RESUMO
Our Nephrology and Dialysis Unit includes three Haemodialysis Centres based in Savona, Albenga and Cairo Montenotte. These provide assistance to 150 patients. We have a Peritoneal Dialysis Clinic with 35 patients, two Post-Transplant Clinics with about 120 patients in follow-up in Savona and Albenga, and three Pre-Dialysis Clinics across the three locations. Finally, there is an autonomous hospital ward with 15 beds that has continued its activity, even if at reduced regimes. With this report we intend to share the strategy we used to prevent the spread of the SARS CoV-2 virus among the patients and the staff at our Unit, following the National, Regional and Corporate guidelines published during "Phase 1". We decided that the Haemodialysis Centres needed to remain a safe place. To insure this, medical and nursing staff and patients had to behave conscientiously and collaboratively, and according to the official Hospital guidance. Our main concern was to protect patients who, despite suffering complications and being at high risk because of their age, immunodepression and multiple comorbidities, were forced to leave their house three times a week to be treated with dialysis. The results of this strategy have ensured that, of the 150 patients undergoing haemodialysis, only 3 have been tested positive: no patients in Albenga, 2 in Savona and 1 in Cairo Montenotte, all of them lived and were infected in their nursing homes. Also, there was no positivity among any of the staff members across the three locations. Our results are extremely positive and confirm the validity that prevention and protection procedures had in the earlier stages of the pandemic.
Assuntos
COVID-19/epidemiologia , Emergências , Serviço Hospitalar de Emergência/organização & administração , Unidades Hospitalares de Hemodiálise/organização & administração , Falência Renal Crônica/terapia , Pandemias , Diálise Renal , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/prevenção & controle , COVID-19/terapia , Teste para COVID-19 , Comorbidade , Gerenciamento Clínico , Feminino , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Quarentena , Avaliação de SintomasRESUMO
Toll-like receptor 4 (TLR4), a component of the innate immune system, is recognized to promote tubulointerstitial inflammation in overt diabetic nephropathy (DN). However, there is no information on immune activation in resident renal cells at an early stage of human DN. In order to investigate this, we studied TLR4 gene and protein expression and TLR4 downward signaling in kidney biopsies of 12 patients with type 2 diabetes and microalbuminuria, and compared them with 11 patients with overt DN, 10 with minimal change disease (MCD), and control kidneys from 13 patients undergoing surgery for a small renal mass. Both in microalbuminuria and in overt DN, TLR4 mRNA and protein were overexpressed 4- to 10-fold in glomeruli and tubules compared with the control kidney and in MCD. In addition, NF-κB signaling was about fourfold higher in the glomeruli. TNF-α, IL6, CCR2, CCL5, and CCR5 mRNAs were markedly (about three- to fivefold) upregulated in microdissected glomeruli. While IL6, CCL2 and CCR5-mRNA, and CD68 were overexpressed in the tubulointerstitial compartment in clinical DN, they were not expressed in microalbuminuria. In a 6-year follow-up of microalbuminuric patients, glomerular TLR4 gene expression was associated with the subsequent loss of kidney function. Thus, innate immunity is activated in the glomeruli of patients with diabetic microalbuminuria. Enhanced TLR4 signaling may contribute to the progression occurring after the incipient, microalbuminuric form of nephropathy evolves to overt disease.
Assuntos
Albuminúria/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Nefropatias Diabéticas/metabolismo , Glomérulos Renais/química , RNA Mensageiro/metabolismo , Receptor 4 Toll-Like/metabolismo , Albuminúria/imunologia , Antígenos CD/genética , Antígenos de Diferenciação Mielomonocítica/genética , Biomarcadores/química , Quimiocina CCL5/genética , Quimiocina CCL5/metabolismo , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/imunologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Imunidade Inata , Interleucina-6/genética , Interleucina-6/metabolismo , Túbulos Renais/química , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/metabolismo , Receptores CCR2/genética , Receptores CCR2/metabolismo , Receptores CCR5/genética , Receptores CCR5/metabolismo , Transdução de Sinais , Receptor 4 Toll-Like/genética , Fator de Transcrição RelA/metabolismo , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Regulação para CimaRESUMO
INTRODUCTION: Alkaline-encrusted cystitis or pyelonephritis is a chronic inflammatory condition due to deposition of crystals usually caused by urea-splitting bacteria. Corynebacterium urealyticum (CU) is a gram-positive, urea-splitting and multi-antibiotic resistant bacillus with special tropism for the urinary tract and it is often associated with encrusted pyelocystitis. METHODS AND RESULTS: Here we report the case of a 75-year-old Caucasian man with a prolonged history of renal stones who was admitted for gross hematuria associated with renal failure. A diagnosis of encrusted pyelocystitis due to CU infection was made and the patient was appropriately treated. CONCLUSIONS: At 6-month follow-up the patient was in good general conditions and asymptomatic. Signs of urinary tract infection or of renal calculosis were still detectable.
