Biography:

Anil K Mandal is a native of India and a naturalized citizen of the United State of America. He is board certified in Internal Medicine and Nephrology (not yet recertified in nephrology). Diabetes Mellitus is the most common cause of kidney failure in the USA and worldwide. This strong association between diabetes and kidney failure has inspired Dr. Mandal to develop the framework of Mandal Diabetes Research Foundation to assist diabetic patients in living a good life with medical treatment, and avoiding dialysis. He is a published author/editor of 12 books and more than 100 articles on research indiabetes and kidney disease. He is a two-time Fulbright Scholar and a visiting professor of 23 countries which permitted lectures on diabetes, high blood pressure and kidney diseases on five continents of the world. His astute knowledge and total dedication help patients get better and to live a good life. His convictions are that in the office patients come first, at home children come first. Roses are his love, hence rose gardening is his hobby

Abstract:

This treatise of chronic kidney disease (CKD) describes association of hypertension, diabetes and congestive heart failure (CHF) with CKD. CKD is defined by estimated glomerular filtration rate (eGFR) of less than 60ml/min for three months or more. CKD is generally irreversible but not necessarily progressive. Thus progression of CKD into end stage renal disease (ESRD) is the concern here and what can be done to reduce the progression of CKD. Exact data of CKD with progression is unavailable but high incidence of ESRD (dialysis) eleven times more in 2011 than in 1980 accordingly to United States (US) Renal Data System is a testimonial to progression of CKD in patients with diabetes, hypertension, CHF and other renal diseases. US Renal Data System reveals that ESRD has soared in parallel with marketing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs, providing strong indirect evidence that these drugs are someway instrumental in the progression of CKD into ESRD. These drugs produce acute renal failure which is an independent risk factor for CKD. Thus shift in therapy with enthusiastic use of ACEI/ARB drugs has led to dialysis bonanza throughout the world benefiting the professionals and corporations at the expense of vegetative life of the patients associated with family and societal burdens. The ways to turn the pendulum is to treat diabetes with insulin and hypertension with beta blocker, calcium channel blocker and diuretic therapy, and avoid the use of ACEI/ARB drugs. It is important to understand that diuretic orally, by intravenous boluses or by continuous infusion is the cornerstone of therapy for CHF, whereas ACEI/ ARB drugs markedly impair the efficacy of diuretics by lowering the blood pressure to a very low level thereby reducing renal perfusion. An evidence for that is marked elevation of BUN with comparatively slight increase of serum creatinine. Thus with the approaches stated above, CKD is less likely to progress; hence rate of ESRD is likely to decrease.

Biography:

Frank Daly, Ph.D. is an associate professor in the Department of Biomedical Sciences at the University of New England College of Osteopathic Medicine. He received his Doctorate in anatomy & neurobiology in 1997 from Boston University School of Medicine and pursued postdoctoral studies at the Howard Hughes Medical Institute at Massachusetts General Hospital and Harvard University. Dr. Daly teaches gross anatomy & embryology in the osteopathic medical clinical skills course and is course director for gross anatomy, histology and embryology for the dental students. He is the director of the anatomical donor program for the University and the State of Maine.

Abstract:

Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated curriculum, the renal system must be covered relatively quickly after the thorax in the cadaver laboratory, often without the opportunity to fully appreciate the rest of the abdominal contents. This article provides dissection instructions that follow one of the historical surgical approaches for nephrectomy, including preservation of the posterior abdominal wall neurovasclature. Dissection procedures were developed for first-year medical students, intending this posterior approach to the kidneys to be their first introduction to the renal system. It has been successfully implemented with the first-year medical students at the University of New England, College of Osteopathic Medicine. Utilizing this posterior approach to the kidney enabled the study of the anatomy of the kidneys, suprarenal glands, and renal vessels, as well as the muscles of the lumbar spine, while maintaining the integrity of the anterior abdominal wall and peritoneal cavity for future gastrointestinal and reproductive system-based dissections

Biography:

Sadhna Nandwana is an Abdominal Imaging Radiologist who began her career at Rush Medical School and completed her Residency at Beth Israel Deaconess Medical Center. Her research endeavors have been in Quality Assurance and Clinical Research. She has several peer-reviewed published articles and has been an invited Lecturer for multiple national and international meetings.

Abstract:

Review the issue of NSF in renal failure patients with usage of gadolinium based contrast agents (GBCAs) and provide an update of current literature regarding risks of NSF with certain GBCAs. Also, This presentation will discuss the current national/international recommendations and explore eliminating screening of at-risk patients. Presentation will include the timeline of NSF discovery, types of GBCAs, known cases of NSF and current research on commonly used GBCAs in renal impaired patients. Recent landmark papers regarding risk of NSF with gadobenate dimeglumine will be specifically discussed. The controversy of renal failure patients receiving MRIs with contrast will be explored and the risks and benefits will be discussed.

Biography:

Christiane Peuckert has completed her PhD at the University of Jena, Germany, where she studied Eph-Ephrin signaling during embryonal brain development. In 2007, she joined the Department of Neuroscience at Uppsala University in Sweden for her postdoctoral studies to investigate neurotransmission in brain and spinal cord and the role of Eph-mediated signaling in early kidney development. Since 2012, she is a senior researcher at Uppsala University and is focusing on cell-cell communication during organogenesis.

Abstract:

Obstructive nephropathy belongs to congenital anomalies of the kidney and the urogenital tract (CAKUT), which are the most frequent causes of early renal failure. Several developmental abnormalities can underlie obstructive nephropathy such as ectopically or blind ending ureters, a duplex collecting system or duplex kidney and posterior urethral valves. Although recent research using mouse models suggests roles for several genes in facilitating proper ureter insertion and development, underlying molecular mechanisms for congenital obstructive nephropathy in humans remain poorly understood. Eph receptors constitute the largest known family of receptor tyrosine kinases and are involved in the modulation of the cytoskeleton. Consequently, Eph signaling regulates cell adhesion and migration, which are important for mechanisms as cell segregation, border formation, adhesion during embryonic fusion events and axon guidance in the developing embryo. We have performed a detailed analysis of a battery of different Eph and ephrin mutant and signaling deficient mice. Impaired Eph signaling leads to severe hydronephrosis and hydroureter. We found that Eph-mediated signaling is crucial for a number of developmental steps, as ureteric bud induction, ureter muscularization, innervation and insertion, all processes which, if disturbed individually, can potentially lead to impaired urine drainage. Our data suggest that the ligands EphrinB2 and EphrinA5 interact redundant with several Eph receptors in forward and reverse mode. Based on our and on the studies of others, genes coding for Ephrins and Eph receptors should be considered in the etiology of CAKUT

Biography:

EM Ranivoharisoa received Bachelor’s degree with Scientific-option in 2002 ; studied human medicine in University of Madagascar and received Doctorate Degree in 2012 ; then studied internal medicine with nephrology orientation in the same University ; started nephrology training in Bordeaux- France in 2013 and has got Diploma of Specialized Medical Training in Nephrology in 2014 in France; studies also « Systemic disease and Kidney » with the University of Strasbourg, France. Nowadays, she has published some nephrology papers in national and international journals. She is member of SMN Madagascar, SFNDT and ISN education

Abstract:

Patients with Chronic kidney Disease (CKD) are fragile. Hemodialysis, the most useful Renal Replacement Therapy (RRT) in the world is the only one treatment available in Madagascar. It is an invasive act that may expose various and several complications. This present study aims to assess the prevalence of the bacterial complication in patients who lived with chronic hemodialysis. We have conducted a retrospective, exhaustive, descriptive single center study. Record based study was carried in Befelatanana Hemodialysis Center, University Hospital of Antananarivo, the Capital of Madagascar. All patients underwent a chronic hemodialysis who presented an infection sign from 10th May 2006 to 31st July 2010 were included. The Center received 84 patients with End stage of CKD who started chronic hemodialysis. Over 136 infections have been suspected but only 33,8% (n= 45) benefited a bacterial identification. In 42.65% of cases, infection begun in 20 days following the first hemodialysis session. Access vascular using catheter is the principal source of infection in 49,06%, followed by pulmonary (21.3%), urinary (12.5%), and digestive (7.4%) infection. Staphylococcus aureus (34.3%), Escherichia coli (9,4%), Enterococcus spp (9,4%) were the bacteria frequently encountered. Sepsis appeared in 98.52% of cases and any patients presented a septic choc. All patients received an adjusted antibiotic therapy according to susceptibility testing. The survival rate was in 100%. Treatment of CKD is very expensive in Madagascar and less than 3% who need chronic hemodialysis have the opportunity to do it. That explains our few studied population. In our cohort, access vascular related to catheter represents the common source of infection (49.06%). This prevalence is higher than another american studies. Almost of all patients arrive lately at the hospital with an End-stage of CKD imposing starting hemodialysis in emergency with catheter. Another sources of infection have been seen in another sites. Patients can also contract infection independently of hemodialysis. Antibiotic therapy allowed a favorable evolution in almost of the cases. To conclude, using access vascular with catheter is inescapable in our center, inducing bacterial complication, high morbidity in Chronic Hemodialysis. To fix that, promoting native fistula with early nephrology medical follow could be a solution. Renal transplantation with living donor, the best and less expensive RRT than chronic hemodialysis is now in progress, in collaboration with Malagasy Government.

Biography:

Cao Qiong has completed her Master of Science Degree in Medical Science in 2003 from The First Military Medical University . She is the director of Division of Tissue Typing Center, Nanfang Hospital, the largest transplantation center of Southern China. She has published more than 20 papers in reputed journals

Abstract:

Background: End-Stage Renal Disease (ESRD) is a worldwide public health problem. Currently, many genome-wide association studies have suggested a potential association between human leukocyte antigen (HLA) and ESRD by uncovering a causal relationship between HLA and glomerulonephritis. However, previous studies, which investigated the HLA polymorphism and its association with ESRD, were performed with the modest data sets and thus might be limited. On the other hand, few researches were conducted to tackle the Chinese population with ESRD. Therefore, this study aims to detect the susceptibilities of HLA polymorphism to ESRD within the Cantonese community, a representative southern population of China. From the same region, 4541 ESRD patients who were waiting for kidney transplantation and 3744 healthy volunteer bone marrow donors (controls) were randomly chosen for this study. Polymerase chain reaction-sequence specific primer method was used to analyze the HLA polymorphisms (including HLA-A, HLA-B and HLA-DRB1 loci) in both ESRD patients and controls. The frequencies of alleles at these loci and haplotypes were compared between ESRD patients and controls. A total of 88 distinct HLA alleles and 1361 HLA A-B-DRB1 haplotypes were detected. The frequencies of five alleles, HLA-A*24, HLA-B*55, HLA-B*54, HLA-B*40(60), HLA-DRB1*04, and one haplotype (HLA-A*11-B*27-DRB1*04) in ESRD patients are significantly higher than those in the controls, respectively. Five HLA alleles and one haplotype at the HLA-A, HLA-B and HLA-DRB1 loci appear to be associated with ESRD within the Cantonese population

Biography:

Ayman Aly Seddik was born in 1972,Graduated from in Shams University school of medicine 1996 very good with honour ,interenship and residency programm in Internal medicine and Nephrology 1997-2001 Assistant lecturere and Nephrology specialist in ain Shams University hospital , Nasser institute for research 2001-2006 , after obtaining md degree in Internal Medicine & Nephrology 2006 ain Shams University , work as consultant Nephrologist and lecturer Nephrologist in Ain Shams University hospitals ,senior specialist Nephrologist king fahd armed force hospital jeddah saudia arabia 2006-2008,consultant Nephrologist Northeren area armed force hospital 2009-2011 , programme director of Internal medicine residency programme in northeren area armed force hospital ,degree of assistant profeessor of Internal Medicine and Nephrology Ain Shams University, cairo, egypt 2012.Currently working as Nephrologist , Dubai hospital - Dubai health authority 2011-present .

Abstract:

Introduction: 
Central Line associated Blood Stream Infection CLABSI as defined a single blood culture for organisms not commonly present on the skin and two or more blood cultures for organisms commonly present on the skin in a patient who has a central line at the time of infection or within the 48-hour period before development of infection. CRBSI constitutes a major clinical and economic problem and Antimicrobial lock therapy is commonly used for CVC management in a prophylactic modality in patients with protracted central venous access for hemodialysis (HD), chemotherapy, or total parenteral nutrition

Patients And Methods:
A prospective, open-label randomized trial conducted at a single medical center at Hemodialysis unit Ain Shams university hospital . 41 Patients were randomly assigned to receive interdialytic catheter locking with either vancomycin/ heparin or taurolidine/citrate; Taurolock at the end of each dialysis session and continuously since catheter insertion.

Biography:

Sujit Bhattacharya is currently working as a faculty of medicine in Department of Endocrinology (Medicine) at SCB Diabetes & Hormone Research Foundation and Calcutta Medical Research Institute, Kolkata.

Abstract:

Diabetes affects the kidneys and once it is clinically evident it is like a perfect storm, one of the most dreaded micro vascular complications. It not only increases the morbidity and mortality. It shortens the life span by more than 20 years and severely affects the quality of life. It also has significant socioeconomic implications. Currently approximately 50% of ESRD or dialysis patients are Diabetic and the figures are increasing because of the increasing incidence of Diabetes itself.

The epicenter of the storm is the altered metabolic milieu in Diabetes which drives the changes in the glomerular capillaries with consequent glomerulosclerosis coupled with tubule interstitial inflammation, atrophy and fibrosis mainly mediated by TGF-beta and other intermediate molecules. The changing concept of glomerular and tubular injury as well as the pathogenic mechanisms will be unraveled.

The changing epidemiology along with genetic, ethnic and other intercurrent or concurrent metabolic or other risk factors will be discussed. The gold standard of diagnosis is micro albuminuria but it lacks specificity and sensitivity and hence the need for markers for early diagnosis, progression or preservation of renal function.

The duration and the degree of glycemic control can modify the natural history of the storm. Once evident, control of all the modifiable risk factors is the only option. We will discuss the general measures and effective control of hypertension, diabetes and lipid parameters along with other metabolic changes. Emerging strategies of glucose control and its efficacy and benefit with optimal RAAS blockade is an area of interest as it may improve long-term hard endpoints including death. However, we are still short of achieving any improvement beyond a third and yet to overcome the residual risk of the tsunami in the years to come. Hence the way forward is better understanding of the epidemiology, cause and the natural history of the Diabetic nephropathy to find out the most effective multifactorial strategy which can save millions of dollars and thousands of life. Till then, the best control of the storm is primary prevention in the backdrop of the grim forecast of the twin epidemic of Diabetes and Obesity for the next few decades.

Biography:

Shuk-Man Ka has completed her PhD from National Defense Medical Center, Taipei, Taiwan and postdoctoral studies from the Department of Pathology, Tri-Service General Hospital, Taipei, Taiwan and the Initiative of Gene Therapy, Harvard Medical School. She is working as an associate professor at the Academy of Medicine, National Defense Medical Center, Taipei, Taiwan. She has published more than 50 papers in reputed journals.

Abstract:

Lupus nephritis (LN) is a major complication of systemic lupus erythematosus. Development of a novel molecular pathogenesis-oriented therapeutic remedy preventing progression is clinically warranted. The development of accelerated and severe LN (ASLN) has been attributed to a wide range of pathogenic
pathways, such as overt activation of T and B cells, NLRP3 inflammasome and oxidative stress. Unfortunately, the current treatment of ASLN is insufficient. Therefore, to establish novel yet practical therapeutic agents for ASLN is clinically warranted. Xenon (Xe), a noble gas, has been used as an anesthetic, with very low toxicity. In present study, Xe was used to test its renoprotective effects in an ASLN model induced by repeated injections of lipopolysaccharide to SLE-prone NZB/Wf1 mice. The results showed that (1) Xe significantly ameliorated the proteinuria, hematuria, severe renal lesions and improved renal function; (2) Xe suppressed renal inflammation via blocking of the activation of NLRP3 inflammmasome and NF-ĸB; (3) Xe inhibited renal cells apoptosis via blocking Bax/Bcl-2 mediated apoptotic pathway; (4) Xe decreased mitochondrial injury in macrophage, including mitochondrial ROS generation and mitochondrial DNA release into the cytosol. Our data suggest that Xe alleviated the mouse ASLN model by inhibiting the activation of NLRP3 inflammasome and mitochondrial ROS production. Xe may be useful for the treatment of human ASLN.

Biography:

Hoda EL-Attar has completed her MBBS in 11/1979, MS in Chemical Pathology 4/1987 ,MD in Chemical Pathology in 4/2001. She worked as an assistant Professor in Chemical Pathology from 28/8/2006 .Now She is working as a professor in Chemical Pathology since 30/8/2011 in Alexandria University Egypt. She is a member of the European Society of Cardiology (ESC): Working Group on Atherosclerosis and Vascular Biology. She has published 27 papers.

Abstract:

Background: 
The first cloned long pentraxin is Pentraxin 3(PTX3) and C-reactive  protein is a human short pentraxin. Pentraxin 3 has a bigger molecular size (40.6 KDa) compared to CRP (21.5 KDa).The long PTX3 is produced by diverse cell types in response to primary inflammatory signals and specific neutrophil granules store PTX3 .

 Aim:
Evaluation of serum levels of long Pentraxin 3 and high sensitivity C-reactive protein in patients with chronic  kidney disease treated with or without haemodialysis.

The study included 75 subjects,25 heathy controls(group1),50 patients without cardiovascular disease subdivided into:25 patients with chronic kidney disease (CKD) on conservative therapy(group 2a) and 25CKD patients on maintenance hemodialysis (group2b).To all studied subjects the following was done :electocardiography,carotid intima media thickness, fasting serum glucose ,renal, liver and lipid profiles,high- sensitivity C-reactive protein (hsCRP) and PTX3by ELISA.

Biography:

Fizza Hassan is a student of Karachi Medical and Dental College. She has been a keen researcher since High School and took part in many scientific projects at city level. She is now a Research Associate and has helped in the intellectual contribution, data collection and data entry, summarization of results and presentation of research papers. She is a Medical Student Researcher and has contributed in a couple of papers in international medical journals. She has attended several national and international seminars and conferences. She is looking forward to a bright future in medical career.

Abstract:

Biography:

Nicolas VIALLET is a thirty-year-old medical doctor. He completed his medical study in Montpellier University, France. Since November 2014, he is nephrologist in Felix Guyon University Hospital, St Denis, Reunion island, France

Abstract:

The RenalGuard system helps to achieve a high diuresis while simultaneously balancing urine output and venous fluid infusion to maintain euvolemia. This strategy has revealed to be beneficial to prevent contrast-induced acute kidney injury. We hypothetise it could be extended to kidney transplantation as a renoprotective action to prevent delayed graft function. The objective of our pilot study was to evaluate the feasibility and safety of RenalGuard in kidney transplant. Between december 2013 and september 2014, eleven kidney transplanted patients had a forced diuresis by Furosemide with matched hydratation by RenalGuard during the first 36 hours post transplantation (DF group). They were retrospectively compared to eleven similar patients who had spontaneous diuresis (DS group). The 11 patients of the DF group were transplanted from 7 deceased donors (4 with extended criteria) and 4 living donors. Their urine output was 265 (154-350) ml/h versus 69 (51-107) ml/h in the DS group. The diuresis quantification by RenalGuard appeared strongly correlated with the nurse measurement (R² = 0.96, p<0.001) and real-time matched hydration allowed no significant change in weight of patients. Three patients of DF group had major hyperglycemia when using glucose 5% as compensation. Hypokalemia were significantly more frequent in DF group. Use of Ringer lactate with the addition of 1g of KCl per liter should prevent the occurrence of electrolyte disturbances. There was no difference of renal function. We report for the first time the RenalGuard experience in renal transplant patients. Some precautions seem necessary in this population to prevent hyperglycemia, hypokalemia or disorders of bladder emptying

Biography:

Carolina Becerra is currently a student in the Master of Epidemiology at the Universidad Industrial de Santander. She additionally completed her Global Health and Infectious Disease postgraduate diploma at the University of Edinburgh in 2011. Actually she is part of the INEFAC and CARDIECOL workgroup and is in charge of supporting the recruitment, measurement and interviewing processes of the participators in the 2016 follow up. According to the aforementioned, her dissertation is related to the INEFAC database and thus the master student formation process is enhanced with every roll she has had in the investigation.

Abstract:

The INEFAC cohort was initiated in 2000 in Bucaramanga, Colombia to estimate the incidence of cardiovascular diseases (CVD) and their risk factors. Follow-up evaluations were conducted in 2007 and 2013. Currently, we are completing the second follow up. Chronic kidney disease (CKD) is a risk factor for cardiac events and involves high mortality rates as a consequence of progression to kidney failure. Recent studies have found that the triglycerides/high-density lipoprotein cholesterol (TG/HDL-c) ratio is an independent risk factor for CKD. The objective of the present study was to evaluate the association between the TG/HDL-c ratio and CKD in the 2007 evaluation of the cohort. The methodology included questionnaires and anthropometric measures in every assessment. CKD was defined as having a glomerular filtration rate <60ml/min/1.73m2 with the use of CKD-EPI equation. A stepwise forward logistic regression was done to assess the association adjusted by other covariates. The prevalence of CKD in the population was 2.46% among which only 0.55% knew their condition at the time of the evaluation. The results demonstrated that the odds for having CKD increases 10% for every unit  augmentation of the ratio (p=0.002) when adjusted for independent variables as diabetes, hypertension and age. Additionally, the ROC curve of the fitted model revealed an AUC=91.6%. The model showed an excellent adjustment evidenced through the diagnostic test. In conclusion, the TG/HDL-c ratio was an independent factor associated with the prevalence of CKD in the INEFAC cohort.

Biography:

Coming Soon

Abstract:

Cardiovascular disease (CVD) is the leading cause of death in the general population and a major cause of morbidity and mortality in chronic kidney disease (CKD) and end stage renal disease (ESRD) patients . The high prevalence of CVD in incident dialysis populations suggests that CVD begins during or before the stage of chronic renal insufficiency. However the cause of the increased in the CVD in patients of CKD including those who are on dialysis is not explained by the traditional risk factors alone. Various nontraditional factors such as hyperhomocysteinemia, hyperparathyroidism, inflammation (indirectly measured with highly selective CRP), acute phase reactants (albumin and fibrinogen), oxidative stress and endothelial dysfunction have all been proposed for this increased incidence of CVD. In fact oxidative stress, endothelial dysfunction, and inflammation represent a key triad serving as the foundation for the development and progression of atherosclerosis. Chronic kidney disease patients, peritoneal and haemodialysis patients, as well as renal transplant patients all show an equal susceptibility in oxidative stress, indicative of a higher degree of inflammatoty activity in these patients. N – acetylcysteine (NAC) serves as an antioxidant by virtue of its interaction with reactive oxygen species. The drug acts on atherosclerosis through several mechanisms including decreased apoptosis, vasoconstriction and endothelial dysfunction

Biography:

Dwijen Das has completed his MBBS at the age of 23 years from Gauhati University and MD in general Medicine from Dibrugarh University, Assam, India in 2004. He is working as Associate Professor and In Charge dialysis unit in Silchar Medical College, a premier Medical Institute in north eastern India. He has published more than 15 papers in reputed journals and has been serving as an editorial board member of Assam Journal of Internal Medicine. He is also a peer reviewer in 2 national reputed journals

Abstract:

Labeo rohita, commonly known as “Rohu” an Indian variety of the fish belonging to the carp species is a fresh water fish and is commonly consumed in north eastern India. The raw fish gall bladder is consumed by some people with different beliefs ranging from visual improvement, cure for gastric related diseases, rheumatism or aphrodisiac especially among the younger population. The toxicity induced by the fish bile leads to a variety of manifestations ranging from gastro intestinal upset, hepatic and renal dysfunctions which can be fatal and may lead to mortality unless timely intervention is done. We, report a series of three consecutive cases of fish bile toxicity all of whom had similar presentations of acute onset abdominal pain, cramps, nausea, vomiting with tachycardia, tachypnoea, abdominal distension followed by hepatic dysfunctions like jaundice, raised alanine aminotransferase and aspartate aminotransferase and nephrotoxic manifestations in the form of acute kidney injury leading to oliguria or anuria and raised creatinine levels. All the cases recovered with intravenous fluid replenishment, symptomatic management and supportive hemo- dialysis. Apart from the established nephrotoxins like paraphenylenediamine hair dye, snake venom, paraquat, paracetamol, herbal medicines, cotinarius mushrooms leading to acute kidney injury, lesser known substances like various bile components namely cyprinol, a C-27 alcohol found in the bile of cyprinid fish and 5α cyprinol sulfate has a deleterious effect on the kidneys. 5α cyprinol sulfate found in 5 species of fish belonging to the order cypriniformes have been associated with bile induced hepatitis and renal failure

Biography:

2Dr Kallol Bhattacharjee has completed his MBBS at the age of 22 years from Gauhati University and MD in general Medicine from Gauhati University, Assam, India in 1990. He is working as Associate Professor and In Charge of ICU in Silchar Medical College, a premier Medical Institute in north eastern India. He has published more than 15 papers in reputed journals

Abstract:

Labeo rohita, commonly known as “Rohu” an Indian variety of the fish belonging to the carp species is a fresh water fish and is commonly consumed in north eastern India. The raw fish gall bladder is consumed by some people with different beliefs ranging from visual improvement, cure for gastric related diseases, rheumatism or aphrodisiac especially among the younger population. The toxicity induced by the fish bile leads to a variety of manifestations ranging from gastro intestinal upset, hepatic and renal dysfunctions which can be fatal and may lead to mortality unless timely intervention is done. We, report a series of three consecutive cases of fish bile toxicity all of whom had similar presentations of acute onset abdominal pain, cramps, nausea, vomiting with tachycardia, tachypnoea, abdominal distension followed by hepatic dysfunctions like jaundice, raised alanine aminotransferase and aspartate aminotransferase and nephrotoxic manifestations in the form of acute kidney injury leading to oliguria or anuria and raised creatinine levels. All the cases recovered with intravenous fluid replenishment, symptomatic management and supportive hemo- dialysis. Apart from the established nephrotoxins like paraphenylenediamine hair dye, snake venom, paraquat, paracetamol, herbal medicines, cotinarius mushrooms leading to acute kidney injury, lesser known substances like various bile components namely cyprinol, a C-27 alcohol found in the bile of cyprinid fish and 5α cyprinol sulfate has a deleterious effect on the kidneys. 5α cyprinol sulfate found in 5 species of fish belonging to the order cypriniformes have been associated with bile induced hepatitis and renal failure

Biography:

Rob Perkins is a nephrologist and a Medical Director for US Medical Affairs at Bayer. He received an AB from Harvard College, an MD from the University of Pittsburgh School Of Medicine, and an MPH from the Johns Hopkins Bloomberg School of Public Health. Prior to his work at Bayer after having most recently worked as a clinical investigator and clinical nephrologist at Geisinger Medical Center in central Pennsylvania. Prior to that, he served on active duty in the United States Army for 9 years, including a deployment to Baghdad, Iraq in 2006, where he was the Assistant Chief of the trauma ICU at the 10th Combat Support Hospital. He has maintained an active research program in chronic kidney disease, diabetic kidney disease, and acute kidney injury, with a particular focus on risk prediction and cardiovascular complications.

Abstract:

Longitudinal changes in screening and treatment patterns for patients with CKD, and their impact on clinically-relevant outcomes, have not been reported. It is expected that implementation of the 2012 KDIGO chronic kidney disease (CKD) classification system will accelerate the identification of more individuals with earlier stages of CKD compared with the 2002 NKF KDOQI system, based on the addition of ‘high albuminuria’ as a disease-defining criterion.

As with any screening test designed to diagnose a condition or disease, the availability of effective treatments to manage the condition as well as the identification and management of modifiable risk factors among those newly diagnosed are necessary to justify the costs (economic and otherwise) associated with the testing. It is not currently known to what extent modifiable risk factors are present in the population of patients with early CKD.

This report has three objectives. Leveraging a clinical database from a large, integrated health care system, we first evaluated incident (stage G3) CKD  patients in 2004-2006, 2007-2009, and 2010-2012 to determine trends in proteinuria screening; treatment (prescription for angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and statin); and nephrology referral. Adjusted rates for mortality, progression to stage G4 CKD, and hospitalization for myocardial infarction or heart failure were calculated and compared across time periods in order to estimate the impact of changes in screening and treatment patterns over this time frame. Second, we compared the risk prediction characteristics of the 2002 NKF and 2012 KDIGO systems using the net reclassification index, for both cardiovascular and renal outcomes. Finally, we aimed to identify the burden of modifiable risk factors among those with ‘preserved’ eGFR but albuminuria in the pathologic range.

The results suggest that more aggressive management of moderate CKD over time has not resulted in improved outcomes over a relatively short follow-up period; that implementation of the 2012 KDIGO CKD classification system improves risk characterization; and that the burden of modifiable risk factors among those with early disease is substantial.  Early identification of CKD is therefore feasible and likely clinically important; however, additional research into the impact of early CKD diagnosis and management on clinically relevant outcomes is needed