Initial Serum Creatinine Level Research Articles

Clinical Features and Prognostic Predictors in Patients with Renal Transplant Complicated by SARS-CoV-2 Infection, a Retrospective Single-Center Study.

This study examines the clinical outcomes and prognostic factors of COVID-19 in renal transplant recipients. Given their immunosuppressed status, these patients are at higher risk of severe complications from COVID-19. The study aims to provide healthcare professionals with critical insights for diagnosing and managing this vulnerable population. This retrospective cohort study included adult renal transplant recipients diagnosed with COVID-19. Data on demographics, medical history, laboratory results, and patient outcomes were analyzed to identify clinical characteristics and prognostic factors. This study included 115 renal transplant recipients with COVID-19, predominantly male, with a mortality rate of 10.4% (12 deaths). The overall vaccination rate was 20%. Univariate analysis showed significant differences between survivors and non-survivors in initial serum creatinine levels, and percentages of neutrophils, monocytes, and lymphocytes, along with CRP levels on day 3. Additionally, CRP levels, hemoglobin, and platelet counts on day 7 also differed significantly. Multivariate analysis identified CRP levels on days 3 and 7, day 7 hemoglobin and platelet counts, and concurrent bacterial infections as independent risk factors for mortality. Elevated CRP levels, renal impairment, and bacterial co-infections play a significant role in the outcomes of COVID-19 in kidney transplant recipients. This study highlights the importance of monitoring these factors for early identification and management of high-risk patients.

The Effect of Oral N-Acetyl Cysteine Administration on Acute Kidney Injury Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that includes structural damage (injury) or malfunction (impairment). AKI is a common complication that occurs in 5-10% of patients due to various underlying etiologies. One of the underlying pathophysiology of AKI is the role of discharge reactive oxygen species (ROS), which causes injury to kidney cells. From various studies, it has been reported that N-acetylcysteine (NAC) has anti-inflammatory and antioxidant effects and has an effect on reducing serum creatinine values.
 Methods: This research is an open randomized clinical trial without control involving 30 patients at Dr. Mohammad Hoesin General Hospital, Palembang, who were all given intervention in the form of NAC 1200 mg/day, starting in September – October 2023. This study aimed to determine the role of NAC in reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data analysis was carried out using SPSS 21 univariate and bivariate.
 Results: From the research results, it was found that the average age of patients was 53.9 years, involving 21 males (70%, N=30) and 9 females (30%, N=30). The most common causes were prerenal and then renal (53.3% and 46.7%). The initial serum creatinine level was found to be 2.12± 0.79 mg/dL (n = 30 samples), and after administration of the intervention, the mean serum creatinine level was 1.28± 0.63 mg/dL (n = 30 samples). By using a paired t-test, there was a decrease in serum creatinine levels significant (p=0,012).
 Conclusion: NAC administration to patients with acute kidney injury of pre-renal or post-renal causes has a statistical effect on reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Serum Complement C4 Levels Are a Useful Biomarker for Predicting End-Stage Renal Disease in Microscopic Polyangiitis.

This study aimed to evaluate the risk factors for end-stage renal disease (ESRD) in microscopic polyangiitis (MPA). In total, 74 patients with MPA were enrolled, and we compared the baseline clinical characteristics and disease activity between MPA patients who have progressed to ESRD and those without ESRD to select predictive factors for ESRD. Out of 74 patients, 12 patients (16.2%) had ESRD during follow-up. Serum C4 levels were significantly higher in MPA patients who have progressed to ESRD than in those without ESRD (p = 0.009). Multivariate analyses revealed that high serum creatinine levels (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.25-15.5) and high serum C4 levels (OR 1.24, 95% CI 1.03-1.49) were risk factors for ESRD. Using receiver operating characteristic analysis, the cut-off value for initial serum C4 levels and serum creatinine levels were 29.6 mg/dL and 3.54 mg/dL, respectively. Patients with MPA with a greater number of risk factors (serum C4 levels > 29.6 mg/dL and serum creatinine levels > 3.54 mg/dL) had a higher ESRD progression rate. Serum C4 levels were significantly positively correlated with serum creatinine levels and kidney Birmingham vasculitis activity score (p = 0.02 and 0.04, respectively). These results suggest that serum C4 levels are useful tools for assessing renal disease activity and prognosis in MPA.

Posterior Urethral Valve: Factors Affecting the Renal Outcome

Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male children with associated sequlae. Different factors, such as age at presentation, initial and nadir serum creatinine, renal parenchymal echogenicity on initial USG, vesicoureteric reflux (VUR) , recurrent UTI, bladder dysfunction and the presence or absence of pop-off mechanism like VURD have significant impact on ultimate renal outcome. The main aim of the study was to observe the effects of different prognostic factors like age of presentation and preoperative VUR of the PUV respondents on postoperative long term renal outcome as well as changes of renal function status on the basis of initial and postoperative serum creatinine level in our settings. Material Methods: This was a quasi-experimental study and conducted in the Department of Pediatric urology of Bangladesh Shishu Hospital and Institute, Dhaka. We enrolled 58 male children of different ages having posterior urethral valve, who were admitted in the pediatric urology department from July,2018 to Dec,2021. Results: Total 58 patients included in our study. Among all patients 53.4% were aged between 1 month to 1 year, 39.7% of them were more than 1 year old and 6.9% of them were neonates. Among 31 respondents, 32.3 % had poor renal function 35.5 % of them also had moderately impaired renal function. Again, out of 23 respondents, 30.4% had poor renal function 6% had moderately impaired renal function. The relation between age category and postoperative renal function status (On the basis of postoperative eGFR) of the posterior urethral valve respondents were statistically not significant. Patients who had no VUR, 66.7% of them had normal renal function, 25% had moderately impaired renal function and 8.3% had poor renal function. Respondents who had bilateral VUR, 55% of them had poor renal function and 35% had moderately impaired renal function. Among respondents who had unilateral VUR, 28.6% of them had poor renal function and 28.6% had moderately impaired renal function but 42.9% had normal renal function. The relation between preoperative VCUG findings and postoperative long term renal function status of the PUV patients were statistically significant. 7 (100%) respondents who had preoperative abnormal renal function, more than 71.4% of them had returned to normal renal function after operative procedure. But abnormal renal function was present in 2 (28.6%) patients during follow up. In our study we found 29.3% of our patients had poor renal outcome and 29.3% patients had moderately impaired renal function within the mean follow up period of 19.33±12.38 months (ranges from 9months to 4 years). Conclusion: Our research highlights the significance of age at presentation, despite its statistically negligible effect on long-term renal outcomes. However, among the children with PUV following valve ablation and with a long-term follow-up, beginning serum creatinine and the presence of various types of VUR on initial VCUG had a significant effect (p.05) on postoperative renal function on the basis of serum creatinine.

A Novel Risk Score to Predict In-Hospital Mortality in Patients With Acute Myocardial Infarction: Results From a Prospective Observational Cohort.

ObjectivesThe aim of this study was to develop and validate a novel risk score to predict in-hospital mortality in patients with acute myocardial infarction (AMI) using the Heart Failure after Acute Myocardial Infarction with Optimal Treatment (HAMIOT) cohort in China.MethodsThe HAMIOT cohort was a multicenter, prospective, observational cohort of consecutive patients with AMI in China. All participants were enrolled between December 2017 and December 2019. The cohort was randomly assigned (at a proportion of 7:3) to the training and validation cohorts. Logistic regression model was used to develop and validate a predictive model of in-hospital mortality. The performance of discrimination and calibration was evaluated using the Harrell’s c-statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The new simplified risk score was validated in an external cohort that included independent patients with AMI between October 2019 and March 2021.ResultsA total of 12,179 patients with AMI participated in the HAMIOT cohort, and 136 patients were excluded. In-hospital mortality was 166 (1.38%). Ten predictors were found to be independently associated with in-hospital mortality: age, sex, history of percutaneous coronary intervention (PCI), history of stroke, presentation with ST-segment elevation, heart rate, systolic blood pressure, initial serum creatinine level, initial N-terminal pro-B-type natriuretic peptide level, and PCI treatment. The c-statistic of the novel simplified HAMIOT risk score was 0.88, with good calibration (Hosmer–Lemeshow test: P = 0.35). Compared with the Global Registry of Acute Coronary Events risk score, the HAMIOT score had better discrimination ability in the training (0.88 vs. 0.81) and validation (0.82 vs. 0.72) cohorts. The total simplified HAMIOT risk score ranged from 0 to 121. The observed mortality in the HAMIOT cohort increased across different risk groups, with 0.35% in the low risk group (score ≤ 50), 3.09% in the intermediate risk group (50 < score ≤ 74), and 14.29% in the high risk group (score > 74).ConclusionThe novel HAMIOT risk score could predict in-hospital mortality and be a valid tool for prospective risk stratification of patients with AMI.Clinical Trial Registration[https://clinicaltrials.gov], Identifier: [NCT03297164].

Clinical features and prognosis of severe-to-profound sudden sensorineural hearing loss

PurposeSudden sensorineural hearing loss (SSNHL) is an otologic emergency. Despite multiple efforts to clarify the factors affecting the prognosis of severe-to-profound SSNHL, various studies showed inconsistent results and lack of clinical significance. Therefore, we examined the clinical features and outcomes of severe-to-profound SSNHL. Materials and methodsWe included patients who experienced SSNHL between 2018 and 2021 and were diagnosed according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; hearing loss over 70 dB on initial pure tone audiometry (PTA) was used to define severe-to-profound SSNHL. We retrospectively examine the demographic, laboratory, radiologic, and audiometric data of SSNHL patients. We also evaluated the final hearing gain of these patients by assessing their PTA findings and word-recognition scores. ResultsOf the 178 patients, 94 (52.81%) and 84 (47.19%) showed profound (>90 dB) and severe (>70 to 90 dB) hearing loss, respectively. The presence of vertigo and hypertension differed significantly between the severe and profound groups (p < 0.001 and p = 0.012, respectively), as did the initial serum creatinine level (p = 0.043). Recovery in PTA showed a reliable correlation with the interval between onset and treatment in the severe group and periventricular white-matter findings in the profound group (p < 0.001 and p = 0.011, respectively). The presence of hypertension was related to recovery of low tone (p = 0.023 for 250 Hz; p = 0.034 for 500 Hz), while glycated hemoglobin level was related to recovery of high tone in the severe group (p = 0.049 for 4000 Hz; p = 0.047 for 8000 Hz). ConclusionsSevere-to-profound SSNHL showed poor prognosis for hearing gain. The interval from onset to treatment was a significant prognostic factor for severe SSNHL, while the presence of vertigo, estimated glomerular filtration rate, and periventricular white-matter findings were significant prognostic factors for profound SSNHL.

AKI In Suspected Meningitis/Encephalitis May Be "Avoidable Kidney Injury".

AKI In Suspected Meningitis/Encephalitis May Be "Avoidable Kidney Injury".

Acute interstitial nephritis associated with ingestion of Achyranthes japonica extract: a case report

BackgroundThe Japanese chaff flower, Achyranthes japonica, is used as complementary medicine to control degenerative arthritis. Although commonly used in South Korea, there has been no report of side effects. We report the first case of acute interstitial nephritis (AIN) that occurred in a woman who ingested A. japonica extract for 4 months.Case presentationA 56-year-old Korean woman was admitted for deterioration of renal function. She had general weakness and nausea for 1 month. Her initial blood urea nitrogen and serum creatinine levels were 26.3 mg/dL and 3.2 mg/dL, respectively. She acknowledged ingesting A. japonica extract for the past 4 months. Renal histology demonstrated AIN represented by immune cell infiltration into the interstitium, tubulitis, and tubular atrophy, but the glomeruli were intact. A. japonica was discontinued immediately and conservative management was started. Renal function was nearly restored to the baseline level without medication after 13 months.ConclusionThis is a rare case report of AIN associated with a pure A. japonica extract. In the case of unknown etiology of AIN, physicians should ask about the use of herbal medicines, nutraceuticals, and traditional folk medicines including A. japonica.

Predicting the outcome of COVID-19 infection in kidney transplant recipients

BackgroundWe aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19.MethodsWe conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission.ResultsOne hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9–3.8] vs. 3.8 g/dl [3.5–4.1], p = 0.002), higher serum ferritin (679 μg/L [184–2260] vs. 331 μg/L [128–839], p = 0.048), and lower lymphocyte counts (700/μl [460–950] vs. 860 /μl [545–1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis.ConclusionOver the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.

Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy.

Ketamine-associated diseases have been increasing with the rise in ketamine abuse. Ketamine-associated uropathy is one of the most common complications. We investigated the effects of ketamine-associated uropathy on renal health and determined predictors of renal function decline in chronic ketamine abusers. This retrospective cohort study analyzed 51 patients (22 with ketamine-associated hydronephrosis and 29 with ketamine cystitis) from Kaohsiung Veterans General Hospital in Taiwan. Primary renal outcome was end-stage renal disease or estimated glomerular filtration rate decline >30% from baseline. Compared with the ketamine cystitis group, the hydronephrosis group had lower initial and final estimated glomerular filtration rates and higher alkaline phosphatase and gamma-glutamyl transferase levels (p < 0.05). Elevated cholestatic liver enzyme levels correlated with renal dysfunction in ketamine-associated uropathy. The hydronephrosis group had a higher proportion of patients reaching endpoints than the ketamine cystitis group (50% and 7%, respectively, p < 0.001). After adjusting for age, sex, and initial serum creatinine level, hydronephrosis remained an independent risk factor for renal function deterioration. Ketamine-associated hydronephrosis was a poor renal outcome and strong predictor of renal function decline in chronic ketamine abusers. Elevated cholestatic liver enzyme levels correlated with the severity of ketamine-associated uropathy. Ultrasonography screening of these high-risk groups and regular renal function follow-ups are necessary.

Renal Function Evaluation in Secondary Amyloidosis According to Location of Deposition

It aimed to evaluate the renal functions according to the accumulation site of amyloid in patients diagnosed with secondary amyloidosis by renal biopsy. Fifty patients diagnosed with secondary amyloidosis, who referred to the nephrotic syndrome outpatient clinic included in the study. According to the findings of renal biopsy, only-glomerular amyloid deposition (group- 1) detected in 9 patients and glomerular+ tubulointerstitial deposition (group- 2) identified in 41 patients. Serum creatinine, creatinine clearance, and total proteinuria levels compared between groups at the time of presentation and on 3rd, 6th, 12th, and 24th months. Initial and subsequent serum creatinine, creatinine clearance, and total proteinuria levels not found to be significantly different between groups (p&gt;0,05 for all). Among subjects with only-glomerular deposition, statistically significant descents in total proteinuria, when compared to initial levels, were observed from the beginning of the 6th month to the end of the 24th month (p

Impact of Very Low-Dose Trimethoprim-Sulfamethoxazole on Serum Creatinine after Renal Transplantation: A Retrospective Study

BackgroundIt is well known that high-dose trimethoprim, through its effect of inhibiting creatinine secretion, increases serum creatinine levels without changes in real glomerular filtration rate. However, there has been no report regarding the effect of very low-dose trimethoprim on serum creatinine levels after renal transplantation. MethodsWe retrospectively investigated 76 renal transplantation recipient outpatients who completed their course of initial prophylaxis at our institution. Twelve patients who experienced events that might affect their serum creatinine levels were excluded. Fifty-one patients who required readministration of trimethoprim-sulfamethoxazole to prevent a possible outbreak of pneumocystis jirovecii pneumonia and 13 patients who did not receive readministration (control) were analyzed. Dosage was 80 mg/400 mg (per tablet), administered as 3 tablets per week for 30.6 ± 13.5 days. This study strictly complied with the Helsinki Congress and the Istanbul. Declaration regarding donor source. ResultsAll patients completed readministration without adverse events. Serum creatinine increased significantly in the readministration group (1.40 ± 0.64 mg/dL to 1.48 ± 0.70 mg/dL, P < .01) while not in the control group. The higher the initial serum creatinine level, the greater the increase of Δ serum creatinine (R = 0.59, P < .001). Sex, baseline urine protein level, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, donor type, and time after renal transplantation did not affect Δ serum creatinine. Serum creatinine returned to baseline levels after cessation. ConclusionsVery low-dose trimethoprim-sulfamethoxazole prophylaxis significantly raised serum creatinine reversibly by 6% after renal transplantation.

New Criterion to Evaluate Acute-on-Chronic Kidney Injury Based on the Creatinine Reference Change

Background: The lack of consensus criteria of acute on chronic kidney injury (ACKI) affects the judgment for its clinical prognosis. Methods: In this study, we analyzed the data from 711,615 hospitalized adults who had at least 2 serum creatinine (SCr) tests within 30 days. We estimated the reference change value (RCV) of SCr given initial SCr level in adults without known risks of acute kidney injury other than chronic kidney disease (CKD). We proposed a criterion for ACKI based on the RCV of SCr (cROCK), which defined ACKI as a ≥25% increase in SCr in 7 days. We validated cROCK by its association with the risks of in-hospital mortality, death after discharge, and CKD progression in a large cohort of patients with CKD stage 3. Results: In 21,661 patients with CKD stage 3, a total of 3,145 (14.5%), 1,512 (7.0%), and 221 (1.0%) ACKI events were detected by both cROCK and Kidney Disease Improving Global Outcomes (KDIGO), cROCK only, and KDIGO only, respectively. cROCK detected 40% more ACKI events than KDIGO. Compared with patients without ACKI by both definitions, those with cROCK- but not KDIGO-defined ACKI had a significantly increased risk of in-hospital mortality (hazard ratio [HR] 5.53; 95% CI 3.75–8.16), death after discharge (HR 1.51; 95% CI 1.21–1.83), and CKD progression (OR 5.65; 95% CI 3.05–10.48). Conclusions: RCV-based criterion (cROCK) for ACKI is clinically valid in that it has a substantially improved sensitivity in identifying patients with high risk of adverse outcomes.

Risk factors for treatment resistance and relapse of Chinese patients with MPO-ANCA-associated vasculitis.

Identification of risk factors for treatment resistance and relapse would be crucial to personalization therapy in patients with myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (MPO-AAV). Current evidence with regard to the risk factors for treatment resistance and relapse remains limited and inconclusive. We aimed to assess the predictors for treatment resistance and relapse in a single-center cohort of Chinese patients with MPO-AAV in this study. In total, 184 patients with MPO-AAV were included. Treatment resistance occurred in 64 (34.9%) of 184 patients and was positively associated with lung involvement (odds ratio [OR] 3.581, 95% CI 1.137-11.278, p = 0.029) and the initial serum creatinine level (OR 1.004, 95% CI 1.001-1.007, p = 0.010) and was negatively associated with platelet (OR 0.992, 95% CI 0.987-0.998, p = 0.007) and serum C3 levels (OR 0.998, 95% CI 0.996-0.999, p = 0.004). Relapse occurred in 29 (24.17%) of 120 patients in whom remission was achieved and was independently associated with lung involvement (hazard ratio [HR] 4.595, 95% CI 1.272-16.599, p = 0.020) and cardiovascular involvement (HR 3.689, 95% CI 1.237-11, p = 0.019,). The serum globulin was demonstrated to be negatively associated with relapse independently (HR 0.876; 95% CI 0.806-0.953; p = 0.002). This retrospective study of MPO-AAV patients in a single Chinese center suggests that treatment resistance was positively associated with lung involvement and the initial serum creatinine level and was negatively associated with platelet and serum C3 levels. Lung involvement and cardiovascular involvement were associated with an increased risk of relapse, while the higher serum globulin was demonstrated to be in association with a decreased risk of relapse.

Renal Function Evaluation in Secondary Amyloidosis According to Location of Deposition

It aimed to evaluate the renal functions according to the accumulation site of amyloid in patients diagnosed with secondary amyloidosis by renal biopsy. Fifty patients diagnosed with secondary amyloidosis, who referred to the nephrotic syndrome outpatient clinic included in the study. According to the findings of renal biopsy, only-glomerular amyloid deposition (group- 1) detected in 9 patients and glomerular+ tubulointerstitial deposition (group- 2) identified in 41 patients. Serum creatinine, creatinine clearance, and total proteinuria levels compared between groups at the time of presentation and on 3rd, 6th, 12th, and 24th months. Initial and subsequent serum creatinine, creatinine clearance, and total proteinuria levels not found to be significantly different between groups (p&gt;0,05 for all). Among subjects with only-glomerular deposition, statistically significant descents in total proteinuria, when compared to initial levels, were observed from the beginning of the 6th month to the end of the 24th month (p&lt;0,05). On the other hand, subjects with both glomerular + tubulointerstitial deposition, statistically significant descents in total proteinuria levels observed from the beginning of follow-up to the end of the 24th month (p&lt;0,01). In subjects with both glomerular + tubulointerstitial accumulation, a statistically significant increase in serum creatinine, compared to baseline levels, observed in 12th and 24th months (p&lt;0,01). According to the biopsy findings, progressive deterioration of renal functions and an increase in proteinuria were higher in patients with both glomerular and tubulointerstitial amyloid deposition than patients with only-glomerular removal.

An overlap of antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis and IgG4-related kidney disease

BackgroundWe investigated the characteristics of antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) and immunoglobulin G4 (IgG4)-related kidney disease (IgG4-RKD) overlap syndrome. MethodsThis is a 2-center study with 19 patients. ResultsFifteen patients were classified as microscopic polyangiitis (MPA). The initial serum creatinine levels were 320.9 ± 191.4 μmol/l and the BVAS was 19.7 ± 7.4 at diagnosis. Hematuria was absent or slight in 13 (68.4%) cases. Renal histology of these patients revealed concurrent ANCA-GN and IgG4-RKD. Regarding the histological classification of ANCA-GN, 9 (47.4%), 8 (42.1%), 1 (5.3%) and 1 (5.3%) patients were classified as focal, crescentic, mixed and sclerotic ANCA-GN, respectively. MPO-ANCA could be detected in 17/19 (89.5%) patients. IgG subclasses of MPO-ANCA were tested in 10 patients, and all were positive for IgG4-MPO-ANCA. In patients with combined ANCA-GN and IgG4-RKD, the percentage of positive IgG1-MPO-ANCA was significantly lower than the control group of 20 AAV patients without IgG4-RKD (P = 0.002), and the percentage of positive IgG4-MPO-ANCA was higher than the control group, but this difference was not statistically significant (P = 0.14). ConclusionsANCA-GN and IgG4-RKD overlap syndrome concerned mainly MPO-ANCA positive patients. The IgG subclass analysis of MPO-ANCA showed lower percentage of IgG1 subclass. The association between ANCA-GN and IgG4-RKD is possible and represents a special entity.

Factors of Acute Kidney Injury Donors Affecting Outcomes of Kidney Transplantation From Deceased Donors

BackgroundThis study aimed to investigate the outcomes of kidney transplantation (KT) from deceased acute kidney injury (AKI) donors and analyzed the factors affecting these outcomes. MethodsAll patients who underwent KT from deceased donors at our institution from 1998 to 2016 were retrospectively reviewed. Recipients were divided into the AKI and non-AKI donor groups. We analyzed delayed graft function (DGF), serum creatinine levels at 1 month and 1 year after KT, cold ischemia time, donors’ initial and terminal serum creatinine levels, Kidney Donor Profile Index, and patient and graft survival in each group. ResultsOf 181 recipients, 30 received kidneys from 21 AKI donors, whereas the remaining 151 received kidneys from donors without AKI. DGF more frequently developed in the AKI donor group than in the non-AKI donor group (40% vs 7.28%; P = .001). Allograft functions at 1 month and 1 year after KT did not differ between the AKI and non-AKI donor groups (1 month: P = .469; 1 year: P = .691). Factors affecting DGF were recipient weight and donor AKI. Recipient factors affecting graft function at 1 year were recipient height, length of hospital stay, serum creatinine levels at 1 month and 6 months, and biopsy-proven acute rejection. Older donor age was the only donor factor that affected graft function at 1 year. ConclusionKT from deceased AKI donors showed a higher DGF rate but favorable patient and graft survival and graft functions. Donor AKI and recipient weight affected DGF, and only older donor age affected graft function at 1 year.

SAT-095 CLINICAL OUTCOME OF KIDNEY TRANSPLANTATION FROM DECEASED DONORS WITH ACUTE KIDNEY INJURY

There are reports that kidney transplantation (KT) from donors with acute kidney injury (AKI) have similar long-term renal function and graft survival compared with KT from donors without AKI, but there is no established recommendation. Clinicians may hesitate to use the kidney with acute kidney injury due to fear of a poor outcome. This study aimed to investigate the clinical outcome in patients who received kidneys from deceased donors with AKI. From 1998 to 2016, we retrospectively reviewed patients undergone kidney transplantation from deceased donors. We divided donors into two groups of AKI (acute kidney injury) group and non-AKI group. We analyzed delayed graft function, serum creatinine at 1-month after KT, serum creatinine at 1-year after KT, cold ischemic time, donor’s initial and last serum creatinine level, The Kidney Donor Profile Index (KDPI) etc. Of 181 recipients, kidneys from 21 donors with AKI were transplanted into 30 recipients (AKI group). Another 151 recipients received kidneys from donors without AKI (Non-AKI group). Delayed graft function developed more frequently in the AKI group than in the non-AKI group (40% vs 7.28%; P <0.001). Allograft functions at 1-month and 1-year after KT did not differ between the AKI and non-AKI groups(1-month sCr : 1.25 vs 1.30, p=0.469, 1-year sCr: 1.38 vs 1.13, p=0.691). KT from deceased donors with AKI showed comparable outcomes at 1,6 and 12 months despite high rates of delayed graft function. Our clinical outcome suggests that kidneys from donors with AKI are a potential source to expand the donor pool.

Rhabdomyolysis – Go big or go home

ObjectiveTo evaluate the occurrence of renal injury in hospitalized patients with the diagnosis of rhabdomyolysis among a series of patients presenting to an urban emergency department. MethodsA retrospective chart review between January 2006 and February 2017 was conducted on patients aged 21–65 years old that were admitted with a diagnosis of Rhabdomyolysis. We included patients with an initial serum creatinine (Cr) level < 1.3 mg/dL and an initial serum creatine phosphokinase (CPK) level > 1000 U/L. We excluded patients with preexisting renal disease, hypertension, diabetes, patients currently on medications in the statin class, patients with muscular dystrophy and neuromuscular disorders. ResultsOne hundred and fifteen patients (100 men, 15 women) were enrolled, with a mean age of 36 years old. The mean CPK at presentation was 18,965 U/L and the highest CPK was 168,300 U/L. The mean Cr upon presentation was 0.95 mg/dL. The average length of stay of our patients was 4.6 days. The longest length of stay was 30 days and the shortest was 1 day. Seven patients had hospital stays longer than 10 days. None of the patients had prolonged admissions due to rhabdomyolysis alone. The patient admitted for 30 days had a protracted admission due to liver failure and sepsis thought to be unrelated to Rhabdomyolysis. No patients that fit our inclusion criteria developed renal insufficiency (Cr > 1.3 mg/dL) or failure regardless of their CPK upon presentation, peak CPK or therapies received during their hospitalization. ConclusionPatients in our data set that presented to the Emergency Department with a CPK of >1000 U/L and a Cr of <1.3 mg/dL that were hospitalized with a diagnosis of rhabdomyolysis are not at risk for developing renal insufficiency or failure if treated promptly with fluid rehydration, regardless of their initial CPK values.

A2430 Glomerulomegaly and blood pressure may predict renal progression after 10 yrs in IgA nephropathy

Objectives: We previously reported that blood pressure (BP) and glomerular size are related to pathologic findings and renal function in IgAN. We reanalyzed these effects on long-term renal progression. Methods: We analyzed renal biopsy specimens and clinical information in patients with IgAN (n = 34). Glomerular surface area (GSA) was determined using a computer imaging analyzer. Results: There were significant correlations between mean or maximal GSA and age, body mass index, systolic and diastolic BP, eGFR, and pathological findings including glomerulosclerosis, interstitial fibrosis, and tubular atrophy. The group with higher GSA had higher BP, pathological grade and lower eGFR. Twenty-two patients with initial normal serum creatinine levels were followed up for >10 yrs. As well as GSA was reversely correlated with final eGFR, GSA and initial BP were higher in the progressor group (n = 6; two on hemodialysis) than in the normal group (n = 16). Conclusion: These results suggest that glomerulomegaly and BP may predict the long-term renal progression in IgA nephropathy.