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

According to World Health Organization data from July 2023, human immunodeficiency virus (HIV) remains a global public health issue, having claimed approximately 40 million lives so far, with ongoing transmissions in every country globally. Changes in hematologic parameters, such as anemia or thrombocytopenia, are among the most common complications in people living with HIV/AIDS (PLWHA). These complications arise due to the bone marrow being targeted by the combined effects of HIV infection, inflammatory mediators released in response to the infection, and opportunistic pathogens. HIV-associated thrombotic thrombocytopenic purpura (TTP) is a rare condition that can lead to end-organ ischemia and requires prompt treatment to prevent permanent organ damage. We present the case of a previously healthy 54-year-old man who presented at the emergency department with profound asthenia and unexplained weight loss of 10 kg over a few weeks. Diagnostic investigations were remarkable for a positive HIV rapid antigen/antibody combination test, severe thrombocytopenia and hemolytic anemia. As HIV-associated TTP was the likely diagnosis, the patient was transferred to the Division of Nephrology for therapeutic plasma exchange (TPE). Monitoring platelet counts and hemoglobin levels in HIV/AIDS patients affected by HIV-associated TTP is essential for assessing disease progression and identifying thrombocytopenia or its related clinical symptoms.

Introduction. Acute kidney injury is one of the most severe complications of severe malaria, with an overall incidence reaching 60% and a mortality rate of up to 45%. We conducted this study to determine the prevalence of acute kidney injury in malaria, acute kidney injury, associated factors and the impact of acute kidney injury on vital prognosis. Patients and Methods. This was a multicenter, retrospective, descriptive, and analytical study over a 5-year period from January 1, 2019 to December 31, 2023, in the nephrology and infectious diseases departments and intensive care units of Dakar hospitals. We included all admitted patients during this period, regardless of whether they had acute kidney injury or not. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcomes criteria. Severe malaria was defined according to world health organization criteria. Results. A total of 321 patients were included, 158 of whom had acute kidney injury, with a prevalence of 49.2%. The study population comprised 244 men and 77 women, with a sex ratio of 3.14. The mean age of patients was 36.25 years (12 and 86 years). Anuria was present in 64.3% of cases, oliguria in 26.8%, and edema in 7.14%. Mean blood urea was 1.20 g/L ± 2.60. Mean creatinine was 34.7 mg/L ± 40.1. Rehydration was performed in 96.8% of cases. Hemodialysis was performed in 19 patients, with an average of 1.89 sessions. Death occurred in 41 (12.77%) patients. In multivariate analysis, acute kidney injury-associated factors were herbal medicine (p = 0.045; OR = 1.509; IC95%: [0.513- 4.439]), diabetes (p = 0.044; OR = 3.375; IC95%: [0.850-13.393]), respiratory distress (p = 0.034; OR = 2.758; IC95%: [0.907-8.389]) and anemia (p = 0.002; OR = 0.407; IC95%: [0.232-0.713]). Acute kidney injury was a factor associated with death (p = 0.004; OR = 3.584; IC 95%: [1.467-8.754]). Conclusion. Acute kidney injury is common during malaria. Acute kidney injury is associated with the severity of malaria, the presence of comorbidities and the use of nephrotoxic products. Acute kidney injury is independently associated with increased risk of death in malaria.

Introduction. Contrast-induced nephropathy (CIN), often referred to as post-contrast acute kidney injury (PC-AKI), remains a significant issue in diagnostic imaging procedures that utilize iodinated contrast agents. This study aims to examine the knowledge, perceptions, and practices of radiologists and radiographers regarding PC-AKI. Methods. A survey was conducted among South Indian radiologists and radiographers in November and December of 2024. Following widespread outreach, 80 radiologists and 224 radiographers completed the survey. A 30-item multiple-choice survey was used to gather data utilizing Google Forms. Results. Most radiologists (93.8%) and radiographers (63.8%) correctly identified a 25% or 0.5 mg/dL increase in serum creatinine (SCr) within 48-72 hours as a diagnostic criterion for PC-AKI. However, 12.5% of radiographers incorrectly identified increases in HbA1c and (11.6%) temporary reductions in renal function as markers of PC-AKI. Radiologists (97.5%) and radiographers (79%) recognized eGFR and SCr as renal function indicators. 76.8% of radiographers and 91.3% of radiologists considered diabetes, heart failure, and chronic kidney disease as the greatest risk factors. 68.8% of radiologists preferred immediate CT for emergency polytrauma patients, whereas 23.7% preferred waiting for renal function findings. Discussion. This research highlights the important roles of radiologists and radiographers in managing and preventing PC-AKI. There are significant knowledge gaps, particularly in emergency situations and when dealing with pregnant or paediatric patients. Radiographers, in particular, demonstrate a lack of understanding regarding PC-AKI prevention, indicating a need for specialized training.

Background. Although renal ultrasound or computed tomography (CT) without contrast may allow the diagnosis of complicated acute pyelonephritis (PN), they may fail to diagnose renal abscesses and complicated PN, which is allowed by the upper level imaging: contrast CT or Nuclear Magnetic Resonance (MRI). Case presentation. We report three clinical cases of patients admitted to the Nephrology, Dialysis and Transplantation Unit at Padua University Hospital in which renal ultrasound (US) and Computed Tomography (CT) without contrast failed to allow diagnosis of PN complications, while contrast CT showed renal abscesses in two patients and Nuclear Magnetic Resonance (NMR) without contrast a frank PN in one. Conclusion. Contrast CT or MRI should be preferred to renal US and/or CT without contrast and are the most indicated imaging analyses to be prescribed in acute complicated PN, in particular in the presence of acute kidney injury.

SGLT-2 inhibitors are a relatively new class of antidiabetic drugs. They activate a transcriptional response similar to calorie restriction characterized by the up-regulation of sensors involved in nutrient deprivation, such as SIRT1 and AMPK, and the down-regulation of mTOR, a molecule involved in nutritional excess signaling. The purpose of this review is to illustrate the main pathways of nutrient deprivation: a complex mechanistic framework partly responsible for the cardio-renal benefits that makes these drugs unique.

Introduction. Hyperkalemia is a common and serious complication in dialysis patients, with increased incidence and severity over time. Newer potassium binders, patiromer and sodium zirconium cyclosilicate (SZC), offer improved tolerability compared to older agents. This meta-analysis aims to evaluate the efficacy and safety of these newer binders in dialysis patients. Methods. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, adhering to PRISMA guidelines. Searches were performed in MEDLINE, PubMed, CINAHL, and EMBASE up to November 1, 2024. RCTs comparing patiromer or SZC to placebo, sodium polystyrene sulfonate (SPS), or calcium polystyrene sulfonate (CPS) in dialysis patients were included. Primary outcomes were differences in serum potassium levels. Secondary outcomes included adverse events (AEs) and mortality. Data were analyzed using fixed and random-effects models, and heterogeneity was assessed. Results. Six RCTs, involving 3155 patients, were included. SZC and SPS significantly reduced pre-HD potassium levels compared to placebo (mean difference -0.68 mmol/L and -0.62 mmol/L, respectively; p<0.0001). Patiromer did not show a significant difference compared to placebo (mean difference -0.17 mmol/L; p=0.16). All treatments demonstrated a reduction in hyperkalemia events compared to placebo. Adverse event data were limited and not statistically analyzable, but no significant differences in total AEs were observed. Mortality data were sparse, with only one death reported in the placebo group. High heterogeneity was observed in the comparison between new and old binders/placebo. Conclusion. SZC and SPS effectively reduce pre-HD potassium levels in dialysis patients compared to placebo. Patiromer's effect was not statistically significant. All binders reduced hyperkalemia events. Safety profiles appeared comparable, but data were limited. The lack of sufficient RCTs, especially those directly comparing newer binders, highlights a significant knowledge gap. Further studies are needed to evaluate long-term outcomes, including quality of life and cardiovascular effects, and to directly compare the efficacy and safety of different potassium binders in this population.

Gout is the oldest recorded form of inflammatory arthritis to affect humankind, with roots stretching back to 2640 BC and known in Greece by 1700 BCE. It is due to deposition of sodium monourate driven by hyperuricemia. The association of humours with causation stems from Hippocrates (460-370 BCE). More specifically, a toxic humour was suspected by Celsus (25 BCE-50 CE) and Rufus of Ephesus (98-138 CE), and confirmed by Alfred Garrod in 1849. Its therapy has been based on colchicine since Severus Iatrosophista, Theodosius the Philosopher, and Jacobus Psychrestos, introducing Colchicum as an innovative treatment for podagra in the early Byzantine period. A breakthrough in treatment was the introduction of allopurinol in 1966. This study aimed to examine gout in the Corpus Hippocraticum. For Hippocrates, gout is a disease caused by bile and phlegm, not by the wrath of a god. Gout is mentioned in the Corpus 20 times, and a total of five Aphorisms are dedicated to podagra. In Affections, "Gout is a disease that induces burning pains in the joints; it comes to paroxysms, now in one limb, now in the other, where it causes ailments of variable severity". In Prorrhetics, it is described as a disease not amenable to cure in the elderly patients with tophi - a goal achievable in the young patient willing to adhere strictly to the therapy suggested by the physician.

The prevalence of obesity is progressively increasing on a global scale. Among its negative health consequences, renal damage is also observed. It is due to hemodynamic, metabolic, and inflammatory alterations. Ciliopathies are a group of disorders caused by dysfunction of the primary cilium; these include autosomal dominant polycystic kidney disease (ADPKD) as well as Alström and Bardet-Biedl syndromes. In ADPKD, obesity accelerates kidney disease progression. In Alström and Bardet-Biedl syndromes, renal disease is likely due to both local and systemic factors; in these syndromes, obesity represents one of the most common clinical manifestations, and studies are currently underway to evaluate its role in the progression of chronic kidney disease. The management of obesity involves lifestyle interventions, medications, and surgery. Interesting new pharmacological advances are now available for both obesity in the general population and obesity associated with certain genetic disorders; the protective role of many of these drugs in the progression of chronic kidney disease - sometimes even independent of weight loss - is an observation that further highlights the intricate relationship between dysmetabolism and kidney disease.

Objectives. We report here the results of the 9th National Census (Cs-24) of Peritoneal Dialysis in Italy, carried out in 2025 by the Italian Society of Nephrology's Peritoneal Dialysis Project Group and relating to 2024. Methods. The Census was conducted in the 228 non pediatric centers which performed Peritoneal Dialysis (PD) in 2024. The results have been compared with previous Censuses carried out since 2005. Results. Incidence: in 2024, 1,398 patients (CAPD = 55.1%) started on PD (1st treatment for ESRD). PD was started incrementally by 40.2% of these in 155 Centers. The catheter was positioned exclusively by a Nephrologist in 19.2% of known cases. Prevalence: of the 4,322 patients on PD at 31/12/2024 (CAPD=43.7%), 21.4% were on assisted PD (family member caregiver: 86.2%). Out: in 2024 the PD dropout rate (ep/100 pt-yrs) was: 12.7 to HD; 9.7 death; 8.5 Tx. The main cause of transfer to HD remains peritonitis (21.8%), although it is still decreasing (Cs-05: 37.9%). Peritonitis/EPS: the incidence of peritonitis in 2024 was 0.164 ep/pt-yr (647 episodes). The incidence of new cases of EPS in 2023-24 (9 cases) was unchanged. Other results: 3.86%-PET remains the most widely-used test (58.1%); most of the Centers do not carry out Home Visits (54.1%); training is mainly carried out in-Center (49.1% of the Centers). Conclusions. Cs-24 confirms the good results PD is having in Italy, where it is experiencing a slight upturn.