F Quarello

Ospedale San Giovanni Bosco, Torino, Piedmont, Italy

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Publications (177)406.99 Total impact

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    ABSTRACT: Introduction: Demographic analysis shows the ageing of the global population and the consequent increase in the age of hospitalized subjects and of patients starting dialysis. Hence, interest in the feasibility, safety, and usefulness of renal biopsy in elderly patients is growing. We examined the data of 131 patients over the age of 75 who underwent renal biopsy. We analyzed the safety of the procedure, treatment, and outcomes. Results: Histological diagnoses included: membranous glomerulonephritis (GN) 20.6%, crescentic GN 12.9%, IgAGN 10.6%, focal segmental glomerulosclerosis 9.1%, acute GN 4.5%, amyloidosis 9.1%, and acute tubular necrosis 3.8%. Mean glomerular obsolescence was 28.9 ± 27.9%. Mean age of the patients was 78.7 ± 5.73 years. At the time of biopsy, serum creatinine (SCr) was 4.47 ± 2.56 mg/dL and proteinuria was 4.82 ± 6.78 g/day. Targeted treatment was given to 51.9% of patients, 52.9% of whom had a good clinical response. Eight patients had clinically non-relevant side effects (11.7%). A positive response (defined as a more than 50% reduction of SCr, or by partial or complete remission of proteinuria) was observed in 36 patients (52.9%). 76 patients were monitored for 57 ± 9.89 months: 18 patients were on dialysis (follow-up 2.56 ± 3.61 months), 15 died (follow-up 58.5 ± 13.43 months), and 52 remained under nephrologic observation for 36 ± 31 months (SCr was 2.56 ± 0.75 mg/dL and proteinuria was 4.82 ± 6.78 g/day). Conclusion: In our experience, renal biopsy is safe even in very elderly patients; it allowed targeted treatment in 51.9% of patients, 52.9% of whom had a good clinical response, possibly contributing to prolonged patient survival and improved quality of life.
    No preview · Article · Aug 2014 · Clinical nephrology
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    ABSTRACT: Volume overload is typical of haemodialysis patients; correct volume status evaluation is crucial in achieving blood pressure homeostasis, hypertension management and good treatment planning. This study evaluates the effect of acute volume depletion on ultrasonographic parameters and suggests two of them as able to predict patients volume overload. 27 patients with end stage renal disease treated with haemodialysis underwent a complete echocardiographic exam before, after 90 min and at the end of the dialysis. Blood pressure levels significantly drop during the first 90 min of dialysis (139 ± 20 vs 126 ± 18; p < 0.0001), reaching a steady state with significantly lower values compared to baseline (130 ± 28; p = 0.02). LV and left atrial volume significantly decreased (baseline vs end dialysis 98 ± 32 vs 82 ± 31 p = 0.003 and 28 ± 10 vs. 21 ± 9 cc/m(2) p < 0.001). A significant reduction of systolic function (EF 61.6 % ± 9 vs 58.7 % ± 9 p = 0.04), of diastolic flow velocities (E/A 1.13 ± 0.37 vs. 0.87 ± 0.38 p < 0.001) and mitral annulus TDI tissue velocity (i.e. E' lat 10.6 ± 3 vs. 9.4 ± 3 cm/s; p 0.0001) were observed. Stroke work (SW) and LV end-diastolic diameter (LVEDd) indexed to height 2.7(LVEDdi) were able to predict volume overload: cut off values of respectively 13.5 mm/m(2.7) for LVEDdi and 173 cJ for SW were able to predict with a specificity of 100 % the presence of a volemic overload of at least 4 %. Blood pressure, cardiac morphology and function are significantly modified by acute volume depletion and such variations are strictly interrelated. SW and LVEDd/height(2.7) may identify ESRD patients carrying an higher volume load.
    No preview · Article · Feb 2014 · High Blood Pressure & Cardiovascular Prevention
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    Full-text · Dataset · Nov 2013
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    ABSTRACT: Background: Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested. Methods: We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021)).
    Full-text · Article · Jul 2013 · Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
  • Marco Pozzato · Fiorenza Ferrari · Sergio Livigni · Francesco Quarello
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    ABSTRACT: Acute kidney injury (AKI) occurs in 5-45% of critically ill patients, and renal replacement therapy (RRT) is required in 4-10% of patients with AKI. AKI has long been considered to be hemodynamic damage from low blood flow resulting in shock, and efforts have been made to prevent and cure it by increasing the renal blood flow and improving the cardiac output and perfusion pressure. In recent years, new experimental studies on patients with septic AKI have shown that the renal blood flow remains unaltered or even increases in septic shock. An important mechanism in the pathophysiology of sepsis and septic shock appears to be apoptosis rather than ischemic necrosis. The type of treatment as well as the dose and timing of initiation of RRT seem to have strategic importance in the recovery of AKI in patients admitted to the ICU. In critically ill (often postsurgical and septic) patients with acute renal failure the use of new anticoagulation strategies has permitted to perform treatments for a sufficient number of hours to achieve the correct level of purification by minimizing the downtime and the bleeding risk. In our center the use of protocols for different methods and different types of anticoagulants has simplified the treatment of all patients with AKI and septic shock admitted to the ICU.
    No preview · Article · Dec 2012
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    Preview · Article · Nov 2012 · Critical Care
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    ABSTRACT: Acute pyelonephritis (APN) is a frequent pathological condition. Its etiology is prevalently due to E. coli and risk factors include sexual activity, genetic predisposition, old age and urinary instrumentation. No correlation between APN and vesicoureteral reflux has been established in adults. The diagnosis of APN is usually clinical, but computed tomography (CT) and magnetic resonance imaging (MRI) allow a more precise definition and can document evidence of abscesses. Severe cases should be treated with a fluoroquinolone or an extended-spectrum cephalosporin. Treatment should last 10-14 days. The long-term evolution of APN is prevalently favorable in adults, even though formation of cortical scars and development of macroalbuminuria and renal failure have been described. The formation of renal abscesses is underestimated and must be evaluated by CT or MRI. Abscesses need to be drained only when they are large, and medical treatment is successful in the majority of cases.
    No preview · Article · Sep 2012 · Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
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    ABSTRACT: Background Intradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH. Methods Fifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment. HFR-Aequilibrium (HFR-Aeq) is an evolution of the haemofiltration with endogenous reinfusion (HFR) dialysis therapy, with dialysate sodium concentration and ultrafiltration rate profiles elaborated by an automated procedure. The primary end point was the frequency of IDH. Results Symptomatic hypotension episodes were significantly lower on HFR-Aeq versus HFR (23 ± 3 versus 31 ± 4% of sessions, respectively, P l= l0.03), as was the per cent of clinical interventions (17 ± 3% of sessions with almost one intervention on HFR-Aeq versus 22 ± 2% on HFR, P <0.01). In a post-hoc analysis, the effect of HFR-Aeq was greater on more unstable patients (35 ± 3% of sessions with hypotension on HFR-Aeq versus 71 ± 3% on HFR, P <0.001). No clinical or biochemical signs of Na/water overload were registered during the treatment with HFR-Aeq. Conclusions HFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na+ measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice.
    Full-text · Article · May 2012 · Nephrology Dialysis Transplantation
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    ABSTRACT: Acute pyelonephritis (APN) is a common disease which rarely evolves into abscesses. We prospectively collected clinical, biochemical and radiological data of patients hospitalized with a diagnosis of APN from 2000 to 2008. Urinary culture was positive in 64/208 patients (30.7%) and blood cultures in 39/182 cases (21.4%). Two hundred and thirteen patients were submitted to computed tomography (CT) or nuclear magnetic resonance (NMR): confirmation of APN was obtained in 196 patients (92%). Among these, 46 (23.5%) had positive urine culture, 31 (15.8%) had positive blood culture and 15 (7.6%) had positive cultures of both urine and blood. In 98 patients, either urine or blood cultures were negative, but CT/NMR were positive for APN. Fifty of the 213 patients submitted to CT/NMR (23.5%) had intrarenal abscesses: only 2 were evidenced by ultrasound examination. No differences were found between patients with positive or negative CT with regards to fever, leucocytosis, C-reactive protein, pyuria, urine cultures and duration of symptoms before hospitalization. No differences were found between patients with or without abscesses with regards to these parameters and risk factors. Patients with abscesses had a longer duration of treatment and hospitalization. Our data suggest that in APN it is not always possible to routinely document urinary infection in a clinical setting. This finding could be explained by previous antibiotic treatment, low bacterial growth or atypical pathogens. Systematic CT or NMR is necessary to exclude evolution into abscesses, which cannot be suspected on clinical grounds or by ultrasound examination and may also develop in the absence of risk factors.
    Full-text · Article · Feb 2012 · Nephrology Dialysis Transplantation
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    ABSTRACT: Hemodialysis is complicated by a high incidence of intradialytic hypotension and disequilibrium symptoms caused by hypovolemia and a decrease in extracellular osmolarity. Automatic adaptive system dialysis (AASD) is a proprietary dialysis system that provides automated elaboration of dialysate and ultrafiltration profiles based on the prescribed decrease in body weight and sodium content. A noncontrolled (single arm), multicenter, prospective, clinical trial. 55 patients with intradialytic hypotension or disequilibrium syndrome in 15 dialysis units were studied over a 1-month interval using standard treatment (642 sessions) followed by 6 months using AASD (2,376 sessions). AASD (bicarbonate dialysis with dialysate sodium concentration and ultrafiltration rate profiles determined by the automated procedure). Primary and major secondary outcomes were the frequency of intradialytic hypotension and symptoms (hypotensive events, headache, nausea, vomiting, and cramps), respectively. More stable intradialytic systolic and diastolic blood pressures with lower heart rate were found using AASD compared with standard treatment. Sessions complicated by hypotension decreased from 58.7% ± 7.3% to 0.9% ± 0.6% (P < 0.001). The incidence of other disequilibrium syndrome symptoms was lower in patients receiving AASD. There were no differences in end-session body weight, interdialytic weight gain, or presession natremia between the standard and AASD treatment periods. A noncontrolled (single arm) study, no crossover from AASD to standard treatment. This study shows the long-term clinical efficacy of AASD for intradialytic hypotension and disequilibrium symptoms in a large number of patients and dialysis sessions.
    No preview · Article · Jul 2011 · American Journal of Kidney Diseases
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    ABSTRACT: INTRODUCTION AND AIMS: Recent studies have highlighted that podocyte injury and decrease in glomerular podocyte number leads to proteinuria (PU) and glomerulosclerosis. Urinary detection of podocyte injury by measurement of podocyturia and podocyte-specific protein has been used to estimate ongoing glomerular damage. These urinary tests are widely discussed as a more sensitive indicators of CGN activity and prognosis than PU. The aim of study: was to define urinary levels of slit membrane protein - nephrin as a feature of podocyte dysfunction and to clarify its significance for the CGN prognosis and therapy efficiency. METHODS: Nephrinuria (NU) levels were measured by ELISA in 74 CGN pts:18 - without clinical activity (I group), 18- with PU 1-3g/d (II group), 38 - with nephrotic syndrome (NS) (III group). 10 healthy subjects were evaluated as control. Response to immunosuppressive therapy was evaluated in 23 pts with the different NU levels. RESULTS: We revealed significantly increased NU in pts with active CGN (II and III group) compared to I group and control. Furthermore, NU in NS was greatly higher than in pts with lower PU and depends on persistent NS duration (Rs =0,5 p<0,01). View this table: In this window In a new window
    No preview · Article · Jun 2011 · CKJ: Clinical Kidney Journal
  • Giacomo Forneris · Roberto Boero · Carlo Massara · Francesco Quarello
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    ABSTRACT: The number of immigrants has been rapidly increasing in Italy in the last decade, with potentially profound effects on the national health care system. Yet, few data are available on the clinical and demographic features of these subjects, or on their need for nephrological care and dialysis treatment. A survey was conducted in 19 dialysis facilities of Piedmont (a northwestern Italian region) about immigrants on chronic dialysis treatment. Data on native country, administrative position, clinical and dialysis aspects were anonymously collected. Overall, 93 immigrant dialysis patients coming from 24 foreign countries were registered. Most of them were young (mean age 46∓14 years) and on extracorporeal treatment (87%); late referral (38%) or starting dialysis in emergency (17%) were common modalities of presentation. Glomerular (33%) or unknown (31%) nephropathies were the most representative causes of end stage renal disease. No difference in incidence of HCV, HBV and HIV compared with native Italian patients was observed. Notably, more than 50% of the immigrant patients had low-level knowledge of Italian. As regards administrative position, 69% were regular foreign citizens, 19% were temporary foreign workers, and 9% had a residence permit. Our survey confirms the existence of a young immigrant population on dialysis in Piedmont, whose social and relational problems are more challenging than clinical aspects and call for new organizational models to manage this growing population on dialysis.
    No preview · Article · May 2011 · Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
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    ABSTRACT: In March 2009 a clinical audit was held in Turin on peritoneal dialysis in order to analyze the problems that still hinder the effective deployment of the technique in Piedmont-Aosta Valley. Various data about epidemiological and clinical management were collected by means of a questionnaire that all 26 nephrology centers of the two regions responded to. The two major critical issues highlighted were the role of the outpatient facility dedicated to uremic patients and why the peritoneal technique was not chosen for new dialysis patients. With regard to the first issue, the presence of a well structured outpatient facility dedicated to chronic renal failure seems to direct more uremic patients to peritoneal dialysis, at the same time decreasing the rate of late referrals. Regarding the second issue, patient choice was the leading cause followed by problems related to the partner, while traditional clinical contraindications interfered to a lesser extent with the choice of dialysis technique. We therefore believe that it will be possible to increase the use of peritoneal dialysis by improving organizational aspects of the dialysis center and trying to remedy the lack of social support. Accurate information and early care of uremic patients by dedicated outpatient facilities are in fact able to lead more patients to choose peritoneal dialysis. The implementation of measures of support, such as financial incentives to dialysis patients following a recent decision of the Piedmont region, could help to overcome problems related to the lack or unhelpfulness of a partner.
    No preview · Article · Mar 2011 · Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
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    ABSTRACT: The nephrotoxicity of some cancer drugs is well known. Given the rapid development of cancer research, careful assessment of patients treated with new drugs, which may have new toxicity profiles, is mandatory. The nephrotoxicity of cisplatin is likely due to inhibition of autophagy priming, while that of methotrexate is related to direct tubular toxicity and intratubular precipitation. Both can be prevented by adequate hydration. The mechanism of radiation nephropathy development is unclear, but chronic oxidative stress and inflammation seem to play a key role. Mesangiolysis is a characteristic feature, followed by vascular alterations, atrophy, fibrosis, and necrosis. Inhibitors of vascular endothelial growth factor (VEGF), such as bevacizumab, sunitinib, and sorafenib, interfere with angiogenesis. Bevacizumab is a humanized monoclonal antibody which binds to circulating VEGF. Sunitinib and sorafenib are small molecules inhibiting tyrosine kinase of the intracellular domain of the VEGF receptor. Treatment with anti-VEGF drugs is frequently complicated by proteinuria, acute renal failure, and hypertension. The most frequent histological lesion is thrombotic microangiopathy. Inhibitors of the BCR-Abl tyrosine kinase domain on the Philadelphia chromosome (imatinib, nilotinib and dasatinib) may cause acute renal failure.
    No preview · Article · Sep 2010 · Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
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    ABSTRACT: Isolated asymptomatic hematuria is frequently encountered in clinical practice but there are no established recommendations for its evaluation and management. There is controversy regarding which tests are necessary and whether renal biopsy is indicated. In the pediatric population, renal biopsy should be considered if there is evidence of progressive renal disease or when parents are worried about their child's diagnosis or prognosis. In adults, examinations for isolated microhematuria should include exclusion of pharmacological causes, journeys to endemic areas for S. haematobium or tuberculosis, sickle-cell disease, endometriosis and, in patients older than 40 years, kidney, ureteral or bladder cancer. Examination of urinary sediment may help in identifying the origin of microhematuria. If it is decided to perform a renal biopsy, the patient should be carefully informed of the possible complications of renal biopsy, including the possibility of finding normal renal tissue.
    No preview · Article · Jul 2010 · Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
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    Full-text · Article · Sep 2009 · New England Journal of Medicine
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    ABSTRACT: An increase in mortality due to accelerated atherosclerosis has been reported in patients affected with Systemic Lupus Erythematosus (SLE). Anti-phospholipid antibodies (aPA) may play a pathogenetic role in the development of atherosclerosis. We measured carotid intima-media thickness (IMT), as a surrogate parameter of atherosclerosis, by B-mode ultrasound examination in 42 patients affected with SLE (11 men and 31 women) and in 42 healthy age- and sex-matched subjects. Lupus Anticoagulant (LA) (APTT sensitive, silica clotting time, DRVVT), Anti-cardiolipin antibodies (ACA) IgG and IgM, anti-β2glycoprotein 1 (anti-β2GP1) IgG and IgM and anti-prothrombin (anti-PT) IgG and IgM in ELISA (Orgentec Bouty) were also detected. IMT was 0.538±0.128 mm (0.310-0.866 mm) in SLE vs 0.473±0.084 mm in healthy subjects (-p 0.003-). IMT correlated with patients' age (p<0.005) and with C Reactive Protein (CRP) (p<0.005), but not with years of disease, hypertension, number of anti-hypertensive drugs, total cholesterol, serum creatinine and proteinuria. Sixteen patients (38%) had aPL: 12 LA, 6 ACA IgG, 4 ACA IgM, 4 anti-β2GP1 IgG, 3 anti-β2GP1 IgM, 2 anti-PT IgG and 1 anti-PT IgM. IMT was not statistically correlated with aPA. Positive and negative aPA patients only differed as regards glomerular filtration rate (76 ml/min vs 113 ml/min - p<0.01-). Frequency of aPA positivity was 50% in patients with IMT >0.600 mm and 33.3% in those with IMT <0.600 mm. If LA positivity was considered separately, it was 41.6% in patients with IMT >0.600 mm and 23.3% in patients with IMT <0.600 mm. Among the 5 patients with IMT >0.7 mm, 2 had LA positivity (40%) vs 10/37 (27%) of those with minor carotid thickness. In conclusion, IMT, a surrogate parameter of atherosclerosis, was correlated with patients' age and CRP and not with presence of aPA, even though, in the group of patients with greater IMT, there was a non-significant higher proportion of positivity for anti-phospholipid antibodies, in particular for Lupus Anticoagulant.
    No preview · Article · Jan 2009 · European Journal of Inflammation
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    ABSTRACT: Retroperitoneal fibrosis (RPF) is characterized by replacement of the normal tissue of the retroperitoneum with fibrosis and/or chronic inflammation. About two-thirds of cases of RPF are idiopathic and one-third is secondary to drugs, infections (tuberculosis, syphilis, actinomycosis, fungal infections), retroperitoneal hemorrhage, or malignancy. We report the case of a patient who was diagnosed as having RPF and schistosomiasis caused by Schistosoma haematobium with histological documentation. He was treated with praziquantel and afterwards with corticosteroids with remission of RPF. To our knowledge, the association between schistosomiasis and RPF has not been described in the literature. We postulate that there is a causal relationship between these two conditions.
    No preview · Article · Jul 2008 · European Journal of Internal Medicine

  • No preview · Article · Dec 2006 · Journal of Biomechanics

  • No preview · Article · May 2006 · Gastrointestinal Endoscopy