Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia最新文献

{"title":"[Tempistica e Durata delle Visite Nefrologiche in Italia].","authors":"Simonetta Cimino, Andrea Ambrosini, Vincenzo Bellizzi, Luca De Nicola, Filippo Aucella, Laura Cosmai, Paolo De Paolis, Giuseppe Di Cienzo, Gianluca Leonardi, Nicola Lepori, Carmelita Marcantoni, Giuseppe Mennella, Marcello Napoli","doi":"10.69097/43-01-2026-02","DOIUrl":"https://doi.org/10.69097/43-01-2026-02","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Kidney Disease: A New Concept in the Interaction Between Obesity, Prediabetes, Diabetes and Liver Dysfunction.","authors":"Jorge Rico Fontalvo, Rodrigo Daza Arnedo, María Raad Sarabia, Javier Jiménez, Juan Montejo-Hernández, Tomas Rodríguez-Yánez, María José Soler, Maria Teresa Sciarrone-Alibrandi, Rodolfo Fernando Rivera","doi":"10.69097/43-01-2026-06","DOIUrl":"https://doi.org/10.69097/43-01-2026-06","url":null,"abstract":"<p><p>Metabolic abnormalities such as obesity, insulin resistance, prediabetes, type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD) increasingly contribute to chronic kidney disease (CKD). Although often treated as separate entities, these conditions share common mechanisms - including glomerular hyperfiltration, adipokine imbalance, chronic low-grade inflammation, endothelial dysfunction and lipid accumulation - that initiate and sustain renal injury long before classical CKD becomes clinically evident. The concept of Metabolic Kidney Disease (MKD) offers a unified framework that captures the continuum of renal involvement across the metabolic spectrum. Obesity- and prediabetes-related MKD frequently precede diabetic kidney disease, while MASLD - according to updated EASL-EASD-EASO guidelines - is a multisystem disorder with direct renal consequences. Mixed metabolic phenotypes further intensify metabolic stress, accelerating progression toward CKD. Recognising MKD has important clinical implications. Expanded screening strategies may identify early renal alterations in individuals with metabolic vulnerability who are not targeted by traditional CKD criteria. Integrating metabolic evaluation into nephrology practice may facilitate earlier, more holistic interventions and ultimately improve cardio-renal outcomes.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apolipoprotein L1 (APOL1) and Nephropathy.","authors":"Alanis Yael Szyferman, Soledad Kleppe, Fabrizio Cristiano, Juan C Conde-Manotas, Andrés Cadena-Bonfanti, Gustavo Aroca-Martinez, Carlos G Musso","doi":"10.69097/43-01-2026-05","DOIUrl":"https://doi.org/10.69097/43-01-2026-05","url":null,"abstract":"<p><p><b>Introduction.</b> End-stage renal disease exhibits a disproportionate prevalence among Black individuals and older adults within the United States and worldwide. A significant genetic contributor to this disparity is the Apolipoprotein L1 (APOL1) gene, found exclusively in populations of African ancestry. <b>Materials and Method.</b> We aim to perform a narrative review regarding the current understanding of APOL1 and its complex role in kidney disease pathogenesis. <b>Results.</b> The G1 and G2 APOL1 risk alleles are strongly associated with an elevated risk for non-diabetic chronic kidney disease (CKD), including hypertensive nephropathy, focal segmental glomerulosclerosis, and HIV-associated nephropathy, in individuals who are homozygous or compound heterozygous for these variants. While 10-15% of African Americans carry two APOL1 risk alleles, approximately 80% remain disease-free, suggesting incomplete penetrance and the involvement of additional risk factors. In this condition, renal damage could be induced through different mechanisms such as altered cellular ion transport, mitochondrial dysfunction, and the requirement for additional stressors or \"second hits\". <b>Conclusion.</b> The increased susceptibility to end-stage renal disease (ESRD) in individuals of African ancestry is influenced by variations in the APOL1 gene.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fast-Track Program: A new Organizational Model to Enhance Living Donor and Pre-emptive Kidney Transplantation.","authors":"Anna Regalia, Maria Letizia De Simeis, Carlo Alfieri, Evaldo Favi, Paolo Molinari, Simona Verdesca, Anna Sikharulidze, Antenore Giussani, Samuele Iesari, Luca Lamperti, Sara Maritato, Roberto Cacciola, Mariano Ferraresso, Giuseppe Castellano","doi":"10.69097/43-01-2026-07","DOIUrl":"https://doi.org/10.69097/43-01-2026-07","url":null,"abstract":"<p><p>Living donor kidney transplantation (LD KTx), especially when performed pre-emptively, remains the gold standard for treating end-stage renal disease (ESRD). In Italy, however, this resource remains underutilized due to significant organizational hurdles and protracted evaluation timelines. To overcome this limitation, a Fast-track program (FTp) was developed in our Center, aiming to perform the clinical work-up of donor and recipient candidates pairs (DR) in five consecutive days with dedicated schedules on outpatient basis. The results so far obtained in twenty DR evaluated with the FTp indicate an important reduction in the time between the first consultation and LD KTx and a higher proportion of pre-emptive KTx compared to fifty-four DR studied with the traditional work-up protocol (Tp). By simplifying logistics for patients traveling from distant regions, this model could serve as a scalable template to improve transplant access and outcomes at both regional and inter-regional levels.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bidirectional Interaction Between the Gastrointestinal System and the Kidney: Pathophysiological and Clinical Perspective.","authors":"Emre Leventoğlu, Derya Cevizli, Yavuz Emre Parlar","doi":"10.69097/43-01-2026-09","DOIUrl":"https://doi.org/10.69097/43-01-2026-09","url":null,"abstract":"<p><p>The gastrointestinal (GI) system and the kidneys, though anatomically separate, are functionally interconnected through shared responsibilities in maintaining fluid-electrolyte balance, acid-base homeostasis, immune regulation, and hormonal signaling. Disruptions in one system often lead to secondary complications in the other, highlighting the need for a comprehensive understanding of their bidirectional interactions. Kidney involvement in GI diseases commonly results from mechanisms such as fluid loss, malabsorption, systemic inflammation, and exposure to toxins, as seen in conditions like inflammatory bowel disease (IBD), celiac disease, liver failure, and enteric infections. Conversely, GI complications frequently arise in the context of chronic kidney disease (CKD), dialysis, and immunosuppressive therapies post-transplantation, manifesting as symptoms including uremic gastropathy, anorexia, and enteropathy. This review explores these interactions under two main categories: renal complications of GI diseases and GI manifestations of kidney disorders. It also discusses the underlying pathophysiological mechanisms and clinical implications, emphasizing the importance of an integrated, multidisciplinary approach. By highlighting current knowledge gaps, the review aims to foster future research in this complex and clinically significant area. Understanding these bidirectional interactions can inform individualized patient care and improve outcomes in both GI and renal disease contexts.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Reduction in Glucose Ultrafiltration Associated to a Continuously \"Full Abdomen\" Prescription After Introducing a Long Icodextrin Dwell: A Case Series.","authors":"Giulia Boni Brivio, Irene Santinello, Agnese Cappelletti, Marco Heidempergher, Althea Cossettini, Romina Graziani, Giusto Viglino, Loris Neri","doi":"10.69097/43-01-2026-11","DOIUrl":"https://doi.org/10.69097/43-01-2026-11","url":null,"abstract":"<p><p>The decline in residual renal function (RRF) and the increasing peritoneal membrane permeability often require a progressive increase in glucose concentrations and the use of icodextrin (ICO) for the long dwell to maintain adequate ultrafiltration (UF). When these strategies are no longer effective and ultrafiltration failure (UFF) develops, patients typically need to be transferred to hemodialysis (HD). We describe four cases in which the introduction of a daytime dwell with ICO was associated with an unexpected and rapid decline in glucose UF with a full abdomen (overnight in Automated Peritoneal Dialysis (APD) and daytime in Continuous Ambulatory Peritoneal Dialysis (CAPD)), which was \"resolved\" by reintroducing an empty abdomen for part of the day, even while maintaining ICO. The observed phenomenon seems to be less related to the specific solution used during the daytime dwell and more to the continuous 24-hour full abdomen prescription.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Tocilizumab in Kidney Transplantation: A Narrative Review on Desensitization and Antibody-Mediated Rejection Treatment.","authors":"Sonila Mocka, Stefano Ferraro, Michele Marchini, Michela Ardini, Matteo Trezzi, Lucio Manenti","doi":"10.69097/43-01-2026-08","DOIUrl":"https://doi.org/10.69097/43-01-2026-08","url":null,"abstract":"<p><p>Kidney transplantation is generally considered as the best therapeutic approach for patients with end-stage kidney disease. A considerable proportion of patients on the transplant waiting list, nearly one-third, present anti-Human Leukocyte Antigen donor-specific antibodies, a condition that tends to reduce the chances of receiving a transplant and increases the risk of immunological complications after transplantation. Among the different factors influencing graft survival, the immune response remains central in determining long-term outcomes. Antibody-mediated rejection remains a significant clinical challenge, as it contributes to both acute damage and progressive graft deterioration, ultimately affecting its survival. Interleukin-6 has been implicated in several inflammatory and immune regulatory pathways. In kidney transplantation, it is thought to participate in the mechanisms that favor the persistence of plasma cells and the interaction between T and B lymphocytes, thereby sustaining antibody production. By modulating Interleukin-6 signaling, it may be possible to interfere with these processes and limit the extent of alloimmune injury. Tocilizumab, an Interleukin-6 receptor antagonist originally developed for autoimmune conditions, has recently been investigated in the kidney transplant field. Preliminary reports suggest that it could play a role both in desensitization strategies for highly sensitized patients and in the management of antibody-mediated rejection, supporting its potential as an additional option in kidney transplantation.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Raccogliere un'eredità e aprire nuove prospettive].","authors":"Laura Cosmai","doi":"10.69097/43-01-2026-01","DOIUrl":"https://doi.org/10.69097/43-01-2026-01","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Automatic Dynamic Ultrafiltration Compared to Constant Ultrafiltration Methods on Hypovolemic Intradialytic Symptoms: A Single-center Experience.","authors":"Maria Rita Stancanelli, Giuseppe Restivo, Maria Eva Sberna, Veronica Cucci, Veronica Santina Fortunato, Salvatore Gianna, Francesco Scofano, Vincenzo Calabrese","doi":"10.69097/43-01-2026-04","DOIUrl":"https://doi.org/10.69097/43-01-2026-04","url":null,"abstract":"<p><p><b>Background.</b> Hypovolemic intradialytic complications, including cramps, fatigue, and hypotension, are common in hemodialysis patients. Bioimpedance spectroscopy is the gold standard for fluid assessment, but it is not available in all dialysis centers. Ultrasound techniques can help clinicians, but they are operator-dependent and time-consuming. Ultrafiltration control (UF-control), a newer technology, allows for continuous monitoring of real-time blood volume changes (RBV%) and it adjusts ultrafiltration rates optimizing plasma refilling. This study aims to evaluate UF-control's effectiveness in reducing hypovolemia-related events and post-dialysis weight adjustments in chronic dialysis patients. <b>Methods.</b> We enrolled 21 chronic hemodialysis patients, each undergoing 3 treatments with standard constant UF and 3 treatments with UF-control modalities. Hypovolemia-related events were recorded both individually and as a composite outcome. An individualized \"critical RBV%\" was determined for each patient, with UF-control programmed to avoid dropping below this threshold. Data were analyzed using the Wilcoxon signed-rank test and generalized linear mixed models (GLMM), adjusted for interdialytic weight gain (IDWG) and the difference between prescribed and effective ultrafiltration. <b>Results.</b> Hypovolemia-related symptoms were reduced from 32% in the constant UF setting to 7% in UF-control setting (p = 0.007). Similarly, intradialytic hypotension decreased from 18% to 4% (p = 0.022). GLMM analysis confirmed UF-control's significant effect (adj-OR: 0.12, 95% CI: 0.06-0.26, p = 0.004). UF-control also enabled dynamic adjustments to post-HD weight in most patients, with no signs of fluid overload observed. <b>Conclusions.</b> UF-control seems to actually reduce hypovolemic events in dialysis patients and provides a valuable tool for personalized fluid management. This technology can optimize patient tolerance and facilitate precise, session-by-session, dry weight adjustments.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrotic Syndrome and Rapidly Progressive Renal Failure in a Patient with a Monoclonal Component: A Case Report.","authors":"Claudia Lopez, Marica Giliberti, Di Leo Vincenzo, Adriano Montinaro, Adele Mitrotti, Michele Rossini, Loreto Gesualdo","doi":"10.69097/43-01-2026-13","DOIUrl":"https://doi.org/10.69097/43-01-2026-13","url":null,"abstract":"<p><p>We present the case of a 53-year-old woman with nephrotic syndrome, progressive worsening of renal function, anemia, and detection of an IgG lambda monoclonal component. The clinical picture was characterized by nephrotic-range proteinuria, active urinary sediment, selective hypocomplementemia (reduced C3), splenomegaly, and multiple lymphadenopathies. Immunological and infectious investigations were negative. Serum and urine electrophoresis documented an IgG λ monoclonal component with a marked increase in free λ light chains. A kidney biopsy was performed to define the histopathological features and guide therapeutic management. This case highlights the importance of timely multidisciplinary evaluation in nephropathies associated with monoclonal gammopathy of renal significance (MGRS).</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}