bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO136RELATIONSHIP BETWEEN UPCR AND EGFR IN C3 GLOMERULOPATHY
Authors: Nester Carla , Breheny Patrick , Hall Monica , Charney Alan , Lefkowitz Martin , Trapani Angelo , Wang Yaqin , Smith Richard 
Published: May 2021

Abstract

Background and Aims
Considerable knowledge gaps exist in our understanding of the natural history of C3 glomerulopathy (C3G). Disease rarity, multiple nomenclature changes, and the inclusion of dissimilar cases in historical cohorts have precluded retrospective studies to define the natural course of C3G and identify risks for progression to kidney failure (end stage renal disease/ESRD). In the present analysis, we focus on C3G patients with native kidneys and examine the relationship between reductions in UPCR and disease progression as indicated by changes in eGFR.

Method
Patients included in this study were consented and enrolled in the University of Iowa C3G ReCom Registry, which was created in 2013. Beginning in 2017, complement activity and renal function data were collected prospectively at approximately 6-month intervals to define the natural history of C3G. Analyses were performed across 1-year periods of time (“spans”). To be included in a span, a patient had to meet the following criteria at the start of the 1-year period: native C3G, eGFR ≥30 mL/min/1.73 m2, UPCR ≥1 g/g and ≥12 years of age. An individual patient could be included in more than one span.

Results
Analyses were performed using 34 one-year spans for 24 patients who met inclusion criteria at the beginning of the 1-year span. Baseline characteristics for the 34 spans were: male, 59%; mean age, 22.7 years; mean eGFR, 83.1 ml/min/1.73m2; mean UPCR, 2.86 g/g; mean plasma C3, 75.1 mg/dL.
Similar analyses using only the first 1-year span for each of the 24 patients produced results that were consistent with those generated using all 1-year spans. Limitations of this study include its small sample size and data variability due to its observational nature.

Conclusion
The findings of this observational study support the premise that reductions in proteinuria are associated with a more stable eGFR in native kidney C3G. Regression analyses using UPCR as a continuous variable demonstrate the relationship between reduction in UPCR and preservation of eGFR. This association was also observed using both change in eGFR by UPCR reduction subgroup and UPCR-eGFR categorical analyses.
MO141ACUTE KIDNEY INJURY AS A RISK FACTOR FOR MORTALITY IN ONCOLOGICAL PATIENTS RECEIVING CHECK-POINT INHIBITORS
Authors: García Carro Clara , Bolufer Mónica , Bury Roxana , CAstañeda Zaira , Muñoz Eva , Felip Enriqueta , Lorente David , Carreras Maria Jose , Gabaldon Alejandra , Agraz Irene , Seron Micas Daniel , Soler María José 
Published: May 2021

Abstract

Background and Aims
Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy.

Method
All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population.

Results
759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality.

Conclusion
15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.
MO124THE SINGLE-CELL TRANSCRIPTOMIC OF HUMAN IDIOPATHIC MEMBRANOUS NEPHROPATHY*
Authors: Zhong Yong , Zhou Qiaoling 
Published: May 2021

Abstract

Background and Aims
Idiopathic membranous nephropathy (IMN) is an organ-specific autoimmune disease of the kidney glomerulus. Although substantial advances have been made in the understanding of the molecular bases of IMN in the last 10 years, there remain largely unanswered questions.

Method
To define the transcriptomic landscape at the single-cell resolution, we analyzed kidney samples from 6 patients with idiopathic membranous nephropathy (IMN) and 2 healthy control subjects using single-cell RNA sequencing.

Results
Based on transcriptional expression patterns, we identified all previously described cell types in the kidney. Also, we identified a novel population of the epithelial cell which is mainly from IMN patients. GO enrichment analysis showed that DEGs were enriched in the regulation of apoptosis and type I interferon signaling pathway in mesangial cells, while DEGs were enriched in the regulation of programmed cell death, and various cytokine-mediated signaling pathway in endothelial cells and the regulation of protein modification in pericytes. KEGG enrichment analysis revealed that DEGs were mainly associated with the IL-17 signaling pathway, TNF signaling pathway, NOD-like receptor signaling pathway as well as MAPK signaling pathway in endothelial cells as well as pericytes DEGs of proximal tubules cells (PT) and PCs between IMN and control subjects were both enriched in IL-17 signaling, TNF signaling, NOD-like receptor signaling. Moreover, the cell-cell crosstalk highlighted the extensive communication of mesangial cells, which infers great importance in IMN. IMN with massive proteinuria displayed elevated genes participating in the inflammatory signaling pathways that may be involved in the pathogenesis of the progression of IMN.

Conclusion
Overall, we applied single-cell RNA sequencing to IMN to uncover intercellular interactions, elucidate key pathways underlying the pathogenesis, and identify novel therapeutic targets of IMN.
MO147ASSOCIATION OF CHA2DS2-VASC SCORE WITH CAROTID-FEMORAL PULSE WAVE VELOCITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Vodošek Hojs Nina , Ekart Robert , Bevc Sebastjan , Piko Nejc , Hojs Radovan 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) patients suffer from high cardiovascular morbidity and mortality. Arterial stiffness is an important parameter for the evaluation of cardiovascular risk. Carotid-femoral pulse wave velocity (cfPWV) is the gold standard measure for the assessment of arterial stiffness. CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF). However, it is also useful in predicting outcome in different cardiovascular conditions, independent of the presence of AF. Therefore, the aim of our research was to assess the association of CHA2DS2-VASc score with cfPWV in CKD patients.

Method
Eighty-seven non-dialysis CKD patients from our outpatient clinic were included. At the time of inclusion, medical history data and standard blood results were collected, CHA2DS2-VASc score was calculated, cfPWV measurements (SphygmoCor System) were done. Correlation between CHA2DS2-VASc score and cfPWV was assessed. Multiple regression analysis with cfPWV as dependent and CHA2DS2-VASc score, eGFR, urinary albumin/creatinine, haemoglobin, high sensitivity CRP, serum calcium, phosphate and intact PTH as independent variables was performed. Additionally, patients were divided into two groups according to median value of CHA2DS2-VASc score (group 1: CHA2DS2-VASc score ≤2, group 2: CHA2DS2-VASc score &gt;2). Data of both groups were compared by t-test or Mann-Whitney test.

Results
CHA2DS2-VASc score correlated with cfPWV (r=0.380, p=0.001). In multiple regression analysis only CHA2DS2-VASc score was significantly associated with cfPWV (p=0.001). Data of both groups of patients divided according to median value of CHA2DS2-VASc score are presented in table 1. cfPWV was significantly higher in group 2 (13.40±3.50 vs 10.46±2.93, p=0.001). Groups of patients also differed significantly in age, presence of diabetes, eGFR and serum phosphate.

Conclusion
CHA2DS2-VASc score is associated with cfPWV in CKD patients. Patients with a higher CHA2DS2-VASc score have stiffer arteries.
MO164NOVEL PARAMETERS TO ASSESS ENDOTHELIAL DYSFUNCTION BY PULSE WAVE ANALYSIS
Authors: Mueller Niklas , Müller Sandra , Streis Joachim , Reuter Stefan , Pavenstädt Hermann Josef , Felderhoff Thomas , Busch Veit 
Published: May 2021

Abstract

Background and Aims
Pulse wave morphology changes under the high flow condition of reactive hyperaemia. We hypothesized, that those alterations may be able to indicate endothelial dysfunction.

Method
We recorded digitized pulse waves measured tonometrically with the SphygmoCor® device of 64 persons, 41 kidney transplant recipients and 23 healthy individuals, under normal conditions (NC) and under reactive hyperaemia (RH). Using matlab®, we calculated novel parameters, which had a temporal relationship with 3 charactereristic points (PO) of the normalized pulse wave, namely the maximum of the antegrade wave (1), the diacrotic notch (2) and the first diastolic inflection point (3). The following parameters were calculated: Mean slope between PO 1 and 2 (λ2), area under the curve (AUC) in the systole (Asys), AUC between PO 1 and 3 (A13), AUC between PO 1 and 2 (A12) and AUC between PO 2 and 3 (A23). Parameters were analyzed as their difference under reactive hyperaemia and under normal conditions. Also the maximum of the instantaneous difference of normalized pulse waves under NC und RH (Dmax) was analyzed. Endothelial function was evaluated by duplex sonography using ROC-analysis of peak systolic and end-diastolic flow difference under NC and RH.

Results
ROC-assessment of endothelial dysfunction as indicated by systolic peak flows demonstrated AUCs of 0.733 for λ2 (p=0.002), 0.751 for Dmax (p&lt; 0.001), 0.698 for Asys (p=0.006), 0.648 for A13 (p=0.077), 0.678 for A12 (p=0.027) and 0.732 for A23 (p=0.001). For the diastole the values were 0.753 for λ2 (p=0.003), 0.733 for Dmax (p=0.002) 0.670 for Asys (p=0.038), 0.566 for A13 (p=0.495), 0.664 for A12 (p=0.091) and 0.722 for A23 (p=0.015) respectively.

Conclusion
Pulse wave analysis under the condition of reactive hyperaemia probably is useful to assess endothelial function in kidney transplant recipients.
MO169FUNCTIONAL STATE OF THE KIDNEYS IN PATIENT AFTER CORONARY REVASCULARIZATION
Authors: Muminov Shavkat , Saipova Durdona 
Published: May 2021

Abstract

Background and Aims
The aim of the study was to study the functional state of the kidneys in patients with coronary artery disease in the long-term period after coronary revascularization.

Method
There were 160 patients with coronary artery disease under observation who underwent re-endovascular procedures (RE). The average age of the patients was 56.6 ± 1.27 years. The study included patients with an eGFR of at least 60 ml / min, determined by the serum creatinine concentration. A dynamic determination of the serum creatinine concentration was carried out to isolate patients in whom the postoperative REB was complicated by contrast-induced nephropathy (CIN). In the present study, CIN was defined as an increase in serum creatinine concentration by 25% 24 or more hours after REB. In the future, all patients underwent dynamic determination of serum creatinine concentration in terms of 3 months - 1 year -2 years. Patients received standard therapy for coronary artery disease: antiplatelet therapy (in the case of stenting of coronary arteries - double therapy), bisoprolol, valsartan, atorvastatin.

Results
The results of the study showed that during 2 years of follow-up after coronary revascularization, a progressive decrease in eGFR was observed. So, by the 3rd month, eGFR decreased by -17.39 ± 1.17%, by the end of the 1st year - by -43.62 ± 1.28%, by the end of the second year of observation - by -46.50 ± 1.79%. At the same time, the decrease in eGFR was significantly more pronounced in the group of patients who had CIN in the early period after endovascular intervention (37 patients): (-39.82 ± 2.02% by the end of the 3rd month, -54.61 ± 2.94% by the end of the 1st year and -60.10 ± 3.99% by the end of the 2nd year of observation versus -10.65 ± 0.57%, -40.32 ± 1, 27% and -42.41 ± 1.85% in patients with CIN-, respectively, p &lt;0.001 for intergroup comparisons of the relative dynamics of eGFR at all three time points).

Conclusion
Thus, the present study has demonstrated that in patients with coronary artery disease after revascularization, there is a significant decrease in the glomerular filtration function of the kidneys as early as 3 months after the endovascular procedure. CKD progression continues for at least 2 years after revascularization. One of the predictors of CKD progression is the development of CIN in the early period after endovascular intervention.
MO173SPONTANEOUS RENAL ARTERY DISSECTION (SRAD): IS IT REALLY SO RARE?
Authors: Catapano Fausta , Galaverni Maria Cristina , NIcoletti Simone , Mancini Elena 
Published: May 2021

Abstract

Introduction.
Spontaneous Renal Artery Dissection (SRAD) is a rare and often unrecognized clinical entity, which only accounts for 1-2% of all arterial dissections. Due to its rarity, it may be difficult to diagnose and treat.

Methods.
All patients affected by SRAD and admitted in our Unit in the last year were included.

Results.
Five patients presented with renal infarction due to SRAD were admitted in our Unit in 2020. Patient Characheristics are shown in Table 1. At onset, all suffered from abdominal pain and high blood pressure. In all patients renal function was normal. Abdomen computed tomography angiography (CTA) was diagnostic in all patients (Figure 1). They were treated with antihypertensive drugs and systemic anticoagulation followed by oral anticoagulants. At 3 month-follow-up, all patients became normotensive and partial or total renal artery recanalization were found (Figure 2).

Conclusions.
In our experience, SRAD seems to be not very rare in young and healthy patients with minimal comorbidities. Abdomen CTA is one of the “gold standard” non invasive diagnostic method. In patient treated with conservative medical therapy renal outcome is favourable. More studies are necessary to find underlying causes.
MO176IS IT REALLY INDICATED TO INCREASE FLUID INTAKE IN ELDERLY PATIENTS DURING SUMMER MONTHS?
Authors: Cases Corona Clara Maria , Arroyo Santayana Adrian , Acedo Juan Manuel , Casas Maria Luisa , Dominguez Torres Patricia , Diaz Enamorado Yunayka , Landaluce-Triska Eugenia , Tato Ribera Ana , Fernandez Juarez Gema Maria 
Published: May 2021

Abstract

Background and Aims
Thirst mechanism is essential to maintain an adequate osmolarity and homeostasis. During summer heat waves, there is an increased morbidity and mortality in elderly patients that has led to generally recommend an increase in fluid intake in all elderly patients beyond thirst stimulation, even in those independent patients with free access to water.
The aim of this study was to observe the differences in calculated serum osmolarity (cOsm) between young, elderly and very elderly patients who were neither institutionalized nor hospitalized, in different seasons throughout the year.

Method
We conducted a retrospective cross-sectional study in outpatients between 18-104 years old that had undergone a blood test between July 2019 and January 2020, in which serum osmolarity could be calculated. Patients with serum creatinine above 1.5 mg/dl were excluded.

Results
The study included 45236 blood samples from 41132 patients, 56.1% were female. 50% of patients were between 18 and 65 years old, 45.4% were between 65 and 85 years old and 4.6% were &gt;85 years old. The mean cOsm in patients between 18-65 years was 288.3 mOsm/kg, compared to 289.8 mOsm/kg in those between 65- 85 years old (p&lt;0.0001). In patients &gt;85 years, mean cOsm was 289.4 mOsm/kg.
When comparing cOsm between different seasons of the year, cOsm in summer months was about 1 mOsm/kg higher than in autumn-winter (288.9 mOsm/kg vs 287.8 mOsm/kg in young patients, p=0.0001; 290.5 mOsm/kg vs 289.4 mOsm/kg in elderly patients, p=0.0001). In the very elderly (&gt;85 years) the difference was smaller and non-significant (289.6mOsm/kg vs 289.1mOsm/kg).

Conclusion
Under physiologic conditions, patients &gt;65 years have a slightly higher calculated serum osmolarity than younger patients, nevertheless staying within normal range. These differences only increase in 1 mOsm/kg during the summer months. Therefore, it is not indicated to force an increase in fluid intake in the elderly or very elderly population under physiologic conditions.
MO185THE GUT MICROBIOME-DERIVED METABOLITE TRIMETHYLAMINE N-OXIDE AS A POTENTIAL BIOMARKER IN LUPUS NEPHRITIS PATIENTS
Authors: Salah Mohamed , Shemies Rasha Samir , Elsherbeny Mona , Enein Asmaa 
Published: May 2021

Abstract

Background and Aims
Both human and animal studies suggest that the gut microbe-derived metabolite Trimethylamine N-oxide (TMAO) is strongly associated with several autoimmune disease including Rheumatoid arthritis and psoriatic arthropathy. TMAO has been previously studied as a discriminator between SLE patients and healthy volunteers with higher reported TMAO levels in the SLE group; this suggests that gut microbiota may enhance TMAO generation in response to disease severity. The aim of this study was to investigate the diagnostic and prognostic validity of TMAO as a potential biomarker in lupus nephritis patients. To the best of our knowledge this is the first study to investigate the gut microbe-derived metabolite Trimethylamine N-oxide (TMAO) in patients with lupus nephritis correlating to the criteria of disease severity.

Method
A total of 90 subjects were included in this cross-sectional study and divided into 3 equivalent groups; group I (lupus nephritis patients (LN)), group II (SLE patients without nephritis (NN)), and group III (healthy controls). Serum Trimethylamine Levels were assessed, compared between the study groups and correlated to the clinical, laboratory and Histo-pathological criteria obtained from kidney biopsies of the included patients.

Results
Unpredictably, TMAO levels were found to be significantly higher in healthy controls compared to the total SLE population (p=0.003), and to LN, and NN groups individually (p=0.01). There was no significant statistical difference of TMAO levels between (NN) and (LN) patients (p=0.62). TMAO levels correlated to Anti-dsDNA titres (p=0.02) and Red Blood Cells count (p=0.02) among LN patients while they haven’t shown any correlations to the other studied clinical-laboratory and histopathological factors.

Conclusion
Contrary to the results of the previous studies, TMAO levels were found to be higher in healthy controls rather than SLE patients and did not discriminate between LN and NN patients as well as did not show significant correlation to most studied criteria of disease severity. The possible confounding effect of the dietary pattern and ingested drugs on the gut microbiome underestimate the diagnostic and prognostic utility of TMAO as a potential marker in different diseases. Further studies considering the dietary pattern of the included patients are still warranted.
MO191MANAGEMENT OF HYPERKALAEMIA TO FACILITATE RAASI THERAPY IN PATIENTS WITH HEART FAILURE IN A BESPOKE UK CLINIC
Authors: Ali Ibrahim , Kalra Philip A 
Published: May 2021

Abstract

Background and Aims
Best practice for treatment of patients with chronic heart failure involves beta-blockers and renin-angiotensin-aldosterone system inhibitors (RAASi) such as ACE inhibitors (ACE-i), angiotensin receptor blockers (ARB), mineralocorticoid antagonists (MRA) and neprolysin inhibitor/ARB. However, use of these agents, and optimisation of their dosage, is frequently limited by hyperkalaemia, the incidence of which is increased by the co-prevalence of chronic kidney disease (CKD). Management of patients in a bespoke Hyperkalaemia Clinic can be advantageous in facilitating optimal use of RAASi.

Method
A Hyperkalaemia Clinic was opened in July 2019 in this tertiary renal centre within an NHS trust that hosts 4 district hospital heart failure services. Referrals of patients with left ventricular systolic dysfunction whose RAASi could not be optimised because of hyperkalaemia were encouraged from heart failure specialist nurses and cardiologists. Management of the patients incorporated commencement of patiromer at 8.4g daily and increases in RAASi was usually devolved to the referring team. This report describes the activity and short-term outcomes of the first 17 months after opening of the clinic (follow up until 1st January 2021).

Results
34 patients with systolic heart failure and problems with RAASi-associated hyperkalaemia were referred to the clinic. Mean age was 74 (range 44-88) years, 28% had stage 3a, 28% 3b and 8% stage 4 CKD. ACE-I or ARB were being used in 73% of patients at referral, 73% were using beta blockers and 50% MRA with loop diuretic use in 70%. At first visit 64% had normokalaemia, and 36% serum potassium 5.4-6.0 mmol/L. During follow-up, 6 (18%) patients discontinued patiromer due to gastrointestinal side effects, 3 no longer required the binder because of decrease in RAASi use and 2 patients died (one each from stroke and sepsis). One patient was switched to an alternative potassium binder. As of 1st January 2021, patiromer was still being administered to 22 (65%) patients, 8 of which had received this for &gt;12 months; all patients remained normokalaemic and none of them required magnesium supplementation. An increase in RAASi therapy had occurred in only 12 (35%) patients.

Conclusion
Our experience demonstrates the relative simplicity of managing hyperkalaemia via a bespoke clinic in cardio-renal patients. As this was nephrology-led, optimised management was dependent upon the assertive and collaborative involvement of the referring heart failure teams who helped with biochemical monitoring and alteration of RAASi therapy. However, less than half of the patients benefitted from an increase in RAASi therapy after normalisation of serum potassium, and there was definitely scope for improving this component of the care pathway via more direct multi-disciplinary interaction with the heart failure teams.