bluuebunny/crossref_metadata_2025_split huggingface dataset:
#5878 PROTECTIVE EFFECTS OF VITAMIN D ON HYPERANDROGENEMIA-INDUCED-ACUTE KIDNEY INJURY THROUGH THE INTERACTION WITH THE RAS/INOS PATHWAY
Authors: Masjedi Fatemeh , Karimi Zeinab , Roozbeh Jamshid 
Published: June 2023

Abstract

Background and Aims
The onset and development of metabolic abnormalities are closely related to polycystic ovary syndrome (PCOS). It has not yet been determined whether PCOS contributes to kidney injury, and the mechanism underlying the condition is not fully understood. Treatment with vitamin D has been shown to have beneficial effects on women with PCOS and renal disease. This study investigated the hypothesis that vitamin D supplementation exerts renoprotective effects via regulating the renin-angiotensin system (RAS)/inducible nitric oxide synthase (iNOS) pathway

Method
Female Sprague-Dawley rats were randomly divided into five groups (n = 10): (a) control, (b) sham, (c) dehydroepiandrosterone (DHEA, 6 mg/100 g day-1 S.Q.), (d) DHEA + vitamin D (1000 IU/Kg; 3 days/week), and (e) vitamin D. Plasma, ovary, and kidney levels of angiotensin-converting enzyme (ACE) activity was determined using FAPGG-based colorimetric method. The amount of NO was measured by determining the concentrations of nitrite and nitrate end products in the plasma and tissue samples using the Griess method. Histopathological changes in the ovary and kidney were also evaluated.

Results
Plasma testosterone increased in DHEA-treated rats compared with controls, indicating a hyperandrogenic state. Further, hyperandrogenemia-induced-acute kidney injury increased the plasma, renal, and ovarian angiotensin-converting enzyme (ACE) activities in association with elevations in the plasma and urine nitrite and nitrate levels; these changes were reversed by vitamin D treatment.

Conclusion
Hyperandrogenemia causes systemic abnormalities through RAS imbalance and NO metabolism disturbances, followed by apparent destruction of renal and ovarian tissues. Vitamin D supplementation attenuated these hyperandrogenemia-associated acute kidney injuries, likely via interaction with the RAS/iNOS pathway.
#5884 HLA COMPATIBILITY DOES NOT INFLUENCE KIDNEY GRAFT SURVIVAL AND DOES NOT IMPACT THE DEVELOPMENT OF POST-TRANSPLANT NEOPLASIA
Authors: Bartoli Giulia , Strologo Andrea Dello , Simone Simona , Arena Maria , Salerno Maria Paola , Silvestri Patrizia , Ditonno Pasquale , Romagnoli Jacopo , Gesualdo Loreto , Grandaliano Giuseppe 
Published: June 2023

Abstract

Background and Aims
HLA compatibility is a key issue in deceased and living kidney allocation, although the continuous improvement of immunosuppressive protocols might have reduced its relevance. However, an increased immunosuppression is associated with several adverse events, including the development of post-transplant neoplasia. Indeed, several reports demonstrated that the improvement in immunosuppressive drug efficiency corresponded to an increase incidence of malignancies after kidney transplantation. Thus, the aim of our study was to investigate the effect of HLA compatibility on kidney graft survival and incidence of post-transplant neoplasia.

Method
This is an observational, retrospective, multicenter center study including 1506 patients receiving a single kidney transplant at the Gemelli and Policlinico “Consorziale” kidney transplant centers from 1/1/2000 to 1/2/2022. The primary outcomes were death-censored graft survival and the development of post-transplant neoplasia. HLA compatibility was measured as the number of HLA mismatches (MM) at the three main class I (A and B) and class II (DR) loci. To this purpose, both donor and recipients were genotyped for HLA A, B and DR. We included in the analysis all deceased and living kidney donor transplants and excluded recipients from AB0 incompatible living kidney donors and with pre-transplant donor specific antibodies.

Results
Based on HLA compatibility, we divided our patients’ population in three groups (0-2 MM, 369 patients 3-4 MM, 856 patients and 5-6 MM, 281 patients). At univariate analysis (Kaplan-Meyer) number of MM were not associate with death-censored graft survival (Logrank p = 0.6) whereas we observed a significant association with the development of post-transplant neoplasia (Logrank p = 0.01). However, multivariate analysis (Cox model including recipient age, induction and maintenance immunosuppressive therapy) demonstrated that patients with 3-4 (HR 1.033, 95% CI 0.676-1.580, p = 0.9) and 5-6 MM (HR 1.342, 95% CI 0.853-2.111, p = 0.2) did not have any statistically significant increase in the risk to develop a post-transplant malignancy.

Conclusion
In this observational retrospective multicenter analysis, we demonstrated that HLA incompatibility, as indicated by the number of HLA A, B and DR MM, does not predict death-censored graft survival and does not impact the development of post-transplant neoplasia. Our observation would suggest that the missing effect of HLA compatibility on graft outcome is not associated with an increased long-term over-immunosuppression.
#5885 HYPOXIA INDUCES COMPLEMENT ACTIVATION ON HUMAN KIDNEY EPITHELIAL CELLS
Authors: Moldakhmetova Saltanat , Ali Simi , Sheerin Neil 
Published: June 2023

Abstract

Background and Aims
Ischemia-reperfusion injury is an inevitable event associated with kidney transplantation (Tx) and has a major impact on short- and long-term graft survival. Proximal tubular epithelial cells are both a source of complement during Tx and a target of complement activation. The normal kidney has a capacity to protect itself from complement activation through cellular expression of complement regulatory proteins. In this study we investigated whether hypoxia and reoxygenation increase C3 deposition and alter complement regulatory protein expression (CD46, CD59 and CD55).

Method
In vitro, HKC-8 renal proximal tubular epithelial cells were subjected to 24h of hypoxia (1% O2) and then reoxygenated for 4h (O2 = 21%) in the presence of 40% normal human serum. qRT-PCR was used to estimate the level of VEGF-A (as a positive control), C3, CD46, CD59 and CD55 expression. Similar analysis was performed in untreated, normoxic cells. Immunofluorescence staining was used to determine C3 deposition on the cell surface and intensity quantified by ImageJ. Experiments were repeated three times.

Results
qRT-PCR analysis of HKC-8 cells in hypoxia revealed significant increases in the expression of VEGF-A after 24h (p = 0.0113). C3 expression following hypoxia and reoxygenation increased insignificantly. Increased expression of CD59 with the presence of serum was observed in epithelial cells (p = 0.026). However, no significant change was seen in the expression of CD55 and CD46. Reoxygenation in human serum led to significantly greater deposition of C3 on hypoxic cells compared with normoxic HKC-8 cells (Figure 1, 2).

Conclusion
Our preliminary data suggests that hypoxia and reoxygenation significantly increases C3 deposition on the proximal tubular cell surface. CD59, as one of the regulators of complement activation is upregulated at mRNA level after hypoxia followed by 4h reperfusion in the presence of serum. These data demonstrate that hypoxia and reoxygenation activate complement system with upregulation of CD59 as a cell defence. However, expression of CD46 and CD55 do not change. Further study is needed to identify the impact of hypoxia on complement regulation in primary epithelial cells and kidney tissues.
#5891 REPEAT RENAL BIOPSIES IN ADULT LUPUS NEPHRITIS PATIENTS
Authors: Majid Zakia , Afifi Rania , Mikdam Najoua , Chkaari Nawfal Mtioui , Khayat Salma El , Zamd Mohamed Ali , Medkouri Ghislaine , Benghanem M 
Published: June 2023

Abstract

Background and Aims
The role of repeat renal biopsy in lupus nephritis (LN) to guide treatment or predict prognosis has been controversial.The objective of this work is to evaluate the indications requiring the use of a second renal biopsy, as well as to describe the histological results and the therapeutic management according to the results.

Method
This is a descriptive retrospective study, covering 450 renal biopsy performed between January 1, 2020 and December 31, 2022 at the nephrology department of the Casablanca University Hospital. The patients were selected from the kidney biopsy register.

Results
Thirty patients followed for lupus nephritis had benefited from a 2nd renal biopsy. The average age of our patients was 36.4 years with a sex ratio of 0.8. The average time from first to second biopsy was 2, 1 years. The indications for a second renal biopsy was included a suspected flare (76.6%), of which had worsening proteinuria with or without rising serum creatinine (90%), or lack of treatment response (23.4%). 22 patients (73,3%) had proliferative class on their first renal biopsy. When comparing first and second renal biopsy, 26 patients (86.6%) switched histological classes .When categorized as proliferative versus non-proliferative, 21 (95.4%) patients with proliferative class on the first biopsy remained similar on the second biopsy. The mean chronicity index (CI) was significantly different for 10 consecutive biopsies with worsening CI noted with increased number of renal flares. 11 patients (36,6%) required intensification in immunosuppressive therapy after the second renal biopsy whereas 3 patients (10%) experienced a reduction in immunosuppression. 16 patients (53,3%) did not experience any change in immunosuppression.

Conclusion
A 2nd renal biopsy was justified in most cases, making it possible to establish a precise diagnosis, to identify the evolution of the histological lesions, and to guide the therapeutic management.
#5902 KIDNEY INVOLVEMENT IN HAEMATOLOGICAL MALIGNANCIES: THE IMPORTANCE OF EARLY NEPHROLOGICAL REFERRAL
Authors: Maso Vittorio DI , Perencin Brigitta , Zacchi Alberto , Yazbek Ahmad , Toffoli Federico , Zanconati Fabrizio , Bianco Francesco 
Published: June 2023

Abstract

Background and Aims
Kidney is often injured in the setting of hematological malignancies. Although, kidney involvement negatively influences the prognosis of these patients, often the referral to clinical nephrology is late. The aims of this study were to investigate the long-term outcomes of haematological diseases with renal involvement demonstrated by kidney biopsy and the association between nephrological referral earliness and survival.

Method
Monocentric retrospective study evaluating overall survival (OS) (time to death) and renal free survival (RFS) (time to renal replacement therapy) in patients affected by hematologic malignancies with renal involvement demonstrated by kidney biopsy. Data have been collected by January 1st 2009 to December 30th 2021. Results reported as median (min-max) and percentage (%).

Results
46 patients; M/F = 1.3; age: 70 years (39.5-91.2). Follow-up: 17,8 months (0.13-125.4). Data at kidney biopsy: creatinine was 3.13 mg/dL (0.6-14), eGFR was 20 ml/min/1.73 m2 (3-110), proteinuria was 5.1 g/24h (0.15-38.6), Bence-Jones proteinuria detected in 74% of patients. Clinical presentations: AKI (63.1%), Nephrotic syndrome (36.9%). Patient referral by Nephrologist (28.2%), Hematologist (26.1%), General Practitioner (21.7%); Emergency Department (17.4%), Others (6.6%). The most frequent histological diagnosis was amyloidosis (32.7%), followed by cast nephropathy (19.2%). Renal Replacement Therapy was required in 41.3% patients. Treatment: 38 patients underwent chemotherapy (56.4% complete/very good hematologic response; 12.8% partial and 30.6% without response). Overall Survival at 24 months was 63.8% and it was reduced in patients with AKI at presentation (Fig. 1) and in patients without treatment response (Fig. 2). RFS was shorter in patients who presented with AKI and affected by Myeloma Cast. Early Nephrological referral was associated with a better RFS (Fig. 3).

Conclusion
Haematological malignancies with renal involvement causing AKI have the worst prognosis. Kidney biopsy has a prognostic significance and early nephrological referral associated with haematological treatment response correlate with a better renal outcome. These data point to the central role of a multidisciplinary team aimed to the detection and treatment of renal damage due to hematologic malignancies.
#5903 CLINICAL OUTCOME CORRELATION AMONG NEWLY DIAGNOSED LUPUS NEPHRITIS IN RELATION TO PERIPHERAL BLOOD LYMPHOCYTE SUBSET: A PROSPECTIVE STUDY
Authors: Balasubramaniam Karthik , Rangaswamy Dharshan 
Published: June 2023

Abstract

Background and Aims
Given the heterogeneity in presentation, treatment practices and the outcome of lupus nephritis, there is a need for new protocols to predict outcome and rationalize treatment.

Aim
To prospectively study the correlation between peripheral blood lymphocyte subset, inflammatory markers and clinical outcomes among newly diagnosed lupus nephritis patients.

Method
Lymphocyte subset typing by flow cytometry method done at diagnosis and end of 6 months. SLEDAI -2k score. Intensive phase of Immunosuppression individualized by treating physician. Urine protein excretion was used to assess the final treatment outcome. Statistical analyses done using SPSS software. Two-sided P value of &lt; 0.05 was considered significant. Pearson correlation coefficient formula used for correlations. Logistic regression done to identify factors responsible for clinical remission achieved at six months. Inclusion: All newly diagnosed renal biopsy proven Class 3, class 4, Class 5 or a combination class of lupus nephritis patients seen at Kasturba Hospital and Medical College, Manipal. Exclusion: Patients with active/recent infection, active malignancy, those with prior explosion to immunosuppression. Outcome measures, 1. To detect correlation if any, between peripheral blood lymphocyte subset, serum inflammatory markers and disease activity score at presentation. 2. To determine correlation if any, between peripheral blood lymphocyte subset and clinical remission achieved following immunosuppressive regimens at the end of six months of initial intensive treatment phase.

Results
22 patients were taken for study. Relationship between SLEDAI score, lymphocyte subset characters, and clinical outcome given in Table 1 and 2. There was good correlation between lymphocyte subset characters, inflammatory markers and SLEDAI score, indicating ability of lymphocyte subset characters to characterize the severity of lupus nephritis. We found significant difference in lymphocyte subset characters between baseline and at the end of 6 months treatment. But there was no significant correlation for remission attainment with lymphocyte subset characters and SLEDAI score.

Conclusion
1. Correlation found between peripheral blood lymphocyte subset, serum inflammatory markers and disease activity score at presentation and 6 months of treatment of lupus nephritis. 2. Peripheral blood Lymphocyte subset analysis was not found useful in predicting clinical outcome in lupus nephritis at the end of 6 months of intensive treatment.
#5999 GRADES II-III INTRA-ABDOMINAL HYPERTENSION INCREASE THE RISK OF GRAFT LOSS OR DEATH AFTER KIDNEY TRANSPLANTATION
Authors: Ardura Paula , Manrique María Martínez , Acosta-Ochoa Isabel , Gordillo Raquel , Sanz-Ballesteros Sandra , Peláez Ana Lucía Valencia , Lorenzo Arturo , Fidalgo Veronica , Mendiluce Alicia , Coca Armando 
Published: June 2023

Abstract

Background and Aims
Intra-abdominal hypertension (IAH) is common among post-surgical, critically ill and kidney transplant patients, and is associated with acute kidney injury and increased morbidity and mortality. We aimed to describe the medium-term effect of IAH on graft and patient survival after deceased-donor kidney transplantation.

Method
192 consecutive patients who received a cadaveric renal allograft transplant at our hospital were included in this study. IAP was measured every 8h for at least the first 72h after surgery using the urinary bladder technique, and an average value was obtained. Patients were followed up for 24 months or until a composite outcome (defined as graft loss or recipient death) occurred. Clinical, anthropometric, and analytical data was extracted from our hospital's database. Statistical analysis was performed using IBM SPSS Statistics 22. The study was approved by the local ethics committee.

Results
192 patients were included. Relevant clinical and anthropometric data are summarized in Table 1. Patients with grades II or III IAH were more frequently male, had longer dialysis vintage, received more frequently hemodialysis as renal replacement therapy and suffered delayed graft function, graft loss or death more repeatedly. In Kaplan-Meier analysis, grade II IAH or higher were associated with lower composite-outcome free survival (Log-Rank: 8.053; p = 0.018) (Figure 1).

Conclusion
Grade II-III IAH appear to be a risk factor for graft loss or recipient death in our sample of deceased donor kidney transplant recipients. Monitoring of intra-abdominal hypertension could provide useful information to identify patients at higher risk of post-transplant complications.
#6004 THE EFFECT OF COVID-19 WITH OR WITHOUT ACUTE KIDNEY INJURY ON INPATIENT MORTALITY IN ENGLAND
Authors: Kolhe Nitin , Fluck Richard , Taal Maarten 
Published: June 2023

Abstract

Background and Aims
COVID-19 and acute kidney injury (AKI) are each associated with increased mortality but the interaction between these two conditions has not been adequately investigated with appropriate control groups. The aim of this national study was to assess patient characteristics and mortality and well as associations with higher mortality in patients with or without COVID and with or without AKI.

Method
We extracted 3,324,748 finished consultant episodes (FCE) of all adult patients admitted patients between March 20 and March 21 from England's national database of all hospitals. We excluded patients on chronic dialysis, acute dialysis in CKD, acute dialysis with no AKI codes or not residing in England. We also excluded multiple FCEs within same spell and duplicate FCEs. We extracted all diagnoses and procedure codes for the cohort. We divided the study period in two phases of SARS CoV-2 strains. “Other” strain of SAR CoV-2 was dominant between 1st March 2020 and 21st December 2020 and “Alfa” strain was dominant between 22nd December 2020 to 17th May 2021. The end date of each phase was based on more than 50% decline in each variant. We further categorised phases based on publication of the RECOVERY trial.

Results
There were 663,628 patients with 2,385,337 admissions out which 856,544 had AKI as identified by N17 codes while 1,528,793 had no AKI. There were 1,008,774 admissions in 133,988 patients who did not have AKI or COVID (group 1) and 520,019 admissions in 256,037 patients who had COVID (group 2). Amongst admission with AKI, there were 630,342 admissions in 218,270 patients who did not have COVID-19 (group 3) and 226,202 admissions with COVID in 55,333 patients (group 4). Patients in group 4 were older (75.4 ± 13.8 years) and had greater length of stay (17.1 ± 17 days) than all other groups. Acute dialysis was performed in 1.4% of patients in group 3 and 3.6% of patients in group 4. Crude in-hospital mortality was highest in group 4 at 28.7% and lowest in group 1 (1.1%). Critical care requirement was lowest in group 1 (1.2%) compared to group 4 (10.9%) as was ITU mortality (4.8% versus 47.8%). In multivariable analysis, when compared with group 1, patients in group 4 had highest odds of death (OR 22.28, 95%CI 21.79, 22.78) followed by patients with group 2 (OR 9.67, 95%CI 9.46, 9.88) (Figure 1). Patients in group 3 had OR of 6.44, 95%CI 6.30, 6.58. Odds of death were lower during post-RECOVERY phase with “Other” (OR 0.80, 95%CI 0.79, 0.81) and "Alfa" (OR 0.86, 95%CI 0.85, 0.87) SARS CoV-2 strains (Figure 2).

Conclusion
This national study shows that the COVID pandemic had great impact on mortality in England and the odds of death increased substantially when complicated by AKI. Moreover, AKI associated with COVID was associated with a substantially higher odds of death than AKI due to other causes. The change in practice after publication of the RECOVERY trial was associated with a lower odds of death.
#6011 VIRAL INFECTION AND DE NOVO PRODUCTION OF DONOR SPECIFIC ANTIBODIES IN KIDNEY TRANSPLANTATION: DCD VS DBD
Authors: Gianassi Iacopo , Lomi Jacopo , Bartiromo Marilù , Maria Lorenzo DI , Caroti Leonardo , Larti Aida , Cutruzzulà Roberta , Antognoli Giulia , Odone Ludovica , Sossai Giulia , Moscato Marco , Palazzini Giulia , Allinovi Marco , Cirami Calogero 
Published: June 2023

Abstract

Background and Aims
Viruses are among the most common causes of opportunistic infection after transplantation and an accurate screening and follow-up is needed in order to prevent related complication as systemic damages and worsening of kidney function. On the other hand, in the first years after transplantation, antibody-mediated rejection (ABMR) is one of the first cause of graft lost and de novo production of donor specific antibody (dnDSAs) is the main source. In this monocentric study we analysed data of 255 patient transplanted from January 2016 to February 2022. We studied the incidence of viral infection and dnDSAs in the first one year after transplantation in different sub-groups of patients.

Method
Data was obtained from our monocentric registry, from January 2016 to February 2022. Starting from 299 kidney transplantation we obtained 255 patients with a complete annual follow-up for viral infection and DSA monitoring. We compared the incidence of viral infection and dnDSAs in different sub-group: transplanted from donation after brain-death treated with Basiliximab as induction therapy (DBDb), transplanted from donation after brain-death treated with rabbit anti-human thymocyte immunoglobulin (rATG) as induction therapy (DBDt), transplanted from donation after circulatory death treated with rATG as induction therapy (DCD) and transplanted treated with rATG as induction (DBDt+DCD).

Results
Global incidence of viral infection was 73% and dnDSAs formation was present in 12,5% of all patients. DBDs showed an incidence of 69% of viral infection and 10% of dnDSAs while in DBDt these values were 77,4% and 25%, respectively. In DCD data of viral infection was higher (96,7%) whereas dnDSAs was 14%. rATG (DBDt+DCD) displayed 87,1% of viral infection and 19% of dnDSAs.

Conclusion
Viral infection and dsDNAs are two paramount aspects in kidney transplantation and demonstrate different incidences depending on donation profile and immunosuppressive induction therapy. Specifically rATG seems to be associated to an higher rate of viral infection and DCD is the more relevant sub-group. Furthermore, rATG was associated with higher dsDNAs rate, especially in DBD treated with rATG. On the best of our knowledge, this data was never observed before. These data, due to the low number of cases, need to be confirmed from larger cohorts. Moreover our study underlines how significant is to develop a personalized approach in order to reduce complications associated to immunosuppressive therapies.