Autoimmune polyglandular syndrome in a woman of 51 years.

Autoimmune polyglandular syndromes (APS) are constellations of symptoms and signs of multiple glandular insufficiencies. We report a rare case of type III APS in a female patient. A 51-year-old woman was treated with radiotherapy because of thymus hyperplasia when she was two years old; she was diagnosed with celiac disease and autoimmune hypothyroidism at 41 years old and with sicca syndrome and myasthenia gravis seronegative a few years later. Our patient demonstrates a previous constellation of diseases of APS, which may be a random association but may also indicate a common immunological and genetic disturbance. The APS is an expression of a system impairment of immune tolerance to autoreactive clones, and this is necessary because the phenomena can become aggressive and expressed clinically. We suppose that the development of thymic hyperplasia or its radiotherapy in childhood may have compromise the patient's immune system

The Pivotal Role of Oxidative Stress in the Pathophysiology of Cardiovascular-Renal Remodeling in Kidney Disease

none5noneVerdiana Ravarotto, Giovanni Bertoldi, Georgie Innico, Laura Gobbi, Lorenzo CalòRavarotto, Verdiana; Bertoldi, Giovanni; Innico, Georgie; Gobbi, Laura; Calo', Lorenz

Vitamin D deficiency, insulin resistance, and ventricular hypertrophy in the early stages of chronic kidney disease

Background: Chronic kidney disease (CKD) is associated with markedly increased cardiovascular (CV) risk. This increase is not fully explained by traditional CV risk factors but may in part be mediated by nontraditional risk factors, such as inadequate vitamin D (vit D) levels and insulin resistance (IR). Although IR is shown in nondiabetic CKD, its association with vit D deficiency and vascular disease in this population is unknown and what this study aims to investigate. Materials and methods: The study comprised 67 patients with CKD (eGFR >= 30 mL/min) and 15 healthy controls matched for age and sex. The phlogosis indexes, vit D levels, IR, carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured. Results: In our study, the mean value of LVMI and cIMT was significantly higher in patients with eGFR >= 30 mL/min compared with controls (p = 0.037 and p < 0.001). The IR and intact parathyroid hormone (iPTH) levels were increased in CKD patients, whereas the serum levels of vit D were significantly reduced (p = 0.044, p = 0.012, p = 0.038). A positive correlation was found between LVMI and IR (r = 0.704, p = 0.041) and a negative correlation was found between IR and vit D levels (r = -0.238, p = 0.031). Conclusions: In our study, IR and vit D deficiency were found to be independent predictors of left ventricular hypertrophy and atherosclerotic disease. Vitamin D deficiency and IR are thus associated with increased CV risk. More novel approaches to improving IR and vit D supplementation in the CKD population might lead to potential strategies for preventing excess CV mortality

Prevention of complicated UTIs with biocompatible hyaluronic acid copolymer (deflux\uae) treatment of the kidney transplanted vescicoureteral reflux. a single centre experience.

Introduction: Urinary tract infections (UTI) are the most frequent early and late infectious complications in renal transplant patients. Vesicoureteral reflux (VUR) occurs in more than 86% of renal transplants. It is considered as a possible cause of the onset of complicated urinary tract infections although its actual impact remains uncertain. A therapeutic option in the treatment of VUR, successfully used in particular in pediatric patients, is represented by the injection in the ureter of hyaluronic acid/dextranomer polymers (Dx/HA, Deflux\uae) performed through the endoscopy procedure. In this study the experience of the Nephrology Unit at the University of Padova is reported. Methods: Six renal transplanted female patients (mean age 45.6 years) who presented a history of recurrent complicated UTIs (more than 3/year), were considered. In these patients a retrograde and voiding cystography documented the presence of VUR at the transplanted kidney. Between February 2016 and July 2018 all these patients underwent endoscopic treatment with Dx/HA. Results: Five patients, after endoscopic treatment with Dx/HA, did not show at the follow up until present any episode of complicated UTIs, confirming the successful of this therapeutic option for the UTI due to VUR in renal transplanted patients. Conclusions: Although based on a limited number of patients, the endoscopic treatment of VUR with hyaluronic acid copolymer Deflux\uae in kidney transplanted patients is safe, non-invasive, repeatable if necessary, and the results in our patients are favorable. Although considering a period of observation of two years, it might be too short to demonstrate the effectiveness of the treatment in the long-term. However, being able to successfully correct the VUR in kidney transplanted patients represents a very important chance to reduce complicated UTIs in kidney transplanted patients thus increasing the chance for the transplanted organ\u2019s survival

Ultrasound for the Clinical Management of Vascular Access Cannulation and Needle Position in Hemodialysis Patients

A native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis (HD) treatment. Compared with other types of vascular access such as grafts and central venous catheters, it functions longer and is associated with a lower risk of complications. The aim of the study described here was to assess, in an HD population, the position of the fistula needles during an HD session and evaluate the role of ultrasound in the management of AVF puncture. Forty-five consecutive chronic HD patients with an AVF or an arteriovenous vascular graft were included in the study for ultrasound evaluation. Each patient underwent an ultrasound evaluation during HD treatment to assess the position of the needles inside the vascular access. The ultrasound evaluation revealed that 81.8% of the traditional needles were incorrectly adjacent to the vessel walls, in the absence of clinical symptoms or hemodynamic alterations detectable on the dialysis monitor. A greater frequency of malpositioning has been observed for needles in the arterial portion of the vascular access, closer to the anastomosis. The absence of clinically detectable signs of venipuncture-related complications does not ensure correct positioning of the needles within the AVF. Ultrasound evaluation may not only resolve suboptimal cannulation problems of new or complicated vascular accesses but may also be useful in the prevention of acute and chronic damage to the AVF

Vascular endothelial growth factor inhibitor therapy and cardiovascular and renal damage in renal cell carcinoma

Background: Sunitinib, a tyrosine kinase inhibitor of vascular endothelial growth factor (VEGF), is approved for first and second line treatment of advanced renal cell carcinoma (RCC). Knowledge on the effects of sunitinib on cardiovascular (CV) risk and renal damage is limited. Aim: To evaluate possible renal and CV damage in patients with RCC treated with sunitinib. Materials and Methods: Patients with metastatic RCC treated with sunitinib were enrolled. This population was evaluated before starting treatment (T0) and after 3 months (T1). Laboratory and instrumental parameters, including interventricular septum (IVS) and left ventricular mass index (LVMI) were recorded before and after treatment. Results: Thirty-two patients (13 female, 19 male, mean age 62.7±9.9 years) were enrolled. We observed overtime, a significant reduction in estimated glomerular filtration rate (eGFR) (p=0.01), hemoglobin (Hb) (p=0.04) and 25-hydroxyvitamin D (25-OH-VitD) (p=0.002), in association with a significant increase in serum phosphorus (p&lt;0.001), systolic blood pressure (SBP) (p&lt;0.001), diastolic blood pressure (DBP) (p&lt;0.001), IVS (p=0.03) and proteinuria (p&lt;0.001), while we showed no significant differences in glycosuria, phosphaturia, serum uric acid, intact parathormone, and LVMI. Conclusion: We observed the development of renal damage and worsening of CV indices in patients treated with sunitinib. We suggest to consider a careful assessment of renal function and CV risk factors, before initiation and during administration of this drug