely affected human health but also restricted the activities of daily living and weakens the global economy. Organs other than the lungs can be affected, including the kidneys. The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 disease has been reported to range from 0.5% to 80%; thus, a better understanding of the pathophysiology of AKI during COVID-19 is crucial to manage and improve the survival of patients who develop an acute kidney injury (AKI) attributed to COVID-19 is a common complication of severe cases and is further associated with high mortality; and there is glomerular involvement associated with COVID-19, characterized in some cases by collapsing glomerulopathy or by tubular necrosis in other cases. The objectives of our study are to determine the incidence and describe the risk factors as well as the evolution of AKI in patients admitted for pulmonary infection with COVID-19 in intensive care unit.

METHOD

RESULTS

Our study included 4261 patients hospitalized in intensive care in the different cities of Morocco; among them, 1495 (1/3) presented an AKI or 35.09%, the average age of our patients was 68.5 years or (25–99), with a male predominance or a sex ratio of 3 men to a woman.

There is hypertension in 80% of cases, diabetes in 75% of cases, the association of hypertension and diabetes in 63% of cases, coronary heart disease in 10%, epilepsy in 1% and lymphoma in 0.5% of cases.

CONCLUSION

AKI is a complication that appears to be common in patients with severe SARS-CoV-2 infection, associated with a poor prognosis. Nephroprotection measures should be put in place to prevent the occurrence of AKI. Any patient hospitalized with SARS-CoV-2 should undergo an initial nephrologic evaluation, including proteinuria and urine sediment examination.
MO323: Effects of Patient Frailty and Comorbidity on Duration of Hospitalisation as an Outcome Among Adults With Acute Kidney Injury
Authors: Lobo Aquiline , Waters Christopher , Aspin Nicola , Dasgupta Tanaji
Published: May 2022

BACKGROUND AND AIMS

Acute kidney injury (AKI) is commonly associated with an adverse outcome in hospitalised patients. Frailty and comorbidity are risk factors for acute kidney injury. The aim of this study was to assess the strength of association between frailty and comorbidity as modifiers for duration of hospitalisation (LOS) as an outcome among inpatients with acute kidney injury in our institution.

METHOD

A retrospective observational study as part of a service assessment of adult inpatients, in a 1-month period, during the pre-pandemic phase was conducted to evaluate for changes needed to existing care pathways in our institution. AKI was identified with the help of the national algorithm endorsed by NHS England, which is incorporated in hospital reporting systems. Clinical frailty and comorbidity were estimated using the Rockwood Clinical Frailty Scale (CFS) and the Charlson comorbidity index (CCI). Pairwise correlations between LOS, CFS and CCI were estimated and tested for statistical significance using Bonferroni-adjusted significance levels. Ordinary least-squares linear regression was used to assess the prediction of LOS using CFS and CCI in separate models.

RESULTS

In 148 patients in our cohort, the mean age was 76.4 [95% confidence interval (95% CI) 74.1–78.8] years. Of these, 54% were male, 24.3% were diabetic, 29.7% had at least one criterion for prior vascular disease and 16.2% had a history of cancer. A total of 22.3% had a prior history of chronic kidney disease. In terms of severity at presentation, 67.6% had stage 1 AKI, 18.9% had stage 2, and 13.5% had stage 3 AKI.

The mean CCI was 5.4 (95% CI 5.06–5.81) and the mean RFI was 4.6 (95% CI 4.3–5.0). 50% were both at least moderately frail (CFS ≥ 5) and had a CCI of >5.

The mean duration of hospitalisation was 8.7 days.

Spearman's correlation coefficient constant for CFS with LOS was 0.23 and was 0.11 with CCI, with only the correlation between LOS and CFS being statistically significant at the 5% level after Bonferroni correction. As expected, there was a statistically significant correlation between CCI and CFS (0.49). Beta coefficients for ordinary least-squares linear regression individual models with LOS as the outcome variable were 0.69 (95% CI 0.18–1.19; P < .007) for CFS and 0.27 (95% CI –0.16 to 0.70; P = .22) for CCI.

CONCLUSION

Compared with patient comorbidity, clinical frailty has a stronger and statistically significant association with the duration of hospitalisation among hospitalised adults with AKI. This study quantifies the magnitude of factors over and above those resulting from patient comorbidity that are contributory to frailty in adult inpatients with AKI. Further studies are required to improve understanding of how clinical frailty affects duration of hospitalisation in patients with AKI, to help inform future clinical care pathways and improve duration of hospitalisation as a clinical outcome.
MO368: Study of Relationship Between Some Biomarkers of Inflammation and Microbiomal Status in Patients With Chronic Kidney Disease
Authors: Olimkhonova Komilakhon
Published: May 2022

BACKGROUND AND AIMS

In view of the fact that the human microbiota varies depending on many factors, including comorbid pathology, it seems reasonable to investigate the intestinal microbiota in patients with chronic kidney disease and its likely relationship with markers of systemic inflammation.

PURPOSE OF THE STUDY

To reveal the relationship between some biomarkers of inflammation with changes in the composition of the intestinal microbiota in patients with chronic kidney disease.

METHOD

The study included 85 patients with CKD C 2–4. The average age of the patients was 52 ± 4 years (48 men and 37 women). The control group consisted of 30 healthy volunteers aged 50 ± 3 years, 15 men and 15 women, comparable to the main group in terms of gender and age. Blood samples were taken using standard methods. GFR was assessed using the CKD-EPI formula (2011). In addition, biomarkers such as interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) were evaluated. Bacteriological examination of feces was carried out in the bacteriological laboratory of the third clinic of the TMA. Markers of systemic inflammation were assessed on the basis of an increase in the level of leukocytes (>11 × 109/L), C-reactive protein (>5.0 mg/L) by the immunoturbodimetric method, fibrinogen (>4.0 g/L), as well as interleukin-6 by enzyme immunoassay. Differences between groups were considered statistically significant at P<0.05; correlation analysis was performed using Spearman’s nonparametric rank correlation method.

RESULTS

Analysis of fecal matter showed a deficiency of Bifidobacterium bacteria (<108 CFU) in the examined patients. In addition, the examined patients showed an increase in the number of Escherichia (>108 CFU). According to the results of the study, in the group of CKD patients, the level of inflammatory markers was higher (CRP: 55%, IL-6: 60%, leukocytes 62%) than in the control group (CRP: 45%, IL-6: 40%, leukocytes: 38%).

  In men, the IL-6 index was higher than in women. The results of the study demonstrated that in patients with CKD, an imbalance of the intestinal microbiota is combined with an increased level of CRP, IL-6 and leukocytes.

CONCLUSION

The study of markers responsible for proinflammatory effects in the body showed that such indicators as IL-6, CRP, fibrinogen showed a significant correlation with the composition of the microbiota in patients with CKD.