Volume 96 (2021), No. 7/2021(Supplement 1)
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7th Slovenian Congress of Nephrology, Virtual Congress, March 11 — 14, 2021
The whole issue as pdf-file
Page No. 0
Abstract
The whole issue as pdf-file
The role of kidney function on patient survival after percutaneous coronary intervention for acute coronary syndrome in left main coronary artery disease
Igor Balevski, Sandra Burja, Tadej Petreski, Nejc Piko, Vigor Arva, Vojko Kanič, and Sebastjan Bevc
Page No. 1
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S1-S5)
The role of kidney function on patient survival after percutaneous coronary intervention for acute coronary syndrome in left main coronary artery disease
Igor Balevski1, Sandra Burja2, Tadej Petreski3,4, Nejc Piko5, Vigor Arva6, Vojko Kanič1,4, and Sebastjan Bevc3,4
1Department of Cardiology and Angiology, Clinic for Internal Medicine, Maribor, 2Department of Internal Intensive Care, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, 3Department of Nephrology, Clinic for Internal Medicine, 4Faculty of Medicine, University of Maribor, Maribor, 5Department of Dialysis, Clinic for Internal Medicine, and 6Department of Anesthesiology, Clinic for Surgery, University Medical Center Maribor, Maribor, Slovenia
Background: The prevalence of chronic kidney disease (CKD) is increasing on a global scale. Patients with CKD have a reduced quality of life and are more likely to develop significant cardiovascular disease, most commonly coronary artery disease (CAD). Left main coronary artery disease (LMCAD) is one of the most severe forms of CAD, where revascularization is needed. The aim of the study was to determine the impact of CKD on the mortality of patients after undergoing percutaneous coronary intervention (PCI) for the acute coronary syndrome (ACS) due to LMCAD. Materials and methods: 210 Caucasian patients (142 male; 67.6%, mean age 69.2 ± 11.3 years) with ACS due to LMCAD who underwent primary PCI were included in this retrospective study. Basic demographic and laboratory data were recorded. Patients were divided into two groups by their estimated glomerular filtration rate (eGFR). Those in the CKD group had eGFR ≤ 60 mL/min/1.73m2 (n = 82), and those in the non-CKD group had eGFR > 60 mL/min/1.73m2 (n = 128). Results: The mean survival time of patients in the CKD group was 1,550 ± 1,393 days, compared to the non-CKD group of 2,149 ± 1,235 days. Kaplan-Meier survival analysis showed a statistically significant (log-rank, p < 0.0005) difference in mortality for patients in the CKD group compared to those in the non-CKD group. Cox-regression analysis showed a correlation between CKD and mortality (B = 0.541, p = 0.036), independent of arterial hypertension, diabetes mellitus, total cholesterol, and triglycerides. Conclusion: CKD is an independent risk factor for increased mortality after PCI due to an ACS in LMCAD.Correspondence to:
Sandra Burja, MD, Department of Internal Intensive Care, Clinic for Internal Medicine, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
Email: [email protected]
Characteristics of renal sarcoidosis and tubulointerstitial nephritis and uveitis syndrome in Slovenia: An analysis of the national renal biopsy registry and patient datasets in the last decade
Maja Frelih, Nejc Piko, Željka Večerić-Haler, Nika Kojc, and Špela Borštnar
Page No. 6
Abstract
Clinical Nephrology, Vol. 96 – Suppl 1/2021 (S6-S15)
Characteristics of renal sarcoidosis and tubulointerstitial nephritis and uveitis syndrome in Slovenia: An analysis of the national renal biopsy registry and patient datasets in the last decade
Maja Frelih1, Nejc Piko2, Željka Večerić-Haler3,4, Nika Kojc1, and Špela Borštnar3,4
1Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, 2Department of Dialysis, University Medical Center Maribor, Maribor, 3Department of Nephrology, University Medical Center Ljubljana, and 4Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Background: Sarcoidosis is characterized by granulomatous inflammation in multiple organs. Renal involvement is rare, and granulomatous tubulointerstitial nephritis (TIN) is the predominant histologic feature. TIN is also a hallmark of tubulointerstitial nephritis and uveitis (TINU) syndrome. Diagnoses of both sarcoidosis and TINU syndrome are usually made by exclusion and by combining clinical and histological findings, and often remain misdiagnosed. The aim of this retrospective study was to determine the characteristics of renal sarcoidosis and TINU syndrome in Slovenia in the last decade (2010 – 2020). Materials and methods: A thorough search of the national database of renal biopsies from January 2010 to December 2020 was performed. Inclusion criteria were TIN and a clinical history of either sarcoidosis or TINU syndrome. To compare the characteristics of our cohort with others, we also reviewed the global literature reported since 2010. Results: 13 patients (9 female, 4 male) were included in our study. Indications for kidney biopsy were acute kidney injury (n = 8), acute exacerbation of chronic kidney disease (n = 4), and proteinuria (n = 1). Seven patients had clinical and histological evidence of sarcoidosis, and 6 patients were classified as having TINU syndrome. All patients were treated with corticosteroids. Of the 13 patients, 11 had improved kidney function 6 months after treatment, and proteinuria decreased in 9 patients. One patient was on dialysis at the time of diagnosis and remained so thereafter. Conclusion: Renal sarcoidosis and TINU syndrome are rare but important causes of kidney injury, with a favorable long-term prognosis if properly diagnosed and treated in a timely manner.Correspondence to:
Špela Borštnar, MD, Msc, Department of Nephrology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
Email: [email protected]
Complement activation and cryoglobulinemia are common in monoclonal gammopathy of renal significance: Data from a case series
Andrej Škoberne, Matevž Škerget, Nika Kojc, Maja Frelih, Andreja Aleš Rigler, Željka Večerić Haler, Špela Borštnar, Nuša Avguštin Rotar, Damjan Kovač, Jelka Lindič, and Samo Zver
Page No. 16
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S16-S23)
Complement activation and cryoglobulinemia are common in monoclonal gammopathy of renal significance: Data from a case series
Andrej Škoberne1,3, Matevž Škerget2,3, Nika Kojc4, Maja Frelih4, Andreja Aleš Rigler1,3, Željka Večerić Haler1,3, Špela Borštnar1,3, Nuša Avguštin Rotar1,3, Damjan Kovač1,3, Jelka Lindič1,3, and Samo Zver2,3
1Department of Nephrology, 2Department of Hematology, University Medical Center Ljubljana, 3Faculty of Medicine, and 4Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: Monoclonal gammopathy of renal significance (MGRS) denotes kidney diseases caused by monoclonal immunoglobulins in patients who do not have an overt hematological malignancy. Treatment is primarily directed against the underlying clone. Complement activation and cryoglobulinemia are known factors that can contribute to tissue damage, however, the full extent of their involvement is not clear. Materials and methods: This was a retrospective study including all patients with MGRS referred for consultation to our hospital over a 3-year period. Results: We identified 17 patients, of which 12 had proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID). Treatment with anti-clonal or immunosuppressive therapy was successful in 60% of patients with PGNMID, and treatment success was more common in patients with λ chain (100%) compared to κ chain deposits (20%). Serum markers of complement involvement were identified in 41% of all patients (88% of tested samples), most commonly high serum C5b-9 values or anti-factor H autoantibodies (both 24%). Patients with complement involvement did not respond well to treatment, which was unsuccessful in all treated patients with anti-factor H autoantibodies and 75% of patients with high serum C5b-9 values. Cryoglobulinemia was identified in 29% of all patients (71% tested samples) and was monoclonal in 40% of positive cases and mixed in 60%. None of the patients with cryoglobulinemia had organized deposits, however, there was a trend toward more common intramembranous deposits. In patients with monoclonal cryoglobulinemia both anti-clonal and immunosuppressive treatment were unsuccessful. All patients with mixed cryoglobulinemia were treated successfully with immunosuppressive therapy. Conclusion: Treatment of patients with PGNMID was successful in most cases. Complement involvement as well as monoclonal and mixed cryoglobulinemia were relatively common in our cohort, with the first two generally associated with unsuccessful treatment and the latter with successful treatment.Correspondence to:
Andrej Škoberne, MD, PhD, Department of Nephrology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Histomorphological and clinical characteristics of patients with thin glomerular basement membrane nephropathy
Aleksandra Pečovnik, Željka Večerić Haler, Karmen Wechtersbach, Jerica Pleško, Maja Frelih, Jelka Lindič, and Nika Kojc
Page No. 24
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S24-S30)
Histomorphological and clinical characteristics of patients with thin glomerular basement membrane nephropathy
Aleksandra Pečovnik1, Željka Večerić Haler2,3, Karmen Wechtersbach4, Jerica Pleško4, Maja Frelih4, Jelka Lindič2,3, and Nika Kojc4
1Department of Pathology and Cytology, General Hospital Celje, Celje, 2Clinical Department of Nephrology, University Clinical Center Ljubljana, 3Faculty of Medicine, and 4Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Background: Thin basement membrane nephropathy (TBMN) is a disorder characterized by ultrastructural abnormalities of the glomerular basement membrane (GBM), representing a spectrum of genetic and clinical phenotypes ranging from benign hematuria to proteinuria and chronic kidney disease. Recent studies have shown that a significant percentage of patients who initially present with hematuria later develop proteinuria and worsening renal function. Materials and methods: We retrospectively analyzed records of patients diagnosed with TBMN, including their clinical, laboratory, and histological features, in Slovenia from 2015 to 2020. Results: TBMN was the main diagnosis at kidney biopsy in 34 (65%) of 52 included patients, while in 18 patients (35%) TBMN was diagnosed in addition to other renal diseases. In the isolated TBMN group, 29 of 34 patients had glomerulosclerosis (global, global and segmental, segmental only) accompanied by interstitial fibrosis/tubular atrophy of varying degrees. 13 patients with isolated TBMN had signs of advanced chronic kidney disease at the time of diagnosis, with estimated glomerular filtration rate < 60 mL/min/1.73m2. 29 patients had proteinuria, which exceeded 3 g/day in 4 patients. TBMN represents a proportion of patients with focal segmental glomerulosclerosis (FSGS) that have often been classified in the past as etiologically indeterminate FSGS. Conclusion: Ultrastructural examination showing diffuse thinning of the GBM is crucial for the TBMN diagnosis. TBMN was the main diagnosis of kidney biopsy in 2/3 of our patients, while it was accompanied by other renal diseases in 1/3. Up to 1/3 of patients with isolated TBMN had evidence of advanced chronic kidney disease at the time of diagnosis.Correspondence to:
Nika Kojc, MD, PhD, Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
Email: [email protected]
The impact of kidney function on survival in elderly patients diagnosed with acute myeloid leukemia
Nejc Pulko, Tadej Petreski, Jasmina Hauptman, Nejc Piko, Zlatko Roškar, and Sebastjan Bevc
Page No. 31
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 01/2021 (S31-S35)
The impact of kidney function on survival in elderly patients diagnosed with acute myeloid leukemia
Nejc Pulko1, Tadej Petreski2,3, Jasmina Hauptman1, Nejc Piko2,4, Zlatko Roškar1, and Sebastjan Bevc2,3
1Department of Hematology, 2Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, 3Faculty of Medicine, University of Maribor, and 4Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
Background: Acute myeloid leukemia (AML) is an aggressive hematological cancer that involves myeloid cells. Elderly patients with comorbidities and poor performance status (PS) receive treatment with hypomethylating agents or supportive care. Several models are available to predict treatment-related mortality and they all primarily focus on PS. Little is known about the impact of chronic kidney disease (CKD) on survival in elderly patients with AML. Materials and methods: We performed a retrospective analysis of 81 patients (51.9% male) aged over 65 years when the diagnosis of AML was established. The median observation period lasted 108 days (IQR 292, maximum 1,169). Patients’ documentation was examined for previous illnesses, PS was calculated, basic laboratory blood tests and a bone marrow biopsy were done. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. Results: The median age of patients was 75 years (IQR 14, maximum 93). The mean eGFR was 59.5 ± 24.0 mL/min/1.73m2. CKD was present in almost half of patients (49.4%). Altogether, 69 (85.2%) patients died during the observation period. Kaplan-Meier survival analysis showed statistically lower survival for CKD patients (log-rank χ2 = 6.736; p = 0.009). Cox regression model, adjusted for age, comorbidities, and treatment, revealed the main predictors for patient survival to be PS, AML type, and blast percentage. Conclusion: Our results indicate that elderly patients with AML have worse survival when diagnosed with CKD, however CKD was not one of the main predictors of patient survival.Correspondence to:
Tadej Petreski, MD, Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
Email: [email protected]
Body composition obtained by bioelectrical impedance with a nutritional questionnaire in children with chronic kidney disease, obesity, or hypertension
Marjetka Švigelj, Sonja Golob Jančič, Mirjam Močnik, and Nataša Marčun Varda
Page No. 36
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S36-S42)
Body composition obtained by bioelectrical impedance with a nutritional questionnaire in children with chronic kidney disease, obesity, or hypertension
Marjetka Švigelj1, Sonja Golob Jančič2, Mirjam Močnik2, and Nataša Marčun Varda1,2
1Medical Faculty, University of Maribor, and 2Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
Aim: The purpose of the study was to determine body composition using bioimpedance (BIA), to obtain perinatal parameters and eating habits of a group of children with chronic kidney disease (CKD), children with obesity and arterial hypertension (AH), and children with normal weight and AH, and to compare results with a healthy population. Materials and methods: Body composition data were collected using Nutrilab Bioimpedance device (Akern 2016 with Biatrodes, Akern electrodes). The results, namely fat-free mass (FFM), total body water (TBW), extracellular water (ECW), body cell mass (BCM), fat mass (FM), phase angle (PA), and nutritional questionnaire have been statistically analyzed by SPSS software using independent samples t-test and Pearson’s correlation test. Results: 128 children were analyzed – 30 with CKD, 30 obese children with AH, 30 normal-weight children with AH, and 38 healthy children as a control group. Results showed significant differences in parameters between our control group and hypertensive patients and between our control group and obese patients with AH. There was a statistically significant difference for TBW and ECW between the control group and children with CKD, other parameters were in lower ranges compared to the control group. The questionnaire evaluation showed significant differences in perinatal parameters, food habits, and family history in all groups. Conclusion: Our pilot study confirmed that BIA parameters of some chronic pediatric patients differ significantly compared to the healthy pediatric population. The results give insight into the importance of monitoring the nutritional status of patients with presumed risk and thus preventing further complications.Correspondence to:
Marjetka Švigelj, Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
Email: [email protected]
Cystatin C and arterial stiffness in patients without chronic kidney disease
Nejc Piko, Tadej Petreski, Franjo Naji, Robert Ekart, Radovan Hojs, and Sebastjan Bevc
Page No. 43
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S43-S48)
Cystatin C and arterial stiffness in patients without chronic kidney disease
Nejc Piko1, Tadej Petreski2,3, Franjo Naji3,4, Robert Ekart1,3, Radovan Hojs2,3, and Sebastjan Bevc2,3
1Department of Dialysis, 2Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, 3Faculty of Medicine, University of Maribor, and 4Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Background: Cystatin C (cysC) is freely filtered in the glomeruli, and its serum concentration is independent of muscle mass, diet, gender, or age. In patients with chronic kidney disease (CKD), cysC is associated with advanced atherosclerosis and increased arterial stiffness. The purpose of this study was to define possible associations between arterial stiffness parameters and cysC in patients without CKD. Materials and methods: The study included 111 non-CKD patients. Basic demographic and laboratory data were recorded. Arterial stiffness was measured by applanation tonometry (sphygmocor, Australia). Results: Mean age of the patients was 64.3 ± 9.4 years, 65.8% were men. Most common co-morbidities were arterial hypertension (AH) (n = 86, 77.5%), hyperlipidemia (n = 64, 57.7%), and diabetes mellitus (DM) (n = 22; 19.8%). Mean creatinine was 77.7 ± 13.8 µmol/L (range 49 – 108), estimated GFR 81.3 ± 9.4 mL/min/1.73m2 (range 62 – 90), and cysC 0.94 ± 0.18 mg/L (range 0.67 – 1.63). Mean carotid-femoral pulse wave velocity (cfPWV) was 10.1 ± 2.4 m/s (range 6.2 – 16.8), subendocardial viability ratio (SEVR) 165.7 ± 36.1% (range 92 – 299), ejection duration (ED) 33.8 ± 4.4 ms (range 22 – 46), and pulse pressure (PP) 46.6 ± 14.8 mmHg (range 17 – 94). A statistically significant association was found between cysC and cfPWV (r = 0.472, p < 0.001), SEVR (r = –0.316, p < 0.001), ED (r = 0.217, p = 0.025), and pulse pressure (PP) (r = 0.241, p = 0.012). Multiple regression analysis between arterial stiffness parameters and cysC, age, male gender, AH, DM, hyperlipidemia, and eGFR confirmed a statistically significant and independent association between cysC and cfPWV (β = 0.220, p = 0.038), between cysC and SEVR (β = –0.278, p = 0.017), and between cysC and ED (β = 0.241, p = 0.045). Conclusion: Elevated cysC is associated with increased cfPWV, increased ED, and decreased SEVR.Correspondence to:
Nejc Piko, MD, Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
Email: [email protected]
The predictive value of urinary erythrocyte morphology for proliferative glomerular kidney disease
Nuša Avguštin Rotar, Alexander Jerman, Andrej Škoberne, Špela Borštnar, Nika Kojc, and Jelka Lindič
Page No. 49
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S49-S55)
The predictive value of urinary erythrocyte morphology for proliferative glomerular kidney disease
Nuša Avguštin Rotar1,3, Alexander Jerman1,3, Andrej Škoberne1,3, Špela Borštnar1,3, Nika Kojc1,2,3, and Jelka Lindič1,3
1Department of Nephrology, University Medical Center Ljubljana, 2Institute of Pathology, Faculty of Medicine, and 3Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Background and aim: Glomerular erythrocyturia (GlomEry) is usually associated with proliferative kidney diseases. In our retrospective cohort, we aimed to validate the predictive value of GlomEry criteria ≥ 40% dysmorphic erythrocytes (DysEry) or ≥ 5% acanthocytes (AcaEry) or at least 1 erythrocytic cast (CastEry) and of two new indices – the count of DysEry per high power field (HPF) and per microliter of urine (Stansfeld-Webb (SW)) method, for proliferative disease. Materials and methods: We included patients with erythrocyturia from 2015 to 2016. Based on renal histology, we divided them into a proliferative and a non-proliferative disease group. Urine erythrocyte count was done using SW and urinary sediment examination was carried out by skilled nephrologists. Sensitivity, specificity, and cutoff values were determined using ROC curves. Results: We included 90 patients (33% women), median age of 63 (IQR 51, 71) years. In the proliferative group, proteinuria was lower (2.4 vs. 6.6 g/day), and SW erythrocyturia was higher (174 (IQR 60, 353) vs. 44 (IQR 20, 67) × 106/L) than in the non-proliferative group. The threshold to differentiate between the proliferative and non-proliferative group was determined at ˃ 43% of DysEry (sensitivity 73%, specificity 79%, AUC 0.808) and at ˃ 2% AcaEry (sensitivity 71%, specificity 56%, AUC 0.647). No significant difference in CastEry was found between groups. Among tested parameters, the calculated number of DysEry/HPF > 6.7 (sensitivity 77%, specificity 92%, AUC 0.878), followed by DysEry/SW > 28 × 106/L (sensitivity 76%, specificity 86%, AUC 0.879), discriminated those two groups best. Conclusion: In concordance with known GlomEry criteria, > 43% of DysEry predicted proliferative kidney disease, whereas CastEry did not, and AcaEry predicted poorly. The best predictor of proliferative glomerular disease was DysEry/HPF, closely followed by DysEry/SW.Correspondence to:
Nuša Avguštin Rotar MD, Department of Nephrology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Clinical characteristics of Slovenian pediatric patients with autosomal recessive polycystic kidney disease
Anja Fon Gabršček, Anamarija Meglič, Gregor Novljan, Tanja Kersnik Levart, and Rina Rus
Page No. 56
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S56-S61)
Clinical characteristics of Slovenian pediatric patients with autosomal recessive polycystic kidney disease
Anja Fon Gabršček1, Anamarija Meglič2,3, Gregor Novljan2,3, Tanja Kersnik Levart2,3, and Rina Rus2,3
1Community Health Center Tolmin, 2Pediatric Nephrology Department, Children’s Hospital, University Medical Center Ljubljana, and 3Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Aims: Autosomal recessive polycystic kidney disease (ARPKD) is a rare inherited disease. We reviewed the clinical characteristics, management, and outcomes in Slovenian pediatric patients with ARPKD. Materials and methods: All patients with ARPKD who were treated at the Pediatric Nephrology Department of the University Children’s Hospital in Ljubljana between 1980 and 2020 were included in the study. The data were assessed retrospectively by reviewing the patients’ medical records and analyzed using descriptive statistics. Results: We included 13 patients, 6 boys and 7 girls. A prenatal diagnosis was established in 3 (23%) patients. In 4 (31%) patients, the diagnosis was confirmed within the first few days of life, while in 6 (46%) patients the disease manifested later during childhood. Four babies (31%) needed ventilatory support after birth. Arterial hypertension developed in all patients. Liver function was affected in 12 (92%) patients and was the predominant clinical concern in 2 of them. Two (15%) patients presented with end-stage renal disease (ESRD). Portal hypertension was found in 7 (54%) patients. Initial sonography revealed enlarged kidneys in 12 (92%) patients, hyperechoic kidneys or poor cortico-medullary differentiation in 10 (77%), and liver abnormalities in 5 (38%) patients. Unilateral nephrectomy was necessary before dialysis in 1 patient. Six (46%) patients started maintenance dialysis at an average age of 15.3 years. Kidney transplantation was performed in 2 (15%) and liver transplantation in 1 (8%) patient. Two (15%) patients died because of sepsis or respiratory failure. Conclusion: ARPKD is a progressive disease leading to ESRD and renal replacement treatment in almost half of our patients. Our data confirm the phenotypic variability of ARPKD in Slovenian patients.Correspondence to:
Rina Rus, MD, PhD, Pediatric Nephrology Department, Children’s Hospital Ljubljana, Bohoričeva ulica 20, 1000 Ljubljana, Slovenia
Email: [email protected]
Secondary oxalate nephropathy in a patient with exocrine pancreatic insufficiency successfully treated, with complete kidney recovery
Rok Tilia, Nika Kojc, and Andrej Škoberne
Page No. 62
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S62-S67)
Secondary oxalate nephropathy in a patient with exocrine pancreatic insufficiency successfully treated, with complete kidney recovery
Rok Tilia1,2, Nika Kojc3, and Andrej Škoberne1,2
1Department of Nephrology, University Medical Center Ljubljana, 2Faculty of Medicine, and 3Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Introduction: Oxalate nephropathy is a relatively rare and under-recognized condition that commonly presents as acute kidney injury (AKI) and often leads to end-stage renal disease. Complete recovery of kidney function is extremely rare even when treatment is instituted early on. Case presentation: We present the case of a 68-year-old man with known type 2 diabetes mellitus and an asymptomatic unrecognized exocrine pancreatic insufficiency, who was admitted due to dialysis-dependent AKI. Kidney biopsy revealed oxalate nephropathy. A wide diagnostic assessment and a multi-factorial treatment plan that included a change of diet, therapy for exocrine pancreatic insufficiency and fat malabsorption, sodium bicarbonate and potassium citrate, calcium supplements with meals, and methylprednisolone, resulted in complete recovery of kidney function. Conclusion: It is important for physicians to be aware of oxalate nephropathy in cases of prolonged AKI. After confirmation of diagnosis, a wide diagnostic approach is imperative to identify all the causes that have led to oxalosis. A multi-factorial therapeutic approach can lead to complete kidney recovery.Correspondence to:
Andrej Škoberne, MD, PhD, Department of Nephrology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Assessment of volume status with bioimpendance prior to hemodialysis and its importance for predicting survival in hemodialysis patients
Gašper Keber, Radovan Hojs, Benjamin Dvoršak, Sebastjan Bevc, Nina Vodošek Hojs, Tadej Petreski, and Robert Ekart
Page No. 68
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S68-S73)
Assessment of volume status with bioimpendance prior to hemodialysis and its importance for predicting survival in hemodialysis patients
Gašper Keber1, Radovan Hojs1,2, Benjamin Dvoršak2, Sebastjan Bevc1,2, Nina Vodošek Hojs2, Tadej Petreski1,2, and Robert Ekart1,3
1Faculty of Medicine, University of Maribor, 2Department of Nephrology, Clinic for Internal Medicine, and 3Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Background: Optimal fluid management is a physician’s everyday challenge in patients on maintenance hemodialysis (HD). Bioimpedance spectroscopy (BIS) is a non-invasive method to estimate body composition, including estimates of fluid overload (FO). Our study aimed to analyze the association between FO and the mortality rate in HD patients. Materials and methods: We performed a retrospective single-center cohort study in 92 HD patients. The body composition was measured before HD using the portable whole-body BIS device Body Composition Monitor (BCM). We have analyzed the mortality rates of HD patients in two FO groups, a standard definition FO group (> 1.1 L), and a severe FO group (> 2.5 L) and compared them to mortality rates of patients without FO or without severe FO, respectively. Results: The mean age of patients was 64.3 ± 13.0 years, mean dialysis vintage 64 months, 60.9% were men. 68 (73.9%) patients had FO of > 1.1 L and 30 (32.6%) had FO of > 2.5 L. During the follow-up period of 1,020 ± 417 days, 29 (31.5%) patients died. Kaplan-Meier survival analysis showed that patients with FO > 2.5 L had worse survival (p = 0.039). In a Cox regression model, which included FO > 2.5 L, age, dialysis vintage, hemoglobin, C-reactive protein, and albumin, only FO > 2.5 L and advanced age turned out to be predictors of death (p = 0.044 and p = 0.001, respectively). Conclusion: HD patients with FO > 2.5 L before HD have poorer survival than patients with normohydration or lower overhydration.Correspondence to:
Prof. Robert Ekart, MD, PhD, University Medical Center Maribor, Clinic for Internal Medicine, Department of Dialysis, Ljubljanska 5, 2000 Maribor, Slovenia
Email: [email protected]
Volume status and arterial stiffness evaluation in peritoneal dialysis patients
Denis Fornazarič, Manja Antonič, and Bojan Knap
Page No. 74
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S74-S79)
Volume status and arterial stiffness evaluation in peritoneal dialysis patients
Denis Fornazarič1, Manja Antonič2, and Bojan Knap1,3
1University Medical Center Ljubljana, Department of Nephrology, Ljubljana, 2General Hospital Slovenj Gradec, Internal Medicine Department, Division for Nephrology and Dialysis, Slovenj Gradec, and 3Faculty of Medicine, University of Ljubljana, Slovenia
Background: Arterial stiffness represents an independent risk factor for cardiovascular mortality in dialysis patients and is strongly connected to hypervolemia. The aim of the study was to evaluate different methods for fluid status assessment and their association with arterial stiffness parameters in peritoneal dialysis patients. Materials and methods: In 16 peritoneal dialysis patients (53 ± 18 years, 9/16 men) fluid status was determined by clinical examination, lung ultrasound (number of B-lines, normal up to 4), overhydration degree by bioimpedance monitor device, estimation of central venous pressure by ultrasound measurement of vena cava inferior, measurement of serum N-terminal pro b-type natriuretic peptide (NT-proBNP), and albumin level. Pulse wave velocity and augmentation index were measured non-invasively with an oscillometric device to indirectly assess arterial stiffness, blood pressure (BP) was obtained by the same device. Results: Clinical evaluation (BP 136 ± 15/93 ± 15 mmHg, edema in 2/16 patients) and lung ultrasound (on average 3 ± 6 B-lines) showed mostly normal fluid status of patients. Patients had slightly lower albumin values (37 ± 4 g/L), slightly elevated central venous pressure (10 ± 4 mmHg), and elevated NT-proBNP (11,596 ± 13,635 ng/L). Body composition evaluation showed mild overhydration (1.5 ± 2 L), which significantly correlated with central venous pressure (p = 0.046) and NT-proBNP (p = 0.004). Lung ultrasound significantly negatively correlated with albumin (r = –0.82, p < 0.001) and positively with NT-proBNP (r = 0.62, p = 0.011). Augmentation index (22 ± 11%) and augmentation pressure correlated with lung ultrasound (r = 0.54, p = 0.032 and r = 0.67, p = 0.004, respectively), although pulse wave velocity (8.4 ± 2.5 m/s) showed no significant correlation with fluid status parameters. The multivariate model showed that lung ultrasound B-lines were an independent determinant of augmentation pressure (β = 0.58, p = 0.043). Conclusion: Fluid status evaluated with lung ultrasound showed good correlation with augmentation index and augmentation pressure, which are markers of arterial stiffness. The lung ultrasound B-lines were found to be an independent determinant of augmentation pressure. Overall arterial stiffness evaluated with pulse wave velocity and augmentation index was not markedly elevated in our patients, which could be due to a good euvolemic status. We conclude that different methods for fluid status evaluation are complementary, with lung ultrasound as a beneficial tool in routine clinical practice in peritoneal dialysis patients.Correspondence to:
Denis Fornazarič, MD, University Medical, Center Ljubljana, Department of Nephrology, 1000 Ljubljana, Slovenia
Email: [email protected]
Association between lung comets and subendocardial viability ratio in peritoneal dialysis patients
Robert Ekart, Lucijan Lučič Šrajer, Katharina Marko, Nejc Piko, Tadej Petreski, Nina Vodošek Hojs, Radovan Hojs, and Eva Jakopin
Page No. 80
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S80-S84)
Association between lung comets and subendocardial viability ratio in peritoneal dialysis patients
Robert Ekart1,2, Lucijan Lučič Šrajer2, Katharina Marko2, Nejc Piko1, Tadej Petreski3, Nina Vodošek Hojs3, Radovan Hojs2,3, and Eva Jakopin3
1Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, 2Faculty of Medicine, University of Maribor, and 3Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Aims: Pulmonary congestion is a direct result of either general overhydration or cardiac dysfunction. Lung ultrasonography (LUS) with lung B-lines (LUS comets) can be used to assess extravascular lung water in patients with end-stage renal disease on hemodialysis or peritoneal dialysis (PD). Subendocardial viability ratio (SEVR) is a pulse wave analysis parameter that is a non-invasive measure of coronary perfusion and is related to cardiac work and oxygen consumption. Our aim was to investigate the association between LUS comets and SEVR in PD patients. Materials and methods: We performed an observational study in 25 PD patients in a single dialysis center. Extravascular lung water was quantified by the number of LUS comets, using a portable ultrasound (US) device. LUS comets were recorded in each intercostal space and defined as hyperechoic US bundles at a narrow base extending from the transducer to the edge of the screen. The sum of LUS comets yields a score reflecting the extent of water accumulation in the lungs. SEVR was determined non-invasively by radial applanation tonometry. Results: Mean age of patients was 54.7 ± 10.7 years, mean PD vintage 27 ± 33 (1 – 167) months, 60% were men. The mean number of LUS comets was 13 ± 19 (0 – 71), and the mean SEVR was 153 ± 40%. We found a statistically significant negative correlation between the number of LUS comets and SEVR (r = –0.467; p = 0.019). Multiple regression analysis with LUS comets as dependent variable, and SEVR and age as independent variables showed a statistically significant relationship between SEVR and the number of LUS comets (β = –0.467, p = 0.021). Conclusion: Higher number of LUS comets is associated with lower SEVR in PD patients.Correspondence to:
Prof. Robert Ekart, MD, PhD, University Clinical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Ljubljanska 5, SI-2000 Maribor, Slovenia
Email: [email protected]
Lung ultrasound, hemoglobin, and NT-proBNP in peritoneal dialysis patients
Lucijan Lučič Šrajer, Katharina Marko, Nina Vodošek Hojs, Nejc Piko, Sebastjan Bevc, Radovan Hojs, and Robert Ekart
Page No. 85
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S85-S88)
Lung ultrasound, hemoglobin, and NT-proBNP in peritoneal dialysis patients
Lucijan Lučič Šrajer1, Katharina Marko1, Nina Vodošek Hojs2, Nejc Piko3, Sebastjan Bevc1,2, Radovan Hojs1,2, and Robert Ekart1,3
1Faculty of Medicine, University of Maribor, 2Department of Nephrology, Clinic for Internal Medicine, and 3Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
Background: Lung ultrasound (LUS) is a non-invasive technique for estimating extravascular lung water in patients with end-stage renal disease and heart diseases. In this study, we examined an association between the severity of lung congestion as detected by LUS B-lines (LUS comets), anemia, and serum biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) in peritoneal dialysis (PD) patients. Materials and methods: 19 patients, who were treated with PD in our dialysis center were enrolled. On the day of their routine check-up, we performed a lung auscultation, LUS on 28 typical locations and determined blood levels of hemoglobin and NT-proBNP. Results: The average age of patients was 54 (range 30 – 71) years, the average duration of PD treatment was 53 (range 10 – 194) months, 63% (12) of the patients were male. Nine (47.4%) patients had peripheral edema, and only 1 (5.3%) patient had inspiratory crackles. Using LUS, we found mean 17 (range 1 – 87) lung comets. Mean hemoglobin level was 108.6 g/L (SD ± 10.4), mean NT-proBNP level 1,151 pmol/L (SD ± 1,077). We found a statistically significant correlation between the number of lung comets and hemoglobin level (r = –0.655; p = 0.002) and NT-proBNP (r = 0.759; p < 0.0001). Multiple regression analysis with the number of lung comets as dependent variable and hemoglobin and NT-proBNP levels as independent variables confirmed a statistically significant association between the number of lung comets and NT-proBNP (β = 0.572; p = 0.009). Conclusion: In PD patients, the number of LUS comets is associated with hemoglobin and NT-proBNP.Correspondence to:
Prof. Robert Ekart, MD, PhD, University Clinical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Ljubljanska 5, SI-2000 Maribor, Slovenia
Email: [email protected]
Peritonitis related to chronic peritoneal dialysis in Slovenian pediatric patients
Gregor Novljan, Veronika Križan-Hergouth, and Nina Battelino
Page No. 89
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S89-S95)
Peritonitis related to chronic peritoneal dialysis in Slovenian pediatric patients
Gregor Novljan1,2, Veronika Križan-Hergouth3, and Nina Battelino1
1Pediatric Nephrology Department, Children’s Hospital, University Medical Center Ljubljana, 2Faculty of Medicine, and 3Institute for Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Aims: Peritonitis is the most significant complication of chronic peritoneal dialysis (PD). We aimed to define the frequency and country-specific characteristics of peritonitis in Slovenian pediatric patients. Materials and methods: All 23 children and adolescents treated with PD at our center between November 1995 and December 2019 were included in the study. There were 15 boys (65.2%) and 8 girls (34.8%). The median age at PD start was 4.8 years (range: 0 – 16.8 years). Patient demographic data, PD modality, treatment duration, and PD-related infections were collected retrospectively by reviewing the patients’ medical records and the microbiology database. Data on the number of peritonitis episodes, microbiology results, and treatment outcomes were of prime interest. Results: 30 peritonitis episodes were registered. The incidence rate was 1/33 patient-months (0.35/year). Twelve patients never experienced peritonitis (52.2%). Gram-positive organisms were isolated in 52.9% (Staphylococcus aureus (4/18), Staphylococcus epidermidis (4/18)). Gram-negative isolates were present in 32.4% (Escherichia coli (4/11), Pseudomonas species (2/11)). Fungal peritonitis occurred in 2.9% and negative culture peritonitis in 11.8%. Initial empirical treatment with vancomycin and ceftazidime was successful in 89.5%. PD was discontinued in 2 patients (8.7%) because of fungal peritonitis and refractory peritonitis. Conclusion: Our results compare favorably with the published literature. Awareness of local patient and microbial characteristics is crucial for the successful treatment and prevention of PD-associated infections.Correspondence to:
Gregor Novljan, MD, PhD, Pediatric Nephrology Department, Children’s Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
Email: [email protected]
Hemostasis assessment with standard coagulation tests and rotational thromboelastometry (ROTEM) during therapeutic plasma exchange treatment
Matej Zrimšek and Andreja Marn Pernat
Page No. 96
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S96-S100)
Hemostasis assessment with standard coagulation tests and rotational thromboelastometry (ROTEM) during therapeutic plasma exchange treatment
Matej Zrimšek1,2 and Andreja Marn Pernat1,2
1Department of Nephrology, University Medical Center Ljubljana, and 2Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Aims: In therapeutic plasma exchange (TPE), large amounts of plasma with all components, including antibodies, albumin, coagulation factors and inhibitors, are removed and usually replaced with replacement fluid without coagulation factors. Hemostatic parameters should be closely monitored in patients at risk of bleeding or with large volume exchanges with a short recovery interval. In this prospective study, we compared standard coagulation parameters and the rotational thromboelastometry (ROTEM) point-of-care test to identify hemostatically severely compromised patients treated with TPE. Materials and methods: 22 patients without recent or planned invasive procedures received 63 TPE treatments with regional citrate anticoagulation. One plasma volume was exchanged with replacement fluid containing albumin and electrolytes. Standard coagulation tests, fibrinogen concentration, and rotational thromboelastometry (ROTEM, including EXTEM test, INTEM test, and FIBTEM test) were performed before and after each TPE treatment. Results: Fibrinogen concentration decreased significantly and international normalized ratio increased slightly after TPE. Activated partial thromboplastin time, EXTEM, INTEM, and FIBTEM clotting times as well as clot formation times were prolonged, and maximum clot firmness decreased after TPE procedures. No serious adverse events occurred during TPE treatment. Conclusion: Our study showed that ROTEM parameters changed significantly after TPE performed with replacement fluid without coagulation factors. Among all parameters, FIBTEM clotting time showed the highest percentual change after TPE. According to this data, the ROTEM point-of-care test may have a potential to guide TPE therapy, particularly in patients at high risk for bleeding.Correspondence to:
Matej Zrimšek, MD, Center for Acute and Complicated Dialysis, Department of Nephrology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Treatment of preeclampsia at extremely preterm gestation with therapeutic plasma exchange
Jakob Gubenšek, Rafael Ponikvar, Tanja Premru Sršen, Vesna Fabjan Vodušek, Manfred Georg Moertl, and Miha Lučovnik
Page No. 101
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S101-S106)
Treatment of preeclampsia at extremely preterm gestation with therapeutic plasma exchange
Jakob Gubenšek1,2, Rafael Ponikvar1,2, Tanja Premru Sršen2,3, Vesna Fabjan Vodušek3, Manfred Georg Moertl4, and Miha Lučovnik2,3
1Department of Nephrology, University Medical Center Ljubljana, Ljubljana, 2Faculty of Medicine, University of Ljubljana, 3Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia, and 4Department of Obstetrics and Gynecology, Clinic Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
Aims: Different forms of apheresis have been proposed as potential therapeutic approaches to remove soluble Fms-like tyrosine kinase-1 (sFlt-1) and allow safe pregnancy prolongation in cases of extremely preterm preeclampsia. This is a follow-up study presenting our experiences with therapeutic plasma exchange (TPE) in 5 women with preeclampsia at < 28 weeks of gestational age. Materials and methods: All women received standard treatment for preeclampsia and 2 – 3 TPE treatments per week. Blood samples for sFlt-1 and placental growth factor (PlGF) measurements were collected before and after each TPE. Results: Seventeen TPE procedures were performed, 2 – 5 per patient. TPE significantly reduced sFlt-1 (by 35 ± 6%), sFlt-1/PlGF ratio (by 24 ± 13%), and to a lesser degree also PlGF (by 12 ± 16%), with a rebound observed on day 1 post procedure. TPE procedures were well tolerated by pregnant women and fetuses. Stabilization of sFlt-1 allowed pregnancy prolongation for a median of 8 (range 2 – 14) days from first TPE and for a median of 10 (range 4 – 17) days from hospital admission. There were no signs of increased risks of adverse neonatal outcome associated with TPE. One neonate died due to extreme prematurity 3 days after delivery, 2 had bronchopulmonary dysplasia, and 1 had retinopathy of prematurity. Conclusion: This study provides new evidence of effective reduction in sFlt-1 and sFlt-1/PlGF ratio with TPE treatment, which seems to allow a clinically meaningful prolongation of pregnancy. Controlled studies are necessary to convincingly show the potential benefit of apheresis treatment in preeclampsia at extremely preterm gestation.Correspondence to:
Prof. Miha Lucovnik, MD, PhD, University Medical Center Ljubljana, Slajmerjeva 4, 1000 Ljubljana, Slovenia
Email: [email protected]
Optimization of isolation protocol and characterization of urinary extracellular vesicles as biomarkers of kidney allograft injury
Ivana Sedej, Magda Tušek Žnidarič, Vita Dolžan, Metka Lenassi, and Miha Arnol
Page No. 107
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S107-S113)
Optimization of isolation protocol and characterization of urinary extracellular vesicles as biomarkers of kidney allograft injury
Ivana Sedej1,3, Magda Tušek Žnidarič2, Vita Dolžan3, Metka Lenassi3, and Miha Arnol1,4
1Department of Nephrology, University Medical Center Ljubljana, 2Department of Biotechnology and Systems Biology, National Institute of Biology, 3Institute of Biochemistry and Molecular Genetics, and 4Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Aims: Long-term kidney allograft survival requires a personalized approach to allograft injury recognition in a timely and reliable manner. Kidney biopsy is invasive and unsuitable for continuous function assessment. Alternatively, in urine, we find extracellular vesicles (uEVs), stable carriers of kidney pathology signals. Analysis of uEVs and their cargo could allow for more frequent and non-invasive assessment of allograft function. We aimed to optimize the uEVs isolation method applicable for kidney allograft injury biomarker studies. Materials and methods: To this end, we optimized several steps of size-exclusion chromatography (SEC)-based method for uEVs isolation from second morning urine of kidney allograft recipients. uEVs were characterized by transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA), western analysis, and quantitative PCR. Results: According to TEM and NTA, SEC isolated high concentrations (8.64 × 108 EVs/mL of urine) of EVs that showed typical morphology and mean size (171 nm), but addition of EDTA and filtration step were needed to remove impurities. Additionally, typical EV proteins Hsc70, CD63, flotillin, tubulin, GAPDH, and miR hsa-let-7i were detected in isolated uEVs, further confirming their identity. Conclusion: Optimized method based on SEC was effective and adequate in isolating pure EVs from urine of kidney allograft recipients and could be used in future biomarker studies.Correspondence to:
Miha Arnol, MD, PhD, Department of Nephrology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia or Metka Lenassi, PhD, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
Email: [email protected]
Glucocorticoid pathway polymorphisms and diabetes after kidney transplantation
Klemen Pahor, Blaž Maver, Tanja Blagus, Blaž Vončina, Monika Praznik, Katja Goričar, Vita Dolžan, Miha Arnol, and Gregor Mlinšek
Page No. 114
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S114-S118)
Glucocorticoid pathway polymorphisms and diabetes after kidney transplantation
Klemen Pahor1, Blaž Maver2, Tanja Blagus3, Blaž Vončina3, Monika Praznik3, Katja Goričar3, Vita Dolžan3, Miha Arnol4,5, and Gregor Mlinšek4,5
1Department of Urology, University Medical Center Ljubljana, Ljubljana, 2Department of Otorhinolaryngology and Cervicofacial Surgery, General Hospital Celje, Celje, 3Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, 4Department of Nephrology, University Medical Center Ljubljana, and 5Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Aims: To find possible associations between new-onset diabetes after transplantation and polymorphisms in glucocorticoid pathway. Materials and methods: A total of 290 patients from our national cohort of kidney transplant patients with functioning graft transplanted in 6 consecutive years (2010 – 2015) were included in the study. All patients were genotyped for polymorphisms in genes coding for glucocorticoid receptor (NR3C1 rs33389, rs6198 and rs33388), P-glycoprotein (ABCB1 rs1045642, rs1128503, and rs2032582), and glutathione S-transferase P1 (GSTP1 rs1695 and rs1138272). For interim analysis, clinical data were obtained from medical records for 79 patients. Results: 22.8% of patients developed NODAT in the first post-transplant year. GSTP1 rs1695 and rs1138272 polymorphisms were associated with an increased risk for NODAT. NR3C1 rs6198 polymorphism was associated with higher serum glucose at the end of the first post-transplant year. Conclusion: The observed incidence of NODAT in the first post-transplant year is in accordance with the literature data. GSTP1 genotypes leading to decreased conjugation capacity were associated with higher probability of NODAT. As these polymorphisms can be determined already before kidney transplantation, they can help planning early glucocorticoid withdrawal if a favorable post-transplant course permits it.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]
Chronic hepatitis B virus infection in Slovenian national cohort of kidney transplant patients
Gregor Mlinšek, Manca Oblak, Miha Arnol, and Mojca Matičič
Page No. 119
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S119-S126)
Chronic hepatitis B virus infection in Slovenian national cohort of kidney transplant patients
Gregor Mlinšek1,2, Manca Oblak1, Miha Arnol1,2, and Mojca Matičič2,3
1Department of Nephrology, University Medical Center Ljubljana, 2Faculty of Medicine, University of Ljubljana, and 3Clinic for Infectious Diseases and Febrile Illnesses, University Medical Center Ljubljana, Ljubljana, Slovenia
Aims: To estimate the prevalence of anti-HBc-positive patients with functioning kidney graft, to detect the anti-HBc-positive patients in danger for hepatitis B virus (HBV) reactivation and to update Slovenian guidelines on hepatitis B follow-up, vaccination, introduction of chemoprophylaxis or treatment. Materials and methods: The Slovenian national cohort of kidney transplant patients with functioning graft managed at the University Medical Center Ljubljana was included. In a cross-sectional study between March and September 2020, all included patients were screened for the presence of anti-HBc; all anti-HBc-positive patients were additionally tested for anti-HBs, HBsAg, and HBV DNA. Results: Out of a total of 778 included patients, 72 were anti-HBc positive (9.2%). Eight patients (1%) presented with asymptomatic chronic HBV infection: 6 were HBsAg-positive/HBV DNA-negative, and 2 were HBsAg-negative/HBV DNA positive. In one of the latter, HBsAg mutant variant P120QD144E was proven. By the time of the study, 12 anti-HBc-positive patients (16.6%) have already been receiving chemoprophylaxis. Conclusion: The prevalence of anti-HBc-positive patients in the national cohort of kidney transplant patients in Slovenia was 9.2%. Based on the specific combination of HBV markers (anti-HBc, anti-HBs, HBsAg, HBV DNA) we stratified patients into six subgroups. Algorithm on follow-up, hepatitis B vaccination, chemoprophylaxis, or treatment is presented for each of the specific subgroups.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]
Glomerular and tubulointerstitial foscarnet nephropathy of kidney allograft with emphasis on ultrastructural findings: A case report
Jerica Pleško, Damjan Kovač, Zoran Arsov, Jelka Lindič, Andrej Škoberne, Dušan Ferluga, and Nika Kojc
Page No. 127
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S127-S132)
Glomerular and tubulointerstitial foscarnet nephropathy of kidney allograft with emphasis on ultrastructural findings: A case report
Jerica Pleško1, Damjan Kovač2,3, Zoran Arsov4, Jelka Lindič2,3, Andrej Škoberne2,3, Dušan Ferluga1, and Nika Kojc1
1Institute of Pathology, Faculty of Medicine, University of Ljubljana, 2Department of Nephrology, University Medical Center Ljubljana, 3Faculty of Medicine, University of Ljubljana, and 4Department of Condensed Matter Physics, Jozef Stefan Institute, Ljubljana, Slovenia
Introduction: Foscarnet (trisodium phosphonoformate hexahydrate) is standard treatment for ganciclovir-resistant cytomegalovirus (CMV) infections. In the kidney, foscarnet-induced injury may be attributed to reversible tubulointerstitial lesions, but foscarnet crystals have also been observed within glomerular capillaries, suggesting that foscarnet can lead to glomerular lesions such as crescentic glomerulonephritis. We present biopsy and autopsy findings of foscarnet induced nephropathy in a transplanted kidney, with a particular emphasis on the histopathology and electron micrographic peculiarities of drug crystal deposits. Case presentation: A 72-year-old Caucasian male patient with a deceased donor kidney was treated with several foscarnet applications due to ganciclovir-resistant CMV infection. Transplant kidney biopsy revealed massive glomerular crystalline precipitates, resulting in crescentic glomerulonephritis and tubular damage. The last foscarnet application was complicated with several infections and kidney graft failure. Autopsy revealed multi-organ damage due to foscarnet crystal precipitations associated with systemic CMV and fungal infection. On autopsy of kidney specimens, we succeeded in preserving the rectangular flat plate-like foscarnet crystals in stacks detected by transmission electron microscopy (TEM) after 100% alcohol fixation. The chemical composition of the crystals was confirmed by attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Conclusion: Transplant kidney biopsy remains the gold standard in distinguishing between foscarnet crystalline glomerular and/or tubulointerstitial lesions, and various forms of rejection and other causes of impaired renal function in transplant kidney.Correspondence to:
Nika Kojc, MD, PhD, Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
Email: [email protected]
