Nephrology Commons^™

Serum Tests For Donor-Derived Cell-Free Dna Are Well Correlated With Renal Transplant Rejection In Renal Biopsies: Our Preliminary Experience Of New Surveillance For Monitoring Rejection, Reenal Patel, Brandon Metcalf, Dilip Samarapungavan, Hassan D. Kanaan, Wei Li, Sarah T. Suliman, Atul Singh, Ping L. Zhang

Conference Presentation Abstracts

Context: Noninvasive serum test for donor-derived cell-free DNA (dd-cfDNA) has been found useful for monitoring acute cellular rejection (ACR) and antibody-mediated rejection (AMR) since 2018, and the accepted threshold to indicate rejection is 1%. The goal of this pilot study was to determine if this test can correlate with renal biopsy results during a 1-year period when the dd-cfDNA test was initiated in our medical center.

Design: Renal transplant biopsies were evaluated for various rejection and nonrejection etiologies. Their corresponding dd-cfDNA percentages were identified. The biopsy data and dd-cfDNA results were correlated.

Results: During a year, we noticed a trend …

Hiv-Associated Nephropathy Presenting As The First Manifestation Of Hiv-2 Infection, Kamil Sardarli, Rania Daboul, Sumesh Khanal, Sami Zarouk

Conference Presentation Abstracts

HIV-2 is distinguished from HIV-1 with low virulence, longer asymptomatic period, slower decline in CD4 count, low viral load, and low mortality from AIDS. While the kidney pathology associated with HIV-1 is well established, due to its low prevalence, kidney pathology in HIV-2 is not well documented. We report a case of HIV associated nephropathy (HIVAN) as the first presentation in a patient with HIV-2. A 65 year old man from Ghana presented within a few days of arrival to the United States with nausea, loss of appetite, shortness of breath, and bilateral lower extremity edema. He has a past …

Impact Of Difelikefalin On 5d-Itch Domains In Patients With Ckd-Associated Pruritus, Anjay Rastogi, Joel M. Topf, Thilo Schaufler, Isabelle Morin, Frederique Menzaghi, Warren Wen, Kieran Mccafferty

Conference Presentation Abstracts

Background: Chronic kidney disease-associated pruritus (CKD-aP) is common in hemodialysis (HD) patients, impacting quality of life (QoL). In the Phase 3 KALM studies, difelikefalin (DFK), a selective kappa opioid receptor agonist approved in the United States and Europe for the treatment of moderate–severe pruritus in adults undergoing HD, improved itch intensity and QoL. The impact of DFK treatment on the subdomains of the 5D-itch scale (a multidimensional questionnaire validated in patients with chronic pruritus) were explored.

Methods: In this pooled KALM-1 and KALM-2 analysis (n=712), HD patients with moderate–severe CKD-aP were randomized 1:1 to receive intravenous DFK 0.5 µg/kg or …

#Askrenal: Use Of An Automated Twitter Account To Crowdsource Nephrology Queries, Jade M. Teakell, Alicja Rosolowska, Swapnil Hiremath, Matthew A. Sparks, Edgar V. Lerma, Joel M. Topf, Nikhil A. Shah

Conference Presentation Abstracts

Background: Social media platforms are used in contemporary crowdsourcing, and Twitter is apt for reaching a large number of people with a common interest. Users, especially those with a small follower count may find it challenging to reach a large audience. #AskRenal was developed as a Twitter crowdsourcing tool to help users get answers to nephrology questions. We hypothesized that the #AskRenal hashtag could be used by anyone to receive helpful and timely responses to simple or complex nephrology questions posed on the social media platform. Methods: A Twitter account @AskRenal, and an online Twitter bot that automatically retweeted any …

Dual Paraneoplastic Syndrome In Small Lung Cancer, Kamil Sardarli, Austin M. Morris, Jamal Abukhaled

Conference Presentation Abstracts

Introduction: Small cell lung cancer (SCLC) is an aggressive neuroendocrine lung cancer associated with paraneoplastic syndromes – syndrome of inappropriate ADH (SIADH) in 7-16% of cases and Ectopic ACTH Syndrome (EAS) in 3.5-4.3% of cases. Both syndromes are associated with a poor prognosis in patients with SCLC. We describe a patient who presented with SIADH, leading to a diagnosis of SCLC who subsequently developed EAS. Case Description: A 71-year-old female with a past medical history of hypertension, depression, and tobacco use presented with lethargy. She noted headache, but otherwise was unable to provide history due to altered mentation. Per her …

Recurrent Focal Segmental Glomeruloscleosis Progressing To Collapsing Glomerulopathy In Renal Graft Of An Autopsy Study, C Thorburn, K J Jabbar, W Li, H Kanaan, P Zhang

Conference Presentation Abstracts

Introduction/Objective: Collapsing glomerulopathy (CGN) mainly occurs in patients of African descent because a majority of these patients have APOL-1 gene mutations that results in damage of terminally differentiated podocytes, diffuse fusion of foot processes, and podocyte hyperplasia. Idiopathic FSGS is associated with high rates of recurrent FSGS in renal transplants and can be seen in patients with APOL-1 gene mutations as well, but recurrent FSGS progressing to CGN is not reported. Here we report an autopsy case with renal transplant showing recurrent FSGS progressing to CGN. Methods/Case Report: Our patient was a 32 year old African American man who had …

Acute Renal Failure And An Acid-Base Dilemma, Kamil Sardarli, Russell Leong, Matthew Weatherhead, Bhavinkumar Dalal

Conference Presentation Abstracts

Introduction: Acute renal failure (ARF) is well-recognized to result in metabolic acidosis. The acidosis of ARF is associated with decreased ammoniagenesis and anion excretion. Alkalosis in the presence of ARF presents diagnostic uncertainty and therapeutic challenges. This vignette describes a case of ARF resulting in several electrolyte imbalances and metabolic alkalosis. Case Description: A 54-year-old female with past medical history of small bowel resection with colostomy presented for nausea and vomiting for two weeks. On presentation, she was noted to be tachycardic and lethargic. Her workup revealed a serum creatinine of 6.8 mg/dL, blood urea nitrogen of 147 mg/dL, bicarbonate …

Mosaic Pattern Of Progenitor Cell Marker Cd133 Expression To Identify Podocyte Proliferation Supports Collapsing Variant Of Focal Segmental Glomerulosclerosis (Fsgs), A Xiao, H Kanaan, W Li, P Zhang

Conference Presentation Abstracts

Introduction: Previous studies using immunofluorescent methods indicate that both the cellular crescents in crescentic glomerulonephritis and the podocyte proliferation in collapsing FSGS may both originate from parietal epithelial cells, which serve as CD133 positive progenitor cells. We have previously confirmed positive CD133 staining in the cellular crescents of crescentic glomerulonephritis. However, the role of CD133 expression in highlighting the proliferative podocytes in collapsing FSGS has not been adapted to the renal pathology practice. Methods: We have identified 19 collapsing FSGS from our archive over past 10 years (out of 3942 renal biopsies, 0.5 %). The collapsing FSGS cases were either …

A Patient With Combined Metformin-Induced Lactic Acidosis And Euglycemic Diabetic Ketoacidosis, Kamil Sardarli, Russell Leong, Inayat Gill, Sami S. Zarouk

Conference Presentation Abstracts

Introduction: Metformin is a small, non-protein-bound molecule that can cause lactic acidosis in 6 out of 100,000 patients with a mortality rate of 30-50%. Concurrent euglycemic diabetic ketoacidosis (DKA) from sodium-glucose co-transporter-2 (SGLT2) inhibitor has been reported in one case. We report a unique case of a patient with acute kidney injury (AKI) in the setting of metformin-induced lactic acidosis and osmotic diuresis due to euglycemic DKA complicated by celecoxib use. Case Description: A 66-year-old female with a past medical history of type 2 diabetes mellitus for 21 years on metformin 1000 mg twice daily and empagliflozin 25 mg daily …

Diagnosis Of Early Delayed Graft Function (Dgf) Using Timp-2*Igfpb-7 Product In Transplant Recipients: Preliminary Results, Russell Leong, Cassandra Rodd, Kellyann M. Gomes, Solomiia Savedchuk, Paul S. Kellerman

Conference Presentation Abstracts

Background: DGF is acute kidney injury (AKI) defined as need for dialysis within one week of renal transplant. AKI is defined by a change in serum creatinine (SCr), however early recognition is limited by delay in creatinine rise. Accurate early biomarkers may lead to prevention or treatment of established AKI. The product of two novel biomarkers of cell cycle arrest, tissue Inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IGFBP-7) have shown promise in predicting AKI. In prior studies, TIMP-2*IGFPB-7 ≤0.3 had high negative predictive value, and ≥2 high positive predictive value for AKI. Aims - 1) Investigate …