Day 2 :
Keynote Forum
Ching-Yuang Lin
China Medical University, Taiwan
Keynote: Treatment of critically ill children with kidney injury by sustained low efficiency daily diafiltration
Time : 09:35-10:15
Biography:
Ching-Yuang Lin obtained his Ph.D. at the National Osaka University, Osaka, Japan. He is the Professor and Associated Dean, College of Medicine, China Medical University and Division Chief of Pediatric Nephrology, China Medical University Children's Hospital, Taiwan. He is an honorary member of the American Pediatric Society. He was awarded the Best Research Award of National Science Council Taiwan three times, and the Outstanding Award for Best Submitted Abstract at 17th Annual Conference of Peritoneal Dialysis by the International Society of Peritoneal Dialysis. He has written more than 300 articles and book chapters on varied fields in Pediatric Nephrology.rnrn
Abstract:
Continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) offer diverse benefits and drawbacks for critically ill children with acute kidney injury (AKI). Sustained low-efficiency daily diafiltration (SLEDD-f) involves a conceptual and technical hybrid of CRRT and IHD. We report our SLEDD-f application to critically ill children in the pediatric intensive care unit (PICU). SLEDD-f was delivered by the new Fresenius 5008 therapy system with blood flow 5 ml/kg/min, dialysate flow 260 ml/min, hemofiltration 35 ml/kg/h for 8–10 h daily. Changes in blood pressure, blood gas, electrolyte, hemoglobulin (Hb), and hematocrit (Hct) were closely monitored. From February 2010 to June 2015, 34 critical patients with a total of 100 SLEDD-f sessions were studied retrospectively. Heparin was used in 56 sessions with no bleeding complications. Hypertension above 135 mmHg returned to normal, hypotension below 90 mmHg showed no drop. Metabolic acidosis and hyperkalemia normalized. Elevated Hb, Hct, and their ratio revealed improving hemodilution. Three episodes of intradialytic hypotension and one of circuit clotting led to premature termination. The 28-day survival rate was 81%. This pilot investigation demonstrates that SLEDD-f provides good hemodynamic tolerance and correction of fluid overload, pH, and electrolyte imbalance for critically ill children with AKI.
- Nephrology and Hypertension
Clinical Nephrology
Chair
Xiaorong Liu
China Medical University, Taiwan
Co-Chair
Falguni Das
University of Texas Health Science Center, USA
Session Introduction
Ahmed Abdel Samie Mahmoud
Theodor Bilharz Research Institute, Egypt
Title: The role of Doppler in evaluation of systemic lupus erythematosus nephritis
Time : 10:15-10:45
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 evaluate role of renal Doppler in assessment of systemic lupus erythematosus nephritis. Materials & Methods: The study included 32 systemic lupus erythematosus patients with renal affection and pathologically proven lupus nephritis (LN) by renal biopsy and pathological classification was divided into five different classes of lupus nephritis LN according to the 2003 International Society of Nephrology (ISN)/Renal Pathology Society (RPS) classification. Ultrasound and Doppler for both kidneys were performed for all of them; ultrasound assessed renal size, parenchymal thickness and echogenicity, corticomedullary differentiation and back pressure changes. Doppler examination evaluated general renal vascularity; kidney vascularity was assessed by measuring 3 different segmental arteries, approximately at the junction of renal sinus and parenchyma. Resistivity indices were calculated from segmental, lobar and interlobar arteries. Our radiological findings were correlated with clinical, laboratory and pathological findings. Results: The patients’ age ranged from 13-45 with a mean 28.19±8.026 SD there was a significant increase in renal resistivity index RI in LN patients when compared with SLE patients without renal affection and normal group, P value 0.022. Only 2 cases (6.3%) of LN cases showed a decrease in vascularity of the kidneys which showed no significant correlation with the disease severity or duration, distribution of renal pathologic findings according to International Society of Nephrology and the Renal Pathology Society classes within the LN group. Class II represented 9%, class III represented 38%, class IV represented 31% and class V represented 16% and class IV represented 6% of LN patients according to biopsy results. There is positive correlation between RI and renal biopsy classification with high significance, P value 0.001 with r=0.794. Conclusion: Color Coded Doppler play an important role in diagnosis of different lupus nephritis classes and RI could be used as a marker of severity in SLE patients with kidney involvement, suggesting the possible use of RI as a marker in the assessment of outcome and treatment.
Dario Xavier Jimenez Acosta
Enrique Garces Hospital, Ecuador
Title: Choosing the best dialysis treatment for critically ill patients with sepsis in a developing country
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:
Introduction: AKI is a serious problem in critically ill patients with sepsis; in Ecuador it has a prevalence of 10% and a high undocumented mortality rate. The type of renal replacement therapy used is also very discussed in countries with several options. In Ecuador there are no continuous treatments available for patients. Objective: The aim was demonstrate advantages in AKI treatment between hemodiafiltration with an own scheme vs. intermittent hemodialysis. The primary outcomes were mortality, vasoactive drugs, mechanical ventilation dependence and time of ICU stay. Results: Cohort and tracing study in ICUs in patients with sepsis and AKI. Two groups undergoing treatment for intermittent hemodialysis GA (n30) vs. hemodiafiltration GB (n21). 51 patients were observed. The general mortality was 54.9%, (63% GA vs. 42.8% GB p=0.09) had no statistical significance. Apache and SOFA index media were 26 and 11 respectively without statistical significance between both groups (p=0.65). Time ICU stay (GA: 18.33, GB: 10.76 p=0.027) vasoactive drugs dependence (GA: 9.77, GB: 4.19 p=0.089) MV dependence (GA: 12.13, GB: 6.62 p=0,036). Conclusions: HDF showed benefits in vasoactive drugs, MV dependence and ICU stay. The mortality was not statistically significative. We recommended HDF with our scheme for AKI treatment in critically ill patients with sepsis independent of mortality results.
Falguni Das
University of Texas Health Science Center, USA
Title: Ser-660 Phosphorylation of Protein Kinase C beta II ( pkcβii) by mammalian target of rapamycin complex 2 (mtorc2) Regulates High Glucose (HG)-induced Mesangial Cell Hypertrophy
Time : 11:30-12:00
Biography:
Falguni Das has received his PhD from University of Calcutta, India. He has joined the Department of Medicine’s Division of Nephrology as a Post doctoral fellow at University of Texas Health Science Center at San Antonio. He has worked extensively in areas of kidney physiology, signal transduction, gene regulation and the fundamental pathogenic mechanism of injury to kidney. He has produced several exciting findings which have been published in highly reputed journals. He has received several prestigious awards from his own institutes and also like New York Academy of Sciences.
Abstract:
Protein kinase C beta II (PKCβII) has been implicated in diabetic nephropathy (DN). Mesangial cell (MC) hypertrophy is a pathologic feature of DN. PKCβII undergoes phosphorylation at the hydrophobic motif site Ser-660 for its activity. We have shown that mTOR complex 1 (C1) regulates MC hypertrophy. How activation of PKCβII by Ser-660 phosphorylation fits into mTOR signaling to control MC hypertrophy is not known. HG significantly increased phosphorylation of PKCβII at Ser-660 in a PI 3 kinase dependent manner. siRNAs against PKCβII, dominant negative PKCβII and non-phosphorylatable mutant of PKCβII, PKCβIIS660A, blocked mTORC1 activity due to lack of PRAS40 phosphorylation, resulting in significant inhibition of HG induced MC protein synthesis and hypertrophy. Also, PKCβIIS660A attenuated phosphorylation of Akt at Ser-473, a putative mTOR complex 2 (C2) site. Specific inhibition of mTORC2 by shRNAs against rictor or Sin1, two exclusive and required components for its activity, suppressed HG induced phosphorylation of PKCβII Ser-660 and Akt Ser-473, resulting in attenuation of mTORC1 activity leading to inhibition of MC hypertrophy. Constitutively active (CA) Akt or CA mTORC1 reversed shRictor or shSin1 mediated inhibition of HG induced MC hypertrophy. Furthermore, CA PKCβII reversed the shRictor or shSin1 induced inhibition of HG stimulated Akt Ser-473 phosphorylation and MC hypertrophy. Finally, we show increased phosphorylation of PKCβII Ser660, PRAS40 and Akt Ser-473 in association with activation of mTORC1 in renal cortices of OVE26 mice with type-1 diabetes. These results provide the first evidence that HG induced activation of mTORC2 phosphorylates and activates PKCβII to increase the phosphorylation of Akt at Ser-473 to finally activate mTORC1 to induce MC hypertrophy. Thus, we uncover a specific role of mTORC2 for Akt/mTORC1 activation via PKCβII Ser-660 phosphorylation.
Jacques Vigan
Abomey-Calavi University, Africa
Title: Means of communication for an early detection of diabetic nephropathy among the diabetics followed in the academic hospital of Cotonou
Time : 12:00-12:30
Biography:
Jacques Vigan is a Nephrologist, currently working as an Assistant in the Faculty of Health Sciences at Abomey-Calavi University, Benin.
Abstract:
The purpose of this study is to determine the level of knowledge and the means of communication for early detection of diabetic nephropathy. This is a prospective study which took place from 06 February to 31 May 2012, in the Academic Clinics of Nephrology- Hemodialysis and the Endocrinology and Metabolic Diseases. Included all patients with diabetes mellitus in two sexes, older than fifteen years and hospitalized in one of these two clinical or received in consultation during the study period. A questionnaire is used for data collection. Statistical analysis was performed by Stata 11 in its English version. One hundred sixty patients were enrolled. More than 4 out of 5 patients had reported knowledge of diabetes mellitus while only 26.67% had acknowledged that manifests itself by high glycemia. More than half of the patients (57.50%) had said that diabetes mellitus can be complicated by renal impairment. Three out of four diabetics (75.63%) did not know that it is possible to make a nearly diagnosis of diabetic nephropathy. The radio and television broadcasts and sensitizations during medical consultations represented the best means of communication for early detection of diabetic nephropathy. The combination of several means of communication will raise awareness on early detection of diabetic nephropathy.
Punit G
Pt. Jawaharlal Nehru Memorial Medical College, India
Title: A study of treatment of steroid resistance and steroid dependent nephrotic syndrome by Mycophenolate mofetil & deflazacort in pediatric age group –a study from developing country (India)
Biography:
Punit Gupta has completed his MD (General Medicine), DM (Nephrology) & PhD from Pt. Ravishankar Shukla University, India. He has been awarded with two international fellowships from American Society of Nephrology & International Society of Peritoneal Dialysis. He is the Head & Medical Superintendent of DKS Post Graduate Institute & Research Centre, a premium institute of India in health sector. He has more than 170 papers & abstracts published in national & international journals. He has developed two unique machines in the field of dialysis which has been appreciated in Nephrology Committee.
Abstract:
Introduction: Idiopathic nephrotic syndrome affects 1-3 per 100,000 children <16 years of age; whereas most children will be responsive to corticosteroid therapy, approximately 20% will be classified as steroid resistant i.e., failure to achieve complete remission after initial therapy with corticosteroids. Method: The study was conducted in the Department of Medicine, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur. 28 patient of pediatric age group of nephrotic syndrome were included for the purpose of study admitted in Nephrology Unit, Pt. J.N.M. Medical College Raipur from was studied. All patients were subjected to routine investigations like complete blood counts, urea, creatinine, serum bilirubin, liver enzymes, electrolytes (sodium, potassium, chloride and calcium), urine routine microscopy, 24 hour urinary protein; thyroid function test, chest X-ray and ultrasonography of abdomen. Results: A total no of patients included in study are 28. The mean age of the patient is 11±2.86 years. Out of 65% patients are male while 35% patients are female. All patients have hypoalbuminea. The mean 24 hour urine protein is 3.1±1.2 grams. 46% patients are hypothyroid; out of them 62% was male & 38% was female. 72% patients shows electrolyte imbalance. 97% patients shows abnormal usg findings in which, ascites, increased echotexture pleural effusion seen in 43.5%, 28%, 28.5% respectively. Average weight of the nephrotic syndrome patient is 28±13.69 kg. Average weight reduction in week duration is 6.78±0.78 kg; dose of deflazacort used is 1 mg/kg body weight. Dose of mycophenolate mofetil used is 12 mg/kg body weight. No patients’ shows complication related to mycophenolate mofetil. 96.4% patients’ showed improvement in 6 month follow up & only 1 patient had relapse because of irregular medication. Conclusion: Male shows greater improvement than female. Maximum weight reduction was from 69 kg to 59 kg at the time of discharge. Hypoalbuminemia and hypothyroidism was common in female than male. 96.4% patients showed improvement with deflazacort & mycophenolate mofetil. Deflazacort & mycophenolate mofetil shows better results in treatment of nephritic syndrome.