Volume 104 (2025), No. 7/2025(Supplement 1)
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8th Slovenian Congress of Nephrology, November 28 - December 1st, 2024
The whole issue as pdf-file
Page No. 0
Abstract
The whole issue as pdf-file
Supplement
Metabolic health in the Slovenian national cohort of kidney transplant patients
Gregor Mlinšek, Anja Ponikvar Ležaić, Petra Finderle, and Miha Arnol
Page No. 1
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S1-S9)
Metabolic health in the Slovenian national cohort of kidney transplant patients
Gregor Mlinšek1,2, Anja Ponikvar Ležaić1,2, Petra Finderle2,3, and Miha Arnol1,2
1Department of Nephrology, University Medical Center Ljubljana, 2Faculty of Medicine, University of Ljubljana, and 3Clinical Institute for Clinical Chemistry and Biochemistry, University Medical Center Ljubljana, Ljubljana, Slovenia
Introduction: Metabolic health refers to the proper functioning and balance of metabolic processes in our bodies. The metabolism of carbohydrates, lipids, and proteins has a direct impact on the cardiovascular system. Recent advances in pharmacotherapy have introduced several drugs into clinical practice that can improve cardiometabolic health. Materials and methods: Between September 2023 and March 2024, we systematically collected cardiometabolic data from 800 kidney transplant patients (KTPs) during their routine outpatient visits. These included clinical data – office blood pressure, body weight and height, body mass index (BMI), and waist circumference (WC) – and laboratory data such as high-sensitivity C-reactive protein (hs-CRP), lipid profile, lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), serum urate, serum albumin, and proteinuria from spot urine samples. Patients who required treatment adjustment were selected. Results: Deviations from the desired values of individual components of the metabolic syndrome (blood pressure, WC, triglycerides, high-density lipoprotein cholesterol, and fasting glucose) were observed in 23 – 61.5% of patients. Elevated hs-CRP levels (5 – 10 mg/L), a known cardiovascular risk factor, were observed in 13.5% of patients. Lp(a) levels exceeded the upper normal limit (> 500 mg/L) in 17% of patients. Only a small proportion of patients with moderate to advanced kidney disease – 13% and 23.6%, respectively – had low-density lipoprotein cholesterol levels within the reference range. Conclusions: Between 23% and 61.5% of patients failed to meet target values for individual components of metabolic health. The largest deviation (61.5%) was observed in WC among women. WC and waist-to-height ratio are two simple and reliable parameters for assessing metabolic status.
Correspondence to:
Gregor Mlinšek MD, PhD, Department of Nephrology, Center for Kidney Transplantation, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
Comparison of Torque teno virus viral load and QuantiFERON Monitor assay and their association with the degree of immunosuppression in kidney transplant patients
Špela Borštnar, Željka Večerić-Haler, Anja Ponikvar Ležaić, Neva Bezeljak, Miha Arnol, Mario Poljak, Maja M. Lunar, and Gregor Mlinšek
Page No. 10
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S10-S19)
Comparison of Torque teno virus viral load and QuantiFERON Monitor assay and their association with the degree of immunosuppression in kidney transplant patients
Špela Borštnar1,2, Željka Večerić-Haler1,2, Anja Ponikvar Ležaić1, Neva Bezeljak1,2, Miha Arnol1,2, Mario Poljak3, Maja M. Lunar3, and Gregor Mlinšek1,2
1Department of Nephrology, University Medical Center Ljubljana, 2Faculty of Medicine, and 3Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: Solid organ transplant patients require appropriate immunosuppression to sufficiently control the allorecognition of the graft. Two tests, the QuantiFERON Monitor (QFM) and the Torque teno virus load (TTVL) provide an option to monitor the strength of immunosuppression. Materials and methods: TTVL and QFM were simultaneously determined in kidney transplant patients. Clinical data, microbiological and histopathological findings were collected from the patients’ medical records. Results: 128 TTVL and QFM values were quantified in 107 patients. 69 patients (54%) had recurrent infections in the previous 6 months, 19 (15%) had malignancies, 47 (37%) had a recent kidney biopsy and among them 17 (36%) had histologically proven graft rejection. Results showed that there was no significant correlation between TTVL and QFM (ρ = –0.169, p = 0.061). In patients with histologically proven rejection, TTVL was significantly lower than in patients without rejection (3.64 ± 2.45 vs. 5.02 ± 1.67 log<sub>10</sub> copies/mL, p = 0.026), but there was no difference between the groups in QFM (1.63 ± 0.67 vs. 1.55 ± 0.80 log<sub>10</sub> IU/mL, p = 0.735). Patients with known malignancy had lower TTVL compared to patients without it (p = 0.041). No statistically significant difference was observed in TTVL and patients with or without infections (p = 0.278). QFM was not different in patients with or without infection or malignancy. Conclusion: TTVL as an immune marker was associated with transplant rejection. There were no clinically significant associations between QFM and rejection and TTVL or QFM with infections and malignancies. Further prospective studies should be performed to confirm these results.
Correspondence to:
Gregor Mlinšek, MD, PhD, Department of Nephrology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
Measurement of ionized calcium with a point-of-care ionometer during etelcalcetide therapy
Andreja Marn Pernat, Jernej Pajek, and Jadranka Buturović-Ponikvar
Page No. 20
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S20-S27)
Measurement of ionized calcium with a point-of-care ionometer during etelcalcetide therapy
Andreja Marn Pernat1,2, Jernej Pajek1,2, and Jadranka Buturović-Ponikvar1,2
1Department of Nephrology, University Medical Center Ljubljana, and 2Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: Hypocalcemia is a common and clinically significant side effect of etelcalcetide therapy. The aim of this study was to evaluate the utility of ionized calcium (iCa) measurements with a point-of-care ionometer compared to albumin-corrected total calcium and to assess the incidence of hypocalcemia in patients receiving etelcalcetide therapy using pre-dialysis iCa values. Materials and methods: This was a phase IV, non-interventional, prospective, single-arm, observational study. A total of 20 chronic hemodialysis patients were included in the study. The iCa concentration was determined before dialysis using a point-of-care ionometer (GEM Premier 3000) at the patient’s bedside. Hypocalcemia was defined by a pre-dialysis iCa concentration of less than 0.90 mmol/L. Results: Pre-dialysis corrected total calcium and iCa decreased over time during treatment with etelcalcetide. A statistically significant linear association was observed between point-of-care iCa and albumin-corrected calcium (r = 0.532, p = 0.019; R2 = 0.283). Visual comparisons generally showed parallel behavior, but only a moderate correlation. Of 240 iCa values measured, 3 cases (1.25%) were < 0.90 mmol/L and 20 cases (8.3%) were between 0.90 and 0.96 mmol/L. Conclusion: Our results highlight the value of direct iCa monitoring as a practical and sensitive tool for detecting hypocalcemia and guiding etelcalcetide therapy. Bedside measurement enabled timely dialysate calcium adjustments, preventing clinically significant hypocalcemia and treatment discontinuation. Point-of-care iCa monitoring offers a safer, more responsive strategy for optimizing calcium management in hemodialysis patients.
Correspondence to:
Andreja Marn Pernat, MD, PhD, Department of Nephrology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
Eight-point lung ultrasonography protocol for assessing hypervolemia in chronic hemodialysis patients: A pilot study
Luka Varda, Nejc Piko, Renata Smogavec, Nino Vreča, Sebastjan Bevc, and Robert Ekart
Page No. 28
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S28-S34)
Eight-point lung ultrasonography protocol for assessing hypervolemia in chronic hemodialysis patients: A pilot study
Luka Varda1, Nejc Piko1, Renata Smogavec1, Nino Vreča2, Sebastjan Bevc2,3, and Robert Ekart1,3
1Department of Dialysis, 2Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, and 3Faculty of Medicine, University of Maribor, Maribor, Slovenia
Background: Hypervolemia (HV) and arterial stiffness present an important problem for chronic hemodialysis (HD) patients. The most promising methods for evaluating excess fluid are bioelectrical impedance analysis (BIA) and lung ultrasonography with B-line assessment (LUS). The latter is traditionally performed in 28 anatomical locations on the front side of the chest. The study aimed to investigate whether a shorter LUS procedure in 8 locations correlates with other markers of HV and arterial stiffness. Materials and methods: We performed a single dialysis center observational study in adult chronic HD patients. Patients had to be without active malignancy, infection, chronic atrial fibrillation, carotid stenosis, severe aortic stenosis, or peripheral artery disease. We performed predialysis blood pressure measurements, LUS on 8 predefined locations, BIA, carotid-femoral pulse wave velocity (cfPWV) assessment, and laboratory values of the N-terminal prohormone of brain natriuretic peptide. Results: 19 patients were included, 7 male (36.8%). The median age of the patients was 71 years (IQR (60 – 74)), the median dialysis vintage was 51 months (IQR (27 – 87)). We found a statistically significant positive correlation between LUS and overhydration measured by BIA (r<sub>s</sub> = 0.697; p < 0.001), LUS and intracellular water measured by BIA (r<sub>s</sub> = 0.478; p = 0.038), and between LUS and extracellular water measured by BIA (r<sub>s</sub> = 0.462; p = 0.046). Furthermore, we also found a statistically significant negative correlation between LUS and cfPWV (r<sub>s</sub> = –0.539; p = 0.026). Conclusion: LUS in 8 locations is associated with markers of HV in HD patients, correlating positively with BIA measurements. Its correlation with cfPWV should be further investigated.
Correspondence to:
Assist. Luka Varda, MD, Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
Email: [email protected]
Supplement
Impact of dietary counseling on Mediterranean diet principles on dietary fiber intake and serum uremic toxins in patients treated with peritoneal dialysis: A pilot study
Kaja Pajk, Nina Bremec, Aljoša Kuzmanovski, Jelka Lindič, Jernej Pajek and Bojan Knap
Page No. 35
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S35-S40)
Impact of dietary counseling on Mediterranean diet principles on dietary fiber intake and serum uremic toxins in patients treated with peritoneal dialysis: A pilot study
Kaja Pajk1, Nina Bremec1, Aljoša Kuzmanovski2, Jelka Lindič3,4, Jernej Pajek3,4 and Bojan Knap3,4
1Department for food science, Biotechnical Faculty, University of Ljubljana, 2Dietetics and Nutrition Service, 3Department of Nephrology, University Medical Center Ljubljana, and 4Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: The Mediterranean diet (MD) offers numerous health benefits, including improvements in cardiovascular health, cognitive function, and reduced inflammation. Its role in patients with chronic kidney disease (CKD), particularly those undergoing peritoneal dialysis (PD), remains understudied, but attractive. This study evaluated achieved adherence to the MD, impact on dietary fiber intake, and serum uremic toxins in PD patients. Materials and methods: An interventional randomized pilot study was conducted on 21 PD patients, randomized into intervention (MD diet counseling) and control groups (standard diet). Dietary intake, fiber consumption, serum potassium, phosphate and serum uremic toxins (trimethylamine-N-oxide (TMAO), p-cresyl sulfate (pCS), and indoxyl sulfate (IS)) were measured before and after a 4-week intervention. Dietary adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS). Statistical analyses compared the changes between groups. Results: Adherence to the principles of MD significantly improved in the intervention group (MEDAS: 6.6 ± 1.0 to 8.8 ± 1.2, p < 0.001). Dietary fiber intake increased modestly but not significantly (16.7 ± 6.7 g/day to 19.8 ± 7.5 g/day, p = 0.374). Serum levels of uremic toxins showed no significant change, while potassium and phosphate levels remained stable. Conclusion: The MD counseling improved dietary adherence to the goals of MD without negatively affecting serum electrolyte and phosphate control in PD patients. No significant changes were observed in serum uremic toxin levels or dietary fiber intake.
Correspondence to:
Assoc. Prof. Bojan Knap, MD, PhD, Department of Nephrology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
24-years’ experience of peritoneal dialysis in a university hospital dialysis center: Management and outcome
Robert Ekart, Tina Stropnik Galuf, Benjamin Dvoršak, Tadej Zorman, Maša Knehtl, Eva Jakopin, Nina Vodošek Hojs, Martin Hren, Nejc Piko, Renata Smogavec, Sebastjan Bevc, Radovan Hojs, and Matjaž Horvat
Page No. 41
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S41-S46)
24-years’ experience of peritoneal dialysis in a university hospital dialysis center: Management and outcome
Robert Ekart1,2, Tina Stropnik Galuf1, Benjamin Dvoršak3, Tadej Zorman1, Maša Knehtl3, Eva Jakopin3, Nina Vodošek Hojs3, Martin Hren4, Nejc Piko1, Renata Smogavec1, Sebastjan Bevc2,3, Radovan Hojs2,3, and Matjaž Horvat5
1Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, 2Faculty of Medicine, University of Maribor, 3Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, 4OptimaMed Vojnik, Vojnik, and 5Department of General and Abdominal Surgery, Clinic for Surgery, University Medical Center Maribor, Maribor, Slovenia
Introduction: The aim of our study was to analyze the results of peritoneal dialysis (PD) treatment in all patients treated with PD in our dialysis center. Materials and methods: This is a retrospective observational study in which we included all PD patients from the start of PD treatment in 2000 until the end of follow-up on 30 September 2024. Results: During an observation period of 24 years, 89 patients started PD treatment. Two patients who started PD treatment due to heart failure were excluded. The mean age of the patients was 47 ± 14 years, 61 (70.1%) were men. During PD treatment, 30 (34.5%) patients developed PD-related peritonitis after a median PD duration of 1,174 ± 936 days. During follow-up, 27 (31%) were converted to hemodialysis, 24 (27.6%) received a kidney transplant, 15 (17.2%) patients died during PD treatment, and the remaining 21 patients were still being treated with PD at the end of follow-up. The median duration of PD for all patients was 1,414 ± 1,253 days. Cardiovascular disease (50%) and infection (50%) were the most common causes of death among patients. The comparison between surviving and deceased PD patients showed that surviving patients had a higher baseline serum albumin level (37.7 vs. 34.5 g/L; p = 0.004). The Kaplan-Meier survival analysis showed a worse outcome for diabetics (log rank (Mantel-Cox) = 5.457; p = 0.019). Conclusion: Cardiovascular disease and infection were common causes of death in PD patients. Peritonitis was the most common cause of PD discontinuation. Diabetics undergoing PD had a poorer survival rate. The average duration of PD treatment was 3.9 years. The average time until the first peritonitis was 3.2 years.
Correspondence to:
Prof. Robert Ekart, MD, PhD, Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
Email: [email protected]
Supplement
Catheter-related bloodstream infection rates: Comparing cuffed vs. uncuffed catheters in a nationwide series of small children on chronic hemodialysis
Gregor Novljan, Rina R. Rus, and Nina Battelino
Page No. 47
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S47-S54)
Catheter-related bloodstream infection rates: Comparing cuffed vs. uncuffed catheters in a nationwide series of small children on chronic hemodialysis
Gregor Novljan1,2, Rina R. Rus1,2, and Nina Battelino1,2
1Pediatric Nephrology Department, Children’s Hospital, University Medical Center Ljubljana, and 2Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: Catheter-related bloodstream infections (CBSI) are serious complications in pediatric hemodialysis (HD) patients. We aimed to compare the CBSI rates associated with cuffed and uncuffed central venous catheters (CVC) in small children. Materials and methods: All HD patients weighing < 15 kg and dialyzed via cuffed CVCs for at least 3 months between March 2016 and March 2022 were included. The CBSI rate was compared to that of a well-matched historical series of our patients before implementing cuffed CVCs. Results: Three boys and 1 girl (median weight: 14.0 kg) matched the inclusion criteria and received HD using the same type of cuffed CVC. Eleven CBSIs occurred during 4,870 days with cuffed CVCs, yielding a CBSI rate of 2.3/1,000 catheter days, compared to 7.7/1,000 catheter days in our historical series with uncuffed CVCs (p = 0.002). A 70% reduction in the CBSI rate was achieved with cuffed CVCs (p = 0.002). The median catheter survival times for cuffed and uncuffed CVCs were 189 and 53 days, respectively (p = 0.002). Conclusion: Our results show that cuffed CVCs are associated with reduced CBSI rates and improved catheter longevity compared to uncuffed ones in small children.
Correspondence to:
Gregor Novljan, MD, PhD, Pediatric Nephrology Department, Children’s Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
Single-center experience on catheterrelated sepsis in tunneled central venous catheters in hemodialysis patients
Tjaša Furlan, Karmen Terbovc, and Boštjan Leskovar
Page No. 55
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S55-S60)
Single-center experience on catheterrelated sepsis in tunneled central venous catheters in hemodialysis patients
Tjaša Furlan, Karmen Terbovc, and Boštjan Leskovar
Vascular Disease and Vascular Access Unit, Trbovlje General Hospital, Trbovlje, Slovenia
Introduction: Catheter-related infections significantly increase the morbidity and mortality of dialysis patients. Our study aimed to assess the incidence of catheter-related infections in tunneled central venous catheters at our dialysis center. Materials and methods: We retrospectively analyzed the incidence of catheter-related bloodstream infections (CRBSI) and tunnel infections in patients with a tunneled central venous catheter inserted at Trbovlje General Hospital between January 2015 and August 2024. The indication for catheter insertion was a reduced left ventricular ejection fraction (< 30%), polymorbidity with a short life expectancy (< 1 year), or a condition of the vascular system that made construction of an arteriovenous fistula/graft impossible. Results: We included 344 patients (average age 73 ± 13 years, 49% men). In all patients, we inserted a tunneled central venous catheter with a symmetrical tip in a retrograde manner (64% through the right jugular vein). During the observed period, there were 16 cases of CRBSI (after 10 (IQR 5 – 14) months) and 4 cases of catheter tunnel infection (after 9 (IQR 4 – 16) months). In all cases of CRBSI, the catheter was replaced. In the case of catheter tunnel infections, the outer part of the catheter was replaced, and the tunnel infection was treated locally. The incidence of CRBSI was 0.09/1,000 catheter days. Conclusion: The incidence of CRBSI in our cohort was low, likely due to the implementation of preventive protocols for insertion and maintenance of tunneled central venous catheters.
Correspondence to:
Assist. Tjaša Furlan, MD, Vascular Disease and Vascular Access Unit, Trbovlje General Hospital, Rudarska cesta 9, 1420 Trbovlje, Slovenia
Email: [email protected]
Supplement
Using resorbable extracellular bio-matrix for construction and reconstruction of hemodialysis vascular access
Nina Keršnik, Tjaša Furlan, Jernej Vrtek, Zvezdana Dolenc Stražar, and Boštjan Leskovar
Page No. 61
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S61-S65)
Using resorbable extracellular bio-matrix for construction and reconstruction of hemodialysis vascular access
Nina Keršnik1, Tjaša Furlan1, Jernej Vrtek1, Zvezdana Dolenc Stražar2, and Boštjan Leskovar1
1Vascular Disease and Vascular Access Unit, Trbovlje General Hospital, Trbovlje, and 2Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: We assessed the use of resorbable extracellular bio-matrix in vascular access surgery. Materials and methods: A retrospective analysis was made of procedures where a resorbable extracellular bio-matrix was used for the construction or reconstruction of an arteriovenous (AV) fistula. A tubular shape of a certain length and diameter was made from sheets of resorbable bio-matrix (CorMatrix), which was then incorporated into AV anastomosis. Puncturing for hemodialysis began 8 – 10 weeks after construction. Results: Since 2016, our unit has used resorbable extracellular bio-matrix in 22 patients. We used it as an arterial circuit to the AV fistula vein, a reduction segment in high-flow AV fistulas, to extend the puncture area, as a connecting segment after partial removal of an AV fistula, and to construct the entire AV fistula instead of a graft. All procedures were successful with no significant peri- or post-operative complications. Additional procedures to ensure patency were also successfully performed. Histopathological analysis showed complete vascular differentiation of the bio-matrix resulting in thickening of the wall and narrowing of the lumen. Conclusion: The use of resorbable extracellular bio-matrix in vascular surgery is safe and feasible. It is recommended to use wider grafts to avoid thrombosis due to narrowing of the lumen. Further research and pre-prepared tubular bio-grafts of different diameters and lengths are needed.
Correspondence to:
Assist. Tjaša Furlan, Dr. med, Spec. Int. Med, Vascular Disease and Vascular Access Unit, Trbovlje General Hospital, Trbovlje, Slovenia
Email: [email protected]
Supplement
Fibrillary glomerulonephritis: A retrospective analysis of a case series from a tertiary center
Ana Dovč, Željka Večerić-Haler, Nika Kojc, Špela Borštnar, Andrej Škoberne, and Andreja Aleš Rigler
Page No. 66
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S66-S72)
Fibrillary glomerulonephritis: A retrospective analysis of a case series from a tertiary center
Ana Dovč1,2, Željka Večerić-Haler1,2, Nika Kojc3, Špela Borštnar1,2, Andrej Škoberne1,2, and Andreja Aleš Rigler1,2
1Department of Nephrology, Division of Internal Medicine, University Medical Center Ljubljana, 2Faculty of Medicine, and 3Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: Fibrillary glomerulonephritis is a rare diagnosis, and guidance on diagnosis and management is scant. We present a case series of patients with fibrillary glomerulonephritis from University Medical Center Ljubljana. Materials and methods: We conducted a retrospective analysis of patients with the diagnosis of fibrillary glomerulonephritis since 2006. We analyzed data on clinical presentation, treatment modalities, and kidney survival. For a subset of patients, data on DNAJB9 staining and markers of complement activation were also available. Results: We included 17 patients with fibrillary glomerulonephritis, 59% female, with a median age of 61 years (range 33 – 71). The most common clinical presentation was asymptomatic proteinuria with preserved kidney function (41%). Eight patients had complement activity testing performed, which revealed elevated serum C5b-9 at least at 1 time point in 5 patients (63%). One patient had positive anti-factor H antibodies, and 2 patients had positive anti-C1q antibodies. Nine patients had available staining results for DNAJB9, which was positive in all 9 cases. The median time of follow-up was 12 months. The most common form of treatment was with corticosteroids in 8 patients, followed by rituximab in 5 patients. Seven patients (41%) had at least partial remission with stabilization of kidney function, 8 patients (47%) reached end-stage kidney disease during follow-up. Due to the small number of patients, analysis of impact of treatment on kidney survival was not performed. Conclusion: Fibrillary glomerulonephritis is a heterogenous disease, and a significant number of patients present with a slowly progressive disease, warranting long-term treatment. New treatment strategies are necessary.
Correspondence to:
Ana Dovč, MD, Department of Nephrology, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
Clinical profile, treatment response, and outcomes in adult primary focal segmental glomerulosclerosis: A single-center experience
Željka Večerić-Haler, Andreja Aleš Rigler, Andrej Škoberne, Špela Borštnar, Nuša Avguštin Rotar, Damjan Kovač, Ana Dovč, Nika Kojc, and Jelka Lindič
Page No. 73
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S73-S84)
Clinical profile, treatment response, and outcomes in adult primary focal segmental glomerulosclerosis: A single-center experience
Željka Večerić-Haler1,2, Andreja Aleš Rigler1,2, Andrej Škoberne1,2, Špela Borštnar1,2, Nuša Avguštin Rotar1,2, Damjan Kovač1,2, Ana Dovč1,2, Nika Kojc3, and Jelka Lindič1,2
1Department of Nephrology, University Medical Center Ljubljana, 2Department of Internal Medicine, Faculty of Medicine, and 3Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Objective: Primary focal segmental glomerulosclerosis (FSGS) is a major cause of nephrotic syndrome in adults. This study evaluates the clinical profile, treatment response, and outcomes of patients with primary FSGS at the University Medical Centre (UMC) Ljubljana, Slovenia. Materials and methods: Patients diagnosed and treated at UMC Ljubljana from 2008 to 2024 were included. Clinical, laboratory, histological, and treatment data were analyzed. Results: 56 patients were followed for a median of 71 months (range: 2 – 186). At diagnosis, 91.1% had nephrotic syndrome, with proteinuria of 10.2 ± 9.8 g/day, serum albumin of 23.7 ± 6.5 g/L, and estimated glomerular filtration (eGFR) of 66.7 ± 27.7 mL/min/1.73m2. Histological subtypes included tip (37.5%), cellular (25%), collapsing (14.3%), not-otherwise specified (16.1%), while in 7.1% the variant was not defined. First-line therapy, mainly corticosteroids, led to remission in 67.3%, but 71% experienced relapses or steroid resistance. Calcineurin inhibitors (CNIs) and corticosteroids were used in 20 patients, achieving 60% remission, however the majority of patients experienced relaps following their discontinuation. Rituximab was given to 23 patients with refractory disease, with 78.2% achieving remission (56.5% complete, 21.7% partial) in 5.1 ± 4.9 months. Among initial rituximab responders, 30.4% experienced relapse. At the last follow-up, mean eGFR was 59.6 ± 33.2 mL/min/1.73m2, 21.4% progressed to end-stage renal disease (ESRD), and 5.3% died. Four patients underwent kidney transplantation, with early recurrence in 3. Conclusion: Despite high steroid resistance, use of CNIs and rituximab improved remission rates. However, ESRD remains a significant concern, highlighting the need for early intervention and optimized treatment strategies.
Correspondence to:
Željka Večerić-Haler, MD, PhD, Department of Nephrology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Supplement
Anti-nephrin antibodies in minimal change disease: Case report series
Maša Knehtl, Nejc Piko, Tadej Petreski, Tadej Zorman, Tina Stropnik-Galuf, Nika Kojc, Karmen Wechtersbach, Robert Ekart, and Sebastjan Bevc
Page No. 85
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S85-S91)
Anti-nephrin antibodies in minimal change disease: Case report series
Maša Knehtl1, Nejc Piko2, Tadej Petreski1, Tadej Zorman2, Tina Stropnik-Galuf2, Nika Kojc3, Karmen Wechtersbach3, Robert Ekart2,4, and Sebastjan Bevc1,4
1Department of Nephrology, 2Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, 3Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, and 4Faculty of Medicine, University of Maribor, Maribor, Slovenia
Introduction: Minimal change disease (MCD) is one of the causes of nephrotic syndrome (NS) in adults. Recently, anti-nephrin antibodies have been detected in a certain subset of patients with MCD, supporting the proposed autoimmune etiology and appearing to be markers of disease activity. Despite their diagnostic and prognostic potential, the use of anti-nephrin autoantibodies in routine clinical practice is not yet widespread. Studies have shown that patients with anti-nephrin-associated MCD have a more fulminant NS and a better response to antibody-depleting therapy than those who are anti-nephrin-negative. Materials and methods: We report cases of a 79- and a 42-year-old male patient presenting with new-onset NS and acute kidney injury. Both patients had negative immunologic tests, including antibodies against phospholipase A2-receptor (anti-PLA2R) and thrombospondin-7A (anti-THSD7A). Renal biopsy was performed in both patients. Results: In both cases, light microscopy of kidney samples from thick-needle biopsy showed acute tubular injury attributed to severe proteinuria. Electron microscopy revealed diffuse (90%) effacement of the podocyte foot processes without electron-dense deposits. Immunofluorescence presented discrete intracytoplasmic IgG podocyte deposits with a high probability of MCD due to anti-nephrin autoantibodies. In addition to therapy with angiotensin convertase inhibitors, calcium channel blockers, and furosemide, we started treatment with low-dose oral glucocorticoids and mycophenolic acid (case 1) or oral glucocorticoids alone (case 2) depending on patients’ comorbidities. We administered rituximab, resulting in a fast and complete resolution of proteinuria and improvement of kidney function. Conclusion: Anti-nephrin autoantibodies have been detected in a subgroup of patients with MCD supporting the autoimmune etiology of the disease. Targeted anti-B-cell therapy with rituximab is an additional therapeutic option in patients with relapsing or treatment-resistant disease, or drug-related adverse effects to standard therapy.
Correspondence to:
Assistant Professor Maša Knehtl, MD, PhD, Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, Ljubljanska ulica 5, Maribor, 2000, Slovenia
Email: [email protected]
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Blood biomarkers of disease activity in pediatric idiopathic nephrotic syndrome: A prospective study
Matjaž Kopač, Aleš Jerin, Tanja Kersnik Levart, and Joško Osredkar
Page No. 92
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S92-S98)
Blood biomarkers of disease activity in pediatric idiopathic nephrotic syndrome: A prospective study
Matjaž Kopač1, Aleš Jerin2,3, Tanja Kersnik Levart1, and Joško Osredkar2,3
1Department of Nephrology, Division of Pediatrics, 2Institute of Clinical Chemistry and Biochemistry, University Medical Center Ljubljana, and 3Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenija
Abstract. Introduction: The etiology and pathogenesis of idiopathic nephrotic syndrome (INS) in children remains incompletely understood. We investigated correlations of blood concentrations of eosinophilic cationic protein (ECP), some vitamins, and anti-nephrin antibodies with disease activity of INS in Slovenian children. Materials and methods: In this prospective, single-center study, we took sequential blood samples from children with INS at disease onset or relapse (before corticosteroid (CS) treatment), at time of remission, and after discontinuation of CS treatment, whenever feasible. We performed the quantitative detection of anti-nephrin antibodies in patients serum with enzyme-linked immuno-sorbent assay, blood concentration measurements of ECP and vitamins with standard laboratory methods and statistical analysis with ANOVA. Results: We included 17 children with INS (15 boys and 2 girls). We detected statistically significantly highest ECP concentrations at disease onset or relapse, lowest vitamin E concentrations in remission after CS treatment and highest vitamin A concentrations at time of remission achievement. We also detected decreased levels of vitamin D at times of disease onset, relapse and remission achievement. However, we did not detect anti-nephrin antibodies in any serum sample. Conclusion: We confirmed significant concentration variations of ECP and vitamins E, A, and D at different stages of INS disease activity. These findings suggest their potential role in the etiology of INS and make these molecules as candidates for biomarkers of disease activity. We did not confirm the pathogenic role of anti-nephrin antibodies in our pediatric population.
Correspondence to:
Assist. Prof. Matjaž Kopač, MD, DSc, Department of Nephrology, Division of Pediatrics, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
Email: [email protected]
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Real-world evidence for using urine osmolality as a practical tool in tolvaptan dose optimization in patients with ADPKD
Andreja Marn Pernat, Kaja Hrovatin, Valentina Černetič Korelec, and Andrej Škoberne
Page No. 99
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S99-S104)
Real-world evidence for using urine osmolality as a practical tool in tolvaptan dose optimization in patients with ADPKD
Andreja Marn Pernat1,2, Kaja Hrovatin1, Valentina Černetič Korelec1, and Andrej Škoberne1,2
1Department of Nephrology, University Medical Center Ljubljana, and 2Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: The aim of this prospective single-center study was to evaluate the role of morning urine and 24-hour urine osmolality as biomarkers for guiding individualized dosing of tolvaptan in adults with rapidly progressive autosomal dominant polycystic kidney disease (ADPKD), with the aim of minimizing treatment discontinuations and adverse events. Materials and methods: 24 patients (13 men, 11 women; aged 21 – 54 years) received tolvaptan for 7 – 50 months. Dosing was titrated based on tolerability and achievement of urine osmolality ≤ 250 mOsm/kg, measured by freezing point osmometry in both morning spot and 24-hour urine samples. Results: 16 patients (66.7%) remained on 45/15 mg, 7 (29%) required 60/30 mg, and 1 patient (4%) escalated to 90/30 mg of tolvaptan. Morning urine osmolality decreased significantly from 404 ± 231 mOsm/kg to 153 ± 61 mOsm/kg (p < 0.001), and 24-hour urine osmolality was maintained at ≤ 250 mOsm/kg in all patients. No significant differences in osmolality were observed between the patients on 45/15 mg and 60/30 mg. Mild liver enzyme elevations occurred in 9% of 504 total measurements, with 1 patient discontinuing treatment due to a 3-fold rise in transaminases. Another patient discontinued treatment due to aquaretic side effects. Conclusion: Urine osmolality is a practical and effective biomarker for guiding individualized tolvaptan titration in patients with ADPKD. This approach enabled adequate vasopressin suppression and was associated with a low discontinuation rate, supporting its use in real-world clinical practice.
Correspondence to:
Andreja Marn Pernat, MD, PhD, Department of Nephrology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
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The association of long-term kidney function decline with mortality in patients with multiple myeloma: Single-center experience
Rebeka Simić, Ana Rožič, Tadej Petreski, Nejc Pulko, and Sebastjan Bevc
Page No. 105
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S105-S109)
The association of long-term kidney function decline with mortality in patients with multiple myeloma: Single-center experience
Rebeka Simić1, Ana Rožič1, Tadej Petreski2, Nejc Pulko3, and Sebastjan Bevc1,2
1Faculty of Medicine, University of Maribor, 2Department of Nephrology, Clinic for Internal Medicine, and 3Department of Hematology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Introduction: Kidney dysfunction is a frequent complication of multiple myeloma (MM) and is associated with worse survival outcomes. Despite its prevalence, the prognostic value of long-term kidney function decline remains insufficiently explored. This study aimed to investigate the impact of the estimated glomerular filtration rate (eGFR) slope on survival in patients with MM. Materials and methods: A retrospective cohort study was conducted on 43 patients with MM treated at the University Medical Center Maribor between 2015 and 2020, with a minimum follow-up of 1 year. Kidney function was assessed quarterly using eGFR. Kaplan-Meier analysis and Cox regression were applied to evaluate the association between eGFR slope and overall survival. Results: The median baseline eGFR was 52.8 mL/min/1.73m2 (interquartile range: 35.2 – 78.1), with 39.5% of patients classified as having stage 3 or worse chronic kidney disease. We observed an association between faster annual eGFR slope decline and increased mortality (log-rank; p < 0.001). Cox regression confirmed eGFR slope as an independent predictor of mortality (hazard ratio = 1.121, 95% confidence interval: 1.069 – 1.174, p < 0.001). Additional prognostic factors included a lower platelet count. Conclusion: Kidney function decline is an independent prognostic factor in patients with MM. Regular monitoring and early nephrology intervention may help mitigate its impact. Future research should focus on targeted strategies to slow kidney function deterioration and improve patient outcomes.
Correspondence to:
Tadej Petreski, MD, Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Email: [email protected]
Supplement
Efficacy and safety of add-on treatment with finerenone in patients with diabetic kidney disease already treated with SGLT-2 inhibitors
Manja Antonič, Anton Adamlje, Boštjan Leskovar, and Denis Fornazarič
Page No. 110
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S110-S116)
Efficacy and safety of add-on treatment with finerenone in patients with diabetic kidney disease already treated with SGLT-2 inhibitors
Manja Antonič1, Anton Adamlje1, Boštjan Leskovar1, and Denis Fornazarič2
1Department of Dialysis, General Hospital Trbovlje, Trbovlje, and 2Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia
Introduction: This study evaluated the effectiveness and safety of an add-on treatment with finerenone as combination therapy in patients with diabetic kidney disease (DKD), an area where real-world data is limited. Materials and methods: We retrospectively evaluated patients with DKD treated with sodium-glucose cotransporter 2 (SGLT-2) inhibitors and add-on finerenone, to assess the effectiveness and safety of the combination therapy (data collected between June 2021 and October 2024). Outcomes included changes in urinary albumin-to-creatinine ratio (UACR), protein-to-creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), and serum potassium before and after finerenone initiation. Results: Among 23 patients (mean age 72 ± 7; 17 male) on SGLT-2 inhibitors, 21 (91%) also received renin-angiotensin system (RAS) inhibitors and 9 (39%) glucagon-like peptide-1 (GLP-1) receptor agonists. Addition of finerenone significantly reduced UPCR from 0.52 (0.18 – 1.35) to 0.41 (0.16 – 1.78) g/g (p = 0.046), a median decrease of 35% (IQR –53 to –8). UACR showed a reduction trend from 285 (36 – 1,020) to 266 (57 – 1,006) mg/g (p = 0.15), with a median decrease of 36% (IQR –65 to +14). Kidney function remained stable with a small non-significant decline in eGFR (45 ± 22 to 44 ± 21 mL/min/1.73m2; –4% ± 13%; p = 0.13). Serum potassium increased slightly but significantly (4.3 ± 0.5 to 4.5 ± 0.4 mmol/L; p = 0.045), with 1 mild hyperkalemia case (5.6 mmol/L) and no treatment discontinuations. Conclusion: In this real-world cohort, the renoprotective combination therapy with added finerenone was associated with a further reduction in albuminuria and proteinuria. The treatment was well tolerated with a minimal increase in potassium levels and generally stable renal function.
Correspondence to:
Manja Antonič, MD, PhD, Department of Dialysis, General Hospital Trbovlje, Rudarska cesta 9, 1420 Trbovlje, Slovenia
Email: [email protected]
Supplement
The effect of finerenone on arterial stiffness in patients with diabetic kidney disease: A pilot study
Nejc Piko, Robert Ekart, Andrijana Koceva, Nika Aleksandra Kravos Tramšek, Aleksandra Kukovič, Tadej Petreski, Luka Varda, and Sebastjan Bevc
Page No. 117
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S117-S122)
The effect of finerenone on arterial stiffness in patients with diabetic kidney disease: A pilot study
Nejc Piko1, Robert Ekart1,2, Andrijana Koceva3, Nika Aleksandra Kravos Tramšek3, Aleksandra Kukovič3, Tadej Petreski4, Luka Varda1, and Sebastjan Bevc2,4
1Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, 2Faculty of Medicine, University of Maribor, 3Department of Endocrinology and Diabetes, Clinic for Internal Medicine, and 4Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Introduction: Patients with diabetic kidney disease (DKD) have an increased risk of not only renal, but also cardiovascular events. Finerenone is a novel, non-steroidal antagonist of the mineralocorticoid receptor that reduces albuminuria, protects kidney function, and improves cardiovascular outcomes. Materials and methods: Our aim was to evaluate the impact of finerenone on arterial stiffness parameters following 6 months of treatment. Additionally, we aimed to assess its effects on kidney function, potassium level, albuminuria (urinary albumin-to-creatinine ratio (UACR)), and hydration status, as measured by lung ultrasound (B-lines) and bioimpedance spectroscopy (BIS). Statistical analysis was conducted using SPSS. Results: We included 25 patients, with the average age 63.8 ± 8.4 years (range 43 – 73 years). Serum potassium increased after 1 month of treatment (4.5 ± 0.4 vs. 4.3 ± 0.4 mmol/L at baseline, p = 0.017) and remained stable afterwards. Kidney function remained stable, and UACR decreased slightly, with the lowest value at 3 months (67.0 ± 97.7 vs. 82.6 ± 116.6 g/mol at baseline, p = 0.054). Carotid-femoral pulse wave velocity decreased from 12.0 ± 3.1 m/s at baseline to 10.9 ± 3.1 m/s (p = 0.015). No effect on blood pressure or the degree of BIS overhydration was noted. However, we found a decrease in the number of B-lines after 6 months of treatment (4.9 ± 5.5 vs. 7.4 ± 8.4 at baseline, p = 0.021). Conclusion: Our findings indicate that after 6 months of treatment, finerenone led to a decrease in central arterial stiffness and interstitial lung water. Kidney function remained stable, no clinically significant hyperkalemia occurred.
Correspondence to:
Assistant Professor Nejc Piko, MD, PhD, Department of Dialysis, Clinic for Internal medicine, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
Email: [email protected]
Supplement
Central obesity – the most common nutritional disorder in non-frail patients with chronic kidney disease
Aljoša Kuzmanovski, Bojan Knap, Mojca Poljanec, Tjaša Bonča, Gašper Poljšak, and Jelka Lindič
Page No. 123
Abstract
Clinical Nephrology, Vol. 104 – Suppl. 1/2025 (S123-S129)
Central obesity – the most common nutritional disorder in non-frail patients with chronic kidney disease
Aljoša Kuzmanovski1, Bojan Knap2,3, Mojca Poljanec4, Tjaša Bonča4, Gašper Poljšak4, and Jelka Lindič2,3
1Dietetics and Nutrition Service, 2Department of Nephrology, Division of Internal Medicine, University Medical Center Ljubljana, 3Faculty of Medicine, and 4Biotechnical Faculty, University of Ljubljana, Slovenia
Introduction: Patients with chronic kidney disease (CKD) often experience various nutritional disorders, leading to increased frailty, morbidity, and mortality. The aim of our study was to explore the impact of dietary habits and physical activity on body composition in non-dialysis CKD patients. Materials and methods: This cross-sectional study included 199 non-frail CKD patients (stages 1 – 5) from the University Medical Center Ljubljana. Participants completed a food frequency questionnaire, and anthropometric measurements were collected. Body composition was assessed using bioelectrical impedance analysis (BIA), and muscle strength was evaluated with handgrip dynamometry. Results: Central obesity was present in 79.9% of participants, and obesity based on body mass index (BMI) was found in 26.6%. Elevated fat mass was observed in 58.3% of patients. Sarcopenia was identified in 1%, and sarcopenic obesity in 0.5%. Based on the Global Leadership Initiative on Malnutrition (GLIM) criteria, 11.6% of patients were malnourished. Dietary analysis revealed too frequent intake of refined carbohydrates, red meat, and sweets, while intake of fruits and vegetables was not often enough. Dietary habits were suboptimal, with no significant differences between individuals with normal waist circumference and BMI and those with central obesity and elevated BMI. However, a significant difference was observed in physical activity, with those having central obesity engaging in less physical activity. Conclusion: Central obesity was the most prevalent nutritional disorder in non-frail CKD patients that was markedly more prevalent than obesity defined by BMI. Waist circumference was a more sensitive marker of increased fat mass determined with BIA than BMI. Inadequate dietary habits and insufficient physical activity were major contributing factors to the observed nutritional disorders in our CKD patients and call for long-term lifestyle modifications.
Correspondence to:
Aljoša Kuzmanovski, MSc. in Nutrition, Dietetics and Nutrition Service, University Medical Center Ljubljana, Zaloška 7, Ljubljana, Slovenia
Email: [email protected]
