Renal involvement in psychological eating disorders.

Psychological eating disorders--anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder--are an increasing public health problem with severe clinical manifestations: hypothermia, hypotension, electrolyte imbalance, endocrine disorders and kidney failure; they are of interest to nephrologists, but pathophysiological mechanisms in determining the renal involvement are still unclear. We describe pathophysiology, histological features and clinical manifestations of the most frequent psychological eating disorders: AN and BN. Regarding AN, we analyze the recent literature, and identify 3 principal pathways towards renal involvement: chronic dehydration-hypokalemia, nephrocalcinosis and chronic rhabdomyolysis. Regarding BN, we describe the correlation between obesity and many proinflammatory cytokines, chemokines, growth factors and adipokines, having potential metabolic and hemodynamic effects on the kidney and an important role in the pathogenesis of obesity-related renal injury, independently of hypertension and diabetes.

Takayasu's disease effects on the kidneys: current perspectives.

Takayasu arteritis (TA) is a chronic vasculitis disease of unknown etiology. Clinically significant renal disease is relatively common, and renovascular hypertension is the major renal problem. The assessment of TA activity is usually challenging because vascular inflammation may progress to fixed vascular injury without findings of active disease. Until now, the best therapeutic options have not been identified. This review highlights the current perspectives of renal involvement in TA.

[A case of encapsulating of peritoneal sclerosis with fast and ominous evolution]. / Un caso di sclerosi peritoneale incapsulante a rapida infausta evoluzione.

Encapsulating peritoneal sclerosis (EPS) is a rare and life-threatening complication of long-term peritoneal dialysis and until now, there is no established medical treatment for it. Many factors have been incriminated in its pathogenesis but they do not explain all risk conditions. EPS is significantly associated with PD duration, particularly more than 5 years, however the relationship between long-term PD and EPS increased risk is currently unknown. The "two-hit hypothesis" analyzes the relationship between the histological changes Peritoneal Dialysis-induced and intercurrent acute inflammatory episodes, but it does not explain the transition from Sclerosis Simple to EPS. We report our experience and we investigate the predisposing factors. The abdominal cocooning is a pathognomonic finding but it requires further investigations. Probably unidentified factors make some patients more susceptible to developing encapsulating peritoneal sclerosis.

Acute kidney injury in a patient with metabolic syndrome.

INTRODUCTION: The metabolic syndrome (MS) encompasses many metabolic abnormalities and the insulin resistance is considered as one of the most significant denominators. The chronic kidney disease (CKD) is an emerging health problem but only few patients would reach the end stage renal disease. There exists an increasing strong association between MS and CKD, but up until now the link between MS and CKD is unclear and there are few studies regarding the renal histology in MS. METHODS: We describe an acute tubulointerstitial nephritis case, due to both infective and pharmacological aetiology, overlapping relevant histological changes (focal segmental glomerulosclerosis [FSG], hyaline arteriosclerosis) in a patient with MS and previously normal renal function. Despite the severe vascular finding (elevated renal arterial resistive index), the patient recovered a normal renal function. RESULTS: We reviewed the kidney pathological studies in MS and analyzed the principal renal histological images of glomerulomegaly, segmental glomerulosclerosis, and obesity-related glomerulopathy. CONCLUSION: Despite the strong association, the renal involvement in MS has not been proven. A greater knowledge of the combination of histological renal changes in MS can help to understand the pathophysiological mechanism(s) of MS.