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INACCURACY OF BLOOD PRESSURE (BP) MEASUREMENTS (Mm) BEFORE HEMODIALYSIS (HD) TREATMENTS (RX). Paul G. Jenkins and Marilyn Nuens, ARA Milwaukee Dialys is Center, Milwaukee, WI, USA. BP Mm prior to each HD RX is used as a measure of adequacy of hypertension (HTN) control in chronic HD patients (pts). We obtained serial upper extremity sitting BP Mm on 54 adult outpatient HD pts, as they arrived at their station (1stBP), after 5 minutes of sitting (2ndBP), and at the initiation of HD (3rdBP), using the automated device in the Fresenius 2008F HD machines. The 3rdBP was usually obtained within 5 minutes of the 2ndBP. Pts (#) 1st BP 2nd BP 3rd BP P value

All patients (54) 145/76 139/73 134/71 <0.05 BP>140/90 (31) 165/84 154/77 149/76 <0.01 BP< 140/90 (23) 119/67 118/65 115/64 NS

Systolic HTN was present in 31 pts (57%) at 1stBP but in only 19 pts (35%) at 3rdBP. Diastolic HTN was present in 12 pts (22%) at 1stBP but in only 5 pts (9%) at 3rdBP. All pts normotensive at 1stBP remained so. There was a significant decrease in BP between the 1stBP and 3rdBP in the 54 pts and particularly in the 31 pts with high BP (>140/90). We conclude that pre-dialysis BP is often falsely elevated. We recommend that the pre-dialysis BP of record in HD pts should be the BP taken at the initiation of HD RX or after sitting for 5-10 minutes before the HD RX and not the BP taken when pts arrive at their dialysis station.

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ULTRASOUND VERSUS CT-SCAN GUIDED KIDNEY BIOPSY Amit Joshi, Suresh Pasya, Gaurav Jain, Peter Hart. Section of Nephrology, John H. Stroger Hospital of Cook County, Chicago, Illinois, 60612, USA Ultrasound (US) guided kidney biopsy has been standard procedure to evaluate medical renal disease. Over the period of time, use of computed tomography (CT) to localize kidney has become increasingly popular. Although it helps with precise biopsy needle location, data regarding the safety and success of this method are not very extensive. We retrospectively examined the efficacy and complication rate in 210 successive patients who underwent percutaneous native kidney biopsy at our institute. In the US-group (n=108), biopsy was performed using manual 14- gauze needle or 18-gauze needle with automated biopsy gun. All patients (n=102) in the CT-group had biopsy using automated gun with 18-gauze needle. We considered ≥5 glomeruli adequate sample size as pathologic diagnosis could be obtained in almost all the cases in our series. Major complications included bleeding requiring PRBC transfusion, AV fistula, septicemia attributed to procedure, biopsy of non-renal tissues, hematomas requiring intervention or death. Macroscopic hematuria, and subcapsular or peri-nephric hematoma without need for intervention or PRBC transfusion were categorized under minor complications. Mean number of glomeruli obtained was similar with either method (CT= 22 vs. US=21.7). Five or more glomeruli could be obtained in 99% (101 out of 102) of the cases in the CT-group and 86% (93 out of 108) of the cases in the US-group. Total numbers of major complications were also similar in both groups (CT=9 vs. US=10). More numbers of minor complications were noted in the CT-method (10 vs. 2). In the CT-group, hematoma was detected right away at the time of kidney biopsy. Patients in the US-group were screened only if they had excessive pain or a significant drop in the hematocrit. Overall, CT-guided kidney biopsy technique is not inferior to the US-guided method. Although CT-guided method uses smaller needle size, it allows more precise needle placement and thus adequate tissue yield. Higher incidence of minor complications in the CT-group was partly because patients in the US-group were not specifically examined for hematoma at the time of biopsy.

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THE KIDNEY EARLY EVALUATION PROGRAM: PROGRAM DESIGN AND DEMOGRAPHIC CHARACTERISTICS Claudine Jurkovitz,1 Yang Qiu, 2 Changchun Wang,2 Wendy Brown 3 1Christiana Care Center for Outcomes Research, Christiana Care Health System, Newark, DE; 2Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, 3Jesse Brown Veterans Administration Medical Ce nter, Chicago, IL, United States Chronic kidney disease (CKD) was recently identified as a public health problem requiring a prevention approach. The Kidney Early Evaluation Program (KEEP), initiated in 2000, meets the definition of a public health program, offering surveillance and detection of CKD. This report aims to detail the demographic characteristics of KEEP participants and compare them to the characteristics of participants in the National Health and Nutrition Examination Study (NHANES). KEEP is a CKD screening program enrolling individuals aged ≥ 18 years, with a family history of kidney disease or a personal or family history of diabetes or hypertension. CKD was defined as an estimated glomerular filtration rate (eGFR)<60 mL/min/1.72m2 or eGFR ≥ 60 and albumin/creatinine ratio≥30mg/g. Time trends in demographic characteristics were analyzed.

The number of KEEP participants grew exponentially between 2000 and 2006. Most participants were aged 46-60 years. KEEP enrolled twice as many women as men (68.4% vs. 31.5%). Minorities were well represented (33.4% Black, 12.3 % Hispanic). Almost 58% of the participants had some college or more education, close to 85.0% had a physician and more than 80% were non smokers. The proportion of new KEEP participants with comorbid conditions increased over time (test of trend for self-reported diabetes, hypertension and kidney disease, p<0.0001). Compared with a similar group in NHANES, the KEEP population was older, and included a larger proportion of women (68.5% vs. 54.7%) and blacks (34.1% vs. 12.1%). Self-reported hypertension, self-reported diabetes, obesity, and CKD were higher in KEEP than NHANES (53.8% vs. 38.5%, 26.9% vs. 9.9%, 44.3% vs. 35.5%, and 27.1% vs. 17.6%, respectively). As evidenced by the high levels of self reported hypertension and diabetes, KEEP has been successful in enrolling individuals at high risk for kidney disease.

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EMPHYSEMATOUS PYELONEPHRITIS NOT IDENTIFIED ON ROUTINE RENAL ULTRASOUND Sarika Kadam1, Satyarth Kulshrestha2, Edwin Anand3 Leon Kurtz4

Louis Eichel5, John Kevin Hix6

12346Dept of Medicine, 5 Dept of Urology at Rochester General Hospital, Rochester, NY Emphysematous pyelonephritis (EPN) is an uncommon, life-threatening acute suppurative infection of renal parenchyma with gas forming bacteria like E coli. The presence of gas in kidney may interfere with imaging the renal parenchyma by ultrasound. A 68y/o female with uncontrolled diabetes mellitus presented with a 3 day history of fevers, and abdominal pain. She was tachycardic and febrile on presentation. Examination was significant for mild tenderness on deep palpation of left lower quadrant of abdomen. There was no costovertebral angle tenderness. Her laboratory work up was most significant for glucose = 616 mg/dl, BUN = 33 mg/dL, Creatinine was 2.4 mg/dL, WBC count =17900 /mm3 and HbA1c = 12.5%. Urinalysis revealed glucose>1000, negative nitrite and leukocyte esterase. Urine culture was negative. Blood cultures revealed E Coli bacteremia. Renal ultrasound to evaluate the acute renal failure demonstrated a 13cm right kidney with normal echotexture, but was unable to visualize a left kidney. A CT scan revealed emphysematous pyelonephritis of the left kidney with most of renal parenchyma replaced by gas; no fluid collection could be identified. She ultimately required nephrectomy. We came across other 2 cases in which uncontrolled DM was presented as EPN and in one of the cases diabetic ketoacidosis was difficult to control due to EPN. In this case neither clinical exam nor urine culture was initially suggestive of renal infection, and routine renal ultrasound failed to identify the severe renal parenchymal changes. The case reveals the limitations of ultrasound in imaging an emphysematous kidney, and emphasized the importance of complete imaging of the kidneys and collecting system in the setting of bacteremia with acute renal failure.

NKF 2008 Spring Clinical Meetings Abstracts A55