Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd International Conference on Nephrology & Therapeutics Valencia, Spain.

Day 2 :

  • Track 5: Dialysis in Renal Disorders
Location: Valencia, Spain
Speaker

Chair

Thomas Ryzlewicz

ViaMedis Kidney Center, Germany

Speaker

Co-Chair

Matthew Joseph Trainor

University of Massachusetts Medical School, USA

Session Introduction

Matthew Joseph Trainor

University of Massachusetts Medical School, USA

Title: Overview of the science of renal replacement therapy focusing on its application in acute kidney injury

Time : 09:00-09:20

Speaker
Biography:

Matthew Joseph Trainor, MD attended Trinity College Dublin Medical School. He completed an Internal Medicine Residency and a Nephrology Fellowship at the University of Massachusetts Medical School. He was a Chief Medical Resident following his Residency program. Currently, he is an Assistant Professor in the Division of Renal Medicine at the University of Massachusetts Medical School. He serves as the Medical Director of Dialysis Services at the University. He has given talks at the local and national level on Renal Replacement Therapy and has published in journals and textbooks on renal failure and renal replacement therapies.

Abstract:

This talk will be divided into two main parts: Acute Kidney Injury and Continuous Renal Replacement Therapy. The overall focus will be on renal replacement and the clinical questions that arise during its application in renal failure. The number of patients with acute kidney injury continues to increase worldwide. As the level of care becomes more intense, owing to advances in medical technology and therapeutic options so too has the delivery of renal replacement therapy. This talk will cover the early history of renal replacement therapy up to the present day. Review of the technical considerations and different modalities responsible for blood purification and volume hemostasis will be covered. There is a growing body of literature on different areas of blood purification and its use in the critically ill. This talk will address issues of dosing dialysis, initiation of therapy and volume hemostasis.

Speaker
Biography:

Thomas Ryzlewicz has completed his MD at the age of 25 years from Free University West-Berlin. He was Senior Consultant of a Dialysis Center near Munich, Germany. In order to realize an own Medical Project (> Bloodline with very much reduced contact between Blood and AirOxyless-Line) an employed Job was disadvantageous. He realized this Project with Partners (Foundation of BHR GmbH (Germany), Foundation of Oxyless Ltd. (Reading), Patents with partners, PEMA-Audit in London). He is invited for Lectures with Technical Background concerning Dialysis regularly. His clinical work he does today in the viamedis Kidney Center in Riesa / Dresden (Germany). Two publications as Co-Author in Kidney International.

Abstract:

Acidification is done in all mammals because of high energy turnover including the body temperature of 37°C. So bicarbonate is the way of logistics of carbone dioxide in the body. In order to prevent calcification of the ions with severe solubility (Ca++, Mg++ and bicarbonate-) the gas carbon dioxide shifts the actual reaction (pH) in acid direction. So this is also done in the dialysis fluid since 1978 in the vast majority with 3 mmol/l acetate. There is an elevated pCO2 concentration and calcification due to the higher concentration of bicarbonate (32 mmol/l) in comparison to the condition of the healthy man. This problem of calcification can be realized, when the dialysis supply system is opened. When a dialysis monitor is used to treat a dialysis patient, then it’s necessary to descale this monitor urgently. But there is no descaling of the patient. Problems of Calcification will just start with beginning of dialysis treatment, as even in late CKD-4 states the FGF-23 system is works to eliminate the inorganic phosphate. With the exchange of 3 mmol/l acetate to equimolar 1 mmol/l citric acid, there won’t be any calcification. At the market, dialysis concentrates with 1 mmol/l citric acid are available and licensed. Hence, there is no need for therapy with a chemical unstable chemical prescription (> acidification of 3 mmol/l acetate). In order to prevent this avoidable calcification from the patients, the licencing departments should be forced to forbid the acidification with 3 mmol/l acetate, as this is an unstable chemical prescription.

Speaker
Biography:

Atsuhiro Maeda passed the national examination for medical practitioners in 2000 at the age of 25 years from Fukuoka University. He has published 7 papers in reputed journals. His speciality is hemodialysis, continuous ambulatory peritoneal dialysis, renal transplantation, treatment of chronic kidney disease and acute kidney injury.

Abstract:

Introduction and Aims: Inadequate dialysis is known to be a risk factor for resistance to erythropoietin (EPO) therapy. High doses of EPO increase the risk of death and cardiovascular outcomes in hemodialysis (HD) patients. This study aimed to explore the relationship between EPO dosage and dialysis time in HD patients. Methods: A cross-sectional analysis of the relationship between EPO dosage and dialysis time in HD patients with diabetes was explored. A total of 78 HD patients with diabetes who were receiving maintenance HD at four outpatient HD facilities in Japan were included. They were classified in two groups. Group 1 was made up of 4 hour-HD (n=40) patients who started HD between 1991 and 2011. Group 2 was made up of 6 hour-HD (n=38) patients who started HD between 1994 and 2011. We studied the parameters of hemoglobin (Hb), ferritin, albumin (Alb), C-reactive protein (CRP), intact parathyroid hormone (i-PTH), the standardized HD dose of urea (Kt/V) and EPO requirement. These parameters were analysed using the statistical software, JMP6TM (SAS Institute). Results: The mean age of 78 patients was 66.3±10.6 years, the mean Hb was 11.0±1.0 g/dl, the mean Alb was 3.7±0.4 g/dl, the mean CRP was 0.4±0.6 mg/dl, the mean i-PTH was 125.3±115.8 pg/ml and the mean Kt/V was 1.5±0.2. There were no significant differences between the two groups. EPO requirement was significantly higher in group1 than in group2 (5375.0±461.6 versus 3111.8±473.6 IU/week, P<0.05). Multiple regression analysis revealed that there was a statistically significant relationship between the dialysis time and the EPO requirement (r2=0.24. P=0.002). Conclusions: 6 hours dialysis in HD patients with diabetes can reduce the dose of EPO. Shortening the session time without decreasing significantly the dialysis dose, as judged by Kt/V, was therefore associated with impaired EPO responsiveness.

Hiromichi Suzuki

Saitama Medical University, Japan

Title: Predialysis care for elderly subjects with Chronic kidney disease

Time : 10:00-10:20

Speaker
Biography:

Hiromichi Suzuki has completed his MD at the age of 27 years from School of Medicine, Hokkaido University and Postdoctoral studies from School of Medicine, Keio University. Currently, he is the Professor of Department of Nephrology, Saitama Medical University and the Director of Community Health Science Center, Saitama Medical University. He has published more than 400 papers and has been serving as an editorial board member of several repute journals.

Abstract:

Chronic kidney disease (CKD) and its complications, which involve most organ systems, can be prevented. Cardiovascular diseases and neoplasms are the two major fatal complications. Although it is important to prevent these two, there have been few discussions, and awareness and use of accurate methods are needed to enable timely diagnosis. Based on our more than 10 years experience in a long term care of predialysis patients with CKD, simple and accurate tests will be presented. A single center, retrospective cohort study was performed that included 553 patients (female/male; 179/343; 71 + 4 years old) in stages 4 and 5 CKD (estimated GFR 15 + 6 ml/min/1.73 m2) were treated in the kidney disease center from 2001 to 2009. 11 patients had fatal myocardial infarctions, 6 patients had non fatal cerebrovascular infarction and 19 patients had neoplasms. Based on these data, we started to search for a method for early detection of cardiovascular diseases and neoplasms. For cardiovascular diseases, left ventricular hypertrophy found in echocardiography was associated with progression to dialysis but not with early detection of catastrophic cardiovascular diseases. On the other hand, occult blood in stool samples helped to find polyploid lesions with malignancy in the large intestine.

Paulo Roberto Santos

Federal University of Ceara, Brazil

Title: Dyspepsia: An underestimated problem among end-stage renal disease patients

Time : 10:20-10:40

Speaker
Biography:

Paulo Roberto Santos is Associate Professor at Federal University of Ceará, Brazil, and coordinates the Graduate Program in Health Sciences of the Sobral Faculty of Medicine. His main research interests are self-perceived outcomes (quality of life, depression, coping and sexuality) among end-stage renal disease patients.

Abstract:

Dyspepsia is one of the most common symptoms among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Nonetheless, there is little information about the pathophysiological mechanisms involved in dyspepsia and its impact on patients’ quality of life. We produced some evidence on this topic, placing side-by-side clinical assessments of dyspepsia and an experiment to measure gastric motility in a sample of ESRD patients on HD in the Dialysis Unit of Santa Casa Hospital, in Sobral, northeast Brazil. Dyspepsia was assessed using a validated Brazilian version of a standardized questionnaire named the Porto Alegre Dyspeptic Symptoms Questionnaire. Quality of life was evaluated using a validated Brazilian version of the SF-36. The octanoic acid breath test using 13 carbon was employed to assess the gastric emptying time. Based on the test, gastric emptying time was estimated by calculating the t1/2 (t1/2 being the time in minutes to metabolize the first half of the 13 carbon in the test meal). According to our results, more than half of the patients were dyspeptics. Regarding the impact of dyspepsia on quality of life, we found that patients with dyspepsia presented lower scores (worse quality of life) related to bodily pain, vitality, role-emotional and mental health, compared to non-dyspeptics. Regarding gastric motility, gastric emptying time was longer among dyspeptics compared to non-dyspeptics. Moreover, the t1/2 was positively correlated with dyspepsia score, indicating that the longer the gastric emptying time is, the more severe the dyspeptic symptoms tend to be. Based on our findings, dyspepsia should be considered a target for efforts to improve the quality of life of HD patients. And, due to the association between dyspepsia and gastric emptying delay, prokinetics can be tried in cases of proven functional dyspepsia when other treatments of dyspeptic symptoms are not successful.

Break:
Coffee Break 10:40-10:55

Mabel Aoun

Saint-Georges Hospital Ajaltoun, Lebanon

Title: Cerebral hemorrhage in haemodialysis patients

Time : 10:55-11:15

Speaker
Biography:

Mabel Aoun has graduated in 2004 as a Nephrologist from the Université Saint-Joseph in Beirut-Lebanon. She completed her fellowship in nephrology at Kremlin- Bicêtre Hospital in Paris-France. She has a diploma in Renal Pathology from Université Saint-Antoine, Paris. She is the head of department of Nephrology and Dialysis at Saint-Georges Hospital Ajaltoun-Lebanon. She was responsible for the training of interns and residents from Saint-Joseph University and Kaslik University between 2007-2012. She is also a consultant in nephrology at the lebanese ministry of public health since 2012. Her main interests are glomerulonephritis’ pathology and treatment as well as the improvement of haemodialysis and peritoneal dialysis treatments in her country.

Abstract:

Antiplatelets therapy and anticoagulants are widely used in hemodialysis (HD) patients as a primary or secondary prevention for cardiovascular diseases. Their major side effect in this population is cerebral or digestive hemorrhage. We conducted a retrospective study in our center between 2005 and 2011 to find out whether the prescription of these drugs is well indicated and when it should be avoided in hemodialysis patients. 125 patients were dialyzed in our center between January 2005 and December 2011. They were divided into two groups. Group I included 68 patients who were not taking any antiplatelet or anticoagulant treatment. Group II included 57 patients: 26 were taking aspirin, 16 clopidogrel and 15 acenocoumarol. The mortality in Group I was 50% without any hemorrhagic complications. In Group 2 the mortality was 74 %. 19% in group 2 experienced hemorrhagic complications (6 cerebral and 5 digestive). 9 out of 42 deaths (21%) in Group 2 were secondary to hemorrhagic events: five patients on antiplatelet therapy developed hemorrhagic stroke and four patients on oral anticoagulant died because of digestive bleeding. The five patients who were on aspirin and died of cerebral hemorrhage were all uncontrolled hypertensive patients. Our results suggest that antiplatelet therapy represent a high risk for cerebral hemorrhage in patients with end-stage renal disease on chronic hemodialysis especially in those with uncontrolled hypertension. In summary we conclude that prophylactic aspirin should be used with caution in hypertensive patients on HD.

Speaker
Biography:

Ashish Verma graduated in medicine from Govt. Stanley Medical College, Chennai. After that, he worked as a research affiliate in the Dialysis Vascular Access research group in University of Cincinnati Medical center. He worked as junior resident and clinical research assistant in Department of Kidney, Urology and Transplantation in Madras Medical Mission Hospital. He has published cases and manuscripts in peer reviewed journals and also presented abstracts in international Congress. Currently He is a Clinical Research Assistant in the Department of Nephrology in MMM Hospital.

Abstract:

Peritoneal dialysis (PD) is an efficient renal replacement method (RRT) for AKI as it is simple and does not produce hemodynamic instability. There is scarcity of published data on the use of PD for patients with AKI due to acute myocardial infarction, cardiac failure and cardiac dysarrythmia.We retrospectively analyzed the outcome of AKI using PD as a cost effective modality in 84 patients over a period of 36 months (January 2009-December 2011) out of 6,687 patients admitted to CCU. Among 84 patients, males-64.3% and females-35.7% with mean age 59.23±11.28 years. The total mortality was 14.3% (12). Of the remaining 72 patients, we observed functional recovery in 68 patients (81 %). Four (4.8%) patients were transferred to hemodialysis. Complication was exit site leak which was noted in 8 patients (9.5%). Among those 8 patients, 3 recovered, 4 patients were transferred to hemodialysis and 1 patient died. All leaking catheters were removed. None developed peritonitis. We observed decrease in serum creatinine by 47% (p<0.0001). The stay in CCU was 5-8 days. Patients recovered with a 58% (p<0.0001) increase in mean urine output. Univariate analysis did not showed gender (p=0.375), diabetes (p=0.227), fluid overload (p=0.793) and ventilation (p=0.064) associated with complications. The complications were less with a swan neck catheter (p=0. 021). P<0.05 was considered significant. With 81% functional recovery, PD is an inexpensive, effective treatment for AKI patients in CCU with MI, cardiogenic shock and cardiac dysarrythmias. PD is a cost effective treatment which does not need machinery, skill and financial resources as compared to other modalities.

Lydia Benhocine

University Hospital of Beni Messous, Algeria

Title: Current state of vascular access in chronic hemodialysis patients in Algeria

Time : 11:35-11:55

Speaker
Biography:

Lydia Benhocine is MD, and Nephrologist. She received her medical doctorate from Medical School of Algiers in 2003 and completed her Residency in Nephrology with honor as an Assistant Professor in 2008. She worked on pediatric and adult renal transplantation and was trained for transplantation in Clinic Barcelona with Pr. Campistol. She is actually Head of Department of Hemodialysis in one of the biggest University Hospitals of Algiers. She has made numerous presentations at national and international scientific meeting and publications in national journals. She is member of the Algerian Society of Nephrology and also representative of North African Region for the Middle East Society for Organ Transplantation (MESOT).

Abstract:

Despite all the progress made in the techniques of renal replacement therapy, hemodialysis (HD) survival depends in a large part on the quality of vascular access. In Algeria, a country with a population of 37.1 million inhabitants, more than 17,000 patients are on dialysis (98% HD) distributed in 275 hemodialysis centers across the country. We made a prospective study in order to identify what type of vascular access for hemodialysis is made on first intention and then realize a clinical expertise on the vascular access for dialysis in patients after a certain period of HD. Our study was multicenter and collated in 60 days (data collection and statistical study). 1029 chronic hemodialysis patients treated and supported in 21 hemodialysis centers (public and private center) located in the capital city of Algiers and neighboring towns. We found that sex ratio in our patients was identical and population is relatively young. Percentage of unknown nephropathy (30%) is important and alarming. The percentage of diabetic nephropathy and hypertensive join international datas. The catheter is still representing the first vascular access for HD. Despite 40% of AVF, it shows the needs of follows up and screening of patients with chronic kidney disease before the end-stage of renal disease. First seat of AVF is distal than proximal for just 50% and one patient in five has “a poor” vasculature at less than 10 years of HD. The vasculature of hemodialysis patients is vital. It is important to preserve it carefully by encouraging education of chronic uremic patients and nursing staff and realize a careful evaluation of where the anastomosis should be performed using radiological ways if necessary. Multidisciplinary planning seems essential to achieve this goal and improve the survival of patients on chronic hemodialysis.

Speaker
Biography:

Mohamed Khaled El Hatw graduated from the faculty of medicine, Cairo University. He got a Master degree in pediatrics in 1987 and MD in pediatrics in 1995. Recently he got a Diploma of Public health from Liverpool University. He holds the position of a Pediatric Nephrology consultant in Cairo University Children hospital and currently works as pediatric consultant in a military hospital in Saudi Arabia. He has published 12 papers in reputed journals and holds 12 patents in the field of medical engineering in the Egyptian and US patent offices.

Abstract:

In rapid accelerated hemodialysis (R-AHD), blood partially recirculates from the venous (outflow) to the arterial (inflow) line through a recirculation line (R) to selectively increase the filter blood flow rate (BFR). R-AHDPR uses two blood pump segments at the patient segment of the arterial line and at (R). To determine the effectiveness of R-AHD with regard to increasing anticoagulation and dialysis efficiency, ten children with end-stage renal disease in two stages were studied: stage 1 with 10 routine heparin R-AHD, then 10 half-dose heparin R-AHD, then 145 routine heparin R-AHD sessions for 1 month and then routine heparin double needle hemodialysis (DNHD) for one month (control). In stage 2, the patients with 10 routine heparin-mixed AHDPR and DNHD sessions were dialyzed, then eight low-dose heparin R-AHDPR” sessions, then one of the children with 10 no-heparin R-AHDPR sessions and then 10 routine heparin DNHD sessions” (control). Signs of blood clotting and dialysis efficiency were monitored. Blood clots appeared in four out of 165 R-AHD0 (one pump circuit) sessions but in none of the 28 R-AHDPR sessions. In stage 1, the mean urea reduction rate was 0.60, 0.60 and 0.70 for the R-AHD protocols, compared with 0.71 for the control (P>0.05). In stage 2, the arterial blood urea nitrogen was reduced by 0.66±0.15 after an R-AHDPR period, compared with 0.79±0.18 after a DNHD period (P=0.059). In conclusion, R-AHDPR allowed successful low heparin and no heparin hemodialysis in children without increasing the patients’ BFR. However, the technique did not increase the efficiency of dialysis.

Lavinia-Oltita Brătescu

Sf. Pantelimon International Healthcare Systems Nephrology and Dialysis Medical Center, Romania

Title: Hepcidin-25-A useful clinical guide for iron-restricted erythropoiesis detection in haemodialysis patients

Time : 12:15-12:35

Speaker
Biography:

Lavinia-Oltita Bratescu graduated from University of Medicine and Pharmacy from Timisoara, in Romania (on 2000). She completed her studies with specialization in Nephrology, in 2006. From 2007, she has worked as a neprologist in Sf Pantelimon International Healthcare Systems Nephrology and Dialysis Medical Center, in Bucharest. From 2012, she has been a chief physician of the same medical center. She completed her PhD in November 2013. She has participated in national and international nephrology conferences as a speaker and as poster presenter.

Abstract:

Background: Iron-restricted response to erythropoietic stimulating agents (ESAs) is difficult to identify; the best criterion seems to be haemoglobin response to intravenous (IV) iron but hepcidin-25 could be a useful marker. There are some indices that hepcidin is directly regulated by the intensity of erythropoietic activity, more than by iron stores or inflammation. Thus, giving more iron to properly selected patients would restore the erythropoietic activity with a decrease in hepcidin ESAs doses and darbepoetin resistance index, so response on hemoglobin. The study investigates influence of additional IV iron doses on serum hepcidin-25 levels in haemodialysis (HD) patients without obvious iron deficiency, according to peripheral iron indices, as it is mentioned in reference guidelines. Results: At baseline, 21% of patients had optimal iron status; none had absolute or functional iron deficiency, while 15% had iron overload. Mean haemoglobin was within the target range for HD patients. Reversal of iron-restricted erythropoiesis was further sustained by stable Hb and decrease in darbepoetin doses and darbepoetin resistance index. After a 75% augmentation in IV iron doses, prevalence of functional iron deficiency rose to 24% and of iron overload declined to 0%. More than that, hepcidin-25 decreased by 70%. Transferrin increased, TSAT and ferritin decreased, while Hb did not significantly change, although it shows an uptrend. Variation (assessment vs. baseline ratio) in serum hepcidin was correlated inversely with variation in transferrin and directly with variation in ferritin and in TSAT, supporting hepcidin’s value for the diagnosis of iron-restricted erythropoiesis. A model of multivariable linear logistic regression predicted 34% of hepcidin variability. Only assessment versus baseline ratios of transferrin and ferritin were significant contributors. Conclusions: Reversal of iron-restricted erythropoiesis after additional IV iron administration in haemodialysis patients without evident iron deficiency was associated with significant decreasing trend in serum hepcidin-25. Hepcidin-25 could add useful information to guide iron supplementation in ESAs treated dialysis patients when iron indices are not evocative for iron deficiency. Thus, trends in serum hepcidin-25 could be clinically useful, if confirmed in controlled studies.

Break:
Lunch Break 12:35-13:15
Workshop on "Anti-complement therapy of renal diseases"
By
Kenneth V Lieberman
Hackensack University Medical Center, USA
13:15:14:15
  • Track 6: Glomerular Diseases
    Track 7: Metabolic Disorders and Nephrology
    Track 8: Treatments in Nephrology
    Track 9: Renal Transplantation
Location: Valencia, Spain
Speaker

Chair

Lois J Arend

John Hopkins University School of Medicine, USA

Speaker

Co-Chair

Manuela Stoicescu

University of Oradea, Romania

Session Introduction

Lois J Arend

Johns Hopkins University, USA

Title: Novel roles for PKD genes in the reproductive tract and in stromal cells of the kidney

Time : 14:15-14:35

Speaker
Biography:

Lois J Arend is Associate Professor of Renal Pathology at Johns Hopkins University School of Medicine. She received a PhD in Physiology and her MD at Michigan State University, then completed residency and a fellowship in renal pathology at The University of Michigan. She has studied renal function and disease in areas such as the role of adenosine in normal kidney function, development of the kidney, and cystic kidney disease, and the pathology of vascular access and transplantation for 30 years, publishing over 65 peer-reviewed articles, reviews, and chapters in major textbooks such as Heptinstall’s Pathology of the Kidney. She is Director of Clinical Fellowship training for the Department of Pathology at Johns Hopkins University.

Abstract:

Autosomal dominant polycystic disease (ADPKD) is a very common genetic disease, affecting up to 1 in 500 people. Many affected individuals progress to end-stage renal disease (ESRD) by the fifth to sixth decade of life. Mutations in the Pkd1 gene account for over 85% of ADPKD cases, while the Pkd2 gene is believed responsible for the remainder. Despite this well-established genetic basis, current mouse models do not adequately explain the clinical progress or reveal underlying pathogenic mechanisms in human ADPKD. Many of these models have been used as the basis for developing therapeutic strategies that have failed to produce results in subsequent clinical trials. We have used novel approaches to investigate the renal and reproductive tract abnormalities in mice, opening new avenues for understanding PKD and its associated morbidities. Infertility and reproductive tract abnormalities in male ADPKD patients are very common and have higher incidence than in the general population. In mouse models we developed, we identified novel defects in the reproductive tract that could form the basis for some of these issues. In addition, a mouse model targeting Pkd1 gene deletion in the stromal cells of the kidney offered a more faithful reproduction of human ADPKD than currently available models. In particular, these mice are being used to investigate the hypothesis that a “third hit” occurs during childhood or early adulthood leading to faster, more vigorous or larger cyst development and greater risk of progression to ESRD. The study of ADPKD has stagnated due to a lack of models that reproduce the human condition for understanding pathogenesis, progression, and targeting therapies. These models may provide new mechanistic understanding of ADPKD and hold promise as a foundation for new therapeutic strategies.

Speaker
Biography:

Marwa Eltoweissy completed her PhD at the age of 30 through a scholarship and cooperation work between faculty of Science, Alexandria University, Egypt and Rheinische Friedrich-Wilhelms-University Medical Center Bonn, Institute for Physiology II, Germany. She achieved her postdoctoral studies from Gastroenterology and Endocrinology department, Georg-August University Medical Center, Göttingen, Germany. She works as scientific researcher at the Nephrology and Rheumatology department, Georg-August University medical center, Göttingen, and as an Assistant Professor of Physiology, Zoology department, Alexandria University, Egypt. She has published 15 papers in reputed journals and serving as reviewer for privileged journals.

Abstract:

Oxidative stress (OS) is known to desperately affect the survival and proliferation of renal cells resulting in impairment of kidney function and final progression of renal tubulointerstitial fibrosis. The purpose of present study was to investigate the correlation between oxidative stress and renal fibrosis progression. Further to investigate the effect of profibrotic cytokines on PARK7 expression. In order to identify new molecular targets associated with oxidative stress induction and renal fibrosis, cells were treated with profibrogenic agonists PDGF and oxidative stress triggering factors ANGII, and the proteome alterations were investigated. 2D gel analysis coupled with mass spectrometry was performed with established renal cell lines (TK173 and HK-2). The in vitro results were further confirmed with Col4A3 knockout mice as a fibrosis model. 2D gel analysis showed that an increase of ROS in the renal cell lines upon the different treatments was accompanied by alteration of a large number of proteins. Differentially regulated proteins were classified into different functional categories by the DAVID bioinformatic database resource. A major category was proteins responding to stress and involved in OS pathway. As part of OS response, we identified an over expression of PARK7, PRDX1, PRDX5, PRDX6, SOD1, SOD2). Immuno-histochemical and Western blot analyses of progressive stages of Col4A3 knockout mice further showed an enhanced expression of these OS proteins with progressive increase in fibrosis. Identifying PARK7 interaction partners and characterizing the mechanism of its action further clarified the role of PRK7 in balancing OS in renal fibrosis. The present study suggests a direct correlation of fibrosis progression and expression of OS proteins.

Matthew Joseph Trainor

University of Massachusetts Medical School, USA

Title: Controversies in the medical managment of kidney stones

Time : 14:55-15:15

Speaker
Biography:

Matthew Joseph Trainor, MD, attended Trinity College Dublin Medical School. He completed an Internal Medicine Residency and a Nephrology Fellowship at the University of Massachusetts Medical School. He was a Chief Medical Resident following his Residency program. Currently he is an Assistant Professor in the Division of Renal Medicine at the University of Massachusetts Medical School. He has a special focus in metabolic stone disease and acts the local expert. He is working on establishing a formal Renal Stone Clinic with Urology and a Dietician.

Abstract:

Kidney stones prevalence has been increasing in most countries and account for a large burden on their economies. A better understanding of the pathogenesis and prevention can help curb this growing epidemic. This talk will review stone genesis and the metabolic conditions that would foster this. As kidney stone disease is quite common, and many myths and “home remedies” have gained traction; this talk will help weed the myth from medical science. Attendees will leave with a better understanding of how to establish the metabolic abnormalities that lead to stone formation and how to address these with pharmaceutical and non-pharmaceutical interventions.

Break:
Coffee Break 15:15-15:30
Speaker
Biography:

Alex Constantinescu obtained his MD degree from the “Victor Babes” University of Medicine and Pharmacy in Timisoara, Romania and completed pediatric nephrology specialty training at Montefiore Medical Center, Albert Einstein College of Medicine in New York. Subsequently, he joined the faculty at Robert Wood Johnson Medical School in New Brunswick, NJ. He relocated with his family to Florida in 2003. Currently he maintains Board Certification in Pediatric Nephrology, is the Medical Director of Pediatric Nephrology, Dialysis and Hypertension at Joe DiMaggio Children’s Hospital, Hollywood, FL, and is part of the voluntary faculty at University of Miami and Florida Atlantic University.

Abstract:

Minimal Change Disease (MCD) is the most common cause of nephrotic syndrome (NS) in children. Although most cases are steroid-sensitive, the high rate of relapse demands a larger cumulative dose, leading to growth retardation in some. The impact of steroid therapy is more significant during the first 3 months, with some children failing to achieve catch-up growth even after 6 months. Since repeated doses of steroids add significant toxicity over time, several approaches have been suggested to minimize this adverse effect, all with various rates of success. Some of these approaches include: prolongation of the initial duration of treatment, addition of calcineurin inhibitors (CNIs), or various protocols for weaning steroids once response is achieved. CNIs are not a good first solution. They require costly drug monitoring, while only bringing marginal benefits to the rate of relapse. To decrease the cumulative dose of steroids, we attempted first to predict the relapse pattern from the initial presentation. In our study, the absence of hematuria along with a rapid response to steroids (less than 7 days), predicted an infrequent relapsing course. This pattern was opposite to the phenotype of MDR-1 gene mutants. Since 2003, at our center, children with MCD who showed both a faster response time and an absence of hematuria are treated with a shorter course of steroids, as per ISKDC protocol. This approach led to improved growth velocity rate and height SDS, thus minimizing the adverse effects of steroids on growth in these children.

Manuela Stoicescu

University of Oradea, Romania

Title: Acute renal failure after therapy with Interferon

Time : 15:50-16:10

Speaker
Biography:

Manuela Stoicescu is a consultant internal medicine physician, PhD, Assistant Professor of University of Oradea, Faculty of Medicine and Pharmacy, Medical Disciplines Department, Romania. She also works at Emergency Hospital Internal Medicine Department and Internal Medicine Office. She has published two books, one monograph and papers in reputed journals. She was invited as a speaker at 9 national and 20 International Conferences. She is Member of Romanian Society of Internal Medicine, Cardiology, Medical Chemistry, Biochemistry and Member of the Balkan Society of Medicine.

Abstract:

Objectives: The main reason for the presentation of this clinical case is to attract attention of the dangerous possible risks of the therapy with Interferon at the patients with chronic hepatitis virus B or virus C positive who follow this protocol of therapy. Material and Methods: A clinical case where a patient aged 48 years old was hospitalized for the diagnosis of active chronic hepatitis with virus B positive with increase value of liver enzymes (TGO=248UI/l, TGP=342UI/l, Gama GT=121, indirect bilirubin=2,32, total bilirubin=3mg/dl, viremia=6 millions unites, AgHBs+, liver biopsy with histopathology examination confirmed active chronic hepatitis, summary of the urine revealed - presence of urobilinogen, proteinuria, absence of glucose and found to have normal urinary sediment, the value of urea=32mg/dl and creatinine=0.9mg/dl. After the patient followed with the protocol of therapy with @Interferon 3MU 3 times/week during three weeks presented the apparition of a palpable purpuric rash at the lower limbs and the nephritic syndrome was accented: proteinuria=30mg/dl, hematuria=20g/dl. After the skin biopsy was performed the result confirmed safe diagnosis of polyarteritis nodosa. The histopathological examination with fibrinoid necrosis of the vessel wall with surrounding perivascular lymphocytic infiltrates, polyarteritis nodosa was confirmed as the safe diagnosis. After that the patient developed a syndrome of progressive azotized retention uremia with increase level of creatinemia=5,08mg/dl and urea=402mg/dl with anuria so an acute renal failure in context of systemic vasculitis with secondary nephropathies hence an imposition of dialysis for the normalization of the azotized parameters. Histopathological examination after kidney biopsy revealed secondary subacute glomerulonephritis in context of systemic vasculitis. Results and Discussions: The patients with chronic hepatitis virus B or virus C positive is possible to have a systemic vasculitis in the context of the disease without clinical manifestations (subclinical) unknown and with secondary nephropathy in this context with minimal nephritic syndrome manifested with isolated proteinuria, isolated hematuria or proteinuria and hematuria identify after summary urine examination was performed. If the patient had this result with nephritic syndrome after urine examination before she start the therapy with @Interferon for active chronic hepatitis with virus C or B positive, the patient has risk to develop after the protocol therapy sub acute or acute renal failure with severe evolution of the patient with rapid progressive azotes retention syndrome to necessary dialysis for the patients. Conclusion: We must monitor very carefully the kidney function with the azotized parameters every day if the patient follow the protocol of therapy with @Interferon for active chronic virus B hepatitis because in context of unknown (subclinical) systemic vasculitis with a secondary glomerulonephritis the patient with virus B positive is possible to develop sudden and unexpected acute renal failure and dialysis is necessary.

Speaker
Biography:

Hayam Gad has completed her PhD in 1994 from Alexandria University. She is Professor of Physiology at College of Medicine, Alexandria University since 2005. Now, she is working at College of Medicine, King Saud University since 2001. She has published more than 25 papers in reputed journals and serving as supervisor for many master and PhD thesis. She has got six research grant awards from King Abdel Aziz City for Science and Technology. Her research interests include therapeutic and prophylactic treatments of diabetic nephropathy, changes in blood biomarkers during menopause and its implications on cardiovascular structure and function, homeostatic imbalance of osteoporosis and its treatment etc.

Abstract:

Objective: The present study aimed at attenuating the effects of early streptozotocin-induced diabetes on renal functions through supplementation of either pravastatin or 12/15-LO pathway inhibitors. Materials and Methods: The current study was carried out on 88 male Wistar assigned to 3 groups (8 rats/group): Group I included control rats receiving vehicle. Groups IIa, IIb, IIc, IId, IIe: included normoal buminuric diabetic rats receiving vehicle, NDGA, NDGA + insulin, pravastatin or pravastatin + insulin respectively. Groups IIIa, IIIb, IIIc, IIId, IIIe included microalbuminuric diabetic rats receiving vehicle, NDGA, NDGA + insulin, pravastatin or pravastatin + insulin respectively. Renal function tests were measured and blood samples were analyzed for glycosylated hemoglobin (HbA1c), serum levels of cholesterol, triglycerides and lipid peroxide and plasma levels of VEGF, total nitric oxide (NO) products and homocysteine (Hcy). Results: The results of the present study demonstrated favorable effects of both NDGA and pravastatin to the same extent on renal functions and more favorable effects when diabetes is controlled. Microalbuminuri rats received NDGA experienced a decrease in urinary albumin creatinine ratio (ACR) to the same extent as did microalbuminuric rats received pravastatin. Indices of DN and oxidative stress as lipid peroxide, VEGF, and Hcy all were reduced by NDGA or pravastatin therapy with no statistical difference between the two lines of therapy. Conclusion: 12/15-LO inhibition and statins like pravastatin may be useful as therapeutic strategies for prevention or amelioration of DN. Confirmation of these preliminary observations must await careful long-term studies on experimental DN.

Biography:

Teresa Sousa, PharmD (1999), PhD in Pharmacology (2006), is an Investigator at the Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto. Her major research interests are oxidative stress, renin-angiotensin system and resolution of inflammation mediators in arterial hypertension and heart failure. She has received several prizes/awards, including the Poster Award from EPHAR, the Lars-Erik Gelin Conference Travel Award from the European Society for Microcirculation, the Young Investigator Prize from the Calouste Gulbenkian Foundation, the Young Investigator Prize from the Portuguese Society of Hypertension and the Alberto Ferrari Poster Prize from the European Society of Hypertension.

Abstract:

The combined treatment with low-dose aspirin and losartan appears to elicit a higher cardiovascular protection than losartan alone in hypertensive patients but the mechanisms involved have not been elucidated. The acetylation of cyclooxygenase 2 (COX-2) by aspirin induces the synthesis of 15-epi-lipoxins (15-epi-LXs) which act as stop signals in inflammation and also limit oxidative damage, induce vasodilation and improve renal function. The study was aimed at evaluating if low-dose aspirin improves renal function and the antihypertensive efficacy in hypertensive rats treated with losartan and whether this putative protective effect is associated with changes in COX-2 derived eicosanoids and oxidative stress. Twelve week-old spontaneously hypertensive rats (SHR) were assigned to 4 groups: control, aspirin (10 mg/kg/day, 8 days), losartan (15 mg/kg/day, 8 days) and losartan+aspirin (8 days). Systolic blood pressure (SBP), renal function, renal COX-2 expression and the plasma and/or urinary levels of 15-epi-LXA4, 11-dehydro-thromboxane B2 and 8-isoprostane were evaluated. The combined treatment with aspirin and losartan in SHR was associated with significantly lower levels of systolic blood pressure, proteinuria, plasma urea, plasma uric acid, urinary excretion of 11-dehydro-thromboxane B2 and 8-isoprostane and renal COX-2 expression, when compared to losartan alone. Urinary 15-epi-LXA4 was also tendentially higher in SHR treated with aspirin or losartan+aspirin. Thus, it is concluded that the addition of low-dose aspirin to losartan improves the antihypertensive efficacy and renal function in SHR. These effects appear to be related to a reduced ratio between renal eicosanoids with vasoconstrictor and pro-inflammatory activity (thromboxane A2, 8-isoprostane) and those with vasodilator, anti-inflammatory and antioxidant properties (15-epi-LXs).

Speaker
Biography:

Nadezda Petejova, MD, PhD, graduated from the Medical Faculty of the Safarik University in Kosice (Slovakia). After studies she started her professional carrier at the internal department of the City hospital in Svidnik (Slovakia) from 1998 to 1999, in 1999-2003 at internal department of City hospital in Rimavska Sobota (Slovakia) and from 5/2003 to present she has been working at internal department of University hospital of Ostrava (Czech Republic). She received the first-degree attestation in internal medicine in 2001, the second-degree attestation in 2005 and attestation in nephrology in 2009. Her research interests span various aspects of Internal and Critical care medicine but center mainly in critical care nephrology including renal replacement therapy and blood purification in critically ill patients with acute kidney injury. She is regularly publishing in impacted journals and presenting her scientific results at leading critical care and nephrology congress.

Abstract:

Background: Acute kidney injury (AKI) is a common complication in patients with sepsis. Dosing of antibacterial agents in critically ill septic patients is complicated by altered pharmacokinetics due to both AKI and critical illness. Vancomycin (VAN) is a widely used antibiotic drug that has an important role in the treatment of infections in critical care units. The pharmacokinetics of VAN in critically ill patients with AKI on high-volume continuous venovenous hemofiltration (CVVH) at a filtration rate 45 mL/kg b.w./hour and on low-flux and high-flux extended daily dialysis (EDD) is substantially different from other patients. Methods: 17 septic patients with AKI treated with VAN on CVVH and 9 patients on EDD (5 low-flux and 4 high-flux) were included. In the CVVH group, patients received the first dose of 1.0 g intravenously followed by 1.0 g/12 hours if not adjusted. The VAN maintenance dose was optimized to achieve AUC0-24/MIC ≥400 (Cmin >10 mg/L). In the EDD group was VAN administered over the last hour of dialysis. Blood samples were obtained before VAN administrations, immediately after infusion, 1 hour and 2 hours after administration and before dialysis. Maintenance doses were adjusted according to drug serum concentrations. Results: In the CVVH group: median VAN Cltot was 0.89 and 0.55 mL/min/kg on the first and second day of study. ClCRRT accounted for about 50 to 60% of VAN Cltot found in a healthy population (0.97 mL/min/kg). VAN serum concentrations after the first dose were below the required target of 10 mg/L as early as 6 hours in 10 patients. AUC0-24/MIC ≥400 ratio was achieved in 67% of patients in the first day. In the EDD group, median percentage of VAN removal by low-flux membrane dialysis was 17% (range 8-38%) and by high-flux membrane dialysis 31% (range 13-43%). VAN removal by high-flux membrane EDD was about two-fold higher than dialysis with low-flux membrane. Conclusions: CVVH at a filtration rate of 45 mL/kg b.w./hour leads to rapid and high removal of VAN. Due to change in patient΄s clinical status it was impossible to predict a fixed dosage regimen. We recommend administration of unreduced loading dose and blood sampling as early as 6 hours after first VAN dose and maintenance dose should be based on drug levels monitoring. Both high-flux and low-flux membrane EDD remove considerable amounts of VAN in critically ill patients with AKI and therapeutic drug monitoring is substantial for optimalization of dosage adjustment.

Salil Jain

Fortis Memorial Research Institute, India

Title: Ethical challenges in organ donation

Time : 17:10-17:30

Biography:

Salil Jain did his Medical Graduation and Post-graduation in Medicine from Mumbai University in 1995 and subsequently got trained as Nephrologist and Renal transplant physician. He also did a Fellowship in Adult Nephrology and Renal Transplantation from University of Toronto, Canada. His main interest is in field of renal transplantation and in last 15 years he has been involved in promoting deceased donor transplant, paired exchange transplant and ABO incompatible renal transplant. Presently he is working as senior consultant at Fortis Memorial Research Institute, Gurgaon, India.

Abstract:

In developing nations like India non communicable diseases like diabetes, hypertension and chronic kidney disease are now assuming epidemic proportions. As renal transplant is the best option for a patient of end stage renal disease the need for organs is ever increasing. To streamline organ donation and curb unethical practices, the Govt. of India enacted the ‘Transplantation of human organ act “in 1994. This accepted brain death as a form of death and made sale of organs a punishable offence. Despite this act there have been constant reports of organ sale in India and the implementation of the law has left a lot to be desired. To overcome these legal and ethical issues various strategies have been devised. 1. Increasing the deceased donor pool by education, mandating of presumed consent, giving incentives or expanding the donor criteria 2. Increasing living donation by doing transplants across the blood group barrier, paired exchanges, accepting borderline diabetics as donors, incentives in financial and non-financial manner 3. Alternative organ sources like animal organs, artificial organs, stem cells and aborted fetuses

Ali Reza Khoshdel

AJA University of Medical Sciences, Iran

Title: Development of a renal risk score by an artificial neural network (PARRS study)

Time : 17:30-17:50

Speaker
Biography:

Ali Reza Khoshdel graduated as a medical doctor in 1994 and completed his PhD in 2007 from the University of Newcastle, Australia. He did his postdoctoral studies in chronic kidney diseases, diabetes and hypertension as well as renal replacement therapies and is expert in arterial stiffness studies. He is working as an associate professor in clinical epidemiology and is the director of the Modern Epidemiology Research Centre, and is currently the Dean of education in his affiliated university. He has published more than 80 papers and book chapters in reputed journals and serving as an editorial board member and of several international journals.

Abstract:

Background: The incidence of diabetes mellitus (DM) and chronic kidney disease (CKD) is increasing worldwide with many cases remaining undiagnosed until later disease stages when medical intervention has limited benefit. Although many risk factors for development and progression of diabetic nephropathy (DN) have been recognized, few attempts have been made to incorporate them into a reliable and practical renal risk score. Method: Two hundred and seven outpatients (100 DM, 55% male, average age 60) were evaluated for predictors of GFR. After exclusions, 44 variables (demographic, medical historic, metabolic, hemodynamic) relating to 186 patients were modeled by two artificial neural network (ANN) systems (for a binary GFR with 60 and a four-level GFR with 60, 80 and 100 cut-off points) with a forward feed, back propagation method and two hidden layers while 69, 15 and 16 percent of the cases were randomly selected for the training, validation and test sets respectively. In addition, the data was analyzed by a support vector machine (SVM) system with a boosting classifier wrapping. Results: Eleven factors with binary outcome and 12 factors for the four-level outcome remained as important determinants after elimination steps with a corresponding 94.6% and 89.2% total accuracy for the applied ANN models for GFR prediction. This was superior to the SVM model result. Age, DM, arterial stiffness, aortic blood pressure and anemia as well as microalbuminuria, non-dipping nocturnal blood pressure, triglyceride and ARB medication were among the top ten important factors but gender had a minimal impact. Conclusion: The designed PARRS risk score by ANN, although requires validation, strongly predicted impaired GFR from its early stages. The network of interrelationships between demographic, metabolic, arterial and hemodynamic factors as well as anemia and medication also supports the previously proposed “Circulatory Syndrome” hypothesis.

Speaker
Biography:

George J Dugbartey is pursuing his PhD at University Medical Center Groningen, Netherlands and will finish in December 2014 after which he intends to do a Postdoctoral research in renal transplantation. He has just submitted four research papers to reputed journals and awaiting reviewers’ feedback, and currently writing two review papers.

Abstract:

Background: Hibernation represents the most radical example of hypometabolism among mammalian species and is characterized by repetitive cycles of cooling (torpor) and rewarming, which resembles several clinically relevant conditions such as deep hypothermia, organ storage for transplantation, major surgery and ischemia-reperfusion. Therefore mechanisms applied by hibernators to undergo hibernation without reperfusion injury or other ill effects may have potential application to human medicine. Recently, we have shown that cultured hamster cells are protected from cooling induced apoptotic cell death by an increased production of endogenous H2S through upregulation of cystathionine-β-synthase (CBS). This study aimed at investigating the role of CBS enzyme and H2S in the induction of torpor and kidney preservation during hibernation. Method: Male Syrian golden hamsters (Mesocricetus auratus) were housed in cages in a climate controlled chamber at 5°C under dim red light to induce torpor. Movement of all animals was continuously monitored with passive infrared detectors. Osmotic mini-pumps filled with saline or CBS inhibitor aminooxyacetic acid (AOAA; 100 mg/kg/day) were implanted i.p. during torpor following a bolus injection of AOAA (70 mg/kg) under 2.5% isoflurane anesthesia. At 4 days following implantation of pumps, hamsters which re-entered torpor were aroused by handling for 4 hours and euthanized under pentobarbital anesthesia. Blood samples were taken and kidney of the hamsters was obtained. Summer euthermic hamsters served as controls. Results: Torpid hamsters were aroused during pump implantation. In contrast to saline infusions, infusion of AOAA prevented hamsters from re-entry into torpor. Infusion of AOAA also induced excess renal damage as indicated by high expression of kidney injury marker as well as changes in renal morphology. In contrast, renal morphology was well preserved during hibernation in the saline and non-hibernating summer control groups. Conclusion: Our data show that CBS/H2S pathway is essential in entrance into torpor and preservation of kidney morphology and function during hibernation. These findings might be relevant for a number of clinical conditions such as therapeutic hypothermia or organ preservation for transplantation medicine.