[Report of the National Renal Ultrasound Study Group on the ultrasound activity of nephrology care units in Italy]. / Report del gruppo di studio nazionale di ecografia renale sull'attivita' ecografica delle U.O. di Nefrologia in Italia.

The presence of operational and organizational differences in the use of ultrasonography in Italian nephrology units has prompted this survey on a nationwide scale. The survey was carried out by questionnaire and included questions about the activity and equipment of each nephrology unit, dedicated personnel and relevant training, and the fields of ultrasonography application. Seventy-five percent of the contacted care units replied to the questionnaire. Twenty-six percent of these performed their ultrasound examinations outside the care unit, sharing equipment with other units. The mean lifetime of ultrasound devices was longer (5.8 years) than allowed by the electro-medical equipment regulations. In spite of an increasing number of nephrologists with ultrasonographic expertise, in each care unit the percentage of physicians performing ultrasound examinations was very low. The number of operators who learned this methodology directly at surgeries using ultrasound devices was higher than that of operators who attended training courses and obtained the relevant certificates. In addition to the kidneys and urinary tract, other body districts investigated included abdominal organs, parathyroids, vascular access for hemodialysis treatment, and the bone-joint system. Moreover, ultrasonography was widely used for surgical procedures in nephrology. However, in spite of the widespread application of ultrasound imaging, the use of radiology was unexpectedly high (80%). Finally, the questionnaire results evidenced the particular care of nephrologists towards follow-up for situations of nephrological interest, such as acquired renal cysts, vascular access visualization, and monitoring of parathyroids.

Patient re-training in peritoneal dialysis: why and when it is needed.

The aim of this multicenter, quantitative, observational study was to analyze compliance and re-training needs of patients on peritoneal dialysis (PD) through the assessment of patient knowledge (with a Patient Questionnaire; phase 1) and patient behavior (home visit with a Score Card; phase 2). A total of 353 patients from 11 Italian centers participated in the first phase and 191 patients from nine centers in the second phase. Overall, 66% of questions on the Patient Questionnaire were answered correctly. Correct answers were more frequent in females than males, in patients under 55 years of age, and in those with higher education. The lowest rate of correct answers involved questions related to diet and physical activity (67% and 51%, respectively). Data collected during the home visit showed that 25% of patients were partially compliant with their drug therapy. Twenty-three percent of patients were non-compliant with the exchange protocol procedures, with a significant association between compliance and the incidence of peritonitis, and 11% were non-compliant with the exit-site protocol procedures without a statistically significant correlation to peritonitis. By combining the two evaluations, we found that approximately one-third (29%) of patients needed reinforcement of knowledge and ability to correctly perform PD as related to infection control and 27% for the correct use of drugs. Looking at the combined evaluation of infection control and drug use, results showed that 47% of patients needed re-training. This need for re-training was greater for younger patients (less than 55 years old), patients with lower education degree and patients in the early or late phase of PD therapy (less than 18 months or more than 36 months). Gender and degree of autonomy had no effect on the need for re-training.

[Early therapeutic education in chronic renal disease: a new approach]. / La presa in carico precoce nell'insufficienza renale cronica: un nuovo approccio.

Chronic renal failure (CRF) remains a significant problem. Early referral of patients reduces cardiovascular risk and allows better quality of life and life expectancy. Uremic patients represent a typical example of chronic disease, which requires multidisciplinary team involvement and stratification of treatment processes. During the evolution of the disease to chronicity, the patient requires different clinical approaches that form part of a unique treatment process, involving day-to-day management, carried out by the general practitioner, as well as the handling of acute events requiring specialized clinical management. Early referral essentially requires three steps. The first step is therapeutic education, which includes information, sensitiveness, training and acceptance of the disease. The second step is the assembling of a multidisciplinary team in which the members are able to work together, coordinating and managing treatment protocols. These two steps allow the design of the third step, disease management, which consists of a methodology based on an integrated approach to the dis-ease allowing continuous improvement in medical care, in the patient's quality of life and a better use of economic resources.

Antihypertensive effect of captopril, canrenoate potassium, and atenolol. Relations with red blood cell sodium transport and renin.

We compared the antihypertensive efficacy of atenolol (100 mg/d), canrenoate potassium (200 mg/d), and captopril (75 mg/d) in 30 essential hypertensives. The three drugs were administered in a randomized change-over sequence for four-months each. The main variables associated with blood pressure regulation were measured in the basal condition and at the end of each treatment period. The erythrocyte Na transport systems were measured only in the basal condition and at the end of the first treatment period. The average blood pressure reduction was similar for each drug. Mean blood pressure levels after captopril correlated positively with those after atenolol in the individual patients (P less than 0.0001); mean blood pressure levels after canrenoate potassium, on the contrary, did not correlate with those after the other two drugs. Captopril and canrenoate potassium treatment reduced intraerythrocyte Na content (P less than 0.02), canrenoate potassium increased Na-K pump (P0.05), atenolol did not change any erythrocyte membrane Na transport parameters. The ouabain-resistant Na transport systems were not modified by any drug. The patients were divided in three groups according to their antihypertensive response: nonresponders (six patients), canrenoate potassium responders (nine patients) and captopril-atenolol responders (15 patients, equally responsive to both drugs). Nonresponders had the lowest basal Na pump (P less than 0.02). Canrenoate potassium responders had higher basal Na-K cotransport than captopril-atenolol responders (P less than 0.02). Atenolol-captopril responders had the highest basal plasma renin activity (PRA, P less than 0.02). The blood pressure reduction after atenolol correlated with the induced fall in PRA (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenetic mechanisms in essential hypertension. Analogies between a rat model and the human disease.

Essential hypertension is a genetic disease. Its phenotypic expression depends on the interaction between genetic and environmental factors. In prehypertensive rats of the Milan hypertensive strain (MHS) a genetically inherited increase of tubular reabsorption was found, which causes the increase of blood pressure. Studies of ion transport systems in these rats have shown that the Na-K cotransport activity is increased both in erythrocytes and in tubular cells of MHS rats compared with their normotensive controls (MNS) and that this alteration is genetically linked to the transmission of high blood pressure levels. Also, in young human normotensives prone to develop essential hypertension there is an abnormal pattern of renal function which could be in agreement with a primitive increase in tubular reabsorption. Studies of erythrocyte ion transport systems in these subjects suggest that at least in a subgroup of humans predisposed to develop essential hypertension a pathogenetic mechanism similar to the one proposed for the MHS rat can be at work.