bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO1024CLOSTRIDIUM SEPTICUM INFECTION COMPLICATING HEMOLYTIC UREMIC SYNDROME: A CASE REPORT AND LITERATURE REVIEW
Authors: Cirillo Luigi , Becherucci Francesca , Guzzi Francesco , Errichiello Carmela , Buti Elisa , Roperto Rosa Maria , Materassi Marco , Romagnani Paola 
Published: May 2021

Abstract

Background and Aims
C.septicum is an anaerobic bacterium that resides in the gastrointestinal tract of herbivores. Its presence in human fecal flora is still debated, being found in only 2.8% of healthy adults. Transmitted by oral-fecal route, it reaches the systemic circulation, causing bacteremia, myonecrosis, bowel necrosis, intracranial abscesses/encephalitis. Shiga-toxin producing E. Coli related hemolytic uremic syndrome (STEC-HUS) is a thrombotic microangiopathy characterized by hemolytic anemia, thrombocytopenia and kidney damage, related to STEC infection. Severe presentation includes gastrointestinal and neurologic involvement. Microangiopathic lesions in the colonic mucosa can facilitate the colonization of systemic circulation by C.septicum, spreading the superinfection.
Since the first report in 1988, very few cases of STEC-HUS complicated by C.septicum superinfection have been described in literature and thus the factors predicting clinical outcome are not clear.

Method
We describe the case of a 5-years-old girl admitted for anemia, AKI, thrombocytopenia and diarrhea. Previous history was unremarkable. STEC-HUS diagnosis was made. Despite prompt conservative treatment, 12h later her clinical condition worsened, showing ESKD needing dialysis, abdominal pain, progressive hyporesponsiveness. The brain CT scan showed pneumocephalus and encephalitis; blood cultures were drawn and broad-spectrum antibiotic therapy was set (Tab.1). Cardiovascular instability prevented surgical treatment of pneumocephalus to be done. The patient died shortly after because of septic shock. Post-mortem stool and blood cultures confirmed STEC infection complicated by C.Septicum.
Previous literature on this specific clinical picture has been reviewed and summarized.

Results
Eleven additional cases (7 males) have been previously described. Mean age of presentation was 2.9 years. A; abdominal symptoms (commonly distention and pain) were reported in all cases, while ESRD was present in 10 cases. Six patients presented fever. Central nervous system presentation as pneumocephalus was associated with poor prognosis, while surgical treatment availability of brain lesions to survival. In one case the infection caused myonecrosis (Tab. 1).
The mortality rate was about 60%. In 7 cases, clinical conditions worsened in less than 24h and this was in all cases related to poor outcome.

Conclusion
C.septicum superinfection complicating STEC-HUS is a rare but fearsome complication to be aware of. Rapid diagnosis and surgical treatment are essential for the successful management of this particular condition.
MO1025SCREENING FOR CELIAC DISEASE AMONG PEDIATRIC PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Ibrahim Magid A Abd El Fattah , Hamdy Ahmed M , Anwar Doha , Ragia M Said 
Published: May 2021

Abstract

Background and Aims
Chronic kidney diseases (CKD) in children are a group of diseases that not only affects the kidneys but also all systems of the body particularly causing anemia, bone diseases and failure to thrive in that age group. Gastrointestinal tract (GIT) manifestations are not thoroughly highlighted in those patients although they definitely have repercussions on their growth and development. GIT diseases such as celiac disease (CD) has been long linked to renal manifestations either through increasing risk of kidney diseases or as a proved association. The aim of this study was screening for celiac disease and GIT symptoms among pediatric patients with chronic kidney disease.

Method
A case-control study included 90 CKD patients from Nephrology unit, Children’s Hospital, Ain Shams University, who has been diagnosed for at least 3 months and not receiving steroids or immunosuppressive therapy: 60 patients with end stage renal disease (ESRD) on regular hemodialysis (HD) & 30 with CKD on conservative treatment. Their ages ranged between 2-13 years old, 47 males, 43 females. 200 controls were also enrolled in the study (for GIT manifestations): healthy children with ages ranging from 2-13 years old, 77 males, 123 females within a period of 12 months. All patients & controls were interviewed about GIT manifestations they regularly experience and any GIT troubles they have. All CKD patients were screened for CD by Anti Tissue transglutaminase IgG and IgA blood testing.

Results
Reviewing the most significant GIT symptoms among patients, we found that 86.7% had mucoid diarrhea, 77.8% had abdominal distension, 75.6% had anorexia, 64.4% had epigastric pain, 51.1% had watery diarrhea, 30% had nausea, 30% had vomiting, and 25.6% had constipation. None suffered from hematemesis, melena or bloody diarrhea. GIT symptoms were significantly more pronounced in CKD patients compared to controls and even more in ESRD patients than CKD patients. All patients were negative for CD screening by Anti Tissue transglutaminase IgG and IgA. No significant correlations were seen between Anti Tissue transglutaminase IgG and IgA and age, sex, anthropometric measures (except for BMI), biochemical results (except for s. ferritin) or eitiology of renal disease were observed.

Conclusion
GIT troubles are more pronounced in children with CKD compared to age and sex matched healthy controls. CD is not particularly prevalent among CKD pediatric patients compared to the known percentage among this age population.
MO1028EFFECTIVENESS AND KIDNEY PROGNOSIS IN THE TREATMENT OF CORTICORRESISTANT NEPHROTIC SYNDROME IN PEDIATRICS
Authors: Vinuesa Jaca Ana , Hernández Zúñiga Lina Catherine , Arango Sancho Pedro , Codina Sampera Elena , Calzada Baños Yolanda , López Baez Víctor , Madrid Aris Álvaro 
Published: May 2021

Abstract

Background and Aims
To report the response to different treatments and the renal prognosis in a cohort of patients with corticosteroid-resistant nephrotic syndrome (CRNS).

Method
Retrospective observational study in patients with CRNS. For this, the results of the histology, the different treatment guidelines used in each case and the evolution of renal function were collected, determining the results in terms of remission and renal survival in the different groups.

Results
Of the initial cohort of 37 patients, 33 were included, excluding 4 patients with Finnish-type genetic CRNS. The mean age at diagnosis was 6.1 years. 54.5% were women. Regarding the initial biopsy, 45.5% corresponded to minimal changes (15 patients), 27.3% (9) focal and segmental glomerulosclerosis, 15.1% (5) diffuse mesangial proliferation and 12.1% (4) others. The mean follow-up was 53 months (3-115 months). 27 patients (84.4%) received cyclosporine (CyA), 66.7% (18) of them presented complete remission and 22.2% (6) partial response. Of the patients in complete remission, 33% had at least one relapse after 17 months of treatment (7–27 months). Rituximab was administered in 12 patients (37.5%), of which 7 had not previously responded to immunosuppressants. 100% of frequent relapsers presented complete remission after administration of Rituximab, although 3 had subsequent relapses (60%) after 21 months of treatment (12-34 months). 57% of the patients who did not respond to immunosuppressants did not respond to Rituximab either, with Ofatumumab allowing complete remission in one of them. When relating the results with the histology, we saw how the remission in minimal changes and diffuse mesangial proliferation was 100% and 80%, respectively, although it was 33.3% in focal and segmental glomerulosclerosis. Similarly, renal failure was more frequent in patients with focal segmental glomerulosclerosis (77.7%). Of the remissions (24; 72.7%), 3 were partial (9.1%) and 6 (18.2%) did not respond to any immunosuppressive treatment, with the need for kidney transplantation in 2 of them (6%) and with 1 deceased due to an infectious cause (3%).

Conclusion
Histology and, especially, focal and segmental glomerulosclerosis, play a prognostic role in the CRNS with a lower remission rate and a greater deterioration in renal function and the need for associated kidney transplantation.
MO1006COMPARISON OF DIFFERENT DEFINITION OF PARTIAL AND COMPLETE REMISSION IN A COHORT OF CHILDREN WITH LUPUS NEPHRITIS*
Authors: de Mutiis Chiara , Tullus Kjell 
Published: May 2021

Abstract

Background and Aims
Lupus Nephritis (LN) occurs in up to 80% of children with SLE and it affects the long term outcome and the overall survival. Achieving and maintaining renal remission is crucial. However definition of remission in children is not clearly defined. We compared the outcomes using different published definitions of complete and partial remission.

Method
248 children with biopsy proven LN class III or higher (ISN/RPS) diagnosed and treated in 23 international centers in the last 10 years were included. Data regarding their renal outcome were collected for twenty-four months after the start of induction therapy. We applied seven definitions of remission to compare the number of children achieving partial and complete remission. Definitions applied have been adapted from the Bristol-Myers Squibb (BMS) trial, the American College of Rheumatology (ACR) recommendations, the Lupus Nephritis Assesment with Rituximab (LUNAR) trial, the Aspreva Lupus Management Study (ALMS) trial, the Abatacept and Cyclophosphamide Combination: Efficacy and Safety Study (ACCESS) trial, the Kidney Disease Improving Global outcomes (KDIGO) guidelines and the Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis (BLISS-LN).
We also focused on the BMS trial, the ACCESS trial and the KDIGO guidelines definitions to analyse the importance of gender, age, ethnicity and the economic income of the country (as defined by the World Bank) where patients had been treated.

Results
The mean age at diagnosis was 11 years and 4 month. 71.4% were females. They were mainly East-Asian (34.3%), South-Asian (24.6%) and Caucasian (18.6%). 42.7 % were from middle income countries and 57.3% high income countries. The kidney biopsies showed LN class III in 35.5%; class IV in 45.6% and class V in 18.9%.
The different definitions varied significantly in terms of outcomes, with that of the ACCESS trial having the highest percentages of complete remission and the BMS trial the lowest (Figure 1). A relatively small percentage of children achieved partial remission during the follow-up for all the definitions (Figure 2).
Focusing on the BMS, ACCESS and KDIGO definitions, we found no statistically significant differences of gender and age in the rate of children entering complete remission at 6, 12 and 24 months. East Asian children did however achieve remission more often than other ethnic groups (p &lt; 0.05) (Figure 3).
Children treated in high income countries showed a statistically significant higher percentage of complete remission at 12 and 24 months (p &lt; 0.05) (Figure 4).

Conclusion
Rate of complete and partial remission varied considerably when using the different definitions. Ethnicity and income of the country where the patients were treated did influence outcome. The findings of our study can help in deciding how to define remission in urgently needed future treatment studies in children.
MO1007RELATIONSHIP BETWEEN DIALYSIS ADEQUACY, ULTRAFILTRATION RATE AND SURVIVAL IN YOUNG HEMODIALYSIS (HD) PATIENTS HAVING INITIATED CHRONIC HD IN CHILDHOOD*
Authors: Gotta Verena , Marsenic Olivera , Atkinson Andrew , Pfister Marc 
Published: May 2021

Abstract

Background and Aims
Hemodialysis (HD) adequacy is currently assessed based on weight-normalized small solute clearance (spKt/V), with same targets in both adult and pediatric patients on chronic thrice weekly hemodialysis, despite lack of pediatric studies to support this. It has been hypothesised that pediatric patients of small size may require higher spKt/V targets, due to higher ratio of body surface area (BSA) to body weight and/or greater post-dialysis urea rebound. Ultrafiltration rates (UFR) &gt;10-13 mL/kg/h, associated with increased mortality in adults, are furthermore routinely exceeded in pediatric patients with uncertain consequences. We aimed to characterize how different delivered HD adequacy metrics and UFR are associated with survival in a large cohort of patients who started HD in childhood.

Method
Retrospective analysis on a cohort of patients &lt;30y on chronic HD since childhood (&lt;19y), having received thrice-weekly HD 2004-2016 in outpatient DaVita dialysis centers. Mean delivered dialysis dose (spKt/V) and alternative measures of HD adequacy and fluid balance, including eKt/V, body-surface normalized Kt (Kt/BSA) and ultrafiltration rate (UFR), were investigated as predictors of survival in a Weibull regression model.

Results
A total of 1780 patients were included (age at initiation of HD: 0-12y: n=321, &gt;12-18y: n=1459), with median spKtV=1.55, eKt/V=1.31, Kt/BSA=31.2 L/m2 and UFR=10.6 mL/kg/h. Kt/BSA was a better predictor of survival than spKt/V or eKt/V (P&lt;0.001 versus P=0.002, respectively). UFR was associated with survival (P&lt;0.001), with increased mortality &lt;10/&gt;18 mL/kg/h. Associations remained significant after adjusting for age, ethnicity, and etiology of kidney disease.

Conclusion
We found that targeting Kt/BSA&gt;30 L/m2 in children and young adults on maintenance HD is associated with improved long-term outcomes, corresponding to spKt/V&gt;1.4 (&gt;12 years) and &gt;1.6 (&lt;12 years), respectively. Relatively high UFR of 10-18 ml/kg/h appears to be risk-free in this HD population.
MO1008IMPACT OF RAMIPRIL ON ENDOTHELIAL DYSFUNCTION IN CHILDREN ON REGULAR HEMODIALYSIS
Authors: Mohamed Ateya Areej , Kreutz Reinhold , Elhakim Ihab , Shaheen Sara , Maher Radwa , Sabri Nagwa 
Published: May 2021

Abstract

Background and Aims
Endothelial dysfunction is an important risk factor for cardiovascular disease and therefore for increased mortality in end-stage renal disease patients. Asymmetric dimethyl arginine (ADMA), a potent inhibitor of nitric oxide synthase, strongly contributes to endothelial dysfunction. In dialysis patients, ADMA levels are markedly elevated. Previous studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) can significantly reduce ADMA levels in a variety of patients. In contrast, a previous study suggested that short-term treatment with ACEIs may even increase ADMA levels in adult patients on maintenance hemodialysis. However, no study has evaluated the effect of ACEIs in pediatric patients undergoing hemodialysis.

Method
We conducted a prospective, randomized, double-blinded and placebo-controlled trial (NCT04582097) at two nephrology centers in Cairo, Egypt. Patients below the age of 16 years and on regular hemodialysis for 6 months or longer were eligible for inclusion. Exclusion criteria at screening included uncontrolled hypertension, serum potassium level &gt; 5.5 mmol/L, acute infection or treatment with immunosuppressive agents within the previous month, known intolerance of ACEI treatment and inability to discontinue previous ACEI or angiotensin receptor blocker treatment. A total of 135 eligible patients (mean age, 12.6 years; range 7-15 years; 53.3% males) were randomly (1:1) assigned to once oral daily treatment with identical capsules containing either 2.5 mg ramipril (n=68) or placebo (n=67) for four months. Systolic and diastolic blood pressure (BP) and serum ADMA concentrations were measured as primary efficacy and serum potassium levels as primary safety parameter.

Results
At baseline, systolic and diastolic BP and ADMA levels were similar between both treatment groups (Table). After four months, both systolic and diastolic BP were significantly lower in the ramipril compared to the placebo group. Treatment with ramipril resulted in a profound reduction in ADMA levels (-77% compared to baseline) while ADMA levels were unchanged in the placebo group after four months (p &lt;0.001). Serum levels of potassium increase in both groups with no reported symptoms of severe hyperkalemia No serious adverse events were reported in neither group.

Conclusion
Ramipril treatment in pediatric patients on maintenance hemodialysis causes a marked reduction in ADMA levels. This may contribute to improved endothelial vascular function besides its efficacious BP lowering effect.
MO1043EXPLORATION OF REMOTE SCIENTIFIC RESEARCH TRAINING FOR MEDICAL STUDENTS DURING THE COVID-19 PANDEMIC
Authors: Yin Huanhuan , Ji Peili , Shi Xiaoxiao , Zhao Bingbin , Xia Peng , Chen Limeng 
Published: May 2021

Abstract

Background and Aims
We aimed to investigate a new team-based remote teaching model (TRTM) among M.D and Ph.D. candidates major in nephrology to improve their scientific research training and reduce stresses during the COVID-19 pandemic.

Method
From February 1 to April 30 in 2020, we set up TRTM (Fig 1) via online conferencing systems as: (i) Plan-Do-Check-Action cycle every two to three days to promote project progress, (ii) weekly lab meetings for sharing experiences and ideas; and (iii) weekly journal clubs for literature reading and knowledge expansion. We recruited nine students in TRTM training, and another 25 students as control group, who arranged their schedule by themselves during the quarantine.

Results

1. A survey about the remote teaching
25 mentors and 34 students had received a survey and all believed that teamwork, lab meeting, and short-term academic goals were essential in remote training. Non-scheduled discussion (72.0%,18/25) and regular online lab meetings (60.0%,15/25) were the most common traditional methods. About 85.3% of students and 28.0% of the mentors agreed that “poor self-control” was the main cause of remote-teaching difficulty.

2. The effectiveness of TRTM training
Compared to the control group, students in TRTM had more self-reported benefits from “mentors’ feedback”, “team support”, and “team communication” (All P&lt;0.05), despite no significant differences in learning productivity or daily work progress. Meanwhile, the TRTM group presented with lower “anxiety related to the COVID-19 pandemic” and lower “stress-related to scientific research” (Both P&lt;0.05). For TRTM students, the academic ability was also evaluated at the baseline and after three months of practice, by team members (7 teachers and 9 students). They made progress in varied aspects during the pandemic, such as executing planned tasks, self-improvement based on feedback, and teamwork ability (All P&lt;0.001).

Conclusion
Our team-based remote teaching model helped students gain more supports and growth in academics and reduce psychological pressures caused by isolation.
MO1044DESIGN OF THERAPEUTIC EDUCATION WORKSHOPS FOR HOME HEAMODIALYSIS IN A PATIENT-CENTERED CKD RESEARCH: A QUALITATIVE STUDY
Authors: Guerraoui Abdallah , Galland Roula , Belkahla-Delabruyere Flora , Didier Odile , Sauvajon Pierre , Caillette-Beaudoin Agnes 
Published: May 2021

Abstract

Background and Aims
A quarter of the patients did not receive any information on any modality before the start of Renal Remplacement Therapy (RRT). We have therapeutic education workshops for all RRT except for home haemodialysis (HHD). We aimed to identify and describe the needs of patients and caregivers for RRT with HHD. Lastly, to conceive and carry out a Therapeutic Education Workshop.

Method
Two sequential methods of qualitative data collection were undertaken: (1) interviews with a patient who had been on HHD and a doctor specialized in HHD. (2) semi-structured interviews with HHD patients in our center.

Analytic Approach
Thematic analysis. We used thematic analysis and systematically coded and identified themes inductively from data. To ensure that the range and depth of data were reflected in the analysis, transcripts were independently analyzed by 2 research team members experienced in qualitative research.
Transcribed interviews were entered into RQDA 3.6.1 (2019-07-05) software for data organization and coding purposes (Version 3.6.1). Patient interviews were ceased when no new codes were identified (data saturation) after five consecutive interviews.

Results
We identified six themes related to the barriers, facilitators, and potential solutions to home dialysis therapy: (1) HHD allows autonomy and freedom with constraints, (2) safety of the care environment, (3) the caregiver and family environment, (4) patient’s experience and experiential knowledge, (5) self-treatment experience - Impact on life, and (6) factors that impact the choice of treatment with HHD.
we designed a model for a therapeutic education workshop in a group of 4 patients and 4 caregivers. Our approach is the person-centered model of care. The workshop is composed of 4 educational sequences

Conclusion
Our study confirmed previous results obtained about the major barriers, facilitators, and potential solutions to HHD. There are three important points regarding HHD: (1) the impact of the HHD on the caregiver, (2) the experience of patients already treated with HHD, and (3) the role of nurses and nephrologists in informing and educating. A program to develop patient-to-patient peer mentorship, allowing patients to discuss their dialysis experience, would be invaluable.
MO1035KIDNEY KNOWLEDGE AMONG USERS OF AN ONLINE SELF MANAGEMENT PLATFORM FOR PEOPLE WITH CKD
Authors: Van den Brand Jan , Quint Karl , Naranjo Karen 
Published: May 2021

Abstract

Background and Aims
Renal Tracker is a blended on- and offline self management platform for people with CKD. One of the goals of the program is to increase user’s knowledge about their kidney disease in order to facilitate communication with their health care providers. In the present study we aim to a baseline data for kidney knowledge to which the program could be compared.

Method
We recruited a cohort of 74 users from the United States of America via social media channels, including Facebook, Pinterest and Google Adwords. The users were offered a 12 week online course program in addition to a 1-on-1 call with a health coach specialized in renal nutrition. Before starting the program users were prompted to complete the Kidney Knowledge Survey (Wright et al AJKD 2011). We compared our results to those in the study by Wright. Pseudonymized data for users was obtained from the RenalTracker analytics server, and analyses were performed using Python 3.8.5 with a JupyterLab 2.2.28 shell.

Results
The mean overall score for our cohort was 18.8 (SD 4.0) for a 67% (SD 14%) correct. By comparison, Wright reported a mean score of 66% (15%). Users found the question about what medication to avoid hardest (26% correct). In addition, users were only able to identify half of the usual symptoms associated with kidney disease. Likewise, they were able to point out about only half of the functions of the kidney. Conversely, 88% knew their target blood pressure, possible long term consequences of CKD.

Conclusion
Our results highlight that even among a subgroup of patients actively researching and looking for information, kidney specific health knowledge needs to be improved. In particular limited knowledge about nephrotoxic drugs is worrying.