POS0765 IS THERE ANY DIFFERENCE IN THE CLINICAL FEATURES AND OUTCOMES OF PROLIFERATIVE AND NON-PROLIFERATIVE FORMS OF LUPUS NEPHRITIS PROVEN BY BIOPSY?

Background

Lupus nephritis (LN), which occurs in 60-70% of patients with systemic lupus erythematosus, is a major determinant of morbidity and mortality. There still are many uncertain aspects in clinical, pathological, and prognostic characteristics about LN.

Objectives

We aimed to compare clinical features, outcomes, and to define the predictive factors of complete renal response (CRR) in patients with proliferative and non-proliferative LN.

Methods

Patients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had a kidney biopsy were the subject of the study. One hundred and sixteen patients whose kidney biopsy reported as LN were evaluated retrospectively. Clinical features, laboratory values at the time of kidney biopsy, histopathological forms of LN, and renal response (complete or partial) were recorded. The predictive factors for CRR during the two-year follow-up after induction therapy were analyzed.

Results

Of 116 (93 females, 23 males) patients, 95 (81.9%) were in the proliferative (class III and IV) and 21 (18.1%) were in the non-proliferative group (class II and V). In the proliferative group, elevated basal creatinine, median daily proteinuria, anti-dsDNA positivity, low C3 and C4, the presence of active urinary sediment, and median renal SLE Disease Activity Index (SLEDAI) scores at the time of kidney biopsy were significantly higher than non-proliferative group. During the two-year follow-up after LN diagnosis, 70 patients achieved CRR and time-to-CRR was similar for the groups (p=0.64, log-rank). The Cox proportional hazards model showed that achieving CRR was associated with female gender [HR: 2.15 (1.19-3.89 95% CI), p=0.011], newly diagnosed SLE with renal biopsy [2.15 (1.26-3.67), p=0.005], hypertension [0.40 (0.27-0.94), p=0.032], eGFR increase [1.01 (1.00-1.01), p=0.046], and presence of active urinary sediment [0.46 (0.22-0.96), p=0.039].

Conclusion

Achieving CRR was similar in both the proliferative and non-proliferative LN patients although certain laboratory parameters differed at onset. Our results indicated the importance of kidney biopsy in the decision-making of treatment of SLE patients with renal involvement and that the defined factors associated with CRR achievement help to predict good renal response.

Table 1.

Demographic, clinical characteristics, and outcomes of the patients with LN

Variables*All patientsProliferative LNNon-Proliferative LNpn=116n=95n=21Age at SLE diagnosis, years18.3 (16)19.2 (15)16 (16)0.32Sex, female93 (80.2)75 (78.9)18 (85.7)0.48Age at kidney biopsy, years21 (17.7)22 (17)18 (15)0.19Patients newly diagnosed SLE with renal biopsy65 (56)53 (55.8)12 (57.1)0.91Follow-up time for LN, years5.5 (8)5.1 (8.2)6.2 (5.1)0.80SLE disease duration8 (8.7)8.1 (9.6)7.9 (7.3)0.53Hypertension31 (26.7)26 (27.4)5 (23.8)0.74Laboratory values on the kidney biopsy Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.56 (0.1)0.006 Creatinine > UNL37 (32.5)34 (36.6)3 (14.3)0.04 eGFR (mL/min/1.73m2)113 (54)107 (54)129 (45)0.04 Albumin (g/dL)3.3 (1.1)3.1 (1.2)3.5 (1)0.09 24-hour urine protein, gr/day2.3 (3.3)2.4 (3.6)0.9 (1.8)0.03 Anti-dsDNA positivity94 (81)80 (87.9)14 (70)0.04 Low C3 and C4 levels93 (80.2)81 (88)12 (57.1)0.001 Active urinary sediment91 (83.5)78 (89.8)12 (57.1)<0.001Renal SLEDAI12 (8)12 (8)4 (4)<0.001During the two-year follow-up after LN diagnosis Complete renal response70 (70.7)56 (70.9)14 (70)0.99 Partial renal response23 (23.2)17 (21.5)6 (30)0.64 No response6 (6.1)6 (7.6)0NA Relapse20 (21.5)15 (20.5)5 (25)0.84 ESRD4(4)4 (4.2)0NA Death3 (3)3 (3.2)0NA

* n (%), if otherwise specified; median (IQR) for numeric values

ESRD: End-stage renal disease, GFR: Glomerular filtration rate, LN: Lupus nephritis, SLE: Systemic lupus erythematosus, SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; UNL: Upper normal limit

Figure 1.

Kaplan-Meier survival curve for complete renal response (CRR) achievement during the two-year follow-up according to the kidney biopsy results

Disclosure of Interests

None declared

AB0469 CLINICAL DISEASE MIGHT BE DIVIDED INTO TWO PHENOTYPES IN ANCA ASSOCIATED VASCULITIS; RESULTS OF A CLUSTER ANALYSIS

Background:

One of the controversial matters in ANCA associated vasculitis is the definition of disease based on clinical characteristics since there is remarkable overlap between disease groups. For instance, single organ disease like renal limited vasculitis (RLV) is not take place most of the definitions or classification criteria.

Objectives:

The aim of this study to determine clinical subgroups that may incorporate different clinical phenotypes including RLV in AAV patients followed up in two tertiary centers.

Methods:

Baseline clinical features of AAV patients were studied. To analyse our data and identify sub-groups of AAV patients with similar clinical characteristics, a two-step cluster analysis using log-likelihood distance measures was performed. For clustering we evaluated the following variables: gender, age at symptom onset, the presence of major organ involvement (renal, upper and lower respiratory tract, skin, joint, eye) and ANCA specificity.

Results:

In total 165 (87 [53%] male, age at diagnosis 51.6± 15.2 years) out of 238 (126 [53%] male, age at diagnosis 51.3± 15.6 years) AAV patients included in the analysis. Some of the demographic and clinical characteristics were summarized in the table 1. There are two distinct cluster in AAV patients. Of 78% those AAV patients with MPO/pANCA, 56% with renal involvement and 89% without ENT involvement were in Cluster 1. Of 77% those patients with PR3/cANCA, 89% with arthritis, 74% with eye involvement, 83% with skin, 91% with upper, and 60% with lower respiratory tract involvement and 92% of those without renal disease were in Cluster 2. Most of the (89%) patients classified as MPA and all as RLV were repositioned in Cluster 1 and 74% of GPA and 64% of EGPA patients were in Cluster 2.

Table 1.

Baseline characteristics of 165patients with AAV

Age at diagnosis, mean years ± SD, (n)51.6 ±15.2, 163Male, n (%)87 (52.7)Labaratory results at diagnosisGFR =<60, n (%)100/145 (69)MPO-ANCA or p-ANCA /Pr3-ANCA or c-ANCA68 (41.2)/ 97 (58.8)Variants of AAVn (%)MPA26(15.8)GPA108 (65.5)EGPA11 (6.7)RLV20 (12.1)Organ systems involved at diagnosis n (%)Cutaneous24 (14.5)Eye23 (13.9)Ear, nose and throat90 (54.5)Low respiratory tract111 (67.3)Cardiovascular system5/163 (3.1)Gastrointestinal system10/164 (6.1)Renal129 (78.2)Peripheral nervous system16 (9.7)

GFR: glomeruler filtration rate; ANCA: antineutrophil cytoplasmic antibodies; Pr3: proteinase 3; MPO: myeloperoxidase; p-ANCA: perinuclear ANCA; c-ANCA: cytoplasmic ANCA; MPA: Microscopic Polyangiitis; GPA: Granulamatosis and Polyangiitis; EGPA:Eosinophilic Granulomatosis with Polyangiitis; RLV: Renal limited vasculitis

Conclusion:

Patients with AAV could be separated into two distinct categories. PR3 ANCA specificity and more organ/system involvement determine one and MPO ANCA specificity in renal disease define other subgroup.

Figure. Determining characteristics of ANCA associated vasculitis clusters

Figure.

Disclosure of Interests:

None declared

Effect of polyethylene glycol induced drought stress on photosynthesis in two chickpea genotypes with different drought tolerance

Responses of parameters related with photosynthesis and the involvement of various factors in photosynthetic damage in two chickpea genotypes, Gokce (tolerant) and Kusmen (sensitive) under drought stress were assessed. Photosynthetic pigment content decreased under drought stress in two genotypes. Significant decreases in gs, Pn and E were determined in Kusmen. No significant change in these parameters was measured in Gokce under drought stress. Fv/Fm, ΦPS2 and ETR decreased in drought stressed plants of Kusmen as compared to control plants however Fv/Fm, ΦPS2 and ETR did not change in Gokce under drought stress. Increases in NPQ were determined under stress in both genotypes. Drought stress did not affect rubisco activity and rubisco concentration in Gokce while, the activity and the content declined in Kusmen. The drought tolerance of the Gokce genotype is a consequence of a balance among leaf water potential, stomatal conductance, photosynthesis, and transpiration. On the other hand, photosynthesis in Kusmen may be not only restricted by stomatal limitations but also by non-stomatal limitations under drought stress.

The abdominal cocoon: a rare cause of intestinal obstruction

The abdominal cocoon is a very rare entity leading to bowel obstruction. A 30-year-old man was admitted to the emergency department with symptoms and signs of mechanical intestinal obstruction. In addition to these, the recurrent episodes of obstruction in the patient's history and palpable abdominal mass found during the physical examination, appeared as important clinical characteristics of the pathology. A CT scan of the abdomen showed a conglomerate of bowel loops encased in a membrane. A Cocoon-like mass consisting of encapsulated bowel loops was the main finding of surgical exploration. Dissection and excision of the encapsulating membrane and release of encased loops provided definitive treatment of this rare entity.

The comparison of heavyweight mesh and lightweight mesh in an incisional animal model

PURPOSE

An incisional hernia may occur through the incision area following a surgical operation, through the trocar opening and even through drainage exit points. Various synthetic surgical meshes have recently been used for the surgical repair of incisional hernias. In this study, we analysed the burst strength forces of heavyweight mesh and lightweight mesh in an incisional animal model.

METHODS

Following experimental formation of incisional hernias in 32 Wistar albino rats, they were divided into four groups. Polypropylene suture was used for closure of the abdominal incision in Group 1. In Groups 2, 3 and 4, polyester, polypropylene + polyglactin and polypropylene meshes, respectively, were fixed on the surface of the fascia after closing the defects in the rats. Polypropylene and polyester meshes are classified as heavy mesh. Light mesh is composed of a non-absorbable part (polypropylene) and an absorbable part (polyglactin), which will disappear 80 days after implantation. The rats were sacrificed at the end of the experiment. The pullout force of the fascia and meshes were recorded by use of a digital tension meter.

RESULTS

The mean pullout forces for Groups 1, 2, 3 and 4 were found to be 123.4 +/- 13.3, 292.33 +/- 17.4, 281.66 +/- 16.3 and 310.60 +/- 26.1 N, respectively.

CONCLUSION

At the end of the experiment, the polypropylene (25 g/cm(2)) present in the lightweight mesh was found to lose only a small percentage of the burst strength compared to the polypropylene (85 g/cm(2)) present in the heavyweight mesh.

Lymphovascular invasion, as a prognostic marker in patients with invasive breast cancer

PURPOSE

The markers of prognosis are used to predict the clinical course of disease and the outcome for patients with invasive breast cancer. Our aim is to investigate the relationship of peritumoural lymphovascular invasion (LVI) with well-known prognostic markers.

PATIENTS AND METHODS

Eighty-one surgically treated patients with invasive breast cancer were evaluated in this study during a mean follow-up period of 46 months (12-72). The patient's age (menopausal status), tumour size, nuclear grade, axillary lymph node involvement, and hormone receptor status were determined as markers of the prognosis. The relationship of LVI with these markers was established.

RESULTS

Except for menopausal status (p = 0.25) a close relationship was found between the presence of LVI and studied prognostic factors. LVI was positive in 29% of T1, 54% of T2 (p = 0.028) and 100% of T3 tumours (p = 0.002). The rate of LVI (+) has increased gradually as 0%, 38% and 77% (p = 0.001) with grades 1, 2 and 3 respectively. Positive LVI has been determined in 85% (p < 0.0001) and 73% (p = 0.0004) of oestrogen and progesterone receptor negative tumours respectively. LVI was present in 14% and 73% (p < 0.0001) of patients with negative and positive axilla respectively. Metastatic cancer caused mortality in seven patients of whom 86% had more than four involved axillary nodes, and 100% LVI (+).

CONCLUSION

The high rate of positive LVI shows a close relationship with known markers of poor prognosis. The presence of LVI can predict a worse outcome for patients with invasive breast cancer. LVI may be used as an indicator of aggressive behaviour, metastatic ability (nodal and systemic) of the primary malignancy.

Effects of probiotics on the severity of experimental acute pancreatitis

OBJECTIVE

This study was designed to evaluate the effects of probiotics on the severity of experimental acute pancreatitis.

DESIGN

Experimental study.

SETTING

Experiments were done in a laboratory at Haydarpasa Numune Teaching and Research Hospital.

SUBJECTS

A total of 50 Wistar rats were randomly divided into five groups.

INTERVENTIONS

Group 1 was control group. Group 2 received an intraperitoneal injection of a 20% solution in 0.15 mol/l NaCL. Group 3 was injected NaCL and fed with probiotics. Acute pancreatitis was induced in rats by intrperitoneal injection of L-Arginine in groups 4 and 5. The rats in group 5 were treated with probiotics. The pancreas was removed for histologic examination. Evaluation of the pathologic changes was done by a new combined histopathologic grading scale.

RESULTS

The mean scores of fibrosis, acinar cell loss, oedema, parenchymal necrosis, mononuclear cells infiltration, polymorphonuclear leucocytes infiltration, ductal damage and atypical reactive regeneration in group 5 were significantly lower than group 4.

CONCLUSIONS

We demonstrated that enteral feedings with added probiotics can reduce the severity of acute pancreatitis.

SPONSORSHIP

None.

Breast carcinoma with three coexistant type of metaplasia: sarcomatoid, giant cell and squamous differantiation

We report on a women with metaplastic carcinoma of the right breast. After diagnosis she had a simple mastectomy operation. Pathological investigations were carried out on mastectomy material. Immunohistochemical analyses were performed. Bizarre, malignant giant cells and diffuse inflammatory reactions were predominantly noted. Sarcomatous metaplasia and rare squamous metaplasia were also seen. There was not any area of classic intraductal, invasive ductal, lobular or papillary carcinoma. The patient is still alive and well for more than five years. This uncommon case is described and discussed, and the related literature is reviewed.

Fetal biometry: size and configuration of the third ventricle

PURPOSE

To evaluate the normal configuration and size of the third ventricle in second and third trimester fetuses in a normal population, and to compare our values with those of previously published studies.

MATERIAL AND METHODS

Evaluation of fetal third ventricular width and configuration was obtained by antenatal ultrasonography in 474 fetuses with gestational age between 12 weeks and term (mean 28 weeks). Percentiles for third ventricle width were estimated by combining separate fractional polynominal regression models fitted to the mean and standard deviation, assuming that the measurements had a normal distribution at each gestational age. Appearance of the third ventricle was correlated with each gestational age.

RESULTS

The third ventricle could be visualized in 471 (99%) of 474 fetuses. The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. The third ventricle was seen as a single echogenic line in 153 (32.4%) of 474 fetuses. Two-hundred-and-ninety-nine (61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen. V-shaped third ventricular configuration was seen in only 28 (5.9%) of the fetuses. From 24 weeks to term, parallel echogenic lines were the most commonly (83.7% to 79.6%) encountered configuration for the third ventricle.

CONCLUSION

The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. In the early second trimester, 77% of the fetuses had a single echogenic line appearance on ultrasonography. As the brain and ventricular structures mature, a parallel echogenic line becomes the prominent ultrasonography appearance (>80% of fetuses) in third trimester healthy fetuses.

Coexistence of lactating adenoma and invasive ductal adenocarcinoma of the breast in a pregnant woman

A 36 year old pregnant woman was admitted to hospital complaining of an enlarging mass in her left breast. Histopathological examination of the mastectomy specimen revealed a high grade infiltrating ductal adenocarcinoma intermixed with a lactating adenoma. Lactating adenomas are rare entities but are the most common masses that occur during pregnancy. Although they are not thought to carry an increased risk of cancer there are two other case reports in the literature of a lactating adenoma associated with an infiltrating carcinoma. In this case, areas where the lactating adenoma and the infiltrating carcinoma were intermixed could be identified. This case could simply be a collision tumour, although the possibility of an invasive carcinoma arising within a lactating adenoma cannot be ruled out. Because of the relative lack of experience with lactating adenomas, the question of an increased association with carcinoma development remains unclear.

Isolated metastasis of malignant melanoma into follicular carcinoma of the thyroid gland

A 38-yr-old woman with a history of malignant melanoma (MM) presented with a thyroidal nodule. Fine needle aspiration biopsy of the thyroid was consistent with metastatic MM. The patient underwent thyroidectomy: microscopic examination revealed a follicular carcinoma nodule harboring a focus of metastatic melanoma. On review of the fine needle aspiration biopsy specimen, the population of cells with more uniform nuclei with focal follicle formation, which initially was interpreted as cells originating from normal thyroid tissue, was seen to actually represent the follicular carcinoma component. Tumor-to-tumor metastasis is an interesting phenomenon and there are only few cases of MM metastasis to other tumors. MM metastasis into a neoplastic thyroid nodule is a very rare combination and may be explained because the nodule in question represents the most highly vascularized component of the thyroid.

Synergistic effects of carboxymethylcellulose and low molecular weight heparin in reducing adhesion formation in the rat uterine horn model

OBJECTIVE

To investigate the effect of sodium carboxymethylcellulose (SCMC) and the combination of low molecular weight heparin (LMWH) with SCMC in the prevention of intraperitoneal adhesion.

DESIGN

Thirty-eight rats underwent bilateral surgical injury to the uterine horn and the parietal peritoneum. In 13 rats, a solution of SCMC was instilled at laparotomy. In 11 rats, LMWH was delivered on to serosal and peritoneal defects, and SCMC was instilled. As a control group 14 rats were included in the study.

SETTING

Surgical Research Laboratory, Erciyes University.

PARTICIPANTS

Female Wistar-Albino rats, weighing 200 to 250 g each.

MAIN OUTCOME MEASURES

Adhesions between the uterine horn and the abdominal sidewall were scored for extent and severity two weeks after the initial surgery.

RESULTS

Although the mean adhesion score both in the SCMC group (2.8, s.d. 1.15) and in the SCMC with LMWH group (1.6, s.d 1.18) was found to be significantly lower than in the control group (3.4, s.d. 0.89) (p < 0.05 and p < 0.001, respectively), more favorable adhesion prophylaxis was achieved in the SCMC with LMWH group in comparison with the SCMC treatment group without any hemorrhagic complications (p < 0.001).

CONCLUSION

We conclude that SCMC with LMWH are highly effective in reducing postoperative adhesions in this animal model. SCMC with LMWH appears promising in adhesion prophylaxis.

Control of plasma glucose with somatostatin analogue (SMS 201-995) during surgical removal of insulinomas

Prevention of hypoglycaemia may sometimes be difficult in the operative period of insulinoma when parenteral volume overload is contraindicated due to severe cardiac failure. We investigated the effects of octreotide on hypoglycaemia during operations in two patients with insulinoma, one of whom had severe congestive heart failure. We found no hypoglycaemic values by using octreotide 100 micrograms administered subcutaneously one hour before surgery. Octreotide therapy can safely be used before surgery to prevent hypoglycaemia in patients with insulinoma.