Difference In Glomerular Filtration Rate Research Articles

Analysis of glomerulopathies in kidney neoplasms

Background. Malignant neoplasms, including those of the kidneys, are widespread in the world. The main treatment for kidney tumors is surgery, one of its options is nephrectomy. Malignant tumors of various localizations can lead to a variety of kidney damage. Glomerulopathies of various origins are often asymptomatic, and therefore, patients do not seek medical help. For the diagnosis of glomerulopathies, it is necessary to assess morphological changes with the formulation of an immunofluorescence reaction and electron microscopy.The aim: to analyze the clinical manifestations, frequency and structure of glomerulopathies in kidney neoplasms.Patients and Methods. The study included 141 patients. The patients underwent nephrectomy, the daily protein loss, the number of altered erythrocytes in the urine, the level of creatinine in the blood serum were determined, and the glomerular filtration rate (CKD-EPI) was calculated. Morphological evaluation of samples included immunofluorescence reaction and electron microscopy. To assess the statistical significance of the relationship between variables, Spearman's nonparametric rank correlation coefficient (Rs) was calculated. The results obtained were considered significant at p<0.05. RESULTS. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies. CONCLUSION. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist Keywords: tumor, glomerulonephritis, diabetic nephropathy, glomerular filtration rate> ˂ 0.05.Results. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies.Conclusion. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist.

Impact of physical activity in non-dialysis CKD patients followed in a multidisciplinary care network on the progression of chronic renal failure – PHYSALYS study

Physical activity (PA), has a proven effect on overall health. The study assessed the difference in glomerular filtration rate (GFR) over one year in non-dialysis renal failure patients between those who practiced exercise (P) and those who did not (NP). Patients were categorised as P or not P using the Global Physical Activity Questionnaire (GPAQ2), completed by telephone, at inclusion and at 12 months. Among the 259 patients included, 195 (75.3%) practiced a PA and 64 (24.7%) did not practiced. There was no significant difference in the slope of GFR decline from inclusion to month 12 between the two groups, p = 0.4107. Only the type of kidney seemed to be significantly associated with the slope of GFR decline over the 12 months (p = 0.0039). These results may be explained by a follow-up time too short to identify an effect of behavioural change on the progression of kidney disease.

#5280 PREVALENCE OF POLYPHARMACY AND ASSOCIATED ADVERSE OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS

Abstract Background and Aims Polypharmacy (PP) continues to increase, and is associated with numerous adverse clinical outcomes and mortality. Although the burden of medication in kidney transplant recipients (KTRs) is well-known, PP has not been characterized in detail in the KTRs. The aim of this study was to assess the prevalence of PP among KTRs and the association between PP and clinical outcomes in the KTRs. Method A total of 1,080 KTRs from multicenter observational cohort study in Korea between 2012 and 2016 (KNOW-KT) were included in the study. PP was defined as the use of more than 10 medications per day. Results The PP prevalence at 1, 2, 3, 5, and 8 years after transplantation was 37.9%, 37.3%, 36.5%, 37.1% and 25.4%, respectively. The prevalence of diabetes, dyslipidemia and history of cardiovascular disease was significantly higher in PP group than in non-PP group (the use of fewer than 10 medications). The mean follow-up period was 6.9 years, and there were 69 graft failures, 63 new-onset cardiovascular diseases, and 36 deaths. When the effect of PP prescribed at 1-year post-transplant on clinical outcomes was analyzed, there was no difference in glomerular filtration rate between the non-PP and PP groups, and the hazard ratio of graft failure and death in the PP group was 1.07 (0.718 to 1.59) and 1.37 (0.71 to 2.64), respectively, compared to the non-PP group. However, multivariate analysis adjusted for classical risk factors showed that PP independently increased the risk of new cardiovascular disease (adjusted HR 1.78 (1.07-2.96)) after KT. Conclusion These results showed that PP is common in KTRs, and considering the adverse effects of PP on KT outcomes, physician's attention and efforts are needed to systematically manage and prevent inappropriate PP after KT. Long-term and large-scale research is needed to establish management guidelines for PP in the future.

Sex and strain differences in renal hemodynamics in mice.

The present study was to examine sex and strain differences in glomerular filtration rate (GFR) and renal blood flow (RBF) in C57BL6, 129/Sv, and C57BLKS/J mice, three commonly used mouse strains in renal research. GFR was measured by transdermal measurement of FITC-sinitrin clearance in conscious mice. RBF was measured by a flow probe placed in the renal artery under an anesthetic state. In C57BL6 mice, there were no sex differences in both GFR and RBF. In 129/Sv mice, females had significantly greater GFR than males at age of 24 weeks, but not at 8 weeks. However, males had higher RBF and lower renal vascular resistance (RVR). Similar to 129/Sv, female C57BLKS/J had significantly greater GFR at both 8 and 24 weeks, lower RBF, and higher RVR than males. Across strains, male 129/Sv had lower GFR and higher RBF than male C57BL6, but no significant difference in GFR and greater RBF than male C57BLKS/J. No significant difference in GFR or RBF was observed between C57BL6 and C57BLKS/J mice. Deletion of eNOS in C57BLKS/J mice reduced GFR in both sexes, but decreased RBF in males. Furthermore, there were no sex differences in the severity of renal injury in eNOS-/- dbdb mice. Taken together, our study suggests that sex differences in renal hemodynamics in mice are strain and age dependent. eNOS was not involved in the sex differences in GFR, but in RBF. Furthermore, the sexual dimorphism did not impact the severity of renal injury in diabetic nephropathy.

The effect of rs776746 polymorphism in the <i>CYP3A5</i> gene on heart rate when using bisoprolol in patients with acute coronary syndrome

Aim. The aim of this work was to study the occurrence of the rs776746 allelic variant of the CYP3A5 gene and its effect on heart rate (HR) when using bisoprolol in patients hospitalized with acute coronary syndrome (ACS).Materials and methods. The study included patients with ACS who were prescribed bisoprolol for clinical indications. All patients underwent molecular genetic testing. In order to evaluate the effectiveness of the therapy with bisoprolol, all patients underwent Holter electrocardiogram (ECG) monitoting on days 10, the following parameters were assessed: minimum, average, maximum heart rate and heart rate during an exercise test. The stress test was performed as a ladder test.Results. The study involved 97 patients (63,5±10,5 years), including 60 men and 37 women. The frequency of occurrence of the desired alleles of the CYP3A5 gene was: CYP3A5*3 - 93%, and CYP3A5*1 - 7%, which corresponds to its prevalence in the European population. 84 carriers of the CYP3A5*3*3 genotype (87%), 12 heterozygous carriers of the *1 allele (12%) and one patient with the *1*1 genotype (1%) were identified. In order to search for differences in the effects of bisoprolol depending on the genetically predetermined activity of CYP3A5, we divided the general group of patients into two subgroups: subgroup 1 (CYP3A5*3*3), represented by carriers of the genotype associated with the synthesis of the inactive form of CYP3A5, and subgroup 2 (CYP3A5*1*3 and CYP3A5*1*1), represented by carriers of at least one allele encoding the synthesis of a fully functional protein CYP3A5, coupled with an increased metabolic rate. Patients did not differ in clinical and demographic characteristics. By the time of daily ECG monitoring, both groups reached comparable heart rate values. In carriers of at least one CYP3A5*1 allele (n = 13), associated with an increased metabolic rate, the daily dose of bisoprolol on the 10th day of hospitalization was significantly higher (p <0.05). The only carrier of the homozygous CYP3A5 *1*1 variant receives bisoprolol at a daily dose of 10 mg. Taking into account the close to significant differences in glomerular filtration rate (GFR) in patients in the groups with the studied genetic variants, and the known eliminating role of the kidneys for bisoprolol, a linear regression model was built with the inclusion of factors that could affect the dose of bisoprolol: GFR, functional class of chronic heart failure, gender, age, number of simultaneously assigned CYP3A5 substrates. Of the parameters listed, only the CYP3A5 genotype significantly predicted the dose of bisoprolol (F=8.5; p<0.005; R2=0.096).Conclusion. In this study, it was demonstrated for the first time that patients with different genetic variants of CYP3A5, in particular with respect to the rs776746 polymorphism, may differ in individual requirements for the dose of bisoprolol.

Differences in glomerular filtration rate estimated with the new eGFRcr CKD EPI age and sex 2021 vs. the eGFRcr CKD EPI 2009 formula.

Article Differences in glomerular filtration rate estimated with the new eGFRcr CKD EPI age and sex 2021 vs. the eGFRcr CKD EPI 2009 formula was published on July 4, 2022 in the journal Advances in Laboratory Medicine / Avances en Medicina de Laboratorio (volume 0, issue 0).

MO433: Nitric-Oxide Precursors and Dimethylarginines as Risk Factors for Accelerated GFR Decline in the Non-Diabetic General Population

Abstract BACKGROUND AND AIMS Nitric oxide (NO) deficiency is associated with endothelial dysfunction, hypertension, vasoconstriction, atherosclerosis and chronic kidney disease (CKD) [1]. Reduced NO bioavailability is hypothesized to play a vital role in kidney function impairment and CKD. The worldwide prevalence of CKD is increasing and is a major contributor to morbidity and mortality. Differences in glomerular filtration rate (GFR) are only partly explained by conventional CKD risk factors [2]. Therefore, we investigated the association of serum levels of endogenous inhibitors of NO, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) and precursors of NO, arginine, citrulline and ornithine, with a decline in GFR and new-onset CKD. METHOD In a prospective cohort study of 1407 participants in the Renal Iohexol Clearance Survey (RENIS) without self-reported kidney disease, cardiovascular disease, or diabetes, GFR was measured repeatedly with iohexol clearance during a median follow-up time of 11 years [3]. GFR decline rates were analysed using a linear mixed model, new-onset CKD (GFR < 60 ml/min/1.73 m2) with interval-censored Cox regression and accelerated GFR decline (the 10% with the steepest GFR decline) with logistic regression. RESULTS Neither ADMA nor arginine was associated with any outcomes. Higher SDMA was associated with a slower annual GFR decline and a lower arginine/dimethylarginine ratio with a steeper GFR decline. Higher levels of citrulline and ornithine were associated with accelerated GFR decline with an odds ratio (OR) of 1.43 [95% confidential interval (CI) 1.16–1.76] per standard deviation (SD) higher citrulline and an OR of 1.23 (95% CI 1.01–1.49) per SD increase in ornithine (Table 1). Higher citrulline was associated with new-onset CKD, with a hazard ratio of 1.31 (95% CI 1.05–1.63) per SD higher citrulline. CONCLUSION Associations between NO precursors and the outcomes suggest that NO-metabolism plays a significant role in the pathogenesis of age-related GFR decline, and the development of CKD in middle-aged people. Our findings warrant further investigation into the pathogenesis of NO-metabolism and the possible therapeutic targets and preventive measures.

Comparison of chlorthalidone and spironolactone as additional diuretic therapy in patients with acute heart failure and preserved ejection fraction.

Patients with acute heart failure (AHF) require intensification in the diuretic strategy. However, the optimal diuretic strategy remains unclear. In this work, we aimed to evaluate the effect of chlorthalidone compared with spironolactone on diuretic efficacy and safety profile in a cohort of patients with AHF and preserved ejection fraction (AHF-pEF). It was a prospective observational study in a single centre in Spain, included 44 consecutive patients admitted between June 2020 and March 2021, with AHF-pEF in which an additional diuretic was prescribed. The primary endpoint was changes in urinary sodium at 24 and 72 h, and the secondary were urine output, and other security endpoints. Mixed linear regression models were used to analyse the endpoints. Estimates were reported as least squares mean with their respective 95% confidence intervals. The median age of the study population was 85 years (82.5-88.5), and 30 (68.2%) were women. After multivariate analysis, the linear mixed regression analysis confirmed a greater natriuretic response of chlorthalidone over spironolactone, especially at 24 h (P = 0.009). Multivariate analysis also showed a greater cumulative diuretic response in those treated with chlorthalidone (P = 0.001). We did not find significant differences in glomerular filtration rate, serum sodium, and serum potassium at 72 h, neither significant differences were found in 24 and 72 h in systolic blood pressure. In patients with AHF and left ventricular ejection fraction ≥50% receiving intravenous loop diuretics, chlorthalidone administration was associated with a greater short-term natriuresis.

Differences in advanced glycation endproducts (AGEs) in plasma from birds and mammals of different body sizes and ages

Birds and mammals provide a physiological paradox: similar-sized mammals live shorter lives than birds; yet, birds have higher blood glucose concentrations than mammals, and higher basal metabolic rates. We have previously shown that oxidative stress patterns between mammals and birds differ, so that birds, generally, have lower blood antioxidant capacity, and lower lipid peroxidation concentration. There is a close association between oxidative stress and the production of carbohydrate-based damaged biomolecules, Advanced Glycation End-products (AGEs). In mammals, AGEs can bind to their receptor (RAGE), which can lead to increases in reactive oxygen species (ROS) production, and can decrease antioxidant capacity. Here, we used plasma from birds and mammals to address whether blood plasma AGE-BSA concentration is associated with body mass and age in these two groups. We found a statistically significantly higher average concentrations of AGE-BSA in birds compared with mammals, and we found a significantly positive correlation between AGE-BSA and age in mammals, though, this correlation disappeared after phylogenetic correction. We propose that the higher AGE concentration in birds is mainly attributable to greater AGE-production due to elevated basal glucose concentrations and decreased AGE-clearance given differences in glomerular filtration rates in birds compared with mammals. Additionally, due to the potential lack of an AGE receptor in birds, AGE accumulation may not be closely linked to oxidative stress and therefore pose a lesser physiological challenge in birds compared to mammals.

Glomerular Function and Urinary Biomarker Changes between Vancomycin and Vancomycin plus Piperacillin-Tazobactam in a Translational Rat Model.

Clinical studies have reported additive nephrotoxicity associated with the combination of vancomycin (VAN) and piperacillin-tazobactam (TZP). This study assessed differences in glomerular filtration rate (GFR) and urinary biomarkers between rats receiving VAN and those receiving VAN + TZP. Male Sprague-Dawley rats (n = 26) were randomized to receive 96 h of intravenous VAN at 150 mg/kg/day, intraperitoneal TZP at 1,400 mg/kg/day, or VAN + TZP. Kidney function was evaluated using fluorescein-isothiocyanate sinistrin and a transdermal sensor to estimate real-time glomerular filtration rate (GFR). Kidney injury was evaluated via urinary biomarkers, including kidney injury molecule-1 (KIM-1), clusterin, and osteopontin. Compared to a saline control, only rats in the VAN group showed significant declines in GFR by day 4 (-0.39 mL/min/100 g body weight; 95% confidence interval [CI], -0.68 to -0.10; P = 0.008). When the VAN + TZP and VAN alone treatment groups were compared, significantly higher urinary KIM-1 marginal linear predictions were observed in the VAN alone group on day 1 (18.4 ng; 95% CI, 1.4 to 35.3; P = 0.03), day 2 (27.4 ng; 95% CI, 10.4 to 44.3; P = 0.002), day 3 (18.8 ng; 95% CI, 1.9 to 35.8; P = 0.03), and day 4 (23.2 ng; 95% CI, 6.3 to 40.2; P = 0.007). KIM-1 was the urinary biomarker that most correlated with decreasing GFR on day 3 (Spearman's rho, -0.45; P = 0.022) and day 4 (Spearman's rho, -0.41; P = 0.036). Kidney function decline and increased KIM-1 were observed among rats that received VAN only but not those that received TZP or VAN + TZP. The addition of TZP to VAN does not worsen kidney function or injury in our translational rat model.

Blood pressure and glomerular filtration rate in obese adolescents

Background: Obesity in children has the potential to increase the risk of morbidity and even death in the future. One of the diseases that are at risk due to obesity is hypertension and also impaired kidney function. Glomerular filtration rate differences in obese and normal-weight children are somehow contradictory. This study aims to prove the difference in blood pressure and kidney function in adolescents with obese and non-obese.Methods: A cross-sectional study was conducted among high school children in Denpasar. Subjects were classified as obese and non-obese. The Mann-Whitney test was used to assess the mean difference of blood pressure, whereas the Independent t-test was used to determine the mean difference of GFR. Multivariate analysis was performed with logistic regression and ANCOVA. Data were analyzed using SPSS version 20 for Windows.Results: A total of 68 subjects with obese and 52 subjects with non-obese were included in this study. Systolic and diastolic blood pressure in the obese group was higher than in a non-obese group, with the mean difference in systolic and diastolic blood pressure was 29 mmHg (P<0.001) and 18 mmHg (P=0.002), respectively. Obesity increases the risk of hypertension 9.78 times (95% CI: 1.86-51.39; P=0.007), and obese adolescents have an average GFR of 11.51 lower than non-obese (95% CI: 17.32 – (-5.69); P<0.001).Conclusion: Hypertension is higher in obese adolescents than non-obese, while glomerular filtration rate is lower than non-obese adolescents.

Dynamics of changes in renal function in patients undergoing radical cystoprostatectomy with various variants of heterotopic reservoir

Relevance. Chronic renal failure in patients undergoing radical cystoprostatectomy (RCPE) with various variants of urine derivation is one of the significant problems that requires an interdisciplinary approach. To date, there is an insufficient number of studies comparing a significant decrease in glomerular filtration rate (GFR) between different types of urine diversion after radical cystectomy. Purpose of research. To study glomerular filtration rate (GFR) indicators in patients who underwent radical cystectomy with a heterotopic Bricker reservoir and compare them with similar indicators in patients who underwent radical cystectomy with a « V « shaped heterotopic reservoir. To compare early postoperative complications in patients who underwent radical cystoprostatectomy with the formation of a heterotopic Bricker reservoir and with a modified V-shaped heterotopic reservoir. Materials and methods. To study and compare the dynamics of glomerular filtration rate (GFR), we retrospectively selected patients after radical cystoprostatectomy with heterotypic ileocystoplasty. Patients were divided into two groups: the control group — patients with radical cystoprostatectomy and Bricker ileocystoplasty (n=46), the study group — patients with radical cystoprostatectomy and modified V-shaped heterotopic ileocystoplasty (n=49). Results. At the stage of discharge of patients from the hospital after radical cystoprostatectomy, the level of glomerular filtration rate (GFR) was not statistically significant differences between the study and control group (P=0.3791), including patients with the presence of hydronephrosis (P=0.4664). The difference in glomerular filtration rate (GFR) between the study group and the control group was statistically significant after 6 years of dynamic follow-up. As a result, it can be argued that the dynamics of glomerular filtration rate (GFR) reduction in the study group is lower than in the control group. A particularly significant difference in glomerular filtration rate (GFR) was observed in patients with existing hydronephrosis at the preoperative stage. Conclusion. Modified «V» — shaped heterotopic urine derivation can be recommended for patients who have undergone radical cystoprostatectomy, especially with existing hydronephrosis at the preoperative stage. This method should be used in patients with chronic pyelonephritis against the background of previously diagnosed ureterohydronephrosis, which is a fairly frequent consequence of the invasive nature of the growth of bladder cancer with ureteral obstruction.

The effect of early everolimus administration on the renal function while reducing the dosage of calcineurin inhibitors in liver transplant recipients in a long-term follow-up

Introduction. The lifelong use of calcineurin inhibitors in liver transplant recipients leads to an increased incidence of chronic kidney disease.Objective. To compare the changes in glomerular filtration rate over five years in liver transplant recipients between those on everolimus with a reduced exposure to calcineurin inhibitors and those on standard doses of calcineurin inhibitors.Material and methods. Fourteen liver transplant recipient switched to everolimus with a minimization of calcineurin inhibitors exposure in the first months after liver transplantation from February 2009 to February 2015 who had received that therapy continuously for at least 60 months were included in the case-control study. Twenty eight liver transplant recipients (matched by sex, etiology of the underlying disease, calcineurin inhibitors) who were followed-up for at least 60 months after liver transplantation, who had received no dose of everolimus, in whom the glomerular filtration rate could be calculated at all points of analysis were selected as a comparison group (1:2). Glomerular filtration rate was calculated immediately before liver transplantation; 12, 24, 36, 48, and 60 months after liver transplantation. The glomerular filtration rate after liver transplantation was also calculated for liver transplant recipients from the main group immediately before the conversion to everolimus.Results. Before liver transplantation, the median of glomerular filtration rate in the main group of liver transplant recipients was lower (81.2 ml/min) than in the comparison group (97.5 ml/min, p=0.01). After liver transplantation, the renal function worsened in both groups of patients. In a pairwise comparison, the medians of glomerular filtration rate were statistically significantly lower after 12 months, 24 months, 36 months, 48 months after liver transplantation, than before liver transplantation. The median of glomerular filtration rate at the time of immunosuppression conversion was 44.3 ml/min. After the conversion of immunosuppression, the median of glomerular filtration rate gradually increased, and after 36 months the differences in glomerular filtration rate reached statistical significance compared with the level before conversion (69.4 ml/min;p=0.048). These differences still increased after 60 months after conversion (72.3 ml/min; p=0.041).Conclusion. Long-term administration of everolimus with minimization of calcineurin inhibitors exposure with the early conversion to this immunosuppression regime provides a steady improvement in renal function in liver transplant recipients with a low glomerular filtration rate in the preoperative and early post-transplant period.

A single dose of aminophylline administration during therapeutic hypothermia; does it make a difference in glomerular filtration rate?

Aminophylline has been demonstrated to be effective in improving renal functions of the infants suffering from acute kidney injury (AKI) due to perinatal asphyxia. We aimed to evaluate the effect of a single-dose aminophylline on estimated glomerular filtration rate (eGFR), urine output (UO), and incidence and severity of AKI according to the pediatric-modified RIFLE and neonatal RIFLE criteria in newborns with perinatal asphyxia under therapeutic hypothermia. This was a single-center, retrospective cohort study including newborns (gestational age ≥36 weeks) who underwent therapeutic hypothermia due to hypoxic ischemic encephalopathy between 2016 and 2019. Demographic and clinical data were obtained from electronic medical records and patient files. Two patient groups were established: aminophylline group and control group which were only under therapeutic hypothermia. Twenty-one newborns were in the aminophylline group and 13 newborns were in the control group. Our study revealed that on the third day of life (DOL), eGFR was significantly higher in the control group (p=0.025), but UO was significantly higher in the aminophylline group (p=0.021). In the aminophylline group, eGFR on the first DOL was higher than the value on the second DOL (p=0.017) while UO was higher on the second and third DOL compared to the first DOL (1-2 DOL p=0.006, and 1-3 DOL p=0.004). However, in the control group, there was no statistically significant difference in UO over the four DOL. Both groups were similar in the presence, severity, and outcome of AKI.Conclusion: This study demonstrated that aminophylline increases UO even in the infants under therapeutic hypothermia. However, the eGFR did not significantly increase in the aminophylline group. Understanding how therapeutic hypothermia affects pharmacokinetics may help us improve our results in future studies. What is known: • Therapeutic hypothermia (TH) reduces the incidence of acute kidney injury in asphyxiated newborns. • Aminophylline is effective in improving renal functions in asphyxiated newborns. What is new: • This is the first study evaluating the effect of a single dose of aminophylline on renal functions in newborns under TH. • A single dose of aminophylline administration in newborns under TH was associated with increased urine output especially on the third day of life. However, no significant increase was detected in glomerular filtration rate associated with aminophylline administration.

Early Renal Function Alterations in Renal Branches vs. Renal Fenestrations – A Dynamic Scintigraphy Based Prospective Study

The objective of this prospective single centre study was to assess whether branches and fenestrations have different outcomes on renal function in the early phase. From March 2018 to June 2019, 67 patients who underwent elective fenestrated and branched endovascular aneurysm repair (F/BEVAR) procedures were enrolled in this study. The patients were divided into two groups according to the renal bridging component configuration (fenestration vs. branch). All of them underwent dynamic renal scintigraphy with 99mTc diethylenetriaminepentaacetic acid (DTPA), two weeks pre-operatively, and three months and one year post-operatively. The primary end points were peri-procedural technical success, 30 day major adverse events, differences in glomerular filtration rate (GFR) between the branch and fenestration configurations, and variations between the pre-operative and the post-operative dynamic renal scintigraphy. Overall, 135 kidneys were analysed: 63 in the 32 patients treated with fenestrations, and 72 in the 35 patients treated with branches; the mean GFR on baseline scintigraphy was 58.4±30.9mL/min in the fenestration group, and 65.1±29.2mL/min in the branch group. Only kidneys associated with a patent fenestration/branch were included in the split GFR final analysis. The mean total GFR at three month scintigraphy decreased by 6.0±2.9mL/min in the fenestration group and by 23.4±6.4mL/min in the branch group. The split GFR decreased by 3.5±0.6mL/min in the fenestration group, and by 15.4±5.4mL/min in the branch group. The GFR decrease remained stable at one year. In this study, the use of branches for renal arteries during F/BEVAR resulted in a greater decrease in the GFR than in those patients who were treated with fenestrations alone. The scintigraphic alterations were evident at an early phase.

Stroke Prevention in Patients with Atrial Fibrillation in Real Clinical Practice, Emphasis on Efficacy and Safety of Anticoagulant Therapy

Aim To evaluate frequency of administration of anticoagulant therapy (ACT) for atrial fibrillation and to study the effect of chronic antithrombotic therapy (ATT) on kidney function.Material and methods Due to a high medical and social significance of AF, much attention is presently paid to appropriate administration of ACT for AF in clinical practice. The study retrospectively analyzed 776 case reports of hospitalized patients with AF. The effect of chronic ATT on kidney function was studied in 70 patients who were rehospitalized, including 25 patients treated with warfarin, 25 patients treated with direct oral anticoagulants (DOAC), and 20 patients treated with acetylsalicylic acid (ASA).Results In January 2014, at the prehospital stage, 74.3 % of patients did not receive ATT, 14.7 % of patients received antiplatelet therapy, and only 11 % received anticoagulants. In the hospital in January 2014, ACTs were administered to 74.3 % of patients (warfarin, 58.6 %; DOAC, 15.7 %), 20.6 % of patients received antiplatelet drugs, and 5.1 % of patients were discharged without ATT. In January 2019, the number of patients receiving ACT at the prehospital stage increased to 58.1 % (warfarin, 13.8 %; DOAC, 44.3 %); 12 % of patients received antiplatelet drugs; and 29.9 % of patients did not receive ATT. The number of patients treated with warfarin and DOAC in the hospital increased to 14.8 % and 70.6 % (rivaroxaban, 33.4 %; apixaban, 25.5 %, and dabigatran, 11.7 %), respectively. The number of patients taking antiplatelet drugs decreased to 3.7 %, and the number of patients without ATT decreased to 10.9 %. There were no statistically significant differences in glomerular filtration rate (GFR) between these three groups at baseline. Only in the warfarin treatment group, GFR was significantly decreased from baseline during the follow-up period. Comparison of GFR in three study groups at the finale stage of the study showed significant differences between mean GFRs in the warfarin treatment group and the DOAC treatment group and between the warfarin treatment group and the ASA treatment group.Conclusion Among the prescribed and taken anticoagulants, DOACs are presently in the first place. Among DOACs, the most frequently prescribed drug is rivaroxaban. GFR decreases with the DOAC treatment slower than with the warfarin treatment. Despite the slower decrease in GFR with the ASA treatment compared to warfarin, ASA is not indicated for prevention of stroke in AF due to its low efficacy.

MP03-06 ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEY FUNCTION DECLINE

INTRODUCTION AND OBJECTIVE: Prior studies have shown significant differences in glomerular filtration rate (GFR) between stone formers and non-stone formers. There is evidence that nephrolithiasis is a risk factor for chronic kidney disease (CKD). The role of kidney function in kidney stone formation however largely remains unexplored. The objective of this study is to investigate differences in kidney function decline between stone formers and non-stone formers over time. METHODS: A retrospective study was undertaken using de-identified patient data at our tertiary care center. Serum creatinine values of adults (age ≥ 18) were used to calculate GFR using the CKD-EPI creatinine equation. The primary outcome was change in GFR per year using an adjusted linear model. An adjusted cox-model was used to calculate the average risk of stone formation associated with GFR decline in stone formers based on date of initial nephrolithiasis diagnosis. Our secondary outcome was GFR change post stone formation stratified by surgical versus non-surgical intervention. RESULTS: Complete data for analysis was obtained from 3,450 stone formers and 112,072 non-stone formers after review of medical record data between 2010 and 2019. Stone formers had an overall GFR decline of 2.8 cc/min per year (p-value < 0.001) compared to a decline of 0.04 cc/min per year (p-value = 0.38) in non-stone forming patients. A fully adjusted cox-model indicated, on average, each 1 cc/min decline in GFR was associated with an increased risk of stone development in the following 2 years by 3.7%. Stone formers who underwent surgical intervention (PNL, URS, or SWL) had stable GFR post-operatively at 1 year. Patients who did not undergo surgical intervention had GFR decline of 0.82 cc/min CI [-1.56, -0.08] at 1 year (p-value = 0.03). CONCLUSIONS: A decline in GFR is associated with risk of kidney stone presentation up to 2 years prior to a stone event. This suggests that upstream changes in the renal papilla which affect GFR also may be contributing to mineralization. Kidney function decline could be used as a possible predictive tool for risk of stone formation. Additionally, surgical intervention is associated with preservation of GFR within one year after stone event. Clinically, unexplained GFR decline should increase suspicion for nephrolithiasis and appropriate evaluation and treatment should be considered.Source of Funding: none

Using race in the estimation of glomerular filtration rates: time for a reversal?

Bedside estimates of renal function are essential for clinical practice in the modern era and have largely relied on serum creatinine concentrations despite the known drawbacks associated with this choice of biomarker, including the fact that creatinine clearance overestimates the glomerular filtration rate. Initial estimates relied primarily on equations that incorporated factors known to influence creatinine concentrations such as age, sex and anthropometric measures. More recent estimates of glomerular filtration rate have replaced the anthropometric measures with the social construct of race, suggesting that glomerular filtration rates for black individuals are higher at the same concentration of creatinine. This approach has led to large variations in the estimated differences in glomerular filtration rate between black and nonblack individuals in the United States that have not been reproducible, resulting in a plethora of population-specific formulae across the country. The introduction of race in estimated glomerular filtration rate equations may have potential unintended negative consequences for the very population with the greatest burden of kidney disease. These potential disadvantages underscore the need to perhaps return to the replacement of race with more objective anthropometric measures without the loss of precision.

Comparative outcomes of radio frequency ablation versus partial nephrectomy for T1 renal tumors: a systematic review.

The role of radio frequency ablation (RFA) in small renal tumors remains controversial. This systematic review was performed to compare clinical outcomes of RFA versus partial nephrectomy (PN) for the treatment of T1 renal tumors. A total of 11 studies including 2,397 patients were analyzed in this systematic review after searching the databases of PubMed, EMBASE and Web of Science. P value and odds ratio (OR)/hazard ratio (HR) with 95% confidence interval (CI) were used to evaluate the strength of the association. A total of six studies (2,056 patients) provided either survival curves or HR and its 95% CI, demonstrating that the majority of the patients with RFA treatment tended to exhibit a similar long-term survival rate to those with PN treatment. In addition, according to four studies, no differences were found in the overall rate of complications between the two groups. Furthermore, there were significant differences in glomerular filtration rate (GFR) change between the two methods in four studies but no differences were observed in other two. Our systematic review indicated that RFA is an effective treatment option which could provide comparable oncologic outcomes to PN. Moreover, it may present obvious advantages in renal function preservation.

Evaluation of Kidney Function Parameters in Diabetic Rats Following Virgin Coconut Oil Diet.

Diabetes mellitus (DM) leads to disruption of kidney function parameters (KFPs) which are markers of kidney diseases, especially nephropathy. Virgin coconut oil (VCO) has been implicated in playing a significant role in DM management. However, its role on KFPs in DM is scarce. To evaluate the kidney function parameters following VCO diet in diabetic rats. Twenty-five (25) male rats of 150 - 200 g were divided into 5 groups (n=5): Non-diabetic control (Group 1), diabetes control (Group 2), diabetes + metformin (Group 3), diabetes + 10% VCO (Group 4) and diabetes + 20% VCO (Group 5). Apart from Group 1, other groups were given intraperitone-ally 50 mg/kg of streptozotocin to induce diabetes mellitus. After 72 hours, fasting hyperglycaemia was confirmed by glucose oxidase method. All the rats were fed normal rat chow for 8 weeks. At 8th week, serum and urine samples were analysed for biochemical analysis. After 8 weeks, Group 1 and Group 2 continued to be fed on normal rat chow while other groups were treated with diets (VCO) or drug (metformin) for 4 weeks. At 12th week, urine samples were collected for biochemical analysis, the rats were sacrificed, and blood samples were collected by cardiac puncture. There were significant differences in some KFPs in diabetes control (Group 2) compared to other experimental groups. However, there was no significant difference in glomerular filtration rate (GFR) and serum sodium in all the groups. VCO supplementary diet improved the altered KFPs and could be a therapy for kidney problems.