bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO162: Renal Function During Long-Term Use of Oral Anticoagulants in Patients with Atrial Fibrillation
Authors: Abdullaev Sherzod , Igamberdieva Ranokhon 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Long-term oral anticoagulant should be recommended in patients with atrial fibrillation (AF) and CHA2DS2VASc score ≥ 1 for stroke prevention. Warfarin and different direct oral anticoagulants are metabolized differently by the kidney. The impact on renal function during long-term use of oral anticoagulants in the patients with AF remains unclear. The aim of our study was to compare rivaroxaban's and warfarin's impact on the decline in renal function in patients with AF.

METHOD
This study included patients with non-valvular AF from 2016 to 2020, mainly through the medical history of the Republican nephrology inpatient departments. Baseline estimated glomerular filtration rate (eGFR), follow-up eGFR and the change in eGFR between 2-year eGFR and baseline eGFR were compared between different anticoagulants after propensity score matching. The primary study endpoint was acute kidney injury (AKI). A total of 289 patients were enrolled (n = 131 rivaroxaban, n = 158 warfarin) in this study, and the mean observation time was 2.9 ± 0.8 years.

RESULTS
During the observation period, there was a significantly higher incidence of AKI during follow-up in the warfarin group than in the rivaroxaban group before and after propensity score matching (before: warfarin versus rivaroxaban: 8.9% versus 4.6%, P &lt; .001; after: warfarin versus rivaroxaban: 8.2% versus 3.8%, P &lt; .001). The change in eGFR between 2-year eGFR and baseline eGFR did not differ between the warfarin and rivaroxaban groups after propensity score matching (warfarin versus rivaroxaban: − 1.31 ± 20.31 versus –1.82 ± 16.23 mL/min/1.73 m2, P  =  .452).

CONCLUSION
During the mean observation time of 2.9 ± 0.8 years, warfarin was associated with a higher incidence of AKI compared with rivaroxaban. The decline in renal function did not differ among warfarin and rivaroxaban groups.
MO164: Is there a Place for the Resistivity and Pulsatility Index in Diabetic Nephropathy?
Authors: Liana Gliga Mirela , Chirila Cristian , Gliga Mihail , Tilea Ioan , Chirila Paula 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Resistivity index (RI) and pulsatility index (PI) are important Doppler ultrasound (US) parameters for the evaluation of intrarenal haemodynamics. One of the pathogenetic mechanism in diabetic nephropathy (DKD) is the arteriolar hyalinosis and the interlobar arteries were proved as hallmarks for distal vasoconstriction or dilatation. Therefore, Doppler parameters are commonly used in the early detection of intrarenal vasoconstriction. We compared the results of colour Doppler parameters RI and PI in type 2 diabetic nephropathy (DKD) with hypertensive (HT) patients with proteinuria and tried to assess the risk for the disease progression.

METHOD
A total of 141 patients with DKD and 146 hypertensive patients were examined using an Esaote MyLab X8 eXP Ultrasound device following a precise protocol by a single examiner. All patients had proteinuria values 300–500 mg/24 h. RI and PI were measured in the interlobar arteries on three levels for each kidney, and a mean was calculated. All patients were age and sex matched and had eGFR over 45 mL/min/1.73 m2. GraphPad Prism program was used, and correlation indices were calculated.

RESULTS
Mean RI values were 0.71 for ND group (SD = 0.06; 95% CI), 0.66 for HT group (SD 0.06; 95% CI); t-test was highly significant (P &lt; .05). Mean PI values were 1.27 for ND group (SD = 0.33; 95% CI), 1.04 for HT group (SD = 0.24), t-test was also highly significant between the two groups with P values under.05. Cut-off values for RI in DKD were above 0.72. PI values were higher with age in diabetic patients. PI and RI were highly significant in case of patients with more than 5 years from the onset of diabetes.

CONCLUSION
RI can be considered a suggestive parameter for the presence of DN. PI alongside RI correlated with the duration of diabetes, age and incipient DN. We recommend the use of RI in the early evaluation of DKD. Although Doppler US examination is time-consuming, it can be easily performed in non-obese and compliant patients.
MO188: Elevated Serum Soluble Urokinase-Type Plasminogen Activator Receptor Level is Linked to Aortic Stiffness in Chronic Haemodialysis Patients
Authors: Lin Wei-Chen , Lai Yu-Hsien , Hsu Bang-Gee 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with inflammation and contributing in the pathogenesis of atherosclerosis. Aortic stiffness is associated with aging-associated vascular diseases and is also an independent risk factor of cardiovascular morbidity and mortality. We evaluated the association between serum suPAR and aortic stiffness in patients with chronic haemodialysis (HD).

METHOD
A total of 135 patients with HD were enrolled in this study. Carotid–femoral pulse wave velocity (cfPWV) was measured using the SphygmoCor system. Patients with cfPWV &gt;10 m/s were defined as the aortic stiffness group. Serum suPAR levels were measured using a commercial enzyme-linked immunosorbent assay kit.

RESULTS
Fifty-five HD patients (40.7%) had aortic stiffness and higher percentages of diabetes (P = .001), hypertension (P = .039), were of older age (P = .007) and had higher systolic blood pressure (P = .025), serum glucose level (P = .019), C-reactive protein (P = .039) and suPAR levels (P &lt; .001) compared to control group. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum suPAR [odds ratio (OR): 1.910, 95% confidence interval (CI): 1.485–2.458, P &lt; .001] and age (OR: 1.040, 95% CI: 1.001–1.080, P = .048) were independently associated with aortic stiffness in patients with chronic HD. After multivariable forward stepwise linear regression analysis also noted that serum suPAR level (β = 0.442, adjusted R2 change = 0.250, P &lt; .001) was positively associated with with cfPWV values in HD patients.

CONCLUSION
Serum suPAR level is positively associated with cfPWV values and is a biomarker for aortic stiffness in patients with chronic HD.
MO206: HLA Frequency in A Spanish Transplant Patients Cohort With ANCA-Associated Vasculitis
Authors: Martin Irene , Mínguez Toral Irene , Castillo Rodriguez Esmeralda , Viera Ramírez Elizabeth , Jimenez Sara , Ferreira Marta , Elias Triviño Sandra , Gañan Israel , Galeano Cristina , Fernandez Lucas Milagros 
Published: May 2022

Abstract

BACKGROUND AND AIMS
ANCA-associated vasculitis (AAV) is an autoimmune disease that causes end-stage renal disease in ∼20%–25% of patients who develop kidney failure with progression to end-stage kidney disease with requirement of renal replacement therapy. Previous studies have found a genetic association between some major histocompatibility complex (MHC) loci, like the locus DPB1*0401, and AAV. We conducted a retrospective observational unicentric study with the objective to identify other possible loci related to AAV.

METHOD
As MHC determination is not usually done in patients with AAV, we looked for patients with AAV included in the kidney transplant list with a complete classic HLA allele determination registered (A, B, C, DR, and DQ). Only 14 patients with diagnosis of AAV included in the kidney transplant list from August 1993 to December 2020 in our hospital centre fulfilled this inclusion criterion. To the statistical analysis, we compared the observed proportion to the theoretical one using a normal test, since the groups in our sample included at least five subjects. We also use a continuity correction factor to approach to a binomial test.

RESULTS
The highest allele frequency in our cohort were the HLA B*51and the haplotype HLA DRB1*04-DQB1*03:02. We identified a B*51 frequency of 42.8% (6/14 patients) in our AAV register, while its population frequency in Spain is 15%, difference = 27.86% [Confidence interval (CI) 1.93%–53.78%] P = .01. We detected a DRB1*04 frequency of 57.1% (8/14 patients) in our cohort, while the population frequency of DRB1*04 and its associated loci DQB1*03:02 is 22%, difference = 35.14% (CI 9.22%–61.07%) P &lt; .05.

CONCLUSION
HLA B*51 and the haplotype DRB1*04-DQB1*03:02 are alleles more frequent in patients with AAV than general population. This could translate a genetic predisposition of people with these alleles to develop AAV.
MO215: Intrarenal Single Cell Sequencing of MPO-Anca Associated Glomerulonephritis Patients Reveal Novel Targetable Treatment Options
Authors: Zhong Yong , Ooi Joshua 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The etiopathogenesis underlying myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (MPO-ANCA-GN) remains incompletely understood. Furthermore, there are only limited treatment options and treatment resistance of MPO-ANCA-GN is still a common problem.

METHOD
To identify new targeted treatment options, intrarenal single-cell RNA sequencing (scRNA-seq) was applied to 11 kidney biopsies from MPO-ANCA-GN patients and 2 health kidney tissues to define the transcriptomic landscape at single-cell resolution. Intrarenal scRNAseq was also applied to a pre-clinical mouse model of MPO-ANCA-GN to show that this model of disease can be used to trial new targeted treatments.

RESULTS
We found that kidney endothelial cells in MPO-ANCA-GN patients displayed increased expression of several genes, including CD9 and SPARC, which were closely related to parietal epithelial hyperplasia and crescent formation. NF-κB pathway activation was confirmed in a variety of kidney cells in MPO-ANCA-GN patients. Kidney infiltrating immune cells of MPO-ANCA-GN patients were mainly enriched in inflammatory pathways including TNF signalling, IL-17 signalling and NOD-like receptor signalling. These findings were similar in our pre-clinical mouse model of MPO-ANCA-GN. Furthermore, there was an overexpression of inflammasome-related genes (AIM2, IFI16) in MPO-ANCA-GN patients. Treatment resistance was associated with increased infiltration of CD8+ T cells and elevated expression of SPARC, LAMA4, IL33 and CFL1 in mesangial cells when compared with patients who achieved remission after induction therapy.

CONCLUSION
These results offer new insight into the pathogenesis of MPO-ANCA-GN, treatment resistance and identify new therapeutic targets for MPO-ANCA-GN that can be tested in a pre-clinical model of disease.
MO220: Comparison of the Effects of Hydroxychloroquine and Glucocorticosteroids on Immunological Parametrs in Patients with IGA Nephropathy
Authors: Komissarov Kirill , Nizheharodava Darya , Pilotovich V. , Zafranskaya Maryna 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Current treatment strategies of IgA nephropathy (IgAN) primarily involve blood pressure control, renin–angiotensin–aldosterone system inhibitors (RAASIs), and glucocorticosteroids (GCs), which are recommended when the supporting therapies fail to reduce proteinuria (PU) levels below 1 g/day. Hydroxychloroquine (HCQ) is considered to have an immunomodulatory rather than an immunosuppressant effect. The immune pathways targeted by HCQ are not fully investigated during treatment of IgAN. The aim of this study was to compare effects of HCQ and GCs on immunological parameters in patients with IgAN.

METHOD
32 IgAN patients aged 32.0 (26.7 ÷ 36.0) y.o., male/female ratio as 24/8 with PU &gt; 1 g/day and estimated glomerular filtration rate (eGFR) 78 (61; 103) mL/min were divided into three treatment groups: RAASIs (n = 12); HCQ (n = 10); GCs Pozzi protocol (n = 10). The changes in clinical and immunological parameters were analyzed 6 months after treatment. Phenotypic and functional markers of peripheral blood lymphoid cells were identified by flow cytometry method (Cytoflex, «Beckman Coulter», USA). The concentrations of total immunoglobulins (Ig) class M, G, A and E were determined by ELISA method («VectorBest», Russia). Statistical analysis was done using Statistica 8.0.

RESULTS
After 6 months of treatment HCQ has shown effectiveness in decreasing of PU (P &lt; .001), haematuria level (P &lt;.01) as well as the same effect was noted in the other treatment groups after 6 months course. The renal function was stable in all investigated groups during follow up. There were no any adverse effects of the treatment.
The decrease of potential cytotoxic γδTCR+Т-cells (P &lt;.01) and CD3 + 56 + TNK-cells (P &lt; .01) numbers in peripheral blood (Fig. 1) as well as the reduction of IgM (P &lt; 0.05) and IgG (P &lt; .05) serum levels (Table 1) were established in patients receiving HCQ. While GCs treatment resulted in CD3 + T-cells (P &lt; .05) suppression (Fig. 1) mainly due to CD3 + CD4 + T-helpers down-regulation (P &lt; .05) but stimulation of cytotoxic CD3 + CD8 + T-cells (P &lt; .05) (data not shown) and increasing of IgE level (P &lt; .05) (Table 1). It was not revealed any influence of RAASIs treatment either on the number of lymphoid cells populations (Fig. 1) or Ig levels.

CONCLUSION
This study demonstrates different ways of pathogenic treatment in IgAN. HCQ has exhibited an immunomodulatory action on the effector mechanisms of cellular cytotoxicity via minor lymphoid T-cells populations reduction as well as on productive phase of humoral immunity via IgM and IgG levels decreasing. While GCs have suppressed CD3 + T-cell and supported IgE-mediated autoinflammation.
MO225: A Past Medical History of Autoimmune Disease Predicts a Future With Fewer Relapses in Patients With ANCA Vasculitis
Authors: Lionaki Sophia , Marinaki Smaragdi , Fragkioudaki Sofia , Bellos Ioannis , Kalaitzakis Emmanuel , Kalogeropoulos Petros , Sardeli Angeliki , Liapis George , Boletis Ioannis 
Published: May 2022

Abstract

BACKGROUND AND AIMS
To explore the frequency and impact of an autoimmune disease past-medical history (PMH) in the clinical picture and outcomes of patients with ANCA-associated vasculitis (AAV).

METHOD
This is a retrospective study of patients with biopsy-proven AAV, &gt;16 years old, with detailed information about their PMH. Outcomes of interest included remission, treatment resistance, relapse, end-stage kidney disease (ESKD), and death.

RESULTS
215 patients with biopsy-proven AAV and available information regarding their PMH were studied. A total of 65 (30.2%) of them had a history of autoimmune disease prior to PIV diagnosis. The mean age overall was 53.9 years. One hundred and five patients (48.8%) were positive for PR3-ANCA, 101(47.2%) for MPO-ANCA, and 9(4.2%) were negative ANCA. Granulomatosis with polyangiitis was diagnosed in 79 (36.7%), microscopic polyangiitis in 101(47.0%) and renal-limited vasculitis in 35 (16.3%) individuals. Remission rate was similar among patients with and without a PMH of autoimmune disease. Time-to-event analysis indicated that the relapse-free survival was significantly longer in patients with PMH of autoimmune disease (148.2 versus 52.8 months, P-value &lt; .001). After adjusting for covariates, autoimmune disease history was associated with significantly lower risk of relapse {HR 0.31, [95% confidence interval (CI) 0.14–0.69]}, which remained significant in males, patients ≥ 60 years old and those with C/PR3-ANCA, kidney and lung involvement.

CONCLUSION
Patients with a PMH of autoimmune disease, prior to AAV diagnosis, experienced significantly fewer relapses after achievement of remission, compared with patients without such a history, underlining the importance of individualization of maintenance immunosuppressive therapy, given the different etiopathogenetic settings the disease was developed.
MO227: Anca-Associated Vasculitis Following Pfizer-Biontech COVID-19 Vaccine: True Association or Circumstantial?
Authors: Marouço Catarina , Carvalho Dulce , Magriço Rita , Ribeiro Francisco , Nolasco Fernando 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Antineutrophil cytoplasmatic antibody (ANCA) associated vasculitis (AAV) is a small vessel vasculitis hallmarked by the presence of antibodies against antigens in cytoplasmic granules of neutrophils. Vaccines per se stimulate the immune system, including the innate and the adaptive immune response. Therefore, it is possible that an excess of autoimmunity is observed after vaccine administration. Vaccination (notably influenza) is a recognized trigger for the relapse of ANCA-associated vasculitis. ANCA associated vasculitis and autoimmune reactions have been reported with COVID-19 infection and following vaccination.
We report the case of a Caucasian, 62-year-old-man, with a previous history of type 2 diabetes mellitus, hypertension and atrial fibrillation. Blood analysis 1 year before presentation showed preserved renal function and normal urinalysis. He received the first dose of Pfizer-BioNTech COVID-19 vaccine and 2 weeks later routine blood analysis showed acute kidney injury with serum Creatinine 1.75 mg/dL with de novo hematuria, a protein-to-creatinine ratio (RPC) 1.1 mg/g and candersartan (4 mg twice daily) was started. The patient received the second dose of COVID-19 vaccine 21 days after the first injection. Two weeks later, he developed anorexia, nausea and de novo hematuria. He was admitted at the emergency department with deteriorating renal function with a sCr of 5.5 mg/dL, worsening hematuria with dysmorphic red blood cells and proteinuria (RPC 2.9 mg/g). Renal ultrasound was normal. Immunological studies revealed an elevated ANCA-MPO titer of 561. A kidney biopsy was performed and showed a crescentic necrotizing glomerulonephritis. Immunofluorescence confirmed pauci-immune glomerulonephritis. He was diagnosed with renal limited myeloperoxidase (MPO) ANCA AAV. He started three pulses of 500 mg I.V methylprednisolone followed by prednisolone 1 mg/kg/day after that. He also started rituximab (four doses of 500 mg I.V. once a week apart). Despite the immunosuppression, the patient never recovered renal function and remained dialysis dependent.

CONCLUSION
Whether autoimmune diseases can be triggered after vaccination remains a matter of discussion among experts. ANCA-associated vasculitis and autoimmune reactions have been reported with COVID-19 infection and following vaccination, which prompts the question whether this response could be a direct reaction to the RNA present in the vaccine. While an association with de novo ANCA vasculitis and COVID-19 vaccine may be possible, further investigation is necessary.
MO232: Amyloidosis AL in Nephrology
Authors: Najla Dammak , Faten Ghabi , Ikram Agrebi , Asma Amouri , Arwa Kammoun , Salma Toumi , Soumaya Yaich , Kammoun Khawla , Hafedh Makni , Tahya Boudawara , Hmida Mohamed Ben 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Systemic AL amyloidosis is a rare pathology associated with the precipitation of monoclonal immunoglobulin light chains in the form of fibrils in various organs. Clinical presentations are extremely variable and diagnosis is often delayed. The two most affected organs are the kidney and the heart. The treatment is based on chemotherapy to eliminate the medullary clone that produces the monoclonal light chain. However, the outcome is still poor. The aim of our study was to describe the demographic, clinicobiological, histological, therapeutic and evolutionary characteristics of AL amyloidosis in our population.

METHOD
We carried out a single-center retrospective descriptive trial of patients who were diagnosed with histologically confirmed AL amyloidosis in our Nephrology Department during the period from 2014 to 2021.

RESULTS
We enrolled 12 patients with a mean age of 61.25 ± 8.17years. The sex ratio (M/F) was 3. The histological confirmation of AL amyloidosis was based on biopsies: kidney (n = 7) and salivary glands (n = 5). The immunoglobulin type was Ig G Lambda in 75% of cases (n = 9), IgG kappa in 16.6% of cases (n = 2) and IgM in 8.3% of cases (n = 1). The cause of amyloidosis was multiple myeloma in 66.6% of cases (n = 8) and Waldenström disease in 8.3% of cases (n = 1). The mean creatinine at diagnosis was 441.33 ± 334.47 umol/L, i.e. a median creatinine clearance (MDRD) of 36.67 ± 46.77 mL/min. At the time of diagnosis, 50% of the patients (n = 6) had end-stage renal disease and 25% (n = 3) had reached it after a few more months. The mean proteinuria was 6.33 g/24 h within 83.3% of cases (n = 10) with the presence of a nephrotic syndrome. The cardiac involvement was found in 58% of the patients (n = 7) at the time of diagnosis with a Mayo Clinic prognostic score of III. The neurological involvement was observed in 8.3% of cases (n = 1) and was confirmed by spinal MRI as polyradiculoneuritis. As for the therapeutical management, 75% of the patients (n = 9) received first-line treatment with Bortezomib Cyclophosphamide Dexamethasone, and 16.6 of the patients (n = 2) were treated with corticosteroids and Melphalan (the 12th patient died early). The outcome was fatal in 41.5% (n = 5) and the cause of death was a state of septic shock, and the rest of the patients are alive with a mean follow-up of 1 year.

CONCLUSION
AL Amyloidosis is one of the most severe complications of monoclonal lymphocyte proliferation. This overgrowth is most frequently related to myeloma, and rarely to another malignant B-cell disease. The prognosis is related to cardiac and renal impairment. It requires urgent management to improve its outcome and to reduce mortality.
MO233: Real-World Signs and Symptoms at Diagnosis in Patients With IGA Nephropathy
Authors: Roccatello Dario , Kattlun Julia , Przybysz Raymond , Thomas George Aneesh , Aldworth Carolina , Proudfoot Clare , Wang Weijia , Decourcy Jonathan , Lafayette Richard 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide, with an estimated annual incidence of 25 per million. Patients with persistent proteinuria ≥ 1 g/day are at increased risk of disease progression, with 30% or more progressing to kidney failure within 10 years. Hematuria and proteinuria are among the most common clinical manifestations of IgAN. The aim of this analysis was to better understand the clinical characteristics of IgAN patients from Europe, Asia and the USA, at the time of diagnosis.

METHOD
A retrospective analysis was conducted using data from the Adelphi IgAN Disease Specific Programme (DSP), a cross-sectional survey of IgAN-treating nephrologists in EU4 (France, Germany, Italy, UK), USA, China and Japan between June and October 2021. Nephrologists completed structured forms administered via online links for successive patients presenting with IgAN in their practice. The forms included demographic and clinical information including signs, symptoms and lab values amongst others.

RESULTS
A total of 269 nephrologists completed records for 1685 patients in this survey. Mean patient age was 43.3 years, and most were male (58%). The diagnosis was confirmed by biopsy in 86% of the patients. The mean eGFR at diagnosis ranged from 58.1 (median 55.5) in the USA to 78.3 (median 79.0) mL/min/1.73 m2, in China and Japan. Mean proteinuria ranged from 2.7 (median 2.0) in the USA to 3.4 (median 2.1) g/day in EU4 (Table 1). The main clinical signs at diagnosis were proteinuria (75%) and visible hematuria (63%). Edema and fatigue were reported in 38% and 27% of patients; 10% and 9% of patients reported appetite loss and sleep problems. A sizable proportion of patients (31%) also experienced pain in various parts of the body.

CONCLUSION
This comprehensive study of IgAN patients across varied geographies presents evidence that patients experience substantial symptomatic and clinical burden at diagnosis, irrespective of the region. The relatively high levels of proteinuria and low eGFR levels, especially in the USA, suggest that the disease is often severe and advanced by the time of diagnosis. Facilitating early diagnosis of IgAN—perhaps through better recognition of clinical signs and symptoms—could be beneficial in optimizing early treatment and preventing disease progression.