Development Of End-stage Renal Disease Research Articles

Lower urinary tract dysfunction in cases of anorectal malformations

Association of genitourinary anomalies in patients with ano-rectal malformations (ARM) is well known and its incidence is reported to be 30 -50%. Many of these anomalies either have less number of functioning renal units or have conditions with risk of continuous damage to renal units, increasing the risk of developing End stage renal disease (ESRD) in adolescence or adulthood. Although frequently described as associated malformations but few of these entities like Vesico ureteric reflux (VUR) could be the result of lower urinary tract dysfunctions.: To study incidence and spectrum of Lower urinary tract dysfunction in toilet trained patients of ARM. To find whether LUTD is the cause of worsening of VUR/HUN/ renal functions in patients with ARM. 2 years (October 2018 to 30 September 2020): Department of Paediatric surgery, Chacha Nehru Bal Chikitsalaya, Geeta Colony Delhi Prospective observational study. : Forty-two patients of ARM, meeting all inclusion criteria were enrolled in the study. All the following criteria were checked for enrolment of patient in the study. 1. Patients of all categories of anorectal malformations who were toilet trained; 2. Age more than 4 years; 3. Completed set of investigations planned for diagnosis of LUTD. 4. Consented to participate in the study and for follow up as and when required.Central cause of neurological deficits.A total of 125 patients who underwent PSARP during our study period. However only 42 patients met the inclusion criteria and got their work up completed for urological problems. 1.LUTD and renal failure can be seen even in absence of spinal malformations in patients with ARM; 2. Severity of LUTD in absence of neurological involvement changes with time; 3. Thorough history and clinical evaluation may provide important clues in suspecting presence of occult LUTD.

V01-01 UTILITY OF 3-D MODELING IN COMPLEX UPPER TRACT RECONSTRUCTION: ROBOTIC-ASSISTED URETEROPELVICOSTOMY OF NATIVE URETER TO TRANSPLANT RENAL PELVIS

You have accessJournal of UrologyCME1 Apr 2023V01-01 UTILITY OF 3-D MODELING IN COMPLEX UPPER TRACT RECONSTRUCTION: ROBOTIC-ASSISTED URETEROPELVICOSTOMY OF NATIVE URETER TO TRANSPLANT RENAL PELVIS Bridget L. Findlay, Jayson P. Kemble, Elizabeth N. Bearrick, Katherine T. Anderson, and Boyd R. Viers Bridget L. FindlayBridget L. Findlay More articles by this author , Jayson P. KembleJayson P. Kemble More articles by this author , Elizabeth N. BearrickElizabeth N. Bearrick More articles by this author , Katherine T. AndersonKatherine T. Anderson More articles by this author , and Boyd R. ViersBoyd R. Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 3-D models have been used successfully in oncologic planning, however there are limited data supporting their use and efficacy in complex genitourinary reconstructive cases. Due to complex and variable regional anatomy with transplant vasculature and collecting system, surgical planning requires an individualized approach based on anatomic relationships. Herein, we aim to illustrate the novel utility of 3-D modeling in surgical planning for complex upper tract reconstruction, and to describe an alternative approach to transplant proximal ureteral stricture reconstruction. METHODS: The index patient is a 17-year-old male with a history of bilateral grade 4 vesicoureteral reflux (VUR) who developed end stage renal disease despite ureteroneocystostomies in childhood. He underwent a living-unrelated donor renal transplantation in November 2021, complicated by a focal proximal ureteral stricture. His anatomy was further complicated due to prior ligation of his native distal right ureter and intraperitoneal location of his transplant kidney. Therefore, a 3-D printed anatomical model was created to aid in surgical planning. RESULTS: The 3-D model highlighted a complex trajectory of the proximal transplant ureter and area of stricture directly posterior to the renal hilar vessels. Additionally, the native right ureter ligation was noted distal to the transplant renal pelvis and was not amenable for use in reconstruction. Given these anatomic considerations, the patient underwent an uncomplicated robotic-assisted ureteropelvicostomy between his native left proximal ureter and transplant renal pelvis. Total robotic operative time was 2 hours 17 minutes. He was dismissed on postoperative day (POD) 1 with a creatinine nadir near his post-transplant baseline level at 10-week follow-up. CONCLUSIONS: 3-D printed models have utility in select cases with complex anatomy. These models facilitate accurate regional and spatial anatomy of critical structures to enable effective operative planning. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e79 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bridget L. Findlay More articles by this author Jayson P. Kemble More articles by this author Elizabeth N. Bearrick More articles by this author Katherine T. Anderson More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

Angiopoietin-like protein 3 deficiency combined with valsartan administration protects better against podocyte damage in streptozotocin-induced diabetic nephropathy mice.

Diabetic nephropathy (DN) is a common leading cause of end-stage renal disease (ESRD). Podocyte injury is a major pathogenesis of DN. Pharmacological inhibition of the renin-angiotensin-aldosterone system (RAAS) is insufficient to fully prevent the development of ESRD. The present investigation aims to evaluate the protective function of valsartan, an angiotensin receptor blocker, alone and in combination with angiopoietin-like protein 3 (Angptl3) knockout against renal damage and podocyte injury in streptozotocin (STZ)-induced diabetic mice. The mice were divided into four groups: normal control group, STZ-induced DN group, valsartan+DN group (val, 100mg/kg, po), and Angptl3-/- + valsartan+DN group. Tests on kidney function, renal pathology, podocyte ultrastructure, podocyte apoptosis, reactive oxygen species (ROS) production, and autophagy were performed. The combined Angptl3 knockout/valsartan treatment significantly attenuated diabetes-induced renal pathological damage and improved podocyte ultrastructure compared with valsartan alone. The combined administration ameliorated glomerular injury by increasing nephrin, podocin, and CD2-associated protein (CD2AP) expression levels and inhibiting podocyte loss by apoptosis. Compared with valsartan alone, Angptl3-/- and valsartan combination therapy significantly improved the renal function, as demonstrated by decreasing levels of serum urea nitrogen, creatinine, and urinary albumin. Additionally, the combination treatment significantly activated autophagy and reduced the ROS production than valsartan alone. These findings highlight the role of valsartan to Angptl3 knockout could have much better outcome that opens the future for drugs that could inhibit Angptl3.

Agomelatine improves streptozotocin-induced diabetic nephropathy through melatonin receptors/SIRT1 signaling pathway.

Diabetic nephropathy (DN) is a major cause of end-stage renal disease (ESRD). Agomelatine, a melatonin receptor agonist, has a potent anti-inflammatory activity. The current study aimed to determine the ameliorative anti-inflammatory effect of agomelatine against DN. We used 10% fructose with streptozotocin (STZ) to induce DN in male Wistar rats. Diabetic rats were treated with agomelatine in presence or absence of melatonin receptor antagonist (luzindole) or Sirtuin1 (SIRT1) inhibitor (EX527). SIRT1 expression was measured by qRT-PCR and immunohistochemical analysis. The expression of nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), 5'adenosine monophosphate-activated protein kinase (AMPK), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1), and monocyte chemoattractant protein-1 (MCP-1) were measured using ELISA. Histological assessment was performed using hematoxylin and eosin-stained renal sections. Fructose and STZ treatment induced diabetes, insulin resistance, and renal damage accompanied by reduced SIRT1 expression, increased NFκB activation, and decreased AMPK phosphorylation in the kidney. Agomelatine treatment improved kidney histology and function and upregulated SIRT1 expression (2-fold). Inhibition of melatonin receptors and SIRT1 activity increased NFκB phosphorylation (2.13 and 1.98-folds, respectively), reduced AMPK activation (0.51 and 0.53-folds, respectively), increased inflammatory markers ICAM-1 (2.16 and 2.23-folds, respectively), VCAM-1 (2.19 and 2.26-folds, respectively), and MCP-1(2.84 and 3.12-folds, respectively), and inhibited the ameliorative effect of agomelatine on kidney structure and function. Our findings reveal the ameliorative anti-inflammatory activity of agomelatine against STZ-induced DN and this effect is SIRT1- and melatonin receptor-dependent. Therefore, agomelatine may be beneficial to prevent the development of ESRD from diabetes mellitus.

ODP215 Insulinoma Evaluation Before and After Development of End Stage Renal Failure: A Case Report

Abstract Introduction Fasting hypoglycemia in chronically ill patients with kidney disease is frequently multifactorial. Patients with chronic kidney disease are prone to hypoglycemia due to decreased renal clearance of insulin, impaired renal gluconeogenesis and increased prevalence of other medical problems and medications. However, ruling out the presence of an insulinoma can be difficult in this patient population due to the impact of kidney disease on laboratory evaluation of hypoglycemia. Case A 43-year-old male with history of paraplegia from gunshot wound, neurogenic bladder, colostomy, chronic osteomyelitis, frequent polymicrobial bacteremia was noted to have persistent, asymptomatic hypoglycemia during multiple inpatient hospitalizations dating back to 2007. He was taking no medications associated with hypoglycemia. Following normal ACTH stimulation and thyroid testing, he underwent a 72-hour fast in 2017 when his creatinine was 1.32 mg/dL and GFR was >60; BMI was 22.32 kg/m 2 with prealbumin of 15 mg/dL. The fast was concluded after 23.5 hours with serum glucose of 46 mg/dL, insulin level of 3.1 uIU/mL, c-peptide of 2.4 ng/mL, undetectable proinsulin, and beta-hydroxybutyrate of 0.62mmol/L and a negative sulfonylurea screen. Administration of glucagon at time of fast completion improved glucose to 65 mg/dL. He was started on diazoxide 85mg every 8 hours during that hospitalization, which he discontinued without medical recommendation in 2018. He developed end stage renal disease requiring hemodialysis in 2019. During an admission in 2020, serum fasting glucose as low as 30mg/dL. Further laboratory evaluation at that time revealed glucose of 47 mg/dL, with insulin level 39.1 uIU/mL, c-peptide 18.2 ng/mL, and proinsulin of 20.1 pmol/L. Multiple CT abdomen imaging studies confirmed normal pancreas. Diazoxide 110mg every 8 hours was resumed and patient had decreased frequency of hypoglycemia episodes. Diazoxide has since the tapered to 80mg twice daily without increase in hypoglycemia frequency, with goal to taper further in the future. Conclusion Here we present the case of an individual patient who underwent laboratory evaluation of hypoglycemia before and after development of end stage renal disease with profound differences in lab results despite similar degree of hypoglycemia. It has been demonstrated previously that c-peptide and insulin levels are elevated in patients with end stage renal disease and that these labs decrease with hemodialysis while remaining above normal range. The elevation of c-peptide in this population is thought to be due to the kidney being the main site of beta-cell polypeptide degradation. Additionally, this case suggests successful use of diazoxide therapy in patients without classic endogenous hyperinsulinism. Presentation: No date and time listed

ODP544 Cumulative exposure of metabolic syndrome components and the risk of end-stage renal disease in the general population: a nationwide cohort study

Abstract Aims Status of metabolic syndrome (MetS) and its components can changes over time. However, few studies have investigated the cumulative burden of MetS and its components on clinical renal outcomes in the general population. Methods Using nationally representative data from the Korean National Health Insurance System, 2,664,270 subjects who underwent health examinations for four consecutive years and were free from end-stage renal disease (ESRD) from 2009 to 2013. We used exposure-weighted scores in two ways: (1) cumulative number of MetS diagnosis at each health examination (MetS exposure score, range: 0 to 4); (2) the composite of its five components (MetS component exposure score, 0 to a maximum of 20). Hazard ratio and 95% confidence interval (CI) values for ESRD were analysed using the Cox proportional-hazard model. Results Overall, 63.4%, 14. 0%, 8.2%, 6.2% and 8. 0% met the MetS diagnostic criteria 0 to 4, respectively. After a median follow up of 5.3 years, 2,303 incident ESRD cases were identified. In the multivariate adjusted model, the hazard ratio (HR) and 95% confidence interval (CI) for the development of ESRD showed a gradual increase with increasing exposure score of MetS and its components, which was independent of age, sex, and baseline estimated glomerular filtration rate (each p for trend < 0. 0001). The HR of ESRD was 6.48 (95% CI, 4.12 to 10.20) in subjects with a MetS component exposure score of 20 compared with those with a score of 0. Conclusions This provides evidence supporting the strategy of reducing MetS exposure to prevent the development of ESRD in the general population. Presentation: No date and time listed

Serum glycated albumin as a predictive biomarker for renal involvement of antineutrophil cytoplasmic antibody-associated vasculitis in non-diabetic patients

BackgroundGlycated albumin (GA) is known to reflect the current inflammatory burden in non-diabetes mellitus (DM) patients. In this study, we investigated whether GA at diagnosis could reflect the cross-sectional activity and predict poor outcomes during follow-up in non-DM patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).MethodsThe medical records of 118 immunosuppressive drug-naïve AAV patients were retrospectively reviewed, and 76 patients who had both GA and glycated haemoglobin (HbA1c) results but not DM were included in this study. Demographic, clinical, and laboratory data at diagnosis were assessed.ResultsThe median age of AAV patients was 61 years, and 31 patients were male. GA was positively correlated with five-factor score (r = 0.282), Birmingham vasculitis activity score (BVAS) assigned to renal manifestation (r = 0.315), and blood urea nitrogen (r = 0.382), whereas negatively correlated with haemoglobin (r = -0.345). AAV patients with end-stage renal disease (ESRD) exhibited significantly higher GA than those without ESRD (15.8% vs. 13.6%). When the cut-off of GA at diagnosis for ESRD was set at GA ≥ 14.25%, AAV patients with GA ≥ 14.25% had a significantly higher risk for ESRD development than those without (relative risk 12.040). In addition, AAV patients with GA ≥ 14.25% exhibited significantly lower cumulative ESRD-free survival rates than those without (P = 0.020).ConclusionIn conclusion, GA at diagnosis can reflect the cross-sectional BVAS assigned to renal manifestation of AAV and predict ESRD development during follow-up better than HbA1c or GA/HbA1c in AAV patients.

Gut Microbiota Correlates With Clinical Responsiveness to Erythropoietin in Hemodialysis Patients With Anemia.

The main treatment for renal anemia in end-stage renal disease (ESRD) patients on hemodialysis is erythropoiesis (EPO). EPO hyporesponsiveness (EH) in dialysis patients is a common clinical problem, which is poorly understood. Recent searches reported that gut microbiota was closely related to the occurrence and development of ESRD. This study aims to explore the changes in gut microbiota between ESRD patients with different responsiveness to EPO treatment. We compared the gut microbiota from 44 poor-response (PR) and 48 good-response (GR) hemodialysis patients treated with EPO using 16S rDNA sequencing analysis. The results showed that PR patients displayed a characteristic composition of the gut microbiome that clearly differed from that of GR patients. Nine genera (Neisseria, Streptococcus, Porphyromonas, Fusobacterium, Prevotella_7, Rothia, Leptotrichia, Prevotella, Actinomyces) we identified by Lasso regression and ROC curves could excellently predict EH. In contrast, five genera (Faecalibacterium, Citrobacter, Bifidobacterium, Escherichia–Shigella, Bacteroides) identified by the same means presented a protective effect against EH. Analyzing the correlation between these biomarkers and clinical indicators, we found that gut microbiota may affect response to EPO through nutritional status and parathyroid function. These findings suggest that gut microbiota is altered in hemodialysis patients with EH, giving new clues to the pathogenesis of renal anemia.

Lymphocytes in the neighborhood: good or bad for the kidney?

Lupus nephritis (LN) is common in people with systemic lupus erythematosus (SLE) and advances, almost invariably, to end-stage renal disease (ESRD). In this issue of the JCI, Abraham, Durkee, et al. presented a large-scale immune cell landscape of kidney biopsies from patients with LN by combining multiplexed confocal microscopy imaging with customized computer vision and quantification. The presence of diverse CD4– T cells in small neighborhoods, but not of B cells or CD4+ T cells in large neighborhoods, is linked to the development of ESRD. Unexpectedly, B cells in the kidney heralded a good prognosis. The precise location of different types of immune cells allows inference on possible interactions between different immune cells and also between immune and kidney-resident cells. The data have important implications on the development of prognostic tools and effective targeted therapies in patients with LN.

Gut microbiota diversity in middle-aged and elderly patients with end-stage diabetic kidney disease.

BackgroundDiabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD), but the mechanism between DKD and ESRD remains unclear. Some experts have put forward the “microbial-centered ESRD development theory”, believing that the bacterial load caused by gut microecological imbalance and uremia toxin transfer are the core pathogenic links. The purpose of this study was to analyze the genomic characteristics of gut microbiota in patients with ESRD, specifically DKD or non-diabetic kidney disease (NDKD).MethodsIn this cross-sectional study, patients with ESRD were recruited in a community, including 22 DKD patients and 22 NDKD patients matched using gender and age. Fecal samples of patients were collected for 16S rDNA sequencing and gut microbiota analysis. The distribution structure, diversity, and abundance of microflora in DKD patients were analyzed by constructing species evolutionary trees and analyzing alpha diversity, beta diversity, and linear discriminant analysis effect size (LEfSe).ResultsThe results of our study showed that there were statistically significant differences in the richness and species of gut microbiota at the total level between DKD patients and NDKD patients. The analysis of genus level between the two groups showed significant differences in 16 bacterial genera. Among them, Oscillibacter, Bilophila, UBA1819, Ruminococcaceae UCG-004, Anaerotruncus, Ruminococcaceae, and Ruminococcaceae NK4A214 bacteria in DKD patients were higher than those in NDKD patients.Conclusions16S rDNA sequencing technology was used in this study to analyze the characteristics of intestinal flora in ESRD patients with or without diabetes. We found that there was a significant difference in the intestinal flora of ESRD patients caused by DKD and NDKD, suggesting that these may be potential causative bacteria for the development of ERSD in DKD patients.

Serum ferritin level in type 2 diabetic patients with renal dysfunction

Background and objective: Nephropathy is the major cause of end-stage renal disease (ESRD) in type 2 diabetes mellitus (T2DM). Delay in identification and management of nephropathy in T2DM may cause development of ESRD. An increased level of serum ferritin plays a role in the pathogenesis of chronic kidney disease (CKD) in T2DM. Hence, the present study intended to assess the level of serum ferritin in renal dysfunction in patients with T2DM. Material and methods: This was a retrospective study with 81 T2DM patients with and without nephropathy. They were categorized into two groups. Group-1 consisted of 46 T2DM cases without nephropathy and remaining 35 with nephropathy.The clinical and biochemical parameters such as blood glucose, urea, creatinine, iron, ferritin, transferrin, total iron binding capacity (TIBC), and haemoglobin were measured by standard methods, and estimated glomerular filtration rate (eGFR) by MDRD formula. Results: Significantly (p<0.05) elevated level of serum ferritin along with urea and creatinine was found in patients with T2DM with nephropathy.A significant positive correlation (r = 0.37) of serum ferritin and negative correlation (r = - 0.852) of eGFR with creatinine were found. It indicated that ferritin could be a good marker to monitor kidney function in T2DM. Conclusion: Apart from eGFR and serum creatinine, raised serum ferritin level was a good indicator of renal dysfunction in T2DM patients and might play an important role in renal dysfunction in early stage diabetic nephropathy. IMC J Med Sci 2022; 16(2): 008. DOI: https://doi.org/10.55010/imcjms.16.018 *Correspondence: Dr. Siva Prasad Palem., M.Sc., Ph.D., Department of Biochemistry, Faculty of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar-505001, Telangana, India. Affiliated with Kaloji Narayana Rao University of Health Sciences (KNRUHS), Warangal, Telangana, India. E-mail: sp.biocom@yahoo.co.in.

Urolithins and their possible implications for diabetic kidney

The increasing prevalence of diabetic kidney disease (DKD), a common complication of type 1 and type 2 diabetes, is becoming a leading risk factor of developing end stage renal disease (ESRD). The multiple mechanisms involved in renal tissue damage are a challenge for effective targeted therapy. Urolithins are metabolites generated by gut microbiota upon dietary intake of plant-derived ellagitannins. Multidirectional effects of these compounds include their anti-inflammatory, antioxidant, anti-proliferatory, anti-migratory and antiglycative properties that are mediated by modulation of signaling pathways and gene expression. Biochemical properties of urolithins indicate their capacity to regulate numerous mechanisms responsible for developing the hyperglycemia-induced tissue injury. The potentially beneficial effects of urolithins on podocytes, the most vulnerable renal cells should be particularly considered. The purpose of this review is to provide the evidence from the in vivo and in vitro studies showing that urolithin-based therapy could be a useful tool for protecting the kidneys from damage in diabetes.

Effects of Blood Pressure According to Age on End-Stage Renal Disease Development in Patients With Diabetes: A Nationwide Population-Based Cohort Study.

Background:Recent hypertension guidelines have recommended lower blood pressure (BP) targets in high-risk patients. However, there are no specific guidelines based on age or systolic and diastolic blood pressure (SBP and DBP, respectively). We aimed to assess the effects of age-related BP on development of end-stage renal disease (ESRD) in patients with diabetes.Methods:A total of 2 563 870 patients with diabetes aged >20 years were selected from the Korean National Health Screening Program from 2009 to 2012 and followed up until the end of 2019. Participants were categorized into age and BP groups, and the hazard ratios for ESRD were calculated.Results:During a median follow-up of 7.15 years, the incidence rates of ESRD increased with increasing SBP and DBP. The hazard ratio for ESRD was the highest in patients younger than 40 years of age with DBP≥100 mm Hg. The effect of SBP and DBP on ESRD development was attenuated with age (interaction P was <0.0001 for age and SBP, and 0.0022 for age and DBP). The subgroup analysis for sex, antihypertension medication, and history of chronic kidney disease showed higher hazard ratios for ESRD among males, younger than 40 years, not taking antihypertension medications and chronic kidney disease compared to those among females, older than 40 years, antihypertension medication, and nonchronic kidney disease groups.Conclusions:Higher SBP and DBP increase the risk of developing ESRD in patients with diabetes, and in particular, younger individuals face greater risk. Therefore, intensive BP management is warranted in younger patients to prevent ESRD.

PD33-05 INCIDENCE AND SIGNIFICANCE OF 20% DECREASE FROM NEW BASELINE ESTIMATED GLOMERULAR FILTRATION RATE AFTER RADICAL AND PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 May 2022PD33-05 INCIDENCE AND SIGNIFICANCE OF 20% DECREASE FROM NEW BASELINE ESTIMATED GLOMERULAR FILTRATION RATE AFTER RADICAL AND PARTIAL NEPHRECTOMY Bo Fan, Minato Yokoyama, Yosuke Yasuda, Yuki Nakamura, Yusuke Uchida, Shohei Fukuda, Sho Uehara, Hajime Tanaka, Soichiro Yoshida, Yoh Matsuoka, and Yasuhisa Fujii Bo FanBo Fan More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Yusuke UchidaYusuke Uchida More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Sho UeharaSho Uehara More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002584.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New baseline estimated glomerular filtration rate (NBeGFR) after radical or partial nephrectomy (RN or PN) was shown to be associated with non-renal cancer mortality. In general population, 20% eGFR decrease from the baseline within 2 years was reported to have impact on the overall mortality and development of end-stage renal disease (ESRD). Here, we investigated the incidences and risk factors of 20% decrease from NBeGFR within 2 years and its impact on the development of ESRD. METHODS: 607 Japanese patients with non-metastatic renal masses undergoing RN (n=238) or PN (n=369) between 2007 and 2018 and followed for longer than 2 years were enrolled in this retrospective study. NBeGFR was defined as eGFR at 1 month after RN/PN. The primary endpoint of this study was 20% decrease from NBeGFR within 2 years. Potential risk factors including surgery type for 20% decrease from NBeGFR within 2 years were assessed by logistic regression analysis. The secondary endpoint was ESRD defined as eGFR <15 ml/min/1.73 m2. The development of ESRD was compared according to the presence or absence of the 20% decrease from NBeGFR. RESULTS: The median preoperative eGFR and NBeGFRs after RN and PN were 69, 44 and 67 ml/min/1.73 m2, respectively. The 20% decrease from NBeGFR within 2 years was observed in 37 patients (6.1%), showing no significant differences between patients undergoing RN and PN (4.2% vs 7.3%). Diabetes mellitus, proteinuria, and perioperative complications were shown to be independent risk factors for the 20% decrease, while surgery type was not associated. During the median follow-up of 5 years, ESRD was observed in 10 patients (1.6%), including 5 (2.1%) and 5 (1.4%) managed with RN and PN, respectively. 5 (13.5%) of the 37 patients with the 20% decrease from NBeGFR eventually developed ESRD, while 5 (0.9%) of the 570 without the 20% decrease did. The incidence of ESRD at 6 years was 21.0% and 0.4% in patients with and without 20% decrease from NBeGFR (figure, p<0.001). CONCLUSIONS: Approximately 5% of patients undergoing RN or PN experienced 20% decrease from NBeGFR with 2 years irrespective of surgery type. Because the incidence of ESRD after the 20% decrease from NBeGFR was considerably high, such patients should be followed with maximal care. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e554 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bo Fan More articles by this author Minato Yokoyama More articles by this author Yosuke Yasuda More articles by this author Yuki Nakamura More articles by this author Yusuke Uchida More articles by this author Shohei Fukuda More articles by this author Sho Uehara More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Yoh Matsuoka More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF DownloadLoading ...

New body mass index for predicting prognosis in patients with antineutrophil cytoplasmic antibody-associated vasculitis.

ObjectivesBody mass index (BMI) is a known indicator of all‐cause mortality. However, conventional BMI does not reflect the three‐dimensional human body. To overcome this limitation, a new BMI has been proposed that provides a closer approximation of real human body shape. This study investigated the associations between the new BMI and poor outcomes in patients with antineutrophil cytoplasmic antibody‐associated vasculitis (AAV).MethodWe retrospectively reviewed the medical records of 242 patients with AAV in a single tertiary medical center. Based on the new BMI, the patients were categorized into four groups: underweight (<18.5 kg/m2.5), healthy weight (18.5 to <25.0 kg/m2.5), overweight (25.0 to <30.0 kg/m2.5), and obese (≥30.0 kg/m2.5). The association among the new BMI and death, relapse, end‐stage renal disease (ESRD) development, cerebrovascular accident, and cardiovascular disease was analyzed.ResultsThe underweight group, according to the new BMI, had higher hazard ratios (HRs) for all‐cause mortality (HR: 3.180, 95% confidence interval [CI]: 1.134–8.922, p = 0.028), relapse (HR: 2.141, 95% CI: 1.019–4.368, p = 0.036), and ESRD development (HR: 2.729, 95% CI: 1.190–6.259, p = 0.018) than the healthy weight group. However, according to the conventional BMI, there were no differences in the risks for all poor outcomes between the underweight and healthy weight groups. Multivariate logistic regression analysis demonstrated that being underweight, according to the new BMI, was an independent risk factor for all‐cause mortality (HR: 5.285; 95% CI: 1.468–19.018; p = 0.011).ConclusionBeing underweight, according to the new BMI, is associated with poor outcomes in patients with AAV.

Prevalence of nephropathy in Indian children and youth with type 1 diabetes mellitus.

Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased risk of developing end stage renal disease. The present study aimed to determine the prevalence of DN and its predictors in Indian children and youth with T1D. This cross-sectional study included 319 children and youth (2.6-21 years) with T1D having disease duration of at least 2 years. Demographic data and laboratory findings were obtained using standard questionnaires and protocols. Diagnosis of diabetic nephropathy was based on albuminuria on two occasions within a period of 3months. The prevalence of DN in our study subjects was13.4%. 7.5% subjects were known cases of diabetic nephropathy on treatment with enalapril. Hypertension was found in 14.3% subjects with DN in contrast to 4.1% without DN (p<0.05). Duration of diabetes and estimated glucose disposal rate were the important predictors of DN. Interestingly, of the 43 children with DN, 11.3% (n=8) were under 10 years age. We found a high prevalence of DN in children and youth with T1D including in children under the age of 10 years. Early screening and timely intervention are required to retard the disease progression and avoid end stage renal disease.

Artificial Intelligence for Risk Prediction of End-Stage Renal Disease in Sepsis Survivors with Chronic Kidney Disease.

Sepsis may lead to kidney function decline in patients with chronic kidney disease (CKD), and the deleterious effect may persist in patients who survive sepsis. We used a machine learning approach to predict the risk of end-stage renal disease (ESRD) in sepsis survivors. A total of 11,661 sepsis survivors were identified from a single-center database of 112,628 CKD patients between 2010 and 2018. During a median follow-up of 3.5 years, a total of 1366 (11.7%) sepsis survivors developed ESRD after hospital discharge. We adopted the random forest, extra trees, extreme gradient boosting, light gradient boosting machine (LGBM), and gradient boosting decision tree (GBDT) algorithms to predict the risk of ESRD development among these patients. GBDT yielded the highest area under the receiver operating characteristic curve of 0.879, followed by LGBM (0.868), and extra trees (0.865). The GBDT model revealed the strong effect of estimated glomerular filtration rates <25 mL/min/1.73 m2 at discharge in predicting ESRD development. In addition, hemoglobin and proteinuria were also essential predictors. Based on a large-scale dataset, we established a machine learning model computing the risk for ESRD occurrence among sepsis survivors with CKD. External validation is required to evaluate the generalizability of this model.

Evolution of renal function in patients with cT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment

Introduction and objectivesTo analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for renal function impairment. Materials and methodRetrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2 and single renal tumor cT1, treated in our center between 2005 and 2018. ResultsA total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated with RN and 216 (58.1%) with PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age >60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR <60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR <45 mL/min/1.73 m2 at discharge. The median follow-up of the series was 57 (IQR 28–100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age >70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR <60 mL/min/1.73 m2. The independent predictors for GFR <45 mL/min/1.73 m2 were age >70 years, DM (HR 1.99 CI 95% 1.04–3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57–13.45, p = 0.0001). ConclusionsRN is a short- and long-term risk factor for CKD although with a low probability of severe CKD or ESRD in patients with preoperative GFR >60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up.

Low waist circumference prior to percutaneous coronary intervention predict the risk for end-stage renal disease: a nationwide Korean population based-cohort study.

Background/AimsThe obesity paradox has been known in end-stage renal disease (ESRD). However, the effect of body mass index (BMI) or waist circumference (WC) prior to percutaneous coronary intervention (PCI) on the development of ESRD is not clear.MethodsUsing nationally representative data from the Korean National Health Insurance System, we enrolled 140,164 subjects without ESRD at enrolment who underwent PCI between 2010 and 2015, and were followed-up until 2017. Patients were stratified into five levels based on their baseline BMI and six levels based on their WC with 5-cm increments. BMI and WC were measured at least 2 years prior to PCI. The primary outcome was the development of ESRD.ResultsDuring a median follow-up of 5.4 years, 2,082 (1.49%) participants developed ESRD. The underweight group (hazard ratio [HR], 1.331; 95% confidence interval [CI], 0.955 to 1.856) and low WC (< 80/< 75) (HR, 1.589; 95% CI, 1.379 to 1.831) showed the highest ESRD risk and the BMI 25 to 30 group showed the lowest ESRD risk (HR, 0.604; 95% CI, 0542 to 0.673) in all participants after adjusting for all covariates. In the subgroup analysis for diabetes mellitus (DM) duration, WC < 85/80 cm (men/women) increased ESRD risk in only the DM group (DM < 5 years and DM ≥ 5 years) compared to the reference group (85–90/80–85 of WC), but not the normal or impaired fasting glucose group.ConclusionsLow WC prior to PCI showed an increased ESRD risk in patients with DM undergoing PCI as compared to those without DM.

P.157: NK and B Cell Subset Assessment in Type I Diabetes Patients on Waitlist for Pancreas Transplantation

Introduction: Type 1 Diabetes (T1D) is an immune mediated disease with near complete destruction of beta cells. About 40 % patients with T1D develop End Stage Renal disease (ESRD) during their lifetime and require kidney and/or kidney pancreas transplantation. Recent genetic studies have described differences in genomic regions associated with immune responses and types of cells infiltrating islets between patients with early onset of diabetes (< 7 yrs.) and later onset of diabetes (≥ 7 yrs.). Limited data are available regarding immune profiles of these subsets of patients especially when evaluated for transplantation. Therefore, we studied flow cytometric profiles of immune subsets in these patients with the long-term vision of developing personalized immunosuppression. Methods: After IRB approval, we prospectively performed quantitative B cell and Natural Killer (NK) cell subset immunophenotyping by flow cytometry, and measured Immunoglobulin (IgA, IgM and IgG) levels by Nephelometry on 18 T1D subjects with ESRD waitlisted for Simultaneous Pancreas and Kidney Transplantation (SPK) in two age and gender matched groups of patients: a) onset < 7 yrs. (Group 1, n=9), and b) onset > 7 yrs. (Group 2, n=9). Results: Detailed baseline demographics of the two groups are shown under Table 1, both groups were comparable. B cells, NK cells and their subsets are shown in Table 2. Group 1 showed a significantly lower number of CD 16 + 56- cells (p-value 0.027) as compared to group 2; other cells count, and percentages were not significantly different.Conclusion: While previous work has shown a link between altered NK cells and the early onset of type I diabetes, our data do not show a significant difference in the major NK cell subsets between the two groups of patients. Additional studies with a larger sample size could help resolve this disparity.