Between the days 25^th - 26^th of June, the common congress ERA-EDTA and German nephrology company (a new company which was founded by merging of two former companies in German-speaking countries in 2009) took place in Munich. To be precise, it was the 67^th ERA-EDTA congress and 2^nd congress of the nephrology company which took place in the centre of Europe in a German city – Munich. The place of the meeting was the international congress centre Internationales Congress Center Munchen (ICM) – a very modern congress centre. The scientific committee led by Professor Josef M. Grinyo from Spain provided wide offer of lectures and symposiums, which covered different aspects of clinical nephrology and also the latest researches in this field. A special attention was paid to young research workers and nephrologists, especially to those, who obtained a support in terms of an ERA-EDTA membership programme and also the latest clinical studies. The president of the congress was a professor Christoph Wanner from Germany. A specialized programme was divided into more parts – plenary lectures, „mini“ lectures, symposiums, literature updating, compact primers and pre - congress CME courses. A section of posters from different countries of the world was widely represented here too.

The first day 25^th of June 2010
On Friday morning we had the possibility to hear pre-congress CME courses in three different lecture rooms. The courses were divided into more parts: animal models of kidney illnesses, transplantation immunology, ultrasound of kidneys, a rheumatology for nephrologists and instructive course of kidney pathology and so on. A festive opening of the congress was at 6 p.m. After the welcoming speech of the congress president Christoph Wanner, some interesting pieces of knowledge were spoken by acknowledged authorities as, for example, professor Gérard London, a president ERA-EDTA, and professor Reinhard Brunkhorst, a president of German nephrology company. Above it we enjoyed the inspiring key notes to the topic „research makes us happy“ from professor Jozef Reichholf from Munich. A very famous 65-year-old biologist, the head of ornithology section in the National zoological collection in Munich, spoke humorously and educationally at the same time about the evolution of zebras and ecology of river forests. This festive opening was closed by a concert of Regensburg cathedral chorus – The Regensburger Domspatzen.

The second day 26^th of June 2010
During Saturday morning we heard the plenary lecture given by a professor Ludger Klein from immunological institute of Munich University about the importance of the T-cells in an immune system. He identified CD4+ regulation T-cells (so-called Tregs cells) as ancillary cells in fight against autoimmune illnesses. Tregs cells have the same importance in a development of renal illnesses in transplantation immunology. In the afternoon there followed some blocks of „mini“ lectures, symposiums and company lectures. The interesting happening was KDIGO symposium - Guidelines in AKI. There was defined a suggested need of a uniform definition of AKI for clinical practice, nowadays we know two similar definitions based on concentration of creatinin and secretion of urine (RIFLE and AKIN). KDIGO suggests that acute renal damage should be defined as an increase of serum creatinine in more than 0,3 mg/dl (26,4 umol/l) in 48 hours, increase of serum creatinine 1,5 times more to former value during 7 days, decrease of diuretic to less than 0,5ml/kg/h in 6 hours. On the basis of this definition, three phases of AKI were settled. A new definition of acute kidney disease (AKD) was suggested – it included the above mentioned definition of AKI, or decrease of GFR in more than 35%, or increase of serum creatinine in more than 50% to former measured value in less than 3 months, or decrease of kidney functions to less than 60ml/min/1, 73 m2 in less than 3 months, or kidney damage lasting less than 3 months. Recommendations in prevention by amino glycosides and contrast inducted by AKI, volume therapy, therapy by vasopressors, a check of glycaemia with critically ill patients, timing and end of MEL were described in detail.

The third day 27^th June 2010
On Sunday morning we joined some interesting lectures named – when to start in vitro elimination cure, progression of kidney damage, cardiovascular risk with patients with kidney disease, rare kidney diseases, a cure of anaemia and ESA in nephrology and a number of company symposiums. During the lunchtime we joined the symposium sponsored by the company Shire named: Management of phosphorus and FGF-23 v CKD-MBD: Should we cure earlier to improve the care about patients? The lecturers were Dr. Alastair Hutchison from Manchester in Great Britain, Professor Keiht Hruška from St. Luis in the USA and professor Jorge Cannata - Andía from Ovieda in Spain. On the bases of the heard data we can sum up – with patients in CKD there is an increased risk of a ferrum lack rise, there exist some markers in a diagnosis of the ferrum level in an organism, but almost all of them have certain limitations, i.v. ferrum is a benefit preferably for patients with CKD in a pre-dialysis also in the case when a cure ESA is absent (newer preparations can repress limitations of older preparations). The news was a new key regulator of ferrum availability - hepcidine – a liver antimicrobial peptide secreted by kidneys, regulating flow of ferrum into plasma, set by RIA and ELISA methods. It was found that hepcidine is a main mediator of a lack of ferrum and can also be a key factor in pathogenesis of erythropoietin resistance by inflammations and infections.

The fourth day 28^th Jun 2010
The final morning of the congress was closed by topics such as anaemia in CKD, a cure of glomerular diseases, bones and CKD, vascular accesses, cardiovascular diseases and kidneys. New therapeutic possibilities of chronic kidney diseases were presented – hot news in cure - antagonist of endoteline-1, which has a strong influence at renal and cardiovascular physiology and pathophysiology. There were also presented new studies which made clear a task of mTOR inhibitors by polycystic kidney disease, cinacalcet (in study ADVANCE) and atorvastatin in 4D study at patients with CKD. In the cure of glomerular diseases, there it was paid more attention mostly to cure ANCA associated vasculitis - rituximab is not less effective as cyklofosfamide for remission induction, relapses : still high – golden standard - azathioprin, alternative – metotrexat (GFR less than 50ml/min), leflunomid, mykofenolat, mofetil (these days not supported).

Munich is the capital of Free State of Bavaria. After Berlin and Hamburg cities, it is the third largest city in Germany. The Oktoberfest – a beer festival is the most famous event in the whole Germany. During the sightseeing of the city, we had a possibility to see a well-known castle Nymphenburg, car fans could enjoy the BMW museum devoted to famous car brands made in Munich. We could not avoid seeing the Olympic Park, in which one can see Bayern Munich Stadium, where the Olympic Games were held in 1972. A famous central station „Hauptbanhof“ placed almost in the city centre allows us via an underground U-Bahn to get to many different German and European cities. You must definitely try Bavarian cuisine – a speciality – pork liver, potato dumplings and red cabbage, and, of course, outstanding Bavorian beer.

The congress was very well-organised with the programme of a high quality. I am grateful to Logman Ltd. that I was able to join this event.

(MUDr. Martina Sokirkova, July 23, 2010)