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University of Southern California, USA
Elaine M Kaptein has completed her MD in 1973 from the University of Saskatchewan, and her Internship, Residency and Fellowship at McGill University in Montreal Quebec in 1977. She is a Full Professor of Medicine at the University of Southern California, Los Angeles, CA. She has published 65 peer-reviewed articles in reputed journals.
Wide ranges of sodium concentrations for different body fluid losses have been noted with
minimal substantiating data and variability among sources, leading to use of “cumulative fluid balance” regardless of composition in hospitalized patients. We defined sodium concentrations of body fluid losses by performing a systematic literature review in adult humans using PubMed database. Inclusion criteria were met for 107 full-text articles. Mean sodium concentrations were significantly lower for acidic (mean+SD:44+12 mEq/L) than for alkaline (55+13 mEq/L) gastric fluid, higher for bile (184+24 mEq/L) or pancreatic fluid (156+3 mEq/L) than all other body fluids, and similar between intact small bowel (119+14 mEq/L) and ileostomy outputs (116+25 mEq/L). Sodium concentrations were significantly greater for cholera-induced diarrhea (128+18 mEq/L) and lower for osmotic-induced cause (28+16 mEq/L) than all other causes of diarrhea. For osmotic diarrheas, sorbitol-induced diarrhea sodium concentration was higher (63+17 mEq/L) than for carbohydrate malabsorption (43+20 mEq/L), lactulose (26+19 mEq/L), Idolax (16+13 mEq/L) and polyethylene glycol (13+7 mEq/L). For pleural, peritoneal, and edema fluid, sodium concentrations (137+13 mEq/L) were similar to plasma. In summary, this is the first in-depth review of verifiable sodium concentrations of body fluids most commonly lost in hospitalized patients. Sodium concentrations are fluid-specific and consistent. Sodium concentrations of enteral and parenteral fluids have been summarized. (Clinical Nephrology 86 (10): 203-28, 2016. PMID: 27616761). We have used these data to develop a calculator to assess net volume and water inputs and losses, to facilitate prevention and treatment of free water and volume disorders in hospitalized patients. Case examples of this application are included.
Christian Medical College Vellore, India
Keynote: Pediatric kidney transplantation
Veerasamy Tamilarasi is working as Head of Department of Nephrology in Christian Medical College Vellore, India. She was a Dean of Vellore Medical College. She has attended several national and international conferences.
Introduction: Renal transplantation is undoubtedly the treatment of choice for children with End Stage Renal Disease. Successful transplantation in children and adolescents not only ameliorates uremic symptoms but also allows for significant improvement, and often correction, of delayed skeletal growth, sexual maturation, cognitive performance, and psychosocial functioning. In addition, lack of awareness among parents and physicians alike, resource allocation and the perceived infective milieu makes pediatric renal transplantation in India a challenge.
Method: A retrospective analysis on 133 pediatric renal transplants (age at transplant <18yr) done in a tertiary care center in south India over a 25 year period (1991 to 2016) was done. Data was collected from renal transplant database and Clinical workstation network. Mortality and graft loss were primary outcome variables studied.
Results: The mean age of the recipients was 25 years (6 to18 years), [accounting for 6.1% of all the renal transplants done at our center (133/3455). 96% of patients received kidney from live related donors. The major causes of ESRD were glomerulonephritis (29%) and urological abnormalities (18%), while the aetology was unknown in 46.5%. Immunosuppression was based on a triple drug regimen in 99% of children. Amongst complications, any rejection episode (41.7%), UTI (29.7%) and CMV disease (16.8%) were predominated. The mean duration of follow up was 38.6±33.5 months (4,159) Graft loss occurred in 10 children (10%) at a mean duration of 35±22 month (6.70). Overall 1, 5 and 10 year graft survival was 97% 83%, and 75% respectively Overall 1.5 year and 10 year patient survival was 95%, 86% and 79%. The significant predictor of graft loss was CMV disease (p=0.039) while sepsis (p=0.01) was the most important contributor to patient loss.
Conclusion: Pediatric renal transplantation in India can be accomplished successfully. The graft and patient survival in our study, the largest from India, is comparable to those published from developed countries and is encouraging given the limited resources.