bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0558DICLOFENAC ENHANCES RENAL INFLAMMATION IN EXPERIMENTAL SUBCLINICAL ACUTE KIDNEY INJURY (AKI)
Authors: Störmer Johanna , Gueler Faikah , Rong Song , Jang Mi-Sun , Shushakova Nelli , Schmidt Sonja , Haller Hermann , Greite Robert 
Published: June 2020

Abstract

Background and Aims
Diclofenac is frequently used for pain control. In a previous study, we showed that already a single oral dose of diclofenac could reduce renal perfusion in healthy individuals. To investigate the influence of oral diclofenac administration on renal inflammation in the setting of pre-existing renal damage, we used a mouse model of subclinical acute kidney injury (AKI) induced by renal ischemia-reperfusion injury (IRI) followed by diclofenac administration.

Method
Male CD1 mice (7-8 weeks old) underwent unilateral renal pedicle clamping for 15min to induce subclinical AKI. After reperfusion mice received a single oral dose of 100 or 200mg/kg diclofenac via oral gavage. Vehicle treated mice with unilateral IRI served as control. At day 1, mice were placed into metabolic cages to collect urine. Histology was performed on day 1 and 14 for renal morphology. Inflammation and fibrosis were investigated by immunohistochemistry and qPCR.

Results
Diclofenac treated mice showed reduced urine production. Morphologically, signs of AKI were more pronounced in diclofenac treated kidneys which also showed more Cox-2 positive tubuli in the cortex. On mRNA expression level the pro-inflammatory markers IL-6 and CXCL2, the chemoattractant for neutrophils, were elevated in the diclofenac group. Early upregulation of the pro-fibrotic markers CTGF and PAI-1 was detected already on d1 after IRI in the diclofenac group and tubular atrophy was pronounced after two weeks.

Conclusion
Already, a single oral dose of diclofenac causes aggravation of renal inflammation and progressive renal fibrosis in the setting of pre-existing subclinical acute kidney injury.
P0567ACUTE KIDNEY INJURY IN OBSTRUCTIVE UROPATHY; EPIDEMIOLOGY, RENAL OUTCOME AND MORTALITY
Authors: Sun Bong Gyun , Min Hyeon-jin , Son Young-Bin , Choi Eunho , Yang Jihyun , Oh Se Won , Kim Myung-gyu , Jo Sang-Kyung , Cho Won-Yong 
Published: June 2020

Abstract

Background and Aims
Urinary tract obstruction (UTO) is a common clinical problem leading to acute or chronic renal impairment. Unlike pediatric population in which congenital anomalies of urinary tract account for a majority of UTO and contribute to end stage renal disease (ESRD), etiologies, clinical manifestation and outcome in adult UTO remain uncertain due to lack of large epidemiological data.

Method
We performed a multi-center, retrospective study analyzing 1,711 patients who underwent percutaneous nephrostomy (PCN) from 2001 to 2015.

Results
The most common cause of UTO was malignancies (55.6%) followed by urolithiasis (28.5%) and others. Metastatic colorectal cancer were the most common type of malignancies. Patients with UTO caused by malignancies were significantly older, had more advanced stage acute kidney injury (AKI) and higher mortality rate, while those with urolithiasis had higher prevalence of hypertension, diabetes, cardio-cerebro-vascular diseases. Eighty two percentage of patients developed AKI and 15.2% of patients needed a temporary dialysis. Older age, malignancy associated UTO and high uric acid level were independently associated with AKI. Among patients with AKI, 38.2% patients showed a renal functional recovery defined as eGFR ≥60ml/min/1.73m2 on day 7 after PCN. Multivariate analysis showed that older age and lower hemoglobin level were independent factors predicting a nonrecovery of renal function. During the median follow up period of ∼∼months, overall mortality rate was 33.9% with the highest rate was found in malignancy associated UTO (51.9%), followed by other causes (15.9%) and urolithiasis (8.8%). Malignancy associated UTO (OR 4.754, 95% CI 3.151-7.174, p&lt;0.001), lower albumin level (OR 0.731, 95% CI 0.568-0.942, p&lt;0.001) and stage 3 AKI (OR 2.529, 95% CI 1.332-4.803, p=0.005) were found to be independently associated with mortality. However, the impact of AKI on overall mortality was more prominent in non-malignancy associated UTO with stepwise increase of mortality as KDIGO stage increased.

Conclusion
In conclusion, malignancy is the most common cause of upper UTO in adults and AKI is frequently associated. Short term renal recovery after PCN was observed only in 38.2% patients and older age, lower hemoglobin level were associated with nonrecovery of renal function. Malignancy associated UTO showed the highest mortality rate compared to urolithiasis or other causes and stage 3 AKI as well as lower hemoglobin and lower albumin level were found to be independent predictors of mortality in UTO.
P0568INCIDENCE AND RISK FACTORS OF ACUTE KIDNEY INJURY AND TUMOR LYSIS SYNDROME IN PATIENTS WITH MULTIPLE MYELOMA TREATED WITH BORTEZOMIB
Authors: SONG SEUNGMIN , Boo Hyo jin , Jang Hye Ryoun , Huh Wooseong , Kim Dae Joong , Kim Yoon-Goo , Lee Jung Eun 
Published: June 2020

Abstract

Background and Aims
Nephrotoxicity of bortezomib, a proteasome inhibitor, has not yet been described frequently, while tumor lysis syndrome (TLS) associated with multiple myeloma (MM) has been increased after introduction of the drug. This study compared the incidence and risk factors of acute kidney injury (AKI) and TLS in patients with MM after bortezomib-based chemotherapy to investigate the drug-related nephrotoxicity.

Method
From 2006 to 2017, 276 patients who underwent first cycle of bortezomib-based chemotherapy for MM were identified in single tertiary hospital. Laboratory TLS was defined according to the Cairo-Bishop definition. Development of AKI was assessed by AKI Network (AKIN) criteria within 7 days after first chemotherapy.

Results
The age was 65 [56-72] years old, and 47% (n=131) of participants were female and baseline estimated glomerular filtration rate (eGFR) was 61.3 [34.1-89.1] mL/min/1.73m2. The incidences of AKI and laboratory TLS were 17% (n=47) and 13% (n=36), respectively. Ten (3.6%) subjects corresponded to the both AKI and TLS criteria. Multivariate analyses showed that lower eGFR category (30∼59, odds ratio [OR]=3.063 [1.278-7.339]; 15∼29, OR=3.417 [1.088-10.726]; &lt;15, OR=10.080 [2.677-37.951] vs ≥ 60), lower serum albumin level (OR=0.491 [0.278-0.868], P=0.0144) and renal amyloidosis (OR=11.174 [3.974-31.420], P&lt;0.0001) were predictors of development of AKI. MM stages and β2-microglobulin were not associated with AKI occurrence.
Regarding laboratory TLS, MM stage and β2-microglobulin were higher in those with TLS. In multivariate analyses, β2-microglobulin levels (OR=1.194 [1.066-1.337], P=0.0021) and any chromosomes abnormalities at high risk (OR=0.115 [0.026-0.503], P=0.0041) were associated with higher risk of TLS.

Conclusion
Development of AKI was often observed without being accompanied by TLS in patients with MM after treatment of bortezomib. In addition, risk factors of AKI and TLS were widely different. These findings implicated the potential nephrotoxicity of bortezomib besides TLS in patients with decreased kidney function. The efforts to prevent bortezomib associated AKI are needed in patients at high risk.
P0571EPIDEMIOLOGY AND OUTCOMES OF ACUTE KIDNEY INJURY IN CHILDREN IN UKRAINE
Authors: Fomina Svitlana , Lavrenchuk Olga , Bagdasarova Ingretta 
Published: June 2020

Abstract

Background and Aims
The problem of acute kidney injury (AKI) in children continues to be relevant for pediatric nephrology and pediatrics due to the increasing frequency and the lack of a unified approach to management and further monitoring of these patients. The aim of our study was to determine the etiology and outcomes of acute kidney damage in children.

Method
101 patients (aged from 3 months) were studied in referral center from early period after AKI (first month) to 18 years old. They were observed every 6 months during first year of disease course, and once per year till transfer to adult clinic. The outcomes were identified as complete recovery, isolated albuminuria and chronic kidney disease (CKD). The AKI outcomes were analyzed up to 1.5-3, 5-10 and 15 years of follow up (stage 1, 2 and 3, respectively).

Results
The predominant patients were males (72/71.3%). The most of the children were younger than 3 years old at the time of AKI (58/57.4%), and only a small part of patients were adolescents (7/6.9%).
The hemolytic uremic syndrome (HUS) related to diarrhea was the main cause of the AKI (64/63.4%), and children of the first years of life formed the basis of this clinical group (0-3 years old: 44/68.8%). Sepsis and complicated acute viral and bacterial infections have also been confirmed as common AKI causes (12/11.9% and 8/7.9%, respectively). In some cases AKI were associated with hemolytic anemia (5/5.0%), acute glomerulonephritis (5/5.0%), vaccination (1/1.0%), contrast nephrotoxicity (1/1.0%) or unknown cause (3/3.0%).
At stage 1 (1.5-3 years after event, n=60) complete remission were documented in
24/40.0%, albuminuria from 45 to 601 mg/day without other clinical signs – in 22/36.7%, and CKD 2-4 – in 12/23.3%.
At stage 2 (5-10 years after event, n=54) complete remission were confirmed in 29/53.7%, persisted albuminuria – in 6/14.8%, and CKD 2-4 – in 19/31.5%.
At stage 3 (15 years after event, n=12) CKD 2-4 were founded in all patients with arterial hypertension (n=7), focal-segmental glomerulosclerosis (n=2) and kidney cysts (n=3).

Conclusion
AKI was the most often in children of the first 3 years old, mainly in boys. The development of disease was firstly associated with HUS and severe infections. The long-term outcomes of AKI with distance from the event (AKI) to CKD even with recovery renal function and absence of clinical symptoms were difficult to predict. The prolongation of the observation period, the collaboration between the pediatric and adult centers, the widest usage of verified prognostic markers (i. g. albuminuria) and search for new ones are the most important options in post-AKI management.
P0578QUININE EXPOSURE AND THE RISK OF ACUTE KIDNEY INJURY: A POPULATION BASED OBSERVATIONAL STUDY OF OLDER PEOPLE
Authors: Duncan Andrew , Hapca Simona , De Souza Nicosha , Morales Daniel , Bell Samira 
Published: June 2020

Abstract

Background and Aims
Quinine can precipitate Acute Kidney Injury (AKI) by immune-mediated reactions. Cramps, for which quinine is traditionally prescribed, may be a symptom of conditions that are risk factors for AKI. The relationship between quinine and AKI at a population level is unclear. The aim of this study was to establish and quantify any observable association between the exposure to community prescriptions for quinine and AKI events in a population of older adults.

Method
We performed two observational studies of older adults (60+ years) who received quinine prescriptions in Tayside, Scotland, between January 2004 and December 2015. The first study was a retrospective longitudinal cohort study with the primary outcome AKI. Creatinine measurements less than seven days apart were grouped as episodes of care. Multivariable logistic regression was used to calculate odds ratios (OR) for AKI comparing between episodes with and without recent quinine exposure after adjustment for demographics, comorbidities and concomitant medications. A self-controlled case series (SCCS) was then conducted with follow-up divided into periods “on” and “off” quinine for the same individual, calculating incidence rate ratios (IRR) for AKI adjusting for age.

Results
The first study included 12,744 individuals who experienced 13,616 AKI events during cohort follow-up (crude incidence 12.5 per 100 person-years). Exposure to quinine before an episode of care was significantly associated with an increased probability of AKI (adjusted OR=1.27, 95% CI 1.21-1.33). The SCCS cohort included 5,907 people with quinine exposure with ≥1 AKI event. Exposure to quinine was associated with an increased relative incidence of AKI compared to unexposed periods (IRR=1.20, 95% CI 1.15-1.26), with the greatest risk observed within 30 days of quinine initiation (IRR=1.48, 95% CI 1.35-1.61).

Conclusion
Exposure to quinine in patients aged 60 years and over was associated with an increased risk of AKI, the incidence of which is unlikely to simply be explained be immune-mediated reactions only. Further research is required to determine exact reasons for the increased risk of AKI.
P0587CLINICAL PROFILE AND SHORT-TERM OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH PRE-ECLAMPSIA AND ECLAMPSIA
Authors: Sharma Manjuri , MAZUMDER MASTAKIM AHMED , Mahanta Pranab Jyoti , Doley Prodip Kumar , Pegu Gayatri , Alam Shahzad 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is rare in women during pregnancy and puerperium. Although sepsis remains the predominant cause of AKI in pregnancy in developing countries, pre-eclampsia and eclampsia are important causes and can be life threatening. The primary focus of this study was to analyze the clinical profile as well as maternal and fetal outcomes of AKI in pregnant females with pre-eclampsia and eclampsia.

Method
A prospective study of patients admitted with pre-eclampsia or eclampsia and AKI in Gauhati Medical College Hospital from June 2018 to June 2019. Clinical profiles and outcome data were recorded. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results
A total of 26 cases were recorded. The mean maternal age at delivery was 27.5 ± 5.1 years. At least one recorded preexisting medical condition, including hypertension, diabetes mellitus, or chronic kidney disease was present in 5 cases (19.2%). Cesarean section was performed in 9 cases (34.6%). Eighteen patients (69.2%) developed AKI in third trimester and 6 (23.1%) within 12 weeks postpartum. Four patients (15.4%) were treated with dialysis. Four women (15.4%) died and 2 (7.7%) remained dialysis dependent 12 weeks after delivery. Low birth weight (&lt;2500 g), small for gestational age or preterm birth (&lt;37 weeks gestation) occurred in 11 pregnancies (42.3%). There were 2 (7.7%) neonatal deaths. AKI occurring before 34 weeks of gestation had worse fetal outcomes as compared to those after 34 weeks (p&lt;0.05).

Conclusion
AKI in pregnancies with pre-eclampsia or eclampsia can not only lead to maternal mortality and morbidity but also poor perinatal outcomes. Preeclampsia or eclampsia presenting with AKI early during gestation had worse fetal outcomes.
P0589ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING LIVING DONOR LIVER TRANSPLANT-INCIDENCE ,RISK FACTORS AND SHORT TERM PATIENT OUTCOMES ,A PROSPECTIVE SINGLE CENTER STUDY
Authors: Rana Abhyudaysingh , Gadde Ashwini , Mahapatra Amit , Saraf Neeraj , Soin Arvinder , Bansal Shyam 
Published: June 2020

Abstract

Background and Aims
AKI is a major concern in the management of candidates for liver transplantation. Post-LT AKI is associated with worse short- and long-term recipient and graft outcomes and the subsequent development of chronic kidney disease (CKD ).Most of the studies done on this are on deceased donor Liver transplant ,or if done on Living donor are retrospective in nature & there is inconsistency in studies regarding definition of AKI
To assess incidence, risk factor and outcomes of patient developing acute kidney injury(AKI) in patients undergoing living donor liver transplant(LT).

Method
This is a single center prospective study. Patients over age of 18 years undergoing living donor liver transplant were selected consecutively from Jan 19 to April 19, prospectively followed for 1 month post op to assess incidence of AKI(Early-&lt;=7,Late &gt;7 to &lt;30) & reassessed at 3 months for persistence of renal dysfunction .Patients with fulminant liver failure, those undergoing combined liver kidney transplant & who died within first 72 hour post-LT were excluded .AKI was defined by KDIGO criteria. Preoperative, Intraoperative & Post operative variables were analysed for risk factor & patient outcomes by regression analysis.

Results
62 patients underwent LDLT between period of Jan 2019 to April 2019 .22(35%) patients developed AKI .15 (68%) had stage 1 AKI ,5 (23%) Stage 2 & 2(9%) had stage 3 AKI requiring CRRT.14 (64 %) patients had early AKI ,8 (36%) had late AKI.Acute CNI toxicity (3,14%) was most common cause of early AKI.Most common cause of Late AKI was Sepsis (7,11%).Use of vasopressors intra op & Past history of AKI (HRS) were the only statistically significant(p &lt;0.001) risk factors for AKI .The mean ICU stay among patients with AKI was 7.2 ±4.2 days vs 4.5±1.2 days in patients without AKI .Median days to normalization of liver enzymes in non AKI group was 10 days vs 20 days in AKI group.2 (3.2%)patient had persistence of renal dysfunction at 3 month. 7(11.2%) patients died during analysis period, 2(3%) of them from AKI group.

Conclusion
- Incidence of AKI (35%) was higher in our study as compared to other cohort but lead to CKD in 2 patients . Past history of AKI (HRS) was a significant risk factor for Post op AKI though pre transplant e GFR did not differ in both group. Although AKI was transient but it lead to increase ventilator stay ,ICU stay and prolonged normalization of graft function in patients undergoing Living donor liver transplant.
P0590ADVERSE RENAL OUTCOME FOLLOWING ADMINISTRATION OF INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN A SINGLE TERTIARY CENTRE IN MALAYSIA
Authors: Jalalonmuhali Maisarah , Tengku Kamalden Tengku Ain Fathlun , Ismail Nurul 'Ain Sham , Yong See Yen , Teo Wei Ting , Lim Soo Kun 
Published: June 2020

Abstract

Background and Aims
Intravenous (IV) anti-vascular endothelial growth factor(VEGF) is a potent anti-angiogenic factor for the treatment of solid tumours. While, intravitreal anti-VEGF injection is used in the treatment for macular and retinal diseases. The effects of IV anti-VEGF agents are well documented to cause hypertension, renal impairment and proteinuria. However only few reports showed the significance of intravitreal anti-VEGF injection causing minimal change disease (MCD) and acute kidney injury (AKI). Hence, this study is to determine the outcome of renal function following intravitreal anti-VEGF injection.

Method
This is a prospective, cross sectional study recruiting patients from ophthalmology day-care operation theatre that were scheduled for intravitreal anti-VEGF injection in University Malaya Medical Centre (UMMC). On the day of the injection of anti-VEGF, patients’ demographic data (age, gender, medical background, medications), blood pressure, height, weight and investigations for serum creatinine and urine protein creatinine ratio (PCR) were collected. Following these, they will receive the intravitreal anti-VEGF as per schedule. All these patients were given a follow-up within 72hours to reassess blood pressure, serum creatinine and urine PCR.

Results
A total of 90 patients were recruited. However, 15 patients were subsequently excluded as there was no repeated serum creatinine at 72-hours post treatment. Their mean age was 67.25 ± 10.41. Among all, 3 patients had significance increased in serum creatinine (4%) with significance changed of urine PCR post treatment. Table 1 showed baseline parameters prior to treatment and table 2 was post treatment parameters.
Higher serum creatinine and proteinuria pre intravitreal anti-VEGF were identified to have higher OR of 1.018 (95% CI 1.001-1.035) (p=0.043) and OR 1.004 (1.000-1.007) (p=0.025) respectively among those who developed AKI. In assessing the association between higher pre-treatment creatinine and proteinuria (independent variable) and development of AKI (dependent variable) estimated by logistic regression with no AKI as a reference group we found that there were no significance.

Conclusion
Following intravitreal anti-VEGF administration, there were no significant changes in blood pressure. However, 4% from our cohort had AKI and worsening proteinuria at 72 hours post treatment. These patients had higher serum creatinine and proteinuria prior to treatment. However, our study is underpowered to establish the relationship between intravitreal anti-VEGF and development of AKI. Further study with larger sample size and longer-term outcome is needed.
P0592RISK FACTORS FOR SEPSIS ASSCOCIATED-ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT PATIENTS
Authors: Wang Xin , Zhou Jiaojiao , Yang Jia , Wang Siwen , Yang Lichuan 
Published: June 2020

Abstract

Background and Aims
To explore the risk factors of acute kidney injury in patients with sepsis in intensive care unit (ICU).

Method
The medical records of patients diagnosed with sepsis in ICU of west China hospital of Sichuan university from March 2009 to June 2016 were retrospectively analyzed. Differences between AKI group and Non-AKI group in general data, background disease, ICU entry and exit dates, complications, laboratory data and other related data were analyzed through univariate and multivariate statistical methods.

Results
A total of 2331 patients with sepsis were included in the study, including 626 patients in the AKI group and 1695 patients in the Non-AKI group. The multivariate logistic regression analysis confirmed that age &gt;40 yr. [odds ratio (OR) =2.811], diabetes (OR=2.818), hypertension/coronary heart disease (OR=1.781), CKD (OR=13.221), the length of ICU stay ≥14 days (OR=3.327), heart failure (OR=2.316), ARDS (OR=2.105), SAP (OR=2.566), hypotension (OR=2.048), hypoproteinemia (OR=1.607), lactic acidosis (OR=2.380), hypoproteinemia (OR=1.607), organ failure &gt;1 (OR=4.604),WBC &gt; 10 ×109/L (OR=4.197), serum creatinine (OR=4.535), PCT (OR=1.808), Cys-C (OR=7.066), mild anemia (OR=2.321), moderate anemia (OR=4.047), and severe anemia (OR=6.100) were all independent risk factors of SA-AKI.

Conclusion
A variety of risk factors are related to the occurrence of SA-AKI. Early identification and monitoring of risk factors for SA-AKI and early prevention of AKI can improve the prognosis of sepsis patients.
P0595CHANGING EPIDEMIOLOGY AND OUTCOME OF AKI PATIENTS IN TEACHING HOSPITAL FROM A DEVELOPING COUNTRY: A POPULATION-BASED COHORT STUDY
Authors: Ponce Daniela , Zamoner Welder , Batistoco Marci , Balbi Andre 
Published: June 2020

Abstract

Background and Aims
While considerable information is available on acute kidney injury (AKI) in North America and Europe, large comprehensive epidemiologic studies of AKI from Latin America and Asia are still lacking. The present study aimed to evaluate the epidemiology and outcome of AKI in patients evaluated by nephrologists in a teaching Brazilian hospital.

Method
We performed a large retrospective observational study that looked into epidemiology for AKI and its effect on patient outcome across time periods. For comparison purposes, patients were divided into two groups according to the year of follow up: 2011-2014 and 2015-2018.

Results
We enrolled 7,976 AKI patients and after excluding patients with Chronic Kidney Disease stages 3 to 5, kidney transplanted and those with incomplete data, 5,428 AKI patients were included (68%). The maximum AKI stage was 3 (50.6%) and mortality rate occurred in 1865 patients (34.3%). Dialysis treatment was indicated in 928 patients (17.1%). Patient survival improved along study periods: patients treated at 2015-2018 had a relative risk death reduction of 0.89 (95% CI 0.81–0.98, p=0.02). The independent risk factors for mortality were sepsis, older &gt;65 anos, admission to ICU, AKI-KDIGO 3, recurrent AKI, no metabolic and fluid demand to capacity imbalance as dialysis indication and the period of treatment.

Conclusion
We observed an improvement in AKI patient survival along the years even after correction for several confounders and using a competing risk approach. Identification of risk factors for mortality can help in decision making for timely intervention, leading to better clinical outcomes.