Proteinuria predicts end-stage renal failure in non-diabetic chronic nephropathies. The "Gruppo Italiano di Studi Epidemiologici in Nefrologia" (GISEN).

We correlated baseline parameters with glomerular filtration rate (GFR) decline and kidney survival in 274 patients with proteinuric non-diabetic chronic nephropathies (creatinine clearance 20 to 70 ml/min/1.73 m2 and proteinuria > 1 g/24 hr over the last three months) enrolled in the Ramipril Efficacy In Nephropathy (REIN) trial. The GFR, evaluated at baseline, one, three and six months after randomization then every six months, declined linearly by 0.52 +/- 0.83 ml/min/1.73 m2/month (mean +/- SD) over a follow-up (median: range) of 21:3 to 52 months, and kidney survival was 64%. In multivariate analysis, higher baseline proteinuria (P = 0.006), and lower GFR (P = 0.0001) and creatinine clearance (P = 0.0001) correlated with a faster GFR decline. Higher proteinuria was the only baseline predictor of a shorter kidney survival (P = 0.0007) and its predictive value was independent of the underlying renal disease, treatment randomization, and blood pressure control during the followup. Patients in the lowest tertile of baseline proteinuria (< 2.5 g/24 hr) had the slowest rate of GFR decline (-0.25 +/- 0.72 ml/min/1.73 m2/month) and the highest kidney survival (94%), compared with patients in the middle tertile (proteinuria 2.5 to 4.3 g/24 hr; delta GFR, -0.59 +/- 0.82 ml/min/1.73 m2/month, P = 0.008; kidney survival 57%, P = 0.0011) and in the highest tertile (proteinuria > 4.3 g/24 hr; delta GFR, -0.79 +/- 0.87 ml/min/1.73 m2/month, P = 0.0001, kidney survival 44%, P = 0.0001). Kidney survival significantly differed even between the middle and highest tertiles (P < 0.05). Thus, in non-diabetic chronic nephropathies proteinuria is an independent and accurate predictor of disease progression and ESRF.

Feasibility in needle exchange programme: an evaluation of a pilot programme in Catania, Sicily.

INTRODUCTION: Intravenous drug use (10 V) is a primary transmission route for HIV and other blood borne disease. A criminal approach to illicit drug use leads to aggressive attitudes towards drug users and forces them underground, thus hindering their access to Health Service outlets. A 6-month pilot Needle Exchange Programme was set up in Catania, with the aim of reducing the negative effects and consequences of drug use, preventing the spread of blood borne diseases by encouraging the use of clean needles and reduction of needle sharing. To establish contact with the hidden population of the city's, intravenous drug users (IDUs) and promote condom use and safer sex. METHOD: An equipped camper was parked daily in two of the city's main public squares according to a preset timetable, morning and afternoon. A flexible needle exchange policy, i.e. free clean needles given out regardless of those returned, was adopted as a strategy considered necessary in order to, ensure maximum user-friendliness. Safer shooting information leaflets were given out alongside material for the correct use of the condom and condoms. RESULT: The number of IDUs, contacted who had previously been referred to a National Health Service Drug Unit (Ser.T.) and not, and number of syringes exchanged were low but increased month by month. CONCLUSION: Future projects should be undertaken after building up, a collaborative network between Street Unit and local courts; the city police force; social service outlets; hospitals and other health outlets; Ser.T. units and local pharmacies. In the light of our current experience, the one to one strategy instead to the flexible strategy could lead to stricter adherence to harm reduction strategies amongst IDUs.

Precision of plasma clearance of iohexol for estimation of GFR in patients with renal disease.

The choice of the optimal method for the measurement of renal function is based on the accuracy and the precision of the technique. The plasma clearance of nonradioactive iohexol has been proposed as a reliable alternative to renal clearance of inulin for estimation of GFR. However, the precision of this method in estimating GFR in patients with renal disease has not been determined so far. This issue was assessed by determining plasma clearance of iohexol on three different occasions during a 12-d period in 24 patients with renal disease and a wide range of renal function (creatinine clearance: 14 to 104 ml/min per 1.73 m2). Overall, the mean intraindividual coefficient of variation was 5.59%, and the reproducibility was 6.28%. The precision of the method also applied to the subgroup of patients with moderate-to-severe renal insufficiency, because a low coefficient of variation (5.71%) and a high reproducibility (6.57%) were found in patients with GFR < or =40 ml/min per 1.73 m2. It was also shown that the precision of GFR measurement by the plasma clearance of iohexol is not affected by the gender. These findings indicate that the method of plasma clearance of iohexol allows a good precision in the estimation of GFR in patients with normal renal function and different degrees of renal dysfunction.