Day 2 :
New York Medical College, USA
Time : 09:15-09:55
Michael S Goligorsky, MD, PhD, holds the Alvin I Goodman Chair in Nephrology and is Professor of Medicine, Pharmacology and Physiology, Academic Chief of Renal Division, and Director of Renal Research Institute at the New York Medical College. After completing residency and fellowship, he joined the faculty of the State University of New York at Stony Brook (1988). He became a Professor of Medicine and Physiology in 1997 and named an Honorary Professor at the University College London (1998). In 2002 he was recruited by the New York Medical College to inaugurate Renal Research Institute. In 1991, he was elected to the American Society of Clinical Investigations; in 2002 elected to the American Association of Physicians. MSG serves as an Associate Editor for Am J Pathology, Am J Physiology: Cell, and a Topic Editor for Nephrology, Dialysis, and Transplantation. His research interests include: the mechanisms of endothelial dysfunction as a harbinger of atherosclerotic, diabetic, and hypertensive vascular damage; stress-induced premature senescence (SIPS) of endothelial cells and the role of lysosomal dysfunction in this process; mechanisms of functional incompetence of endothelial progenitor cells (EPC) in chronic kidney disease; mechanisms of Alarm Signaling by an ischemic organ; and proteomic analysis of the urine in kidney disease.
Although historically endothelial contribution to chronic kidney disease (CKD) had been neglected, recent investigations provide conclusive evidence of its role in maintaining tissue homeostasis, supporting tissue regeneration and, when dysfunctional, instigating development and progression of tissue fibrosis. These findings are of critical importance for the development of nephrosclerosis and progression of CKD. Three endothelial pathways involved in the progression of CKD include stress-induced premature senescence of endothelial cells, endothelial-mesenchymal transition, and the loss of the endothelial surface layer. These abnormalities orchestrate the development of proteinuria, pro-inflammatory microenvironment, microvascular rarefaction, pro-fibrotic state, and regenerative failure. Therapeutic strategies to overcome endothelial cell dysfunction and its renal consequences will be discussed.
SUNY Downstate Medical Center, USA
Time : 09:55-10:35
Mariana Markell after graduating from Yale University, he received an MD from New York Medical College, followed by a Residency in Internal Medicine at the Columbia-Presbyterian Hospital and a Nephrology Fellowship at UCLA. At SUNY Downstate she has been Director of Transplant Medicine, Director of the Transplant Fellowship and is currently Professor of Medicine, serving in multiple leadership positions for the Medical School. He is the author of hundreds of abstracts, book chapters and papers and is a Fellow of the American College of Physicians, the American Society of Transplantation and the National Kidney Foundation.
Men and women with kidney disease are often treated as if there is no difference between the genders. Studies suggest, however, that there are intrinsic differences in the male and female kidney, as well as effects of estrogen and progesterone on the kidney that differ from that of testosterone. These observations may underlie the “female advantage” that delays the progression of most kidney diseases to ESKD in women compared to men, as well as protection from AKI. When women reach ESKD, however, disparities in care arise, including fewer women starting dialysis with AV fistulae, as well as a much lower rate of living donor transplantation, and kidney transplant overall. It is hoped that recognition of the need for individualized care by gender will help to improve the care of women with kidney disease and especially ESKD.
Michael S Goligorsky
New York Medical College, USA
SUNY Downstate Medical Center, USA
New Jersey Kidney Care, USA
Time : 10:55-11:25
Deepika Jain has completed her MD in New Delhi, India and continued her career in internal medicine and nephrology in the USA at University of Pittsburgh Medical center. She is currently working in the New Jersey as part of New Jersey Kidney Care group. She has published several papers on health literacy on dialysis patients.
Health literacy is the capacity of an individual to understand information related to a disease in order to make an informed decision. In patients with kidney diseases, studies have reported increasing impact of limited health literacy on health outcomes. Our paper discusses current literature on health literacy in kidney diseases.
Health literacy is an increasing recognized cause of suboptimal care and management of chronic diseases in patients. Our paper reviews the current literature on its prevalence and impact in the population with kidney diseases. More studies are needed in patients with kidney diseases to better understand the effect of limited health literacy.
Muthu Jayaraman completed MBBS, MD (Int. Medicine), DM (Nephrology). She is a Gold Medalist in Anatomy and Surgery. Presently, she is a Senior Consultant Nephrologist, Bharathi Rajah Super Specialty Hospital, Chennai. She published Twenty five Papers in Journals and Textbooks, Forty-Two papers presented at National and Inter National Conferences and Twenty Seven Guest Lectures Given in state and national conferences. She is a member of API, Indian Society of Nephrology, ISN Executive Committee and Member Advisory Board of Editorial Board of Journal of ISN.
Aging is a programmed biological process associated with a small transcriptional difference in many genes. It is also called ‘senescence’ which means ‘irreversible growth arrest’. Cellular or replicative senescence is the key element of aging. Aging plays an active role in fibrogenesis and atrophy of renal tissue. The discussing topics includes:
Common renal disorders in the elderly: CKD: Over 60% of the elderly have a GFR less than 60ml/min. However, the serum creatinine is not altered and is stable around 1mg%. In differentiating aging vs CKD, the context is more important. Regardless of age, if the GFR is less than 45ml/mt, with albuminuria of 50-500 mg per day for more than 3 months, it is labeled as CKD.
Hypertension: The optimum BP in the elderly remains uncertain. Studies have shown that aggressive control of BP may lead to hypotension, syncope, acute kidney injury, hypokalemia, and hyponatremia. The consensus is to keep systolic BP, less than 140mmHg and never less than 120mmHg.
Acute Kidney Injury: Acute Kidney Injury (AKI) is a common clinical problem in the elderly. Numerous factors like age-related low GFR, associated comorbid conditions, the risk of dehydration due to lack of thirst, inadequate handling of sodium and water by the aging kidneys, urinary tract obstruction, bladder dysfunction, retention of urine, and poly-pharmacy predispose to AKI.
(RRT) for Elderly: Age is not a limitation for dialysis and the number of patients getting dialysis beyond the age of 75 is increasing. Vascular access like AVF, Vascular graft, and Central venous catheterization can be used in these patients. The risks are an infection, the maturity of AV fistula, early closure, hypotension, and hypoglycemia.
Transplantation for elderly: Number of candidates above the age of 65 years listed for Transplant is very low. Although the survival of elderly after transplantation is favorable, non-availability of donor kidneys, priority given to a younger individual and co-morbidities in the elderly restrict their selection from the pool of potential recipients. Although rejection is less common in the elderly, coronary artery disease and infection account for the higher mortality.
Hospital Sao Joao de Deus, Brazil
Time : 11:55-12:25
Sergio Wyton L Pinto is working in the division of nephrology, Hospital Sao Joao de Deus, Divinopolis, Brazil.He has published several articles in the international journals.
Background: Scarce information on outcomes of epidemic post infectious glomerulonephritis is available. This is a 10-year follow-up of the patients that developed acute glomerulonephritis in an epidemic outbreak caused by group C Streptococcus zooepidemicus in Brazil in 1998 that were also previously evaluated 2 and 5 years after the acute episode.
Methods: In this prospective study 60 cases (out of 134 in 1998) were reevaluated after 10 years, as well as community controls matched by gender and age. They underwent clinical and renal function evaluation, including serum creatinine and cystatin C, estimated glomerular filtration rate (eGFR), albuminuria and hematuria.
Results: Comparisons of clinical and renal function aspects of 60 patients and 48 community controls have not shown significant differences (eGFR <60 ml/min/1.73m2 and/or albuminuria >30mg/g creatinine: 13.8% vs. 12.2%, respectively, p=0.817) except for a higher frequency of hypertension in the cases (45.0% vs. 20.8%, p=0.009). Comparing the same patients affected in the acute episode, 2, 5 and 10 years later, it was observed an improvement of median eGFR levels at 2 years and a trend toward subsequent stabilization in these levels, associated with a decrease in albuminuria and increased hypertension rates in the last survey. At 10 years it was not observed an additional reduction of renal function using serum creatinine, eGFR, and Cystatin C.
Conclusion: During the acute episode of epidemic GN a considerable proportion of patients presented hypertension and reduced renal function; after 2 years and particularly at this 10-year follow-up survey there was no worsening of renal function parameters, except for persistent higher frequency of hypertension. Nevertheless, a longer follow up is necessary to confirm that progressive loss of renal function will not occur.
Padmanabhan Subramanian completed his DM in Nephrology from the All India Institute of Medical Sciences, New Delhi, India. He did his MBBS from Madurai Medical College Madurai and DNB in Internal Medicine from Southern Railway Head Quarters Hospital Hospital, Chennai. He was awarded the ISPD Fellowship in October 2003 and he trained under Late Dr DG Oreopoulos in Toronto Western Hospital, Toronto, Ontario, Canada. He did Postdoctoral Fellowship in Renal Medicine at the Singapore General Hospital, Singapore and was the Staff Nephrologist at the National Kidney Foundation Singapore before returning back to India. He is currently the Senior Consultant Nephrologist and Incharge of the Renal Transplant Program at NU Hospitals, Bengaluru, India. He has published over 30 papers in reputed journals. He is a peer reviewer for reputed journals. He is serving as the Executive council Member of the Southern Chapter of India Society of Nephrology.
The factors that contribute to the correction of anemia of Chronic Kidney Disease (CKD) after successful renal transplantation include the production of erythropoietin (EPO) from the allograft and elimination for bonemarrow inhibitors which are present in the uremic milieu. Usually, anemia gets corrected by the 3rd post-transplant month. About 20% of the renal allograft recipients develop persistent high hematocrit of over 51%, a condition termed as post-transplant erythrocytosis (PTE). The pathogenesis of PTE is yet to be fully understood. A quarter of them remits spontaneously within 2 years while in others it persists for many years. Male sex, retention of native kidneys, transplant renal artery stenosis and a normal graft function are some of the predisposing factors for the development of PTE. Thromboembolic events occur in about 10-30% of those with PTE. The mortality rate is very less. Use of ACE inhibitors is a safe and well-tolerated treatment for PTE. Therapeutic phlebotomy is usually done when the hematocrit crosses 55% and is very effective. At NU hospitals, we had an unusually high incidence of PTE (26%). Fortunately, none were symptomatic.
Hospital Carlos G Durand, Argentina
Title: Amyloidosis with peritoneal involvement, continuous ambulatory peritoneal dialysis: A case report
Time : 13:55-14:25
Maria Celeste Ríos obtained her medical degree at the Buenos Aires University of Medicine (UBA). Later, she got her specialty in general medicine at the Central Aeronautical Hospital, where she was a chief resident for one year. She has recently finished her postgraduate studies in Nephrology at the Carlos G. Durand Hospital, along with the postgraduate course in Nephrology at the Buenos Aires University of Medicine. She has participated in multiple national conferences as a speaker, exposing different works made during my academic training in Nephrology. She is currently working as a staff nephrologist at the Deutsches Hospital in Buenos Aires.
Amyloidosis is a systemic disease characterized by the extracellular deposition of amorphous fibrillar protein, which leads to the loss of the function of the affected organ. Renal involvement is a common case expressed as nephrotic syndrome with varying degrees of functional deterioration, until a final stage in which renal replacement therapy is required. In the same way, the gastrointestinal tract is affected by the amyloid deposits, which are located mainly around the arterioles and in muscles causing ischemia and eventually, leading to mucosal erosion. However, peritoneal secondary amyloidosis (AA amyloidosis) is unusual. In our bibliographic search, there are no records or data related to patients with peritoneal AA amyloidosis undergoing continuous ambulatory peritoneal dialysis (CAPD) in whose procedure the peritoneum is used as a dialysis membrane. We therefore hereby describe the case of a patient with a history of pulmonary tuberculosis diagnosed in 2001 with reactivations in 2005 and 2011, with complete treatment that evolves with nephrotic syndrome and CKD stage V. The histological diagnosis was: renal and peritoneal AA amyloidosis. Because of the requirement of renal replacement, our patient started with positive selection, continuous ambulatory peritoneal dialysis (CAPD). We stand out that despite presenting peritoneal amyloidosis; the peritoneum could be used as dialysis membrane over 3 years. Moreover, our patient had a satisfactory quality of life, maintaining values of hematocrit, adequate mineral-bone metabolism and improvement of values of albumin along the therapeutic, as well as adequate control of urea levels and preserving residual renal function.
I.K. Akhunbaev Kyrgyz State Medical Academy, Kyrgyzstan
Time : 14:25-14:55
Murkamilov Ilkhom Torobekovich was born in the Osh region of the Karasuisky district in 1983 on April 22. He received his higher professional education in the KSMA named after I.K. Akhunbaeva. Candidate dissertation is devoted to the topic "The influence of erythropoietin and the combination of erythropoietin with hypoxic pressure chamber training on anemia in chronic glomerulonephritis. (2016). More than 20 scientific publications on the problems of clinical nephrology have been published. At the moment, a doctoral student at the KRSU named after B.N. Yeltsin at the Department of Therapy No.2 specialty "Medical Business". Research topic: Chronic kidney disease and cerebrovascular disease. He is the chairman of the Society of Specialists on Chronic Kidney Disease in Kyrgyzstan.
The prevalence of chronic kidney disease (CKD) in recent years growing in many countries of the world, accounting for more than 10% of the total population, and among persons, the frequency of CKD is significantly higher in older age groups. In the last time, the problem of kidney dysfunction and associated cerebrovascular diseases (CVD) becomes very relevant. The most important and complex aspects of this problems are the inhibition of progression of both CVD and renal dysfunction. Numerous studies show that in CKD, the risk of vascular complications increases even at the pre-dialysis stage of the disease. Exactly vascular events, not progressive deterioration of kidney function-the most frequent cause of death the patients with CKD. It is known that the most common variant structural changes in the arteries of CKD is atherosclerotic lesion carotid arteries (CA). In this study, the thickness of the intima-media complex (TIM) with the help of B-mode ultrasound (ultrasound) with an assessment of carotid plaque is currently a recognized surrogate marker of atherosclerosis, frequency, and severity of which in CKD depends on the value of the glomerular filtration rate (GFR). Atherosclerosis CA-an indispensable element in the pathogenesis of cerebrovascular and renal diseases, considered as a factor, it contributes to the further progression of these pathologies. Lately the possibility of using as a laboratory predictor Atherosclerosis CA and CVD Cystatin C-one of the renal biomarkers. The main aim was to study the role of cystatin C as a biomarker of atherosclerotic lesions of carotid arteries and cerebrovascular diseases in patients with a therapeutic profile.
Conclusion: An increase in the content of cystatin C is associated with an increase in the level of systolic and central blood pressure, calcium and cholesterol of the blood plasma, as well as with thickening of TIM.
Dr HL Trivedi Institute of Transplantation Sciences, India
Time : 14:55-15:25
Kamlesh Suthar completed his MD in 2006 from Gujarat University, India. He qualified with a post-doctoral certificate course (PDCC) of Renal and Transplant Pathology (Indian College of Pathologists) in 2009 and has >10-years experience in the field. Currently, he is Associate Professor in the Department of Pathology, Laboratory Medicine, Immunohematology, and Transfusion services at IKDRC-ITS, Ahmedabad, India. He has >30 publications, several oral and poster presentations at national and international conferences. He serves as reviewer and editorial board member of various journals. He received “Young Investigator Award” in “Transplant Update-2015” for his research on BKV nephropathy in renal transplantation.
Membranous nephropathy (MN) is the commonest cause of nephrotic syndrome in adults, with male preponderance. Immunosuppressive agents are the main treatment. However, ≈40% patients progress to end-stage renal disease and ≈15% develop recurrence post-renal transplantation. It is important to differentiate MN in to primary/ idiopathic (pMN) and secondary (sMN) type since their treatment and prognosis are different. Morphologically it can be differentiated with the aid of light, immunofluorescence (IF) and electron microscopy. Antibody against M-Type Phospholipase A2 Receptor (anti-PLA2R) which is the target antigen present in the glomerular basement membrane is commonly associated with pMN. PLA2R antigen in glomerulus can be located by through IF/immunohistochemistry (IHC). Renal biopsy is an invasive procedure, hence non-invasive biomarkers like the anti-PLA2R antibody in serum can be helpful and preferable to differentiate and monitor pMN vs sMN. It can be detected in serum by various assays like western blot, indirect immunofluorescence (IIF) -Cell-based assay and enzyme-linked immunosorbent assay (ELISA). Each method has its own advantages and limitations. ELISA is commonly used assay with 70-75% sensitivity and >95% specificity. Our experience of 70 patients has shown that anti-PLA2R antibody by ELISA may be positive in both pMN as well as sMN with 39.13% sensitivity. Negative anti- PLA2R antibody titer does not exclude the possibility of primary or idiopathic MN and such cases require further evaluation. Larger sample size with follow-up would be required to establish the role of anti- PLA2R antibody titer as a prognosticator in MN.
University of Niš, Serbia
Title: Polypharmacy in elderly patients with chronic kidney failure and its association with potentially inappropriate prescribing of drugs
Time : 15:25-15:55
Gorana Nedin Rankovic was born on September 18th, 1985 in Nis, where she finished her primary and high school with great success. She enrolled Medical Faculty in Nis in 2003 and graduated in 2009. In 2009 she enrolled Doctoral Academic Studies at the Medical Faculty in Nis. By the Teaching Scientific Council of the Medical Faculty in Niš, she got her PhD thesis approved under the title "Analysis of factors that influence the rational prescription of drugs in elderly patients with renal insufficiency". In 2012 she enrolled Specialistic Academic Studies, Clinical Pharmacology. In October 2012 she started working as a teaching associate at the Department of Pharmacology and Toxicology, Medical Faculty in Niš, and in October 2015 she was selected as teaching assistant at the same Department. During her professional career, she was the author and co-author of twenty-five (25) scientific papers printed in domestic and international journals. She is one of the authors of the book "Physiology with Physiology of Sport". She is a member of the Serbian Pharmacology Society and a member of the Clinical Pharmacology section of Serbia.
Introduction: Given that the number of people over 65 years of age is increasing worldwide, polypharmacy is becoming more and more present in the elderly. Unfortunately, polypharmacy can be associated with many negative outcomes, such as higher costs of treatment, both for the patient and the health care system in general, due to the increased use of health care, increased risk of drug-related adverse events, no adherence to therapy due to the numerous medications that the patient takes, drug interactions, etc.
Purpose: The aim of this study was to determine the prevalence of polypharmacy in elderly patients with chronic kidney failure (CKF), and also to explore if it affects the occurrence of potentially inappropriate prescribing (PIP) of drugs.
Methods: The study was based on a cross-sectional design, and it was conducted at the Department of Nephrology, Clinical Center in Nis. Criteria for inclusion in the study were: age of 65 years and more, written consent for participation in the study, and the presence of chronic kidney failure The data were collected from the interviews with patients, as well as from medical files. The presence or absence of inappropriate drug prescription was determined by two explicit criteria Beers and STOPP.
Results: The study included 135 patients aged 65 years and over with varying degrees of CKF, whereby the majority of patients (34.9%) had the third stage of CKF. 78 (57.78%) patients were men and 57 (42.22%) were women. The average number of prescribed drugs was 7,13±2,61 (maximum 16). According to the Beers criteria, PIP was found in 44 (32.6%) patients, while 55 (40.7%) patients experienced PIP according to the STOPP criteria. A major factor associated with PIP by both criteria was polypharmacy. Each additional drug increased the risk of PIP according to Beers criteria 1.6 times (p<0.001).
Conclusion: Although polypharmacy paradoxically connects with poorer treatment, it is first necessary to estimate the overall quality of the prescribed drugs and not only the total number of medications taken by the patient.
SCB Medical College, India
Time : 16:15-16:45
Mangal Charan Murmu (Age: 44yrs) completed his MBBS (1991-97) from MKCG Medical College, Berhampur and he obtains his MD (Pediatrics-1999-2002) from VSS Medical College, Burla, Sambalpur. Now he is working as Associate Professor in SCB Medical College, Cuttack, Odisha, India. He has got 5 international, 15 national and 20 state publications. He is the examiner of both Undergraduate & Postgraduate for West Bengal Health University, Chhattisgarh Health University, Andhra Health University, Manipur Health University.
Aim: To study the use of Dialysis in Acute Kidney Injury (AKI) in different clinical conditions in pediatric practice in a tertiary care hospital.
Method: It’s a direct prospective study done in the Paediatric Department of SCB Medical College, Cuttack, Odisha, India. The child admitted with a clinical feature of AKI was taken into study. Total numbers of cases taken in the study from January 2015 to December 2017 were 48. AKI due to severe malaria (n=18), septicaemia (n=14), vasculotoxic snake bite (n=8), severe dehydration (n=6), complicated urinary tract infection (n=2) were included. The data obtained were analyzed and statistically validated.
Results: Prerenal was the most common cause of AKI needing dialysis.
Conclusion: The dialysis done in the early phase of clinical condition reduces the mortality due to ARF.