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Cacciapuoti M, Caputo I, Stefanelli LF, Davis PA, Nalesso F, Calò LA. "Every Cloud Has a Silver Lining": How Three Rare Diseases Defend Themselves from COVID-19 and What We Have Learnt from It. Clin Pract 2024; 14:614-618. [PMID: 38666806 PMCID: PMC11048753 DOI: 10.3390/clinpract14020048] [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: 12/19/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
The process of SARS-CoV-2 infection, responsible for the COVID-19 pandemic, is carried out through different steps, with the interaction between ACE2 and Spike protein (S) being crucial. Besides of that, the acidic environment of endosomes seems to play a relevant role in the virus uptake into cells and its intracellular replication. Patients affected by two rare genetic tubulopathies, Gitelman's and Bartter's Syndromes, and a rare genetic metabolic disease, Fabry Disease, have shown intrinsic protection from SARS-CoV-2 infection and COVID-19 on account of specific intrinsic features that interfere with the virus uptake into cells and its intracellular replication, which will be reported and discussed in this paper, providing interesting insights for present and future research.
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Affiliation(s)
- Martina Cacciapuoti
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.C.); (I.C.); (F.N.)
| | - Ilaria Caputo
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.C.); (I.C.); (F.N.)
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.C.); (I.C.); (F.N.)
| | - Paul A. Davis
- Department of Nutrition, University of California, Davis, CA 95616, USA;
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.C.); (I.C.); (F.N.)
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.C.); (I.C.); (F.N.)
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Carraro G, Di Vico V, Martinetti L, Bettin E, Cacciapuoti M, Stefanelli LF, Gobbi L, Nalesso F, Martino FK, Calò LA. Tolvaptan Treatment and Long-Term Impact on Quality of Life in Autosomal Dominant Polycystic Kidney Disease Patients: A Pilot Study. Clin Drug Investig 2024; 44:289-291. [PMID: 38430434 DOI: 10.1007/s40261-024-01350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Gianni Carraro
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Valentina Di Vico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Loris Martinetti
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Elisabetta Bettin
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Martina Cacciapuoti
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Francesca Katiana Martino
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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Nalesso F, Martino FK, Bogo M, Bettin E, Alessi M, Stefanelli LF, Silvestre C, Furian L, Calò LA. The Ultrasound Renal Stress Test for the Assessment of Functional Renal Reserve in Kidney Transplantation: A Pilot Study in Living Donors. J Clin Med 2024; 13:525. [PMID: 38256658 PMCID: PMC10816091 DOI: 10.3390/jcm13020525] [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: 11/21/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
In the evolving landscape of nephrology and kidney transplants, assessing renal functional reserve (RFR) in living kidney donors is essential for ensuring donor safety and successful transplantation. This study explores the use of the Intra-Parenchymal Renal Resistive Index Variation (IRRIV) test, a novel non-invasive method, to measure RFR in living donors. Our observational study included 11 participants undergoing living kidney donations, evaluated using the IRRIV-based Renal Stress Test (RST) before and 12 months post-nephrectomy. The study demonstrated significant changes in creatinine and eGFR CKD-EPI levels post-donation, with an average creatinine rise from 69 to 97 µmol/L and a reduction in eGFR from 104 to 66 mL/min/1.73 m2. These variations align with the expected halving of nephron mass post-nephrectomy and the consequent recruitment of RFR and hyperfiltration in the remaining nephrons. This pilot study suggests that the IRRIV-based RST is a practical, safe, and reproducible tool, potentially revolutionizing the assessment of RFR in living kidney donors, with implications for broader clinical practice in donor eligibility evaluation, even in borderline renal cases. Furthermore, it confirms the feasibility of RST in living kidney donors and allows us to assess the sample size in 48 donors for a future study.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Francesca K. Martino
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Marco Bogo
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Elisabetta Bettin
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Marianna Alessi
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Lucia F. Stefanelli
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Cristina Silvestre
- Department of Surgical Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplant Unit, University of Padua, 35128 Padua, Italy; (C.S.); (L.F.)
| | - Lucrezia Furian
- Department of Surgical Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplant Unit, University of Padua, 35128 Padua, Italy; (C.S.); (L.F.)
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
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Martino FK, Novara G, Nalesso F, Calò LA. Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine. J Clin Med 2023; 13:41. [PMID: 38202048 PMCID: PMC10779521 DOI: 10.3390/jcm13010041] [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: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice.
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Affiliation(s)
- Francesca K. Martino
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy; (F.K.M.); (F.N.)
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic University of Padua, 35124 Padua, Italy
| | - Federico Nalesso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy; (F.K.M.); (F.N.)
| | - Lorenzo A. Calò
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy; (F.K.M.); (F.N.)
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Stefanelli LF, Alessi M, Di Bella C, Billo ME, Viola L, Gnappi M, Bettin E, Cacciapuoti M, Calò LA. EBV Reactivation in Transplant Recipients following SARS-CoV-2 Infection: A Retrospective Study. Pathogens 2023; 12:1435. [PMID: 38133317 PMCID: PMC10748065 DOI: 10.3390/pathogens12121435] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Reactivation and primary infection with a high Epstein Barr Virus (EBV) DNA level in kidney transplant patients could cause severe complications, including the development of Post-Transplantation Lymphoproliferative Disease (PTLD). While in the general population the reactivation of EBV after SARS-CoV-2 infection has been reported, very few data are available in transplant recipients. Our retrospective study aimed to evaluate a possible EBV reactivation in kidney transplant patients following SARS-CoV-2 infection and a possible impairment of the immune system. In addition, the effects of changes in immunosuppressive therapy on EBV DNA reactivation and vaccination were also evaluated. A total of 166 kidney transplant patients followed at the Kidney-Pancreas Transplant Ambulatory Nephrology Unit at Padova University Hospital were retrospectively considered for an observation period of 6 months from January 2020 to April 2023. EBV DNA level was measured by Rt-PCR and evaluated 6 months before and after SARS-CoV-2 infection. Patients' serological states were established via quantification of anti-VCA and anti-EBNA (chemiluminescence). Patients' immune systems were characterized by CD4+/CD8+ lymphocyte ratio (flow cytometry). EBV DNA was reactivated in 50% of the 166 patients with COVID-19 who completed the study. Older patients with more severe forms of COVID-19 had higher EBV reactivation (p < 0.05). EBV reactivation significantly increased in patients with severe SARS-CoV-2 infection requiring hospitalization compared to patients managed at home (p < 0.001). CD4+/CD8+ lymphocyte ratio was reduced in patients with a younger age of transplant (p < 0.01) and on a higher dose of steroids (p < 0.01). The results of our study confirm the role of immunodepression, especially in recent transplant patients and those on high steroids, in EBV reactivation. These results combined with the few available in the literature might contribute to providing an optimal management of immunosuppressive treatment for these patients in order to obtain an immune state unfavorable to the activation of latent viruses, including EBV.
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Affiliation(s)
- Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Marianna Alessi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Caterina Di Bella
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, 35128 Padova, Italy;
| | - Maria Elena Billo
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Ludovica Viola
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Maddalena Gnappi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Elisabetta Bettin
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Martina Cacciapuoti
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy (M.A.); (M.E.B.); (L.V.); (M.G.); (E.B.); (M.C.)
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Ceol M, Gianesello L, Trimarchi H, Migliorini A, Priante G, Radu CM, Naso E, Angelini A, Calò LA, Anglani F, Del Prete D. Human parietal epithelial cells (PECs) and proteinuria in lupus nephritis: a role for ClC-5, megalin, and cubilin? J Nephrol 2023; 36:2499-2506. [PMID: 37594671 PMCID: PMC10703968 DOI: 10.1007/s40620-023-01725-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/30/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Parietal epithelial cells are a heterogeneous population of cells located on Bowman's capsule. These cells are known to internalize albumin with a still undetermined mechanism, although albumin has been shown to induce phenotypic changes in parietal epithelial cells. Proximal tubular cells are the main actors in albumin handling via the macromolecular complex composed by ClC-5, megalin, and cubilin. This study investigated the role of ClC-5, megalin, and cubilin in the parietal epithelial cells of kidney biopsies from proteinuric lupus nephritis patients and control subjects and identified phenotypical changes occurring in the pathological milieu. METHODS Immunohistochemistry and immunofluorescence analyses for ClC-5, megalin, cubilin, ANXA3, podocalyxin, CD24, CD44, HSA, and LTA marker were performed on 23 kidney biopsies from patients with Lupus Nephritis and 9 control biopsies (obtained from nephrectomies for renal cancer). RESULTS Two sub-populations of hypertrophic parietal epithelial cells ANXA3+/Podocalyxin-/CD44-, both expressing ClC-5, megalin, and cubilin and located at the tubular pole, were identified and characterized: the first one, CD24+/HSA-/LTA- had characteristics of human adult parietal epithelial multipotent progenitors, the second one, CD24-/LTA+/HSA+ committed to become phenotypically proximal tubular cells. The number of glomeruli presenting hypertrophic parietal epithelial cells positive for ClC-5, megalin, and cubilin were significantly higher in lupus nephritis patients than in controls. CONCLUSIONS Our results may provide further insight into the role of hypertrophic parietal epithelial cells located at the tubular pole and their possible involvement in protein endocytosis in lupus nephritis patients. These data also suggest that the presence of hypertrophic parietal epithelial cells in Bowman's capsule represents a potential resource for responding to protein overload observed in other glomerulonephritis.
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Affiliation(s)
- Monica Ceol
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Lisa Gianesello
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Hernan Trimarchi
- Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Alberto Migliorini
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Giovanna Priante
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Claudia M Radu
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Elena Naso
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology and Pathological Anatomy, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenzo A Calò
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Franca Anglani
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy
| | - Dorella Del Prete
- Nephrology Unit- Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 235128, Padua, Italy.
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Caputo I, Bertoldi G, Driussi G, Cacciapuoti M, Calò LA. The RAAS Goodfellas in Cardiovascular System. J Clin Med 2023; 12:6873. [PMID: 37959338 PMCID: PMC10649249 DOI: 10.3390/jcm12216873] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
In the last two decades, the study of the renin-angiotensin-aldosterone system (RAAS) has revealed a counterregulatory protective axis. This protective arm is characterized by ACE2/Ang 1-7/MasR and Ang 1-9 that largely counteracts the classic arm of the RAAS mediated by ACE/Ang II/AT1R/aldosterone and plays an important role in the prevention of inflammation, oxidative stress, hypertension, and cardiovascular remodeling. A growing body of evidence suggests that enhancement of this counterregulatory arm of RAAS represents an important therapeutic approach to facing cardiovascular comorbidities. In this review, we provide an overview of the beneficial effects of ACE2, Ang 1-7/MasR, and Ang 1-9 in the context of oxidative stress, vascular dysfunction, and organ damage.
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Affiliation(s)
| | | | | | | | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine—DIMED, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy; (I.C.); (G.B.); (G.D.); (M.C.)
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Martino FK, Pini S, Scaparrotta G, Schirinzi M, Gnappi M, Fragasso A, Zanella R, Naso E, De Giorgi ML, Carraro G, Nalesso F, Calò LA. Recombinant Varicella Zoster vaccine in haemodialysis facilities: adherence and safety. J Nephrol 2023; 36:2155-2158. [PMID: 37392330 DOI: 10.1007/s40620-023-01690-0] [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: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Francesca K Martino
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Stefano Pini
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giuseppe Scaparrotta
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Marilena Schirinzi
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Maddalena Gnappi
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Antonio Fragasso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Ruggero Zanella
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Elena Naso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Maria Loreta De Giorgi
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Gianni Carraro
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Nalesso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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Nalesso F, Bettin E, Bogo M, Cacciapuoti M, Cattarin L, Scaparrotta G, Calò LA. Safety of Citrate Anticoagulation in CKRT: Monocentric Experience of a Dynamic Protocol of Calcium Monitoring. J Clin Med 2023; 12:5201. [PMID: 37629242 PMCID: PMC10455350 DOI: 10.3390/jcm12165201] [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: 07/18/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Regional Citrate Anticoagulation (RCA) is considered the first-line anticoagulation for Continuous Kidney Replacement Therapy (CKRT). The RCA requires strict protocols and trained staff to avoid unsafe use and ensure its benefit. We have analyzed all our CKRT prescriptions from December 2020 to April 2022 anonymously, collecting data on CKRT, lab tests, clinical conditions, and complications of RCA. In addition, in order to better detect citrate accumulation, we have performed an RCA protocol by reducing the CaTot/Ca2+ ratio cut-off from 2.50 to 2.40 and increasing the number of calcium checks according to its trend. Among the 374 patients in CKRT, 104 received RCA prescriptions, of which 11 (10.6%) were discontinued: 4 for the suspicion of citrate accumulation, 1 for the development of metabolic alkalosis, 1 for the shift to a different CKRT procedure due to the need for a higher bicarbonate dose, 4 for the elevation of hepatocytolysis indexes, and 1 due to a preemptive discontinuation following massive post-surgery bleeding. None of the patients have had citrate toxicity as indicated by a CaTot/Ca2+ greater than 2.50, and our protocol has allowed the early identification of patients who might develop clinical citrate toxicity.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplant, University of Padua, 35128 Padua, Italy (L.A.C.)
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Caputo I, Bertoldi G, Driussi G, Sgarabotto L, Carraro G, Stefanelli LF, Davis PA, Calò LA. Impaired ACE2 glycosylation and protease activity in Fabry disease protects from COVID-19. J Intern Med 2023. [PMID: 37227252 DOI: 10.1111/joim.13672] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ilaria Caputo
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | - Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | - Giulia Driussi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | - Luca Sgarabotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | - Gianni Carraro
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | | | - Paul A Davis
- Department of Nutrition, University of California, Davis, CA, USA
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
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Calò LA, Sgarabotto L, Stefanelli LF, Di Vico V, Davis PA. COVID 19, Paxlovid and the lesson from rare genetic diseases with naturally occurring protection from SARS-CoV-2 infection. J Nephrol 2023; 36:925-927. [PMID: 36114370 PMCID: PMC9483540 DOI: 10.1007/s40620-022-01439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/08/2022] [Indexed: 10/27/2022]
Affiliation(s)
- Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Luca Sgarabotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Valentina Di Vico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, USA
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12
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Sgarabotto L, Ravarotto V, Stefanelli LF, Cacciapuoti M, Davis PA, Nalesso F, Calò LA. Oxidants and Cardiorenal Vascular Remodeling—Insights from Rare Genetic Tubulopathies: Bartter’s and Gitelman’s Syndromes. Antioxidants (Basel) 2023; 12:antiox12040811. [PMID: 37107186 PMCID: PMC10135094 DOI: 10.3390/antiox12040811] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Two human genetic tubulopathies, Bartter’s (BS) and Gitelman’s (GS) syndromes, have normo/hypotension and absent cardiac remodeling despite their apparent angiotensin system (RAS) activation. This seeming contradiction has led to an extensive investigation of BSGS patients, the result of which is that BSGS represents a mirror image of hypertension. BSGS’s unique set of properties has then permitted their use as a human model to probe and characterize RAS system pathways and oxidative stress in cardiovascular and renal remodeling and pathophysiology. This review details the results using GSBS patients that provide a deeper understanding of Ang II signaling and its associated oxidants/oxidative stress in humans. By providing a more complete and complex picture of cardiovascular and renal remodeling pathways and processes, studies of GSBS can inform the identification and selection of new targets and therapies to treat these and other oxidant-related disorders.
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Affiliation(s)
- Luca Sgarabotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Verdiana Ravarotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Martina Cacciapuoti
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Paul A. Davis
- Department of Nutrition, University of California, Davis, CA 95616, USA
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-8213071
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13
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Gobbi L, Innico G, Spagnolo P, Vertolli U, Calò LA. Massive lung calcifications in a four times renal transplanted patient: the fight against dialysis, hyper and hypoparathyroidism. Minerva Endocrinol (Torino) 2023; 48:122-124. [PMID: 34748295 DOI: 10.23736/s2724-6507.21.03612-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Laura Gobbi
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Georgie Innico
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Spagnolo
- Unit of Respiratory Disease, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ugo Vertolli
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Lorenzo A Calò
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy -
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14
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Ravarotto V, Bertoldi G, Rigato M, Pagnin E, Gobbi L, Davis PA, Calò LA. Tracing angiotensin II's yin-yang effects on cardiovascular-renal pathophysiology. Minerva Med 2023; 114:56-67. [PMID: 34180640 DOI: 10.23736/s0026-4806.21.07440-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adverse changes in cardiovascular and renal systems are major contributors to overall morbidity and mortality. Human cardiovascular and renal systems exhibit a complex network of positive and negative feedback that is reflected in the control of vascular tone via angiotensin II (Ang II) based signaling. This review will examine in some depth, the multiple components and processes that control the status and reflect the health of these various cardiovascular and renal systems, such as pathways associated to monomeric G proteins, RhoA/Rho kinase system and ERK, oxidative stress and NO balance. It will specifically emphasize the "yin-yang" nature of Ang II signaling by comparing and contrasting the effects and activity of various systems, pathways and components found in hypertension to those found in Gitelman's and Bartter's syndromes (GS/BS), two rare autosomal recessive tubulopathies characterized by electrolytic imbalance, metabolic alkalosis, sodium wasting and prominent activation of the renin-angiotensin-aldosterone system. Notwithstanding the activation of the renin-angiotensin-aldosterone system, GS/BS are normo-hypotensive and protected from cardiovascular-renal remodeling and therefore can be considered the mirror image, the opposite of hypertension.
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Affiliation(s)
- Verdiana Ravarotto
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Giovanni Bertoldi
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Matteo Rigato
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Elisa Pagnin
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Laura Gobbi
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Paul A Davis
- Department of Nutrition, University of California at Davis, Davis, CA, USA
| | - Lorenzo A Calò
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy -
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15
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Stefanelli LF, Di Vico V, Davis PA, Calò LA. Magnesium is crucial in renal-cardiovascular fibrosis but the Gitelman's syndrome paradox still awaits resolution. Int Urol Nephrol 2023; 55:487-488. [PMID: 35925487 DOI: 10.1007/s11255-022-03333-y] [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: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Valentina Di Vico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, USA
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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16
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Nalesso F, Rigato M, Cirella I, Protti MP, Zanella R, Rossi B, Putti MC, Martino FK, Calò LA. The Assessment of Renal Functional Reserve in β-Thalassemia Major Patients by an Innovative Ultrasound and Doppler Technique: A Pilot Study. J Clin Med 2022; 11:jcm11226752. [PMID: 36431228 PMCID: PMC9699445 DOI: 10.3390/jcm11226752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Beta-thalassemia syndromes are the most common inherited monogenic disorders worldwide. The most common pathophysiologic and clinical renal disease manifestations of in β-TM patients is the tubular dysfunctions related to iron overload, chronic anemia, and the need for chronic iron chelation therapy. The aim of this pilot study is to apply an innovative ultrasound and Doppler technique to assess the Renal Functional Reserve (RFR) in β-TM patients, and to evaluate its reliability in iron overload tubulopathy. Ultrasound assessment of intra-parenchymal renal resistive index variation (IRRIV) has recently been proposed as a safe and reproducible technique to identify RFR presence. We define the preserved RFR when the Delta Renal Resistive Index (RRI) is >0.05 (baseline RRI—minimum RRI value during stress) in the Renal Stress Test (RST). Nineteen β-TM patients were enrolled for this study. In our series, we found a strong negative correlation between mean ferritin values and Delta RRI (R = −0.51, p = 0.03). This pilot study suggested the RST as reliable tool for assessing the RFR by ultrasound. Specifically, RST could help in clinical practice suggesting the patient’s management and iron chelation therapy.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Matteo Rigato
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Irene Cirella
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | - Ruggero Zanella
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Bartolomeo Rossi
- Haematology-Oncology Clinic, Women and Child’s Health Department, University of Padua, 35122 Padua, Italy
| | - Maria Caterina Putti
- Haematology-Oncology Clinic, Women and Child’s Health Department, University of Padua, 35122 Padua, Italy
| | | | - Lorenzo A. Calò
- Department of Medicine, University of Padova, 35128 Padova, Italy
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17
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Vertolli U, De Giorgi L, Melega E, Albertoni L, Stefanelli LF, Calò LA. Severe diarrhoea and the McKittrick and Wheelock syndrome. QJM 2022; 116:310-312. [PMID: 36355562 DOI: 10.1093/qjmed/hcac255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ugo Vertolli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | - Loreta De Giorgi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
| | - Enrico Melega
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy
| | - Laura Albertoni
- Pathology Unit, Department of Medicine, University of Padova, Italy
| | | | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Italy
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18
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Sgarabotto L, Gianesello L, Bertoldi G, Nalesso F, Stefanelli LF, Calò LA. Rare genetic tubulopathies Gitelman's and Bartter's syndromes and their naturally occurring protection from COVID-19. Minerva Med 2022; 113:876-877. [PMID: 35384438 DOI: 10.23736/s0026-4806.22.08088-0] [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: 01/11/2023]
Affiliation(s)
- Luca Sgarabotto
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Lisa Gianesello
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Giovanni Bertoldi
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Federico Nalesso
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Lucia F Stefanelli
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy
| | - Lorenzo A Calò
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University of Padua, Padua, Italy -
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19
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Calò LA, Stefanelli LF, Nalesso F. Angiotensin II, RAS activation and RAS blockers in COVID-19: unambiguous evidence. Kidney Blood Press Res 2022; 47:593-596. [PMID: 36063794 DOI: 10.1159/000526791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
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20
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Pini S, Scaparrotta G, DI Vico V, Fragasso A, Stefanelli LF, Nalesso F, Calò LA. Vitamin D intoxication induced severe hypercalcemia from self-medication for COVID-19 infection: a public health problem? Minerva Endocrinol (Torino) 2022; 47:371-374. [PMID: 35775886 DOI: 10.23736/s2724-6507.22.03795-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Stefano Pini
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Giuseppe Scaparrotta
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Valentina DI Vico
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Antonio Fragasso
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Lucia F Stefanelli
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Federico Nalesso
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Lorenzo A Calò
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, University Hospital of Padua, Padua, Italy -
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21
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Ravarotto V, Bertoldi G, Stefanelli LF, Nalesso F, Calò LA. Pathomechanism of oxidative stress in cardiovascularrenal remodeling and therapeutic strategies. Kidney Res Clin Pract 2022; 41:533-544. [PMID: 36239057 PMCID: PMC9576462 DOI: 10.23876/j.krcp.22.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2023] Open
Abstract
The high prevalence of cardiovascular disease in patients with chronic kidney disease indicates significant interactions between pathogenic pathways operating in the kidney and heart. These interactions involve all cell types (endothelial cells, smooth muscle cells, macrophages, and others), components of the vasculature, glomeruli, and heart that are susceptible to oxidative damage and structural alterations. A vicious cycle occurs whereby harmful factors such as reactive oxygen species and inflammation damage of vascular structures that themselves become sources of additional dangerous/toxic components released into the local environment. The evidence of this vicious cycle in chronic kidney disease should therefore lead to add other factors to both traditional and nontraditional risk factors. This review will examine the processes occurring during progressive kidney dysfunction with regard to vascular injury, renal remodeling, cardiac hypertrophy, and the transversal role of oxidative stress in the development of these complications.
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Affiliation(s)
- Verdiana Ravarotto
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Giovanni Bertoldi
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Lucia Federica Stefanelli
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A. Calò
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
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22
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Nalesso F, Garzotto F, Martello T, Contessa C, Cattarin L, Protti M, Di Vico V, Stefanelli LF, Scaparrotta G, Calò LA. The patient safety in extracorporeal blood purification treatments of critical patients. Front Nephrol 2022; 2:871480. [PMID: 37675020 PMCID: PMC10479693 DOI: 10.3389/fneph.2022.871480] [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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 09/08/2023]
Abstract
Today, health systems are complex due to both the technological development in diagnostic and therapeutic procedures and the complexity of the patients that are increasingly older with several comorbidities. In any care setting, latent, organizational, and systematic errors can occur causing critical incident harmful for patients. Management of patients with acute kidney injury (AKI) requires a multidisciplinary approach for the diagnostic-therapeutic-rehabilitative path that can also require an extracorporeal blood purification treatment (EBPT). The complexity of these patients and EBPT require a clinical risk analysis and the introduction of protocols, procedures, operating instructions, and checklists to reduce clinical risk through promotion of the safety culture for all care providers. Caregivers must acquire a series of tools to evaluate the clinical risk in their reality to prevent incidents and customize patient safety in a proactive and reactive way. Established procedures that are made more needed by the COVID-19 pandemic can help to better manage patients in critical care area with intrinsic higher clinical risk. This review analyzes the communication and organizational aspects that need to be taken into consideration in the management of EBPT in a critical care setting by providing tools that can be used to reduce the clinical risk. This review is mostly addressed to all the caregivers involved in the EBPT in Critical Care Nephrology and in the Intensive Care Units.
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Affiliation(s)
- Federico Nalesso
- Nephrology, Dialysis and Transplant Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Francesco Garzotto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Tiziano Martello
- Department of Directional Hospital Management, Medical Directorate, Padua University Hospital, Padua, Italy
| | - Cristina Contessa
- Department of Directional Hospital Management, Medical Directorate, Padua University Hospital, Padua, Italy
| | - Leda Cattarin
- Nephrology, Dialysis and Transplant Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Mariapaola Protti
- Nephrology, Dialysis and Transplant Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Valentina Di Vico
- Nephrology, Dialysis and Transplant Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Giuseppe Scaparrotta
- Nephrology, Dialysis and Transplant Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplant Unit, Department of Medicine, University of Padua, Padua, Italy
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23
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Ravarotto V, Bertoldi G, Stefanelli LF, Nalesso F, Calò LA. Gitelman's and Bartter's syndromes: from genetics to the molecular basis of hypertension and more. Kidney Blood Press Res 2022; 47:556-564. [PMID: 35858584 DOI: 10.1159/000526070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gitelman's and Bartter's syndromes (GS/BS) are rare genetic tubulopathies characterized by electrolyte imbalance and activation of the renin angiotensin aldosterone system (RAAS). These syndromes have intriguing biochemical and hormonal abnormalities that leads them to be protected from hypertension, cardiovascular and renal remodeling. SUMMARY In this review we explore the biochemical/molecular mechanisms induced by the activation of the RAAS and its counterregulatory arm which is particularly activated in GS/BS patients, in the context of blood pressure regulation. In addition, we report our findings in the context of COVID-19 pandemic where we observed GS/BS subjects being protected from infection. KEY MESSAGES The intracellular pathways induced by Ang II starting from induction of oxidative stress and vasoconstriction, are crucial for the progression toward cardiovascular-renal remodeling and might be useful targets in order to reduce/halt the progression of Ang II/oxidative stress-induced cardiovascular-renal morbidity in several diseases.
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Affiliation(s)
- Verdiana Ravarotto
- Department of Medicine (DIMED) Nephrology, Dialysis and Transplantation Unit University of Padova, Padova, Italy
| | - Giovanni Bertoldi
- Department of Medicine (DIMED) Nephrology, Dialysis and Transplantation Unit University of Padova, Padova, Italy
| | - Lucia Federica Stefanelli
- Department of Medicine (DIMED) Nephrology, Dialysis and Transplantation Unit University of Padova, Padova, Italy
| | - Federico Nalesso
- Department of Medicine (DIMED) Nephrology, Dialysis and Transplantation Unit University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine (DIMED) Nephrology, Dialysis and Transplantation Unit University of Padova, Padova, Italy
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24
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Bertoldi G, Carraro G, Ravarotto V, Di Vico V, Baldini Anastasio P, Vitturi N, Francini F, Stefanelli LF, Calò LA. The Effect of Green Tea as an Adjuvant to Enzyme Replacement Therapy on Oxidative Stress in Fabry Disease: A Pilot Study. Front Nutr 2022; 9:924710. [PMID: 35873439 PMCID: PMC9304972 DOI: 10.3389/fnut.2022.924710] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Enzymatic replacement therapy (ERT) is not very effective in halting the progression of Fabry disease (FD) toward cardiovascular (CV)-renal remodeling, particularly in case of late diagnosis. FD patients have increased oxidative stress (OS), critical for the induction of CV-renal remodeling. We investigated the effects of an adjuvant antioxidant treatment to ERT on OS and the possible advantages for related complications. OS was evaluated in 10 patients with FD before ERT, after 12 months of ERT, and after 6 months of adjuvant green tea (GT) to ERT by the following experiments: expression of p22phox; phosphorylation state of MYPT-1 and ERK 1/2 (by western blotting); and quantification of malondialdehyde (MDA) and heme oxygenase (HO)-1 levels (by ELISA). p22phox and MYPT-1 phosphorylation decreased after ERT and significantly further decreased after GT. ERK 1/2 phosphorylation and MDA levels remained unchanged after ERT, but significantly decreased after GT. HO-1 significantly increased after ERT and further increased after GT. This study provides preliminary data highlighting the antioxidant effect exerted by ERT itself, further amplified by the adjuvant antioxidant treatment with GT. The results of this study provide evidence of the positive effect of early additive antioxidant treatment to reduce OS and prevent/alleviate cardio and cerebrovascular-renal complications related to OS.
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Affiliation(s)
- Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Gianni Carraro
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Verdiana Ravarotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Valentina Di Vico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Paola Baldini Anastasio
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Nicola Vitturi
- Metabolic Diseases Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Francesco Francini
- Clinical Nutrition Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padua, Italy
- *Correspondence: Lorenzo A. Calò,
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25
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Cirella I, di Vico V, Rigato M, Bugnotto B, Baldini Anastasio P, Campo D, Carraro G, Calò LA. [Tolvaptan in ADPKD patients at the University of Padova Nephrology Unit: impact on quality of life, efficacy and safety]. G Ital Nefrol 2022; 39:2022-vol3. [PMID: 35819042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is responsible of the 10% of the dialysis patients. Tolvaptan is a consolidate option for treatment of ADPKD patients; it slows renal deterioration rate and cysts' growth, although its acquaretic effects often impact on quality of life (QoL) and treatment adherence. Few studies have documented the tolvaptan long term efficacy and safeness profiles and, mostly, the impact of treatment with tolvaptan on patients' QoL. Our study aimed to investigate in 13 ADPKD patients of our cohort the differences in terms of QoL before and after the start of treatment via a questionnaire based on SF-36 and PSQI tests, integrated with other original questions. In addition we have also examined the tolvaptan long term efficacy and safeness profiles. The results of our study show that tolvaptan does not significantly reduce patients QoL notwithstanding its expected acquaretic effects, the only reported side effects. Finally, the average annual renal deterioration rate was lower in patients treated with tolvaptan than in the others. Relevant limits of our study are the small number of selected patients and the relative short study duration. However, on one hand, the results of our study provide further information to the few data available in literature; on the other hand, they may serve as a useful working hypothesis for further studies with a larger number of patients enrolled and an extended study duration. They would demonstrate the absence of significant impact of tolvaptan on patients' QoL.
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Affiliation(s)
- Irene Cirella
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
| | - Valentina di Vico
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
| | - Matteo Rigato
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
| | - Beatrice Bugnotto
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
| | | | - Daniela Campo
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
| | - Gianni Carraro
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
| | - Lorenzo A Calò
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina (DIMED), Università di Padova
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Rigato M, Carraro G, Cirella I, Dian S, Di Vico V, Ravarotto V, Bertoldi G, Calò LA. [Reduced oxidative stress in ADPKD patients treated with tolvaptan]. G Ital Nefrol 2022; 39:2022-vol2. [PMID: 35470999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent monogenic kidney disease. It causes hypertension and progressive renal failure, both strictly linked to oxidative stress (OxSt). Treatment with tolvaptan is a consolidate option which slows renal deterioration rate, although the molecular mechanisms involved are not fully clarified. We evaluated the OxSt state in tolvaptan-treated ADPKD patients, untreated patients and healthy subjects. OxSt was assessed in 9 patients for each group as mononuclear cell protein expression, MYPT-1 phosphorylation state (Western blot) and heme oxygenase (HO-1) (ELISA). p22 phox protein expression was lower in tolvaptan treated ADPKD and controls compared to untreated patients: 0.86 ±0.15 d.u. p=0.015; 0.53 ±0.11, p<0.001; 1.42 ±0.11 respectively. The same was observed for phosphorylated MYPT-1: 0.68 ±0.09, p=0.013 and vs 0.47 ±0.13, p<0.001, 0.96 ±0.28, while HO-1 of untreated patients was significantly lower compared to treated and controls: 5.33 ±3.34 ng/mL, 2.08 ±0.79, p=0.012, 1.97 ±1.22, p=0.012. Tolvaptan-treated ADPKD patients have reduced OxSt, which might contribute to slowing down the loss of renal function.
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Affiliation(s)
- Matteo Rigato
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Gianni Carraro
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Irene Cirella
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Silvia Dian
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Valentina Di Vico
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Verdiana Ravarotto
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Giovanni Bertoldi
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Lorenzo A Calò
- UOC Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina, Università di Padova, Padova, Italy
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Ravarotto V, Bertoldi G, Stefanelli LF, Gobbi L, Calò LA. Molecular aspects of the altered Angiotensin II signalling in Gitelman’s syndrome. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2066996] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Verdiana Ravarotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED) University of Padova, Italy
| | - Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED) University of Padova, Italy
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED) University of Padova, Italy
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED) University of Padova, Italy
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED) University of Padova, Italy
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28
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Nalesso F, Garzotto F, Gobbi L, Cattarin L, Calò LA. In vitro use of standard fluid infusion central venous catheter for Slow Continuous Ultrafiltration feasibility assessment. Artif Organs 2022; 46:1695-1700. [PMID: 35403263 DOI: 10.1111/aor.14253] [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: 09/16/2021] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Slow Continuous Ultrafiltration (SCUF) by Central Venous Catheter (CVC) for hemodialysis is a simple extracorporeal ultrafiltration that can reduce and control fluid overload in patients with chronic or acute on chronic heart failure unresponsive to medical therapy. In order to avoid complications and risks related to the catheterization with a standard CVC for hemodialysis to provide the SCUF, considering that hospitalized patients affected by congestive heart failure commonly undergo CVC placement for medications delivering, we tested an in vitro model to use a standard CVC for infusion to perform SCUF. METHODS We performed an in vitro SCUF experimental model through two different lumens of a triple (8Fr x 20 cm Tri-lumen catheter Kit - Envans Extra) and a quad-lumen CVC (8.5Fr x 20 cm Quad-lumen catheter kit - Benefis Medical Devices) commonly used in our Intensive Care Unit for fluids and medications infusions. We used Prismaflex with HF-20 set (Baxter, IL, USA) to perform the SCUF treatment. RESULTS Our in vitro data confirm the technical feasibility of the use of standard CVC for fluid infusion to perform a SCUF treatment with a theoretical weight loss up to 200 mL/h by a blood flow ranging from 30 to 45 mL/min. CONCLUSIONS The use of standard infusion CVC could be utilized in Intensive Care Unit to perform SCUF not exposing patients to the risks and complications related to the placement and permanence of CVC for hemodialysis.
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Affiliation(s)
- Federico Nalesso
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
| | | | - Laura Gobbi
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
| | - Leda Cattarin
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
| | - Lorenzo A Calò
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
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29
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Bertoldi G, Ravarotto V, Sgarabotto L, Davis PA, Gobbi L, Calò LA. Impaired ACE2 glycosylation and protease activity lowers COVID-19 susceptibility in Gitelman's and Bartter's syndromes. J Intern Med 2022; 291:522-524. [PMID: 34875124 PMCID: PMC9414342 DOI: 10.1111/joim.13426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Verdiana Ravarotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Sgarabotto
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, California, USA
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
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30
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Verploegen MFA, Vargas-Poussou R, Walsh SB, Alpay H, Amouzegar A, Ariceta G, Atmis B, Bacchetta J, Bárány P, Baron S, Bayrakci US, Belge H, Besouw M, Blanchard A, Bökenkamp A, Boyer O, Burgmaier K, Calò LA, Decramer S, Devuyst O, van Dyck M, Ferraro PM, Fila M, Francisco T, Ghiggeri GM, Gondra L, Guarino S, Hooman N, Hoorn EJ, Houillier P, Kamperis K, Kari JA, Konrad M, Levtchenko E, Lucchetti L, Lugani F, Marzuillo P, Mohidin B, Neuhaus TJ, Osman A, Papizh S, Perelló M, Rookmaaker MB, Conti VS, Santos F, Sawaf G, Serdaroglu E, Szczepanska M, Taroni F, Topaloglu R, Trepiccione F, Vidal E, Wan ER, Weber L, Yildirim ZY, Yüksel S, Zlatanova G, Bockenhauer D, Emma F, Nijenhuis T. Parathyroid hormone and phosphate homeostasis in patients with Bartter and Gitelman syndrome: an international cross-sectional study. Nephrol Dial Transplant 2022; 37:2474-2486. [PMID: 35137195 PMCID: PMC9681919 DOI: 10.1093/ndt/gfac029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Small cohort studies have reported high parathyroid hormone (PTH) levels in patients with Bartter syndrome and lower serum phosphate levels have anecdotally been reported in patients with Gitelman syndrome. In this cross-sectional study, we assessed PTH and phosphate homeostasis in a large cohort of patients with salt-losing tubulopathies. METHODS Clinical and laboratory data of 589 patients with Bartter and Gitelman syndrome were provided by members of the European Rare Kidney Diseases Reference Network (ERKNet) and the European Society for Paediatric Nephrology (ESPN). RESULTS A total of 285 patients with Bartter syndrome and 304 patients with Gitelman syndrome were included for analysis. Patients with Bartter syndrome type I and II had the highest median PTH level (7.5 pmol/L) and 56% had hyperparathyroidism (PTH >7.0 pmol/L). Serum calcium was slightly lower in Bartter syndrome type I and II patients with hyperparathyroidism (2.42 versus 2.49 mmol/L; P = .038) compared to those with normal PTH levels and correlated inversely with PTH (rs -0.253; P = .009). Serum phosphate and urinary phosphate excretion did not correlate with PTH. Overall, 22% of patients had low serum phosphate levels (phosphate-standard deviation score < -2), with the highest prevalence in patients with Bartter syndrome type III (32%). Serum phosphate correlated with tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) (rs 0.699; P < .001), suggesting renal phosphate wasting. CONCLUSIONS Hyperparathyroidism is frequent in patients with Bartter syndrome type I and II. Low serum phosphate is observed in a significant number of patients with Bartter and Gitelman syndrome and appears associated with renal phosphate wasting.
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Affiliation(s)
| | - Rosa Vargas-Poussou
- Department of Genetics, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK
| | - Harika Alpay
- Division of Paediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Atefeh Amouzegar
- Division of Nephrology, Department of Medicine, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gema Ariceta
- Paediatric Nephrology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Bahriye Atmis
- Department of Paediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Justine Bacchetta
- Department of Paediatric Nephrology, Rheumatology and Dermatology, Reference Centre for Rare Renal Diseases, Reference Centre for Rare Diseases of Calcium and Phosphate Metabolism. University Children's Hospital, Lyon, France
| | - Peter Bárány
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stéphanie Baron
- Department of Physiology, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Umut Selda Bayrakci
- Department of Paediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, Çankaya/Ankara, Turkey
| | - Hendrica Belge
- Center for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Martine Besouw
- Department of Paediatric Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne Blanchard
- Clinical Research Centre 1418, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Arend Bökenkamp
- Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olivia Boyer
- Department of Paediatric Nephrology, Necker Hospital, APHP, MARHEA, Imagine Institute, Paris University, Paris, France
| | - Kathrin Burgmaier
- Faculty of Medicine, University Hospital of Cologne, Children's and Adolescents' Hospital, Paediatric Nephrology, University of Cologne, Cologne, Germany
| | - Lorenzo A Calò
- Department of Medicine (DIMED), Nephrology, Dialysis, Transplantation, University of Padova, Padova, Italy
| | - Stéphane Decramer
- Department of Paediatric Nephrology. Centre de Références SORARE, Toulouse University Hospital, Toulouse, France
| | - Olivier Devuyst
- Division of Nephrology, UCLouvain Medical School, Brussels, Belgium; Institute of Physiology, Mechanism of Inherited Kidney Disorders Group, University of Zurich, Zurich, Switzerland
| | - Maria van Dyck
- Department of Paediatric Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marc Fila
- Pediatric Nephrology, CHU Arnaud de Villeneuve, Montpellier University Hospital, Montpellier, France
| | - Telma Francisco
- Department of Paediatric Nephrology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Leire Gondra
- Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; Paediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Nakysa Hooman
- Ali-Asghar Clinical Research Development Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pascal Houillier
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France,Department of Physiology, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Konstantinos Kamperis
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jameela A Kari
- Pediatric Nephrology Centre of Excellence and Paediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Martin Konrad
- Department of General Paediatrics, Paediatric Nephrology, University Hospital Münster, Munster, Germany
| | - Elena Levtchenko
- Department of Paediatric Nephrology & Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Laura Lucchetti
- Department of Paediatric Subspecialties, Division of Nephrology, Bambino Gesù Children's Hospital – IRCCS, Rome, Italy
| | - Francesca Lugani
- Division of Nephrology, Dialysis and Transplantation, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Barian Mohidin
- Department of Renal Medicine, University College London, London, UK
| | - Thomas J Neuhaus
- Department of Paediatrics, Children's Hospital of Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Abdaldafae Osman
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London, UK
| | - Svetlana Papizh
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Manel Perelló
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maarten B Rookmaaker
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Fernando Santos
- Department of Paediatrics, Asturias Central University Hospital, University of Oviedo, Oviedo, Spain
| | - Ghalia Sawaf
- Department of Paediatric Nephrology, Damascus Hospital, Damascus, Syria
| | - Erkin Serdaroglu
- Department of Paediatric Nephrology, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Maria Szczepanska
- Department of Paediatrics, Faculty of Medical Sciences in Zabrze, SUM in Katowice, Katowice, Poland
| | - Francesca Taroni
- Paediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Rezan Topaloglu
- Department of Paediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Enrico Vidal
- Division of Paediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Elizabeth R Wan
- Department of Renal Medicine, University College London, London, UK
| | - Lutz Weber
- Faculty of Medicine, University Hospital of Cologne, Children's and Adolescents' Hospital, Paediatric Nephrology, University of Cologne, Cologne, Germany
| | - Zeynep Yuruk Yildirim
- Department of Paediatrics, Division of Paediatric Nephrology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selçuk Yüksel
- Department of Paediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Galia Zlatanova
- University Children's Hospital Medical University, Sofia, Bulgaria
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London, UK,Paediatric Nephrology Unit, Great Ormond Street Hospital, London, UK
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Nalesso F, Gobbi L, Calò LA. Systemic anticoagulation and new biocompatible dialyzers in the different kidney replacement techniques: More doubts than certainties. Artif Organs 2022; 46:516-517. [DOI: 10.1111/aor.14168] [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: 09/16/2021] [Revised: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Federico Nalesso
- Department of Medicine ‐ Nephrology, Dialysis and Transplantation Unit University of Padua Padua Italy
| | - Laura Gobbi
- Department of Medicine ‐ Nephrology, Dialysis and Transplantation Unit University of Padua Padua Italy
| | - Lorenzo A. Calò
- Department of Medicine ‐ Nephrology, Dialysis and Transplantation Unit University of Padua Padua Italy
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32
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Nalesso F, Garzotto F, Cattarin L, Innico G, Gobbi L, Calò LA. Impact of different hemodiafiltration solutions on ionemia in long-term CRRT. Int J Artif Organs 2021; 44:807-815. [PMID: 34472996 DOI: 10.1177/03913988211043203] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Critical patients with Acute Kidney Injury (AKI) requiring renal replacement therapy are in most cases eligible only for continuous modalities where the electrolyte balance control is a critical issue. The standard solutions used for hemodiafiltration, containing potassium at 2 mmol/L and no phosphorus, determines during the extended renal replacement therapy hypokalemia and hypophosphatemia. Therefore, solutions containing potassium and phosphate in physiological concentrations were formulated to avoid electrolyte imbalances and reduce ion alterations in prolonged treatments, these solutions are not routinely used in the standard clinical practice. To avoid electrolyte imbalances, we have first introduced in our practice two different solutions and then we have retrospectively analyzed the electrolyte balance upon these two solutions in order to identity the impact of these solutions on potassium and phosphate according to our clinical practice. We retrospectively analyzed 96 patients treated with Continuous Renal Replacement Therapy (CRRT) in the intensive care units (ICU) at Padua's University Hospital to evaluate the role on electrolyte balance of Phoxilium® and Prismasol 2® that differ in their composition and the need for electrolytes infusions. In the Phoxilium group the frequency of hypokalemia, hypophosphatemia, and the need of potassium and phosphate replacement were significantly reduced resulting in a reduction in complications, workload, and clinical risk associated with infusions of electrolytes. Our data demonstrated that the use of these two different hemodiafiltration solutions can reduce the occurrence of hypokalemia and hypophosphatemia during CRRT performing personalized treatments without the use of potassium and phosphate infusions.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | | | - Leda Cattarin
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | - Georgie Innico
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | - Laura Gobbi
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
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Francini F, Gobbi L, Ravarotto V, Toniazzo S, Nalesso F, Spinella P, Calò LA. The Dietary Approach to the Treatment of the Rare Genetic Tubulopathies Gitelman's and Bartter's Syndromes. Nutrients 2021; 13:nu13092960. [PMID: 34578838 PMCID: PMC8467039 DOI: 10.3390/nu13092960] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
Gitelman’s (GS) and Bartter’s (BS) syndromes are rare, inherited autosomal recessive tubulopathies characterized by hypokalemia, metabolic alkalosis, renal sodium, chloride, and potassium and magnesium-wasting. While the treatment based on potassium, sodium, chloride, and magnesium supplementation in addition to other pharmacologic options are widely established, recommendations about the dietary approach to GS and BS still remain generic. In this review we focus on the dietary strategies to increase sodium, potassium, and magnesium intake in GS and BS patients. Potassium and magnesium-rich foods and supplements are considered together with those that may reduce through different mechanisms the potassium and magnesium plasma level. Magnesium supplementation is often poorly tolerated, causing abdominal pain and diarrhea in most patients. New formulations using liposome and, in particular, sucrosomial technology have been recently proposed for magnesium supplementation in order to increase magnesium supplement tolerability and intestinal absorption. The dietary approach to GS and BS may be very important in the therapeutic approach to these syndromes. Due to the relevance of the dietary approach to these syndromes, a nutritional counseling should always be recommended and the nutritionist should join nephrologists in the follow-up of GS and BS patient care.
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Affiliation(s)
- Francesco Francini
- Department of Medicine (DIMED), Clinical Nutrition, University of Padova, 35128 Padova, Italy; (F.F.); (S.T.); (P.S.)
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
| | - Verdiana Ravarotto
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
| | - Silvia Toniazzo
- Department of Medicine (DIMED), Clinical Nutrition, University of Padova, 35128 Padova, Italy; (F.F.); (S.T.); (P.S.)
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
| | - Paolo Spinella
- Department of Medicine (DIMED), Clinical Nutrition, University of Padova, 35128 Padova, Italy; (F.F.); (S.T.); (P.S.)
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
- Correspondence: ; Tel.: +39-04-9821-3071
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Gobbi L, Naso E, Dal Santo L, Fedrigo M, Del Prete D, Angelini A, Vertolli U, Calò LA. Light chain deposition disease with low glomerular proteinuria and multiple myeloma: If you search you find. Nephrology (Carlton) 2021; 26:842-843. [PMID: 34056800 PMCID: PMC8453844 DOI: 10.1111/nep.13903] [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: 04/07/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Elena Naso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Luca Dal Santo
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Marny Fedrigo
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dorella Del Prete
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Ugo Vertolli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
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Innico G, Gobbi L, Bertoldi G, Rigato M, Basso A, Bonfante L, Calò LA. Oxidative stress, inflammation, and peritoneal dialysis: A molecular biology approach. Artif Organs 2021; 45:1202-1207. [PMID: 34037984 PMCID: PMC8519152 DOI: 10.1111/aor.14001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/11/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022]
Abstract
The key role of oxidative stress (OxSt) and inflammation for the induction of cardiovascular disease, the leading cause of excess morbidity/mortality in chronic kidney disease and dialysis patients, is known and both the activations of NADPH oxidase and RhoA/Rho kinase (ROCK) pathway are pivotal for their effects. While specific hemodialysis procedures, such as hemodiafiltration with on‐line reinfusion of ultrafiltrate and/or the use of vitamin E‐coated dialyzers, are beneficial for OxSt and inflammation, studies in peritoneal dialysis (PD) are instead scarce and results seem not favorable. In nine patients under PD OxSt in terms of mononuclear cell protein level of p22phox (Western blot), subunit of NADPH oxidase, essential for the generation of OxSt, and MYPT‐1 phosphorylation state (Western blot), a marker of ROCK activity, have been measured at the beginning and after 3 and 6 months of PD. Blood levels of interleukin 6 (IL‐6), ferritin, and albumin have been considered for evaluating the inflammatory state. p22phox protein expression, MYPT‐1‐phosphorylation, and ferritin level were increased both at baseline vs healthy subjects (P = .02, P < .0001, P = .004, respectively) and vs baseline after 3 and 6 months of peritoneal dialysis (P = .007, P < .001, P = .004, respectively). Albumin was lower after 6 months of PD (P = .0014). IL‐6 was increased at baseline vs reference values and remained unchanged at 3 and 6 months. OxSt and inflammation increase during PD confirming via molecular biology approach a report at biochemical level. To improve OxSt state in PD, a multitarget approach is necessary. It might include the use of more physiologic pH, low glucose degradation products, low lactate and iso‐osmolar PD solutions, patients’ strict glycemic control, optimal volume management, and antioxidant administration, such as N‐acetylcysteine.
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Affiliation(s)
- Georgie Innico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Matteo Rigato
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Anna Basso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Luciana Bonfante
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
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Calò LA, Rigato M, Sgarabotto L, Gianesello L, Bertoldi G, Ravarotto V, Davis PA. ACE2 and SARS-CoV-2 Infection Risk: Insights From Patients With Two Rare Genetic Tubulopathies, Gitelman's and Bartter's Syndromes. Front Med (Lausanne) 2021; 8:647319. [PMID: 34017843 PMCID: PMC8129173 DOI: 10.3389/fmed.2021.647319] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is spreading globally with the angiotensin converting enzyme (ACE)-2 serving as the entry point of SARS-CoV-2 virus. This raised concerns how ACE2 and the Renin-Angiotensin (Ang)-System (RAS) are to be dealt with given their roles in hypertension and their involvement in COVID-19's morbidity and mortality. Specifically, increased ACE2 expression in response to treatment with ACE inhibitors (ACEi) and Ang II receptor blockers (ARBs) might theoretically increase COVID-19 risk by increasing SARS-CoV-2 binding sites. However, ACE2 is part of the protective counter-regulatory ACE2-Ang1-7-MasR axis, which opposes the classical ACE-AngII-AT1R regulatory axis. We used Gitelman's and Bartter's syndromes (GS/BS) patients, rare genetic tubulopathies that have endogenously increased levels of ACE2, to explore these issues. Specifically, 128 genetically confirmed GS/BS patients, living in Lombardia, Emilia Romagna and Veneto, the Northern Italy hot spots for COVID-19, were surveyed via telephone survey regarding COVID-19. The survey found no COVID-19 infection and absence of COVID-19 symptoms in any patient. Comparison analysis with the prevalence of COVID-19 in those regions showed statistical significance (p < 0.01). The results of the study strongly suggest that increased ACE2 does not increase risk of COVID-19 and that ACEi and ARBs by blocking excessive AT1R-mediated Ang II activation might favor the increase of ACE2-derived Ang 1-7. GS/BS patients' increased ACE2 and Ang 1-7 levels and their characteristic chronic metabolic alkalosis suggest a mechanism similar to that of chloroquine/hydroxychloroquine effect on ACE2 glycosylation alteration with resulting SARS-COV-2 binding inhibition and blockage/inhibition of viral entry. Studies from our laboratory are ongoing to explore GS/BS ACE2 glycosylation and other potential beneficial effects of BS/GS. Importantly, the absence of frank COVID-19 or of COVID-19 symptoms in the BS/GS patients cohort, given no direct ascertainment of COVID-19 status, suggest that elevated ACE2 levels as found in GS/BS patients at a minimum render COVID-19 infection asymptomatic and thus that COVID-19 symptoms are driven by ACE2 levels.
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Affiliation(s)
- Lorenzo A Calò
- Dialysis and Transplantation Unit, Department of Medicine, Nephrology, University of Padova, Padua, Italy
| | - Matteo Rigato
- Dialysis and Transplantation Unit, Department of Medicine, Nephrology, University of Padova, Padua, Italy
| | - Luca Sgarabotto
- Dialysis and Transplantation Unit, Department of Medicine, Nephrology, University of Padova, Padua, Italy
| | - Lisa Gianesello
- Dialysis and Transplantation Unit, Department of Medicine, Nephrology, University of Padova, Padua, Italy
| | - Giovanni Bertoldi
- Dialysis and Transplantation Unit, Department of Medicine, Nephrology, University of Padova, Padua, Italy
| | - Verdiana Ravarotto
- Dialysis and Transplantation Unit, Department of Medicine, Nephrology, University of Padova, Padua, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, Davis, CA, United States
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Davis PA, Bertoldi G, Calò LA. On the imbalanced protective arm of RAS in COVID-19: Lesson from rare genetic tubulopathies. Int J Clin Pract 2021; 75:e14075. [PMID: 33887873 PMCID: PMC8250254 DOI: 10.1111/ijcp.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Paul A. Davis
- Department of NutritionUniversity of CaliforniaDavisCAUSA
| | - Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation UnitDepartment of MedicineUniversity of PadovaItaly
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation UnitDepartment of MedicineUniversity of PadovaItaly
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Calò LA, Davis PA. Far di Necessità Virtù, using rare tubulopathies, Gitelman's and Bartter's syndromes, to inform the fight against COVID-19. J Nephrol 2021; 34:281-283. [PMID: 33387334 PMCID: PMC7776285 DOI: 10.1007/s40620-020-00951-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, USA
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Scaparrotta G, Gobbi L, Calò LA. Switching to HFR Supra resolved refractory itch and quality of life in a chronic dialysis with liver transplant patient. Artif Organs 2020; 45:320-321. [PMID: 33009689 DOI: 10.1111/aor.13811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Giuseppe Scaparrotta
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
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Gianesello L, Del Prete D, Anglani F, Calò LA. Genetics and phenotypic heterogeneity of Dent disease: the dark side of the moon. Hum Genet 2020; 140:401-421. [PMID: 32860533 PMCID: PMC7889681 DOI: 10.1007/s00439-020-02219-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 06/24/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
Dent disease is a rare genetic proximal tubulopathy which is under-recognized. Its phenotypic heterogeneity has led to several different classifications of the same disorder, but it is now widely accepted that the triad of symptoms low-molecular-weight proteinuria, hypercalciuria and nephrocalcinosis/nephrolithiasis are pathognomonic of Dent disease. Although mutations on the CLCN5 and OCRL genes are known to cause Dent disease, no such mutations are found in about 25–35% of cases, making diagnosis more challenging. This review outlines current knowledge regarding Dent disease from another perspective. Starting from the history of Dent disease, and reviewing the clinical details of patients with and without a genetic characterization, we discuss the phenotypic and genetic heterogeneity that typifies this disease. We focus particularly on all those confounding clinical signs and symptoms that can lead to a misdiagnosis. We also try to shed light on a concealed aspect of Dent disease. Although it is a proximal tubulopathy, its misdiagnosis may lead to patients undergoing kidney biopsy. In fact, some individuals with Dent disease have high-grade proteinuria, with or without hematuria, as in the clinical setting of glomerulopathy, or chronic kidney disease of uncertain origin. Although glomerular damage is frequently documented in Dent disease patients’ biopsies, there is currently no reliable evidence of renal biopsy being of either diagnostic or prognostic value. We review published histopathology reports of tubular and glomerular damage in these patients, and discuss current knowledge regarding the role of CLCN5 and OCRL genes in glomerular function.
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Affiliation(s)
- Lisa Gianesello
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy
| | - Dorella Del Prete
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy
| | - Franca Anglani
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy.
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy
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Abstract
LINKED CONTENT This article is linked to Panarese et al and Kumar et al papers. To view these articles, visit https://doi.org/10.1111/apt.15752 and https://doi.org/10.1111/apt.15801.
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Affiliation(s)
- Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation UnitDepartment of MedicineUniversity of PadovaPadovaItaly
| | - Lisa Gianesello
- Nephrology, Dialysis and Transplantation UnitDepartment of MedicineUniversity of PadovaPadovaItaly
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation UnitDepartment of MedicineUniversity of PadovaPadovaItaly
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Calò LA, Savica V, Casablanca G, Dian S, Bonfante L, Nalesso F, Calò LA. Spontaneous Perforation of an Unknown Esophageal Diverticulum in a Hemodialysis Patient. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.07.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Zenker’s diverticulum is a rare disease, with an annual incidence of about 2 cases per 100000, occurring
most often in elderly men. No data are reported in dialysis patients. We report a case of a hemodialysis
patient who experienced a sudden spontaneous perforation of an unknown esophageal diverticulum. To our
knowledge, this is the first case reported in a hemodialysis patient. Its description could be helpful to
consider in such patients the possibility of the perforation of an esophageal diverticulum when typical
symptoms are referred in addition to the exclusion of other events with similar symptoms (acute esophagitis
and gastroduodenitis, perforated peptic ulcer, acute pancreatitis, myocardial infarction, pneumothorax,
dissecting aortic aneurysm).
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Calò LA, Davis PA, Rigato M, Sgarabotto L. ACE2 and prognosis of COVID-19: Insights from Bartter's and Gitelman's syndromes patients. J Med Virol 2020; 92:2308-2309. [PMID: 32374416 PMCID: PMC7267417 DOI: 10.1002/jmv.25978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Lorenzo A Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, California
| | - Matteo Rigato
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Italy
| | - Luca Sgarabotto
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Italy
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Calò LA, Rigato M, Bertoldi G. ACE2/Angiotensin 1-7 protective anti-inflammatory and antioxidant role in hyperoxic lung injury: support from studies in Bartter's and Gitelman's syndromes. QJM 2020; 113:440-441. [PMID: 31851364 DOI: 10.1093/qjmed/hcz319] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L A Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - M Rigato
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - G Bertoldi
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
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Nalesso F, Garzotto F, Cattarin L, Gobbi L, Qassim L, Sgarabotto L, Tiberio I, Calò LA. A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19. J Clin Med 2020; 9:jcm9051529. [PMID: 32438617 PMCID: PMC7291081 DOI: 10.3390/jcm9051529] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 01/21/2023] Open
Abstract
COVID-19 often leads to acute respiratory distress syndrome complicated by acute kidney injury (AKI). The indications for renal replacement therapy for these patients are those commonly accepted to treat AKI. We describe a continuous veno-venous haemodialysis (CVVHD) protocol for AKI, which aims to provide the best treatment according to the particular patient's and medical personnels' needs in biohazard settings with limited human and technological resources. We designed a CVVHD protocol with a high cut-off (HCO) filter in regional citrate anticoagulation (RCA). The HCO filter in diffusion determines the enhanced cytokines clearance with less filter clotting due to a lower filtration fraction. In our hospital, at the beginning of the pandemic outbreak, we treated seven COVID-19 patients with AKI stage 2 and 3 and recorded the circuit lifespan and the number of interventions on monitors. CVVHD in RCA appears to be safe, effective and easy to be performed in a biohazard scenario using lower blood flows and less bag changes with fluid savings, a biohazard reduction and sparing of resources. Although the data come from a very small cohort, our protocol seems related to a low mortality.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (F.N.); (L.C.); (L.G.); (L.Q.); (L.S.)
| | - Francesco Garzotto
- Veneto Institute of Oncology IOV-IRCCS, Healthcare Directorate Unit, 35128 Padova, Italy;
| | - Leda Cattarin
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (F.N.); (L.C.); (L.G.); (L.Q.); (L.S.)
| | - Laura Gobbi
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (F.N.); (L.C.); (L.G.); (L.Q.); (L.S.)
| | - Laila Qassim
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (F.N.); (L.C.); (L.G.); (L.Q.); (L.S.)
| | - Luca Sgarabotto
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (F.N.); (L.C.); (L.G.); (L.Q.); (L.S.)
| | - Ivo Tiberio
- Emergency-Urgency Department, Anesthesia and Intensive Care, Azienda Ospedaliera di Padova University of Padova, 35128 Padova, Italy;
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (F.N.); (L.C.); (L.G.); (L.Q.); (L.S.)
- Correspondence: ; Tel.: +39-049-8213071; Fax: +39-049-8217921
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Sella S, Bonfante L, Fusaro M, Neri F, Plebani M, Zaninotto M, Aghi A, Innico G, Tripepi G, Michielin A, Prandini T, Calò LA, Giannini S. Efficacy of weekly administration of cholecalciferol on parathyroid hormone in stable kidney-transplanted patients with CKD stage 1-3. Clin Chem Lab Med 2020; 59:343-351. [PMID: 32374278 DOI: 10.1515/cclm-2020-0282] [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: 03/08/2020] [Accepted: 04/10/2020] [Indexed: 11/15/2022]
Abstract
Objectives Kidney transplant (KTx) recipients frequently have deficient or insufficient levels of serum vitamin D. Few studies have investigated the effect of cholecalciferol in these patients. We evaluated the efficacy of weekly cholecalciferol administration on parathyroid hormone (PTH) levels in stable KTx patients with chronic kidney disease stage 1-3. Methods In this retrospective cohort study, 48 stable KTx recipients (37 males, 11 females, aged 52 ± 11 years and 26 months post-transplantation) were treated weekly with oral cholecalciferol (7500-8750 IU) for 12 months and compared to 44 untreated age- and gender-matched recipients. Changes in levels of PTH, 25(OH) vitamin D (25[OH]D), serum calcium, phosphate, creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline, 6 and 12 months. Results At baseline, clinical characteristics were similar between treated and untreated patients. Considering the entire cohort, 87 (94.6%) were deficient in vitamin D and 64 (69.6%) had PTH ≥130 pg/mL. Serum calcium, phosphate, creatinine and eGFR did not differ between groups over the follow-up period. However, 25(OH)D levels were significantly higher at both 6 (63.5 vs. 30.3 nmol/L, p < 0.001) and 12 months (69.4 vs. 30 nmol/L, p < 0.001) in treated vs. untreated patients, corresponding with a significant reduction in PTH at both 6 (112 vs. 161 pg/mL) and 12 months (109 vs. 154 pg/mL) in treated vs. untreated patients, respectively (p < 0.001 for both). Conclusions Weekly administration of cholecalciferol can significantly and stably reduce PTH levels, without any adverse effects on serum calcium and renal function.
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Affiliation(s)
- Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Luciana Bonfante
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Maria Fusaro
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Flavia Neri
- Department of Surgery, Renal and Pancreas Transplant Unit, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Georgie Innico
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Italy
| | - Alberto Michielin
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Tancredi Prandini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
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Seccia TM, Rigato M, Ravarotto V, Calò LA. ROCK (RhoA/Rho Kinase) in Cardiovascular-Renal Pathophysiology: A Review of New Advancements. J Clin Med 2020; 9:jcm9051328. [PMID: 32370294 PMCID: PMC7290501 DOI: 10.3390/jcm9051328] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 04/06/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Rho-associated, coiled-coil containing kinases (ROCK) were originally identified as effectors of the RhoA small GTPase and found to belong to the AGC family of serine/threonine kinases. They were shown to be downstream effectors of RhoA and RhoC activation. They signal via phosphorylation of proteins such as MYPT-1, thereby regulating many key cellular functions including proliferation, motility and viability and the RhoA/ROCK signaling has been shown to be deeply involved in arterial hypertension, cardiovascular–renal remodeling, hypertensive nephropathy and posttransplant hypertension. Given the deep involvement of ROCK in cardiovascular–renal pathophysiology and the interaction of ROCK signaling with other signaling pathways, the reports of trials on the clinical beneficial effects of ROCK’s pharmacologic targeting are growing. In this current review, we provide a brief survey of the current understanding of ROCK-signaling pathways, also integrating with the more novel data that overall support a relevant role of ROCK for the cardiovascular–renal physiology and pathophysiology.
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Affiliation(s)
- Teresa M. Seccia
- Department of Medicine, Hypertension Clinic, University of Padova, 35128 Padova, Italy;
| | - Matteo Rigato
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (M.R.); (V.R.)
| | - Verdiana Ravarotto
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (M.R.); (V.R.)
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128 Padova, Italy; (M.R.); (V.R.)
- Correspondence: ; Tel.: +39-049-8213071; Fax: +39-049-8217921
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Gobbi L, Scaparrotta G, Rigato M, Cattarin L, Qassim L, Carraro G, Rossi B, Calò LA. Intravenous ferric carboxymaltose for iron deficiency anemia in dialysis patients: Effect of a new protocol adopted for a hemodialysis limited assistance center. Ther Apher Dial 2020; 24:642-647. [PMID: 32154642 DOI: 10.1111/1744-9987.13488] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/27/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
Iron and erythropoietin deficiencies are determinants of anemia in chronic kidney disease. In hemodialysis (HD) patients, intravenous (IV) iron is associated with a greater hemoglobin (Hb) production and better erythropoietin response but may be associated to hypersensitivity reaction. After the 2013 European Medicines Agency report regarding early detection/management of iron allergic reactions, IV iron administration dramatically reduced in Italian Hemodialysis-Limited-Assistance-Centre (HD-CAL) where a physician is present only once a week. Objective of the study was providing an effective and secure IV iron administration protocol for HD-CAL patients. IV ferric carboxymaltose (FCM) administration was more effective and better tolerated than sodium ferric gluconate for iron deficiency correction and resolution of anemia in 24 patients undergoing HD in our HD-CAL. Six months of FCM IV treatment once a week increased ferritin and Hb compared to sodium ferric gluconate once a week leading to decreased erythropoietin consumption from 24 000 to 15 000 U/patient/week with an erythropoietin annual expense reduction. No blood transfusions, gastrointestinal intolerance or other adverse effects were reported. The FCM IV administration protocol for our HD-CAL patients was safe and no adverse events were reported, resulting in significantly increased ferritin, transferrin saturation, and Hb levels, reduction of erythropoietin requirements, and consequently reduction of erythropoietin expenses.
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Affiliation(s)
- Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Giuseppe Scaparrotta
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Matteo Rigato
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Leda Cattarin
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Laila Qassim
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Gianni Carraro
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Barbara Rossi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
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49
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Nalesso F, Garzotto F, Muraro E, Cattarin L, Rigato M, Gobbi L, Innico G, Calò LA. Ultrasound for the Clinical Management of Vascular Access Cannulation and Needle Position in Hemodialysis Patients. Ultrasound Med Biol 2020; 46:455-459. [PMID: 31753599 DOI: 10.1016/j.ultrasmedbio.2019.10.018] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/05/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
A native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis (HD) treatment. Compared with other types of vascular access such as grafts and central venous catheters, it functions longer and is associated with a lower risk of complications. The aim of the study described here was to assess, in an HD population, the position of the fistula needles during an HD session and evaluate the role of ultrasound in the management of AVF puncture. Forty-five consecutive chronic HD patients with an AVF or an arteriovenous vascular graft were included in the study for ultrasound evaluation. Each patient underwent an ultrasound evaluation during HD treatment to assess the position of the needles inside the vascular access. The ultrasound evaluation revealed that 81.8% of the traditional needles were incorrectly adjacent to the vessel walls, in the absence of clinical symptoms or hemodynamic alterations detectable on the dialysis monitor. A greater frequency of malpositioning has been observed for needles in the arterial portion of the vascular access, closer to the anastomosis. The absence of clinically detectable signs of venipuncture-related complications does not ensure correct positioning of the needles within the AVF. Ultrasound evaluation may not only resolve suboptimal cannulation problems of new or complicated vascular accesses but may also be useful in the prevention of acute and chronic damage to the AVF.
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Affiliation(s)
- Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | | | - Eva Muraro
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Leda Cattarin
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Matteo Rigato
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Georgie Innico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova-Azienda Ospedaliera Padova, Padova, Italy.
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50
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Nalesso F, Cattarin L, Calò LA. Regional citrate anticoagulation dose for continuous renal replacement therapy. Nephrology (Carlton) 2019; 25:361. [PMID: 31642131 DOI: 10.1111/nep.13671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Leda Cattarin
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
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