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2.
G Ital Nefrol ; 37(1)2020 Feb 12.
Artigo em Italiano | MEDLINE | ID: mdl-32068363

RESUMO

Atrial fibrillation is the most common cardiac disorder among chronic nephropathic patients. Possible therapeutic approaches include the use of anticoagulants, which are able to reduce the risk of thromboembolism but lead to an increasing bleeding risk, especially in this cohort of patients. Also, novel oral anticoagulant agents (NAO), due to their mainly renal clearance, are a relative contraindication in advanced renal disease. As an alternative to the oral anticoagulant therapy, left atrial appendage occlusion seems a promising opportunity in high risk, difficult to manage patients. Since there is limited evidence of LAAO in advanced chronic renal disease or dialysis patients, we report here a monocenter experience on 12 patients (6 of which in regular dialytic treatment) with a median clinical follow-up of fourteen months (3-22 months).


Assuntos
Apêndice Atrial , Fibrilação Atrial/complicações , Insuficiência Renal Crônica/complicações , Oclusão Terapêutica/instrumentação , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Apêndice Atrial/diagnóstico por imagem , Contraindicações de Medicamentos , Inibidores do Fator Xa/uso terapêutico , Hemorragia/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Diálise Renal , Insuficiência Renal Crônica/terapia , Medição de Risco , Tromboembolia/etiologia
3.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373468

RESUMO

In the last few years, the increasing awareness of the complex interaction between monoclonal component and renal damage has determined not only a new classification of the associated disorders, called Monoclonal Gammopathy of Renal Significance (MGRS), but has also contributed to emphasize the importance of an early diagnosis of the renal involvement, which is often hard to detect but can evolve towards terminal uraemia; it has also pointed at the need to treat these disorders with aggressive regimens, even if they are not strictly neoplastic. The case described here presented urinary abnormalities and renal failure secondary to a membranoproliferative glomerulonephritis (MPGN), with intensively positive immunofluorescence (IF) for monoclonal k light chain and C3, and in the absence of a neoplastic lympho-proliferative disorder documented on bone marrow biopsy. After the final diagnosis of MGRS, the patient was treated with several cycles of a therapy including dexamethasone, cyclophosphamide and bortezomib, showing a good functional and clinical response.


Assuntos
Glomerulonefrite Membranoproliferativa/complicações , Paraproteinemias/complicações , Insuficiência Renal/etiologia , Biópsia , Bortezomib/uso terapêutico , Complemento C3c , Ciclofosfamida/uso terapêutico , Dexametasona/uso terapêutico , Diagnóstico Precoce , Feminino , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulonefrite Membranoproliferativa/patologia , Glucocorticoides/uso terapêutico , Humanos , Cadeias kappa de Imunoglobulina , Glomérulos Renais/patologia , Glomérulos Renais/ultraestrutura , Pessoa de Meia-Idade , Paraproteinemias/tratamento farmacológico
4.
G Ital Nefrol ; 34(1)2017.
Artigo em Italiano | MEDLINE | ID: mdl-28177096

RESUMO

Hyponatremia is the most common electrolyte disorder observed in hospitalized patients. The most severe forms are neurological and potentially fatal emergencies; yet increased morbidity, length of hospital stay and costs associated with less severe forms are aspects of major concern. Nephrologists are frequently consulted regarding the therapeutic management and the key pathophysiological issues of hyponatremia, as this latter aspect represents a true challenge in an emergency setting. We report a case of a woman admitted to the emergency room for gait instability caused by a very severe multifactorial hyponatremia with a favourable clinical outcome.


Assuntos
Hiponatremia/etiologia , Feminino , Humanos , Hiponatremia/diagnóstico , Pessoa de Meia-Idade , Índice de Gravidade de Doença
5.
Clin Exp Nephrol ; 20(3): 433-42, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26453483

RESUMO

BACKGROUND: The beneficial effects of dietary restriction of proteins in chronic kidney disease are widely recognized; however, poor compliance to prescribed low-protein diets (LPD) may limit their effectiveness. To help patients to adhere to the dietary prescriptions, interventions as education programmes and dietary counselling are critical, but it is also important to develop simple and attractive approaches to the LPD, especially when dietitians are not available. Therefore, we elaborated a simplified and easy to manage dietary approach consisting of 6 tips (6-tip diet, 6-TD) which could replace the standard, non-individualized LPD in Nephrology Units where dietary counselling is not available; hence, our working hypothesis was to evaluate the effects of such diet vs a standard moderately protein-restricted diet on metabolic parameters and patients' adherence. METHODS: In this randomized trial, 57 CKD patients stage 3b-5 were randomly assigned (1:1) to receive the 6-TD (Group 6-TD) or a LPD containing 0.8 g/kg/day of proteins (Group LPD) for 6 months. The primary endpoint was to evaluate the effects of the two different diets on the main "metabolic" parameters and on patients' adherence (registration number NCT01865526). RESULTS: Both dietary regimens were associated with a progressive reduction in protein intake and urinary urea excretion compared to baseline, although the decrease was more pronounced in Group 6-TD. Effects on serum levels of urea nitrogen and urinary phosphate excretion were greater in Group 6-TD. Plasma levels of phosphate, bicarbonate and PTH, and urinary NaCl excretion remained stable in both groups throughout the study. 44 % of LPD patients were adherent to the dietary prescription vs 70 % of Group 6-TD. CONCLUSIONS: A simplified diet, consisting of 6 clear points easily managed by CKD patients, produced beneficial effects either on the metabolic profile of renal disease and on patients' adherence to the dietary plan, when compared to a standard LPD.


Assuntos
Dieta Saudável , Dieta com Restrição de Proteínas , Cooperação do Paciente , Insuficiência Renal Crônica/dietoterapia , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Nitrogênio da Ureia Sanguínea , Dieta com Restrição de Carboidratos , Dieta Hipossódica , Comportamento Alimentar , Feminino , Frutas , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Fosfatos/sangue , Fosfatos/urina , Tamanho da Porção , Estudos Prospectivos , Recomendações Nutricionais , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/urina , Índice de Gravidade de Doença , Sódio/urina , Fatores de Tempo , Resultado do Tratamento , Ureia/urina , Verduras
6.
G Ital Nefrol ; 32(6)2015.
Artigo em Italiano | MEDLINE | ID: mdl-26845210

RESUMO

Theophylline/aminophylline use for asthma and chronic obstructive pulmonary disease has declined over time, as new and safer therapies developed. However, theophylline/aminophylline overdose can occur. Hereby it is described an unusual case of severe aminophylline intoxication due to mesodermic injections treated with CVVHDF session.


Assuntos
Aminofilina/intoxicação , Doença Aguda , Adulto , Feminino , Humanos
7.
G Ital Nefrol ; 31(6)2014.
Artigo em Italiano | MEDLINE | ID: mdl-25504165

RESUMO

Lactic acidosis metformin-related is a potentially fatal complication. Reviews show a stable prevalence of this phenomenon, but nephrological experience is required since it is frequently involved in therapeutic management. Here we report the cases of two old patients with severe lactic acidosis and acute renal failure treated with hemodiafiltration.


Assuntos
Acidose Láctica/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
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