bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0639COMPARISON OF SIRS AND QSOFA CRITERIAS IN RECOGNITION OF SEPSIS RELATED ACUTE KIDNEY INJURY
Authors: Alkan Özlem , Arıkan İzzet Hakkı 
Published: June 2020

Abstract

Background and Aims
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Epidemiological studies have shown that the incidence of sepsis is increasing and therefore it is a public health problem. AKI is often associated with critical illnesses such as sepsis, and is associated with prolonged hospital stay, need for intensive care, increased morbidity and mortality. Although the mechanism of sepsis-induced AKI is not fully understood, it is thought that it has a different pathogenesis and requires a different approach and therefore it has been the focus of the studies. The aim of this study was to compare the criteria of SIRS and qSOFA in patients with suspected infection to determine which is more valuable in predicting sepsis associated AKI.

Method
SIRS and qSOFA scores of 120 patients with sepsis who were admitted to the Emergency Department of Marmara University Hospital were calculated at the time of admission. Age, gender and chronic diseases were recorded. The laboratory values at the time of admission and follow-up were recorded and the factors associated with the development of AKI were investigated by statistical analysis.

Results
Of the patients evaluated in the study, 60.8% (n = 73) were male and 39.2% (n = 47) were female. The median age was 66 (18-89) years. About 96% (n = 116) of the patients met the SIRS criteria, 54.2% (n = 65) met the qSOFA criteria, and 51.7% (n = 62) met both the SIRS and qSOFA criteria. AKI was found in 62.5% (n = 75) of the patients. According to AKIN staging, 40 (53.3%) patients had stage 1, 19 (25.3%) patients had stage 2 and 16 (21.4%) patients had stage 3 AKI. There was no correlation between SIRS criteria and development of AKI. However, all patients who received 3 points from qSOFA criteria developed AKI. According to the results of multivariate analysis, age, abnormal mental status and procalcitonin were associated with development of AKI.

Conclusion
Sepsis-associated AKI is related with deterioration in clinical outcomes, early diagnosis and treatment is important. According to our results, the risk of AKI is higher in patients with qSOFA score 3 but not SIRS criterias.
P0640DIAGNOSTIC AND TREATMENT OF THE SEVERE FORMS OF ACUTE RENAL FAILURE DURING MALARIA UNDER LIMITED CONDITIONS
Authors: Pilcevic Dejan , Kojic Miroslav , Milic Veljko 
Published: June 2020

Abstract

Background and Aims
To explore clinical features and outcome of the most severe forms of acute renal failure (ARF) during Plasmodium falciparum malaria in United Nations personnel stationed in Central African Republic, during “MINUSCA ” mission. ARF is one of the most important negative predictive criteria for outcome of malaria.Etiology is multifactorial, but most often is consequence of prerenal dehydration and tubular damages with hemoglobinuria during severe hemolysis

Method
We analyzed records of 54 inpatients with complicated forms of Plasmodium falciparum malaria who were treated in the Serbian level 2 hospital during 2017. Diagnosis of ARF was estimated based on RIFLE criteria. Having in mind the occasional lack of diagnostic kits for creatinine, at the almost one third of patients we used daily diuresis monitoring (with follow up of volume status) to diagnose this complication (according with RIFLE criteria).

Results
Total of 19 patients (35,19%) have developed ARF. Beside parenteral treatment with Artemisin, they were treated with parenteral solutions and diuretics. Despite therapy, 8 patients (14,81%) developed progressive and dialysis depended form of ARF (one had hemolytic-uremic syndrome) and they have been urgently evacuated accompanied by AMET into a senior medical institution. Based on provided back information, average creatinine on admission was 1242+/-342 µmol/l, Hb level 10,6 g/dl, potassium 6,8mmol/l. Six out of 8 patients completely recovered renal function (they needed average 7+/- 2 HD procedures; patient with HUS performed 5 plasma exchange sessions), one developed CRF grade 3 and one developed ESRD with necessity for chronic HD treatment. There were not lethal outcomes.

Conclusion
Early recognition of systemic complications including parameters of acute renal failure (decreasing urine output or changing of urine color could be useful markers under limited medical conditions)is necessaryin the purpose of timely recognition and promptly evacuation into higher medical facilities for further treatment.
P0647ACUTE KIDNEY INJURY SECONDARY TO SUCROSE CONTAING INTAVENOUS IMMUNOGLOBULIN
Authors: Al Lawati Sadiq , Al Salmi Issa , Hannawi SUAD 
Published: June 2020

Abstract

Background and Aims
Intravenous immunoglobulins (IVIG) are pooled polyvalent IgG antibodies extracted from the human plasma. While the initial indications were mainly immune deficiency states and some autoimmune diseases, the usage has been widened to include several immune mediated diseases, viral infections, and organ transplant rejection. Stabilizers in IVIG may include sugars, such as sucrose, glucose, or maltose. Sucrose in IVIG preparations may cause acute kidney injury. We report the case of a renal transplant patient who developed acute kidney injury due to sucrose nephropathy following the administration of sucrose containing IVIG.

Method
Four months after transplantation he was referred to our Hospital for deterioration of kidney function with eGFR (by MDRD formula) of 27ml/min. Cytomegalovirus virus (CMV) PCR turned positive (3300 copies/ml). Cyclosporine levels were high (C2: 2937 ng/ml) and hence, cyclosporine dose was adjusted. Induction therapy with Injection Ganciclovir for 2 weeks, followed by therapeutic dose of oral Valganciclovir was administered for the treatment of CMV infection. Skin examination revealed annular purple patches, suspicious of Kaposi Sarcoma, on the upper limbs. Skin biopsy confirmed the diagnosis.
It was planned to give total IVIG of 2 gm/ kg in four daily divided doses. After completion of the second dose, serum creatinine increased to 370 µmol/L. He was clinically asymptomatic, euvolumic, vital signs were stable, and his urine output remained normal and his urinalysis was inactive.

Results
The ultrasound of the transplant kidney was normal with normal resistivity index. IVIG was stopped. He was well hydrated and underwent ultrasound guided biopsy. The graft biopsy showed acute tubular injury with flattening and vacuolation of tubular epithelial cells. Mitosis indicating tubular regeneration was seen. There was mild focal interstitial inflammation (20%) with mild lymphocytic tubulitis not amounting to graft rejection. Immunohistochemistry for C4d and polyomavirus (BKV) were both negative. The features were most consistent with sucrose induced nephropathy (Figure 1).
Subsequent visits showed a decrease in BKV-PCR serum level and eventually undetected serum level of BKV-PCR at follow up about a month later.

Conclusion
In this paper, we presented a case of a living unrelated kidney transplant recipient who developed BKV nephropathy and developed impaired kidney function. The patient also had new onset diabetes mellitus after kidney transplantation (NODAT) but was otherwise in good general health. Treatment included sucrose containing IVIG. The patient subsequently developed acute kidney injury.
The outcome was favorable with recovery of filtration rate to the baseline within 21 days without the need for dialysis.
We conclude that the administration of sucrose containing IVIG may lead to acute kidney injury. We recommend the use of sucrose-free IVIG whenever possible. In all cases, caution is required when administrating IVIG.
P0652THYMOSIN BETA 4 AND KIDNEY FUNCTION: AN INVERSE RELATIONSHIP?
Authors: He Tianlin , Schanstra Joost , Siwy Justyna , Beige Joachim , Latosinska Agnieszka , Mischak Harald 
Published: June 2020

Abstract

Background and Aims
Thymosin β4 (Tβ4) is an abundant peptide in urine and plasma, involved in multiple processes including cell morphology, wound healing, and inflammation. A major, yet not well defined role of Tβ4 was described in the context of kidney and cardiovascular disease. Knock out of Tβ4 resulted, among others, in increased albuminuria in a nephrotoxic nephritis model. In animal models it has been shown that Tβ4 can modify renal and cardiovascular disease, fibrosis and inflammation. However, most of the data are derived from animal models and the relevance of Tβ4 in human is less clear. As a first step towards investigating the potential relevance of Tβ4 in chronic kidney disease (CKD) in human, we investigated the abundance of Tβ4 in human urine.

Method
We investigated human urine in 2240 subjects with a wide spread of kidney function for the presence of Tβ4 using capillary-electrophoresis coupled mass spectrometry (CE-MS) and tandem mass spectrometry. In addition, we evaluated the presence of Tβ4 abundance in hemodialysis fluid of 10 subjects.

Results
The full length acetylated Tβ4 peptide could be identified in human urine in high abundance (molecular mass 4960.485 Da). In addition, an oxidized isoform could also be observed at high abundance. When investigating the distribution of both isoforms in control subjects and patients at different stages of CKD, a highly significant inverse association of the abundance of Tβ4 with eGFR could be observed for both, with rho -0.388 for the non-oxidized and -0.387 for the oxidized isoform, p&lt;0.0001 in each case. In hemodialysate, Tβ4 is found as the most abundant peptide in 2 of the 10 analyzed subjects, on average the second most abundant peptide, with β2 microglobuline being the most abundant one.

Conclusion
Tβ4 is highly significantly inversely associated with kidney function, suggesting a role of Tβ4 in kidney disease and/or its complications. Based on the experimental data published from animal models, the increase in Tβ4 may reflect a potential physiological mechanism to counteract CKD and its complications. Investigation of association of Tβ4 levels with progression in CKD, cardiovascular complications and death may inform on a potentially beneficial effect of Tβ4, is currently ongoing in longitudinal datasets and will be presented.
P0657CHANGES IN CREATININE MAY NO REFLECT MEASURED RENAL FUNCTION CHANGES IN PREDIALYSIS
Authors: Beatriz Escamilla Cabrera , Sánchez Dorta Nuria Victoria , Negrã­n Mena Natalia , Luis-Lima Sergio , Gonzalez Rinne Federico , Porrini Esteban , Torres Ramírez Armando 
Published: June 2020

Abstract

Background and Aims
Serum creatinine is the most used biomarker of renal function in clinical practice. However, the correlation between creatinine and measured GFR is poor with a variability as wide as 200%. The causes of this phenomena are not clear. Some studies observed tubular handling (reabsorption and secretion) as well as intestinal secretion of creatinine, and depends of nutritional status . Importantly, these changes increased with the loss of renal function, masking changes in the evolution of real renal function. However, scarce evidence is available about the reliability of creatinine in reflecting the changes of renal function over the time in predialysis patients, compared to measured GFR. This information is relevant in the setting of clinical decisions.

Method
Spanish unicenter study developed at the Hospital Universitario de Canarias (Tenerife). In the pre-dialysis outpatient clinic, subjects are followed with measured GFR (clearance of iohexol by DBS). Measured GFR is performed at baseline and repeated as suggested by the clinical evolution. For this study we included all patients with repeated determinations of creatinine and measured GFR. The changes of creatinine in terms of increase (&gt;10%), decrease (&lt;10%) and stability (±10%) were compared with the changes in measured GFR.

Results
89 cases with repeated measurement of GFR and creatinine were evaluated. In 61 cases (68.53%) discrepancies between changes in creatinine and measured GFR were evident. Graphic 1 shows differents discordancing cases with 39 cases (43.8%) overestimation, 7 (7.8%) of infraestimation and 15 cases (24.7%) not change of mGFR with changes on Cr.

Conclusion
Changes in creatinine do not reflect real changes in real renal function in about 70% of the cases. Whenever possible, the measurement of GFR by whichever method available should be considered in the renal care and follow-up of these patients.
P0658MATRIX AND FLOW MODULATE GENE EXPRESSION IN A 3D VASCULARISED TUBULE MODEL
Authors: Williams Julie , Robinson Sanlin , Alaei Babak , Homan Kimberly , Clausen Maryam , Hicks Ryan , Belfield Graham , William-Olsson Lena , Bak Annette , Lewis Jennifer , Laerkegaard Hansen Pernille 
Published: June 2020

Abstract

Background and Aims
Questions abound regarding the translation of in vitro 2D cell culture systems to the human setting. This is especially true of the kidney in which there is a complex hierarchical structure and a multitude of cell types. While it is well accepted that extracellular matrix plays a large part in directing cellular physiology emerging research has highlighted the importance of shear stresses and flow rates too. To fully recapitulate the normal gene expression and function of a particular renal cell type how important is it to completely reconstitute their in vivo surroundings?

Method
To answer this question, we have cultured proximal tubular (PT) epithelial cells in a 3-dimensional channel embedded within an engineered extracellular matrix (ECM) under physiological flow that is colocalised with an adjacent channel lined with renal microvascular endothelial cells that mimic a peritubular capillary. Modifications to the system were made to allow up to 12 chips to be run in parallel in an easily handleable form. After a period of maturation under continuous flow, both cell types were harvested for RNAseq analyses. RNA expression data was compared with cells cultured under static 2-dimensional conditions on plastic or the engineered ECM. Additionally, the perfusion of glucose through this 3D vascularised PT model has been investigated in the presence and absence of known diabetes modulating agents.

Results
PCA of RNAseq data showed that a) static non-coated, b) static matrix-coated and c) flow matrix-coated conditions separated into 3 distinct groups, while cell co-culture had less impact. Analysis of transcriptomic signatures showed that many genes were modulated by the matrix with additional genes influenced under flow conditions. Several of these genes, classified as transporters, are of particular importance when using this model to assess drug uptake and safety implications. Co-culture regulated some interesting genes, but fewer than anticipated. Preliminary experiments are underway to monitor glucose uptake and transport between tubules under different conditions.

Conclusion
We have developed a medium throughput system in which matrix and flow modulate gene expression. This system can be used to study the physiology of molecular cross-talk between cells. Ongoing analysis will further consider relevance to human physiology.
P0662A NOVEL NOMOGRAM TO PREDICT THE RELIABILITY OF ESTIMATED GLOMERULAR FILTRATION RATE FORMULA IN ONCOLOGY PATIETNS
Authors: Cheng Yichun , Huang Liu , Han Yunfeng , Vanisha Chummun , Ge Shu-wang , Xu Gang 
Published: June 2020

Abstract

Background and Aims
Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to identify population characteristics where eGFR formulae performed poorly and thereby build a nomogram to predict the reliability of estimates.

Method
Measured GFR (mGFR) using isotope from 444 oncology patients were compared with eGFR from four formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration and Wright). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram.

Results
The Cockcroft–Gault formula exhibited estimates with lowest bias and highest precision. Nonetheless, it was still unreliable in a relevant proportion of patients. The percentage of patients within 30%, 20%, and 10% of the accurate percentage error (APE) was seen in only 62.8%, 47.7% and 24.8% of patients respectively. Inaccuracy was found in overweight patients or in patients with BUN/Scr ratio greater than 20 or with eGFR greater than 120 ml/min. A novel nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement.

Conclusion
Our results suggest that all eGFR formulae tend to overestimate the eGFR in oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.
P0681TIMP-1 DEFICIENCY DAMPENS RENAL GALECTIN-3 RESPONSE IN DIABETES
Authors: Kokeny Gabor , Popovics Helga , Mikone Krisztina , Mozes Miklos 
Published: June 2020

Abstract

Background and Aims
Overexpression of tissue inhibitors of metalloproteases (TIMPs) are a hallmark of renal fibrosis, and elevated TIMP-1 has been reported in experimental and human diabetes. Also, renal galectin-3 (Lgals3) overproduction might link macrophages to fibrosis progression. However, the possible association of renal Lgals3 with TIMP-1 in diabetes is still unclear. Thus, we investigated nephropathy and renal Lgals3 in type-1 diabetic wild type and TIMP-1 knockout (KO) mice.

Method
Type-1 diabetes was induced in 6 week-old male TIMP-1 KO (DM KO, n=7) and wild type (DM, n=6) mice with daily intraperitoneal streptozotocin (50 mg/kg/day) injections for 5 consecutive days. Non-diabetic controls (CTL, n=5) were injected with vehicle. Fasting blood glucose was monitored, and after 8 weeks kidneys were analyzed for histology and mRNA expression.

Results
Both diabetic groups developed similar hyperglycemia (CTL: 6±2, DM: 29±5, DM KO: 33±7 mmol/l, p&lt;0.01). However, serum creatinine was elevated only in wild type diabetic mice (CTL: 9±2, DM: 47±28, DM KO: 11±2 ug/dl, p&lt;0.001). Histology revealed significant tubular damage in DM mice (score: CTL: 0.4±0.1, DM: 2.3±0.2, DM KO: 1.6±0.2, p&lt;0.05), accompanied by 10-fold lipocalin-2 (CTL: 1.0±0.3, DM: 10.9±6.2, DM KO: 3.3±1.7, p&lt;0.05) and 2-fold collagen-1 overexpression (CTL: 1.0±0.2, DM: 1.9±0.7, DM KO: 1.2±0.4, p&lt;0.05), practically absent in diabetic KO kidneys. Similarly, TIMP-1 deficiency was associated with twofold decrease in renal Lgal3 (CTL: 1.0±0.6, DM: 2.0±1.1, DM KO: 0.8±0.3, p&lt;0.05) and tenfold decrease in CCL2 expression levels (CTL: 1.0±0.3, DM: 20.2±4.2, DM KO: 2.3±1.5, p&lt;0.01) as compared to DM.

Conclusion
In our model of type-1 diabetes, TIMP-1 deficiency attenuated the development of renal fibrotic and inflammatory response by reducing galectin-3 and CCL2 (MCP-1), preserved tubular integrity and renal function. This might implicate TIMP-1 to be a possible therapeutic target in the future.
P0682PSYCHOLOGICAL STRESS AS A RISK FACTOR FOR RENAL FUNCTION DECLINE
Authors: Kim Jaeyoung , Kim Jihye , Jung Chan-Young , Jo Wonji , Park Jung Tak 
Published: June 2020

Abstract

Background and Aims
Accumulating evidences propose that psychological stress leads to changes in biological processes or behavioral patterns that effects disease risks. Supporting this possibility, recent animal experiments and population studies show a probable link between psychological stress and cardiovascular and metabolic diseases. However, the association between psychological stress and kidney function is not well elucidated yet.

Method
Data were retrieved from a prospective community-based cohort study (Korean Genome and Epidemiology Study). Psychological distress was assessed as the primary exposure using PWI-SF (psychosocial well-being index short form) scores. The decline rate of estimated glomerular filtration rate (eGFR) over time was calculated using linear regression analysis of serial eGFR measurements for each subject. Rapid eGFR decline was defined as an average decline in eGFR ≥3 ml/min/1.73 m2 per year.

Results
In total, 6,968 participants were analyzed. During a median follow-up of 10.49 years, rapid eGFR decline was observed in 886 (12.7%) participants. When the participants were categorized into tertiles according to PWI-SF score, rapid eGFR decline was more prevalent in the highest PWI-SF score group (14.0%) compared to the lowest PWI-SF score group (11.1%). Multivariate logistic regression analyses revealed that the risk of rapid eGFR decline was significantly increased in the highest PWI-SF score group compared to the lowest group (odds ratio, 2.04; 95% confidence interval 1.27-3.27). When PWI-SF score was treated as a continuous variable, each 1 standard deviation increase in PWI-SF was associated with a 12% increased risk of rapid eGFR decline.

Conclusion
The amount of psychological stress was significantly associated with an increased risk of rapid renal function decline in participants with normal renal function.
P0696CHARACTERIZATION OF A DAPA-CKD-LIKE POPULATION USING A CONTEMPORARY US HEALTHCARE SYSTEM: COHORT CHARACTERISTICS AND CLINICAL OUTCOMES
Authors: Olufade Tope , Lamerato Lois , Garcia Sanchez Juan Jose , Jiang Like , Huang Joanna , Nolan Stephen 
Published: June 2020

Abstract

Background and Aims
The Sodium Glucose Co-Transporter 2 inhibitor (SGLT-2i) class of drugs have demonstrated significant cardiorenal benefits in patients with type 2 diabetes (T2D), including reducing the composite renal outcome of significant eGFR decline, End Stage Kidney Disease (ESKD) or renal death in patients with T2D and preserved renal function and also in patients with overt Diabetic Kidney Disease. In addition, SGLT-2i have proven to have beneficial effects on cardiovascular (CV) outcomes in patients with heart failure with reduced ejection fraction (HFrEF) independent of glycaemic status. The DAPA-CKD Trial (A study to evaluate the effect of dapagliflozin on renal outcomes and CV mortality in patients with CKD) is the first SGLT-2i renal outcome trial to test the efficacy and safety of an SGLT-2i, dapagliflozin, in patients with diagnosed CKD with and without T2D.
In order to appropriately evaluate the future results and aid clinical interpretation of the DAPA-CKD trial, the present study assessed the renal and CV outcomes of a “DAPA-CKD-like population” (eGFR 25-75ml/min/1.73m2 and UACR 200-5000mg/g) in a contemporary US real healthcare system.

Method
Administrative data from the Henry Ford Health System was used to identify persons with CKD stages 2 through 4 between 2006 and 2016 based on eGFR lab reading (n=38,376). Exclusions included no confirmatory eGFR &gt; 90 days from index date, death within 30 days, history of renal transplant, and evidence of renal replacement therapy, or progression to CKD stage 5 during the baseline period (6 months pre or post index date). Within that cohort, 17,742 had eGFR (25-75ml/min/1.73m2) and 9,177 had a UACR (0-5000 mg/g) within 12 months of index date. Additional exclusions included type 1 diabetes (n=2,546), lupus nephritis (n=1) and polycystic kidney disease (n=20). Patients were followed through December 31st, 2018.

Results
Of the 6,557 patients that met the eligibility criteria and were included in the study cohort, the mean age was 62.9 years and 46.2% were male. The population was stratified by UACR (0-&lt;30, 30–199, 200–5,000mg/g). Across all outcomes assessed, the clinical outcomes were highest in the DAPA-CKD-like cohort (UACR 200-5000mg/g) (HF 36.1%; MI 11.3%, Stroke 8.9%; ESKD 18.6%; Mortality 18.5%; see Figure 1). The greatest increase was observed for renal outcomes particularly ESKD, increasing from 0.9% (UACR 0-&lt;30mg/g) to 3.4% (UACR 30-199mg/g) to 18.6% (UACR 200-5000mg/g).

Conclusion
In a contemporary US healthcare system, there remains significant adverse renal, CV and mortality outcomes among patients fitting the DAPA-CKD study inclusion criteria. These results highlight the unmet need existing for additional therapies to delay disease progression and improve patient outcomes and survival in this population.