15th International Conference on Nephrology and Hypretension Novmber 11-12,2019 Istanbul,Turkey

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Aim: Permcath. Is a known vascular acess for haemodialysis patients, which may last for 2 years or more.it is a 1st line for hemodialysis for patients who were not prepaired by AVF few months before starting dialysis ,but in Egypt most of patients start dialysis with temporarily catheters (cheap)but causes stricture or occlusion of the used central vein. Method: We studied 146 patients who were submitted for permcath. Insertion in our hospital as regard:the vein used-cause of insertion –failure of insertion or using it in dialysis and longevity. Result: The results were as following: *64 (rt, int. jugular) 1- 16 were 1st prick 2-26 were waiting for maturity of AVF 3-20 due to cardiac causes 4-02 due to failed multiple AVF *30(rt. Subclavian) 1-09 were waiting for maturity of AVF 2-11 due to cardiac cuses 3-10 due to failed multiple AVF *15(left jugular) all has thromosed rt. Int. jugular 1- 06 were waiting for maturity of delayed AVF 2- 09 due to failure of multiple AVF *07(left subclavian) all were due failure of multiple AVF *30(femoral vein ) all of them has no available vascular access and 12 of them had cardiac causes Conclusion: From this study we found that most patients who were referred for permcath .insertion had a history of single or multiple temporarily catheter insertion that caused single or multiple central vein occlusion Suggestion: we recommend to use permcath. As a first prick in patients who are not prepared by AVF and avoid using temporarily catheters to save veins of patients, because the use of temporarily catheters causes stricture or occlusion of central veins

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Dr Punit Gupta is MBBS, MD (Medicine), DM (Nephrology) and PhD. He is the member of many important academic and management committees of various medical institutions in the country.He has presented papers in many national and international conferences 

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Nada Elgiw currently is working in Department of Genetic Engineering, Biotechnology Research Center, Tripoli, Libya.

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Sanae Ezzaki has completed her Graduation from the University of Medicine and Pharmacy of Rabat, Morocco. She is currently Resident in Nephrology Hemodialysis at the Ibn Rochd University and Hospital Center in Casablanca, Morocco. 

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Introduction: Allopurinol is a xanthine oxidase inhibitor that prevents the production of uric acid to reduce plasma uric acid levels to a normal range. It is the most frequently used anti-hyperuricemic agent in the world due to its long-term pharmacological effect. However, allopurinol is also one of the most frequent causes of Severe Cutaneous Adverse Drug Reactions (SCAR) including Stevens–Johnson Syndrome (SJS), therefore, SJS is a serious problem in allopurinol therapy, in spite of the ideal anti-hyperuricemia effect of allopurinol. We report two cases report of Stevens-Johnson syndrome induced by allopurinol in patients with chronic kidney disease (CKD). Case Report-1: N.E 70 years old, followed for CKD stage-IV for three months put on allopurinol 300 mg/day for one month for asymptomatic hyperuricemia, admitted for Stevens Johnson syndrome, he was conscious, feverish at 38.5 °C, hemodynamically stable, having a prominent bullous detachment on the back, anuric for 24 hours. He had kidney failure at 76 mg/l of serum creatinine, urea at 3.34 g/l, a hyper eosinophilia at 720 e/mm3. Allopurinol was stopped; he was put on antihistamines, corticosteroids and hyperhydration. He received a total of three hemodialysis sessions. The evolution was marked by the aggravation of the dermatological lesions with improvement of the renal function. The evolution was marked by the aggravation of skin lesions with improved renal function, but he died seven days after admission in an array of multiple organ failure. Case Report-2: S.O 74 years old, followed for CKD stage-IV for three years, turning on allopurinol 300 mg/ day for five weeks for asymptomatic hyperurcemia, admitted to Stevens Johnson syndrome. She was conscious, feverish at 38 °C, hemodynamically stable, she had bilateral conjunctivitis, cheilitis, and macular lesions with early skin peeling and preserved diuresis. She had kidney failure at 66 mg/L of serum creatinine, urea 2.21 g/l. Allopurinol was arrested and she was put on antihistamines and corticosteroids and hyperhydaration. The evolution was marked by the return of the glomerular filtration rate to baseline value after 15 days. Discussion: Allopurinol is the first xanthine oxidase inhibitor to be marketed more than 40 years ago. It constitutes the reference treatment of symptomatic hyperuricemia. Although it is generally well tolerated, the severe toxidermias associated with it constitute a major risk when it is used. Thus, allopurinol is currently the leading cause of severe bullous toxidermia including Lyell and Stevens-Johnson syndromes in Europe and one of the first providers of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in the world. The action is due to a hypersensitivity reaction type-III probably triggered by the Oxipurinol, main metabolite of allopurinol. The clearance of Oxipurinol depends mainly on renal function, which explains the high frequency in patients with CKD. Conclusion: These cases illustrate the significant morbidity associated with the irrational use of allopurinol in patients with chronic kidney disease

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Sana Tariq is Medical Physiologist, Researcher, Trainer and Speaker. She is currently pursuing MS in Public Health from Shaheed Zulfikar Ali Bhutto Institute of Science and Technology (SZABIST), Pakistan. She had 04 years of experience working in an internationally recognized institute Sindh Institute of Urology & Transplantation (SIUT) and joined Tabba Kidney Institute in 2019 has engaged the organization in number of research projects nationally and internationally

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In the last decade, approximately 50,000 people have died every year because of end-stage organ failure in Pakistan. An amount this high needs urgent manifestations and accelerated solution. Some institutes in Pakistan are working day and night to make transplantation and organ donation accessible and understandable for everyone because there is a large population in desperate need of organ donation for living including children. This article reviews the possible strategies to understand the attitude towards alive or deceased organ donation and transplantation in Pakistan and how we can change this negative perspective. We strongly believe that the lack of understanding of transplant procedure and the fear of being rejected by the almighty prevent most people from donating their organs. Correct knowledge, family consultation, sympathetic medical staff and easy access to health care institutes may change this situation. 

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Ahmad Makeen Senior Internal Medicine Resident King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia. 

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Background & Objectives: There is a significant shortage of kidneys available for donation. Family members of Hemodialysis (HD) patients are experiencing the suffering of their close relatives, which can be a factor toward better acceptance to kidney donation. The knowledge is another important factor that might affect willingness, it was found in a study conducted in Nigeria that the presence of desirable knowledge about organ donation will influence the rate of willingness and in another study where educational intervention done, they found this approach significantly improves the knowledge and changes the attitude and beliefs towards organ donation. We aimed in this study to estimate the rate of willingness to donate kidneys as Live Donors (LD) and identify related potential barriers among family members of HD patients. Methods: A cross-sectional observational study involving family members of adult HD patients from King Abdulaziz Medical City and King Abdullah International Foundation- Dialysis Project-Jeddah. Participants were interviewed through phone calls using a pre-tested questionnaire. Calculated sample size was 385. Results: A total of 370 family members of HD patients were included. Median age was 37 (IQR: 33 to 44) years and 64% were male. All participants were first-degree relatives to HD patients. Majority reported willingness to donate kidneys as LD (n=300, 81%), a proportion 0.81% with 95% Confidence Interval [CI], 0.77-0.85. Only 42 (11%) graded their knowledge about kidney transplantation as high or very high. On multivariable analysis, less willingness was shown with age >40 years (Adjusted Odds Ratio [AOR] 0.459; 95% CI 0.2660.792; P 0.005) and female gender (AOR 0.496; 95% CI 0.287-0.856; P 0.012). Conclusion: Majority of family members of HD patients were willing to donate kidneys. The willingness rate was lower among participants 40 years of age and older as well as among female gender. Majority of patients graded their knowledge about kidney transplantation as average or lower. Therefore, education-targeting relatives of HD patients may help optimize knowledge and hence improve acceptance of kidney donation.

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Imane Failal is a Nephrology Resident at the ibn rochd university and hospital center in Casablanca, Morocco

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Introduction & Objective: In kidney transplantation, the immediate per and postoperative period is a critical period for patient and graft survival. The objective of our study is to highlight the different modalities of anaesthesia and resuscitation in the context of the management of renal transplantation from a living donor. Method: We conducted a retrospective study on all kidney transplant patients admitted to the Nephrology Department of Ibn Rochd University Hospital in Casablanca between June 2007 and March 2019 in consultation with the paediatric anaesthesia and paediatric resuscitation Department at Abderrahim El Harouchi Paediatric University Hospital of Casablanca. Results: The age of our patients ranged from 5 to 17 with an average age of 11 years. The sex ratio was 1.2 with 11 boys and 9 girls. Initial nephropathy dominated by congenital malformations. A history of hypertension was found in 45% of patients. The infectious antecedents were found in 45% of the cases. The surgical history was found in 40% of cases. At the time of the transplant, 19 patients had undergone dialysis for at least six months. Renal transplantation was pre-emptive in one patient. Regarding the systemic impact, the majority of our patients had a failure to thrive. All patients underwent a complete clinical examination and further investigations after which dedifferentiated kidneys without other abnormalities on ultrasound found in 80% of patients. Immediate follow-up was simple for 65% of patients. In the medium and long term, 8 patients experienced complications including peritonitis, CMV infection and hemothorax. All these complications have been treated with a good evolution later. Conclusion: A general mobilization must be carried out to establish the infrastructure and the human and technical necessary resources to care children with end-stage of renal failure; this could be accomplished through kidney transplantation, promotion of organ donation to allow patients with chronic renal failure to access to the best treatment that can currently be offered.

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Sanae Ezzaki has completed her Graduation from the University of Medicine and Pharmacy of Rabat, Morocco. She is currently Resident in Nephrology Hemodialysis at the Ibn Rochd University and Hospital Center in Casablanca, Morocco. 

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Imane Failal is a Nephrology Resident at the ibn rochd university and hospital center in Casablanca, Morocco 

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Objective: The evaluation of quality of life is a new approach to the patient with ESRD. The goal of this work is to investigate the QOL of patients by KDQoL-SF 36 scale Tm and objectify factors influencing this quality. Method: This is a cross observational study conducted between July to September 2019, including 78 chronic hemodialysis patients assessed by a specific questionnaire kidney disease translated and validated in Arabic dialect: KDQoL-SF36 Tm. The socio-demographic and clinical data that may influence QOL were collected from the patient's medical record. The search for predictors of QOL was conducted by a united analysis and multi varied. Results: The average age of patients was 45.78+/-15.20 with a sex ratio 0.92. Over 50% of patients did not have their bachelor's degree and 85.9% unemployed 4% having a stable job and 2.6% more students; causal nephropathy was undetermined in 52.6% of cases. The average length of hemodialysis was 8.34+/-6.07 years and the majority of patients enjoyed three sessions/week. 47% of our patients had anemia. In univariate analysis, the comparative study of the various components of the score found statistically significant association between the mental component of the scoring and age, le niveau study and the socioeconomic level of quality dialysis (Kt/V). For cons, the length of the MR and anemia were associated with greater weight in the RM and the physical component. In multivariate analysis, the presence of CVD has increased the risk of poor QOL on Plan symptoms and consequences of MR and age >60 years has increased the risk of poor QOL. On the contrary, having a profession is a good QOL factor in terms mental and seniority in HD >5 years was positively impacted QOL physically. QOL is a complex concept which results from an interaction of several components, which explains the multiplicity of scales and assessment scores. Conclusion: This study provides an understanding of the factors that are associated with quality of life in HD patients. Low QOL among HD patients is closely associated with a higher risk of morbidity and mortality