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specially in tubular cells [Figure 1.D]. Carotid doppler showed atherosclerosis with 50% stenosis on the right side and 60% on the left side. In view of refractory anasarca not responding to high dose of diuretic, regular ultrafiltration was initiated. Improvement of the fluid overload was achieved but patient still suffer muscle pain, weakness, and intermittent air hunger. Which improved after L-carnitin was added to improve the mitochondrial metabolism.Methods: -Results: -Conclusions: we report a rare case of podocytopathy associated with advanced diabetic nephropathy in type II DM that suggesting acquired mitochondrial cytopathy.

mittee approved the study (certificate 308/2020), and an online survey was designed using a REDCap database hosted at the University of Pretoria 15,16 . The survey was administered to all nephrologists registered with the South African Renal Society between May and August 2020. All patient data was entered online by the treating nephrologist. Odds ratios were calculated using mortality as the outcome, with international comparative mortality data derived from Fominskiy et. al.Results: At the completion of the study, 142 responses were received. Of these, 52 (36.62%) were removed due to incomplete data or incomplete informed consent, resulting in 90 (63.38%) responses available for analysis. No significant increase in deaths was fond when comparing our data to international COVID-19 ICU mortality data (odds ratio [OR] 1.14, 95% confidence interval (CI) 0.64 -2.06, P = 0.6532), but a significant increase in mortality was seen when compared to international COVID-19 in-hospital mortality (OR 2.05, 95% CI 1.13 -3.72, P = 0.0176). Our data revealed that mortality was significantly increased in patients who were treated in the state sector (OR 2.15, 95% CI 1,00 -4,63, P = 0,0497) or were diagnosed with shock (OR 2.73, 95% CI 1.11 -6.71, P = 0.028). Similarly, mortality was significantly increased in patients who required ventilation (OR 2.24, 95% CI 1.10 -4.56, P = 0.026), inotropes (OR 2.78, 95% CI 1.26 -6.16, P = 0.0115) or continuous dialysis therapy (OR 3.11, 95% CI 1.33 -7.26, P = 0.0087). In contrast, mortality was significantly decreased in patients diagnosed with ischemic heart disease (OR 0.19, 95% CI 0.04 -0.95, P = 0.0431) and patients who received intermittent hemodialysis during their admission (OR 0.28, 95% CI 0.11 -0.72, P = 0.0081). Conclusions: 1) Our findings from a developing country are similar to developed countries.2) Significant predictors of mortality were continuous dialysis therapy, ventilation, inotropes, shock and treatment in the state sector.3) Significant predictors of survival were intermittent hemodialysis and ischemic heart disease.No conflict of interest

Figure 1. Scr from before and after plasmapheresis. The PRA and DSA levels were repeated after the 6 sessions of plasma exchange the DSA had drastically reduced by 1/3 rd whereas PRA had not reduced. Scr stabilized at 4.0mg/dl In Dec.2018 Scr started rising in mid-Jan.2019. Following which we did 5 more plasma exchange this showed some benefit. after 11 cycles of plasma exchange a renal biopsy was repeated showing Marked tubular atrophy and interstitial fibrosis. Due to peri-tubular capillaritis and C4D positivity resistant ABMR Is favored. Currently patients Scr is 3.7mg/dl and is off hemodialysis Conclusions: late presentation of ABMR poses immunologically challenges that was managed using a combination of plasma exchange, immunoglobulins and rituximab.

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