bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6502 ETIOLOGICAL SPECTRUM OF MEMBRANOUS NEPHROPATHY
Authors: Tiwari Vaibhav , Jain Akash , Gupta Anurag 
Published: June 2023

Abstract

Background and Aims
Primary MN includes forms of MN in which there is a humoral autoimmune response to a normal podocyte antigen in the absence of secondary features or etiologies of disease. Antigens implicated in primary MN include PLA2R, thrombospondin type-1 domain-containing 7A (THSD7A), neural epidermal growth factor-like 1 (NELL1), semaphorin 3B (Sema3B), the serine protease high-temperature requirement A1 (HTRA1), protocadherin 7 (PCDH7), and others. PLA2R associated MN is most common MN among primary MN. Nowadays, a significant number of newer antigens implicating MN are being discovered. Research is ongoing for a better understanding of the role of these antigens in pathophysiology, and targeted therapeutic implications in future if possible. We aim to analyze the etiological spectrum associated with different antigens in patients with Membranous Nephropathy. We assessed the renal tissue staining of autoantigens PLA2R, THSD7A, and NELL-1 in patients with biopsy-proven Membranous Nephropathy.

Method
This was a single center ambispective observational study. The study was performed up till September 2022 for prospective data, and retrospective data from January 2018 to March 2021 was retrieved from the medical records department of the institute. The study included patients with biopsy-proven Membranous Nephropathy (Primary and secondary). The primary outcome was to study the etiological spectrum of Membranous Nephropathy.

Results
A total of 90 patients were included in the study of membranous nephropathy over the period of 4 years. 72 cases had primary MN whereas 18 cases had secondary MN. The mean age was 42.01 ± 14.6 years. Among 18 cases of Secondary MN, the majority of the cases were of lupus nephritis 14 (78%), while other etiologies of secondary MN were malignancy related (11%), rheumatoid arthritis (5.5%) and HCV (5.5%). PLA2R renal tissue positivity was found in 44 (61.1%) cases of primary MN, whereas in 4 (22.2%) cases of Secondary MN. The THSD7A was found in 4 (5.6%) cases of primary MN. One patient of MN was dual PLA2R and NELL1 positive. Two cases of MN were dual PLA2R and THSD7A positive. Renal tissue staining for NELL-1 was found in 8 (11.1%) cases of primary MN whereas it was found in 1 (5.6%) case of secondary MN. In terms of clinical presentation, proteinuria is the most common clinical finding present in nearly all the patients (80%). Most of the cases with nephrotic syndrome (60%) belonged to primary MN.

Conclusion
PLA2R is the most common etiology of Primary membranous nephropathy. None of the antigens was exclusive to primary membranous nephropathy.
#6505 POST-BURNS PERSISTENT INFLAMMATION LEADS TO KIDNEY PROGRAMMED CELL DEATH THROUGH ACTIVATION OF THE CASPASES SIGNALING PATHWAY
Authors: Yang Guang , Tan Lishan , Fengping Zheng , Xiong Zibo 
Published: June 2023

Abstract

Background and Aims
The underlying mechanism for the increased incidence of chronic kidney disease (CKD) in burn patients discharged from hospital remains unclear. Recent studies have shown that burn patients are discharged from the hospital with chronic inflammation despite normalization of all physiological parameters. We hypothesized that severe burns accelerate the onset and progression of CKD by activating persistent inflammation. This study aimed to investigate the long-term effects of severe burns on kidney and its possible mechanisms.

Method
The study was divided into three parts. First, to understand the effect of burns on the general population and the CKD population, 4-month-old C57BL/6 mice were divided into a blank control group (Blank) and an adenine-induced CKD group. Some mice were established by burns in a 10% total body burn surface area model at 5-month-old. Experiments were terminated at 7-month-old. The function, morphology, inflammatory response and oxidative stress of the kidney were assayed. Second, the effect of activated macrophages on podocytes was studied by in vitro experiments.

Results
In the Blank group, burns did not cause kidney function and weight alterations, but caused a small amount of organic lesions, glomerular atrophy, apoptosis, and macrophage infiltration. In the CKD group, burns not only significantly reduced kidney function, but also caused kidney atrophy, organic lesions, glomerular atrophy, apoptosis and macrophage infiltration. In addition, burns significantly increased Caspase-1 and -3 pathway expression in all mice. Electron microscopy showed that burns significantly aggravated glomerular injury in the CKD group, including podocyte injury, cell membrane blubbing and rupture. In vitro studies showed that polarized M1 macrophages increased MPC5 podocytes death.

Conclusion
Severe burns cause programmed cell death through activation of inflammation-induced Caspase-dependent pathways leading to kidney injury in mice. This phenomenon has a small effect on normal populations and a larger effect on CKD populations. This study has important implications for determining the prognosis of kidney function in burn patients and provides a promising therapeutic strategy.
#6535 SEXUAL DIMORPHISMS OF ACUTE KIDNEY INJURY: DIVERGENT PERFORMANCES OF BIOMARKERS OR DIFFERENT MOLECULAR MECHANISMS?
Authors: Piedrafita Alexis , Siwy Justyna , Sanz Ana Belen , Bousquet Paul , Klein Julie , Alves Melinda , Casemayou Audrey , Minville Vincent , Benjamin Breuil , Mischak Harald , Ortiz Alberto , Schanstra Joost , Faguer Stanislas 
Published: June 2023

Abstract

Background and Aims
Before implementing individualized strategies to prevent or treat acute kidney injury (AKI), identifying clusters of patients with common (or divergent) pathophysiological mechanisms, diagnosis criteria or outcome is of upmost importance.

Method
We compared the characteristics of 1170 male and female patients referred for cardiac surgery with cardiac bypass (CBP) using multivariate logistic regression and propension score-based analysis. Performances of the candidate urinary biomarkers neutrophil gelatinase-associated lipocalin (uNGAL), [IGFBP7].[TIMP-2] product (Nephrocheck), and a recently developed AKI signature of 204 urinary peptides (PeptAKI) were compared, and sex-dependent individual urinary peptide changes were studied.

Results
In these patients referred for CBP-surgery, incidence and severity (K/DIGO classification) of AKI were similar in men and women (about 25%), even after adjustment of the usual risk factors of AKI including baseline estimated glomerular filtration rate, age, diabetes mellitus, length of CBP and red blood cell transfusion. Performances of uNGAL, Nephrocheck and PeptAKI strongly diverged between males and females. In the overall cohort, as well as in sub-groups of males and females, the multi-markers PeptAKI signature outperformed uNGAL and NephroCheck. Reanalysis of peptides included in PeptAKI at the single peptide level suggested divergences of AKI mechanisms between sexes. In women, the peptide score-derived risk of AKI strongly relied on peptides indicating kidney inflammation (including SERPINs, SAA1, osteopontin, uromodulin fragments) and hemolysis (HBA1, HBB), whereas a peptide derived from a stress-responsive protective gene in kidney tubular epithelial cells (VGF nerve growth factor) was dramatically less abundant in women developing AKI.

Conclusion
In patients referred for CBP-surgery, significant clinical and biological differences between men and women, as well as sexual dimorphism of AKI biomarkers performances, were identified. Urinary peptide signatures may help to personalize prevention of AKI progression by giving both quantitative and sex-related qualitative information on molecular mechanisms underlying AKI.
#6572 FLUORINATED GRAPHENE REDUCES PLATELET ACTIVATION AND ADHESION ON HEMODIALYSIS CATHETER
Authors: Liu Chen , Liu Zhuang , Zhang Ling , Fu Ping 
Published: June 2023

Abstract

Background and Aims
Catheter thrombosis remains one of the major complications of hemodialysis. Superhydrophobic surfaces are suggested to be capable of creating an energy barrier that prevents cells and proteins from contacting with the catheter surface directly, making catheter less thrombotic. Fluorinated graphene (FG) is a superhydrophobic material. It has been applied to create self-cleaning surfaces. It also shows good biocompatibility. Based on these features of FG, we prepared an FG coating on hemodialysis catheter attempting to reduce clinical thrombotic events.

Method
FG suspension was made in a solution of 95 wt.% ethanol, 5 wt.% deionized water and 3 wt.% 1H,1H,2H,2H-Perfluorooctyltriethoxysilane (POTS, C14H15F17O3Si). Immediately following the plasma activation, catheter segments of 1 cm²(Gamcath, GDHK1325) were spray coated with FG suspension both inside and outside the catheter lumen. Samples were air-dried for later use. We tested the hemolysis rate, platelet activation and adhesion performances, and the partial thromboplastin time (PTT) of the FG-coated samples. Test for hemolysis was performed with FG-coated catheter and the isotonic extract of the FG coating in direct contact with fresh rabbit blood respectively. Platelet activation and adhesion was performed according to the ASTM F2888-19 standard and also assessed by scanning electron microscope. PTT assay was performed according to the ASTM F2382-18 standard.

Results
FG-coated catheter is hydrophobic and shows a water contact angle of 150° (Figure 1a). It reduced 83.5% of platelet adhesion per 100 μm² catheter surface area and avoided 35.86% of platelet loss from the blood when compared to uncoated catheter (Figure 1b, 1c). It has a hemolysis rate of less than 2% in both direct blood contact test and the extract test (Figure 1d). The PTT of FG-coated sample was 88.92±1.31s versus 83.03±9.49s of the uncoated catheter yet with no statistical significance (P&gt;0.05) (Figure 1e).

Conclusion
FG coating has great hemocompatibility. Though no significant improvement was observed in the PTT assay, FG coating still significantly reduced the adherent and activated platelet on catheter, which seems promising to reduce thrombotic events. Yet, more tests needed to be performed, and the antithrombotic ability of FG coating in the fluid state needs to be further confirmed in the following study.
#6597 THE EFFECT OF PATHOGEN ON THE OUTCOME OF HEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS IN HOSPITALIZED PATIENTS: A SINGLE CENTER ANNUAL RECORD
Authors: Kalogeropoulos Petros , Tsotsorou Ourania , Tsoympoy Ioanna , Nikolopoulos Petros , Lionaki Sophia 
Published: June 2023

Abstract

Background and Aims
Tunneled double-lumen catheters are increasingly used as permanent vascular access in hemodialysis patients, particularly in those with limited vascular access options. Catheter-related bloodstream infection (CRBSI) is a major cause of hospitalization with increased mortality and cost. The purpose is to study the effect of the pathogen on the clinical course of the hemodialysis patients with CRBSI.

Method
Patients hospitalized in our department from 11/2021 to 12/2022 with established CRBSI were retrospectively studied. Their demographics, duration of hospitalization, microbiological data, central venous catheter management and hospital outcome were recorded.

Results
A total of 27 patients with median age (SD) 68,03 (16,93) years were treated, 12 (44.4%) were men. The following pathogens were isolated from the blood cultures: Staphylococcus aureus in 7 (25.9%) patients, coagulase-negative Staphylococcus in 10 (37%) patients, Gram-positive bacteria in 4 (14.8%) patients, Gram-negative bacteria in 3 (11.1%) patients, candida in one (3.7%) patient, while 2 (7.4%) patients had negative cultures. Mean (SD) duration of hospitalization was 16,85 (13,15) days for all patients. Patients in whom Staphylococcus aureus and Candida were isolated had longer hospital stay than other infections with a mean (SD) 29 (18) days and 41 days respectively (p = 0.014). Metastatic infections occurred in 4 (14,8%) patients, of whom 2 had endocarditis, one endocarditis and pulmonary abscess, and one endocarditis, lung abscess and brain abscess. All 4 patients isolated Staphylococcus aureus in blood culture out of a total of 7 (57,1%) patients with this pathogen (p = 0.02). 3 of 7 (42,8%) patients with Staphylococcus aureus, 1 of 10 (10%) with coagulase-negative Staphylococcus, and 1 of 3 (33,3%) with Gram-negative bacteria died (p = 0.385). In 26 of the 27 patients (96.3%) central venous catheter was removed.

Conclusion
The majority of patients in the present sample required central venous catheter removal. The type of pathogen seems to play an important role both in the duration of hospitalization and in the occurrence of metastatic infections.
#6598 STUNNING RENAL FUNCTION RECOVERY AFTER TREATMENT WITH DARATUMAMB IN A CASE OF C3 GLOMERULOPATHY WITH MONOCLONAL GAMMOPATHY
Authors: Costigliolo Francesca , Esposito Pasquale , Macciò Lucia , Viazzi Francesca 
Published: June 2023

Abstract

Background and Aims
38 years old man with C3GN linked to Monoclonal Gammopathy recovers from dialysis after treatment with Daratumamb.

Case report
C3 glomerulonephritis related to monoclonal gammopathy is a challenging entity and the efficacy of treatment with Daratumumab is not clearly defined yet. We would like to describe the case of a stunning renal response to Daratumumab in a young man with MGUS and C3 glomerulonephritis. In July 2021 a 38 years old man presented to our nephrology division with full nephrotic syndrome, creatinine 1.2 mg/dl, low C3 and little IgG lambda spike of 2 g/dL on serum electrophoresis. Kidney biopsy revealed a membranoproliferative GN with bright C3 staining by immunofluorescence, no other positive immune-reactant and no masked deposits on pronase digested tissue. Electron microscopy confirmed the presence of subendothelial electron dense deposits. The diagnosis was consistent with C3 glomerulonephritis. Complement genetic test and C3 nephritic factor were negative. Assuming a form of C3GN associated to monoclonal gammopathy (MGRS), a bone marrow biopsy was performed and revealed a small clonal plasma cells population. In November 2021 he was started on velcade/dexamethasone but unfortunately stopped early due to severe side effects. Subsequently he begun cyclophosphamide and steroids without clinical or serological response. In few months renal function rapidly worsened requiring dialysis since April 2022. A repeat kidney biopsy confirmed C3GN with still moderate activity and low chronicity. In May 2022 he was started on Daratumamab/Lenalidome/Dexamethasone. After eight months of dialysis the diuresis progressively increased and the renal function improved so remarkably that dialysis was discontinued since December 2022. At present the patient renal function is stable with creatinine 3.5 mg/dl, proteinuria 3g/L, and monoclonal component decreased to 1.1 g/L from 3.5 g/L. He continues Daratumumab single agent monthly and we have scheduled a further renal biopsy in the next week. To our knowledge this is the first time a patient recovers from dialysis after treatment with Daratumamb for a C3GN linked to a monoclonal gammopathy. It definitely makes this case unique and inspiring for further studies and considerations regardinf this intriguing field of MGRS.
#6603 THE ROLE OF ANTICOAGULATION IN KIDNEY TRANSPLANTATIONS FROM UDCD WITH HIGH RESISTANCE INDEX
Authors: Gomez Maria Molina , Urrutia Marina , Romero-González Gregorio A , Paúl Javier , Torres Fredzzia Amada Graterol , Riera Josep , Fugasot Carles Cañameras , Perezpaya Ines , Taco Omar , Cañas Laura , Rodriguez Rosely , Fernandez Mario , Montes Ester Gonzalez , Sevillano Angel , Morales Enrique , Cabrera Jimena , Bover Jordi , Vila Ana , Belmonte Amado Andrés 
Published: June 2023

Abstract

Background
Kidney transplantations (KT) from uncontrolled donation after cardiac death (uDCD) achieve very good outcomes to short and long follow-up, but the incidence of primary non-function and venous thrombosis (VT) is very high. The resistance index (RI) after kidney transplantation increase in the VT cases and in other kidney diseases.

Aims
To describe the effect of prophylactic anticoagulation in KT from uDCD with RI ≥0.8 to avoid VT and its secondary effect.

Method
Unicentric retrospective cohorts study that included all KT from uDCD with RI ≥0.8 measured by ecodoppler in the first 72 hours post-transplantation. We compared one group, which never received anticoagulation (Group I), and a second one which received prophylactic anticoagulation (Group II). Sodic heparin was the administer anticoagulant to achieve aPTT 1.5-2 time normal range and/or low molecular weight heparin adjusted to patient's weight and renal function.

Results
We included 107 KT from uDCD with RI≥0.8, with 36 in Group I and 76 in Group II. In Group I the donors were younger (39 ± 12 vs 46 ± 8; p = 0.003) and there were more men donors (97.2% vs 81.7%; p = 0.032). The prevalence of VT was higher in Group I (19.4% vs 0%; p&lt;0.001). Patients in Group II needed more red blood transfusions (19.4% vs 39.4%; p = 0.05) and had more macroscopic haematuria (5.6% vs 21.1%; p = 0.049). The competing risk analysis showed a higher probability to develop a VT in non-anticoagulation group (p = 0.00012) than anticoagulation group or other causes of primary non-function (Figure 1).

Conclusion
The prophylactic anticoagulation treatment in KT from uDCD with RI≥0.8 decreases the VT incidence and it is safe for a donor recipient.
#6606 MEDICATION VOLUME COMPARISON TO BIND PHOSPHATE
Authors: Sprague Stuart , Vayalakkada Suresh , Jermasek Doug , Gupta Shalabh , Gupta Pramod 
Published: June 2023

Abstract

Background and Aims
Elevated phosphate concentrations are associated with a significantly increased risk of cardiovascular disease and overall mortality in patients with chronic kidney disease. Current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend lowering elevated serum phosphorus concentrations toward the normal range in patients with end-stage kidney disease on dialysis through restriction of dietary phosphorus intake, increase in clearance by dialysis, and the use of phosphate binders. However, ∼75% of dialysis patients are not achieving normal phosphate concentrations, potentially due to low adherence and/or binders’ insufficient phosphate binding capacity to match dietary intake. A phosphate binder with a higher phosphate binding capacity could improve phosphate control and potentially clinical outcomes. This study evaluated the medication volume of various phosphate binders to bind 1 gram of phosphorus.

Methods
Five phosphate binders were assessed: ferric citrate (210 mg ferric iron), calcium acetate (667 mg calcium acetate), lanthanum carbonate (500 and 1,000 mg lanthanum), sevelamer carbonate (800 mg sevelamer carbonate), and lanthanum dioxycarbonate (500 and 1,000 mg lanthanum). The mean daily dose volume to bind 1 g of phosphate was calculated as volume per tablet multiplied by the mean number of tablets taken per day. The volume to bind 1 g of phosphate was calculated by dividing the volume per tablet by its in vivo binding capacity, based on NIH DailyMed website.

Results
Binding to 1 g of phosphate required 5.6 cm3 of lanthanum dioxycarbonate compared with lanthanum carbonate (19.8 cm3), calcium acetate binders (25.0 cm3), ferric citrate (46.5 cm3), and sevelamer carbonate (73.4 cm3) (Figure 1).

Conclusion
The study found that lanthanum dioxycarbonate had the lowest volume to bind the same amount of phosphate compared to other binders. With a low medication volume and high phosphate binding capacity, lanthanum dioxycarbonate, a novel investigational nanotechnology product, can be a welcoming choice for patients to manage their hyperphosphatemia. The drug's decreased pill size (making it easy to swallow) and its tolerability have the potential to increase medication adherence and improve phosphate control.
#6612 ACUTE KIDNEY INJURY ASSOCIATED WITH IMMUNE CHECKPOINT INHIBITOR THERAPY: REPORT OF 4 CASES
Authors: Sardeli Angeliki , Petrou Dimitra , Kalogeropoulos Petros , Nikolopoulos Petros , Liapis George , Lionaki Sophia 
Published: June 2023

Abstract

Background and Aims
Immunotherapy using immune check point inhibitors (ICIs) is the cornerstone of modern cancer therapy. Despite significant clinical benefits, ICIs are associated with remarkable adverse events of autoimmune nature involving various organs. Acute Kidney Injury (AKI) occurs more rarely, mainly with the appearance of acute interstitial nephritis. We present a series of patients with AKI after administration of immunotherapy with ICIs.

Method
Patient 1 with metastatic small cell lung cancer on immunotherapy with atezolizumab presented with purpura on the trunk and lower extremities, AKI, microscopic glomerular hematuria, and proteinuria. Patient 2 with esophageal malignancy on immunotherapy with pembrolizumab and worsening renal function. Patient 3 with endometrial malignancy on immunotherapy with pembrolizumab developed AKI, nephrotic syndrome and microscopic hematuria. Patient 4 with melanoma on immunotherapy with pembrolizumab presented with microscopic hematuria and rash.

Results
A kidney biopsy was performed in all 4 patients unreavealling the following; Patient 1: pauci-immune necrotizing glomerulonephritis with fibrinoid necrosis and inflammation in the wall of a vessel. Patient 2: acute interstitial nephritis with intense inflammation. Patient 3: findings consistent with focal segmental glomerulosclerosis (FSGS, NOS), without evidence of immune complex disease. Patient 4: focal segmental glomerulosclerosis, moderate interstitial fibrosis and interstitial nephritis in remission. The patient had already been treated with glucocorticoid. In all 4 patients immunotherapy was temporarily discontinued and they were treated with intravenous pulses of methyl-prednisolone followed by oral glucocorticoids, with significant improvement of kidney function and resolution of all extra renal manifestation i.e skin rash etc. Escalation of immunosuppressive therapy with the addition of another agent was avoided in order not to cause relapse of the malignancy.

Conclusion
AKI is a rare but potentially serious complication of ICIs. Temporal discontinuation of the implicated agent is of major importance while treatment with glucocorticoids may be critical for kindey function. Yet, constant vigilance and sustained collaboration among medical specialists are becoming essential in the increasing use of immunotherapy.