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

{"title":"How to Assess the Glomerular Filtration Rate, and Which Method is Deemed Most Reliable?","authors":"Fabrizio Cristiano, Cosima Posari, Benito d'Angelo, Alessandra Schiazza, Anna Gigante, Ludovico Caravelli, Alessandra Piano, Stefania Fulle, Jenny Cristiano, Ginevra di Matteo, Guillermo Rosa Diez, Vittore Verratti","doi":"10.69097/41-04-2024-02","DOIUrl":"https://doi.org/10.69097/41-04-2024-02","url":null,"abstract":"<p><p>The prevalence of chronic kidney disease (CKD) continues to rise globally, paralleled by an increase in associated morbidity and mortality, as well as significant implications for patient quality of life and national economies. Chronic kidney disease often progresses unrecognized by patients and physicians, despite diagnosis relying on two simple laboratory measures: estimated glomerular filtration rate (eGFR) and urine analysis. GFR measurement has been grounded in renal physiology, specifically the concept of clearance, with creatinine identified as a suitable endogenous marker for estimating creatinine clearance (CrCl). On this foundation, various equations have been developed to calculate CrCl or estimated GFR (eGFR) using four variables that incorporate creatinine and certain demographic information, such as sex and age. However, creatinine measurement requires standardization to minimize assay variability across laboratories. Moreover, the accuracy of these equations remains contentious in certain patient subgroups. For these reasons, additional mathematical models have been devised to enhance CrCl estimation, for example, when urine collection is impractical, in elderly or debilitated patients, and in individuals with trauma, diabetes, or obesity. Presently, eGFR in adults can be immediately measured and reported using creatinine-based equations traceable through isotope dilution mass spectrometry. In conclusion, leveraging insights from renal physiology, eGFR can be employed clinically for early diagnosis and treatment of CKD, as well as a public health tool to estimate its prevalence.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145529","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":"Risk Factors for Idiopathic Nephrotic Syndrome Relapse in Pediatric Age.","authors":"Luca Pecoraro, Germana Longo, Mattia Parolin, Enrico Vidal, Nadia Antonucci, Valeria Silecchia, Maria Sangermano, Elisa Benetti","doi":"10.69097/41-04-2024-04","DOIUrl":"10.69097/41-04-2024-04","url":null,"abstract":"<p><p><b>Introduction.</b> Eighty percent of children with primitive nephrotic syndrome (NS) will have at least one relapse in their life. Specific risk factors could be associated with a higher incidence of relapses and a worse prognosis. This study aims to deepen the demographic and onset-related risk factors in children with known diagnosis of primitive NS attending the Pediatric Nephrology Unit of the University Hospital of Padua. <b>Methods.</b> Observational, descriptive study of all children (1-11 years old) with a known diagnosis of Primitive NS who attended our Pediatric Nephrology Unit between 1 January 2002 and 31 March 2023. <b>Results.</b> 49 patients were involved. 79.5% had at least one episode of NS relapse during their lifetime. 69.4% were classified as frequently relapsing or steroid-dependent NS. The relapse risk factor \"non-Western ethnicity\" was related to a worse prognosis and steroid-dependent NS classification (p = 0.041). The onset-related risk factor \"thrombocytosis\" appears to be related to a better prognosis (p = 0.03). <b>Conclusion.</b> The relapse risk factors \"non-Western ethnicity\" and \"thrombocytosis\" are characterized by worse and better prognosis, respectively. This evidence could support the follow-up of primitive NS in pediatric age.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145532","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":"[\"Quality\" Peritoneal Dialysis].","authors":"Antonino Previti, Giorgio Laudadio, Paolo Luca Lentini","doi":"10.69097/41-04-2024-01","DOIUrl":"10.69097/41-04-2024-01","url":null,"abstract":"<p><p>Evaluation of a peritoneal dialysis (PD) program in a nephrology center involve qualitative and quantitative indicators on clinical outcomes. International guidelines recommend monitoring outcomes of peritoneal catheter implantation, catheter-related infections, peritonitis and purification adequacy. However, none of these parameters can determine the organizational efficiency of a peritoneal dialysis (PD) program. It is desirable that centers with PD programs serving ≤14 patients, once capable of performing the peritoneal equilibration test, either safeguard their expertise or establish collaborations with nephrology units that have well-established PD programs.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145522","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":"Renal Functional Reserve in Naïve HIV Patients.","authors":"Carlos G Musso, Rossina Juarez, W Belloso, Henry Gonzalez-Torres, Mercedes Capotondo, Terrasa Sergio, Fabrizio Cristiano, Gustavo Aroca Martinez","doi":"10.69097/41-04-2024-11","DOIUrl":"https://doi.org/10.69097/41-04-2024-11","url":null,"abstract":"<p><p><b>Introduction.</b> Renal functional reserve (RFR) is the kidney capability of increasing its basal glomerular filtration rate (GFR) at least 20% after an adequate stimulus. Renal disorders have been reported in seropositive HIV patients, particularly the decrease in glomerular filtration rate (eGFR), nephrotic syndrome, and proximal tubular deficiency associated with the disease itself or the use of some anti-retroviral treatments. Thus, it was decided to carry out a prospective study in order to evaluate if RFR test was preserved in naive HIV patients. <b>Material and Method.</b> GFR was measured by using cimetidine-aided creatinine clearance (CACC), and RFR as described Hellerstein et al. in seropositive naive HIV patients and healthy volunteers. <b>Results.</b> RFR was evaluated in 12 naïve HIV patients who showed positive RFR (24.8±2%), but significantly lower compared to RFR in 9 control individuals (90.3 ± 5%). <b>Conclusion.</b> In this study was found that renal functional reserve was positive in naïve HIV patients, but significantly lower compared to renal functional reserve achieved by seronegative healthy individuals.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145531","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 Thermography for the Management of Hemodialysis Vascular Access].","authors":"Giuseppe Gatta, Antonio Scarlatella, Francesco Aucella, Maria Nardella, David Perpetuini, Michele Tritto, Daniela Cardone, Carlo Lomonte, Arcangelo Merla, Filippo Aucella","doi":"10.69097/41-04-2024-10","DOIUrl":"https://doi.org/10.69097/41-04-2024-10","url":null,"abstract":"<p><p>The arteriovenous fistula (AVF) represents the favorite vascular access in individuals with chronic kidney disease (CKD). Because AVF is a guarantee of survival for these patients, proper surgical packing and a timely follow-up program is crucial. Although a good objective examination of the limb site of FAV provides useful information both in planning the fistula surgery and in its surveillance and monitoring, it is now well established that the advent of instrumental diagnostics (ultrasonography, digital angiography, Angio-TC, MRI) has contributed significantly to improving primary and secondary patency of FAV and early diagnosis of vascular access complications. In this area, clinical thermography, a noninvasive and nondestructive diagnostic technique for assessing minute surface temperature differences, has shown good potential for the assessment of AVF. In fact, thermographic analysis of a limb site of AVF shows an increase in temperature at the site of the anastomosis and along the course of the arterialized vein. In this article we report our experience on the use of thermography in preoperative evaluation and postoperative surgical packing of an AVF. Further studies could validate the use of clinical thermography as a diagnostic technique to be used in the field of hemodialysis vascular accesses.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145524","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 Effect of Dialysate Temperature on Dialysis Adequacy and Hemodynamic Stability: An Experimental Study with Crossover Design.","authors":"Gerry George Mathew, Suganya Muthukarupiah, Muthamizh Muniappan, Judhajit Maiti, Varadharajan Jayaprakash","doi":"10.69097/41-04-2024-12","DOIUrl":"https://doi.org/10.69097/41-04-2024-12","url":null,"abstract":"<p><p>Cool dialysate has variable impact on hemodynamic stability and dialysis adequacy. Hemodynamic stability and dialysis adequacy are crucial indicators for better life expectancy and cardiovascular mortality. This research aims to evaluate the impact of cool dialysate temperature (35.5°C) compared to standard dialysate temperature (37°C) on blood pressures, pulse rate, and dialysis adequacy (Urea reduction ratio and online Kt/V) in a cross over design. <b>Material and Methods.</b> Consenting ESRD patients on maintenance haemodialysis (HD) with minimum 3 months dialysis vintage and functioning permanent vascular access are included for the study. Each participant had two sessions of HD at 37°C followed by two sessions at 35.5° C on a Fresenius 4008S HD machine. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and Pulse rate are measured pre-HD, every hourly and post dialysis. Pre-HD Blood urea nitrogen (BUN) and post-HD BUN are measured, and Urea reduction rate was calculated for each HD session. Kt/V was calculated by ionic conductance by HD machine for each session. <b>Results.</b> 25 patients (5 females and 20 males) were enrolled. The mean age was 54 ± 9.58 years. Dialysis vintage was 21.48 ± 6.9 months for study participants 10 patients (40%) were diabetic nephropathy, 9 patients (36%) were presumed chronic glomerulonephritis, 2 patients (8%) were lupus nephritis and 4 patients (16%) were chronic interstitial nephritis. There was statistically no difference between pre-HD BUN (p = 0.330), post-HD BUN (p = 0.776), URR (p = 0.718) and Kt/V (p = 0.534) among the dialysis sessions done at 37°C and 35.5°C. SBP variability in the low temperature (35.5°C) group at 4th hour and post dialysis assumed statistical significance with p = 0.05 and p = 0.025 respectively. DBP variability in the low temperature (35.5°C) group at 3rd hour, 4th hour and post-dialysis demonstrated statistical significance with p = 0.027, p = 0.36 and p = 0.016 respectively. Pulse rate variability was more in the low temperature (35.5°C) group at 3rd hour and 4th hour which showed statistical significance with p = 0.037 and p = 0.05 respectively. <b>Conclusion.</b> Cool dialysate is non inferior to standard dialysate temperature in terms of dialysis adequacy and is associated with less variability in diastolic blood pressure, systolic blood pressure and more pulse rate variability thereby contributing to better hemodynamic stability.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145544","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 Serum Phosphorus on Hemoglobin: A Literature Review.","authors":"Fortunata Zirino, Antonella Lipari, Alessia Tigano, Alfio Edoardo Giuffrida, Concetto Sessa, Dario Galeano, Ivana Alessandrello, Roberta Maria Messina, Roberta Pilato, Walter Morale, Vincenzo Calabrese","doi":"10.69097/41-04-2024-03","DOIUrl":"10.69097/41-04-2024-03","url":null,"abstract":"<p><p>Phosphorus is a macroelement found in the body, mostly in the bones as crystals of hydroxyapatite. Higher levels are found in patients affected by chronic kidney disease (CKD). Since the early stage of CKD phosphorous excretion is impaired, but the increase of PTH and FGF23 maintains its level in the normal range. In the last decades, the role of FGF23 in erythropoiesis was studied, and now it is well known for its role in anemia genesis in patients affected by conservative CKD. Both Hyperphosphatemia and anemia are two manifestations of CKD, but many studies showed a direct association between serum phosphorous and anemia. Phosphorus can be considered as the common point of more pathogenetic ways, independent of renal function: the overproduction of FGF23, the worsening of vascular disease, and the toxic impairment of erythropoiesis, including the induction of hemolysis.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145530","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":"[Two Cases of Pseudo-Bartter Syndrome in Childhood: When to Suspect a Rare Onset Pattern of Cystic Fibrosis].","authors":"Gianluca Vergine, Giulia Fressola, Maura Ambroni, Monica Gessaroli, Barbara Bigucci, Martina Mazzocco, Maria Luisa Conte","doi":"10.69097/41-03-2024-05","DOIUrl":"10.69097/41-03-2024-05","url":null,"abstract":"<p><p>Cystic fibrosis is a multisystem disease with extremely variable onset, symptoms and course. One of the onset modality but also a complication of the disease is the pseudo-Bartter syndrome, characterized by hyponatremia, hypochloremic dehydration and metabolic alkalosis in absence of any renal disease. This syndrome occurs more frequently in the first year of life and has a peak in the summer. In this article, we describe two cases of cystic fibrosis associated with pseudo-Bartter syndrome in childhood. Excluding every possible cause of metabolic alkalosis associated with hyponatremia was crucial for our diagnostic pathway, and the experience gained with the first case helped a lot with the second one.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467337","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":"Prognostic Factors of Peritonitis in Patients on Peritoneal Dialysis: a Retrospective Observational Study.","authors":"Cinzia Fabbri, Elisa La Malfa, Mattia Ricco, Lea Godino, Stefano Mancin, Walter Longo, Giovanni Spadafora, Beatrice Del Grosso, Marco Sguanci, Maria Pia Zito, Sergio Cinocca, Domenica Gazineo","doi":"10.69097/41-03-2024-011","DOIUrl":"10.69097/41-03-2024-011","url":null,"abstract":"<p><p><b>Background/Objectives.</b> Peritoneal dialysis stands as an established form of renal replacement therapy; yet peritonitis remains a major complication associated with it. This study, analyzing two decades of data from the Nephrology, Dialysis, and Hypertension Division of the University-Hospital IRCCS in Bologna, aimed to identify prognostic factors linked to peritonitis events. It also sought to evaluate the suitability of different peritoneal dialysis techniques, with a focus on Automated Peritoneal Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). Additionally, the study assessed the impact of an educational program introduced in 2005 on peritonitis frequency. <b>Methods.</b> Conducting an observational, retrospective, single-center study, 323 patients were included in the analysis, categorized based on their use of APD or CAPD. <b>Results.</b> Despite widespread APD usage, no significant correlation was found between the dialysis technique (APD or CAPD) and peritonitis onset. The analysis of the educational program's impact revealed no significant differences in peritonitis occurrence. However, a clear relationship emerged between regular patient monitoring at the reference center and the duration of peritoneal dialysis. <b>Conclusions.</b> Despite the absence of a distinct association between peritonitis onset and dialysis technique, regular patient monitoring at the reference center significantly correlated with prolonged peritoneal dialysis duration.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467416","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":"[Polytrauma and Acute Kidney Injury: A Multidisciplinary Approach].","authors":"Antonio Giudicissi, Delia Apuzzo, Manlio Cosimo Claudio Meca, Fulvia Zanchelli, Lucia Neri, Paolo Ferdinando Bruno, Marco Ruggeri, Veronica Sgarlato, Sara Signorotti, Vanni Agnoletti, Andrea Buscaroli","doi":"10.69097/41-03-2024-02","DOIUrl":"10.69097/41-03-2024-02","url":null,"abstract":"<p><p>The development of acute kidney injury (AKI) in polytrauma patients is a common and serious complication, with an incidence ranging from 6% to 50%. Polytrauma is a complex pathological condition that involves the collaboration of various specialists. On one hand, hemodynamic stabilization through fluid therapy and aminic support, with specific attack protocols, managed by anesthetists. On the other hand, if necessary, the initiation of renal replacement therapy such as Continuous Renal Replacement Therapy (CRRT), managed by nephrologists. CRRT is chosen both for managing fluid balance and ensuring the removal of toxic substances, as well as for proper control of electrolytes and acid-base balance.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467335","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}