Acute kidney injury (Aki) before and after kidney transplantation: Causes, medical approach, and implications for the long-term outcomes

Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short-and long-term outcome of transplantation. However, some forms of AKI may induce graft rejection, fibrosis, and eventually graft dysfunction. Therefore, various strategies have been proposed to identify conditions at highest risk of AKI-induced DGF, that can be treated by targeting the donor, the recipient, or even the graft itself with the use of perfusion machines. AKI that occurs early post-transplant after a period of initial recovery of graft function may reflect serious and often occult systemic complications that may require prompt intervention to prevent graft loss. AKI that develops long after transplantation is often related to nephrotoxic drug reactions. In symptomatic patients, AKI is usually associated with various systemic medical complications and could represent a risk of mortality. Electronic systems have been developed to alert transplant physicians that AKI has occurred in a transplant recipient during long-term outpatient follow-up. Herein, we will review most recent understandings of pathophysiology, diagnosis, therapeutic approach, and short-and long-term consequences of AKI occurring in both the donor and in the kidney transplant recipient

Fecal microbiota and inflammatory and antioxidant status of obese and lean dogs, and the effect of caloric restriction

IntroductionObesity is the most common nutritional disease in dogs, and is generally managed by caloric restriction. Gut microbiota alteration could represent a predisposing factor for obesity development, which has been associated with a low-grade inflammatory condition and an impaired antioxidant status. Besides, weight loss has been shown to influence the gut microbiota composition and reduce the inflammatory response and oxidative stress. MethodHowever, these insights in canine obesity have not been fully elucidated. The aim of this study was to assess the differences in serum and inflammatory parameters, antioxidant status, fecal microbiota and bacterial metabolites in 16 obese and 15 lean client-owned dogs and how these parameters in obese may be influenced by caloric restriction. First, for 30 days, all dogs received a high-protein, high-fiber diet in amounts to maintain their body weight; later, obese dogs were fed for 180 days the same diet in restricted amounts to promote weight loss. ResultsBefore the introduction of the experimental diet (T0), small differences in fecal microbial populations were detected between obese and lean dogs, but bacterial diversity and main bacterial metabolites did not differ. The fecal Dysbiosis Index (DI) was within the reference range (< 0) in most of dogs of both groups. Compared to lean dogs, obese dogs showed higher serum concentrations of acute-phase proteins, total thyroxine (TT4), and antioxidant capacity. Compared to T0, dietary treatment affected the fecal microbiota of obese dogs, decreasing the abundance of Firmicutes and increasing Bacteroides spp. However, these changes did not significantly affect the DI. The caloric restriction failed to exert significative changes on a large scale on bacterial populations. Consequently, the DI, bacterial diversity indices and metabolites were unaffected in obese dogs. Caloric restriction was not associated with a reduction of inflammatory markers or an improvement of the antioxidant status, while an increase of TT4 has been observed. DiscussionIn summary, the present results underline that canine obesity is associated with chronic inflammation. This study highlights that changes on fecal microbiota of obese dogs induced by the characteristics of the diet should be differentiated from those that are the consequence of the reduced energy intake

Reduced mortality in COVID-19 patients treated with colchicine: Results from a retrospective, observational study

Objectives Effective treatments for coronavirus disease 2019 (COVID-19) are urgently needed. We hypothesized that colchicine, by counteracting proinflammatory pathways implicated in the uncontrolled inflammatory response of COVID-19 patients, reduces pulmonary complications, and improves survival. Methods This retrospective study included 71 consecutive COVID-19 patients (hospitalized with pneumonia on CT scan or outpatients) who received colchicine and compared with 70 control patients who did not receive colchicine in two serial time periods at the same institution. We used inverse probability of treatment propensity-score weighting to examine differences in mortality, clinical improvement (using a 7-point ordinary scale), and inflammatory markers between the two groups. Results Amongst the 141 COVID-19 patients (118 [83.7%] hospitalized), 70 (50%) received colchicine. The 21-day crude cumulative mortality was 7.5% in the colchicine group and 28.5% in the control group (P = 0.006; adjusted hazard ratio: 0.24 [95%CI: 0.09 to 0.67]); 21-day clinical improvement occurred in 40.0% of the patients on colchicine and in 26.6% of control patients (adjusted relative improvement rate: 1.80 [95%CI: 1.00 to 3.22]). The strong association between the use of colchicine and reduced mortality was further supported by the diverging linear trends of percent daily change in lymphocyte count (P = 0.018), neutrophilto- lymphocyte ratio (P = 0.003), and in C-reactive protein levels (P = 0.009). Colchicine was stopped because of transient side effects (diarrhea or skin rashes) in 7% of patients. Conclusion In this retrospective cohort study colchicine was associated with reduced mortality and accelerated recovery in COVID-19 patients. This support the rationale for current larger randomized controlled trials testing the safety/efficacy profile of colchicine in COVID-19 patients. Copyright

Ramipril and Risk of Hyperkalemia in Chronic Hemodialysis Patients

Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1.25 to 5 mg per day. They underwent serum potassium concentration measurements before ramipril introduction and in 1 to 3 months afterwards. No significant increase in kalemia was found. Results of our study encourage the use of ACE inhibitors in chronically hemodialyzed patients, but close potassium monitoring is mandatory

Energy efficiency uptake within the Project House Building Industry

Abstract not available

What you need

Il tema di Europan 12, "Adaptable City, inserting Urban Rhythms", è incentrato sulle trasformazioni urbane, sull'esigenza di ridurre l’impatto ambientale e per far fronte alla crisi energetica, operando sia sulla morfologia delle città che sul loro ‘metabolismo’, immaginando luoghi più adattabili agli scenari abitativi contemporanei, alla gestione e alla condivisione degli spazi comuni e al riuso degli edifici. L’obiettivo del concorso può essere sintetizzato attraverso la riduzione del consumo di suolo, rigenerando i manufatti esistenti attraverso il principio di utilizzo ‘7/24’, così da risparmiare tempo per gli spostamenti attraverso la qualità dello spazio pubblico, inteso come strumento di regolazione della città seguendo le stagioni, le generazioni o ritmi quotidiani. Il progetto presentato interessa il quartiere Za Zelazna Brama a Varsavia (PL), ritenuto un luogo emblematico per la riqualificazione di ampie porzioni urbane costruite dopo la Seconda Guerra Mondiale. Il progetto è stato selezionato ed esposto alla conferenza internazionale presso l’Università degli Studi di Trento dal titolo: R.E.D.S.2 ALPS - Resilient Ecological Design Strategies. Designing a sustainable future Toward an ecological approach

What you need for adaptable future

Recycle the residential buildings. The case study of Zelazna Brama district in Warsaw (Poland). Project proposal: 'What you need for adaptable future'. Design team: Barbara Angi (team leader), Nadia Bertolino, Ioanni Delsante, Luca Fogliata, Emanuele Giorgi, Alessandra Peroni, Giorgio Davide Manzoni, Elisa Masserdotti, Alessandro Mensi, Giorgia Zurla. 'What you need' aims to adapt the existing residential neighborhoods on one side to the needs of the inhabitants and, on the other, to the wish to preserve the urban voids, intended as essential spaces for the development of innovative social activities. In the first instance we divided the adaptability level according to the sizes of the space and the time of use. This approach, from home to the city, helped us to define three design strategies that, in our view, can also be applied in other sites where there are linear residences. The strategies are: 'graft '- building between existing buildings - 'slab' - visual and functional connection between the new and existing - 'bay' - urban creeks accessible from a commercial front, which then tend to enlarge themselves in correspondence of residential areas. The project aims to improve the character of landmark of housing buildings observing as much as possible the existing green areas and intends to reactivate the district with economic processes of development thank to insertion of the commercial functions so from reducing the existing mono-functional nature

COVID-19 in Kidney Transplant Recipients

The authors report the outcomes of two deceased-donor kidney transplant recipients with COVID-19 pneumonia admitted to the Hospital of Parma (Parma, Italy), between March 2 and 12, 2020