[A case of intrarenal hematoma: role of ultrasonography in the early diagnosis of a possible complication of anticoagulant therapy]. / Un caso di ematoma intrarenale: ruolo degli ultrasuoni nella diagnosi in urgenza di una possibile complicanza del trattamento anticoagulante.

Uremia associated with anticoagulant therapy is a high risk factor for bleeding complications in patients undergoing hemodialysis. We report a case of intrarenal hematoma arising in a uremic patient treated with warfarin. The hematoma was rapidly diagnosed by ultrasonography of the abdomen and treated with embolization. Our experience confirms that the availability of an ultrasound facility within the renal unit allows better assessment of our patients, also in the management of the most fearsome and rare complications. Moreover, it strengthens the evidence that uremic patients are at high risk of bleeding complications when treated with oral anticoagulants.

[Karyomegalic interstitial nephritis: an atypical case]. / La nefrite interstiziale cariomegalica: descrizione di un caso clinico atipico.

Karyomegalic interstitial nephritis (KIN) is a rare disease entity that was first described by Burry in 1974. The prevalence of this disease is less than 1% and its pathogenesis is unclear. KIN is characterized by chronic tubulointerstitial nephritis associated with enlarged tubular epithelial cell nuclei, which leads to progressive decline of renal function. The disease has no known treatment. Here, we report on a 50-year-old female patient who presented with asymptomatic progressive decline of renal function. Renal biopsy demonstrated chronic tubulointerstitial nephritis with markedly enlarged and hyperchromic nuclei of tubule epithelial cells the hallmark of karyomegalic nephritis. Clinical and pathologic findings of this case are discussed in light of the available literature.

[Ultrasound-guided renal biopsy: evaluation of different models of biological simulator]. / La biopsia renale-ecoguidata: valutazione di diversi modelli di simulatore biologico.

Percutaneous ultrasound-guided renal biopsy is the gold standard for diagnosis and treatment of renal diseases. Recently, many studies strongly support the role of renal biopsy for the management of small renal mass. The experience of the operator is crucial in reducing the incidence of major complications. The use of simulators can accelerate the learning curve in those individuals who train in renal biopsy. We describe four simple and affordable phantoms for renal biopsy. The first two simulators were constructed by a porcine kidney wrapped in perirenal fat or covered by a flap of abdominal skin. The third simulator was constructed by embedding a porcine kidney in a turkey breast and olives to simulate the presence of small tumors. For the fourth model, we used the loin of a pork. Given the encouraging results of our in vitro study, we believe that simulators allow trainees to familiarize themselves with the handling of the equipment in an environment that is risk-free when compared to the clinical scenario.