CHRONIC KIDNEY DISEASE

Immune system in CKD and infection in GN pts In CKD and HD patients dysfunction of immune system alterations belonge to involving innate and adaptive immunity 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 correct diagnosis and treatment of infection, as well as weighing the risk of infection with the risk of untreated glomerular disease

ANCA 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

Oncology 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.

Contrast 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.

How to retarding the transition from CKD to ESRD Detection of CKD at risk groups and referral 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 education (low-protein diets; ketoanalogs; correct metabolic acidosis; oral antioxidants)

HEMODIALYSIS

Vascular access In 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 is no significant difference in color Doppler findings but successful creation of VA in diabetics is less common

Vascular 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.

CV disease In ESRD patients clinical, diagnostic and therapeutic approach of different CV manifestation differ from that in non-dialysis population and outcome is less favourable

Oxidative 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.

Kidney transplantation

14th BANTAO congress confirmed Great difference between Balkan countries in number and development of kidney Tx

The development of transplantation program in countries with small number of kidney Tx improved many medical fields and provided continuous education of medical staff

Donor 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.

Hypertension 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

HCV and Tx Patients with HCV infection should be transplanted but the timing of treatment (before or after TX) should be individualized Direct acting antiviral therapy have revolutionarized the field

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. IS 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.