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

Roy Aghwana obtained his bachelor's degree in medicine and surgery from the University of Benin teaching hospital in 2004. In 2017 he also obtained membership with the west African college of physicians, Dr. Aghwana is currently undergoing subspecialty training in nephrology in Delta State University Teaching Hospital. He is also in the process of attaining the ISN clinical nephropathology certificate.

Urine microscopy remains a very relevant investigation, as it is affordable and non-invasive, this study aims to determine the pattern of urinary abnormalities, the frequency of urinary tract infections, the pattern of microorganisms causing UTI, and the antibiotic sensitivities.

Methodology and Theoretical Orientation: A retrospective study carried out in DELSUTH, using the urine microscopy results of all patients tested over a 3month period from January 1st, 2017 to March 31st 2017. Available demographic data and urine exam reports were collected using Microsoft Excel. Data analysis was performed using SPSS version 22. Findings: Majority of patients were females (54.9%). The mean age was 49 ± 17year, while age range was between 10-99yr. The highest proportions of patients were between 60-69 (25.5%) and patients between ages 90-99 made up only 0.7%. The prevalence of hematuria and pyuria were 19% and 52.3% respectively; casts were seen in only 2.7% and crystals in 6.5% of the sample. The commonest crystals found were ca oxalate (3.9%). Of the 152 patients, 72 patients (47.1%) had significant cultures and the most common organisms grown were E. coli (40%), Klebsiella (19.4%), and candida (9.7%). UTI was more prevalent in males compared to females (53.6% vs. 41.7%, p=0.188). Overall, antibiotic sensitivity to Amoxicillin/clavulanic acid was 24.1%, Ofloxacin 12.5%, and Gentamicin 9.7%. Conclusion and Significance: Urine abnormalities are common in the sample studied; the frequency of haematuria and pyuria were higher compared to casts and crystalluria. Hematuria was significantly commoner in males and more males had UTI. E.coli was the commonest organism implicated. Although urine microscopic examination is an indispensable tool in nephrology care, to benefit from its wealth of information, it has to be properly executed by trained personnel, with the right protocols and equipment.

Tetsuhiro Tanaka is a currently working at the Division of Nephrology and Endocrinology, the University of Tokyo, School of Medicine. His major research interest is the role of chronic hypoxia and hypoxia-inducible gene transcription in the pathogenesis of CKD. He has completed Graduation from the University of Tokyo, School of Medicine in 1997 and has obtained his PhD degree at the University of Tokyo, Graduate School of Medicine in 2005. He has received the Young Investigator Award of the Japanese Society of Nephrology in 2014. He is currently serving as an Editorial Board Member of Kidney International and Clinical and Experimental Nephrology.

Tubulointerstitial hypoxia plays an essential role as the final common pathway to end-stage renal disease. Hypoxia-Inducible Factor (HIF) is a master transcriptional factor responsible for tissues to adapt to the environment of reduced oxygen concentration. Such mechanisms include regulation of downstream target genes involved in angiogenesis, erythropoiesis and anaerobic metabolism. In some pathophysiological contexts, hypoxia may be recorded as epigenetic changes (“hypoxic memory”) and be responsible for the progression of the kidney disease in the long term. In this regard, we performed genome-wide analysis of HIF-1 binding sites using high-throughput sequencers and found novel downstream targets relevant to epithelial cell behavior. By simultaneously checking histone modification marks, we identified novel roles of HIF-1 in histone modification which enhances its target gene expression. Furthermore, microarray analysis and RNA-seq in cultured tubular cells exposed to hypoxia demonstrated the expression of several novel long non-coding RNA (lncRNA), including aspartyltRNA synthase anti-sense 1 (DARS-AS1), which was most strongly induced by hypoxia and suggested to play anti-apoptotic roles. In an AKI to CKD transition model of ischemia-reperfusion injury in vivo, we observed that pharmacological targeting of histone modifications was effective in ameliorating fibrosis. In summary, HIF is responsible for a variety of epigenetic changes and may ultimately determine the consequences of the disease phenotypes.

It’s common practice in Africa for patients including those diagnosed or undiagnosed with Kidney diseases to first contact Primal Health Care prior to using the western health care systems such as primary health care and nephrology department. It is also believed by most Western-trained practitioners that Primal Health care is harmful to patients with Kidney diseases, however, it’s not the case and therefore, the researcher attempts to correct this misconception by exploring two attributes

(Ubuntu and Holism) of African primal health care (APHC) to facilitate healing on patients suffering from Kidney disease.

‘Primal’ was coined during a colloquium by Dr Mbulawa and Seboka team members; however, no formal conceptualization took place, only operational definition.

Aim: Exploring two attributes (Ubuntu and Holism) of African primal health care to facilitate healing on patients suffering from Kidney disease.

Objectives: Explore philosophical grounding of APHC in Patients with kidney diseases; Describe epistemology of APHC with kidney diseases;

Method: Narrative synthesis, concept analysis (qualitative design). Lekgotla was used as a method of data collection

Results: APHC uses a holistic approach and the family & community are involved in the healing process of patients diagnosed with kidney disease. The praxis involved during the healing process including medicinal plants are anchored in the concept of holism and Ubuntu and therefore does not only focus on the patient diagnosed with kidney disease but also the cosmos. The practices come from the community, for the community and be authenticated by the community.

Michael T Fawzy has completed his Graduation from Minia University Medical School (Egypt). He is dually trained in Internal Medicine and Nephrology. He has fulfilled his training program in 3 countries i.e.; the UK, Egypt and Saudi Arabia. He has been practicing since 2001, the last 3 years in London, UK, at Guy’s hospital (selected as one of the top 5 hospitals in the UK). His practice specializes in the care of renal failure in critically ill patients, chronic kidney disease, hypertension and Vasculitis. His special interests also include end-of-life issues, advanced directives and furthering organ procurement. He is also a Clinical Associate Lecturer of Medicine at University Medical School in Egypt and is a Member of Royal College of Physicians in London. He used to be lecturer and examiner at King’s college medical school in London.

Until the law in the United Kingdom (UK) changed in May 2016 so-called "legal highs" or "new psychoactive substances" were freely available in high street shops across the UK. Following prohibition, these drugs are still easily purchased illegally via the internet. We report a case of a patient who self-administered 3-fluorophenmetrazine intravenously with catastrophic consequences. Adverse effects were almost immediate with symptoms of malaise and tachycardia. Two days post administration he was transferred to the intensive therapy unit with acute kidney injury and irreversible four limb ischemia. He required a period of renal replacement therapy and bilateral lower limb amputation. This case highlights the fact that new psychoactive substances have many unintended adverse effects which has not been previously described. Multiple routes of administration are used by people taking these agents including intravenously. Medical practitioners should always consider ingestion of new psychoactive substances in the differential diagnosis of acutely ill patients.

Pércia Bezerra has completed his Graduation in Medicine at Federal University of Pernambuco (2002), Internal Medicine Residency and Nephrology Residency

at São Paulo University.

Acute Kidney Injury is a life-threatening disease that occurs in about 9-16% of hospitalized patients, however, it can be higher in different settings, like in Intensive Care Units, where AKI can be seen in about 22-57% of the patients, depending on the population studied. AKI increase the morbidity and mortality of the patients, even in episodes of subclinical AKI, as demonstrated by Husain-Sayed F et al and many others authors. Besides that, the costs after an episode of AKI can increase dramatically the cost of hospitalization, the length of stay and can also lead to late no complete recovery of kidney function, leading to a real public health problem. In a recent past and also in the majority of Countries, the diagnosis of AKI is still based on an increase in creatinine levels and low urinary output. However, there are promises advances in techniques trying to detect the presence of AKI in subclinical stages, what could be a great step in prevention and also in precise interventions that could try to stop that damage caused by an episode of acute kidney failure. A promising in earlier diagnosis of AKI is the use of cell-cycle arrest biomarkers of acute kidney damage, like the use of Urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7). The combination of these both biomarkers can detect AKI in a subclinical stage when there were still no changes in creatinine level or urinary output. In a recent paper published by Husain-Syed F and co-workers, in a specifical population of patients undergoing to elective cardiac surgery, the use of the biomarkers [TIMP-2]. [IGFBP7] in the immediate postoperative could predict the development of AKI with an AUC of 0.87. But we cannot talk about the advances in the treatment of AKI when the patients had to go to hemodialysis. The machines are becoming each day more precise, with control of the amount of volume that should be removed from the patient, different kind of alarms that prevent eventual complications during the therapy and also the possibility to combine hemodialysis with others treatments like ECMO, machines to support patients for liver transplantation and many others. In conclusion, there are still a lot of to do, but all community of nephrologists, critical care intensivists and physicians are focus on studying ways to make an early diagnosis, interventions that could prevent the development of AKI and new strategies of treatment.