Prevalence of CKD in northeastern Italy: results of the INCIPE study and comparison with NHANES.

BACKGROUND AND OBJECTIVES: Sufficiently powered studies to investigate the CKD prevalence are few and do not cover southern Europe. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: For the INCIPE study, 6200 Caucasian patients ≥40 years old were randomly selected in northeastern Italy in 2006. Laboratory determinations were centralized. The albumin to creatinine ratio in urine and estimated GFR from calibrated creatinine (SCr) were determined. A comparison with 2001 through 2006 NHANES surveys was performed. RESULTS: Prevalence of CKD was 13.2% in northeastern (NE) Italy (age and gender standardized to the U.S. 2007 Caucasian population). Prevalence of CKD in U.S. Caucasians is higher (20.3%), the major difference being in CKD 3. Risk factors for CKD are more prevalent in the United States than in Italy. With use of CKD 3a and 3b stages, CKD prevalence decreased in NE Italy (8.5%) and in the United States (12.8%). CONCLUSIONS: The prevalence of CKD is high in NE Italy, but lower than that in the United States. A large part of the difference in CKD prevalence in NE Italy versus that in the United States is due to the different prevalence of CKD 3. The higher prevalence of a number of renal risk factors in persons from the United States explains in part the different dimensions of the CKD problem in the two populations.

Dent's disease and prevalence of renal stones in dialysis patients in Northeastern Italy.

Dent's disease (DD) involves nephrocalcinosis, urolithiasis, hypercalciuria, LMW proteinuria, and renal failure in various combinations. Males are affected. It is caused by mutations in the chloride channel CLCN5 gene. It has been suggested that DD is underdiagnosed, occurring in less overt forms, apparently without family history. A possible approach to this problem is to search for CLCN5 mutations in patients who may have a high prevalence of mutations: end-stage renal disease (ESRD) patients with previous calcium, struvite, or radio-opaque (CSR) stones. We looked for CLCN5 mutations in 25 males with ESRD-CSR stones selected from all of the patients (1,901 individuals, of which 1,179 were males) of 15 dialysis units in the Veneto region. One DD patient had a new DD mutation (1070 G > T) in exon 7. The new polymorphism IVS11-67 C > T was detected in intron 11 in one patient and one control. We also found 28 females with ESRD and stone history, and seven more males with ESRD and non-CSR stones. The prevalence of stone formers among dialysis patients in our region was 3.2%, much lower than the prevalence observed in older studies. Struvite stones continue to play a major role in causing stone-associated ESRD .

Convective and adsorptive removal of beta2-microglobulin during predilutional and postdilutional hemofiltration.

BACKGROUND: Beta(2)-microglobulin (beta2-m) removal in patients with end-stage renal disease (ESRD) is maximal with convective techniques, such as hemofiltration (HF) or hemodiafiltration (HDF). Although the infusion mode of the replacement solution (predilution or postdilution) is expected to influence the efficiency of HF, experimental data in this respect are scanty. We therefore investigated the impact of the fluid reinfusion mode on the efficiency of HF in 11 ESRD patients who underwent both treatments. METHODS: The dialyzer (AK 200 ULTRA) was equipped with a 3-layer polyamide membrane (Poliflux 21 S, surface 2.1 m(2)) and blood flow was kept between 300 and 400 mL/min. beta2-m concentrations were measured in plasma water and ultrafiltrate at appropriate times during a 240-minute treatment. The following dialytic parameters were calculated: total amount of beta2-m removed (A(tot)), beta2-m removed by convection (A(con)) and by adsorption (A(ads)), percent reduction in beta2-m plasma water concentration (% Cpw(in)), total plasma water clearance (CLpw(tot)), convective plasma water clearance (CLpw(con)), adsorptive plasma water clearance (CLpw(ads)), and sieving coefficient (SC). RESULTS: CLpw(tot), CLpw(ads), and% Cpw(in) were similar in pre- and postdilutional conditions, whereas CLpw(con) and SC were higher and CLpw(ads) was lower in postdilution than in predilution HF. Since a significant inverse correlation was found between A(ads) and SC, predilution probably determines greater protein fouling than postdilution. CONCLUSION: The 2 techniques appear to be equivalent in terms of total beta2-m removal, although this final result is obtained by different contributions of convective and adsorptive elimination.

Acute renal failure due to a calculus obstructing a transplanted kidney.

Nephrolithiasis is a rare finding in kidney transplantation and anuria could be the only clinical sign. We report the case of a 52-year-old Caucasian male renal transplant recipient admitted due to acute renal failure (ARF) and anuria. He reported no symptoms and a palpable bulge in the right iliac fossa corresponding to the graft was present. Ultrasonography showed hydronephrosis of the graft. A double-J ureteral stent was inserted with resolution of ARF. ARF with anuria and the presence of a palpable non-tender, elastic mass over the graft could be the clinical picture of obstructive ARF in a transplanted kidney.