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Issue I
Issue I
Disclaimer: ISNews is an educational newsletter service depicting current information in the fi eld of Nephrology and published by Promedica Health Communication Pvt. Ltd. The information presented in ISNews is for educational purposes only and exclusively for use of registered medical practitioners. The Information contained in ISNews includes content derived from various third parties which are neither endorsed nor supported by Indian Society of Nephrology and does not necessarily refl ect any policies, procedures, standard or guidelines of the Indian Society of Nephrology. The Indian Society of Nephrology accepts no responsibility for any error, omission or misleading statement in this publication or for any injury, loss or damage that occurs as a result of an opinion expressed or information provided. Neither can the Indian Society of Nephrology guarantee that any information or services are still current and/or applicable and it is the sole responsibility of the user to ensure that any information that they access from this publication is accurate, complete and useful. Indian Society of Nephrology takes no responsibility for the accuracy, currency, reliability and correctness of any information included in the Information provided by third parties nor for the accuracy, currency, reliability and correctness of references to information sources (including Internet Sites). To the extent permitted by applicable law, the Indian Society of Nephrology disclaims all warranties and representations (whether express or implied) as to the accuracy of any information contained in this publication and does not guarantee that this publication will be fault free. The statements and opinions contained in ISNews are solely those of the individual authors and do not necessarily refl ect those of the Indian Society of Nephrology or of the publisher. The Indian Society of Nephrology does not warranty, endorse or approve products or services advertised or of their safety in this publication. The Indian Society of Nephrology disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Promedica Health Communication Pvt. Ltd., has endeavored to utilize graphic and texts which do not require a license or, if this is not possible, to designate the authorship of the material used. Material created and published in ISNews is under open access and distributed under the Creative Commons Attribution License, Attribution 3.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Although the publishers of ISNews have prepared the Information with all due care and updates the Information regularly, it does not warrant or represent that the Information is free from errors or omission. Whilst the Information in ISNews is considered to be true and correct at the date of publication, changes in circumstances after the time of publication may impact on the accuracy of the Information. Scientifi c and medical knowledge is ever-changing. The authors, artists and publisher have attempted to provide information that is complete and in accord with the standards accepted at the time of the publication. However, in view of the possibility of human error by the authors, artists, or publisher in the material herein, or changes in scientifi c and medical knowledge, neither the authors, artists, or publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as there is any mention of a dosage or clinical application, this does not involve, imply, or express any guarantee or responsibility on the part of the authors or publisher in respect of any dosage instructions and forms of clinical application stated herein. Every reader is requested to examine carefully the manufacturers’ leafl ets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in ISNews. Such examination is particularly important with drugs that are either rarely used or have been newly released. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publisher request every reader to report to the publishers any discrepancies or inaccuracies noticed in the material contained herein.
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An Offi cial Publication of the Indian Society of Nephrology
ISNews Published on behalf of the Indian Society of Nephrology by PROMEDICA New Delhi | Mumbai | USA. [email protected]., www.promedica.co.inwww.isnews.com
Felicitations from the Indian Society of Nephrology!
Dr. Vivekanand Jha, on being elected as the President of the International Society of Nephrology.
Dr. Manisha Sahay, on being elected as Council Member for South Asia Region by the International Society of Nephrology
Governing BodyPresidentDr. Vijay Kher
Immediate Past PresidentDr. Pradeep Deshpande
President-ElectDr. Chakko Jacob
Vice-PresidentDr. HS Kohli
Hon.Secretary Dr. Narayan Prasad, Lucknow
Treasurer Dr. Santosh Varughese
Executive Members Dr. Sanjay Kumar Agarwal, New Dr. Manish Rathi Dr. Sree Bhushan Raju
Zonal Members Dr. K.C. Gurudev (South Zone)Dr. DS Chafekar (West Zone)Dr. D.S. Ray (East Zone) Dr. Ashwini Gupta (North Zone)
Ex. Offi cio Members Prof. Sanjay Kumar Agarwal Editor, Indian Journal of Nephrology Dr. Pradeep Deshpande, Chairman, Credential Committee Dr. M.M. Rajapurkar, Chairman, Scientifi c Committee Organizing Secretary (ISNCON 2017)
Credentials CommitteeChairman Dr. Pradeep Deshpande, Hyderabad
Members Dr. Georgi Abraham , ChennaiDr. PP Varma Dr. Umesh Khanna, MumbaiDr. Jayant Basu, Kolkatta
Member, IJN Editor Dr. SK Agarwal, New Delhi
Convenor Secretary, ISN Dr. Narayan Prasad, Lucknow
Scientific CommitteeChairman Dr. MM Rajapurkar, Nadiad
MembersDr. Vivekanand Jha, Chandigarh Dr. Sandeep Mahajan, New DelhiDr. N Gopalkrishanan, ChennaiDr. Sampath Kumar, MaduraiDr. Arpita Roy Chaudhary, KolkottaDr. Om Kumar, PatnaDr. Tarun Jeloka, Pune
Convenor Secretary, ISN Prof. Dr. Narayan Prasad, Lucknow
ISN Leadership 2016-2017
Message from the Secretary Message from the Secretary
ISNews will continue to engage the Nephrology network!
We are pleased to launch ISNews - a robust newsletter to keep nephrologists informed and connected. This periodical proposes to capture most of ISN’s capacity-building activities, refl ect on the future trajectory of kidney care in India, and foster communication among practitioners. The newsletter is available in print and online versions. The latter can be accessed on the home page of www.isn-india.com. Members are encouraged to populate subsequent issues by sharing their experiences, and comments to [email protected].
- Prof. Dr. Narayan Prasad
Message from the President
Welcome to the Inaugural Issue of the ISNews!
The scope of ISNews is to provide up-to-date information on all societal activities as well as presents an ideal forum for exchange of ideas and expertise. This newsletter will leverage breakthroughs, facilitate collaboration among experts and celebrate the continued success of ISN Initiatives. With time, the periodical shall expand, to include perspectives of interprofessional renal and various health care teams thus contributing more to the profession and to the kidney community. The publication will be available in print and online versions bimonthly. Members are encouraged to enrich subsequent issues with their experiences and initiatives.
- Dr. Vijay Kher
Message from the President
ISNews | Aug. 2017 | 4ISN-INDIA.ORG
ANNOUNCEMENT FOR ISNCON 2017Abstract submissionThe ISNCON 2017 is scheduled to be held from 14th to 17th December 2017 at New Delhi. The abstract submission for the conference will open from 1st May 2017. The last date of abstract submission will be 15th August 2017. Kindly submit your abstract through abstract submission link on the website www.isn-india.org.
Call for ISN Orations and FellowshipWe are pleased to announce that call for ISN Awards and fellowship applica-tion is now open.Nominations/applications are invited for the following.
Dr VN Acharya Memorial OrationThis award is intended to recognize outstanding research work done in India by a member that significantly advances the field of nephrology and/or kidney transplantation in India.
Eligibility Any memberApplication / Nomination ApplicationSubmission documents 1. Application
2. CV 3. Write-up of oration
Addressee Secretariat of SocietyLast Date 31st July 2017Evaluating authority Scientific CommitteeHonor Certificate
JCM Shastri Memorial OrationThis award is intended to recognize outstanding research work done in India by a member that significantly advances the field of nephrology and/or kidney transplantation in India.
Eligibility Senior Nephrologist
Application / Nomination Application
Submission documents 1. Application 2. CV 3. Write-up of oration
Addressee Secretariat of Society
Last Date 31st July 2017
Evaluating authority Credential Committee
Honor Certificate
Bansal Award OrationThe award is reserved for outstanding research work done by ISN member.
Eligibility Any member below the age of 40 years
Application / Nomination Application
Submission documents 1. Application 2. CV 3. Write-up of oration
Addressee Secretariat of Society
Last Date 31st July 2017
Evaluating authority Scientific Committee
Honor Certificate
Fellowship of the Indian Society of NephrologyEach year the Society elects members who have made significant impact on the service and practice of Nephrology or medicine, made an extra ordinary contribution to the education of Nephrology, contributed to the advance of Nephrology by research or contributed to the development of Nephrology services in other ways, such as by working in public health or in the com-munity to its fellowship.
Eligibility Any member of 10 years standing
Application / Nomination Nomination in a prescribed form
Downloaded by Click here Or you can down-load the form on the website
Submission documents 1. Nomination form 2. Enclosures as required in form 3. CV
Addressee Secretariat of Society
Last Date 31st July 2017
Evaluating authority Credential Committee
Honor Certificate
Lifetime Achievement AwardEach year the Society confers this award to senior Indian nephrologists for specific accomplishments that are truly extraordinary, and widely recognized. Recognition can be granted for activities within any theoretical framework for a wide range of areas relating to the field of kidney diseases and transplantation in any part of the India, including but not limited to research or education.
Eligibility Senior Nephrologist
Application / Nomination Nomination
Submission documents 1.Covering letter for nomination 2.Brief contribution of nominee
Addressee Secretariat of Society
Last Date 31st July 2017
Evaluating authority Credential Committee
Honor Honor
Rekha Memorial Tankar AwardThe award is reserved for outstanding research work done by ISN member.
Eligibility Any member below the age of 40 years
Application / Nomination Application with abstract submission
Submission documents 1. Application 2. CV 3. Abstract
Best abstract (Oral Presentation) will receive award
Addressee Secretariat of Society
Last Date 31st July 2017
Evaluating authority Scientific Committee
Honor Certificate & prize money
Criteria 1. The paper should be based on original work done in India
2. The Scientific Committee will shortlist maximum of four abstracts and its decision will be final.
3. Three judges will decide the award based on the following criteria: Each criterion will carry 10 points
a. Study design b. Relevance of research work c. Originality d. Formatting e. Discussion & Conclusions
Applications/Nominations should reach to the secretariat on the following address: Prof. Narayan Prasad, Hon. Secretary, Indian Society of Nephrol-ogy, Department of Nephrology, SGPGIMS, Lucknow, Rae Bareli Road Lucknow-226014, UP, India. Email:[email protected]
ISNews | Aug. 2017 | 5ISN.ORG
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Acute Kidney Injury (AKI) is Preventable & TreatableAt the 2013 World Congress of Nephrology in Hong Kong, immediate past President of the International Society of Nephrology (ISN), Prof. Giuseppe Remuzzi, set out the organisation’s vision for a world in which no one dies of preventable and treatable acute kidney injury (AKI).
To achieve this ambitious goal, the ISN launced the 0by25 initiative which aims to eliminate preventable deaths from Acute Kidney Injury (AKI) worldwide by 2025.
Our aim is to call for globally applicable strategies that permit timely diagnosis and treatment of AKI for patients with potentially reversible diseases.
0by25 is a global initiative with a strong emphasis on developing countries in Africa, Asia, and Latin America with disadvantaged populations and poor access to care.
We Are Working To Eliminate Preventable Deaths From Aki In Three Key Ways
ActionAwareness & Education
0by25 will promote increased awareness of AKI across the
global healthcare community, predominantly through education and training.
Targeted information and educational materials will be
developed for a broad range of audiences, including healthcare
professionals, patients and governments.
0by25 will work with those most affected to develop a sustainable infrastructure to
enable “need driven” approaches to education, training and care delivery. Through pilot projects, 0by25 will implement globally
applicable strategies that permit timely diagnosis and treatment of AKI for patients with potentially
reversible diseases.
Evidence
0by25 will provide compelling new evidence to demonstrate
the global burden of AKI, especially in low and middle-
income countries, with the aim of establishing AKI as a contributor to the Global Burden of Disease. 0by25 will compile existing and
prospective data in order to better understand AKI’s prevalence
and to improve diagnostic and treatment methods.
ISNews | Aug. 2017 | 6NEW IN NEPHRO
Increased Risk Of Melanoma In Renal Transplant RecipientsA recent investigation published online by JAMA Dermatology found renal transplant recipients with greater risk of developing melanoma compared with their non-renal transplant coun-terparts. Risk factors for developing melanoma included older, age, male sex, living donors, sirolimus therapy, and cyclosporine therapy. Of 105,174 patients (64,151 or 60.7% male, mean age 49.5) examined who received kidney transplants between 2004 and 2012, 488 or 0.4% had a record of melanoma after transplantation. This investigation shows that kidney transplant recipients should be monitored for risk factors for developing melanoma.
Patients with thin melanomas removed prior to organ transplantation are not at increased risk of
recurrence following transplantation. Immunosuppressive medications predispose to de novo melanoma
and are associated with worse outcomes in tumors of greater
Breslow thickness.
Researchers surveying 1170 living donors from 1970 to 2012 found that only 18.6% of donors had less-than-annual primary care provider (PCP) follow-up post-donation. The strongest predictor of post-donation PCP visit frequency was pre-donation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were 14-times more likely to report less-than-annual PCP visits post-donation. Men were 1.6-times more likely to report less-than-annual PCP visits post-donation than women, and this association was amplified in unmarried/non-cohabiting men. Donors without college education were also more likely to report less-than-annual PCP visits post-donation. These results were published in Clinical Transplantation.
Living Kidney Transplantation, A Superior Alternative To Dialysis In ESRD
Living kidney transplantation is a superior alternative to dialysis for individuals diagnosed with ESRD. Living kidney donors are physically and mentally healthier when compared to the general population. To promote living kidney donation, it is essential to
identify factors that deter potential donors from pursuing living kidney donation. Fear of surgical complications is the primary deterrent from organ donation.
Barriers To Deceased Donor Transplantation In India
• Lack of awareness of brain-death concept
• Lack of organ donation awareness
• Low number of cadaver renal transplant centres with inadequate infrastructure, and personal
Patterns Of Primary Care Use After Living Kidney Donation
Reduced Renal Perfusion Responsible For Mild Renal Impairment After Marathon Cycling
Competitive marathon cycling increases serum creatinine by 20%, urea by 54% and uric acid by 42 %. Creatinine clearance declines by 18%, serum urea/creatinine ratio rises above 40 and fractional sodium excretion and fractional uric acid excretion falls below
0.4% and 15% respectively, indicating reduced renal perfusion. Post-exercise proteinuria is small and of the mixed glomerular-tubular type. These effects last for at least 24-hours despite a stable fluid balance during the race and an expanding plasma volume in the recovery period.
A study of 22 runners in the 2015 Hartford Marathon found that most temporarily devel-oped acute kidney injury (AKI) directly after the race. Blood creatinine and urine albumin levels peaked in 82% of the runners to at least stage 1 AKI while microscopy showed urine sediments in 73% thus indicating acute tubular injury. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3-mg/dL increase in serum creatinine level within 48 hours of day 0 and stage 2 was defined as a more than 2- to 3-fold increase in creatinine level. Serum creatinine, urine albu-min, and injury and repair biomarker levels peaked on day 1 and were significantly elevated compared to day 0 and day 2. Serum creatine kinase levels continued to increase significantly from day 0 to day 2.
Marathon Running Tied to Short-Term Kidney Injury
Fracture Risks Lower Among Hemodialysis Patients Undergoing Parathyroidectomy
Parathyroidectomy is associated with lower long-term risks for hip and combined fractures. In hemodialysis patients, radial BMD and lumbar spine BMD increases by 5% and 15% respectively, three years after parathyroidectomy. Improvement is greatest for patients with highest preoperative
serum PTH levels. Parathyroidectomy is associated with a significant 32% lower risk for hip fracture and a 31% lower risk for any analyzed fracture.
Hip Fracture & Proton Pump Inhibitors Use After Kidney TransplantAlthough proton pump inhibitors (PPIs) are associated with elevated risk of hip fracture, they continue to be widely prescribed post renal transplantation. PPIs accentuate the risk of fracture primarily because of kidney disease-associated bone disease and corticosteroid use. A recent study in AJKD, examining the risk of hip fracture and PPI use in the general population, reported transplant recipients to be 1.4 times more likely to have a hip fracture with PPIs. PPI treatment may directly impair both osteoblast and osteoclast function, result-ing in abnormal bone turnover. This reiterates for a more judicious approach to PPI use in kidney transplant recipients.
Average sleep sys-tolic blood pressure (BP) is the most sig-nificant predictor of CKD (after adjust-ing for age, diabetes, serum creatinine,
urinary albumin, and hypertension treatment time). In a study of 2763 individuals followed for a median of 5.9 years, predictive values of average clinic BP and average awake or 48-hour ambulatory BP were not significant when corrected by average sleep BP. There was a 27% reduction in the risk of CKD per 1-SD decrease in average sleep systolic BP, independent of changes in average clinic BP or awake ambulatory BP.
Nondialysis-dependent CKD patients have impaired cardiac baroreceptor sensitivity (BRS), which is related to decreasing GFR and associated with poor prognosis. Cardiac BRS may provide a simple, bedside, noninvasive assessment of overall cardiovascular risk.
Cardiac Baroreceptor Sensitivity In Predialysis CKD
Sleep-Time BP Prognostic Marker For CKD
ISNews | Aug. 2017 | 7
Collagen IV Sulfi limine Cross-Links Linked To Kidney Tubular StiffnessCollagen IV is major constituent of basement membrane (BM) that forms an extensively cross-linked oligomeric network. Its deficiency leads to BM instability. It has been shown that collagen IV and its cross-links determine BM stiffness. A sulfilimine bond (S=N) between a methionine sulfur and lysine nitrogen cross-links collagen IV and is formed by the matrix enzyme peroxidasin. Data from peroxidasin knock-out models with reduced collagen IV sulfilimine cross-links, shows reduced renal tubular BM stiffness.
Are Cyclosporine-Based Therapies Best For Steroid-Resistant FSGS?Cyclosporin-based treatment for steroid-resistant focal segmental glomerulosclerosis provides a significantly better partial remission rate than other therapies, according to a meta-analysis of 5 randomized controlled trials. Cyclosporin-based therapy was not linked with better complete or overall remission rates, however. Cyclosporin-based therapy resulted in similar changes in pro-teinuria, serum creatinine, and eGFR compared with other therapies.
Serum Irisin Levels Linked to Peritoneal Dialysis AdequacyIrisin is an exercise-induced peptide released from muscle involved in metabolism abnormalities in dialysis patients. In a recent study, serum irisin levels were lower in nondiabetic peritoneal dialysis patients (17.02 ng/mL) compared with healthy controls (22.17 ng/mL). Peritoneal Kt/V
urea and
peritoneal CCr positively correlated with serum irisin levels, suggesting that adequate dialysis may improve irisin secretion.
Optimal Iron Status For Hemodialysis ReportedRecent findings presented at the European Renal Association-European Dialysis and Transplant Association 54th Congress in Madrid and pub-lished online in PLOS One, described the optimal iron status for hemodialysis patients receiving erythropoietin treatment. Using a combination of a serum ferritin level of 90 ng/mL or higher and TSAT less than 20% as reference, those patients with serum ferritin level below 90 ng/mL and TSAT of 20% or higher were more likely to have a significant 46.7-fold greater odds of achieving hemoglobin level of 10 g/dL or higher.
NEW IN NEPHRO
Higher serum thyrotropin levels among patients on hemodialysis (HD) impairs health-related quality of life (HRQoL), according to a new study published in the Clinical Journal of the American Society of Nephrology. Researchers from the University of California-Irvine examined serum thyrotropin levels from 450 HD patients from 17 outpatient dialysis facilities in southern California as well as patients’ responses to Short-Form 36 questionnaires. In categorical analyses, the highest
baseline thyrotropin tertile was associated with a 5-point lower Short-Form 36 domain score for energy/fatigue compared with the lowest tertile. Higher baseline thyrotropin levels were associated with worse scores in role limitations due to physical health, energy/fatigue, and pain by 3 to 5 points for every standard deviation increase in thyrotropin. Higher time-dependent thyrotropin was associated with worse physical health scores.
Hypothyroidism Worsens Post Hemodialysis Quality Of Life
New findings show that short-term aerobic exercise does not improve lipid pro-files in patients with stage 3 chronic kidney disease (CKD). Given that exercise can improve both HDL-C levels and particle patterns in people without CKD, re-
searchers from the Springfield College in Mas-sachusetts, performed a secondary analysis of a randomized controlled trial in which 46
patients with stage 3 CKD were assigned to a 16-week moderate-intensity exercise program, with three weekly supervised exercise sessions, or a control group. Neither group showed changes in estimated glomerular filtration rate. Peak oxygen uptake improved by 8.2% in the exercise group, but decreased in the control group. There were no changes in HDL-C lev-els, particle size or body composition in either group. There was a trend toward lower total cholesterol and lower low-density lipoprotein cholesterol in the control patients.
Exercise Does Not Improve HDL-C Profi le In CKD
Although kidney allograft recipients with dia-betes at transplantation have increased risk of cellular rejection, this condition does not pose an adverse impact on short-to-medium term allograft function or survival. Data from a retrospective cohort study of kidney allograft recipients at a single centre between 2007 and 2015 showed that patients with versus without diabetes had a higher risk of cellular rejection
(19.7% vs 12.4%) but not of antibody-mediated rejection (3.4% vs 3.7%). Kidney al-lograft recipients with diabetes had higher risk of death and overall graft loss than those without diabetes. This analysis was done on 1140 kidney transplant recipients median follow-up had a 4.4 years post-transplantation and published in the May issue of Diabet Med. 2017.
Pre-Existing Diabetes Increases Risk Of Cellular Rejection After Kidney Transplantation
ISNews | Aug. 2017 | 8NEW IN NEPHRO
Podocytopenia is involved in the progression of diabetic nephropathy. Apoptosis is thought to be a major mechanism for loss of podocytes. However, apoptotic podocytes (Podo) are not seen in renal biopsy specimens with diabetes. Instead mitotic catastrophe (MC) is a newly recognized form of podocyte death characterized by Podo multinucleation, aberrant mitotic spindles and micronucleoli. Recent data shows that urine from diabetic patients contains a significant number of urinary Podo with MC and no Podos with apoptotic bodies.
Majority Of Urine Podocytes In Diabetics Due To Mitotic Catastrophe
Serum amyloid A (SAA) activates inflamma-tion and apoptosis in kidney cells. SAA is also increased in the blood, urine, and kidneys of people with diabetic kidney disease (DKD). Recent analysis, to determine if SAA adds to risk prediction models for death and end-stage renal disease (ESRD) in DKD, showed higher serum SAA concentration to be associated with increased risk of death and ESRD. SAA improved risk prediction when added to traditional risk factors. It was a candidate biomarker that could advance DKD risk assessment and also could be a potential therapeutic target.
Serum Amyloid A And End-Stage Renal Disease In Diabetic Kidney Disease
Mechanistic insight into the role of epigenetic factors regulat-ing renal ageing is already gain-ing value in the
analysis of clinical and epidemiological co-horts. Noncoding RNAs provide epigenetic regulatory circuits within the kidney, which reciprocally interact with DNA methylation processes, histone modification and chromatin. These interactions reflect the biological age
and function of renal allografts. Epigenetic factors control gene expression and activity in response to environmental perturbations. They also have roles in highly conserved signalling pathways that modulate ageing, including the mTOR and insulin/insulin-like growth factor signalling pathways, and regulation of sirtuin activity. Nutrition, the gut microbiota, inflammation and environmental factors, including psychosocial and lifestyle stresses, provide potential mechanistic links between the epigenetic landscape of renal ageing and dysfunction.
The Role Of Epigenetics In Renal Ageing
Incident symptomatic stone formers have a rise in serum creatinine levels that resolves. However, stone formers have higher cystatin C levels and proteinuria that may affect long-term risk of chronic kidney disease. Mayo Clinic nephrologists have uncovered a connection between first-time kidney stone formers and chronic kidney disease in a group of 384 stone formers three months after their first stone event. Compared to the control group, kidney stone formers maintained higher levels of the blood marker cystatin C and higher levels of urine protein – both of which are connected with higher risk of chronic kidney disease.
Kidney Stone Episode Subsequently Develops Abnormal Kidney Function
Decreased Dietary Zinc Associated With Calcium Nephrolithiasis
In a study of association between dietary zinc intake (DZI) and prevalent kidney stone disease in 15,444 men and women, higher DZI was associated with increased risk of kidney stone disease. After
categorizing zinc intake into three groups, those with highest DZI (>15 mg/day) were also associated with a significantly increased risk of kidney stone disease, compared to those with lower DZI.
Kidney research at the University of Virginia, School of Medicine, has unexpectedly led to a discovery about the formation of the heart, including the identification of a gene responsible for a deadly cardiac condition. Researchers at the Child Health Research Center were investigating how the kidney forms when they noted that the deletion of the S1P1 gene in research mice led to deadly consequences elsewhere in the body. This led researchers to look more closely at the heart which showed thin heart walls and other cardiac problems in developing mice embryos resulting from gene deletion. Number of stud-ies describe increased plasticity in precursor cells and the role of cardiac precursor cells present in the embryonic heart in giving rise to components of the heart and blood cells.
Kidney Research Unexpectedly Throws Light On Formation Of The Heart
Nephrolithiasis is a highly prevalent disease worldwide with rates ranging from 7 to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Management of stones is expensive and the disease has a high level of acute and chronic morbidity. There has been a rising incidence in stone disease throughout the world with a narrowing of the gender gap. Increased stone prevalence has been attributed to population growth and increases in obesity and diabetes. General dietary recommenda-tions of increased fluid, decreased salt, and moderate intake of protein have not changed. Geography and environment influence the likelihood of stone disease and more infor-mation is needed regarding stone disease in a large portion of the world including Asia and Africa.
Rising Incidence In Stone Disease Throughout The World
Effects Of Crystal Shape On Cell Injury And Stone Risk
Calcium oxalate m o n o h y d r a t e crystals cause more se r i ous injury to renal epithelial cells than same-sized
calcium oxalate dihydrate crystals. Crystals with large active crystal faces exhibit high cytotoxicity and possess large adhesion area with cell surface. These crystals also display a large adhesion amount on the cell surface. Crystals with sharp edges cause physical damage to the renal epithelial cells more easily than the round crystals. They also induce excessive reactive oxygen species generation and cause injury to intracellular organelles.
ISNews | Aug. 2017 | 9
Researchers have discovered a new anti-rejection drug that is gentler on the kidneys after liver transplant, and reduces weight gain which commonly leads to serious complications for transplant patients. Re-searchers from the Intermountain Medical Center Transplant Program in Salt Lake City, conducted a randomized, interna-tional multi-center study of more than 700 patients. The study compared a new drug, Everolimus, to Tacrolimus, a routinely prescribed anti-rejection drug. It was found that transplant patients taking Everolimus gained less weight -- and kept it off at one and two years after starting the treatment.
A new, minimally invasive system which uses radiofrequency energy instead of open surgery to create access for patients needing hemodialysis is reliable with minimal complications, according to data published in the American Journal of Kidney Disease. A single-arm, prospective study of 80 predialysis and dialysis patients from nine centres in Canada, Australia and New Zealand for one year showed that an arteriovenous fistula (AV-fistula) -- the recommended type of vascular access for patients to connect to a hemodialysis machine -- was created successfully in 98% of all cases, with 87% being physiologically suitable for dialysis within three months of creation by this new magnet-based endovascular technology.
New Anti-Rejection Drug Reduces Weight Gain, Enhances Outcomes For Liver Transplant Recipients
New Magnet Technology Creates Easy Blood Access For Hemodialysis Patients
NEW IN NEPHRO
Diabetic nephropathy has a higher risk of cardiovas-cular (CV) events and end-stage renal disease (ESRD). Recent investigation into the relationship between the glomerular or vascular
lesions of renal specimen and CV events or ESRD in biopsy-proven diabetic nephropathy, showed vascular lesion of renal tissue to have predictive value for the development of CV events. The background features were as follows: 390 patients with biopsy-proven diabetic nephropathy were examined with the average observation period of 9.3 ± 8.0 years. During the observation period 164 patients had outcome of CV events and 71 patients reached ESRD.
Renal Biopsy For Diabetic Nephropathy Predicts Cardiovascular Events
Testing for molecular mark-ers in the urine of kidney transplant patients could
reveal whether the transplant is failing and why, according to research presented at the 27th European Congress of Clinical Microbiol-ogy and Infectious Diseases (ECCMID). The study focused on a virus called BK. The BK virus causes a common infection which most people experience during childhood mainly with no symptoms. Following infec-tion the virus remains in the body, lying dormant in the kidneys and urinary tract.
However, when transplant patients are given immune-suppressing drugs, the virus can reactivate, infecting and destroying the new kidney. This usually happens within two years of the transplant. The research was a pilot study in four Spanish hospitals involving 30 kidney transplant patients. Ten of the patients had been diagnosed with T-cell mediated acute rejection (TCMR), meaning the kidney was being rejected. Another ten had been diagnosed with BK virus nephropathy, implying that the virus was destroying the kidney.
Testing For A Unique Urinary Protein May Prevent Kidney Transplant Failure
Several studies to date have assessed the clinical importance of serum hepcidin in non-dialysis CKD patients. Ferritin was found to be an independent predictor of serum hepcidin levels. Analysis of a large-scale multicentre prospective Korean study involving 2238 patients, showed serum hepcidin levels to correlate directly with CKD stage and inversely with estimated glomerular filtration rate. Treatment with erythropoiesis-stimulating agents (ESA) is significantly associated with increased serum hepcidin levels, particularly in patients with advanced CKD. Moreover, there is a positive relationship between serum hepcidin and ESA dose, independent of haemoglobin level. Further, iron supplementation is associated with increased serum hepcidin levels, which explains the lack of association between iron supplements and high (≥25.1 ng/ml) serum hepcidin, given that serum hepcidin levels are about two-fold higher in advanced than in early CKD.
Is Hepcidin, A Novel Uremic Toxin, Related To Erythropoietin Resistance?
ISNews | Aug. 2017 | 10
BK virus nephropathy (BKVN) and allograft rejection are two distinct disease entities which occur at opposite ends of the immune spectrum. However, they coexist in renal trans-plant recipients. Predisposing factors for this coexistence remain elusive. Recent findings suggest higher variability of tacrolimus trough level to be associated with the coexistence of BKVN and acute rejection. Such cases are often associated with poor prognosis and fraught with treatment challenges. Transplant clinicians should strive to avoid fluctuations in immunosuppressant drug levels in patients with either one of these two disease entities.
NEW IN NEPHRO
1000 Genomes-Based Meta-Analysis Identifi es 10 Novel loci For Kidney Function
HapMap imputed genome-wide association studies (GWAS) have revealed >50 loci at which common vari-ants with minor allele fre-quency >5% are associated with kidney function. GWAS using more complete refer-
ence sets for imputation, such as those from The 1000 Genomes project, promise to identify novel loci that have been missed by previous efforts. Recent investigation into the value of a more complete variant catalog was conducted using a GWAS meta-analysis of kidney function based on the estimated glomerular filtration rate
(eGFR) in 110,517 European ancestry partici-pants using 1000 Genomes imputed data. Study identified 10 novel loci with p-value < 5 × 10–8
previously missed by HapMap-based GWAS. Six of these loci (HOXD8, ARL15, PIK3R1, EYA4, ASTN2, and EPB41L3) are tagged by common SNPs unique to the 1000 Genomes reference panel. Using pathway analysis, the study identified 39 significant (FDR < 0.05) genes and 127 significantly (FDR < 0.05) en-riched gene sets. Among those, the 10 identified novel genes are part of pathways of kidney development, carbohydrate metabolism, cardiac septum development and glucose metabolism.
Link Between RBC Distribution Width And Dialysis-Related MortalityNew study confirms the po-tential association between red blood cell distribution width (RDW) and all-cause mortality in hemodialysis
(HD) patients. These findings were published in a study of 8817 HD patients starting dialysis in Europe from 2000 to 2012. Investigators
computed patients’ mean pre-HD RDW values within their first year on HD and stratified pa-tients to tertile: RDW less than 14.7%; RDW of 1 4.7% to 15.9%; and RDW greater than 15.9%. The cohort was part of the Monitoring Dialysis Outcomes (MONDO) initiative. Patients had a mean age of 63 years, and 59% of them were male. A total of 1422 patients died in the second
year on dialysis. Among patients in the higher and the highest tertiles, RDW was associated with a 1.5-fold and 2.1-fold increase in all-cause mortality compared with patients in the lower tertile. A marker for differentiating anemias, RDW is known to be elevated in most cases of iron, vitamin B12 and folate deficiencies.
Vitamin D Improves Vascular Function In Stage 3-4 CKDCurrent data from randomized, double-blind, placebo-controlled trial, comparing the effect of cholecalciferol supplementation on vascular function in 120 patients, showed cholecalcif-erol supplementation to significantly increases endothelium-dependent brachial artery flow-
mediated dilation at 16 weeks when compared to placebo. The intervention also improved pulse wave velocity and circulating IL-6 levels. These findings were published in the J Am Soc Nephrol., June 2017.
Chronic kidney disease has been linked to cogni-tive impairment and morphological brain change. However, less is known about the impact of renal dysfunction on cerebral cortical thickness. Recent study investigated the relationship between kidney functions and global or lobar cerebral cortical thickness (CTh) in 259 non-demented elderly persons. Forty-three participants (16.7%) had kidney dysfunction, which was defined as either a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2 or presence of proteinuria. Kidney dysfunction was associated with lower global (β = –0.05, 95% CI = –0.08 to –0.01) as well
as frontal, parietal, temporal, occipital, and insular lobar CTh. In the stratified analysis, the associations were more pronounced in women, APOEε4 non-carriers, and participants with a lower cognitive score. Besides, kidney dysfunc-tion significantly increased the risk of cortical thinning, defined as being the lowest CTh tertile, in the insular lobe (adjusted odds ratio = 2.74, 95% CI = 1.31–5.74).
Kidney dysfunction should be closely monitored and managed in elderly
population to prevent neurodegeneration
Effect Of Kidney Dysfunction On Cerebral Cortical Thinning In Elderly Population
BK virus was first isolated in 1970 from a kidney transplant recipient with a ureteric
stricture. Epidemiologic studies have shown that up to 90% of some human
populations become exposed to BK virus by adulthood. After kidney transplant, 10-60% of patients excrete the virus in
their urine. However, viruria is typically asymptomatic or associated with only
transient graft dysfunction.
Tacrolimus Predisposes To Bk Virus Nephropathy And Allograft Rejection
Prebiotics In CKDPrebiotics work symbiotically with the probiotics to benefit the host. To be considered a prebiotic, the nondigestible carbohydrate must meet the following qualifications: (1) be resistant to stomach acid and digestive enzymes, (2) be able to be fermented by gut bacteria, and (3) nourish and/or improve activity of gut bacteria. Types of fiber that currently meet prebiotic criteria are fructans (fructooligosaccharides, inulin, oligosaccharides), lactulose, soybean oligosaccharides, and galactosaccharides. It is estimated that CKD patients average only 15g of fiber daily, compared with the 20 to 30g recommended. To date, no recommendations for prebiotics have been made for CKD patients.
ISNews | Aug. 2017 | 11
Protein Energy Wasting In Chronic Kidney DiseaseProtein energy wasting (PEW) is common in CKD and is associated with adverse out-comes. Dietary interventions and nutritional support seem to be effective in mitigating or correcting PEW and improving the outcomes in patients with CKD. All patients with CKD should be assessed monthly or quarterly for the presence of PEW and should be offered oral nutritional support whenever required. Providing meals or oral nutritional supplements and other nutritional interventions to
patients with CKD is the most promising way to increase serum albumin concentration and improve longevity and quality of life in this patient population.
NEW IN NEPHRO
Children with CKD have many risk factors for lean mass and muscle wasting, including poor appetite, infl ammation, growth hormone resistance, and metabolic acidosis. Mortality risks in patients with CKD increases as body mass index and weight decreases. However, data regarding cachexia/PEW and muscle wasting in children with CKD is scarce due to lack of consensus in diagnostic criteria and an appropriate investigative methodology.
Muscle Wasting In Chronic Kidney Disease
Knowledge Of Micronutrient Disorders In CKD Is ScarceRecent reports indicate that a high proportion of CKD patients may be using supplements without medi-cal consultation, which emphasizes the need for
nephrologists to enquire about the use of
dietary supplements. Water-soluble vitamin levels may be inadequate in patients not receiv-ing supplements and this may be associated with increased mortality. Vitamin A levels are generally quite high, vitamin D is low and requires supplementation, and the benefits of vitamin E may be linked to its usage in a
modified dialysis membrane. The European Best Practice Guidelines (EBPG) and the guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) recommend exact doses of vitamin supplements, mostly corresponding with the recommended daily allowance for healthy adults.
Kidney Disease Risk Score Now Integrated Into Electronic Health Records
A new electronic health record (EHR) tool could help phy-sicians quickly and accurately flag pa-tients that should be refer red to a nephrologist. De-
signed by Brigham and Women’s Hospital inves-tigators, this tool draws upon recent research
that has identified several tests that can be used to calculate an individual’s risk score. Now, an automatic calculator can be built into EHRs and displayed prominently for a physician to see when they open a patient’s record. The tool was piloted at ten North Shore Physicians Group clinics this year, and a paper detailing the design and implementation of the application was recently published in the Journal of the American Medical Informatics Association.
Furosemide Does Not Alter Acute Kidney Injury Course Prior studies have found conflicting findings on whether furosemide modifies the course and outcome of acute kidney injury (AKI). In a current pilot multi-center randomized blinded placebo-controlled trial, AKI patients were randomly allocated to furosemide bolus and infusion or 0.9% saline placebo. Mean age was 61.7 (14.3), 79.5% were medical admissions, mean APACHE II score was 26.6 (7.8), 90.4% received mechanical ventilation and 61.6% re-ceived vasoactives. No differences were found in the proportion with worsening AKI (43.2% vs. 37.1%, p=0.6), kidney recovery (29.7% vs. 42.9%, p=0.3), or RRT (27.0% s. 28.6%, p=0.8).
Do We Still Need Renal Biopsy In Lupus Nephritis?The natural course of SLE is characterized by periods of disease activity and remission. Re-sponse of the kidney to treatment can be shown in biopsies done directly after induction therapy. Generally, a decline in active lesions with an increase in scarring lesions is observed. Repeat kidney biopsies at the end of the maintenance phase of LN, in patients who had clinically responded to the treatment, can be planned to assess disease activity before discontinuing therapy while the decision to repeat a biopsy at LN flare according to some reports should be based on the LN class from the initial biopsy.
Correcting Low Albumin Improves Renal Function Hypoalbuminemia is a well-established risk factor for increased morbidity and mortality and has also been associated with an increased risk of acute kidney injury (AKI) occurrence; it is modi-fiable by infusion of human albumin solution. Evidence, from observational studies show low serum albumin to be a significant independent predictor of AKI and of death following AKI. Serum albumin level should be monitored to aid early identification of patients at increased risk and who may stand to benefit from treatment to correct hypoalbuminemia.
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ISNews | Aug. 2017 | 12
Theme: Innovative findings and Novel
technologies in Nephrology & Urology
th12 Annual Conference on
July 06-07, 2017 Kuala Lumpur, Malaysia
Nephrology &
Urology
nd 2 Annual Kidney Congress
Theme: Fostering kidney health across the Globe
August 28-30, 2017
Philadelphia, USA Theme: Recent advancements
of research and treatment in the field of nephrology
th13 World Nephrology
Conference
October 18-19, 2017 Dubai, UAE
Theme: Inventive discoveries
and therapeutic advancements in Nephrology
th16 European Nephrology
ConferenceOctober 02-03, 2017
Barcelona, Spain
Fairmont Copley Plaza • Aug 14-18, 2017
Boston, MA
Theme: Recent advancements
of research and treatment in the field of nephrology
th13 World Nephrology
Conference
October 18-19, 2017 Dubai, UAE
NOVEMBER 8-10, 2017 | SAN DIEGO, CA
CiDA 2017
CONTROVERSIES IN DIALYSIS ACCESS
Sex Kidneys
and the
Sex Difference in Renal Disease
July 13-14, 2017
Natcher Conference centre Building 45 Bethesda, MD
June 26-28, 2017 London, UK
th12 Global Nephrologists
Annual Meeting
Theme: Developing new remedial methods
and awareness to prevent Kidney diseases
TH54 ERA-EDTACONGRESS
Madrid, Spainrd thJune 3 -6 2017
th48 Annual Conference of Indian Society of Nephrology th th14 – 17 December 2017 | New Delhi
Venue: Pullman – Novotel, Aerocity, New Delhi
Indian Society of Nephrology
201748TH ANNUAL CONFERENCE OF INDIAN SOCIETY OF NEPHROLOGY
NEPHRO MEET
ISNews | Aug. 2017 | 13ALSO OF INTEREST
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ISNews | Aug. 2017 | 14PRODUCT LAUNCH
ISNewsAn Official Publication of the Indian Society of Nephrology
www.isnews.comTrends & Traditions in Nephrology
The Highest Daily Dose of Sevelamer Carbonate Studied was 14 grams in CKD Patients on Dialysis
For Patients Switching from Sevelamer Hydrochloride Tablets to Sevelamer Carbonate Tablets Use Same Dose
