bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0605ACUTE KIDNEY INJURY AFTER MAJOR ABDOMINAL SURGERY
Authors: Milinkovic Marija 
Published: June 2020

Abstract

Background and Aims
We analyzed the incidence of acute kidney injury (AKI) after major abdominal surgery, as well as demographic, clinical, laboratory and surgical factors that might have contributed in it's development.

Method
Retrospective data analysis of 83 pts who underwent major abdominal surgery at the emergency surgery department (intraperitoneal approach, hospitalization longer than 48 hours, surgery duration over one hour). Demporaphic data, comorbidities, biochemical parameters (blood count, serum concentrations of nitrogenous substances, electolytes etc), type of surgery, intraoperative characteristics (duration of surgery, blood pressure, use of vasoactive substances), postoperative complications including AKI, defined as serum creatinine concentrations increase of 0.3mg/dl and more or reduction in diuresis, as well as intrahospital mortality.

Results
The mean age of the patients was 60.9 ± 12.9 years. A total of 45 (54.2%) patients were male. AKI was registered in 15 (18.1%) patients with an average age of 69.5 ± 9.2 years, of which 8 (53.3%) were male. The average duration of surgery in the group of patients with AKI was 2.5 ± 0.8 hours, and the most common operations performed in this group involved reconstruction of the small and large intestine. The total intrahospital mortality was 10.8% and in the AKI group 33.3%.

Conclusion
Patients with AKI were significantly older, with more comorbidities and more frequent surgery that involved resection of the small and large intestine. The development of AKI was accompanied by a higher mortality rate. Given the specific pathophysiological mechanisms in abdominal surgery, further study of the factors responsible for the development of AOB is required to contribute to the development of preventive protocols and to reduce the rate of this serious postoperative complication.
P0606OUTCOME OF CANCER PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS
Authors: Isaranuwatchai Suramath , Worawichawong Supanat 
Published: June 2020

Abstract

Background and Aims
Recent advances in treatment of cancer lead to improvement in mortality among cancer patients. However, data regarding outcomes of cancer patients with acute kidney injury (AKI) requiring dialysis were scarce. We conducted this study to see the difference in mortality and other outcomes between cancer and non-cancer patients who had AKI requiring dialysis.

Method
We reviewed medical record of previous 18 months in our institute. Patients with age at least 18 years with acute kidney injury requiring dialysis were included in our study. Primary outcome was mortality at 30 days. Renal recovery and chronic kidney disease (CKD) after AKI events were also recorded.

Results
A total of 61 patients were included in our study; 28 patients had no cancer and 33 patients had cancer. Of cancer patients, 81.8% had advanced stage cancer. Modality of dialysis was continuous renal replacement therapy in 36.1%. Mortality at day 30 was not significantly different between cancer patients and non-cancer patients (57.6% vs. 53.6%, P = 0.754). Of alive patients, renal recovery among cancer patients and non-cancer patients was also not significantly different (69.2% vs. 50.0%, P = 0.310). CKD after episodes of AKI was also not significantly different between cancer patients and non-cancer patients (42.8% vs. 77.8%, P = 0.302).

Conclusion
This is the first study to compare mortality between cancer and non-cancer patients who had AKI requiring dialysis. We found no significant difference regard to mortality between AKI patients requiring dialysis with and without cancer. Renal recovery and CKD development were also not significantly different between two groups. More studies in nephro-oncology field are required for better treatment in cancer patients.
P0613POSTPARTUM ACUTE RENAL FAILURE AND VITAMIN D STATUS A MULTICENTER STUDY OF RISK FACTORS
Authors: Mohamed Cherif Tehir 
Published: June 2020

Abstract

Background and Aims
The postpartum AKI is a particular pathological and chronological entity, which remains a public health problem in Algeria.
The main objective was to describe the epidemiological, clinical and evolutionary profile of postpartum AKI and secondarily to evaluate the impact of Vit D status on: The severity of AKI (using AKIN Classification 2012), the use of the RRT and the Delays and quality of recovery of renal function.

Method
This is an observational, descriptive, prospective and multicentric study performed in two University hospital centers situated in East of Algeria (Annaba and Setif).
All patients admitted to ICU for postpartum complications over a 4 year (2014 to 2018) were included.

Results
Among the 538 pathological post partums identified in the two basins of life 179 (33.28%) presented AKI, the average age is 32.9 years and the average delivery time is 33.88 weeks.
AKI was defined by the KDIGO AKIN classification, the proportion of severe AKI requiring RRT was 34 (18.9%) and the incidence of CKD was 6.7 % with dialysis dependence for 1.11%.
Preeclamptic pathology is in the most commen cause of postpartum AKI (72.3%). However, it is not associated in univariate analysis with the occurrence and severity of AKI.
Associated factors (p &lt;0.05) in univariate and multivariate analysis are: the HELLP syndrome, especially when associated with postpartum hemorrhage (PPH) and acute fatty liver of Pregnancy.
Maternal mortality is dramatically high 20% especially in severe stage of AKI. Absolute deficiency of vitamin D (25OH D) &lt; 10ng/ml is correlated with the severity of the AKI.

Conclusion
The postpartum AKI is inexorably linked to pre-eclamptic pathology and its complications. The frequency of maternal and fetal deaths should prompt new strategies including early detection and closer surveillance, especially of women at risk. A particular attention should be given to vitamine D sttatut during Pregnancy
P0614URINARY EXOSOMAL MICRORNA-21 AS A MARKER OF SCRUB TYPHUS-ASSOCIATED ACUTE KIDNEY INJURY
Authors: Sun In O , Lee Kwang Young , Cho A Young 
Published: June 2020

Abstract

Background and Aims
Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus.

Method
In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI.

Results
Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P&lt;0.01) and chronic kidney disease (8% vs. 0%, P&lt;0.01). Total leukocyte count were higher in patients with AKI than in those without AKI (10.40 × 103/ mL vs. 6.40 × 103/mL, P&lt;0.01). The levels of urinary miRNA-21 were higher in the AKI group than in the non-AKI group. Urinary exosomal miRNA-21 levels correlated directly with serum neutrophil gelatinase-associated lipocalin values and total leukocyte counts and inversely with estimated glomerular filtration rate. The receiver operator characteristics curve analysis for urinary exosomal miRNA-21 showed good discriminative power for the diagnosis of scrub typhus-associated AKI, with area under the curve value of 0.907.

Conclusion
Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.
P0618PREOPERATIVE LOW URINE SPECIFIC GRAVITY PREDICTS ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY
Authors: Jo Wonji , Jung Chan-Young , Kim Jaeyoung , Kim Jihye , Lee Sangmi , Park Jung Tak 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is a common and serious complication following cardiac surgery. However, strategies that effectively predict AKI risk before cardiac surgery are scarce. Recent investigations identified urinary osmolality to be associated with non-glomerular kidney damage in normal kidney function individuals, suggesting urine concentration ability to be a surrogate of early kidney damage. Therefore, hypothesizing that urine specific gravity (SG) could reflect asymptomatic kidney damage, the clinical implication of preoperative urine specific gravity on AKI occurrence after cardiac surgery was investigated in subjects with normal kidney function.

Method
A total of 4135 patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from were enrolled. Patients whose eGFR was lower than 60mL/min/1.73m2 were excluded. Fasting urinary SG was measured from the morning first void a day before the surgery. The patients were divided into tertiles based on urine SG. The primary outcome was occurrence of AKI within 48hours of cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria.

Results
The mean age of the patients was 60 years and 60% were male. Diabetes consisted of 25.6% of the patients and 54.5% were hypertensive. The mean eGFR and urine SG was 98.8mL/min/1.73m2 and 1.020, respectively. AKI developed in 1,089 (26.3%) patients. The incidence of AKI was highest in the lowest urine SG tertile group (410, 29.0%) and lowest in the highest tertile group (304, 23.5%) (P &lt; 0.001). Multivariable logistic regression analysis revealed that being included in the lowest preoperative urine SG tertile group was significantly related with higher post cardiac surgery AKI incidence risk (odd ratio (OR), 1.33; CI, 1.12-1.57; P =0.001). This association was significant even after adjustments were made for confounding factors.

Conclusion
Low urine SG was associated with increased risk of cardiac surgery associated AKI in patient with normal renal function. Evaluating preoperative urine SG may be useful in stratifying post cardiac surgery AKI risk.
P0620OXIDANT-INDUCED RENAL PRECONDITIONING BIOMARKERS FOR AKI PREVENTION WITH RBT-1
Authors: Zager Richard , Johnson Ali , Ruiz Stacey , Guillem Alvaro , Keyser Jeff , Rasmussen Henrik , Singh Bhupinder 
Published: June 2020

Abstract

Background and Aims
Ischemic preconditioning has shown tissue protective effects in various organs including kidneys in animal models. However, the translation of these findings to human acute kidney injury (AKI) has not been successful, at least partly because of difficulty in simulating an ischemic state, as attempted by remote ischemic preconditioning (RIPC). RBT-1 is a novel therapeutic composed of SnPP (tin protoporphyrin) and FeS (iron sucrose) and was designed to induce non-ischemic, oxidant renal preconditioning to prevent AKI. It has shown efficacy in various models of AKI: glycerol-induced (rhabdomyolysis), maleate (ATP depletion), ischemia/reperfusion (I/R), and post-AKI progression to CKD (long-term progression). This study investigated the mechanism of action of RBT-1 in mice, and its translation to the clinical setting.

Method
Male CD-1 mice were pretreated with control or RBT-1 for 18 hours; animals were then sacrificed for assessment of biomarkers of cytoprotection. Nrf2-/- mice were treated for 18 hours with RBT-1 prior to indication of ischemia/reperfusion (I/R); AKI was assessed by blood urea nitrogen (BUN) and plasma creatinine (PCr). Patients with CKD (Stage 3 and 4) were enrolled in Phase 1 studies of FeS and SnPP and cytoprotective biomarkers were assessed.

Results
In mice, RBT-1 significantly increased several Nrf2-dependent antioxidant, anti-inflammatory genes, such as HO-1, NQO1, SRXN1, and GCLC. RBT-1 also increased cytoprotective heavy chain ferritin (Fhc) levels. Nrf2-/- mice were resistant to RBT-1-mediated protection against AKI. At baseline, CKD patients had elevated plasma HO-1 and urinary NQO1 levels. Ferritin and hemopexin levels were also elevated at baseline. RBT-1 components were shown to further increase HO-1, NQO1, ferritin, and hemopexin in patients with CKD.

Conclusion
RBT-1 represents a novel therapeutic approach for the prevention of AKI. It mediates kidney protection by upregulating antioxidant and anti-inflammatory genes. Translation of RBT-1-mediated upregulation of cytoprotective markers has been demonstrated in the clinic in patients with CKD. These data, along with the broad range of RBT-1 activity previously shown in various models of AKI, highlight the potential of RBT-1 in AKI and suggest oxidant-induced renal preconditioning may be protective in preventing AKI.
P0623ACUTE RENAL FAILURE IN HAPOLIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION. TWO GRAFT VS HOST DISEASE (GVHD) PROFILAXIS PROTOCOL COMPARISON
Authors: Solis Miguel Angel , Pérez Ys Aurora , Pérez Ariadna , Hernández-Boluda Juan Carlos , Juan-Garcia Isabel , Gimenez-Civera Elena , Hernani-Morales Rafael , Solano-Vercet Carlos , Torregrosa Maicas Isidro , Gorriz Jose Luis 
Published: June 2020

Abstract

Background and Aims
Haplo-hematopoietic cell transplantation (Haplo-HCT) assures a valid donor in short notice in over 95% of the patients with high risk haematological neoplasia. High doses of post-transplant cyclophosphamide, in combination with other inmunosupressive drugs like calcineurin inhibitors, rapamycine and micophenolate mofetil, is safe and useful in GVHD prevention.
The aim of the study was to analyze and compare acute kidney injury (AKI) in the first 100 days after transplantation, the characteristics of the patients who went on haplo-HCT, and prophylaxis for GVHD with cyclosporine (n=32) (group 1) or rapamycine (group 2), in combination with other immunossupresors.

Method
Fifty-two consecutive patients who recieved a Haplo-HCT at our institution between october/2012 and February/2019 were retrospectively reviewed.

Results
A total of 52 patients were included, 34 male (65.4%), with a median age median age of 52.8 years old (range 18-71). Co-morbidities: hypertension: 13 (25%), Diabetes: 13 (5.8%), previous neoplasia: 4(7.7%). 27 patients received previously platinum-based chemotherapy with and 50% had received a previous HCT. No chronic kidney disease (CKD) were present in any patient. Haematological diseases were :non Hodgkin lymphoma (28.8%), Hodgkin lymphoma (23.1%), acute myeloid leukemia (21.2%), myelodysplastic syndrome (13.5%), other (13.4%). 42 patients (80.8%) received reduced intensity conditioning. Major complications were: TMA: 7(13.5%), Sinusoidal Obstruction Syndrome: 3 (5.8%) and sepsis 27 (51.9%). During the first 100 days post-transplantation follow up, 26 patients (83.2%) in group 1 and 5 patients (25%) in group 2 developed AKI attending KDIGO classification (p&lt;0.0005). At day 100 post-transplantation, 14.5% of survivors had renal failure, defined as increased of serum creatinine ≥ 0.3mg/dL with respect to their baseline. In group 2 none of the patients developed acute kidney injury (0%) at 100 days post-transplantation follow up.
Median serum Cr in survivors at day 100 was 0,65mg/dL in group 1 VS 0.62mg/dL in group 2, (p&lt;0.001).
In the multivariate analysis, treatment with CI (p&lt;0.01) and sepsis (p&lt;0.05) were independent predictors of ARF.

Conclusion
Rapamycin use instead cyclosporine is associated with a significatively lower incidence of AKI in the first 100 days post-tansplantation in our group of patients. The findings of this study call for further research identifying if non cyclosporine group have similar results in term of prevention of GVHD and if this protocol has a better impact in renal function and surveillance in the follow up.
P0627INTRAOPERATIVE DIALYSIS DURING LIVER TRANSPLANTATION IS SAFE AND BENEFICIAL
Authors: Kościelska Małgorzata , Matuszkiewicz-Rowińska Joanna , Zieniewicz Krzysztof , Krawczyk Marek , Giercuszkiewicz Dorota , Sierdziński Janusz , Żebrowski Paweł , Malyszko Jolanta 
Published: June 2020

Abstract

Background and Aims
Orthotopic liver transplantation (OLt) is a technically complex surgical procedure associated with a major risk of hemodynamic instability and metabolic derangement, especially in patients with coexisting renal dysfunction. It remains uncertain if intraoperative renal replacement therapy (ioRRT) during OLt could be beneficial and in which subset of patients.

Method
A retrospective observational study of all adult patients undergoing intraoperative renal replacement therapy during OLt in our center from January 2010 till December 2018. IoRRT consisted of dialysis performed with the use of mobile Genius® single-pass batch dialysis system.

Results
1319 OLts were conducted during the study period and 129 patients (9,8%) were treated with intraoperative dialysis. Seven patients with incomplete documentation were excluded from the study. The mean age of the cohort was 47,8±14,7 years, and 73 (60%) of patients were men. The mean calculated MELD score was 33,7±12,5. 41 procedures (33,6%) were retransplantations and 7 patients underwent simultaneous liver and kidney transplantation. 18 (14,7%) recipients had fulminant liver failure. 66 (54,1%) of patients were admitted to Intensive Care Unit before transplantation. The mean preoperative serum creatinine level was 2,95±1,15 mg/dl and 95 (78%) patients were undergoing renal replacement therapy or had creatinine level ≥2 mg/dl preoperatively. Others required emergent ioRRT due to intraoperative complications and development of significant hyperkalemia or acidosis. The mean preoperative serum potassium concentration was 4,23±0,68 mmol/l and the mean bicarbonate level was 19,8±4,5 mmol/l. Intraoperative dialysis was performed without anticoagulation. The mean surgical time was 400±90,6 minutes and the mean ioRRT duration remained 308 ±109 minutes. Dialysis circuit clotting occurred in 9 (7,3%) cases. There were no other adverse events of ioRRT. Achieved mean arterial bicarbonate and potassium levels after graft reperfusion were 18,5±3,6 and 3,8±0,95 mmol/l, respectively. In 111 cases dialysis was initiated at least 15 minutes before reperfusion. 13% of this subgroup (16 pts) experienced post-reperfusion syndrome (defined as a decrease in the mean arterial pressure of more than 30% of the baseline, occurring within first 5 minutes after the reperfusion of the graft and lasting at least 1 minute).

Conclusion
Our data suggests that intraoperative dialysis in severely ill patients with high MELD score is safe and effective. Lower than expected post-reperfusion syndrome occurrence needs to be confirmed in a study designed with appropriate control group.
P0632RISK FACTORS FOR ACUTE KIDNEY INJURE AMONG PATIENTS WITH RHABDOMYOLYSIS
Authors: Yang Jia , Yang Lichuan , Wang Xin , Wang Siwen 
Published: June 2020

Abstract

Background and Aims
Rhabdomyolysis (RM) is a syndrome characterized by the abruption of the integrity of skeletal muscle cells with subsequent release of intracellular components into extracellular fluid and circulation. Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis. The aim of this study was to assess patients at high risk for the occurrence of AKI defined by KDIGO criteria and in-hospital mortality.

Method
We performed a retrospective study of patients with creatine kinase levels in excess of 1000 U/L, admitted in West China Hospital of Sichuan University from January 2011 to march 2019. The sociodemographic, clinical and laboratory data of the patients were obtained in an electronic medical record database. Univariate and multiple regression analyses were conducted.

Results
329 patients were included in our study. The incidence of AKI was 61.4%, the overall mortality was 19.8%, and patients with AKI tend to have higher mortality than those without AKI (24.8% versus 11.8%, P &lt; 0.01). The clinical conditions most frequently associated with rhabdomyolysis were trauma (28.3%), infection (14.6%), bee stings (12.8%), thoracic and abdominal operations (11.2%) and exercise (7.0%). Patients resulted from sepsis, bee stings and acute alcoholism were susceptible to AKI. The risk factors for the occurrence of AKI among rhabdomyolysis patients included age≥60 (OR 3.070), chronic alcoholism (OR 3.256), hypertension (OR 4.252), multiple organ dysfunction syndrome (OR 7.244), elevated white blood cell counts (OR 1.047) and serum phosphorus (OR 5.526). Age≥60 (OR 3.188), multiple organ dysfunction syndrome (OR 2.262), diabetes (OR 2.746) and elevated prothrombin time (OR 1.079) were independent risk factors for in-hospital mortality of rhabdomyolysis patients with AKI.

Conclusion
AKI is independently associated with mortality in rhabdomyolysis patients. Several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. The findings aiming to suggest early prevention of AKI should target on patients with high risk and more effective management to improve the quality of medical care.
P0634RISK OF HYDROELECTROLYTIC AND ACID-BASE DISORDERS INDUCED BY LIPOSOMAL AMPHOTERICIN B USE IN VISCERAL LEISHMANIASIS PATIENTS
Authors: Freire Bezerra Gabriela , Cavalcante Meneses Gdayllon , Bandeira Lima Danya , Bezerra da Silva Junior Geraldo , Nobre Jacinto Vittoria , Paula Magalhães Emanuel , Pereira da Rocha Thaiany , Prado de Azevedo Isabella Evelyn , De Francesco Daher Elizabeth , Costa Martins Alice Maria 
Published: June 2020

Abstract

Background and Aims
Visceral leishmaniasis (VL) is a serious illness if untreated. Liposomal Amphotericin B (L-AMB) is the more effectiveness treatment against LV and less nephrotoxic formulation. We aim to evaluate expression of kidney transporters in VL patients before and during L-AMB use.

Method
This is a prospective study with 9 selected VL patients that used only L-AMB during hospital stay. Renal transporter analyzes were from before and during the treatment and compared with a control group composed by healthy people. The urine transporters (AQP2, aquaporin 2; NKCC2, Na-K-2Cl cotransporter; NHE3, Na/H exchanger) and a constitutive exosome marker (TSG 101) expressions were measured after urinary exosomes isolation.

Results
No significant increase of TSG 101 was observed in all comparisons, including between both times and vs healthy controls. Additionally, were observed increased urinary protein expression in VL patients in both times (before and after L-AMB use) in comparison with healthy controls of the AQP2: (105.32 (22.90 – 140.27) vs 1362.97 (627.93-2620.09) or 846,20(552.60-1249.14) %, p&lt;0.01); NHE3: (74.81 (57.17 – 126.33) vs 3373.36 (282.69-6877.97) or 462.67 (123.80-7280.21) %, p&lt;0.01); and NKCC2: (90.98 (79.07 – 120.30) vs 634.45 (345.18-1588.41) or 545.74 (284.34-2183.87) %, p=0.03). Moreover, the patients treated with L-AMB showed a significant decrease in AQT2 (P=0.023) and NHE3 (P=0.008) expression.

Conclusion
We suggest that despite less nephrotoxic, the L-AMB use may be monitored to investigate patients at risk of hydroelectrolytic and acid-base disorders.