The Fourth  Workshop on clinical Nephrology and

Progression of Renal Disease

Date                   : October 26 - 27, 2000

Site                    : Ceremony Hall of Suez Canal University Hospital.

Head                  : Prof. Aasem K. Al-Sherif

Coordinated by: Renal Unit of Suez Canal University (SCU-RU)

                             Sheffield Kidney Institute (SKI)

The Workshop Report

This workshop was held for the fourth year as part of the educational collaborative activities accomplished through the partnership between the Renal Unit of Suez Canal University (SCU-RU) and Sheffield Kidney Institute (SKI).  This two-day workshop is advocated by the Sistering Program of the International Society of Nephrology (ISN) and was held this year under the auspices of this society and the Egyptian Society of Nephrology (ESN)

Professor Assem K. Al-Sherif of SCU-RU was the workshop coordinator and professor Prof. A M El-Nahas provided a visiting team from SKI, including Dr. John Shortland (Renal Pathology), Dr. Sam Morcos (Uro0radiology) and Dr. Peter Brown (Interventional Radiology). Professor Rashad Barsoum, the secretary general, and Professor Guissepppe Recuzzi of Bergamo, Italy, the ISN representative to the workshop.

The workshop maintained its original objectives of promoting the capabilities of mid-career nephrologists in the management of patients with Chronic Medical Renal Disease through updating their knowledge ion the patho-physiological mechanisms underlying its situations met in their daily practice. The workshop was primarily based on discussion of true cases with multi-disciplinary case discussions. In addition, five lectures and three mini-workshops were dedicated to cover the following topics:

1.      Malignancy and the kidney.

2.      Guidelines for management of Diabetic Nephropathy.

3.      Guidelines for management of renal bone disease.

4.      A new insight into the hemolytic uremic syndrome.

5.      Evaluation and salvage of arterio-venous fistulae.

6.      Radiological diagnosis and management of Renal Vascular Disease.

The workshop was attended by about 200 participants, mostly young and mid-career nephrologists, and was proves very successful. The following were the particularly stressed recommendations, though discussions have in fact emphasized important elements in management of several other situations, reflecting the diversity of the seventeen presented cases.

1. One should adopt an integrated approach towards controlling the established risk factors for the development and progression of diabetic nephropathy.

Good metabolic control with HB_1c values less than 8% should be the target in both type 1 and type 2 diabetics patients, whether insulin or oral hypoglycemic agents are used.

Control of hypertension in the diabetic patients with and without proteinuria is the most important step towards halting progression of vascular complications.

One should aim at systolic blood pressures of 125 to 130 mmHg and a diastolic blood pressure of 75 to 85 mmHg in both types of diabetes.

Strict control of hypertension seems obviate the need to reduce protein intake to effect further slowing of progression of diabetic nephropathy.

Control of hyperlipedemia in diabetic patients is also encouraged in view of its positive impact on cardiovascular morbidity and mortality, even though its role in progression of renal disease has not been well established in humans.

2. There is a need to redirect attention of nephrologists to the importance of prevention of occurrence of renal bone disease in dialysis patients; this has become particularly important with the increase longevity of these patients.

The complex nature of bone problems in these patients calls for an individualized approach to each one. Frequent monitoring of serum parathormone concentration, as well as monthly evaluation of serum calcium, phosphate and alkaline phosphatase are essential to guide the monthly prescription for any patient on chronic dialysis therapy.

Dietary recommendations, alpha calcidol, calcium carbonate and use of dialysates with the appropriate calcium concentration, all are integral tools that have to be tuned for the management of each individual patient. The target should be a total serum calcium of 8.1 to 10.2 mg/dl, serum phosphate of 3-5.5 mg/dl and a serum parathormone level 2-4 folds the upper limit of normal.

The development of symptomatic renal bone disease not associated with radiological features of secondary hyper-parathyroidism should alert the dialysis center to aluminum intoxication.

In the pre-end-stage renal disease patient, when prescription of calcium-containing phosphate binders and alpha-calcidol is done, one should be alert that the calcium x phosphate product should not exceed 50 and is better kept at < 45.