bluuebunny/crossref_metadata_2025 huggingface dataset:
MO227: Anca-Associated Vasculitis Following Pfizer-Biontech COVID-19 Vaccine: True Association or Circumstantial?
Authors: Marouço Catarina , Carvalho Dulce , Magriço Rita , Ribeiro Francisco , Nolasco Fernando
Published: May 2022

BACKGROUND AND AIMS

Antineutrophil cytoplasmatic antibody (ANCA) associated vasculitis (AAV) is a small vessel vasculitis hallmarked by the presence of antibodies against antigens in cytoplasmic granules of neutrophils. Vaccines per se stimulate the immune system, including the innate and the adaptive immune response. Therefore, it is possible that an excess of autoimmunity is observed after vaccine administration. Vaccination (notably influenza) is a recognized trigger for the relapse of ANCA-associated vasculitis. ANCA associated vasculitis and autoimmune reactions have been reported with COVID-19 infection and following vaccination.

We report the case of a Caucasian, 62-year-old-man, with a previous history of type 2 diabetes mellitus, hypertension and atrial fibrillation. Blood analysis 1 year before presentation showed preserved renal function and normal urinalysis. He received the first dose of Pfizer-BioNTech COVID-19 vaccine and 2 weeks later routine blood analysis showed acute kidney injury with serum Creatinine 1.75 mg/dL with de novo hematuria, a protein-to-creatinine ratio (RPC) 1.1 mg/g and candersartan (4 mg twice daily) was started. The patient received the second dose of COVID-19 vaccine 21 days after the first injection. Two weeks later, he developed anorexia, nausea and de novo hematuria. He was admitted at the emergency department with deteriorating renal function with a sCr of 5.5 mg/dL, worsening hematuria with dysmorphic red blood cells and proteinuria (RPC 2.9 mg/g). Renal ultrasound was normal. Immunological studies revealed an elevated ANCA-MPO titer of 561. A kidney biopsy was performed and showed a crescentic necrotizing glomerulonephritis. Immunofluorescence confirmed pauci-immune glomerulonephritis. He was diagnosed with renal limited myeloperoxidase (MPO) ANCA AAV. He started three pulses of 500 mg I.V methylprednisolone followed by prednisolone 1 mg/kg/day after that. He also started rituximab (four doses of 500 mg I.V. once a week apart). Despite the immunosuppression, the patient never recovered renal function and remained dialysis dependent.

CONCLUSION

Whether autoimmune diseases can be triggered after vaccination remains a matter of discussion among experts. ANCA-associated vasculitis and autoimmune reactions have been reported with COVID-19 infection and following vaccination, which prompts the question whether this response could be a direct reaction to the RNA present in the vaccine. While an association with de novo ANCA vasculitis and COVID-19 vaccine may be possible, further investigation is necessary.
MO232: Amyloidosis AL in Nephrology
Authors: Najla Dammak , Faten Ghabi , Ikram Agrebi , Asma Amouri , Arwa Kammoun , Salma Toumi , Soumaya Yaich , Kammoun Khawla , Hafedh Makni , Tahya Boudawara , Hmida Mohamed Ben
Published: May 2022

BACKGROUND AND AIMS

Systemic AL amyloidosis is a rare pathology associated with the precipitation of monoclonal immunoglobulin light chains in the form of fibrils in various organs. Clinical presentations are extremely variable and diagnosis is often delayed. The two most affected organs are the kidney and the heart. The treatment is based on chemotherapy to eliminate the medullary clone that produces the monoclonal light chain. However, the outcome is still poor. The aim of our study was to describe the demographic, clinicobiological, histological, therapeutic and evolutionary characteristics of AL amyloidosis in our population.

METHOD

We carried out a single-center retrospective descriptive trial of patients who were diagnosed with histologically confirmed AL amyloidosis in our Nephrology Department during the period from 2014 to 2021.

RESULTS

We enrolled 12 patients with a mean age of 61.25 ± 8.17years. The sex ratio (M/F) was 3. The histological confirmation of AL amyloidosis was based on biopsies: kidney (n = 7) and salivary glands (n = 5). The immunoglobulin type was Ig G Lambda in 75% of cases (n = 9), IgG kappa in 16.6% of cases (n = 2) and IgM in 8.3% of cases (n = 1). The cause of amyloidosis was multiple myeloma in 66.6% of cases (n = 8) and Waldenström disease in 8.3% of cases (n = 1). The mean creatinine at diagnosis was 441.33 ± 334.47 umol/L, i.e. a median creatinine clearance (MDRD) of 36.67 ± 46.77 mL/min. At the time of diagnosis, 50% of the patients (n = 6) had end-stage renal disease and 25% (n = 3) had reached it after a few more months. The mean proteinuria was 6.33 g/24 h within 83.3% of cases (n = 10) with the presence of a nephrotic syndrome. The cardiac involvement was found in 58% of the patients (n = 7) at the time of diagnosis with a Mayo Clinic prognostic score of III. The neurological involvement was observed in 8.3% of cases (n = 1) and was confirmed by spinal MRI as polyradiculoneuritis. As for the therapeutical management, 75% of the patients (n = 9) received first-line treatment with Bortezomib Cyclophosphamide Dexamethasone, and 16.6 of the patients (n = 2) were treated with corticosteroids and Melphalan (the 12th patient died early). The outcome was fatal in 41.5% (n = 5) and the cause of death was a state of septic shock, and the rest of the patients are alive with a mean follow-up of 1 year.

CONCLUSION

AL Amyloidosis is one of the most severe complications of monoclonal lymphocyte proliferation. This overgrowth is most frequently related to myeloma, and rarely to another malignant B-cell disease. The prognosis is related to cardiac and renal impairment. It requires urgent management to improve its outcome and to reduce mortality.
MO233: Real-World Signs and Symptoms at Diagnosis in Patients With IGA Nephropathy
Authors: Roccatello Dario , Kattlun Julia , Przybysz Raymond , Thomas George Aneesh , Aldworth Carolina , Proudfoot Clare , Wang Weijia , Decourcy Jonathan , Lafayette Richard
Published: May 2022

BACKGROUND AND AIMS

Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide, with an estimated annual incidence of 25 per million. Patients with persistent proteinuria ≥ 1 g/day are at increased risk of disease progression, with 30% or more progressing to kidney failure within 10 years. Hematuria and proteinuria are among the most common clinical manifestations of IgAN. The aim of this analysis was to better understand the clinical characteristics of IgAN patients from Europe, Asia and the USA, at the time of diagnosis.

METHOD

A retrospective analysis was conducted using data from the Adelphi IgAN Disease Specific Programme (DSP), a cross-sectional survey of IgAN-treating nephrologists in EU4 (France, Germany, Italy, UK), USA, China and Japan between June and October 2021. Nephrologists completed structured forms administered via online links for successive patients presenting with IgAN in their practice. The forms included demographic and clinical information including signs, symptoms and lab values amongst others.

RESULTS

A total of 269 nephrologists completed records for 1685 patients in this survey. Mean patient age was 43.3 years, and most were male (58%). The diagnosis was confirmed by biopsy in 86% of the patients. The mean eGFR at diagnosis ranged from 58.1 (median 55.5) in the USA to 78.3 (median 79.0) mL/min/1.73 m2, in China and Japan. Mean proteinuria ranged from 2.7 (median 2.0) in the USA to 3.4 (median 2.1) g/day in EU4 (Table 1). The main clinical signs at diagnosis were proteinuria (75%) and visible hematuria (63%). Edema and fatigue were reported in 38% and 27% of patients; 10% and 9% of patients reported appetite loss and sleep problems. A sizable proportion of patients (31%) also experienced pain in various parts of the body.

CONCLUSION

This comprehensive study of IgAN patients across varied geographies presents evidence that patients experience substantial symptomatic and clinical burden at diagnosis, irrespective of the region. The relatively high levels of proteinuria and low eGFR levels, especially in the USA, suggest that the disease is often severe and advanced by the time of diagnosis. Facilitating early diagnosis of IgAN—perhaps through better recognition of clinical signs and symptoms—could be beneficial in optimizing early treatment and preventing disease progression.
MO242: Intrarenal Single Cell Sequencing of Hepatitis B Virus Associated Membranous Nephropathy
Authors: Zhong Yong
Published: May 2022

BACKGROUND AND AIMS

The pathogenesis underlying hepatitis B virus (HBV)-associated membranous nephropathy (MN) remains incompletely understood.

METHOD

To decipher the etiopathogenesis of HBV-associated MN, intrarenal single-cell RNA sequencing (scRNA-seq) was applied to the kidney biopsy from a HBV-associated MN patient and a health control to define the transcriptomic landscape at single-cell resolution. Differentially expressed genes (DEGs) and enrichment analysis were compared between HBV-associated MN and anti-PLA2R positive idiopathic membranous nephropathy (IMN) using intrarenal scRNAseq.

RESULTS

We generated 4114 intrarenal single-cell transcriptomes from a HBV-associated MN patient by single-cell RNA-sequencing. We found that kidney podocytes cells in the HBV-associated MN patient displayed increased expression of several genes, including EDIL3, GPC6, HSPA5 and CTGF, which were closely related to extracellular matrix formation. Kidney endothelial cells of HBV-associated MN were mainly enriched in inflammatory pathways including TNF signaling, IL-17 signaling, NOD-like receptor signaling, NF-kappa B signaling pathway and Toll-like receptor signaling pathway. TNF signaling pathway and IL-17 signaling pathway activation were confirmed in proximal tubule cells from the HBV-associated MN patient. Moreover, ligand-receptor analysis highlighted the extensive communication of mesangial cells, which infers great importance in HBV-associated MN. Furthermore, gene ontology (GO) function enrichment analysis revealed that DEGs of endothelial cells from the HBV-associated MN patient were enriched in interleukin-6 secretion and interleukin-1 secretion when compared with anti-PLA2R positive IMN.

CONCLUSION

These results offer new insight into the pathogenesis of HBV-associated MN.
MO246: Belimumab Disrupts Memory B Cell Trafficking in Patients with Systemic Lupus Erythematosus
Authors: Arends Eline J , Zlei Mihaela , Tipton Christopher M , Osmani Zgjim , de Bie Fenna , Kamerling Sylvia W A , Rabelink Ton , Sanz Ignacio , Van Dongen Jacques J M , van Kooten Cees , Teng Yeo K O
Published: May 2022

BACKGROUND AND AIMS

Belimumab (BEL), a recombinant human monoclonal antibody directed against B-cell activating factor (BAFF), is the first approved biological agent for patients with systemic lupus erythematosus (SLE) and a high level of disease activity or lupus nephritis (LN). BEL inhibits primary humoral immune responses by depleting naive B-cells that are dependent on BAFF for their survival while secondary humoral immune responses by memory B cells (MBCs) remain intact. Indeed, some studies reported an increase of circulating MBCs following neutralization of BAFF [1–3]. So far these effects of BEL on the MBC compartment in SLE patients have not been investigated. This study aimed to establish the dynamics of circulating MBCs in patients with SLE treated with BEL and to perform an in-depth analysis of the impact of BEL on the MBC compartment.

METHOD

First, extensive B cell subset phenotyping was performed prospectively by employing high-sensitivity flow cytometry (HSFC) based on EuroFlow protocols [4] in severe SLE/LN patients treated with BEL [5]. Additionally, in-depth characterisation of surging MBCs in circulation was performed by single-cell RNA sequencing (scRNA-seq).

RESULTS

HSFC established that the increase in MBCs was non-specific and observed in a broad range of MBC immunoglobulin subclasses peaking as early as 2 weeks after BEL initiation. Subsequent scRNA-seq analysis of the emerging MBCs revealed a non-proliferating phenotype with a prominent decrease in activation status. In these circulating MBCs, a large amount of migration and adhesion genes were downregulated suggesting that the accumulation of MBCs by BEL initiation was related to their impaired cell–cell adhesion disrupting cell-trafficking and preventing extravasation.

CONCLUSION

After initiation of BEL treatment, a substantial increase of circulating MBCs was firmly established in patients with SLE/LN. The surge of circulating MBCs appeared to be associated with disrupted lymphocyte trafficking of MBCs, thereby suggesting a new potential therapeutic mechanism of BEL on MBCs in SLE. These findings have important implications to our understanding and consequent improvement of B-cell targeted treatment strategies in patients with active SLE and LN as MBC accumulation in circulation might allow for more efficient targeting of the B-cell compartment.
MO248: A Renal Biopsy Might be a Mandatory Procedure in Patients with Hypertension and Decreased Renal Function Despite Normal Urinalysis Findings
Authors: Hee Cho Won , Cho Byoung-Soo , Min Jung Sung , Soon Lee Hyun
Published: May 2022

BACKGROUND AND AIMS

The most common cause of the end-stage renal disease is diabetes and hypertension. However, most centers do not try to find the cause of hypertension in patients with early-stage CKD but give antihypertensive medicine because most centers regard the cause as essential hypertension. Since blood pressure is regulated by the kidneys, we tried to find the cause of hypertension related to kidney disease.

METHOD

We carried out a single-center retrospective analysis of 1440 kidney biopsies performed for 8 years at a single center in Korea. All cases were done at the OPD level without admission, of which 367 cases (25.5%) showed hypertension/early-stage CKD with normal urinary findings at the time of renal biopsy.

RESULTS

The results are as follows in order of frequencies: IgA nephropathy (32.7%), mild focal nonspecific glomerulonephritis (GN) (17.7%), focal segmental glomerulosclerosis (FSGS) (15.3%), diffuse mesangial proliferative GN (12.8%), interstitial nephritis with tubular atrophy (7.6%), podocyte disease (3.3%) and membranous nephropathy (1.9%), and others include lupus nephritis, membranoproliferative GN, C1q nephropathy, C3GN, malignant hypertension (1.4%), etc. Most patients (95%) with hypertension/early-stage CKD were associated with chronic glomerulonephritis. Most patients with serious glomerular disease that may progress to ESRD, such as IgAN, FSGS and diffuse mesangial proliferative glomerulonephritis, have improved by aggressive immunotherapy.

CONCLUSION

In conclusion, before considering antihypertensive medicine in patients with early-stage CKD, a renal biopsy might be a mandatory procedure to save the kidney because more than 90% of cases are associated with glomerular disease.
MO258: Urinary Single-Cell Sequence Analyzes the Urinary Macrophage in Different Outcomes of Membranous Nephropathy
Authors: Liu XI , Zhao Yu , Niu Yangyang , Xie Qionghong , Zuo Wei , Yu Chen
Published: May 2022

BACKGROUND AND AIMS

Great progresses have been made in the diagnosis and treatment of membranous nephropathy (MN), but some patients still do not respond to the treatment. We performed single-cell sequencing to analyze the urine cells of patients with and without complete remission of MN. Hope to provide some insights for understanding the different outcome of MN.

METHOD

Urine single-cell RNA sequencing was performed on 12 healthy controls (HC) and 15 patients with MN. The patients were divided into complete remission group (CR, n = 9) and no remission group (NR, n = 6), according to the response to at least 6 months of immunosuppressive treatment.

RESULTS

(i) Macrophages were the largest group in urine cells; they were 48.02%, 68.96% and 20.95% in the HC, CR and NR group, respectively. (ii) Detecting cell surface markers to tell their origins. The results showed that urinary macrophages expressing FIColin-1 and S100 calcium binding protein A8 were mainly in NC group and CR group, indicating that they were derived from bone marrow and peripheral blood, while the urinary macrophages expressing the regulator of G-protein signaling 1 and HLA-DPA1, mainly in the NR group, were differentiated from intrinsic kidney cells. (iii) There were different characteristics of urinary macrophage in the three groups. In healthy adults, urine macrophages expressed the metallothionein family, indicating that they can regulate anti-inflammatory and proinflammatory functions bidirectionally. In the CR group, the urine macrophages showed strong proinflammatory properties. In the NR group, the urinary macrophages mainly associated with the level of proteinuria and the impaired renal function with poor proinflammation.

CONCLUSION

Our study firstly delineated urinary cell maps of healthy individuals and the MN patients. Not only in origin but also in function of urine, macrophages were different in the NC, CR and NR group. This might be a significant help to our understanding of membranous nephropathy.
MO266: Deficiency of Urokinase-Type Plasminogen Activator Exacerbates CBSA-Induced Membranous Nephropathy in Mice
Authors: Jao Tzu-Ming , Guo Chian-Huei , Bai Chia-Yu , Chen Jin-Shuen
Published: May 2022

BACKGROUND AND AIMS

In nondiabetic population, primary membranous nephropathy (PMN) is the most common cause of idiopathic nephrotic syndrome in the world. Urokinase-type plasminogen activator (uPA) is one of the key members of fibrinolysis system, which functions as dissolving blood clots to prevent obstruction of blood vessels. Currently, the roles of uPA in PMN remain undefined.

METHOD

Six-week-old male mice with Plau wild-type and knockout in BALB/c strain were used to induce MN by cationic bovine serum albumin (cBSA). Biochemistry assays of blood and urine were measured by a Fuji Dri-Chem FDC NX 500 machine. Glomerular polyanions were determined by using Colloidal Iron Stain Kit. Reactive oxygen species (ROS) was detected by immunohistochemistry stained by 4-HNE antibody. TUNEL positivity in the kidneys of mice was determined using an ApopTag® Plus Peroxidase In Situ Apoptosis Kit. The deposition of immune complex in glomeruli was examined by a transmission electron microscope. Lymphocyte subsets were determined by flow cytometry. Serum concentrations of IgG1 and IgG2a were measured by ELISA.

RESULTS

It has been reported that BALB/c mice is an ideal strain for mimicking human PMN. Thus, we generated uPA deficient mice (Plau-/-) in BALB/c strain by backcrossing C.129S2-Plautm1Mlg/J mice with BALB/c wild-type mice to N10. Plau-/- mice exhibited severe urinary albumin-to-creatinine ratio significantly when compared with wild-type mice at 2 weeks post-cBSA administration. Consistently, cBSA-induced Plau-/- mice displayed higher serum creatinine, hypoalbuminemia and hypercholesterolemia than wild-type mice. Histologically, Plau-/- mice presented more severed glomerular basement thickening, IgG granular deposition, intensified podocyte effacement, irregular thickening of glomerular basement membrane and subepithelial deposits than wild-type mice. Attenuated colloidal iron stain was observed in Plau-/- mice when compared with wild-type mice. Moreover, elevated ROS and apoptosis in the kidneys of Plau-/- mice were observed. B lymphocyte subsets were enriched significantly in the Plau-/- mice with MN, suggesting that pathological aggravation of MN is associated with dominant B lymphocyte population. The enriched ratio of IgG1 to IgG2a further confirmed predominant Th2 subset in Plau-/- mice.

CONCLUSION

uPA deficiency enhances Th2 dominant immune response, leading to enhancement of ROS and apoptosis in the kidneys, which subsequently exacerbates the progression of MN. Maintenance of uPA homeostasis may be a promising therapeutic approach for MN management.
MO283: A Novel Hemoperfusion Adsorbent for Selective Removal of Circulating Histones in Septic Blood
Authors: LI Yupei , Song Tao , Jiang Luojia , Yu Qiao , Wang Liya , Xiong Yuqin , Chang Kaixi , Deng Ningyue , Geng Jiwen , Zhao Weifeng , Su Baihai
Published: May 2022

BACKGROUND AND AIMS

Circulating histones play a crucial role in the development and progression of sepsis and is associated with high mortality. Hemadsorption with the CytoSorb® filter has been shown to non-specifically eliminate systemic circulating histones in plasma from injured patients ex vivo and in vitro. The aim of this study was to fabricate another novel hemoperfusion adsorbent for selective removal of histones in the blood of septic patients.

METHOD

Chitosan-cellulose composite hydrogels (CSCE) were first prepared using a liquid-liquid inversion method. Then, negatively charged heparin was grafted onto the surfaces of the CSCE hydrogels by EDC chemistry to obtain the histone sorbents (CSCEHEP hydrogels). The chemical structure of CSCEHEP hydrogels was characterized by Fourier transform infrared spectroscopy (FTIR) and its hemocompatibility was evaluated. The adsorption capacity and adsorption selectivity of CSCEHEP hydrogels for histone were then analysed by BCA protein quantitative method. Besides, the antagonistic effect of CSCEHEP hydrogels on histone-induced cytotoxicity was verified by in vitro cell experiments using HK-2 cell lines.

RESULTS

The obtained CSCEHEP hydrogels showed characteristic adsorption peaks of the sulfonic group at 1217 and 940 cm-1 in their FTIR spectrum, suggesting the successful immobilization of heparin onto the surface of the sorbent. The clotting time of plasma after a 30-min incubation with CSCEHEP hydrogels was significantly prolonged by 3 times while no obvious hemolysis, platelet activation, complement activation and other blood-material adverse reactions occurred during this incubation. With a heparin grafting, the adsorption capacity of CSCEHEP hydrogels towards histones (from calf thymus) increased significantly to 314.3 μg/g, with a clearance rate of 62.8%, compared to that of pristine CSCE, which is dependent on the initial histone concentrations in testing solutions. On the contrary, the adsorption capacity of bovine serum albumin by CSCEHEP hydrogels was significantly lower than that of histones, suggesting that the adsorption process of histone by CSCEHEP in plasma was selective. Meanwhile, CSCEHEP hydrogels significantly antagonized histone-induced cytotoxicity by binding histones, and the cell viability increased significantly from 47.1% (model group) to 72.0% (CSCEHEP-treat group).

CONCLUSION

CSCEHEP hydrogels are of good hemocompatibility and can effectively adsorb histones in PBS solution and antagonize histone-induced cytotoxicity. It is believed that the use of such a histone sorbent for extracorporeal blood purification may provide a novel insight into the modulation of aberrant immune responses in patients with sepsis.
MO288: Kidney Tubule Polyploidization Preserves Residual Kidney Function and Assures Survival During Acute Kidney Injury
Authors: De Chiara Letizia , Lazzeri Elena , Romagnani Paola
Published: May 2022

BACKGROUND AND AIMS

Acute Kidney Injury (AKI) is characterized by a rapid deterioration of kidney function. Recently, we showed that tubular epithelial cells (TC) respond to AKI by triggering polyploidy, a condition in which a normally diploid cell acquires additional sets of chromosomes. Polyploidy offers several advantages, but in the kidney the biological significance of polyploidization remains unclear. In this study we hypothesized that polyploidy (i) is the predominant cellular response early during AKI and (ii) that is an adaptive stress response required to maintain a residual kidney function assuring survival.

METHOD

To address these hypotheses, we employed in vivo transgenic models based on the Fluorescence Ubiquitin Cell Cycle Indicator (FUCCI) technology in combination with YAP1 downregulation. In these models, mice were subjected to unilateral ischemia reperfusion injury (IRI) or glycerol-induced rhabdomyolysis to induce AKI. Polyploid cells have been then characterized by single cell-RNA sequencing analysis, cell sorting, FACS analysis, super-resolution and transmission electron microscopy.

RESULTS

After AKI, YAP1 is activated triggering TC polyploidization. Polyploid TC increase in parallel to massive cell death triggered by AKI suggesting that polyploidization could be a means to escape cell death. Indeed, we found that polyploid TC tends to accumulate genome instability and survive, while diploid TC do not. Of note, virtually all dying cells were cycling cells based on the Fucci2aR reporter suggesting that TC death occurred during the S or G2/M phase. As polyploid TC increase immediately following AKI, they may be required to survive injury and damage by sustaining renal function. In order to evaluate the functional role of polyploid cells during AKI, we generated mice where YAP1 is knocked-out specifically in TC (YAP1ko mice). Indeed, after AKI, YAP1ko mice showed a reduced number of polyploid cells, worsened kidney function and a dramatic reduction of mouse survival, proving that polyploidization is required to survive AKI.

CONCLUSION

We demonstrated that (i) after AKI TC accumulate genome instability and die or become polyploidy; (ii) TC polyploidy is essential to preserve residual kidney function immediately after AKI.
MO291: Comparison of Acute Kidney Failure in Patients With SARS-COV-2 Infection During the First and Second Waves in a Third-Level Hospital in Andalusia
Authors: Cintra Melissa , Burgos Martin Javier , Almenara Tejederas Marina , Valverde Ortiz Rocío , Galván Toribio Raquel , Salguiera Lazo Mercedes
Published: May 2022

BACKGROUND AND AIMS

The incidence of acute renal failure (ARF) is frequent and has an implication in the morbidity and mortality of SARS-CoV-2 infection.

METHOD

A retrospective descriptive study of patients admitted for SARS-CoV-2 infection during the first (G1) and second (G2) waves who presented with ARF. They correspond to the period from March to May 2020 (G1) and from August to December 2020 (G2). We compare populations, outcomes and treatments.

RESULTS

A total of 73 patients in the first wave (G1), with a cumulative incidence (CI) of 28.3% (G1), compared with 58 patients in the second wave (G2), with a CI of 8% (G2). The mean age was higher in G2 [65.8 ± 15 years (G1); 75.3 ± 14 (G2); P <.05], with no difference regarding sex [63% (G1); 54% (G2)]. In G2, there was a higher proportion of patients with cardiovascular disease [23% (G1); 57% (G2)], hypertension [56% (G1); 83% (G2)]. The baseline glomerular filtration rate (GFR) being similar for both groups (CKD EPI: 69 mL/min/1.73² (G1); P = .27). In the first wave, the mean days from admission to ARF was 3.1 days ± 4.2, and 42% of the patients were diagnosed at admission (31 patients). In the second, it was 2.9 days ± 5.7, of which 60% at admission (35 patients). The most prevalent cause was prerenal in both. Higher proportion in G1 of KDIGO stage 3 (G1: 30% versus G2: 17%) and renal replacement therapy (RRT) (G1: 9 versusG2: 2 patients). Only 3 patients remained in RRT in G1 and 1 patient in G2. In G1, 64% recovered their GFR [mean time (MT): 7.5 ± 8 days], and the percentage of deaths was 34%. In G2, 72% recovered GFR (MT: 16 ± 25 days), and 19% of patients died.

CONCLUSION

Despite a lower age and comorbidity of the first wave patients, the severity and lethality was higher. There were no differences in the proportion of patients who recovered their baseline renal function, although the recovery time was longer in the second wave.
MO293: Evaluation of Uric Acid Concentration and Acute Renal Impairment in Patients on Admission for Hospital Treatment
Authors: Tasic Danijela , Dimitrijevic Zorica , Radenkovic Sonja , Kocic Gordana , Ignjatović Aleksandra , Djordjević Katarina
Published: May 2022

BACKGROUND AND AIMS

Elevated uric acid (UA) is associated with comorbidities such as hypertension, diabetes, cardiovascular disease and chronic kidney disease. There are more studies that discuss the importance of uric acid (UA) for acute kidney failure. Anaemia is a common risk factor for the development of AKI in hospitalized patients. There is an association between elevated iron and urate production in healthy people. The aim of this study was to evaluate value of UA as a risk factor for the development of acute kidney damage on admission for hospital treatment. We also determined, risk factors related to UA value and its relationship with anaemia.

METHOD

The study included 86 hospitalized patients with acute renal impairment who were divided according to the stage of renal impairment at admission to hospital treatment into three groups. The assessment of acute renal impairment and the classification of disease stages were based on the diagnostic stages by the KDIGO group. All the examined patients were >18 years of age. In the first stage of the disease, it was 12.79%, in the second stage, it was 15.12% and in the third, it was 72.09% of patients.

RESULTS

UA values were the lowest in the first stage 551.00 ± 225.64 μmol/L and highest in the third stage 670.02 ± 86.72 μmol/L, but without statistical significance. The lowest percentage with renal function was 12.9% in patients with stage 3 acute renal impairment. There was a statistically significant difference with patients with stage 1 and stage 2 (P < .017) renal impairment. The ROC curve for the cut-off value of uric acid 903.00 μmol/L based on the Youden index method with a sensitivity of 91.70% and a predictive value of 17.00% as a marker of acute kidney damage in stage 2 disease is larger than in other stages acute kidney injury. Although there is a significant relationship with risk of UA with haemoglobin values according to the following results: OR 1.036 [95% confidence interval (95% CI) 1.003–1.071; P = .030] and haematocrit level based on predicted probability and OR 1.149 (95% CI 1.028–1.285; P = .015).

CONCLUSION

The study showed that high values of uric acid in patients with acute kidney damage at the beginning of hospital treatment did not show the same significance in different phases of kidney damage. We confirmed the link between anaemia and UA levles. Ineffective renal UA clearance means progression of the disease course to the next stage, and over time as a sign of progression of the renal continuum to chronic damage.
MO294: Multidisciplinary Management of Obstructive Anuria: Uro-Nephrological Interdependence of the Patient Service
Authors: Afifi Rania , Alafifi M , Zamd Mohammed , Mtioui N , Elkhayat Ss , Medkouri G , Ramdani B , Benghanem M , Dakir M , Debbagh A , Aboutaieb R
Published: May 2022

BACKGROUND AND AIMS

Obstructive anuria is defined as a total cessation of diuresis or a volume of <200 or even 400 mL/24 h due to bilateral or unilateral blockage of a single anatomical or functional kidney. It is rapidly the cause of acute renal failure, endangering the vital prognosis in the short term and requiring emergency treatment in a specialised environment, whatever its aetiology.

It accounts for 10% of all anurias. They are significant conditions that might jeopardise the kidney's functional prognosis.

The goal of our study is to to describe the epidemiological profile, clinical and medical-surgical management performed at the CHU IBN ROCHD CASABLANCA in partnership with various services to manage this pathology, which remains severe.

METHOD

From January 2018 to December 2020, we conducted a 3-year retrospective and descriptive study of patients treated at the CHU IBN ROCHD of Casablanca's nephrology and haemodialysis department and urology department.

RESULTS

There were a total of 217 patients; 92 women and 125 men, i.e. 42.39% and 57.6%, respectively, with an average age of 56.7 years ‘22–79’. The circumstances of discovery were: oligo anuria 69.12%, haematuria 23.04% and AEG 7.83%. Obstruction was neoplastic in 64.51%; lithiasis 26.27%; bladder malformation 0.92% and of undetermined aetiology in 4.6%. The neoplastic origin was cervical cancer, followed by bladder and prostate. The mean creatinine level was 86.86mg/L. The indication for haemodialysis was:   threatening hyperkalaemia,  uraemic syndrome,  acidosis and acute lung oedema in 58%, 25.8%, 8.2% and 8% of cases, respectively.

The total number of haemodialysis sessions was 260 with an average number of 1.198. Obstacle removal was performed by percutaneous nephrostomy in 70.96% of cases, by double J catheterization in 26.26% of cases. The outcome was good in 78.34% of cases, 13.82% progressed to CKD. Mortality was 6.9%. The risk factors for mortality were: age, aetiology of neoplasia.

CONCLUSION

Obstructive anuria is an emergency requiring multidisciplinary management. The aetiologies were dominated by pelvic cancers and lithiasis in our context. Depending on the severity of the obstruction, treatment consists of three steps: treatment of metabolic abnormalities induced by acute renal failure, drainage of the obstructed excretory tract and treatment of the source of the obstruction. Prevention is based on early and adequate management of the various causative conditions.
MO297: Acute Kidney Injury Among COVID-19 Positive Patients is Associated With Higher Mortality: Single Center Experience
Authors: Ashry Ahmed Gheith Osama , Maher Nagib Ayman , Elserwy Nabil , Abbas Ahmad , Elsawi Islam S , Nair Prasad , Khalid Mahmoud , Hammad Mohamed , Fayyad Zohair , Atta Ahmed , Mostafa Ahmed , Deraz Ahmed , Abdelmonem Mohamed , Alotaibi Torki
Published: May 2022

BACKGROUND AND AIMS

Despite the lungs are the major targets of COVID-19, other organs such as the kidneys are also affected. Renal complications of COVID-19 are not yet well studied. We aimed to study the prevalence of acute kidney injury (AKI) among positive COVID-19 cases that were managed in the intensive care unit (ICU) in a single isolation hospital during the pandemic, and to explore its impact on patient outcome.

METHOD

This retrospective study included 616 patients with COVID-19 who were managed in the ICU in a single isolation hospital in Kuwait during the pandemic, from February to December 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Of the 616 patients, 40.2% developed AKI (group 1, n = 248) and were compared with the patients without AKI (group 2, n = 368).

RESULTS

Most of cases in the two groups were males (73% versus 70.7%), aged (60.8 ± 14 versus 51.7 ± 16 years), respectively. The two groups were comparable regarding chronic kidney disease (2% versus 0.8%) and chronic pulmonary disease. Other factors were significantly predominating among group 1 as diabetes mellitus (63.7 versus 40.5%), hypertension (74.2% versus 40.5%) and ischemic heart disease (26.2% versus 12.5%) (P < .05).

Fever, cough, shortness of breath and dehydration were significantly more frequent presentations among patients of group 1, and had radiological findings that were synchronized with COVID-19 (89.5% versus 50.8%) (P < .05). Moreover, sepsis, volume depletion, shock, arrhythmias and ARDS predominated among the AKI group (P < .05). The number of cases who were managed by therapeutic anticoagulation was significantly higher in AKI patients (89.9% versus 51.9%); also, cases who received supportive vasopressors and convalescent plasma transfusion as well as steroid were significantly higher in the same group (P < .05). Other therapeutic modalities such as antivirals, tocilizumab and hydroxychloroquine were comparable in both groups.

We found that acute respiratory failure requiring mechanical ventilation was significant among the AKI group (66.8% versus 29.4%), and the overall mortality rate was significantly higher in the same group (62.5% versus 32.8%).

CONCLUSION

The prevalence of AKI in patients with COVID-19 was 40.2%, and it was associated with poor prognosis among ICU COVID-19 positive cases.
MO312: Long-Term Kidney Function Outcome After COVID-19 Associated Acute Kidney Injury and Kidney Replacement Therapy in Intensive Care
Authors: Smolander Jessica , Rashid Tony Qureshi Abdul , Bruchfeld Annette
Published: May 2022

BACKGROUND AND AIMS

Acute kidney injury (AKI), frequently with concurrent albuminuria and haematuria, is common and increases mortality in COVID-19 infection. We present the clinical course and long-term outcomes of COVID-19 survivors with AKI and continuous kidney replacement therapy (CKRT) with follow-up of kidney function at 6 and 12 months.

METHOD

A total of 29 non-CKD COVID-19 infected patients with AKI required mechanical ventilation and CKRT at the intensive care unit (ICU). Of those, 15 died (52%) and 14 survived. Written informed consent to collect and publish data was obtained from 13 survivors.

We estimated eGFR with CKD-EPI creatinine in population-based healthy controls (n = 80, median age 62 years) for comparison.

RESULTS

A total of 13 survivors, median age 58 years, 85% male, 15% diabetes and median BMI 30 kg/m2. None had CKD before admission or at admission following rehydration.

The typical scenario was a normal or slightly elevated creatinine level at admission, normalizing after IV fluids, but rising creatinine from day 8 (median) and the start of CKRT on day 10 (median). Urine analysis was available in 7 patients, of which only 1 had no urinary findings, 6 had albuminuria and/or haematuria and/or leukocyturia. Dialysis could be weaned in all 13 survivors after a median time of 16 days in dialysis (range 1–40 days). The median length of stay at the ICU was 41 days (range 10–72 days) and the median weight loss was 16 kg (range 8–27 kg).

The survivors had a median eGFR of 100 mL/min/1.73 m2 (range 66–113) at baseline and a median eGFR of 69 mL/min/1.73 m2 (range 49–97) at 12 months estimated with CKD-EPI creatinine. Population-based control subjects had a median eGFR of 85 mL/min/1.73 m2 estimated CKD-EPI creatinine. Urine analysis was available in 11 patients at 12 months, of which 5 had no urinary findings, 3 had microalbuminuria and 3 had haematuria and/or leukocyturia.

Since the weight loss was accompanied by a decline in creatinine, we used both creatinine-based, and cystatin C-based eGFR to evaluate kidney function at 6 month follow-up. At 6 months, the survivors had a median eGFR of 70 mL/min/1.73 m2 (range 44–111) estimated with CKD-EPI creatinine as compared with 46 mL/min/1.73 m2 (range 36–65) estimated with cystatin C eGFR, suggesting that cystatin C-based formulae are clinically more useful after COVID-19 associated critical illness.

CONCLUSION

The AKI mortality in COVID-19 despite CKRT is high, but a substantial number of patients survive and can be weaned off dialysis. Kidney function at 12 months did improve substantially but did not return to its baseline values and was lower compared with healthy age-matched population-based control subjects. Kidney outcome follow-up after COVID-19 and AKI is likely to be important for assessing long-term CKD prognosis and is proposed to be evaluated with both creatinine and cystatin C as well as urinalysis.
MO317: The Impact of Early Versus Late Initiation of Renal Replacement Therapy in Critically ill Patients With Acute Kidney Injury on Mortality and Clinical Outcomes: A Systematic Review With Meta-Analysis
Authors: Relvas Miguel , Castro Inês , Gameiro Joana , António Lopes José , Monteiro-Soares Matilde , Coentrao Luis
Published: May 2022

BACKGROUND AND AIMS

Renal replacement therapy (RRT) is consensual in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This systematic review with meta-analysis aims to compare the benefits between early and late RRT initiation strategies in critically ill patients with AKI.

METHOD

Studies were obtained from three databases (MEDLINE, CENTRAL and SCOPUS), searched from inception to May 2021. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and RRT-associated adverse events. A random-effects model was used for summary measures. Heterogeneity was assessed through Cochrane I2 test statistics. Potential sources of heterogeneity for the primary outcome were sought using sensitivity analyses. Further subgroup analyses were conducted based on the RRT modality.

RESULTS

A total of 13 randomized controlled trials, including 5193 participants, were analyzed. No significant differences were found between early and late RRT initiation regarding 28-day mortality [risk ratio (RR) 1.00, 95% confidence interval (95% CI) 0.89–1.12; I² = 30%], overall mortality (RR 1.00, 95% CI 0.90–1.12; I² = 42%) and RRF (RR 1.02, 95% CI 0.92–1.13; I² = 53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34, 95% CI 1.17–1.53; I² = 6%) and infectious events (RR 1.83, 95% CI 1.11–3.02; I² = 0%).

CONCLUSION

Early RRT initiation does not improve the 28-day or overall mortality, nor the likelihood of RRF and increases the risk for RRT-associated adverse events, namely hypotension and infection.
MO319: AKI in Patients With COVID-19 Supported on ECMO: A Single Center Experience in Mexico
Authors: Rizo Topete Lilia , Gomez Rene , Contreras Veronica , Borja Silvia , Sanchez Sergio , Lopez Alicia , Chavarria Uriel
Published: May 2022

BACKGROUND AND AIMS

AKI is a common complication in critically ill patients, during the COVID-19 pandemic, it has been presented directly associated with damage by the virus, due to the severity of the disease and secondary to treatment, that is, secondary to the crosstalk of organs and the crosstalk of support equipment, such as the extracorporeal oxygenation membrane (ECMO), which has been used in patients with severe respiratory failure. According to the international bibliography, the incidence of AKI in ECMO ranges from 26% to 85% depending on the characteristics of the patient, the percentage that requires KRT is around 45%.

OBJECTIVE

Our hospital is a national reference center for ECMO support therapy as for lung transplantation, it is the only center that has an active program, so understanding the epidemiology of AKI associated with ECMO in our population is important, in addition to representing a part of the experience in Latin America.

METHOD

Retrospective and descriptive studies were included all patients 18 years or older connected to ECMO with a diagnosis of severe pneumonia for COVID-19 from June 2020 to August 2021. Data were collected in Excel and using the ECMO Team platform data that is shared in the ELSO. Descriptive data analysis was performed with SPSS V21 and Excel.

RESULTS

A total of 48 patients were connected to ECMO for COVID-19 severe pneumonia in our center, of which 39 were men. Average age 49 years (min 21 year, max 68 year), average weight 93 kg (min 55 kg, max 125 kg) 25 patients (52%) with AKI, 22 (45%) required KRT and 100% CKRT. Of them, 10 patients (20%) have kidney recovery function, all of them get out form ECMO. From all, 45% patients died, these 45% were still in ECMO. In most of the cases, the AKI cause is multifactorial, but the most common cause identified was sepsis, the second nephrotoxicity (antibiotics like vancomycin and colistin) and the third hemolysis (an ECMO membrane complication). About the indication of star KRT: 50% fluid overload, 30% acidosis and uremia and 20% anuria. A total of 100% of patients were in ECMO-VV at time CKRT started, all were connected in parallel in ECMO in post-blood pump and return pre-blood pump, with no coagulation problems as long as they have the ECMO anticoagulation, 93% patients with heparin and 7% with argatroban for HIT suspicious. As data to highlight from our population, there is the first bilateral lung transplant secondary to COVID-19 in Latin America and the longest air transfer in ECMO in the world.

CONCLUSION

In our center, the AKI, KRT and mortality in patients with ECMO are much like other centers reported. In COVID-19, there is not yet very clear evidence and more studies should be done. This is the first study in Mexico about ECMO, AKI and COVID-19.
MO325: Renal Glycosuria in Acute Kidney Injury Predicts the Diagnosis of Acute Interstitial Nephritis
Authors: Landaluce Triska Eugenia , Shabaka Amir , León-Póo Mariana , Maria Fernandez Juarez Gema
Published: May 2022

BACKGROUND AND AIMS

Acute interstitial nephritis (AIN) is one of the most frequent causes of acute kidney injury (AKI). Interstitial inflammation can lead to tubular epithelial infiltration producing tubular dysfunction, which could be clinically detected by glycosuria (with or without Fanconi syndrome), leukocyturia, microscopic haematuria or tubular proteinuria. The aim of this study was to determine the predictive value of renal glycosuria in AKI for the diagnosis of AIN.

METHOD

We conducted a retrospective study of kidney biopsies performed at out centre between May 1998 and December 2021, and included patients whose kidney biopsy was performed while presenting with AKI. We excluded patients with other indications for kidney biopsy, patients with diabetes mellitus and patients who presented a serum glucose level of > 120 mg/dL at presentation. We registered demographic, clinical and laboratory variables at presentation of AKI, and compared patients with a final diagnosis of AIN to patients with other causes of AKI.

RESULTS

The study included 211 patients; 39 patients (18.5%) with a diagnosis of AIN and 172 patients (81.5%) with other diagnoses for AKI. Eight patients with AIN presented with renal glycosuria (20.5%) compared with seven patients with other causes of AKI (4.1%) (P < .001). Patients with AIN presented less frequently haematuria (46.2% versus 86%; P < .001), lower albuminuria [86 (35–151) mg/g versus 694 (136–1414) mg/g; P < .001], proteinuria [0.43 (0.22–0.92) g/24 h versus 1.43 (0.76–2.97) g/24 h; P < .001], serum glucose (89.5 ± 12 versus 94.7 ± 12.5 mg/dL;   P = .019) and uric acid (6.5 ± 2.5 versus 7.8 ± 2.3 mg/dL;   P = .003), and more frequently metabolic acidosis (68.6% versus 33.3%; P < .001) and eosinophilia (17.9% versus 5.2%; P = .007) than in patients with other causes of AKI. There were no differences in age, sex, extrarenal manifestations, serum creatinine, potassium or phosphorus levels at presentation. The presence of at least traces (≥50 mg/dL) of glycosuria had a specificity of 96.5% (92.6–98.7) for the diagnosis of AIN, with a positive predictive value of 57.1% (32.9–78.3) and a negative predictive value of 84.3% (82%–86.3%). The positive likelihood ratio was 5.9 (2.2–16) and the negative likelihood ratio was 0.82 (0.7–0.97). The presence of > 100 mg/dL of glycosuria had a specificity of 99.4% for the diagnosis of AIN, with a positive predictive value of 75% (24.3–96.6) and a positive likelihood ratio of 13.2 (1.4–123.8).

CONCLUSION

AIN can lead to proximal tubular dysfunction, which can be clinically expressed as renal glycosuria. The presence of renal glycosuria in patients with AKI guides towards the diagnosis of AIN, with an excellent specificity when glycosuria > 100 mg/dL.