Biography:

Karin Janssen van Doorn has completed her PhD in Medicical Sciences at the University of Antwerp and Brussels (Belgium) and has a Master’s in Ethics. She has 20 years of clinical experience in Nephrology, with special interest in Acute Kidney Injury and Intensive Care. T present, she is Clinical Assessor for the Belgian Federal Agency for Medicines and Health Products. She has published more than 20 papers in reputed journals and is an alternate member of the Scientific Advisory Working Party of the European Medicines Agency in London. 

Abstract:

Sepsis has been found to be a leading contributing factor in acute kidney injury (AKI) during critical illness. In patients with sepsis, prerenal factors significantly contribute to AKI. Despite optimal hemodynamic monitoring, rapid hemodynamic resuscitation and intravascular volume restoration, certain patients remain hypotensive. We examined the impact of hypotension on the evolution of AKI in septic patients. Therefore, we focused on the role of hypotension as the principal objective and examined: 1) The influence of hypotension during sepsis, 2) the influence of proven sepsis to failure and 3) the influence of hypotension on the evolution to failure. Patients were divided into four groups based on their RIFLE classification on the day of positive blood stream infection (BSI) detection. Between all groups, there was no difference in the delay of antibiotic treatment, episodes of septic shock or the total number of days in septic shock. In total, 75% of the study population evolved to AKI during their ICU stay and most patients evolved to failure. There was no significant difference between patients with Gram-positive or -negative infection in the occurrence of hypotension, the duration of hypotension or the number of periods of hypotension. After BSI, the probability for a patient to be in failure is significantly higher than before BSI (OR=1.94, p=0.0276). Patients have a significantly higher risk of evolving to failure if the duration of severe hypotension is longer (OR=1.02 for 10 minutes increase in duration of hypotension is, p=0.0472). In our population of septic patients, a cut-off of at least 51 minutes of severe hypotension (<65 mmHg (sens=0.55, spec=0.68)) or at least 5.5 periods of severe hypotension within 1 day was determined to identify patients with increased risk of evolving to failure. This study underscores the observation that low mean arterial pressure levels are associated with a higher incidence of AKI in septic patients.

Biography:

Sandeep Sahu has done his MBBS in 2001 and Post-graduation (MD) in Anaesthesiology in 2005 from MLB Medical College, Jhansi, India. He is working as Additional Professor and Consultant in Transplant Anaesthesiology and Critical Care at Department of Anaesthesiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India since 2009. He had published more than 50 papers in reputed journals and has been serving as an Editorial Board Member of reputed journals.

Abstract:

Background & Aim: Transesophageal Doppler (TED)-guided intraoperative fluid therapy has shown to noninvasively optimize intravascular volume and reduce postoperative morbidity. The aim of this study was to compare the effects of Doppler-guided intraoperative fluid administration and central venous pressure (CVP)-guided fluid therapy on renal allograft outcome and postoperative complications.

Material & Methods: A prospective nonrandomized active controlled study was conducted on end-stage renal disease patients scheduled for living donor renal transplant surgery. 110 patients received intraoperative fluid guided by corrected flow time (FTc) and variation in stroke volume values obtained by continuous TED monitoring. Data of 104 patients in whom intraoperative fluid administration was guided by CVP values were retrospectively obtained for a control.

Results: The amount of intraoperative fluid given in the study group (12.20±2.24 ml/kg/h) was significantly lower than in the controls (22.21±4.67 ml/kg/h). The amount of colloid used was also significantly less and fewer recipients were seen to require colloid (69 vs. 85%). The mean arterial pressures were comparable throughout. CVP reached was 7.18±3.17 mmHg in the study group. It was significantly higher in the controls (13.42±3.12 mmHg). The postoperative graft function and rate of dysfunction were comparable. Side-effects like postoperative dyspnoea (4.8 vs. 0%) and tissue edema (9.6 vs. 2.7%) were higher in the controls.

Conclusion: FTc-guided intraoperative fluid therapy achieved the same rate of immediate graft function as CVP-guided fluid therapy but used a significantly less amount of fluid. The incidence of postoperative complications related to fluid overload was also reduced. The use of TED may replace invasive central line insertions in the future.

Biography:

Kenrick Berend completed his studies to become an internist at the University of Utrecht, the Netherlands. He is working in Curaçao at the Department of Nephrology and Internal Medicine in the St. Elisabeth Hospital Curaçao and the Curaçao Dialysis Centre. He wrote a dissertation on subacute aluminium intoxication in haemodialysis patients in 2003. He published several papers on different subjects, including those on hypertension, acid-base and haemodialysis. His main research area is acid-base disturbances and he authored the guideline on this subject for all hospitals in the Netherlands in a chapter in a booklet on acute internal medicine problems and among others a review in the New England Journal of Medicine. He gave lectures on acid-base disturbances in several places, including the General Massachusetts Hospital in Boston, several university hospitals in the Netherlands and at conferences in the USA, China, the Netherlands, St. Maarten and Curaçao. He also has trained numerous medical students and residents from the Netherlands. 

Abstract:

The study of chloride channels of membranes has seen an explosion of interest recently and exciting developments have sparked renewed interest in this field. In contrast, despite the prominent concentration of chloride in serum, textbooks in general do not allocate chapters exclusively on chloride or hypochloremia and hyperchloremia. Although chloride was the first electrolyte to be easily measured, its importance always has been overshadowed by other major serum electrolytes, seemingly serving as a sort of appendix of sodium or potassium or just a stand-in for bicarbonate. Chloride is responsible for about 100 of the 300 mosm/L of extracellular fluid tonicity and for two-thirds of all negative charges in plasma. To maintain acid–base balance, chloride has an inverse relationship with bicarbonate, which is part of the major chemical buffering system responsible for maintaining a normal pH when bicarbonate is lost by the kidneys or the intestines. Chloride and bicarbonate shift into and out of erythrocytes and tubuli to maintain acid–base balance. Because of its high concentration, chloride is the most important anion to maintain the balance of extracellular cations and anions to ensure electrical neutrality as the number of anions and cations in body fluids must always be equal. The high intracellular [Cl⁻] in erythrocytes allows chloride to move in and out of the red blood cells very effectively, as dictated by electrical charges on either side of the cell membrane. This important difference from other cells is the basis of the so-called “chloride-shift” with the movement of chloride from the plasma into erythrocytes as blood moves from the arterial to the venous end of systemic capillaries. The Donnan ratio represents the behaviour of charged particles near a semi-permeable membrane with imbalanced distribution across the two sides of the membrane. Since most of the CO₂ carried by the blood is in the form of HCO3⁻, the chloride shift is important because it enhances the carrying capacity of the blood for HCO3⁻. A major role of the chloride shift is therefore mitigation of the change in pH that occurs during gas transport. The chloride concentration is primarily regulated by the gastrointestinal tract and the kidneys. Chloride channels are expressed along the entire mammalian nephron. They participate in transepithelial chloride transport, cell volume regulation and acidification of intracellular vesicles. Abnormal chloride levels alone usually signify a more serious underlying metabolic disorder, such as metabolic acidosis or alkalosis. Abnormalities in chloride channel expression and function in many organs can cause a wide range of disorders. Chloride also is an irreplaceable component of diagnostic tests in many clinical situations.

Biography:

Hala Kandil is a Consultant Microbiologist at West Hertfordshire Hospitals NHS Trust, UK. She graduated from Medical School, University of Alexandria, Egypt. She began her career in Immunology and obtained MSc, MD and PhD in Clinical Immunology from Imperial College, London University in 2004. After 10 years’ career in Immunology, she received her Microbiology specialist training at Royal Free London NHS Foundation Trust and obtained her MSc in 2009 in Microbiology from Queen Mary University and FRCPath in Medical Microbiology and Virology in 2010, Royal College of Pathologist, UK. She was appointed as Microbiology Consultant at Royal Free London NHS Foundation Trsut then at East and North Hertfordshire NHS Trust, where she was the Lead of Microbiology service provision for the Nephrology departments. She also has interest in diabetic foot infections, outpatient antimicrobial therapy (OPAT) and antimicrobial stewardship. She is currently the Antimicrobial and OPAT Lead and the Lead of Diabetic Foot Infections at West Hertfordshire Hospitals NHS Trust.

Abstract:

For many years, resistance profiles for many of the Gram-negative pathogens were relatively stable. However, the past few decades have seen a significant global upsurge in antimicrobial resistance particularly among Enterobacteriaceae. Worldwide, the prevalence of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae is increasing, and these organisms are frequently resistant to many other key antibiotics such as fluoroquinolones and aminoglycosides. Carbapenem-producing Gram negative bacteria are an emerging threat, leaving few treatment options. UTIs are among the most common types of infections in urology practice, with approximately 150–250 million cases globally per year. Owing to their high prevalence, UTIs are a major contributor to global antibiotic use and resistance. Increasing antimicrobial resistance represents a challenge to urologic practice and without effective antibiotics active against common uropathogens, many urologic procedures would carry excessive risk. Although new antiobiotics with activity against Gram-negative bacteria, including activity against strains with highly resistant phenotypes, are now available and some more might be available in the near future, they are likely to be used as last resort, owing to their high cost. Furthermore, it is unlikely that any single agent would be effective against the great diversity of resistance we are currently facing. This presentation will summarise the mechanisms of resistance, the current European resistance trends of Gram-negative uropathogens, examine the effect of resistance on common urology procedures, and discuss key antibiotic options in the era of resistance.

Biography:

Kallol Bhattacharjee obtained his MBBS degree from Guwahati University, Guwahati, Assam, India and completed his Master’s in Internal Medicine in 1990. He has been working in the Department of Medicine in Silchar Medical College and Hospital, Silchar, Assam, India in various capacities since 1992 and presently working as Associate Professor of the department, Incharge of the Medical ICU and Deputy Superintendent of the hospital. He has published approximately 20 research papers in various national and international journals and in January 2017, he was conferred a Fellowship by the Indian College of Physicians, the academic wing of the Association of Physicians of India. 

Abstract:

Approximately 40% of world’s population lives in areas where malaria is endemic mainly in tropical and sub tropical regions. World Health Organization (WHO) estimated a staggering figure of 214 million new cases of malaria in 2015 with an estimated death of 438,000 worldwide, majority of which occurred in African countries. Acute kidney injury (AKI) is fairly common, and serious complications are seen in acute falciparum malaria in adults. Malaria associated kidney disease (MAKI) is defined as “An abrupt decline in renal function in a patient who is suffering from acute malaria within 48 hours of onset characterized by an elevation of serum creatinine >0.3 mg/dl or elevation of creatinine level by >50% and/or oliguria with urine output <0.5 ml/kg/hr in >6 hours.” Incidence of AKI varies from 0.4-60% and is due to the variation in age, immunity status and locality. Complications are caused by interaction of the parasite with the host resulting in mechanical, immunological and humoral responses. MAKI is a result of combinations of two processes - cytoadherance and cytokines. Parasite containing RBCs express a protein called ‘variant surface antigen’ (VSA) on their surface. These RBCs attach to vascular endothelium using VSA and sequestration of the same into glomerular and tubulo-interstitial capillaries may cause AKI. Cytokines cause an increase in nitric oxide in the vessels or facilitate mitochondrial shutdown thereby leading to generalized arterial vasodilatation, increased permeability, increased interstitial volume, renal vasoconstriction with retention of Na⁺ and H₂O, tissue hypoxia and thereby leading to glomerular injury. The vulnerable groups of patient include the pregnant women, high parasitemia, jaundice, prolonged dehydration and those on NSAID therapy. Two subsets of population – AKI occurring as a component of multi organ dysfunction (MOD) or AKI as a sole complication of malaria appearing at a later stage when other components have subsided or treated or did not appear. The later bears a better prognosis. Urine output is usually <400 ml/day and may persist for 3-10 days. Cerebral malaria is associated with AKI in 30% of cases and worsens the prognosis. MAKI usually resolves in days to weeks, do not progress to chronic kidney disease (CKD) or acute tubular necrosis (ATN) and mortality ranges from 15 to 50%. Anti-malarials, fluid management, treatment and prevention of complications and dialysis are the mainstay of treatment. Early initiation of dialysis has proven mortality benefit. 

Biography:

Kiatkriangkrai Koyratkoson graduated with Doctor of Pharmacy (PharmD) from Chiang Mai University (CMU), Thailand in 2016. At present, he works as a Lecturer in Department of Pharmaceutical Care, Faculty of Pharmacy, CMU. He has been working in research focusing on patient-reported outcomes (PROs), medication effectiveness and safety. He is a part of a research group “The Thai Renal Outcomes Research (THOR) Investigators” which receive funding from Health Systems Research Institute of Thailand (HSRI) and National Research Council of Thailand (NRCT). He has experience of sharing his work in both national and international conferences and published several papers in well-known international journals.

Abstract:

Depression and mortality association is well recognized. However, studies regarding the link between depression and mortality among peritoneal dialysis (PD) are scarce. A prospective single cohort study was conducted, involving adults treated with PD within Kidney Center, General Hospital, Chiang Mai, Thailand between 15 May 2012 and 31 December 2014, and followed until 31 December 2016. Presence of depression was reported a Beck Depression Inventory (BDI) II score ≥ 14 at baseline. A sensitivity analysis was evaluated using a BDI-II threshold ≥ 20. Data on sociodemographics and risk factors for mortality were collected. Risk for all-cause mortality, CV mortality, and CV hospitalization were estimated using the multivariable Cox proportional hazards regression. 409 participants (mean age of 59.3±12.4 years, 56.0% men) were included. Of those, 117 (28.6%) reported BDI-II score ≥ 14. During the median follow-up period of 20.8 months (10,023 person-months), 139 died, of 50 were attributable to CV death. Depression were associated with all-cause mortality (adjusted hazard ratio, 2.54 [95% confidence interval, 1.87-3.64; P<0.001]), CV mortality (3.36 [1.43-7.87; P=0.005]), and CV hospitalization (2.96 [1.67-5.26; P<0.001]). For sensitivity analysis, a higher BDI-II score (≥20) were associated with all-cause mortality (3.28 [1.71-6.30; P<0.001]) and CV mortality (3.80 [1.98-7.29; P<0.001]), but not CV hospitalization (1.26 [0.48-3.30; P=0.630]). Depression is associated with a substantially increased risk of death and adverse CV outcomes in PD patients. Further studies are needed to determine whether the interventions to alleviate these symptoms would alter adverse clinical outcomes, including mortality.

Biography:

Salil Jain completed his Medical graduation from University of Mumbai and has done Clinical fellowship in Adult Nephrology from University of Toronto as well. He has interest in kidney transplant and is actively involved in live, deceased, ABO incompatible and high immunological risk transplants. Presently, he is working as Additional Director in Department of Nephrology and Renal Transplant at Fortis Memorial Research Institute, Gurgaon, India.

Abstract:

Kidney transplantation is treatment of choice for advanced chronic kidney disease patients as it gives better quality and quantity of life as compared to dialysis. The morbidity and mortality secondary to infections after transplantation is determined by various factors which include age, pre-existing chronic diseases, living versus diseased graft, induction and degree of immunosuppression, nutritional and socio-economic status. Newer immunosuppressive drugs including induction agents have resulted in better graft and hence better patient survival. The main drawback however is the risk of infections. In India around 50% of the recipients have mortality secondary to infection. Urinary tract infection (UTI), tuberculosis, CMV, Hepatitis C and B were the most common infections encountered previously. With better immunization (Hepatitis B), prophylactic drugs (CMV) and treatment (Hepatitis C) their incidence have come down considerably. The spectrum has changed now to more of viral and fungal infections. BK virus, Herpes, EBV, parvo virus, nocardiosis, pneumocystis and fungal infections are being detected more frequently. It is essential for all physicians to be aware of this new trend and to be more suspicious of these infections in transplant recipients so that an early diagnosis and treatment can be initiated which translates into a better survival. There are very few studies about the infectious complications from India. Hence, we conducted this retrospective data analysis to dertermine the etiology of infections in single tertiary care center in India.

Biography:

M Hoshyarikhani is currently a 5^th year Medical student (of 6-year education) at Belarusian State Medical University. He had 5 international publications in fields of Pediatrics Nephrology and Cardiology, Neurology and Dermatology. He has interests in different fields like Medicine, Pediatrics Nephrology and Cardiology. He is also interested in Pediatrics Neurosurgery, Radiology, Research and Laboratory Studies.

Abstract:

Introduction: Despite the significant progress achieved in the treatment and outcome of children with renal involvement due to systemic diseases (lupus, vasculitis), many questions remain in the early detection of cardiovascular complications, the leading cause of death in these patients in adulthood.

Aim: This study is contributed to find out the risk of developing cardiovascular disease (CVD) in patients with lupus nephritis (LN), IgA Henoch-Schonlein purpura nephritis (HSPN) and ANCA-associated nephritis.

Materials: 49 children were enrolled in the study: 24 with lupus (2 boys, 7-17 years, median age 13.8), 21 with HSPN (10 boys, 3-17 yrs, median 10.5) and 4 with ANCA nephritis (2 boys, 7-17 yrs, median 11.8). All patients had morphological verification of the disease. As a control group 37 healthy children were examined. 24 hours monitoring of blood pressure (BP), ECHO-CG, carotid intima media thickness (cIMT), left ventricles mass index (LVMI), relative thickness of left ventricles wall (RTLV), body mass index (BMI), serum lipids levels, serum glucose, serum uric acid, eGFR and markers of vascular endothelial dysfunction VEGF and TGF1β were measured.

Results: Arterial hypertension was observed in 35/49 (72%) of children with glomerular diseases. In 21/24 of patients with LN (88%), in 100% of ANCA nephritis and 10/21 HSPN (48%), required of an average 3 hypotensive drugs. Dilatations of the LV in 24%, reduced ejection fraction in 2.1% of all patients were seen. LVMI, RTLV, BMI and cIMT were higher compared with healthy (p<0.05). In patients with nephritis concentration of serum VEGF and TGF1β correlated with AG. The mean serum cholesterol level was 5.8 mmol/l in LN, 6.94 in ANCA nephritis and 5.16 in patients with HSPN (p<0.05), lipoproteins of low and very low density prevailed. The mean serum glucose level was not significantly higher than in healthy, in contrast to the level of uric acid (p<0.05), especially in patients with ANCA nephritis (p<0.01).

Conclusions: In patients with LN, HSPN and ANCA-associated nephritis abnormalities in serum lipids level were correlated with disease activity and duration, younger age of diagnosis, mean cIMT, eGFR, increased systolic and diastolic BP, BMI, LVMI, RTLV, concentration of VEGF and TGF1β. Such patients are at high risk of early development of cardiovascular complications requiring early correction.

Biography:

Yu-Jun Chang completed her PhD from China Medical University. She is a Senior Research Fellow of Epidemiology and Biostatistics Center of Changhua Christian Hospital. She has published more than 75 papers in reputed journals and is serving as the Lead Guest Editor of the special issue “Cardiovascular Emergencies” of BioMed Research International.

Abstract:

Nocturnal enuresis is a common disorder that affects the social life and mental health of a child. The objective of this study was to understand the remission rates, shifts in treatment methods used by parents and parents’ attitudes towards their children with primary nocturnal enuresis. A total of 408 children aged 6-12 years, diagnosed with primary nocturnal enuresis from a 2004 epidemiological study in Taiwan, were enrolled in this follow-up study. After a 5.5 year follow-up period, the remission rates of the children of each age group were evaluated, and the corresponding treatment methods were employed daily. Furthermore, the major risk factors that influenced the remission rates in these children were investigated. The overall remission rate was 93.1% among all age groups and the median age of remission was 9.9 years (95% C.I. = 9.5-10.2 years). The most common coping strategy was limiting water intake before sleep (42.3%). However, if enuresis continued to worsen as their children mature, parents will consider medical intervention. A Cox proportional hazards regression model revealed that girls, young children, those with fewer instances of bed-wetting, and light sleepers had higher remission rates than those of their counterparts. Children who were deep sleepers or affected by severe enuresis had a low probability of achieving dryness. However, girls and young children had a higher probability of achieving remission than their counterparts.