BACKGROUND AND AIMS The actual definition of chronic kidney disease (CKD) applied to patients ˃80 years has generated an increase in the number of referrals to Nephrology for consultation. Nowadays there is a debate about the evolution of kidney function in elderly patients, from physiological evolution of kidney function to identifying which factors are associated with a real progression of CKD. The aim of this study is to analyse the evolution of kidney function in patients ˃80 years referred to Nephrology for consultation for the first time. METHOD A single-centre retrospective study in which we included patients ˃80 years with an estimated glomerular filtration rate (eGFR) <60 mL/min/1,73m2 who were referred to Nephrology consultation from 2015 to 2018. We collected clinical and analytical parameters at the following points in time: 12 months before the visit, baseline and 12 months after the initial visit. We divided patients into two groups based on annual eGFR loss: Group 1 progressors (>5 mL/min/1.73m2) and group 2 non-progressors (≤5 mL/min/1.73m2). RESULTS A total of 348 patients were included in the study, 55.2% were women and the mean age was 84 years (80–97). At the time of first medical visit, the mean creatinine value was 1.6 ± 0.6 mg/dL, median eGRF was 38 mL/min/1.73m2 (29–44) and median albumin/creatinine ratio was 55 mg/g (6–419), with 12% of the patients, presenting albuminuria over 1000 mg/g. The most frequent referral criteria were worsening of renal function (85.6%). Comorbidities were very common, and hypertension, dyslipidaemia and diabetes mellitus were present in 89.4%, 42.8% and 42.2% respectively. A total of 51% of the patients met the definition of progressor at baseline (initial-progressors) and 29.4% were progressors after a 12-month follow-up. Interestingly, only 21.6% of initial-progressors kept meeting this definition 12 months after (Figure 1). The main risk factors for progression were a higher baseline eGFR (P < 0.001) and albuminuria (P < 0.002). No association with comorbidities was found in the multivariate analysis. CONCLUSION The majority of patients ˃80 years evaluated by a Nephrologist were non-progressors at 12 months according to our definition (70.6%). It is more important to estimate the progression of CKD patients and request albuminuria and/or proteinuria than an isolated GFR value. It is likely that non-progressors do not need to be followed by a Nephrologist and may remain under primary care control.

Background and Aims Longer survival in renal transplantation means an increase in the number of patients who return to dialysis after graft loss. There is little literature about the management of immunosupression(IS) in these patients and the complications derived from its maintenance and its withdrawal/reduction. Method We conducted a retrospective study involving a cohort of patients who returned to dialysis after graft failure at Doce de Octubre Hospital from 2015 to 2022. We analyzed baseline characteristics, IS withdrawal scheme, and the complications derived in the 27 months following the restart of dialysis. Results A total of 50 patients were enrolled in the study: 58% male, 86% hypertensive, 30% diabetic and 52% with heart disease. The median age at transplant was 41.5 (33.7-53.2). 70% of donations were in brain death, 18% asystole and 10% alive. The duration of the graft was 8.5 years (5,14), 96% of patients developed anti-HLA antibodies and 40% suffered active rejection. Upon restarting dialysis, all the patients were receiving IS: 84% calcineurin inhibitors (CNI) (tacrolimus, cyclosporine), 58% antimetabolites (mycophenolate, azathioprine), and 10% mTOR inhibitors (everolimus). Haemodialysis was performed in 70% of patients through central venous catheterization in 68.6%. The median time to stop IS was 10 months (6,19). Between the first and the third month, imTOR [0(0.4)] and antimetabolite [1(0.3)] were finalized. Discontinuance of CNI and steroids was at 2 months (1,8) and 8 months (3,15.7) respectively. As complications derived of IS, 64% of patients developed serious infection and 12% were diagnosticated of neoplasms. On the other hand, eighteen patients presented immunological intolerance to the graft, 100% requiring an increase of steroids, 72.2% percutaneous embolization and finally 50% require a transplantectomy. The rate of immunological intolerance, embolization and transplantectomy was higher in patients with withdrawal IS during the first year. Patients on haemodialysis (HD) had higher rate of graft intolerance compared to peritoneal dialysis (PD) (40.5% vs 23%), attributable to early suspension of IS (62% before the first year), but similar rate of infection (61.5%PD, 64.8%HD). At 27 months (14.5,44.2) of follow-up after returning dialysis, 64% of patients remained on dialysis (30% on waiting list for a second kidney transplantation), 28% were retransplanted, and 8% were died. Conclusion Most of transplant recipients returned to haemodialysis through a venous catheter. Withdrawal of immunosuppression was performed on a median of 10 months, faster in mTOR and antimetabolites, and more progressive in CNI and steroids. Stop IS before the first year is more common in haemodialysis group and it is associated with a higher rate of graft intolerance. Finally we want to highlight the significant percentage of embolizations in our hospital, that let us avoid a 12.2% of the transplantectomies.

Background and Aims Secondary atypical hemolytic uremic syndrome (secondary aHUS) is a heterogeneous group of thrombotic microangiopathies (TMA) associated with various underlying conditions. Unlike primary aHUS, there is still no hard evidence on the efficacy of complement blockade in treating secondary aHUS since the two main series in the literature that investigate this subject show discrepant results. Our work aims to reassess Eculizumab's efficacy in treating secondary aHUS. Method Observational, retrospective, single-center study, in which we analyzed the hematological and renal evolution of 24 patients diagnosed with secondary aHUS who received treatment with Eculizumab compared with a control cohort of 14 patients who did not receive Eculizumab. Complete renal response was defined as the recovery of renal function before the event, partial renal response as a recovery of 50% of lost glomerular filtration rate, and hematological response as normalization of hemoglobin and platelets. Results We found no statistically significant differences in baseline characteristics or disease severity between both groups. After a median of 5 doses of Eculizumab, the group of patients who received complement blockade presented a significant difference in renal response (complete in 47.8% of patients and partial in 17.4%) compared to the control cohort (complete response 14.3% and partial of 14.3%). Rates of hematological remission were similar in both groups (87% in the eculizumab cohort and 85.7% in the control cohort). Conclusion Rational and early use of Eculizumab in patients with secondary aHUS could be an effective and safe therapeutic option, guaranteeing better renal recovery compared to patients who do not receive complement blockade.

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Background and Aims Atypical haemolytic uremic syndrome (aHUS) is a clinical entity characterized by acute kidney injury, thrombocytopenia and microangiopathic hemolytic anemia. There are several cases of AHUS in non-renal solid organ transplants described in the literature, included lung transplant. Kidney and patient survival are compromised by this complication because of the lack of an effective treatment. Eculizumab is C5 complement factor specific blocker already administered in another kind of secondary aHUS with encouraging results Method We analys six lung transplants in a retrospective single-center study between 2018-2020 who developed an aHUS and were treated with eculizumab. Clinical and analytical data were collected along the follow-up. Principal outcome was to explore haematologycal and renal response after treatment with eculizumab. Results We included a total of six patients (83% were female) with a median age of 57 years at the time of transplantation. Aetiologies of lung transplantation were chronic obstructive pulmonary disease in 2 patients, interstitial lung disease in another 2, and cystic fibrosis in the remaining two. Induction and maintenance immunosuppressive therapy were based on tacrolimus, mycophenolate and prednisone in all cases. Baseline serum creatinine after lung transplantation was 1.1 mg/dl (0.9-2.4). Two patients developed an aHUS in the immediate post-transplant, one of them died because of surgical complications. Another four patients developed an aHUS 59 months (33-95) after transplantation. Previously of thrombotic microangiopathy, three patients were on treatment with everolimus instead of mycophenolate and two lung transplants have cytomegalovirus reactivation. At the aHUS onset, median serum creatinine was 4mg/dl (2.4-5-7) and acute dialysis was performed in 50% of patients. Median hemoglobin was 7.2g/dl (6.9-7.7), platelet count was 32x1000/µL (17-58), and DHL was 1343 U/L (581-1597) at the start of eculizumab despite having treated the trigger. After a median of 6 doses of eculizumab, the five surviving patients had haematologycal and renal response. No patients underwent chronic dialysis. Serum creatinine was 2.2 mg/dl (1.7-2.3), hemoglobin 9.8 g/dl and platelet count 159x1000/µL at the end of follow-up. Conclusion AHUS is a critical complication in lung transplantation, shortly related with immunosuppressive therapy. Patients are at risk of end stage renal disease. Eculizumab treatment appears promising.