Proposal Of Collaboration For Establishment Of Nephrology Practice

By:
Prof. Gamal Saadi
Prof of Internal Medicine & Nephrology Cairo University
President of ETS & ASOT
Prof. May Hassaballa
Prof of Internal Medicine & Nephrology Cairo University
President elect of Egyptian Society of Nephrology & Transplantation ESNT
Chair of Registration chapter ESNT
Prof. Fatina Fadel
Prof of Pediatric Nephrology Cairo University
Head of Pediatric Nephrology Unit Abo ElReesh
Chair of Interventional Nephrology Chapter ESNT

We would offer at Egyptian centers training facilities in the field of nephrology including critical nephrologic care, renal biopsies and nephropathology, management of glomerulonephritis and CKD, hemodialysis and transplantation for adult and pediatric practice to nephrologists and nurses.
There will be facility for training periods ranging from 3 to 12 months as well as longer fellowships including applying to postgraduate degrees or training diplomas. Specialized nurses diplomas are also available.

(A) Kidney Transplantation Program

[I] Man Power

(1) Nephrologists: to include a consultant and minimum of 2 Junior trainees to be trained for a period of 3 months to get acquainted with:
- Preparation of Recipients and Donors
- Perioperative care
- Graft biopsies
- Immunosuppression and management of rejections
- Infections related to immunosuppression
- Other transplantation related complications
- Management of Hypertension, NODAT, Anemia, MBD, etc,
- Tx in selected cases as FSGS

Trainers: [Fees of group 2000 $ / month]
- Supervisor
- Consultant
- Coordinator
- Assistant

(2) Nurse: to include 3 nurses to be trained for a period of 3 months to get acquainted with:
- Postoperative care
- Infection control
- Fluid and electrolyte balance

Trainers: [Fees of group 600 $ / month]
- Head Tx nurse
- Attending nurse
- Infection control supervisor

(3) Pathologist: to include 2 pathologists (provided a trained technician is available) to be trained for a period of 2 months to get acquainted with:

Acute and chronic Cell MR
Acute and chronic AMR
Drug Toxicity
Recurrence of original disease
Viral infections

For the pathology technician if not available:
Processing
Cutting
Special stains
Basics of immunohistochemistry
[Training fees additional 600 $ for 2 months training]

Trainer: [Fee of supervisor 2000 $]
Nephropathology expert

(4) Clinical Pathologist: to include 2 clinical pathologists and 2 technicians to be trained for a period of 2 months to get acquainted with:
- Luminex
- SSO (Sequence Specific Oligotyping)
- PCR
- Lymphocytotoxicity
- Lymphocyte cross match
- HLA typing
- DSA Luminex testing
- Drug monitoring
- Virology antibodies and PCR
- ABO Rh and routine Laboratory

Course of 2 months 4 days per week including 8 lectures and practical work with follow up training including consumables for 1000 $
Trainers: [Fees of group 2500 $ for the 2 months course]
[Training technicians if included 500 $ for course]
[Total 4000 $ per course]

(5) Transplant surgeon: to include 2 surgeons to be trained for a period of 1 month to attend 12 cases

Trainers: [Fees of group 4000 $ / month]
Donor Surgeon
Recipient bed
Vascular anastomosis
Ureteric anastomosis

In addition to:
* Centre registration fees
* Licenses fees (Interior affairs, MOH, Syndicate)
* Accommodation expenses
* Flight tickets


[II] Facilities and Requirements

Laboratory
Luminex 3D 1,800,000 LE
2 centrifuges 160,000 LE
PCR machine for typing 100,000 LE
Vortex
5 Micropipettes x 6000 = 30,000 LE
Shaking water bath 18,000 LE
Inverted microscope (Olympus) 100,000 LE
Light microscope (Olympus) 25,000 LE
Nanodrop ( for DNA) 100,000 LE
Electrophoresis chamber 60,000 LE
Total = 2,393,000 LE
= 133,000 $
Pathology
Rotary Microtome (Preference Shandon, Leica)
Microscope – 5 opticals including x40 and x100 (Olympus, zeiss, leica)
Special stains (PAS Masson Trichrome,Congo red)
Set up for immunohistochemistry or
[Immunofluorescence requires IF microscope, cryostat]
Primary antibodies: IgG, IgA, C3, C4d


Radiology:
Spiral CT
Duplex ultrasonography

ICU

Extracorporeal Interventions:
Hemodialysis
Plasma Exchange

Operative Theater

Registry

[III] Activity Implementation

(B) Nephrology training programs

Hemodialysis 3 months training

[I] Man Power
(1) Nephrologists:
To be trained for a period of 3 months to get acquainted with:
Nurses items following in addition to
CKD MBD chronic kidney disease – Metabolic Bone Disease
Management of comorbidities
Management of Acute complications
Drug prescription for dialysis patient
Follow up of laboratory results

Trainers: [Fees of group 1000 $ / month]
- Supervisor
- Assistant

(2) Nurse
to be trained for a period of 3 months to get acquainted with:
Care of vascular access
Needle insertion
Patient monitoring
Infection control
Principles of dialysis
Machine preparation with priming, session maintenance, and termination
Interdialysis machine sterilization
Dialysate specifications
Anticoagulation
Complications expected during session
Principle of dry weight
Management of anemia
Records and registry

Trainers: [Fees of group 1000 $ / month]
- Head Dialysis nurse
- Supervisor
- Resident
- Attending nurse




[II] Facilities and Requirements to establish hemodialysis units
For small and ICU units: machines with integral special water treatment unit.
For larger units (at least 4 machines) central water treatment unit
Maintenance facilities of both water units and machines
Area for one bed and machine 3m2
Hand washing area
Room for vascular access fixation
Clean Storage area
Waste collection area
Local unit Pharmacy
Secretary room
Doctors room
Waiting area