Annual Congress on Nephrology & Hypertension December 06-07, 2018
Hotel Hyatt Place Amsterdam Airport, Netherlands

Biography:

Peter Rutherford qualified in Medicine from Newcastle University, UK and then completed nephrology training in the UK and at the Yale School of Medicine, USA, obtaining a PhD in 1994. Following 11 years as Senior Lecturer in Nephrology, Consultant Physician he moved to Pharma in 2007 and is now Global Medical Lead for Rare Renal Diseases at Vifor Pharma. He has over 70  peer reviewed publications and has a particular research interest in patient education and decision making.

Abstract:

ANCA-associated vasculitis (AAV) is a major challenge for nephrologists due to acute kidney injury and progressive renal disease. It is a relapsing remitting disease with relapses occurring in 5-10% patients/year. This study examined presenting illness, clinical outcomes and treatment adverse events (AEs) at baseline, 1, 3, 6 and 12 months following relapse of AAV. A retrospective clinical audit of 1197 patients in 4 European countries included 268 with acute relapse. Mean age was 58.3 years (± 13.2 SD), 60% male and more granulomatosis with polyangiitis and proteinase 3 positivity (54.1%). Renal relapse was common (73%) as was haematuria (59%). Only 16.0% patients had no comorbidity and 7.1% had experienced a previous steroid AE when initiated with induction therapy time of the relapse Response to induction treatment was variable. Among patients seen at month 1, only 18.5% had a full response (no vasculitis activity and steroid taper on track), 71% had a partial response only, and 10% were refractory to treatment. Early response was predictive of full response at 12 months (81% of month 1 full responders vs 49% of month 1 partial responders). Treatment AEs were common particularly early in relapse (54.3% of patients seen at 1 month), as was infection (53.4% of patients seen at 1 month). AAV relapse often has renal involvement, and AEs and infection add to cumulative organ damage in these patients. Response to treatment is variable but early responders are more likely to be in remission still at 12 months. New therapy advances should focus on improved efficacy and lower AE burden.

Biography:

Nicholas Lever graduated from University of Bristol in 1996 and was appointed as a Consultant Nephrologist  in 2013. He practices at Queens Hospital where he is the Clinical and Academic Lead for the Department. He is actively involved in improving kidney disease both in the primary and secondary care setting. 

Abstract:

Introduction:

Acute Kidney Injury (AKI) is a prevalent clinical feature in the secondary care setting, the severity of which is correlated with mortality. The NCEPOD AKI Audit 2009 identified substandard management of AKI across NHS England despite the availability of clinical guidelines (e.g. KDIGO) and protocol driven measures such as 'AKI care bundles'. Barking, Havering and Redbridge University Hospitals Trust (BHRUT) present an audit examining the efficacy of a dedicated ‘AKI Nurse' service employing a systematic approach to oversee management of patients with AKI across the medical and surgical specialities.

Method:

Baseline data were retrospectively obtained from patients admitted to BHRUT identified as AKI-3 as defined by the KDIGO criteria from 2015-17 (n=389).

Outcomes of interest:

1. Length of hospital stay
2. Mortality during hospital stay

Patients with CKD4 and 5 or on dialysis were excluded.

Intervention:

Patients with AKI-3 were identified to the AKI Nurse by the laboratory software prompting clinical review, ensuring implementation of the trust’s AKI care bundle and promoting appropriate consultant review. After implementation, further patient data meeting the same inclusion/exclusion criteria were collected for a period of 12 months (n=303).

Results and Conclusion:

Initial analysis demonstrates a reduction of inpatient mortality post intervention (32.3% Vs 48%). A small expected increase inpatient stay was identified in those who did not suffer inpatient mortality (13 days Vs 18 days). Additionally, the mean length of stay for all patients was again expectedly increased (18.6d vs 12d). These initial findings suggest an improvement in patient outcomes with the input of a dedicated AKI Nurse service.

Biography:

Nikhil has completed his MBBS from KLE University,Belgaum and postgraduate studies from KIMS university, Karad, currently he is the DNB resident at Jupiter Hospital,Thane. Dr.Paramanand is the head of Pediatric ICUs at Jupiter Hospital,Thane & Honorary Consultant at B.J.Wadia hospital,Parel.Dr.Uma Ali is consulting pediatric nephrologist at Jupiter hospital,Thane & Ex Head of Pediatric ICU at B.J.Wadia hospital,Parel.

Abstract:

A  41days female infant presented with h/o refused feeds, fever, convulsions, hypotension, decreased urine output,admitted outside for same complaints for 3 days then referred .Birth History: PT, 32 weeks, RDS, LBW, received Surfactant and  CPAP ventilation for 6 days .Child was drowsy with generalized abdominal distension and no urine output in past 24 hours.RFTs were grossly derranged with high BUN,Creatinine & Potassium.Blood & Urine Cultures sent.USG Abdopelvis suggested Gross B/L Hydronephrosis with both Ureters not visualized, Bladder collapsed, Ascites with debris in pelvicalyceal regions.Suspecting Fungal Urosepsis,started on Inj Fluconazole and Piptaz,transfused with PRBC, FFP and prepared for Peritoneal Dialysis,intubated and PD was started.Percutaneous Nephrostomy Tubes were inserted bilaterally under USG guidance,urine samples from tubes also sent for culture and Irrigation of Fluconazole through PCN was started along with Inj  Fungisome therapy.PD was stopped after 4 days as  hemodynamics and RFT improved.Urine Cultures grew Candida albicans,sensitive to Fluconazole.Extubated and weaned off respiratory support, started on feeds as tolerated, fluids  tapered.Urine culture after 2 weeks showed E. Coli growth(>1,00,000 CFU) , Inj  Tigecycline and  Collistin added as per sensitivity.Gradually, due to decreasing output from PCNs and repeat USG showing clearing of fungal pus pockets from PC systems,PCNs were clamped and removed.Repeat Urine Culture showed no growth.Baby was given Inj Fluconazole for 42 days, Inj Colistin & Inj Tigecycline for 14 days, on full feeds with adequate per urethral urine output, hemodynamically stable, with normal RFT, latest Urine Cultures showing no growth, good weight gain on follow up.

Biography:

L.Sadaoui is a Doctor in Nephrology CHU Oran in Algeria. His research interest are Nephrology, Haemodialysis, Diabetis.

Abstract:

Pathological fractures are common among dialysis patients. They are related to a disturbance of the phosphocalcic balance with consequent qualitative and quantitative bone involvement. They often occur during a minor trauma, sometimes they are spontaneous. Fractures of the femoral neck, seem to be very frequent, they strike earlier and more frequently women than men, their gravity comes from the fact that they engage the functional and vital prognosis because of the difficulty of their therapeutic management. We report the observation of 03 hemodialysis patients including one man and two women who presented femoral neck fractures of different grades, simple and complex and whose evolution was pejorative for two of them

Case 1: patient G. A 67-year-old with end-stage renal failure of undetermined etiology, hemodialysis for more than 20 years, with severe bone and mineral disorders including hypercalcemia, hyperphosphatemia and refractory hyperparathyroidism, vascular calcification (aortic arch, radial artery, and femoral), experienced a sharp pain, after a fall, at the wrist and hip (right side) for which a standard radiograph objectified a double fracture of the cervical femoral cervical Garden II and subtrochanteric and a fracture of the upper end of the radius. In view of the significant fragility of the bone, the patient benefited from a plaster immobilization. The evolution was marked by disabling sequelae. 

Biography:

Peter Rutherford qualified in Medicine from Newcastle University, UK and then completed nephrology training in the UK and at the Yale School of Medicine, USA, obtaining a PhD in 1994. Following 11 years as Senior Lecturer in Nephrology, Consultant Physician he moved to Pharma in 2007 and is now Global Medical Lead for Rare Renal Diseases at Vifor Pharma. He has over 70  peer reviewed publications and has a particular research interest in patient education and decision making.

Abstract:

ANCA-associated vasculitis (AAV) is a major challenge for nephrologists due to acute kidney injury and progressive renal disease. It is a relapsing remitting disease with relapses occurring in 5-10% patients/year. This study examined presenting illness, clinical outcomes and treatment adverse events (AEs) at baseline, 1, 3, 6 and 12 months following relapse of AAV. A retrospective clinical audit of 1197 patients in 4 European countries included 268 with acute relapse. Mean age was 58.3 years (± 13.2 SD), 60% male and more granulomatosis with polyangiitis and proteinase 3 positivity (54.1%). Renal relapse was common (73%) as was haematuria (59%). Only 16.0% patients had no comorbidity and 7.1% had experienced a previous steroid AE when initiated with induction therapy time of the relapse Response to induction treatment was variable. Among patients seen at month 1, only 18.5% had a full response (no vasculitis activity and steroid taper on track), 71% had a partial response only, and 10% were refractory to treatment. Early response was predictive of full response at 12 months (81% of month 1 full responders vs 49% of month 1 partial responders). Treatment AEs were common particularly early in relapse (54.3% of patients seen at 1 month), as was infection (53.4% of patients seen at 1 month). AAV relapse often has renal involvement, and AEs and infection add to cumulative organ damage in these patients. Response to treatment is variable but early responders are more likely to be in remission still at 12 months. New therapy advances should focus on improved efficacy and lower AE burden.

 

Biography:

Brenda Luna is a PhD student in the Deparment of Pharmacology from Center for Research and Advanced Studies of the National Polytechnic Institute (Cinvestav-IPN). Her research is focused on renal regeneration in early stages of diabetes and the analysis of the expression and function of Gas1 protein in the kidney.

 

Abstract:

In the present study, we evaluated whether the decrease in Gas1 expression favors the activation and differentiation into podocytes of the progenitor cells (PC`s) of the Bowman's capsule (BC), in a model of experimental murine diabetes. We describe for the first time that parietal cells of BC express Gas1 and observe that in  early stages of diabetes its expression is decreased. On the other hand the expression of progenitor cell markers like NCAM, CD24 and SIX1/2 is augmented, suggesting that PC`s of BC are activated and/or proliferating. When the PC`s are activated, they express mesenchymal renal markers. To determine if the decrease of Gas1 in the BC favors this process; we analyzed PAX2 and we found that the expression of PAX2 increases in diabetes. In order to study if these PC`s that are  activated can be differentiate into podocytes. We analyzed in the BC the expression of Wilms tumor protein 1 (WT1), a specific podocyte marker and noticed that the number of WT1+ cells augmented in diabetes in comparison to controls. We explored the expression of Gas1 in other nephron segments; we found that Gas1 is also expressed in the collecting duct in diabetic and control condition, mainly at the principal cells. These findings suggest that diabetes induces a decrease in the expression of Gas1 and this possibly promotes the activation and differentiation of PC`s into podocytes. We propose that Gas1 is a novel protein in kidney with an important role in renal regeneration at the early stages of diabetes.

 

 

Biography:

Aamer Mehmood Khan did my graduation MBBS from Rawalpindi Medical College Pakistan(Punjab University) in 1999 then started residency in pediatric .I did my DCH in 2003 from Karachi University and completed my fellowship (FCPS)in pediatric in 2005 then went to do post fellowship(IPNA) in pediatric nephrology from Singapore in 2008.Currently working as senior pediatrician/pediatric nephrologist/faculty  at Mafraq Hospital ,Gulf Medical University,Abu Dhabi  ,United Arab Emirates.I published and presented many presentations’ at various forums.

Abstract:

Hypertension is one of the most common and well known complications following diabetes and heart diseases in adult population but etiology and presentation of hypertension in pediatric population is quite different.Yet,despite numerous available resources and therapies, many hypertensive kids continue to have poorly controlled blood pressure management in this population might be inadequate . We will try to define hypertension in kids,will discuss different causes and managing issues in pediatric population.We also discuss different options how to evaluate hypertension in children.In addition we will try to discuss best treatment options in children.In this educational review we discuss key elements of managing blood pressure in children and suggest ways that may be reliably implemented in to clinical practice.

Biography:

Wafaa Abdel-Rehim works as assistant professor of biochemistry, Medical Research Institute, Alexandria University, Egypt. I have published more than 20 papers in reputed journals, including Journal of Cellular Biochemistry in 2017 and Biological Chemistry in 2016. 

Abstract:

Background: klotho is recognized as an anti-aging protein, protects the cardiovascular system through endothelium – derived NO. Klotho deficiency disturbs endothelial integrity, but the molecular mechanism is not fully clarified.

Objective: To observe the relationship between klotho protein and biochemical marker of oxidative stress, endothelial dysfunction and arterial aging in non-treated and ACEI-treated patients with essential hypertension (EH).

Subjects& Methods: 80 subjects with essential hypertension, divided into two groups the first didn’t receive any hypertensive treatment (n=40) while the other (n=40) received angiotensin converting enzyme inhibitors (ACEIs), and 20 age and sex matched controls were included in the study. Serum levels of nitric oxide (NO), malondialdehyde (MDA), vascular endothelial growth factor-A (VEGF-A) and klotho protein were measured. Carotid Intima- Media Thickening (IMT) were determined by ultrasonography for all participants.

Results: Mean values of MDA, VEGF-A and IMT revealed significant increment while those of NO and Klotho showed significant reduction in non-treated EH patients compared to controls. Mean levels of MDA, VEGF-A and IMT showed significant reduction while those of NO and Klotho exhibited significant elevation in ACEI- treated patients compared to corresponding values of non-treated ones. Significant negative correlation between serum MDA concentration and NO levels and positive correlation between klotho level and NO were observed in the present study. 

Conclusion: soluble klotho may become an important target in vascular medicine, mainly in situations where senescence and stress is responsible for accelerated vascular damage as in hypertension. The addition of exogenous klotho may prevent the oxidative stress that induces premature senescence.

Biography:

Jaiju James Chakola has completed MBBS at the age of 24 years from Cochin University of Health And Technology and his MD Pediatrics at the age of 29 years from Rajiv Gandhi University of Health Science and is currently pursuing his DM Nephrology at Sri Ramachandra Institute of Higher Education and Research Centre, Chennai, India.

 

Abstract:

Dengue is a growing public health problem and AKI is one of the major complications of dengue virus infection. A total 922 dengue patients (2017–2018) were retrospectively evaluated and were stratified into AKI and non-AKI groups. Two groups were compared using appropriate statistical methods. There were 103 patients (11.2%) who had AKI, with AKIN-I, II and III in 68.8%, 23.6% and 7.6% patients, respectively. Significant differences (P<0.05) in demographics and clinic-laboratory characteristics were observed between patients with and without AKI. Presence of DHF [OR (95% CI): 8.0 (3.64–17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04–20.49)], MODS [OR (95% CI): 34.6 (14.14–84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12–19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12–19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12–19.86), P = 0.006] were associated with AKI. Longer hospital stay (>7 days) was also observed among AKI patients (OR = 1.3, P = 0.044). Additionally, 24.5% AKI patients had renal insufficiencies at discharge that were significantly associated with severe dengue. Overall mortality was 1.8% and all fatal cases had AKI. The incidence of AKI is high at 11.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stay and poor renal outcomes.

 

Biography:

In Young Cho has her expertise in chronic disease care and is dedicated to improving the health and wellbeing of her patients. She has been responsible for treating patients with tobacco dependence at the smoking cessation clinic in Seoul National University Bundang Hospital.

 

Abstract:

Bakground: Chronic kidney disease can increase the risk for cardiovascular diseases, and cardiovascular diseases contribute to a significant proportion of morbidity and mortality in CKD patients. While smoking is a strong risk factor for CVD complications, currently no population-based studies are available examining change in smoking habit behavior in newly diagnosed CKD patients. Therefore, this study aimed to examine the prevalence of sustained smoking among patients recently diagnosed with CKD, and factors associated with persistent smoking. Patients & Methods: Data was collected from a cohort study using representative samples in the Korean National Health Insurance database. A total of 10,473 male CKD patients who were first diagnosed between January 1, 2004 and December 31, 2011 were included in the study. Change in smoking status, and demographic, socioeconomic and clinical variables were examined for association with sustained smoking. Results: Out of 935 male smokers newly diagnosed with CKD, 628 (67%) continued smoking while 307 (33%) quit. Multivariate logistic regression analysis showed that persistent smoking after diagnosis of CKD was associated with younger age at diagnosis and higher fasting blood glucose levels. Conclusion: Almost two-thirds of men continue to smoke after being diagnosed with CKD, suggesting that more can be done to encourage and help men recently diagnosed with CKD to quit smoking. Men who are younger, and who may benefit most from early interventions for smoking cessation, are less likely to quit, suggesting that future smoking cessation policies should take into consideration this population.

 

Biography:

Joana Manuel  Tavares is a student researcher in Nephrology Department, Centro Hospitalar do Porto. Her research interest is in Nephrology, Kidney Transplant, Pathology.

 

Abstract:

INTRODUCTION AND AIMS: In Europe the incidence of pauci-immune glomerulonephritis, the most common cause of crescentic glomerulonephritis, has presented an increasing trend until the beginning of the millennium. We wanted to analyze retrospectively the characteristics, the presentation and long-term outcomes of our cohort of ANCA-associated vasculitis (AAV) diagnosed patients in whom a biopsy was performed.  

METHODS:  In 28 patients with the diagnosis of AAV with a current histological evaluation available between 2007 and 2016, demographic, clinical and laboratorial data and respective outcomes were analyzed. The patients were divided into two groups according to serum creatinine (sCr) at initial presentation and then classified if sCr <4 mg/dL as Mild Renal Injury (Mild RI) and if sCr ≥ 4 mg/dL as Severe Renal Injury (Severe RI). Comparisons between groups were explored using the Mann-Whitney test for continuous variables and chi-square test for categorical variables. Follow-up was made until dialysis dependency, death or until the 31 st of December of 2017 (at least one year of follow-up after biopsy). Predictors to dialysis or death were explored with multivariable Cox regression.

RESUTLS: The cohort had a median age of 71 (IQR 60-79) years old and was followed-up during a median time of 52 (IQR: 18-72) months. In the group of severe RI, patients were significantly older (p=0,024), had higher proteinuria (p=0,045) and less extra-renal manifestations (p=0,047). Dialysis free survival was also significantly lower in this group (29% vs. 77%; p=0,008). There were no differences in associated comorbidities or in the urine analysis between both groups. Independent predictors of dialysis dependency in our cohort were female gender (HR 14,6; p=0,009), proteinuria (HR 1,79 per unit; p=0,006) and entry sCr (HR 1,65 per unit; p=0,009). In terms of treatment, plasma exchange added to corticoids (CT) plus cyclophosphamide (CPP) was used more frequently in patients with higher sCr (median 6,85 mg/dL vs. median 3,16 and 3,40 mg/dL in the groups of CT and CT + CPP, respectively; p=0,023) but in the end the choice of treatment hasn’t proved to be different to avoid dialysis. 5 patients died and the only predictor of death found was the entry sCR (HR 1,39 per unit; p=0,03). On the other hand, 13 patients remain independent of dialysis with an average creatinine of 1,34±0,62 mg/dL at the end of follow-up. Predictors of renal function found were the age, for each 10 years (β= - 0,30; p=0,04), MPO against PR3 (β=1,48; p=0,007), hypertension (β=1,103; p=0,018)  and presence of crescents (β=1,232; p=0,014).

CONCLUSIONS: Patient survival as well as renal function maintenance was dependent of entry sCr, with higher values being related with poorer outcomes. Female gender and proteinuria were independent predictors of dialysis dependency but not death predictors. Plasma exchange was added in the presence of a worse renal function but in our cohort, differently from the literature, it did not seem to change the prognosis.  Essentially and independently of the therapeutics given it is necessary a high suspicion to lead to an early diagnose and treatment.      

 

Biography:

Pratik Shete is a professor in Dr. D.Y.Patil Medical College, India. His research interest is Chronic kidney disease, Nephrology and Kidney Transplant.

 

Abstract:

Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is consistent with immunoglobulin precipitation or deposition diseases occurring with B cell proliferation. Diagnostic features:  Proteinuria (>60% nephrotic range), Microscopic hematuria (>65%), Hypertension (>50%), Renal insufficiency, ANA Positive-Speckled pattern (19%). Electron microscopy reveals 10- 30 nm micro fibrils with random orientation in mesangium and glomerular capillary wall.

Case report:  A 36 yrs old Male, presented with history of  generalised weakness, nausea, reduced appetite and reduced urine output since 2 months. Hemodialysis was initiated  in view of progressive renal dysfunction and underwent kidney biopsy. Autoimmune work up was not significant. Diagnosis of dense deposit disease was made. Steroids started at 40 mg OD and tapered by 5 mg weekly. Hemodialysis (HD) sessions advised thrice a week through left femoral uncuffed non-tunnelled HD catheter. Left brachiocephalic Artriovenous fistula was created. Patient came for Kidney Transplant work up our center with wife as a prospective donor. He was admitted for further work up. His biopsy was reviewed. Free kappa/lambda ratio of 28.38 (0.26 – 1.65). Biopsy Impression was: 1) Widespread effacement/ loss of visceral epithelial foot processes. 2) Massive mesangial accumulation of intermediate electron dense deposits with fine granular/ short fibrillary appearance. Diagnosed as a case of Chronic kidney disease/ stage Vd/ Fibrillary glomerulonephritis.

At present patient is asymptomatic and on thrice a week HD at our center. Patient underwent 6 cycles of Bortezomib and Dexamethasone (Once a week regimen). His initial serum Creatinine was 10.8mg/dl and now it had come down to 4.5mg/dl. Repeat kappa/lambda ratio is 7.78.

Biography:

Ahmed Fayed is currently working in Nephrology unit at the Internal Medicine Department, School of Medicine in Cairo University, Egypt. His research interests are Hepatitis C, antiviral therapy and nephrology etc.

Abstract:

Introduction: The side effects profile of the new direct antiviral agents (DAA) for the treatment of hepatitis C virus (HCV) is not fully elucidated. A few reports have described adverse renal effects of sofosbuvir (SOF) based regimens. In this case series, we describe 50 cases of de novo renal cryoglobulinemic glomerulonephritis after successful treatment with DAA.

Methodology: Patients with HCV (genotype IV) who did not receive antiviral therapy with peg interferon before (naïve)  were referred to the nephrology department after successful treatment with DAA for an opinion for assessment of deranged renal functions or proteinuria; the clinical manifestations ranged from lower limb edema to development of purpuric skin lesions. Cryoglobulins were tested in the serum using the PCR detection.

Results: All patients had a detectable de novo cryoglobulins in the serum. The most common glomerulonephritis in renal biopsies was membranoproliferative (52%) and CKD developed in 46% of cases.

Conclusion: The use of the DAA for the treatment of HCV infected patients may result in unfavourable renal outcome. The observed adverse effects included de novo cryoglobulinemic glomerulonephritis and the development of CKD.