8th World Nephrology Conference August 15-16, 2016 Sao Paulo, Brazil

Biography:

Alexandre Toledo Maciel was graduated in Medicine at the Federal University of Rio de Janeiro and made his Medical Residency at the University of São Paulo in the area of Intensive Care Medicine. He works as an intensivist and is also the Clinical Research Manager of the Imed Group, which is a group of physicians and nurses dedicated to improve the care of critically ill patients. He has published more than 35 papers in international critical care journals.

Abstract:

Early diagnosis of acute kidney injury (AKI) is a major challenge and a great area of research, particularly in critically ill patients. However, serum creatinine (sCr) and urine output (UO) remain so far the only two widely accepted and available parameters for AKI diagnosis, although they are clearly late markers of renal damage. Tubular damage markers have gained a lot of attention but none of them are widely available especially in developing countries and their roles are not clearly established in clinical practice. We have observed that some biochemical alterations in blood and urine occur in a standardized way during most AKI development, even before increases in sCr. Sequential assessment of urine sodium, urine creatinine and the fractional excretion of potassium are simple, low cost and widely available parameters that have a still under-recognized potential to help in the early detection of kidney impairment. Many controversies still remain in how to interpret their values especially after increasing evidence that urine biochemistry is not a tool for renal perfusion evaluation as suggested for decades in the classic “pre-renal” paradigm. More research is needed in order to optimize the use of urine biochemistry in AKI diagnosis and management.

Biography:

R.G. Singh after doing his MD in Medicine and DM in Nephrology in 1982 from prestigious central university of Asia i.e. Banaras Hindu University joined as faculty at the institute of medical science where he has served as a Assist Prof., Asso Prof., Prof., Dean of faculty and Director of institute and finally he is serving as a lifelong Distinguished Prof. of nephrology at BHU and also Prof & Head of Nephrology in one of the upcoming institute of medical science, HIMS. Prof. Singh has published more than 350 papers in national and international journals, more than 3 dozen orations and has been conferred one dozen fellowships of different scientific bodies and organisations. He has conducted one and half dozen research projects and guided more than 3 dozen postgraduate students in medicine and nephrology. For last 20 years he has been involved in Tribal and Herbal medicine research

Abstract:

Different variety of herbal plant salacia (from celastracea family) are available.The important species of salacia are  oblonga, chinesis, rosburgai, reticulatea etc. Out of that salacia, oblonga is quite effective. This plant has been used by tribal population for treating no. of medical ailment. The root of the plant was initially used to tide over the hunger at the time of femine since it produces temporary anorexia. After taking small bit of root the person did not feel hunger for one to two days. Subsequently few reports have suggested that it lowers the blood sugar level in diabetics, thus helps in controlling blood sugar and diabetes and also preventing long term complication of diabetes. No. of studies have revealed that it also reduces LDL, VLDL, total cholesterol and TG and increases HDL cholesterol causing beneficial effects in lipid metabolism

    Various components like athocyanidins, catechins, phenolic acids, quinines, friede-oleananes triterpene quinine-methides and related triterpenoids (celastroloids), mangiferin, gutta-percha, and dulcitol have been isolated from plants of the salacia species.

        The animal studies with highest single dose-2000mg/kg. of body weight in rat was given and no untoward effects was noticed in neurobehavioral toxity , histamine levels, hemopoitic function, LFT and renal function. In the clinical study with one year follow up 102 patients were included in the study out of which only 90 completed the follow up. They were devided in two groups age, sex, matched. Both the groups received antihypertensive specially calcium channel blocker, centrally acting antihypertensive drugs and vitamin supplements. One group was given  the trial drug (salacia oblonga) as add on therapy for one year and followed at monthly interval. The salient findings are as follows.

Male pre-dominated 78-80 % in both the groups, common symptoms at presentation were weakness, anorexia, vomiting and edema. There was no significant symptomatic deteriotation  in DN patients who received salacia  no adverse effect or allergic reaction was noticed in patients suggesting that the salacia is safe. Majority of patients at presentation were hypertensive and baseline blood pressure in group 1 and 2 were comparable respectively. Strict blood pressure control was achieved in both the groups. There was stable kidney function as measured by serum creatinine and blood urea in patients who received, salacia  as compared to DN patients who did not receive the trial drug, suggesting that the drug may retard the progression of patients of diabetic nephropathy. The salacia group also showed anti-proteinuric effect and had  significant impact on fasting blod glucose level in diabetic nephropathy but there was no effect on post-prandial glucose level. It had no significant effect on cholesterol , HDL, LDL, and TG. Drug decreased the level of Homocystine significantly in DN patients. C-Reactive protein and Endothelin levels also decreased significantly in the trial group. TNF-α did not decrease in diabetic nephropathy patients who received herbal compound.

In  conclusion  it seems that salacia a tribal drug seems to have promising role in the management of diabetic kidney disease.

Biography:

Prof Dr Itir Yegenaga has completed her docent degree at the University of Istanbul Medical School in Turkey; worked as visiting professor in Medical College of Georgea/USA in Department of Cell and Molecular Biology. She gets Nephrology degree in University of Gent Medical School/Belgium She is working as a Professor of Medicine in Kocaeli University Medical School/Turkey for 20 years. She has published more than 25 papers in reputed journals.

Abstract:

Detection of acute kidney injury (AKI) as early as possible can be lifesaving in intensive care unit (ICU) patients. The conventional methods are not early enough to detect AKI; therefore, new predictive biomarkers are under development.

One hundred eighty-three adult patients without chronic kidney disease or renal replacement therapy were included in this study. Plasma and urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) were assessed at 48 hours after ICU admission and were subsequently measured each day for 7 days to monitor the development of AKI. AKI diagnosis was based on the risk, injury, failure, loss, end-stage renal failure (RIFLE) criteria.

Thirty-four percent of the patients had AKI, 73% of whom were diagnosed within the first 48 hours after ICU admission. Seventeen additional patients were diagnosed with AKI after 3 to 7 days. The mean serum creatinine level did not significantly differ between the non-AKI patients and the 17 patients diagnosed after 3-7 days (0.72±0.20 and 0.83±0.21; p=0.060). However, the serum and urinary NGAL levels significantly differed between these patient groups (median 75.69 (54.18-91.18) and 123.68 (90.89-166.31), p=0.001, and median 17.60 (8.56-34.04) and 61.37 (24.59-96.63), p=0.001, in the AKI and non-AKI patients, respectively); notably, the serum CysC level at 48 hours did not differ.

NGAL concentrations in the urine and serum measured within 48 hours of ICU admission could be used to predict the development of AKI after 3 to 7 days in the ICU, but the CysC concentration did not demonstrate predictive value. 

Biography:

R.G. Singh after doing his MD in Medicine and DM in Nephrology in 1982 from prestigious central university of Asia i.e. Banaras Hindu University joined as faculty at the institute of medical science where he has served as a Assist Prof., Asso Prof., Prof., Dean of faculty and Director of institute and finally he is serving as a lifelong Distinguished Prof. of nephrology at BHU and also Prof & Head of Nephrology in one of the upcoming institute of medical science, HIMS. Prof. Singh has published more than 350 papers in national and international journals, more than 3 dozen orations and has been conferred one dozen fellowships of different scientific bodies and organisations. He has conducted one and half dozen research projects and guided more than 3 dozen postgraduate students in medicine and nephrology. For last 20 years he has been involved in Tribal and Herbal medicine research

Abstract:

Drugs have taken a very important place in the day to day life of man, more so for sick persons. The drug is the end product of all medical disciplines in the term of the patient relief and well being. The important uses of drug include the therapeutic purpose, maintaining the health, preventing diseases and promoting healthy living. The various sources of drug include animal, plant,microbial, chemical and synthetic. Out of various sources mentioned above, herbs play a very important role as a source of drug from the ancient days. Even village tribal medicine is predominately made of herbs. Lot of chemical, synthetic and genomic drugs are presently used in medical practice with no. of beneficial effects. The itrogenic problems are increasing day by day causing increased mortality to the tune of 1 to 2% of all hospital admissions worldwide. The scientific world is looking for more safe and effective drugs which can be tailored with the genetic constitution of the individual. The common drugs used in Indian system of medicine, that is, Ayurveda are mainly in the following groups which are used for treating renal problems. Herbal diuretics: The various indigenous herbs have been used “Arjun” (Terminalia arjuna), ‘Vajradanti’ (Barleria prionitis), ‘Shrivalika’ (Celosia argentea), ‘Varuna’ (Crataevic negligiousa), ‘Uma (Linum usitatissimum), ‘Kutuki’ (Loffa amiru), etc. Herbal Antilithic Drugs: The drugs indentified in these groups are ‘Varuna’, ‘Pasan Bheda’, ‘Apamarga’, ‘Shigaru’, ‘Kulatha’, ‘Kohurika’, etc. They have been grouped as ‘Veertavadi’, ‘Musk a kadi’, Usakadi’, and ‘Varunadi’ in herbal literature. Herbal Urinary Analgesics: The important drugs in this group are ‘Chandan’, ‘Kumuda’,‘Kamla’, ‘Priyanju’, ‘Madhulika’ and ‘Dhataki’, which are regularly being used in Indian system. Herbal Renoprotective drugs: Presently popularly used ‘Rhubarb’ (Ravendchini) is one of the important drugs in this group. Similarly, Purnarnava (Boerhaevia diffusa Linn.) has been tried as protective agent in acute pyelonephritis in experimental condition where authors have concluded evidence of renoprotection. Antibacterial and antiseptic agents: Important herbs in this group are ‘Neem’, ‘Punarnava’, ‘Chandan’, etc. Anubha et al. 1987 reported antibacterial activity in punarnava in experimental pyelonephritis. Immunopotentiating drugs: Few herbal drugs have been claimed to be very important for immunopotentiating drug like Kutki, Kulchi, Punarnava in this group. However, most of the scientific details have to be worked out for these drugs. Antihypertensive Drugs: The herbal drugs like ‘Brahmi’, ‘Sankhpuspi’, etc.,are important in this group which are used for centuries. Anti-proteinuric Agents: The important drugs in this group are ‘Punarnava’,‘Gokhuru’,etc.Few studies have been reported with convincing results and which requires further scientific documentation.Miscellaneous drugs: Citrus fruit and ‘Saijan’ have been used for centuries as renoprotective drug in renal practice. Thus the tailored individualized herbal & tribal drugs have promising role to become the drug of tomorrow in medical practice.

Biography:

Paulo Roberto Santos is Associate Professor at Federal University of Ceará, Brazil, and coordinates the Graduate Program in Health Sciences of the Sobral Faculty of Medicine. His main research interests are self-perceived outcomes (quality of life, depression, coping strategies and sexuality) among end-stage renal disease patients.

Abstract:

Sexual dysfunction (SD) occurs both among men and women with end-stage renal disease (ESRD) undergoing hemodialysis (HD). There are contradictory data about SD’s impacts on patients’ quality of life (QOL) according to gender. It seems that impacts of SD on QOL can be quite different among men and women. Indeed, there are studies showing that women are less emotionally affected by SD than men. We conducted three studies in this area encompassing ESRD patients undergoing HD in the only two dialysis centers in northern Ceará state, northeast Brazil. In all studies we used the Brazilian version of the Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) to assess QOL level. SF-36 covers eight dimensions of QOL: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health. Among men between 20 and 50 years of age, the International Index of Erectile Function Index (IIEF) was used to measure erectile function. In turn, among sexually active women with age between 18 and 55 years, we used the Female Sexual Function Index (FSFI), which evaluates six domains of sexual function: Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain. We found 42.4% prevalence of erectile dysfunction (ED) among men. Men with ED presented lower scores concerning all QOL dimensions when compared to men without ED. However, only the Mental Health dimension was significantly different. On the other hand, we found SD in 79.3% of women. Scores related to Physical Functioning, Bodily Pain, Vitality and Social Functioning were significantly lower among women with SD compared to women without SD. Moreover, the presence of SD was an independent predictor of depression among women on HD, increasing nearly six times the risk of depressive symptoms, as assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). We concluded that ED and SD affect QOL of men and women in different ways. Among men with ED, the mental aspect of QOL (represented by the dimension Mental Health) is more affected, while among women the physical aspect of QOL (represented by the dimensions Physical Functioning, Bodily Pain, Vitality and Social Functioning) is more affected by SD. We concluded that routine screening of sexual function is necessary among HD patients aiming to detect SD, which is a treatable variable associated with poor QOL. In addition, after the start of therapy for SD, effects of the treatment on QOL dimensions should be checked to ensure an efficient result, taking into consideration the differences regarding gender.

Biography:

Degree in Biological Sciences from the Federal University of Ceará (UFC), he worked at graduation in biochemistry area of protein, specifically in Proteome area. Master and PhD in Pharmacology from the Federal University of Ceará (UFC) in the area of Cardio-Renal Pharmacology and Toxicology, which operates in the kidney hormones (ANP uroguanylin, urodilatin) involved in NaCl regulation ingested in the diet and vascular effects and kidney of venomous animal poisons. He is currently a post doctoral by CNPq.

Abstract:

Guanylin (GN), uroguanylin (UGN), and the bacterial heat-stable enterotoxin (ST) peptides comprise a new family of cyclic guanosine 3’-5’ monophosphate (cGMP)-regulating agonist. Ingestion of a salt meal induces secretion of GN and UGN into the intestinal lumen, where they inhibit Na+ absorption and induces Cl-, HCO3- , and water secretion. Simultaneously, these hormones stimulate renal electrolyte excretion by inducing natriuresis, kaliuresis, and diuresis. The highly integrated mechanism allows the organism to maintain sodium balance by eliminating excess NaCl in the urine. However, their physiological regulation within the kidney has not been studied. The aim of this study was showing changes on daily metabolism and renal function of rat under high sodium chloride ingestion. Its effects were examined using wistar rats maintained for ten days in metabolic cages. Control group received only water, two more groups received 1% and 2% solutions of sodium chlroride. We daily analyzed urinary volume, weigh, and food and water consume. The renal function was evaluated using isolated perfused kidneys, in which the kidneys were perfused after ten days in metabolic cages, only with Krebs-Henseleit solution containing 6g% of a previously dialysed bovine albumine serum. All data were analyzed by ANOVA and Student t-test with level of significance set at *p<0,05. Rat’s weights of 2% group decreased after eighth day, compared with control group, while 1% group did not show significative weight lost. Urinary volume and water consume increased, in both treatments, from second day. Food consume did not show significative among groups. In isolated kidney both treatments increase perfusion pressure (PP). The renal vascular resistence (RVR), urinary flow (UF), glomerular filtration rate (GFR) and the osmolar clearance (Cosm) increased in the 1% group compared with control group, however decreased in 2% NaCl group. Treatment with 2% NaCl decreased the sodium (%TNa+, %pTNa+), potassium (%TK+, %pTK+) and chloride (%TCl-, %pTCl-). These results suggest that a high salt ingestion on diet promote significative changes on daily metabolism and the renal function of rats.

Biography:

Carlos Tagliati is a Professor of Toxicology in the School of Pharmacy, Federal University of Minas Gerais, Brazil. He received his master's degree in Toxicology and Toxicological Analysis and his doctorate in Drugs and Medicines from the University of São Paulo (Brazil). He completed his post-doctorate in Toxicology In Vitro from the Universidad de Murcia (Spain). He published many articles in national and international journals in the field of Toxicology. Author of book chapters in the areas of in vivo and in vitro Toxicology. Project Coordinator in the area of in vivo and in vitro Toxicity.

Abstract:

Among hospital admissions due to acute kidney injuries, 20% are due to drug-induced nephrotoxicity. This stems from the fact that available in vivo methods (animal) are unable to reliably predict nephrotoxic effects. Only 7% of all new drugs fail in preclinical studies arising from the onset of nephrotoxicity, while the incidence of acute kidney injury in patients in Intensive Care Units is approximately 30-50%. Therefore, it is paramount the development of new techniques for in vitro models (which also reduce the use of animals) and low-scale analyses to determine toxicological profiles, aimed at improving the early diagnosis of the toxicity of new molecules. Nevertheless, due to the functional and biochemical heterogeneity of nephrons, susceptibility to toxicity can vary among nephron segments. Thus, it becomes necessary to use renal strains from different parts of nephron. Some cell lines, such as the LLC - PK1 (proximal tubule), MDCK (distal tubule) and BGM (a mixture of cells of proximal and distal tubules), have all been employed to evaluate nephrotoxicity. For this reason, interdisciplinary in related areas becomes essential in an attempt to apply mutual knowledge. In the Toxicology Biochemistry to be addressed in this study is the biochemical pathway involved in the context of pathophysiology. Gene expression also have demonstrated an important tool to identify new biomarkers. Using drugs such as Cyclosporine, Amphotericin B, Gentamicin and Cisplatin our results suggest this strategy have predictive value to identify early toxic effects, improving the selection of the candidate for the clinical stage.

Biography:

Carlo Briguori was born in Catanzaro (Italy), on June 28, 1967. In 1991 he had his bachelor degree in Medicine and Surgery at the “Federico II” University School of Medicine in Naples. In 1995 he had his Board Certification in Cardiology at the “Federico II” University School of Medicine in Naples. In 2000 he had his PhD in Pathophysiology of Cardiovascular System at the University School of Modena (Italy). From 1999 to 2002 he was research fellow in Interventional Cardiology, at the Laboratory of Interventional Cardiology in San Raffaele Hospital in Milan, under the guidance of Antonio Colombo. Since 2002 he has been chief of the Laboratory of Interventional Cardiology at the Clinica Mediterranea in Naples, Italy. At present Dr. Briguori his also consultant and co-director of clinical research at the Laboratory of Interventional Cardiology, “Vita e Salute” University, San Raffaele Hospital, Milan (Italy).

Abstract:

Background. High urine flow rate (UFR) has been suggested as a target for effective prevention of contrast-induced acute kidney injury (CI-AKI). The RenalGuard therapy (saline infusion plus furosemide controlled by the RenalGuard system) facilitates the achievement of this target. Methods. Four-hundred consecutive patients with an estimated glomerular filtration rate ≤30 ml/min/1.73 m2 and/or an high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed. The primary endpoints were 1) the relationship between CI-AKI and UFR during pre, intra, and post-procedural phase of the Renalguard therapy, and 2) the rate of acute pulmonary edema and impairment in electrolytes balance. Results. UFR was significantly lower in the patients with CI-AKI in the pre-procedural phase (208±117 versus 283±160 mL/h; p< 0.001) and in the intra-procedural phase (389±198 versus 483±225 mL/h; p = 0.009). The best threshold for CI-AKI prevention was a mean intraprocedural phase UFR ≥450 mL/h (area-under-curve = 0.62; p = 0.009; sensitivity 80%; specificity 46%). Performance of percutaneous coronary intervention (hazard ratio [HR] = 4.13; 95% confidence intervals [CI] 1.81-9.10; p <0.001), the intra-procedural phase UFR <450 mL/h (HR = 2.27; 95% CI 1.05-2.01; p = 0.012), and total furosemide dose >0.32 mg/kg (HR = 5.03; 95% CI 2.33-10.87; p< 0.001) were independent predictors of CI-AKI. Pulmonary edema occurred in 4 patients (1%). Potassium replacement was required in 16 (4%) patients. No patients developed severe hypomagnesemia, hyponatremia or hypernatremia. Conclusions. RenalGuard therapy is safe and effective in reaching high UFR. Mean intraprocedural UFR ≥450 mL/h should be the target for optimal CI-AKI prevention

Biography:

Graduated in medicine from the Federal University of Ceará, Master of Nephrology at the University of Sao Paulo and a PhD in Nephrology, University of São Paulo. Associate Professor IV of the Federal University of Ceará. Coordinator of the medical of the Faculty of Medicine of the UFC, medical assistance of the General Hospital of Fortaleza and Voluntary Assistance Teacher - University of Miami. She has experience in the area of medicine, focusing on Nephrology, acting on the following topics: acute renal failure in the intensive care unit, renal function in leptospirosis, leprosy, dengue fever, cutaneous leishmaniasis, kala azar and HIV. Professor of Postgraduate Medical Sciences, Department ofl Medicine of UFC Medical School. Fellow researcher at the CNPQ Level 2.

Abstract:

It was conducted by the research group on tropical diseases several prospective controlled studies with patients with visceral leishmaniasis, schistosomiasis, leprosy leptospirosis and monitored in outpatient clinics or admitted to tertiary hospitals in Fortaleza, Ceará. To assess glomerular function, the glomerular filtration rate was estimated using the equation and CKD-EPI to plasma creatinine. It measured proteinuria and albuminuria, normalizing values by the urinary creatinine (mg / g-creatinine). The renal tubular function was assessed by: a fractional sodium excretion (FENa +), potassium excretion fraction (FEK +). Were also measured in urine MCP-1, NGAL and KIM-1, novel early biomarkers of renal injury, which were quantified by immunoassay technique of enzyme-linked (ELISA). Urinary biomarkers were normalized by urinary creatinine in the same sample and expressed in "mg / gCreatinina". The concentration of nitric oxide was carried out indirectly through the formation of its stable metabolite. It was also evaluated and endothelial injury through glococálice dosages Syndecam-1 and ICAM-1. The MCP-1 was shown useful as urinary biomarker for detecting subclinical renal dysfunction and as a predictor of long-term kidney disease in tropical diseases. In patients with mild renal damage secondary to leptospirosis, endothelial injury and especially their glycocalyx could be demonstrated by elevated serum levels of syndecan-1 and ICAM-1 and are related to the presence of Acute Kidney Injury.

Biography:

Pedro Henrique Sá Costa is graduated in Pharmacy, and Master in Pharmacology from Federal University of Ceará. Currently, he is a PhD student linked to the Department of Physiology and Pharmacology of the Federal University of Ceará, where he researches the theme of experimental chronic kidney disease and natriuretic peptides.

Abstract:

Chronic kidney disease (CKD) is characterized by loss usually slow, progressive and irreversible of renal function. In this context, more studies are necessary for establishment of a link between DRC and regulation of natriuretic peptides, as guanylin (Gn), uroguanylin (UGn) and atrial natriuretic peptide (ANP), and the effect of angiotensin II (Ang II) on regulation of these peptides. Thus, we sought to evaluate a possible modulation of the guanylin by enalapril in the 5/6 nephrectomy model (nx5/6). We used male Wistar rats, weighing between 250-300g. The animals were divided into 4 groups (n = 8): untreated control group treated or not with enalapril (10 mg/kg oral) (SHAM and SHAM+E) and group subjected to nx5/6 treated or not with enalapril (10 mg / kg oral) (Nx and Nx+E). Kidney samples were sent for histological analysis and evaluation of mRNA expression of Gn, UGn, ANP and membrane guanylate cyclase receptors, GC-A and GC-C, and the clearance receptor (NPR-C). Nx showed increased intrarenal gene expression of Gn (Nx=13.92 ± 5.13; SHAM=1.08 ± 0.20) UGn (Nx= 12.77 ± 7.00; SHAM=1.04 ± 0.13), GC-A (Nx=5.91 ± 1.36; SHAM=1.06 ± 0.17) and NPR-C (Nx=7.84 ± 1.72; SHAM =1.15 ± 12.27), and Nx+E had reduced genes for UGn (Nx+E= 0.10 ± 0.03; Nx = 1.75 ± 0.96), GC-A (Nx + E= 0.031 ± 0.01; Nx= 1.18 ± 0.27) and NPR-C (Nx+E= 0,03 ± 0.01; Nx= 1.8 ± 0.24) when compared to Nx. Together, these data suggest a hyperactivation the path of guanylin in CKD, and modulation of this peptide class by Ang II.

Biography:

Graduated in Pharmacy from the Federal University of Ceará (2010), specialist in transplantation for the University Hospital Multidisciplinary Residency Walter Cantídio (2013-2015). Master´s degree in Pharmaceutical Sciences from the Federal University of Ceará (2015).

Abstract:

Kidney transplantation is the best treatment for patients with chronic renal failure. Procedure that brings many benefits, but the later use of immunosuppressants is associated with the occurrence of adverse drug reactions. Immunosuppressive therapy tends to be specific in each transplant center and consist of a combination of various agents, including corticosteroids, calcineurin inhibitors, antimetabolites and mTOR inhibitors. Patients transplanted due to immunosuppression, have higher incidence of viral, bacterial and fungal infections such as cytomegalovirus, pneumocystosis and candidiasis, it is necessary to include prophylaxis antimicrobial therapy. Immunosuppressive drugs and prophylactic antibiotics are discussed in recent studies about the risk of haematological disorders and bone marrow, report pancytopenia, isolated manifestations of anemia, leucopenia and thrombocytopenia. More specific hematological disorders such as lymphocytic syndrome, erythrocytosis, thrombotic microangiopathy, lymphoproliferative disorder and hemophagocytic syndrome, are less frequent, but have been described. Hematologic changes in renal transplant patients can cause complications life-threatening, so they should be carefully monitored and treated by the health team. The aim of this study was to report the main after renal transplantation hematologic complications described in the literature and its association with the use of immunosuppressive as well as the strategies and protocols for the clinical management of these changes.

Biography:

Abstract:

Backgound: Diabetic nephropathy is associated with specific histological changes. An early detection of the depletion of the glomerular and tubular function can be done, with biomarkers of diabetic disease. The aim of this study, was to evaluate the accuracy of early kidney dysfunction biomarkers in type 2 diabetes.Methods: Patients with type 2 diabetes, were split according to their levels of glycated hemoglobin. Their urine and blood samples were taken to measure Cystatin C (CysC), NGAL, Beta-Trace Protein (BTP) and the first morning void Albumin-Creatinine Ratio (ACR). Patients in the end stage of the renal disease or in dialysis were not included. Receiver-Operating characteristic Curves (ROC) were generated and the Areas Under the Curve (AUCs) were compared with the performance of the biomarkers used in early detection of kidney dysfunction in type 2 diabetic patients. Results: Ninety patients with type 2 diabetes were chosen. CysC was positively correlated with creatinine (p<0.001), Estimated Glomerular Filtration Rate (eGFR) (p<0.001), and urinary βTP (p=0.01). The AUC for CysC was 0.635, 0.621 for serum NGAL and 0.660 for ACR. The crude logistics regression model, observed a positive association between serum CysC (p=0.01), and serum NGAL (p<0.001).The linear regression model, showed a positive association between serum CysC, creatinine and eGFR (p<0.001), but did not show a positive association with Glicated Hemoglobin (p=0.892).Conclusions: NGAL and serum CysC were positively associated with the presence of renal dysfunction and better performance on the ROC analysis in relation to other markers evaluated in patients with T2D without kidney disfunction.

Biography:

Master in Pharmacology from the Federal University of Ceará (2011). PhD in Pharmacology from the Federal University of Ceará (2015), researching the renal effects and cellular fraction L amino acid oxidase (LAAO) isolated from the venom of Bothrops leucurus. Trained on his doctorate sandwich methodologies for signaling of cell death such as flow cytometry, western blott, PCR and immunofluorescence in the center of Investigacion Principe Felipe- CIPF- Valencia-Spain under the supervision of researcher Dr. Mar Orzaez Calatayud. It has experience in Pharmacy, with emphasis in Pharmacology, Physiology, Toxicology, studying mainly toxins in the search for new therapeutic targets.

Abstract:

The pit viper Bothrops leucurus (White-tailed-jararaca) is a poisonous snake habituating area in the northeast of Brazil. The biological effects due envenomation have similar profile than those observed with other Bothrops, such as coagulant activity, hemorrhagic, fibrinolytic, and acute renal failure (ARF). ARF is a common complication caused by Bothrops snakebite with relevant morbidity and mortality. Pathogenesis of ARF in snakebite envenomation may be related to hypovolemia and hypoperfusion secondary to cardiovascular disturbances, deposit of fibrin in the glomerular capillaries leading thrombotic microangiopathy and high venom concentration at the renal tissue, direct venom action on the tubular cells and oxidative stress. Recently, we observed that Bothrops leucurus venom induces nephrotoxicity in the isolated perfused kidney of rats associated with cytotoxicity against renal tubular epithelia cells. In this study, it was evaluated the direct nefrotoxicity of a main component of B. leucurus venom called L-aminoacid oxidase (LAAO-Bl) by using tubular epithelial cell lines MDCK and HK-2. In these cells treated with LAAO-Bl, 1.56 – 100 µg/mL for 12 h, there was a decrease in their viability in a concentration-dependent manner. We next evaluated if necrosis was implicated in the cellular viability decrease observed by analyzing lactate dehydrogenase (LDH) release. In MDCK cells LDH release was not observed after 12 h of LAAO-Bl exposure while LAAO-Bl induced an apparent membrane rupture in HK-2 cells at the highest concentrations studied when compared with untreated cells. Annexin V/PI staining was applied to detect apoptotic/necrotic cells after LAAO-Bl treatment. In MDCK cells, LAAO-Bl significantly increased the percentage of early apoptotic (Annexin-V+, PI-), necrotic (Annexin-V-, PI+) and secondary necrotic cells (Annexin-V+, PI+) when compared with control untreated cells. In HK-2 cells, in accordance with data obtained in the LDH-release assay, the Annexin-V-PI loading cell analysis demonstrated an increase in necrotic (PI+ cells) and secondary necrotic cells (Annexin-V+, PI+) in a concentration-dependent manner. MDCK and HK-2 apoptosis induction was accompanied with Ca2+ release from the endoplasmic reticulum, reactive oxygen species (ROS) generation, mitochondria dysfunction with enhanced expression of Bax protein levels, caspase-3 and caspase-7 activation, suggesting that LAAO-Bl causes nephrotoxicity by acting in multiple cell death pathways. LAAO-Bl (10 µg/mL) exerts significant effects on the isolated kidney perfusion increasing perfusion pressure and urinary flow and decreasing the glomerular filtration rate and sodium, potassium and chloride tubular transport. Taken together our results suggest that LAAO-Bl is responsible for the nephrotoxicity observed in the envenomation by snakebites.

Biography:

Bachelor's at Pharmacy from Federal University of Ceara- UFC (2011) and master's at Pharmacology at the age of 27 from School of Medicine, UFC (2013). Scholarship student of CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) and doctoral studentin Pharmacology from UFC since 2014. Has experience in pharmacology, with emphasis on renal pharmacology, focusing in the following topics: toxinology, venoms and renal alterations. Member of Laboratory of Pharmacology of Venoms, Toxins and Lectins (LAFAVET).

Abstract:

The hyperglycemia associated with transplantation (HAT) is associated with worse patient survival outcomes and renal graft. The aim of this study was to evaluate clinical features and risk factors for the development of hyperglycemia after renal transplantation in a university hospital (Fortaleza / Ceará). This is a retrospective cohort study of kidney transplant patients from July 2012 to July 2013. All 121 transplant patients in this period were selected for the study, 37 patients were excluded for: transfer to another transplant center, death, loss graft, pre-transplant diabetes mellitus or double transplantation during the study. The 84 patients were divided into 3 groups according to glycemic status (normal glycemic, pre-diabetics and diabetics) and parameters were analyzed in laboratory during the period of 1 year post-transplant and hypoglycemic agents used within 2 years after transplantation. Advanced age was the risk factor that had a significant association with hyperglycemia (p <0.05). The percentage of diabetic patients was found to be 8.3% (n = 7) and pre-diabetic 48.8% (n = 41). In the study 14 patients used glucose-lowering drug therapy (oral and / or injectable), being 8 (57.1%) patients in pre-diabetic group and 6 (42.9%) of the diabetic group, with the median time to onset treatment of 216 days, median of 47 days and range from 12-692 days, and hypoglycemic metformin more frequent. The hyperglycemia associated with renal transplantation has a strong relationship with older, so older individuals need more intensive monitoring of glycemic parameters.

Biography:

Graduated in Pharmacy from the Federal University of Ceará (2010), specialist in transplantation for the University Hospital Multidisciplinary Residency Walter Cantídio (2012), Title of specialist in Hospital Pharmacy from SBRAFH (2011) and Master in Pharmaceutical Sciences from the Federal University of Ceará (2014). PhD student in Pharmaceutical Sciences from the Federal University of Ceará.

Abstract:

Antibody-mediated rejection (AMR) is one of the important complications of renal transplant that results in the loss of the kidney graft when not treated. The Ministry of Health of the Brazil recommends the use of immunoglobulin (IVIg) or a combination of plasmapheresis (PP) for treatment. The aim of the study was to identify and describe the results of use of PF, IVIg and RIT in the treatment of AMR in after kidney transplantation in the literature. This is an integrative literature review using the key words: "rituximab", plasmaphereses", "immunoglobulin", "antibody-mediated rejection" and "kidney transplantation" in the databases PubMed, LILACS and Cochrane. Inclusion criteria were studies published between 2005 and 2015, follow-up type with clinical outcome analysis and combination of PP therapy and/or IVIG and/or RIT. The study included six papers, after analysis of 490 articles found. The mean duration of follow-up was 3.8 ± 1.9 years (min: 1, max: 6) and the number of monitored patients was on average 19.3 ± 18.0 (min:7, max:54). The studies analyzed that combined PP, IVIg and RIT, it was evaluated that there was articles in which the graft survival rate was 50% after 10 months of treatment, 71.4% at 1 year and 90% at the end of follow-up two years. In conclusion, the combination of PP, IVIg and RIT is protocol for the treatment of AMR in different transplant centers and were no differences between graft survival rates in relation to follow-up and early treatment, requiring the completion of prospective studies with longer follow-up.

Biography:

Bachelor's at nurse from Universidade de Fortaleza (2009) and master's at Pharmacology from Universidade Federal do Ceará (2011). Fortaleza, Ceará, Brazil. PhD Pharmacology from Universidade Federal do Ceará (Brazil), with research internship in Valencia , Spain (2013). Acting on the following subjects: pharmacology, histology, pathology, physiology, nursing and toxinology. She is currently a professor by Universidade Federal de Pernambuco (UFPE)

Abstract:

The acute renal failure it is one of main complications in lethal cases of snakebites with Bothrops. A recenty proteomic analysis showed that the B. jararaca venom from southeast (SEv) has more metalloproteinases, while the from south (Sv) has a higher amount of venom PLA2. We have studied the renal effects induced by the Bothops jararaca venom from the two populations from geographic isolated regions within the Brazilian Atlantic rainforest, southeastern(SEv) and a southern(Sv). Isolated kidneys from Wistar rats weighing 250 to 300g (n=6) were perfused with Krebs-Henseleit solution containing 6% of bovine serum albumin previously dialysed for 120 minutes. The effects of the SEv and Sv (10µg/mL) were studied on glomerular filtration rate (GFR), urinary flow (UF), perfusion pressure (PP), renal vascular resistance (RVR) and percentage of sodium (%TNa+), potassium (%TK+) and chloride (%TCl-) tubular transport at 60, 90 and 120 minutes of experiment. All data were analyzed by unpaired t test with level of significance of *p<0.05. In the treated group, the addition of the substance occurred 30 minutes (internal control) after the start of the each experiment. Results: The SEv decreased PP and RVR at 60minutes, increased UF at 90 and 120 minutes. Sv decreased GFR at 60, 90 and 120 minutes. It was observed an decrease on the percent of tubular transport of %TNa+, %TK+ and %TCl- at 60, 90 and 120 minutes in the two pools venoms. Discussion and conclusion: Both the venoms, caused significative and different alterations in the renal parameters, and perhaps associated with differences in the protein content of the poison.

Biography:

Professor Elisa Mieko Suemitsu Higa has graduated from Medical School in São Paulo, Brazil. After obtaining the Master and PhD degree at the Nephrology Division of Universidade Federal de São Paulo (UNIFESP), she has been at University of Colorado Health Sciences Center, in Denver, Colorado, USA, for a Post Doctoral Program, under Dr Robert W. Schrier supervision, for 2 ½ years . She obtained a specialization title for Nephrology and Intensive Care Medicine. Currently she is a Full Professor of Medicine Department at Universidade Federal de Sao Paulo, UNIFESP. She is the Chief of Nitric Oxide and Oxidative Stress Laboratory and she is involved in the Translational Medicine and Nephrology Post graduation Programs. In the Laboratory, she has currently 12 students under her supervision, including Research Initiation students (2), Master (7), PhD (2) and Post- doctoral (1) applicants. Prof Elisa is an elected Member of Physiology/ Physiopathology Department of Brazilian Society of Nephrology. She is a peer reviewer for Scientific Journals like PLOS ONE, Nitric oxide, ETAP, BMC Research Notes and Medical Principles and Practice. Research Lines: - Studies on pathophysiology of acute renal failure, diabetic nephropathy, aging and metabolic syndrome, targeting mainly on the role of nitric oxide, oxidative stress and inflammatory mediators. - Studies on alternative approaches for the treatment of chronic kidney diseases: exercises, probiotics and antioxidants.

Abstract:

Introduction: Gentamicin (G) is an antibiotic largely used to treat Gram negative infections; however, its main side effect is the acute tubular necrosis. It was previously observed, both in experimental models in our Laboratory, as in the clinical settings by others, that after suspension of gentamicin, renal function apparently recovers to normal, based on plasma urea and creatinine clearance. However, when the animals or the patients are challenged with the same antibiotic again, or with other nephrotoxins, the reduction of renal function is maximized. Physical activity has been used as an adjuvant tool to prevent many diseases such as hypertension and diabetes. The aim of this study was to evaluate the effects of aerobic exercises on the recovery phase of G induced acute kidney injury (AKI) in rats. Methods: Male adult Wistar rats were allocated into 4 groups: W10+R30, G10+R30, W10+EX30 and G10+EX30; in which W10 received water (G vehicle) and G10 received G for 10 days; R30 remained resting and EX30 made exercise. Moderate training was performed on treadmill during 30 days. Pre and post training, blood and 24hr urine were collected for creatinine, urea, proteinuria, nitric oxide (NO), TBARS (thiobarbituric acid reactive substances, an indirect measurement of lipid peroxidation), ROS (reactive oxygen species) and antioxidant analysis. Post training, kidneys were removed for ROS, antioxidant and histological analysis. Results: After 10 days of G treatment, renal function was decreased, but it was recovered by R30 or EX30; NO synthesis was increased in the plasma and urine, and decreased in the kidney of G10+R30 and G10-EX30 groups. In G10+EX30 vs G10+R30 plasma, urinary and renal TBARS were reduced; catalase, glutathione and superoxide dismutase were increased. Histological analysis showed no difference between these groups. Conclusions: We believe that the aerobic training, through its effect on oxidative stress and on the antioxidant defense, can protect against further functional deterioration that could occur to the kidneys, and/or protect this organ against new insults. Keywords: nephrotoxicity, gentamicin, nitric oxide, acute kidney injury, oxidative stress and antioxidants.

Biography:

Daniela Ponce has completed his PhD in nephrology at the age of 30 years at Botucatu Medical School , Sao Paulo, Brazil. She is Associate Professor of Nephrology from internal medicine department and vice-coordinator of the posgraduate course Pathophysiology in Internal Medicine. She is responsible for the care of hospitalized AKI patients and for the implants of catheters for acute and chronic dialysis. Key Areas: Internal Medicine, Critical Care and Nephrology, mainly in acute kidney injury and chronic kidney disease.

Abstract:

Peritoneal dialysis (PD) may be a feasible, safe and complementary alternative to hemodialyis (HD) not only in the chronic, but also in the acute setting. Recently, interest in using PD to manage acute kidney injury (AKI) patients has been increasing. The Brazilian studies have shown that, with careful thought and planning, critically ill patients can be successfully treated by PD. To overcome some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications and no metabolic control, they have proposed the use of cycles, flexible catheter, and a high volume of dialysis fluid. This knowledge can be used in the concept of unplanned start on chronic PD and may be a tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy. Although data on unplanned initiation of chronic PD are scarce, they indicate that mortality is the same or even better than for unplanned initiation of HD and the number of infectious complications seems to be lower. In conclusion, unplanned PD is an option and should be offered in an unbiased way to all patients without contraindications to starting urgent PD and it should be offered in an unbiased way to all patients without contraindications to PD starting unplanned dialysis.

Biography:

Davide Severino has completed his PhD at the age of 25 years from Faculdade de Ciências da Saúde. In 2010 he iniciates his specialization in Cardiology in the Hospital of Santarém were he is now a attending physician.

Abstract:

Primary cardiac lymphoma is defined as non-Hodgkin lymphoma involving the heart and/or pericardium. It is a rare cancer that primarily affects the right heart and in particular the right atrium. By contrast, renal cell carcinoma is a relatively common cancer, which in rare circumstances can metastasize to the heart. It is now known that there is an association between non-Hodgkin lymphoma and renal cell carcinoma, although the underlying mechanisms are not fully understood. The authors present a case of primary cardiac non-Hodgkin lymphoma in a patient with concomitant renal cell carcinoma and explore the possible reasons for this association

Biography:

Mohamed Siyab Eldin Elsadig Ahmed has completed his doctorate at the age of 39 years from University of Tuebingen. He is the head department of molecular biology. He has published about 10 papers in reputed journals. Ahmed is also an editorial and advisory board member of JBRC.

Abstract:

Anemia in end stage renal disease is attributed to impaired erythrocyte formation due to erythropoietin and iron deficiency. On the other hand, end stage renal disease enhances eryptosis, the suicidal erythrocyte death characterized by cell shrinkage and phosphatidylserine-exposure at the erythrocyte surface. Eryptosis may be triggered by increase of cytosolic Ca2+-activity ([Ca22+]i) and by ceramide, which sensitizes erythrocytes to [Ca2+]i. Mechanisms triggering eryptosis in endstage renal disease remained enigmatic. The present study explored the effect of indoxyl sulfate, an uremic toxin accumulated in blood of patients with chronic kidney disease. In this study Cell volume was estimated from forward scatter, phosphatidylserine-exposure from annexin V binding, ceramide abundance by specific antibodies, hemolysis from hemoglobin release, and [Ca2+]i from Fluo3-fluorescence. Our results showed that a 48 hours exposure to indoxyl sulfate significantly increased [Ca2+]i (≥ 300 μM), significantly decreased forward scatter (≥ 300 μM) and significantly increased annexin-V-binding (≥ 50 μM). Indoxyl sulfate (150 μM) induced annexin-V-binding was virtually abolished in the nominal absence of extracellular Ca2+. Indoxyl sulfate (150 μM) further enhanced ceramide abundance. Finally we concluded that Indoxyl sulfate stimulates suicidal erythrocyte death or eryptosis, an effect in large part due to stimulation of extracellular Ca2+ entry with subsequent stimulation of cell shrinkage and cell membrane scrambling.

Biography:

Abstract:

Introduction- Acute kidney injury (AKI) is now an established and preventable cause for chronic Kidney disease. Poor outcome of Acute Kidney Injury is influenced by severity and duration of AKI... Aims-We hypothesize that recurrent episodes of acute kidney injury are associated with adverse renal and patient related outcome. Material and Methods- Study was undertaken to look into etiological risk factors for recurrent AKI and its effect on renal and patient related outcome. This retrospective analytical study was conducted at tertiary care health care centre from northern part of India from January 2003 to December 2013. All patients with the diagnosis of "acute renal failure" or "acute kidney injury" as their hospital admission diagnosis was identified and individuals with recurrent Acute Injury were included in the study. Results- Recurrent acute kidney injury was found in 21 (0.56%) of 3698 patients who presented with acute kidney injury during the 10 years period. Topical infections were the most common etiology of recurrent AKI followed by rhabdomyolysis and intravascular hemolysis leading to pigment nephropathy. Acute tubular necrosis was the most common histopathological diagnosis among patients biopsied. As the episodes of AKI increased from 2 to >2 episodes, there was poor immediate as well as late renal outcome. 50% were protienuric and 87.5% were hypertensive at 1 year among patients who had >2 episodes of AKI while it was 15.3% and 7.69% among patients having < 2 episodes respectively. Conclusion- Recurrent episodes of AKI are associated with poor patient and renal outcome suggesting that each episode of acute kidney injury needs close evaluation and follow up following hospital discharge with particular attention to renal outcomes.