Day 1 :
- Diabetic Nephropathy & Renal Dialysis & Diabetics and Hypertension
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.
DIABETIC NEPHROPATHY (DN)
Mustafa Nur Elhuda, professor of medicine and consultant nephrologist.
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.
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.
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.
Russian Dialysis Society,Russia
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).
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.
University of Hail, Saudi Arabia
Nawaf Oudah M Alhazmi is a medical student at College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia.
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.
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.
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.
Dubai Health Authority, Dubai, UAE
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.
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.
Resident Physician at Ministry of Health Saudi Arabia
Abdullah AlMalki is a Resident Physician at Ministry of Health Saudi Arabia
Shifa International Hospital, Pakistan
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.
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.
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.
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.
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.
- Clinical Nephrologists & Nephrology and Therapeutics
Dr. K.L Gupta is the Chief of Nephrology in the premier Medical Institute i.e. Postgraduate Institute of Medical Education & Research, Chandigarh, India. After having done MBBS in 1976, he had passed MD(Medicine) in 1980 and then Doctorate of Nephrology (DM) in 1983. He is serving as the faculty member in the department of Nephrology at PGI, Chandigarh since 1983 and has over the years has made an excellent contribution different areas including the Clinical, Academics and Research. He has published more than 200 papers in reputed journals and written 10 chapters in different books. He has also been honored with various fellowships of National Academic of Nephrology in India, Royal College of Physicians, UK, and American Society of Nephrology etc.
Acute Kidney Injury (AKI) has been recognized as an important risk factor for Chronic Kidney Disease (CKD). In CKD, dietary protein restriction is used to mitigate its progression by reducing intra-glomerular pressure. We believe that post AKI, the kidney is vulnerable to the metabolic demands and dietary protein control may facilitate renal recovery and retard progression to CKD.
This will be a pilot, single center, open label, randomized, controlled trial of adult subjects who would be recovering from an episode of Stage 2/3 AKI at the Postgraduate Institute of Medical education and Research, Chandigarh, India. The subjects will be randomized to a low protein and KetosterilÒ (LPD-K) or ad-lib diet for 3 months. The randomization procedure will be non-stratified, using random permuted blocks of 4 subjects to guarantee groups of equal size throughout the study. After the 3-month period, subjects will continue ad lib diet and followed for additional three months. Clinical and laboratory investigations details would be recorded every 2 weeks for first 3 months and finally, at the end of 6 months. The primary objective is change in nutritional status (as measured by anthropometry, subjective global assessment, nutrition biomarkers and bioelectrical impedance) at 6 months. The secondary objectives are rate and degree of recovery of renal function at 3 months and proportion of patients who progress to one CKD stage higher than their baseline at 3 months and 6 months.
Recent data suggest that when dietary compliance is achieved in CKD patients, LPD-K diet is feasible for the majority and rate of decline in glomerular filtration rate is significantly lower on LPD-K than on low protein diet alone. Protein restriction has not been studied at all in AKI. It is possible that, by the same mechanisms, LPD-K will reduce the tubular workload in the recovering kidney, ameliorate further tubular damage, and enhance recovery of renal function, or at least retard the progression to CKD. If successful, it will set the stage for a larger trial and might become one of the first interventions to decrease development of CKD following AKI.
Department of Biochemistry, University of Hail, Kingdom of Saudi Arabia
Abdullah Ahmad Jarllah Alkhalaf working as PhD scholar in the University of Hail loacted in Saudi Arabia. Abdullah Ahmad Jarllah Alkhalaf Editorial Board Member of many peer reviewed journals and area of expertise, as an Research Scholar credits with many publications in national and international journals. Abdullah Ahmad Jarllah Alkhalaf committed to highest standards of excellence and it proves through his co-authorship of many books.
The clinical usefulness of gentamicin is limited due to the development of nephrotoxicity. The abnormalities in lipid and lipoprotein pattern produce number of pathological diseases including nephrotoxicity. Reactive oxygen species produce cellular injury and necrosis via several mechanisms including peroxidation of membrane lipids, protein denaturation, and DNA damage. Potential therapeutic approaches to protect (or) reverse GM damage would be having very important clinical consequences in increasing the safety of the drug. Several natural agents have been used to ameliorate drugs toxicity. The survey of literature reveals that the parsley (Petroselinum crispum) are found to be used in the traditional system of medicine. In addition, the aqueous extract of parsley reduced the number of calcium oxalate deposits and therefore parsley can be used for kidney and bladder stones. However, the nephroprotective and antidyslipidemic effect of P.crispum has not been scientifically investigated. So, the present study was design to evaluate the efficacy of parsley (P.crispum) extract and decoction on the kidney of gentamicininduced nephrotoxicity in rats. Freshly prepared ethanolic extract and decoction of P.crispum (PCE and PCD) were orally administered to rats. The altered renal markers (Urea, uric acid, creatinine and BUN) after GM administered were normalized in extracts treated animals. The modified levels of lipid profiles (total cholesterol, triglycerides, phospholipids, HDL, LDL, and VLDL) in GM administered rats were normalized in PCE and PCD treated animals. The membrane stabilizing effects were confirmed by erythrocytes osmotic fragility and to RBC morphology. In conclusion, this study revealed that PCE and PCD administered at a dose of 250mg/kg.bwt and 250mg/kg.bwt were effective respectively. Further, the results of the present study indicate that P.crispum may emerge as a putative nephroprotective, antihyperlipidemic and membrane-stabilizing agent against nephrotoxicity. Further studies need to be undertaken in order to confirm these findings and its extrapolation in humans. Keywords: Petroselinum crispum, gentamicin, nephrotoxicity, RBC and antihyperlipidemic, osmotic fragility, membrane-stabilizing agent.
university hospital of Marrakech,Morocco
Elassas hajar is a second year resident in Nephrology in the university hospital of Marrakech , having her internship in nephropatholgy from 2015 to 2016
Involvement of Religious Factors on the Attitude Toward Organs
Donation Among University students in Morocco
Introduction. The attitude toward cadaveric organ donation is modulated by different factors, such as religious beliefs. This study sought to analyze the attitude of University student in Morocco regarding deceased organ donation depending on their religious beliefs.
Material and Methods. A sample of university students of Marrakech (n =503) stratified by age and sex was selected. Data of this cross sectional study was collected by self administered and anonymous questionnaire from 4 universities in Marrakech . The c2 test, Student t test, and logistic regression analysis were used to analyze data.
Results. Of the 503 survey respondents, 40.3% were females, 40.3% were males. 99.4% (n =500) were Muslims , 0.6% (n =3) were Catholic. Mean age of the sample was 21.5 ± 1.7. 100% of students answered the questionnaire. Majority of students (86.4%) were aware of organ donation in Morocco with media as the main source of information. 57.6% agreed to donate their organs. In the students’ opinion, The most commonly donated organs and tissues were kidney and heart. 24.5% of the students thought that organ donation was performed only in Public hospitals. 33.4% were aware of organs that could be transplanted. A significant association between the religious beliefs and attitude toward organ donation among those tested can be objectified: 60.6% of respondents believed their religion was favorable toward donation and 39.4% consider their religion contrary to donation . Among the respondents who considered their religion contrary to donation , only 45.45% were in favor of cadaveric organ donation (P < .001).
Conclusions. The attitude toward cadaveric organ donation among University students in Morocco
are influenced by religious beliefs and consider what their religion says regarding organ donation.
Faculty of Basic Medical Sciences,Nigeria
Favour N. Beshel has expertise in renal physiology with evaluation and passion in improving the health and wellbeing. She also has expertise in experimentation in hematology and renal physiology using animal models. She has done some research work on humans in the area of respiratory physiology. Her most recent publication exposes the deleterious effects of some commonly ingested substances on the renal function. This study creates awareness on the need for women to do early registrion for antenatal care in reputable health centres.
PROTEINURIA AND GLYCOSURIA OF PREGNANT WOMEN IN CALABAR METROPOLIS
F. N. BESHEL, PhD kidney Functions
Department of Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
Statement of research problem꞉ Proteinuria and glycosuria are common features in pregnancy as a result of the fact that renal function is usually compromised in this state. Some risk factors for this are uncontrolled weight gain, hypertension and genetic predisposition. Unfortunately, in this part of the globe, most women are ignorant of the risk factors and do not register at antenatal clinic on time. Awareness has been ongoing for the past couple of years. The purpose of this study is therefore to access the prevalence of proteinuria and glycosuria in the Calabar metropolis in southern Nigeria. Methodology and theoretical orientation꞉ An epidemiologic study was done employing the use of questionnaires. Personal information was obtained from the pregnant women through dialogue and collection of some other data from their hospital records. Their urine samples were collected after the questionnaires were satisfactorily filled and were there after analysed for protein and glucose. The results showed that most women still registered for antenatal care in their third trimester. As a result, the number of subjects accessed in the first trimester was quite reduced compared to those in their third trimester of pregnancy. Conclusion and significance꞉ There was significant proteinuria and glycosuria in the first and third trimester highlighting the fact that there is need for early antenatal registration. We recommend early screening exercise for pregnant women in order to detect and treat pregnant women who may be predisposed to renal complications in pregnancy.
Banaras Hindu University,India
Biography: Usha working as PhD scholar in the Banaras Hindu University loacted in India. Usha Editorial Board Member of many peer reviewed journals and area of expertise, as an Research Scholar credits with many publications in national and international journals. Usha committed to highest standards of excellence and it proves through his co-authorship of many books.
SLE is a multisystemic autoimmune disorder affecting multiple organs like kidney, heart, lungs, CNS. The lupus nephritis is a very important entity where kidney gets involved and variety of histological lesions are seen which has been classified in six types and treatment differs from class to class Number of markers have been reported from the cytokines namely TN-α, IL-6, IL-10, IL-11, IL-12 etc. The present study has been planned to evaluate role of IL-6 as a diagnostic and prognostic biomarker for this condition
Method and Material- The study has been completed in two years time which included 32 patients on lupus nephritis and 20 healthy controls. Female predominated in the ratio of 7:1. The clinical future was recorded and immunological, urinalysis, biochemical test and immunological test was performed and data was analysed and result were concluded
Summary and Conclusion- The multi systematic involvement is a common presentation at time of inclusion. The renal involvement in the form of proteinurea, hematuria, azotemia were common finding. Patient presenting with hypertension decreased GFR and having class IV lesion showed very poor prognosis. The IL-6 was found to provide simple, non invasive, potential biomarker of the disease activity in patients of lupus nephritis. Urinary IL-6 was significantly high in patient of lupus nephritis. It was also significantly high in patients of class IV lupus nephritis. It showed a positive correlation with serum creatnine and active urinary sediment. Patient having complete remission had normal IL-6 whereas who did not remission at higher level. The present study was carried out for a period of 2 years and the data was small. For establishing the finding of the present study a large perspective multicentric study is recommended.
Arab society of nephrology, Libia
Abdulhafid Shebani, MBBch, MSc, FRCP, currently holds an academic position head of nephrology department at the Libyan national disease control, a role that combines clinical, research and teaching
He qualified from Tripoli University in 1983 and trained in nephrology Tajoura nephrology department
In 1992 he received a MSc degree at university colleague Dublin research tilted “rejection of transplanted organs an immunohistological study “
Trained in St. Vincent's hospital Dublin (94-96) and in St James’s hospital Dublin (96-2000)
2004 Consultant nephrologist to the organ transplantation program in central hospital Tripoli
He is Libya representative to Arab society of nephrology and transplantation و Mediterranean society of transplantation and recently appointed as General Secretary to ASNRT
Classic Fabry disease, an X-linked nephropathy resulting from deficiency of lysosomal α-galacto sidase A, typically leads to renal failure, cardiac disease, and cerebrovascular disease by the third to fifth decades of life.
Nephropathy is one of the major complications of Fabry disease. Kidney biopsies show globotriaosylceramide (GL-3) accumulation in tubular epithelial cells, glomerular and endothelial cells, and vascular smooth muscle cells. With time, progressive GL-3 accumulation leads to microvascular dysfunction, occlusion, and ischemia, with subsequent development of tubular atrophy, segmental and global sclerosis, and interstitial fibrosis. Affected male individuals classically develop ESRD by the fourth decade of life.
Increasing evidence emphasizes the importance of early treatment of Fabry disease, before renal pathology becomes irreversible. The recent randomized, double-blind, placebo-controlled clinical trial of Enzyme replacement therapy (ERT) in Fabry patients with mild to moderate renal failure found that risk rates for renal, cardiac, and cerebrovascular events, together and individually, were significantly decreased in patients on ERT after the pre specified adjustment for baseline proteinuria, particularly in patients with milder renal disease.
The goal for treatment of Fabry nephropathy is reduction in the rate of loss of GFR to #21.0 ml/min per 1.73 m2/yr. Measuring proteinuria and urinary sodium excretion are important first steps. If proteinuria is not controlled, then antiproteinuric dosing increases are recommended, It may be necessary to reduce the dosage of other antihypertensive agents (e.g., b blockers, diuretics, calcium channel blockers) so that ACEI or ARB dosing can be increased.
Enzyme replacement therapy (ERT) with re combinant α-galactosidase A is safe and effective in Fabry disease, reversing pathologic glycosphingolipid deposits in renal vascular endothelial, interstitial, and mesangialcells, and reducing accumulations of these deposits in the podocytes and tubular epithelial cells.
- Treatments in Nephrology & diagnostic and images
Tianjin GongAn Hospital, Tianjin, China.
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.
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.