bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0207PLASMA CHEMOKINE CXC MOTIF-LIGAND 16 AS A PREDICTOR OF RENAL PROGNOSIS IN IMMUNOGLOBULIN A NEPHROPATHY
Authors: Luo Ran , Yang Yi , Chang Dan , Liu Tingting , Li Yue-Qiang , Dai Wei , Zuo Mei-Ying , Xu Yu-lin , Zhang Chun-Xiu , Xu Gang , Ge Shu-wang 
Published: June 2020

Abstract

Background and Aims
A recognized non-invasive biomarker to improve risk stratification of IgA nephropathy (IgAN) patients is scarce. CXCL16 has been shown to play a key role in inflammatory disease as chemoattractant, adhesion and fibrosis factor. This study assessed the possibility of plasma CXCL16 as a potential biomarker in IgAN patients.

Method
Plasma CXCL16 was measured in 230 patients with renal biopsied IgAN from 2012 to 2014. The patients were followed for 41.3 months with 50% reduction in eGFR or ESRD as end-points.

Results
The plasma CXCL16 levels in IgAN patients were significantly correlated with the uric acid, estimated glomerular filtration rate and tubular atrophy/interstitial fibrosis score in multivariate analysis. In addition, the counts of CD4+ T cells, CD8+ T cells and CD20+ B cells in renal biopsies of IgAN patients were significantly correlated with the plasma CXCL16 levels, but not CD68+ macrophage. Finally, we concluded that patients with higher plasma CXCL16 levels had a higher risk of poor renal outcome compared with those with lower. No association was observed between the CXCL16 polymorphisms and clinical parameters including plasma CXCL16 levels and prognosis.

Conclusion
Plasma CXCL16 levels were associated with clinical parameters, pathological damage, the CD4+ T cells, CD8+ T cells and CD20+ B cells infiltration in renal tissue and renal outcome in IgAN patients. Plasma CXCL16 might be a potential prognosis predictor in Chinese IgAN patients.
P0212IMMUNOSUPPRESSIVE TREATMENT OF PATIENTS WITH ANCA ASSOCIATED VASCULITIS (AAV) IN CHRONIC DIALYSIS PROGRAM
Authors: File Ibolya , Ujhelyi László , Balla Jozsef , Bidiga László , Csilla Trinn , Markóth Csilla , Gabriella Szűcs , Mátyus János 
Published: June 2020

Abstract

Background and Aims
There are numerous studies on AAV, however, data describing the use of immunosuppressive treatment in AAV patients (pts) on chronic dialysis are limited. Most studies found that the incidence of infection is much higher than that of relapses (0.05-0.1 pt per year), suggesting that immunosuppression should be stopped after 3 months in pts with end-stage renal failure.

Material, Method
Retrospective analysis of immunosuppressive treatment in pts on chronic dialysis due to AAV. From 1995 to 2019 139 pts were diagnosed with AAV. Among them 38 patients (26 female, 12 male, mean age 58 years) needed chronic dialysis (&gt;90 days) due to severe renal AAV (29), relapsing renal disease (6) or progressive CKD without active vasculitis (3).

Results
Microscopic polyangiitis was diagnosed in 20, granulomatosis with polyangiitis in 14, eosinophilic granulomatosis with polyangiitis in 4 cases. MPO-ANCA was more frequent than PR3-ANCA (23 vs 12), in one case both ANCAs were positive, and in two cases both were negative. The mean dialysis duration was 55 months (4–180 months). 18 pts (47%) had at least one relapse during the observation period. The mean age, the clinical diagnosis, the type of ANCA did not cause any difference, the dialysis time was longer in the relapsed pts group (72+/-38 vs. 40+/-29 months) compared to pts without relapse. High relapse rate was seen in 6 cases. Three patient had continuously high level of PR3-ANCA without relapse or any sign of disease. Relapses were treated mostly with combined therapy of corticosteroids and oral/intravenous cyclophosphamide followed by azathioprin maintenance therapy. Cortocosteroid alone was used in 7 pts, rituximab in five pts as maintenance therapy. Serious infection (needing hospital care) rate during any immunosuppressive treatment was 0.12 per patient-years. There were 12 deaths on dialysis, the median time to death was 61 months (range 3–132). The deaths rate was higher (9/18 vs. 4/20) in relapsed pts, 4 occurring during immunosuppressive treatment. Causes of deaths were cardiovascular (8), sepsis (3), malignancy (2 pts). Seven pts received kidney grafts, 15 pts remained on dialysis, but in three case dialysis could be discontinued after 16, 35 and 36 months.

Conclusion
Our study points to higher relapse rate and lower serious infection rate in AAV pts on chronic dialysis compared to previous studies. It seems reasonable to continue immunosuppression above 3 months in pts remaining on chronic dialysis. This approach may decrease the relapse rate preventing damage of other organs, allowing transplantation and in some pts recovery of renal function could be achieved.
P0215EXCESSIVE TISSUE SODIUM STORAGE IN PATIENTS WITH NON-DIALYSIS DEPENDENT CARDIO-RENAL SYNDROME IS COMPARABLE TO HEMODIALYSIS PATIENTS
Authors: Lemoine Sandrine , Salerno Fabio , Akbari Alireza , McIntyre Christopher 
Published: June 2020

Abstract

Background and Aims
Both CKD and heart failure (HF) are characterized by a propensity to retain sodium. Renal dysfunction worsens the progression of heart failure and is associated with worse outcomes. This may be a result of synergistic aggravation of sodium retention by the two conditions. We aimed to compare tissue Na storage in skin and muscle between cardiorenal (CR) patients and patients with a range of renal dysfunction, including those requiring hemodialysis (HD).

Method
Proton and 23Na images of the lower limb were acquired on a 3T MRI. We studied 9 CR patients, 7 matched CKD 2-5 patients (without HF) and 31 established HD patients. Regions of interest including skin and soleus were drawn on images to provide a quantitative sodium measurement and these tissue concentrations compared between groups. Blood samples were drawn at each scan in all patients. Spot urine samples were collected for CR patients.

Results
For CR patients, mean age was 66 ± 8 years, 78% of male, mean estimated glomerular filtration rate (eGFR) was 52 ± 18 mL/min/1.73m2, urea was 11 ± 6 mmol/L. For HD patients, mean age was 66 ± 8.7 years, 68% of male and mean dialysis vintage was 38 ± 37 months for HD patients. Mean age was 63 ± 8, 71 % of male, eGFR 45 ± 29 mL/min/1.73m2 for CKD patients. CR patients displayed an increased amount of salt in skin (32.5 ± 13 mmol/L) and muscle (26 ±4 mmol/L) with levels significantly higher than that seen in GFR matched controls (without HF) and comparable to HD patients (31 ±12 and 28 ± 6 mmol/L p=0.9 and p=0.3 respectively) without meaningful residual renal function.

Conclusion
The combination of HF and CKD is associated with intense tissue Na storage; resulting in tissue Na accumulation in CR patients (with reasonably well-preserved renal function) similar to CKD patients requiring HD.
P0221SOLUBLE UROKINASE RECEPTOR (SUPAR) IS A PREDICTOR OF DISEASE STATE AND RENAL PROGNOSIS IN PRIMARY NEPHROTIC SYNDROME
Authors: Fujimoto Keiji , Kagaya Yu , Fujii Ai , Kumano Syo , ADACHI HIROKI , Kengo Furuichi , Yokoyama Hitoshi 
Published: June 2020

Abstract

Background and Aims
A hypothesis has been proposed that serum (s-) soluble urokinase receptor (suPAR) activates glomerular podocyte β3 integrin to cause podocyte injury and onset of proteinuria in primary nephrotic syndrome (pNS). However, s-suPAR has been questioned as a disease marker for pNS because it did not correlate with urinary protein (UP). Furthermore, there are a few reports that suggested a correlation between urinary (u-) suPAR and UP by univariate analysis, but the correlation between the two has not been studied by multivariate analysis taking confounding factors into account. In addition, it is unclear how u-suPAR is involved in the pathogenesis of pNS.

Method
In 36 patients with pNS including minimal change (n=18), focal segmental glomerulosclerosis (n=7), membranous nephropathy (n=9) and membranoproliferative glomerulonephritis (n=2), the relationship between u-suPAR (pg/mgCr) and UP (g/gCr) was examined by cross-sectional analysis of baseline values before treatment and longitudinal analysis of changes during the first 2 months of treatment (⊿). In addition, the localization and staining intensity of activated β3 integrin in renal tissue were examined by immuno-histochemistry methods. We also examined whether s-suPAR (pg/ml) or u-suPAR is useful for predicting renal prognosis (1.5-fold increase from baseline in s-Cr) using Cox proportional hazard analysis.

Results
In cross-sectional analysis, u-suPAR was a UP predictor independent of s-suPAR, eGFR and selectivity index (S.I.) [standardized partial regression coefficient (stdβ) = 0.879, p &lt;0.00001]. Also in the longitudinal analysis, ⊿u-suPAR was a ⊿UP predictor independent of ⊿s-suPAR, ⊿eGFR and S.I. (stdβ = 0.574, p = 0.003). Furthermore, there were significant correlations between u-suPAR and u-L-FABP (r = 0.522, p = 0.001), and between ⊿u-suPAR and ⊿u-L-FABP (r = 0.395, p = 0.017). Activated β3 integrin was mainly detected on proximal tubular brush-border (PTBB), but not glomerular capillaries, moderate to strongly positive in pNS. ⊿s-suPAR was the only predictor of 1.5-fold increase from baseline in s-Cr (Hazard Ratio: 1.361 per 500 pg/ml increase of s-suPAR, p=0.006).

Conclusion
In pNS, u-suPAR was a proteinuria predictor independent of s-suPAR, suggesting the possibility of the mechanisms of proteinuria through β3 integrin activation in PTBB by u-suPAR. In addition, s-suPAR was useful in predicting renal prognosis.
P0225THE PRESENCE OF SIMPLE RENAL CYST IS ASSOCIATED WITH INCREASED RISK OF ALBUMINURIA IN YOUNG ADULTS
Authors: Boo Hyo Jin , SONG SEUNGMIN , Lee Jung Eun , Jang Hye Ryoun , Huh Wooseong , Kim Dae Joong , Kim Yoon-Goo 
Published: June 2020

Abstract

Background and Aims
It is well-known that the prevalence of simple renal cyst increases with age. However, simple cysts are occasionally found in adults younger than 40 years of age. This cross-sectional study evaluated the clinical significance of simple renal cysts in young adults, focusing on the associations with hematuria and albuminuria.

Method
Adults younger than 40 years who received a comprehensive medical checkup from January 2005 to December 2013 were included. Simple renal cysts were identified by ultrasonography.

Results
Among 5832 subjects, renal cysts were found in 276 (4.7%). Subjects diagnosed with polycystic kidney disease (n=5) or medullary sponge kidney (n=1) were excluded from the analyses. A single cyst and multiple cysts were found in 234 (4.0%) and 42 (0.7%) subjects, respectively. The locations of single cyst were cortex in 187, medulla in 26, and parapelvic region in 21. Age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02-1.12 per 1-year increment, P = 0.002), systolic BP (OR, 1.01; 95% CI, 1.00-1.02 per 1-mmHg increment, P = 0.006), and hypertension (OR, 1.85; 95% CI, 1.24-2.76, P = 0.003) were independent predictors of the presence of simple cyst. The presence of cysts was not associated with increased prevalence of hematuria. While, the subjects with cysts had higher prevalence of albuminuria than those without cysts (11.3% vs. 4.5%, P &lt;0.001). Multivariate analyses of albuminuria revealed that the presence of simple renal cyst was associated with a 2.30-fold increase in the prevalence of albuminuria (95% CI 1.512-3.519, P &lt;0.001) independently of other risk factors. The location of the cysts was not related to the prevalence of albuminuria.

Conclusion
The presence of simple renal cysts was independently associated with increased prevalence of albuminuria. The causal relationship between renal cysts and albuminuria needs to be elucidated in further studies.
P0226CONSEQUENCES OF SUPRAPHYSIOLOGICAL DYALYSATE MAGNESIUM CONCENTRATION ON ARTERIAL STIFFNESS, HEMODYNAMIC PROFILE AND ENDOTHELIAL FUNCTION IN HEMODIALYSIS: A RANDOMIZED CROSS-OVER STUDY AND FOLLOW-UP
Authors: Del Giorno Rosaria , Lavorato Soraya , Stefanelli Kevyn , Allegra Giampiero , Zapparoli Claudia , Lazarevic Pedrag , Berwert Lorenzo , Gabutti Luca 
Published: June 2020

Abstract

Background and Aims
Increasing dialysate magnesium improves vascular stiffness in subjects undergoing maintenance hemodialysis. The present findings merit a larger trial to evaluate the effects of a 0.75 mmol/L D-Mg2+ on major clinical outcomes.

Method
A randomized 4-week cross-over study aimed at investigating the consequences of increasing D-Mg2+ from 0.50 to 0.75 mmol/L on arterial stiffness, hemodynamic profile, and endothelial function in subjects undergoing hemodialysis. The long-term effect of higher D-Mg2+ on mineral metabolism markers was investigated in a six-month follow-up. Data were analysed by linear mixed models for repeated measures.

Results
Pulse wave velocity and pulse pressure significantly decreased on the higher D-Mg2+ compared with the standard one by -0.91 m/sec (95% confidence interval: -1.52 to -0.29; p=0.01) and -9.61 mmHg (-18.89 to -0.33, p=0.04), respectively. A significant reduction in systolic blood pressure of -12.96 mmHg (-24.71 to -1.22, p=0.03) was also observed. No period or carryover effects were observed. During the long-term follow-up the higher D-Mg2+ significantly increased total serum and ionized Mg (mean percentage change from baseline to follow-up +21%; and + 27%; p≤0.001 for both), while parathormone (PTH) decreased significantly (-11%, p=0.03).

Conclusion
Increasing dialysate magnesium improves vascular stiffness in subjects undergoing maintenance hemodialysis. The present findings merit a larger trial to evaluate the effects of a 0.75 mmol/L D-Mg2+ on major clinical outcomes.
P0233ISOLATED MICROHEMATURIA IN ADOLESCENTS IS NOT ASSOCIATED WITH RENAL OR URINARY TRACT CANCER IN MIDDLE AGE
Authors: Leiba Adi , Fishman Boris 
Published: June 2020

Abstract

Background and Aims
Chronic or persistent isolated microhematuria (microhematuria without proteinuria) is not as benign as originally thought. It has been associated with an almost 20-fold risk of developing ESRD ( End Stage Renal Disease) in adulthood. It is still unclear if this chronic glomerular bleed increases the risk of renal or urinary tract tumors, secondary to ongoing irritation and inflammation. This is a valid question, especially as an adult with long standing isolated “glomerular” microhematuria can appear with an event of macrohematuria. In order to answer these questions, we studied the association between adolescent microhematuria and renal or urinary tract tumors in adulthood.

Method
A retrospective study based on a cohort of 2,172,866 Jewish adolescents (60% men) aged 16-19 who underwent a mandatory physical examination between ages of 16 and 19 years from 1967 to 2007 prior to their conscription. Urothelial Transitional cell carcinoma (TCC) and Renal cell carcinoma (RCC) incidence through December 31, 2012 was identified by linkage to the national cancer registry. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for RCC and TCC among adolescents who were diagnosed with persistent asymptomatic isolated hematuria after comprehensive medical evaluation. The models were adjusted for: Sex, age, year of birth, socio-economic status, BMI, years of education and country of origin.

Results
Over a median of 22 years (interquartile range of 13-31 years) of follow-up, 2007 and 1112 incident cases of TCC and RCC, respectively, occurred amongst the study population. Persistent hematuria was not associated with TCC with crude HR 1.15 (95% CI, 0.37-3.57) and adjusted HR of 1.08 (95% CI, 0.35-3.36), nor with RCC with crude HR 1.11 (95% CI, 0.28-4.457) and adjusted HR of 0.93 (95% CI, 0.23-3.75).

Conclusion
Isolated persistent microhematuria, while carrying a small risk of kidney disease progression, is not associated with either renal or urinary tract tumors. Screening guidelines among these patients should follow the general age and sex- matched approach.
P0234LOW URINARY CITRATE LEVELS ARE NOT SPECIFIC OF AUTOSOMAL POLYCYSTIC KIDNEY DISEASE (ADPKD) AND ARE PRESENT WHEN RENAL FUNCTION IS IMPAIRED IN ALL NEPHROPATIES
Authors: Borrego-Utiel Francisco-Jose , Merino Garcia Enoc , Herrera Isidoro , Moriana Dominguez Clara , Camacho Reina Victoria , Ocaña Perez Esther , García Cortés Maria José 
Published: June 2020

Abstract

Background and Aims
In polycystic kidney disease (PKD) it is frequently found a reduction in urinary citrate that is related with degree of renal impairment but it is unknown if this alteration is specific or if it is also present in other nephropathies. Recently it has been suggested that urinary citrate could be a marker of covert metabolic acidosis and reflects acid retention in chronic kidney disease (CKD). Our aim was to compare urinary citrate in PKD with other renal diseases and to show its relation with serum bicarbonate and excretion of uric acid and calcium.

Method
We determined citrate, calcium and uric acid in 24-hour urine in patients with PKD and with other nephropathies with varied degree of renal impairment followed in a outpatient clinic of nephrology.

Results
We included 291 patients, 119 with glomerular diseases, 116 with PKD, 21 with other nephropathies, and 35 patients with normal renal function. Urinary citrate was higher in women (Females 309±251 mg/gCr vs. males 181±145 mg/gCr, p&lt;0.001) and in patients with normal renal function (normal 380±210 mg/gCr; PKD 203±166 mg/gCr; glomerular 279±282 mg/gCr; p&lt;0,001). PKD patients showed similar values of urinary citrate to patients with glomerular diseases and with other nephropathies. We observed a progressive reduction in urinary citrate parallel to degree of renal impairment, in a comparable way among patients with PKD and glomerular diseases. We did not observe a relationship between urinary citrate and serum bicarbonate levels. Calcium and uric acid elimination in ADPKD patients was similar to other nephropathies and lower to patients with normal renal function. However, serum uric acid was significantly higher in glomerular patients than other nephropathies after adjust with glomerular filtration rate and sex.

Conclusion
Hypocitraturia is not specific of PKD but it is also present in all nephropathies. Urinary citrate are related to degree of renal impairment and it is not related with serum bicarbonate. We think that it could be interesting to study urinary citrate as a marker of renal function and its role as prognostic factor of renal deterioration.
P0237COMPARISONS OF CLINICAL FEATURES IN GITELMAN SYNDROME PATIENTS WITH DIFFERENT URINARY CALCIUM EXCRETIONS
Authors: Zhang Lei , Zhao Bingbin , Peng Xiaoyan , Wang Ying , Chen Limeng 
Published: June 2020

Abstract

Background and Aims
Hypocalciuria is considered typical in Gitelman syndrome (GS). However, a few GS cases diagnosed by gene testing presented as normocalciuria have been reported in recent years. Our study is to observe the clinical features in GS patients with different urinary calcium excretions, and investigate the value of urinary calcium excretion in the clinical classification for GS.

Method
GS cases from the National Rare Diseases Registry System of China (NRSC) (2016-2018) with SLCl2A3 gene screened in Peking Union Medical College Hospital were collected. The features of urinary calcium excretion were analyzed, and the phenotypes of patients with hypocalciuria were compared to those with normocalciuria. Hydrochlorothiazide (HCT) test was performed and the maximal increasement of chloride excretion fraction (△FECl) was calculated to evaluate the extent of NCC dysfunction.

Results
A total of 83 genetically proven GS patients was included, with the mean age at diagnosis of 31.0±13.0 years, and the male/female ratio was 1.4:1. Among them, 53 (63.9%) patients had hypocalciuria. The ratio of urinary calcium/creatine was significantly lower in patients with hypocalciuria (0.08±0.06mmol/mmol) compared to those with normocalciuria (0.47±0.28mmol/mmol), with a P value of &lt;0.001. Age, gender, estimated glomerular filtration rate, blood pressure, alkalosis, and serum and urinary electrolytes including potassium, magnesium, natrium, chloride, and phosphorus were all comparable between patients with hypocalciuria and normocalciuria. Based on a standardized symptom questionnaire, fatigue (52.8% vs. 76.7%, P=0.03) and polyuria (9.4% vs. 30.0%, P=0.02) were less frequently reported in hypocalciuria patients, while all the other clinical symptoms were comparable. Sixteen patients in each group underwent HCT test, and the △FECl value was comparable between patients with hypocalciuria and normocalciuria (median, 0.54% vs. 0.83%, P=0.88), both of which indicated a blunt response to HCT (&lt;2.86% according to our previous study).

Conclusion
The results show that 63.9% of the GS patients in this study had hypocalciuria. There is no definite relationship between urinary calcium excretion, phenotype and the extent of NCC dysfunction.
P0242SUBGROUP EFFICACY ANALYSIS OF SODIUM ZIRCONIUM CYCLOSILICATE (SZC) IN HYPERKALAEMIC HAEMODIALYSIS PATIENTS IN THE DIALIZE STUDY
Authors: McCafferty Kieran , Fishbane Steven , Spinowitz Bruce , Rastogi Anjay , Ford Martin , Guzman Nicolas 
Published: June 2020

Abstract

Background and Aims
Patients with end-stage renal disease have severely reduced renal potassium excretion and many require haemodialysis (3 days/week) to maintain normal serum potassium (sK+). The phase 3b DIALIZE study (NCT03303521) showed that sodium zirconium cyclosilicate (SZC) reduces predialysis sK+ after the long interdialytic interval and is well tolerated in haemodialysis patients with hyperkalaemia. This post-hoc analysis of the DIALIZE data assessed the efficacy of SZC in patient subgroups.

Method
The DIALIZE study randomised 196 patients 1:1 to placebo (n=99) or SZC (n=97). The study consisted of an 8-week treatment period, comprising a 4-week SZC dose titration phase followed by a 4-week evaluation phase. The starting dose of SZC was 5 g orally once daily on non-dialysis days (4 days/week) for the 4-week dose titration phase (titrated in 5 g increments to a maximum of 15 g) to achieve predialysis sK+ 4.0–5.0 mmol/L. Patients maintained a stable SZC dose for the 4-week evaluation phase (SZC 5, 10 or 15 g). Here, we assessed the proportion of treatment responders, i.e. those who during the 4-week evaluation phase achieved predialysis sK+ of 4.0–5.5 mmol/L during ≥3 of 4 haemodialysis treatments after the long interdialytic interval and who did not require potassium-lowering rescue therapy. Treatment responders were stratified by patient subgroups: sex, country, race, age (years), baseline weight (kg) and baseline sK+ (mmol/L).

Results
For patients receiving SZC, at baseline 59% were male, mean age was 55.7 years, 52% were white, 11% were Black or African American and 34% were Asian, and mean predialysis sK+ was 5.8 mmol/L. Using a predialysis sK+ range of 4.0–5.5 mmol/L, 69.1% (n=67/97) of SZC patients and 19.2% (n=19/99) of placebo patients were deemed treatment responders. Response to SZC was generally consistent across patient subgroups vs placebo for sex, country, race, age, baseline weight and baseline sK+, with some variation between subgroup subcategories (Table).

Conclusion
Our results suggest that SZC is generally effective across all groups of haemodialysis patients with hyperkalaemia. SZC responder rates for some patient subgroup subcategories were limited by low patient numbers.