Chronic kidney disease and urological disorders: systematic use of uroflowmetry in nephropathic patients

Background. Chronic kidney disease (CKD) is a highly prevalent condition. Urologic disorders are known causes of CKD, but often remain undiagnosed and underestimated also for their insidious onset and slow progression. We aimed to evaluate the prevalence of urological unrecognized diseases in CKD patients by uroflowmetry. Methods. We enrolled consecutive stable CKD outpatients. The patients carried out two questionnaires, the International Prostate Symptom Score and Incontinence Questionnaire-Short Form, and they also underwent uroflowmetry, evaluating max flow rate (Qmax), voiding time and voided volume values. Results. A total of 83 patients (43 males, mean age of 59.8613.3 years) were enrolled. Our study showed 28 males and 10 females with a significant reduction of Qmax (P<0.001) while 21 females reported a significant increase of Qmax (P<0.001) with a prevalence of 49.5% of functional urological disease. Moreover, we showed a significant association between Qmax and creatinine (P¼0.013), estimated glomerular filtration rate (P¼0.029) and voiding volume (P¼0.05). We have not shown significant associations with age (P¼0.215), body mass index (P¼0.793), systolic blood pressure (P¼0.642) or diastolic blood pressure (P¼0.305). Moreover, Pearson’s chi-squared test showed a significant association between Qmax altered with CKD (v2 ¼1.885, P¼0.170) and recurrent infection (v2¼8.886, P¼0.012), while we have not shown an association with proteinuria (v2¼0.484, P¼0.785), diabetes (v2¼0.334, P¼0.563) or hypertension (v2¼1.885, P¼0.170).Conclusions. We showed an elevated prevalence of urological diseases in nephropathic patients; therefore, we suggest to include uroflowmetry in CKD patient assessment, considering the non-invasiveness, repeatability and low cost of examination. Uroflowmetry could be used to identify previously unrecognized urological diseases, which may prevent the onset of CKD or progression to end-stage renal disease and reduce the costs of management

Tenofovir-related nephropathies in HIV-infected patients

Background: The number of human immunodeficiency virus (HIV)-infected patients has increased significantly, although the number of deaths due to HIV and acquired immunodeficiency syndrome (AIDS) has dramatically reduced. Highly active antiretroviral therapy (HAART) has increased not only survival but also the risk of deaths caused by other diseases or by long-term side effects of these drugs. AIM: The aim of this study is to evaluate the nephrotoxicity of one of the most common anti-retroviral drugs, tenofovir disoproxil fumarate (TDF). Materials and Methods: We examined 27 patients with HIV infection (10 women). Patients assumed TDF for a mean period of 8.03 months. Indexes of renal function and serum electrolytes were measured, and glomerular filtration rate was estimated (eGFR). Proteinuria, glycosuria, bicarbonaturia, and phosphaturia were assessed, and renal ultrasound examination was carried out. Results: Acute kidney injury with glycosuria, bicarbonaturia, and phosphaturia was seen in 22 patients. Substantial recovery of renal function occurred in 19 patients. Conclusion: This study highlights that TDF nephrotoxicity is a widely frequent but reversible form of renal damage with preferentially proximal tubular dysfunction. We suggest that all patients at the time of HIV diagnosis should carry out a screening for kidney disease with eGFR assessment, proteinuria, and urine analysis