Al Zahra Hospital, UAE
Al Zahra Hospital, UAE
Francisco Kidney & Medical Centre, Singapore
Francisco Salcido-Ochoa studied Medicine in the National Autonomous University of Mexico. He did both his Master of Science (Immunology) and his PhD in ‘Transplantation Tolerance and Immunoregulation’ at Imperial College London. He also worked in Internal Medicine at the Royal London and Barts Hospitals, obtaining his MRCP (UK). He did his specialisation in Nephrology at the Singapore General Hospital, where he worked for 10 years as a nephrologist. Currently, he is a nephrologist and transplant immunologist practicing at Francisco Kidney & Medical Centre in Singapore, focusing on general nephrology, kidney transplantation, diabetic kidney disease, diabetes prevention, including weight loss. Dr Francisco has several international publications and has been invited for several oral presentations in different countries including the UK, Mexico, Switzerland, Malaysia, Spain and Singapore.
Diabetes has reached epidemic proportions around the World and is a top cause of adult disability and mortality. As a consequence, the incidence and prevalence of diabetic kidney disease have also increased. Diabetic kidney disease takes a big toll on patients, on their health, lifespan, economy and quality of life. Furthermore, caring for diabetic kidney disease and end-stage kidney disease impinges severely in the healthcare budget. Therefore, it is imperative to be up to date not only in the detection and management of diabetic kidney disease to retard its progression and complications, but importantly and strategically to prevent it at the earliest stages possible, which is before diabetes or even pre-diabetes ensue. This presentation provides a summary of the evidence and gives advice on the prevention, detection and management of diabetic kidney disease.
Ministry of Health & Qol, Mauritius
Swalay FEDALLY, Nephrologist at Ministry of Health & Qol, Mauritius and reviewer for peer-review European Journal. He was graduated in Nephrology, M.D. from University of Chongqing, China. His research titles are Changes in Metabolism of Calcium and Phosphorus in patients with Renal Insufficiency treated by Hemodialysis, and Improvement of Drug-Associated Acute Interstitial Nephritis by Corticosteroids. He has an interest over writing and reading medical research articles and case studies. His interest is Interventional Nephrology
Acute interstitial nephritis (AIN) is a form of nephritis that affects the renal interstitium, which is an important cause of reversible acute Kidney Injury (AKI). Drug induced AIN is the commonest aetiology and accounts up to 80% of the causes.AIN is always of sudden onset and fast decline in renal function, usually presenting with an acute rise in blood urea nitrogen (BUN) and creatinine (Cr) values.Renal biopsy provides the most definitive means of diagnosis.Because of its role as anti-inflammatory, inhibition of immune, anti-allergy and prevention of fibrosis, corticosteroids is widely used as a treatment for AIN.
Boston University, USA
Dr. 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.
End Stage Renal Disease (ESRD) impacts the lives of over 700,000 American patients (including transplant recipients) and their families and costs United States taxpayers approximately $32.8 billion in annual Medicare expenditures. Spending continues to rise each year, likely due to an increase in various comorbid conditions which contribute to ESRD, including diabetes and hypertension in the context of an aging population. In 1972, President Nixon created an ESRD program in response to ‘God panels’ that were tasked with determining a patient’s eligibility for hemodialysis based on their social worth, since dialysis was seen as too costly to perform universally for all patients with ESRD. Unfortunately, the government grossly underestimated the future cost of this program, since it assumed that most patients who are medically suitable for dialysis are under age 54 with few if any comorbidities and that only one in five ESRD patients are eligible for dialysis. In hindsight, it was an altruistic but economically infeasible plan. In addition, while this program provides funding to the Center for Medicare Services (CMS) to treat patients under 65 with ESRD, it doesn’t help defray the cost of disease prevention. Medicare spends $32.9 billion per year on the treatment of ESRD but only $564 million annually on research geared towards the prevention and treatment of kidney disease. In contrast, in 2015 the NIH had a $3 billion research budget for the study of HIV/AIDS. As a result, there hasn’t been a significant improvement in dialysis delivery systems over the past four decades.
The payment structure for dialysis therapies remains complex, with Medicare bearing the brunt of the responsibility. Upon initiation of dialysis, if a patient is already a Medicare recipient, Medicare becomes the primary payer for dialysis service and covers approximately 80% of the cost, leaving supplemental insurance to cover the balance. For those who only have private employer-based insurance, their insurance is the primary payer for the first 33 months of care (a.k.a. the ‘waiting period’), after which time they are eligible for Medicare. Private insurance companies typically reimburse dialysis organizations at a significantly higher rate than Medicare or Medicaid. Therefore, it is during the waiting period that the dialysis organizations accrue the most financial benefit. Without employer insurance, a gap in payment would exist until the patient moved over to Medicare insurance after the standard waiting period.
Fortis Hospital Shalimar Bagh & Fortis Gurgaon, India
Urologists are much familiar with operating renal stones in normally located well ascended retroperitoneal kidneys. However operating on a renal stone in an anomalous pelvic dystopic kidney is a challenge. A multitude of treatment options are available for renal lithiasis like open surgery, ESWL, PCNL, Laparoscopy, RIRS. Conventional PCNL cannot be easily done in ectopic pelvic kindney because of overlying bone and risk of injuring bowel and anomalous blood supply of low lying kidney. An ectopic pelvic kidney can be safely dealt with various Laparoscopic techniques without any major complications. The first report of laparoscopic pyelolithotomy for calculus removal in a pelvic kidney was reported by William et.al in 1996 in J.Urol. So far only few cases of Laparoscopic stone surgery for ectopic pelvic kideny have been reported
Ministry of Health, Sri Lanka
Chronic kidney disease of unknown aetiology (CKDu) is known as a problem among paddy farmers of the North Central province. Ministry of Health published a three-tiered epidemiological case definition in 2016 as suspected, probable and confirmed CKDu. Suspected CKDu provides a uniform method to estimate the burden in epidemiological studies and is defined as the presence of essential criteria of eGFR < 60mL/min AND/OR albuminuria >=30mg/g. Among those satisfying essential criteria, those with urine protein:creatinine ratio >2g/g creatinine OR urine albumin:creatinine ratio >0.3g/g creatinine; hypertensive on >2 drugs OR untreated blood pressure >160/100mmHg; history of diabetes OR being on treatment OR capillary random plasma glucose >200mg/dL were excluded.
Pt.Jawaharlal Nehru Memorial medical College, India
Professor Dr. 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 was felicitated for being the only research scholar who had presented 29 abstracts in Indian Society of Nephrology conference, Pune and 11 research papers at Asia Pacific congress of Nephrology, 2008 in Malaysia on tribal kidney diseases.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 distinguish 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.
Sickle cell nephropathy is defined as structural and functional abnormalities of kidney function seen in patients with Sickle cell haemoglobinopathy (SCA or Sickle cell Disease; SCD) in the absence of other secondary causes of kidney disease is common and contributes to mortality (CIN 2011). Sickle cell nephropathy consists of a variety of renal abnormalities, i.e. tubular changes and glomerulopathy .The hallmark of sickle cell nephropathy is the combination of an impaired renal concentrating capacity and a normal diluting capacity.Maximum number of patient were in the age group between 15-25 years in patients of Sickle cell disease with nephropathy and Sickle cell disease without nephropathy. The mean age in our study was 25.31 ± 8.47 years and the mean age in patients of sickle cell disease with nephropathy was 29.26 ± 9.30 years, while it was 21.36 ± 9.30 in patients of sickle cell disease without nephropathy.16 (53.33%) were male and 14 (46.67%) were female.
Shamim Ahmed now working as Professor of Nephrology and Senior Consultant, Kidney Foundation Hospital and Research Institute, Mirpur, Dhaka, Bangladesh. He was former Director and Professor of Nephrology National Institute of Kidney Disease and Urology (NIKDU). He also worked as Professor and Head, Department of Nephrology in Dhaka Medical College and Hospital. He graduated MBBS degree from Dhaka Medical College in 1979. He obtained FCPS (Medicine) degree from BCPS in 1987. He received clinical training in Nephrology for one year in 1992 from PGIMER Chandigarh, India under WHO fellowship. He also completed 13th Especial Foundation Training in 1989 from BATC, Saver. He was awarded FRCP (Edin) in 2003, FRCP (USA) in 2004, FRCP (Glasg) in 2005. He had more than 90 scientific papers published in different journals of home & abroad. He is life member BRA, BMA, teachers Association of DMC & RMC, BCPS, Kidney Foundation Bangladesh. He is also member of ISN, New York Academy of Science & other organizations. He worked as Asstt. Editor, Bangladesh Renal Journal, editor of TAJ (Joumal of teachers Association RMC). He was Vice President and General Secretary of Bangladesh Renal Association. At present he is member of executive committee of Bangladesh renal Association and treasurer of Kidney Foundation. He attended Scientific conferences in different countries like India, Pakistan, Sri Lanka, Thailand, Singapore, Malaysia, Japan, UK, USA, Brazil, Italy, Sweden & South Africa, France, Germany, Cze Republic, Canada, Philippine, Nepal, Australia, Austria and Turkey. He was honored with Mother Terasha Gold Medal award, Mirror Health award, Netaji Subash Chandro Basu award, Bangabandhu Gold Medal award, Deshpramiksarmana award and Kazi Nazrul Islam sarmanona award by different organizations of the country.
Normal metabolism of the body produce approximately 15000 mmol of carbon dioxide and 50 to 100 mmol of nonvolatile or fixed acid each day. Acid base balance is maintained by normal elimination of carbon dioxide by lungs and normal excretion of non volatile acid by kidneys. Metabolic acidosis occurs when either an increase in production non volatile acid or increase loss of bicarbonate from the body overwhelms the mechanism of homeostasis or when renal acidification mechanism are compromised. Metabolic acidosis (Chronic) is commonly associated with chronic kidney disease (CKD). The number of functioning nephrons declined in CKD, acid excretion is initially maintained by an increase in ammonium excretion. However total ammonium excretion begin to fall when glomerular filtration rate (GFR) is below 40ml/min. CKD leads to retention of hydrogen ion which is buffered by bicarbonate in the extra cellular fluid, tissue buffer and bone. With worsening of renal function progressive metabolic acidosis and academia develop. Serum bicarbonate concentration is <22meq/L is about 25% patient of non dialysis dependent CKD stage 5. Serum bicarbonate trends to stabilize 12 to 18 meq/L in CKD when GFR is < 10ml/min. Anion gap remains normal until late stage CKD when it begins to widen due to retaining anion such as phosphate and sulfate. The consequences in CKD are bone resorption and osteopenia, increase muscle protein catabolism, aggravation of secondary hyperparathyroidism, reduced respiratory reserve, exhaustion body buffer system, increase severity of acute intercurrent illness, reduce Na-K-ATPase activity in RBC, myocardial cells resulting impair myocardial contractility, producing heart failure, systemic inflammation and hypotension. Endocrine disorder in metabolic acidosis in CKD are resistance to growth hormone and insulin and hypertriglyceridemia. African American Study of Kidney disease (AASK) trial and CRIC observational study in patients of non dialysis depended CKD have found that lower serum bicarbonate concentration, higher net endogenous acid production, higher dietary acid load and inability to excrete acid are all associated with a higher risk of progressive renal function loss. Potential mechanism for progression of CKD is metabolic acidosis promotes increase of ammonium excreted per nephron is associated with activation of complement system, renin angiotensin system with increase production of endothelin which may produce tubulointerstitial inflammation and chronic damage to kidneys. Treatment of metabolic acidosis in CKD are sodium bicarbonate or sodium citrate. In mild acedemia (arterial ph>7.2 ) in asymptomatic adult does not require bicarbonate therapy. KDIGO guideline advocate alkali therapy in patient with CKD in a dose 0.5 to 1mg per/kg/day to maintain target range 23 to 28 meq/L. Sodium citrate should be avoided in patient also taking aluminum containing antacid. Sodium bicarbonate therapy may cause volume expansion and hypertension in CKD patients and raising ph can precipitate tetany in patient with hypocalcaemia. Bicarbonate supplement appears to slow the progression of CKD, prevent or delay the progression of both osteopenia and hyperparathyroid bone disease and improved nutritional status and lean body mass. In conclusion several but not all studies of patients with chronic metabolic acidosis in CKD have demonstrated bicarbonate therapy improves or decrease the progression of bone disease, normalizes growth, reduce muscle degradation, improves of albumin synthesis and retards progression of CKD. At present recommendation to maintain bicarbonate level 22-23mmol/L in CKD patients.
Universitas 17 Agustus 1945 Jakarta, Indonesia
Diana Laila R has completed his PhD at the age of 30 years from Universiti Sains Malaysia. She is the head of department of pharmacist programme Universitas 17 Agustus 1945 Jakarta. She has published more than 30 papers, 100 case reports either national, international and reputed journals. She has published 2 books about clinical pharmacy as internationally. She is the active member of pharmacy organization in Indonesia. She had experience as a speaker in national and international forum and 2 times got grants from Indonesian government for clinical pharmacy research.
Isolation and using special hemodialysis machine are not necessary for hemodialysis patients who has been infected by hepatitis C viral from the association of Nephrologist in Indonesia (Pernefri) recommendation meanwhile Ministry of Health Malaysia gives recommendation that hepatitis C patients will be dialyzed in a separate room or a separate area with a fixed partition and dedicated machines. To identify the correlation between the recommendation which had been followed by two hemodialysis centers in different countries and the impact of that to the hepatitis C infection issue. A cohort prospective and retrospective study was done in this research. The study included hemodialysis patients who had followed up for 9 months and who died in last 5 years. Universal sampling were used to select the inclusion criteria. There was a significance relationship between HCV first checked and HCV second checked among 9 months followed up hemodialysis patients in HD center Jakarta, Indonesia. The total number of patients who had hepatitis C in the second checked increased around 30% of total hemodialysed patients who infected HCV in the first check in this HD center. Besides, provide special hemodialysis rooms and machines for hemodialysis patients with hepatitis C, minimizing blood transfusion to the patients on hemodialysis is important to reduce the chance for the patients to get hepatitis C and to increase the percentage of the survival.
Asgar Ali Hospital, Bangladesh
She has done MD in Laboratory Medicine from Bangabandhu Sheikh Mujub Medical University, Dhaka Now, she has Four(4) months of experience as specialist in Laboratory service in Asgar Ali Hospital, Dhaka. She had Three (3) years of experience in Laboratory service in Bangabandhu Sheikh Mujub Medical University (BSMMU), Dhaka
Histopathology is gold standard in diagnosis of prostate cancer but it is a cumbersome method. On the other hand, prostate specific screening has revolutionized in detection of prostate cancer but due to PSA’s lack of sensitivity and as it is not cancer specific novel biomarkers are needed to improve risk assessment. To measure and compare the level of soluble E-cadherin and prostate specific antigen in the detection of prostate cancer, this cross-sectional study was conducted at the Department of Laboratory Medicine in collaboration with the Department of Urology, BSMMU, Dhaka, from March 2017 to February 2018. Total 70 patients were enrolled and divided into Group A (PCa) and Group B (BPH). Each group was consisted of 35 subjects who had histopahtologically proven prostate cancer and benign prostatic hyperplasia. E-cadherin with a cut off value 7.3, 95% CI 0.91-1.00, had 74.3% sensitivity and 97.1% specificity for prediction of PCa. 80 KDa fragment of E-cadherin is more specific but was not available. Comparison of E-cadherin in prostate cancer without metastasis and with metastasis is recommended. Immunohistochemical examination of E-cadherin in biopsy sample is also recommended