Indicators Of Acute Kidney Injury Research Articles

Urinary NGAL in gastrointestinal diseases can be used as an indicator of early infection in addition to acute kidney injury marker.

Neutrophil gelatinase-associated lipocalin (NGAL) is characterized by increased expression before the rise in serum creatinine and has been used as a biomarker for the early prediction of acute kidney injury (AKI). However, there have been no comprehensive analyses of its significance in gastrointestinal diseases. This study aimed to analyze the usefulness of measuring urinary NGAL levels in patients with gastrointestinal diseases. This study included 171 patients with a wide range of gastrointestinal diseases. Urinary NGAL levels were measured in all patients within 24 h of admission and 72 h later. Urinary NGAL levels were higher in patients with acute pancreatitis and acute cholangitis/cholecystitis than in those with other diseases. Although lower than in these diseases, urinary NGAL tends to be higher in inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease, as well as in acute and chronic liver diseases, and is higher in liver cirrhosis as the Child-Pugh grade increases. Furthermore, we found that the group with higher urinary NGAL levels, which continued to increase over time, had worse hospital stays and prognosis. Urinary NGAL could be used as an indicator of infectious diseases rather than an indicator of AKI in inflammatory bowel diseases and cirrhosis, and could predict the prognosis of patients with gastrointestinal diseases.

Clinical toxicology of acute glyphosate self-poisoning: impact of plasma concentrations of glyphosate, its metabolite and polyethoxylated tallow amine surfactants on the toxicity

Introduction Common major co-formulants in glyphosate-based herbicides, polyethoxylated tallow amine surfactants, are suspected of being more toxic than glyphosate, contributing to the toxicity in humans. However, limited information exists on using polyethoxylated tallow amine concentrations to predict clinical outcomes. We investigated if plasma concentrations of glyphosate, its metabolite and polyethoxylated tallow amines can predict acute kidney injury and case fatality in glyphosate poisoning. Methods We enrolled 151 patients with acute glyphosate poisoning between 2010 and 2013. Plasma concentrations of glyphosate, its metabolite, aminomethylphosphonic acid, and polyethoxylated tallow amines were determined in 2020 using liquid chromatography-tandem mass spectrometry. Associations between exposure and poisoning severity were assessed. Results Plasma concentrations of glyphosate and aminomethylphosphonic acid demonstrated good and moderate performances in predicting acute kidney injury (≥2), with an area under the receiver operating characteristic curve of 0.83 (95% CI 0.69–0.97) and 0.76 (95% CI 0.59–0.94), respectively. Polyethoxylated tallow amines were detected in one-fifth of symptomatic patients, including one of four fatalities and those with unsaturated tallow moieties being good indicators of acute kidney injury (area under the receiver operating characteristic curve ≥0.7). As the number of repeating ethoxylate units in tallow moieties decreased, the odds of acute kidney injury increased. Glyphosate and aminomethylphosphonic acid concentrations were excellent predictors of case fatality (area under the receiver operating characteristic curve >0.9). Discussion The 2.7% case fatality rate with 49% acute, albeit mild, acute kidney injury following glyphosate poisoning is consistent with previously published data. A population approach using model-based metrics might better explore the relationship of exposure to severity of poisoning. Conclusions Plasma concentrations of glyphosate and its metabolite predicted the severity of clinical toxicity in glyphosate poisoning. The co-formulated polyethoxylated tallow amine surfactants were even more strongly predictive of acute kidney injury but were only detected in a minority of patients.

Monocytes to lymphocytes multiplying platelets ratio as an early indicator of acute kidney injury in cardiac surgery with cardiopulmonary bypass: a retrospective analysis.

The monocyte-to-lymphocyte multiplying platelets ratio (MLPR) is a novel systemic inflammatory marker, deriving from the monocyte-to-lymphocyte ratio (MLR). However, the link between MLPR and acute kidney injury following cardiac surgery (CSA-AKI) with cardiopulmonary bypass (CPB) has not been investigated yet. We comprehensively explored the potential linear and nonlinear relationship between MLPR or MLR and CSA-AKI. Data of patients who underwent cardiac surgery with CPB between December 2018 and April 2021 were retrospectively collected at Fuwai Hospital, Beijing, China. MLPR was defined as monocyte count (×109/L)×1000/(lymphocyte count (×109/L)×platelets (×109/L)). MLR was defined as monocyte count (×109/L)/lymphocyte count (×109/L). Logistic regression and restricted cubic spline (RCS) were used for linear and nonlinear analysis. The primary outcome was postoperative AKI within 48 h of after cardiac surgery. Of the 2420 patients screened, 2387 eligible patients were enrolled in the final analysis; the mean age was 54.7years, and 1501 [62.9%] were men. The incidence of AKI was 25.8%. Logistic regression showed that MLPR (odds ratio [OR]=1.31, 95% confidence interval [CI]: 1.16-1.48, p<.001) and MLR (OR = 3.06, 95% CI: 1.29-7.29, p=.012) were independent risk factors for AKI. Moreover, in the RCS model with adjustment for age (median: 56), female sex, and history of diabetes, a significant statistical difference was detected between preoperative MLPR, MLR, and AKI (p for non-linearity <.001). The subgroup analyses revealed similar results. The study revealed a nonlinear relationship between MLPR and MLR with AKI. MLPR exhibited a J-shaped curve, and MLR showed a favorable S-shaped curve in relation to AKI. Particularly, MLPR emerges as a promising clinical composite index for early CSA-AKI prediction. These findings emphasize the significance of MLPR as a valuable tool in clinical practice for timely identification and management of CSA-AKI.

Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis

BackgroundProenkephalin A 119-159 (PENK) is freely filtered in the glomerulus with plasma levels correlating with glomerular filtration rate. Therefore, PENK has been proposed as an early indicator of acute kidney injury (AKI) although its performance is dependent on the clinical setting. This meta-analysis aimed to investigate the correlation between PENK levels and the development of AKI.MethodsWe conducted a comprehensive search on the PubMed, Embase, Cochrane databases, the website ClinicalTrials.gov and Cnki.net until June 26, 2023. Summary receiver operating characteristic (SROC) curves were used to amalgamate the overall test performance. Diagnostic odds ratio (DOR) was employed to compare the diagnostic accuracy of PENK with other biomarkers. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria.ResultsWe incorporated 11 observational studies with 3969 patients with an incidence of AKI of 23.4% (929 out of 3969 patients) with the best optimal cutoff value of PENK for early detection of AKI being 57.3 pmol/L. The overall sensitivity and specificity of PENK in identifying AKI were 0.69 (95% CI 0.62–0.75) and 0.76 (95% CI 0.68–0.82), respectively. The combined positive likelihood ratio (LR) stood at 2.83 (95% CI 2.06–3.88), and the negative LR was 0.41 (95% CI 0.33–0.52). The SROC curve showcased pooled diagnostic accuracy of 0.77 (95% CI 0.73–0.81). Interestingly, patients with a history of hypertension or heart failure demonstrated a lower specificity of PENK in correlating the development of AKI.ConclusionOur results indicate that PENK possesses significant potential as a biomarker for the early detection of the development of AKI, using a cutoff point of 57.3 pmol/L for PENK.

Elevated Renal-Resistive Index as an Indicator of Acute Kidney Injury Associated With Neonatal Extracorporeal Membrane Oxygenation

ObjectiveThis study aims to assess the relationship between elevated renal resistive index (RRI) and acute kidney injury (AKI) related to extracorporeal membrane oxygenation (ECMO) in neonatal patients. DesignThis was a retrospective study. SettingThe study was performed in a teaching hospital. ParticipantsSixteen neonates treated with ECMO in our hospital between June 2021 and December 2022 were included in this study. InterventionsDemographic and clinical data of patients were collected from the computer database. The RRI of patients before and during ECMO treatment was measured by bedside ultrasound. A receiver operating characteristic curve (ROC curve) was constructed to evaluate the diagnostic value of elevation of RRI as an evidence of neonatal ECMO-related AKI. Logistic regression analysis was utilized to calculate the odds ratio (OR) with a 95% confidence interval. Measurements and Main ResultsA total of 16 patients met the inclusion criteria. For the primary outcome, we observed that the RRI during ECMO therapy was significantly elevated in patients with AKI compared to those without AKI. As for the secondary outcome, Receiver Operating Characteristic (ROC) curve analysis revealed an optimal RRI cutoff of 0.797, with an area under the curve (AUC) of 0.855 (95% CI, 0.664-1, p=0.027). The sensitivity and specificity of RRI values greater than 0.797 for diagnosing AKI were 72.7% and 80%, respectively. Univariate logistic regression analysis indicated an odds ratio (OR) of 1.433 (95% CI 1.192-1.873, p < 0.05) for RRI values above 0.797. This association remained statistically significant even after adjusting for serum cystatin C and SOFA score, with an adjusted OR of 1.352 (95% CI 1.108-1.612, p < 0.05). ConclusionThe elevation of the RRI demonstrates a strong correlation with the onset of neonatal ECMO-related AKI, which may offer valuable support for diagnosing neonatal ECMO-related AKI.

Early clinical indicators of acute kidney injury caused by administering high-dose methotrexate therapy to juvenile pigs.

Early identification of compromised renal clearance caused by high-dose methotrexate (HDMTX) is essential for initiating timely interventions that can reduce acute kidney injury and MTX-induced systemic toxicity. We induced acute kidney injury (AKI) by infusing 42 juvenile pigs with 4 g/kg (80 g/m2) of MTX over 4 hours without high-volume alkalinizing hydration therapy. Concentrations of serum creatinine and MTX were measured at 15 time points up to 148 hours, with 10 samples collected during the first 24 hours after the start of the HDMTX infusion. During the first 28 hours, 81% of the pigs had increases in the concentrations of serum creatinine in one or more samples indicative of AKI (i.e., > 0.3g/dL increase). A rate of plasma MTX clearance of less than 90% during the initial 4 hours after the HDMTX infusion and a total serum creatinine increase at 6 and 8 hours after starting the infusion greater than 0.3 g/dL were predictive of AKI at 28 hours (p < 0.05 and p < 0.001, respectively). At conclusion of the infusion, pigs with a creatinine concentration more than 0.3 g/dL higher than baseline or serum MTX greater than 5,000 μmol/L had an increased risk of severe AKI. Our findings suggest that serum samples collected at conclusion and shortly after HDMTX infusion can be used to predict impending AKI. The pig model can be used to identify biological, environmental, and iatrogenic risk factors for HDMTX-induced AKI and to evaluate interventions to preserve renal functions, minimize acute kidney injury, and reduce systemic toxicity.

Use of Renal Near-Infrared Spectroscopy and Urinary Neutrophil Gelatinase-Associated Lipocalin Monitoring as Indicators of Acute Kidney Injury in Pediatric Cardiac Surgery.

Acute kidney injury (AKI) is a common complication following cardiac surgery under cardiopulmonary bypass (CPB) in children. A prospective study for examining urinary neutrophil gelatinase-associated lipocalin (NGAL) and renal near-infrared spectroscopy (NIRS) trends during AKI was conducted among pediatric patients undergoing cardiac surgery with CPB. Urinary NGAL showed a significant difference between intensive care unit admission (0 h) and 2 h post-admission (p < 0.001) and remained significant up to 4 h (p < 0.05). The renal NIRS in the AKI group showed a significant rate of decrease and lower values during the intraoperative period (p < 0.05). The cumulative median saturation of renal regional saturation of oxygen (rSO2) during CPB was 1637.5% min in the AKI group and 943.0% min in the non-AKI group. The median renal rSO2 scores at a reduction of 20% and 25% were significantly higher (p < 0.001) in the AKI group. Our results suggest that monitoring renal rSO2 scores and limiting their decline might be useful in preventing AKI. The combination of NGAL, renal rSO2, and renal rSO2 scores might be useful in the early diagnosis of AKI during pediatric cardiac surgery.

Abstract 125: Kidney-specific Biomarkers For Predicting Acute Kidney Injury Following Cardiac Arrest

Introduction: Acute kidney injury (AKI) is a common complication following cardiac arrest (CA) and is associated with poor outcomes. Early detection of AKI is crucial; serum creatinine (sCR) is the most commonly used indicator of AKI, despite low sensitivity and specificity for early detection of AKI. Hypothesis: Kidney-specific serum biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and cystatin-C could better predict post-CA AKI than sCR. Methods: Adult CA patients who had kidney-specific biomarkers of AKI collected shortly after return of spontaneous circulation (ROSC) as part of four randomized trials and one observational study were included. Patients with Kidney Disease Improving Global Outcome (KDIGO) stage III AKI or end-stage renal disease, or renal replacement therapy at the time of enrollment were excluded. The association between renal biomarker levels (sCR, NGAL, KIM-1, cystatin-C) shortly after ROSC and the development of KDIGO stage III AKI within 7 days of enrollment were assessed as well as their predictive value of future AKI development. Results: Of 155 patients, 46 (29.7%) developed stage III AKI within 7 days, and 98 (63.2%) died prior to hospital discharge. Patients who developed stage III AKI, compared to those who did not, had higher median levels of sCR (1.4 mg/dL [IQR: 1.2, 1.9] vs. 1.2 [IQR: 1.0, 1.5]; p=0.001), NGAL (868,208 pg/mL [IQR: 412,547.1, 1,341,597] vs. 298,928.3 [IQR: 170,786.6, 594,389.7], p&lt;0.001). and cystatin-C (1,649,202 pg/mL [IQR: 1,184,788, 2,440,583] vs. 1,132,955 [IQR: 795,323.7, 1,580,415]; p&lt;0.001). There was no difference in KIM-1 between groups (150.6 pg/mL [IQR: 150.8, 288.4] vs. 158.9 [IQR: 78.8, 284.7]; p=0.351). There was no significant difference between biomarkers in their ability to predict development of stage III AKI (NGAL AUC=0.75 [95%CI: 0.67-0.83], cystatin-C AUC=0.71 [95%CI: 0.62-0.79], KIM-1 AUC=0.55 [95%CI: 0.45-0.65], sCR AUC=0.67 [95%CI: 0.57-0.76], p&gt;0.05 for all). Both NGAL and cystatin-C performed better than KIM-1 (p&lt;0.01). Conclusion: In post-CA patients, sCR, NGAL, and cystatin-C (but not KIM-1) measured shortly after ROSC were higher in patients who subsequently developed AKI. No biomarker was statistically superior to sCR. Comparison was limited by the small number of patients who developed AKI.

Acute kidney injury in group A streptococcal bacteraemia: incidence, outcome and predictive value of C-reactive protein

Background A ubiquitous human pathogen, Streptococcus pyogenes (Group A Streptococcus, GAS) causes infections from mild pharyngitis to severe septic infections. Acute kidney injury (AKI) is a condition of prompt decline of renal function. The aim of the present study was to report the incidence and outcome of AKI in GAS bacteraemia and to evaluate the diagnostic value of serum C-reactive protein as an indicator of AKI. Methods All adult patients with GAS bacteraemia treated at Turku University Hospital from 2007 to 2018 were identified and their patient records were scrutinised. Results Of 195 included patients, 38 (19.5%) had AKI stage 1, 20 (10.3%) AKI stage 2 and 26 (13.3%) AKI stage 3 and 111 (56.9%) did not have AKI. The adjusted seven-day mortality was significantly higher in AKI stages 2 and 3 compared to the non-AKI group (15% and 19% vs. 3.6%; p = .046 and .006, respectively). Of the survivors, 95.8% met the criteria of renal recovery at discharge. The higher the AKI stage, the higher was the mean serum CRP level on admission. The optimal cut-off for CRP to identify patients with AKI stage 2 or 3 was ≥244 mg/l (sensitivity 82.6% and specificity 75.8%). Conclusions AKI is common in patients with GAS bacteraemia and the severity of AKI correlates with the CRP level on admission. The mortality of patients with GAS bacteraemia and AKI is significantly higher than of patients without AKI. Most survivors, however, show renal recovery. Key Message AKI is common in group A Streptococcal bacteraemia and increases mortality compared to bacteraemia alone. However, renal recovery is also common. A high CRP level on admission correlates significantly positively with the degree of severity of AKI.

Cystatin C is a marker for acute kidney injury, but not for mortality among COVID-19 patients in Mexico

BackgroundPatients infected with SARS-CoV-2 can develop acute kidney injury (AKI), associated with adverse clinical outcomes. In Mexico, an AKI incidence of 60.7% was reported in patients with COVID-19. Serum cystatin C is a well-known marker for AKI. It has been postulated as a marker for mortality in Chinese patients with COVID-19. Information regarding levels of cystatin C in COVID-19-infected patients is nonexistent among Mexican or Latin American populations. AimThis work aimed to assess the level of cystatin C as an indicator of AKI and mortality among COVID-19 patients from Mexico. MethodsA cross-sectional study among 38 adults was performed in the Regional High Specialty Hospital of the Yucatan Peninsula in Merida, Yucatan, Mexico. Baseline characteristics and clinical and biomechanical parameters were collected, and serum levels of cystatin C were measured by ELISA. ResultsA total of 71% (27 patients) with COVID-19 developed AKI; 78% were men, and 22% were women. In addition, 60% of individuals (16 men; 7 women) died due to COVID-19 complications. Serum levels of cystatin C were higher in those individuals who developed AKI (p = 0.001). A logistic regression model indicated that individuals with serum levels of cystatin C above 0.84 ng/mL had a 23-fold increased risk of developing AKI (OR, 23.7, 95% CI, 2.59-217.00, p = 0.005). However, increased cystatin C was not independently associated with mortality in the Mexican population (HR, 1.01, 95% CI, 0.66-1.56, p = 0.959). ConclusionThe results suggest that serum levels of cystatin C indicate AKI in COVID-19 patients. Although we recommend caution when using serum cystatin C levels as an indicator of mortality among the Mexican population, it is essential to note that cystatin C elevates earlier than creatinine, which is an advantage for timely clinical interventions.

Cox-LASSO Analysis for Hospital Mortality in Patients With Sepsis Received Continuous Renal Replacement Therapy: A MIMIC-III Database Study.

BackgroundSepsis remains the leading cause of mortality in-hospital in the intensive care unit (ICU). Continuous renal replacement therapy (CRRT) is recommended as an adjuvant therapy for hemodynamics management in patients with sepsis. The aim of this study was to develop an adaptive least absolute shrinkage and selection operator (LASSO) for the Cox regression model to predict the hospital mortality in patients with Sepsis-3.0 undergoing CRRT using Medical Information Martin Intensive Care (MIMIC)-III v1.4.MethodsPatients who met the Sepsis-3.0 definition were identified using the MIMIC-III v1.4. Among them, patients who received CRRT during ICU hospitalization were included in this study. According to the survival status, patients were split into death or survival group. Adaptive LASSO for the Cox regression model was constructed by STATA software. At last, nomogram and Kaplan-Meier curves were drawn to validate the model.ResultsA total of 181 patients who met Sepsis 3.0 criteria received CRRT were included in the study, in which, there were 31 deaths and 150 survivals during hospitalization, respectively. The overall in-hospital mortality was 17.1%. According to the results of multivariate Cox-LASSO regression analysis, use of vasopressor, international normalized ratio (INR) ≥1.5, and quick sequential organ failure assessment (qSOFA) score were associated with hospital mortality in patients with sepsis who underwent CRRT, but lactate level, mechanical ventilation (MV) support, PaO2/FiO2, platelet count, and indicators of acute kidney injury (AKI), such as blood urea nitrogen (BUN) and creatinine, were not independently associated with hospital mortality after adjusted by qSOFA. The risk nomogram and Kaplan-Meier curves verified that the use of vasopressor and INR ≥1.5 possess significant predictive value.ConclusionsUsing the Cox-LASSO regression model, use of vasopressor, INR ≥1.5, and qSOFA score are found to be associated with hospital mortality in patients with Sepsis-3.0 who received CRRT. This finding may assist clinicians in tailoring precise management and therapy for these patients who underwent CRRT.

Dismal Prognosis of Acute Allergic Tubulointerstitial Nephritis in Patients with AA Amyloidosis

Introduction: Patients with AA amyloidosis may present with acute kidney injury that progresses to end-stage kidney disease in a short period of time. Acute allergic tubulointerstitial nephritis (aTIN) is a frequent cause of acute kidney injury in patients with AA amyloidosis. Although aTIN has a favorable prognosis in the general population, the course of aTIN in patients with AA amyloidosis was not previously reported. In this retrospective study, we determined the prognosis of aTIN superimposed on AA amyloidosis. Methods: Thirty-two patients with combined pathological diagnosis of AA amyloidosis + aTIN and 32 patients with isolated aTIN were compared in terms of 1-year renal functions after the biopsies were performed with an indication of acute kidney injury. Baseline renal functions and number of patients requiring hemodialysis at the time of biopsy was similar in both groups. Results: At the end of the 12-month follow-up period, 29 of 32 patients in the amyloidosis + aTIN group and 1 of 32 patients in the isolated aTIN group required dialysis. Most of these patients with AA amyloidosis had completely normal renal function before the episode of acute kidney injury and had clear exposures to drugs associated with aTIN. Conclusion: In contrary to the patients without AA amyloidosis, patients with AA amyloidosis have extremely high risk of permanent renal failure in case of development of aTIN. Great caution should be exercised in prescribing drugs that are associated with aTIN, in patients with AA amyloidosis.

Renal Resistive Index as A Potential Indicator of Acute Kidney Injury in Horses

Reliable and simple tests are constantly being sought to enable the quick detection of acute kidney injury in humans and animals. Diagnosis of subclinical AKI in horses, mainly in field practice, is difficult. An ultrasound scan is a routine test performed when kidney disease is suspected. The aim of the study was to establish the value of the renal resistive index (RRI) in intrarenal arteries in horses with clinical AKI and compare it to that of healthy horses. The second goal was to determine whether potentially nephrotoxic agents can influence RRI. The kidney ultrasonography examination was performed in 30 healthy horses, 11 horses with AKI and 30 horses at risk for AKI (10 colic horses, 10 horses receiving gentamicin and 10 horses receiving NSAIDs). RRI values were measured using pulsed-wave Doppler. Differences in RRI between groups were observed only in the right kidney. Horses with AKI had significantly higher RRI values compared to healthy horses. In the risk group, there was no effect of potentially nephrotoxic agents on the RRI value. RRI value in horses seem to be lower than in other species. The increase in this parameter in horses with AKI affected only one kidney and these values did not reach values obtained in other species. The clinical application of this method in non-cooperating animals remains questionable, and therefore RRI Doppler ultrasonography of blood flow in the intrarenal arteries may have poor clinical utility as a diagnostic tool in the diagnosis of AKI in horses.

Circ_0023404 sponges miR-136 to induce HK-2 cells injury triggered by hypoxia/reoxygenation via up-regulating IL-6R.

The significance of circular RNAs (circRNAs) is reported in various kidney diseases including acute kidney injury (AKI). Specific circRNAs have the capacity to function as novel indicators of AKI. Circ_0023404 exhibits an important role in several diseases. Nevertheless, the detailed biological role of circ_0023404 in AKI remains poorly known. The present study aimed to investigate the effect of circ_0023404 on renal ischaemia/reperfusion (I/R) injury in vitro. Here, we evaluated the function of circ_0023404 in HK‐2 cells in response to hypoxia/reoxygenation (H/R). We established a cell AKI model induced by H/R in HK‐2 cells. We found circ_0023404 was significantly increased in AKI. Then, we found loss of circ_0023404 increased cell growth, repressed apoptosis, reduced inflammatory factors secretion and oxidative stress generation in vitro. Besides, circ_0023404 sponged miR‐136. miR‐136 overturned the effects of circ_0023404 on HK‐2 cell injury. We assumed IL‐6 receptor (IL‐6R) as a target of miR‐136 and IL‐6R was activated by circ_0023404 via sponging miR‐136. In conclusion, we revealed circ_0023404 contributed to HK‐2 cells injury stimulated by H/R via sponging miR‐136 and activating IL‐6R.

P050 Influence factors in mortality of COVID-19 pateints with underlying rheumatological disorders

Background/Aims Since the outbreak and rapid spread of COVID-19, rheumatologists have sought to provide the best solutions to provide proper shielding of patients vulnerable to COVID-19. Set aside from social distancing and self-isolating, the British Society for Rheumatology proposed pragmatic guidance for different groups of patients for shielding. Clinical presentation, epidemiology, and potential treatment opinions of the management of COVID-19 patients with rheumatic disease had been reported, but a few reports which show a comparison between survivors and non-survivors in relation to their co-morbidities. Methods We collected data from a search identifying 1,200 patients testing positive for SARS-COV-2 with an identified rheumatological condition until 31st April 2020 at Imperial College NHS Trust. A positive laboratory finding is defined as one or more positive result for SARS-COV-2 PCR on nasopharyngeal swab done for inpatients. Results Among 1,200 patients, 39 patients had underlying rheumatological diseases.12 patients died, and 27 patients were discharged. 50% of the patients who died had chronic kidney disease as an existing comorbidity (OR 26, 95%CI ( 2.6-258.1), p value 0.001) compared with only 3% of patients who survived. All the patients with heart failure in this sample died in hospital (33%, OR 29, 95%CI (1.4-597.4, p value 0.006). Regarding drug therapy, 50% of patients who died were receiving more than one immunosuppressant compared with 37% of those who survived. There was a significant association linking non-survivors with a high CRP value (54% , OR 25.2, 95% CI ( 2.44-258.2), p value 0.009) compared with only 4.5% in patients who survived. 70% of patients who died had d-dimer of (>2000ng/ml) compared with 16% of those who survived (OR 11.6, 95% CI ( 1.86-73.06), p value 0.011). Creatinine level also had a significant link with non-survival. 58% patients who died had an initial creatinine (>140umol/l) compared with 18% of survivors (p value 0.0232). Additionally the patients with an elevated creatinine prior to deterioration (which is an indication of acute kidney injury) represented 32% of the total sample and of those, 66% did not survive compared with 13% who did (p value 0.007).We also reviewed the medication adjustment according to NICE guideline. In our study, it was observed that medications were properly adjusted after discussion with rheumatologist. Conclusion Patients with chronic kidney disease and cardiovascular disease should be strictly shielded as a same priority as patient who are taking high dose of immunosuppressive therapy. Follow-up could only be considered for remote consultation in virtual clinic apart from severity of sickness that require for hospital admission. I believe many questions remain for the rheumatology society: How will we continue better rheumatology service during and beyond the pandemic? How particularly important to shield the high-risk patients by widespread adoption of the virtual clinic? Disclosure W.W. Soe: None. F. Hassan: None. W. Phyu: None.

POS-052 EARLY CHANGES URINARY AFTER THE USE OF CISPLATIN: CLINICAL PROSPECTIVE STUDY

Cisplatin (CDDP), one of the first chemotherapeutic drugs discovered, is still used as the first line of treatment for solid tumors, but its use is restricted by its known nephrotoxicity. The search for early indicators of acute kidney injury (AKI) and nephroprotective strategies is necessary to prevent the interruption of cancer treatment.The objectives of this study were to analyze the early renal changes in patients using CDDP and the occurrence of cisplatin-mediated nephrotoxicity.

Effects of Angiotensin II Type 1A Receptor on ACE2, Neprilysin and KIM-1 in Two Kidney One Clip (2K1C) Model of Renovascular Hypertension.

Activation of the renin angiotensin system plays a pivotal role in the regulation of blood pressure, which is mainly attributed to the formation of angiotensin-II (Ang II). The actions of Ang II are mediated through binding to the Ang-II type 1 receptor (AT1R) which leads to increased blood pressure, fluid retention, and aldosterone secretion. In addition, Ang II is also involved in cell injury, vascular remodeling, and inflammation. The actions of Ang II could be antagonized by its conversion to the vasodilator peptide Ang (1–7), partly generated by the action of angiotensin converting enzyme 2 (ACE2) and/or neprilysin (NEP). Previous studies demonstrated increased urinary ACE2 shedding in the db/db mouse model of diabetic kidney disease. The aim of the study was to investigate whether renal and urinary ACE2 and NEP are altered in the 2K1C Goldblatt hypertensive mice. Since AT1R is highly expressed in the kidney, we also researched the effect of global deletion of AT1R on renal and urinary ACE2, NEP, and kidney injury marker (KIM-1). Hypertension and albuminuria were induced in AT1R knock out (AT1RKO) and WT mice by unilateral constriction of the renal artery of one kidney. The 24 h mean arterial blood pressure (MAP) was measured using radio-telemetry. Two weeks after 2K1C surgery, MAP and albuminuria were significantly increased in WT mice compared to AT1RKO mice. Results demonstrated a correlation between MAP and albuminuria. Unlike db/db diabetic mice, ACE2 and NEP expression and activities were significantly decreased in the clipped kidney of WT and AT1RKO compared with the contralateral kidney and sham control (p < 0.05). There was no detectable urinary ACE2 and NEP expression and activity in 2K1C mice. KIM-1 was significantly increased in the clipped kidney of WT and AT1KO (p < 0.05). Deletion of AT1R has no effect on the increased urinary KIM-1 excretion detected in 2K1C mice. In conclusion, renal injury in 2K1C Goldblatt mouse model is associated with loss of renal ACE2 and NEP expression and activity. Urinary KIM-1 could serve as an early indicator of acute kidney injury. Deletion of AT1R attenuates albuminuria and hypertension without affecting renal ACE2, NEP, and KIM-1 expression.

Proteinuria and Bilirubinuria as Potential Risk Indicators of Acute Kidney Injury during Running in Outpatient Settings.

Background and objectives: The purpose of this study was to explore which urinary markers could indicate acute kidney injury (AKI) during prolonged trail running in outpatient settings. Materials and Methods: Twenty-nine experienced trail runners (age 39.1 ± 8.8 years, weight 71.9 ± 11 kg, height 171.9 ± 8.3 cm) completed a 35 km event (cumulative positive ascend of 1815 m, altitude = 906 to 1178 m.a.s.l.) under a temperature of 25.52 ± 1.98 °C and humidity of 79.25 ± 7.45%). Two participant groups (AKI = 17 and No-AKI = 12) were made according to AKI diagnosis criteria based on pre- and post-race values of serum creatinine (sCr) (an increase of 1.5 times from baseline). Blood and urinalysis were performed immediately pre- and post-race. Results: Pre- vs. post-race differences in sCr and sBUN were found in both AKI and No-AKI groups (p < 0.01). Differences in post-race values were found between groups (p = 0.03). A total of 52% of AKI runners presented significant increases in proteinuria (χ2 = 0.94, p = 0.01) and 47% in bilirubinuria (χ2 = 0.94, p = 0.04). Conversely, No-AKI participants presented no significant increases in urine markers. Conclusions: These study’s findings may suggest the potential use of urinalysis as an accessible alternative in the outpatient setting to early identify transitional AKI until a clinical confirmation is performed.

Kidney Injury Molecule 1 in Children with Heart Failure

Background: Kidney injury molecule-1 (KIM-1) is a novel biomarker that was initially identified and evaluated in patients with acute kidney injury. It predominantly indicates tubular injury and is an earlier and more sensitive indicator of acute kidney injury than plasma creatinine. Objective: To evaluate the role of KIM-1 as an early marker of renal dysfunction in children with heart failure and to assess whether KIM-1 concentration is related to heart failure severity and cardiac function. Patients and Methods: This case-control study was carried out at the Cardiology Unit, Outpatient Cardiology Clinic, and Clinical Pathology Unit, Zagazig University Hospitals during the period from November 2018 to May 2019 included 93 children. Results: KIM-1 was higher in patients with acute and chronic heart failure as compared with controls also it has positive correlations with LVEDD, LVESD, and serum creatinine, while it had a negative correlation with GFR. An optimal admission KIM-1 cut off at >588 ng/ml, with a sensitivity of 85.5%, a specificity of 83.9% for WRF prediction in HF, with an area under the curve (AUC= 0.948, P>0.001). While the sensitivity of GFR and serum creatinine was 67.7%, 72.6% respectively and the specificity was 71%, 90.3% respectively with an area under the curve of 0.773 and 0.875 respectively. Conclusions: KIM-1 can be considered as a sensitive diagnostic marker superior to both GFR and creatinine for early detection of impaired renal function in acute and chronic HF even before GFR is markedly reduced and even before serum creatinine is significantly affected.

Kidney Injury Molecule 1 in Children with Heart Failure

Background: Kidney injury molecule-1 (KIM-1) is a novel biomarker that was initially identified and evaluated in patients with acute kidney injury. It predominantly indicates tubular injury and is an earlier and more sensitive indicator of acute kidney injury than plasma creatinine. Objective: To evaluate the role of KIM-1 as an early marker of renal dysfunction in children with heart failure and to assess whether KIM-1 concentration is related to heart failure severity and cardiac function. Patients and Methods: This case-control study was carried out at the Cardiology Unit, Outpatient Cardiology Clinic, and Clinical Pathology Unit, Zagazig University Hospitals during the period from November 2018 to May 2019 included 93 children. Results: KIM-1 was higher in patients with acute and chronic heart failure as compared with controls also it has positive correlations with LVEDD, LVESD, and serum creatinine, while it had a negative correlation with GFR. An optimal admission KIM-1 cut off at >588 ng/ml, with a sensitivity of 85.5%, a specificity of 83.9% for WRF prediction in HF, with an area under the curve (AUC= 0.948, P>0.001). While the sensitivity of GFR and serum creatinine was 67.7%, 72.6% respectively and the specificity was 71%, 90.3% respectively with an area under the curve of 0.773 and 0.875 respectively. Conclusions: KIM-1 can be considered as a sensitive diagnostic marker superior to both GFR and creatinine for early detection of impaired renal function in acute and chronic HF even before GFR is markedly reduced and even before serum creatinine is significantly affected.