UHS Medical Times March 2017

UHS Medical Times 1

Newsletter |March 2017

WORLD KIDNEY DAY The awareness drive that bring widespread attention to the importance of kidney health is celebrated every second Monday of March. Established in 2006, World Kidney Day was a joint initiative of International Society of Nephrology (ISN) and the International Federation of Kidney Foundation (IFKF). It aims to highlight the risk elements that bring about Chronic Kidney Disease (CKD). The primary goal of this initiative is to inform the public about the management of CKD as well as to encourage the masses to consider kidney donation and transplantation as an effective way to support those suffering from kidney failure.

This year’s theme for World Kidney Day is Kidney Disease and Obesity, Healthy Lifestyle for Healthy Kidneys. The association of obesity and kidney disease and promoting a healthy lifestyle are being magnified in this year’s subject.

Practice

Healthy Lifestyle

THEME OVERVIEW In the recent World Health Organization global estimate, worldwide obesity has more than doubled since 1980. Three years ago, more than 1.9 billion adults (18 years and older), were overweight. Of these over, 600 million were obese. Not only adults, it also affects children. In fact, 41 million youngsters worldwide under the age of 5 were overweight or obese in 2014.

Furthermore, majority of the world's populace live in countries wherein overweight and obesity kills more people than underweight.

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FIGURES IN UAE An analysis made by Global Burden of Disease Study suggested that more than 66 percent of men and 60 percent of women in the United Arab Emirates are overweight or obese. In Dubai, more than 36 percent of men and 30 percent of women are overweight, with 11.9 percent people being obese, as stated by a health survey conducted by the DHA in collaboration with Dubai Statistics Centre. For the predominance of diabetes in this part of the world, there were over 1 million cases of diabetes in 2015 that is according to the International Diabetes Federation.

Having all that ďŹ gures, we can infer that CKD is particularly prevalent in the UAE. Claimed by the latest reports, there are more than 2,000 UAE residents who have CKD and need kidney dialysis.

The ďŹ gure is rising per annum by minimum 10 percent.

Kidney Diseases are Rapidly Increasing Affecting all Age Groups and Gender Major Cause

Lifestyle & Obesity

OBESITY AND KIDNEY DISEASE

There are many numbers of health conditions that can ascend from being overweight and obese. Chances are if you are overweight or obese, you have a bigger possibility of developing diabetes and high blood pressure or hypertension, which are the foremost causes of kidney disease and kidney failure.

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Newsletter |March 2017

ANATOMY OF KIDNEYS The kidneys are bean-shaped organs, roughly a size of a fist. In a more accurate measurement, the average size of an adult human kidney is about 10 to 13 cm (4 to 5 inches) long, approximately 5 to 7.5 cm (2 to 3 inches) wide and about 2 to 2.5 cm (1 inch) thick. These organs are not symmetrical in position. The left kidney is located slightly higher than the right kidney due to the bigger size of the liver on the right side of the body. The kidneys lie behind the peritoneum that lines the abdominal cavity and are thus deliberated to be retroperitoneal organs. Each kidney contains nephrons that act as microscopic filter for blood.

WHAT KIDNEY DOES? The kidneys' functions are to clean the blood. The blood in our body continuously passes through the kidneys. The kidneys remove wastes, control the body's fluid balance, and regulate the balance of electrolytes. As the kidneys filter blood, they create urine, which collects in the kidneys' pelvis -- funnel-shaped structures that drain down tubes called ureters to the bladder.

The waste product of the blood comes from normal activity and from digesting food. The body uses food as a fuel to energy and self-repairs and after it has taken what it needs, the waste products are sent to the blood. If for instance the kidney did not filter the blood for waste product, the toxins will build up and damage the body. It's possible to lose as much as 90% of kidney function without feeling any symptoms or problems.

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Newsletter |March 2017

WHAT CAUSES THE DAMAGE IN THE KIDNEYS? Chronic Kidney Disease (CKD) take place when an ailment or condition impairs kidney function, causing kidney damage to worsen over several months or years.

The two most common causes of CKD – Diabetes and Hypertension, these two are responsible for two thirds of all CKD cases.

Diseases and Conditions that Cause Chronic Kidney Disease Includes: Type 1 or Type 2 Diabetes – High blood sugar levels in the body can damage several organs in the body including the kidneys.

High Blood Pressure - Uncontrolled High Blood Pressure can cause arteries around the kidneys to narrow, weaken or harden. These damaged arteries will not able to deliver enough blood to the kidney tissue resulting in the kidneys losing the ability to filter blood and regulate fluid, hormones, acids and salt in the body.

Glomerulonephritis - an inflammation of the kidney's filtering units (Glomeruli).

Interstitial Nephritis - an inflammation of the kidney's tubules and surrounding structures.

Polycystic Kidney Disease - Prolonged Obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers.

Vesicoureteral Reflux - a condition that sends urine back to the kidneys.

Recurrent Kidney Infection - also called pyelonephritis.

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Newsletter |March 2017

SIGNS AND SYMPTOMS OF KIDNEY PROBLEM The manifestations of a chronic kidney disease develop over time if kidney damage progresses slowly. Kidney disease is often nonspeciďŹ c; they can also be caused by other illnesses. Because kidneys are highly adaptable and able to recompense for its loss of function, signs and symptoms may not appear until permanent damage has happened.

Indications of a kidney disease may include:

Nausea and Vomiting

Loss of Appetite

Muscle Spasms and Cramps

Bulging of Feet and Ankles

Tiredness and Weakness

Itching

Sleep DifďŹ culties

Chest Pain

Changes in the Amount of Urine

Shortness of Breath

Reduced Mental Sharpness

Uncontrolled High Blood Pressure (Hypertension)

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Newsletter |March 2017

DIAGNOSTICS AND LABORATORY TESTS FOR CHRONIC KIDNEY DISEASE Timely testing is essential to early recognition of Chronic Kidney Disease (CKD).

Taking appropriate action at an early stage of CKD will help your kidneys work longer and defer the need for dialysis.

The ďŹ rst step toward diagnosis of kidney disease is your physician discusses personal and family medical history with you. Among other things, he/she might ask questions about whether you've been diagnosed with high blood pressure, taken a medication that might affect kidney function and if you have noticed changes in your urinary habits. Your doctor will perform a physical assessment. He/she will also check for signs of problems with your heart or blood vessels, and conducts a neurological exam.

For kidney disease diagnosis, you may also need certain tests and procedures, such as:

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LOREM bIOPSY IPSUM 05 KIDNEY

Blood Tests

kidney Disease Diagnosis 02

04 Imaging Tests 03 Newsletter from University Hospital Sharjah

Glomerular Filtration Rate (GFR)

Urine Tests

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Newsletter |March 2017

Blood Tests Kidney function tests look for the level of waste products, such as creatinine and urea in your blood.

Glomerular Filtration Rate (GFR)

This test is a measure of how well the kidneys are removing wastes and excess uid from the blood. It is measured by the calculation from serum creatinine level using age, weight, and gender and body size. GFR can vary according to age because as you get older it can decrease.

The normal value for GFR is 90 or above. Below 60 is a sign that the kidneys are not working properly, GFR below 15 shows that treatments for kidney failure likely dialysis or kidney transplantation will be needed.

Urine Tests Studying a sample of your urine may tell irregularities that point to chronic kidney failure and help categorize the cause of chronic kidney disease.

Imaging Tests The use of ultrasound to assess your kidneys' structure and size; other imaging test may be used in some cases like CT scan.

Kidney Biopsy Your physician may recommend a kidney biopsy to remove a sample of kidney tissue. It is done under local anesthesia. Kidney biopsy is often done by means of a thin needle with a sharp cutting edge that's inserted through your skin and into your kidney to slice small pieces of tissue for analysis under a microscope. The biopsy sample is sent to a laboratory for testing to help determine what's causing your kidney problem.

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Newsletter |March 2017

TREATMENT FOR CHRONIC KIDNEY DISEASE Depending on the primary cause, some types of kidney disease can be treated. However, chronic kidney disease is incurable.

Management comprises of measures to help control signs and symptoms, decrease complications, and slow progression of the disease. If your kidneys become severely damaged, treatment for end-stage kidney disease needs to be initiated.

Treating the cause Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary, depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled.

Treating the complications Kidney disease complications can be controlled to make you more comfortable.

Treatments may include: Medications for Hypertension People with kidney disease may experience worsening high blood pressure. The doctor may recommend drugs to lower blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you may need frequent blood tests to monitor your condition. Your physician might also recommend a water pill (diuretic) and a low-salt diet.

Medications to Lower Cholesterol Levels Statins are medications your doctor might prescribe to lower cholesterol. People with chronic kidney disease mostly suffer from high levels of bad cholesterol. This condition will increase their risk of heart disease.

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Newsletter |March 2017

Medications to Correct Anemia Supplements of the hormone erythropoietin in certain situations the doctor may recommend to aid in the production of more blood cells. Erythropoietin supplements aid in production of more red blood cells, which may relieve fatigue and weakness associated with anemia.

Medications to Relieve Swelling People with chronic kidney disease may hold fluids in their body that can lead to swelling in the legs and also high blood pressure. Diuretics are medications that help maintain the balance and remove excess fluids in the body.

Medications to Protect Your Bones Calcium and Vitamin D are supplements to prevent weak bones and lower the risk of fracture.

The doctor might also prescribe medication known as a phosphate binder to lower the amount of phosphate in your blood, and safeguard the blood vessels from damage by calcium deposits (calcification).

Low Protein Diet This is to minimize waste products in the blood. The body processes protein from foods creating waste products that kidneys must filter from blood. To reduce the amount of work your kidneys, your physician may recommend eating less protein. Your doctor refer you to a clinical dietitian who can discuss about this dietary regime and suggest ways to lower your protein intake while still eating a healthy diet.

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Newsletter |March 2017

TREATMENT FOR END-STAGE KIDNEY DISEASE If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.

Dialysis

Dialysis is a way of cleaning the blood when kidneys can no longer do its function. It gets rid of the body's waste, extra salt and water, and helps to control your blood pressure. There are two kinds of dialysis, peritoneal and hemodialysis.

1.

Peritoneal Dialysis A surgical procedure is done to place a plastic tube or catheter in the belly. A sterile cleaning solution is placed into your abdomen through this catheter. After the filtering process is finished, the fluid leaves your body through the catheter.

2.

Hemodialysis Hemodialysis is a treatment to filter wastes and water from your blood, allowing people with kidney failure to feel better and continue the things they enjoy. Before initiating dialysis, a vascular surgeon will create an “access”. The access serve as a site usually in the arm, where blood can be safely removed and returned to the body.

Hemodialysis at UHS University Hospital Sharjah has 6 fully operational dialysis unit; open from 07:00 am to 07:00 pm, Saturday to Thursday.

It has a Nikkiso Dialysis System – a flexible dialysis system to drive advanced treatment. The most important feature of this system is that, it has the capacity to adapt itself to the varying needs of patients.

Nikkiso Dialysis System

Kidney Transplantation A kidney transplantation involves surgically placing a healthy kidney from a donor to the body of a person with diseased kidney. Transplanted kidneys can come from a dead or living donors. The recipient of the new kidney will have to take medication for his/her entire life to prevent his/her body rejecting the new kidney.

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Newsletter |March 2017

TEAM AT UHS

QUALIFICATIONS Dr. Guella gained his MD degree at the Faculty of Medicine, University of Oran, Algeria and completed his French Board in Nephrology (C.E.S; Certificat d’ Etudes Speciales de Nephrologie) from the Faculty of Medicine of Lille, France.

EXPERIENCE Dr. Adnane has 28 years’ experience in the diagnosis and treatment of acute and chronic kidney diseases, follow-up and care of dialysis patients as well as preparation, evaluation and follow-up of kidney transplant patients. His expertise includes also acute dialysis (CRRT) in intensive care unit, vascular access catheter insertions, and renal biopsy.

He has special interest and expertise in all Apheresis techniques (plasmapheresis, cascade filtration, LDL – Apheresis, Red cell apheresis, platelet apheresis, leukapheresis and photopheresis). He performed the first LDL-Apheresis (1998) in the Arab World, using Cobe ultracentrifugation machine in two patients with familial hypercholesterolemia and the first red cell apheresis (2004) in a patient with sickle cell crisis.

Dr. Adnane Guella MD, CES/French Board in Nephrology Consultant Nephrologist

Dr. Adel completed his Iraqi Board for Cardiovascular and Thoracic Surgery in 2003 after obtaining his basis medical education from University of Baghdad in 1993. He is a member of the Royal College of Surgeons (MRCS), UK and the European Society for Vascular Surgery (ESVR) in addition to being a Fellow of the American College of Surgeons (FACS).

Thanks to his efforts and passion to medical research, he recently obtained Fellowship of the Peripheral Endovascular Intervention in Kiel University, Germany and Fellowship of Aortic Aneurysm Endograft Repair also in Kiel University, Germany.

He is an active member in the European Society for Vascular Surgery (ESVR), Denmark where he participated in various conferences and training courses for surgeons. Huge scientific, medical and academic support was provided by this society in various vascular fields for all vascular surgeons in UAE.

EXPERIENCE

Fellow of the American College of Surgeons (USA), Fellow of the Peripheral Endovascular Intervention (Germany), Fellow of the Aortic Aneurysm Endograft Repair (Germany), Member of the Royal College of Surgeons(UK), PhD in Cardiovascular Surgery Consultant Vascular and Thoracic Surgeon

SPECIAL INTEREST

Kidney Diseases Acute Dialysis Chronic Dialysis Kidney Transplantation Hypertension Apheresis

LANGUAGE KNOWN Arabic, English and French

Prior to joining UHS, Dr. Adnane was Consultant Nephrologist and Head of the Nephrology division of King Fahd Military Medical Complex, Dhahran, Saudi Arabia, where he was also involved in renal transplantation from living and cadaveric donors.

QUALIFICATIONS

Dr. Adel Aswad

Dr. Adnane got his initial training in France and was associated with various hospitals in France including Amiens University Hospital, Lille University Hospital and Roubaix General Hospital.He has authored several scientific papers in peer reviewed journals in the field of nephrology and transplantation and is widely published in medical journals.

He is also reviewer for the American Journal of Kidney Diseases. He received an award from the International Society of Nephrology in Sydney for young first author of a poster.

Dr. Adel Aswad, a Consultant Cardiovascular and Thoracic Surgeon with intensive experience in the treatment of vascular and thoracic diseases and surgical pathologies especially the management of vascular and thoracic emergencies. Before joining UHS as Vascular and Thoracic Surgeon, he has worked in a reputable government hospital in Sharjah for 11 years.

His clinical interest includes surgical and endovascular intervention for vascular access creation for hemodialysis unit including permanent catheterization and vascular direct autogenous/graft anastomosis for the same purpose. He has also a thorough experience in thoracic surgery includes diagnostic/therapeutic bronchoscopies.

Newsletter from University Hospital Sharjah

Academically, he is at present a faculty member of the Royal College of Surgeons of England in basic surgical skills training courses held at Surgical Training Centre of University of Sharjah and an Assistant Professor for Thoracic and Vascular Surgery in M. Gorky Donetsk Medical University in Ukraine.

In his efforts to promote vascular awareness, Dr. Adel participated in many conferences, courses and scientific symposia both locally and internationally. He also presented medical publications to international medical journals for surgical cases including removal of tumors and chest wall reconstruction.

SPECIAL INTEREST Cardiovascular Surgery Thoracic Surgery Trauma Surgery including Rescue and Limb Rehabilitation Varicose Surgery and Lower Limb Venous Diseases Surgical Intervention and Endovascular Endograft for Aortic Aneurysm Repair Surgical and Endovascular Intervention for Carotid Artery Stenosis/Occlusion

Surgical Management and Interventions for Various Vascular Diseases

Surgical and Endovascular Intervention for Vascular Access Creation for Hemodialysis Surgical and Endovascular Interventions for Peripheral Vascular Diseases Diagnostic/Therapeutic Fiber Optic/Rigid Bronchoscopic Surgery

LANGUAGE KNOWN Arabic, English, German, Ukrainian

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Newsletter |March 2017

SCOPE OF SERVICES AT UHS MEDICAL SERVICES

SURGICAL SERVICES

CARDIOLOGY

NEUROPHYSIOLOGY

Anesthesiology

Bariatric Surgery

24-Hour BP Monitoring

Electroencephalogram (EEG)

Aviation Medicine

Ears, Nose and Throat Surgery

24-Hour Holter Monitoring

Electromyography (EMG)

Cardiology

General Surgery

2D/3D Echo

Evoked Potential Test

Critical Care

Neurological Surgery

3D Transesophageal Echo

Brain Auditory Evoked Potential

Dermatology

Obstetrics and Gynecologic Surgery

CT coronary Angiography

(BAEP)

Emergency Medicine

Ophthalmic Surgery

Somato Sensory Evoked Potential

Endocrinology

Orthopedic Surgery

Dobutamine Stress Echo for Ischemia and Viability Studies

Family Medicine

Pediatric Surgery

Gastroenterology

Plastic and Reconstructive Surgery

Internal Medicine

Urologic Surgery

Medical Oncology

Vascular Surgery

Neonatology Nephrology Neurology Pediatrics Psychiatry Pulmonology Rheumatology MEDICAL DIAGNOSTICS IMAGING (MDI) 128 Channel CT Scan with Coronary and Cardiac Facility

PATHOLOGY & LABORATORY MEDICINE

Interventional Cardiology Stress Test

(SSEP) Visual Evoked Potential ( VEP) Nerve Conduction Studies (NCS)

Treadmill Stress Test

AUDIOLOGY

OTHER SPECIALTY SERVICES

Biochemistry

Acoustic Reflex Threshold

24/7 Emergency Services

Blood Transfusion Medicine

Auditory Brainstem Response

Ambulance

Cytology

Auditory Steady State Response

Hemodialysis

Hematology

Cochlear Implant Mapping

Physiotherapy

Histology

Electrocochleography

Pharmacy

Immunology

Free Field Audiometry

Sharjah Breast Centre

Microbiology

Hearing Aid Fitting and Programming

Phlebotomy

Newborn Hearing Screening

Bone Densitometry

Otoacoustic Emission

Digital X-Ray and Fluoroscopy

Pure Tone Audiometry (PTA)

Mammography and Guided Breast Intervention

Speech Audiometry

MRI 1.5 TESLA

Tinnitus Evaluation

Ultrasound

Tympanometry

Vascular Interventional Lab

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