Non-Alcoholic Fatty Liver Disease Is Associated With Reduced Glomerular Filtration Rate in Patients With Chronic Plaque Psoriasis.

BACKGROUND: Chronic plaque psoriasis has been associated with metabolic comorbidities, including non-alcoholic fatty liver disease (NAFLD). A causal relationship between NAFLD and chronic kidney disease (CKD) is debated. OBJECTIVES: To assess whether NAFLD is associated with impaired renal function in patients with psoriasis. METHODS: A multicenter, retrospective, observational study including 337 patients with moderate-to-severe chronic plaque psoriasis, who had no history of excessive alcohol consumption or other secondary causes of chronic liver and renal diseases was conducted. NAFLD was diagnosed by ultrasonography, and CKD stage ≥2 or stage ≥3 were defined by an estimated glomerular filtration rate (e-GFR) of <90 ml min-1 1.73 m-2 or <60 ml min-1 1.73 m-2, respectively. Logistic and linear regression analyses were undertaken to assess the independent association of NAFLD with CKD or eGFR levels. RESULTS: Patients with NAFLD (n = 212, 62.9% of total) had significantly lower e-GFR levels (83.4 ± 18.0 vs. 93.5 ± 15.8 ml min-1 1.73 m-2, P<.001) and a remarkably higher prevalence of both CKD stage ≥2 (56.1% vs. 30.4%, P<.0001) and CKD stage ≥3 (10.4% vs. 3.2%, P<.0001) compared with their counterparts without NAFLD. Multivariable logistic regression analysis showed that NAFLD was associated with a nearly 2.5-fold increased risk of prevalent CKD stage ≥2 (adjusted-odds ratio= 2.60 95% confidence intervals 1.4-4.8, P=.02), independently of components of metabolic syndrome, psoriasis severity, and psoriatic arthritis. CONCLUSIONS: Ultrasound-diagnosed NAFLD is strongly associated with a reduced eGFR in patients with moderate-to-severe psoriasis, independently of cardiometabolic risk factors and psoriasis-related variables.

Rare localizations of echinococcosis: personal experience.

BACKGROUND: The rare localizations of hydatidosis represent an interesting topic, especially with reference to epidemiological and diagnostic problems. Hydatid disease, common in Mediterranean countries, still remains endemic in some regions of Italy. METHODS: In the period April 1983-October 2003 73 patients with hydatid disease were observed. RESULTS: Seven patients (9.5%) presented a primary rare localization (thyroid, kidney, sacrospinal muscle, peritoneum and spleen). The main peculiarity of primary rare hydatidosis localizations concerns diffusion of the infecting embryo; the most reliable hypothesis is that liver and lung can be bypassed through precapillary anastomosis between pre- and post-parenchymal circulation. The new imaging techniques allow a correct topographic evaluation and so a radical surgical treatment. The chemotherapy, complementary to surgery, produced degenerative modifications of parasite in 75.8% of the present cases and reduction of recurrence from 23.3% to 6.7%. At follow up of 1-5 years no patients had recurrence. CONCLUSION: It is important to be aware, especially in countries where echinococcosis is endemic, that it is possible to find an echinococcosis cyst in a rare localization.