Incidence Of Renal Insufficiency Research Articles

Volume, but Not the Location of Necrosis, Is Associated with Worse Outcomes in Acute Pancreatitis: A Prospective Study.

Background and Objectives: The course and clinical outcomes of acute pancreatitis (AP) are highly variable. Up to 20% of patients develop pancreatic necrosis. Extent and location of it might affect the clinical course and management. The aim was to determine the clinical relevance of the extent and location of pancreatic necrosis in patients with AP. Materials and Methods: A cohort of patients with necrotizing AP was collected from 2012 to 2018 at the Hospital of Lithuanian University of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (<30%, 30–50%, >50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. All contrast enhanced computed tomography (CECT) scans were evaluated by at least two experienced abdominal radiologists. All patients were treated according to the standard treatment protocol based on current international guidelines. Results: The study included 83 patients (75.9% males (n = 63)) with a mean age of 53 ± 1.7. The volume of pancreatic necrosis exceeded 50% in half of the patients (n = 42, 51%). Positive blood culture (n = 14 (87.5%)), multiple organ dysfunction syndrome (n = 17 (73.9%)) and incidences of respiratory failure (n = 19 (73.1%)) were significantly more often diagnosed in patients with pancreatic necrosis exceeding 50% (p < 0.05). Patients with >50% of necrosis were significantly (p < 0.05) more often diagnosed with moderately severe (n = 24 (41.4%)) and severe (n = 18 (72%)) AP. The number of surgical interventions (n = 18 (72%)) and ultrasound-guided interventions (n = 26 (65%)) was also significantly higher. In patients with whole-pancreas necrosis, incidence of renal insufficiency (n = 11 (64.7%)) and infected pancreatic necrosis (n = 19 (57.6%)) was significantly higher (p < 0.05). Conclusions: The clinical course and outcome were worse in the case of pancreatic necrosis exceeding 50%, rendering the need for longer and more complex treatment.

Inflammatory Bowel Diseases in Renal Transplantat Recipients: A Case Series and Review of the Literature.

Inflammatory bowel diseases are autoimmune disorders affecting the gastrointestinal tract and producing a wide variety of extraintestinal manifestations. Kidneys are a rare target organ of their extraintestinal activity, but if affected, renal function could deteriorate to end-stage kidney disease, which is curable only by organ transplantation. Renal calculi are the most common pathological kidney manifestation in IBD patients, followed by tubulointerstitial nephritis, glomerulonephritis, and other kidney pathologies. The liver is the most commonly transplanted organ in IBD patients (primary sclerosing cholangitis and autoimmune hepatitis), and a scarcity of literature on kidney recipients is present to date regarding the incidence of renal insufficiency, kidney transplantations, post-transplant IBD course and further complications such as graft rejection or infections in this specific group of patients. De novo IBD is a paradoxical entity in the setting of rigorous post-transplant immunosuppression. In this case series, we present three patients who underwent kidney transplantation with a history of an IBD and one patient who developed de novo Crohn's disease after the deceased donor organ transplant was performed.

The Incidence and Risk Factors of Renal Insufficiency among Korean HIV infected Patients: The Korea HIV/AIDS Cohort Study.

Renal insufficiency is one of the common issues in people living with human immunodeficiency virus (PLHIV). We studied the incidence and risk factors for renal insufficiency in male PLHIV using the Korea HIV/acquired immunodeficiency syndrome (AIDS) Cohort Study. Among the 830 enrolled patients, 32 (3.9%) cases of renal insufficiency occurred over 9576 patient-years of follow-up. The incidence of renal insufficiency in HIV-infected men in this study was 3.3 per 1000 patient-years. Diabetes mellitus, dyslipidemia, tenofovir or non-nucleoside reverse transcriptase inhibitor exposure for >1 year, and AIDS-defining illness were risk factors for renal insufficiency.

Renal function and use of medication preceding new-onset atrial fibrillation – results from the nationwide FinACAF study

Abstract Background and aims Chronic kidney disease (CKD) is a global public health problem with an increasing number of patients due to obesity, hypertension, diabetes, and aging. CKD is an independent risk factor for atrial fibrillation (AF) and the incidence of AF in patients with CKD is two- to threefold higher compared to the general population. The relationship between CKD and AF is bidirectional, and the incidence of renal insufficiency is higher in patients with AF. Both AF and CKD are associated with increased risk of stroke and systemic thromboembolism, as well as an increased bleeding risk. The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study among AF patients conducted as a retrospective register-based linkage study combining data from several Finnish health care registers. We aimed to characterize demographics and medications of patients with new-onset AF included FinACAF according to stages of renal function. Method The FinACAF study includes data from 411000 patients covering all Finnish AF patients from 1 January 2004 to 31 December 2018. Using national unique personal identification numbers, individual patients' data from ten nationwide population registries and six regional laboratory databases were linked together. The inclusion criteria of this substudy were all patients 20 years or older with a new-onset AF diagnosis between January 2010 and December 2018 and a measured estimated glomerular filtration rate (eGFR) within the proximity of the AF diagnosis. Drug purchases (date, Anatomical Therapeutic Chemical (ATC) codes, and amount) were obtained from the National Prescription Register upheld by the Social Insurance Institution of Finland. Results 147001 patients from the initial FinACAF cohort were included in this substudy. The mean age at the time of AF diagnosis was 73 years (range 20 to 107 years), 48.9% of the patients were female. The mean age of AF patients increased in various stages of glomerular filtration at the cohort entry during 2010–2018. Baseline medications are shown in Table. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) at the cohort entry decreased from 27.4% to 22.1% during 2010–2018 (p&amp;lt;0.001). Conclusions Medications were used increasingly with worsening renal function, except for NSAIDs. NSAIDs use remained remarkably high in all stages of renal function, albeit much less with the lowest eGFRs. The number of patients with lipid-lowering medication was unexpectedly low considering the high cardiovascular risk in patients with impaired renal function. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported by Aarne Koskelo Foundation, Yrjö Jahnsson Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund (TYH2019309).

Advances in the Treatment of Relapsed and Refractory Multiple Myeloma in Patients with Renal Insufficiency: Novel Agents, Immunotherapies and Beyond.

Simple SummaryThe treatment of patients with relapsed/refractory multiple myeloma has advanced considerably in recent years, irrespective of whether they are younger or older patients. Treating patients with relapsed/refractory multiple myeloma and renal impairment is far more complicated than treating patients with normal renal function due to the frequent dose adjustments that are necessary and the resulting loss in effectiveness.Background: Renal insufficiency is one of the most frequent complications in multiple myeloma. The incidence of renal insufficiency in patients with multiple myeloma ranges from 20% to 50%. Renal impairment in patients with multiple myeloma results primarily from the toxic effects of monoclonal light chains on the kidneys. Dehydration, hypercalcemia, hyperuricemia, the application of nephrotoxic NSARs, antibiotics, contrast agents, etc., all play a major role in the deterioration of renal function in patients with multiple myeloma. The diagnosis and treatment of these patients use an interdisciplinary approach in consultation with hematologist–oncologists, radiologists, nephrologists and intensive care specialists. Using new drugs in the treatment of patients with refractory/relapsed multiple myeloma and renal insufficiency markedly improves progression-free survival and overall survival in these patients. Conclusions: New drugs have helped to widen the treatment options available for patients with renal impairment and refractory/relapsed multiple myeloma, since dose adjustments are unnecessary with carfilzomib as well as with panobinostat, elotuzumab, pomalidomide or daratumumab in patients with renal impairment. Several new substances for the treatment of refractory/relapsed multiple myeloma have been approved in the meantime, including belantamab mafodotin, selinexor, melflufen, venetoclax, CAR T-cell therapy and checkpoint inhibitors. Ongoing studies are investigating their administration in patients with renal impairment.

Acute Promyelocytic Leukemia (APL) Induction Therapy and Incidence of Renal Insufficiency

Background: Survival rates of patients with APL have increased >90% with the introduction of all- trans retinoic acid (ATRA) and arsenic trioxide (ATO). However in addition to infections that are common during leukemia induction, bleeding and differentiation syndrome (DS) are frequently seen and are potentially fatal complications unique to APL. Renal failure is considered to be a manifestation of DS but can also occur secondary to infections. Herein, we report development of renal insufficiency (RI) during induction and outcomes in a cohort of patients managed by our program.Methods: Between 1/2007 and 3/2017, we treated or co-managed a total of 210 patients.Our new group (NG) consists of 138 patients which included, 120 patients treated on a prospective clinical trial in a network of Leukemia treatment centers established in Georgia, South Carolina and neighboring states between July 2013 and May 2016. This program was designed to decrease population wide induction deaths. The other 18 patients were referred to our institution from June 2016 to April 2017 and managed on the same algorithm as the prospective trial. Early Group (EG) consisted of 72 patients between 1/2007 and 5/2013 before initiation of this program.We divided patients into four groups based on the CTCAE v.4.03 classification: Grade I - Creatinine (Cr) rise but less than 1.5 times baseline value; Grade II- Cr greater than 1.5 to 3 times baseline; Grade III- Cr greater than 3 times but less than 6 times baseline and Grade IV - Cr greater than 6 times baseline. Institutional review board approval was obtained and statistics are descriptive.Results: All patients were treated at our institution in the EG while in the NG 62 (45%) were treated at our institution and 76 (55%) were managed in 33 outlying centers. The median age in EG and NG was 45 years (range 18-86) and 53 (range 19-84) and 61% and 54.3% were females respectively. RI of all grades developed in 29 (40%) in the EG and 32 (23 %) in NG. The breakdown in EG vs NG is given in Table1.ATRA was the only therapy in 5 (17.2%) vs 5 (15.6%) patients in EG and NG. Other treatment for EG-RI included chemotherapy combined with ATRA in 19 (65.5%), where as in NG-RI only 6 (18.7%) received chemotherapy and ATRA. ATO was combined with ATRA in 4 (13.7%) of EG-RI and 19 (59.3%) of the NG-RI patients. Only 1 (3.4%) patient received ATRA, ATO and chemotherapy in EG-RI and 2 (6.2%) in NG-RI.Complications among the patients with RI in EG and NG were: DS and infection in 9 (31%) vs 9 (28.1%), DS only in 4 (13.7%) vs 6 (18.7%); infection only in 12 (41.3%) vs 9 (28.1%) respectively. There were 4 (13.7%) vs 8 (25%) in EG and NG which had neither infection nor DS. Among those with DS, steroids were used in 100% of the patients in both EG and NG. There were 11 (37.9%) vs 6 (18.7%) early deaths in patients with renal insufficiency in EG and NG.Conclusion: By our observation, RI is a frequent complication during induction in APL. Mortality in patients who develop RI tends to be high. Meticulous attention should be paid to kidney function during induction and the drugs should be appropriately dose reduced or held till resolution. [Display omitted] DisclosuresArellano:Cephalon Oncology: Research Funding. Kota:Pfizer: Consultancy; Novartis: Consultancy; Xcenda: Consultancy; Incyte: Consultancy; Leukemia Lymphoma Society: Research Funding; Takeda Pharmaceuticals: Consultancy.

Chronic kidney disease in lithium-treated patients, incidence and rate of decline

BackgroundLithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer. The aim of this study is to establish the incidence of chronic kidney disease and the rate of decline of renal function in patients using lithium and to identify risk factors.MethodsWe selected 1012 patients treated with lithium from the laboratory database of the Antes Centre for Mental Health Care spanning a period from 2000 to 2015. Serum lithium and creatinine concentrations were retrieved and eGFR was calculated using the 4-variable CKD-EPI formula. We calculated the incidence of renal insufficiency and the rate of decline. We compared patients with and without chronic kidney disease (CKD) stage 3 regarding duration of lithium exposure.ResultsIncidence of chronic kidney disease was 0.012 cases per exposed patient-year. Average decline of eGFR was 1.8 ml/min/year in patients who developed chronic kidney disease stage 3. Incidence of chronic kidney disease stage 4 was only 0.0004 per patient year. No cases of end stage renal disease were found in this cohort. Odds of reaching chronic kidney disease stage 3 were increased with longer duration of lithium exposure.ConclusionsThe use of lithium seems to be related to a higher incidence of chronic kidney disease. Longer duration of lithium exposure significantly increased the risk of renal failure.

A study proposal on short term outcome and prognosis of primary and delayed fulguration in posterior urethral valve

Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male neonates. The incidence is 1 in 4000, 1 in 7500 births PUV occur exclusively in males. This disease has a broad spectrum of presentations. They may present at any age during childhood and may vary from ascites in the neonate to renal failure in infants and only minor voiding dysfunction in an older child. Urinary tract infection is common at all ages. The objectives of the study were to assess the impact of primary impaction on short term outcomes and to assess the outcome of diversion and delayed fulguration.Methods: This retrospective study was conducted at the Pediatric Urology outpatient department (OPD) at the Institute of Child Health and Hospital for Children, Madras Medical College, Chennai including the patients who attended the pediatric surgery from August 2008 to December 2011.Results: In the current series, the incidence of renal insufficiency in patients with urosepsis was 45%. Recurrent urosepsis &gt;3 episodes in a year (fever with urine culture showing infection) primarily due to poor patient compliance lead to progressing pyelonephritis and nephron damage and plays an important role in the outcome of these children.Conclusions: The incidence of renal insufficiency in children with posterior urethral valves in this series was 38% (30-45%) with an average follow up 3 years. Several factors were important in prognosticating the progression towards renal insufficiency and bladder dysfunction. Urodynamics is of immense help in cases having symptoms despite good stream. The use of anticholinergic for abnormal urodynamics gives encouraging results.

Comparison of secondary IgA nephropathy in patients with ankylosing spondylitis and rheumatoid arthritis

Objectives: The aim of the present study was to investigate the differences in clinic-pathological features of secondary IgA nephropathy (SIgAN) between patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA).Methods: Forty-six patients with SIgAN related to AS (SIgAN-AS) and 26 patients with SIgAN related to RA (SIgAN-RA) were enrolled in this retrospective study. The two groups were compared for their clinic-pathological characteristics.Results: The 10-year prevalence of SIgAN-AS and SIgAN-RA were 167 per 1000 and 51.3 per 1000, respectively. Compared with SIgAN-RA patients, SIgAN-AS patients had lower incidences of edema and nephrotic syndrome, but higher levels of eGFR, serum C3, and CD3- and CD8-positive T-cell counts, but less incidences of acute tubulointerstitial lesions and interlobular arterial lesions. IgM was the most familiar co-depositing immune complex on tissue with significantly different frequencies. In SIgAN-AS patients, those with positive HLA-B27 presented with lower levels of proteinuria, higher levels of serum IgG and C3, and less incidence of renal insufficiency, crescents >14.5%, glomerular sclerosis >32.6% and segmental sclerosis >5.2%.Conclusion: SIgAN was more prevalent in AS than in RA. SIgAN-AS patients differed from SIgAN-RA patients in certain clinic-pathological characteristics. HLA-B27 likely protected SIgAN-AS patients from renal insufficiency.

Kliničke i laboratorijske odlike pojedinih imunoloških tipova multiplog mijeloma

Introduction: Multiple myeloma (MM) is a malignant blood disease, characterized by clonal proliferation of malignant plasma cells in the bone marrow and clinical manifestation of a disease that is heterogeneous and it's stratified by an internationally recognized Durie-Salmon classification (DS). Aim: The aim of this study was to determine whether the immune type of multiple myeloma affects the clinical and laboratory characteristics of the disease. Material and methods: The study included 45 newly diagnosed patients with MM (25 men and 20 women), the average age of 62.21 ± 8.62 years. A comparative analysis was performed between the class of M - protein and the mean value of the parameters contained in the DS classification. Results: The most common immune type was IgG MM. Considering gender, age, serum albumin values, total proteins, LDH, hemoglobin, beta 2 - MG, radiographic findings (number of osteolysis) and DS stages, there was no statistically significant difference in relation to individual immunological types MM. The IgD type was associated with a higher incidence of hypercalcemia than IgG and IgA type (p < 0.01) and with a higher incidence of renal insufficiency, compared to IgA MM (p < 0.01) and IgG MM (p < 0.05). Conclusion: Our findings exclude the association of Ig type of multiple myeloma with individual biochemical parameters, except for the increased incidence of hypercalcemia and renal insufficiency in IgD MM, which corresponds to literature data.

Impact of pre- and post-procedural anemia on the incidence of acute kidney injury and 1-year mortality in patients undergoing transcatheter aortic valve implantation (from the French Aortic National CoreValve and Edwards 2 [FRANCE 2] Registry).

The relationship between anemia, renal insufficiency, and the outcomes of TAVI patients has not been thoroughly studied. We aimed to evaluate the influence of pre- and post-procedural anemia on the incidence of renal insufficiency, especially AKI, and on the outcomes of TAVI. Data from the French national TAVI registry were collected in 3,472 patients who underwent TAVI between January 2010 and December 2012. Of these 2,137 were in the no/mild anemia group, 748 were in the moderate anemia group, and 587 were in the severe anemia group before TAVI. Furthermore, we divided the 3,472 patients into three groups according to post-procedural anemia, measured as post-procedural hemoglobin (Hb) drop: <2 g/dl (n=1,633, group 1), 2 to <4 g/dl (n=1,458, group 2), and >4 g/dl (n = 381, group 3). Procedure and outcome variables were compared. Increased severity of anemia before TAVI was associated with significantly different rates of 1-year mortality (15%, 19%, and 24%, P<0.01), with similar differences in the incidence of AKI (5%, 8%, and 10%, P<0.01). Increased severity of Hb drop was associated with significantly different rates of 1-year mortality (16%, 18%, and 23%, P<0.01), and with similar differences in the incidence of AKI (6%, 7%, and 10%, P=0.04). Both pre- and post-procedural anemia were predictors of the incidence of AKI (OR 1.82, P<0.01; OR 1.82, P<0.01, respectively) and 1-year mortality (HR 1.44, P<0.01; HR 1.50, P<0.01, respectively). Both pre- and post-procedural anemia were significantly associated AKI and 1-year mortality.

Abstract T MP37: Incidence of New or Worsening Renal Insufficiency (RI) Among Stroke Patients Receiving IV Contrast Dye: A Population-Based Study

Background: CT angiography (CTA) and conventional angiogram provide timely vascular anatomical information in stroke patients. However, the iodinated contrast dye may cause renal injury. Within a large, biracial population, we examined in-hospital incidence of new or worsening RI in stroke patients and its association with administration of intravenous (IV) dye. Methods: All residents of the Greater Cincinnati/Northern Kentucky region ≥ 20 years of age with ischemic stroke (IS), subarachnoidhemorrhage (SAH), or intracerebral hemorrhage (ICH) who presented to an emergency department in 2010 and survived at least two days were included. Medical records from the acute hospitalization were retrospectively reviewed, and age, race, sex, stroke risk factors, admission serum creatinine (Cr), vascular imaging, and metformin use were abstracted. Incidence of RI was assessed and stratified by use of IV dye. RI on presentation was defined as history of RI or ESRD or Cr ≥ 1.5 on admission. Development of RI during the hospital stay was defined as renal failure/insufficiency after day 2 of hospitalization or new dialysis documented in the record. Results: In 2010, 2350 stroke patients in the region met inclusion criteria (86% IS, 11% ICH, 3% SAH); mean age 69 years (SD 15), 22% black, 54% female. Among these patients, 22% had RI at baseline, 25 (3%) developed new RI, while 11 (2% had worsening RI during hospitalization). Among all 2350 patients, 340 (14%) had IV dye-based vascular imaging. Table presents demographics and incidence of new or worsening RI stratified by IV dye administration. Discussion: Incidence of new or worsening renal insufficiency in stroke patients in this population based study was extremely low (36/2350; 1.5%). One patient had severe enough RI to warrant new dialysis. We did not find an association between IV dye and new or worsening RI. This confirms prior single-center reports that the risk of severe renal complications after contrast dye is extremely low.

Autologous stem cell transplantation in dialysis-dependent myeloma patients.

8601 Background: The incidence of renal insufficiency at presentation is approximately 30% in patients with multiple myeloma (MM). 5% of these patients are dialysis dependent. Presence of renal dysfunction is associated with increased treatment related toxicity and poor survival. Methods: We retrospectively analyzed our transplant database from July 2000 to June 2012 to identify myeloma patients who received autologous hematopoietic stem cell transplantation (autoHCT) while they were dialysis dependent. Univariate Cox proportional hazards regression was performed to assess the association between survival and covariates of interest. Kaplan Meier curve was used to estimate progression free survival (PFS) and overall survival (OS). Results: 2,091 patients underwent autoHCT during this interval. 24 (1.1%) were dialysis dependent (21 on hemodialysis and 3 on peritoneal dialysis). Median age was 53 (29-70) years. 63% were male. ISS stage at diagnosis was I & II in 4%, III in 54%, and unknown in 38%. Median dur...

Everolimus-Based Immunosuppression Improves Renal Function in Long-Term Heart Transplanted Patients: Five Years Results of a Prospective Randomized Trial

Purpose Renal insufficiency is a leading cause of morbidity and mortality after heart transplantation (Htx). CyA-based immunosuppression may contribute to kidney disease and a reduction of CyA seems reasonable. We aimed to assess whether changing from a CyA- to an Everolimus-based (EVL) immunosuppression can reduce the incidence of renal insufficiency in long-term Htx pts. We compared, in a prospective randomized trial, a reduction of >75% of CyA dose and EVL administration with conventional treatment. Methods and Materials Randomization was stratified by age, creatinine, gender and f-up in 213 pts >18 yrs (1-20 yrs of f-up, median 9). They were assigned to CyA reduction + EVL (n=108) or conventional treatment (n=105). At enrollment, 6 months, 1, 2, 3, 4 and 5 yrs f-up we estimated MDRD, creatinine, albuminuria, dialysis, and clinical outcome. An improvement in renal function was defined as an increase of > than 5 ml/min in MDRD. Results At entry, the two groups were similar. Eleven deaths were observed in each group. Renal function worsened in the conventional treatment pts. Mean creatinine (1,6±0,6) increased to 1,7±0,8 after 5 yrs in the control group and decreased to 1,5±0,86 in the EVL group (p = 0,01). MDRD improved from 55±24 to 64±34 ml/min (p Conclusions Conversion of a CyA- to EVL-based immunosuppression improves 5 yrs renal function in patients without proteinuria. Survival is not affected. This practice may be harmful for kidney function in the presence of heavy proteinuria.

The protective effect of low molecular dextran combined with salvia miltiorrhiza Injection against kidney damage from contrast agent

Objective To explore the protective effect of low molecular dextran combined with salvia miltiorrhiza injection against kidney damage from contrast agent after percutaneous coronary intervention(PCI) and the effect of preventing kidney damage.Methods 120 patients who underwent PCI were randomly divided into two groups:the treatment group( low molecular dextran combined with salvia miltiorrhiza treatment) and the control group,each group 60 cases.The control group was given the conventional treatment,and the treatment group was treated with 250ml low molecular dextran and 16ml salvia miltiorrhiza injection for 7d on the basis of conventional treatment.The levels of blood urea nitrogen ( BUN ),serum creatinine ( SCR),β2 microglobulin ( β2-MG),24h urine protein were detected before and 1 d,6d after surgery.Results At one day after application of contrast agent,the levels of BUN,SCR,β2-MG,24h urine protein were increased,and returned to baseline level at 6th day.The levels of BUN,SCR,β2-MG,24h urine protein of the treatment group were significantly lower than those of the control group at 6th day ( P ＜ 0.05 ).Conclusion The low molecular dextran combined with danshen injection treatment in the perioperative period could effectively reduce the kidney impairment from contrast agent and the incidence of renal insufficiency. Key words: Agents; Renal damage; Low molecular dextran; Danshen injection

Renal impairment in multiple myeloma: Presenting features in different departments

In order to analyze the cai]ses of delayed diagnosis and raise the level of early diagnosis of atypical multiple myeloma (MM), the differences of presenting features between the patients presented to nephrologists and those presented to hematologists were compared. MM patients in our hospital were studied retrospectively. Those who referred renal impairment were divided into two groups: group I presented to nephrologists prior to MM diagnosis (n=29) and group II presented to hematologists directly (n=62). The age, sex, initial symptoms, haematological and biochemical parameters, the phenotype of paraprotein, bone marrow biopsy and cytology were undertaken and analyzed. The results showed that the median time between the initial symptoms and diagnosis in the patients of group I was longer than that in group II (P<0.001); patients in group I had significantly lower incidence of bone pain (P<0.01) and worse renal function (P<0.05) on presentation. There were lower level of myeloma cells (P<0.05), lower incidence of hypergammaglobulinemia (P<0.05), lower positive rate of monoclonal immunoglobulin (M protein) (P<0.05) and M protein level (P<0.05) in the patients of group I than those in group II. The ratio of monoclonal to lambda monoclonal proteins in a population was 1:3.67 in patients of group I, whereas 1:0.90 in patients of group II (P<0.01). Moreover, patients with λ type had a higher degree of renal insufficiency than those with κ type (P<0.05). It was suggested that the median time between the initial symptoms and diagnosis in the patients presented to nephrologists was longer than that in those presented to hematologists; the patients presented to nephrologists had the lower incidence of bone pain, lower level of myeloma cells and M protein, which made early diagnosis more difficult; more patients presented to nephrologists had the majority of λ light chain type, moreover, patients with λ light chain type had a higher incidence of renal insufficiency.

Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT

Although pre-existing renal insufficiency (RI) is the most important risk factor for contrast-induced nephropathy (CIN), the background distribution of baseline renal function has not been investigated thoroughly in patients scheduled for contrast-enhanced CT. To investigate the incidence and severity of baseline RI evaluated by estimated glomerular filtration rates (eGFR) in patients who underwent contrast-enhanced CT at an academic center. A total of 6586 patients (3630 men and 2956 women; mean age 57.0 ± 11.9 years) who underwent contrast-enhanced CT between January and December 2008 were retrospectively studied. Of these, 829 had cardiovascular diseases (CVD), 5116 had oncologic diseases, 178 had diabetes mellitus (DM), and 1572 had chronic liver disease (CLD). The eGFR (mL/min/1.73 m(2)) was calculated from their serum creatinine level. Mild, moderate-a, moderate-b, and severe RI were recorded at 60 < =eGFR < 90, 45 < =eGFR < 60, 30 < =eGFR < 45 and eGFR < 30, respectively. Of the 6586 patients, 1.6%, 3.7%, 13.7%, and 54.2% were judged to present with severe, moderate-b, moderate-a, and mild RI, respectively. While moderate-b-to-severe RI was recorded in 133 (3.2%) of 4161 patients aged 70 years or less, it was observed in 218 (9.0%) of the 2425 patients who were 71 years or older. Among the 829 CVD patients, 9.9% manifested moderate-b-to-severe- and 73.0% mild-to-moderate-a RI. The corresponding rates were 4.4% and 68.9% for oncologic disease, 16.9% and 61.2% for DM, and 4.8% and 71.5% for CLD patients. By univariate analysis, there was a significant association between moderate-b-to-severe RI and the advanced age, CVD, DM, and non-oncologic disease. Multivariate analysis showed that the advanced age, DM, and non-oncologic disease were statistically associated with moderate-b-to-severe RI. The incidence of RI of eGFR < 45mL/min/1.73 m(2) at baseline was high in patients with advanced age, CVD and DM and in patients without oncologic disease.

Prognostic value of serum creatinine levels in children with posterior urethral valves treated by primary valve ablation

We evaluated the prognostic value of serum creatinine level at presentation and nadir creatinine during follow up for future renal function (RF) in children with posterior urethral valves (PUV). Between 1987 and 2004, 120 cases of PUV were treated initially at our hospital with valve ablation. Initial assessment included serum creatinine measurement, urine analysis and culture, renal ultrasonography and voiding cystourethrography. After valve ablation, renal ultrasound and serum creatinine measurement were repeated and thereafter during visits until the end of follow up. Follow up ranged from 2 to 12 years (mean=4.4). Renal insufficiency (RI) developed at the end of follow up in 44 patients (36.5%). The mean initial and nadir serum creatinine in the RI group was higher than in the normal RF group (P<0.05). With a cut-off value of 1mg/dl for initial and nadir serum creatinine, the incidence of RI was significantly different (P<0.05). Our data confirm the high prognostic value of nadir serum creatinine after relief of valvular obstruction. Further, the serum creatinine level before valve ablation correlates significantly with long-term RF in children with PUV.

Long-term treatment with intravenous bisphosphonates in metastatic breast cancer (MBC)

1035 Background: Intravenous bisphosphonates (IV BPs) are safe and effective in reducing skeletal related events in MBC. The effects of IV BPs after 24 months of therapy are unknown. The incidence of osteonecrosis of the jaw (ONJ) and renal insufficiency (RI) among women with MBC receiving &gt;= 24 months of IV BPs is also poorly defined. We studied the long term effect of IV BPs in a cohort of women with MBC. Methods: We maintain an ongoing prospective database of &gt;600 women with MBC diagnosed and treated at our institution from January 1999. A long-term cohort (LTC) of 159 women with metastatic breast cancer to bone treated for &gt;= 24 months with pamidronate (n = 9), zoledronic acid (n = 110), or both (n = 40) was identified. A control cohort (CC) of 62 women with MBC to bone treated with IV BPs for 12–23 months was also identified. RI was defined as an increase in serum creatinine (scr) of &gt; 0.5 mg/dl or an absolute level of scr &gt;1.5mg/dl; ONJ was diagnosed by dental consultation. Results: Median follow-up of the LTC was 39 months (range 24–99) months. Median overall survival in this cohort was 43 months (range 24–114). The vast majority of women in the LTC (140/159, 88.1%) continued to receive IV BPs at standard dose every 3–4 weeks. The incidence of ONJ in the LTC was 6/159 (3.8%), after a mean 42.2 treatment cycles, with a median time to ONJ of 44 months. Three of six patients with ONJ (50%) underwent surgical resection, and 3/6 (50%) were managed conservatively, and 3/6 (50%) resumed IV BPs after a mean 12 month hold. The incidence of RI (all pts had baseline scr &lt; 1.4 mg/dl) in the LTC was 19/159 (11.9%), occurring after a mean 43.4 treatment cycles, with a median time to RI of 43 months. Eleven of 19 patients (57.9%) recovered to baseline scr and 7/19 (36.7%) patients showed partial recovery. Seventeen of 19 patients (89.4%) were able to resume therapy after temporary discontinuation, decreasing the dose, or increasing the interval of the IV BP. Incidence of ONJ in the CC was 1/62 (1.6%) and RI in the CC was 6/62 (9.7%). Conclusions: Long term (&gt;=24 month) IV BP use in MBC is well tolerated and safe, with relatively low incidence of ONJ and RI. Most patients were able to resume IV BP therapy after a therapy hold without further complication. No significant financial relationships to disclose.

Pulsatile perfusion with intra-aortic balloon pumping ameliorates whole body response to cardiopulmonary bypass in the elderly*

The growing life expectancy has led the elderly to be increasingly referred to coronary artery bypass grafting. Preexisting comorbidities may benefit from theoretical advantages of pulsatile perfusion during cardiopulmonary bypass (CPB). Prospective randomized trial. Cardiac surgery unit in a university hospital. Eighty consecutive patients older than 70 years. Elective coronary artery bypass grafting on CPB, randomizing to conventional linear CPB (40 patients, group A) or intra-aortic balloon pump (IABP)-induced pulsatile CPB (40 patients, group B). We evaluated hemodynamic response by pulmonary artery flotation catheter, metabolic/splanchnic response by lactate and transaminase, bilirubin, amylase, and renal function (creatinine clearance, creatinine, incidence of renal insufficiency and failure), respiratory response by Pao2/Fio2, respiratory compliance, scoring of chest radiograph, intubation time, and need for noninvasive positive-pressure ventilation, hematologic response by chest drainage, hemocoagulative and fibrinolytic cascades, and transfusions. IABP-related complications were recorded. Two minor IABP-related complications (2.5%) were registered. Hemodynamics was comparable, except for a slightly better cardiac index and indexed systemic vascular resistances at the end of CPB and at intensive therapy unit (ITU) admission (p < 0.05). Transaminases, bilirubin, amylase, proved lower in group B (p < 0.05 from ITU admission to 48 hours). Creatinine clearance, serum creatinine, and lactate were better in group B (p < 0.05), and acute renal insufficiency was accordingly lower (p = 0.02). Respiratory response demonstrated better Pao2/Fio2 and respiratory compliance from aortic declamping to 48 hours, with better scoring of chest radiograph (p < 0.05 from ITU admission to 48 hours), lower noninvasive positive-pressure ventilation (p = 0.002) and intubation time (p = 0.031) in group B. Lower chest drainage (p < 0.05 at first and second day), transfusions (p < 0.05), activated partial thromboplastin time, international normalized ratio, white blood cells, and D-dimer (p < 0.05 from ITU admission to 48 hours), together with higher platelets, fibrinogen, and antithrombin III (p < 0.05 from ITU admission to 48 hours) were demonstrated in the pulsated group. IABP-induced pulsatile flow significantly improves whole body perfusion in the elderly undergoing CPB.