bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1777BIOMARKERS OF KIDNEY INJURY AS INDICATOR OF PRECLINICAL TRANSPLANT DYSFUNCTION IN PATIENTS WITH TYPE 1 DIABETES MELLITUS AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION AND THEIR RELATIONSHIP WITH EARLY REPARATIVE PROCESSES OF NONMYELINATED FIBERS
Authors: Larina Irina , Severina Anastasia , Shamhalova Minara , Shestakova Marina , Nikankina Larisa , Artemova Ekaterina , Dmitriev Ilya , Pinchuk Aleksey , Kaabak Michael , Musaeva Gulya 
Published: June 2020

Abstract

Background and Aims
To evaluate the relationship of early kidney transplant dysfunction markers with complications of end-stage renal disease (ESRD) and corneal nerve structures in patients with type 1 diabetes mellitus (T1DM) аnd long-term history of diabetes, who reached stable euglycemia after simultaneous pancreas-kidney transplantation (SPKT).

Method
The study included 27 patients with T1DM duration for 21 [19; 28] years, diabetic nephropathy (DN) duration 7,0 [5,5; 13,5] years and duration of renal replacement therapy (dialysis) for 2 [1; 4] years after successful SPKT. The posttransplantation period at the time of inclusion was 61 [20; 90] months. Assessment included examination of level of the main kidney transplant dysfunction markers (KIM-1, NGAL, podocin), examination of state of corneal nerve structures according to corneal confocal microscopy (CCM) as indicator of early reparation processes, diabetes complications/ complications of ESRD with dynamic observation for 1 year. All patients received three-component immunosuppressive therapy.

Results
Despite of reached stable euglycemia (HbA1c 5.5 [5.1; 5.9] %, 5.5 [5.3; 5.7] % after 1 year of follow – up), the restoration of graft function to the rate of estimated glomerular filtration rate (eGFR) CKD-EPI stage C2, albuminuria stage A1, 41% of patients still needed antihypertensive therapy, 37% needed treatment with recombinant human erythropoietin and 30% - antiosteoporotic therapy. There were no statistically significant changes in NGAL, KIM-1, and podocin at baseline and after 1 year in assessment of early kidney transplant dysfunction markers. The results of the correlation analysis revealed associations of NGAL and indicators of CCM (CNFD & NGAL (R=0.61, p = 0.01), CNBD & NGAL (R=0.56, p=0.02), CNFL & NGAL (R=0.65, p=0.009) and vitamin D (R=-0.67, p = 0.008), correlation of KIM-1 with albumin-to-creatinine ratio (ACR) (R=0.43, p= 0.04), correlation of podocin with HbA1c (R=-0.46, p=0.03).

Conclusion
SPKT as the way to achieve euglycemia and compensation of uremia does not provide complete regress of DN and complications of ESRD. The revealed correlations of early, most sensitive kidney transplant dysfunction markers with degree of carbohydrate metabolism compensation, ACR and vitamin D level may reflect the persistence of microstructures damage with stable graft function and demonstrate need of multifactorial management in renal function preservation. At the same time, the statistically significant correlations of early kidney transplant dysfunction markers with the state of corneal nerve structures need more detailed investigation.
P1778PROFILE OF NON-BACTERIAL INFECTIONS SPECIFIC TO RENAL TRANSPLANT RECIPIENTS
Authors: Gupta Anurag , Kanjilal Rahul , Rana Devinder Singh , Bhalla A K , Gupta Ashwani , Malik Manish , Bhargava Vinant , Tiwari Vaibhav 
Published: June 2020

Abstract

Background and Aims
Infections in renal transplant recipients are a major cause of morbidity and mortality. It is the one of the major cause of patient death with functioning graft. Hence this project was done to study the profile of non-bacterial infections specific to renal transplant recipients and to determine the risk factors associated with such infections.

Method
Renal-transplant recipients admitted to the department of nephrology with suspected infection were included in the study.

Results
: A total of 342 patients were included in the study. The mean age of the patients was 45.2 ± 13.3 years. 17.5% had ABO incompatible renal transplant. 91% (87% received leukocyte depleting and 4% received non-leukocyte depleting agents) had received induction as majority had three or more HLA mismatch (70%) and the most common donor was wife. 12.8% had history of graft rejection. A total of 147 infectious episodes were encountered in 121 patients. The incidence of non-bacterial infections was 35% (121/342). Viral infections (68/147 = 46%) and invasive fungal infections (44/147 = 30%) were the most common. Cytomegalovirus infection was the most common 35%. Other viral infections encountered were BK virus associated nephropathy (2.3%) and reactivation of Hepatitis B or C virus (2.6%). The most common site of invasive fungal infection were lower respiratory tract, urinary tract, CNS cryptococcosis, soft tissue infection or cellulitis and oesophageal candidiasis in 41%, 32%, 9%, 9% and 9% respectively. Aspergillus (61%) and Rhizopus (33%) was the most common organism causing fungal pneumonia. Four patients were diagnosed with Pneumocystis jirovecii pneumonia. Majority (60%) of the infections were detected after one year post-transplant. Risk factors found to have statistically significance were ABO incompatibility, diabetes mellitus (pre or post-transplant) and history of graft rejection. Nine patients (7%) died of non-bacterial infections specific to renal transplant recipients.

Conclusion
Non-bacterial infections are not uncommon in Indian scenario and the timeline of such infections has changed.
P1781CONVERSION TO SIROLIMUS IN ADVANCED STAGES OF CHRONIC ALLOGRAFT NEPHROPATHY. A RANDOMIZED CLINICAL TRIAL
Authors: Ghafari Ali , Ghafari Negar 
Published: June 2020

Abstract

Background and Aims
Some studies have shown that proteinuria more than 800 mg per day and glomerular filtration rate (GFR) less than 40 ml/min are the most important relative contraindications for mTOR inhibitors prescription. There is no pathophysiologic reason to put aside mTOR inhibitors in more advanced stages of chronic allograft nephropathy(CAN). To clarify the safety of conversion to mTOR inhibitors in more advanced stages of CAN we conduct a randomized clinical trial

Method
Among 1911 renal transplant recipients which was performed from May 1989 to May 2016, patients (pts) with CAN included to the study. CAN was defined by pathology results and rule out of other causes of renal dysfunction and GFR less than 60 ml/min. pts with recent acute rejection, chronic Ab mediated rejection, active viral infection, malignancy, advanced cardiac, liver and respiratory diseases, obstructive uropathy and non-adherence were excluded from the study. After exclusion there were 211 pts with CAN. Among CAN pts 112 pts have GFR less than 40 ml/min. These patients were assigned in two group randomly. Group 1 continued their immunosuppression which consists of mycophenolate mofetil/myfortic, Cyclosporin A /Tacrolimus and prednisolone. Group B which received Sirolimus 2 mg daily instead of CyclosporinA / tacrolimus. All pts followed for 18 months. allograft function and pts morbidity and mortality were monitored every two months. results were recorded in clinic sheets and were analyzed using SPss version 22

Results
G1 consist of 53 and G2 59 pts. There were no differences in two group in respect to sex (M/F was 0.89 and 0.84 in G1 and G2 respectively), and age (mean age was 41 6 9.5 and 43 6 8.23 in G1 and G2 respectively). there were no differences in admission rate for medical reasons (0.43 and 0.39 admission per pts per year in G1 and G2 respectively p=0.23). There was no difference between two group in respect to cardiovascular events (0.23 and 0.27 events per pts per year in G1 and G2 respectively p=0.31). The average trough level of SRL was 8.38± 3.12 ng/mL at 18 months. At 18 months, the incidence of acute rejection was not higher in G2 (21% vs. 18.8 %, p = 0.21) and renal function was superior in patients converted to SRL (eGFR 32.3 vs. 23.4 mL/min/ 1.73 m2, p = 0.019) compared to those maintained on CsA/TAC. There were no significant differences in pts survival (one death in each group) Graft loss was higher in G1( 5 versus 2 at 18 months p= 0.014). there were no significant differences in respect to liver, respiratory, GI, hematologic and infectious complications. pts in G2 group had lower BP and uric acid levels.

Conclusion
Conversion to mTOR inhibitors in more advanced stages of CAN is safe and has beneficial effect on renal allograft function with no more side effect.
P1786THE HIGHWAY TO KIDNEY TRANSPLANTATION
Authors: Scheuter-van Oers Daènne , Kooij van Ton , Schelfhout Renske , Dorpel van den René 
Published: June 2020

Abstract

Background and Aims
Close cooperation between nephrologist, nurse coördinator and social workers in a large non academic hospital.
By timely starting the process of education and examinations we have increased the possibilities of pre-emptive transplantation

Method
When a patiënt needs to be informed about renal replacement therapy, the digital program is used by the nephrologist to inform all necessary disciplines involved. They each will make an appointment within the given time slot with te patient. At first the social worker start the education process, preferably, in the home situation. General information about the procedures and actions to be taken in the coming period, is given to the patient and his family/friends. They support patients in making difficult dicisions. Secondly, the nurse coordinator in the process, gives information about all options in renal transplantation and gives an explanation about the test procedures which are necessary to decide if patients are able te receive a kidney and donors are appropriate candidates. In case of availability of a potential donor, information is directly given about living donation and the procedure can directly be started. The nurse coordinator ensures that the patient and potential donor complete all required tests in the shortest time possible in their own hospital.
The close cooperation consists of daily deliberation between all disciplines and quickly changing the process of a patient or donor when needed. The progress is reported in the digital file and everyone involved will be informed.

Results
From 2013 until 2020
516 patients entered the program. 575 donors ( for 348 recipients) entered the program. 191 couples have been approved ans presented for transplantation of which 87 couples have been transplanted, 61 couples have been put on hold because of a stabilised kidney function. 40 couples are still in the work up program.
44 recipients were not transplantable due to medical/psychological reasons.
The median work up time of the procedure of the recipients was 260 days from start of the process to transfer tot he transplant centre. (2017) Various patient/medical retarding factors are discribed.
The median work up time fort he donors was 191 days (2017) days from start of the process to transfer tot the transplant centre. Various donor/medical retarding factors are discribed.

Conclusion
Patients and family are well informed about the treatment options, with a special attention for kidney transplantation. The efficient work up program in the patients treating hospital, results in a significant improvement of the possibility of pre-emptive renal transplantation, or otherwise, patients are earlier registered on the waiting list.
P1787DESENSITIZATION IN LIVE KIDNEY DONOR RECIPIENTS PROVIDES GOOD OUTCOME AT MID-TERM FOLLOW-UP
Authors: APAYDIN SUHEYLA , KASAPOGLU UMUT , AKBAY FATIH GOKHAN , Ozdemir Kayalar Arzu , KUDU AYSEGUL , Dikec Mehmet , DEGER GUNDEN , TOPRAK ZEKI , CARIN MAHMUT 
Published: June 2020

Abstract

Background and Aims
The recipients who have antibodies againts to donors’ HLA (Anti HLA- DSA) carrie a huge risk for allograf (AG) losing. In current study, it was retrospectively evaluated whether the live donor kidney recipients (LDKRs) under desensitization (DS) were exposed to more AG loss, lower AG survival and more complications.

Method
In 17 of 269 LDKRs had high anti-HLA DSA were found prior to kidney transplantation (KTX). DS was performed with plasmapheresis (PF) and rituximab (RTX) before KTX. In order to determine the risks of DS, LDKRs who had not PF for any reason, were admitted immediately before and after those with LDKRs under DS were used as controls (n: 31). Immucor™ luminex method was used for detecting the anti HLA DSA. DS was performed to the Rs who had more than 5000 MFI DSA against to at least one donor HLA locus with double check. Non-parametric Fisher’s exact test was used for statistical analysis because of distribution of our patients was heterogeneous.

Results
In 15 Rs had DSA more than 2 HLA loci (MFI range: 5880-21712), remaining 2 Rs had one HLA locus DSA (9959-7762). Mean PF number was of 7 before TX, while 3 after TX. RTX was used in 9 Rs (53%) before TX. KTX performed when anti DSA MFI below 2000 under triple immunosuppression plus anti-thymocitic globulin (ATG) induction therapy. In 4 Rs (13%) had DSA below 5000 MFI among controls (Cs). More female Rs (88% vs. 19%, p&lt;001) were in Rs under DS. ATG was used in 65 % of Cs. Comparison of the complications between Rs under DS and Cs, rate of rejection (35% vs. 19%, respectively, p&gt;0.05), rate of indication biopsy (24 % vs 16 %, p&gt;0.05), rate of CNI toxicity (5.5% vs. 6.5%, p&gt;0.05) were indifferent. During whole follow-up period, creatinine levels and eGFR were compatible at both groups. Urinary infections were more frequent in Rs under DS (53% vs 6.5%, p&lt;0.001) while the rate of viral infections were same. Also, late AG rejection were found in only 2 Rs under DS. Loss of AG and mortality were not seen in Rs under DS. Allograft survival for 3 years were found same (100% vs 91.2%, respectively) in groups.

Conclusion
Although our results belong to a single center and also a small group, desensitization before kidney transplantation for high risk kidney recipients are seem to be useful, effective and successful procedure.
P1792SUCCESSFUL TRANSPLANTATION OF STEM CELLS AND KIDNEY IN REFRACTORY LUPUS NEPHRITIS: REMOTE OUTCOMES
Authors: Demin Aleksandr , Demina Larisa 
Published: June 2020

Abstract

Background and Aims
Lupus nephritis is a common part of systemic lupus erythematosus (SLE), severe autoimmune disease that affects multiple organ systems and associated with pure prognosis. Patients with lupus nephritis who experience persisted disease activity despite conventional immunosuppression are at high risk of early death. Re-setting of the immune system and self-tolerance by high-dose immunosuppressive therapy with autologous stem cell transplantation (ASCT) is a new approach in the treatment of refractory SLE. Remote outcomes of this method and effectiveness relapse treatment are still unclear and were the aims of this study.

Method
We report a sick woman 39 years old, with refractory severe lupus nephritis. Standard therapy was ineffective, SLEDAI score remains 22 so patient was underwent high dose immunosuppressive therapy with ASCT and included in European Group for Blood and Marrow Transplantation European League against Rheumatism (EBMT/EULAR) registry on 53 pts who received ASCT for SLE between 1996 and 2005. Ethical approval was obtained for this study from Cambridge University Hospital Ethics Committee.

Results
The ASCT induced complete clinical and serological remission (SLEDAI score was 0) for 3 years. Than relapse with nephritic syndrome and anti-dsDNA positivity occurred and caused renal failure, creatinine clearance decreased to 21. Despite therapy including prednisolone, 45 mg daily, and mycophenolate mofetil, 2000 mg daily, disease activity persisted, creatinine clearance remained decreasing and 3 years later became 15 ml/min. During 1 year patient was on regular hemodialysis, then renal transplantation performed. Now, follow up is 15 years after ASCT and 8 years after kidney transplantation. Patient received a standard post-transplant immunosuppression with prednisolone, 5 mg daily, tacrolimus, 2.5 mg daily, and azathioprine, 100 mg daily, and her conditions remains stable, she has functioning renal allograft, SLEDAI score is 2 (anti-dsDNA positivity in low titer).

Conclusion
We present the successful remote outcomes of first case of immunoablation and double transplantation of autologous stem cells and allogeneic kidney in severe refractory to conventional immunosuppression SLE with lupus nephritis.
P1801RISK FACTORS FOR URINARY TRACT INFECTION CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE GRAM NEGATIVE BACTERIA IN INFANT
Authors: Lee Juyoung , Kim Dong Hyun , Park Ji Young , Lee Hyunju , Ahn Yo Han 
Published: June 2020

Abstract

Background and Aims
Community-acquired extended-spectrum beta-lactamase (ESBL) producing bacterial infections are an evolving public health problem. Urinary tract infections (UTIs) due to ESBL-producing bacteria are increasing even in infants rarely exposed to antibiotic. We aimed to identify risk factors for UTI caused by ESBL-positive bacteria in infants.

Method
We retrospectively analyzed the medical records of hospitalized infants with first episode of UTI from March 2018 to August 2019. Data includes demographic characteristics, birth history, previous use of antibiotic, febrile event, urinalysis results, and urine isolated organisms and their ESBL status. Multivariate regression analysis was used to quantify independent risks associated with ESBL-positive UTI.

Results
UTIs were diagnosed in 266 patients at median age of 3.6 (interquartile range (IQR) 2.3-5.4) months. Sixty-two (30.4%) patients were diagnosed with UTI caused by ESBL-producing bacteria. When we divided patients according to ESBL status, there was no difference in gender, age, birth history, milk type, and use of postpartum care center. Maternal use of antibiotic during pregnancy and previous antibiotic exposure to patients were higher in ESBL-positive group than in ESBL-negative group (32.3% vs. 10.3%, P &lt;0.001 and 22.6% vs. 12.3%, P =0.044, respectively). Klebsiella species was more frequently identified in ESBL-positive group than in ESBL-negative group (19.4% vs. 4.9%, P =0.002). In multivariate analysis, maternal use of antibiotic during pregnancy (odds ratio (OR), 3.817; 95% confidence interval (CI) 1.812-8.040, P &lt;0.001), previous antibiotic exposure to patients (OR 2.418; 95% CI 1.071-5.461, P =0.034), and Klebsiella species as a causative organism (OR 6.222; 95% CI 2.396-16.158, P &lt;0.001) were associated with ESBL positivity. In comparison of clinical courses of patients, ESBL-positive group showed severe leukocytosis (WBC 16,795 (IQR 12,210-20,270)/μL vs. WBC 14,620 (IQR 12,000-18,330)/μL, P =0.04), and stayed longer in hospital than ESBL-negative group (7.0 (IQR 5.5-8.5) days vs. 4.5 (IQR 3.7-5.1) days, P &lt;0.001).

Conclusion
In this study, high rate of ESBL positivity was detected in infantile UTI. Antibiotics exposure on both patients and mothers was associated with UTI caused by ESBL producing bacteria. Identification of underlying risk factors could improve treatment and preventive strategies.
P1812DOES THE TOTAL KIDNEY VOLUME REFLECT ALPORT SYNDROME PROGRESSION?
Authors: AKSENOVA MARINA , Konkova Natalia , Lepaeva Tatjana , Nikishina Tatjana , Piruzeeva Oxana , Dobrynina Marina , Chumak Olga 
Published: June 2020

Abstract

Background and Aims
The kidney volume can reflect kidney function and predict renal disease progression. The aim of the study was to define the clinical significance of kidney volume in children with Alport syndrome (AS).

Method
The medical records were obtained from 86 children (age Me 8(5;11) years; 50M/36F) with genetically (n=78) and morphologically (n=8) confirmed AS; follow-up Me 4(2;6) years. Albuminuria (Alb), proteinuria (Pr), nephrotic proteinuria (nPr) and decreased eGFR were defined as urine Alb&gt;30 mg/gr Cr, Pr≥100 mg/m2/day, Pr≥960 mg/m2/day and eGFR&lt;90 ml/min/1,73m2, respectively. The Body Superficial Area Related Total Kidney Volume (BSARTKV) was calculated as relation of US kidney volume to BSA: BSARTKV[ml/m2]=(L*W*D*π/6)/BSA and compared with normal volume range (Th.Scholbach, D.Weitzel, 2012).

Results
The renal volume ≥95‰ was revealed in ½ and ¾ of children at initial and last evaluation, respectively (0.51 vs 0.76, p&gt;0.05); two boys (q=0.02) with CKD stage 4 had a BSARTKV ≤10‰ at the last presentation. BSARTKV correlated with age (r=0.3, p&lt;0.05), mean blood pressure percentile (r=-0,22, p&lt;0,05), Alb (r=0.25, p&lt;0.05), Pr (r=0.4, p&lt;0,001) and eGFR (r=0.23, p&lt;0.05). No correlation was found between BSARTKV and birth weight and gender. Each 1SD (23.5 ml/m2) increase in BSARTKV was related with higher eGFR: OR=6.7 (95%CI 3.51;8.69, p&lt;0,001). The children with nPr and eGFR&gt;35 ml/min/1,73m2 had enlarged kidneys: OR=30.75(95%CI 2.56;369, p&lt;0,001); the patients with eGFR≤35 ml/min/1,73m2 had small BSARTKV: OR=167 (95%CI 10.4;2681.3, p&lt;0,0001).

Conclusion
The kidney volume reflects the progression of nephropathy in AS. Probably, an increased renal mass compensates decreased glomerular function, whereas small kidney volume represents the loss of function of most nephrons.
P1815LONG-TERM OUTCOME OF BLADDER DYSFUNCTION IN CHILDREN
Authors: Kari Jameela , Banakhar, Mai , Khashoggi Khalid , El-Desoky Sherif 
Published: June 2020

Abstract

Background and Aims
Bladder dysfunction is an important cause of chronic kidney disease (CKD) due to neurogenic causes such as a spinal lesion (SL), Hinman's syndrome, or non-neurogenic neurogenic bladder (NNNB), and valve bladder syndrome (VBS). In this study, we evaluated the outcomes of neurogenic bladder caused by different etiologies.

Method
Single-center retrospective study of children with neurogenic bladder (NB) over 13 years (2005-2017).

Results
Totally, 199 children (134 boys, 67.3%) were included and divided into three groups: Group 1 (75, NNNB), Group 2 (64, SL), and Group 3 (60, VBS). Urodynamic examination revealed impaired bladder capacity in 49 children (57.6%), atonic bladder in 1 child (1.1%), and normal bladder compliance in 35 children (41.1%). Additionally, 113 children (56.8%) experienced clean intermittent catheterization (CIC). A significant improvement in the mean estimated glomerular filtration rate and CKD stages was observed among the three studied groups, but the NNNB group showed the least improvement. Children diagnosed and treated during their first year of life had better outcomes than those who presented at a later age. CIC without the need for surgical intervention was associated with improved renal function. Pyelonephritis and hydronephrosis had significant negative impacts on kidney function

Conclusion
Early diagnosis and management of NB in infancy are associated with better outcome and preservation of renal function. CIC is associated with better preservation of kidney function, while vesicostomy is associated with a worse outcome. Children with NB caused by SL experienced the best kidney function preservation, while those with VBS experienced the worst.