12^th Global Nephrologists Annual Meeting June 26-28, 2017 London, UK

Ming-Yuh Shiau has completed his PhD from Chung Shan Medical University. He is an Associate Professor and Chairman of Division of Basic Medical Sciences at Department of Nursing, College of Medicine & Nursing, Hungkuang University, Taiwan. He has published more than 34 papers in reputed journals and has been serving as an Editorial Board Member of Case Reports in Immunology.

Enhanced production of collagen, mediated by matrix metalloproteinases (MMPs), is a key event in the development of diabetic glomerular extracellular matrix (ECM) abnormalities. The MMP- mediated ECM alterations are also required for the processes of adipose tissue expansion which requires the differentiation and transformation of pre-adipocytes into mature adipocytes. Nevertheless, the pre-adipocytes behaviors, and their possible roles in energy homeostasis have long been overlooked. The present study aimed at examining the cross talk among glucose, insulin and interleukin-4 (IL-4) on regulating MMP-2 expression and activity in 3T3-L1 pre-adipocytes. Our results revealed that glucose level is a pre-requisite for pre-adipocytes responding to insulin and/or IL-4 treatment. In high glucose-containing environment, short-term acute insulin treatment (AI) and long-term chronic insulin exposure (CI) showed opposite regulation to MMP-2 expression and activity. Interestingly, the dominant MMP-2 regulatory role of CI under euglycemic condition was attenuated in cells exposed to high glucose concentration. It indicates that chronic insulin exposure has dominant effects on modulating MMP-2 and possibly the ECM remodeling under hyperglycemic state. This finding raises the possibility that continuous insulin injection, required for patients suffering from T1DM and T2DM with long duration, is likely to potentiate the onset of diabetic complications by causing ECM remodeling through MMP-2 alterations once their insulin treatment is not properly monitored. The present study uncovers novel observations regarding pre- adipocytes behaviors and suggests their roles in the process of increased adiposity and diabetic complications.

Edwin Rodríguez-Cruz has completed Doctorate degree from the San Juan Bautista School of Medicine PR. he specializes in Internal Medicine & Pediatrics. He completed Pediatric Cardiology fellowship and sub-fellowship in Interventional Cardiology from the Children's Hospital of Michigan. Currently is the Director of Cardiology of the San Jorge Children's Hospital, and Associate Professor of Medicine and Pediatrics at the San Juan Bautista School of Medicine, PR, USA. Has published over 20 articles in peer review journals and many specialty opinions by editors' request. His interests are in the areas of heart failure, structural heart diseases, and difficult venous accesses. Special interest in chronic total venous occlusions (CTVO).

Renal arteries obstructions are not common in the pediatric population. That is the reason why they are a great challenge for their diagnosis and treatment for the clinician when they present. The case of an 8 y/o female who presented with severe arterial hypertension is discussed. Initially, the patient was evaluated and up to 5 antihypertensive medications were started. After complete evaluation, she was found to have severe right renal artery's ostial and proximal stenosis. For these, she underwent recurrent angioplasties and then a bare metal stent (BMS) implantation, due to recurrence of the stenosis. Later the BMS developed a circumferential fracture, so, another stent was implanted. But the second stent used was a drug eluting stent (DES). Since the last intervention she has been stable for 8 years, although, on 2 antihypertensive medications. Renal artery stenosis is rare in the pediatric population. Angioplasty and surgery have been used to treat it. Stent implantation has been used more often in adults for its treatment, too. The use of BMS and DES may add another tool in the armamentarium of the pediatric interventionist to treat these children with recurrent stenosis that fail to angioplasty.

Dr. Zaher Armaly Clinical Lecturer in the Faculty of Medicine, Bar Ilan University has been a member of the Faculty since 2009. He received his MD degree from Padua, Italy in 1989. After a one-year Medical Training in Nahariya Medical Center, he moved to Rambam Medical Center for Residency & Specialization in Internal Medicine and subsequently sub-specialization in nephrology and hypertension. Since 2003 he serves as Director of the department of Nephrology and Hypertension at Nazareth Hospital, Nazareth, Israel. Dr. Armaly has received several awards for his research and clinical activity including Dangur Family Award from Bar Ilan University. Dr. Armaly has over 30 original publications in peer review journals and text books. Besides his recent and past achievements in research, he had excellent achievements as a lecturer, expressed by a wide variety of prizes that he received for (constantly) excellence in teaching including the best Bar Ilan Lecturer Award. Dr. Armaly had also worked as a supervisor for a broad range of talented graduate and undergraduate students in the Faculty of Medicine and Nazareth Hospital. Dr. Armaly has extensive experience in Nephrology research. His main interest is anemia and the impact of carnitine on iron-induced oxidative stress in CKD patients. Over the last 10 years his group has been studying the pathophysiology of inflammation and oxidative stress following IV iron administration. In addition, Dr. Armaly research focuses on contrast-induced nephropathy and novel therapeutic approaches to this common disease state. Finally, Dr. Armaly studies the incidence of depression in ESRD patients on hemodialysis and peritoneal dialysis and the factors underlying this phenomenon.

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis, with high incidence of progression to end-stage renal disease ESRD. Although the pace of decline in kidney function in IgAN is affected by proteinuria, hypertension and decreased estimated glomerular filtration rate (eGFR) at the time of diagnosis, exact mechanisms underlying the pace of deterioration is still largely unknown. In recent years, the role of genetic risk factors in pathogenesis of IgAN is being elucidated by genome-wide association studies, with multiple risk alleles has been described. However, the impact of haptoglobin (Hp) genotype on the progression of IgAN was not studied yet. Therefore, the current study examines whether Hp genotype influences disease progression and response to treatment. Methods: The present study included 28 patients with IgAN (mean age of 42.5±2.5 years), 26 non-IgAN chronic kidney disease (CKD), 54 patients on hemodialysis, and 150 healthy subjects. Blood and urine samples were collected at baseline and 6 months after initiation therapy. Serum creatinine (SCr) and total proteinuria were determined in all IgAN patients. Blood analysis for Hp genotype was performed for all patients and healthy controls. Results: 29% of IgAN patients were Hp 1-1, 36% Hp 2-1, and 36% Hp 2-2. In contrast, in patients with non-IgAN chronic kidney disease, the prevalence of Hp 1-1, Hp 2-1, and Hp 2-2 was 8%, 19%, and 73%, respectively. In hemodialytic patients, prevalence of Hp 1-1, Hp 2-1, and Hp 2-2 was 19%, 28%, and 54%, respectively. In healthy subjects, the distribution of Hp 1-1, Hp 2-1, and Hp 2-2 was 7%, 39%, and 54%, respectively. Interestingly, IgAN Hp 2-2 patients were more stable and responded better to treatment with routine therapy (RAS or inhibitors steroid) than other Hp genotype. Conclusions: Hp 1-1 genotype is more common in IgAN patients as compared to the general population in Israel and even more than CK patients and subjects on HD. Patients with Hp 2-2 responded better to appropriate therapy. The mechanisms underlying this phenomenon remain to be explored.

M Karavetian earned her PhD in Health Promotion 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 patients. She shares her experience in conferences and workshops locally and regionally in the aim of training health care professionals for better health care. She also is trained and specialized in health care quality (setting policies and procedures and training staff on the new set of rules in health care settings). Her research is focused on identifying 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. She has shared her experience in national and international conferences. She currently is an Assistant Professor in the Department of Natural Sciences in Public Health, College of Sustainable Sciences and Humanities, Zayed University, Dubai.

We assessed the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients. 545 prevalent patients were allocated to DD, trained hospital dietitian (THD) and existing practice (EP) groups. During Phase I (6 months), DD (n=116) received intensive education by DD trained on renal nutrition; THD (n=299) received usual care from trained hospital dietitians; EP (n=130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months). At baseline, EP had the lowest weekly hemodialysis time and DD had the highest mean serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD:$76.7,$21,007.7; EP:$4.6,$18,675.4; THD:$17.4,$20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and highest mean decrease in costs (DD:-$2,364.0; EP:-$1,727.7; THD:-$1,105.7). At endline, DD experienced the greatest mean decrease in adjusted serum phosphorus (DD:-0.32; EP:+0.16; THD:+0.04 mg/dL), no difference in quality-adjusted-life-years (QALY), and highest costs. DD protocol had a cost-effectiveness ratio of $7,853.6/mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key outcomes. DD yielded the greatest effectiveness and decrease in costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP but had a low probability of being cost-effective compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing DD’s long-term cost-effectiveness, on similar groups, is recommended.