Day 1 :
- Track 1: Nephrology
Track 2: Renal Pathology
Trcack 3: Kidney and Anemia
Location: Cape Town, South Africa
Session Introduction
Desiree de Waal
University of Vermont Medical Center, USA
Title: Medical Nutrition therapy delays dialysis and improves biomarkers
Biography:
Desiree joined the Nephrology Team at the University of Vermont Medical Center in 2002. She is a member of the dialysis team and started the Medical Nutrition Therapy Clinic in 2003. She has coordinated multiple investigational trials and recently completed her own research on Medical Nutrition Therapy improving CKD outcomes. Desiree was awarded the Dietitian of the Year Award in Vermont (2013) and Fellow of the Academy of Nutrition and Dietetics (2014). She participates in Evidence Analysis Projects and a member of the Evidenced- Based Practice Committee. She is the Editor of the Peer Reviewed Newsletter “Renal Nutrition Forumâ€.
Abstract:
As kidney disease progresses, altered nutrition biomarkers are observed which may be related to poor dietary habits. The typical North American diet is low in fruits, vegetables and whole grains high in protein and processed foods which can affect the balance of the body’s electrolytes, minerals and contributes to the uremic environment of the digestive system. Evolving evidence has found a link between the gut and kidney health suggesting a need for emphasis on nutrition for the care of a patient with compromised kidney function. Recently a 10 year retrospective study was recently published in the Journal of Renal Nutrition demonstrating that the decline in kidney function was less in patients who received Medical Nutrition Therapy (MNT) at follow-up compared to those not receiving MNT. The participants who received MNT were less likely to start dialysis and had more favorable biomarkers. Albumin and biomarkers of chronic kidney disease- mineral and bone disorder were more likely to be within normal limits in the MNT group. The kidney diet is one of the most challenging obstacles patients face. Diet is often entrenched as part of a person’s lifestyle and they do not feel an immediate negative physical response with poor diet choices. With costs of kidney disease rising, it seems prudent to recommend a therapy that has been shown to delay the progression of kidney disease and improve biomarkers.
Dominic S. Raj
The George Washington University School of Medicine, USA
Title: The Gut Microbiome, Kidney Disease, and Targeted Interventions
Biography:
Dr. Dominic S. Raj graduated from the Madurai Med Coll, T N Dr M G R Med Univ, Madurai, Tn, India in 1982. He works in Washington, DC and specializes in Nephrology. Dr. Raj is affiliated with George Washington University Hospital, Medstar Georgetown University Hospital and Sibley Memorial Hospital.
Abstract:
The human gut harbors >100 trillion microbial cells, which influence the nutrition, metabolism, physiology, and immune function of the host. Here, we review the quantitative and qualitative changes in gut microbiota of patients with CKD that lead to disturbance of this symbiotic relationship, how this may contribute to the progression of CKD, and targeted interventions to re-establish symbiosis. Endotoxin derived from gut bacteria incites a powerful inflammatory response in the host organism. Furthermore, protein fermentation by gut microbiota generates myriad toxic metabolites, including p-cresol and indoxyl sulfate. Disruption of gut barrier function in CKD allows translocation of endotoxin and bacterial metabolites to the systemic circulation, which contributes to uremic toxicity, inflammation, progression of CKD, and associated cardiovascular disease. Several targeted interventions that aim to re-establish intestinal symbiosis, neutralize bacterial endotoxins, or adsorb gut-derived uremic toxins have been developed. Indeed, animal and human studies suggest that prebiotics and probiotics may have therapeutic roles in maintaining a metabolically-balanced gut microbiota and reducing progression of CKD and uremia-associated complications. We propose that further research should focus on using this highly efficient metabolic machinery to alleviate uremic symptoms.
Jason Glaser
College in Chicago, Illinois
Title: Fructokinase activity mediates dehydration-induced renal injury(
Biography:
Jason Glaser was worked as a chief investigator on three of the largest international human rights litigations in history. An educator, He have chaired numerous panels and spoken at leading universities about the intersection of human rights and public health.
Abstract:
The epidemic of chronic kidney disease in Nicaragua (Mesoamerican nephropathy) has been linked with recurrent dehydration. Here we tested whether recurrent dehydration may cause renal injury by activation of the polyol pathway, resulting in the generation of endogenous fructose in the kidney that might subsequently induce renal injury via metabolism by fructokinase. Wild-type and fructokinase-deficient mice were subjected to recurrent heat-induced dehydration. One group of each genotype was provided water throughout the day and the other group was hydrated at night, after the dehydration. Both groups received the same total hydration in 24 h. Wild-type mice that received delayed hydration developed renal injury, with elevated serum creatinine, increased urinary NGAL, proximal tubular injury, and renal inflammation and fibrosis. This was associated with activation of the polyol pathway, with increased renal cortical sorbitol and fructose levels. Fructokinase-knockout mice with delayed hydration were protected from renal injury. Thus, recurrent dehydration can induce renal injury via a fructokinase-dependent mechanism, likely from the generation of endogenous fructose via the polyol pathway. Access to sufficient water during the dehydration period can protect mice from developing renal injury. These studies provide a potential mechanism for Mesoamerican nephropathy.
Omega Mellyana
University/Dr. Kariadi Hospital, Indonesia
Title: The effects of combined vitamin C and E on the ox-LDL, sCD36, sVCAM-1, and NOx levels in idiopathic pediatric nephrotic syndrome
Biography:
Omega Mellyana was pediatrician in Department of Child Health, Medical School, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia.
Abstract:
dy aimed to investigate whether combined supplementation of vitamin C and E were able to modify the ox-LDL, sCD36, sVCAM-1, and NOx levels in pediatric nephrotic syndrome patients. The study involved 36 children nephrotic syndrome patients allocated randomly into the treatment group and the placebo group (18 children each). The treatment group received combined supplementation of vitamin C and E. The serum levels of ox-LDL, sCD36, and sVCAM-1 were assayed by enzyme linked immunosorbent assay. The serum levels of NOx were assayed by colorimetric assay. The levels of ox-LDL, sVCAM-1, and NOx were decreased after treatment with combined supplementation of vitamin C and E, but can not reach statistically different (P>0.05) After treatment, there was an increase of sCD36 level in both groups both in treatment, although not significantly different (P>0.05). The level of ox-LDL was significantly lower in remission-INS group compared with non-remission-INS group (P < 0.05). The level of ox-LDL and sVCAM-1 were significantly lower in remission-treated group than that non remission-treated group (P < 0.05). In conclusion, combined supplementation of vitamin C and E cannot modify the ox-LDL, sCD36, sVCAM, and NOx levels in idiopathic pediatric nephrotic syndrome patients. In remission cases, combined supplementation of vitamin C and E reduces the ox-LDL and sVCAM-1 level.
Tarek A Ghonemy
Zagazig University, Egypt
Title: Vascular access complications and risk factors in hemodialysis patients: A single center study
Biography:
Dr. Tarek Abdellatif Ghonemy has completed his PhD from zagazig univeristy,Egypt in 2005. and postdoctoral study in university hospital , birmingham, UK in 2008.. He has published more than 15 papers in reputed journals and has been serving as reviwer for many nephrology journal.
Abstract:
Morbidity related to vascular access is the leading cause of hospitalization for chronic hemodialysis patients and is associated with high cost. Since data on vascular access complications are scarce, this study was designed to focus on vascular access complications in hemodialysis patients. 119 patients with End Stage Renal Disease (ESRD) on regular hemodialysis were recruited for the study, They were subjected to the following Laboratory blood tests: Kidney function tests, CBC, KT/V, serum albumin, fasting blood sugar, swab culture and sensitivity from the skin over the vascular access and blood culture and sensitivity from both central and peripheral samples, In addition, radiological Doppler ultrasound was done for all patients to evaluate the vascular access.
Youhe Gao
Beijing Normal University, China
Title: A Tool for Biomarker Discovery in the Urinary Proteome: A Manually Curated Human and Animal Urine Protein
Biography:
Youhe Gao is a Professor, Beijing Normal University. He received his MD from Peking Union Medical College, his PhD from University of Connecticut and Postdoctoral training from Beth Israel Deaconess Medical Center Harvard Medical School. He was the professor of Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/ Peking Union Medical College from 2001-2014. His research interests include biomarker discovery in urine proteome, protein interaction and related bioinformatics.
Abstract:
Urine proteome was changed by different diuretics, anticoagulants. Other medications may cause changes in urine too. When clinical biomarker studies were designed, sex, age, disease stages, complications were usually taken into consideration. But different medicines taken by the patients were usually not. If this difference can be balanced off later in the study, it may not be a problem at all. But what if the disease is strongly associated with a particular medication, and healthy control is strongly associated with no medication, the result of the study may reveal the difference of the medicine instead of the disease. And the effects of disease and medicine can never be separated in the study. Normally and ethically, we can never stop medicine for the patients; we can never give the healthy volunteers, medicines they do not need, just for the sake of biomarker study. So the patients-medicine, healthy-no medicine associations exist in all of clinical biomarker studies. It is devastating for the field. Clinical biomarker studies are not cheap. We now have to reevaluate the candidate biomarkers proposed from most of early biomarker studies. We have to rule out the effect of the medicine. This becomes so urgent; it becomes part of the foundation of urinary biomarker study. This is why the author cannot wait to propose the pharmuromics (pharm-uro-mics) which studies the effect of the medicine on urine. The other parts can probably be named physiouromics, pathouromics which are the effect of a physiological or pathological process on urine.
Marcus WL Chow
Tan Tock Seng Hospital, Singapore
Title: Tumour Lysis Syndrome: a rare acute presentation of advanced testicular cancer
Biography:
Marcus Chow graduated from the University of Edinburgh in 2012 and completed his housemanship at the John Radcliffe Hospital in Oxford before returning home to work in Singapore. He is currently a Medical Officer with a special interest in Urology.
Abstract:
Tumour lysis syndrome (TLS) is a potentially fatal complication of malignancy or its treatment. This uncommon syndrome comprises of laboratory findings of hyperuricaemia, hypocalcaemia, hyperkalaemia and hyperphosphataemia. A literature search revealed a total of 8 case reports of TLS in testicular cancer. We present the case of a 47-year-old gentleman we saw in clinic and discuss the diagnosis and management of TLS. The patient was referred for progressive right groin swelling of 1-year duration, with known undescended right testis. Physical examination revealed a 15cm firm right groin lump, not extending into the scrotum. His right testis was not palpable. A CT Abdomen/Pelvis scan done prior revealed a 15x11x16cm right groin mass suggestive of gonadal malignancy. He was noted to be dyspnoiec and tachypnoiec. CT Pulmonary Angiogram excluded pulmonary embolism and lung metastases.
Ievgeniia Burlaka
National O.O. Bogomolets Medical University, Ukraine
Title: Apoptosis dependent kidney damages in children with primary and secondary proteinuric diseases
Biography:
Ievgeniia Burlaka was conducting her MD from National O.O. Bogomolets Medical University in the Department of Pediatrics.
Abstract:
Research shows that the level and type of proteinuria (whether the urinary proteins are albumin only - albuminuria) are a good indicator of the extent of kidney damage and a predictor of the irreversible kidney damage. Proteinuria may occur as a sing of kidney disease that are primary proteinuric i.e. nephrotic syndrome and in kidney diseases that develop proteinuria secondary to primary injury (diabetic nephropathy). The aim of the study was to investigate the level of metabolic-hypoxic disorders and the condition of apoptosis controlling system in children with nephrotic syndrome and diabetic nephropathy.
Jose de jesus oswaldo Islas garcia
Rio de Janeiro State University, Brazil
Title: There is a trans-abdominal testicular descent during the second gestational trimester? Study in human fetuses between 13 and 23 weeks post conception
Biography:
Jose de jesus oswaldo Islas garcia was working as professor at Rio de Janeiro State University in the department of urology located in Brazil.
Abstract:
To confirm if a real inner descend of testis occurs the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring We studied 29 human fetuses between 13 and 23 weeks post conception (WPC). The foetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter we measured the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test.