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PHYSICAL ACTIVITY AND ALBUMINURIA Emily S. Robinson*,1 Naomi D. Fisher,2 John P. Forman,1 Gary C. Curhan1, 3 1Renal Division and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA 2Division of Endocrinology and Hypertension, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA 3Department of Epidemiology, Harvard School of Public Health, Boston, MA Higher urinary albumin excretion predicts future cardiovascular disease, hypertension, and chronic kidney disease. Physical activity improves endothelial function so may reduce albuminuria. Among diabetics, physical activity decreases albuminuria. In non-diabetics, prior studies have shown no association. We explored the cross-sectional association between physical activity and albuminuria in 3587 non-diabetic women in two United States cohorts, Nurses’ Health Study (NHS) I in 2000 and NHS II in 1997. Physical activity was expressed as metabolic equivalents (METs) per week. The outcome was the top albumin/creatinine ratio (ACR) decile. Multivariate logistic regression was used. Secondary analyses explored the association of ACR with strenuous activity and walking. The mean age was 58.6 years. Compared with women in the lowest physical activity quintile, the multivariate-adjusted odds ratio for the top ACR decile for those in the highest quintile was 0.65 (95% CI: 0.46,0.93). The multivariate-adjusted odds ratio for the top ACR decile for those with greater than 210 minutes per week of strenuous activity compared with no strenuous activity was 0.61 (95% CI: 0.37,0.99), and for those in the highest quintile of walking compared with the lowest quintile was 0.69 (95% CI: 0.47,1.02). Higher physical activity is associated with a lower ACR in non-diabetic women.

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A CASE REPORT OF HIV ASSOCIATED IMMUNE COMPLEX GLOMERULONEPHRITIS IN AN AFRICAN-AMERICAN MALE Margaret Rose, Roy Zent .Vanderbilt University Hospital, Nashville, TN USA HIV-associated Nephropathy is typically described as a type of Focal Sclerosing Glomerulonephrosis, which is predominant in African-American patients infected with HIV. Patients typically present with nephrotic-range proteinuria, enlarged kidneys on renal ultrasound, and are usually normotensive. On renal biopsy patients have dilated tubules, reticular aggregates and the collapsing-variant of FSGS. Immune-complex glomerulonephritis has been described in HIV-infected patients but is typically described in Caucasian patients with concomitant Hepatitis infection. We present a case report of a young HIV + African-American patient with an immune-complex glomerulonephritis. A 32 y/o African-American male was referred to nephrology clinic from ID clinic after multiple urinalyses over a yearʼs time were positive for microscopic hematuria and proteinuria. His past medical history was significant for poorly controlled hypertension and HIV of 10 years duration. His last CD 4 count was 11 and he had a significant HIV viral load (approximately 240,000 copies/ml). His glomerular filtration rate was in the low 60s. Hepatitis B and C serologies, serum protein electrophoresis and urine protein electrophoresis were negative. Protein to creatinine ratio was notable for 650mg/24 hr. Complement levels were checked and both C3 and C4 were decreased significantly. Renal biopsy was performed and was notable for immunoflurescent granular mesangial staining for C3 and IgG. He had subepithelial immune complex deposits, 10-20% fibrosis and a moderate lymphocytic infiltrate. Review of the international literature, reveals that immune complex glomerulonephritis is not uncommon in patients of African heritage associated with HIV, despite prevailing opinions otherwise in the United States. There is also evidence that immune-complex glomerulonephritis can occur without co-infection with hepatitis. The patient was urged to be compliant with both his HAART and his blood pressure medications. On repeat evaluation his microscopic hematuria had markedly improved, as had his GFR.

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THE ASSOCIATION OF SERUM PHOSPHORUS AND PULSE PRESSURE IN MEN AND WOMEN WITH CHRONIC KIDNEY DISEASE: DATA FROM THE KIDNEY EARLY EVALUATION PROGRAM Georges Saab1, Adam Whaley-Connell2,3, Shu-Chen Cheng4, Suying Li4, James R. Sowers2,3, Keith Norris5,George L. Bakris6, Peter A. McCullough7 1 Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO USA Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO USA 3 Harry S. Truman VA Hospital, Columbia, MO USA 4 KEEP Data Coordinating Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA 5 Department of Internal Medicine, Charles Drew University of Medicine and Science, Los Angeles, CA, USA6 University of Chicago School of Medicine, Chicago, IL, USA7 William Beaumont Hospital, Royal Oak, MI, USA Background: Higher serum phosphorus is associated with CVD and the association may be stronger in men than women. Methods: A total of 6335 participants in the Kidney Early Evaluation Program (KEEP) with CKD (eGFR < 60 ml/min/1.73m2) at screening were included in the analysis. Results:Mean Pulse Pressure (PP) across increasing phosphorus quartiles for men was 60.8 ± 17.1, 60.5 ± 16.9, 58.5 ± 16.0, 60.9 ± 17.4 mmHg (p for trend =.09) . Mean PP across increasing phosphorus quartiles for women was 60.2 ± 17.9, 60.1 ± 18.3, 60.4 ± 18.4, and 58.2 ± 17.6 ( p for trend= .03) respectively. After multivariate djustment ,the gender difference persisted (p for gender interaction = .02). Among women with CKD, PP was 1.6 mmHg lower in the highest phosphorus quartile than in the other quartiles (95% CI: 0.3-2.8, p=.01) but similar to the other quartiles in men. Conclusions: Higher serum phosphorus is associated with lower pulse pressure in women but not men with CKD. Whether pulse pressure mediates gender differences of phosphorus and CVD requires further study.

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AFRICAN AMERICAN RACE & MALE SEX AS RISK FACTORS FOR SIROLIMUS ADVERSE EFFECTS IN RENAL TRANSPLANT RECEPIENTS Sachin Sachdev1, Adeem Akbar1, Pallavi Batwar1, Hiral Desai1, John Madigan1, Sadanand Palekar1. 1Newark Beth Israel Medical Center. Newark, NJ We discuss one transplant center's experience with SRL and high rate of discontinuation in renal transplant recipients due to various adverse effects; in particular pulmonary complications. We performed retrorespective chart review of patients (pts) receiving SRL & reviewed pts age, gender, race, serum creatinine, reasons for discontinuation, dosage & trough levels at time of discontinuation & duration for adverse effects to occur. Of 34 pts receiving SRL, 14 (41%) had to be discontinued. Average age of pts was 49 years (34 72). All were > 1 year post transplant. 11 pts were switched to SRL due to chronic transplant rejection or CNI toxicity while 3 were started de novo on SRL. Average dose of SRL at onset of adverse reaction was 3.8 mg & average trough level was 11.2 ng/ml (within therapeutic range). 8/14 (57%) were males, 8/14 (57%) were African-Americans (AA), 12/14 (85%) were DD & 2/14 were LD recipients. Mean serum creatinine at onset of side effects was 2.68 mg/dl. Mean treatment time was 12 months. Most common adverse event was pulmonary toxicity. 5/14 (35%), all males of which 3 were AA (60%), had pulmonary complications including 3 pts with bilateral pulmonary infiltrates, 1 alveolar hemorrhage & 1 BOOP. 3/14 (21%) had hyperlipidemia, 2 (14%) impaired wound healing, 1 liver enzyme elevation, 1 lymphocele, 1 discontinued due to failed transplant & 1 stopped due to financial limitations. Adverse events rapidly resolved with SRL discontinuation with exception of patient with BOOP. Temporal relationship between SRL exposure and onset of patient's symptoms suggest that SRL was cause of adverse effects more commonly among DD recipients. These results not only reinforce that male sex continues to be a major risk factor for pulmonary complications of SRL but AA race is also a risk factor. High discontinuation rate (41%) of SRL in our patients indicates that clinicians must remain vigilant to its potential complications especially in males and AA patients.

NKF 2010 Spring Clinical Meetings Abstracts A95