Urinary Protein Loss Research Articles

PB2008: CUTANEOUS HEMORRHAGIC SYNDROME IN PATIENTS WITH AL-AMYLOIDOSIS

Background: Hemorrhages on the skin and mucosa are seen in 30-40% of patients with systemic AL amyloidosis (AL-A). The pathogenesis and clinical significance of this syndrome are poorly understood. Aims: To analyze the relationship of cutaneous and mucous hemorrhagic syndrome in AL-A patients with the hemostatic system parameters and the leading clinical syndromes. Methods: A prospective study included 49 patients with newly diagnosed systemic AL-A. 18 (37%) patients were diagnosed with stage I, 16 (33%) with stage II, and 6 (12%) and 9 (18%) with stage III and stage IV, respectively (Mayo 2004/Europian). Activated partial thromboplastin time, thrombin time, fibrinogen concentration, XIIa-dependent fibrinolysis time, antithrombin III (ATIII), D-dimer, factors VIII (FVIII), X (FX) and Von Willebrand factor (VWF) activity were determined before therapy. Patients with cutaneous hemorrhagic syndrome were included in the Group №1, and those without cutaneous hemorrhages in the Group №2. Results: Cutaneous and mucosal hemorrhagic syndrome was observed in 23 (47%) patients. Hypercoagulable syndrome (increase of fibrinogen, D-dimer, FVIII, VWF, and decrease of ATIII) was registered in 18 (78%) patients, significantly more frequently than in Group №2 patients (11 patients - 42%; p=0,01). Eight (35%) patients with skin hemorrhages developed venous and arterial thrombosis before treatment, which were absent in the control group (p=0.002). Nephrotic syndrome was present in 19 (82%) group №1 patients, nephrotic syndrome was 2 times less frequent in group №2 (10 (38%) patients, p=0,001). Patients with hemorrhages had higher urinary protein loss (5.7 g/day vs 2.4 g/day; p=0.03) and lower serum albumin values (23 g/l vs 33 g/l; p=0.001). In patients from the first group, the development of hydropericardium, hydrothorax and anasarca was more often observed (p=0.02). We didn’t find significant correlation between cutaneous hemorrhagic syndrome and involvement of other organs, content of free light chains and cardiac markers. Summary/Conclusion: Cutaneous hemorrhagic syndrome is a clinical manifestation of hypercoagulable disorders in the hemostasis system in AL-A patients and associated with a high frequency of thrombosis development. Skin hemorrhages were more often associated with severe nephrotic syndrome, which may indicate a single pathogenetic mechanism in the form of small vessel lesions.

A minimal change disease (MCD) related nephrotic syndrome preceding a Hodgkin Lymphoma diagnosis – a case report

We admitted a 21 -year -old female to the Nephrology ward due to proteinuria and generalized oedema, which started soon after consuming clonixin 300mg thrice a day for two weeks. Her initial blood work showed nephrotic -range proteinuria, hypoalbuminaemia, hypercholesterolaemia and normal kidney function. We conducted a full auto -immune and serological study: there were no signs of infection, complement consumption or underlying auto -immune diseases. Suspecting minimal change disease, we started prednisolone 1mg/kg/day, with good clinical response and a reduction of urinary protein losses. By the third day, a kidney biopsy was performed: the glomeruli were morphologically normal and no immune deposits were found, which suggested minimal change disease. After seven days, the patient was discharged from the hospital with a corticoid taper until her Nephrology consultation. In the following weeks she maintained clinical and laboratorial remission and prednisolone was stopped after six months. Two months after, the patient noticed a growing bilateral cervical mass and went to the emergency room. The diagnostic workup was inconclusive, so an ultrasound -guided biopsy was requested. The biopsy revealed lymphoid cell proliferation, positive for CD30, CD15, MUM -1 and BCl6. These findings confirmed a Hodgkin’s Lymphoma diagnosis and the patient started radiotherapy and chemotherapy (ABVD -doxorubicin, bleomycin, vinblastin, dacarbazine). In the following months her clinical status improved and the cervical mass had a significant size reduction. The kidney disease remained in remission, without therapeutic adjustments. A post- -treatment PET scan was requested, showing only a residual mediastinal mass.

Assessment of fibroblast growth factor-23 in children with nephrotic syndrome treated with glucocorticosteroids

ObjectivesTo evaluate fibroblast growth factor-23 (FGF-23) levels in children with nephrotic syndrome treated with glucocorticosteroids in comparison with existing markers of bone metabolism.BackgroundNephrotic syndrome is a frequent chronic illness defined by changes of permselectivity at the capillary wall of renal glomeruli, resulting in the glomerular inability to limit protein loss in urine. FGF-23 is an effective phosphaturic hormone secreted by osteocytes, which has a vital role in vitamin D and phosphate homeostasis.Patients and methodsThis case–control study included 80 children of which 40 children with idiopathic nephrotic syndrome were subdivided into three groups: steroid-dependent, steroid-resistant, and frequent relapse, as well as 40 children as the control group. Venous blood samples were taken for estimation of serum phosphorus, calcium, and parathormone hormone (PTH). The level of FGF-23 was assayed by enzyme-linked immunosorbent assay. Correlations of FGF-23 level with serum calcium, phosphorus, and PTH were also investigated.ResultsSerum levels of calcium, phosphorus, and PTH for children in steroid-dependent, steroid-resistant, and frequent-relapse groups were significantly lower than the controls (P < 0.001). Serum levels of FGF-23 were significantly higher in steroid-dependent, steroid-resistant, and frequent-relapse groups with a mean of 5.16, 5, and 4.51 ng/l, respectively, compared with the control group with a mean of 0.48 ng/l (P < 0.001). There was a significant negative correlation between FGF-23 and each of PTH, phosphorus, and calcium (P < 0.05).ConclusionFGF-23 could be used as a biomarker for osteodystrophy in nephrotic kidney disease in children.

Management of Acute Kidney Injury in Patient with Dengue and COVID-19 Illness Simultaneously

Dengue is a viral illness spreads through the bite of Aedes aegypti mosquito leading to a serious health hazard. Dengue induced acute kidney injury is a fatal consequence and there are very few studies reported. Hence early identification of high risk groups is crucial for prevention, to restrict progression and effective treatment of acute kidney injury and to minimise associated morbidity and mortality. The coronavirus disease outbreak has widely spread into a pandemic all over the world. COVID-19 cases have presented with wide spectrum of severity ranging from a mild presentation to severe cases affecting the lungs(ARDS) mainly and rapidly affecting various body organs leading to multiorgan failure. Among these renal involvement is common, the severity of which ranges from mild loss of protein in urine to progressive acute kidney injury requiring renal replacement therapy.

Diagnosis of preeclampsia in women with diabetic kidney disease

ABSTRACT Objective: assessing the incidence of preeclampisa (PE) in women with diabetic kidney disease (DKD) and analyzing the significance of clinical characteristics and changes in laboratory findings throughout the pregnancy on the onset of PE. Methods: the study included 79 patients with DKD. All patients had elevated urinary protein loss (30–299 mg/24 h) or proteinuria (≥300 mg/24 h) in the first trimester of pregnancy. PE was diagnosed in 22,8% patients with DKD. Results: women with proteinuria and/or proliferative retinopathy at the admission developed preeclampsia significantly more frequently than those without these findings. The degree of proteinuria was significantly associated with the risk of PE development in each trimester of pregnancy. Patients with chronic hypertension developed PE significantly more frequently than those who had no chronic hypertension. Conclusion: chronic hypertension and the degree of primary kidney injury and dysfunction are crucial determinants of PE development in women with DKD. Proteinuria seems to be the best renal predictive factors of PE.

51-Year-Old Man With Ascites and Abdominal Pain

51-Year-Old Man With Ascites and Abdominal Pain

Phase Separation of MAGI2-Mediated Complex Underlies Formation of Slit Diaphragm Complex in Glomerular Filtration Barrier.

Slit diaphragm is a specialized adhesion junction between the opposing podocytes, establishing the final filtration barrier to urinary protein loss. At the cytoplasmic insertion site of each slit diaphragm there is an electron-dense and protein-rich cellular compartment that is essential for slit diaphragm integrity and signal transduction. Mutations in genes that encode components of this membrane-less compartment have been associated with glomerular diseases. However, the molecular mechanism governing formation of compartmentalized slit diaphragm assembly remains elusive. We systematically investigated the interactions between key components at slit diaphragm, such as MAGI2, Dendrin, and CD2AP, through a combination of biochemical, biophysical, and cell biologic approaches. We demonstrated that MAGI2, a unique MAGUK family scaffold protein at slit diaphragm, can autonomously undergo liquid-liquid phase separation. Multivalent interactions among the MAGI2-Dendrin-CD2AP complex drive the formation of the highly dense slit diaphragm condensates at physiologic conditions. The reconstituted slit diaphragm condensates can effectively recruit Nephrin. A nephrotic syndrome-associated mutation of MAGI2 interfered with formation of the slit diaphragm condensates, thus leading to impaired enrichment of Nephrin. Key components at slit diaphragm (e.g., MAGI2 and its complex) can spontaneously undergo phase separation. The reconstituted slit diaphragm condensates can be enriched in adhesion molecules and cytoskeletal adaptor proteins. Therefore, the electron-dense slit diaphragm assembly might form via phase separation of core components of the slit diaphragm in podocytes.

A Novel Model for Nephrotic Syndrome Reveals Associated Dysbiosis of the Gut Microbiome and Extramedullary Hematopoiesis

Glomerular kidney disease causing nephrotic syndrome is a complex systemic disorder and is associated with significant morbidity in affected patient populations. Despite its clinical relevance, well-established models are largely missing to further elucidate the implications of uncontrolled urinary protein loss. To overcome this limitation, we generated a novel, inducible, podocyte-specific transgenic mouse model (Epb41l5fl/fl*Nphs1-rtTA-3G*tetOCre), developing nephrotic syndrome in adult mice. Animals were comprehensively characterized, including microbiome analysis and multiplexed immunofluorescence imaging. Induced knockout mice developed a phenotype consistent with focal segmental glomerular sclerosis (FSGS). Although these mice showed hallmark features of severe nephrotic syndrome (including proteinuria, hypoalbuminemia and dyslipidemia), they did not exhibit overt chronic kidney disease (CKD) phenotypes. Analysis of the gut microbiome demonstrated distinct dysbiosis and highly significant enrichment of the Alistipes genus. Moreover, Epb41l5-deficient mice developed marked organ pathologies, including extramedullary hematopoiesis of the spleen. Multiplex immunofluorescence imaging demonstrated red pulp macrophage proliferation and mTOR activation as driving factors of hematopoietic niche expansion. Thus, this novel mouse model for adult-onset nephrotic syndrome reveals the significant impact of proteinuria on extra-renal manifestations, demonstrating the versatility of this model for nephrotic syndrome-related research.

Serum Albumin Modifies the Effect of Peripheral Blood Monocytes on Severity of Diabetic Nephropathy in an Adult Population

BackgroundOur aim in this study was to characterize clinical associations between peripheral blood immune populations and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus. MethodsWe queried hospital records from an outpatient diabetes primary care clinic between 2018 and 2019 for clinical and laboratory data, including complete blood counts with differentials, serum albumin and globulin, glycated hemoglobin (A1C) and urine albumin-to-creatinine ratio. One hundred ninety-eight patients had complete cross-sectional data with temporally proximate complete blood counts and urine albumin-to-creatinine ratios. After univariable correlation assessment, we used a forward multivariable linear regression model to test the hypothesis that higher numbers of circulating innate immune populations would be associated with DKD, while accounting for known demographic, clinical and laboratory risk factors. We defined DKD as an albumin-to-creatinine ratio of >3 mg/mmol or an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 from the Chronic Kidney Disease Epidemiology Collaboration. ResultsAdjusted analyses demonstrated significant (p<0.01) associations between higher urine albumin-to-creatinine ratio and peripheral circulating monocytes, independent of other established significant risk factors, including blood pressure, A1C, age and sex. We also identified serum albumin as a potentially important modifying factor of albuminuric kidney disease, which interacts with monocytes in more advanced disease. In contrast, the variable most strongly predictive of eGFR was age. ConclusionsCirculating monocytes and serum albumin are significantly associated with albuminuria, but not eGFR in DKD. These results support the potential role of the innate immune system in diabetic microvascular end-organ damage and urinary protein loss, and may be readily translatable clinical markers to incorporate into risk-assessment models for prognostication in diabetes.

Ménétrier Disease; 2-Year-Old Boy Presenting With Prolonged Emesis, Generalized Edema and Chance Histopathological Finding of Cytomegalovirus Gastritis: A Case Report

Ménétrier disease (MD) is characterized by enlarged gastric folds with associated protein losing gastropathy. In children it is a rare and self-limited cause of protein losing gastropathy. We report a case of a 2-year-old male who presented with prolonged, refractory emesis and peripheral edema. Workup revealed severe hypoalbuminemia, hypoproteinemia, iron deficiency anemia, and high stool alpha-1 antitrypsin. Hepatic protein synthesis was normal with no urinary protein loss. Endoscopy showed antrum sparing, severe erosive gastritis in body and fundus, characteristic of MD. Histologic examination displayed inflammation with eosinophilia, foveolar hyperplasia, atrophic oxyntic epithelium, and rare CMV inclusions. Patient received antiviral therapy, intravenous albumin, diuretic and was discharged on high protein diet. Follow-up revealed clinical recovery, with endoscopy and histology showing normal gastric mucosa throughout the stomach. It is important to remain vigilant of this condition in pediatric population and to include it in the differential diagnosis in cases of protein losing gastroenteropathy.

Ménétrier Disease; 2-Year-Old Boy Presenting With Prolonged Emesis, Generalized Edema and Chance Histopathological Finding of Cytomegalovirus Gastritis: A Case Report

Ménétrier disease (MD) is characterized by enlarged gastric folds with associated protein losing gastropathy. In children it is a rare and self-limited cause of protein losing gastropathy. We report a case of a 2-year-old male who presented with prolonged, refractory emesis and peripheral edema. Workup revealed severe hypoalbuminemia, hypoproteinemia, iron deficiency anemia, and high stool alpha-1 antitrypsin. Hepatic protein synthesis was normal with no urinary protein loss. Endoscopy showed antrum sparing, severe erosive gastritis in body and fundus, characteristic of MD. Histologic examination displayed inflammation with eosinophilia, foveolar hyperplasia, atrophic oxyntic epithelium, and rare CMV inclusions. Patient received antiviral therapy, intravenous albumin, diuretic and was discharged on high protein diet. Follow-up revealed clinical recovery, with endoscopy and histology showing normal gastric mucosa throughout the stomach. It is important to remain vigilant of this condition in pediatric population and to include it in the differential diagnosis in cases of protein losing gastroenteropathy.

Suppressor of cytokine signalling 3 (SOCS3) expressed in podocytes attenuates glomerulonephritis and suppresses autoantibody production in an imiquimod-induced lupus model

ObjectiveRecently, podocytes have been recognised not only as a physical barrier to prevent urinary protein loss but also as producers of proinflammatory cytokines. However, the roles of podocytes in the...

A rehabilitation effect of water with low surface tension on the functional condition of the kidneys

The aim of the research was to determine the influence of low surface tension water load on the excretory function of kidneys and the urine surface tension compared to induced diuresis by ordinary tap water. In the experiments on 40 white nonlinear male rats weighing 0.16–0.18 kg the effect of low surface tension water load (43 dyn/cm) was studied, which was obtained by treating tap water with coral calcium (Sango Coral, Okinawa, Japan). The excretory function of kidneys was studied under the conditions of water-induced diuresis and low surface tension water loading, for which the fluids in the amount of 5% of body weight were injected into the stomach of rats with the help of a metal probe with further urine collection after 2 hours. Urinary creatinine concentrations were determined based on the reaction with picric acid. Concentrations of sodium and potassium ions were studied by using flame photometry on PFP-1. The concentration of urinary protein was estimated by the method with sulphosalicylic acid. The urine pH as well as the concentrations of titratable acids and ammonia was determined. We calculated the excretion of potassium and sodium ions, protein, titratable acids, ammonia, and ammonium coefficient. The urine surface tension was determined by the Harkinson method of stalagmometric droplet counting, based on the determination of the weight of the droplet which is detached from the capillary due to gravity. As a result of the experiments on 40 white nonlinear pubertal male rats with induced diuresis under low surface tension water load (43 dyn/cm) compared to conventional tap water (the surface tension is 73 dyn/cm) a systemic effect was found on inhibition of the surface tension of urine from 75.00±0.000 dynes/cm to 74.05±0.260 dyn/cm (p&lt;0.01), a decrease in the loss of urinary protein from 0/36±0.0074 mg/2h×100g to 0.012±0.0024 mg/2h×100g (p&lt;0.01), sodium ions and the presence of significant interdependencies between the urinary surface tension, the concentrations of sodium ions and urinary protein. The low surface tension water load (43 dyn/cm) compared to the diuresis induced by ordinary tap water (surface tension 73 of dyn/cm) is characterized by the systemic impact along with the inhibition of the urine surface tension (p&lt;0.01), reduction of urinary protein losses and presence of reliable interdependencies between the urine surface tension, concentrations of sodium ions and urinary protein. Thus, the use of water treated with the Coral-mine preparation may be recommended as a rehabilitation remedy with a view of improving the functional condition of the kidneys both in health and damaged tubules of the nephron.

Predictive Value of Platelet Aggregation Responses and Coagulation Parameters for Thromboembolic Risk in Children with Idiopathic Nephrotic Syndrome.

Introduction: Idiopathicnephrotic syndrome (INS) is the most common renal disease among children. INS present with proteinuria, hyperlipidemia, edema, hypoalbuminemia, and hypercoagulability. A serious consequence of INS is arterial and/or venous thromboembolism e.g., deep vein thrombosis (DVT), pulmonary emboli and renal vein thrombosis. This hypercoagulability may be due to urinary loss of small proteins, specifically antithrombin (AT) III, protein C and S. INS children have been observed to develop thrombocytosis and platelet hyper aggregation leading to increased thromboembolic risk. Aim of the Study: To evaluate the coagulation profile and results of platelet functions during active nephrosis in children with steroid sensitive and steroid resistant INS. Methods: Thirty-six children with INS were studied.Twenty-four steroid sensitive and 12 steroid resistant patients were evaluated for platelet function and coagulation parameters during active nephrosis (either at presentation or relapse). The study also included 15 healthy age and sex matched children as control.Doppler imaging was done to confirm thromboembolic events. Results: Thrombo-embolic complications were observed in 14/36 patients, diagnosed both clinically and/or by doppler.Prolonged PTT was observed during active nephrosis, compared to control. Hypoalbuminemia and hyperlipidemia contributed to hypercoagulability. Mean platelet aggregation to ADP and Ristocetin were significantly elevated among both groups (108.3±10.8% and 104.8±13.2% respectively). Levels of ATIII were significantly reduced, further adds to thrombotic risk. Conclusion: Thromboembolic complications are not uncommon in nephrotic children. Platelet hyperaggregability positively correlated with VTE in INS children and can be a beneficial predictor of thrombosis during active nephrosis especially those past history of VTE.

Reduction of Renal Preservation/Reperfusion Injury by Controlled Hyperthermia During Ex Vivo Machine Perfusion

The possible reno‐protective effect of a controlled brief heat‐shock treatment during isolated ex vivo machine perfusion of donor grafts prior to reperfusion should be investigated in a primary in vitro study. Porcine kidneys (n = 14) were retrieved after 20 minutes of cardiac standstill of the donor and subjected to 20 hours of static cold storage in University of Wisconsin solution. Prior to reperfusion, kidneys were subjected to 2 hours of reconditioning machine perfusion with gradual increase in perfusion temperature up to 35°C. In half of the kidneys (n = 7), a brief hyperthermic impulse (10 minutes perfusion at 42°C) was implemented in the machine perfusion period. Functional recovery of the grafts was observed upon normothermic reperfusion in vitro. Hyperthermic treatment resulted in a 50% increase of heat shock protein (HSP) 70 and HSP 27 mRNA and was accompanied by ~ 50% improvement of tubular re‐absorption of sodium and glucose upon reperfusion, compared with the controls. Furthermore, renal loss of aspartate aminotransferase was significantly reduced to one‐third of the controls as was urinary protein loss, evaluated by the albumin to creatinine ratio. It is concluded that ex vivo heat‐shock treatment seems to be an easily implementable and promising option to enhance renal self‐defense machinery against reperfusion injury after preservation that merits further investigation in preclinical models.

Effects of methanolic leaf extract of Pterocarpus santalinoides on the recovery from gentamicin-induced nephrotoxicity in albino rats

This study evaluated the effects of methanolic leaf extract of Pterocarpus santalinoides (MLEPS) on the recovery from gentamicin-induced nephrotoxicity in albino rats. Fresh leaves of P. santalinoides were collected, dried, pulverized, and extracted by cold maceration technique using 80% methanol. Thirty male albino rats randomly assigned into six groups (A–F) of five rats each were used for the study. Nephrotoxicity was induced in groups A–E by intra-peritoneal administration of gentamicin (GM) once a day at 100 mg/kg for 10 days. Thereafter, the nephropathic (NP) rat groups (A–E) were used to assess the therapy with MLEPS. Group A was given drinking water (negative control). Groups B, C, and D were treated orally with MLEPS at 125, 250, and 500 mg/kg, respectively. Group E was treated orally with silymarin at 200 mg/kg (positive control). Group F was not treated with GM and MLEPS (normal control). Parameters measured relating to kidney function were serum creatinine and urea concentrations, urine protein level, and 24-h water consumption. All the parameters were significantly (p 0.05) to that of the group F (normal control) rats on days 5 and 10 PTWE, though it was not significantly (p > 0.05) different from the untreated control (group A). Urine protein levels of rats treated with 500 mg/kg MLEPS (group D) were lower and comparable to that of rats treated with silymarin (group E). Also, treatment with MLEPS at 250 and 500 mg/kg led to amelioration of renal tubular necrosis in the NP rats. It was concluded that treatment with MLEPS at 500 mg/kg significantly improved recovery time from GM-induced kidney damage in rats, based on the enhancement of creatinine and urea clearance from blood, reduction of protein loss in urine, and amelioration of histological lesions.

Standardized aqueous stem bark extract of Gmelina arborea roxb. possesses nephroprotection against adriamycin-induced nephrotoxicity in Wistar rats

Nephrotoxicity is a major limitation of adriamycin (ADR) chemotherapy. We hypothesized that administration of standardized aqueous bark extract of Gmelina arborea Roxb. (GA) (Family; Verbenaceae), a traditional therapeutic agent, may reduce the nephrotoxicity caused by ADR in Wistar rats. The dose-dependent nephroprotective activity of the standardized GA extract was investigated in ADR-induced (20 mg/kg, ip) nephrotoxicity in male Wistar rats (n = 6/group). The lyophilized powder of the aqueous refluxed (4 h) GA extract was administered at 100, 300 and 500 mg/kg doses orally for three consecutive days. Fosinopril sodium (0.09 mg/kg) was used as the positive control. Assessment of biochemical parameters on serum, urine and histopathology on H and E stained kidney sections were done at the end of the intervention. The treatment with GA and fosinopril decreased the elevation of serum creatinine, blood urea nitrogen, cystatin C, β2-microglobulin and loss of total protein in urine in nephrotoxic rats in a dose-dependent manner (p < 0.05). In contrast, serum concentrations of albumin and total protein were increased significantly (p < 0.05). H and E stained kidney sections showed an attenuation of renal parenchymal injury following the treatment. The aqueous extract of GA demonstrated antioxidant potential in vitro. Present findings conclude that the standardized aqueous extract of GA stem bark exerted a dose-dependent protection against ADR-induced nephrotoxicity in vivo and may be a promising adjunct in ADR chemotherapy.

STUDY OF NR1I2 GENE POLYMORPHISM (A7635G) AND STEROID RESISTANCE IN EGYPTIAN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME

Nephrotic Syndrome (NS) is a common chronic disorder, characterized by alterations of the permeability of the glomerular capillary wall, resulting in its inability to restrict the urinary loss of protein. INS ( also called nephrosis ) is defined by the combination of a nephrotic syndrome (proteinuria, hypoalbuminemia, hyperlipidemia, and edema) and non-specific histological abnormalities of the kidney including minimal changes (MC), focal and segmental glomerular sclerosis (FSGS), and diffuse mesangial proliferation. As INS response to treatment with steroids varies. Several studies was done to analyze the correlation between steroid -related genes and the response to steroid treatment.The influence of polymorphisms on treatment response of children with INS was investigated. The results may be useful for predicting the treatment response of children with INS.. Nowadays it is clear that NR1I2 gene is also involved in regulation of intermediate metabolism through trans-activation and trans-repression of genes controlling glucose, lipid, cholesterol, bile acid, and bilirubin homeostasis. so it affects steroid drug metabolism and as a consequence the mutation of this gene may affect the response of NS children to treatment. valuable information in prognosis and pathology of the disease types.

P0766ACUTE KIDNEY INJURY INCREASES THE RISK OF PROGRESSION OF RENAL DISEASE AFTER CARDIAC SURGERY : A SINGLE CENTER EXPERIENCE

Abstract Background and Aims With increasing global burden of cardiovascular diseases and advances in managing them, the number of cardiac surgeries performed in India has been increasing in the last couple of decades.A lot of western data from the last 5 to 10 years say that AKI episodes can cause significant renal damage and progress to chronic kidney disease (CKD) ,however the association between acute kidney injury (AKI) and chronic kidney disease (CKD) remains elusive in cardiac surgery. We investigated the association between postoperative AKI and CKD development, emphasizing the role of AKI in post cardiac surgery patients. Method We observed the incidence of cardiac surgery associated AKI (CSA-AKI), determinants of progressive kidney disease after CSA-AKI and followed the patients with CSA-AKI for three months to find out the incidence of CKD or progressive renal dysfunction. Results 150 consecutive post cardiac surgery patients were included in the study. CSA-AKI incidence was 35.4%[Figure 1].Incidence of AKI was significant with prior AKI episodes(P&amp;lt;0.01) and with pre-existing CKD (P&amp;lt;0.01)[Figure 2].Among intraoperative risk factors for CSA-AKI, need for CPB(P-0.01), prolonged pump time(P-0.01), blood transfusion(P-0.04) and ultrafiltration(P-0.01) during surgery were found to be significant[Figure 3,4].Duration of ICU stay (P&amp;lt;0.01), hospital stay (P&amp;lt;0.01) and death rate (P-0.04) was higher in patients with AKI[Table 1]. Out of 53 patients who developed CSA-AKI, follow up for the progression of renal disease was done for 50 patients, as 3 patients with AKI died during hospital stay. Progressive renal dysfunction (new development of CKD or progressive CKD ) after 90 days was seen in 48% of patients with CSA-AKI. All the risk factors for the progression of renal disease after AKI like increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage&amp;gt;2) and multi factorial AKI was higher in patients who had progressive renal disease after AKI in the study group, however the relation was not statistically significant[Table 2]. Conclusion AKI is not uncommon after cardiac surgery, progressive renal dysfunction was seen in 48% of patients after CSA-AKI and progressive renal dysfunction was common in those with increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage&amp;gt;2) and multi factorial AKI. Mean age of patients with AKI in the study group was found to be 61±10 years and for NO AKI group mean age was found to be 58±12 years. This variation was not found to be statistically significant. Among other pre-operative risk factors, though there was some difference in percentage for many risk factors, but the percentage variation was quite significant for subjects with prior AKI episodes and those with existing CKD. The increased incidence of AKI in patients with prior AKI episodes (P&amp;lt;0.01) and in those with pre-existing CKD (P&amp;lt;0.01) was found to be statistically significant. Low socioeconomic status was found to be high in NO AKI group, however this was not found to be statistically significant (P-0.11). When compared to both the groups, duration of stay in ICU (P&amp;lt;0.01), overall duration of hospital stay (P&amp;lt;0.01) and death rate (P-0.04) was higher in AKI group and this variation was found to be statistically significant. All the risk factors for the progression of renal disease after AKI like increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage&amp;gt;2) and multifactorial AKI was higher in patients who had progressive renal disease after AKI in the study group, however the relation was not statistically significant.

Role of urinary nitrites in predicting steroid responsiveness of nephrotic syndrome: a study conducted in tertiary care center

Background: Nephrotic Syndrome (NS) is a common chronic disorder, characterized by alterations of selective permeability at the glomerular capillary wall, resulting in its inability to restrict the urinary loss of protein. Urinary nitrite excretion serves as a useful investigation in differentiating between steroid responsive and steroid resistant nephrotic syndrome. The aim of the study was to assess the relation between urinary nitrite levels and steroid responsiveness in nephrotic syndrome in children.Methods: 76 children were enrolled in the study suffering with nephrotic syndrome of which 58 children were Steroid Sensitive (SSNS) and 18 were Steroid Resistant (SRNS). 25 children were enrolled as controls. The urinary nitrites were estimated in these subjects and the results were analyzed.Results: All the control subjects were tested negative for urinary nitrites. After achieving remission with steroids, out of 58 SSNS subjects’ 27 subjects tested positive for urinary nitrites, remaining 31 tested negatives for the same. Of the 18 SRNS subjects 1 subject tested positive for urinary nitrites remaining 17 subjects were tested negative for the same.Conclusions: The findings of present study suggest that urinary nitrite excretion is increased in patients with steroid responsive nephrotic syndrome. The urinary nitrite estimation has low NPV and high PPV in predicting steroid responsiveness.