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

{"title":"A Case Report and Literature Review: Chlorhexidine-induced anaphylaxis in a hemodialysis patient.","authors":"Rajendran Rajasekar, Ajit Kumar Shamini, Moses Lamech Tanuj, Sakthivel Pragatheeswaran, Babu A Jenish, Varadharajan Jayaprakash","doi":"10.69097/43-02-2026-11","DOIUrl":"10.69097/43-02-2026-11","url":null,"abstract":"<p><p>Chlorhexidine is a widely used antiseptic in healthcare settings, particularly for catheter site preparation in hemodialysis patients. While generally considered safe, chlorhexidine can rarely cause severe IgE-mediated anaphylactic reactions. Here we report the case of a 47-year-old man on maintenance hemodialysis who experienced two episodes of severe allergic reactions during dialysis sessions. During the first episode the patient presented with dyspnea, hypotension, and pruritus, which we initially attributed to the dialyzer membrane reaction. After changing the dialyzer membrane, the patient remained asymptomatic for 19 sessions. However, a second, more severe episode occurred with urticaria, profound hypotension, and respiratory distress requiring intravenous adrenaline. Retrospective analysis revealed chlorhexidine antisepsis at the tunneled catheter site as the causative agent, confirmed by elevated serum IgE (285 IU/mL), with complete resolution after switching to povidone-iodine as an antiseptic instead. This case demonstrates a concept called \"sensitization window\" where compromised skin integrity at the catheter exit site facilitated chlorhexidine penetration despite three years of uneventful exposure of the same during fistula use. This case highlights the importance of considering chlorhexidine hypersensitivity in such unexplained dialysis-related allergic reactions. Early recognition and prompt antiseptic substitution are thereby crucial to prevent potentially fatal anaphylactic episodes in this vulnerable population.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963329","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":"New Frontiers in the Treatment of Chronic Kidney Disease-associated Pruritus: A Case of Hemoperfusion with HA130.","authors":"Paolo Sipari, Luca Piscitani, Marilena Tunno","doi":"10.69097/43-02-2026-10","DOIUrl":"10.69097/43-02-2026-10","url":null,"abstract":"<p><p>Chronic kidney disease-associated pruritus (CKD-aP) has a high incidence in patients with end-stage chronic kidney disease on dialysis and significantly affects the quality of life of hemodialysis patients. The pathogenesis is multifactorial and still under investigation. Due to its clinical impact and its association with increased mortality, it cannot be considered merely a symptom. New drugs and treatments have been developed. We report our experience with a patient whom we had the opportunity to treat with hemoperfusion using an HA130 cartridge.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963262","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":"Reappraisal of Goal-Directed Medical Therapy in Diabetic Kidney Disease: Beyond the Quadruple Therapy Paradigm.","authors":"Gerry George Mathew","doi":"10.69097/43-02-2026-03","DOIUrl":"10.69097/43-02-2026-03","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) affects 40% of individuals with diabetes and is the leading cause of chronic kidney disease worldwide. While the KDIGO guidelines have established quadruple therapy comprising renin-angiotensin system inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and mineralocorticoid receptor antagonists as the cornerstone of DKD management, substantial phenotypic and molecular heterogeneity among patients limits the efficacy of standardized protocols. Emerging evidence highlights distinct DKD subtypes defined by inflammatory, metabolic, fibrotic, and vascular pathobiological pathways, which may warrant tailored therapeutic strategies. Novel biomarkers, including tubular injury markers, inflammatory mediators, and genetic variants such as APOL1, offer opportunities for phenotype-driven treatment. Multi-omic integration, encompassing genomics, transcriptomics, proteomics, and metabolomics, combined with machine learning algorithms, enables the identification of treatment-responsive phenotypes and supports clinical decision-making. Emerging therapeutic targets, including complement system inhibitors, ketone metabolism modulators, and JAK-STAT pathway inhibitors, have further expanded the precision medicine landscape in DKD management. Implementation challenges include biomarker standardization, healthcare infrastructure requirements, cost-effectiveness, regulatory validation, and equitable access to diverse populations. Addressing these barriers through multidisciplinary collaboration, point-of-care diagnostics, and inclusive clinical trials is essential for personalized DKD management. Goal-directed personalized DKD management represents a transformative paradigm with the potential to optimize outcomes, minimize adverse effects, and reduce long-term healthcare costs.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963294","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":"Acute Kidney Injury and Early Diagnostic Biomarkers: A Narrative Literature Review.","authors":"Georgios Gerasopoulos, Andreas Kapellakis-Malliaras, Achilleia-Maria Pavlou","doi":"10.69097/43-02-2026-07","DOIUrl":"10.69097/43-02-2026-07","url":null,"abstract":"<p><p><b>Introduction.</b> Acute kidney injury (AKI) is a serious entity characterized by sudden impairment of renal function in hospitalized patients, particularly in the intensive care unit, resulting in high morbidity and mortality. Current diagnostic methods based on changes in serum creatinine (sCr) and urine output are prone to many confounding variables. The aim of this study is to investigate the role of specific biomarkers, namely NGAL, Cystatin C, IL-18, and KIM-1, in the diagnosis of AKI. <b>Materials and methods.</b> In this literature review, a thorough search of the PubMed, Scopus and Google Scholar databases was conducted to investigate the early diagnostic potential of NGAL, Cystatin C, IL-18, and KIM-1 in AKI patients. <b>Biomarkers.</b> Neutrophil Gelatinase-Associated Lipocalin (NGAL), both serum and urinary, was discovered to rise shortly after AKI onset, several hours before sCr elevation, differentiating AKI from chronic kidney disease and prerenal azotemia. Cystatin C (CysC), a protein constantly produced and filtered, was identified as a reliable marker for AKI, although its high cost prohibits its use. Interleukin-18 (IL-18), a pro-inflammatory cytokine, demonstrated potential, particularly in critically ill and post-cardiovascular surgery patients, although results on its predictive ability were inconsistent. Kidney Injury Molecule-1 (KIM-1), a protein released into urine after proximal tubular injury, demonstrated high sensitivity and specificity shortly after AKI onset, while it has been associated with a number of kidney diseases. <b>Conclusions.</b> Novel biomarkers (NGAL, CysC, IL-18, and KIM-1) provide a faster and more accurate diagnosis of AKI than traditional methods in various clinical settings. Additional research is required to fully incorporate these promising molecules into everyday clinical practice.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963341","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":"Linguistic and Cultural Adaptation and Italian Validation of the Renal iNUT, a Nutrition Screening Tool for Hospitalized Patients with Chronic Kidney Disease.","authors":"Sara Morales Palomares, Silvia Cappelletti, Gaetano Ferrara, Stefano Mancin, Giovanni Cangelosi, Giada Vrenna, Mauro Parozzi, Domenica Gazineo, Marco Sguanci, Mattia Bozzetti, Elena Sandri","doi":"10.69097/43-02-2026-04","DOIUrl":"10.69097/43-02-2026-04","url":null,"abstract":"<p><p><b>Background/aim.</b> Malnutrition is a frequent and serious issue among patients with chronic kidney disease (CKD), often leading to worse clinical outcomes. The Renal Inpatient Nutrition Screening Tool (Renal iNUT), originally developed in the United Kingdom, provides a quick and renal-specific method for screening hospitalized CKD patients. While a Spanish version has been adapted, no validated Italian translation is currently available. This study set out to translate and culturally adapt the Renal iNUT for application in Italian clinical contexts, as well as to evaluate its psychometric properties. <b>Methods.</b> The adaptation followed the methodological approach described by Sousa and Rojjanasrirat, proceeding through seven structured phases to secure conceptual, linguistic, and cultural equivalence. After a pilot phase with healthcare professionals, the tool was administered to hospitalized patients with CKD to assess both inter- and intra-rater reliability. <b>Results.</b> Feedback from the pilot testing indicated that the Italian Renal iNUT was clear, intuitive, and easy for clinicians to use in daily practice. Psychometric testing confirmed good intra-rater reliability [Intraclass Correlation Coefficients (ICC) = 0.83; 95% Confidence Interval (CI) 0.69 - 0.91] and excellent inter-rater reliability (ICC = 0.90; 95% CI 0.82-0.95). Total scores remained stable across repeated measurements [median = 2.0; Interquartile Range (IQR) 1.0 - 3.0/2.5]. <b>Conclusions.</b> Overall, the Italian version of the Renal iNUT demonstrated strong reliability and practical usability, supporting its use for nutritional screening in patients with CKD. Its implementation may help promote standardized nutritional screening and early nutritional interventions in Italian hospital settings, ultimately improving the quality of care and patient outcomes for individuals with CKD.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963304","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":"Fibronectin Glomerulopathy: A Case Report of Membranoproliferative Glomerulonephritis.","authors":"Anna Sannino, Pierluigi d'Angiò, Simona Laurino, Antonella Marino, Maria Luigia Sellitti, Valentina Urcioli, Armando Genovese, Giuseppe Gigliotti","doi":"10.69097/43-02-2026-09","DOIUrl":"10.69097/43-02-2026-09","url":null,"abstract":"<p><p><b>Background.</b> Fibronectin glomerulopathy (FNG) is a rare autosomal dominant glomerulopathy characterized by proteinuria, hematuria, hypertension, and gradual progression to end-stage renal disease (ESRD) over 15-20 years. The disease is caused by mutations in the FN1 gene. Currently, there is no specific treatment for FNG. <b>Case Report.</b> A 22-year-old female presented with sub-nephrotic proteinuria and microscopic hematuria. Renal biopsy revealed mesangial expansion and electron-dense deposits consistent with FNG. Genetic testing confirmed a mutation in the FN1 gene (c.5773T>A, W1925R). No kidney disease was observed in patient's parents; later genetic diagnosis was confirmed also in the patient's brother. She was treated with conservative therapy. Three years later, her kidney function remained stable, with a serum creatinine of 0.5 mg/dL and proteinuria reduced to 0.7 g/24h. <b>Discussion.</b> FNG is caused by mutations in the FN1 gene, leading to abnormal fibronectin deposition in the kidneys. No specific treatment exists, but conservative therapy with ACE inhibitors may help slow disease progression. Steroid therapy is controversial, with limited success in preventing ESRD. <b>Conclusion.</b> Early diagnosis and conservative treatment are crucial for managing FNG. Further research is needed to explore effective therapies and better understand the disease's progression.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963286","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":"Salivary Bicarbonate Fails to Mirror Systemic Acid-Base Balance in Pediatric Patients at Risk of Metabolic Disturbances.","authors":"Nicola Bertazza Partigiani, Marco Moi, Alessandro D'Uva, Ester Valentini, Giulia Debertolis, Irene Toldo, Enrico Vidal","doi":"10.69097/43-02-2026-05","DOIUrl":"10.69097/43-02-2026-05","url":null,"abstract":"<p><p><b>Introduction.</b> The utility of salivary bicarbonate as a non-invasive marker of systemic acid-base status in pediatric patients remains unclear. This study investigated the possible correlation between salivary and blood gas analysis at risk for acid-base disturbances, including those with chronic kidney disease (CKD) or receiving acetazolamide. <b>Methods.</b> In a single-center cross-sectional study (July 2024-March 2025), 94 pediatric patients (6-18 years) underwent simultaneous blood and saliva sampling for gas analysis. Patients were stratified into metabolic acidosis (<22 mmol/L), normal (22-26 mmol/L), or metabolic alkalosis (>26 mmol/L) groups based on serum bicarbonate. <b>Results.</b> No relationship was observed between salivary and serum bicarbonate (r = 0.112, p = 0.281), pH, or base excess. However, strong correlations emerged within salivary parameters: bicarbonate was positively associated with salivary pH (r = 0.682, p < 0.001) and base excess (r = 0.865, p < 0.001). Patients with eGFR <30 ml/min/1.73m² had significantly higher salivary bicarbonate (13.6 mmol/L vs 6.8 mmol/L, p = 0.004), independently of bicarbonate supplementation. This was also negatively associated with calcium (β = -8.67, p = 0.004) and lactate (β = -0.82, p = 0.008). Dialysis status and underlying diagnosis were additional independent predictors. While patients with metabolic acidosis showed higher median salivary bicarbonate than those with normal or alkalotic profiles, this difference was not statistically significant (p = 0.545). <b>Conclusions.</b> Salivary bicarbonate does not reflect systemic acid-base balance but is elevated in advanced CKD, suggesting a local regulatory phenomenon worthy of further exploration.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963316","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 Disorders in Multiple Myeloma: Beyond Pseudohyponatremia to Clinical Pitfalls and Mechanistic Insights.","authors":"Elena Tanzarella, Michele Paolisi, Martina Catania, Francesca Tunesi, Liliana Italia De Rosa, Pierpaolo Bianca, Kristiana Kola, Alessandro Barruscotti, Rodolfo Fernando Rivera, Paolo Manunta, Giuseppe Vezzoli, Maria Teresa Sciarrone Alibrandi","doi":"10.69097/43-01-2026-08","DOIUrl":"10.69097/43-01-2026-08","url":null,"abstract":"<p><p>Hyponatremia is a relatively frequent finding in multiple myeloma (MM) and may result from either pseudohyponatremia, due to marked hyperproteinemia, or true hyponatremia from genuine sodium-water imbalance. Differentiating between these two entities is essential, as they differ in pathogenesis, clinical relevance, and management. Pseudohyponatremia, observed in approximately 15-20% of MM patients, is a measurement artifact occurring with indirect ion-selective electrode techniques when plasma water fraction is reduced by high M protein levels. Serum osmolality remains normal, and no sodium correction is required. True hyponatremia (<135 mEq/L with hypo-osmolality) is less common but clinically significant, often associated with worse prognosis. Mechanisms include renal impairment (cast nephropathy, Fanconi syndrome, light chain deposition), hypervolemia from advanced renal failure, hypovolemia from gastrointestinal losses or diuretics, drug-induced effects (notably bortezomib, cyclophosphamide), and paraneoplastic SIADH. Alterations in electroneutrality and strong ion difference (SID) from highly cationic M protein may further lower sodium, usually mildly. Pseudohyponatremia is managed by controlling the underlying myeloma and reducing paraproteinemia. True hyponatremia treatment is etiology-specific: isotonic saline for hypovolemia, fluid restriction ± solute supplementation for SIADH, careful diuretic adjustment for hypervolemia, and withdrawal of causative drugs when possible. Optimal control of the plasma cell clone, through modern triplet or quadruplet regimens prevents recurrence. A structured diagnostic approach integrating volume status, laboratory evaluation, and medication review is critical to distinguish pseudo from true hyponatremia, prevent inappropriate interventions, and address the underlying disease.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963318","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":"[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":"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}