bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0251PERCUTANEOUS ANGIOPLASTY OF RENAL ARTERY STENOSIS IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING HEMODIALYSIS
Authors: Abu amer Nabil , Dinour Dganit 
Published: June 2020

Abstract

Background and Aims
Atherosclerotic renal artery stenosis (RAS) is a common disease, associated with significant morbidity and mortality. Several studies have shown that percutaneous angioplasty with stenting (PTA/S) is not superior to medical treatment. The benefit of endovascular intervention among acute kidney injury (AKI) patients requiring hemodialysis secondary to RAS has not been studied. We investigated the effects of PTA/S in patients with atherosclerotic RAS, specifically those who presented with AKI indicated for hemodialysis.

Method
We collected data between 2003 and 2019. We defined a subgroup of patients who presented with AKI and underwent the procedure after starting hemodialysis. Data collected included demographic parameters, medical background, indication for intervention, technical procedure parameters and complications and long term data including dialysis treatment and mortality. Patients who underwent PTA/S due AKI with dialysis were categorized as responders or non-responders based on improvement in kidney function and weaning off dialysis.

Results
We identified 109 PTA/S performed in 92 patients. Technical success was 97% and complication rate was 15.5%. Creatinine and blood pressure improved in 8.9% and 32% respectively, based on predetermined criteria. A subgroup of 11 patients underwent PTA/S for hemodialysis-dependent AKI. 8 patients (73%) improved kidney function and discontinued dialysis. The average time on dialysis was 17 days (range 3-35 days) to PTA/S and 22 days (range 3-42 days) to recovery of kidney function, which occurred 6.5 days (range 1-24 days) after PTA/S. two of the 8 patients required long term hemodialysis after 12 and 22 months post procedure. Only two cases were reported with mild complications (pseudo-aneurysm and brachial hematoma). Factors associated with response to PTA/S include a higher baseline eGFR, less proteinuria, larger kidney size and better contrast enhancement on imaging.

Conclusion
In patients with hemodialysis dependent AKI, PTA/S should be considered as a rescue treatment and may recover kidney function even after prolonged time on dialysis.
P0256RESEARCH OF GUT MACROBIOTA IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Olimxanova Kamila 
Published: June 2020

Abstract

Background and Aims
Currently, it is estimated that the intestinal microbiota has hundreds of species of bacteria. It is known that intestinal dysbiosis contributes to the development of many diseases, such as obesity, diabetes mellitus, cardiovascular diseases, including CKD. The question of the relationship between bacterial contamination and the process of endogenous inflammation in patients with chronic kidney disease of the pre-dialysis stages is not completely clear. The aim of the study the composition of the intestinal microbiota in fecal samples and the level of inflammatory markers (CRP, IL-6, leukocytes) in patients with pre-dialysis stages of CKD.

Method
60 patients with CKD of the pre-dialysis stages (C2-C4) were examined. The diagnosis of CKD was made on the basis of clinical, instrumental, and laboratory data. To study the relationship between the composition of the intestinal microbiota and inflammation in patients with CKD, we studied markers of inflammation such as CRP and IL-6. CRP was determined in blood serum by a highly sensitive method on a Humareader Single analyzer, IL-6 by enzyme-linked immunosorbent assay on a solid-phase analyzer. eGFR was calculated using the formula CKD-EPI-2011. The control group consisted of 30 healthy subjects. Statistical processing was carried out using methods of variation statistics. The results were processed using Microsoft Exel 2002 & Statistica 6.0.

Results
The average age of patients was 59 years. Of these, 25 women (40%) and 35 (60%) men. The estimated glomerular filtration rate varied from 30 to 60 ml / min / 1.73 m2, which corresponded to the indicators of the pre-dialysis stages of CKD. Analysis of intestinal microbiota showed a deficiency of Bifidobacterium bacteria (&lt;108 CFU), and an increase in the number of Escherichia (&gt; 108 CFU) in patients with CKD of the pre-dialysis stages. According to the results of the study, in the group of patients with CKD, the level of inflammatory markers was higher (CRP-55%, IL-6-60%, leukocytes 62%) than in the control group (CRP-45%, IL-6-40%, leukocytes 38% ) However, in men, the IL-6 index was higher than in women. In patients with CKD with obesity, the titer of pathogenic bacteria and their spectrum showed the worst results, although unreliable.

Conclusion
All examined patients had dysbiosis of the 2nd degree. At the same time, an imbalance of the intestinal microbiota is combined with an increased level of CRP, IL-6, and white blood cells.
P0259PARAPROTEIN-RELATED RENAL LESIONS IN NEWLY DIAGNOSED MULTIPLE MYELOMA: CLINICAL AND PATHOLOGICAL CHARACTERISTIC OF 51 PATIENTS WITH KIDNEY BIOPSIES
Authors: Lin Zishan , Yu Xiaojuan , Wang Suxia , Cen Xinan , Zhou Fude , Zhao Minghui 
Published: June 2020

Abstract

Background and Aims
Renal involvement is common in multiple myeloma (MM). In this study, we examined kidney biopsy findings in patients with newly diagnosed MM (NDMM) and correlated them with clinical characteristics and survival.

Method
Renal pathological findings were retrospectively studied in 56 patients with NDMM. Clinical and laboratory data as well as outcomes were collected from 51 patients with paraprotein-related renal lesions in NDMM. Patients were categorized according to the with or without myeloma cast nephropathy (MCN).

Results
Among 56 patients with NDMM, 51 had paraprotein-related renal lesions, of which MCN was the most common lesion in 31 patients (60.8%), followed by amyloidosis in 12 patients (23.5%) and light chain deposition disease (LCDD) in 8 patients (15.7%). Five patients had nonparaprotein-associated lesions, of which minimal change disease was the most common diagnosis, seen in 3 patients (60%). Patients with MCN had significantly higher serum creatinine levels, a lower eGFR, a higher percentage of requiring dialysis at diagnosis, a higher incidence of progressing to end-stage renal disease (ESRD), lower hemoglobin levels, a lower percentage of albumin in urine protein, a higher level of serum albumin and were more likely to have a detectable M-spike but less likely to have a detectable monoclonal whole immunoglobulin than patients without MCN. Compared with patients with MCN, the median overall survival time of patients without MCN was significantly longer (not reached vs 39 months (95% CI: 9–69 months); P=0.047; Fig.1). According to the multivariate analysis, the independent predictors of overall survival were the number of myeloma casts (HR: 1.12, 95% CI: 1.07-1.25; P=0.014) and male sex (HR: 4.99, 95% CI: 1.36-18.38; P=0.016).

Conclusion
Patients with MCN suffer from more serious and more urgent renal damage and can also present with high-grade albuminuria but without hypoalbuminemia. The number of myeloma casts and male sex are independent predictors of overall survival.
P0272COMPARATIVE GUT MICROBIOME DIFFERENCES BETWEEN FERRIC CITRATE AND CALCIUM CARBONATE PHOSPHATE BINDER TREATMENT IN HEMODIALYSIS PATIENTS
Authors: Wu Ping-Hsun , Lin Yi-Ting , Liu Po-Yu , Kuo Mei-Chuan , Chiu Yi wen 
Published: June 2020

Abstract

Background and Aims
Gut microbiome alteration increases uremic toxin levels inducing chronic inflammation and leading morbidity and mortality in patients with chronic kidney disease. Phosphate-binding agents may potentially change the composition of the gut microbiota. However, the limited clinical study investigates the microbiome difference between iron-containing and calcium-containing phosphate binders. The aim of this study was to compare the microbiota composition in hemodialysis patients treated with ferric citrate or calcium carbonate.

Method
The stool microbiota was investigated in hemodialysis patients with ferric citrate used (n=8) and calcium carbonate used (n=46) by 16S rRNA next-generation gene sequencing profiling. The altered microbiota between two different phosphate binders was analyzed. Differences in the microbial composition of the two patient groups were assessed using linear discriminant analysis effect size.

Results
Hemodialysis patients with calcium carbonate used revealed significantly reduced microbial species diversity (Shannon index and Simpson index) and increased microbial dysbiosis index compared with ferric citrate users. Compared to patients taking calcium carbonate, a distinct microbial community structure in patients taking ferric citrate, with an increased abundance of Bacteroidetes phylum and decreased abundance of phylum Firmicutes. In comparison between two phosphate binder users, members of the order Lactobacillales were prominent in calcium carbonate therapy, including family Streptococcaceae and genus Streptococcus. In contrast, taxa of the genus Ruminococcaceae, Flavonifractor, and Cronobacter were enriched in ferric citrate phosphate binder users.

Conclusion
The fecal microbiota was richer and more diverse in the ferric citrate group than in the calcium carbonate group. Hemodialysis patients with ferric citrate used were associated with differences in the gut microbiome composition compared to calcium carbonate users.
P0274A NOVEL METHOD FOR THE ASSESSMENT OF RENAL BIOPSY WITH THE ACTIVATABLE FLUORESCENT PROBE
Authors: Iyama Takuji , Takata Tomoaki , Mae Yukari , Taniguchi Sosuke , Ida Ayami , Ogawa Masaya , Yamamoto Marie , Fukuda Satoko , Isomoto Hajime 
Published: June 2020

Abstract

Background and Aims
Renal biopsy is one of the most important procedures in nephrology. The histological analysis of biopsy tissues is important for the diagnosis and prognosis assessment of renal diseases, as well as determining the treatment strategy. It is necessary to obtain biopsy specimens containing renal cortex for such purpose. Although renal biopsy is the undisputed diagnostic procedure, there always is a need to weigh the benefits against the potential complications. A novel activatable fluorescent probe that reacts with a peptide, which is highly expressed in the renal cortex, has been developed. We evaluated the feasibility of this probe for assessing renal biopsy specimens.

Method
The fluorescent probe was firstly applied to renal proximal tubular cells in order to evaluate the fluorescent emission. Then the probe was applied to mouse kidneys ex vivo. Finally, it was applied to human biopsy specimens (n=12). Fluorescent images were acquired using commercially available digital camera equipped with optical interference filter. Fluorescent intensities were quantified and the intensities in cortex and medulla were compared.

Results
We observed fluorescent emission from the renal proximal tubular cells immediately after the administration of the fluorescent probe. The fluorescent intensity gradually increased with time. The fluorescence signal was detected in the mouse kidneys ex vivo without markedly affecting the tissue morphology. The probe on human biopsy specimens also emitted fluorescent and the fluorescent could be detected in all the patients examined. In addition, the cortico-medullary junction could be identified in the fluorescent image (Figure). The fluorescent intensities in renal cortex were remarkably stronger than in medulla.

Conclusion
Renal biopsy specimens can be assessed by fluorescent image using this activatable fluorescent probe. This novel fluorescent probe is useful in clinical nephrology.
P0279DIABETIC KIDNEY DISEASE VERSUS CHRONIC KIDNEY DISEASE IN ADULTS WITHOUT DIABETES MELLITUS: A RENAL SURVIVAL ANALYSIS
Authors: Stefan Gabriel , Petrescu Ligia , Stancu Simona , Mircescu Gabriel 
Published: June 2020

Abstract

Background and Aims
Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease, but the decline in kidney function varies considerably between chronic kidney diseases (CKD), and determinants of renal function loss, early in the course of the disease, are still a matter of debate.

Method
We retrospectively examined the renal outcome at 31 July 2017 of 309 CKD patients (age 59.1 (50.1-68.6) years; 60% male; eGFR 32.7 (21.7-44.8) mL/min) admitted in our hospital during January 2007-December 2012 with a median follow up time of 7.2 (95%CI, 6.8-7.6) years. Only patients who had at least 3 admissions and who were alive during the study period were included. CKD was defined as the presence of an eGFR &lt;60ml/min/1.73m2 or the presence of albuminuria &gt;30mg/g creatinine for more than 3 months. The primary endpoint was renal survival defined as renal replacement therapy (RRT) initiation. Factors affecting renal survival were evaluated in a Cox proportional hazard model.

Results
DKD (24%), glomerular (GN, 24%), tubulo-interstitial (TIN, 27%) and vascular nephropathies (VN, 25%) were the causes of CKD. Patients with DKD (66.8 (56.5-72.2) years) and VN (68.5 (59.7-76.2) years) were older than those with GN (50.3 (37.4-59.0) years) and TIN (55.6 (45.8-61.8) years). Moreover, the highest cardiovascular comorbidity score was found in patients with VN and DKD (p&lt;0.001). Median eGFR decline was -1.23 ( -3.39 – 0.35) mL/min/year; 29% of the patients had CKD progression of &gt;3mL/min/year and 14% had rapid progression (&gt;5mL/min/year). Patients with GN had the lowest eGFR (26.8 (19.1-38.9) versus DKD 36.2 (23.4-47.7), VN 34.9 (22.4-51.0), TIN 32.4 (21.8-44.8) mL/min, p&lt;0.001), the fastest eGFR decline (-3.1 versus DKD -1.9, VN -1, TIN -1,2 mL/min/year, p 0.5) and the highest proteinuria (2.7 versus DKD 1.4, VN 0.4, TIN 0.6 g/24h, p&lt;0.001). During follow up, 29% of the studied patients started RRT; mean renal survival time for the entire cohort was 7.4 (95%CI, 7.0-7.8) years. CKD cause (versus DKD p=0.04, Figure 1), lower eGFR (HR 0.89 (95%CI, 0.85-0.93)), elevated albuminuria (HR 1.4 (95%CI, 1.2-1.7)), higher total serum cholesterol (HR 1.00 (95%CI, 1.00-1.01)) and elevated mean arterial blood pressure (HR 1.03 (95%CI, 1.00-1.06)) were associated with RRT initiation in the Cox regression model.

Conclusion
Patients with DKD and VN had similar poorer renal survival as compared with GN and TIN. Earlier referral to the diabetic renal clinic and intensive management of the modifiable risk factors (albuminuria, hypercholesterolemia, hypertention) are necessary to retard progression of CKD and, subsequently, prolong renal survival.
P0301FIT FOR PURPOSE VALIDATION OF A CLINICAL ASSAY FOR THE DETECTION OF SERUM LEVELS OF GALACTOSE-DEFICIENT IMMUNOGLOBULIN A1 (GD-IGA1) IN PATIENTS WITH IGA NEPHROPATHY (IGAN)
Authors: Sponton Laura , Jin Hulin , Fluck Markus , Suzuki Yusuke , Kao Amy 
Published: June 2020

Abstract

Background and Aims
Analysis of serum or plasma from patients with IgA nephropathy (IgAN) has confirmed the presence of elevated levels of circulating immune complexes containing Gd-IgA1 (Czerkinsky 1986). New sensitive and reasonably specific noninvasive tests are emerging to guide the therapeutic strategy that is applicable to all stages of IgAN (Suzuki 2014).
Here we are reporting the fit for purpose validation of an ELISA method for the quantitative determination of Gd-IgA1 in human serum samples to support biomarker investigations in clinical studies of Merck KGaA, Darmstadt.

Method
The assay was developed based on a commercially available immunoassay kit. The dynamic range of the calibration curve was determined from 1.56 ng/mL (LLOQ) to 100 ng/mL (ULOQ). With a minimum required dilution of 200-fold and standard assay volume of 50.0 μL, the range of the method in matrix was from 312 ng/mL to 20, 000 ng/mL.
In assay validation phase, multiple validation parameters were evaluated, which included minimum required dilution (MRD), calibration curve, matrix effect, Intra- & Inter run accuracy & precision, selectivity, and parallelism. Additional validation parameters include sample stability (short/long term, freeze-thaw) and batch-to-batch comparison.

Results
All samples measured for intra & Inter - assay precision, accuracy, fulfilled the specifications according to the acceptance criteria. The selectivity was assessed using blank serum matrix from 10 individuals: the result indicated that matrix components in serum did not interfere with the detection of Gd-IgA1. Parallelism assessment was performed successfully for both samples from healthy donors and IgAN patient samples up to dilution factor (DF) 3200 (serum samples from healthy donors were determined up to DF 1600). All DF-corrected results within the assay range were determined with %CV ≤ 30.0%. Batch to batch comparison was assessed successfully based on the known shelf life of the kit. Short term stability using QC samples were given for up to 24hrs at room temperature. Freeze-thaw stability was given for up to 3 cycles at -20°C±5°C and -75°C±15°C.
The investigations were performed according to general guidelines for method validation and applicable regulations. The results of investigated validation parameters fulfilled the requirements and recommendations, generally accepted for bioanalytical projects.

Conclusion
The present validation qualified the method for the quantitative determination of Gd-IgA1 in human serum samples from clinical studies.
P0304POINT OF CARE ULTRASOUND IN NEPHROLOGY: THE SOONER THE BETTER!
Authors: Gliga Mirela Liana , Gliga Mihail Gheorghe , Chirila Cristian , Lie-Ungurean Raluca-Maria , Chirila Paula 
Published: June 2020

Abstract

Background and Aims
Point of care ultrasound (POCUS) is performed at the bedsite of the patient by de treating clinician. In nephrology a particular situation is related to severly ill patients, immobilized with elevated creatinine, which can not be deffered to imaging investigations such as CT scan or MRI. Using a small portable device, important clinical problems can be solved in no time.

Method
We examined 360 out of 670 patients admitted to the nephrology departament in a period of one year. They were severely ill due to following pathologies: 35 severe sepsis with hypotension, 53 decompensated heart failure, 24 stroke, 248 with renal failure and acido-basic or electrolitic disturbances. Evaluation was made using a portable US device with a 10 MHz linear probe and 3.5 MHz convexe probe with abdomen and thoracic software. Diameter of inferior vena cava (IVC), respiratory collapse of IVC, effusions in pleura, pericardium or peritoneum, liver dimensions, kidneys and spleen were described.

Results
31 out of 35 patients with hypotension had collapsed IVC, diameter less than 1cm, PPV 88.5%; 48 from 53 heart failure had enlarged IVC with reduced respiratory collapse, PPV 90.6% and 201 from 248 renal failure patients had kidney changes, 81.04%. As compared with standard diagnostic tools (echocardiography, native CT scan and clinical examination, Sensitivity was over 98% in all cases.

Conclusion
POCUS is a very usefull test for the rapid bed-site examination of kidney patients, were a rapid decision has to be made using a portable device. Sensitivity of the method proved to be comparable as with standard diagnostic tools.
P0305DIAGNOSTIC VALUE OF TGF-B-1 AND ANG II EXCRERION IN URINE IN CHILDREN WITH VESICOURETERAL REFLUX DEPENDING ON THE THERAPEUTIC APPROACH
Authors: Zaicova Natalia , Sudareva Tatiana , Dlin Vladimir , Sinitsina Lilia , Korsunskiy Anatolii 
Published: June 2020

Abstract

Background and Aims
to determine the diagnostic value of profibrogenic cytokines of transforming growth factor (TGF-β1) and angiotensin II (AngII) in urine to detect the severity of tubulointerstitial fibrosis in children with vesicoureteral reflux (VUR) depending on the therapeutic approach.

Method
117 patients aged 3 to 16 years (mean age 10.2 ± 4.5, 70.1% of girls) with VUR were examined. The control group consisted of 20 healthy children. All children underwent a complete nephrological examination. The levels of TGF-β1 and AngII were determined in morning urine using the ELISA method and counted for urine creatinine. To identify the severity of the lesion of the renal parenchyma, a static DMSA scintigraphy was performed.

Results
depending on the therapeutic approach, the children were divided into 2 groups: 1 gr. - children on conservative treatment (63.2%), 2 gr. - children, after surgical correction of VUR (36.8%). In each group, 3 subgroups were identified depending on the development of tubulo-interstitial fibrosis according to DMSA: A subgr. - without signs of sclerosis (15.4%), B subgr. - 1-2 foci (44.74%) and C subgr - &gt; 3-4 foci of sclerosis (40.1%). All patients with VUR had a high urinary excretion of TGF-β1/Cr and AngII/Cr when compared with the control group (p&lt;0.05). Regardless of the therapeutic approach, in subgroups A (without foci of sclerosis) and B (1-2 foci of sclerosis), patients had a statistically significantly lower level of excretion of these cytokines when compared with patients from subgroup C (p &lt;0.05). No significant difference was found in the urinary excretion of TGF-β1/Cr and AngII/Cr depending on the therapeutic approach.

Conclusion
we established a reliable dependence of the excretion of TGF-β1/Cr and AngII /Cr in the urine on the severity of tubulo-interstitial fibrosis according to DMSA scintigraphy in children with VUR. At the same time, we did not note the dependence of the excretion of TGF-β1/Cr and AngII/Cr in the urine on the method of the therapeutic approach. Therefore, the study of the excretion of TGF-β1/Cr and AngII/Cr in the urine as non-invasive markers can be used as a criterion for the progression of nephropathy in VUR, regardless of treatment methods.
P0309IMPACT OF ACUTE KIDNEY INJURY ON CLINICAL COURSE AND TREATMENT RESPONSE IN PATIENTS WITH MINIMAL CHANGE NEPHROTIC SYNDROME
Authors: Okushima Hiroki , Iwata Yukimasa , Takatsuka Taisuke , Yoshimura Daisuke , Kawamura Tomohiro , Ueda Yoshiyasu , Shoji Tatsuya , Hayashi Terumasa 
Published: June 2020

Abstract

Background and Aims
Minimal change nephrotic syndrome (MCNS) has acute onset and is occasionally complicated with acute kidney injury (AKI) in its clinical course. Few studies concerning factors associated with AKI and impact of AKI on clinical course and response to treatments are available to date. Thus, we assessed the prevalence of and factors associated with AKI and its effect on clinical course in MCNS patients.

Method
Single center retrospective cohort study was conducted on 72 biopsy-proven MCNS patients presented to Osaka General Medical Center, between January 2006 and December 2016. Multivariate logistic regression analysis and Cox proportional hazards analysis were used to assess contributing factors to AKI and its effect on the duration until remission.

Results
Median age was 58 years and 50% were male. At first presentation, the mean albumin and total cholesterol were 1.7±0.5g/dl and 402±118mg/dl, respectively. The mean urinary protein and eGFR were 12.8±8.2g/gCr and 60.1±29.4ml/min/1.73m2, respectively. A total of 29 patients (40%) had AKI and 10 of them needed renal replacement therapy (RRT). Corticosteroid and cyclosporine A were used in 66 (91%) and 3 (4%) patients, respectively for initial treatment and 3 patients (4%) received neither. 67 patients (93%) achieved complete remission (CR) with a median duration of 18 days after treatment, while 20 of those relapsed during the median follow-up period of 38 months. Logistic regression analysis revealed that older age, lower albumin, and higher urinary protein were significantly associated with AKI. Furthermore, patients with AKI had longer duration to CR induction compared with those without AKI (Log-rank test: p=0.03). Cox proportional hazards analysis showed that older age and RRT induction were associated with the delay of CR.

Conclusion
AKI occasionally occurs in patients with MCNS and need for RRT is associated with the delay of CR.