L'industria dell'evidenza scientifica e la salute del metodo galileiano

Abstract non disponibil

Cardionephrology: A Widespread Discipline for 21th Century Medical Students and Young Nephrology Residents

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Does Systematic Preliminar Colour Doppler Study Reduce Kidney Biopsy Complication Incidence?

While ultrasonography is widely performed prior to biopsy, colour Doppler examination is often used only to discover post-biopsy complications. Aim of this paper was to evaluate the usefulness of colour Doppler examination in planning the optimal site of puncture for renal biopsy. Present analysis includes 561 consecutive percutaneous renal biopsies performed from the same operator. Until August 2000 332 biopsies were performed after a preliminary ultrasonography (Group A). From September 2000, 229 patients underwent even a preliminary colour Doppler study (Group B). Postbioptic bleeding were categorized as minor (gross hematuria or subcapsular perinephric hematoma < 4 cmq of greater diameter) or major (hematoma >4 cmq of greater diameter; requiring blood transfusion or invasive procedures; leading to acute renal failure, urine tract obstruction, septicaemia, or death). Major complications were seen in 2.1% in Group A while in Group B only one case was reported (0.43%). Minor clinically significant complications occur in 7.8% in Group A and in 3.4% of cases of Group B. Colour Doppler reduced drastically the incidence of complications observed before the introduction of routine colour Doppler examination prior to biopsy. In our opinion, these data support the use of preliminary colour Doppler study when a biopsy is planned

Ultrafiltrazione peritoneale e sindrome cardiorenale: gestione del sovraccarico di fluidi e ruolo del sodio

Congestion represents a crucial clinical component of both heart failure and cardiorenal syndrome and it has been postulated to modulate heart and kidney cross-link. Diuretic therapy is a corner stone in the treatment patients with heart failure, and renal replacement therapies are mainly used for patients with refractory heart failure who have not reached the worst stages of renal disfunction. Peritoneal dialysis is a home-based therapeutic modality providing both solute clearance and ultrafiltration, together with relief from congestion in decompensated heart failure patients. The following review will focus on sodium removal in refractory decompensated heart failure patients undergoing peritoneal dialysis. (Cardionephrology

L'eritropoietina e la cardiopatia ischemica: un nuovo attore tra apoptosi e angiogenesi cardiovascolare

L'eritropoietina, per molti anni intesa unicamente come principale regolatore della massa eritrocitaria circolante, ha svelato nel corso degli anni sempre nuove pagine di fisiologia, che l'hanno mostrata come elemento centrale di un complesso sistema che mantiene l'equilibrio tra ossigenazione periferica, stabilità vascolare e stress ossidativo. Al crescere delle conoscenze sulla fisiologia autocrina e paracrina dell'EPO, sono cresciute le aspettative verso l'utilizzo clinico-pratico di tali conoscenze. La presente review propone una rapida carrellata sulle diverse potenziali applicazioni dell'EPO nel management clinico della cardiopatia ischemica, con particolare riguardo alle strategie testate per ottenere gli effetti pleiotropici dell'EPO senza indurre indesiderati incrementi dell'ematocrito

A Complex Renal Cyst: It Is Time to Call the Oncologist?

Introduction. Hydatid disease is a cyclozoonotic parasitic infestation caused by the cestode Echinococcus granulosus. The cysts mainly arise in the liver (50 to 70%) or lung (20 to 30%), but any other organ can be involved, in abdominal and pelvic locations, as well as in other less common sites, which may make both diagnosis and treatment more complex. Isolated renal involvement is extremely rare. Case Presentation. We report a rare case of isolated renal hydatid disease in a 71-year-old man with a history of vague abdominal pain, anemia, fever, and microhematuria. Ultrasonographic examination revealed a complex cyst in the right kidney, including multiple smaller cysts with internal echoes. A magnetic resonance scan of the abdomen confirmed the findings, and hydatid cyst disease was diagnosed. Right nephrectomy was performed, and microscopic examination confirmed the diagnosis of hydatid cyst. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively). Conclusion. Isolated primary hydatidosis of the kidney should always be considered in the differential diagnosis of any cystic renal mass, even in the absence of accompanying involvement of liver or other visceral organs

L'ecocardiografia e il nefrologo: seconda e ultima puntata della "pocket guide"

Abstract non disponibile (Cardionephrology

Ivabradina, insufficienza cardiaca e malattia renale cronica

Abstract non disponibile (Cardionephrology

Anomalie cardiovascolari in pazienti con malattia renale policistica autosomica dominante

La malattia autosomica dominante policistica renale (ADPKD) è la malattia genetica più comune in nefrologia. Due geni sono stati implicati nello sviluppo della malattia: PKD1 sul cromosoma 16 (85%) e PKD2 sul cromosoma 4 (15%). La ADPKD è clinicamente caratterizzata da coinvolgimento renale ed extrarenale espresso con la comparsa di manifestazioni cistiche e non cistiche. Dal momento che le complicanze cardiovascolari sono la principale causa di morbilità e mortalità, questa revisione si propone di analizzare il coinvolgimento cardiaco e vascolare in ADPKD. L'ipertensione è uno dei sintomi più frequenti e comune e si verifica in circa il 60% dei pazienti prima della comparsa di disfunzione renale. L'effetto dell'ipertensione sulla progressione verso stadi terminali della malattia renale, rende tale fattore di rischio uno dei più importanti e potenzialmente trattabili in ADPKD. L'ipertrofia ventricolare sinistra, spesso rilevata in questi pazienti, rappresenta un altro importante fattore di rischio indipendente per morbilità e mortalità cardiovascolare nella ADPKD. Altre anomalie come la disfunzione diastolica biventricolare, la disfunzione endoteliale e l'aumento dello spessore intima-media carotideo sono presenti anche in giovani pazienti con ADPKD con normale pressione sanguigna e la funzione renale ben conservata. Gli aneurismi intracranici, quelli extracranici e i difetti valvolari cardiaci sono altre manifestazioni cardiovascolari di comune riscontro nei pazienti con ADPKD. Il trattamento precoce dell'ipertensione mediante l'uso di agenti bloccanti del sistema renina-angiotensina-aldosterone potrebbe svolgere un effetto nefroprotettivo e ridurre l'insorgenza di complicanze cardiovascolari nei pazienti con ADPKD

recombinant human erythropoietin influences revascularization and healing in a rat model of random ischaemic flaps

In order to ascertain whether erythropoietin plays a role in early and late repair processes following ischaemic skin flap injury, a dorsal, caudally based skin flap was created in rats. The rats were successively divided into four groups. Group 1 was not treated. The other groups were treated with a subcutaneous administration of 0.9% NaCl saline solution (group 2), a subcutaneous administration of vehicle (group 3) or a subcutaneous administration of 300 IU/kg/day of recombinant human erythropoietin (group 4). We evaluated the possible relationships between neutrophil accumulation, myeloperoxidase activity and content in flap tissue, flap survival, flap temperature (using telethermography) and flap revascularization (using videocapillaroscopy). Necrosis in the flap was significantly less extensive in group 4 than in groups 1, 2 and 3. A significant increase in neutrophil infiltration occurred between the 1st and 24th hour in these groups, but this was not observed in group 4. These findings were confirmed by biochemical data of myeloperoxidase activity and malonyldialdehyde content. Between the 1st and 7th days, we recorded an increase of about 20% in flap temperature in groups 1, 2 and 3, whereas no significant variation was observed in group 4. On the 7th day, videocapillaroscopic findings showed an increase in the mean vascularization index in group 4. Our findings suggest that recombinant human erythropoietin administration can improve the wound healing process, in both early and late stages of injury, by reducing inflammatory response, increasing the density of capillaries in ischaemic flaps and allowing earlier repair of a damaged area