World Nephrology Congress
Scientific Program
Keynote Session:
Title: Progress on 100 years of blood purification
Biography:
Ghodrat A Siami is a professor of Medicine and Nephrology at Vanderbilt School of Medicine. He was promoted to Professor Emeritus in 2011, received 50 years Service Award from AMA, and published more than 100 Abstracts, original papers, editorials and book chapters. He was President of International Society for Apheresis and Vice President of Word Apheresis Association. He is on Editorial board of several journals and Reviewer for FDA. He is now a Emeritus member of ASN, ISN, and Emeritus Board member of ISFA. He was invited by NIH to teach Nephrology at Tehran School of Medicine and is Invited Speaker in more than 100 Congress all around the world. He Chaired Celebration of 100 years plasmapheresis Congress in Saint Petersburg Russia.
Abstract:
First plasma separation was done by Abel in 1913 USA. Rosenberg and Yurevitch performed the first plasmapheresis in 1913 in St. Petersburg, Russia. The 100 years anniversary was celebrated in April 2013 in St. Petersburg Russia. I was the Congress Chair Person. Phlebotomy was first used in 1520 and we still use it to treat
familial hyperchromatosis. Blood letting was the ancient way to treat patients. Leeches were also used to remove blood. Transfusion from animal to human was performed in 17 century. Moravits transfused RBC from one dog to another in 1906. The first transfusion was performed in Cleveland, Ohio in 1906. Haas performed dialysis in a dog in 1914 and in human in 1924. Cohn used blood component in WWII. Rotating Drum was used by Kolffin 1942. Nose used artificial liver in 1960. Malchesky did the first membrane, Thermofiltration, and Cryojel removal in the USA in 1978. Agishi, from Japan, performed double filtration in 1980. Siami developed Cryo-filtration, and tandem with hemodialysis in USA. Eight types of LDL pheresis was developed. Today, we are able to do many advancedapheresis, Photo-pheresis Cryo-filtration, chemo and Immuno-adsorption. Today we have developed many advances in Blood Purification to treat many diseases, specially many different immunoadsorption columns for diseases specific to the patient. They all proven to be effective and safe.
Title: Advances in management of autosomal dominant polycystic kidney disease (ADPKD)
Biography:
Roy Michael Culpepper earned his MD from the University of Alabama in Birmingham (UAB) and completed post-doctoral training at Loma Linda University, California, and UAB, AL. He serves as Professor of Medicine and Nephrology at the University of South Alabama and has been Director of Nephrology and served on Board of Directors of the National Kidney Foundation and the regional dialysis Network 8.
Abstract:
ADPKD accounts for 5-7% of patients requiring dialysis or kidney transplant worldwide. The natural course of the disease was first characterized in the 1950’s. The basis of the disorder is now known to involve 2 genes, PKD1 and PKD2 that account for about 85% and 15%, respectively, of disease in affected individuals. PKD1 mutations are associated with the more rapid decline in kidney function with an average age to reach end-stage disease of 50-55 year in males and slightly longer in females. Recent data demonstrate a clear relation between the rate of cyst growth, measured as total kidney volume (TKV), and the rate of decline in kidney function, measured as eGFE. Further research implicates AVP as a key factor in the stimulation of cyst growth and increase in TKV. A number of intracellular targets to slow cyst growth have been identified and clinical studies with long-acting somatostatin analogs and with the renal AVP V2 receptor antagonist tolvaptan have been completed. Two seminal studies with tolvaptan have shown sufficiently robust effects to slow increases in TKV and declines in GFR as to warrant approval for use in ADPKD patients for prolongation of kidney function. ERA-EDTA has devised a concise outline, based on TKV and patient characteristics, to guide clinicians in the choice of patients most likely to benefit from tolvaptan.
Title: The Impact of treatment modality on employment and the economic benefit above the cost of providing direct treatment
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, or ESRD, impacts the lives directly of 660,000 for transplant, hemodialysis, and peritoneal dialysis patients. Much has been discussed and researched regarding to the type of treatment modalities via transplant, peritoneal dialysis, in-center hemo dialysis, and home hemodialysis and the ability to continue employment. Without including transplant, the treatment of ESRD on an on-going basis is quite expensive. Studies have shown that the cost of in-center hemodialysis is less expensive than both peritoneal dialysis (both CCPD and CCPD) and home hemodialysis due to the cost of supplies despite an advantage (or disadvantage depending on in center utilization). However, these studies have only concentrated on the cost and not the economic benefit in a quantitative nature. It is this study’s conclusion that home hemodialysis, despite its higher costs, as well as peritoneal dialysis, is the clear economic benefit to the United States health care system although may have the same economic drawbacks to peritoneal dialysis, but will certainly contribute above and beyond the simple cost analysis. This analysis also is correlation with studies that support these two modalities for treatment outcomes from a clinical perspective.
Oral Session 1:
- Workshop
Title: Common non-infectious and non-malignant diseases of the urinary system and their therapeutic treatment with Dr Allen’s devices
Biography:
Simon Allen obtained a PhD in Medicine in 1978, Dr Simon Allen specialised in internal medicine. For years, he worked at and subsequently headed a hospital’s cardio-vascular department, and treated patients with various internal diseases, including renal diseases. He authored many scientific articles on metabolic disorders, including obesity, arthritis, renal, cardio-vascular and gastroenterological diseases. He lectured doctors pursuing higher medical qualifications. He then devoted two decades to pioneering medical research into various chronic internal diseases. He established Fine Treatment in Oxford, UK, authored The Origin of Diseases Theory, invented and patented therapeutic Dr Allen’s Devices as effective tools of Thermobalancing therapy.
Abstract:
10-year long empirical observations and 2 clinical trials have demonstrated high efficacy of therapeutic Dr Allen’s Devices in alleviation of symptoms and treatment of diseases of the renal/urinary system. Treatment progress with two innovative Dr Allen’s Devices, for kidney and prostate care, are assessed in this report. In most cases, chronic diseases of the renal system are not immediately life-threatening. Thus, the most optimal firstline treatment approach is therapeutic. It ensures no side effects for patients undergoing treatment. The renal system produces, stores and eliminates urine. The kidneys produce urine by filtering wastes and extra water from blood. Urine travels from the kidneys through two ureters and fills the bladder. When the bladder is full, a person urinates through the urethra to eliminate the waste. Health disorders may emerge in every part of this renal/urinary system. The most common kidney diseases are kidney failure, partial or complete loss of kidney function, and kidney stone disease. It is common for sufferers to experience no symptoms while losing kidney function and developing chronic kidney disease (CKD). Hypertension is the main symptom of CKD. Thus, the diagnosis and treatment of hypertension is a major concern for the prevention of CKD. The most common disorders of the urinary system are prostate enlargement and incontinence. An enlarged prostate in men causes various symptoms, such as frequent urination, nocturia, difficulty to empty the bladder. Urinary incontinence is the unintentional passing of urine. Early diagnosis and treatment of urinary symptoms are key in prevention of their progress.
Title: Efficacy of taurolockTM in preventing primarybacterial peritonitis in patients undergoing peritoneal dialysis for renal insufficiency: A randomized, multicenter, double-blind study with placebo
Biography:
Bernard R Branger has completed his MD at the age of 30 years from Montpellier -Nimes School of Medicine, University, Montpellier, France. He was chief of Nephrology department of Nimes University hospital and still president of AIDER regional association of dialysis. He has published more than 20 papers in reputed journals.
Abstract:
Peritoneal dialysis is increasingly used in patients with chronic renal insufficiency, yet it is associated with the risk of peritonitis. In this parallel randomized controlled trial, a catheter locking solution (Taurolock™) was tested against a placebo in the reduction of peritonitis episodes and other secondary effects over two years. Patients from 11 French centers were randomized to Taurolock (n=75) or placebo (n=73). No significant difference was seen in the number of peritonitis events (24% IC95%= [15.2%-35.5%] Taurolock™ vs 27.4% IC95%= [17.9%-39.3%] placebo, p=0.78) or relapses (5.6% Taurolock™ vs 4.3% placebo, p=0.55). Similarly, death rate did not differ significantly between the groups (21.3% Taurolock™ vs 12.3% placebo, p=0.21) nor did the number of serious adverse events (58.7% Taurolock™ vs 63.0% placebo, p=0.71). However, pain upon injection was higher for patients in the Taurolock™ group at each visit (p<0.001). No difference was observed in bacterial analysis between groups: 31.4% of infections in the Taurolock™ group were Gram+, compared to 43.4% in the placebo group (p=0.34). Thus, administration of Taurolock™ every six months does not reduce the incidence of peritonitis or secondary events of peritoneal dialysis, but it does cause transient pain. The nature of the biofilm in peritonitis may have been misunderstood and further studies are required to better determine its role and how to reduce infections.
Title: From autosomal recessive renal tubular dysgenesis to the renin-angiotensin system
Biography:
Marie Claire Gubler Gribouval performed the genetic analysis of the RAS genes in the Laboratory of Hereditary Kidney Diseases (INSERM U 1163) headed by C Antignac. A Michaud performed the in vitro expression of the mutations in the laboratory headed by P Corvol. MC Gubler is the pathologist at the origin of the work.
Abstract:
Renal tubular dysgenesis (RTD) is a severe disorder of renal development characterized by early onset foetal anuria leading to persistent oligohydramnios with the resulting sequence of malformations including lung hypoplasia. The usual issue is foetal or post-natal death due to hypotension, anuria and respiratory distress.Absence of differentiated proximal tubules is the hallmark
of the disease. Familial cases, with an autosomal recessive inheritance, are frequent. Histological analysis of renal tissues directed us toward the renin-angiotensin system (RAS). Accordingly, genetic investigation confirmed that hereditary RDT was linked to mutations in the AGT, REN, ACE and AGTR1 genes. The absence of functional RAS leads to foetal and neonatal hypotension, renal hypoperfusion, and the development of anuria and tubular dysgenesis. Interestingly, DTR is also observed in foetuses exposed to RAS blockers, and
in various pathological conditions leading to chronic renal hypoperfusion such as severe cardiopathies, hepatic failure or in the donor foetus in the twin-to-twin transfusion syndrome. By expressing the mutations in cellular models, progresses in the knowledge of the structure-function relationship of the proteins have been obtained notably by showing that the defective misfolded proteins undergo either intracellular accumulation and retention or rapid degradation. These studies also confirmed that ACE has to be anchored in the
plasma membrane to be active. The identification of the disease on the basis of precise clinical and histological analyses and the characterization of the genetic defects allow genetic counseling and early prenatal diagnosis.
Oral Session 2:
- Nephrology | Clinical Nephrology | Pediatric Nephrology | Treatments in Nephrology
Chair
John D. Sullivan
Boston University, USA
Co-Chair
R. Michael Culpepper
University of South Alabama College of Medicine, USA
Title: Benefit of isonatric dialysis patients over 70 years
Biography:
Goumri Nabila has completed the Nephrology Internal Residency at the age of 28years from Algiers Medecin, nephrologist in practice from Rodez Hospital Toulouse University and Nephrologist TOURS CHU (2016-2017), LOUIS PASTEUR Chartres ( 2017-2018).
Abstract:
Intradialytic hypotension (IDH) is still a major medicalproblem for hemodialysis patients over 70 years. isonatric dialysis has been an alternative able to reduce incidence of IDH and could help to improve hemodynamic stability in patients with cardiovascular comorbidities.
Method: 24 patients were included in prospective study ( jan - april 2016) , we evaluated the impact of isonatric HD on cardiovascular stability during 24 sessions compared to conventional HD 12 sessions.
Method: 24 patients were included in prospective study ( jan - april 2016) , we evaluated the impact of isonatric HD on cardiovascular stability during 24 sessions compared to conventional HD 12 sessions.
Results: IDH 40,7% (Iso HD) VS 27,1% (conventional HD) P 0,005, the predialytic blood pressure pre HD PAS decrease from 12mmhg the differential between two groups P 0,014, the diastolic BP decrease from 3± 12 mmhg P=0,073), the dry weight did not vary significantly during the study 1.57±0,63
to 1.24±0,43, the number of intolerance symptoms was not significantly different except for vomiting 79/216 sessions (Iso HD) vs 134/432 (HD conventional) P 0,005, cramps 36/216 vs 24/432 sessions , nausea 67/216 vs 117/432, how we can see isonatric dialysis has an implication for hemodialysis tolerance also with patients over 70 years so it can be an option to management intradialytic hypotension we should think to revisiting prescription of Na dialysate.
Title: Co-relation of lipid profile with proteinuria in sickle cell nephropathy patients for local area of India
Biography:
Punit Gupta is MBBS, MD (Medicine), DM (Nephrology) and PhD. He is the Honorary Nephrologists to the Governor of Chhattisgarh State since 2009. He is Chairman and Members of many important academic and management committees of various Government Medical Institutions in the country and the Pt. Deen Dayal Upadhyay Health Sciences University, Raipur. He has guided over 100 Postgraduate & Technologist student for their thesis & Project in Nephrology & Research and also severed as an examiner for the university examinations. A man of researches and publication, he has presented more than 160 research papers and abstracts on kidney diseases in tribal populations at renowned national and international conferences. He has developed and economic, efficient and effective walkie talkie system for consultation and directions to the hospital staff and doctors. He has been awarded Dr. B. C. Roy National Award for his research to give aid or assistance to research project for the year 2016.
Abstract:
Materials & Methods: Total75 patients were admitted. All patients were subjected to routine blood investigations, blood glucose, urine analysis, routine biochemical investigations, sickling, lipid profile, ECG, Serum Protein, X Ray chest, USG(KUB), serum calcium, potassium, chloride, sodium,phosphorus,albumin,globulin, bilirubin triglyceride,HDL,LDL,VLDL,SGOT,SGPT, Hb Electrophoresis, Serum Thyroid levels.
Result:
• Mean age of the patients was 26.8 ± 11.6 years.
• Males were 29.41% & Females were 70.59%, Ratio being M: F:: 1:2.75.
• In patients of Sickle cell nephropathy, 41.4% patients had deranged lipid profile.
• In Sickle cell trait,27.2 % had deranged lipid profile.
• Among Sickle cell disease, all the patients had deranged lipid profile.
• Derangement in individual lipids are as follows:-
1) Hypercholesterolemia(≥ 200 mg/dl) - 7.31 %,
2) TG(≥160 mg/dl) - 7.31%,
3) LDL (˃130 mg/dl ) – 2.4%
4) HDL(≤40 mg/dl) - 58.5% .
• Proteinuria in patients of Sickle cell nephropathy:
<1 gm/d = 21.9% had deranged lipid profile.
>1 gm/d = 34.1 % patients had deranged lipid profile.
Conclusion:
1) Lipid derangement is almost seen in all the patients of Sickle cell Nephropathy.
2) Hypercholesterolemia & Hypertriglyceridemia is common in males then in female.
3) Low levels of HDL was common in females as compare to male.
4) Deranged lipid profile was more common in proteinuria more than 1gm/dl
Title: MGRS: One of the nephrological challenges of the 21st century
Biography:
Mariana Ciocchini is MD by the National University of La Plata and Nephrologist by the University of Buenos Aires. Her research is focused on monoclonal gammopathy of renal significance and she has published papers about this subject in a reputed journal. She is a member of the Glomerulopathy Council, ANBA, Argentinian Society of Nephrology being one of the co-authors of the book “Glomerular diseases” recently published by this group.
Abstract:
Monoclonal gammopathy of renal significance (MGRS) is a recently described hemato-nephrological metaentity whose pathogenesis depends on monoclonal
immunoglobulins (Ig) or humoral factors secreted by small B-cell clones affecting any nephronal area with a broad spectrum of histopathological patterns and even the presence of, at least, two different kinds of MGRS in the same patient. The importance of MGRS is based on its association with an increased morbidity and mortality, included its recurrence in post-renal transplant period and even as “de novo” presentation; and its improvement after performing the cell-B clone treatment. The relevance of renal biopsy in nephrological practice depends on its reliability to achieve a precise MGRS diagnosis which may be the only indication for hematological treatment. Kidney injury mediated by monoclonal Ig is mainly the result of its deposit in renal tissue, as is the case of light chain deposition disease. Monoclonal Ig can also have auto-antibody activity which is responsible for a cluster of disorders related to the dysregulation of the alternative pathway of complement, for example, C3 glomerulopathy with a big impact in the difficult treatment of its. The third pathophysiological mechanism depends on humoral factors like in POEMS syndrome’s nephropathy. Taking into account only one type of paraproteinemia, the monoclonal gammopathy of undetermined significance, MGRS’s prevalence is being estimated around 0.32 and 0.57 % depending on the population age. MGRS as a meta-entity is changing nephrological paradigms related to diagnosis, treatment and prognosis, and this is a fascinating challenge which a multidisciplinary approach.
Keynote Session:
Title: Geographical distribution of urinary tract malignancies in Jablanica District – Southern Serbia –Possible link to renal diseases and Balkan endemic nephropathy
Biography:
Nikola M. Pavlovic has graduated at the Medical Faculty, University Nis, Serbia in 1974, and become BMedSci 1979, Lecturer in Internal Medicine 1979, Specialist in Internal Medicine 1982, PhD of Medical Sciences 1986, and Associate Professor in Internal Medicine1988, British Council Scholar, Research Fellow, October 1982 – June 1984 at the Department of Renal and Nephrology Services, Royal Free Hospital, London, UK. As the Research Fellow, he was doing clinical and experimental work aimed at looking at the role of lipids in the initiation and the progression of renal diseases.
Abstract:
Urinary tract cancers are common and comprise a wide range of lesions ranging in terms of size and malignancy from small benign tumors to aggressive neoplasms with high mortality. The predominant urinary tract malignancy is urinary bladder cancer. The exact etiopathogenetic mechanisms are not established yet, but there is most likely an interplay between environmental and genetic factors. Tobacco, obesity, occupational exposures ageing, and lifestyle factors remain the top contributing etiologic factors. In order get an insight into the type of cancer, incidence, gender ratio and geographical distribution we performed the descriptive epidemiology of several urinary tract cancers, utilizing incidence data from Pathology Unit Registry, General Hospital Leskovac, Jablanica county, Southern Serbia, 2007-2017. Over the period 2007-2017, there were 530 cases, 136 females and 394 males with the ratio 1:3. The overall incidences of all tumors increased in both sexes. There was a tendency for an exponential increase, but more so for males. (Fig.1). The urological cancers were recorded in 149 out of 193 settlements ranging from 1 to 174 cases. Remarkably, no cases were found in 44 settlements. We assume that differences in population-level exposure to environmental modifiable risk factors are a key driver of recorded cancer incidence. Several studies have demonstrated the carcinogenic potential of aristolochic acids (AAs) contained in Aristolochia plants. The AAs– derivative d-aristolactams are associated with a specific mutation in the p53 encountered in patients with Chinese herbs or Balkan endemic nephropathy (BEN) who present with UTUC. Although the incidence of BEN and UTUC has not been elucidated yet there is possible link between the two.
Title: Dr Allen’s device for kidney care as the first-line treatment for kidney stone disease
Biography:
Simon Allen obtained a PhD in Medicine in 1978, Dr Simon Allen specialised in internal medicine. For years, he worked at and subsequently headed a hospital’s cardio-vascular department, and treated patients with various internal diseases, including renal diseases. He authored many scientific articles on metabolic disorders, including obesity, arthritis, renal, cardio-vascular and gastroenterological diseases. He lectured doctors pursuing higher medical qualifications. He then devoted two decades to pioneering medical research into various chronic internal diseases. He established Fine Treatment in Oxford, UK, authored The Origin of Diseases Theory, invented and patented therapeutic Dr Allen’s Devices as effective tools of Thermobalancing therapy.
Abstract:
Kidney stone disease is a highly prevalent disease worldwide. Overall, the prevalence of kidney stones ranges from 1% to 13%, depending on race, gender and geographical location. Kidney stone disease affects men 3 times greater than women. However, studies of the past decade have showed an increase in the incidence of kidney stones around the world with a reduction in the gender gap. In the recent decade, Dr Allen’s Device for Kidney Care has been successfully used for the natural dissolution of kidney stones. Dr Allen’s Device that provides Thermobalancing therapy is a class 1 medical device, so it can be used by everyone at home. This is a safe therapeutic treatment of kidney stone disease, with absolutely no side effects and complications. Common standard treatments for kidney stone are: extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). These methods were introduced in 1980s. The initially promising results of ESWL and PCNL are overshadowed by the widespread side effects and complications caused by these procedures. For instance, the long-term side effects after ESWL are hypertension, diabetes and chronic kidney disease (CKD), and after PCNL infection and residual stones. After both surgical methods of kidney stone removal, the additional treatments are needed. The results of over 10-year long clinical observations confirm that Thermobalancing therapy with Dr Allen’s Device is effective for patients with kidney stone disease. In addition, there is preliminary evidence that the therapy can improve kidney function in people with long-lasting kidney stone disease. Thermobalancing therapy gives an opportunity to treat kidney stone disease therapeutically – that will improve the quality of life of millions of men and women globally.
Title: Feasibility of measuring the central pressure during dialysis with the Complior Analyzer
Biography:
Mabrouk Brahimi has completed his PhD at the age of 25 years from RENE DESCARTES PARIS University and Postdoctoral Studies from School of Medicine. He is the Director of DIALYSE CENTER, a premier Bio-Soft service organization. He has published more than 25 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Arterial stiffness and central pressure are independent predictor of mortality in renal patients1-4. Central systolic blood pressure (cSBP) could also be useful to monitor and possibly anticipate hypotension episodes during dialysis. However most cSBP devices are based on peripheral estimates which might be unreliable during the specific hemodynamic state of dialysis. Complior Analyse (Alam Medical, France) presents the advantage of measuring cSBP, hand-free, directly from the carotid artery with no mathematical estimation. Our study aims to document cSBP variability from Complior Analyse before and during dialysis. cSBP was measured in 19 stable patients (10M/9F, age:65±16yrs) with regular heart beats who underwent dialysis in Fresenius center, Montfermeil hospital, France (10 patients before dialysis, 13 patients 130±24min after the start of dialysis including 4 patients with data both before and during dialysis). Carotid waveforms were measured in triplicate within 5min and calibrated to mean (MAP) and diastolic pressures (DBP) obtained with a Philips SureSigns monitor on the fistula-free arm. Mean±SD values and coefficient of variation(CV) of repeated measurements are shown in the table below. Peripheral form factor (FF) was 37±13% (range 19-59) before dialysis and 39±21% (13-61) during dialysis while central FF was 45±7% (30-57) and 39±21% (21-46), respectively. Estimation of cSBP during dialysis was feasible with Complior Analyse. Its variability was similar to peripheral BP variability. The wide range of peripheral form factor values suggested that there is a need to improve peripheral BP estimation during dialysis.
Oral Session 1:
- Workshop
Title: Applicability of electrolysis for artificial blood purification
Biography:
Nikolai Bazaev has completed his PhD at the age of 27 years from National Research University MIET, Russia. He is the chief executive for wearable artificial kidney and artificial pancreas projects. He has published more than 30 papers in peer-reviewed journals.
Abstract:
Hemodialysis and peritoneal dialysis are the two main methods of renal replacement therapy. Several teams around the world are developing and testing a prototype of wearable artificial kidney (WAK), the central component of which is the dialysis regeneration unit (DRU). Its task is to restore the initial physical and chemical state of the dialysate solution. The main markers of the therapy effectiveness are the concentrations of creatinine, uric acid and urea. The first two substances are easily removed with activated carbon, but for urea elimination, it is necessary to use special methods: enzymatic or electrochemical. The enzymatic method uses urease, which catalyzes the hydrolysis of urea to carbon dioxide and ammonia, which are subsequently adsorbed by activated carbon. The disadvantage of this method is the complexity of manufacturing and storing urease. In the electrochemical method, electrolysis of waste dialysate is used in an electrochemical cell. The key complexity of this method is the selection of a method for the long-term and controlled removal of urea from spent dialysate. Urea can be electrochemically oxidized in a neutral medium using catalysts made of platinum group metals such as Ru-TiO2, Ti-Pt, Ti-(Pt-Ir), or from carbon materials such as coal, carbon foam, graphite, etc. In this work, electrodes made of various materials are studied to evaluate the applicability of their use as part of an electrochemical regenerator in WAK. Among the materials studied were platinum deposited on titanium by electrodeposition and by the blasting; rhodium, deposited on titanium by electrodeposition; ruthenium deposited on titanium by electrodeposition method, as well as electrodes from foamed coal; silicon-carbon films deposited on titanium substrates by vacuum spraying, doped with molybdenum; silicon-diamond films deposited on titanium substrates; platinum, sputtered on titanium substrates.
Oral Session 2:
- Special Session
Title: Telomerase activates a latent stem cell population that drives regeneration of podocytes in the adult mouse kidney
Biography:
Marina Shkreli after completing her PhD training in December 2006 in the University of Tours (France) where she studied telomerase functions in virus induced tumorigenesis, Marina Shkreli joined Stanford University School of Medicine as a postdoctoral fellow in January 2007 (California, USA). During her postdoctoral training, she used in vivo genetic approaches to study non- canonical functions of telomerase. Marina Shkreli have been awarded an ATIP-AVENIR grant by the CNRS-INSERM that allowed her to setup and lead her research team within the Institute for Research on Cancer and Aging, Nice (IRCAN) since January 2013.
Abstract:
While it is likely that stem/progenitor cells contribute to podocyte turnover, the mechanisms by which podocytes are maintained during life remain obscure. The studies led so far on podocyte regeneration have been performed in several disease and injury models. Although partial podocyte replenishment is observed in those models, podocyte regenerative potential does not match podocyte loss in these contexts, and kidney function recovery remains therefore limited in those models. To date, the only model described in which extensive, fast and efficient podocyte regeneration is observed in the adult organism consists of a telomerase-enforced mouse model1. In this study, we used this enforced-regeneration system combined with lineage tracing strategies in order to decipher the cellularmechanism that supports efficient podocyte renewal in the adult mouse kidney. We show that upon telomerase stimulation, renewed podocytes are generated by synergetic activation of stem cells and podocyte duplication, and we found that endogenous telomerase is reactivated in physiologic regeneration following injury. Importantly, using an unbiased stochastic multicolor tracing approach, we further provide evidence for expansion of stem cells located in specific compartment within the adult kidney. Altogether, those data reveal an important plasticity of stem/ progenitor and differentiated cells within the adult mammalian kidney that yields efficient and fast renewal of podocytes. Moreover, those data significantly strengthen the knowledge regarding the potent effects of telomerase on adult stem cells.
Oral Session 3:
- Nephrology Nursing | Diabetes and Hypertension | Renal Dialysis and Care | Renal Surgery
Chair
Ghodrat A.Siami
Vanderbilt School of Medicine, USA
Co-Chair
Joelle Nortier
Free University of Brussels, Belgium
Title: Fluoride and kidney- A study from tribal areas of Chhattisgarh, India
Biography:
Punit Gupta is MBBS, MD (Medicine), DM (Nephrology) and PhD. He is the Honorary Nephrologists to the Governor of Chhattisgarh State since 2009. He is Chairman and Members of many important academic and management committees of various Government Medical Institutions in the country and the Pt. Deen Dayal Upadhyay Health Sciences University, Raipur. He has guided over 100 Postgraduate & Technologist student for their thesis & Project in Nephrology & Research and also severed as an examiner for the university examinations. A man of researches and publication, he has presented more than 160 research papers and abstracts on kidney diseases in tribal populations at renowned national and international conferences. He has developed and economic, efficient and effective walkie talkie system for consultation and directions to the hospital staff and doctors. He has been awarded Dr. B. C. Roy National Award for his research to give aid or assistance to research project for the year 2016.
Abstract:
Objective: To evaluate the renal profile and fluorosis associated abnormalities in patients living at endemic fluoridated tribal areas of Chhattisgarh. Material And Methods: The cross-sectional study was conducted at village Supebeda block Devbhog District gariyabandh C.G. India. An ethical clearance was obtained from the concerned authorities. 70 families were screened and 280 Subjects who had renal failure/ Anemia/ Dental/skeletal fluorosis were included in the study. The aim and objective were explained to the studied subjects of the village and biochemical, Hematological and radiological assessment was done. The main source of drinking water in this area was hand pump.
Result:
• In the present study, out of total 280 subjects, 94 were found to have renal injury.
• Out of 94 patients of renal injury, 53.19% were male, 46.8% were female.
• In Kidney injury patients, 6.38% were between 6-12 yrs age, 17.02 % were between
13-20 yrs, 67.02% were between 20-60yrs and 9.57% were in geriatric age
• Hematogical study of these patients reveals that 42.55% were anemic.
• In Kidney injury patients, Dental mottling was present in38.29%.
• Urine fluoride of these patients reveals that 28.72 % with increased urine fluoride
• Evidence of skeletal fluorosis is present in 71.27% subjects of renal injury in
C.T.Scan L.S. Spine.
• 36.17% of renal injury patients are having both skeletal fluorosis and dental
mottling.
• 29.7 % of renal injury patients are having both dental mottling and anemia.
• 22.3% of renal injury patients are having both skeletal fluorosis and anemia.
• 35.1% presented with renal parenchymal disease grade II in ultrasonography.
Conclusion:
• Males were mainly affected as compared to females.
• Maximum patients were between 20-60 yrs age group.
• Maximum were affected with renal injury & dental mottling
• 30% of renal injury patients are having both dental mottling and anemia.
• Skeletal fluorosis was presented more as compared to dental fluorosis in renal
injury patients.
• Young children also suffered from renal injury with dental mottling due to flurosis.
• Maximally combination of skeletal fluorosis and dental mottling is present in Renal
injury patients.
Result: In the present study, a total of 280 subjects were examined including 138 males (49.28%) and 142 females (50.71%).all the results obtained after various investigations were recorded and data was analyzed by using the SPSS. The subject examined in present study is having a variety of fluorosis associated abnormalities including renal failure, dental mottling, and skeletal abnormalities. 20% of the subjects belong to age group 6-12 yrs, 24.6% were between 13-20 yrs, 27.14 % were between 20-60 yrs and 28.12% belongs to geriatric age group. Hematogical study reveals that 33.57% population were in renal failure( increased serum creatinine ), 41.07% were anemic. Dental mottling was present in 38.2 %. 24 hr urine fluoride reveals that 29.28% of the studied subjects were with increased urine fluoride. 35.35% presented with renal parenchymal disease grade II in ultrasonography. Evidence of skeletal flurosis is present in 71.07% subjects in C.T. Scan L.S. Spine. Present study shows that out of all 280 subject examined, 94 subjects were in renal failure, in which53.19% were male, 46.8% were female , 42.55% were anemic, 38.29% with mottling , 28.72 with increased urine fluoride and 71.27 % with skeletal fluorosis
Title: Animal toxins for human health, case of the Mambaquaretin for the treatment of polycystic kidney diseases
Biography:
Nicolas Gilles has completed his PhD at the age of 34 years from Paris Descartes University. He is pioneering the investigation of animal toxins acting on GPCRs, the largest therapeutic target class. His strongest expertise lies in receptor pharmacology, synthetic production of disulfide-linked animal toxins and in vivo experiments. He has published more than 70 papers and three patents. His strongest interest is now to stimulate the therapeutic development of animal toxins for the benefit of human health.
Abstract:
Autosomal dominant polykystose kidney disease affects 1 over 1,000 peoples, leading to end-stage renal disease. The blockage of the Vasopressin type 2 receptor (V2R) is a validated therapeutic line in human by preventing the vasopressin-induced elevation in intracellular cAMP concentration. Currently, only tolvaptan (jirnac) succeed to reach the market but with many concerns (Torres et al., 2017). Scorpions, spiders, snakes, conus, insects, miriapodes are often seen as dangerous, frightening and ugly animals. Their venoms are extremely rich in toxins historically identified for their toxicities. We believe that animal toxins are highly valuable in the context of human use and drug development. We developed a specific strategy in order to identified toxins with the purpose of discover novel drug candidates. Mambaquaretin was discovered in the green mamba venom by a bioguidage strategy directed against the V2R. This toxin belongs to the Kunitz fold peptide family, and its displays a nanomolar affinity for the V2R. Molecular pharmacological essays demonstrated that mambaquaretin is the most selective V2R antagonist. Daily injection of 13 μg of mambaquaretin to pcy mice, a model of juvenile recessive
kidney polykystose, over a period of 99 days, allowed the drug candidate to inhibit cyst growth area by almost 30%. No apparent toxicity was observed in treated animals (Cioleket al., 2017). Mambaquaretin is a promising drug candidate with an original mode of action. Molecular modelling and structure- function analysis allowed us to propose a model of interaction of the mambaquaretin/V2R complex. Torres, V.E., Chapman, A.B., Devuyst, O., Gansevoort, R.T., Perrone, R.D., Dandurand, A., et al. (2017). Multicenter, open-label, extension trial to evaluate the long-term efficacy and safety of early versus delayed treatment with tolvaptan in autosomal dominant polycystic kidney disease: the TEMPO 4:4 Trial. Nephrol. Dial. Transplant 1–13.
Title: Aristolochic acid nephropathy in Belgium: Update of clinical and experimental data
Biography:
Joelle Nortier received the PhD degree in experimental nephrology from the Université libre de Bruxelles (ULB), Brussels, Belgium, in 1997. As a nephrologist and researcher, she aims to develop translational projects in relation with natural and synthetic nephrotoxic agents (in vitro and in vivo models) as well as strategies of renal protection. She has published more than 100 papers in reputed peer-reviewed journals. She is currently teaching pharmacology at the Faculty of Medicine, ULB, Brussels, Belgium
Abstract:
Aristolochic acid nephropathy (AAN) is a rapidly progressive interstitial nephritis leading to endstage kidney disease (ESKD) and urothelial malignancy. It was originally reported in Belgium in more than 100 individuals having ingested slimming pills containing powdered root extracts of a Chinese herb, Aristolochia fangchi. Seventy-five patients have been treated in our dept. Among them, 50 out of 57 (F/M ratio 56/1) received a kidney transplant for ESKT; 21 presented with urothelial carcinoma of the upper tract (invasive in 2 cases) or the bladder (3 cystectomies required), leading to 5 deaths. Four additional kidney recipients developed cancer of the digestive tract, one a brain lymphoma and 8 lethal cardiovascular or infectious complications. Among the 7 patients still followed for chronic kidney disease (CKD), a left nephro-ureterectomy had to be performed for pelvic carcinoma. One case of metastatic urothelial carcinomawas diagnosed without concomitant CKD. The causal link with the intake of pills containing AA was demonstrated by the detection of DNA adducts specific to AA metabolites in renal tissue samples. Experimentally, rodent models of AAN have been developed in order to investigate the pathophysiology of AA induced tubulotoxicity and renal fibrosis. An early phase of acute tubular necrosis triggers a massive interstitial inflammatory cell influx involved in the onset and progression of collagen deposition and renal dysfunction. Moreover, microvasculature injury and imbalance between endothelial vasoactive agents could contribute to the rarefaction of peritubular capillaries and hypoxia. Such animal models of AAN are useful tools in studying mechanisms of AKI-to-CKD transition.
Title: Uro-nephrological effects of the products used by drug users: A review of the literature and a pharmacoepidemiological survey in France and in the Marseille region
Biography:
Marion Gully is a resident in Nephrology at Aix-Marseille University, Marseille, France. She has been training in Nephrology and Infectious Diseases, where she took care of patients abusing drugs, some of whom had developped kidney damage. She became familiar with the French addictovigilance network and is now responsible for the reporting of renal adverse events of drugs of abuse in the department of Nephrology of Marseille University Hospital.
Abstract:
A great diversification of drugs of abuse has been observed in recent years, both in the population using them and in the types of drugs. Although dependency and psychiatric disorders associated are well known, uro nephrotoxicity are less recognized. We propose here an overview of the products used by drugs abusers in France, through the analysis of the national pharmaco-epidemiological study “Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse” (OPPIDUM). Among the 5003 patients who participated in this survey, 84% were on prescribed psychoactive substances, with indicators of abuse in 28% of cases; more than half of these patients had also been using drugs of abuse (mainly cannabis) in the previous week. We then describe the main urological and renal toxicities of these drugs, in particular of heroin, cocaine, cannabis, ecstasy, LSD, amphetamine, new designer drugs, ketamine and opiate substitution treatment. We finally present a pharmaco-epidemiological survey of patients hospitalized for drugs complications in nephrology at the university hospital of Marseille. Between 2000 and 2015, 22 patients aged 18 to 57 years were hospitalized for renal adverse effects of drugs of abuse, such as glomerulonephritis, focal segmental glomerulosclerosis, acute kidney injury of chronic kidney disease. The somatic complications of drugs participate in their dangerousness and should be a red flag. They should be systematically reported to the addictovigilance national network to allow the improvement of information given to the patients and the medical community, and to adapt the prevention and risk reduction policies.
Keynote Session:
Oral Session 1:
- Special Session
Title: Aristolochic acid nephropathy and/or Balkan Endemic nephropathy as the worldwide problem: Tip of the iceberg?
Biography:
Nikola M. Pavlovic has graduated at the Medical Faculty, University Nis, Serbia in 1974, and become BMedSci 1979, Lecturer in Internal Medicine 1979, Specialist in Internal Medicine 1982, PhD of Medical Sciences 1986, and Associate Professor in Internal Medicine1988, British Council Scholar, Research Fellow, October 1982 – June 1984 at the Department of Renal and Nephrology Services, Royal Free Hospital, London, UK. He has a long-standing interest in looking at the clinical and epidemiologic characteristics of
BEN and has the vast experience and expertise in diagnosis and treatment of renal and disorders in hemodialysis and peritoneal dialysis patients. He is Skilled in Research, Clinical Research, and Customer Service. Strong professional graduated from Medical Faculty, University of Nis, Serbia.
Abstract:
Balkan Endemic Nephropathy (BEN) is a chronic renal disease that occurs following the fourth decade in residents of confined regions of the Balkan affecting up to 5% of the population and shows a very high association with Upper Tract Urothelial Cancer (UTUC). The first cases described in Serbia and Bulgaria date to the late 1950’s. The etiology of BEN has been the extensively studied which resulted in the publication of numerous hypotheses. Only one them putting forward the chronic Aristolochic acids (AAs) as the etiologic agent provided conclusive evidence related to BEN etiology. Aristolochic acid nephropathy (AAN) was initially reported in early 1990’ after the intake of slimming pills containing Chinese herbs. This nephropathy was initially called Chinese-Herb Nephropathy (CHN) and developed a high risk of UTUC. Similarities of CHN and BEN implied a common etiological agent for both diseases. Based on the studies of AAs-specific DNA adducts and TP53 mutation spectra in AAN and/or BEN-associated UUC, the causative role of AAs have been demonstrated. The recent studies showed that some food crops can uptake AAs from the soil or nutrient solution. Consequently, the consumption of such AAscontaminated food may represent the major exposure pathways and one of the leading causes of AAN and/or BEN and attendant UTUC. It is likely that due to the lack of our understanding of exposure pathways AAN and/or BEN remain under diagnosed and underestimated beyond the Balkans. Therefore, BEN and/or AAN are worthwhile to trace in any case of unclassifiable progressive decline in renal function.
Oral Session 2:
- Kidney Cancer | Kidney Transplantation | Renal Nutrition & Metabolism
Chair
Nikolai Bazaev
Moscow State Medical University, Russia
Co-Chair
M Ciocchini
University of Buenos Aires, Argentina
Title: Comparing the effects of emergent ureteral stenting and percutaneous nephrostomy in relieving obstructive nephropathy in advanced non-urological cancer patients
Biography:
SH Kim has completed his MD at the age of 30 years from Seoul National University of Medicine, Seoul, Korea and postdoctoral studies from National Cancer Center, Goyang, Korea and Seoul National University of Medicine, Seoul, Korea. He is the Clinical Staff and Associate Researcher of director of Jinsoo Chung, Prostate Cancer Center, National Cancer Center, Goyang, Korea. He has published more than 30 papers in reputed journals.
Abstract:
Objective: The aim of this study was to compare the effects of DJ and PCN on renal functional recovery after relieving obstructive nephropathy. Two groups of patients were compared: the DJ-PCN group, where patients underwent DJ followed by PCN and the PCN-DJ group, where patients underwent PCN followed by DJ.
Methods: The medical records of 193 patients with advanced or metastatic non-urological cancer and obstructive nephroureterosis between 2002 and 2017
were analyzed retrospectively to evaluate the efficacy of DJ-PCN and PCN-DJ procedures on the renal functional recovery after relieving obstructive nephropathy. Further subset analysis was performed among 113 (59.5%) patients who underwent another procedure within 90 days of the previous (prePCN-postDJ vs. preDJ-postPCN).
Results: Among 193 patients, 141 (73.1%) patients underwent PCN-DJ and 52 (26.9%) patients underwent DJ-PCN. No significant differences were observed after comparing the demographic factors between PCN-DJ and DJ-PCN groups (p>0.05), except for cancer-type, differential changes in sCr and eGFR values, and overall survival (p<0.05). Thus, the PCN-DJ group manifested significantly better renal functional recovery with better sCr, eGFR, and the overall time of survival than that manifested by the DJ-PCN group (p<0.05).
An additional analysis of 113 patients showing conversion to another procedure within 90 days of the previous revealed that, PCN-DJ group showed significantly poor baseline physical activity, but better recovery of sCr and of eGFR (p<0.05) values. In view of overall survival rate, the PCN-DJ group reported significantly higher mortality despite significantly better renal functional recovery. The risk factor analysis revealed that the timing of relieving procedure was not a significant risk factor for overall survival. The survived patients exhibited higher incidence of pre-treatment with targeted medical therapy, female gender predominance, lesser incidence of colorectal and gastric cancers, lower sCr levels at the 6-month follow-up, and lesser incidence of history of diabetes (p<0.05).
Conclusion: The prePCN-postDJ group reported significantly better renal functional recovery than the preDJ-postPCN group. The results of first-month follow-up for evaluating renal function significantly correlated with the overall
survival.
Title: Correlation between risk scores for foot ulceration in diabetics and chronic kidney disease
Biography:
Irfan Ahmeti has completed his PhD at the age of 47 years from University and Postdoctoral Studies from School of Medicine, University “St. Cyril and Methodius”-Skopje, Macedonia. He is the Chief of Department for diabetic foot and president of National commission for diabetes in Macedonia. Vice-president of Macedonian Scientific Association of endocrinologists and diabetologists. He has published more than 30 papers in national and international journals and has been serving as an editorial board member of “Vox Medici”.
Abstract:
The present study assesses the correlation between the risk scores for ulceration of the foot and the degree of chronic kidney disease, in contrast to determining the impact on metabolic risk factors and timely identifying factors of progression that affect the risk for foot ulceration and the degree of renal disease in patients with type 2 DM. Of a total number of 107 patients, 50.5% were men, and 49.5% women. The average age was 59.12 years, furthermore the average duration of diabetes was 12,9±6.15 years, and the average HbA1c 9,5%±1.86%, while 6 months later the HbA1c was 8,8% (p <0.004). BMI was 28±3.3 kg/ m2. The Risk score in V 1 and V 3 has statistical significance (p <0.004) i.e. V3 shows higher risk score. In groups, the largest percentage of 60% had score of 1, 20% had score 2 and 15% had score 3. The average eGFR was significantly higher in the beginning (V1=78, 02±24, 08, V3=71, 48±21, 41, p<0,039), and 70% had microalbuminuria. About 30% had grade 3 and 4 of nephropathy. The correlation shows that groups with higher risk of ulceration score (2,3) have also a higher degree of nephropathy (3,4) during V1 and also during V3 (p <0,001). In individuals with T2DM, average age, duration of type 2 DM, HbA1c and high BP have a significant role in the assessment of risk for ulceration of the foot and the progression of CKD. Patients with a higher degree of nephropathy have higher risk score for foot ulceration
Title: Renal biopsy, indications and results: About 431 cases
Biography:
Seba Atmane has completed the diploma of Doctor in Medicine from University of Algiers in 1983. He earned CES of Nephrology from the University RENE DESCARTES Paris in 1986. He is the Professor and Head of Department at Centre hospitalo-universitaire de Tizi Ouzou.
Abstract:
The histological analysis of renal parenchyma obtained by renal biopsy is necessary for the diagnosis and monitoring of renal pathologies, whether acute or chronic. Since its first description in 1951 by Iversen and Brun, The technique has significantly improved over the past two decades as a result of the introduction of ultrasonography and automatedgun biopsy devices,and made this technique more reliable with a low rate of complications. Optical microscopy, immunofluorescence and in some cases electron microscopy should be performed. Nephrotic syndrome is the most common form of presentation of kidney disease in our patients of all ages. It represents the first indication of the renal biopsy in our experience, with a frequency of 58%. The analysis of our results from renal biopsy shows that the first causes of nephrotic syndrome are respectively; focal and segmental hyalinosis glomerulosclerosis(FSGS), membranous glomerulonephritis,and minimal change nephrotic syndrome (MCNS).
Oral Session 3:
