Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

Intradialytic hypotension (IDH) is a frequent and well-known complication of hemodialysis, occurring in about one third of patients. An integrated approach with different methods is needed to minimize IDH episodes and their complications. In this prospective observational study, recruited patients underwent a multiparametric evaluation of fluid status through a lung ultrasound (LUS) with the quantification of B-lines, a physical examination, blood pressure, NT-proBNP and chest X-rays. The evaluation took place immediately before and at the end of the dialysis session, and the patients were divided into IDH and no-IDH groups. We recruited a total of 107 patients. A pre-dialysis B-line number ≥ 15 showed a high sensitivity in fluid overload diagnosis (94.5%), even higher than a chest X-ray (78%) or physical examination (72%) alone. The identification at the beginning of dialysis of <8 B-lines in the overall cohort or <20 B-lines in patients with NYHA 3–4 class are optimal thresholds for identifying those patients at higher risk of experiencing an IDH episode. In the multivariable analysis, the NYHA class, a low pre-dialysis systolic BP and a low pre-dialysis B-line number were independent risk factors for IDH. At the beginning of dialysis, the B-line quantification at LUS is a valuable and reliable method for evaluating fluid status and predicting IDH episodes. A post-dialysis B-line number <5 may allow for an understanding of whether the IDH episode was caused by dehydration, probably due to due to an overestimation of the dry weight

Safety and Efficacy of Eculizumab Therapy in Multiple Sclerosis: A Case Series

(1) Background: Complement system activation has been proposed as one of the different factors that contribute to Multiple Sclerosis (MS) pathogenesis. In this study, we aimed to describe the potential effects of eculizumab, an anticomplement therapy, on MS disease activity in a cohort of relapsing–remitting (RR) MS patients who discontinued IFN-β therapy due to IFN-β-related thrombotic microangiopathy (TMA) onset. (2) Methods: In this retrospective observational multicentric study, we searched for all patients with MS treated by eculizumab with a survey of several nephrological and neurological centers (over 45 centers). (3) Results: Nine patients were included. The mean follow-up time under eculizumab was 3.72 ± 2.58 years. There were no significant differences in disease activity (EDSS, relapses, new T2, and/or Gd-enhancing lesions at MRI) considering the two years before and after eculizumab therapy. No adverse events potentially related to eculizumab therapy were reported during follow-up. (4) Conclusions: In this preliminary study, we described a good safety profile for eculizumab therapy in MS. However, the available data are not sufficient to make firm conclusions about the possible efficacy of eculizumab as a disease-modifying therapy for MS patients

Novel Biomarkers for Early Detection of Acute Kidney Injury and Prediction of Long-Term Kidney Function Decline after Partial Nephrectomy

Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase–associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Methods: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. Results: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (−20.75 vs. −7.20, p p = 0.008) and NephroCheck at 10 h (p = 0.001) were, at multivariable linear regression analysis, efficient predictors of post-operative AKI and long-term eGFR decline if compared to creatinine (R2 0.33 vs. 0.04). Conclusions: NephroCheck and kineticGFR have emerged as promising noninvasive, accurate, and early biomarkers of postoperative AKI and long-term GFR decline after rNSS. Combining NephroCheck and kineticGFR in clinical practice would allow to identify high risk of postoperative AKI and long-term GFR decline as early as 10 h after surgery

Fig 4 -

Cardiac manifestations in symptomatic patients with ATTRv amyloidosis and the (A) F64L, (B) I68L, (C) I107V, and (D) S77Y variants in THAOS. Cardiac manifestations are shown across all countries and in countries with the largest number of patients with the given variant. ATTRv amyloidosis, hereditary transthyretin amyloidosis; THAOS, Transthyretin Amyloidosis Outcomes Survey.</p

Baseline demographic and clinical characteristics of symptomatic patients with ATTRv amyloidosis and the I68L variant in THAOS, detailed by country of origins.

Baseline demographic and clinical characteristics of symptomatic patients with ATTRv amyloidosis and the I68L variant in THAOS, detailed by country of origins.</p

Baseline demographic and clinical characteristics of symptomatic patients with ATTRv amyloidosis and the I107V variant in THAOS, detailed by country of origins.

Baseline demographic and clinical characteristics of symptomatic patients with ATTRv amyloidosis and the I107V variant in THAOS, detailed by country of origins.</p

STROBE statement—checklist of items that should be included in reports of observational studies.

STROBE statement—checklist of items that should be included in reports of observational studies.</p

Baseline demographic and clinical characteristics of symptomatic patients with ATTRv amyloidosis and the S77Y variant in THAOS, detailed by country of origins.

Baseline demographic and clinical characteristics of symptomatic patients with ATTRv amyloidosis and the S77Y variant in THAOS, detailed by country of origins.</p

mPND score distribution of symptomatic patients with a predominantly neurologic or mixed phenotype at enrollment with ATTRv amyloidosis and the F64L, I68L, I107V, or S77Y variant in THAOS.

mPND score distribution of symptomatic patients with a predominantly neurologic or mixed phenotype at enrollment with ATTRv amyloidosis and the F64L, I68L, I107V, or S77Y variant in THAOS.</p

Fig 3 -

Neurologic symptoms in symptomatic patients with ATTRv amyloidosis and the (A) F64L, (B) I68L, (C) I107V, and (D) S77Y variants in THAOS. Neurologic symptoms are shown across all countries and in countries with the largest number of patients with the given variant. ATTRv amyloidosis, hereditary transthyretin amyloidosis; THAOS, Transthyretin Amyloidosis Outcomes Survey.</p