Biography:

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.

Abstract:

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.

Biography:

Loai A Eid is a Consultant and Head of Pediatric Nephrology Department at Dubai Hospital since 2013. He has done Pediatric Residency and completed Fellowship in Pediatric Nephrology from the Children’s National Medical Center, Washington DC in 2013. Additionally, he has obtained Master of Science degree in Health Science (Clinical & Translational Research) from George Washington University in 2013. He is serving as a Lecturer and Examiner at Dubai Medical College and Adjunct Instructor in Pediatrics at The George Washington University. He has published articles in well-known international journals. He is a Member of the International Pediatric Transplant Association, International Pediatric Nephrology Association, the American Society of Pediatric Nephrology and the American Academy of Pediatrics among others. He is actively involved in clinical researches nationally and internationally.

Abstract:

Introduction: Management of AKI and hyperosmolality using conventional renal replacement methods places patient at higher risk of rapid osmolar shifting that leads to major neurological consequences. CRRT provides the ability to control rate of reduction in osmolality by allowing the adjustment of dialysate solution and narrowing osmolar gap between the patient and dialysate. Further, inefficient solute clearance will less the rate of pH and osmolar changes over time.

Case Presentation: A 16-kg male child with known case of Central Diabetes Insipidus presented unconscious and anuric with septic shock, anemic (Hb 4.8 g/l), AKI (BUN 427 mg/dl, Creatinine 7.6 mg/dl), severe hypernatremia (Na 216 mmol/l), and a PH of 7.0. Measured osmolality was 593 osmols/l. Patient was resuscitated, incubated and shifted to PICU. Inefficient CVVHD using PrismaSate® was begun at 8 mls/kg/hr with an additional 80 meq/l of NaCl to give total Na of 220 meq/L, resulting in a dialysate bath of 550 osmols/l. Patient osmols were recalculated at 3 hours increments and additional Na in the dialysate was decreased as needed.

Results: Based upon patient osmolar changes, additional sodium was adjusted until normal osmols were obtained. Over 72 hours the child had gradual drop of sodium till reaching 170 mmol/l then CVVHD was stopped and patient was shifted to medical treatment of hypernatremia. Over time, patient had recovery of osmols, PH, renal and neurological function and continued on medical management.

Biography:

Hind Hassan Al Nour is a Senior Nephrologist in the Renal Unit of Dubai Hospital, Dubai Health Authority since 1998 to till date. She has received her Medical Bachelor’s degree from Dubai Medical College and completed her Residency in Internal Medicine and Nephrology in Dubai, UAE. She has obtained her MRCP (UK) in 2008 and attended several nephrology courses and conferences including Nephrology course in Harvard Medical School in 2013. She has special interest in educating medical students of Dubai Medical College. She has different publications and clinical research in many international journals.

Abstract:

Post-transplantation diabetes mellitus (PTDM), also known as new-onset Diabetes Mellitus after kidney transplantation (NODAT), occurs in 10-15% of renal transplant recipients and is associated with cardiovascular disease and reduced lifespan. It is considered one of the major complications in kidney transplant recipients and has associated with reduced patient and graft survival. In the majority of cases, PTDM is characterized by β-cell dysfunction, as well as reduced insulin sensitivity in liver, muscle and adipose tissue. Multiple risk factors contributes to the development of post-transplant diabetes including: (1) Immunosuppression medications notably steroids and calcineurin inhibitors (Tacrolimus confers greater risk) also Sirolimus have been associated with greater risk of post-transplant diabetes mellitus, (2) Age higher in recipients with age more than 40 years, (3) Family history of diabetes mellitus, (4) Greater risk in patients with metabolic syndrome (hyperuricemia , hypertriglyceridemia and hypertension) and (5) Recipients of graft from deceased donor. Multiple strategies have been adopted for reducing incidence of post-transplant diabetes mellitus, dietary changes and increase physical activity are the cornerstone of such strategies. Modification of immunosuppression, as for steroid sparing protocols and withdrawal of steroids few days after transplantation have been associated with lower incidence of post-transplant diabetes mellitus only in patients receiving cyclosporine compared to Tacrolimus. Induction with Belatacept has also been associated with less incidence of diabetes mellitus compared with cyclosporine. Evidence-based treatment regimens used in patients with type-2 diabetes mellitus cannot be directly implemented in patients with PTDM. Studies investigating the latest drugs are required to direct the development of improved treatment strategies for patients with PTDM. Glucose-lowering therapy must be compatible with immunosuppressant agents, reduced glomerular filtration rate (GFR) and severe arteriosclerosis. Such therapy should not place the patient at risk by inducing hypoglycemic episodes or exacerbating renal function owing to adverse gastrointestinal effects with hypovolemia. First-generation and second-generation sulphonylureas are generally avoided and caution is currently advocated for the use of metformin in patients with GFR <60 ml/min/1.73 m². DPP-4 inhibitors do not interact with immunosuppressant drugs and have demonstrated safety in small clinical trials.

Biography:

Dr Abhishek Dixit is currently specializing in Nephrology and already is selected for fellowship in Harvard. Valedictorian at Medical school level and has special interest in AKI and Transplantation.

Abstract:

Rhabdomyolysis is characterized by the acute breakdown of skeletal muscle, which can lead to AKI in severe cases. A number of etiologies have been identified in rhabdomyolysis with drugs and trauma account for the majority of cases. Rhabdomyolysis following a massage session is rare. We report a unique case of rhabdomyolysis with AKI following an aggressive massage session. 57 year old gentleman with history of diabetes and hypertension presented with fever, breathlessness and decreased urine output. On investigations it was found that his serum creatinine was 5.7 mg%. Further investigations revealed a Hb of 12.7 gm% and the TLC was 21400/cumm. His other blood tests showed: LDH 1095 U/l, CPK 58928 U/l with 100% of CPK-MM form, potassium 6.7 mEq/l, creatinine 6.3 mg/dl and BUN 76 mg/dl. In view of the hyperkalemia and fluid overload he was dialyzed once and the potassium was corrected. The qualitative test of urine for myoglobin was positive. The time concentration curve of CPK and LDH was similar to that of WBC and CRP level. Downward trend of creatinine also associated with fall in CPK, LDH, CRP and WBC levels. After 2 weeks, patient was discharged with a stable creatinine. To determine the etiology of raised CPK a detailed history was taken and he confessed that he regularly received body massage for 1 hour. However a day prior, he received prolonged body massage session for 2 hours served by two masseurs simultaneously with higher intensity. Compression-induced rhabdomyolysis has been reported in coma or immobilized patients, but it has rarely been associated with body massage. Myoglobinuria is a key player in the complex pathogenesis of AKI only in presence of hypovolemia, hypotension and aciduria. Sinert et al., reported that AKI is not observed when nephrotoxic cofactors are absent. The people receiving body massage should drink adequate amount of water to prevent rhabdomyolysis-associated AKI which is exacerbated by volume depletion.

Biography:

Anandam Sivamani is currently working as an Advanced Clinical Nurse in Singapore. She is an Editorial Board Member of many peer reviewed journals has many publications in national and international journals.

Abstract:

There is an increasing number of aging patients among hemodialysis population. This resulted in an increase in frequency of patient monitoring to ensure timely interventions and early referrals in providing a seamless delivery of care to our patients. There were variations in the way care was delivered among different dialysis centers. Gaps were identified in areas of staff awareness and accountability of patient care due to a lack of an effective primary nursing checklist. Primary nursing is a care delivery system that supports professional nursing practice. In primary nursing, a therapeutic relationship is established between a registered nurse, patient and his or her family. The purpose of the study is to improve nurse’s compliance for primary nursing responsibilities and to improve nurses’ awareness on primary nurse’s role. For the purpose of this study, a descriptive correlational design was used. Registered nurses and enrolled nurses with more than one-year experience in National Kidney Foundation participated in the study. A questionnaire was developed; focusing on nurses’ awareness on primary nursing responsibilities was distributed to all participants. In addition, data collected on nurses’ compliance on carrying out on primary nursing responsibilities by conducting cross audit in 7 dialysis centers. Root cause analysis revealed that there was lack of awareness and non-compliance among nurses due to a non-standard work flow and confusion among nurses related to various reasons. The findings showed that there were improvements in primary nurse’s compliance for primary nursing care from 58.7% to 76.6% and also nurses’ awareness on primary nurse role from 12% to 58%. This study showed that implementation of Primary Nurses Checklist help nurses to organize and prioritize his/her primary nursing responsibility and accountability thus enhancing patients’ continuity of care.

Biography:

Qusay Osman Mohamed Abdalla is a young researcher, has received his Bachelor of pharmacy with emphasis in clinical pharmacy from Omdurman Islamic university in 2016. He is working as attached teacher assistant at clinical pharmacy department at Omdurman Islamic university, he is attached researcher assistant at the national center for research

Abstract:

Acute kidney injury (AKI) is a common disease which has chronic complications and carries a high risk of mortality in Sudan. Despite enhanced education about AKI has been recommended to improve its management, till now no study has determined the gaps in knowledge or practice in Sudan. This study is one of the few studies that reflect the orientation of AKI management in developing countries. Study purpose: To evaluate the awareness among physicians toward management of AKI according to KDIGO guidelines. Methodology & Theoretical Orientation: Descriptive cross-sectional questionnaire survey of 263 physicians via questionnaires sheets with face-to-face interviews, obtained from three main hospitals in Khartoum state, data were collected from May to September, 2016. All physicians’ professional degrees were included and the majority of them were females (54.75%). Findings: The Awareness among physicians toward management of AKI according to KDIGO guidelines expressed as score is found to be (57.85±14.04%, mean score ± Standard Deviation).

Conclusion & Significance: The awareness among physicians toward AKI management is found to be suboptimal and there is substantial requirement to improve their knowledge. There is Significant relationship between physician’s knowledge with continuous education (P= 0.005) and professional degree (P=0.013), while gender is not significantly related (P=0.480). There is a strong relation between hospital and knowledge of physicians (P=0.005), specialized hospital physicians get higher scores. Recommendations: we recommend to perform Continuous education programs to improve the awareness and consequently AKI management. And to direct more studies and research toward AKI issue to improve its management and outcomes

Biography:

Ala A Habaibeh studied Medicine at Jordan University of Science and Technology, Jordan. He has completed his Clinical Fellowship in Pediatric Nephrology at Queen Rania Children’s Hospital and joined Dubai Hospital in 2012. He is a Tutor at Dubai Medical College, Member of the International Pediatric Hypertension Association (IPHA), International Pediatric Nephrology Association (IPNA) and the European Society of Pediatric Nephrology (ESPN).

Abstract:

High blood pressure is the leading risk factor-related cause of death throughout the world. 12.8% of all deaths, 51% of stroke deaths and 45% of coronary heart disease deaths are related to hypertension. In USA, 33% of adult more than 20 years old are hypertensive and after age of 55 years 90% will go on to develop hypertension in their lifetime. From 2011 to 2012 in the United States, the prevalence of high blood pressure in pediatrics was 1.6 %. It was found that the distribution of childhood BP has shifted upward in the United States by 1.4 mm Hg for systolic BP and 3.3 mm Hg for diastolic BP. BMI has the most substantial effect on age related increase in BP as the obese adolescents had 7.6 mmhg higher SBP than normal weight adolescents. It is fundamental to recognize and manage hypertension during childhood, moreover classifying this group of population using ambulatory blood pressure monitoring caries the same importance if not more. 24 hours blood pressure monitoring using ambulatory recorder categorizes the hypertensive child to be pre-hypertensive, hypertensive or severely hypertensive. New blood pressure parameters should be considered when managing a hypertensive patient beside of the systolic and diastolic blood pressure; this includes the systolic and diastolic blood pressure load, the mean arterial blood pressure during sleep and awake period and the dipping. The presentation will focus on our work as a single center experience in managing pediatric hypertension with aid of a 24 hours blood pressure monitoring with further discussion on the indications for routine performance of ABPM, usefulness of ABPM to classify BP, approach for ABPM and its role in diagnosis of pre-hypertension in and the risk of progression to sustained (ambulatory) hypertension

Biography:

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).

Abstract:

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 2^nd and 3^rd 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.

Biography:

The head of Institute for the Nuclear Medicine, Military Medical Academy, Belgrade.  Prof. Dr Sc. Med of Nuclear Medicine. Born in Vrginmost, Croatia, February 1^st, 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.

Abstract:

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.

Biography:

Mianzhi Zhang has completed hisMD from Hebei MedicalUniversity. He has published more than 90 papers in reputed journals.He got the first prize of the provincescience and technology progress award in Tianjin; the fifteenth China youth five four medalandthe specialist of the special government allowances.Heisalsothe jury ofNational Natural Science Foundation.He participated in editing publications such as The Basic Theory of Zhang Daning's Traditional Chinese Medicine,The Research on Zhang Daning's Academic Thoughts,The Study on Zhang Daning's Methods Of The Kidney Invigorating And Blood Activating,The Progress Academic Thought on Zhang Daning,TheBasis And Clinical Treatment of Diabetic Nephropathy.

Abstract:

Biography:

Fakhriya Alalawi is a senior nephrologist in Dubai hospital, Dubai health authority, United Arab Emirates. She had received her Medical Bachelor degree from Dubai medical college in 1995, and then she had completed her residency in Internal Medicine and nephrology in Dubai, United Arab Emirates in 2001. She had obtained her MRCP (UK) in 2004, SCE (UK) in Nephrology in 2012. She is a fellow of American society of nephrology (FASN) and fellow of the Royal College of Physicians of London (FRCP).

Dr. Fakhriya is interested in medical education, as well as Public awareness of kidney disease and she had conducted different clinical audits and has many publications in various nephrology journals.

Abstract:

Managing diabetic patients on maintenance haemodialysis is challenging, as both uraemia and dialysis can complicate glycaemic control by affecting the secretion, clearance, and peripheral tissue sensitivity of insulin.  Moreover, Dialysis patients are at increased risk of hypoglycemia due to decreased clearance of insulin, poor nutritional intake; decreased hepatic gluconeogenesis and altered pharmacokinetics of glucose-lowering drugs by kidney failure while the conventional methods of glycemic monitoring (as glycated hemoglobin (HbA1c), fructoasmine, and glycated albumin) are confounded by the laboratory abnormalities and comorbidities related to ESRD.

There are a number of controversies in regards to the current management of diabetic patients maintained on hemodialysis. Generally Diabetes control should be optimized for each individual patient, in order to reduce diabetes-related complications, minimize adverse events and to increase survival rates among diabetic dialysis patients. However, the role of tight glycemic control in ameliorating the high mortality risk of diabetic dialysis patients is uncertain and does not appear to improve the outcomes in such population.

Ultimately, many glucose-lowering drugs with their active metabolites are metabolized and excreted through the kidneys; hence require dose adjustment or avoidance in dialysis patients.

Biography:

Loai A Eid is a Consultant and Head of Pediatric Nephrology Department at Dubai Hospital since 2013. He has done Pediatric Residency and completed Fellowship in Pediatric Nephrology from the Children’s National Medical Center, Washington DC in 2013. Additionally, he has obtained Master of Science degree in Health Science (Clinical & Translational Research) from George Washington University in 2013. He is serving as a Lecturer and Examiner at Dubai Medical College and Adjunct Instructor in Pediatrics at The George Washington University. He has published articles in well-known international journals. He is a Member of the International Pediatric Transplant Association, International Pediatric Nephrology Association, the American Society of Pediatric Nephrology and the American Academy of Pediatrics among others. He is actively involved in clinical researches nationally and internationally.

Abstract:

Introduction: Management of AKI and hyperosmolality using conventional renal replacement methods places patient at higher risk of rapid osmolar shifting that leads to major neurological consequences. CRRT provides the ability to control rate of reduction in osmolality by allowing the adjustment of dialysate solution and narrowing osmolar gap between the patient and dialysate. Further, inefficient solute clearance will less the rate of pH and osmolar changes over time.

Case Presentation: A 16-kg male child with known case of Central Diabetes Insipidus presented unconscious and anuric with septic shock, anemic (Hb 4.8 g/l), AKI (BUN 427 mg/dl, Creatinine 7.6 mg/dl), severe hypernatremia (Na 216 mmol/l), and a PH of 7.0. Measured osmolality was 593 osmols/l. Patient was resuscitated, incubated and shifted to PICU. Inefficient CVVHD using PrismaSate® was begun at 8 mls/kg/hr with an additional 80 meq/l of NaCl to give total Na of 220 meq/L, resulting in a dialysate bath of 550 osmols/l. Patient osmols were recalculated at 3 hours increments and additional Na in the dialysate was decreased as needed.

Results: Based upon patient osmolar changes, additional sodium was adjusted until normal osmols were obtained. Over 72 hours the child had gradual drop of sodium till reaching 170 mmol/l then CVVHD was stopped and patient was shifted to medical treatment of hypernatremia. Over time, patient had recovery of osmols, PH, renal and neurological function and continued on medical management.

Conclusions: To our best knowledge, this is the first case in literature to have such presentation and manage by this way. The patient presented with severe hyperosmolality and significant metabolic acidosis. A rapid correction of either of these conditions places him at risk for herniation and pontine demyelination. Utilizing a slow approach to osmolar and pH corrections is recommended in the literature to avoid these risky complications. Standard dialysis dosing of 35 mls/kg/hr or 2000 mls/m2/hr will result in significant solute clearance. By making the CVVHD prescription inefficient, one can then do a slow correction of the metabolic acidosis and with manipulation of the sodium bath of the dialysate one can narrow the osmolar gap between the patient and dialysate allowing for slow and continuous correction of the osmolality.

Biography:

Dr. Amna Khalifa Mohamed Salim Al-Hadari  is a Consultant Nephrologist at the Renal Department at Dubai Hospital. Dubai health authority. Dubai, UAE. Where taking an active part in the management of patients  with renal diseases including general nephrology , dialysis , post- transplant follow ups.

obtained  diploma, masters and  MD  in nephrology from Sheffield kidney institute, University of Sheffield, Sheffield , UK from 1999 to 2004.

Dr Amna  is also interested in medical education and member of the Dubai hospital residency program, Supervisor of the resident in nephrology department in Dubai hospital, also a member of the teaching staff of Dubai medical college.

Program director of activities in dubai hospital, also organizer of World Kidney Day in Dubai Health Authority since 2010, which aims at increasing awareness of kidney diseases among the public.

Abstract:

The incidence and prevalence of diabetes mellitus are increasing worldwide, including the burden of its complication. (1) considerable proportion of this burden is attributable to the effect on the on the kidneys, accounting for increased incidence of DKD . (2) IN spite of a well controlled blood sugar and blood pressure , there is a proportion of diabetics who progress to end stage renal failure. Hence pathologic molecular mechanisms of DN, which may provide valuable tools for early diagnosis and prevention of disease have been studied to prevent its progression to end stage renal failure. Currently, there are few therapeutic drugs for DN, which mainly consist of antihypertensive and antiproteinuric measures .  current research into original therapies to treat DN is focusing on the intrinsic renal pathways that intervene with intracellular signaling of anti-inflammatory, antifibrotic, and metabolic pathways.

More over early identification of the complications such as anemia, which are common to both DKD and diabetes, (3) are, therefore, an important therapeutic strategy to improve outcomes in patients with DKD.

The guidelines concern several issues as renal replacement modality selection, glycaemic control, the choice of glycaemia controlling drugs and cardiovascular risk management aiming to improve the quality of life of the patients, as well as to reduce the costs of the medical care.

Biography:

Ayse Seker is currently working as a Faculty of Medicine in Uludag University, Turkey. She has worked as Faculty of Medicine Nephrology in Cumhuriyet University and also worked in Bursa Hayat Hospital as Internal Medicine Specialist.

Abstract:

The association between amyloidosis and collagen vascular diseases such as rheumatoid arthritis is well documented. A 55 years old man with 7 years hemodialysis was assessed for decreased appetite, dysphagia and nausea during hemodialysis session. He had been diagnosed with rheumatoid arthritis 20 years ago and had used prednisone regularly. On physical examination, the thyroid was diffusely enlarged (grade 4) with multiple nodules. He was biochemically euthyroid. Anti-thyroglobulin and anti-thyroid peroxidase autoantibodies were negative. Thyroid ultrasound showed multinodular goiter. Total thyroidectomy was performed. Histopathological examination showed dilated follicles surrounded by abundant homogenous substance which stained positive with Congo red. There was no evidence of medullary carcinoma. Complaints of dysphagia, nausea and decreased appetite of the patient improved after the operation. In literature, amyloid goitre with rheumatoid arthritis in a hemodialysis patient is very rare. Amyloidosis should be considered if there is a goiter that is rapidly growing and causes pressure symptoms in rheumatic disease patients.

Biography:

Anastasia Putintseva is a qualified doctor working in the department of dialysis since 2010. She is a member of the Russian Dialysis Society, a member of ERA-EDTA. Her area of ​​interest is conservative nephrology, hemodialysis (especially reproductive function in dialysis patients and tourism of dialysis patients), transplantation. Regularly improves her level of knowledge, introducing advanced achievements of medicine in practice. Actively participates in scientific and practical conferences, nephrological and dialysis societies of St. Petersburg. Conducts practical exercises with patients in the form of "schools of patients”. In her practice, she widely uses renal replacement therapy (hemodialysis and hemodiafiltration as prolonged and intermittent, constant outpatient dialysis), efferent therapy (plasmapheresis, plasmosorption, intravascular laser therapy, ozone therapy). 

Abstract:

The case features qualified care and treatment in a specialized hemodialysis department of the EMERCOM of Russia in St. Petersburg for a patient aged 39 years with CKD and pregnancy, starting with a preconception preparation. Chronic glomerulonephritis with the outcome to CKD was diagnosed since the patient was 17 y/o. The first pregnancy in the patient was diagnosed at the age of 27 years against the backdrop of a 10-year period of dialysis therapy, which contributed to the normalization of the most important functions of the body, including reproductive. This is evidenced by the fact of overcoming infertility. At the time of the beginning of the pregravid preparation, the duration of the prolonged dialysis therapy was 22 years. This clinical case confirms the high frequency of pregnancy complications, starting already at 12 weeks: cholestasis of pregnancy, anemia. At 16 - 17 weeks gestation cervical insufficiency is formed. Closure of the cervix reduces the incidence of preterm delivery, up to 33 weeks, according to the references. In this case, a contraindication to surgical treatment of the cervical insufficiency is the disease that is a contraindication to the preservation of pregnancy, in particular, CKD. Continued conservative therapy preserves pregnancy at 23-24 weeks in the third level obstetric clinic allowed to prolong for 5 more weeks, prevent the respiratory distress syndrome of fetus using glucocorticoids. The optimum method of delivery was caesarean section. As a result the mother and the child were discharged in satisfactory condition after 7 days and 4 months respectively. 

Biography:

Nawaf Oudah M Alhazmi is a medical student at College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia.

Abstract:

Essential minerals have significant role in the glucose metabolism and energy production inside the cell. Imperfect minerals metabolism have been associated with the increased mortality of renal dialysis patients, but their effects in these patients are less characterized. The literature suggested that the incidence of renal dialysis patients in Saudi Arabia showed rapid increase over the last 3 decades. In the present study, we examined the correlations between levels of minerals (serum calcium, phosphorus and magnesium) and HbA1c in diabetic and non-diabetic renal dialysis patients of Hail region. Total 76 blood samples of renal dialysis patients (diabetic and non-diabetic) were analyzed by using biochemical methods. As expected, no significant relationship was observed (p>0.05) in baseline parameters such as age, sodium, potassium, bilirubin, creatinine, urea and glucose, in both diabetic and non-diabetic renal dialysis patients. The results also showed that there is no significant relationship between calcium and phosphorus, calcium and magnesium as well as magnesium and phosphorus in non-diabetic renal dialysis patients; however, in diabetic patients calcium and phosphorus have minor significant association (p=0.057). Further, there was no significant relationship between phosphorus and HbA1c in both types of renal dialysis patients. However, in diabetic renal dialysis patients there was significant relationship (p<0.05) between calcium and HbA1c as well as magnesium and HbA1c. These preliminary results indicate the supportive role of calcium, magnesium and Hb1Ac in the better management of diabetes. The supplementation of calcium and magnesium might be beneficial to manage energy level associated with weakness in the diabetic patients.

Biography:

Mustafa Nur Elhuda, professor of medicine and consultant nephrologist. Founder of nephrology services in Dubai and the Northern Emirates and a founding member of Seha Dialysis Services in Abu Dhabi.

Abstract:

Biography:

Dr. Entesar is a true veteran Pediatric with over 16 years of experience both in local and international medical institutions. Started her career back in 2000 at al Qasmi Hospital as an intern, she went on to establish herself as an ambitious self motivated pediatric resident at the hospital till 2005. Driven by her insatiable thirst for knowledge and career development within the pediatric realm, Dr. Entesar traveled across the globe to Halifax, Canada, to continue her successful residency endeavor. Soon enough, Halifax’s renowned Dalhousie University made her its chief pediatric resident between 2007 – 2008, followed by a Pediatrics Nephrology fellowship in Hospital for sick Children, Toronto Canada , July2008-Sept2010, and was named chief fellow of Pediatrics nephrology fellows in 2009 -2010.

Equipped with her newly acquired knowledge, Dr. Entesar returned back to her home country and resumed work in Al Qasimi Hospital in 2010 as a General Pediatrician and Pediatrics Nephrologist, in addition to heading the  Accident and Emergency Dept between 2010-2011. Her excellence at her field carried her to new heights as she now Heads the Pediatrics in Dubai Hospital in addition to her role as the Director of Pediatrics Arab Board in DHA since Sept 2014, consultant pediatrician and consultant pediatrics nephrologist and Head of pediatrics nephrology department in DHA, and Head of kidney center and medical co director of AL Jalilah children hospital.

Dr. Entesar academic history is equally impressive. A Bachelor of Medicine and Surgery from Jordan University of Science and Technology, She also achieved the American board of pediatricians, Canadian board of pediatrics and Masters in health care management in Royal college of Surgeons in Ireland, Dubai Campus. through her career, she attended tens of international conferences, and was head speaker at many high level medical gatherings locally and globally. She strongly believes in passing the knowledge to new generations, so she tutored 4th year medical students in Sharjah University Medical School, and also worked in Dubai woman college in Dubai. 

Abstract:

Atypical hemolytic uremic syndrome (aHUS) aHUS is a very cahllenging childhood disease  , often  get missed .

Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease that was first recognized in children but also affects adults. This study assessed the disease presentation and outcome in a nationwide cohort of patients with aHUS according to the age at onset and the underlying complement abnormalities.

Over the past decade, atypical hemolytic uremic syndrome (aHUS) has been demonstrated to be a disorder of the regulation of the complement alternative pathway. Among approximately 200 children with the disease, reported in the literature, 50% had mutations of the complement regulatory proteins factor H, membrane cofactor protein (MCP) or factor I. Mutations in factor B and C3 have also been reported recently. In addition, 10% of children have factor H dysfunction due to anti-factor H antibodies. Early age at onset appears as characteristic of factor H and factor I mutated patients, while MCP-associated HUS is not observed before age 1 year. Low C3 level may occur in patients with factor H and factor I mutation, while C3 level is generally normal in MCP-mutated patients. Normal plasma factor H and factor I levels do not preclude the presence of a mutation in these genes. The worst prognosis is for factor H-mutated patients, as 60% die or reach end-stage renal disease (ESRD) within the first year after onset of the disease. Patients with mutations in MCP have a relapsing course, but no patient has ever reached ESRD in the first year of the disease. Half of the patients with factor I mutations have a rapid evolution to ESRD, but half recover. Early intensive plasmatherapy appears to have a beneficial effect, except in MCP-mutated patients. There is a high risk of graft loss for HUS recurrence or thrombosis in all groups except the MCP-mutated group. Recent success of liver–kidney transplantation combined with plasmatherapy opens this option for patients with mutations of factors synthesized in the liver. New therapies such as factor H concentrate or complement inhibitors offer hope for the future.

Mortality rate was higher in children than adults with aHUS, but renal prognosis was worse in adults than children. In children, the prognosis strongly depends on the genetic background.

Biography:

Lavinia-Oltita Bratescu  working as PhD scholar in the Diaverum Morarilor Nephrology loacted in Romania. Lavinia-Oltita Bratescu  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. Lavinia-Oltita Bratescu  committed to highest standards of excellence and it proves through his  co-authorship of many books.

Abstract:

Background

Catheter-related infections – exit site, tunnel and bacteraemias are common complications and present high morbidity, mortality and costs. Bacteraemias are the most clinically important -potential to transform into sepsis. The prevalent CVC use in patients initiate HD has increased to ~25% while >80%, in some countries.

Materials and Methods

A 67-year-old woman, insulin-requiring diabetes, vascular lesions - by-pass aorto-coronary, left amputation, secondary hypertension, CKD stage 5 is HD initiated by right jugular tunneled CVC - 2016. The malfunctioning CVC is replaced in 2017. After 7 days appear: intens posterior chest pain, fever, absence of infection’signs at exit site, with suspicion of infectious discitis. RMN and CT spine scan have been highlighted paravertebral abscess T3-T5 in contact with right pleura, without neuro surgical indication. After 5 days of treatment with Vancomycin, Rifampicin si Ceftriaxone, febrile syndrome persists; the temporo-spatial disorientation and stiftness of the cervico-thoracic spine appear. LCR examination has put the diagnosis of positive Staphilococcus Aureus meningitis. 14 days of treatment with Linezolid 600mg/day, i.v., together with Vancomycin 500 mg i.v./ HD session and oral Rifampicina 600 mg/day  - 6 weeks is initiated. The patient associates Clostridium Difficile diarrhea, treated with oral Vancomycin in lower doses and on alternate days. Evolution is clinically and paraclinically favorable – RMN and LCR cellularity.

Discussions

The case particularities – 1. Its complexity through the two relatively rare complications – paravertebral abscess and secondary meningitis in patient with many comorbidities and 2. Simultaneos administration of intravenous and oral Vancomycin for bacteraemia and Clostridium Difficile treatment.

Biography:

Abdullah AlMalki is a Resident Physician at Ministry of Health Saudi Arabia

Abstract:

Biography:

 Shoab Saadat working as PhD scholar in the Shifa International Hospital loacted in Pakistan. Shoab Saadat  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. Shoab Saadat committed to highest standards of excellence and it proves through his  co-authorship of many books.

Abstract:

Introduction:

Dialysis patients usually have a long commitment to a certain lifestyle. This, in turn has a significant impact on their quality of life (QOL) irrespective of the modality used (1). Several factors like environmental, social, psychological, financial and physical play an important role in determining the QOL that an individual enjoys (2). Several studies have been carried out worldwide with a purpose of identifying the most significant correlates with a better QOL (3,4). Because, there has been no study specifically aiming at the most important predictors of QOL in Pakistani population in the order of their strength of association using modern machine learning techniques, therefore, the purpose of this study is to produce a classification model for the most significantly associated positive and negative predictors for the QOL in hemodialysis patients in our population. This will be helpful in directing resources to a segment of patients who are at the highest risk of a worsening QOL score.

Methods:

This is a cohort study that will include all the consenting patients (by non-probability convenience sampling) who have received hemodialysis for at least 3 months at the dialysis center of Shifa International Hospital, Pakistan. By the first interim analysis, a total of 78 patients were successfully enrolled. Each patient was administered a proforma containing questions about demographics and the validated Urdu version of WHO BREF questionnaire for the QOL assessment by a MBBS qualified doctor. The same questionnaire was again administered after a month’s period to the same patient by the same investigator. This was to find whether any change in QOL (delta QOL) is associated with another significantly changing variable. Statistical analysis was performed using SPSS version 24, while machine learning algorithms including the classification tree were generated using Orange.

Results:

A total of 78 patients were enrolled and analyzed for the first interim analysis (42 males, 36 females). The mean scores for all the four domains of WHO BREF questionnaire for QOL at the end of the cohort’s observation period of one month were: D1 (Physical) =12.9 (SD=3.7), D2 (Psychological) =15.0 (SD=3.4), D3 (Social) =15.2 (SD=2.75), D4 (Environmental) =16 (SD=2.9) respectively. Initially, a linear regression model (p<0.000) was generated with an R-square of 0.418, which showed monthly income (p<0.000) and serum albumin (p<0.000) to be positively and significantly associated with better quality of life. Later, using machine learning algorithms, two models (classification tree and Naïve Bayes) were generated that would predict an improvement or decrement of 5% in a patient’s BREF QOL score over a period of one month. Classification tree was selected as the most accurate among the two with an area under curve (AUC) of 83.3% for the prediction of 5% increase in QOL and an AUC of 76.2% for the prediction of 5% decrease in QOL over the coming 1 month. The most important variables associated with an increase of QOL by 5% were a positive change in domain 4 (environmental variables), a total QOL score of <65 at the beginning of cohort study, age less than 19 years and higher doses of iron sucrose (>278mg / month) administered. Factors associated with a decrease of 5% in QOL over the following month included a decrease in domains 2, 1 and 3 (psychological, physical and social variables respectively) and a greater than 61 total QOL score at the start of cohort study, in order of their importance.

Conclusion:

There is a significant relationship between a better household income and serum albumin levels with an improved quality of life in patients of hemodialysis. Also, machine learning algorithms can be used to classify patients into those with higher probabilities of having a positive or a negative change of 5% or more in QOL over the coming month. These algorithms also help in identifying the most important factors related with these changes in QOL. This can in turn be used to risk stratify patients and to concentrate on those at high risk to improve the physiological, psychological, social and environmental aspects of their lives.

These results represent an interim analysis into the whole project. The expected duration to complete the study is one year with an expected enrolment of more than 250 patients. A small sample size and patients selected from a single center certainly limit the external validity of this study but with enrolment of more cases, this can be taken care of.

Biography:

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.

Abstract:

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.  

Biography:

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.

Abstract:

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

Biography:

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 

Abstract:

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. 

Biography:

Dr. K.L Gupta is the Chief of Nephrology in the premier Medical Institute i.e. Postgraduate Institute of Medical Education & Research, Chandigarh, India. After having done MBBS in 1976, he had passed MD(Medicine) in 1980 and then Doctorate of Nephrology (DM) in 1983. He is serving as the faculty member in the department of Nephrology at PGI, Chandigarh since 1983 and has over the years has made an excellent contribution different areas including the Clinical, Academics and Research. He has published more than 200 papers in reputed journals and written 10 chapters in different books. He has also been honored with various fellowships of National Academic of Nephrology in India, Royal College of Physicians, UK, and American Society of Nephrology etc.

Abstract:

Background

Acute Kidney Injury (AKI) has been recognized as an important risk factor for Chronic Kidney Disease (CKD). In CKD, dietary protein restriction is used to mitigate its progression by reducing intra-glomerular pressure. We believe that post AKI, the kidney is vulnerable to the metabolic demands and dietary protein control may facilitate renal recovery and retard progression to CKD.

Methods

This will be a pilot, single center, open label, randomized, controlled trial of adult subjects who would be recovering from an episode of Stage 2/3 AKI at the Postgraduate Institute of Medical education and Research, Chandigarh, India. The subjects will be randomized to a low protein and Ketosteril^Ò (LPD-K) or ad-lib diet for 3 months. The randomization procedure will be non-stratified, using random permuted blocks of 4 subjects to guarantee groups of equal size throughout the study.  After the 3-month period, subjects will continue ad lib diet and followed for additional three months.  Clinical and laboratory investigations details would be recorded every 2 weeks for first 3 months and finally, at the end of 6 months. The primary objective is change in nutritional status (as measured by anthropometry, subjective global assessment, nutrition biomarkers and bioelectrical impedance) at 6 months. The secondary objectives are rate and degree of recovery of renal function at 3 months and proportion of patients who progress to one CKD stage higher than their baseline at 3 months and 6 months.

Relevance

Recent data suggest that when dietary compliance is achieved in CKD patients, LPD-K diet is feasible for the majority and rate of decline in glomerular filtration rate is significantly lower on LPD-K than on low protein diet alone. Protein restriction has not been studied at all in AKI. It is possible that, by the same mechanisms, LPD-K will reduce the tubular workload in the recovering kidney, ameliorate further tubular damage, and enhance recovery of renal function, or at least retard the progression to CKD. If successful, it will set the stage for a larger trial and might become one of the first interventions to decrease development of CKD following AKI.

Biography:

 Abdullah Ahmad Jarllah Alkhalaf  working as PhD scholar in the University of Hail loacted in Saudi Arabia. Abdullah Ahmad Jarllah Alkhalaf  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. Abdullah Ahmad Jarllah Alkhalaf  committed to highest standards of excellence and it proves through his  co-authorship of many books.

Abstract:

The clinical usefulness of gentamicin is limited due to the development of nephrotoxicity. The abnormalities in lipid and lipoprotein pattern produce number of pathological diseases including nephrotoxicity. Reactive oxygen species produce cellular injury and necrosis via several mechanisms including peroxidation of membrane lipids, protein denaturation, and DNA damage. Potential therapeutic approaches to protect (or) reverse GM damage would be having very important clinical consequences in increasing the safety of the drug. Several natural agents have been used to ameliorate drugs toxicity. The survey of literature reveals that the parsley (Petroselinum crispum) are found to be used in the traditional system of medicine. In addition, the aqueous extract of parsley reduced the number of calcium oxalate deposits and therefore parsley can be used for kidney and bladder stones. However, the nephroprotective and antidyslipidemic effect of P.crispum has not been scientifically investigated. So, the present study was design to evaluate the efficacy of parsley (P.crispum) extract and decoction on the kidney of gentamicininduced nephrotoxicity in rats. Freshly prepared ethanolic extract and decoction of P.crispum (PCE and PCD) were orally administered to rats. The altered renal markers (Urea, uric acid, creatinine and BUN) after GM administered were normalized in extracts treated animals. The modified levels of lipid profiles (total cholesterol, triglycerides, phospholipids, HDL, LDL, and VLDL) in GM administered rats were normalized in PCE and PCD treated animals. The membrane stabilizing effects were confirmed by erythrocytes osmotic fragility and to RBC morphology. In conclusion, this study revealed that PCE and PCD administered at a dose of 250mg/kg.bwt and 250mg/kg.bwt were effective respectively. Further, the results of the present study indicate that P.crispum may emerge as a putative nephroprotective, antihyperlipidemic and membrane-stabilizing agent against nephrotoxicity. Further studies need to be undertaken in order to confirm these findings and its extrapolation in humans. Keywords: Petroselinum crispum, gentamicin, nephrotoxicity, RBC and antihyperlipidemic, osmotic fragility, membrane-stabilizing agent.

Biography:

Elassas hajar is a second year resident in Nephrology in the university hospital of Marrakech , having her internship in nephropatholgy from 2015 to 2016

Abstract:

Material and Methods. A sample of university students of Marrakech (n =503) stratified by age and sex was selected. Data of this cross sectional study was collected by self administered and anonymous questionnaire from  4 universities in Marrakech . The c2 test, Student t test, and logistic regression analysis were used to analyze data.

Results. Of the 503 survey respondents, 40.3%  were females, 40.3% were males.  99.4% (n =500) were Muslims , 0.6% (n =3) were Catholic.  Mean age of the sample was 21.5 ± 1.7. 100% of students answered the questionnaire. Majority of students (86.4%) were aware of  organ donation in Morocco with media as the main source of information. 57.6% agreed to donate their organs. In the students’ opinion, The most commonly donated organs and tissues were kidney and  heart. 24.5% of the students thought that organ donation was performed only in Public hospitals. 33.4% were aware of organs that could be transplanted. A significant association between the religious beliefs and attitude toward organ donation among those tested can be objectified: 60.6% of respondents believed their religion was favorable toward donation and 39.4% consider their religion contrary to donation . Among the respondents who considered their religion contrary to donation , only 45.45% were in favor of cadaveric organ donation (P < .001).

Conclusions. The attitude toward cadaveric organ donation among University students in Morocco

are influenced by religious beliefs and consider what their religion says regarding organ donation.

Biography:

Favour N. Beshel has expertise in renal physiology with evaluation and passion in improving the health and wellbeing. She also has expertise in experimentation in hematology and renal physiology using animal models. She has done some research work on humans in the area of respiratory physiology. Her most recent publication exposes the deleterious effects of some commonly ingested substances on the renal function. This study creates awareness on  the need for women to do early registrion for antenatal care in reputable health centres.                                                                       

Abstract:

PROTEINURIA AND GLYCOSURIA OF PREGNANT WOMEN IN CALABAR METROPOLIS

F. N. BESHEL, PhD kidney Functions

Department of Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria.

Statement of research problem꞉ Proteinuria and glycosuria are common features in pregnancy as a result of the fact that renal function is usually compromised in this state. Some risk factors for this are uncontrolled weight gain, hypertension and genetic predisposition. Unfortunately, in this part of the globe, most women are ignorant of the risk factors and do not register at antenatal clinic on time. Awareness has been ongoing for the past couple of years. The purpose of this study is therefore to access the prevalence of proteinuria and glycosuria in the Calabar metropolis in southern Nigeria. Methodology and theoretical orientation꞉ An epidemiologic study was done employing the use of questionnaires. Personal information was obtained from the pregnant women through dialogue and collection of some other data from their hospital records. Their urine samples were collected after the questionnaires were satisfactorily filled and were there after analysed for protein and glucose. The results showed that most women still registered for antenatal care in their third trimester. As a result, the number of subjects accessed in the first trimester was quite reduced compared to those in their third trimester of pregnancy. Conclusion and significance꞉ There was significant proteinuria and glycosuria in the first and third trimester highlighting the fact that there is need for early antenatal registration. We recommend early screening exercise for pregnant women in order to detect and treat pregnant women who may be predisposed to renal complications in pregnancy.

Biography:

Biography: Usha working as PhD scholar in the Banaras Hindu University loacted in India. Usha 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. Usha committed to highest standards of excellence and it proves through his  co-authorship of many books.

Abstract:

Introduction-

SLE is a multisystemic autoimmune disorder affecting multiple organs like kidney, heart, lungs, CNS. The lupus nephritis is a very important entity where  kidney gets involved and variety of histological lesions are seen which has been classified in six types and  treatment differs from class to class Number of markers have been reported from the cytokines namely TN-α, IL-6, IL-10, IL-11, IL-12 etc. The present study has been planned to evaluate role of IL-6 as a diagnostic and prognostic biomarker for this condition

Method and Material- The study has been completed in two years time which included 32 patients on lupus nephritis and 20 healthy controls.  Female predominated in the ratio of 7:1. The clinical future was recorded and immunological, urinalysis, biochemical test and immunological test was performed and data was analysed and result were concluded

Summary and Conclusion- The multi systematic involvement is a common presentation at time of inclusion. The renal involvement in the form of proteinurea, hematuria, azotemia were common finding. Patient presenting with hypertension decreased GFR and having class IV lesion showed very poor prognosis. The IL-6 was found to provide simple, non invasive, potential biomarker of the disease activity in patients of lupus nephritis. Urinary IL-6 was significantly high in patient of lupus nephritis. It was also significantly high in patients of class IV lupus nephritis. It showed a positive correlation with serum creatnine and active urinary sediment. Patient having complete remission had normal IL-6 whereas who did not remission at higher level. The present study was carried out for a period of 2 years and the data was small. For establishing the finding of the present study a large perspective multicentric study is recommended.   

Biography:

Abdulhafid Shebani, MBBch, MSc, FRCP, currently holds an academic position head of nephrology department at the Libyan national disease control, a role that combines clinical, research and teaching

 He qualified from Tripoli University in 1983 and trained in nephrology Tajoura nephrology department

In 1992 he received a MSc degree at university colleague Dublin research tilted “rejection of transplanted organs an immunohistological study “

Trained in St. Vincent's hospital Dublin (94-96) and in St James’s hospital Dublin (96-2000)

2004   Consultant nephrologist to the organ transplantation program in central hospital Tripoli

He is Libya representative to Arab society of nephrology and transplantation Ùˆ Mediterranean society of transplantation and recently appointed as General Secretary to ASNRT 

Abstract:

Classic Fabry disease, an X-linked nephropathy resulting from deficiency of lysosomal α-galacto sidase A, typically leads to renal failure, cardiac disease, and cerebrovascular disease by the third to fifth decades of life.

Nephropathy is one of the major complications of Fabry disease. Kidney biopsies show globotriaosylceramide (GL-3) accumulation in tubular epithelial cells, glomerular and endothelial cells, and vascular smooth muscle cells. With time, progressive GL-3 accumulation leads to microvascular dysfunction, occlusion, and ischemia, with subsequent development of tubular atrophy, segmental and global sclerosis, and interstitial fibrosis. Affected male individuals classically develop ESRD by the fourth decade of life.

Increasing evidence emphasizes the importance of early treatment of Fabry disease, before renal pathology becomes irreversible. The recent randomized, double-blind, placebo-controlled clinical trial of Enzyme replacement therapy (ERT) in Fabry patients with mild to moderate renal failure found that risk rates for renal, cardiac, and cerebrovascular events, together and individually, were significantly decreased in patients on ERT after the pre specified adjustment for baseline proteinuria, particularly in patients with milder renal disease.

The goal for treatment of Fabry nephropathy is reduction in the rate of loss of GFR to #21.0 ml/min per 1.73 m2/yr.  Measuring proteinuria and urinary sodium excretion are important first steps. If proteinuria is not controlled, then antiproteinuric dosing increases are recommended, It may be necessary to reduce the dosage of other antihypertensive agents (e.g., b blockers, diuretics, calcium channel blockers) so that ACEI or ARB dosing can be increased.

Enzyme replacement therapy (ERT) with re combinant α-galactosidase A  is safe and effective in Fabry disease, reversing pathologic glycosphingolipid deposits in renal vascular endothelial, interstitial, and mesangialcells, and reducing accumulations of these deposits in the podocytes and tubular epithelial cells.