Day 1 :
Keynote Forum
Thomas Ryzlewicz
Via Medis Dialysis Center, Germany
Keynote: The wrong prescription of dialysis fluid
Time : 09:30-10:00
Biography:
Thomas Ryzlewicz is a Nephrologist since 40 years with regular clinical work with RRT patients. In 1974 he used several of the first Dialysis Set-Up’s (Travenolrn120 Batch System, Milton Roy B II, Gambro AK 3) and in 1978 Bag-Hemofiltration was done (with the Equipment of 3 Blood Pumps, one Bed Scale and a Cup tornmeasure the Filtration Rate (with a Stop-Watch).
Abstract:
The worldwide use of acidification with 3 mmol/L of acetate is critical, as there is a big problem of calcification. The majorityrnof the CKD-5 patients has own big problems with calcification. After each Dialysis it is necessary to descale the monitor.rnOnly the patient never will be descaled. To elevate the dosage of acetate is no good idea as the production of CO2 becomesrnbigger. This is a problem for cold patients as well as for patients weaning from the respirator. The alternative prescription withrn1 mmol/L citrate has the same amount of CO2 production as 3 mmol/L acetate but the dialysis fluid with citrate never has arnproblem of calcification. There is a second principle of working, the chelate binding of the two problems ions Ca++ and Mg++.rnUnfortunately, this essential problem will not well understand by the doctors and by the FDA Department, medical productsrnas it is a problem of chemical solubility. Dialysis concentrate is a medical product and so there is no follow-up concerning thisrncalcification problem. First target is to reach a chemical evaluation; second target is the prohibition of dialysis concentrate byrn3 mmol/L acetate.
Keynote Forum
Phuong-Thu Pham
Ronald Reagan UCLA Medical Center, USA
Keynote: Clinical decision-making dilemma: Liver alone or combined liver-kidney transplantation?
Time : 10:00-10:30
Biography:
Phuong-Thu Pham is a Professor of Medicine and Director of Outpatient Services of the Kidney Transplant Program at UCLA Medical Center. Her major areas of interest include recurrence of glomerular diseases following primary renal transplantation, new onset diabetes after transplantation, BK virus screening andrnmanagement after kidney transplantation, the link between hypomagnesemia and renal function decline in patients with diabetes mellitus type 2 as well asrnin recipients of kidney transplant and acute and chronic kidney injury following liver transplantation. Her interests have resulted in publications in well-known Nephrology textbooks and journals as well as invitations to speak at both national and international meetings. She has written over 20 book chapters for major Nephrology and solid organ transplantation textbooks including Comprehensive Clinical Nephrology, Textbook of Organ Transplantation, Transplantation of thernLiver, Pancreas, islet and stem cell transplantation for diabetes, Chronic Kidney Disease: Dialysis and Transplantation, and Handbook of Kidney Transplantation.rnShe has also served as Moderator for transplant-related conferences at the American Society of Nephrology and World Congress of Nephrology, EditorialrnBoard Member for the Case Reports in Nephrology and Transplantation Technologies and Research journals and Member of the Organizing Committee for thernInternational Conference on Nephrology and Therapeutics.
Abstract:
With the introduction of the MELD score for the allocation of orthotopic liver transplant (OLT) in February 2002, arnstriking 278% increase in the number of simultaneous liver-kidney transplants (SLKT) was observed during the 9-yearrnperiod post-MELD when compared with the preceding 9-year in the pre-MELD era (pre- vs. post-MELD era, n=1049 vs. 2914rnrespectively). For OLT candidates with simultaneous end-stage kidney failure, SLKT is a well-established effective therapeuticrnoption for virtually all suitable candidates. However, there have been no well-defined guidelines to determine whether a kidney rntransplant should be offered to OLT candidates who have chronic kidney disease (CKD) or prolonged acute kidney injuryrn(AKI) secondary to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) while awaiting a liver transplant. Specificrnchallenges in the decision making process include the accurate assessment of the degree of existing renal dysfunction in thosernwith CKD, progression of established CKD and the prediction of the extent of renal function recovery in those with AKI withrnor without underlying CKD. Currently existing consensus guidelines for SLKT in OLT wait-listed candidates are presentedrnfollowed by the author’s opinion on identification of candidates who are best suited for double-organ transplantation.
- Track 1: Renal Dialysis and Procedures
Track 2: Renal Genetic syndromes
Track 3: Chronic and End Stage Renal Diseases
Session Introduction
Varun Agrawal
University of Vermont, USA
Title: Use of statins in chronic kidney disease
Time : 10:50-11:15
Biography:
Varun Agrawal is an Assistant Professor of Medicine (Nephrology) at the University of Vermont, Burlington, Vermont USA. He is board certified in Internal Medicine and Nephrology. He is a Fellow of the American Society of Nephrology and American College of Physicians. His areas of interest are chronic kidney disease, hypertension, kidney stones, patient education, provider education, medical education and obesity. He has published many peer-reviewed journal articles in these areas and has performed numerous peer-review activities for a variety of nephrology and medicine journals. He is actively involved in teaching medical students, residents and Nephrology fellows. He has developed a new curriculum for medicine residents rotating in Nephrology that has been well received and appreciated at his institute.
Abstract:
Cardiovascular disease is the major cause of morbidity and mortality in patients with chronic kidney disease. Statins (or HMG-CoA reductase inhibitors) have been shown in clinical trials to reduce cardiovascular events in chronic kidney disease, but are not effective in patients receiving dialysis. While statins are clearly indicated in patients with coronary artery disease or diabetes mellitus to reduce cardiovascular risk, it is not clear if patients with chronic kidney disease without these cardiovascular risk factors benefit from receiving statin therapy. Professional organizations provide different guidelines for use of statins in chronic kidney disease that may confuse the primary care physicians. Current evidence on use of statins in chronic kidney disease will be reviewed. Expert recommendations on how to optimally reduce cardiovascular risk with statins in chronic kidney disease will be provided.
John D Sullivan
Boston University, USA
Title: Creating an oligopoly in the treatment of end stage renal disease and the subsequent impact on home hemodialysis therapies
Time : 11:15-11:40
Biography:
John D Sullivan is an expert in health care policy, finance, and asset valuation. Prior to joining Boston University, he worked for Fresenius Medical Care, completing the acquisitions of over one hundred health care companies with an estimated value of over $5 billion. In 2008, Sullivan co-founded Reliant Renal Care with private equity funding. He has provided strategic guidance for many of the largest health care organizations in the United States. Sullivan presently teaches mergers and acquisitions, corporate finance, investments, and financial markets and institutions.
Abstract:
End Stage Renal Disease impacts the lives of almost 600,000 Americans requiring hemodialysis, peritoneal dialysis or transplantation for continued survival. Incidence and prevalence of this disease is increasing as a by-product of the epidemic of obesity resulting in higher rates of diabetes and hypertension as well as the general aging population. Hailed in 1972 as a first step towards universal health care, the ESRD program has been an expensive undertaking with expenditures of approximately 6% of the Medicare budget for less than one half of one percent of the Medicare population. The government’s response to the increase expenditure has been to reduce cost outlays through an erosion of reimbursement through inflation as well as shifting to a bundled payment system. As a consequence of this policy, consolidation has been aggressive during the past thirty years creating two large dialysis chains that control over 60% of the market with a massive investment in outpatient clinic infrastructure as well as medical product manufacturing to support the outpatient treatment setting. Asset leverage has also led to lower costs through economies of scale, but not without treatment option side effects. While costs have been somewhat contained on a per treatment basis in the face of increased volume demand, new and old therapies have been suppressed including home therapies such as peritoneal dialysis and home hemodialysis attributed to an oligopolistic environment. This paper will track the evolution of the creation of this oligopoly and reflect on the impact on home therapy treatment options for patients.
Narender Goel
Montefiore Medical Center & Albert Einstein College of Medicine, USA
Title: Vascular Access Placement in Patients with Incident CKD Stage 4 and 5 attending an Inner City Nephrology Clinic: A Cohort Study and Survey of Providers
Time : 11:40-12:05
Biography:
Dr Narender Goel has completed his Nephrology fellowship from Montefiore Medical Center & Albert Einstein College of Medicine, NY. He is presently working as a Nephrologist and Clinical Hypertension Specialist at Middletown Medical PC and Orange Regional Medical Center, NY. He is also an Adjunct Clinical Assistant Professor of Internal Medicine and Nephrology at Touro College of Osteopathic Medicine, New York, NY. He is also a founder of non-profit nephrology global website.His primary interests include mineral bone disorder, electrolytes, hypertension and vascular access.
Abstract:
The majority of incident hemodialysis (HD) patients initiate dialysis via catheters. We sought to identify factors associated with initiating hemodialysis with a functioning AV access. We conducted a retrospective chart review of all adult patients, age >18 years seeing a nephrologist with a diagnosis of CKD stage 4 or 5 during the study period between 06/01/2011 and 08/31/2012 and conducted a survey of providers about the process. The 221 patients (56% female) in the study had median age of 66 years (IQR, 57-75) and were followed for a median of 1.26 years (IQR 0.6-1.68). By the end of study, 48 patients had initiated dialysis. Thirty-four of the patients started dialysis with a catheter (1 failed and 10 maturing AVFs), 9 with an AVF and 5 with an AVG. During the study period, 61 total AV accesses were placed (54 AVF and 7 AVG). A higher urinary protein/ creatinine ratio and a lower eGFR at study entry were associated with AV access placement and dialysis initiation. A greater number of nephrology visits were associated with AV access creation but not with the initiation of dialysis. Hospitalizations and hospitalizations with an episode of acute kidney injury were strongly associated with dialysis initiation (odds ratio (OR) 13.0 (95% confidence interval (CI) 2.3 to 73.3, p-value = 0.004) and OR 6.6 (95% CI 1.9 to 22.8, p-value = 0.003)). Nephrologists may not be referring the correct patients to get an AV access surgery. A hospitalization with AKI is strongly associated with the need for dialysis in patients with stage 4 and 5 CKD.
Julio G Davalos
University of Maryland , USA
Title: Current guidelines and trends for kidney stone management; Advancing care of renal stone disease in the united states – Optimizing surgical outcomes and focusing on prevention
Time : 12:05-12:30
Biography:
Julio Davalos is the Medical Director of the Chesapeake Urology Kidney Stone Center. He is the Director of Endourology and Kidney Stone Disease at the University of Maryland Baltimore Washington Medical Center. He has trained over 60 community urologists on percutaneous stone surgery and is actively involved with resident education. He has several publications in the area of stone disease and has particular interest in advanced surgical techniques for the treatment of complex stones. In addition he has developed a comprehensive metabolic program at Chesapeake Urology and is focused on stone prevention.
Abstract:
Kidney stone disease is a common malady affecting approximately 1 in 11 people in the United States (19% men and 9% women) by age 70 years, with a cost exceeding two billion dollars annually. Prevalence has demonstrated a significant rise over the last 20 years and stones are likely to recur in at least 50% of patients within 10 years of the first occurrence. Renal stone disease is primarily a renal physiologic abnormality and approximately 15% of stones require surgical intervention. Stone disease is one of the primary bridge points between the fields of nephrology and urology. A comprehensive review of the American Urological Association guidelines for initial evaluation, conservative versus surgical intervention, metabolic evaluation and medical treatments, optimal surgical modalities, and suggested follow-up for stone formers will be detailed. Current advancements in the surgical treatment of stone disease including an outlook toward contemporary management and future trends in urological stone treatment will also be reviewed. One recent modification in the endoscopic treatment of stones is the advent of “stone dusting.” This technique uses commonly available holmium laser technology to fragment stone into minute particles that can easily pass through the urinary tract. We present our current protocol and early experience with this approach to surgical stone management. Percutaneous Nephrolithotomy (PCNL) is a well-established surgical treatment option for large and complex upper urinary tract kidney stones. PCNL has traditionally been performed as an inpatient procedure with the aid of interventional radiology to provide renal access and nephrostomy tube drainage. We present our series of outpatient PCNLs performed with the urologic surgeon obtaining access and without the routine placement of nephrostomy tube for drainage post-operatively.
H Sudarshan Ballal
Manipal Hospitals, India
Title: Renal replacement therapy in the ICU: Time to end the controversy
Time : 12:30-12:55
Biography:
Dr. H. Sudarshan Ballal was the best outgoing student (Blue Ribbon awardee) of the Kasturba Medical College, Manipal and a recipient of many Gold Medals in MBBS and MD which he completed at the age of 23 years and later had his further training in the USA and had the distinction of being one of the few to be triple Board certified in Internal Medicine, Nephrology & Critical Care. He has the rare distinction of being appointed as Professor of Medicine with St. Louis University School of Medicine (USA) and is also Adjunct Professor of Medicine at Manipal University.He was conferred the fellowship of the Royal College of Physicians, London for his contribution in Medicine.
Abstract:
Acute Kidney Injury (AKI) is defined as a sudden, sustained decline in glomerular filtration rate (GFR), usually associated with uremia and a decline in urine output. The mortality for AKI patients in an ICU setting needing RRT is estimated to be 50% to 70%. Since the introduction of hemodialysis by Kolff in the early 1940s, intermittent renal replacement therapy (IRRT) was offered as a bridge until recovery of kidney function. In the 1980s, Kramer and colleagues introduced continuous renal replacement therapy (CRRT) as an alternative. Since then, few topics in nephrology have been the subject of so many randomized controlled trials (RCTs), meta-analyses and reviews. The theoretical advantages of CRRT mentioned includes, increased time-averaged dialysis dose, less hemodynamic instability and removal of high molecular weight solutes such as inflammatory cytokines. From its early days, questions were raised as to which of CRRT or IRRT was related to better outcomes. The general perception was that the continuous approach, due to its slow protracted nature, would result in better outcomes. At least seven published RCTs and three meta-analyses were unable to demonstrate a difference in outcome between both approaches, with a reported relative risk of 0.99. The Cochrane Meta analysis of 15 studies (1550 patients) showed that CRRT did not differ from IRRT with respect to in-hospital mortality, ICU mortality, number of surviving patients not requiring RRT, hemodynamic instability or hypotension needing escalation of pressor therapy. Patients on CRRT were likely to have significantly higher mean arterial pressure (MAP) and higher risk of clotting dialysis filters. The application of CRRT in combating severe fluid overload is widely popular despite the evidence. CRRT has also been proposed as the preferred option for combined acute renal and hepatic failure and acute brain injury because of prevention of cerebral edema. Arguments in favour of IRRT are practical considerations like user-friendliness, limitation of expenses, restriction of bleeding complications; and small solute removal in acute life threatening conditions.In summary, CRRT and IRRT are equivalent dialysis strategies. Both therapeutic strategies should not be considered as competitors, but rather as alternatives, usage depending on the unit expertise and the metabolic or the fluid balance needs of the patient.
Dmytro D Ivanov
Shupky National Medical Academy, Ukraine
Title: Development of new drugs or OMICS-diagnostics of treatment failure
Time : 13:55-14:20
Biography:
Dmytro Ivanov, 1964, MD, PhD, Prof in Nephrology, Chief of Nephrology and RRT Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine. Has 26 years’ experience in nephrology and pediatric nephrology. He has published more than 400 papers, 15 text- books, ERA-EDTA member since 1997.
Abstract:
The aim - identifying the biological trends in formation of treatment efficacy in various kidney diseases. 20-year observation of treatment results in 4 groups: urinary tract infection - UTI (5643) patients, glomerulonephritis, nephrotic syndrome - NS (464), lupus nephritis - LN (68), and month from the treatment beginning (1) and 1 year follow-up (2). For each nosology isolated characteristics that determine the effectiveness of therapy in steps 1 and 2 were adjusted. For UTI – microbe and antibiotics sensitivity was 87 ± 4% (1), recovering - 96 ± 2% (2),total - 82% (RR 1.08 0.98-1.17 95%). NS steroid sensitivity was 49 ± 7% (1) and the remission79% ± 3 (2), total - 72% (RR 1,03, 95% 0,97-1,09). In LN - remission was observed in 44 ± 4% (1) and 68% ± 3 (2), in total 63% (RR 1,28, 95% of 1.11-1.41). In CKD - reduction of albuminuria ascertained at 69 ± 2% (1) and GFR preservation- 87 ± 2% (2), a total of 83% (RR 1,08, 95% 0.98-1.17). As a result, depending on the nosology, 3 months efficacy was 96-57% (71 ± 7), 1 year - 91-69% (75 ± 3). The average of efficiency therapy was 74.8%. Thus, the response to therapy in 1 year follow-up was the dominant sign in a ratio of 3:1 to non response subjects (Mendelian inheritance). Conclusions. Modern therapy provides cure / remission in 75% of nephrology patients, which corresponds to the dominant hence inheritance trait of population. Failure of treatment in 25% of patients is not due to lack of efficiency, population- recessive traits. Seems that marginal efficiency of existing treatment facilities in general has already been exhausted. Development of new drugs are likely to be ineffective without seeking genetic mechanisms/markers leading to the development of renal process itself, rather than improve the sensitivity to the drug. In our opinion, OMICS-diagnostics detect a marker (s), allowing understanding why a given individual has developed kidney disease, will be crucial in the treatment of nephrology patients.
Alison Kent
Canberra Hospital, Australia
Title: What is the risk of chronic kidney disease after acute kidney injury in the neonatal period
Time : 14:20-14:45
Biography:
Prof Alison Kent commenced her pediatric training in Adelaide, Australia, completing her Neonatal Fellowship at McMaster University, Ontario, Canada. She is a Senior Consultant at the Centenary Hospital for Women and Children, Canberra Hospital, Australia. She completed her MD in 2009, her thesis based on neonatal blood pressure and renal injury risks from being born preterm. She has over 50 peer reviewed publications; she is a founding member of the Executive Committee of the Neonatal Kidney Collaborative, a group of Nephrologists and Neonatologists investigating the incidence of acute kidney injury in the neonatal population and its long term consequences.
Abstract:
The incidence of acute kidney injury (AKI) in neonates has been poorly studied, but recent studies suggest ranges from 18-40%. Risk factors for AKI in the neonatal population include sepsis, perinatal asphyxia and ECMO (extracorporeal membranous oxygenation). Mortality rate of neonates who have AKI is significantly elevated with a range of 45-70%. Over the last 15 years, studies of acute kidney injury in the paediatric and adult population has shown both increased mortality rates as well as risk of developing chronic kidney disease later in life. The preterm neonatal kidney is extremely vulnerable to injury with glomerulogenesis ongoing after birth, as well as other cardiovascular and respiratory compromises. Defining AKI in neonates has been difficult due to maternal creatinine influences in the first 24-48 hours and the significant changes that occur in the glomerular filtration rate in the first few weeks of life. A new definition of neonatal AKI has been proposed based on modified KDIGO (Kidney Diseases: Improving Global Outcomes) criteria, which will allow comparison of data between patient groups, neonatal units and countries. With recent literature suggesting premature neonates, especially those with AKI during the early neonatal period, are at increased risk of long-term renal insufficiency, an international group of nephrologists and neonatologists has formed the Neonatal Kidney Collaborative. This group is currently undertaking the multi-center international AWAKEN (Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates) study. This presentation will discuss AKI in the neonatal period, risks of premature birth on renal development, and provide progress on the AWAKEN study.
Rajendra Bhimma
Natal University, South Africa
Title: UTI in Children: A changing paradigm
Time : 14:45-15:10
Biography:
Rajendra Bhimma has received his PhD in Medicine from the University of Natal University during the period of 1999 to 2002. Currently, he is working as Paediatrics and Child Health at this University. He has successfully completed his Administrative responsibilities as Associate Professor of Paediatrics and Principal Specialist. His research has included kidney diseases in children. Based on this research and fellowship training he has received several awards and honors, He is serving as an editorial member of several reputed journals like The World Journal of Nephrology and Asian Journal of Nephrology & expert Reviewers for journals like American Journal of Kidney Disease, Pediatric Nephrology, Journal of Therapeutics and Nephrology etc. He has authored over 50 peer reviewed research articles and has written 5 chapters for books.
Abstract:
Purpose: To review the changing paradigms in the diagnosis, investigation and management of urinary tract infections (UTIs) in children beyond the neonatal period. Methods: A literature search was done using PUBMED, EBSCO host database and GOOGLE SCHOLAR of all articles including reviews and guidelines on UTIs in children for the last ten years. A total of 2 725 articles including review articles and guidelines published over the last 10 years were searched and reviewed.
Thomas Ryzlewicz
Via Medis Dialysis center, Germany
Title: online HDF - a concept for baltimore
Time : 15:35-16:00
Biography:
Thomas Ryzlewicz at 66 years, born in West-Berlin (Germany). Nephrologist since 40 years with regular clinical work with RRT Patients. In 1974 he used several of the first Dialysis Set-Up’s (Travenol 120 Batch System, Milton Roy B II, Gambro AK 3). 1978 Bag-Hemofiltration done (with the Equipment of 3 Blood Pumps, one Bed Scale and a Cup to measure the Filtration Rate (with a Stop-Watch).
Abstract:
online-Hemofiltration (Shaldon, Gambro AK 10-Dextran Blue System with 20 Ultrafilters). 1991 Prototype of AFB (Acetate Free Biofiltration). 1991 Prototype for cavHD for ICU Patients to the German TÜV for permission as a Prototype (> duration of one entire year!). 1991 conversion of a Hemofiltration Monitor from TMP-driving to Weight-driving to perform cvvH in ICU Patients. 1993 first use of the online Monitor of today as a Prototype (Gambro AK 100 ultra). 1995 contact with the MARS-Group (Stange and Mitzner, Rostock / Germany, “Albumin-Dialysis” in Hepatic Coma). I introduced to them the conversed cvvH-Monitor, in order to treat these severe ill Patients (> Hepatic Coma) with sterile Fluid. Development of an own Bloodline (> very much reduced contact between Blood and Air) in 2007 (BHR GmbH). First Patents in 2010. In 2012 Joint Venture Company with Brook Herderson Group (Oxyless Ltd., Reading, GB). - 25 years employed at the KfH (first Dialysis Provider in Germany), in between 2 years in a Physiologic Institute.
Ihab Wahba
University of Pennsylvania, USA
Title: Importance of venous congestion and perfusion pressure in acute kidney injury and the cardiorenal syndrome
Time : 16:00-16:25
Biography:
Ihab Wahba, MD is Associate Professor of Clinical Medicine at the University of Pennsylvania Perleman School of Medicine, Philadelphia, PA. He received his Nephrology Training at the Oregon Health and Science University. He has practiced Nephrology in both the academic and private settings over the last 16 years. He has published many scientific manuscripts and book chapters in the field of clinical nephrology encompassing the disciplines of acute kidney injury, drug nephrotoxicity and dosing, obesity, and renal dysfunction in the setting of cardiac dysfunction.
Abstract:
Renal dysfunction is very common in patients with heart failure and is associated with poor longevity and poor overall prognosis.The term “cardiorenal syndrome” has been given to this condition to highlight its importance. The pathophysiology of acute kidney injury (AKI) and chronic kidney disease in the setting of heart failure is complex and poorly understood, and therefore, treatment options are not clearly defined. Recent observational data challenge the long-held hypothesis that renal dysfunction in that setting is mainly due to reduced cardiac output. This presentation will review evidence published both in the older literature and in recent studies that expand our understanding of this complex syndrome, with an emphasis on the role of venous congestion and low perfusion pressure in patients with the cardiorenal syndrome. Real case scenarios will be presented to highlight the pathophysiology and to propose effective treatment strategies. The role of medications and other factors that are usually overlooked yet may be crucial in the pathophysiology AKI and diuretic resistance in the setting of venous congestion and low perfusion will be emphasized.
Satish Kumar Kolar Venkatesh
Baby Memorial Hospital Ltd., India
Title: Is there a better outcome for posterior urethral valve (PUV) presenting antenatally? A unicentre experience in 81 children
Time : 16:25-16:50
Biography:
Satish Kumar Kolar Venkatesh has completed his Pediatric Surgery Training in the year 2006 from Mumbai, India and has worked as an Overseas Fellow for 2 years in Perth, Australia. After returning back to India, he has been practising as a Consultant in corporate hospitals and is engaged in clinical research/audits. He has presented more than 15 papers in national and international conferences and published more than 14 papers in reputed journals. He has special interest in embryogenesis of surgically correctable urological malformations in children.
Abstract:
Renal dysfunction is very common in patients with heart failure and is associated with poor longevity and poor overall prognosis. The term “cardiorenal syndrome” has been given to this condition to highlight its importance. The pathophysiology of acute kidney injury (AKI) and chronic kidney disease in the setting of heart failure is complex and poorly understood, and therefore, treatment options are not clearly defined. Recent observational data challenge the long-held hypothesis that renal dysfunction in that setting is mainly due to reduced cardiac output. This presentation will review evidence published both in the older literature and in recent studies that expand our understanding of this complex syndrome, with an emphasis on the role of venous congestion and low perfusion pressure in patients with the cardiorenal syndrome. Real case scenarios will be presented to highlight the pathophysiology and to propose effective treatment strategies. The role of medications and other factors that are usually overlooked yet may be crucial in the pathophysiology AKI and diuretic resistance in the setting of venous congestion and low perfusion will be emphasized.
Satish Kumar Kolar Venkatesh
Baby Memorial Hospital Ltd., India
Title: Is there a better outcome for posterior urethral valve (PUV) presenting antenatally? A unicentre experience in 81 children
Biography:
Satish Kumar Kolar Venkatesh has completed his Pediatric Surgery Training in the year 2006 from Mumbai, India and has worked as an Overseas Fellow for 2 years in Perth, Australia. After returning back to India, he has been practising as a Consultant in corporate hospitals and is engaged in clinical research/audits. He has presented more than 15 papers in national and international conferences and published more than 14 papers in reputed journals. He has special interest in embryogenesis of surgically correctable urological malformations in children.
Abstract:
Purpose: Posterior urethral valve (PUV) is a disease spectrum with varied presentation and prognosis, dependant to a large extent on pre-existing renal damage. Excluding those fetuses that are severely affected, early diagnosis and prompt intervention post-natally should theoretically be preventing further renal damage. With the uncertainty of outcome of fetal intervention, our aim should be to optimise treatment after birth. A series of 81 babies with PUV who presented antenatally is discussed here.Methods: This is a 10 year retrospective record review of all operated cases of PUV detected antenatally from a tertiary care hospital. The outcomes analyzed were pertinent to renal function, voiding dysfunction and complications.Results: Eighty four (42%) of 190 patients presented antenatally and 81 are included. The mean gestational age at diagnosis and intervention was 34±4.5 weeks and 130.5±170.9 days respectively. 70 (87%) were fulgurated and 11 had diversion. The nadir creatinine was significantly raised in babies who had oligohydramnios diagnosed in 2nd trimester and in those who were diverted. The data on follow up and continence in toilet trained patients are presented. Conclusion: All boys with antenatally diagnosed hydronephrosis should be followed closely to rule out PUV. Endoscopic therapy should be the initial modality of treatment. In patients with preserved renal function, the prognosis is good if managed early. A nadir creatinine at 6 months of 0.8 mg/dl should be predictive of excellent prognosis. Early postnatal therapy preserves renal function and may prevent late bladder deterioration. Our results should be useful in counselling prospective parents with antenatally suspected PUV.
Phuong Thu Pham
University of California, USA
Title: Clinical decision making dilemma: Liver alone or combined liver-kidney transplantation
Biography:
Phuong-Thu Pham is Professor of Medicine and Director of Outpatient Services of the Kidney Transplant Program at UCLA Medical Center. Her major areas of interest and research include recurrence of glomerular diseases following primary renal transplantation, new onset diabetes after transplantation, BK virus screening and management after kidney transplantation, the link between hypomagnesemia and renal function decline in patients with diabetes mellitus type 2 as well as in recipients of kidney transplant, and acute and chronic kidney injury following liver transplantation. Her interests in these topics have resulted in publications in well-known Nephrology textbooks and journals as well as invitations to speak at both national and international meetings. She has written over 20 book chapters for major Nephrology and solid organ transplantation textbooks including Comprehensive Clinical Nephrology, Textbook of Organ Transplantation, Transplantation of the Liver, Pancreas, islet, and stem cell transplantation for diabetes, Chronic Kidney Disease: Dialysis and Transplantation, and Handbook of Kidney Transplantation. She has also served as moderator for transplant-related conferences at the American Society of Nephrology and World Congress of Nephrology, editorial board member for the Case Reports in Nephrology and Transplantation Technologies and Research journals, and member of the organizing committee for the International Conference on Nephrology and Therapeutics.
Abstract:
With the introduction of the MELD score for the allocation of orthotopic liver transplant (OLT) in February 2002, a striking 278% increase in the number of simultaneous liver-kidney transplants (SLKT) was observed during the 9-year period post-MELD when compared with the preceeding 9-year in the pre-MELD era (pre- vs. post-MELD era, n= 1049 vs. 2914, respectively). For OLT candidates with simultaneous end-stage kidney failure, SLKT is a well-established effective therapeutic option for virtually all suitable candidates. However, there have been no well-defined guidelines to determine whether a kidney transplant should be offered to OLT candidates who have chronic kidney disease (CKD) or prolonged acute kidney injury (AKI) secondary to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) while awaiting a liver transplant. Specific challenges in the decision making process include the accurate assessment of the degree of existing renal dysfunction in those with CKD, progression of established CKD, and the prediction of the extent of renal function recovery in those with AKI with or without underlying CKD. Currently existing consensus guidelines for SLKT in OLT wait-listed candidates are presented followed by the author’s opinion on identification of candidates who are best suited for double-organ transplantation.
Edward J. Filardo
Brown University School of Medicine, USA
Title: A putative role for the G protein-coupled estrogen receptor-1, GPER-1, in the renoprotective effects of estrogen
Biography:
Dr. Filardo is the Director of Research & Development at Radix BioSolutions, Ltd.. Previously, he served as faculty at the Brown University Medical School where his research group discovered the newly appreciated plasma membrane estrogen receptor, GPER-1. Studies by his group, revealed its molecular mechanism of action and desensitization. Moreover, their published works indicate that GPER-1 plays a homeostatic role in neural and renal tissue and its expression is positively associated with advanced breast cancer.
Abstract:
Estrogen promotes renoprotective effects that are linked to the G-protein-coupled estrogen receptor-1 (GPER-1). Our studies have shown that GPER-1 immunoreactivity is primarily localized in distal convoluted tubules and the Loop of Henle (stained with Tamm-Horsfall Protein-1). Lower GPER-1 expression is observed in proximal convoluted tubules marked with megalin, and GPER-1 is not readily detected in collecting ducts. Plasma membrane fractions prepared from whole kidney tissue or HEK293 cells expressing recombinant human GPER-1 (HEK-GPER-1) display high-affinity, specific [3H]-17ï¢-estradiol ([3H]-E2) binding, but no specific [3H]-aldosterone binding. In contrast, cytosolic preparations exhibit specific binding to [3H]-aldosterone but not to [3H]-E2, consistent with the subcellular distribution of GPER-1 and mineralocorticoid receptor (MR) in these preparations. Aldosterone and MR antagonists, spironolactone and eplerenone, failed to compete for specific [3H]-E2 binding to membranes of HEK-GPER-1 cells. Furthermore, aldosterone did not increase [35S]-GTP-ï£S binding to membranes of HEK-GPER-1 cells, indicating that it is not involved in G-protein signaling mediated through GPER-1. During the follicular phases of the estrus cycle, GPER-1 is upregulated on renal cortical epithelia and localized to the basolateral surface during proestrus and redistributed intracellularly during estrus. GPER-1 is down-modulated during the luteal phases of the estrus cycle with significantly less receptor on the surface of renal epithelia, and as measured by gel electrophoretic analysis. Our results demonstrate that GPER-1 is associated with specific estrogen binding and not aldosterone binding and that GPER-1 expression is modulated during the estrus cycle which may suggest a physiological role for GPER-1 in the kidney during reproduction. Presenting author.
Samy L Habib
University of Texas , USA
Title: Kidney atrophy vs hypertrophy in diabetes: Which cells are involved?
Biography:
Samy L Habib has completed his Ph.D. at Roswell Park Cancer Center, Buffalo, NY and was trained at University of California, Irvine, University of Texas, Austin, TX and University of Texas Health Science Center, San Antonio, TX. He has published more than 45 papers in reputed journals and serving as an editorial board member and Editor of 14 Journals. He is associate professor at UTHSCSA and holds Research Scientist position at the South Texas Veterans Health Care System at Audie Murphy VA Hospital. He is a recipient of several research grant awards from American Diabetes Association, American Heart Association, National Kidney Foundation, New Investigator Award and Merit Review Award from Veterans Affairs, and Pilot Research Award from NIH/NIDDK. He has been a regular member of several study sections for Department of Defense.
Abstract:
Renal enlargement, one of the first structural changes in diabetic nephropathy (DN), is due to the hypertrophy of existing glomerular and tubular cells rather than to cellular proliferation. The initial tubular epithelial cell hypertrophy is considered “compensatory†and “adaptive†hypertrophy. Hypertrophic cells are arrested in the G1-phase of the cell cycle and increase protein and RNA content, but do normally not replicate their DNA. Each kidney contains about a million nephrons, which are the basic functional units of the kidneys. Increase in renal size, predominantly due to proximal tubular epithelial cell hypertrophy. On the other hand, kidney atrophy results from loss or inadequate circulation of nephrons. The renal veins and arteries start to shrink because of the loss of the function of the kidney. A loss of nephrons or abnormal nephron function is most likely to have an adverse effect on the kidney function as well as could lead to shrink the kidney. However overtime, tubular cell hypertrophy is associated with the subsequent infiltration of macrophages/monocytes of T and fibroblast cells into the tubulointerstitial space, which results in tubular atrophy and tubulointerstitial fibrosis. The rate of deterioration of kidney function shows a strong correlation with the degree of tubulointerstitial fibrosis. Alterations in renal structure may occur that are not specific to nephropathy but reflect a consequence of long-standing diabetes/hyperglycemia. The type of renal cells in atrophy and hypertrophy in diabetes will be evaluated.
Biography:
Abbott received his medical degree from Western University of Health Sciences, underwent 2 years general surgery training at West Virginia University/CAMC before entering urological surgery completing his residency at St John Providence in Detroit, MI. He served as Chief Resident 2012-2015 to complete his six-year residency and was selected into the highly competitive Endourology/Robotics fellowship at the University of California, San Diego. He is a well-published scientific author and has made countless presentations in local, regional, and international arenas. He has received numerous awards for his teaching prowess including the ACOS/Erwin Literary Award, the MOA Scientific Research Award, the AUA Thirlby Award, and the AOF Outstanding Resident of the Year award.
Abstract:
Kidney stone disease is a common malady affecting approximately 1 in 11 people in the United States (19% men and 9% women) by age 70 years, with a cost exceeding two billion dollars annually. Prevalence has demonstrated a significant rise over the last 20 years and stones are likely to recur in at least 50% of patients within 10 years of the first occurrence. Renal stone disease is primarily a renal physiologic abnormality and approximately 15% of stones require surgical intervention. Stone disease is one of the primary bridge points between the fields of nephrology and urology.A comprehensive review of the American Urological Association guidelines for initial evaluation, conservative versus surgical intervention, metabolic evaluation and medical treatments, optimal surgical modalities, and suggested follow-up for stone formers will be detailed. Current advancements in the surgical treatment of stone disease including an outlook toward contemporary management and future trends in urological stone treatment will also be reviewed.One recent modification in the endoscopic treatment of stones is the advent of “stone dusting.†This technique uses commonly available holmium laser technology to fragment stone into minute particles that can easily pass through the urinary tract. We present our current protocol and early experience with this approach to surgical stone management. Percutaneous Nephrolithotomy (PCNL) is a well-established surgical treatment option for large and complex upper urinary tract kidney stones. PCNL has traditionally been performed as an inpatient procedure with the aid of interventional radiology to provide renal access and nephrostomy tube drainage. We present our series of outpatient PCNLs performed with the urologic surgeon obtaining access and without the routine placement of nephrostomy tube for drainage post-operatively.
Aicha Merouani
University the Montreal, USA
Title: Renal replacement therapy in pediatric acute kidney injury
Biography:
Aicha Merouani was Professor at nephrology pediatrics in chez hopital ste justine ,his main interest is paediatric nephrology
Abstract:
Acute kidney injury is associated with increased risk of morbidity and mortality in patients. In children, it affects approximatively 5% of critically ill children. Neonate represents a higher risk population especially in the setting of cardiac surgery. No specific recommendations exists on the choice of the renal support for pediatric acute kidney injury based on outcomes; in fact, depending on centers, the preferred modality of renal replacement therapy is influenced by local expertise and financial resources. In pediatrics, the large variation in weight ranging from 1 to 60 kg as well as the small number of patients needing renal replacement therapy is a challenge for management, organization and maintenance of expertise. In our experience, the need for renal replacement therapy in patients with acute kidney injury when all modalities are employed is less than 15 cases/year. In neonate, renal replacement therapy is still difficult and peritoneal dialysis is most of the cases the best choice. This presentation provides an overview on current available practices in renal replacement therapy in children, and proposes a decision making algorithm for the use of renal replacement therapy in critically ill children with acute kidney injury.
Sorin Fedeles
Yale School of Medicine, USA
Title: Sec63 is an Hsp40 co-chaperone that is associated with the Sec61 translocon complex in the endoplasmic reticulum
Biography:
Sorin Fedeles is a postdoctoral associate in the nephrology department at the Yale School of Medicine. He grew up in Romania and came to the U.S. to study biochemistry and genetics. Following his B.A. at Hampshire College, he enrolled in the B.B.S. program at Yale where he obtained his Ph.D. in genetics in 2010.
Abstract:
Sec63 is an Hsp40 co-chaperone that is associated with the Sec61 translocon complex in the endoplasmic reticulum. Mutations in SEC63 cause polycystic liver disease in humans. Loss of Sec63 in mice induces cyst formation both in liver and kidney which is mitigated by polycystin-1 (PC1) overexpression. We now find that inactivation of Sec63 suppressed G protein–coupled receptor proteolysis site (GPS) cleavage-dependent maturation of PC1, showing an unexpected role of Sec63 in this autoproteolytic process that is critical for cystogenesis. Loss of Sec63 selectively activated the IRE1α-XBP1 branch of the unfolded protein response (UPR), and the inactivation of both Sec63 and XBP1 exacerbated the polycystic kidney phenotype in mice by markedly suppressing GPS cleavage of PC1. Enforced expression of the spliced XBP1s enhanced the GPS cleavage of PC1 in Sec63 deficient cells, suggesting that XBP1 activation normally serves to ameliorate the effects of Sec63 inactivation. XBP1 overexpression in vivo ameliorated cystic disease caused by a model of reduced PC1 function unrelated to Sec63, indicating a general protective role of XBP1s activity against cystic diseases resulting from defective PC1 maturation. Selective activation of IRE1α was also achieved by silencing of ERdj4, Sec61α and BiP, but not by depletion of calnexin, calreticulin or Grp94, implicating the dependence of IRE1α activation on select ER chaperones. Collectively, we demonstrated that Sec63 function regulates IRE1α-XBP1 activation, that Sec63 and XBP1 control PC1 maturation and that activation of XBP1 can protect against polycystic disease in the setting of impaired maturation of PC1.
Mujtaba Hasnain
Saint Barnabas Medical Center, USA
Title: Refractory anemia caused by parvovirus B19 infection in kidney transplant recipient
Biography:
Mujtaba Ali Hasnain, MD FACP is working as a Chief Fellow at Department of Nephrology, Newark Beth Israel Medical Center, New Jersey, USA. He completed his Internal Medicine Residency at Saint Barnabas Medical Center and also earned his degree in Medical Humanities at Drew University in New Jersey, in 2012 and also served as an Instructor in Medicine for students of Saint Georges Medical University in Grenada. Mujtaba was moved to U.S.A. for higher studies after he earned his MD with honors at the King Edward Medical University. He was awarded FACP during a prestigious convocation ceremony at American College. He has presented numerous research papers at both national and international conferences. His interview which was based on a unique phosphate binder was published in American Journal of Kidney Diseases in March 2015.
Abstract:
Anemia is a common problem in patients (pt) after kidney transplantation (KT). The causes of posttransplant anemia include ineffective erythropoietin, medication side effects, nutritional deficiencies, and, less commonly, infections. Human Parvovirus B19 (PV B19) is infrequently considered as a cause of anemia. It should always be considered as an etiology of resistant anemia in KT patients.Our pt is a 43 year old male with end stage renal disease due to Alport syndrome who received a living unrelated renal transplant. He was given simulect induction and finally his immunosuppression (IS) consisted of prednisone, tacrolimus and mycophenolic acid (MFA). He presented with fever and fatigue 6 weeks after the transplant. His hematocrit (hct) was found to be 18.7%. After 2 units of pack red blood cells (PRBC) transfusion, his hct improved. His iron stores, stool guaiac, vit B12 and serum folic acid levels were unrevealing. There was no evidence of hemolysis. His serum PV B19 PCR result was >100,000,000 copies/ml. Initially MFA was held but ultimately he was given intravenous immunoglobulin (IVIG) at 1g/kg due to refractory anemia and persistently elevated PV B19 level. He presented again within 1 week of receiving three doses of IVIG with exertional dyspnea and fatigue. He was transfused PRBCs again due to presence of severe anemia with hct of 16.1 %. Another dose of IVIG was given as his repeat serum PV B19 result was >2.6 million copies/ml. His subsequent hct levels has been stable with PV B19 levels now steadily decreasing.PV B19 is a single stranded DNA virus belonging to the family Parviviridea. Though not common, it can cause red cell aplasia in immunocompromised patients. When other causes of anemia have been eliminated, investigation into an acute PV B19 infection should be a part of the work up. Treatment of acute PV B19 associated red cell aplasia can be either conservative by decreasing IS or more aggressive with the use of IVIG.