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Sessa C, Zanoli L, Noto G, Alessandrello I, Galeano D, Giglio E, Giuffrida AE, Distefano G, Ficara V, Messina RM, Musumeci S, Scollo V, Zirino F, Zuppardo C, Morale W. [Contrast Media Toxicity and Its Prevention]. G Ital Nefrol 2023; 40:2023-vol5. [PMID: 38010244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Intravenous iodinated contrast media are commonly used in clinical practice, ranging from medical imaging to interventional radiology (IR) procedures and endovascular interventions. Compared with patients with normal renal function, nephropathic patients have an increased risk of acute kidney injury (AKI). Nevertheless, this condition cannot represent a limit to diagnostics or endovascular interventions. Despite the literature of the last five years, conflicting management and approaches for nephropathic patients persist, including the use of contrast agents and treatments replacing renal functions, which are often mistakenly considered as part of preventive strategies. Though the issue has been widely discussed, specialists often cope with uncertainty in handling properly the administration of contrast media and renal counselling requests. Furthermore, there is a general difficulty in distinguishing the Post-Contrast Acute Kidney Injury (PC-AKI) from the Contrast-Associated Acute Kidney Injury (CI-AKI). The present review aims to provide an update on the issue and examine strategies to reduce the acute kidney injury risk after the administration of contrast media. These strategies include the early identification of high-risk individuals, the choice of the contrast media and the proper dosage, the suspension of nephrotoxic drugs, the follow-up of the high-risk individuals, and the early identification of AKI.
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Affiliation(s)
- Concetto Sessa
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Luca Zanoli
- Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania (CT)
| | - Giovanni Noto
- U.O.C. Medicina e Chirurgia d'Accettazione e Urgenza, P.O. Giovanni Paolo II, Ragusa (RG)
| | - Ivana Alessandrello
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Dario Galeano
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Elisa Giglio
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | | | - Giulio Distefano
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Vincenzo Ficara
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | | | - Stella Musumeci
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Viviana Scollo
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Fortunata Zirino
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Carmelo Zuppardo
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
| | - Walter Morale
- U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG)
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Morale W, Sessa C, Alessandrello I, Aprile G, Galeano D, Giglio E, Ficara V, Musumeci S, Scollo V, Zuppardo C, Baglieri A, Rizza G, Bonomo P, Modica S, Patriarca G, Elia R, Aliquò A, Musso S. [The management of nephropathic patients during the Covid-19 pandemic: the experience of Ragusa]. G Ital Nefrol 2021; 38:38-02-2021-05. [PMID: 33852221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The public emergency caused by Covid-19 has forced health services to reorganize in order to separate positive patients from negative ones. In nephrology, this reorganization involves several levels of assistance concerning hospitalizations, ambulatory care and haemodialysis. Within the Complex Unit of Nephrology in Ragusa, the distribution of nephro-dialytic resources has involved four different hospitals, hence ensuring haemodialysis services for asymptomatic and pauci-symptomatic Covid-19 patients as well as for patients in Covid-Unit, Sub-Intensive Therapy and Intensive Care Unit. In this complex context, we had to create a common protocol involving all the professionals who provide assistance in our Unit, across the different structures. We also report some encouraging data that seem to indicate the effectiveness of the protocols put in place.
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Affiliation(s)
- Walter Morale
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Concetto Sessa
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Ivana Alessandrello
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Giorgio Aprile
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Dario Galeano
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Elisa Giglio
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Vincenzo Ficara
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Stella Musumeci
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Viviana Scollo
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Carmelo Zuppardo
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Andrea Baglieri
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Giovanni Rizza
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Pietro Bonomo
- Direzione Sanitaria Ospedale "Maggiore", Modica (RG), Italy
| | | | - Giuseppe Patriarca
- Direzione Generale Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Raffaele Elia
- Direzione Generale Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Angelo Aliquò
- Direzione Generale Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Salvatore Musso
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
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Atteritano M, Visconti L, Dattilo G, Zuppardo C, Lacquaniti A, Parato VM, Migliorato A, Conti G, Santoro D. Non-Invasive Imaging for Evaluating Cardiovascular Involvement in Patients with Primary and Lupus Nephritis. Open Rheumatol J 2019. [DOI: 10.2174/1874312901913010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Evidence suggests that proteinuric diseases, such as primary or secondary glomerulonephritis, increase cardiovascular risk, but few studies confirmed this association.
Methods:
This is a cross-sectional, observational study on 32 patients, 17 with Primary Glomerulonephritis (PG) and 15 with Lupus Glomerulonephritis (LG). The control group consisted of 32 healthy individuals. Intima-media thickness (IMT) of the left common carotid artery, carotid bifurcation and internal carotid artery was measured by ultrasound. Left ventricular myocardial deformation was assessed by the use of the Global Circumferential Strain (GCS) and the Global Longitudinal Strain (GLS) following 2-Dimensional (2D) echocardiography in all participants.
Results:
Patients with glomerulonephritis in both groups showed significantly lower GLS compared with controls (p=0.0005). There was also a significant difference in common carotid IMT values between the LG and GP group (0.45±0.09 vs. 0.58±0.17 mm, respectively; p=0.01), but there was no difference with the control group. In patient group (n=32), a significantly positive correlation was observed between C-reactive protein and proteinuria (r=0.98; p<0.0001), whereas negative correlations were found between common carotid IMT and creatinine clearance (r=-0.97; p<0.0001) and between carotid bifurcation IMT and phosphate levels (r=-0.97; p<0.0001)
Conclusion:
Subclinical systolic myocardial dysfunction is present early in the course of glomerular disease. The use of 2D GLS revealed that LG and PG patients with no cardiovascular symptoms or history and a preserved left ventricle ejection fraction on conventional echocardiography had subclinical reduction in LV global longitudinal systolic function compared with controls.
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Sessa C, Galeano D, Alessandrello I, Aprile G, Distefano G, Ficara V, Giglio E, Musumeci S, Pocorobba B, Zuppardo C, Musso S, Granata A. [Osteoporosis and chronic kidney disease: review and new therapeutic strategies]. G Ital Nefrol 2019; 36:36-4-2019-4. [PMID: 31373465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Osteoporosis affects a segment of the population in which Chronic Kidney Disease is also greatly represented. Nephropathic patients may present peculiar biochemical abnormalities related to Chronic Kidney Disease, defining the Mineral and Bone Disorder. This kind of anomalies, in the worst scenarios, configure the typical histomorphology patterns of Renal Osteodystrophy. Scientific Societies of Endocrinology have established therapy guidelines for patients with osteoporosis only based on the glomerular filtration rate and recommend avoiding the use of some drugs for the more advanced classes of nephropathy. However, there is no clear therapeutic approach for patients with advanced nephropathy and bone abnormalities. In this paper we propose a systematic review of the literature and present our proposal for managing patients with advanced nephropathy, based on eGFR and on presence of Mineral and Bone Disorder.
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Affiliation(s)
- Concetto Sessa
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Dario Galeano
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Ivana Alessandrello
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Giorgio Aprile
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Giulio Distefano
- U.O. Radiologia I, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania
| | - Vincenzo Ficara
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Elisa Giglio
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Stella Musumeci
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Barbara Pocorobba
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Carmelo Zuppardo
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Salvatore Musso
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Antonio Granata
- U.O.C. Nefrologia e Dialisi - P.O. "San Giovanni di Dio", Agrigento - Italia
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Zuppardo C, Visconti L, Dattilo G, Quattrocchi S, Pellicanò V, Atteritano M, Ricciardi CA, De Gregorio F, Lacava V, Buemi M, Santoro D. MP113CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH GLOMERULONEPHRITIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw185.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Santoro D, Ingegnieri MT, Vita G, Lucisano S, Zuppardo C, Canale V, Savica V, Buemi M. Socio-Economic Factors, Food Habits and Phosphorus Levels in Patients on Hemodialysis. Nephrourol Mon 2015; 7:e27114. [PMID: 26539414 PMCID: PMC4628210 DOI: 10.5812/numonthly.27114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/07/2015] [Accepted: 02/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperphosphoremia is one of the most important risk factors for morbidity and mortality for chronic kidney disease (CKD) patients, and also, for the general population. Excessive dietary intake of phosphate (P) is one of the key factors. In particular, P in its inorganic form, which is contained in food additives, is more readily absorbed. Unfortunately, these food additives are mostly present in convenience so called "fast foods" (pre-cooked), soft drinks, which represent the typical food consumed by our hemodialysis (HD) population, composed by elderly people, mostly low-socio economic class, who often live alone. OBJECTIVES We performed an observational retrospective multicenter study to find any association between social, cultural and economic situation, as well as food habits, and P levels in a cohort of patients on HD. Secondarily; we also examined the association between the fast food consumption and increased P levels, as well as patient compliance for P binding products. PATIENTS AND METHODS To explore the association between socio-economic factors and serum P levels, we enrolled 100 patients on periodic HD treatment from three different units. Information on social, cultural, economic, diet habits, therapy for hyperphosphoremia and hematological and clinical parameters had been collected through specific questionnaires, administered by a physician. RESULTS Results showed serum P level was reduced in patients who live alone compared to patients in family (P = 0.04), in self-sufficient (P = 0.05) and in patients belonging to middle-upper class, versus low-class (P = 0.003). Fast foods intake correlates with increase in P serum levels (P = 0.002), whilst the same correlation was not found for cheese intake. Our data show that socio-economic status and food habits are useful predictors of P serum levels. CONCLUSIONS In conclusion, dietary counseling of patients on HD is mandatory. Interventions that consider the socio-economic situation allow delivering important messages on foods with the least amount of P and adequate protein content, and they may be a successful strategy in targeting patients at a higher risk of hyperphosphoremia.
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Affiliation(s)
- Domenico Santoro
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
- Corresponding author: Domenico Santoro, Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, P. O. Box: 98100, Messina, Italy. Tel/Fax: +39-0902212331, E-mail:
| | - Maria Teresa Ingegnieri
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
| | - Silvia Lucisano
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
| | - Carmelo Zuppardo
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
| | - Valeria Canale
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
| | - Vincenzo Savica
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
| | - Michele Buemi
- Department of Clinical and Experimental Medicine, AOU G MArtino University of Messina, Messina, Italy
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Di Bartolo CE, Leonardi V, Dell'Aera C, Puntorieri E, Zuppardo C, Mileto G. Increased pancreatic enzymes and inflammatory bowel diseases: What correlation? J Crohns Colitis 2011; 5:378-9. [PMID: 21683315 DOI: 10.1016/j.crohns.2011.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/07/2011] [Indexed: 02/08/2023]
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