Biography:

Abstract:

Objective

This study aimed at evaluating the prevalence and clinical characteristics of Saudi dialysis patients with a positive family history of kidney disease and to compare these to those without a family history of kidney disease.

Secondary objectives were to assess the certainty of the diagnoses of causes CKD among the patients by their physicians

Methods & Material

This is a cross-sectional survey based study on adult Saudi patients on hemodialysis in six dialysis centers in four Saudi cities.

The survey had two parts. The first part (filled by the physicians of the patient) asked about the patient’s sex, age, dialysis vintage, CKD vintage, cause of the renal failure and whether the diagnosis is definitive or speculative. The second part (filled by the patients) asked about the presence of kidney disease among first degree relatives ( history of CKD, urinary abnormality and/or is or having been on dialysis.

Results

1080 patients were included, 55.4% males. The Mean age was 56.1±20 years and the mean dialysis vintage was 5.7±5.9 years and the mean time between diagnosis of CKD and onset of dialysis was 3.0±5.6 years 

Table 1 shows the causes of the CKD as determined by the patients’ physician and whether this diagnosis is “definitive” or “speculative”. Of all the diagnoses given, 57.8% were either “unknown” (33%) or only “speculative (25.3%).  In those with a diagnostic label, the diagnosis was thought to be definitive in only 62.2% of the cases’”.(Table 1).

 21.5% had first-degree relatives with kidney disease with no significant difference cities. There were more patients with “unknown” or “hypertensive” diagnosis among patients with FH of kidney than in those without (p=007 and 0.005 respectively). No differences were observed when the cause was DN or GN.

No significant difference in the prevalence FH was seen by age (p=0.5). Dialysis vintage was significantly shorter (p=0.03) and CKD vintage was significantly longer  (p=0.0001) in the patients with FH  (table 2)

Table 1 The causes of the CKD as determined by the patients’ physician and whether this diagnosis is “definitive” or “speculative”.

Table 2 comparing some patient characteristics between those with and those without FH of kidney diseases

Conclusion

More patients with “unknown” or “hypertensive” diagnostic labels were seen in patients with FH but not when the causes of the patients were DN or GN  This suggests that under the umbrella of “unknown” or “hypertensive” diagnostic labels, a number of genetically-based kidney diseases might well be concealed. The dialysis vintage was significantly shorter and CKD vintage was significantly longer in the patients with FH.

Biography:

Dr Ronald Chong was born in Trinidad, West Indies and graduated from the University of the West Indies with his MBBS in 2008. He went on to obtain his MRCP(UK) in 2013 and decided to explore The asian medical world. He entered the SingHealth Internal Medicine Residency Program, Singapore from 2016 to 2019 and then joined the National Health Group Advanced Internal Medicine Senior Residency Program, Singapore in July 2019.

Abstract:

Acute glomerulonephritis due to anti-GBM antibody disease is rare, estimated to occur in fewer than one case per million population. Patients usually present with acute renal failure with urinalysis showing proteinuria not in nephrotic range and a nephritic sediment characterized by dysmorphic red cells.

Systemic signs and signs, such as malaise, weight loss, fever, or arthralgia, are typically absent.

In this case study, a 38yo Chinese woman presented to us with a cough and fever for 3 months with a background history of treated latent pulmonary tuberculosis 2 years ago.

Positive findings for her on examination were fever with cough and sputum, weightloss of 5 kg and basic blood screening, she had iron deficiency anemia of haemoglobin 7.1, renal impairment(Cr194umol/L) and ESR >140 Sputum for acid fast bacilli, bronchoscopy, bone marrow aspirate and biopsy, ultrasound abdomen, auto immune screening were all negative including ANA, DsDNA, C3,c4,ANCA. Her anti GBM antibody was negative. Renal biopsy showed necrotizing and crescentic glomerulonephritis with inconclusive immunofluorescence studies.

Subsequent anti MPO and anti-GBM ELIZA was positive

She was subsequently treated with High dose IV methylprednisolone and plasma exchange which showed resolution of her persistent fevers and improvement in her renal function.

Biography:

Sanae ezzaki graduated from the University of Medicine and Pharmacy of Rabat, Morocco (2016). She is currently resident in nephrology hemodialysis at the ibn rochd university and hospital center in Casablanca, Morocco. Dr. Ezzaki was currently following a clinical research pathway with numerous abstracts and case presentations while practicing as a resident physician. She has participated in national and international conferences on nephrology

Abstract:

Abstract

Introduction:

In Morocco, there is a big disparity between donation needs and the number of available grafts. This is partly due to families refusing to take the organs of their loved ones diagnosed with brain death and largely to the lack of knowledge about organ donation and transplantation. In this regard, we conducted a survey of a representative sample of the Moroccan population with the objective of assessing the perception of citizens about organ donation in Morocco.

Materials and methods:

We conducted a survey of 1000 Moroccan citizens through a questionnaire launched on social networks to assess their knowledge, attitudes and beliefs about organ donation.

We also sought to know the reasons for refusal and those of acceptance to donate their own organs and those of their relatives following a brain death.

Results:

One hundred percent of the subjects surveyed responded to this questionnaire. Of those surveyed, two-thirds were female. The average age was 27 years old. Among the 1000 participants, 90.4% knew organ donation in Morocco. Half with a value of 51.9% think that religion is in favor of giving. The majority agreed to give their organs after death with a value of 87.4%. Among the group refusing the donation of their organs after brain death the lack of confidence in the procedure of the donation process comes at the top of the list with a value of 43.3%. Moreover, only 65.8% would be able to donate organs of their loved one after brain death. Among the group of investigations refusing the donation of the organs of their relatives, the ignorance of the will of the deceased comes in first with a value of 65,1%. Regarding the legislation 66.9% of our participants are unaware of the potential of donors, 70.7% are aware of the register of donors. Finally, only 39.1% intend to register their acceptance in the register of donors.

Conclusion:

Young Moroccans have limited knowledge relating to organ donation. The development of this therapy needs to establish an adequate project of information and motivation of general population.

Biography:

I.Failal is serving at an esteemed position in Service de néphrologie, hémodialyse et transplantation rénale CHU Ibn Rochd. Casablanca. Maroc. He is the recipient of numerous awards for his expert research works in related fields. His research interests reflect in his wide range of publications in various national and international journals.

Abstract:

Introduction:

Viral hepatitis B and C has been one of the perilous problems in chronic hemodialysis (HDC). It is a serious public health issue in this population due to its high prevalence and risk of becoming a chronic disease and developing cirrhosis and hepatocellular carcinoma.

The objective: This study is aimed to determine the seroprevalence of HCV, potential risk factors and the effectiveness of anti-viral treatment in chronic hemodialysis patients in 14 different centers of hemodialysis in the region of Casablanca Settat.

Patients and Methods:

A retrospective study conducted from October 1 st 2016 to September 30th 2017, including 1406 patients with chronic hemodialysis.

Results:

In the light of the serological survey, the prevalence of antibodies against HCV positive is 6.4%, and that of HBs antigen is 0.88%.

In patients infected with HCV, the average age is 52.11 ± 14.4 years, with a slight predominance of men.  The most dominant genotypes are G1 in 47.3% and G2 in 49.1%. The median duration of hemodialysis is 8 years.

There is no significant difference between HCV+ and HCV- patients’ age, sex, transfusion and the number of packed red blood cells In addition to that, the median duration in hemodialysis  as well as the number of attended hemodialysis centers are significantly higher in the HCV + group (P <0.01). While no risk factor has been implicated in hepatitis B infection (P = NS).

17 patients in our series were treated for viral hepatitis C. 7 of them had received a treatment based on the association “sofosbuvir 400 mg/j” and “daclatasvir 60 mg/j”. SVR at 12 weeks after discontinuation of treatment was obtained in 100% of cases. Tolerance was very good.

Conclusion: The seroprevalence of HCV in Moroccan hemodialysis is gradually decreasing, and the factor of transfusion is incriminated and gradually loses its importance. However, seniority in hemodialysis and the number of hemodialysis centers attended seem to be a factor favoring the Adherence to hygiene measures and the rigorous application of prevention recommendations against HCV transmission could further improve the prevalence of hepatitis C in dialysis units

Biography:

Abstract:

Introduction: Chronic kidney disease (CKD) has become a global public health threat. The irreversible nature of the disease, its association with significant morbidity and mortality as well as the cost of renal replacement therapy leads to a large burden for health care providers, particularly in developing countries like Egypt.

Objective: to find a non-invasive method to evaluate association of serum visfatin with chronic kidney disease secondary to diabetic nephropathy and compare to patients with chronic kidney disease secondary to other causes.

Methods: Ninety individuals including 30 healthy controls and 60 patients of CKD were included in this study. Patients with CKD were further grouped based on etiology of CKD into 30 diabetic patients and 30 non-diabetic patients. Patients with type 1 diabetes mellitus, urinary tract infection, urolithiasis, liver cirrhosis, stroke, ischemic heart disease, and rheumatoid arthritis were excluded. Measurement of serum visfatin was done through ELISA Kit (Elabscience pharmaceuticals).

Results: Visfatin concentration was significantly high in patients with CKD compared to controls (p < 0 .001). No significant difference in Visfatin concentrations between patients of CKD with and without diabetes was detected (p > 0.05). Visfatin concentration was significantly high in patients with CKD stage 2 compared to CKD stage 1 (p < 0 .001).

Conclusion: The present study confirms the association of visfatin with CKD, however further studies at molecular level to check its expression within renal tissue may clarify its definitive role in CKD.

Biography:

Abstract:

Introduction:  Delays in AV fistula (AVF) maturation cause increased costs. Poor arm veins delay phlebotomy procedures.  Early use of non-invasive devices may help assist clinical AVF maturation and vein dilation.

Method:  One week after AVF creation, a novel compression device [Fist Assist (FA)] was applied 15 cm proximal to the AVF in order to apply intermittent, cyclic compression for 60 mm Hg for six hours daily for 30 days. Forty (n=46) AVF patients were enrolled in an IRB approved study to test vein maturation at baseline and with the FA. Controls (n=17) used a sham device. Vein size was measured and recorded at baseline and after 30 days by duplex measurement. Clinical results (percentage increase) were recorded and tested for significance using standard t-tests.

Results:  No patients experienced immediate thrombosis or adverse effects. After one month, the mean percentage increase in vein diameter in the FA treatment group for all fistulas was significantly larger (p=0.05) than controls in the first 5 mm segment of the AVF vein . Forearm AVF veins dilated in all segments of the veins compared to upper arm veins. No fistulas had complications on dialysis or after needle placement.

Discussion: Vein enlargement and dilation occurred with intermittent pneumatic compression in a home environment. Patients tolerated the device and it worked with no reported complications leading to commercialization.

Conclusion:  Early application of an intermittent pneumatic compression device may assist in AVF maturation and success. FA may assist in forearm vein dilation and may provide the first wearable for the renal community to assist in AVF dilation and superficial arm vein enhancement.

Biography:

Abstract:

Change in the rate of blood toxic substances have made dialysis as the best treatment method for patients with renal failure. Changing in the structure and geometry of dialyzer hollow fibers, blood and dialysate flow rate can help optimization of dialysis operations and control of prevention of filtration of large molecular weight minerals.

In this study, filtration of substances with different molecular weights were simulated in a polyflux 210H dialysis hollow fiber with three-layer membrane. Momentum equations were used to obtain dialysate and blood flow parameters like velocity and pressure at pulsatile flow. Dialysis membrane was simulated as porous region by Using Darcy model afterward mass transfer equations were employed for determination of toxins concentration in the blood side and dialysis fluid side. Finally, these groups of the equations were solved in COMSOL 5.2a software as coupled and then the concentration values were explored.

In the oscillatory flow, increased blood flow rate was effective in filtration of all molecules with low molecular weight; however, it didn’t cause decreased filtration in the molecules with high molecular weight. Hence with increase of the blood flow rate from 200 to 400 ml/min filtration of urea increased by 33.83 %, but albumin decreased by 17.28.

Change in the thickness of blood adjacent layer in the three-layer membrane had insignificant effect on the minerals filtration, so that increase of the diameter from 8 to 10  caused was decreased filtration of substances with different molecular weights.

Biography:

Dr. Culpepper is Professor of Medicine at the University of South Alabama School of Medicine, past Director of the Division of Nephrology and has served  on the Board of Directors of the National Kidney Foundation and Network 8 of the ESRD surveillance organization. He has published works in renal physiology and clinical nephrology.

Abstract:

Hyperkalemia occurs with intense exercise in individuals with normal renal function. Exercise is deemed beneficial to patients on hemodialysis to forestall frailty and  improve overall well-being. We examined the magnitude of rise in serum [K+], any accompanying electrocardiographic effects and hemodynamics in functionally anephric hemodialysis patients subject to brief, exhaustive exercise. The time course of changes in [K+] in both venous blood and arterial blood were charted and correlated  to changes in arterial pH, blood glucose, blood glucose, serum [Na+] and hematocrit. The study was approved  by the Committee for Protection  of Human Subjects andl participants gave their written informed consent. None of the subjects has known active cardiac disease and none were taking β-adrenergic blocking agents, digitalis preparations or potassium sparing drugs.   Arterial [K+] peaked at 3.5 minutes with a mean  rise of 1.67 mEq/L. Venous [K+] peaked  about 1 minute earlier, averaging 0.84 mEq/L increase yielding a mean A-V difference in [K+] of 0.81 mEq/L. All values returned to baseline within 3 minutes of rest. There were significant falls in arterial pH averaging  -0.15u and rises in serum lactate with a mean increase of 8.14 mmol/L at 5 minutes. Changes in serum glucose, insulin, serum [Na+] and hematocrit were insignificant throughout the study. We conclude that  resting skeletal muscle buffers rises in exercise-induced hyperkalemia in hemodialysis patients as has seen in normal persons.

Biography:

Abstract:

Introduction:

The early detection of the skeletal metastasis is very important and necessary for the optimal treatment and accurate staging of the stage of cancer. Wilms tumor is considered as the second most common pediatric solid tumor and is found to be one of the most common renal tumour found in the infants and young children (Uslu et al, 2015). The role of imaging is one of the primary ways to evaluate plan the intervention for a metastatic disease. The majority of the renal tumours arises from the mesodermal precursors of the renal parenchyma, which are also known as metaphors and are responsible for the cause of atleast 90 % of the paediatric renal tumours.

Purpose:

            Skeletal scintigraphy (Davila, Antoniou and Chaudhry, 2015) assists in diagnosing and testing a range of skeleton diseases and disorders using tiny amounts of radioactive isotopes called radiotracers that are inserted into the bloodstream. The radiotracer passes via the area getting investigated and delivers radiation in the range of gamma rays and a special gamma camera and a device is kept to track and create images of ones's bones. As it can detect molecular movement within the body, skeletal scintigraphy provides the ability in its earliest stages to recognize pathology. The paper below discusses and reviews the benefit of using a radiotracer, which helps in the better and swift detection of bone metastases in renal carcinomas occurring in the children.

Methodology:

            Positron emission tomography (PET) has developed among the most effective scanning modalities for staging, re-staging, identifying reoccurrence and/or metastasis and tracking therapeutic action in most malignant diseases. Most widely utilized in PET imaging is 18F-fluoro-2-deoxy-2-d-glucose (FDG), a non-radiotracer with a chemical composition close to that of naturally occurring glucose. FDG reaches the cells via the same glucose-membrane proteins used by alcohol, usually overexpressed in cancer cells. FDG imaging (Takahashi et al, 2015) depends on Warburg's finding that enhanced glycolysis of adenosine triphosphate is needed to meet the metabolic requirements of progressively dividing tumor cells. Membrane glucose transporters, primarily GLUT-1, successfully transmit FDG to the cell where hexokinase transforms it to FDG-6-phosphate. As FDG-6-phosphate is not a medium for further measures in glycolysis, it is stuck in the cell and builds up the glucose metabolic activity significantly. Metabolic quantitation by measuring SUV on FDG PET / CT may play a significant role in assessing lesion biological activity and predicting the prognosis of patients. A total of 60 tests were conducted in patients with bone metastases in renal carcinoma using 18F-FDG-PET / CT within a five-year span. Such patients were 15 baby boys and 15 baby girls aged 6 months to 12 years of age were found either a conservative approach to treatment or progressive surgery. A longitudinal review of the prospectively collected data was carried out about the therapeutic approach choice and the patients ' future fate. From the judgment regarding the type of treatment the patients were tracked for at least 12 months. Mortality was tracked across the entire group, conservatively handled in subsets of surgically treated babies and the patients. The study of the relationship between the average 18F-FDG accumulation and survival was undertaken, as well as the correlation between the 18F-FDG deposition amount and the histological tumor rating.

Results:

In addition to metabolic activity and general morphological improvements, the vascular system was also assessed using multiplanar reconstructions (MPR) and thickness reconstructions with the assistance of maximum strength projection (MIP), with an emphasis on blood flow to the kidneys, as well as pathophysiological adjustments in the blood vessels linked to the tumor. The existence of arteriovenous malformation was assessed, as well as occurrence of a nodular or diffuse tumor hypervascularization and the possibility of tumor entry into the renal vein or vena cava is also checked. Overall mortality exceeded 46.7%, the largest (18) F-FDG concentration revealed a grade 4 tumor (mean SUV(max)=10.7, range=5-23), the maximum mortality rate for tumors above the SUV(max) value was reported to be 10 (mortality 62.5%). In 85 per cent of cases, new knowledge was provided by (18)F-FDG-PET / CT.

Table 1: patients sample description, treatment and 12 months mortality

Table 2: 18 F-FDG SUV_max and twelve months mortality, showing the benefit of using radiotracer.

Conclusion:

            As per certain findings 18F-FDG-PET / CT in renal carcinoma, where local or usually advanced cancer is presumed, is also considered as an examination which assists in making decisions about the therapy strategy. This enables both a clinical prognosis and a more specific removal of neoplastic distribution. Realizing 18F-FDG-PET / CT with automated and fully-diagnostic two-phase CT-angiography is a necessary condition for obtaining the advantages of this test.

Biography:

Abstract:

Aim: Anemia is a common sequealae of chronic kidney disease (CKD), associated with significant morbidity. The study was conducted to know hematological manifestations in patients of Chronic Kidney Disease admitted to Dept of Nephrology and organ transplantation , Sharda superspecialtly hospital, delhi ncr

Material & Methods: Renal diseases are associated with a variety of hematological changes, and anemia is the most predominant feature   . 55 patients with Chronic Kidney Disease admitted in Nephrology Unit were studied. All patients were subjected to all routine investigations including Complete Blood Count, Blood Sugar, RFT & electrolytes and other relevant tests.

Results:

• Mean Age of the patients was 49.5 + 8.5 years.
• 69.3% patients were males and 30.7% patients were females.
• As per the WHO criteria for anemia grading , following are the anemia with severity graging in ckd patients

• Stage wise distribution of patients in stage I, II, IIIa,111b, IV, and V was nil, 3.6%, 3.6%, 1.8%, 9.09%& 81.1% respectively
• Ckd stage from stage 2 to 3b ,patients had mild anemia and from ckd stage 4 to 5 patients have moderate to life threatening anemia .( as per WHO grading).

• Among patients with Hemoglobin > 11 gm/dl, % 3.6were diabetic and 7.2% were non diabetic.
• Normocytic, normochromic anemia was the most common abnormality and was found in 65% of patients having Hemoglobin < 10 gm/dl.
• Microcytic Hypochromic anemia was found in 30% of patients and rest patients had normocytic, hypochromic anemia.

Conclusion:

• Hemoglobin level drops with increasing stages of ckd.
• Higher proportion of diabetic patients was found in the group having hemoglobin less than 11 gm/dl.
• Maximum number of patients was in mild grading of anemia in our study.
• Most of the patients having moderate to severe anemia were in ckd stage 5 as per our study.
• Normocytic, Normochromic Anemia was the most common peripheral smear finding among Chronic Kidney Disease patients.