15^th World Nephrology Conference May 20-21, 2019 Tokyo, Japan

Biography:

Boris Ajdinovic is the Head of Institute for the Nuclear Medicine, Military Medical Academy, Belgrade. He is a Professor and has obtained Doctor of Science degree in Nuclear Medicine. He has graduated from University of Belgrade in 1978 and has obtained Nuclear Medicine specialization. He is an Instructor of Nuclear Medicine for students specializing in internal medicine and surgery from 1985. He has over 250 specialized and scientific published articles and is the recipient of many awards and honors

Abstract:

Objective.The purpose of this study was to evaluate damage of the kidney with Tc99m-DMSA scintigraphy in children with antenatal hydronephrosis (ANH)  and  the influence of other postnatal associated diagnoses on abnormal DMSA findings. Subjects and Methods. DMSA scintigraphy  in 54 children (17 girls and 37 boys), aged from 2 months to 5 years  ( median 11 months)  with 66 antenatally  detected  hydronephrotic renal units (RU) ( 42 unilateral hydronephrosis  – 29 boys and 13 girls;  12 bilateral hydronephrosis – 8 boys and 4 girls) was done.  Male/female ratio was 2,2: 1, unilateral/bilateral hydronephrosis ratio was 4:1 Hydronephrosis classified into three groups according to ultrasound measurement of the antero-posterior pelvic diameter APD) : mild (APD 5–9.9 mm) was present in 13/66 RU, moderate (APD 10–14.9mm) in 25/66 RU,  and  severe (APD ≥ 15 mm)  in 28/66 RU. Simple hydronephrosis was present   in 15 RU,  and  he postnatal associated clinical diagnosis were vesicoureteric reflux (VUR) in 21, pelviureteric junction (PUJ) obstruction  in 7, pyelon et ureter duplex in 11, megaureter  in 11  and posterior urethra valves in 1  RU respectively. Static renal scintigraphy was performed 2 to 3 hours after intravenous (iv) injection of 99mTechnetium labeled dimercaptosuccinic acid (DMSA) using a dose of 50 μCi (1.85 MBq/kg; minimal dose: 300 μCi). Four views (posterior, left and right posterior oblique and anterior) were obtained with a single head gamma camera “Orbiter” filtered with high resolution parallel whole collimator. All images were stored in an Pegasys computer with a matrix size of 256 × 256. The relative kidney uptake (RKU) between the left and right kidney was calculated as an average number counts from anterior and posterior view. Renal pathology was defined as inhomogenous or focal/multifocal uptake defects of radiofarmaceutical in hydronephrotic kidney  or as split renal uptake of < 40%, and poor kidney function was defined as split renaluptake <10%. Descriptive and analytical statistics (SPSS version 20.0) was performed. Analytical statistics implied the non-parametric Mann-Whitney test for determination of statistically significant difference between the normal and pathological findings on DMSA scan. The default level of significance was p<0.05. Results and Conclusions.  DMSA scintigraphy findings in children with ANH  were: decreased or enlarged kidney with inhomogeneous kidney uptake radiopharmaceutical  in 22, irregular shape kidney with inhomogeneous accumulation of radiopharmaceutical in 3, connected ( fused) kidney in 1 patient, and poorly or nonvisual kidney in 14 RU respectively (total 40/66 renal units with pathlogical  DMSA finding, 60,6%)Relative accumulation in hydronephrotic kidney was  less  or equal to  40% in 17 renal units, less than 10  in 14 renal units. Inhomogeneous radiopharmateutical uptake with relative accumulation over  40% was detected  in 9 RU. Regular kidney morphology with homogeneous accumulation of radiopharmateutical (normal DMSA scintigraphy finding) were found in 26/66 renal units (39,4%).  Statistically significant correlation between the degree of the hydronephrosis  (APD) and  DMSA scan finding (p<0.001) and between the degree of the VUR  and  DMSA scan finding (p=0.002)  was established. In our study, other associated diagnosis were not statistically correlated with pathological findings on DMSA scan. On the basis of these results we recommend DMSA scintigraphy in the evaluation renal pathology in children with ANH. Greater number of patients is needed for the estimation of the associated diagnosis (other than VUR) influence on the renal parenchymal damage in children with ANH.

Biography:

Efren A. Hernandez M. studied medicine on the Autonomous University of Coahuila. He made his specialty in Pediatrics in one of the biggest hospitals in Mexico, the National Medical Center La Raza, indorsed by the National Autonomous University of Mexico (UNAM) from 2011 to 2015. Then he studied his medical sub-specialty on Pediatric Nephrology in the National Medical Center of the West (CMNO-UNAM), in Guadalajara, Mexico and finished in 2017. He was the first of his generation to complete the fellowship on Clinical Preparation in Kidney Transplant in Pediatrics at CMNO in 2018. Actually Dr. Efren Hernandez is working in the Mexican Institute of Social Security in Cancun, Mexico

Abstract:

The lack of adherence to treatment in transplant patients is a direct factor associated with the loss of graft and even death. Amongst the tools to measure adherence to treatment is the Simplified Medication Adherence Questionnaire (SMAQ). SMAQ is a brief and simple instrument, based on questions to the patient about his habit in taking medication, validated to measure adherence in patients with kidney transplant. Multiple studies have been conducted to assess adherence to treatment and the repercussion in rejection in patients with poor adherence, but so far, we do not have any study of this type in Mexico. The National Medical Center of the West (CMNO) has the most number of cases of kidney transplants in pediatric patients in Mexico, for this reason, we considered it pertinent to perform this study in the population of CMNO.

The aim of this study was to determine the association of attachment to treatment measured by the SAMQ in the pediatric patients with a history of rejection to kidney transplantation in our hospital.

We performed transversal analysis in pediatric patients with kidney transplant of the Pediatric Hospital of CMNO. We reviewed the clinical records of the patients that came to follow up on January 2017 and applied the SMAQ to those patients.

A total of 89 questionnaires were applied during the period. The SMAQ showed that patients with functional graft were adhered to the treatment 96.7%, while patients with dysfunctional graft had 50% treatment adherence. Patients without treatment adherence have a higher risk of transplant dysfunction (p<0.001). When adherence to treatment is less than 95%, the risk of graft dysfunction is 39% (p = 0.006), compared to those who show adherence to treatment of 95% or more.

Based on the Simplified Medication Adherence Questionnaire (SMAQ), patients who are not adhered to treatment and those who have adherence to immunosuppressive treatment of less than 95%, have a higher risk of graft dysfunction

Biography:

Deepanjan Bhattacharya has completed his MBBS from West Bengal University of Health Sciences and is currently a Postgraduate Resident Doctor in PGIMER, Chandigarh. He has published 5 papers in reputed journals.

Abstract:

Congenital nephrotic syndrome is defined by the presence of nephrotic range proteinuria, hypoalbuminemia and edema, with onset in the first 3 months of life. It is usually secondary to genetic mutations of the components of the glomerular filtration barrier, although infective causes must be ruled out. Congenital heart disease is extremely rare in congenital nephrotic syndrome, accounting for less than 20% of cases and is mostly associated with podocin mutation. We report a 2 month girl, presenting with anasarca in the first 2 months of life and was diagnosed to have congenital nephrotic syndrome. Infectious causes including malaria, cytomegalovirus, toxoplasmosis, syphilis, human immunodeficiency virus and rubella were ruled out. In view of a systolic murmur, echocardiography was done which revealed ostium secundum atrial septal defect and branch pulmonary artery stenosis. Genetic analysis showed homozygous single base pair duplication in exon 20 of the NPHS1 gene (chr19:36332624dupG; Depth: 216x) resulting in a frameshift and premature truncation of the protein 6 amino acids downstream to codon 937 (p.Ser937GlnfsTer6; ENST00000378910.5). This is the first case of NPHS1(nephrin) mutation associated with congenital cardiac disease along with congenital nephrotic syndrome.

Biography:

Osama Mohammady Mohammed working as professor in Cairo University located in Egypt.  Osama Mohammady Mohammed  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.   

Abstract:

Introduction: The Metabolic Syndrome (MS) is a constellation of clinical abnormalities related to insulin resistance and inflammation. The syndrome is now recognized as a risk factor for diabetes and cardiovascular disease in the general population. We studied the prevalence of MS in Egyptian kidney transplant recipients (from Kasr Al-Aini School of Medicine) and its correlation with C-Reactive Protein (CRP), Serum Uric Acid (UA), Alkaline Phosphatase (ALP), different immunosuppressive intakes and Hepatitis C Virus (HCV) in these patients.

Method: The present cross-sectional study was conducted in 2012 on 100 renal transplant recipients, 68 male (68%) and 32 female (32%), with stable kidney function (serum creatinine=1.5±1 mg/dl) in King Fahd Unit, Cairo University. All clinical and laboratory data were recorded, including serum creatinine, UA, cholesterol, Triglyceride (TGL), low-density lipoprotein, High-Density Lipoprotein (HDL), ALP, CRP and HCV Abs. The presence of MS was determined using NCEP-ATP III criteria, with B M used in place of waist circumference.

Result: Patients were divided into two groups-MS (group 1): 26 patients, 12 female (46.2%) and 14 male (53.8%) with a mean age of 34.46±9.69 years; and non-MS (group 2): 74 patients, 20 female (27%) and 54 male (73%), with a mean age of 27±8.33 years. There was a highly significant correlation (P≤0.001) between CRP and MS, BMI and diabetes mellitus, whereas the correlation between CRP and hypertension, ALP, HCV Abs, Alanine Amino Transferase (ALT), TGLs level and HDL was insignificant.

Conclusion: Metabolic syndrome is prevalent in post-renal transplant patients. Serum CRP concentration correlates positively with metabolic syndrome in kidney transplantation patients. The age, weight, BMI, systolic and diastolic BP, serum triglycerides, ALT of MS group were significantly higher than in non-MS group. The duration of hypertension in the MS cases was significantly longer than in non-MS cases.

Biography:

Chanchana Boonyakrai has completed her Master’s degree from Chulalongkorn University and Nephrology study from King Chulalongkorn Memorial hospital. She is the Director of Medicine Department of Taksin Hospital, Bangkok Metropolitan Administration Thailand.

Abstract:

Background: Diabetes confers an increased risk of deteriorating renal impairment. The role of Renin Angiotensin Aldosterone blocking agent (RAAS blocking agent) in treatment diabetic kidney disease needs re-evaluation. The effects of RAAS blocking agents in inappropriate administration (defined as sub-optimal or overdose) on renal event in patients with diabetes were assessed.

Method: In this retrospective 2-year period study from 2016 to 2017, patients with type 2 diabetes were treated with Angiotensin Converting Enzyme (ACE) inhibitors or angiotensin receptor blockers. Multivariable logistic regression model was used to access the risk factors of the rapid decline estimated Glomerular Filtration Rate (eGFR) compared with non-rapid decline eGFR. Secondary renal outcome were composites of new-onset persistent albuminuria in appropriate used RAAS blocking agent compared with inappropriate usage.

Result: Of total 500 patients, 195 (39%) subjects developed to rapidly decreased eGFR of more than 5 ml/min/1.73 m² over one year. There were the significant difference between the rapid decline eGFR group and non-rapid eGFR group, including myocardial infarction (8.21% vs. 1.97%; p=0.001), angina pectoris (10% vs. 2%; p=0.001) higher level of albuminuria (746.37 vs. 281.68 mg/g; p=0.017) and lower level of serum albumin (3.93 vs. 4.22 mg/dl; p<0.001). Multiple logistic regression analysis revealed the significant associations between rapid decline eGFR and myocardial infarction (adjusted odds ratio 3.37 [95% CI 1.24, 9.15]; p=0.017), angina pectoris (adjusted OR 5.49 [95% CI 1.13; 26.74]; p=0.035) and hypo albuminemia (adjusted OR 2.77 [95% CI 1.31, 5.85]; p=0.007). Analysis of RAAS blocking agent showed that there were 281 (56.2%) patients received inappropriate RAAS blocking agents and 219 (43.8) patients received appropriate RAAS blocking agents. There was the significantly association with the risk of new onset micro albuminuria 22% in patients received inappropriate RAAS blocking agents comparing with patients received appropriate RAAS blocking agents (RR 1.22 [95% CI 1.05; 1.43]; p=0.006).

Conclusion: Cardiovascular disease, albuminuria and hypoalbuminemia are the major risk factors leading to rapid decline eGFR developing in type 2 DM patients received RAAS blocking agents. Moreover, the appropriate RAAS blocking agents should be the concerned issue.

Biography:

Piyush Gondaliya has completed his Diploma and Bachelor’s in Pharmacy from L.M. College of Pharmacy (Ahmedabad). He has pursued his Master’s in Biotechnology at NIPER-A. He is currently pursuing his PhD research work in Biotechnology at NIPER-A. He has many publications in reputed journals and his research interests includes exploring role of microRNAs and other epigenetic modifications in diabetic nephropathy.

Abstract:

DNA methylation plays a major role in the pathophysiology of Diabetic Nephropathy (DN). According to recent reports, it has been inferred that hypermethylation could be one of the principle reason behind aggravation in DN condition. Through in silico analysis, an interrelationship between miR-29b and DNA methylation was suggested. We have validated that miR-29b prominently targets DNA Methyl Transferase (DNMT), specifically DNMT1, DNMT3A and DNMT3B. We have developed an in vitro DN model using Renal Proximal Tubule Epithelial Cells (RPTECs), in which there was a significant alleviation in RNA and protein expression levels of DNMT3A, DNMT3B and DNMT1. The developed model also demonstrated downregulation in expression of miR-29b. Our studies have suggested that miR-29b targets DNMT1 via targeting its transcription factor SP1. In addition to this, downregulation of a specific biomarker for kidney injury, tubular kidney injury molecule-1 (KIM-1) and fibrosis causing glycoprotein i.e. fibronectin, was also demonstrated. Hence, the developed model revealed that hypermethylation was a key factor incorporated in DN and miR-29b could effectively ameliorate defensive actions in DN pathogenesis. To further validate this correlation, we developed an in vivo Streptozotocin induced DN model in which we reconfirmed the role of miR-29b in modulation of DNA methylation. Hence, this research suggests role of miR-29b in amelioration of defensive actions in DN and paves the way for microRNA mediated hypermethylation in DN condition.