Gender differences in new hypoglycemic drug effects on renal outcomes: a systematic review

INTRODUCTION

Lifetime diabetes risk is greater in women than in men. Women with diabetes mellitus (DM) have a greater prevalence of diabetic kidney disease (DKD) risk factors. The diagnosis of DM is often delayed in women, with poorer outcomes and with expected therapeutic goals missed.

AREA COVERED

A systematic literature review following PRISMA guidelines was conducted in the PubMed gateway of the MEDLINE database and Clinicaltrials.gov. The purpose of our research was to establish the sex differences on renal outcomes in users of the new hypoglycemic drugs: sodium-glucose transport protein 2 inhibitors (SGLT-2i), dipeptidyl peptidase-IV Inhibitors (DPP-IVi) and glucagon-like peptide-1 inhibitors (GLP-1i).

EXPERT OPINION

New hypoglycemic drugs represent promising tools in the treatment and prevention of severe complications of diabetes, cardiovascular diseases and chronic kidney disease. Even if renal outcomes are investigated in both randomized controlled trials and cardiovascular outcome trials, gender-based analysis is not always performed. This may lead to relevant information for risk-benefit evaluation and therapeutic choices being missed, with gender-based equality in outcomes lacking. Our systematic review demonstrated that the gap among sexes in DKD can be partially filled using new hypoglycemic drugs. Sexual dimorphism analysis could represent a keystone for the development of adequate gender-specific therapies.

Indole-3-acetic acid correlates with monocyte-to-high-density lipoprotein (HDL) ratio (MHR) in chronic kidney disease patients

PURPOSE

Indole-3-acetic acid is a protein-bound indolic uremic toxin deriving from tryptophan metabolism. Increased levels are associated with higher thrombotic risk and both cardiovascular and all-cause mortality. An emerging biomarker of cardiovascular disease is the monocyte-to-high-density lipoprotein ratio (MHR). The main purpose of this study was to investigate the association of indole-3-acetic acid with MHR and other markers of cardiovascular risk in patients with chronic kidney disease (CKD).

METHODS

We enrolled 61 non-dialysis CKD patients and 6 dialysis patients. Indole-3-acetic acid levels were measured with ELISA technique.

RESULTS

In the whole cohort of 67 patients, indole-3-acetic acid was directly related to Ca × P (ρ = 0.256; P = 0.0365) and MHR (ρ = 0.321; P = 0.0082). In the 40 patients with previous cardiovascular events, indole-3-acetic acid correlated with uric acid (r = 0.3952; P = 0.0116) and MHR (ρ = 0.380; P = 0.0157). MHR was related with fibrinogen (ρ = 0.426; P = 0.0010), arterial hypertension (ρ = 0.274; P = 0.0251), C-reactive protein (ρ = 0.332; P = 0.0061), gender (ρ = - 0.375; P = 0.0017; 0 = male, 1 = female), and CKD stage (ρ = 0.260; P = 0.0337). A multiple regression analysis suggested that indole-3-acetic acid might be an independent predictor of MHR.

CONCLUSION

This study shows a significant association between indole-3-acetic acid and MHR. Prospective studies are required to evaluate if decreasing indole-3-acetic acid concentrations may reduce MHR levels and cardiovascular events and improve clinical outcomes.

A proof-of-concept experimental study for vacuum-driven anaerobic biosolids fermentation using the IntensiCarb technology

This study demonstrates the potential of an innovative anaerobic treatment technology for municipal biosolids (IntensiCarb), which relies on vacuum evaporation to decouple solids and hydraulic retention times (SRT and HRT). We present proof-of-concept experiments using primary sludge and thickened waste activated sludge (50-50 v/v mixture) as feed for fermentation and carbon upgrading with the IntensiCarb unit. IntensiCarb fully decoupled the HRT and SRT in continuously stirred anaerobic reactors (CSAR) to achieve two intensification factors, that is, 1.3 and 2, while keeping the SRT constant at 3 days (including in the control fermenter). The intensified CSARs were compared to a conventional control system to determine the yields of particulate hydrolysis, VFA production, and nitrogen partitioning between fermentate and condensate. The intensified CSAR operating at an intensification factor 2 achieved a 65% improvement in particulate solubilization. Almost 50% of total ammonia was extracted without pH adjustment, while carbon was retained in the fermentate. Based on these results, the IntensiCarb technology allows water resource recovery facilities to achieve a high degree of plant-wide intensification while partitioning nutrients into different streams and thickening solids. PRACTITIONER POINTS: The IntensiCarb reactor can decouple hydraulic (HRT) and solids (SRT) retention times in anaerobic systems while also increasing particulate hydrolysis and overall plant capacity. Using vacuum as driving force of the IntensiCarb technology, the system could achieve thickening, digestion, and partial dewatering in the same unit-thus eliminating the complexity of multi-stage biosolids treatment lines. The ability to partition nutrients between particulate, fermentate, and condensate assigns to the IntensiCarb unit a key role in recovery strategies for value-added products such as nitrogen, phosphorus, and carbon, which can be recovered separately and independently.

The Use of Adaptive Learning Technology to Enhance Learning in Clinical Veterinary Dermatology

Clinical teaching in veterinary medicine is challenging for both educators and students. There is an increasing interest in the use of technology-based techniques using adaptive learning to provide students with additional learning experiences. Few studies have evaluated the use of this technique in veterinary medical education. We hypothesized that students with access to adaptive learning modules during dermatology rotation would have significantly higher dermatology test scores compared to students who did not have access to the adaptive learning modules on the same rotation. Incoming third and fourth-year veterinary students to the dermatology rotation, who agreed to participate, were randomly assigned to treatment (provided access to 10 modules using adaptive technology during the rotation) or control group (provided no access to the modules). Study participants completed a pretest two weeks before the rotation start date and a post-test near the rotation end date and a questionnaire to assess students' learning experience using adaptive learning modules. Students in the treatment group scored significantly higher on the posttest (p = .019) compared to students in the control group, with an effect size of d = 0.83. Students in both groups scored significantly higher at post-test (p < .001; d = 1.52 treatment and p = .002; d = 0.74 control) when compared to their pretest. This study shows that the tested adaptive learning platform may be an effective method to augment clinical teaching in veterinary dermatology. This study also indicates that veterinary students perceive the use of adaptive learning technology as beneficial for their education.

Effect of the substrate on the electrical transport and fluctuation processes in NbRe and NbReN ultrathin films for superconducting electronics applications

NbRe-based superconducting thin films recently received relevant interest in the field of low-temperature electronics. However, for these materials the electrical conduction mechanisms, in particular in the normal state, still need to be investigated in more detail. Here, NbRe and NbReN films of different thicknesses have been deposited on two different substrates, namely monocrystalline Si and [Formula: see text] buffered Si. The films were characterized by DC electrical transport measurements. Moreover, a connection with the charge carriers fluctuation processes has been made by analyzing the electrical noise generated in the normal state region. Despite the films morphology seems not to be affected by the substrate used, a lower noise level has been found for the ones grown on [Formula: see text], in particular for NbReN. From this study it emerges that both NbRe and NbReN ultrathin films are of very good quality, as far as the low-temperature electrical noise and conduction are concerned, with noise levels competitive with NbN. These results may further support the proposal of using these materials in a nanowire form in the field of superconducting electronics.

New-Onset Anemia and Associated Risk of ESKD and Death in Non-Dialysis CKD Patients: A Multi-Cohort Observational Study

Background

Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known.

Methods

We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m² regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11–12 g/dL in women and 11–13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia.

Results

The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m² and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1–1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m² and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30–44 mL/min/1.73 m²) and moderate proteinuria (0.15–0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02–1.98]} and all-cause death [HR 1.55 (95% CI 1.04–2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20–2.51)] and death [HR 1.83 (95% CI 1.05–3.19)].

Conclusions

New-onset anemia is frequent, particularly in patients with more severe renal damage and in those with diabetes mellitus. The occurrence of anemia, even of a mild degree, is associated with mortality risk and faster progression towards ESKD.

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

There is growing interest in the relationship between chronic kidney disease (CKD) and fragility fracture risk. Bone mineral density (BMD) is a major determinant of bone strength, although its role as a predictor of fracture in advanced CKD and hemodialysis is still under debate. We aimed to further investigate surrogates of bone quality and their associations with muscle strength and fracture risk in hemodialysis. Multiple clinical risk factors for fracture and an estimated 10-year probability of fracture, BMD at lumbar spine and femur, trabecular bone score (TBS), X-ray vertebral morphometry, phalangeal bone quantitative ultrasonography (QUS), tibial pulse-echo ultrasonography (PEUS), and handgrip strength were evaluated in a setting of hemodialysis patients in treatment with acetate-free biofiltration (AFB) or bicarbonate hemodialysis. The bone ultrasound measurements, both at phalangeal and tibial sites, were significantly associated with lumbar and femoral DXA values. Handgrip strength was significantly associated with the 10-year probability of fracture (r = -0.57, p < 0.001 for major fractures and r = -0.53, p < 0.001 for hip fracture, respectively), with femur neck, total femur, and L1-L4 BMD values (r = 0.47, p = 0.04; r = 0.48, p = 0.02; r = 0.58, p = 0.007, respectively), with TBS at the lumbar spine (r = 0.71, p < 0.001) and with the phalangeal QUS measure of AD-SoS (r = 0.369, p = 0.023). In the hemodialysis group, 10 participants (24.3%) reported at least one morphometric vertebral fracture (Vfx); conversely, only six participants (15%) showed Vfx in the control group. In the hemodialysis group, participants with Vfx compared with participants without Vfx reported significantly different TBS, bone transmission time (BTT), cortical thickness, and handgrip strength (p < 0.05). At multiple regression analysis, by identifying as dependent variable the 10-year fracture risk for major fracture, after correcting for age, BMI, time since dialysis, AD-SoS, cortical bone thickness, and handgrip strength, only BTT (β = -15.21, SE = 5.91, p = 0.02) and TBS (β = -54.69, SE = 21.88, p = 0.02) turned out as independently associated with fracture risk. In conclusion, hemodialysis patients showed a higher fracture risk and lower surrogate indices of bone strength as TBS and QUS parameters. In this cohort of patients, handgrip strength measurements appeared to be a useful instrument to identify high-fracture-risk subjects.

Kinetics of aerobic cellulose degradation in raw municipal wastewater

Cellulose contributes approximately one third of the influent suspended solids to wastewater treatment plants and is a key target for resource recovery. This study investigated the temperature impact on biological aerobic degradation of cellulose in laboratory-scale sequencing batch reactors (SBR) at four different temperatures (10-33 °C) and two different solids retention times (SRT) of 15 days and 3 days. The degradation efficiency of cellulose was observed to increase with temperature and was slightly dependent on SRT (80%-90% at an SRT of 15 days, and 78%-85% at an SRT of 3 days). Hydrolysis followed 1st order kinetics, rather than the biomass dependent Contois kinetics (default in the activated sludge models), with a hydrolysis coefficient at 20 °C of 1.14 ± 0.01 day^-1.

609 Prognostic role of renal function in patients with previous myocardial infarction. A study with cardiac magnetic resonance

Aims

There is not strong evidence in literature about the impact of renal function on the prognosis of patients with ischaemic cardiomyopathy. Thus, the aim of the study was to investigate mild renal impairment [estimated glomerular filtration rate (eGFR): 60–89 ml/min] as an independent prognostic factor in patients with history of myocardial infarction (MI).

Methods and results

We studied 339 consecutive patients (65 ± 13 years old, female 13%) from 2001 and 2012 with previous MI. Patients with eGFR &lt;60 ml/min were excluded. We performed cardiac magnetic resonance (CMR) in all patients to quantify left ventricular ejection fraction (LVEF), volumes, and wall motion score index (WMSI), and to measure the infarction extent by late gadolinium enhancement (LGE). Renal function was estimated by creatinine value with Cockcroft–Gault formula and patients were divided according to normal (≥90 ml/min) and reduced (60–89 ml/min) eGFR. Patients with normal eGFR were 106 (31%, 56.9 ± 10.5 years old), 233 (69%, 66.1 ± 9.9 years old) had renal impairment. During follow-up (median 3.5 years), cardiac events (cardiac death or appropriate intra-cardiac defibrillator shock) occurred in 28/233 (12%) of patients with eGFR &lt;90 ml/min and in 4/106 (4%) of patients with eGFR ≥90 ml/min (P &lt; 0.05). Furthermore, survival curve showed a significantly worst prognosis in patients with renal impairment (P &lt; 0.03). In the group of patients with ejection fraction (EF) &lt; 35% (121 patients), cardiac events were observed only in patients with eGFR &lt;90 ml/min (23/99, 23%, P &lt; 0.05). At multivariate stepwise analysis, age &gt;65 years old, eGFR &lt;90 ml/min and WMSI &gt;1.7 turned out to be independent predictor of cardiac events (P &lt; 0.05).

Conclusions

In patients with previous MI, a mild renal impairment (eGFR between 60 and 89 ml/min) was an independent predictor of prognosis, especially if combined with left ventricular disfunction.

Second Wave Antibodies in Autoimmune Renal Diseases: The Case of Lupus Nephritis

Clinical Trial registry name and registration number: Zeus study, NCT02403115.

Biological nutrient removal enhancement using fermented primary and rotating belt filter biosolids

This research compared the impact of two primary treatment options (i.e. primary clarification and rotating belt filtration (RBF)) on biological nutrients removal (BNR) process, using sludge fermentation liquid (SFL) as a carbon source. The liquid fraction of both fermented primary and RBF sludges comparably enhanced BNR. Despite the significant contribution of the unpurified SFL to the sharp increase in nutrient levels; i.e. 47%-64% (primary effluent; PE), and 45%-53% (RBF) of the soluble nitrogen and phosphorus loads; readily biodegradable COD and volatile fatty acids (VFAs) fractions of the combined feed increased significantly (2.5-6.1 times), compared to the original feed by additional SFL. Removal efficiencies in the reactors reached 57% (total nitrogen) and 92% (total phosphorus) after addition of SFL. Effluent nitrogen and phosphorus of the two reactors were close in the range of 15 ± 6 mg N/L, and 0.5 ± 0.3 mg P/L, respectively. Kinetics studies showed denitrification rates of 1.3, and 1.13 kg NO₃-N/m³.d for primary effluent and RBF effluent-fed reactors, respectively. Phosphorus release rates were 11.7 and 9.7 mg PO₄-P/g VSS.h, for primary, and RBF effluents, respectively; showing 20%-22% lower rates in the RBF SFL. Incorporating experimental data into a plant-wide model for a 100 MLD facility receiving typical medium strength wastewater, showed that although primary treatment enhanced the biogas production by 96% (primary clarification) and 62% (RBF) trains; combined fermentation and anaerobic digestion was effective to enhance the biogas production by 59% on average, compared to the base scenario without primary treatment. Additionally, if primary clarification exists, then the addition of fermentation results in additional revenue of C$1890/d in the plant, considering additional revenue of C$2230/d due to VFA generation in contrast to only C$340/d loss due to the reduced methane production.

Renal involvement in sarcoidosis: histological patterns and prognosis, an Italian survey

Background

Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent, but in <1% causes acute kidney injury (AKI).

Methods

This Italian multicentric retrospective study included 39 sarcoidosis-patients with renal involvement at renal biopsy: 31 sGIN-AKI, 5 with other patterns (No-sGIN-AKI), 3 with nephrotic proteinuria. We investigate the predictive value of clinical features, laboratory, radiological parameters and histological patterns regarding steroid response. Primary endpoint: incident chronic kidney disease (CKD) beyond the 1°follow-up (FU) year; secondary endpoint: response at 1°line steroid therapy; combined endpoint: the association of initial steroid response and outcome at the end of FU.

Results

Complete recovery in all 5 No-sGIN-AKI-patients, only in 45% (13/29) sGIN-AKI-patients (p=0.046) (one lost in follow-up, for another not available renal function after steroids). Nobody had not response. Primary endpoint of 22 sGIN-AKI subjects: 65% (13/20) starting with normal renal function developed CKD (2/22 had basal CKD; median FU 77 months, 15-300). Combined endpoint: 29% (6/21) had complete recovery and final normal renal function (one with renal relapse), 48% (10/21) had partial recovery and final CKD (3 with renal relapse, of whom one with basal CKD) (p=0.024). Acute onset and hypercalcaemia were associated to milder AKI and better recovery than subacute onset and patients without hypercalcaemia, women had better endpoints than men. Giant cells, severe interstitial infiltrate and interstitial fibrosis seemed negative predictors in terms of endpoints.

Conclusions

sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.

Digital solutions for continued operation of WRRFs during pandemics and other interruptions

This paper includes survey results from 17 full-scale water resource recovery facilities (WRRFs) to explore their technical, operational, maintenance, and management-related challenges during COVID-19. Based on the survey results, limited monitoring and maintenance of instrumentation and sensors are among the critical factors during the pandemic which resulted in poor data quality in several WRRFs. Due to lockdown of cities and countries, most of the facilities observed interruptions of chemical supply frequency which impacted the treatment process involving chemical additions. Some plants observed influent flow reduction and illicit discharges from industrial wastewater which eventually affected the biological treatment processes. Delays in equipment maintenance also increased the operational and maintenance cost. Most of the plants reported that new set of personnel management rules during pandemic created difficulties in scheduling operator's shifts which directly hampered the plant operations. All the plant operators mentioned that automation, instrumentation, and sensor applications could help plant operations more efficiently while working remotely during pandemic. To handle emergency circumstances including pandemic, this paper also highlights resources and critical factors for emergency responses, preparedness, resiliency, and mitigation that can be adopted by WRRFs.

Hypernatraemia and low eGFR at hospitalization in COVID-19 patients: a deadly combination

Background

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the general population and the burden of pre-existing comorbidities has heavily affected the outcome of the infection. Hyponatraemia has been frequently described. Conversely, hypernatraemia has rarely been described in COVID-19.

Methods

The studied cohort encompasses all COVID-19 patients consecutively admitted to the Messina Hospital, Italy, during the first wave of the epidemic. Since healthcare structures were not overwhelmed at that time, indications for hospitalization were homogeneous throughout the study period. Serum sodium levels, kidney function [estimated glomerular filtration rate (eGFR)], demographic and clinical characteristics were recorded at admission. Correlation between mortality, sodium and eGFR was evaluated by survival curves and univariate and multivariate regression models.

Results

Baseline biochemical and clinical data at the time of admission were available for 115 COVID-19-confirmed patients. The median age at admission was 73 years (48% men), with a median Charlson Comorbidity Index of 4. A total of 23.5% of patients presented with a sodium level ≥146 mmol/L, while 7.8% had sodium <135 mmol/L. Hypernatraemic patients were older, with higher comorbidity. Age, hypernatraemia and reduced eGFR were associated with increased mortality in both univariate and multivariate regression models (P < 0.001). The combination of hypernatraemia and reduced renal function at admission had an odds ratio of 47.67 (95% confidence interval 10.08–225.43) of dying compared with patients with an eGFR ≥60 mL/min and sodium <145 mmol/L.

Conclusions

Our study suggests that the association between hypernatraemia and reduced eGFR at referral is a highly relevant prognostic marker for death during hospitalization. The role of this association should be further tested in larger, multicentre cohorts.

Amyloidosis and Glomerular Diseases in Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is a genetic autoinflammatory disease with autosomal recessive transmission, characterized by periodic fever attacks with self-limited serositis. Secondary amyloidosis due to amyloid A renal deposition represents the most fearsome complication in up to 8.6% of patients. Amyloidosis A typically reveals a nephrotic syndrome with a rapid progression to end-stage kidney disease still. It may also involve the cardiovascular system, the gastrointestinal tract and the central nervous system. Other glomerulonephritis may equally affect FMF patients, including vasculitis such as IgA vasculitis and polyarteritis nodosa. A differential diagnosis among different primary and secondary causes of nephrotic syndrome is mandatory to determine the right therapeutic choice for the patients. Early detection of microalbuminuria is the first signal of kidney impairment in FMF, but new markers such as Neutrophil Gelatinase-Associated Lipocalin (NGAL) may radically change renal outcomes. Serum amyloid A protein (SAA) is currently considered a reliable indicator of subclinical inflammation and compliance to therapy. According to new evidence, SAA may also have an active pathogenic role in the regulation of NALP3 inflammasome activity as well as being a predictor of the clinical course of AA amyloidosis. Beyond colchicine, new monoclonal antibodies such as IL-1 inhibitors anakinra and canakinumab, and anti-IL-6 tocilizumab may represent a key in optimizing FMF treatment and prevention or control of AA amyloidosis.

Evaluation of the effects of chlorhexidine digluconate with and without cBD103 or cCath against multidrug-resistant clinical isolates of Staphylococcus pseudintermedius

Background

Because of the increased incidence of multidrug‐resistant (MDR) bacteria, the use of disinfectants over antibiotics has been encouraged. However, the interactions between disinfectants and host local immunity are poorly understood.

Objective

To assess the effects of chlorhexidine digluconate (Chx), with and without selected host defence peptides (HDPs), against MDR Staphylococcus pseudintermedius (MDR‐SP).

Methods and materials

Ten clinical isolates of MDR‐SP were tested, using a modified microbroth dilution method. Four two‐fold dilutions of 2% Chx and 1 μg/mL the HDPs synthetic canine β‐defensin 103 (cBD103) or cathelicidin (cCath) were tested alone or in combination. Colony counts after 5, 15, 30 and 60 min, and a minimum inhibitory concentration (MIC) after 24 h were recorded. Friedman followed by Dunn’s multiple comparison tests with significance of P < 0.05 were used for statistical analysis. Synergy, additivity/neutrality or antagonism were calculated.

Results

Growth was not inhibited by either HDP alone. An MIC of 0.312 μg/mL Chx was achieved for nine of the isolates. One isolate had an MIC of 0.078 μg/mL Chx. A MIC₉₀ (in nine of 10 isolates) of 0.312 µg/mL was seen for Chx in combination with either HDP. Synergy was seen in the combination Chx/cCath used at the highest concentrations of Chx (0.624 µg/mL and 0.312 µg/mL) after 30 and 60 min incubation. Additivity/neutrality was seen for most of the other concentrations and times of incubation.

Conclusions and clinical importance

These results suggest a synergistic/additive effect between Chx and HDPs in dogs. Further studies evaluating the mechanisms behind this effect are needed.

The Aggressive Diabetic Kidney Disease in Youth-Onset Type 2 Diabetes: Pathogenetic Mechanisms and Potential Therapies

Youth-onset Type 2 Diabetes Mellitus (T2DM) represents a major burden worldwide. In the last decades, the prevalence of T2DM became higher than that of Type 1 Diabetes Mellitus (T1DM), helped by the increasing rate of childhood obesity. The highest prevalence rates of youth-onset T2DM are recorded in China (520 cases/100,000) and in the United States (212 cases/100,000), and the numbers are still increasing. T2DM young people present a strong hereditary component, often unmasked by social and environmental risk factors. These patients are affected by multiple coexisting risk factors, including obesity, hyperglycemia, dyslipidemia, insulin resistance, hypertension, and inflammation. Juvenile T2DM nephropathy occurs earlier in life compared to T1DM-related nephropathy in children or T2DM-related nephropathy in adult. Diabetic kidney disease (DKD) is T2DM major long term microvascular complication. This review summarizes the main mechanisms involved in the pathogenesis of the DKD in young population and the recent evolution of treatment, in order to reduce the risk of DKD progression.

Commonly used immunosuppressive drugs for kidney diseases and pregnancy: focus on open questions

Pregnancy is still a challenge in women with autoimmune diseases or kidney transplantation. In this context, management of the immunosuppressive therapy is critical, but, in spite of more than 60 years of experience, many issues remain open, also because of the difficulty in disentangling, in complex patients, the effect of the disease and of the frequent multiple treatments. For this purpose, we have tried to synthesize the existing knowledge and the unresolved issues, to support counseling and promote patient empowerment.

Feline allergic diseases: introduction and proposed nomenclature

BACKGROUND

Feline allergic diseases present as challenging problems for clinicians, not least because of the number of reaction patterns of the feline skin, none of which are specific for allergy. Furthermore, there is some controversy over the nomenclature that should be used in their description.

OBJECTIVES

To review the literature, assess the status of knowledge of the topic and the extent to which these diseases could be categorized as atopic in nature, and make recommendations concerning nomenclature.

METHODS

Atopic diseases in humans and cats were researched. A comparison then was made of the essential features in the two species.

RESULTS

There were sufficient similarities between human atopic diseases and the manifestations of feline diseases of presumed allergic aetiology to justify the use of "atopic" to describe some of the feline conditions affecting the skin, respiratory and gastrointestinal tract. However, none of the allergic skin diseases showed features consistent with atopic dermatitis as described in man and the dog.

CONCLUSIONS AND CLINICAL IMPORTANCE

The term "Feline Atopic Syndrome" (FAS) is proposed to encompass allergic diseases of the skin, gastrointestinal tract and respiratory tract, and "Feline atopic skin syndrome" (FASS) proposed to describe allergic skin disease associated with environmental allergies. We are not aware of any adverse food reactions in cats that are attributable to causes other than immunological reactions against the food itself. We therefore propose an aetiological definition of "Food Allergy" (FA) to describe such cases.

Mechanistic modeling of peracetic acid wastewater disinfection using computational fluid dynamics: Integrating solids settling with microbial inactivation kinetics

While the impact of suspended solids on chemical disinfection kinetics has been widely recognized, a detailed modeling framework for assessing their contribution on disinfection efficiency in municipal contact tanks is yet unavailable. In this paper, we conducted experimental and modeling studies to mechanistically describe the interplay between suspended solids (not removed by gravity settling in secondary clarifiers) and disinfection performance of an emerging disinfectant, peracetic acid, operated in a municipal contact tank. Specifically, we developed an integrated computational fluid dynamics (CFD) model to simultaneously predict the fate and transport of suspended solids, Escherichia coli and peracetic acid in a hypothetical reactor using an exposure-based (i.e., CT-based) inactivation rate expression. The integrated CFD model, calibrated against laboratory data, was used to gain insights on the vertical distribution and local PAA decay effect associated with solids settling and their impact on disinfectant decay and microbial inactivation. Results indicated that: (a) solids settling in contact tanks is a significant phenomenon that cannot be neglected, which can substantially impact disinfection efficiency under low flow conditions; (b) vertical solids distribution and stratification in contact tanks can strongly affect Escherichia coli inactivation by peracetic acid, as highlighted by the CFD modeling studies; (c) Escherichia coli settling is experimentally measurable, and strongly correlated with solids settling. These phenomena can be successfully integrated into a CFD model to obtain a comprehensive description of the PAA disinfection process in presence of changes in secondary effluent quality and flow, a situation typically encountered in municipal contact tanks operated in full scale wastewater treatment plants.