bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2664 CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) PATIENTS WITH LYSOZYME NEPHROPATHY AND CMML RENAL INFILTRATION DISPLAY MARKERS OF SEVERE DISEASE
Authors: Lafargue Marie-Camille , Van Huyen Jean-Paul Duong , Isnard Pierre , Rennke Helmut , Essig Marie , Carre Martin , Mercadal Lucile , Farhi Jonathan , Bobot Mickaël , Sakhi Hamza , Comont Thibault , Golbin Leonard , Chemouny Jonathan , Cambier Nathalie , Laribi Kamel , Selamet Umut , Riella Leonardo , Fain Olivier , Adès Lionel , Fenaux Pierre , Cohen Camille , Mekinian Arsène 
Published: June 2023

Abstract

Background and Aims
Chronic myelomonocytic leukemia (CMML) is a hematologic disorder which is an overlap syndrome between myelodysplastic syndromes, and myeloproliferative neoplasms, and can be associated with autoimmune and inflammatory diseases. The objective of this study was to describe kidney involvement in CMML patients, their treatments, and outcomes.

Method
We conducted a French and American multicenter retrospective observational study in fifteen centers, identifying CMML patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities.

Results
Sixteen patients (males, n = 14, median age 76.5 [71.9-83]) developed a kidney disease 6 months [1.6-25.6] after the diagnosis of CMML. Median urinary protein to creatinine ratio was 2 g/g [1.3-3.4], and median serum creatinine was 2.26 mg/dL [1.46-2.68]. Fourteen patients (87.5%) underwent a kidney biopsy. The two main renal diagnoses were either a lysozyme nephropathy (n = 9, 56%), or a renal infiltration by the CMML (n = 6, 37.5%). Histological findings showed lesions of acute tubular injury with focal tubular epithelial necrosis (n = 4), a vacuolization of the epithelial cells of the proximal tubules (n = 7), and an inflammatory infiltrate with mostly mononuclear myeloid cells (n = 9). Ten patients received a new treatment following the CMML-associated kidney injury. The effect of CMML treatment on kidney injury could be assessed in 10 patients, and renal function evolution was heterogenous. After a median follow-up of 15 months [9.9-34.9], 4 patients had CKD stage 3, 4 CKD stage 4, 1 an end-stage kidney disease. Two patients evolved to an acute myeloid leukemia (AML), and 5 died. Compared with 116 CMML controls, patients who had a kidney involvement had a higher monocytes count (p&lt;0.001), had more CMML-1 (p = 0.005), were more susceptible to develop an AML (p = 0.02), and were more eligible to receive a specific hematologic treatment, with hydroxyurea, or hypomethylating agents (p&lt;0.001), but no survival difference was seen between the two groups (p = 0.6978).

Conclusion
In this largest published cohort of CMML patients with a kidney injury, the two most frequent renal complications were lysozyme-induced nephropathy, and renal infiltration by the CMML. The development of a kidney injury during CMML appears to worsen the patient prognosis.
#2667 CARDIOVASCULAR AND MORTALITY RISKS IN YOUNG HEALTH SCREENING EXAMINEES WITH MARGINAL ESTIMATED GLOMERULAR FILTRATION RATE
Authors: Kim Minsang , Kim Dong Ki , Kim Jung-Hyun , Joo Kwon Wook , Park Sehoon 
Published: June 2023

Abstract

Background and Aims
Additional evidence is necessary to interpret the kidney function parameters in young adults, particularly in those with marginal eGFR values. We aimed to study the clinical significance of marginal eGFR values in large-scale general health screening examinees of young age (20-39 years).

Method
We performed a nationwide retrospective cohort study using the health screening database of South Korea. We included young adults aged 20-39 years without a history of major cardiovascular events (MACE) or end-stage kidney disease who underwent a nationwide health screening in 2012. The study exposure was eGFR categorized into 15 mL/min/1.73 m2 intervals, with a reference group and a main group of interest: &lt; 30, 30-45, 45-60, 60-75, 75-90 (reference), 90-105, 105-120, and ≥ 120 mL/min/1.73 m2. The risks of all-cause mortality and MACE were calculated using Cox regression analysis adjusted for various clinicodemographic characteristics.

Results
In total, 3,132,409 young adults were included in this study. During a median follow-up of 7.3 years, marginal eGFR (60-75 mL/min/1.73 m2) was not significantly associated with a higher risk of all-cause mortality [adjusted HR 0.92 (0.86-0.99)]. The results were similarly identified for the MACE outcome [adjusted HR 1.01 (0.94-1.07)]. On the other hand, those with presence of albuminuria, even the marginal eGFR range was significantly associated with higher risks of all-cause mortality [adjusted HR 1.52 (1.01-1.29)] and ischemic stroke [adjusted HR 1.73 (1.10-2.74)].

Conclusion
Marginal eGFR alone was not associated with higher risks of all-cause mortality and MACE in general young adults. However, in those with albuminuria, the mortality risk was higher even in eGFR of 60-75 mL/min/1.73 m2.
#2704 MANAGEMENT OF HAEMODIALYSIS PATIENTS UNDERGOING RADIOACTIVE IODINE THERAPY FOR THYROID CANCER
Authors: Lin Raymond , Malaroda Alessandra , Ryder William , Wong Veronica , Wong Nikki 
Published: June 2023

Abstract

Background and Aims
Radioactive iodine (RAI) 131I is used in the adjuvant treatment of thyroid carcinoma following thyroidectomy. 131I is renally excreted, with reduced clearance in patients with end-stage kidney disease (ESKD). There are no established protocols for RAI dosing, timing of dialysis and safety in this population [1]. We describe a single-centre experience with a modified protocol and setup for RAI in haemodialysis (HD) patients including serum 131I measurements to monitor for red marrow toxicity. We present the outcomes in two HD patients.

Method
A protocol was developed for performing HD post-RAI administration. HD sessions were performed at 24, 72 and 144 hours post-treatment. Custom HD plumbing was installed within existing lead-lined infrastructure. Specific considerations were made for radiation safety including emergency protocols, handling of blood samples, nursing education, patient self-cannulation and dose-reduction of thyrogen pre-treatment. In addition to standard dose-rate meter measurements of radiation, serum 131I measurements were taken pre- and post-HD as a more accurate measurement of red marrow toxicity.

Results
The two patients included in the study were aged 41 and 60 years. Special considerations for these patients included anuric state in one patient (bilateral nephrectomy) and morbid obesity in the other. Both had early-stage papillary thyroid cancer treated with thyroidectomy. Retained radioactivity measured by dose-rate meter is shown in Figure 1. The largest reduction in radioactivity occurred after the first HD session (approximately 60%). The highest risk of radiation exposure was in the 24 hours prior to the first HD session. Pre-and post-HD serum 131I measurements estimated the radiation dose to red marrow to be below 0.2Gy (maximum tolerated radiation dose for red marrow is 2.0Gy2). Radiation received by HD nurses is shown in Figure 2. Overall exposure was well within national regulatory dose limit of 0.5mSv for members of the public.

Conclusion
HD at 24, 72 and 144 hours produced a radiation clearance profile similar to controls with normal renal function. The effect of residual renal function on 131I clearance was minimal and HD was the main determinant of 131I clearance in ESKD. Non-routine serum measurements of 131I can be used to assess toxicity to red marrow and guide HD session timing during RAI therapy. Performing HD at 24 and 72hrs post- 131I resulted in a radiation burden to the red marrow well below the accepted radiotoxicity threshold of 2Gy [2]. RAI can be given safely to HD patients with thyroid cancer in centres with the appropriate protocol and setup.
#2779 THROMBOMODULIN IS A SPECIFIC MARKER OF ENDOTHELIAL DYSFUNCTION IN HEMODIALYSIS PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: Hebah Hayam , Sabry Manal , Elnagar Mohamed , Abdelmegied Shaimaa 
Published: June 2023

Abstract

Background and Aims
Non-alcoholic fatty liver disease (NAFLD) is associated with endothelial dysfunction which is a common problem in hemodialysis patients and a risk for high cardiovascular mortality in hemodialysis. Thrombomodulin is a promising marker of endothelial cell injury in different pathological conditions. This study evaluates the additive effect of non-alcoholic fatty liver disease (NAFLD) in prevalent HD patients on endothelial dysfunction.

Methods
A case-control study was conducted on 60 end-stage renal disease (ESRD) patients on conventional hemodialysis: group A: 30 patients with NAFLD, group B: 30 patients without NAFLD, and control group of 30 apparently healthy subjects. Excluding elderly, diabetic patients, chronic Liver disease, advanced heart Failure, active infection, COVID-19 infection, autoimmune diseases and patients with hemodialysis catheters. Thrombomodulin was measured for all participants by ELISA technique.

Results
Thrombomodulin could detect endothelial dysfunction in patients with NAFLD at Cut off value &lt;0.8 ng/ml with sensitivity 53.33%, specificity 80%, PPV 72.7%, and NPV 63.2%. On comparing Thrombomodulin in patients with NAFLD (4.378±3.762 ng/ml), Non-NAFLD (1.126±0.591 ng/ml), and control (0.755±0.314 ng/ml) there was a significant difference (P-value&lt;0.001). Post hoc analysis showed significantly high Thrombomodulin levels in patients with {NAFLD versus Non-NAFLD} and {NAFLD versus control} with p-value&lt;0.001, 0.001 respectively while there was no significant difference between patients with Non-NAFLD and control p-value 0.792. NAFLD patients with positive thrombomodulin have a risk of 2.5 times having endothelial dysfunction. There was no significant correlation between Thrombomodulin and all variables in the study.

Conclusions
Thrombomodulin can be used as specific marker for endothelial dysfunction in hemodialysis patients with Non Alcoholic fatty liver disease.
#2794 ISOLATED GLOMERULITIS IS STRONGLY ASSOCIATED WITH THE ABSENCE OF ANTIBODY-MEDIATED REJECTION BY MOLECULAR DIAGNOSTICS
Authors: Schmid Nicolas , Weidmann Lukas , von Moos Seraina , Gaspert Ariana , Helmchen Birgit , Mueller Thomas , Schachtner Thomas 
Published: June 2023

Abstract

Background and Aims
According to the 2018 Banff classification, the Molecular Microscope Diagnostic System (MMDx) is indicated in cases when histology is insufficient to diagnose antibody-mediated rejection (ABMR) due to an absence of diagnostic criteria groups 2 and/or 3. The impact of isolated glomerulitis (g&gt;0, ptc0) on the likelihood of ABMR diagnosis by the MMDx appears critical to the implementation of this new biomarker.

Method
We analyzed 251 kidney allograft biopsies by histology and molecular diagnostics at the University Hospital Zurich from October 2018 to November 2022. Histologic findings were classified concerning the absence of (1) diagnostic criteria groups 2 and 3 (n = 18), (2) diagnostic criteria group 2 only (n = 18), and (3) diagnostic criteria group 3 only (n = 28). In addition, cases with histologically proven ABMR were used for comparison (n = 65). High-resolution re-typing was performed from the kidney allograft biopsies if necessary.

Results
The MMDx diagnosed ABMR in 1 of 18 cases (6%) with absent diagnostic criteria groups 2 and 3, 4 of 18 cases (22%) with absent diagnostic criteria groups 2, and 19 of 28 cases (68%) with absent diagnostic criteria groups 3. On the contrary, MMDx confirmed the diagnosis of ABMR in 42 of 65 cases (65%) with histologically proven ABMR but did not in 23 of 65 cases (35%). Among 28 cases with absent diagnostic criteria group 3, only 2 of 19 cases (11%) with ABMR by MMDx but 6 of 9 cases (67%) with no ABMR by MMDx showed isolated glomerulitis (p = 0.0048). Among 65 cases with histologically proven ABMR, only 7 of 42 cases (17%) with ABMR by MMDx but 14 of 23 cases (61%) with no ABMR by MMDx showed isolated glomerulitis (p&lt;0.001). Overall, 14 of 65 cases (21%) with isolated glomerulitis showed ABMR diagnosis by MMDx.

Conclusion
Isolated glomerulitis is strongly associated with the absence of ABMR by MMDx not only when diagnostic criteria group 2 is missing but also when diagnostic criteria 3 is missing or ABMR is proven by histology. Our results may help to guide the indication for MMDx in clinical practice. However, the clinical significance of these results needs further investigation.
#2795 PROSPECTIVE ASSESSMENT OF THE NEED FOR AND ADDED VALUE OF MOLECULAR DIAGNOSTICS OF KIDNEY ALLOGRAFT BIOPSIES: AN EVALUATION IN CLINICAL PRACTICE
Authors: Schmid Nicolas , Weidmann Lukas , von Moos Seraina , Helmchen Birgit , Gaspert Ariana , Mueller Thomas , Schachtner Thomas 
Published: June 2023

Abstract

Background and Aims
The Molecular Microscope Diagnostic System (MMDx) may resolve inconclusive histology findings, as preserved biopsy material can be examined after histology findings have been obtained. The extent to which this proposed approach can be implemented in clinical practice remains an open question.

Method
We prospectively analyzed 104 consecutive indication kidney allograft biopsies by histology and molecular diagnostics at the University Hospital Zurich from April 2022 to December 2022. Pathologists and clinicians with experience in molecular diagnostics assessed the need for MMDx by questionnaire when the histology report was available. Clinicians then assessed the added value of the molecular diagnostics by questionnaire when the MMDx report was available.

Results
29 of 104 cases (28%) showed rejection by histology, 42 of 104 cases (40%) showed no rejection by histology, and 33 of 104 cases (32%) showed histologic findings insufficient to diagnose ABMR due to an absence of diagnostic criteria groups 2 and/or 3. Pathologists considered molecular diagnostics indicated in 42 of 104 cases (40%), 9 cases to give extra confidence, and 33 cases for diagnostic clarification concerning rejection. Clinicians considered molecular diagnostics indicated in 54 of 104 (52%) cases, 5 cases to give extra confidence, and 49 for diagnostic clarification concerning rejection. In 33 cases with histologic findings insufficient to diagnose ABMR, molecular diagnostics were considered indicated by pathologists and clinicians. Molecular diagnostics allowed the diagnosis of ABMR in 8 of 33 cases (24%). In addition, 11 of 104 cases (11%) showed a discrepancy between the histologic findings and the molecular diagnosis. Clinicians considered adjustment of treatment based on the MMDx report in 3 of 11 discrepant cases. Pathologists and clinicians considered molecular diagnostics indicated in 2 of 11 and 3 of 11 discrepant cases, respectively.

Conclusion
The need for molecular diagnostics goes beyond the recommendation of the 2018 Banff classification for histologic findings insufficient to diagnose ABMR. However, the added value of molecular diagnostics appears to be largely limited to these cases.
#2803 ECG ABNORMALITIES AND MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Kharsa Chloé , Chlawit Roy , Aoun Mabel 
Published: June 2023

Abstract

Background and Aims
Hemodialysis patients undergo electrocardiogram (ECG) testing for acute events or as a part of the regular workup. It is still unknown whether chronic ECG abnormalities could be considered as a prognostic factor in dialysis patients. This study aims to analyze the association between mortality and ECG abnormalities of the last two years of follow-up of hemodialysis patients.

Method
This is a retrospective study that included all patients treated with chronic hemodialysis in a single center between January 2002 and December 2021. Patients who had no ECG in their medical file during the last two years of follow-up were excluded. ECGs were interpreted by two physicians. Logistic regression analysis evaluated the association between ECG signs and mortality. The study was approved by the institutional ethics committee and was conducted in accordance with Helsinki Declaration.

Results
A total of 298 medical files were reviewed, 149 files included an ECG in the last two years of follow-up. Mean age of patients was 67.1 ±13.2 years, 64.4% were males, 54.4% had diabetes, 44.2% had documented coronary artery disease (CAD), 14.8% had chronic or paroxysmal atrial fibrillation. The median left ventricular ejection fraction (LVEF) was 60% [55.5, 64.5]. 55% percent died after a median follow-up of 47 [25, 87] months. Table 1 summarizes the ECG characteristics found among all patients. In the univariate analysis, age, CAD, LVEF, left axis deviation, large QRS, ST depression and first-degree AV block were significantly associated with mortality. After adjustment to age, dialysis vintage, sex, diabetes, CAD and LVEF, we found a significant association between all-cause death and left axis deviation (Table 2). The poor R wave progression was associated with increased sudden cardiac arrest after adjustment to age, dialysis vintage, sex, diabetes and CAD (OR = 2.65, 95%CI 1.01-6.94, p = 0.048).

Conclusion
This study showed that left axis deviation on ECG of patients treated with chronic hemodialysis is an independent factor associated with increased all-cause mortality after adjustment to demographic and medical factors. Poor R wave progression was associated with sudden cardiac arrest.
#2804 ALBUMINURIA IS ASSOCIATED WITH DECREASED SEVR AND ANKLE-BRACHIAL INDEX IN PATIENTS WITHOUT CKD
Authors: Piko Nejc , Bevc Sebastjan , Hojs Radovan , Naji Franjo , Petreski Tadej , Varda Luka , Ekart Robert 
Published: June 2023

Abstract

Background and Aims
Albuminuria signifies subclinical vascular damage in the kidneys and other organs and is associated with systemic endothelial dysfunction and increased future cardiovascular risk.
Subendocardial viability ratio (SEVR) is defined as diastolic to systolic pressure-time integral ratio and is a marker of subendocardial perfusion. Reduced SEVR has been uncovered in patients with chronic kidney disease (CKD) and simultaneous albuminuria. Albuminuria is also considered a risk factor for peripheral artery disease, especially in patients with additional atherosclerosis risk factors or diabetes mellitus. The aim of our study was to determine the impact of albuminuria on SEVR and ankle-brachial index (ABI) in patients without known CKD.

Method
We included 111 patients (73% male, mean age 64.2±9.3 years) that were hospitalized at our Cardiology department between 2016-2020 due to elective cardiac catheterization. Albuminuria was determined by urine albumin to creatinine ratio (UACR) from a random urine specimen. SEVR was determined by using applanation tonometry on radial artery (Sphygmocor, Atcor Medical, Australia). Ankle-brachial index (ABI) was measured by using an automated, non-invasive waveform analysis device (MESIÒ, Slovenia), mean ABI between the left and right side was used. Glomerular filtration rate was estimated (eGFR) by using the CKD-EPI 2009 creatinine equation. All the data were obtained prior to cardiac catheterization and only patients with eGFR ³60 ml/min/1.73 m2 were included. Statistical analysis was performed with the Statistical Package for Social Sciences version 22.0 (SPSS Inc, USA).

Results
Basic descriptive statistics, comorbidities, and medications are presented in Tables 1 and 2. Spearmann's correlation test showed significant correlation between UACR and SEVR (r = - 0.238; p = 0.017) and UACR and ABI (r = - 0.304; p = 0.003). Multiple regression analysis with SEVR as the dependent variable and waist-to-hip ratio, body mass index (BMI), arterial hypertension, diabetes, dyslipidemia, eGFR and UACR as independent variables, showed a significant association between UACR and SEVR (b = - 0.232; p = 0.029). The same model was used for ABI as the dependent variable, and a significant association was found only between UACR and ABI (b = - 0.232; p = 0.029).

Conclusion
Albuminuria is independently associated with decreased SEVR and ABI even in the absence of CKD.
#2818 UNIQUE SIGNATURES OF EXTRACELLULAR MATRIX REMODELING IN PATIENTS WITH LUPUS NEPHRITIS, FSGS, AND MCD: A PILOT STUDY
Authors: Sparding Nadja , Genovese Federica , Karsdal Morten A , Derner Ondrej , Neprasova Michaela , Frausova Doubravka , Kollar Marek , Hruskova Zdenka , Tesar Vladimir 
Published: June 2023

Abstract

Background and Aims
Glomerulonephritis is one of the most common causes of chronic kidney disease (CKD). Causes of glomerular diseases include lupus nephritis (LN), focal segmental glomerulonephritis (FSGS) and minimal change disease (MCD). The hallmark of CKD is renal fibrosis characterized by an imbalanced turnover of extracellular matrix (ECM) components and CKD is associated with increased inflammation. The aim for this study was to screen a biomarker panel based on extracellular matrix remodeling biomarkers as well as fibrotic activity and inflammation biomarkers. Additionally, to identify biomarkers that are differentially expressed in glomerular diseases compared to healthy and that are differently expressed between the different etiologies.

Method
The study included 79 healthy controls (age (median years): 35, sex (%women): 51), 48 patients with LN (age: 39, sex: 63), 13 patients with FSGS (age: 44, sex: 23), and 14 patients with MCD (age: 51, sex: 47). The following biomarkers were measured in serum and/or urine samples from all 154 subjects:
• Interstitial matrix remodeling biomarkers; formation of collagen type III (PRO-C3) and VI (PRO-C6), and degradation of collagen type III (C3M).
• Basement membrane remodeling biomarkers; MMP-mediated degradation of collagen type IV (C4M, C4G, TUM), laminin (LG1M) and perlecan (LG3).
• Two biomarkers of fibrotic activity; acetylated N-terminal of alpha-smooth muscle actin (αSMA) and transforming growth factor β (TGF-β).
• An inflammation biomarker of calprotectin (CPa9-HNE) reflecting neutrophil activity.

Results
Overall, all three diseases showed the same trend of change (either no change, increase or decrease compared to healthy controls) in biomarker levels. There was a significant increase of PRO-C3, PRO-C6, TUM, LG1M, αSMA, and CPa9-HNE in serum, and a significant decrease of C3M and C4M serum in patients compared to heathy controls. Four of the biomarkers were differently expressed between the different etiologies. In serum, C4G levels were significantly higher LN and MCD compared to FSGS, LG1M levels were significantly higher in LN compared to MCD, and CPa9-HNE levels were significantly higher in MCD compared to LN (all, P&lt;0.05). In urine, TUM levels were significantly higher in LN compared to FSGS and MCD (P&lt;0.05).

Conclusion
The data presented in this study indicate that both biomarkers of interstitial matrix and basement membrane remodeling as well as biomarkers of fibrotic activity and inflammation reflect the changes that take place during development of glomerular diseases. Some of these markers may be able to distinguish etiologies including the hardly differentiated diseases FSGS and MCD. This needs to be tested in larger studies.