Biography:

Abstract:

Diuretic therapy has been mainstay of treatment in chronic kidney disease (CKD) patients, primarily for hypertension and fluid overload. Apart from their beneficial effects, diuretic use is associated with adverse renal outcomes. Current study aimed to determine outcomes of diuretic therapy. A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by Bioimpedance analysis (BIA). A total 312 patients (mean age 64.5 ± 6.43) were enrolled. Among 144 (46.1%) diuretic users, furosemide and hydrochlorothiazide (HCTZ) were prescribed in 69 (48%) and 39 (27%) patients respectively, while 36 (25%) prescribed with combination therapy (furosemide plus HCTZ). Changes in BP, fluid compartments, eGFR decline and progression to RRT were assessed over a follow-up period of 1 year. Maximum BP control was observed with combination therapy (-19.3 mmHg, p<0.001) followed by furosemide (-10.6 mmHg with 80 mg thrice daily (p<0.001)), -9.3 mmHg with 40-60 mg (p<0.001) & -5.9 mmHg with 20-40 mg (p=0.02) while HCTZ offered minimal SBP control (-3.7 mmHg with 12.5-25mg (p=0.04)). Decline in extracellular water (ECW) ranged from -1.5L (p=0.01) with thiazide diuretics to -3.8L (p<0.001) with combination diuretics. Decline in eGFR was maximum (-3.4 ml/min/1.73m², p=0.01) with combination diuretics and least with thiazide diuretics (-1.6 ml/min/1.73m², p=0.04). Progression to RRT was observed in 36 patients. It is cautiously suggested to discourage the use of diuretic combination therapy and high doses of single diuretic therapy. Prescribing of diuretics should be done by keeping in view benefit versus harm for each patient.

Biography:

Abstract:

Background-Rapidly progressive glomerulonephritis (RPGN), the most common cause of Rapidly progressive renal failure( RPRF),usually has extensive crescent formation. Hence, RPGN is also called Crescentic Glomerulonephritis(CrGN). CrGN is a histological term, defined as the presence of crescents in >50 % of glomeruli. There is limited data on the etiology, clinical and histopathological spectrum of crescentic glomerulonephritis (CrGN) in adult Indian population.

Objective- To study the clinical and histopathological profile  of patients with CrGN.

Study design- retrospective, descriptive study.

Setting- Department of Nephrology,SMS Medical College & Hospital, Jaipur.

Methods- Patients aged >18 years, with CrGN(defined as the presence of crescents in  >50 % of glomeruli) biopsied in 2015 & 2016 were included in the study.

Results- Out of 323 renal biopsies done at our centre in the years 2015 & 2016, 32 patients had CrGN. Immune-complex glomerulonephritis (ICGN) was the most common etiology (n=26;81.25%) found followed by pauci-immune  glomerulonephritis (Pauci GN; n=4;12.50%). The most common etiology of ICGN  was IgA Nephropathy(n=7,21.80%). This was followed by C3 glomerulopathy n=6,18.75, Lupus Nephritis(LN;n=4;12.50%),Post-sinfectious glomerulonephritisPIGN;n=4;12.50%,unclassifiedn=4;12.50% followed by MPGNn=1;3.12%. Two cases of Anti-GBM disease(n=2;6.25%) were detected, one of which was also pANCA positive. Histopathological correlation was done with clinical parameters. The mean age was 32  years(range- 9 yrs to 74 yrs ).The mean duration of symptoms at the time of presentation was 32 days. Amongst the ICGN group, 57.69% of patients  and 25%  patients with Pauci GN were hypertensive at presentation. Gross Hematuria was present in 30.76% of patients with ICGN and in 25 % of patients with Pauci GN. Anuria was found in 34.6 % of patients with ICGN and in 50 % of patients with Pauci GN. RRT was required in  65.38  % and in 75% of patients with ICGN and Pauci GN, respectively. Mean S.Creatinine level at presentation was 5.06 mg/dl & 7.17mg/dl for ICGN and Pauci GN,respectively. The difference between the percentage of total crescents amongst the two groups was not found to be statistically significant. However, the percentage of cellular crescents was significantly higher in the ICGN group as compared to the Pauci GN (32.93% vs 8.57 %;p=0.0150).On the other hand, the percentage of fibrous crescents was  significantly higher in the Pauci GN group than in the ICGN group (36.22% vs 10.08;p=0.0050).It was also found that the percentage of Interstitial Fibrosis/Tubular Atrophy was  significantly higher in the Pauci GN group than in the ICGN group 43.33% vs 17.95;p=0.0052.

Conclusion- The most common cause of Cr GN in our centre was found to be ICGN, out of which IgA Nephropathy  was the most common etiology, followed by C3 glomerulopathy. The patients with ICGN had a higher proportion of cellular crescents than those with Pauci GN.

Biography:

Abstract:

The prevalence of chronic kidney disease has reached epidemic proportions with 10% to 12% of the population and 50% of the eldery showing signs of kidney dysfunction. Today, the different stages of disease progression to dialysis are recognised and influence the risks and conditions associated with kidney disease itself, such as anaemia, malnutrition and bone disease which affect both morbidity and mortality. Treatment is comprehensive and requires proactive protection while reducing the risk of cardiovascular complication. Timely referral of patients ensures adequate time for the proper preparation of these patients for a form of replacement therapy in the form of dialysis or transplantation. Educating patients before dialysis in order to increase "health literacy" results in a number of benefits for patients, including: Delaying the onset of dialysis, reducing morbidity and mortality, avoiding complications of kidney disease, preparing patients for the start of dialysis and increasing the quality of life of these patients.

 

Keywords: chronic kidney disease, predialysis care, structured predialysis education

Biography:

Dr. Das received his Ph.D. from University of Calcutta, India, one of the prominent scientific institutions in India; he joined the Department of Medicine’s Division of Nephrology as a post-Doctoral fellow at University of Texas Health Science Canter at San Antonio. Dr. Das has worked extensively in areas of kidney physiology, signal transduction, gene regulation and the fundamental pathogenic mechanism of injury to kidney. Pathological conditions associated with kidney disease, such as glomerulonephritis, diabetes and cancer are emerging as major public health problems in World.Dr.Das has produced several exciting findings which have been published in highly reputed journals. He received several prestigious awards from his own institutes and also like New Your Academy of Sciences.

Abstract:

Protein kinase C beta II (PKCβII) has been implicated in diabetic nephropathy (DN). Mesangial cell (MC) hypertrophy is a pathologic feature of DN. PKCβII undergoes phosphorylation at the hydrophobic motif site Ser-660 for its activity. We have shown that mTOR complex 1 (C1) regulates MC hypertrophy. How activation of PKCβII by Ser-660 phosphorylation fits into mTOR signaling to control MC hypertrophy is not known. HG significantly increased phosphorylation of PKCβII at Ser-660 in a PI 3 kinase-dependent manner. siRNAs against PKCβII, dominant negative PKCβII and nonphosphorylatable mutant of PKCβII, PKCβIIS660A, blocked mTORC1 activity due to lack of PRAS40 phosphorylation, resulting in significant inhibition of HG-induced MC protein synthesis and hypertrophy. Also, PKCβIIS660A attenuated phosphorylation of Akt at Ser-473, a putative mTOR complex 2 (C2) site. Specific inhibition of mTORC2 by shRNAs against rictor or Sin1, two exclusive and required components for its activity, suppressed HG-induced phosphorylation of PKCβII Ser-660 and Akt Ser-473, resulting in attenuation of mTORC1 activity leading to inhibition of MC hypertrophy. Constitutively active (CA) Akt or CA mTORC1 reversed shRictor- or shSin1-mediated inhibition of HG-induced MC hypertrophy. Furthermore, CA PKCβII reversed the shRictor- or shSin1induced inhibition of HG-stimulated Akt Ser-473 phosphorylation and MC hypertrophy. Finally, we show increased phosphorylation of PKCβII Ser660, PRAS40 and Akt Ser-473 in association with activation of mTORC1 in renal cortices of OVE26 mice with type 1 diabetes. These results provide the first evidence that HG-induced activation of mTORC2 phosphorylates and activates PKCβII to increase the phosphorylation of Akt at Ser-473 to finally activate mTORC1 to induce MC hypertrophy. Thus, we uncover a specific role of mTORC2 for Akt/mTORC1 activation via PKCβII Ser-660 phosphorylation.

Biography:

Shoab Saadat has an illustrious medical education background. Apart from being an orator / speaker, he enjoys the distinction of being the best graduate of his medical college with 10 gold medals to his name. He has also been involved in many research mentoring activities and has been the premier research organizer for his hospital. He is also currently a student in data science with special interest in machine learning algorithms. He intends to apply the modern machine learning and data science techniques to the field of Nephrology.

Abstract:

Statement of the Problem: Lifestyle of hemodialysis patients has a significant impact on their quality of life (QOL). Physical, psychological, social, environmental, and financial factors play an important role in determining the QOL. Several studies identify the most significant correlates with a better QOL in these patients. Because, there has been no study specifically aiming at predicting a change in QOL using modern machine learning techniques, therefore, the purpose of this study is to produce a classification model for the most important positive and negative predictors for the QOL in hemodialysis patients. Methodology & Theoretical Orientation: This is a prospective cohort study of patients on at least 3 months of hemodialysis. By the first interim analysis, a total of 78 patients were administered a proforma containing questions about demographics and the validated Urdu version of WHO BREF questionnaire for the QOL assessment by a MBBS qualified doctor on day 0 and 30. Statistical analysis was performed using SPSS version 24, while machine learning algorithms including the classification tree were generated using Orange. Findings: A total of 78 patients were enrolled and analyzed for the first interim analysis (42 males, 36 females). The domain means of WHO BREF questionnaire for QOL were: Physical =12.9 (SD=3.7), Psychological =15.0 (SD=3.4), Social =15.2 (SD=2.75), Environmental =16 (SD=2.9) respectively. Linear regression model (p<0.000, R2=0.418), showed monthly income (p<0.000) and serum albumin (p<0.000) to be positively and significantly associated with better QOL. Among machine learning algorithms (classification tree and Naïve Bayes models), classification tree was the most accurate (AUC=83.3%). Conclusion & Significance: Machine learning algorithms can be used to classify patients into those with higher probabilities of having a given change in QOL in future. This can in turn be used to risk stratify patients and for better utilization of health resources.

Biography:

Upon completion of Medical Degree and further specialization in General Surgery Dr. Dmitry Klokol proceeded with PhD in Surgery in Institute of Emergency and Reconstructive Surgery and postdoctoral study in the field of Regenerative medicine and Cell therapy. He has vast clinical, academical and research experience in surgery, anti-aging, regenerative, complementary medicine and cell therapy. He has published more than 50 articles, 2 books and is a member of the editorial board in one of American journals. At present he is Head of Medical Advisory Board in International Biomolecular research Company and Medical Director of European Wellness Centers.

Abstract:

Chronic kidney disease (CKD) is characterized by progressive deterioration of renal function due to loss of functioning nephrons. In spite of available treatments CKD is still considered as irreversible, gradually worsening condition that ultimately results in end-stage renal failure (ESRF).

Such situation urges to seek for new advanced therapeutic modalities that are able to restore renal function or at least substantially slow down the progression of CKD. Recent research and studies has shown that the most promising opportunity to restore nephron functionality is stem cell therapy. Due to morphological complexity of the kidney’s ultrastructure the available options of autologous stem cell therapy has proven its failure to restore the anatomy and functionality of nephron. On the other hand embryonic and induced pluripotent stem cells have multiple unsolved safety issues. Latest scientific developments demonstrate that fetal precursor stem cells transplantation is the safest and most reliable method of renal cellular pool replacement in patients with CKD.

In our study we present data on efficacy of combination of precursor stem cells (FCTI) and targeted organ-specific peptides (SBI, MF+, Germany) in patients with CKD. Results of stem cell implantation were evaluated 6 months and 1 year after the procedure. Certain improvements of parameters of renal function test and downstaging of CKD, depending on the stage of the disease, were noted.

There were no adverse reactions observed in treated patients. Precursor stem cells and organ-specific peptides (SBI, MF+, Germany) in management of CKD ise a promising therapeutic modality and requires further detailed analysis and continued clinical trials.

Biography:

Abstract:

Background AKI is a disease associated with high morbidity and mortality. Drug induced AKI is a common cause of AKI. Traditional biomarkers (i.e. creatinine, UOP) can’t provide early diagnosis for AKI, so there is increasing need for novel biomarker. Many novel biomarkers emerged to solve this problem. One of them is KIM-1. We studied its’ ability for early diagnosis of AKI in patient taking therapeutic platinum based chemotherapy.

Methods We prospectively analyzed 132 patients taking platinum based chemotherapy treatment. AKI patients was diagnosed according to KDIGO 2012. Serum creatinine were done for all patients prior to and at 2^nd and 5^th days of each cycle.  Serum calcium and magnesium were done for all patients basal (before 1^st day of 1^st cycle) and at end point. Urinary KIM-1 concentrations were assessed prior to and at 2^nd and 5^th days of chemotherapy cycle.

*End point for each patient was one of the following:-

1.      In non AKI patients was the completion of platinum based chemotherapy plane.

2.      In AKI patients was the day which AKI was occurred.

Results AKI occurred in 35 patients (26.52% of patients). Serum calcium and magnesium significantly decreased between basal and at end point (P= 0.000).KIM 1 showed significant increase in sample(b) in comparison to sample(c) (P= 0.004)and significant increase in sample(a) in comparison to sample(c)(P= 0.001), but insignificant increase in sample(a) in comparison to sample(b) (P=0.117)(table-1).

*Sample a (Urine sample of AKI day), Sample b (Urine sample collected day before Sample a) and Sample c (Collected day before Sample b).

Table (1): Mean values of KIM 1 in AKI group (comparing mutable values of patients):

AKI Patients (n=35)		ng/ml	P*
KIM 1	Sample a(mean±SD)	2.25 ± 0.87	0.117
	Sample b(mean±SD)	2.10 ± 0.78
KIM 1	Sample b(mean±SD)	2.10 ± 0.78	0.004
	Sample c(mean±SD)	1.5 ± 0.34
KIM 1	Sample a(mean±SD)	2.25 ± 0.87	0.001
	Sample c(mean±SD)	1.5 ± 0.34

There was significant between marker value in comparison to comparative group (p= 0.000)(chart 1).

The best capacity for urinary KIM-1 to discriminate between AKI group and comparative group was found at sample b (Chart 1)

*Comparative group, ware 35 patient from non AKI group, KIM1 was analyzed in similar day and cycle to AKI occurrence in AKI group. Patients are selected to be well matched to AKI group as regard to age, gender, malignant disease and type and dose of chemotherapy.

Chart (1): Comparing sample a & b versus comparative group.

 

	Area under curve	P*	95 % Confidence Interval
Sample a	0.911	0.000	0.822 - 0.999
Sample b	0.954	0.000	0.895 - 1.013

Conclusions AKI is a common complication in patients receiving platinum based chemotherapy. Urinary KIM-1concentrations may predict platinum based chemotherapy induced AKI in early stages with high sensitivity and specificity.