KARACHI, Oct 20: Speakers at a symposium on Sunday discussed the various aspects of renal diseases.
The two-day symposium, which was conducted by the Kidney Foundation, was titled “Excellence in dialysis — update in nephrology”.
Speaking on the subject of “Bone disease in dialysis”, Fazal Akhtar of the Sindh Institute of Urology and Transplantation said renal osteodystrophy was the term used to describe the complex metabolic bone disorder that occurred as complication to renal failure. “Abnormality of bone and mineral metabolism are responsible for a significant proportion of morbidity experienced by the individual with renal failure which occur early in the course of renal failure.”
Stanley Shaldon delivered the Dorab Patel Memorial lecture on the subject of “Development of haemodialysis from access to machines”.
Speaking on the subject of “Hypertension in ESRD and its implications to morbidity”, Rasib Raja of the Jefferson Medical College, Philadelphia, said that hypertension was a very important risk factor for cardiovascular disease which was a leading cause of mortality in renal failure patients. “As renal function declines, incidence of hypertension rises and exceeds 80-90 per cent at the time of end-stage renal diseases.
Hypertension is due to impaired renal salt and water excretion. Other contributory factors include increased sympathetic nerve activity, enhanced rennin angiotensin system, endothelial dysfunction with impaired EDRF or nitric oxide pathway.”
Bilal Jamil of Aziz Tabba Dialysis Centre spoke on the subject of “Preliminary data of dialysis registry of Pakistan.” He said that in order to collect the much-needed database of haemodialysis centres, and patients undergoing haemodialysis in Pakistan, the Kidney Foundation had identified hospitals and dialysis centres providing chronic heamodialysis.
“Data collection took eight months, from Dec 2001 to July 2002. 105 centres shared their data for the registry: 37 of the participating centres are in Sindh, 54 in Punjab, 5 in the NWFP, 4 in Balochistan and 5 in Islamabad. Thirty-one dialysis centres are in government hospitals, two in semi-government hospitals, 27 dialysis centres are by non-governmental organizations or trusts and 45 dialysis centres are in private hospitals. A total of 2,387 patients are being dialyzed in these centres.”
Speaking on the subject of “Infection in kidney transplant patients”, Sameeh J. Khan of the department of nephrology at the Pakistan Institute of Medical Sciences said that compared to other sold organ transplants, kidney transplantation is associated with the lowest rate of infections but none the less it could cause significant morbidity and mortality.
“Pretransplant screening of the donor and recipient is mandatory to minimize the risk of infections in post transplant setting. Bacterial infections predominate in the first month post transplant. These included aerobic gram-negative bacilli and gram positive enterococcus requiring surgical prophylaxis. Fever may not always be present in an infected immuno-compromised patient.”
Mujtaba Quadri spoke on the subject of “Ethics of organ transplantation”. He said: “Important questions include pros and cons of cadaveric transplantation vis-a-vis issues of brain death and the sanctity of the human body. The issues of living donors whether paid, underpaid or under coercion will be highlighted. What should be the role of the transplant nephrologist and surgeon.”