Day 1 :
Keynote Forum
Anastasia Putintseva
The Federal State Budgetary Institute
Keynote: Case of pregnancy favorable outcome in a patient receiving hemodialysis therapy
Time : 10:00-10:50
Biography:
Anastasia Putintseva is a Doctor working in the Department of Dialysis. She is a Member of the Russian Dialysis Society and a Member of ERA-EDTA. Her area of ​​interest is conservative nephrology, hemodialysis (especially reproductive function in dialysis patients and tourism of dialysis patients) and transplantation. 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 and 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.
- Glomerulonephritis | Urinary tract infections | Treatments in Nephrology | Diabetic Nephropathy | Diabetics and hypertension
Session Introduction
Ala Habaibeh
Dubai Hospital
Title: Title: Childhood hypertension and 24 hours blood pressure monitoring
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
Francesco Paolo Schena
University of Bari, Italy
Title: The global burden of Immunoglobulin a nephropathy. A message for general practitioners and nephrologists.
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 2nd and 3rd decade of life develop the disease; ii) 40% of these patients arrive in ESKD by 20 years from the biopsy-proven diagnosis when they are in a productive working time of their life.
A great effort should be done for the early diagnosis of the disease in individuals who manifest persistent microhematuria and/or mild proteinuria. It is necessary to introduce more stringent indications for kidney biopsy. This preventive approach followed by early therapy may reduce the global burden of end-stage kidney disease caused by IgAN.
Key words: IgA nephropathy, Berger's disease, microscopic hematuria, gross hematuria, kidney biopsy.
Boris Ajdinovic
Military Medical Academy, Belgrade, Serbia
Title: Imaging in children with urinary tract infection
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 1st, 1954. Graduated from the University of Belgrade in 1978, Nuclear Medicine specialization in 1984, and in London in 1987. He defends his doctoral thesis in the field of nuclear medicine in 1996. Instructor of Nuclear Medicine for Students Specializing in Internal Medicine and Surgery from 1985. Since 2004. the head of The Institute for the Nuclear Medicine, Military Medical Academy; since 2011. the head of The Group of Diagnostic Institutes at the Military Medical Academy; since 2012. professor in The Medical School of the Military Medical Academy for the course Nuclear Medicine; 2013. tenured professor for the course Nuclear Medicine. Has over 250 specialized and scientific published articles, in domestic and foreign journals, chapters in books: “The Lung Tumors,” 2000, and “Tc Generators,” 2003; author of the chapter in the textbook for the Medical School in the University of Thessaloniki, 2014; Ajdinović, B. at al., “Normal and pathological parathyroid glands,” Medical College, Belgrade, 2004; Ajdinović, B. at al, “Child with an urinary tract infection,” Belgrade, 2008; Ajdinović, B. at al, “Nuclear medicine - Textbook for students in The Medical School of the Military Medical Academy,” Belgrade, 2015. In charge of the nuclear medical research on kidneys in 1987, and, in 2006, of the research about the urinary tract infection in children; participates in the international project “Variability in DMS scintigraphy findings,” in 2007. From 2011 to 2014, participates in the project “Cellular and molecular pathogenetic mechanisms in disorders of reproduction and genital organs - prevention, diagnostics, and therapy” - subproject: “Treatment of antenatal hydronephrosis” of the Ministry of Science and Technological development; from 2011 to 2015, in charge of the project: Nuclear medical research of urinary tract in children: antenatal hydronephrosis, infection of urinary tract in children, and vesicoureteral reflux as causes of renal parenchymal disease. In 2001, awarded The Medal of White Angel from the president of the SR Yugoslavia; in 2008, “Author of the year” by the Military Sanitation Examination magazine; in 2011, awarded third prize at the first Medicinal Olympics in Thessaloniki, and in 2015, the first prize at the third Medicinal Olympics in Thessaloniki. Member of the World Association of Radiopharmacological and Molecular Therapy of the European Society of Nuclear Medicine, Serbian Medical Society, and the Society of Nuclear Medicine of Serbia.
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.
Mianzhi Zhang
Tianjin GongAn Hospital, Tianjin, China.
Title: Influence of Bushenhuoxue on podocytes of focal segmental glomerulosclerosismice.
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:
Focal segmental glomerulous sclerosis (FSGS) is a common, difficult to treat glomerular disease that can eventually lead to end-stage renal disease (ESRD). Its pathogenesis is not entirely clear, and treatment methods remain controversial. Many studies have shown that podocyte injury at different stages is a key event of FSGS pathology. Consequently, protecting injured podocytes has become a key aspect of current FSGS treatments. The podocyte is an intrinsic, highly specialized kidney cell with limited regenerative ability. It is difficult for the podocyte to repair itself and proliferate when it is damaged or reduced. Podocyte mutations, and changes in their numbers and distribution can cause structural changes and induce albuminuria and glomerular sclerosis. Treatment of FSGS using western medicine does not result in a cure, it is expensive, and there are serious side effects. Traditional Chinese medicine could offer an effective way to treat FSGS. Daningused Bushenhuoxue to treat and cure renal diseases; Bushenhuoxue comprises greater than ten kinds of Chinese herbal medicines that promote blood circulation and Qi, remove blood stasis, and tonify the kidney. We focused on desmin, nephrin and wt1 expression in podocytes of FSGS mice, and their regulation by Bushenhuoxue. We also sought to elucidate the protective mechanisms of Bushenhuoxue on injured podocytes.
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:
How to manage diabetes in dialysis patients?
The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, primarily due to the increased incidence of type 2 diabetes. This overall increase in the number of individuals with diabetes has had a major impact on development of diabetic kidney disease (DKD). Diabetic kidney disease (DKD) affects approximately 20–40 % of diabetic patients prompting to ESRD, making it one of the major and increasing global public health issues.
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.
Amna Khalifa
Dubai Health Authority, Dubai, UAE
Title: Diabetic kidney disease. Measure to slow the progression to ESRF
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.
Ayse Seker,
Dmed Dialysis Center, Turkey
Title: Amyloid goitre in a hemodialysis patient with rhematoid arthritis
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.
Anastasia Putintseva
Russian Dialysis Society,Russia
Title: CASE OF PREGNANCY FAVORABLE OUTCOME IN A PATIENT RECEIVING HEMODIALYSIS THERAPY
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.
Nawaf Oudah M Alhazmi
University of Hail, Saudi Arabia
Title: Relationship between glycated hemoglobin and macrominerals in renal dialysis patients of Hail, Saudi Arabia
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:
DIABETIC NEPHROPATHY (DN)
Mustafa Nur Elhuda, professor of medicine and consultant nephrologist.
Dubai, UAE
DN has now emerged as the most common single cause of ESKD in the world. Indeed, over 40% of patients entering the dialysis programme, do so because of DN. This is basically because of at least two reasons: that diabetes especially T2D is on the increase and secondly because diabetic patients are now living longer as opposed to earlier when these patients were denied treatments like dialysis. However, even now with the full advent of dialysis, the mortality is higher among diabetic patients compared to nondiabetics in the first and fifth year after commencement of dialysis.
DN is thought to result from an interplay between haemodynamic and metabolic factors. The haemodynamic changes of glomerular hyperperfusion and hyperfiltration are evident long before any measurable clinical signs of DN. The best evidence to demonstrate the importance of hyperperfusion in the genesis of DN, is the development of unilateral DN: one kidney is spared the development of DN because of concurrent renal artery stenosis on the ipsilateral side preventing hyperperfusion developing. Hyperglycaemia plays a central role in a cascade of damaging effects mediated by cytokines and growth factors but hyperglycaemia alone is not conclusive. It does not fully explain the risk of diabetic nephropathy as evidenced by experimental studies in which kidneys were transplanted from nondiabetic donors to diabetic recipients; these kidneys developed DN irrespective of the blood sugar level. Hyperglycaemia is therefore important but not enough.
Since not all diabetic patients develop nephropathy, there must be some predisposing factors that put these patients at a higher risk of developing this complication. These factors include genetic susceptibility, hypertension, hyperglycaemia and others which denote the important role of blood sugar and BP control in preventing the development of DN.
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.
Lavinia-Oltita Bratescu
Diaverum Morarilor Nephrology,Romania
Title: Thoracic paravertebral abscess and secondary meningitis in hemodialysed patient – case presentation
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.
Almalki A
Resident Physician at Ministry of Health Saudi Arabia
Title: Cognitive Function Among Hemodialysis Patients in Saudi Arabia: An Observational Study
Biography:
Abdullah AlMalki is a Resident Physician at Ministry of Health Saudi Arabia
Abstract:
Shoab Saadat
Shifa International Hospital, Pakistan
Title: What changes the quality of life in a hemodialysis patient - a machine learning approach
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.