[Notes on a case of clinostatic chyluria]. / Note su un caso di chiluria clinostatica

A clinical case of clinostatic chyluria of unknown non-parasitic aetiology, is reported. Ascending pyelography showed the presence of lymphatic communications between right renal pelvis and homolateral lumbo-aortic lymph nodes. Aetiology, pathogenesis, prognosis and diagnostic tools of use in the syndrome are discussed. The problem of the possible lymphatic origin of benign proteinuria, in relation to anatomic considerations and to quality and quantity resemblances between individual protein fractions in chyluria and benign proteinuria encountered in the present case, is also discussed. In order to clarify the problem, emphasis is laid on the advisability of simultaneously studying urinary protein composition in postural chyluria and lipid composition in benign proteinuria.

[Mechanisms of progression of glomerular sclerosis in chronic renal diseases in man]. / Meccanismi di progressione delle sclerosi glomerulari nelle nefropatie croniche dell'uomo.

The available data indicate that in chronic renal failure (CRF) loss of renal function usually progresses at a constant rate toward end-stage renal disease. Although immunological events might be responsible for initiating most glomerular diseases, certain clinical and experimental observations suggest that the rate of progression of these diseases is influenced by several non immunological factors. These factors include systemic hypertension, proteinuria, hyperlipidemia, high protein intake, and probably conditions leading to glomerular hypertrophy. Interventions designed to minimize the potential contribution of these factors to the progression of renal insufficiency may halt or slow the loss of function at early and late stages of CRF.

[Adherence to dietetic treatment, the nutritional metabolic status and the progression of chronic kidney failure]. / Aderenza al trattamento dietetico, stato metabolico nutrizionale e progressione dell'insufficienza renale cronica.

Effects of two protein restricted diets on dietary compliance, nutritional and metabolic state, and progression of chronic renal failure (CRF) were investigated. Twenty-one patients with CRF were randomly assigned to either a conventional low protein diet (0.6 g of protein/kg b.w./day) or to a very low protein diet, providing 0.4 g of protein/kg b.w./day, supplemented with a mixture of essential amino acids which contained HIS, TYR and a high proportion of branched chain amino acids. Nutrition, assessed by body weight, anthropometry, serum protein levels and nitrogen balance studies, was maintained in all patients. Some metabolic abnormalities of CRF (i.e., secondary hyperparathyroidism, glucose intolerance) improved in both groups. The supplemented diet provided better adherence to protein prescription, corrected the depletion of VAL and LEU in muscle and was more effective than conventional diet in slowing the rate of progression of CFR.

[Lymphoma and renal failure]. / Linfoma e insufficienza renale.

The Authors examine the main causes of renal failure in lymphoma (infiltration of kidneys, glomerulonephritis, paraproteinemic nephropathy), the difficulties for a correct diagnosis with ultrasonography, urography and CT scan, the importance of renal biopsy. The histologic examination should be promptly performed in patients with sudden renal failure of unknown aetiology and clinical suspicion of malignancy, because renal function can improve dramatically with aggressive chemotherapeutic treatment of lymphoma.

[Acute cardiotoxicity of tricyclic compounds: remarks on a clinical case]. / Cardiotossicità acuta dei composti triciclici: considerazioni su un caso clinico.

Tricyclic compounds have complex effects on the cardiovascular system, causing dangerous arrhythmias even in patients free of cardiac disease, especially after overdose. We report on a case of cardiac arrhythmia during low dosage therapy of post-herpetic neuralgia with Carbamazepine and Amitriptyline in a patient with chronic renal rejection and cirrhosis. Pharmacologic properties and side effects of these drugs are examined from the current literature. Both drugs prolong AV conduction, consequently You can observe AV blocks of various degrees of His bundle branch blocks also during low-dosage therapy in patients with hepatic failure. It seems to be judicious to provide to ECG monitoring during the complete period of therapy.

Critical appraisal of haemofiltration and ultra-filtration. The development of ultra-short dialysis: preliminary results.

The clinical experience obtained with 2 hours every other day recirculation dialysis, using 20-40 liters of dialysate, without sorbents, and standard cuprophane dialyzers of 1.0-1.5 sq.mt. is reported. So far, over 350 treatments in 8 patients have been performed. After 2 hours of treatment the removal of urea, creatinine, phosphate and uric acid, is similar to that obtained by 4-6 hours of haemofiltration. The alkalinazation of the patient through direct venous infusion of bicarbonate, makes predialysis acid-base significantly better than in standard haemodialysis and haemofiltration. Asymptomatic correction of severe fluid overload is easily obtained like in isolated ultrafiltration. The role of osmolality and vasopressors are discussed. A dry weight below the value obtained by previous dialysis treatment is achieved, and volume dependent hypertensions as in haemofiltration are corrected after 2-8 weeks. As an additional advantage, this method offers a highly semplified technical approach and a further reduction of the dialysis time.

Time-dependent increase of glomerular filtration rate after oral protein load: evidence for diurnal variations in renal response.

Seven healthy male volunteers were studied to test the effect of timing of an oral protein load on renal function. Creatinine clearance (Ccr) was measured during the 4-h period after administration of 72 g of protein in the form of cooked red meat at 1200 hours (lunch protein load, PL) and at 2000 hours (supper PL) the next evening. A low-protein meal in the form of vegetables was given as a control load at 2000 hours on the first day (supper control load, CL) and at 1200 hours on the second day (lunch CL). The 12-h night-time Ccr at fasting was used as the baseline reference value. After the lunch PL, Ccr (mean 127 +/- 6.8 ml/min) was 45% (p less than 0.001) higher than the baseline value (mean 87.9 +/- 5.3 ml/min) and 33% (p less than 0.001) higher than lunch CL (mean 95.8 +/- 5.6 ml/min). After the supper PL, Ccr (mean 106.2 +/- 8.7 ml/min) was 20% (p less than 0.01) higher than the baseline value and 15% (p less than 0.01) higher than the supper CL (mean 93.0 +/- 9.3 ml/min). The differences between baseline and control load values were not statistically significant. In all seven patients, the protein load induced a maximum Ccr value at lunchtime, and Ccr after the lunch PL was 22% higher than Ccr after the supper PL (p less than 0.01). We conclude that in healthy individuals, the Ccr after an oral protein load is correlated to the hour of the day when the study is performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary non-Hodgkin's lymphoma of the kidney.

A 53-year-old woman was admitted to the hospital because of end-stage renal failure of unknown etiology. She had to begin hemodialysis a few days later. An open biopsy showed non-Hodgkin's lymphoma of the kidney. The patient died after the first cycle of chemotherapy and necroscopy confirmed that the lymphomatous involvement of the kidney was primary. From the current literature we are not aware of other cases of primary non-Hodgkin's lymphoma of the kidney.

Short dialysis schedules (SDS)--finally ready to become routine?

One hundred and one patients were treated for up to two years for three hours every other day (10.5 hr/week), or four hours thrice-weekly with conventional disposable 1m2 dialysers have been investigated. Rigorous control of water balance and the maintenance of predialysis serum K and PO4 within normal limits were the main criteria for judging the adequacy of the treatment. The results regarding blood pressure, phosphate problems, haematocrit, peripheral nerve status, pericarditis and range of rehabilitation are discussed.

Preliminary results obtained with short dialysis schedules.

The results regarding the treatment of 55 patients, 6 of them treated for, at least 10 months, with 1 sq. meter disposable dialyzers and a dialysis strategy of 3 hours every other day or 4 hours trice weekly have been presented. Clinical indexes especially regarding erythropoiesis and peripheral nerve status will be discussed. Th results show that this new method of treatment is feasible and may become in the future a routine strategy for chronic intermittent dialysis.

Protein-induced changes in kidney function depend on the time of administration but not on the dietary source.

Two separate experiments were carried out to study the effects of the same acute protein load given at different hours of the day and to assess the ability of proteins from different sources to induce hyperfiltration. In the first experiment, 9 healthy volunteers were kept at strict bedrest for 48 h, during which both a meat high-protein meal (protein load, PL) and a vegetable low-protein meal (control load, CL) were given either at lunch or at suppertime. As compared to a CL, PL determined a significant increase in GFR, total proteinuria (uTP), albuminuria (uA), and urinary retinol-binding protein (uRBP). These effects were much more significant after lunch PL than after supper PL, thus indicating an interaction between the PL and the time of the day. The existence of a circadian rhythm for GFR, uTP, uA, and uRBP was corroborated by spontaneous changes over baseline levels, which also were prominent after lunch CL as compared to those following supper CL. In the second experiment, 7 healthy volunteers ingested at lunch three protein-rich meals at 1-week intervals. The three protein loads consisted of about 80 g protein in the form of cooked red meat, cheese, and soya, respectively. The only significant differences between groups were urea appearance and urea clearance, lower and higher, respectively after soya load. These findings suggest that when evaluating the renal functional reserve after acute protein load both the spontaneous changes and the time-dependent sensitivity of kidney functions to acute challenges should be considered. Finally, the amount rather than quality of dietary proteins seems to be the determinant factor for protein-induced glomerular hyperfiltration.