121 PREGABALIN THERAPY IN REFRACTORY UREMIC PRURITUS Guru PK, Ganguli A, Bains AS, Chaudhary S, Bhargava A, Lund R. Omaha, Nebraska, USA and Mohali, Chandigarh, India. Pruritus in hemodialysis patients is a vexing clinical problem for which many medical therapies have been proposed. Gabapentin has been used successfully in some studies but has the disadvantage of sedation and other neurological adverse drug reactions (ADR). Pregabalin a derivative of gabapentin associated with less neurological ADRs and could potentially be used for symptoms relief in uremic pruritis. Twenty patients on thrice a week maintenance hemodialysis with severe pruritis refractory to traditional measures including emollients, antihistamines, xylocaine cream and tacrolimus ointment were enrolled in a non-randomized single arm study to evaluate the efficacy of pregabalin at 75 mg every alternate day for four weeks. Pruritis was measured with visual analogue scale (VAS) on a 10 cm line at 0, 1, 2,3and 4 weeks after starting therapy. Patients with pre- existing liver and skin diseases were excluded. No changes were done dialysis Rx. ADRs associated with pregabalin, especially neurological, were noted. Baseline characteristic of patients included mean age 57.05±7.52 yrs, sex (M/F) 12/8, mean time on dialysis 291.65±156.61days, mean kt/v per session 1.27±0.07, mean iPTH 169.35±64.21 pg/ml, mean Ca 9.48±0.43mg/dl, mean iP 4.48±0.83 mg/dl, Ca x P 42.467±.80 mg2/dl2, mean Hb 10.21 0±.65 g/dl and mean S.albumin 3.44±0.46g/dl. VAS sore showed significant improvement at the end of 4 weeks (7.720±.93 and 5.941±.36, p<0.0001). ADRs included drowsiness (n=1, stopped Rx after 2 weeks), vertigo (n=1), sedation (n=4) and ataxia (n=1). Presence of diabetes mellitus correlated with response to therapy (p=0.029).Pregabalin is a promising agent for uremic pruritis although the incidence of ADRs appears to be high in the ESRD population primarily as the drug is renally excreted. Large trials are necessary to establish the efficacy and safe dose of this agent in the chronic kidney disease patients. 122 A UNIQUE CASE OF COLLAPSING GLOMERULOPATHY IN A PATIENT WITH MIXED CONNECTIVE TISSUE DISEASE Hemalatha Gutta , Stephen I Rifkin, Reji Nair, Christopher McFarren, Donald E Wheeler, Univ .of South Florida, Tampa, Fl, USA Collapsing glomerulopathy (CG) is a distinct clinicopathological entity characterized by glomerular capillary collapse, podocyte proliferation, diffuse mesangial sclerosis, and podocyte maturation arrest. Mixed connective tissue disease (MCTD) is a disease with overlapping features of systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), and polymyositis. To our knowledge, there has been only one reported case of MCTD associated with CG and very limited data was presented with that case. Our patient is a 60yr old AA female who was diagnosed with MCTD on the basis of findings of polymyositis, Raynaud's phenomenon, arthritis, pulmonary hypertension, gastrointestinal dysmotility, and positive ANA and anti-ribonucleoprotein antibody tests. Her disease dates back to the 1980's, but was relatively well-controlled with the use of a variety of anti-inflammatory and cytotoxic agents. In early 2008 mild proteinuria was first noted. In February 2009, she was admitted to our institution with abdominal pain. During the admission she developed nephrotic range proteinuria, acute renal failure, and worsening Raynaudʼs phenomenon. A renal biopsy with three glomeruli per section showed prominent podocyte injury and hyperplasia with collapse of the underlying glomerular tuft, consistent with CG. There was also an acute tubulointerstitial nephritis and an arteriolar thrombotic microangiopathy. Immunofluorescent staining and EM showed no good evidence of an immune complex mediated process. HIV and parvovirus B19 serologies were negative. She was started on steroids and hemodialysis. She remained on dialysis for 4 weeks and then recovered renal function with her serum creatinine improving to 1.5mg% and her proteinuria decreasing to 1.3gm/day. In summary, MCTD is a rare connective tissue disease that tends to evolve over a period of years. Our patient had MCTD for many years and then developed an acute exacerbation of disease associated with finding of CG on renal biopsy. Our case represents the first biopsy proven well documented case of CG in a patient with MCTD. 123 ACUTE RENAL FAILURE SECONDARY TO CARBIDOPA/LEVODOPA INDUCED RETROPERITONEAL FIBROSIS Hemalatha Gutta , Jorge Lamarche, Alfredo Peguero, Craig Courville, University of South Florida and James A. Haley Veterans Hospital, Tampa, FL, USA Retroperitoneal Fibrosis (RF) is an uncommon but treatable cause of obstructive nephropathy. RF presents insidiously making the diagnosis difficult. Prompt diagnosis is essential in order to avoid sequelae such as ESRD. Dopamine agonists such as bromocriptine have been reported as having an association with developing RF. In the present report, a 59 y/o male with history of benign prostatic hypertrophy (BPH) was initiated on carbidopa/levodopa to treat restless leg syndrome. Four weeks after initiating treatment, the patient presented with testicular pain and low back pain of 2 weeks duration. The serum creatinine was 1.7 mg/dl. His baseline creatinine was 0.8 mg/dl. A renal ultrasound revealed bilateral hydronephrosis. He underwent a cytoscopy, which was normal, and discharged with a foley catheter as it was presumed his renal failure was secondary to BPH. One week later his serum creatinine was 10.8 mg/dl. A CT scan of the abdomen and pelvis revealed findings suggestive of RF. He was offered biopsy to rule out malignancy as a cause but he declined. Bilateral nephrostomy tubes (NT) were placed and oral prednisone was initiated. In 4 days his serum creatinine was 2.4 mg/dl. One year later the RF has almost completely regressed and his serum creatinine is 1.2 mg/dl.. To our knowledge this is the first reported case of a temporal association between carbidopa/levodopa and RF. 124 THE USE OF INTERNET AS A RESOURCE FOR HEALTH INFORMATION AMONG CKD PATIENTS: A CLINIC BASED STUDY Hooman Hajian , W Brian Reeves, Nasrollah Ghahramani. Penn State Hershey Medical Center, Hershey, PA, USA The Internet is rapidly changing the way patients access health- related information, learn about their illnesses, and make healthcare- related decisions. There is, however, very limited data regarding the use of Internet by Chronic Kidney Disease patients. This is particularly significant considering that this subset of patients may have different characteristics compared to the general patient population. We compiled a questionnaire to obtain demographic data, determine patientsʼ use of the Internet as a medical information resource, and to determine their experiences and perceptions of the quality and reliability of the information available online. The survey instrument consisted of 33 multiple-choice questions completed voluntarily and anonymously by patients visiting the outpatient nephrology clinic and dialysis center as well as the internal medicine clinic within a tertiary care center. Statistical analyses were performed using SAS software. A total of 350 questionnaires were completed by 63 internal medicine and 287 CKD patients. The median age in the CKD group was 64 (18- 91) compared to 50 (18-94) in the internal medicine (comparison) group. Over half of the CKD patients (56.55%) were retired and only 29% were in the active workforce, compared to 74.58% active workforce in the comparison group. 48.16% of the CKD group had education beyond high school, compared to 83.87% in the comparison group (p<.0001). 95.16% of the internal medicine group had access to Internet, compared to only 61.65% in the CKD group (p<.0001). 47.85% of the CKD patients, compared to 84.61% in the other group, had an annual household income of more than $50,000 (p<.0001). In conclusion, this analysis suggests significant differences between the majority of CKD patients and the general patient population. Several factors such as age, level of education, and socioeconomic status appear to contribute to these difference and limit the use of Internet as a viable resource by CKD patients. This is an area which clearly needs further exploration in an effort to make the Internet a better and more accessible resource for CKD patients. NKF 2010 Spring Clinical Meetings Abstracts A62