Chronic Tubulointerstitial Nephritis Research Articles

#2849 A change in the paradigm of onconephrology

Abstract Background and Aims Recently, with the emergence of checkpoint inhibitors and other new oncological therapies, the cancer paradigm has changed. These new treatment possibilities have led to an improvement in the life expectancy of patients with cancer. However, these new oncological treatments are often linked to adverse renal events that require a specifical nephrological evaluation at the onconephrology units. These renal adverse events may increase the morbidity and mortality of cancer patients. Therefore, the aim of this study was to analyze the changes in renal involvement of patients with solid organ malignancy who underwent kidney biopsy after the onset of new oncological therapies. Method A retrospective observational study was performed analyzing kidney biopsies conducted in a 9.2-year period. This study included patients with history of solid organ malignancy before and one year after kidney biopsy. All the results are represented as mean ± standard deviation for variables with a normal distribution, or in percentage (%). Normality was assessed by the Shapiro-Wilk test. Group comparisons were conducted using Student´s t test for normally distributed quantitative variables and chi-square for qualitative variables. The statistical software utilized was SPSS version 27. Results Six patients who underwent a kidney biopsy before 2019 (Group A) were compared to 22 patients who underwent a kidney biopsy in 2019 and after (Group B). In Group A, the mean age was 68.5 ± 7.1 years old, while in Group B, it was 70.7 ± 7.1. In Group A, there was a predominance of females (66.7%), whereas in Group B, there was a higher proportion of males (81.8%). In Group A, higher intake of statins and acetylsalicylic acid were observed compared to Group B (83.3% vs. 31.8%, p = 0.024; 33.3% vs. 4.5%, p = 0.043). At the time of kidney biopsy, concerning the history of solid organ malignancy, 66.7% patients in Group A were disease-free, while in Group B they were predominantly stable (50%) (p < 0.001). In Group A, all nephropathies were caused by factors unrelated to oncological disease, while in Group B 63.6% nephropathies were secondary to oncospecific treatment (p = 0.003). In Group A, longer time from oncological diagnosis to death was observed compared to Group B (3033 ± 1889.09 days vs. 692 ± 719.47 days, p = 0.012). Regarding renal function at the time of kidney biopsy, we observed predominantly normal or stable renal function in Group A (66.7%), while Group B showed a higher frequency of renal dysfunction (77.3%) (p = 0.041); resulting in creatinine levels of 1.82 ± 0.68 mg/dl in Group A and 3.95 ± 2.48 mg/dl in Group B (p = 0.049). Finally, kidney biopsies in Group A showed acute tubular necrosis and acute or chronic tubulointerstitial nephritis in 16.7%, while in Group B these diagnoses were found in 81.8% of kidney biopsies (p = 0.002). Conclusion After the onset of new oncospecific therapies, the paradigm of kidney disease in cancer patients in terms of diagnosis and treatment has changed. Kidney biopsy may be a useful diagnostic and prognostic tool. But also, a specialized onconephrologist may have a key role to discern the different etiologies of kidney damage and provide the best management to these patients. This new trend may lead to a growth and an empowerment of onconephrology subspecialty.

#1438 Review of the use of peritoneal catheter sealing in peritonitis

Abstract Background and Aims Relapsing peritonitis is a new episode of peritonitis caused by the same microorganism occurring less than 4 weeks after the end of treatment of the previous one. It is associated with the formation of biofilm formation in the lumen of the peritoneal catheter and may lead to its removal. It is associated with increased technique failure, morbidity and mortality and health care costs. The aim of this study is to demonstrate the efficacy of peritoneal catheter sealing with taurolidine-heparin (T-H) in the prevention of relapsing peritonitis and thus avoid more aggressive measures in these cases, such as catheter removal. Method We performed a single-center retrospective analysis study. We analyzed episodes of peritonitis in our peritoneal dialysis (PD) unit over a 5-year period from January 1st 2019 to December 31st 2023. We collected demographic data and risk factors during this period: age, sex, CKD etiology, diabetes, modality, assisted PD, and S. aureus nasal carrier status. We documented peritonitis during the period, causative germs, treatment performed, and catheter sealing. We documented sealing patterns and evolution (cure, recurrence, catheter removal). We performed T-H sealing with a full abdomen and once the treatment had been completed. The catheter sealing with antibiotics was performed right after the intraperitoneal antibiotics’ doses during the treatment. Results We analyzed a total of 84 patients. Demographic characteristics were: mean age 66.5 years (range 24-88 years), 71.4% male, 28.6% diabetic, 45.2% on APD, 11.9% assisted PD, 5.9% nasal S. aureus carriers. Etiology of CKD: 66.7% unaffiliated etiology, 11.9% glomerulonephritis, 7.1% ADPKD, 5.9% chronic tubulo-interstitial nephritis and 1.2% vasculitis, multiple myeloma, anephritis, acute tubular necrosis, lupus, Alport syndrome and nephronophthisis. There were 71 episodes of peritonitis, in 32 patients. The causative germs were: 36.6% coagulase negative staphylococci, 21.1% streptococci, 19.7% negative culture, 7% enterobacteria, 7% polymicrobial, 4.2% S. aureus, 2.8% enterococci and 1.4% corynebacteria. We performed some type of sealing in 47 peritonitis cases: 34% with antibiotic alone, 21.3% with antibiotic plus T-H and 44.6% with T-H alone. A total of 55.3% of the sealings were performed in peritonitis caused by coagulase-negative staphylococci, 65.4% of which were sealed with T-H or antibiotic plus T-H (Table 1). Two of the peritonitis relapsed with conventional treatment (unsealed or sealed with antibiotic) and, after sealing the peritoneal catheter with T-H, no recurrence was observed. The catheter was removed from a patient with peritonitis plus S. aureus tunnelitis, a new catheter was placed deferred, but he had a new episode of peritonitis with S. aureus tunnelitis and the catheter was removed again; this patient's case is special as he has not maintained adequate hygiene measures in addition to lack of adherence to therapy. Conclusion Peritoneal catheter sealing, especially with T-H, appears to be effective in the treatment and prevention of relapsing peritonitis. In our case, we did not observe any recurrent peritonitis after its use. Despite its widespread use, there are hardly any studies on its use and the most recommendable guidelines for its use, which is why we believe that further studies should be conducted to establish guidelines and methods for its use.

Causal association of plasma circulating metabolites with nephritis: a Mendelian randomization study.

Nephritis is a pivotal catalyst in chronic kidney disease (CKD) progression. Although epidemiological studies have explored the impact of plasma circulating metabolites and drugs on nephritis, few have harnessed genetic methodologies to establish causal relationships. Through Mendelian randomization (MR) in two substantial cohorts, spanning large sample sizes, we evaluated over 100 plasma circulating metabolites and 263 drugs to discern their causal effects on nephritis risk. The primary analytical tool was the inverse variance weighted (IVW) analysis. Our bioinformatic scrutiny of GSE115857 (IgA nephropathy, 86 samples) and GSE72326 (lupus nephritis, 238 samples) unveiled anomalies in lipid metabolism and immunological characteristics in nephritis. Thorough sensitivity analyses (MR-Egger, MR-PRESSO, leave-one-out analysis) were undertaken to verify the instrumental variables' (IVs) assumptions. Unique lipoprotein-related molecules established causal links with diverse nephritis subtypes. Notably, docosahexaenoic acid (DHA) emerged as a protective factor for acute tubulointerstitial nephritis (ATIN) (OR1 = 0.84, [95% CI 0.78-0.90], p1 = 0.013; OR2 = 0.89, [95% CI 0.82-0.97], p2 = 0.007). Conversely, multivitamin supplementation minus minerals notably increased the risk of ATIN (OR = 31.25, [95% CI 9.23-105.85], p = 0.004). Reduced α-linolenic acid (ALA) levels due to lipid-lowering drugs were linked to both ATIN (OR = 4.88, [95% CI 3.52-6.77], p < 0.001) and tubulointerstitial nephritis (TIN) (OR = 7.52, [95% CI 2.78-20.30], p = 0.042). While the non-renal drug indivina showed promise for TIN treatment, the use of digoxin, hydroxocobalamin, and liothyronine elevated the risk of chronic tubulointerstitial nephritis (CTIN). Transcriptome analysis affirmed that anomalous lipid metabolism and immune infiltration are characteristic of IgA nephropathy and lupus nephritis. The robustness of these causal links was reinforced by sensitivity analyses and leave-one-out tests, indicating no signs of pleiotropy. Dyslipidemia significantly contributes to nephritis development. Strategies aimed at reducing plasma low-density lipoprotein levels or ALA supplementation may enhance the efficacy of existing lipid-lowering drug regimens for nephritis treatment. Renal functional status should also be judiciously considered with regard to the use of nonrenal medications.

Massive Myocardial Calcification: A Rare Autopsy Finding

Introduction: Myocardial calcification is rare and occur by two mechanisms- dystrophic and metastatic. It can present with variable clinical manifestations like congestive heart failure, cardiomyopathy, arrhythmia and sudden cardiac death. Case Report: Post mortem viscera of a 50 year old male was received in the department of pathology with alleged history of burns, who died after two weeks of hospital treatment. There was no past history or investigation available in the post mortem papers. Whole heart, pieces of brain, both lungs, liver, spleen and both kidneys were received. On gross examination no abnormality was observed in any of these viscera. Microscopic examination revealed extensive calcification in anterior, lateral &amp; posterior walls of left ventricle of the heart. Sections from kidney showed features of chronic tubulointerstitial nephritis. Conclusion: Myocardial calcification is rare and mostly diagnosed incidentally or on autopsy. Extensive sampling of heart and other viscera might help in finding the etiology in such rare cases of massive calcification in myocardium . Antemortem diagnosis can be made with computed tomography (CT) scan and endomyocardial biopsy.

Renal Injury During Viral Infections

Renal pathologies following viral infections have become an emerging public health problem in both developed and developing countries. Diagnostic criteria are complex. In most cases, they involve correlation between clinical, biological and histological data, with occasional recourse to molecular biology techniques. Several mechanisms are involved in the pathogenesis of virus-related nephropathy, including virus tropism in the kidney, formation of immune complexes in situ or in the bloodstream, direct cytopathogenic effects, and multiple organ failure. The hepatitis C virus is responsible for three main types of kidney disease: membranoproliferative glomerulnephritis, cryoglobulinemia and membranous nephropathy. Hepatitis B virus is associated with membranous nephropathy, membranoproliferative glomerulnethritis, and IgA nephropathy. HIV (human immunodeficiency virus) infection is associated with several glomerular and tubular kidney damage. HIVAN (HIV-associated nephropathy), a specific entity mainly affecting Africans and African-Americans, presents as a rapidly progressive glomerulonephritis rapidly progressing to the terminal stage. Infections secondary to adenovirus, cytomegalovirus, epstein-barr virus, poliomavirus and coronavirus are often responsible for acute or chronic tubulointerstitial nephritis. Treatment is mainly symptomatic, based on nephroprotection measures, rarely combined with antiviral therapy. Prophylaxis with vacci-nation, when available, remains the best means of preventing viral nephropathy.

Causal relationship between gut microbiota and kidney diseases: a two-sample Mendelian randomization study.

The interplay between gut microbiome genera and inflammatory kidney-related diseases, such as nephrotic syndrome, glomerulonephritis, tubulo-interstitial nephritis, and chronic kidney disease, has been observed. However, the causal relationships between specific bacterial genera and these renal diseases have not been fully elucidated. To investigate the potential causal links between different genera of the gut microbiome and the susceptibility to various renal conditions utilizing two-sample Mendelian randomization (MR) analyses. Genome-wide association study (GWAS) summary statistics of gut microbiota and inflammatory kidney-related diseases were obtained from published GWASs. Two-sample MR analyses were conducted using methods including inverse-variance weighted (IVW), MR Egger, and others to identify potential causal links between gut microbial genera and renal conditions. Sensitivity analyses, including Cochran's Q test and the MR-PRESSO global test, were performed to validate the robustness of the results and detect horizontal pleiotropy. In addition, a reverse MR analysis was conducted to assess reverse causation possibilities. By synthesizing insights from both primary and sensitivity analyses, this study unveiled critical associations of 12 bacterial genera with nephrotic syndrome, 7 bacterial genera with membranous nephropathy, 3 bacterial genera with glomerulonephritis, 4 bacterial genera with acute tubulo-interstitial nephritis, 6 bacterial genera with chronic tubulo-interstitial nephritis, and 7 bacterial genera with chronic kidney disease. Various genera were pinpointed as having either positive or negative causal relationships with these renal conditions, as evidenced by specific ranges of IVW-OR values (all P< 0.05). The congruence of the sensitivity analyses bolstered the primary findings, displaying no marked heterogeneity or horizontal pleiotropy. Notably, the reverse MR analysis with nephritis as the exposure did not reveal any causal relationships, thereby strengthening the resilience and validity of the primary associations. This study explored the causal associations between several gut microbial genera and the risk of several inflammatory kidney-related diseases, uncovering several associations between specific gut microbial genera and nephrotic syndrome, membranous nephropathy, glomerulonephritis, tubulo-interstitial nephritis, and chronic kidney disease. These findings enhance our understanding of the complex interplay between the gut microbiome and kidney diseases, and they will be beneficial for early diagnosis and subsequent treatment.

Parathyroid carcinoma case-report in a patient with multinodular goiter and chronic kidney disease: difficulties in diagnosis and treatment (observation from practice)

We would like to present a clinical case of severe primary hyperparathyroidism due to a parathyroid carcinoma of atypical location in a patient with chronic kidney disease of complex etiology and multinodular goiter. Patient S., 59 years old, was followed-up for a long time in tertiary referral hospitals for “chronic tubulointerstitial nephritis with nephrosclerosis”, secondary hyperparathyroidism due to chronic kidney disease (CKD) G3–4, osteoporosis, and a multinodular euthyroid colloid goiter. In July 2021 she was referred to the Endocrinology Research Centre in order to clarify the diagnosis because of the persistence of an extremely high level of parathyroid hormone (PTH) despite cinacalcet treatment. During examination, primary hyperparathyroidism, a left parathyroid gland lesion, multinodular goiter with subclinical thyrotoxicosis, and vitamin D deficiency were diagnosed. After the removal of the left parathyroid gland lesion (histologically confirmed parathyroid carcinoma) and a left-sided hemithyroidectomy, hypocalcemia («hungry bone syndrome») developed, but the level of parathyroid hormone remained elevated. After 3–18 months after surgery, no data for relapse of primary hyperparathyroidism was obtained. The persistent moderate increase in PTH was regarded as secondary hyperparathyroidism in CKD and hypocalcemia. Complex therapy of osteoporosis with the antiresorptive drug denosumab, vitamin D and its active metabolite, calcium preparations, and parathyroidectomy led to a significant increase in bone mineral density (BMD) and no repeated fractures 18 months after surgery.Conclusion. In patients with pre-dialysis CKD and high PTH levels, it is necessary to make a differential diagnosis between primary (PHPT) and secondary hyperparathyroidism (SHPT). Severe manifestations of primary hyperparathyroidism can be suspicious for parathyroid carcinoma.

Abstract 26 — Clinical Characteristics of Familial Mediterranean: Fever in Hemodialysis Patients

Introduction Familial Mediterranean fever (FMF) is an inherited genetic disorder characterized by recurrent episodes of fever, serositis, arthritis, and skin rash. Uncontrolled disease can lead to amyloid A disposition, nephrotic syndrome and progressive renal failure. Recurrence of AA amyloidosis post kidney transplantation has been reported. Long-term colchicine therapy will reduce the FMF attacks and risk of AA amyloidosis. Although there is high prevalence of FMF in MENA region, the data of end stage renal disease (ESRD) in FMF is limited. We report our center experience. Method A retrospective chart review study was conducted at Tawam Hospital over 12 years (January 2010 to January 2023). We included adult ESRD on hemodialysis with FMF disease and studied their management outcomes. Descriptive analysis was used. Results 1900 ESRD patients were on hemodialysis during study period, and only two patients were diagnosed with FMF and renal amyloidosis. Case 1: A 60-year-old male patient from Syria who is known to have FMF and polycystic kidney disease leading to ESRD. He underwent successful LRD kidney transplantation in 2009. He was on mycophenolic acid: 540 mg, BID, prednisolone: 5 mg, tacrolimus: 1 mg am, 0.5 mg and colchicine 0.5 mg BID. He developed progressive renal allograft dysfunction with evidence of nephrotic syndrome. The renal biopsy revealed recurrence of AA amyloidosis due to FMF in kidney allograft in 2018. He had decline in renal function over years was initiated on hemodialysis on 2022. He developed two attacks of FMF peritonitis while on hemodialysis that responded well to steroid/colchicine therapy. Case 2: 48 years old male, from Egypt, known to have irritable bowel syndrome. He presented to our hospital with bilateral lower limb edema, and progressive shortness of breath for one month. Investigations revealed heavy proteinuria (8.98 g/g Creat) and acute kidney injury. Serology and autoimmune workup were negative. Kidney biopsy showed renal amyloidosis, and chronic tubulointerstitial nephritis with severe interstitial fibrosis (60%). History taken again and was positive for FMF in his uncle. Genetic study and clinical confirmed the diagnosis of FMF. He was started on colchicine, but developed ESRD within 8 months and initiated on hemodialysis. He had attacks of FMF. Conclusion Renal amyloidosis in FMF patient leads to progressive renal failure despite colchicine therapy. In our dialysis cohort over 12 years, only two FMF patients were identified. Colchicine therapy is required in ESRD-FMF in order to managed FMF attacks and prevent other organ AA amyloidosis.

Chronic kidney disease in a giant panda (Ailuropoda melanoleuca): a case report

BackgroundChronic kidney disease (CKD) is a common cause of morbidity and mortality in captive wildlife species. However, CKD has been rarely documented in giant pandas.Case presentationThe following report describes a case of an eight-year-old female giant panda showing clinical signs of epistaxis, bloody diarrhea, polyuria, azotemia and anemia. The animal died despite of supportive treatments. Necropsy was performed. Grossly, both kidneys were shrunken and scarred with pallor. Subcutis edema and petechia on the epicardium of the heart were observed. The tissue samples were made into paraffin sections and stained by H.E and special staining including Periodic Acid-Schiff (PAS), von Kossa, Masson’s trichrome, Phosphotungstic acid-hematoxylin (PTAH), and Congo red. Histopathology examination revealed severe chronic tubulointerstitial nephritis with marked interstitial fibrosis, glomerulosclerosis, tubular atrophy and calcification in kidneys, and acute necrotizing hemorrhagic myocarditis with calcification in heart. Other lesions included intestinal hemorrhage, hepatic fatty degeneration and necrosis with hemosiderin, and splenic hemosiderin.ConclusionsIn summary, chronic kidney disease was finally diagnosed based on the association of clinical, gross, and histopathological findings. Heart failure secondary to CKD is the leading cause of death in this giant panda. The potential cause of CKD in this animal is possibly due to long term and uncontrolled hypertension. Blood pressure monitoring is essential in establishing the diagnosis and management of hypertension in giant panda.

Cancer before and after the start of hemodialysis and association with mortality – an Eastern-European multicenter study

Introduction East-European data on cancer in patients undergoing hemodialysis (HD) are scarce. This study aimed to assess the pattern of cancer and related mortality in patients with end-stage kidney disease (ESKD) undergoing HD. Methods Retrospectively analyzing data from 7 HD centers, this study examined 1377 incident HD patients divided into three groups: no-cancers (NoC), cancers that occurred prior to HD initiation (CPI) and de novo cancer developed after HD initiation (DNC). Mortality risk and survival trends within groups were analyzed using Cox regression and Kaplan-Meier methods. Results In the cohort, 89.46% of the patients had no cancer (NoC group), 3.63% had cancer before (CPI group), and 6.89% had cancer after HD initiation (DNC group). The mean time from HD initiation to DNC diagnosis was 1 [2.75] years. Older age was associated with a higher risk of developing DNC (p < 0.001). Chronic tubulointerstitial nephritis (CTIN) is more prevalent in cancer patients. The most common cancer sites among DNC patients were the digestive (29.47%) and urinary tracts (18.95%), while those in CPI subjects were hematologic (22%) and digestive (20%). Cancer was an independent predictor of mortality risk (HR = 6.9, 95% [CI]:4.5–10.6, p < 0.001). Conclusions East-European ESKD patients undergoing HD have a high incidence of de novo cancers whose primary cancer sites are the digestive and urinary tracts. Almost half of the HD patients with CPI have hematologic and digestive tract cancers. Age and CTIN were associated with cancer risk. Cancer is an independent risk factor for all-cause mortality in patients undergoing hemodialysis (HD).

Chronic kidney disease of unknown aetiology: A comprehensive review of a global public health problem.

The term chronic kidney disease of unknown aetiology (CKDu) refers to chronic kidney disease (CKD) in the absence of diabetes, long-standing hypertension, glomerulonephritis, obstructive uropathy or other apparent causes. An increasing number of CKDu cases have been reported from Latin America, Sri Lanka, India and others over the last two decades. These regional nephropathies share the following common attributes: (a) they affect low-to-middle income countries with tropical climates, (b) involve predominantly rural agricultural communities, (c) male predilection, (d) absence of significant proteinuria and hypertension, and (e) chronic tubulointerstitial nephritis on kidney biopsy. The current body of literature suggests that CKDu may be caused by heat stress, agrochemicals, contaminated drinking water or heavy metals; however, considerable regional disparities in CKDu research make it difficult to establish a common causal link. In the absence of a definite aetiology, specific preventive and therapeutic interventions are lacking. Improvement of working conditions of farmers and labourers, provision of safe drinking water and changes in agricultural practices are some of the measures that have been implemented; however, there is lack of data to assess their impact on the incidence and progression of CKDu. There is a need for a concerted global effort to address the current knowledge gaps, and to develop effective and sustainable strategies to tackle this devastating disease.

#5974 CLINICAL AND HISTOPATHOLOGICAL CHARACTERISTICS OF THE ONCONEPHROLOGICAL POPULATION: A MULTICENTRE PROSPECTIVE OBSERVATIONAL STUDY

Abstract Background and Aims Onconephrology is a recently developed discipline aimed at diagnosing and managing renal disease in cancer patients. Few data are available regarding clinical and histological aspects concerning the whole population referred to an onconephrology clinic. Our study aimed to describe the clinical and histopathological characteristics of these patients and to evaluate indices of renal function recovery, renal damage progression, and mortality; a specific aim was to determine in our cohort the prevalence of acute kidney injury (AKI), chronic kidney disease (CKD) and acute kidney disease (AKD) which included all patients meeting KDIGO criteria for AKD but not for AKI. Secondary aims were the analysis of the immunotherapy subgroup and to determine the rate of immune-related adverse events (IRAEs). Method In this prospective observational study, we consecutively enrolled 84 patients for the clinical analysis and 10 patients in two centres for the histopathological study. Clinical assessment in the former group were performed at the first visit (T0), 1 month (T1), 3 months (T2) and 1 year (T3) and compared with a pre-determined baseline. Complete oncological and nephrological assessments were performed. For kidney biopsies, histopathological findings were expressed with quantitative and semi-quantitative parameters. Outcomes were: AKI or AKD complete or partial recovery of renal function (respectively defined as: return to baseline; sCr reduction ≥ 0.3 mg/dl or ≥ 25% or improvement to a lower stage of AKI); a composite of events (MAKE) based on CKD development or progression or death (only at T3). Results Our population was predominantly elderly, hypertensive, in metastatic phase (64.2%), M&amp;gt;F; other factors associated with increased cardiovascular risk were: previous AKI (18.8%), diagnosis of type 2 diabetes (25.9%), history of former/current smoker (55.4% and 19.6%), hyperuricemia (mean uric acid 7 mg/dl), previous/current cisplatin treatment (15.5% and 3.6%). The estimated prevalence in our cohort was: AKI 30.1%; CKD 27.7%; AKI on CKD 25.7%; AKD 9.6%. Regarding AKI, 68.4% were stage 1; for CKD, most patients were stage 3A and 3B (28.2% and 46.2%). More than 1/3 of the patients presented with suspended anticancer treatment; complete therapy resume rates were modest. Complete and partial AKI recovery rates at T2 were both ∼33%. Renal function was fully recovered in 50% of the AKD patients. During the follow-up, a new episode of AKI was observed in 15.5% of the patients, more frequently in the first 3 months. Patients receiving immunotherapy showed worse renal function (sCr 2.02 vs 1.51 mg/dl at T0, p&amp;lt;.001) and higher mortality (4 vs 0, p&amp;lt;.05); patients with IRAEs (25.8%) presented more frequently with discontinued therapy (Table 1). Of 36 patients with data available at 1 year, 21 (58.3%) presented the outcome MAKE; 11 patients died, 4 in the first three months. No nephrological conditions were found to predict MAKEs; presence of metastasis and female sex were the only predictors with Cox regression. Patients who underwent renal biopsy showed marked heterogeneity in the diagnoses (4 Membranous nephropathy, 1 drug-induced podocyte damage, 1 extracapillary GN after SARSCoV2 vaccination, 1 Light/Heavy Chain Deposition Disease, 1 Chronic Tubulointerstitial Nephritis, 1 sclerohyalinosis, 1 nonspecific); histopathological data was unremarkable. Conclusion AKI and CKD occur frequently in the onconephrological population. These patients are susceptible to new AKI episodes. The absence of AKI recovery and anticancer therapy withdrawal are common, potentially holding negative prognostic value. Particular attention should be paid to patients undergoing immunotherapy, especially when associated with IRAE. A larger number of patients is needed to estimate the impact of nephrological factors in the extended follow-up.

#2776 KIDNEY INVOLVEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract Background and Aims In rheumatoid arthritis (RA) kidney is commonly affected organ with clinical presentation characterized by proteinuria and microalbuminuria, followed by chronic renal failure. RA is associated with reduced kidney function, possibly due to chronic inflammation or the use of nephrotoxic therapies. Renal diseases occurring in patients with RA may have a variable clinicopathological picture. Little is known about the effects of using the novel biological agents on the risk of kidney diseases. The aim of this study was to determine the relationship between effect of therapy and kidney involvement in patients with RA and evaluated the histopathological findings and associated clinical manifestation. Method In this retrospective study 275 patients with diagnosis of RA were included. In 48 patients renal biopsy was performed. The patients were divided in three groups according to changes in management of RA: 1991-2001, 2002-2011 and 2012-2022 year. Data of demographic characteristics, clinical symptoms and pathological diagnosis were extracted from medical records and pathological reports. Results In our study amyloidosis was the most common histologic pattern, followed by chronic glomerulonephritis (GN) and tubulointerstitial nephritis. Renal amyloidosis was diagnosed in 13 patients, membranous GN – in 9, mesangioproliferative GN – in 7 patients, focal segmental necrotizing GN – in 5, focal segmental sclerosis – in 4, minimal change disease – in 3, tubulointerstitial nephritis – in 7 patients. Between 1991 and 2001 year the most common clinical manifestation was nephrotic syndrome and the most common histopathological findings – renal amyloidosis, followed by membranous GN and focal segmental necrotizing GN. The membranous GN was related to the use of gold and its frequency decreased after 2001. The mesangioproliferative GN was the leading cause of kidney disease between 2002–2011 years and focal segmental sclerosis – between 2012–2022. In our study 68 patients had a decrease of glomerular filtration rate (GFR) &amp;lt; 60 mL/min/m2. No kidney biopsies were performed in these cases because no urine abnormalities were detected. We found that age, duration of the disease, arterial hypertension, C-reactive protein were significant risk factors for GFR decline in patients with RA. Patients with RA who are treated with biologic agents are less likely to experience progressive decline in kidney function than those not receiving biologic treatment (hazard ratios {HRs] [95% CI], 0,84 [0,68-1,02]}. Conclusion In all patients with RA, renal function should be monitored and in the case of pathologic results, renal biopsy should be performed. In RA patients with renal disorder, suspected causal drug should be removed from the treatment and specific immunosuppressive therapy initiated. Improved pain management associated with biologic treatment may help to reduce the need for potentially nephrotoxic anti-inflammatory agents such as NSAIDs and certain types of non-biologic DMARDs, which could consequently reduce the risk of drug-induced nephrotoxicity and thereby contribute to the lower risk of renal diseases.

Tubulo-interstitial disorders

The diagnosis of tubulo-interstitial nephritis is increasing worldwide in parallel with access to healthcare, changing prescribing habits and socio-ecological changes. The histopathological differentiation of acute and chronic tubulo-interstitial nephritis is necessary to better understand the epidemiology, presentation and clinical management of the underlying aetiologies. This review endeavours to provide a clinical update on the diagnosis and management of acute and chronic tubulo-interstitial nephritis.

Biopsy Proven Renal Morphology Cognizance into its Four-Year Evolving Pattern; A Pakistani Perspective

Objective: To determine the pattern of Biopsy Proven Renal Diseases (BPRD) in a single tertiary care centre in Islamabad, Pakistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Nephrology, KRL Hospital, Islamabad Pakistan, from Mar 2016 to Nov 2020.&#x0D; Methodology: The archival records of all native renal biopsies performed in adults (&gt;18 years) were retrospectively analyzed.The biopsies were performed according to standard indications and evaluated by light microscopy and immunofluorescence.&#x0D; Results: A total of 134 renal biopsies were studied. Among these, 85(61.1 %) were males, and 49(36.5 %) were females. The mean age was 44.70±14.63 years. Primary glomerulonephritis’s were the predominant group of diseases found in 93(69.4%) cases. Membranous nephropathy (MN) was the most common lesion in 52(38.8%), followed by focal segmental Glomerulosclerosis (FSGS) in 22(16.4%) cases. Chronic tubulointerstitial nephritis (Ch. TIN) 12(9.0%) was the third most common lesion among all biopsies. Other diagnoses included lupus nephritis (LN) 10(7.5%) and IgA nephropathy (IgAN) 9(6.7%). One sample one-sided t-test was used to estimate the minimum proportion of occurrence of different biopsies in our concerned population. The estimated minimum proportion of membranous nephropathy (MN) was 0.31, with a p-value of 0.034.&#x0D; Conclusion: We concluded that primary Glomerulonephritis (PGN) is the most common renal disease, and membranous nephropathy is the most common biopsy-proven Glomerulopathy in our concerned population.

Risk factors associated with fatal thrombosis in hospitalized coronavirus disease 2019 (COVID-19) patients on anticoagulant therapy.

The purpose of this study was to determine the factors that increase the risk of fatal thrombotic events in hospitalized coronavirus disease 2019 (COVID-19) patients receiving standard therapy according to the National Clinical Practice Guidelines (National Guidelines). In this case-control study, cases included 83 adults with COVID-19 who had died from thrombosis and controls comprised 83 COVID-19 patients with comparable criteria who survived. Data was abstracted by reviewing the medical records of selected patients and analyzed using Statistica. Parametric and non-parametric tests, as appropriate, were used to compare continuos variables between cases and controls, whereas Chi-square test was employed to compare categorical variables. Odds ratio (OR) was also calculated to measure the strength of association of case status and various independent variables. Fatal outcomes were higher in patients with chronic tubulointerstitial nephritis, (OR = 2.4, 95% CI 1.2-4.9); obesity, (OR = 2.1, 95% CI 0.5-8.6); and coronary heart disease (OR = 1.6, 95% CI 0.8-3.2). In the group with a D-dimer level from 250 to 1000 ng/ml, a statistically significant moderate positive correlation was found between the day of death and D-dimer level (P = 0.026). The lack of use of the PADUA Prediction Score for the risk of venous thromboembolism scale (PADUA Scale) and control of laboratory parameters (APTT and D-dimer) were associated with increased risk of fatal outcome. Overall, 19.2% cases and 8.4% of controls had no coagulation control; (OR = 2.6, 95% CI 1-6.7). Chronic tubulointerstitial nephritis, obesity, and coronary heart disease were associatied with fatal thrombosis. A slight elevation of D-dimer level, lack of the PADUA Scale and laboratory monitoring in the management of hospitalized patients with COVID-19. was associated with an increased risk of thromboembolism.

Chronic tubulointerstitial nephritis in children: New approaches to diagnosis and treatment

A survey of 120 children with HTIN, aged from 4 to 15 years, was conducted. Taking into account the clinical variant of HTIN, all patients were divided into 2 groups: group 1 –52 (43%) children with recurrent form of HTIN and group 2 -68 (57%) patients with latent HTIN. Among them, there were 65 boys (54%), 55 girls (46%). The conducted studies have shown that with the development of rHTIN and lHTIN, an important mechanism of damage to interstitial kidney tissue, the development of clinical symptoms and the course of the disease is both a metabolic disorder leading to structural shifts at the level of various elements of the nephron and changes in the functional state of the kidneys, and instability of the cytomembranes of tubular cells. The analysis of the results of the study showed that the method of treatment proposed by the authors is the most effective way of treating HTIN, due to accelerated recovery, both clinical and laboratory parameters of the disease and indicators of protein metabolism, as well as in relation to the restoration of the functional state of the kidneys, which leads to a reduction in the length of hospital stay, a reduction in the number of relapses of exacerbation, prevention complications of the chronic process. All this contributes to preventing the development of disability and reducing the number of child deaths from CRF.

Urticaria with Immunoglobulin G4-Related Disease: An Association or Coincidence?

Immunoglobulin (Ig) G4-related disease is a recently described fibro-inflammatory disease with diverse clinical manifestations but consistent and characteristic histopathological features across multiple organ systems and skin, leading to tissue sclerosis and ultimately organ failure if not treated adequately. Here, we report a case of 56-year-old male patient presenting with urticarial lesions and generalized itching for 4 months. Routine investigations showed elevated 24-h urine protein, absolute eosinophil count, serum IgE, reversed albumin: globulin ratio, and “M” spike on serum electrophoresis. Renal biopsy showed storiform fibrosis, diffuse dense inflammatory cells (plasma cells and eosinophils), and IgG4-positive cells on immunohistochemistry which was histologically highly suggestive of IgG4-related chronic tubulointerstitial nephritis. Quick response was seen with oral corticosteroids.

SARCOPENIC OBESITY IN PATIENTS RECEIVING TREATMENT WITH PROGRAMMED HEMODIALYSIS

BACKGROUND . The term "sarcopenic obesity" has been used not so long ago. The epidemiology of this phenomenon during renal replacement therapy in the Russian Federation has not been studied. THE AIM : to assess the prevalence of sarcopenic obesity in patients on hemodialysis (HD). PATIENTS AND METHODS . 140 patients receiving treatment with programmed bicarbonate HD in 2 dialysis centers of St. Petersburg were examined, among them 68 women and 72 men, the average age was 56.8±12.8 years. The main cause of the development of terminal renal insufficiency was chronic glomerulonephritis – in 43, autosomal dominant polycystic kidney disease – in 14, chronic pyelonephritis – in 9, hypertension – in 15, chronic tubulointerstitial nephritis – in 6 and other diseases – in 53 people. The prevalence of these pathological conditions in men and women did not differ. To assess the component composition of the patient's body, we used: 8–point tactile tetrapolar multi–frequency bioimpedance (BIM) on the InBody device (South Korea) with a frequency range of 1 – 1000 kHz, 10 measurements for each of 6 frequencies for each of 5 body segments (right and left arm, right and left leg, torso), followed by the calculation of the index of appendicular skeletal muscles. The criteria of RN. Baumgartner (2000) were used to diagnose sarcopenic obesity. RESULTS . Sarcopenic obesity was detected in 62 patients (44.3 %). There was no correlation with the underlying pathology. Patients with sarcopenic obesity were distinguished by a longer period of renal replacement therapy, the lowest concentration of serum creatinine and the number of points of the physical component of the SF-36 scale, higher levels of C-reactive protein, parathyroid hormone, HOMA-IR index, Charleson index. Also in this group, the lowest score on the IPAQ scale of motor activity and the worst results in the 6-minute walking test were noted. CONCLUSION . Currently, it is not entirely clear what is the primary link in the development of sarcopenic obesity and whether it is realistic to isolate it in a particular patient. We believe that the main cause of the development of this syndrome is obesity, which causes the expression of pro-inflammatory cytokines and insulin resistance. The most important modifiable risk factor for obesity is considered to be the hypercaloric intake of patients, which is due to the lack of nutritionists with experience in the field of nephrology and indexing the amount of calories indicated in clinical recommendations to the real, and not to the recommended body weight.

MO865: Epidemiological Characteristics of Cancer in Incident Dialysis Patients. A Multicentre Spanish Study

Abstract BACKGROUND AND AIMS There is evidence that cancer risk is increased in people with chronic kidney disease (CKD), specially when glomerular filtration rate decreases [1,2]. This association do appear to be site-specific [3,4]. Cancer incidence increases by time since first dialysis in addition [5]. The aim of our study is to describe characteristics of dialysis incident patients with diagnosis of malignancy in a multicentre spanish cohort. METHOD We performed a multicentre collaborative retrospective study over the period 2015–20 of clinical and demographical data from incident dialysis patients with diagnosis of cancer. Data from Seville, Cadiz, Marbella and Huelva was collected from the Registry of Renal Patients of the Andalusian Health Service (SICATA). Data from Canary Islands was collected from Registry of Renal Patients of the Canary Islands Health Service. Data from Cantabria was collected from the Registry of Renal Patients of Cantabrian Health Service. Rest of centres provided their own collected data (Gregorio Maranon General University Hospital and University Hospital October 12). Statistics: Quantitative variables are expressed as mean/-SD (normal distribution) or median (IQ 25–75) (non-normal distribution). Qualitative variables are expressed as percentage. RESULTS 727 incident dialysis patients were diagnosed with cancer before (79.9%) or after (20%) starting dialysis over the study period. Prevalence was 15.9% among all incident patients. 73.2% of patients were men with a mean age 70.1 (SD 10.3) years old. At the time of starting dialysis, 30.6% were smokers, 45.5% patients presented diabetes, 88% high blood pressure, 18.5% received immunosupresive therapy in the past, 4.1% had history of hepatitis B, C or HIV infection and mean proteinuria was measured in 2990 mg/g (SD 3832). Diabetic kidney disease and chronic tubulointerstitial nephritis were the most common causes of CKD (22.1% and 22.9%, respectively). 14.4% of patients had history of glomerular nephropathy. Mean time from CKD diagnosis to dialysis start was 6 years and from CKD diagnosis to cancer diagnosis was 5.4 years (SD 6.4). Solid cancer was found in 88% of patients and 12% had hematological malignancy. Most common malignancies were urinary tract cancers (bladder, 17%, kidney 17.3% and prostate 13.2%) followed by colon cancer, 11.27% of cases. 32% of patients had active neoplasia at the time of starting dialysis and 15.1% had metastatic disease. 33.8% of patients died over follow-up. Neoplastic disease was the most common cause of death (29.6%) followed by cardiovascular (19.5%) and infectious disease (16.2%). A total of 7.1% of patients underwent kidney transplant (previous malignancies were prostate, kidney cancer and multiple myeloma in majority of these cases). CONCLUSION Among our spanish multicentre cohort of incident dialysis patients, the average duration between the diagnosis of CKD and cancer was 5.4 years. The most commonly observed cancer sites were urinary tract and kidney malignancies, as previously reported in other cohorts. Study findings may be a useful reference for cancer screening guidelines in our population.