Day 1 :
- Nephrology and Therapeutics | Chronic Kidney Disease | Acute Kidney Injury | Clinical Nephrology
Session Introduction
Aruni Malaweera
Eastern Health, Victora, Australia
Title: Case report on an interesting case of a 31 year old lady with post-partum Systemic lupus erythematosis
Biography:
Dr Malaweera graduated from Cardiff University in 2011 with an Honours Degree in Medicine and Surgery (MBBCH). She completed Physicians Training in London, gaining membership with Royal College of Physicians (MRCP,UK). She is currently working in Australia as a medical Registrar in Australia and recently have completed Physicians training with Royal College of Australasian Physicians
Abstract:
Systemic lupus erythematosus (SLE) is an autoimmune systemic disease that is more common in women of child bearing age. Although the impact of pregnancy on SLE activity has been debated in the literature, majority of studies have noted increased SLE activity during pregnancy, causing peri-partum complications like pre-eclampsia, pre-term labour and stillbirth. Our case is a 31 year old woman who suffered pre-eclampsia during her pregnancy presenting one month later with haemolytic anaemia, decompensated cardiomyopathy with serositis and acute renal impairment. She was diagnosed with systemic lupus erythematosis with Lupus Nephritis and started on immunosuppressive therapy with Steroids and Mycophenolate Mofetil. This case highlights the importance of understanding the heterogeneous nature of SLE presentation with multiple organ involvement and the impact on SLE activity on pregnancy and its outcomes.
Sherine Aly Hamed Elnaggar
Alexandria University hospital, Egypt
Title: Mycophenolic Acid Monttornic In Renal Aliograft Recipients; Associatation With Safety And Efficacy
Biography:
Sherine Aly Hamed Elnaggar, graduated from faculty of medicine 2004, master in internal medicine and nephrology 2011, doctorate degree in internal medicine and nephrology 2017. Working since graduation in the field of nephrology till reached a consultant in nephrology in Alexandria university hospitals in Egypt. Interested in renal transplantation and clinical nephrology. Keen to attend most of the national and international conferences in my field of interest. Previously published internationally in reputed journals.
Abstract:
Introduction: Mycophenolic acid (MPA) is one of the cornerstones immunosuppressants in the setting of transplantation. Advances in the pharmacokinetic studies have uncovered the high inter and intra_individual variability of plasma mycophenolic acid level. This variability in drug concentration can cause both supra therapeutic and sub therapeutic drug plasma levels which can have hazardous results in transplant patients. To date, routine therapeutic drug monitoring of MPA has not been established in clinical practice.
Aim of the work: Our objective was to monitor the level of MPA in relation to the occurrence of gastrointestinal (GI) complications and renal function in renal allograft recipients.
Methods: MPA trough level was measured in 51 renal allograft recipients at the entry of the study and 4 weeks after any dose modification. Levels were correlated with the side effects recorded during the study follow up period.
Results: GI toxicity, hematological toxicity and biopsy proven acute rejection (BPAR) were diagnosed in 29.4%, 9.8% and 11.7% of the studied population respectively. Higher MPA 12-hr trough levels were associated with hematological side effects, yet, the correlation with GI side effects was largely negative. A significant correlation between low MPA plasma levels and the development of BPAR after kidney transplantation was detected. An MPA level of 3.5 µg/mL best discriminated between patients who developed hematological toxicity from those who didn’t while MPA level of 2.4 µg/mL best discriminated between patients with and without BPAR.
Conclusion: Monitoring of MPA trough level should be practiced in renal allograft recipients in order to avoid drug toxicity without compromising efficacy.
Keywords: Mycophenolic Acid; Therapeutic Drug Monitoring; Renal Allograft Recipients.
Joseph Faraj
Royal Perth Hospital, Australia
Title: The Relationship Between ‘Immediate’ Resistive Index Measurements Post-Renal Transplantation And Renal Allograft Outcomes
Biography:
Dr Joseph Faraj has completed his medical training at the University of Notre Dame, Fremantle Australia by the age of 25. He went onto complete a Masters of Surgery with a dissertation in vascular surgery at the University of Sydney, Australia. With a passion for vascular surgery, he has worked across Western Australia with exposure to various surgical disciplines, including experience in transplant medicine and surgery. He currently works as a Junior vascular doctor at Fiona Stanley Hospital, Perth Western Australia and has published papers in reputable journals and presented research at conferences on a national and international level.
Abstract:
Background
The arterial resistivity index [also called as Resistance index (RI) or Pourcelot Index], developed by Leandre Pourcelot, is a measure of pulsatile blood flow. Previous studies demonstrated the usefulness of RI as a predictor of allograft outcomes were based on RIs measured in the later stages after transplant.
Study Design
Retrospective cohort study of 305 renal transplants was reviewed, with analysis of their early RI measurements and its association with donor, recipient and surgical factors.
Setting & Participants
Adult kidney transplantation candidates carried out between 2003 and 2013
Predictor
Correlation between early RI and delayed graft failure (DGF) and transplant failure (TF).
Outcomes
To determine the relationship between immediate (24hr) RI measurements and renal allograft outcomes.
Measurements
All models were examined for goodness of fit using the test of Hosmer and Lemeshow. We also compared models based upon their concordance between observed TF and DGF values and the values predicted from the multivariate models using the area under the ROC curve (AUC).
Results
From a cohort of 305 patients who underwent renal transplants between 2003 and 2013. The mean recipient age was 48.4 years, 57.5% of recipients were male and approximately one third had diabetes. 226 recipients had a RI < 0.8, whilst only 27 patients had a RI ≥ 0.8. There was a significant association between a high RI (RI ≥ 0.8) and both outcomes (OR=3.54, p=0.008 for TF and OR= 3.22, p=0.006 for DGF).
Conclusions
An elevated resistive index was strongly a predictive of DGF and TF, when performed within 24 hours of time of transplantation.
Index Words:
End-stage renal disease (ESRD), Kidney transplantation, resistive index (RI), delayed graft function (DGF), transplant failure (TF).
Pongpot Namasae
Hatyai hospital, Thailand
Title: Prevalence and Pathophysiology of hypokalemia in adult with dengue virus infection
