The complement system has been recently proposed to play an important role in the pathogenesis of ANCA-associated vasculitis (AAV). This study evaluated the value of serum and kidney deposited C3 i...

Background/Objectives: Glomerulopathy is a term used to describe a broad spectrum of renal diseases, characterized by dysfunction of glomerular filtration barrier, especially of podocytes. Several podocyte-associated proteins have been found and proved their usefulness as urine markers of podocyte dysfunction. Two of them are nephrin (NEP) and prodocalyxin (PDC). This study aims to evaluate the association of podocyte damage, as it is demonstrated via the concentrations of urinary proteins, with clinical and histological data from patients with several types of glomerulonephritis. Methods: We measured urine levels of two podocyte-specific markers, NEP and PDC (corrected for urine creatinine levels), in patients with a wide range of glomerulopathies. Serum and urine parameters as well as histological parameters from renal biopsy were recorded. Results: In total, data from 37 patients with glomerulonephritis and 5 healthy controls were analyzed. PDC and NEP concentrations correlated between them and with serum creatinine levels (p = 0.001 and p = 0.013 respectively), and with histological lesions associated with chronicity index of renal cortex, such as severe interstitial fibrosis, severe tubular atrophy and hyalinosis (for PDC/NEP, all p < 0.05). In addition, the PDC and NEP demonstrated statistically significant correlations with interstitial inflammation (p = 0.018/p = 0.028). Regarding electron microscopy evaluation, PDC levels were correlated with distinct characteristics, such as fibrils and global podocyte foot process fusion, whereas the NEP/CR ratio was uniquely significantly associated with podocyte fusion only in non-immune-complex-mediated glomerulonephritis (p = 0.02). Among the other clinical and histological parameters included in our study, a strong correlation between proteinuria >3 g/24 h and diffuse fusion of podocyte foot processes (p = 0.016) was identified. Conclusions: Podocalyxin and nephrin concentrations in urine are markers of podocyte dysfunction, and in our study, they were associated both with serum creatinine and histological chronicity indices.

Introduction: Glomerulopathy is a term used to describe a broad spectrum of renal diseases, character-ized by dysfunction of glomerular filtration barrier, especially of podocytes. Several podocyte-associated proteins have been found and proved their usefulness as urine markers of podocyte dysfunction. Two of them are nephrin (NEP) and prodocalyxin (PDC). Purpose: This study aims to evaluate the association of podocyte damage, as it is demonstrated via the concentrations of urinary proteins, with clinical and histological data from patients with several types of glomerulonephritis. Methods: We measured urine levels of two podocyte-specific markers, NEP and PDC (corrected for urine creatinine levels), in patients with a wide range of glomerulopathies. Serum and urine parameters as well as histological parameters from renal biopsy were recorded. Results: In total, data from 37 patients with glomerulonephritis and 5 healthy controls were analyzed. PDC and NEP concentrations correlated between them and with serum creatinine levels (p=0.001 and p=0.013 respectively), and with histological lesions associated with chronicity index of renal cortex, such as severe interstitial fibrosis, severe tubular atrophy and hyalinosis (for PDC/NEP, all p3gr/24h with diffuse fusion of podocyte foot processes (p=0.016) was identified. Conclusions: Podocalyxin and nephrin concentrations in urine represent markers of podocyte dysfunction and in our study they were associated both with serum creatinine and histological chronicity indices.

Background and Aims: The role of plasmapheresis in the overall and renal survival of patients with ANCA-associated vasculitis (AAV) has not been fully elucidated. The aim of this study is to address whether plasmapheresis is associated with improvement in renal function and survival at 12 months in patients with severe manifestations of AAV and to record the indications, adverse events and treatment characteristics. Method: Retrospective, descriptive study of 28 patients with AAV diagnosed over the last five years in a tertiary center. Patients were included if they had received therapeutic plasmapheresis adjunctive to conventional therapy (steroids and immunosuppressants) for the first episode of AAV or in relapse. Results: 12 patients (75% male) were enrolled with average age at diagnosis 78.5±6.14 years. The patients were followed for a median period of 20 months. In 75% of the patients MPO-ANCA was positive, in 17% ANCA negative and in 8% double positive anti-GBM/ANCA. On admission, all patients had abnormal renal function with average serum creatinine 5mg/dl±2.12 and the majority of patients (9/12) were dialysis dependent. Indications for plasmapheresis were: alveolar hemorrhage in 33%, renal impairment in 25% and combination of the two above in 42%. 11 patients received plasmapheresis for the first episode of AAV and 1 patient for relapse. Plasmapheresis was performed using filtration and fresh frozen plasma as replacement fluid. The mean number of plasmapheresis treatment was 8 (range 1 to 19 days) and the average internal time between admission and first plasmapheresis treatment was 3 days. One patient had a severe allergic reaction resulting in early discontinuation and no episodes of severe infection or death were recorded during plasmapheresis. As far as treatment all patients received concomitant immunosuppressive therapy with cyclophosphamide (CYC) and corticosteroids while Rituximab (RTX) was added in 3 patients (3/12). Alveolar hemorrhage was resolved in all patients (100%). After one year, 75% of the patients had renal recovery (cre=5mg/dl±2.12 vs cre=2.6mg/dl±1.6, p=0.06) and 67% of the patients who required hemodialysis at the time of diagnosis, during the first year became independent of dialysis (75% vs 33%, p=0.5). Finally, survival at the end of the first year was 83% with cancer and ischaemic heart disease being the cause of death. Conclusion: Plasmapheresis is quite often used in daily clinical practice with remarkable results in dialysis independence and survival, without serious complications. The actual role of plasmapheresis in ANCA-vasculitis therapeutic algorithm will be determined shortly with the expected results of a randomized multicenter study.

Background and Aims: Acute Kidney injury (AKI) is a serious disease with a significant social and economic burden worldwide. The epidemiology of AKI is not well defined, nevertheless the incidence of AKI in hospitalized patients is deemed to be 10- 15%. AKI is a syndrome provoked from various clinical conditions and has different management depending on the cause, the stage and the comorbidities of the patients. The aim of this study is to describe the heterogeneity of hospital acquired AKI as it concerns the underlying cause and the applied treatment as well as to emphasize on the high importance of the time of nephrology assessment Method: This is a retrospective observational single-center study, including 1082 adult patients with hospital acquired AKI according to the KDIGO guidelines, hospitalized in different departments of our hospital from January 2021 to September 2022. Patients with End Stage Renal Disease were excluded from this study. Results: A total of 1082 adult patients were recorded with median age 77 years. The majority of them had several comorbidities, 457(42%) diabetic, 424(39%) hypertensive and 442(41%) with Chronic Kidney Disease (CKD). Principal causes of AKI were cardiovascular disease (405;38%), infection (198;18%), gastrointestinal disorders (130;12%) and malignancy (103;10%). Other etiologies comprise obstructive nephropathy (45;4%), bleeding (36;3%), surgery (29;3%), cardiovascular surgery (13;1%) and miscellaneous (123;12). Management of AKI included fluid resuscitation applied in 405;37% cases, intravenous diuretic therapy applied in 241;22% patients, while 216;20% cases required hemodialysis. The mean creatinine value at assessment was 3.9±2 mg/dl while 15% of the patients had a normal admission creatinine (1 mg/dl. The mean value of hospitalization days for each of the 3 above groups was calculated as 10.8 ± 10.3, 10.7 ± 8.1 and 14.7 ± 11.4 respectively, p<0.05 for the comparisons with the 3rd group. In comparison, there was no significant difference in the treatment method of AKI between the first 2 groups, but Hemodialysis was applied more frequent in the 3rd group (44 vs 46 vs 124 patients, p<0.05 for the comparisons with the 3rd group). Regarding the difference between the creatinine levels on admission and the creatinine levels on discharge, a statistically significant difference was found between the 3 groups (p<0.05) with prevalence of worst discharge creatine levels to the third group. 15% exited with creatinine <1.3 mg/dl. In a multivariate linear regression model, it was also found that for the difference in admission-discharge creatinine levels, diabetes mellitus was an independent factor (p = 0.035) as well as the group categorized based on the increase in creatinine during assessment (p<0.01). Conclusion: Hospitalized patients in non-nephrology clinics may develop AKI and require different treatment plan as well as management of the primary cause. The heterogeneity of AKI and the need for dialysis as well as the days of hospitalization, underlines the need for close observation, personalized care, vigilance of other specialists and the cooperation with nephrologists. As it is shown from this study the early nephrology assessment is associated with fewer days of hospitalization and better outcome for the patient's renal function, as well as the severity of the treatment. As the prevalence of chronic kidney disease is rising around the world is of great importance for the patients with AKI to be able to maintain their kidney function.

Acute Kidney Injury (AKI) is a frequent clinical entity. There are three AKI definition clasifications: RIFLE, AKIN and KDIGO. The endpoint of this study is to compare KDIGO and RIFLE regarding the prediction of AKI stage and adverse outcomes and to evaluate the renal prognosis of patients with a history of chronic kidney disease (CKD), who develop AKI during hospitalization. It is a well-known fact that Diabetes mellitus (DM) is the most common cause of end-stage chronic kidney disease (CKD). The epidemiology and outcome of diabetic patients with AKI during hospitalization, needs further study and comparison with the data of non-diabetic patients. As a secondary end point of this study we observed the progression of kidney function and severity of treatment in diabetic patients with stage III AKI (KDIGO) in comparison with the non-diabetic patients. This is a retrospective epidemiological study where data of 1083 adult patients were examined with AKI, who were hospitalized in various clinics at General Hospital of Athens Hippokratio between January 2021-September 2022. A total of 1083 patients were registered (63% male, mean age 74.5 ±12.6 years). 42% suffered from diabetes mellitus, 39% from arterial hypertension and 41% from CKD. RIFLE identified fewer patients with AKI than KDIGO (69.7% vs. 100%, p<0.001). Of all patients, 45.1% corresponded to AKI stage 1 (AKI-1), 7.3% to AKI stage 2 (AKI-2) and 47.6% to AKI stage 3 (AKI-3) according to KDIGO. 41.9% of AKI-3 patients underwent hemodialysis. Of the 214 patients on dialysis, 31.8% were not identified as AKI by RIFLE. In addition, patients with a history of CKD showed a higher percentage of AKI-3 (47.1% vs. 39.3% AKI-1, p=0.003 and 13.6% AKI-2, p=0.001) and underwent hemodialysis in a higher percentage (56.6% vs. 43.4%, p= 0.002). On the secondary end point 1083 patients, 458 (42.3%) diabetic and 625 (57.7%) non-diabetic were recognized. Hemodialysis was required in 83(18%) diabetic patients and in 132(21.1%) non-diabetic patients. Patients who ended up on end stage CKD requiring chronic hemodialysis or with GFR<15ml/min/1.73 m² one month after hospital discharge were 37.7% and 51, 1% respectively. More specifically patients with the worst prognosis, who developed end stage CKD or ended up with GFR<15ml/min/1.73 m² one month after hospital discharge, were categorized in three groups according to CKD Stage at hospital admission : in group A) CKD STAGE II out of 29, 8 (27.3%) non-diabetics and out of 19, 4 (21%) diabetic, in group B) STAGE IIIa out of 30 patients 5 (16.6%) non-diabetic and out of 15 3 (20%) diabetic and in group C) STAGE IIIb out of 17 patients 8 (47%) non-diabetic and out of 20 6 (30%) diabetics. It should be mentioned that the worst prognosis was observed in patients who were hospitalized for infection out of 30, 16(63%), with prerenal AKI out of 19 patients, 10(53%) and with a cardiovascular event out of 18 patients, 6(33%). RIFLE criteria identified a lower proportion of patients with AKI compared to KDIGO, while not classifying a proportion of patients undergoing hemodialysis as AKI. Additionally, CKD was associated with worse renal prognosis in hospitalized patients with AKI. Patients with AKI on CKD who required hemodialysis during their hospitalization did not appear to have a worse prognosis at one month after discharge,compering diabetic with non-diabetic in group A and B. On the contrary there was a significant difference between patients in group C.