[Cardiorenal physiopathology and heart failure: current aspects and therapeutic prospects]. / Fisiopatologia cardio-renale e scompenso cardiaco: attualità e prospettive terapeutiche.

The heart and the kidney exert a reciprocal control of their function in order to maintain a steady state of haemodynamics, both in physiological and pathological conditions. The functional relationship between the two organs becomes particularly evident during heart failure. The knowledge of such relationship may play an important role in the management of heart failure. We also report here our experience in the treatment of congestive heart failure with depletive techniques vicarious of kidney function.

[Treatment of refractory heart failure with different dialysis technics]. / Il trattamento dello scompenso cardiaco refrattario con differenti tecniche dialitiche.

The efficacy of the dialysis in the heart failure non responsive to the traditional methods is well known. In our study we have evaluated the effects of three different dialytic methods (UFI: ultrafiltration isolate; HF: hemofiltration; CAVH: continuous arteriovenous hemofiltration). These methods are used to cause a good depletion in the patients with intractable heart failure following from ischaemic valvular or primitive cardiomiopathy. We have treated 18 patients (6 for each method) and the patients with organic or functional renal disease were treated with the methods (HF and CAVH) that have depletive and depurative effects. Each of these methods is capable, without important differences, of achieving the following aim: the hydro-sodium depletion, the correction of the haemodynamic alteration and the re-establishment of the response to the traditional medical treatment. Using the hemofiltration and continuous arteriovenous hemofiltration, both soft methods, we have obtained values of dehydratation, absolute and for each session, higher than isolated ultrafiltration. The follow-up has not pointed out differences, of both prognosis and survival among patients treated with the three methods studied, whose effects are always only temporary; only the heart transplantation or the valvular correction, by operating in a very important way on the basal cardiopathy, is the resolutive event.

[Report on long-term hemofiltration in the treatment of end-stage renal failure]. / Bilancio di una esperienza a lungo termine con emofiltrazione nel trattamento della insufficienza renale cronica terminale.

Thirteen uraemic patients in chronic hemofiltration was studied over a 37.3 +/- 25.4 months period. Hemofiltration value in long-term treatment of uraemia was verified by: dialytic adequacy, clinical data, complications, drop-out morbidity and survival. Our experience indicates that hemofiltration and especially high efficiency hemofiltration is an effective and soft therapy for substitutive long-term treatment in high risk patients.

Bezafibrate-induced myopathy: no evidence for defects in muscle metabolism.

A 58-year-old man with chronic renal failure developed severe muscle pain and tenderness 1 week after starting bezafibrate 400 mg daily. Serum creatine kinase was 32,280 U/l. Muscle biopsy revealed scattered necrotic fibers and mild type 2b atrophy. Muscle total and free carnitine were at the upper limits of the normal range. Biochemical investigations of muscle homogenate showed normal carnitine pelmityl transferase (CPT) as well as normal individual glycolytic and mitochondrial enzyme activities. Withdrawal of the drug was followed by rapid clinical improvement. Our study casts doubt on the hypothesis that bezafibrate is able to affect muscle metabolic pathways. It is likely that the drug acts on cholesterol constituents of the muscle membrane, producing discontinuities of the sarcolemma and initiating cell necrosis.

[A case of severe recurrent transient granulocytopenia during hemofiltration: possible pathogenetic interpretations]. / Su di un caso di severa granulocitopenia transitoria ricorrente in corso di emofiltrazione: possibili interpretazioni patogenetiche.

The authors report a case of severe granulocytopenia without increased susceptibility to infections in a patient with IRC (chronic renal failure) on hemofiltration treatment. The possible pathogenetic mechanisms are examined. The phenomenon is probably due to an altered compartmentation of neutrophils; the temporariness and the quick correction of the granulocytopenia explain the lack of clinical manifestations.