- Email: [email protected]
Characterizing the Burden of Anemia Among Non-Dialysis-Dependent CKD Patients
NKF 2017 Spring Clinical Meetings Abstracts Gustavo Borda, Ashfaq Balla. Metrowest Medical Center, Framingham, MA, USA IMMUNE COMPLEX GLOMERULONEPHRITIS WITH PERSISTENTLY 59NEGATIVE Sevelamer Induced Crystal Colitis: Case Metrowest Report of ANA ASSAY:Diffuse Gustavo Borda, AshfaqABalla, a Rarely Reported Side Effect Medical Center, Framingham, MA, USA Samir Brahmbhatt, Michael Cruise, James Simon. Cleveland Antinuclear (ANA) assay is a sensitive test and is positive in 97% Cleveland, OH,negative USA ANA assay remain of Clinic Lupus Foundation, patients. Lupus cases with 61rare. An Unusual Case of Hyponatremia Attributed to We present a case with biopsy suggesting Trimethoprim-Sulfamethoxazole Therapy lupus nephritis but persistently negative serum ANA assays. Adam Bsiso, Michael Sheffield, Roberto Collazo56 yr old AAF underwent kidney biopsy for 2-3 gm range Maldonado. Methodist Dallas Medical Center, Dallas, TX, proteinuria despite being on good dose of angiotensin blocker. USA Serum creatinine was elevated at 1.5 range. Biopsy showed 62 Enteroccous Species Causing Bacterial-Endocarditis Assoimmune-complex mediated glomerulonephritis with segmental ciated Glomerulonephritis in an At Risk Population membranoproliferative pattern of injury and subendothelial and Emma Keyrillos Rizg, Mario Cisneros, Juan IgM Chique mesangialBueno, immune deposits reactive for IgG, IgA, and Figueroa, Ryan Kunjal, Andreea Poenariu, Raafat F complement components (Full House Pattern). Serum ANA assay Makaray.negative University of Florida College Medicineremained on multiple occasions overoftime. Double Jacksonville, Antibody Jacksonville, USA Other labs including strength-DNA wasFL, positive. 65Complements, Recurrent Thrombotic a Renal profile, AlloRF, ENA, Microangiopathy Sjogren’s screen,inHepatitis graft: A ClinicalAntibody Conundrum Antiphospholipid and Cryoglobulins were negative. Work-up recentJose infection to explain such renal was Olivia for Campa, A. Morfin. University of deposits California negative. She also hadCA, evidence Davis, Sacramento, USA of premature vascular disease needCase for of CABG and Bartter CEA in Syndrome absence of diabetes and 68with A Rare Neonatal significant HTN that could go with Lupus. Even though ANA was 1 Tushar Chaturvedi , Rupesh Raina2. 1Akron Nephrology persistently negative her biopsy findings and other presentation 2 Associates, Akron, OH, USA; Cleveland Clinic Akron warranted treatment and she remains currently on oral General, Akron, OH, USA immunosuppression meds. 71 An Unusual Case of Negative Anion Gap in a Patient with Hypercalcemia Avantika Chenna, Pradeep Reddy Thodima, Rasib Raja. Albert Einstein, Philadelphia, PA, USA 74 Atypical Presentation of Metastatic Esthesioneuroblastoma with Ectopic ACTH Syndrome After 7 Years 58 Vamsi Chilluru, Jay Hawkins. University of Nebraska Medical Center, Omaha, IN NE, USA RISING CKD PREVALENCE THE UNITED STATES (19881 JL Bragg-Gresham V Shahinian1, H Morgenstern , N Powe2, T 86 2014): Prosthetic Valve 1,Endocarditis from Mycobacterium 2 3 3 1 1 Banerjee , NR Burrows , S Saydah , and R Saran . Univ. Michigan, Chimaera Infection Causing Granulomatous Interstitial Ann Arbor, MI; 2UCSF, San Francisco, CA; 3CDC, Atlanta, GA. Nephritis Recent findings stabilization of CKD prevalence in thePeter US Jonathan Da suggest Costa, aAhmed Abdalrhim, Ivan Porter, from 2003 to 2012. We extend this trend analysis through 2013-14 and Fitzpatrick, Cherise Cortese, Nabeel Aslam. Mayo Clinic, assess any influence from the changing prevalence of CKD risk factors. Jacksonville, FL, USA Using NHANES data on 56,064 adults aged ≥ 20 years, biannual 87 trends Health or Beauty: Case CKD of anprevalence Unusual(CKD-Epi Cause ofeGFR Severe in unadjusted and A adjusted < 60Hypercalcemia ml/min/1.73m2 or UACR ≥ 30 mg/g) since NHANES III (1988-94). Gulshan Dangol, Ariyaratne, Hilmer Negrete. Adjusted prevalence wasSashi estimated from survey-weighted logistic St. Elizabeth Youngstown Hospital, Youngstown, OH, USA regression models, standardized to the following risk-factor mean from 1988-94: sex, race,Aheight, weight, diabetes, and blood 88 values Recurrent Denseage, Disease: Report of Two Cases with pressure. Trends were examinedPathologic with ordinal variables cohorts. Varying Presentations, Findingsforand Patient Unadjusted Outcomesprevalence of CKD has fluctuated over time, with an overall increase from 12% to 15.5% from 1988-1994 to 2013-2014 Dilini Daswatta, Sharon Graves, Carla Ellis. Emory (trend p-value <0.001). When adjusting for changes in the risk-factors, University, Atlanta, GA, USA the overall rise in CKD prevalence was much smaller (1.1% vs. 3.5%). 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 ItPegfilgrastim is important to distinguish unadjusted and adjusted prevalence Hatem Naheed Ansari,needs Belinda Jim. Jacobi Medical trends whenElabd, forecasting health-care and addressing health-policy Center, New number York, NY, USAis increasing. issues, as overall of patients
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Am J Kidney Dis. 2017;69(4):A1-A105
108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome SEVELAMER INDUCED DIFFUSE CRYSTAL COLITIS: A CASE Thomas Kim, SIDE Isaiarasi Gnanasekaran. REPORT OF Frohwein, A RARELY Susan REPORTED EFFECT. Samir Lincoln Medical and Mental Bronx, Brahmbhatt, Michael Cruise, JamesHealth Simon, Center, Cleveland Clinic NY, USA Cleveland, Ohio, USA Foundation, the Treatment most commonly usedVein non-calcium containing 110 Sevelamer Diagnosisisand of Renal Thrombosis (RVT) phosphate binder in end-stage renal disease. Up to 20% of in the Setting of Lupus Nephritis and Antiphospholipid patients experience bothersome gastro-intestinal (GI) side Syndrome (APS) effects while taking it. Here we present a rarely reported, but a Garcia, FelixofRenneberg, veryPablo unique side effect sevelamer. Maanit Kohli, Steve Bibu, 40Navya years old female with end-stage renal disease on Dwivedi. Kuchipudi, Anne Van Hoven, Shaunak intermittent hemodialysis presented to New the emergency with Saint Peter’s University Hospital, Brunswick,room NJ, USA complaints of diarrhea and left lower quadrant pain for 2 days. 111 Renal Crisis Setting Systemic SheScleroderma denied hematochezia, dark(SRC) stoolsinorthe fever. Initialofworkup (ssSSc) in diarrhea. Pregnancy wasSclerosis negative Sine for anScleroderma infectious cause of the CT scan of the abdomen and pelvis with IVChauhan, contrast showed Pablo Garcia, Shaylika Maanit diffuse Kohli,colonic Navya wallKuchipudi, thickening. She underwent colonoscopy revealed a Shaunak Dwivedi. Saint that Peter’s University fungating, non-obstructing, circumferential, 6 cm mass in the Hospital, New Brunswick, NJ, USA proximal sigmoid colon, which on biopsy showed necro121 Red Eyesdebris and with Renal Insufficiency in fragments A Middle Age inflammatory embedded crystalline Gentleman consistent with sevelamer deposition. Random biopsies taken throughout colon also showed debris Yale MaryamtheGondal, Heidi Mae luminal Timbol,crystalline Jeffery Turner. consistent with sevelamer. After sevelamer was replaced with University, New Haven, CT, USA calcium acetate, her symptoms gradually resolved. 125 While Atypical Case is of Behcet’ssideDisease IGA GI distress a common effect of Leading sevelamer,tosevere diarrheal symptoms should not be attributed as a pure side effect Nephropathy alone. RatherGupta, further investigation be considered with Sanjeev Anastasios should Papanagnou, Yorg Al-Azzi. sevelamer crystal deposition being on the differential. A few Westchester Medical Center, Westchester, NY, USA cases of sevelamer crystal induced GI mucosal injury have been 126 Cefepime asisStatus in a reported in the Toxicity literature. Presenting But this case the firstEpilepticus to demonstrate diffuse colonic injury from Disease crystalline debris, showing Patient withmucosal End Stage Renal 1 1 the potential severity of this entity.Dasari It is possible many1,other , Jayaprakash , Aziz that Bakhous Raed Mohit Gupta patients with that resolve when1switched 1 diarrhea on sevelamer 1 Azzem , Donald Dumford , Patrick Gallegos , Rupesh to an alternate phosphate binder have crystalline deposition, but 1 1 Raina . Clevelandstudy, Clinic Akron, USA without a prospective theAkron exact General, frequency of thisOH, adverse reaction cannotCausing be determined. 129 Tenofovir Hospitalization Due to Severe Symptomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 60 Westchester Medical Center, Valhalla, NY, USA CHARACTERIZING THEofBURDEN OF ANEMIA AMONG NON-in a 130 The Significance Anti-Phospholipase Antibodies DIALYSIS-DEPENDENT CKD PATIENTS: Steven M. Brunelli1, Patient with Membranous Nephropathy 2 2 1 2 Shaum Kabadi , Julia Catini , Scott Sibbel , Deborah Anzalone ; 1 2 Mohit Gupta, Jayaprakash Dasari, Rupesh Raina, Pallavi DaVita Clinical Research, Minneapolis, MN, USA; AstraZeneca, Wilmington, USA Clinic Akron General, Akron, OH, USA Reddy. DE, Cleveland This study characterized CKD stage and hemoglobin (Hb) levels in a 132 A Mystery Case of Blood Leak Alarm Going Onpatients. contemporary cohort of non-dialysis-dependent (NDD) CKD Among patients enrolledRhyan in Healthcare Partners, a large medical Seifeldin Hakim, Maditz, Sadichhya Lohani, Sami stage ≥3), Hospital, no group, adults with eGFR <60 mL/min/1.73 m2 (CKD Zarouk. Oakland University William Beaumont priorRoyal historyOak, of ESRD, dialysis, or kidney transplant, who between MI, USA 7/1/2013 and 6/30/2015 had at least 1 Hb measurement while not on 133 Undiagnosed ANCA were Associated Vasculitis ESAPreviously were identified (N=26,833). Patients categorized by eGFR Presenting One Month After Kidney Transplantation of 45-59 (stage 3a, n=17,559), 30-44 (stage 3b, n=6848), 15-29 (stage and Hb S. Yaqub. 4, n=1976), <15 mL/min/1.73 m2 (stage 5, n=450) Aymanand Hallab, Karthik Kannegolla, Mohammad concentration of <9.0, 9.0-9.9, 10.0-10.9, 11.0-11.9, 12.0-12.9, and ≥13 University of Medicine,(age, Indianapolis, g/dL.Indiana In descriptive analysis,School patient characteristics sex, race, IN, USAconditions) were described. With decreasing eGFR, the comorbid proportion patients in Hb categories (<9 to 11-11.9 g/dL) 149 Case ofReport of thea lower Dialysis Dependent Immunotactoid 3a compared with increased, ranging from with 0.8%-13.0% for stage Glomerulopathy Favorable Response to Rituximab 5. For Hb ≥12 g/dL2categories, greater 3 12.0%-24.7% for stage 1 2 Rohan , Glen m Markowitz , Aaron MehakofIdrees (stage 3a and b). proportion patients, had eGFRBhojwani ≥30 mL/min/1.73 4 1 Dommu . Griffin Hospital, Derby, USA;of 2men Fairview In CKD stage 3-4, patients were younger and the CT, proportion was Hospital, highest in Hb categories OH, <9 and 9-9.93g/dL. Conversely, in stageNew Columbia University, Cleveland, USA; 5, patients and4the proportion of women higher in the lowerCT, York,were NY,older USA; Nephrology Associates, Bridgeport, Hb levels. Prevalence of comorbidities varied across eGFR and Hb USA groups. CHF prevalence was highest in the lower Hb categories for 150 De inNovo Hemolytic Uremic Syndrome Fourteen patients CKD Atypical stage 3b. The prevalences of coronary artery disease (CAD) and cardiovascular (CVD) increased in the lower Hb Months After Renaldisease Transplant categories (28%-29% for CAD, 16% for CVD) compared with the Olusola Isikalu, Jennifer Thompson, Maria Aurora Posadas higher Hb categories (21%-23% for CAD, 9%-12% for CVD) among Medical CKDSalas. stage 3b patients. University of South Carolina, Charleston, SC, USA of NDD-CKD patients with Hb <10 g/dL increased as The proportion eGFR declined. Lower Hb levels were associated withHistopathological younger age 151 “Lone” Lupus Nephritis: A Seronegative, and male sex in CKD stage 3-4 and older age and female sex in CKD Diagnosis stage 5. Further investigation is needed to determine the impact of Jamal Janjua, Pratima Aiman Riaz. Gundersen anemia on comorbidities, such asKamada, CVD. Health System, La Crosse, WI, USA
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Am J Kidney Dis. 2017;69(4):A1-A105
108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome SEVELAMER INDUCED DIFFUSE CRYSTAL COLITIS: A CASE Thomas Kim, SIDE Isaiarasi Gnanasekaran. REPORT OF Frohwein, A RARELY Susan REPORTED EFFECT. Samir Lincoln Medical and Mental Bronx, Brahmbhatt, Michael Cruise, JamesHealth Simon, Center, Cleveland Clinic NY, USA Cleveland, Ohio, USA Foundation, the Treatment most commonly usedVein non-calcium containing 110 Sevelamer Diagnosisisand of Renal Thrombosis (RVT) phosphate binder in end-stage renal disease. Up to 20% of in the Setting of Lupus Nephritis and Antiphospholipid patients experience bothersome gastro-intestinal (GI) side Syndrome (APS) effects while taking it. Here we present a rarely reported, but a Garcia, FelixofRenneberg, veryPablo unique side effect sevelamer. Maanit Kohli, Steve Bibu, 40Navya years old female with end-stage renal disease on Dwivedi. Kuchipudi, Anne Van Hoven, Shaunak intermittent hemodialysis presented to New the emergency with Saint Peter’s University Hospital, Brunswick,room NJ, USA complaints of diarrhea and left lower quadrant pain for 2 days. 111 Renal Crisis Setting Systemic SheScleroderma denied hematochezia, dark(SRC) stoolsinorthe fever. Initialofworkup (ssSSc) in diarrhea. Pregnancy wasSclerosis negative Sine for anScleroderma infectious cause of the CT scan of the abdomen and pelvis with IVChauhan, contrast showed Pablo Garcia, Shaylika Maanit diffuse Kohli,colonic Navya wallKuchipudi, thickening. She underwent colonoscopy revealed a Shaunak Dwivedi. Saint that Peter’s University fungating, non-obstructing, circumferential, 6 cm mass in the Hospital, New Brunswick, NJ, USA proximal sigmoid colon, which on biopsy showed necro121 Red Eyesdebris and with Renal Insufficiency in fragments A Middle Age inflammatory embedded crystalline Gentleman consistent with sevelamer deposition. Random biopsies taken throughout colon also showed debris Yale MaryamtheGondal, Heidi Mae luminal Timbol,crystalline Jeffery Turner. consistent with sevelamer. After sevelamer was replaced with University, New Haven, CT, USA calcium acetate, her symptoms gradually resolved. 125 While Atypical Case is of Behcet’ssideDisease IGA GI distress a common effect of Leading sevelamer,tosevere diarrheal symptoms should not be attributed as a pure side effect Nephropathy alone. RatherGupta, further investigation be considered with Sanjeev Anastasios should Papanagnou, Yorg Al-Azzi. sevelamer crystal deposition being on the differential. A few Westchester Medical Center, Westchester, NY, USA cases of sevelamer crystal induced GI mucosal injury have been 126 Cefepime asisStatus in a reported in the Toxicity literature. Presenting But this case the firstEpilepticus to demonstrate diffuse colonic injury from Disease crystalline debris, showing Patient withmucosal End Stage Renal 1 1 the potential severity of this entity.Dasari It is possible many1,other , Jayaprakash , Aziz that Bakhous Raed Mohit Gupta patients with that resolve when1switched 1 diarrhea on sevelamer 1 Azzem , Donald Dumford , Patrick Gallegos , Rupesh to an alternate phosphate binder have crystalline deposition, but 1 1 Raina . Clevelandstudy, Clinic Akron, USA without a prospective theAkron exact General, frequency of thisOH, adverse reaction cannotCausing be determined. 129 Tenofovir Hospitalization Due to Severe Symptomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 60 Westchester Medical Center, Valhalla, NY, USA CHARACTERIZING THEofBURDEN OF ANEMIA AMONG NON-in a 130 The Significance Anti-Phospholipase Antibodies DIALYSIS-DEPENDENT CKD PATIENTS: Steven M. Brunelli1, Patient with Membranous Nephropathy 2 2 1 2 Shaum Kabadi , Julia Catini , Scott Sibbel , Deborah Anzalone ; 1 2 Mohit Gupta, Jayaprakash Dasari, Rupesh Raina, Pallavi DaVita Clinical Research, Minneapolis, MN, USA; AstraZeneca, Wilmington, USA Clinic Akron General, Akron, OH, USA Reddy. DE, Cleveland This study characterized CKD stage and hemoglobin (Hb) levels in a 132 A Mystery Case of Blood Leak Alarm Going Onpatients. contemporary cohort of non-dialysis-dependent (NDD) CKD Among patients enrolledRhyan in Healthcare Partners, a large medical Seifeldin Hakim, Maditz, Sadichhya Lohani, Sami stage ≥3), Hospital, no group, adults with eGFR <60 mL/min/1.73 m2 (CKD Zarouk. Oakland University William Beaumont priorRoyal historyOak, of ESRD, dialysis, or kidney transplant, who between MI, USA 7/1/2013 and 6/30/2015 had at least 1 Hb measurement while not on 133 Undiagnosed ANCA were Associated Vasculitis ESAPreviously were identified (N=26,833). Patients categorized by eGFR Presenting One Month After Kidney Transplantation of 45-59 (stage 3a, n=17,559), 30-44 (stage 3b, n=6848), 15-29 (stage and Hb S. Yaqub. 4, n=1976), <15 mL/min/1.73 m2 (stage 5, n=450) Aymanand Hallab, Karthik Kannegolla, Mohammad concentration of <9.0, 9.0-9.9, 10.0-10.9, 11.0-11.9, 12.0-12.9, and ≥13 University of Medicine,(age, Indianapolis, g/dL.Indiana In descriptive analysis,School patient characteristics sex, race, IN, USAconditions) were described. With decreasing eGFR, the comorbid proportion patients in Hb categories (<9 to 11-11.9 g/dL) 149 Case ofReport of thea lower Dialysis Dependent Immunotactoid 3a compared with increased, ranging from with 0.8%-13.0% for stage Glomerulopathy Favorable Response to Rituximab 5. For Hb ≥12 g/dL2categories, greater 3 12.0%-24.7% for stage 1 2 Rohan , Glen m Markowitz , Aaron MehakofIdrees (stage 3a and b). proportion patients, had eGFRBhojwani ≥30 mL/min/1.73 4 1 Dommu . Griffin Hospital, Derby, USA;of 2men Fairview In CKD stage 3-4, patients were younger and the CT, proportion was Hospital, highest in Hb categories OH, <9 and 9-9.93g/dL. Conversely, in stageNew Columbia University, Cleveland, USA; 5, patients and4the proportion of women higher in the lowerCT, York,were NY,older USA; Nephrology Associates, Bridgeport, Hb levels. Prevalence of comorbidities varied across eGFR and Hb USA groups. CHF prevalence was highest in the lower Hb categories for 150 De inNovo Hemolytic Uremic Syndrome Fourteen patients CKD Atypical stage 3b. The prevalences of coronary artery disease (CAD) and cardiovascular (CVD) increased in the lower Hb Months After Renaldisease Transplant categories (28%-29% for CAD, 16% for CVD) compared with the Olusola Isikalu, Jennifer Thompson, Maria Aurora Posadas higher Hb categories (21%-23% for CAD, 9%-12% for CVD) among Medical CKDSalas. stage 3b patients. University of South Carolina, Charleston, SC, USA of NDD-CKD patients with Hb <10 g/dL increased as The proportion eGFR declined. Lower Hb levels were associated withHistopathological younger age 151 “Lone” Lupus Nephritis: A Seronegative, and male sex in CKD stage 3-4 and older age and female sex in CKD Diagnosis stage 5. Further investigation is needed to determine the impact of Jamal Janjua, Pratima Aiman Riaz. Gundersen anemia on comorbidities, such asKamada, CVD. Health System, La Crosse, WI, USA
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