bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6871 RISK FACTORS FOR SHORT-TERM CHRONIC KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY WITH RECOVERY OF NORMAL RENAL FUNCTION
Authors: Mahmoud Nouha Ben , Lahouimel Rania , Hammouda Mouna , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Sabra Aloui , Skhiri Habib 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is a clinico-biological syndrome encompassing the entire spectrum of acute renal failure that is responsible for a higher short-term risk of developing chronic kidney disease (CKD) even after recovery of normal renal function. The risk of developing new CKD has been estimated at 4 times that of the population without an episode of AKI in several studies. Our objective was to identify its risk factors

Method
We conducted a retrospective descriptive study that included patients hospitalized for AKI with recovery of normal renal function between January 2002 and December 2015 who were followed up to one year after discharge. In order to achieve our objective, we collected data related to the patients' age, history, multitargeted or not, mechanism of AKI, KDIGO stage, glomerular filtration rate (GFR) at hospital discharge, using a pre-designed form.

Results
In the short term, 176 patients were followed up, among whom 18 patients (10.2%) had developed CKD with a mean delay of 9.07±0.4 months. Patients reaching CKD stage were older, half were over 70 years old, 61% were diabetics; 13 of them were multitargeted and 15 had a GFR &lt; 60 ml/min at discharge. All these parameters were statistically different from patients who did not progress to CKD. However, regardless of the mechanism of AKI or the KDIGO stage selected, these two parameters were not retained as risk factors for the development of CKD. In multivariate analysis by logistic regression, only being an elderly subject remains a significant risk factor (p = 0.034) of developing short-term CKD with an OR of 3.3; 95% CI (1.09 - 10.01)

Conclusion
Our results suggest that the development of CKD occurred most often in the first year following an episode of AKI, hence the interest in following these patients.
#6879 ASSOCIATION OF THE BERDEN CLASSIFICATION AND THE PROGNOSIS OF ANCA VASCULITIS
Authors: Mahmoud Nouha Ben , Ghabi Faten , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Hammouda Mouna , Sabra Aloui , Skhiri Habib 
Published: June 2023

Abstract

Background and Aims
ANCA-associated vasculitides (AAVs) are systemic diseases characterized by inflammatory involvement of the small vessel wall, and renal involvement is frequent and severe. The new Berden histo-pathological classification established in 2010 has made it possible to classify ANCA-associated glomerulonephritis (GAA) into focal, mixed, cellular, and sclerotic forms in order to better guide the therapeutic management and to assess the prognosis. The aim of this work was to evaluate the prognostic value of this anatomopathological classification.

Method
We conducted a single-center retrospective descriptive and analytical study of patients diagnosed with histologically confirmed GAA in our Nephrology Department during the period from 2016 to 2022.

Results
We collected 20 patients, median age 52 years [21-77 years]. The sex ratio (M/F) was 0.8. Histological confirmation of GAA was based on renal biopsies in 100% of cases. Rapidly progressive glomerulonephritis was the nephrological presentation in 15 patients. One patient had no hematuria and one had no proteinuria and renal failure was present in all cases. Good Pasture syndrome was present in 7 cases. The Berden classification was applied to the 20 renal biopsies: the focal form (2 cases), the cellular form (7 cases), the mixed form (7 cases) and the sclerotic form (4 cases). The evolution was marked by a partial remission for 11 patients. After an evolution of 1 year, end-stage renal failure (ESRD) was retained in 13 patients. The sclerotic form was not associated with a poor prognosis in our population (p = 0.642).

Conclusion
Of course, our sample size was small and in our population we found a predominance of the mixed and cellular forms compared to the sclerotic form, contrasting with poor therapy with a rapid evolution towards CKD.
#6881 ELEVATED LEVELS OF THE C5B9 TERMINAL COMPLEMENT COMPLEX IN PATIENTS RECEIVING RENAL REPLACEMENT THERAPY
Authors: Nordbø Ole Petter , Tam Ga Kei , Osman Tarig Al-Hadi , Marti Hans-Peter , Mollness Tom Eirik , Leh Sabine 
Published: June 2023

Abstract

Background and Aims
The complement cascade and its inhibitors play an important role in health and disease. Complement activation represents a key pathogenic mechanism underlying inflammatory diseases affecting the kidney. The study aimed to investigate the C5b9 system in renal biopsies, where we stained all obtained kidney biopsies from the year 2017 (n = 256).

Method
Antibody staining against terminal C5b9 was performed, and a C5b9 score for each glomerulus (n = 1942) was generated based on automated image analysis. Mean scores for the interstitium, tubules and blood vessels, and whole biopsy sections were also calculated.

Results
Globally and segmentally, sclerosed areas in glomeruli stained much stronger than their non-sclerosed glomerular counterparts. The results were linked with Renal Replacement Therapy (RRT) status and clinical data from the Norwegian Kidney Biopsy Registry. The study's main findings were that elevated levels of C5b9 were present in patients on RRT in glomeruli, blood vessels and whole section staining. Fibrillar glomerulopathy and Membranous Glomerulonephritis had the highest C5b9 scores, while glomeruli from Hypertensive Nephrosclerosis were represented with a low score. C5b9 scores correlated weakly or non-significantly with clinical variables like age, blood pressure and eGFR. The degree of fibrosis showed an associated positive correlation to C5b-9 staining intensities. Additionally, patients with an elevated C5b9 score (from the 50th percentile and above) showed a significantly elevated risk of receiving RRT within 60 months of biopsy.

Conclusion
C5b9 levels were significantly elevated in sclerotic glomeruli as well as in patients receiving RRT. A weak correlation between C5b9 scores and clinical variables for renal function suggest that the C5b9 complement system may be an independent effector in CKD.
#6891 MACHINE LEARNING NEPHROPATHOLOGY DIAGNOSTICS OF THROMBOTIC MICROANGIOPATHIES
Authors: Cicalese Pietro Antonio , Rizvi Syed , Seshan Surya V , Sciascia Savino , Roccatello Dario , Barreca Antonella , Schroeppel Bernd , Kar Nicole Van De , Roelofs Joris , Kers Jesper , Mohan Chandra , Nguyen Hien , Becker Jan Ulrich 
Published: June 2023

Abstract

Background and Aims
Thrombotic microangiopathies, comprising atypical hemolytic uremic syndrome (aHUS) and other diseases, can present with a broad clinical and histopathological spectrum. On our way to an evidence-base for the nephropathological work-up of TMAs, we have chosen a machine-learning approach, thus eliminating suboptimal reproducibility of descriptors for individual lesions in the three decisive compartments artery, arteriole and glomerulus with human experts. Here, we present our results for an end-to-end diagnostic system.

Method
We collected 50 random biopsies with TMAs of various etiologies (including aHUS, hypertension-associated, systemic sclerosis, anti-phospholipid antibody syndrome and others) and 50 biopsies with Mimickers (differential diagnoses of TMA), including severe hypertensive nephropathy, necrotising arteritis/arteriolitis, cryoglobulinemic vasculitis from the three participating centers Cologne, Weill-Cornell Medical Center, and Turin. Whole slide images (WSIs) from all four nephropathology stainings HE, PAS, trichrome and Jones were included in this study. We developed an instance segmentation Mask-RCNN model with a Swin Transformer (t) backbone on tissue crops detected using a lightweight variant of the U-Net segmentation architecture. For the classification model we used our own MorphSet++ set transformer architecture to process batches of EfficientNetv2s-encoded tissue crops entered in three separate compartment channels. Batches were chosen with Monte Carlo sampling or using our own soft Markov Chain Monte Carlo (MCMC) approach. Results of the classification model are reported with 5-fold internal cross-validation.

Results
Segmentation performance measured as mIOU, mAP, mAR, mF1, mAS for artery reached 0.565, 0.739, 0.679, 0.704, 0.995, for arteriole 0.342, 0.531, 0.488, 0.490, 0.996, for glomeruli 0.818, 0.880, 0.919, 0.896, 0.993. Classification accuracy reached 90% with no false positives for TMA. Missed cases of TMA could be salvaged by an experienced nephropathologist on the display of decisive compartment crops, which were selected using model confidence averaged across each sampling iteration.

Conclusion
We have designed and trained architectures capable of segmenting decisive compartments and diagnosing TMAs on renal biopsy sections. This will enable automatic analysis of clinicopathological datasets with TMA in large cohorts. Our ultimate goal is to use large cohorts from collaborating institutions for weakly supervised, case-level-annotated training of diagnostic, prognostic and theranostic classifiers.
#6899 MICROVASCULAR LESIONS IN LUPUS NEPHRITIS
Authors: Knezevic Tamara , Padjen Ivan , Ivkovic Vanja , Laganovic Mario , Bulimbasic Stela , Lukač Ana , Ćorić Marijana , Anić Branimir 
Published: June 2023

Abstract

Background and Aims
Microvascular lesions (MVL) can be found in the kidneys of lupus nephritis (LN) patients and might be associated with worse outcomes. There are very few studies which evaluated MVLs in these patients and we aimed to provide a comprehensive evaluation of all MVLs, their frequency, characteristics and association with renal outcomes one year after kidney biopsy.

Method
We have conducted a retrospective cohort study to evaluate the characteristics and prognostic significance of MVLs in the kidney of subjects with LN. We have collected data on demographics, clinical and laboratory parameters and histopathology (light, immunofluorescent and electron microsopy). MVLs were characterized according to previous classifications. SLE was diagnosed using the American College of Rheumatology criteria.

Results
A total of 56 patients with biopsy-proven LN were followed up for at least one year after kidney biopsy (79% women, mean age at biopsy 38±13 years). Forty patients (71%) had MVLs in the kidney. The most common MVLs were arteriolar endotheliocyte swelling (54%), arteriolar hyalinosis (25%) and endothelialitis (8%) and the frequency distribution of all microvascular lesions is shown in Figure. Median number of lesions in the MVL group was 1 (interquartile range 1 to 2) and subjects had up to 6 MVLs. There was no difference in the median number of MVLs across LN classes (p&gt;0.05). Proteinuria was highest in class V (5.5 g/day, p = 0.06 vs. all other classes). Subjects with MVLs had lower baseline proteinuria compared with those with no lesions (3.6 vs. 5.4 g/day, p = 0.037), but there was no difference in serum creatinine (92 vs. 119 umol/L, p = 0.25). There were no differences in the occurrence or number of MVLs across LN classes (p = 0.63). The number of MVLs was not correlated with proteinuria (p&gt;0.05). There was no difference in the frequency of proliferative lupus between MVL and no MVL groups (79% vs. 60%, p = 0.15). A total of 48% of subjects achieved complete response (CR), 27% achieved partial response (PR) and 25% had no response (NR). MVLs were not associated with response (defined as CR or PR) in a multivariate regression model (OR 3.5 [0.5, 24.6]).

Conclusion
MVLs are common in LN. They were associated with lower baseline proteinuria, but not with proliferative LN or renal outcomes. The association with proteinuria warrants further research.
#6915 IMMUNOLOGIC EFFECTS OF THE DECREASE OF IMMUNOSUPPRESSION AFTER SARS-COV-2 INFECTION IN KIDNEY TRASPLANT RECIPIENTS
Authors: Urrutia Marina , Paúl Javier , Gomez Maria Molina , Riera Josep , Fugasot Carles Cañameras , Perezpaya Ines , Taco Omar , Gelpi Rosana , Casas Angela , Cañas Laura , Rodriguez Rosely , Bover Jordi , Vila Ana 
Published: June 2023

Abstract

Background and Aims
The decrease of immunosuppression (IS) in kidney transplant (KT) recipients with SARS-CoV-2 infection was proposed during the first years of the pandemic due to the lack of knowledge of the course of the infection and the absence of vaccines and specific treatment. The effects of this decrease are being assessed in a medium-long term.

Method
Unicentric retrospective study that included 19 patients with a kidney biopsy after a SARS-CoV-2 infection (120 days). We measured acute kidney injury (AKI) after de infection, decrease in the IS during the infection, rejection episodes and renal function evolution during 24 months after the infection.

Results
The studied group was constituted by 19 patients from which 57.9% (11/19) men, age 56 (51, 70), being the first KT in 78.9% (15/19) of them. The IS induction was in a 57.9% (11/19) Basilximab and in a 42.1% (8/19) thymoglobulin, and the usual IS of all of them was done with prednisone, tacrolimus and mycophenolic acid. There was a graft loss in 26.3% (5/19), being all of immunologic cause, and 10.5% (2/19) of patients died. The severity of the SARS-CoV-2 infection was different between patients (21.1% (4/11) asymptomatic, 47.1% (9/19) mild respiratory symptoms, 5.3% (1/19) severe pneumonia not requiring critical care unit and 26.3% (5/19) severe pneumonia requiring critical care unit, with a decrease in IS in a 42% (8/19) of patients (steroids in monotherapy in a 31.6% (6/19) and bitherapy with steroids and tacrolimus in a 10,5% (2/19), to achieve 5-7ng/mL blood levels). AKI was found after the first month after the infection in a 57.9% (11/19) of patients, being in a 42% (8/19) AKI KDIGO1 and in a 16% (3/19) AKI KDIGO3. Renal function kept worsening until the sixth month after the infection [CKDEPI before SARS-CoV-2 37mL/min (32, 45) vs CKDEPI 6months after 34mL/min (22, 48.3); p = 0.3]. There was an improvement in renal function in 12 months after the infection (38mL/min (25, 48)). Acute graft rejection was detected in renal biopsies after the infection in 31.6% (6/19) being cellular in 15.8% (3/19), humoral in 10.5% (2/19) and mixed in 5.3% (1/19), de novo DSA were found in 15.8% (3/19).

Conclusion
The decrease in IS after SARS-CoV-2 in KT recipient has an elevated immunologic price. Glomerular filtrate rate decreases after 6 months from infection with a recovery at 1 year.
#2502 THE FREQUENCY AND RISK FACTORS OF NODAT AND ELECTROLYTE DISORDERS IN KIDNEY TRANSPLANT PATIENTS
Authors: Başdoğan Elif , Başdoğan Servet , Paydas Saime , Kaya Bülent , Sertdemİr Yaşar 
Published: June 2023

Abstract

Background and Aims
The purpose of the study is to investigate at the incidence and risk factors for post-transplant diabetes mellitus (PTDM) in non-diabetic kidney transplant patients (KTrs).

Method
The study included 120 KTRs who did not have diabetes in the pretransplant period. The diagnosis of PTDM was made according to the 2003 ADA DM diagnostic criteria. The relationship between PTDM and clinical and laboratory data on the 0th, 1st, 3rd, 6th, 12th and 24th months was investigated.

Results
The mean age of the patients was 33.3±11.5 years, 65% (78) of them were male. PTDM was developed in 29.1% (35) and 80% of PTDM at first 3 months. The risk factors for PTDM were found to be older (4.4%), family history of diabetes mellitus (5.24 times), beta-blocker use (2.55 times). KTRs with and without PTDM; Pretransplant dialysis type (Hemodialysis (P=0.822) and Peritoneal dialysis (P = .583)), living donor (101/84.2%)/cadaveric donor (19/ 15.8%), donor age and gender were similar. Serum magnesium and potassium were different only in the first month between the groups with and without PTDM (P = .019 and 0.008 respectively). The negative effect of PTDM on GFR was not observed in the 2-year follow-up.

Conclusion
It can be predicted that diabetes mellitus may develop with a family history of diabetes, advanced age and the use of beta-blockers. The risk of developing PTDM is higher in the first 3 months and hypomagnesemia in the first month may contribute to diabetes development.
#2515 GENDER DIFFERENCES IN KIDNEY TRANSPLANTATION: A 10-YEAR RETROSPECTIVE STUDY
Authors: Dedinska Ivana , Graňák Karol , Vnučák Matej , Beliančinová Monika , Kleinova Patricia 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease represents a world-wide health problem, affecting approximately 195 million women around the world. Risk of development of chronic kidney disease is greater in women in comparison to men.

Method
We retrospectively analysed cohort of 1457 patients after kidney transplantation from all transplant centres in Slovakia over period of ten years from 2010 – 2020. Parameters taken into account were cause of end-stage renal disease (ESRD), outcome of transplantation in a context of differences between the genders.

Results
Out of 1,457 patients, 557 (517 primary transplantation) were women, 900 (831) men. Primary causes leading to end-stage renal disease (ESRD) in female recipients where we observed a statistically significant difference between genders were tubulointerstitial nephritis (32.1% in females vs. 22.3% in males, p&lt;0.0001), autosomal dominant polycystic kidney disease (17.6% vs. 11.6%, p = 0.0013), and systemic lupus erythematosus (2.3% vs. 0.2%, P = .0001). In male recipients native kidneys were more frequently affected by glomerulonephritis (38% vs. 25.7%, p&lt;0.0001), nephropathy as a complication of type 2 diabetes mellitus (7.8% vs. 4.1%, p&lt;0.0001), and IgA nephropathy (2.9% vs. 1.1%, P = .0232). There were no statistically significant gender differences in other causes of ESRD. However, there was no significant difference in time spent on dialysis between female and male recipients (39.4 ± 39 months vs. 35.8 ± 33.2 months, p&gt;0.05), female recipients waited for a kidney transplant significantly longer (32.9 ± 27.4 months vs. 39.4 ± 31.5 months, p&lt;0.0001). Overall death-censored graft survival rates in our cohort in female and male recipients were after 12 months 91.2% vs. 93.1%, p=NS, 5 years 80.7% vs. 82.6%, p=NS, and 10 years 60% vs. 66.7%, p=NS (Fig. 1). After 12 months, 5 and 10 years, the overall patient survival rates among female vs. male recipients were 96.8% vs. 97.1%, p=NS; 89.9% vs. 88.9%, p=NS; and 72.9% vs. 76%, p=NS (Fig. 2), respectively.

Conclusion
Despite comparable patient and graft survival rates in male and female recipients in our study, there are other studies showing that gender, as well as gender mismatch significantly influence outcomes of transplantation.
#2538 HEALTHY PLANT-BASED DIET IN CHRONIC KIDNEY DISEASE THROUGH USE OF SODIUM ZIRCONIUM CYCLOSILICATE (HELPFUL TRIAL): LABORATORIAL FINDINGS
Authors: Avesani Carla Maria , Heimbürger Olof , Sallstrom Torsten , Danielsson Awa , Rubin Charlotta , Irving Gerd Faxen , Lindholm Bengt , Stenvinkel Peter 
Published: June 2023

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) and hyperkalemia (HK) are counselled to follow a diet restricted in potassium (K) which limits the intake of fruits and vegetables. This is a cause of complaints for many patients. The use of the K lowering medication sodium zirconium cyclosilicate (SZC) has the potential to treat HK and allow a healthy plant-based diet (PBD). We designed a clinical trial to explore the safety and feasibility of prescribing a healthy PBD to CKD patients with HK with the concomitant use of SZC.

Method
The HELPFUL trial is an ongoing single-arm study with patients with CKD stage 4-5 not on dialysis and with plasma K between 5.1 to 6.5 mmol/L at inclusion. Patients are followed for 6 weeks. In the first 3 weeks, SZC is prescribed to normalize plasma K (pK) while ingesting a low protein diet with low K+ content. In the subsequent 3 weeks, a healthy PBD with a target K intake of 3700 mg/day is prescribed maintaining the use of SZC. A food basked with the PBD is delivered to the participants weekly. A weekly monitoring of pK and titration of SZC to keep normokalemia is performed. Other laboratorial measurements and food intake are assessed at baseline, week 3 and week 6. Food intake is evaluated using the 24-hour food record (24HFR). Data was analyzed by repeated measures-ANOVA or by Friedman test for related samples, as appropriate. The protocol is registered at www.clinicaltrials.gov (identifier NCT04207203).

Results
22 patients were included (59±13 years; 13 men, 59%). Table 1 describes the main findings. During the study, eGFR did not change, serum urea decreased, and P-carbon dioxide increased significantly. Inflammatory markers, 24hour urinary sodium and K excretion did not change. Potassium intake from 24h-FR increased, as well as the intake of fruits, vegetables and nuts after the PBD. The mean pK normalized in week 3 and 6. After the start of PBD, 3 patients (13.6%) had pK between 5.1 and 5.3 mmol/L. Most patients needed SZC dose of 10g/day. No changes were observed in dose of RAAS.

Conclusion
The strategy of PBD food basket with concomitant use of SZC allowed an increase in dietary K intake with higher intake of fruits, vegetables and nuts. P-carbon dioxide, a surrogate of bicarbonate improved as well. The pK was kept withing normal values for most of the patients.
#2649 INFECTIOUS COMPLICATIONS AFTER KIDNEY TRANSPLANTATION IN RELATION TO INDUCTION IMMUNOSUPPRESSIVE THERAPY
Authors: Vnučák Matej , Graňák Karol , Beliančinová Monika , Kleinova Patricia , Dedinska Ivana 
Published: June 2023

Abstract

Background and Aims
Infections are the most common non-cardiac cause of death after kidney transplantation (KT). The main goal of immunosuppressive therapy is to find a balance between the low incidence of acute rejection and infectious complications.

Method
We conducted a retrospective, monocentric analysis of transplant patients at the Transplant Center University Hospital Martin from 2011 to 2020 with various induction immunosuppressive therapies. We monitored the incidence of infections in terms of etiology, localization and severity at different intervals after KT.

Results
Our study included 39 patients on induction therapy with basiliximab to whom we paired 39 patients with induction therapy with thymoglobulin based on gender and age, in total our population consisted of 78 patients (56 men, 22 women), the mean age was 45 years. In the group of patients with induction therapy with thymoglobulin, we noted a higher proportion of fungal (P=0.0409), urogenital infections (P=0.0384), sepsis (P=0.0497) and leukopenia (0.0384) from 1st to 6th month after KTx, higher incidence of skin infections (P= 0.0218) and serious infections requiring hospitalization (P = 0.0269) from 6th-12th months to TO. On the other hand, in the basiliximab patient group, we identified a higher incidence of acute humoral and cellular rejection (P=0.0218) after 6 months of TO. From the perspective of recurrent infections, in the Thymoglobulin induction group, we noted a higher incidence of infections by localization, etiology and severity. Risk factors for recurrent bacterial infections from 1st to 6th month after KT are: history of respiratory diseases (P = 0.0108), thrombocytopenia (P = 0.0104) and infections caused by multi-resistant bacteria (P = 0.0003).

Conclusion
Patients on inductive immunosuppressive therapy with thymoglobulin are at a higher risk of recurrent, multidrug-resistant and severe infections after KT compared to induction with basiliximab with identical maintenance immunosuppressive therapy. On the other hand, patients on induction therapy with basiliximab have a higher risk of developing acute rejection. Therefore, it is essential to identify risk groups of patients benefiting from milder or more intensive inductive immunosuppressive therapy without a concomitant increased risk of infectious complications or acute graft rejection