The IX t h Makassed Medical Congress - American University of Beirut

T h e I X t h M a k a s e d M e d i c a l C o n g r e s s
POSTERIOR URETHRAL VALVES, CURRENT PERINATAL AND LONG TERM
MANAGEMENT
Alaa EL GHONEIMI, MD, PhD, FEBPS, FEAPU
“Thrombosis, both venous and arterial, is a major cause of morbidity and mortality worldwide.
Consequently, there is an ongoing search for new antithrombotic drugs, particularly novel
anticoagulants. Recently, this armamentarium undergoes a major change with the introduction
of new specific and oral anticoagulants that are likely to fulfil many of the unmet needs of
current warfarin and heparin therapies. A direct thrombin inhibitor, dabigatran etexilate, and
a direct factor Xa inhibitor, rivaroxaban are actually marketed for an easier and safer venous
thromboembolism prevention following orthopaedic surgery.
Large ongoing trials try todemonstrate that these drugs would also simplify and optimize
stroke prevention in atrial fibrillation, treatment of venous thromboembolism and prevention of
ischemic events in acute coronary syndrome. This presentation reviews the latest developments
of new anticoagulants and focuses on those which have been approved or are in advanced
development”.
NEPHROPROTECTION IN PEDIATRICS
Georges Deschênes M.D, Ph.D
Nephroprotection is an advanced form of the conservative treatment of chronic renal failure that aims at
preventing the progression of chronic renal disease to end stage renal failure, whatever the level of the
glomerular filtration rate. All patients with a history of congenital or acquired renal disease that is known
to decrease the nephron mass are concerned: congenital abnormalities of the kidney and urinary tract,
polycystic diseases, chronic glomerular disease (Berger-Hinglais disease, Alport syndrome, membranous
and membranoprolipherative glomerulonephritis, lupus nephritis and autoimmune vasculitis), acute
and chronic haemolytic and uremic syndromes. In addition, nephroprotection also concerns patients
with a systemic disease potentially affecting the kidney: diabetes mellitus, sickle cell disease, metabolic
syndrome, essential hypertension, obesity and also history of low birth weight for term.
Chronic renal disease is now classified according to the level of glomerular filtration rate: Stage 1: >
90 ml/min/1.73 m²; Stage 2: 60-90 ml/min/1.73 m²; Stage 3: 30-60 ml/min/1.73 m²; Stage 4: 15-30 ml/
min/1.73 m²; Stage 5 < 15 ml/min/1.73 m² representing end stage renal failure. The most determinant
factors of progression of renal disease are proteinuria/microalbuminuria and hypertension that
have to be both carefully controlled using drugs modifying the renin-angiotensin-aldosterone
axis. Inhibitors of angioconvertase (ACEi) and antagonists of the angiotensin-2 receptor (ARA-
2) have definitely proven their efficiency to prevent the progression or chronic renal disease.
The targets of these therapies are to maintain the blood pressure at the 50 th percentile and the
level of microalbuminuria below 3 mg/mmol of urine creatinine. Other factors able to aggravate
the status of chronic renal disease include anemia, carbohydrate intolerance, hyperuricemia
and dyslipidemia. Anemia has to be controlled by supplements in iron, vitamine B6 and B12,
and erythropoietic stimulating agents, carbohydrate intolerance by a specific diet and insulin id
needed, hyperuricemia by administration of allopurinol and dyspipidemia by the administration
of statins. Of note, 1/ chronic renal disease and most of the associated factors of progression to
renal failure are also factors at risk of cardiovascular disease in the adult age; 2/
Drugs used to control the progression of chronic renal disease are also efficient to prevent the
cardiovascular risk at adult age.
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