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

Marguerite Barnard is a Medical Doctor at Stellenbosch University with a dedicated interest in Urology and Nephrology. Her research was recently published in the African Journal of Urology.

Introduction: The knowledge urethral stricture patients in a developing country Specialist Clinic have regarding their own

the disease remains uncertain.

Objectives: To measure patient’s knowledge of own disease attending Tygerberg Urethral Stricture clinic.

Patients & Methods: A total of 81 patients were assessed from May to August 2015, presented with a questionnaire containing

questions on demographics, ten knowledge questions and qualitative comments. Subgroups were created for patient less and

more than 50 years of age, and education level up to Grade 10 and more than Grade 10. Means were compared using the

Student t-test, correlations were assessed using Pearson’s correlation coefficient and the significance was assumed at an alpha

level of 0.05.

Results: Average age of patients attending the clinic was 55, the average level of education Grade 7 (completed Primary School).

The average level of knowledge for all patients was 46%, with the highest score for question 2 (80%) relating to the definition of

a urethral stricture. The lowest score was achieved for question 8 (28%) relating to self-catheterization frequency. There was no

linear correlation between knowledge and age and a very weak correlation between patient knowledge and level of education.

Conclusion: This study demonstrates that the level of knowledge of owns disease is unacceptably poor across the whole patient

profile. Interventions to improve patient knowledge regarding urethral stricture disease are indicated.

Sameh Mohamed Abouzeid is the Assistant Professor of Internal Medicine and Nephrology, Theodor Bilharz Research Institute (TBRI). He is the Director of

Nephrology unit Al shorouk hospital, Consultant Nephrologist and Head of Nephrology Departments at Mahmoud Hospitals Group.

There is an increasing awareness about the risks of arterial and venous thromboembolism (TE) in hospital patients and the general public which has led to consideration of thrombosis prevention measures in earnest. Early recognition of the symptoms of TE disease has led to timely administration of antiplatelet and anticoagulant drugs, translating to the better outcome in many of these patients. In this respect, patients with chronic kidney disease (CKD) represent a special group. They indeed represent a high-risk group for thrombosis both in the cardiovascular territory and also in the venous circulation. At the same time, abnormalities in the platelet membranes put them at risk of bleeding which is significantly more than other patients with chronic diseases. Anticoagulation may be ideal to prevent the former, but the co-existing bleeding risk and also that the commonly used drugs for inhibiting coagulation are eliminated by renal pathways pose additional problems. In this review, we try to explain the complex thrombotic-hemorrhagic state of chronic kidney disease patients, and practical considerations for the management of anticoagulation in them with a focus on novel anticoagulant drugs.

The prediction of renal allo-graft dysfunction is one of the major concerns in a

patient’s early follow-up, regarding any surgical or non-surgical complications; thus raising the demand for a non-invasive, affordable, non-toxic and an accurate method of screening. Also graft color doppler and ultrasound examination during follow up with any deterioration in kidney functions, urine output, episodes of uncontrolled hypertension or urinary symptoms. It's better to be held by bedside nephrologist for better correlation of image findings and clinical condition. In addition to treatment modifications according to ultrasound findings or need of surgical or non-surgical interventions the examination protocol includes the following: Preparation of the patients, Transplant drugs that interfere with proper examination, Grey scale ultrasound examination of the graft, graft ureter, if there is a stent, perinephric space, Color Doppler ultrasound to evaluate arterial anastomosis, ilio-renal ratio and venous anastomosis, as well as acceleration and resistivity indices, Power Doppler and B-flow to estimate perfusion defects. Also candidates will be able to know methods of examination, timing and interpretation of results simple calculations.

Mahmoud Montasser is a Lecturer of Internal Medicine and Nephrology at Ain Shams University in Cairo/Egypt. Currently, works as a specialty trainee registrar in Renal Medicine in the UK. He also worked as an Honorary Lecturer of Medicine and Nephrology at St. Georges University London and has completed his Post-Graduation in Healthcare and Biomedical Science. His primary interest is hemodialysis and dialysis in the elderly population.

An increasingly older End-Stage Renal Disease (ESRD) population requires nephrologists to focus on issues relating to palliative care. The Renal Physicians Association (RPA), for example, sponsored an evidence-based guideline relating to withholding and withdrawing from dialysis, and the United Kingdom Expert Consensus Group published guidelines for symptom management in adults dying with Chronic Kidney Disease (CKD). Kidney Disease: Improving Global Outcomes (KDIGO) sponsored a workgroup on the topic of palliative or supportive care in CKD outlining the need for additional study and the initiation of palliative treatments. Since nearly 20% of dialysis patients stop dialysis before death and increasingly, older patients are choosing not to begin dialysis in part due to poor outcomes and decreasing functional status with dialysis, it is likely that all nephrologists will be involved in end-of-life care of ESRD and CKD patients. As a group, however, physicians are poorly trained in palliative care and often feel uncomfortable with the responsibility of dying patients. In one survey of American and Canadian physicians, for example, only approximately 40% of 360 nephrologists stated that they were very well prepared to make end-of-life decisions. Despite the identification of the importance of palliative care in ESRD care, nephrology fellows remain uncomfortable and poorly trained in these aspects of clinical care. The primary aim of this talk is to highlight the importance of this critical point and make nephrologists more aware and more familiar with dealing with such a problematic and essential topic.

Gina Granger is a lifelong learner, who completed a Master’s Degree in Nursing, a Bachelor Degree in General nursing, a Bachelor Degree in Education and Community Health, a Diploma in Midwifery, a Diploma in Psychiatric Nursing, Certification in NICU Nursing, Certification as International Board Certified Lactation Consultant  and she is a certified AHA BLS Instructor. During a nursing career of over 40 years (in General Nursing, Midwifery, Psychiatric Nursing, Community Health, NICU and Nursing Education); she was a preceptor, mentor, and educator for nurses in South Africa, as well as in the United Arab Emirates. This included the commissioning of education departments, planning training for dialysis nurses to up-skill them, preparing staff for international accreditation; training basic & advanced life support; and developing of and training staff on nursing policies, procedures and competency assessment tools in various healthcare facilities.

Patients with Chronic Kidney Disease commonly develop End-Stage Renal Disease (ESRD); which requires renal replacement therapy at some stage. The disease combined with the treatment, have a major impact on patients’ personal, family and social lives. Patients have to get used to changes in their lifestyles, diet & fluid intake; due to the condition, routine medical procedures, doctor’s visits, and medical expenses. Studies have found that elderly and younger patients experience the disease and treatment differently, and have different needs. In one study, younger patients have expressed certain gaps in healthcare; that can help improve younger patients’ experiences. Many of them volunteered to act as mentors for other “new” patients; to improve patient education. Families are usually the main social support system for patients, and can greatly contribute to the patient’s disease management. In patients with ESRD consultation is large with the families. One large study showed a close relationship between family education levels and PD patient outcomes. This may be due to higher education levels being associated with better access to healthcare, as well as better understanding of information. Apart from the effects on the patient, the disease also impacts on the patient’s family; who may have to help care for him/ her. The whole family is affected by the fact that dialysis and kidney transplant is needed, and this can be overwhelming for both patient and family members. Financial pressures due to medical costs and sick leave, place a further strain on the wellbeing of the whole family. The speaker will present the experience of a peritoneal dialysis patient whose father also suffered from CKD, and had a kidney transplant.

Moataz Fatthy Abdelnaeem is a lecturer and consultant nephrology and internal medicine at Cairo university medical college and hospitals, interested in

interventional nephrology and bedside diagnostic ultrasound ,received training on interventional sonography skills at Egypt and Preston England my hope is to let

all clinicians be a sonographers also so as to better interpret diseases and save time and this will be the future of examination

Introduction of this modality for nephrologists will help them examine patients in better reliable way as ultrasound machines are available and new technologies of mobile ultrasound will be installed in near future and will be available for every physician and it may a part of the clinical examination, not such an investigation ordered by the clinician. The scope of lung ultrasound (LUS) in emergency and critical care settings has been studied extensively. LUS is easily available at a bedside, free of radiation hazard and real time. All these features make it useful in reducing the need of bedside X-rays and CT scan of the chest. LUS has been proven to be superior to the bedside chest X-ray and equal to chest CT in diagnosing many pleural and lung pathologies. The first International Consensus Conference on Lung Ultrasound (ICC-LUS) has given recommendations for a unified approach and language in major six areas of LUS. The LUS diagnosis is to be given after integration of findings of both lungs.