Background and Aims Delayed graft function (DGF) is a common complication after renal transplant. Definitions of DGF are based on analysis of estimated glomerular filtration rate (eGFR) underlying the plasma creatinine fluctuations after renal transplant. We tried to validate an early parameter of DGF in a renal transplant population based on the kinetic estimation of glomerular filtration rate, since this formula adds a quantitative dimension to the assessment of kidney function, and consequently predicting DGF could get a better post-transplant management. Method This is a longitudinal study of 886 renal transplant recipients from our center during the first post-transplant month. As we are searching for functional biochemical markers in renal transplant from decesased donors, we excluded patients with primary gtaft disfunction.The final simple was composed of 574 adult kidney transplant recipients, 348 renal transplant from donors after circulatory death (DCD) and 226 from donors after brain death (DBD). The following are analyzed 5creatinine concentrations, serum Lactate dehydrogenase (LDH) and urinary creatinine excretion rate (CER). Results In DCD there was a significant correlation between DGF duration and all KeGFR and CER determinations during the first post-transplant week. The parameters that achieved the best correlation to predict DGF were KeGFR (r = 0.515; p<0.001) and CER on the fourth day (r = 0.584; p<0.001) (Figure 1). In the DBD, a weak correlation was observed between DGF duration and KeGFR determinations in the first days, being KeGFR at the fourth day the one that presented the highest correlation (r = 0.59 p<0.001). We observed that serum LDH on the first day in the DBD group is associated with worse renal graft function at first, third month and one year after transplantation (p<.045, p<.05 and p<.067 respectively). Conclusion The determination of KeGFR and CER could predict the duration of DGF, especially in DCD recipients. DCD recipients with DGF have significantly better graft survival at one year than DBD recipients with DGF. (p<.001).

Background and Aims Association between nephrotic syndrome (NS) and cancer is well known. However, it has been barely studied and scarcely sustained. Membranous nephropathy (MN) has been identified often as a glomerular paraneoplastic disease. Reported incidence of cancer at the time of biopsy or one year follow-up of MN is 10-20%. Incidence rates in other glomerulopathies are limited. Concomitant malignancy is associated with poor renal outcome in NS. Therapy for cancer is priority and immunosuppressives therapies should be restricted. Furthermore, there is no consensus for cancer screening in patients with NS with or without known risk factors for cancer, as smoking or alcohol consumption. The aim of our study is to stablish the incidence of neoplasia in a cohort of patients of a tertiary hospital of Spain who develop NS. We analyze clinical characteristics, glomerular disease, type of malignancies, screening procedures and risk factors for cancer in this population. Method All patients with NS at our center between January 2013 and December 2019 were included. Demographical and clinical data, and laboratory results were collected, as well as all tests performed for cancer screening. Patients who presented cancer the year before or 24 months after the diagnosis of NS were identified. We performed a logistic regression model to identify independent risk factors for cancer in this population. Results During the study period, 47 patients presented with NS at our center. 38.3% were women and mean age was 57.28±17.3 years. 46.8% patients presented high blood pressure and 23.4% type 2 DM. 5 patients presented HIV infection, and 4 hepatitis C. 51% reported smoking, and 19% of alcohol consumption. Mean creatinine at NS diagnosis was 2.48±2.30 mg/dL, and proteinuria 10.9±6.7 g per day. Histologic diagnosis were: MN (n=7), membranoproliferative glomerulonephritis (n=5), diabetic nephropathy (n=5), and focal and segmental glomerulosclerosis (n=4). 9 out 47 patients presented cancer: 6 patients had a malignancy diagnosed the year before the NS onset (prostate carcinoma n=2, gastrointestinal carcinoma n=2, lung carcinoma n=1, and Hodgkin lymphoma n=1), and 3 patients one the year after the NS onset (thyroid carcinoma n=1, melanoma n=1, and multiple myeloma n=1). In the univariate analysis, patients with cancer were older (69.3±12.1 vs 54.4±17.2 years old, p=0.018) and had more frequently alcohol consumption (33.3% vs 15.8%, p=0.0187). There were no differences in terms of smoking, viral infections, renal function, proteinuria or type of glomerulopathy. In multivariate analysis including these two variables and gender, neither age nor alcohol intake were a risk factors for the presence of cancer in patients with NS. Conclusion: 19.1% patients with NS presented also concomitant cancer in our cohort, without association to the type of glomerulopathy, age or known risk factors for neoplasia such as alcohol, tobacco or viral infection. As our data showed, the presence of cancer in patients with NS is considerable, so the development of screening strategies to find occult malignancies in this group of patients is necessary since this condition compromises renal outcome and life expectancy