Ammonium Excretion Rate is Directly Associated with Urine Transforming Growth Factor-β1 in CKD

NKF 2017 Spring Clinical Meetings Abstracts Gustavo Borda, Ashfaq Balla. Metrowest Medical Center, Framingham, MA, USA RHABDOMYOLYSIS CAUSING ACUTE KIDNEY INJURY 59AFTER Sevelamer Induced Diffuse Crystal Colitis: A Case Report of LAPAROSCOPIC LIVING DONOR a Rarely Reported Side Effect Christine Du, Maria C NEPHRECTOMY: Jason C George, Bermudez, Geisinger Medical Center, Danville, PA, USA. Samir Brahmbhatt, Michael Cruise, James Simon. Cleveland Laparoscopic donor nephrectomy (LDN) is a frequently-used Clinic Foundation, Cleveland, OH, USA surgical technique for harvesting renal allografts. 61Rhabdomyolysis An Unusualis known Case but of rare Hyponatremia Attributed cause of acute kidney injury to Trimethoprim-Sulfamethoxazole Therapy (AKI) after laparoscopic donor nephrectomy with various risk factors that have yet toMichael be fully elucidated. Adam Bsiso, Sheffield, Roberto CollazoAMaldonado. 38 year-old male (weightDallas 123 kg, body mass indexDallas, 33.1) TX, Methodist Medical Center, with no medical problems underwent LDN. Pre-operative USA creatinine level was 1.1 mg/dL. He was taken to the OR and 62placed Enteroccous Speciesdecubitus Causingposition. Bacterial-Endocarditis in a right lateral All joints were Associated padded Glomerulonephritis an At Risk Population properly and supported.in Propofol, fentanyl and inhaled sevoflurane were administered. Dissection difficult dueChique to a Emma Bueno, Keyrillos Rizg, Mario was Cisneros, Juan large amount ofRyan peri-nephric fat. Andreea Total OR time was 6.5 hrs with F Figueroa, Kunjal, Poenariu, Raafat noMakaray. significant intra-operative No nephrotoxic University ofhypotension. Florida College of Medicinemedications or intravenous contrast were given. Post-op labs Jacksonville, Jacksonville, FL, USA showed creatinine of 1.7 mg/dL, BUN 12 mg/dL. He developed 65bilateral Recurrent Thrombotic Microangiopathy inwith a Renal Allobuttock and posterior right shoulder pain graft: Adark Clinical associated urine Conundrum on post-op day #1. Labs 14 hours post-op showed 2.1 mg/dL with serum creatinineofkinase Oliviacreatinine Campa,ofJose A. Morfin. University California (CK) levelSacramento, of 17,827 units/L. Urinalysis was largely positive for Davis, CA, USA blood but with only 20-29 RBC’s. Urine myoglobin level was 6850,500 A Rare Case of Neonatal Syndrome mcg/L (reference rangeBartter <28mcg/L). He was treated with 1 2 1 normal saline infusion and oral sodium bicarbonate urinary Tushar Chaturvedi , Rupesh Raina . AkronforNephrology 2 alkalinization. post-opOH, day #7, CK level decreased to 820Akron Cleveland Clinic Associates, By Akron, USA; units/L with Akron, creatinine of 1.8 mg/dL. He remained non-oliguric General, OH, USA without need of renal replacement therapy. 71 An Unusual Caseisof Negative Anion Gap a Patient Rhabdomyolysis a rare cause of AKI in thein setting of with Hypercalcemia laparoscopic donor nephrectomy. Identification of potential risk factors, including male gender, mass index, Avantika Chenna, Pradeepincreased Reddy body Thodima, Rasib Raja. prolonged surgery time, lateral decubitus position and use of Albert Einstein, Philadelphia, PA, USA inhaled anesthetic is critical for prevention of severe renal injury. 74 Atypical Presentation of Metastatic Esthesioneuroblastoma with Ectopic ACTH Syndrome After 7 Years 114Vamsi Chilluru, Jay Hawkins. University of Nebraska MedicalINCenter, Omaha, NE, USA TRENDS HOSPITALIZATION, EMERGENCY DEPT AND STAYS IN PREVALENTfrom HEMODIALYSIS 86OBSERVATION Prosthetic Valve Endocarditis Mycobacterium PATIENTS: Kidney Care InitiativeGranulomatous Investigators, Minneapolis, ChimaeraPeer Infection Causing Interstitial MN, USA Nephritis Hospitalization rates continue to decrease for prevalent Medicare Jonathan patients, Da Costa, Ahmed Ivanencounters Porter, Peter hemodialysis while rates ofAbdalrhim, emergency dept. Fitzpatrick, Cherise Cortese, Nabeel Aslam. Clinic, (EDE) and observation stays (OBS) have increased. WeMayo examined concurrent trends of acute interactions with the healthcare system Jacksonville, FL,these USA in prevalent hemodialysis patients. 87 Using Health or Beauty: A Case of an Unusual Cause of Severe data obtained from the USRDS for 2004-2013, we computed Hypercalcemia unadjusted hospitalization, EDE and OBS rates. Hospitalizations declined fromAriyaratne, 206 to 164 perHilmer 100 pt years, while St. Gulshan Dangol, Sashi Negrete. EDE/OBS rates increased, from 166 in 2004 to 200 per 100 years by Elizabeth Youngstown Hospital, Youngstown, OH,pt USA the end of 2013. The combined burden of hospitalizations or ED/OBS 88wasRecurrent Dense until Disease: Twothereafter, Cases with relatively constant 2011, A butReport declinedof slightly Varying Presentations, Findings and Patient reaching 350 per 100 pt years inPathologic 2013. Outcomes Dilini Daswatta, Sharon Graves, Carla Ellis. Emory University, Atlanta, GA, USA 90 Crystalglobulin-Induced Nephropathy and Keratopathy Matthew D’Costa, Sandhya Manohar, Joe Grande, Samih Nasr, Marie C. Hogan. Mayo Clinic, Rochester, MN, USA 91 Vitamin C Induced Oxalate Nephropathy Matthew D’Costa, Loren Herrera Hernandez, Sandra Herrmann. Mayo Clinic, Rochester, MN, USA 92 A Case of Severe Hyponatremia and Acute Kidney Injury Eddy DeJesus, Nasr, Rabih. Bronx Lebanon Hospital Center, Bronx, NY, USA 103 Acute Glomerulonephritis Post Administration of EDE/OBS rates have now exceeded hospitalization rates, and Pegfilgrastim decreases in hospitalizations have been mostly offset by increases in Hatem Elabd, Naheedacute Ansari, Belinda Jim. Medical EDE/OBS. The combined interactions with the Jacobi healthcare system York,per NY, USA areCenter, almost 4New per patient year.

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Am J Kidney Dis. 2017;69(4):A1-A105

108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome AMMONIUM EXCRETION RATE IS DIRECTLY ASSOCIATED Thomas Susan GROWTH Kim, Isaiarasi Gnanasekaran. WITH URINE Frohwein, TRANSFORMING FACTOR-1 IN CKD: Mental Bronx, NY, SarahLincoln Gilligan,Medical Kalani L.and Raphael, Salt Health Lake CityCenter, VA & University of Utah,USA Salt Lake City, UT, USA production increases maintain serum tCO CKD, renal and NH3 Treatment 2 in 110In Diagnosis of RenaltoVein Thrombosis (RVT) the normal In animal modelsNephritis of CKD, enhanced renal NH3 in therange. Setting of Lupus and Antiphospholipid production activates the alternative pathway of complement in the Syndrome (APS) kidney, contributing to renal fibrosis. Whether high renal NH3 is Pablo with Garcia, Renneberg, Maanit Kohli, Bibu, associated renal Felix fibrosis in human CKD has not been Steve evaluated. Using multivariate linear Anne regression, determined the relationship Navya Kuchipudi, VanweHoven, Shaunak Dwivedi. between kidneyUniversity profibrotic marker urinary SaintthePeter’s Hospital, Newtransforming Brunswick,growth NJ, USA factor-1, indexed to urine Cr, (uTGF-1/Cr) as the dependent variable 111 Scleroderma Renal Crisis (SRC) + in the Setting of Systemic and the independent variables (i) uNH4 excretion rate (mEq/hr), (ii) Sine (TA) Scleroderma in Pregnancy urineSclerosis titratable acids excretion (ssSSc) rate (mEq/hr), and (iii) serum tCO2 (mEq/L) in 144 stage 2-4 CKD patients. FromMaanit timed urine collections, Pablo Garcia, Shaylika Chauhan, Kohli, Navya + and urine Dwivedi. TA by the formalin-titrimetric method we measured uNH4Shaunak Kuchipudi, Saint Peter’s University and uTGF-1 ELISA. The multivariate linear regression models Hospital,byNew Brunswick, NJ, USA were adjusted for demographics, eGFR, proteinuria, diabetes mellitus 121 Red Eyes and Renal Insufficiency Age + of (DM) status, SBP, BMI, serum K , protein intake,inandAuseMiddle Gentleman ACE/ARB and/or alkali. Cohort characteristics 65 years,Jeffery 78% male, 95% Yale nonMaryam Gondal, were: Heidimean Maeage Timbol, Turner. Hispanic white, 62% DM, mean SBP 125 mm Hg, mean eGFR 42 University, New Haven, CT, USA mL/min per 1.73m2, mean uNH4+ excretion 1.27 mEq/hr, mean TA 125 Atypical Case and of mean Behcet’s Leading Log-to IGA excretion 1.14 mEq/hr, serum Disease tCO2 23 mEq/L. Nephropathy transformed uTGF-1/Cr was higher with each 1 mEq/hr higher uNH4+ (0.28Sanjeev ng/gm, 95% CI, 0.14-0.42). There was no association Gupta, Anastasios Papanagnou, Yorgbetween Al-Azzi. log-transformed and eachWestchester, unit higher urine excretion WestchesteruTGF-1/Cr Medical Center, NY,TA USA rate (0.04 ng/gm, 95% CI -0.14 to 0.22) or serum tCO2 (0.02 ng/gm, 126 Cefepime Toxicity Presenting as Status Epilepticus in a 95% CI -0.01 to 0.05). Patient with End Stage Renal Disease is positively associated with uTGF-1, whereas uNH4+ excretion 1 Jayaprakash Dasari , Aziz Bakhous , Raed results suggest that, in1terms urineMohit TA andGupta serum1,tCO 2 are not. These 1 1 1 associated with of theAzzem acid-base indicatorsDumford assessed, NH 3 is specifically , Donald , Patrick Gallegos , Rupesh 1 1 in CKD. Interventions that lower renal NH3 production kidney fibrosis Raina . Cleveland Clinic Akron General, Akron, OH, USA may reduce renal fibrosis and preserve renal function in CKD. 129 Tenofovir Causing Hospitalization Due to Severe Symptomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 116 Westchester Medical Center, Valhalla, NY, USA URINE AMMONIUM, BUT NOT URINE ANION GAP, PREDICTS 130 The Significance of Anti-Phospholipase Antibodies in a RENAL AND SURVIVAL OUTCOMES IN CKD: Sarah Gilligan1, Patient Membranous 2 1 Joachim H. Ixwith , Kalani L. Raphael1,Nephropathy University of Utah, Salt Lake 2 UCSD, San Diego, CA, USA Rupesh Raina, Pallavi City,Mohit UT, USA; Gupta, Jayaprakash Dasari, + + excretion predicts ESRD Akron, and deathOH, in CKD. Low urine NH 4 (uNH4 )Clinic Reddy. Cleveland Akron General, USA However, most clinical labs do not measure uNH4+. We evaluated the 132 A Mystery Case of Blood Leakgap Alarm On ) and UAG that correlation between standard urine anion (UAGGoing STD + SO4 (UAG included measurements PO4 andMaditz, Seifeldin Hakim,ofRhyan Sadichhya Lohani, PLUS) with uNH 4 and Sami + clinical outcomes in CKD. whether these estimates ofUniversity uNH4 predict Zarouk. Oakland William Beaumont Hospital, + + + WeRoyal measured NHMI, 4 , Na , K , Cl , PO4, and SO4 from 24-hour urine Oak, USA collections obtained at baseline from participants in the African 133 Previously ANCA Associated(n=1044). Vasculitis PreAmerican Study ofUndiagnosed Kidney Disease and Hypertension + + as (Na + KKidney – Cl-) and UAGPLUS as (Na+ + K+ UAGsenting One Month After Transplantation STD was calculated – PO4 – SO – Cl-Ayman 4) in mEq/day. We determined pairwise correlations Hallab, Karthik Kannegolla, Mohammad S. Yaqub. between uNH4+ and (i) UAGSTD and (ii) UAGPLUS. Cox regression Indiana University School measured of Medicine, Indianapolis, models (adjusted for demographics, GFR, proteinuria, net IN, USA acid production, serum K+ and tCO2, smoking, SBP, heart endogenous disease, BMI, and use of ACE-i/ARB diuretics) determined the 149 Case Report a Dialysisand/or Dependent Immunotactoid + UAGPLUS. hazards of ESRD or death by tertiles of uNH 4 , UAGSTD Glomerulopathy with Favorable Response to, and Rituximab + instead of negative, UAGSTD had a positive, 1 2 correlation with uNH 3 4 , Rohan , Glen Markowitz , Aaron Mehak Idreeswas and the correlation low (r =Bhojwani 0.18). The correlation of uNH4+ and 4 1 2 . the Griffin Hospital, expected direction Derby, (negative)CT, and USA; moderateFairview (r = UAGDommu PLUS was in 3 -0.72). Compared to those in OH, the highest the HRUniversity, for those in the Columbia New Hospital, Cleveland, USA;tertile, were 1.11Bridgeport, (95% CI, 0.86middle and lowest tertiles4of uNH4+ excretion York, NY, USA; Nephrology Associates, CT, 1.43) and 1.47 (95% CI, 1.13-1.91), respectively. Compared to those in USA + the lowest tertile of UAGSTD (corresponding with higher uNH4 ), the 150 Novoin Atypical Uremic Syndrome 0.85 HRs De for those the middle Hemolytic and highest tertiles of UAG STD wereFourteen (95%Months CI, 0.67-1.08) 0.85Transplant (95% CI, 0.65-1.10), respectively. After and Renal Compared to those in the lowest tertile of UAGPLUS (corresponding Olusola Isikalu, Jennifer Thompson, Maria Aurora Posadas with higher uNH4+), the HRs for those in the middle and highest tertiles Salas. Medical University of South Carolina, Charleston, of UAG PLUS were 0.98 (95% CI, 0.77-1.25) and 0.98 (95% CI, 0.76SC, USA 1.27), respectively. better correlation measurements that includeAPOSeronegative, 4 and SO4 have Histopathological 151UAG “Lone” Lupus Nephritis: with uNH4+ than UAG that only considers Na+, K+, and Cl-. Diagnosis Nevertheless, these estimates of daily uNH4+ excretion do not predict + Jamal Janjua, Pratima Kamada, Aiman clinical outcomes in CKD and should not replace uNHRiaz. 4 as a Gundersen prognostic Healthmarker. System, La Crosse, WI, USA

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