#5133 MONTREAL COGNITIVE ASSESSMENT (MOCA) AND DYSMORPHIC RED BLOOD CELLS IN PATIENTS WITH IMMUNOGLOBULIN A NEPHROPATHY
Authors: Popova Anna , Halturina Marija , Rācenis Kārlis , Saulīte Mikus , Seilis Jānis , Saulite Anna Jana , Petersons Aivars , Kroiča Juta , Cernevskis Harijs , Oļeiņika Kristīne , Šlisere Baiba , Lejnieks Aivars , Kuzema Viktorija 
Published: June 2023

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) are at an increased risk of cognitive dysfunction, which is characterized by deficits in executive functions, memory and attention. Previous studies have suggested that albuminuria and lower estimated glomerular filtration rate (eGFR) are related to mild cognitive impairment (MCI) and dementia. There are no studies that have noticed connection between glomerular activity presented by dysmorphic red blood cells (RBC) count and cognitive evaluation results. The aim of the study was to investigate the association of cognitive decline with renal function and other possible risk factors such as albuminuria, proteinuria, and hematuria in patients with immunoglobulin A nephropathy (IgAN).

Method
A prospective study that took place from January 2020 till January 2022 at Pauls Stradins Clinical University Hospital Nephrology center included patients with IgAN. Diabetes mellitus, oncology, acute inflammation processes, transplantation in anamnesis were exclusion criteria. Demographic, anamnestic, clinical, laboratory data for renal function evaluation were collected. GFR was calculated using CKD-EPI Creatinine Equation. Urine spot protein/creatine ratio was used for proteinuria measurement. Urine microscopy was performed by a nephrologist. Patients were assessed with a MoCA. Results of MoCA have been compared with potential risk factors.

Results
Sixty-five patients were included in the study. The mean age of the participants was 42.06 ± 10.71 years (IQR 35-47.75; range, 21-65), with predominance of male sex (62.1%), mainly with higher education (45.5%). Dialysis was performed in 7 patients. The average duration of illness was 89.97 months ± 97.95 (IQR 31.5-120, range 1-456 months/38 years). Average GFR was 59.26 ± 38.66 (IQR 20.25-91.75, range 3-131) ml/min/1,73m2, urea 12.57± 9.88 (IQR 6.3-15.45, range 4-62). Patients did not have anemia, average hemoglobin 135.20± 14.8. Average proteinuria was 0.53±0.99 g/g (IQR 0.064-0.52, range 0.06-6.20), albuminuria - 69.34±107.3 g/mol (IQR 10.95-69.4, range 0.45-620). Average hematuria was 116.68±239.67 RBC/mkl (IQR 9.9-92.1, range 1.5-1421.3), while dysmorphic RBC count was 4.02±12.08 RBC/hpf (IQR 0-2.5, range 0-80). MoCA ≤ 26 was observed in 41% of the patients. The MoCA total score have moderate correlation with the patients age (p = 0.01, r = -0.39). Patients age correlated with memory task score (p = 0.002, r = -0.42). Dysmorphic RBC count in urine sediment corelated with attention task (p = 0.002, r = -0.42).

Conclusion
Mild cognitive impairment is frequent even in our young age IgAN patient's cohort. Even small age difference plays role in MoCA evaluation score. No correlations have been found between proteinuria or albuminuria and MoCA score. Association between dysmorphic RBC and cognitive decline should be studied in bigger cohorts’ studies.