bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO979THERAPEUTIC OPTIONS FOR RECURRENCE OF PRIMARY FOCAL SEGMENTAL GLOMERULONEPHRITIS (FSGS) IN THE RENAL ALLOGRAFT: SINGLE-CENTER EXPERIENCE
Authors: Vallianou Kalliopi , Marinaki Smaragdi , Skalioti Chrysanthi , Lionaki Sophia , Darema Maria , Melexopoulou Christina , Boletis Ioannis 
Published: May 2021

Abstract

Background and Aims
Focal Segmental Glomerulosclerosis (FSGS) recurrence after kidney transplantation (KTx) is relatively frequent and is associated with poor graft survival. The aim of this study was to investigate which management strategies were associated with better outcomes in our cohort of KTx recipients with primary FSGS.

Method
We retrospectively collected data on patients with primary FSGS who received a KTx between 1993 and 2019. A history of biopsy proven FSGS in native kidneys and new onset of significant proteinuria early post-KTx led to the diagnosis of recurrence, which was confirmed by graft biopsy.

Results
From 1993 to 2019 we performed 46 KTxs in patients with primary FSGS. We identified 26 episodes of recurrence in 25 patients, 67% of them occurring in males. They were younger at the time of KTx (33.8 vs 41.1 years old, p=0.067) and had progressed to end stage renal disease (ESRD) faster after FSGS diagnosis (61.4 vs 111.2 months, p=0.038), while they were less likely to have received prophylactic plasmapheresis (61.5% vs 90%, p=0.029). 76.7% of recurrences were found early, after a median of 0.5 months (IQR 0.1-1) with a median proteinuria was 8.5 (IQR 4.9-11.9) g/day. All patients with recurrence were treated with plasmapheresis, while 8 (30.7%) additionally received rituximab, 1 (3.8%) abatacept and 4 (15.4%) ACTH. 7 (27%) patients experienced complete and 11 (42.3%) partial remission after a mean time of 3 (±1.79) and 4.4 (±2.25) months respectively. Prognosis was worse for patients who experienced a recurrence. 11 (42.3%) patients lost their graft from FSGS in a median time of 33 (IQR 17.5-43.3) months.

Conclusion
In this series of patients, primary FSGS recurred frequently after KTx. Prophylacic plasmapheresis was shown efficacious in avoiding FSGS recurrence, while timely diagnosis and plasmapheresis-based regimens induced remission in more than half of the patients.
MO985EFFICACY AND SAFETY OF FERRIC CARBOXYMALTOSE IN THE MANAGEMENT OF EARLY POST-RENAL TRANSPLANT ANEMIA
Authors: Núñez Delgado Sara , Solà-Porta Eulàlia , Arias-Cabrales Carlos , Redondo-Pachón Dolores , Buxeda Anna , Burballa Carla , Mir Marisa , Pascual Julio , Crespo Marta , Pérez-Sáez María José 
Published: May 2021

Abstract

Background and Aims
The efficacy and safety of intravenous ferric carboxymaltose (FeCarb) has been demonstrated both in patients with chronic kidney disease and dialysis, but its effects have not been evaluated in kidney transplant (KT) recipients.

Method
Retrospective study (2016-2018) of KT recipients who received FeCarb during the first 30 days after kidney transplantation (KT). Early efficacy was analyzed by evaluating the first determination of ferrokinetics and hemoglobin levels after administration and late efficacy with the determination &gt;90 days post-administration. Safety parameters were also analyzed.

Results
Out of 283 KT performed, 77 recipients received one dose of FeCarb (52 received a 500mg dose and 25 a 1000mg dose) after a median of 6 days after the KT (IQR 3.5-9 days). 24 patients required transfusion after administration, 7 of them in the setting of concomitant event and 17 for non-response to FeCarb. Among the non-responders (n=17) there was a higher percentage of women, the initial hemoglobin was lower and they received a higher dose of FeCarb (Table). Responders (n=53) improved early and late ferrokinetic and anemia parameters (Figure). In the multivariate analysis adjusted by gender, controlled infection at the time of FeCarb administration, dose of FeCarb administered, immunosuppression, and previous treatment with erythropoietin, hemoglobin levels below 8 g/dL were associated with increased risk of transfusion after FeCarb administration (HR 11.30 [3.03-42.2]). Tolerability was excellent, with no immediate adverse reactions after FeCarb administration. 17 responders had a controlled infection at the time of FeCarb administration (median days under antibiotic treatment: 3, IQR 1-5). The infection did not worsen the response to FeCarb and no clinical impairment after FeCarb administration was observed.
Conclusion: FeCarb administration in early post-transplant anemia is effective in patients with hemoglobin higher than 8g/dl and is not associated with increased risk of infection deterioration.
MO920TRANSITION FROM GENERIC TO BRAND TACROLIMUS IN TUNISIAN RENAL TRANSPLANT RECIPIENTS
Authors: Amor Dorra , Wissal Sahtout , Ellouz A , Abderrahman Ameni , Azzabi Awatef , HadjBrahim Mayssa , Mrabet Sanda , Fradi Asma , Ben Aicha Narjes , Zallema Dorsaf , Sabri Ferdaous , Omezzine Asma , Guedri Yosra , Achour Abdeltif 
Published: May 2021

Abstract

Background and Aims
Due to unavailability of the generic tacrolimus, commonly used in renal transplant patients in Tunisia, all renal transplant switched to the Brand. No previous studies have assessed the pharmacokinetic differences of this generic tacrolimus compared to the brand. The aim of the present study was to evaluate the effect of this switch on the tacrolimus dose (D) and on the dose-adjusted tacrolimus trough blood concentrations (C0/D) in Tunisian renal transplant recipients.

Method
For the 255 renal transplant monitored in biochemestry department of Sahloul University hospital, 808tacrolimus trough concentration (C0) were collected from october 2018 to February 2020 and were divided to 406 C0 determination before switch and 402 after switch. The dose and the post-transplantation period was recorded for each C0.

Results
The generic tacrolimus doses used were significantly higher compared to the brand: 0,12 mg/kg [0,02-0,6] vs 0,11 mg/kg [0,02-0,22] p&lt;0,001 and this was reported in different post graft periods: 0,17 [0,03-0,22] vs 0,13 [0,06-0,22] p&lt;0,001in the 3 first months after the transplantation and 0,11 [0,02-0,48] vs 0,08 [0,02-0,22] p&lt;0,001 above.The C0/D were significantly lowe runder the the generic tacrolimus compared to the brand 48,34ng/ml per mg/kg/day [11,58-210,00] vs77,35ng/ml per mg/kg/day[19,38-221,67]; p&lt;0,001 and this was reported in different post graft periods: 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 in the 3 first months after the transplantation and 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 above. Dose needed to reach target tacrolimus C0 seems to be higher with the generic tacrolimus compared to the brand.

Conclusion
Approval of a generic is dependent on bioequivalence testing in healthy adult volunteers after a single dose, however studies on renal graft recipient populations after chronic use are needed to assed bioequivalence in this special population.
MO1054IMUP: THE ROLE OF TELEMEDICINA ON THE HOMECARE OF CHRONIC KIDNEY DISEASE PATIENTS AFFECTED WITH COVID19
Authors: Yuste Claudia , Caro Espada Paula Jara , Aubert Lucia , Gutiérrez Elena , Frías González Aida , Berzal Raquel , Bergesio Luca , Besada Juan , Bernardos Ana 
Published: May 2021

Abstract

Background and Aims
COVID19 worldwide crisis has shown the fragility of usually overbooked hospital care, encouraging improvements on the homecare and remote monitoring of patients. IMUP (Intelligent Manager for Ubiquitous Personal Mobile Care) is a Mobile App developed by UPM to follow up chronic kidney disease (CKD) patients affected with COVID19.

Method
CKD patients (or their home caregivers) with access to a mobile phone were asked to introduce daily their symptoms (headache, tiredness, short of breath, cough and diarrhea) in addition to blood pressure and temperature. IMUP also allowed: (1) free asynchronous message exchange between patients and physicians, (2) provided general information and guidelines to reduce household COVID19 transmissions, (3) countdown of isolation days, and (4) notified alarms and alerts. All patients consented to a mobile phone monitor. Physicians categorized clinical situations reviewing IMUP symptoms into: (1) stable, (2) alert, and (3) presential assistance advised.

Results
A total of 38 patients (9 kidney transplant, 23 haemodialysis, 3 peritoneal dialysis, 3 low clearance)( 58.8% male, age 62.2 ± 15.6 years, 17.6 % diabetics) with confirmed COVID19 infection were followed up with IMUP, 23 after hospitalization (median of 10 [4-16] days) and 15 with complete outpatient follow-up. The mean follow-up with IMUP was 8 [4,17] days. Four houndred and seven daily symptoms were introduced in IMUP, being tiredness the commonest (27%), followed by cough (21.5%) and diarrhea (20.6%). Reviewing IMUP daily symptoms, 185 clinical situations were categorized in stable and 21 alert. Five patients required presential assistance, 3 of them requiring hospital admission (1 rehospitalization). 81 messages were exchanged, delivering 17 therapeutic recommendations. IMUP countdown helped to organize isolation on the HD unit (cases and contacts), plus follow up with chest X rays and blood samples.

Conclusion
The easy and intuitive use of mobile apps makes them widely accepted by the general population. Remote monitoring by mobile phone apps brings a new opportunity to alleviate our overbooked hospital care. Besides, remote monitoring could help to stratify and organize clinical follow up, allowing a closer communication between physicians and patients.
MO1055JUDICIOUS DIALYSIS DISCONTINUATION IN CHRONIC KIDNEY DISEASE: LENDING MORE TIME TO ECONOMICALLY BURDENED PATIENTS IN DEVELOPING COUNTRY
Authors: Sharma Sourabh , Sharma Neha , Sharma Kailash 
Published: May 2021

Abstract

Background and Aims
Chronic kidney disease (CKD) is important public health problem owing to its high prevalence, morbidity, mortality and socio-economic burden. Patients with end stage kidney disease need to be on kidney replacement therapy which significantly impacts livelihood. Annual average cost of treatment for patients on dialysis is reported to be USD 3151 in developing country like India. It’s quiet high given per capita income of USD 1670

Method
One hundred fifty one CKD Stage 5D patients from Punjab and Rajasthan states, North India were studied in this cross-sectional study. Patients initiated on dialysis within 3 months or protein energy wasting (as per criteria proposed by ISRNM) were excluded. Asymptomatic willing patients, clinically stable for at least 3 months and with pre-dialysis serum Creatinine &lt;6mg/dl, serum potassium &lt;5mg/dl were given a trial for dialysis discontinuation after informed written consent. Biochemical and hemodynamic parameters were measured weekly for 4 weeks and later once monthly. Patients who developed uremic features or rapid rise in serum creatinine were restarted on dialysis.

Results
Fourteen (9.27%) asymptomatic patients with well controlled blood pressure were discontinued from dialysis. Out of them, thirteen patients were on hemodialysis and one on peritoneal dialysis. Twelve (85.71%) out of them were presumed chronic interstitial nephritis while two (14.28%) were autosomal dominant polycystic kidney disease. Mean age of patients was 52.5 years (SD ±18.14 years). Most patients (11/14) were on three or more anti-hypertensive. Mean dialysis vintage was 8.14 months (range 4-16 months). Most patients were non-compliant to dialysis (Mean frequency once in seven days). Two patients were on once in two week dialysis schedule. Mean 24 hour urine output (calculated over 1 week) was 1500ml. Mean baseline serum creatinine was 4.4 mg/dl (SD ±1.06 mg/dl). Mean pre-dialysis serum potassium was 4.5 mg/dl (SD ±0.42 mg/dl). Post-discontinuation serum creatinine levels has been outlined in figure 1. Mean distance of dialysis centre from residence was 83.43 Km (range 1-240 km). One patient need to be restarted on dialysis at fourth week of dialysis discontinuation. Rest patients remained symptom-free and tolerated well.

Conclusion
CKD Stage5D patients should be regularly screened for residual renal function. Recovery of renal function could be seen in some (&lt;10%) cases. Dialysis discontinuation in these cases would decrease their financial and stress burden. However, these cases should be monitored closely and followed-up regularly
FC 043SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR (SUPAR) DETERMINES OUTCOMES IN CLINICAL AND EXPERIMENTAL SEPTIC ACUTE KIDNEY INJURY
Authors: Nusshag Christian , Wei Changli , Hahm Eunsil , Szudarek Roman , Kälble Florian , Speer Claudius , Uhle Florian , Eugen-Olsen Jesper , Weigand Markus A , Zeier Martin , Morath Christian , Brenner Thorsten , Reiser Jochen 
Published: May 2021

Abstract

Background and Aims
Sepsis is the main contributor to the development of acute kidney injury (AKI) in critically ill patients. Plasma soluble urokinase plasminogen activator receptor (suPAR) is a circulating risk factor for AKI and a new prognostic marker for renal outcome prediction. We analyzed the pathophysiological role and kinetic properties of suPAR in septic AKI in critically ill patients and in a murine model of septic AKI.

Method
200 critically ill patients were enrolled prospectively after meeting Sepsis-3 criteria. Serum suPAR levels were measured at 0, 12, 24, 48, 72, 96, 120 and 168-hour after enrollment (n=1440) and the need for RRT within 7 days (predefined criteria) was assessed as the primary outcome measure. Polybacterial sepsis was induced by cecal slurry injection in three mouse strains, respectively wild type (WT, N=16), uPAR-knockout (KO, N=15), and suPAR transgenic overexpression (OE, N=14).

Results
No or mild AKI occurred in 62 patients (31.0%), moderate or severe AKI without the need for RRT in 102 patients (51.0%), criteria for RRT were met in 36 patients (18.0%) and 7 patients (3.5%) died within the 7-day period. Compared to all other maximum AKI stages and AKI disease courses within 7 days, patients requiring RRT showed significantly higher suPAR levels at all time-points. Patients with suPAR levels ≥ 12.7 ng/mL (highest quartile) had an unadjusted odds ratio (OR) of 9.73 (95% confidence interval [CI], 4.31-21.98) and an adjusted odds ratio of 5.22 (95% CI, 2.16-12.65) for the need for RRT; and 7.47 (95% CI, 3.54-15.74) and 4.44 (95% CI, 1.98-9.97) for RRT or death within 7 days compared to patients with levels &lt; 12.7 ng/mL. Compared to KO mice, WT and OE mice showed a significantly greater impairment of renal function, structure and tubular apoptosis 24 hours after induction of sepsis. The inflammation levels with respect to Interleukin 6 were comparable between different strains. Kaplan-Meier analysis revealed a survival benefit of KO mice over OE mice within 24h (86.7% vs. 50.0%, p=0.033).

Conclusion
SuPAR distinguishes between divergent AKI stages/courses and the need for RRT at any time within 7 days after sepsis diagnosis. Our experimental data suggest that suPAR is a pathophysiological driver of septic AKI and may serve as a target for future interventional strategies.
FC 044THE LONG-TERM EFFECTS OF ACUTE KIDNEY INJURY ON INTESTINAL OXALATE-DEGRADING BACTERIA IN RATS
Authors: Stepanova Natalia , Tolstanova Ganna , Nepomnyashchii Valentyn , Akulenko Iryna , Savchenko Svitlana , Kolesnyk Mykola 
Published: May 2021

Abstract

Background and Aims
Gut microbiota is considered an important factor affecting oxalate handling in the intestine. It has been demonstrated that intestinal oxalate secretion provides a complementary route of excretion, and it becomes more evident when kidney function declines. A diversity of gut oxalate-degrading bacteria (ODB) has been hypothesized to play a role in this process. However, there is a general lack of research on the long-term effects of acute kidney injury (AKI) on ODB and their total oxalate-degrading activity (ODA) in fecal microbiota. In this study, we evaluated whether renal dysfunction could affect intestinal ODB and their total ODA in a rat model of glycerol-induced AKI.

Method
The Male Wistar rats (200-300 g, n=20) on oxalate-free diet were randomly divided into 2 groups. After 24-h of water deprivation, Group 1 (n=10) received an intramuscular injection of 50% glycerol (10 ml/kg of body weight), and Group 2 (n=10) served as control. The numbers of ODB (incubated in a highly selective Oxalate Medium and determined using culture method) and total fecal ODA were measured after injection on days 7 and 70. The method of redoximetric titration with a KMnO4 solution was adopted to evaluate total ODA in fecal microbiota; the results were expressed as % of oxalate degradation per 0.01 g of feces.
Renal injury was assessed by histopathological examination, serum creatinine and daily proteinuria levels after removing the animals from the experiment on day 70. Cortical interstitial fibrosis was measured by computerized image analysis on sections stained with picrosirius red. The median (Me) and the interquartile ranges (Q25; Q75) were calculated and compared using the nonparametric Mann-Whitney test. The Spearman correlation coefficient was used to evaluate association between the examined parameters.

Results
The obtained results demonstrated: 1) after glycerol injection on day 7, no differences were found in the numbers of ODB and total fecal ODA between the experimental and control groups: 5.9 (5.4-6.0) vs 6.0 (5.4-6.4) CFU/g, p=0.65 and 2.0 (0.1-5.0) vs 2.5 (2.0-9.0) %/0.01g, p=0.24, respectively; 2) after AKI initiation on day 70, the numbers of ODB and total fecal ODA were significantly lower in Group I compared with control Group II (Fig. 1); 3) the higher percentage of renal interstitial fibrosis was, the higher total fecal ODA occurred in the experimental rats (Fig. 2). In addition, the number of ODB in feces in Group 1 had an inverse association with serum creatinine (r=-0.52, p=0.006) and 24-h proteinuria levels (r=-0.86, p&lt;0.0001).

Conclusion
AKI had the long-term negative effects on the quantitative and qualitative characteristics of ODB in fecal microbiota in rats. Moreover, the results of our study confirmed an increasing trend in total fecal ODA according to the aggravation of renal interstitial fibrosis in rats.
FC 070USE OF POTENTIALLY NEPHROTOXIC MEDICATIONS IN PERSONS WITH CHRONIC KIDNEY DISEASE: PARALLEL COHORT STUDIES IN SWEDISH AND U.S ROUTINE CARE
Authors: Bosi Alessandro , Carrero Juan Jesus , Shin Jung-Im , Xu Yunwen , Grams Morgan , Chang Alexander , Wettermark Bjorn , Barany Franz Peter , Gasparini Alessandro 
Published: May 2021

Abstract

Background and Aims
Many adverse drug events are preventable, such as those potentially resulting from the prescription of nephrotoxic drugs to persons with chronic kidney disease (CKD). We here quantify the extent of contemporary nephrotoxic medication use in patients with CKD.

Method
In two observational cohorts of Swedish (Stockholm CREAtinine Measurements [SCREAM] project, Stockholm, Sweden) and U.S. (Geisinger Health System, Pennsylvania) adults with confirmed CKD stages G3-G5 undergoing routine care during 2016-2018, we explored the prescription (in U.S.) and dispensation (in Sweden) of 115 different ambulatory drugs with proven or purported nephrotoxicity during the 12 months following study inclusion. We evaluated the proportion of participants receiving nephrotoxic drugs, ranked main contributors and identified clinical predictors.

Results
In the Swedish cohort, there were 57880 patients (54.6% women) with median age of 80.00 (inter-quartile range [IQR]: 73.0-86.0) years and eGFR 48.9 ([IQR]: 39.9-55.0) mL/min/1.73 m2. In the U.S. cohort, there were 16255 patients (59% women) with median age of 76 years and eGFR 44 mL/min/1.73 m2. During observation, 20% (Sweden) and 17% (U.S.) of patients received at least one nephrotoxic drug. The top 3 potentially inappropriate nephrotoxic drugs identified were NSAIDs (9% and 11% of participants in U.S. and Sweden received it), antivirals (2.0% and 2.5%) and immunosuppressants (1.5% and 2.7%). Bisphosphonate use was common in Sweden (3.3% of participants), but not in U.S. (0.5%). Conversely, fenofibrates were common in U.S. (3.6%), but not in Sweden (0.13%). In adjusted analyses, patients with young age (&lt;65 years old), women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts (P&gt;0.05 for all). Notably, patients aware of their CKD (identified either by issued diagnosis or recent visit to a nephrologist), were at lower risk of nephrotoxic drug use (OR 0.87, 95% CI 0.82-0.92 in Sweden and 0.89, 95% CI 0.81-1.01 in U.S.).

Conclusion
In two geographically distinct health systems, one in five patients with CKD received potentially inappropriate nephrotoxic medications, mainly NSAIDs. Strategies to increase CKD awareness and physician’s knowledge of drug nephrotoxicity may reduce inappropriate ambulatory prescriptions and prevent iatrogenic kidney injury.
FC 005DEPOSITION OF PLATELET-DERIVED MICRO-PARTICLES IN PODOCYTES CONTRIBUTES TO DIABETIC NEPHROPATHY
Authors: Huang Sijia , Lu Jian , Chen Pei Pei , Zhang Jia Xiu , Li Xue Qi , Liu Bicheng , Ma Kun Ling 
Published: May 2021

Abstract

Background and Aims
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in the developed world. Podocyte injury has been shown to be a critical cellular event in the progression of DN. Our previous studies demonstrated that platelet-derived microparticles (PMPs) mediated endothelial injury in diabetic rats. Therefore, this study aimed to investigate whether the PMPs deposit in podocytes and its potential effects on podocyte injury in DN.

Method
Deposition of PMPs in podocytes was checked by immunofluorescent staining and electron microscopy. Renal pathological change and ultra-microstructure were respectively checked by periodic acid-schiff staining and electron microscopy. The protein expression of inflammatory cytokines and extracellular matrix was measured by immunohistochemical staining and Western blot.

Results
The PMPs were found to be widely deposited in podocytes of glomeruli in diabetic patients and animal models and closely associated with progression of DN. Interestingly, aspirin treatment significantly inhibited accumulation of PMPs in glomeruli of diabetic rats, accompanied with alleviated mesangial matrix expansion, fusion of foot processes, decreased protein expression of inflammatory cytokines and extracellular matrix secretion. The in vitro study further confirmed the deposition of PMPs in podocytes. Moreover, PMPs stimulation induced phenotype transition of podocytes through decreased protein expression of podocin and increased protein expression of α-SMA and fibronectin, which was correlated with increased production of inflammatory cytokines.

Conclusion
Our findings for the first time demonstrated that deposition of PMPs in podocytes contributed to the development of DN.