Presentazione di una nuova Rubrica: la Nefrologia Narrativa

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Valutazione Del Benessere Psico-Fisico Nell'aderenza Terapeutica Nelle Donne Con Malattia Renale Policistica Autosomica Dominante: Uno Studio Osservazionale

Evaluation Of The Psychophysical Well-Being In The Compliance Of Women With Autosomal Dominant Policystic Kidney Disease: An Observational Study BACKGROUND: Autosomal dominant polycystic kidney disease is the most common inherited renal disease and affects less than 1 every 400-1,000 people. There are many effective treatments, including blood pressure management, physical activity, low sodium diet and hydration. Therapeutic education is part of a patient's care and treatment. This approach is an essential strategy in order to face the current healthcare scenario, in which the number of people affected by chronic diseases is progressively increasing. OBJECTIVES: This article aims to analyze the effect of therapeutic education in patients with ADPKD, the level of adherence to pharmacological therapy and their compliance to dietetic and lifestyle recommendations as part of a nursing-led education. METHODS: This is a prospective, longitudinal, observational pilot study. The following measurements were used: Kidney Disease Quality of life - Short Form, Hospital Anxiety and Depression Scale, Body Uneasiness Test. At the T0 visit, a nurse selected patients and carried out a personalized educational intervention with the aims of adhering to drug therapies, monitoring blood pressure and dietary behavior (physical activity and water intake). At the T1 visit, patients performed psychological tests. At the T2 visit, the following evaluations were performed: a psychological interview together with the delivery and evaluation of the tests performed, an interview with the nurse to evaluate the adherence to the prescriptions, and a control of parameters such as physical activity, diet, water intake, drug therapy, and blood pressure. RESULTS: Therapeutic education can have a positive impact on patients' health by improving adherence to the pharmacological therapy, diet and lifestyle. CONCLUSIONS: Therapeutic education improve the patient's knowledge, treatments and correct behaviors as well as promotes an independent management of the disease. Through an educational intervention, the patient acquires the ability and the awareness to modify the wrong behaviors and to guarantee a balance between his needs and the pathology, thus improving the quality of life

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

Valutazione Visiva Degli Exit Site Nei Cateteri Venosi Centrali in Emodialisi: Validazione Preliminare Di Una Scala Italiana

Il catetere venoso centrale (CVC) rappresenta, per i pazienti in emodialisi, un'alternativa alla fistola arterovenosa (FAV), ma, purtroppo, è spesso associato a un importante numero di complicanze infettive. L'infermiere è il primo operatore sanitario che rileva le possibili infezioni e, per questo, è importante sviluppare una scala visiva che gli sia di ausilio. Tale scala è importante anche per consentire a chi si avvicina da poco alla medicazione dei CVC di prendere in considerazione i principali indicatori di una possibile infezione. Essa, infine, può essere di ausilio per tenere conto dell'evoluzione del CVC nella cartella clinica del paziente. Questo studio presenta una prima validazione italiana di una scala utilizzabile per la valutazione degli exit site dei CVC in emodialisi (derivata dalla "Scala Twardowski"). La validazione ha coinvolto gli infermieri di una Rete di Nefrologia e Dialisi e un'infermiera esterna, non impegnata nella medicazione, la quale ha valutato gli exit site di tutti i pazienti della Rete, subito prima che la stessa scala venisse utilizzata da chi effettuava la medicazione. La buona correlazione di Spearman (ρ=0.85) tra la valutazione dell'infermiera esterna e le valutazioni degli altri colleghi conferma la bontà di questa prima traduzione italiana della scala. (nursing

Multi-parasite infection in an immigrant from Ghana: potential for new epidemic foci.

Introduction: Imported parasitosis, which do not require an invertebrate vector, are extremely dangerous and can lead to the occurrence of disease in currently parasite free areas. In the present study we report a case of multi-parasitic infection in a young immigrant from Ghana to Italy caused by filaria, Schistosoma sp. and Strongyloides sp. Case presentation: A 27-year-old Ghanaian man attended the Hospital of Nuoro (Sardinia), Italy, at the end of August 2015, claiming pain to the kidney and hypertensive crisis; the patient presented with dyspnea and epistaxis, chronic itchy skin of the back, shoulders, arms and legs, anuria and high creatinine, metabolic acidosis and hypereosinophilic syndrome. Serological test for parasitic infections were done, and showed a marked positivity for filaria, Schistosoma sp. and Strongyloides sp. The patient started the treatment immediately with two doses per day of Bassado Antibiotic (tetracycline) for twenty days and then with a single dose of 3 mg of ivermectin that was repeated after 3 months. Conclusions: Immigrant patients from endemic areas who show clinical signs, such as a general itching on the back, shoulders and arms and legs, should have a thorough history in order to make early diagnosis and prevent further complications. Therefore, general practitioners and doctors in Europe and in other parasitosis non-endemic countries, should consider to test for parasites in any immigrant from endemic countries to aid in establishing the final diagnosis and prevent further complications

Il futuro delle tecniche ultrasonografiche in nefrologia

Thanks to the wide geographical diffusion, low cost and lack of ionizing radiation, ultrasound is now the most widely used imaging technique in clinical practice, second only to chest radiography. Recent technological innovations and introduction of ultrasound contrast agents, further expanded the fields of application of ultrasound, guarantying for the future to this technique an important role in imaging of the urinary tract. The nephrologist must be able to exploit the potential offered by technological innovations in ultrasound imaging for the study of the kidney. The proper management of equipment, in fact, allows to obtain ultrasound images in gray scale of the highest quality, to optimize the diagnostic accuracy of Doppler techniques and take full advantage of the tools offered by means of ultrasound contrast agents