10^th European Nephrology Conference October 24-26, 2016 Rome, Italy

The cause of chronic kidney disease isn't always known. But any condition or disease that damages blood vessels or other structures in the kidneys can lead to kidney disease. The conditions that can damage the kidneys and cause chronic kidney disease include: Kidney diseases and infections, such as polycystic kidney disease, pyelonephritis, glomerulonephritis, or a kidney problem you were born with.

Having a narrowed or blocked renal artery. A renal artery carries blood to the kidneys.

Long-term use of medicines that can damage the kidneys. Examples include non-steroidal anti-inflammatory drugs (NSAIDs), such as celecoxib and ibuprofen, and certain antibiotics.

Kidney or bladder stones are solid build-ups of crystals made from minerals and proteins found in urine. Bladder diverticulum, enlarged prostate, neurogenic bladder and urinary tract infection can cause an individual to have a greater chance of developing bladder stones. If a kidney stone becomes lodged in the ureter or urethra, it can cause constant severe pain in the back or side, vomiting, hematuria (blood in the urine), fever, or chills.

Bladder stones are hard masses of minerals in your bladder. Bladder stones develop when urine in your bladder becomes concentrated, causing minerals in your urine to crystallize. Concentrated, stagnant urine is often the result of not being able to completely empty your bladder. If bladder stones are small enough, they can pass on their own with no noticeable symptoms. However, once they become larger, bladder stones can cause frequent urges to urinate, painful or difficult urination and hematuria.

Kidney stones (nephrolithiasis): Minerals in urine form crystals (stones), which may grow large enough to block urine flow. It's considered one of the most painful conditions. Most kidney stones pass on their own but some are too large and need to be treated.

Glomerular disease can occur by itself (eg, affecting only the kidney), or may be associated with an underlying medical condition that affects other organ systems, such as lupus, diabetes, or certain infections. Glomerular disease can develop suddenly (called Acute), or develop slowly over a period of years (called Chronic). Treatment of glomerular disease depends upon its cause and type. Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories:

Glomerulonephritis (gloh-MEHR-yoo-loh-nef-RY-tis) describes the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood.

Glomerulosclerosis (gloh-MEHR-yoo-loh-skleh-ROH-sis) describes the scarring or hardening of the tiny blood vessels within the kidney.

Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body. Renal cell carcinoma may remain clinically occult for most of its course. Only 10% of patients present with the classic triad of flank pain, hematuria, and flank mass. Surgical resection remains the only known effective treatment for localized renal cell carcinoma, and it is also used for palliation in metastatic disease. Targeted therapy and immunomodulatory agents are considered standard of care in patients with metastatic disease.

Kidney cancer: Renal cell carcinoma is the most common cancer affecting the kidney. Smoking is the most common cause of kidney cancer.

High blood pressure (hypertension) is a leading cause of disease and kidney failure (end-stage renal disease). Renal hypertension, also called Reno vascular hypertension, is elevated blood pressure caused by kidney disease. It can usually be controlled by blood pressure drugs. Some people with renal hypertension can be helped by angioplasty, stenting, or surgery on the blood vessels of the kidney. Hypertension can cause damage to the blood vessels and filters in the kidney, making removal of waste from the body difficult. Once a person is diagnosed with end-stage renal diseases, dialysis a blood cleansing process or kidney transplantation are necessary. Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood. Sometimes this filtering system breaks down.

The Division of Pediatric Nephrology specializes in the diagnosis and management of children with a variety of acute and chronic kidney-related disorders. The division evaluates and treats hypertension, hematuria, proteinuria, renal tubular acidosis, nephrolithiasis, glomerulonephritis, and kidney failure.

Pediatric Nephritis is clinically and genetically heterogeneous entity characterized by either relapsing and course with significant morbidity and mortality resulting from complications of the disease itself, and its therapy. Pediatric Kidney stones are a group of crystals that are difficult to pass from the body. All essential topics in the field of pediatric nephrology are covered, including anatomy and physiology, renal replacement therapies and kidney transplantation such as Glomerulo Nephritis and some common clinical conditions involving the kidney include the nephritic and nephrotic syndromes, tubular disorders and pathophysiology of their disorders.

Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Unfortunately, the exact causes of some kidney diseases are still unknown, and specific treatments are not yet available for them. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease.

Acute renal failure (kidney failure): A sudden worsening in kidney function. Dehydration, a blockage in the urinary tract, or kidney damage can cause acute renal failure, which may be reversible.

Our Nephrology Conference 2016 is a remarkable event which brings together a unique and International mix of nephrologists and kidney specialists from leading universities and research institutions making the conference a perfect platform to share experience, foster collaboration across industry and academia, and evaluate emerging technologies across the globe.

Dialysis, the more common form of kidney-replacement therapy, is a way of cleaning the blood with an artificial kidney. There are two types of dialysis: haemodialysis and peritoneal dialysis.

Haemodialysis

In hemodialysis, an artificial kidney removes waste from the blood. A surgeon must first create an "access," a place where blood can easily be taken from the body and sent to the artificial kidney for cleaning. The access, usually in the forearm, can be made from the patient's own blood vessels or from a piece of implanted tubing. The access is inside the body and cannot be seen from the outside. Usually, this surgery is done 2 to 3 months before dialysis starts so the body has time to heal.

Peritoneal dialysis

Another form of dialysis is called peritoneal dialysis. The lining inside your abdomen (the peritoneum) becomes the filter. A soft plastic tube is put into the abdomen by a surgeon. The two main types of peritoneal dialysis are continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). People perform CAPD themselves by attaching a plastic bag filled with cleansing fluid to the tube in the abdomen and raising it to shoulder level. In CCPD, a machine puts the cleansing fluid into the abdomen and drains it automatically. This is usually done at night during sleep.

The urinary tract is the body’s drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra.

Ultrasound is used to evaluate a person’s native kidneys (the ones you were born with) as well as transplanted kidneys.

Renal scintigraphy uses small amounts of radioactive materials called radiotracers, a special camera and a computer to evaluate your kidneys’ function and anatomy and determine whether they are working properly

Angiography is the test of choice for the renal hypertension or high blood pressure caused by narrowing of the renal arteries that carry blood to the kidneys. Initial evaluation could be done by the use of ultrasound.

MRI involves a large and powerful magnet. Hydrogen ions in the body are used to obtain pictures of the body parts. But in regard to the kidney, an MRI gives the same information as a CT scan. In the past it was thought that the advantage was that the contrast material called gadolinium, used in an MRI, had no risk of kidney damage. However, gadolinium has now been associated with nephrogenic systemic fibrosis (NSF), a potentially fatal skin disease in people with decreased kidney function. And, in a small fraction of patients, separate from NSF, gandolinium may decrease glomerular filtration rate (GFR), similar to other contrast dyes. Talk to your physician to find out if an angiogram or CT scan would be a better choice than an MRI.

A kidney transplant is an operation in which a person with kidney failure receives a new kidney. The new kidney takes over the work of cleaning the blood. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your family. It may also be your spouse or close friend. In some cases, it may be a stranger who wishes to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants.

If you have advanced and permanent kidney failure, kidney transplantation may be the treatment option that allows you to live much like you lived before your kidneys failed. Since the 1950s, when the first kidney transplants were performed, much has been learned about how to prevent rejection and minimize the side effects of medicines. But transplantation is not a cure; it's an on going treatment that requires you to take medicines for the rest of your life. And the wait for a donated kidney can be years long. A successful transplant takes a coordinated effort from your whole health care team, including your nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietician, and social worker. But the most important members of your health care team are you and your family.

The kidneys’ job is to keep the body’s fluids, electrolytes, and organic solutes in a healthy balance. Their functional units are the million or so nephrons in the renal cortex which filter most constituents of the blood other than red blood cells and protein, reabsorb needed substances, secrete hydrogen ions to maintain acid-base balance, and secrete wastes.

Urine formation consists of three basic processes: glomerular filtration, tubular secretion, and tubular reabsorption. Several disease conditions can interfere with these functions. Inflammatory and degenerative diseases can involve the small blood vessels and membranes in the nephrons. Urinary tract infections and kidney stones can interfere with normal drainage, causing further infection and tissue damage. Circulatory disorders, such as hypertension, can damage the small renal arteries. Other diseases, such as diabetes, gout, and urinary tract abnormalities can lead to impaired function, infection, or obstruction. Toxic agents such as insecticides, solvents, and certain drugs may also harm renal tissue.

Although medicine cannot reverse chronic kidney disease, it is often used to help treat symptoms and complications and to slow further kidney damage. Most people who have chronic kidney disease have problems with high blood pressure at some time during their disease. Medicines that lower blood pressure help to keep it in a target range and stop any more kidney damage. You may need to try several blood pressure medicines before you find the medicine that controls your blood pressure well without bothersome side effects. Most people need to take a combination of medicines to get the best results. Your doctor may order blood tests 3 to 5 days after you start or change your medicines. The tests help your doctor make sure that your medicines are working correctly.

Medicines may be used to treat symptoms and complications of chronic kidney disease. These medicines include:

Erythropoietin (rhEPO) therapy and iron replacement therapy (iron pills or intravenous iron) for anemia.

Medicines for electrolyte imbalances.

Diuretics to treat fluid buildup caused by chronic kidney disease.

ACE inhibitors and ARBs. These may be used if you have protein in your urine (proteinuria) or have heart failure. Regular blood tests are required to make sure that these medicines don't raise potassium levels (hyperkalemia) or make kidney function worse.

Both erythropoietin (rhEPO) therapy and iron replacement therapy may also be used during dialysis to treat anemia, which often develops in advanced chronic kidney disease.

Erythropoietin (rhEPO) stimulates the production of new red blood cells and may decrease the need for blood transfusions. This therapy may also be started before dialysis is needed, when anemia is severe and causing symptoms.

Iron therapy can help increase levels of iron in the body when rhEPO therapy alone is not effective.
Vitamin D helps keep bones strong and healthy