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Oral Session 1:
- Advances in Nephrology | Kidney Diseases | Renal Nutrition and Metabolism| Hemodialysis | Clinical Nephrology
Director, Fine Treatment, United Kingdom
Marilena Koukou has completed my PhD at the age of 34 years from National and Kapodistrian University of Athens in Medicine. She worked like Medical Science Liaison & Tender Manager. She is also representing the company at opening of the tenders in both Public and Private Hospitals.
We made an assessment of the situation of Hemodialysis (HD) patients in the period of economic crisis compared to international data through the recording of demographic characteristics. Our sample consists of 2,586 subjects undergoing HD (27% of patients in HD), with the most common cause of end-stage renal disease for patients undergoing HD is the "unknown cause" with 33.02%. Similar is the situation in Spain (30.3%), Italy (30.3%), Hungary (41.7%), Poland (25.8%) and Portugal (28.1%). The mean age was determined at 68.7 ± 14.1 years (63.7% men) and 66.3 ± 13.2 years (49.4% men) for the Czech Republic up to 68.9 ± 15 years (58 , 8% men) for France. We noticed that patients with "unknown cause" are following an ESRD patient in HD. In their dossier, drugs such as,epoetin alfa, IV iron therary, levocarnitine, vitamins, clopidogrel and hydrochloride. At the same time, there is no mention of another co-existing disease, such as fabry disease, which could have led the patient either to hemodialysis or to cause a worsening of the dementia of patients on hemodialysis. This situation should be of worldwide interest as there are several countries within the European Union but possibly outside of the country where there is no examination of the primary cause of renal insufficiency, with the result that the patient does not have the right treatment even though he is in dialysis.
Farzaneh Sharifiadagh is currently working as Professor at Labbafinejad hospital, Iran
Sacral neuromodulation(SNM) is a new approach in the treatment of Bladder Bowel dysfunction(BBD),as well as neuropathic lower urinary tract disorders.The aim of this study is to evaluate the non- technical reasons Of failure for SNM. The document of all adult patients who had undergone stage one(test phase)or stage two(Implantation of pulse Generator and tined lead) in our center were reviewed.All reasons related to technical problems were excluded and other documented factors evaluated.
360 documents for stage one (test phase),and 72 documents for stage two(implantation of pulse Generator) were evaluated.For stage one the most common reasons were temporary wire displacement (54/360),Acontractile detrusor(20/360),psychologic problems(severe anxiety,depression (19/360) and congenital anomalies of lumbosacral vertebra(Myelomeningocele,partial sacral agenesis). For stage two the most common reasons for failure were: psychologic problems(5/72), HTlV1-2 infection (2/72),Addiction(1/72),lead migration(1/72),IPG infection(1/72)
Title: To study the calcium and phosphorus metabolism in patients of sickle cell nephropathy from tribal area of central India
Punit Gupta has completed 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. His oral paper was awarded first prize in ISNCON 2007, New Delhi. He was awarded internationally prestigious APCN Developmental awards in Malaysia 2008 and a follow scholarship by International Society of Peritoneal Dialysis in Turkey 2008. His paper was recognized as a best Paper in API 2014, Bhilai. He was awarded Certificate of Excellence awards by the Times of India groups 2016. His work was appreciated with certificate of appreciation by Indian Dietician association 2016. He was felicitated by Agrasen Agrawal Samaj for his excellent work in Tribal Population 2016. He was honoured with excellence award by ‘Z’ TV Chhattisgarh for this distinguishes work in kidney disease in rural population of Chhattisgarh in 2017. He has developed a concept of Teledialysis, first of its kind in Asia. He has developed Portable dialysis Machine (MAKE-D) for 60 billion kidney patients in world who require dialysis many times in a week. He has developed an abdominal Pressure Measurement Scale, which is very useful of Continuous Ambulatory Peritoneal Dialysis Patients (type of dialysis). 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.
To study calcium and phosphorus metabolism in patients of sickle cell nephropathy, presenting to a Tertiary care hospital in a series of patients with sickle-cell anaemia, serum phosphate and magnesium concentrations were elevated. Serum calcium concentrations were normal. Urinary excretion of calcium was decreased. The maximum tubular reabsorption of phosphate per litre of glomerular filtrate (TmP/GFR) was significantly increased in these patients.The increase in phosphate reabsorption explains the elevated serum phosphate observed in these patients.
Material and Method: 45 patients with Sickle cell nephropathy admitted in Nephrology Unit, Department of Medicine, Pt.J.N.M. Medical College, Raipur were studied. All patients were subjected to Renal Function Tests, serum electrolytes including Calcium and phosphorus and all other relevant routine investigations.
Result: A total of 45 patients were studied of which 13 were males and 32 females.Fig.1. The mean age of the patients was 26.48 ± 11.6 years. Male to female ratio was1: 2.462. Mean serum Calcium level was 9.404±0.562 while mean serum Phosphorus was 4.348±1.8109. Mean Calcium Phosphorus product was 40.76±18.09 and it was ≥55 in 11% cases out of which 80% were females and 20% were males. Among patients with Calcium Phosphorus product ≥ 55, 20% patient had aortic valve calcification compared to 2.5% in those with Calcium Phosphorus product < 55. In patients with Proteinuria ≥ 1 mean Calcium Phosphorus product was 39.669± 20.19 compared to 41.67 ± 15.13 in patients with Proteinuria < 1gm/day. Also Proteinuria ≥ 1 was present in 40% while Proteinuria < 1gm/24hrs was 60% among patients with Calcium phosphorus product more than 55.Fig.2
Conclusion: Females had more commonly Calcium phosphorus product more than 55 as compared to males. 11% patients had Calcium phosphorus product more than 55. Aortic valve calcification is the most common cardiac abnormality seen. Itching and other skin manifestations were much more common in patients with Calcium phosphorus product more than 55.
Title: Treatment of kidney and prostate non-malignant diseases should be personalised with the help of innovative thermobalancing therapy
Allen Simon obtained PhD in Medicine in 1978. For many years he was treated patients with chronic internal diseases, including various kidney problems: nephritis, nephrosis, chronic kidney failure and kidney stones, developing diets for them. Later Dr Allen headed health clinic for the treatment of chronic internal conditions. Then he devoted two decades to further medical research and developed Thermobalancing therapy and Dr Allen’s Devices for chronic internal diseases, which received a patent in the USA, as “Therapeutic device and method”. He is Director of Fine Treatment, United Kingdom, the Company that distributes these devices worldwide.
10-year empirical data and results of the clinical trials on side effects free innovative Thermobalancing therapy with Dr Allenâ€™s Device in people with kidney stones, benign prostatic hyperplasia (BPH), and chronic prostatitis / chronic pelvic pain syndrome (CP / CPPS) showed positive changes in the symptoms and parameters of these chronic internal conditions. The cases of 4 people with different sizes of kidney stones that used Dr Allenâ€™s Device confirmed the dissolving effect of the therapy. Thermobalancing therapy with Dr Allenâ€™s Device was used in 124 men withÂ BPH and 45 men with CP / CPPS in 2 clinical studies.Â International Prostate Symptom Score andÂ National Institute of Health Chronic Prostatitis Symptom Index, prostate volume (PV) were measured in groups who underwent therapy and control groups and compared between groups. These studies demonstrated that Thermobalancing therapy with Dr Allenâ€™s Device reduced prostate volume from 45 mL to 31 mL (P<0.001) and, consequently, urinary symptoms from 14.2 to 4.9 (P<0.001) Â Â in the BPH treatment group. Pain score was reduced from 10.3 to 3.5 (P<0.001) and prostate volume decreased from 31 mL to 27 mL (P<0.001) in men with CP/CPPS. In the control groups no difference in the symptoms and parameters was observed. Common standard treatments for kidney stone disease, BPH and CP / CPPS do not treat the affected organs but symptoms. Furthermore, these treatments have serious side effects. For instance, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy may cause bleeding, infection, hypertension, diabetes and chronic kidney disease. Medical treatments for BPH and CP / CPPS, such as alpha blockers and 5 alpha reductase inhibitors are responsible for irreversible side effects: impotence, depression, testicle pain, and even diabetes. BPH surgical procedures may cause unpleasant complications, which develop depression, almost in 25%. Thermobalancing therapy gives an opportunity to treat non-malignant kidney stone disease, BPH and CP / CPPS without side effects. In May 2019, Personalized Medicine Universe, the official peer-reviewed journal of the International Society of Personalized Medicine, with the headquarter in Japan: published an article â€œPersonalized care using thermobalancing therapy can help men with chronic prostatitis and chronic pelvic pain to recover,â€ which stated - Dr Allenâ€™s Device is the safe and effective tool for a person. Thus, the use of Thermobalancing therapy will improve the quality of life of millions of men and women globally.
Title: Acute kidney injury in children in the department of nephrology of Tizi Ouzou University Hospital, etiologies and results
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
Acute kidney Injury (AKI) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. There are many causes of AKI, . Some causes of AKI, such as rapidly progressive glomerulonephritis (RPGN), may present as AKI but rapidly evolve into chronic kidney disease (CKD). Several renal diseases, such as the hemolytic–uremic syndrome (HUS), Henoch–Schönlein purpura, and obstructive uropathy with associated renal dysplasia, may present as AKI with improvement of renal function to normal or near-normal levels, but the child’s renal function may slowly deteriorate, leading to CKD several months to years later.
Methods : Type of study: Our study is retrospective. It was conducted in the Department of Nephrology of the University Hospital Center (UHC) of Tizi Ouzou, between 2015 and 2018.Patients: They were selected from the hospitalization register of our department. We included all children with acute renal injury during this time period. Evidence collected: Data was collected from patients' medical records. We found the following: - Age, sex, Etiological Diagnosis and Evolution.
Results : Over the four years, 26 patients (34% male and 64% femals) with a median age of 7 years (range 40 days to 15 years) were managed. The most affected age group in our study is [12-16] with a frequency of 36%.
The circumstances of discovery in the majority of our patients being revealed by digestive signs (diarrhea, vomiting, ,,,,,) and that related to the etiology of AKI (HUS post diarrhea).
In our study, 44% of the patients have thrombocytopenia associated with AKI; and this is due to the origin of this syndrome (Atypical HUS). The etiology of AKI is : Nephropathy glomerular in 37% hemolytic and uremic syndrom in 54% and obstructive nephropathy in 9%. Patients survived in 92 % of the cases and 58% of them had a normal renal function. We had 7% of death. Peritoneal dialysis is the most commonly used emergency treatment for AKI in children at a frequency of 37%. Also Hemodialysis is more used.
Title: Role of Acacia Senegal fibres (Gum Arabic) as Antioxidant and Anti-inflammatory among Haemodialysis Patients
Nour Elkhair Ali is currently working as Professor at Alneelain University, Sudan
Statement of the Problem: Several studies suggested that oxidative processes might increase in patients with end stage renal disease (ESRD). Oxidative stress (OS) was considered as a risk of atherosclerosis and cardiovascular complication that are the major causes of mortality among ESRD patients’ .Haemodialysis (HD) is a state of chronic inflammatory activation which is associated with accelerated cardiovascular disease and high cardiovascular mortality. Gum Arabic (GA) has been claimed to act as an anti-oxidant and cytoprotective agent, protecting against experimental hepatic, renal and cardiac toxicities in both animal and human studies. This study was designed to test a hypothesis that Gum Arabic supplementation of the diet in a population of patients receiving renal replacement therapy by haemodialysis will reduce oxidative stress and therefore reduce the state of chronic inflammatory activation associated with chronic HD. Methodology & Theoretical Orientation: In this study 40 end stage renal failure (ESRF) patients aged 18-80 years who were on regular haemodialysis in Arif Renal Center, Omdurman, Sudan, were recruited. All recruited patients met the inclusion criteria and signed the informed consent. Patients received 30 g/day of GA for 12 weeks. Renal function test (RFT), C-reactive protein (CRP), Total anti-oxidant capacity (TAC) and the oxidative stress marker malondialdehyde (MDA) levels were measured before and after GA intake .Ethical approval from the national medicine and poisons board was obtained. Findings: Gum Arabic significantly increased TAC level (P < 0.001) and decreased the oxidative marker MDA and CRP (P < 0.001). Conclusion & Significance: GA has revealed potent anti- oxidative and anti-inflammatory properties in hemodialysis patients. Daily supplementation of GA (30 g/day) significantly reduced the oxidative stress in hemodialysis patients.
Reuven Friedmann is a physician specelized in internal medicine and geriatrics. He is the director of acute geriatric ward and geriatric rehabilitation unit in Shaare Zedek Medical Center in Jerusalem, Israel. He is a senior teacher in the medical school of the Hebrew University and Hadassah Medical Center. His main concern are geriatric clinical issues as infectious diseases, dilemmas around feeding the demented patients, running monitoring units in geriatric department, evaluation of prognostic reasons for long hospital stay in elderly patients etc.
Transient proteinuria is frequent in various clinical kidney pathologies and can be a result or tubular damage. As Urinary Tract Obstruction (UTO) can induce tubular injury, we hypothesized that UTO can cause transient proteinuria. The aims of this study were to determine whether patients with UTO have a higher incidence or severity of proteinuria compared with catheterized patients without UTO, and whether such proteinuria resolves at short term follow up. The study was a prospective, matched case-control study that included 50 patients with acute UTO and 50 controls. Proteinuria was quantified using three consecutive 24 hour urinary collections and its incidence, severity, and quantitative changes were compared between the study groups.
Results: There were no statistically significant differences between the groups in age (83.12± 7.94 versus 84.48±9.39 (p=0.44)), major co morbidities, chronic medical treatment and causes of hospitalization. Abnormal proteinuria was observed in all patients with UTO and 94% of the control group. The degree of proteinuria was similar between groups in first, second and third collections (638.07±419.69 vs. 620.99±639.57, 828.43±743.15 vs. 648.69±741.48, and 728.30±944.76 vs. 732.80±841.8 mg/24 hours. Either with or without UTO. Proteinuria does not resolve in the early period after relief of UTO. Future study with longer follow up is needed to determine if this proteinuria resolves or persists following hospital discharge and if it has long-term prognostic significance. p=0.88, 0.23 and 0.99, respectively). Proteinuria did not change significantly during a week of in-hospital follow up in either study group (p=0.19 for trend).
Conclusion: This study demonstrated a very high incidence of significant proteinuria in a cohort of hospitalized elderly patients