Glomerulonefrite crioglobulinemica: una manifestazione extraepatica dell'infezione cronica da virus dell'epatite C (HCV)

Clinical Management Issue

Assessment of the in-plane deformability of RC floors with traditional and innovative lightening elements in RC framed and wall structures

In this paper, the in-plane deformability of floors in Reinforced Concrete (RC) structures has been investigated in order to establish the role of lightening elements made of both traditional ceiling bricks and Expanded Polystyrene (EPS) blocks. The study has been firstly developed via the implementation of three-dimensional finite element models simulating the real geometry of the floors. The numerical results have been, then, used to assess the thickness of equivalent slabs introduced in three-dimensional finite elements models of simple structures made of Reinforced Concrete frames or walls. These models have been used for verifying the effective in-plane floor deformability as a function of the vertical resistant elements typology (frames or walls), the building geometry (plane shape ratio, height, number of floor, dimensions of vertical elements), and the thickness of the equivalent slab. The numerical analyses have enabled to give interesting indications about the reliability of the hypothesis of rigid floors as the investigated parameters change

Haploidentical Hematopoietic Stem Cell Transplant Complicated by Atypical Hemolytic Uremic Syndrome and Kidney Transplant from the Same Donor with No Immunosuppression but C5 Inhibition

Background Atypical hemolytic uremic syndrome (aHUS) is life-threatening condition particularly when complicating allograft hematopoietic stem cell transplant (HSCT). In the past, the outcome was very poor with the majority of patients reaching end-stage renal disease or dying with little or no chances of kidney transplant (KTx) due to the high risk of relapse. The availability of C5 inhibition has opened up significant therapeutic opportunities and has improved the outcome particularly if complement dysregulation (CD) is the underlying pathogenetic mechanism. Methods We describe a peculiar case of a girl with aHUS complicating HSCT and her subsequent successful KTx received from the same donor thus performed without immunosuppression but anti-C5 inhibition. Results Soon after HSCT performed for acute lymphoblastic leukemia, the patient developed a TMA due to CD and reached end-stage renal disease. After 2 years on dialysis, the patient received a KTx from her father who was already the HSCT donor. Given the full chimerism, no immunosuppressive agent was prescribed except a short (2 days) course of steroids and eculizumab to prevent aHUS relapse. Nine months after the KTx, the patient is well with normal renal function, no immunosuppression and continues eculizumab prevention of aHUS (1 infusion every 21 days). Conclusions All patients with transplant-associated thrombotic microangiopathy should be screened for the causes of CD. C5 inhibition with eculizumab is an important therapeutic resource to manage this complication. When KTx is necessary, immunosuppression can be safely withhold in case of same donor for both grafts and documented full chimerism