bluuebunny/crossref_metadata_2025_split huggingface dataset:
#916 Outcomes of renal replacement therapy in ICU adult patients with acute kidney injury: a retrospective cohort study
Authors: Mattus Miguel Manuel , Anson Jose Maria 
Published: May 2024

Abstract

Background and Aims
Continuous renal replacement therapy (CRRT) and sustained low-efficiency dialysis (SLED) are usually used for critically ill patients with acute kidney injury when indicated. Most studies done throughout the years showed no statistically significant difference in outcomes between the two modalities. Thus, this study aims to determine the outcomes and associated factors of both CRRT and SLED in patients with AKI. Hence, this will allow us to determine our competency as an institution in using CRRT and SLED to formulate recommendations and protocols in the future.

Method
We conducted a retrospective cohort study of patients who developed acute kidney injury and underwent either SLED or CRRT in the ICU of a tertiary hospital in Makati City, Metro Manila. Patients who are on maintenance hemodialysis, who underwent both sustained low-efficiency dialysis and continuous replacement therapy, and who did not complete or tolerate 1 session of SLED or 24 hours of CRRT were excluded in the study. Key outcomes investigated were all-cause mortality at 30 days and dialysis dependence at 30 days after initiation of treatment.

Results
Eighty-four patients who were initiated with either SLED (N=48) or CRRT (N=36). There was a significant difference in terms of all-cause mortality between modalities 20 (42%) for SLED and 33 (92%) for CRRT, p-value=0.000). Among variables used in the study, higher vasopressor requirement (aOR 2.78, 95% CI: 1.47-5.25, p=0.002) and age (aOR 2.21, 95% CI: 1.13-4.33, p=0.021) at initiation were associated with higher likelihood of mortality across modalities. Thirteen patients (28%) who underwent SLED were dependent on dialysis at 30 days. Baseline serum creatinine (aOR 3.21 95% CI: 1.17-8.79, p=0.023) and serum creatinine at initiation (aOR 4.11, 95% CI: 1.43-22.56, p=0.014) were identified to be associated with dialysis dependence. Sub-analysis of the CRRT group showed continuous veno-venous hemodialysis (CVVHD) (aOR 16.57, 95% CI: 3.54-77.49, p&lt;0.001) was associated with higher likelihood of mortality among CRRT modalities.

Conclusion
Increased mortality was seen in patients who underwent CRRT especially CVVHD and was associated with age and number of vasopressors present during initiation of renal replacement therapy.
#330 Pattern of short-term outcomes of renal function in postpartum acute kidney injury patients: a single-center study in Bangladesh
Authors: Islam Hasanul 
Published: May 2024

Abstract

Background and Aims
Postpartum acute kidney injury (PPAKI) is a formidable health problem in pregnant woman especially in developing country. Monitoring outcomes like serum creatinine levels and glomerular filtration rates is vital. Understanding these short-term results is crucial for timely interventions and better patient care, improving prognosis in this critical condition. The aim of the study was to assess the short-term outcomes of renal function in postpartum acute kidney injury patients.

Method
This prospective observational study was conducted at Mymensingh Medical College Hospital in Bangladesh between March 2020 and April 2021. The study enrolled 153 postpartum acute kidney injury (AKI) patients from the Departments of Nephrology and Departments of Obstetrics & Gynaecology using purposive sampling. Data on patient demographics, etiology, and presentation were collected. Statistical analysis was performed using SPSS version 23.0 and a p- value of &lt;0.05 was considered statistically significant.

Results
After three months, among 153 postpartum acute kidney injury (PPAKI) patients, 77.8% of the patients fully recovered, 5.2% of the patients developed chronic kidney disease. Dialysis was required in 24.2% of the patients, among them 2.2% remained on dialysis. Sadly, 15.7% didn't survive, that highlight the severity of postpartum acute kidney injury. Mortality rates didn't significantly differ between vaginal delivery (14.9%) and cesarean section (16.0%) groups (p=0.488). Both groups show positive outcomes, with 75.5% of vaginal delivery and 79.2% of cesarean section patients achieving full recovery. Blood urea also significantly decreased from 128.51 ± 39.59 to 101.65 ± 55.57 mg/dl during this period

Conclusion
Most postpartum acute kidney injury patients show promising recovery, but some still grapple with persistent renal impairment. Tragically, mortality rates underscore the severity of this condition. Importantly, survival rates don't significantly differ between vaginal delivery and cesarean section patients, emphasizing timely interventions.
#1090 POCUS for diagnosis of congestive kidney due to severe acidemia
Authors: Shibagaki Yugo , Shirai Kana 
Published: May 2024

Abstract

Background and Aims
Point-of-Care Ultrasonography (POCUS) is a novel approach where the treating physician directly performs ultrasonography at the bedside, enabling rapid understanding of the patient's condition, diagnosis, and immediate connection to treatment. Venous Excess Ultrasound (VExUS), one method in POCUS, can swiftly identify structural or functional abnormalities in internal organs, allowing for more accurate assessment of congestion in organs. Here, we report a typical case which illustrates the usefulness of VExUS in correct diagnosis and appropriate management of congestive kidney failure.

Method
A case report.

Results
A 51-year-old woman with mitochondrial myopathy with chronic heart failure was admitted due to loss of appetite and failure to thrive. She presented with acute kidney injury (AKI) and severe acidemia. Given her medical history and physical examination, prerenal causes (hypovolemia/hypotension) of AKI were considered most likely. However, with a significantly elevated NT-proBNP level of 14700, congestive kidney was also considered. Bedside echocardiography showed no evidence of low output syndrome, whereas VExUS (Venous Excess Ultrasound) Score indicated assessed as Grade 2 (moderate congestion). In addition to administering fluids for the suspected prerenal causes (hypovolemia/hypotension), sodium bicarbonate was administered suspecting a negative impact of severe acidemia on cardiac function. With the improvement of acidemia and only a small volume of fluid therapy, there was a rapid improvement in AKI with normalization of VExUS score. This suggested that the main cause of AKI was congestive kidney.

Conclusion
This case demonstrated the significant contribution of VExUS in accurate diagnosis and treatment.
#2026 Hypokalemia associated to neuroendocrine carcinoma of the cervix
Authors: González David Menéndez , Rosado Consolación , Cornejo Gilda Carreño , Felipe Maria Carmen , Manzanedo Rosario , Jiménez Miguel Ángel Navas , Garcia Jesus Martin 
Published: May 2024

Abstract

Background and Aims
Hypokalemia is one of the most common electrolyte disorders seen in clinical practice. Hypokalemia can be caused by decreased intake of potassium, redistribution of potassium (K+) in cells or by excessive gastrointestinal losses or renal losses. In this setting, hypokalemia may also be caused by the paraneoplastic production of ectopic adrenocorticotropic hormone (ACTH) by some tumors.
Cancer of the uterine cervix is the fourth common cancer affecting women worldwide and the fourth most common gynecologic cancer in Spain. Neuroendocrine carcinoma of the cervix represents about 2% of all cervical neoplasms.

Method
We report the case of a 44-year-old Peruvian woman with hypokalemia who was diagnosed with Cushing syndrome secondary to paraneoplastic production of ACTH by neuroendocrine carcinoma of cervix.

Results
Patient was overweight and affected by uterine myoma and anemia without further investigations. She was admitted to our hospital due to lower back pain, leg swelling and constipation. Blood pressure was normal, chest radiography did not show abnormal findings and ECG showed the U wave. Laboratory tests at admission revealed hypokalemia (2.3 mmol/L), metabolic alkalosis, anemia (hemoglobin 9.5 g/dL), hyperkaliuria (K+ urine/Creatinine urine 70 mmol/g) with an elevated transtubular potassium gradient (TTKG=12) and normal renal function. Laboratory data are presented in Table 1.
She developed hypertension in the first day of hospitalization. Renin, aldosterone and cortisol tests was performed. Hypercortisolism was observed and confirmed with 24-hour urinary cortisol excretion. Because of an elevated ACTH (263 pg/mL), pituitary magnetic resonance imaging was performed without lesions.
Whole-body computed tomography revealed a cervical mass. PET scan showed pelvic, adrenal, hepatic and local lymphadenopathy activity (see Fig. 1).
After the histopathological study, diagnostic of small cell neuroendocrine carcinoma of the cervix was made. Chemotherapy therapy was initiated with cisplatin/etoposide regimen. The patient decide to return to Peru because of the poor prognosis of her illness. At discharge, potassium level was 3 mmol/L despite the treatment with spironolactone, ramipril, losartan and oral potassium chloride (160 mmol).

Conclusion
Hypokalemia is a common clinical disorder. In some patients it may be caused by an increased mineralocorticoid activity due to ectopic ACTH-secreting tumors. Applying diagnostic algorithms to electrolyte disorders, beyond their simple treatment, can unmask secondary causes and serious diseases.
#2462 Impact of tacrolimus peak concentration on kidney graft outcomes
Authors: Monchal Quentin , Mariat Christophe , Maillard Nicolas , Claisse Guillaume 
Published: May 2024

Abstract

Background and Aims
Low tacrolimus (Tac) trough concentration-to-dose ratio (C0/D ratio) identifies kidney transplant patients with high level of Tac metabolization and has been shown to be associated with lower graft function and survival. Why fast metabolizers experience poorer outcomes is however unclear. We hypothesized that fast metabolization is associated with higher maximal Tac blood concentration (Cmax) and that Tac Cmax has a detrimental effect by itself.

Method
We retrospectively selected consecutive kidney transplant patients who (I) were treated by Tac (irrespective of the pharmaceutical formulation), (ii) had systematic abbreviated pharmacokinetic tac evaluation at 3- and 12-months’ post-transplant, and (iii) had a minimal follow-up of 5 years. Fast metabolizers were defined by a C0/D ratio &lt;1.05. Cmax was defined by the higher value of Tac concentration observed at 30, 90 or 180 minutes after Tac morning ingestion and was indexed to C0 in order to exclusively focus on patients with no obvious Tac overexposure. Association between Tac Cmax/C0 with traditional transplant outcomes was analysed by univariate and multivariate cox model and logrank test when appropriate.

Results
436 patients transplanted from 2008 to 2016 (64% of male, mean age of 55 ± 13 y) with a median follow-up of 8 years (Q1: 6; Q3: 11) were analysed. Fast metabolizers had lower C0 while receiving higher dose of Tac and displayed significantly higher median Cmax (20 vs 17 μg/l, p &lt; 0.001). Median Cmax/C0 was 3 and 2 in fast and non-fast metabolizers, respectively (p &lt; 0.001). At 15 years’ post-transplant, death-censored graft survival was 13% lower for patients with the highest Cmax/C0 values (p = 0.04). In multivariate cox analysis, higher Cmax/C0 was independently associated with death-censored graft survival (HR = 1.30 (1.03;1.64), p = 0.026).

Conclusion
Our data support the hypotheses 1—that fast metabolizers exhibit higher Tac Cmax even in situations where Tac C0 are not elevated and 2—that exposure to high Cmax is a potential mechanism underlying their poorer outcome. Tac formulations prone to mitigate pharmacokinetic peak could thus be particularly beneficial to fast metabolizers and should be thoroughly evaluated in this indication.
#370 Macroscopic hematuria-associated severe acute kidney injury from thin basement membrane disease
Authors: Kaneko Shuzo , Murata Ririko , Hoshimoto Ainori , Hisada Rina , Harano Makiko , Anno Emi , Hagiwara So , Imai Eri , Nagata Michio , Tsukamoto Yusuke 
Published: May 2024

Abstract

Background
Macroscopic hematuria-associated acute kidney injury (MH-AKI) is a rare condition reported in IgA nephropathy and others, and the mechanism of renal tubular damage caused by red blood cells in the tubules appears to be similar to that of anticoagulant nephropathy.

Case presentation
A 66-year-old Japanese woman with no previous medical history was referred to our hospital with anuric severe kidney injury. Seven days earlier, she had transient acute lumbar back pain, which was followed by gradual worsening of malaise and loss of appetite. On admission, her serum BUN was 147.8 mg/dL, serum Cr 18.57 mg/dL, hemoglobin 11.2 g/dL, urinary red blood cells&gt; 100/HPF, urinary protein 28.8 g/gCr, no hydronephrosis in either kidney, but a small stone in the right kidney. After admission, while starting hemodialysis, she was treated with methylprednisone 1000 mg for 3 days followed by prednisone 40 mg/day because of suspected rapidly progressive glomerulonephritis, but both MPO-/PR3-ANCA and anti-GBM antibodies were negative. Renal biopsy from left kidney showed acute tubular injury with large amounts of red blood cells and red blood cell casts filling the distal tubules (Figure), and prednisone was discontinued. Subsequently, urine flowed out with gross hematuria, and her hematuria and renal function improved with increased urine output, and she was weaned from hemodialysis. Electron microscopy showed glomerular thin basement membrane (TBMD) (Figure). Her renal function and hematuria slowly improved and the right kidney stone disappeared. Microscopic hematuria eventually disappeared, and her serum Cr level was 1.1 mg/dL one year after onset.

Conclusions
This is the first report of MH-AKI in TBMD without a background of anticoagulation, severe thrombocytopaenia, or iron overload. In one report, compared to IgA nephropathy, TBMD is associated with increased urinary Ca and uric acid excretion, which is associated with gross hematuria and back pain [1]. In this case of MH-AKI from TBMD, both red blood cells and crystal formation in the tubular lumens may have transiently and synergistically caused renal tubular obstruction and heme iron-induced tubular damage.
#569 Proenkephalin A 119-159 (penKid) for the early identification and risk stratification of delayed graft function following kidney transplantation
Authors: Benning Louise , Reineke Marvin , Kälble Florian , Speer Claudius , Göth Daniel , Hartmann Oliver , Mieth Markus , Zeier Martin , Mehrabi Arianeb , Weigand Markus A , Morath Christian , Nusshag Christian 
Published: May 2024

Abstract

Background and Aims
Delayed graft function (DGF) frequently occurs following kidney transplantation, and prolonged duration of DGF adversely affects 1-year graft function and long-term graft survival. Recently, Proenkephalin A 119-159 (penKid) was shown to reflect kidney function and predict acute kidney injury (AKI) in critically ill patients. Given the similarities between DGF in transplanted and AKI in native kidneys, we hypothesized that penKid may aid in identifying and risk-stratifying DGF post-transplantation.

Method
In a prospective study of 159 consecutive kidney transplant recipients at Heidelberg University Hospital from November 2021 to July 2023, penKid was quantified using an immunoluminometric assay until patient discharge. DGF was primarily defined as the necessity for dialysis within 7 days post-transplant. Additionally, penKid was examined in the context of DGF severity, discriminating the different durations of post-transplant dialysis treatment. Similarly, penKid was assessed to differentiate uptake of graft function, defined as slow or immediate by a serum creatinine reduction ratio of pre-transplant and 7 days post-transplant levels of &lt;0.7 and ≥0.7, respectively.

Results
DGF, defined as the need for dialysis within the first week post-transplant, occurred in 53/159 (33.3%) patients. penKid enabled the differentiation of patients with and without DGF from the first day post-transplant onward (P &lt; 0.001, Fig. 1), and consistently outperformed SCr in discriminating DGF from no DGF at all time points studied (P &lt; 0.001). Additionally, penKid allowed identification of DGF severity from the first day post-transplant (P &lt; 0.001) and early differentiation between slow and delayed graft function (AUC 0.79 [95% CI 0.68-0.90]). In a multivariate model, delta penKid from pre-transplant to the first day post-transplant emerged as the strongest predictor for DGF (C index = 0.88). On the first day post-transplant, penKid, with a cut-off at 300 pmol/L, discriminated DGF from no DGF with a sensitivity of 95.1% (95% CI 83.9–98.7) and a specificity of 56.5% (95% CI 46.3–66.2).

Conclusion
penKid is a promising biomarker shown to accurately differentiate DGF from no DGF as early as the first day post-transplant and to predict DGF severity, allowing for earlier intervention in these at-risk patients. Due to its high discriminatory power to identify and predict DGF post-transplantation, penKid shows great potential to accompany future studies examining the occurrence of DGF in transplant programs, where DCD is introduced into practice, machine perfusion techniques are assessed, or in trials that assess potential therapeutic interventions in patients with DGF.
#2205 Varying practice patterns in prevention, screening and treatment of diabetes early after kidney transplantation: a European survey
Authors: Laghrib Yassine , Hilbrands Luuk , Oniscu Gabriel , Crespo Marta , Gandolfini Ilaria , Mariat Christophe , Mjøen Geir , Watschinger Bruno , Velioglu Arzu , Dedinská Ivana , Pippias Maria , Hellemans Rachel 
Published: May 2024

Abstract

Background and Aims
Although post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplantation, there is no consensus on preventive measures, nor on the optimal screening and treatment strategy.

Method
The European Renal Association—DESCARTES working group—distributed a web-based survey to transplant centers across Europe to gather information on the risk assessment, screening procedures and management practices for the prevention and treatment of PTDM in kidney-transplant recipients.

Results
Answers were obtained from 121 transplant centers across 15 European countries. Screening practices for pre-existing diabetes during the transplant work-up varied considerably, with only 13% of centers using the recommended oral glucose tolerance test (OGTT), while 14% did not screen at all. At transplantation, 19% (n = 23) of centers tailored the immunosuppressive regimen based on perceived PTDM risk, employing strategies like cyclosporin use (12/23), or early steroid withdrawal (2/23). Fifty-two percent adopted strict glycemic control with long-acting insulin in the first days post-transplant. Sixty-eight percent had defined screening protocols for early PTDM (45 days—six months), mostly based on fasting glycemia and/or HbA1c, while only 8/82 incorporated an OGTT. Changes in immunosuppression were considered by 41% in cases of early hyperglycemia (&lt;45 days) and by 58% in established PTDM (&gt;45 days). Besides insulin therapy, dipeptidyl peptidase-4 (DPP4) inhibitors and metformin were most frequently used to manage early hyperglycemia (&lt;45 days) and PTDM (&gt;45 days).

Conclusion
This European survey underscores significant variation in PTDM prevention, screening, and treatment practices, emphasizing the imperative for clearer guidance in approaching this complication.
#1463 Assessment of salt-sensitive hypertension in a novel Lanosterol Synthase knock-in mouse model
Authors: Lanzani Chiara Livia , Faienza Sipontina , Boustani Maguie E l , Migliaro Vincenzina , Citterio Lorena , Messaggio Elisabetta , Zagato Laura , Canciani Barbara , Simonini Marco , Manunta Paolo 
Published: May 2024

Abstract

Background and Aims
The diversity in blood pressure (BP) response to various salt intakes, known as Salt Sensitivity (SS), exhibits significant differences among individuals within the hypertensive subjects relative to the general population. Hypertension (HT) and SS are correlated to elevated levels of plasma Endogenous Ouabain (EO).
We aimed at delineating the role of the missense variation rs2254524 (Val642Leu; C&gt;A) within the Lanosterol Synthase gene (LSS), encoding for an enzyme involved in steroid biosynthesis. Individuals with the AA LSS variant, adherent to a low-salt diet, had a more significant BP reduction compared to those with CC genotype.

Method
Utilising CRISPR-Cas9, we established a knock-in mouse model carrying the analogous LssV643L/V643L. Male mice were subjected to a normal-salt diet (0.5% NaCl), high-salt diet (4% NaCl), or low-salt diet (&lt;0.03% Na) and BP was monitored every two days using a tail-cuff system for 10 days. Blood and urine were collected separately in metabolic cages.

Results
Homozygous mice for Lss mutation demonstrated normal viability and healthy phenotype, undistinguishable from the WT. At baseline, the Lss AA mice were affected by a significant augmentation in kidney weight at 3 and 12 months of age, relative to WT. The Lss V643L does not influence EO levels or systolic BP (SBP), specifically at 3 and 12 months, but affects the SBP response to dietary salt. AA mice showed a high SBP in a high-salt diet against control diet at the same time intervals. Moreover, the Lss variant impacted the pressure-natriuresis relationship, with the mutated AA strain showing a less steep curve both in control diet versus the high-salt diet and in control diet versus the low-salt diet, displaying the SS phenotype of the AA mice. The 12-month-old mice in high-salt diet displayed cardiac hypertrophy with the AA genotype exhibiting an elevated prevalence of cardiac fibrosis. The level of Lss mRNA decreased in the adrenal glands in response to a high-salt diet. RNASeq analysis identified distinct patterns in several Slc genes, Cbr2 and Arhgap26 within the kidneys of these mice, in control or high-salt dietary conditions.

Conclusion
The established LssV643L/V643L mouse model effectively mirrors the SS-HT phenotype. Our findings highlight the significance of the Lss in modulating BP in response to salt stimuli suggesting a potential organ damage pathway requiring further exploration in older mice.