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