Day 1 :
- Kidney Diseases | Pediatric Nephrology | Dialysis | Hypertension
Hasselt University, Belgium
Objectives – Low systolic blood pressure (BP) and fluid overload (FO) are associated with the highest mortality risk in haemodialysis (HD) patients, however only assessed during the peridialytic period. The aim of this study was to evaluate BP and fluid status (FS) during the interdialytic period. Methods – In this cross-sectional two-centre study, BP and FS were measured during a mid-week HD session and at home during the interdialytic period. Systolic hypertension was defined as > 140mmHg, systolic hypotension < 90mmHg. FS was assessed using the body composition monitor and categorized as normal [FO/extracellular volume (ECW) < 6% or > -6%], fluid depleted (FO/ECW
≤ -6%), or fluid overloaded (FO/ECW ≥ 6%).
Results – A total of 68 HD patients were enrolled, mean age was 70.8 years. The prevalence of interdialytic systolic hypotension was 16.1%, with 33.3% being fluid depleted and 20% FO. Only 2.9% of all subjects had postdialytic systolic hypotension, all of them had a normal FS. Prevalence of interdialytic systolic hypertension was 38.7%, of which 33.3% was FO and 8.3% was fluid depleted. Interdialytic systolic BP was not associated with postdialytic BP. Overall, 32.1% of the subjects with postdialytic normal FS developed interdialytic FO.
Conclusion – Home measurements showed a higher prevalence of interdialytic systolic hypotension and FO compared to postdialytic measurements. Interdialytic systolic BP was not correlated to interdialytic nor postdialytic FS. Home measurements of BP and FS during the interdialytic period provide valuable information to the haemodynamic profile of HD patients and might be detected more easily by remote monitoring techniques in the near future.
Bukovinian State Medical University, Ukraine
Olenovych O.A. is an Associate Professor of the Department of Clinical Immunology, Allergology and Endocrinology in HSEEU «Bukovinian State Medical University» (Chernivtsi, Ukraine). She has achieved the specialty certificate in Endocrinology in 2003 and completed her PhD degree in Endocrinology in 2005. She specializes in the study of kidney functions in case of endocrine pathology and her current field of scientific interest is diabetic kidney disease. She has published more than 50 papers in reputed journals and has been a speaker in national and international conferences.
Adequate assessment of the functional renal state, especially in the case of early diagnosis of its disorders, requires an analysis not only of the glomerular apparatus of the kidney, but also of the condition of tubulointerstitial tissue (TIT) known to be involved into the pathological process in the kidneys much earlier than glomerular apparatus, and consequently the relatively preserved glomerular structure, however, does not ensure the normal functioning of the nephron. Considering an importance of timely diagnosis of tubulo-interstitial syndrome, its character, severity of TIT lesions for prediction of renal impairment progression intensity in clinical and experimental studies, the objective of this research was to clarify the peculiarities of tubulointerstitialsyndrome (TIS) in alloxan-induced experimental diabetes mellitus (EDM) known to be accompanied by the pathology of the interstitium, tubular-interstitial dysfunction. On 26th day of after the induction of EDM in white non-linear male rats the kidneys of diabetic and control animals were removed, dissected to renal cortex, medulla and papilla for further measurement of tissue sodium content and calculation of papillary-cortical, papillary-medullar and cortical-medullar osmotic concentrational sodium gradients. The results of the investigation demonstrated a decrease of sodium concentration, mainly in the renal papilla and, accordingly, a decline of papillar-medullar, medullar-cortical and papillar-cortical gradients as compared to the control parameters. The detected changes are indicative of the inhibition of proximal tubular sodium reabsorption and, despite regulatory control of the renal countercurrent multiplication system and intensification of sodium reabsorption at the level of the ascending Henle loop, excretion of urine with high osmolarity and significant sodium loss from the body.
School of Clinical Medicine, Youjiang Medical College For Nationalities, China
Jie Wang has completed his Master Degree at the age of 34 years from Guangxi Medical University. She is the director of Nephrosis Internal Department, a premier clinician and researcher. She has published more than 10 papers in reputed journals and has been serving as an editorial board member of Youjiang Medical Journal
At present clinical treatment of primary membranous nephropathy is still symptomatic, thus the curative effect is not sufficient, which is mainly due to the lack of understanding the mechanism of glomerular injury. The filtering barrier of the glomerulus consists of vascular endothelial cells, basement membranes and podocytes. Previous studies have focused on podocyte damages, but the mechanisms of vascular endothelial cells and basement membrane damage need to be further studied. Our previous research based on patients' renal punctures showed that the distribution density of neutrophil elastase in the glomeruli is closely related to the pathological stage of the disease; the glomerular vascular endothelial cells co-localized with this enzyme were obviously damaged ( Endothelial cells lose normal morphology and impaired tight junctions), as well as degradation of basement membrane substances such as Collagen IV and Laminin β2. This project aims to combine clinical patient samples and animal models, using laser confocal, flow cytometry, and in vitro cell culture experiments to reveal the role of neutrophil elastase in primary membranous nephropathy, to explore the mechanism of glomerular vascular endothelial cells and basement membrane damage, and further animal experiments will be conducted to evaluate taking neutrophil elastase as a therapeutic target protein in the treatment of primary membranous nephropathy.
University of Brasília, Brasília, Brazil
Tayse Tâmara da Paixao Duarte holds a master's degree in Health Sciences from the University of Brasília (UnB). Since 2013 is a professor at the University of Brasília, Brazil. Member of the Group of Integrated Studies and Groups of Research in Technology of Care. Since then, she has presented a poster at the international and national congress of cardiology and nephology and has been involved in various teaching projects. At present isa PhD student in a Postgraduate Program in Nursing. University of Brasília, Brasília, Brazil.
Objective: To verify the factors that contribute to acute kidney injury (AKI) among patients with systemic arterial hypertension (SAH) and diabetes mellitus (DM).
Methods: Longitudinal, prospective, quantitative cohort study carried out at the medical clinic of a public hospital in the Distrito Federal, Brazil. Non-probabilistic, convenience sample consisting of 88 patients. A questionnaire was adopted to collect clinical and laboratory data. AKI was defined as an increase in serum creatinine (SCr) ≥ 0.3mg / dL in 48 hours or an increase of 1.5 to 1.9 times its baseline value within seven days, according to the Kidney Disease Improving Global Guidelines (KDIGO). P≤0.05 was considered significant.
Results: There was a predominance of males (51.1%), with DM (64.8%) and SAH (64.8%). The altered mean arterial pressure was present in 71.6% of the cases. Most of the patients presented AKI (54.5%), the most severe ones (stage 2 and 3) prevailing, which affected 37.5% of the patients. Among those with SAH and DM (57 patients), advanced age significantly contributed to AKI [70 (62-76) years, p = 0.001], overweight [26.9 (24-31.1) kg / m2, p = 0.01), in addition to the presence of comorbidities such as heart disease (p <0.001) and liver disease (p = 0.001).
Conclusion: Among patients with AKI and DM, advanced age, high BMI, comorbidities such as heart disease and liver disease contributed to AKI. The data obtained can support an adequate management of patients with AKI, providing subsidies for additional measures and individualized intervention strategies, in order to prevent progression, chronicity of kidney disease and mortality of these patients.
Tel-Aviv University, Israel
Dr Yacov Shacham has completed his MD at the age of 29 years from Semmelweis university of medicine . He had completed residencies in internal medicine,cardiology and critical care cardiology. He is the director of the cardiac intensive care unit in the Tel-Aviv Sourasky medical center. He has published more than 85 papers in reputed journals and has been serving as an reviewer for many peer reviewd journals.
Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of renal tubular damage. We investigated the incidence and possible implications of elevated NGAL levels (suggesting renal damage) compared to both functional and damage markers (manifested as serum creatinine (sCr) elevation) and no NGAL/sCr change, among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI). We included 131 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn 24 hours following PCI. We used the terms NGAL(−) or NGAL(+) with levels ≥100ng/ml suggesting renal tubular damage and the terms sCr(−) or sCr(+) to consensus diagnostic increases in sCr defining acute kidney injury. Patients were also assessed for in hospital-adverse outcomes.
Of the study patients (42%) were NGAL(-)/sCr(−), (44%)NGAL(+)/sCr(−), and 14% were both NGAL(+)/sCr(+). According to the three study groups there was a stepwise increase in the proportion of left ventricular ejection fraction ≤ 45% (43% vs. 60%. Vs. 72%; p=0.04), in–hospital adverse outcomes (9% vs, 14% vs. 56%; p<0.001) and their combination. Specifically, more NGAL(+)/sCr(−) patients developed the composite endpoint when compared to NGAL(-)/sCr(−) patients [64% vs.46%; OR 2.1 (95% CI 1.1–4.5), P=0.05]. A similar and consistent increase was observed in peak sCr, length of hospital stay and C-reactive protein levels.Similarly NGAL level aid in the early identification of acute kidney injury.In conclusion,elevated NGAL levels suggesting renal tubular damage, increased inflammation, or both, are common among STEMI patients and are associated with adverse outcomes even in the absence of diagnostic increase in sCr.
Wroclaw Medical University, Canada
Iwona Bil-Lula is serving at an esteemed position in Wroclaw Medical University, Canada. She is the recipient of numerous awards for his expert research works in related fields. Her research interests reflect in her wide range of publications in various national and international journals.
Since dialysis is accompanied by low quality of life and life expectancy, kidney transplantation is the option of choice for many patients . However, the transplantation of a kidney is necessarily accompanied by injury [2,3]. The consequences include delayed allograft function, acute tubular necrosis, and acute kidney injury .
A pharmaco-proteomics approach was used to identify potential molecular targets associated with kidney preservation injury. The main aim was to better describe the nephroprotective activity of doxycycline (Doxy) during ex vivo kidney cold perfusion in a rat model.
Rat kidneys were cold perfused with or without Doxy for 22 hours. Perfusates were analyzed for the presence of injury markers. Proteins extracted from kidneys were analyzed by 2-dimensional gel electrophoresis. Proteins of interest were identified by MS.
A two-fold increases in LDH activity and 10-fold in NGAL was seen in perfusates from ischemic kidneys compared to the controls (p<0.05). Levels of all analyzed markers were normalized by 100 µM Doxy. Perfusion with 100 µM Doxy protected mitochondria and inhibited formation of dense bodies, observed by the electron microscopy.
Mass spectrometry analysis identified that N(G),N(G)-dimethylarginine dimethylaminohydrolase and phosphoglycerate kinase 1 were decreased after cold perfusion, and perfusion with Doxy led to an increase in their levels.
Machine cold perfusion led to significant kidney injury, however doxycycline, an inhibitor of MMPs, decreased kidney injury, may be as a result of mitochondrial protection and hence the maintenance of mitochondrial structure.
José do Rosário Vellano University, Brazil
Julia Paravizo Lello Santos is an 18-year-old medical student at José de Rosário Vellano University (UNIFENAS) in Brazil.
We present two cases of acute abdominal surgical presentations, secondary to PTLD developing after renal transplantation.
Case 1: A 45-year-old male underwent a livinghaploidentical donor renal transplantation and received immunosuppression therapy (cyclosporine, mycophenolate mofetil, and prednisolone). Nine years after transplantation his graft function was stable (creatinine 1.1 mg/dL), when presented with diffuse abdominal pain with perforation intestine signals. The pathological finding were compatible with post-transplant lymproliferative monomorphic disorder, high-grade lymphocytes of B-cell origin by their CD20 positivity and co-expression of CD10 and negative for BCL 2.In situhybridization for EBV-encoded RNA (EBER) was strongly positive (Figure 1). Patient had mTOR conversion, and sirolimus was included in the immunosuppression schedule.
Case 2: A 35-year-old female was submitted to a renal transplant with HLA-distinct living related donor, receiving prednisone, cyclosporine and azathioprine. After 13 years with stable clinical/laboratorial outcomes, she was attended with small bowel obstruction symptoms. The cells in this tumour were confirmed immunohistochemically as lymphocytes of B-cell (Figures 2) origin by their CD20 (Figure 3) and CD79a, with a proliferation rate of 80% (Ki67). Sirolimus was initiated with CNI suspension.
Discussion: PTLD has become an important comorbidity in kidney transplant recipients. Some studies focus on the differences between early-onset and late-onset PTLD, that is, the segregation between EBV-driven disease versus later coincidental lymphomas expected in the general immunocompetent population. The disease can occur in a wide range of locations. Minimization of immunosuppression is the mainstay of treatment after PTLD diagnosis and a multidisciplinary oncological approach is essential.
Sharda super specialty hospital, Delhi NCR, India
Professor Dr. Punit Gupta is MBBS, MD (Medicine), DM (Nephrology) and PhD. He is the Honorary Nephrologists to the Governor of Chhattisgarh State since 2009. He is Chairman and Members of many important academic and management committees of various Government Medical Institutions in the country and the Pt. DeenDayalUpadhyay Health Sciences University, Raipur. He has guided over 100 Postgraduate & Technologist student for their thesis & Project in Nephrology & Research and also severed as an examiner for the university examinations. A man of researches and publication, he has presented more than 160 research papers and abstracts on Kidney Diseases in Tribal populations at Renowned National and International Conferences. He was felicitated for being the only research scholar who had presented 29 abstracts in Indian Society of Nephrology conference, Pune and 11 research papers at Asia Pacific congress of Nephrology, 2008 in Malaysia on tribal kidney diseases.His Oral Paper was awarded first prize in ISNCON 2007, New Delhi. He was awarded internationally prestigious APCN Developmental awards in Malaysia 2008 and a Follow Scholarship by International Society of Peritoneal Dialysis in Turkey 2008. His paper was recognized as a best Paper in API 2014, Bhilai. He was awarded Certificate of Excellence awards by the Times of India groups 2016. His work was appreciated with certificate of appreciation by Indian Dietician association 2016. He was felicitated by AgrasenAgrawalSamaj for his excellent work in Tribal Population 2016. He was honored with excellence award by ‘Z’ TV Chhattisgarh for this distinguishes work in kidney disease in rural population of Chhattisgarh in 2017. He has developed a concept of Teledialysis, first of its kind in Asia.He has developed Portable dialysis Machine (MAKE-D) for 60 billion kidney patients in world who require dialysis many times in a week. He has developed an abdominal Pressure Measurement Scale, which is very useful of Continuous Ambulatory Peritoneal Dialysis Patients (type of dialysis). He has developed and economic, efficient and effective walkie talkie system for consultation and directions to the hospital staff and doctors. He has been awarded Dr. B. C. Roy National Award for his research to give Aid or Assistance to Research Project for the year 2016.
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 ,Shardasuperspecialtly hospital, delhincr
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.
· 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.
· 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.
National center for Cancer Care and Research, Qatar
Hissa Mohammed is serving at an esteemed position in National center for Cancer Care and Research, Qatar. She is the recipient of numerous awards for her expert research works in related fields. Her research interests reflect in her wide range of publications in various national and international journals.
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 tumoursarises 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.
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.
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.
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.
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.