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I. Basir, M.S., Ph.D.

Clinical Director, West Virginia University School of Medicine

During treatment for the infection, he presented acute kidney injury with nephrotic range proteinuria and hematuria, and required hemodialysis. Renal biopsy revealed diffuse endocapillary proliferative glomerulonephritis with cellular crescents. Since renal failure was persistent despite infection resolution, he started steroid treatment, lead to improve kidney injury. Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi-do, Republic of Korea. IgA1 splice variants were integrated into the hg38 reference genome to identify IgA1-secreting cells and the data analyzed using Seurat and Alteryx workflow. Results: In 2019 the 200 patients needed for Part A were randomized, with top-line data expected in Q4 2020. Conclusions: Randomization will continue until 360 patients are reached for Part B, which is expected to report in 2022. The percent reduction in proteinuria at 6 months was similar between the two groups (-39. The cumulative frequency of patients with a 50% reduction in proteinuria during the study was also comparable between the two groups (53. However, little is known about the clinical indication of immunosuppressive therapy related to each histological finding. Cox proportional hazard models were used to investigate the association between corticosteroid therapy and renal survival with adjustments of confounders including the Oxford classification. The dots represent the median value, the bars represent the 25th and 75th percentiles. Remission of proteinuria was more common in patients with lower baseline creatinine levels (p=0. Poster Thursday Glomerular Diseases: Clinical, Outcomes, and Trials - 1 Rituximab in IgA Vasculitis with Aggressive Glomerulonephritis: A Real-Life Experience Roberta Fenoglio, Savino Sciascia, Dario Roccatello. Patients included 8 males and 4 females, mean age 45 years with mean follow-up duration of 31 months. The patients who underwent tonsillectomy (T1) and who did not undergo tonsillectomy (T0) were propensity score matched, and the 20-year renal survival rates were evaluated until the serum creatinine level doubled (primary endpoint) and end-stage renal disease was reached (secondary endpoint). In Study 1, the renal survival rates at the primary and secondary endpoints were significantly higher in T1 than in T0 (primary endpoint: 82. In Study 2, the renal survival rate at the primary endpoint tended to be higher and the renal survival rate at the secondary endpoint was significantly higher in T1 compared with T0 (primary endpoint: 97. Multivariate Cox regression analyses showed that immunosuppressants and tonsillectomy prevented disease progression (hazard ratio, 0. Oxford T2 histologic score was removed from the full model analysis as the number of observations is low (n=2). The R2D for the full models with and without race when applied to our validation cohort were 39% and 32% respectively, both were similar or better than the R2D for the same models applied to the original derivation and validation cohorts (26. Both full models were well-calibrated in our cohort, with good agreement between predicted and observed risk of the primary outcome at 5 years post-biopsy. Sub-phenotype associations and microbiome annotations were undertaken for better understanding how genes shaped phenotypes. The total duration of first remission was treated as a time-varying exposure using longitudinal proteinuria measurements. The relationship between duration of proteinuria remission and the primary outcome was non-linear (Figure). Results were robust to multivariable adjustment and consistent across subgroups including immunosuppression exposure. When considering proteinuria as a surrogate outcome, our findings illustrate the need to consider the duration of remission in addition to the magnitude of proteinuria reduction when evaluating the anticipated impact on long-term clinical endpoints. IgG values remained in normal ranges with no increase of infections post-treatment. However, the association between intensity of Gd-IgA1 deposition and histological severity and clinical parameters are not clear. We quantified the intensity of glomerular Gd-IgA1 by Image J software, and analyzed its association with histological findings. We also analyzed the association of intensity of glomerular Gd-IgA1 with serum levels of Gd-IgA1 and creatinine, urinary Gd-IgA1 and proteinuria. In the Gd-IgA1 high-intensity group, acute lesions such as cellular crescents are dominant compared with low-intensity group (P=0.

Dutch electronics giant Philips created a global competitive advantage for its Norelco shaver product line by centralizing global production in a few strategically located plants. And the increased use of global (corporate) branding over product branding is a powerful example of creating economies of scale and scope. As these examples show, geographic aggregation strategies have potential application to every major business model component. Geographic aggregation is not the only avenue for generating economies of scale or scope. Major book publishers, for example, publish their best sellers in but a few languages, counting on the fact that readers are willing to accept a book in their second language (cultural aggregation). As for economic aggregation, the most obvious examples are provided by companies that distinguish between developed and emerging markets and, at the extreme, focus on just one or the other. Whirlpool manufactures appliances across all major categories-including fabric care, cooking, refrigeration, dishwashing, countertop appliances, garage organization, and water filtration-and has a market presence in every major country in the world. In 2008, Whirlpool realized annual sales of approximately $19 billion, had 70,000 employees, and maintained 67 manufacturing and technology research centers around the world. In the late 1980s, Whirlpool Corporation set out on a course of growth that would eventually transform the company into the leading global manufacturer of major home appliances, with operations based in every region of the world. In the process, Whirlpool would establish new relationships with millions of customers in countries and cultures far removed from the U. In the western hemisphere, Whirlpool expanded its longtime involvement in the Latin America market and established a presence in Mexico as an appliance joint-venture partner. By the mid-1990s, Whirlpool had strengthened its position in Latin America and Europe and was building a solid manufacturing and marketing base in Asia. GenericstrateGiesForGlobalValuecreation 51 In 2006, Whirlpool acquired Maytag Corporation, resulting in an aligned organization able to offer more to consumers in the increasingly competitive global marketplace. In other words, the challenge is not in buying the individual businesses-the real challenge is to effectively integrate all the businesses together in a meaningful way that creates the leverage and competitive advantage. Whirlpool successfully refocused a number of its key functions to its global approach. Procurement was the first function to go global, followed by technology and product development. The two functions shared much in common and have already led to significant savings from efficiencies. More important, the global focus has helped reduce the number of regional manufacturing platforms worldwide. In North America, key brands include Whirlpool, KitchenAid, Roper by Whirlpool Corporation, and Estate. Arbitrage A third generic strategy for creating a global advantage is arbitrage (see Figure 3. Arbitrage is a way of exploiting differences, rather than adapting to them or bridging them, and defines the original global strategy: buy low in one market and sell high in another. Less visible but equally important absolute economies are created by greater differentiation with customers and partners, improved corporate bargaining power with suppliers or local authorities, reduced supply chain and other market and nonmarket risks, and through the local creation and sharing of knowledge. Favorable effects related to country or place of origin have long supplied a basis for cultural arbitrage. For example, an association with French culture has long been an international success factor for fashion items, perfumes, wines, and foods. Similarly, fast-food products and drive-through restaurants are mainly associated with U. Another example of cultural arbitrage-real or perceived-is provided by Benihana of Tokyo, the "Japanese steakhouse. Through this and other similar actions, it successfully lowered its tax liabilities to an average rate of less than 10%, rather than the statutory 30% to 36% of the three main countries in which it operated: Britain, the United States, and Australia. By comparison, major competitors such as Disney were paying close to the official rates. It is quite common today for doctors in the United States to take X-rays during the day, send them electronically to radiologists in India for interpretation overnight, and for the report to be available the next morning in the United States.

Increased expression of inflammatory cytokines was detected in particular immune cell clusters. Resident macrophages which took the majority of macrophage subtypes in the kidney are decreased after injury. By Macspectrum analysis, we found a spectrum of diabetic macrophage activation states with greater complexity than traditional M1/M2 definitions. Methods: In vivo, exosomes were isolated from kidney cortical tissues of Akita and streptozotocin-induced diabetic mice for analysis. Knockdown and overexpression were used to study the roles of Rab27b and Foxo1 on exosome secretion. Results: In vivo, diabetic mice had a reduced number of exosomes in renal cortical tissues compared with non-diabetic mice. For the mechanism of Rab27b downregulation, bioinformatic analysis predicted Foxo1-binding sites at Rab27b gene promoter. Overexpression of Foxo1 increased Rab27b expression, whereas Knockdown of Foxo1 had opposite effects. Conclusions: In diabetic kidney cells and tissues, Foxo1 is phosphorylated and inactivated, leading to decreases in Rab27b expression and consequential secretion of exosomes. Moreover, apoptosis and cell cycle of podocytes were detected by flow cytometry and the expression of G2/M transition-related proteins (p21cip1/waf1, cyclin B and cdc2). Background: In type 2 diabetes, lipid metabolism disorder is frequently complicated due to insufficient insulin secretion and cytokines by visceral fat and regarded as one of the most important risk factors for renal dysfunction. However, specific lipid metabolites that have critical effects on renal dysfunction are not fully understood. Significantly fluctuating metabolites in patients with rapidly impaired renal function within 3 years (called "fast decliners"; about 10% in total) were statistically extracted. All mice were euthanized at 20 weeks of age and assessed for functional and histological changes in the kidney. Whole sections were imaged using an Axioscan Z1 scanner (20X objective) and quantitative image analyses were performed using Visiopharm software Results: Tissue integrity and histological stage were independently assessed by two renal pathologists. The majority of cases presented a moderate or severe diagnosis, and 20% of the cohort displayed no overt sign of kidney disease despite long-standing diabetes. Quantification of renal markers was performed using machine learning classification methods. Heasman,4 Elena Liarte Marin,4 Sonja Hess,1 Chelsea Boo,1 Denis Feliers,4 David J. Gene profiling data (Microarray) were obtained from glomeruli and tubulointerstitium. In particular, urinary exosomal miR-30a-5p and miR335-3p levels showed positive correlation with the degree of interstitial inflammation and arterial hyalinosis, respectively. Finally, we found significant correlation between urinary protein-tocreatinine ratio and the levels of urinary exosomal miR-98-5p. Protein abundance data were analyzed using Kruskal-Wallis rank sum tests with an unadjusted p-value 0. Methods: Urine and serum were collected from 34 diabetic patients at the time of kidney biopsy, and from 30 healthy volunteers who served as controls. Another treatment group(n = 6) was subcutaneous administered insulin against hyperglycemia and was given hydralazine against hypertension for matching both levels of blood glucose and blood pressure with the liraglutidegroup. Wolf,1 Anne Steglich,1 Friederike Kessel,1 Florian Gembardt,1 Jan Sradnick,1 Simone Reichelt-Wurm,2 Kathrin Eidenschink,2 Miriam C. In the adult kidney, glomerular endothelial cells lack diaphragms in the fenestrae. Poster Thursday Diabetic Kidney Disease: Basic Mechanisms progression of this microvascular complication. Phenotypic parameters of male mice were measured, and samples were harvested from the mice at 4 months.

Conclusions: Women with preeclampsia have higher senescent burden compared to normotensive pregnant women at the time of delivery. Senolytic agents that target senescence may offer the opportunity for mechanisam-based therapies. Wesson,2 Navdeep Tangri,3 Yuri Stasiv,4 Dawn Parsell,4 Elizabeth Li,5 Gerrit Klaerner,4 David A. Here we analyzed efficacy and safety among the women in these studies of up to one year. Results: Of the 217 pts randomized, 83 (32%) were women, of whom 81% were post-menopausal (55 yrs). Select comorbidities included hypertension (95%), diabetes (64%), and congestive heart failure (30%). Because of hypotention, polyuria and natriuresis, hydrocortisone and fluticortisone were started. Over next few days, he became normotensive and his mentation improved with increasing dose of hydrocortisone. Introduction: Renal injury has been reported in the setting of hematolymphoid neoplasms. Diagnostic evaluation is important in differentiating mechanism of kidney injury, which will affect management and prognosis. Case Description: 50-year-old male with new diagnosis of high-grade lymphoma found to have severe kidney failure. The patient was managed with volume replacement to alleviate the pre-renal component. Kidney function worsened over days and a decision to initiated dialysis was determined. After establishing dialysis access, kidney function demonstrated an improvement trend without dialysis initiation. This type of lymphoma accounts for approximately 25 percent of all Non-Hodgkin Lymphomas in the developed world. Location of lymphocytic infiltration determines the extent of renal dysfunction, whether interstitium or glomerulus. The presence of acute renal failure, proteinuria, or enlarged kidneys should be suspicious of lymphocytic infiltrate of the kidneys. Nevertheless, absence of radiologic changes or proteinuria, similar to our patient, should not rule out kidney involvement. We recommend a low threshold for kidney biopsy to assist in the diagnosis of renal lymphocytic infiltration. Results: 145,942 participants were identified free of kidney stone history at baseline. Among them, 6024 (4%) developed incident kidney stone during 1,601,750 person-years of follow up. Older age, histories of hypertension, diabetes and heart disease, low serum vitamin D, cigarette smoking, and hormone replacement associated significantly with mortality, p<0. She required only 1 session of hemodialysis with the recovery of renal function and mental status. Sucrose is absorbed into proximal convoluted tubular cells and is followed by water due to the changed osmotic pressure. Early recovery of renal function can be achieved by dialytic removal of sucrose from the circulation. A clinical diagnosis is made after ruling out other causes and is confirmed with a renal biopsy. Patient denied having any recent trauma and had no urinary or gastrointestinal complaints. He remained non-oliguric, with gradual improvement of his renal functions and never required renal replacement therapy or any intervention for Page kidney. He presented with markedly elevated blood pressure of 190/110 mmHg and his hospital course was significant for sustained elevated blood pressure requiring addition of four new anti-hypertensive medications by discharge. Discussion: Page phenomenon is a rare but potentially fatal condition that can result from trauma, tumor, vasculitis, renal cyst rupture, or procedures like kidney biopsy.