MO282EARLY RENAL RECOVERY AFTER A FIRST FLARE OF PAUCI IMMUNE GLOMERULONEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jeremy Zaworski ◽  
Cyrille Vandenbussche ◽  
Pierre Bataille ◽  
Eric Hachulla ◽  
Francois Glowacki ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Interstitial Fibrosis ◽  
Univariate Analysis ◽  
Renal Recovery ◽  
Neurological Involvement ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal involvement is a severe manifestation of ANCA-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after a first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in eGFR between diagnosis and follow-up at 3 months (ΔeGFRM0–M3) in a cohort of patients with a first flare of pauci-immune glomerulonephritis. Methods This was a retrospective study over the period 2003–2018 of incident patients in the Nord-Pas-de-Calais (France). Patients were recruited if they had a first histologically-proven flare of pauci immune glomerulonephritis with at least 1 year of follow up. Kidney function was estimated with MDRD-equation and analysed at diagnosis, 3rd, 6th and 12th months. The primary outcome was ΔeGFRM0–M3. Factors evaluated were histological (Berden classification, interstitial fibrosis, percentage of crescents), clinical (extra-renal manifestations, sex, age) or biological (severity of acute kidney injury, dialysis, ANCA subtype). Results One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs 28 ± 26 ml/min/1.73 m2, p < 0.001), with a ΔeGFRM0–M3 of 12 ± 19 ml/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs 40 ± 24 ml/min/1.73m2, p = 0.003). The factors significantly associated with ΔeGFRM0–M3 in univariate analysis were: sclerotic class according to Berden classification, percentage of interstitial fibrosis, percentage of cellular crescents, acute tubular necrosis, neurological involvement. The factors associated with ΔeGFRM0–M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in eGFR was 2.90 ± 0.06 ml/min/1.73m2 for every 10-point gain in the percentage of cellular crescents. ΔeGFRM0–M3 was not associated with the risks of end-stage renal disease or death in long-term follow-up. Conclusions Early renal recovery after a first flare of pauci-immune glomerulonephritis occurred mainly in the first three months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.

scholarly journals Factors associated with blood pressure in end stage renal disease patients receiving regular hemodialysis at Wangaya general hospital, Denpasar

2021 ◽  
Vol 8 (8) ◽  
pp. 1201
Author(s):  
I. Kadek Aditya Nugraha ◽  
Theodore Dharma Tedjamartono ◽  
Wayan Sunaka
Keyword(s):  
Blood Pressure ◽  
Renal Disease ◽  
General Hospital ◽  
End Stage Renal Disease ◽  
Univariate Analysis ◽  
Antihypertensive Medications ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage ◽  
Regular Hemodialysis

Background: Hypertension is common findings in end-stage renal disease (ESRD) patients receiving hemodialysis, around two third among them are poorly controlled. We analyzed factors affecting blood pressure in patients undergoing regular hemodialysis.Methods:A single center cross-sectional study conducted including 65 patients receiving regular hemodialysis at hemodialysis unit Wangaya general hospital, Bali, Indonesia. Ordinal regression test was performed to analyze the relationship between factor associated with blood pressure in regular hemodialysis patients.Results: Among subjects included, 64 (98.5%) subject had hypertension and 22 (34.4%) subjects had well controlled blood pressure (<140/90 mmHg), 20 (31.3%) subjects had blood pressure between 140/90 to 160/100 mmHg and 22 (34.4%) subjects had blood pressure >160/100 mmHg. Univariate analysis showed statistically significant associated factors were higher number of antihypertensive medications (p=0.002), higher level of hemoglobin (p=0.008), hematocrit (p=0.012) and urea (p=0.041). Multivariate analysis showed higher amount of anti-hypertensive medications and year of dialysis were statistically significant associated with blood pressure in regular hemodialysis patients.Conclusions:Significant factors associated with blood pressure in regular hemodialysis patients were higher amount of anti-hypertensive medications and increased year of dialysis.  

Clinical, Social and Demographics Factors Associated with Spiritual Wellbeing in End Stage Renal Disease

2017 ◽  
pp. 77-88 ◽  
Author(s):  
Evangelos C. Fradelos ◽  
Konstantinos Tsaras ◽  
Foteini Tzavella ◽  
Evmorfia Koukia ◽  
Ioanna V. Papathanasiou ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Spiritual Wellbeing ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals P0181PERSISTENT C3 HYPOCOMPLEMENTEMIA AND MODERATE TUBULOINTERSTITIAL SCARRING AS EARLY PREDICTORS OF END-STAGE RENAL DISEASE IN LUPUS NEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Giovanni Maria Rossi ◽  
Francesco Peyronel ◽  
Marco Delsante ◽  
Avi Z Rosenberg ◽  
Paride Fenaroli ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Regression Models ◽  
Kidney Biopsy ◽  
Cox Regression ◽  
Activity Index ◽  
Renal Recovery ◽  
Early Predictors ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims The prognosis of lupus nephritis (LN) has become progressively more favorable thanks to the introduction of cyclophosphamide and mycophenolate as the mainstay of induction of remission treatment regimens. However, 10-15% of patients still progress to end-stage renal disease (ESRD). Early predictors of ESRD, i.e. in the first six months between kidney biopsy and the completion of induction, are currently limited to few histological and clinical features: ≥ 25% interstitial fibrosis and tubular atrophy (IFTA), fibrinoid necrosis, fibrous crescents, and thrombotic microangiopathy (TMA) [Rijnink EC et al CJASN 2017; Song D Arthritis Res Ther 2013]; lack of decrease in proteinuria &lt; 0.5 g/24-h at 3 and 6 months from kidney biopsy [Tamirou F Ann Rheum Dis 2016], baseline GFR ≤ 90 ml/min/1.73 m2, lack of decrease in urinary protein-to-creatinine ratio (UPCR) &lt; 1 and anti-dsDNA positivity at the end of induction [Dall’Era M Lupus Sci Med 2015]. In this study we sought to identify further clinical and histological predictors of ESRD in LN. Methods Adult patients diagnosed with LN between 1995 and 2018 in two centers (NIAMS, Bethesda, Maryland, USA, and Nefrologia, AOU di Parma, Italy) were retrospectively identified. Patients with available serum C3 and C4 levels at the time of biopsy and 6 months thereafter, and a follow-up of at least 6 months, were included. Baseline and follow-up data (until March 2019) including age, sex, ethnicity, clinical, histological and laboratory findings were collected. Histology slides were reviewed by an experienced renal pathologist and biopsies re-scored using the ISN/RPS classification and NIH activity and chronicity indices. Distinct histological features were assessed individually (e.g. TMA). Persistent C3 hypocomplementemia was defined as decreased serum C3 levels at the time of biopsy and after 6 months (i.e. after the completion of induction), with concurrent normal serum C4 levels at 6 months. Early renal recovery was defined as either an increase in eGFR above 60 in those with a baseline eGFR &lt; 60 ml/min/1.73 m2, or a 50% decrease in proteinuria in those with a baseline eGFR ≥ 60 ml/min/1.73 m2 and ≥ 0.5 g/24-h or g/g UPCR at the time of biopsy. Variables were tested for their predictive power of death-censored ESRD in univariate and multivariate Cox regression models. Results 74 patients (NIAMS n = 36; Parma n = 38) met our criteria. Median follow-up duration was 64 months (range 6-230). On univariate analysis, the following parameters predicted ESRD: Hispanic ethnicity; age at biopsy; persistent C3 hypocomplementemia; normalization of both C3 and C4; renal recovery after induction; NIH activity index; presence of TMA; ≥ 25% IFTA. Multivariate Cox regression models for ESRD were created considering statistically significant variables (p &lt; 0.05). In a model including Hispanic ethnicity, age at biopsy, and persistent C3 hypocomplementemia, the latter predicted ESRD with an HR of 5.22 (95% CI [1.33, 20.58] p = 0.018) when adjusting for renal recovery after induction. Upon including histological features in the model, persistent C3 hypocomplementemia, TMA, and the NIH activity index lost significance, while ≥ 25% IFTA predicted ESRD with an HR of 27.26 (95% CI [2.12, 350.54], p = 0.011). Conclusion In patients with LN, ≥ 25% IFTA at baseline biopsy is a predictor of ESRD, allowing for early risk stratification with the potential of informing treatment strategies. Where percent IFTA is unavailable or its assessment unreliable (e.g. inadequate biopsy specimen for tubulointerstitial assessment), persistent C3 hypocomplementemia represents a reliable and reproducible early predictor of ESRD, irrespective of early renal recovery after induction.

scholarly journals Perfusion defects on real-time myocardial contrast echocardiography predict higher mortality in patients with end-stage renal disease – A 3-year follow-up

Renal Failure ◽  
2010 ◽  
Vol 32 (10) ◽  
pp. 1160-1166 ◽  
Author(s):  
Anna Tomaszuk-Kazberuk ◽  
Bozena Sobkowicz ◽  
Jolanta Malyszko ◽  
Jacek S. Malyszko ◽  
Marek Kalinowski ◽  
...  
Keyword(s):  
Renal Disease ◽  
Real Time ◽  
End Stage Renal Disease ◽  
Contrast Echocardiography ◽  
Myocardial Contrast Echocardiography ◽  
Perfusion Defects ◽  
Stage Renal Disease ◽  
End Stage

Incidence and risk factors for HPV-associated cancers in women with end-stage renal disease

2020 ◽  
Vol 68 (5) ◽  
pp. 1002-1010
Author(s):  
Joan Han ◽  
Jennifer L Waller ◽  
Rhonda E Colombo ◽  
Vanessa Spearman ◽  
Lufei Young ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
General Population ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Herpes Infection ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Human papillomavirus (HPV) causes the majority of cervical, anal/rectal, and oropharyngeal cancers in women. End-stage renal disease (ESRD) is also associated with an increased risk of malignancy, but the incidence of and risk factors for HPV-associated cancers in US dialysis patients are not defined. We queried the US Renal Data System for women with HPV-associated cancers and assessed for incidence of cancer diagnosis and association of risk factors. From 2005 to 2011, a total of 1032 female patients with ESRD had 1040 HPV-associated cancer diagnoses. Patients had a mean age of 65 years, were mostly white (63%), and on hemodialysis (92%). Cervical cancer (54%) was the most common, followed by anal/rectal (34%), and oropharyngeal (12%). The incidence of HPV-associated cancers in patients with ESRD increased yearly, with up to a 16-fold increased incidence compared with the general population. Major risk factors associated with the development of any HPV-associated cancer included smoking (adjusted relative risk=1.89), alcohol use (1.87), HIV (2.21), and herpes infection (2.02). Smoking, HIV, and herpes infection were prominent risk factors for cervical cancer. The incidence of HPV-associated cancers in women with ESRD is rising annually and is overall higher than in women of the general population. Tobacco use is a universal risk factor. For cervical cancer, the presence of HIV and herpes are important comorbidities. Recognizing risk factors associated with these cancers may improve diagnosis and facilitate survival. The role of HPV vaccination in at-risk dialysis patients remains to be defined but warrants further study.

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