Acute kidney injury (AKI) is one of the leading causes of in-hospital morbidity and mortality, particularly in critically ill patients. Although our understanding of AKI at the molecular level remains limited due to its complex pathophysiology, recent advances in both quantitative and spatial mass spectrometric approaches offer new opportunities to assess the significance of renal metabolomic changes in AKI models. In this study, we evaluated lipid changes in early ischemia-reperfusion (IR)-related AKI in mice by using sequential window acquisition of all theoretical spectra (SWATH)-mass spectrometry (MS) lipidomics. We found a significant increase in two abundant ether-linked phospholipids following IR at 6 h postinjury, a plasmanyl choline, phosphatidylcholine (PC) O-38:1 (O-18:0, 20:1), and a plasmalogen, phosphatidylethanolamine (PE) O-42:3 (O-20:1, 22:2). Both of these lipids correlated with the severity of AKI as measured by plasma creatinine. In addition to many more renal lipid changes associated with more severe AKI, PC O-38:1 elevations were maintained at 24 h post-IR, while renal PE O-42:3 levels decreased, as were all ether PEs detected by SWATH-MS at this later time point. To further assess the significance of this early increase in PC O-38:1, we used matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI-IMS) to determine that it occurred in proximal tubules, a region of the kidney that is most prone to IR injury and also rich in the rate-limiting enzymes involved in ether-linked phospholipid biosynthesis. Use of SWATH-MS lipidomics in conjunction with MALDI-IMS for lipid localization will help in elucidating the role of lipids in the pathobiology of AKI.

SESSION TITLE: Miscellaneous Case Report Posters II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM -02:30 PM INTRODUCTION: Myocarditis is a rare complication of many viral syndromes. Most commonly described viral etiologies are adenovirus, coxsackievirus, CMV, HIV, and parvovirus B-19. We present a rare case of coronavirus related fulminant myocarditis. CASE PRESENTATION:Nine month old male presented with two day history of cough, rhinorrhea, and fever. Initial vitals were significant for respiratory rate of 60 breaths per minute and a heart rate of 180 beats per minute. Physical examination revealed nasal flaring and crackles on auscultation. Electrocardiograph revealed diffuse ST segment elevation, and echocardiogram showed ejection fraction(EF) of 25 %. Intubation was performed for respiratory failure and shock. The patient suffered cardiovascular collapse post-intubation and received CPR for 1.5 hours until veno-arterial ECMO was initiated. On ECMO day two, a heart catheterization revealed left atrial hypertension (17mmHg) and balloon atrial septostomy was performed. Comprehensive PCR based viral respiratory panel (which has a sensitivity and specificity of more than 90%) was positive for coronavirus and Ebstein barr virus. Patient was treated with two doses of intravenous immunoglobulin (2 milligram per kilogram). He was successfully decannulated on ECMO day six. Repeat echocardiogram showed EF 55%. Patient subsequently was weaned off and had full neurological recovery.

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A primary infection in a remote site resulting in vision threatening complications like panophthalmitis in a person who is not immune-compromised is rare. We report a case of endogenous bilateral bacterial endophthalmitis progressing into panophthalmitis in one eye requiring evisceration of that eye. A patient admitted with severe ESBL E. coli urosepsis was effectively treated with source control (bilateral DJ stenting for hydroureteronephrosis) and antibiotics. She was found to have features suggestive of bilateral conjunctivitis which progressed to panophthalmitis possibly due to delay in appropriate diagnosis and treatment. Diagnosis requires a very high index of suspicion if eye involvement is noted in a patient with features of bacteraemia and early intervention could possibly produce better outcomes. To our knowledge, this is the first case of ESBL E. coli urosepsis complicated by microbiologically confirmed panophthalmitis.

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