Efficacy and safety of pegylated interferon plus ribavirin for the treatment of hepatitis C virus-positive cryoglobulinemic glomerulonephritis.

BACKGROUND: The most frequent form of renal involvement in patients with hepatitis C infection is cryoglobulinemic membrano-proliferative glomerulonephritis. Nonetheless, some reports indicate that the eradication of the hepatitis C virus may also lead to the remission of this renal disease. METHODS: The virological, immunological and nephrological response to pegylated interferon α plus ribavirin (48 weeks in patients infected with genotype 1, and 24 weeks for patients infected with genotypes 2 and 3) was evaluated retrospectively in 10 patients with cryoglobulinemic glomerulonephritis. RESULTS: 6 patients obtained end of treatment virological response (60%); during follow-up, 2 relapsed, and 4 patients maintained a sustained virological response (40%). At the end of follow-up, three patients obtained a significant nephrological response and decrease in cryoglobulin levels (p<0.05). No significant changes in clinical and biological parameters were observed in non-responders/relapsers. CONCLUSIONS: Eradication of hepatitis C may be associated with the regression of cryoglobulinemic glomerulonephritis.

Incremental value of arterial stiffness over traditional risk factors in predicting subclinical cardiovascular remodeling in patients with moderate chronic renal failure.

Cardiovascular remodeling in chronic kidney disease (CKD) is responsible for the high mortality found in this condition. A total of 89 consecutive outpatients with stage III CKD and 52 patients with stage II CKD with similar degree of traditional atherosclerotic risk factors underwent routine echocardiographic and carotid Doppler examination, evaluating vascular and cardiac remodeling (intima-media thickness [IMT] and left ventricular mass index [LVMi]), and its relation with arterial stiffness, determined in the same examination, using an echo-tracking technique. Also the absolute values of LVMi and IMT were statistically similar between the 2 groups, their determinants were completely different, only in stage III the markers of renal impairment and arterial stiffness being independent predictors of cardiac and vascular modifications. We concluded that macroanatomical measurements do not fully describe cardiovascular remodeling in this setting. Arterial stiffness echo-tracking derived could add valuable information, being an easy-to-perform parameter during a routine examination.

Successful Long-Term Central Venous Access.

Daily home hemodialysis (DHHD) requires simple, vascular access to minimize patients' discomfort but also to guarantee tolerance and long-term efficiency. The arteriovenous fistula is not ideal for DHHD because of the double puncture required every day; in addition, the rate of dysfunction is probably greater because of the more frequent use. Central venous catheters may be a good alternative to the arteriovenous fistula as long-term vascular access for DHHD. In this study we report our experience with the internal jugular vein two-catheter access for long-term dialysis and evaluate its possible use for DHHD. Since 1988, Tesio's twin catheters have been positioned in 908 patients with exhausted peripheral vascular bed. In all patients hemodialysis could be performed a few minutes after the surgical procedure. The survival rate of catheters, in a selected group of 46 patients, at 1, 2, and 5 years was, respectively, 92%, 87%, and 82%. The mean blood flow was 282±29 mL/min at 1 month, 286±36 mL/min at 1 year, and 274±37 mL/min at 5 years. Venous pressure in the inlet side was 102±31 mm Hg at 1 month, 126±36 mm Hg at 1 year, and 132±58 mm Hg at 5 years. Catheter clotting was treated either with thrombolytic agents or with catheter (one or both) replacement. Sepsis was treated with systemic antibiotic therapy or catheter removal. Data support the potential role of the internal jugular vein two-catheter system for DHHD.