bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0209PRESENTATION AND OUTCOMES OF ANCA ASSOCIATED VASCULITIS: THE SCOTTISH EXPERIENCE
Authors: Stevens Kate , Kidder Dana , Lim Michelle , Hunter Rob , Kelly Mike , Joss Nicola , Cousland Zoe , Traynor Jamie , Geddes Colin C , McQuarrie Emily , Mackinnon Bruce 
Published: June 2020

Abstract

Background and Aims
This is a national project undertaken on behalf of the Scottish Renal Biopsy Registry describing the presentation, biopsy appearances, management and outcomes of patients presenting with a new diagnosis of renal biopsy proven ANCA associated vasculitis (AAV) to all units in Scotland.

Method
The Scottish Renal Biopsy Registry collects data annually on all renal biopsies performed across Scotland. From the Registry, all patients with a possible diagnosis of AAV found on renal biopsy performed between1/1/2014 and 31/12/2017 were identified. Individual units searched the electronic patient records of each patient and identified all those with a new diagnosis of AAV. Those undergoing repeat biopsy or who were not felt to have AAV on biopsy were excluded. Demographic data including immunological and outcome data were recorded and statistical analysis was undertaken in SPSS (v22).

Results
267 patients were identified as having AAV across 8 centres and followed up for an average of 989 (IQR 610-1247) days. In 52% (n= 140) the biopsy indication was acute kidney injury.
38% (n=101) had a diagnosis of granulomatosis with polyangiitis (GPA). 52% (n=140) were female and the mean age at biopsy was 66.6±12.1 years. 38% (n=100) were PR3 positive. The average number of glomeruli on biopsy was 14 (IQR 11-21) with 3 (IQR 2-7 crescents. 28% (IQR 7-51) of viable glomeruli contained crescents. 41% (n=110) had at more than 10% interstitial fibrosis on biopsy. Creatinine at biopsy was 208µmol/L (IQR 141-380 µmol/L) and at 90 days 141 µmol/L (IQR 101-222 µmol/L).
Most patients received standard induction therapy of cyclophosphamide and steroid. 24% (n=65) had plasma exchange at presentation and 11% (n=30) renal replacement therapy (RRT).
15% (n=39) patients relapsed with an average time to relapse of 511 (IQR 223-11127) days. 62% (n=24) of relapses were treated with rituximab. Those with GPA relapsed earlier.
12% (n= 31) developed end stage renal disease (ESRD). 18% (n=49) died with 14 patients (5%) dying within 90 days of biopsy. Average time to death was 246 (IQR 89-321) days. There was a trend towards an increased risk of death with those who developed ESRD. Patients who received PEX or RRT during initial admission were no more likely to relapse or die than those who did not.

Conclusion
This study accurately describes the presentation, management and outcomes of patients with AAV and renal involvement in Scotland. This allows comparison between centres within Scotland and other countries. The cohort will added to and followed to look at longer term outcomes.
P0224THE POSSIBLE LINK BETWEEN UNDETERMINED CHRONIC KIDNEY DISEASE (CKDU) AND ACUTE INTERSTITIAL NEPHRITIS (AIN) IN THE DRY ZONE REGIONS OF SRI LANKA
Authors: Premarathne Shakila , Nanayakkara Nishantha , Chandrajith Rohana , Rathnayake R M S K , Rathnathunga Neelakanthi , Badurdeen Zeid , Abeysundara Hemalika , Elladeniya Nalaka , Guruge Kumudumali , Madushan Sudath , Samrasiri Udaga , Hewavitharane H P M 
Published: June 2020

Abstract

Background and Aims
An environmental nephropathy which is widely known as Chronic Kidney Disease of uncertain aetiology (CKDu) has been reported in dry zone of Sri Lanka and few other tropical countries. It is already become a major public health problem resulting immense social, economic and health impacts. In recent past, symptomatic presentation of CKDu with tubulitis (CKDuT)/ Acute Interstitial Nephritis indicating activity (AIN) has been reported from Sri Lanka and Central America. The AIN is a nonspecific response of kidney to an injurious agent. Usually the responsible aetiology is obvious in AIN, but not in CKDu cases, however, believed to be a sequel of interstitial nephritis. The aim of this study was to identify the occupational exposures or risk factors associated in AIN cases.

Method
In a two years of a comprehensive investigation, 60 individuals who reported with AIN were investigated. Once a case is reported, a home visit was carried out and behavioural pattern associated risk factors were assessed by a structured questionnaire in which working behaviours and conditions, spraying of agrochemical, usage of Personal Protective Equipment (PPE) and probable exposed environmental conditions were considered.

Results
Majority of AIN patients were male (90:10%) with the mean age of (44 ± 1.2) ranging from 26 - 62years. Among the study group, 53% were full time farmers while 77% of were doing farming either full time or part time. 55% of patients applied agrochemicals by themselves. 52% of individuals have used Personal Protective Equipment (PPE). 12% of individuals were sand miners while 7% and 5% were full time masons or labourers. 2% were engaged both farming and mason as full time employment. 15% were doing other employment except the above. Smoking, alcohol consumption and betel chewing were reported in the group as 50%, 57% and 72% respectively. Majority of patients were reported from Girandurukotte (17%), Wilgamuwa (32%) and Mahiyanganaya (35%) regions where CKDu are widely reported. Study indicated that there was no any significant pattern of AIN incidents over the study period.

Conclusion
Mean age of reported CKDuT were at least ten years younger than the mean age of CKDu. Comparatively higher number of sex ratio has been found in CKDuT indicating the male dominance. Some of the demographic features of AIN patients were similar with CKDu patients and both CKDu and AIN patients are engaged in farming either full time or part time.
P0231PREGNANCY AND DELIVERY OUTCOMES IN PATIENTS WITH COMPLEMENT GENE VARIANT MEDIATED THROMBOTIC MICROANGIOPATHY
Authors: Haninger Natalja , Gaggl Martina , Aigner Christof , Renate Kain , Prohaszka Zoltán , Böhmig Georg A , Leah Charlotte Piggott , Raute Sunder-Plassmann , Sunder-Plassmann Gere , Alice Schmidt 
Published: June 2020

Abstract

Background and Aims
In pregnancy and the postpartum period, complement gene variant mediated thrombotic microangiopathy (P-cTMA) can be life threatening for the mother and the child. We describe pregnancy and delivery outcomes of pregnancies a) before cTMA manifestation, b) complicated by P-cTMA, and c) after first manifestation of cTMA in such women.

Method
This study provides an update of patients enrolled in the Vienna TMA Cohort (VTC) as of January 2020. Demographic and clinical data were retrieved from the electronic and paper-based health care records of our institution and from the Austrian Mother-Child Health Passport. Pregnancy outcomes include live births (full term, moderate to late preterm, very preterm, extremely preterm) or deaths (miscarriage, foetal death, stillbirth, neonatal death). Among delivery outcome we ascertained spontaneous vaginal delivery; Caesarean section, gestational age, birth weight and birth weight categories, birth height, head circumference, Apgar scores, admission to a neonatal intensive care unit, and the presence of malformations.

Results
We recorded 58 pregnancies (41 live births/21 women, including one set of twins; 4 abortions and 1 stillbirth in 3 women without live births; 1 ongoing pregnancy; successful pregnancies: 40/57=70%) of 25 women (mean age [years] at first pregnancy 28.2±7.4, at cTMA manifestation 33.2±16.5). Currently 6 women have a kidney transplant and 4 have died (each death not related to pregnancy). Detailed pregnancy outcomes are shown in Figure 1. Table 1 indicates delivery outcomes of 41 live births. 6/8 neonates of pregnancies complicated by cTMA were female. Caesarean sections (female: 11/19, 58%; male: 9/24, 38%; p=0.11), preterm deliveries (female: 7/19, 37%; male: 5/24, 21%; p=0.09), and low birth weight (female: 6/19, 32%; male: 3/24, 13%; p=0.02) were more frequent among 43 pooled live births and stillbirths with known sex.

Conclusion
Overall, pregnancy and delivery outcomes were poor in pregnancies complicated by cTMA as compared to pregnancies before or after cTMA manifestation. The rate of Caesarean section, preterm delivery, and low birth weight was somewhat higher among female as compared to male neonates and stillbirths. Furthermore, neonatal female gender should be explored as risk factor for cTMA manifestation.
P0235LOW SERUM 3-METHYL HISTIDINE LEVEL IS ASSOCIATED WITH AORTIC STIFFNESS IN HEMODIALYSIS PATIENTS
Authors: Chang Yu-Chi , Tang Chi-Chong , Hsu Bang-Gee 
Published: June 2020

Abstract

Background and Aims
3-methyl histidine (3MH) is a non-proteinogenic amino acid and an index of muscle breakdown. Subclinical protein malnutrition is an independent association with arterial stiffness. The aim of this study was to evaluate the relationship between serum 3MH levels and carotid-femoral pulse wave velocity (cfPWV) values in chronic hemodialysis patients.

Method
Fasting blood samples and baseline characteristics were obtained from 136 chronic hemodialysis patients. Serum 3MH was performed with high-performance liquid chromatography and mass spectrometry. Aortic arterial stiffness was defined as cfPWV values &gt;10 m/s according to the ESH-ESC 2013 guidelines.

Results
Among 110 chronic hemodialysis patients, 45 patients (40.9%) were in the aortic arterial stiffness group. When compared to those in the control group, the aortic arterial stiffness group had high prevalence of diabetes mellitus (p &lt; 0.001), hypertension (p = 0.006), older age (p = 0.002), higher systolic blood pressure (p = 0.016), and lower serum 3MH level (p = 0.001). Multivariable logistic regression analysis of the factors significantly associated with aortic arterial stiffness revealed that serum 3MH levels (odds ratio (OR): 0.791, 95% confidence interval (CI): 0.691–0.906, p = 0.001) was the independent predictor of aortic arterial stiffness in chronic hemodialysis patients. Multivariable forward stepwise linear regression analysis also showed that logarithmically transformed 3MH level (log-3MH, β = -0.322, adjusted R2 change = 0.127, p &lt; 0.001) was an independent predictor of cfPWV values in chronic hemodialysis patients. The area under the receiver-operating characteristic (ROC) curve indicates the diagnostic power of 3MH at predicting aortic stiffness of chronic hemodialysis patients was 0.691 (95% CI: 0.595-0.775, p = 0.0002).

Conclusion
Serum-free 3MH level is negatively associated with aortic arterial stiffness in chronic hemodialysis patients.
P0241ACUTE KIDNEY INJURY AFTER NEPHRECTOMY: A NEW NOMOGRAM TO PREDICT POSTOPERATIVE RENAL FUCTION
Authors: Xu Lingyu , Li Chenyu , Guan Chen , Zhang Yue , Xu Yan 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) due to nephrectomy is associated with adverse prognosis. The study aimed to develop a nomogram based on preprocedural features for early prediction of AKI and to assess the prognosis in patients after nephrectomy.

Method
The study included a development cohort of 1111 patients and an additional validation cohort of 356 patients who underwent nephrectomy. Stepwise and logistic regression analyses were used to evaluate the association between predictors and AKI. Incorporating all independent predictors, a nomogram for postoperative AKI was developed and validated. Patients were followed up for 5 years to assess renal fuction, acute kidney disease (AKD), chronic kidney disease (CKD), hospital readmission and death were key prognostic outcomes we focused on.

Results
Radical nephrectomy (odds ratio (OR) = 3.57, p &lt; 0.001), aspirin (OR = 1.79, p = 0.008), systolic blood pressure (OR = 1.41, p = 0.004), triglyceride (OR = 1.26, p = 0.024) were independent risk factors for postoperative AKI, while albumin (OR = 0.72, p = 0.031) was a protective factor for postoperative AKI. Patients with a higher estimated glomerular filtration rate (eGFR) (60-90 ml/min/1.73 m2, OR = 0.41, p = 0.004; ≥ 90 ml/min/1.73 m2, OR = 0.37, p &lt; 0.001) were less prone to AKI than those with a lower eGFR (&lt; 15 ml/min/1.73 m2). These predictors were all included in the final nomogram to calculate the probability of postoperative AKI. The incidence of AKD and CKD were 27.12% and 18.64% in AKI group, which were much higher than those in no AKI group (p &lt; 0.001).

Conclusion
The nomogram had excellent predictive ability and might have significant clinical implications for the early detection of AKI in patients undergoing nephrectomy.
P0243WOMEN WORKERS THAT DO NOT HAVE A WATER BOTTLE AT THE WORKPLACE HAVE HIGHER PREVALENCE OF URINARY TRACT SYMPTOMS AND INFECTION
Authors: NERBASS FABIANA , Santo Cintia , Fialek Edilaine , Calice-Siva Viviane , Vieira Marcos 
Published: June 2020

Abstract

Background and Aims
Hydration and toilet behavior at work are associated with urinary tract symptoms (UTs) and infection (UTI) in women. We aimed to evaluate the association between self-reported hydration habits, water access and toilet adequacy at work with UTs and UTI in female workers from five dialysis clinics in Southern Brazil.

Method
All women employed were invited (n=258), and 69.4% (n=179) agreed to participate. For this analysis, we included female workers employed for at least 12 months who were not pregnant or breastfeeding in the last year. Weekly work shift varied from 30 to 42 hours, divided into five or six weekdays. Participants answered an online questionnaire comprising questions regarding UTs (burning feeling; frequent or intense urge to urinate; bloody urine; lower abdomen pain) and UTI episodes in the last year; usual daily beverage intake, usual urine frequency and color according to urine color chart; water access and toilet adequacy perception at work. Workers were divided into two groups according to the employee permission in having a water bottle (WB) at the workplace. Administrative and multidisciplinary staff are allowed (WB group) and nurse staff can not have (non-WB group) due to infection control regulation in dialysis rooms.

Results
We included 133 women (age=36.9±9.5 years old). Self-reported usual daily beverage intake= 6.6±2.9 cups/day (∼1320 ml); daily urine frequency= 5.1±2.1; urine color chart score= 3.0±1.2. At least one UTs was reported by 53% (n=70) and UTI episode by 34% (n=45) in the last year. Participants with UTs had a lower urine frequency (4.7±2.3 versus 5.5±1.7 times/day; P=0.03) and a higher urine color score (3.3±1.2 versus 2.6±1.1;P=0.002). Non-WB workers (N=66/49.6%) reported a lower beverage intake (6.0±2.6 versus 7.3±3.0 cups/day;P=0.01), had a higher prevalence of UTs (65% versus 45%; P=0.02) and UTI (42% versus 25%; P=0.04). Among non-WB participants, 47% considered that the distance to water supply from the workplace spot impairs adequate hydration, and 39% answered that the number of toilets available also as a barrier. A higher prevalence of UTs was reported by these subgroups that perceived environment infrastructure barriers (77% versus 54%; P=0.04 and 92% versus 47%; P&lt;0.001, respectively). Non-WB who responded that toilet hygiene impairs hydration (11%) had a higher prevalence of UTI (86% versus 37%; P=0.03). No significant association between work environment perception and urinary problems was found in the WB group.

Conclusion
Lower urine frequency and darker urine color were associated with UTs in this population. Workers who do not have a water bottle at the workplace reported a lower beverage intake, higher UTs and UTI prevalence. Non-WB participants that perceived work barriers to adequate hydration had a higher prevalence of urinary problems.
P0257CLINICOPATHOLOGICAL SPECTRUM OF KIDNEY INVOLVEMENT IN MONOCLONAL GAMMOPATGY
Authors: Mayssa Hadj Brahim , Ben salem Meriem , Amal Ouni , Insaf Handous , Manel Bensalah , Ahmed Letaief , Mouna Hammouda , Sabra Aloui , Amine Boukadida , Habib Skhiri 
Published: June 2020

Abstract

Background and Aims
The occurrence of kidney diseases associated with a monoclonal gammopathy is increasingly recognized.Renal biopsy and evaluation by light microscopy, electron microscopy and immunofluorescence,in association with adequate clinical examination are essential in accurate diagnosis. The objective of our study is to describe the types of kidney damage secodary to monoclonal gammopathies and to study its renal prognosis.

Method
It is a monocentric RETOSPECTIVE DESCRIPTIVE STUDY carried out in the nephrology department of CHU FATTOUMA BOURGUIBA MONASTIR spread over a period of 7 years from January 2012 to December 2018.

Results
we collected 40 cases of monoclonal gammopathies. The median age was 61 years.The sex ratio was 0,9. the circumstances of discovery were dominated by renal failure. it revealed the diagnosis in 77.5% of cases. the renal presentation proteinuria in 70%, microscopic hematuria in 12.5%, edematous syndrome in 27.5% and nephrotic syndrome in 37,5%. The mean creatinine level was 500 umol / L and proteinuria at 4,3 g / 24 h with a maximum rate of 17.5 g / 24h. the electrophoresis of serum proteins showed the presence of a monoclonal peak in 90% of the cases in the gamma zone. The plasmocytosis was less than 10% in 15% of cases and more than 60% in 22,5% of the cases. Radiology showed bone localizations in 32,5% of cases. These gammopathies were classified as Multiple myeloma in34 patients, POEMS in one case and 5 MGRS. Kidney biopsy was performed in 10 patients showing cast nephropathy, AL amyloidosis and vasculites(endocapillary glomerulonephritis with hyaline thrombi in all vessels and double contour appearance of the glomerular basement membrane) in respectively 12,5%, 7,5% and 2,5% of cases. the main indications were rapidly progressive renal failure, unexplained acute renal failure and nephrotic syndrome. The renal involvement retained was a myeloma tubulopathy in 28 patients, 3 of whom were confirmed histologically . AL amyloidosis was found in 5 patients and the confirmation was histological. Type 1 cryoglobulinemia was diagnosed in only one patient. Glomerular nephropathy remained undetermined in 6 patients whose PBR was indicated but not made in the presence of hemostasis disorders. The chemotherapy was started in 34 patients based on bortezomide-thalidomide-dexamethasone in 30% of cases. An autograft of the bone marrow was done in one patient. Hemodialysis was required in 15 patients. The renal function was improved in 42.5% of the cases and a passage on chronic hemodialysis in 10% of cases. 10% of patients have achieved complete hematological remission.

Conclusion
Patients with MG can develop a large variety of related renal lesions.Renal involvement darkens the prognosis hence the need for adequate care .
P0261NARRATIVE NEPHROLOGY: A BIO-PSYCHO-SOCIAL APPROACH WITH CDK PATIENTS
Authors: Lombardi Marco , Toccafondi Alessandro , Caraccia Umberto , Mari Leonardo , Dattolo Pietro Claudio 
Published: June 2020

Abstract

Background and Aims
Poor medication adherence in CKD patients can reach up to 80%. Non-adherence is associated with high mortality and morbidity and it is a negative criterion for the inclusion in the transplant waiting list. Poor adherence increases also the costs for health care in terms of diagnostic procedures, dialysis in emergency, etc. Therefore, to increase patients’ adherence to medical treatments is one of the priority of clinical nephrology.
According to the WHO adherence behaviors are associated to several factors (e.g. organization of health services, doctor-patient relationship, patients’ psychosocial factors). The most efficacy interventions descried in the literature to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients.
In the last years, narrative evidenced-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting adherence to treatments.
Aim of this clinical project is to obtain the best control of the evolution of chronic kidney disease through a multidisciplinary approach of narrative medicine.

Method
Within the pre-dialysis service of the Division of Nephrology and Dialysis Firenze 2, it has been integrated the clinical care for CKD patients with a protocol based on a narrative medicine approach (Fig.1).
The clinical protocol is composed by the following procedures:

Results
This project begun around 2 months ago. In this period 15 patients were met, collecting stories by 12 of them (80%). Most of the stories were rich of contents and useful from a medical point of view. None patients refuse the medical consultation at the presence of psychologist, and 5 of them asked for psychotherapy sessions. In line with the literature, 30% of patients presented symptoms of depression. Due to logistic reasons we are going to start the pharmacy counseling intervention at the end of January. All patients were grateful to have been included in this protocol. In the following months we will be able to assess the impact of this protocol in terms of medical outcome.

Conclusion
To promote an active role of patients in taking care of themselves and follow medical prescriptions, it has been implemented a clinical protocol based on narrative medicine approach in which the biological, psychological and social needs of patients are considered and discussed with them. The empirical results obtained in these first months indicate a positive response from patients in terms of wish to write the experience with the disease and to receive the medical visit with the nephrologist at the presence of a psychologist.
P0262DIAGNOSIS OF PNEUMOCYSTIS PNEUMONIA BY METAGENOMIC NEXT-GENERATION SEQUENCING IN PERIPHERAL BLOOD OF PATIENTS WITH KIDNEY DISEASE
Authors: GU Peng , XU Shutian , JIANG Xue , CHAO Zhouyu , ZHOU Yun , LI Zhe , LI Shijun 
Published: June 2020

Abstract

Background and Aims
Pneumocystis jirovecii is an opportunistic infectious pathogen that can cause pneumocystis pneumonia in HIV patients. The kidney transplant recipients and patients with kidney diseases receive immunosuppressive therapy, PCP is not uncommon in such patients, but early etiological diagnosis is difficult. Metagenomic next-generation sequencing (mNGS) has higher sensitivity for pathogen identification in a variety of infections. In this study, mNGS was used to detect peripheral blood samples of patients with kidney disease complicated with PCP, and to evaluate the diagnostic value of mNGS in peripheral blood for the etiology of PCP.

Method
From August 2018 to December 2019, We collected 37 cases with kidney disease complicated with pulmonary infection and clinically diagnosed with PCP after receiving immunosuppressive therapy. mNGS was used to analyze the pathogen types and sequences in peripheral blood samples to evaluate the detection efficiency to PCP. To compare the efficacy of mNGS and traditional clinical diagnosis (fungal G combined with lactate dehydrogenase detection) of PCP. In addition, patients with Bacterial/fungal pneumonia or viral pneumonia were mNGS positive controls.

Results
37 peripheral blood samples were collected from 37 patients, results for all samples were obtained within 72 hours. Pneumocystis jirovecii was detected by mNGS in 35 of the 37 samples, with a sensitivity of 94.59%, specificity of 100%. 31 patients had mixed infection. Cytomegalovirus (CMV) was detected in 19 of the 37 cases (51.4%), epstein-barr virus (EBV) was detected in 6 cases, herpes simplex virus (HSV) was detected in 5 cases, and Torquetenovirus was detected in 8 cases. There were 8 cases of bacterial infection, including 2 cases of staphylococcus, 2 cases of acinetobacter, 1 case of klebsiella pneumoniae, 1 case of escherichia coli, and 4 cases of other uncommon bacteria. There were 33 patients with positive fungal G test and elevated lactate dehydrogenase (BG/LDH), and 4 patients with multiple negative fungal G test .The sensitivity of BG/LDH was 89.19%, the specificity was 56.0%.

Conclusion
mNGS has obvious advantages over the traditional method of diagnosing PCP. It has the characteristics of accuracy, simplicity and noninvasiveness, and is of great value for the early diagnosis of PCP.