Occurrence Of Kidney Disease Research Articles

Association between Metabolic Disorders and Impaired Kidney Function Thereafter in the Japanese General Population

Plain Language SummaryKidney is an organ of the silence because a symptom of kidney disease appears only in its end stage. However, kidney disease even in its early stage is a risk of cardiovascular events, a leading cause of death worldwide. It is extremely difficult to restore impaired kidney function. Early detection or primary prevention of kidney disease is quite important; thus, identifying individuals with increased risk of developing kidney disease is one of the most attractive approaches to reduce a burden of cardiovascular disease. Metabolic syndrome (MetS) is a condition that several metabolic disorders are clustered, and kidney disease often coexists with a component of metabolic disorders, such as increased blood pressure, impaired glucose tolerance, and dyslipidemia. The present study investigated whether MetS is a risk of kidney disease. A total of 14,917 subjects with normal kidney function were enrolled and followed up for 5 years with the endpoint of kidney disease. During the follow-up, 2,150 participants developed kidney disease and the occurrence of the disease was more frequent in individuals who had MetS at baseline than in those who did not. Moreover, each metabolic disorder was associated with future occurrence of kidney disease and the risk of kidney disease increased with increasing the number of metabolic disorders. Testing for MetS and its components can help identify individuals at increased risk of developing kidney disease.

Research progress of traditional Chinese medicine on the treatment of diarrhea by regulating intestinal microbiota and its metabolites based on renal-intestinal axis.

Intestinal microbiota and its metabolites are involved in many physiological processes of the human body and play a vital role in maintaining human health. The occurrence of kidney disease can cause intestinal microbiota imbalance, resulting in diarrhea. The change of intestinal microbiota and its metabolites content can aggravate renal function injury, which has a bidirectional regulating effect. The theory of renal-intestinal axis further clarified that the impaired renal function is related to the imbalance of intestinal microorganisms, and the impaired intestinal barrier is related to the accumulation of toxin products. Because of its unique therapeutic advantages, Traditional Chinese Medicine can treat diarrhea by enhancing the growth of beneficial bacteria, inhibiting pathogenic bacteria and immune regulation, and slow down the continuous deterioration of kidney disease. This paper focuses on the relationship between intestinal microbiota and its metabolites and diarrhea, the influence of Traditional Chinese Medicine on intestinal microbiota in the treatment of diarrhea, and the role of intestinal microbiota and its metabolites in the renal-intestinal axis. It provides a theoretical basis for Traditional Chinese Medicine to regulate intestinal microbiota and its metabolites based on the renal-intestinal axis theory to treat nephrology-induced diarrhea, and also provides a new idea and method for Traitional Chinese Medicine to treat nephrology-induced diarrhea.

Evaluation and Correlation of Urinary Micro Albumin in Early Diagnosis of Patients with Hypertension Related Chronic Kidney Disease

Abstract One of the main organs targeted by hypertension, which is now understood by science to be an inflammatory disease, is the kidney. Urinary microalbumin, serum blood urea nitrogen, and creatinine are examples of clinical biochemical indicators for kidney illness that are often employed. This study aimed to study the role of Urinary microalbumin as a marker of inflammation in hypertensive chronic kidney disease patients. Evaluate the association of Urinary microalbumin levels in chronic kidney disease with/without hypertension. Possible usage of this marker as a predictive index for regular kidney disease occurrence. A case–control study was conducted on 100 participants, including 48 individuals identified as male and 52 individuals identified as female; in addition, their ages ranged from (20 to 70), these 100 participants, including (35) chronic kidney disease patients with hypertension (35) chronic kidney disease patients without hypertension, and (30) healthy control group, were evaluated concerning Urinary Micro Albumin using an immunochromatographic test kit. The results illustrated that Urinary microalbumin, Urea and Creatinine in CKD with the HBP group showed a highly significant increase (p˂0.05) compared to the control group according to case/ control, sex and age. In contrast, the most negligible value was in the Control group. In conclusion The research findings indicate a correlation between hypertension and chronic kidney disease (CKD). The presence of hypertension resulted in elevated levels of Urinary microalbumin, urea, and creatinine in patients as compared to the control group. Urinary microalbumin has the potential to serve as a marker for the assessment of glomerular and tubular function in adults. It performs comparably to the Cr-based estimating equations as an indicator of renal function.

Improving Kidney Disease Care: One Giant Leap for Nephrology.

Nephrology is an ever-evolving field of medicine. The importance of such a discipline is related to the high clinical impact of kidney disease. In fact, abnormalities of kidney function and/or structure are common in the general population, reaching an overall prevalence of about 10%. More importantly, the onset of kidney damage is related to a strikingly high risk of cardiovascular events, mortality, and progression to kidney failure which, in turn, compromises quality and duration of life. Attempts to comprehend the pathogenesis and molecular mechanisms involved in kidney disease occurrence have prompted the development and implementation of novel drugs in clinical practice with the aim of treating the 'specific cause' of kidney disease (including chronic kidney disease, glomerular disease, and genetic kidney disorders) and the main immunological complications following kidney transplantation. Herein, we provide an overview of the principal emerging drug classes with proved efficacy in the context of the aforementioned clinical conditions. This can represent a simplified guide for clinical nephrologists to remind them of the vast and heterogeneous armamentarium of drugs that should be used in the present and the future to improve the management of patients suffering from kidney disease.

Gestational Exposure to Maternal Systemic Glucocorticoids and Childhood Risk of CKD

Background & ObjectivesThe potential effects of antenatal glucocorticoid exposure on the health of children are unclear. We examined the association of gestational exposure to maternal systemic glucocorticoids (SG) and the risk of developing chronic kidney disease (CKD) in childhood. Study designRetrospective cohort study. Setting & ParticipantsNewborns cared for at the largest healthcare delivery system in Taiwan between 2004 and 2018. ExposureMaternal prescriptions for SG between the last menstrual period and birth as a proxy for gestational exposure. OutcomeIncidence of childhood CKD, including congenital anomalies of the kidney and urinary tract (CAKUT) and other kidney diseases (non-CAKUT) over 10 years. Analytical ApproachCox proportional hazards models with stabilized inverse probability of treatment weighting and robust sandwich estimator were used to estimate the average association between SG and incident CKD after adjustment for offspring characteristics (aHR). ResultsAmong 23,363 singleton-born children, gestational SG exposure was significantly associated with a higher risk of childhood CKD (aHR, 1.69 [95% CI, 1.01–2.84]). Stratified analyses showed stronger associations between SG and childhood CKD within the strata of birth <37 weeks gestational age (aHR, 2.38 [95% CI, 1.19–4.78]), male sex (aHR, 1.89 [95% CI, 1.00–3.55]), gestational exposure in the second trimester (aHR, 6.70 [95% CI, 2.17–20.64]), and total dose >24 mg hydrocortisone equivalent (aHR, 1.91 [95% CI, 1.05–3.47). LimitationsStudy was limited to the Taiwan healthcare delivery system and childhood CKD events through age 10 years. ConclusionsThe findings of this study suggest that gestational exposure to systemic glucocorticoids is associated with the occurrence of kidney disease in childhood. If these findings are confirmed, they may inform clinicians who are considering prescribing SG during pregnancy.

Severity and Remission of Metabolic Dysfunction-Associated Fatty/Steatotic Liver Disease With Chronic Kidney Disease Occurrence.

The association of the severity of hepatic steatosis in metabolic dysfunction-associated fatty liver disease (MAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) and the remission of MAFLD/MASLD with CKD occurrence is unclear. The study enrolled 79 540 participants from the Kailuan cohort. Hepatic steatosis was diagnosed by ultrasound. MAFLD/MASLD was defined as hepatic steatosis combined with metabolic dysfunction and MASLD further excluded alcohol or other causes of liver disease. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate<60 mL/min per 1.73 m2 or positive proteinuria (≥1+). Hazard ratio (HR) was calculated by Cox regression models. After a median follow-up of 12.9 years, CKD occurred in 20 465 participants. After adjusting for potential confounders, MAFLD was associated with a higher risk of CKD compared with non-MAFLD (HR, 1.12 [95% CI, 1.09-1.16]), and this risk increased with increasing severity of hepatic steatosis (P-trend<0.001). Consistent findings were observed when MASLD was used as the exposure. Compared with persistent non-MAFLD, no statistical difference was found in the risk of CKD in MAFLD remission (HR, 1.04 [95% CI, 0.95-1.15]); however, MASLD remission still had a higher risk of CKD compared with persistent non-MASLD (HR, 1.15 [95% CI, 1.03-1.27]). When grouped according to the prior severity of hepatic steatosis, there was no statistically significant difference in risk of CKD in mild-MAFLD/MASLD remission compared with persistent non-MAFLD/MASLD, but moderated/severe-MAFLD/MASLD remission still had a higher risk. The risk of CKD in patients with MAFLD/MASLD increased with the severity of hepatic steatosis. Even after remission of the disease, patients with MAFLD/MASLD with prior moderate to severe hepatic steatosis still had a higher risk of CKD.

Twenty-Three-Year Trends in the Use of Potentially Nephrotoxic Drugs in Denmark.

The occurrence of acute and chronic kidney diseases has been rising in the last decades. Although drug use is a common risk factor for impaired kidney function, changes in utilization of potential nephrotoxic drugs have received little attention. To describe temporal trends in the utilization of potentially nephrotoxic drugs in Denmark between 1999 and 2021. Specific drugs known or suspected to be nephrotoxic were identified in the literature. Data on the sold defined daily doses (DDDs) of potentially nephrotoxic drugs between 1999 and 2021 were retrieved using the Danish Register of Medical Product Statistics. Trends in sales of DDDs per 1000 inhabitants per day were tabulated and illustrated graphically. From 1999 to 2021, the total sale of all selected drugs increased from 286 to 457 DDDs per 1000 inhabitants per day. The overall sale reached a preliminary peak in 2012 with 449 DDDs per 1000 inhabitants per day and remained relatively stable thereafter until reaching an all-time high in 2021 with 457 DDDs per 1000 inhabitants per day. Contributing with the majority in volume, sales of drugs inhibiting the renin-angiotensin-aldosterone system (RAAS) increased dramatically throughout the period. The same was observed for acetaminophen, methotrexate, tacrolimus, and iodinated contrast dye. In contrast, the sales of diuretics, acetylsalicylic acid, and ciclosporin decreased during the last decade of the study period. From 1999-2021 considerable changes in sales of potentially nephrotoxic drugs were observed. In general, the sales increased, in volume predominated by RAAS inhibiting drugs. This increase in sales of potential nephrotoxins could contribute to an increasing occurrence of kidney diseases.

Long‐term prognosis of focal segmental glomerulosclerosis treated with therapeutic low‐density lipoprotein‐apheresis in patients with severe kidney dysfunction and proteinuria

AbstractBackgroundThe prognosis of focal segmental glomerulosclerosis patients with nephrotic syndrome is estimated to be 10%–20% in 5 years and 30%–50% in 10 years, leading to end‐stage kidney disease. The response rate with steroid therapy is 40%–60%. Therapeutic low‐density lipoprotein‐apheresis (LDL‐A) may be effective in patients with steroid resistance. Information regarding the long‐term prognosis of patients with focal segmental glomerulosclerosis receiving this therapy is scarce.MethodsWe investigated the effectiveness of treatment in 50 patients with primary focal segmental glomerulosclerosis diagnosed between 1961 and 2017 at Kanazawa University Hospital and related facilities. The patients were observed at least 12 months after biopsy or until end‐stage kidney disease occurrence or death.ResultsLDL‐A was performed in four patients who presented with steroid‐resistant nephrotic syndrome (two patients had concurrent acute renal failure for which hemodialysis was performed). In comparison with 17 patients who did not receive LDL‐A after 1989, the LDL‐A group had higher urinary protein excretion (13.7 vs. 5.2 g/day, P = 0.053) and serum creatinine (4.11 vs. 1.65 mg/dL) levels at onset, and a numerically higher remission rate (75.0% vs. 58.7%) compared with the nonlipoprotein‐apheresis group.ConclusionTherapeutic LDL‐A can be performed for critical cases and may improve the remission rate.

A comparison of outcomes between transperitoneal and retroperitoneal robotic assisted partial nephrectomy in patients with completely endophytic kidney tumors

IntroductionRetroperitoneal robotic partial nephrectomy (RPN) has been shown to have comparable outcomes to the transperitoneal approach for renal tumors. However, this may not be true for completely endophytic tumors as they pose significant challenges in RPN with increased complication rates. Hence, we sought to compare the safety and feasibility of retroperitoneal RPN to transperitoneal RPN for completely endophytic tumors. MethodsWe performed a retrospective analysis of patients who underwent RPN for a completely endophytic renal mass using either transperitoneal or retroperitoneal approach from our multi-institutional database (n = 177). Patients who had a solitary kidney, prior ipsilateral surgery, multiple/bilateral tumors, and horseshoe kidneys were excluded from the analysis. Overall, 156 patients were evaluated (112 [71.8%] transperitoneal, 44 [28.2%] retroperitoneal). Baseline characteristics, perioperative and postoperative data were compared between the surgical transperitoneal and retroperitoneal approach using Chi-square test, Fishers exact test, t test, Mood median test and Mann Whitney U test. ResultsOf the 156 patients in this study, 86 (56.9%) were male and the mean (SD) age was 58 (13) years. Baseline characteristics were comparable between the 2 approaches. Compared to transperitoneal approach, retroperitoneal approach had similar ischemia time (19.6 [SD = 7.6] minutes vs. 19.5 [SD = 10.2] minutes, P = 0.952), operative time (157.5 [SD = 44.8] minutes vs. 160.2 [SD = 47.3] minutes, P = 0.746), median estimated blood loss (50 ml [IQR: 50, 150] vs. 100 ml [IQR: 50, 200], P = 0.313), median length of stay (1 [IQR: 1, 2] day vs. 1 [IQR: 1, 2] day, P = 0.126) and major complication rate (2 [4.6%] vs. 3 [2.7%], P = 0.621). No difference was observed in positive surgical margin rate (P = 0.1.00), delta eGFR (P = 0.797) and de novo chronic kidney disease occurrence (P = 1.000). ConclusionRetroperitoneal and transperitoneal RPN yielded similar perioperative and functional outcomes in patients with completely endophytic tumors. In well-selected patients with purely endophytic tumors, either a retroperitoneal or transperitoneal approach could be considered without compromising perioperative and postoperative outcomes.

Tatalaksana Komprehensif Gangguan Ginjal pada Pekerja Industri Gula

Sugarcane workers have a higher risk of being exposed to pesticides where pesticides have high toxicity. One of the most common diseases is kidney disorders, including acute kidney injury and chronic kidney disease of unknown disease or known as mesoamerican nephropathy. This study is a literature review to determine the comprehensive management of kidney disorders in sugar industry workers. A comprehensive review was conducted by searching for national and international journals in the last 6 years which were identified according to the topic. Kidney disease in sugarcane workers can take the form of acute kidney injury in the acute phase and become chronic if the risk factors cannot be overcome. Risk factors for kidney disease in sugarcane workers are dehydration, pesticides, heat stress, strenuous physical activity, exposure to sugarcane burning smoke. Preventive steps that can be taken include providing good fluid intake, providing good rest areas, setting working hours, modifying special backpacks for water bottles, procuring appropriate personal protective equipment and using bagasse to reduce cadmium ions in pesticides. If kidney disease has occurred, monitoring and treatment is carried out according to the level of the disease so that it does not get worse. Sugar industry workers have various risks for the occurrence of kidney disease. Management that includes promotive, preventive, curative and rehabilitative can be done to provide comprehensive services for kidney disorders in sugarcane workers.

High risk APOL1 genotypes and kidney disease among treatment naïve HIV patients at Kano, Nigeria.

Racial disparities are known in the occurrence of kidney disease with excess risks found among people of African descent. Apolipoprotein L1 (APOL1) gene variants G1 and G2 are associated with kidney disease among HIV infected individuals of African descent in the USA as well as among black population in South Africa. We set out to investigate the prevalence of these high-risk variants and their effects on kidney disease among HIV infected patients in Northern Nigeria with hitherto limited information despite earlier reports of high population frequencies of these alleles from the Southern part of the country. DNA samples obtained from the whole blood of 142 participants were genotyped for APOL1 G1 and G2 variants after initial baseline investigations including assessment of kidney function. Participants comprised 50 HIV positive patients with no evidence of kidney disease, 52 HIV negative individuals with no kidney disease and 40 HIV positive patients with chronic kidney disease (CKD) evidenced by persistent proteinuria and/or reduced eGFR, who also had a kidney biopsy. All the HIV positive patients were newly diagnosed and treatment naïve. The distribution of the APOL1 genotypes among the study participants revealed that 24.6% had a G1 risk allele and 19.0% a G2. The frequency of the High Risk Genotype (HRG) was 12.5% among those with CKD compared to 5.8% in the HIV negative group and zero in the HIV positive no CKD group. Having the HRG was associated with a higher odds for developing HIV Associated Nephropathy (HIVAN) (2 vs 0 risk alleles: OR 10.83, 95% CI 1.38-84.52; P = 0.023; 2 vs 0 or 1 risk alleles: OR 5.5, 95% CI 0.83-36.29; P = 0.07). The HRG was also associated with higher odds for Focal Segmental Glomerulosclerosis (FSGS) (2 vs 0 risk alleles: OR 13.0, 95% CI 2.06-81.91; P = 0.006 and 2 vs 0 or 1 risk alleles: OR 9.0, 95%CI 1.62-50.12; P = 0.01) when compared to the control group. This study showed a high population frequency of the individual risk alleles of the APOL1 gene with higher frequencies noted among HIV positive patients with kidney disease. There is high association with the presence of kidney disease and especially FSGS and HIVAN among treatment naive HIV patients carrying two copies of the HRG.

Study on the Mechanism of circRNA Regulating the miRNA Level in Nephrotic Syndrome.

Background Nephrotic syndrome is an enormous public healthy threaten, which causes a variety of complications and secondary disease; however, the molecular mechanism of nephrotic syndrome remains unclear. Methods In our study, RNA-seq were used to test the transcription level of patients with nephrotic syndrome, in order to investigate the interaction of circRNA-miRNA-mRNA in nephrotic syndrome patients. Results Consistent with our hypothesis, miRNAs were confirmed to be associated with nephrotic syndrome, majority of their targeting circRNAs downregulated in nephrotic syndrome patients and at the same time, the KEGG pathway analysis found that target genes of the circRNAs bonding miRNAs was highly correlated with the occurrence of kidney diseases. Conclusion Thus, we can draw a conclusion that downregulated circRNAs cause miRNA expressing aberrant and then affect the expression level of mRNA, finally leading to the generation of nephrotic syndrome.

In Vivo Ultrasound Localization Microscopy Imaging of the Kidney's Microvasculature With Block-Matching 3-D Denoising.

Structural abnormalities and functional changes of renal microvascular networks play a significant pathophysiologic role in the occurrence of kidney diseases. Super-resolution ultrasound imaging has been successfully utilized to visualize the microvascular network and provide valuable diagnostic information. To prevent the burst of microbubbles, a lower mechanical index (MI) is generally used in ultrasound localization microscopy (ULM) imaging. However, high noise levels lead to incorrect signal localizations in relatively low-MI settings and deep tissue. In this study, we implemented a block-matching 3-D (BM3D) image-denoising method, after the application of singular value decomposition filtering, to further suppress the noise at various depths. The in vitro flow-phantom results show that the BM3D method helps the significant reduction of the error localizations, thus improving the localization accuracy. In vivo rhesus macaque experiments help conclude that the BM3D method improves the resolution more than other image-based denoising techniques, such as the nonlocal means method. The obtained clutter-filtered images with fewer incorrect localizations can enable robust ULM imaging, thus helping in establishing an effective diagnostic tool.

Kidney Function Test for Screening of the Kidney Disease among Hypertensive Patients

Background: Kidney disease results in some loss of renal function and can lead to kidney failure, which is Renal failure is defined as the full loss of kidney function. Renal failure is the last stage of kidney disease, at which point dialysis or a kidney transplant are the only treatments available. The prevalence rate of kidney disease among hypertensive patients in India is 29.8% [1].&#x0D; Objective: 1. To evaluates the kidney function test by using serum creatinine, blood urea nitrogen and uric acid among hypertensive patients.&#x0D; &#x0D; To associate the demographic variables with the selected kidney function test among hypertensive patients.&#x0D; &#x0D; Methodology: It is a cross sectional, analytical hospital based study. The patients of hypertension has selected for the study. Patients are chosen based on inclusion criteria, and the nature and aim of the study are explained in detail and the written and informed consent, from the subject will be taken before data collection by the investigator after that the blood and urine samples will be taken from the hypertensive patients for further investigation respectively. The setting of the study is selected hospitals of Vidarbha Region.&#x0D; Expected Results:&#x0D; &#x0D; There may be a possibility of occurrence of kidney disease among hypertensive patients&#x0D; &#x0D; Conclusion: Following the end of data gathering, the statistical analysis will be used to develop conclusions.

Improved oral hygiene care and chronic kidney disease occurrence: A nationwide population-based retrospective cohort study.

Oral diseases or poor oral hygiene have close connections with systemic inflammatory reaction, which is one of major mechanism in the development of chronic kidney disease (CKD). We conducted a research assuming that better oral hygiene care would be negatively related with the risk of developing new-onset CKD.From 2003 to 2004, a total of 158,495 participants from the Korean national health insurance data sharing service which provides health screening data including variables as age, sex, vascular risk factors, medication information, indicators regarding oral hygiene, and laboratory results. The diagnosis of CKD and vascular risk factors were defined according to the International Statistical Classification of Diseases and Related Health Problems codes-10th revision. The follow-up period for the study subject was until the occurrence of CKD, until death, or Dec 31, 2015.Approximately 13.3% of the participants suffered from periodontal disease, and 40.7% brushed their teeth at least three times a day. With a median of 11.6 (interquartile range 11.3–12.2) years’ follow-up, the cohort included 3223 cases of incident CKD. The 10-year incidence rate for CKD was 1.80%. In multivariable analysis with adjustment for age, sex, demographics, vascular risk factors, blood pressure, and blood laboratory results, frequent tooth brushing (≥3 times a day) was negatively related to occurrence of CKD (hazard ratio: 0.90, 95% confidence interval [0.83–0.99], P = .043, P value for trend = .043).Participants with improved oral hygiene (≥3 times a day) have showed less risk of CKD. Additional interventional studies are in need to establish causative relationship between oral hygiene and risk of CKD.

Monoclonal gammopathy of renal significance: Spectrum of diseases and approach to a case.

The occurrence of kidney diseases associated with a monoclonal gammopathy in the absence of symptomatic multiple myeloma is increasingly recognized. When the kidney is involved, the monoclonal etiology of these diseases results in clinical and laboratory features distinct from those of other disease, necessitating the nomenclature monoclonal gammopathy of renal significance (MGRS). The detection of these monoclonal diseases involving the kidney is important since they are poorly responsive to conventional immunosuppression and instead require clone-directed therapy. The new International Kidney and Monoclonal research group consensus definition of MGRS includes all proliferative conditions of B cells and/or plasma cells. Renal lesions due to monoclonal immunoglobulins are quite capable of progression with resulting end-stage renal disease development. Hence, these lesions require therapeutic intervention even if they do not satisfy myeloma criteria or the presence of any myeloma defining event. The spectrum of renal lesions that can be observed in a case of MGRS is wide and mirrors the list that may be seen in a case of any plasma cell neoplasm. This includes Ig light chain, heavy chain, and heavy and light chain amyloidosis; immunotactoid glomerulonephritis (GN); monoclonal immunoglobulin deposition disease including light chain, heavy chain, or heavy and light chain disease; light chain proximal tubulopathy; crystal-storing histiocytosis; proliferative GN with monoclonal immunoglobulin deposits; C3 glomerulopathy with monoclonal gammopathy and cast nephropathy. The initial approach after histological assessment is based on presence or absence of monoclonal immunoglobulin deposits. If monoclonality is evident, it is important to distinguish between conditions with deposition of intact immunoglobulin molecule or light chains only. The treatment of MGRS is directed at the underlying neoplastic B-cell or plasma cell clones.

Evaluation of Longitudinal Exposure to Tacrolimus as a Risk Factor of Chronic Kidney Disease Occurrence Within the First-year Post-Liver Transplantation.

Renal failure is predictive of mortality in the early postliver-transplantation period and calcineurin inhibitors toxicity is a main challenge. Our aim is to assess the impact of longitudinal tacrolimus exposure (TLE) and other variables on chronic kidney disease (CKD)-free 1-year-survival. Retrospective data of consecutive patients transplanted between 2011 and 2016 and treated with tacrolimus were collected. TLE and all relevant pre- and post-liver transplantation (LT) predictive factors of CKD were tested and included in a time-to-event model. CKD was defined by repeated estimated glomerular filtration rate (eGFR) values below 60 mL/min/1.73m2 at least for the last 3 months before M12 post-LT. Data from 180 patients were analyzed. CKD-free survival was 74.5% and was not associated with TLE. Pre-LT acute kidney injury (AKI) and eGFR at 1-month post-LT (eGFRM1) <60 mL/min/1.73m2 were significant predictors of CKD. By distinguishing 2 situations within AKI (ie, with or without hepatorenal syndrome [HRS]), only HRS-AKI remained associated to CKD. HRS-AKI and eGFRM1 <60 mL/min/1.73m2 increased the risk of CKD (hazard ratio, 2.5; 95% confidence interval, 1.2-4.9; hazard ratio, 4.8; 95% confidence interval, 2.6-8.8, respectively). In our study, TLE, unlike HRS-AKI and eGFRM1, was not predictive of CKD-free survival at 1-year post-LT. Our results once again question the reversibility of HRS-AKI.

P0257CLINICOPATHOLOGICAL SPECTRUM OF KIDNEY INVOLVEMENT IN MONOCLONAL GAMMOPATGY

Abstract Background and Aims The occurrence of kidney diseases associated with a monoclonal gammopathy is increasingly recognized.Renal biopsy and evaluation by light microscopy, electron microscopy and immunofluorescence,in association with adequate clinical examination are essential in accurate diagnosis. The objective of our study is to describe the types of kidney damage secodary to monoclonal gammopathies and to study its renal prognosis. Method It is a monocentric RETOSPECTIVE DESCRIPTIVE STUDY carried out in the nephrology department of CHU FATTOUMA BOURGUIBA MONASTIR spread over a period of 7 years from January 2012 to December 2018. Results we collected 40 cases of monoclonal gammopathies. The median age was 61 years.The sex ratio was 0,9. the circumstances of discovery were dominated by renal failure. it revealed the diagnosis in 77.5% of cases. the renal presentation proteinuria in 70%, microscopic hematuria in 12.5%, edematous syndrome in 27.5% and nephrotic syndrome in 37,5%. The mean creatinine level was 500 umol / L and proteinuria at 4,3 g / 24 h with a maximum rate of 17.5 g / 24h. the electrophoresis of serum proteins showed the presence of a monoclonal peak in 90% of the cases in the gamma zone. The plasmocytosis was less than 10% in 15% of cases and more than 60% in 22,5% of the cases. Radiology showed bone localizations in 32,5% of cases. These gammopathies were classified as Multiple myeloma in34 patients, POEMS in one case and 5 MGRS. Kidney biopsy was performed in 10 patients showing cast nephropathy, AL amyloidosis and vasculites(endocapillary glomerulonephritis with hyaline thrombi in all vessels and double contour appearance of the glomerular basement membrane) in respectively 12,5%, 7,5% and 2,5% of cases. the main indications were rapidly progressive renal failure, unexplained acute renal failure and nephrotic syndrome. The renal involvement retained was a myeloma tubulopathy in 28 patients, 3 of whom were confirmed histologically . AL amyloidosis was found in 5 patients and the confirmation was histological. Type 1 cryoglobulinemia was diagnosed in only one patient. Glomerular nephropathy remained undetermined in 6 patients whose PBR was indicated but not made in the presence of hemostasis disorders. The chemotherapy was started in 34 patients based on bortezomide-thalidomide-dexamethasone in 30% of cases. An autograft of the bone marrow was done in one patient. Hemodialysis was required in 15 patients. The renal function was improved in 42.5% of the cases and a passage on chronic hemodialysis in 10% of cases. 10% of patients have achieved complete hematological remission. Conclusion Patients with MG can develop a large variety of related renal lesions.Renal involvement darkens the prognosis hence the need for adequate care .

IL-17 aggravates renal injury by promoting podocyte injury in children with primary nephrotic syndrome.

Primary nephrotic syndrome (PNS) is the most common chronic kidney disease in childhood, where podocyte injury is a key factor in the occurrence of kidney disease. In the present study, the expression of IL-17 in renal tissues of patients with PNS and its relationship with podocyte injury were examined. Reverse transcription-quantitative PCR (RT-qPCR), western blot analysis and immunochemistry were used to measure the expression of IL-17 in renal biopsies of patients with ONS, including 9 patients with minimal change nephrotic syndrome (MCNS), 15 patients with mesangial proliferative glomerulonephritis (MsPGN) and 9 patients with focal segmental glomerulosclerosis (FSGS), in addition to 15 normal kidney tissues. IL-17 was found to be highly expressed in the renal tissues from patients with PNS, with the highest expression levels found in tissues from patients with FSGS and the lowest in those from MCNS. A negative correlation was observed between the levels of IL-17 mRNA and PCX mRNA in renal tissues, whereas a positive correlation between IL-17 mRNA levels and the number of urinary podocytes in patients with PNS was found. In vitro, IL-17 induced podocyte apoptosis and reduced the expression of markers associated with podocytes, including Wilm's tumor 1, nephrin, synaptopodin and podocalyxin, whilst increasing the levels of Fas, Fas ligand (FasL), active-caspase-8, active-caspase-3 and phosphorylated-p65. However, treatment with helenalin, a NF-κB inhibitor, decreased p65 phosphorylation, attenuated IL-17-induced podocyte apoptosis and suppressed the IL-17-activated Fas/FasL/caspase-8/caspase-3 apoptotic pathway. Taken together, these observations suggest that IL-17 was highly expressed in renal tissues from patients with PNS, where it induced podocyte apoptosis by activating the Fas/FasL/caspase-8/caspase-3 apoptotic pathway in a NF-κB-dependent manner.

Expenditure for Hemodialysis: A Study among Patient Attending at Hospitals of Pokhara Metropolitan City, Nepal

Incidence and prevalence of chronic kidney disease (CKD) is increasing worldwide. It is contributing significantly to deaths and disability. Every year, numbers of cases of renal failure requiring hemodialysis are also increasing. Government of Nepal has made a provision to support the patients undergoing hemodialysis; nevertheless, the patient has to bear the huge financial and psychological burden for dialysis. This study was carried out to study the expenditure made by the patients for dialysis in the Pokhara Metropolitan City Nepal. This was an institution based cross sectional descriptive study. A total of 157 patients who had dialysis or undergoing dialysis at different hospitals of Pokhara Metropolitan City were interviewed using structured interview guideline. Expenditure records of patients were also reviewed. The study was carried out during August to October, 2018. Results are presented in table and diagrams aided by statistical tests like mean, median, standard deviations and ranges. Majority of the patients were male (61.8%). Mean age of the patients under hemodialysis was 49.75±14.91 years. Majorities were Janajati (53.5) and most of them were unemployed (78.3%). Total expenditure made for hemodialysis was NRs. 32,810 (US$ 289.87). The median monthly out of pocket expenditure for haemodialysis per patients was Nepalese Rupees (NRs) 32,810 (US$ 289.87) in which median monthly indirect cost of hemodialysis was NRs 9,200 (US$ 81.28) and median direct cost of hemodialysis per month was NRs 23610 (US$ 208.59). A great majority (78%) of the respondents faced catastrophic health expenditure for dialysis. Patients with renal failure requiring dialysis faced catastrophic health expenditure. The government should focus on programs supporting for dialysis and pay attention on the preventive measures for occurrence of kidney diseases.&#x0D; Key words : Hemodialysis, Expenditure, Patient