Acute Nephropathy Research Articles

Renal and Genitourinary Ultrasound Evaluation in Emergency and Critical Care: An Overview.

Renal and genitourinary ultrasound are fundamental resources employed by emergency and critical care healthcare providers to make prompt diagnoses and perform ultrasound-guided procedures. At the bedside, ultrasound can aid in the diagnosis of relevant pathologies, such as post-renal obstruction or kidney stones, and life-threatening conditions such as aortic dissection or hemoperitoneum. A narrative overview was performed, providing an updated review of renal and genitourinary ultrasound for emergency and critical care healthcare providers, emphasizing its advantages and the latest advances in the field. A thorough summary that can be utilized as a guide for emergency and critical care healthcare providers is presented. The daily hemodynamic management of critically ill patients involves the implementation of new protocols, such as VexUS or the evaluation of the renal resistance index. The role of ultrasound in managing acute nephropathy and genitourinary issues is increasingly crucial given its bedside availability, thus this imaging modality not only facilitates the initiation of therapeutic interventions but also provides swift prognostic insights that are vital to provide tailored patient care. As further advances in ultrasound will arise, it is important for healthcare providers to foster the use of these technologies capable of improving patient outcomes.

Sex-related differences in pre-dialysis trajectories and dialysis initiation: A French nationwide retrospective study.

In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start. Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups. Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18). This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making.

A Simple Strategy to Reduce Contrast Media Use and Risk of Contrast-Induced Renal Injury during PCI: Introduction of an "Optimal Contrast Volume Protocol" to Daily Clinical Practice.

Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN prevention (statin prescription, prehydration, contrast media (CM) clearance from the blood system, and decrease amounts of contrast volume). The CM volume to patient's creatinine clearance ratio is the main factor to predict the risk of CIN development. The safe CM to creatinine clearance ratio limits have been established. The usage of CM amount depends on personal operators habits and inside center regulations. There is no standardized contrast usage protocol worldwide. The aim of this study was to establish an easy to use, cheap, and efficient protocol to estimate a personalized safe CM dose limit for every patient based on their kidney function. These limits are announced during the "Time Out" before the procedure. Our study included 519 patients undergoing interventional coronary procedures: 207 patients into the "Optimal Contrast Volume" arm and 312 into the control group. Applying the protocol into a daily clinical practice leads to a significant reduction in CM volume used for all type of procedures and the development of CIN in comparison with a control group.

Radioprotective Effects of Carvacrol and/or Thymol against Gamma Irradiation-Induced Acute Nephropathy: In Silico and In Vivo Evidence of the Involvement of Insulin-like Growth Factor-1 (IGF-1) and Calcitonin Gene-Related Peptide.

Radiotherapy (RT) is an effective curative cancer treatment. However, RT can seriously damage kidney tissues resulting in radiotherapy nephropathy (RN) where oxidative stress, inflammation, and apoptosis are among the common pathomechanisms. Carvacrol and thymol are known for their antioxidative, anti-inflammatory, and radioprotective activities. Therefore, this study investigated the nephroprotective potentials of carvacrol and/or thymol against gamma (γ) irradiation-induced nephrotoxicity in rats along with the nephroprotection mechanisms, particularly the involvement of insulin-like growth factor-1 (IGF-1) and calcitonin gene-related peptide (CGRP). Methods: Male rats were injected with carvacrol and/or thymol (80 and 50 mg/kg BW in the vehicle, respectively) for five days and exposed to a single dose of irradiation (6 Gy). Then, nephrotoxicity indices, oxidative stress, inflammatory, apoptotic biomarkers, and the histopathological examination were assessed. Also, IGF-1 and CGRP renal expressions were measured. Results: Carvacrol and/or thymol protected kidneys against γ-irradiation-induced acute RN which might be attributed to their antioxidative, anti-inflammatory, and antiapoptotic activities. Moreover, both reserved the γ -irradiation-induced downregulation of CGRP- TNF-α loop in acute RN that might be involved in the pathomechanisms of acute RN. Additionally, in Silico molecular docking simulation of carvacrol and thymol demonstrated promising fitting and binding with CGRP, IGF-1, TNF-α and NF-κB through the formation of hydrogen, hydrophobic and alkyl bonds with binding sites of target proteins which supports the reno-protective properties of carvacrol and thymol. Collectively, our findings open a new avenue for using carvacrol and/or thymol to improve the therapeutic index of γ-irradiation.

A Single Oral Dose of Diclofenac Causes Transition of Experimental Subclinical Acute Kidney Injury to Chronic Kidney Disease.

Nephrotoxic drugs can cause acute kidney injury (AKI) and analgesic nephropathy. Diclofenac is potentially nephrotoxic and frequently prescribed for pain control. In this study, we investigated the effects of single and repetitive oral doses of diclofenac in the setting of pre-existing subclinical AKI on the further course of AKI and on long-term renal consequences. Unilateral renal ischemia–reperfusion injury (IRI) for 15 min was performed in male CD1 mice to induce subclinical AKI. Immediately after surgery, single oral doses (100 mg or 200 mg) of diclofenac were administered. In a separate experimental series, repetitive treatment with 100 mg diclofenac over three days was performed after IRI and sham surgery. Renal morphology and pro-fibrotic markers were investigated 24 h and two weeks after the single dose and three days after the repetitive dose of diclofenac treatment using histology, immunofluorescence, and qPCR. Renal function was studied in a bilateral renal IRI model. A single oral dose of 200 mg, but not 100 mg, of diclofenac after IRI aggravated acute tubular injury after 24 h and caused interstitial fibrosis and tubular atrophy two weeks later. Repetitive treatment with 100 mg diclofenac over three days aggravated renal injury and caused upregulation of the pro-fibrotic marker fibronectin in the setting of subclinical AKI, but not in sham control kidneys. In conclusion, diclofenac aggravated renal injury in pre-existing subclinical AKI in a dose and time-dependent manner and already a single dose can cause progression to chronic kidney disease (CKD) in this model.

Spectrum of Kidney Disorders Associated with T-Cell Immunoclones.

Large granular T-cell leukemia is a clonal hematological condition often associated with autoimmune disorders. Whether small-sized T-cell clones that are otherwise asymptomatic can promote immune kidney disorders remains elusive. In this monocentric retrospective cohort in a tertiary referral center in France, we reviewed characteristics of 29 patients with T-cell clone proliferation and autoimmune kidney disorders. Next-generation sequencing of the T-cell receptor of circulating T-cells was performed in a subset of patients. The T-cell clones were detected owing to systematic screening (mean count 0.32 × 109/L, range 0.13–3.7). Strikingly, a common phenotype of acute interstitial nephropathy was observed in 22 patients (median estimated glomerular filtration rate at presentation of 22 mL/min/1.73 m2 (range 0–56)). Kidney biopsies showed polymorphic inflammatory cell infiltration (predominantly CD3+ T-cells, most of them demonstrating positive phospho-STAT3 staining) and non-necrotic granuloma in six cases. Immune-mediated glomerulopathy only or in combination with acute interstitial nephropathy was identified in eight patients. Next-generation sequencing (n = 13) identified a major T-cell clone representing more than 1% of the T-cell population in all but two patients. None had a mutation of STAT3. Twenty patients (69%) had two or more extra-kidney autoimmune diseases. Acute interstitial nephropathies were controlled with corticosteroids, cyclosporin A, or tofacitinib. Thus, we showed that small-sized T-cell clones (i.e., without lymphocytosis) undetectable without specific screening are associated with various immune kidney disorders, including a previously unrecognized phenotype characterized by severe inflammatory kidney fibrosis and lymphocytic JAK/STAT activation.

English

BACKGROUND Sickle delta beta thalassemia is a rare genetic disorder, with varied symptoms, signs, requiring careful monitoring for potential complications. It is due to sickle mutation and thalassemia mutation occurring together, with sparse data available worldwide. The purpose of this study was to assess the clinical and laboratory profile of possible sickle delta beta thalassemia. METHODS The study design is retrospective analysis of clinical information of those selected patients done in our multi-specialty tertiary care referral hospital situated in Telangana state in south India. The case material was collected from December 2017 to December 2019 (2 years duration). All haemoglobin electrophoresis reports were collected with no prior blood transfusions in preceding 4 months. The information collected was analysed and presented. RESULTS Total 9 patients were diagnosed as possible sickle delta beta thalassemia, with male to female ratio of 5 : 4 and age ranging from 12 years to 45 years of age. The commonest symptoms were joint pain and jaundice in 5 patients and sign was splenomegaly in 2 patients. Ultrasonogram of abdomen showed that 3 patients had gall stones, 1 patient had gall bladder sludge, 1 patient had autosplenectomy and 3 patients had splenomegaly. Mild to moderate anaemia was seen with reticulocytosis, sickling test positive in all patients, with haemoglobin in the range of 5.5 g/dl to 12.7 g/dl. 3 patients had iron over load, 2 patients had hepatopathy, 5 patients had unconjugated hyperbilirubinemia, Acute chest syndrome, hepatic necrosis, and nephropathy was seen in 1 patient each. Haemoglobin electrophoresis showed Hb S was from 46.1 % to 76.4, Hb A from 5.3 % to 34.7 %, Hb F from 4.8 % to 22.7 %, Hb A2 from 1.5 % to 3.3 %. 2 patients were treated with hydroxyurea. 2 patients had mutation analysis elsewhere that was reported as compound heterozygous for β-globulin gene for Hb S (GAG-GTG) and IVS 1 - 5 (G-C). CONCLUSIONS Sickle delta beta thalassemia presents as mild to moderate anaemia haemolysis, splenomegaly with vaso-occlusive crises. Hydroxyurea may help in the treatment. Genetic analysis helps in diagnosis and future therapies. KEYWORDS Haemoglobin S, Haemoglobin A2, Haemoglobin A, Haemoglobin F

"Acute Hyperuricemia Secondary to Epileptic Seizures Leading to Acute Urate Nephropathy: A Case report"

"Acute Hyperuricemia Secondary to Epileptic Seizures Leading to Acute Urate Nephropathy: A Case report"

Lipophilicity Determines Routes of Uptake and Clearance, and Toxicity of an Alpha-Particle-Emitting Peptide Receptor Radiotherapy.

Lipophilicity is explored in the biodistribution (BD), pharmacokinetics (PK), radiation dosimetry (RD), and toxicity of an internally administered targeted alpha-particle therapy (TAT) under development for the treatment of metastatic melanoma. The TAT conjugate is comprised of the chelator DOTA (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate), conjugated to melanocortin receptor 1 specific peptidic ligand (MC1RL) using a linker moiety and chelation of the 225Ac radiometal. A set of conjugates were prepared with a range of lipophilicities (log D 7.4 values) by varying the chemical properties of the linker. Reported are the observations that higher log D 7.4 values are associated with decreased kidney uptake, decreased absorbed radiation dose, and decreased kidney toxicity of the TAT, and the inverse is observed for lower log D 7.4 values. Animals administered TATs with lower lipophilicities exhibited acute nephropathy and death, whereas animals administered the highest activity TATs with higher lipophilicities lived for the duration of the 7 month study and exhibited chronic progressive nephropathy. Changes in TAT lipophilicity were not associated with changes in liver uptake, dose, or toxicity. Significant observations include that lipophilicity correlates with kidney BD, the kidney-to-liver BD ratio, and weight loss and that blood urea nitrogen (BUN) levels correlated with kidney uptake. Furthermore, BUN was identified as having higher sensitivity and specificity of detection of kidney pathology, and the liver enzyme alkaline phosphatase (ALKP) had high sensitivity and specificity for detection of liver damage associated with the TAT. These findings suggest that tuning radiopharmaceutical lipophilicity can effectively modulate the level of kidney uptake to reduce morbidity and improve both safety and efficacy.

Two cases of acute urate nephropathy in women with asymptomatic hyperuricemia

The article presents a description of two own observations of the development of acute urate nephropathy in women with asymptomatic hyperuricemia. Clinical data and the results of additional laboratory and instrumental studies are presented; in one of the observations, the morphological picture of intravital biopsy material against the background of prolonged use of diuretics is described. The second case characterizes tophus kidney damage (according to the pathological examination data) without characteristic clinical manifestations of gout in vivo. The authors draw attention to the need to study serum uric acid levels in all cases of acute kidney injury.

Regulated cell death in cisplatin-induced AKI: relevance of myo-inositol metabolism.

Regulated cell death (RCD), distinct from accidental cell death, refers to a process of well-controlled programmed cell death with well-defined pathological mechanisms. In the past few decades, various terms for RCDs were coined, and some of them have been implicated in the pathogenesis of various types of acute kidney injury (AKI). Cisplatin is widely used as a chemotherapeutic drug for a broad spectrum of cancers, but its usage was hampered because of being highly nephrotoxic. Cisplatin-induced AKI is commonly seen clinically, and it also serves as a well-established prototypic model for laboratory investigations relevant to acute nephropathy affecting especially the tubular compartment. Literature reports over a period of three decades have indicated that there are multiple types of RCDs, including apoptosis, necroptosis, pyroptosis, ferroptosis, and mitochondrial permeability transition-mediated necrosis, and some of them are pertinent to the pathogenesis of cisplatin-induced AKI. Interestingly, myo-inositol metabolism, a vital biological process that is largely restricted to the kidney, seems to be relevant to the pathogenesis of certain forms of RCDs. A comprehensive understanding of RCDs in cisplatin-induced AKI and their relevance to myo-inositol homeostasis may yield novel therapeutic targets for the amelioration of cisplatin-related nephropathy.

Therapeutic Plasma Exchange in Postpartum Hemolytic Uremic Syndrome: A Case Report

BACKGROUND AND AIM: Adult, non-infective, haemolytic-uremic syndrome (HUS) although a rare disease in itself, has a high likelihood of occurrence in pregnancy and immediate post partum period. It is an important differential diagnosis in the evaluation of thrombotic microangiopathies. Patients with post-partum HUS display a classical triad of microangiopathic haemolytic anaemia, acute nephropathy and thrombocytopenia. I hereby present a case of post partum HUS treated with therapeutic plasma exchange (TPE) MATERIAL AND METHODS: A total of six sessions of TPE were performed daily, three sessions for consecutive days and remaining three sessions were performed on alternate days. All the procedures were carried out with Haemonetics MCS+ exchanging one plasma volume using fresh frozen plasma and saline as replacement fluid. Haemodialysis was started and four sessions were carried out on alternate days. RESULT: A 37 year old, 85 kg female, G2 P1, underwent emergency LSCS because of foetal distress at 38 weeks of pregnancy. Post surgery she developed decreasing urine output, anuria ensued. Emergency therapeutic plasma exchange was carried out within 24 hours of diagnosis. It could be found that with TPE, patient had improvement in renal function, decrease in LDH levels and increase in platelet count. Patient had sustained remission and discontinuation of haemodialysis. CONCLUSION: HUS is a disorder with high mortality and long term morbidity, if prompt treatment is not instituted. The decision to intervene with plasma exchange should be based upon the severity of thrombocytopenia, microangiopathic haemolytic anaemia and neurological abnormalities, even if the diagnosis and nomenclature is uncertain. Improved survival after this disorder has been attributed to aggressive treatment with plasma exchange therapy.

Kontrastmittelinduzierte akute Nierenschädigung – Konsensuspapier der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. und der Deutschen Gesellschaft für Nephrologie e. V.

This consensus paper summarizes the expert consensus and recommendations of the working group "Heart and Kidney" of the German Cardiac Society (DGK) and the German Society of Nephrology (DGfN) on contrast medium-induced acute kidney injury. Potentially nephrotoxic contrast agents containing iodine are frequently used in interventional medicine and for computer tomography diagnostics. Acute kidney injury occurs in approximately 8-17% of patients exposed to contrast media. The risk factors and underlying pathophysiology are discussed and recommendations for the prophylaxis and treatment of contrast medium-induced acute nephropathy are presented.

Correlation of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) with Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Interventions.

IntroductionContrast-induced acute nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) in the setting of acute coronary syndromes (ACS) is associated with adverse outcomes, including longer hospitalization and short and long-term mortality. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are inflammatory markers that have been validated separately in prior studies as a predictor of CIN in patients with ACS who undergo a left heart catheterization. Our study aims to further investigate the role of NLR and PLR together as markers for predicting CIN in patients with ACS. MethodsA retrospective chart review was performed on a total of 1,577 patients aged 18 - 90 who presented with ACS and underwent PCI between January 2011 to December 2015 at the Florida Hospital Orlando. Cut-off values used for a high PLR and NLR were PLR > 128 and NLR > 2.6. CIN was defined as an increased serum creatinine level by ≥ 0.5 mg/dL, or ≥ 25%, over the baseline value within 72 hours after contrast agent administration. Patients with end-stage renal disease (ESRD) were excluded. ResultsOf the 1,577 patients included in the study, 213 (13.51%) patients had CIN. On multivariate logistic regression analysis, high NLR showed an independent association with an elevated risk of CIN (OR 2.03, 95% CI: 1.403 - 3.176, P < 0.001). High PLR did not correlate with CIN (OR 0.831, 95% CI: 0.569 - 1.214, P = 0.339). ConclusionElevated NLR is an independent predictor of CIN in patients with acute myocardial infarction (AMI) and may be used to improve on current risk prediction models.

Prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention.

Intravascular administration of contrast media is an irreplaceable step of percutaneous coronary intervention. Since the latter is a very common procedure, contrast‑induced acute kidney injury (CI‑AKI) has become one of the most frequent causes of acute nephropathy, and a relevant prognostic impact of CI‑AKI has been observed. Some patient comorbidities and procedural characteristics have been identified as key risk factors of CI‑AKI. In this review, we discuss current evidence and future research directions on CI‑AKI prevention in patients undergoing percutaneous coronary intervention.

Potential synergistic antioxidant effect of thymoquinone and vitamin E on cisplatin-induced acute nephropathy in rats

Summary Background Nephrotoxicity occurs as a side effect of treating solid tumor with a single dose of cisplatin as anticancer drug because of the increase in oxidative stress. In this study, the free radicals scavenging capacity of thymoquinone (TQ) and vitamin E were tested to decrease the oxidative stress resulted from cisplatin treatment in male rats. Material and methods Sixty male rats were divided into 6 groups. The 1st group was the negative control (G1) intraperitoneally injected only once with saline and 40 rats were injected intraperitoneally with a single dose of 20 mg/kg body weight (b.w.) of cisplatin and divided into four groups. The 2nd group (G2) was cisplatin positive control group, the 3rd group (G3), the 4th group (G4), and the 5th group (G5) were treated daily with 50 mg/kg b. w. of TQ, 1000 mg/kg b. w. vitamin E and TQ (50 mg/kg b. w.) + vitamin E (1000 mg/kg b. w.) daily, respectively. The 6th group (G6) was intraperitoneally injected once with saline then treated with same doses of TQ and vitamin E. The experiment was conducted for 30 days. Results Cisplatin treated group (G2) showed altered biochemical parameters and severe damage in kidney tissues. Catalase, glutathione peroxidase, SOD and reduced glutathione levels were decreased, whereas lipid peroxidation was increased in the kidney tissue homogenate. Kidney and liver functions were altered as compared to the control group. Treating with TQ or vitamin E and their combination in G3, G4, and G5, respectively alleviated the effect of cisplatin injection and reduced the oxidative stress. Conclusions TQ and Vit E could be good protective supplements may be given to cancer patients that might exposed to nephropathy during their treatment with cisplatin.

P1022HEMATURIA AND ABSENCE OF RETINOPATHY ARE NOT INDICATIVE OF NON -TYPE 2 DIABETES ASSOCIATED RENAL DISEASE IN PATIENTS WITH OTHERWISE TYPICAL DIABETIC KIDNEY DISEASE

Abstract Background and Aims Diabetic Nephropathy (DN) is usually a presumptive diagnosis based on clinical and biological evidences. However, Renal Biopsies (RB) may be performed when the suspicion of Non-Diabetic Renal Disease (NDRD) with potential specific treatment arises from atypical features mainly identified through studies focusing on the power of individual clinical and biological features to predict NDRD. We aimed to assess the actual value of RB indications (RBi) to discriminate NDRD from Type 2 Diabetes (T2D) Associated Renal Disease (T2D-ARD) such as DN and Hypertensive nephropathy which are frequently associated, seen in similar patients with high cardiovascular risk, lack for specific treatment and might be therefore be considered as “failure events” in the context of RB performed to diagnose NDRD with specific treatment. Method We conducted a retrospective multicenter study in four nephrology units and reviewed the charts of patients with T2D who underwent a first RB from 2006 to 2015. Clinical and biological characteristics, RBi and diagnoses were retrospectively collected from the patients’ medical charts. RBi were defined according to the sequence in Figure 1. As such, diabetic retinopathy may be absent in patients of all indication groups, conversely, patients in group 6 and 7 had stable proteinuria and renal function. Similarly, patients with monoclonal gammopathy were all included in group 1.We considered missing data regarding the absence/presence of Diabetic Retinopathy (DR) as meaningful, suggesting the data was unneeded to reach a decision of RBi. We performed univariate and multivariate logistic regression analyses to identify clinical or biological features associated with the diagnosis of NDRD. We also compared the number and percentage of actual NDRD diagnosed for each of the RBi. Results 464 first renal biopsies were performed in 464 patients during the study period. Two RB were excluded because the RBi could not be clearly identified through careful reviewing of the patients’ medical charts. Of the 462 remaining RB, 40% revealed NDRD. The most frequent were acute interstitial nephritis, IgA nephropathy and acute tubular necrosis (8.7%, 5.8% and 4.1% respectively). Patients with NDRD were more frequently &amp;gt;65yo (55 vs 44%), with serum creatinine (SCr) &amp;gt;250 µmol/l (52 vs 30%), hematuria (58 vs 36%), non-retrieved DR status (45 vs 17%), and less frequently with urinary-to-protein ratio (UPCR) &amp;gt;3g/g (33 vs 57%), HbA1c &amp;gt;7% (32 vs 50%) and duration of diabetes &amp;gt;5 years (52 vs 72%).Logistic regression analyses identified high SCr, UPCR, hematuria and low diabetes duration as predictive of NDRD. Surprisingly, missing RD status rather than absence of RD was predictive of NDRD. As expected NDRDs were frequent in patient with RBi 1 to 3 (53%, 40% and 21%), infrequent in patients with RBi 5 (7%) and totally absent from patients with RBi 6 and 7 despite their predictive value as regards with NDRD. Conclusion Our study confirms several well-known facts on the subject of renal biopsy in patients with T2D: 1) Renal biopsy is useful in selected patients with T2D and renal disease to diagnose NDRD with specific treatment. 2) Hematuria and short duration of diabetes are predictive of NDRD. On the other hand, our study suggests two novel and antidogmatic findings: 1) Assessing the presence of diabetic retinopathy is not required for RBi. 2) Hematuria is not indicative of NDRD in patients with otherwise typical diabetic kidney disease. Of course, our study is limited by its retrospective design precluding us of precisely defining what was considered rapid evolution of DFG or proteinuria emphasizing the need for prospective studies.

P0609THE INCIDENCE AND RISK OF CONTRAST INDUCED ACUTE KIDNEY INJURY IN THE ELDERLY UNDERGOING PULMONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY

Abstract Background and Aims Contrast-induced acute kidney injury nephropathy (CI-AKI) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. Advanced age has been reported as risk factor for CI-AKI. However, limited studies available to determine the exact incidence of CI-AKI in elderly patient. The aim of this study was to investigate the incidence of, risk factors for developing CI-AKI in patient above 65 years old who underwent Pulmonary Computed Tomography Angiography (PCTA). Method This single center retrospective study, performed in a large, tertiary care hospital in Riyadh, Saudi Arabia. It is a sub-study of (3 P-CIAKI) The Practice Pattern of Preventive Measures for Contrast Induced Acute Kidney Injury in Patients Undergoing Pulmonary Computed Tomography Angiography. Patients &amp;gt; 65 years of age, who underwent PCTA during a 5-year period (2014 to 2018) were included. Patients receiving long-term hemodialysis or peritoneal dialysis, and those without repeated serum creatinine 48-72 hours post procedure were excluded from the analysis. CI-AKI defined as raise of serum creatinine by 44 mmol/l 48-72 hours post PCTA. Results 272 out of 908 patients, with a mean age of 74.93 ± 7.09 years, 58.1% having diabetes mellitus (DM) and estimated GFR of 74.92 ± 23.57 ml/min per 1.73 m2 were enrolled. 201 patients (73.9%) had eGFR &amp;gt; 60 ml/min. Diuretics was used by 37.1% of the patients, while 33.1 % of the patients on ACEI / ARBs. Prophylactic measures used in 35.7 % of the procedures. CI-AKI occurred in 19 cases (7.0 %) as compared with 4.7 % in the original 3 P-CIAKI study with mean age of 52 years and eGFR 97 ml/min. Renal replacement therapy required in 3 patients who had CI-AKI. DM status was only significant predictor for the development of CI-AKI. Conclusion Elderly patients are at greater risk for the development of CI-AKI even with eGFR above 60 ml/min specially in DM patient .The Incidence of CI-AKI in patients &amp;gt; 65 years of age is up to 7 %, that is less than the reported in the literature and this can be explained by higher base line eGFR in our study .

P0465NEPHROTIC SYNDROME IN ELDERLY PATIENTS

Abstract Background and Aims Nephrotic syndrome (NS) is one of the manifestations of acute or chronic glomerular nephropathy in the elderly. Our study objective was to determine the particularities of NS in the elderly. Method This is a retrospective study, carried out in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. This study included subjects aged 65 years old or over hospitalized for NS. Results We studied 115 patients with an average age of 71 ± 5 years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/l [3-19.5 g/l], the mean albumin level was 20 ± 6g/l and the mean protidemia was 50.6 ± 6.9 g/l. Nephrotic syndrome was impure in 89.5 % of patients with high blood pressure in 54 % of cases, hematuria ≥2 + in 30% of cases and renal failure in 82.7 % of cases. Renal biopsy was performed in 45 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (24.5 %). NS was secondary in 65.2 % of cases mainly to amyloidosis (35.6 %) and diabetes (19 %). Idiopathic nephropaty was dominated by membranous nephropathy (9.5 %) and primitive primitive (MPGN) (4.3 %). The treatment was symptomatic for 84.4% of patients. Corticosteroids and/or immunosuppressive treatment have been used for 15.6% of patients. At the end of follow-up, 35.3 % of patients achieved complete or partial remission and 56.6 % progressed to ESRD. Conclusion Elderly NS was characterized by a poor prognosis due to delayed cosultation and non-uniform treatment strategies. Multicentric study in order to identify different action axes could improve the prognosis of this disease. Multicentric study in order to identify different action axes could improve the prognosis of this disease.

ACTIVITY OF ANTIOXIDANT PROTECTION ENZYMES IN BLOOD AS A MARKER OF NEPHROPROTECTIVE EFFECT BY SODIUM POLY-(2,5-DIHYDROXYPHENYLEN)-4-THIOSULFATE ACID

The article presents the results of assessing the activity of catalase and superoxide dismutase enzymes in the blood as markers of the nephroprotective effect by sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid under conditions of ethylene glycol and glycerol acute kidney injury and gentamicin-induced nephropathy. The studies were conducted on 96 white mature, full-grown non-linear rats of both sexes weighting 180-200 grams. Models of acute kidney pathology in the rats were reproduced in accordance with the methodological recommendations of the Ministry of Health of Ukraine. Blood activity of superoxide dismutase and catalase was determined spectrophotometrically with standard methods. It has been established that oxidative stress plays a significant role in the pathogenesis of ethylene glycol and glycerol acute kidney damage and gentamicin nephropathy, as evidenced by significant changes in the antioxidant defence system, and namely by inhibition of the activity of superoxide dismutase and catalase enzymes. Under the conditions of acute kidney injury and nephropathy, the sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid contributed to the activation of superoxide dismutase and catalase better than reference medicines as plan-based chophytol, and mexidol as antihypoxant and thiotriazoline as antioxydant. Thus, the antioxidant enzymes as superoxide dismutase and catalase can serve as markers of the nephroprotective effect produced by the preparation of sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid. And therefore, we suggest sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid exhibiting antihypoxic, cytoprotective, antioxidant properties is a promising drug for the treatment of acute kidney diseases.