bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO138ASSOCIATION OF NT-PROBNP WITH OBESITY IN CKD PATIENTS
Authors: Lin Ting-Yun , Hung Szu-Chun 
Published: May 2021

Abstract

Background and Aims
Obesity is associated with lower circulating levels of N-terminal pro-BNP (NT-proBNP) both in the general population and in patients with heart failure. In asymptomatic patients with CKD, NT-proBNP levels are generally elevated. The prevalence of obesity is markedly increasing among patients with CKD. However, whether obesity affects NT-proBNP levels and thresholds for increased risk of clinical outcomes is unclear.

Method
We examined the associations between NT-proBNP and obesity in 408 stage 3–5 CKD patients (268 men and 140 women; mean age 65±13 years) free of heart failure at baseline, who were categorized into 3 groups according to body mass index (BMI; kg/m2) as normal (&lt;24.0), overweight (24.0–27.9), and obese (≥28.0). Multivariate Cox proportional hazards models were used to compare the risk associations of NT-proBNP with the composite of ESKD (needing chronic dialysis or kidney transplantation) or all-cause mortality across BMI categories.

Results
NT-proBNP levels were significantly lower in obese patients than in normal weight and overweight subjects (P &lt;0.001). Within each CKD stage, NT-proBNP levels decreased with increasing BMI. In a multivariate analysis, NT-proBNP was inversely associated with obesity, as well as BMI and its fat and lean body mass components (all P &lt;0.001), independent of demographics, comorbidities, and severity of CKD. During a median follow-up of 2.2 years, 117 patients progressed to ESKD and 46 patients died. Overall, higher NT-proBNP levels were independently associated with ESKD or death (HR, 1.52; 95% CI, 1.22–1.89). Specifically, higher NT-proBNP levels were consistently associated with poor outcomes in all BMI categories (P for interaction = 0.096).

Conclusion
Obese CKD patients have significantly lower NT-proBNP levels. Nevertheless, BMI category did not modify the relationship between NT-proBNP and clinical outcomes. Increased risk may be seen at relatively lower levels of NT-proBNP in obese CKD patients.
MO140INDOXYL SULFATE INDUCES THE APOPTOSIS OF THE DIFFERENTIATING NEURONS BY ENHANCING OXIDATIVE STRESS AND CLINICAL COGNITIVE IMPAIRMENT
Authors: Hou Yi-Chou , Lu Kuo-Cheng , Huang Chuen-Lin , Lin Yuh-Feng , Chen Ruei-Ming 
Published: May 2021

Abstract

Background and Aims
Indoxyl sulfate (IS) is a protein-bounded uremic toxin involving the multi-organ dysfunction, including neurologic system. It has been noticed that IS could induce the oxidative stress within brain by activating the inflammation mediated by astrocyte, and its concentration was associated with cognitive impairment. It has been noticed that the neuronal progenitor cells with differentiating abilities could replace the damaged neuron. The damage of IS on the progenitor cells with differentiating ability is still lacking. The aim of the study is to investigate the IS mediated cell damage on differentiating neuronal progenitor cells

Method
The study was divided into 2 parts: clinical investigation and in vitro study. The clinical investigation collected 36 participants (12 health controls and 24 ESRD patients with cognitive impairment by MMSE&lt;=24). The in vitro study used the human neuroblastoma cell line SH-SY5Y cells with differentiating protocol by retinoic acid (RA, with concentration 10%). Indoxyl sulfate was given at concentration at 0, 25, 50 and 100μM at initiation of retinoic acid given and the 7 days after retinoic acid was given. Microscopic morphology, MTT assay, annexin V-PI dual stain, and western blotting for cleaved-caspase 3, Bax, Bcl-2 and oxidative stress (DCFCA) were measured.

Results
Among the 36 participants, the concentration of IS was higher in the ESRD patients with cognitive impairment (43365.26±24291.55 vs 5212.00±14621.82 mg/dL, p=0.00). The serum concentration of IS was negatively correlated with the total MMSE score (r=-0.446, p=0.006) and the categories of MMSE (orientation to time: r=-0.537, p=0.001, calculation: r=-0.541, p=0.001; recall: r=-0.402,p=0.014). In in vitro study, the cell viability was not influenced in undifferentiated and differentiated (retinoic acid treated for 7 days) SH-SY5Y cells. When IS during the initiation of RA treatment, the cell viability decreased 3 hours after IS was given. The annexin-V-PI dual stain demonstrated that the early apoptotic cells with annexin-V stained increased in IS treated cell with dose-dependent manner. The caspase 8 and cleaved caspase 3 increased at 6 hours after IS treated when RA given. The Bax increased after IS treated at 6 hours. The Bax/Bcl2 ratio increased at the IS concentration 50μM. The DCFCA increased after IS treated at 1 hour with dose-dependent manner, and the cell viability was rescued by N-acetylcystein.

Conclusion
The serum IS was negatively correlated the MMSE and predictive to cognitive impairment in our cohort with 36 participants (12 health control and 24 ESRD patients with MMSE &lt;=24). The in vitro study demonstrated that IS induced differentiating SH-SY5Y cells apoptosis by activating caspase-dependent cell death after generating oxidative stress.
MO142A SINGLE-CENTER CASE SERIES OF 150 PATIENTS WITH RENAL FANCONI SYNDROME
Authors: Shi Xiaoxiao , Wang Ying , Li Jiaying , Chen Zhixin , Ma Tiantian , Wen Yubing , Ye Wei , Qin Yan , Li Xuemei , Yu Yang , Chen Limeng 
Published: May 2021

Abstract

Background and Aims
Renal Fanconi syndrome (RFS) is characterized by generalized dysfunctions of renal proximal tubular (PT) transport. The causes of FS can be inherited or acquired, the latter of which mostly includes drugs, heavy metals, monoclonal light chains (LC), and primary Sj gren’s syndrome (pSS). We intended to observe the clinico-pathological features of RFS with different etiologies.

Method
From January 2012 to September 2018, all the patients diagnosed as RFS in our hospital were enrolled. Their clinicopathological records were retrospectively reviewed. The diagnosis of RFS was defined as existence of ≥ 3 of the following five items alone or ≥ 2 items combined with an evidence of PT damages in kidney pathology: (I) normoglycemic glycosuria; (II) generalized aminoaciduria; (III) hypophosphatemia and hyperphosphaturia; (IV) hypouricemia and hyperuricosuria; (V) proximal RTA.

Results: 1.

Clinical characteristics
We identified 150 RFS patients, with an average age of (45.9±14.2) years old and male: female ratio 1.3:1. They presented with different degrees of PT dysfunctions and the most common were hypophosphatemia (83.2%) and aminoaciduria (80.6%). Their mean eGFR levels were 76.3 (4.5-188.6) ml/min/1.73m2 with 73.5% had proteinuria.

2. Renal pathological features
47 RFS patients received kidney biopsy and the most common pathological diagnosis was interstitial nephritis. They all presented with different degrees of proximal tubule atrophy, defective brush border, interstitial edema and fibrosis.

3. Etiology-related clinicopathologic features
The most common causes of our RFS were LC (14.0%), drugs (13.3%), and pSS (9.3%). Compared to pSS associated RFS, LC associated RFS patients showed a higher prevalence of bone involvement, more severe proteinuria and less severe hypokalemia (P &lt; 0.05) despite similar eGFR levels. Specific renal pathological features were seen in different etiology groups, including crystalline formation and increased lysosomes in PT cells under electron microscope in LC associated RFS, and CD21 positive ectopic germinal center formation in renal interstitum in parts of the pSS associated RFS.

Conclusion
We identified 150 RFS with different etiologies and they showed etiology-specific patterns of PT dysfunctions and renal pathologic changes.
MO144OVERLAP SYNDROME OF ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS AND IGG4-RELATED DISEASE: DISTINCT CLINICOPATHOLOGIC CLUES FOR PRECISE DIAGNOSIS
Authors: Liang Peifen , Han Qianqian , Liu Bo , Yang Qiongqiong 
Published: May 2021

Abstract

Background and Aims
Both antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and IgG4-related disease (IgG4-RD) are multi-system inflammatory disorders. The coexistent of both diseases present the possibility of a new overlap syndrome which leads to different treatment and outcome. In this study, we aim to investigate the possibility and clinicopathologic clues to the diagnosis of this overlap syndrome.

Method
A case of a 67-year-old man in our hospital who exhibited the clinicopathologic characteristics of both AAV and IgG4-RD was presented. The serial alterations in serum parameters and treatment response of the case were followed up for the next 15 months. Then, a systematic literature review of the overlap syndrome was performed on PUBMED database from 1976 until January 2020.

Results
Forty-two patients fully met both AAV and IgG4-RD criteria in the literature. The median age was 60 years ranged from 31 to 73 years at diagnosis. Twenty-eight (66.7%) patients were men. Serum IgG4 concentration increased in 41 (97.6%) patients (median:395 mg/dl; range:177-876mg/dl). Forty-one patients (97.6%) tested positive for ANCA with 37 (90.2%) patients showing a specificity for MPO. Kidney histology of 23 (69.7%) patients presented pauci-immune necrotizing or crescentic glomerulonephritis and IgG4-relative tubulointerstitial nephritis. Glucocorticoids combined with cyclophosphamide therapy was commonly prescribed with a high remission rate within 3 months. Four common clinicopathologic features of the overlap syndrome were identified from the case and literature.

Conclusion
AAV may overlap with IgG4-RD while presenting atypical manifestations. Four common clinicopathologic characteristics could be used as specific clues to the diagnosis of overlap syndrome.
MO145CAROTID PLAQUE THICKNESS COMPARED WITH SEVERITY OF CAROTID AND CORONARY ARTERY CALCIFICATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3
Authors: Saurbrey Bjergfelt Sasha , Soerensen Ida Maria Hjelm , Hjortkjaer Henrik Oeder , Landler Nino Emanuel , Freese Ballegaard Ellen Linnea , Biering-Sørensen Tor , Kofoed Klaus F , Lange Theis , Feldt-Rasmussen Bo , Hegaard Sillesen Henrik , Christoffersen Christina , Bro Susanne 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) accelerates both atherosclerosis and arterial calcification. The aim of the present study was to explore whether maximal carotid plaque thickness (cPT max) was increased in patients with CKD stage 3 compared to controls and associated with cardiovascular disease and severity of calcification in the carotid and coronary arteries.

Method
The study group consisted of 200 patients with CKD stage 3 from the Copenhagen CKD Cohort and 121 age- and sex-matched controls. cPT max was assessed by ultrasound and arterial calcification by computed tomography scanning.

Results
Carotid plaques were present in 58% of patients (n=115) compared with 40% of controls (n=48), P=0.002. Among participants with plaques, cPT max (median, interquartile range) was significantly higher in patients compared with controls (1.9 (1.4-2.3) versus 1.5 (1.2-1.8) mm, P=0.001. Cardiovascular disease was present in 9.4% of patients without plaques (n=85), 23.2% of patients with cPT max 1.0-1.9 mm (n=69) and 34.8% of patients with cPT max &gt;1.9 mm (n=46), P=0.001.
Carotid and coronary calcium scores &gt;400 were present in 0.0% and 4.0%, respectively, of patients with no carotid plaques, in 19.1% and 24.2% of patients with cPT max 1.0-1.9 mm, and in 47.5% and 52.6% of patients with cPT max &gt;1.9 mm, P&lt;0.001.

Conclusion
This is the first study showing that cPT max is increased in patients with CKD stage 3 compared to controls and closely associated with prevalent cardiovascular disease and severity of calcification in both the carotid and coronary arteries.
MO146RENAL FUNCTION MEDIATES THE EFFECT OF FLUID EXCESS ON LUNG CONGESTION IN PATIENTS WITH HFREF
Authors: Popa Raluca , Sascau Radu , Statescu Cristian , Vasiliu Vlad , Neamtu Andreea , Bucur Andreea , Kanbay Mehmet , Siriopol Dimitrie 
Published: May 2021

Abstract

Background and Aims
Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Pulmonary congestion is considered the leading cause for hospital admissions and death among patients with HF. The aim of this study is to investigate if the effect of fluid status, as assessed by bioimpedance spectroscopy (BIS) on lung congestion is mediated by renal function, inflammation or cardiac function.

Method
This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction (LVEF) below 45% was required for inclusion (HFrEF).
Mediation is the process through which an exposure causes disease. We hypothesized that some of the total effect of extracellular water (ECW) to intracellular water (ICW) (as assessed by bioimpedance) ratio on lung congestion (as assessed by lung ultrasonography) is mediated by C-reactive protein (CRP), left atrium volum index (LAVI) or estimated glomerular filtration rate (eGFR) – the mediators.

Results
Our study included 153 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 ml/min/1.73m2. The mean median value for CRP was 25.6 (IQR 9.0-56.4) mg/L.
Figure 1 depicts the structural equation models with the calculated magnitude of the direct and indirect effects of ECW/ICW on the B-lines number in our population. In this model, the fluid status has both direct and indirect effects on lung congestion. Specifically, it has a direct effect on LAVI and eGFR, which in turn have a direct effect on the number of B-lines. Therefore, the indirect effect mediated by LAVI and eGFR accounts for a significant proportion of 27.6% of the total effect of ECW/ICW on lung congestion
Although ECW/ICW has a direct effect on inflammation, this doesn’t have any effect on renal function or lung congestion.

Conclusion
We show that eGFR and LAVI partly mediate the effect of ECW/ICW on lung congestion in patients with HFrEF. While the deleterious effects of fluid overload on lung congestion have long been recognized, this study provides evidence for a relationship of significant magnitude linking fluid overload with decreased eGFR and increased LAVI, which in turn lead to elevations in the B-lines number.
This work was supported by a grant of the Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1.1-PD-2016-0287, within PNCDI III and by a grant of the “Grigore T. Popa” University of Medicine and Pharmacy, contract number 27505/2018.
MO151CLINICAL COURSE AND OUTCOMES OF COVID-19 PATIENTS WITH BIOPSY-PROVEN GLOMERULAR AND TUBULAR KIDNEY DISEASE. LOW HEMOGLOBIN LEVELS AS A RISK FACTOR FOR MORTALITY
Authors: León Román Juan , García Carro Clara , Agraz Irene , Toapanta Néstor , Vergara Arana Ander , Gabaldon Alejandra , Torres Rodriguez Irina , Bury Roxana , Baldallo Cinthia , Seron Micas Daniel , Soler María José 
Published: May 2021

Abstract

Background and Aims
COVID-19 infection is responsible for respiratory infection with variable clinical expression from its asymptomatic form to severe pneumonia associated with acute respiratory distress syndrome and death. Risk factors related to higher mortality are age over 65 years, cardiovascular, pulmonary and kidney disease, hypertension, and diabetes. There is limited scientific literature on COVID-19 infection and previous kidney disease, specifically in patients with glomerular and tubular kidney disease. The aim of this study was to determine general characteristics, analytical parameters and clinical evolution of patients with kidney disease who have undergone kidney biopsy and who presented infection or high suspicion of infection by COVID-19. Identify mortality and associated risk factors.

Method
we studied patients with high clinical suspicion of infection or confirmed infection by COVID-19 from March 2020 to May 15, 2020 of all patients who underwent percutaneous renal biopsy at the Vall d'Hebron Hospital between January 2013 and December 2019.

Results
39 of the 553 patients have been diagnosed with COVID-19 infection since March 2020. The average age was 63±15 years and 48.7% were male. Hypertension was present in 79.5% of patients, chronic kidney disease without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older patients (p=0.01), patients with hypertension (p=0.005), immunosuppression (p=0.01), use of RAS-blocking drugs (p=0.04) and gastrointestinal symptoms (p=0.02) were more likely to be tested for COVID-19. 22 patients required hospitalization and 15.4% died. In the bivariate analysis, mortality was associated with older age (p=0.03), cardiovascular disease (p=0.05), chronic obstructive pulmonary disease (COPD) (p=0.05) and low hemoglobin levels (p=0.006). Adjusted Cox regression showed that low hemoglobin levels (10.12±1.89g/dL) at admission had 1.81 greater risk of mortality [1.04-3.13; p=0.04].

Conclusion
Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, use of RAS-blocking drugs, immunosuppressed patients and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.
MO155RENAL DAMAGE IN COVID-19: RESULTS FROM A COHORT STUDY IN 1,280 PATIENTS
Authors: Chebotareva Natalia , Berns Svetlana , Berns Angelina , Androsova Tatyana , Moiseev Sergey 
Published: May 2021

Abstract

Background and Aims
The development of acute kidney injury in COVID-19 patients is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19; however, these data are still controversial.

Method
A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 disease was confirmed by RT-PCR through a nasopharyngeal swab and typical images from a computed tomography scan in all patients. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We finally assessed the acute kidney injury (AKI) incidence and mortality defined by the survival status at discharge.

Results
In 648 (50.6%) of the patients with COVID-19, proteinuria was evidenced. Haematuria was detected in 77 (6%) patients, and leukocyturia was detected in 282 (22%) hospitalized patients. AKI was determined in 371 (29%) patients, and 10 (2.7%) of them required dialysis. Independent AKI risk factors were age &gt;65 years, augmentation of CRP, ferritin and increase in aPTT values as a result of consumption coagulopathy. A total of 162 (12.7%) of the 1,280 hospitalized patients and 111 (30%) of the 371 patients with AKI did not survive. The hazard ratio for mortality 3.96 [CI 95% 2.828 – 5.542] for patients with AKI vs. No-AKI.

Conclusion
AKI was determined in 29% patients, in 2.7% of them severe kidney injury required dialysis. Risk factors for AKI in COVID-19 patients are old age, the inflammatory response, the severity of lung involvement and DIC. The same factors and arterial hypertension were found to increase risk of mortality.
MO157HYPONATREMIA AND DISEASE SEVERITY IN LEPTOSPIROSIS
Authors: Cavalcante Meneses Gdayllon , Andrade de Carvalho Gomes Pedro Eduardo , Studart Galdino Gabriela , Bezerra da Silva Junior Geraldo , Coelho Lopes Nicole , Costa Martins Alice Maria , Brasil Gadelha Farias Luis Arthur , De Francesco Daher Elizabeth 
Published: May 2021

Abstract

Background and Aims
Hyponatremia is associated with severe complication in tropical diseases and may be associated with higher mortality. The aim of this study was to investigate the association between hyponatremia and disease severity in patients with leptospirosis.

Method
This is a retrospective study including patients with confirmed diagnosis of leptospirosis admitted to three reference hospitals in Fortaleza, northeast Brazil, in the period from 1985 to 2018. Demographic, clinical and laboratory data were analyzed, and the incidence of unfavorable outcomes were investigated: acute kidney injury (AKI) – defined according to KDIGO criteria, hemodialysis need and death. Patients were divided in groups according to the levels of sodium at hospital admission (&lt; or ≥135mEq/L). Statistical analysis was done with the SPSS program version 23.0.

Results
A total of 319 patients were included. Hyponatremia was found in 163 cases (51%) at hospital admission. Patients’ mean age was 37±15 years, and 84% were male. The group with hyponatremia had higher frequency of some symptoms and signs, such as disorientation (8.1% vs 1.3%, p=0.047) and jaundice (76% vs 54%, p&lt;0.001). Higher levels of urea (130±80 vs 94±34mg/dL, p&lt;0.001) and creatinine (4.3±2.7 vs 3.0±2.6mg/dL, p&lt;0.001) were observed at hospital admission, as well as maximum levels of bilirubins, in the group with hyponatremia (p&lt;0,05). Median lower levels of platelets during hospital stay were observed in the group of hyponatremia (45 [26 – 110] vs 73 [42 – 157] x103/µL p=0.001). A higher frequency of complications was also observed in the group with hyponatremia: hemodialysis need (38% vs 20%, p&lt;0.001) and AKI stage 3 (71% vs 46%, p=0.002). There was no difference regarding mortality rate between the two groups (14.1% vs 10.1%, p=0.281).

Conclusion
Hyponatremia in patients with leptospirosis, at hospital admission, is associated with worse prognosis and can be an important parameter to guide clinical care in this group of patients.
MO159CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Vodošek Hojs Nina , Ekart Robert , Bevc Sebastjan , Piko Nejc , Hojs Radovan 
Published: May 2021

Abstract

Background and Aims
Cardiovascular mortality is high in chronic kidney disease (CKD) patients. Recognizing patients with higher cardiovascular risk might help in their treatment. 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 role of CHA2DS2-VASc score in cardiovascular mortality 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 and CHA2DS2-VASc score was calculated. Patients were followed for assigned time or until their death. Mean follow-up time was 1696.45±564.60 days.

Results
Descriptive statistics of our patients are presented in table 1. During follow-up 11 patients suffered from cardiovascular death. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular mortality (HR: 2.19, CI: 1.42-3.37, p=0.001). In multivariate Cox regression analysis in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, haemoglobin, high sensitivity CRP and intact PTH were included, CHA2DS2-VASc score was an independent predictor of cardiovascular mortality (HR: 2.04, CI: 1.20-3.45, p=0.008) (table 2).

Conclusion
CHA2DS2-VASc score is a simple and quick way to identify cardiovascular risk in CKD patients.