bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0247PREGNANCY IN WOMEN WITH NEPHROTIC-RANGE PROTEINURIA
Authors: Svetitsky Shuli , Lightstone Liz 
Published: June 2020

Abstract

Background and Aims
The adverse effects of chronic kidney disease on pregnancy and pregnancy on renal function have been described, but the effect of severe proteinuria in early pregnancy is not known. The aim of this study was to evaluate the obstetric and renal outcomes of pregnant women with severe proteinuria manifesting in early pregnancy.

Method
We retrospectively assessed the records of over 400 women with renal disease who were cared for during pregnancy in Queen Charlottes and Chelsea hospital and identified women with nephrotic range proteinuria in early pregnancy. Their records were reviewed and outcomes were compared to women with CKD and little or no proteinuria in early pregnancy.

Results
The study included 99 women with renal disease, of these 37 with severe proteinuria, and 62 patients who had mild or no proteinuria. The baseline GFR and blood pressure in the groups was similar. There were significantly more women with glomerular diseases in the group with proteinuria. The group with severe proteinuria had significantly higher rates of delivery by C-section, and prematurity including severe prematurity (&lt;34 weeks). They had lower average birth weight and more babies born with very low birth weight. Their renal outcomes were poorer, with a lower eGFR at 3 years and a higher rate of advanced CKD and renal replacement therapy.
In the women with proteinuria, the level of scarring on renal biopsy was found to be a significant predictor of several poor outcomes, including premature birth and developing advanced kidney disease.

Conclusion
Severe proteinuria early in pregnancy is associated with lower birth weight, greater prematurity and poorer renal function in the long term.
Physicians treating these women must be aware that they are at a higher risk of complications than women with renal disease without severe proteinuria.
P0248HEPARIN-INDUCED THROMBOCYTOPENIA (HIT): A POSSIBLE CAUSE OF VENOUS THROMBOEMBOLISM IN ACTIVE SYSTEMIC VASCULITIS
Authors: Boni Francesca , Gregorini Alessandra Gina , Salviani Chiara , Merelli Sara , Portesi Nicola , Martini Giuliana , Alberici Federico , Scolari Francesco 
Published: June 2020

Abstract

Background and Aims
Increased incidence of venous thromboembolism in active phase of vasculitis has been found by several authors. Examining large cohorts of patients, the underlying mechanisms still remain unclear. Patients with active vasculitis are not rarely exposed to heparin mainly because of dialysis, plasmafiltration or ECMO. In the high inflammatory context of active vasculitis, as in major surgery, heparin exposure could promote the formation of anti-PF4/heparin antibodies and induce HIT.

Method
Description of cases with active vasculitis and HIT observed in our cohort of ANCA-associated vasculitis patients from 1994 to 2019. Review of cases reported in the literature.

Results
We observed 18 patients with systemic vasculitis and HIT (10 M and 8 F, median age: 69.5 yo). Fourteen had ANCA antibodies, one patient had both ANCA and anti-GBM antibodies (double positive), two had positive anti-GBM antibodies, one had negative ANCA and anti-GBM antibodies. Among 15 patients with positive ANCAs, 13 had anti-MPO antibodies and 2 anti-PR3 antibodies (Fig. 1).
All patients were exposed to heparin, 10 because of plasmafiltration and dialysis, 8 for dialysis alone. Mean platelet count nadir was 76100/mm3 (range 23000-197000/mm3).
In all patients PF4–heparin antibody immunoassay was strongly positive (optical density &gt;1 in 13 patients).
The most frequent manifestations were thrombocytopenia and repeated clotting of the extracorporeal circuit and dialyzer with thrombosis of the hemodialysis catheter (6/18 patients). Four patients developed deep vein thrombosis almost invariably in the site of the hemodialysis catheter. Pulmonary embolism was observed in only one patient (Fig. 2).
To our knowledge, only 11 cases of HIT in patients with vasculitis have been reported in literature (Table I). Detailed data are available for 7 patients (6 M and 1 F, median age 69.6 yo). Three patients had anti-PR3 antibodies, 2 anti-MPO antibodies, 1 both ANCA anti-MPO and anti-GBM antibodies (double positive), 1 only anti-GBM antibodies. Mean platelet count nadir was 45625/mm3 (range 17000-131000/mm3). Three out of 11 patients developed repeated clotting of the extracorporeal circuit and dialyzer, 2 patients had deep vein thrombosis in the site of the hemodialysis catheter, and one patient had also leukopenia and subarachnoid hemorrhage. Six patients were asymptomatic and developed only thrombocytopenia.

Conclusion
When patients with active systemic vasculitis develop venous thromboembolism and thrombocytopenia after exposure to heparin, or repeated coagulation of the extracorporeal circuit and dialyzer or plasma-filter, HIT should be included in the possible differential diagnosis, and Platelet factor 4–heparin antibody tests should be performed.
P0252TROPONIN T AND LEFT ATRIAL VOLUME INDEX ARE ASSOCIATED WITH THE OCCURRENCE OF NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4-5
Authors: Hakamäki Markus , Hellman Tapio , Lankinen Roosa , Koivuviita Niina , Pärkkä Jussi , Kallio Petri , Kiviniemi Tuomas , Airaksinen Juhani , Järvisalo Mikko , Metsarinne Kaj Peter 
Published: June 2020

Abstract

Background and Aims
Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and often co-existing conditions. However, little is known on the prevalence and incidence of AF in patients with CKD stage 4-5.

Method
We prospectively recruited 210 consecutive non-dialysis patients with CKD stage 4-5 between 2013 and 2017. Follow-up data on AF occurrence as well as baseline medical history, laboratory tests and echocardiography were collected.

Results
At baseline, mean age was 62 years, 73/210 (34.8%) of the participants were female, mean estimated glomerular filtration rate was 12.8ml/min and 41/210 (19.5%) patients had a prior diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF was detected in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition, most commonly severe infection or surgery, and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age &gt;60 years (HR 4.27, CI95% 1.57-11.64, p&lt;0.01), elevated troponin T (TnT) &gt;50ng/l (HR 3.61, CI95% 1.55-8.37, p&lt;0.01) and left atrial volume index (LAVI) &gt;30ml/m2 (HR 4.82, CI95% 1.11-21.00, p=0.04) independently predicted the occurrence of new-onset AF. Furthermore, the predictive effect of the covariates was cumulative (Figure 1).

Conclusion
The incidence rate of AF was remarkably high in this prospective study on patients with CKD stage 4-5. Elevated TnT and increased LAVI are associated with the occurrence of new-onset AF in patients with severe CKD.
P0290THERAPEUTIC PLASMAPHERESIS EXPERIENCE DUE TO NEPHROLOGICAL INDICATIONS
Authors: Baloglu İsmail , Serin Hatice Ozge , Tonbul Halil Zeki , Selcuk Nedim Yılmaz , Turkmen Kultigin 
Published: June 2020

Abstract

Background and Aims
Therapeutic plasma exchange (PEX) has an increasingly long list of indications in recent years, in addition to immunosuppressive therapies in many life-threatening immune activations, it provides significant improvements in mortality and morbidity. In this study, we aimed to investigate the laboratory and clinical effects of PEX performed with nephrologic indication in our clinic.

Method
The records of 67 patients (36 females, 31 males; mean age, 45.7±15.8 years) who underwent PEX with nephrological indication between 2012 and 2017 in our clinic were retrospectively reviewed. Characteristics of the patients such as, indications of PEX, laboratory values and number of PEX sessions were recorded. In addition, clinical responses were also evaluated.

Results
When a total 398 PEX sessions were examined, the most common indication (40.3%) was acute humoral rejection after renal transplantation, followed by granulomatosis with polyangiitis (19.4%) and thrombotic microangiopathy (9%), respectively. The average of the PEX sessions was 5.94. There was a statistically significant increase in the bicarbonate value when the arterial blood gas of the patients was evaluated after PEX (p=0.002). However, no significant difference was observed in the pH and ionized calcium values (p=0.135, p=0.969, respectively) (Table 1).
When all the patients were evaluated, there was no significant change in hemoglobin values (p=0.174), but platelet values decreased significantly (p=0.011) after PEX. However, when the patient group admitted with thrombotic microangiopathy was examined, it was observed that platelet count increased and LDH level decreased significantly (p=0.063, p=0.028, respectively).
When the serum creatinine values of all patients were evaluated, a significant decrease was observed in the serum creatinine values after PEX (p=0.001). In addition, after 2 years following PEX treatment, 70.1% of patients were still alive and 12.5% of patients undergoing PEX for acute humoral rejection were undergoing on hemodialysis treatment.

Conclusion
According to the results of our study, patients should be followed up especially for acid-base and electrolyte changes after PEX. In addition, therapeutic PEX might be effective in terms of improving morbidity and 2 year-mortality of these patients.
P0308IMPACT OF MAJOR SURGICAL OPERATIONS ON CLINICAL OUTCOME IN DIALYSIS PATIENTS
Authors: Eren Sadioğlu Rezzan , Kumru Şahin Gizem , Kutlay Sim , Şengül Şule , Keven Kenan , Nergizoglu Gökhan , Ateş Kenan , Duman Neval , Ertürk Şehsuvar 
Published: June 2020

Abstract

Background and Aims
We aimed to study the impact of major surgical operations on clinical outcome in patients with end-stage kidney disease treated with haemodialysis (HD) or peritoneal dialysis (PD).

Method
We retrospectively evaluated the records of all patients on HD and PD, who had been treated for at least 3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory parameters, data on all major surgical operations were recorded.

Results
Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. The mean age (±SD) was 58.3±14.5 years, 48% were female and 28% had diabetes mellitus. Forty-seven patients (23%) had a major surgical operation. The operation types were cardiovascular in 14 patients, orthopaedic in 11, gastrointestinal in 8, genitourinary in 6, parathyroidectomy in 5 and brain, pulmonary and breast in 1 patient each. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study population, 59 patients (29%) died during the study period. In Kaplan-Meier analysis (Figure), mean (95% CI) survival time in operated patients was 43 months (37 to 49 months), while it was 49 months (46 to 52 months) in the others (p=0.023). Fifteen out of 23 deaths (65%) among the operated patients occurred in the first month after surgery. Severe perioperative complications (arrhythmias, hypervolemia, hypotension, bleeding, acute coronary syndrome, respiratory failure and cerebrovascular event) were recorded in 17 (36%) of the operated patients, of whom 16 died (p=0.001). Although did not reach a significant level, mortality rate tended to be higher after emergent operations than that after elective operations. Cox regression analyses revealed that age (RR 1.033, 95% CI 1.010-1.057, p=0.005), diabetes (RR 2.581, 95% CI 1.474-4.521, p=0.001), preoperative C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, p&lt;0.0001) and having a major surgical operation (RR 1.868, 95% CI 1.068-3.268, p=0.028) were the independent predictors of mortality.

Conclusion
Although prospective studies with a higher patient number are needed to confirm, our study shows that, in addition to age, diabetes and inflammatory status, having a major surgical operation is an independent risk factor for mortality in dialysis patients. The prevention and management of perioperative complications properly may result in more favourable outcomes in these patients.
P0312ALTERATIONS IN THE PROGRESS OF LYMPHOCYTE APOPTOSIS IN PRE- AND POST- DIALYSIS END STAGE RENAL DISEASE PATIENTS
Authors: Daikidou Dimitra Vasileia , STANGOU MARIA , Sampani Erasmia , Asouchidou Despoina , Nikolaidou Vasiliki , Dimitriadis Chrysostomos , Lioulios Georgios , Pella Eva , Anastasiou Aikaterini , Fylaktou Asimina , Papagianni Aikaterini 
Published: June 2020

Abstract

Background and Aims
Lymphocyte apoptosis, as a programmed mechanism of lymphocyte death, is essential in maintaining homeostasis and balance between inflammatory and immune reactions. Disturbances in the apoptotic progress, leading to fragmented lymphocytes, “late apoptotic” cells, may result in immunodeficiency, oncogenesis, atheromatosis, etc. Aim of the present study was to investigate the lymphocyte apoptotic progress in End Stage Renal Disease (ESRD) and the effect of dialysis.

Method
The study included patients on ESRD; measurements were performed at the first day of dialysis (T0) and repeated 6 months later (T6), while being on dialysis. Total lymphocytes and B lymphocytes (CD19+) were gated and stained with Annexin V to detect apoptotic cells; early and late apoptotic cells were quantified. The results were compared to age-matched healthy control group.

Results
ESRD patients had reduced lymphocyte and B cell count, 1550±592μ/L vs. 2692±690μ/L, p&lt;0.001 and 120.4±80μ/L vs. 321.7±184.7μ/L, p=0.002, respectively, compared to controls. There was an increase in total lymphocytes and B cells, being on later apoptotic stages (LAS) in ESRD-T0 compared to controls, 0.3±0.8% vs. 0.06±0.1%, and 0.04±0.08% vs. 0.01±0.03%, respectively, although differences did not reach statistical significance. After 6 months on dialysis, a reduction was noticed in the population of lymphocytes on LAS, 0.18±0.2% from 0.34±0.8%, while there was an increase of B cells on LAS, 0.1±0.2% from 0.02±0.07, with subsequent alterations in total numbers of apoptotic cells were also evident

Conclusion
Late apoptotic changes affecting total and particularly B lymphocytes happen in ESRD, and initiation of dialysis seem to cause further alterations, which may be implicated in the increased morbidity and mortality of disease
P0315SUCCESFUL TREATMENT OF A STRETOCOCCUS-PNEUMONIAE-ASSOCIATED HAEMOLYTIC URAEMIC SYNDROME BY A SHORT COURSE OF ECULZIMAB
Authors: Frimmel Silvius , Hinz Michael , Henschel Joerg , Mitzner Steffen , Koball Sebastian 
Published: June 2020

Abstract

Background and Aims
Hemolytic uraemic syndrome (HUS) is a known rare complication of Streptococcus pneumonia infections (SP-HUS) and is characterized by microangiopathic hemolytic anemia, thrombocytopenia and renal failure. In adults it is associated with a higher mortality than HUS due to other etiologies.

Method
Case Report

Results
A 33-years old female patient with a history of alcohol abuse was referred to hospital with hypotension and symptoms of infection, including high fever and diarrhea, which had occurred since three days. On admission the patient presented with septic shock and was transferred to the intensive care unit. There she showed signs of hemolytic uraemic syndrome, including severe thrombocytopenia (11 Gpt/l), schistocytosis, elevated lactate-dehydrogenase (LDH; max. 2300 U/l), low haptoglobine (&lt;0,3g/l) and acute anuric renal failure with need of continuous renal replacement therapy. Severe confusion and necrotic lesions of the extremities completed the clinical picture. Plasma exchange (PE) was initiated under suspected thrombocytopenic thrombotic purpura (TTP). Under PE the clinical situation did not ameliorate and signs of severe HUS persisted. A total of four PE were realized, TTP was excluded by Factor VIII-ADAMTS13-activity above the diagnostic limit. In the peripheral blood cultures Streptococcus pneumonia was detected, and antimicrobial was deescalated from piperacillin/tazobactam to penicillin G. Under the clinical picture of a persistent severe pneumococcal associated HUS, without clinical benefit of PE, we decided to start therapy with eculizumab, a monoclonal anti-C5-antibody, approved for the therapy of aHUS and with anecdotical evidence of efficacy in SP-HUS. We started with 1200 mg of ECZ, followed by doses of 900 mg weekly with a total of four doses. Under therapy thrombocyte count normalized, renal function ameliorated and dialysis could be discontinued, the levels of haptoglobin and LDH normalized. The patient could be referred to a rehabilitation clinic, where renal function normalized and no further signs of hemolysis were seen three months after discontinuation of therapy under monitoring. The forefoot remained necrotic with need of surgery in future, the ischemic lesions of the hands completely disappeared.

Conclusion
Eculizumab could provide a therapeutic option of pneumococcal associated HUS. Therapy could be safely discontinued after 1 month under strict monitoring of signs of HUS. Further studies are required to document the benefit of complement blockade therapy in severe forms of SP-HUS.
P0316RELATION OF RENAL ULTRASONOGRAPHIC MEASUREMENTS WITH BODY HEIGHT
Authors: Spasovska Vasilova Adrijana , Trajcheska Lada , Milenkova Mimoza , Canevska Aleksandra , Kabova Angela , Stojanoska Ana , Pushevski Vladimir , Rambabova Bushljetikj Irena , Nikolov Igor , Severova- Andreevska Galina , Pavleska Kuzmanoska Svetlana , Petronijevic Dzvezdana , Gerasimovska Kitanovska Biljana , SELIM GJULSEN , Sikole Aleksandar , Ristovska Vesna , Spasovski Goce 
Published: June 2020

Abstract

Background and Aims
Kidney size has been found to be correlated with anthropometric features and is different among different ethnicities. In this study, we used ultrasonography for measurement of kidney volumes in healthy individuals and evaluated the relationships with body height, age and gender.

Method
We conducted a cross-sectional observational study and evaluated 108 healthy individuals whose serum creatinine level was within reference range. Patients’ medical clinical and laboratory records were reviewed. Age, gender and height were recorded. Pearson correlation coefficients were used to evaluate the strength of association between ultrasonographic parameters with each other and with other parameters, and were expressed as r2. Variations in left and right renal dimensions between various age groups were compared using a one-way analysis of variance, followed by a post-hoc Tukey's test.

Results
Subjects’ age ranged from 16 to 84 years and the mean age was over 50 years. There was an equal distribution among genders. Strong and positive correlations were seen for the measured length, parenchyma thickness and also for both total and parenchymal volumes with subjects’ height for both kidneys. The strongest correlations were observed for the left and right kidney length and also for the right kidney parenchymal volume (r=0.536, p=0.001; r=0.469, p=0.001; r=0.44, p=0.001). On the opposite, most of the relations with age were negative, but week and insignificant. When we divided the study subjects into three age groups and compared them for the height, there was no significant difference among them. Regarding the parenchymal and total kidney volumes of both kidneys, the different age groups showed similar findings in the ultrasonographic measurements. The mean calculated volumes were slightly declining with age and showed the largest values in the first group of patients under 30 years and lowest values in patients over 70 years old. Ultrasonographic measurements were also compared among the two genders. Both (men and women) showed similar age (53.55 ± 18.22 vs. 50.79 ± 18.13 p= 0.430, respectively). As for the height, men were significantly taller than women (1.734 ± 0.007 vs.1.637 ± 0.005, p= 0.001). The kidney length, volume and parenchymal volumes of both kidneys were significantly larger in men.

Conclusion
Renal length and volume are strongly correlated with body height. This relation must be considered in clinical decisions on further investigations regarding kidney disease progression.
P0321OUR EXPERIENCE OF PATIROMER (VELTASSA) USE AND POTENTIAL COST-BENEFITS AT SOUTH TYNESIDE AND SUNDERLAND NHS FT, U.K
Authors: Coates James , Hinchliffe William 
Published: June 2020

Abstract

Background and Aims
Patiromer is a new medication used to manage hyperkalaemia and acts as a bowel cation-exchange polymer with a simpler dosing and more favourable side effect profile than existing agents. In May 2018, South Tyneside and Sunderland NHS Foundation Trust (STSFT) implemented a protocol for the use of Patiromer in managing chronic hyperkalaemia to enhance options for managing cardio-renal patients in clinic. Conditional on our successful formulary application, was an audit against the protocol aiming to understand utility. Our second aim was to identify potential cost-benefits of patiromer. In particular, we were interested in preventing hospital admissions, bed days saved, temporary venous lines and dialysis sessions. It is important to note this analysis is subject to interpretation based on likely outcome should patiromer not have been given.

Method
To be eligible, patients had to have eGFR &lt;30 and either a potassium &gt;5.5 precluding the use of RAASi/MRAs or a recurrent potassium &gt;6. Using electronic patient record system, we investigated 49 patients commenced on patiromer between October 2018 and October 2019.

Results
Only 14% of the incident prescriptions were in clinic with over half starting at a higher than UK licensed dose (once daily). The distribution of hyperkalaemia was varied as defining hyperkalaemia onset is challenging and what we found as more emergency use. We also identified the following clinical savings: 12 fewer bed days, 15 temporary lines and a minimum of 25 dialysis sessions avoided. Interestingly, we also found that in 2 cases, physicians utilised patiromer and avoided a referral to the renal team. Furthermore, we identified 11 uses of patiromer in the conservative/palliative setting allowing patients to withdraw from dialysis and to prevent discussions on commencing renal replacement therapy for concerns around hyperkalaemia. It would also provide a quality of life benefit avoiding recurrent cannulation to facilitate the standardised medical management of hyperkalaemia.

Conclusion
In conclusion, whilst this may not demonstrate an objective cost benefit, it does show the versatility of patiromer use in clinical practice. We have found an emphasis on usage in the inpatient setting to avoid dialysis and its attendant costs, rather than where its evidence base originates: as a renin-aldosterone blockade enabler in the outpatient setting. We have demonstrated awareness of adhering to the protocol criteria, whilst understanding the pitfalls of the protocol and why the medication has been administered out with of it, especially with regards to dosing. We wish to share our experience with clinicians and raise awareness of their growing armamentarium.