Abstracts Nephrology Dialysis Transplantation granul and an antigen for anti-neutophil cytoplasmic antibody (ACNA). However, function of PTX3 in MPO-ANCA production has been unrevealed. METHODS: We used aluminium gel (Alum) that is able to induce NETosis, as an adjuvant for producing anti MPO-Ig. Alum and recombinant MPO (rMPO) were intraperitoneally (i.p.) immunized in 12-16 weeks old MPO-deﬁcient mice at day 0 and day 14, and then rMPO was injected at day 21 for boost. After immunization and boost, concentration of anti-MPO IgG in their serum was examined by ELISA. To show the involvement of extracellular PTX3 in this model, protein level of PTX and quantitative double strand DNA in their peritoneal ﬂuid after Alum i.p. immunization. Furthermore, we simultaneously administrated recombinant PTX3 in addition to rMPO + Alum immunization to examine the function of PTX3 in producing antiMPO Ig in vivo. RESULTS: (1) Anti-MPO IgG was produced by Alum + rMPO immunization model in MPO-deﬁcient mice, but not wild type mice. (2) I.p. injection of Alum induced extracellular release of PTX3 as well as double strand DNA and dead cells. (3) Simultaneous injection of recombinant PTX3 attenuated production of anti-MPO IgG (Control: 617627 vs. +PTX3: 416622). CONCLUSIONS: A evidence for regulation by PTX3 in production of murine antiMPO IgG was demonstrated. MP225 TREATMENT AND CLINICAL OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN THE ELDERLY Eunjin Bae1, Jung Pyo Lee3, Jung Tak Park4, Se-Ho Chang2 Internal Medicine Gyeongsang National University Changwon Hospital Changwon Korea, Republic of, 2Internal Medicine Gyeongsang National University Hospital Jinju Korea, Republic of, 3Internal Medicine Seoul National University Boramae Medical Center Seoul Korea, Republic of and 4Internal Medicine Yonsei University College of Medicine Seoul Korea, Republic of and 72.2% in P group, respectively. Baseline urine protein-to-Cr ratio (PCR), serum albumin and creatinine concentrations were 5.9063.47 g/gCr, 2.0560.56 g/dl, 0.9160.22 mg/dl in MP group, and 6.7963.51 g/gCr, 2.0360.65 g/dl, 0.9360.21 mg/ dl, respectively. The response to the therapy was evaluated following Japanese guideline for nephrotic syndrome, which deﬁnes complete remission (CR): PCR<0.3, type-1 partial remission (PR1): 0.3<PCR<1.0, type-2 partial remission (PR2): 1.0<PCR<3.5, no response (NR): PCR3.5 g/day or g/gCr. RESULTS: In results, concomitant use of MZB seemed to be more advantageous than solely use of PSL in the early phase of therapeutic period (PCR at 3M: 2.7962.30 g/gCr (47% of baseline value) in MP vs 3.4563.42 g/gCr (51%) in P), however, there was no difference in both groups in the latter phase (12M). At 3M, the ratio of high responder (CR+PR1) in MP group was 35.3% whereas that in P group was 26.7%. Logistic analysis showed estimated odds ratio of the high responder in MP group was 1.50 (95% CI was 0.33-6.83), suggesting that the concomitant use of MZB might expedite the remission. In the group of qualitatively negative PLA2R antibody, the odds ratio of high responder group was 2.67 (95% CI: 0.28-25.64) in MP group vs 1.00 in P group whereas the ratio was 0.33 and 0.40 in MP and P groups respectively in cases showing qualitatively positive PLA2R antibody, suggesting that concomitant use of MZB might be more effective in PLA2R antibody negative cases. CONCLUSIONS: In conclusion, although MZB is considered to be a gentle immunosuppressant, its concomitant use might be considerable therapeutic strategy in the management of MN-induced NS in the elderly. MP227 OUTCOMES OF PATIENTS WITH LUPUS NEPHRITIS 1 INTRODUCTION AND AIMS: Idiopathic membranous nephropathy (MN) is most common in elderly patients showing nephrotic syndrome. However, little is known about treatment option and outcome of the elderly MN patients with long term follow up. METHODS: We retrospectively enrolled patients with biopsy proven MN between April 1990 and December 2015 from eight tertiary hospitals in Korea. Among them, we excluded patients who had secondary causes of the MN and had subnephrotic range proteinuria. We evaluated presenting features, clinical outcomes and analyzed the allcause mortality, infection, renal outcome and remission with respect to age or treatment option. RESULTS: 198 younger patients (<65 years) and 133 elderly patients ( 65 years) were enrolled. Median follow up was 95.4 months (range, 3.2-393.1 months). Mortality rate and infection rate were signiﬁcantly higher in elderly group than younger group. In elderly patients, use of ACEi or ARB and achievement of remission were associated with lower mortality rate and renal outcome. Achievement of remission was signiﬁcantly related with male gender, higher estimated glomerular ﬁltration rate and use of ACEi or ARB. The treatment option was not signiﬁcantly with achievement of remission. However, the immunosuppressant therapy was signiﬁcantly associated with higher renal outcome and infection compared with conservative therapy. In addition, steroid monotherapy was independent predictor of higher renal outcome and infection than steroid plus other immunosuppressant therapy. CONCLUSIONS: This study showed conservative treatment could be a better treatment option in elderly MN patients in aspect of infection and renal outcome. MP226 CLINICAL ADVANTAGE OF CONCOMITANT USE OF MIZORIBINE AND PREDNISOLONE ON PRIMARY MEMBRANOUS NEPHROPATHY IN THE ELDERLY Hajime Hasegawa1,2, Tetsuya Mitarai2,1, Yasuhiko Tomino2, Hitoshi Yokoyama2, Kunihiro Yamagata2, Masayuki Iwano2, Kaori Takayanagi1 1 Dept of Nephrol and Hypertens, Faculty of Blood Puriﬁcation Saitama Medical Center, Saitama Medical University Kawagoe Japan and 2Study group for nephrotic syndrome in the elderly Study group for nephrotic syndrome in the elderly Kawagoe Japan INTRODUCTION AND AIMS: Membranous nephropathy (MN) often causes prednisolone (PSL)-resistant nephrotic syndrome (NS) in the elderly, and forces to use immunosuppressant which shows multiple adverse effects. Mizoribine (MZB) is an immunosuppressant eliciting its action through the inhibition of nucleic acid metabolism, and known to show lesser adverse effects comparing to cyclophosphamide or cyclosporine. In this multi-centered cohort study, we investigated the clinical advantage of MZB in the elderly with MN-induced NS. METHODS: Thirty-six patients with biopsy-proven primary MN showing NS were enrolled from 24 independent facilities in Japan. Enrolled patients, being older than 65 of age and preliminary obtained none of therapy, were randomly assigned to two therapeutic groups, solely administered 30 mg of PSL (P group, n=18), or concomitantly administered 150 mg of MZB (MP group, n=18). Withdrawing procedure of PSL was controlled by the study protocol. Measurement of urine protein and blood test was scheduled at 0, 3, 6, 9 and 12 M after administration of medications. In a part of cases, qualitative analysis of anti-phospholipase A2 receptor (PLA2R) titer was performed. Averaged ages and ratio of male in both groups were 73.3 and 66.7% in MP and 72.8 Ondrej Derner1, Satu Pesickova1, Zdenka Hruskova1, Barbora Svobodova1, Jakub Zavada3, Martin Lenicek2, Romana Rysava1, Vladimir Tesar1 1 Department of Nephrology General University Hospital and First Faculty of Medicine, Charles University in Prague Prague Czech Republic, 2Department of laboratory diagnostics Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague Prague Czech Republic and 3Institute of Rheumatology Institute of Rheumatology, First Faculty of Medicine, Charles University in Prague Prague Czech Republic INTRODUCTION AND AIMS: Lupus nephritis (LN) is one of the most severe organ manifestations of systemic lupus erythematosus and despite great progress in the treatment of LN in past decades, it remains a signiﬁcant cause of morbidity and mortality. The aim of this retrospective study was to compare different types of initial treatment in terms of long-term outcome and to assess short term response after initial therapy. METHODS: Patients with most severe forms of lupus nephritis (class III, IV and combined forms III+V and IV+V) were enrolled into a study (n=157; median age 32.6 years; M/F 25/132), where patients were divided into 3 groups based on the initial treatment administered: cyclophosphamide (CYC, 70.1 %), cyclosporine A (CsA, 15.9 %) and mycophenolate mophetil (MMF, 13.4 %) group. Renal response (using criteria as deﬁned by EULAR/ERA-EDTA recommendation 2012) after one year of treatment was assessed in a sub study counting a total of 102 patients with biopsy proven LN diagnosed between 2007 and 2013 in our centre. RESULTS: Median time of follow-up was 7.2 years (range 3 - 16 years). At baseline, the CYC group had signiﬁcantly higher proteinuria (median 2.3 g/day) compared to MMF (median 0.8 g/day) (p = 0.0436) while it did not differ from CsA group. There were no statistically signiﬁcant differences in renal function among the groups at baseline. At the end of follow-up, nor renal function neither proteinuria differed in the three groups. During the follow up, 11/110 (10 %) patients from CYC group, 4/25 (16 %) in the CsA group and 1/21 (4.7 %) in the MMF group died. There was no difference in the overall survival (p=0.395). Renal replacement therapy was needed in 7/110 (6.4 %) in CYC group, 4/25 (16 %) in CsA group and 1/21 (4.7 %) in MMF group, and the renal survival did not signiﬁcantly differ between groups. In a sub study of 102 patients, complete response at one year after renal biopsy was achieved in 72 % of patients and partial response in 23 %, the remaining 5 % of patients were classiﬁed as non-responders. Renal relapse during follow-up occurred in 34 % of patients. CONCLUSIONS: Our retrospective study of patients with ﬁrst manifestation of lupus nephritis did not show any difference in long-term survival comparing three common types of initial therapy. Short term outcomes were comparable with results of similar studies. MP228 CASE SERIES OF NON-IMMUNE COMPLEX GLOMERULONEPHRIDITIES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS Fadel Alrowaie1, Ali AlFayez1, khalid Almatham1 Medical Specialities Department King Fahad Medical City Riyadh Saudi Arabia 1 INTRODUCTION AND AIMS: Lupus nephritis (immune complex) is the most serious complication of systemic lupus erythematosus (SLE) and the strongest predictor of poor outcome. The spectrum of renal involvement includes podocytopathies, renal thrombotic microangiopathy, tubulointerstitial nephritis and amyloidosis. No data about non-immune complex nephritis is published in Saudi Arabia.This study aimed to better characterize the incidence, clinical and morphological features, and outcomes of SLE patient with non immune complex renal involvement from large Saudi SLE cohort. doi:10.1093/ndt/gfx165 | iii509 Abstracts METHODS: SLE patients were identiﬁed using nephrology section glomerulonephritis (GN) registry. All SLE patients who had renal biopsy between 2006-2014 were reviewed. The biopsy result were divided into two groups: Immune complex lupus nephritis (based on ISN/RPS classiﬁcation from I-VI) and non immune complex (renal pathology not consistent with ISN/RPS classiﬁcation). RESULTS: A total of 78 patients with SLE who had renal biopsies identiﬁed. 69 with lupus nephritis class 1-6 were excluded from the study, and nine (11.5 %) found to have other forms of renal involvement were included. Mean age is (26 6 7.6), Female : Male (8:1), laboratory data at presentation (mean); Cr (126 6 126), Hb (10.6 6 2), all except one had subnephrotic proteinuria. Interestingly antinuclear antibody was positive in 3 patients while anti-double stranded DNA (anti-dsDNA) and antiphospholipid antibody (APL ) were positive in 7 patients ( 77 % ). Histological diagnoses identiﬁed were as follows: three focal segmental glomerulosclerosis (FSGS), two minimal change nephropathy (MCD), two thrombotic microangiopathic glomerulonephritis (TMA), one membranoproliferative glomerulonephritis (MPGN) 3, and one ﬁbrillary glomerulonephritis (FGN). Most of the patients achieved remission, while 2 were lost to follow up, and one patient died of sepsis. CONCLUSIONS: Non-immune complex GN contribute to 11.5 % of renal biopsies in SLE patients, the majority has at least one of APL antibody positive with FSGS as predominant pathology followed by MCD, that may suggest podocytopathies as pathogenesis. Our data consistent with Hertig et al 2001 and Baranowska-Daca et al 1999 data but none of our FSGS patients were of collapsing variant in comparison to Salvatore et al 2012 study. Nephrologist and rheumatologist should have low threshold in performing renal biospies in patient with SLE, as not every renal abnormalities is ( immune complex )lupus nephritis . MP229 HEAT SHOCK PROTEIN 27 AND 70 IN CHRONIC GLOMERULONEPHRITIS (CGN) Natalia Chebotareva1, Irina Bobkova1, Natalia Neprinzeva1 Nephrology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation 1 INTRODUCTION AND AIMS: In kidney tissue heat shock proteins are an important part of the intracellular defense system, that fulﬁll a range of functions, including cytoprotection and the intracellular assembly, folding and translocation of proteins. Moreover, the unique properties of Heat shock protein (HSP)70 provide an important immunoregulatory function results in differentiation of speciﬁc regulatory phenotypes T cells (FoxP3 positive), producing IL-10. HSPs may play an important role in the immune diseases, such as CGN. Our study aim was to assess urinary excretion of HSPs in urine and expression in renal tissue in patients (pts) with different CGN course. METHODS: Concentrations of HSP27 and HSP70, IL-10 in urine were determined in 70 patients with CGN by using ELISA technique. 30 pts - with proteinuria (PU) 1-3 g/ d, 40 - with nephrotic syndrome (NS), including 10 pts with severe NS (anasarca, PU to 12 g/d, hypoalbuminemia < 20 g/L), and 11 pts - with NS and impaired renal function. Expression of HSP70 and FoxP3 (a marker of Treg cells) was assessed in renal tissue by immunohistichemistry. RESULTS: HSP27 and HSP 70 urine levels were signiﬁcantly elevated in patients suffering from active courses of chronic glomerulonephritis predominantly in nephrotic syndrome versus healthy controls (Tab). The urinary HSP-27 and HSP 70 in pts with active CGN correlated directly with proteinuria (Rs = 0,4, p < 0,05; Rs= 0,34, p<0,05, respectively) and negatively with the level of serum albumin (Rs = -0,32 p < 0,05, Rs = -0, 2, p = 0,05). In CGN patients with severe NS (anasarca, PU to 12 g/d, hypoalbuminemia < 20 g/L) urinary HSP27 and HSP-70 level were higher compared to CGN pts with moderate NS (Tab). HSP70 urinary values were signiﬁcantly elevated (0,8 [0,7;3,4]ng/ml) in pts with higher expression of this protein in the renal tissue. Upregulation of HSP70 was detected in tubulointerstitium (tubular cells, inﬁltrate cells, myoﬁbroblasts), in podocytes and epithelial parietal cells. But tubulointerstitial expression of HSP70 was pronounced in active nephritis courses with a higher degree of tissue damage. But the number of positive FoxP3 cells (T regulatory anti-inﬂammatory cells, expressing IL-10) in the interstitium by severe nephrotic syndrome signiﬁcantly decreased (2,0 [0,44; 4] vs 8,5 [3; 16] positive cells in pts without NS). At the same time urinary IL-10 levels were decreased to trace values in this pts group (trace vs 0,11 [0; 1,12]ng/ml ) iii510 | Abstracts Nephrology Dialysis Transplantation CONCLUSIONS: We provide evidence for elevated HSP27 and HSP70 concentrations in urine in patients suffering from CGN. Urinary levels of HSP70 corresponding to the high expression in the renal tubulointerstitium may be used as a marker of tubulointerstitial injury in CGN. MP230 EFFECT OF CYCLOPHOSPHAMIDE AND MYCOPHENOLATE MOFETIL ON LYMPHOCYTE SUBSETS IN PATIENTS WITH ACTIVE LUPUS NEPHRITIS EFFECT OF CYCLOPHOSPHAMIDE AND MYCOPHENOLATE MOFETIL ON LYMPHOCYTE SUBSETS IN PATIENTS WITH ACTIVE LUPUS NEPHRITIS Desmond YH Yap1, Paul Lee1, Irene Yam1, Chun Hay Tam2, Sunny Wong2, Susan Yung1, Tak Mao Chan1 1 Department of Medicine The University of Hong Kong Hong Kong Hong Kong and 2 Department of Medicine and Geriatrics United Christian Hospital Hong Kong Hong Kong INTRODUCTION AND AIMS: Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are standard induction treatments for active lupus nephritis (LN). CYC induction might be associated with more sustained response compared with MMF. Lymphocyte subsets have been implicated in the pathogenesis of LN, but the impact of CYC and MMF treatment has not been investigated. METHODS: Lymphocyte subsets and serum cytokine levels were determined using ﬂow cytometry and ELISAs respectively in 14 patients with active LN randomized to receive either CYC or MMF (n=7 in each group), combined with prednisolone, as induction immunosuppression. RESULTS: At 24-week after starting induction immunosuppression, CYC treated patients showed a higher percentage of circulating CD8+ cytotoxic T cells compared with the MMF group (47.6610.9% vs. 20.363.8%, p=0.015). CYC treated patients also had a numerically lower percentage of Th1 cells (1.661.2% vs. 6.964.0%, p=0.094) and a higher percentage of regulatory T cells (3.062.2% vs 1.962.0%, p=0.534). The percentages of circulating naı̈ve B, memory B and plasma cells were similar in the two groups. The percentage of circulating memory B cells correlated with anti-dsDNA antibody level in both groups (r=0.964, p=0.036 for the CYC group and r=0.951, p=0.049 for the MMF groups respectively). CYC treated patients had lower serum IFN-gamma level (83.66136.9 pg/mL vs. 453.16349.1 pg/mL, p=0.032), whereas serum IL-2, IL-4, IL-6, IL-10, IL-17, IL-18, IL-21, IL-23, BAFF, IFN-alpha and MCP-1 levels were similar in both groups. CONCLUSIONS: Induction immunosuppressive treatment with corticosteroids and CYC or MMF resulted in differences in lymphocyte subsets and serum cytokine proﬁle in LN patients, which might have clinical implications. MP231 ANCA-ASSOCIATED VASCULITIS PRESENTING WITH SEVERE RENAL FAILURE Javier Villacorta2, Mercedes Acevedo3, Teresa Cavero1, Francisco Diaz-Crespo4, Alfredo Cordon, Beatriz Sanchez Alamo, Manuel Praga1, Gema FernandezJuarez 1 Nephrology Hospital Universitario Doce de Octubre Madrid Spain, 2Nephrology Hospital Universitario Fundacion Alcorcon madrid Spain, 3Nephrology Hospital Virgen de la Salud Toledo Spain and 4Pathology Hospital Virgen de la Salud Toledo Spain INTRODUCTION AND AIMS: Renal failure secondary to ANCA-associated vasculitis represents a clinical and therapeutic challenge. In this study we aimed to assess the treatment response rates and long-term outcomes of vasculitis patients presenting with renal failure. METHODS: This retrospective study included 151 patients with renal vasculitis from three hospitals who underwent a renal biopsy between 1997-2014. Patients with renal failure which required dialysis at the onset were compared to those presenting with more preserved renal function. The primary end point was treatment response and patient surivival. RESULTS: Patients with severe renal involvement had a lower response to treatment compared to those having preserved renal function (26.6% versus 93.4%; p<0.001). Dialysis dependent patients who received plasmapheresis in addition to immune suppressants associated a higher rate of renal recovery (41.6% versus 12.5%; p=0.05). A higher incidence of severe infections was observed among patients withsevere renal involvement (38.4% versus 18.1%, p=0.01). The mortality rate was signiﬁcantly higher among vasculitis patients presenting with renal failure (53.8% versus 22.2%, p=0.001). Global survival at1 and 5 years was 60% and 47% in patients requiring dialysis compared with 90% and 80% among those with more preserved renal function (p<0.001). After multivariate adjustement, the need for dialysis remained as an independent predictor of death (HR 2.5; 95% CI, 1.1 to 5.7; p=0.03). CONCLUSIONS: The presence of severe renal dysfunction represents an independent risk factor for patient survival in renal vasculitis. Patients requiring dialysis associate a lower response rate to immunosuppressive therapy and a higher incidence of severe infections.