Early Renal Disease Research Articles

410-P: Two-Year (2y) eGFR Slope in People with Type 2 Diabetes (T2D) Receiving a Very Low Carbohydrate Diet (VLCD) Intervention

A VLCD including nutritional ketosis is an effective T2D intervention, but its use is cautioned in renal disease. We compared eGFR slope among people with T2D with varying renal function who received a VLCD intervention via continuous remote telemedicine care (CCI, n=262) or Usual Care without carbohydrate restriction (UC, n=87) over two years. Four ketosis trajectory classes (KTs) were identified within CCI using latent class trajectory modeling. We compared eGFR slopes for CCI KTs using a linear mixed effect model with UC as the reference. The eGFR slope was positive in all CCI KTs and negative in UC (Table 1). eGFR slope improved in CCI (p=0.045), in sustained nutritional ketosis (SNK) group (p=0.01), and in those with baseline eGFR <90 (p<0.001) compared with UC. KT with higher blood ketones (SNK and MDNK) had greater eGFR rise. These results show that eGFR slopes rose in people with T2D on CCI and declined in UC. Rise of eGFR slope appears to have a dose-dependent relationship with endogenous ketone concentration and duration of maintenance of ketosis, including those with stage 2 chronic kidney disease, suggesting nutritional ketosis VLCD may provide benefit rather than risk in early renal disease. Disclosure S.J.Athinarayanan: Employee; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.D.Phinney: Board Member; Virta Health Corp., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. J.Volek: Stock/Shareholder; Virta Health Corp. A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp.

1373-P: The Prevalence and Risk Factors of Chronic Kidney Disease in Patients with Type 2 Diabetes in China—A Cross-Sectional Study

Chronic Kidney Disease (CKD) is a major long-term complication of diabetes and the leading cause of end-stage kidney disease worldwide. It has become very important to regularly screen for early renal disease and rationally use medicines in patients with diabetes and CKD. This was a cross-sectional study, an analysis of baseline data from an ongoing prospective multicenter cohort study, ClinicalTrials.gov ID: NCT05047471. The subjects were outpatients and inpatients from 45 hospitals participating in the endocrinology department from December 2021 to September 2022. Univariate and multivariate binary logistic regression were used to identify risk factors correlated to CKD in patients with type 2 diabetes (T2D). A total of 9886 patients with T2D met our inclusion criteria, please refer to table 1 for the baseline characteristics. The prevalence, screening rate, and awareness rate of CKD was 32.5% [95%CI 31.6, 33.4], 55.3% [95%CI 54.3, 56.3], and 26% [95%CI 24.5, 27.6], respectively. The risk factors independently associated with CKD in patients with T2D were age, duration of T2D, hypertension, LDL-C elevated, poor glycemic control, diabetic foot, diabetic retinopathy, diabetic neuropathy etc., shown in table 2. This work will be helpful in promoting the standardized diagnosis and treatment of CKD in patients with T2D in China, and in arousing the attention of patients with T2D to CKD. Disclosure D.Zhu: None. Y.Mu: Speaker's Bureau; Abbott Diabetes, Boehringer Ingelheim Inc., Novo Nordisk (China), Sanifit. L.Shi: None. Y.Xue: None. X.Yu: None. Y.Wang: None. T.Hong: Speaker's Bureau; Novo Nordisk (China), Sanofi China, Eli Lilly and Company, Merck Sharp & Dohme Corp., Merck & Co., Inc., Boehringer Ingelheim Inc., AstraZeneca, Bayer Inc. X.Li: None. J.Ma: None. Funding Beijing Great Physician Commonwealth Foundation (DYJ20210621)

A COMPARATIVE STUDY ON CHRONIC KIDNEY CANCER PREDICTION USING SUPERVISED MACHINE LEARNING ALGORITHMS

Early detection and appropriate treatment can halt or postpone the progression of this chronic condition until the point at which kidney transplantation or dialysis are the only options left for saving the patient's life. Consequently, it is crucial to have reliable tools for the purpose of early chronic renal disease detection.In this paper we will be using supervised machine learning models to predict chronic kidney disease.We integrated the influencing factors of Chronic kidney cancer ,collected a sample dataset , conducted data analysis and optimized the dataset .A kidney cancer prediction model was created using five supervised machine learning algorithms: Xgboost, gradient boosting, support vector machine, logistic regression, and random forest classifier.The predictive performance of these five algorithms were compared and discussed..The models are compared using a variety of metrics, including accuracy, precision, recall, F1 score, etc. The results of the experiment demonstrate that the random forest algorithm is the most accurate method for predicting kidney cancer. Key Words: Chronic kidney disease, Classification metrics, Logistic regression, Xgboost , Random forest classifier, Support vector machine, Gradient boosting

DF-5 COMPOUND DELAYS DEVELOPMENT OF DIABETIC NEPHROPATHY IN RATS

Advanced glycation end-products play an important role in the development of diabetic complications, so slowing down of glycated proteins’ cross-links formation have been suggested as a potential therapeutic option for the treatment of vascular diabetic complications and preventing their progression.The aim of the work was to assess the influence of novel anticrosslinking agent DF-5 on the renal advanced glycation end-products and collagen contents, body weight, blood glucose and glycated hemoglobin levels and the development of early renal disease in streptozotocin-induced diabetic rats.Materials and methods. 40 male Sprague-Dawley rats were used in the study. Two months after inducing diabetes, the study substance was administered intragastrically once a day for 28 days (12.5 mg/kg). Measurements included the assessment of blood glucose and HbA1c levels, the evaluation of the renal function, and the results of histology and immunohistochemical staining of kidneys.Results. A repeated intragastric administration of DF-5 for 30 days significantly reduced the level of HbA1c in the blood, but did not affect the level of fasting blood glucose. DF-5 compound significantly reduced proteinuria and prevented kidney damage in experimental animals by limiting damage of the glomeruli and tubules. It was found that DF-5 inhibits the progression of an early renal dysfunction in rats with streptozotocin-induced diabetic nephropathy. This was associated with a decreased accumulation of advanced glycation end-products in the kidney, accompanied by the improvement of both renal morphology and function.Conclusion. The results obtained provide investigators with additional therapeutic options for the treatment of diabetic nephropathy and possibly other complications of diabetes.

Association of Retinal Microangiopathy with Albuminuria in Patient with Chronic Kidney Disease: a Meta-analysis Study.

Chronic kidney disease (CKD) patients suffer renal and cardiovascular problems and early death. In 2016, 13.4% of all ages globally had CKD. Kidney disease, diabetes, and hypertension have a microvascular component. Diabetic retinopathy (DR) and diabetic nephropathy (DN) commonly occur concurrently, indicating that the same mechanisms may be at action in the eyes and kidneys. Chronic kidney disease (CKD) has been a tough medical problem because of late signs and late treatment. Retinal vessels are a non-invasive technique to examine systemic microvasculature. Novel predictors may enhance microvascular disease risk categorization, leading to better therapy. Retinal vascular diameter and retinopathy are reported most often. Numerous investigations have linked this condition to kidney or other systemic disorders. The retinal microvasculature was linked with both the incidence and prevalence of renal illness in this investigation. We wanted to determine whether retinal microvasculature might be utilized to diagnose renal disease. Initial searching found 625 papers, of which 542 articles were rejected due to primary screening unrelated titles and/or abstracts. There were a total of 81 papers selected for full-text evaluation and due to insufficient data provided and duplication, we got 5 papers to enter the next step. In five investigations, retinal microvascular symptoms correlated with albuminuria. All studies connected retinal vascular diameter with albuminuria. As a categorical variable, CRAE narrowed. There was a U-shaped relationship between CRAE and albuminuria in quintiles 1 and 5. There were relationship between albuminuria to a larger CRVE and a narrower CRAE. Studies relate AVR to albuminuria were associated as well. Our investigation demonstrated retinal vascular symptoms are linked to renal illness. Retinopathy correlates with CKD and ESRD in diabetic and nondiabetic individuals. Evidence linking retinal vascular width to early renal disease implies fundus photography might be a useful screening technique for CKD patients. Insufficient evidence links retinal vascular diameter to kidney-related morbidity and death. Future studies should stratify by age, gender, obesity, hypertension, ethnicity, and others.

Plasma exchange and glucocorticoids to delay death or end-stage renal disease in anti-neutrophil cytoplasm antibody-associated vasculitis: PEXIVAS non-inferiority factorial RCT.

Plasma exchange and glucocorticoids to delay death or end-stage renal disease in anti-neutrophil cytoplasm antibody-associated vasculitis: PEXIVAS non-inferiority factorial RCT.

Comparison of Microalbuminuria Status in Type 2 Diabetes Mellitus Patients With Chronic Periodontitis: A Cross-Sectional Study.

BackgroundDiabetes has increased the risk for various other ailments in various organs of the body. This can be contributing to periodontitis also as it is the sixth complication related to diabetes mellitus. There is a bidirectional relationship between both. Given the high global prevalence of type-2 diabetes mellitus (T2DM) with periodontitis, it is of great importance to determine the link between periodontitis and microalbuminuria in T2DM patients, which shows early renal disease.MethodologyIn the present study, a total of 500 patients having T2DM were assessed for periodontitis using Community Periodontal Index (CPI). Anthropometric and biochemical measurements were obtained. Blood samples were estimated for glycemic control tests such as fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and lipid profile. The subjects who participated in the study were categorized into three groups depending on the albuminuria level. The data were tabulated and analyzed using SPSS Statistics software (IBM Corp., Armonk, USA).ResultsOut of 500 T2DM subjects, 342 subjects had periodontitis. A statistically significant difference was found in FPG, HbA1c, total cholesterol (TC), triglycerides, and low-density lipoprotein (LDL) between subjects with periodontitis and without periodontitis using a t-test (p = <0.001). The prevalence of normoalbuminuria, micro-, and macroalbuminuria among periodontitis patients was 24.6%, 72.8%, and 2.6% respectively, and the Chi-square analysis revealed that was highly significant. In terms of albuminuria, one-way analysis of variance (ANOVA) revealed statistically significant differences among the periodontitis subjects for the following variables: inputs such as the number of teeth, diabetes mellitus (DM) duration, the level of LDL, and also the depth of the pocket. Intergroup comparison of variables among subjects with albuminuria using the statistical test of Tukey Post Hoc found that there is a significant difference between normoalbuminuria and microalbuminuria. CPI score, tooth mobility, smoking, education level, family income, tooth brushing duration, along with the use of other dental hygiene aids was also found to be statistically significant among subjects with periodontitis.ConclusionThe study concluded that T2DM patients had a higher incidence of microalbuminuria among individuals with periodontitis. These subjects also had significantly higher HbA1c and FPG levels than subjects with normoalbuminuria. In addition, subjects with periodontitis exhibited a significant reduction in the total teeth numbers present in the case of albuminuria. The longitudinal correlation between DM, microalbuminuria, and periodontitis could be further investigated in detail to explore possible pathways.

Lipoprotein(a) in systemic lupus erythematosus is associated with history of proteinuria and reduced renal function.

Proteinuria is the clinical expression of lupus nephritis and despite recent advances in the therapeutic armamentarium for lupus nephritis, morbidity and mortality rates remain high. Therefore, the identification of factors that predict lupus nephritis is paramount in preventing damage accrual and disease progression. Lipoprotein (a) (Lp[a]) is a primarily genetically inherited plasma lipoprotein with pro-thrombotic and pro-atherosclerotic effects. Elevated Lp(a) has been observed at early stages of renal impairment in the general population and is associated with the development of chronic kidney disease. However, little is known about renal implications of Lp(a) in SLE. Thus, we evaluated Lp(a) and atherosclerotic events, thrombotic events, renal disease, and disease activity in patients with SLE. SLE patients fulfilling the revised American College of Rheumatology (ACR) or SLICC classification criteria with a measurement of Lp(a) were included in the analysis. A cutoff of 125nmol/L was chosen based on expert opinion. Chi-square test was used to compare the differences between patient characteristics and Lp(a) levels. Logistic regression or linear regression were used, where appropriate, to assess the association between Lp(a) values and the measured outcomes. Lp(a) levels from 562 patients were analyzed. There was an association between elevated Lp(a) and a history of proteinuria (OR 1.58, p-value = 0.02). This association remained significant following adjustment for age, sex, race, low C3, and elevated anti-dsDNA (OR = 1.55, p-value = 0.04). There was also an association with eGFR < 60 (p = 0.02). Patients with elevated Lp(a) had higher physician global activity (p = 0.01) and erythrocyte sediment rate (p = 0.03). Elevated Lp(a) was associated with proteinuria, independent of known factors associated with lupus proteinuria, as well as reduced eGFR and physician global activity. Our findings highlight the potential role of Lp(a) as a noninvasive biomarker for early renal disease in SLE.

EE336 Budget Impact Analysis of Nefecon for the Treatment of Primary IgA Nephropathy in the United States

IgA nephropathy (IgAN) is a progressive autoimmune disease caused by an accumulation of immunoglobulin A in the kidneys. Complications can include the development of chronic kidney disease (CKD) and early end stage renal disease which may result in early death. The NefIgArd trial (NCT03643965) demonstrated favorable results for targeted release formulation (TRF)-budesonide compared to placebo for the treatment of primary IgAN. This study aims to assess the budget impact of introducing TRF-budesonide as a novel oral treatment for adult patients with primary IgAN in the United States.

STUDY OF CORRELATION OF RETINOPATHY AND MICROALBUMINURIA IN PATIENT OF ESSENTIAL HYPERTENSION

Background: Hypertension is one of the leading causes of global burden of disease. Essential hypertension produces clinical proteinuria and microalbuminuria and is an early sign of kidney disease. Microalbuminuria has been shown to be a marker for end organ damage and results in retinopathy in the eye. Aims: The aim of the study was to determine the correlation between microalbuminuria and hypertensive retinopathy in patients of essential hypertension. Methods:This cross-sectional study was performed in 100 patients with essential hypertension of a tertiary care teaching hospital in eastern India, conducted between July 2020 to June 2021. Urinary albumin excretion was assessed by turbidimetry method and fundus was examined for grading of hypertensive retinopathy Result: Microalbuminuria was found to be present in 36 % patients of whom 65 % were males and 35% were females. Hypertensive retinopathy was observed in 66.7 % (24) patients, out of which 36 % patients had associated microalbuminuria. (p=0.001871) Conclusion: Investigation must be initiated for evidence of early renal disease in hypertensive patients to prevent MA and the resultant end organ damage. Furthermore, MA had a signicant correlation with retinopathy therefore fundus examination should be undertaken to predict the presence of ongoing vascular damage which can prevent atherosclerotic processes in the entire vascular system

Reliability of different estimated glomerular filtration rate as measures of renal function in children with sickle cell disease

BackgroundThere is no reliable marker for detecting early renal disease in early children with sickle cell disease (SCD). Estimation of glomerular filtration rate (eGFR) as derived from the height/plasma creatinine formula is dependent on the accuracy of the creatinine analytical method used. The aim of this study was to evaluate different equations for eGFR. MethodsChildren aged 5–16 years recruited. mGFR was obtained using plasma disappearance of Inutest/Iohexol, serum creatinine (SCr) was measured either by standard laboratory method or by tandem mass spectrometry (MSMS). Estimated GFR was then calculated either by “Bedside Schwartz method” or by the full-age spectrum (FAS) equation. FindingsA total of 79 patients (mean age 9.8 ± 4.0 years). A revised eGFR constant was calculated for Schwartz equation from the slope of the plot of height/plasma creatinine versus mGFR. Mean values for mGFR (132.7 ± 32.1 ml/min/1.73m2) and eGFR methods compared: eGFR from standard SCr was significantly higher (144.2 ± 37.3 ml/min/1.73m2, p = 0.008). The MSMS eGFR showed the lowest SD (SD = 27.5), while both FAS eGFR and FAS-height eGFR showed the highest correlation coefficient (r = 0.67). InterpretationeGFR calculation based on height and SCr determined with MSMS traceable creatinine is more reliable than Schwartz formula using jaffe/enzymatic methods in SCD children.

Female African Green Monkeys Exhibit Higher Insulin Sensitivity and Lower Blood Pressure than Age‐matched Males

Type 2 Diabetes (T2DM) has become the most prevalent form of diabetes worldwide. In some studies, females have increased insulin sensitivity with greater glucose tolerance than males. Pre-menopausal females may also be protected from early onset T2DM, hypertension and early onset end stage renal disease. A subpopulation of African Green Monkeys (AGM; Chlorocebus aethiops sabaeus) exhibit spontaneous glucose intolerance and co-morbidities such as insulin insensitivity, and spontaneous hypertension. The AGM’ similarities to human pathologies make them an optimal experimental model for diabetes. Thus, we hypothesize that female AGM may differ in insulin sensitivity compared to age-matched males. Healthy, middle-aged AGM were utilized (n= 22 female, n=13 male). Systolic blood pressure (SBP) was measured by forearm plethysmography. Glucose tolerance was assessed via conscious and anesthetized oral glucose tolerance tests (OGTT). All AGM were fasted 12-18 hours with water provided ad libitum. Blood glucose was measured via standard glucometry at 0, 15, 30, 60, 90, and 120 min after an oral glucose load. Conscious AGM’ OGTT were delivered as 0.75g glucose/kg body weight. Anesthetized AGM (ketamine, 15mg/kg, i.m.), received 5g/dl glucose and 15 ml/kg in water. Venous blood samples were taken at 0, 30, 90 and 120 min after glucose administration in anesthetized AGM. All data between conscious and anesthetized OGTT were similar. All AGM were normotensive, however, male SBPs averaged 117.6 ± 4.2 mmHg compared with female SBPs of 104.1 ± 4.1 mmHg (p< 0.05). Female AGM area under the curve (AUC) for glucose was 12,102±466.9 min*mg/dl compared to 13,799.4±564.1 min*mg/dl for males over the 120 min after the glucose load. The peak blood glucose AUC response for females was 6,211.4 ± 219.5 min*mg/dl and 7,482 ±600.1 min*mg/dl in males (p<0.05). Insulin and C-peptide were also compared at the same time points. There were no differences in insulin or C-peptide responses between males and females. Overall renal glomerular function was assessed by measuring fasted, plasma creatinine concentrations. Average plasma creatinine was not different between males and females. These data demonstrate that middle-aged, males have decreased glucose tolerance compared to age-matched females despite similar OGTT induced changes in plasma insulin and C-peptide. Thus, middle-aged males have decreased insulin sensitivity in their response to glucose following an oral glucose load compared to females. All AGM in this study were normotensive however, females had significantly lower SBP than males, indicating that reduced glucose tolerance in males may contribute to elevated SBP. Together, the glucose and SBP data may suggest early onset of T2DM in males compared to age-matched females. This potential early onset T2DM has yet to induce overt alterations in renal glomerular filtration. Long-term studies are needed to assess whether further blood pressure elevation can lead to a decline in renal function and renal injury. Future studies will include differentiation of renal function in males and females including proteinuria, glomerular filtration, and kidney histology of AGM.

POS-337 CANADIAN REAL-WORLD ASSESMENT OF TOLVAPTAN IN ADPKD: C-MAJOR STUDY AND SAFETY MONITORING AND DISTRIBUTION PROGRAM

Tolvaptan is the only approved treatment in Canada for slowing renal function decline and kidney enlargement in ADPKD patients. As per Health Canada requirements, a patient registry evaluating long-term clinical outcomes (the C-MAJOR study) and a hepatic safety monitoring and distribution program (the HSMDP) to mitigate the risk of liver injury were implemented and have been ongoing nationally for 5 years. The aim of this interim analysis is to describe baseline characteristics of patients at initiation of tolvaptan through the C-MAJOR study and to report on rates of treatment persistence and liver test abnormalities through the HSMDP. C-MAJOR is a non-interventional, multi-centre study of Canadian ADPKD patients treated with tolvaptan. The HSMDP ensures tolvaptan is dispensed under controlled liver enzyme and function monitoring. As of April 2020, 398 patients, 51% female, were enrolled in C-MAJOR. At baseline, mean (SD) age was 45.1 (11.5) years, BP was 129.4 (13.4)/83.1 (10.0) mmHg and eGFR was 63.6 (27.8) mL/min/1.73 m2. Total kidney volume was 1949 (1562) mL, 80.7% of patients had family history of ADPKD and 39.4% had family history of early end-stage renal disease. As per Mayo classification, 90.2% were at high risk of disease progression (1C-D-E). Most common ADPKD clinical manifestations were hypertension (83.2%), hepatic cysts (69.6%) and kidney pain (24.1%). Over a mean (SD) follow-up of 2.0 (1.0) years, adverse events were reported in 82.7% of patients, most common being polyuria (19.6%), fatigue (18.6%), and nocturia (15.1%). Over a mean follow-up of 23.0 (SD = 17.6) months in the HSMDP, 2.4% (n=39) of the 1,600 patients who received at least one shipment of tolvaptan reported an elevation of transaminases >3x ULN. There were 0.3% (n=5) of patients meeting the guidelines for permanent discontinuation. No cases of drug-induced liver injury were reported. Treatment discontinuation rates at 12, 24 and 36 months were 14%, 21% and 26%, respectively. This analysis provides Canadian real-world evidence of high-risk for disease progression at tolvaptan initiation, 3-y persistence data similar to phase III studies and HSMDP data showing that tolvaptan was permanently discontinued in 0.3% of patients because of hepatic effects. This abstract was also submitted for the ASN 2020 congress.

Nedosiran Dramatically Reduces Serum Oxalate in Dialysis-Dependent Primary Hyperoxaluria 1: A Compassionate Use Case Report

Primary hyperoxaluria 1 (PH1) is a devastating condition involving recurrent urolithiasis, early end-stage renal disease and multisystemic deposition of calcium oxalate crystals. Treatment options for PH1 are limited, inevitably requiring transplantation, usually combined kidney and liver transplant. Here we report successful compassionate use of Nedosiran, an RNA interference targeting lactate dehydrogenase, in an index patient. Monthly Nedosiran injections led to dramatically decreased plasma oxalate levels, decreased frequency of weekly hemodialysis sessions from 6 to 3, and deferral of combined kidney and liver transplant. Nedosiran represents a novel and impactful potential therapeutic for PH1 patients with end-stage renal disease.

Effect of vitamin D therapy on bone mineral density in patients with diabetic nephropathy; a randomized, double-blind placebo controlled clinical trial.

Diabetes compromises bone strength resulting increased risk of osteoporosis. Objective of this study was to determine the effect of vitamin D given to patients with early diabetic renal disease on BMD and BMC. Patients with diabetic nephropathy were recruited. Treatment group received 50,000IU of vitamin D3 intramuscularly and the control group was given an equal volume of distilled water (0.25mL) monthly for six months. Baseline BMD, BMC in the total body, lumbar spine and proximal femur were measured by DXA. After six months measurements were repeated. When trial period was over, a randomly selected subgroup of patients (25 from each group) was followed up for further six-months and measurements were repeated. Selected patients were randomly assigned to two groups. After six months, the treatment group total body BMD, total body BMC and BMDs of spine, femoral neck and total hip regions increased by 2.0%, 2.2%, 1.8%, 2.1% and 2.6% (P < 0.05 for all within-group differences), respectively. In the Control group, BMD or BMC of any region mentioned above did not change significantly during the initial 6months (P < 0.05 for the between-groups differences). After 6months of stopping treatment, a statistically significant reduction of total BMD and BMC was observed in the treatment group (P = 0.009). This study showed that treatment with high dose vitamin D significantly influences total body BMC, total body BMD, BMDs of spine, femoral neck and hip among patients with diabetic nephropathy.

Urinary screening for detection of renal abnormalities in asymptomatic pre-school children referred to Ardabil city health centers from 2016 to 2017

Background: Urinary screening for detection of proteinuria, hematuria, and pyuria for early diagnosis curable or preventable renal disease in three decade has been considered. The aim of this study was urinary screening for Detection of renal abnormalities in asymptomatic pre-school children referred to health center in Ardabil city from 2016 to 2017.Methods: This was a cross-sectional descriptive study that has been done on urine specimens of 350 children who referred to Ardabil city health center to injection DTP vaccine from April 2016 to Sep 2017. In these infants, proteinuria, hematuria, pyuria and urinary casts were examined and abnormal finding were referred to future investigation to nephrologist. Information was collected and analyzed by statistical methods in SPSS version 21.Results: A total of 350 children were enrolled in the study. There were 196 (56%) boys and 154 (44%) girls. The prevalence of urinary abnormalities in all children was 8.3%. Of all urinary abnormalities, proteinuria and hematuria were detected in 12 children (3.44 %). Of all infants, 9 children (2.57%) had pyuria. Also, 6 children (1.8%) had urinary casts that of them two cases had acid ureic cast and four cases had calcium oxalate cast.Conclusions: This study showed that the prevalence of urinary abnormalities in Ardabil city children was similar to other studies in other country or cities. The reasons of this may be different in race and ethnic. We suggest that routine urinalysis should be part of screening of children at the school entry in Ardabil.

Diabetic nephropathy associates with deregulation of enzymes involved in kidney sulphur metabolism.

Nephropathy is a major chronic complication of diabetes. A crucial role in renal pathophysiology is played by hydrogen sulphide (H2S) that is produced excessively by the kidney; however, the data regarding H2S bioavailability are inconsistent. We hypothesize that early type 1 diabetes (T1D) increases H2S production by a mechanism involving hyperglycaemia‐induced alterations in sulphur metabolism. Plasma and kidney tissue collected from T1D double transgenic mice were subjected to mass spectrometry‐based proteomic analysis, and the results were validated by immunological and gene expression assays.T1D mice exhibited a high concentration of H2S in the plasma and kidney tissue and histological, showed signs of subtle kidney fibrosis, characteristic for early renal disease. The shotgun proteomic analyses disclosed that the level of enzymes implicated in sulphate activation modulators, H2S‐oxidation and H2S‐production were significantly affected (ie 6 up‐regulated and 4 down‐regulated). Gene expression results corroborated well with the proteomic data. Dysregulation of H2S enzymes underly the changes occurring in H2S production, which in turn could play a key role in the initiation of renal disease. The new findings lead to a novel target in the therapy of diabetic nephropathy. Mass spectrometry data are available via ProteomeXchange with identifier PXD018053.

Effect of Added Dietary Betaine and Soluble Fiber on Metabolites and Fecal Microbiome in Dogs with Early Renal Disease.

Renal diets are recommended for dogs with chronic kidney disease (CKD). This study examined the effects of foods with added betaine and fiber on the plasma and fecal metabolome and fecal microbiome in dogs with early stage CKD. At baseline, several metabolites differed between healthy dogs and those with CKD. Dogs with CKD (n = 28) received a control food, low soluble fiber plus betaine food (0.5% betaine, 0.39% oat beta-glucan, and 0.27% short-chain fructooligosaccharides (scFOS)), or high soluble fiber plus betaine food (0.5% betaine, 0.59% oat beta-glucan, and 0.41% scFOS) each for 10 weeks in different sequences. Consumption of test foods led to several favorable, significant changes in the plasma metabolome, including decreases of several uremic toxins and other deleterious metabolites, and increases in favorable metabolites compared with the control food. Only 7 fecal metabolites significantly changed with consumption of the test foods compared with the control food, largely increases in polyphenols and lignans. Few changes were seen in the fecal microbiome, though some taxa that significantly changed in response to the test foods have beneficial effects on health, with some negatively correlating with uremic toxins. Overall, foods with added betaine and soluble fiber showed positive effects on the plasma and fecal metabolomes.

Sonographic Correlation Between Renal Cortical Thickness and Early Chronic Renal Disease

Mostly poor diet and not timely checkup of kidney may lead to chronic renal disease. Ultrasound examination of renal disease depends on sonologists. When patient has acute or chronic renal disease, renal cortical thickness could be correlated with renal length and renal echogenicity grades.

Re: Prenatal Renal Parenchymal Area as a Predictor of Early End-Stage Renal Disease in Children with Vesicoamniotic Shunting for Lower Urinary Tract Obstruction.

Re: Prenatal Renal Parenchymal Area as a Predictor of Early End-Stage Renal Disease in Children with Vesicoamniotic Shunting for Lower Urinary Tract Obstruction.