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Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare oculorenal inflammatory entity with a probable autoimmune etiology. Interstitial nephritis may be asymptomatic and usually has a benign course with spontaneous resolution. Uveitis, instead, is classically anterior, bilateral, and nongranulomatous, but it can be unilateral and presents as posterior uveitis or panuveitis, sometimes with a chronic or recurrent evolution. The frequent time lag of ocular and renal manifestations makes this diagnosis particularly challenging. The authors describe four cases of this rare entity, two with tubulointerstitial nephritis preceding ocular manifestations and the remaining, instead, with uveitis preceding renal involvement. The therapeutic approach included systemic corticosteroids in all cases. The addition of immunosuppressive therapy was required in three patients to achieve uveitis control. TINU is probably an underrecognized entity and should always be considered in the differential diagnosis of a chronic or recurrent idiopathic uveitis, especially in young patients who may have mild and asymptomatic renal disease.

BACKGROUND AND AIMS Enhanced recovery after surgery (ERAS) protocol is an evidence-based programme that englobe more restrictive fluid therapy to maintain euvolemia and the use of multimodal analgesia, which includes non-steroidal anti-inflammatory drugs (NSAIDs). Consequently, it's pertinent to assess the risk and potential consequences of acute kidney injury (AKI) in the short and medium term. METHOD A descriptive and single-center retrospective study, which included 428 patients that were submitted to colon-rectal surgery according to ERAS protocol between November 2016 and May 2020. AKI was defined according to KDIGO criteria. RESULTS Data were collected from 428 patients. AKI occurred in 25.2% of patients (108), mostly KDIGO 1 (63.9%) and 6.5% required haemodialysis. The median time of follow-up was 25.6 months (IQ 15.6–38.8). Patient-related variables that positively influenced AKI were ASA Class III/IV [F (1, 426) = 23.2; P AKI group had a superior length of stay (9 versus 6 days; P CONCLUSION AKI was frequent among ERAS patients and was associated with worst outcomes—higher costs (since it was associated to longer hospitalization, higher readmission at 30 days and ICU admission), higher risk of reduction in GFR in the first 2 years and higher mortality.

One of the most common causes of rapidly progressive glomerulonephritis (RPGN) is pauci-immune crescentic glomerulonephritis (CrGN). In the majority of cases, this condition has a positive serologic marker, the anti-neutrophil cytoplasmic antibodies (ANCAs), but in approximately 10% there are no circulating ANCAs, and this subgroup has been known as the ANCA-negative pauci-immune CrGN. RPGN can be associated with systemic diseases, but there are only few case reports describing the association with mixed connective tissue disease (MCTD). The authors report a case of ANCA-negative CrGN associated with a MCTD.

Background and Aims Anemia is a well-know complication of Chronic Kidney Disease (CKD) and it seems to contribute for deterioration of kidney function. Experimental data suggest that anemia produces hypoxia of tubular cells which leads to tubulointerstitial damage resulting on CKD progression. Other mechanism described is that red blood cells have antioxidant properties that prevent the damage of tubulointerstitial cells and glomerulosclerosis from oxidative stress. There aren’t many observational studies that evaluated the association between anemia and progression of CKD. Therefore, our aim was to evaluate the association of anemia and CKD progression and its association outcomes in an outpatient ND-CKD population. Method We conduct a retrospective, patient-level, cohort analysis of all adult ND-CKD patients evaluated in an outpatient nephrology clinic over a 6 years period. The follow up time was at least 12 months. Anemia was defined according to the WHO definition (hemoglobin [hb] < 13.0 g/dL in men and 12.0 g/dL in women). Progression of CKD was defined by one of the following criteria: decline in eGFR (CKD-EPI) superior to 5 ml/min/1.73 m2/year; duplication of serum creatinine or the need renal replacement therapy. Demographics and clinical data were also accessed. Results Out of 3008 patients referred to the nephrology clinic, 49.9% had anemia (mean age 71.9±15.9 years; 50.4% male; 92% white; mean follow-up time of 2.3±1.2 years). The mean Hb was 11.8 ±1.9 g/dL. Important cardiovascular comorbidities in patients with anemia were arterial hypertension (86.7%), obesity (65.5%), Diabetes Mellitus (DM) (52%) and dyslipidemia (46%). In univariate analysis, mortality was associated with anemia (36.9 vs 13.0%, p Conclusion Our study suggests that anemia, at first consultation, increases the risk for rapid CKD progression and global mortality. This study could guide us on the development of futures studies in order to prove if anemia correction can slow the progression of CKD.

Background and Aims Sarcopenia is common in chronic kidney disease (CKD) and it has been reported a correlation between the increased prevalence of sarcopenia and worsening kidney function. Computed tomography (CT) is the gold standard for studying sarcopenia because of its capacity to identify quantitative and qualitative changes in muscle mass. Our major aim was to evaluate the prevalence of sarcopenia ant its association with renal function, in non-dialysis CKD patients, using a diagnostic criterion that has not been applied before in this population. Method We conducted a longitudinal retrospective analysis on a cohort of non-dialysis CKD patients who visited an outpatient Nephrology clinic between January 2012 and December 2012 and continued follow-up until December 2018. We selected those who underwent a CT scan as part of their clinical workup and simultaneously had a serum creatinine determination within 90 days of the scan. CT images were obtained and evaluated for body composition analysis by one investigator blinded to clinical data. Images were selected by radiologists at the third lumbar vertebra (L3). Segmentation of tissue cross-sectional areas was conducted according to the following Hounsfield unit thresholds: -29 to 150 for skeletal muscle, -190 to -30 for subcutaneous and intramuscular adipose tissue and -50 to -150 for visceral adipose tissue. Skeletal muscle area (SMA) was normalized for stature to calculate the skeletal muscle index (SMI). Sarcopenia was defined as SMI lower than 41 cm2/m2 in women and 43 cm2/m2 in men with body mass index (BMI) < 25 kg/m2 and < 53 in men with BMI > 25 kg/m2, as described by Martin et al, based on the International Consensus of Sarcopenia. Visceral obesity was defined as visceral fat area > 130 cm2. Diagnosis and classification of CKD were based on the Kidney Disease Improving Global Outcomes criteria and the glomerular filtration rate was estimated from the serum creatinine levels using the CKD Epidemiology Collaboration equation. Results Out of the 521 non-dialysis CKD patients referred to the nephrology clinic, 43 patients met the inclusion criteria. Mean age was 71.0 ± 14.6 years, 55.8% were male and 97.7% were caucasian. The mean follow-up time was 4.3 ± 2.3 years. Most patients had CKD stages 3 to 5 (67.4%) and the mean GFR was 45.4 ± 32.6 ml/min/1.73m2. In our entire cohort, 16 patients were sarcopenic (37.3%; median age: 77.5 years; 9 female and 7 male) and a high prevalence of sarcopenia was observed in stages 3 and 4 of CKD (54,5% and 50%, respectively). There was a non-significant difference in age (77.5 vs. 68, p=0.068), comparing with patients without sarcopenia. The group of the sarcopenic patients had lower BMI (24.4 vs. 28.4 Kg/m2, p=0.008) and height (65.9 vs. 77.6, p=0.01), although BMI > 30 Kg/m2 (1 vs. 9, p=0.052) and visceral obesity (7 vs. 19, p=0.084) were not significantly different between the two groups. Moreover, we observed that patients with sarcopenia tended to have lower albumin levels (2.9 vs. 3.7, p=0.034) and higher LDL levels (135 vs. 67.5, p=0.04). Regarding mortality, 18 patients (41,9%) died during follow-up and the frequency of sarcopenia was significantly higher among non-survivors (68.8% vs. 25.9%, p=0.006). In the univariate logistic regression, for every decrease of one unit in the SMI, mortality increased by 10% (p=0.012). Conclusion Sarcopenia is common in patients with non-dialysis dependent CKD, particularly in advanced stages, and is strongly associated with mortality in this population. Our study highlights the importance of early diagnosis and implementation of therapeutic strategies to minimize the adverse outcomes in CKD patients.

Background and Aims The high prevalence of CKD and its increasing awareness by primary care clinicians is posing a huge burden over health care systems, especially over Nephrology departments. While the referral of CKD stage 4 and 5 to a nephrology clinic is undisputable, the need for stage 3 patients referral is still subject to debate. Our objective was to investigate baseline characteristics of CKD stage 3 patients associated with subsequent CKD progression, in order to help determine which patients should be referred at this stage. Additionally, we investigated the association of CKD stage 3 progression with morbidity and overall mortality. Method We conducted a patient-level, retrospective, cohort analysis of all patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 36 months of follow-up or 24 to 36 months of follow up with more than 3 serum creatinine determinations. CKD progression was defined by one of the following: 1) an eGFR (CKD-EPI) decline superior to 5mL/min/year; 2) Serum creatinine duplication; 3) The need for chronic RRT. Baseline covariates included demographics, comorbid conditions and laboratory values. Univariate and multivariate analysis were employed to determine independent predictors of CKD progression and mortality. Results Out of the 3008 patients referred to the nephrology clinic, 1288 (42.8%) were CKD stage 3 patients and from these, 594 (19.8%) met the inclusion criteria (median age: 71.9 years; 63.8% male). Median follow-up was 4.9 years (IQR 2.2). 133 (22.4%) met the criteria for CKD progression and 110 (18.6%) died. In univariate analysis, CKD progression was associated with higher proteinuria (405.7 vs 65.5mg/gr, p In multivariate logistic regression analysis, albuminuria over 300 mg/gr [Odds ratio (OR) 3.57, 95% CI 2.20 - 5.80, p The independent predictors of mortality were: CKD progression (OR 4.49, 95% CI 2.69-7.50, p= Conclusion Our study suggests that patients with macroalbuminuria and anemia at first consultation are at increased risk for rapid CKD stage 3 progression. In this group, patients with CHF, anemia and hyperkalemia (even at first consultation) have a higher risk of mortality. This study may be useful and help us in guiding which CKD stage 3 patients should be referred to a nephrology clinic.

Background and Aims Anemia is a major complication of Chronic Kidney Disease (CKD). There are few large observational studies analyzing the association between anemia and significant clinical outcomes in non-dialysis dependent CKD (ND-CKD) patients. Our aim was to evaluate the prevalence of anemia and iron deficiency and their association with mortality, cardiovascular events, need for renal replacement therapy and hospitalizations in an outpatient ND-CKD population. Method A patient-level, retrospective, cohort analysis of all adult ND-CKD patients evaluated in an outpatient nephrology clinic between January 2012 to December 2017 with at least one year follow up. Anemia (defined according to the WHO definition - Hemoglobin [Hb] < 13.0 g/dL in men and 12.0g/dL in women), absolute iron deficiency (ferritin < 100 ng/mL), other demographic and clinical data (CKD staging and etiology, comorbidities) were assessed at the first visit through individual consultation of electronic medical records. Results During the 6-year period, 3008 patients were identified (mean age 70.9±14.1 years; 54.5% male; 91.7% white) with a mean follow-up of 3.3±2.0 years. The most frequent cardiovascular comorbidities were arterial hypertension (81.9%), obesity (58%), diabetes mellitus (57.9%) and dyslipidemia (43.9%). The mean Hb was 11.8 ±1.9 g/dL. Anemia was present in 49.9 % of patients, with similar distribution between genders (50.4% in men vs 49.6% in women) and more frequent in white patients (92% vs 8% p= 0.019). Anemia prevalence increased across CKD stages - 12.9%, 25.9%, 57.2%, 72.7% and 86.4% for stages 1 to 5, respectively (p Conclusion As expected, anemia prevalence increases across CKD stages and, as well as absolute iron deficiency, is independently associated with adverse clinical outcomes in ND-CKD patients, including death. Future studies should be developed to investigate if correction of these factors improves adverse outcomes.

Background and Aims Hyperkalemia (HK) is a common and dangerous complication of CKD because of impaired kidneýs ability for potassium elimination. On the other hand, HK is a common complication of extremely beneficial therapeutic agents acting on the renin–angiotensin–aldosterone system (RAAS). Its initiation at early CKD stages is even more benefic but HK could lead to stop it. We wonder if there is a possible relation between HK, therapeutic changes in RAAS inhibition (not initiating or stopping it) and mortality. Our goal was to investigate incidence, prevalence and clinical outcomes of at least one episode of HK in a CKD population outpatient setting. Additionally, we investigated the association of HK with changes in RAAS inhibition and mortality risk. Method We conducted a patient-level, retrospective, cohort analysis of all adult patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 24 months of follow up and three or more serum potassium determinations. The prevalence of HK (blood potassium level ≥ 5,5mmol/L) at first consultation and incidence during follow up were accessed. Patients were spited in two groups prior to analysis: A) Patients without any HK episode and B) Patients with at least one HK episode. Baseline and follow up covariates included demographics, comorbid conditions, laboratory values, HK-associated drugs [ACEis, ARBs, potassium-sparing diuretics and diuretics]. The impact of HK and therapeutic changes on mortality was evaluated through a logistic regression. Results Out of the 3008 patients referred to the nephrology clinic, 575 (19.1%) met the inclusion criteria (mean age: 70.4 years; 63.7% male and 94.0% caucasians). Mean follow-up was 4.1±1.8 years. Important cardiovascular comorbidities included hypertension (HTN) (90.3%); overweigh (67.4%), DM (49.0%) and Heart Failure (31.4%). CKD stage progression was present in 122 (21.2%). The prevalence of HK at first consultation was 8.7% and follow up incidence 21.7%. From this cohort, 164 (28.5%) had at least on episode of HK (Group B) and 101 (17.6%) died. During the follow up, RAAS inhibition drugs was removed or not started in 200 (34.8%) patients and diuretic was initiated in 165 (28.7%). In univariate analysis, at least one HK episode was associated with Diabetes (65.9 vs 42.3%, p In multivariate logistic regression analysis, the independent predictors of mortality were: At least one HK episode (OR 1.82, 95% CI 1.08-3.04, p=0.02); Heart Failure (OR 1.97, 95% CI 1.16-3.35, p=0.01); Older age (OR per 1 year increase 1.04, 95% CI 1.02-1.07, p=0.001); CKD progression (OR 4.18, 95% CI 2.43-7.19, p Conclusion Our study confirms that RAAS inhibition had a protector and independent impact in mortality when prescribed in CKD early stages. On the other hand, patients with at least one episode of HK have a higher risk of mortality. All efforts should be made to maintain these therapeutic agents, looking for other ways to control hyperkalemia rather than stop it.

Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.

Background The Portuguese Society of Nephrology (PSN) reported that Portugal has one of the highest incidences of dialysis in Europe. However, this claim was based on aggregated data supplied by dialysis providers, hampering comparisons between countries. In 2009, an individual registry of patients starting dialysis was set up by the Portuguese Ministry of Health. We analysed individual data of patients starting dialysis from January 2010 until December 2016. Methods Demography, starting treatment day, modality, regional distribution and outcomes, such as death, recovery of renal function, transfer to renal transplantation, peritoneal dialysis or conservative management, were extracted. Incidence, prevalence and survival analysis were calculated and compared with the PSN registry. Results Out of 19 190 registrations, 16 775 were incident patients (61.8% men). Yearly incidence of renal replacement therapy was 250, 248, 229, 239, 230, 231 and 244 per million population (p.m.p.) for 2010 to 2016, compared with 235, 224, 218, 230, 234, 225 and 239 p.m.p. reported by the PSN registry. On the other hand, prevalence increased from 998 p.m.p. in 2010 to 1286 p.m.p. in 2016, compared with 1010 p.m.p. in 2010 increasing to 1203 p.m.p. in 2016 from the PSN registry. The regions of Alentejo (122.9 p.m.p.) and the the Centre (160.8 p.m.p.) had the lowest regional incidence, while Lisbon had the highest (386 p.m.p. in 2016). Unadjusted survival analysis revealed that 93.5% of the patients were alive on the 91st day, whereas 85.2 and 78.3% were alive at 1 and 2 years, respectively. Crude survival at 7 years was 40%. Conclusions For the first time, an individual registry of patients starting dialysis in Portugal was subject to analysis and added new information about long-term survival and regional differences in the incidence and prevalence of renal replacement therapy. We were able to confirm that Portugal has one of the world’s highest incidences and prevalences of dialysis. We also demonstrate, for the first time, a striking regional difference in the incidence of dialysis and an excellent early and long-term survival of patients on dialysis. These results compare well with other European countries in terms of the dialysis efficiency.

Aortic coarctation (AC) represents ∼7% of congenital cardiac diseases and is usually diagnosed in childhood or early adult life, depending on the severity of obstruction and associated malformations. Left untreated fewer than 20% of patients survive to age 50. We describe a case of thoracic AC, diagnosed at age 61, in a woman with known hypertension since age 45. At age 56 the patient was admitted with a subarachnoid hemorrhage and, during cerebral angiography, a thoracic aortic aneurysm was detected. Four years later the patient was referred to the outpatient hypertension clinic due to uncontrolled hypertension and cardiac failure. The echocardiogram disclosed left ventricular hypertrophy and aggressive treatment failed to control her hypertension. At age 61, due to lower limb muscular fatigue, arterial Doppler ultrasound was performed that revealed symmetrically decreased ankle/brachial pressure index, suggesting aortic stenosis. MRI angiography enabled a diagnosis of AC with a large poststenotic dilation which had been interpreted as an aortic aneurysm in successive CT scans. The authors highlight the unusually late clinical presentation and misdiagnosis despite extensive radiologic investigation. The subarachnoid hemorrhage was probably a disease manifestation, since berry aneurysms are among the noncardiac malformations associated with AC. Resumo: A coartação da aorta (CA) representa ∼7% das cardiopatias congénitas sendo habitualmente diagnosticada na infância ou no início da vida adulta, dependendo da gravidade da obstrução e das malformações associadas. Não tratados, menos de 20% dos doentes sobrevivem até aos 50 anos. Descreve-se um caso de CA torácica, diagnosticada aos 61 anos, numa mulher com HTA conhecida desde os 45. Aos 56 anos foi internada por hemorragia subaracnoideia e, aquando da realização de angiografia cerebral, foi detetado aneurisma da aorta torácica. Quatro anos mais tarde foi referenciada à Consulta de Hipertensão por HTA não controlada e insuficiência cardíaca. O ecocardiograma mostrava hipertrofia ventricular esquerda e a HTA mantinha-se não controlada apesar de polimedicada. Aos 61 anos, por queixas de fadiga muscular intensa dos membros inferiores, efetuou Doppler Arterial que identificou índices de pressão sistólica diminuídos, bilateralmente e de forma simétrica, sugerindo estenose da aorta abdominal. A angio-RMN permitiu o diagnóstico de CA torácica com importante dilatação pós-estenótica, que foi interpretada em TAC seriadas como correspondendo a aneurisma da aorta descendente. Destaca-se a apresentação clínica tardia e diagnóstico erróneo, apesar de extensa investigação radiológica. Salienta-se ainda que a hemorragia subaracnoideia foi, provavelmente, uma manifestação da doença já que os aneurismas do polígono de Willis são uma das malformações extracardíacas associadas à CA. Keywords: Aortic coarctation, Hypertension, Aortic aneurysm, Palavras-chave: Coartação da aorta, Hipertensão, Aneurisma da Aorta

Prevalence of chronic kidney disease (CKD) is increasing and CKD has a long asymptomatic phase suitable for screening. SCORED (Screening for Occult Renal Disease) is a prescreening test which has compared favorably with KEEP. We report the results of SCORED testing in subjects attending a World Kidney Day event. After SCORED, subjects were tested for creatinine, urinary albumin and creatinine, and renal ultrasound. Eighty-eight subjects participated (32 men; mean age 59.7 ± 14.8 years; 58% hypertensive and 15.9% diabetics) of which 60 had a high score for kidney disease. Thirty-eight of 47 (80.8%) subjects that were further evaluated had a high-risk score. All subjects with CKD had a high score (100% sensitivity). SCORED showed low specificity (24.3%), but a high negative predictive value (100%). Including albuminuria in the definition of CKD increased the positive predictive value to 43.6%. In conclusion, SCORED is good for prescreening subjects for CKD in a European population as it captures all patients with CKD. Moreover, in subjects with low risk, the probability of CKD is low. SCORED is useful in alerting the general population and the medical community about the risk factors of CKD.

Background. Acute kidney injury (AKI) in hospitalized human immunodeficiency virus (HIV)-infected patients in the highly active antiretroviral therapy (HAART) era has not been extensively addressed. The aim of the present study was to analyze the incidence, etiology, risk factors and the impact of AKI on in-hospital mortality in this population. Methods. A total of 489 HIV-infected patients hospitalized in the Department of Infectious Diseases of the Hospital de Santa Maria (Lisbon, Portugal) between January 2005 and December 2007 were retrospectively studied. AKI was defined by ‘Risk Injury Failure Loss of kidney function Endstage kidney disease’(RIFLE) criteria based on serum creatinine. Comparisons between patients with and without AKI were performed using the Student’s t-test or the v2 test. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P-value

Intermediate early graft function is associated with increased incidence of graft loss and worse long-term graft function in kidney transplantation.Delayed graft function (DGF) is associated with premature graft loss, increased rate of allograft function decline, and greater incidence of acute rejection episodes (ARE). Regarding early intermediate graft function (IGF), these prognostic observations have not been clearly made. Our objective was to investigate the impact of IGF as compared with excellent graft function (EGF) on these outcomes.Retrospective analysis included all patients who underwent transplantation in a tertiary care center between 1989 and 2009. Definitions are as follows: DGF, need for dialysis in the first 7 days posttransplantation; EGF, serum creatinine (sCr)3 mg/dL at 5 days posttransplantation; IGF, absence of dialysis need but with a sCr3 mg/dL at 5 days posttransplantation. For univariate analysis we performed Student t test, Mann- Whitney test, or Chi-square test, as appropriate. For survival analysis we performed Kaplan-Meier method to determine survival curves and we used the log-rank test for comparison. Multivariate logistic regression analysis was used to determine independent predictors of IGF and of graft survival.Five hundred seventy patients were included: 69.0% had EGF, 22.6% had IGF, and 8.4% had DGF. Patients with IGF had worse graft survival at 5 and 10 years posttransplantation (75% vs 92% and 69% vs 85%, respectively; P.001 for both comparisons) and higher incidence of ARE (41% vs 27%; P = .001), compared with EGF. In multivariate analysis, IGF was independently associated with an increased risk of graft loss compared with EGF (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.32-4.35; P = .004]. Donor age (OR, 1.03 per year; 95% CI, 1.02-1.05; P.001) was the strongest predictor of the occurrence of IGF. IGF was also associated with worse long-term graft function until 7 years posttransplantation (mean glomerular filtration rate [GFR] 48.3 ± 18.9 vs 57.4 ± 20.4 mL/min/1.73 m(2); P = .008).IGF, as DGF, is associated with increased rates of graft loss and ARE, as well as worse long- term graft function. Donor age was the strongest risk factor for the occurrence of IGF. This is especially relevant regarding the increasing use of extended criteria donors.

Background Randomized clinical trials have supported the use of interleukin-2 receptor (IL-2R) antagonists as induction therapy in renal transplantation. This strategy has reduced the incidence of acute rejection episodes (ARE) but not improved graft survival. Our objective was to investigate the impact of induction therapy using the IL-2R antagonist basiliximab, as compared with no induction therapy, on relevant clinical outcomes—initial length of stay, incidence of ARE, long-term graft function, and graft survival. Methods We retrospectively reviewed the medical records of patients transplanted in a tertiary care center between 1996 and 2011. We selected patients who received cyclosporine, mycophenolate mofetil, and prednisolone ( n = 334) to classify as: no induction therapy ( n = 131; group 1); induction therapy with basiliximab ( n = 203; group 2). Estimated glomerular filtration rate (eGFR) was assessed with the 4-variable Modification of Diet in Renal Disease (MDRD) equation. Results Mean follow-up was 72.7 ± 35.4 months. Patients who received basiliximab had a shorter mean hospital stay (19.2 versus 22.5 days; P = .02), lower incidence of ARE (10.8% versus 23.7%; P = .02) and better graft function post transplantation at 12 months (mean eGFR 59.4 ± 18.4 versus 54.8 ± 18.7 mL/min/1.73 m 2 ; P = .015) and 5 years (mean eGFR 64.1 ± 21.5 versus 55.4 ± 19.6 mL/min/1.73 m 2 ; P = .009). On multivariate analysis, induction therapy with basiliximab was independently associated with a lower incidence of ARE and better graft function at 1 and 5 years after transplantation. There was no difference in 5-year graft survival between the two groups (log-rank: P = .54). Conclusions Induction therapy with basiliximab was associated with a reduced incidence of ARE and better long-term graft function but no difference in 5-year graft survival.

Donor age, cold ischemia time, delayed graft function (DGF), prior sensitization, HLA mismatches, acute rejection episodes, glomerular disease and viral nephropathy are some factors that shorten graft survival. Patients with excellent graft function at 10 years posttransplant have probably successfully overcome these detrimental factors. The effect of initial functional renal mass is probably associated with this outcome. The objective of the present study was to identify factors that show predictive value for the population of patients with excellent graft function at 10 years posttransplantation.This retrospective observational study included 117 patients transplanted from deceased donors. They all presented glomerular filtration rates (GFR) ≥ 40 mL/min. They were stratified as group I (n = 56) estimated GFR ≥ 4060 mL/min versus group II (n = 61) estimated GFR ≥ 60 mL/min. We analyzed the variables of donor age, recipient age and gender, DGF, immunosuppression, obesity, acute rejection episodes, HLA mismatches, panel-reactive antibodies and the mean estimated GFR at 1, 5, and 10 years posttransplant.Donor age and patients with DGF were significantly different between the two groups upon univariate analysis. Multivariate logistic regression analysis showed only donor age to be independently associated with an eGFR60 mL/min at 10 years. In both groups a decrease of eGFR10 mL/min between the 1st and the 10th year correlated significantly with donor age (P = .04). The deterioration of graft function was greater among group I than group II (6.7 vs 0.23 mL/min; P = .007).Donor age was the most significant predictive factor for graft function at 10 years.

Background Acute kidney injury (AKI) is common in hospitalized human immunodeficiency virus (HIV)-infected patients and is associated with hospital mortality. We aimed to evaluate the impact of AKI on long-term mortality of hospitalized HIV-infected patients. Methods Retrospective analysis of a cohort of 433 hospitalized HIV-infected patients who were discharged alive from the hospital. AKI was defined according to ‘Risk Injury Failure Loss of kidney function End-stage kidney disease’ creatinine criteria, as an increase of baseline serum creatinine (SCr) X 1.5 or in patients with baseline SCr > 4 mg/dL if there was an acute rise in SCr of at least 0.5 mg/dL. Cumulative mortality curves were determined by the Kaplan-Meier method, and log-rank test was employed to analyze statistically significant differences between curves. Cox regression method was used to determine independent predictors of mortality. Risk factors were assessed with univariate analysis, and variables that were statistically significant (P < 0.05) in the univariate analysis were included in the multivariate analysis. Results Sixty-four patients (14.8%) had AKI. Median follow-up was 37 months. At follow-up 81 patients (18.7%) died. At 1, 2 and 5 years of follow-up, the cumulative probability of death of patients with AKI was 21.2, 25 and 31.3%, respectively, as compared with 10, 13.3 and 16.5% in patients without AKI (log-rank, P = 0.011). In multivariate analysis AKI was associated with increased mortality (adjusted HR 1.7, 95% CI 1.1-3; P = 0.049). Conclusions AKI was independently associated with long-term mortality of hospitalized HIV-infected patients.

As acute kidney injury (AKI) has not been formally defined in patients with cirrhosis, members of the Acute Dialysis Quality Initiative and the International Club of Ascites formed a working group in March 2010 to discuss the definition of renal dysfunction (acute and chronic) in patients with cirrhosis. The final consensus proposal of the working party was to accept the definition of AKI in cirrhosis as an increase in serum creatinine (SCr) of >50% from baseline or a rise in SCr of >26.4 mmol/l (>0.3 mg/dl) in

We evaluated retrospectively the incidence of acute kidney injury (AKI), defined by risk, injury, failure, loss and end-stage kidney disease (RIFLE) and its influence on long-term survival, in 82 patients aged 18-60 years who underwent a reduced intensity conditioning (RIC) haematopoietic cell transplantation (HCT). Patients (53.6%) developed AKI after HCT: 25% were on risk, 45.5% on injury and 29.5% on failure. In all, 64 patients survived after 100 days of post transplant and were available for long-term survival analysis. At follow-up, 43.7% of patients died. A 5-year overall survival of AKI patients was 41.6% as compared with 67.1% for those who did not develop AKI (P=0.028), and decreased according to AKI severity (risk, 55.6%; injury plus failure, 33.3%; P=0.045). After adjusting for age, history of cardiovascular disease, high-risk disease and chronic GVHD, AKI predicted 5-year overall mortality (AKI: adjusted hazards ratio (AHR), 2.36, 95% CI: 1.03-5.37; P=0.041). Moreover, moderate and severe AKI (injury plus failure) was also associated with an increased 5-year overall mortality (injury plus failure: AHR, 1.64, 95% CI: 1.06-2.54; P=0.024). According to RIFLE, 53.6% of patients had AKI after RIC HCT. Such patients have poor long-term survival, particularly in moderate or severe AKI.