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

Introduction: peritoneal dialysis (PD) is a widely used renal replacement therapy allowing end-stage renal disease patients to undergo a home-based treatment. The remote monitoring (RM) and the telemedicine in patients undergoing automated peritoneal dialysis (APD) improve the technique and the patient survival. This study evaluated their impact on PD patients, evaluating the safety of the technique, infectious complications and hospitalizations, and the effects on the quality of life. Patients and methods: 73 patients undergoing PD at the Nephrology and Dialysis Unit of the Papardo Hospital in Messina were enrolled. 39 patients (APD group) were followed with scheduled visits at the hospital centre, whereas the remaining 34 patients (RM-APD group) received complete assistance at home. Results: the hospitalizations were statistically lower in the RM-APD group than APD patients (7 vs 17; p: 0.03). During the follow-up period, 13 patients were switched from the PD technique to HD. In particular, 10 patients belonged to the ADP group, whereas the remaining 3 patients were followed through the remote control. PD patients had a better psycho-physical state, with better scores in physical performance (p = 0.02) and psycho-emotional well-being (p = 0.001), performing social functions more adequately than HD patients (p = 0.01). The final result is a better perception of health in general in PD patients. Conclusion: the telemedicine and the remote control have opened new ways to increase the number of patients who can perform PD treatment at home safely, reducing the infective risk and the rate of hospitalization.

Natural emergencies represent unpredictable events which, due to their intensity, can determine multiple effects on the healthcare system with increased pressure on the hospital network. The purpose of this article is to focus attention on dialysis patients and provide a quick overview of the possible complications that can occur following emergency events, also suggesting a working scheme to deal with them in the nephrology field. Both the preventive and operational procedures to be implemented to ensure the safety of patients undergoing dialysis treatment will therefore be discussed, focusing on the need to set up a working group to make the territorial response homogeneous.

The KDOQI guidelines (Kidney Disease Outcomes Quality Initiative) recommend autologous arteriovenous fistula (AVF) as the primary vascular access in hemodialysis patients because of the higher quality of life and lower complication rates if compared to arteriovenous grafts (AVGs) or central venous catheter (CVC). Several studies used various inflammatory biomarkers to evaluate the association between systemic inflammation and AVF dysfunction. A novel inflammatory biomarker, the platelet-lymphocyte ratio (PLR), is a useful and easy laboratory parameter that can reveal systemic inflammation. Our study aimed to evaluate the relationship between PLR value changes over time and AVF dysfunction. The impact of PLR on our outcome showed a trend close to the significance (OR: 4,9; 95%CI: [0.84-28.5]; p = 0.08) but the slope was not linear. Therefore, we performed the same analysis splitting the patients by the median PLR value and we highlighted a significant relationship between our outcome and the PLR (log-transformed) for PLR-value under the median value (OR: 9.97; 95%CI: [2.53-39.25]; p = 0.001). Furthermore, in patients with PLR above the median value, the interaction visit-PLR showed an impact close to the statistical significance (OR: 7.7; 95%CI: [0.81-72.97]; p = 0.07). PLR (log-transformed) was positively correlated with AVF age (Rho: 0.254, p = 0.002).

Hypokalemia is among the most common electrolyte abnormalities, often well tolerated, but sometimes responsible for an increase in morbidity and mortality due to cardiovascular causes. The kidneys play a key role in potassium homeostasis, making the nephrologist the professional directly involved in the diagnosis and treatment of this condition. We present the clinical case of a 24-year-old man who came in with multiple episodes of emesis and hyperpyrexia. The patient rapidly developed severe hypokalemia with ascending flaccid paralysis. Despite early treatment with potassium chloride, intensive therapy was necessary to manage the complications. The clinical case illustrates the diagnostic and therapeutic challenges encountered and demonstrates how a multidisciplinary approach and a thorough diagnostic process, including genetic testing, identified a heterozygous mutation in the CACNA1S gene, confirming the diagnosis of hypokalemic periodic paralysis type I. The importance of early recognition and appropriate management of hypokalemia is emphasized to prevent potentially fatal complications.

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.

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.

Introduction. 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. Methodology. 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. Results. 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. Conclusions. 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.

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.

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.