Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis

Background and Objectives: Glomerular C4d deposits are associated the severity and outcomes of IgA nephropathy. Whether this holds true in immunoglobulin A vasculitis (IgAV) is not known. The main objective of the study was to analyze the prognostic value of glomerular C4d immunolabelling on kidney impairment in adults with IgAV.Design, Setting, Participants, Measurements: This retrospective cohort study included 120 adults with IgAV and a kidney biopsy performed between 1995 and 2018 in two French university hospital centers. All paraffin-embedded biopsies were reassessed according to Oxford classification. Immunofluorescence for C4d was performed in all cases. For analysis, patients were grouped according to positivity for C4d in the glomerular area. The main outcome was a composite endpoint of 50% increase in 24 h-proteinuria, or eGFR decrease by 50%, or kidney replacement therapy.Results: The median follow-up was 28.3 months. Twenty-three patients met the composite endpoint, 12 for kidney replacement therapy, 6 for an eGFR decrease >50% and 5 for a >50% increase in proteinuria. At time of biopsy, the median proteinuria was 1.9 g/24 h and the median eGFR 73.5 mL/min/1.73 m2. Among the 102 patients evaluable for C4d, 24 were positive on >30% glomeruli, mainly with a parieto-mesangial pattern. In this group, the initial proteinuria was more frequently nephrotic than in the C4d– group (60% vs. 33%, P = 0.039). Mesangial hypercellularity was more frequent in the C4d+ group (42% vs. 13%; P = 0.006) whereas macroscopic hematuria was more frequent in the C4d– group (18% vs. 0%; P = 0.03). After a median follow-up of 28 months, kidney survival did not differ according to C4d status.Conclusion: In a population of adult IgAV patients, glomerular positivity for C4d was associated with the severity of the kidney disease at presentation, but not with subsequent renal function deterioration.

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POS-053 90-day post-hospital follow-up in survivors after COVID-19-associated acute kidney injury requiring kidney replacement therapy

Kidney International Reports ◽

10.1016/j.ekir.2021.03.059 ◽

2021 ◽

Vol 6 (4) ◽

pp. S24

Author(s):

H. Stockmann ◽

J.H.B. Hardenberg ◽

C. Hinze ◽

A. Aigner ◽

G. Inka ◽

...

Keyword(s):

Acute Kidney Injury ◽

Replacement Therapy ◽

Kidney Injury ◽

Kidney Replacement Therapy

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Twice weekly hemodialysis is safe at the beginning of kidney replacement therapy: the experience of the Nephrology Department at Hedi Chaker University Hospital, Sfax, south of Tunisia

Pan African Medical Journal ◽

10.11604/pamj.2020.35.129.20285 ◽

2020 ◽

Vol 35 ◽

Author(s):

Hanen Chaker ◽

Faiçal Jarraya ◽

Salma Toumi ◽

Khawla Kammoun ◽

Yosra Mejdoub ◽

...

Keyword(s):

Replacement Therapy ◽

University Hospital ◽

Kidney Replacement Therapy

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Association of Kidney Biopsy Findings With Short- and Medium-Term Outcomes in Children With Moderate-to-Severe Iga Vasculitis Nephritis

10.21203/rs.3.rs-293781/v1 ◽

2021 ◽

Author(s):

Stéphanie Clavé ◽

Maud Sordet ◽

Michel Tsimaratos ◽

Stéphane Decramer ◽

Marc Fila ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Kidney Disease ◽

Kidney Biopsy ◽

Immunoglobulin A ◽

International Study ◽

Clinical Severity ◽

Grade Ii ◽

Kidney Impairment ◽

Grade Iii

Abstract Assessing the initial severity of immunoglobulin A vasculitis nephritis (IgAV-N) is challenging important due to its determining effect on kidney management and outcomes. This study paper aims to describe describes a multicentre paediatric multicenter pediatric cohort of IgAV-N patients and discusses whilst investigating the relationships among between clinical presentation, histological features, and kidney outcome. A cohort consisting of 170 children requiring early kidney with biopsy because of IgAV-N, which was diagnosed between 2007 and 2017, was assessed including 27% of children with nephrotic syndrome (NS). One-quarter of the cohort (27%) presented with initial nephrotic syndrome (NS). Kidney biopsy revealed International Study of Kidney Disease (ISKDC) grade II or grade III in 83% of cases. An International Study of Kidney Disease (ISKDC) grade II or grade III was revealed through kidney biopsy in 83% of cases. Endocapillary proliferation was were observed in 73% of patients, and chronic lesions were observed in 25%of patients. Data analysis demonstrated showed a significant association between clinical severity (NS at onset and histological findings such asendocapillary proliferation and cellular crescents. After a median follow-up of 21 months (IQR 12-39), 30% of patients had persistent kidney impairment (proteinuria or decreased eGFR. WorseAt the end of follow-up, kidney outcome impairment was significantly associated more often observed in patients with NS at onset and those with cellular crescents and chronic lesions on initial kidney biopsy.Conclusions: This study highlights the relationship between the clinical and histological presentation of IgAV-N and the factors that affect kidney outcome. The ISKDC classification may be improved by including lesions that are more discriminating for disease severity and prognosis.

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Prognostic ability of intraoperative electromyographic monitoring during microvascular decompression for hemifacial spasm to predict lateral spread response outcome

Journal of Neurosurgery ◽

10.3171/2016.1.jns151782 ◽

2017 ◽

Vol 126 (2) ◽

pp. 391-396 ◽

Cited By ~ 9

Author(s):

Sung Ho Lee ◽

Bong Jin Park ◽

Hee Sup Shin ◽

Chang Kyu Park ◽

Bong Arm Rhee ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Prognostic Value ◽

University Hospital ◽

Lateral Spread ◽

Symptom Duration ◽

Group A ◽

Lateral Spread Response ◽

Group B

OBJECTIVE Abnormal lateral spread response (LSR) is a typical finding in facial electromyography (EMG) in patients with hemifacial spasm (HFS). Although intraoperative monitoring of LSR has been widely used during microvascular decompression (MVD), the prognostic value of this monitoring is still debated. The purpose of this study was to determine whether such monitoring exhibits prognostic value for the alleviation of LSR after treatment of HFS. METHODS Between January 2009 and December 2013, a total of 582 patients underwent MVD for HFS with intraoperative EMG monitoring at Kyung Hee University Hospital. The patients were categorized into 1 of 2 groups according to the presence of LSR at the conclusion of surgery (Group A, LSR free; Group B, LSR persisting). Patients were assessed for the presence of HFS 1 day, 6 months, and 1 year after surgery. Various parameters, including age, sex, symptom duration, offending vertebral artery, and offending perforating artery, were evaluated for their influence on surgical and electrophysiological results. RESULTS Overall, HFS was alleviated in 455 (78.2%) patients 1 day after MVD, in 509 (87.5%) patients 6 months after MVD, and in 546 (93.8%) patients 1 year after MVD. Patients in Group B were significantly younger than those in Group A (p = 0.022). Patients with a symptom duration of less than 1 year were significantly more likely to be classified in Group A than were patients whose symptoms had persisted for longer than 10 years (p = 0.023); however, analysis of the entire range of symptom durations did not reveal a significant effect (p = 0.132). A comparison of Groups A and B according to follow-up period revealed that HFS recovery correlated with LSR alleviation over a shorter period, but the same was not true of longer periods; the proportions of spasm-free patients were 80.6% and 71.1% (p = 0.021), 89.4% and 81.9% (p = 0.022), and 93.5% and 94.6% (p = 0.699) 1 day, 6 months, and 1 year after surgery in Groups A and B, respectively. CONCLUSIONS Although intraoperative EMG monitoring during MVD was beneficial for identifying the offending vessel and suggesting the most appropriate surgical end point, loss of LSR did not always correlate with long-term HFS treatment outcome. Because the HFS cure rate improved over time, revision might be considered for persistent LSR when follow-up has been performed for more than 1 year and the spasm remains despite adequate decompression.

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Effect of Platelet Count on Prognostic Value in Patients with Chronic Heart Failure

10.21203/rs.3.rs-115907/v1 ◽

2020 ◽

Author(s):

Zhi Li ◽

Zhenyu Jiao ◽

Yang Xie ◽

Yanbing Li

Keyword(s):

Heart Failure ◽

Platelet Count ◽

Chronic Heart Failure ◽

Prognostic Value ◽

Composite Endpoint ◽

Plate Count ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models ◽

Low Platelet Count

Abstract Background: The prognostic value of platelet count in chronic heart failure (CHF) is not clearly established. The present study aimed to assesse the independent prognostic value of platelet count in patients with CHF.Methods: From Januay 2016 to December 2019, 1162 patients with a discharge diagnosis of CHF were recorded in present study. The patients were divided into two groups according to the platelet count: low platelet count (LP, ≦140,000/μl) and high plate count (HP, >140,000/μl). The main outcomes were defined as all-cause death or cardiogenic rehospitalization within 3 years. Survival analysis and Cox proportional hazard models adjusted by an established risk score were performed. Results: During 3 years follow-up, the overall main outcomes including all-cause death (P=0.0475) and composite endpoint events of all-cause death or cardiogenic rehospitalization (P=0.0053) were higher in LP group than in those with HP group. After adjusting for other covariables, including gender, age, et al., low platelet count was related to increased the risk of main outcomes during 3 years follow-up (all-cause death, HR:1.151, 95%CI: 1.082-1.670, P=0.040; composite endpoint events, HR: 1.313, 95%CI: 1.152-1.964, P=0.016). Conclusions: Low platelet count was associated with risk for higher adverse outcome in patients with CHF.

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Discharge Documentation and Follow-Up of Critically Ill Patients With Acute Kidney Injury Treated With Kidney Replacement Therapy: A Retrospective Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.710228 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xin Yi Choon ◽

Nuttha Lumlertgul ◽

Lynda Cameron ◽

Andrew Jones ◽

Joel Meyer ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Kidney Disease ◽

Replacement Therapy ◽

Kidney Injury ◽

Disease Stage ◽

Essential Information ◽

Kidney Replacement Therapy ◽

Discharge Summaries

Leading organisations recommend follow-up of acute kidney injury (AKI) survivors, as these patients are at risk of long-term complications and increased mortality. Information transfer between specialties and from tertiary to primary care is essential to ensure timely and appropriate follow-up. Our aim was to examine the association between completeness of discharge documentation and subsequent follow-up of AKI survivors who received kidney replacement therapy (KRT) in the Intensive Care Unit (ICU). We retrospectively analysed the data of 433 patients who had KRT for AKI during ICU admission in a tertiary care centre in the UK between June 2017 and May 2018 and identified patients who were discharged from hospital alive. Patients with pre-existing end-stage kidney disease and patients who were transferred from hospitals outside the catchment area were excluded. The primary objective was to assess the completeness of discharge documentation from critical care and hospital; secondary objectives were to determine cardiovascular medications reconciliation after AKI, and to investigate kidney care and outcomes at 1 year. The development of AKI and the need for KRT were mentioned in 85 and 82% of critical care discharge letters, respectively. Monitoring of kidney function post-discharge was recommended in 51.6% of critical care and 36.3% of hospital discharge summaries. Among 35 patients who were prescribed renin-angiotensin-aldosterone system inhibitors before hospitalisation, 15 (42.9%) were not re-started before discharge from hospital. At 3 months, creatinine and urine protein were measured in 88.2 and 11.8% of survivors, respectively. The prevalence of chronic kidney disease stage III or worse increased from 27.2% pre-hospitalisation to 54.9% at 1 year (p < 0.001). Our data demonstrate that discharge summaries of patients with AKI who received KRT lacked essential information. Furthermore, even in patients with appropriate documentation, renal follow-up was poor suggesting the need for more education and streamlined care pathways.

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Prognostic value of integrated cardiopulmonary ultrasound in inpatients with acute heart failure with preserved and reduced ejection fraction and without heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1215 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N.R Pugliese ◽

F Frassi ◽

P Frumento ◽

E Poggianti ◽

M Mazzola ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Prognostic Value ◽

Multivariable Analysis ◽

Composite Endpoint ◽

Signs And Symptoms ◽

Reduced Ejection Fraction ◽

B Lines

Abstract Objective To assess the prognostic value of B-lines integrated with echocardiography in patients admitted to a Cardiology Department, with and without acute heart failure (AHF). Background Lung-ultrasound (LUS) B-lines are sonographic signs of pulmonary congestion and can be used in the differential diagnosis of dyspnea to rule in or rule out AHF. Their prognostic value at admission is less established, as well as the different role in AHF with reduced and preserved ejection fraction (HFrEF and HFpEF), or patients admitted for cardiac conditions but without overt signs and symptoms of AHF. Methods A total of 1021 consecutive in-patients (69±12 years) admitted for various cardiac conditions were enrolled. Patients were classified into three groups: 1) acute HFrEF; 2) acute HFpEF; 3) no AHF. All patients underwent on the admission an echocardiogram coupled with LUS, according to standardised protocols. Results Patients were followed-up for a median of 14.4 months (interquartile range: 4.6–24.3) for death and HF readmission (composite endpoint). During the follow-up, 126 events occurred. Kaplan-Meier survival analyses showed admission B-lines >30 identified patients with worse outcome at follow-up in the overall population and each of the three groups (Figure). At multivariable analysis (Table), admission B-lines >30, EF <50%, tricuspid regurgitation velocity >2.8 m/s and tricuspid annular plane systolic excursion (TAPSE) <17 mm resulted in independent predictors of the composite endpoint. B-lines >30 had a strong predictive value in HFpEF and non-AHF, but not in HFrEF. Conclusions Ultrasound B-lines can detect subclinical pulmonary interstitial edema in patients thought to be free of congestion, and provide useful information not only for the diagnosis but also for the prognosis in different cardiac conditions. Their added prognostic value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF. Figure 1 Funding Acknowledgement Type of funding source: None

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Characterisation of Acute Kidney Injury in Critically Ill Patients with Severe Coronavirus Disease-2019 (COVID-19)

10.1101/2020.05.06.20069872 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sébastien Rubin ◽

Arthur Orieux ◽

Renaud Prevel ◽

Antoine Garric ◽

Marie-Lise Bats ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

University Hospital ◽

Urinary Analysis ◽

Stage 1

AbstractBackgroundCOVID-19-associated acute kidney injury frequency, severity and characterisation in critically ill patients has not been reported.MethodsSingle-center cohort performed from March 3, 2020, to April 14, 2020 in 4 intensive care units in Bordeaux University Hospital, France. All patients with COVID19 and pulmonary severity criteria were included. AKI was defined using KDIGO criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterisation (transient vs. persistent acute kidney injury; proteinuria, hematuria and glycosuria), and short-term outcomes was evaluated.Results71 patients were included, with basal serum creatinine of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median follow-up was 17 [12–23] days. AKI developed in a total of 57/71 (80%) patients with 35% Stage 1, 35% Stage 2, and 30% Stage 3 acute kidney injury; 10/57 (18%) required renal replacement therapy. Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median urine protein/creatinine of 82 [54–140] (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20 indicating predominant tubulo-interstitial injury. Only 2 (4%) patients had glycosuria. At Day 7 onset of after AKI, six (11%) patients remained dependent on renal replacement therapy, nine (16%) had SCr > 200 µmol/L, and four (7%) died. Day 7 and day 14 renal recovery occurred in 28% and 52 % respectively.ConclusionCOVID-19-associated AKI is frequent, persistent severe and characterised by an almost exclusive tubulo-interstitial injury without glycosuria.

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The Prognostic Value of a Validated and Automated Intravascular Ultrasound-Derived Calcium Score

Journal of Cardiovascular Translational Research ◽

10.1007/s12265-021-10103-1 ◽

2021 ◽

Author(s):

Tara Neleman ◽

Shengnan Liu ◽

Maria N. Tovar Forero ◽

Eline M. J. Hartman ◽

Jurgen M. R. Ligthart ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Prognostic Value ◽

Calcium Score ◽

Composite Endpoint ◽

Coronary Calcification ◽

Automated Algorithm ◽

Unit Increase ◽

Ivus Imaging

Abstract Background Coronary calcification has been linked to cardiovascular events. We developed and validated an algorithm to automatically quantify coronary calcifications on intravascular ultrasound (IVUS). We aimed to assess the prognostic value of an IVUS-calcium score (ICS) on patient-oriented composite endpoint (POCE). Methods We included patients that underwent coronary angiography plus pre-procedural IVUS imaging. The ICS was calculated per patient. The primary endpoint was a composite of all-cause mortality, stroke, myocardial infarction, and revascularization (POCE). Results In a cohort of 408 patients, median ICS was 85. Both an ICS ≥ 85 and a 100 unit increase in ICS increased the risk of POCE at 6-year follow-up (adjusted hazard ratio (aHR) 1.51, 95%CI 1.05–2.17, p value = 0.026, and aHR 1.21, 95%CI 1.04–1.41, p value = 0.014, respectively). Conclusions The ICS, calculated by a validated automated algorithm derived from routine IVUS pullbacks, was strongly associated with the long-term risk of POCE. Graphical abstract

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