bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO298A SPECIFIC TUBULAR APOA-I DISTRIBUTION IS ASSOCIATED TO FSGS RECURRENCE AFTER KIDNEY TRANSPLANTATION
Authors: Jacobs Cachá Conxita , Puig Gay Natàlia , Vergara Ander , Gabaldon Alejandra , Sellares Joana , Villena Yolanda , Agraz Irene , Seron Micas Daniel , Moreso Francesc , Soler María José , López Hellín Joan 
Published: May 2021

Abstract

Background and Aims
A major complication primary focal segmental glomerulosclerosis (FSGS) is its recurrence after kidney transplantation that happens in 30 to 40% of the patients. The diagnosis of this relapses is not always easy as the histological lesions are not highly specific and appear after the proteinuria increase. Currently, there are no accurate biomarkers to detect FSGS recurrence. Our group identified a modified form of Apolipoprotein A-I (ApoA-I), named ApoA-Ib, specifically present in urine of recurrent FSGS patients after kidney transplantation. Aberrant forms of ApoA-I have also been described in urine of native primary FSGS patients and have associated this feature to a prominent staining of ApoA-I at the apical membrane of the tubular cells. In this study we aim to analyze the ApoA-I distribution in kidney allograft biopsies of recurrent FSGS patients.

Method
We detected ApoA-I by immunohistochemistry in kidney allograft biopsies of patients with FSGS relapse after kidney transplantation (urinary ApoA-Ib positive) and in kidney allograft biopsies of patients with a disease different from FSGS in the native kidney (No-FSGS, urinary ApoA-Ib negative).

Results
In ApoA-Ib positive recurrent FSGS patients, ApoA-I was prominently localized at the brush border of the tubular cells while in the No-FSGS patients ApoA-I was found along the cytoplasm of the tubular cells (Figure 1).

Conclusion
The localization of ApoA-I at the brush border of the tubular cells is a specific feature of primary FSGS in relapse. This suggests that ApoA-I staining in kidney biopsies, coupled with ApoA-Ib measurement in urine, could be used as a diagnostic tool of primary FSGS relapse after kidney transplantation due to its highly specific tubular distribution.
MO248P-GLYCOPROTEIN EXPRESSING IL-17A+IFN-GAMA+ TH17/1 CELLS ARE REFRACTORY TO GLUCOCORTICOID IN NEPHROTIC SYNDROME*
Authors: Jaiswal Akhilesh Kumar , Prasad Narayan , Agarwal Vikas 
Published: May 2021

Abstract

Background and Aims
Th17 cells are critical effectors mediating the autoimmunity in nephrotic syndrome (NS). Elevated IFN-γ has also been involved in NS; however, it remains unclear to what extent Th1 cells contribute to glucocorticoids resistance in NS. P-glycoprotein (P-gp) effluxes glucocorticoids outside the cells and selectively expressed differentially on T cell subtypes. In this study, we investigated the role of P-gp and cellular source of IFN-γ and assessed its contribution to glucocorticoids resistance in NS.

Method
We analyzed the frequency of pathogenic IL-17A+IFN-γ+ Th17/1 lymphocytes and P-gp expression on their surface by flow cytometry in SSNS (n = 32; mean age: 9.06 ± 5.84) and SRNS (n = 28; mean age: 11.29 ± 3.73) patients. We also included 15 age- and sex-matched healthy controls. All patients were of biopsy proven minimal change disease and all patients were treated with steroids. All patients were recruited as per the criteria of ISKDC.

Results
We found a significant IL-17A+IFN-γ+ Th17/1 population (P &lt; 0.001) in steroid resistant NS (SRNS) as compared to steroid sensitive NS (SSNS) patients. IL-12 and IL-23 are significantly higher in SRNS as compared to SSNS patients which are require for transition of pathogenic Th17 cells to IFN-γ producers. Of the IL-17A+IFN-γ+ Th17/1 population 95.8% cells were expressed P-gp on their surface in SRNS; however only 30.1% cells expressed P-gp in SSNS group (Figure 1). We also observed that P-gp expression correlate positively with IL-17A+IFN-γ+ Th17/1 population (r= 0.739, p&lt; 0.001) significantly.

Conclusion
The above findings clearly show that higher expression of P-gp on IL-17A+IFN-γ+ Th17/1 cells associated with steroid resistance in nephrotic syndrome through both IL-17A and IFN-γ.
MO302ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN ADULTS: A TUNISIAN SINGLE CENTER EXPERIENCE
Authors: El Meknassi Imen , Sanda Mrabet , Yosra Guedri , Dorsaf Zellema , Awatef Azzabi , Wissal Sahtout , Salma Toumi , Asma Fradu , Sabri Ferdaous , Ben Amor Samira , Abdellatif Achour 
Published: May 2021

Abstract

Background and Aims
Acute post-infectious glomerulonephritis (APIGN) is a reactive immunological disease. Its prevalence in industrialized countries is declining contrasting with developed ones. It is uncommon in adults but the prognosis may be reserved. The aim of our study was to evaluate the epidemiological, clinical and histological features of APIGN as well as its prognosis.

Method
A retrospective and descriptive study was conducted in our department. Were included all cases of histologically proven APIGN between December 2006 and December 2017.

Results
We had collected 38 cases. The mean age was 37.7 ± 17.8 years. The sex ratio was 1.92. Twelve (31.6%) patients were diabetic and four of them had already a chronic kidney disease (CKD). APIGN was preceded by an infection in 27 cases with an average interval of 10 ± 5 days. The most common site of infection was the respiratory tract (15 cases). At presentation, 27 patients had nephritic syndrome and 13 had nephrotic-range proteinuria. Hematuria was observed in 97.4%, peripheral edema in 84.2% and hypertension in 73.7% of cases. Most patients (78.9%) had acute kidney injury and 10 (26.3%) patients required dialysis. Renal biopsy had shown benign acute glomerulonephritis in 31 cases and malignant form in 7 cases. An underlying nephropathy was found in 12 cases with mostly a diabetic nephropathy. Corticosteroids were used in 3 cases of benign APIGN and 5 cases of malignant form. During the follow-up, CKD was noted in 14(36.8%) patients including 7(18.4%) patients who progressed to end-stage renal disease. Poor prognostic factors were diabetes, the presence of an underlying nephropathy in the biopsy, acute kidney injury and the need for dialysis.

Conclusion
The APIGN is uncommon in adults, yet its prognosis may be reserved with progression to CKD.
MO309SARS COV2 INFECTION COMPLICATING CRYOGLOBULINEMIC VASCULITIS WITH RENAL INVOLVEMENT
Authors: Bouafif Hanene , Mariem Hajji , Barbouch Samia , Hafedh Hedri , Gorsane Imen , Ben Hmida Fethi , Ben abdallah Taieb 
Published: May 2021

Abstract

Background and Aims
Cryoglobulinaemic vasculitis (CV) leading to clinically apparent skin lesions, and in some cases also to internal organ involvement such as renal involvement. The SARS Cov2 infection in this field is very serious and in the case of our patient the outcome was fatal.
The aim of this work is to highlight the particularities of CV in this case

Case presentation
We report a case of a 62-year-old woman followed since 2014 for CV type 1 IgG Lambda revealed by vascular purpura and nasal septal perforation. the etiological assessment was negative. Hepatitis C virus serology was negative. A corticosteroid therapy at a dose of 1 mg/kg/day was started with partial improvement. Then the cyclophosphamide at a dose of 150 mg/d was added with a fairly good clinical result but stopped for hemorrhagic cystitis.
Chlorominophene was started at a dose of 6 mg/d and then reduced to 4 mg/d for leuconeutropenia but the peripheral arterial manifestations (acrocyanosis of the limbs and ears) were not treated.
The evolution was marked by the appearance of renal failure (creatinine 482.33 umol/l) associated with proteinuria at 1.32 g/24h. An outbreak of cryoglobulinemia was suspected.
Plasma exchange was discussed as a therapeutic alternative and the patient was scheduled for a renal biopsy.
However, the patient became febrile with the appearance of a dry cough and the presence of a biological inflammatory syndrome (CRP at 72). A SARS-CoV-2 PCR was completed which was positive. Therefore, she was put on antibiotic therapy (Azythromycin and Cefotaxime) associated with vitamin therapy and anticoagulant treatment.
The patient was stable in terms of respiration and hemodynema, but her renal function worsened and progressed well under hydration. In addition, she presented with a slippage syndrome and she was died

Conclusion
The natural history of CV is not predictable and strongly depends on concomitant diseases and complications and response to treatment. The SARS Cov2 infection can complicate its evolution. There is no association has been described between them to our knowledge
MO319BEDSIDE URINE SEDIMENT EXAMINATION IN IMMUNOGLOBULIN A NEPHROPATHY PATIENTS PERFORMED BY NEPHROLOGISTS
Authors: Popova Anna , Racenis Karlis , Saulite Anna Jana , Vasilvolfa Aiga , Petersons Aivars , Cernevskis Harijs , Kuzema Viktorija 
Published: May 2021

Abstract

Background and Aims
Urine sediment microscopy is mostly abandoned by nephrologists nowadays, however it is an important diagnostic tool in kidney and urinary tract diseases. The aim of this study is to emphasize the benefits of urine microscopy performed by a nephrologist.

Method
A prospective cohort study at Pauls Stradins Clinical University Hospital Nephrology center included patients with histologically confirmed diagnosis of IgA nephropathy from 1st January 2020 till December 2020. Appropriately collected urine samples were examined using manual microscopy within an hour after sample collection and by automated urinalysis. Samples were centrifuged at 4000 rpm for 4 minutes, the supernatant urine was carefully decanted, 1 - 1,5 ml of the left urine was mixed by gentle agitation and placed on a standard glass slide with a cover slip. Sample examination was performed using low (magnification x10) and high power (magnification x40) using brightfield microscopy with a minimum of 10 fields.

Results
A total of 37 patients (24 men, mean age 42.7 ± 10.9 years) were included in the study. 59.5 % of patients (n = 22) had hematuria based on automated urine sediment analysis and 62.2 % (n = 23) of patients had hematuria based on manual urine microscopy. 45.9 % of patients (n=17) had dysmorphic erythrocytes, 13.5 % of patients (n = 5) had isomorphic red blood cells (RBC) and 40.5 % of patients (n = 15) did not have RBC in urine samples by manual urine microscopy. 54.2 % (13/24) of men and 30.8 % (4/13) of women had dysmorphic RBC in urine.

Conclusion
Manual urine sediment examination was more sensitive than automated analysis. Majority of IgA nephropathy patients have active urine sediment with hematuria and dysmorphic RBC. Manual microscopy remains an effective and reliable method that can be easily and quickly performed by nephrologists.
MO322VENOUS THROMBOEMBOLISM AND NEPHROTIC SYDROME: A FAMOUS BUT STILL SURPRISING COUPLE
Authors: Ruosi Carolina , Cavasso Michele , Caprio Francesca , Giuliana Sofia , Perna Alessandro , Orefice Giuseppe , Perna Alessandra , Simeoni Mariadelina 
Published: May 2021

Abstract

Background
Venous thromboembolism (VTE) is a multifactorial disorder, accounting for high morbidity and mortality rates, due to a complex interplay of several variables classifiable as inherited (mutated Leiden V factor, prothrombin, protein C, protein S and antithrombin) and acquired (lupus anticoagulants, pregnancy, major surgery procedures, cancer and inflammatory diseases) risk factors.
The association of VTE with the nephrotic syndrome, particularly deep vein and renal vein thrombosis (DVT and RVT, respectively) is tightly established. This risk is particularly high in patients with idiopathic membranous nephropathy. In fact, thromboembolic events occur with a frequency between &lt;10% and 45% in this disease. The reason(s) underlying the hypercoagulable status in nephrotic patients are not clearly understood. Multiple hemostatic abnormalities have been described, including decreased levels of antithrombin and plasminogen (due to urinary losses), increased platelet activation, reduced plasminogen activation, overproduction of fibrinogen and factors V and VIII as a compensatory response to hypoalbuminemia. The risk of thrombosis seems to be related to the severity and duration of the nephrotic status and seems to be particularly increased with serum albumin concentrations ≤2.0 g/dl (20 g/L).

Case report
We report the case of a 28 year-old male with nephrotic syndrome due to membranous nephropathy positive for serum anti-phospholipase-A2 receptor antibody. The patient was asymptomatic for VTE, but abdominal ultrasound showed endoluminal obstruction of both renal veins. Abdominal Computer Tomography confirmed the extensive bilateral renal vein thrombosis and also revealed an extension of the thrombosis to the inferior cava vein and the left common iliac vein. He was treated with low-molecular weight heparin for six months. According to our internal protocol, a complete Thrombophilia Molecular Study was performed and showed a normal Leiden V factor, but a rare homozygous mutation of the G20210A gene encoding for prothrombin. The prevalence of this is less than 5% in the general population, but is highly variable with ethnicity. The G20210A mutation confers a mildly increased thrombotic risk that is amplified by the presence of other risk factors, such as nephrotic syndrome.

Conclusions
In our case report, the association of a nephrotic syndrome secondary to a primitive membranous glomerulonephritis and the mutation in homozygous of the G20210A prothrombin, a rare mutation associated with a high thrombotic risk, led to a severe VTE in an still asymptomatic 28-year-old patient. Based on this experience, we would highlight the importance of the genetic screening for polymorphisms associated with inherited thrombophilia in nephrotic patients complicated with VTE.
MO103PREDICTION OF CARDIOVASCULAR OUTCOMES WITH PERIDIALYTIC, INTRADIALYTIC, SCHEDULED INTERDIALYTIC AND AMBULATORY BP RECORDINGS IN HEMODIALYSIS PATIENTS
Authors: Iatridi Foteini , Theodorakopoulou Marieta , Loutradis Charalampos , Karpetas Antonios , Bikos Athanasios , Alexandrou Maria Eleni , Tsouchnikas Ioannis , Mayer Christopher , Haidich Anna-Bettina , Papagianni Aikaterini , Sarafidis Pantelis 
Published: May 2021

Abstract

Background and Aims
Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysis subjects due to high accuracy and strong associations with outcomes. The agreement and prediction of averaged intradialytic BP readings and home BP readings with ABPM and clinical outcomes is not known. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular outcomes and mortality in this population.

Method
We prospectively followed for 49.1±25.6 months 242 hemodialysis patients with valid 48-hour ABPMs to examine the association of pre-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings, scheduled interdialytic BP (the average of out-of-dialysis day readings at 8:00 am and 8:00 pm) and 44-hour ambulatory BP with outcomes. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary revascularization procedure or peripheral revascularization procedure.

Results
Cumulative freedom from the primary end-point was significantly lower with increasing 44-hour SBP (group 1, &lt;120 mmHg, 64.2%; group 2, ≥120 to &lt;130 mmHg 60.4%, group 3, ≥130 to &lt;140 mmHg 45.3%; group 4, ≥140 mmHg 45.5%; logrank-p=0.016). Similar were the results for intradialytic (logrank-p=0.039), intradialytic plus pre/post-dialysis (logrank-p=0.044), and scheduled interdialytic SBP (logrank-p=0.030), but not for pre-dialysis SBP (logrank-p=0.570). With group 1 as the reference group, the Hazard Ratios of the primary end-point showed a gradual increase with higher BP levels with all BP metrics, except pre-dialysis SBP. An inverse association of DBP levels with outcomes was shown with all BP metrics.

Conclusion
Averaged intradialytic and scheduled home BP measurements (but not pre-dialysis readings) display similar patterns of prognostic associations with 44-hour ambulatory BP in hemodialysis patients and represent valid metrics for hypertension management in these individuals.
MO106A PROSPECTIVE STUDY ON ANXIETY AND BLOOD PRESSURE LEVELS IN HAEMODIALYSIS PATIENTS DURING COVID-19 PANDEMIC
Authors: Eren Sadioğlu Rezzan , Aktar Merve , Duman Berker , Kutlay Sim , Sengul Sule , Keven Kenan , Nergizoglu Gökhan , Ateş Kenan , Ertürk Şehsuvar 
Published: May 2021

Abstract

Background and Aims
Coronavirus Disease-19 (COVID-19) pandemic has currently been one of the leading causes of psychosocial stress worldwide. We hypothesized that possible changes in anxiety status might affect blood pressure in haemodialysis (HD) patients during COVID-19 pandemic.

Method
Seventy one prevalent HD patients were included in this prospective study. Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI) were applied to assess psychological status of the patients. Peridialysis blood pressure measurements were performed and average of 6 consecutive HD sessions’ pre-dialysis systolic blood pressure measurements were used for statistical analyses. All assessments were performed both at the beginning (March) and after ending (June) of the partial lock-down, which was officially instituted by the Government in parallel with the status of the pandemic in Turkey.

Results
Mean age (±SD) was 59.2±14.8 years and 52% of the patients were female. Dose of medications including antihypertensives, dry weight, interdialytic weight gain, and Kt/Vurea were stable during the study period. STAI-state score was higher in March than that in June (44.6±12.6 vs 42.3±11.5, respectively, p=0.047), whereas HADS-anxiety, HADS-depression, and STAI-trait scores were not different. Pre-dialysis systolic blood pressure was significantly higher in March than in June (127.9±20.3 vs 124.8±22.8 mmHg, respectively, p=0.029). Change in state anxiety score from March to June was remarkable particularly in patients not taking a beta-blocker (49.3±9.6 to 43.8±11.1, p=0.001) and in patients younger than the median age of 64 years (48.6±12.8 to 45.3±12.5, p=0.029). Change in blood pressure level from March to June was found to be significant only in patients not taking a beta-blocker (123.4±20.2 to 118.2±20.6 mmHg, p&lt;0.001), while did not reach a statistically significant level in the others.

Conclusion
Our findings, though need to be confirmed by further studies, revealed an association between a higher state of anxiety and a higher blood pressure level in HD patients in COVID-19 pandemic era, which was remarkable particularly in patients not taking a beta-blocker.
MO107CLINICAL CHARACTERISTICS OF A PATIENT POPULATION WITH ATYPICAL HAEMOLYTIC URAEMIC SYNDROME AND MALIGNANT HYPERTENSION: THE GLOBAL AHUS REGISTRY ANALYSIS
Authors: Halimi Jean-Michel , Al-Dakkak Imad , Anokhina Katerina , Ardissino Gianluigi , Licht Christoph , Lim Wai , Massart Annick , Schaefer Franz , Van de Walle Johan , Rondeau Eric 
Published: May 2021

Abstract

Background and Aims
Atypical haemolytic uraemic syndrome (aHUS) is a rare disease that manifests as complement-mediated thrombotic microangiopathy (TMA), which can lead to severe organ damage. Some patients with aHUS may present with malignant hypertension (MHT); both conditions can result in TMA. The objective of this analysis was to characterise patients with aHUS and MHT.

Method
In this analysis, patients from the Global aHUS Registry (NCT01522183) were included if they were diagnosed with MHT and were followed ≥90 days after initial aHUS symptom presentation or diagnosis date; patients were excluded if they withdrew from the registry or discontinued treatment with eculizumab due to a diagnosis other than aHUS. Demographics and clinical characteristics were evaluated.

Results
Seventy-one of 1903 registry patients were included in the analysis. Clinical characteristics are presented in the table. Seventeen patients (24%) had a paediatric (&lt;18 years) onset of disease, and 54 (76%) were adults at aHUS diagnosis; female patients were slightly overrepresented (61%). Sixty-nine percent of patients were reported to have MHT at around the same time as aHUS diagnosis (+/-2 months), while 11% and 13% experienced MHT before and after aHUS diagnosis, respectively. aHUS triggering conditions were reported in 6/71 patients (8%) (Table). Cardiovascular (27%) and gastrointestinal (21%) symptoms were the most commonly reported extra-renal manifestations. Eight patients (11%) had a reported family history of aHUS and 40 patients (56%) had a complement pathogenic variant or an anti-CFH-antibody. Thirty-three patients (46%) had a kidney transplant; of these, 20 were prescribed eculizumab in the peri- or post-transplant period.

Conclusion
In this analysis of patients with aHUS and MHT, the observed high prevalence of pathogenic variants in complement genes or anti-CFH antibodies, alongside the high proportion of patients with extrarenal manifestations and/or requiring kidney transplant, indicate a high severity of presentation and poor prognosis of aHUS associated with MHT.
MO108ACCURACY OF PERIDIALYTIC, INTRADIALYTIC AND SCHEDULED INTERDIALYTIC RECORDINGS FOR DIAGNOSING HIGH AMBULATORY BLOOD PRESSURE IN HEMODIALYSIS
Authors: Theodorakopoulou Marieta , Iatridi Foteini , Loutradis Charalampos , Alexandrou Maria Eleni , Karpetas Antonios , Koutroumpas Georgios , Raptis Vasileios , Ferro Charles , Papagianni Aikaterini , Sarafidis Pantelis 
Published: May 2021

Abstract

Background and Aims
Hypertension is highly prevalent in hemodialysis patients. Current recommendations suggest the use of ambulatory-BP-monitoring (ABPM) as the gold-standard for hypertension diagnosis and management in these subjects. This study assessed the accuracy of peridialytic, intradialytic and scheduled interdialytic recordings in diagnosing high 44-h interdialytic BP.

Method
A total of 242 hemodialysis patients that underwent valid 48-h ABPM were included in the analysis. We used ambulatory BP as reference standard and tested the accuracy of the following BP metrics: Pre- and post-dialysis, Intradialytic, Intradialytic plus pre/post-dialysis readings and Scheduled interdialytic BP (out-of-dialysis day: readings at 8:00 am, 8:00 pm or their average).

Results
44-h SBP/DBP levels had significant differences with and pre- or post-dialysis BP, but no or minor differences with any of the other BP metrics. 44-h SBP and DBP correlated strongly with Intradialytic (r=0.713/0.753, p&lt;0.001), Intradialytic plus pre/post-dialysis (r=0.725/0.758, p&lt;0.001) and averaged Scheduled interdialytic BP (r=0.874/0.823, p&lt;0.001). Bland-Altman plots showed absence of systemic bias for all index metrics, but large between-method difference and wider 95% limits of agreement for pre- and post-dialysis BP compared to Intradialytic, Intradialytic plus pre/post-dialysis and averaged Scheduled interdialytic BP. In ROC-analysis for diagnosing 44-h SBP≥130mmHg, the Area-Under-the-Curve of pre-dialysis (0.723) and post-dialysis SBP (0.746) were significantly lower than that of Intradialytic (0.850), Intradialytic plus pre/post-dialysis (0.850) and Scheduled interdialytic SBP (0.917) (z-test, p&lt;0.001 for all pairwise comparisons). The corresponding sensitivity/specificity values were 76.6%/54.5%, 78.7%/59.4%, 73.0%/81.2%, 68.1%/88.1% and 82.3%/89.1%, respectively. Similar observations were made for DBP.

Conclusion
In contrast to pre- and post-dialysis BP, the average of intradialytic, intradialytic plus pre/post-dialysis or scheduled interdialytic BP recordings show reasonable agreement with ambulatory BP and may be used for hypertension diagnosis and management in hemodialysis.