[A 'lucky' patient]. / Un caso 'fortunato'

A 72-year-old male diabetic patient admitted to our operative unit of nephrology and dialysis underwent hemodialytic treatment because of rapidly progressive renal failure. A moderate hypertensive state was associated to nephrotic proteinuria and microematuria. Renal angiography showed a severe stenosis of the right renal artery and a smaller left kidney. Right renal artery stenting induced a significant reduction in serum creatinine (Cr) and the patient discontinued with the dialytic treatment.

[Ultrasound evaluation of the bone tissue of the proximal phalanges of hands in patients with suspected type I osteoporosis]. / Valutazione del tessuto osseo con ultrasuoni (US) sulla falange prossimale delle mani nelle pazienti con sospetta osteoporosi di tipo I.

The authors assessed the effectiveness and reliability of a new ultrasound system for evaluating the quality of bone tissue in a series of female patients with suspected type I osteoporosis. Evaluation with ultrasound was performed at the distal metaphysis of the first phalanx of the long fingers of the non-dominant hand. The investigation involves the measurement of the AD-SoS and the evaluation of the screen trace of the US signal transmitted through the phalanx. The data supplied by US were compared with the measurement of BMC through DPA on the ultradistal radius performed on the same day. The study involved 94 patients of age 42 to 73 years. A positive correlation was found between AD-SoS and BMC, r = 0.75, and a negative correlation between AD-SoS and the age of the patients, r = -0.62. Ultrasound investigation enables correct identification in 78% of patients; in particular, none of the patients recognized as pathologic at ultrasound investigation figured as normal at DPA. The authors conclude that the system studied is reliable and supplies important information on the quality of bone tissue, and can usefully complement the methods for measuring BMC.

Nephrotic syndrome from 5-ASA for ulcerative colitis? Complicated by carcinoma of the colon and sclerosing cholangitis.

A patient with nephrotic syndrome had been treated with mesalazine for ulcerative colitis, and also had a carcinoma of the colon and sclerosing cholangitis. This seemingly unrelated series of complications gives us the opportunity to review the problem of nephropathy in ulcerative colitis.

Circadian rhythm of proteinuria: effects of an evening meat meal.

Ten healthy volunteers were studied to test the effect of a meat meal on the circadian rhythm of urinary proteins. All subjects were kept at bed-rest during the whole 24-h evaluation period. An oral protein load (0.6 g/kg bodyweight) was given at supper-time (19.00 hours). Urinary and serum samples were collected every 3 h and examined for total protein, albumin, retinol-binding protein, and creatinine. All these variables and glomerular filtration rate (GFR), as measured by creatinine clearance, showed circadian rhythms. Acrophases were located at 14.21 hours (range 11.11-16.25) for urinary total protein, at 17.27 hours (13.14-22.31) for serum total protein, at 15.13 hours (13.01-18.04) for urinary albumin, at 14.18 hours (11.13-19.20) for serum albumin, at 21.22 hours (18.42-02.41) for urinary retinol-binding protein, at 14.51 hours (08.52-19.57) for serum retinol-binding protein, and at 16.17 hours (13.38-19.25) for creatinine clearance. Thus, the acrophases of urinary total protein and urinary albumin excretion rates occurred before the supper protein load, in a time span common to the acrophases of their serum levels and maximal GFR, whereas the acrophase of urinary retinol-binding protein occurred after the supper meat meal, concomitantly with the lowest value of serum retinol-binding protein. These findings suggest that circadian rhythms of urinary total protein and urinary albumin are influenced by changes in GFR, which occur also independently from an oral protein load. In fact, the latter did not modify creatinine clearance when administered at supper time.(ABSTRACT TRUNCATED AT 250 WORDS)