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one case. All patients improved their renal function. The median esti-
mated creatinine clearance was 25 ml/min after 6 months. Two patients
had normalized their renal fonction.
Conclusions: Granulomatous interstitial nephritis may be the first
manifestation of a systemic disease . Histologic features do not seem to
distinguish the underlying cause of GIN. Corticosteroids therapy seems
to be efficient and must be introduced early to prevent progression to
chronic renal failure and it is associated with a good prognosis.
No conflict of interest
POS-476
OPTIMIZATION OF SDS-BASED KIDNEY
DECELLULARIZATION RESULTS IN ECM
SCAFFOLDS APPLICABLE FOR 3D
RECELLULARIZATION
BONGOLAN, T*
1,2
, Chow, T
1
, Whiteley, J
1
, Larsen, B
1
,
Mazilescu, L
3
, Hamar, M
3
, Jonebring, A
4
, Hicks, R
4
, Selzner, M
3
,
Rogers, I
5,6
1
Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto,
Canada,
2
University of Toronto, Department of Physiology, Toronto, Can-
ada,
3
University Health Network, Toronto General Hospital Research Insti-
tute, Toronto, Canada,
4
AstraZeneca, Translational Genomics- Discovery
Sciences, Gothenburg, Sweden,
5
Mount Sinai Hopsital, Lunenfeld-Tanen-
baum Research Institute, Toronto, Canada,
6
University of Toronto, Depart-
ment of Obstetrics and Gynecology, Toronto, Canada
Introduction: Kidney decellularization is used to obtain extracellular
matrix (ECM) scaffolds as a platform for 3D culturing and kidney tissue
regeneration. ECM contains biological molecules such as growth factors
necessary for cell survival, proliferation, and maturation during organ-
ogenesis. While decellularization allows for the complete removal of cells,
it also causes the removal of specific growth factors from the ECM, which
could have deleterious effects on cell survival, proliferation, and differ-
entiation during recellularization. We hypothesize that using a mild
decellularization protocol which employs the use of sodium dodecyl
sulphate (SDS) below its critical micelle concentration (CMC) of 0.2% in
water at room temperature will allow for the greater retention of bioac-
tive molecules which will improve recellularization efficiencies.
Methods: Porcine kidney cortex was cut into 1mm x 6mm slices and
decellularized using 0.05%, 0.075%, or 0.1% SDS in a soak and
agitation protocol for 24 hours at room temperature. Decellularization
was determined through histological and immunofluorescent staining,
and DNA quantification. The retention of ECM proteins and bio-
molecules was determined by histological and immunofluorescent
staining, mass spectrometry, and protein array analysis. Four different
cell lines were used for recellularization; human-induced pluripotent
stem cells (hiPSC), mesoderm derived from hiPSC, intermediate meso-
derm derived from hiPSC, and primary human renal epithelial cells.
ECM scaffolds were dried on Transwell inserts and cells were pipetted
on the surface of the scaffold. ECM-cell constructs were grown for two
weeks in culture at air-liquid interface. Recellularization efficiency, cell
organization, and differentiation were determined using whole mount
staining.
Results: Complete decellularization was achieved when SDS was used in
concentrations below its CMC. Decellularizing with 0.05% SDS resulted
in the greatest retention of glycosaminoglycan chains (GAGs), revealing
that GAGs are still significantly removed from the ECM when using
SDS below its CMC. Upon protein quantification, scaffolds decellular-
ized with higher SDS concentrations were more enriched with matri-
some proteins compared to scaffolds decellularized with lower SDS
concentrations, which correlated to a decrease in growth factors and
cytokines present on the scaffolds as determined by protein array.
Following 14-day recellularization, hiPSCs and kidney progenitor cells
proliferated on the ECM and expressed markers such as LIM1, WT1,
PBX1 and CD31. Primary renal epithelial cells maintained a mature
phenotype, expressing LTL, cytokeratin, and KSP.
Conclusions: Herein, we describe a novel protocol for the decellulari-
zation of kidney cortex scaffolds that allows for greater retention of
biomolecules. This retention of growth factors and cytokines aids in the
proliferation and directed differentiation of hiPS and kidney progenitor
cells toward mature renal lineages. Thus, we determined that our ECM
scaffolds are able to support the growth of both hiPS and organ-
matched cells. This can be applied to other organ decellularization/
recellularization protocols, as well as for the generation of kidney tissue
for further in vitro studies.
No conflict of interest
POS-477
CLINICAL PRESENTATIONS AND OUTCOMES
OF RENAL DISEASE IN SARS-COV PATIENTS -A
SINGLE CENTRE STUDY
BRAHMBHATT, R*
1
, Shah, H
1
, Nikam, S
1
, Appu, J
1
,
Deorukhkar, D
1
, Tilve, P
1
, Kirpalani, D
1
, Billa, V
1
, Bichu, S
1
,
Kirpalani, A
1
1
Bombay Hospital, Nephrology, Mumbai, India
Introduction: To study the clinical presentation and renal outcomes in
SARS-COV infected patients with renal dysfunction.
Methods: In this single center observational study, SARS-COV infected
inpatients referred to Nephrology Dept. over a period of 4 months were
classified in to 2 groups. 1) De novo AKI and 2) Chronic kidney disease-
includes CKD stage 1-4, CKD stage 5D (Maintenance Hemodialysis-
MHD) and CKD 5T (Post kidney transplant- KTx).
Results: In this observational study total 184 patients were included.
Mean age was 66.1 + 8.2 years, 68 % males. 51% patients were dia-
betic, 79% hypertensive, 37.5% underlying heart disease (IHD + LVD)
and 18.5% were having chronic lung disease. 52% MHD group patient
had no respiratory complaints. Loose motion was most common in KTx
group (32%) and altered sensorium was most common in MHD group
(22%).
Table-1: Presentation
Table-2A: Outcomes
Table 2B: Outcomes
Mechanical Ventilator required in 9% KTx, 35 % MHD, 42 % CKD
and 55 % De novo AKI.
Conclusions: In this cohort of renal patients in the first 4 months of the
COVID pandemic, it was observed that:
1. Typical respiratory complaints were less common among patients on
MHD (p <0.05).
Symptoms De novo AKI (N= 99) CKD (N= 85)
CKD stage 1-4
(N= 40)
CKD stage 5D (MHD)
(N= 23)
CKD stage 5T (KTx)
(N= 22)
Fever 93 (94%) 36 (90%) 18 (78%) 21 (95%)
Dyspnea 83 (84%) 25 (62.5%) 16 (69.5%) 9 (41%)
Cough 75 (76%) 24 (60%) 12 (52%) 13 (59%)
Altered sensorium 10 (10%) 7 (17.5%) 5 (22%) 0
Loose motion 22 (22%) 8 (20%) 4 (17%) 7 (32%)
Outcomes De novo AKI (N= 99)
Complete GFR recovery 45 (45.5%)
Partial GFR recovery 12 (12.1%)
Need for RRT 16 (16%)
Total mortality 42 (42.5%)
Mortality in HD patient 16/16 (100%)
Mortality without HD 26/83 (31%)
Outcomes CKD (N=85)
CKD stage 1-4 (N=40) CKD stage 5D
(MHD) (N=23 )
CKD stage
5T (KTx) (N=22)
Stable renal function 21 (52.5%) - 8 (36%)
AKI 19 (47.5%) - 14 (63.5%)
Needed RRT 10 (25%) 23 (100%) 2 (9%)
Complete GFR Recovery 7/19 (37 %) - 12 (86%)
Partial GFR recovery 3/19 (15.7%) - 0
Conversion to ESRD 1/19 (5.2%) - 0
Total Mortality 8 (20%) 8 (35%) 2 (9%)
Mortality with HD 8/10 (80%) 8 (35%) 2/2 (100%)
Mortality without HD 0 - 0
ISN WCN 2021, MONTREAL, CANADA
S206 Kidney International Reports (2021) 6, S1–S362
2. De novo AKI patients had higher mortality as compared to CKD
patients (p <0.005).
3. Patients who required de novo initiation of RRT had a worse
outcome. Mortality in patients who were initiated on RRT was 93 % as
compared to 19.5 % in MHD patients (p <0.0001).
4. Post kidney transplant patients had a better outcome in terms of
mortality and complete GFR recovery as compared to other CKD Groups
(p <0.05).
No conflict of interest
POS-478
TRENDS IN THE SPECTRUM OF BIOPSY-
PROVEN GLOMERULOPATHIES IN ADULTS
FROM SOUTH-EASTERN ROMANIA OVER A
TEN YEARS PERIOD
Popa, O
1
, Pana, N
1
, Petre, N
2
, Lipan, M
3
, Chiotan, L
1
,
Mircescu, G
1,4
, CAPUSA, C*
1,4
1
“Carol Davila”University of Medicine and Pharmacy, Nephrology,
Bucharest, Romania,
2
“Dr. Carol Davila”Teaching Hospital of Nephrology,
Pathology, Bucharest, Romania,
3
“Dr. Carol Davila”Teaching Hospital of
Nephrology, Laboratory, Bucharest, Romania,
4
“Dr. Carol Davila”Teaching
Hospital of Nephrology, Nephrology, Bucharest, Romania
Introduction: Since little is known about the epidemiology of glomer-
ulopathies (GP) in Romania and there are evidence on the changing prev-
alence of GP over the years worldwide, the current study aimed to assess the
trends in the frequency of biopsy-proven GP in adults admitted to a ter-
tiary, university-affiliated center of Nephrology that provides specialized
care to the southeastern region of Romania, over a period of ten years.
Methods: A retrospective, cross-sectional study was conducted. From
the hospital’s kidney biopsy (KB) database subjects with a histological
diagnosis of GP between 01.01.2008-31.12.2017 were selected. Exclu-
sion criteria were: age <18 years, biopsy on kidney graft, any repeated
biopsy in any patient, and insufficient tissue sample. All selected bi-
opsies were analyzed by light microscopy, immunofluorescence, and
electron microscopy. Clinical and laboratory data were extracted from
the electronic medical records for all the selected subjects. De-
mographic, clinical, laboratory, and histological data were compared
between subjects who underwent KB in the first and last five years
(2008-2012 vs. 2013-2017) of the studied period.
Results: A total of 1254 subjects were enrolled, 355 from the first period
and 899 from the second. In the last five years subjects were older, with
lower eGFR and proteinuria. In both intervals, the main reason for KB
was nephrotic syndrome, but its frequence decreased after 2013 (36.7%
vs. 53.8%, p<0.001). In addition, chronic renal failure and acute
nephritic syndrome were more commonly seen between 2013-2017
(16.1% vs. 5.9%, p<0.001 and 11.5% vs. 6.2%, p=0.005, respectively).
The two most frequent biopsy-proven GP (IgA nephropathy followed
by membranous nephropathy) had similar proportions in both studied
periods. Conversely, diabetic nephropathy and crescentic glomerulo-
nephritis showed increased frequences over time (12.3% vs. 4.8%,
p<0.001 and 6.6% vs. 3.1%, p=0.02, respectively), while minimal
change disease was more rarely diagnosed (8.8% vs. 14.4%, p<0.001).
Conclusions: These findings suggest rather a change in the medical
practice concerning native kidney biopsy, than a true change in the
prevalence of biopsy-proven GP in adults from the southeastern region of
Romania. It seems that over time the indications for performing kidney
biopsy have been extended to older patients, with diabetes mellitus, with
more severe kidney function decline, and less proteinuria.
No conflict of interest
POS-479
ACCEPTABILITY AND FEASIBILITY OF A WEB-
BASED SELF-MANAGEMENT SUPPORT
INTERVENTION FOR ADULTS WITH CHRONIC
KIDNEY DISEASE: A MIXED-METHODS STUDY
DONALD, M*
1
, Beanlands, H
2
, Straus, S
3
, Smekal, S
1
,
Herrington, G
4
, Waldvogel, B
4
, Sparkes, D
4
, Delgado, M
4
,
Hemmelgarn, B
5
1
University of Calgary, Medicine, Calgary, Canada,
2
Ryerson University,
Daphne Cockwell School of Nursing, Toronto, Canada,
3
University of Tor-
onto, Medicine, Toronto, Canada,
4
Can-SOLVE CKD Network, n/a, Vancou-
ver, Canada,
5
University of Alberta, Medicine, Edmonton, Canada
Introduction: Our previous work identifiedtheneedforaperson-
centered, theory-informed web-based tool for CKD self-management
targeting individuals not receiving kidney replacement therapy (KRT)
that can be tailored to a patient’s unique situation, priorities, and pref-
erences. To meet this need we have developed My Kidneys My Health; a
website to inform, activate, and promote communication with the intent
to empower patients and their caregivers. In this study we explore
acceptability of the website and feasibility of its implementation.
Methods: A mixed-methods study design using a consecutive sampling
strategy including adults from across Canada with CKD, not receiving
KRT. Baseline demographic and eHealth literacy data were collected
prior to having access for 8-weeks to My Kidneys My Health.
Acceptability was evaluated using the Technology Acceptance Model
(TAM) to determine ease of use, perceived usefulness, and intention to
use. Participants were invited to participate in a 30-minute telephone
interview to elicit their perspectives on adopting the website into their
self-management strategy, in addition to facilitators and barriers to
successful implementation of the website. Analysis was conducted
using data triangulation (i.e., quantitative and qualitative data analyzed
separately then merged) for interpretation.
Results: Recruitment has been completed (32 participants) with follow-
up data collection to be finalized by January 2021. Baseline de-
mographic data are available for 26 participants; majority being male
(58%), urban dwellers (62%), Caucasian (81%), with a higher level of
education (73%). Participants represent all levels of CKD severity (not
receiving KRT) and varied duration since diagnosis. Based on pre-
liminary findings from 12 participants who have completed the study,
participants found the website to be understandable, with the majority
of these participants indicating (i.e., agree/totally agree) the website
was useful for content (83%), supplemented their care (66%), and
supported them in dealing with consequences of living with CKD
(66%). Participants who have been managing their CKD for many years
reported that the general content on the website is relevant for in-
dividuals recently diagnosed, however they would revisit the website
when they had changes in their health status (e.g., diet, medications,
symptoms) as they see living with CKD as a “dynamic process”.
Conclusions: Study findings suggest that My Kidneys My Health
shows promise as a self-management support tool for those with CKD
not receiving KRT. Future work will focus on dissemination, imple-
mentation, and potential adaptations.
No conflict of interest
POS-480
THE PROGNOSTIC VALUE OF C4D STAINING IN
KIDNEY BIOPSIES OF IMMUNE-COMPLEX-
MEDIATED GLOMERULAR DISEASES
EREN SADIOGLU, R*
1
, Kiremitci, S
2
, Aktar, M
1
, Sengul, S
1
,
Gokmen, D
3
, Keven, K
1
, Nergizoglu, G
1
, Erturk, S
1
, Ates, K
1
,
Ensari, A
2
, Kutlay, S
1
1
Ankara University School of Medicine, Nephrology, Ankara, Turkey,
2
Ankara University School of Medicine, Pathology, Ankara, Turkey,
3
Ankara
University School of Medicine, Biostatistics, Ankara, Turkey
Introduction: C4d staining in native kidney biopsies could indicate
antibody related renal damage. We investigated the prognostic role of
C4d staining and C4d load in glomerular diseases taking into account
their immune-complex (IC) mediated nature.
Methods: We retrospectively evaluated the renal biopsies of 498 patients
with focal segmental glomerulosclerosis, membranous nephropathy, IgA
nephropathy, minimal change disease, membranoproliferative glomerulo-
nephritis, lupus nephritis, hemolytic uremic syndrome, C1q nephropathy
and vasculitis. Patients were separated as ‘IC-mediated’(n=300) and ‘non-
IC-mediated’(n=198) groups. C4d expressions examined in glomeruli
(mesangial and/or capillary wall, vascular pole, sclerotic areas), tubular
region and vascular areas. Additionally, a novel glomerular C4d score (G-
C4d-S) was achieved on the basis of the localization, pattern, extent and
intensity of the C4d expression.
Results: Of the patients (241 females, mean age 43 years) with a median
follow-up time of 23 months, mean proteinuria, eGFR, and albumin
level were 3780 mg/day, 74 ml/min/1.73m
2
, 3.07 g/dL, respectively.
Median G-C4d-S was higher in IC-mediated group (median, min-max; 8,
0-13 vs. 6, 0-13). Higher load of C4d is associated with higher pro-
teinuria in all glomerular diseases at the time of diagnosis. There were
no difference in remission rates, recurrences and renal outcomes be-
tween the two groups, however mortality was higher in non-IC-com-
plex group (3.7% vs 6%, p=0.02). In IC-mediated group, capillary wall
ISN WCN 2021, MONTREAL, CANADA
Kidney International Reports (2021) 6, S1–S362 S207