Maintenance Of Renal Function Research Articles

II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment

ObjectiveTo develop the second evidence-based Brazilian Society of Rheumatology consensus for diagnosis and treatment of lupus nephritis (LN).MethodsTwo methodologists and 20 rheumatologists from Lupus Comittee of Brazilian Society of Rheumatology participate in the development of this guideline. Fourteen PICO questions were defined and a systematic review was performed. Eligible randomized controlled trials were analyzed regarding complete renal remission, partial renal remission, serum creatinine, proteinuria, serum creatinine doubling, progression to end-stage renal disease, renal relapse, and severe adverse events (infections and mortality). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to develop these recommendations. Recommendations required ≥82% of agreement among the voting members and were classified as strongly in favor, weakly in favor, conditional, weakly against or strongly against a particular intervention. Other aspects of LN management (diagnosis, general principles of treatment, treatment of comorbidities and refractory cases) were evaluated through literature review and expert opinion.ResultsAll SLE patients should undergo creatinine and urinalysis tests to assess renal involvement. Kidney biopsy is considered the gold standard for diagnosing LN but, if it is not available or there is a contraindication to the procedure, therapeutic decisions should be based on clinical and laboratory parameters. Fourteen recommendations were developed. Target Renal response (TRR) was defined as improvement or maintenance of renal function (±10% at baseline of treatment) combined with a decrease in 24-h proteinuria or 24-h UPCR of 25% at 3 months, a decrease of 50% at 6 months, and proteinuria < 0.8 g/24 h at 12 months. Hydroxychloroquine should be prescribed to all SLE patients, except in cases of contraindication. Glucocorticoids should be used at the lowest dose and for the minimal necessary period. In class III or IV (±V), mycophenolate (MMF), cyclophosphamide, MMF plus tacrolimus (TAC), MMF plus belimumab or TAC can be used as induction therapy. For maintenance therapy, MMF or azathioprine (AZA) are the first choice and TAC or cyclosporin or leflunomide can be used in patients who cannot use MMF or AZA. Rituximab can be prescribed in cases of refractory disease. In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy.ConclusionThis consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil.

A novel antidiuretic hormone governs tumour-induced renal dysfunction.

Maintenance of renal function and fluid transport are essential for vertebrates and invertebrates to adapt to physiological and pathological challenges. Human patients with malignant tumours frequently develop detrimental renal dysfunction and oliguria, and previous studies suggest the involvement of chemotherapeutic toxicity and tumour-associated inflammation1,2. However, how tumours might directly modulate renal functions remains largely unclear. Here, using conserved tumour models in Drosophila melanogaster3, we characterized isoform F of ion transport peptide (ITPF) as a fly antidiuretic hormone that is secreted by a subset of yki3SA gut tumour cells, impairs renal function and causes severe abdomen bloating and fluid accumulation. Mechanistically, tumour-derived ITPF targets the G-protein-coupled receptor TkR99D in stellate cells of Malpighian tubules-an excretory organ that is equivalent to renal tubules4-to activate nitric oxide synthase-cGMP signalling and inhibit fluid excretion. We further uncovered antidiuretic functions of mammalian neurokinin 3 receptor (NK3R), the homologue of fly TkR99D, as pharmaceutical blockade of NK3R efficiently alleviates renal tubular dysfunction in mice bearing different malignant tumours. Together, our results demonstrate a novel antidiuretic pathway mediating tumour-renal crosstalk across species and offer therapeutic opportunities for the treatment of cancer-associated renal dysfunction.

Evaluation of Renal Function and Stent Durability Following Resonance Stent Placement for Benign Disease.

Introduction: The metal-based Resonance stent (RS) has traditionally been placed in patients with malignant ureteral obstruction; as such, the long-term utility of RS among patients with benign ureteral obstruction (BUO) remains underinvestigated. Methods: We retrospectively reviewed our database for patients with BUO who underwent RS placement between 2010 and 2020. The impact of chronic RS placement on renal function was evaluated by estimated serum creatinine-based glomerular filtration rate (eGFR), furosemide renal scan, and CT-based renal parenchymal volume measurement. The number of and reason for RS stent exchanges during the follow-up period, incidence of encrustation, and the average indwell time were recorded. A cost analysis of placing the RS vs a polymeric stent was performed. Results: Among 43 RS patients with BUO, at a mean follow-up of 26 months, there was no change in eGFR (p = 0.99), parenchymal volume (p = 0.44), or split renal function of the stent-bearing side on renal scan (p = 0.48). The mean RS indwell time was 9.7 months. Eleven patients (26%) underwent premature stent replacement (6 cases) or removal (5 cases). Stents in 9 patients (32%) were encrusted, of which 4 (44%) required laser lithotripsy. Overall, 25 patients (58%) and 12 patients (28%) had a mean stent indwell time of ≥6 months and ≥12 months, respectively. Placing an RS resulted in a 52%, 37%, and 5.6% cost reduction compared with a regular polymeric stent placement, where it was exchanged every 6, 4, or 3 months, respectively. Conclusions: RS deployment in the patient with a BUO results in cost-effective maintenance of renal function and of renal parenchymal volume at a mean follow-up of 2 years; however, only 28% of patients fulfilled the 1-year criterion for RS indwell time.

Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma.

Current guidelines recommend endoscopic management (EM) for patients with low-risk upper urinary tract urothelial carcinoma, as well as those with an imperative indication. However, regardless of the tumor risk, radical nephroureterectomy is still mainly performed worldwide despite the benefits of EM, such as renal function maintenance, no hemodialysis requirement, and treatment cost reduction. This might be explained by the association of EM with a high risk of local recurrence and progression. Furthermore, the need for rigorous patient selection and close surveillance following EM may be relevant. Nevertheless, recent developments in diagnostic modalities, pathological evaluation, surgical devices and techniques, and intracavitary regimens have been reported, which may contribute to improved risk stratification and treatments with superior oncological outcomes. In this review, considering recent advances in endourology and oncology, we propose novel treatment strategies for optimal EM.

A case of idiopathic nodular glomerulosclerosis successfully treated by intensive blockade of the renin-angiotensin-aldosterone system.

Idiopathic nodular glomerulosclerosis has a poor renal prognosis and is characterized by diffuse nodular glomerulosclerotic lesions in the absence of diabetic mellitus. Here, we report the case of a 69-year-old woman with no smoking history who developed renal dysfunction and proteinuria in the absence of overt diabetes or obesity. A biopsy specimen showed nodular mesangial sclerosis with arteriolar hyalinosis and severe large-vessel arteriosclerosis, leading to a diagnosis of idiopathic nodular glomerulosclerosis. Addition of esaxerenone to her existing renin-angiotensin-aldosterone inhibitor therapy led to a rapid decrease in the proteinuria levels and the maintenance of renal function without any complications for more than a year. The results suggest that intensive renin-angiotensin-aldosterone blockade might be an effective treatment for idiopathic nodular glomerulosclerosis.

MO152: SARS-COV-2 Infection and Kidney Impairment

Abstract BACKGROUND AND AIMS The objectives of the present study are to compare the renal impairment between patients with SARS-COV-2 in two different time periods with dominant beta and delta SARS-COV-2 variants, with or without prior chronic kidney disease (CKD). METHOD The study was performed on 80 patients from Bucharest Emergency University Hospital, Nephrology ward, 40 out of 80 patients were diagnosed with SARS-COV-2, beta variant dominant and 40 were diagnosed with SARS-COV-2 delta variant dominant. All patients were confirmed with SARS-COV-2 infection with positive PCR tests. In order to assess the renal function for the patients with beta and delta variant of SARS-COV-2, the values of urea, creatinine, sodium, potassium, calcium, phosphorus and haemoglobin were observed during their hospitalization. Only 4 out of 40 patients with beta variant (10%) had documented pre-existing CKD. The average period of hospitalization was 14 days, with three exceptions (7.5%) in which due to the advancement of acute respiratory failure patients were transferred to the ICU. Only 3 out of 40 patients with delta variant (7.5%) were diagnosed with acute kidney injury (AKI). Average period of hospitalization was 14 days, with three exceptions (7.5%) in which due to the advancement of acute respiratory failure patients was transferred to the ICU. RESULTS In 36 out of 40 patients (90%) with beta variant dominant of SARS-COV-2, the analysis of biological parameters shows a minimal change in their values during hospitalization with normal maintenance of renal function. In two patients (5%), diagnosed with CKD, an average of three to four haemodialysis sessions were performed with the improvement of renal function, while maintaining a minimum nitrogen retention. In two patients with CKD (5%), renal function depreciated, leading to haemodialysis initiation. In 33 out of 40 patients (82.5%) with delta variant dominant of SARS-COV-2, the analysis of biological parameters shows a minimal change in their values during hospitalization with normal maintenance of renal function. In 4 out of 40 patients (10%), the renal function depreciated in context of multiple system organ failure (MSOF), and subsequently they died. During hospitalization, in three patients (7.5%) who were admitted with AKI, the renal disfunction was resolved by the time of their discharge. There were no statistically relevant differences (P &amp;gt; .1) in measured parameters between the two time periods with the different SARS-COV-2 strings. CONCLUSION According to this statistical analysis, the delta variant does not cause more kidney damage than the beta variant of SARS-COV-2. For the six patients (7.5%) with renal impairment, two from the beta batch (2.5%) and four from the delta batch (5%), the suspicion of renal damage in SARS-COV-2 infection may be raised, but excluding other causes of renal damage is necessary. For the three patients (7.5%) with AKI from the delta batch, the suspicion of renal damage caused by COVID-19 may be raised because there were no other causes for renal impairment.

Evaluation of circulatory microRNA-196 levels during the progression of chronic renal (kidney) disease of unknown etiology

Chronic renal disease of unknown etiology is prevalent &amp; clinically silent until its late stages at which point patients may suffer significant irreversible damage or mortality in the lack of early screening &amp; intervention. If diagnosed early stage 1-3 the progression of chronic renal disease can be altered and complications reduced. Current diagnosing markers of renal function, serum creatinine, blood urea and uric acid have been shown to be lacking high predictive value. So, there is a need for next generation biomarkers suitable for Chronic renal disease of unknown etiology and should not be influenced by age, sex, nutritional status, current health concern. microRNAs appears to be very stable in tissues &amp; biological fluids even under adverse conditions like extreme pH, long term room temperature storage, multiple freeze thaw cycles &amp; RNAase activity. microRNAs elaborate in renal development, maintenance of renal function &amp; progression of renal disease. miRNA-196 is a renal derived biomarker, extensively distributed in renal, shows an important role in renal diseases &amp; superior to other renal biomarkers. The aim of present study is to evaluate circulatory miRNA-196 during progression of chronic renal disease of unknown etiology.

Influence of Polyunsaturated Fatty Acid Intake on Kidney Functions of Rats with Chronic Renal Failure.

Arachidonic acid (ARA), an omega-6 (ω-6) polyunsaturated fatty acid (PUFA), is involved in the development and maintenance of renal functions, whereas docosahexaenoic acid (DHA) is an omega-3 (ω-3) PUFA that has anti-inflammatory effects and attenuates nephropathy. However, their effects on the progression of chronic kidney disease (CKD) remain unknown. The aim of this study was to assess the effects of feeding ARA, DHA, and ARA and DHA-containing diets on rats with 5/6 nephrectomized kidneys. Urine and feces were collected every 4 weeks, and the kidneys were collected at 16 weeks after surgery. Urinary albumin (U-ALB) excretion increased gradually with nephrectomy, but the U-ALB excretion was attenuated by feeding the rats with an ARA + DHA-containing diet. Reactive oxygen species (ROS) levels in the kidneys were lower in the ARA + DHA group than in the other groups. At 4 weeks after surgery, the lipid peroxide (LPO) levels in the plasma of the ARA + DHA groups decreased significantly after surgery compared to the control CKD group, but this did not happen at 16 weeks post-surgery. There was a significant negative correlation between LPO levels in the plasma at 4 weeks and creatinine clearance, and a positive correlation with urinary albumin levels. These results suggest that the combination of ARA and DHA inhibit the progress of early stage CKD.

MP59-02 PURELY-OFF CLAMP VS ON-CLAMP IMPERATIVE MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES

MP59-02 PURELY-OFF CLAMP VS ON-CLAMP IMPERATIVE MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES

Long-Term Angiotensin II Infusion Induces Oxidative and Endoplasmic Reticulum Stress and Modulates Na+ Transporters Through the Nephron.

High plasma angiotensin II (Ang II) levels are related to many diseases, including hypertension, and chronic kidney diseases (CKDs). Here, we investigated the relationship among prolonged Ang II infusion/AT1 receptor (AT1R) activation, oxidative stress, and endoplasmic reticulum (ER) stress in kidney tissue. In addition, we explored the chronic effects of Ang II on tubular Na+ transport mechanisms. Male Wistar rats were subjected to sham surgery as a control or prolonged Ang II treatment (200 ng⋅kg–1⋅min–1, 42 days) with or without losartan (10 mg⋅kg–1⋅day–1) for 14 days. Ang II/AT1R induced hypertension with a systolic blood pressure of 173.0 ± 20 mmHg (mmHg, n = 9) compared with 108.0 ± 7 mmHg (mmHg, n = 7) in sham animals. Under these conditions, gene and protein expression levels were evaluated. Prolonged Ang II administration/AT1R activation induced oxidative stress and ER stress with increased Nox2, Nox4, Cyba and Ncf1 mRNA expression, phosphorylated PERK and eIF2α protein expression as well as Atf4 mRNA expression. Ang II/AT1R also raised Il1b, Nfkb1 and Acta2 mRNA expression, suggesting proinflammatory, and profibrotic effects. Regarding Na+ tubular handling, Ang II/AT1R enhanced cortical non-phosphorylated and phospho/S552/NHE3, NHE1, ENaC β, NKCC2, and NCC protein expression. Our results also highlight the therapeutic potential of losartan, which goes beyond the antihypertensive effect, playing an important role in kidney tissue. This treatment reduced oxidative stress and ER stress signals and recovered relevant parameters of the maintenance of renal function, preventing the progression of Ang II-induced CKD.

EDITORIAL COMMENT

Although maintenance of renal function in patients with spina bifida (SB) is listed as a urologic priority, up to 15% of SB, patients will develop end-stage renal disease (ESRD) by the third decade of life.1 In this regard, the timely diagnosis and early treatment of stage 3 chronic renal failure (CRF; GFR 30-59 mL/min/BSA) becomes a mandatory diagnostic component to improve patient outcomes.2

Off-clamp Retroperitoneoscopic Tumour Evacuation for Sporadic Renal Angiomyolipomas with High RENAL Nephrometry Scores: A Novel Surgical Technique and Its Outcomes

BackgroundPartial nephrectomy or angioembolisation is commonly used for sporadic renal angiomyolipomas (RAMLs) with high RENAL scores, but there is a risk of reduced renal function, postoperative complications, and recurrence. ObjectiveTo describe a new technique for off-clamp laparoscopic evacuation of sporadic RAMLs with high RENAL scores that promotes maximal renal function maintenance and low postoperative complication and lesion recurrence rates. Design, setting, and participantsA retrospective cohort of patients undergoing off-clamp laparoscopic evacuation for sporadic RAMLs with RENAL scores ≥9 from January 2013 to June 2018 was included. Surgical procedureWe highlighted the curettage, suction, packing, and binding (CSPB) technique, a new off-clamp retroperitoneoscopic evacuation technique for sporadic RAMLs. MeasurementsDemographics, preoperative, intraoperative, and postoperative outcomes were assessed. Results and limitationsA total of 141 cases were included. The median (interquartile range [IQR]) tumour size was 7 (6.2–8.2)cm. The median (IQR) RENAL score was 10 (9–11). The median (IQR) operative time was 80 (65–125) min, with a median (IQR) estimated blood loss of 130 (90–362.5)ml. Conversion to neither open surgery nor standard laparoscopy occurred. The warm ischaemia time was zero for all cases. Postoperatively, 13 minor complications (Clavien grade 1) were recorded. No blood transfusions were reported. The glomerular filtration rate did not change significantly from preoperative period to 12-mo follow-up. Recurrence did not occur at the median follow-up period of 48 (36–60) mo. The retrospective design and lack of a control group are limitations of this study. ConclusionsOff-clamp retroperitoneoscopic tumour evacuation using the CSPB technique is feasible, safe, and effective for treating complex sporadic RAMLs. Patient summaryWe report a curettage, suction, packing, and binding technique for off-clamp retroperitoneoscopic evacuation of sporadic renal angiomyolipomas that leads to complete lesion clearance, excellent renal function preservation, and minimal perioperative complications.

Abstract 16443: Effects of Dietary Salt Intakes on Blood Pressure, Renal Function and Oxidative Stress in Rats Treated With Candesartan

Candesartan is one of angiotensin II type1 receptor blockers(ARB) and commonly used as first-line antihypertensive treatment. Low salt diet is often recommended by clinicians to the patients with hypertension and kidney diseases. However,it is not clear whether salt restriction is beneficial to the patients taking ARB. In order to explore this problem, the impacts of different salt diets on blood pressure (BP),renal function and oxidative stress were determined in 2-3 months old male Sprague Dawley rats treated with candesartan. The rats were randomly divided into 4 groups fed agar-gelled food rationally with NaCl content at 0.01%, 0.8%, 2% and 4% respectively(4-7 rats/group) while all rats were intraperitoneally injected with candesartan at 1mg / kg / day for 7 days. SBP started to decline on day 2 in all except 4% NaCl groups relative to day 0 (recorded 5-6 hrs before the first injection). On day 6, systolic BP (mmHg, tail-cuff, Softron,BP-98A) was lower in 0.8% (103.7+2.3) &amp; 0.01% (101.6+3) groups than 2% (113.5+4.1) &amp; 4% (129.9+4.6) groups (one way ANOVA,LSD test, P&lt;0.05) and correlated positively with food NaCl intakes (R 2 =0.9832). DBP was changed in a similar pattern as SBP. Serum creatinine (μmol/L) was higher in 0.01% group (225+39) than groups of 0.8% (1328+350), 2% (2095+242) and 4% (1576+703) while creatinine clearance (ml/day) was lower in 0.01% group (69.3+9) than groups of 0.8% (43.7+9), 2%(27.7+2) and 4%(29+0.6). In order to determine whether oxidative stress plays any role in the BP regulation and renal function maintenance, we also checked renal protein expression of ROS components. Relative to 0.8% group, renal NOXs were not altered in 0.01% group while NOX1 (145+18,% of 0.8% group), NOX2 (240+54) and NOX4 (197+41) was higher in 2% group than other groups. Mn-SOD (77+7.8), not Cu-Zn SOD, was decreased while HO1 (170+16), not HO2, was increased in 0.01% group. Renal abundance of nitrotyrosine was lower in 0.01% than other groups indicating a decreased oxidative stress, possibly caused by increase in HO1. We concluded that salt restriction with candesartan is beneficial to antihypertensive effect of AT1R blockade but disadvantage to maintenance of renal function. Thus, cautions to choice of low salt intakes are necessary when taking ARB agents.

Confounding Factors in Renal Denervation Trials: Revisiting Old and Identifying New Challenges in Trial Design of Device Therapies for Hypertension.

Recent randomized sham-controlled trials have demonstrated significant blood pressure reductions following renal denervation (RDN) in patients with hypertension, both in the presence and absence of antihypertensive therapy. These new data encouraged us to revisit previously published insights into potential clinical trial confounding factors that informed the design and conduct of forthcoming trials. Initially identified confounders related to procedural technique, medication variability, and selected patient subgroups have been addressed in contemporary trial design. Regarding procedural method and technology, blood pressure reductions may be improved by ensuring circumferential lesion creation in the distal renal arteries and branch vessels. Safety of the RDN procedure has been demonstrated in multiple independent meta-analyses including thousands of treated patients with low reported rates of renal vessel complications and maintenance of renal function. However, a newer generation of RDN trials has also introduced insights related to medication adherence, patient selection, and the definition of treatment response. Evolving evidence indicates that RDN therapy may be considered in higher risk populations of uncontrolled hypertension regardless of ethnicity and in patients expressing a strong preference for a nondrug therapy option. Despite advances in procedural technique and clinical trial conduct, inconsistent antihypertensive-drug adherence behavior remains perhaps the most critical clinical trial design issue for device-based hypertension therapies. As the balance in clinical equipoise increasingly favors RDN, justification of sham-controlled trial designs will be revisited, and novel study designs may be required to evaluate the safety and efficacy of novel devices and procedures intended to address the escalating prevalence of poorly controlled hypertension.

Role of VEGF-A and LRG1 in Abnormal Angiogenesis Associated With Diabetic Nephropathy.

Diabetic nephropathy (DN) is an important public health concern of increasing proportions and the leading cause of end-stage renal disease (ESRD) in diabetic patients. It is one of the most common long-term microvascular complications of diabetes mellitus that is characterized by proteinuria and glomerular structural changes. Angiogenesis has long been considered to contribute to the pathogenesis of DN, whereas the molecular mechanisms of which are barely known. Angiogenic factors associated with angiogenesis are the major candidates to explain the microvascular and pathologic finds of DN. Vascular endothelial growth factor A (VEGF-A), leucine-rich α-2-glycoprotein 1, angiopoietins and vasohibin family signal between the podocytes, endothelium, and mesangium have important roles in the maintenance of renal functions. An appropriate amount of VEGF-A is beneficial to maintaining glomerular structure, while excessive VEGF-A can lead to abnormal angiogenesis. LRG1 is a novel pro-angiogenic factors involved in the abnormal angiogenesis and renal fibrosis in DN. The imbalance of Ang1/Ang2 ratio has a role in leading to glomerular disease. Vasohibin-2 is recently shown to be in diabetes-induced glomerular alterations. This review will focus on current understanding of these angiogenic factors in angiogenesis and pathogenesis associated with the development of DN, with the aim of evaluating the potential of anti-angiogenesis therapy in patients with DN.

P0844PREDICTION MODEL FOR RENAL FUNCTION DECLINE WITH SUGGESTING HOW TO CONTROL CLINICAL PARAMETERS TO MAINTAIN RENAL FUNCTION BY AN INTERPRETABLE MACHINE LEARNING IN JAPANESE OUTPATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Prediction models for renal function decline has already been developed. However, few prediction models can suggest how to control clinical parameters to maintain renal function. The present study aimed to develop a prediction model for renal function decline that can suggest how to control clinical parameters to maintain renal function by an interpretable machine learning in Japanese outpatients with chronic kidney disease (CKD). Method The present study used a retrospective cohort design. The eligible criteria of the present study were outpatients with CKD stage 3, 4, and 5, treated in Daiko-Sunadabashi Clinic in Japan between 2005 and 2019. Among the patients, we analyzed patients whose 24-hour urine samples were collected 3 times and over between 6 and 36 months. The primary outcome was renal function decline defied by glomerular filtration rate (GFR) decreased by &amp;gt;30% from the baseline. As predictors, we used baseline CKD stage and baseline values and change rate from the baseline to the next-to-last observations of the following clinical parameters: urine volume, GFR, quantity of protein in urine, intake of protein and salt, and body mass index (BMI). We used a random forest model with actionable feature tweaking to develop the prediction model with suggesting how to control those clinical parameters. This method has been developed recently and to improve interpretability of the random forest method. This can suggest how to alter predictor values in order to change prediction results from bad to favorable outcome (e.g., changing from predicted decline to predicted maintenance of renal function). Predictability of the prediction model was assessed by accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in training and testing datasets. Results We analyzed 355 participants whose mean age (SD) was 69.2 (13.0) years old. Of the participants, 65.4% were men, 37.5%, 37.2% and 25.3% were CKD stage 3, 4, and 5, respectively. Of the participants, the 80% were included in the training dataset, and the 20% in the testing dataset. Predictability of the developed prediction model was summarized in Table 1, showing the prediction model had good predictability. The developed prediction model suggested that decreasing protein in urine and salt intake, and increasing GFR could be important to change from predicted decline to predicted maintenance of renal function. The prediction model could also suggest how to control those clinical parameters at individual-level (e.g., #53 and #67 patients in Figure 1). Conclusion The present study developed the prediction model for renal function decline with high predictability. The prediction model suggested that decreasing protein in urine and salt intake, and increasing GFR could be important to maintain renal function.

Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study.

Dietary management is highly important for the maintenance of renal function in patients with chronic kidney disease (CKD). Cerebral oxygen saturation (rSO2) was reportedly associated with the estimated glomerular filtration rate (eGFR) and cognitive function. However, data concerning the association between cerebral rSO2 and dietary intake of CKD patients is limited. This was a single-center observational study. We recruited 67 CKD patients not undergoing dialysis. Cerebral rSO2 was monitored using the INVOS 5100c oxygen saturation monitor. Energy intake was evaluated by dietitians based on 3-day meal records. Daily protein and salt intakes were calculated from 24-h urine collection. Multivariable regression analysis showed that cerebral rSO2 was independently associated with energy intake (standardized coefficient: 0.370) and serum albumin concentration (standardized coefficient: 0.236) in Model 1 using parameters with p < 0.10 in simple linear regression analysis (body mass index, Hb level, serum albumin concentration, salt and energy intake) and confounding factors (eGFR, serum sodium concentration, protein intake), and the energy/salt index (standardized coefficient: 0.343) and Hb level (standardized coefficient: 0.284) in Model 2 using energy/protein index as indicated by energy intake/protein intake and energy/salt index by energy intake/salt intake in place of salt, protein and energy intake. Cerebral rSO2 is affected by energy intake, energy/salt index, serum albumin concentration and Hb level. Sufficient energy intake and adequate salt restriction is important to prevent deterioration of cerebral oxygenation, which might contribute to the maintenance of cognitive function in addition to the prevention of renal dysfunction in CKD patients.

2210-PUB: Despite Optimal Use of Angiotensin Receptor Blockers There Exists Substantial Cardiovascular Risk as Suggested by Elevated NT-ProBNP in 259 T2DM Patients

259 T2DM patients with microalbuminuria eUACR &amp;gt;30 irrespective of their A1c, on standard glucose lowering, lipid lowering and ARB (telmisartan TM or valsartan Vs as first line BP lowering therapy until optimal dose was achieved, were followed-up for 2 years. Renal (Cr, eGFR, UACR) and CV (BP, BMI, Lipid profile, hs-CRP) parameters were assessed every 6 months. NT-ProBNP was measured at the end of 2 years. Patients with history of major surgery, coronary intervention, IHD or hospitalization in last 1 year, eGFR &amp;lt;45, hyperkalemia &amp;gt;5.3 were excluded Data was analyzed using PSPP version 1.0.1 and represented as Mean (SD) and paired-t test was used, p-value of 0.05 was considered to be significant. Results: 42.1% used TM and 57.9% used Vs. Average dose of TM 66.76mg (±52.63) and Vs 165.33 (±89.94) Baseline characteristics: 259 patients (females 45.6%, male 54.4%), mean age 61.22 years (±9.50); weight 78.91kg (±15.78), BMI 30.63 (5.81±), DOD 12.9 years (7.52±), SBP 137.09mm (±20.60), DBP 77.54 (±11.31). There was a significant mean reduction observed in HbA1c 1.21% (95% CI 1.02-1.39, p-&amp;lt;0.001), SBP 3.37mm (95% CI 0.66-6.08, p-0.015), TC 14.13mg% (95% CI 8.43-19.83, p &amp;lt;0.001), LDL 10.64mg% (95% CI 5.87-15.41, p &amp;lt;0.001), TG 19.52mg% (95% CI 11.50-27.55, p&amp;lt;0.001), non-HDL 25.31mg% (95% CI 18.95-31.66, p&amp;lt;0.001), Chol remnant 8.25mg% (95% CI 5.27-11.22, p &amp;lt;0.001), UACR 147.5mg% (95% CI 61.27-233.79, p 0.001). There was no significant change seen in weight, BMI, DBP, HDL, Cr, eGFR, potassium. The NT-ProBNP was 166.30 pg/ml (±242.72) remained elevated after 2 years. Conclusion: Despite optimal use of ARB and reduction in renal (UACR, maintenance of renal function) and CV risk factors there remains a significant risk for future CV mortality as suggested by elevated NT-ProBNP in T2DM with microalbuminuria. Disclosure V. Gupta: None. V. Teli: None.

Intraoperative mannitol during robotic-assisted-laparoscopic partial nephrectomy.

Mannitol is routinely used during partial nephrectomies due to its renoprotective properties. With minimally invasive techniques, the need for mannitol has been questioned. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has been shown to decrease warm ischemia time, which may potentially minimize the benefit of mannitol. To date, no prospective, randomized, controlled trials have investigated the use of mannitol in only robotic procedures. We hypothesize that the intraoperative mannitol use during RALPN provides no statistically significant benefit for post-operative renal function outcomes. We conducted a randomized, controlled, double-blinded, single surgeon, prospective study to assess renal function after RALPN. Patients were randomized into a control group with intravenous normal saline infusion prior to clamping of the vessels or to an experimental group with an infusion of mannitol. Estimated glomerular filtration rate (eGFR) were obtained prior to the surgery as well as post operatively at 24h, 1week, and 30days. Preoperative eGFR showed no statistical differences between the groups and evaluation of median percent change in eGFR after surgery did not indicate a statistical difference between the groups after RALPN. After prospective analysis of the change in post-operative renal function of randomized groups who received 12g of mannitol following RALPN, we determined that infusion of mannitol does not provide significant improvement of maintenance of renal functions after RALPN. Based on our results, we recommend discontinuing routine use of mannitol during RALPN.

Survival Benefit of Tolvaptan for Refractory Ascites in Patients with Advanced Cirrhosis

Aims: The study aimed to evaluate the effects of tolvaptan treatment on survival of patients with decompensated liver cirrhosis with refractory ascites. Methods: This multicenter, retrospective, observational study included patients with cirrhosis who were treated with tolvaptan for hepatic ascites refractory to conventional diuretics. Patients who could and could not decrease accompanying diuretics within 1 month after tolvaptan administration were defined as the “Decreased” and “Not-decreased” groups, respectively. Results: Median body weight change 1 week after tolvaptan treatment was –1.95 kg, with the 50% of patients experiencing a 2 kg/week reduction. Spot urinary sodium was found to be a better predictor of tolvaptan response than liver function and liver fibrosis markers. Median survival was significantly longer (not reached versus 116 days, p = 0.005) and serum creatinine concentrations 12 weeks after tolvaptan administration significantly lower (0.99 vs. 1.55 mg/dL, p < 0.05) in the Decreased than in the Not-decreased group. Multivariate analysis showed that the presence of viable hepatocellular carcinoma (hazards ratio [HR] 2.14, p = 0.02) and a decrease in diuretics were independently prognostic of survival (HR 0.36, p < 0.01). Conclusions: The maintenance of renal function is essential in enhancing survival of patients with cirrhosis. Doses of diuretics should be adjusted appropriately during tolvaptan treatment.