Efficacy of non-surgical periodontal therapy in reducing periodontal indexes in kidney-transplant patients

Efficacy of non-surgical periodontal therapy in reducing periodontal indexes in kidney-transplant patients. I. Casula, L. Zanardini*, M. Bianchi, V. Spotti, E. Marchesini Department of Medical and Surgical Specialties and Public Health Dentale - Dental School – University of Brescia, Italy Aim: kidney-transplant patient must take cyclosporine-A and calcium channel blockers chronically. Both medicines involve a gingival overgrowth (G.O.) as a collateral effect and this is due to their dosage: it appears 1-3 months after the beginning of the therapy. The prevalence of the G.O. is 84%. The G.O. originates from anterior interdental papilla and it appears as a red and soft tumefaction, that becomes more fibrinous as time goes by. The G.O. takes place in apical-coronal verse and also in vestibular-lingual verse and it looks like a gingival hypertrophy and hyperplasia, which is due to an abnormal increase of the number of fibroblasts into gingival connective tissue. The G.O. involves a great aggregation of extracellular Matrix, or less degradation of it, or both these processes simultaneously. The G.O. leads to the formation of pseudopockets, which interfere with the correct oral hygiene practices. This condition gives rise to mature plaque retention , that leads to infection, inflammation and the increase of the G.O. This condition becomes worse because of bad pre-transplant oral hygiene state. The aim of this study is to estimate the efficacy of non-surgical periodontal therapy in reducing the G.O. in kidney-transplant patient. Materials and methods: a sample of 32 simple random kidney transplant subjects was enrolled in this study (mean age: 58,44; range: 33-81, 21 m., 11f.). All of them were taking cyclosporine A and calcium channel blockers. Patients taking idantoine, pregnant women, patients suffering from diabetes mellitus or people who have undergone gingival surgery were excluded. The study started on November 2012 and finished on September 2013. Periodontal indexes and Professional oral hygiene practices were performed by the same dental hygienist. The plaque, calculus, bleeding, G.O. and probing depth indexes were evaluated at T0, T1, T2, T3 (at 0, 2, 4, 6 months respectively). Every time the same oral hygiene protocol was applied: non-surgical periodontal therapy with ultrasonic instruments above and below the gum. Results: 787 teeth analysed and 4722 periodontal sites probed. Plaque index (PI), calculus index (CI) and bleeding index (BoP) show significant statistical reduction (p<0,0001). T-test was used for statistic analysis. PI at T0=82,09%, at T3=29,89%/ CI at T0=53,44%, at T3=23,70%/ BoP at T0=71,98%, at T3=26,18%. Probing depth (PD), at six-monthly control , shows a significant statistical reduction (p<0,0001). PD 1-3 mm at T0=16,58%, at T3=30,45%. PD 4-6mm at T0=74,06%, at T3=64,70%. PD 7-9 mm at T0=9,36%, at T3=4,85%. G.O. At T0=54,93%, at T3=44,98%, with a significant statistical reduction (p<0,0001). Conclusions: the applied oral hygiene protocol is simple but effective in reducing drug-induced gingival overgrowth in kidney-transplant patient taking Cyclosporine-A. These clinic results assure a better oral health, improving the quality of life form an aesthetic and functional point of view

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes “normal” or “good” kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1–2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage “non-ideal” situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial “third element”

The Italian registry of pulmonary non-tuberculous mycobacteria - IRENE:The study protocol

Background: A substantial increase in pulmonary and extra-pulmonary diseases due to non-tuberculous mycobacteria (NTM) has been documented worldwide, especially among subjects suffering from chronic respiratory diseases and immunocompromised patients. Many questions remain regarding the epidemiology of pulmonary disease due to NTM (NTM-PD) mainly because reporting of NTM-PD to health authorities is not mandated in several countries, including Italy. This manuscript describes the protocol of the first Italian registry of adult patients with respiratory infections caused by NTM (IRENE). Methods: IRENE is an observational, multicenter, prospective, cohort study enrolling consecutive adult patients with either a NTM respiratory isolate or those with NTM-PD. A total of 41 centers, including mainly pulmonary and infectious disease departments, joined the registry so far. Adult patients with all of the following are included in the registry: 1) at least one positive culture for any NTM species from any respiratory sample; 2) at least one positive culture for NTM isolated in the year prior the enrolment and/or prescribed NTM treatment in the year prior the enrolment; 3) given consent to inclusion in the study. No exclusion criteria are applied to the study. Patients are managed according to standard operating procedures implemented in each IRENE clinical center. An online case report form has been developed to collect patients' demographics, comorbidities, microbiological, laboratory, functional, radiological, clinical, treatment and outcome data at baseline and on an annual basis. An IRENE biobank has also been developed within the network and linked to the clinical data of the registry. Conclusions: IRENE has been developed to inform the clinical and scientific community on the current management of adult patients with NTM respiratory infections in Italy and acts as a national network to increase the disease's awareness

Aspetti epidemiologici della calcolosi di calcio in Italia: distribuzione dei fenotipi intermedi nella popolazione italiana

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The genetic architecture of membranous nephropathy and its potential to improve non-invasive diagnosis

Membranous Nephropathy (MN) is a rare autoimmune cause of kidney failure. Here we report a genome-wide association study (GWAS) for primary MN in 3,782 cases and 9,038 controls of East Asian and European ancestries. We discover two previously unreported loci, NFKB1 (rs230540, OR = 1.25, P = 3.4 × 10-12) and IRF4 (rs9405192, OR = 1.29, P = 1.4 × 10-14), fine-map the PLA2R1 locus (rs17831251, OR = 2.25, P = 4.7 × 10-103) and report ancestry-specific effects of three classical HLA alleles: DRB1*1501 in East Asians (OR = 3.81, P = 2.0 × 10-49), DQA1*0501 in Europeans (OR = 2.88, P = 5.7 × 10-93), and DRB1*0301 in both ethnicities (OR = 3.50, P = 9.2 × 10-23 and OR = 3.39, P = 5.2 × 10-82, respectively). GWAS loci explain 32% of disease risk in East Asians and 25% in Europeans, and correctly re-classify 20-37% of the cases in validation cohorts that are antibody-negative by the serum anti-PLA2R ELISA diagnostic test. Our findings highlight an unusual genetic architecture of MN, with four loci and their interactions accounting for nearly one-third of the disease risk

Reading/Writing Multilingualism: language, literature and creativity in the multilingual classroom

This article examines the relationship between the discipline of ‘English Literature’, and the contemporary multilingual classroom. It argues that our field has often been cast as a kind of corrective to the ‘problem’ of language diversity by helping to teach language norms, literature can – and should – be made a preeminent space for students to reflect on their own experiences of language diversity, and to translate this into self-reflexive critical tools to think about language in literature. As an example of this kind of practice in action, the article discusses the practices and outcomes of a project in the English Literature department at Queen Mary University of London, called Reading/Writing Multilingualism, working with year 10 and 12 students from two local secondary schools who have English as an additional language

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR &lt; 60 mL/min/1.73 m2) or eGFR reduction &gt; 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR &lt; 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR &gt; 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening