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
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
Types of Courses
Three types of CME Courses or Educational activities:
ERA-EDTA London Council Meeting Feb 22-24 2018
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)
4. Primary and Secondary GN, vasculitis and auto-immune diseases Coppo (IT) Tesar (CZE)
12 CME courses, pre-congress12 CME courses, pre-congress
Continuous Education & Professional Development(CEPD)Continuous Education & Professional Development(CEPD)
4. Primary and Secondary GN, vasculitis and auto-immune diseases Coppo (IT) Tesar (CZE)
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)
4. Primary and Secondary GN, vasculitis and auto-immune diseases Coppo (IT) Tesar (CZE)
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
ERA-EDTA London Council Meeting Feb 22-24 2018
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
ERA-EDTA London Council Meeting Feb 22-24 2018
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
ERA-EDTA London Council Meeting Feb 22-24 2018
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):
ERA-EDTA London Council Meeting Feb 22-24 2018
”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 ”
ERA-EDTA Working Project
1. original (no overlapping with the aims of existing
working group),
2 . open to the strong contribution of basic
ERA-EDTA London Council Meeting Feb 22-24 2018
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
ERA-EDTA Working Project
After many discussion and passionate debates on
the future of ERA-EDTA , the topic of the project will
ERA-EDTA London Council Meeting Feb 22-24 2018
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)
ERA-EDTA London Council Meeting Feb 22-24 2018
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)
ERA-EDTA London Council Meeting Feb 22-24 2018
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.
ERA-EDTA London Council Meeting Feb 22-24 2018
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.
ERA-EDTA London Council Meeting Feb 22-24 2018
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
ERA-EDTA London Council Meeting Feb 22-24 2018
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
ERA-EDTA London Council Meeting Feb 22-24 2018
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)
ERA-EDTA London Council Meeting Feb 22-24 2018
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
ERA-EDTA London Council Meeting Feb 22-24 2018
→ 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
ERA-EDTA London Council Meeting Feb 22-24 2018
• 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
ERA-EDTA London Council Meeting Feb 22-24 2018
• 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,....
ERA-EDTA London Council Meeting Feb 22-24 2018
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
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.
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
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/
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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