The European Rare Kidney Disease Registry (ERKReg): objectives, design and initial results

BACKGROUND: The European Rare Kidney Disease Reference Network (ERKNet) recently established ERKReg, a Web-based registry for all patients with rare kidney diseases. The main objectives of this core registry are to generate epidemiological information, identify current patient cohort for clinical research, explore diagnostic and therapeutic management practices, and monitor treatment performance and patient's outcomes. The registry has a modular design that allows to integrate comprehensive disease-specific registries as extensions to the core database. The diagnosis (Orphacode) and diagnostic information (clinical, imaging, histopathological, biochemical, immunological and genetic) are recorded. Anthropometric, kidney function, and disease-specific management and outcome items informing a set of 61 key performance indicators (KPIs) are obtained annually. Data quality is ensured by automated plausibility checks upon data entry and regular offline database checks prompting queries. Centre KPI statistics and benchmarking are calculated automatically. RESULTS: Within the first 24 months since its launch, 7607 patients were enrolled to the registry at 45 pediatric and 12 specialized adult nephrology units from 21 countries. A kidney disease diagnosis had been established in 97.1% of these patients at time of enrolment. While 199 individual disease entities were reported by Orphacode, 50% of the cohort could be classified with 11, 80% with 43 and 95% with 92 codes. Two kidney diagnoses were assigned in 6.5% of patients; 5.9% suffered from syndromic disease. Whereas glomerulopathies (54.8%) and ciliopathies including autosomal dominant polycystic kidney disease (ADPKD) (31.5%) were the predominant disease groups among adults, the pediatric disease spectrum encompassed congenital anomalies of the kidney and urinary tract (CAKUT) (33.7%), glomerulopathies (30.7%), ciliopathies (14.0%), tubulopathies (9.2%), thrombotic microangiopathies (5.6%), and metabolic nephropathies (4.1%). Genetically confirmed diagnoses were reported in 24% of all pediatric and 12% adult patients, whereas glomerulopathies had been confirmed by kidney biopsy in 80.4% adult versus 38.5% pediatric glomerulopathy cases. CONCLUSIONS: ERKReg is a rapidly growing source of epidemiological information and patient cohorts for clinical research, and an innovative tool to monitor management quality and patient outcomes

Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation

Background: Neonates with congenital urinary tract dilatation (UTD) may have an increased risk of urinary tract infections (UTI). At present, the management of these patients is controversial and the utility of continuous antibiotic prophylaxis (CAP) remains uncertain as the literature presents contradicting evidence. The aim of this observational study was to assess UTI occurrence in children with prenatal diagnosis of urinary collecting system dilatation without antibiotic prophylaxis. Methods: Between June 2012 and August 2016, we evaluated the incidence of UTI and the clinical and ultrasonography evolution in 407 children with a prenatally diagnosed UTD. All subjects underwent two prenatal ultrasounds scans (USs) at 20 weeks and 30 weeks of gestation and within 1 month of birth. Patients with a confirmed diagnosis of UTD underwent US follow-up at 6, 12 and 24 months of life. According to the UTD classification system stratify risk, after birth UTD were classified into three groups: UTD-P1 (low risk group), UTD-P2 (intermediate risk group), and UTD-P3 (high risk group). Voiding cystourethrogram was performed in all patients who presented a UTI and in those with UTD-P3. No patient underwent CAP. Results: Postnatal US confirmed UTD in 278 out of 428 patients with the following rates: UTD-P1 (126), UTD-P2 (95) and UTD-P3 (57). During postnatal follow-up, 6.83% patients presented a UTI (19 out of 278). Eleven out of 19 had vesicoureteral reflux (VUR), and other four were diagnosed with obstructive uropathy and underwent surgical correction. Five patients presented a UTI reinfection. Conclusion: The occurrence of UTI in patients with urinary collecting system dilatation was low. The recent literature reports an increased selection of multirestistant germs in patients with VUR exposed to CAP. This study constitutes a strong hint that routine continuous antibiotic prophylaxis could be avoided in patients with UTD

Pilot tone as a key to improving the spatial resolution of eBPMs

At Elettra, the Italian synchrotron light source, an internal project has been started to develop an electron beam position monitor capable of achieving sub-micron resolution with a self-compensation feature. In order to fulfil these requirements, a novel RF front end has been designed. A high isolation coupler combines the input signals with a known pilot tone which is generated by the readout system. This allows the parameters of the four channels to be continuously calibrated, by compensating the different responses of each channel. A similar technique is already known, but for the first time experimental results have shown the improvement in resolution due to this method. The RF chain was coupled with a 4-channel digitizer based on 160\u2005MHz, 16 bits ADCs and an Altera Stratix FPGA. At first, no additional processing was done in the FPGA, collecting only the raw data from the ADCs; the position was calculated through the FFT of each signal. A simulation was also performed to verify the analytic relation between spatial resolution and signal-to-noise ratio; this was very useful to better understand the behaviour of the system with different sources of noise (aperture jitter, thermal noise, etc.). The experimental data were compared with the simulation, showing indeed a perfect agreement with the latter and confirming the capability of the system to reach sub-micrometric accuracy. Therefore, the use of the pilot tone greatly improves the quality of the system, correcting the drifts and increasing the spatial resolution by a factor of 4 in a time window of 24 hours

A Novel Electron-BPM Front End With Sub-Micron Resolution Based on Pilot-Tone Compensation: Test Results With Beam

In this paper we present a novel and original four channel front-end developed for a beam position monitor (BPM) system. In this work, we demonstrate for the first time the continuous calibration of the system using a pilot tone for both beam current dependency and thermal drift compensation, eliminating the need for thermoregulation. By using this original approach, we were also able to investigate several odd and well-known behaviours of BPM systems; the influence of important issues, like the non-linearity of ADCs and the gain compression of amplifiers which do affect the reliability of the measurement, have been fully understood. To achieve these results, we developed a new radio frequency front-end that combines the four pick-up signals originated by the beam with a stable and programmable tone, generated within the readout system. The signals from a button BPM of Elettra storage ring, have been acquired with a 16 bit - 160MS/s digitizer controlled by a CPU that evaluates the acquired data and applies the correction factor of the pilot tone. A final resolution equal to 1.0um, on a 20mm average radius vacuum chamber, has been measured with a long-term stability less than 1um

Improved 2D‐HPLC of red wine by incorporating pre‐process signal‐smoothing algorithms

Twomultidimensional HPLC separations of an Australian red wine are presented, >70% of the available separation space was used. A porous graphitic carbon (PGC) stationary phase was used as the first dimension in both separations with both RP core–shell and hydrophilic interaction chromatography fully porous columns used separately in the second dimension. To overcome peak analysis problems caused by signal noise and low detection limits, the data were pre-processed with penalised least-squares smoothing. The PGC × RP combination separated 85 peaks with a spreading angle of 71 and the PGC × hydrophilic interaction chromatography separated 207 peaks with a spreading angle of 80. Both 2D-HPLC steps were completed in 76 min using a comprehensive stop-and-go approach. A smoothing step was added to peak-picking processes and was able to greatly reduce the number of false peaks present due to noise in the chromatograms. The required thresholds were not able to ignore the noise because of the small magnitude of the peaks; 1874 peaks were located in the non-smoothed PGC × RP separation that reduced to 227 peaks after smoothing was included

Improving peak shapes with counter gradients in two-dimensional high performance liquid chromatography

To achieve the greatest peak capacity in two-dimensional high performance liquid chromatography (2D-HPLC) a gradient should be operated in both separation dimensions. However, it is known that when an injection solvent that is stronger than the initial mobile phase composition is deleterious to peak performance, thus causing problems when cutting a portion from one gradient into another. This was overcome when coupling hydrophilic interaction with reversed phase chromatography by introducing a counter gradient that changed the solvent strength of the second dimension injection. It was found that an injection solvent composition of 20% acetonitrile in water gave acceptable results in one-dimensional simulations with an initial composition of 5% acetonitrile. When this was transferred to a 2D-HPLC separation of standards it was found that a marked improvement in peak shape was gained for the moderately retained analytes (phenol and dimethyl phthalate), some improvement for the weakly retained caffeine and very little change for the strongly retained n-propylbenzene and anthracene which already displayed good chromatographic profiles. This effect was transferred when applied to a 2D-HPLC separation of a coffee extract where the indecipherable retention profile was transformed to a successful application multidimensional chromatography with peaks occupying 71% of the separation space according to the geometric approach to factor analysis

Assessing the detectability of antioxidants in two-dimensional high-performance liquid chromatography

This paper explores the analytical figures of merit of two-dimensional high-performance liquid chromatography for the separation of antioxidant standards. The cumulative two-dimensional high-performance liquid chromatography peak area was calculated for 11 antioxidants by two different methods--the areas reported by the control software and by fitting the data with a Gaussian model; these methods were evaluated for precision and sensitivity. Both methods demonstrated excellent precision in regards to retention time in the second dimension (%RSD below 1.16%) and cumulative second dimension peak area (%RSD below 3.73% from the instrument software and 5.87% for the Gaussian method). Combining areas reported by the high-performance liquid chromatographic control software displayed superior limits of detection, in the order of 1 × 10(-6) M, almost an order of magnitude lower than the Gaussian method for some analytes. The introduction of the countergradient eliminated the strong solvent mismatch between dimensions, leading to a much improved peak shape and better detection limits for quantification

A non-destructive test to assess the axial heterogeneity of in situ modified monoliths for HPLC

This paper describes a non-destructive "peak parking" protocol in order to assess the axial heterogeneity of an in situ modified monolithic column for high performance liquid chromatography; a "gradient stationary phase" was designed whereby the ligand density decreases along the length of the rod in the "forward flow" configuration. The results of multi-location peak parking demonstrated a consistent increase in peak variance from the 1 cm position of the column to the 9 cm location. This increase in band broadening supported the theory of a decreasing ligand density along the length of this gradient column. This is consistent with efficiency measurements performed in both the forward and reverse flow directions, with an improved efficiency (15% increase in N m-1) in the reverse direction. These results are consistent with theoretical investigations into stationary phase gradients

Protocols for finding the most orthogonal dimensions for two-dimensional high performance liquid chromatography

The selection of two high performance liquid chromatography (HPLC) columns with vastly different retention mechanisms is vital for performing effective two-dimensional (2D-) HPLC. This paper reports on a systematic method to select a pair of HPLC columns that provide the most different separations for a given sample. This was completed with the aid of a HPLC simulator that predicted retention profiles on the basis of real experimental data, which is difficult when the contents of sample matrices are largely-or completely-unknown. Peaks from the same compounds must first be matched between chromatograms to compare the retention profiles and optimised 2D-HPLC column selection. In this work, two methods of matching peaks between chromatograms were explored and an optimal pair of chromatography columns was selected for 2D-HPLC. First, a series of 17 antioxidants were selected as an analogue for a coffee extract. The predicted orthogonality of the standards was 39%, according to the fractional surface coverage \u27bins\u27 method, which was close to the actual space utilisation of the standard mixture, 44%. Moreover, the orthogonality for the 2D-HPLC of coffee matched the predicted value of 38%. The second method employed a complex sample matrix of urine to optimise the column selections. Seven peaks were confidently matched between chromatograms by comparing relative peak areas of two detection strategies: UV absorbance and potassium permanganate chemiluminescence. It was found that the optimal combinations had an orthogonality of 35% while the actual value was closer to 30%