Day 1 :
Keynote Forum
Dario Xavier Jimenez Acosta
Central University of Ecuador, Ecuador
Keynote: Ocular disorders detected in end stage renal disease undergoing hemodialysis patients and laboratorial correlations
Time : 10:00-10:40
Biography:
Dario Xavier Jimenez Acosta MD. Nephrologist Born in 1977, October 03. Medical Doctor at Central University of Ecuador (1994-2001). Nephrologist by Pichincha Medical College, at Eugenio Espejo Specialty Hospital (2002-2007). Did Nephrology mini fellowship at Colorado University, Denver (2007).He is the Past Secretary of Ecuadorian Society of Nephrology (2012-2015), Medical Director of DIALNEF (Critical Nephrology) Quito-Ecuador (2012-actually). Nephrology Chief at Enrique Grace’s General Hospital (Ecuadorian Health Public Ministry). One book published (coauthor), 16 paper published.
Abstract:
The eye disorders and the ocular fundus in CKD stage 5 patients have been little studied, with no literature available in our country. The uremic state of these patients due to systemic diseases or kidney own diseases produces eye affectations. Objective: To document the prevalence of ocular abnormalities in ERC5 patients and laboratorial correlation. Materials and Methods: A comprehensive optometric examination was realized to 105 patients with CKD 5 in hemodialysis(HD) and fundus eye a significant sample (n 50). Variables such as: distance visual acuity (AVL) and close (AVP), external examination, slit lamp and fundus photograph of the posterior pole were performed. Results: 55 patients were male (52%) and 50 women (48%), aged between 18 and 91 years (mean 49 yo). 70% (n73) achieved acceptable vision and 5% (n5) had 20/200 or less vision. The cataract was observed in 30% (n31) dry eyes 28% (n29), pterygium28% (n29) and hyperemia 22% (n23) of cases. Laboratorial correlations were performed with seric calcium, phosphorus and parathyroid hormone (PTH). There was no statistically significant difference between the groups with and without cataract for PTH levels in both diabetics (p = 0.98) and non-diabetics (p = 0.79). However the hypocalcemia seems to have a strong correlation with cataract, and the triad Hypercalcemia, hyperparathyroidism and hyperphosphatemia a high correlation with other ocular disorders. 213 photographs were taken and analyzed 100 photographs, 6% of patients (n3) showed bilateral Normal Fundus. Hypertensive retinopathy was found (32%), abnormalities we have found them as typical of the ESRD (24%) were present in 79% of patients who had glomerulopathies. Conclusions: The final results showed high incidence of eye disease in ESRD patients. 6% of 50 patients tested had normal eye Fund bilateral. This shows the great importance of a comprehensive optometric examination and eye fundus in this group of patients and the possible presence of uremic retinopathy as own nosological entity of these patients.
- Pediatric Nephrology
Nephrology- Diagnosis, Treatment, Prognosis
Diagnostic techniques
Chair
Dario Xavier Jimenez Acosta
Central University of Ecuador, Ecuador
Co-Chair
Maxime Bouchard
McGill University, Canada
Session Introduction
Maxime Bouchard
McGill University, Canada
Title: A point mutation in the F-actin regulator p190A RhoGAP affects ciliogenesis and leads to glomerulocystic kidney disease
Time : 11:00-11:30
Biography:
Dr. Bouchard received his PhD from Laval University, Canada and pursued his postdoctoral studies at the Institute for Molecular Pathology, Vienna, Austria. He joined McGill University in 2003 and is currently Associate Professor at the Goodman Cancer Research Centre and in the Department of Biochemistry. His research focuses on the developmental genetics of renal diseases using the mouse as a model system.
Abstract:
Rho family GTPases act as molecular switches regulating actin cytoskeleton dynamics. Attenuation of their signaling capacity is provided by GTPase-activating proteins (GAPs), including p190A, that promote the intrinsic GTPase activity of Rho proteins. We recently identified a novel loss of function allele of the p190A gene Arhgap35, which introduces a Leu1396 to Gln substitution in the GAP domain. This change results in decreased GAP activity for the prototypical Rho-family members, RhoA and Rac1. Consequently, Arhgap35-deficient animals exhibit hypodysplastic and glomerulocystic kidneys. We show that p190A is required for appropriate primary cilium formation in proximal tubules. P190A localizes to the base of the cilia to permit axoneme elongation, which requires a functional GAP domain. Pharmacological manipulations further reveal that inhibition of either Rho kinase (ROCK) or F-actin polymerization is able to rescue the ciliogenesis defects observed upon loss of p190A activity. We propose a model in which p190A acts as a modulator of Rho GTPases in a localized area around the cilia to permit the dynamic actin rearrangement required for cilia elongation. Together, our results establish an unexpected link between Rho GTPase regulation, ciliogenesis and glomerulocystic kidney disease.
Ronak Lakhia
University of Texas Southwestern Medical Center, USA
Title: Title: miR-21 promotes cyst growth in polycystic kidney disease
Time : 11:30-12:00
Biography:
Dr. Ronak Lakhia completed her M.D. form the University of Texas Southwestern Medical School in Dallas, TX in 2008. She then completed her residency in Internal Medicine at Baylor College of Medicine in Houston, TX. In 2012, she came back to the University of Texas Southwestern Medical Center in Dallas for nephrology fellowship. After her clinical year, Dr. Lakhia joined Vishal Patel’s laboratory where she is working on understanding the role of micro-Rna’s in polycystic kidney disease. Dr. Lakhia is funded by a NIH T-32 training grant. She has recently published her findings in the Journal of American Society of Nephrology.
Abstract:
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the presence of numerous fluid-filled cysts in the kidney. MicroRNAs (miRNAs), short noncoding RNAs that regulate gene expression, have emerged as promising new therapeutic targets for many diseases, but the role of these noncoding RNAs in ADPKD pathogenesis is still poorly understood. Here, we investigated the role of miR-21, an oncogenic miRNA, in kidney cyst growth. We found that transcriptional activation of miR-21 is a common feature of murine models of PKD. Furthermore, compared with renal tubules from kidney samples of normal controls, cysts in kidney samples from patients with ADPKD had increased levels of miR-21. cAMP signaling, a prominent pathogenic pathway in PKD, transactivated the miR-21 promoter in kidney cells and enhanced miR-21 expression in cystic kidneys of mice. Furthermore, genetic deletion of miR-21 reduced cyst burden, attenuated kidney injury, and prolonged survival of an orthologous model of ADPKD. RNA sequencing analysis and additional in vivo studies showed that miR-21 inhibits apoptosis of cyst epithelial cells, likely through direct repression of its target gene programmed cell death 4 (Pdcd4). Thus, miR-21 functions downstream of the cAMP pathway and promotes cyst growth in a mouse model of ADPKD. Our results suggest that inhibiting miR-21 is a potential new therapeutic approach to slow cyst growth in PKD.
Ahmed Abdel Samie Mahmoud
Theodor Bilharz Research Institute, Egypt
Title: Role of MRI corticomedullary differentiation in the assessment of renal post transplantation complications
Time : 12:00-12:30
Biography:
Ahmed Abdel Samie Mahmoud has completed his Master’s degree in Radiology from Cairo University and MD from Alazhar University School of Medicine. He is an Assistant Professor and Head of Radiology Department in Theodor Bilharz Research Institute, Cairo, Egypt. He has published 10 papers in reputed journals and has been serving as a Reviewer for the Egyptian Journal of Radiology and Nuclear Medicine.
Abstract:
Objective: To observe MRI features about renal corticomedullary differentiation in the assessment of renal allograft complications during the post transplantation period. Materials & Methods: 30 patients with post transplantation complications underwent MR T_1 weighted fat saturation (T_1 FS) and contrast enhanced gradient echo scan. The signal intensity of the cortex and medulla were measured on the coronal scans and the cortio-medullary contrast (CMC) was calculated. Results: All the patients with acute rejection showed loss of the corticomedullary differentiation with a negative CMC% with a sensitivity of 75%, a specificity of 31% and a positive predictive value of 11% and a negative predictive value of 92%. One of the 2 cases with ATN showed a decreased CMD with a CMC% of 6% and the other one showed a negative CMC% of -3%, having a sensitivity of 100%, a specificity of 36%, a positive predictive value of 15% and a negative predictive value of 100%. The cases with cyclosporine nephrotoxicity showed a wide variability in their CMD, where 40% showed normal CMC% of >9%, 17% showed a decreased CMD ranging between 0-9% and 43% showed loss of CMD. The MR assessment by this modality showed a sensitivity of 63%, a specificity of 28% and a positive predictive value of 18% and a negative predictive value of 75% in detection of this type of medical complication. On the other hand, all patients with CAN showed decreased CMD ranging from 0-9% with a sensitivity of 100%, a specificity of 32%, a positive predictive value of 7% and a negative predictive value of 100%. There was a statistically significant decrease in the CMD seen in patients with chronic allograft rejection and those of the controls (p=0.02). Conclusion: In conclusion, alteration in CMC is a sensitive but nonspecific indicator of renal disease.
Xiaorong Liu
Beijing Children’s Hospital, China
Title: Urinary CD80 is elevated in minimal change disease but not in focal segmental glomerulosclerosis
Time : 13:15-13:45
Biography:
Dr. Xiaorong Liu is currently a professor and Chief Physician, Director of Department of Nephrology, Beijing Children's Hospital affiliated with Capital Medical University, Director of the Beijing Children's Blood-Purification Center. She is a member of Beijing Blood Purification Center of Quality Control and Improvement Committee, a member of nephropathy rheumatology group, Pediatrics Branch, Beijing Medical Society, a member of Kidney Disease Committee of Beijing Traditional Chinese Medical Society, and a member of Therapeutic Medicine Research Committee of Pharmacological Society of China. Dr. Liu is a Standing Committee member of Physicians Association of China, an Editorial Board member of Chinese Journal of Applied Clinical Pediatrics, Chinese Journal of Practical Pediatrics, Journal of Pediatric Grand Rounds. She has participated in and presided over National 863-Projects, Fifteenth-Five Year Plan of China Projects, the Beijing Municipal Science and Technology Commission’s Characteristics of the Capital Projects, Development of Capital’s Business and Industry Projects. Prof. Liu has published more than 40 papers, and ten of them in Pediatric Nephrology, Pediatric Pulmonlogy, Medicine and other high-caliber journals and have been included in SCI.
Abstract:
Background:Early diagnose of minimal change disease(MCD)in nephrotic syndrome (NS)patients remains challenge.We often make a diagnose of MCD by invasive kidney-biopsy.CD80,is a transmembrane protein, present on podocytes in a number of experimental models of nephrotic syndrome.Urinary CD80 is significantly elevated in MCD but not in focal segmental glomerulosclerosis(FSGS)or other glomerulopathies. The aim of this study was to investigate the role of the urinary CD80 as a biomarker for diagnosis of MCD. Materials and Methods:A total of 165 subjects,129 males and 36 females were enrolled in this study. Urinary were collected from 37 patients with active MCD, 27 patients with FSGS,30 patients with other glomerulopathies and 71 healthy people. Using ELISA, compared values with the result of kidney-biopsy. Results: The concentration of urinary CD80 was significantly higher in the active MCD group (689.66±378.21ng/g creat) than those in the FSGS group (123.49±167.88ng/g creat p <0.001) ,other glomerulopathies group(152.37±220.14ng/g creat,p <0.001) and the control group(81.83±23.01 ng/g creat; p < 0.001).A cut-off value of 328.98(ng/g creat) was proposed,with an sensitivity of 81.1% and specificity of 94.4 %.The area under the ROC (receiver operating characteristic) curve for the urinary CD80 to diagnosis MCD was 0.925(95% confidence interval: 0.873-0.978）. Conclusions: This experiment has preliminarily confirmed urinary CD80 as a non-invasive diagnostic biomarker which owned a practical and significant value in the diagnosis of MCD
K S Nayak
Deccan Institute of Nephrology and Renal Transplantation, India
Title: Treatment of Chronic Kidney Disease patients with ketoanalogue supplemented low protein diet and ketonalogue supplemented very low protein diet
Time : 13:45-14:15
Biography:
He is a pioneer in the field of Peritoneal Dialysis Internationally and Cadaver Kidney Transplantation (http://blogs.hbr.org/2012/11/a-great-ideafor-lowering-cost/) and well known in the areas of Chronic Kidney Disease Management, Critical Care Nephrology including CRRT, Liver Dialysis (MARS & FPSA; Prometheus: Largest series in the Country).He was responsible for the Country’s first Simultaneous Heart and Kidney Transplantation (SHK). A Member of various Task Forces & Committees that has developed Best Practice Guidelines CKD and Anemia management. He is the Chief Co-ordinator of the Asia Pacific Chapter for ISPD and Past Councillor of ISPD. He successfully held the prestigious 2nd Asian Chapter Meeting Of the ISPD, Hyderabad in January 2005 and Co-Director of the 3rd Haemodialysis UniversityTMof ISHD at Hyderabad, March 2014(http://hdu2014.com/).He is an internationally Acknowledged expert in Telemedicine in Dialysis (http://blogs.hbr.org/2012/04/how-telemedicinesaves-lives-a/), reverse ‘Medical’ Innovation & Medical Tourism. He has contributed extensively in International Journals such as KI,AJKD,JASN,NDT,Transplantation Proceedings,PDI, Nephrology, American Journal of Gastroenterology, Contributions to Nephrology etc, and also, Harvard Business Review, Invited Editorials and Book Chapters and has delivered invited lectures worldwide, including regularly at the ‘Ronco’meetings in Vicenza, Italy, International society of Peritoneal Dialysis(ISPD),World Congress of Nephrology, Annual Dialysis Conference, USA, International Society of Haemodialysis(ISHD),the prestigious Salzburg Global Seminar(http://www.salzburgglobal.org/current/sessionsc.cfm?nav=faculty_tab&IDSPECIAL_EVENT=3898) etc. The Harvard Business Review Magazine cited his dialysis work at Deccan Hospital as having world class
Abstract:
Introduction: A low protein diet (0.6 G/Kg BW) and a very low protein diet(0.3 G/Kg BW) supplemented with ketoanalogues have been shown to be even more efficacious in further improving the benefits of a low protein diet in CKD patients. Material & Methods: 164 adult patients with Stage 3 to Stage 5 (Predialysis) were initiated on ketoanalogue supplemented low protein diet (sLPD) after informed consent and the necessary Institutional Ethics Committee approvals. Based on their affordability, 116 patients randomly were assigned to the sLPD group whereby they received 0.6gm/kg BW of dietary proteins supplemented by ketoanalogues (Renolog: La RenonHealthCare, Ahmedabad, India) at a dosage of one tablet per 10 Kg body weight. 48 patients received 0.3 gm/kg BW supplemented by Renologat a dose of one tablet per 5 Kg body weight. Renal, metabolic, nutritional parameters and anthropometric analysis were done in both groups at the start of the study, at the end of six months and at the end of twelve months of treatment. Results: Total number of patients in the study group were 164 of which 116 were on sLPD and 48 were on sVLPD regimen. Period of study was twelve months. The number of Renolog tablets consumed per day in the sLPD group was 6.10+_1.03 and 12.19 +_1.83 in the sVLPD group. The difference was statistically significant (p <0.001 ).
Lamiaa Adel Salah El Din
Cairo University School of Medicine, Egypt
Title: Diagnostic value of fetal MRI in evaluating fetal urinary anomalies
Time : 14:15-14:45
Biography:
Lamiaa adel salah el din has completed her masters degree in radiology at the age of 30 years and MD at age of 35 years from Cairo University. She is currently assisstant professor at radiology department, cairo university. she has published more than 20 papers in reputed journals and has participated in many national and international conferences. (Up to 100 words)
Abstract:
Purpose To detect the accuracy of fetal MRI in diagnosing urinary tract anomalies in comparison with ultrasonographic findings and fetal outcome. Methods We examined 30 fetuses with sonographically suspected congenital urinary tract anomalies by 2D/3D ultrasound and MRI. The gestational age range was 18–36 weeks. 43% of the women were in the second trimester. The diagnosis was confirmed by postnatal ultrasound, cystogram and biopsy in born babies and autopsy in still born or abortus fetuses. Results We found different urinary tract anomalies including: bilateral autosomal recessive polycystic kidney disease (n = 8), unilateral autosomal recessive polycystic kidney disease (n = 1), dilated collecting system (n = 8), renal agenesis (n = 3), bilateral enlarged multicystic dysplastic kidneys (n = 5), unilateral enlarged multicystic dysplastic kidney (n = 4) and renal dysplasia (n = 1). MRI changed the US diagnosis in 6 cases and added information in 4 cases. MRI changed the patient’s management in 3 cases. MRI confirmed US diagnosis in 20 fetuses. Ultrasound was superior to MRI in one case of renal failure. Associated extrarenal anomalies were detected in 9 cases (30%). MRI showed 96% accuracy in diagnosis. Mortality rate reached 56%. Conclusion Fetal MR imaging may be used as a complementary modality to US in diagnosing inconclusive or equivocal fetal urinary abnormality.