bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO619GOODRENAL: HOLISTIC PATIENT CARE INTRADIALYSIS PROGRAM IN HEMODIALYSIS THROUGH A VIRTUAL HEALTH PLATFORM
Authors: Segura-Ortí Eva , Clyne Naomi , Garcia-Testal Alicia , Kouidi Evangelia , Van Craenenbroeck Amaryllis , Avesani Carla , Mesa-Gresa Patricia , Lozano-Quilis José Antonio , Lindholm Bengt , Moscoso Paula , Reboredo Maycon Moura , Lauer Andreas 
Published: May 2021

Abstract

Background and Aims
There is wide evidence that weak points of the care of end-stage Chronic kidney disease (CKD) patients in hemodialysis include three aspects that are suitable for intervention: exercise, nutrition and psychological support. Evidence shows that exercise for patients on hemodialysis results in increased functional capacity and strength and improved health-related quality of life and survival. Additionally, earlier studies have shown the benefits of psychological interventions and the positive effect of educational programs on nutritional status for patients on hemodialysis. Despite the well-known benefits of exercise, these programs are not being implemented in the routine clinical care of hemodialysis patients. Thus, the GoodRENal project aims to promote a healthy lifestyle among hemodialysis patients using a holistic pedagogical approach that, addressing adult learners, combines exercise, nutrition and psychological well-being as well as cognitive functioning.

Method
GoodRENal is a project funded by the European Community, Erasmus + program (336.327 euros). The project will last 3 years, from September 2020 to August 2023 and the Partners of the consortium include institutions from five European countries: Spain (Universidad CEU Cardenal Herrera, Hospital de Manises, Univesitat de Valéncia, Universitat Politécnica de Valéncia), Sweden (Skane University Hospital and Karolinska Institutet), Greece (Aristotles University of Thessaloniki) and Belgium (Katholieke Universiteit Leuven). Other supporting institutions are located in the UK, Chile and Brazil.

Results
The project will develop a virtual platform comprising three aspects of care: physical activity/exercise, nutrition, psychological well-being/cognition. In summary, the project outputs will be: 1. A didactic content on a modular platform with an educational program for integrated treatment in patients on hemodialysis; 2. A guideline to promote a healthy lifestyle among patients on hemodialysis for healthcare providers; 3. A guideline to promote a healthy lifestyle among patients on hemodialysis for patients, and their formal- and non-formal carers. At the present stage exploratory questionnaires regarding physical activity/exercise-nutrition-psychological well-being/cognition have been developed in consensus with all the partners. Data from this first exploratory study regarding needs and barriers of the stakeholders (patients, health professionals, carers) will be presented at the ERA-EDTA congress.

Conclusion
GoodRENal aims at improving the overall health, and thus the health-related quality of life, of patients on hemodialysis through a holistic and pedagogical approach that will target especially improvements of patient reported outcomes including quality of life.
MO225CMV ENCEPHALITIS IN A SLE FLARE
Authors: Marouço Catarina , Carvalho Dulce , Ribeiro Francisco , Magriço Rita , Nolasco Fernando 
Published: May 2021

Abstract

Background and Aims
Cytomegalovirus (CMV) infection is an opportunistic pathogen in immunocompromised patients and its management is well described after solid organ/bone marrow transplant or in HIV patients. Although less common, since Systemic Lupus Erythemathous (SLE) is a chronic auto immune disease often requiring intense immunosuppression to induce remission of disease exacerbation, SLE patients are also prone to it. Besides complicating the course of the disease, it may be a life-threatening infection. Due to the heterogeneity of SLE manifestations, usually is difficult to distinguish between a SLE flare and CMV active infection, making the diagnose challenging. It has also been described in the literature as an exacerbating SLE factor.
We report the case of an Asian, 27-year-old woman, with a recent SLE diagnosis that was admitted with a SLE flare while developing a CMV encephalitis. She was previously admitted due to a nephrotic syndrome. Immunological studies revealed an ANA title of 1:640 and a positive anti dsDNA Ab with diminished C3 and C4 levels, nephrotic range proteinuria and a diagnose of SLE was made. Renal biopsy revealed class IV lupus nephritis. She started high dose intravenous methylprednisolone (3 pulses of 500mg) and mycophenolate mofetil (MMF) at a dose of 2g per day. She was discharged taking 60 mg of oral prednisolone and the same dose of MMF. Two weeks after being discharged, she was readmitted due to worsening anaemia (Hb 6.8 g/dL), thrombocytopenia (Pl 27 000/µL) and deteriorating renal function with a sCr of 5.5 mg/dL with de novo haematuria. It was admitted a severe SLE flare and she was given another 3 pulses of 500mg I.V methylprednisolone and cyclophosphamide (CYC) was started (1 pulse of 500mg I.V). At the same time, she started to complain of myalgias and malaise, generalized hypotonia, developed fever, leukopenia with neutropenia and seizures. Serum CMV viremia was 71 000 copies and CMV polymerase chain reaction was positive in cerebrospinal fluid. She was started on I.V Ganciclovir, CYC was suspended and clinical improvement was observed.

Conclusion
Studies about the risk of different treatment drugs and other risk factors on the development of CMV disease in SLE are lacking. These studies will be useful for establishing guidelines on the institution of prophylaxis or pre-emptive treatment of CMV infection in SLE patients. Protocols for screening and prevention in this population should be implemented to account for this emerging problem. Given the rising prevalence of CMV infection in the past few years, the authors recommend that patients recently diagnosed with SLE while taking high doses of corticosteroids, which appears to be a risk factor for CMV reactivation, should be routinely tested for CMV viremia.
There should be a low threshold for suspicion, hence treatment should be started as soon as possible given the high morbidity and mortality in severe cases.
MO226A NEW DIAGNOSTIC TOOL FOR CKD PATIENTS: CONTRAST-ENHANCED ULTRASONOGRAPHY. A SINGLE CENTER EXPERIENCE
Authors: Gliga Mirela Liana , Chirila Cristian , Chirila Paula , Gomotarceanu Adriana , Torok Imola , Gliga Mihail Gheorghe 
Published: May 2021

Abstract

Background and Aims
Contrast-enhanced ultrasonography (CEUS) is a minimally invasive diagnostic tool available for diagnosing microvascular disturbances in tumors and many vascular pathologies. Unlike other radiological contrast agents, it is completely harmless for CKD patients and therefore it is used for the safe diagnosis of many diffuse or focal pathologies.

Method
We used CEUS examination in 50 CKD patients for the following pathologies: 10 atypical cysts, 15 liver focal lesions, 2 splenic focal lesions, 3 renal infarcts, 12 kidney focal lesions and 8 other organ involvements.
Examination was made using a VOLUSON E8 machine (GE Medical System Kreztechnik GmbH Tiefenbach 15, Austria) with a 3.5 MHz convex array abdominal transducer. 2.4 ml of microbubble contrast-agent was administered intravenously and recording of the results were made for 3-5 minutes after injection.

Results
Depending on the organ vascular characteristics, contrast enhancement and/or wash-out were suggestive for the final diagnosis. In liver lesions there are three phases and in kidneys, spleen, gallbladder, adenopathies there are two vascular phases. We obtained a very good positive predictive value and sensitivity in detecting malignant lesions.

Conclusion
According to The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound they are used both for hepatic and Non-Hepatic Applications. Being non-invasive and non-irradiating it could be the main diagnostic examination in CKD population in the future.
MO227RELATIONSHIP BETWEEN KIDNEY DAMAGE AND COGNITIVE FUNCTIONS IN PATIENTS WITH GLOMERULOPATHIES
Authors: Borriello Gianmarco , Viggiano Davide , Capasso Giovambattista 
Published: May 2021

Abstract

Background and Aims
Mild Cognitive Impairment (MCI) has been found to be highly prevalent amongst patients with Chronic Kidney Disease (CKD). In this cohort, the prevalence of MCI was estimated to be between 30% and 63%. Mild cognitive impairment is an intermediate state between normal aging and dementia. An individual suffering from MCI has difficulty in remembering, sustaining attention, or decision making which can negatively affect their daily lives.
The aim of this study was to verify the role of different glomerular diseases diagnosed by kidney biopsy on the MCI through a retrospective study.

Method
We recruited 45 patients with bioptic diagnosis of the following glomerular diseases: Focal Segmental Glomerulo Sclerosis (FSGS), minimal change disease (MCD), membranous glomerular disease (MG), IgA nephropathy. The renal function was analyzed using clinical variables, while Cognitive functions using the MoCA test. Patients were divided into two groups based on 24h proteinuria.

Results
The MoCA score was directly correlated to the uric acid levels (R=0.13; p=0.03). The MoCa score in the group with higher proteinuria levels was significantly lower than those of the group with lower proteinuria levels (p = 0.03). Finally, the MoCA score in subjects with FSGS or MCD is significantly higher compared the other groups (p&lt;0.05).

Conclusion
Our data suggest that serum uric acid and proteinuria in glomerular diseases influence cognitive functions. Interestingly, uric acid plays a neuroprotective role, as low levels of uric acid reduce the MoCA score. This result agrees with previous observations of a protective role of uric acid on dopamine neurons. Conversely, the extent proteinuria seems to negatively affect cognitive functions, suggesting a role of the endothelial dysfunction. Finally, glomerulopathies with a lower degree of inflammation (FSGS, MCD) have minor impact on cognitive functions.
MO229PROFILE OF TUBERCULOSIS AND ITS MANAGEMENT IN CHRONIC KIDNEY DISEASE
Authors: Datta Divya , Prabhu Ravindra Attur , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Nagaraju Shankar Prasad , Bhojaraja Mohan V , Khader Nisha Abdul 
Published: May 2021

Abstract

Background and Aims
Estimates of Tuberculosis(TB) burden indicate an estimated incidence and mortality of 199 and 32 respectively per 100000 in our country. Risk factors for acquiring TB disease include HIV infection, Diabetes Mellitus, Tobacco consumption and undernutrition. We retrospectively studied profile of TB in Chronic Kidney disease(CKD) in our population.

Method
Retrospective case record based study of consecutive TB patients visiting a Tertiary care hospital attached to a Medical College diagnosed by standard methods to demonstrate TB bacilli in sputum or affected tissue. CKD was diagnosed based on estimated Glomerular filtration rate less than 60 ml/min/m2 for at least three months. Pattern of TB and adverse drug effects were studied. Statistical analysis was done on SPSS version 20

Results
Over ten months, of 746 TB patients seen, 41(5.4%) had CKD, Stage 3b,4 and 5 in 7/41(17.1%), 11(26.8%), 23(56.1%) respectively. Among CKD 24(58.5%) had Diabetes Mellitus, 1(2.4%) HIV and 37(90.2%) hypertension. Pattern of TB is shown in table 1. Adverse drug reactions were significantly higher in CKD 24/41(54.5% vs 17% in non CKD, P &lt; 0.05). Mortality in CKD was 3/41(7.3%) and not significantly higher on multivariable analysis than in those without CKD.

Conclusion
In this retrospective survey of TB patients CKD constituted 5.4%, was associated with more adverse drug reactions but did not impact on mortality. Pulmonary TB was the common pattern in CKD.
MO233RENAL ARTERY STENOSIS: DO NOT FORGET INHERITED THROMBOPHILIA
Authors: Omrane Marwa , Ben Ariba Yosra , Ouertani Imen , Labidi Jannet 
Published: May 2021

Abstract

Background and Aims
Inherited thrombophilia can be defined as a genetically determined predisposition to develop thromboembolic complications. Inherited prothrombotic risk factors include antithrombin deficiency, protein C and protein S deficiencies, activated protein C resistance due to Leiden factor V mutation, inherited hyperhomocysteinemia, prothrombin G20210A variant, dysfibrinogenemia and elevated factor VIII levels.

Method
We report the case of a patient with history of bilateral renal artery stenosis who presented with renal artery bypass thrombosis related to an inherited thrombophilia.

Results
We report a case of 40-year-old male patient who presented with extremely high blood pressure and hypokalemia without other biological abnormalities. The duplex ultrasound showed bilateral renal stenosis with chronic occlusion of the right renal artery and a tight stenosis of the left renal artery estimated at 50%. Renal angiography confirmed the bilateral stenosis, associated to a small right kidney. Renal scintigraphy with DMSA showed normal left renal function and right renal function estimated at 2%. The therapeutic decision was to perform an aorto-renal bypass surgery by the saphenous vein.After renal artery bypass the blood pressure improved markedly, maintaining this result at 12 months follow-up at clinical examination and duplex ultrasound. One year later, the patient presented with high blood pressure. The duplex ultrasound showed a stenosis of the bypass with a double stenosis of the left aorto renal bypass on renal angioscanner. The patient underwent angioplasty of the venous bridge with implantation of 2 stents with improvement of blood pressure after angioplasty. Six months later, the patient presented an unbalanced blood pressure, the ultrasound control with a vascular Doppler showed a stenosis at the stent. The antihypertensive treatment was increased, a thrombophilia balance was requested concluding a combined protein C and protein S deficiency.

Conclusion
An etiological assessment should be carried out systematically in the event of thrombosis occurring before the age of 40 or in the case of iterative venous or arterial thrombosis. A genetic study where appropriate and a family screening are then recommended.
MO239ORAL FUNGAL INFECTION IN ESRD PATIENTS
Authors: Nedunchezhiyan MohanKumar , Anjum Afza , Shenoy Nandita , Nayak Rohith 
Published: May 2021

Abstract

Background and Aims
Chronic Kidney Disease is an increasing health alarm worldwide with systemic signs like hematologic changes, bone metabolic error, and compromised immune status presenting to a dental practitioner with oral complications. Hence a study was done to assess the oral health condition, cytological changes, and presence or absence of candida in patients with chronic renal disease undergoing dialysis aged between 30 to 65 years and controls in South India.

Method
A cross sectional study was conducted among 80 adults with CKD and controls, attending KMC and MCODS, Mangalore. Oral manifestations and oral hygiene were assessed; Cytological smears were taken for morphometric analysis of buccal mucosal cells from the subjects. Oral smears were cultured to check for the growth of fungal species in subjects and controls. Statistical analysis was done using SPSS Version 13. Chi square test was used to compare categorical variables between the groups.

Results
There was a significant difference in oral hygiene status and cytological changes in patients with CKD. Oral Fungal Infection was found in 32% of our patients on dialysis and oral lesions, defined as clinical signs associated with OFI such as erythematous oral stomatitis, membranous candidiasis, or angular cheilitis, were found in 37% of the patients with OFI, while 5% of the patients without findings of fungal infection presented oral lesions associated with OFI (p=0.0002). Furthermore, patients with self-reported mouth dryness were three times more likely (p=0.02) to be diagnosed with OFI.

Conclusion
Hemodialysis patients are found to have significantly more OFI than controls. Oral dryness and dental plaque formation also seem to be at risk of developing OFI. Detection of oral lesions associated with OFI should be combined with a histopathological diagnosis before antifungal treatment. The prevalence of oral candida in these cases is alarming and can be a predictor of a poor prognostic index. As medicine advances, oral health care professionals should have a holistic approach to the management of patients with complex medical problems especially to diseases of the renal system as it is pivotal in maintaining a stable internal environment and homeostasis.
MO134COVID-19-ASSOCIATED KIDNEY INJURY IS CHARACTERIZED BY ACUTE TUBULAR NECROSIS AND CAPILLARY CONGESTION WITH EVIDENCE FOR SARS-COV-2 IN THE NEPHRON
Authors: Bouquegneau Antoine , Erpicum Pauline , Grosch Stéphanie , Habran Lionel , Hougrand Olivier , Huart Justine , Krzesinski Jean-Marie , Misset Benoit , Hayette Marie-Pierre , Delvenne Philippe , Bovy Christophe , Kylies Dominik , Huber Tobias B , Puelles Victor , Delanaye Pierre , Jouret François 
Published: May 2021

Abstract

Background and Aims
Kidney damage has been reported in COVID-19 patients. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial.

Method
We consecutively performed 16 immediate (≤3h) post-mortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from 5 patients who died from sepsis and were free from COVID-19 were used as controls. Samples were methodically evaluated by 3 pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (nCoV2019 N-Protein), fluorescent in situ hybridization (nCoV2019-S) and electron microscopy.

Results
The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were males (68.7%). Proteinuria was observed in 53.3% of cases, while acute kidney injury occurred in 60% of cases. Acute tubular necrosis of variable severity was found in all cases, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus control samples. Congestion in glomerular and peri-tubular capillaries was respectively observed in 56.3 and 87.5% of patients with COVID-19 compared to 20% of controls, with no evidence of thrombi. The nCoV2019 N-Protein was detected in proximal tubules and also at the basolateral pole of scattered cells of the distal tubules in 9/16 cases. In situ hybridization confirmed these findings. RT-PCR of kidney total RNA detected SARS-CoV-2 N gene in one case. Electron microscopy did not show typical viral inclusions.

Conclusion
Our immediate post-mortem kidney samples from patients with COVID-19 highlight a congestive pattern of acute kidney injury, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest that SARS-CoV-2 is present in various segments of the nephron.
MO242RECTAL ADENOCARCINOMA IN TUBEROUS SCLEROSIS: A CASE REPORT
Authors: Omrane Marwa , Babchia Amel , Jaballah Raja , Mahersia Afef , Saidane Olfa 
Published: May 2021

Abstract

Background and Aims
Tuberous sclerosis (TS) is an autosomal dominant genetic disorder that is characterized by a neurocutaneous syndrome. Usually, the disease is diagnosed in childhood but there are frustrates form of tuberous sclerosis with or without genetic mutation.

Method
This clinical case is about a women with tuberous sclerosis on hemodialysis who is diagnosed a colonic polyposis and a rectal adenocarcinoma.

Results
We report the case of a 64-year-old patient with no particular family history, followed for renal failure discovered at the end stage with TS. She was treated with intermittent hemodialysis. During his follow-up, she presented melena stools and she reported lightheadedness when standing. Physical examination revealed conjunctival pallor. The patient’s heart rate was normal; her blood pressure was 120/80 mmHg supine and 120/70 mmHg standing. There was no distention or peritoneal irritation. The hemoglobin level was 78 g/L; three weeks previously, it had been stable at 106 g/L. The platelet count, prothrombin time and partial thromboplastin time were all normal. The patient was admitted to hospital. Two units of packed red blood cells were transfused. Gastroscopy was performed and it was normal. Colonoscopy revealed a fixed, circumferential rectal tumor at 6 cm and multiple colorectal polypes. Rectal biopsy confirmed a moderate to poorly differentiated adenocarcinoma of large bowel type. Computed tomography scan showed no metastases. She was operated and actually she is receiving chemotherapy cures.

Conclusion
In the literature, there is a case of invasive rectal adenocarcinoma in a 17-year-old girl with TS. We do not yet have enough data on the other types of polyps encountered. In the two small series described, the prevalence of colonic polyps is high unlike cancer which could be an isolated event. In view of all these data, it seems judicious to us to carry out a national register of patients with TS and to specify the prevalence of digestive disorders in order to organize a systematic screening if it is high, in the same way as the familial polyposis as well as to confirm or refute the hypothesis of the link between polyposis of TS and colorectal cancer.
MO137DIFFERENCES IN GUT MICROBIOTA PROFILES AND FUNCTIONS BETWEEN END-STAGE KIDNEY DISEASE AND HEALTHY POPULATIONS
Authors: Wu Ping-Hsun , Lin Ting-Yun , Ho Hsiu J , Tseng Ching-Hung , Lin Yi-Ting , Liang Shih-Shin , Lee Hei-Hwa , Kuo Mei-Chuan , Hung Szu-Chun , Chiu Yi-Wen , Wu Chun-Ying 
Published: May 2021

Abstract

Background and Aims
Patients with end-stage kidney disease (ESKD) are characterized by altered gut microbiota, impaired intestinal barrier function, and experienced gut microbiota-derived metabolites related to systemic complications. However, limited studies evaluated the microbial diversity and function in ESKD patients previously.

Method
Compared to age- and gender-matched subjects without kidney disease, 82 ESKD patients in the discovery cohort and 58 ESKD patients in the validation cohort were investigated for the microbial richness, biodiversity, gut dysbiosis, microbial composition differences, and the functional changes by gut metabolic module analysis. Bacterial derived free form protein-bound uremic toxins were analyzed by mass spectrometry and their association with microbial richness in ESKD patients was determined.

Results
Compared to controls, an increased α-diversity and distinct β-diversity were found in ESKD (Figure). The increase in α-diversity was correlated with protein-bound uremic toxins, particularly hippuric acid. A higher microbial dysbiosis index (MDI) was found in ESKD patients with the following enriched genera: Facealibacterium, Ruminococcus, Fusobacterium, Dorea, Anaerovorax, Sarcina, Akkermansia, Streptococcus, and Dysgonomonas. MDI at the genus level successfully differentiated between ESKD and controls in the discovery cohort (area under the curve [AUC] of 81.9%) and the validation cohort (AUC of 83.2%). Regarding functional enrichment analysis with gut metabolic modules, ESKD subjects presented with gut microbial function of increased saccharide and amino acid metabolism compared with matched controls.

Conclusion
An enriched but dysbiotic gut microbiota was presented in ESKD patients, in which the bacteria that were present increase amino acid metabolism linked to the production of protein-bound uremic toxins.