International Conference on Nephrology November 19-21, 2018 Cape Town, South Africa

Renal Transplantation is the method of treatment where the person is in the End Stage Renal Disease. Generally the initial stages of the disease can be treated, transplantation is done only in the final stage of kidney disease where the kidney cannot perform its function further. In this method the affected person is treated with the replacement of healthy kidney. Deceased Donor transplantation is the method where the kidney is transplanted from the dead person. In most cases the dead individuals are strangers who want to donate the kidney. Transplantation can also be done through living ones which could be genetically related person & different person. While dealing with the immunology, there might the chance of rejection due to incompatibility. Therefore the donor and recipient should be in the ABO blood group and cross match Human Leucocyte Antigen (HLA) compatible. If a potential living donor is contrary with his/her recipient, the donor could be traded for a good kidney. To reduce the rejection rate during incompatible transplantation, ABO & HLA antibodies are reduced which recipient may have for the donor through desensitization procedure using intravenous immunoglobulin (IVIg). In early 1980s experimental protocols were performed for ABO incompatible transplants using increases amount of immunosuppression drugs. Panel Reactive test is a test which is done to measure the sensitization of the recipients. Multi organ transplantation is a surgical procedure where multiple organs are transplanted from the healthy single donor through series of operation. These cases are rare where the recipients have organ-specific failure and general disorders are considered for the multiple organ transplantation where all other treatment cannot be done to save the person. There are many causes for the failure of the multiple organs finally leads to the need for multiple organ transplants. In the renal disorders, kidney transplantation mostly includes transplant of pancreas also due to diabetes which affect the pancreas. 

When kidney function decreases to a critical level or complications arise, a person may need to start dialysis. Dialysis allows people with kidney failure a chance to live productive lives. Dialysis is a treatment where the purification and filtration is done by the machines. This helps the body to maintain balance when the kidneys losses their function. When the kidney losses their major function that is removal of excess salt and other waste product from the blood which could be toxic to the body, the same would be imitated in artificial form and that’s known as dialysis.

Under dialysis there are two methods; “Hemodialysis” is one of the common types of dialysis in which doctors use artificial kidney to filter the blood and which will be done outside the body. Patient’s blood is drawn out through vascular access, filtered and again put it back to the patient.  There are two types of vascular access for long term dialysis and are arterivenous fistula (AV-fistula) which connects an artery and a vein and an AV graft and for short term treatment catheter is inserted in the large vein present in the neck of the patients.  Another type of dialysis known as “peritoneal dialysis” in which surgically implanted catheter located in the belly region will assists in the purification of blood. The catheter will contain special fluid in the abdomen which will purify the blood and removes waste from the blood

 To detect or diagnose the kidney disease, doctor usually follow few test and are blood test where the blood is collected from the subjected patient and measured for amount of creatinine is present in the blood.  Through this the calculation is done according to your age, body weight and ethnic group to find out how many liters of waste your kidneys are able to filter in a minute.  This is known as estimated Glomerular Filtration Rate (eGFR). A normally functioning kidney can filter about 90ml/min. Urine test is done to measure the amount of albumin-creatinine ratio (ACR) in the urine. Along with eGFR this urine test will depict exact working condition of the kidney. Kidney Biopsy is a surgical procedure where small tissue from the infected kidney of the patient is taken and examined for any sign of damages present in the cells.

 For the most part we know the manifestations of the patient who is influenced by kidney sickness. In this way to repudiate the indications the medications are taken against the side effects. Anti-hypersensitive tablets are taken to lower the blood pressure which is caused by kidney disease. Diuretics tablet are taken since the damaged kidneys are unable to produce more. This drug will encourage and assists in producing more amount of urine.  Erythropoietin is a hormone which stimulates the production of Red blood cells in the bone marrow but persons with damaged kidney cannot secrete erythropoietin.  Hence erythropoietin injection is administered to stimulate the production of RBC. Likewise Vitamin D and phosphate binder drugs are used for production of calcium and maintain phosphate balance in the body respectively. Some of drugs listed here (lisinopril oral, Losartan oral, Cozaar oral, Avapro oral, Captopril oral)

Geriatric Nephrology is the field which deals with the functions of the kidneys, its diseases, infections and treatment of various disorders in the aged people. Populace of unending kidney illness in the senior individuals continues expanding which frequently undetected until the point when they are subjected to the dialysis system. Besides it is comprehended that maturing prompts its own particular interesting analysis and treatment method to be taken after. In the matured individual the digestion and insusceptibility will vary from ordinary grown-ups. Henceforth senior individuals have more shot of getting kidney malady than grown-ups. Filtration rate and assimilation rate in the grown-up will be increasingly when contrasted with senior individuals. 

Pediatric nephrology is specialization of diagnosis & management of children with kidney diseases.  Different kidney infections like pediatric nephritis is clinically and genetically heterogeneous substance depicted by falling away from the faith, and relentless course with essential in suspiciousness and mortality happening as a result of complexities of the disorder itself, and its treatment.  Autosomal recessive polycystic kidney disease is a rare type of kidney disease (ARPKD) which occurs in the children. Since Kidney and liver manifestation progress different, the decision for transplantation is carefully taken because of rejection of organ might happen

 Nephropathy is the damage or disease of the kidney. Diabetic nephropathy is that kidney disease which is caused by the diabetes. Kidney may have tiny blood vessels which filters the blood. High blood sugar from diabetes can disrupt and destroy this blood vessel and Glomerular Filtration Rate will enormously get decreased. As a result kidneys will no longer perform its function properly and lead to the renal failure stage. Cardiovascular disease and kidney disease are related to each other. Heart continuously sends oxygenated blood to the body and kidney performs filtration of waste from the blood. Therefore if any problem in the heart causes congestion of blood in the main vein which is connected to the kidney due to inefficiency of pumping. Due to this congestion kidney will not get oxygenated blood.  When kidney becomes impaired, hormone which regulates blood pressure goes in overdrive to increase the blood supply in the kidney. Now heart has to pump against this high pressure in the artery eventually suffers from overwork. Most common cause for both heart disease and kidney disease is diabetes and hypertension.  Hypertensive kidney disease is medical term referring to impairment of kidney due to chronic high blood pressure. Hence patients who have high blood pressure will be more vulnerable to the kidney diseases. Patients with kidney disease also advised to diagnose blood pressure level.  

Kidneys have small lining of tubules which assist in absorption and purification of waste products. In the cancer case, tubules will contain malignant cells and which will affect the normal function of the kidneys. The most common type of kidney cancer is renal adenocarcinoma and is mostly seen in the age group of 50 to 70. Treatment for renal cell cancer includes immunotherapy, surgically removal of part of the infected kidney, molecular targeted therapy. There is a chance of getting kidney disease due to break down of cancer cells through chemotherapy. Cancer cells will die but it will affect the kidney and may cause injury to the kidney. Onconephrology is a branch of nephrology which deals with the relation between cancer and kidney function. Cancer patients are generally diagnosed for the activity of kidney and all other kidney function.

Nephritis is a term, which refers to inflammation of either one or both the kidneys which impaired kidney function. Inflammation happens generally in the glomeruli, tubules, or  surrounding the glomeruli and tubules. There are two types of nephritis they are glomerulonephritis & Tubo-interstitial nephritis. There are many causes for nephritis and similarly treatment will vary. Most common cause is the infections and toxins. Pyelonephritis is the inflammation in the kidney caused by urinary tract infection which reaches the pelvic region of the kidney. Pyelonephritis is generally caused by the bacteria present in the intestine.  Lupus nephritis is an inflammation to the kidney due to systemic lupus erythematous (SLE). SLE is an autoimmune disease where immune system mistakenly triggers immune responses towards own body tissue. Athletic nephritis is due to strenuous exercise which may cause trauma to the red blood cell eventually lead to the rupture of RBC and release of hemoglobin in the urine.  Nephritis can produce glomeruli injury and as a result decreased Glomerular blood flow takes place. As the kidneys inflame, needed protein start secreting from the body in the urine stream. Loss of important protein from the body will lead many life threatening symptoms.

 Diet and nutrition are important part of living well with kidney disease. Patients who are affected by kidney disease should be more concerned about their diet and should follow the special dietary plans. Diet plan will vary according to the stage of kidney disease. Dialysis clinic will have dieticians who can plan the diet of the patient. Dietician will give complete guidance about daily intake of food. Normal food plan is that: high intake of protein containing food, less salt, high phosphorous & potassium foods. They are also advised to take safe fluid intake levels. This is because extra fluid can increase blood pressure and make heart to work harder eventually increasing the stress of dialysis treatment. More amount of sodium (salt) can make thirsty and intake of fluid will be more. Foods like banana, orange, potato and dried fruit must be avoided. Evaluation of food intake, particularly protein intake is monitored at a regular periodic interval to ensure the daily intake of protein which is important part for good quality of life. Since dialysis patient follow special diet plan, their diet may miss several vitamins. Dialysis also removes some vitamins from the body. The treating physician must prescribe vitamin tablets specially made for kidney disease patients.

Urology also referred to as genitourinary surgical procedure is branch of medicine which deals with the surgical and medical illness present in the urinary tract and infection in any part of the urinary tract is known as urinary tract infection. Depends on the place of infection it is named differently. When the infection happens in the lower urinary tract then it is called bladder contamination and when the infection is on the upper urinary tract then is referred to as pyelonephritis. An organ which comes under urology is kidneys, adrenal glands, urethra, uterus and male reproductive organ. Common illness consists of UTI, Urinary Stones, Urinary incontinence, benign prostatic hyperplasia. The most common cause of infection is Escherichia coli other than bacteria fungi can also cause the infection. Diagnosis to these infections encompasses few tests like urinalysis, urine microscopy. Analysis procedure differs to the aged people and it also difficult. Although urinary system has natural defense to this infection sometimes it fails to encounter. Remedy to this infection is antibiotics. Phenazopyridine is prescribed and which helps in decreasing burning sensation and urgency often felt during bladder infection. About 150 million people develop urinary tract infection each year. Women are more infected than male. They more often develop bacterial infection and they occur in the age of 16 to 35.

There is a growing awareness among the people about health and fitness. People have started reviewing and questioning the modern lifestyle. They are more conscious about their diet and food supplements.  Most of the healthcare specialist strongly believes that numerous diseases to which people affected is due to wrong living habits and pollution in the environment.  Therefore natural way of treating disease is more accepted across the globe. Natural way of curing is an art of living healthy and drugless method of curing diseases. Infrared therapy is one of the most eminent methods to keep kidneys warm and it can be done through biomat while sleeping. It will keep kidneys warm all the night. Herbal medicines are very effective in treating the kidney diseases. Herbal medicines like Juniper Berry, Uva Ursi leaf are powerful cleanser of kidney and bladder.

 Nephrology Nursing is a ponder push to build nursing learning by the disclosure of most recent certainties through orderly enquiry. It incorporates improvement in the patients care, decreased cost of kidney care provision, responsibility and assurance against suit. Expansion to the current collection of nursing learning improvement of nursing as a calling. Renal care nursing is the field of nursing with an attention on the most extraordinary thought of the discriminatingly wiped out or shaky perpetual kidney patients. Defilement repugnance and nursing thought is the control worried about dismissing nosocomial or well-being mindfulness related ailment, an utilitarian (instead of academic) sub-request of the investigation of ailment transmission. Youngsters' who require raised therapeutic thought are routinely surrendered into a remarkable district of the facility called the Neonatal genuine care and nursing thought. The piece of sponsorship in segregating nursing thought: Critical thought restorative specialists work in a wide arrangement of settings, filling various parts including bedside clinicians, orderly instructors, nursing experts, clinical nursing specialists, nursing directors and therapeutic chaperon experts. Estimations of Renal Care Nursing's central goal are to give orderlies correct, present and relevant information and cabin to surpass desires in separating thought practice.

Some diseases inside the kidneys are due to the mutation in the single copy of gene. Humans have about 250000-30000 gene.  There might be mutation which affects the kidney and another one is due to hereditary traits which pass from one generation to another. Therefore if parents have kidney disease then there is chance that their children can also get kidney diseases at some point of time in their life. Whereas in the mutation case, single gene disorder in which single copy of gene gets mutated and will code for different protein. In polygenic disorder, multiple genes get mutated and code for wrong protein and cause disease. Single gene disorder is found 25% in children and 15% in adults. Monogenic (single gene disorder) has more genetic causality and high penetrance when compared with polygenic disorder. This low causality is due to weak correlation of genotype and phenotype. Dominant disease usually manifest in the adults e.g.: Autosomal Dominant polycystic Kidney disease. Whereas recessive disease usually appears prenatally in the childhood, in adolescence. Autosomal dominant polycystic kidney disease is the most common inherited disease and is due to single copy mutation of gene. Many people with autosomal dominant pkd live for many decades without any symptoms. For this cognition autosomal pkd is often referred as “adult polycystic kidney disease”. There are several other inheritable genetic diseases which affect the kidney. 

There is much similar symptoms arises in both coronary illness and kidney diseases. Both may give shortness of breath and chest trouble, and thusly it isn't stunning that biomarkers of extreme myocardial and renal disorder every now and again exist together in numerous specialist symptomatic works. The high event of cardiovascular events in interminable kidney sickness warrants a correct evaluation of danger went for reducing the activities of ailment and its results. The usage of biomarkers to perceive patients at high risk has been being utilized as a part of the general open for a drawn-out period of time and has become mixed reactions in the therapeutic gathering. A few specialists have ended up being staunch supporters and customers while others question the utility of biomarkers and from time to time gauge them. In Chronic Kidney Disease patients different markers like those used as a piece of the comprehensive group and others more specific to the uremic masses have risen; however their utility for routine clinical application remains to be totally delineated. The high recurrence of cardiovascular sickness (CVD) events and awkward mortality in patients with Kidney ailments with a sharp augmentation in chance as glomerular filtration rate (GFR) decays underneath 60 mL/min/1.72 m2, offers a technique for thinking for better danger stratification in this people. A few conventional hazard factors and factors more immovably related to loss of (whiteness, oxidative nervousness, disturbance, and bone mineral issue) add to the high rate of cardiovascular complexities found in patients with CKD. Despite whether biomarkers help upgrade the unmistakable confirmation of patients in risk of cardiovascular events has been at the focal point of wide research in the comprehensive group and in patients with CKD.

Technological advancements have a lot of impact in the quality of life. Life has been made simpler and better. In nephrology many techniques have been established for the creation of artificial kidney, and for the surgeries.  Technologies like stem cell technique in which the human stem cells have the ability to regenerate the kidney and these stem cells have stem cell banks where it can be stored and used several times. New and better advancements have been made in surgical equipment one such example is Laparoscopic Nephrectomy is safe and helps in the removal of diseased  kidney. Laparosopic nephrectomy is a minimally invasive surgery technique, which gives patients good results equivalent when compared to large incision which requires traditional open surgery. When compared to conventional open surgery, earlier return to work, a shorter hospital stay and easier return to our daily activities make minimally invasive surgeries one of the preferred ways of surgery.

Small endocrine glands present on top of each kidney are adrenal glands that produce various hormones such as adrenaline, aldosterone, cortisol, and steroids. Out of these, cortisol helps in responding to stress and has other crucial functions. In adrenal gland disorders, the hormones are either over produced or are produced in low amounts. For e.g., in Cushing's syndrome, cortisol is over-produced while in Addison's disease the cortisol is produced in less amounts. Insufficient production of cortisol is sometimes genetic and the condition is seen by birth. Primary hyperaldosteronism is overproduction of aldosterone causing high blood pressure. Patients with excess production of cortisol have impaired wound healing in addition to increased susceptibility to infections. Acute adrenal insufficiency must be diagnosed and treated quickly since it is a medical emergency with symptoms such as abdominal pains coupled with circulatory collapse and low blood sugar levels. Overproduction of androgens results in excessive hair growth, menstrual disorders among other disorders caused by steroids. Causes of adrenal gland disorders include genetic mutations, infections, pheochromocytomas and tumors.

“Prevention is better than cure”- for any diagnosis to be carried out understanding the disease is a must.  There are many diseases in nephrology out of which some are very common and widespread.  Awareness on how these diseases are caused and curing is important. Some of the most common diseases are kidney stones and glomerulonephritis.  Kidney stones are hard deposits made of minerals and salt that form inside the kidneys. Kidney stones have many causes and can affect any part of your urinary tract from the kidneys to the bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together. Glomerulonephritis is the injury of glomeruli, which is the part that filters blood. When the kidney is damaged, extra waste and fluids cannot be removed from the body. If this continues kidney may eventually stop working, resulting in kidney failure. Surveys have found that African Americans in their late teens are more to develop kidney failure, as well as diseases that cause damage to the tiny blood vessels in the kidney. Boys are more likely than girls to develop kidney failure from birth defects, hereditary diseases and Polycystic kidney disease