Severe Impairment Of Renal Function Research Articles

Bridging Stent-Graft Implantation in the Renal Artery During Complex Endovascular Aortic Procedures does not alter the Renal Sonographic Resistance Index

Abstract Background Ultrasound examination of the resistance index (RI) of both kidneys can provide evidence of renal artery stenosis. The extent to which the RI is changed after bridging stent-graft implantation due to altered flow characteristics is not known. Aims The aim of the study was to investigate the influence of renal bridging stent-grafts on the RI of the kidneys after fenestrated endovascular aortic repair (FEVAR). Methods Ultrasound examinations of the kidneys were conducted using a GE LOGIQ S7 XDclear ultrasound system (GE Medical Systems AG, Glattburg, Switzerland). The evaluation was performed according to SGUM 2D standard criteria. The RI was determined in all consecutive patients on the day before and after renal bridging stent-graft implantation. For this purpose, the kidneys were divided into 3 areas according to the standard protocol and 2 RI values were recorded per area by evaluating intrarenal arterial Doppler signals. Mean values were calculated and compared for each kidney. Results For 64 kidneys in 32 consecutive patients (73.9±7.8 years, 4 female, 28 male) treated with FEVAR and renal bridging stent–graft implantation pre- and postinterventional examinations were carried out. Sono-morphologically, the kidneys examined were inconspicuous (pre: size at least 107.1x52.4 mm, parenchymal margin 18.3 mm versus post: size at least 107.9x52.9 mm, parenchymal margin 18.6 mm, p>0.4). The arborization of the renal perfusion was preserved pre and post implantation. The RI did not differ before and after implantation (0.66±0.06 versus 0.67±0.07; p=0.10). None of the patients experienced severe impairment of renal function. Conclusion After successful implantation of a bridging stent-graft in a non-stenosed renal artery, there is no relevant change in the RI of the kidney. The RI seems therefore to be suitable for assessing renal perfusion after complex endovascular aortic therapy.

Renal function-adapted D-dimer cutoffs in combination with a clinical prediction rule to exclude pulmonary embolism in patients presenting to the emergency department.

D-dimer levels significantly increase with declining renal function and hence, renal function-adjusted D-dimer cutoffs to rule out pulmonary embolism were suggested. Aim of this study was to "post hoc" validate previously defined renal function-adjusted D-dimer levels to safely rule out pulmonary embolism in patients presenting to the emergency department. In this retrospective, observational analysis, all patients with low to intermediate pre-test probability receiving D-dimer measurement and computed tomography angiography (CTA) to rule out pulmonary embolism between January 2017 and December 2020 were included. Previously defined renal function-adjusted D-dimer cutoffs (1306µg/l for moderate and 1663µg/l for severe renal function impairment) were applied to determine sensitivity, specificity, negative and positive predictive values. One thousand, three hundred sixty-nine patients were included of which 229 (17%) were diagnosed with pulmonary embolism. The estimated glomerular filtration rate (eGFR) was ≥ 60ml/min in 1079 (79%), 30-59ml/min in 266 (19%) and < 30ml/min in 24 (2%) patients. Only three patients (1.1%) with an eGFR < 60ml/min had a D-dimer level < 500µg/l. There was a significant correlation between D-dimer and eGFR (R = -0.159, p < 0.001). Calculated on the standard D-dimer cutoff value of 500 µg/l, sensitivity of D-dimer testing was 97% for patients with an eGFR ≥ 60ml/min and 100% for those with 30-60ml/min, while specificity decreased in patients with renal function impairment. A negative predictive value of 0.99 as a premise to safely rule out pulmonary embolism was achieved by applying a D-dimer cutoff of 1480µg/l for eGFR 30-59ml/min and 1351µg/l for eGFR < 30ml/min. The findings of this study underline that application of renal function-adapted D-dimer levels in combination with a clinical prediction rule appears feasible to rule out pulmonary embolism. Out of the current dataset, renal function-adjusted D-dimer cutoffs to rule out pulmonary embolism were slightly different compared to previously defined cutoffs. Further studies on a larger scale are needed to validate possible renal function-adjusted D-dimer cutoffs.

Markers of end-stage renal disease progression: beyond the GFR

Chronic kidney disease may progress to end-stage renal disease (ESRD) with a high risk of morbidity and mortality. ESRD requires immediate initiation of therapy or a decision on dialysis or kidney transplantation. Therefore, timely diagnosis of pathology progression is critical for many patients. ESRD is associated with pathological changes, including inflammation, fibrosis, endocrine disorders and following epigenetic changes in various cells, all these alterations could serve as markers for ESRD identification. This review summarizes conventional and promising biomarkers of ESRD, which can be evaluated in kidney tissue, blood, or urine. Some of them are narrowly specific to a particular pathology, while others are more versatile. We suggested several universal inflammatory, fibrotic, hormonal, and epigenetic markers indicative of severe deterioration of renal function and progression of ESRD for improvement of ESRD diagnostics.

Lifetime risk of severe kidney disease in lithium-treated patients: a retrospective study

BackgroundLithium is an essential psychopharmaceutical, yet side effects and concerns about severe renal function impairment limit its usage.AimsOur objectives were to quantify the occurrence of chronic kidney disease stage 4 or higher (CKD4 +) within a lithium-treated population, using age- and time-specific cumulative incidence and age-specific lifetime risk as measures of disease occurrence. Additionally, we aimed to investigate the association between the duration of lithium treatment and the risk of CKD4 + .MethodsWe identified patients from the Sahlgrenska University Hospital’s laboratory database. We conducted a retrospective cohort study employing cumulative incidence functions that account for competing deaths to estimate cumulative and lifetime risk of CKD4 + . A subdistribution hazards model was employed to explore baseline covariates. For measuring the association between the duration of lithium treatment and CKD4 + occurrence, we used a matched 1:4 case–control study design and logistic regression.ResultsConsidering a 90-year lifetime horizon, the lifetime risk of CKD4 + for patients initiating lithium treatment between ages 55 and 74 ranged from 13.9% to 18.6%. In contrast, the oldest patient group, those starting lithium at 75 years or older, had a lower lifetime risk of 5.4%. The 10-year cumulative risk for patients starting lithium between ages 18 and 54 was minimal, ranging from 0% to 0.7%. Pre-treatment creatinine level was a predictive factor, with a hazard ratio of 4.6 (95% CI 2.75–7.68) for values within the upper third of the reference range compared to the lower third. Moreover, twenty or more years of lithium exposure showed a strong association with an increased risk of CKD4 + compared to 1–5 years of lithium use, with an odds ratio of 6.14 (95% CI 2.65–14.26).ConclusionsThe risk of CKD4 + among lithium-treated patients exhibited significant age-related differences. Patients under 55 years old had negligible 10-year risk, while the lifetime risk for those aged 75 and older was limited. Duration of lithium treatment, especially exceeding 20 years, emerged as a significant risk factor. For individual risk assessment and prediction, consideration of age, pre-treatment creatinine levels, and the chosen time horizon for prediction is essential.

Entrectinib-induced tubulointerstitial nephritis: a case report

Introduction and importance: Entrectinib has been approved and increasingly administered for the treatment of non-small cell lung cancer, especially with intracranial metastasis. Although previous clinical studies have confirmed its safety, disproportionality analysis showed unusually high potential adverse renal effects. Case presentation: We present a case of a 71-year-old woman with pulmonary adenocarcinoma who developed severe renal function impairment during the treatment with entrectinib. Urinary sediment examination revealed leukocyte casts, while urinary culture was negative, suggesting the presence of possible tubulointerstitial nephritis (TIN). A kidney biopsy was performed, and the diagnosis of TIN was confirmed. The administration of oral methylprednisolone improved renal function. Clinical discussion: Protein kinase inhibitors might lead to renal function impairment in several different ways. It is of utmost importance to differentiate between the underlying pathomechanism, which is often challenging. TIN is a potentially reversible condition when treated appropriately. Conclusion: In the case of renal function impairment during entrectinib therapy, the possibility of TIN should be considered, and a kidney biopsy should be performed since corticosteroid therapy might improve renal function.

Daratumumab, Bortezomib, and Dexamethasone for Treatment of Patients with Relapsed or Refractory Multiple Myeloma and Severe Renal Impairment: Results from the Phase 2 GMMG-DANTE Trial.

Renal function impairment (RI) is a common complication in multiple myeloma (MM). However, limited data exist on the safety and efficacy of anti-MM regimens in patients with severe RI, as these patients are frequently excluded from clinical trials. This investigator-initiated multicentric phase II GMMG-DANTE trial evaluated daratumumab, bortezomib, and dexamethasone (DVd) in relapsed or refractory (r/r) MM patients with severe RI. r/rMM patients with ≥1 prior treatment line and a GFR <30 mL/min/1.73 m2 or undergoing hemodialysis were eligible and received eight cycles of DVd followed by daratumumab maintenance. The trial closed prematurely after 22/36 planned patients. The primary endpoint was overall response rate (ORR). Median age of patients was 70 (range 55-89) years, with a median GFR of 20.1 mL/min/1.73 m2 (interquartile range, 9.4-27.3 mL/min/1.73 m2), and eight patients under hemodialysis. Median number of prior lines was two (range 1-10). The trial was successful, albeit with premature termination, as it met its primary endpoint, with an ORR of 67% (14/21). The rates of partial response, very good partial response, and complete response were 29%, 29%, and 10%, respectively (n = 6, 6, and 2). Fourteen patients (67%) achieved renal response. After median follow-up of 28 months, median progression-free survival was 10.4 months; median overall survival was not reached. Higher-grade toxicity was mainly hematologic, and non-hematologic toxicities ≥Grade 3 were mostly infections (24%). The prospective GMMG-DANTE trial investigating DVd exclusively in r/rMM patients with severe RI showed efficacy and safety to be comparable to data from patients without RI.

Machine learning-based multimodal MRI texture analysis for assessing renal function and fibrosis in diabetic nephropathy: a retrospective study.

Diabetic nephropathy (DN) has become a major public health burden in China. A more stable method is needed to reflect the different stages of renal function impairment. We aimed to determine the possible practicability of machine learning (ML)-based multimodal MRI texture analysis (mMRI-TA) for assessing renal function in DN. For this retrospective study, 70 patients (between 1 January 2013 and 1 January 2020) were included and randomly assigned to the training cohort (n1 = 49) and the testing cohort (n2 = 21). According to the estimated glomerular filtration rate (eGFR), patients were assigned into the normal renal function (normal-RF) group, the non-severe renal function impairment (non-sRI) group, and the severe renal function impairment (sRI) group. Based on the largest coronal image of T2WI, the speeded up robust features (SURF) algorithm was used for texture feature extraction. Analysis of variance (ANOVA) and relief and recursive feature elimination (RFE) were applied to select the important features and then support vector machine (SVM), logistic regression (LR), and random forest (RF) algorithms were used for the model construction. The values of area under the curve (AUC) on receiver operating characteristic (ROC) curve analysis were used to assess their performance. The robust T2WI model was selected to construct a multimodal MRI model by combining the measured BOLD (blood oxygenation level-dependent) and diffusion-weighted imaging (DWI) values. The mMRI-TA model achieved robust and excellent performance in classifying the sRI group, non-sRI group, and normal-RF group, with an AUC of 0.978 (95% confidence interval [CI]: 0.963, 0.993), 0.852 (95% CI: 0.798, 0.902), and 0.972 (95% CI: 0.995, 1.000), respectively, in the training cohort and 0.961 (95% CI: 0.853, 1.000), 0.809 (95% CI: 0.600, 0.980), and 0.850 (95% CI: 0.638, 0.988), respectively, in the testing cohort. The model built from multimodal MRI on DN outperformed other models in assessing renal function and fibrosis. Compared to the single T2WI sequence, mMRI-TA can improve the performance in assessing renal function.

Pharmacokinetic/Pharmacodynamic Target Attainment of Ceftazidime in Adult Patients on General Wards with Different Degrees of Renal Function: A Prospective Observational Bicenter Cohort Study.

No prospective evidence exists on the pharmacokinetic/pharmacodynamic (PK/PD) target attainment of ceftazidime in adult patients on general wards. We aimed to investigate whether the PK/PD target of ceftazidime (50% T > MIC) is attained in adult patients on general wards with adequate and impaired renal function receiving regular and guideline-recommended reduced doses of ceftazidime. In this observational, prospective, bicenter cohort study, adult patients admitted to a general ward receiving ceftazidime as part of standard care were included. Three blood samples per patient within 72 h after start of treatment were collected. Data were analyzed with nonlinear mixed effects modeling. The primary endpoint was target attainment of 50% T > MIC during the first 24 h of treatment (50% T0-24 > MIC). Forty patients were included from whom 121 blood samples were obtained. All 25/25 patients with adequate renal function, 9/10 patients with moderately impaired renal function (eGFR 30-50 mL/min/1.73 m2) and 5/5 patients with severe impaired renal function (eGFR < 30 mL/min/1.73 m2) attained 50% T0-24 > MIC when applying the clinical breakpoint MIC for Pseudomonas aeruginosa of 8 mg/L. The one patient not attaining the PK/PD target did not differ in any of the collected patients' characteristics, except that this patient was the oldest in the study population. However, age was not statistically significantly associated with clearance or volume of distribution in the population pharmacokinetic model and, therefore, not likely the cause for this patient not attaining the PK/PD target. Our results suggest ≥90% probability of the PK/PD target attainment of ceftazidime in patients on general wards with adequate and impaired renal function receiving regular and guideline-recommended reduced doses of ceftazidime for treatment of infections with Pseudomonas aeruginosa and all bacteria with lower MIC-values.

Quanduzhong capsules for the treatment of grade 1 hypertension patients with low-to-moderate risk: A multicenter, randomized, double-blind, placebo-controlled clinical trial.

Background: Duzhong [DZ (Eucommia ulmoides Oliv.)] is regarded as a traditional Chinese medicine with a history dating back more than 2000years. This herb is considered a nourishing herb in China and is commonly used as a tonic to strengthen muscles and bones, nourish the kidneys and liver, and soothe miscarriages. Moreover, there is evidence that DZ is capable of regulating blood pressure (BP), and several compounds isolated from DZ have been shown to have a BP-lowering effect. Quanduzhong capsules contain an extract of DZ [Eucommia ulmoides Oliv. (Eucommiaceae; Eucommiae cortex)] that is effective in treating hypertension. This multicenter, randomized, double-blind, placebo-controlled clinical trial sought to evaluate the clinical efficacy of Quanduzhong capsules in the treatment of low-to-moderate risk grade 1 hypertension patients. Materials and methods: A total of 60 patients from 3 centers with documented low-to-moderate risk grade 1 hypertension were randomly assigned in a 1:1 ratio to the test group or the control group. After a 1week lead-in period using sham Quanduzhong capsules, all patients who met the entry criteria (29 cases in the test group and 29 cases in the control group) entered the 4week test period. The test group took Quanduzhong capsules, and the control group continued to take sham Quanduzhong capsules. The primary endpoints [24-h mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) determined via 24-h ambulatory blood pressure monitoring (ABPM); office SBP and DBP] and secondary endpoints [mean arterial pressure; mean pulse; daytime mean SBP and DBP; nocturnal mean SBP and DBP; SBP and DBP load; area under the blood pressure (BP) curve; morning peak BP; early morning SBP and DBP; smoothness index of SBP and DBP; 24h BP mean coefficient of variation (CV); percentage of patients with circadian restoration in ABPM; home BP; quality of life evaluated by WHO Quality of Life-BREF questionnaire; grading and quantitative evaluation of hypertension symptoms; values of plasmatic renin activity, angiotensin II, aldosterone, β-2 microglobulin and homocysteine] were assessed following the treatment. Drug-related adverse events and adverse drug reactions were also compared. Results: After a 4week test period, a significant difference in the DBP CV between the two groups was observed (-2.49 ± 4.32 vs. 0.76 ± 4.3; p < .05). Moreover, the mean office SBP change was -7.62 ± 9.32mmHg, and the mean DBP change was -4.66 ± 6.03 (p < .05). Among the three subjects with abnormal homocysteine levels in the test group, homocysteine levels decreased by 6.23 ± 9.15μmol/L after treatment. No differences were observed between the two groups in any other indicators. After 4weeks of treatment, there were no significant differences between the groups in terms of safety indicators (p > .05). No abnormal vital signs (except BP) or severe liver or renal function impairment were observed during the treatment periods; in addition, adverse events and drug reactions were mild. Conclusion: Treatment with Quanduzhong capsules reduced office SBP and DBP as well as DBP CV determined by 24-h ambulatory BP monitoring in patients with grade 1 hypertension at low-to-moderate risk. Clinical Trial Registration: https://www.chictr.org.cn/showproj.aspx?proj=32531, identifier ChiCTR1900021699.

Clinical Characteristics and Prognosis of Diabetic Foot Ulcers Patients of Different Renal Function Statuses

To explore the clinical characteristics and the prognosis of diabetic foot ulcers (DFU) inpatients of different renal function statuses. A retrospective analysis of 962 inpatients with DFU was conducted. The patients were divided into three groups according to their renal function statuses, and the clinical characteristics of the three groups were compared to identify differences. In addition, the patients were followed up in outpatient clinics or by telephone and their prognostic status and risk factors for death were analyzed. Analysis of the clinical characteristics showed that, compared with diabetic patients with normal renal function or mild renal function impairment, diabetic patients with moderate and severe renal function impairment had a longer course of disease ( P<0.001). Patients with foot ulcers of Wagner grade 4 predominates the moderate and severe renal function impairment groups ( P<0.05). Patients in the moderate and severe renal function impairment groups had a relatively higher proportion of comorbidities, including hypertension, coronary heart disease, and peripheral arterial disease ( P<0.05). These patients had relatively lower levels of glycosylated hemoglobin and hemoglobin (all P<0.05) and relatively higher levels of neutrophil ratio and procalcitonin (all P<0.05). Of the two groups, patients in the moderate renal function impairment group were older ( P<0.001) and had lower ankle-brachial index ( P<0.001). The severe renal function impairment group had a higher proportion of patients with foot ulcers of Wagner grades 3 and 5 (all P<0.05). For the purpose of conducting prognostic analysis, 748 patients were followed up in outpatient clinics or by telephone for a median length of 41 months. Among them, 239 died. The all-cause mortality was 31.9%, and the mortality in the three groups was 25.8%, 46.2% ( P<0.001), and 59.4% ( P<0.001), respectively. The survival rate of patients in the moderate and severe renal function impairment groups was significantly lower than those in the normal renal function and mild renal function impairment groups ( P<0.001). Univariate Cox regression analysis showed that age, concomitant coronary heart disease and peripheral arterial disease, degree of renal function impairment, and foot ulcers of Wagner grade 4 and 5 were associated with all-cause deaths. Furthermore, multivariate Cox regression analysis showed that moderate and severe renal function impairment was an independent risk factor for all-cause deaths in DFU patients ( P<0.001). As renal function impairment worsens, patients with DFU present clinical characteristics of greater complexity, higher risks of cardiovascular events, and higher mortality. It is essential to prevent kidney damage and foot ulcers, to pay attention to the cardiovascular risks of DFU patients with moderate and severe renal function impairment, and to reduce mortality.

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

The Urinary Glucose Excretion by Sodium–Glucose Cotransporter 2 Inhibitor in Patients With Different Levels of Renal Function: A Systematic Review and Meta-Analysis

ObjectivePrevious evidence suggested that sodium–glucose cotransporter 2 inhibitor (SGLT2i)-mediated urinary glucose excretion (UGE) appeared to be reduced with a decrease in glomerular filtration rate. Thus, we conducted a systematic review and meta‐analysis to compare SGLT2i-mediated UGE among individuals with different levels of renal function.MethodsWe conducted systematic searches in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov from inception to May 2021. Clinical studies of SGLT2i with reports of UGE changes in predefined different levels of renal function were included. The results were expressed as pooled effect sizes with 95% confidence interval (CI). A random-effects model was used to calculate the pooled effect sizes.ResultsIn total, eight eligible studies were included. Significant differences were observed in the post-treatment UGE level among subgroups stratified by renal function (P <0.001 for subgroup difference), which were gradually decreased along with the severity of impaired renal function. Consistently, changes in UGE before and after SGLT2i treatment were also decreased along with the severity of impaired renal function [67.52 g/day (95%CI: 55.58 to 79.47 g/day) for individuals with normal renal function, 52.41 g/day (95%CI: 38.83 to 65.99 g/day) for individuals with mild renal function impairment, 35.11 g/day (95%CI: 19.79 to 50.43 g/day) for individuals with moderate renal function impairment, and 13.53 g/day (95%CI: 7.20 to 19.86 g/day) for individuals with severe renal function impairment; P <0.001 for subgroup differences].ConclusionsSGLT2i-mediated UGE was renal function dependent, which was decreased with the extent of renal function impairment.

Assessment of renal function using magnetic resonance quantitative histogram analysis based on spatial labeling with multiple inversion pulses.

BackgroundThe incidence of chronic kidney disease (CKD) is high, and is easy to develop into end-stage renal disease (ESRD), which requires kidney dialysis or kidney transplantation. Therefore, we want to explore the clinical value of magnetic resonance quantitative histogram analysis based on spatial labeling with multiple inversion pulses (SLEEK) in assessing renal function in the early stage.MethodsOne hundred and twenty-nine patients underwent abdominal MRI examination, including a coronal SLEEK sequence. The patients were divided into the control group [CG, 47 cases, estimated glomerular filtration rate (eGFR) >90], the mild renal function impairment (mRI) group (48 cases, eGFR =60–90), and the moderate to severe renal function impairment (m-sRI) group (34 cases, eGFR <60). Two experienced radiologists delineated cortex and medulla regions of interest (ROIs) on SLEEK images to obtain cortex and medulla quantitative histogram parameters [Mean, Median, Percentiles (5th, 10th, 25th, 75th, and 90th), Skewness, Kurtosis, and Entropy] using FireVoxel. These histogram parameters were compared by proper statistical methods such as one-way analysis of variance, the χ2 test, and receiver operating characteristic (ROC) curve analysis.ResultsFour histogram parameters (Inhomogeneitycortex, Skewnesscortex, Kurtosismedulla, and Entropymedulla) differed significantly between the CG and the mRI group. One medulla (Entropymedulla) and nine cortex (Meancortex, Mediancortex, Kurtosiscortex, Entropycortex, and 5th, 10th, 25th, 75th, and 90th Percentilecortex) histogram parameters were significantly different between the m-RI and m-sRI groups. The most relevant parameter to eGFR was Inhomogenitycortex (r=−0.450, P<0.001). Inhomogeneitycortex had the largest area under the curve (AUC) for differentiating the mRI group from the CG (AUC =0.718; 95% CI: 0.616–0.806), while 25th Percentilecortex generated the largest AUC (AUC =0.786; 95% CI: 0.681–0.869) for differentiating the mRI and m-sRI groups.ConclusionsQuantitative histogram parameters based on a SLEEK sequence can be used to supplement renal dysfunction assessment. Cortex histogram parameters are more valuable for evaluating renal function than medulla histogram parameters.

Multicystic dysplastic kidney

Multicystic dysplastic kidney

Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross-sectional web-based survey

BackgroundAcute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses...

ACTIVITY OF THE ANGIOTENSIN-CONVERTING ENZYME MEDIATES THE ASSOCIATION BETWEEN PLASMA VITAMIN D AND PLASMA ALDOSTERONE IN HYPERTENSIVE PATIENTS

Abstract Objective: Deficiency of 25-OH Vitamin D (25OHD) and activation of the renin-angiotensin-aldosterone system (RAAS) are both known cardiovascular risk factors. Some studies have shown that 25OHD has a suppressive effect on RAAS but data in literature are conflicting. The aim of the study was to evaluate the relationships between 25OHD level and RAAS parameters in essential hypertensive (EH) patients without obesity and of severe impairment of renal function. Design and method: In 153 EH subjects (age 49 ± 12 years, 87 males, 123 naive, 30 after a wash-out period) we evaluated clinical characteristics, glomerular filtration rate (GFR), plasma levels of 25OHD, 1,25OHD, PTH, potassium, calcium, plasma aldosterone (PA), active renin (AR), angiotensin-converting-enzyme (ACE), 24-h urinary calcium (UCa) and 24-h urinary sodium. Results: 25OHD level was significantly and directly related with UCa (r = 0.209, P = 0.024), ACE (r = 0.470, P &lt; 0.001), PA (r = 0.272, P = 0.001), and inversely related with age (r = -0.301, P &lt; 0.001) and PTH level (r = -0.188, P = 0.025). At multivariate analysis, 25OHD level was independently associated with levels of PTH (B = -0.213, P = 0.023), ACE (B = 0.488, P &lt; 0.001) and PA (B = 0.201, P = 0.039). PA level was positively related with 25OHD, 1,25-OHD (r = 0.256, P = 0.026), and ACE (r = 0.296, P = 0.006) and inversely related with age (r = -0.260, P = 0.019), plasma potassium (r = -0.261, P = 0.001) and alcohol intake (r = -0.224, P = 0.007). In a multivariate model that did not include ACE, PA was independently associated with levels of plasma potassium (B = -0.227, P = 0.004) and 25OHD (B = 0.197, P = 0.018). After inclusion of ACE, PA level remained independently associated only with plasma potassium (B = -0.244, P = 0.015) and alcohol intake (B = -0.244, P = 0.016). At multivariate analysis with ACE as the dependent variable and 25OHD and PA as independent variables, ACE was independently associated with 25OHD level (B = 0.427, P &lt; 0.001). Conclusions: In patients with EH, PA and 25OHD are directly related and this relationship appears to be mediated by the activity of ACE.

Management of Anticoagulant-Related Nephropathy: A Single Center Experience.

Background: Anticoagulant-related nephropathy (ARN) is a form of acute kidney injury that mainly occurs in patients with previously unrecognized glomerular disease in addition to excessive anticoagulation. Since a renal biopsy is not performed in most cases, the diagnosis is often presumptive. Methods: Here, we present the characteristics of a national Slovenian patient cohort with histologically verified ARN, from the first case in 2014 to December 2020, and a review of the current literature (Pubmed database). Results: In Slovenia, ARN has been detected in 13 patients, seven of whom were treated with coumarins, and others with direct oral anticoagulants. In seven patients, ARN appeared after excessive anticoagulation. As many as 11 patients had underlying IgA nephropathy. Similar to the global data presented here, the pathohistological impairment associated with pre-existing glomerulopathy was mild and disproportionate to the degree of functional renal impairment. The majority of our patients with ARN experienced severe deterioration of renal function associated with histological signs of accompanying acute tubular injury, interstitial edema, and occlusive red blood cell casts. These patients were treated with corticosteroids, which (in addition to supportive treatment and discontinuation of the anticoagulant drug) led to a further improvement in renal function. Conclusions: Anticoagulant therapy combined with a pre-existing glomerular injury may lead to ARN. In addition to discontinuation of the anticoagulant and supportive care, corticosteroids, which are currently listed in only a few cases in the world literature, may have a positive influence on the course of treatment. However, the benefits of steroid treatment must be weighed against the risk of complications, especially life-threatening infections.

The "vicious circle" of thyroid metabolism in patients with chronic kidney disease

Background. Decreased thyroid function is common in patients with chronic kidney disease. Under conditions of hypothyroidism, there is significant changes in lipid metabolism, nitrogen excretion function of the kidneys. THE AIM. To study the parameters of the functional state of the thyroid gland in patients with various stages of chronic kidney disease. Patients and methods . A one-stage cross-sectional study of patients with glomerulopathies without clinically significant diseases of the cardiovascular system with preserved EF (&gt; 55 % according to Simpson) from April 2019 to March 2020 was carried out. The study included 270 patients. To identify subclinical hypothyroidism (SH), the TSH level was determined. Patients were divided into groups according to TSH level: low TSH, normal TSH, and subclinical hypothyroidism. In patients, the indicators of biochemical blood analysis, data from a complex laboratory functional examination of the kidneys were assessed. Results. The detection rate of SH in patients with different stages of CKD was 17.56 %. Patients with SH were significantly older than the group of patients with normal TSH levels (p=0.002). In the group of patients with subclinical hypothyroidism, anti-TPO antibodies were detected only in 9.6 % of patients. A correlation was found between GFR and free T3 in patients with 3B and 4 stages of CKD (r=0.3, p&lt;0.05). In the group of patients with subclinical hypothyroidism, there was a decrease in total protein and albumin, an increase in daily proteinuria, a decrease in total calcium, increased inorganic phosphorus, chlorine, decreased renal transport of uric acid. Conclusion. Increased TSH levels are associated with advanced stages of CKD. The increase in TSH levels in patients with CKD is not associated with female sex and older age. In most patients with glomerulopathies, an increase in TSH levels is not an outcome of autoimmune thyroiditis. SH in CKD patients is associated with severe impairment of renal nitrogen excretion function, protein, and electrolyte metabolism.

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2-3a.

To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a. Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. End-points included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni- and multivariable outcome analyses were based on logistic regression. A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P<0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P=0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P=0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P=0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86months, 95% confidence interval 3.83-78.36 vs 81.28months, 95% confidence interval 4.59-72.29, P=0.702). In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.

P0204PREVALENCE AND PREDICTIVE FACTORS OF BIOPSY-PROVEN NEPHROPATHY RELATED TO MONOCLONAL GAMMOPATHY

Abstract Background and Aims The prevalence of monoclonal gammopathy (MG) and kidney disease increases with age. When a patient present with both conditions, it is often necessary to perform a kidney biopsy in order to rule out a Monoclonal Immunoglobulin-Related Nephropathy (MIRN) that may require a specific therapy that targets either an overt hematological malignancy or a MG or Renal Significance (MGRS). The aim of our study was to identify factors that predict the presence of MIRN in this setting. Method This retrospective monocentric study included all patients who underwent a kidney biopsy between 2007 and 2018 with concurrent presence of GM, as defined by positive serum immuno-electrophoresis and/or Bence-Jones proteinuria. Results 328 patients were included, representing 11.8% of all kidney biopsies performed in our center during this period. Indication of biopsy was renal failure (eGFR &amp;lt;60ml/min/1.73m) in 77.4% of cases and/or proteinuria (urine protein-to-creatinine ratio &amp;gt;0.5g/g) in 75.9% of them. Median (IQR) serum creatinine was 155 μmol/L (111-233), eGFR 37.5 (22-56) ml/min/1.73m, serum albumin 29.5 (24-35) g/l. Median age was 67 (57/75), the M/F ratio was 198/130, diabetes mellitus was present in 21.3% of cases, hypertension in 53.1%. Kidney biopsy revealed that nephropathy was related to MG in 91/328 patients (27.7%). Myeloma cast nephropathy and AL amyloidosis were the most common histopathological subtypes (36 and 34% respectively), followed by monoclonal immunoglobulin deposition disease (15%) and cryoglobulinemic glomerulonephritis (8%). Patients with MIRN had more severe renal function impairment with median (IQR) serum creatinine of 176 (119-307) vs 149 (108-216) μmol/l (p=0.003) and heavier proteinuria, 3.9 (2.2-8.2) vs 2.0 (0.9-5.2) g/g (p&amp;lt; 0.001), when compared to non-MIRN patients. Hematological malignancy was diagnosed in 83 cases (25,3%) (Multiple Myeloma in 62, non-Hodgkin Lymphoma in 6, Waldenström Macroglobulinemia in 6, Chronic Lymphoid Leukemia in 6, Plasmocytoma in 3). Among them, MIRN was diagnosed in 51 (61%) cases but tumoral lympho-plasmocytic infiltration was observed in 9 (11%) cases. In this subgroup of patients, no laboratory test could predict the presence of a specific nephropathy. Among patients with no hematological malignancy (n=245), MIRN was diagnosed in 40 cases (16%) to confirm MGRS diagnosis. The markers that were most commonly associated with the presence of MGRS were positive Bence-Jones proteinuria (OR 4.7; 95%CI 2.2-10.3; p&amp;lt; 0.001), abnormal serum Free Light Chain (FLC) ratio (OR 4.2; 95%CI 1.7-10.7; p&amp;lt; 0.001), and serum electrophoresis spike &amp;gt;1.5 g/l (OR 5.9; 95%CI 2.6-13.5; p&amp;lt; 0.001). However, none of those markers had sufficient power to formally predict the result of the biopsy, as positive (PPV) or negative (NPV) predictive values were 36/41/45 % and 89/86/88 % respectively. Conclusion Almost one-third of patients with MG and kidney disease referred to our Department have biopsy-proven related nephropathy. Although negativity of Bence-Jones proteinuria and a normal serum FLC ratio are frequently associated with the absence of MGRS, kidney biopsy, beyond its diagnostic and prognostic interest, remains the most discriminating test.