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ABSTRACT: A 29- year-old male was admitted because of exertion dyspnea and intense headache. These symptoms were associated with severe hypertension, small multiple areas of cerebral ischemia, thrombocytopenia, prolonged aPTT and renal failure. The diagnostic tests performed during hospitalization resulted in a diagnosis of Primary Antiphospholipids Syndrome. The renal biopsy sample suggested histopathological features of uncommon simultaneous occurrence of antiphospholipids nephropathy and a "collapsing variant" of segmental focal glomerulosclerosis. It is fundamental to be aware that this syndrome is very likely to occur, and therefore to perform antiphospholipids antibodies assessment, since only an anticoagulant therapy proves effective; nevertheless, in view of the pathological renal findings, other therapies such as steroids might be added.
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 23(4):442-6.
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ABSTRACT: The renal biopsy is usually performed as an in-patient procedure, with patients admitted to hospital for at least 24 hours. We have carried out renal biopsies on two groups of patients. In the first group, patients rest in the hospital for 8 hours following the procedure. They are discharged after undergoing ultrasonography and a TC scan. These patients return to the hospital after 24 hours to verify possible post-biopsy complications. In the comparison group, patients remain in hospital for 24 hours.
In both groups, the only observed complication was asymptomatic postbiopsy hematoma. No major complications were present in either group.
In selected cases, renal biopsy performed by an expert practitioner as an outpatient procedure is safe and does not require 24-hour observation.
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 20(3):253-7.
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W De Simone,
M De Simone,
A De Simone, S Iannaccone,
R Manganelli,
B Zito,
P Guastaferro,
V Apperti,
C Paglionico,
G Salvati,
P Veniero,
F Ferro,
V Tedesco
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ABSTRACT: Despite technological advances in dialysis treatment, survival, morbidity and the quality of life in hemodialysis (HD) patients are affected by long-term complications, often related to the treatment itself. Among these complications, moderate protein and caloric malnutrition are present in approximately 30% of dialysis patients and are viewed as major contributors to increased mortality. In malnutrition pathogenesis, great importance is given to protein catabolism and to the loss of somatic protein and amino acids during dialysis. On the contrary, toxin clearance is believed to influence, positively, both protein anabolism and dietary protein intake. In hemodiafiltration (HDF), the clearance process is potentiated by three mechanisms (diffusion, convection and adsorption) and this could have a favorable effect on malnutrition. In addition, the reinfusion of regenerated ultrafiltrate (UF) would avoid the loss of large amounts of useful solutes as occurs with standard HD. In fact, all amino acids are present in the UF, which is not important in standard HD, but could be a problem in hemodiafiltration reinfusion (HFR). We treated 16 patients with HFR during the previous 3 months (the study will last for 12 months). Patients had been previously treated with bicarbonate dialysis for at least 6 months. The clinical tolerance of HFR was excellent and the technique appeared to be quite simple. The preliminary biochemical results demonstrated the stabilization of some parameters (such as urea and uric acid) with an adequate clearance of small molecules, while variables related to nutritional status (body weight, serum albumin and serum transferrin) did not change substantially. Surprisingly, the loss of both branched chain amino acids (BCAA) and essential amino acids (EAA) seemed slightly lower in HFR compared with standard HD. However, the reduced loss of amino acids (AA) observed with HFR should take into account other factors, such as absorption on adsorbent material and the basal plasma AA concentrations. Therefore, although each patient is in control of himself, it is difficult to draw any definite conclusions after only 3 months. However, it is evident that the loss of AA in HFR is quite modest and is not increased by the fact that it is a hemofiltration technique with all the consequent positive effects.
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 21 Suppl 30:S161-7.
