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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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Piccoli GB, Burdese M, Mezza E, Consiglio V, Mangiarotti G, Thea A, Bermond F, Gai M, Lanfranco G, Jeantet A, Segoloni GP. Maintenance of Residual Renal Function 10 Years after the Start of Hemodialysis: The Advantage of Tailored Schedules? Int J Artif Organs 2018; 27:251-4. [PMID: 15112891 DOI: 10.1177/039139880402700312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maintenance of residual renal clearance is a clinical advantage, protecting against the long-term effects of uremia: although demonstrated in peritoneal dialysis, the strategies in hemodialysis are less clear. This case suggests that dialysis schedules individualized on the basis of renal clearances may help preserve residual function. SB is a 58 year-old male who started dialysis in emergency (creatinine 30.7 mg/dL) in 1993. He had a history of gout, small shrunken kidneys and moderate hypertension. The clinical diagnosis was vasculointerstitial nephropathy. Eighteen months after starting hemodialysis on a conventional thrice weekly schedule, the patient was switched to 2 sessions/week (creatinine clearance increased to 6 ml/min). Thereafter, clearances were checked in alternate months and treatment was tailored to an equivalent renal clearance 12 ml/min (1–2 sessions, 2-3.30 hours/week). Ten years after beginning dialysis, he is on a twice weekly schedule (3.30 hours), is normotensive, works full-time and does not want to go on a transplant waiting list.
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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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Piccoli GB, Nazha M, Capizzi I, Vigotti FN, Scognamiglio S, Consiglio V, Mongilardi E, Bilocati M, Avagnina P, Versino E. Diet as a system: an observational study investigating a multi-choice system of moderately restricted low-protein diets. BMC Nephrol 2016; 17:197. [PMID: 27927186 PMCID: PMC5142321 DOI: 10.1186/s12882-016-0413-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no single, gold-standard, low-protein diet (LPD) for CKD patients; the best compliance is probably obtained by personalization. This study tests the hypothesis that a multiple choice diet network allows patients to attain a good compliance level, and that, in an open-choice system, overall results are not dependent upon the specific diet, but upon the clinical characteristics of the patients. METHODS Observational study: Three LPD options were offered to all patients with severe or rapidly progressive CKD: vegan diets supplemented with alpha-ketoacids and essential aminoacids; protein-free food in substitution of normal bread and pasta; other (traditional, vegan non supplemented and tailored). Dialysis-free follow-up and survival were analyzed by Kaplan Meier curves according to diet, comorbidity and age. Compliance and metabolic control were estimated in 147 subjects on diet at March 2015, with recent complete data, prescribed protein intake 0.6 g/Kg/day. Protein intake was assessed by Maroni Mitch formula. RESULTS Four hundreds and forty nine patients followed a LPD in December, 2007- March, 2015 (90% moderately restricted LPDs, 0.6 g/Kg/day of protein, 10% at lower targets); age (median 70 (19-97)) and comorbidity (Charlson index: 7) characterized our population as being in line with the usual CKD European population. Median e-GFR at start of the diet was 20 mL/min, 33.2% of the patients were diabetics. Baseline data differ significantly across diets: protein-free schemas are preferred by older, high-comorbidity patients (median age 76 years, Charlson index 8, GFR 20.5 mL/min, Proteinuria: 0.3 g/day), supplemented vegan diets by younger patients with lower GFR and higher proteinuria (median age 65 years, Charlson index 6, GFR 18.9 mL/min; Proteinuria: 1.2 g/day); other diets are chosen by an intermediate population (median age 71 years, Charlson index 6; GFR 22.5 mL/min; Proteinuria: 0.9 g/day); (p <0.001 for age, Charlson index, proteinuria, GFR). Adherence was good, only 1.1% of the patients were lost to follow-up and protein intake was at target in most of the cases with no differences among LPDs (protein intake: 0.47 (0.26-0.86) g/Kg/day). After adjustment for confounders, and/or selection of similar populations, no difference in mortality or dialysis start was observed on the different LPDs. Below the threshold of e-GFR 15 mL/min, 50% of the patients remain dialysis free for at least two years. CONCLUSION A multiple choice LPD system may allow reaching good adherence, without competition among diets, and with promising results in terms of dialysis-free follow-up. The advantages with respect to a non-customized approach deserve confirmation in further comparative studies or RCTs.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy. .,Nephrologie, Centre Hospitalier Le Mans, 72000, Le Mans, France.
| | - Marta Nazha
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
| | - Irene Capizzi
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
| | - Federica Neve Vigotti
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
| | - Stefania Scognamiglio
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
| | - Valentina Consiglio
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
| | - Elena Mongilardi
- SCDU Urology, Department of Oncology, ASOU San Luigi, University of Torino, Torino, Italy
| | - Marilisa Bilocati
- Obstetrics, Department of Surgery, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Paolo Avagnina
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
| | - Elisabetta Versino
- SS Epidemiology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Torino, Italy
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5
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Piccoli GB, De Pascale A, Randone O, Vigotti FN, Priola AM, Naretto C, Ferraresi M, Aroasio E, Gonella S, Mongilardi E, Scognamiglio S, Consiglio V, Roggero S, Piga A, Roccatello D, Veltri A. Revisiting nephrocalcinosis: A single-centre perspective. A northern Italian experience. Nephrology (Carlton) 2016; 21:97-107. [DOI: 10.1111/nep.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Agostino De Pascale
- Radiology; ASOU San Luigi; Department of Oncology; University of Torino; Torino Italy
| | - Olga Randone
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Federica Neve Vigotti
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | | | - Carla Naretto
- Interregional Center for Rare Diseases; G Bosco Hospital; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Martina Ferraresi
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Emiliano Aroasio
- Laboratory; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Silvana Gonella
- Laboratory; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Elena Mongilardi
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Stefania Scognamiglio
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Valentina Consiglio
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Simona Roggero
- Microcythemia Unit; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Antonio Piga
- Microcythemia Unit; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Dario Roccatello
- Interregional Center for Rare Diseases; G Bosco Hospital; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Andrea Veltri
- Radiology; ASOU San Luigi; Department of Oncology; University of Torino; Torino Italy
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Minelli FB, Ferraresi M, Vigotti FN, Nazha M, Consiglio V, Scognamiglio S, Attini R, Todros T, Piccoli G. SaO045PREGNANCY IN DIALYSIS PATIENTS: MYTH OR REALITY? A SYSTEMATIC NARRATIVE REVIEW OF OUTCOMES AND TREATMENTS IN THE NEW MILLENNIUM. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv154.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lemoine S, Fournier T, Kocevar G, Belloi A, Ibarrola D, Sappey-Marinier D, Juillard L, Kaysen G, Usvyat L, Grassmann A, Marcelli D, Pecoits-Filho R, Marelli C, Kooman J, Van Der Sande F, Haviv Y, Power A, Kotanko P, Migliori M, Cantaluppi V, Medica D, Paoletti S, Panichi V, Kuragano T, Yahiro M, Kida A, Nagasawa Y, Hasuike Y, Nanami M, Nakanishi T, Garneata L, Slusanschi O, Dragomir DR, Corbu-Stancu A, Barbulescu C, Mircescu G, Minutolo R, Borrelli S, De Nicola L, Conte G, Basic-Jukic N, Katalinic L, Ivandic E, Kes P, Jelakovic B, Beberashvili I, Sinuani I, Azar A, Shapiro G, Feldman L, Stav K, Sandbank J, Averbukh Z, Bruschetta E, Righetti M, Colombo F, Palmieri N, Prencipe M, Bracchi O, Stefani F, Amar K, Scalia A, Conte F, Rosenberger J, Majernikova M, Kissova V, Straussova Z, Boldizsar J, Cobo G, Di Gioia C, Camacho R, Garcia Lacalle C, Ortega O, Rodriguez I, Mon C, Ortiz M, Herrero J, Oliet A, Vigil A, Gallar P, Kyriazis J, Markaki A, Kourtesi K, Kalymniou M, Vougazianos S, Kyriazis P, Stylianou K, Tanaka H, Tsuneyoshi S, Sawa M, Fujisaki K, Daijo Y, Hristea D, Paris A, Lefrancois G, Volteau C, Savoiu C, Ozenne S, Testa A, Coupel S, Bertho I, Legall MC, Magnard J, Deschamps T, Capusa C, Stoian I, Barbulescu C, Santimbrean C, Dumitru D, Mircescu G, Kato S, Lindholm B, Yuzawa Y, Shiels PG, Hwang JC, Jiang MY, Lu YH, Wang CT, Chiou TTY, Lee YT, Ng HY, Lee CT, Kaminska D, Koscielska-Kasprzak K, Chudoba P, Mazanowska O, Zabinska M, Banasik M, Boratynska M, Lepiesza A, Korta K, Klinger M, Struijk-Wielinga T, Neelemaat F, Slieker T, Koolen M, Ter Wee PM, Weijs PJ\, Tsuchida K, Hirose D, Minakuchi J, Kawashima S, Tomo T, Lee JE, Yun GY, Choi HY, Lee S, Kim W, Jo IY, Ha SK, Kim HJ, Park HC, Migliori M, Scatena A, Cantaluppi V, Rosati A, Pizzarelli F, Panichi V, Shin BC, Kim HL, Chung JH, Malgorzewicz S, Chmmielewski M, Debska-Slizien A, Rutkowski B, Kolesnyk M, Stepanova N, Korol L, Kulizkyi M, Ablogina O, Migal L, Takahashi T, Kitajima Y, Hirano S, Naka A, Ogawa H, Aono M, Sato Y, Hoppe K, Schwermer K, K Ysz P, Kaczmarek J, Baum E, Sikorska D, Radziszewska D, Szkudlarek M, Olejniczak P, Pawlaczyk K, Lindholm B, Oko A, Severova Andreevska G, Trajceska L, Gelev S, Dzekova P, Selim G, Sikole A, Trajceska L, Severova Andreevska G, Rambabova Busletik I, Gelev S, Pavleska Kuzmanovska S, Dzekova Vidimiski P, Selim G, Sikole A, Borrelli S, De Simone E, Laurino S, De Simone W, Ahbap E, Kara E, Basturk T, Sakaci T, Koc Y, Sahutoglu T, Akgol C, Sevinc M, Atan Ucar Z, Unsal A, Girndt M, Fiedler R, Martus P, Pawlak M, Storr M, Boehler T, Templin M, Trojanowicz B, Ulrich C, Glomb M, Liehr K, Werner K, Zickler D, Schindler R, Vishnevskii KA, Gerasimchuk RP, Zemchenkov AY, Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Sameiro-Faria M, Miranda V, Vieira M, Santos-Silva A, Costa E, Zaluska W, Kotlinska-Hasiec EKH, Zaluska A, Rzecki Z, Zadora P, Dabrowski W, Sikole A, Trajceska L, Amitov V, Busletik IR, Dzekova P, Selim G, Severova Andreevska G, Gelev S, Aicardi Spalloni V, La Milia V, Longhi S, Volo L, Del Vecchio L, Pontoriero G, Locatelli F, Martino F, Scalzotto E, Corradi V, Nalesso F, Zanella M, Brandolan A, Perez De Jose A, Abad S, Vega A, Reque J, Quiroga B, Lopez-Gomez JM, Esteve Simo V, Duarte Gallego V, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Carneiro Oliveira J, Ramirez De Arellano Serna M, Ahbap E, Kara E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Sevinc M, Atan Ucar Z, Unsal A, Van Diepen AT, Hoekstra T, De Mutsert R, Rotmans JI, De Boer M, Suttorp MM, Struijk DG, Boeschoten EW, Krediet RT, Dekker FW, Trigka K, Chouchoulis K, Musso CG, Kaza M, Mpimpi A, Pipili C, Kyritsis I, Douzdampanis P, Streja E, Rezakhani S, Rhee CM, Kalantar-Zadeh K, Streja E, Doshi M, Rhee C, Kovesdy C, Moradi H, Kalantar-Zadeh K, Dantas MA, Resende LL, Silva LF, Matos CM, Lopes GB, Lopes AA, Knap B, Arnol M, Buturovic J, Ponikvar R, Bren A, Codognotto M, Piasentin P, Conte F, Righetti M, Limido A, Tsuchida K, Michiwaki H, Minakuchi J, Kawashima S, Tomo T, Mutsaers HA, Jansen J, Van Den Broek PH, Verweij VG, Van Den Heuvel LP, Hoenderop JG, Masereeuw R, Clari R, Mongilardi E, Vigotti FN, Scognamiglio S, Consiglio V, Nazha M, Avagnina P, Piccoli G, Costelloe SJ, Freeman J, Keane DF, Lindley EJ, Thompson D, Kang GW, Lee IH, Ahn KS. DIALYSIS. PROTEIN-ENERGY WASTING, INFLAMMATION AND OXIDATIVE STRESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Piccoli GB, Guzzo G, Vigotti FN, Capizzi I, Clari R, Scognamiglio S, Consiglio V, Aroasio E, Gonella S, Veltri A, Avagnina P. Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: Report on three cases. Hemodial Int 2014; 18:590-5. [DOI: 10.1111/hdi.12168] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Gabriella Guzzo
- SS Nephrology ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Federica Neve Vigotti
- SS Nephrology ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Irene Capizzi
- SS Clinical Nutrition, ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Roberta Clari
- SS Nephrology ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Stefania Scognamiglio
- SS Nephrology ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Valentina Consiglio
- SS Nephrology ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Emiliano Aroasio
- SCDU Laboratory ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Silvana Gonella
- SCDU Laboratory ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Andrea Veltri
- SCDU Radiology ASOU San Luigi; Department of Oncology; University of Torino; Torino Italy
| | - Paolo Avagnina
- SS Clinical Nutrition, ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
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Heisterkamp M, Titze S, Lorenzen J, Eckardt KU, Koettgen A, Kielstein JT, Bouquegneau A, Vidal-Petiot E, Vrtovsnik F, Cavalier E, Krzesinski JM, Flamant M, Delanaye P, Anguiano L, Riera M, Pascual J, Barrios C, Betriu A, Valdivielso JM, Fernandez E, Soler MJ, Denys MA, Viaene A, Goessaert AS, Delanghe J, Everaert K, Kim YS, Choi MJ, Deok JY, Kim SG, Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L, Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L, Piskunowicz M, Hofmann L, Zurcher E, Bassi I, Zweiacker C, Stuber M, Narkiewicz K, Vogt B, Burnier M, Pruijm M, Rusu E, Zilisteanu D, Atasie T, Circiumaru A, Carstea F, Ecobici M, Rosca M, Tanase C, Mihai S, Voiculescu M, Kim YS, Jeon YD, Choi MJ, Kim SG, Polenakovic M, Pop-Jordanova N, Hung SC, Tarng DC, Tuta L, Stanigut A, Mesiano P, Rollino C, Ferro M, Beltrame G, Massara C, Quattrocchio G, Borca M, Bazzan M, Roccatello D, Maksudova A, Urasaeva LI, Khalfina TN, Zilisteanu D, Rusu E, Atasie T, Ecobici M, Circiumaru A, Carstea F, Rosca M, Tanase C, Mihai S, Voiculescu M, Tekce H, Kin Tekce B, Aktas G, Alcelik A, Sengul E, Lindic J, Purg D, Skamen J, Krsnik M, Skoberne A, Pajek J, Kveder R, Bren A, Kovac D, Kin Tekce B, Tekce H, Aktas G, Delgado G, Drechsler C, Wanner C, Blouin K, Pilz S, Tomaschitz A, Kleber ME, Willmes C, Krane V, Marz W, Ritz E, Van Gilst WH, Van Der Harst P, De Boer RA, Scholze A, Petersen L, Hocher B, Rasmussen LM, Tepel M, De Paula EA, Vanelli CP, Caminhas MS, Soares BC, Bassoli FA, Da Costa DMN, Lanna CMM, Galil AGS, Colugnati FAB, Costa MB, Bastos MG, De Paula RB, Santoro D, Zappulla Z, Alibrandi A, Tomasello Andulajevic M, Licari M, Baldari S, Buemi M, Cernaro V, Campenni A, Pallet N, Chauvet S, Levi C, Meas-Yedid V, Beaune P, Thevet E, Karras A, Santos S, Malheiro J, Campos A, Pedroso S, Santos J, Cabrita A, Mayor MM, Ayala R, Ramos C, Franco S, Guillen R, Kim JS, Yang JW, Han BG, Choi SO, Tudor MN, Navajas Martinez MF, Vaduva C, Maria DT, Mota E, Clari R, Mongilardi E, Vigotti FN, Consiglio V, Scognamiglio S, Nazha M, Roggero S, Piga A, Piccoli G, Mukhopadhyay P, Patar K, Chaterjee N, Ganguly K. CKD LAB METHODS, PROGRESSION & RISK FACTORS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Piccoli GB, Deagostini MC, Vigotti FN, Ferraresi M, Moro I, Consiglio V, Scognamiglio S, Mongilardi E, Clari R, Aroasio E, Versino E, Porpiglia F. Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition 2014; 30:992-9. [PMID: 25102817 DOI: 10.1016/j.nut.2014.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/17/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Low protein diets (LPDs) are milestones in chronic kidney disease (CKD). Concerns over compliance and safety limit their use. The aim of this study was to test the feasibility and main results of a multiple-choice approach to LPDs, adapted to patient preferences. METHODS From December 2007 to January 2013, all CKD patients (stages 4/5; progressive stage 3) without contraindications (malnutrition, short life expectancy), were offered two main LPDs (proteins 0.6 g/kg daily): Vegan supplemented (LPD-KA) or with "aproteic" commercial food (LPD-ACF). LPDs followed a qualitative approach based on forbidden and allowed food; one to three free meals per week, and flexible control policy (1-3 mo). Start of dialysis, death, and combined outcome (death-dialysis) were analyzed by Kaplan-Meier curves and Cox model. Comparison with dialysis in patients with glomerular filtration rate (GRF) <15 mL/min, (corresponding to "early" dialysis start) employed standardized mortality rates, with respect to the Italian and the United States Dialysis Registry. RESULTS One hundred eighty-five patients (222 patient-years) started at least a trial of LPD-KA, 122 (177 patients-years) LPD-ACF; only 3 patients with GFR <30 mL/min denied an LPD trial. Patients who chose LPD-KA were younger than those on LPD-ACF (63 versus 74 y), had less comorbidity (82% versus 93%), higher proteinuria (1.4 versus 0.7 g/d) and lower GFR (17 versus 23 mL/min) (P < 0.001). Median daily protein intake was 0.7 g/kg on both diets (Maroni-Mitch formula). The combined outcome (death or dialysis) was not influenced by the diet chosen (Cox analysis). Relative risk for death on the diet (patients with GFR <15 mL/min) was 0.5 with respect to the Italian Registry and 0.3 to the United States Dialysis Registry. The diets had comparable costs (1 y on dialysis: 50 patient-years on LPD). CONCLUSIONS The choice of diet is strictly linked to patient characteristics, thus supporting a multiple-choice offer. Once corrected for baseline data, both LPDs led to similar results, suggesting at least survival equivalence with dialysis, at lesser cost.
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Affiliation(s)
- Giorgina B Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.
| | - Maria Chiara Deagostini
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Federica Neve Vigotti
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Martina Ferraresi
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Irene Moro
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Valentina Consiglio
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Stefania Scognamiglio
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Elena Mongilardi
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Roberta Clari
- SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Emiliano Aroasio
- General Laboratory, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Elisabetta Versino
- Epidemiology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Urology Department of Oncology, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
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Piccoli GB, Ferraresi M, Deagostini MC, Vigotti FN, Consiglio V, Scognamiglio S, Moro I, Clari R, Fassio F, Biolcati M, Porpiglia F. Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many? Nephrol Dial Transplant 2013; 28:2295-305. [PMID: 23751187 DOI: 10.1093/ndt/gft092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low-protein diets are often mentioned but seldom used to slow chronic kidney disease (CKD) progression. The aim of the study was to investigate the potential for implementation of a simplified low-protein diet supplemented with alpha-keto analogues (LPD-KA) as part of the routine work-up in CKD patients. METHODS In an implementation study (December 2007-November 2011), all patients with CKD Stages IV-V not on dialysis, rapidly progressive Stage III and/or refractory proteinuria, were offered either a simplified LPD-KA, or commercially available low-protein food. LPD-KA consisted of proteins 0.6 g/kg/day, supplementation with Ketosteril 1 pill/10 Kg, 1-3 free-choice meals/week and a simplified schema based on 'allowed' and 'forbidden' foods. 'Success' was defined as at least 6 months on LPD-KA. Progression was defined as reduction in glomerular filtration rate (GFR)[(Chronic Kidney Disease Epidemiology Collaboration) formula CKD-EPI] in patients with at least 6 months of follow-up. RESULTS Of about 2500 patients referred (8% CKD Stages IV-V), 139 started LPD-KA; median age (70 years) and prevalence of comorbidity (79%) were in line with the dialysis population. Start of dialysis was the main reason for discontinuation (40 cases, unplanned in 7); clinical reasons were recorded in 7, personal preference in 14 and improvement and death in 8 each. The low gross mortality (4% per year) and the progression rate (from -8 to 0 mL/min/year at 6 months) are reassuring concerning safety. None of the baseline conditions, including age, educational level, comorbidity or kidney function, discriminated the patients who followed the diet for at least 6 months. CONCLUSIONS Our data suggest a wider offer of LPD-KA to patients with severe and progressive CKD. The promising results in terms of mortality and progression need confirmation with different study designs.
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Affiliation(s)
- Giorgina B Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
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De Pascale A, Piccoli GB, Priola SM, Rognone D, Consiglio V, Garetto I, Rizzo L, Veltri A. Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis. Eur Radiol 2013; 23:3077-86. [DOI: 10.1007/s00330-013-2906-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 12/01/2022]
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Steckiph D, Calabrese G, Bertucci A, Mazzotta A, Vagelli G, Gonella M, Stamopoulos D, Manios E, Papachristos N, Grapsa E, Papageorgiou G, Gogola V, So B, Dey V, Spalding EM, Libetta C, Esposito P, Margiotta E, Maffioli P, Bonaventura A, Bianchi L, Romano D, Rampino T, De Rosa G, Mauric A, Haug U, Enzinger G, Kern-Derstvenscheg E, Sluga A, Ausserwinkler C, Beck W, Rosenkranz AR, Maheshwari V, Haroon S, Loy Y, Samavedham L, Rangaiah GP, Lau T, Stamopoulos D, Mpakirtzi N, Panagiotou M, Barbarousi D, Matsouka C, Grapsa E, Bunani AD, Kowalczyk M, Bartnicki P, Banach M, Rysz J, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, Pellanda V, de Cal M, Grazia V, Clementi A, Insalaco M, Dell'Aquila R, Karkar A, Abdelrahman M, Martins AR, Parreira L, Duque AS, Rodrigues I, Baffoun AB, Youssfi MA, Sayeh A, Beji M, Ben Khadra R, Hmida J, Akazawa M, Horiuchi H, Hori Y, Yamada A, Satou H, Odamaki S, Nakai S, Satou K, Aoki K, Saito I, Kamijo Y, Ogata S, Ishibashi Y, Basso F, Wojewodzka-Zelezniakowicz M, Cruz D, Giuliani A, Blanca Martos L, Piccinni P, Ronco C, Potier J, Queffeulou G, Bouet J, Nilsson A, Sternby J, Grundstrom G, Alquist M, Ferraresi M, Di Vico MC, Vigotti FN, Deagostini M, Scognamiglio S, Consiglio V, Clari R, Moro I, Mongilardi E, Piccoli GB, Hancock V, Huang S, Nilsson A, Grundstrom G, Nilsson Ekdahl K, Calabrese G, Steckiph D, Bertucci A, Baldin C, Petrarulo M, Mancuso D, Vagelli G, Gonella M, Inguaggiato P, Canepari G, Gigliola G, Ferrando C, Meinero S, Sicuso C, Pacitti A, Stamopoulos D, Mpakirtzi N, Manios E, Afentakis N, Grapsa E, Tomo T, Matsuyama K, Nakata T, Ishida K, Takeno T, Kadota JI, Minakuchi J, Kastl J, Merello M, Boccato C, Giordana G, Mazzone S, Moscardo V, Kastl J, Giordana G, Reinhardt B, Knaup R, Kruger W, Tovbin D, Kim S, Avnon L, Zlotnik M, Storch S, Umimoto K, Shimamoto Y, Suyama M, Miyata M, Bosch Benitez-Parodi E, Baamonde Laborda EE, Perez G, Ramirez JI, Ramirez Puga A, Guerra R, Garcia Canton C, Lago Alonso MM, Toledo A, Checa Andres MD, Latif FE, Mochida Y, Matsumoto K, Morita K, Tsutsumi D, Ishioka K, Maesato K, Oka M, Moriya H, Hidaka S, Ohtake T, Kobayashi S, Ficheux A, Gayrard N, Duranton F, Guzman C, Szwarc I, Bismuth-Mondolfo J, Brunet P, Servel MF, Argiles A, Tsikliras N, Mademtzoglou S, Balaskas E, Zeid M, Mostafa A, Mowafy MN, Abdo EI, Al Amin OM, Ksiazek A, Zaluska W, Waniewski J, Debowska M, Wojcik-Zaluska A, Elias M, Francois H, Obada E, Lorenzo HK, Charpentier B, Durrbach A, Beaudreuil S, Imamovic G, Marcelli D, Bayh I, Hrvacevic R, Kapun S, Grassmann A, Scatizzi L, Maslovaric J, Daelemans R, Mesens S, Mohamed EA, Wafae A, Kawtar H, Mohamed Amine H, Driss K, Mohammed B. Extracorporeal dialysis: techniques and adequacy - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft116] [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: 11/13/2022] Open
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Borras M, Roig J, Betriu A, Vilar A, Hernandez M, Martin M, Fernandez ED, Dounousi E, Kiatou V, Papagianni A, Zikou X, Pappas K, Pappas E, Tatsioni A, Tsakiris D, Siamopoulos KC, Kim JK, Kim Y, Kim SG, Kim HJ, Ahn SY, Chin HJ, Oh KH, Ahn C, Chae DW, Yazici R, Altintepe L, Bakdik S, Guney I, Arslan S, Topal M, Karagoz A, Stefan G, Mircescu G, Capusa C, Stancu S, Petrescu L, Alecu S, Nedelcu D, Bennett AHL, Pham H, Garrity M, Magdeleyns E, Vermeer C, Zhang M, Ni Z, Zhu M, Yan J, Mou S, Wang Q, Qian J, Saade A, Karavetian M, ElZein H, de Vries N, de Haseth DE, Lay Penne E, van Dam B, Bax WA, Bots ML, Grooteman MPC, van den Dorpel RA, Blankenstijn PJ, Nube MJ, Wee PM, Park JH, Jo YI, Lee JH, Cianfrone P, Comi N, Lucisano G, Piraina V, Talarico R, Fuiano G, Toyonaga M, Fukami K, Yamagishi SI, Kaida Y, Nakayama Y, Ando R, Obara N, Ueda S, Okuda S, Granatova J, Havrda M, Hruskova Z, Tesar V, Viklicky O, Rysava R, Rychlik I, Kratka K, Honsova E, Vernerova Z, Maluskova J, Vranova J, Bolkova M, Borecka K, Benakova H, Zima T, Lu KC, Yang HY, Su SL, Cao YH, Lv LL, Liu BC, Zeng R, Gao XF, Deng YY, Boelaert J, t' Kindt R, Glorieux G, Schepers E, Jorge L, Neirynck N, Lynen F, Sandra P, Sandra K, Vanholder R, Yamamoto T, Nameta M, Yoshida Y, Uhlen M, Shi Y, Tang J, Zhang J, An Y, Liao Y, Li Y, Tao Y, Wang L, Koibuchi K, Tanaka K, Aoki T, Miyagi M, Sakai K, Aikawa A, Martins AR, Branco PQ, Serra FM, Matias PJ, Lucas CP, Adragao T, Duarte J, Oliveira MM, Saraiva AM, Barata JD, Masola V, Zaza G, Granata S, Proglio M, Pontrelli P, Abaterusso C, Schena F, Gesualdo L, Gambaro G, Lupo A, Pruijm M, Hofmann L, Stuber M, Zweiacker C, Piskunowicz M, Muller ME, Vogt B, Burnier M, Togashi N, Yamashita T, Mita T, Ohnuma Y, Hasegawa T, Endo T, Tsuchida A, Ando T, Yoshida H, Miura T, Bevins A, Assi L, Ritchie J, Jesky M, Stringer S, Kalra P, Hutchison C, Harding S, Cockwell P, Viccica G, Cupisti A, Chiavistelli S, Borsari S, Pardi E, Centoni R, Fumagalli G, Cetani F, Marcocci C, Scully P, O'Flaherty D, Sankaralingam A, Hampson G, Goldsmith DJ, Pallet N, Chauvet S, Beaune P, Nochy D, Thervet E, Karras A, Bertho G, Gallyamov MG, Saginova EA, Severova MM, Krasnova TN, Kopylova AA, Cho E, Jo SK, Kim MG, Cho WY, kim HK, Trivin C, Metzger M, Boffa JJ, Vrtovsnik F, Houiller P, Haymann JP, Flamant M, Stengel B, Thervet E, Roozbeh J, Yavari V, Pakfetrat M, Zolghadr AA, Kim CS, Kim MJ, Kang YU, Choi JS, Bae EH, Ma SK, Kim SW, Lemoine S, Guebre-Egziabher F, Dubourg L, Hadj-Aissa A, Blumberg S, Katzir Z, Biro A, Cernes R, Barnea Z, Vasquez D, Gordillo R, Aller C, Fernandez B, Jabary N, Perez V, Mendiluce A, Bustamante J, Coca A, Goek ON, Sekula P, Prehn C, Meisinger C, Gieger C, Suhre K, Adamski J, Kastenmuller G, Kottgen A, Kuzniewski M, Fedak D, Dumnicka P, Solnica B, Kusnierz-Cabala B, Kapusta M, Sulowicz W, Drozdz R, Zawada AM, Rogacev KS, Hummel B, Fliser D, Geisel J, Heine GH, Kretschmer A, Volsek M, Krahn T, Kolkhof P, Kribben A, Bruck H, Koh ES, Chung S, Yoon HE, Park CW, Chang YS, Shin SJ, Deagostini MC, Vigotti FN, Ferraresi M, Consiglio V, Scognamiglio S, Moro I, Clari R, Daidola G, Versino E, Piccoli GB, Mammadrahim Agayev M, Mehrali Mammadova I, Qarib Ismayilova S, Anguiano L, Riera M, Pascual J, Barrios C, Betriu A, Valdivielso JM, Fernandez E, Soler MJ, Tsarpali V, Liakopoulos V, Panagopoulou E, Kapoukranidou D, Spaia S, Kostopoulou M, Michalaki A, Nikitidou O, Dombros N, Zhu F, Abba S, Flores-Gama C, Williams C, Cartagena C, Carter M, Kotanko P, Levin NW, Kolesnyk M, Stepanova N, Driyanska V, Stashevska N, Kundin V, Shifris I, Dudar I, Zaporozhets O, Keda T, Ishchenko M, Khil M, Choe JY, Nam SA, Kim J, Cha JH, Gliga ML, Irimescu CG, Caldararu CD, Gliga MG, Toma LV, Gomotarceanu A, Park Y, Kim Y, Jeon J, Kwon SK, Kim SJ, Kim SM, Kim HY, Montero N, Soler MJ, Barrios C, Marquez E, Berrada A, Arias C, Prada JA, Orfila MA, Mojal S, Vilaplana C, Pascual J, Vigotti FN, Attini R, Parisi S, Fassio F, Deagostini MC, Ghiotto S, Ferraresi M, Clari R, Biolcati M, Todros T, Piccoli GB, Jin K, Vaziri ND, Tramonti G, Romiti N, Chieli E, Maksudova AN, Khusnutdinova LA, Tang J, Shi Y, Zhang J, Li Y, An Y, Tao Y, Wang L, Reque JE, Quiroga B, Lopez JM, Verdallez UG, Garcia de Vinuesa M, Goicoechea M, Nayara PG, Arroyo DR, Luno J, Tanaka H, Flores-Gama C, Abbas SR, Williams C, Cartagena C, Carter M, Thijssen S, Kotanko P, Levin NW, Zhu F, Berthoux FC, Azzouz L, Afiani A, Ziane A, Mariat C, Fournier H, Kusztal M, Dzierzek P, Witkowski G, Nurzynski M, Golebiowski T, Weyde W, Klinger M, Altiparmak MR, Seyahi N, Trabulus S, Bolayirli M, Andican ZG, Suleymanlar G, Serdengecti K, Niculae A, Checherita IA, Neagoe DN, Ciocalteu A, Seiler S, Rogacev KS, Pickering JW, Emrich I, Fliser D, Heine G, Bargnoux AS, Obiols J, Kuster N, Fessler P, Badiou S, Dupuy AM, Ribstein J, Cristol JP, Yanagisawa N, Ando M, Ajisawa A, Tsuchiya K, Nitta K, Bouquegneau A, Cavalier E, Krzesinski JM, Delanaye P, Tominaga N, Shibagaki Y, Kida K, Miyake F, Kimura K, Ayvazyan A, Rameev V, Kozlovskaya L, Simonyan A, Scholze A, Marckmann P, Tepel M, Rasmussen LM, Hara M, Ando M, Tsuchiya K, Nitta K, Kanai H, Harada K, Tamura Y, Kawai Y, Al-Jebouri MM, Madash SA, Leonidovna Berezinets O, Nicolaevich Rossolovskiy A. Lab methods / biomarkers. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft108] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Piccoli GB, Attini R, De Pascale A, Pagano A, Consiglio V, Scognamiglio S, Vigotti F, Bossotti C, Gollo E, Veltri A, Todros T. Protean presentation and multiple challenges of nephrocalcinosis in pregnancy (six pregnancies in four patients). Nephrol Dial Transplant 2012; 27:1131-1138. [DOI: 10.1093/ndt/gfr390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Piccoli GB, Consiglio V, Deagostini MC, Serra M, Biolcati M, Ragni F, Biglino A, De Pascale A, Frascisco MF, Veltri A, Porpiglia F. The clinical and imaging presentation of acute "non complicated" pyelonephritis: a new profile for an ancient disease. BMC Nephrol 2011; 12:68. [PMID: 22171968 PMCID: PMC3268718 DOI: 10.1186/1471-2369-12-68] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 12/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute pyelonephritis (APN) is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking.Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan). METHODS All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009). Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. RESULTS There were 119 patients, all females, median age 32 years (15-72). At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal < 0.8). Incomplete presentations were frequent: fever was absent in 6.7%, pain in 17.8%, lower urinary tract symptoms in 52.9%. At CT or MR scan the lesions were bilateral in 12.6%, multiple in 79.8%; abscesses were present in 39.5%. Renal scars were found in 15.1%. Positive cultures were correlated with multiple foci (multivariate OR 4.2; CI 1.139-15.515). No other sign/symptom discriminated between small lesions, abscesses or multifocal involvement. CONCLUSIONS APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Nephrology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Valentina Consiglio
- Nephrology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Maria Chiara Deagostini
- Nephrology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Melania Serra
- Emergency Medicine; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Marilisa Biolcati
- Materno Foetal Unit, sant'Anna Hospital, University of Torino, Italy
| | - Francesca Ragni
- Urology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Alberto Biglino
- Infectious Diseases Department of Clinical and Biological Sciences, Ospedale di Asti, University of Torino, Italy
| | - Agostino De Pascale
- Radiology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Mauro Felice Frascisco
- Emergency Medicine; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Andrea Veltri
- Radiology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
| | - Francesco Porpiglia
- Urology; Department of Clinical and Biological Sciences ASOU san Luigi Gonzaga Regione Gonzole 10, Orbassano, University of Torino, Italy
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Piccoli GB, Consiglio V, Deagostini MC, Manente E, Scarpa RM. Starting together: a focus group for the organization of a CKD outpatient care unit. J Nephrol 2010; 23:699-704. [PMID: 20383868] [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] [Accepted: 12/01/2009] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The growing interest in patient empowerment in chronic diseases underlines the importance of assessing patients' opinions in planning healthcare strategies. Focus groups are flexible tools for investigating innovative aspects of care. The aim of the study was to use a focus group to define the main requirements for a chronic kidney disease (CKD) outpatient care unit. METHODS The focus group met during the opening of a new CKD outpatient facility. It consisted of 12 patients with long-term experience of CKD, dialysis and transplantation; they had been followed previously by the senior physician, who moderated the discussion. The discussion was tape-recorded and the results were summarized and approved by all participants. RESULTS The group made 10 major suggestions: 1. Therapeutic continuity in all disease phases, from pre-dialysis to transplantation; 2. Possibility to choose the reference physician; 3. Strict integration with the nursing activities; 4. Organizational flexibility, to adapt to the needs of daily life; 5. To be "fully" taken care of, with organizational support for blood tests, imaging and consultations; 6. Need for time with the reference physician in critical phases of the disease; 7. Identification of a network of consultants, in keeping with the need for continuity of care; 8. Educational sessions; 9. Meetings for critical discussion of organizational performances; 10. As a setting: a home for the disease and not a disease to take home. CONCLUSION Continuity of care and flexibility of organization, allowing time for education and discussion, are the quality requirements of our CKD patients.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Unit of Nephrology, San Luigi University Hospital, University of Torino, Orbassano, Turin, Italy.
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Piccoli GB, Attini R, Vasario E, Gaglioti P, Piccoli E, Consiglio V, Deagostini C, Oberto M, Todros T. Vegetarian supplemented low-protein diets. A safe option for pregnant CKD patients: report of 12 pregnancies in 11 patients. Nephrol Dial Transplant 2010; 26:196-205. [PMID: 20571094 DOI: 10.1093/ndt/gfq333] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pregnancy in CKD is an increasing challenge, considering also the paucity of therapeutic tools available in pregnant women. While theoretically interesting, the experience with low protein diets in pregnancy is limited. Aim of this feasibility study is to review our experience with supplemented vegetarian low protein diets in pregnancy, as a "rescue treatment" for severe CKD and/or proteinuria. METHODS Data were gathered prospectively. Diet schema: proteins: 0.6-0.7 g/Kg/day, amino and chetoacid supplementation, 1-3 free meals/week. Compliance, side effects, biochemical data recorded at each visit (at least twice monthly). RESULTS Between January 2000 and February 2010, out of 168 pregnancies referred, 12 were managed by the diet (11 patients; median age 33, range 20-38). One pregnancy was terminated (patient's choice); the other 10 patients delivered 11 healthy babies. At referral, 2 patients were in stage 4 CKD, 4 in stage 3, 4 had nephrotic proteinuria (3.6-6.3 g/day). One patient doubled serum creatinine; none needed renal replacement therapy within 6 months from delivery. No patient complained of side effects, nor developed hyperkalemia or hypercalcaemia. Two babies from mothers in CKD stage 4 were small for gestational age; 9/11 were delivered by caesarean section (median gestational age 33 weeks: range 28-37; birth weight 935-2620 g) within a policy of delivery in the presence of foetal growth impairment and/or worsening of proteinuria, GFR, hypertension or foetal conditions. All babies are well, 1 month, 7.5 years from delivery. CONCLUSION Our report suggests considering vegetarian diets as an additional tool in the management of pregnant CKD patients.
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Affiliation(s)
- Giorgina B Piccoli
- SS Nefrologia, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Italy.
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Piccoli GB, Arena V, Consiglio V, Depascale A, Deagostini MC. Positron emission tomography: a precious tool in the challenge of the infected cysts in ADPKD. NDT Plus 2010; 3:492-3. [PMID: 25984064 PMCID: PMC4421707 DOI: 10.1093/ndtplus/sfq104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 05/19/2010] [Indexed: 11/25/2022] Open
Affiliation(s)
- Giorgina Barbara Piccoli
- ASOU San Luigi Gonzaga, Regione Gonzole 10 , Orbassano, Torino and IRMET Via Onorato Vigliani 89/A, 10135 - Torino , Italy
| | | | - Valentina Consiglio
- ASOU San Luigi Gonzaga, Regione Gonzole 10 , Orbassano, Torino and IRMET Via Onorato Vigliani 89/A, 10135 - Torino , Italy
| | | | - Maria Chiara Deagostini
- ASOU San Luigi Gonzaga, Regione Gonzole 10 , Orbassano, Torino and IRMET Via Onorato Vigliani 89/A, 10135 - Torino , Italy
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Piccoli GB, Attini R, Vasario E, Conijn A, Biolcati M, D'Amico F, Consiglio V, Bontempo S, Todros T. Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol 2010; 5:844-55. [PMID: 20413442 DOI: 10.2215/cjn.07911109] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) is a challenge for pregnancy. Its recent classification underlines the importance of its early phases. This study's aim was to evaluate outcomes of pregnancy according to CKD stage versus low-risk pregnancies followed in the same center. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The prospective analysis was conducted from January 2000 to May 2009 with the start of observation at referral and end of observation 1 month after delivery. Ninety-one singleton deliveries were studied; 267 "low-risk" singleton pregnancies served as controls. Because of the lack of hard end points (death, start of dialysis), surrogate end points were analyzed (cesarean section, prematurity, neonatal intensive care). RESULTS CKD outcome was worse than physiologic pregnancies: preterm delivery (44% versus 5%); cesarean section (44% versus 25%); and need for neonatal intensive care (26% versus 1%). The differences were highly significant in stage 1 CKD (61 cases) versus controls (CKD stage 1: cesarean sections = 57%, preterm delivery = 33%, intensive care = 18%). In CKD, proteinuria and hypertension were correlated with outcomes [proteinuria dichotomized at 1 g/24 h at referral: need for intensive care, relative risk (RR) = 4.16 (1.05 to 16.46); hypertension: preterm delivery, RR = 7.24 (2.30 to 22.79); cesarean section, RR = 5.70 (1.69 to 19.24)]. Statistical significance across stages was reached for preterm delivery [RR = 3.32 (1.09 to 10.13)]. CONCLUSIONS CKD is a challenge for pregnancy from early stages. Strict follow-up is needed for CKD patients, even when there is normal renal function.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Struttura Semplice Nefrologia Department of Clinical and Biological Sciences, Azienda Sanitaria Ospedaliera Universitaria San Luigi Gonzaga, University of Torino, Torino, Italy.
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Piccoli GB, Consiglio V, Vigotti FN, Deagostini MC, Scarpa RM. Stable flexibility: the secret for a successful daily dialysis program. A focus group. Clin Kidney J 2010. [DOI: 10.1093/ndtplus/sfp174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Piccoli GB, Capobianco M, Odetto L, Deagostini MC, Consiglio V, Radeschi G. Acute renal failure, severe sodium and potassium imbalance and sudden tetraplegia. NDT Plus 2010; 3:247-252. [PMID: 28657059 PMCID: PMC5477952 DOI: 10.1093/ndtplus/sfq017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/27/2009] [Revised: 01/09/2010] [Accepted: 02/10/2010] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Lorenzo Odetto
- Intensive Care Unit ASOU San Luigi, Orbassano, Torino, Italy
| | | | | | - Giulio Radeschi
- Intensive Care Unit ASOU San Luigi, Orbassano, Torino, Italy
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Piccoli GB, Consiglio V, Arena V, Pelosi E, Anastasios D, Ragni F, Fiori C, Cortese G, Deagostini MC, Porpiglia F, Scarpa RM. Positron emission tomography as a tool for the 'tailored' management of retroperitoneal fibrosis: a nephro-urological experience. Nephrol Dial Transplant 2010; 25:2603-10. [PMID: 20157170 DOI: 10.1093/ndt/gfq051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Retroperitoneal fibrosis (RF) is a complex clinical entity characterized by a fibro-inflammatory reaction around the abdominal aorta and iliac arteries extended into the retroperitoneum. No biochemical marker correlates with the disease severity and progression, and imaging data fail to discriminate between fibrotic and florid lesions. Positron emission tomography (PET) was recently suggested as a promising tool to detect the disease. METHODS We report on seven consecutive cases of RF managed by tailoring therapeutic interventions to the metabolic activity detected by PET. In 2006-09, seven patients with RF (five new diagnoses) were referred to the same nephro-urological facility. There were six males and one female aged 41-79. RF was associated with autoimmune diseases in three patients, with an aortic aneurysm in another three, and was 'idiopathic' in one. The diagnoses were made by imaging techniques [computed tomography (CT) or nuclear magnetic resonance (NMR)]; PET scan was performed in all patients in the same setting at referral and during follow-up. RESULTS Patients were followed up with tailored interventions (medical therapy: tamoxifen, steroids, and immunosuppressors according to disease activity, side effects and tolerance). Six patients needed ureteral stenting for obstruction. PET imaging was used as a guide for the tapering of immunosuppressors and for stent removal. In this way, stents were safely removed when a negativization of disease activity was revealed by PET. Only one relapse was recorded over 163 months of follow-up (median 24 months) detected in time by PET. CONCLUSION PET is a promising tool for surveillance of disease activity and for planning the removal of ureteral stents in RF.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Urology and Nephrology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano Torino, Turin, Italy.
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Piccoli GB, Vigotti FN, Consiglio V, Deagostini MC. Quiz page. Severe hypocalcemia caused by intravascular calcium phosphate precipitation after sodium phosphate-containing bowel preparation. Am J Kidney Dis 2010; 55:A35-7. [PMID: 20116677 DOI: 10.1053/j.ajkd.2009.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 09/14/2009] [Indexed: 11/11/2022]
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Piccoli GB, Conijn A, Consiglio V, Vasario E, Attini R, Deagostini MC, Bontempo S, Todros T. Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy? Clin J Am Soc Nephrol 2009; 5:62-71. [PMID: 19965547 DOI: 10.2215/cjn.05660809] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although successful pregnancy is rare, results attained with higher dialysis efficiency and the spread of dialysis to different cultural and religious settings are changing the panorama. In this study, we systematically review the recent literature (2000 through 2008) on pregnancy in dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Medline on OVID was searched in November 2008, with MESH and free terms on pregnancy and chronic kidney disease or dialysis; limits were human subjects and English-language articles. Case reports were excluded to minimize publication bias. The final selection and extraction of data were performed in duplicate. RESULTS From 2840 references, 241 full-text articles were retrieved; eight fulfilled the selection criteria, and two were added from reference lists. In the 10 studies (nine of 10 monocentric), 90 pregnancies were observed in 78 patients (range of cases five to 15). The studies were heterogeneous for definition of outcomes, duration (2 to 16 yr), period (1988 through 1998 to 2000 through 2006), age (25 to 35 yr), and support and dialysis therapy. Daily dialysis was frequently used; type of treatment, membranes, and flows varied widely. Hypertension and anemia were frequent concerns for the mothers. Intrauterine deaths, hydramnios, and small-for-gestational-age or preterm infants were frequent. The possibility of a healthy offspring ranged from 50 to 100% (overall 76.25%). CONCLUSIONS Evidence on pregnancy in dialysis is heterogeneous; however, the growing number of reports worldwide and the improving results suggest that we should reconsider our counseling policy, which only rarely includes pregnancy in dialysis patients.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Unit of Nephrology, Department of Clinical and Biological Sciences, University of san Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy.
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Piccoli GB, Soragna G, Putaggio S, Consiglio V, Mezza E, Bonetto A, Geuna S. Drug use and kidney donation: what are high-risk behaviors today? Transplant Proc 2006; 38:1221-3. [PMID: 16797268 DOI: 10.1016/j.transproceed.2006.02.095] [Citation(s) in RCA: 3] [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] [Received: 09/17/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND "Social risk behaviors" are usually considered as contraindications for organ donation. The organ shortage, however, necessitates expansion of the donor pool. Reconsideration of the policy toward substance abusers may be important. Opinions of the overall population may be of use to define this cultural-sensitive issue. METHODS A semistructured questionnaire on organ donation, including opinions on drug use (cannabis and cocaine), was administered to various groups of the general public and caregivers: high school students (liceo classico: 59 students, median age 18 years; istituto tecnico: 108, age 17); first- and fourth-year medical school (77, age 19; 46, age 22); continuing medical education (44, age 32); third-year nursing school (31, age 23); "senior citizen university" (51, age 63). RESULTS Cannabis use was mainly accepted for kidney donation (48.6% yes, 26.6% no, 29.8% uncertain/blank), but cocaine use was not (22.1% yes, 44.2% no, 33.7% uncertain/blank). In the univariate analysis, opinions differed according to age, sex, and belonging to the health care teams upon multivariate analysis being a member of the health care team was the strongest predictor of responses (P<.01). CONCLUSION It is difficult to define social risk behaviors. Since opinions are important for organ donation, further studies and discussion are needed to periodically analyze our policies.
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Affiliation(s)
- G B Piccoli
- Nephrology, University of Torino, Torino, Italy.
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Piccoli GB, Picciotto G, Rossetti M, Burdese M, Consiglio V, Magnano A, Soragna G, Sargiotto G, Maas J, Guarena C, Veglio V, Messina M. Imaging data suggesting acute pyelonephritis in the kidney graft: report of five cases with atypical clinical presentation. Int J Antimicrob Agents 2006; 28 Suppl 1:S64-71. [PMID: 16854571 DOI: 10.1016/j.ijantimicag.2006.05.018] [Citation(s) in RCA: 3] [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: 11/20/2022]
Abstract
Acute pyelonephritis is a common complication of kidney transplantation, occurring in up to 1% of grafts. Diagnosis is mainly clinical and atypical presentations have seldom been reported. The diagnostic role of imaging techniques has not been defined. Five cases of acute graft pyelonephritis are reported (three kidney, two pancreas-kidney grafts). The patients (median age 48 years) comprised three females and two males. Median post-transplant follow-up was 3 months, with three patients having predisposing factors for diabetes and one for an enteric bladder. None of the patients presented the 'classic' diagnostic tetrad (i.e. fever, positive urine cultures, low urinary tract symptoms and serum creatinine increase); although, at diagnosis, two of five patients presented with fever, one had increased creatinine levels and one had positive urine cultures. Of note, three patients had leucocyte casts at urinary sediment analysis, thus raising clinical suspicion. Renal ultrasounds were negative in all patients. Renal (99m)Tc-MAG3 (mercaptoacetyltriglycine) scintigraphy, which was used for the definition of kidney function impairment (one patient) or because of the presence of urinary casts (three patients), or after the biopsy diagnosis to locate the parenchymal lesions (one patient), was positive in all patients. The presence and pyelonephritic origin of the parenchymal lesions was confirmed by nuclear magnetic resonance or computed tomography scans. Acute graft pyelonephritis may develop in the absence of a full-blown clinical picture. Smouldering symptoms may occur in the presence of large perfusion deficits. (99m)Tc-MAG3 scintigraphy could be an important diagnostic tool in such cases.
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Piccoli GB, Consiglio V, Colla L, Mesiano P, Magnano A, Burdese M, Marcuccio C, Mezza E, Veglio V, Piccoli G. Antibiotic treatment for acute 'uncomplicated' or 'primary' pyelonephritis: a systematic, 'semantic revision'. Int J Antimicrob Agents 2006; 28 Suppl 1:S49-63. [PMID: 16854569 DOI: 10.1016/j.ijantimicag.2006.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/30/2022]
Abstract
The definition of acute pyelonephritis is controversial. There are two contrasting approaches: (1) acute pyelonephritis is a severe infectious disease involving the kidney parenchyma, and specific imaging techniques are required for diagnosis; (2) acute pyelonephritis is a urinary tract infection, and diagnosis and therapy follow simplified clinical and laboratory pathways. In this study, recent randomized controlled trials (RCTs) were systematically reviewed and the diagnostic and therapeutic approaches to acute 'uncomplicated' pyelonephritis were analysed. Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) and Chinal were searched employing Mesh, Emtree and free terms on 'pyelonephritis'. Limits included human, period (1995-2004), and trials-reviews (where available). In total, 904 references and 175 full-text were retrieved; 29 were pertinent RCTs. Seven RCTs were added from reference lists (indexed on urinary tract infections). Imaging examinations were performed in 11 of 14 studies on children (diagnostic requisite in two) and in two studies on adults; scarring was not analysed in adults. Clinical definitions varied widely (fever >37.8 to >39 degrees C, culture titres 10(4) >10(5)). Studies on adults were limited to short-term end-points (microbiological sterilization, clinical improvement). Duration of therapy was 4-20 days. The trend was towards shorter periods of therapy, mainly on an outpatient basis; intravenous therapy, if performed, was usually limited to the first 1-3 days. For acute uncomplicated pyelonephritis, the tendency is towards 2 weeks of mainly oral antibiotic therapy. However, the recent literature on adults does not discriminate among different upper urinary tract infections nor does it provide data on renal scarring. While cost constraints point towards short-term therapies, further studies are needed to assess the prevalence and long-term effect of kidney scars.
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Piccoli GB, Soragna G, Putaggio S, Consiglio V, Magnano A, Mezza E, Bonetto A, Geuna S. Is male homosexuality still a cultural taboo for kidney donation? Transplant Proc 2006; 38:1224-6. [PMID: 16797269 DOI: 10.1016/j.transproceed.2006.02.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Among the so-called social risk behaviors, male homosexuality is probably one of the most interesting and difficult taboos. Because of changing attitudes of the general population toward irregular sexual behaviors, often considered as markers of unhealthy life styles, there is a need to reconsider at least the most important one-homosexuality. METHODS A semistructured questionnaire included opinions on homosexuality with respect to kidney donation: Would you consider a male homosexual as a kidney donor? If you were on dialysis, would you accept a kidney from a homosexual donor? This instrument was administered to various groups of the general public and caregivers: high school students (Liceo Classico: 59 students, median age 18 years; Istituto Tecnico: n=108, median age 17); first and fourth year of medical school (n=77, age 19; 46, age 22); continuing medical education (n=44, age 32); third year of nursing school (n=31, age 23); "senior citizen university" (n=51, age 63). RESULTS Male homosexuality was well accepted for kidney donation (71.6% yes, 9.6% no, 18.8% uncertain/blank). However, the opinions were different among the groups with male students of a technical institute showing discrimination against male homosexuals. In the univariate analysis, opinions differed according to age, gender, and belonging to the health care team. In the multivariate analysis, the latter was the strongest predictor (P<.01). The specific threats for the health are not well known, even among the caregiver population. CONCLUSION It is difficult to define the role of homosexuality among the so-called social risk behaviors. Negative attitudes existed in some subsets of the population.
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Affiliation(s)
- G B Piccoli
- Nephrology, University of Torino, Torino, Italy.
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Burdese M, Consiglio V, Mezza E, Bergamo D, Grassi G, Soragna G, Rossetti M, Segoloni GP, Mazzucco G, Piccoli GB. 'Primary' nephrosclerosis in a type 1 diabetic patient. Nephrol Dial Transplant 2005; 20:817-9. [PMID: 15772267 DOI: 10.1093/ndt/gfh659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Manuel Burdese
- Department of Internal Medicine, University of Turin, Italy
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Piccoli GB, Sargiotto A, Burdese M, Consiglio V, Mezza E, Rossetti M, Picciotto G, Segoloni GP. Grafted kidney, native kidney and proteinuria after pre-emptive pancreas-kidney transplantation: questions and answers. Nephrol Dial Transplant 2005; 21:1139-40. [PMID: 16280377 DOI: 10.1093/ndt/gfh969] [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: 11/13/2022] Open
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Piccoli GB, Sargiotto A, Burdese M, Colla L, Bilucaglia D, Magnano A, Consiglio V, Piccoli G, Picciotto G. Cholesterol emboli syndrome in type 2 diabetes: the disease history of a case evaluated with renal scintigraphy. Rev Diabet Stud 2005; 2:92-6. [PMID: 17491684 PMCID: PMC1783551 DOI: 10.1900/rds.2005.2.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cholesterol crystal emboli syndrome (CCE) is an emerging disease, whose progression reflects the currently observed increase in cardiovascular diseases. Diagnostic criteria shifted from pathological to clinical criteria: creatinine increase, skin lesions, recent endovascular interventions and severe vasculopathy). Diabetes, hypertension and diffuse vascular disease are inter-linked, major risk factors. The role of imaging techniques in the diagnosis and treatment of the disease has been little investigated thus far. The AIM of this report is to describe a case exemplifying the potentials for renal scintigraphy in CCE, an emerging disease in type 2 diabetic patients. THE CASE A 75 year-old, type 2 diabetic for over 15 years, obese, hypertensive white man was referred to the Nephrology Unit after an acute coronary syndrome. Stenosis of the left renal artery was diagnosed from the angiography. Serum creatinine (baseline: 1.9 mg/dl) increased after multiple angioplasties to 3.3 mg/dl, then slowly returned towards baseline (2.2 mg/dl), but rose, on referral, to 3.9 mg/dl, with an increase in acute phase reactants and peripheral livedo reticularis, a picture highly suggestive of CCE. The first renal scintiscan showed a reduction of the parenchymal phase, and a non-homogeneous parenchymal pattern in the right dominant kidney. The patient was started on corticosteroid therapy with a prompt decrease in creatinine; four days later (creatinine 2.5 mg/dl) a second scintiscan showed an improvement of the peak time and of the radionuclide parenchymal transit, and was further confirmed two months later (creatinine 2.2 mg/dl). No modification was detected in the left kidney, presumably mechanically "protected" from the cholesterol shedding by the stenosis. CONCLUSIONS This is the first description of an imaging demonstration of the morpho-functional substratum to the rapid clinical response of corticosteroid therapy in a case of CCE and type 2 diabetes, underlining the potential of 99mTc-MAG3 dynamic scintiscan in this disease.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Internal Medicine, University of Turin, Corso Bramante 86-88, 10126 Torino, Italy.
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Burdese M, Veglio V, Consiglio V, Soragna G, Mezza E, Bergamo D, Tattoli F, Rossetti M, Jeantet A, Segoloni GP, Piccoli GB. A dance teacher with kidney–pancreas transplant and diarrhoea: what is the cause? Nephrol Dial Transplant 2005; 20:1759-61. [PMID: 16033769 DOI: 10.1093/ndt/gfh881] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Manuel Burdese
- Chair of Nephrology of the University of Torino, Corso Bramante 86-88, 10126 Torino, Italy
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Mezza E, Oggé G, Attini R, Rossetti M, Soragna G, Consiglio V, Burdese M, Vespertino E, Tattoli F, Gai M, Motta D, Segoloni GP, Todros T, Piccoli GB. Pregnancy after kidney transplantation: an evidence-based approach. Transplant Proc 2005; 36:2988-90. [PMID: 15686677 DOI: 10.1016/j.transproceed.2004.10.064] [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: 11/20/2022]
Abstract
Despite the relatively little space for transplantation in most medical schools, this issue is considered interesting by the students both for its clinical and ethical implications. The students were asked to choose a particular aspect of nephrology for a 2-hour case discussion. They chose the case of a 35-year-old female, kidney transplant recipient now 1.5 years postoperatively, who was coming to seek advice about pregnancy. The aim of the present work is to report an integration between narrative and evidence-based medicine (EBM) approaches. The search strategy was developed within a multidisciplinary working group, two of whose members were also masters in the methodology of systematic revisions. The first step in the discussion was the identification of ethical and methodological problem. In a rapidly developing field, books are unlikely to be able to give updated information. One needs to interact with electronic databases. In this context, no randomized controlled trial on pregnancy is expected. The evidence is likely to be heterogeneous. Prenatal care delivery differs around the world in part related to attitudes toward pregnancy, which depend upon religion and traditions. The second step was the definition of the search strategy. The third step, was selecting and cataloging the evidence. The titles and abstracts retrieved by the search strategy (272 items) were examined to identify full papers to be retrieved. The evidence retrieved was screened for the type of paper (reviews, primary studies, case reports, case series) and for the authors to give an indirect idea of duplicate publication bias. Teaching a complex and ever-changing subject, such as kidney transplantation, is a difficult task. The case of a young woman seeking information on the probability to undergo a successful pregnancy was particularly likely to exemplify the importance of being aware of the biases of the book-based information and on the need to interact with the internet. The search strategy developed by the working group of postgraduate trainees allowed students to have a direct experience with the complexity of the field. This preliminary study, as the basis for development of a checklist informed consent form on pregnancy in kidney transplantation, may give a first rough quantification of the work needed by a physician who wants to have a direct idea of the odds and risks of pregnancy in kidney transplant patients.
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Affiliation(s)
- E Mezza
- Department of Internal Medicine, University of Turin, Turin, Italy
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Burdese M, Consiglio V, Mezza E, Savio D, Guarena C, Rossetti M, Messina M, Soragna G, Suriani C, Rabbia C, Segoloni GP, Piccoli GB. Diffuse vascular damage in a transplanted kidney: an indication for nuclear magnetic resonance? Transplant Proc 2005; 37:2063-5. [PMID: 15964339 DOI: 10.1016/j.transproceed.2005.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Indexed: 11/16/2022]
Abstract
Vascular lesions are an increasing challenge after renal transplantation due to the wider indications for recipients and acceptance criteria for donors. Diagnostic approach and prognostic interpretation are still matter of controversy. The case reported herein may summarize some of the issues in this regard. A 54-year-old woman, on renal replacement therapy since 1974, and a kidney graft recipient from 1975 to 1999, received a second graft in 2001. The donor age was 65 years (cold ischemia 22 hours; two mismatches). The early posttransplant follow-up was characterized by delayed graft function, hypertension, and diabetes. During the initial hypertension workup, renal graft ultrasound (US) Doppler demonstrated increased vascular resistances, stable over time (resistance index 0.74 to 0.77); renal scintiscan displayed homogeneously parenchymoa and angio-magnetic resonance imaging (MRI), an homogeneous parenchymal vascularization. Initial immunosuppression with tacrolimus and steroids was modulated by adding mycophenolate mofetil to taper tacrolimus (to reduce nephrotoxicity and hypertension). Despite this, kidney function slowly deteriorated; serum creatinine reached 3 to 3.5 mg/dL by the second year. After a severe hypertensive crisis with unchanged scintiscan and US doppler examinations, angio-MRI revealed the almost complete disappearance of parenchymal enhancement beyond the lobar arteries. A renal biopsy confirmed the severe vascular damage. The patient was switched to rapamycine and a low-dose of an angiotension converting enzyme (ACE) inhibitor. She did relatively well (serum creatinine 2.2 to 3 mg/dL) for 6 months, when rapid functional impairment forced her to restart hemodialysis. This case, almost paradigmatic of the problems occurring when the rigid vasculature of long-term dialysis patients is matched with "marginal kidneys," suggests that MRI may be a sensible good to define vascular damage in the grafted kidney.
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Affiliation(s)
- M Burdese
- Department of Internal Medicine, University of Turin, Bramante 88, 10126 Turin, Italy
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Piccoli GB, Soragna G, Mezza E, Burdese M, Consiglio V, Gai M, Giacchino F, Segoloni GP. Living life: mottos and logos on renal transplantation designed by high school students. Nephrol Dial Transplant 2005; 20:1307-10. [PMID: 15928102 DOI: 10.1093/ndt/gfh668] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mezza E, Consiglio V, Soragna G, Putaggio S, Burdese M, Perrotta L, Jeantet A, Segoloni GP, Piccoli GB. CKD Patients and Erythropoietin: Do We Need Evidence-Based Informed Consent? Int J Artif Organs 2005; 28:591-9. [PMID: 16015569 DOI: 10.1177/039139880502800608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BackgroundConsent to therapy is increasingly requested in the form of “informed consent”.ObjectiveTo validate an evidence-based informed consent form for erythropoietin (EPO) therapy and to evaluate patient opinions about the informed consent approach.MethodsAn evidence-based informed consent form was developed as part of the Evidence-Based-Medicine course at the Medical School of Turin, Italy. It was validated by anonymous questionnaires (0–10 analogical scales and open answers) administered to patients at different stages of CKD (19 pre-ESRD, 26 hemodialysis, 12 transplant patients) attending an outpatient unit of the University of Turin, to 8 nurses, and to 26 medical students.ResultsAll individuals filled in the questionnaire. Interest in a detailed explanation of the therapy was high (median 9), as was comprehension (median 9), with no differences between patients with regard to disease stage (pre-ESRD vs. RRT) or educational level. Prior knowledge of the therapy was affected by the educational level (p=0.013 for the advantages and p=0.004 for the side effects) and the professional role (patients vs caregivers: p=0.009 for the advantages and p<0.001 for side affects); patient knowledge of the advantages (median 6) tended to increase as the disease progressed (p=0.015). The most common response by patients was that informed consent was necessary for all drugs (35.1%); 73.1% of the caregivers considered it necessary only for severe side effects. The preferred modality of consent was discussion with the caregiver during the clinical controls (42% of all cases).ConclusionsPatient interest in and comprehension of an informed consent form with a detailed explanation of the therapy was high; the caregiver's opinion was still the most valued teaching tool.
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Affiliation(s)
- E Mezza
- Department of Internal Medicine, University of Torino, Torino, Italy
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Piccoli GB, Burdese M, Rossetti M, Savio D, Suriani C, Guarena C, Consiglio V, Mezza E, Soragna G, Rabbia C, Segoloni GP, Piccoli G. Quiz page. Acute infarction in a grafted kidney. Am J Kidney Dis 2005; 45:A49, e73-4. [PMID: 15861337] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Piccoli GB, Mezza E, Burdese M, Consiglio V, Vaggione S, Mastella C, Jeantet A, Maddalena E, Martina G, Gai M, Motta D, Segoloni GP, Piccoli G. Dialysis choice in the context of an early referral policy: there is room for self care. J Nephrol 2005; 18:267-75. [PMID: 16013014] [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: 05/03/2023]
Abstract
BACKGROUND Predialysis care is vital for the patient and is crucial for dialysis choice: empowered, early referred patients tend to prefer out-of-hospital and self-care treatment; despite these claims, early referral remains too often a program more than a reality. Aim of the study was to evaluate the pattern and reasons for RRT choice in patients treated in a long-standing outpatient network, presently following 850 chronic patients (about 80% diabetics), working with an early referral policy and offering a wide set of dialysis options (home hemo and PD; self care and limited care hemodialysis; hospital hemodialysis). METHODS Prospective historical study. All patients who started RRT in January 2001-December 2003 were considered. Correlations between demographical (sex, age, educational level) or clinical variables (pre-RRT follow-up, comorbidity, SGA and Karnofsky) and treatment choice have been tested by univariate (chi-square, Kruskal-Wallis) and multivariate models (logistic regression), both considering all choices and dichotomising choice into "hospital" versus "out of hospital dialysis". RESULTS Hospital dialysis was chosen by 32.6% of patients; out of hospital in 67.4% (PD 26.5%, limited-care 18.4%, home hemodialysis 4.1%, self-care 18.4%). Hospital dialysis and PD were chosen by elderly patients (median age: 67.5 and 70 years respectively) with multiple comorbidities (75% and 92.3%); no difference for age, comorbidity, Karnofsky, SGA and educational level. 6/13 PD patients needed the help of a partner. Self-care/home hemodialysis patients were younger (median age 52), had higher educational level (p = 0.014) and lower prevalence of comorbidity (63.6% vs 94.7% in the other dialysis patients, p = 0.006). In the context of a long follow-up period (3.9 years) a statistically significant difference was found comparing hospital dialysis (3.3 years) vs out of hospital dialysis (4.9 years) (p = 0.035). In a logistic regression model, only pre-RRT follow-up was correlated with dialysis "hospital vs "out of hospital" choice (p = 0.014). CONCLUSION Early nephrological follow-up may enhance self and home-based dialysis care.
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Burdese M, Rossetti M, Guarena C, Consiglio V, Mezza E, Soragna G, Gai M, Segoloni GP, Piccoli GB. Sirolimus and ACE-inhibitors: a note of caution. Transplantation 2005; 79:251-2. [PMID: 15665781 DOI: 10.1097/01.tp.0000140966.13047.85] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Piccoli GB, Mezza E, Bontempo S, Burdese M, Soragna G, Gai M, Consiglio V, Jeantet A, Segoloni GP, Piccoli G, Todros T. Vasculitis and kidney involvement in pregnancy: evidence-based medicine and ethics bear upon clinical choices. Nephrol Dial Transplant 2005; 19:2909-13. [PMID: 15496568 DOI: 10.1093/ndt/gfh353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dell'Olio R, Mezza E, Rossetti M, Soragna G, Putaggio S, Burdese M, Gai M, Motta D, Vespertino E, Bianchi V, Consiglio V, Tattoli F, Bonetto A, Segoloni GP, Piccoli GB. Continuing education in medicine: a useful tool for nurses' empowerment in renal transplantation. Transplant Proc 2004; 36:2553-5. [PMID: 15621087 DOI: 10.1016/j.transproceed.2004.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Continuing Education in Medicine (CEM) underlines the importance of updates and information for the health care team. Our aim was to describe the organization and results of a CEM course "educate to organ donation" that involved the nursing team in an educational experience with high school students. The course consists of theory (4 hours; the physician-patient relationship, the educational role of the nurse, the teaching policy, checklist, and results of a school education program) and practice (10 hours; the attendants join the teaching team in the classrooms and in the plenary session). Analysis of anonymous questionnaires performed after the course contained semistructured questions and analog scales. RESULTS The first acknowledgment came from the Cabinet of Public Health, which gave the maximum number of credits (14 for 14 education hours). PARTICIPATION presently 40 nurses, about 40% of those working in the renal unit (over 30 CEM courses are available in the hospital). Satisfaction: Overall score was median 8.5 (6 to 10) including teaching materials = 8 (4 to 10). Among the theoretical part, the lesson on patient-physician relationship obtained the highest score. The main drawback was the shortness of the practical part. The classroom meeting achieved a median score of 9.5 (7 to 10), the general session = 9 (5 to 10). All but one nurse registered for an "advanced" course, giving more time to the practical part (20 hours). CONCLUSION CEM may represent an important way to deliver education on transplant-related issues to patients and to the general population.
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Affiliation(s)
- R Dell'Olio
- Centro Didattico, University of Turin, Italy
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Mezza E, Soragna G, Consiglio V, Putaggio S, Burdese M, Maddalena E, Bravin M, Gai M, Motta D, Tattoli F, Piccoli GB. Asclepiad's cock: a patient-physician association is a useful tool for educational programs in nephrology, dialysis, and transplantation. Transplant Proc 2004; 36:2546-9. [PMID: 15621085 DOI: 10.1016/j.transproceed.2004.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The negative impact of the mass media, the lack of information, and the request for in-depth knowledge are the basis for the present need for educational programs on transplantation, brain death, and chronic kidney diseases end-stage renal disease; (ESRD). The aim of the present article was to critically review the activities performed by Il Gallo di Esculapio, a nonprofit association, in the education on the different phases of ESRD. The associates are physicians and patients, and the activities are integrated institutionally. METHODS This report is a narrative review of the material produced and performed by Il Gallo di Esculapio ONLUS in 1996-2004. RESULTS The two main activities developed were book writing and an educational program. Eight books for patient education were written on different aspects of dialysis, transplantation, and ESRD. Most were designed as theses of the Medical School. Cooperation with patients was important in all cases and fundamental for the collection of interviews. EDUCATION A 4-hour educational program on transplantation started in 2000-2001 (1 high school was involved). The checklist originally included only transplantation and organ donation, but progressively gave space also to dialysis, ESRD, and social health care problems. In 2003-2004 the program involved 67 high schools. The association coordinated progressive patient involvement. CONCLUSION Small, nonprofit patient-physician associations linked with the University allow enrolling resources for educational activities to often-neglected parts of the medical profession.
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Affiliation(s)
- E Mezza
- Nephrology, University of Torino, Torino, Italy
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Rossetti M, Piccoli GB, Burdese M, Guarena C, Giraudi R, Mezza E, Consiglio V, Soragna G, Messina M, Segoloni GP. Tailored immunosuppression and steroid withdrawal in pancreas-kidney transplantation. Rev Diabet Stud 2004; 1:129-36. [PMID: 17491675 PMCID: PMC1783543 DOI: 10.1900/rds.2004.1.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Recent improvements in simultaneous pancreas-kidney transplantation (SPK) and the striking decrease in acute rejection lead us to focus on the effects of long-term immunosuppression. AIM OF THIS STUDY Evaluation of a policy of steroid withdrawal and tailored immunosuppression in pancreas-kidney patients treated in a single center. METHODS review of the clinical charts in 9 SPK recipients (male/female = 5/4, median age 41 years, median follow-up 42 months), by the same operator, under supervision of the two usual caregivers. Therapeutic protocols. Induction phase: all patients received mycophenolate mophetil (starting dose: 2 grams), tacrolimus and steroids, 8 received Simulect, 1 received thymoglobulins. Maintenance therapy was slowly reduced, with the goal of steroid withdrawal. RESULTS The therapeutic adjustments were mainly determined by two almost opposing elements: 1. Rapid adjustments in the case of side-effects (gastrointestinal problems, infections and neoplasia); 2. Slow tapering off in the case of good organ function. On the other hand, a switch to cyclosporine A and to rapamycine was considered in the case of chronic organ malfunction. By these means, over a median of 42 months follow-up, steroid withdrawal was slowly obtained in 6/9 patients (at a median time of 25 months). CONCLUSIONS Within the limits of this small-scale study, a tailored immunosuppressive policy allows at least some "positively selected" patients to reach the "dream" of steroid withdrawal after SPK.
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Piccoli G, Segoloni GP, Soragna G, Mezza E, Burdese M, Tognarelli G, Putaggio S, Bergamo D, Consiglio V, Vespertino E, Bonetto A, Jeantet A, Piccoli GB, Giacchino F, Gai M, Dell'Olio R. Teenagers' point of view on living donor kidney transplantation: Cinderella or princess? J Nephrol 2004; 17 Suppl 8:S47-54. [PMID: 15599886] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
UNLABELLED Living kidney donation is an important clinical option, encountering different fortunes in the world. AIM To analyse the opinions of a large subset of older teenagers attending high school (7999 students, median age 18) on different aspects of living kidney transplantation. METHODS Analysis of semistructured questionnaires submitted within an educational campaign on dialysis and transplantation in the high schools of Torino and its county (about 2,000,000 inhabitants). RESULTS Over 90% of the students had already heard of transplantation, mainly via television (88.4% county, 84.5% city). 80% would donate a kidney to a family member (3.5% wouldn't, 16.5% uncertain); answers were correlated with sex (females more than males p<0.0001), school type (istituti tecnici versus licei p=0.007), interest (yes versus other p<0.0001). A lower percent of individuals would receive a kidney (58.4% county, 59.4% city), only 10% would ask for donation. Over 40% of students consider legally buying a kidney a patient's right, only 26.6% would discourage this choice. The answers were correlated with the reverse pattern as for non-mercenary donation with type of school (licei more than istituti tecnici: p<0.0001), sex (males versus females p<0.0001), interest (not versus yes: p=0.002). CONCLUSIONS Teenagers are favourable towards all forms of living kidney donation. The lower prevalence of positive answers on acceptance versus donation suggests that fears of endangering the donor's health may be one of the causes for a low living donation rate in our setting. The mixed answers on mercenary donation suggest discussing this complex issue in future educational programs.
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Affiliation(s)
- Giuseppe Piccoli
- Department of Internal Medicine, University of Torino and Unit of Nephrology, Dialysis and Transplantation, San Giovanni Battista Hospital, Torino, Italy.
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Piccoli GB, Novaresio C, Mezza E, Soragna G, Rossetti M, Burdese M, Putaggio S, Dell'Olio R, Bravin M, Consiglio V, Tattoli F, Maddalena E, Gai M, Motta D, Bonetto A, Jeantet A, Segoloni GP. Making a movie on kidney transplantation: A medical school graduation thesis to explain kidney transplantation from students to students. Transplant Proc 2004; 36:2550-2. [PMID: 15621086 DOI: 10.1016/j.transproceed.2004.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/18/2022]
Abstract
The aim of this study was to report on the production and the opinions of a video movie on transplantation and organ donation. The video was developed by a medical school student with the help of the students and teachers of a high school for applied arts. For this task, the making of the video was included in the high school program of the participating class. The students were tutored by their photography teacher. The video movie lasts about 50 minutes. Each "scene" lasts no more than 5 minutes, to avoid reducing the attention level. The choice of a nonmedical frame helped to have some moments to digest the technical information and to stress the importance of the patient-physician relationship. The video was employed as a part of small-group lessons in the nephrology course. A semistructured anonymous questionnaire gathered the opinion of 65 students at the end of the lessons. Student satisfaction was high; the median score was the highest (8, range 6 to 10) for the lesson based upon the movie, as compared with the conventional ones on chronic kidney disease or dialysis (7, range 5 to 10). As far as the authors know, this is the first experiment of a multimedia approach, dedicated to medical and nonmedical targets, developed as a graduation thesis in an Italian Medical School. In conclusion, the positive opinions of the students, who highly appreciated the peer-developed message, may suggest implementing such nonconventional educational approaches to support human resources and enthusiasm for kidney transplantation among the new generations.
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Affiliation(s)
- G B Piccoli
- Nephrology, Department of Internal Medicine, Torino 10126, Italy.
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Piccoli GB, Motta D, Gai M, Mezza E, Maddalena E, Bravin M, Tattoli F, Consiglio V, Burdese M, Bilucaglia D, Ferrari A, Segoloni GP. Tailored dialysis start may allow persistence of residual renal function after graft failure: A case report. Transplant Proc 2004; 36:2607-9. [PMID: 15621101 DOI: 10.1016/j.transproceed.2004.09.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
BACKGROUND Restarting dialysis after kidney transplantation is a critical step with psychological and clinical implications. Maintenance of residual renal function a known factor affecting survival in chronic kidney disease, has so far not been investigated after a kidney transplantation. THE CASE A 54-year-old woman who started dialysis in 1974 (first graft, 1975-1999) received a second "marginal" kidney graft in February 2001 (donor age, 65 years). Her chronic therapy was tacrolimus and steroids. She had a clinical history as follows: nadir creatinine level of 1.5 mg/dL, moderate-severe hypertension, progressive graft dysfunction, nonresponsiveness to addition of mycophenolate, tapering FK levels, and a rescue switch from tacrolimus to rapamycin. From October to December 2003, the creatinine level increased from 2-2.8 to 7 mg/dL. Biopsy specimen showed malignant and "benign" nephrosclerosis, posttransplantation glomerulopathy, and tacrolimus toxicity. Chronic dialysis was started (GFR <3 mL/min). Rapamycin was discontinued. Dialysis was tailored to reach an equivalent renal clearance of >15 mL/min (2 sessions/wk). Blood pressure control improved, nephrotoxic drugs were avoided, and fluid loss was minimized (maximum 500 mL/hr). By this policy, renal function progressively increased to GFR >10 mL/min in May 2004, allowing a once or twice weekly dialysis schedule, with good clinical balance, and obvious advantages for the quality of life. CONCLUSION This long-term patient, who restarted dialysis with severely reduced renal function, regained sufficient renal function to allow once weekly dialysis. Thus, careful tailoring of dialysis sessions at the restart of dialysis may allow preservation of residual kidney function, at least in individuals for whom a subsequent graft is unlikely.
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Affiliation(s)
- G B Piccoli
- Nephrology, University of Torino, 101260 Torino, Italy.
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Piccoli GB, Motta D, Martina G, Consiglio V, Gai M, Mezza E, Maddalena E, Burdese M, Colla L, Tattoli F, Anania P, Rossetti M, Soragna G, Grassi G, Dani F, Jeantet A, Segoloni GP. Low-protein vegetarian diet with alpha-chetoanalogues prior to pre-emptive pancreas-kidney transplantation. Rev Diabet Stud 2004; 1:95-102. [PMID: 17491671 PMCID: PMC1783536 DOI: 10.1900/rds.2004.1.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pre-emptive pancreas-kidney transplantation is increasingly considered the best therapy for irreversible chronic kidney disease (CKD) in type 1 diabetics. However, the best approach in the wait for transplantation has not yet been defined. AIM To evaluate our experience with a low-protein (0.6 g/kg/day) vegetarian diet supplemented with alpha-chetoanalogues in type 1 diabetic patients in the wait for pancreas-kidney transplantation. METHODS Prospective study. Information on the progression of renal disease, compliance, metabolic control, reasons for choice and for drop-out were recorded prospectively; the data for the subset of patients who underwent the diet while awaiting a pancreas-kidney graft are analysed in this report. RESULTS From November 1998 to April 2004, 9 type 1 diabetic patients, wait-listed or performing tests for wait-listing for pancreas-kidney transplantation, started the diet. All of them were followed by nephrologists and diabetologists, in the context of integrated care. There were 4 males and 5 females; median age 38 years (range 27.9-45.5); median diabetes duration 23.8 years (range 16.6-33.1), 8/9 with widespread organ damage; median creatinine at the start of the diet: 3.2 mg/dl (1.2-7.2); 4 patients followed the diet to transplantation, 2 are presently on the diet, 2 dropped out and started dialysis after a few months, 1 started dialysis (rescue treatment). The nutritional status remained stable, glycemia control improved in 4 patients in the short term and in 2 in the long term, no hyperkalemia, acidosis or other relevant side effect was recorded. Proteinuria decreased in 5 cases, in 3 from the nephrotic range. Albumin levels remained stable; the progression rate was a loss of 0.47 ml/min of creatinine clearance per month (ranging from an increase of 0.06 to a decrease of 2.4 ml/min) during the diet period (estimated by the Cockroft-Gault formula). CONCLUSIONS Low-protein supplemented vegetarian diets may be a useful tool to slow CKD progression whilst awaiting pancreas-kidney transplantation.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Internal Medicine, University of Turin, Corso Dogliotti 16, 10126 Torino, Italy.
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Piccoli GB, Rossetti M, Guarena C, Consiglio V, Mezza E, Soragna G, Grassi G, Burdese M, Gai M, Marchetti P, Boggi U, Segoloni GP. Myalgia: an uncommon or underestimated side effect of mycophenolate mophetil after transplantation? Nephrol Dial Transplant 2004; 19:1940-2. [PMID: 15199214 DOI: 10.1093/ndt/gfh199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Piccoli GB, Soragna G, Putaggio S, Burdese M, Longo P, Rinaldi D, Bergamo D, Mezza E, Consiglio V, Novaresio C, Gai M, Motta D, Malfi B, Giacchino F, Jeantet A, Segoloni GP. How many organs should one patient receive? the ethics of transplantation in the medical school. Transplant Proc 2004; 36:444-5. [PMID: 15110551 DOI: 10.1016/j.transproceed.2004.02.064] [Citation(s) in RCA: 3] [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: 11/17/2022]
Abstract
BACKGROUND Interest in the humanities in the medical school is growing; while several medical schools, mainly of Anglo-Saxon background, have developed dedicated courses, the experience in Italy is limited. METHODS Since the academic year 2000 to 2001, a discussion of ethical problems was implemented in the nephrology course (fourth year of the Medical School of Torino, Italy; overall 6 years). In 2002 to 2003, a case entitled "Retransplantation of Multiple Organs (Prog Transplant 2002)" was discussed in 2 hours of small-group tutorial teaching: a boy received a renal graft at age 5, failed at age 7 due to recurrent glomerulonephritis, required a heart-kidney graft at age 11, and a second heart-kidney graft at 17. Student opinions were gathered by anonymous semistructured questionnaires at the beginning of the lessons as a basis for discussion. RESULTS Following the lessons all students returned the questionnaires (n = 104). In the absence of competition for allocation, retransplantation was approved by 76.2%, unacceptable for 1% (22.9% uncertain-blank). With a waiting list of 10 patients, the opinions changed: 32.4% approved transplantation, 6.7% didn't approve it, 60.9% were uncertain. A theoretical categorization into deontological or utilitaristic approaches favored the first (41.9% vs 26.7%), with a high prevalence of blank-uncertain (31.5%); 21.9% of the students would change their opinion was that study head of the Transplant Department. CONCLUSION Ethical aspects of the medical profession have been discussed with interest by medical school students; the high prevalence of uncertain answers and requests to develop specific tools underline the importance of this educational approach.
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Affiliation(s)
- G B Piccoli
- Cattedra di Nefrologia, Dipartimento di Medicina Interna, Università di Torino, Torino, Italy.
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