bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0268A COMPARATIVE STUDY OF CYCLOPHOSPHAMIDE, THALIDOMIDE AND DEXAMETHASONE (CTD) VERSUS BORTEZOMIB AND DEXAMETHASONE (BDEX) IN AL AMYLOIDOSIS: A REAL-WORD STUDY IN CHINESE PATIENTS
Authors: Sun Shiren , Liu Baojian , Wang Yan , Bai Ming 
Published: June 2020

Abstract

Background and Aims
Amyloid light-chain (AL) amyloidosis is a plasma cell dyscrasia characterized by the deposition of misfolded immunoglobulin light chains. The prognosis of AL patients is poor. About 70% of patients have renal involvement and one third of patients would progress to dialysis. Cyclophosphamide, thalidomide and dexamethasone (CTD) and bortezomib and dexamethasone (BDex) have shown great efficacy in patients with AL amyloidosis, especially in Chinese patients. But which option is more suitable for Chinese patients is unclear.

Method
We retrospectively evaluated 81 AL patients who received CTD (n = 42) or BDex (n = 39) and used Mayo stage 2012 to match 26 pairs of patients.

Results
In the whole cohort, the overall hematologic responses were 86% vs 91% in the CTD and BDex groups, including a complete response of 56% vs 71%, higher than most of the previously reported chemotherapies. One- and two-year overall survival (OS) was 90.2% and 81.7% with CTD regimen, and 87.6% and 82.7% with BDex regimen. After matching by Mayo stage 2012, BDex regimen showed the advantage in the depth and speed of hematologic response over CTD regimen, but there were no statistically significant differences in OS both based on the ITT analysis (P = 0.24) and 6-month landmark analysis (P = 0.48). Cardiac response was similar, while there was a trend for higher renal response in patients treated with BDex (68% vs 44%, P = 0.09). Additionally, we found that if the patients were limited to Mayo stage III or worse, BDex regimen was associated with improved survival (P = 0.009). Overall toxicities were manageable in both regimens. Severe hematologic toxicities and diarrhea should get more attention in patients treated with BDex.

Conclusion
This is the first comparison of BDex versus CTD in patients with AL amyloidosis. These results indicated that CTD and BDex regimens can be active and safe chemotherapy for Chinese patients, but BDex regimen is superior to CTD in achieving more rapidly and deeper clonal response, as well as in improving OS in selected patients.This conclusion is significant because we confirmed BDex regimen may be an optimal option in treating Chinese patients with AL amyloidosis. The definite advantages on long-term prognosis need to be verified in the further studies.
P0271SERUM VASCULAR ENDOTHELIAL GROWTH FACTOR-D LEVEL CORRELATES WITH RENAL FUNCTION AND ALBUMINURIA IN PATIENT WITH DIABETIC CHRONIC KIDNEY DISEASE
Authors: Kim Hyeongwan , Chong Jong Hwan , Park Woong , Park Sung Kwang , Kim Won 
Published: June 2020

Abstract

Background and Aims
Biomarkers associated with chronic kidney disease (CKD) may play a crucial role in patients with diabetic kidney diseases. Vascular endothelial growth factor (VEGF)-C and VEGF-D are lymphangiogenic growth factors. It has been well demonstrated that there is lympnagiogenesis in fibrotic kidney disease in human. Previously, we showed that renal VEGF-C and VEGF-D are involved in lymphangiogensis in renal fibrosis model. Recent studies have shown a relationship between sodium load and serum VEGF-C levels in hypertensive patients. Lymphatic endothelial proliferation has been detected in diabetic nephropathy. Thus, serum VEGF-C level has been introduced as a candidate marker of chronic kidney disease. However, until now, there have been few report about serum VEGF-D in patients with diabetic CKD. Thus, we evaluated the relationships between serum VEGF-D and renal function and albuminuria of diabetic CKD.

Method
We divided diabetic CKD patients into four groups: CKD stage 3, CKD stage 4, and CKD stage 5 (without dialysis). Total forty two Asian patients with diabetic CKD (14 patients with CKD stage 3, 14 patients with CKD stage 4 and 14 patients with CKD stage 5) and seven healthy controls without diabetes mellitus have been enrolled in this study. In this cross-sectional study, we performed comparative analysis with serum level of VEGF-D in patients with each group. We measured the levels of VEGF-D through the multiplexing using Luminex® technology.

Results
The serum levels of VEGF-D were higher in the CKD 3, CKD 4 and CKD 5 group compared with the control group (25.9±5.6 pg/ml in control group, 60.3±9.7in stage 3, 62.9±8.5 in stage 4, and 66.5±8.0 in stage 5). However, there was not a significant difference between CKD stage III or IV and CKD stage V in serum levels of VEGF-D. Serum VEGF-D level were negatively correlated with estimated glomerular filtration rate and positively correlated with serum creatinine. At GFR level ≥60 ml/min per 1.73 m2, serum VEGF-D were biomarkers in ROC analysis. There was a positive correlation between serum VEGF-D level and albuminuria in patient with diabetic CKD. We also found that serum VEGF-D level also correlated with urine protein-to-creatinine ratio in patient with diabetic CKD.

Conclusion
Serum VEGF-D is correlated with renal function in patients with diabetic CKD. VEGF levels in the serum correlate to the severity of proteinuria and albuminuria in diabetic CKD patients. Further large-scale studies are required to confirm these findings.
P0273THE EFFECT OF END STAGE RENAL DISEASE AND RENAL REPLACEMENT THERAPY ON B LYMPHOCYTE SUBPOPULATIONS
Authors: Daikidou Dimitra Vasileia , STANGOU MARIA , Sampani Erasmia , Nikolaidou Vasiliki , Asouchidou Despoina , Dimitriadis Chrysostomos , Lioulios Georgios , Pella Eva , Anastasiou Aikaterini , Fylaktou Asimina , Papagianni Aikaterini 
Published: June 2020

Abstract

Background and Aims
End-stage renal disease (ESRD) is linked to immunodeficiency, which makes a significant contribution to morbidity and mortality. Disturbances in innate and adaptive immunity have been described in patients on dialysis, although their association with the therapy itself is yet to be defined. The present study aimed to assess the impact of dialysis on B cell subpopulations

Method
B cells (CD19+) and their subsets B1a (CD19+CD5+), naive (CD19+CD27−), memory (CD19+CD27+), (CD19+BAFFR+) and (CD19+IgM+), were quantified using flow-cytometry of in the peripheral blood of ESRD patients, the first day on dialysis (T0), and repeated 6 months later (T6). The results were compared to age-matched healthy control group. Exclusion criteria were age &lt;18 or&gt;75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months

Results
Pre dialysis ESRD patients had reduced lymphocyte count (1527±646μ/L vs. 2459±520μ/L, p&lt;0.001) and B cell (CD19+) count (82.7±59.5μ/L vs. 177.6±73.8μ/L, p&lt;0.001) compared to controls, whereas the percentages of B cell subsets were not particularly affected, except for B1a subset which presented a significant increase (4.1±3.6% vs. 0.7±0.7% p&lt;0.001). In 17 patients who had a follow-up sample 6 months later, the percentage of most subsets was reduced (CD19+CD5+: 1.02±0.8% from 3.6±4.6%, p=0.015, Naive: 40±22.3% from 61±17.4%, p=0.001, CD19+BAFF+:75.8±12.6% from 82.1±9.1%, p=0.04,), apart from memory B cells percentage, which was increased (49.4±52.1% from 32,9±35,5%, p=0.01) and CD19+ IgM+ percentage, which was unaffected .

Conclusion
A significant reduction of almost all subsets of B cells was noticed in patients with ESRD on pre-dialysis stage. Furthermore, the initiation of renal replacement therapy may be linked to further alterations in B cells subpopulations, especially at their early stages.
P0277PATIENTS WITH PYELONEPHRITIS PRESENTING ONLY WITH LOWER URINARY TRACT SYMPTOMS
Authors: Rehman Fazal , Umair Farrukh 
Published: June 2020

Abstract

Background and Aims
The rate of acute pyelonephritis (APN) is assessed at almost 9– 11 cases for every 10,000 tenants. Its prevalence is more in developing countries and among those having low socioeconomic status. The demographics of the population in our region is different from the western population with multiple factors such as delayed presentation to hospital, varying socioeconomic status, malnutrition and lack of knowledge about basic treatment leads to increased morbidity and mortality as compared to western population. To the best our knowledge this will be the first study of its kind to describe the frequency of pyelonephritis without upper urinary tract symptoms in hospital setting.
AIM To determine the frequency of pyelonephritis in patients presenting only with low urinary tract symptoms, at a tertiary care hospital, Karachi.

Method
Study is conducted at a tertiary care hospital charts and files were reviewed from 01-11-2018 to 28-02-2019 for all the patients having diagnosis of APN from medical record files.

Results
In our study total five hundred and twenty-one (n=521) patients were included (n=492 (94%) of the participants were suffering from pyelonephritis. Approximately, 22.8% of the patients showed absence of both flank pain and costo-vertebral tenderness but were diagnosed with pyelonephritis on the basis of CT/MRI as presented. While 27% of the patients reported both upper urinary tract symptoms and were also positive on CT-MRI. It is also witnessed that 24% and 16% of the patients either reported flank pain or costo-vertebral tenderness respectively. Insignificant association between gender, age, comorbid with pyelonephritis. While, the total leucocytes count was significantly related with CT/MRI.

Conclusion
Our study showed significant number of patients having pyelonephritis in the absence of any upper tract symptoms. Ignoring the diagnosis as serious can lead to under treatment, possibility of higher rate of re-admissions or poor selection of initial antibiotics. Whereas, other side of the spectrum haunts with higher investigation cost of imaging and broad spectrum use of antibiotic for every patient presenting with just urinary tract infection in Emergency department. A balance should be devised to equilibrate the balance between two extremes.
P0281THE EFFECT OF DIRECT ANTIVIRAL AGENTS ON GLOMERULAR FILTRATION RATE
Authors: Sarhan Iman , Elsharabasy Reem , Ahmed Fatma , Hassan Mohamed 
Published: June 2020

Abstract

Background and Aims
HCV infects 170 million individuals approximately worldwide. The kidney is a major component of the HCV clinical syndrome. This viral infection imposes itself as a cause of kidney disease, a major risk in hemodialysis units and a significant threat in kidney transplantation. In 2011, direct acting antivirals (DAA) had been developed, which represented a huge boom in the treatment of HCV. Some doubtful data suggest possibility of association between some DAA administration and AKI occurrence, but larger prospective studies are recommended for confirming this suggestion.

Method
Retrospective cohort study of 118 adult HCV infected patients with normal baseline kidney functions (GFR ≥ 60ml/min) were included. Patients coinfected with HBV and those with impaired kidney functions at beginning of treatment were excluded. Patients were divided into 3 groups according to their DAA-combination treatment regimen. Patients’ eGFR were measured at baseline, at the end of treatment and one year later.

Results
Our results showed that patients who received Sofosbuvir/Daclatasvir/Ribavirin, their pre-treatment eGFR Mean ± SD. was (86.15±16.37). Post treatment eGFR showed an insignificant change after end of treatment (84.73±17.41) and 1 year after treatment (82.0±18.07) (P-value: 0.998 and 0.220 respectively). Those who received Sofosbuvir/Daclatasvir, their pretreatment eGFR Mean ± SD was (94.60±19.32). Post treatment eGFR showed an insignificant change after end of treatment (89.39±18.39) and 1 year after treatment (89.17±20.27). (P-value: 0.156 and 0.097 respectively). As for patients who received Sofosbuvir/Simeprevir, their pretreatment eGFR Mean ± SD was (92.71±15.11). Post treatment eGFR showed an insignificant change after end of treatment (88.36±16.27) and 1 year after treatment (89.01±15.72). (P-value: 0.620 and 0.676 respectively).

Conclusion
The new direct antiviral agents (sofosbuvir, daclatasvir and simeprevir) are effective and safe regarding glomerular filtration rate in patients with normal renal function. However, a meticulous monitoring of kidney function is mandatory during the use of these medications to early detect any untoward side effects.
P0282SARCOIDOSIS WITH RENAL INVOLVEMENT: APPROACH TO DIAGNOSIS AND MANAGEMENT
Authors: Chemli Imen , Ben salem Meriem , Letaief Ahmed , Hammouda Mouna , Aloui Sabra , Ben Salah Manel , Skhiri Habib 
Published: June 2020

Abstract

Background and Aims
Renal involvement in sarcoidosis is rare. It is most often the consequence of calcium metabolism disorders, interstitial granulomatous damage or secondary glomerular damage. It can progress to kidney failure in around 3% of cases.
In this study, we determined the clinical presentation of sarcoidosis with renal involvement and we described the histological lesions. We report our experience about the management and the follow-up.

Method
we analyzed all cases of renal failure caused by sarcoidosis in our department during the period of 13 years (2006-2019). There were five patients (one man and four women) at the time of diagnosis. The middle age was 53.8 years.

Results
The renal involvement was revealing in 60% of the cases. The extrarenal localizations were: pulmonary (100%), cutaneous (knotty erythema 20%), ocular (dry eye syndrome (60%) and anterior uveitis (20%)), the reticuloendothelial system (adenitis (20%) and medullary (20%)), exocrine glands (sialadenitis (40%), nasal (20%), nervous (optic neuritis 20%)). The middle renal clearance (eGFR) at the time of diagnosis of renal involvement was 33ml / min / 1.73 m. Moderate proteinuria was observed in four patients (median: 0.99 g / 24 hours), aseptic leukocyturia in one patient. No patient had microscopic hematuria. Hypercalcemia was noted in 60% of patients with hyper calciuria (median: 3 mmol / kg / 24 hours). Nephrolithiasis was noted in only one patient. No cases of nephrocalcinosis was noted. Renal biopsy showed tubulointerstitial nephropathy with granulomatous in 2 cases (40%), absence of granuloma in one case, extra-membranous glomerulonephritis in one patient and moderate interstitial fibrosis with tubular atrophy in two patients, fibrous andarteritis in a single case. A granuloma without caseous necrosis was objectified on the osteo-medullary biopsy in a single case. All patients received oral corticosteroids (Prednisone: 1 mg / kg / day for 4 patients; 0.5 mg / kg / day for one patient) associated with the treatment of hypercalcemia (hydration and diuretics). The follow-up varied from 2 to 156 months with an median of 56.4 months. 3 patients improved their renal function with a middle clearance : M0: 29 ml / min, M1: 42 ml / min, M3: 68 ml / min, M6: 67 ml / min, M12: 95 ml / min. A non-recovery of renal function was noted in only one patient. An end-stage renal disease was observed in two patients. A renal and extrarenal (lymph node) relapse was noted in a single patient with an interval of 7 years after the initial presentation.

Conclusion
Renal involvement in sarcoidosis is probably underestimated. Treatment is based on corticosteroid, which must be introduced early to prevent progression to renal failure.
P0285A COMPARISON OF URINE MICROSCOPY AND CULTURE IN HIV-INFECTED AND NON HIV-INFECTED INDIVIDUALS IN THE ANTI-RETROVIRAL ERA
Authors: Madela EIY , Assounga Alain 
Published: June 2020

Abstract

Background and Aims
Urinary tract infection is among the most common causes of sepsis presenting in hospitals. The aim was to collect data to enable empirical treatment of urinary tract infections in HIV negative and positive nephrology patients while waiting for urine culture results in order to reduce hospital stay. Our aim is also to assess incidence and antimicrobial susceptibility of urinary tract infections in HIV negative and positive patients.

Method
A retrospective chart review of nephrology patients admitted from January to December 2014 in Nephrology ward and the first consecutive 200 outpatients seen in Nephrology clinic in 2014 at Inkosi Albert Luthuli Central Hospital was conducted. Information was gathered with the use of a data collection sheet and urinary tract infection was based on urine culture results. All data was analysed using Statistical Package for Social Sciences version 23. Percentages of basic characteristics were calculated between groups. Logistic regression analysis was used to identify factors associated with positive urine culture.

Results
There were 654 patients in the study, 514 (79%) were HIV negative and 139 (21%) were HIV positive. The incidence of UTI in nephrology patients was 9%, 10.1% in inpatients and 6.5% in outpatients. 22% were HIV positive (p value 0.883, 95% CI 0.550-2.003). 19% had Diabetes mellitus, 15% had Systemic Lupus Erythematosus and 5% were post renal transplant patients. Escherichia coli and Klebsiella pneumonia were the common causes of urinary tract infection at 40.7% and 15.3% respectively with 22% cases on extended beta lactam resistance.

Conclusion
There was no statistically significant difference on the incidence and anti-microbial isolates between HIV infected and HIV negative nephrology patients with urinary tract infection. Hence, empirical treatment for UTI should remain the same in the 2 groups. Escherichia coli and Klebsiella pneumoniae were the most commonly cultured organisms in both groups. There is microbial resistance to commonly used antibiotics. Constant assessment of anti-microbial sensitivity of urinary tract infections is of paramount importance.
P0289MULTI-PARAMETRIC RENAL MAGNETIC RESONANCE IMAGING IN EARLY KIDNEY TRANSPLANTATION
Authors: Gillis Keith , Rankin Alastair , Allwood-Spiers Sarah , Woodward Rosemary , Roditi Giles , Radjenovic Aleksandra , Kuehn Bernd , Patel Rajan , Mark Patrick 
Published: June 2020

Abstract

Background and Aims
Existing methods of investigating renal transplant dysfunction do not provide reliable information regarding diagnosis nor prognosis. Multi-parametric magnetic resonance imaging (MRI) may provide novel biomarkers for evaluation of transplant dysfunction. We aim to determine how MRI parameters change over the first year of transplantation, and how these relate to future renal function.

Method
Patients receiving a kidney transplant attended for study visits at 6, 26 and 52 weeks post operatively, comprising measurement of clinical and biochemical parameters, together with research multi-parametric MRI. Imaging measurements comprised kidney volume, arterial spin labelling (ASL) perfusion, T1 relaxation time, T2*, apparent diffusion coefficient (ADC) and fractional anisotropy (FA). Imaging was performed at 3.0 Tesla using a Siemens MAGNETOM Prisma system. Regions of interest were drawn in whole kidney (WK), cortex (Cx) and medulla (Md) (figure 1).

Results
20 patients were included: 16 were male, with age 55.5±12.8 years, baseline eGFR 54.0±23.6 ml/min/1.73m2, and blood pressure 146/80 ± 15/15 mmHg. 14 received deceased, and 6 received live, donor transplants. Patients were all managed with tacrolimus, mycophenolate and low dose prednisolone, following induction therapy with either basiliximab or anti-thymocyte globulin.
6 week ADC was 1.69±0.14 in WK, 1.65±0.08 in Cx, and 1.67±0.10 ×10-3 mm2/s in Md. FA was 0.19±0.04 in WK, 0.14 ± 0.04 in Cx and 0.22 ± 0.10 in Md. T2* was 57.6±9.4 in WK, 63.9±8.7 in Cx and 45.0±8.0 ms in Md. Over the 3 visits there was reduction in FA (p=0.008) and medullary T2* (p&lt;0.001). There was no significant change over 12 months in any other MRI parameter.
Over 1 year the median change in eGFR was -2ml/min/1.73m2. There was correlation between baseline eGFR and the following variables: volume (r=0.29, p=0.04), whole kidney ADC (r=0.36, p=0.01), cortical ADC (r=0.46, p=0.001), representative cortex ADC (r=0.48, p&lt;0.001) and medullary ADC (r=0.29, p=0.04). There was no correlation between eGFR and other imaging biomarkers. There was correlation between baseline whole kidney ADC (r=0.54, p=0.02), cortical ADC (r=0.49, p=0.03), and renal function at 12 months.

Conclusion
Diffusion weighted MRI measurements correlate with eGFR and may allow improved prognostication regarding future renal function. Certain MRI parameters including FA and R2* vary depending on time point of transplantation which may reflect changes in transplant microstructure in the early postoperative period. Multi-parametric MRI provides a novel method of evaluating renal transplants non-invasively and may allow more accurate prediction of future transplant function than existing biochemical measures.
P0293FRACTIONAL EXCRETION OF TOTAL PROTEIN IS AN ACCURATE INDICATOR OF PROTEINURIA IN NPHROTIC PATIENTS
Authors: Takahashi Shori , Shimizu Shoichi , Saito Hiroshi , Morohashi Tamaki , Morioka Ichiro , Hamada Riku 
Published: June 2020

Abstract

Background and Aims
Urinary total protein/creatinine ratio (U-TP/Cr) is a simple and useful indicator of proteinuria. And it had been shown to correlate well with 24-hour urinary protein test (24hr UPT). However, U-TP/Cr is not always accurately reflecting the degree of proteinuria, especially in cases with heavy proteinuria.
Proteinuria in nephrotic syndrome could be defined as the result of changed sieving coefficient (SC) of plasma total protein through the glomerular capillary wall. Therefore, we studied fractional excretion of total protein (FETP; total protein clearance/creatinine clearance %) instead of directly unmeasurable SC. The accuracy of the FETP was verified by 24hr UPT in comparison with U-TP/Cr.

Method
Sixty-three serum and urine samples were collected from 35 pediatric patients with various age (age: 3 − 20 y; mean: 10.3 y, 22 male, 13 female) with hypoproteinemia (TP≦ 5.0 mg/dL), heavy proteinuria (FETP≧ 0.01%), and normal GFR (creatinine clearance ≧ 100 ml/min). The correlations between 24hrUPT and U-P/Cr and FETP were studied using samples obtained the same time and the superiority was statistically examined.

Results
Mean±SE of 24hUPT, U-TP/Cr and FETP (%) were 5.53±0.71 (g/day), 10.23±1.26 (g/gCr), and 0.12±0.016 (%) respectively. R values for the correlation between 24hrUPT and U-TP/Cr and 24hr UPT and FETP were 0.64 and 0.86 respectively. FETP showed a statistically better correlation with 24hrUPT than with U-TP/Cr (P: 0.0001).

Conclusion
FETP is an accurate indicator of 24hr UPT for nephrotic patients under conditions of heavy proteinuria and hypoproteinemia in comparison with UTP/CR.