Acute renal failure and nephrotic syndrome due to membranoproliferative nephritis during the second trimester of pregnancy.

We report the case of a patient with acute renal failure and nephrotic syndrome during the second trimester of an otherwise uncomplicated pregnancy. Despite pregnancy, percutaneous renal biopsy was performed to evaluate the etiology, showing Type I membranoproliferative glomerulonephritis. Two therapeutic options were considered: pregnancy termination, suggested by the gynecologists, and our proposal of starting steroid therapy, in order to reduce proteinuria and improve renal function. The patient refused pregnancy termination. She received i.v. methylprednisolone boluses, followed by maintenance oral prednisone and aspirin, with prompt acute renal failure resolution and reduced proteinuria. At Week 34 + 5 days of gestation, cesarean section was performed, without intra- and postoperative complications both for mother and newborn. Clinical maternal and fetal outcomes were excellent. One-year follow-up showed normal renal function and absence of proteinuria. Lacking guidelines concerning treatment of acute renal failure due to primary nephropathy in pregnancy, we consider this case of interest for our decision-making process and for the favorable outcome.

Renal hemodynamics and urinary excretion of 6-keto-prostaglandin F1 alpha and thromboxane B2 in newly diagnosed type I diabetic patients.

We have studied the functional importance of renal eicosanoids in renal hemodynamics of seven newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients by treatment with two structurally unrelated inhibitors of cyclooxygenase (i.e., piroxicam and sulindac). Glomerular filtration rate (GFR), renal plasma flow (RPF), daily urinary excretion of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha, the stable hydrolysis product of prostacyclin), and thromboxane B2 (TXB2, the stable hydrolysis product of thromboxane A2) were measured before, during, and after piroxicam (all patients) or sulindac (3 patients) treatment. Urinary excretion of 6-keto-PGF1 alpha was significantly increased (P less than .01) in diabetic patients compared with seven healthy subjects, whereas urinary excretion of TXB2 was unchanged. The baseline value of GFR was significantly (P less than .01) higher in diabetic compared with normal volunteers, whereas baseline RPF was comparable in both groups. Piroxicam (20 mg/day) reduced urinary excretion of 6-keto-PGF1 alpha and TXB2 by 65.7 +/- 26 and 64.6 +/- 33%, respectively. These biochemical changes were temporally associated with the approximately 19% decrease in GFR (P less than .01). A week after discontinuation of the drug, GFR and urinary excretion of 6-keto-PGF1 alpha were still significantly (P less than .05) reduced, whereas urinary excretion of TXB2 returned to control values. In contrast, urinary excretion of eicosanoids and renal function were not affected by sulindac (0.4 g/day) treatment. No functional changes were detected in healthy subjects despite a similar suppression of renal cyclooxygenase activity when they were treated with piroxicam.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of furosemide-induced activation of the renal prostaglandin system.

A detailed time course of changes in plasma renin activity (PRA), urinary prostaglandin (PG) E2, PGF2 alpha, thromboxane (TX) B2 and sodium excretion rates following furosemide was obtained in 7 women. PRA increased within the first 15 min and remained elevated all through the experiment. PGE2, PGF2 alpha, TXB2 and sodium increased simultaneously, reached a peak between 15 and 45 min after furosemide and declined thereafter. It is concluded that furosemide induces a generalized activation of the renal PG system temporally related to the increase of renin release and natriuresis.

IgA nephropathy in cystic fibrosis.

The kidney does not usually present specific lesions in cystic fibrosis (CF), although in recent years renal involvement has been reported, particularly amyloidosis and immune complex glomerulonephritis. IgA nephropathy is rare. We report four cases of IgA nephropathy out of five renal biopsies performed in the last three years in patients with CF and renal involvement and discuss the possibility of a relationship between IgA nephropathy and CF.

[Modern views on the physiopathologic and clinical aspects of pre-eclampsia]. / Moderne vedute sulla fisiopatologia e clinica della preeclampsia.

After an introduction on the hypertensive disease of pregnancy, the paper reviews recent studies on the etiological, pathophysiological and clinical aspects of preeclampsia.

Could an echo contrast agent be helpful in identifying renal artery stenosis?

BACKGROUND: Diagnosis of renal artery stenosis using echo color-Doppler is subjected to several limitations. The aim of this study was to examine if the routine use of a contrast agent could be helpful in identifying renal artery stenosis (RAS). METHODS: We analysed 35 patients affected by RAS using an echo color-Doppler coupled with a contrast agent. All patients presented arterial hypertension, with a good drugs control, and mean serum creatinine of 1.8 mg/dL. All patients previously underwent angiography. RAS was at the origin of the artery in 27 patients, at the intermediate tract in 8. All patients had already been submitted to a basal echo color-Doppler. RESULTS: The contrast agent determined a significant increase in the average colour signal in all the subjects, and a better evaluation of the spectral waveforms, if compared to the basal examination. CONCLUSIONS: The results obtained showed that the contrast agent doesn't improve the diagnosis of RAS, especially in vascular origin stenosis, while it shows a real advantage in the intermediate or distal stenosis which are better visualized.

[The concept of "preclinical arterial hypertension" - in light of non-invasive, ambulatory blood pressure monitoring]. / Il concetto di "pre-ipertensione arteriosa" alla luce del monitoraggio ambulatorio non-invasivo della pressione arteriosa.

In clinical medicine it is possible to find subjects who show initial signs of hypertensive damage being normotensive at the "casual" sphygmomanometry. In order to verify whether or not these subjects are "true normotensives", it was applied the noninvasive ambulatory monitoring of blood pressure (BP). Five studies were performed: I. Normotensives with initial hypertensive retinopathy; II. normotensives with initial hypertensive cardiohypertrophy; III. Normotensives with initial hypertensive cardiohypertrophy of the transplanted heart; IV. Normotensive pregnant women with altered uterine blood flow; V. Normotensive pregnant women with intrauterine growth retardation. From all the studies, it was possible to derive that the subjects were all true normotensive. However, they were characterized by BP values on average higher than those of their controls, but below the reference limits given by WHO. Because of the relative elevation of BP, it was possible to argue that there exists a BP regimen which is potentially dangerous for the target organs, even though there is no evidence of manifest arterial hypertension. Such a hemodynamic condition causing hypertensive cardiovascular damage was defined "arterial pre-hypertension".

[Asymptomatic isolated hematuria in the adult: proposal of a diagnostic algorithm]. / L'ematuria isolata asintomatica dell'adulto: proposta di un algoritmo per la diagnosi.

Isolated asymptomatic hematuria in the adult, i.e. hematuria and no evidence of renal or systemic disease, is a perplexing clinical problem. It is usually difficult to decide to what extent to pursue a diagnosis, especially whether to perform renal angiography or renal biopsy. An algorithm is provided to optimize detection of structural defects and intrinsic renal diseases, in an effort to avoid subjecting the patient to unnecessary invasive tests. Since the age-related recommendations of the algorithm are controversial, a discussion of renal cell carcinoma and intrinsic glomerular diseases is proffered.

Defective calcium absorption in the proximal small intestine in chronic renal failure: effect of dihydrotachysterol.

Intestinal absorption of calcium was evaluated in 6 uraemic patients and in 7 control subjects by a two isotope technique exploring absorption in the four hours following ingestion of the dose. In the first two hours, calcium absorption in the patients was markedly lower than normal and was corrected by 6-10 day administration of dihydrotachysterol, 0.66 mg per day. The administration of 0.33 mg per day proved less effective. The data indicate the existence of impaired intestinal calcium absorption in chronic renal failure and reversal of the defect after DHT administration. The method of investigation appears to be a valid procedure for the study of calcium malabsorption of CRF and in the evaluation of the effect of vitamin D metabolities and analogs.

Relationship between kallikrein and PRA after intravenous furosemide.

Interrelationships between plasma renin activity (PRA), urinary kallikrein and sodium excretion were studied before and after furosemide iv administration in nine normal volunteers and in one low renin non hypertensive patient. PRA, urinary kallikrein and sodium excretion increased within 15 min of furosemide injection in nine subjects; kallikrein excretion then decreased sharply, whereas plasma renin activity reached peak values within 15-120 min of stimulation. In low renin subject low basal levels of PRA paralled undetectable values of kallikrein excretion, and PRA and kallikrein excretion showed no increase after furosemide, despite the expected natriuretic response. The following conclusions appear feasible: (i) the natriuretic effect of fuorsemide is direct and independent of the effect on PRA and urinary kallikrein; (ii) in man, furosemide induces an increase in urinary kallikrein excretion which is immediate, of short duration and simultaneous in all the patient studied; (iii) no statistical correlation is demonstrated between the temporal behavior of urinary kallikrein and PRA; it is however possible that, at least for certain stimuli, renin release is in some way correlated with the activation of the renal kallikrein-bradykinin system.

Describing and interpreting 24-hour blood pressure patterns in physiologic pregnancy.

The time course of blood pressure in clinically healthy (pregnant and nonpregnant) women was followed by automatic ambulatory monitoring. Chronobiologic methods revealed the time course of dynamic rhythm characteristics as a function of gestational age. Differences were found between nonpregnant and pregnant women with an overall lowering during pregnancy of the rhythm-adjusted midline estimating statistic of rhythm (mesor).

Urinary kallikrein activity is not altered in human essential hypertension.

Urinary kallikrein excretion was evaluated in 85 normal subjects and in 149 uncomplicated and recently diagnosed essential hypertensive patients. Moreover, the possible interrelationships between urinary kallikrein excretion and age, sex, electrolyte excretion, and plasma renin activity were examined. In patients with essential hypertension, urinary kallikrein excretion was similar to that of normal subjects. In these patients the enzyme was weakly and positively related to urinary potassium and plasma renin activity; no correlation was found with blood pressure, urinary sodium, age, or sex. In normal subjects and in patients with essential hypertension, the variables studied account for only 25% and 17%, respectively, of the variability of urinary kallikrein excretion. We conclude that the relatively short duration of hypertension in our patients may explain the unaltered values of urinary kallikrein excretion with respect to controls.

Plasma renin activity: effect of temperature during blood processing.

Plasma renin activity may be affected by temperature during the processing of blood samples (loss of activity or cryoactivation). We measured plasma renin activity on samples maintained at room temperature up to 240 min. No significant change was found in comparison with samples maintained at 0 degrees C; similarly, no cryoactivation was observed when routine freezing procedures were employed instead of instant freezing.