17^th International Conference on Nephrology & Urology March 12-13, 2018 London , UK

AIK Mahanama completed her MBBS degree at the age of 27 years from the Faculty of Medicine, Colombo and Post graduate Diploma in Medical Microbiology from the Post Graduate Institute of Medicine, Sri Lanka. She currently works as a post graduate trainee in MD in Medical Virology at Medical Research Institute, a premier research institution in Sri Lanka. She has several local and international publications by her name and is also engaged in several research studies at the moment.

Pre-transplant serology guided monitoring of high-risk renal transplant recipients {donor positive (D+)/ recipient negative(R-)} is recommended to initiate early pre-emptive therapy to prevent EBV disease/Post-Transplant Lymphoproliferative Disorder. Sri-Lanka, is yet to implement this due to limited resources, although many renal transplants performed annually. This descriptive cross sectional study aims to evaluate the practice of pre-transplant EBV serology testing, determine the magnitude of high-risk population and to describe active EBV infection within first post-transplant year. Plasma of 118 adult post-transplant patients over four months tested for EBV DNA with a commercially validated quantitative real-time PCR kit. EBV serology and other transplant details collected using clinical records. Majority were males with mean age of 44.97 years (SD 12.48). 54.3% were > 6 months post-transplant, 90.8% received a live related kidney, all were on maintenance with Tacrolimus, MMF and Prednisolone. Pre-transplant serology available in 37/118 recipients. Donor serology available in 27/118 recipients, 12 IgM, 13 IgG and 2 had both. Sero -compatibility details available in 15/118 with 20% being D+/R- . All samples were negative for EBV DNA despite ensuring maximum viral DNA recovery. Study concludes; pre-transplant screening for EBV infection was poor with incorrect antibody selection in donor. Many belonged to high-risk category emphasizing the need for implementing routine pre-transplant EBV screening guided post-transplant monitoring to improve the quality of care. None had active EBV infection, use of single sample per patient, few recruits in early transplant period and short study period may have affected the EBV DNA detection rate.

rnExtracorporeal shock wave lithotripsy (ESWL) was first used in the 1980s for renal and ureteral stones, which later became one of the main treatments for urinary tract stones. In order to have the patient’s compliance, it’s necessary to have a potent pain reliever with least side effects. For this purpose, different painkillers including opioids, NSAIDs, local anesthetics and combination of such drugs have been used. The aim of this study was to lower the need for opioids and to compare pain control and recovery period of fentanyl alone, in combination with midazolam and in combination with pregabalin. Among 141 patients, one third were given 4mg fentanyl (10 minutes before the procedure), another group were given 2mg fentanyl in combination with 1mg midazolam and the other 47 patients were given 3mg fentanyl in combination with 75mg pregabalin (30 minutes before the procedure as it was used orally). The pain intensity was evaluated by numeric rating scale (NRS) before, during, 1 hour and 2 hours after the procedure. Comparing these drugs show that using both midazolam and fentanyl can lessen the extra required dose of fentanyl, but increased recovery time due to midazolam mechanism of action, which was desirable for the patients as it decreased their stress but is not suitable for low health facility areas. Combination of pregabalin and fentanyl increased nausea and vomit before starting the procedure which was hard to tolerate for the patients. Using fentanyl alone, decreased recovery period and the patient’s pain without requiring any other medications.rn

Mohammad Safaei Saruei is a senior medical student. He is a member of Student Research Committee. He is a young enthusiastic researcher, eager to for on Urology and Radiology projects

Kirill Shiranov has completed Medicine from Rostov State Medical University and graduated in Urology from Urologic Residency in 2013. He has surgical experience\r\nthat includes ESWL (> 200 case per year), flexible endoscopy (> 50 cases per year), PCNL (25 cases per year), TUR (> 20 cases per year), TURP (20 cases per\r\nyear), TURBT (20 cases per year) and HoLEP (20 cases per year). In 2012-2013, he was a member in ESRU NCO, Russia. He worked as EAU guidelines translator\r\nfrom English to Russia in 2010, 2011, 2014, 2016, and 2017.

Introduction: The conventional diagnosis of acute kidney injury is based on serum creatinine measurement, but this marker is\r\nnot appropriate for early recognition. During last decade there were a lot of studies evaluating biomarkers of kidney injury after\r\nminimally invasive treatment of kidney stones. However, there is no published data about biomarkers level after treatment of\r\nureteric stones. The aim of our study was to evaluate impact of different treatment methods on kidney parenchyma in patients\r\nwith proximal ureteric stones.\r\nMaterials & Methods: From 1st January to 31st October 2017 a total of 75 patients with unilateral large proximal ureteric stones\r\nwere prospectively included in our study. They were randomized in three groups. In group 1 patient’s undergone to retrograde\r\nureterolithotripsy, in group 2 ESWL was performed and in group 3 mini-percutaneous antegrade ureterolithotripsy was\r\ntreatment method. In all groups some biomarkers level were measured, including KIM-1, NAG and cystatin C, preoperatively, 2\r\nhours, 24 hours and 72 hours after procedure. Also, we evaluate stone-free rate (residual fragments < 4 mm) and complications\r\nrate. In all cases KUB and renal ultrasound were performed one month after intervention.\r\nResults: The mean stone size was 12 mm (9-13), 11 (8-12) and 13 mm (8-14) (p < 0.05). The mean age was 56 years (64, 57\r\nand 62 years respectively). Stone-free rate in group 1, 2 and 3 was 76%, 60% and 88%. In all groups there was no significant\r\ndifference in baseline biomarker level, except slight elevation of cystatin C in group 2 (p>0.05). In all groups the mean KIM-\r\n1, cystatin C and NAG level increased two hours after intervention. However, after 1 and 7 days in group 1 the level of all\r\nbiomarkers was not significantly different compared to baseline level. In group 2 and 3 KIM-1 and NAG level increased after 1\r\nand 7 days after intervention, but in group 2 elevation at 7 days was not significant. Complication rate in group 1, 2 and 3 was\r\n16%, 8% and 28%. There was greater grade 2 complication (according to Clavien-Dindo).\r\nConclusions: Our study showed that retrograde ureterolithotripsy is safe treatment method, which cause minimal kidney\r\nparenchyma injury, according to biomarkers level change. Percutaneous antegrade ureterolithotripsy is the most invasive but\r\nthe most efficient method; however, first day after intervention biomarker elevation is comparable with ESWL, despite on its\r\nminimally-invasive nature. These data must be confirmed in large study with strict laboratory and clinical follow-up.