la società europea di nefrologia e dialisi : a che punto ... ·...

La Società Europea di Nefrologia

e Dialisi : a che punto siamo ?e Dialisi : a che punto siamo ?

Prof. Giovambattista Capasso

Professore Ordinario di Nefrologia

Direttore Dipartimento Interaziendale di Nefrologia

AOU Vanvitelli-Azienda dei Colli

Direttore Dipartimento di Medicina Translazionale

Università Luigi Vanvitelli

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Clinical Governance and Registry Coordination Renal Science Coordination

ERA-EDTA Registry

European CKD cohorts initiative

European Best Practice in Nephrology

Education in Clinical Epidemiology

Working groups coordination and overseeing

EURO DOPPS

Newly created working group on basic renal sciences

Promotion of Basic science and Translational Research

collaboration in nephrology within the ERA EDTA (to be

developped with SAB)

Kidney Research and Public Health Advocacy-

Nephrology and Public Health advisory committee

Inter-society collaboration (ASN, ISN, ESC, ESH etc) and

exchanges

Scientific Advisory Board (SAB) and international fellowships

(former COMIA)

ERA-EDTA Scientific Congress Programme Committee

Working groups annual meeting

Awards Nominating Committee

Scientific CommunicationsNDT, CKJ, NDT Educational, Communication Team and Press

Office

Education and professional

development & harmonization of

nephrology teaching (Educational

activities and courses)

Education & Professional

Development

National Societies and Nephrology

Workforce initiative development (now

at the stage of «Activation Committees»)

Women in Nephrology initiative

Young Nephrology Platform

Special ERA-

EDTA Initiatives

exchanges

European Kidney Health Alliance (EKHA)

Descartes (Transplantation)

EUDIAL Diabesity

CKD-MBD

European

Renal

Nutrition

EURECA-m

Some existing WG have

clearly overlapping EUDIAL

Inherited

Kidney

Disorders

Diabesity Renal

Nutrition

Immunonephrology

clearly overlapping

knowledge areas

CME committee

ERA-EDTA London Council Meeting Feb 22-24 2018

CME committee2016-2018

Loreto Gesualdo

Types of Courses

Three types of CME Courses or Educational activities:


TYPE A. ERA-EDTA Courses (Registry; ERBP; Working Groups;

Endorsed WGs; YNP; etc.)

TYPE B. ERA-EDTA Supported Courses.

TYPE C. ERA-EDTA Special Courses.

12 CME courses, pre-congress12 CME courses, pre-congress

Pre-Registration at least 1 month before the coursesPre-Registration at least 1 month before the courses

Continuous Education & Professional Development(CEPD)Continuous Education & Professional Development(CEPD)

All pre-registered participants will receive (by email)

before the ERA EDTA Congress the list of references

whereupon the CME courses are based

All pre-registered participants will receive (by email)

before the ERA EDTA Congress the list of references

whereupon the CME courses are based

The chairs and co-chairs will be responsible for collecting

pertinent literature that they should timely request to

the speakers

The chairs and co-chairs will be responsible for collecting

pertinent literature that they should timely request to

the speakers

COURSES Chair co-Chair

1. Basic and Translational Nephrology Romagnani (IT) Bruchfeld (SWE)

2. CKD Wiecek (POL) Stengel (France

3. Hypertension, Diabetes and CV disease in CKD Mallamaci (IT) Porrini (SP)

4. Primary and Secondary GN, vasculitis and auto-immune diseases Coppo (IT) Tesar (CZE)

COURSES Chair co-Chair

1. Basic and Translational Nephrology Romagnani (IT) Bruchfeld (SWE)

2. CKD Wiecek (POL) Stengel (France

3. Hypertension, Diabetes and CV disease in CKD Mallamaci (IT) Porrini (SP)


12 CME courses, pre-congress12 CME courses, pre-congress

Continuous Education & Professional Development(CEPD)Continuous Education & Professional Development(CEPD)


5. Bone Mineral disorders in CKD Ketteler (GER) Vervoelt (NETH)

6. Hemodialysis and Vascular access Blankestijn (NETH) Schroff (UK)

7. Peritoneal Dialysis Heimburger (SWE) Davenport (UK)

8. Renal Transplantation Abramowicz (BEL) Watschinger (AUST)

9. Genetic Diseases and rare diseases Devuyst (BEL) Kottgen (GER)

10. AKI Sever (TURKEY) Kribben (GER)

11. Electrolytes and renal lythiasis Wagner (SWITZ) Unwin (UK)

12. Nephropathology Becker (Germany) Cannata (Spain)


5. Bone Mineral disorders in CKD Ketteler (GER) Vervoelt (NETH)

6. Hemodialysis and Vascular access Blankestijn (NETH) Schroff (UK)

7. Peritoneal Dialysis Heimburger (SWE) Davenport (UK)

8. Renal Transplantation Abramowicz (BEL) Watschinger (AUST)

9. Genetic Diseases and rare diseases Devuyst (BEL) Kottgen (GER)

10. AKI Sever (TURKEY) Kribben (GER)

11. Electrolytes and renal lythiasis Wagner (SWITZ) Unwin (UK)

12. Nephropathology Becker (Germany) Cannata (Spain)

The Working Groups day and Nephrology Update

1,5-2,0 days (Friday/Saturday) in October just before the Fall-Council

To attract sponsorship by the industry and participation of WGs members


To attract sponsorship by the industry and participation of WGs members

beyond the WGs Boards, the WGs Day will contemplate

an educational session of about 4 hours whose contents (focused on topics

of clinical relevance) will be designed by the WGs chairs and preliminarily

approved by the CME , the Renal Science and Clinical Governance chairs.

The Council will eventually grant the final approval of these Nephrology

Updates.

- e-learning course (10 to 20 hours)

- Topic: scientific communication including “How to

Write a paper” and “How to make an

Renal Academy Course


Write a paper” and “How to make an

effective presentation/lecture”

This course will be developed with the help of

Bettina Albers.

To increase the attractiveness of nephrology to

medical students, the CME Committee will develop

Web-based platform for Medical Students


a web-based platform (Portal, Facebook page, Twitter and

Instagram) dedicated to medical students

Content: explaining the nephrology working scenario and

the career and research opportunities.

Of course young colleagues of the YNP will be involved.

ERA-EDTA Working Project

When I applied to become member of the ERA-EDTA council ,

the first point of my program was (posted on the ERA-EDTA

web side):


”Promotion of the scientific growth of the Association by stimulating the collaboration between European basic scientists and clinicians, an essential task to foster ERA-EDTA importance and prominence ”


1. original (no overlapping with the aims of existing

working group),

2 . open to the strong contribution of basic


2 . open to the strong contribution of basic

scientists, especially those that until now have not

been involved in the study of renal function (this

is the hallmark of the new group)

3. translational , i.e. with potential large clinical

implications


After many discussion and passionate debates on

the future of ERA-EDTA , the topic of the project will


the future of ERA-EDTA , the topic of the project will

be to explore :

The Brain- Kidney- Brain Circuit

ERA-EDTA Working ProjectWorking group

Carsten Wagner (Zurich)

Robert J. Unwin (London)

Ewout Hoorne (Rotterdam)


Ewout Hoorne (Rotterdam)

Sebastian Frische (Aarhus)

Francesco Trepiccione (Naples)

Davide Viggiano (Naples)

Vincenzo Di Marzo (Naples)

Erasmus Medical Center

Rotterdam, the Netherlands

Nephrology

Prof. Ewout J. Hoorn (145 publications, H-factor 29)

Expertise: Renal tubular function

Potential role in working group: Coordinate, integrate and translate the

neuroscience and neuro-epidemiological expertise in our center (below)

to serve the goals of the kidney-brain working project.

Neuroscience

Prof. Chris I. De Zeeuw (256 publications, H-factor 54)


Prof. Chris I. De Zeeuw (256 publications, H-factor 54)

Expertise: Regulation of sensorimotor integration

Potential role in working group: Expertise in pre-clinical mutant mouse

models including transporters relevant to brain and kidney.

Neuro-epidemiology

Prof. M. Arfan Ikram (523 publications, H-factor 54)

Expertise: Epidemiology of neurological diseases in the elderly

Potential role in working group: PI of the population-based Rotterdam

Study with access to extensive brain and kidney phenotypes and

genetics.

Department of Biomedicine

Aarhus University, Denmark

Renal Physiology

Assoc. Prof. Sebastian Frische (41 publications, H-factor 21)

Expertise: In vivo and quantitave imaging of brain, kidney and other

organs.

Potential role in working group: Design and conduct experiments in

rodents to address functional relationships between pathologies in

the kidney and the brain.


Specific project interest

How does the kidney respond to increased

intracranial pressure (ICP)?

Figure shows how increased ICP due to water

intoxication halts urine production in mice.

(unpublished data from our lab, Bordoni et al.)

Research tool:

Retrograde viral infection of renal innervation in rodents for optogenitic activation

Using a retrograde infection strategy, neurons innervating the kidney is infected to allow

optogenetic stimulation/inhibition of the renal nerves 1).

This model will allow in vivo measurement of a range of renal functions with

simultaneous control of renal neural stimulation by application by application of light.


simultaneous control of renal neural stimulation by application by application of light.

Example of use:

- Measurements of renal blood flow, SNGFR, and other funtional parametres by intravital

microscopy can be done in the presence and absence of renal neural activity, repeatedly

in the same animal

- Renal neural activity can be turned on and off in fully awake mice during telemetric

recording of blood-pressure and other vascular parameters

1) Packer, A. M., Roska, B., & Häusser, M. (2013). Targeting neurons and photons for

optogenetics. Nature Neuroscience, 16(7), 805–815. http://doi.org/10.1038/nn.3427

Unanswered questions(Davide Viggiano, Neaples)

1) Nerve fibers travel close to the vessels but do not contact

the tubules: how can they regulate tubular functions?→ Exp: transgenic mice expressing fluorescent nerve endings +

optogenetic; measure of nerve fibers and their activity by in vivo 2P

microscopy


2) Nerve fibers of the kidney can regenerate after lesion,

however the dynamics are not well described and the new

fibers might not carry the same effects as the original ones

(hemodynamics/tubular function/renin secretion)→ Exp: transgenic mice expressing fluorescent nerve endings and calcium

sensors+ renal denervation+optogenetic; measure of neurotransmitter

release with in vivo 2P microscopy of false fluorescent neurotransmitters,

immunofluorescence for CGRP/TH/Substance P

Unanswered questions

3) Are different nerve fibers regulating different kidney

function? Or the same fibers are using different 'codes' (eg

frequency codes)?

→ Exp: transgenic mice with optogenetic actuator and GFP-TH;

2P microscopy of the nerve activated renal tubule


4) What is the amount of neurotransmitter release as a

function of the pattern of depolarization of sympathetic

nerves?

→ Exp: transgenic mice expressing channel rhodopsin/GFP-TH;

measure of neurotransmitter release using false fluorescent

neurotransmitters

Unanswered questions5) Can the craving for salts (Bartter) be due to a signal from the

kidney to the brain?

→ Exp: Conditional knockouts for the Na/K/Cl co-trasporter +

renal denervation or spinal lesions interrupting ascending

pathways from the peripheral nervous system to the CNS;

measurement of salt craving (behavioral test)


6) How can the kidney induce behavioral alterations (e.g.

depression)?

→ Exp: Animal models of kidney disease + renal denervation (+

dialysis ?), monitoring of brain activity by fMRI, cytochrome

oxidase histochemistry, cfos /arc immunostaining, and 2P

imaging of activity-related fluorescent compounds + Behavioral

monitoring

Unanswered questions

7) How the kidney innervation influences the immune system

in the basal state and under pathological conditions

(glomerulopathies, hypertension)?

→ Exp: Animal models of kidney disease/hypertension + renal


→ Exp: Animal models of kidney disease/hypertension + renal

denervation; measurement of resident kidney

lymphocytes/macrophages by histology, immunohistochemistry

and flow cytometry

The brain-kidney axis

Approaches and technologies

• Build on European patient cohorts for genetic and clinical analyses (e.g. after renal

nerve ablation)

• Innovative model organisms using latest genetic technologies: e.g. CRISPR/Cas

combined with mouse/Xenopus/zebra fish


• Imaging technologies (e.g. intravital 2-Photon microscopy) in combination with

genetically encoded reporter dyes

• Interdisciplinary group of European top scienticists from Nephrology, Genetics,

Physiology, Pharmacology, Neuroscience, ....

• Partnership with non-European scientists (not funded through network)

The brain-kidney axisBackground

• Afferent and efferent innervation of kidney vasculature,

nephron, and interstitium

• Neuronal modulation of

• renal blood flow

• salt excretion

• renin-angiotensin II-aldosterone system


• renin-angiotensin II-aldosterone system

• Sensory systems in kidney

• Mechano- and flow sensors

• Metabolic sensors ?

• Neuronal crosstalk with renal immune system

• Clinical relevance

• nerve ablation for hypertension

• cognitive impairment and neuropathies of CKD patients

• common genetic/developmental pathways (disorders affecting kidney and

brain, e.g. deafness)

The brain-kidney axisMajor areas and open questions

Identification of genetic/developmental basis for diseases affecting brain and kidney

(from rare disease to population-based genetic approaches).

Identification of genetic susceptibility factors for CKD-related neuropathies, neuronal

factors in hypertension,....


factors in hypertension,....

Cellular and molecular mechanisms of neuronal control of kidney function

Crosstalk of sensory systems in kidney and brain in control of metabolism and

homeostatic functions (blood pressure, acid-base, phosphate, glucose...)

Neuronal modulation of renal immune cells: relevance for AKI and CKD

Position documents by global institutions

https://noharm.org/

Interaction between health/disease and environment is bi-directional

Effect of climate change / environment on health

Effect of health care sector on environment

This is in conflict with: Primum non nocere.

Effect of climate change / environment on health

Lancet Planet Health 2017; 1: e267-76

Lancet Planet Health 2017; 1: e261-2

Examples within Nephrology

• Out patients clinic:

– e-health, video-consultation, and other modern i-technology

– home BP, home blood sampling, etc.

• Explorative talks with dialysis industries

– Fresenius: Marcus Menzer, Alessio Orlandi, Rino Marano

– BBraun: Martin Kuhl

– Baxter: Angelito Bernardo

– Medtronic: no response

Examples

First edition: 2011

Examples

www.greendialysis.org

The ERA-EDTA should recognise sustainability as a domain of quality in healthcare and will therefore start to define actions to be undertaken by the organization to support the creation of carbon smart health care. Areas of activities include: clinical care,

What can the ERA-EDTA do?

carbon smart health care. Areas of activities include: clinical care, research and education.

Sustainable healthcare education is teaching and learning which prepares future health professionals to promote sustainable health and deliver sustainable health care.

Concrete actions to be undertaken by the ERA-EDTA

• Increase awareness– Put subject on the program of annual (and other) meetings

– Invite experts to give presentations and/or produce topic papers in NDT / CKJ

– Create / organize educational activities

• Initiate, support and/or provide platform for initiatives, task forces etc. • Initiate, support and/or provide platform for initiatives, task forces etc. – Addressing topics, discussions with stake holders, in particular industries, but

also policy makers, “sister” organizations within and outsite nephrology, etc.

– Defining research questions

• Provide platform for reporting progress of initiatives, share experiences, etc.

• Organize meetings in a “green” way

Activities by the ERA-EDTA

• 2018– Open slots in the program? Change subject of my lecture in EuDial CME

– Introduce the topic in opening speech by President

– Organize meeting in Copenhagen with industries to discuss activities

– Article in NDT, which will be released during Copenhagen meeting.

– Start discussions with ASN, ISN, other societies China, Japan etc. – Start discussions with ASN, ISN, other societies China, Japan etc.

• 2019– Organize special sessions, invited speakers

– Invited articles in NDT

– Etc.

• 2020

ERA-EDTA

members

Non-kidney sister

organisations

European Commission

Interactions of ERA-EDTA with others

industries ASN, ISN etc.

European Commission

Governments

Regulatory authorities

Etc.

CleanMed 2018May 7-9, 2018 | San Diego, California

Sheraton San Diego Hotel & Marina http://cleanmed.org/

Europe's leading conference on

sustainable healthcare

http://www.cleanmedeurope.org

The ERA-EDTA should recognise and accept its responsibility, task

and opportunity to “translate” the general aims formulated by

global institutions into concrete action within the nephrology. The

ERA-EDTA needs to become an active contributor to the global task

Conclusions

ERA-EDTA needs to become an active contributor to the global task

to transform to a more climate smart health care and “lead by

example”.

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