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

Infection related glomerulonephritis and more specifically streptococcal glomerulonephritis is a rare disease in adults, and so is C3 glomerulonephritis. It has been recognized that a clinical and morphological overlap between these two entities exists. We present a case of a 59-year-old man with previous treated HIV infection with virological response, treated hepatitis b infection, treated syphilis and non-Hodgkin lymphoma in remission; presenting and acute sore throat with high ASO titers two weeks before a rapidly progressive glomerulonephritis requiring dialysis since presentation; biopsy showed acute diffuse and proliferative glomerulonephritis with crescentic pattern with exclusive C3 staining. It was considered an acute crescentic glomerulonephritis meeting criteria for infection related glomerulonephritis but also had criteria for C3 glomerulonephritis.

Background. Anemia is a common problem that greatly affects the quality of life and prognosis of those with CKD (chronic kidney disease). The conventional course of treatment has traditionally used ESAs (erythropoiesis-stimulating agents) such as erythropoietin; however, more recent medications, such as Desidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), may be more advantageous in terms of both efficacy and cost. In this study, CKD patients receiving hemodialysis are compared for efficacy, safety, and cost-effectiveness between Desidustat and erythropoietin treatment. Methods. This prospective, single-center, open-label study with parallel groups was carried out at Saveetha Institute of Medical Sciences in Chennai. A total of 60 patients with CKD on maintenance hemodialysis were randomized to receive either Desidustat (100 mg orally, 3 times a week) or Erythropoietin (subcutaneous injections) for 12 weeks. At baseline, four weeks, eight weeks, and 12 weeks, hemoglobin levels, biomarkers (TSAT, ferritin, and hepcidin), and status of physical and mental health had been noted. The key finding was the proportion of hemoglobin responders (defined as a rise from baseline of ≥1g/dL). Secondary outcomes included predictors of hemoglobin response, adverse effects, and cost-effectiveness. Results. The proportion of hemoglobin responders was 83.33% in the Desidustat compared to 73.33% in the Erythropoietin group (p = 0.530), indicating no significant difference in efficacy. Hemoglobin levels increased gradually in both groups over 12 weeks. Higher serum albumin (OR = 3.32, 95% CI: 1.54-7.16, p = 0.008) and lower iPTH levels (OR = 0.98, 95% CI: 0.97-0.99, p = 0.004) have been important indicators of hemoglobin response. Hepcidin levels decreased significantly in the Desidustat group in contrast to Erythropoietin (p = 0.038), suggesting improved iron metabolism with Desidustat. No significant differences were noted in TSAT or ferritin levels. Adverse effects were comparable between the groups, with similar hospitalization and infection rates. Desidustat demonstrated better cost-effectiveness, with a lower monthly cost compared to Erythropoietin. Conclusions. When treating anemia in individuals with CKD receiving hemodialysis, Desidustat is a safe and efficient substitute for erythropoietin, with the added advantage of cost-effectiveness. Serum albumin and iPTH were significant predictors of hemoglobin response. To validate these results larger multicentric studies are necessary.

Rhizobium radiobacter and Achromobacter xylosoxidans are two Gram-negative microorganisms found in soil. They are only rarely pathogenic to humans. There have been few cases reported of human infections, and even fewer cases of peritonitis in peritoneal dialysis. However, there is a higher risk in immunocompromised individuals. These microorganisms have the ability to form biofilms, leading to catheter-related infections, and possess intrinsic antibiotic resistance properties that are not well understood, making it challenging to identify specific therapies. We present a clinical case of a 61-year-old man undergoing automated peritoneal dialysis (APD) for end-stage renal disease due to light chain deposition disease in multiple myeloma. He was admitted to our department just over a month after starting replacement therapy due to a positive combur test and turbid fluid. The subsequent diagnosis was polymicrobial peritonitis caused by R. radiobacter and A. xylosoxidans. Despite initial empirical intraperitoneal antibiotic therapy with cefazolin and tobramycin, the treatment was optimized by introducing cefepime both intravenously and intraperitoneally, but without significant improvement. Given the diagnosis of refractory polymicrobial peritonitis, removal of the peritoneal catheter was necessary, resulting in drop-out from peritoneal dialysis. Although the outcome was unfavorable for the dialytic method, the purpose of our case report is to describe the first Italian case of peritonitis in peritoneal dialysis caused by these atypical pathogens in an immunocompromised patient. We hope this information will assist clinicians in their practice, as the available literature helped us in our diagnostic and therapeutic approach for this patient.

Background. Complications of chronic kidney disease include endocrine and metabolic abnormalities, anaemia and a wide range of disorders of homeostasis. Our study aims to better determine the role of CKD stage on the timing of the various complications associated with renal dysfunction. Methods. We performed an observational study on 71 (F:M = 39:32) patients with 486 repeated measurements, recording anemia, BUN, hyperparathyroidism, hyperphosphatemia, hyperkalemia, metabolic acidosis. Data were summarized as mean and standard deviation, median and interquartile range, or absolute number. Differences among groups were tested through the Mann-Whitney test or Pearson's Chi-Square. The associations between eGFR and each outcome was tested by Spearman's correlation test. All variables related to the outcomes (with p-value <0.1) were included in the multivariate models. Longitudinal analysis was performed using generalized estimated equations (GEE) for binary outcome and by Linear Mixed Models for continuous variables. The ROC Curve with the Youden J index was evaluated for all binary outcomes. Results. Baseline analysis revealed hyperparathyroidism in 49 patients (69.1%), hyperphosphatemia in 11 patients (15.5%), hyperkalemia in 20 patients (28.6%), and mean serum urea was 78 mg/dl [IQR: 59-99]. CKD stage was related with all outcomes. Youden J index suggested an eGFR predictive value of 37 ml/min/m2 for anemia, 34 ml/min/m2 for hyperkalemia, 26 ml/min/m2 for hyperphosphatemia, and 46 ml/min/m2 for hyperparathyroidism. Conclusion. Based on our findings, screening tests for endocrine and metabolic complications of CKD should be initiated at the beginning of the CKD stage III. We suggest screening for hyperphosphataemia at the CKD stage IV.

Chronic kidney disease (CKD) is an increasingly prevalent pathological condition. The global rise in the number of individuals affected by CKD is dependent on the ageing, as well as on the growing prevalence of obesity, diabetes and hypertension. The need for treatment strategies aimed at preventing the onset of CKD and slowing its progression has led to the implementation of combination therapy, consisting of a Renin-Angiotensin-Aldosterone System inhibitor (RAASi) and a sodium-glucose cotransporter-2 inhibitor (SGLT-2i), which has demonstrated efficacy in slowing CKD progression and reducing the occurrence of cardiovascular events. Updated guidelines recommend a tailored, multi-drug approach based on the residual cardiorenal risk of the individual patient. The KDIGO guidelines advocate for a stepwise approach in managing diabetes mellitus and CKD, with RAASi and SGLT-2i as first-line therapy, and GLP-1 receptor agonists (GLP-1 RA) and non-steroidal mineralocorticoid receptor antagonists (MRAs) as additional agents for further cardiorenal protection. Endothelin Receptor Antagonists (ERAs), a newer class of drugs, have shown antiproteinuric and nephroprotective effects in various trials. The objective of developing increasingly effective and personalized therapeutic strategies underscores the need to combine multiple drug classes that can act synergistically on different pathways.

Gender medicine explores how sex differences influence the onset, progression, and perception of specific diseases. In the case of ADPKD, female sex seems to impact various aspects of the condition. Women with ADPKD may experience a different progression of the disease compared to men, with a higher predisposition to developing certain complications such as polycystic liver disease, which can have a range of clinical consequences of varying severity. Perception and subjective experience of the disease can also vary significantly, affecting emotional well-being and quality of life. Pregnancy, for instance, represents a critical phase for women with ADPKD, requiring specialized monitoring and specific management to address potential complications. Genetic counseling is essential for providing informational support and helping families understand the hereditary implications of the disease. Modern pre-implantation diagnostic techniques also allow for the identification of the disease before birth, improving family planning and reducing the risk of transmission. Another important aspect is hormonal therapy, which was previously excluded in women with ADPKD due to concerns about potential effects on the growth of hepatic cysts. However, with advances in knowledge and increasing attention to specific needs, a targeted individual approach to hormonal therapy may prove beneficial, offering new therapeutic opportunities. Looking ahead, it is desirable for gender medicine to continue evolving, leading to increasingly personalized disease management and optimized care, with a positive impact on the overall well-being of individual patients.

Osteoporosis is a chronic skeletal disease characterized by reduced bone mineral density and deteriorated bone microarchitecture, which increases fracture risk. In patients with chronic kidney disease (CKD), osteoporosis management is complicated by disturbances in mineral and bone metabolism (CKD-MBD) that adversely affect bone health. Diagnosis requires a thorough clinical evaluation, including bone mineral density measurement via DEXA, bone microarchitecture assessment with TBS, and analysis of bone turnover biomarkers. Therapeutic management must be personalized and may include anti-resorptive or anabolic therapies, depending on the patient's bone metabolism and renal function. Policlinico Sant'Orsola employs an integrated care model involving nephrologists, endocrinologists, radiologists, and other specialists for optimal osteoporosis management. This multidisciplinary approach addresses the complexities of CKD-MBD comprehensively, improving diagnosis and treatment and, consequently, enhancing patient quality of life through a coordinated and personalized treatment plan.

Introduction. Central Catheter-related infections and biofilm formation are significant issues in the context of nosocomial infections that increase resistance to conventional therapies. Methodology. This case report describes an unconventional treatment for a Serratia Marcescens Central Venous Catheter infection in a hemodialysis patient through the combination of polyguanide and betaine. Clinical evaluations were conducted using the Visual Exit-Site Score and culture swabs. Results. After the first four treatment sessions there was a significant reduction in redness and pain (VES=1); the culture swab at the end of treatment was negative. Conclusions. The results of this case report encourage further research on the effectiveness of non-antibiotic treatments.