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Virzì GM, Morisi N, Marturano D, Milan Manani S, Tantillo I, Ronco C, Zanella M. Peritoneal Inflammation in PD-Related Peritonitis Induces Systemic Eryptosis: In Vitro and In Vivo Assessments. Int J Mol Sci 2024; 25:4284. [PMID: 38673869 PMCID: PMC11049828 DOI: 10.3390/ijms25084284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Erythrocytes (RBCs) have a highly specialized and organized membrane structure and undergo programmed cell death, known as eryptosis. Our preliminary data show a significant increase in the eryptosis during peritoneal dialysis (PD)-associated peritonitis. The objectives of the present study were assessment of the incrementation of eryptosis in PD patients with peritonitis, evaluation of the relationship between systemic eryptosis in peritonitis and specific peritonitis biomarkers in PD effluent (PDE), and confirmation of the induction of eryptosis by peritonitis in a vitro setting. We enrolled 22 PD patients with peritonitis and 17 healthy subjects (control group, CTR). For the in vivo study, eryptosis was measured in freshly isolated RBCs. For the in vitro study, healthy RBCs were exposed to the plasma of 22 PD patients with peritonitis and the plasma of the CTR group for 2, 4, and 24 h. Eryptosis was evaluated by flow cytometric analyses in vivo and in vitro. PDE samples were collected for biomarkers analysis.The percentage of eryptotic RBCs was significantly higher in PD patients with peritonitis than in CTR (PD patients with peritonitis: 7.7; IQR 4.3-14.2, versus CTR: 0.8; IQR 0.7-1.3; p < 0.001). We confirmed these in vivo results by in vitro experiments: healthy RBCs incubated with plasma from PD patients with peritonitis demonstrated a significant increase in eryptosis compared to healthy RBCs exposed to plasma from the control group at all times. Furthermore, significant positive correlations were observed between eryptosis level and all analyzed peritoneal biomarkers of peritonitis. We investigated a potential connection between systemic eryptosis and peritoneal biomarkers of peritonitis. Up-regulation of inflammatory markers could explain the increased rate of systemic eryptosis during PD-related peritonitis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Niccolò Morisi
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
- Nephrology Dialysis and Renal Transplantation Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Claudio Ronco
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
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Caprara C, Virzì GM, Chieregato K, Marchionna N, Corradi V, Brendolan A, Ronco C, Zanella M. Immunomodulation Driven by Theranova Filter during a Single HD Session. J Clin Med 2024; 13:2147. [PMID: 38610912 PMCID: PMC11012367 DOI: 10.3390/jcm13072147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Patients with end-stage kidney disease (ESKD) have altered immunity. Patients on hemodialysis (HD) present a coexistence of immunodeficiency and activation of the immune system. We evaluated the immunophenotypic profile induced by the medium cut-off of Theranova filter during a single HD session in the same individual. Methods: This pilot observational study explored 11 patients (75 ± 8 years and 73% male). Blood samples were collected prior to (predialytic, PRE) and after 4 h (postdialytic, POST) standard HD session with a medium cut-off, polyarylethersulfone and polyvinylpyrrolidone blend, BPA-free membrane. We performed an immunophenotyping characterization by using flow cytometry. We evaluated eryptosis RBCs and HLA-DR expression on monocytes and Treg cells. Results: The percentages of eryptosis in lymphocytes (CD3+), lymphocyte T helper (CD3+ and CD4+) cells, and monocytes (CD45+ and CD14+) were similar pre- and post-HD. On the contrary, HLA-DR expression and Treg cell numbers significantly decreased after HD. Conclusions: Many studies have focused on the comparison between healthy volunteers and HD patients, but very few have focused on the changes that occur after an HD session in the same individual. With this pilot observational study, we have revealed an immunomodulation driven by HD treatment with Theranova filter. Our preliminary results can be considered to be a hypothesis, generating and stimulating further studies with better designs and larger populations.
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Affiliation(s)
- Carlotta Caprara
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (C.C.); (G.M.V.); (C.R.)
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Berica, Ospedale San Bortolo, 36100 Vicenza, Italy; (N.M.); (A.B.); (M.Z.)
| | - Grazia Maria Virzì
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (C.C.); (G.M.V.); (C.R.)
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Berica, Ospedale San Bortolo, 36100 Vicenza, Italy; (N.M.); (A.B.); (M.Z.)
| | - Katia Chieregato
- Advanced Cellular Therapy Laboratory, Hematology Unit, S. Bortolo Hospital, AULSS 8 Berica, Contra’ San Francesco 41, 36100 Vicenza, Italy;
- Hematology Project Foundation, 36100 Vicenza, Italy
| | - Nicola Marchionna
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Berica, Ospedale San Bortolo, 36100 Vicenza, Italy; (N.M.); (A.B.); (M.Z.)
| | - Valentina Corradi
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (C.C.); (G.M.V.); (C.R.)
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Berica, Ospedale San Bortolo, 36100 Vicenza, Italy; (N.M.); (A.B.); (M.Z.)
| | - Alessandra Brendolan
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Berica, Ospedale San Bortolo, 36100 Vicenza, Italy; (N.M.); (A.B.); (M.Z.)
| | - Claudio Ronco
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (C.C.); (G.M.V.); (C.R.)
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, AULSS8 Berica, Ospedale San Bortolo, 36100 Vicenza, Italy; (N.M.); (A.B.); (M.Z.)
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Virzì GM, Morisi N, Milan Manani S, Tantillo I, Gonzàlez Barajas JD, Villavicencio BD, Castiglione C, Alfano G, Donati G, Zanella M. Scheduling of Remote Monitoring for Peritoneal Dialysis Patients. J Clin Med 2024; 13:406. [PMID: 38256540 PMCID: PMC10816117 DOI: 10.3390/jcm13020406] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Peritoneal dialysis (PD) is performed as a home-based treatment and in this context, telemedicine has been proven helpful for improving clinicians' surveillance and maintaining PD patients in their home setting. The new e-health devices make remote patient monitoring (RPM) for automated peritoneal dialysis (APD) treatment possible, evaluating the data at the end of every treatment and adapting the prescription at distance if necessary. This paper aims to share a method for improving clinical surveillance and enabling PD patients to receive their treatment at home. In the present case series, we delineate the clinical protocol of the Vicenza PD Center regarding patient characteristics, timing, and the purpose of the APD-RPM. We present the Vicenza PD Center's experience, illustrating its application through three case reports as exemplars. Telemedicine helps to carefully allocate healthcare resources while removing the barriers to accessing care. However, there is a risk of data overload, as some data might not be analyzed because of an increased workload for healthcare professionals. A proactive physician's attitude towards the e-health system has to be supported by clinical instructions and legislative rules. International and national guidelines may suggest which patients should be candidates for RPM, which parameters should be monitored, and with what timing. According to our experience, we suggest that the care team should define a workflow that helps in formulating a correct approach to RPM, adequately utilizing resources. The workflow has to consider the different needs of patients, in order to assure frequent remote control for incident or unstable patients, while prevalent and stable patients can perform their home treatment more independently, helped by periodic and deferred clinical supervision.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; (G.M.V.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
| | - Niccolò Morisi
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.A.); (G.D.)
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; (G.M.V.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; (G.M.V.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
| | - José David Gonzàlez Barajas
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
- Departiment of Nephrology, University of Guadalajara Health Sciences Center, Guadalajara 44100, Mexico
| | - Bladimir Diaz Villavicencio
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
- Departiment of Nephrology, University of Guadalajara Health Sciences Center, Guadalajara 44100, Mexico
| | - Claudia Castiglione
- Department of Medicine, Section of Nephrology, University of Verona, 37129 Verona, Italy;
| | - Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.A.); (G.D.)
| | - Gabriele Donati
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.A.); (G.D.)
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; (G.M.V.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy; (N.M.); (J.D.G.B.); (B.D.V.)
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Milan Manani S, Virzì GM, Morisi N, Marturano D, Tantillo I, Giuliani A, Miranda N, Brocca A, Alfano G, Donati G, Ronco C, Zanella M. Ongoing Peritoneal Dialysis Training at Home Allows for the Improvement of Patients' Empowerment: A Single Center Experience. J Clin Med 2024; 13:411. [PMID: 38256544 PMCID: PMC10816326 DOI: 10.3390/jcm13020411] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients' prognoses. MATERIAL AND METHODS We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD). RESULTS A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable. CONCLUSIONS A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Niccolò Morisi
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
- Nephrology Dialysis and Renal Transplantation Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.A.); (G.D.)
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Nunzia Miranda
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Alessandra Brocca
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Viale F Rodolfi, 37, 36100 Vicenza, Italy
| | - Gaetano Alfano
- Nephrology Dialysis and Renal Transplantation Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.A.); (G.D.)
| | - Gabriele Donati
- Nephrology Dialysis and Renal Transplantation Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.A.); (G.D.)
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy (G.M.V.); (D.M.); (N.M.)
- IRRIV—International Renal Research Institute Foundation, 36100 Vicenza, Italy
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Virzì GM, Mattiotti M, Milan Manani S, Gnappi M, Tantillo I, Corradi V, De Cal M, Giuliani A, Carta M, Giavarina D, Ronco C, Zanella M. Neutrophil Gelatinase-Associated Lipocalin in Peritoneal Dialysis-Related Peritonitis: Correlation with White Blood Cells over Time and a Possible Role as the Outcome Predictor. Blood Purif 2023; 53:316-324. [PMID: 37992697 PMCID: PMC10997251 DOI: 10.1159/000535300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION The present study aimed to monitor peritoneal neutrophil gelatinase-associated lipocalin (pNGAL) during peritonitis episodes and to enhance its diagnostic value by evaluating pNGAL at scheduled times in parallel with white blood cell (WBC) count. In addition, we investigated possible correlations between pNGAL and the etiology of peritonitis, evaluating it as a possible marker of the clinical outcome. METHODS Twenty-two patients with peritoneal dialysis (PD)-related peritonitis were enrolled. Peritonitis was divided into Gram-positive, Gram-negative, polymicrobial, and sterile. WBC count and neutrophil gelatinase-associated lipocalin (NGAL) in PD effluent were measured at different times (days 0, 1, 5, 10, 15, and/or 20 and 10 days after antibiotic therapy discontinuation). NGAL was measured by standard quantitative laboratory-based immunoassay and by colorimetric NGAL dipstick (NGALds) (dipstick test). RESULTS We found strong correlations between peritoneal WBC, laboratory-based NGAL, and NGALds values, both overall and separated at each time point. On day 1, we observed no significant difference in WBC, both NGALds (p = 0.3, 0.9, and 0.2) between Gram-positive, Gram-negative, polymicrobial, and sterile peritonitis. No significant difference has been found between de novo versus relapsing peritonitis for all markers (p > 0.05). We observed a parallel decrease of WBC and both NGAL in patients with favorable outcomes. WBC count and both pNGAL resulted higher in patients with negative outcomes (defined as relapsing peritonitis, peritonitis-associated catheter removal, peritonitis-associated hemodialysis transfer, peritonitis-associated death) at day 10 (p = 0.04, p = 0.03, and p = 0.05, respectively) and day 15 (p = 0.01, p = 0.04, and tendency for p = 0.005). There was a tendency toward higher levels of WBC and NGAL in patients with a negative outcome at day 5. No significant difference in all parameters was proven at day 1 (p = 0.3, p = 0.9, p = 0.2) between groups. CONCLUSION This study confirms pNGAL as a valid and reliable biomarker for the diagnosis of PD-peritonitis and its monitoring. Its trend is parallel to WBC count during peritonitis episodes, in particular, patients with unfavorable outcomes.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Maria Mattiotti
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Maddalena Gnappi
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
- Medicine Dipartiment (DIMED), University of Padova, Padova, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Valentina Corradi
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Massimo De Cal
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
| | - Mariarosa Carta
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy St Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy St Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
- Medicine Dipartiment (DIMED), University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis, and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV- International Renal Research Institute, Vicenza, Italy
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Mattiotti M, Milan Manani S, Gnappi M, Virzì GM, Marcello M, Marturano D, Tantillo I, Giuliani A, La Manna G, Ronco C, Zanella M. [Contrast Induced Encephalopathy after carotid percutaneous transluminal angioplasty in a patient with end stage renal disease undergoing peritoneal Dialysis]. G Ital Nefrol 2023; 40:2023-vol5. [PMID: 38010249] [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
Introduction. Contrast Induced Encephalopathy (CIE) belongs to Major Adverse Renal and Cardiovascular Events (MARCE) after iodinated contrast medium (IOCM), especially for high-risk patients with several comorbidities such as hypertension, diabetes, heart failure, and Chronic Kidney Disease (CKD). We report a case of CIE in a Peritoneal Dialysis (PD)-patient. Case report. A 78-year-old, affected by diabetes, hypertension, chronic heart failure, and End Stage Renal Disease (ESRD) treated with PD, underwent a carotid Percutaneous Angioplasty (PTA). Immediately after the exam, he developed mental confusion and aphasia. Encephalic CT scan and MRI excluded acute ischemia or hemorrhage but showed cerebral oedema. Mannitol and steroids were administered and additional PD exchange was performed with depurative aim. Within 2 days the patient completely recovered. Discussion. CIE mimics severe neurological diseases. It should be considered as a differential diagnosis if symptoms occur immediately after administration of IOCM, especially in high-risk patients and in case of intra-arterial injection. Clinical presentation includes transient cortical blindness, aphasia, focal neurological defects, and confusion. CIE is often a diagnosis of exclusion, and imaging plays a significant role. Symptoms generally resolve spontaneously within 24-48h, rarely in few days. Symptomatic therapy, including mannitol and steroids could be considered. In literature, CIE is reported only in a few patients affected by ESRD treated with chronic HD, and our is the first available case of a patient treated with chronic PD who developed this rare complication.
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Affiliation(s)
- Maria Mattiotti
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Maddalena Gnappi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Matteo Marcello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Transplant Unit, IRCCS Policlinico Sant'Orsola, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
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Marcello M, Virzì GM, Marturano D, de Cal M, Marchionna N, Sgarabotto L, De Rosa S, Ronco C, Zanella M. The Cytotoxic Effect of Septic Plasma on Healthy RBCs: Is Eryptosis a New Mechanism for Sepsis? Int J Mol Sci 2023; 24:14176. [PMID: 37762478 PMCID: PMC10531772 DOI: 10.3390/ijms241814176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis is a life-threatening multiple-organ dysfunction induced by infection and is one of the leading causes of mortality and critical illness worldwide. The pathogenesis of sepsis involves the alteration of several biochemical pathways such as immune response, coagulation, dysfunction of endothelium and tissue damage through cellular death and/or apoptosis. Recently, in vitro and in vivo studies reported changes in the morphology and in the shape of human red blood cells (RBCs) causing erythrocyte death (eryptosis) during sepsis. Characteristics of eryptosis include cell shrinkage, membrane blebbing, and surface exposure to phosphatidylserine (PS), which attract macrophages. The aim of this study was to evaluate the in vitro induction of eryptosis on healthy RBCs exposed to septic plasma at different time points. Furthermore, we preliminary investigated the in vivo levels of eryptosis in septic patients and its relationship with Endotoxin Activity Assay (EAA), mortality and other biological markers of inflammation and oxidative stress. We enrolled 16 septic patients and 16 healthy subjects (no systemic inflammation in the last 3 months) as a control group. At diagnosis, we measured Interleukin-6 (IL-6) and Myeloperoxidase (MPO). For in vitro study, healthy RBCs were exposed to the plasma of septic patients and CTR for 15 min, 1, 2, 4 and 24 h. Morphological markers of death and eryptosis were evaluated by flow cytometric analyses. The cytotoxic effect of septic plasma on RBCs was studied in vitro at 15 min, 1, 2, 4 and 24 h. Healthy RBCs incubated with plasma from septic patients went through significant morphological changes and eryptosis compared to those exposed to plasma from the control group at all time points (all, p < 0.001). IL-6 and MPO levels were significantly higher in septic patients than in controls (both, p < 0.001). The percentage of AnnexinV-binding RBCs was significantly higher in septic patients with EAA level ≥0.60 (positive EAA: 32.4%, IQR 27.6-36.2) compared to septic patients with EAA level <0.60 (negative EAA: 14.7%, IQR 5.7-30.7) (p = 0.04). Significant correlations were observed between eryptosis and EAA levels (Spearman rho2 = 0.50, p < 0.05), IL-6 (Spearman rho2 = 0.61, p < 0.05) and MPO (Spearman rho2 = 0.70, p < 0.05). In conclusion, we observed a quick and great cytotoxic effect of septic plasma on healthy RBCs and a strong correlation with other biomarkers of severity of sepsis. Based on these results, we confirmed the pathological role of eryptosis in sepsis and we hypothesized its use as a biomarker of sepsis, potentially helping physicians to face important treatment decisions.
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Affiliation(s)
- Matteo Marcello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35100 Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Nicola Marchionna
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Luca Sgarabotto
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Silvia De Rosa
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
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8
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Virzì GM, Mattiotti M, Milan Manani S, Gnappi M, Tantillo I, Corradi V, de Cal M, Giuliani A, Carta M, Giavarina D, Ronco C, Zanella M. Peritoneal NGAL: a reliable biomarker for PD-peritonitis monitoring. J Nephrol 2023; 36:2139-2141. [PMID: 36646971 DOI: 10.1007/s40620-022-01547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/03/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.
- IRRIV-International Renal Research Institute, Vicenza, Italy.
| | - Maria Mattiotti
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
- Nephrology, Dialysis and Transplant Unit, IRCCS Policlinico Sant'Orsola, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Maddalena Gnappi
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
- DIMED, University of Padova, Padua, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Valentina Corradi
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | | | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
- DIMED, University of Padova, Padua, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
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9
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Clementi A, Virzì GM, Manani SM, de Cal M, Battaglia GG, Ronco C, Zanella M. Plasma Cell-Free DNA and Caspase-3 Levels in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:5616. [PMID: 37685683 PMCID: PMC10488719 DOI: 10.3390/jcm12175616] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Cell-free plasma DNA (cfDNA) is circulating extracellular DNA arising from cell death mechanisms (apoptosis, necrosis, etc.). It is commonly existent in healthy individuals, but its ranks increase in diverse clinical circumstances, such as kidney disease, sepsis, myocardial infarction, trauma and cancer. In patients with advanced chronic kidney disease, cfDNA is connected to inflammation, and it has been associated with higher mortality. Caspase-3 plays a dominant role in apoptosis, a mechanism of programmed cell death involved in the pathogenesis and progression of chronic kidney disease (CKD). The aim of this pilot study was the evaluation of cfDNA levels and caspase-3 concentrations in patients with chronic kidney disease, in order to investigate the potential role of these molecules, deriving from inflammatory and apoptotic mechanisms, in the progression of renal damage. METHODS We compared cfDNA and caspase-3 levels in 25 CKD patients and in 10 healthy subjects, evaluating their levels based on CKD stage. We also explored correlations between cfDNA and caspase-3 levels in CKD patients and between cfDNA and caspase-3 levels and serum creatinine and urea in this population. RESULTS We observed that cfDNA and caspase-3 levels were higher in patients with CKD compared to healthy subjects, in particular in patients with advanced renal disease (CKD stage 5). A positive correlation between cfDNA and caspase-3 levels and between cfDNA and caspase-3 and creatinine and urea were also noticed. CONCLUSIONS Patients with chronic kidney disease show higher levels of cfDNA and caspase-3 levels compared to the control group. Based on these preliminary results, we speculated that the worsening of renal damage and the increase in uremic toxin concentration could be associated with higher levels of cfDNA and caspase-3 levels, thus reflecting the potential role of inflammation and apoptosis in the progression of CKD. Future studies should focus on the validation of these promising preliminary results.
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Affiliation(s)
- Anna Clementi
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy; (A.C.); (G.G.B.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Sabrina Milan Manani
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimo de Cal
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Giovanni Giorgio Battaglia
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy; (A.C.); (G.G.B.)
| | - Claudio Ronco
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Monica Zanella
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
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10
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Milan Manani S, Mattiotti M, Marcello M, Virzì GM, Gnappi M, Marturano D, Tantillo I, Ronco C, Zanella M. Contrast-Induced Encephalopathy: A Rare Complication in a Patient on Peritoneal Dialysis with Several Risk Factors. Nephron Clin Pract 2023; 147:665-672. [PMID: 37442103 DOI: 10.1159/000531771] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Major adverse renal and cardiovascular events are reported for high-risk patients undergoing intra-arterial procedures, even if performed with iso-osmolar contrast media (CM). We report a case of contrast-induced encephalopathy (CIE) in a peritoneal dialysis (PD) patient, affected by diabetes, hypertension, and chronic heart failure. A 78-year-old PD patient (diuresis 1,000 mL) underwent a percutaneous angioplasty of the carotid. Immediately after the exam, he developed mental confusion and aphasia. Encephalic computed tomography scan and magnetic resonance imaging excluded ischemia or hemorrhage, but both showed cerebral edema; EEG showed right hemisphere abnormalities, sequelae of recent ischemia. Mannitol and steroids were administered to reduce edema, and additional PD exchange was performed with depurative aim. Within 2 days the patient completely recovered. CIE mimics severe neurological diseases, and it should be considered as differential diagnosis if symptoms come out soon after intra-arterial administration of CM, especially in high-risk patients. Our patient suffered from diabetes, chronic kidney disease, hypertension, chronic heart failure, which are possible contributing factors to the development of CIE. Moreover, this clinical scenario is noteworthy because the development in a patient who underwent PD had never been described before.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Maria Mattiotti
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Matteo Marcello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | | | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Claudio Ronco
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
- DIMED, University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
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11
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Gechelin C, Milan Manani S, Virzì GM, Marturano D, Mattiotti M, Tantillo I, Ferrara A, Zirino F, Giuliani A, Ronco C, Zanella M. [Psychological support in anxiety management for patients affected by chronic kidney disease and treated by dialysis]. G Ital Nefrol 2023; 40:40-01-2023-08. [PMID: 36883924] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Introduction: The quality of life of patients with chronic kidney disease stage V is strongly affected by the recommended therapies. Such a situation alters the state of anxiety, which expresses a perception connected to a specific context and it overlaps with trait anxiety, which evaluates relatively stable aspects of being prone to anxiety. The study aims to analyze the anxiety level of uremic patients and to demonstrate the benefit of psychological support either in person or online in order to mostly reduce the state of anxiety. Materials and methods: 23 patients treated at the Nephrology Unit of the San Bortolo Hospital in Vicenza have undergone at least 8 psychological sessions. The first and the eighth sessions have been held in person, while the others were either in person or online based on the patients' preference. The State-Trait Anxiety Inventory (STAI), which means to evaluate the current state of anxiety and aspects of being prone to anxiety, was submitted during the first and the eighth sessions. Results: Patients, before being submitted to psychological treatment, showed high rates of both State and Trait anxiety levels. After eight sessions the trait anxiety features and even better the state anxiety ones have significantly reduced both thanks to in-person or online treatments. Conclusions: A treatment of minimum eight sessions shows a significant improvement of the nephropathic patient's trait and, even better, state anxiety level and it also fosters the achievement of advanced adjustment levels compared to the new clinical status together with an improvement of the quality of life.
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Affiliation(s)
- Chiara Gechelin
- I.R.R.I.V. (International Renal Research Institute) Foundation, Vicenza
| | | | | | - Davide Marturano
- I.R.R.I.V. (International Renal Research Institute) Foundation, Vicenza
| | - Maria Mattiotti
- I.R.R.I.V. (International Renal Research Institute) Foundation, Vicenza
| | - Ilaria Tantillo
- I.R.R.I.V. (International Renal Research Institute) Foundation, Vicenza
| | - Alida Ferrara
- Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale "San Bortolo", Vicenza
| | - Fortunata Zirino
- Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale "San Bortolo", Vicenza
| | - Anna Giuliani
- Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale "San Bortolo", Vicenza
| | - Claudio Ronco
- Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale "San Bortolo", Vicenza
| | - Monica Zanella
- Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale "San Bortolo", Vicenza
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12
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Virzì GM, Mattiotti M, de Cal M, Ronco C, Zanella M, De Rosa S. Endotoxin in Sepsis: Methods for LPS Detection and the Use of Omics Techniques. Diagnostics (Basel) 2022; 13:diagnostics13010079. [PMID: 36611371 PMCID: PMC9818564 DOI: 10.3390/diagnostics13010079] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Lipopolysaccharide (LPS) or endotoxin, the major cell wall component of Gram-negative bacteria, plays a pivotal role in the pathogenesis of sepsis. It is able to activate the host defense system through interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. A large amount of LPS induces inappropriate activation of the immune system, triggering an exaggerated inflammatory response and consequent extensive organ injury, providing the basis of sepsis damage. In this review, we will briefly describe endotoxin's molecular structure and its main pathogenetic action during sepsis. In addition, we will summarize the main different available methods for endotoxin detection with a special focus on the wider spectrum offered by omics technologies (genomics, transcriptomics, proteomics, and metabolomics) and promising applications of these in the identification of specific biomarkers for sepsis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
- Correspondence: ; Tel.: +39-0444753650; Fax: +39-0444753949
| | - Maria Mattiotti
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
| | - Silvia De Rosa
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
- Centre for Medical Sciences—CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, 38122 Trento, Italy
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13
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Virzì GM, Milan Manani S, Marturano D, Clementi A, Lerco S, Tantillo I, Giuliani A, Battaglia GG, Ronco C, Zanella M. Eryptosis in Peritoneal Dialysis-Related Peritonitis: The Potential Role of Inflammation in Mediating the Increase in Eryptosis in PD. J Clin Med 2022; 11:jcm11236918. [PMID: 36498493 PMCID: PMC9737953 DOI: 10.3390/jcm11236918] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Peritonitis and exit site infections are the main complications of patients treated with peritoneal dialysis (PD). Erythrocytes (red blood cells—RBCs) are very sensitive cells, and they are characterized by eryptosis (programmed cell death). The purpose of this research was to assess eryptosis in PD patients with PD-related peritonitis and its connection to inflammatory markers in vivo and in vitro. Material and Methods: In this study, we included 65 PD patients: 34 PD patients without systemic inflammation nor PD-related peritonitis in the previous 3 months, and 31 PD patients with an acute episode of PD-related peritonitis. We measured C-reactive protein (CRP) and cytokine (IL-1β, IL-6, and IL-18) levels as systemic inflammatory markers. Eryptosis was evaluated by flow cytometric analyses in freshly isolated RBCs. The induction of eryptosis due to in vitro exposure to IL-1β, IL-6, and IL-18 was verified. Results: Eryptosis was significantly higher in PD patients with peritonitis (9.6%; IQR 4.2−16.7), compared to the those in the other group (2.7%; IQR 1.6−3.9) (p < 0.0001). Significant positive correlations were noticed between eryptosis and CRP, IL-1β, and IL-6. RBCs, incubated with greater concentrations of all cytokines in vitro, resulted in significantly higher occurrences of eryptosis in comparison with those incubated with lower concentration and with untreated cell (p < 0.05), and for those with extensive exposure (p < 0.05). Conclusion: In conclusion, we investigated a potential relationship between systemic eryptosis and the in vivo and in vitro inflammatory damage of the peritoneal membrane during peritonitis. Thus, the presented results revealed that upregulated inflammatory markers and immune system dysregulation could be the cause of high levels of systemic eryptosis during PD-related peritonitis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Correspondence: ; Tel.: +39-0444757714
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Medicine (DIMED), University of Padua, 35100 Padua, Italy
| | - Anna Clementi
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Medicine (DIMED), University of Padua, 35100 Padua, Italy
| | - Silvia Lerco
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Catania, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
| | | | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Catania, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
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14
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Castellani C, Radu CM, Morillas-Becerril L, Barison I, Menato F, Do Nascimento TM, Fedrigo M, Giarraputo A, Virzì GM, Simioni P, Basso C, Papini E, Tavano R, Mancin F, Vescovo G, Angelini A. Poly(lipoic acid)-based nanoparticles as a new therapeutic tool for delivering active molecules. Nanomedicine 2022; 45:102593. [PMID: 35907619 DOI: 10.1016/j.nano.2022.102593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/26/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
Pluronic-coated polylipoic acid-based nanoparticles (F127@PLA-NPs) have great potential as biodegradable nanovectors for delivering active molecules to different organs in complex diseases. In this study we describe the in vivo biodistribution, safety and ability to deliver molecules of F127@PLA-NPs in healthy rats following intravenous administration. Adult rats were injected with 10 mg/kg of rhodamine B-labeled F127@PLA-NPs, and NPs fluorescence and MFI rate were measured by confocal microscopy in whole collected organs. The NPs accumulation rate was maximal in the heart, compared to the other organs. At the cellular level, myocytes and kidney tubular cells showed the highest NPs uptake. Neither histopathological lesion nor thrombogenicity were observed after NPs injection. Finally, F127@PLA-NPs were tested in vitro as miRNAs delivery nanosystem, and they showed good ability in targeting cardiomyocytes. These results demonstrated that our F127@PLA-NPs constitute a biological, minimally invasive and safe delivery tool targeting organs and cells, such as heart and kidney.
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Affiliation(s)
- Chiara Castellani
- Dept. of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Claudia Maria Radu
- Thrombotic and Hemorrhagic Diseases Unit, Dept. of Medicine, Padua University Hospital, Padua, Italy
| | | | - Ilaria Barison
- Dept. of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federica Menato
- Dept. of Chemical Sciences, University of Padua, Padua, Italy
| | | | - Marny Fedrigo
- Dept. of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessia Giarraputo
- Dept. of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Grazia Maria Virzì
- Dept. of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Simioni
- Thrombotic and Hemorrhagic Diseases Unit, Dept. of Medicine, Padua University Hospital, Padua, Italy
| | - Cristina Basso
- Dept. of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Emanuele Papini
- Dept. of Biomedical Sciences and Centre for Innovative Biotechnological Research-CRIBI, University of Padua, Padua, Italy
| | - Regina Tavano
- Dept. of Biomedical Sciences and Centre for Innovative Biotechnological Research-CRIBI, University of Padua, Padua, Italy
| | - Fabrizio Mancin
- Dept. of Chemical Sciences, University of Padua, Padua, Italy
| | | | - Annalisa Angelini
- Dept. of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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15
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Clementi A, Virzì GM. Novel Clinical Updates in Uremia. J Clin Med 2022; 11:jcm11133791. [PMID: 35807076 PMCID: PMC9267798 DOI: 10.3390/jcm11133791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Anna Clementi
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy
- Correspondence: (A.C.); (G.M.V.)
| | - Grazia Maria Virzì
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- Correspondence: (A.C.); (G.M.V.)
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16
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Marcello M, Virzì GM, Muciño-Bermejo MJ, Milan Manani S, Giavarina D, Salvador L, Ronco C, Zanella M. Subclinical AKI and Clinical Outcomes in Elderly Patients Undergoing Cardiac Surgery: Diagnostic Utility of NGAL versus Standard Creatinine Increase Criteria. Cardiorenal Med 2022; 12:94-105. [PMID: 35661656 DOI: 10.1159/000525221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/10/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and serious postoperative complication in patients undergoing cardiac surgery and its incidence is particularly high among elderly patients. Cardiac surgery-associated AKI (CSA-AKI) represents the second most common cause of AKI in the intensive care unit but its true incidence could be underestimated, especially in elderly population. The current biomarkers of AKI are unreliable and delayed during acute changes in kidney function. In the setting of subclinical AKI (SAKI), biomarkers of tubular damage, such as NGAL, seem to be an early indicator of kidney damage. The aim of this study was to investigate NGAL utility in the SAKI diagnosis in the first 48 h after cardiac surgery and its helpfulness in predicting adverse clinical outcomes in comparison to current criteria for AKI. METHODS This is an observational study of 72 patients admitted to San Bortolo's cardiac surgery department for elective cardiosurgical procedure enrolled over a 5-months period. All patients underwent peripheral venous sample 48 h after cardiac surgery to assess plasmatic creatinine (48Cr) and NGAL (48pNGAL) in addition to exams already foreseen by clinical practice. For each patient we studied renal, respiratory and cardiovascular outcome during hospitalization as well as 30 days and 6 months mortality. Creatinine Increase AKI (CrIAKI) was defined by 48CrI ≥0.3 mg/dL and SAKI was defined by 48pNGAL ≥100 pg/dL. We also assessed Respiratory (ArespO) as well as Cardiovascular (ACvO) outcome. RESULTS Thirty days mortality was 8.3% (6 patients) and 6 months mortality was 12.5% (9 patients). A total of 27 patients (37.5%) presented AKI according to KDIGO (4) and 4 (5.5%) needed renal replacement therapy (RRT). SAKI was significantly associated with 30 days mortality (p = 0.0238), 6 months mortality (p = 0.002), Adverse renal outcome (ARenO) (p = 0.004) and need for RRT (p = 0.005). CrIAKI was significantly associated with 30 days mortality (p = 0.009) and ARenO (p = 0.0001), but not with 6 months mortality nor need for RRT.
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Affiliation(s)
- Matteo Marcello
- 1IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy, .,Libera Università Vita Salute San Raffaele, Milano, Italy,
| | - Grazia Maria Virzì
- 1IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - María-Jimena Muciño-Bermejo
- 1IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Sabrina Milan Manani
- 1IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- 1IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- 1IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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17
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Milan Manani S, Virzì GM, Marcello M, Zanella M. Neutrophil gelatinase-associated lipocalin dipstick test in peritoneal dialysis patients with peritonitis. Clin Kidney J 2021; 15:825-826. [PMID: 35371459 PMCID: PMC8967666 DOI: 10.1093/ckj/sfab249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV––International Renal Research Institute, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV––International Renal Research Institute, Vicenza, Italy
| | - Matteo Marcello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV––International Renal Research Institute, Vicenza, Italy
- Libera Università Vita Salute San Raffaele, Milano, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV––International Renal Research Institute, Vicenza, Italy
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18
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Milan Manani S, Virzì GM, Tantillo I, Giuliani A, Dian S, Marcello M, Costa E, Marturano D, Ronco C, Zanella M. Peritoneal Vicenza "Short" Catheter Outcomes and Comparison with International Society for Peritoneal Dialysis Guidelines. Blood Purif 2021; 51:726-731. [PMID: 34883486 DOI: 10.1159/000519316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A well-functioning peritoneal catheter is key to success of peritoneal dialysis (PD). The Vicenza "short" catheter is a modified Tenckhoff catheter with a shorter intraperitoneal segment. The aim of this study was to evaluate the incidence of catheter-related complications and catheter survival rate using the Vicenza "short" catheter, according to the goals suggested by the International Society for Peritoneal Dialysis (ISPD) guidelines. Second, we compared insertion techniques used in our center. METHODS This is a retrospective cohort, single-center study analyzing incident PD patients undergoing Vicenza "short" peritoneal catheter placement between January 1, 2015, and December 31, 2019. As clinical outcomes, we evaluated catheter patency at 12 months, exit-site/tunnel infection and peritonitis within 30 days of catheter insertion, visceral injury, or significant hemorrhage during the procedure, in accordance with ISPD guidelines. RESULTS The percentage of patency at 12 months for all catheter insertion methods was 88.91%, and the percentage for laparoscopic placement was 93.75%. The exit-site/tunnel infection and peritonitis occurring within 30 days of catheter insertion were, respectively, 0.75% and 2.2%; the visceral injury leading to intervention was 0.75%. We did not have any case of significant hemorrhage. All results were in line with ISPD guidelines. CONCLUSION We conclude that the Vicenza "short" catheter is a suitable device for peritoneal access. The implantation procedure is safe and easy to perform, and both nephrologists and surgeons can do it. A confident use and a proper implantation of the Vicenza "short" catheter help achieve the clinical ISPD goals for the PD access procedure in terms of catheter survival and complication rates.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Silvia Dian
- International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,DIMED, University of Padova, Padova, Italy
| | - Matteo Marcello
- International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,Libera Università Vita Salute San Raffaele, Milan, Italy
| | - Elisa Costa
- Department of Internal Medicine, Nephrology Dialysis and Transplantation Clinics, Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Marturano
- International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,DIMED, University of Padova, Padova, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,DIMED, University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
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19
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Virzì GM, Clementi A, Milan Manani S, Castellani C, Battaglia GG, Angelini A, Vescovo G, Ronco C. The Role of Cell-Free Plasma DNA in Patients with Cardiorenal Syndrome Type 1. Cardiorenal Med 2021; 11:218-225. [PMID: 34518452 DOI: 10.1159/000518553] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent research highlighted the potential role of circulating cell-free DNA (cfDNA), resulted by apoptosis or cell necrosis, as a prognostic marker in the setting of different clinical conditions. Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Apoptosis of renal epithelial cells is proposed as a mechanism involved in CRS type 1. In this study, we investigated cfDNA levels in patients with acute heart failure (AHF) and CRS type 1 and the possible correlation between cfDNA levels and inflammatory and apoptotic parameters. METHODS We enrolled 17 AHF patients and 15 CRS type 1 who exhibited AKI at the time of admission (caused by AHF) or developed AKI during the first 48 h from admission. cfDNA was extracted from plasma and quantified by real-time polymerase chain reaction. Plasma levels of NGAL, tumor necrosis factor-α, interleukin (IL)-6, IL-18, and caspase-3 were measured. RESULTS We observed significantly higher levels of cfDNA in patients with CRS type 1 than patients with AHF. Caspase-3, IL-6, IL-18, and NGAL levels resulted significantly increased in patients with CRS type 1. Moreover, a positive correlation between cfDNA levels and caspase-3 levels was found, as well as between cfDNA levels and IL-6 and renal parameters. CONCLUSION Our study explores the premise of cfDNA as a marker for apoptosis and inflammation in CRS type 1 patients. cfDNA could potentially serve as an index for noninvasive monitoring of tissue damage and apoptosis in patients with AKI induced by AHF.
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Affiliation(s)
- Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Anna Clementi
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy
| | - Sabrina Milan Manani
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Chiara Castellani
- Department of Medicine DIMED, University of Padua Medical School, Padua, Italy
| | | | - Annalisa Angelini
- Department of Medicine DIMED, University of Padua Medical School, Padua, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit Sant'Antonio Hospital Padua, Padua, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine DIMED, University of Padua Medical School, Padua, Italy
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20
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Milan Manani S, Baretta M, Giuliani A, Virzì GM, Martino F, Crepaldi C, Ronco C. Remote monitoring in peritoneal dialysis: benefits on clinical outcomes and on quality of life. J Nephrol 2020; 33:1301-1308. [PMID: 32779144 PMCID: PMC7416995 DOI: 10.1007/s40620-020-00812-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/04/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
Background Automated peritoneal dialysis (APD) has been proved benefit from remote monitoring (RM), but evidences are limited. In this study, we compared clinical outcomes and quality of life (QoL) in two group of patients undergoing APD, with and without exposure of RM. Methods This is a retrospective cohort study, comparing outcomes in two groups of APD patients monitored during 6 months with RM (group A: n = 35) or standard care (group B: n = 38 patients). In our clinical practice, we assign the RM system to patients who live more distant from the PD center or difficulty in moving. We evaluated emergency visits, hospitalizations, peritonitis, overhydration, and dropout. QoL was assessed with the Kidney Disease Quality of life-Short Form (KDQOL-SF). We included four additional questions focused on patient’s perception of monitoring, safety and timely problems solution (Do you think that home-therapy monitoring could interfere with your privacy? Do you think that your dialysis sessions are monitored frequently enough? Do you think that dialysis-related issues are solved timely? Do you feel comfortable carrying out your home-based therapy?). Results The case group presented a higher comorbidity score, according to Charlson Comorbidity Index (group A: 5.0; IQR 4.0–8.0 versus group B: 4.0; IQR 3.0–6.0) (p = 0.042). The results in group A showed a reduction in the urgent visits due to acute overhydration (group A: 0.17 ± 0.45 versus group B: 0.66 ± 1.36) (p: 0.042) and in the number of disease-specific hospitalization (group A n = 2.0; 18.2% versus group B n = 7.0; 77.8%) (p = 0.022). We did not find any difference between the two groups in terms of hospitalization because of all-cause, peritonitis, overhydration, and dropout. The analysis of KDQOL-SF subscales was similar in the two groups; on the contrary, the answers of our pointed questions have showed a significant difference between the two groups (group A: 100 IQR 87.5–100.0 versus group B 87.5; IQR 75.0–100.0) (p: 0.018). Conclusion RM improved clinical outcomes in PD patients, reducing the emergency visits and the hospitalizations, related to nephrological problems, especially in patients with higher comorbidity score. The acceptance and satisfaction of care were better in patients monitored with RM than with standard APD.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy.
| | - Michele Baretta
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Francesca Martino
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy.,Università degli Studi di Padova, Via 8 Febbraio 1848, 2, 35122, Padova, Italy
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21
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Ferrari F, Scalzotto E, Esposito P, Samoni S, Mistrorigo F, Rizo Topete LM, De Cal M, Virzì GM, Corradi V, Torregrossa R, Valle R, Bianzina S, Aspromonte N, Floris M, Fontanelli A, Brendolan A, Ronco C. Neutrophil gelatinase-associated lipocalin does not predict acute kidney injury in heart failure. World J Clin Cases 2020; 8:1600-1607. [PMID: 32432138 PMCID: PMC7211536 DOI: 10.12998/wjcc.v8.i9.1600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute cardiorenal syndrome type 1 (CRS-1) is defined by a rapid cardiac dysfunction leading to acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) is expressed on the surface of human neutrophils and epithelial cells, such as renal tubule cells, and its serum (sNGAL) and urinary have been used to predict AKI in different clinical settings.
AIM To characterize CRS-1 in a cohort of patients with acute heart diseases, evaluating the potentiality of sNGAL as an early marker of CRS-1.
METHODS We performed a retrospective cohort, multi-centre study. From January 2010 to December 2011, we recruited 202 adult patients admitted to the coronary intensive care unit (CICU) with a diagnosis of acute heart failure or acute coronary syndrome. We monitored the renal function to evaluate CRS-1 development and measured sNGAL levels within 24 h and after 72 h of CICU admission.
RESULTS Overall, enrolled patients were hemodynamically stable with a mean arterial pressure of 92 (82-107) mmHg, 55/202 (27.2%) of the patients developed CRS-1, but none of them required dialysis. Neither the NGAL delta value (AUC 0.40, 95%CI: 0.25-0.55) nor the NGAL peak (AUC 0.45, 95%CI: 0.36-0.54) or NGAL cut-off (≥ 140 ng/mL) values were statistically significant between the two groups (CRS-1 vs no-CRS1 patients). The area under the ROC curve for the prediction of CRS-1 was 0.40 (95%CI: 0.25-0.55) for the delta NGAL value and 0.45 (95%CI: 0.36-0.54) for the NGAL peak value. Finally, in multivariate analysis, the risk of developing CRS-1 was correlated with age > 60 years, urea nitrogen at admission and 24 h-urine output (AUC 0.83, SE = 60.5% SP = 93%), while sNGAL was not significantly correlated.
CONCLUSION In our population, sNGAL does not predict CRS-1, probably as a consequence of the mild renal injury and the low severity of heart disease. So, these data might suggest that patient selection should be taken into account when considering the utility of NGAL measurement as a biomarker of kidney damage.
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Affiliation(s)
- Fiorenza Ferrari
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Elisa Scalzotto
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, Nephrology, Dialysis and Transplantation Clinics, Genoa University and IRCCS Policlinico San Martino, Genova 16132, Italy
| | - Sara Samoni
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Flavio Mistrorigo
- Department of Cardiology, Coronary Intensive Care Unit, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Lilia Maria Rizo Topete
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Massimo De Cal
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Grazia Maria Virzì
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Valentina Corradi
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Rossella Torregrossa
- Department of Cardiology Coronary, Intensive Care Unit, Chioggia Hospital, Venezia 36100, Italy
| | - Roberto Valle
- Department of Cardiology Coronary, Intensive Care Unit, Chioggia Hospital, Venezia 36100, Italy
| | - Stefania Bianzina
- Neonatal and Pediatric Intensive Care Unit, G. Gaslini Institute, Genoa 16147, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart Agostino Gemelli Foundation, Rome 00168, Italy
| | - Matteo Floris
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, Cagliari 09134, Italy
| | - Alessandro Fontanelli
- Department of Cardiology, Coronary Intensive Care Unit, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Alessandra Brendolan
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Claudio Ronco
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
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22
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Breglia A, Godi I, Virzì GM, Guglielmetti G, Iannucci G, De Cal M, Brocca A, Carta M, Giavarina D, Ankawi G, Passannante A, Yun X, Biolo G, Ronco C. Subclinical Contrast-Induced Acute Kidney Injury in Patients Undergoing Cerebral Computed Tomography. Cardiorenal Med 2020; 10:125-136. [PMID: 32036364 DOI: 10.1159/000505422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The nephrotoxicity of modern contrast media remains controversial. Novel biomarkers of kidney damage may help in identifying a subclinical structural renal injury not revealed by widely used markers of kidney function. OBJECTIVE The aim of this study was to investigate clinical (contrast-induced acute kidney injury [CI-AKI]) and subclinical CI-AKI (SCI-AKI) after intra-arterial administration of Iodixanol and Iopamidol in patients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2. METHODS This is a prospective observational monocentric study. Urinary sample was collected at 4-8 h after contrast medium exposure to measure neutrophil gelatinase associated lipocalin (NGAL) and the product tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 ([TIMP-2] × [IGFBP7]), while blood samples were collected at 24 and 48 h after exposure to measure serum creatinine. RESULTS One hundred patients were enrolled, of whom 53 were exposed to Iodixanol and 47 to Iopamidol. Patients in Iodixanol and Iopamidol groups were comparable in terms of demographics, pre-procedural and procedural data. No patient developed CI-AKI according KDIGO criteria, while 13 patients reported SCI-AKI after exposure to iodine-based medium contrast (3 patients in Iodixanol group and 10 patients in Iopamidol group), defined by positive results of NGAL and/or [TIMP-2] × [IGFBP7]. A positive correlation was found between NGAL and [TIMP-2] × [IGFBP7] in the analysed population (Spearman's rho 0.49, p < 0.001). In logistic regression analysis, Iopamidol exposure showed higher risk for SCI-AKI compared to Iodixanol (OR 4.5 [95% CI 1.16-17.52], p = 0.030), even after controlling for eGFR and volume of contrast medium used. CONCLUSIONS This study showed that intra-arterial modern contrast media administration may have a nephrotoxic effect in a population without pre-existing chronic kidney disease. Further investigations on larger scale are warranted to confirm if Iopamidol exposed patients to increased risk of SCI-AKI compared to Iodixanol.
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Affiliation(s)
- Andrea Breglia
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Emergency Department of Arzignano Hospital, Arzignano, Vicenza, Italy.,Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Ilaria Godi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy, .,Department of Medicine, University of Padova, Padova, Italy,
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Gabriele Guglielmetti
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale (UPO), "Maggiore della Carità" University Hospital, Novara, Italy
| | | | - Massimo De Cal
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Mariarosa Carta
- Department of Laboratory Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Laboratory Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Ghada Ankawi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Internal Medicine and Nephrology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alberto Passannante
- Department of Anaesthesia and Intensive Care, University of Trieste, Trieste, Italy
| | - Xie Yun
- Department of Nephrology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Gianni Biolo
- Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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23
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Milan Manani S, Virzì GM, Giuliani A, Baretta M, Corradi V, De Cal M, Biasi C, Crepaldi C, Ronco C. Lipopolysaccharide Evaluation in Peritoneal Dialysis Patients with Peritonitis. Blood Purif 2020; 49:434-439. [PMID: 31914448 DOI: 10.1159/000505388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lipopolysaccharide (LPS), also known as endotoxin, is cell wall component of Gram-negative (GN) bacteria, which may contribute to the progression of a local infection to sepsis. Previous studies demonstrate that LBP is detectable in peritoneal effluents of peritoneal dialysis (PD) patients and it is significantly elevated in PD patients with peritonitis caused by both GN and Gram-positive (GP) bacteria. AIM The aim of this study was to evaluate LPS levels in PD patients; in particular, we investigated different LPS levels in the context of GP and GN peritonitis. MATERIAL AND METHODS We enrolled 49PD (61% Continuous Ambulatory PD and 39% Automated PD) patients: 37 with peritonitis and 12 without. Quantitative determination of LPS was performed by Enzyme-linked Immunosorbent Assay Kitin peritoneal and plasma samples. RESULTS Quantitative analysis of peritoneal and plasma LPS showed significantly higher levels in PD patients with peritonitis compared to patients without (p = 0.001). Furthermore, we divided patients with peritonitis in 2 groups on the basis of Gram staining (GP 27; GN 12). Peritoneal and plasma LPS levels showed significantly lower levels in PD patients with GP peritonitis than in patients with GN (p = 0.001). The median level of LPS showed no significant differences between patients without peritonitis and with GP peritonitis (p = 0.195). On the contrary, LPS levels showed significantly higher levels in PD patients with GN peritonitis compared to patients without peritonitis (p = 0.001). A significant positive correlation was observed between peritoneal white blood cells count (pWBC) and peritoneal LPS (Spearman's rho = 0,412, p = 0.013). However, no statistically significant correlation was observed between plasma LPS and WBC count. CONCLUSION We observed LPS presence in all PD patients. In particular, our results demonstrated that LPS is significantly elevated in PD patients with GN peritonitis. Furthermore, pWBC and LPS levels increased proportionally in PD patients with peritonitis. Peritoneal and plasma LPS levels could be a useful marker for diagnosis and management of GN peritonitis in PD patients.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy, .,IRRIV, International Renal Research Institute, Vicenza, Italy,
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Michele Baretta
- IRRIV, International Renal Research Institute, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
| | - Valentina Corradi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Massimo De Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Caterina Biasi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
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24
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Cantaluppi V, Medica D, Quercia AD, Dellepiane S, Figliolini F, Virzì GM, Brocca A, Quaglia M, Marengo M, Olivieri C, Senzolo M, Garzotto F, Della Corte F, Castellano G, Gesualdo L, Camussi G, Ronco C. Perfluorocarbon solutions limit tubular epithelial cell injury and promote CD133+ kidney progenitor differentiation: potential use in renal assist devices for sepsis-associated acute kidney injury and multiple organ failure. Nephrol Dial Transplant 2019; 33:1110-1121. [PMID: 29267971 DOI: 10.1093/ndt/gfx328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/23/2017] [Indexed: 01/16/2023] Open
Abstract
Background The renal assist device (RAD) is a blood purification system containing viable renal tubular epithelial cells (TECs) that has been proposed for the treatment of acute kidney injury (AKI) and multiple organ failure. Perfluorocarbons (PFCs) are oxygen carriers used for organ preservation in transplantation. The aim of this study was to investigate the effect of PFCs on hypoxia- and sepsis-induced TEC injury and on renal CD133+ progenitor differentiation in a microenvironment similar to the RAD. Methods TECs were seeded in a polysulphone hollow fibre under hypoxia or cultured with plasma from 10 patients with sepsis-associated AKI in the presence or absence of PFCs and were tested for cytotoxicity (XTT assay), apoptosis (terminal deoxynucleotidyl transferase dUTP nick end labeling assay, caspases, enzyme-linked immunosorbent assay, Fas/Fas Ligand pathway activation), mitochondrial activity, cell polarity [transepithelial electrical resistance (TEER)] and adenosine triphosphate production. The effect of PFCs on proliferation and differentiation of human CD133+ progenitors was also studied. Results In the presence of PFCs, TECs seeded into the polysulphone hollow fibre showed increased viability and expression of insulin-like growth factor 1, hepatocyte growth factor and macrophage-stimulating protein. Plasma from septic patients induced TEC apoptosis, disruption of oxidative metabolism, alteration of cell polarity and albumin uptake, down-regulation of the tight junction protein ZO-1 and the endocytic receptor megalin on the TEC surface. These detrimental effects were significantly reduced by PFCs. Moreover, PFCs induced CD133+ renal progenitor cell proliferation and differentiation towards an epithelial/tubular-like phenotype. Conclusions PFCs improved the viability and metabolic function of TECs seeded within a polysulphone hollow fibre and subjected to plasma from septic AKI patients. Additionally, PFCs promoted differentiation towards a tubular/epithelial phenotype of CD133+ renal progenitor cells.
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Affiliation(s)
- Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, Maggiore della Carità Hospital-University of Eastern Piedmont, Novara, Italy.,Department of Medical Sciences and Center for Experimental Medical Research (CeRMS), Nephrology, Dialysis and Kidney Transplantation Center, University of Torino, Torino, Italy
| | - Davide Medica
- Department of Medical Sciences and Center for Experimental Medical Research (CeRMS), Nephrology, Dialysis and Kidney Transplantation Center, University of Torino, Torino, Italy
| | - Alessandro Domenico Quercia
- Nephrology, Dialysis and Kidney Transplantation Unit, Maggiore della Carità Hospital-University of Eastern Piedmont, Novara, Italy.,Department of Medical Sciences and Center for Experimental Medical Research (CeRMS), Nephrology, Dialysis and Kidney Transplantation Center, University of Torino, Torino, Italy
| | - Sergio Dellepiane
- Department of Medical Sciences and Center for Experimental Medical Research (CeRMS), Nephrology, Dialysis and Kidney Transplantation Center, University of Torino, Torino, Italy
| | - Federico Figliolini
- Department of Medical Sciences and Center for Experimental Medical Research (CeRMS), Nephrology, Dialysis and Kidney Transplantation Center, University of Torino, Torino, Italy
| | - Grazia Maria Virzì
- Nephrology, Dialysis and Kidney Transplantation Unit, San Bortolo Hospital and International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Alessandra Brocca
- Nephrology, Dialysis and Kidney Transplantation Unit, San Bortolo Hospital and International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Marco Quaglia
- Nephrology, Dialysis and Kidney Transplantation Unit, Maggiore della Carità Hospital-University of Eastern Piedmont, Novara, Italy
| | | | - Carlo Olivieri
- Intensive Care Unit, Maggiore della Carità Hospital-University of Eastern Piedmont, Novara, Italy
| | - Mara Senzolo
- Nephrology, Dialysis and Kidney Transplantation Unit, San Bortolo Hospital and International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Francesco Garzotto
- Nephrology, Dialysis and Kidney Transplantation Unit, San Bortolo Hospital and International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Francesco Della Corte
- Intensive Care Unit, Maggiore della Carità Hospital-University of Eastern Piedmont, Novara, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni Camussi
- Department of Medical Sciences and Center for Experimental Medical Research (CeRMS), Nephrology, Dialysis and Kidney Transplantation Center, University of Torino, Torino, Italy
| | - Claudio Ronco
- Nephrology, Dialysis and Kidney Transplantation Unit, San Bortolo Hospital and International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
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25
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Virzì GM, Milan Manani S, Clementi A, Castegnaro S, Brocca A, Riello C, de Cal M, Giuliani A, Battaglia GG, Crepaldi C, Ronco C. Eryptosis Is Altered in Peritoneal Dialysis Patients. Blood Purif 2019; 48:351-357. [PMID: 31291616 DOI: 10.1159/000501541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Red blood cells (RBCs) undergo programmed cell death known as eryptosis. Triggers of eryptosis include increased cytosolic Ca(2+) concentration, oxidative stress, osmotic shock, energy depletion and several uremic toxins. Little is known about the pathogenesis of eryptosis in peritoneal dialysis (PD) patients; furthermore, its relevance in worsening clinical conditions in these patients is still not completely defined. OBJECTIVES We investigated eryptosis levels in PD patients and its association with inflammatory and clinical parameters. MATERIAL AND METHODS A total of 46 PD patients and 17 healthy subjects (CTR) were enrolled. All eryptosis measurements were made in freshly isolated RBCs using the flow cytometer. RESULTS Eryptosis was significantly higher in PD patients than that in CTR (p < 0.001). Eryptosis levels did not differ significantly between PD patients with and without diabetes, with and without hypertension, and with and without cardiovascular disease. Eryptosis showed no significant differences between patients treated with continuous ambulatory PD/automated PD, with Kt/Vurea value ≤1.7 and >1.7, with a negative or positive history of peritonitis. On the contrary, eryptosis showed significantly lower levels in PD patients with weekly creatinine clearance ≥45 L/week/1.73 m2 (2.8%, 1.7-4.9 vs. 5.6%, 5.0-13.5; p= 0.049). Eryptosis showed significantly lower levels in PD patients with residual diuresis (n = 23) than that in patients without (3.7%, 2.6-5.6 vs. 5%, 3.1-16; p = 0.03). In these 23 patients, significant negative correlations between percentage of eryptosis and residual glomerular filtration rate (rGFR; Spearman's rho = -0.51, p = 0.01) and diuresis volume (Spearman's rho = -0.43, p = 0.05) were found. CONCLUSIONS The present study demonstrated higher eryptosis levels in PD patients compared to corresponding levels in CTR. Furthermore, important PD comorbidity and main PD parameters do not influence eryptosis. Importantly, our data have reported an increase in eryptosis levels with progressive residual diuresis and rGFR loss, probably due to decreased uremic toxins clearance.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy, .,International Renal Research Institute, IRRIV, Vicenza, Italy,
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Anna Clementi
- International Renal Research Institute, IRRIV, Vicenza, Italy.,Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy
| | - Silvia Castegnaro
- International Renal Research Institute, IRRIV, Vicenza, Italy.,Hematology Project Foundation, St Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy.,Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Caterina Riello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | | | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
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26
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Virzì GM, Breglia A, Ankawi G, Bolin C, de Cal M, Cianci V, Vescovo G, Ronco C. Plasma Lipopolysaccharide Concentrations in Cardiorenal Syndrome Type 1. Cardiorenal Med 2019; 9:308-315. [PMID: 31238313 DOI: 10.1159/000500480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome (CRS) type 1 is characterized by a rapid worsening of cardiac function that leads to acute kidney injury (AKI). This study evaluated the role of lipopolysaccharide (LPS) in the development of AKI in patients with acute heart failure (AHF) and its relationship with renal parameters, to enable a better comprehension of the pathophysiology of CRS type 1. METHODS We enrolled 32 AHF patients, 15 of whom were classified as having CRS type 1. Eight of these 15 exhibited AKI at the time of admission (caused by AHF) and the other 7 developed AKI during their stay in hospital (in the first 48 h). We evaluated the plasmatic LPS concentrations as well as conventional (serum creatinine [sCr] and urea) and unconventional (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C) renal markers. RESULTS LPS levels were significantly higher in the CRS type 1 patients. No significant difference in LPS level was found in patients who were admitted with AKI and those developed AKI in hospital, but there was a tendency towards a higher level of LPS in CRS type 1 patients admitted with AKI. The LPS concentrations at admission were similar in CRS type 1 survivors (n = 12) and nonsurvivors (n = 3) (p = 0.22). We observed a positive correlation between LPS level and NGAL, Scr at admission and peak Scr during hospitalization and urea at admission. CONCLUSION CRS type 1 patients present with an increased level of LPS and there is a direct correlation between LPS and renal parameters. This pilot research is the first study to explore the premise of LPS as novel pathophysiological factor in CRS type 1.
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Affiliation(s)
- Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy, .,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy,
| | - Andrea Breglia
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Emergency Department of Arzignano Hospital, Arzignano, Italy
| | - Ghada Ankawi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Internal Medicine and Nephrology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Vito Cianci
- Emergency Department of Arzignano Hospital, Arzignano, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit, Sant'Antonio Hospital Padua, Padua, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,Nephrology, Department of Medicine, University of Padua, Padua, Italy
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27
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Abstract
AKI is a common clinical condition associated with the risk of developing CKD and ESKD. Sepsis is the leading cause of AKI in the intensive care unit (ICU) and accounts for nearly half of all AKI events. Patients with AKI who require dialysis have an unacceptably high mortality rate of 60%-80%. During sepsis, endothelial activation, increased microvascular permeability, changes in regional blood flow distribution with resulting areas of hypoperfusion, and hypoxemia can lead to AKI. No effective drugs to prevent or treat human sepsis-induced AKI are currently available. Recent research has identified dysfunction in energy metabolism as a critical contributor to the pathogenesis of AKI. Mitochondria, the center of energy metabolism, are increasingly recognized to be involved in the pathophysiology of sepsis-induced AKI and mitochondria could serve as a potential therapeutic target. In this review, we summarize the potential role of mitochondria in sepsis-induced AKI and identify future therapeutic approaches that target mitochondrial function in an effort to treat sepsis-induced AKI.
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Affiliation(s)
- Jian Sun
- Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.,International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Jingxiao Zhang
- Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.,International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Jiakun Tian
- Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Kumar Digvijay
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Molecular Biotechnology Center, Department of Medical Sciences, University of Turin, Italy
| | - Laura Cueto
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, Virgen de la Salud Hospital, Toledo, Spain; and
| | - Yongjie Yin
- Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China;
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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28
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Milan Manani S, Virzì GM, Giuliani A, Crepaldi C, Ronco C. Catheter-related infections in peritoneal dialysis: comparison of a single center results and the literature data. J Nephrol 2019; 32:837-841. [PMID: 30955154 DOI: 10.1007/s40620-019-00604-3] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Catheter-related infections are important causes of morbidity in patients undergoing peritoneal dialysis (PD). There are different protocols of exit site care for the prevention of catheter-related infections. The aim of this study was to evaluate the incidence of catheter-related infections and their complications in our PD center. METHODS We performed a retrospective, observational study for all patients receiving PD in our center. We observed prevalent patients every year for 5 years. The patients performed the exit-site care three times a week, cleaning the exit site with 10% sodium hypochlorite. From 2017, update of ISPD recommendations suggests the application of antibiotic creams. We recorded the incidence rate of ESI and TI, gentamicin resistance, catheter lost, related post-ESI peritonitis and fungal infections, and we compared our results with the data in the literature. RESULTS Prevalent patients per year were 117.6 ± 5.5. The "time at risk" was 356.46 years. The median values of TESI (tunnel and exit site infections), TI, gentamicin resistance, related post-ESI peritonitis and fungal infection rate were similar in our results and the literature data. The ESI and the catheter lost caused by infection were significantly lower in our patients. No significant adverse effects, such as skin allergy or intolerance, were reported. CONCLUSIONS Our results confirm the utility and the safety of routinely exit site care using 10% sodium hypochlorite. This protocol resulted similar to the data reported in the literature. Our analysis of the literature highlighted the wide variation in the infection rate of ESI and TI.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine, University of Padua, Padua, Italy
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29
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
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30
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Clementi A, Virzì GM, Battaglia GG, Ronco C. Multi-Biomarkers Panel in Cardiac Surgery Patients. Blood Purif 2019; 48:192. [PMID: 30726836 DOI: 10.1159/000497230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy, .,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy,
| | | | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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31
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Husain-Syed F, Ferrari F, Sharma A, Hinna Danesi T, Bezerra P, Lopez-Giacoman S, Samoni S, de Cal M, Corradi V, Virzì GM, De Rosa S, Muciño Bermejo MJ, Estremadoyro C, Villa G, Zaragoza JJ, Caprara C, Brocca A, Birk HW, Walmrath HD, Seeger W, Nalesso F, Zanella M, Brendolan A, Giavarina D, Salvador L, Bellomo R, Rosner MH, Kellum JA, Ronco C. Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery. Nephrol Dial Transplant 2019; 34:308-317. [DOI: 10.1093/ndt/gfy227] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Faeq Husain-Syed
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Aashish Sharma
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Pércia Bezerra
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Sara Samoni
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Valentina Corradi
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Carla Estremadoyro
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Gianluca Villa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Jose J Zaragoza
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Carlotta Caprara
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Horst-Walter Birk
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Hans-Dieter Walmrath
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brendolan
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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Milan Manani S, Rosner MH, Virzì GM, Giuliani A, Berti S, Crepaldi C, Ronco C. Longitudinal Experience with Remote Monitoring for Automated Peritoneal Dialysis Patients. Nephron Clin Pract 2019; 142:1-9. [PMID: 30699410 DOI: 10.1159/000496182] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is an ideal model for testing remote monitoring (RM). In this study, we evaluated the RM application longitudinally in stable patients undergoing automated PD (APD). METHODS This was an observational study, comparing outcomes in patients with (current patients) and without (historical data) exposure of RM. We analyzed cost-effectiveness of RM-APD measuring the number of night alarms, number of hospital visits, direct and indirect costs. RESULTS Changes in APD prescription were almost double in the case group (RM) compared to the control group (p = 0.0005). The need for in-person visits and nocturnal alarms was significantly less in RM-APD than in traditional APD (p = 0.01 and p = 0.002, respectively). The distance traveled by patients in the case of RM-APD was reduced by 1,134 km with a time saving of 1,554 min for patients. The overall cost reduction for the PD center in terms of time/nurse and time/physician was 2,647 and 3,673 min, respectively. All these advantages were obtained in the presence of an improved technique survival with a significant reduction of dropouts. All patients found that it is easy to use the RM system and were satisfied with the high level of interaction with the care team and with the possibility of timely resolving technical problems. CONCLUSION These data confirm the long-term benefits of RM applied to APD. RM-APD is cost-effective; it allows early detection and resolution of problems, improved treatment compliance, reduction of patient's access to hospital center for technical and clinical complications with consequent savings, and improved patient's quality of life.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy, .,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy,
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Sonia Berti
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Full Professor of Nephrology, Department of Medicine, University of Padua, Padua, Italy
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Virzì GM, Borga C, Pasqualin C, Pastori S, Brocca A, de Cal M, Nalesso F, Zanella M, Brendolan A, Ronco C. Direct Effect of Septic Plasma in Human Cell Lines Viability. Blood Purif 2018; 47:270-276. [PMID: 30522094 DOI: 10.1159/000494597] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sepsis is a life-threatening condition often associated with a high incidence of multiple organs injury. Several papers suggested the immune response by itself, with the production of humoral inflammatory mediators, is crucial in determining organ injury. However, little is known of how sepsis directly induces organ injury at the cellular levels. To assess this point, we set up an in vitro study to investigate the response of renal tubular cells (RTCs), monocytes (U937) and hepatocytes (HepG2) after 24 h-incubation with septic patients' plasma. METHODS We enrolled 26 septic patients ("test" group). We evaluated cell viability, apoptosis and necrosis by flow cytometer. Caspase-3,-8,-9 and cytochrome-c concentrations have been analyzed using the Human enzyme-linked immunosorbent assay kit. RESULTS We found that a decrease of cell viability in all cell lines tested was associated to the increase of apoptosis in RTCs and U937 (p < 0.0001) and increase of necrosis in HepG2 (p < 0.5). The increase of apoptosis in RTCs and U937 cells was confirmed by higher levels of caspase-3 (p < 0.0001). We showed that apoptosis in both RTCs and U937 was triggered by the activation of the intrinsic pathway, as caspase-9 and cytochrome-c levels significantly increased (p < 0.0001), while caspase-8 did not change. This assumption was strengthened by the significant correlation of caspase-9 with both cytochrome-c (r = 0.73 for RTCs and r = 0.69 for U937) and caspase-3 (r = 0.69 for RTCs and r = 0.63 for U937). CONCLUSION Humoral mediators in septic patients' plasma induce apoptosis. This fact suggests that apoptosis inhibitors should be investigated as future strategy to reduce sepsis-induced organ damages.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy, .,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy,
| | - Chiara Borga
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Chiara Pasqualin
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine, UOC di Nefrologia 2, Azienda Ospedaliera, University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brendolan
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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Vescovo G, Castellani C, Fedrigo M, Virzì GM, Vescovo GM, Tavano R, Pozzobon M, Angelini A. Data on the stem cells paracrine effects on apoptosis and cytokine milieu in an experimental model of cardiorenal syndrome type II. Data Brief 2018; 21:1430-1434. [PMID: 30456267 PMCID: PMC6234273 DOI: 10.1016/j.dib.2018.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 11/27/2022] Open
Abstract
The data reported in this article are related to the paper entitle “Stem cells transplantation positively modulates the heart-kidney cross talk in Cardiorenal Syndrome Type II” (Vescovo et al., 2019), which analyzed the impact of stem cells injection in cardiorenal syndrome type II. The dataset contains detailed information on apoptosis and cytokines milieu modification after injection of c-Kit–selected human amniotic fluid stem cells (hAFS) or rats vascular progenitor cells (rSVC-GFP group) in an experimental model of CRSII. The data can be useful for clarifying the paracrine effects exerted by the injected cells.
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Affiliation(s)
| | - Chiara Castellani
- Dept. Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padova, Italy
| | - Marny Fedrigo
- Dept. Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padova, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Resarch Institute of Vicenza, Italy
| | - Giovanni Maria Vescovo
- Dept. Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padova, Italy
| | - Regina Tavano
- Dept. Biomedical Sciences, University of Padua, Padova, Italy
| | - Michela Pozzobon
- Dept. Women and Children Health, University of Padua, Padova, Italy.,Institute of Pediatric Research Città della Speranza, Padova, Italy
| | - Annalisa Angelini
- Dept. Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padova, Italy
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Vescovo G, Castellani C, Fedrigo M, Virzì GM, Vescovo GM, Tavano R, Pozzobon M, Angelini A. Stem cells transplantation positively modulates the heart-kidney cross talk in cardiorenal syndrome type II. Int J Cardiol 2018; 275:136-144. [PMID: 30509369 DOI: 10.1016/j.ijcard.2018.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We investigated the effects of human amniotic fluid stem cells (hAFS) and rat adipose tissue stromal vascular fraction GFP-positive cells (rSVC-GFP) in a model of cardio-renal syndrome type II (CRSII). METHODS AND RESULTS RHF was induced by monocrotaline (MCT) in 28 Sprague-Dawley rats. Three weeks later, four million hAFS or rSVC-GFP cells were injected via tail vein. BNP, sCreatinine, kidney and heart NGAL and MMP9, sCytokines, kidney and heart apoptosis and cells (Cs) engraftment were evaluated. Cell-treated rats showed a significant reduction of serum NGAL and Creatinine compared to CRSII. In both hAFS and rSVC-GFP group, kidney protein expression of NGAL was significantly lower than in CRSII (hAFS p = 0.036 and rSVC-GFP p < 0.0001) and similar to that of controls. In both hAFS and rSVC-GFP treated rats, we observed cell engraftment in the medulla and differentiation into tubular, endothelial and SMCs cells. Apoptosis was significantly decreased in cell-treated rats (hAFS 14.07 ± 1.38 and rSVC-GFP 12.67 ± 2.96 cells/mm2) and similar to controls (9.85 ± 2.1 cell/mm2). TUNEL-positive cells were mainly located in the kidney medulla. Pro-inflammatory cytokines were down regulated in cell-treated groups and similar to controls. In cell-treated rats, kidney and heart tissue NGAL was not complexed with MMP9 as in CRSII group, suggesting inhibition of MMPs activity. CONCLUSION Cell therapy produced improvement in kidney function in rats with CRSII. This was the result of interstitial, vessel and tubular cell engraftment leading to tubular and vessel regeneration, decreased tubular cells apoptosis and mitigated pro-inflammatory milieu. Reduction of NGLA-MMP9 complexes mainly due to decrease MMPs activity prevented further negative heart remodeling.
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Affiliation(s)
| | - Chiara Castellani
- Dept. Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Marny Fedrigo
- Dept. Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Resarch Institute Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Regina Tavano
- Dept. Biomedical Sciences, University of Padua, Italy
| | - Michela Pozzobon
- Dept. Women and Children Health, University of Padua, Italy; Insitute of Pediatric Research Città della Speranza, Padova, Italy
| | - Annalisa Angelini
- Dept. Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Italy.
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Virzì GM, Breglia A, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C. Levels of Proinflammatory Cytokines, Oxidative Stress, and Tissue Damage Markers in Patients with Acute Heart Failure with and without Cardiorenal Syndrome Type 1. Cardiorenal Med 2018; 8:321-331. [PMID: 30205401 DOI: 10.1159/000492602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Inflammation and oxidative stress seem to play a pivotal role in its pathophysiology. In this in vivo study, we examined the putative role of inflammation and humoral markers in the pathogenesis of the CRS type 1. METHODS We enrolled 53 patients with acute heart failure (AHF); 17 of them developed AKI (CRS type 1). The cause of AKI was presumed to be related to cardiac dysfunction after having excluded other causes. We assessed the plasma levels of proinflammatory cytokines (TNF-α, IL-6, IL-18, sICAM, RANTES, GMCSF), oxidative stress marker (myeloperoxidase, MPO), brain natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in AHF and CRS type 1 patients. RESULTS We observed a significant increase in IL-6, IL-18, and MPO levels in CRS type 1 group compared to AHF (p < 0.001). We found higher NGAL at admission in the CRS type 1 group compared to the AHF group (p = 0.008) and a positive correlation between NGAL and IL-6 (Spearman's rho = 0.45, p = 0.003) and between IL-6 and BNP (Spearman's rho = 0.43, p = 0.004). We observed lower hemoglobin levels in CRS type 1 patients compared to AHF patients (p < 0.05) and inverse correlation between hemoglobin and cytokines (IL-6: Spearman's rho = -0.38, p = 0.005; IL-18: Spearman's rho = -0.32, p = 0.02). CONCLUSION Patients affected by CRS type 1 present increased levels of proinflammatory cytokines and oxidative stress markers, increased levels of tissue damage markers, and lower hemoglobin levels. All these factors may be implicated in the pathophysiology of CRS type 1 syndrome.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Andrea Breglia
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy.,Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy.,Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit Sant'Antonio Hospital, Padua, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
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Breglia A, Virzì GM, Pastori S, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C. Determinants of Monocyte Apoptosis in Cardiorenal Syndrome Type 1. Cardiorenal Med 2018; 8:208-216. [PMID: 29847820 DOI: 10.1159/000488949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Its pathophysiology is complex and not completely understood. In this study, we examined the role of apoptosis and the caspase pathways involved. MATERIAL AND METHODS We enrolled 40 acute heart failure (AHF) patients, 11 of whom developed AKI characterizing CRS type 1. We exposed the human cell line U937 to plasma from the CRS type 1 and AHF groups and then we evaluated apoptotic activity by annexin-V evaluation, determination of caspase-3, -8 and -9 levels, and BAX, BAD, and FAS gene expression. RESULTS We observed significant upregulation of apoptosis in monocytes exposed to CRS type 1 plasma compared to AHF, with increased levels of caspase-3 (p < 0.01), caspase-9 (p < 0.01), and caspase-8 (p < 0.03) showing activation of both intrinsic and extrinsic pathways. Furthermore, monocytes exposed to CRS type 1 plasma had increased gene expression of BAX and BAD (intrinsic pathways) (p = 0.010 for both). Furthermore, strong significant correlations between the caspase-9 levels and BAD and BAX gene expression were observed (Spearman ρ = - 0.76, p = 0.011, and ρ = - 0.72, p = 0.011). CONCLUSION CRS type 1 induces dual apoptotic pathway activation in monocytes; the two pathways converged on caspase-3. Many factors may induce activation of both intrinsic and extrinsic apoptotic pathways in CRS type 1 patients, such as upregulation of proinflammatory cytokines and hypoxia/ischemia. Further investigations are necessary to corroborate the present findings, and to better understand the pathophysiological mechanism and consequent therapeutic and prognostic implications for CRS type 1.
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Affiliation(s)
- Andrea Breglia
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine DIMED, University of Padua Medical School, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit, Sant'Antonio Hospital, Padua, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
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Crepaldi C, Virzì GM, Milan Manani S, Giuliani A, Berti S, Ronco C. FP480LIPOPOLYSACCHARIDE (LPS) EVALUATION IN PERITONEAL DIALYSIS PATIENTS WITH PERITONITIS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Milan Manani S, Crepaldi C, Giuliani A, Virzì GM, Garzotto F, Riello C, de Cal M, Rosner MH, Ronco C. Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient's Independence. Blood Purif 2018; 46:111-117. [PMID: 29694954 DOI: 10.1159/000487703] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Remote monitoring (RM) supports a healthcare model that enhances patients' self-management. We evaluated the utility of RM in patients undergoing automated peritoneal dialysis (APD). METHODS We observed 37 -RM-APD patients, 16 incidents, and 21 prevalents switched from traditional APD (T-APD). We observed the number of changes for APD prescription, the frequency of visits, and PD adequacy parameters during 1 year of RM utilization in APD. RESULTS The APD prescriptions were modified more frequently in RM-APD vs. T-APD in incident (p = 0.002) and prevalent patients (p = 0.045). Visits were significant less in -RM-APD than in T-APD for incident patient (p = 0.008). No significant difference was found between prevalent populations. PD adequacy was similar in both groups. CONCLUSIONS Our results demonstrate that RM allows an efficient use of healthcare resources, helping to improve personalization of APD prescription and to intervene early with "trouble shooting", thereby reducing the frequency of in-person visits for emergency problems.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Francesco Garzotto
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Caterina Riello
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
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Husain-Syed F, Ferrari F, Sharma A, Danesi TH, Bezerra P, Lopez-Giacoman S, Samoni S, de Cal M, Corradi V, Virzì GM, De Rosa S, Muciño Bermejo MJ, Estremadoyro C, Villa G, Zaragoza JJ, Caprara C, Brocca A, Birk HW, Walmrath HD, Seeger W, Nalesso F, Zanella M, Brendolan A, Giavarina D, Salvador L, Bellomo R, Rosner MH, Kellum JA, Ronco C. Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation. Ann Thorac Surg 2018; 105:1094-1101. [PMID: 29382510 DOI: 10.1016/j.athoracsur.2017.12.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although acute kidney injury (AKI) frequently complicates cardiac operations, methods to determine AKI risk in patients without underlying kidney disease are lacking. Renal functional reserve (RFR) can be used to measure the capacity of the kidney to increase glomerular filtration rate under conditions of physiologic stress and may serve as a functional marker that assesses susceptibility to injury. We sought to determine whether preoperative RFR predicts postoperative AKI. METHODS We enrolled 110 patients with normal resting glomerular filtration rates undergoing elective cardiac operation. Preoperative RFR was measured by using a high oral protein load test. The primary end point was the ability of preoperative RFR to predict AKI within 7 days of operation. Secondary end points included the ability of a risk prediction model, including demographic and comorbidity covariates, RFR, and intraoperative variables to predict AKI, and the ability of postoperative cell cycle arrest markers at various times to predict AKI. RESULTS AKI occurred in 15 patients (13.6%). Preoperative RFR was lower in patients who experienced AKI (p < 0.001) and predicted AKI with an area under the receiver operating characteristic curve (AUC) of 0.83 (95% confidence interval [CI]: 0.70 to 0.96). Patients with preoperative RFRs not greater than 15 mL · min-1 · 1.73 m-2 were 11.8 times more likely to experience AKI (95% CI: 4.62 to 29.89 times, p < 0.001). In addition, immediate postoperative cell cycle arrest biomarkers predicted AKI with an AUC of 0.87. CONCLUSIONS Among elective cardiac surgical patients with normal resting glomerular filtration rates, preoperative RFR was highly predictive of AKI. A reduced RFR appears to be a novel risk factor for AKI, and measurement of RFR preoperatively can identify patients who are likely to benefit from preventive measures or to select for use of biomarkers for early detection. Larger prospective studies to validate the use of RFR in strategies to prevent AKI are warranted. ClinicalTrials.gov identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759.
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Affiliation(s)
- Faeq Husain-Syed
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy; Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Aashish Sharma
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Pércia Bezerra
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Sara Samoni
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Valentina Corradi
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Carla Estremadoyro
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Gianluca Villa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Jose J Zaragoza
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Carlotta Caprara
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Horst-Walter Birk
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Hans-Dieter Walmrath
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brendolan
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John A Kellum
- Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
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Virzì GM, Zhang J, Nalesso F, Ronco C, McCullough PA. The Role of Dendritic and Endothelial Cells in Cardiorenal Syndrome. Cardiorenal Med 2018; 8:92-104. [PMID: 29617002 DOI: 10.1159/000485937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/29/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUNDS Dendritic cells (DCs) are antigen-presenting cells that play a central role in innate and adaptive immune responses; however, the cross talk between cardiac and renal DCs in cardiorenal syndrome (CRS) has not yet been fully elucidated. In this setting, endothelial cells (ECs) also contribute to immune responses. SUMMARY DC and EC activation and dysfunction have a central role in the pathogenesis of CRS. Regarding immune responses in CRS, it is unknown whether ECs may serve as antigen-presenting cells or act synergistically with DCs to actively participate in innate and adaptive immune responses. This review first focuses on the burden of concomitant heart and renal DCs in the context of CRS; it examines what is known of DCs in animal models, and proposes a central role for DCs in all types of CRS. Second, this review briefly describes the role of ECs in the context of CRS. Key Messages: Understanding the role of DCs and ECs in immune response could lead to the development of novel therapies for the prevention and treatment of CRS.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Jun Zhang
- Baylor Heart and Vascular Institute, Dallas, Texas, USA
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Texas, USA.,Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA.,The Heart Hospital, Plano, Texas, USA
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De Rosa S, De Cal M, Joannidis M, Villa G, Pacheco JLS, Virzì GM, Samoni S, D'ippoliti F, Marcante S, Visconti F, Lampariello A, Zannato M, Marafon S, Bonato R, Ronco C. The effect of whole-body cooling on renal function in post-cardiac arrest patients. BMC Nephrol 2017; 18:376. [PMID: 29284424 PMCID: PMC5747082 DOI: 10.1186/s12882-017-0780-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 12/07/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Silvia De Rosa
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy. .,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy. .,Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy.
| | - Massimo De Cal
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Gianluca Villa
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Health Science, Section of Anaesthesiology and Intensive Care, University of Florence, Florence, Italy
| | | | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
| | - Sara Samoni
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Fiorella D'ippoliti
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Stefano Marcante
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Federico Visconti
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Antonella Lampariello
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Marina Zannato
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Silvio Marafon
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Raffaele Bonato
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
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Abstract
Lipopolysaccharide or endotoxin, the major cell wall component of gram-negative bacteria, plays a pivotal role in the pathogenesis of sepsis. It is able to activate the host defense system through the interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. When the production of inflammatory mediators becomes uncontrolled and excessive, septic shock develops with multiple organ dysfunction, such as myocardial and renal impairment, which are hallmarks of cardiorenal syndrome type 5. In this review, we will analyze the role of endotoxin in the pathogenesis of sepsis, its effects on cardiac and renal interactions in the setting of cardiorenal syndrome type 5 and the possible use of extracorporeal therapies in this clinical condition.
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Affiliation(s)
- Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology and Dialysis, San Giovanni Di Dio Hospital, Agrigento, Italy
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
- Department of Medicine DIMED, University of Padova Medical School, Padova, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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Virzì GM, Clementi A, Brocca A, de Cal M, Ronco C. Epigenetics: a potential key mechanism involved in the pathogenesis of cardiorenal syndromes. J Nephrol 2017; 31:333-341. [PMID: 28780716 DOI: 10.1007/s40620-017-0425-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022]
Abstract
Epigenetics is defined as the heritable changes in gene expression patterns which are not directly encoded by modifications in the nucleotide DNA sequence of the genome, including higher order chromatin organization, DNA methylation, cytosine modifications, covalent histone tail modifications, and short non-coding RNA molecules. Recently, much attention has been paid to the role and the function of epigenetics and epimutations in the cellular and subcellular pathways and in the regulation of genes in the setting of both kidney and cardiovascular disease. Indeed, deregulation of histone alterations has been highlighted in a large spectrum of renal and cardiac disease, including chronic and acute renal injury, renal and cardiac fibrosis, cardiac hypertrophy and failure, kidney congenital anomalies, renal hypoxia, and diabetic renal complications. Nevertheless, the role of epigenetics in the pathogenesis and pathophysiology of cardiorenal syndromes is currently underexplored. Given the significant clinical relevance of heart-kidney crosstalk, efforts in the research for new action mechanisms concurrently operating in both pathologies are thus of maximum interest. This review focuses on epigenetic mechanisms involved in heart and kidney disease, and their possible role in the setting of cardiorenal syndromes.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.
| | - Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology and Dialysis, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine DIMED, University of Padova Medical School, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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45
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Milan Manani S, Virzì GM, Giuliani A, Clementi A, Brocca A, Dissegna D, Martino F, d''Amore ESG, Ronco C. Hemolytic Uremic Syndrome and Kidney Transplantation: A Case Series and Review of the Literature. Nephron Clin Pract 2017; 136:245-253. [PMID: 28419995 DOI: 10.1159/000468528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) can be triggered by Shiga toxin producing Escherichia coli (STEC) infection or it can be defined as atypical HUS (aHUS) if it is related to uncontrolled complement activation. aHUS is characterized by a high incidence of recurrence after kidney transplantation, and it can also occur de novo in transplant recipients. Eculizumab is used both to prevent and to treat aHUS following kidney transplantation. In this paper, we report our centre experience and we present 4 cases of HUS in patients who underwent kidney transplantation. METHODS This is a single-center experience about HUS development in transplanted patients. RESULTS Patient 1 with end-stage renal disease (ESRD) due to STEC-HUS undergoing kidney transplantation without prophylactic therapy with eculizumab. Patient 2 with HUS secondary to an episode of diarrhea at 8 years old. After a slow progression to ESRD, she underwent kidney transplantation and she received prophylactic therapy with eculizumab due to the presence of anti-complement factor H antibodies. Patient 3 underwent pre-emptive living donor ABO-incompatible kidney transplantation and developed HUS secondary to antibody-mediated rejection. Patient 4 developed de novo HUS 16 years after kidney transplantation without a known cause. CONCLUSION The correct diagnosis of HUS and the identification of the complement component alterations in case of aHUS are important parameters required to predict the risk of post-transplant recurrence of the disease. In the cases we reported, eculizumab has been found to be effective both to prevent and to treat aHUS following kidney transplantation.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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46
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Brocca A, Virzì GM, de Cal M, Giavarina D, Carta M, Ronco C. Elevated Levels of Procalcitonin and Interleukin-6 are Linked with Postoperative Complications in Cardiac Surgery. Scand J Surg 2017; 106:318-324. [PMID: 28737097 DOI: 10.1177/1457496916683096] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury is a frequent and serious postoperative complication of cardiac surgery and is associated with an increased risk of morbidity, mortality, and length stay. In this study, we hypothesized that persistent elevation in inflammation in the first 48 h might be a powerful predictor of clinical outcome. Our aim was to elucidate the usefulness of interleukin-6 and procalcitonin postoperative levels in predicting mortality and renal complications in cardiac surgery patients. METHODS A total of 122 cardiac surgery patients were enrolled. Procalcitonin and interleukin-6 concentrations were measured on the second postoperative day, and their levels were evaluated versus a number of conditions and endpoints. RESULTS Procalcitonin has a good predictive value for adverse renal outcome (p < 0.05). Interleukin-6 has a good predictive value for 30 days and overall mortality in cardiac surgery population (p < 0.05). We did not observe a significant difference in procalcitonin and interleukin-6 levels among patients with different types of surgery and different extracorporeal circulation time, but the levels of both the molecules increase significantly depending on number of transfusions received by patients (p < 0.01). CONCLUSION We speculated that procalcitonin and interleukin-6 could be two effective biomarkers. There is a possibility of having a combined inflammatory multi-biomarker panel, with procalcitonin for predicting renal outcome and interleukin-6 for predicting mortality.
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Affiliation(s)
- A Brocca
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,3 Department of Medicine-DIMED, Medical School, University of Padova, Padova, Italy
| | - G M Virzì
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - M de Cal
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - D Giavarina
- 4 Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - M Carta
- 4 Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - C Ronco
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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47
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Clementi A, Brocca A, Virzì GM, de Cal M, Giavarina D, Carta M, Muciño-Bermejo MJ, Hinna Danesi T, Salvador L, Ronco C. Procalcitonin and Interleukin-6 Levels: Are They Useful Biomarkers in Cardiac Surgery Patients? Blood Purif 2017; 43:290-297. [PMID: 28125806 DOI: 10.1159/000454672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Cardiac surgery-associated acute kidney injury is an independent predictor of chronic renal disease and mortality. The scope of this study was to determine the utility of procalcitonin (PCT) and plasma interleukin-6 (IL-6) levels in predicting renal outcome and mortality in these patients. METHODS PCT and plasma IL-6 levels of 122 cardiac surgery patients were measured at 48 h after the surgical procedure. Primary endpoints were adverse renal outcome and mortality. Secondary endpoints were length of stay, bleeding, and number of transfusions. RESULTS PCT was found to be a better predictor of adverse renal outcome than IL-6. IL-6 seemed to be a better predictor of both 30-day and overall mortality than PCT. Neither PCT nor IL-6 levels were found to be good predictors of intensive care unit stay and bleeding. CONCLUSION PCT may be considered a good predictor of adverse renal outcome in cardiac surgery patients, whereas IL-6 seems to possess a good predictive value for mortality in this population of patients.
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Affiliation(s)
- Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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48
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Virzì GM, Clementi A, Brocca A, Ronco C. Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes. Blood Purif 2017; 44:314-326. [PMID: 29161706 DOI: 10.1159/000480424] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/10/2017] [Indexed: 01/03/2023]
Abstract
Gram-negative sepsis is a major cause of morbidity and mortality in critical ill patients. Recent findings in molecular biology and in signaling pathways have enhanced our understanding of its pathogenesis and opened up opportunities of innovative therapeutic approaches. Endotoxin plays a pivotal role in the pathogenesis of multi-organ dysfunction in the setting of gram-negative sepsis. Indeed, heart and kidney impairments seem to be induced by the release of circulating pro-inflammatory and pro-apoptotic mediators triggered by endotoxin interaction with immune cells. These molecules are responsible for cellular apoptosis, autophagy, cell cycle arrest, and microRNAs activation. Therefore, the early identification of sepsis-associated acute kidney injury and heart dysfunction may improve the patient clinical outcome. In this report, we will consider the role of endotoxin in the pathogenesis of sepsis, its effects on both cardiac and renal functions, and the interactions between these 2 systems in the setting of cardiorenal syndromes (CRS), particularly in CRS type 5. Finally, we will discuss the possible role of extracorporeal therapies in reducing endotoxin levels.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Agrigento, Italy
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49
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Virzì GM, Clementi A, Brocca A, de Cal M, Marcante S, Ronco C. Cardiorenal Syndrome Type 5 in Sepsis: Role of Endotoxin in Cell Death Pathways and Inflammation. Kidney Blood Press Res 2016; 41:1008-1015. [PMID: 28006779 DOI: 10.1159/000452602] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cardiorenal Syndrome Type 5 (CRS Type 5) is characterized by concomitant cardiac and renal dysfunction in the setting of different systemic disorders, such as sepsis. In this study, we investigated the possible relationship between endotoxin levels, renal cell death and inflammation in septic patients with CRS Type 5. METHODS We enrolled 11 patients with CRS Type 5. CRS Type 5 was defined according to the current classification system. AKI was defined by Acute Kidney Injury Network (AKIN) criteria. Acute cardiac dysfunction was documented by echocardiography as acute left and/or right ventricular dysfunction leading to decreased ejection fraction. Endotoxin activity was measured by the Endotoxin Activity Assay (EAA). Plasma from CRS Type 5 patients was incubated with renal tubular cells (RTCs) and cell death levels were evaluated. Plasma cytokines levels were measured as well. RESULTS Accordingly to EAA levels, patients were divided into two groups: 45.4% of patients had low endotoxin activity level (negative EAA), while 54.5% of patients showed high endotoxin activity (positive EAA). RTCs incubated with plasma from EAA positive patients showed significantly higher apoptosis levels and higher caspase-3 activation compared to cells incubated with plasma from EAA negative patients, and a significant positive correlation was observed between EAA levels and RTC apoptosis levels. Furthermore, IL-6 and IFN-γ levels were significantly higher in CRS Type 5 patients with positive EAA. CONCLUSION Our data suggest a possible relationship between endotoxin levels and renal cell death in septic patients with CRS Type 5. Furthermore, this study highlights the presence of renal apoptosis, the immune deregulation and the strong inflammation in CRS Type 5 patients, especially in those with high endotoxin activity.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Vicenza, Italy
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50
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Milan Manani S, Virzì GM, Gastaldon F, Proglio M, Brocca A, Ronco C. Brief Review and a Clinical Case of Hemolytic Uremic Syndrome Associated with Interferon β Treatment. Blood Purif 2016; 43:136-143. [PMID: 27951532 DOI: 10.1159/000454671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/21/2016] [Indexed: 11/19/2022]
Abstract
The hemolytic uremic syndrome (HUS) is one of the thrombotic microangiopathies and it consists of the triad of nonimmune microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. The atypical form of HUS (aHUS) is related to causative mutations in complement genes. Some conditions act as a trigger for aHUS in individuals that have a genetic background predisposing to complement activation. Interferon β is a recombinant-protein therapy approved to treat multiple sclerosis (MS), and can be a causative agent in the occurrence of HUS through anti-angiogenic activity. In this paper, we briefly review aHUS clinical and genetic characteristics. Furthermore, we present a case of a 48-year-old woman, diagnosed with MS and treated with INFβ-1b from 2008. In December 2015, she presented with asthenia and loss of muscular strength in the legs and she quickly developed aHUS. Our case suggests that INFβ is a possible triggering factor for HUS.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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