0 évaluation0% ont trouvé ce document utile (0 vote)
247 vues21 pages
Fluid overload and renal angina index are associated with worse outcomes in critically ill children. Fluid overload predicted oxygenation index, independent of age, gender and PELOD score (P 0.05) Peak fluid overload was associated with longer duration of ventilation, and Intensive Care unit and hospital length of stay. Day-3 AKI rates were higher in patients with RAI cutoff >8.
Fluid overload and renal angina index are associated with worse outcomes in critically ill children. Fluid overload predicted oxygenation index, independent of age, gender and PELOD score (P 0.05) Peak fluid overload was associated with longer duration of ventilation, and Intensive Care unit and hospital length of stay. Day-3 AKI rates were higher in patients with RAI cutoff >8.
Fluid overload and renal angina index are associated with worse outcomes in critically ill children. Fluid overload predicted oxygenation index, independent of age, gender and PELOD score (P 0.05) Peak fluid overload was associated with longer duration of ventilation, and Intensive Care unit and hospital length of stay. Day-3 AKI rates were higher in patients with RAI cutoff >8.
Delhi, India, 4-6 December 2014. President: Arvind Bagga Selected Abstracts Acute kidney injury Fluid overload and renal angina index are associated with worse outcomes in critically ill children S.K. Sethi 1 , V. Raghunathan 1 , R. Raina 2 , M. Kumar 1 , M. Dhaliwal 1 , J. Sharma 1 , V. Kher 1 1 Kidney Institute &Pediatric Intensive Care, Medanta Medicity Hospital, Gurgaon, India; 2 Pediatric Nephrology, Akron Children's Hospital, Cleveland, Ohio, USA 2 Objectives: We investigated the association of fluid overload and oxy- genation, and correlated with outcomes (duration of ventilation, ICUstay and mortality). We also assessed whether renal angina index (RAI) at admission, can predict acute kidney injury (AKI) on day 3, and mortality. Design and setting: Prospective study, pediatric intensive care in a tertiary hospital Duration: June 2013- June 2014 Patients: Need for invasive mechanical ventilation for >24 hr and pres- ence of an indwelling arterial catheter. Patients with congenital heart disease or those who received renal replacement therapy were excluded. Methods: Oxygenation index, fluid overload percent (daily, cumulative), RAI at admission and pediatric logistic organ dysfunction (PELOD) score were obtained in all critically ill children. Admission data included for determination of RAI included the use of vasopressors; invasive mechanical ventilation; percent fluid overload and change in kidney function (estimated creatinine clearance). Univariate and multivariate approaches were used to assess the independent relation between fluid overload, oxygenation index and clinical outcomes. RAI cutoff >8 was used to analyze the predictive performance to predict AKI on day 3 of admission and mortality. Results: 102 patients were recruited. Fluid overload predicted oxygena- tion index, independent of age, gender and PELOD score (P <0.05). Peak fluid overload was associated with longer duration of ventilation, and intensive care unit and hospital length of stay (P <0.05), controlled for age and gender, PELOD. Day-3 AKI rates were higher in patients with RAI of 8 or more with the area under the curve of RAI higher for predicting Day- 3 AKI. An RAI <8 had high negative predictive values (9299%) for Day-3 AKI. RAI was as good as traditional markers of pediatric severity of illness (pediatric risk of mortality) for prediction of AKI on day 3. Conclusions: This study emphasizes that positive fluid balance adversely affects the intensive care unit course in critically ill children. Renal angina index prediction model may further help in a reliable prediction of AKI and help optimize treatment. Activation of Tim-3/Gal-9 pathway promotes the proliferation of Foxp3 + Treg in mice with renal ischemia reperfusion injury W. Yamei, T. Yuhong Department of Pediatrics, West China Second University hospital, Si- chuan University, Chengdu, China Background: Foxp3 + regulatory T cells (Tregs) participate in the repair of renal ischemia reperfusion injury (IRI). Others have shown that galactin-9 (Gal-9), a -galactoside binding mammalian lectin, binds to negative regulatory molecule Tim-3 on CD4 + T cells and regulates im- mune responses by increasing Foxp3 + Treg in vitro and in vivo. Objectives: To study if activation of Tim-3/Gal-9 pathway promotes proliferation of Foxp3 + Treg in mice with renal IRI. Methods: The left renal pedicle was clamped in C57BL6 male mice for 45 min, followed by reperfusion. Animals were sacrificed at baseline, and day 1, 3, 10, 21 after renal IRI. Expression of renal Gal-9 was detected by real-time RT-PCR, immunohistochemistry staining and Western blot. Tim-3 in kidney mononuclear cells (KMNC) was determined using real-time RT-PCR and flow cytometry. The percentage of Foxp3 + Treg in KMNC and renal Foxp3 mRNA in kidney were measured with flow cytometry and real-time RT-PCR. To research the influence of Tim-3/Gal- 9 pathway to the proliferation of Foxp3 + Treg and the protection effect of renal IRI, recombinant adeno associated virus (rAAV) carrying Gal-9 was injected to mice two days before kidney IRI surgery in order to overex- press Gal-9 and activate Tim-3/Gal-9 pathway. The proportion of Foxp3 + Tregs, Foxp3 mRNA and cytokines (TNF-, IFN-, IL-10 and TGF-) in kidney were evaluated on day 3, 10 and 21. Results: The expression of Gal-9 and Tim-3 in the injured kidney at day3, 10 and 21 increased significantly compared with injured kidney at day 1 and baseline (P<0. 05). The percentage of Foxp3 + Treg in CD4 + Tcells and Foxp3 mRNAwas up-regulated with time. The mRNAexpressionof Gal-9 andTim- 3 was positively correlated with the percentage of Foxp3 + Tregs and Foxp3 mRNA at day 3, 10 and 21. Mice treated with RAAV carrying Gal-9 were significantly protected fromrenal IRI. Over expression of Gal-9 decreased the level of inflammatory cytokines (TNF- and IFN-) and increased the levels of IL-10 and TGF-in injured kidney. Furthermore, the proportion of Foxp3 + Treg cells and the level of Foxp3 mRNAin injured kidney were significantly higher than those in uninjured kidney and adenovirus group. Conclusion: Tim-3/Gal-9 pathway involves proliferation of Foxp3 + Treg in mice with renal IRI. Gal-9 is a potential therapeutic target in renal IRI. Independent risk factors for acute kidney injury after surgery for congenital heart disease D. Hirano, A. Ito, A. Yamada, D. Kakegawa, S. Miwa, H. Ida Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan Objectives: Despite advances in surgical treatment and postoperative care for congenital heart disease (CHD), 30% patients develop acute kidney disease (AKI). Risk factors for postoperative AKI include usage time of cardiopulmonary bypass, presence of ischemia, reduced postop- erative cardiac output, young age, type of heart disease, and use of cardiovascular agents. This study aimed to investigate the incidence and risk factors of postoperative AKI. Methods: This study retrospectively investigated 418 patients (males: 259; females: 159; median age: 5 months) who underwent heart surgery for CHD at our hospital over the6-year period fromApril 2007 through August 2013. AKI was defined according to pediatric RIFLE (pRIFLE) classifications and required a decrease in estimated creatinine clearance of 25%. Pediatr Nephrol DOI 10.1007/s00467-014-2981-6 Results and Conclusions: AKI developed postoperatively in 104 cases (24.9%). Approximately 80% patients were allocated into risk category according to pRIFLE classification and did not require treatment. Multi- variate analysis revealed the following independent risk factors for AKI: young age at surgery (<1-yr), surgery with risk adjusted classification of congenital heart surgery score (RACHS-1) grade 4 and long usage time of cardiopulmonary bypass (90 minutes). NGAL and IL-18 levels in first spontaneous void urine samples are biomarkers of renal dysfunction in babies born after fetal distress S.K. Patnaik 1, 2 , P Haritha 2 , M Udhayakumar 2 , R Joshi 2 , V Venkateshwar 2 1 Department of Pediatrics, Army Hospital, Delhi; 2 Department of Pedi- atrics, Command Hospital, Bangalore, India Objectives: We hypothesized that high levels of NGAL and IL-18 in the first urine passed at birth is a biomarker of in utero/intrapartumacute renal dysfunction. We conducted a study of the utility of measurement of NGAL and IL-18 levels in spontaneous first void urine samples in babies born with or without fetal distress as a marker of renal dysfunction. Methods: Prospective follow-up of 2 cohorts of neonates over 1 week after birth during a 1-yr period. Group A: Neonates with fetal distress defined as abnormal cardiotocography, fetal bradycardia or tachycardia, cord pH <7.15 or fresh meconium stained liquor; group B: Normal spontaneous labor in healthy mothers with no signs of fetal distress. Patients with premature rupture of membranes, maternal fever, positive sepsis screen within first week, IUGR, congenital malformations or small kidneys on postnatal ultrasound were excluded. Serial creatinine and urinary NGAL and IL-18 levels were estimated at 24, 48 hr and day 7. Outcomes: Urinary NGAL and IL-18 levels in first void samples; tem- poral profile of urinary biomarkers, AKI in first week of life, change in serum creatinine between birth and day 7. Results: Spontaneous void urine samples could be collected in the delivery suite for 61 babies (Group A: 26; Group B: 35). Resuscitation and intensive care was needed for 17 babies. Apart from neonatal jaun- dice, no significant co morbidity was observed in Group B. Median urinary biomarker levels were significantly elevated at birth (IL-18 56.5 vs. 22.4 pg/ml; NGAL 53.6 vs. 20.5 ng/ml), 24-hr (IL-18: 59.2 vs. 23.2 pg/ml; NGAL: 57.4 vs. 21.9 ng/ml) and 48-hr (NGAL: 49.1 vs. 16.6 ng/ ml) birth in babies with fetal distress and were associated with a mean change of serum creatinine of 0.62 (0.2-0.9) mg/dl in gr. A compared to 0.25 (0.1-0.29) mg/dl in gr. B within the first week. Biomarker levels had a trend for being higher in girls and normalized by day 7 with no significant effect of male sex (r=-0.18), birth weight (r=0.19) and gesta- tional age (r= 0.13). There was a significant correlation with occurrence of fetal distress on univariate and multivariate regression. Conclusions: Babies with fetal distress had significantly higher levels of NGALand IL-18 in the first voided urine sample and significantly greater change in serum creatinine levels in the first week. The biomarker levels reached comparable levels for normal neonates by day 7 of life. Outcome of acute kidney injury in children with falciparum malaria R. Prasad, O.P. Mishra, A. Abhinay, U.K. Singh Departments of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi Objectives: Acute kidney injury (AKI) in P. falciparum malaria is an important morbidity in children. The present study was done to observe the changes in renal functions and their outcome. Methods: Patients admitted to pediatric ward of a tertiary-care hospital with severe falciparum malaria who developed AKI were included. Results: Of 156 patients, 31(19.9%) had AKI; 4 patients were classified at Risk, 11 Injury and 16 Failure, per pRIFLE criteria. There were 20 males, and mean age of patients with AKI was 7.73.2 years. Blood urea and creatinine levels were 132.640.4 and 3.91.9 mg/dL, respectively. Anemia (90.3%), hypoglycemia (41.9%), jaundice (38.7%), convulsions (35.5%), pulmonary edema (32%), coma (29%), disseminated intravas- cular coagulation (29%) and shock (26%) were co-morbidities. Twelve cases (38.7%) required peritoneal dialysis; 8 patients (25.8%) with AKI died. Non-survivors had longer duration of illness (P=0.003), oliguria (P <0.001), and high levels of urea (P <0.01) and creatinine (P=0.042). On regression analysis, DIC (odds ratio 73.5, 95% CI 6.9-707.9), jaundice (OR 25.2, CI 3.0-188.8) and pulmonary edema (OR 6, CI 1.1-31.8) were determinants of outcome. Conclusions: AKI in falciparum malaria is a severe complication; dura- tion of illness and presence of co-morbidities adversely affect outcomes. RIFLE criteria in critically ill neonates with acute renal failure M. Mohkam, A. Afjeii, F. Golchin, A. Ghafari Pediatric Infectious Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction: Neonatal ARF is defined as urine flow rate <1 ml/kg/hr, with serum creatinine >1.5 mg/dl for at least 24-hr. The aim of this study was to compare the RIFLE criteria to the old definition of ARF for diagnosis of neonatal acute kidney injury (AKI) and prediction of mortality. Methods: This cohort study was conducted on 904 critically ill neonates. RIFLE score was determined for each neonate based on serum creatinine and urine output on the second day of admission. Prevalence of AKI was detected based on old definition of ARF and RIFLE criteria. Results: Based on RIFLE criteria, 22.5%of study group had normal renal function and 77.5% had AKI at the second day of admission. Among patients with AKI 43% met the risk, 51% the injury and about 6% the failure criterion. Based on old definition of ARF in neonates, the rate of ARF in our study group was 3.2%. There was a significant difference between AKI prevalence by RIFLE criteria and old definition (P <0.001). The overall mortality rate in critically ill neonates was 14%. Of those who died, 81.9%had AKI. In patients with normal renal function there was no mortality and in patients with AKI based on RIFLE criteria the mortality rate was 21.7%(P=0.031, OR1.1, 95%CI 1.05-1.16) and in patients with ARF based on old definition the mortality rate was 61.5% (P <0.001, OR 6.7). A progressive and significant elevation in mortality was correlated with increasing RIFLE severity in neonates. Conclusion: RIFLE criteria can detect neonatal AKI earlier and is a satisfactory predictor for mortality in critically ill neonates. Chronic kidney disease Effect of cholecalciferol supplementation on FGF-23 levels in children with chronic kidney disease (CKD) having vitamin D insufficiency A. Sheriff, P. Hari, R.W. Thergaonkar, D. Bhatia, S. Hari, N. Gupta, A. Sinha, A. Bagga Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India Objectives: Primary objective was to compare FGF-23 before and 8 wk after supplementation of cholecalciferol in children with CKD having vitamin D insufficiency. Secondary objectives included comparison of serum calcium, phosphate, parathormone, 25 hydroxyvitamin D and brachial artery flow mediated dilatation (FMD). Methods: Children between 2-12 yr of age with CKD stages II to IV, having vitamin D insufficiency (25 OH vitamin D <30 ng/ml) were administered 600000 IU of cholecalciferol over 3 days. Children with phosphate > 6 mg/dl, calcium >10.5 mg/dl, those having received Pediatr Nephrol cholecalciferol supplements in past 3 months, or currently receiving sevelamer, statins, cinacalcet and corticosteroids were excluded. Results: Of 71 patients with CKDstage II-IVscreened, 41 had vitamin D insufficiency. The rise in median (95% CI) FGF-23 levels after interven- tion from 157.3 (99.6-181.9) to169.4 (133.7-215.8) RU/ml was not statistically significant (P=0.3). Median phosphate levels did not rise after intervention (4.6 vs. 4.9 mg/dl) (P=0.8). However, on subgroup analysis, median FGF-23 increased significantly from 77.4 (55.8-128.5) RU/ml to 140.9 (77.4-177.4) RU/ml (P=0.01) and phosphate increased significant- ly from 4.7 (4.2-5.1) pg/ml to 5.0 (4.7-5.2) pg/ml in stage II CKD (P=0.01). Median calcium levels increased significantly from 9.1 (8.9- 9.5) to 9.5 (9.2-9.8) mg/dl (P=0.02). The alkaline phosphatase and parathormone levels reduced from 742 (600-871) to 615 (553-723) IU (P <0.001) and 72.5 (43-93) to 50.8 (28-67) (P <0.001), respectively. Median 25-hydroxyvitamin Dlevels rose from13 (11-18.5) to 50 (39-62) ng/ml (P <0.001). The change in median FMDafter intervention from7.7 (5.2-8.7) to 8.3 (5.8-9.0) % was not significant (P=0.6). Conclusions: There is a high prevalence of vitamin D insufficiency in Indian children with CKD II to IV and is effectively corrected by high dose cholecalciferol. Cholecalciferol supplementation leads to rise in phosphate & FGF-23 level in early CKD, but not later stages. There is no change in brachial artery FMD with cholecalciferol supplementation. Estimated GFR is an independent predictor of FGF levels. A composite risk score of novel biomarkers predicts arteriopathy in pediatric CKD and ESRD S. Chaturvedi 1 , I.D. Liu 1 , Y.W. Lau 1 , L.P. Resontoc 1 , M. Tan 1 , K.H. NG 1,2 , W.S. Yeo 1 , Y.H. Chan 3 , L.L. Gong 4 , L.H. Ling 4 , A.M. Richards 5 , H.K. Yap 1,2 1 Shaw-NKF-NUH Childrens Kidney Center, KTP University Children's Institute, National University Health System; 2 Yong Loo Lin School of Medicine, National University of Singapore (NUS); 3 Biostatistics Unit, Yong Loo Lin School of Medicine, NUS; 4 Department of Medicine, Yong Loo Lin School of Medicine, NUS; 5 Cardiovascular Research Institute, National University Health System Background: Children with chronic kidney disease (CKD) have in- creased risk of death from cardiovascular disease. This study explored novel biomarkers for early detection of arteriopathy among high-risk children with CKD. Methods: 16 pre-dialysis CKD stages 3-4 (Group 1) and 25 CKD stage 5D patients (Group 2) were recruited. High resolution B-mode ultraso- nography was performed on carotid, brachial and femoral arteries and arteriopathy parameters measured were augmentation index, pulse wave velocity/height, age-height standardized carotid and femoral intima- media thickness, stiffness parameter and flow-mediated dilatation. An arteriopathy score was computed by adding the scores of individual arteriopathy parameters (abnormal=1, normal=0). ABPMwas performed, and diastolic and systolic BP scores were calculated by adding individual scores for 24-h, wake, sleep blood pressure index and load and dipping. Biomarkers such as time averaged hemoglobin, uric acid, calcium, phos- phate and parathormone were examined. Novel biomarkers such as serum GDF-15, ST2, hsTNT, homocysteine, ADMA, hsCRP, NT-proBNP and urine NGAL were examined. An ROC model using the odds ratios as the risk score from a multivariate logistic regression on univariate significant clinical and biochemical parameters was developed. Results: All patients, mean age 16.26.6 years and CKDduration 4.23.7 years, had at least one abnormal arteriopathy parameter (median arteriopathy score=4). Only pulse wave velocity/height [PWV (ht)] was significantly different between group 1 (3.30.7 m/s) and group 2 (4.10.9 m/s) (P=0.006). Parameters which were associated with abnormal PWV (ht) (defined as 3.74 m/s) were uric acid, diastolic BP score >5, GDF-15, hsTNT, ADMA and NTproBNP. The risk score model developed includ- ing these parameters had AUCof 0.806. Using a threshold score of 15, the sensitivity, specificity, PPV and NPV were 76.2%, 85.0%, 84.2% and 77.3% respectively. Conclusion: Arteriopathy abnormalities were detected in all patients with CKD, with significant worsening of vascular reactivity as measured by PWV in advanced CKD stage 5. The composite risk score model devel- oped is a useful predictor of severe arteriopathy in CKD. Growth in children with chronic kidney disease: report from Korean cohort study for outcome in patients with pediatric chronic kidney disease (KNOW-Ped CKD) E. Park 1 , Y.H. Ahn 1 , J.M. Lee 1 , H.J. Choi 1 , H.G. Kang 1 , H.Y. Cho 2 , J.H. Lee 3 , J.I. Shin 4 , M.H. Cho 5 , Y.S. Park 3 , H.I. Cheong 1 , I.S. Ha 1 , C. Ahn 6 1 Seoul National University Childrens Hospital, Seoul; 2 Samsung Med- ical Center, Seoul; 3 University of Ulsan College of Medicine, Seoul; 4 Yonsei University College of Medicine, Seoul; 5 Kyungpook National University Hospital, Daegu; 6 Department of Internal Medicine, National University Hospital, Seoul, Korea Objective: We investigated the risk factors related with stunted growth in children with CKD. Methods: Growth of 309 children (M: F 206:103) enrolled in KNOW- Ped CKD (2011-13) were quantified by age-sex-specific height SDS score. Cox regression analysis was done to identify risk factors for growth impairment (height SDS <-1.88) before growth hormone (GH) treatment. Results: Median height SDS of overall patients were -0.85 with the interquartile range -1.75~0.05. Growth impairment was observed in 21% patients and 15% of them were treated with GH. Children with growth impairment were mostly girls and had lower BMI, advanced CKD stage, preterm birth and low birth weight. Conclusion: Girls, lowBMI, advanced CKDstage, pretermbirth and low birth weight are associated with growth failure in children with CKD. Children with these findings may require close attention on their growth and earlier intervention to avoid severe growth impairment. Acknowledgement: This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2013E3301600, 2013E33081601). Complement associated diseases Anti-factor H autoantibodies associated with atypical HUS or C3 glomerulopathy: one target, two diseases S.K. Togarsimalimath 1 , C. Blanc 1 , L. Roumenina 1 , S. Chauvet 3 , Y. Ashraf 1 , B. Moulin 4 , P.L. Pogamp 5 , A. Bagga 6 , V. Fremeaux-Bacchi 1,2 , MA Dragon-Durey 1,2,7 1 INSERM UMRS1138, Paris; 2 Service dimmunologie biologique, Hpital Europen Georges Pompidou, APHP, Paris; 3 Service de Nphrologie, Hpital Tenon, APHP, Paris; 4 Service de Nphrologie et Transplantation rnale, CHU Hautepierre, Strasbourg; 5 Service de Nphrologie, CHU Pontchaillou, Rennes; 6 Department of Pediatrics, AIIMS, New Delhi, India; 7 Universit Paris Descartes, Paris, France Objectives: Dysregulation of complement factor H (CFH) results in kidney disease. One mechanism is production of anti-factor H autoanti- bodies (aFH) as atypical hemolytic uremic syndrome defining the autoim- mune form (AI-aHUS), leading to acute renal insufficiency. Anti-FH anti- bodies are also present in some chronic diseases comprising C3 glomeru- lopathies (GP), dense deposit disease & type I membranoproliferative GN leading to progressive renal insufficiency. This study compares the func- tional consequences of aFH developed in context of GP and AI-aHUS. Methods: Samples from7 children (mean age 7.5 yr) presenting with GP associated with aFH were studied. Samples from17 children with AI- aHUS (mean age 8.9 yr) were used as controls. Immune complexes Pediatr Nephrol quantification and epitope mapping of aFH were performed by ELISA; cell lysis assays were performed using non sensitized sheep erythrocytes and genetic analysis was performed by MLPA. Results: GP and AI-aHUS patients had comparable antibody titers, but GP patients had very lowFH-anti-FHIgGcirculating immune complexes (CIC) in comparison to aHUS patients. Epitope mapping revealed that aFH bound to only the N-terminal part in GP, whereas they bound to both N and C-terminal domains of FH in AI-aHUS. Cell lysis assays showed low levels of lysis with GP samples as compared to AI-aHUS samples. None of the GP patients had homozygous CFHR1/R3 deletion, which is the predisposing factor for AI-aHUS; 6/7 patients were C3Nef positive. Conclusions: Anti-factor H autoantibodies of GP bound to epitopes different from AI-aHUS and impair the alternative pathway in a distinct mechanism. They are not developed in the same genetic condition. This data provides an insight of differences between aHUS and GP and also an example of autoantibodies directed against the same protein associated with two pathologically distinct diseases. Clinical features and outcomes in children with C3 glomerulopathy S. Bhardwaj 1 , A. Sinha 1 , P. Hari 1 , G. Singh 2 , A.K. Dinda 2 , A. Bagga 1 1 Division of Nephrology, Department of Pediatrics; 2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India Background: Dense deposit disease (DDD) and C3 glomerulonephritis (C3GN), classified together as C3 glomerulopathy, are rare diseases characterized by glomerular deposition of C3 without significant immu- noglobulin deposits. Information on management and outcomes of C3 glomerulopathies is limited to case series. Methods: Records of patients, 1-18 yr-old, with biopsy between 2004 and 2014 were reviewed to identify patients with C3 glomerulopathy. Diagnosis was based on light microscopy suggesting proliferative GN, with glomerular C3 staining in absence of immunoglobulin on immuno- fluorescence, and electron dense deposits that are intramembranous (DDD) or in subendothelial and mesangial location (C3GN). Results: 22 children (59% boys) were diagnosed with DDD (n=19) or C3GN (n=3) at meanSD age 9.62.2 yr. Findings included anasarca (n=22), hematuria (n=6), stage II hypertension (n=13) and nephrotic range proteinuria (21); renal function was impaired at onset in 41%. Indications for biopsy were steroid resistant nephrotic syndrome (54%), atypical GN (18%) and rapidly progressive GN (23%). Low levels of complement C3 were present in 91% patients. Investigations excluded lupus, HIVand hepatitis Band Cin all patients. There were no differences in clinical features between patients with DDD and C3GN. Light micros- copy confirmed basement membrane thickening and splitting in 70% cases. Patients received therapy with prednisolone and enalapril (100%) along with mycophenolate mofetil (72%), cyclophosphamide (27%), tacrolimus (13%) or rituximab (18%); therapeutic plasmapheresis was performed in 3 patients for rapidly progressive glomerulonephritis & in one for disease recurrence in the allograft. Five patients progressed to chronic kidney disease stage 5 over 3 months to 10.7 yr. Conclusions: Membranoproliferative pattern of injury is not universal in C3 glomerulopathy. Presentation and disease course are heterogeneous and response to therapy is variable. A significant proportion of patients progresses to advanced kidney disease. Nationwide data on anti-complement factor H associated hemolytic uremic syndrome A. Bagga, A. Sinha, A. Gupta, S. Saini on behalf of HUS database Division of Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India Objectives: Antibodies to complement factor H (CFH) are an important cause of atypical hemolytic uremic syndrome (HUS) in children, where specific therapy enables satisfactory outcomes. Results: We report findings from a multicenter cohort of 209 Indian children with anti-CFH antibodies, constituting 55.4% pa- tients with HUS. Antibody titers, chiefly IgG3, were high (mean SEM 74361374 AU/ml) & correlated inversely with levels of C3, but not CFH. Homozygous CFHR1 deletion was found in 88% patients & 9% healthy subjects. Therapies included dialysis (86%) and plasma exchanges (PEX, 76%). Median decline of antibodies was 74%, 88% & 84% after 3, 5 & 7 PEX respectively (P=0.08). Induction consisted of prednisone & IV cyclophospha- mide or rituximab; serial antibody titers over 12-months were similar in those receiving either therapy (GEE; P=0.63). Adverse outcome (stage 4-5 CKD, death) was seen in 26% at 3-mo and 30% at follow up; 6-mo from the onset, 11% had relapses. Risk factors for adverse outcome were antibody titer >8000 AU/ml, low C3 & delayed PEX; titer >1300 AU/ml at 6-mo predicted relapses (sensitivity 80%, specificity 76%). Combined PEX & induction therapy resulted in better renal survival; one adverse outcome prevented for every 2.6 patients treated. Maintenance immunosuppression reduced the risk of relapses. Conclusions: Anti-CFH antibody associated HUS associated with homozygous deletion in CFHR1 affects school children and is characterized by severe features. Prompt PEX & immu- nosuppressive agents are useful for improving outcomes. Pa- tients with persistent high antibody titers are at risk of relapses. When to start and how to stop eculizumab in children with atypical hemolytic uremic syndrome? C. Terano 1 , K. Ishikura 1 , Y. Yoshida 1 , W. Kubota 1 , Y. Okuda 1 , S. Shinozuka 1 , J. Hashimoto 1 , R. Hamada 1 , R. Harada 1 , H. Hataya 1 , S. Iyoda 2 , T. Miyata 3 , Y. Yoshida 4 , Y. Fujimura 4 , M. Honda 1 1 Department of Nephrology, Tokyo Metropolitan Childrens Medical Center; 2 Department of Bacteriology I, National Insti- tute of Infectious Diseases; 3 Department of Molecular Patho- genesis, National Cerebral and Cardiovascular Center; 4 Depart- ment of Blood Transfusion Medicine, Nara Medical University, Japan Introduction: Diagnosis of atypical hemolytic uremic syndrome (aHUS), particularly in infants, is difficult and may be detrimental to outcome. Eculizumab (ECZ) can be a first-line therapy for aHUS, but the rationale for long-term use of ECZ needs to be carefully discussed. Cases: We experienced 4 patients with suspected aHUS in whom ECZ was administered from the acute phase. ECZ was discontinued in only 1 patient, without relapse of HUS. In this case, after confirmation of negative stool culture, ECZ was started. However, after more detailed investigation of stool cul- ture, enterohemorrhagic Escherichia coli O76 was detected and lead to diagnosis of typical HUS. In others, lacking definite etiological confirmation, ECZ has been continued without signif- icant side effects. Discussion: We recommend that ECZ treatment be started as soon as aHUS is suspected, because early treatment results in better prog- nosis, and complication of plasma exchange, particularly for in- fants, can be avoided. Concerns with long-term use of ECZ include: (i) increased risk for infection by encapsulated organisms; (ii) unknown long-term side effects; and (iii) frequent and regular administration has negative impact on patients QOL. These con- cerns should be balanced against the risk of relapse of thrombotic microangiopathy, not only in the kidney, but also in other critical organs. Improvement of detection rate of relevant gene mutations is also warranted. Conclusion: ECZis effective in acute phase of aHUS, but rationale for its long-term use has yet to be established. Pediatr Nephrol Developmental nephrology and disorders of development Seventeen known dominant disease causing genes in patients with congenital abnormality of kidneys and urinary tract X. Wang, Q. Shen, L. Sun, Y. Gong, J. Liu, C. Wang, H. Xu Department of Nephrology and Rheumatology, Childrens Hospital of Fudan University, Shanghai, China Objective: Congenital anomalies of the kidney and urinary tract (CAKUT) account for 40-50% of children with chronic kidney disease. The aim of this study was to determine patients with CAKUT that could be explained by mutations in 17 known dominant CAKUT-causing genes. Method: By next generation sequence technology, we analyzed the coding exons and UTR of 17 known dominant CAKUT-causing genes in 7 patients (vesicoureteric reflux in 3; ureteropelvic junction obstruc- tion, ureterovesical junction obstruction, renal aplasia and agenesis 1 each). The genes were: BMP4, BMP7, CDC5L, CHD1L, EYA1, GATA3, HNF1B, PAX2, RET, ROBO2, SALL1, SIX1, SIX2, SIX5, SOX17, UMOD, and UPK3A. Result: We identified 19 novel heterozygous mutations in 10 of the 17 known genes: PAX2 (2), GATA3 (1), RET (2), ROBO2 (1), UMOD (1), SALL1 (2), SOX17 (3), SIX5 (4), BMP4 (2), HNF1B (1). 14 were non- synonymous mutations in the coding sequence, 2 were located in splice sites and 3 were UTR variations. Damaging mutations predicted by Sift and Polyphen 2 were: PAX2: c.1094A>C, P.365N>T; GATA3: c.466A>C, p.156T>P; ROBO2: c.775-c.779 frameshift deletion. The PAX2 mutation was seen in one patient each with VUR and UVJO; ROBO2 deletion was seen with UVJO; GATA3 mutation was seen in the patient with unilateral VUR. Conclusion: To date, 23 monogenic CAKUT- causing genes have been identified that result in isolated CAKUTor syndromic CAKUTwith mild extra-renal manifestations, most of which are dominant inheritance. Our research revealed that GATA3, PAX2, ROBO2 are common disease causing genes in CAKUT patients, which is coincident with previous reports. More samples are needed to identify the relation between geno- type and phenotype by next generation sequencing. NPHP2 and NPHP3 mutation in 15 Chinese patients with infantile nephronophthisis: Correlation of genetics and clinical data L. Sun 1 , H. Tong 1 , H. Wang 2 , T. Liu 1 , C. Wang 3 , J. Li 3 , X. Jiang 1 , Y. Mo 1 , Z. Yue 1 1 Department of Pediatrics, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou; 2 Department of Pediatrics, Sun Yat-Sen Memo- rial Hospital, Guangzhou; 3 Department of Transplantation, Sun Yat-Sen Memorial Hospital, Guangzhou, PR China Objectives: To determine the frequency and clinico-genetic correlation of NPHP2 and NPHP3 mutations in cases of infantile NPHP Method: Of 15 patients included, DNA was available in 14 patients. NPHP1 homozygous deletion was excluded by PCR amplification of satellite markers initially. All patients were screened for mutations and polymorphisms with Sanger sequencing in NPHP2 and NPHP3. Results: We identified NPHP3 mutations in 8 patients: compound mu- tations in 7 (P1~P7) and a heterozygous mutation in P8. There were 11 novel mutations (p.Ala434 del, p.Glu602Glyfs621X, p.Gln153Pro, p.Lys678X, p.Cys816X, p.Asn711Ser, p.Arg756Gln, ISV9-40TG, p.Asp216His, IVS13-11TG, ISV14+5 GA, respectively) and 2 known mutations (p.Leu790Pro, p.Arg973Pro). P9 was from the same family and considered with the same mutation as P8. All patients (P1~P9) had growth retardation; anemia was seen in 7, liver lesion (P3) and respiratory infection (P5) in one patient each. All presented with ESRD before 5-yr age, except for P8. Renal pathology was diverse with pre- dominantly chronic tubulointerstitial nephritis and tubular cysts, dilated Bowman capsule, irregular tubular basement membrane, and glomerulosclerosis or mesangial proliferation. Eight patients had hepatic involvement, and one each had congenital heart disease and hypothyroid- ism with thyroid cyst. Only1 patient had NPHP2 mutation, which progressed to ESRD at 1 month and had inguinal hernia. Conclusion: NPHP2 and NPHP3 mutations in infantile NPHP were high (64.3%); patients with NPHP3 mutations also had liver lesions. NPHP1 knockdown induced epithelial-mesenchymal transdifferentiation in MDCK cells and activation of ZO-1/ZONAB signalling pathway H. Tong 1 , L. Liu 1 , H. Wang 2 , X. Li 3 , T. Liu 1 , Z. Yue 1 , L. Sun 1 1 Department of Pediatrics, First Affiliated Hospital, Sun Yat-Sen Univer- sity, Guangzhou; 2 Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Guangzhou; 3 Department of Nephrology, First Affiliated Hos- pital, Sun Yat-Sen University, Ministry of Health, Guangzhou, PR China Objective: To explore the pathogenesis of tubular interstitial fibrosis in nephronophthisis type I Methods: The expression of NPHP1 in MDCKcells were knockdown by siRNA. Cell morphology and cell migration were observed under micro- scope. The expressions of E-cadherin, -catenin, ZO-1, ZONAB and - SMA both in mRNA and in protein were analyzed by real time PCR, western blot and immunofluorescence, respectively. The mRNAlevels of MMP-2, MMP-9 and FSP-1 were detected by real time PCR. The activity of MMP-2 and MMP-9 were detected by gelatin zymography. Result: MDCK cells become elongated and the migration capacity enhanced after NPHP1 knockdown. The expressions of E-cadherin, - catenin and ZO-1 decreased whereas ZONAB increased both in mRNA and in protein in NPHP1 knockdown MDCK cells. mRNA expression of FSP-1 and the protein level of -SMAwere both increased. Both mRNA expressions and activities of MMP-9 and MMP-2 were increased. Conclusion: NPHP1 knockdown by siRNA interference induced ep- ithelial mesenchymal transition (EMT) in MDCK cells. ZO-1/ ZONAB signaling pathway was activated in NPHP1 knockdown MDCK cells. These contribute to tubular interstitial fibrosis in nephronophthisis type I. The role of perlecan in the prenatal kidney programming X.S. Tang, H. Xu, Q. Shen, J. Chen Department of Nephrology and Rheumatology, Childrens Hospital of Fudan University, Shanghai, China Objectives: Maternal protein restriction results in intrauterine growth restriction (IUGR) with reduced nephron number. We studied the expres- sion of perlecan in kidney development of IUGR rat and association with cell apoptosis and proliferation level to investigate its role in prenatal kidney programming. Methods: IUGR rat model was established with maternal low- protein (6%) isocaloric diets through gestation. mRNA transcription of perlecan during kidney development was detected by real-time PCR. Perlecan immunohistochemistry was performed to show pro- tein expression. Ki-67 and TUNEL were applied to mark prolifera- tion and apoptotic cells; changes of cell apoptosis and proliferation level were detected. Results: 1. At four weeks postnatally, IUGR offspring had fewer glo- meruli per kidney than those in controls (2670213 vs. 36662889, P<0.05). IUGR newborn weights were significantly lower. 2. In embry- onic period overall, perlecan mRNA transcription level gradually in- creased and then to a lower level for four weeks after birth. Embryonic 18-day and neonatal rats of IUGRgroup perlecan transcription level were lower than control group (E18: 0.470.082 vs. 0.760.164, P<0.001; P0: 0.410.043 vs. 0.550.094, P<0.05). 3. Perlecan is mainly expressed around the ureteric bud and the matrix of mesenchymal cells in Pediatr Nephrol nephrogenic zone during embryonic period. For embryonic 18-day (0.0190.0048 vs. 0.0440.0086, P<0.001) and neonatal rats (0.0034 0.0016 vs. 0.0110.0037, P<0.05) of IUGR group, perlecan protein level were also lower than control group. 4. Cell apoptosis and prolifer- ation of various kidney developmental periods are mainly located in nephrogenic zone and IUGR proliferation level was significantly lower than controls at embryonic 18-day (44.177.3 vs. 76.327.6, P<0.001). In addition, cell apoptosis level of IUGR newborn (315.1855.7 vs. 157.1 40.32, P<0.001) and 1 week-old rats (77.8711.11 vs. 23.695.47, P<0.001) were much more. Conclusion: Perlecan is expressed around the ureteric bud and the matrix of mesenchymal cells in nephrogenic zone during kidney development. For middle stage (E18 and P0), perlecan expression level of IUGR group were significantly lower than controls and was related to imbalance of cell proliferation and apoptosis. Influence of cyclosporine on glomerular growth and protective effect of mizoribine & losartan on cyclosporine nephrotoxicity in rat J.H. Kim Department of Pediatrics, Gangnam Severance Hospital, Yonsei Univer- sity College of Medicine, Seoul, Korea Introduction: The pathogenesis of chronic CsA-induced nephropathy is multifactorial. The main factors include (i) activation of the intrarenal renin-angiotensin system (RAS), (ii) renal ischemia via arteriolar con- striction, (iii) increases in transforming growth factor (TGF-1) and inflammatory cytokines such as osteopontin (OPN). Objective: Mizoribine (MZR) suppresses infiltration of macrophages, which play a role in development of interstitial fibrosis. Since the RAS plays an important role in pathogenesis of chronic CsAinduced nephrop- athy, blocking this system with either losartan (LSRT), or angiotensin converting enzyme inhibitors (ACEI) suppresses expression of pro- inflammatory mediators and profibrogenic cytokines. The study tested the hypothesis that the administration of MZR & LSAR prevents CsA induced chronic nephropathy in rats. Methods: Six-weeks old male Spraque Dawley rats maintained on low salt diet were given vehicle, CsA (15 mg/kg), CsA and LSRT (30 mg/kg/ day), CsA and MZR (5 mg/kg), or a combination of CsA, LSRT and MZR for 4 and 7 weeks. Blood chemistry and histopathology (tubular vacuolization and drop out, arteriolopathy, tubulointerstitial fibro- sis, and inflammatory cell infiltration) was compared among treat- ed groups. Inflammatory and fibrotic factors, OPN and TGF-1 were studied by immunohistochemistry and quantification with real-time PCR. Results: MZR attenuated the tubular cell vacuolization and drop out at 4 weeks (P<0.05). MZR and MZR+LSRT reduced tubulointerstitial fibro- sis at 7 weeks (P<0.01, P<0.05). Arteriolopathy was decreased in MZR+ LSRT at 7 weeks (P<0.05). OPN and TGF-1 mRNA expression was decreased in MZR (P<0.01) and MZR+LSRT (P<0.05) at 4 weeks. OPN mRNA expression was decreased at 7 weeks in MZR+LSRT (P<0.05). TGF-1 mRNA expression was decreased at 7 weeks in MZR (P<0.01) and MZR+LSRT (P<0.01). ED-1(+) cell decreased in MZR (P<0.05) and MZR+LSRT (P<0.05). Glomerular decreased in CsA group and recovered in MZR (P<0.01) and MZR+LSRT (P<0.05) at 7 weeks. Conclusions: This study shows that MZR has protective effects on inflammatory process in chronic CsA nephropathy and led to improve- ment of tubular damage, tubulointerstitial fibrosis and arteriolopathy by down regulation of OPN and TGF-1. Combined treatment with MZR and LSRT provided synergistic effects in attenuating inflammatory and fibrotic processes in chronic CsA induced nephropathy. MZR & LSRT can potentially be used for protecting against CsA nephro- toxicity and glomerular size contraction as an adjuvant for long term CsA treatment. The effects of bone marrow derived-mesenchymal stem cells in adriamycin induced nephropathy in the rat Y.H. Park 1 , K.J. Jung 2 , I.H. Song 2 1 Departments of Pediatrics and 2 Anatomy, YeungnamUniversity College of Medicine, Daegu, Korea Objectives: Adriamycin (ADR) induced nephropathy is widely used animal model of progressive renal disease resulting in glomerulosclerosis, podocyte injury and fibrosis. The present study investigated the protective effects of human bone marrow derived mesenchymal stem cells (hBMSC) on ADR induced nephropathy rat model. Methods: Male Sprague-Dawley rats were divided into normal controls (Normal), ADR+Vehicle (CON) and ADR+hMSC (MSC) groups. Ne- phropathy was induced by single injection of ADR (4 mg/kg IV). Four days later, 0.5 ml of saline with or without 210 7 hBMSC was injected via tail vein for CON or MSCgroup. The rats were sacrificed 1 week and 6 weeks after ADR injection. hBMSC were characterized by cell surface CD marks expression as well as differentiation induction into osteoblasts and adipocytes. To evaluate homing of hBMSC, the cells were labeled with CFSE (5(6)-carboxyfluorescein N-hydroxysuccinimidyl ester) and examined several tissues 3 h after injection. Kidney and body weight, as well as serum level of protein, albumin, cholesterol, triglycerides and creatinine were measured at 1- and 6-weeks. Western blot for inflamma- tory cytokines, nephrin, type I collagen was carried out. Light and electron microscopic observation were done for structural analysis. Results and Conclusions: hBMSC were observed in lung, liver and spleen but hardly detected in kidney. There was no significant difference in body and kidney weight as well as serum levels of protein, albumin, cholesterol, triglycerides and creatinine between CON and MSC groups. Pro-inflammatory cytokines (COX2, TNF-, INF- and IL-12) expres- sion was decreased in MSC compared to CON but nephrin expression was increased. hBMSC have little effect for improving nephropathy by direct regeneration but preserve kidneys by indirect anti-inflammatory effect. Dialysis The development of pediatric peritoneal dialysis in China: Brief data report from IPPN China Y. Zhai 1 , H. Xu 1 , Q. Yang 2 , X. Dang 3 , S. Sun 4 , X. Shao 5 , X. Liu 6 , Y. Wu 7 , J. Wu 8 , A. Liu 9 , Y. Dong 10 , Q. Ma 11 , C. Yan 12 , G. Kang 13 , W. Huang 14 , Y. Guo 15 , R. Fu 16 , H. Bao 17 , R. Xu 18 , Q. Sun 19 , L. Lai 20 , Y. Mo 21 , J. Huang 22 , J. Luan 23 on behalf of IPPN China investigators 1 Department of Nephrology and Rheumatology, Childrens Hospital of Fudan University, Shanghai; 2 Yuying Childrens Hospital of Wenzhou Medical College, Wenzhou; 3 The Second Xiangya Hospital of Central South University, Changsha; 4 Shandong Provincial Hospital, Jinan; 5 Gui- yang Childrens Hospital, Guiyang; 6 Jinan Childrens Hospital, Jinan; 7 Shenjing Hospital of China Medical University, Shenyang; 8 The First Affiliated Hospital of Xiamen University, Xiamen; 9 The Childrens Hos- pital of Zhejiang University School of Medicine, Hangzhou; 10 Anhui Provincial Childrens Hospital, Hefei; 11 Departments of Pediatric Ne- phrology and 12 Neonatology, The First Hospital of Jilin University, Jilin; 13 Ningbo Women and Childrens Hospital, Ningbo; 14 Shanghai Chil- drens Hospital, Shanghai; 15 The First Hospital of Xinjiang Medical University, Urumqi; 16 Jiangxi Childrens Hospital, Nanchang; 17 Nanjing Childrens Hospital, Nanjing; 18 Qilu Hospital of Shandong University, Jinan; 19 Qingdao Women and Childrens Hospital, Qingdao; 20 The Third Peoples Hospital of Jingdezhen, Jingdezhen; 21 The First Affiliated Hos- pital, Sun Yat-sen University, Guangzhou; 22 Bayi Childrens Hospital of the Military General Hospital of Beijing PLA, Beijing; 23 Wuhan Women and Childrens Hospital, Wuhan, China. Pediatr Nephrol Objective: To investigate the development of pediatric peritoneal dialysis in China Methods: Analyze the data from IPPN China (www.pedpd.org.cn) Results: IPPN China is the Chinese version of International Pediatric Peritoneal Dialysis Network (IPPN). It is managed by Childrens Hospital of Fudan University, to increase the communication among Chinese pediatric renal centers and improve the development of pediatric perito- neal dialysis in China. It was online on Jul. 2012. The members of IPPN China increased from13 to 23 for now, which distributed in 19 cities from 16 provinces in China. The registered data of the year 2014 show the number of patients on the current chronic PD (CPD) is 113, distributed in 18 centers from15 cities. These 18 centers can offer CAPD, among which 11 can offer APD. Among all the centers, only 3 have the current CPD patients more than 10, which cover 51.3% of all the CPD patients registered. Eight centers have improved significantly from 2012 to 2014, whose number of CPD patients increased 1.24~8 times. Childrens Hospital of Fudan University is the biggest CPD center in China for now, with 36 cases of current CPD and over 80 in total. The percentage of patients with weekly Kt/V<1.8 has decreased from7.7%to 5.7%between 2011 and 2014. The average level of Hb increased from 10.82.1 g/L to 11.52.5 g/L. The percentage of patients with severe LVHdecreased from 38.5%to 27%. The peritonitis rate decreased from26.5 per patient month to 40.1 per patient month. Conclusion: According to our data which represent some of the pediatric renal centers in China, many cities in China can offer CPD for pediatric patients. Although these centers are with different scale and level, most of them make progression in recent years. We believe that IPPN China, as a good communication platform, can help improving the development of pediatric CPD in China. Rotary Southend Sparsh Initiative: pediatric hemodialysis services in New Delhi A. Agarwal 1 , A. Bagga 2 1 Batra Hospital and Medical Research Center, New Delhi; 2 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi India is a developing country in the lower middle income stratum (World Bank 2013, GNI per capita). The outcome in children with end stage renal disease (ESRD) depends on availability of health services. More than 70- 80 percent children with ESRD do not receive any form of renal replace- ment therapy, chiefly due to financial constraints, lack of health care facilities and scarcity of trained physicians and technical staff that can cater to the specific needs of children and adolescents. Objectives: With the intent of providing free, state of art care to children with ESRD, who were awaiting kidney transplantation, an exclusive pediatric dialysis centre Southend Sparsh began services from June 2013. We report the activities undertaken at the unit and the achievements. Methods: Manpower for the 3-bed pediatric hemodialysis unit, inaugu- rated in June 2013, includes 1 pediatric nephrologist, 1 dialysis techni- cian, 3 staff nurses and 1 nursing aid. The personnel were recruited and trained in pediatric dialysis at the All India Institute of Medical Sciences. Other challenges included generating funds and finding a center where the Unit could be located, in order to provide medical facilities in case of emergency. Funds were generated by Rotary Southend Charitable Trust, New Delhi and rent free space with optimum back up services was provided by Batra Hospital and Medical Research Centre, New Delhi. The cost of setting up a 3-bed dialysis unit was about INR 3.2 million, while the annual running cost is almost same at INR 3 million, which includes staff salaries and consumables. Annual cost does not include maintenance of hemodialysis machines and water treatment. The approx- imate cost of a single dialysis session at this center is INR 3250, which does not include other medications apart from those used during dialysis. Results: During one year (2013-14), 28 patients (17 boys) have received a total of 1029 hemodialysis sessions. The chief cause of chronic kidney disease was steroid resistant nephrotic syndrome secondary to FSGS; the next diagnosis was atypical hemolytic uremic syndrome. Of 28 patients 2 needed support for acute kidney injury and eventually become dialysis independent. During 1029 dialysis sessions 197 adverse events were noted, including hypotension (32.9%), pain abdomen, dizziness, intradialytic hypertension, vomiting, catheter malfunction, muscle cramps, hypersensitivity reaction and headache. Four received kidney transplant, one was shifted to continuous ambulatory peritoneal dialysis, 2 patients with AKI improved and become dialysis independent; 5 were lost to follow up, 1 child died at home and 15 are undergoing hemodialysis. Conclusion: Considering the large number of children with ESRD, there is need for more dedicated pediatric dialysis centers, which provide comprehensive care to children. Vitamin C overload leads to secondary hyperoxalosis in young pediatric dialysis patients S.S. Thyle 1 , A. Perilloux 1 , R. Pereira 1 , G. Handelman 2 , I.B. Salusky 1 , K. Wesseling-Perry 1 1 Division of Pediatric Nephrology, UCLA, Los Angeles, CA; 2 Health and Clinical Sciences, University of Massachusetts, Lowell, MA Objective: Vitamin C supplementation is recommended in dialysis pa- tients to prevent anemia, gingival disease and scurvy. Case reports sug- gest that very large doses of vitamin C intake led to secondary hyperoxalosis in some adult dialysis patients. We sought to study the impact of current enteral formulas on vitamin C and oxalate levels in dialyzed children. Methods: We identified oxalate crystal deposits in bone of two 5-year- old hemodialysis patients who underwent routine bone biopsy prior to parathyroidectomy. Gene analysis for AGXT ruled out primary hyperoxaluria, and both had a history of high vitamin C intake from enteral feeding. Therefore, we assessed the daily recommended intake (DRI) of vitamin C from enteral feedings in 13 pediatric patients aged 8 months to 8 years fed primarily formula through a gastrostomy tube, treated with either hemodialysis (n=3) or peritoneal dialysis (n=10) in order to assess the impact on oxalate burden. Total vitamin C intake, serum oxalate levels and ascorbic acid levels were assessed in these patients. Results: All patients were receiving 1.2-8.3 times the DRI for vitamin C from enteral feedings. Ascorbic acid levels ranged from 1.5 to 10.0 mg/ dL (ref range: 0.2-1.9 mg/dL); values were elevated in 85% patients. Oxalate levels were elevated (>30 mol/L) in 69% patients and ascorbic acid levels did not correlate with oxalate levels (r=0.44, P=0.13). Ascor- bic acid and oxalate levels did not correlate with the amount of vitamin C received corrected by the DRI (r=0.42, P=0.15 and r=0.09, P=0.77 respectively). Conclusion: Oxalate deposition in bone demonstrates that oxalate is present in toxic levels in some dialyzed children; excess vitamin C ingestion contributes to secondary oxalosis in predominantly formula- fed infants and children. Plasma ascorbic acid levels vary, correlate poorly with oxalate levels, and may not reflect total body stores, suggesting that a portion of ascorbic acid is unavailable for clearance during dialysis. Retrospective study of arteriovenous fistula used in pediatric patients of ESRD L. Ying, S. Ning, W. Hui, S. Ying Department of Nephrology, Beijing Children Hospital, Beijing, PRChina Objective: To study the clinical features of arteriovenous-fistula (AVF) in pediatric patients who need maintenance hemodialysis. Methods: Comprehensive analyses were performed on data of patients who had AVF surgery in our hospital during June 2007 to April 2014, including clinical features and laboratory examination. Sex, choice of Pediatr Nephrol surgery side and vein, anesthesia, model of vascular suture were assessed with chi-square statistics respectively, age of surgery, inner diameter, hemoglobin, platelets, hematocrit, serum creatinine, prothrombin time, fibrinogen, activated prothrombin time were assessed with t-test respectively. Result: 41 male, average age of surgery was 10y11m (2y4m to 16y1m). Underlying diagnosis was chronic glomerulonephritis (29%), kidney dysplasia (27.4%), nephrotic syndrome (11.3%), reflux nephropathy (11.3%), obstructive nephropathy (4.8%) and others (24.2%). Average interval from diagnosis to surgery was 30.8 days. General anesthesia (n=42), brachial plexus block (n=7) were used. All AVF were made on forearm; 58 on left, 4 on right. 55 were radio-cephalic end-to-lateral anastomosis, 7 were radio-non cephalic anastomosis. Inner diameter of AVF was 2 mm in 22 (35.5%), 2.5 mm in 3 (4.8%), 3 mm in 31 (50%), 4 mmin 3(4.8%). We regarded tremor and vascular bruit at the operative site 1 week after surgery as success standard, success rate was 80.7% (50/62); failure rate was 19.4% (12/62). Acute complication were throm- bosis in 6 (9.7%), errhysis in 5(8.0%), pain and swelling in 4 (6.5%), hemorrhage and anesthesia in fingers in 1 each (1.6%). Type of anesthe- sia, inner diameter of AVF and Hb affected success rate (P <0.05). Conclusion: The interval from diagnosis to surgery was shorter than suggested by 2006 NKF-KDOQI guidelines. We preferred to choose radiocephalic end-to-lateral anastomosis on left wrist. The most common acute complication was thrombosis and errhysis. Anesthesia, inner diam- eter of AVF and Hb may affect success rates. Training evaluation results of caregivers in childrens peritoneal dialysis and teachings on nursing intervention Q. Zhou, Ru-Ping Gao, Pei-Lian Yao, H. Zhang, J. Zhou, Er-Zhuang Qian, H. Xu Department of Nephrology and Rheumatology, Childrens Hospital of Fudan University, Shanghai, China Objective: To prevent peritonitis and other complications for children undergoing peritoneal dialysis (PD), the aim of this study is to analyze training evaluation results of home PD caregivers, and to explore the appropriate frequency of re-training. Methods: From Jan 2012 to Dec 2013, 32 children received surgical placement of PD catheters and obtained training certificates with their caregivers. Based on time intervals of training, the patients were divided into two groups: experimental group (every 3 months) and routine group (every 6 months). Hand-washing, exit-site care, continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) operating procedure were brought into evaluation standards. PD special- ized nurses took charge of children in peri-operative period. Evaluation results and peritonitis incidences in the first 6 months after catheterizing were analyzed. Results: There is no statistic difference in the gender, age, education level of caregivers and surgical method between these two groups (P>0.05). Qualified rates of hand-washing and exit-site care were significantly higher in experimental group (87.5% and 81.25% respectively) than in routine group (both 37.5%, P<0.05). Compared with 31.25% of cases in routine group, peritonitis occurred zero in experimental group (P<0.05). Conclusion: Re-training and evaluating on home PD caregivers every 3 months, shows a positive effect on reducing peritonitis. However, further clinical randomized controlled trials are needed to explore an effective and reasonable training program for home PD caregivers, in accord with health economics. Application of portable water-treatment system in chronic hemodialysis in children with end stage renal disease in China Q Zhang 1 , H. Xu 2 , Q. Shen 2 , J. Rao 2 , X. Fang 2 , Y. Zhai 2 , Q. Zhou 2 , H. Zhang 2 1 Department of Nephrology, Ningbo Womens and Childrens Hospital, Zhejiang Province; 2 Department of Nephrology and Rheumatology, Chil- drens Hospital of Fudan University, Shanghai, China Objective: To explore the value and safety of single-bed mobile dialysis water treatment system in chronic hemodialysis (HD) in ESRD. Methods: Dialysis water produced by the portable water-treatment sys- tem, composed of water pretreatment device, water softening machine and reverse osmosis water treatment machine, was used for chronic HD. The water quality index as well as the dialysis adequacy, complications and outcome of 20 children with ESRD, on chronic HDin our center from Aug 2010 to Mar 2014, was analyzed. Before April 2013, the compo- nents of water pretreatment device were a PP polypropylene filter in series with two charcoal canisters. After May 2013, the components of water pretreatment device were the first PP polypropylene filter, quartz sand filter, activated carbon filter and the second PP polypropylene filter. Results: The water quality index, including endotoxin level, bacteria culture and heavy metals level, were consistent with the criteria of standard operation procedures of blood purification (SOP) issued by the Chinese Ministry of Health. From May 2013, dialysis water endotoxin level was further decreased after the water pretreatment device was improved, with the quantitative values less than 0.5 EU/ml, of which, 85.2% was less than 0.25 EU/ml. During HD, there was no heat reaction, hemolysis, hard water syndrome and other water-related complications. The dialysis Kt/v was 1.2 0.23 and urea clearance was 66.68 7.32%. The achieved rate of hemoglobin, serum calcium, serum phosphorus and PTH after 6 months of HD were 66.7%, 53.3%, 13.3% and 20% respec- tively, 60%, 50%, 50%and 20% respectively after 12 months and 87.5%, 62.5%, 37.5% and 87.5% after 18 months. At the end of follow-up, patient survival rate was 95%; 11 cases returned to normal schooling during HD. Conclusion: The quality of dialysis water produced by portable water- treatment system conformed to the standard of dialysis water, which was superior to the criteria of SOP recommendation. The portable water- treatment system was suitable for children with chronic HD in China. Glomerulonephritis and glomerular diseases The validation study of Oxford Classification of IgA nephropathy in Chinese children B. Su 1 , J. Ding 1 , Y. Ren 1 , S. Wang 1 , N. Zhou 2 , Y. Shen 2 , C. Zhou 2 , M. Chu 3 , L. Cao 3 , J. Liu 1 , X. Yang 4 1 Pediatric Department, Peking University First Hospital, Beijing; 2 Beijing Childrens Hospital; 3 Capital Institute of Pediatrics; 4 First Affiliated Hospital of Henan College of Traditional Chinese Medicine, China Background: The Oxford classification of IgA nephropathy presented that four histopathological features had independent predictive value of clinical prognosis. Considering the limitations of study cohort, validation study in Chinese children is necessary. Methods: 223 children with IgA nephropathy from 4 centers in China were included. The inclusion criteria referred to the Oxford study. Results: Depending on the Oxford Classification, with scoring of path- ological features, the extended pathology dataset included 18 pathologi- cal lesions. After analyzing the reproducibility and independency of these variables, 4 features were selected. Three lesions, mesangial proliferation, endocapillary proliferation and interstitial fibrosis/tubular atrophy were similar to original Oxford study (instead of segmental sclerosis/adhesion) and crescents were picked out. There were 165 (74%) with mesangial proliferation (M1), 153 (69%) with endocapillary proliferation (E1), 87 (39%) with crescent, 3 (1%) with moderate tubulointerstitial fibrosis (T1 26-50% of cortex scarred) and 4 (2%) with severe tubulointerstitial Pediatr Nephrol fibrosis (T2, >50% of cortex scarred). In our single center study (156 patients) the median follow-up duration was 17 months; 80 patients had follow up >6 months. We completed the correlations study between pathological lesions and clinical prognostic indicators like proteinuria. Conclusions: Mesangial proliferation, endocapillary proliferation and crescents were common in Chinese children with IgA nephropathy then adults. The reproducibility of scoring of histological lesions was impor- tant in the classification. DNA methylation in Cosmc promoter region and aberrantly glycosylated IgA1 associated with pediatric IgA nephropathy Q. Sun, J. Zhang, N. Zhou, X. Liu, Y. Shen Department of Nephrology, Beijing Children Hospital, Beijing, PRChina Objectives: IgA nephropathy (IgAN) is one of the most common glo- merular diseases leading to end-stage renal failure. Elevation of aberrantly glycosylated IgA1 is a key feature. The expression of the specific molec- ular chaperone of core11, 3galactosyltransferase (Cosmc) is known to be reduced in IgAN. We aimed to investigate whether the methylation of CpG islands of Cosmc gene promoter reign could act as a possible mechanism responsible for down-regulation of Cosmc and related higher secretion of aberrantly glycosylated IgA1 in lymphocytes from children with IgA nephropathy. Methods: Three groups were included: IgANchildren (n=26), other renal diseases (n=11) and healthy children (n=13). B-lymphocytes were isolat- ed and cultured, treated or not with IL-4 or 5-Aza-2'-deoxycytidine (AZA). Results: The levels of DNA methylation of Cosmc promoter region were not different between the lymphocytes of the three children populations (P=0.113), but there were significant differences between IgAN lympho- cytes and lymphocytes of the other two children populations after IL-4 (P<0.0001) or AZA (P<0.0001). Cosmc mRNA expression was low in IgAN lymphocytes compared to the other two groups (P<0.0001). The level of aberrantly glycosylated IgA1 was markedly higher in IgAN group compared to the other groups (P<0.0001). After treatment with IL-4, the levels of Cosmc DNA methylation and aberrantly glycosylated IgA1 in IgAN lymphocytes were remarkably higher than the other two groups (P<0.0001) with more markedly decreased Cosmc mRNAcontent (P<0.0001). After treatment with AZA, the levels in IgAN lymphocytes were decreased, but was still remarkably higher than the other two groups (P<0.0001), while Cosmc mRNA content in IgAN lymphocytes were more markedly increased than the other two groups (P<0.0001). The alteration of DNA methylation by IL-4 or AZA specifically correlates in IgAN lymphocytes with alterations in Cosmc mRNA expression and with the level of aberrantly glycosylated IgA1 (r= -0.95, r=0.71). Conclusion: Our results suggested that hypermethylation of Cosmc promoter reign could be a key mechanism for the reduction of Cosmc mRNA expression in IgAN lymphocytes with associated increase in aberrantly glycosylated IgA1. Long-term outcomes with multi-targeted immunosuppressive protocol in severe pediatric lupus nephritis YWLau, ETAragon, LP Resontoc, YHChan, KHNg, Yeo WS, HKYap Shaw-NKF-NUH Childrens Kidney Center, National University Health System, Singapore Background: The gold standard of treatment of proliferative lupus nephritis (LN) using corticosteroid and intravenous cyclophosphamide (CYC) resulted in improved patient and renal survival rate. Alternative treatment is the multi-targeted induction protocol using intravenous methylprednisolone, mycophenolate and cyclosporine to induce remis- sion in our patients with severe proliferative lupus nephritis. This study examined the long-term renal outcomes using the multi-targeted induc- tion and maintenance protocol. Method: 16 children with severe proliferative LN (WHO class III and IV) treated with multi-targeted therapy were studied. Median follow-up was 9.2 yr (range 3.8-12.8). Primary treatment outcome was complete renal remission. Secondary outcomes were patient and renal survival and relapse- and event-free survival. Mixed-model analysis was performed to compare pre-induction and last follow-up parameters, adjusting for age at induction, gender, duration of disease prior to induction, prior treatment with CYCand/or azathioprine (AZA), and duration of follow-up. Kaplan- Meier was used to analyze relapse- and event-free survival. Results: All patients achieved complete renal remission within a median time of 8.7 months (range 4- 24). Clinical and laboratory parameters at induction and last follow-up, SLEDAI score (25.48.7 vs. 0.40.8), serum C3 (4715 vs. 10727 mg/dL,), C4 (1214 vs. 2314 mg/dL) and urine protein (6.97.1 vs. 0.20.02 g/day/1.73 m 2 ) improved signif- icantly (P<0.05). Kaplan-Meier analysis showed a cumulative 10-yr renal relapse-free survival of 73.3% when considering relapses with severe proteinuria. Cumulative probability that hospitalization would not be required was 93.8% at 1-yr and 71.4% at 10-yr. Conclusion: Our multi-targeted induction and maintenance protocol for treatment in children with severe proliferative LN resulted in good long- term patient survival and renal preservation, with a good safety profile. Hypertension Risk factors for increased blood pressure among aboriginal children & adolescents S. Kim 1,2 , P. Macaskill 2 , E.M. Hodson 1,2 , J. Daylight 1 , R. Williams 1 , N. Vukasin 1 , R. Kearns 1 , D.M. Lyle 3 , J.C. Craig 1,2 1 Centre for Kidney Research, The Children's Hospital at Westmead, Westmead; 2 Sydney School of Public Health University of Sydney, Camperdown; 3 Department of Rural Health, University of Sydney, Camperdown NSW, Australia Objective: To determine relative changes in blood pressure between Aboriginal and non-Aboriginal children as they move through adoles- cence into young adulthood. Background: Hypertension is associated with increased risk of chronic kidney disease (CKD) in adulthood. Aboriginal children have a higher prevalence of overweight/obesity, a known risk factor for hypertension in adolescence. Methods: A prospective cohort study of Aboriginal and non-Aboriginal school children commenced in 2002 across 15 different screening centers involving 38 primary schools and 213 high schools across urban, regional and remote NSW. Blood pressure, BMI and urinalysis were measured every 2 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were standardized for sex, age and height. We fitted a series of mixed linear regression models adjusting for age, sex, BMI SDS, Aboriginality, birth weight and socioeconomic status (SES). Results: 3418 (1949 Aboriginal) participants were screened over a total of 11 years followup. At baseline, the prevalence of systolic hypertension (SBP SDS >95 th centile) was 7.2% (mean age 11 yr) which increased to 15.4% at 8-yr follow up. The prevalence of diastolic hypertension remained relatively unchanged at 3.1% and 2.9% at baseline and 8-yr follow up respectively. Multivariate analysis showed mean SBP SDS increased with increasing age (0.06 SDS per yr of age, P<0.01) but there was no significant difference in SBP between Aboriginal and non- Aboriginal children. Low birth weight was significantly associated with an increase in mean SBP (0.12 SDS, P=0.01) as was increasing BMI (0.31 SDS per 1 unit increase in BMI SDS, P<0.01). Lower SES was associated with increasing SBP (<25 th quartile: 0.20 SDS, P <0.01). A similar effect of increasing age (0.03 SDS per yr of age, P<0.01) and BMI (0.14 SDS per 1 unit increase in BMI SDS, P<0.01) was seen for DBP, whilst lower SES was associated with a lower DBP (<25 th quartile: -0.12 Pediatr Nephrol SDS, P<0.01). The mean DBP was not significantly different between Aboriginal and non-Aboriginal children. Conclusions: Increasing BMI remains the greatest modifiable risk factor for SBP and DBP, with prevention of low birth weight and improving SES also important to reduce cardiovascular risk in children and adolescents. Screening of hypertension in school going children of Dhaka and its downtown in Bangladesh Md AH Khan, ANM Saiful Hasan Department of Pediatric Nephrology, National Institute of Kidney Dis- eases and Urology (NIKDU), Dhaka, Bangladesh Background: Hypertension is an important cause of morbidity and mortality and childhood hypertension is the predictor of adult hyperten- sion. Different studies worldwide documented that hypertension may begin in adolescent and perhaps even in childhood. The purpose of this study was to screen hypertension and its risk factors among school going children in Dhaka and its downtown. Methods: School going children aged between 4-16 yr, of five schools were selected randomly and blood pressure (BP) measurements were taken by mercury sphygmomanometer. Hypertension was considered as BP more than 95 th percentile by age and sex. BP was recorded among 1682 children. Children were screened for hematuria and proteinuria. Dietary history and family history of hypertension was recorded. Results: Total children having hypertension was 43 (2.6%); male (2.8%) and female (2.2%). One boy had hypertension, proteinuria and hematuria; 5 patients (0.3%) had hypertension with proteinuria and 5 (0.3%) had hypertension with hematuria. Among hypertensive children 13 (30.2%) had family history of hypertension. 1495 (88.9%) had come from lower and lower middle socioeconomic condition. 5 (0.3%) were underweight with hypertension and 7 (0.4%) had stunting with hypertension. Conclusion: We found that prevalence of hypertension was 2.6% diag- nosed only after screening. So, for the prevention of complications of hypertension every child should be screened for hypertension and remain under follow up. Hypertension prevalence and risk factors in children and adolescents of school-going age in the Phoenix Area, Durban, South Africa R. Bhimma 1 , M. Pillay 1 , D.P. Naidoo 1 , M. van den Bergh 2 , P.F. Smuts 3 , R. Onia 3 1 School of Clinical Medicine, University of KwaZulu-Natal, Durban; 2 HEXOR, Johannesburg; 3 Merck Serono, Johannesburg, South Africa Introduction: Hypertension is a leading cause of morbidity and mortality in adults, but few studies have presented the significance of the preva- lence of pre-hypertension and hypertension in school-going populations. Objective: The objective of this study was to determine the prevalence of hypertension, and define its contributing risk factors in children and adolescents of school-going age within an urban community in Durban, South Africa. Methods: A cross-sectional assessment of blood pressure was conducted in the central Phoenix region, KwaZulu-Natal, South Africa in 2012. Initial measurements of the 423 children and adolescents (ages 6-18 years) included height, weight, and waist circumference and oscillometric blood pressure readings. Furthermore, demographic information, factors of lifestyle, medical and family history of suspected risk factors as well as biochemical measurements of blood glucose, triglycerides and HDL cholesterol levels were obtained by finger prick testing to describe their significance on influencing blood pressure. Results: The prevalence of pre-hypertension and hypertension amongst school going children in the central Phoenix area in Durban, South Africa is estimated to be 2.1% (0.8-3.5%) and 2.6% (1.1-4.1%) respectively, similar to the 3-5% indicated in the literature. The risk of high blood pressure was found to rise with an increase in age, weight, height, waist circumference, increased triglyceride levels and heart rate, family history of high blood pressure and diabetes and suspected substance abuse. Lack of exercise and consumption of soft drinks were associated with increased risk for hypertension; probably related to high BMI associated with lifestyle factors. Conclusions: Given the prevalence of the disease in the community, the fact that the condition is undetected as well as long-term sequelae with respect to target-organ damage, this study will help inform authorities in making recommendations on the evaluation and management of high blood pressure in the young in developing countries. Nephrotic syndrome Randomized controlled trial to compare the eff icacy and safety of mycophenolate mofetil versus levamisole in children with frequently relapsing and steroid dependent nephrotic syndrome A. Sinha, M. Puraswani, M. Rawat, P. Hari, A. Bagga Department of Pediatrics, All India Institute of Medical Sciences, New Delhi Introduction: While observational studies suggest that relapses in fre- quently relapsing steroid sensitive nephrotic syndrome (NS) are prevented by use of levamisole or mycophenolate mofetil (MMF), the relative efficacy of these corticosteroid-sparing agents has not been studied in clinical trials. This open label randomized controlled trial examines the efficacy & safety of oral levamisole versus MMF during1-yr of therapy in patients with frequently relapsing & steroid dependent NS [CTRI/2012/02/002394]. Methods: Following written consent, consecutive patients with steroid sensitive NS, 6-18 yr-old, with frequent relapses or steroid dependence in the preceding six months are randomized to receive oral levamisole (2-2.5 mg/kg on alternate days) or MMF (800-1000 mg/m 2 daily) for 12- months, while stratifying for disease severity and ensuring allocation concealment. Therapy with prednisolone is tapered & discontinued at 4 months; relapses are treated with prednisolone 2 mg/kg/d until remission, followed by 1.5 mg/kg/d for 4-wk.The relative proportions of T and B lymphocyte subsets is compared at baseline and during therapy in a subset of consecutive patients randomized to either arm. Outcomes, based on intention-to-treat analysis at 12 months of therapy, include the fre- quency of relapses, the proportions in sustained remission and frequent relapses, the time to first relapse, the cumulative prednisolone require- ment, the types & number of adverse effects, the types & rates of infections in the groups, and the growth and growth velocity. Assuming that therapy with MMF shall reduce relapse rates by 40%over the relapse rates observed during therapy with levamisole, 66 patients are required in each group at a power of 80% and two-tailed alpha error of 0.05, while allowing for 10% loss of follow up. Results: Baseline characteristics of 146 patients (123 boys) randomized, including 44 with steroid dependence are presented. Conclusions: Randomization into the study was completed in September 2013 and analysis of 1-yr outcomes is due in August 2014. Results of the study shall have implications for guiding the choice of corticosteroid sparing agents in patients with frequent relapses. Effect of zinc supplements in reducing relapses among steroid sensitive nephrotic syndrome and steroid dependent nephrotic syndrome in children, a randomized double blind placebo control study R.P. Pardillo, Z. Antonio, M. Rosel, O. de Leon, M.A. Marbella, C.A. Imbisan, R. Manuel National Kidney and Transplant Institute, Quezon City, Philippines Pediatr Nephrol Objective: To determine the effect of zinc supplements in reducing relapse rates in steroid-dependent (SDNS) and steroid-sensitive (SSNS) nephrotic syndrome. Methods: A randomized, double-blind, placebo control study done at the outpatient section of our Institute from May 2010-January 2013. 34 pediatric patients with steroid-sensitive (SSNS) or steroid-dependent nephrotic syndrome (SDNS) were divided into two arms: those who received zinc supplementation at the recommended daily allowance for age and those who received placebo. Monthly urinalysis and follow up were done for 6 months. The incidence of relapse at 3 and 6 months of placebo/zinc supplementation as well as the incidence of infection rate during episodes of relapse was determined. Results: More than half of the patients were children with SSNS. Base- line characteristics were similar in both groups. Patients who received zinc showed fewer relapse at 6 months treatment. Pa- tients who received zinc had higher likelihood of achieving re- mission compared to the placebo. Relapses occurring at 3 and 6 months of zinc/placebo supplementation were associated with infections. Conclusion: There was no significant difference in the mean relapse rates at 3 months of therapy with either zinc or placebo; after 6 months there was significant decrease in the mean relapses among patients using Zinc. Patients receiving zinc had higher likelihood of achieving sustained remissions. Relapses occurring at 3 and 6 months of zinc/placebo sup- plementation are associated with the incidence of infection. Nephrotic children have an increased susceptibility to infections due to a defect in T- lymphocyte function. These infections may result in relapses and poor response to steroid therapy. Zinc supplementation is proposed to augment gene expression in the activation of T lymphocytes, resulting in decreased incidence of infection. Understanding the mechanisms of CD80 induced podocyte injury B. Khullar 1 , A. Sharma 1 , N. Jain 2 , V. Bal 2 , S. Rath 2 , S. Sopory 1 1 Translational Health Science and Technology Institute, Gurgaon; 2 National Institute of Immunology, New Delhi, India Objective: CD80/B7-1 (a T cell co-stimulatory molecule expressed on antigen presenting cells) expression was induced in the podocytes in genetic, bacterial toxin and drug induced experimental models of protein- uria in mice. Subsequently, CD80 expression was also detected in the podocytes of patients with Minimal change disease (MCD) and elevated secretion of CD80 was detected in the urine of these patients during an active episode of the disease. The objective of this study is to understand the mechanisms and signaling pathways which lead to elevated levels of CD80 in the podocytes and the consequences of these elevated levels at the molecular level, specifically looking at the disruption of the slit diaphragm which forms the final barrier to urinary protein loss. Methods: Serum from LPS treated mice is added to podocytes followed by RT-PCR to detect CD80 induction in the podocytes. Podocyte cell lines stably expressing CD80 were generated and various techniques including immunoblotting, immunofluorescence microscopy, RT-PCR analysis, co-immunoprecipitation were used to look for changes in ex- pression and localization of slit diaphragm (SD) proteins. Results and Conclusions: There was no major change in the absolute levels of podocyte proteins in presence of CD80. Therefore effects of CD80 could be at the level of causing mislocalization or sequestration of SD proteins. Preliminary data indicates possible interaction of Neph 1 with CD80, which could prevent interactions with endogenous proteins essential for maintaining the SD structure. Serum from LPS treated wild type and CD80 -/- mice both induced CD80 in cultured podocytes, on the other hand serum from LPS treated mice defective in TLR4 (receptor for LPS) signaling did not induce CD80 on podocytes suggesting that a soluble factor downstreamof TLR4 signaling is involved in inflammation induced proteinuria. Quantitation of serumand urine angiopoietin-like 3 and 4 in children with nephrotic syndrome R. Dai, H. Xu, G. Li, H. Liu, Y. Zhai Department of Nephrology and Rheumatology, Childrens Hospital of Fudan University, Shanghai, China Objectives: Studies have explored several circulating or podocyte- secreted proteins, such as the angiopoietin-like-4 (Angptl4) which results in damage to the glomerular filtration barrier via an autocrine or paracrine pathway. Studies have shown that Angptl3, a homologue of Angptl4, is a secreted protein. The aim of this study is to quantify the serum and urine ANGPTL3 and 4 levels in children with nephrotic syndrome (NS). Methods: Serum and urine ANGPTL3 concentration were detected by ELISA. Results: Serum and urine samples (n=280) of 180 children (age 64yr) with NS were analyzed. The average serum concentration of ANGPTL3 was 713.94432.65 ng/ml [higher than healthy children 308.20 87.93 ng/ml], and of ANGPTL433.3257.71 ng/ml, similar to healthy children. Urine concentration of ANGPTL3 was 1.941.97 ng/ml (similar to healthy children) and of ANGPTL4 0.18 0.07 ng/ml [higher than healthy children 0.020.01 ng/ml, n=18]. ANGPTL3 serum level was positively correlated with 24-hr urine protein excretion (P=0.004), Up/ Ucr (P=0.006), triglyceride (P=0.021), and cholesterol (P=0.001), but not with creatinine (P=0.477) or BUN (P=0.717); ANGPTL4 urine levels was positively correlated with Up/Ucr (r=0.318, P=0.01); ANGPTL3 urine levels and ANGPTL4 serum levels had no difference with all the selected clinical parameters. Serum ANGPTL3 level varied in different conditions: minimal change disease (438.35200.61 ng/ml), FSGS (678.35361.67 ng/ml), membranous nephropathy (343.51169.85 ng/ ml), mesangial proliferative glomerulonephritis (1112.39446.53 ng/ml) and membranoproliferative glomerulonephritis (489.31247.76 ng/ml). ANGPTL3 serumlevels may indicate the degree of proteinuria in NS and not be affected by lipid levels. In terms of treatment response, no differ- ence of serum and urine ANGPTL3 and 4 levels were found among steroid sensitive, steroid-resistant, or steroid-dependent NS group, as well as between the frequently relapsing and infrequently elapsing group. Conclusions: Our data showed that serum ANGPTL3 level and urine ANGPTL4 level were elevated in children with NS. Serum ANGPTL3 level was positively related to proteinuria and serum lipid level in NS. Urine ANGPTL4 level correlated with proteinuria. Predictive markers of relapse in pediatric focal segmental glomerulosclerosis (FSGS) patients treated with rituximab W.S. Yeo, C.Y. Chan, L.P. Resontoc, I.D. Liu, Y.W. Lau, K.H. Ng, H.K. Yap Department of Pediatrics, National University Health System, Singapore Objectives: Rituximab is increasingly used in nephrotic children with FSGS who failed conventional immunosuppressive therapy. The effect of rituximab, however, is not sustained especially post-B-cell recovery. This study aimed to determine the immunological markers that predict relapse in rituximab-treated FSGS patients with complete response. Methods: 15 FSGS nephrotic children (median age 15 yr, duration of follow-up 7.4-32.8 months) treated with rituximab were studied. Urinary/ blood biochemical parameters and 31 T- and B-cell subsets were moni- tored at day 0, day 14, 3 and 6 months and at relapse. Complete responders to rituximab were defined as urine protein: creatinine ratio <0.02 g/mmol and ability to wean off steroids and calcineurin inhibitors within 3 months. Statistical analysis was performed using Mann-Whitney U test and receiver-operating curve (ROC) analysis. Results: CD19+ subset was significantly decreased in all patients post- rituximab (11.571.36% vs. 0.230.06%, P<0.001). Nine (60%) patients achieved complete response with 7/9 (78%) eventually relapsing (dura- tion of remission: 262-484 days). All patients who relapsed had B-cell Pediatr Nephrol recovery. Amongst the various immunological subsets, ICOS+CD8+ CD3+ and FAS+ICOS+CD8+ cells at day 0 were predictive of relapse within 300 days of rituximab therapy (R<300). Mean ICOS+CD8+CD3+ of R<300 group was 1.240.37% compared to 0.150.06% in non- R<300 group (P=0.04), whereas mean FAS+ICOS+CD8+ of R<300 group was 0.700.06% compared to 0.140.06% in non-R<300 group (P=0.037). ROC analysis revealed an area under curve of 1.00 (95% CI: 1.00-1.00, P=0.027) for both markers. Using a threshold subset value of >0.64% for ICOS+CD8+CD3+ and >0.52% for FAS+ICOS+CD8+ cells yielded a sensitivity and specificity of 1for predicting relapse within 300 days of rituximab therapy for both markers. Conclusions: Our study illustrated the potential utilization of ICOS+ CD8+CD3+ and FAS+ICOS+CD8+ as predictive markers of relapse within 300 days of rituximab therapy, possibly providing a guide for further rituximab dosing following B-cell recovery but prior to clinical relapse. Analysis of risk factors for cyclosporine nephrotoxicity in children with idiopathic nephrotic syndrome M. Takahashi 1 , K. Kamei 1 , M. Fuyama 1 , K. Saida 1 , Z. Kiuchi 1 , M. Sato 1 , M. Ogura 1 , K. Matsuoka 2 , S. Ito 1 1 Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo; 2 Department of Pathology, National Center for Child Health and Development, Tokyo, Japan Objective: Cyclosporine (CsA) is a well-established treatment for steroid-dependent nephrotic syndrome (SDNS) and steroid-resistant ne- phrotic syndrome (SRNS), with high-grade evidence. However, chronic CsA nephrotoxicity (CsAN), including tubulointerstitial and vascular lesions is a major concern, especially with long-termuse. Previous reports suggest that it is related to long-term CsA administration, frequent re- lapses during CsA treatment, and higher CsA trough levels, but it has seldom been assessed in large numbers of patients. We evaluated the risk factors for CsANin children with idiopathic NS receiving CsAtreatment. Methods: We retrospectively evaluated medical records and renal pa- thology of 83 patients (56 male and 27 female) with idiopathic NS who were treated with long-term CsA for >6 months (mean 34.8 months, range 8128 months) and underwent biopsy between January 2005 and January 2014. Thirty-six patients started CsAbecause of SRNS, but all of them had become steroid sensitive at the last observation. CsA treatment was continued without intermission until biopsy in all patients. CsAN was defined as the presence of tubulointerstitial lesions and/or CsA- associated arteriolar hyalinosis. We evaluated the risk factors for CsAN with regard to 11 clinical and laboratory factors (sex, age of NS onset, age at biopsy, histological findings, past history of SRNS, duration of NS, number of relapses, duration of CsA treatment, number of relapses on CsA treatment, 2-hour CsA concentration (C2), and angiotensin- converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) treatment for >6 months, by univariate and multivariate analysis. Results: CsA-associated arteriolopathy was observed in 34 patients (41%) and tubulointerstitial lesions in 31 patients (37%). Sex, age at renal biopsy, duration of NS, duration of CsA treatment, number of relapse on CsA treatment and use of ACEIs/ARBs were positively associated with CsA associated arteriolopathy by univariate analysis and only use of ACEIs/ARBs was independent risk factor by multivariate analysis [P=0.03, odds ratio (OR): 5.45, 95% CI: 1.2-28.0]. On the other hand, age at biopsy, histological findings, CsA C2 and use of ACEIs/ARBs were positively associated with tubulointerstitial lesion by univariate analysis and CsA C2 (>502.1 ng/ml, P=0.003, OR: 22.7, 95% CI: 2.7- 533.6) and age at biopsy (>9.9 years, P=0.04, OR: 14.37, 95% CI, 1.1- 588.0) were independent risk factors by multivariate analysis. Conclusions: The use of ACEIs/ARBs, C2 and age at biopsy were independent, significant risk factors for CsAN in children with NS. Combination treatment with CsA and ACEI/ARB should be avoided if possible. HRM as a screening tool to detect variants in Wilms tumor 1 (WT1) gene in children with steroid resistant nephrotic syndrome A. Siji 1 , A. Vasudevan 1 , D.K. Babu 1 , K.D. Phadke 2 , A. Vasudevan 1, 2 1 St. Johns Research Institute, Bengaluru; 2 St. Johns Medical College Hospital, Bengaluru, India Objective: The objective of the study was to determine if real-time polymerase chain reaction and high resolution melt (HRM) curve analysis could be used as a screening tool to identify for variants in the Wilms tumor 1 (WT1) gene in comparison to DNA Sanger sequencing. Methods: HRM assay for the analysis of exons 8 and 9 of the WT1 gene were designed, and optimized. Stringent criteria were employed for primer designing in order to enable reproducible detection of variants within the amplicon. HRManalysis for exons 8 and 9 of the WT1 gene in a final set of 60 genomic DNAsamples (5 samples for standardization, 55 samples for validation, including 10 blinded samples) were performed under identical amplification conditions. Results: After the initial standardization, WT1 exons 8 and 9 displayed unique melt curve profiles that were reproducible. A blinded assessment was performed on 10 samples for validation of the HRM technique as compared to sequencing. A 100% specificity and sensitivity was ob- served for prediction of normal variants when compared with the Sangers sequencing. Similar results were obtained during the subsequent analysis of the remaining 45 samples. Both the techniques did not reveal any abnormal pathogenic variant. The screening result using HRM was obtained in 2 hours 15 minutes, while sequencing required a minimumof 5 days. Conclusion: Although sequencing is the gold standard for detecting variants, it involves additional steps and requires a more turnaround time as compared to HRM. Our results showed that HRM could be used as a robust screening technique to detect abnormal variants, which could be further sequenced, to determine the precise variation. HRM curve analy- sis is a quick, reliable and a high throughput post-PCR method to analyze genetic mutations or variances in nucleic acid sequences. Since HRM is a closed tube method, it eliminates the possibility of template contamina- tion. The characteristics of HRM such as its simplicity ease of use, low cost, high sensitivity, and specificity, makes it an efficient tool for se- quence variant detection. The study of urinary CD80 in children with minimal change disease and focal segmental glomerulosclerosis L. Chen, L. Xiaorong, S. Ying, C. Zhi, F. Jianfeng, J. Yeping, M. Qun Department of Nephrology, Beijing Childrens Hospital affiliated to Capital Medical University, Beijing, PR China Background: Early diagnosis of minimal change disease (MCD) in nephrotic syndrome (NS) patients remains challenging. CD80, a trans- membrane protein, is present on podocytes in a number of experimental models of NS. Urinary CD80 levels are significantly elevated in MCDbut not in focal segmental glomerulosclerosis (FSGS) or other glomerulopa- thies. The purpose of this study was to investigate the feasibility of using urinary CD80 levels as a biomarker for diagnosis of MCD. Methods: The clinical data and morning urine samples have been collected from 37 patients with MCD, 27 patients with FSGS, 30 patients with other glomerulopathies who underwent renal biopsy. 71 healthy controls were included. ELISA was used to determine urine CD80 concentration. CD80 concentration between MCD, FSGS, other glomerulopathies and control group were compared. The receiver operating characteristic curve (ROC) analysis was used to determine the cut-off point of urinary CD80 as a biological marker for the diagnosis of MCD. Results: The concentration of urinary CD80 was significantly higher in the active MCD group (689.66378.21 ng/g creat) than FSGS [48.28 (10.36, 163.94) ng/g creat], other glomerulopathies [52.20 (11.41, Pediatr Nephrol 249.75) ng/g creat] and controls (81.8323.01 ng/g creat); P value <0.001 in all. A cut-off value of 328.98 (ng/g creat) was proposed, with sensi- tivity of 81.1% and specificity of 94.4%. The area under the ROC curve was 0.925 (95% CI: 0.87-0.98). Urinary CD80 was elevated in three patients with tip lesion and one with NOS. Mean value was 334.58 208.92 ng/g creat in the patients with tip lesion and 38.54(5.36, 80.16) ng/g creat in NOS. Urinary CD80 was higher in tip lesions than in NOS (P <0.05). Urinary CD80 was elevated in two patients with IgA nephrop- athy and one patient with lupus nephritis. Conclusions: Urine CD80 increased significantly in children with MCD, and can be used as a biomarker to identify MCD with FSGS. A randomized controlled trial to assess the effect of calcium and vitamin D supplementation on bone biochemistry and bone mineral density in pediatric steroid sensitive nephrotic syndrome S. Banerjee, S. Basu, J. Sengupta Institute of Child Health, Kolkata Objectives: Low vitamin D levels, osteoporosis and hypercalciuria are known complications of nephrotic syndrome (NS) and its treatment. The aim is to assess whether supplementation with vitamin D and calcium after relapse protects against hypovitaminosis and maintains bone mineral density (BMD) over 6 months. Methods: A randomized controlled open label trial was designed, with 30 patients in each arm to yield over 90% power. Children (2-10 yr) presenting in active NS relapse are being recruited. Standard treatment of NS is continued. Centralized computer randomisation is followed to allot patients into test group or control group. The test group receives vitamin D and calcium supplementation. Levels of serum creatinine, albumin, calcium, phosphate, alkaline phosphatase, and 25-hydroxy- cholecalciferol [25(OH)D]; urine protein/creatinine and calcium/ creatinine ratios are documented at study entry, 1 month and 6 months. In addition 25(OH)D levels are assessed in case of interim relapse and further supplementation given to optimize levels if required. Ultrasound of the renal tract and lumbar BMD are performed at study entry and at 6 months. At study completion, vitamin D levels and difference in lumbar BMD will be compared between groups and assessed for any correlation with number of interim relapses and cumulative steroid therapy. Results: This is an ongoing study and till date, 28 patients have under- gone randomization. Twenty children have completed the study, 9 in the test group and 11 in the control group. Their mean age is 4.9 years, 6 are female, 12 had a first episode of NS or have infrequent relapses, whereas 8 have frequent relapses or are steroid dependent. The mean vitamin D level at recruitment was 7.7ng/ml, and mean lumbar BMD was 0.52gm/ cm 2 .The mean difference over 6 months in 25(OH)D levels was + 22.95ng/dl in the test group and +1.47ng/ml in the control group, while mean difference in BMD was +11% and +3.4% respectively. None of the children in either group had hypercalciuria or nephrocalcinosis. Conclusions: On study completion we expect to understand whether calciumand vitamin Dsupplementation improves serumvitamin Dlevels and maintains BMD in children with NS, in the short term. This will help in formulating definitive guidelines for the requirement of such supple- ments, in this chronically relapsing disease. Mammalian target of rapamycin complex 2 signaling pathway regulates transient receptor potential cation channel 6 in podocytes F. Ding, X. Li, X. Zhang, Y. Zhang, B. Li, Jie Ding Department of Pediatrics, Peking University First Hospital, Beijing, China Objectives: Abnormal expression and gain of function of TRPC6 were involved in the pathogenesis of hereditary and nonhereditary forms of renal diseases. Although underlying molecular mechanisms of this re- main poorly understood, recent research found that there were many cell signaling pathways involved in regulating the expression and function of TRPC6. The purpose of our study is to examine the effect of distinct mammalian target of rapamycin complex (mTORC1 or mTORC2) sig- naling pathway on TRPC6 in podocytes. Methods: We applied pharmacological inhibitors of mTOR and siRNA specific for component of mTOR to explore mTOR signaling to regulate TRPC6 in podocytes. Podocytes were exposed to rapamycin, an inhibitor of mTORC1 signaling pathway, and ku0063794, a dual inhibitor of mTORC1 and mTORC2. In addition, using specific siRNAknocked down the component of mTORC1 raptor and the component of mTORC2 rictor. By using real-time reverse transcription PCR and western blotting, mRNA and protein expression of TRPC6 were examined. Also, fluorescence calcium imaging was used to study the function of TRPC6 in podocytes. Results: Rapamycin has no effect on mRNA and protein expression levels of TRPC6 at different time points and concentrations. Ku0063794 could down-regulate mRNA and protein of TRPC6 in podocytes. In addition, ku0063794, but not rapamycin suppressed TRPC6-dependent intracellular calcium influx. Furthermore, while knockdown of rictor suppressed TRPC6 protein expression and TRPC6-dependent calcium influx into podocytes, knockdown of raptor didnt change the above. Conclusions: These findings indicate that mTORC2 signaling pathway regulates TRPC6 in podocytes, while mTORC1 signaling pathway may have no effect on TRPC6. Molecular mechanisms of minimal change nephrotic syndrome: Role of CD80 B. Khullar 1 , A. Sharma 1 , N. Jain 2 , V. Bal 2 , S. Rath 2 , S. Sopory 1 1 Translational Health Science &Technology Institute, Gurgaon; 2 National Institute of Immunology, New Delhi, India Objectives: Expression of CD80 (a T cell costimulatory molecule) is induced in LPS, PANand 3-/- mouse models of podocyte injury (Reiser et al. 2004). Proteinuria in response to LPS is not observed in CD80-/- mice which show that CD80 induction is important in LPS-mediated podocyte injury. The objective of our study is to understand the role of CD80 in podocyte disease biology. Methods: Podocyte cell lines which stably express C-terminus Myc- tagged CD80 were generated by transfection and cell sorting to study the role of CD80 expression in podocytes. By confocal microscopy, the CD80+ and wild type (wt) podocytes were compared for changes in the actin morphology to see if CD80 expression alone can cause actin derangement in the cells. Reverse Transcriptase PCR and western blot analysis were done to compare CD80+ and wt podocytes for differences in the expression of important proteins to check if CD80 expression affects the expression of SD and other important podocyte proteins. By monitoring the total cell count of CD80+ and wt podocytes in culture, the growth curves of CD80+ and wt podocytes were compared to see if CD80 affects cell division and/or cell death. To understand the mechanism by which CD80 may be mediating podocyte injury, we are trying to find CD80-interacting podocyte proteins by CoIP and pull down assays. We also examined the interaction of CD80 with major SD proteins by transfection and CoIP studies in a heterologous system i.e. HEK293. Results: Podocyte cell line stably expressing high levels of CD80 were generated. The CD80+ podocytes were similar to the wt podocytes in the actin morphology, in the expression levels of major SDproteins and in the growth curve. In trying to find out CD80-interacting proteins, we have found a novel interaction of CD80 and Neph1 by transfecting the two proteins in a heterologous system and doing a CoIP. Conclusions: The expression of CD80 alone in the podocytes does not cause actin derangement and does not affect the expression levels of major SD and podocyte proteins. CD80 expression causes no change in cell growth and/or death. CD80 may mediate its effects by its interaction with Neph1. The possible mechanism by which CD80-Neph1 interaction affects downstream podocyte SD signaling is under investigation. Pediatr Nephrol Trehalose alleviates human podocyte injury via the induction of autophagy in an mTOR independent manner YL Kang 1,2 , MA Saleem 3 , KW Chan 4 , BYM Yung 1 , HKW Law 1 1 Department of Health Technology & Informatics, Faculty of Health and Social Sciences, Hong Kong Polytechnic University; 2 Department of Nephrology & Rheumatology, Shanghai Childrens Hospital, Jiao Tong University; 3 Academic Renal Unit, University of Bristol, Southmead Hospital, United Kingdom; 4 Department of Pathology, Li KaShing Fac- ulty of Medicine, University of Hong Kong, Hong Kong, China Objectives: Podocytes are highly differentiated cells which play an important role in guarding the permeability of the tripartite renal filtra- tion barrier. Many glomerular diseases are attributed to podocyte dam- age. Strategies for alleviating podocyte injury remain insufficient. Au- tophagy has been regarded as a vital cytoprotective mechanism in podocyte homeostasis. Trehalose, a natural disaccharide, is an mTOR independent autophagy inducer. It is unclear whether trehalose allevi- ates podocyte injury. Therefore, we investigated the efficacy of treha- lose in puromycin aminonucleoside (PAN)-induced podocyte injury model. Methods: Human conditional immortalized podocytes were treated with PAN or (and) trehalose. Autophagy and its signaling pathways were investigated by immunofluorescence staining for LC3 puncta and western blotting for LC3, Atg5, p-mTOR, p-p70S6K, p-4E-BP-1 and p-AMPK. Reactive oxygen species (ROS) was measured by H 2 DCFDA assay. The outcome measurement includes the evaluation of apoptosis, necrosis, and actin cytoskeleton and podocyte motility. Podocyte apoptosis was ana- lyzed by flow cytometry (YO-PRO-1/PI assay and active caspase-3 assay), while necrosis was evaluated by measuring lactate dehydrogenase activity. F-actin was stained for studying the stability of actin cytoskele- ton. In addition, we performed migration assay to examine podocyte motility. To verify the role of trehalose-induced autophagy in alleviating podocyte injury, chloroquine (CQ) and wortmannin (WT) were used to block the autophagic flux. Results: It was shown that trehalose induced podocyte autophagy in an mTOR independent manner without ROS involvement. Podocyte apo- ptosis significantly decreased after trehalose treatment, while inhibition of trehalose-induced autophagy abolished its protective effect. No signifi- cant changes were found in podocyte necrosis after PAN with or without trehalose treatment. The disrupted actin cytoskeleton was partially re- versed by trehalose, accompanying with less lamellipodias and dimin- ished mobility. Conclusions: Trehalose induced podocyte autophagy in an mTOR inde- pendent manner and showed cytoprotective effects in PAN-treated human podocytes. A novel biomarker for predicting steroid resistance in childhood nephrotic syndrome Mahesh Kumar KB 1 , Senguttuvan P 1 , Soundararajan P 1 , Aravind Selvinkumar R 1 , Rathika C 2 , Balakrishnan K 2 1 Department of Nephrology, Sri Ramachandra University, Porur, Chennai; 2 Department of Immunology, Madurai Kamaraj University, Madurai Objectives: Our aim was to study the association of HLA class II (DR & DQ) alleles with steroid resistance in south Indian nephrotic children. Methods: All steroid resistant nephrotic children in the age group of 1 to 12 years were included. Steroid sensitive nephrotics served as controls.. 3ml of whole blood was collected and DNAwas isolated. Genotyping of HLA DR1* and DQB1* by PCR-SSP method was done and the PCR products were run in 2% agarose gel and the allelic frequencies and haplotypes were estimated. Results: We enrolled 95 SRNS and 91 controls. Biopsy was available for all the patients. 47 children had MCN, 40 FSGS, and DMP in 8 cases. HLA-DRB1*07 and DRB1*03 and HLA-DQB1*02 were significantly more frequent in cases when compared to controls. (27.1% vs.16.5%, OR=2.4; P<0.006 and 17.6% vs.10.4%; OR=2.0; P<0.047 and 26.6% vs.12.6%; OR=3.3; P<0.001 respectively). DQB1*07 (subset of DQB1*03) was increased (14.9% vs. 8.8%; OR=1.96; P<0.076) and DQB1*05 was decreased and the results were statistically significant (23.9% vs. 39.0%; OR=0.26; P<0.001). Haplotype analysis revealed the predominance of DRB1*07-DQB1*02 (0.001), DRB1*03-DQB1*02(0.013) DRB1*15- DQB1*05 (0.013) DRB1*10-DQB1*06(0.045). Conclusions: DRB1*07, DRB1*03, DQB1*02 and DQB1*0301, 0304(DQ7) alleles were found to be significantly higher among SRNS patients comparable to the reports of Caucasian, Egyptian and Kuwaiti SRNS Children. DR/ DQ alleles/ allelic combination greatly influences the age of onset. DQB1*05 was found to be strongly protective (P<0.001) against steroid resistance. Alleles DQB1*02, DRB1*03 and DRB1*07 strongly predicts steroid resistance. These alleles could serve as novel biomarkers for steroid resistance in the future. TRPC6 gene promoter polymorphism in steroid resistant nephrotic children Mahesh Kumar KB, P. Senguttuvan, Bhaskar LVKS, Soundararajan P Department of Nephrology, Department of Biomedical Sciences, Sri Ramachandra University, Chennai, India Objectives: To study the prevalence of TRPC6 [calcium ion channel on podocytes] gene promoter polymorphisms in south Indian children with steroid resistant nephrotic syndrome [SRNS]. Methods: A prospective case-control study of SRNS [KDIGO definition] children attending the nephrology clinic at SRMC during 2012-2014 was conducted. Nonproteinuric childrenwere takenas controls. Institutional ethical committee approval was obtained. 2 ml of peripheral blood was collected from all subjects and two promoter polymorphism of TRPC 6 gene (-218A/G: rs56134796 -254C/G: rs3824934) were analyzed using PCR-RFLP. Results: 49 patients with SRNS and 45 controls were enrolled into the study. The mean age of the SRNS and control subjects were 7.784.12 and 9.493.92 years, respectively. Both case and control groups were dominated by male subjects. Renal biopsy was performed on 16 subjects, among whom 12 patients (24.5%) had minimal change nephropathy (MCN), 4 patients (8.2%) had focal segmental glomerulosclerosis (FSGS). Both promoter variants were polymorphic in the study popula- tion with the minor allele frequency of 9% and 17.4% respectively for - 218A/G and -254C/G and followed Hardy-Weinberg equilibrium. The frequencies of promoter polymorphisms -218A/G and -254C/G were 20.4% and 34.0% in SRNS children vs. 15.6% and 35.6% in controls and their distribution were not statistically significant (P=0.37; P=0.88). The distribution of -218A/Gand -254C/Gpolymorphisms were similar in MCN, FSGS and non biopsied cases. Since these markers are separated by only 36 bp, linkage disequilibrium was not strong and the haplotypes were not associated with SRNS. Conclusions: Both -218A/Gand -254C/Ggenotypes and alleles were not associated with SRNS predisposition in south Indian children as reported in Chinese children. The knowledge of the mutated gene carrier status warrants these children to be monitored periodically and screened for the development of renal disease in future. Protective effect of Angptl3 knock-out on LPS-induced nephropathy mice J. Liu 1 , Y. Zhai 1 , H. Xu 1 , Q. Shen 1 , L. Sun 1 , J. Rao 1 , M. Guo 2 , D. Ma 3 1 Department of Nephrology and Rheumatology, Childrens Hospital of Fudan University, Shanghai; 2 Department of Pathology, Shanghai Med- ical College of Fudan University, Shanghai; 3 Institute of Biomedical Sciences, Fudan University, Shanghai, China Objectives: In previous study, we found that the expression of ANGPTL3 in podocytes was upregulated in children with nephrotic Pediatr Nephrol syndrome and adriamycin-induced nephropathy rats. The aim of this study is to investigate the impact of Angptl3 knock-out on LPS-induced nephropathy mice. Methods: LPS-induced nephropathy model was established in B6; 129Sv-Angptl3+/+and B6; 129Sv-Angptl3-/- mice by intraperitoneal injection of 13g/kg LPS. Serum albumin, serum lipid levels, and urine albumin were examined by automatic chemical analyzer. Renal patho- logic analysis, including light microscopy and electron microscopy were performed. Results: Urine protein was negative in both B6; 129Sv-Angptl3-/- mice and B6; 129Sv-Angptl3+/+mice. B6; 129Sv-Angptl3-/- mice had normal serum albumin as B6; 129Sv-Angptl3+/+mice (29.850.71 vs. 28.75 0.41 g/L, P>0.05), but B6; 129Sv-Angptl3-/- mice had lower cholesterol and triglycerides compared to B6; 129Sv-Angptl3+/+mice (cholesterol 1.820.15 vs. 2.860.13 mmol/L, P<0.05; triglyceride 0.480.02 vs. 0.87 0.12 mmol/L, P<0.05). Light and electron microscopy showed no difference in histology in B6; 129Sv-Angptl3-/- & B6; 129Sv- Angptl3+/+mice. In LPS-induced nephropathy model, 30 hours after injection of LPS, B6; 129Sv-Angptl3+/+mice had significant proteinuria (32.030.48 mg/mmol), hypoalbuminemia (23.611.19 g/L) and hyper- cholesterolemia (3.450.29 mmol/L). The urinary albumin creatinine ratio in B6; 129Sv-Angptl3+/+mice was nearly 2 folds higher than that in B6; 129Sv-Angptl3-/- mice (32.030.48 vs. 17.313.21 mg/mmol P <0.05), though both had low serum albumin level (23.611.19 vs. KO 22.141.31g/L, P >0.05). Serum cholesterol in B6; 129Sv-Angptl3+/+ mice was significantly higher (3.450.29 vs. 1.590.33 mmol/L). Light microscopy showed no difference between two groups; electron micros- copy showed severe injury of podocytes in Angptl3+/+mice, and no manifestation of podocyte injury in Angptl3-/- mice 30 hr after LPS injection. Conclusions: Angptl3 knock-out can significantly attenuate proteinuria and prevent hypercholesterolemia in mice after LPS injection, which indicate that Angptl3 might be related to podocyte injury. Reduction of Angptl3 expression might be a potential way to decrease proteinuria in nephrotic syndrome. Screening strategies of causative genes in children with nephrotic syndrome G. Li 1 , H. Xu 1 , Q. Shen 1 , S. Li 1 , H. Liu 1 , Y. An 2 1 Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China; 2 Institutes of Biomedical Sciences of Fudan University, Shanghai, China Objectives: To explore the major causative genes, and to establish screening strategies of causative genes in children with NS. Methods: NPHS1, NPHS2, PLCE1, LAMB2, LMX1B, COQ2 and WT1 genes were tested in patients with congenital NS while NPHS1, NPHS2, PLCE1 and WT1 were tested in patients with infantile NS by direct sequencing. In early- and late-onset NS group and familial AR, we tested NPHS2 and WT1 by direct sequencing, as well as 42 common gene mutations involved in 8 main genes by Snapshot analysis. ACTN4, TRPC6 and INF2 were tested in familial AD group. Whole exon se- quencing (WES) was done when no causative mutation was found in familial forms. Results: Causative mutations of NPHS1 were found in 8; no other mutation was found in CNS (n=10). Among the 12 cases with infantile NS, 6 had mutations in WT1 (n=3), NPHS2 (n=2) and NPHS1 (n=1) mutations, respectively. In 32 cases of initial SRNS 6 had mutations in WT1 (n=3), NPHS2 (n=2) and INF2 (n=1). In 19 cases of later SRNS children, one had mutation of NPHS1 gene. In 42 cases of frequent relapsing SSNS children, one had mutation of NPHS1 gene. There were no causative mutations detected among 84 cases of delayed onset NS children. In two AR-NS pedigrees, we found one pedigree with NPHS2 mutation, while no mutation of NPHS2 and WT1was found in other pedigree, no causative genes were found by WES analysis. In an AD- NS family, all the patients were found had INF2 deletion mutation. Conclusions: NPHS1 is the main causative gene in CNS children, so NPHS1 analysis is recommended. It is recommended to test WT1 and NPHS2 in children of infantile NS. In children of early-onset NS, 18.8% presented related genetic mutations. Among initial SRNS, the major genes were WT1 and NPHS2, testing for these genes is recommended. In children of delayed-onset NS, it is not suggested to analyze gene mutation. NPHS2 and INF2 were causative genes of AR-NS and AD- NS, respectively, and analysis of NPHS2 and INF2 was recommended in families with AR-NS and AD-NS. Influence of tacrolimus on expression and distribution of TRPC6 in podocytes Zhang-Yao, Ma-yuanyuan, Yuli, Yu-shengyou Department of Pediatrics, Guangzhou First People's Hospital, Affiliated to Guangzhou Medical University, Guangdong, 510180, China Objective: By observing the expression and distribution changes of transient receptor potential cation channel protein 6 (TRPC6) in glomer- ular podocytes after puromycin (PAN) stimulation and the following tacrolimus (FK506) intervention, this study investigated the protective effect of FK506 in podocytes and the correlation of TRPC6 with podocyte injury repair. Methods: MPC5 were cultured in vitro, paralleled with the control group, PAN stimulation group, and FK506 intervention group. The control group was cultured in RPMI 1640; PAN stimulation group was added PAN to stimulate Mouse podocyte cell line (MPC5), and FK506 inter- vention group was added with PAN and FK506 simultaneously, then observed cell morphology and collected the cells at 8h, 24h and 48h, respectively. The experiments were further assayed the activity of podocytes using the MTT method and the apoptosis rate with flow cytometry, also detected TRPC6 mRNA and protein expression by RT- PCR and Western blot, and then observed the distribution of TRPC6 with indirect immunofluorescence labeling under confocal microscope. Results: After PAN stimulation, the cell bodies of podocytes were significantly reduced, the foot processes showed retraction and the inter- cellular junctions were lost. At 24-h and 48-h the activities of podocytes were significantly lower, apoptosis rate were increased, TRPC6 mRNA and protein expression were significantly increased when compared with control group; the distribution of TRPC6 was apparently different from the control group. After FK506 intervention, the cell bodies were bigger than in PAN group, most cells maintain normal foot processes; the activities of podocytes significantly increased after FK506 intervention for 24-h and 48-h and the apoptosis rate was markedly lower than that of PAN stimulation group. Conclusion: FK506 can directly act on the podocytes to inhibit PAN- induced damage on podocyte structure and reduce the apoptosis rate of podocytes, which may be related to stabilizing TRPC6 expression and distribution in podocytes by FK506, thus maintaining structure and function integrality of slit diaphragm (SD), and playing a role in protecting podocytes and resulting in antiproteinuric effects. Dexamethasone inhibits glomerular podocyte apoptosis by stabilizing the PI3K/Akt signal pathway Yu-li, Yu-shengyou, Hao-zhihong, Zhang-yao Department of Pediatrics, Guangzhou First People's Hospital, Affiliated to Guangzhou Medical University, Guangdong, China Dexamethasone (DEX) is an established treatment for glomerular disease that, at least in part, protects podocyes fromapoptotic death. To reveal the molecular mechanisms for renal protection, we examined the role of the PI3K/Akt signal pathway in DEX-mediated inhibition of podocyte apo- ptosis. A mouse podocyte cell line was treated with vehicle (DMSO), the Pediatr Nephrol apoptosis inducer puromycin (PAN), DEX + PAN, or DEX + PAN following pretreatment with the PI3K inhibitor LY294002. Western blot- ting, RT-PCR, and immunocytochemistry under laser confocal microsco- py were adopted to measure the expression and subcellular distribution of CD2AP, a major regulator of cytoskeletal dynamics and podocyte mor- phology, at both the mRNA and protein levels, as well as the co- localization of CD2AP protein with the PI3K regulatory subunit p85. Western blotting was also used to detect changes in expression of Akt, p- Akt, GSK3, and p-GSK3. Podocyte apoptosis was measured by flow cytometry. The expression of CD2AP mRNA and protein decreased significantly during PANtreatment (P<0.05). The subcellular distribution of CD2AP protein changed from evenly distributed filaments in cyto- plasmic foot processes and the nucleus to discontinuous rough granules in the perinuclear region. In addition, CD2AP was aberrantly co-localization with p85. Normal CD2AP mRNA expression and subcellular protein distribution were maintained in the PAN + DEX group, and DEX co- application also reduced CD2APp85 co-localization. PAN evoked a concentration-dependent decrease in p-Akt and p-GSK3 expression (P<0.05), with p-Akt expression reaching a nadir at 15 min and p- GSK3 expression at 30 min. DEX treatment induced a concentration- dependent reversal of PAN-induced p-Akt and p-GSK3downregulation (P<0.05). The PI3K inhibitor LY294002 blocked p-Akt and p-GSK3 expression in podocytes (P<0.01). Cells treated with PAN exhibited a significantly higher apoptosis rate than untreated or vehicle-treated cells (P<0.05). Furthermore, LY294002 exacerbated PAN-induced apoptosis (P<0.01). DEX treatment caused a concentration dependent decrease in PAN induced apoptosis (P<0.05). DEX protects podocytes by stabilizing the expression and subcellular distribution of CD2AP and maintaining expression of phosphor-activated Akt and GSK3. Registries KNOW-Ped CKD (Korean Cohort Study for Outcome in patients With Pediatric Chronic Kidney Disease): third-year follow-up report H.G. Kang, H.Y. Cho, J.I Shin, M.H. Cho, J.H. Lee, H. Park, Y.S. Park, Y. Choi, Il-Soo Ha, C. Ahn Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea Objectives: KNOW-CKD (KoreaNcohort study for Outcome in patients With Chronic Kidney Disease) is a nation-wide, 10-yr longitudinal cohort study collecting information of Korean chronic kidney disease (CKD) patients, launched in 2011, to assess the characteristics and risk factors of progression and complications of CKD. Pediatric sub-cohort of KNOW- CKD is planned to enroll 400 children with CKD, stage I to V (pre- dialysis), and collect information for >5 yr. Here we report the third-year follow-up report of pediatric sub-cohort, KNOW-Ped CKD. Methods: Five major pediatric nephrology centers of Korea enrolled children with CKD. After informed consent, medical history taking, questionnaire assessment of socio-economic status, anthropometric mea- surement, and clinical assessment using laboratory and imaging tests were done and recorded using web-based case report form. Results: Total 300 patients (M: F 199:101) were enrolled by Feb. 2014. Average age was 10.01 yr. Etiologies of CKD were congenital renal dysplasia (48%), reflux nephropathy/chronic pyelonephritis (22%), pri- mary glomerular diseases (16%), secondary glomerular diseases (5%), and others. Stages of CKD were I for 16%, II 18%, III 34%, IV 18%, and V 15%. Age groups were less than 2 yr for 10%, 2 to 5 yr for 15%, 6 to 11 yr 28%, and 12 to 19 yr 47%. One third had histories of UTI and 9% had developmental delay. Growth delay was observed even in early stage of CKD stage, with mean height and weight Z score of -0.98 and 0.99, especially younger (<6 yr) with advanced CKD(IVand V). Hypertension was observed in 16% and left ventricular hypertrophy in 9% of the patients. One-year follow-up data were available in 230 patients; renal replacement therapy was introduced in 33(14%) and other 5 (2 %) experienced doubling of Cr. Conclusion: This prospective, multicenter cohort study aiming to im- prove CKD outcome revealed that our current management of pediatric CKD in Korea had room for improvement. We expect to obtain more information on pediatric CKD with this cohort study. An on-line registry of hereditary kidney diseases in children in China F. Wang, J. Ding, H.W Zhang, X.Y. Liu, Y.Q. Zhang, W. Li Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China A paper record of patients with rare hereditary renal diseases had been kept and maintained for about 20 years in Department of Pediatrics, Peking University First Hospital. However, this system was insufficient as records for conducting research and for engaging more sites. An online system will make any data extraction and analysis for research much easier, and be convenient for a greater number of centres (other than Peking First University) to start collecting information on patients with rare kidney diseases. Supported by a grant from "Twelfth Five-Year" Science and Technology Support Project in China, an online registry was developed in 2012. Its language is Chinese. To design the registry, well-established and successful registries such as ASTOR (Alport Syn- drome Treatments and Outcomes Registry) were referred. All IT support was provided by the IT company that developed the registry database. The registry initially developed as a single-site registry at Peking First Hospital, now has been expanded as part of a national collaboration with 6 centres in 6 cities in China (Beijing, Hangzhou, Changsha, Guangzhou, Fuzhou and Chongqing). Training for using the registry in each centre had been performed 10 months ago. Each centre accesses to the registry via a unique Username and Password. Only those individuals who involved in updating and checking the information in the registry can access. Patients are identified by their physicians at each centre. The patients information is recorded on paper, and then transcribed into the database by a research nurse working with the registry. Ten physicians are responsible for collecting, recording and checking the patients informa- tion, 6 persons for transcribing the information into the registry,1 person for coordination, and 1 person for the web service.Until now, more than 1000 patients, classified as 4 kinds of hereditary kidney diseases, were registered. Special issues Inequalities in health care of children with ESRD the case of Brazil P.C. Koch-Nogueira, M.F. Camargo, L. Feltran, T. Konstantyner, R.C. Sesso Hospital Samaritano, Sao Paulo and UNIFESP, Brazil Objectives: Regional discrepancies in health care are frequent among countries and even among regions of the same country. We aimed to determine the incidence and prevalence of ESRD in children (aged<18 years) in Brazil in 2012 and also to quantify regional inequalities. Methods: Data collection fromboth: a) a sample of 239 (out of 708 total) dialysis units randomly selected to represent geographic regions and b) the national transplant waiting list coordinated by the Ministry of Health from Brazil during the period 2010-2013. Results: We collected data from 643-paediatric and 36401-adult dialysis patients, yielding the estimation of a total of 1283 (95% CI 948 to 1618) pediatric and 104577 (95% CI 94673 to 114482) adult ESRD cases on dialysis throughout the country in 2012. This indicates pediatric preva- lence of 20.0 (95%CI=14.8 to 25.3) cases per million (pm) and an adult Pediatr Nephrol prevalence of 539 (95%CI=488 to 590) cases pm in 2012. Prevalence in children contrasted among regions, being 13.8 pm in the North/Midwest, 16.4 pmin the Northeast, 23.3 pmin Southeast and 27.7 pmin the South. The main aetiologies of ESRD were indeterminate (38%), CAKUT (28%), glomerulonephritis (16%), systemic diseases (6%), FSGS (5%), congenital / hereditary diseases (5%) and other causes (2%). In addition, 1211 children were enrolled for renal transplantation in the study period. From these, 769 were transplanted, being 657 (85%) performed with deceased donor. The incidence of deceased donor paediatric transplant in 2012 was 4.1 cases pmand the hazard ratio for achieving a transplant after 2 years in the waiting list was significantly different among regions: a) 1.0 in the North/Midwest (reference), 2.8 in the Northeast, 4.4 in Southeast and finally 4.5 pm in the South (P<0.001). Conclusions: Existence of regions in Brazil with lower prevalence of ESRD and inferior likelihood of transplantation suggests that patients do not receive equitable health care in different areas of the country. There are regions with good indicators alongside others with poor performance. The implementation and evaluation of multicenter school urine screening in China Yi-nyu Gong 1 , Q. Shen 1 , Q. Yang 2 , J. Zhou 3 , X. Lei 4 , Jiang-jin Zhou 5 , Q. Yuan-han 6 , Zhu-wen Yi 7 , Zhen-zhong Gao 8 , Shi-pin Feng 9 , Hai-ming Liu 10 , Jian-hua Mao 10 , QiuLi 11 , Hong Xu 1 1 Childrens Hospital of Fudan University, Shanghai; 2 Yuying Children's Hospital of Wenzhou Medical college, Wenzhou; 3 Tongji Hospital of Central China University, Wuhan; 4 People's Hospital of Gansu, Lanzhou; 5 Ningbo Women and Children Hospital, Ningbo; 6 First affiliated hospital of Guangxi Medical University, Nanning; 7 Xiangya Second Hospital of Central South University, Changsha; 8 Weifang Maternity and Child Care Hospital, Weifang; 9 Chengdu Womens and Childrens Central Hospital, Chengdu; 10 Children's Hospital of Medical School of Zhejiang Univer- sity, Hangzhou; 11 Children's Hospital of Chongqing Medical university, Chongqing, China Objective: Understand asymptomatic urine abnormalities among prima- ry & middle school students and effectiveness of the screening method. Methods: During Jan 2013 to Dec 2013, urine screening of students of 6- 7 and 12-13 years of age in 11 provinces, municipalities and autonomous regions were carried out. Urine samples were collected by unified method and tested by unified urine dipsticks artificially by eyes. The observation indices included urine occult blood and protein. Those who were positive should be tested again in 2 weeks by the same method. The screening method was assessed then. Results: 1) Screening results: A total of 40,774 primary school students and 43,394 middle school students completed the screening, the average positive rate of first test was 8.76 (3.18-16.58%) and 3.18 (3.00-27.16%). And isolated hematuria (IH) or occult blood, isolated proteinuria (IP), hematuria associated with proteinuria (IH+IP) accounted 7.62% and 6.78%, 0.87% and 1.67%, 0.27% and 0.53%, respectively. Then the average positive rate of secondary test was 2.92 (0.31-7.09%) and 0.31(0.34-14.79%). IH, IP and IH+IP accounted 2.56% and 2.56%, 0.26% and 0.80%, 0.11% and 0.38%, respectively. The proportion of IP and IH+IP was significantly higher in middle school students (P< 0.05). The positive rate in south cities was similar to foreign reports, while in north-west, it was high (7.09%and 14.79%in primary and middle school students), which was similar to the reported data of the large-scale urine screening among children in the late 1980s in China. 2) Evaluation of screening method: The school urine screening was conducted with phys- ical examination of students. And two urine samples tested by dipstick, the direct cost was <1.8 RMB per person. Whats more, it was easy to operate, not restricted by device and specific sites and the results were reliable. Meanwhile, false positives of double tests were significantly lower than one-time test. Conclusions: The prevalence of asymptomatic urine abnormalities among primary and middle school students in China was about 3%, implementation of school urine screening and follow-up of the positive detection should be paid attention to. Two urine samples tested by dipstick were cost-effective, suitable for different medical conditions. Standard training and quality control were essential as well. Prevalence and related factors of proteinuria in a primary school children in Bali M.A.K. Levina 1 , K. Suarta 1 , G. Nilawati 1 , R. Widiana 2 1 Department of Child Health; 2 Department Internal Medicine Udayana University Medical School, Sanglah Hospital, Denpasar, Bali, Indonesia Objectives: The prevalence of proteinuria in children in Indonesia is not definitely known. The aim of the study is to determine the prevalence and related factors of proteinuria in primary school children in Bali. Methods: An analytic cross sectional study was conducted on elementary schools students in Bali from July 2013 to December 2013. Data were collected by examination & interviewed using questionnaire. Factors associated with proteinuria were analyzed using Chi-square test. Multi- variate analysis was performed to the related factors with P <0.25 on the bivariate analysis. Results: One thousand and twenty students participated in this study. Prevalence of proteinuria was 2.6%. Male gender, 10-12 years age group, hypertension and renal diseases in parents were related factors for the occurrence of proteinuria with a significance value P<0.05. Multivariate analysis showed hypertension was associated with frequency of protein- uria [OR 4.5, 95% CI 1.2 to 16.9, P=0.02], and 10-12 years age group also associated with frequency of proteinuria [OR 7.13, 95% CI 1.59 to 32.02, P=0.01]. Conclusion: The prevalence of proteinuria in primary school children in Bali is 2.6%. Hypertension and 10-12 years age group are factors that related to frequency of proteinuria in primary school children in Bali. The prevalence of proteinuria depicts an increasing abnormalities and severity of renal kidney disease. An early detection of proteinuria by dipstick test is an important screening for an early marker for renal abnormalities. Does malnutrition affect kidney size: Comparative study of size between malnourished and healthy children S. Gupta, P. Kumar, A. Mehta Division of Nephrology, Department of Pediatric Medicine, SMS Medical College, Jaipur, India Background: Kidney size is an important parameter in the evaluation of renal growth in children. Nutrition is one of the most important factors that determines the growth and size of the human body. Poor renal growth may have some long term consequences. This study planned to study effect of malnutrition on kidney size in the children under 5-yr of age and comparing them with healthy children. Methods Setting: Tertiary care, Department of Pediatrics and Radiodiagnosis, SMS Medical College, Jaipur Sample size: With 80% study power and -error of 0.05 and assuming standard deviation of 10 mm 3 kidney volume and minimum difference to be detected of 5 mm 3 , sample size comes to 68 patients in each group as final sample size. Subjects: Of 230 children, between ages of 6 to 59 months, 137 had severe acute malnutrition (WHO definition) and 93 were well nourished. Patients with anatomical abnor- malities of kidneys (hydronephrosis, VUR, renal scars, nephrolithiasis) and those born premature, small for gestational age or large for gestational age were excluded. Renal size was measured by ultrasonography by single observer. Kidney volume (cc) was: Volume = mean length x mean width x mean depth x 0.523. Left and right kidney volumes were added for combined kidney volume (cm 3 ). Relative kidney volume was calcu- lated as combined kidney volume/body weight (cm 3 /kg). Body surface area (BSA) was estimated by Du Bois equation: BSA=body weight 0.425 x Pediatr Nephrol body height 0.725 x 0.007184. Kidney volume/body height and kidney volume/BSA ratios were calculated. Results: There were 77 (56.2%) males and 60(43.8%) females in mal- nourished group while 68 (73.1%) males and 25(26.9%) females in control group. Malnourished children had smaller kidneys than their healthy controls, mainly affecting kidney length. However, relative renal volume and renal volume/BSA ratio of children with energy deficiency was higher than controls. These differences could be due to short stature and decreased body weight. The strongest correlation was found between height and kidney size in malnourished children. Conclusion: Kidney size differences of marasmic children should be kept in mind while assessing ultrasound imaging. Long-term consequences of poor renal growth, such as increased risk of hypertension or tendency to development of chronic renal insufficiency, need to be investigated. Transplantation Carotid intima-media thickness of pediatric kidney transplant recipients K. Sgambat, S. Clauss, M. Lasota, A. Moudgil Children's National, Washington DC Objectives: Increased carotid intima-media thickness (CIMT) is a known predictor of increased cardiovascular risk in adults, but there are limited data in pediatric transplant (TX) recipients. A prospective controlled study was conducted to investigate CIMT of lean and obese children in predominantly African American (AA) pediatric kidney TX cohort com- pared to healthy controls as well as change in CIMT over time. Methods: Pediatric TXrecipients had the following parameters measured at baseline, 18 and 30 months post TX: CIMT, fasting glucose, HDL, triglycerides (TG), HbA1c, waist circumference percentile (WC), and blood pressure (BP). CIMT was measured using B-mode ultrasound imaging of right and left common carotid arteries and carotid bulbs. TX with metabolic syndrome (MS) were identified as those with 3 of the following criteria: HbA1c >5.6% or fasting glucose >100, BP >90 th percentile, central obesity (WC 95 th percentile), HDL <5 th percentile, TG> 95 th percentile. CIMTof Tx recipients were compared to 24 healthy pediatric controls. Results: Study group comprised of 28 pediatric kidney TX recipients (8 obese, 20 lean), age 13.10.75 yr, 59.2% AA. Controls were 24 healthy children of similar age and race. CIMT of TX was greater compared to healthy controls (0.470.002 vs. 0.460.001, P=0.05). CIMT of AATx was greater than AA controls (0.490.002 vs. 0.470.002, P=0.000). Mean CIMT of TX group improved over time from 0.470.002 mm at baseline to 0.460.002 mm at 18 months (P=0.01) and 0.440.003 mm (P=0.000) at 30 months post-tx. Obese TX had greater CIMT than lean TX (0.480.004 vs. 0.460.002, P=0.001). TX with MS had greater CIMT than those without MS (0.490.004 vs. 0.460.002 mm, P=0.000). AA TX had greater CIMT vs. non-AA TX (0.490.002 vs. 0.430.001, P=0.000). Conclusions: Pediatric kidney TX recipients carry increased CV risk, particularly those with MS, obesity and AA race. This is the first study to demonstrate that AAhave higher CIMTcompared with non-AApediatric TX recipients. Further studies are needed to investigate strategies for decreasing CIMTafter kidney TX, particularly in higher risk groups. Prospective trial of attenuated live vaccines in children receiving immunosuppressants K. Kamei 1 , I. Miyairi 2 , M. Sato 1 , M. Ogura 1 , R. Ito 3 , T. Kudo 3 , K. Arai 4 , S. Ito 1 Departments of 1 Nephrology and Rheumatology, 2 Infectious Diseases, 3 Hepatology and 4 Gastroenterology, National Center for Child Health and Development, Japan Background: Live vaccines are generally contraindicated in patients receiving immunosuppressants. However, viral infections such as mea- sles and chicken pox occasionally result in serious complications in immunocompromised children, and are sometimes fatal. We have previ- ously reported the results of a retrospective study of 50 live vaccinations in children receiving immunosuppressants in ACPN2011. Thereafter, we conducted a further prospective study. Methods: Patients receiving immunosuppressants who showed negative or borderline antibody titers against measles, rubella, chicken pox and/or mumps, were enrolled. They had to show normal cellular and humoral immunity (CD4 500/mm 3 , normal lymphocyte blast transformation by phytohemagglutinin and serumIgG300 mg/dl) for enrollment. The IgG antibody titers against these viruses were measured by enzyme immuno- assay, defined as <2.0, negative; 2.03.9, borderline; 4.0, positive. We monitored the antibody titer at 2 months and 1 year after vaccination. Adverse events were also monitored. This study was approved by the ethical committee in our center and we obtained written informed consent from all parents. Results: A total of 107 vaccinations were given in 66 patients (41 boys; 47 with nephrotic syndrome, 9 inflammatory bowel disease, 5 collagen disease, 3 kidney transplantation, and 1 each with IgA nephropathy & autoimmune hepatitis). Calcineurin inhibitors were used in 29 patients (27%), antimetabolic agents in 47 (44%) and both in 31 (29%) at vaccination. Low doses of steroids were used in 18 patients (17%). Measlesrubella, measles, varicella and mumps vaccines were adminis- tered in 32, 2, 48 and 25 patients, respectively. The overall seropositivity rate was 70% (measles 88%, rubella 100%, varicella 60%, and mumps 40%) 2 months after vaccination. In 57 patients who achieved seropos- itivity, 41(72%) had positive antibody titers 1-yr after vaccination. 87% patients with antibody titer 10 at 2-months had persistent positive antibody titers at 1 year, compared with 42% of patients with titer <10.0 (P=0.001). Eight patients (7%) showed vaccine-related adverse events, including one with varicellavaccine-related events, and two with relapse of nephrotic syndrome. However, these adverse events were not critical. Conclusion: Immunization with attenuated live vaccines was relatively safe even in children receiving immunosuppressants. However, more clinical data are necessary to establish the efficacy and safety. Preemptive rituximab therapy of Epstein-Barr virus (EBV) infection to prevent post-transplant lymphoproliferative disease (PTLD) after pediatric solid organ transplantation (SOT) Y.H. Ahn 1 , J.M. Lee 1 , Nam-Joon Yi 2 , S.I. Min 2 , H.G. Kang 1 , Il-Soo Ha 1 , H.I. Cheong 1 , Yong Choi 1 Departments of 1 Pediatrics and 2 Surgery, Seoul National University College of Medicine, Seoul, Korea Objectives: More than 90% of pediatric PTLD after solid organ trans- plantation is associated with EBVinfection. EBVinfection often persists despite immunosuppression reduction. Following stem cell transplanta- tion, depletion of the EBV reservoir B cells using RTX is used as preemptive strategy for PTLD in some centers. The aim of this study was to assess the efficacy and safety of RTX in prevention of PTLD in pediatric patients with SOT. Methods: From September 2013 to July 2014, pediatric recipients of SOT in Seoul National University Childrens Hospital were studied. We evaluated EBV DNA load using quantitative PCR assay and if the EBV load were greater than 10 5 copies/mL or over 10 4 copies/mL for consec- utive 2 weeks, a single dose of RTX (375 mg/m 2 ) was administered. Results: Nine patients with SOT, 2 kidney, 6 liver, and one kidney-liver recipient, received preemptive RTX therapy for uncontrolled EBVinfec- tion. Median age at TPL was 1.2 years (0.3-5.5 years) and median age at RTX treatment was 2.2 years (0.7-11.7 years). Before SOT, 6 patients were EBV seronegative and 3 patients were EBV seropositive. Median EBV viral loads before and after administration of RTX were 56214 Pediatr Nephrol copies/mL (26464-275349 copies/mL) and 100 copies/mL (0-38082 copies/mL), respectively. In seven patients, EBVviral load was undetect- able after RTX. After RTX therapy, five patients experienced neutropenia and 5 patients were admitted for viral or bacterial infection. During follow-up, rebound of EBV load along with recovery of B cells was observed in 4 patients. Conclusions: Preemptive RTXwas effective for reducing EBVviral load in pediatric recipients of SOT. However, reduction of EBV viral load was not persistent and side effect of RTX, infection and neutropenia, was clinically significant. Tubular disorders NLRP3 inflammasome mediates albumin-induced renal tubular injury through impaired mitochondrial function Y. Zhuang 1,2 , G. Ding 1 , M. Zhao 2 , M. Bai 2 , L. Yang 2 , J. Ni 2 , R. Wang 2 , Z. Jia 1,2 , S. Huang 1,2 , A. Zhang 1,2 1 Department of Nephrology, Nanjing Children's Hospital, Nanjing; 2 Institute of Pediatrics, Nanjing Medical University, Nanjing, China Proteinuria serves as a direct causative factor of renal tubular cell injury and is highly associated with the progression of chronic kidney disease (CKD) via uncertain mechanisms. Recently, evidence demonstrated that both NLRP3 inflammasome and mitochondria are involved in the CKD progression. The present study was undertaken to examine the role of NLRP3 inflammasome/mitochondria axis in albumin-induced renal tu- bular injury. In patients with proteinuria, NLRP3 was significantly up- regulated in tubular epithelial cells and was positively correlated with the severity of proteinuria. In agreement with these results, albumin remark- ably activated NLRP3 inflammasome in both in vitro renal tubular cells and in vivo kidneys in parallel with significant epithelial cell phenotypic alteration and cell apoptosis. Genetic disruption of NLRP3 inflammasome remarkably attenuated albumin-induced cell apoptosis and phenotypic changes under both in vitro and in vivo conditions. In addition, albumin treatment resulted in a significant mitochondrial abnor- mality as evidenced by the impaired function and morphology, which was markedly reversed by invalidation of NLRP3/caspase-1 signaling path- way. Interestingly, protection of mitochondria function by MnTBAP or CsA robustly attenuated albumin-induced injury in mPTCs. Collectively, these findings demonstrated a pathogenic role of NLRP3 inflammasome/ caspase-1/mitochondria axis in mediating albumin-induced renal tubular injury. The discovery of this novel axis provides some potential targets for the treatment of proteinuria-associated renal injury. Differential diagnosis of Bartter/Gitelman syndrome and pseudo-disorder based on clinical characteristics N. Matsunoshita 1 , K. Nozu 1 , N. Kamiyosh 1 , K. Nakanishi 2 , N. Yoshikawa 2 , K. Iijima 1 1 Department of Pediatrics, Kobe University Graduate School of Medi- cine, Kobe; 2 Department of Pediatrics, Wakayama Medical University, Wakayama, Japan Objectives: Bartter syndrome (BS) and Gitelman syndrome (GS) are inherited autosomal recessive, salt-losing tubulopathies characterized by hypokalemic metabolic alkalosis. Phenotypic overlap occurs between type III BS and GS, which are difficult to distinguish based on clinical features. Furthermore, some acquired cases of pseudo-BS/GS (p-BS/GS) present clinical symptoms identical to BS/GS. Therefore, accurate diag- noses of these diseases are important, but differences among their clinical features have rarely been analyzed. Methods: We retrospectively studied 163 patients (type III BS: 30; GS: 90; p-BS/GS: 43) to establish distinctions between these conditions. Results: p-BS/GS patients were significantly older at diagnosis than type III BS and GS patients (P <0.05). Adult patients with p-BS/GS included a significantly higher percentage of women (P <0.05), and had a lower body mass index (BMI) (P <0.05) and estimated glomerular filtration rate (eGFR) (P <0.05) compared with adult GS patients. Furthermore, p-BS/ GS patients had significantly higher serum magnesium levels (P <0.05) and urinary calcium/ creatinine ratio (P <0.05) than GS patients. Although hypomagnesemia and hypocalciuria were leading biochemical findings in patients with GS, five patients with type III BS (16.7%) and 10 with p- BS/GS (23.3%) also showed hypomagnesemia and hypocalciuria and only 41 (45.6%) GS patients presented with both hypomagnesemia and hypocalciuria. Twelve patients with type III BS (40%) presented with chronic kidney disease (CKD), compared with 11 patients with GS (12%), and 27 with p-BS/GS (62.8%). Conclusions: The results of the present study also confirmed the signif- icant phenotypic overlap in serummagnesiumlevels and urinary calcium/ creatinine ratios and incidence of CKD between these three diseases. Our results suggest that p-BS/GS usually occurs in adult women with lower BMI and eGFR. These findings clarify the clinical distinctions among type III BS, GS and p-BS/GS. Clinical and genetic features of Chinese patients with Dent disease Y. Zhang, F. Wang, J. Ding, H. Zhang, Y. Yao Peking University First Hospital, Beijing, China Objectives: Dent disease is an X-linked recessive renal tubulopathy, associated with mutations in either CLCN5 (Dent disease 1) or OCRL (Dent disease 2). The aim of this study was to analyze the clinical and genetic features of patients with Dent disease in China. Methods: We analyzed mutations in CLCN5 and OCRL genes and clinical phenotype of 9 unrelated Chinese patients with Dent disease. Results: Of 9 unrelated patients with Dent disease, 7 possessed mutations in CLCN5 (Dent-1), of which 6 were novel mutations; 2 patients showed mutations in OCRL (Dent-2), one of which were novel. Two patients had de novo mutations. Low-molecular-weight (LMW) proteinuria and hy- percalciuria were found in all the 9 patients. Six patients showed nephrocalcinosis. In addition, three patients did renal biopsy and the pathological changes were mesangial proliferative glomerulonephritis, IgA nephropathy with thin basement membrane disease and minimal change glomerulopathy, respectively. Two patients with mutations in OCRL showed no mental retardation. Conclusions: These results suggest that various renal pathologic changes can be found in Dent disease. Gene analysis is critical for the diagnosis and differential diagnosis of Dent-1 and Dent-2. Urolithiasis in Asian children: evaluation of metabolic factors M. Naseri Dr Sheikh Children Hospital, Mashhad University of Medical Sciences, Iran Objective: This study was conducted to review urolithiasis in Asian children with a focus on urinary metabolic factors. Materials: A literature search of Pub Med and Google identified perti- nent articles from 20 different Asian countries which were subsequently reviewed. A totally of 12913 children (M/F ratio of 2.37:1) were enrolled in the studies. Results: Hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia and decreased urinary magnesiumexcretion were reported in 652 of 4509 (14.45%), 276 of 3137 (8.8%), 1053 of 3973 (26.5%), 1940 of 2846 (68.2%), 32 of 240(13.3%) of subjects, respectively. Cystinuria was noted in 112 of 4106 (2.7%) and mixed metabolic abnormalities were found in 175 of 724 (24.2%) patients. Association of urinary tract infection with stone disease was common (2454 of 6430; 38.16%). Urologic abnormal- ities were uncommon and recorded in only 447 of 9788 patients (4.5%). Pediatr Nephrol The etiology of stone formation was idiopathic in 731 of 2731 (26.8%) patients. Analysis of 3977 stones indicated that 983 (24.9%) were pure calcium; 1579 (40%), 411 (10.4%), 38 (0.95%) and 288 (7.35%) were mixed calcium, uric acid, cystine and struvite, respectively. The study showed that hypocitraturia and hyperoxaluria are the most common metabolic abnormalities. Bladder stones were composed of urate or uric acid alone or in combination with calcium. Uric acid stones were fre- quently reported in Asian children. Urology Robo2 mutant mice with the inserted piggyback transposon: A new model for study of VUR J. Liu, L. Sun, H. Xu, Q. Shen Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China Objectives: ROBO2 is shown to be important for the urinary develop- ment process. Robo2 complete knockout mice die shortly after birth due to severe CAKUT phenotypes and many human studies have found that ROBO2 gene missense mutations are associated with VUR. So we have studied a viable and fertile mouse model carrying a PB (PiggyBac) insertion. Methods: Robo2 mRNA and protein expressions were evaluated by Real-time quantitative PCR and Western blot analysis. Noninvasive ultrasonography was used as a screening method. VUR were tested by injecting methylene blue into the bladder and observed whether the dye refluxed up to the ureter. To test for urinary tract obstruction, the renal pelvis was microinjected with dye and its passage along the urinary tract was monitored to determine if there was evidence of impaired flowalong the tract. The histology and ultrastructure of the kidney and ureter was examined by light microscopy and transmission electron microscopy. Results: The PBinsertion site in mutants was mapped to the first intron of the Robo2 gene. The insertion reduces 50% of the Robo2 RNA expres- sion. Using Vevo 770 micro-ultrasound, we found sever hydronephrosis with hydroureter in 5.66% (6/106) new born Robo2 PB/PB mice. Robo2 PB/PB mice displayed a high frequency 29.56% (60/203) of VUR, com- paring to 7.87% (10/127) in Robo2 PB/+ mice and 6.38% (6/94) in wild- type mice. Only Robo2 PB/PB mice (6.40%, 13/203) displayed sever hydronephrosis. VUR were the most common cause in hydronephrotic mice (46.15%, 6/13). HE staining exhibited cystic renal dysplasia in hydronephrotic kidneys, some dilated tubules had cast. In dilated ureter a thin layer of epithelium or mesenchymal cells or muscle were found. Refluxing Robo2 PB/PB ureters had disorganized smooth muscle fibers at the level of bladder compared with littermate wild-type controls. Using transmission electron microscopy, focal foot process effacement was observed only in Robo2 PB/PB mice. Large intercellular edematous areas and intracytoplasmic vacuoles were found in ureters in Robo2 PB/PB mice. Conclusions: Robo2 PB/PB mice simulate the clinical situation more accurately, the ureters differ from normal ureters in having disorganized smooth muscle fibers and altered smooth muscle cell structure. Meta-analysis and clinical controlled trial of the alarm treatment and desmopressin for children with primary nocturnal enuresis W. Zhou 1,2 , X. Liu 2 , Y. Shen 2 1 Jinan Children's Hospital; 2 Beijing Children Hospital, Beijing, China Objective: To find the best therapy for children with primary nocturnal enuresis (PNE) by meta-analysis on the efficiency of alarm treatment versus desmopressin and a clinical controlled trail of body-worn, bell, alarm device and desmopressin treatment. Methods: Pubmed, Central, Elesvier, CNKI and some other databases were searched to get all randomized controlled trials comparing alarm treatment and desmopressin. The results of short-term and long-term efficacy, compliance were analyzed by Review Manager 5.0. A 6- month clinical trial was performed with patients from our outpatient department: patients 6-14 years old with PNE were divided to body- worn, bell, alarm device and desmopressin treatment groups according to the visiting sequence. Efficacy, compliance and safety were analyzed after follow-up at 1, 3, 6 months of the treatments. Efficacy was evaluated by the decrease of wetting nights. The relationship between efficacy and compliance, family history, functional bladder capacity and other charac- teristics were analyzed. Results: 54 RCTs were retrieved and 11 RCTs were included in the study. There were no significant differences between alarm treat- ment and desmopressin when analyzing by no wetting episode, wetting no more than 1 night per month, wetting nights decrease more than 90% or wetting nights decrease more than 50%. At 3 months follow-up after treatment stopped, alarm treatment can sig- nificantly reduce the wetting nights more than 50% or less than 1 night per month than desmopressin. At 6 months follow-up after treatment stopped, there was no difference between alarm treatment and desmopressin when analyzed by wetting no more than 1 night. The relapse rate of desmopressin was higher than alarm treatment. However, the withdrawal and loss rates of alarm treatment were higher than desmopressin. Severe adverse effects were not found. 120 patients were included in the controlled trial. On intent-to- treat analysis, the efficacy with alarm device was better than body-worn and bell and the efficacy with desmopressin was better than bell. The efficacy with alarm device was better than body- worn and bell treatment at 3-months follow up. The efficacy of alarm device was better than body-worn and bell and the efficacy with desmopressin was better than bell at 6-months follow up. Compliance: alarm device was the best and 90% can persist using it. The compliance of bell was the worst with only 53.3% persisting on it. The cure time of alarm device (2.61.5 months) was shorter than desmopressin (3.22.2 months). The relationship between clinical characteristics and the efficacy: compliance (P=0.012, OR=17.7) was the protection factor of the cure and family history (P=0.024, OR=0.317) was the risk factor. Conclusion: The meta analysis shows no statistically significant difference between alarm device and desmopressin in short-term treatment. The efficiency of alarm device was better than desmopressin in long-term treatment. The controlled trial shows that both the alarm device and desmopressin have a high cure rate and good compliance and safety. The alarm device and desmopressin can be chosen as first-line treatments. The efficacy and compliance of the alarm device was the best. The body-worn and bell have certain effects on children with primary nocturnal enuresis as the alternative treatments of the alarm device. Patients and parents need to be counseled before making a treatment decision. Synergistic effect of mizoribine and a direct renin inhibitor, aliskiren, on unilateral ureteral obstruction-induced renal fibrosis in rats K. Sakuraya 1,2 , A. Endo 2 , T. Someya 2 , D. Hirano 3 , S. Fujinaga 1 , Y. Ohtomo 2 , T. Shimizu 2 1 Division of Nephrology, Saitama Childrens Medical Center, Saitama; 2 Juntendo University Graduate School of Medicine, Tokyo; 3 The Jikei University School of Medicine, Tokyo, Japan Objectives: Renal fibrosis is the major histopathological change ob- served in a variety of renal disorders and closely related to renal dysfunc- tion. Unilateral ureteral obstruction (UUO) is a well-established model of experimental renal disease, which results in tubulointerstitial fibrosis. Previous studies have shown that both aliskiren and mizoribine (MZR) Pediatr Nephrol ameliorate UUO-induced renal fibrosis. However, the protective effect of combination therapy with aliskiren and MZR against renal fibrosis is unknown. In this study, we investigated the synergistic effects of combi- nation therapy with aliskiren and MZR on UUO-induced fibrosis in rats. Methods: Sprague-Dawley male rats underwent UUO, followed by treatment with either aliskiren, MZR, or both drugs. Kidney samples were fixed for histopathology and immunohistochemistry of myofibroblasts (-smooth muscle actin; -SMA) and macrophages (ED-1). Real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) was performed to measure the expression of - SMA, transforming growth factor-1 (TGF-1), osteopontin (OPN), monocyte chemotactic protein-1 (MCP-1) and renin. Results: The scores for tubular dilatation, interstitial volume, and -SMA expression following UUO were significantly reduced by combination therapy compared with monotherapy with either aliskiren or MZR. Com- bination therapy also caused a significant decrease in the number of ED-1 positive cells and expression of TGF-1 gene compared with monother- apy with either drug (both P<0.05). Combination therapy also decreased the expression of OPN and MCP-1 gene (P<0.05). Conclusion: Combination therapy with aliskiren and MZR provides increased renal protection against renal fibrosis and UUO-induced in- flammation. In view of this synergistic protective effect, we suggest that combination therapy with aliskiren and MZR can be a clinical choice of early intervention for progressive renal dysfunction. Pediatr Nephrol