65IMMUNOTACTOID GLOMERULOPATHY IN AN

INCIDENT HIV PATIENT Guiselle Clark, Jose A. Morfin, Univeristy of Californina Davis, Sacramento CA, USA Immunotactoid Glomerulpathy is a rare cause of Nephrotic Syndrome. While most cases are deemed to be idopathic, a small percentage are associated with Chronic Lymphocytic Lymphoma (CLL) and B cell lymphomas, while others can be associated with HIV infection which have been reported in the literature. We present a case of a patient with an initial presentation of Nephrotic Syndrome related to presumed Idiopathic Immunotactoid Glomerulopathy who subsequently developed an AIDS defining illness with a favorable clinical response to HAART Therapy. 30 year old Native American, homeless gentleman with no known past medical history presented with worsening, progressive bilateral lower extremity swelling associated with brown appearing urine over a period of weeks to months. On admission, he was noted to have preserved kidney function, but nephrotic syndrome. Complete serological workup was unremarkable without an HIV test due to lack of consent. A renal biopsy demonstrated immune complex mediated glomerulopathy consistent with Immunotactoid Glomerulonephritis. No secondary causes were identified and due to his marginal housing, the patient was lost to follow up for the next 6 months, at which time, he re-presented with a pulmonary embolus and cryptococcus meningitis consistent with AIDS. Patient was initiated on HAART and anticoagulation without cytotoxic therapy. Over the next 12 months, he had significant improvement in clinical status. HIV has many associated immune complex glomerular diseases and as in this case, the nephrotic syndrome can be the initial presentation of an AIDS Defining Illness. Immunotactoid glomerulopathy is treated with caution when using cytotoxic therapy. The optimal therapy for immune complex glomerulonephritis in the setting of HIV infection is unknown, the role of antiretroviral therapy in modifying the course of these renal lesions appears to be promising as illustrated in this case.

66PREVALENCE AND SEVERITY OF HYPERTENSION AND ASSOCIATED LIFESTYLE FACTORS IN A RURAL COMMUNITY IN WEST AFRICA. Barbara A Clark MD, Andrew C Shannon, Alexander H Shannon. Division of Nephrology and Hypertension, Allegheny General Hospital, Pi�sburgh, PA, Drexel University College of Medicine. Rates of hypertension may be on the rise in Sub Saharan Africa. Establishing the burden of disease and community needs is essen�al to planning and implementa�on of public health prac�ce. The purpose of the present study was to establish the prevalence and severity of hypertension in the rural community of Ouesse, Benin and to iden�fy any modifiable risk factors. 154 persons presented for screening. Of these, 101 had a known history of hypertension. 53 individuals were without known history of hypertension and were used to determine prevalence. The other 101 were evaluated for control and medica�on use. All were interviewed for other CV and lifestyle risks. The prevalence of hypertension was 28.3%, in those with no known history. Other cardiovascular risk factors were low, obesity <10%, smoking 7%, reported diabetes 4% and physical ac�vity high. (90% walk more than 30 min/ day). However, 27% reported no daily fruit/ vegetable intake and 85% salted food. In those with known HTN, control was poor with only 24.8% with a BP of < 140/90 and 54% stage 2 HTN. Only 56.5% were on BP meds. 67% were not aware of consequences of HTN. In summary, the prevalence of HTN is high and control is poor even in this remote rural community with a non sedentary lifestyle. Salt intake is high, fruit/ vegetable intake low. Poten�al areas for interven�on include educa�on about salt, diet, HTN consequences, need for screening and con�nued regular physical ac�vity. As urbaniza�on occurs with a more sedentary lifestyle, hypertension rates may rise further as may obesity and diabetes.

67QUALITY IMPROVEMENT PROJECT: IMPROVING CARDIOVASCULAR RISK FACTOR MODIFICATION IN CHRONIC KIDNEY DISEASE PATIENTS IN NEPHROLOGY FELLOW CONTINUITY CLINIC Jason Cobb, Sejal Sarolia, Titlayo Ilori, Jeff Sands, & James Bailey. Division of Nephrology, Emory University, Atlanta, GA, USA Chronic kidney disease (CKD) is an independent risk factor for the development of cardiovascular disease (CVD). We developed a qualityimprovement project. The purpose is to improve CVD risk factor modification in CKD patients by 25% at the Emory University Nephrology Fellow Continuity Clinic by focusing on physician factors. We used PDCA (Plan, Do, Check, Act) cycle of continuous improvement. First, chart review to obtain baseline information and created fishbone diagram to explain current fellow practices. Established outcomes in the clinic progress notes included aspirin usage (medication list or assessment and plan). Other outcomes included management of dyslipidemia, diet, and exercise (assessment and plan). Intervention 1: Fellow lectures on quality improvement and guidelines on CVD in CKD. Intervention 2: E-mail and presentation to attendings encouraging participation during fellow clinic. Intervention 3: Weekly clinic journal club on CVD in CKD for one month. Baseline data: aspirin usage 52%, dyslipidemia management 14%, diet counseling 12%, and exercise counseling 2%. After each intervention aspirin usage 52%, 65%, and 86% respectively, and dyslipidemia management 41%, 32%, and 63% . After each intervention diet counseling 59%, 47%, and 68%, and exercise counseling 34%, 10%, and 43% respectively. Development of quality improvement curriculum allowed fellows to evaluate current practices and utilize tools to improve practice. It was difficult to maintain the increase in CVD risk factor modification, but with further interventions and repetition we were able to increase above our predetermined goal.

68LANTHANUM CARBONATE (LC) VS SEVELAMER FOR TREATING HYPERPHOSPHATEMIA IN CKD J Brian Copley,1 Raymond Pratt,1 Patrick Martin,1 Rosamund Wilson,2 Lynne Poole,3 Michael Smyth3 1Shire Pharmaceuticals, Wayne, PA, USA; 2Spica Consultants, Marlborough, UK; 3Shire Pharmaceuticals, Basingstoke, UK Phosphate (P)-binding efficacy and impact on vitamin D of LC and sevelamer (hydrochloride [SH] or carbonate [SC]) were evaluated in 3 trials. Study 1: healthy volunteers (HV) received a standard meal alone, or with LC (1000 mg) or SC (2400 mg), in a random order followed by a fasting period, with stool P measured 10 hours later. Study 2: serum P was measured in dialysis patients receiving LC (2250–3000 mg/day) then SH (4800–6400 mg/day), or vice versa, for 4 weeks each. Study 3: serum calcitriol was measured in HV taking calcitriol (1 µg) alone, and with LC (3000 mg/day) or SC (7200 mg/day), in random order. Study 1: P absorption (n=18) was: meal alone, 281.7 ± 14.1 mg; meal + LC, 156.0 ± 14.2 mg; meal + SC, 221.8 ± 14.1 mg (p<0.001; LC vs SC). Bound P was 135.1 ± 12.3 mg with LC and 63.2 ± 12.3 mg with SC (p<0.001), or 135 mg/tablet with LC and 21 mg/tablet with SC. Study 2: P reductions (n = 174) were 1.7 ± 0.1 mg/dL with LC and 1.4 ± 0.1 mg/dL with SH (p=0.113). In study completers (n=119), between-group difference was 0.5 mg/dL in favor of LC (p=0.007). A higher percentage of patients had ≥25% reduction in serum P with LC (51.8%) than with SH (38.5%; p=0.022). Study 3: LC did not affect calcitriol exposure (n=41). SC reduced calcitriol adjusted mean area under the curve (137 pg.h/mL vs 318 pg.h/mL; p=0.024) and maximum serum concentration (40.1 pg/mL vs 49.7 pg/mL; p<0.001) vs calcitriol alone. In conclusion, LC binds dietary phosphorus more effectively than SH or SC and, unlike SC, does not reduce exposure to oral calcitriol.

NKF 2011 Spring Clinical Meetings Abstracts

Am J Kidney Dis. 2011;57(4):A1-A108 A33