Elena Mancini

Policlinico S.Orsola-Malpighi, Bolonia, Emilia-Romagna, Italy

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Publications (75)134.14 Total impact

  • Antonio Santoro, Elena Mancini
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    ABSTRACT: Chronic inflammation is a complication of conventional hemodialysis that induces progressive cardiovascular damage. An apparently straightforward manipulation to treat this-removal of a large amount of uremic toxins by convection-has proven that the relationships between inflammation and convective techniques such as hemodiafiltration are more complicated than we currently understand. This Commentary addresses all the doubts and questions that lie behind the assertion that convection is the solution to the problem of inflammation in dialysis.
    Kidney international. 08/2014; 86(2):235-237.
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    ABSTRACT: Background: Central venous catheter (CVC) preparation for a haemodialysis (HD) session is a critical non-standardized manoeuvre. Methods: We compared the procedure in use at our centre (C) versus the use of Haemocatch® (H), a device recently presented for the management of CVC, in 12 patients, with C during 7 dialysis sessions and H during the subsequent 7 sessions. Results: Out of 75 HD sessions with C and 75 with H, both the number of connections and disconnections of the CVC via a syringe and the amount of blood wasted during the manoeuvres proved significantly lower with H (2.19 ± 0.59 for H vs. 4.23 ± 0.78 for C, p = 0.00093; 5.97 ± 2.77 ml for H vs. 14.57 ± 6.3 ml for C, p = 0.000078, respectively). Conclusions: The new device could improve the quality of care in the HD patients carrying a CVC: standardization of the procedure, reduced blood wasting and infection risk. © 2014 S. Karger AG, Basel.
    Blood Purification 07/2014; 37(4):266-270. · 2.06 Impact Factor
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    ABSTRACT: Introduction and Aims: Different types of cells have been used for the development of potential bioartificial kidney devices. Recently, the reprogramming of adult cells to embryonic nephron progenitors (C.E.Hendry et al JASN 2013) and human embryonic stem cells differentiated to renal proximal tubular cells (K.Narayan et al KI 2013) have been used as potential building blocks for a bioartificial kidney. Here we propose the combination of adult renal progenitor/stem cells with different microfabrication and nanofabrication technologies to develop miniaturized, bioartificial proximal tubule-like platforms, which are very promising tools for next-generation bio-analytic assays and for studying the nephrotoxicity of drugs. The potentialities of these interdisciplinary, cross-cutting platforms for in-vitro testing of drugs are presented and discussed.Methods: Our class of devices is composed of overlapped elastomeric layers, embedding microfluidic connections, porous and functionalized membranes, and polymeric
    Nephrology Dialysis Transplantation 05/2014; 29:iii209-iii222. · 3.37 Impact Factor
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    ABSTRACT: Intradialytic hypotension (IDH) represents a common hemodialysis (HD) complication. Blood volume tracking (BVT) is a tool regulating the relative blood volume changes and potentially reducing the occurrence of IDH. The aim of this study was to evaluate the ability of BVT to reduce the staff workload associated to IDH. Ten hypotension-prone HD patients were treated each with 39 conventional HD (HD) sessions and then switched to 39 HD sessions with BVT (HD-BVT). The staff interventions related to IDH were monitored by a trained staff. Dialysis sessions complicated by IDH and staff interventions were affected by BVT (HD: 102 and 127 vs. HD-BVT: 57 and 59, respectively, for both p<0.001). The time consumed by staff in IDH management was decreased by HD-BVT (1416 vs. 578 min, p<0.001). The effectiveness of BVT to reduce the frequency of IDH leads to a reduction of the dialysis staff workload with fewer staff interventions, allowing for major work-time saving.
    The International journal of artificial organs 05/2014; 37(4):292-8. · 1.76 Impact Factor
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    ABSTRACT: Background: Low and high dialysate calcium (Ca2+) content may have positive and harmful effects depending on the considered pathological aspect: hemodynamic instability, cardiac arrhythmias, parathormone release, adynamic bone disease, cardio-vascular calcifications. We hypothesized that a time-profiled Ca2+ concentration would keep the cardiovascular advantages of high Ca2+ but would reduce the risk of calcium overload. Methods: A prospective, multicenter study using a particular hemodiafiltration technique that allows the profiling of electrolytes was designed. Patients (n = 22) underwent randomly a 3-week dialysis session with low and high constant dialysate Ca2+ (LdCa, 1.25 mM and HdCa, 2 mM) and profiled Ca2+ (PdCa), respectively. Plasma and spent dialysate Ca2+, systolic and diastolic arterial pressure (SAP, DAP) and QT interval corrected for heart rate (QTc) were analyzed. Results: Plasma Ca2+ concentration decreased in LdCa, whereas it increased in HdCa and to a lesser extent, in PdCa. Total amount of Ca2+ given to the patient in PdCa (15.5 ± 1.0 mmol) was higher than in LdCa (4.3 ± 1.6 mmol) but lower than in HdCa (21.9 ± 3.3 mmol). SAP and DAP decreased in LdCa, whereas it was almost constant in both HdCa and PdCa. QTc significantly increased, up to critical values (>460 msec), only during LdCa. Conclusions: PdCa seems to retain the advantages of high Ca2+ in terms of hemodynamic stability and modification of QTc while reducing the excessive positive calcium balance typical of dialysis with high Ca2+ content.
    The International journal of artificial organs 04/2014; 37(3):206-14. · 1.76 Impact Factor
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    ABSTRACT: Multiple myeloma (MM) is still one of the most common haematological diseases and is associated with a poor prognosis. It is frequently worsened by acute kidney failure that, in turn, aggravates the risk of death. In the past few years, the idea has made headway that the removal of free light chains (FLC) by means of extracorporeal blood purification systems may facilitate the recovery of renal function. Up to now, many different extracorporeal techniques have been put forward in FLC removal, such as plasma exchange, dialysis with super-flux filters, and adsorption by means of cartridge of resins. In this paper, we illustrate the use of polymethylmethacrylate (PMMA) dialysis membranes with a high adsorptive capacity (Toray BK-F; Toray Industries, Inc., Tokyo, Japan). We have evaluated light chain removal by means of an original dialysis procedure using a double-filter circuit made of PMMA working in sequential dialysis (DELETE system). The system provides satisfactory results in terms of FLC removal and, at the same time, ensures an adequate dialysis treatment (Kt/V >1.5) with significant reduction in urea, creatinine, and β2-microglobulin. The dual PMMA filter system combines an acceptable cost/efficiency ratio when compared with other methods and constitutes a concrete prospect in FLC removal. Its preferential setting of use is in patients with MM or with monoclonal gammopathies, who are on chronic dialysis and maintain high circulating levels of FLC.
    Blood Purification 01/2013; 35 Suppl 2:5-13. · 2.06 Impact Factor
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    ABSTRACT: Hemodialysis sessions are often complicated by the occurrence of intradialytic hypotension (IDH), mainly due to the decrease of central blood volume. Blood oxygen content may play a role in hypotension onset and can reflect changes in cardiac output and tissue perfusion. Currently, there is an increasing interest in intradialytic monitoring, through the development of biofeedback based technologies aimed to IDH prevention. Blood Oxygen saturation (SO2) is a patient parameter easy to monitor during hemodialysis thanks to optical noninvasive sensors placed on blood line. The aim of this study was to analyze SO2 variations in relationship with IDH in ten hypotension prone patients with central venous vascular access. A higher decrease of SO2 was found in sessions complicated by hypotension, in comparison with stable sessions (p
    Computing in Cardiology Conference (CinC), 2013; 01/2013
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    ABSTRACT: The traditional control of the dialysis session comes about by means of an open-loop system. At the beginning of the session some parameters are set, such as the kind of dialyzer, the blood flow, the ultrafiltration rate, the dialysate conductivity and the dialysate temperature. Generally speaking, these parameters are not modified unless there occur complications in the patient that call for adjustments to be made. The biofeedback concept, which is synonymous with a closed-loop control of biological variables, presupposes, on the other hand: the continuous measurement of a variable thanks to a specific sensor its evaluation by a sort of expert system - the so-called controller and a series of means - the actuators - that allow the behavior of the variable to be directly or indirectly influenced. In clinical practice, different biofeedback systems are emerging, addressed to the control of blood volume, body temperature, and blood pressure. Each one of these systems has been successfully utilized, especially in the management of “difficult” patients unstable from the hemodynamic point of view. However, the future will be an integrated system that sees a complex adaptive, multi-input, multi-output controller which, with a great simplicity of use and low costs, will allow renal replacement therapy to be increasingly physiological and more efficient.
    09/2012: pages 1081-1107; , ISBN: 978-3-642-27557-9
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    ABSTRACT: Uremic Neuropathy (UN) highly limits the individual self-sufficiency causing near-continuous pain. An estimation of the actual UN prevalence among hemodialysis patients was the aim of the present work. We studied 225 prevalent dialysis patients from two Italian Centers. The Michigan Neuropathy Score Instrument (MNSI), already validated in diabetic neuropathy, was used for the diagnosis of UN. It consisted of a questionnaire (MNSI_Q) and a physical-clinical evaluation (MNSI_P). Patients without any disease possibly inducing secondary neuropathy and with MNSI score ≥ 3 have been diagnosed as affected by UN. Electroneurographic (ENG) lower limbs examination was performed in these patients to compare sensory conduction velocities (SCV) and sensory nerve action potentials (SNAP) with the MNSI results. 37 patients (16.4%) were identified as being affected by UN, while 9 (4%) presented a score < 3 in spite of neuropathic symptoms. In the 37 UN patients a significant correlation was found between MNSI_P and SCV (r2 = 0.1959; p < 0.034) as well as SNAP (r2 = 0.3454; p = 0.027) both measured by ENG. UN is an underestimated disease among the dialysis population even though it represents a huge problem in terms of pain and quality of life. MNSI could represent a valid and simple clinical-instrumental screening test for the early diagnosis of UN in view of an early therapeutic approach.
    Clinical nephrology 06/2012; 77(6):468-75. · 1.29 Impact Factor
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    ABSTRACT: It is commonly accepted that the longer the time on extracorporeal cardiopulmonary bypass (CPB), the higher is the likelihood of developing acute renal failure requiring dialysis (ARF-D). Nonetheless, previous works elicited conflicting evidence. We investigated the relationship between CPB duration and ARF-D occurrence. Data were extracted from a large observational study. All factors independently associated with ARF-D were detected. Overall, 11,092 case record forms were analyzed. At the univariate analyses, time on CBP was associated with an increase in the ARF-D risk (odds ratio of fifth vs. first quintile of CBP time: 3.84; 95% confidence interval: 2.58-5.7; P < 0.001). However, after adjusting for confounders, the association between time on CBP and ARF-D lost its statistical significance. In this large dataset, CBP time did not predict ARF-D occurrence. These results might suggest that an accurate risk assessment might be more important than time on CPB in determining ARF-D occurrence.
    Hemodialysis International 11/2011; 16(2):252-8. · 1.44 Impact Factor
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    Antonio Santoro, Elena Mancini, Fabio Grandi
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    ABSTRACT: The progressive increase in mean age and comor-bidity in chronic haemodialysis (HD) patients (espe-cially those with cardiovascular diseases and diabe-tes) has significantly worsened patients' clinical status and tolerance to dialysis treatment. Moreover, constraints on resources (both economic and human), along with the need for shorter treatment times, have increased the risk of haemodynamic instability as well as inadequate dialysis. In traditional dialysis session management, set-ting predefined treatment parameters, with active therapeutic interventions only in the event of com-plications, is definitely unsuitable for short-lasting treatments, often complicated by haemodynamic instability, especially in critically ill patients. The first step towards improving dialysis session management is the use of continuous and noninvasive monitoring systems for the haemodynamic or bio-chemical parameters involved in dialysis quality. Special sensors for continuous blood volume measurement have been developed over the past ten years. As a second step, some of these devices have been implemented in dialysis instrumentation, mainly with a view to prevent-ing cardiovascular instability, but also in order to control dialysis efficiency (e.g. biofeedback control systems or closed-loop biological variable control systems). The basic components of a biofeedback system are the plant, the sensors, the actuators and the controller. The plant is the biological process that we need to control, while the sensors are the devices used for measuring the output variables. The actuators are the working arms of the controller. The controller is the mathematical model that con-tinuously sets the measured output variable against the reference input and modifies the actuators in order to reduce any discrepancies. In practice, however, there are a number of concep-tual, physical and technological difficulties that still need to be overcome. In particular, the patient -monitor sys-tem to be controlled is typically nonlinear and time-varying, with interactions between the actuators and the controlled variable. In these cases, more sophisti-cated control systems are needed, capable of identifying the behaviour of the process, and continuously updat-ing the data while the control is being made. These complex systems are called adaptive controllers. Biofeedback blood volume control is a system used in routine clinical dialysis around the world.
    Port J Nephrol Hypert Port J Nephrol Hypert. 01/2010; 24(24):195-200.
  • American Journal of Kidney Diseases 03/2009; 53(3):563. · 5.29 Impact Factor
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    ABSTRACT: Acute hypotension is a frequent complication of hemodialysis. Blood oxygenation may play a role in hypotension and hypoxemia may be considered as a surrogate marker of hemodynamic instability. Continuous, non-invasive monitoring of oxygen saturation (SO<sub>2</sub>) during hemodialysis is now possible, by means of sensors measuring SO<sub>2</sub> in blood entering the dialyzer. The aim of the present work was to analyze the short-term variability of SO<sub>2</sub> during hemodialysis in sessions with and without hypotension to correlate the SO<sub>2</sub> variability to hemodynamic instability. Our preliminary results showed an interesting, yet to be fully understood, role of SO<sub>2</sub> in anticipating hypotension onset.
    Computers in Cardiology, 2008; 10/2008
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    ABSTRACT: Given the paucity of prospective randomized controlled trials assessing comparative performances of different dialysis techniques, we compared on-line high-flux hemofiltration (HF) with ultrapure low-flux hemodialysis (HD), assessing survival and morbidity in patients with end-stage renal disease (ESRD). An investigator-driven, prospective, multicenter, 3-year-follow-up, centrally randomized study with no blinding and based on the intention-to-treat principle. Prevalent patients with ESRD (age, 16 to 80 years; vintage > 6 months) receiving renal replacement therapy at 20 Italian dialysis centers. Patients were centrally randomly assigned to HD (n = 32) or HF (n = 32). All-cause mortality, hospitalization rate for any cause, prevalence of dialysis hypotension, standard biochemical indexes, and nutritional status. Analyses were performed using the multivariate analysis of variance and Cox proportional hazard method. There was significant improvement in survival with HF compared with HD (78%, HF versus 57%, HD) at 3 years of follow-up after allowing for the effects of age (P = 0.05). End-of-treatment Kt/V was significantly higher with HD (1.42 +/- 0.06 versus 1.07 +/- 0.06 with HF), whereas beta(2)-microglobulin levels remained constant in HD patients (33.90 +/- 2.94 mg/dL at baseline and 36.90 +/- 5.06 mg/dL at 3 years), but decreased significantly in HF patients (30.02 +/- 3.54 mg/dL at baseline versus 23.9 +/- 1.77 mg/dL; P < 0.05). The number of hospitalization events for each patient was not significantly different (2.36 +/- 0.41 versus 1.94 +/- 0.33 events), whereas length of stay proved to be significantly shorter in HF patients compared with HD patients (P < 0.001). End-of-treatment body mass index decreased in HD patients, but increased in HF patients. Throughout the study period, the difference in trends of intradialytic acute hypotension was statistically significant, with a clear decrease in HF (P = 0.03). This is a small preliminary intervention study with a high dropout rate and problematic generalizability. On-line HF may improve survival independent of Kt/V in patients with ESRD, with a significant decrease in plasma beta(2)-microglobulin levels and increased body mass index. A larger study is required to confirm these results.
    American Journal of Kidney Diseases 07/2008; 52(3):507-18. · 5.29 Impact Factor
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    ABSTRACT: In our clinical context, there are two groups that practice blood purification treatments on acute or chronic liver failure (AoCLF) patients: one group used MARS (molecular adsorbent recirculating system) and the other Prometheus. The MARS group used the lack of response to standard medical treatment after 72 hours of observation as the access criterion. The Prometheus group used the access criteria of the multicenter Helios protocol for patients in AoCLF, as well as those with primary nonfunction (PNF) and secondary liver insufficiency. Both groups performed treatment sessions of at least 6 hours, which were repeated at least every 24 to 36 hours. The 56 treated AoCLF patients underwent 278 treatment sessions; 41 out of 191 procedures with MARS and 16 out of 87 procedures with prometheus, which was also applied in two cases in PNF and four in secondary liver insufficiency. The results showed that both systems accomplished a good purification efficiency and that application to patients enabled reinstatement on the transplant list and grafts in 70% of the cases with either method. Treatment led to recovery in dysfunction among patients not destined for transplantation, achieved with a 48.5% 3-month survival in the MARS group and 33.5% in the Prometheus groups. The treatment results were inversely proportional to the MELD at the time of entry; The treatment appeared to be pointless. Among PNF and secondary liver insufficiency cases.
    Transplantation Proceedings 06/2008; 40(4):1169-71. · 0.95 Impact Factor
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    ABSTRACT: Although sudden death is one of the most frequent causes of death in haemodialysis (HD) patients, the problem of cardiac arrhythmias, the major cause of these outcomes, has been little discussed. In 30 arrhythmia-prone HD patients, we compared the arrhythmogenic effects of two dialysis techniques differing in dialysate potassium (K) content. Each patient underwent Acetate-Free Biofiltration sessions with constant (2.5 mEq/l) K (AFB) and sessions with decreasing intra-HD K (AFBK), according to a crossover single blind design. Holter ECG recording and plasma electrolyte measurements were performed during each dialysis session. There was a tendency in the whole sample for arrhythmia appearance in AFBK to be reduced as compared to AFB throughout the 24 hr period, although this reduction was not statistically significant. In the subset of patients sensitive to dialysis as far as arrhythmia onset is concerned, AFBK was systematically less arrhythmogenic than AFB (P < 0.01). The highest difference was achieved around the 14th hour after the end of dialysis, when the premature ventricular contractions in AFB were 3.9 times higher than in AFBK (P < 0.05). Potassium kinetics differed between the two procedures. At the first hour of treatment, the plasma K concentration was lower in AFB than in AFBK (3.67 +/- 0.15 mEq/l in AFB vs 4.06 +/- 0.13 mEq/l in AFBK, P = 0.05). Our study shows a greater arrhythmogenic activity with the use of a constant and relatively low K concentration as compared to decreasing K profiling in dialysis-sensitive arrhythmic patients. Smoother K removal may well engender a kind of protective effect.
    Nephrology Dialysis Transplantation 05/2008; 23(4):1415-21. · 3.37 Impact Factor
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    ABSTRACT: The progressive increase in the mean age and the growing conditions of co-morbidity, especially of cardiovascular pathologies and diabetes, have significantly worsened the patients' clinical status and tolerance to the hemodialysis (HD) treatment. On the other hand, the demand for short treatment times enhances the risk for hemodynamic instability as well as for inadequate depuration. The traditional management of the dialysis session, setting of predefined treatment parameters, with active therapeutic interventions only in the event of complications, is definitely unsuitable for short-lasting treatments, often complicated by hemodynamic instability, especially in critical patients. The first step to improve the management of the dialysis session is the utilization of continuous and uninvasive monitoring systems for hemodynamic or biochemical parameters involved in the dialysis quality. Special sensors for the continuous measurement of blood volume, blood temperature, blood pressure, heart rate, electrolytes, have been realized throughout the last 10 years. As a second step, some of these devices have been implemented in the dialysis instrumentation, mainly with a view to preventing cardiocirculatory instability but also to control the dialysis efficiency (biofeedback control systems). The basic components of a biofeedback system are: the plant, the sensors, the actuators and the controller. The plant is the biological process that we need to control, while the sensors are the devices used for measuring the output variables. The actuators are the working arms of the controller. The controller is the mathematical model that continuously sets the measured output variable against the reference input and modifies the actuators in order to reduce any discrepancies. Yet, in practice there are a number of conceptual, physical and technological difficulties to be overcome. In particular, the behavior of what is to be controlled may be non-linear and time-varying, with interactions between the actuators and the controlled variable. In these cases, more sophisticated control systems are needed, which must be capable of identifying the behavior of the process, and continuously update information data while the control is on. These complex systems are called adaptive controllers. In dialysis, over the last few years, it has been relatively easy to realize some biofeedback systems since a series of sensors have been developed for online monitoring. Three biofeedback devices are routinely used with the aim of improving the cardiovascular instability, one of the main problems limiting the tolerance to treatment by the patient and the quality of HD in itself - the first is the biofeedback control of blood volume, the second is the biofeedback control of thermal balance, and the third is the biofeedback control of blood pressure.
    Contributions to nephrology 02/2008; 161:199-209. · 1.49 Impact Factor
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    ABSTRACT: Introduction: In our clinical context, there are two groups that practice blood purification treatments on acute or chronic liver failure (AoCLF) patients: one group used MARS (molecular adsorbent recirculating system) and the other Prometheus. Materials and methods: The MARS group used the lack of response to standard medical treatment after 72 hours of observation as the access criterion. The Prometheus group used the access criteria of the multicenter Helios protocol for patients in AoCLF, as well as those with primary nonfunction (PNF) and secondary liver insufficiency. Both groups performed treatment sessions of at least 6 hours, which were repeated at least every 24 to 36 hours. Results: The 56 treated AoCLF patients underwent 278 treatment sessions; 41 out of 191 procedures with MARS and 16 out of 87 procedures with prometheus, which was also applied in two cases in PNF and four in secondary liver insufficiency. The results showed that both systems accomplished a good purification efficiency and
    Transplantation Proceedings. 01/2008; 40:1169-1171.
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    ABSTRACT: The removal of small and middle molecules has a relevant impact on haemodialysis (HD) patient survival. Mid-dilution (MD) is a technique combining ease of use with high diffusive-convective clearances. However, MD may increase the intrafilter blood pressure due to the high filtration fraction. We devised a new filter configuration, reverse MD, with an inverted blood inlet and outlet. We compared biochemical and technical performances of reverse MD vs standard MD. Eight HD patients underwent one standard MD treatment and one reverse MD. Samples for instantaneous clearance and total mass removed from dialysate spilling (urea, phosphate, beta2-microglobulin, angiogenin) were obtained. Dialysate and blood pressures in the circuit were monitored every 15 min. The reinfusion rate was set at 6 l/h for both treatments. Absolute removals were very high and statistically comparable in both the configurations. Pressures were significantly lower with the reverse compared with the standard MD: inlet blood pressure was 731+/-222 and 595+/-119 mmHg in the standard and in the reverse MD, respectively. The transmembrane pressures were lower in the reverse compared with the standard MD (422+/-90 and 611+/-136 mmHg for 1st stage; 188+/-54 and 307+/-56 mmHg for 2nd stage). Reverse MD could be an ideal technique for high ultrafiltration routine treatments without any external fluid reinfusion. It allows a very high removal of small and middle molecules, with relatively lower intrafilter pressures.
    Nephrology Dialysis Transplantation 08/2007; 22(7):2000-5. · 3.37 Impact Factor
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    ABSTRACT: Acute renal failure is a sudden and sustained decrease in the glomerular filtration rate associated with a loss of excretory function and the accumulation of metabolic waste products and water. It leads to an increase in serum urea and creatinine, usually with a decrease in urine output. Although routine surveillance of patients by means of laboratory examinations has been well defined, very little is known about renal imaging. Modern technology has provided a large number of sophisticated monitoring systems. Ultrasonography with color-Doppler study of the kidneys may be indicated as a possible monitor of renal perfusion. Ultrasonography is often used as the initial imaging procedure in the examination of patients with renal failure. Aside from excluding hydronephrosis, it is well recognized in characterizing the type of renal disease, especially in an acute setting. This article describes the use of ultrasound to achieve the proper diagnosis of acute renal diseases and to enable the appropriate and early assessment of these patients in intensive care units.
    Critical Care Medicine 06/2007; 35(5 Suppl):S198-205. · 6.12 Impact Factor

Publication Stats

561 Citations
134.14 Total Impact Points

Institutions

  • 1995–2014
    • Policlinico S.Orsola-Malpighi
      Bolonia, Emilia-Romagna, Italy
  • 2013
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy
  • 2012
    • Ospedale Luigi Sacco
      Milano, Lombardy, Italy
  • 2005
    • University of Padova
      Padua, Veneto, Italy
  • 1998–2003
    • University of Bologna
      • Department of Computer Science and Engineering DISI
      Bologna, Emilia-Romagna, Italy