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

{"title":"[Focal Segmental Glomerulosclerosis Due to A3243G Point Mutation in the mtDNA Coding for tRNA^Leu(UUR)].","authors":"Michele Marchini, Valentina Bianco, Matteo Trezzi, Sonila Mocka, Lucio Manenti","doi":"10.69097/41-06-2024-07","DOIUrl":"https://doi.org/10.69097/41-06-2024-07","url":null,"abstract":"<p><p>Mithocondropathies are inherited disorders that can result from abnormalities in the mitochondrial or nuclear DNA. Genetic abnormalities impacting the mitochondrial DNA (mtDNA) are consequently passed down through the maternal line. Renal manifestations of mtDNA disorders are often poorly recognized or misdiagnosed for the widely diverse phenotypic expression of this condition. Here we describe the case of a 34-year-old man with a history of chronic kidney disease, proteinuria, diabetes mellitus and sensorineural hearing loss, with worsening renal function and proteinuria with positive family history. Kidney biopsy showed focal segmental glomerulosclerosis (FSGS) and whole exome sequencing revealed a mtDNA point mutation (A→G) at position 3243 which code for a transfer RNA (tRNA^Leu(UUR)). Different point mutations in mitochondrial DNA have now been associated with focal segmental glomerulosclerosis but genetic screening for mtDNA mutations is often neglected and this condition overlooked. Consideration of an underlying mitochondrial disease should be made in patients presenting with deafness, diabetes, renal failure and a positive family history of kidney disease.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390683","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":"Assessment of Hemodialysis Adequacy by Online Clearance Monitoring.","authors":"Murukeshan Anandi, Muniappan Muthamizh, Suyampirakasam Ilango, Varadharajan Jayaprakash","doi":"10.69097/41-06-2024-11","DOIUrl":"https://doi.org/10.69097/41-06-2024-11","url":null,"abstract":"<p><p>Measuring the uremic solute clearance is an important factor in analyzing the adequacy of maintenance hemodialysis (MHD) therapy. Conventionally hemodialysis (HD) adequacy was measured by urea removal through the Daugirdas single pool kt/V (spKt/V) formula. We aimed in our study to correlate online clearance monitoring (OCM) spKt/V to the Urea Reduction Ratio (URR) and Daugirdas spKt/V in maintenance hemodialysis patients. This single-center cross-sectional study, conducted at the hemodialysis unit in the nephrology department of SRM Medical College Hospital and Research Center, involved 100 participants undergoing maintenance hemodialysis (MHD) therapy for 200 sessions. The OCM with URR and Daugirdas spKt/V values were obtained from each session and the results were analyzed using SPSS software with p <0.05 significance. In the results, we found that the OCM spKt/V, Daugirdas spKt/V, and URR showed positive correlations. These results emphasize that OCM can be an alternative method to assess dialysis adequacy for every session without the need for repeated blood sampling.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390735","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":"Nursing Care and Postgraduate Education of Nephrology and Dialysis Nurses in Italy.","authors":"Stefano Mancin, Federica Bragaglia, Desirèe Andreoli, Sara Morales Palomares, Giovanni Cangelosi, Marco Sguanci, Maruska Bedin, Lea Godino, Cinzia Fabbri, Domenica Gazineo, Gaetano Ferrara, Betrice Mazzoleni","doi":"10.69097/41-05-2024-12","DOIUrl":"10.69097/41-05-2024-12","url":null,"abstract":"<p><p><b>Introduction.</b> Patients with chronic kidney disease undergoing renal replacement therapy have complex care needs. To address this, nephrology and dialysis nurses must possess expertise in advanced specialist and disciplinary skills. The aim of this review is to analyze post-graduate academic training pathways and clinical-care training in the field of nephrology and dialysis nursing in the Italian context. <b>Methodology.</b> A narrative review of the literature was conducted in May 2024, using databases such as CINAHL and Medline-PubMed, with a selection criterion limited to primary and secondary studies published in Italian and English. To supplement the search, particularly within the Italian context, grey literature sources were consulted. <b>Results.</b> Post-graduate nephrology nursing education in Italy is mainly offered through First-Level Masters, as well as Second Level Masters and specialization courses, which are provided at various academic institutions. Analysis of the educational programs revealed the presence of common \"core\" teachings across all pathways, covering renal disease pathophysiology, hemodialysis, peritoneal dialysis, and dialysis nursing care, alongside significant heterogeneity in other proposed teachings. Clinical-care training emerged as a fundamental aspect in both post-graduate education, professional integration for newcomers, and continuous professional development. <b>Conclusions.</b> The growing healthcare need for specialist skills suggests the necessity of integrating field-based training with standardized post-graduate academic pathways, possibly in collaboration with relevant Nursing Scientific Societies. This synergy would not only promote the enhancement of nursing competencies but also ensure a high quality of care delivery.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604249","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":"[Governo clinico in nefrologia: organizzazione e sviluppo della dialisi peritoneale].","authors":"Giovanni Cancarini, Stefano Santarelli, Valerio Vizzardi, Gianpaolo Amici, Elena Alberghini, Roberto Russo, Loris Neri, Pietro Dattolo, Umberto Maggiore, Marcora Mandreoli, Filippo Mariano, Stefano Bianchi","doi":"10.69097/41-05-2024-02","DOIUrl":"https://doi.org/10.69097/41-05-2024-02","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604158","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":"[ANCA-Associated Glomerulonephritis Following SARS-CoV2 Infection: A Case Report].","authors":"Carlo Maiorca, Ilaria Serriello, Laura Pettorini, Chiara Taffon, Marco Belli, Fatma Cossetti, Rosaria Di Matteo, Francesco Londrino, Sandra Papalini, Antonella Propato, Augusto Tricerri, Cinzia Zaccheo, Massimo Magnanti","doi":"10.69097/41-05-2024-06","DOIUrl":"10.69097/41-05-2024-06","url":null,"abstract":"<p><p>Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) primarily affects small- and medium-sized arteries, including kidney vessels, thus causing rapidly progressive glomerulonephritis. The pathogenesis of AAV is intricate and several factors, including infections, are known to possibly trigger the autoimmune process. Numerous studies have reported that SARS-CoV-2 might cause acute kidney injury (AKI). To date, a modest number of AAV with COVID-19 cases has been reported. Herein, we discuss the case of a 61-year-old man with new-onset of diffuse proliferative ANCA-associated glomerulonephritis after COVID-19.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604153","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":"[Thrombosis in Hemodialysis Tunnelled Central Venous Catheters: From Pathogenesis to Therapeutic Strategies].","authors":"Francesca Bagagli, Simone Corciulo, Pasquale Libutti, Carlo Lomonte, Vincenzo Montinaro","doi":"10.69097/41-05-2024-05","DOIUrl":"10.69097/41-05-2024-05","url":null,"abstract":"<p><p>Central venous catheter-related thrombosis is a frequent non-infectious complication, typically associated with catheter dysfunction and hemodialysis inadequacy. Central venous catheters (CVCs) are categorized into non-tunnelled and tunnelled types, wherein the choice depends on patient's clinical conditions and the diagnostic and therapeutic workup. Tunnelled CVCs (tCVCs) are sought whenever an arteriovenous fistula is unfeasible or as primary access in patients with poor prognosis. Dysfunction is defined as the inability to maintain adequate blood flow within the prescribed dialytic session. Amongst non-infectious complications causing tCVC malfunctioning, thrombosis is the most frequent, and it is further classified into intrinsic (being endoluminal, pericatheter or fibrin sleeve-associated thrombosis) and extrinsic forms (including mural and atrial thrombosis). Diagnosis requires imaging tests like chest X-ray or abdominal X-ray, echocardiography, dynamic catheterography and computed tomography. Pharmacological treatment involves use of local thrombolytic agents. In case of extrinsic thrombosis, systemic anticoagulation is mandatory, occasionally requiring tCVC replacement. Prevention of thrombotic complications includes adequate positioning and appropriate use of the tCVC, with anticoagulant/antimicrobial-based locking solutions playing a crucial role in this context. In cases of extrinsic thrombosis, treatment options vary based on thrombus size, ranging from a conservative approach availing of systemic anticoagulation to surgical interventions like thrombectomy or thrombus aspiration, possibly associated with tCVC removal. In conclusion, late dysfunction of tCVCs is primarily due to thrombosis, thus requiring diagnostic imaging and specific drug therapies. Prevention is crucial to minimize complications.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604206","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":"Low-Dose Rituximab in the Treatment of Primary Membranous Nephropathy - A Systematic Review and Meta-Analysis.","authors":"Gerry George Mathew, Shanmugam Sundaramurthy, Prakash Muthuperumal, V Jayaprakash","doi":"10.69097/41-05-2024-04","DOIUrl":"10.69097/41-05-2024-04","url":null,"abstract":"<p><p><b>Introduction.</b> Rituximab (RTX) holds promise as a treatment for idiopathic membranous nephropathy (IMN). While effective in standard regimens, the application of RTX is hampered by cost burdens and severe side effects. To address these issues, low-dose RTX has been proposed as an intervention strategy. Yet, the efficacy of this approach in treating IMN remain subject of debate. This systematic review and meta-analysis seek to examine the effectiveness of low-dose RTX in adult patients with IMN. <b>Methodology.</b> A literature search was conducted using PubMed, Wiley Online Library, ScienceDirect, Cochrane Library, Springer and other sources, published between 2004 and 2024. Specifically, articles reporting the intravenous application of RTX at doses lower than four weekly infusions of 375 mg/m² or two infusions of 1 gram each on day 0 and day 15 were considered for inclusion. The primary outcomes were complete response (CR) and partial response (PR) rates at last follow-up. Secondary endpoints included serum creatinine levels, serum albumin levels, 24-hour proteinuria levels, protein-creatinine ratio (PCR), estimated glomerular filtration rate (eGFR) and anti-PLA2R antibody levels. <b>Results.</b> Sixteen articles were included in this meta-analysis. The pooled analysis of odds ratios (OR) revealed that both main-line (OR = 0.48, 95% CI = 0.30-0.75, p = 0.001) and second-line (OR = 0.27, 95% CI = 0.11-0.67, p = 0.005) RTX treatments induced complete remission (CR) in IMN patients. At the last follow-up, patients treated with both main-line (mean difference [MD] = 1.45, 95% CI = 1.00-1.91, p < 0.00001) and second-line (MD = 0.88, 95% CI = 0.23-1.53, p < 0.00001) RTX treatments showed a significant increase in serum albumin levels. Conversely, in the analysed second line RTX therapy patients, low eGFR trend was noted in the post treatment arm compared to baseline levels (MD = 10.57, 95% CI = 0.30-20.83, p = 0.04). Moreover, RTX was found to be effective in reducing PCR (MD = 24.10, 95% CI= 1.07 to 47.13, p = 0.04) and depleting PLA2R antibody levels (MD = 127.36, 95% CI = 14.90-239.81, P = 0.03). However, RTX might be less effective in lowering proteinuria and serum creatinine levels in patients with nephrotic syndrome. <b>Conclusion.</b> Rituximab in a low-dose regimen is quite effective in treating adult patients with IMN. Therefore, it can be considered a promising treatment for both main-line and rescue therapy. More randomized controlled trials and research on optimizing the low-dose regimen, based on various health factors, are warranted.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604247","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":"[Hypotension and Generalized Edema Due to Plasma Leakage: A Case Report].","authors":"Stefano Gatto, Alessio Di Maria, Cristina Bonesso, Mario Vergone, Elena Momesso, Laura Maria Scichilone, Fabio Fabbian","doi":"10.69097/41-05-2024-07","DOIUrl":"https://doi.org/10.69097/41-05-2024-07","url":null,"abstract":"<p><p>Generalized edema is commonly encountered in everyday clinical practice, usually due to heart, liver and renal disease. On the other hand, edema related to fluid extravasation associated with hypotension, hemoconcentration and hypalbuminemia is a rare clinical disorder. We present a case of a 61-year-old man with 3 subsequent endothelium permeability alteration episodes with increasing severity related to Sars-Cov-2 infection. During the last episode he was admitted to the intensive care unit, a monoclonal gammopathy was diagnosed and acute kidney injury requiring continuous renal replacement therapy developed. Systemic capillary leak syndrome or Cklarkson's disease was diagnosed, and the three phases of the condition were recognized, i.e. the prodromal phase, the acute shock phase and the recovery phase. The patients recovered and his kidney function returned to normal values. Nephrologists should be aware of plasma leakage syndromes being their management, especially fluid infusion, difficult due to the risk of complications such as acute kidney injury, compartment syndrome and neuropathy, rhabdomyolysis, myocardial edema, pericardial-pleural-abdominal effusion, deep vein thrombosis and acute pulmonary edema. Sars-Cov-2 infection appears to have increased the frequency of this rare disease.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604181","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":"[Reactive Perforating Collagenosis in Hemodialysis Patients].","authors":"Francesco Iacono, Angelo Ferrantelli, Onofrio Schillaci, Francesca Spica, Carmela Zigarrigo, Giuseppe Gigliotti","doi":"10.69097/41-05-2024-08","DOIUrl":"https://doi.org/10.69097/41-05-2024-08","url":null,"abstract":"<p><p>Chronic Kidney Disease associated Pruritus (CKD-aP) in hemodialysis affects approximately 38% of our patients. It is not associated with any dermatological lesion other than the common scratching lesions, a consequence of the symptom itself. The causes associated with itching have been studied in various treatments. However, there is a relatively rare condition that involves 10% of hemodialysis patients, known as reactive perforating collagenosis. This is a pathological condition secondary to chronic hemodialysis therapy, where widespread itching develops, associated with a peculiar reactive dermatosis with perforation of the dermis and development of dermal-epidermal continuity solutions with extrusion of matrix components dermal. In this work we report our experience with a diagnosed case of this condition.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604191","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":"A Growing Public Health Problem in Europe with Potential Severe Renal Involvement.","authors":"Enrica Falbo, Tabassum Elahi, Imane Guermah","doi":"10.69097/41-05-2024-03","DOIUrl":"https://doi.org/10.69097/41-05-2024-03","url":null,"abstract":"<p><p>Dengue is an arboviral infection transmitted by the mosquito of the Aedes genus, widespread especially in tropical and subtropical regions but now with worldwide involvement. Cases of contagion are also progressively increasing in Europe, and the differential diagnosis with other infections is not always easy. Renal involvement with acute renal failure is possible and caused by the direct action of the virus, hemodynamic instability, rhabdomyolysis, or acute glomerular damage. In patients most at risk of renal involvement, there is high morbidity and mortality, with more extended hospital stays and follow-ups over time, which increases the burden on healthcare systems. Knowledge of this infection by nephrologists is essential for reducing morbidity, mortality, and, therefore, healthcare costs.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604244","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}