In CKD and HD patients dysfunction of immu ne sy stem a lterations belonge to involv ing i nnate and a daptive i mmunity in T and B lymphocytes Reduced T regulatory cells and memory cells and increased innate cells ID: 930729
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Slide1
CHRONIC KIDNEY DISEASE
Slide2Immune system in CKD and infection in GN pts
In CKD and HD patients dysfunction of immune system alterations belonge
to
involv
ing
i
nnate
and
a
daptive
i
mmunity
in T and B lymphocytes (
Reduced
T regulatory cells and memory cells and increased innate cells).
In GN patients on IS
th
is important to put c
orrect diagnosis
and treatment
of infection
, as well as w
eighing the risk of infection with the risk of untreated glomerular disease
Slide3ANCA vasculitis, SLE and MGRS
New drugs in treatment ANCA vasculitis and SLE are not well established. In patients with MGRS the role of nephrologist is to perform kidney Bx in order to
assess
the
MGRS
type
and
evaluate
the
severity
of
renal
disease
Alport and Fabry
27% of heterozygous women with XLAS (COL4A5 mutation) develop ESRD. For the DG of
Fabry
disease you must think that it could be
Slide5Oncology patients and elderly outpatients
It is important to estimate of renal function in oncology patients (GFR formulas adjusted for body surface area)
In elderly outpatient
drug-related
clinically relevant blood pressure overtreatment
,
resulting in hypotension
.
Slide6Contrast induce AKI
Although there is evidence that CI-AKI is associated with worse outcomes, there is no evidence of a causal relationship or that reducing CI-AKI improves overall outcome.To date there has been no conclusive benefit demonstrated from interventions except for low
osmolar
or
iso-osmolar
contrast and IV hydration.
Slide7How to retarding the t
ransition from CKD to ESRD
Detection of CKD at risk groups and r
eferral to nephrology
in CKD 3B stage
Good partnership
and education of the
primary care
physicians
and other specialties
Dialysis access should be placed sufficiently early to preclude the need for central venous catheters
Patients
e
ducat
ion
(
low-protein diets;
ketoanalogs
; correct metabolic acidosis; oral antioxidants
)
Slide8HEMODIALYSIS
Slide9In elderly patients is more difficult to construct permanent vascular access
and is appropriate starting with a tunnel rather than a temporary catheter. Between diabetics and non-
diabeticsIn
there
i
s no significant difference in
color
Doppler findings but
s
uccessful creation of VA in
diabetics
is less common
Vascular access
Slide10Vascular calcification
Think about association between vascular calcification and anticoagulation therapy (old and new) in CKD and HD patients. Potential role of indoxyl sulphate as an uremic toxin in delopment
od
LVH in ESRD.
Slide11CV disease
In ESRD patients clinical, diagnostic and therapeutic approach
of
different CV manifestation
differ
from
that
in
non-dialysis
population
and o
utcome
is
less
favourable
Slide12Oxidative stress in HD patients
HD patients mortality is associated with higher inflammation and OS. Biomarkers of inflammation (hsCRP), oxidative stress (PAB) and hsTnI are
good predictors of all-cause and CVD mortality.
The combination of
2
biomarkers
of
different
pathophisiological
pathways
proved
to be
better
tool
for the assessment of all-cause
and
CVD
mortality
than
single
biomarker
Fraility
Nephrologists should actively attempt to identify the frail patients with CKD because they are more likely to require hospitalization and more likely to die than their non-frail counterparts.
Slide14Kidney transplantation
Slide1514th BANTAO congress confirmed
Great difference between Balkan countries in number and development of kidney Tx
Slide16The development of transplantation program
in countries with small number of kidney Tx improved many medical fields and provided continuous education of medical staff
Slide17Donor program
Severe organ shortage crisis represents a universal challange which should be faced under the scope of a planned and integrated approach primarily focused on solutions to increase deceased organ donation.Organisation model, legislation and public opinion are necessary frame,
but proactive hospital approach to organ donation is mandatory
to expand the national pool of solid organs for transplantation.
Slide18Hypertension after kidney Tx
Elevated BP levels post-transplant identify patients at high risk of AR independently of graft function. CCB is useful in antagonizing the vc effects of CNI. The RAS inhibitors seem a good option, especially in patients with proteinuria, but their effects on long-term graft and patient survival are controversial.
β -Blockers could be beneficial in pts with coronary heart disease
Thiazide diuretics could be the reasonable option for patients with glomerular filtration rate ≥30 mL/min/1.73 m2
Slide19Patients with HCV infection should be transplanted
but the timing of treatment (before or after TX) should be individualizedDirect acting antiviral therapy have revolutionarized the field
HCV and
Tx
IgA and kidney Tx
Recurrence of IgA nephropathy is common after kidney Tx, especially in young patients, and may be more prevalent in those who receive their transplant from
living related donors.
I
S
therapy specifically directed toward treatment of recurrent IgA may be used in selected
patients
.
The majority of studies demonstrate that overall graft survival in
those with
IgAN
is no worse than those with other causes of ESRD
.
Slide21