Ultrafiltration vs. Conventional Diuretics in Acute Decompensated Heart Failure–A Meta Analysis

NKF 2017 Spring Clinical Meetings Abstracts Gustavo Borda, Ashfaq Balla. Metrowest Medical Center, Framingham, MA, USA A NEW HORIZON: AAV + ANTI-GBM DISEASE TREATED WITH 59 A Sevelamer Induced Crystal Colitis: A Case Report of RITUXIMAB BASEDDiffuse REGIMEN a Rarely Reported Side Effect Gerald Shovlin, Jason George, Rajesh Govindasamy, Ion D. Bucaloiu, Geisinger Medical Center,Michael Danville,Cruise, PA, USA Samir Brahmbhatt, James Simon. Cleveland Cases Anti-GBM disease with positive ClinicofFoundation, Cleveland, OH, ANCA USA antibodies have outcomes. We present here a 61 been Antraditionally Unusualassociated Case with of worse Hyponatremia Attributed to rare case of overlap anti-GBM disease with positive ANCA, Trimethoprim-Sulfamethoxazole Therapy successfully treated with 1 dose of IV Cytoxan followed by 2 Rituxan Adam Bsiso, Michael Sheffield, Roberto Collazoinfusions. Maldonado. Dallassignificant MedicalforCenter, Dallas, TX, A 62 y/o womanMethodist with past history COPD came to the USA for chest pain and was found to have severe renal failure that hospital over the course ofCausing a month. Bacterial-Endocarditis Her creatinine (Cr) was 9.0Asso62 progressed Enteroccous Species mg/dL. month prior, she was seen department for ciatedA Glomerulonephritis in in anthe Atemergency Risk Population dysuria, creatinine was 0.6 mg/dL and a urinalysis showed proteinuria Emma Bueno, Keyrillos Rizg, Mario Cisneros, Juan Chique and hematuria. Hemodialysis was initiated due to volume overload and Figueroa, Ryan Kunjal, Andreea Poenariu, Raafat F anuria. Antibody studies were suspicious for p-ANCA with a high titer Makaray. University of Florida College of Medicineanti-MPO consistent with MPA vasculitis. Anti GBM were present at Jacksonville, Jacksonville, FL, USA 1.9AI. Pulse methylprednisolone therapy was started intravenously 65 daily Recurrent a Renal Allofor 3 daysThrombotic followed by 60Microangiopathy mg prednisone daily.inPlasmapheresis graft: A Clinical Conundrum was initiated on alternate days, with albumin replacement. Renal biopsy showed glomeruli, Jose of which globally sclerosed, 70-80% crescent Olivia11 Campa, A. 1Morfin. University of California formation severe acute tubular injury, and linear deposition of IgG Davis, with Sacramento, CA, USA on immunofluorescence. A dose of Cytoxan 15 mg/kg IV was followed 68 A Rare Case of Neonatal Bartter Syndrome by two weekly Rituximab 375mg/m2 infusions. Following the second 1 2 1 Tushar Chaturvedi , Rupesh Raina . Akron Nephrology rituximab infusion the patient developed leukopenia, anemia and sepsis 2 Associates, Akron, Workup OH, USA; requiring hospitalization. revealed Cleveland nocardia and Clinic CMV Akron General,She Akron, OH, USAtreated with meropenem and pneumonia. was successfully During her second week ofAnion hospitalGap stay,in theapatient 71 ganciclovir. An Unusual Case of Negative Patient with experienced renal recovery (serum creatinine down to 2.8 mg/dL) and Hypercalcemia anti-MPO and anti-GBM titers were undetectable at 30 days after initial Avantika Chenna, Pradeep Reddy Thodima, Rasib Raja. therapy. This case suggests that a Rituximab based regimen may be an Albert Einstein, Philadelphia, PA, USA effective treatment option for ANCA positive anti-GBM disease. 74 Atypical Presentation of Metastatic Esthesioneuroblastoma with Ectopic ACTH Syndrome After 7 Years 298Vamsi Chilluru, Jay Hawkins. University of Nebraska Medical Center,SYNDROME, Omaha, NE, USA NUTCRACKER SPECTRUM OF ANATOMY MANIFESTATIONS: A CASE SERIES: Siddiqui, Al 86AND Prosthetic Valve Endocarditis from Waqas Mycobacterium Jonathan Lee, Infection Jen Schwartz, GregoryGranulomatous Varghese, Christopher Kern, Chimaera Causing Interstitial Navneet Kaur, Hasan Arif, Sandeep Aggarwal, Drexel University Nephritis College of Medicine, Philadelphia, PA, USA. Jonathan syndrome Da Costa,(NCS) Ahmed Abdalrhim, Ivan Porter, Peter Nutcracker is a rare cause of unexplained hematuria Cortese, Nabeel Mayo aorta Clinic, andFitzpatrick, refers to the Cherise entrapment of left renal vein Aslam. (LRV) between and proximal superior FL, mesenteric Jacksonville, USA artery (SMA) where the angle is reduced o (degres) LRV compression. < 35 87to Health or resulting Beauty: inAthe Case of an Unusual Cause of Severe We present two cases with unexplained painful gross hematuria in twoHypercalcemia females in their mid-thirties of unknown etiology. Clinically they hadGulshan pelvic pain and congestion. Infectious,Hilmer uro-gynecological and Dangol, Sashi Ariyaratne, Negrete. St. rheumatologic workup was Hospital, negative. Youngstown, NCS was identified by renal Elizabeth Youngstown OH, USA venous Doppler studies in both cases. In the first patient CT without 88contrast Recurrent Dense Disease: Report of syndrome, Two Casesenlarged with showed pelvic venousA congestion Varying Presentations, Findings andextra-renal Patient collateralized left ovarian veinPathologic and lower pole LRV. The Outcomes LRV was markedly narrowed, measuring 1.6mm compared to 13mm onDilini the right.Daswatta, It was compressed SMA Carla and aorta and theEmory takeoff Sharonbetween Graves, Ellis. of the left renal artery. Renal auto-transplant was attempted but failed University, Atlanta, GA, USA because of extensive venous collateral and patient later on required 90total Crystalglobulin-Induced Nephropathy and Keratopathy hysterectomy for the recurrence of symptoms. Her renal function remains stableD’Costa, after 4 years and with solitary Joe kidney. In theSamih second Matthew Sandhya Manohar, Grande, patient abdomen with contrast disclosed narrowed angle between Nasr,CT Marie C. Hogan. Mayo Clinic, Rochester, MN, USA SMA and aorta of 32o (Normal = 90o) with distance measuring 6 mm 91(normal Vitamin C Induced Oxalate Nephropathy > 8mm) and the IR veno-gram revealed pressure gradient across the area of compression 1 mmHg (normal < 1mmHg) Matthew D’Costa, Loren ofHerrera Hernandez, Sandra suggestive of Mayo LRV Clinic, hypertension. No MN, interventions Herrmann. Rochester, USA were done. Symptoms reduced over months following discharge from daily to non92daily A Case of Severe Hyponatremia Acute Kidney Injury frequency. Of note, her renal biopsyand bared glomerular congestion. The treatment of NCS is controversial ranging from conservative Eddy DeJesus, Nasr, Rabih. Bronx Lebanon Hospital surveillance, LRV NY, stenting Center, Bronx, USAto auto-transplant. NCS also must be differentiated from Nutcracker Phenomenon which refers to anatomic 103andAcute Glomerulonephritis Post in Administration of hemodynamic abnormalities of NCS the absence of clinical Pegfilgrastim manifestation as it may lead to unnecessary investigations and interventions. ThisNaheed diagnostic and treatment heterogeneity warrants Hatem Elabd, Ansari, Belinda Jim. Jacobi Medical larger studies to guide clinical Center, New York, NY, approach USA in such cases.

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108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome ULTRAFILTRATION VS CONVENTIONAL DIURETICS IN Thomas Frohwein, SusanHEART Kim, FAILURE Isaiarasi Gnanasekaran. ACUTE DECOMPENSATED – A META ANALYSIS: Waqas Siddiqui, MyriamHealth Vela-Ortiz, JesseBronx, Goldman, Lincoln Medical and Mental Center, NY, Sandeep USA Aggarwal, Drexel University College of Medicine, Philadelphia, PA, USA 110 Treatment Diagnosiswith andUltrafiltration Treatment of Renal Thrombosis (RVT) (UF) versusVein Conventional diuretics (CD) acute decompensated heartNephritis failure has and been studied in several in inthe Setting of Lupus Antiphospholipid trials with inconsistent Syndrome (APS) results. We present a systematic review of 8 randomized clinical trials (RCT’s) with regards to Cardiac and Renal Garcia, Felix Renneberg, Kohli, Steverates. Bibu, endPablo points, mortality and Maanit readmission Navya Kuchipudi, Anne Van Hoven, Shaunak Dwivedi. MEDLINE search and Systematic review of RCT’s. Total Studies = 511, Total Controlled Trials Hospital, = 38, RCT meeting end points=8. Saint Peter’s University New Brunswick, NJ, USA Subgroup analysis performed for potential source of heterogeneity. 111IBM Scleroderma Crisisand (SRC) in the of Systemic SPSS (chi Renal sq, t-test relative riskSetting and odds ratio) Sclerosis Scleroderma Pregnancy 803 subjectsSine identified. UF=399, (ssSSc) CD=404.inBaseline characteristics were similarGarcia, in both arms except weight and serum creatinine that were Pablo Shaylika Chauhan, Maanit Kohli, Navya higher in CD and percent of diabetics which were higher in UF Kuchipudi, Shaunak Dwivedi. Saint Peter’s University arm (Table 1). Fluid removal and weight loss were significantly higher Hospital, New in Brunswick, NJ,and USA in UF arm. Change creatinine pre post treatment was same in arms.Eyes Mortality similarInsufficiency in both the arms in but A readmission 121bothRed andwasRenal Middlewas Age significantly reduced in the UF arm. (Table 1-Outcomes). Gentleman In our analysis, compared to CD, UF had comparable renal outcomes Maryam Gondal, Heidi Turner. Yale with higher fluid removal and Mae weightTimbol, loss and Jeffery significantly reduced readmission rates. heterogeneity University, NewTrial Haven, CT, USAwas a limitation. Large multicenter RCT with extended follow up is required. 125 Atypical Case of Behcet’s Disease Leading to IGA Table 1 UF n=399 CD n=404 p- value Nephropathy DISTINCTIVE BASELINE CHARACHTERISTICS Sanjeev Gupta, Anastasios Papanagnou, Yorg Al-Azzi. 99.5±17.5 102.6±18.2 0.001 Baseline Weight (Kg) Westchester Medical Westchester, NY, USA 1.62±0.5 1.72±0.54 0.009 Baseline Creatinine (mg/dl)Center, 228 (57)as Status 192 (48)Epilepticus 0.002 in a of Diabetics (%) Presenting 126Number Cefepime Toxicity NOTABLE OUTCOMES Patient with End Stage Renal Disease 10.1±6.7 1 7.9±5.5 0.0001 Fluid Removal (L)1 1 , Jayaprakash Dasari ,6.1±7.2 Aziz Bakhous , Raed Mohit Gupta 6.9±5.7 0.05 Weight Loss 1 (Kg) 1 1 Azzem , Donald Dumford , Patrick Gallegos , 0.64 Rupesh Change in Creatinine (mg/dl) 0.002±0.9 0.063±1 Raina1. 1Cleveland Clinic 57/384 Akron General, OH, USA 57/389Akron,0.99 Mortality 78/330 111/334 0.0063SympReadmission 129 Tenofovir(Days) Causing Hospitalization Due to Severe tomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 300 Westchester Medical Center, Valhalla, NY, USA BONE RESORPTION: BOON DISGUISE 130 The Significance of INAnti-Phospholipase Antibodies in a Priyamvada Salloum, Vipul Chitalia, Boston University, MA, 02118 PatientSingh, withElias Membranous Nephropathy A 68-year-old male with CKD stage 5 presented with progressive neck pain Mohit Gupta, Dasari, Raina, Pallavi and neck deformity withJayaprakash close to 90-degree flexion.Rupesh Examination revealed Reddy. Akron compromise. General, Akron, OH, USA striking cervicalCleveland kyphosis butClinic no neurological The X-ray (figure A), CT and MRI studiesCase showed unstable C5-C6 compression 132 A Mystery of an Blood Leak Alarm Goingfracture, On 80% loss of vertebral height, severe kyphotic deformity, canal narrowing, and cord Seifeldin Hakim, Rhyan Maditz, Sadichhya Lohani, Sami edema. Oakland Beaumont Hospital, HeZarouk. had refused dialysis forUniversity two years. HisWilliam persistently high phosphorus and Royal Oak,hormone MI, USA intact-parathyroid (>2500 ng/ml) supported secondary hyperparathyroidism. Sestamibi scanANCA showed three parathyroid adenomas.PreHe 133 Previously Undiagnosed Associated Vasculitis underwent an emergency corpectomy, and spinal fusion. He was initiated on senting One Month After Kidney Transplantation hemodialysis along with the medical management for secondary Ayman Hallab, Kannegolla, Mohammad S. Yaqub. hyperparathyroidism andKarthik planned for parathyroiectomy. Explanted bone showed no evidence of brownSchool tumor. of Medicine, Indianapolis, IN, Indiana University Despite USAsevere kyphotic deformity from bone resorption, this is an exceptional case to have escaped from cord injury, primarily due to slow 149 Case Report of a Dialysis Dependent Immunotactoid progression of kypho-scoleosis that permitted sufficient stretching of cord to with Favorable to for Rituximab avoidGlomerulopathy cord compression! Nevertheless, it is anResponse alarming case both patients, 3 and medical of the life-threatening consequences that can Bhojwani2, Glen Markowitz , Aaron Mehakprofessionals Idrees1, Rohan 4 1 medical management of the bone-mineral disease. happen from delayed Dommu . Griffin Hospital, Derby, CT, USA; 2Fairview Hospital, Cleveland, OH, USA; 3Columbia University, New York, NY, USA; 4Nephrology Associates, Bridgeport, CT, USA 150 De Novo Atypical Hemolytic Uremic Syndrome Fourteen Months After Renal Transplant Olusola Isikalu, Jennifer Thompson, Maria Aurora Posadas Salas. Medical University of South Carolina, Charleston, SC, USA 151 “Lone” Lupus Nephritis: A Seronegative, Histopathological Diagnosis Jamal Janjua, Pratima Kamada, Aiman Riaz. Gundersen Health System, La Crosse, WI, USA

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