Patients' direction, empowerment and quality of life in haemodialysis

The maintenance of an adequate of quality of life (QoL) represents a critical issue in the management of patients in haemodialysis and is also used to assess the effectiveness of health care programmes. The Consumer Direction Theory of Empowerment (CDTE) implies that greater patient direction in policy formulation and services delivery, together with an increased community integration, endorses a process which leads to a better QOL. The aim of the study was to test a contextualized version of CDTE in an ambulatory for patients in haemodialysis. Sixty-nine patients completed a questionnaire measuring the following variables: Patient direction, family integration, self-efficacy in managing the disease, mental and physical health. The results showed that patient direction and family integration have an indirect effect on QoL, through self-efficacy in managing the disease. The hypotheses were thus confirmed, providing support for the potential of CDTE in the context of health services for haemodialysis patients. Implications for the implementation of health programmes aimed at improving QoL of patients in haemodialysis are discussed, including interventions focused on psychological and contextual factors

New Mutation of CYP24A1 in a Case of Idiopathic Infantile Hypercalcemia Diagnosed in Adulthood

Background Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease. Methods We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed. Results Median (IQR) follow-up was 36 (24–60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08–0.79) when compared to rituximab (p < 0.05). Conclusions In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appear

Therapeutic Plasma Exchange in un paziente in emodialisi cronica con nuova diagnosi di Miastenia Gravis

Caso clinico. C.S.T. (♂ , 71 anni) è un paziente con plurime e severe comorbidità, in trattamento emodialitico cronico trisettimanale dal 2008 in seguito all’evoluzione di una uropatia post-litiasica. Da circa 2 mesi il paziente presentava una progressiva comparsa di ptosi palpebrale, calo della forza muscolare e, infine, di disfagia e disartria insorte negli ultimi giorni. Ricoverato d’urgenza nel reparto di Neurologia, veniva eseguita elettromiografia (EMG) e posta diagnosi di Miastenia Gravis (MG) prevalente del distretto cranico (sierologia anticorpi anti-recettore dell’acetilcolina borderline). Veniva prontamente iniziata una terapia con piridostigmina e steroide. Ritenendo elevato il rischio di scompenso miastenico acuto, veniva intrapresa anche una terapia con Therapeutic Plasma Exchange (TPE) con tecnica di centrifugazione previo posizionamento di CVC femorale. Le sedute di TPE venivano alternate a quelle di emodialisi (HD). Il quadro si complicava dopo la terza seduta con shock settico da Staphylococcus Aureus Meticillino-Sensibile (MSSA). Il paziente veniva trasferito in Terapia Intensiva. Qui, a causa dell’instabilità emodinamica, veniva trattato con Continuous Veno-Venous Hemodiafiltration (CVVHDF) con anticoagulazione con citrato per 72 ore. Risolto il quadro settico, è stato ripreso trattamento intermittente con tecnica di Acetate Free Biofiltration (AFB). Il paziente ha poi terminato le rimanenti tre sedute di TPE e, risolto il quadro acuto, è stato ritrasferito in Neurologia. Qui ha proseguito la terapia e intrapreso un percorso riabilitativo con discreto recupero motorio e funzionale fino alla dimissione. Conclusioni. L’interazione multidisciplinare tra Nefrologi, Neurologi, Anestesisti e Medici del Servizio di Immunoematologia e Medicina Trasfusionale ha permesso la gestione e il trattamento di una patologia non frequente (MG) in un paziente emodializzato cronico ad alto rischio

Therapeutic Plasma Exchange in a Patient with Chronic Hemodialysis and a New Diagnosis of Myasthenia Gravis

Case Report. C.S.T. (♂, 71 years old) is a patient with multiple and severe comorbidities, undergoing thrice-weekly chronic hemodialysis since 2008 due to the progression of post-lithiasic uropathy. Over the past 2 months, the patient had been experiencing progressive ptosis of the eyelids, muscle weakness, and ultimately dysphagia and dysarthria that emerged in the last few days. Urgently admitted to the Neurology department, electromyography (EMG) was performed, leading to a diagnosis of predominant cranial myasthenia gravis (with borderline anti-acetylcholine receptor antibody serology). Prompt treatment with pyridostigmine and steroids was initiated. Considering the high risk of acute myasthenic decompensation, therapeutic plasma exchange (TPE) with centrifugation technique was promptly undertaken after femoral CVC placement. TPE sessions were alternated with hemodialysis. The patient’s condition complicated after the third TPE session, with septic shock caused by Methicillin-Sensitive Staphylococcus Aureus (MSSA). The patient was transferred to the Intensive Care Unit (ICU). Due to hemodynamic instability, continuous veno-venous hemodiafiltration (CVVHDF) with citrate anticoagulation was administered for 72 hours. After resolving the septic condition, intermittent treatment with Acetate-Free Biofiltration (AFB) technique was resumed. The patient completed the remaining three TPE sessions and, once the acute condition was resolved, was transferred back to Neurology. Here, the patient continued the treatment and underwent a rehabilitation program, showing significant motor and functional recovery until discharge. Conclusions. The multidisciplinary interaction among Nephrologists, Neurologists, Anesthesiologists, and experts from the Immunohematology and Transfusion Medicine Service enabled the management and treatment of a rare condition (MG) in a high-risk chronic hemodialysis patient

Efficacy and appropriateness of histological score in prediction of the 3-year outcome of kidney transplantation

Arnould Charles. Dictionnaire des noms de lieux de France, de Dauzat et Rostaing. Lettre de M. Ch. Arnould.. In: Revue Internationale d'Onomastique, 17e année N°4, décembre 1965. pp. 289-291