SIRM-SIN-AIOM: appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations-consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM)

The increasing number of examinations and interventional radiological procedures that require the administration of contrast medium (CM) in patients at risk for advanced age and/or comorbidities highlights the problem of CM-induced renal toxicity. A multidisciplinary group consisting of specialists of different disciplines-radiologists, nephrologists and oncologists, members of the respective Italian Scientific Societies-agreed to draw up this position paper, to assist clinicians increasingly facing the challenges posed by CM-related renal dysfunction in their daily clinical practice.The major risk factor for acute renal failure following CM administration (post-CM AKI) is the preexistence of renal failure, particularly when associated with diabetes, heart failure or cancer.In accordance with the recent guidelines ESUR, the present document reaffirms the importance of renal risk assessment through the evaluation of the renal function (eGFR) measured on serum creatinine and defines the renal risk cutoff when the eGFR is < 30 ml/min/1.73 m2 for procedures with intravenous (i.v.) or intra-arterial (i.a.) administration of CM with renal contact at the second passage (i.e., after CM dilution with the passage into the pulmonary circulation).The cutoff of renal risk is considered an eGFR < 45 ml/min/1.73 m2 in patients undergoing i.a. administration with first-pass renal contact (CM injected directly into the renal arteries or in the arterial district upstream of the renal circulation) or in particularly unstable patients such as those admitted to the ICU.Intravenous hydration using either saline or Na bicarbonate solution before and after CM administration represents the most effective preventive measure in patients at risk of post-CM AKI. In the case of urgency, the infusion of 1.4% sodium bicarbonate pre- and post-CM may be more appropriate than the administration of saline.In cancer patients undergoing computed tomography, pre- and post-CM hydration should be performed when the eGFR is < 30 ml/min/1.73 m2 and it is also advisable to maintain a 5 to 7 days interval with respect to the administration of cisplatin and to wait 14 days before administering zoledronic acid.In patients with more severe renal risk (i.e., with eGFR < 20 ml/min/1.73 m2), particularly if undergoing cardiological interventional procedures, the prevention of post-CM AKI should be implemented through an internal protocol shared between the specialists who treat the patient.In magnetic resonance imaging (MRI) using gadolinium CM, there is a lower risk of AKI than with iodinated CM, particularly if doses < 0.1 mmol/kg body weight are used and in patients with eGFR > 30 ml/min/1.73 m2. Dialysis after MRI is indicated only in patients already undergoing chronic dialysis treatment to reduce the potential risk of systemic nephrogenic fibrosis

What is the actual structure of samarskite-(Y)? A TEM investigation of metamict samarskite from the garnet codera dike pegmatite (Central Italian Alps)

We investigated, by scanning and transmission electron microscopy (SEM, TEM), wavelength-and energy-dispersive spectroscopy (WDS, EDS), and electron diffraction tomography (EDT), several (Y-REE-U-Th)-(Nb-Ta-Ti) oxides from the Garnet Codera dike pegmatite (Central Italian Alps). These oxides have compositions in the samarskite-(Y) field and yield an amorphous response from the single-crystal X-ray diffractometer. Backscattered electron images reveal that the samples are zoned with major substitutions involving (U+Th) with respect to (Y+REE). At the TEM scale, the samples show a continuous range of variability both in terms of composition and in radiation damage, and the amount of radiation damage is directly correlated with the U-content. Areas with high U-content and highly damaged show crystalline, randomly oriented nanoparticles that are interpreted as decomposition products of the metamictization process. On the other hand, areas with lower U-content and radiation dose contained within 0.7 × 1016α-event/mg, although severely damaged, still preserve single-crystal appearance. Such areas, noticeably consisting of relicts of the original samarskite structure, were deeply investigated by electron diffraction techniques. Surprisingly, the retrieved crystal structure of untreated samarskite is consistent with aeschynite and not with ixiolite (or columbite), as believed so far after X-ray diffraction experiments on annealed samples. In particular, the resolved structure is a niobioaeschynite-(Y), with Pnma space group, cell parameters a = 10.804(1), b = 7.680(1), c = 5.103(1) Å, and composition (Y0.53Fe0.22Ca0.10U0.09Mn0.07)Σ=1(Nb1.07Ti0.47Fe0.34Ta0.07W0.06)Σ=2O6. If this finding can be confirmed and extended to the other members of the group [namely samarskite-(Yb), calciosamarskite, and ishikawaite], then the samarskite mineral group should be considered no longer as an independent mineral group but as part of the aeschynite group of minerals. It is finally suggested that the rare crystalline sub-micrometric ixiolite domains, occasionally spotted in the sample by TEM, or the nanoparticles detected in highly metamict areas interpreted as decomposition product of the metamictization process, which may have in fact the ixiolite structure, act as seeds during annealing, leading to the detection of ixiolite peaks in the X-ray powder diffractograms

Burnout in health care providers of dialysis service in Northern Italy—a multicentre study

BACKGROUND: Few data are available regarding the prevalence of burnout among dialysis health care workers. Aims of the present study were to assess and compare burnout levels in a sample of nurses and physicians working in dialysis units, and to investigate their relationships with quality of life, in a cross-sectional observational study. METHODS: A total of 344 workers from 10 dialysis centres in Northern Italy completed a battery of questionnaires including the Maslach Burnout Inventory, the MOS-36 Item Short Form Health Survey [SF36: physical (PCS) and mental (MCS) component scores] and the 30-item General Health Questionnaire (GHQ30). Data on social and demographic characteristics and working conditions were also collected. General Estimating Equations models were used for the analysis. RESULTS: Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, 30% of nurses had high emotional exhaustion vs 18% of physicians (adjusted OR 2.38, P = 0.003). Emotional exhaustion was also predicted by number of worked hours and months worked in dialysis in the previous 2 years. Depersonalisation was predicted by male gender and bad relationship with coworkers. Having no children and having a permanent hospital position predicted low personal accomplishment. PCS was lower in nurses (50.0 vs 53.3, P 5 with depersonalization (P = 0.032). CONCLUSIONS: Although burnout is not a general problem in dialysis health care providers, a subgroup of them may be identified, who would benefit from supportive measures to prevent this condition. Nurses appeared more burned-out in the emotional exhaustion scale than physicians

[New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of Nephrologists form Lombardy]

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

HBV Infection in Italian and Non-Italian Patients in Northern Italy

Aims: The introduction of HBV vaccination in Italy has reduced the incidence and prevalence of HBV infection. However, increasing immigration from countries in which HBV is endemic has led to a wave of new HBsAg-positive subjects and their clinical impact needs evaluation. We compared the serological, clinical and epidemiological data relating to Italian and non-Italian subjects referred to a hospital in Northern Italy. Study Design: We retrospectively analysed the laboratory and clinical records of 488 subjects, including 107 (21.9%) non-Italians, in order to find data concerning clinical diagnoses, possible routes of infection, anti-HCV and anti-HDV antibodies. Results: The differences in gender distribution and mean age between the non-Italian and Italian patients were statistically significant (p<.001). There were no significant differences in the prevalence of anti-HCV (2.9% vs 4.9%, p=.86) or anti-HDV (4.7% vs 5.0%, p=.89) co-infection, or the presence of HBeAg in chronic infection. There were no differences in the rates of acute (3.3% vs 5.1%; p=.68) or chronic infections (96.7% vs 94.9%; p=.68) infections, but there were statistically significant differences (p<.001) in the rates of prevalent (54.5% vs 85.3%) and incident cases (45.5% vs 14.7%). The differences in the rates of asymptomatic (70.6% vs 34.9%) and symptomatic patients (29.4% vs 65.1%) were also statistically significant (p<.001). The only significant differences in terms of risk factors related to transfusions (0% vs 6.8%; p=.04), and vertical/perinatal transmission (44.1% vs 6.8%; p<.001). Conclusion: The non-Italian HBsAg-positive subjects were mainly women and younger than their Italian counterparts, and had a recent diagnosis. They were predominantly asymptomatic and probably considered themselves healthy and fit to emigrate. Perinatal transmission among non-Italians is still an important risk factor that reflects the epidemiological situation of their countries of origin

How immigration can change the prevalence of HBV infection in an urban area of Northern Italy

The introduction of HBV vaccination in Italy has led to a decline in new HBV infections. Increasing immigration over recent years suggests a change in short-term epidemiology of HBV. The aim of this study was to assess the prevalence of HBV infection in the general population living in the catchment area of Legnano Hospital (Northern Italy). In the period 2007-2008, 22,758 inpatients and outpatients were examined for Hepatitis B surface antigen (HBsAg), of whom 1,654 (7.3%) were of foreign origin. Of the 488 patients who were positive for HBsAg (2.1%), 381 (1.8%) were Italian and 107 (6.5%) were born in other countries. In terms of age, the prevalence of HBsAg was significantly higher among non- Italians in every age group (other than those aged &gt;60 and &lt;11 years), and in many of the selected subgroups: the inpatients of some departments (35.4% vs 17.2%), pregnant women (5.3% vs 0.3%), blood donors (4.7% vs 0.1%), and hospital staff (6.4% vs 1.3%). Non- Italians were affected by 16.7% of acute infections and 24.3% of chronic infections; they also accounted for 42.6% of subjects with carrier state, 16.0% of patients with chronic hepatitis, and 12.2% of patients with cirrhosis. In our area, the overall prevalence of HBsAg among Italians is less than 2% (as expected following the introduction of HBV vaccination), but it is significantly higher among patients from areas highly endemic for HBV infection who represent a new reservoir for HBV infection

HBV Infection in Italian and Non-Italian Patients in Northern Italy

Aims: The introduction of HBV vaccination in Italy has reduced the incidence and prevalence of HBV infection. However, increasing immigration from countries in which HBV is endemic has led to a wave of new HBsAg-positive subjects and their clinical impact needs evaluation. We compared the serological, clinical and epidemiological data relating to Italian and non-Italian subjects referred to a hospital in Northern Italy. Study Design: We retrospectively analysed the laboratory and clinical records of 488 subjects, including 107 (21.9%) non-Italians, in order to find data concerning clinical diagnoses, possible routes of infection, anti-HCV and anti-HDV antibodies. Results: The differences in gender distribution and mean age between the non-Italian and Italian patients were statistically significant (

[Clinical practice for the diagnosis of cardiac arrhythmias in patients on renal replacement therapy: data from a Lombard survey]

Among dialysis patients, 40% of deaths are due to cardiovascular causes, and 60% of cardiac deaths are due to an arrhythmia. The purpose of this survey, carried out with the organizational support of the Lombard Section of the Italian Society of Nephrology, is to evaluate the frequency and mode of use of non-invasive instruments for the diagnosis of cardiac arrhythmias in the dialysis centers of Lombardy. Information on the prevalence and type of cardiac devices at December 1, 2016 in this population was also required. Data from 18 centers were collected for a total of 3395 patients in replacement renal therapy, including 2907 (85.6%) in hemodialysis and 488 (14.4%) in peritoneal dialysis. All centers use the 12-lead ECG in case of evocative symptoms of an arrhythmic event and 2/3 perform the exam with programmed cadence (usually once a year). Twenty four-hour ECG Holter is not used as a routine diagnostic tool. The proportion of cardiac devices is relatively high, compared to literature data: n=259, equal to 7.6% of the population. Pace-Maker patients are 166 (4.9%), those with intracardiac defibrillator 52 (1.5%), those with resynchronization therapy 18 (0.5%) and those with resynchronization therapy and intracardiac defibrillator 23 (0.7%). The survey provides interesting information and can be an important starting point for trying to optimize clinical practice and collaboration between nephrologists and cardiologists in front of a major problem like that of arrhythmic disease in patients on renal replacement therapy