Day 2 :
- Glomerular diesease & Urinary tract infections
University of Bari, Italy
Professor Emeritus of Nephrology. University of Bari, Italy. Fellow of the American Society of Nephrology (since 2006). Fellow of the ERA-EDTA (since 2011). Director of the C.A.R.S.O Consortium(since 2003). This public institution is included in the ERA-EDTA list of Scientific institutions involved in basic science. The CARSO Consortium manages National and International Scientific awarded projects for a total of 20 millions of Euros. F.P.Schena leads a team of 10 PhD fellows. Past-Chairman of the Transplant Program of the Puglia Region, Italy. Councilor of the Italian Committee for Organ and Tissue Transplantation (1990-2010). Councilor of the Italian Health Research Committee (2010-13).
Immunoglobulin A nephropathy (IgAN) or Berger's disease is the most common primary glomerulonephritis worldwide, but there are large variations in geographical distribution. Recently, we have investigated on the prevalence of the disease for analyzing factors responsible for this difference.
We have observed that i) systematic mass screenings of urine in populations, as occurring in some Asian countries (Japan, Korea and Singapore), are not a common practice in the Western countries; ii) general practitioners and healthcare professionals underestimate the persistent microscopic hematuria and/or mild proteinuria in apparently health individuals; this approach causes late referral to nephrologist; iii) there are different indications for the kidney biopsy adopted by nephrologists in individuals with persistent urinary abnormalities.
Aim of this lecture is to stimulate the medical community to go beyond these barriers because in all countries IgAN is potentially the largest diffuse kidney disease with annual incidence of ˜40˜50 cases per million population. This very common disease depicts two important aspects: i) IgAN may have a heavy economic impact on the National Healthcare Systems because mainly children, youngsters and adults in 2nd and 3rd decade of life develop the disease; ii) 40% of these patients arrive in ESKD by 20 years from the biopsy-proven diagnosis when they are in a productive working time of their life.
A great effort should be done for the early diagnosis of the disease in individuals who manifest persistent microhematuria and/or mild proteinuria. It is necessary to introduce more stringent indications for kidney biopsy. This preventive approach followed by early therapy may reduce the global burden of end-stage kidney disease caused by IgAN.
Key words: IgA nephropathy, Berger's disease, microscopic hematuria, gross hematuria, kidney biopsy.
The head of Institute for the Nuclear Medicine, Military Medical Academy, Belgrade. Prof. Dr Sc. Med of Nuclear Medicine. Born in Vrginmost, Croatia, February 1st, 1954. Graduated from the University of Belgrade in 1978, Nuclear Medicine specialization in 1984, and in London in 1987. He defends his doctoral thesis in the field of nuclear medicine in 1996. Instructor of Nuclear Medicine for Students Specializing in Internal Medicine and Surgery from 1985. Since 2004. the head of The Institute for the Nuclear Medicine, Military Medical Academy; since 2011. the head of The Group of Diagnostic Institutes at the Military Medical Academy; since 2012. professor in The Medical School of the Military Medical Academy for the course Nuclear Medicine; 2013. tenured professor for the course Nuclear Medicine. Has over 250 specialized and scientific published articles, in domestic and foreign journals, chapters in books: “The Lung Tumors,” 2000, and “Tc Generators,” 2003; author of the chapter in the textbook for the Medical School in the University of Thessaloniki, 2014; Ajdinović, B. at al., “Normal and pathological parathyroid glands,” Medical College, Belgrade, 2004; Ajdinović, B. at al, “Child with an urinary tract infection,” Belgrade, 2008; Ajdinović, B. at al, “Nuclear medicine - Textbook for students in The Medical School of the Military Medical Academy,” Belgrade, 2015. In charge of the nuclear medical research on kidneys in 1987, and, in 2006, of the research about the urinary tract infection in children; participates in the international project “Variability in DMS scintigraphy findings,” in 2007. From 2011 to 2014, participates in the project “Cellular and molecular pathogenetic mechanisms in disorders of reproduction and genital organs - prevention, diagnostics, and therapy” - subproject: “Treatment of antenatal hydronephrosis” of the Ministry of Science and Technological development; from 2011 to 2015, in charge of the project: Nuclear medical research of urinary tract in children: antenatal hydronephrosis, infection of urinary tract in children, and vesicoureteral reflux as causes of renal parenchymal disease. In 2001, awarded The Medal of White Angel from the president of the SR Yugoslavia; in 2008, “Author of the year” by the Military Sanitation Examination magazine; in 2011, awarded third prize at the first Medicinal Olympics in Thessaloniki, and in 2015, the first prize at the third Medicinal Olympics in Thessaloniki. Member of the World Association of Radiopharmacological and Molecular Therapy of the European Society of Nuclear Medicine, Serbian Medical Society, and the Society of Nuclear Medicine of Serbia.
Urinary tract infection (UTI) is common in childhood, and most children recover without complications. Use of imaging to check for abnormalities or complications therefore needs to be targeted carefully.
Because a renal ultrasound (US) is noninvasive and may give supplemental information about a child’s risk for lower tract infections by showing bladder abnormalities, a renal US should be initially ordered study in children with UTI.
Obtaining a voiding cystourethrogram (VCUG) with first UTI in all male patients, females younger than 3 years, children clinically suspected of having pyelonephritis, and those with US abnormalities has been recommended (”bottom-up” approach).
Because of the risks and cost of the VCUG test, as well as its low yield (<10%) for clinically significant (ie, high-grade) VUR, many have advocated obtaining VCUGs selectively. Another approach to imaging is the so-called “top-down” approach, where cortical renal scintigraphy (CRS) is obtained after initially US.
Advocates of this approach cite that it focuses on identification of renal scarring, the long-term adverse effect that we are hoping to avoid, regardless of whether reflux is present or not.
A normal CRS allows to safely dismiss the child without programming further investigation(s) as outpatient. On the contrary, in case of true acute pyelonephritis, investigation for VUR can be scheduled without waiting for a relapse. A first paper lends further support to this approach. Suson & Mathews 2014., retrospectively analysing the clinical application of the American Academy of Pediatrics guidelines to a population of children with the first episode of febrile-UTI, found that one third of those with abnormal renal scan has a normal US and 62% had an undiagnosed grade 3 or more VUR.
Hanan H Hagar working as PhD scholar in the Ain Shams University loacted in Egypt. Hanan H Hagar Editorial Board Member of many peer reviewed journals and area of expertise, as a Research Scholar credits with many publications in national and international journals. Hanan H Hagar committed to highest standards of excellence and it proves through his co-authorship of many books.
Implication of oxidative stress and inflammatory mechanisms in adriamycin nephropathy has been suggested. Reactive oxygen species may activate latent matrix metalloproteinases (MMP) that ultimately may induce glomerulosclerosis and fibrosis. Little is known about the effect of MMP inhibitors on focal segmental glomerulosclerosis. This study examined the role of MMP in adriamycin nephropathy as an animal model of glomerulosclerosis using MMP inhibitors, SB-3CT and doxycycline. Forty male Wistar rats were used and allocated into four groups as follows: normal control rats (n=10), adriamycin treated rats (n=10), and SB-3CT + adriamycin-treated rats (n=10), doxycycline + adriamycin-treated rats (n=10). Adriamycin nephropathy was induced by a single injection of adriamycin (7.5 mg/kg) intraperitoneally. SB-3CT was given at a dose of (1 mg/kg/day, i.p.) while doxycycline was given at a dose of (30 mg/kg/day, i.p.). Therapy was initiated at once after induction of adriamycin nephropathy and continued for 4 weeks. Adriamycin nephropathy resulted in deterioration in lipid profile (elevated serum triglycerides and cholesterol levels) and in kidney function (elevated serum creatinine, BUN) and reduction in serum albumin and total protein levels while their levels were increased in urine. Lipid profile was also changed. Adriamycin-treated rats showed increased tumor necrosis factor-α (TNF-α); intercellular adhesion molecule-1 (ICAM-1), transforming growth factor-b1 and tissue inhibitor of metalloproteinase-1&-2 (TIMP-1 & TIMP-2) in the kidney as assessed by ELISA technique. MMP activities (MMP-2 & MMP-9) were also induced using zymography technique and western blot analysis. Histological changes were also noted on kidney using hematoxylin and Eosin. Immunohistochemical studies revealed increased staining of collagen IV in the renal cortex. MMP inhibitors, doxycycline and SB-3CT significantly reduced serum BUN, creatinine, and renal cytokines. Lipid abnormalities were also corrected back to normal. This was parallel to reduction in collagen IV immunostaining and improvement in histological changes. These results suggested that MMP inhibitors may have promise as anti-inflammatory, anti-proliferative and endothelial cell protective. MMP inhibitors may be potential future candidates to provide more effective therapy to halt the development of glomerulosclerosis. Acknowledgment: The authors would like to thank King Abdul-Aziz City for Science and Technology (KACST) for supporting this work.
- Renal Transplantationn & Immunology & Chronic and End Stage Renal Diseases
College of Medicine & Health Sciences,UAE
Dr Albawardi, is an Associate Professor at the College of Medicine & Health Sciences, and is a consultant Histopathologist & Renal Pathologist at Tawam hospital.
She obtained her Bachelor of Medicine & Surgery (M.B.B.S.) from the College of Medicine & Health Sciences-UAE University, followed by five year residency training in anatomical pathology at McGill University, Canada. In addition, Dr Albawardi did fellowship training in Renal and Transplantation pathology at the Ohio State University Medical Center, USA.
Dr. Albawardi principle areas of interest are cellular bioenergetics and nephrotoxicity, as well as mammary carcinogenesis. She has published more than 25 papers in peer reiviewd journals, and has been serving as an editorial board member of International Pathology & Clinical Research Journal, Annals of Clinccal Case Reports Journal, and Applies Clinical Research, Clincial Trials and Regulatory Affairs journal.
Chronic renal disease (CRD), requiring dialysis or renal transplantation, is a growing health concern in Gulf Council Countries (GCC). The Banff Classification of renal allograft, first published in 1993, still remains a great scientific tool to assess and to quantify allograft renal injury. It helped unify the language between renal transplantation centers, and professionals worldwide, thus promoting patient’s care and collaborative research. Every two years, the world’s transplantation experts, convene to incorporate new evidence-based modification(s) into the existing scheme. The Banff 2013 meeting, introduced major updates in the diagnosis of antibody mediated rejection. In addition, recent literature addresses C4d interpretive issues and introduces newer molecular alternatives such as ENDATs. Finally, the value of post transplantation baseline biopsy cannot be overemphasized.
University of Medical Sciences, Iran
Cirruse Salehnasab working as PhD scholar in the University of Medical Sciences loacted in Shiraz. Cirruse Salehnasab Editorial Board Member of many peer reviewed journals and area of expertise, as an Research Scholar credits with many publications in national and international journals. Cirruse Salehnasab committed to highest standards of excellence and it proves through his co-authorship of many books.
Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD). Prediction of the transplant survival is of paramount importance. The objective of this study was to develop a model for predicting survival in kidney transplant recipients. In a cross-sectional study, 717 patients with ESRD admitted to Nemazee Hospital during 2008–2012 for renal transplantation were studied and the transplant survival was predicted for 5 years. The multilayer perceptron of artificial neural networks (MLP-ANN), logistic regression (LR), Support Vector Machine (SVM), and evaluation tools were used to verify the determinant models of the predictions and determine the independent predictors. The accuracy, area under curve (AUC), sensitivity, and specificity of SVM, MLP-ANN, and LR models were 90.4%, 86.5%, 98.2%, and 49.6%; 85.9%, 76.9%, 97.3%, and 26.1%; and 84.7%, 77.4%, 97.5%, and 17.4%, respectively. Meanwhile, the independent predictors were discharge time creatinine level, recipient age, donor age, donor blood group, cause of ESRD, recipient hypertension after transplantation, and duration of dialysis before transplantation. SVM and MLP-ANN models could efficiently be used for determining survival prediction in kidney transplant recipients
Department of Renal Medicine,Singapore
Dr Mayank Chawla is a Senior Resident in the Department of Renal Medicine at Singapore General Hospital, Singapore
He has done his MD in Internal Medicine both from India and Singapore
Hyperparathyroidism improves after kidney transplantation (KTR). However, persistent- hyperparathyroidism (PH) may occur and is associated with a higher risk of cardiovascular events, fractures, allograft failure, and all-cause mortality. Pre-transplant parathyroidectomy (PTX) has been advocated to prevent the risk of PH and complications of post-transplant PTX. However, there is no defined criteria for timing of pre-transplant PTX. This study seeks to identify predictors of PH following transplantation to guide timely intervention.
All first KTR performed in our tertiary care center, between January 2005 and July 2015 with follow-up of until 12 months and pre-transplant dialysis of more than 3 months were recruited for analysis (n=169). PH was defined as serum corrected calcium (cCA) of > 2.50 and serum iPTH > 6.5pmol/L at 12 months post-transplant Baseline demographic and biochemical data were compared between groups with and without PH. Univariate analysis was performed and significant predictors of PH were further analyzed with multivariate regression analysis.
Mean age of study population was 45.8 (9.9) years. Dialysis vintage was 88 months (36-140) and 84% were on hemodialysis. 68% of patients received deceased donor KTR. PH was diagnosed in 65 patients (38 %). These patients were older (48 (7.9) vs 44.4 (10.8), p=0.025), had longer dialysis vintage (108 vs 77 months p= 0.002), and higher pre-transplant cCA (2.51 (2.34, 2.68) vs. 2.29 (2.07, 2.51), p<0.0001), alkaline phosphatase (127.0 (114.0, 140.0) vs. 88.0 (38.0, 105.0), p=0.016), iPTH (90.2 (29.0, 127.2) vs. 38.0 (11.7, 49.9), P=0.0002), and phosphate (1.90(1.38,2.42) vs 1.66(1.14,2.18), P=0.0056) levels . Estimated GFR was lower in patients with PH at 12 months (54.5 (34.5, 75.0) vs. 61.0 (42.0, 80.0), P=0.0001). Older patients, longer dialysis vintage, and higher pre-transplant alkaline phosphatase , cCA ,iPTH , and phosphate levels were associated with increased risk of PH in univariate analysis. Following multivariate adjustment, longer dialysis vintage (HR = 1.011, 95% CI=(1.001,1.021)), higher pre-transplant cCa (HR=1.647, 95% CI=(1.296, 2.177)), and higher iPTH (HR=1.015, 95% CI=(1.006,1.026)) remained significant.
Conclusion: Longer dialysis vintage, higher pre-transplant iPTH and pre-transplant hypercalcemia are important predictors of PH following kidney transplant.