Reversible acute renal failure from gross haematuria due to glomerulonephritis: not only in IgA nephropathy and not associated with intratubular obstruction

Seven patients with acute renal failure due to gross haematuria caused by glomerulonephritis are described. Gross haematuria lasting 4-40 days led to acute impairment of renal function of variable severity (peak plasma creatinine 1.3-12 mg/dl) and duration. While partial recovery of renal function occurred in all patients within few days, complete remission was observed only some months later. Three patients had IgA nephropathy (2 the primary form and 1 nephritis secondary to Schönlein-Henoch purpura), two patients had acute postinfectious glomerulonephritis, andtwo others had focal necrotizing (pauci-immune) glomerulonephritis. The glomerular changes seen in renal biopsy were not enough to explain per se the renal function impairment. Tubular changes, however, were severe and consisted of tubular necrosis, erythrocyte casts, erythrocyte phagocytosis by tubular cells, accompanied by interstitial damage (oedema, red-cell extravasation, and inflammatory infiltrates). Study of the renal biopsies by immunofluorescence revealed retrodiffusion of Tamm-Horsfall protein into the glomerular Bowman's space, a sign of obstructed tubular flow in any case. It is concluded that acute renal failure due to gross haematuria in glomerulonephritic patients may not occur only in IgA nephropathy, as reported so far, and is not associated with intratubular obstructio

Renal Disease in Essential Mixed Cryoglobulinaemia: LONG-TERM FOLLOW-UP OF 44 PATIENTS

The mode of presentation of renal disease in 44 patients with essential mixed cryoglobulinaemia (EMC) was: acute renal failure (two patients), acute nephritic syndrome (six patients), nephrotic syndrome (eight patients), proteinuria and/or haematuria (28 patients). Renal biopsy, performed in 35 patients, showed proliferative lesions in 33, while only minimal glomerular changes were seen in the remaining two. Immunofluorescence studies showed: IgG (85 per cent), IgA (36 per cent), IgM (90 per cent), C3 (90 per cent), Clq (47 per cent), and C4 (33 per cent) deposits, mainly located in subendothelial position. On electron microscopy, crystalloid structure of deposits and monocyte infiltration of capillary loops were the outstanding feature. The survival rate was 75 per cent at 10 years from the onset of clinical symptoms. Thirty-nine patients were followed for three to 146 months (mean 53·8). Twelve patients died, cardiovascular disease and infection being the commonest cause of death. Thirteen patients showed acute renal failure or acute nephritic syndrome: nine recovered completely, whereas the remaining four died during the acute renal episode. Three patients developed chronic renal failure, but only one required chronic dialysis. The ominous significance of renal impairment in EMC should therefore be revaluated. The high prevalence of hypertension (28/44 patients) which was refractory to treatment in six, may be important to the clinical outcom

Physical inactivity: A modifiable risk factor for morbidity and mortality in kidney transplantation

In patients with chronic kidney disease, sedentary behavior is widely recognized as a sig-nificant risk factor for cardiovascular disease, diabetes, obesity, osteoporosis, cancer, and depression. Nevertheless, the real impact of physical inactivity on the health of kidney transplant (KT) recipients remains uncertain. Over the last decade, there has been a renewed interest in exploring the effects of regular physical exercise on transplant-related outcomes. There is now mounting evidence that physical activity may reduce the burden of cardiovascular risk factors, preserve allograft function, minimize immunosuppression requirement, and ameliorate the quality of life of KT recipients. Many positive feedbacks can be detected in the early stages of the interventions and with a minimal exercise load. Despite these encouraging results, the perceived role of physical activity in the management of KT candidates and recipients is often underrated. The majority of trials on exercise training are small, relatively short, and focused on surrogate outcomes. While waiting for larger studies with longer follow-up, these statistical limitations should not discourage patients and doctors from initiating exercise and progressively increasing intensity and duration. This narrative review summarizes current knowledge about the deleterious effects of physical inactivity after KT. The benefits of regular physical exercise are also outlined

New-onset diabetes after kidney transplantation

New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, whilst the modifiable factors include peri-operative stress, hepatitis C or cytomegalovirus infection, vitamin D deficiency, hypomagnesemia, and immunosuppressive medications such as glu-cocorticoids, calcineurin inhibitors (tacrolimus more than cyclosporine), and mTOR inhibitors. The most worrying complication of NODAT are major adverse cardiovascular events which represent a leading cause of morbidity and mortality in transplanted patients. However, NODAT may also result in progressive diabetic kidney disease and is frequently associated with microvascular complications, eventually determining blindness or amputation. Preventive measures for NODAT include a careful assessment of glucose tolerance before transplantation, loss of over-weight, lifestyle modification, reduced caloric intake, and physical exercise. Concomitant measures include aggressive control of systemic blood pressure and lipids levels to reduce the risk of cardiovascular events. Hypomagne-semia and low levels of vitamin D should be corrected. Immunosuppressive strategies limiting the use of diabetogenic drugs are encouraged. Many hypoglycemic drugs are available and may be used in combination with metformin in difficult cases. In patients requiring insulin treatment, the dose and type of insulin should be decided on an individual basis as insulin requirements depend on the patient’s diet, amount of exercise, and renal function

The Eurotower Strikes Back

The 2008 global financial crisis came with fears—and, for some, hopes—that a new wave of public mobilization would emerge in industrialized countries. Especially throughout the European Union (EU), the epicenter of the crisis, large protests were expected. Yet, the energy with which social groups mobilized against the proposed austerity measures quickly fizzled. This article provides new evidence for why this was the case. In line with Neo-Keynesian theory, we argue that the interest rate adjustments and political announcements of the European Central Bank (ECB) limited the potential for mass unrest in the member states of the Economic and Monetary Union (EMU) affected by the crisis. We provide evidence for our argument with yearly panel data and a new original data set of monthly political protests between 2001 and 2013. Our analyses support the hypothesis that the ECB was able to successfully assuage dissatisfaction with the limited reform options of the Eurozone member states in the wake of the Eurocrisis

The critical role of innate immunity in kidney transplantation

For a long time now, kidney transplant rejection has been considered the consequence of either cellular or antibody-mediated reaction as a part of adaptive immunity response. The role of innate immunity, on the other hand, had been unclear for many years and was thought to be only ancillary. There is now consistent evidence that innate immune response is a condition necessary to activate the machinery of rejection. In this setting, the communication between antigen-presenting cells and T lymphocytes is of major importance. Indeed, T cells are unable to cause rejection if innate immunity is not activated. This field is currently being explored and several experiments in animal models have proved that blocking innate immunity activation can promote tolerance of the graft instead of rejection. The aim of this review is to systematically describe all the steps of innate immunity response in kidney transplant rejection, from antigen recognition to T-cells activation, with a focus on clinical consequences and possible future perspectives

Combined fuzzy and genetic algorithm for the optimisation of hybrid composite-polymer joints obtained by two-step laser joining process

In the present work, genetic algorithms and fuzzy logic were combined to model and optimise the shear strength of hybrid composite-polymer joints obtained by two step laser joining process. The first step of the process consists of a surface treatment (cleaning) of the carbon fibre-reinforced polymer (CFRP) laminate, by way of a 30 W nanosecond laser. This phase allows removing the first matrix layer from the CFRP and was performed under fixed process parameters condition. In the second step, a diode laser was adopted to join the CFRP to polycarbonate (PC) sheet by laser-assisted direct joining (LADJ). The experimentation was performed adopting an experimental plan developed according to the design of experiment (DOE) methodology, changing the laser power and the laser energy. In order to verify the cleaning effect, untreated laminated were also joined and tested adopting the same process conditions. Analysis of variance (ANOVA) was adopted to detect the statistical influence of the process parameters. Results showed that both the laser treatment and the process parameters strongly influence the joint performances. Then, an uncertain model based on the combination of fuzzy logic and genetic algorithms was developed and adopted to find the best process parameters' set able to give the maximum joint strength against the lowest uncertainty level. This type of approach is especially useful to provide information about how much the precision of the model and the process varies by changing the process parameters

Complicazioni Scheletriche Dopo Trapianto Renale

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