BACKGROUND:Even though many organs may be involved and clinical manifestations are extremely variable, a sudden worsening of renal function after vascular surgery or invasive angiographic manoeuvres is a clue for the diagnosis of renal cholesterol crystal embolization. In rare cases the disease may also occur spontaneously during anticoagulant or thrombolytic therapy. Renal atheroembolism is becoming increasingly recognized as an important cause of renal failure particularly in elderly men, and is often associated with a bad outcome. To date there is no specific and proven useful treatment apart from a few anecdotal reports on the benefits of corticosteroids.PATIENTS AND METHODS:We report a group of seven patients with cholesterol atheroembolic disease presenting acute renal failure; in six patients the disease appeared after coronary arteriography and PTCA performed in the last four months, and in one patient in an apparently spontaneous form. All the patients presented cutaneous lesions, livedo reticularis, purpuric rush, necrosis of the toes; laboratory data showed an increase of acute phase proteins and eosinophilia. Results. Treatment with prednisolone was begun at a dose of 40 mg/day i.v. for four days; the dose was reduced to prednisone 0.4-0.5 mg/kg/day for 1 week, than gradually reduced further and stopped within a month. Following therapy renal function rapidly improved; clinical symptoms of malaise and abdominal discomfort subsided, with amelioration of skin lesions and cyanosis of toes.CONCLUSIONS:Despite the small number of patients studied, our experience suggests that corticosteroid treatment is an effective therapeutic option in cholesterol renal atheroembolic disease, especially in the more severe cases of acute renal failure.

Background/Aim: The clearest benefit of recombinant human erythropoietin (rHuEPO) in end-stage renal disease is a substantial reduction in transfusion dependency and an improved quality of life. In this report, we describe the efficacy of weekly subcutaneous administration of rHuEPO in 11 elderly patients with anemia secondary to chronic renal failure. Methods: The role of rHuEPO therapy in increasing the patient’s quality of life and in decreasing the hospitalization rates secondary to cardiac morbidity was verified in 11 elderly patients (age range between 66 and 85 years) with anemia due to chronic renal failure. The mean hemoglobin level at the beginning of the study was 8.2 ± (SD) 0.7 g/dl, and the serum creatinine concentration was 4.8 ± 1.36 mg/dl. The patients underwent baseline and annual echocardiography, in addition to an electrocardiogram. Results: Most patients experienced a partial regression of left ventricular hypertrophy, and no congestive heart failure was documented. The mean hemoglobin level during rHuEPO therapy increased to 11.3 ± 1.2 g/dl, while the mean serum creatinine concentration did not change significantly. Conclusions: Our results confirm that early anemia correction in aged chronic renal failure patients permits improvement of the quality of life, of exercise performance, and of cognitive functions. Reduced transfusion need and regression of left ventricular hypertrophy favor a minor incidence of cardiac morbidity and contribute to reduce health costs.

To assess hepatitis C virus (HCV) incidence rates and identify determinants of infection among hemodialysis patients, a multicenter study was conducted in 58 units in ITALY: An initial seroprevalence survey was conducted among 3,492 patients already on hemodialysis therapy as of January 1997 and among an additional 434 patients who began dialysis up to January 1998. HCV antibodies were assessed by third-generation enzyme immunoassays. Patients testing seronegative at baseline were enrolled into a 1-year incidence study with serological follow-up at 6 and 12 months. For patients who seroconverted, an HCV RNA assay was performed on stored baseline samples to confirm new infection. A nested case-control study was subsequently performed to investigate potential risk factors. For each incident case, three controls negative for both HCV antibodies and HCV RNA were randomly selected. At enrollment, HCV seroprevalence was 30.0%. During follow-up, 23 new HCV cases were documented, with a cumulative incidence of 9.5 cases/1,000 patient-years. By logistic regression analysis, an increased risk for HCV infection emerged for patients attending the dialysis units with a high prevalence of HCV-infected patients at baseline (odds ratio [OR], 4.6) and for those attending units with a low personnel-patient ratio (OR, 5.4). Among extradialysis factors, a history of surgical intervention in the previous 6 months (OR, 16.7) significantly increased HCV risk. These findings suggest that the combination of understaffing and a high level of infected patients in the dialysis setting increases the risk for HCV nosocomial transmission. This is likely related to an increased likelihood for breaks in infection control measures.

Cutaneous periarteritis nodosa (PAN) is a clinical feature characterized by chronic, benign course; its pathogenesis is unknown. In patients submitted to renal transplantation cutaneous PAN is a rare complication. We report a case of cutaneous PAN associated with the reappearance of hepatitis B antigen 16 years after kidney transplantation. A 44-year-old man underwent successful renal transplantation in June 1980. In December 1996 he presented multiple painful erythematous subcutaneous nodules on both legs. Skin lesion biopsy showed the presence of cutaneous PAN. Six months later laboratory data demonstrated the presence of HbsAg. HBeAg, HBcAb and detectable HBV-DNA serum by polymerase-chain-reaction (PCR) assay. Anti-HBs and anti-HBe proved negative. In July 1998 the laboratory tests showed an important increase of HBV-DNA (5.1 billion by Branched DNA), and so lamivudine (100 mg/day) was introduced. HBV-DNA became undetectable by PCR after 3 months of therapy. Seven months later a new skin biopsy was performed. The typical signs of PAN were no longer evident. As HBV infecion was demonstrated six months after the clinical appearance of the PAN, in a patient who was believed to be immune to the virus, it is possible that, in the early stages, the hepatitis B antigen title was methodologically indeterminable, but sufficient to form circulating immune complexes responsible for vasculitis primer. Lamivudine therapy resulted efficacious in favouring the regression of cutaneous PAN, but its long-term efficacy requires further evaluation as regards potential selection of drug resistant hepatitis B virus (HBV) mutants during treatment.

BACKGROUND:Atrial fibrillation (AF) is the most common sustained arrhythmia diagnosed in non-uremic patients and its prevalence increases in older subjects, however, information concerning AF in dialysis patients is scarce. Therefore, we carried out a prospective cross-sectional study from September 1996 to December 1996 in order to evaluate the prevalence and some of the clinical characteristics associated to AF in hemodialysis (HD) patients.SUBJECTS AND METHODS:316 HD patients (age 63 +/- 12 years, dialysis duration 69 +/- 71 months) treated in three different hospital-based units were studied. Standard 12-lead electrocardiograms (ECGs) carried out in the interdialytic day during the study period were reviewed. Data concerning age, history of ischemic heart disease (IHD), cerebrovascular disease (CVD), peripheral vascular disease (PVD), presence of diabetes, smoking history and antihypertensive therapy were collected. Systolic and diastolic blood pressure, fasting cholesterol and triglycerides, albumin and hemoglobin were also derived from the clinical records. Performance status was assessed by Karnofsky index (Ki).RESULTS:74 patients (23.4%) had persistent AF, i.e. presence of AF in all (at least two) ECGs performed in the study time. Patients with AF were older (age 69 +/- 10 vs 62 +/- 12 years, p < 0.001), had lower Ki (54 +/- 20 vs 68 +/- 17, p < 0.01), cholesterol (182 +/- 46 vs 198 +/- 52 mg/dl, p < 0.01) and albumin (3.9 +/- 0.5 vs 4.1 +/- 0.5 g/dl, p < 0.001) compared to those with no AF. Prevalence of IHD (44.5% vs 19%, p < 0.05) and PVD (23% vs 11%, p < 0.05) was higher among AF patients. Logistic regression analysis showed that IHD (p < 0.001) and Ki (p < 0.01) were independently associated to AF.CONCLUSION:We conclude that AF is a frequent arrhythmia in HD patients treated in hospital-based dialysis units, especially in those with low performance status. It appears to be associated to the atherosclerotic damage of coronary arterial tree. Prospective studies are necessary to assess whether it could contribute to cardiovascular morbidity and mortality in end-stage renal disease.

Letters| September 22 2000 'Isolated' Thrombocytopenia by Splenic Sequestration in Hemodialyzed Patients Subject Area: Nephrology Adriano Verzola; Adriano Verzola aDivision of Nephrology, Search for other works by this author on: This Site PubMed Google Scholar Gian Luigi Scapoli; Gian Luigi Scapoli bInstitute of Hematology and Search for other works by this author on: This Site PubMed Google Scholar Isidoro Scirè Risichella; Isidoro Scirè Risichella aDivision of Nephrology, Search for other works by this author on: This Site PubMed Google Scholar Napoleone Prandini; Napoleone Prandini cOperative Unit of Nuclear Medicine, S. Anna Hospital, Ferrara, Italy Search for other works by this author on: This Site PubMed Google Scholar Matteo Rigolin; Matteo Rigolin bInstitute of Hematology and Search for other works by this author on: This Site PubMed Google Scholar Maurizio Bergami; Maurizio Bergami aDivision of Nephrology, Search for other works by this author on: This Site PubMed Google Scholar Paolo Gilli; Paolo Gilli aDivision of Nephrology, Search for other works by this author on: This Site PubMed Google Scholar Pier Luigi Bedani Pier Luigi Bedani aDivision of Nephrology, Search for other works by this author on: This Site PubMed Google Scholar Nephron (2000) 86 (2): 184–185. https://doi.org/10.1159/000045739 Article history Published Online: September 22 2000 Content Tools Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Adriano Verzola, Gian Luigi Scapoli, Isidoro Scirè Risichella, Napoleone Prandini, Matteo Rigolin, Maurizio Bergami, Paolo Gilli, Pier Luigi Bedani; 'Isolated' Thrombocytopenia by Splenic Sequestration in Hemodialyzed Patients. Nephron 1 October 2000; 86 (2): 184–185. https://doi.org/10.1159/000045739 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsNephron Search Advanced Search This content is only available via PDF. 2000Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Article PDF first page preview Close Modal You do not currently have access to this content.

Letters| September 22 2000 Renal Cholesterol Microembolism: Is Steroid Therapy Effective? Subject Area: Nephrology N. Stabellini; N. Stabellini aDivision of Nephrology, Arcispedale S. Anna, Ferrara, and Search for other works by this author on: This Site PubMed Google Scholar E. Rizzioli; E. Rizzioli aDivision of Nephrology, Arcispedale S. Anna, Ferrara, and Search for other works by this author on: This Site PubMed Google Scholar M.R. Trapassi; M.R. Trapassi aDivision of Nephrology, Arcispedale S. Anna, Ferrara, and Search for other works by this author on: This Site PubMed Google Scholar F. Fabbian; F. Fabbian bOperative Unit of Nephrology, Ospedale Civile, Monselice, Italy Search for other works by this author on: This Site PubMed Google Scholar C. Catalano; C. Catalano bOperative Unit of Nephrology, Ospedale Civile, Monselice, Italy Search for other works by this author on: This Site PubMed Google Scholar P. Gilli P. Gilli aDivision of Nephrology, Arcispedale S. Anna, Ferrara, and Search for other works by this author on: This Site PubMed Google Scholar Nephron (2000) 86 (2): 239–240. https://doi.org/10.1159/000045769 Article history Published Online: September 22 2000 Content Tools Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation N. Stabellini, E. Rizzioli, M.R. Trapassi, F. Fabbian, C. Catalano, P. Gilli; Renal Cholesterol Microembolism: Is Steroid Therapy Effective?. Nephron 1 October 2000; 86 (2): 239–240. https://doi.org/10.1159/000045769 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsNephron Search Advanced Search Article PDF first page preview Close Modal 2000Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. You do not currently have access to this content.

Key words: kidney transplantation; renal vein; throm-extended to the inguinal region.The renal allograft bolytic therapy; urokinase was somewhat tender and painful on examination.Laboratory investigation showed a slight increase in serum creatinine (1.8 mg/dl ) and absence of proteinuria.Platelet count and function, prothrombin Because the selective intra-arterial administration of 10.Modrall JG, Teitelbaum GP, Diaz Luna H, Berne T. Local urokinase is not a treatment without complications, thrombolysis in a renal allograft threatened by renal vein thrombosis.

Patients treated with immunosuppressive drugs can develop cancers. The authors present two cases of Kaposi's sarcoma in kidney transplant patients who had been treated with azathioprine, steroids and cyclosporin-A; during this treatment the Langerhans cells decreased and Kaposi's sarcoma appeared. Discontinuation or reduction of the dosage of cyclosporin-A led to complete regression of the illness, and the Langerhans cells reappeared. We suggest that cyclosporin-A damages the immunological function of the epidermal Langerhans cells, and that this is the primary factor in the development of Kaposi's sarcoma.

Accessible online at: http://BioMedNet.com/karger Dear Sir, Hyperlipidemia is one of the most frequent complications in renal transplant recipients (RTR) [1]. Immunosuppressive treatment with corticosteroids and ciclosporin A (CS-A) and impairment of the renal function represent the pivotal etiological factors [1, 2]. The data presented in the literature mostly show short-term posttransplant hyperlipidemia. In this study, we evaluated the differences in the lipid profile of two groups of RTR in relation to immunosuppressive therapy several years after transplantation. Twenty-eight RTR (mean age 52.8 B 7.8, range 36–65 years) were examined. Eligibility criteria were: (1) a time interval since transplantation of at least 100 months, and (2) serum creatinine values ^1.9 mg/dl. On the basis of immunosuppressive therapy, the patients were classified into two groups, homogeneous in number, age, and clearance of creatinine. The first group (mean age 54 B 6.4 years) was treated with corticosteroids and azathioprine; the second group (mean age 51.7 B 9.1 years) received corticosteroids, azathioprine, and CS-A. Both groups were submitted to ultrasonographic scanning of the right and left common carotid artery, the carotid bifurcation and the internal and external carotid. A specific score was applied to classify the results. All patients were on a free diet, did not receive antilipidemic drugs for at least 3 months, and were not affected by hypertension. Statistical analysis was performed using the Wilcoxon test for unpaired data. In spite of a shorter time since transplant, the CS-A group showed significantly higher serum triglyceride concentrations (p ! 0.05, table 1). There were no significant differences in renal function, body mass index and high-density, low-density, and total cholesterolemia, even if the total cholesterol content was high in both groups. Echo color Doppler showed atherosclerotic alterations with a similar score in both groups. Our study brings a further contribution to discussion on etiopathogenetic factors of

Glycosaminoglycans have generalized antibacterial anti-adherent activity, and cooperate with secretory immunoglobulin-A in anti-infection defense mechanisms of the urinary tract. Cyclosporin A modulates T-lymphocytes and fibroblast functions. In this report we analyze urinary glycosaminoglycans and secretory immunoglobulin-A in renal transplant patients with recurrent urinary tract infections treated with cyclosporin. The results show a significant decrease of total glycosaminoglycans and secretory immunoglobulin-A in recurrent urinary tract infections which is unrelated to cyclosporin treatment. The data support the hypothesis that recurrent urinary tract infections may be the consequence of a genetic pathology rather than cyclosporin-induced alterations.

The most widely studied hyperlipidemies in patients affected by renal insufficiency or subsequent to kidney transplant present phenotype IIa, IIb or IV. The lipidic alteration most frequently observed in chronic renal insufficiency and/or dialytic treatment is represented by hypertrigliceridemia as a result of: 1) altered VLDL metabolism; 2) reduced activity of lecithin cholesterol acyltransferase (LCAT); 3) decrease in Apo-A1 and HDL3. Furthermore, marked anomalies in lipoprotein Lp (a) have been reported in hemodialysis. In patients undergoing peritoneal dialysis, hyperlipidemia arises from both an anomalous retrograde absorption of glucose and protein dispersion. Following kidney transplant the most frequent hyperlipidemia is hypercholesterolemia, consequent to immunosuppressive treatment (mainly steroids and cyclosporin). The documented significant increase of cardiovascular risk in the presence of hyperlipidemia points to the need for a clearer etiopathogenic definition of this anomaly, as well as the necessity to find an efficacious pharmacological treatment.

Vibrio vulnificus, a particularly virulent halophilic vibrio, has been isolated from the blood and skin necrotic lesion of a hemodialyzed patient with sepsis. The patient has had exposure of the skin to seawater. Various chronic conditions including renal failure have a great risk for developing septicemia due to V. vulnificus. It is necessary to inform persons with liver diseases or immunocompromising conditions of hazards associated with the consumption of undercooked seafood and seawater exposure.

PURPOSE:This report describes data collected by the Italian Registry of Renal Biopsies (IRRB) (E mail http://www.teseo.it/nephrology/irrb), which includes 15461 renal biopsies (RB) performed over a period of 7 years (1987-1993).METHODS:From 1987 to 1988, the Registry recorded only the histological diagnosis of 3686 RB, whereas beginning in 1989, additional records (sex, age, clinical symptoms and renal function) were obtained from 11,775 patients undergoing RB. This is the first report on such a large number of RB containing data from 96% of Italian renal units which routinely perform RB.RESULTS:In 13,835 RB performed in native kidneys, two groups of renal diseases, primary (59.9%) and secondary (25.4%) glomerulonephritis (gn), were more frequent than others. Among primary gn, the frequency of cases of IgAN, membranous gn, and focal and segmental glomerulosclerosis were 36.9, 21.7 and 10.4% respectively. Renal disease due to immune-mediated causes (51%) and dysgammaglobulinaemia (26.9%) were the most frequent among secondary gn. In the former group, the frequency of cases with lupus nephritis and vasculitis were 51.6 and 25.9% respectively. Renal amyloidosis (39.3%), essential mixed cryoglobulinaemia (30.9%), and multiple myeloma were the most frequent forms in the latter group. In 1993 the incidence of the following groups of renal disease was: primary gn (22.7 p.m.p.), secondary gn (11.1 p.m.p.) of which immune-mediated gn (5.8 p.m.p.), dysgammaglobulinaemias associated with nephritis (2.4 p.m.p.). IgAN and membranous gn, as primary gn, had an incidence of 8.4 and 4.9 p.m.p, respectively, while lupus nephritis (2.6 p.m.p.) and renal vasculitis (1.6 p.m.p.) were the most frequent forms of secondary gn. Clinical data regarding 10357 RB collected during 5 years (1989-1993), showed that the most common indications to perform RB were urinary abnormalities (30.8%) and nephrotic syndrome (27.1%), followed by recurrent episodes of macrohaematuria (8.7%) and nephritic syndrome (5.4%). Acute renal failure was present in 9.2% of patients and chronic renal insufficiency in 18.8% of cases. Membranous gn (32.9%), focal and segmental glomerulosclerosis (12.3%), and minimal-change disease (12.0%) were the most frequent diagnoses in patients with nephrotic syndrome, while post-streptococcal gn (16.1%) and IgAN (14.0%) were frequent in the nephritic syndrome. IgAN was frequently found in patients with urinary abnormalities (29.8%) and recurrent episodes of macrohematuria (71.4%). Twenty per cent of the acute renal insufficiency cases were secondary to necrotizing vasculitis, while chronic renal failure was present in 16.6% of the IgAN patients.FUTURE TRENDS:The IRRB is considering to extend its programme to include (i) paediatric section regarding RB from patients aged less than 18 years; (ii) annual review of clinical data concerning the kidney function of selected groups of patients recorded in IRRB, and (iii) the listing of IRRB records on the INTERNET, to facilitate the distribution of information throughout the scientific community.