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Dai L, Massy ZA, Stenvinkel P, Chesnaye NC, Larabi IA, Alvarez JC, Caskey FJ, Torino C, Porto G, Szymczak M, Krajewska M, Drechsler C, Wanner C, Jager KJ, Dekker FW, Evenepoel P, Evans M, Torp A, Iwig B, Perras B, Marx C, Drechsler C, Blaser C, Wanner C, Emde C, Krieter D, Fuchs D, Irmler E, Platen E, Schmidt-Gürtler H, Schlee H, Naujoks H, Schlee I, Cäsar S, Beige J, Röthele J, Mazur J, Hahn K, Blouin K, Neumeier K, Anding-Rost K, Schramm L, Hopf M, Wuttke N, Frischmuth N, Ichtiaris P, Kirste P, Schulz P, Aign S, Biribauer S, Manan S, Röser S, Heidenreich S, Palm S, Schwedler S, Delrieux S, Renker S, Schättel S, Stephan T, Schmiedeke T, Weinreich T, Leimbach T, Stövesand T, Bahner U, Seeger W, Cupisti A, Sagliocca A, Ferraro A, Mele A, Naticchia A, Còsaro A, Ranghino A, Stucchi A, Pignataro A, De Blasio A, Pani A, Tsalouichos A, Antonio B, Iorio BRD, Alessandra B, Abaterusso C, Somma C, D'alessandro C, Torino C, Zullo C, Pozzi C, Bergamo D, Ciurlino D, Motta D, Russo D, Favaro E, Vigotti F, Ansali F, Conte F, Cianciotta F, Giacchino F, Cappellaio F, Pizzarelli F, Greco G, Porto G, Bigatti G, Marinangeli G, Cabiddu G, Fumagalli G, Caloro G, Piccoli G, Capasso G, Gambaro G, Tognarelli G, Bonforte G, Conte G, Toscano G, Del Rosso G, Capizzi I, Baragetti I, Oldrizzi L, Gesualdo L, Biancone L, Magnano M, Ricardi M, Bari MD, Laudato M, Sirico ML, Ferraresi M, Provenzano M, Malaguti M, Palmieri N, Murrone P, Cirillo P, Dattolo P, Acampora P, Nigro R, Boero R, Scarpioni R, Sicoli R, Malandra R, Savoldi S, Bertoli S, Borrelli S, Maxia S, Maffei S, Mangano S, Cicchetti T, Rappa T, Palazzo V, De Simone W, Schrander A, van Dam B, Siegert C, Gaillard C, Beerenhout C, Verburgh C, Janmaat C, Hoogeveen E, Hoorn E, Dekker F, Boots J, Boom H, Eijgenraam JW, Kooman J, Rotmans J, Jager K, Vogt L, Raasveld M, Vervloet M, van Buren M, van Diepen M, Chesnaye N, Leurs P, Voskamp P, van Esch S, Boorsma S, Berger S, Konings C, Aydin Z, Musiała A, Szymczak A, Olczyk E, Augustyniak-Bartosik H, Miśkowiec-Wiśniewska I, Manitius J, Pondel J, Jędrzejak K, Nowańska K, Nowak Ł, Szymczak M, Durlik M, Dorota S, Nieszporek T, Heleniak Z, Jonsson A, Rogland B, Wallquist C, Vargas D, Dimény E, Sundelin F, Uhlin F, Welander G, Hernandez IB, Gröntoft KC, Stendahl M, Svensson ME, Evans M, Heimburger O, Kashioulis P, Melander S, Almquist T, Woodman A, McKeever A, Ullah A, McLaren B, Harron C, Barrett C, O'Toole C, Summersgill C, Geddes C, Glowski D, McGlynn D, Sands D, Caskey F, Roy G, Hirst G, King H, McNally H, Masri-Senghor H, Murtagh H, Rayner H, Turner J, Wilcox J, Berdeprado J, Wong J, Banda J, Jones K, Haydock L, Wilkinson L, Carmody M, Weetman M, Joinson M, Dutton M, Matthews M, Morgan N, Bleakley N, Cockwell P, Roderick P, Mason P, Kalra P, Sajith R, Chapman S, Navjee S, Crosbie S, Brown S, Tickle S, Mathavakkannan S, Kuan Y. The association between TMAO, CMPF, and clinical outcomes in advanced chronic kidney disease: results from the European QUALity (EQUAL) Study. Am J Clin Nutr 2022; 116:1842-1851. [PMID: 36166845 PMCID: PMC9761748 DOI: 10.1093/ajcn/nqac278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/18/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source. OBJECTIVES We hypothesized that circulating TMAO derived from fish intake might cause less harm compared with red meat sources by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF, and outcomes. METHODS Patients were recruited from the European QUALity (EQUAL) Study on treatment in advanced chronic kidney disease among individuals aged ≥65 y whose estimated glomerular filtration rate (eGFR) had dropped for the first time to ≤20 mL/min per 1.73 m2 during the last 6 mo. The association between TMAO, CMPF, and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 737 patients. Patients were further stratified by median cutoffs of TMAO and CMPF, suggesting high/low red meat and fish intake. RESULTS During a median of 39 mo of follow-up, 232 patients died. Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable HR: 1.46; 95% CI: 1.17, 1.83). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR: 0.79; 95% CI: 0.71, 0.89) and KRT (HR: 0.80; 95% CI: 0.71, 0.90), independently of TMAO and other clinically relevant confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR: 0.49; 95% CI: 0.31, 0.73), whereas those with high TMAO and high CMPF showed no association across adjusted models. CONCLUSIONS High CMPF conferred an independent role in health benefits and might even counteract the unfavorable association between TMAO and outcomes. Whether higher circulating CMPF concentrations are due to fish consumption, and/or if CMPF is a protective factor, remains to be verified.
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Affiliation(s)
- Lu Dai
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France,Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, Team 5, University Versailles-Saint Quentin, University Paris-Saclay, Paris, France
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Islam Amine Larabi
- Laboratory of Pharmacology and Toxicology, CHU, Raymond Poincare, Garches, France,INSERM U1173, UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Jean Claude Alvarez
- Laboratory of Pharmacology and Toxicology, CHU, Raymond Poincare, Garches, France,INSERM U1173, UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Claudia Torino
- IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Gaetana Porto
- G.O.M., Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Friedo W Dekker
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pieter Evenepoel
- Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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Mariano F, Inguaggiato P, Pozzato M, Turello E, David P, Berutti S, Manes M, Leonardi G, Gai M, Mella A, Canepari G, Forneris G, Storace G, Brustia M, Pellù V, Consiglio V, Tognarelli G, Bonaudo R, Gianoglio B, Campo A, Viglino G, Marino A, Maffei S, Roscini E, Calabrese G, Gherzi M, Formica M, Stramignoni E, Salomone M, Martina G, Serra A, Deagostini C, Savoldi S, Marciello A, Todini V, Chiappero F, Vio P, Borzumati M, Costantini L, Filiberti O, Cesano G, Boero R, Vitale C, Chiarinotti D, Manganaro M, Besso L, Cusinato S, Roccatello D, Biancone L. Increase of continuous treatments and regional citrate anticoagulation during renal replacement therapy in the ICUs of the north-west of Italy from 2007 to 2015. Minerva Urol Nephrol 2022; 75:388-397. [PMID: 35274902 DOI: 10.23736/s2724-6051.22.04699-7] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few reports have addressed the change in Renal Replacement Therapy (RRT) management in the ICUs over the years in western countries. This study aims to assess the trend of dialytic practice in a 4.5-million population-based study of the northwest of Italy. METHODS A nine-year survey covering all the RRT provided in the ICUs. Consultant nephrologists of the 26 Nephrology and Dialysis centers reported their activities in the years 2007, 2009, 2012, and 2015. RESULTS From 2007 to 2015 the patients treated increased from 1042 to 1139, and the incidence of RRT from 254 to 263 cases/10^6 inhabitants. The workload for Dialysis Center was higher in the larger hub hospitals. RRT for Acute Kidney Injury (AKI), continuation of treatment in chronically dialyzed patients, or extrarenal indications accounted for about the stable rate of 70, 25 and 5% of all RRT sessions, respectively. Continuous modality days increased from 2731 days (39.5%) in 2007 to 5076 (70.6%) in 2015, when the continuous+prolonged treatment days were 6880/7196 (95.6% of total days). As to RRT timing, in 2015 only the classical clinical criteria, and no K-DIGO stage were adopted by most Centers. As to RRT interruption, in 2015 urine volume was the first criterion. Implementation of citrate anticoagulation (RCA) for RRT patients significantly increased from 2.8% in 2007 to 30.9% in 2015, when it was applied in all 26 Centers. CONCLUSIONS From 2007 to 2015, current practice has changed towards shared protocols, with increasing continuous modality and RCA implementation.
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Affiliation(s)
- Filippo Mariano
- Unit of Nephrology, Dialysis and Transplantation, City of Sciences and Health, CTO and Molinette Hospitals, Turin, Italy - .,Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Paola Inguaggiato
- Unit of Nephrology and Dialysis, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Marco Pozzato
- Unit of Nephrology and Dialysis, San Giovanni Bosco Hospital, Turin, Italy
| | - Ernesto Turello
- Unit of Nephrology and Dialysis, SS Antonio e Biagio Hospital, Alessandria, Italy
| | - Paola David
- Unit of Nephrology and Dialysis, Maggiore Hospital, Novara, Italy
| | - Silvia Berutti
- Unit of Nephrology and Dialysis, Mauriziano Hospital, Turin, Italy
| | - Massimo Manes
- Unit of Nephrology and Dialysis, Umberto Parini Hospital, Aosta, Italy
| | - Gianluca Leonardi
- Unit of Nephrology, Dialysis and Transplantation, City of Sciences and Health, CTO and Molinette Hospitals, Turin, Italy
| | - Massimo Gai
- Unit of Nephrology, Dialysis and Transplantation, City of Sciences and Health, CTO and Molinette Hospitals, Turin, Italy
| | - Alberto Mella
- Unit of Nephrology, Dialysis and Transplantation, City of Sciences and Health, CTO and Molinette Hospitals, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Canepari
- Unit of Nephrology and Dialysis, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giacomo Forneris
- Unit of Nephrology and Dialysis, San Giovanni Bosco Hospital, Turin, Italy
| | - Giulia Storace
- Unit of Nephrology and Dialysis, SS Antonio e Biagio Hospital, Alessandria, Italy
| | | | - Valentina Pellù
- Unit of Nephrology and Dialysis, Umberto Parini Hospital, Aosta, Italy
| | | | | | - Roberto Bonaudo
- Unit of Nephrology, Dialysis and Transplantation, OIRM Hospital, Turin, Italy
| | - Bruno Gianoglio
- Unit of Nephrology, Dialysis and Transplantation, OIRM Hospital, Turin, Italy
| | - Andrea Campo
- Unit of Nephrology and Dialysis, San Lazzaro Hospital, Alba, Cuneo, Italy
| | - Giusto Viglino
- Unit of Nephrology and Dialysis, San Lazzaro Hospital, Alba, Cuneo, Italy
| | - Angela Marino
- Unit of Nephrology and Dialysis, Cardinal Massaia Hospital, Asti, Italy
| | - Stefano Maffei
- Unit of Nephrology and Dialysis, Cardinal Massaia Hospital, Asti, Italy
| | - Elisabetta Roscini
- Unit of Nephrology and Dialysis, Casale Monferrato and Novi Ligure Hospitals, Alessandria, Italy
| | - Giovanni Calabrese
- Unit of Nephrology and Dialysis, Casale Monferrato and Novi Ligure Hospitals, Alessandria, Italy
| | - Mauro Gherzi
- Unit of Nephrology and Dialysis, Savigliano, Mondovi' and Ceva Hospitals, Cuneo, Italy
| | - Marco Formica
- Unit of Nephrology and Dialysis, Savigliano, Mondovi' and Ceva Hospitals, Cuneo, Italy
| | | | - Mario Salomone
- Unit of Nephrology and Dialysis, Chieri and Moncalieri Hospitals, Turin, Italy
| | - Guido Martina
- Unit of Nephrology and Dialysis, Chivasso, Cirié and Ivrea Hospitals, Turin, Italy
| | - Andrea Serra
- Unit of Nephrology and Dialysis, Chivasso, Cirié and Ivrea Hospitals, Turin, Italy
| | - Chiara Deagostini
- Unit of Nephrology and Dialysis, Chivasso, Cirié and Ivrea Hospitals, Turin, Italy
| | - Silvana Savoldi
- Unit of Nephrology and Dialysis, Chivasso, Cirié and Ivrea Hospitals, Turin, Italy
| | - Antonio Marciello
- Unit of Nephrology and Dialysis, Rivoli and Pinerolo Hospitals, Turin, Italy
| | - Vincenzo Todini
- Unit of Nephrology and Dialysis, Rivoli and Pinerolo Hospitals, Turin, Italy
| | - Fabio Chiappero
- Unit of Nephrology and Dialysis, Rivoli and Pinerolo Hospitals, Turin, Italy
| | - Patrizia Vio
- Unit of Nephrology and Dialysis, Verbania-Cusio-Ossola Hospitals, Verbania-Cusio-Ossola, Italy
| | - Maurizio Borzumati
- Unit of Nephrology and Dialysis, Verbania-Cusio-Ossola Hospitals, Verbania-Cusio-Ossola, Italy
| | | | | | - Giulio Cesano
- Unit of Nephrology and Dialysis, Martini Hospital, Turin, Italy
| | - Roberto Boero
- Unit of Nephrology and Dialysis, Martini Hospital, Turin, Italy
| | - Corrado Vitale
- Unit of Nephrology and Dialysis, Mauriziano Hospital, Turin, Italy
| | | | - Marco Manganaro
- Unit of Nephrology and Dialysis, SS Antonio e Biagio Hospital, Alessandria, Italy
| | - Luca Besso
- Unit of Nephrology and Dialysis, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Stefano Cusinato
- Unit of Nephrology and Dialysis, S.S. Trinità Hospital, Borgomanero, Novara, Italy.,Piedmont and Aosta Valley Section, Società Italiana di Nefrologia, Rome, Italy
| | - Dario Roccatello
- Unit of Nephrology and Dialysis, Santa Croce e Carle Hospital, Cuneo, Italy.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Luigi Biancone
- Unit of Nephrology, Dialysis and Transplantation, City of Sciences and Health, CTO and Molinette Hospitals, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
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Eveleens Maarse BC, Chesnaye NC, Schouten R, Michels WM, Bos WJW, Szymczak M, Krajewska M, Evans M, Heimburger O, Caskey FJ, Wanner C, Jager KJ, Dekker FW, Meuleman Y, Schneider A, Torp A, Iwig B, Perras B, Marx C, Drechsler C, Blaser C, Wanner C, Emde C, Krieter D, Fuchs D, Irmler E, Platen E, Schmidt-Gürtler H, Schlee H, Naujoks H, Schlee I, Cäsar S, Beige J, Röthele J, Mazur J, Hahn K, Blouin K, Neumeier K, Anding-Rost K, Schramm L, Hopf M, Wuttke N, Frischmuth N, Ichtiaris P, Kirste P, Schulz P, Aign S, Biribauer S, Manan S, Röser S, Heidenreich S, Palm S, Schwedler S, Delrieux S, Renker S, Schättel S, Stephan T, Schmiedeke T, Weinreich T, Leimbach T, Stövesand T, Bahner U, Seeger W, Cupisti A, Sagliocca A, Ferraro A, Mele A, Naticchia A, Còsaro A, Ranghino A, Stucchi A, Pignataro A, De Blasio A, Pani A, Tsalouichos A, Antonio B, Di Iorio BR, Alessandra B, Abaterusso C, Somma C, D'alessandro C, Torino C, Zullo C, Pozzi C, Bergamo D, Ciurlino D, Motta D, Russo D, Favaro E, Vigotti F, Ansali F, Conte F, Cianciotta F, Giacchino F, Cappellaio F, Pizzarelli F, Greco G, Porto G, Bigatti G, Marinangeli G, Cabiddu G, Fumagalli G, Caloro G, Piccoli G, Capasso G, Gambaro G, Tognarelli G, Bonforte G, Conte G, Toscano G, Del Rosso G, Capizzi I, Baragetti I, Oldrizzi L, Gesualdo L, Biancone L, Magnano M, Ricardi M, Di Bari M, Laudato M, Sirico ML, Ferraresi M, Postorino M, Provenzano M, Malaguti M, Palmieri N, Murrone P, Cirillo P, Dattolo P, Acampora P, Nigro R, Boero R, Scarpioni R, Sicoli R, Malandra R, Savoldi S, Bertoli S, Borrelli S, Maxia S, Maffei S, Mangano S, Cicchetti T, Rappa T, Palazzo V, De Simone W, Schrander A, van Dam B, Siegert C, Gaillard C, Beerenhout C, Verburgh C, Janmaat C, Hoogeveen E, Hoorn E, Dekker F, Boots J, Boom H, Eijgenraam JW, Kooman J, Rotmans J, Jager K, Vogt L, Raasveld M, Vervloet M, van Buren M, van Diepen M, Chesnaye N, Leurs P, Voskamp P, Blankestijn P, van Esch S, Boorsma S, Berger S, Konings C, Aydin Z, Musiała A, Szymczak A, Olczyk E, Augustyniak-Bartosik H, Miśkowiec-Wiśniewska I, Manitius J, Pondel J, Jędrzejak K, Nowańska K, Nowak Ł, Szymczak M, Durlik M, Dorota S, Nieszporek T, Heleniak Z, Jonsson A, Blom AL, Rogland B, Wallquist C, Vargas D, Dimény E, Sundelin F, Uhlin F, Welander G, Hernandez IB, Gröntoft KC, Stendahl M, Svensson M, Evans M, Heimburger O, Kashioulis P, Melander S, Almquist T, Jensen U, Woodman A, McKeever A, Ullah A, McLaren B, Harron C, Barrett C, O'Toole C, Summersgill C, Geddes C, Glowski D, McGlynn D, Sands D, Caskey F, Roy G, Hirst G, King H, McNally H, Masri-Senghor H, Murtagh H, Rayner H, Turner J, Wilcox J, Berdeprado J, Wong J, Banda J, Jones K, Haydock L, Wilkinson L, Carmody M, Weetman M, Joinson M, Dutton M, Matthews M, Morgan N, Bleakley N, Cockwell P, Roderick P, Mason P, Kalra P, Sajith R, Chapman S, Navjee S, Crosbie S, Brown S, Tickle S, Mathavakkannan S, Kuan Y. Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study. Clin Kidney J 2021; 15:786-797. [PMID: 35371440 PMCID: PMC8967670 DOI: 10.1093/ckj/sfab261] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was –0.12 mL/min/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03–1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.
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Affiliation(s)
| | - Nicholas C Chesnaye
- ERA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Robbert Schouten
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands
| | - Wieneke M Michels
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marie Evans
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olof Heimburger
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Fergus J Caskey
- Renal Unit, Southmead Hospital, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Massy ZA, Chesnaye NC, Larabi IA, Dekker FW, Evans M, Caskey FJ, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Jager KJ, Alvarez JC, Schneider A, Torp A, Iwig B, Perras B, Marx C, Drechsler C, Blaser C, Wanner C, Emde C, Krieter D, Fuchs D, Irmler E, Platen E, Schmidt-Gürtler H, Schlee H, Naujoks H, Schlee I, Cäsar S, Beige J, Röthele J, Mazur J, Hahn K, Blouin K, Neumeier K, Anding-Rost K, Schramm L, Hopf M, Wuttke N, Frischmuth N, Ichtiaris P, Kirste P, Schulz P, Aign S, Biribauer S, Manan S, Röser S, Heidenreich S, Palm S, Schwedler S, Delrieux S, Renker S, Schättel S, Stephan T, Schmiedeke T, Weinreich T, Leimbach T, Stövesand T, Bahner U, Seeger W, Cupisti A, Sagliocca A, Ferraro A, Mele A, Naticchia A, Còsaro A, Ranghino A, Stucchi A, Pignataro A, De Blasio A, Pani A, Tsalouichos A, Bellasi A, Di Iorio BR, Butti A, Abaterusso C, Somma C, D'alessandro C, Torino C, Zullo C, Pozzi C, Bergamo D, Ciurlino D, Motta D, Russo D, Favaro E, Vigotti F, Ansali F, Conte F, Cianciotta F, Giacchino F, Cappellaio F, Pizzarelli F, Greco G, Porto G, Bigatti G, Marinangeli G, Cabiddu G, Fumagalli G, Caloro G, Piccoli G, Capasso G, Gambaro G, Tognarelli G, Bonforte G, Conte G, Toscano G, Del Rosso G, Capizzi I, Baragetti I, Oldrizzi L, Gesualdo L, Biancone L, Magnano M, Ricardi M, Di Bari M, Laudato M, Sirico ML, Ferraresi M, Provenzano M, Malaguti M, Palmieri N, Murrone P, Cirillo P, Dattolo P, Acampora P, Nigro R, Boero R, Scarpioni R, Sicoli R, Malandra R, Savoldi S, Bertoli S, Borrelli S, Maxia S, Maffei S, Mangano S, Cicchetti T, Rappa T, Palazzo V, De Simone W, Schrander A, van Dam B, Siegert C, Gaillard C, Beerenhout C, Verburgh C, Janmaat C, Hoogeveen E, Hoorn E, Dekker F, Boots J, Boom H, Eijgenraam JW, Kooman J, Rotmans J, Jager K, Vogt L, Raasveld M, Vervloet M, van Buren M, van Diepen M, Chesnaye N, Leurs P, Voskamp P, Blankestijn P, van Esch S, Boorsma S, Berger S, Konings C, Aydin Z, Musiała A, Szymczak A, Olczyk E, Augustyniak-Bartosik H, Miśkowiec-Wiśniewska I, Manitius J, Pondel J, Jędrzejak K, Nowańska K, Nowak Ł, Szymczak M, Durlik M, Dorota S, Nieszporek T, Heleniak Z, Jonsson A, Blom AL, Rogland B, Wallquist C, Vargas D, Dimény E, Sundelin F, Uhlin F, Welander G, Hernandez IB, Gröntoft KC, Stendahl M, Svensson M, Evans M, Heimburger O, Kashioulis P, Melander S, Almquist T, Jensen U, Woodman A, McKeever A, Ullah A, McLaren B, Harron C, Barrett C, O'Toole C, Summersgill C, Geddes C, Glowski D, McGlynn D, Sands D, Caskey F, Roy G, Hirst G, King H, McNally H, Masri-Senghor H, Murtagh H, Rayner H, Turner J, Wilcox J, Berdeprado J, Wong J, Banda J, Jones K, Haydock L, Wilkinson L, Carmody M, Weetman M, Joinson M, Dutton M, Matthews M, Morgan N, Bleakley N, Cockwell P, Roderick P, Mason P, Kalra P, Sajith R, Chapman S, Navjee S, Crosbie S, Brown S, Tickle S, Mathavakkannan S, Kuan Y. The relationship between uremic toxins and symptoms in older men and women with advanced chronic kidney disease. Clin Kidney J 2021; 15:798-807. [PMID: 35371454 PMCID: PMC8967681 DOI: 10.1093/ckj/sfab262] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing. Results Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women. Conclusion Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.
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Affiliation(s)
- Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team5, France
- University Versailles-Saint Quentin, University Paris-Saclay, Villejuif 91190, France
- Department of Nephrology, CHU Ambroise Paré, APHP, 92104 Boulogne Billancourt Cedex, France
| | - Nicholas C Chesnaye
- ERA Registry, Dept of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research Institute, Amsterdam, The Netherlands
| | - Islam Amine Larabi
- Laboratory of Pharmacology and Toxicology, CHU, Raymond Poincare, Garches, and INSERM U‑1173, UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Evans
- Renal unit, department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University hospital, Stockholm, Sweden
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Claudia Torino
- IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Gaetana Porto
- G.O.M., Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Dept of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA Registry, Dept of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research Institute, Amsterdam, The Netherlands
| | - Jean Claude Alvarez
- Laboratory of Pharmacology and Toxicology, CHU, Raymond Poincare, Garches, and INSERM U‑1173, UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Sciascia S, Aprà F, Baffa A, Baldovino S, Boaro D, Boero R, Bonora S, Calcagno A, Cecchi I, Cinnirella G, Converso M, Cozzi M, Crosasso P, De Iaco F, Di Perri G, Eandi M, Fenoglio R, Giusti M, Imperiale D, Imperiale G, Livigni S, Manno E, Massara C, Milone V, Natale G, Navarra M, Oddone V, Osella S, Piccioni P, Radin M, Roccatello D, Rossi D. Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in patients with severe COVID-19. Clin Exp Rheumatol 2020; 38:529-532. [PMID: 32359035] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES No agent has yet been proven to be effective for the treatment of patients with severe COVID-19. METHODS We conducted a pilot prospective open, single-arm multicentre study on off-label use of tocilizumab (TCZ) involving 63 hospitalised adult patients (56 males, age 62.6±12.5) with severe COVID-19. Clinical and laboratory parameters were prospectively collected at baseline, day 1, 2, 7 and 14. No moderate-to-severe adverse events attributable to TCZ were recorded. RESULTS We observed a significant improvement in the levels of ferritin, C-reactive protein, D-dimer. The ratio of the partial pressure of oxygen (Pa02) to the fraction of inspired oxygen (Fi02) improved (mean±SD Pa02/Fi02 at admission: 152±53; at day 7: 283.73±115.9, at day 14: 302.2±126, p<0.05). The overall mortality was 11%; D-dimer level at baseline, but not IL-6 levels were predictors of mortality. TCZ administration within 6 days from admission in the hospital was associated with an increased likelihood of survival (HR 2.2 95%CI 1.3-6.7, p<0.05). CONCLUSIONS In hospitalised adult patients with severe COVID-19, TCZ could be a safe option. An improvement in respiratory and laboratory parameters was observed. Future controlled trials in patients with severe illness are urgently needed to confirm the definite benefit with IL-6 target therapy.
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Affiliation(s)
- Savino Sciascia
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | - Alessandra Baffa
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | - Simone Baldovino
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | | | - Irene Cecchi
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | - Martina Cozzi
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | | | - Roberta Fenoglio
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | | | | | - Carlo Massara
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | - Valentina Oddone
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | - Massimo Radin
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | - Dario Roccatello
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy.
| | - Daniela Rossi
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
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Affiliation(s)
- R. Boero
- Nephrology and Diarysis Unit S. Giovanni Hospital, Turin, Italy
| | - F. Quarello
- Nephrology and Diarysis Unit S. Giovanni Hospital, Turin, Italy
| | - P. Belardi
- Nephrology and Diarysis Unit S. Giovanni Hospital, Turin, Italy
| | - G. Piccoli
- Nephrology and Diarysis Unit S. Giovanni Hospital, Turin, Italy
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Coppo R, D'Arrigo G, Tripepi G, Russo ML, Roberts ISD, Bellur S, Cattran D, Cook TH, Feehally J, Tesar V, Maixnerova D, Peruzzi L, Amore A, Lundberg S, Di Palma AM, Gesualdo L, Emma F, Rollino C, Praga M, Biancone L, Pani A, Feriozzi S, Polci R, Barratt J, Del Vecchio L, Locatelli F, Pierucci A, Caliskan Y, Perkowska-Ptasinska A, Durlik M, Moggia E, Ballarin JC, Wetzels JFM, Goumenos D, Papasotiriou M, Galesic K, Toric L, Papagianni A, Stangou M, Benozzi L, Cusinato S, Berg U, Topaloglu R, Maggio M, Ots-Rosenberg M, D’Amico M, Geddes C, Balafa O, Quaglia M, Cravero R, Lino Cirami C, Fellstrom B, Floege J, Egido J, Mallamaci F, Zoccali C, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, Coppo R, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, Feehally J, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels JFM, Peters H, Berg U, Carvalho F, da Costa Ferreira AC, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Papastirou M, Galesic K, Toric L, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Rauen T, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders MEJ, Boria Grinyo JM, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Roszkowska-Blaim M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma AM, Ferrario F, Gutiérrez E, Asunis AM, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, GalesicLjubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene HJ, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update. Nephrol Dial Transplant 2018; 35:1002-1009. [DOI: 10.1093/ndt/gfy302] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up.
Methods
In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)].
Results
In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%).
Conclusion
Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Turin, Piemonte, Italy
| | | | | | | | | | - Shubha Bellur
- Cellular Pathology, Oxford University Hospital, Oxford, UK
| | | | | | - John Feehally
- Department of Nephrology, Leicester General Hospital, Leicester, UK
| | - Vladimir Tesar
- Nephrology, General University Hospital, Prague, Czech Republic
| | - Dita Maixnerova
- Nephrology, General University Hospital, Prague, Czech Republic
| | - Licia Peruzzi
- Nephrology, Regina Margherita Hospital, Turin, Italy
| | | | - Sigrid Lundberg
- Department of Nephrology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Francesco Emma
- Department of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy
| | | | - Manuel Praga
- Department of Nephrology, H12Octubre, Madrid, Spain
| | | | | | | | - Rosaria Polci
- Department of Nephrology, Belcolle Hospital, Viterbo, Italy
| | - Jonathan Barratt
- Department of Nephrology, Leicester General Hospital, Leicester, UK
| | | | | | | | | | | | - Magdalena Durlik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Jack F M Wetzels
- Department of Nephrology and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dimitris Goumenos
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | - Marios Papasotiriou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | | | - Luka Toric
- Department of Nephrology, Dubrava University, Zagreb, Croatia
| | - Aikaterini Papagianni
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Stangou
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Ulla Berg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Huddinge, Sweden
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Milena Maggio
- Department of Nephrology, Hospital Maggiore di Lodi, Lodi, Italy
| | | | | | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Olga Balafa
- Department of Nephrology, Medical School University of Ioannina, Ioannina, Greece
| | - Marco Quaglia
- Department of Nephrology, Maggiore della Carità Hospital, Piem, Onte Orientale University, Novara, Italy
| | | | | | | | - Jürgen Floege
- Division of Nephrology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jesus Egido
- Department of Nephrology, Fundacion Jimenez Diaz, CIBERDEM, Madrid, Spain
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Motta D, Airoldi A, Bainotti S, Burdese M, Campo A, Costantini L, Cravero R, Mesiano P, Piccoli GB, Randone O, Serra A, Vio P, Boero R. [Renal Infarction: multicentric cases in Piedmont]. G Ital Nefrol 2018; 35:2018-vol3-11. [PMID: 29786189] [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: 06/08/2023]
Abstract
UNLABELLED We describe factors associated to renal infarction, clinical, instrumental and laboratoristic features, and therapeutic strategies too. This is an observational, review and polycentric study of cases in Nephrologic Units in Piedmont during 2013-2015, with diagnosis of renal infarction by Computed Tomography Angiography (CTA). We collected 48 cases (25 M, age 57±16i; 23 F age 70±18, p = 0.007), subdivided in 3 groups based on etiology: group 1: cardio-embolic (n=19) ; group 2: coagulation abnormalities (n= 9); group 3: other causes or idiopathic (n=20). Median time from symptoms to diagnosis, known only in 38 cases, was 2 days (range 2 hours- 8 days). Symptoms of clinical presentation were: fever (67%), arterial hypertension (58%), abdominal o lumbar pain (54%), nausea/vomiting (58%), neurological symptoms (12%), gross hematuria (10%). LDH were increased (>530 UI/ml) in 96% of cases (45 cases out of 47), PCR (>0.5 mg/dl) in 94% of cases (45 out of 48), and eGFR <60 ml/min in 56% of cases (27 out of 48). Comparison of the various characteristics of the three groups shows: significantly older age (p=0.0001) in group 1 (76±12 years) vs group 2 (54±17 years) and group 3 (56±17 years); significantly more frequent cigarette smoking (p = 0.01) in group 2 (67%; 5 cases out of 9) and group 3 (60%; 12 cases out of 20) than group 1 (17%). No case has been subjected to endovascular thrombolysis. In 40 out of 48 cases, anticoagulant therapy was performed after diagnosis: in 12 (32%) cases no treatment, in 12 cases (30%) heparin, in 8 cases (20%) low molecular weight heparin, in 4 cases (10%) oral anticoagulants, in 3 cases fondaparinux (7%), in 1 case (2%) dermatan sulfate. CONCLUSIONS Although some characteristics may guide the diagnosis, latency between onset and diagnosis is still moderately high and is likely to affect timely therapy.
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Affiliation(s)
| | | | | | - Manuel Burdese
- S.C. Nefrologia e Dialisi, Città della Salute e della Scienza, Torino
| | | | | | | | - Paola Mesiano
- S.C. Nefrologia e Dialisi, San Giovanni Bosco, Torino
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9
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Abstract
A case of splenic large B-cell lymphoma with hemophagocytic syndrome is reported. The difficulties of diagnosis are emphasized especially when peripheral lymph nodes or bone marrow lymphomatous infiltration are not present. Diagnostic criteria for hemophagocytic syndrome and their relationship with the pathogenesis of the disease are also stressed.
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Affiliation(s)
- G Büchi
- Divisione di Medicina Interna, Ospedale Civile di Ivrea, Italy
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10
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Mariano F, Pozzato M, Inguaggiato P, Guarena C, Turello E, Manes M, David P, Berutti S, Consiglio V, Amore A, Campo A, Marino A, Berto M, Carpani P, Calabrese G, Gherzi M, Stramignoni E, Martina G, Serra A, Comune L, Roscini E, Marciello A, Todini V, Vio P, Filiberti O, Boero R, Cantaluppi V. Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units: A Five-Million Population-Based Study in the North-West of Italy. Blood Purif 2017; 44:198-205. [PMID: 28668963 DOI: 10.1159/000471917] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/21/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT). METHODS Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases. RESULTS One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria. CONCLUSION Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=471917.
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Affiliation(s)
- Filippo Mariano
- Department of General and Specialist Medicine, Nephrology, Dialysis and Transplantation U, CTO Hospital, Torino, Italy
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11
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Motta D, Cesano G, Pignataro A, Boero R. [Severe hyperkalemia in patients referred to an emergency departement: the role of antialdosterone drugs and of renin-angiotensin system blockers]. G Ital Nefrol 2017; 34:gin/00250.11. [PMID: 28177101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We analyzed the clinical features and the factors associated with the presence of hyperkalemia (serum potassium >5.3 mmol/L) in a cohort of patients presenting to an Emergency Department. A total of 168 cases were observed (89 males and 79 females), mean age 77.512 years. Fifty-six patients were diabetics (33.3%), 51 patients had chronic kidney disease (30%) and 36 patients with cardiac failure (21.4%). Sixty-nine patients (41%) were treated with RAS-blockers (ACE-I n = 50; ARBs, n = 19). 65 subjects were taking loop diuretics (39%), 17 (10%) thiazides. Thirty-one (18%) were assuming antialdosterone drugs; 16 (52%) out of these had a positive history of heart failure and 14 (41%) had a positive history of chronic kidney disease. In 85 cases (51%) patients were receiving an ACE/ARB or an antialdosterone drug. In 125 patients (74%) eGFR at presentation was <60 ml/min/1.73 m2. Serum potassium values were significantly higher in patients treated with both ACE/ARB and antialdosterone drugs. In 20 cases (12%) serum potassium was 6.5 mmol/L; these patients assumed antialdosterone drugs more frequently, alone and mostly in association with ACE-I/ARBs (65% vs 7%; p<0.0001). The simultaneous assumption of ACE-I/ARBs and antialdosterone drugs emerges as the major cause of severe hyperkalemia in our cases, thus confirming the warnings about this association in the presence of advanced age and reduced glomerular filtration rate.
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12
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Barbour SJ, Espino-Hernandez G, Reich HN, Coppo R, Roberts IS, Feehally J, Herzenberg AM, Cattran DC, Bavbek N, Cook T, Troyanov S, Alpers C, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn J, D’Agati V, D’Amico G, Emancipator S, Emmal F, Ferrario F, Fervenza F, Florquin S, Fogo A, Geddes C, Groene H, Haas M, Hill P, Hogg R, Hsu S, Hunley T, Hladunewich M, Jennette C, Joh K, Julian B, Kawamura T, Lai F, Leung C, Li L, Li P, Liu Z, Massat A, Mackinnon B, Mezzano S, Schena F, Tomino Y, Walker P, Wang H, Weening J, Yoshikawa N, Zhang H, Coppo R, Troyanov S, Cattran D, Cook H, Feehally J, Roberts I, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, RC, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, JF, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels J, Peters H, Berg U, Carvalho F, da Costa Ferreira A, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Kalliakmani P, Gerolymos M, Galesic K, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders M, Boria Grinyo J, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Bellur S, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma A, Ferrario F, Gutiérrez E, Asunis A, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, Galesic Ljubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene H, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. The MEST score provides earlier risk prediction in lgA nephropathy. Kidney Int 2016; 89:167-75. [DOI: 10.1038/ki.2015.322] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 01/12/2023]
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13
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Quarello F, Boero R, Martina G, Forneris G, Piccoli GB, Bonello F, Iadarola GM, Beltrame G, Formica M, Piccoli G. Cardiovascular disease in elderly dialysis patients. Contrib Nephrol 2015; 106:84-9. [PMID: 8174383 DOI: 10.1159/000422929] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- F Quarello
- Nephrology and Dialysis Unit, G. Bosco Hospital, Torino, Italy
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14
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Quarello F, Piccoli GB, Magistroni P, Cavalli PL, Cavagnino A, Salomone M, Boero R, Funaro L, Marciello A, Ferro M, Piccoli G. Arterial hypertension and mortality in dialysis patients. RPDT Working Group. Contrib Nephrol 2015; 119:141-6. [PMID: 8783605 DOI: 10.1159/000425464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- F Quarello
- Nephro-Urology Institute of the University of Torino, Italy
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15
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Piccoli G, Quarello F, Boero R, Pia L, Verzetti G, Pacitti A, Coppo R, Ghezzi PM, Mirone A. Experience in the computer handling of clinical data for dialysis and transplantation units: an Italian regional (Piedmont) registry. Contrib Nephrol 2015; 48:13-23. [PMID: 3912108 DOI: 10.1159/000411861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Giacchino F, Piccoli G, Colla L, Fenoglio R, Marazzi F, Amore A, Rollino C, Stratta P, Vella Maria C, Deluca A, Boero R, Chiarinotti D, Licata C, Cravero R, Bainotti S, Manes M, Marcuccio C, Brezzi B, Filippo M, Pignone E, Reinero R, Radin E, Tamagnone M. [Acute pielonephritis and renal abscesses in Piedmont and Aosta Valley]. G Ital Nefrol 2014; 31:gin/00194.10. [PMID: 25098465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Piedmont Group of Clinical Nephrology compared the activity of 18 nephrology centers in Piedmont and Aosta Valley as regards acute pielonephritis (APN). Data from more than 500 cases per year of APN were examined. The microbial spectrum of APN consists mainly of Escherichia coli and Klebsiella pneumoniae. Diagnosis was based on both clinical and radiological criteria in most of the centers (computed tomography-CT o Magnetic Resonance Imaging-MRI). In four centers diagnosis was made with the radiological criteria and in one center only with the clinical features. CT and MRI were performed in about 47% and 44% of cases respectively. Urine culture was positive in 22 up to 100% of cases. The most commonly used antibiotics were fluoroquinolones (ciprofloxacin or levofloxacin) and ceftriaxone (50% of centers) or amoxicillin/clavulanic acid (25% of centers). In 75% of the centers, patients received a combination of two antibiotics (aminoglycoside in 22% of them ). In 72% of the centers, almost 50% of the patients were re-examined, while 38.8% of centers re-examined all the patients. Renal ultrasound was inappropriate to identify abscesses. The mean of patients in whom renal abscesses were detected by CT or MRI was 18.2%. The analysis shows a high variability in the way of diagnosing and treating APN in Piedmont and Aosta Valley regions. This suggests that even if APN is a frequent pathological condition, practical recommendations are required.
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17
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Haller M, Van Biesen W, Webster AC, Vanholder R, Nagler EV, Lee JE, Kim SK, Park SK, Yun GY, Choi HY, Ha SK, Park HC, Hernandez-Sevillano B, Rodriguez JR, Perez del Valle K, de Lorenzo A, Salas P, Bienvenido M, Sanchez-Heras M, Basterrechea MA, Tallon S, de Arriba G, Greenberg A, Verbalis J, Burst V, Haymann JP, Poch E, Chiodo J, Nagler EV, Vanmassenhove J, van der Veer SN, Nistor I, Van Biesen W, Webster AC, Vanholder R, Pignataro A, Alfieri V, Cesano G, Timbaldi M, Torta E, Boero R, Nagler EV, Haller MC, Van Biesen W, Vanholder R, Webster AC, Cucchiari D, Podesta M, Merizzoli E, Angelini C, Badalamenti S, Alves MT, Moyses RM, Jorgetti V, Heilberg I, Menon V, Lhotta K, Muendlein A, Meusburger E, Zitt E, Bijarnia R, Pasch A, Hwang SW, Lee CH, Kim GH, Leckstrom D, Pereira C, Bultitude M, McGrath A, Goldsmith DJ, Vasquez D, Fernandez B, Palomo S, Aller C, Gordillo R, Perez V, Bustamante J, Coca A, Vitale C, Bagnis C, Tricerri A, Gallo L, Dutto F, Migliardi M, Marangella M, Outerelo C, Figueiredo P, Freitas J, Teixeira Costa F, Ramos A, Rambod M, Melikterminas E, Atallah H, Saadi M, Connery S, Mulla Z, Tolouian R, Cristofaro R, Masola V, Ceol M, Priante G, Familiari A, Gambaro G, Anglani F. Acid-base / electrolytes / nephrolithiasis. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Neild GH, Torta E, Clari R, Boero R. Urine spoke well before the patient. Clin Kidney J 2012; 5:77. [PMID: 26069758 PMCID: PMC4400461 DOI: 10.1093/ndtplus/sfr169] [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: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 12/02/2022] Open
Affiliation(s)
- G H Neild
- Nephrology and Dialysis Unit, Ospedale Martini, Torino, Italy
| | - Elisa Torta
- Nephrology and Dialysis Unit, Ospedale Martini, Torino, Italy
| | - Roberta Clari
- Nephrology and Dialysis Unit, Ospedale Martini, Torino, Italy
| | - Roberto Boero
- Nephrology and Dialysis Unit, Ospedale Martini, Torino, Italy
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19
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Forneris G, Boero R, Massara C, Quarello F. [Immigrants and dialysis: a survey in Piedmont]. G Ital Nefrol 2011; 28:314-318. [PMID: 21626500] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The number of immigrants has been rapidly increasing in Italy in the last decade, with potentially profound effects on the national health care system. Yet, few data are available on the clinical and demographic features of these subjects, or on their need for nephrological care and dialysis treatment. A survey was conducted in 19 dialysis facilities of Piedmont (a northwestern Italian region) about immigrants on chronic dialysis treatment. Data on native country, administrative position, clinical and dialysis aspects were anonymously collected. Overall, 93 immigrant dialysis patients coming from 24 foreign countries were registered. Most of them were young (mean age 46∓14 years) and on extracorporeal treatment (87%); late referral (38%) or starting dialysis in emergency (17%) were common modalities of presentation. Glomerular (33%) or unknown (31%) nephropathies were the most representative causes of end stage renal disease. No difference in incidence of HCV, HBV and HIV compared with native Italian patients was observed. Notably, more than 50% of the immigrant patients had low-level knowledge of Italian. As regards administrative position, 69% were regular foreign citizens, 19% were temporary foreign workers, and 9% had a residence permit. Our survey confirms the existence of a young immigrant population on dialysis in Piedmont, whose social and relational problems are more challenging than clinical aspects and call for new organizational models to manage this growing population on dialysis.
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Affiliation(s)
- Giacomo Forneris
- S.C. Nefrologia e Dialisi, Ospedale S. Giovanni Bosco, Torino, Italy.
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20
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Quarello F, Boero R, Guarena C, Rosati C, Deabate MC, Fidelio T, Piccoli G. Red Blood Cell Na +, K + Pump Activity in Patients on Hemofiltration. Blood Purif 2008. [DOI: 10.1159/000169324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Boero R, Borsa S, Guerzoni V. [Antihypertensive therapy and renoprotection: do we really need to block the renin-angiotension system?]. G Ital Nefrol 2007; 24:396-408. [PMID: 17886209] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Recent studies questioned the existence of a specific renoprotective effects of ACE-inhibitors (ACE-i) and angiotensin receptor blockers (ARBs) besides their blood pressure lowering effect. In the ALLHAT study patients were randomly assigned to receive chlorthalidone, amlodipine and lisinopril. Results showed that, even in patients with reduced GFR, neither lisinopril nor amlodipine was superior to chlorthalidone in reducing the rate of development of ESRD or a 50% or greater decrement in GFR. Because of inclusion criteria the ALLHAT population was selected as at low risk for renal outcomes. Moreover, over 50% of the patients who were randomized to lisinopril either never received the medication or received the lower possible dose. Casas et al selected RCT comparing ACE-i and ARBs with other regimens. They concluded that ACE-i and ARBs are not more renoprotective that can be explained by lowering of blood pressure (BP) in diabetic nephropathy, while in non diabetic kidney disease a blood pressure independent renoprotective effect is uncertain. They made a very heterogeneous selection of trials that was dominated by the ALLHAT study; the analysis was not based on individual patient data. The Benedict Study showed that in hypertensive, normoalbuminuric patients with type 2 diabetes, BP reduction and ACE-i therapy both independently may prevent microalbuminuria. ACE-i therapy is particularly effective when BP is poorly controlled. We conclude that the recommendation of the Guidelines to use ACE-i and/or ARBs as first-line antihypertensive drugs for renoprotection in patients with diabetic and non diabetic kidney disease is still valid.
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Affiliation(s)
- R Boero
- S.C. Nefrologia e Dialisi, Ospedale San Giovanni Bosco, Torino - Italy
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22
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Abstract
Hypertension is a common manifestation of antiphospholipid syndrome (APS). Antiphospholipid antibodies (aPL) have been described in patients with hypertension secondary to renal artery stenosis (RAS). Twenty-six patients with RAS and 25 patients with severe essential hypertension (diastolic blood pressure > 110 mmHg or > or = 3 hypertensive drugs) were studied and compared to 61 age- and sex-matched healthy subjects. Serum samples were tested for lupus anticoagulant (LA), anticardiolipin (aCL) IgG and IgM, antiprothrombin (aPT) IgG and IgM, anti-beta2glycoprotein 1 (abeta2GP1) IgG and IgM. aPL were negative in all patients with RAS. Two patients with essential hypertension had positive aPL (8%) (LA in one patient confirmed in a second assay and abeta2GP1-IgG in the other patient confirmed one year later together with aCL IgG positivity). Among healthy subjects, one case (1.6%) was found to be positive for LA, aCL IgM, abeta2GP1 IgM, aPT IgG, aPT IgM. In conclusion, the association between RAS and aPL seems to be casual rather than an expression of an elective thrombotic localization ofAPS. The positive finding of aPL in 8% of patients with essential hypertension, a frequency higher than that of the control population, deserves further studies in larger series to better explore the relationship between aPL and hypertension.
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Affiliation(s)
- C Rollino
- Division of Nephrology, Ospedale San G. Bosco, Turin, Italy.
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23
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Contu L, Orrù S, Carcassi C, Giuressi E, Mulargia M, Cappai L, Valentini D, Lai S, Boero R, Masala MV, Aste N, Biggio P, Cottoni F, Cerimele D. A psoriasis vulgaris protective gene maps close to the HLA-C locus on the EH18.2-extended haplotype. ACTA ACUST UNITED AC 2004; 64:43-57. [PMID: 15191522 DOI: 10.1111/j.1399-0039.2004.00235.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We determined the molecular haplotypes of the HLA-A, HLA-C and HLA-B loci and the MHC class I-B-related (MIB) microsatellite in 179 unrelated psoriatic patients (72 familial cases) and in 120 controls. The HLA-A*3002-Cw*0501-B*1801-MIB1 haplotype showed a strong negative association with psoriasis vulgaris (PV) and in particular with familial PV, revealing the presence of a PV-protective gene. Analysis of association and linkage disequilibrium of the single alleles and the various two-three-four-locus segments of this haplotype indicated the presence of a protective gene telomeric to the HLA-C locus. This finding was confirmed in 13 informative multiplex PV families, in which at least one parent carried the EH18.2 haplotype. In two families, an affected sibling presented HLA-A/C recombination on the EH18.2 haplotype. A study of 12 polymorphic microsatellites in all members of the informative families, 145 PV patients, 120 controls and 32 EH18.2 homozygous healthy individuals demonstrated that the protection conferred by the EH18.2 haplotype lies within a 170 kb interval between the C143 and C244 loci, most probably in a 60 kb segment between the C132 and C244 loci.
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Affiliation(s)
- L Contu
- Centro Regionale Trapianti, P O R Binaghi, ASL n. 8, Cagliari, Italy.
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24
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Rollino C, Mazzucco G, Boero R, Beltrame G, Quattrocchio G, Ferro M, Milan M, Berruti S, Quarello F. Is it possible to diagnose primary anti-phospholipid syndrome (PAPS) on the basis of renal thrombotic microangiopathy (PAPS nephropathy) in the absence of other thrombotic process? Ren Fail 2004; 25:1043-9. [PMID: 14669864 DOI: 10.1081/jdi-120026040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The kidneys are a major target of PAPS. The histologic lesions of PAPS nephropathy are vascular; among them thrombotic microangiopathy (TMA) is the most characteristic. It is still not clear in the literature whether the nephropathy can be the unique manifestation of PAPS in the absence of other thrombotic processes; that is: do the renal microthrombotic lesions allow to make the diagnosis of PAPS in presence of anti-phospholipid antibodies (APA)? With this purpose we present three clinical cases. The first patient had severe hypertension C4 hypocomplementemia, thrombocytopenia, and mitralic valve insufficiency. LAC and anti-cardiolipin antibodies at high titre were positive. The histologic picture was characterized by basement membrane reduplication and arteriolar mucoid degeneration, which are features of early phase of TMA. The second patient had severe hypertension. The detection of anti-cardiolipin antibodies was performed several times and resulted positive three times, four months after the diagnosis as well. The renal histologic features were consistent with late lesions of TMA. The third patient had severe hypertension, rapidly progressive renal failure, tricuspidal valve insufficiency and two positive anti-phospholipid antibodies determinations three weeks apart (in two occasions anti-cardiolipin and in one occasion LAC as well were found). The renal lesions were characteristic for TMA. In conclusion we think that patients with TMA and antiphospholipid antibodies can be considered affected by PAPS, as the thrombotic process is represented by thrombosis in preglomerular arterioles, which leads to TMA.
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Affiliation(s)
- Cristiana Rollino
- Department of Nephrology and Dialysis, San Giovanni Bosco Hospital, Turin, Italy.
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Boero R, Rollino C, Massara C, Berto IM, Perosa P, Vagelli G, Lanfranco G, Quarello F. The verapamil versus amlodipine in nondiabetic nephropathies treated with trandolapril (VVANNTT) study. Am J Kidney Dis 2003; 42:67-75. [PMID: 12830458 DOI: 10.1016/s0272-6386(03)00410-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We tested whether the combination of verapamil (V) or amlodipine (A) with trandolapril (T) affected proteinuria differently from T alone in patients with nondiabetic nephropathies. METHODS After T, 2 mg, in open conditions for 1 month, 69 patients were randomly assigned to be administered T, 2 mg, combined with V, 180 mg, plus a placebo or T, 2 mg, plus A, 5 mg, once a day in a double-blind fashion. Patients were followed up for 8 months. RESULTS Proteinuria diminished significantly after T treatment from mean protein excretion of 3,078 +/- 244 (SEM) to 2,537 +/- 204 mg/24 h (P = 0.018). In the randomized phase, there was a slight reduction in proteinuria in both groups without significant differences within and between treatments (T + V, protein from 2,335 +/- 233 to 2,124 +/- 247 mg/24 h; T + A, protein from 2,715 +/- 325 to 2,671 +/- 469 mg/24 h). The selectivity index (SI; calculated as the ratio of immunoglobulin G to albumin clearance) was slightly and not significantly reduced in patients treated with T plus V from a median of 0.20 (interquartile range, 0.13) to 0.16 (interquartile range, 0.15; P = not significant), whereas it significantly increased from 0.20 (interquartile range, 0.14) to 0.30 (interquartile range, 0.14; P = 0.0001) in patients treated with T plus A. Modifications in SI and serum creatinine levels at the end of the study from randomization were significantly directly correlated (r = 0.45; P = 0.001). The number of patients reporting adverse effects was significantly higher in the T plus A than T plus V group (63.8% versus 33.3%; P = 0.016). CONCLUSION In patients with nondiabetic proteinuric nephropathies treated with T, the combination of V or A does not significantly increase its antiproteinuric effect.
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Affiliation(s)
- Roberto Boero
- Nefrologia e Dialisi, Ospedale G. Bosco, Torino, Italy.
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Boero R, Prodi E, Elia F, Porta L, Martelli S, Ferraro L, Quarello F. How well are hypertension and albuminuria treated in type II diabetic patients? J Hum Hypertens 2003; 17:413-8. [PMID: 12764404 DOI: 10.1038/sj.jhh.1001568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to assess the management of both hypertension and micro/macroalbuminuria in a cohort of type II diabetic patients. In the first 6 months of the year 2000, 5815 diabetic patients were identified through prescriptions for antidiabetic drugs in our sanitary district (191 568 inhabitants). In all, 65% (3810) of these type II diabetic patients were also given prescriptions for antihypertensive drugs. A total of 400 diabetic patients were randomly selected and 171 entered the study (gender: 94/77 M/F; age: 66.6+/-8 years; diabetes duration: 12+/-9 years): 100 patients (group DT) were treated with antihypertensive drugs and 71 (group DU) were untreated. Blood pressure, urine albumin-to-creatinine ratio (ACR), and glycated haemoglobin were measured in the two groups. A total of 80% (57/71) of DU patients were hypertensive (BP>/=130/85 mmHg). Specifically, 24.4% had diastolic hypertension (BP>/=85 mmHg) and 79% systolic hypertension (BP>/=130 mmHg). Only 63% (100/157) of the hypertensive patients were treated with antihypertensive drugs (two drugs/patient on average, range 1-5). In addition, only 13% of the DT patients were adequately controlled (BP<130/85 mmHg), while the others had above target blood pressure levels (14%: 130-139/85-89 mmHg; 40%: 140-159/90-95 mmHg, and 33%>/=160/95 mmHg). Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) were included in the antihypertensive medical regimen in 70% of the DT patients (ACE-I: 62%; ARB: 8%; diuretics: 39%; dihydropyridine calcium antagonists: 38%; alpha-blockers: 20%, beta-blockers: 17%; clonidin: 8%; nondihydropyridine calcium antagonists: 5%). Only 33% of type II diabetic patients underwent a screening for microalbuminuria as assessed on clinical records. The same percentage of micro- and macroalbuminuric patients (13.5%) was observed in the DT group, whereas 25% micro vs 3% macro were found in the DU group. In all, 73% of microalbuminuric patients were not on ACE-I/ARB. Hypertensive type II diabetic patients were often left untreated and only a minority of those treated were optimally controlled. The importance of an elevated systolic pressure is underestimated and the number of antihypertensive drugs prescribed insufficient. Screening and treatment of albuminuria are inadequate.
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Affiliation(s)
- R Boero
- Nephrology and Dialysis Unit, San Giovanni Bosco Hospital, Turin, Italy.
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Campo A, Boero R, Stratta P, Quarello F. Selective stenting and the course of atherosclerotic renovascular nephropathy. J Nephrol 2002; 15:525-9. [PMID: 12455719] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2002] [Revised: 07/15/2002] [Accepted: 07/27/2002] [Indexed: 02/27/2023]
Abstract
BACKGROUND The effectiveness of percutaneous revascularisation (PTRA) in the treatment of atherosclerothic renovascular nephropathy (ARN), a leading cause of progressive renal failure, is still a matter of debate. METHODS we reviewed 52 patients submitted to selective stenting from 1991 to 2000 because of ARN, followed for a mean of 22.3 months before and 24.6 after the procedure, looking for complications, re-stenosis rates, blood pressure, renal function and survival. RESULTS Arterial patency was achieved in 97.1% of procedures (71.6% by stent deployment); complications occurred in 42% of patients, and re-stenoses in 17.3% of vessels, most often in those without a stent (31.6% vs 8.3%). No effect was detectable on hypertension and renal failure in the whole group, but in the subgroup without technical failure or early dialysis start PTRA reduced the creatinine clearance (BCRC) decline from 0.9 to 0.19 mL/min/month. At univariate analysis, BCRC outcome was better in bilateral or single kidney stenoses, proteinuria < 1 g/day, serum creatinine < 4 mg/dL and resistance index < 0.8. Survival was 68.9% at five years, with a mortality rate of 4.5/100 person-years. CONCLUSIONS Renal outcome of successful PTRA differs from case to case, but efficacy is substantial. Primary stenting in ostial stenosis and selection of patients based on prognostic factors seem likely to improve the effectiveness.
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Affiliation(s)
- Andrea Campo
- Renal Care Unit, S. Lazzaro Hospital, Alba, Italy.
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Rollino C, Boero R, Ferro M, Anglesio A, Vaudano GP, Cametti A, Borsa S, Beltrame G, Quattrocchio G, Quarello F. Acute pyelonephritis: analysis of 52 cases. Ren Fail 2002; 24:601-8. [PMID: 12380905 DOI: 10.1081/jdi-120013963] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute pyelonephritis (APN) is a frequent disease, but diagnostic approach, evolution into abscesses, and indication to hospitalization are still open problems. We have made a retrospective analysis of APN cases observed in our hospital. We identified 58 patients (pt) and selected 52 of these who presented fever and loin pain at the onset (31 were hospitalized in Nephrology and 21 in other units). Urine culture was positive in 11/48 cases (22.9%), blood cultures in 3/26 cases (11.5%) (Escherichia coli). Renal sonography was normal in 20/48 cases (41.6%) and suggestive for APN in 23/48 cases (47.9%). CT with contrast medium was normal in 9/28 cases (32.1%) and positive in 19/28 cases (67.8%), with evidence of unique or multiple hypodense areas; abscesses were found in 8 patients (28.5%). No statistically significant differences were found between patients with positive or negative CT as regards fever, leukocytosis, ESR, CRP, CRP at 20 days, urinary leukocytes, urine culture, duration of symptoms before hospitalization. Moreover no differences were found between patients with and without abscesses. CT was performed more frequently among patients hospitalized in Nephrology than among patients hospitalized in other services (24/31-77.4%-vs. 4/21-19%-, p = 0.05). NMR was abnormal in 6/9 cases. A radiographic documentation of APN was obtained in 61.53% of patients with clinical diagnosis of APN. Of these, only 18.7% had positive urine culture. In conclusion, our data suggest that demonstration of urine infection is not necessary for APN diagnosis, when clinical and/or radiologic diagnosis of APN has been made. Evolution into abscesses is frequent and not easily susceptible on clinical ground; for this reason we think it is advisable to perform CT or NMR systematically. Differences in clinical behavior between different units suggest the need for diagnostic guidelines.
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Affiliation(s)
- Cristiana Rollino
- Department of Nephrology and Dialysis, San Giovanni Bosco Hospital, Turin, Italy.
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Boero R, Prodi E, Borsa S, Berti V, Fiorio E, Ferraro L, Massara C, Quarello F. [Inadequate treatment and control of arterial hypertension in patients with type 2 diabetes mellitus]. G Ital Nefrol 2002; 19:413-8. [PMID: 12369043] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Aim of this study is to evaluate the treatment and control of arterial hypertension in patients with type 2 diabetes. METHODS We identified 5815 diabetic patients in our health-care district (191,568 inhabitants) through prescriptions for insulin and/or hypoglycaemic drugs in the first 6 months of 2000; 3810 of them (65%) also had prescriptions for antihypertensive drugs. We evaluated a randomly selected sample of 171 patients with type 2 diabetes, 100 of whom were receiving antihypertensive drugs (94 males and 77 females, mean age 66.6 +/- 8 years, mean diabetes duration 12+/-9 years). RESULTS Fifty-seven out of 71 patients not treated with antihypertensive drugs (80.3%) had a BP = 130/85 mmHg; 24.4% of them had a diastolic BP = 85 mmHg and 79% had a systolic BP = 130 mmHg. Thirteen out of 100 treated patients (13%) had a BP < 130/85 mmHg. Among the patients treated with antihypertensive drugs 36% received one drug, 36% two drugs and 28%=3 drugs; mean 1.98 +/- 0.9 drugs/patients. Among the patients treated with monotherapy 36.1% received ACE-inhibitors, 36.1% dihydropyridinic calcium-antagonists, 11.1% alpha-blockers, 11%, diuretics, 2.8% non-dihydropyridinic calcium-antagonists, and 2.8% angiotensin II antagonists. Patients treated with two antihypertensive drugs received more frequently an ACE-inhibitor plus a diuretic (31%) or an ACE-inhibitor plus an alpha-blocker (23%) or an ACE-inhibitor plus a dihydropyridinic calcium-antagonists (20%). A diuretic was used in 40% of the patients with two antihypertensive drugs and in 78% of those with >= 3 drugs. CONCLUSIONS Many hypertensive type 2 diabetic patients are left untreated and only a minority of those treated reach optimal blood pressure control. The importance of an elevated systolic pressure is underestimated, and the number of antihypertensive drugs prescribed is suboptimal.
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Affiliation(s)
- R Boero
- S.C. Nefrologia e Dialisi, Ospedale San Giovanni Bosco, Torino. robertoboero@tin.,it
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Boero R, Pignataro A, Quarello F. Salt intake and kidney disease. J Nephrol 2002; 15:225-9. [PMID: 12113591] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We have reviewed the role of salt intake in kidney diseases, particularly in relation to renal hemodynamics, renal excretion of proteins, renal morphological changes and progression of chronic renal failure. High salt intake may have detrimental effects on glomerular hemodynamics, inducing hyperfiltration and increasing the filtration fraction and glomerular pressure. This may be particularly important in elderly, obese, diabetic or black patients, who have a high prevalence of salt-sensitivity. Changes in salt intake may influence urinary excretion of proteins in patients with essential hypertension, or diabetic and non diabetic nephropathies. Moreover, high sodium intake may blunt the antiproteinuric effect of various drugs, including angiotensin-converting-enzyme inhibitors and calcium antagonists. Experimental studies show a direct tissue effect of salt on the kidney, independent of its ability to increase blood pressure, inducing hypertrophy, fibrosis and a decrease in glomerular basement membrane anionic sites. However, no firm conclusion can be drawn about the relationship between salt consumption and progression of chronic renal failure, because most information comes from conflicting, small, retrospective, observational studies. In conclusion, it would appear that restriction of sodium intake is an important preventive and therapeutic measure in patients with chronic renal diseases of various origin, or at risk of renal damage, such as hypertensive or diabetic patients.
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Affiliation(s)
- Roberto Boero
- Nephrology and Dialysis Unit, San Giovanni Bosco Hospital, Turin, Italy.
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Quattrocchio G, Rollino C, Beltrame G, Massara C, Guarena C, Mazzucco G, Sandrone M, Boero R, Quarello F. [Biopsy experience at the G. Bosco Hospital from 1996 to 1999]. MINERVA UROL NEFROL 2001; 53:81-6. [PMID: 11455316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Aim of this study was a retrospective analysis of the renal biopsies performed in our Division. METHODS Since January 1, 1996 to September 30, 1999 289 biopsies were performed on native kidneys, 90 patients were older than 65. RESULTS The most frequent nephropathy was IgA glomerulonephritis (IgAGN) (28%), followed by membranous glomerulonephritis (MGN) (11%). In patients older than 65, the most frequent was MGN (20%), followed by IgAGN (12.2%). The total complications were 84 (29.1%) (hematomas >3 cm 1%; blood transfusion: 1.4%). Complications were not related to age, blood pressure, renal function, clinical presentation, number of shots. In 217 patients, the results obtained with two different modalities were compared: manual system (needle size=15 gauge) and automatic system (18 gauge). No statistically significant differences were found as regards the number of shots for single biopsy, number of glomeruli and major complications (1.6% vs 1.3%), while minor complications were more frequent in the second group. CONCLUSIONS In conclusion, the number of renal biopsies performed in our Division has been increasing year after year. This trend can be partially explained by our wider indications to renal biopsy in elderly population (the data related to resident population showed the greatest prevalence of biopsies in patients 70 to 79 years old). Renal biopsy actually represents a safe examination even in elderly patients. From a technical point of view, on the basis of personal experience, 18 gauge acecut automatic needles seem to be preferred to other kind of devices.
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Affiliation(s)
- G Quattrocchio
- Divisione di Nefrologia e Dialisi, Università degli Studi, Turin, Italy
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Rollino C, Formica M, Minelli M, Boero R, Beltrame G, Bonello F, Pignataro A, Borsa S, Quarello F. Outcome of dialysis patients submitted to coronary revascularization. Ren Fail 2001; 22:605-11. [PMID: 11041292 DOI: 10.1081/jdi-100100901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cardiovascular disease accounts for almost half of the total mortality in patients with end stage renal disease (ESRD). It has recently been debated whether coronary revascularization has the same rate of risks and successes in this cohort of patients compared to patients without renal disease. Since 1991, 17 dialysis patients were submitted to coronary revascularization in our center. Seven patients were following peritoneal, 10 hemodialytic treatment. Four patients were submitted to percutaneous transluminal coronary angioplasty (PTCA) and 13 to surgical revascularization (CABG). In 2 patients the coronary lesion was unique, in the others stenosis of multiple vessels were found. Six patients were diabetic. The mean age at the onset of the coronary artery disease (CAD) was 57.17 +/- 11.6 years. The mean time elapsed from the onset of the CAD and the performance of the PTCA or CABG was 30.1 +/- 35.4 months. The mean time from beginning of dialysis treatment to revascularization was 48.2 +/- 39.6 months. Mean hemoglobin values were 9.7 +/- 1 g/dL, mean phosphorus values were 5.2 +/- 8.7 mg/dL, mean cholesterol values were 211 +/- 49.5 mg/dL. The procedure was technically successful in all patients. Mean survival was 25.09 +/- 28.12 months. Twelve patients died, 5 of whom within one month. Survival at one month was 70.5%, at 6 months 58.8%, at one year 52.9%, at 2 years 47%. There was neither significant difference patients submitted to PTCA and those submitted to CABG, nor between diabetic and non-diabetic patients. In conclusion, coronary revascularization in our experience is a high risk procedure in dialysis patients. The reasons for this could be the severe general conditions of these patients affected with diffuse vasculopathy and the long time elapsed since the onset of the ischemic cardiopathy. Thus, our results could suggest the opportunity of performing earlier screening of coronary situation and revascularization treatment in CAD dialysis patients.
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Affiliation(s)
- C Rollino
- Department of Nephrology and Cardiology, Giovanni Bosco Hospital, Turin, Italy
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Abstract
The aim of this work was to review evidence on the role of the sympathetic nervous system (SNS) in chronic renal failure (CRF). Three main points are discussed: 1) SNS and pathogenesis of arterial hypertension; 2) SNS and cardiovascular risk; 3) implication of SNS in arterial hypotension during hemodialysis. Several lines of evidence indicate the presence of a sympathetic hyperactivity in CRF, and its relationship with arterial hypertension. It is suggested that diseased kidneys send afferent nervous signals to central integrative sympathetic nuclei, thus contributing to the development and maintenance of arterial hypertension. The elimination of these impulses with nephrectomy could explain the concomitant reduction of blood pressure. Several experiments confirmed this hypothesis. Regarding SNS and cardiovascular risk, some data suggest that reduced heart rate variability identifies an increased risk for both all causes and sudden death, independently from other recognized risk factors. Symptomatic hypotension is a common problem during hemodialysis treatment, occurring in approximately 20-30% of all hemodialysis sessions and is accompanied by acute withdrawal of sympathetic activity, vasodilation and relative bradicardia. This reflex is thought to be evoked by vigorous contraction of a progressively empty left ventricle, activating cardiac mechanoceptors. This inhibits cardiovascular centers through vagal afferents, and overrides the stimulation by baroreceptor deactivation. Alternative explanations include cerebral ischemia and increased production of nitric oxide, which inhibit central sympathetic activity. It is hoped that therapies aimed at modulating sympathetic nerve activity in patients with CRF will ameliorate their prognosis and quality of life.
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Affiliation(s)
- R Boero
- Divisione di Nefrologia e Dialisi, Ospedale Giovanni Bosco, Torino, Italy.
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Boero R, Rollino C, Massara C, Vagelli G, Gonella M, Berto IM, Bajardi P, Perosa P, Malcangi U, Giorgi MP, Ghezzi PM, Borzumati M, Baroni AM, Cogno C, Triolo G, Angelini D, Antonelli A, Quarello F. Verapamil versus amlodipine in proteinuric non-diabetic nephropathies treated with trandolapril (VVANNTT study): design of a prospective randomized multicenter trial. J Nephrol 2001; 14:15-8. [PMID: 11281338] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Angiotensin converting enzyme inhibitors (ACEI) are the most effective antiproteinuric agents and should be used as first-line drugs in both diabetic and non-diabetic proteinuric nephropathies. The role of calcium channel blockers (CCB) is much more controversial. In diabetic patients verapamil and diltiazem seem more effective than dihydropyridines in reducing urinary protein excretion, and have additive effects with ACEI, but little is available on chronic treatment of non-diabetic nephropathies for non-dihydropyridine CCBs. To test whether the combination of verapamil 180 mg or amlodipine 5 mg with trandolapril 2 mg reduces urinary protein excretion more than trandolapril 2 mg alone, we planned a prospective, randomized, double-blind, multicenter trial. The secondary aims are to evaluate the effects of both treatments on the selectivity of proteinuria and check their safety. Consecutive patients aged between 18 and 70 years with non-diabetic proteinuria > or =2 g/24 h and plasma creatinine < 3 mg/dl or creatinine clearance > or = 20 ml/min are asked to participate. After a four-week run-in during which previous antihypertensive therapy is withdrawn, a single dose of trandolapril 2 mg is given once a day in open conditions for four weeks. At the end of this period patients are randomly assigned to receive once a day, in a double blind fashion, either trandolapril 2 mg and verapamil 180 mg [plus a placebo], or trandolapril 2 mg plus amlodipine 5 mg. They are monitored after one, two, five and eight months.
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Affiliation(s)
- R Boero
- Division of Nephrology and Dialysis, San Giovanni Bosco Hospital, Turin, Italy.
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Boero R, Borca M, Iadarola GM, Rollino C, Pignataro A, Alfieri V, Ballario R, Quarello F. [Acute kidney failure caused by cholesterol atheroembolism]. MINERVA UROL NEFROL 2000; 52:119-22. [PMID: 11227360] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND To describe the clinical aspects of renal failure due to cholesterol atheroembolism. METHODS An hospital based observational study on renal failure due to cholesterol atheroembolism was carried out. Twenty-two cases (19 males, mean age 68 yrs, range 53-83 yrs) were identified from January 1992 to September 1998. RESULTS Clinical symptoms were acute or rapidly progressive renal failure with blue toe and/or skin livedo reticularis in 13/22 cases (59%) and indolent progressive renal failure in 7/22 cases (32%). In 6/22 cases (27%) an abdominal organ involvement was evident; two (9%) had retinal cholesterol emboli, two (9%) peripheral and two (9%) central nervous system impairment. In 7 patients (32%) the cholesterol atheroembolism occurred spontaneously, while in 15 (68%) it followed invasive or interventional radiology (8 cases, 36%); cardiac or vascular surgery (4 cases, 18%); thrombolytic or anticoagulant therapy (3 cases, 14%). The time interval between the procedure at risk and the onset of symptoms or signs of cholesterol atheroembolism ranged between few hours to 60 days. Eleven patients (50%) required dialysis, which was then withheld in 4 cases (36%), owing to partial functional recovery after a median time of 30 days, ranging from 10 to 690 days. Median follow-up was 2.5 months (ranging from 2 days to 68 months), and eleven patients (50%) deceased. CONCLUSIONS Cholesterol atheroembolism is a cause of renal failure associated with high mortality rates; its prevention needs the skill of all physicians involved in the care of patients with severe atherosclerosis.
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Affiliation(s)
- R Boero
- Divisione di Nefrologia e Dialisi, A.S.L. 4, Ospedale Giovanni Bosco, Torino
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Boero R, Pignataro A, Rollino C, Quarello F. Do corticosteroids improve survival in acute renal failure due to cholesterol atheroembolism? Nephrol Dial Transplant 2000; 15:441. [PMID: 10692543 DOI: 10.1093/ndt/15.3.441] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boero R, Pignataro A, Bancale E, Campo A, Morelli E, Nigra M, Novarese M, Possamai D, Prodi E, Quarello F. [Metabolic effects of changes in dietary sodium intake in patients with essential hypertension]. MINERVA UROL NEFROL 2000; 52:13-6. [PMID: 11517825] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND To evaluate the metabolic effects of modification of sodium intake in patients with essential hypertension. METHODS Thirteen patients with essential hypertension (10 M, median age 51 yrs, range 21-64) followed in random order a low-sodium and a high-sodium diet (50 mmol Na/day vs 250 mmol/day for two weeks each). At the end of each diet an evaluation was made of 24 hour blood pressure (ABPM, Spacelabs 90207) and serum concentration of: glucose, total and HDL cholesterol, uric acid, lipoproteins A, B, Lp(a), total proteins, albumin. RESULTS Twenty-four hours systolic and diastolic BP were significantly higher at the end of high sodium diet than of low sodium diet [respectively 132 mmHg (120-161) vs 128 mmHg (109-150); p = 0.008 and 84 mmHg (71-99) vs 81 mmHg (70-95); p = 0.008)]. No significant variations were found as regards serum glucose and lipidic parameters between low and high sodium diets. Serum uric acid was significantly higher following low sodium diet [5.9 mg/dl (4.5-8) vs 4.6 mg/dl (3.4-6.5); p = 0.003)], as well as serum total proteins [7.2 g/dl (6.9-8.2) vs 7 g/dl (6.5-7.8); p = 0.027)]. A significant direct correlation was found between changes of uric acid and total proteins from low to high sodium diet (Spearman's rho = 0.57; p = 0.04). CONCLUSIONS In patients with essential hypertension a moderate dietary sodium restriction, able to reduce significantly 24 hours arterial pressure, does not worsen serum glucose nor lipids concentration.
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Affiliation(s)
- R Boero
- Divisione di Nefrologia e Dialisi, ASL 4, Ospedale Giovanni Bosco, Piazza Donatore di Sangue, 3, 10154 Torino.
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Zuccalà A, Zucchelli P, Campieri C, Esposti ED, Losito A, Timio M, Boero R. 3 R study: renal outcome in renal ischemia: revascularisation or medical treatment. J Nephrol 2000; 13:106-9. [PMID: 10858971] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Ischemic nephropathy refers to the kidney damage following stenosis or an obstructive lesion in the main kidney arteries. This disorder has been overlooked in the past and a more rational and specific use of clinical criteria, and the development of not very invasive techniques with a good diagnostic accuracy such as spiral CT angiography, NMR angiography and echo-colour-Doppler have improved our ability to identify these patients. It is therefore likely that, in the next few years, we will find ourselves treating an increasing number of patients with renovascular ischemic disorders. Transluminal angioplasty and, more recently, the use of endovascular stents, have led to a marked improvement in the treatment of stenoses and, together with vascular surgery, allow to treat almost all patients with this disorder. There is, however, a lack of prospective and controlled studies, which demonstrate the long term benefit of revascularization treatment, as compared with optimum conservative treatment in reducing cardiovascular mortality, cardiovascular events and preserving renal function. The Ischemic Nephropathy Study Group of the Italian Society of Nephrology has organized a prospective, controlled study over a period of three years, aimed at comparing the effect of revascularization versus medical therapy in 300 patients with renal artery stenosis, ranging between 50 and 90 per cent, who will be randomly assigned to the two treatments. End point will be cardiovascular mortality and morbidity and need for renal replacement therapy.
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Affiliation(s)
- A Zuccalà
- Ischemic Nephropathy and Renovascular Hypertension Study Group of the Italian Society of Nephrology, Bologna Malphighi
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Cocchi R, Degli Esposti E, Fabbri A, Lucatello A, Sturani A, Quarello F, Boero R, Bruno M, Dadone C, Favazza A, Scanziani R, Tommasi A, Giangrande A. Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study. Nephrol Dial Transplant 1999; 14:1536-40. [PMID: 10383021 DOI: 10.1093/ndt/14.6.1536] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The tenet that peritoneal dialysis is capable of either normalizing or improving blood pressure control in uraemic patients is based on outdated or monocentric experiences. Therefore, we assessed the prevalence of hypertension and the efficacy of antihypertensive therapy in a large, multicentric cohort of patients on peritoneal dialysis. METHODS Twenty seven out of the 50 centres belonging to the Italian Co-operative Peritoneal Dialysis Study Group took part in the study. The main patient selection criteria were: peritoneal dialysis therapy for at least 3 months and no peritonitis or changes in dialysis technique for at least 1 month. Clinical blood pressure was measured according to WHO/ISH guidelines. Ambulatory blood pressure monitoring was carried out using a SpaceLabs 90207 recorder. Hypertension was defined according to WHO/ISH criteria and staged according to the criteria of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC), 5th Report. Ambulatory blood pressure monitoring recordings were used to evaluate white-coat hypertension, blood pressure load and the dipping phenomenon. RESULTS Five hundred and four subjects were evaluated. Hypertension was prevalent in 88.1% of the population, and 362 out of 444 hypertensive patients were on antihypertensive therapy. JNC staging revealed that 188 patients had moderate to severe hypertension. Blood pressure load was pathological in 77.3% of the patients receiving antihypertensive treatment. White-coat hypertension was identified in 9.1% of the hypertensive patients not on antihypertensive therapy, and 53.1% of the patients were non-dippers. CONCLUSIONS The study demonstrates that hypertension is a dramatic, unsolved problem in uraemic patients treated with peritoneal dialysis, and casts doubts on the effectiveness of our current peritoneal dialysis strategies and pharmacological management of hypertension.
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Affiliation(s)
- R Cocchi
- Department of Nephrology, S. Maria delle Croci Hospital, Ravenna, Italy
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40
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Contu L, Carcassi C, Orrù S, Mulargia M, Arras M, Boero R, Gessa S, Loizedda AL, Lai S, Floris L. HLA-B35 frequency variations correlate with malaria infection in Sardinia. Tissue Antigens 1998; 52:452-61. [PMID: 9864035 DOI: 10.1111/j.1399-0039.1998.tb03072.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The hypothesis of a possible selective role of malaria in HLA allele frequency variations was investigated in Sardinia by typing completely 1,039 individuals for HLA: 536 from six lowland villages exposed to malaria until 1948, and 503 from six highland villages with no history of malaria. Another 1,928 individuals from 136 villages scattered all over the island were studied to establish if the HLA allele frequencies among villages correlated with the malaria incidence and/or altitude above sea level. Only the HLA-B35 allele yielded significantly higher frequencies in the lowland versus the highland villages (P<1 x 10(-5)). The observed B35 variance was 9.5 times higher than expected in the absence of selection, showing an adaptive origin. The highly significant positive correlation found between HLA-B35 frequency and malaria in 136 villages suggests that malaria has been the selective factor for HLA-B35 in Sardinia.
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Affiliation(s)
- L Contu
- Medical Genetics, University of Cagliari, Italy.
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41
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Canavese C, Barolo S, Gurioli L, Cadario A, Portigliatti M, Isaia G, Thea A, Marangella M, Bongiorno P, Cavagnino A, Peona C, Boero R, D'Amicone M, Cardelli R, Rossi P, Piccoli G. Correlations between bone histopathology and serum biochemistry in uremic patients on chronic hemodialysis. Int J Artif Organs 1998; 21:443-50. [PMID: 9803345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
To define which noninvasive investigations are of value in predicting bone histology, we analyzed transiliac bone specimens (66 biopsies, 14 autopsies) from 80 uremic patients on chronic dialysis. Results were compared with values of different measurements of parathyroid hormone (PTH), alkaline phosphatase (APH), osteocalcin, calcitonin, baseline and post-deferroxamine (DFO) aluminium (Al),--beta 2 microglobulin, ferritin and bone mineral density. Among histomorphometric parameters, woven osteoid, active osteoblastic surface and resorption surface showed the best correlations with dynamic and biochemical marks of active bone metabolism. Among biochemical parameters, intact PTH and APH were better related to histomorphometric and dynamic bone parameters than other PTH measurements as well as osteocalcin, while calcitonin was related to no parameters. Stainable Al alone, and not total bone Al content was related to bone histology. Baseline Al was related to lamellar osteoid, while post-DFO Al was related to stainable Al. beta 2 microglobulin was positively related to active osteoid surface and ferritin was inversely related to the mineral apposition rate, while bone mineral density was related only to total bone volume. We conclude that, though definite diagnosis requires the use of histological methods, few simple biochemical parameters may offer insight to the bone metabolic status, useful to the physician in day to day clinical practice.
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Affiliation(s)
- C Canavese
- Department of Medical Sciences, University of Torino, Italy
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42
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Quarello F, Forneris G, Boero R, Iadarola GM, Borca M, Salomone M. [Vascular access for chronic hemodialysis: current status and new directions in the Piedmont]. MINERVA UROL NEFROL 1998; 50:9-15. [PMID: 9578651] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Long survival on dialysis and wide admissions of very old and high risk patients, have focused attention to the problem of vascular access in uremic patients. The situation is critical in the USA, where PTFE/bovine grafts are utilized in about 75% of the cases. conversely, AV fistulas are the main type of access in Piedmont, where their use approaches 90% of the cases, Cimino-Brescia fistulas account for 58% of vascular accesses versus 25% and 9% of proximal AV fistulas and PTFE/bovine grafts, respectively. However, the latter progressively increase as age and time on dialysis increase. Snuff box fistulas are used only for 3% of the cases and this figure is steadily decreasing. In the meanwhile basilic vein superficializations, even if limited in numbers (1%), provided in some centres satisfactory results in term of survival and function. However, the type of access that deserved in the last few years the highest interest is the internal jugular vein cannulation (Canaud/Tesio catheter). In a preliminary series of 51 cannulations in 47 patients, this vascular access was permanent in 28 cases. A possible future routine utilization of jugular vein catheters is advisable in cases where a waiting period (up to a few months) is requested to allow a new fistula to mature or to maintain an empty abdomen in a patient temporarily withdrawn from peritoneal dialysis. Due to the heavy engagement for catheter maintenance and the high number of removals for systemic (9.8%) or skin exit infections (13.7%), a longer stay of indwelling catheters, although actually safe, should be limited to selected cases.
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MESH Headings
- Adult
- Aged
- Animals
- Arteriovenous Shunt, Surgical/adverse effects
- Arteriovenous Shunt, Surgical/classification
- Arteriovenous Shunt, Surgical/statistics & numerical data
- Arteriovenous Shunt, Surgical/trends
- Bioprosthesis
- Blood Vessel Prosthesis
- Brachiocephalic Veins
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/methods
- Catheterization, Central Venous/statistics & numerical data
- Catheterization, Central Venous/trends
- Catheters, Indwelling/adverse effects
- Catheters, Indwelling/statistics & numerical data
- Catheters, Indwelling/trends
- Cattle
- Equipment Design
- Femoral Vein
- Humans
- Infections/etiology
- Italy
- Jugular Veins
- Middle Aged
- Peritoneal Dialysis/methods
- Polytetrafluoroethylene
- Radial Artery
- Renal Dialysis/methods
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Affiliation(s)
- F Quarello
- Divisione di Nefrologia e Dialisi, Azienda Regionale USL 4, Ospedale G. Bosco, Torino
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43
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Boero R, Rabbia C, Savio D, Quarello F, Piccoli G. Effect of renal-artery stenting on progression of renovascular renal failure. Lancet 1997; 349:1840. [PMID: 9269237 DOI: 10.1016/s0140-6736(05)61725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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44
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Cataldi A, Ronzani G, Boero R. [Unusual etiology of Budd-Chiari syndrome: pericardial cyst]. Radiol Med 1997; 93:301-3. [PMID: 9221430] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Cataldi
- Servizio di Radiologia, Ospedale Civile, USL 9, Ivrea TO
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45
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Carcassi C, Cottoni F, Floris L, Vacca A, Mulargia M, Arras M, Boero R, La Nasa G, Ledda A, Pizzati A, Cerimele D, Contu L. HLA haplotypes and class II molecular alleles in Sardinian and Italian patients with pemphigus vulgaris. Tissue Antigens 1996; 48:662-7. [PMID: 9008308 DOI: 10.1111/j.1399-0039.1996.tb02689.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
HLA class II antigens and DRB1, DQA1, DQB1 alleles were studied in 16 Italian and in 16 Sardinian patients with pemphigus vulgaris (PV). In the last group the complete HLA A-DQ haplotypes, including the complotypes, were defined by family studies. As in other populations, two PV susceptibility haplotypes were found: HLA-DRB1*0402, DQA1*0301, DQB1*0302 and HLA-DRB1*1401, DQA1*0104, DQB1*0503. The first haplotype was largely prevalent in the Sardinian patients and was a part of the extended haplotype HLA-A2, Cw4, B35, S31, DR4, DQ8. The strength of the allele associations to PV is in agreement with the view that the main PV susceptibility genes are the DRB1*0402 and DQB1*0503 alleles. A genetic resistance to PV seems to be conferred by the HLA-DR3, DQ2 haplotype in the Sardinian population.
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Affiliation(s)
- C Carcassi
- Cattedra di Genetica Medica, Università di Cagliari, Italy
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46
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Boero R, Guarena C, Carbone D, Piccoli G. Red blood cell Na(+)-K+ pump activity and arterial hypertension in autosomal dominant polycystic kidney disease. Nephron Clin Pract 1996; 72:321. [PMID: 8684549 DOI: 10.1159/000188864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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47
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Boero R, Martina G, Bosio P, Devos S, Bertolo P, Forneris G, Giachino O, Quarello F, Piccoli G. HCV viremia in hemodialysis patients: detection by a DNA enzyme immunoassay for amplified HCV sequences. Ren Fail 1995; 17:565-73. [PMID: 8570869 DOI: 10.3109/08860229509037621] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The aim of this study was the detection of HCV viremia in both anti-HCV antibody positive and negative hemodialysis patients. Sera from 75 patients on extracorporeal blood purification in the same dialysis unit were analyzed. Anti-HCV antibodies were detected using a 2nd-generation ELISA assay and in all positive cases a RIBA 3rd-generation test was performed. HCV-RNA was tested by a reverse transcription-nested polymerase chain reaction (RT-PCR) assay with primers located in the 5' region. PCR products were analyzed by a nonradioactive hybridation assay. The presence of anti-HCV antibodies was detected in 30 (40%) patients by means of ELISA II test; 28 of them were RIBA III positive and two indeterminate. Twenty-four of the 30 HCV Ab ELISA II positive patients (80%) were HCV-RNA positive (23 RIBA III positive and 1 indeterminate). Six anti-HCV Ab ELISA II positive patients tested negative for HCV-RNA (20%); 5 of these patients were also positive for anti-HCV antibodies with a RIBA III test and 1 was indeterminate. None of the anti-HCV negative patients was HCR-RNA positive. In two cases we documented the disappearance of viremia after an acute HCV infection, with the persistence of antibody reactivity. In conclusion, anti-HCV antibody positive hemodialysis patients should be considered as potentially infectious.
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Affiliation(s)
- R Boero
- Istituto di Nefro-Urologia dell'Università Ospedale Giovanni Bosco, Torino, Italy
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48
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Boero R, Martina G, Bosio P, Devos S, Bertolo P, Forneris G, Giachino O, Quarello F, Piccoli G. HCV Viremia in Hemodialysis Patients: Detection by a DNA Enzyme Immunoassay for Amplified HCV Sequences. Ren Fail 1995. [DOI: 10.1080/0886022x.1995.12098268] [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: 10/23/2022] Open
Affiliation(s)
- Roberto Boero
- Istituto di Nefro-Urologia dell’Università Ospedale Giovanni Bosco, Torino
| | - Guido Martina
- Istituto di Nefro-Urologia dell’Università Ospedale Giovanni Bosco, Torino
| | | | | | | | - Giacomo Forneris
- Istituto di Nefro-Urologia dell’Università Ospedale Giovanni Bosco, Torino
| | | | - Francesco Quarello
- Istituto di Nefro-Urologia dell’Università Ospedale Giovanni Bosco, Torino
| | - Giuseppe Piccoli
- Istituto di Nefro-Urologia dell’Università Ospedale Giovanni Bosco, Torino
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49
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Formica M, Quarello F, Stramignoni E, Pozzato M, Forneris G, Iadarola GM, Maffei S, Basolo B, Martina G, Boero R. [Informatics support and teledialysis]. MINERVA UROL NEFROL 1994; 46:11-6. [PMID: 8036545] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Computer-assisted medical activity is increasing in several fields, with wide perspectives in nephrology and dialysis accounting for the peculiar characteristics of this population such as number, complexity, follow-up length and economic costs. Since 1980 we have been studying a computerized organization of our Region's departments in order to achieve 3 main results: 1) a registry of all patients undergoing dialysis in the area, with a one- a-year complete clinical update; 2) a computerized medical chart, which could gather all the clinical, technical and managerial aspects of the treatment; 3) a teledialysis program, to follow every session in local and remote stations. The first aim has been reached with useful information for the dialytic policy in the area. The second objective is ongoing with straight evidence of easy, speedy procedures, and accurate data collection. The third goal is on a preliminary phase looking at the safety, reliability and precision of the treatments. Informatic procedures seem to be quite advisable in improving as clinical surveillance of the patients, as technical and managerial aspects of dialysis units.
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Affiliation(s)
- M Formica
- Istituto di Nefro-Urologia, Università degli Studi di Torino
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50
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Martina G, Boero R, Forneris G, Iadarola G, Maffei S, Formica M, Basolo B, Rollino C, Quarello F, Piccoli G. [Dialysis treatments outside the hospital]. MINERVA UROL NEFROL 1994; 46:1-5. [PMID: 8036544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In the early sixties a dramatic lack of hospital dialysis facilities prompted the development of home dialysis programs. The same reasons favoured in Turin, several years later, the start of a home-dialysis program and of the first European self dialysis program in an out-of-hospital setting. In the following years continuous ambulatory peritoneal dialysis was begun. In the last few years we are experiencing a new shortening of in-hospital dialysis facilities; moreover, special attention is devoted to the costs of dialysis treatment, often overlooked in the past. It is likely that self-care and home dialysis will again aid us to solve these problems, as in the past. In this paper we report on the clinical, rehabilitative and socioeconomic results of out-of-hospital dialysis treatments, and on the possible future development of home-hemodialysis and CAPD in Piedmont.
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Affiliation(s)
- G Martina
- Divisione di Nefrologia e Dialisi, Ospedale Giovanni Bosco, Torino
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