bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6428 PERCUTANEOUS RENAL BIOPSY (PRB) IN METASTATIC RENAL CELL CARCINOMA (MRCC) PATIENTS WITH ACUTE KIDNEY INJURY (AKI) ON SYSTEMIC ANTICANCER THERAPY
Authors: Milanez Tomaž , Arnol Miha , Premru Vladimir , Kojc Nika , Ocvirk Janja , Ovcaricek Tanja , Jaimes Edgar 
Published: June 2023

Abstract

Background and Aims
PRB is relatively contraindicated in patients with solitary kidney (SK) due to the perception that PRB is a risky procedure in this patient population. There are however situations in which a renal biopsy is essential to assess renal toxicity of systemic therapy and/or to identify the underlying kidney disease in the remaining kidney. Data on pathological findings of the kidney disease in mRCC patients receiving systemic anticancer therapy is scarce and it may influence the cancer treatment plan. The main aim of this study was to characterize the pathological findings of PRB in patients with SK undergoing systemic therapy.

Method
We retrospectively analyzed the pathological findings of mRCC patients with AKI who underwent PRB during systemic treatment with antiangiogenic tyrosine kinase inhibitors (TKIs) and/or immune check point inhibitors (ICIs) at the Institute of Oncology Ljubljana between 2018 and 2022. All biopsies were performed under ultrasound guidance by the treating nephrologist in patients with clinical evidence of AKI and no other formal contraindications for PRB.

Results
A total of 11 PRBs were performed in 10 patients, eight of whom had SK (Table 1). Six patients were treated with TKIs and ICIs, three with ICIs and one with a TKI alone. None of the patients had major bleeding or required any additional intervention as a consequence of the PRB. Histology revealed thrombotic microangiopathy (TMA) in three, diabetic nephropathy in three, acute interstitial nephritis in two and focal segmental glomerulosclerosis in three patients. Based on pathological findings, the therapy was discontinued after seven PRBs. One patient with TMA showed progressive loss of renal function (RF) after discontinuation of antiangiogenic therapy while the other two had either stable or improved RF.

Conclusion
Our results indicate that PRB is a safe procedure in patients with SK undergoing systemic treatment for mRCC. The pathological findings in our patients guided the decision either to continue or to discontinue the treatment, which resulted in improvement or stabilization of RF in the vast majority of patients. This study suggests that in patients with SK, PRB can provide important information, which may have a significant impact on the oncological and the nephrological therapeutic approaches.
#6545 URINARY FETUIN-A FRAGMENT EXCRETION IN PATIENTS WITH TYPE 2 DIABETES AND ITS CORRELATION WITH RENAL FUNCTION
Authors: Bandi Varun Kumar , Narilla Naga Sai Sri Harsha , Chaganti Sindhu , Yarlagadda Sirisha , Eadala Suresh 
Published: June 2023

Abstract

Background and Aims
Fetuin-A is associated with production of pro-inflammatory cytokines, which can lead to progression of vascular complications in patients with diabetes. We planned a study to evaluate the correlation of urinary excretion of post translationally modified fetuin-A fragment (PTM Fetuin A) with albuminuria and chronic kidney disease.

Method
We conducted a cross-sectional study between July to August 2022 in patients with type 2 diabetes. The baseline characteristics such as Age, Gender, history of Diabetes Mellitus, Hypertension, Cardiac disease, and CKD were obtained. The subject's blood pressure, Haemoglobin, Random blood sugar, Creatinine, was obtained, and eGFR (Glomerular Filtration Rate) was calculated using the CKD-EPI equation. The spot urine was tested for urine albumin to creatinine ratio (UACR) and PTM-Fetuin-A: Creatinine ratio (FCR). PTM-Fetuin A was measured by an ELISA using DNlite-IVD103 ELISA test kit, Bio Preventive Medicine Corp, Taiwan.

Results
A total of 68 subjects were included, with 37 being men (54.4%). The mean age, eGFR, UACR, and FCR were 55 ± 11.4 years, 61.9 ± 37.5 ml/min/1.73 m2, 1060.7 ± 1550 mg/g, and 522.2 ± 915.1 ng/g respectively. There was significant positive correlation between FCR and UACR (p&lt;0.005), serum creatinine (p&lt;0.005), and eGFR (p&lt;0.001). There was a trend noted of increasing PTM-Fetuin A levels and UACR with worsening eGFR. The AUROC for UACR and FCR for predicting patients with CKD stage 3 onwards were 0.703 and 0.789 respectively (Figure 1). In our study, the significance of predicting CKD stage 3 onwards with a UACR cut-off of 300 mg/g, UACR cut-off of 1150 mg/g and a FCR cut-off of 123 ng/g were p = 0.008, p = 0.003, and p&lt;0.0001 respectively.

Conclusion
PTM-Fetuin A is significantly associated with worsening renal function. It has very significant correlation with the albuminuria, and at a FCR cut-off of 123 ng/g, it could significantly differentiate CKD stages, compared to UACR. Further prospective studies are needed to evaluate the correlation between PTM-Fetuin A levels and rate of progression of nephropathy.
#6576 SERUM INTERLEUKIN-6 LEVELS AS A PREDICTOR OF ALL-CAUSE MORTALITY IN MAINTENANCE HEMODIALYSIS PATIENTS WITH COVID-19-OMICRON INFECTION: AN OBSERVATIONAL STUDY
Authors: Song Qirong , Luo Yuxin , Fu Sha , Wang Xiaohong , Tang Ying , Chen Junzhe , Liu Aiqun 
Published: June 2023

Abstract

Background and Aims
Interleukin-6 (IL-6) is a key mediators of inflammation and has been linked to the severity and mortality of COVID-19-Omicron in the general population. With higher mortality rates observed in maintenance hemodialysis (MHD) patients infected with COVID-19-Omicron, the study aimed to examine the correlation between IL-6 levels and mortality in this patient population and to indentify the optimal IL-6 level for predicting the risk of death.

Method
The retrospective observational study was conducted in MHD patients diagnosed with COVID-19-Omicron infection between December 01, 2022 and January 31, 2023 at the Third Affiliated Hospital of Southern Medical University during the first wave of infection in COVID-19-Omicron outbreak in China. Clinical and biochemical data were collected during the infection, IL-6 levels of the patients were measured before consecutive dialysis sessions by a commercial kit. The Cox model was used to investigate the risk factors of mortality, meanwhile, ROC curve to determine the cut off value of IL-6 levels on mortality.

Results
A total of 162 MHD patients infected with COVID-19-Omicron were included in this study. During a median follow-up period of 40 days, 10 (6.2%) deaths occurred due to COVID-19 infection. IL-6 levels were significantly higher in patients who died. Univariate Cox regression analyses showed that the risk factors associated with death included IL-6 levels (HR: 1.009; p&lt;0.001), C-reactive protein (HR: 1.01; p = 0.016), serum potassium (HR: 2.258; p = 0.015, procalcitonin(PCT) (HR: 1.01; p = 0.048), and the Charlson comornidity index(CCI)(HR: 1.34; p = 0.002). However, in multivariate analysis, only IL-6 levels was independently associated with all-cause mortality(HR: 1.01; p = 0.001).The ROC curve and Kaplan-Meier survival analysis revealed a significantly worse survival risk among MHD patients with higher serum IL-6 levels (≥104.87 pg/mL) (sensitivity:100%; specificity:78.2%; AUC: 0.92; p = 0.001).

Conclusion
Serum IL-6 levels greater than 104.87 pg/mL were associated with an increased risk of all-cause mortality in MHD patients infected with COVID-19-Omicron. Hemoperfusion or hemofiltration to remove IL-6 may provide appropriate treatment options for hemodialysis patients with COVID-19-Omicron.
#6608 CHARACTERIZING THE RESIDUAL VOLUME IN PERITONEAL DIALYSIS PATIENTS
Authors: Lindholm Elin , Oberg Carl , Bergling Karin 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis (PD) is the most common home dialysis treatment, and is associated with lower societal costs and increased patient autonomy. During routine PD, the exact amount of fluid inside the peritoneal cavity is in general unknown, and the peritoneal catheter may also change position, which may lead to a large residual volume, inefficient dialysis, and potentially harmful overfill. A practical, clinical method to estimate the residual volume is from the dilution of a marker molecule before and after fill of a known volume of fresh dialysis fluid. However, ultrafiltration and transport of the marker molecule during the fill phase may introduce large errors, especially when low molecular weight marker molecules are utilized.

Method
Here we performed a retrospective analysis of clinical data consisting of 56 residual volume estimations utilizing either 1.5% glucose (n = 28) or 4.25% glucose fluid (n = 28). Residual volumes were estimated using creatinine, urea and albumin. The contribution of ultrafiltration and mass transport of the marker molecules were quantified using the Three-pore model.

Results
During the fill phase, the median ultrafiltration volume was 16 mL (IQR 3 to 31) in 1.5% glucose dwells, compared to 52 mL (IQR 38 to 66) during 4.25% glucose dwells (Fig. 1). Assuming that 40% of the ultrafiltration occurs as free-water transport, the median difference between Three-pore model and albumin dilution equation residual volumes were only -1 mL (-8 to 5.5) in 1.5% glucose dwells and 1 mL (-3 to 6) in 4.25% glucose dwells (Fig. 2A). Dilution-based calculations using creatinine overestimated residual volumes by 121 mL (IQR 103 to 149) during fill of 1.5% glucose fluid and 255 mL (IQR 208 to 323) during 4.25% glucose fluid fill (Figure 2B). Overestimation of a similar magnitude was observed in urea calculated residual volumes (Figure 2B). Comparison of intraperitoneal creatinine and urea mass before and after fill revealed a median creatinine mass increase of 37% (creatinine) and 48% (urea) during the fill phase.

Conclusion
This analysis highlights the inherent limitations of residual volume estimations using low molecular weight marker molecules, as both ultrafiltration and dilution marker mass transfer influence results. Since mass transfer rates correlate with molecular size, albumin-based dilution equation residual volumes conformed closely with three-pore model residual volumes, while creatinine and urea, which are subject to mass transfer to a greater extent, overestimated residual volumes. Albumin is superior to both creatinine and urea, but the latter markers may provide reasonable residual volume estimates, especially if the purpose is to exclude a large residual volume.
#6660 HERPES ZOSTER IN LUPUS NEPHRITIS: AN UNDERESTIMATED COMPLICATION
Authors: Reggiani Francesco , Cardi Silvia , Tumminello Fabio , Calatroni Marta , Moroni Gabriella Luisa 
Published: June 2023

Abstract

Background and Aims
Herpes zoster (HZ) is a known complication of lupus nephritis (LN) because of the drug-related immunosuppression. In fact, high dose corticosteroids (CS) and immunosuppressive (IS) therapy are almost always used in this setting. Our aim is to evaluate the predisposing factors for the development of HZ in patients with LN.

Method
Retrospective cohort study on 292 LN patients. Demographic and clinical data are expressed as numbers or percentages in case of discrete variables, whereas, in case of continuous variables, they are expressed as median and interquartile range (IQR). The demographic characteristics have been analyzed with Mann-Whitney U test and Fisher's test where appropriated. A univariate and multivariate logistic regression has been performed to identify potential risk factors.

Results
The incidence of HZ in our cohort is 22.6% (66/226). The patients’ characteristics are shown in Table 1. HZ patients are older (54 vs 45 yo, p&lt;0.001). No differences were found in the clinical characteristics at LN diagnosis, except for higher chronicity index in HZ patients (2 vs 1, p = 0.03). No difference was found in the initial IS therapy. Higher cumulative dose of CS was used in patients with HZ (48.9 vs 21.5 grams, p&lt;0.0001). At univariate and multivariate logistic regression (Table 2) age, female sex, the presence of a proliferative form at renal biopsy (class III or IV) and cumulative CS dose greater than 100 grams are linked to a higher risk for HZ.

Conclusion
Incidence of HZ in our LN cohort is high (22.6%). HZ patients are older, while non-significative differences in clinical presentation or initial IS therapy are present. Age, female sex, the presence of a proliferative form at biopsy and greater cumulative CS dose seems to be a risk factor for HZ development in LN patients. According to these data and to the possible evolution of HZ infection in disseminated forms, HZ vaccination should be strongly recommended in LN patients.
#6677 RELATIONSHIP BETWEEN CARDIAC TROPONIN LEVELS AND ECHOCARDIOGRAPHIC PARAMETERS IN DIABETICS WITH ADVANCED CHRONIC RENAL DISEASE (ACKD)
Authors: Ordoñez Katherine Peña , Romero Pablo Pérez , Naranjo Paola Gabriela Donoso , Collado Natalia Santos , Blandino Maria Luisa Vidal , Prieto Francisco Javier Toro 
Published: June 2023

Abstract

Background and Aims
Cardiovascular disease is the leading cause of chronic kidney disease (CKD) death. On the other hand, elevated cardiac Troponin T (cTnT) levels are associated with cardiovascular events and mortality. Several studies have established an inverse association between CKD and cTnT, and knowledge of this association in diabetic patients would benefit their management. The objective of this study was to analyze the relationship between cTnT levels, renal function and echocardiographic parameters in diabetic patients with advanced chronic kidney disease (ACKD).

Method
A prospective study was carried out during one year of 180 patients attending for the first time for ACKD consultations, with an estimated glomerular filtration rate (eGFR) &lt;30 ml/min/1.72 m2. The following data were analyzed: age, sex, diabetes, HBP, BMI, smoking, peripheral artery disease, coronary artery disease, non-age-adjusted Charlson index (non-age-CCI), eGFR by CKD EPI, ultrasensitive cTnT, Creatinine albumin ratio (ACR), C-reactive protein (CRP), ferritin, hemoglobin (Hb), ejection fraction (EF) and left ventricular hypertrophy (LVH), interventricular septum thickness (IVST) and left ventricular wall thickness (LVWT). Statistical tests were used according to the distribution of the variables.

Results
Baseline characteristics are summarized in Table 1. In the group of patients, when analyzing the presence or absence of diabetes, diabetic patients were significantly older, had higher troponin levels, a higher percentage of smoking, coronary artery disease, peripheral artery disease, non-age-CCI, IVST and LVH than non-diabetic patients. In diabetic patients, troponin levels correlated significantly with eGFR (0.03) and ACR (0.09), with ACR remaining as a predictive variable (0.003). It did not correlate with echocardiographic data. In non-diabetics, the correlation was significant with age and IVST and LVH (Table 2, Figure 1). In the multivariate analysis in diabetic patients, only the association remained with ACR (0.026) and in non-diabetics with eGFR (0.038) and IVST (0.004).

Conclusion
The cTnT levels are found to be higher in diabetic patients and with higher ACR, considering it as a therapeutic target to reduce cardiovascular risk since echocardiographic data would not discriminate this risk in this profile of patients.
#6693 INCREASED INFILTRATION OF LRG1+VCAN+LY6CHIGH MACROPHAGES ARE ESSENTIAL CONTRIBUTORS TO KIDNEY INJURY IN ADR MICE
Authors: Chen Qilin , Jiang Yaru , Zhong Jinjie , Feng Xiaoqian , Jiang Huimin , Wan Junli , Peng Liping , Wang Mo , Yang Haiping , LI Qiu 
Published: June 2023

Abstract

Background and Aims
The ADR mouse model is a well-established rodent model of FSGS that can manifest with albuminuria. Resident macrophages are present in the tubulointerstitium of the kidney, and circulating macrophages can be recruited to the kidney in disease states. However, the presence of macrophages in glomeruli and the role of macrophages in podocyte injury in ADR mouse models remain unknown.

Method
Single-cell RNA sequencing comprehensively characterized the expression of macrophages in mice glomeruli. Eight-week-old male BALB/c mice were used to induce ADR model. Immunofluorescence was used to detect the changes of renal macrophages after injected with ADR at different time points. Transwell co-culture system were used to detect the effect of Lrg1+Vcan+Ly6Chigh macrophages on MPCs. HCH6-1,the FPR1 inhibitor were used to restrain ANXA1-FPR1 pathway.

Results
Totally 506 macrophages were sequenced and Lrg1+Vcan+Ly6Chigh macrophages were significantly increased in ADR induced nephrotic mice glomeruli (P&lt;0.01). The ligand receptor relationship between podocytes and macrophages were changed(P&lt;0.01, means&gt;1). Immunofluorescence demonstrated that macrophages are present in ADR glomeruli(P&lt;0.05). However, the temporal and spatial changes of macrophages in ADR glomeruli still need to be proved by further experiments. After co-culture of Lrg1+Vcan+Ly6Chighmacrophages and MPCs, the expression of nephrin in MPCs decreased(P&lt;0.05), which proved that macrophages can cause podocyte injury. In ADR group, the ANXA1-FPR1 signaling pathway was activated, and renal Lrg1+Vcan+Ly6Chighmacrophage infiltration, albuminuria and renal injury were reduced in ADR+HCH6-1gruop (all P&lt;0.05).

Conclusion
Lrg1+Vcan+Ly6Chighmacrophages are recruited into mice glomeruli by activation of ANXA1-FPR1 signaling pathway and cause the damage of podocyte.
#6695 THE ROLE OF A DEEP LEARING MODEL FOR EVALUATING HISTOPATHOLOGY OF ACUTE RENAL TUBULAR INJURY
Authors: Kim Hyeongwan , Yeom Ji-Hyun , Park Woong , Jung Yujin , Nguyen Thi Thuy Uyen , Shin Yujin , Lee Soojin , Kim Won 
Published: June 2023

Abstract

Background and Aims
Acute tubular injury is the most common intrinsic cause in acute kidney injury. Histopathological diagnosis may help distinguish between different types of acute kidney injury and aid in treatment. Currently, there have not been any studies that uses deep learning model for assisting histopathological diagnosis in acute kidney injury. The aim of our study is histopathological classification and segmentation identified four structures of acute renal tubular injury based on deep learning models.

Method
We used injury classification model to evaluate the degree of renal injury (grade 0, grade 1 and grade 2) and segmentation model (glomerulus, healthy tubules, tubules with cast, and necrotic tubules) specifically to classify the tubular specific injury after cisplatin treatment. We trained a classification model using ResNet-18 to classify the grade of acute tubular injury and a segmentation model using DeepLabV3 with ResNet-50 backbone for four structures of the mouse PAS-stained histopathology of acute renal tubular injury.

Results
The classification algorithm achieved area under the receiver operating characteristics curve of 0.98, 0.77, and 0.80 for grade 0, grade 1, and grade 2, respectively. In segmentation model for four structures, the highest Intersection over Union and the Dice coefficient were obtained for the segmentation of “glomerulus” class, followed by the “healthy tubules”, “tubules with cast”, and “necrotic tubules” classes. The overall performance of the segmentation algorithm for all classes in the test set is Intersection over Union 0.7256, Dice coefficient 0.8185.

Conclusion
The predictive model by deep learning could identify the histopathological structures and classify the grade of renal tubular injury, and may contribute to a more effective evaluation of renal pathology.
#6727 INFLAMMATORY INTERSTITIAL FIBROSIS AND TUBULAR ATROPHY ARE ASSOCIATED WITH HIGHER EXPRESSION OF INTRAGRAFT GRANZYME-B+ AND PHOSPHOSMAD-3+ PROTEIN
Authors: Yadav Brijesh , Prasad Narayan , Agrawal Vinita , Agarwal Vikas , Jain Manoj 
Published: June 2023

Abstract

Background and Aims
Inflammatory Interstitial fibrosis and tubular atrophy (i-IF/TA) is a prominent histological lesion reported in late biopsy and poorly associated with graft survival. Cytotoxic T cell secrets Granzyme-B, which cleaves cytoskeleton protein, and activates pro-IL-1β, and TGF-β into their active form, leading to inflammation, fibrosis, and the apoptosis in target cell. The association of Granzyme-B+ cytotoxic T cell and phospho-SMAD-3 expression has been not explored in i-IF/TA in depth. Therefore, in this study, we aimed to determine the circulating and intragraft profiles of Granzyme-B+ cytotoxic T cell together with fibrosis pathway mediator p-SMAD-3 expression in renal transplant recipients (RTRs) patients with biopsy proven i-IFTA.

Method
The circulating frequency of CD3+CD8+Granzyme-B+ cytotoxic T (CTLc) was measured by the flowcytometry; serum and PBMCs culture supernatants Granzyme-B and proinflammatory cytokines TGF-β, IL-1β level by the ELISA, Intragraft Granzyme-B mRNA transcript expression by the RT-PCR and Granzyme-B+, pSMAD-3+ Cell was analyzed by the immunohistochemistry techniques. Independent T-test for continuous variables and Pearson correlation was applied for the different variables.

Results
The circulating frequency of cytotoxic-T cell (CD3+CD8+Granzyme-B+) in SGF vs i-IF/TA was (27.96±4.86 vs 23.19±3.85%, p = 0.011), CD3+T cell was (66.08±6.8 vs 65.18±9.35%; p = 0.68), CD3+CD8+T cell was (37.29±4.11 vs 34.68±5.43%; p = 0.28). Serum Granzyme-B level was in SGF vs IF/TA was (100.82±22.41 vs 130.32±46.60, p = 0.038 pg/ml), serum TGF-β level was (367.50±31.50 vs 318.81±48.39, p = 0.005), IL-1β level was (49.14±17.03 vs 63.69±23.13, p = 0.076). Intragraft Granzyme-B mRNA transcript expression in SGF vs i-IF/TA was (1.01±0.048 vs 2.10±1.02-fold, p&lt;0.001). Granzyme-B+ cell/mm2 count was (0.40±0.69 vs 2.20±1.27; p = 0.001). The intragraft phosphorylated SMAD-3+ cell was (3.70±1.82 vs 6.73±3.21; p = 0.008). Fig. 1. The intragraft Granzyme-B+ cell count was positively correlated with pSMAD-3+ cell (r = 0.315, p = 0.047). The frequency of circulating CTLc was negatively correlated with urine proteinuria (r = -0.51, p&lt;0.001), serum creatinine (r = -0.28, P = 0.007) and eGFR (r = -0.28, p = 0.037). While urine proteinuria was positively correlated with serum Granzyme-B level (r = 0.343, p = 0.001), intragraft Granzyme-B mRNA transcript expression (r = 0.38, p&lt;0.001).

Conclusions
Higher intragraft Granzyme-B+ Cytotoxic T-cell and phosphoSMAD-3 positive cells are associated with i-IF/TA in RTRs.