5^th Global Nephrologists Annual Meeting April 01-02, 2016 Valencia, Spain

Biography:

Joachim Struck has received his PhD in Biochemistry at the Free University Berlin and worked as Post-doctoral fellow at UMASS Amherst. He has more than 20 years experience in industrial Basic and Clinical Research in vitro diagnostics (IVDs) and is currently CRO at Sphingo Tec GmbH, a company developing innovative IVDs for improved management of acutely diseased patients and for risk prediction in non-hospitalized subjects. He has co-authored more than 150 papers in peer-reviewed journals and is co-inventor of numerous patents.

Abstract:

Enkephalins are well known as small, unstable endogenous opioid peptides. Their peripheral functions are largely unknown, not least due to the fact that their reliable measurement has not been possible so far. To overcome this problem we devised a simple immunoassay method to detect as surrogate marker a stable peptide (“penKid”), which is stoichiometrically generated from the same precursor peptide as the Enkepahlins. Reported high expression levels of both Enkephalins and their receptors in the kidney prompted us to investigate plasma levels of penKid in various clinical settings, where kidney function is impaired. In patients undergoing coronay artery bypass graft surgery (CABG) plasma penKid increased quickly, when patients developed acute kidney injury (AKI). A study employing several thousand patients in various acute disease settings (sepsis, acute myocardial infarction, acute heart failure) consistently revealed a strong correlation of plasma penKid with eGFR and showed that eGFR is the major determinant for penKid. Elevated plasma penKid also predicted developing AKI, use of renal replacement therapy (RRT) and mortality risk. Serial measurements demonstrated penKid to be a dynamic marker, as concentration changes over time improved outcome risk prediction. It is especially noteworthy that penKid levels – as opposed to other kidney biomarkers currently discussed – were not raised over healthy normal concentrations by systemic inflammation only, when kidney function was not impaired. This aspect along with the fact that penKid is determined from plasma (not urine) makes it an especially attractive novel kidney biomarker for use in critically ill patients.

Biography:

KvÄ›ta Bláhová is an Associate Professor in the Department of Pediatrics at Charles University and University Hospital Motol in Prague. She received many awards. She has membership in prestigious European societies. She has published numerous papers in reputed journals.

Abstract:

Chronic peritoneal dialysis (CPD) is the most common dialysis treatment modality used to treat pediatric patients with end-stage renal disease (ESRD), particularly in children less than five years of age. Advantages of CPD include a less restricted diet, treatment at home, no need for vascular access. Contraindications to CPD include specific conditions that affect the integrity of the abdominal cavity and peritoneum. Total number of patients on CPD in our center is 43 in the last 6 years (11 of them are currently active - 5 patients under 1 years of age, 8 patients under 5 years of age). The causes of kidney failure in our center include con-genital kidney anomalies 41.9%, glomerulopathies 32.6%, ischemia 7.0%, pyelonephritis/ interstitial nephritis 2.3%, other 14.3%, unknown 2.3%. CPD modalities are divided into manual and automated options. Continuous ambulatory PD (CAPD) is the manual form of CPD that provides continuous solute and fluid removal throughout the day and night. CAPD is usually used especially in small infants before reaching of sufficient volume for the function of cycler (fill volume >120-130 ml). Automated PD (APD) uses a cycler that performs mul-tiple exchanges at night. APD is used in all child patients at home (20 % with dry day - NIPD, 80 % with wet day - CCPD). The regime of CPD should be individualized to the pa-tient needs for solute transfer and removal of fluid. Main parameters of prescription are osmo-lality of the dialysis solution, fill volume, and number of exchanges. Peritoneal equilibration test (PET) should be performed in all children undergoing CPD to determine the solute trans-fer characteristics of the peritoneal membrane. Fill volume in our center is 792±220 ml/m2 (920±434 ml/m2 in control group - data from 204 centers from International Pediatric Dialysis Network database), total dialysate turnover 8832±4384 ml/m2/day (9299±4703 ml/m2/day in control group), average PD fluid glucose concentration is 1.9±0.4% (1.8±0.5% in control group). Urine output is <100 ml/m2/day in 20 % and 100-500 ml/m2/day in 40% of patients. Infectious complications of CPD include peritonitis and catheter exit site/ tunnel infections. We use a two-cuffed Tenckhoff catheter to reduce the risk of peritonitis and we recommend daily care of the exit site. The incidence of peritonitis was 1 episode of peritonitis every 91.7 months of therapy in our group of patients (34.9 months in the control group). Noninfectious complications are divided into several categories - mechanical complications due to increased intra-peritoneal pressure (hernia, fluid leak, hydrothorax), ultrafiltration failure due to rapid solute transfer/ increased lymphatic flow/ aquaporin deficiency, catheter-related complications (dialysate leakage, catheter dislocation, catheter occlusion), and nutritional and metabolic problems - protein loss, hyponatremia due to sodium loss and subsequent hypovolemia, renal osteopathy. Body mass index (BMI) at CPD initiation was -0.42±1.25 SD and -0.20 ±1.67 SD at last visit. 20% of our patients have percutaneous endoscopic gastrostomy (PEG). CPD is safe and effective method for treatment of ESRD in children of the lowest age groups. Our results are fully comparable with the data from foreign centers for PD. The most severe risk factors for mortality are pulmonary and cardiovascular diseases, infections and severe oliguria/ anuria.

Biography:

Bing He received his MD from Wuhan University School of Medicine, China and PhD from Karolinska Institute, Stockholm, Sweden. He is a senior researcher at Matrix Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Sweden. He has published more than 50 papers in the peer-reviewed scientific journals. His major research interests include molecular genetics of diabetic nephropathy, podocyte biology and molecular control of glomerular development.

Abstract:

Proteinuria usually indicates damage to the glomerular filtration barrier. Clinically, proteinuria is the hallmark of chronic kidney disease (CKD) leading to end-stage renal disease and is also an independent risk factor for cardiovascular disease. Glomerular podocytes play a central role in establishing and maintaining the complex cellular architecture of glomeruli. Dysfunction of podocytes contributes to development of CKD. To address the molecular basis of podocyte development and function, we first validated the phenotypic marker for zebra-fish pronephric podocyte injury by assessment of pericardial edema together with loss or decline of podocyte-specific GFP expression driven by the nphs2 promoter. Using this model, we further identified a podocyte-specific enhancer motif present in the nphs2 proximal promoter as well as its binding proteins. This finding allowed us to predict genome-wide a number of genes potentially co-expressed with Nphs2. Podocin encoded by Nphs2 is a key component of the slit diaphragm protein complex and is constitutively expressed in differentiated/mature podocytes. Accordingly, the predicted genes utilizing the same regulatory element as nphs2 are implicated in controlling podocyte differentiation and maintenance. Currently, four genes (Ccnc, Meis2, Ankrd6 and Slc16a9) have shown that their enhancer motifs predicted can drive reporter expression in zebrafish podocytes and their expression is detectable in mouse glomeruli. Ankrd6 is known to be involved in inhibition of Wnt/ß-catenin signaling, coincident with the absence of Wnt signaling in mature podocytes. Knockdown of zebra-fish homolog of Ankrd6 led to defect of glomerular development associated with up-regulation of active ß-catenin. The Wnt-dependent signaling inhibitor IWR suppressed increased Wnt signal activity in zebra-fish. These data suggest that Ankrd6 is required for podocyte terminal differentiation and maturation by silencing Wnt/ß-catenin signaling. Thus zebra-fish provides an excellent avenue towards revealing fundamental signal pathways controlling glomerular development and maintenance.

Biography:

Pearl Pai qualified from University of Aberdeen, UK and received her MD from the University of Liverpool. She is the Chief of Service (Department of Medicine) and Chief of Nephrologist at University of Hong Kong – Shenzhen Hospital, Guangdong, China. She is also the Honorary Clinical Associate Professor at the Department of Medicine, the University of Hong Kong. She was a NHS Consultant Physician and Nephrologist in Sunderland Royal Hospital and then Royal Liverpool University Hospital before she returned to Hong Kong in 2012.

Abstract:

In China, the vision and direction of the Hospital; the patients’ behavior; the way the Doctors practice and finally the management of the institutions are very different from the UK National Health Service. The University of Hong Kong – Shenzhen Hospital (HKU-SZH) is a new affiliated hospital of the HKU set in China. It is hoped that the Hospital will act as a forerunner of reform Hospital and bring China healthcare closer to international standard. An account about China healthcare, its insurance cover, the preferential reimbursement of hospital hemodialysis compared to peritoneal dialysis will be given. Nephrologists training and competency are very variable. Patients are short of accurate medical information. It is not uncommon for uremia patients to seek medical attention late. Traditional Chinese Medicine is the preferred choice. The Chinese dialysis standard of operation of procedure (SOP) based itself on international guideline such as the KDOQI yet there is insufficient pressure on its reinforcement. The objectives of the HKU-SZH emphasize in prevention, health promotion, high quality and safe service. In spite of some shortcomings, there are also some excellent examples of ingenuity and adaptability in our dialysis setting. It is only through education, promotion of mutual trust and respect and when the facts, differences and difficulties are understood that we could move forward. So far, our approaches as cited are working and yielding results and will be presented here.

Biography:

Dhanya Mohan currently works as Specialist Senior Registrar (Nephrology) at Dubai Hospital, Dubai Health Authority; UAE. She completed her Medical graduation from Christian Medical College, Vellore, India. She won many laurels including university medals and prizes and the ‘Best Outgoing Student’ award. She completed her Post-graduation in Internal Medicine from the same institute and won the B. Braun award instituted for outstanding performance. She went on to complete her MRCP (UK) and Specialty Certificate in Nephrology, her performance gaining her a special mention in the MRCP Annual Review 2010. Her areas of interest include chronic glomerulo-nephritis, peritoneal dialysis, kidney transplantation and medical education. With a keen interest in clinical research, she has publications in peer reviewed international journals. In addition, she is a tutor at the Dubai Medical College for Girls and enjoys teaching medical students.

Abstract:

Post transplant anemia is a common occurrence in kidney transplant recipients (KTRs). Common etiologies include ineffective erythropoietin, drug related erythroid suppression, iron deficiency and infections. Parvovirus B19 infection, though rare, needs to be always considered in the work up of chronic anemia in KTRs, especially in those patients with reticulocytopenia. A 36-year-old Arab male patient underwent living unrelated donor transplantation because of end-stage-renal disease resulting from diabetic nephropathy. He received induction therapy with anti-thymocyte globulin and maintenance with prednisolone, tacrolimus and mycophenolate mofetil (MMF). Allograft function was stable with serum creatinine around 1 mg/ dl. Eighteen months after transplantation, he was detected to have anemia and leucopenia (Hb: 7.3gm/ dl, WBC: 3500/ cc). Blood film revealed microcytosis. Bicytopenia was initially attributed to mycophenolate and the dosage was reduced. Over the next four months, he had recurrent admissions with severe anemia, requiring six units of packed red cell transfusion. Hemoglobin ranged from 4.6- 5.7 gm/ dl. Reticulocyte count varied from 0.41%- 2.22%. Folic acid and B12 levels were unrevealing. CMV DNA PCR was negative. The low reticulocyte count prompted us to consider pure red cell aplasia as a cause for the anemia. Further serologic evaluation was positive for anti parvovirus B19 Ig M, and PV B19 DNA PCR in blood was positive. He received five doses of intravenous immunoglobulin, 400mg/kg body weight daily. Dose of MMF was reduced and tacrolimus level maintained between 4-6 ng/ ml. Hemoglobin improved to 10.8 gm/ dl within a month, and has stabilized at 14 gm/ dl ever since. His clinical follow–up during the subsequent two years has not shown recurrence of anemia, though PV virus levels are just above detection threshold. Parvovirus B19 is a single stranded DNA virus, which has a pronounced tropism for erythroid precursor cells. PV B19 infection is a well-known cause of pure red cell aplasia and should be included in the workup of refractory anemia in KTRs, when more common causes have been excluded. Treatment includes reduction of immunosuppression and administration of intravenous immunoglobulin in severe cases.

Biography:

Hisham Hussein Imam, MD, obtained his primary medical qualification (MBBCH) from the Faculty of Medicine Ain Shams University, Egypt, with an Honor Degree in the year 1985. He obtained his Master and Doctorate Degrees from the Faculty of Medicine, Minia University, Egypt, in the years 1991 and 1995, respectively. He passed through the different grades of University teaching posts. He worked as Demonstrator, assistant Lecturer, Lecturer, assistant Professor and was appointed as Professor of Obstetrics & Gynecology at the Faculty of Medicine, Minia University, Egypt in the year 2005. He has very wide experience in all the aspects of women health both from academic and clinical perspectives. He has a lot of researches in the armamentarium of Obstetrics and Gynecology. He also supervised many candidates in their studies for Masters and Doctorates Degrees in the field of obstetrics and Gynecology. He has also special interest in Medical Education. He is an active member of many Scientific Societies and is a Referee and a peer reviewer for many nationally and internationally recognized scientific journals.

Abstract:

Recent advances in surgical techniques and immunosuppressive therapies allowed a marked increase in successful allogeneic organ transplantation in women. Kidney transplantation is the most frequently encountered transplanted organ. Since the first successful pregnancy in a renal transplantation recipient in 1958, thousands of patients have successful pregnancies after renal transplantation. In this article we will discuss the effect of pregnancy on the allograft function. We will address a discussion of the immunosuppressive agent and their use safety during pregnancy. We will also discuss the factors that affect the course of pregnancy and the co-morbid factors that influence the maternal and fetal outcome. Finally, we will go into a comprehensive discussion of the medical and obstetric management of pregnant women after renal transplantation and how to adequately monitor a woman who got pregnant after successful allogeneic renal transplantation.

Biography:

Khalid Bashar is a doctor at the department of Vascular Surgery in University Hospital Limerick, Ireland.

Abstract:

Introduction: With increasing number of patients diagnosed with ESRD, arterio-venous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death. Aim: Study of demographic factors implicated in the functional maturation of arterio-venous fistulas and also to explore any possible association between pre-operative haematological investigations and functional maturation. Methods: We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs and excluded those who underwent secondary procedures. Results: The overall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with non-maturation (P=0.004) and was the only predictor for non-maturation in a logistic regression model (P=0.011). Patients who had history of renal transplant (P=0.036), had relatively lower haemoglobin levels (P=0.01) or were on calcium channel blockers (P=0.001) showed better functional maturation rates. Conclusion: Female gender was found to be associated with functional non-maturation, while a history of kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

Biography:

Marwa Mounir Ismail graduated class 2008 from faculty of medicine, Alexandria University, Egypt. A master degree candidate. Working as a nephrologist in the Medical Research Institute, Alexandria University

Abstract:

Lupus nephritis develops in up to 75 % of SLE patients with 10 to 30 % progressing to ESRD. Urinary biomarkers to replace serial renal biopsies have been widely studied recently. Uromodulin, the most abundant urinary protein expressed exclusively by the TAL cells, showed its ability to elicit an inflammatory response and be a CKD biomarker. This study was conducted on 70 subjects divided as 23 SLE patients without LN, 27 SLE patients with LN and 20 control volunteers. Renal activity was assessed by SLICC Renal Activity score, positive anti-ds DNA and low complement levels. Urinary Uromodulin results showed lowest values among nephritis patients with mean 5.6 ± 3.4, followed by 9.9 ± 5.2 in SLE patients without nephritis and 12.9 ± 4.6 in the control group, with statistical significant difference (P <0.0001). Uromodulin also showed statistically significant positive correlation with eGFR (P = 0.03), while negative correlations were found with serum Creatinine, 24 hrs urinary proteins and SLICC renal activity score, with statistical significance (P = 0.001), (P = 0.000) and (P = 0.000) respectively. Thus, from the results of this study, we can conclude that decreasing urinary uromodulin levels can be a marker for renal activity in SLE patients, and a marker for CKD in absence of activity markers.

Biography:

Hartmut H J Schmidt has completed his MD from Medical University of Hannover in Germany. He received Post-doctoral training in Gastroenterology at Medical University of Hannover, NIH (Bethesda), Charité (Berlin) and Universitätsklinikum Münster. Since 2010, he serves as Director of Klinik für Transplantations medizin at Universitätsklinikum Münster. He has published more than 125 original articles.

Abstract:

Hepatitis C virus (HCV) is a common infection especially in the cohort of patients with renal failure. Due to new antiviral approaches and the approval of direct-acting antiviral agents (DAA), HCV therapy has become more comfortable. Nevertheless, there are special patient groups, in whom treatment of HCV is still challenging. Due to only few data available, tolerability and efficacy of DAAs in special patient cohorts still remain unclear. Such special patient cohorts comprise HCV in patients with decompensated liver disease (Child-Pugh Class B or C), patients with chronic kidney disease and patients on waiting lists for renal/liver transplantation or those with HCV recurrence after transplantation. HCV infection in transplant recipients has been shown to be associated with increased morbidity and mortality and reduced graft survival. Successful eradication of HCV results in a better outcome concerning liver-related complications and in a better clinical outcome of these patients. In this update, the current therapeutic HCV strategies in patients with GFR < 30 ml/min and in renal transplant recipients will be discussed, but also the role of anti-HCV positive donors.

Biography:

Ma. Eugenia Martínez is a doctoral candidate in Biochemical Engineering Sciences, focusing her thesis in Plant Biotechnology using Taraxacum as a scientific model for bioactives compounds recuperation and biomass valorization. She is currently working in the FP7 DISCO Project for bioactives production under "green chemistry" and further market commercialization

Abstract:

Currently, the most effective treatment for recurrent urinary tract infections in women is the use of antibiotics. However, limitation for this treatment is the duration and dosage of antibiotics and the resistance that bacteria develop after a long period of administration. Therefore, alternatives approaches need to be consider. The most common is the use traditional botanical remedies or preparations, in which the use of dandelion (Taraxacum sp.) has several references in treating bacterial infections. These properties have been attributed to the large number of bioactive compounds in their tissues, particularly triterpenes such as amyrin and lupeol, antioxidants and phenolics compounds. Antibacterial activity was evaluated in vitro by serial microdilution using a hexane extract from T. officinale leaves against Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis as uropathogens, showing 100% inhibition at 400 mg/L for E. coli and 1600 mg/L for the other tested strains. Phytochemical analysis of plant tissue grown in vitro revealed the presence α-amyrin and lupeol both in leaves and in callus cultures, which extract would be further tested in rats. These results corroborate the folkloric use is given to the use of dandelion against bacterial infections and suggest the potential of these compounds for its potential use in the pharmaceutical industry, related to the formulation of natural products associated with improving urinary tract diseases. On the other hand, it can set the groundwork for a potential production system of these compounds for medicinal purposes, using biotechnology techniques that stimulate the synthesis and accumulation of these triterpenes into the plant cell.

Biography:

Sevag Demirjian is the Director of Center for Critical Care Nephrology. He did his Residency in Internal Medicine and Nephrology at the Cleveland Clinic in 2004 and Internship, Cleveland Clinic in 2002. His current speciality interests are the Critical care nephrology, pre-operative risk assessment, continuous renal replacement therapy, acute kidney injury

Abstract:

Background: Hypophosphatemia is common in critically ill patients and has been associated with generalized muscle weakness, ventilatory failure and myocardial dysfunction. Continuous renal replacement therapy causes phosphate depletion, particularly with prolonged and intensive therapy. In a prospective observational cohort of critically ill patients with acute kidney injury (AKI), we examined the incidence of hypophosphatemia during dialysis, associated risk factors and its relationship with prolonged respiratory failure and 28-day mortality. Methods: This is a single-centre prospective observational study. Included in the study were 321 patients with AKI on continuous dialysis as initial treatment modality. Results: Four per cent of the patients had a phosphate level <2 mg/dL at initiation and 27% during dialysis. Low baseline phosphate was associated with older age, female gender, parenteral nutrition, vasopressor support, low calcium, and high urea, bilirubin and creatinine, whereas hypophosphatemia during dialysis correlated with the ischemic acute tubular necrosis etiology of renal failure, intensive dose and longer therapy. Serum phosphate decline during dialysis was associated with higher incidence of prolonged respiratory failure requiring tracheostomy [odds ratio (OR) =1.81; 95% confidence interval (CI) =1.07–3.08], but not 28-day mortality (OR =1.16; 95% CI =0.76–1.77) in multi-variable analysis. Conclusions: Hypophosphatemia occurs frequently during dialysis, particularly with long and intensive treatment. Decline in serum phosphate levels during dialysis is associated with higher incidence of prolonged respiratory failure requiring tracheostomy, but not 28-day mortality.

Biography:

Dr Helena Genberg is a staff member at the Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden since 2002. In 2008 she defended her PhD thesis ABO-incompatible kidney transplantation using antigen-specific immunodasoption and rituximab at the Karolinska Institutet. As specialist in Surgery, her clinical as well as scientific work is focused on kidney transplantation. Dr Genberg is the author of several publications on ABO-incompatible kidney transplantation and rituximab. She has also had a number of assignments as reviewer of scientific manuscripts and was one of the organizers of The First International Workshop on ABO-incompatible kidney transplantation in 2007. Dr Genberg is the Secretary of The Swedish Transplantation Society.

Abstract:

ABO-incompatible (ABOi) living donor (LD) kidney transplantation has gained widespread popularity over the past 15 years. Worldwide over 3000 ABOi LD kidney transplantations have been reported. In Stockholm a protocol for ABOi transplantation was introduced in 2001 based on antigen-specific immunoadsorption for the anti-A/B antibody removal and rituximab to prevent antibody rebound. Since then some 100 ABOi transplantations have been performed there. The results of these transplantations have been evaluated in several studies and shown to be comparable with ABO-compatible LD kidney transplantation short-term. Similar results have also been reported from other centers. However, there are reports of inferior graft survival long-term following ABOi LD kidney transplantation when compared with ABO-compatible (ABOc) LD kidney transplantation. Yet, for the ABOi LD kidney recipients an ABOc living donor is rarely available. The alternative to dialysis or ABOi transplantation, is instead to enter the waiting list to possibly receive a deceased donor ABOc organ. In a recent study we compared the long-term results of ABOi LD kidney transplantation with wait listing. In this study the 10-year patient survival was 93% for the ABOi kidney recipients, 86% for the ABOc LD kidney recipients and 74% for patients entering the waiting list, p (overall) = 0.000. In conclusion, we argue that, for patients in the need of a kidney transplant, ABOi LD kidney transplantation is safe and a superior alternative to deceased donor wait listing.

Biography:

Erman Alci is a doctor at the department of surgery in Manisa State Hospital. His skills and expertise in Kidney Transplantation, Transplantation, Organ Transplantation and Transplant Surgery. His current speciality interests are surgery, clinical immunology and Nephrology.

Abstract:

DJ stents play an important role in modern urology to prevent undesirable side effects after surgery. With this study, we aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, UTI, hematuria of the patients who underwent renal tx. Data of 354 patients who underwent renal tx. between 2008 and 2011 in Ege University were evaluated retrospectively. 331 patients were included in this study. The term DJ (-) represents patients in whom DJ stent was not placed. Primary DJ term represents patients that the DJ stent was placed during the first tx. Secondary DJ term represents the patients who had DJ after tx. due to any complication. 254 (76.7%) patients were in DJ (-) group, 52 (15,7%) were in primary DJ group and 25 (7,6%) were in secondary DJ group. There was significant differences between the groups in terms of Anastomosis type (p =, 000), stay in hospital time (p =, 000), surgical complication (p =, 000), reoperation (p =, 000), percutaneous nephrostomy(p =, 000), UTÄ° (p =, 000), first UTÄ° time (p =, 000), recurrent UTÄ° (p =, 000), positive hemoculture (p =, 000), hematuria (p =, 000), duration of dialysis before tx (p =, 000), live/deceased donor (p =, 000), DGF (p =, 009). Our choice is to use the DJ stent in selected high-risk patients, and to keep the indications of DJ stent wider in deceased donor transplants by considering possible surgical complications. Using stent only in selected cases will decrease surgical complications due to stent placement.

Biography:

Takkar obtained her Bachelor of medicine and surgery (MBBS) from Government medical college, Amritsar, India and moved to the United States for further education. She completed her residency in Internal medicine at University of Texas Medical Branch (UTMB) at Galveston, Texas and served as a chief resident thereafter for a year. She completed her nephrology fellowship training at UTMB, Galveston as well and currently is an Assistant Professor in Nephrology, Internal medicine at University of Texas Health Science Center San Antonio, Texas.

Abstract:

Calcific Uremic Arteriolopathy (CUA) or Calciphylaxis is a rare and frequently fatal, necrotizing skin condition, encountered mostly in patients with ESRD on dialysis. The pathologic hallmark of calciphylaxis is medial calcification, intimal fibroplasia and luminal thrombosis of cutaneous arterioles, leading to ischemic ulceration. Clinical manifestations may include nodules or plaques that often progress to ulceration, frequently complicated by sepsis and death. The term CUA has recently been proposed over calciphylaxis to more accurately reflect the pathophysiology of the disorder, however one must realize that this entity has also been reported, albeit rarely, in non –uremic patients, including those with primary hyperparathyroidism, alcoholic liver disease, malignancy and certain connective tissue disorders. The estimated prevalence of CUA in patients with ESRD is about 4%, with an annual incidence of about 1/1000 cases. The six month mortality may reach upto 80% and a multifaceted approach to treatment is warranted, with emphasis to wound and pain management, optimization of mineral and bone parameters and possible use of sodium thiosulfate.

Biography:

M Karavetian earned her PhD in “Health Promotion in Medical Sciences” from Maastricht University, Netherlands; and her dietetics degree from American University of Beirut, Lebanon. She has extensive experience in nutrition management of the chronically and critically ill; she shares her experience in conferences and workshops locally and regionally in the aim of improving health care. Her research is focused on finding effective strategies to change dietary behavior in chronically ill patients. Her publications focus on dietary management of hemodialysis patients and finding the optimal dietitian-to-patient ratio needed in the hemodialysis unit in the Arab world for optimal clinical outcomes.

Abstract:

The aim of this study was to assess the effect of intensive nutrition education by trained dedicated dietitians on osteodystrophy management among hemodialysis patients. This was done through a randomized controlled trial in 12 hospital-based hemodialysis units equally distributed over clusters 1 and 2. Cluster 1 patients were either assigned to usual care (n=96) or to individualized intensive staged-based nutrition education by a dedicated renal dietitian (n=88). Cluster 2 patients (n=210) received nutrition education from general hospital dietitians, educating their patients at their spare time from hospital duties. Main outcomes were: 1) dietary knowledge (%), 2) behavioral change, 3) serum phosphorus (mmol/L), each measured at T0 (baseline), T1 (post 6 month intervention) and T2 (post 6 month follow up). Analysis of results showed significant improvement only among patients receiving intensive education from a dedicated dietitian at T1; the change regressed at T2 without statistical significance: knowledge (T0: 40.3; T1: 64; T2: 63) and serum phosphorus (T0: 1.79; T1: 1.65; T2: 1.70); behavioral stages changed significantly throughout the study (T0: Preparation, T1: Action, T2: Preparation). In conclusion, the intensive protocol showed to be the most effective. Thus, integrating dedicated dietitians and stage-based education in hemodialysis units may improve the nutritional management of patients in Lebanon and countries with similar health care systems.

Biography:

Cristina Cacndido is a doctor at the department of Nephrology in Centro Hospitalar de Setúbal, Portugal.

Abstract:

Brachiocephalic arteriovenous fistula is the most commonly used and one of the favored hemodialysis access options. Often, these fistulas are associated with drainage disfunction in the Cephalic arch. This terminal portion of the cephalic vein is a frequent site for the development of stenosis. Various strategies have been applied to manage the stenosis, although, in some cases, it is not possible to intervene and access failure occurs. Cephalic vein transposition (CVT) to basilic vein is an alternative approach rarely described in literature for treatment of cephalic arch occlusive lesions. We report two haemodialysis patients, a 41 year-old woman and a 91 year-old man, with brachiocephalic fistula created 18 and 36 months ago respectively, that developed cephalic arch stenosis. In both cases the possibility of endovascular treatment was excluded, and surgical treatment was selected through CVT to basilica vein. In the first case, the access remains patent up to present day (6 months after CVT). In the second case, 9 months after surgical revision, a stenosis occurred close to the re-anastomosis and was treated by percutaneous balloon angioplasty, remaining patent also up to present day (12 months after CVT). The purpose of our study is to demonstrate an alternative approach for preserving brachiocephalic fistula with cephalic arch occlusive lesions. These results might encourage surgeons and nephrologists in Portugal to consider this strategy as a viable option.

Biography:

Anupma Kaul is a doctor at the department of Nephrology in Gandhi Postgraduate Institute of Medical Sciences, India. She has published 6 articles about kidney diseases.

Abstract:

Cytomegalovirus (CMV) and BK polyoma virus (BKV) are common infections in which the one acquires infection in childhood which becomes latent. Reactivation of both these viruses can occur in immunosuppressed states, such as renal transplantation, and can rarely result in virus-associated tubulointerstitial nephritis in renal allografts. The clinical picture can mimic, co-exist with or precipitate the rejection process. There is paucity of data comparing outcomes of renal transplant recipients with these viruses. We compared outcomes in patients with renal biopsy proven viral cytopathies. Method and Material: All patients are taken from in patients department of nephrology of a tertiary care teaching hospital in India. All those renal biopsy reports which are reported or suspicious as viral cytopathic changes in kidney were isolated. These biopsies were further examined by two independent renal histopathologist from our institute. They were classified on three groups: CMV viral cytopathic changes, BKV associated viral cytopathic changes and CMV-BKV co-infection associated viral cytopathic changes. Diagnoses were further confirmed with PCR technology in either serum or urine or both. All 20 patients were categorized in 3 groups: 10 in CMV only, 4 in BKV only and 6 were in CMV-BKV co-infection. Results: Out of 20 patients, 16 were male. Mean age is 37.95±11.09 years. Thirteen patients had chronic glomerulonephritis as basic disease, while chronic interstitial nephritis and diabetic nephropathy were basic disease in 2 each. One patient each had Henoch scholein purpura, hypertensive nephropathy and Ig A nephropathy as basic disease. In eight cases, donors 8 were parents (mother in 7 ), 5 were siblings (sister in 3) and 7 spousal ( wife in 5). One patient each had received ATG and Basiliximab as induction while 18 had no induction. All patients received triple drug immunosuppression, 9 received Tacrolimus, mycophenolate and prednisolone, another 9 received Cyclosporine, mycophenolate and prednisolone and 2 patients were started on cyclosporine, Azathioprine and prednisolone. Mean duration of graft survival was 62.70±30.78 months. In CMV subgroup mean graft survival was 65.40±25.25 months while in BKV subgroup was 61±46.46 months and in CMV and BKV co infection mean survival was 59.33±33.56 months. These are statistically not significant. At the end study period 10(50%) died. Conclusion: Cytomegalovirus and BK Virus infection are important infection in post renal transplant recipients. They can result in virus-associated tubulointerstitial nephritis and can mimic, co-exist or precipitate the rejection process. Although their co-infection is not common but they can co-exist. However their co-infection cannot change the graft survival and difference in not significant.

Biography:

Tanita Thaweethamcharoen obtained the Bachelor of Pharmacy and Bachelor of Public Administration Program in Public Administration, Master degree in the field of community pharmacy. She has completed her doctoral degree in the field of social and pharmacy administration program from Chulalongkorn University. She is the pharmacist and health economist of Siriraj Health Policy Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University. She has published more than 10 papers in the international journals. She also has been serving as the reviewer board member of repute in research center of Mahidol University, Thailand and international journal. She is the first hospital pharmacist in Thailand who received the best poster presentation award from ISPOR in the ISPOR 4th Asia-Pacific Conference, 2010. She also received the Routine to Research (R2R) award and Lean R2R award of Thailand for two consecutive years (2013 and 2014). She is the lecturer and keynote speaker about the cost effective in health care, research methodology in routine to research project, quality of life in chronic kidney disease patient for the student and health personnel in many institutes such as Chulalongkorn University, Mahidol University, Siam University, Infectious Disease Association of Thailand, The Association of Hospital Pharmacy (Thailand), School of Pharmacy Institute Technology Bandung (ITB), Bandung, Indonesia.

Abstract:

Siriraj Hospital is the first university hospital in Thailand, with its vision to be the medical institute with international excellence in education, patient care, and research. Having about 2,100 inpatient beds, provides services to 80,000 admissions and over 3 million outpatients annually. Many health technology is offered to the hospital but the resource is limited thus Economic evaluation is an important tool involving examines consequences of the health care technology and evidence-based medicine in the hospital and societal perspective for policy decision. Economic evaluation research is one of the tools which impacts on decision making of treatments for individual patients because the result of the research concern both clinical outcome and ability to afford in the hospital or societal perspective. The results of the analysis can be a part of the process for the government decision, deciding whether drugs should be subsidized by the government, developing the intervention base on the cost effectiveness. The principles of economic evaluation and health technology assessment are the new challenge which can be applied to the processes as well as to improve patient care and will be useful in the overall movement towards the governance health care system. Role of the health care personnel cannot concern only the clinical outcome but healthcare expenditures also the important topic which are concerned so both of the effective and the expenditure should be considered. Our study start from the high expenditure of injectable drug; erythropoietin. Trend of Erythropoietin (EPO) expenditure was increasing between 2006 and 2009 and the highest expenditures for injectable drugs in 2009 of the large university hospital in Thailand. The major group of patient who use the erythropoietin is chronic kidney disease (CKD). CKD is the important chronic disease and the high expenditure in Thailand especially dialysis patient. Many tools of utility or the disease specific quality of life measurement were developed and applied in cost utility analysis to estimate the utility score and link to the QALYs which is one of the outcomes of the study. The results of the assessment since 2010 until the present are the evidence for many nephrologists and the Nephrology Society of Thailand to prioritize the health technology for health problem resolution and lead to an optimal care of people as well as good academic mission are challenge.

Biography:

Agnieszka Pozdzik has completed her medical study from University School of Medicine (Lublin, Poland) and has completed a PhD from Université Libre de Bruxelles (Brussels, Belgique). She is a nephrologist and Associate Professor at the Department of Nephrology. Since October 2012, she is the manager of the "Biobank of chronic kidney disease and urinary tract" (MARENVU) and, since June 2012, of the multidisciplinary center of nephrolithiasis. She has published more than 20 research papers in reputed journals and has been serving as a reviewer of repute journals

Abstract:

Tubulointerstitial nephritis (TIN) is a manifestation of IgG4-related diseases, which arecharacterized by infiltration of target organs by IgG4+ plasma cells and severe fibrosis. Cortico-sensitivity is one of the diagnostic criteria, but the treatment of steroid resistant and dependent forms is not well defined. We present a case of a 47-years-old patient with IgG4-related NTI followed for 72 months. He complained of fatigue and recurrent postprandial abdominal pain. With the exception of elevated levels of gamma-glutamyl transferase (GGT), transaminases and IgG4, kidney function remained normal (serum creatinine ≤ 0.9 mg/dL). After 2 cures of methylprednisolone (2010-11) azathioprine was associated in 2012. Due to the corticodependence and persistence of bilateral focal renal lesions detected by diffusion-weighted magnetic resonance imaging (DW-MRI), Rituximab (RTX) was given (2 × 376 mg/m²/15 days) in 2013. Before the first injection, positron emission tomography (PET) showed metabolic hyperactivity corresponding to axillary and abdominal aorta lymph nodes but not in the kidney. After 4 months of RTX, the patient became asymptomatic. All biological alterations disappeared. PET showed a decrease in metabolic activity at extrarenal lesions described above. A dramatic regression of bilateral renal lesions was noted by DW-MRI: the apparent diffusion coefficient had almost doubled (0.776 vs 1.111x10-3 mm²/sec) and the volume of renal lesions was reduced by 50%, which was never observed under other treatments. Our observations demonstrate: (1) the clinical, biological and radiological efficacy of rituximab in a steroid-dependent form of IgG4- related TIN and (2) the interest of DW-MRI as a non-nephrotoxic radiological and PET complementary approach not only in monitoring the effectiveness of immunosuppression but also in the early detection of renal involvement during IgG4 related disease.

Biography:

Abstract:

Background: Although conventional chest radiograph remains the first routine radiologic examination in mechanically ventilated patients, chest ultrasound provides more accurate information, with less ionizing radiation and less time delay. Objective: To compare between sensitivity of chest ultrasound and routine daily chest X- ray in diagnosis and follow up of diseases in mechanically ventilated patients admitted at Respiratory ICU of Ain Shams University Hospital. Design: The study was carried out as a prospective analytical study. Patients and methods: The study was conducted upon twenty five mechanically ventilated patients( 16 male patients and 9 female patients ) , with mean of age 58.8 years (SD ± 15.64 ) who were admitted at the Respiratory Intensive Care Unit of Ain Shams University Hospital during the period from October 2012 till May 2013. Chest ultrasound examination was done for patients on mechanical ventilation on first day of enrollment prior to seeing their chest X-ray, then follow up daily chest ultrasound examination was done all over the period of mechanical ventilation with comparison of examination results with that of chest X- ray. Results: Initial chest ultrasound was more sensitive in detection of pleural effusion (40% of cases) than chest X-ray (8% of cases). This superiority of chest ultrasound over chest X-ray persisted in follow up studies (44%, 8% respectively).As regards consolidation, there was no statistically significant difference between chest ultrasound (consolidation was detected in 16 out of 25 cases ) and chest X-ray ( consolidation was detected in 15 out of 25 cases) at the initial studies , and also along the follow up period ,chest ultrasound detected consolidation in17/25 patients, while CXR detected consolidation in 18/25 patients. In the follow up of five mechanically ventilated patients with no obvious radiologic abnormalities on chest X-ray, initial and follow-up ultrasound was also free and detected no localized abnormality. There was statistically significant relationship between chest ultrasound findings in cases with pleural effusion and in cases with consolidation and clinical progress. Conclusion: Chest ultrasound is a reliable tool for evaluation of mechanically ventilated patients.

Biography:

Veena Joshi (M.Sc; Ph.D) has completed her education in India. She has over 25 years of experience in Epidemiology and social research at Ministry of Health in Singapore and various hospitals in India. She has published several papers in reputed journals and has been serving as reviewer board member of repute.

Abstract:

Aim of the study was to conduct a systematic review to summarize the outcome of renal transplantation in adult patients with history of DM [DMRTx] in 1.DMRTx , 2. type 2 DMRTx 3.DM and type 2 DM in comparisons with Non-DMRTx, 4. Type2DMRTx vs dialysis and 5. Preemptive Kidney Transplant (prekTx) vs non prekTx. MEDLINE, EMBASE, Renal transplant registries were searched for observational / cohort/ case-control studies from 1980 to 2014. Type2DM compared to DM studies recruited fewer (<100) and older(>50 years) patients. We identified 22 studies reporting survival after RTx [in DM (1),DM vs Non-DM (10), Type DM (2), Type2DM vs Non-DM (6), Type2DMRTx vs Dialysis (1), PreKTx vs Non PreKTx (2)]. 16, 7, 12, and 3 single center studies showed 1,3, 5 and 10 year patient survival respectively. Seven studies in DM group have reported 5 yr graft and patient survival where one study showed graft survival was significantly (p<.05)better in Non-DM group compared to DM group. Patient survival did not differ. Among five type2DM studies, one and three studies showed graft and patient survival in non-DM to be significantly (p<.05) better than type2DM group. 5 yr survival after RTx was significantly (p=.001) better in RTx patients compared to patients on dialysis. At 10 year, patient survival of non-DM was significantly better than DM or type2DM and survival of preemptive was similar to non-preemptive (p<.05). There is an urgent need for multi-center studies with prediabetes, especially type2DM patients to look at long term survival after renal transplant.

Biography:

Phuong-Thu Pham is Professor of Medicine and Director of Outpatient Services of the Kidney Transplant Program at UCLA Medical Center. Her major areas of interest and research include recurrence of glomerular diseases following primary kidney transplantation, new onset diabetes after transplantation, BK virus screening and management after kidney transplantation, the link between hypomagnesemia and renal function decline in patients with diabetes mellitus type 2 as well as in recipients of kidney transplant, and acute and chronic kidney injury following liver transplantation. Her interests in these topics have resulted in publications in well-known Nephrology textbooks and journals as well as invitations to speak at both national and international meetings. She has written over thirty book chapters for major Nephrology and solid organ transplantation textbooks including Comprehensive Clinical Nephrology, Textbook of Organ Transplantation, Transplantation of the Liver, Pancreas, islet, and stem cell transplantation for diabetes, Chronic Kidney Disease: Dialysis and Transplantation, and Handbook of Kidney Transplantation. She has also served as moderator for transplant-related conferences at the American Society of Nephrology and World Congress of Nephrology, editorial board member for the Case Reports in Nephrology and Transplantation Technologies and Research journals, and member of the organizing committee for the International Conference on Nephrology and Therapeutics.

Abstract:

Over the past two decades, while the proportion of failed kidney transplant patients returning to dialysis has remained stable and comprises of 4- 5% of all incident dialysis patients in the United States, the absolute number of patients reinitiating dialysis after a failed transplant has more than doubled. More importantly, the United States Renal Data System (USRDS) database revealed a greater than 3-fold increase in the annual adjusted mortality rates for patients returning to dialysis after graft loss compared with those with a functioning graft (9.4% vs. 2.8%, respectively). The Canadian Organ Replacement Registry database similarly demonstrated a greater than 3-fold increase in the risk of death among patients with a failed allograft compared with those with a functioning graft. Continuation of low-dose immunosuppression to maintain residual allograft function has been suggested as a contributing factor, presumably via treatment-related infectious and cardiovascular complications, among others. In contrast, a survival advantage in maintaining patients on long-term immunosuppression has been suggested among those returning to peritoneal dialysis. Whether early versus late reinitiation of dialysis or whether allograft nephrectomy has an impact on patient survival remains poorly defined. Despite the significant number of patients requiring reinitiation of some form of renal replacement therapy after a failed transplant and the increasing evidence suggesting their high mortality and morbidity rates, management of the failed allograft in these patients has received little attention. An overview of the literature on the management of immunosuppression after allograft failure, the ideal timing of dialysis reinitiation, a review on the pros and cons of allograft nephrectomy, and the author' perspectives on the management of this special patient population are presented.