Progression Of Chronic Renal Failure Research Articles

Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs.

The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. Retrospective observational multicentre study. Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). Mean age was 55.75 years (18-80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50-42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6-29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6-98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24-180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.

Causal relationship between gut microbiota and chronic renal failure: a two-sample Mendelian randomization study.

Observational studies and some experimental investigations have indicated that gut microbiota are closely associated with the incidence and progression of chronic renal failure. However, the causal relationship between gut microbiota and chronic renal failure remains unclear. The present study employs a two-sample Mendelian randomization approach to infer the causal relationship between gut microbiota and chronic renal failure at the genetic level. This research aims to determine whether there is a causal effect of gut microbiota on the risk of chronic renal failure, aiming to provide new evidence to support targeted gut therapy for the treatment of chronic renal failure. Employing genome-wide association study (GWAS) data from the public MiBioGen and IEU OpenGWAS platform, a two-sample Mendelian randomization analysis was conducted. The causal relationship between gut microbiota and chronic renal failure was inferred using five different methods: Inverse Variance Weighted, MR-Egger, Weighted Median, Simple Mode, and Weighted Mode. The study incorporated sensitivity analyses that encompassed evaluations for pleiotropy and heterogeneity. Subsequently, the results of the Mendelian randomization analysis underwent a stringent correction for multiple testing, employing the False Discovery Rate method to enhance the validity of our findings. According to the results from the Inverse Variance Weighted method, seven bacterial genera show a significant association with the outcome variable chronic renal failure. Of these, Ruminococcus (gauvreauii group) (OR = 0.82, 95% CI = 0.71-0.94, p = 0.004) may act as a protective factor against chronic renal failure, while the genera Escherichia-Shigella (OR = 1.22, 95% CI = 1.08-1.38, p = 0.001), Lactococcus (OR = 1.1, 95% CI = 1.02-1.19, p = 0.013), Odoribacter (OR = 1.23, 95% CI = 1.03-1.49, p = 0.026), Enterorhabdus (OR = 1.14, 95% CI = 1.00-1.29, p = 0.047), Eubacterium (eligens group) (OR = 1.18, 95% CI = 1.02-1.37, p = 0.024), and Howardella (OR = 1.18, 95% CI = 1.09-1.28, p < 0.001) may be risk factors for chronic renal failure. However, after correction for multiple comparisons using False Discovery Rate, only the associations with Escherichia-Shigella and Howardella remain significant, indicating that the other genera have suggestive associations. Sensitivity analyses did not reveal any pleiotropy or heterogeneity. Our two-sample Mendelian randomization study suggests that the genera Escherichia-Shigella and Howardella are risk factors for chronic renal failure, and they may serve as potential targets for future therapeutic interventions. However, the exact mechanisms of action are not yet clear, necessitating further research to elucidate their precise roles fully.

The effect and mechanism of Fushen Granule on gut microbiome in the prevention and treatment of chronic renal failure.

Fushen Granule is an improved granule based on the classic formula Fushen Formula, which is used for the treatment of peritoneal dialysis-related intestinal dysfunction in patients with end-stage renal disease. However, the effect and mechanism of this granule on the prevention and treatment of chronic renal failure have not been fully elucidated. A 5/6 nephrectomy model of CRF was induced and Fushen Granule was administered at low and high doses to observe its effects on renal function, D-lactate, serum endotoxin, and intestinal-derived metabolic toxins. The 16SrRNA sequencing method was used to analyze the abundance and structure of the intestinal flora of CRF rats. A FMT assay was also used to evaluate the effects of transplantation of Fushen Granule fecal bacteria on renal-related functional parameters and metabolic toxins in CRF rats. Gavage administration of Fushen Granule at low and high doses down-regulated creatinine, urea nitrogen, 24-h urine microalbumin, D-lactate, endotoxin, and the intestinal-derived toxins indophenol sulphateand p-cresol sulphate in CRF rats. Compared with the sham-operated group in the same period, CRF rats had a decreased abundance of the firmicutes phylum and an increased abundance of the bacteroidetes phylum at the phylum level, and a decreasing trend of the lactobacillus genus at the genus level. Fushen Granule intervention increased the abundance of the firmicutes phylum, decreased the abundance of the bacteroidetes phylum, and increased the abundance of the lactobacillus genus. The transplantation of Fushen Granule fecal bacteria significantly reduced creatinine(Cr), blood urea nitrogen(Bun), uric acid(UA), 24-h urinary microalbumin, D-lactate, serum endotoxin, and enterogenic metabolic toxins in CRF rats. Compared with the sham-operated group, the transplantation of Fushen Granule fecal bacteria modulated the Firmicutes and Bacteroidetes phyla and the Lactobacillus genus. Fushen Granule improved renal function and intestinal barrier function by regulating intestinal flora, inhibiting renal fibrosis, and delaying the progression of chronic renal failure.

Impact of physical activity in non-dialysis CKD patients followed in a multidisciplinary care network on the progression of chronic renal failure – PHYSALYS study

Physical activity (PA), has a proven effect on overall health. The study assessed the difference in glomerular filtration rate (GFR) over one year in non-dialysis renal failure patients between those who practiced exercise (P) and those who did not (NP). Patients were categorised as P or not P using the Global Physical Activity Questionnaire (GPAQ2), completed by telephone, at inclusion and at 12 months. Among the 259 patients included, 195 (75.3%) practiced a PA and 64 (24.7%) did not practiced. There was no significant difference in the slope of GFR decline from inclusion to month 12 between the two groups, p = 0.4107. Only the type of kidney seemed to be significantly associated with the slope of GFR decline over the 12 months (p = 0.0039). These results may be explained by a follow-up time too short to identify an effect of behavioural change on the progression of kidney disease.

Терапия ксеногенным протеомным комплексом из эмбриональных клеток головного мозга тормозит прогрессирование экспериментально вызванной хронической почечной недостаточности.

Introduction. In previously published experimental studies, we have shown that in rats with pre-modeled acute post-ischemic renal failure, therapy with a proteomic complex isolated from brain cells of pig embryos has a pronounced therapeutic effect, reducing the severity of functional and histological disorders and preventing the transition of the pathological process into chronic kidney insuffiency. The aim of this study is to evaluate the effectiveness of this therapy for the course of artificially induced chronic renal failure (CRF) in rats. Material and methods. Experiments were carried out on 45 white mongrel male rats weighing 200-240 g. CRF was modeled by unilateral nephrectomy and resection of both poles of the remaining kidney, which reduced the mass of the functioning parenchyma by 80%. In the 1-st series of experiments no therapy was performed. In the 2-nd - 4-th series the animals were intraperitoneally injected with a fractionated xenogenic proteomic complex (secretom) from pig brain stem and progenitor cells (SSPC) at a daily dose of 0.1 ml in different modes: two 10-days courses with a 10-days break between them (2nd series); prolongation of the 1st course up to 20 days and a repeated 10-days course after 10 days (3rd series); continuous SSPC therapy for 30 days (4-th series). 5th series – intact animals. The effectiveness of therapy was evaluated based on the severity of the development of compensatory renal hypertrophy, the dynamics of biochemical parameters of kidney function, the activity of enzymes (ALT, AST, LDH, alkaline phosphatase) in blood and urine and the level of uremic neurotoxins 3-indoxyl sulfate and ptolyl sulfate in the blood. Results. SSPC therapy in all variants contributed to a more pronounced compensatory hypertrophy of the remaining kidney, as well as a decrease in the severity of the main functional indicators after 30 and 60 days: the severity of polyuria decreased, the concentration of urea in the blood decreased to a greater extent, and the glomerular filtration rate and tubular reabsorption of sodium and calcium approached normal values, which was not observed in the control series. The severity of the therapeutic effect was more pronounced with continuous 30-day therapy. There was also a less pronounced increase in the activity of enzymes in the blood and their excretion in the urine, which indicated the cytoprotective effect of SSPC therapy. If in the control series of experiments, the deterioration of the studied indicators were noted with an increase in the observation period from 30 to 60 days, whereas in all experimental series they remained at a subnormal level. SSPC therapy also contributed to a lower accumulation of uremic toxins (3-indoxyl sulfate and p-tolyl sulfate) in the blood. Conclusion. Prolonged therapy of SSPC prevents the progression of CRF by stimulating compensatory hypertrophy of the kidney and cytoprotective effect and promotes more effective elimination of uremic toxins, preventing their accumulation in the blood.

Hormonal imbalance in patients with chronic kidney disease in the pre-dialysis and dialysis periods (part 2)

In the previous article, we presented the results of literature review showing the changes in hormone concentrations (parathyroid hormone, insulin, growth factor, prolactin) in patients with chronic renal failure (CRF) at the pre-dialysis and dialysis stages, described pathological relationships between renal failure and serum hormones concentrations, as well as changes in their biological effects. In this article, that continues the general topic, we provide the results of literature review that shows changes in serum concentrations of thyroid, adrenal, sex hormones and the features of the functioning of hypothalamus-pituitary-peripheral glands axis in patients with CRF. The presence of close pathogenic interactions of renal functional condition with hormonal activity of the thyroid gland was evaluated, as well as the ability of thyroid gland to influence the CRF progression both during pre-dialysis and dialysis sta­ges of CRF. Most patients with CRF have low serum triiodothyronine and thyroxine levels. It means that CRF is a pathological condition associated with thyroid hypofunction that progressively worsening as glomerular filtration rate decreases. For patients receiving dialysis treatment, hypothyroidism is associated with higher mortality. Secondary adrenal insufficiency is usually progresses in patients on renal replacement therapy. Non-diagnosed chronic adrenal failure may be life-threating that’s why the analysis of adrenal function is especially actual for patients on both pre-­dialysis and dialysis stages of CRF. Secondary adrenal insufficiency caused by long-lasting treatment with corticoids is a diagnostic problem for patients on dialysis treatment, because many nephrological diseases are treated by corticoids, and immunosuppressive therapy protocols used after the kidney transplantation are usually include prednisone. As the endocrine dysfunction progresses in patients with CRF, sexual dysfunction develops due to sex hormone imbalance. Abnormal androgen concentration is a typical fin­ding in CRF. A negative correlation was found between endogenic testosterone concentration and CRF stages I–V that indicated an abnormal profile of male sex hormones. There are gender-specific features of the development and progression of clinical symptoms of hormonal imbalance. The number of experimental studies show that continuous estradiol treatment may prevent the development of glomerulosclerosis. The results of clinical trials concluded that lower CRF progression and the lower incidence of CRF observed in young females compared to males, as well as the absence of gender protection in post-menopausal period, shows the important role of female sex hormones.

АА-амилоидоз – редкая причина поражения почек у пациентки с артериитом Такаясу

Takayasu’s arteritis (TAK) is a systemic large vessel vasculitis that usually develops at young age in females and affects aorta and its branches (pulseless disease). Patients with TAK frequently present with renal artery stenosis associated with renovascular hypertension and ischemic nephropathy, whereas glomerular and interstitial kidney disease is very rare. As any other chronic inflammatory diseases, TAK can be complicated with AA-amyloidosis manifesting by progressive proteinuria, nephrotic syndrome and chronic renal failure. AA-amyloidosis in patients with TAK and other immune-mediated inflammatory disease justifies intensification of immunosuppressive and antiinflammatory therapy (e.g. using interleukin-6 inhibitors) that is essential to prevent progression of kidney amiloidosis.

ПЕРСПЕКТИВЫ РЕТРАСНПЛАНТАЦИИ ПОЧКИ. КЛИНИЧЕСКИЙ СЛУЧАЙ

According to a number of large epidemiological studies, about 10% of the world's population suffer from chronic kidney disease (CKD), the most severe stage of which is end-stage chronic renal failure (ESRD). Chronic renal failure is a symptom complex that develops in chronic bilateral kidney diseases due to the gradual irreversible death of nephrons and is characterized by a violation of the homeostatic function of the kidneys. The disease is diagnosed in 10-13% of the adult population, and 20% of them are people over 60 years of age. In Russia, according to international studies, up to 27 million people suffer from chronic kidney disease. The task of conservative therapy is to slow down the progression of chronic renal failure, to eliminate factors that aggravate its course, as well as to correct hormonal and metabolic disorders inherent in uremia - anemia, hyperphosphatemia, hyperlipidemia. The fifth stage of chronic kidney disease, also called the stage of end-stage renal disease, means a decrease in kidney function by more than 80%, which leads to life-threatening disorders of homeostasis and metabolism. The only way to continue life at this stage is lifelong use of renal replacement therapy, which includes three varieties: hemodialysis, peritoneal dialysis and kidney transplantation. The aim of each type of this therapy is to replenish, as far as possible, the lost functions of the patient's kidneys. Recently, the quality and reliability of dialysis machines, water purification systems, vascular access has improved significantly. However, there are complications associated with the procedure. This is also facilitated by an increase in the number of patients with diabetes mellitus, cardiovascular pathology, who are most susceptible to interaction with a dialysis machine. If there is no possibility of a transplant, a long waiting list, or there are contraindications to surgery, dialysis therapy is the treatment of choice. It must be remembered that dialysis is also supportive therapy for transplant rejection.

Tartrate resistant acid phosphatases and osteodystrophy in chronic renal failure as related to oxidative stress: - tartrate resistant acid phosphatase is a proxidant

Objective: Oxidative stress has emerged as a constant feature of Chronic Renal Failure (CRF), this possibly helps to promote the progression and complications of CRF. This study aims to evaluate the relation of tartrate resistant acid phosphatase (TRACP) to oxidative stress in patients with End Stage Renal Disease (ESRD). Methods: Forty Iraqi patients with ESRD underwent hemodialysis and thirty seven healthy individuals were included in the present study. Several biochemical parameters such as lipid peroxidation through the concentration of malondialdehyde (MDA), [copper], [iron], [transferrin], [uric acid] and ceruloplasmin ferroxidase activity were measured in sera of control and ESRD patients. Results: The results revealed presence of a significant increase (P&lt; 0.001) in both [MDA] and uric acid level in sera of ESRD patients in comparison with that of the control group. Meanwhile a non-significant increase (P&gt;0.05) was found in copper concentration with a significant decrease (P&lt;0.001) in serum [iron], total iron binding capacity (TIBC),unsaturated iron binding capacity (UIBC), and [transferrin] of the patients group in comparison with that of the control group .Moreover no difference was observed in the saturation percentage of transferrin with iron between both groups and non-significant decrease in both the activity and the specific activity of ceruloplasmin ferroxidase (P &gt; 0.05) in sera of the patients group. Conclusion: we concluded that the increased of TRACP activity takes part in the measured oxidative stress (as indicated by the increased MDA level) in Iraqi patients with ESRD.

Neoxanthin alleviates the chronic renal failure-induced aging and fibrosis by regulating inflammatory process.

Chronic renal failure (CRF) refers to progressive renal damage caused by chronic kidney diseases (CKD). Dialysis therapy and kidney transplantation are the important treatment for CRF. However, due to the limitation of conditions, they cannot be widely utilized. At present, the treatment of renal failure is a worldwide problem in clinic. Therefore, in the current study, we investigated the potential therapeutic effects of neoxanthin on CFR-caused aging and fibrosis. In this work, the effects of neoxanthin on CRF were studied using experimental techniques such as biochemistry, immunohistochemistry and molecular biology. In vitro, neoxanthin alleviated the aging and oxidative damage of kidney cells. In vivo, we found that Neoxanthin could alleviate adenine-induced CRF. Neoxanthin also inhibited CRF-caused renal aging, fibrosis, oxidative stress and inflammation. These findings indicate that neoxanthin could delay the progression of CRF and alleviate CRF-induced aging and fibrosis. Collectively, we found that neoxanthin shows good potential to inhibit CRF-caused kidney aging and fibrosis, suggesting that neoxanthin may be used as a drug (or a functional food) for the treatment of CRF-related diseases.

Usage of Biological Therapy in Rheumatoid Arthritis Patients with Chronic Renal Failure: A Retrospective Study from a Single Center

Kronik böbrek hastalığı (KBH) olan romatoid artrit (RA) hastalarında, potansiyel toksisiteleri nedeniyle hastalığı modifiye edici antiromatizmal ilaçların (DMARD) çoğunu ve steroid olmayan antiinflamatuar ilaçları (NSAİİ) kullanmak uygun değildir. Biyolojik DMARD'lar RA hastaları için oldukça etkili bir tedavi seçeneği olsa da böbrek fonksiyonları üzerindeki etkisi ve güvenilirliği tam olarak belirlenememiştir. KBH’si olan RA’lı hastalarda biyolojik tedavilerin kullanımına ilişkin veriler kısıtlıdır. 2011-2018 yılları arasında RA tanısı ile takip ettiğimiz, biyolojik ajan kullanan ve düzenli vizitleri bulunan 700 hasta arasından tahmini glomerüler filtrasyon hızı (eGFR) üç aydan uzun süredir

A sensitive UPLC-MS/MS method for the simultaneous determination of the metabolites in the tryptophan pathway in rat plasma

Tryptophan (TRP) metabolism plays a crucial role in pathology and physiology. An imbalance in TRP metabolism has been implicated in the pathology of renal failure. To explore the changes in the TRP profile that occurred in renal failure, we induced experimental models of renal ischemia-reperfusion injury (RIRI) and chronic renal failure (CRF) in rats. A simple, rapid and sensitive method coupling ultra-high-performance liquid chromatography to triple quadrupole mass spectrometry (UPLC-MS/MS) was developed for the simultaneous determination of TRP and its seven major metabolites in plasma. The method was validated base on linearity, accuracy, precision, stability, recovery and the matrix effect. In the RIRI group, the levels of kynurenine (KYN), 5-hydroxyindoleacetic acid (5-HIAA), tryptamine (Trpm) and kynurenic acid (KA) were increased, and the level of TRP was decreased significantly compared with those of sham group. Moreover, the levels of most of the metabolites measured using the proposed method changed significantly with CRF progression. In the CRF group, the levels of KYN, 5-HIAA, Trpm, KA, 3-hydroxyanthranilic acid (3-HAA) and 3-hydroxykynurenine (3-HK) were dramatically elevated, and the level of TRP was markedly reduced compared with those of the CON group. Plasma precursor metabolite/product metabolite ratios were calculated to characterize enzyme activity. Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) of the metabolites were performed for both groups. A Spearman correlation coefficient analysis between the metabolite concentrations and renal injury indicators was performed. We identified KYN, TRP, and 5-HIAA as potential metabolite biomarkers for AKI, and 5-HIAA, TRP, 3-HAA, KA, KYN and 3-HK as potential metabolite biomarkers for CRF (VIP>1 and p < 0.05). These results showed significant changes in the tryptophan metabolism profile under the two types of renal failure. In summary, the results of our study depict the changes in the TRP pathway, reveal the role of the TRP pathway in AKI and CRF, and provide insight into finding potential peripheral biomarkers of renal failure and elucidating the mechanism of diseases related to TRP metabolism disorders.

Late-onset neutropenia induced by anti-B cell therapy with rituximab in patients with ANCA-associated systemic vasculitis

In the last decade, anti-neutrophil cytoplasmic antibodies (ANCA)-associated systemic vasculitis (SV) has been treated with the anti-B-cell drug, rituximab (RTM) both for induction and maintenance therapy. One of the problems of the treatment with RTM in patients with ANCA-SV is the risk of late-onset neutropenia (LON), mechanisms of development of which have not been studied enough yet.Objective: to evaluate the incidence and outcomes of LON in patients with ANCA-SV treated with RTM. Patients and methods. A retrospective analysis of the register of 140 patients with ANCA-SV who received RTM treatment at the V.A. Nasonova Research Institute of Rheumatology from 2009 to 2021 years. The median duration of RTM treatment was 49 (6–121) months, the median of the total RTM dose was 3.5 (0.5–9.5) grams. The duration of follow-up exceeded 6 months after the first administration of RTM.Results and discussion. LON was detected in 16 (11.4%) patients, of which 6 suffered from Wegener's granulomatosis with polyangiitis (GPA), 4 – microscopic polyangiitis (MPA), 4 – Churg-Strauss eosinophilic granulomatosis with polyangiitis (EGPA) and 2 – undifferentiated ANCA-SV. In 8 (50%) out of 16 patients, LON developed within 2 months after the 1st course of RTM, in the remaining 8 patients, on average, after 10 (4– 15.5) months. A lethal outcome was documented in 5 (31.2%) of 16 cases of LON (1 with MPA, 3 with GPA, and 1 with EGPA) on average 2 (1.5–9) months after the 1st course of RTM, at the same time, in 4 patients LON was complicated by pneumonia, including 2 with septic shock, in another 1 case LON was combined with the development of acute myocardial infarction and progression of chronic renal failure. Overall mortality among 140 patients with ANCA-SV treated with RTM was 11.4%, while in cases with a fatal outcome, the frequency of LON reached 31.2%.Conclusion. Thus, LON induced by RTM is a common (11%) and clinically significant consequence of B-cell depletion in patients with ANCA-SV, in every 5th case it is complicated by serious infections (including sepsis in 13%) and accounts for a significant proportion in the structure of lethal outcomes (31.2%).Patients treated with RTM require careful monitoring of absolute neutrophil count both during the first months after initiation of anti-B-cell therapy and thereafter. In the combined administration of RTM with cytotoxic drugs (primarily cyclophosphamide) in patients with ANCA-SV, it is necessary to consider the risk of LON developing, secondary immunodeficiency, and infectious complications. During the coronavirus pandemic, one should remember that treatment with interleukin 6 inhibitors used in severe COVID-19 can also be accompanied by neutropenia and requires careful dynamic monitoring of the absolute number of neutrophils in patients with ANCA-SV treated with RTM. It is necessary to inform both patients and physicians of the risk of LON development during the treatment of RTM in ANCA-SV and other rheumatic diseases.

Effect of Bushen Qudu Decoction on TGF-β1/Smads signal transduction pathway in rats with chronic renal failure

Purpose: To study the impact of Bushen Qudu Decoction on renal function, renal tissue morphology and TGF-β1/Smads signal transduction pathway in adenine-induced chronic renal failure rats.Methods: 76 rats were assigned to normal group, model group, uremic clearance group, benazepil group, Bushen Qudu decoction gunshan A group and Bushen Qudu decoction Guiza group. Renal failure was induced in rats using intragastric administration of adenine for 30 days. The expressions of TGF-β1, Smad2, Smad3 and Smad6 were determined with immunohistochemistry. Real-time quantitative PCR was employed to assay the mRNA expression of TGF-β1 in each group, while protein expressions of Smad2, Smad3 and Smad6 were determined with western blot. The scores of glomerular and tubulointerstitial lesions in each group were obtained by histopathological examination.Results: Bushen Qudu decoction significantly reduced BUN and creatinine in rats with chronic renal failure; furthermore, it also lowered the protein expressions of TGF-β1 and SMAD2/3, but Smad6 protein, relative to control (p &lt; 0.05). The TGF-β1mRNA expression was down-regulated (p &lt; 0.05), relative to control group.Conclusion: Bushen Qudu decoction reduces renal interstitial fibrosis in rats and delays the progression of chronic renal failure by regulating TGF-β1/Smads signaling pathway. These findings provide some insight that should facilitate the development of new drugs that would delay the onset of chronic renal failure.

P36 THE ELDEST HEART TRANSPLANTED PATIENT IN EUROPE: 36 YEARS SURVIVAL AND STILL GOING ON

Development of endomyocardial biopsy for acute rejection monitoring in the early Seventies, and above all use of cyclosporine in the clinical practice starting from 1980, introduced the modern era of heart transplantation. Following the initial positive outcomes, the first Italian transplant was performed in Padua by V.Gallucci on November 15th 1985. This pioneering success was rapidly repeated in Pavia, where M.Viganò performed the second transplant on Novembre 17th. Recipient was 20 years old man, suffering from dilated cardiomyopathy, on urgent transplant list. Cardiac index was 1.38 l/min/m2 and pulmonary vascular resistance 1.6 WU. Donor was a 14 years old boy died of brain injury. Total ischemic time was 125 minutes. Induction immunosuppression consisted of horse anti–lymphocyte immunoglobulins, whereas maintenance therapy included cyclosporine, azathioprine and steroids. Postoperative course was complicated by pericardial effusion and cholestatic jaundice. Later pulmonary aspergillosis occurred and due to the profound immunodepression was complicated by fungal localization at L2 vertebral body. The infection was treated with surgical removal of the secondary localization and amphotericin B administration. On December 6th severe acute rejection was found at biopsy and treated with i.v. steroid pulse. Length of ICU and hospital stay was 28 and 72 days, respectively. In 1998 HCV infection was detected and eradicated in 2017 with elbasvir/grazoprevir therapy. Complications of long term immunosuppressive treatment included dyslipidemia, myeloma and basal cell carcinoma. Due to long–term calcineurin inhibitors therapy progressive chronic renal failure occurred, leading to replacement therapy in 2015 and kidney transplantation in 2016. In 2015 the patient underwent percutaneous coronary intervention with stents implantation in two marginal branches and in the anterior descending artery in 2021. Everolimus was introduced to slow down progression of cardiac allograft vasculopathy. In 2020 he suffered from Covid–19, but the course of infection was uneventful being cough the only symptom. We report the eldest survivor after heart transplant in Europe. Our case demonstrates that despite early and long–term complications of immunosuppressive therapy, a careful and patient tailored management allowed an amazing outcome. Nowadays heart transplant remains the best treatment for end stage heart failure and allows to resume a nearly normal quality of life.

Short and Intermediate Term Effects of COVID-19 Infection on Lung Transplant Recipients

PurposeThe characteristics and outcomes, including acute cellular rejection (ACR), of lung transplant recipients (LTR) post COVID-19 infection are incompletely studied. We sought to show whether or not COVID-19 infection in LTR is associated with ACR.MethodsThis single center, retrospective study of LTR examined data among those who contracted COVID-19 between June 2020 and May 2021. Patient demographics, immunosuppression regimen, and hospital course related to COVID-19 infection were recorded. Subsequent spirometry, imaging, and biopsy results were documented.ResultsWe identified 16 LTR who tested positive for COVID by PCR testing. Acute radiographic changes were detected in half (8) of the cohort, 3 patients eventually required ICU admission, 1 which required venovenous extracorporeal membrane oxygenation. The median drop in FEV1 and FVC after COVID-19 infection was -375 (-1140 to +120) and -260mL (-1790 to +410), respectively. ACR was diagnosed in 2 patients at 6 weeks post COVID-19 infection. Both of the patients who were diagnosed with ACR required hospitalization, and one required ICU admission. There was 1 death at >6 months after infection due to progressive chronic lung allograft dysfunction and renal failure.ConclusionThis analysis characterizes short and intermediate term outcomes of LTR after COVID-19 infection. Specifically, the association between such infection and both rates of ACR and allograft function is uniquely described. ACR was observed in 12.5% of patients 6 weeks post COVID-19 infection. There was a notable reduction in lung function, which was mostly accounted for by the 3 patients in our cohort who required ICU admission. This study has several limitations. The sample size is small and involves a single center. It is also retrospective in nature, and there were a large number of asymptomatic patients included. Further analyses, to further assess the incidence of ACR in LTR are warranted to determine the associated factors and optimize management in this at risk patient population.

O004. Assessment of the impact of lupus nephritis on clinical, biological parameters, disease activity and mortality in pediatric Systemic Lupus Erythematosus

Abstract Background Systemic lupus erythematosus (SLE) is an autoimmune disorder affecting multiple organ systems. Kidney involvement is one of the most frequent and severe manifestations of pediatric systemic lupus erythematosus (pSLE), seriously affecting the prognosis. It usually manifests as glomerulonephritis of varying severity. Objective: Knowledge of the correlation of lupus nephritis (LN) with clinical, biological, immunological parameters, disease activity and mortality in pediatric systemic lupus erythematosus is limited. This study aims to describe the impact of renal involvement with these different determinants. Methods This was a prospective, multicenter, descriptive 36-month study (January 2015 - December 2018) including patients less than 16 years of age with LN. The presence of LN was defined according to the American College of Rheumatology classification SLE criteria. The LN class was determined by renal biopsy and was classified according to the Morphology in Kidney International Society of Nephrology (ISN)/Renal Pathology Society (RPS) 2004 classification of lupus nephritis. The disease activity was estimated by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the use of which has been validated in children. Means, percentages and Chi-square tests were specified. P values less than 0.05 were considered statistically significant. Results We included 83 patients in this study. 37/83 patients (44.6%) developed LN with the following urinary signs: 92% of proteinuria (mean 3366.147 mg ± 2785.93 / 24h) including 2/3 of cases of nephrotic syndrome, 81% of hematuria, 14% of acute renal failure with significant reduction in glomerular filtration rate (average creatinine clearance of 32.42 ml / min) and 12% high blood pressure. Out of a total of 30 renal biopsies interpreted at disease diagnosis, 73.4% diffuse proliferative glomerulonephritis forms were observed: (III (30%), IV (36.7%) and VI (6, 7%)). Lupus nephritis were significantly correlated with hypocomplementemia in its C3 (P = 0.00002) and C4 (P = 0.00005) fraction, lymphopenia (P = 0.02), anti-DNA antibodies (P = 0.026), SLEDAI (P = 0.00001) and mortality (P = 0.03). The most frequently used induction drugs for LN classes III, IV and VI were pulsed intravenous methylprednisolone (500 mg daily for 3 doses) in combination with low dose intravenous cyclophosphamide (23%) in the short term (500 mg/m2/15 days X 6) followed by mycophenolate mofetil (28%) (600mg/ m2 in two daily doses) as maintenance treatment associated with a daily dose of oral glucocorticoids with a gradual decrease until reaching the minimum amount necessary to control the disease. All of our SLE patients with nephritis were treated with HCQ with a significant correlation with the decrease in SLEDAI. During the first two years of disease progression, the frequency of LN increased to 43/83 (51.8%) mainly in these severe forms: (IV (41.7%), V (2.8 %). The progression to chronic renal failure had a prevalence of 6, 9% (3/43) of cases; these were mainly patients with severe lupus nephritis (III, and IV) Conclusion Nephritis is a major risk factor for morbidity and mortality in pSLE; LN in children is most often proliferating and more active. The early diagnosis and management of kidney damage are the only guarantee of a good course and prevention of the progression of chronic renal failure. Keywords lupus nephritis; child; systemic lupus erythematosus; disease activity, mortality.

Dalla medicina reattiva alla medicina di precisione

In recent years, there has been increased awareness of a concept of medicine based on individual differences taking into consideration genetic variability, environment, characteristics of the microbiome and individual lifestyles. It makes use of genomics, transcriptomics, proteomics and metabolomics techniques, obtaining a large amount of information which enables a more precise characterization of the patient. This model expands to the principles of prediction, prevention, personalization and participation, including all medical specialties. In nephrology, the application of precision medicine could play a central role, thanks to the information available today in multiple fields: for example the impact of alterations in the intestinal microbiota on the progression of chronic renal failure, in polycystic disease, in diabetic nephropathy and in the personalized approach to the transition period before the beginning of hemodialysis therapy.

Role of MCP-1 in the development of tubulointerstitial fibrosis in patients with primary chronic glomerulonephritis

BACKGROUND. To date, the study of the factors involved in the glomerular-tubular pathological connections leading to damage to the tubulointerstitial tissue is one of the topical areas of nephrology. THE AIM: to study the effect of MCP-1 in the development of tubulointerstitial fibrosis as a factor in the irreversible progression of chronic renal failure. PATIENTS ANDMETHODS. Prospective observation and retrospective analysis of case histories were carried out, which included a total of 75 patients with primary chronic glomerulonephritis. RESULTS. The average age of the patients was 36.7 ± 12.3 years, of which 52 were males, 23 were women. The average length of service in a nephrological disease was 3.0 [1.0; 5.0] years. The calculated GFR values are 87.3 ± 31.2 ml / min / 1.73 m2. In the general population, the moderate degree of MCP-1 expression, estimated at 2 points, was 35 %, pronounced expression was found in 25 % of the respondents. In the mesangium of the glomeruli and in macrophages, the expressed degree of MCP-1 expression was 20 % and 16 %, respectively, which characterizes MCP-1 as a marker produced by resident cells. When studying the relationship of MCP-1 in blood with clinical parameters, a correlation was found with the values of total protein (Rs= –0.43; p &lt;0.05), with erythrocyturia (Rs= –0.28; p &lt;0.05), as well as with an albumin level (Rs= –0.5; p &lt;0.05), which indicates the role of MCP-1 in the development of nephritic forms of glomerulonephritis. Depending on the severity of MCP-1 expression in biopsy specimens, the incidence of focal tubulointerstitial fibrosis with MCP-1 expression estimated at 1 point was 13.3 %, 2 points – 14.3 %, 3 points – 44.0 %. The revealed significant correlation between the serum level of MCP-1 and the severity of tubulointerstitial fibrosis confirms the MCP-1-mediated mechanism of progression of CKD. CONCLUSION. The relationship of serum and tissue forms of MCP-1 with the progression of tubulointerstitial fibrosis in chronic glomerulonephritis has been demonstrated. MCP-1-induced mesangial cell plays a critical role in the development of renal tubular damage, and its increased expression is associated with progressive tubulointerstitial fibrosis and decreased renal function.

The Pharmacological Effect and Mechanism of Lanthanum Hydroxide on Vascular Calcification Caused by Chronic Renal Failure Hyperphosphatemia.

ObjectiveThe present work aimed to explore the efficacy of lanthanum hydroxide in managing the vascular calcification induced by hyperphosphate in chronic renal failure (CRF) as well as the underlying mechanism.MethodsRats were randomly allocated to five groups: normal diet control, CKD hyperphosphatemia model, CKD model treated with lanthanum hydroxide, CKD model receiving lanthanum carbonate treatment, together with CKD model receiving calcium carbonate treatment. The serum biochemical and kidney histopathological parameters were analyzed. The aortic vessels were subjected to Von Kossa staining, CT scan and proteomic analysis. In vitro, the calcium content and ALP activity were measured, and RT-PCR (SM22α, Runx2, BMP-2, and TRAF6) and Western blot (SM22α, Runx2, BMP-2, TRAF6, and NF-κB) were performed.ResultsIn the lanthanum hydroxide group, serum biochemical and kidney histopathological parameters were significantly improved compared with the model group, indicating the efficacy of lanthanum hydroxide in postponing CRF progression and in protecting renal function. In addition, applying lanthanum hydroxide postponed hyperphosphatemia-mediated vascular calcification in CKD. Furthermore, lanthanum hydroxide was found to mitigate vascular calcification via the NF-κB signal transduction pathway. For the cultured VSMCs, lanthanum chloride (LaCl3) alleviated phosphate-mediated calcification and suppressed the activation of NF-κB as well as osteo-/chondrogenic signal transduction. Lanthanum hydroxide evidently downregulated NF-κB, BMP-2, Runx2, and TRAF6 expression.ConclusionLanthanum hydroxide protects against renal failure and reduces the phosphorus level in serum to postpone vascular calcification progression.