bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0310FLUID OVERLOAD AND MARKERS OF CARDIOVASCULAR DAMAGE IN SEVERE NEPHROTIC SYNDROME
Authors: Matyjek Anna , Rymarz Aleksandra , Niemczyk Stanisław 
Published: June 2020

Abstract

Background and Aims
One of the major symptoms of severe nephrotic syndrome is fluid retention. Fluid overload can induce cardiovascular damage. NT-proBNP (N-terminal pro-brain natriuretic peptide) and hsTnT (high sensitivity troponin T) are well known markers of this disorder. The aim of the study was to evaluate the association between volumes of body water compartments and markers of cardiovascular damage in patients with severe nephrotic syndrome (SNS) defined as nephrotic range proteinuria and hypalbuminaemia ≤ 2.5 g/dl.

Method
40 patients with SNS and eGFR &gt;30 ml/min/1.73m2 formed the study group (SNSG) and 40 healthy volunteers without SNS matched according to age, sex, height, body mass and kidney function formed the control group (CG). In all participants serum creatinine, serum albumin concentration, daily proteinuria, hsTnT and NT-proBNP were measured. Body water compartments such as extracellular water (ECW), intracellular water (ICW), total body water (TBW), overhydration (OH) were assessed using Body Composition Monitor, Fresenius Medical Care. For statistical analysis Spearman’s correlation coefficients, chi2 or Mann-Whitney U tests were used (Statistica v 13.1).

Results
SNSG included 28 males (70%) and 12 females. Median age was 55 years (IQR 30-65), the mean daily proteinuria was 10.5 ±5.0 g. The characteristics of the study parameters in two groups are described in the table.
Significantly higher hsTnT (18 vs 6 ng/l, p=0.0001) and NT-proBNP (294.8 vs 47.1 pg/ml, p=0.0003) levels were observed in the severe nephrotic syndrome group in comparison (SNSG) to CG.
In SNSG extracellular water was significantly higher (20.9 ±5,2 vs 17.4 ±3.3 L, p=0.001) and intracellular water (ICW) was significantly lower (18.9 ±5.2 vs 21.4 ±4.8 L, p=0.034) in comparison to CG. Interestingly total body water (TBW) did not differ between the groups (39.8 ±8.6 vs 38.8 ±7.7 L, p=0.603). Also overhydration which is a derivative of ECW, was higher in SNSG (OH: 4.2 vs 0.3 L, p&lt;0.0001) than in CG. Significant, positive correlation was observed between OH and NT-proBNP (R=0.56, p&lt;0.0001) as well as hsTnT (R=0.60, p&lt;0.0001). We did not observed significant correlation between ECW and NT-proBNP or hsTnT.

Conclusion
In the severe nephrotic syndrome group fluid retention was associated with the increase in ECW and the decrease in ICW whereas TBW was the same in both groups. Such constellation can indicate for intracellular underhydration which was not describe so far. Overhydration, which is a derivative of ECW, positively correlated with markers of cardiovascular damage and can be important for patients with resistant SNS and can influence their prognosis.
P0311INFECTION-RELATED GLOMERULONEPHRITIS IN ADULTS: TIME FOR A DEFINITIVE PARADIGM SHIFT?
Authors: Salviani Chiara , Zappa Mattia , Jeannin Guido , Gaggiotti Mario , Tardanico Regina , Fisogni Simona , Cancarini Giovanni , Scolari Francesco 
Published: June 2020

Abstract

Background and Aims
The recent decades have witnessed significant changes in the epidemiology and clinical course of infection-related glomerulonephritis (IRGN). We analyzed the clinicopathological features and long-term outcome of adult patients with biopsy-proven IRGN followed in a large Italian referral centre.

Method
We included patients with biopsy-proven IRGN diagnosed from 2000 to 2018. Clinical and laboratory findings, histological features, possible risk factors and therapy were assessed for both renal and patient outcome.

Results
Forty-one patients met the inclusion criteria (male:female ratio 3:1, mean age 61±16 years). Smoke habit (47.2%), alcoholism (30.6%), and diabetes (27.5%) were the most common risk factors. The most frequently identified sites of infection were skin, lung and heart (Table 1). Staphylococci spp. accounted for 76.5% of positive cultures (Figure 1). Hypocomplementaemia emerged in 48.5% of cases. The most frequent histologic patterns were diffuse proliferative (56.0%) and membranoproliferative (29.3%) glomerulonephritis. Haemodialysis was required by 22.5% of patients at inception. Two thirds of patients developed chronic kidney disease; half of them reached end-stage renal disease (ESRD). By multivariate analysis ESRD was associated with diabetes (HR 13.7; 95% CI, 1.6-121.0; p=0.018), crescents (HR 25.2; 95% CI, 2.7-235.7; p=0.005), and interstitial fibrosis (HR 31.0; 95% CI, 3.3-287.3; p=0.003). Male gender (HR 12.7; 95% CI, 10.8-14.6; p=0.008) hypertension (HR 40.8; 95% CI, 38.6-43.1; p=0.001), gross haematuria (HR 11.8; 95% CI, 9.4-14.2; p=0.047), need for haemodialysis at onset (HR 16.3; 95% CI, 14.7-17.8; p&lt;0.0001), and interstitial infiltrate (HR 13.3; 95% CI, 11.6-15.0; p=0.003) significantly affected survival. Corticosteroids did not affect prognosis.

Conclusion
While traditionally considered a “benign” disease with a favorable course in children, IRGN is a potentially severe disease in adults, particularly when a background of major comorbidities and older age are present. A significant proportion of patients does not recover renal function, with a remarkable risk of ESRD.
P0319DEPRESSIVE BURDEN, QUALITY OF LIFE AND CAREGIVER BURDEN IN END STAGE RENAL DISEASE - A PARADIGMATIC SHIFT IN HOLISTIC MANAGEMENT
Authors: Khan Abdul waheed , Khan Shahbaz ali , Ray Deepak Shanker , Prasad Swetanka , Khan Shagufta , Deshpande Aruna 
Published: June 2020

Abstract

Background and Aims
Depressive illness is not only common in patients of End Stage Renal Disease (ESRD) but also an independent risk factor for morbidity and mortality. The relation between depressive illness, Quality of Life and caregiver burden in this vulnerable group is complex. We attempted to study these 3 important psychosocial domains in patients of ESRD on hemodialysis, peritoneal dialysis as well as those ESRD patients who were not on any dialysis yet

Method
A cross sectional analytical comparative controlled design was done to compare 3 domains of depressive burden, quality of life and caregiver burden in 3 group of patients – ESRD patients on hemodialysis, ESRD patients on peritoneal dialysis and ESRD patients not on any dialysis
Statistical methods used - χ2 statistic or Fisher‘s exact test for categorical variables and comparison of group means. ANOVA was used for continuous variables where more than 3 groups were compared. Correlational analysis done using Spearman’s correlation coefficient . A p-value of &lt;0.05 was considered significant. SPSS 20.0 was used

Results
Depressive symptoms were present significantly across all 3 groups of ESRD. Depressive disorder was significantly higher in the Hemodialysis group (HD) as compared to peritoneal dialysis (PD) group( p=0.038). Mean QOL was significantly higher for PD. Caregiver burden was higher in the HD group.
The study brought out the huge burden of depressive symptoms and depressive illness in patients on ESRD across all 3 group of patients and the significantly higher burden of depressive illness and lower QoL and higher caregiver burden in the hemodialysis group. This assumes significance because the majority of our ESRD patients are on HD

Conclusion
This depressive burden is the hidden factor behind poor Quality of Life as well as poor overall satisfaction as well as treatment outcome in our patients of ESRD whether or not on dialysis. Apart from the inherent factors related to the illness or the type of dialysis, sociodemographic factors seem to play a role in QoL and CG burden in the hemodialyis group. To address this hidden depressive burden comprehensively, we recommend closer cooperation between nephrologist, psychiatrist and psychosocial workers to improve the overall treatment outcome in ESRD patients.
P0323REVERSIBLE RENAL FUNCTION DECLINE ASSOCIATED WITH NIRAPARIB
Authors: Lazareth Helene , Delanoy Nicolas , Raphaël COHEN , Boissier Emilie , Alexandre KARRAS , Thervet Eric , Courbebaisse Marie , Pallet Nicolas 
Published: June 2020

Abstract

Background and Aims
Inhibitors of poly-ADP-ribose-polymerase-1 (PARP) are prescribed for the treatment of metastatic breast and ovarian cancers. Clinical data trials suggest that niraparib may not have adverse effects on the kidney.

Method
We present a descriptive case series of renal function parameters of all the patients who received niraparib for maintenance treatment of recurrent ovarian cancer in a tertiary care center. Twenty patients received niraparib for the first time between april 2018 and march 2019 in the Georges Pompidou European Hospital, Paris, France. Four patients were excluded from the analysis because of lack of repeated serum creatinine (Scr) measurements during the first 4 months following niraparib introduction.

Results
The patients ranged in age from 51 to 82 years. All patients were women with high grade serous ovarian carcinoma. Personal medical history of hypertension was present in 68% and diabetes in 18% of patients. All patients received carboplatin and 90% received bevacizumab as maintenance treatment after first-line chemotherapy. Niraparib was introduced on average 3 years (range 2 to 9 years) after the diagnosis of cancer, at a dosage of 200 mg/day in all patients. The median Scr at baseline was 84 μmol/l (range 62 to 114 µmol/l). All patients experienced an increase in Scr level over the 3 months following niraparib introduction. The average max Scr increase was 1.35 times baseline (median Scr 117µmol/l, range 88 to 155 µmol/l, p&lt;0.0001 compared to baseline values), and 3 patients (18%) developed stage 1 KDIGO Acute Kidney Injury/Disease (Scr increase &gt; 1.5-2 fold baseline). None of the cases had biochemical signs of tubular or glomerular injury. Urinary creatinine clearance was higher than urinary clearance of 51Cr-EDTA, making interaction with tubular creatinine secretion unlikely. Kidney biopsy was performed in one patient who developed albuminuria. Microscopic examination identified mild tubular atrophy and interstitial fibrosis without inflammatory lesion Immunofluorescence analysis did not show immune deposits. Mesangiolysis was found in some glomeruli, typical of bevacizumab effects. Niraparib was interrupted in all but 1 patient (95%), because of haematological toxicity (n=7), tumoral progression (n=7) or gastro-intestinal toxicity (n=1). Average Scr level returned to baseline (82 µmol/l, range 62 to 107 µmol/l) over the 2 months following discontinuation.

Conclusion
Niraparib is associated with a systematic and significant increase in Scr (+35%) without obvious sign of tubular or glomerular injury. Renal dysfunction is mainly reversible after discontinuation. Decline of renal function under treatment may not be an incentive to stop treatment automatically. Physicians prescribing this agent should be aware of this complication.
P0325FREQUENCY AND PREDICTORS OF NON URINARY INFECTIONS AMONG THE ADULT PATIENTS WITH STERILE PYURIA ATTENDED IN NEPHROLOGY DEPARTMENT OF BSMMU, BANGLADESH
Authors: Md Ismail Hossain , Hamid Dr A H Hamid ahmed , Tanzin Dr Mirza Sumaiya Tanzin , Islam Rafi Nazrul 
Published: June 2020

Abstract

Background and Aims
Urinalysis is a test commonly ordered, especially when the patient has a febrile illness. In most cases it provides useful information, but it can sometimes be misleading. A significant proportion of patients with acute febrile illness have transient pyuria without bacteuria. Identification and management of such cases could be improved by better predictive models.To determine predictors of non urinary infections in adult patients with sterile pyuria and to develop a preliminary predictive model.

Method
This cross sectional study was done in the department of Nephrology, BSMMU, during the period of September 2016 to August 2017. All adult patients with sterile pyuria were included in the study. A total number of 233 cases who had urinary WBCs &gt;5 per high power field (HPF) with a negative culture were selected as sample by convenient sampling technique. We performed detailed clinical and laboratory investigations to identify potential causes of the sterile pyuria. Patients were then divided into two groups, those with causative factors within the urinary tract and those with causative factors outside of the urinary tract. Logistic regression was used to create a model to predict causative group.

Results
Most 196(84.1%) patients were found to have disorders related to urinary tract (Group A) and 37(15.9%) patients had infections outside of the urinary tract (Group B). Significant proteinuria and urinary casts were more common in Group A, while urinary WBCs&gt;20/hpf and microscopic hematuria were more common in Group(B). All of these differences were statistically significant (p&lt;0.05). In the logistic regression model patients with sterile pyuria with fever (OR 32.9) and/or pyuria with urinary WBC&gt;20/HPF (OR 2.14) were more likely to involvement outside of the urinary tract. Those with urinary tract symptoms (OR 0.28) and/or proteinuria (OR 0.20) were more likely to have renal and urinary tract involvement.

Conclusion
In patients attended to the nephrology department, sterile pyuria was more likely to have its origin in the urinary tract if there were urinary tract symptoms and/or proteinuria and less likely if there was fever or urinary WBCs &gt;20/hpf.
Figure: Diagnosis of the study population (n=233)
Figure : Bar diagram shows renal status of the study population
P=0.047
P value reached from chi square test
Multivariable logistic regression analysis for infections outside the urinary tract
P0329CLINICAL SIGNIFICANCE OF CREATININE VARIABILITY AND ITS IMPACT ON CARDIOVASCULAR OUTCOMES
Authors: Lee Soojin , Lee Yeonhee , Park Sehoon , Han Kyungdo , Kim Yaerim , Kim Jung-Hyun , Joo Kwon Wook , Kim Dong Ki 
Published: June 2020

Abstract

Background and Aims
Linear decline of glomerular filtration rate (GFR) is associated with aggravating the patient outcomes. Serum creatinine, which is commonly used for estimating GFR, often fluctuates throughout the serial measurement. The clinical significance of creatinine fluctuation among the general population whose renal function is prior to chronic kidney disease (CKD) development had not been demonstrated yet. Thus, we investigated the study to evaluate the impact of creatinine variability on patient outcomes.

Method
A nationwide retrospective cohort study was performed usaing the database of Korean National Health Insurance System. Adult patients who received national health screening program and measured creatinine for ≥3 times between 2012 and 2016 were considered. Those who previously developed CKD were excluded. The variability of creatinine values were presented with variability independent of mean (VIM). The patients were classified into quartiles of the VIM and Q4 presented highest variability of creatinine. Then, the risks of myocardial infarction (MI), stroke and death were assessed according to the extent of variability.

Results
During the median follow up of 3.27 years, 3,509,899 participants were examined for association of creatinine variability and cardiovascular outcomes. Participants with higher creatinine variability were significantly associated with elevated risk of MI (hazard ratio (HR) (95% confidence interval (95% CI)) 1.11 (1.04-1.18), stroke (HR (95%CI) 1.06 (1.00-1.13)) and death (HR (95%CI) 1.15 (1.09-1.21)), compared to those with the lowest quartile of creatinine variability.

Conclusion
Increased creatinine variability exhibited association with elevated risk of MI, stroke and death. In general population, whose renal function is prior to CKD development, monitoring of creatinine variability needs to be considered as the parameter of predicting the adverse outcomes, in addition to the decline of GFR.
P0342A STUDY OF TREATMENT WITH RITUXIMAB IN REFRACTORY LUPUS NEPHRITIS
Authors: Mahanta Pranab Jyoti , Sharma Manjuri , Alam Shahzad , Doley Prodip Kumar , Pegu Gayatri , MAZUMDER MASTAKIM AHMED 
Published: June 2020

Abstract

Background and Aims
SLE patients have 40% to 70% life time risk of developing lupus nephritis (LN). In LN patients rate of end-stage renal disease is 10%, remaining constant in the last 30 years, even after the emergence of various immunosuppressive therapy.
SLE is an example of classical antibody-mediated disease and hence treatment with B cell depleting agent (like the use of Rituximab ) appears to be a promising approach for this unwinnable disease from the Roman era.
The aim of this study was to analyze the outcome in terms of - no renal response (NRR), complete renal response (CRR) or partial renal response (PRR) at week 24 after rituximab treatment initiation in refractory LN.
CRR considered, if serum creatinine (S Cr) level returned to baseline, with a decline in the 24 hour urinary protein to &lt; 500 mg/day. PRR defined as stabilization (+/-25%), or improvement of S Cr, plus a 50% decrease in 24 hour urinary protein (which was &lt; 3.5 gm/day). NRR considered, if participant did not achieve either a CRR or PRR.

Method
It is a single center prospective observational study, comparing short term (24 week) outcomes in resistant lupus nephritis patients of &gt;18 year age group with weekly (total 4) dose of rituximab therapy.
The study was conducted on 25 refractory lupus nephritis patients admitted in Nephrology Department (not responding to conventional immunosuppressive drugs like cyclophosphamide, MMF). Repeat renal biopsy was performed, all baseline investigations were done.
Injection Rituximab 375 mg/m2 weekly 0,1,2,3 week along with premedication treatment were given to every patient. The clinical outcome was assessed monthly post-treatment.

Results
In the study maximum patients were of class IV, n=21 (84 %). Sustained (6 months post treatment) CRR was achieved in n=6 (24%) patients, n=7 (28%) patients achieved PRR, rest n=12 (48%) patients had NRR. Mean blood absolute CD-19 count was significantly negatively correlated with response to rituximab treatment ( p&lt; 0.001) .Mean absolute CD-19 count was 2.33/microliter in CRR, 2.14/microliter in PRR group and 21.25 / microliter in NRR group . No significant side effects of rituximab were observed.
Limitations –Small sample size, single center study, long term follow up not considered.

Conclusion
In refractory LN patients, 24 weeks after Rituximab treatment
P0343RISK PREDICTION MODELS FOR PREDICTING PROGRESSION OF IGA NEPHROLOGY:A VALIDATION STUDY
Authors: Xie Jingyuan 
Published: June 2020

Abstract

Background and Aims
Risk prediction models for IgA nephropathy (IgAN) containing clinical variables (clinical model) or clinical plus pathological variables (full model) have been established based on a large international collaborative study recently, but external validation of these models are still required before clinical application. The aim of this study is to externally validate previously reported risk prediction models based on our multi-center IgAN cohort.

Method
Biopsy-proven IgAN patients with eGFR ≥15 ml/min/1.73 m2 at baseline and a minimum follow-up of 6 months were enrolled. Primary outcome was defined as end-stage kidney disease (ESRD). Cox proportional hazards models were built to validate risk models. R2, Akaike information criterion (AIC) and C statistic were calculated to evaluate model accuracy.

Results
A total of 2300 IgAN patients with a median follow-up of 30 months were enrolled, and 214(9.3%) ESRD occurred during the follow-up period. The median age was 35(interquartile range, 28-44) years, and 1106 cases (48.1%) were men. Our cohort successfully validated the clinical model and the full model based on C statistic (0.90 and 0.91) and R2 (0.32 and 0.32). Our results showed limited improvement in model performance after adding the Oxford classification parameters to clinical parameters. However, both two models performed better than the model consisting only pathological parameters(C statistic 0.83, R2 0.24). We also validated other risk prediction models, including CLIN model (C statistic 0.90, R2 0.32) and CLINPATH model (C statistic 0.91, R2 0.31) derived from Chinese IgAN patients or CKD model (C statistic 0.90, R2 0.32) derived from Canadian CKD patients. It was found that clinical models based on different combinations of clinical parameters performed similarly.

Conclusion
In summary, we successfully validated a recently reported IgAN risk model and we found that clinical parameters alone could accurately predict ESRD risk in IgAN patients.
P0351IMPACT OF APOL1 POLYMORPHISM ON LUPUS NEPHRITIS
Authors: Burger Carole , Alexandre KARRAS 
Published: June 2020

Abstract

Background and Aims
African ancestry is associated with more severe kidney involvement and end stage renal disease (ESRD) in lupus nephritis (LN). Two polymorphisms of the apolipoprotein L1 gene (APOL1), defining the risk allels (RA) G1 and G2, particularly frequent among subjects of African ancestry, markedly increase the risk of ESRD and the occurrence of collapsing glomerulopathy (CG) in the general population. The aim of this study was to assess the impact of ApoL1 RA on clinical, biological, and histological presentation of LN, and its prognosis.

Method
Patients of African ancestry with biopsy-proven LN were included between January 2017 and September 2018. Clinical, laboratory and pathology datas were retrospectively collected and ApoL1 genotyping was performed.

Results
Among the 53 included patients, 31 had no RA, 16 were heterozygous with only one RA and 6 had 2 RA (G1/G1 or G2/G2 or G1/G2). The population was divided in 2 groups: low risk polymorphism (LRP) group defined by the presence of 0 or 1 RA, and high risk polymorphism (HRP) group with 2 RA. At presentation, hypertension (OR 25,4 [1,3-510,3]) and acute renal failure (OR: 9,3 [1,3-65,2]), were more frequent in the HRP group when compared to the LRP group. Initial median serum creatinine was respectively 363 μmol/l (IQR 119-594) vs 64 μmol/l (IQR 55-127). After 2-year follow-up, median eGFR was 59mL/min (IQR 41-91) in the HRP group and 117mL/min (IQR 92-124mL/min) in the LRP group. Patients in the HRP group were more likely to have an impaired renal function with an estimated glomerular filtration rate (eGFR) &lt;60mL/min compared to patients in the LRP group (OR: 13,5 [2,1-86,5]). Moreover, ESRD-free survival was worse in the HRP group (Hazard ratio: 78,8 [5,3-1124,0]) despite similar chronicity indexes on initial kidney biopsy and comparable therapeutic strategies. As for histological findings, CG was observed in 67% of patient’s kidney biopsy in the HRP group whereas it only concerned 12% of patient’s kidney biopsy in the LRP group (OR: 14,8 [2,4-84,8]).

Conclusion
The ApoL1 polymorphism strongly affects LN prognosis in patients with African ancestry, resulting in more severe inaugural presentation, higher risk of subsequent severe chronic kidney disease and development of collapsing glomerulopathy for subjects with 2 RA.