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 < 60 mL/min/1.73 m2) or eGFR reduction > 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 < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 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

Abilitare le comunità nei contesti emergenziali. Urbanistica tattica come strategia

La resilienza co-evolutiva rimanda alle capacità del sistema – e di tutte le sue componenti socio-ecologiche, tecniche, infrastrutturali – di mantenere e/o rapidamente ritornare alle funzioni di base, di adattarsi al cambiamento, di trasformare le componenti che ne limitano l’attuale e futura capacità di evo- luzione, in risposta a shock inattesi. La resilienza, in questa logica, è proprietà strutturale del sistema territoriale correlata alle sue capacità di auto-organiz- zazione, di adattamento alle mutate condizioni (senza ovviamente rinunciare a mitigare gli effetti parzialmente o completamente reversibili) e di mobilitazione di risorse endogene ed esogene, per raggiungere nuovi livelli di funzionamento, in alcuni casi addirittura migliori di quelli preesistenti al disastro. In seguito alla presentazione della metodologia di ricerca portata avanti nei comuni umbri colpiti dai terremoti del 2016/2017, la seconda parte del contri- buto presenta l’innovazione comunitaria in atto in alcuni contesti emergenziali, concentrandosi sul rapporto uomo-ambiente e su come questo si sia modifi- cato attraverso l’azione diretta degli abitanti. Infine, la terza parte propone l’urbanistica tattica quale strumento di co-design della città distrutta, giungendo a prime considerazioni sull’utilità dell’intervento sociale per risignificare modelli tradizionali di gestione dell’emergenza

Gli indicatori di misura delle vulnerabilità socio-economiche per la resilienza territoriale

This paper proposes a reflection on the development of a set of indicators to measure socio-economic vulnerabilities, developed as part of the research project Measuring Resilience of the Research Center R3C (Turin Polytechnic). The set of indicators is finalised to support the decision-making process to identify the most critical areas of the city and to define urban and territorial policies