Day 1 :
Keynote Forum
Kuo-Cheng Lu
Fu-Jen Catholic University Hospital
Keynote: Role of nutritional vit-D in secondary hyperparathyroidism
Biography:
A graduate of the National Defense Medical Center (NDMC), Kuo-Cheng Lu joined the NDMC faculty in 1985 after having training at Internal Medicine and Clinical Nephrology. He devoted the first two decades of his career to the clinical care of dialysis patients at Tri-Service General Hospital and private Kou-Cheng clinic in Taipei, Taiwan. At the same time, he conducted bone biopsy (Histomorphometric study) research for renal patients, especially on the osteitis fibrosa cystica (SHPT) and calcitriol therapy. After managing of private dialysis clinic for ten years, he moved to the Nephrology division of Cardinal-Tien Hospital, an affiliated teaching hospital of Fu-Jen Catholic University. In 2003, he was elected as the chairman of Department of Medicine, Cardinal-Tien Hospital. Since 2003, Dr. Lu’s research has moved toward translation study in renal dystrophy focusing on SHPT treatment. The most significant contributions involved an ongoing trans-disciplinary study of renal bone diseases with a goal of identifying significant differences in renal bone diseases among the different degree of turnover status. Dr. Lu also teaches at other medical schools such as Taipei Medical University and National Defense Medical Center. Moreover, Dr. Lu supervised many PhD students who study in the field of bone cell regulation in various clinical diseases. In 2015, Dr. Lu was recruited to join Fu-Jen Catholic University as Associate Dean of College of Medicine, Fu-Jen Catholic University. Since then, Dr. Lu became more interested in potential of large observational data, biology, and pathophysiology with available renal bone disorders, both at the bedside and through translation study. In Dec 2016, this effort was rewarded when he was selected as the Present of Taiwan Society of Nephrology, devoted to improve the high quality multidisciplinary care for CKD patients in Taiwan. Currently, Dr. Lu also pays attention to study on the possible AKI in the development of CKD. This work led him to organize the faculties across many medical centers in Taiwan for the study on how AKI induces CKD, which may be used to address health care quality. Over the years, Dr. Lu has had the privilege of advocating CKD healthcare education in Tanzania, China, Japan and doing research with the professionals in these counties. Dr. Lu also published papers in the field of music therapy in dialysis patients. Currently, Dr. Lu spends much time on the strengthening international collaboration among the Taiwan Society of Nephrology (TSN) and Nephrology Society of Japan, Korea, Thailand and Malaysia to enhance the academic communicate, share the clinical experience and promote CKD education programs.
Abstract:
In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status. For the high prevalence of vitamin-D deficiency (VDD) in hemodialysis patients, an increase in 1α-hydroxylase to 10-fold and decrease in 24-hydroxylase to 1/10-fold highlight the requirement of more 25D in the PTG of SHPT. The expression of CaSR and VDR were also decreased in the PTG cells, which is thought to be related to calcimimetics or calcitriol resistance. A higher proportion of oxyphil cells as hyperplastic parathyroid progression, lower cytosolic DBP content in oxyphil cells, and calcitriol promote vitamin D degradation by enhancing 24-hydroxylase activity all aggravate vitamin D hunger in PTG. Hence, NVD supplementation in SHPT is relative important. Clinically, NVD supplements can effectively restore serum 25D concentration, alleviate the development of SHPT in early CKD, and have benefits in further lowering PTH in moderate to severe SHPT in dialysis patients. However, these benefit of NVD supplement in SHPT need more randomized control trials to prove.
Keynote Forum
Shena Jo A. Capucion-Quebec
Keynote: Treatment outcomes of direct-acting antiviral (DAA) therapy among chronic kidney disease (CKD) and post kidney transplant patients with hepatitis c virus (HCV) infection: Single center experience
Time : 11:10-12:00
Biography:
Dr. Shena Jo A. Capucion earned her Bachelors of Science in Biology from the University of the Philippines. Attended medical school and earned her M.D. from Remedios Trinidad Romualdez Medical Foundation, Tacloban City, Philippines. She completed then her residency in Internal Medicine at National Kidney and Transplant Institute, Philippines. She is currently a senior Adult Nephrology Fellow-in-Training in the same institution.
Abstract:
Hepatitis C virus (HCV) infection is common among chronic kidney disease (CKD) and kidney transplant recipients. Direct acting antiviral (DAA) regimens has been demonstrated to be effective with high sustained virological response (SVR) rates and tolerated in the general population. Data is limited and remains to be confirmed among CKD and kidney transplant recipients. The study aims to investigate treatment outcomes of DAA therapy among CKD and kidney transplant patients with hepatitis C infection. Specifically, it seeks to describe demographics, determine SVR rates, changes in laboratory values, and adverse effects with DAA therapy. Methods: The study employed a retrospective observational study design. It included all cases of CKD and kidney transplant recipients with chronic HCV infection who are >18 year old on DAA Therapy at National Kidney and Transplant Institute, Philippines from December 2015 to December 2016. Descriptive analysis of treatment outcomes, changes in laboratory values, and adverse events. Results: Twelve patients were included, 7 (58%) CKD and 5 (42%) kidney transplant recipients. All patients (100%) had SVR 12. Changes in laboratory values during treatment included; (1) mean increase in creatinine of 0.3 mg/dL vs 0.04 mg/dL, (2) mean decline in hemoglobin of 2 mg/dL vs 1.5 mg/dL, in platelet of 18 x 10^3/uL vs. 7 x 10^3/uL, in ALT levels of 31 U/L vs 27 U/L, and in bilirubin 0.5 mg/dL vs 0.12 mg/dL in CKD and post kidney transplant recipients respectively. One (8.3%) kidney transplant recipient had disorientation but did not lead to treatment discontinuation. Conclusions/Recommendations: Our study showed an SVR12 rate of 100% in both CKD and kidney transplant recipients. Majority did not experience adverse effects during treatment. Further larger studies are needed to validate our findings.
Keynote Forum
Shena Jo A. Capucion-Quebec
Keynote: Treatment outcomes of direct-acting antiviral (DAA) therapy among chronic kidney disease (CKD) and post kidney transplant patients with hepatitis c virus (HCV) infection: Single center experience
Time : 11:10-12:00
Biography:
Dr. Shena Jo A. Capucion earned her Bachelors of Science in Biology from the University of the Philippines. Attended medical school and earned her M.D. from Remedios Trinidad Romualdez Medical Foundation, Tacloban City, Philippines. She completed then her residency in Internal Medicine at National Kidney and Transplant Institute, Philippines. She is currently a senior Adult Nephrology Fellow-in-Training in the same institution.
Abstract:
Hepatitis C virus (HCV) infection is common among chronic kidney disease (CKD) and kidney transplant recipients. Direct acting antiviral (DAA) regimens has been demonstrated to be effective with high sustained virological response (SVR) rates and tolerated in the general population. Data is limited and remains to be confirmed among CKD and kidney transplant recipients. The study aims to investigate treatment outcomes of DAA therapy among CKD and kidney transplant patients with hepatitis C infection. Specifically, it seeks to describe demographics, determine SVR rates, changes in laboratory values, and adverse effects with DAA therapy. Methods: The study employed a retrospective observational study design. It included all cases of CKD and kidney transplant recipients with chronic HCV infection who are >18 year old on DAA Therapy at National Kidney and Transplant Institute, Philippines from December 2015 to December 2016. Descriptive analysis of treatment outcomes, changes in laboratory values, and adverse events. Results: Twelve patients were included, 7 (58%) CKD and 5 (42%) kidney transplant recipients. All patients (100%) had SVR 12. Changes in laboratory values during treatment included; (1) mean increase in creatinine of 0.3 mg/dL vs 0.04 mg/dL, (2) mean decline in hemoglobin of 2 mg/dL vs 1.5 mg/dL, in platelet of 18 x 10^3/uL vs. 7 x 10^3/uL, in ALT levels of 31 U/L vs 27 U/L, and in bilirubin 0.5 mg/dL vs 0.12 mg/dL in CKD and post kidney transplant recipients respectively. One (8.3%) kidney transplant recipient had disorientation but did not lead to treatment discontinuation. Conclusions/Recommendations: Our study showed an SVR12 rate of 100% in both CKD and kidney transplant recipients. Majority did not experience adverse effects during treatment. Further larger studies are needed to validate our findings.
- Pediatric Nephrology | Nephrology and Therapeutics
Session Introduction
Boris Ajdinović
Military Medical Academy, Serbia
Title: Technetium 99M – dimercaptosuccinic Acid Renal Scintigrafy in Children with Antenatal hydronephrosis
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.
Efrén Alejandro Hernández MartÃnez
Mexican Institute of Social Security, Mexico
Title: Association of adherence to treatment evaluated by the Simplified Medication Adherence Questionnaire (SMAQ) with a history of rejection in pediatric kidney transplant
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
Deepanjan Bhattacharya
Postgraduate Institute of Medical Education & Research, India
Title: Congenital nephrotic syndrome and the heart: Lest we forget
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.
- Diabetes and Hypertension
Session Introduction
Chanchana Boonyakrai
Taksin Hospital, Thailand
Title: Prevalence and predictors of glomerular filtration rate decline in patients with diabetic kidney disease using RAAS blocking agents
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.
- Diabetic Nephropathy
Session Introduction
Piyush Kumar Gondaliya
National Institute of Pharmaceutical Education and Research, India
Title: miR-29b modulates DNA methylation in diabetic nephropathy
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.