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

{"title":"Renal Rehabilitation and Its Relationship with Anemia, Nutritional Status, and Activities of Daily Living in Patients Undergoing Maintenance Hemodialysis: A Systematic Review.","authors":"Padma Jothi, Ram Prabahar Murugesan, Jagadeswaran Dhakshinamoorthy, Arun Kumar M","doi":"10.69097/43-04-2026-09","DOIUrl":"10.69097/43-04-2026-09","url":null,"abstract":"<p><p>Renal rehabilitation is increasingly recognized as a complementary strategy to address the clinical and functional complications of maintenance hemodialysis. This review evaluated the effects of renal rehabilitation, including structured exercise, nutritional support, and multidisciplinary interventions, on anemia, nutritional status, and activities of daily living in adults undergoing maintenance hemodialysis. Studies published between 2015 and 2025 were reviewed according to PRISMA criteria, and 42 studies were included in the qualitative synthesis. Overall, renal rehabilitation was associated with modest improvements in hemoglobin levels and erythropoiesis-stimulating agent responsiveness, as well as favorable changes in nutritional and muscle-related parameters. The most consistent benefits were observed in functional outcomes, including exercise capacity, muscle strength, frailty, and activities of daily living. These findings support renal rehabilitation as a promising multidimensional approach in maintenance hemodialysis, although heterogeneity among interventions and study designs highlights the need for standardized, adequately powered long-term trials.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897229","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":"[Taurolidine in Hemodialysis Central Venous Catheters: A Single-Center Retrospective Study and Future Perspectives].","authors":"Clara Migotto, Federica Cappelli, Milena Maggio, Alessandra Manini, Anna Poltronieri, Fabio Puricelli, Chiara Ronga, Maria Lucia Scaramuzzi, Gianluca Fasoli, Luigi Apuzzo","doi":"10.69097/43-03-2026-02","DOIUrl":"10.69097/43-03-2026-02","url":null,"abstract":"<p><p><b>Background.</b> Catheter-related bloodstream infections (CRBSIs) and thrombosis are the most severe complications associated with central venous catheters (CVCs) in hemodialysis. Taurolidine, a non-antibiotic lock solution with broad antimicrobial and anti-biofilm activity, is a practical option for prevention. <b>Aim.</b> To evaluate, in a real-life cohort, the impact of Taurolidine-based lock solutions on the prevention of CRBSIs and thrombosis in hemodialysis CVCs, and to explore implications for future protocols. <b>Methods.</b> A single-center, retrospective observational study was conducted between January 2023 and August 2025 in the Hemodialysis Unit of Crema Hospital. Seventy-nine patients were included (61 tunneled and 18 temporary CVCs). Data were extracted from electronic medical records and chart reviews. Lock regimens: Taurolidine + Heparin (T/H) routinely used; Taurolidine + Urokinase (T/U) mainly used on an as-needed basis in complex cases; dwell time 48-72 hours according to dialysis interval. Outcomes included CRBSIs, thrombosis, and event-free survival (Kaplan-Meier). <b>Results.</b> A total of 25 CRBSIs (31.6% overall; 41% among tunneled CVCs) and 11 thromboses (13.9% overall; 18% among tunneled CVCs) were recorded, all occurring in tunneled catheters. No de novo events were observed in temporary CVCs. No complications occurred with T/H, whereas events clustered in the T/U group, composed of clinically complex patients with recurrent malfunction. Kaplan-Meier analysis, performed for descriptive purposes, showed a more favorable event-free survival pattern in the T/H group compared with T/U and heparin alone. <b>Conclusions.</b> In our experience, Taurolidine/Heparin was associated with a favorable efficacy and safety profile in preventing CRBSIs and thrombosis in tunneled CVCs. A scheduled use of Taurolidine/Urokinase may provide additional benefit in patients at high thrombotic risk. Prospective multicenter studies and standardized protocols are warranted. The establishment of dedicated AV-teams and registries could also improve organization of care.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411369","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":"Steroid-Sensitive Nephrotic Syndrome and Anti-Nephrin Antibodies: Pathogenic Insights and Therapeutic Opportunities.","authors":"Fabrizio Cristiano, Gustavo Aroca-Martinez, Carlos Guido Musso","doi":"10.69097/43-03-2026-03","DOIUrl":"https://doi.org/10.69097/43-03-2026-03","url":null,"abstract":"<p><p>Steroid-sensitive nephrotic syndrome (SSNS) encompasses a heterogeneous spectrum of podocytopathies, ranging from classical T-cell-mediated forms to those with an autoimmune component. Anti-nephrin autoantibodies have recently emerged as serological markers in a subset of immune-mediated podocytopathies, particularly in minimal change disease (MCD), primary FSGS, and immunoresponsive SSNS/SDNS. Although they correlate with disease activity and remission in selected cases, their sensitivity remains variable and assay standardization is still lacking. Rituximab shows the greatest efficacy in steroid-dependent or frequently relapsing forms, particularly in primary MCD/FSGS, while demonstrating limited benefit in genetic steroid-resistant disease. Overall, anti-nephrin autoantibodies should be regarded as promising yet still emerging biomarkers, potentially useful for refining phenotypic classification and supporting more personalized therapeutic strategies. Prospective studies and standardized detection protocols will be necessary before their integration into routine clinical practice can be recommended.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411029","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":"[Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i): A Therapeutic Revolution Beyond Diabetes. New Indications in Non-Diabetic Chronic Kidney Disease and Heart Failure].","authors":"Fabio Pio Gentile","doi":"10.69097/43-03-2026-09","DOIUrl":"10.69097/43-03-2026-09","url":null,"abstract":"<p><p>Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i), initially developed as hypoglycemic agents, have revolutionized the management of cardiorenal diseases due to potent organ-protective effects. Evidence from large clinical trials (DAPA-CKD, EMPA-KIDNEY, DAPA-HF, EMPEROR-Preserved) has established that their renal and cardiac benefits manifest independently of the presence of Type 2 Diabetes Mellitus (T2DM). Renally, nephroprotection mainly stems from the restoration of tubulo-glomerular feedback, which reduces hyperfiltration and intraglomerular pressure, thereby mitigating structural damage in non-diabetic Chronic Kidney Disease (CKD). Cardiologically, SGLT2i improve myocardial metabolism and reduce congestion, demonstrating efficacy in both Heart Failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). This review synthesizes the pleiotropic mechanisms of action and the clinical evidence that extends the use of SGLT2i across the entire spectrum of CKD (eGFR ≥ 20 mL/min/1.73 m2) and Heart Failure offering practical considerations for clinicians regarding dosing and the management of adverse events, such as the initial eGFR dip and the prevention of euglycemic ketoacidosis.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411378","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":"[Clinical and Pathophysiological Aspects of the Interactions Between the Thyroid and the Kidney].","authors":"Lorenzo D'Elia, Luciano Cencioni, Andrea Dello Strologo, Deborah Di Vico, Aldo Franculli, Giovanni Otranto, Paola Peverini, Annalisa Villani, Simona Cagliostro, Mario Barcellan, Vincenzo Barbera","doi":"10.69097/43-03-2026-07","DOIUrl":"10.69097/43-03-2026-07","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a multifactorial clinical condition consisting of a complex set of manifestations that, in addition to renal involvement, involve multiple organ systems. Endocrine disorders are particularly common in patients with CKD and require proper management given their multisystemic effects. The main endocrine disorder found in patients with kidney disease is alterations in the calcium-phosphorus (PTH) axis, which is why nephrologists often focus exclusively on managing this condition, neglecting any other endocrine alterations observed in this patient group. Thyroid involvement appears worthy of attention both in terms of its numerical frequency and therapeutic implications. The aim of this review is to enable a proper assessment of thyroid disease in patients with kidney disease and to provide the tools for appropriate assessment and treatment.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411265","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":"Impact of Blood Flow Rate and Duration of Dialysis Session on Nutritional Status in Hemodialysis Patients.","authors":"Jayachandran Priyadharshini, Jothi Padma, Jayam Jayanivash, Sivanandan Sathyan, Murugesan Ramprabahar","doi":"10.69097/43-03-2026-04","DOIUrl":"10.69097/43-03-2026-04","url":null,"abstract":"<p><p><b>Background.</b> Chronic kidney disease (CKD) was commonly associated with malnutrition, with many patients exhibiting protein-energy deficiency and muscle wasting. Increasing blood flow rate (BFR) and extending dialysis duration had been considered strategies to improve nutritional outcomes in CKD stage 5 patients on maintenance hemodialysis. <b>Aim.</b> The study aimed to evaluate the effect of increased BFR and prolonged dialysis duration on the nutritional status of CKD stage 5 patients undergoing maintenance hemodialysis. <b>Materials and Methods.</b> This prospective randomized controlled study was conducted from 1st August to 1st October 2023 in a tertiary care centre. Ninety patients were randomized into three groups: Group 1 received BFR 250-300 mL/min for 4 hours; Group 2 received the same BFR for 5 hours; and Group 3 received BFR 300-350 mL/min for 4 hours. Nutritional assessments included serum albumin, BMI, Subjective Global Assessment (SGA), mid-arm muscle circumference (MAMC), triceps skinfold thickness (TSFT), and body composition monitoring (BCM), performed at baseline and after 3 months. <b>Results.</b> Significant improvements in SGA were observed between Group 1 and Group 2 (p = 0.035) and between Group 1 and Group 3 (p = 0.018). BCM also showed significant variation between Group 1 and both intervention groups (p = 0.015). No significant differences were found in MAMC, TSFT, or albumin categories. Group 2 demonstrated improvements in SGA, BCM, and urea, while Group 3 showed improvements in SGA, BCM, urea, and serum albumin. <b>Conclusion.</b> Increased BFR and longer dialysis duration positively influenced nutritional status, with higher BFR demonstrating the most notable benefit.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411385","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":"[Artificial Intelligence: The Pros and Cons of its Adoption in Medicine].","authors":"Eugenio Santoro","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411335","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":"[Posterior Reversible Encephalopathy Syndrome in a Patient with Chronic Kidney Disease on Hemodialysis and Refractory Hypertension: Case Report].","authors":"Stefano Ferraro, Monica Repetto, Sonila Mocka, Francesca Rosa","doi":"10.69097/43-03-2026-11","DOIUrl":"10.69097/43-03-2026-11","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by an acute or subacute neurological onset, typically reversible within a few days following the removal or control of the underlying triggering factor. Diagnosis is based on clinical presentation and imaging findings, particularly brain magnetic resonance imaging (MRI), which in most cases reveals bilateral and symmetrical areas of vasogenic edema, predominantly involving the parieto-occipital regions. PRES is frequently associated with predisposing conditions such as severe arterial hypertension, chronic kidney disease, autoimmune disorders, solid-organ transplantation, and treatment with immunosuppressive or cytotoxic agents. We describe the case of a patient with chronic kidney disease undergoing thrice-weekly hemodialysis who was admitted for acute alteration of consciousness and seizures associated with severe arterial hypertension. Brain MRI demonstrated areas of vasogenic edema consistent with PRES. Within a few days of presentation, adequate control of the severe hypertensive state led to a progressive resolution of the neurological symptoms, accompanied by a marked improvement in the radiological abnormalities, as confirmed by follow-up MRI.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411437","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":"Complement System Inhibitors in Nephrology: A Comprehensive Review.","authors":"Gerry George Mathew, Raghul Raju Lakshmikanthan, Alexander Jenishbabu, Sakthivel Pragatheeswaran, Ajitkumar Shamini, Jayaprakash Varadharajan","doi":"10.69097/43-03-2026-08","DOIUrl":"https://doi.org/10.69097/43-03-2026-08","url":null,"abstract":"<p><p><b>Background.</b> The complement system plays a critical role in the pathogenesis of several kidney diseases. Dysregulation of complement activation, particularly of the alternative pathway, leads to kidney injury via thrombotic microangiopathy, immune complex deposition, and direct podocyte damage. <b>Summary.</b> Complement system inhibitors represent a paradigm shift in nephrology therapeutics, offering targeted treatment for diseases previously associated with poor outcomes. This review comprehensively examines the present landscape of complement inhibition in kidney disease, including established therapies and emerging agents. Terminal complement inhibitors (eculizumab and ravulizumab) have revolutionized the treatment of atypical haemolytic uremic syndrome, demonstrating remarkable improvements in renal outcomes and survival. Proximal pathway inhibitors targeting Factor B (Iptacopan) and C3 (pegcetacoplan) show promise in C3 glomerulopathy and IgA nephropathy, with recent phase 3 trials demonstrating significant proteinuria reduction. Additional applications include immune complex membranoproliferative glomerulonephritis and ANCA-associated vasculitis, in which complement activation contributes to disease pathogenesis. However, these agents present unique challenges, including infection risk, particularly meningococcal disease, cost considerations, and uncertainty regarding optimal treatment duration.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411392","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":"Modern Times? Timing and Duration of Nephrological Visits in Italy.","authors":"Rodolfo Fernando Rivera, Lucia Pisano, Sara Colzani, Sara Auricchio, Antonella Di Giacomo, Giada Bigatti, Maria Enrica Giovenzana, Liliana De Rosa, Giancarlo Joli, Luca D'Urbano, Marco Pozzi","doi":"10.69097/43-03-2026-12","DOIUrl":"https://doi.org/10.69097/43-03-2026-12","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410987","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}