[Renal Damage and Obesity: a Silent Pairing].

Obesity is recognized as a true chronic disease and an independent risk factor for kidney disease. In particular, a correlation was observed between obesity and the development of focal segmental glomerulosclerosis. The clinical consequences of obesity on the kidney can include albuminuria, nephrotic syndrome, nephrolithiasis, and increased risk of development and progression of renal failure. Conventional therapy, which includes low-calorie diet, exercise, lifestyle changes, and drug therapy, including GLP1-RA, phentermine, phentermine/topiramate, bupropion/naltrexone, orlistat, is not always able to achieve the desired results and above all does not guarantee stabilization of body weight over time. On the other hand, bariatric surgery is giving excellent results in terms of efficacy and duration. Bariatric surgery techniques that are generally divided into restrictive, malabsorptive, and mixed are not free from possible metabolic complications such as anemia, vitamin deficiency, and stones. However, they are able to ensure a good maintenance of weight loss obtained with disappearance or reduction of the incidence and severity of comorbidities related to obesity.

[Acute HCV-induced hepatitis in a patient affected by atypical hemolytic uremic syndrome (aHUS) treated with Eculizumab - case report].

Atypical hemolytic uremic syndrome (aHUS) is a rare and heterogenous disease caused by a disregulation of the alternative pathway of the complement cascade. Specifically, microvascular damage is produced that can lead to acute kidney disease, hemolytic anemia and thrombocytopenia. It accounts for 10% of all hemolytic uremic syndromes and can result in death or in end stage renal disease since the first episode. We can differentiate two forms of aHUS: a sporadic form (80%), affecting adult people, and a familial form (20%) that usually became manifest during infancy. In the acute phase of the disease, frequent and severe anemia requires multiple blood transfusions, exposing patients to the risk of catching an infective disease. HCV hepatitis is the most prevalent chronic hepatitis worldwide, with approximately 170 million chronically infected individuals - many of which are unaware of their condition. The evolution of the HCV infection is variable: almost 20% of patients spontaneously clear the infection over time (Anti HCV positive, HCV RNA negative patients); 80% of patients cannot control the virus and develop chronic infection (Anti HCV positive; HCV RNA positive patients) that can evolve into liver cirrhosis and hepatocellular carcinoma. The aim of this paper is to describe a clinical case of acute HCV hepatitis in a patient with aHUS treated with Eculizumab.

[Iodide mumps following low-osmolarity contrast medium use in haemodialysis patients]. / Iodide mumps dopo somministrazione di mezzo di contrasto a bassa osmolarità in pazienti sottoposti ad emodialisi.

Sialadenitis (Iodide Mumps) is a rare complication following the administration of iodinated contrast media. It is characterized by the painless bilateral enlargement of the submandibular salivary glands. The pathogenesis of this adverse reaction remains unclear. It may be due to an idiosyncratic reaction or related to toxic accumulation of iodide in the ductal systems of the salivary glands. Iodide mumps may occur after administration of any iodinated contrast agent: 98% of injected iodide is eliminated by the kidneys and only 2% is excreted from other organs such as salivary, sweat and lacrimal glands. Normally, the injected dose of contrast medium does not provide a sufficiently high iodide concentration to cause iodide mumps, but impaired renal excretion of contrast medium results in liberation of iodide and enables the salivary glands to concentrate inorganic iodide. This condition is rare and self-limiting. The current management is supportive therapy using analgesics and dialysis. We report two cases of iodide mumps in end-stage renal disease (ESRD) patients treated with haemodialysis after administration of iodinated contrast media. The cases were characterized by rapid onset and resolution of the symptoms in the absence of specific treatment.