ISN WCN 2021, MONTREAL, CANADA
POSTER SESSION: TRAINING
POS29
15/04/2021
Poster Area
05:00 – 06:00
POS-817
DIAGNOSTIC AND INTERVENTIONAL
NEPHROLOGY IN ECUADOR: CURRENT AND
FUTURE STATUS
CHEDIAK, C*1, Mendieta, L2, Oñate, M2, Silva, T3, Santacruz, J4,
Orna, M2
1
Hospital Vozandes Quito- Hospital General Docente de Calderón,
Nephrology, Quito, Ecuador, 2Hospital General Docente de Calderón,
Nephrology, Quito, Ecuador, 3Hospital de Especialidades Carlos Andrade
Marín- Hospital Vozandes Quito, Nephrology, Quito, Ecuador, 4Menydial,
Nephrology, Quito, Ecuador
Introduction: The care of chronic kidney disease patients frequently
involves many diagnostic and interventional procedures. Most of these
procedures are currently performed by radiologists, vascular surgeons,
and general surgeons. This has caused fragmented medical care,
generating long waiting lists, and limiting diagnosis and treatment.
Diagnostic and Interventional Nephrology (DIN) has been a rising field
in recent years worldwide. Current status and clinical significance of
interventional nephrology has not been reported from Ecuador.
Methods: Descriptive cross-sectional study based on a survey carried
out to all nephrologists in Ecuador through social networks through the
Ecuadorian Society of Nephrology during July to September 2020.
Results: Of the 180 nephrologists in Ecuador, 68 (37,7%) responded,
belonging to 22 hospitals, from 9 out of 24 provinces and mostly
(57,4%) trained in Ecuador. Of them, 55,9% (38) had their own ultra-
sound (US) equipment, 55,9% (38) were formally trained to perform
renal US during their residency and all (100%) considered that
nephrologist in Ecuador should be more interventional and that
training in US should be more uniform.
In terms of renal ultrasound imaging, 95,6% (65) do two- dimensional
native renal US and 44,1% (30) transplanted kidneys. Less frequently they
perform renal Doppler (Color Doppler, Power Doppler, and pulsed Doppler
as appropriate in 36,8%, 23,5% and 17%) and contrat enhanced renal US
(13,2%). Regarding other types of US: AV- fistula (AVF) US is done by
51,5% (35) and prostate US by 32,4% (22). A smaller proportion can
perform in order of frequency: lung (25%), carotid (25%) and parathyroid
(10,3%) US and only few echocardiogram (8,8%). (Figure 1)
For canalization of temporary vascular accesses, real- time US is used
in 57,4% (39) of the jugular and 44,1% (30) of the femoral accesses.
Ninety-five percent (65) insert tunneled jugular catheters and
92,6%(63) tunneled femoral catheters, of which 60% (39) and 38% (24)
were US-guided, respectively. (Figure 2)
Up to 54,5% (37) perform native renal biopsies, of which 13.5% (5)
are real-time US guided by nephrologists. Of all nephrologists: 83,8%
(57) remove tunneled catheters; 39,7% (27) insert peritoneal catheters;
30,9% (21) remove peritoneal catheters, 25% (17) place AVF and 5,9%
(4) insert nephrostomies.
Median of performed US was 4,5 (IQR:0-18,7) per month; of HD-
catheters placed 5 (2,25-10) per month; of peritoneal catheters 0 (IQR 0-
2,75) per year and of kidney biopsies 2 (IQR: 0-10) per year.
Kidney International Reports (2021) 6, S1–S362
Conclusions: DIN is slowly spreading in Ecuador. Development of DIN
in Ecuador will allow nephrologists to be more independent, efficient,
reduce waiting times and costs, and improve patient care. Therefore,
appropriate training on different techniques is necessary.
No conflict of interest
POS-818
ESTABLISHING AN EFFECTIVE CLINICAL DATA
COLLECTING TOOL FOR PROPER EVALUATION
OF RENAL BIOPSY
FATANI, R*1, Al Qa’qa’, S1, Geldenhuys, L2, Avila-Casado, C3
1
University of Toronto, Laboratory Medicine and Pathobiology, Toronto,
Canada, 2Dalhousie University, Pathology, Halifax, Canada, 3University
Health Network-Toronto General Hospital, Pathology, Toronto, Canada
Introduction: The renal biopsy is currently being used to ach-
ieve optimal patient care in the era of personalized and precision
medicine. Indeed, clinicopathological correlation is mandatory to
establish an accurate diagnosis of kidney diseases. Otherwise, the final
pathology report would only be describing patterns of injury which
will not help the treating physician to decide the appropriate therapy.
Clinical information oriented to the kidney diseases such as history,
physical examination, investigation and management plan, is not al-
ways accessible for renal pathologists. With the advances in technol-
ogy, our aim is to create a quality-improved, standardized, uniform,
electronic, efficient, and environmentally friendly clinical data collect-
ing form to be completed for each renal biopsy request.
Methods: Thirty-three renal pathologists with various levels of expe-
rience in Canadian health care institutions, all of them members of the
Canadian Society of Pathology, Renal Pathology Working Group, were
invited individually by e-mail to respond to a survey. The sur-
vey comprised two parts: native and transplant renal biopsies. The
questions in the survey pertained to the necessity of inclusion of spe-
cific elements of clinical information in the categories of history,
physical examination, investigations and management plan. Based on
the responses to the survey and comments, the pilot preliminary form
was modified. Upon our institutional Quality Improvement Review
Committee (QIRC) review, a formal waiver of the requirement for REB
(Research Ethics Board) approval was obtained. PDF files of the clinical
data collecting form were distributed to more than 80 nephrologists by
e-mail. These forms could only be completed electronically, and no
handwriting was permitted. The nephrologists were encouraged
to complete these forms for hypothetically patients or real patient data.
Estimated time for completing the form was recorded. Nephrologists
also made some comments on the form itself. Simultaneously, a further
short survey to measure the satisfaction of all users was sent.
Results: Twenty renal pathologists representing 14 different academic
centers, completed the survey. The rate of agreement on the survey
questions ranged from 38.89% to 100.00%. On the other hand, 21
nephrologists and their assistants have responded. Average time needed
to complete a PDF form is 11.11 minutes (ranges between 6 and 20
minutes). Few nephrologists considered it too long and they have no
enough time to complete it. Overall, the suggestions were to modify it
and make it more clinically relevant. Among survey respondents, 50%
were satisfied with using these forms and the same percentage of those
clinicians would recommend it to their colleagues.
Conclusions: Clinical data is important for an accurate diagnosis in
renal pathology. An electronic, efficient, and environmentally friendly
clinical data collecting form was developed through consensus by renal
pathologists in Canada. We have tested the form by sending it to the
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