Chronic pain in medullary sponge kidney: a rare and never described clinical presentation.

Medullary sponge kidney (MSK) is a cause of nephrocalcinosis, associated with hematuria, renal colic, pyelonephritis. There are rare and atypical MSK cases characterized by chronic severe pain (CP), whose features are unknown, in particular the relationship with the stone disease activity. This study analyzes a cohort of MSK-CP patients belonging to three North-America self-support Facebook groups. Patients had to self-administer an on-line questionnaire (on intensity, progression and MSK-associated conditions, stone-related disease, pain features, drug use), the Brief Pain Inventory, the Fatigue Severity Score, and Wisconsin Quality of Life (WQL) in stone formers questionnaires. Ninety-two patients with a diagnosis of MSK joined our survey. Stone rate was very high (3.1 stones per patient-year, < 15% of patients had ≤ 1 stone per year). Most patients had repeated hospitalizations for stones symptoms (p < 0.001) or pain (p < 0.005). 71% of participants referred a daily pain that interfered strongly with everyday life and quality of life (WQL mean value 29.4). 69% used pain medications daily (70% opioids). In most cases, pain was associated with stone passage, while 15% referred a sine materia pain. We showed how MSK-CP symptoms affect very negatively on the quality of life of these patients. They also have a definite risk of progressing to end-stage kidney disease. Generally, CP seems to be associated with an exceptionally high lithogenic activity, suggesting that a better and earlier metabolic treatment for stone prevention should be the first approach in these patients before mini-invasive treatments to prevent pain.

Temporal trend of cadmium exposure in the United States population suggests gender specificities.

BACKGROUND: Over the years, environmental cadmium exposure has been linked to increased mortality. Over the years, the use of cadmium has generally decreased. AIMS: Although even relatively low levels of cadmium have been associated with increased mortality in the general population, whether this applies to blood cadmium is not well understood. METHODS: The authors analysed data of the National Health and Nutrition Examination Survey to study the temporal trend of cadmium exposure in the period 1988-2006 and the risk of all-cause, cancer and cardiovascular mortality associated with blood cadmium levels. RESULTS: Urinary cadmium decreased significantly over time in males (0.58 (0.01) mcg/g to 0.41 (0.01) mcg/g; P < 0.001) but not in females (0.71 (0.09) mcg/g to 0.63 (0.08) mcg/g; P= 0.66). All-cause mortality was significantly higher in the highest quartiles compared with the lowest quartile of blood cadmium in both males (hazard ratio 1.89, 95% confidence interval 1.22, 2.89; P= 0.005) and females (hazard ratio 2.03, 95% confidence interval 1.06, 3.89; P= 0.035) after adjustment for age, race/ethnicity, smoke status, alcohol intake, annual household income and body mass index. There was also a significant association with cardiovascular mortality in females (P= 0.025). CONCLUSIONS: Our data show that elevated blood cadmium levels are associated with elevated mortality, that there seem to be gender differences in temporal trends of cadmium exposure and that blood cadmium is a proxy of chronic cadmium exposure.

[Dilated cardiomyopathy in childhood: clinical aspects, echocardiographic diagnosis]. / Cardiomiopatia dilatativa nell'infanzia: clinica, diagnosi ecocardiografica.

The authors report a study of 30 patients admitted to hospital between January 1982 and August 1994 for dilatative cardiomyopathy. The majority of children were under one year old. At the time of admittance all patients were suffering from congestive heart decompensation. A clinical examination, electrocardiogram and chest X-ray led to a suspected diagnosis of dilatative cardiomyopathy, and mono, 2-dimensional and Doppler echocardiography constantly showed left atrial and ventricular failure, widespread parietal hypokinesia and associated mitralic insufficiency, all of which represent the essential data for a full and reliable diagnosis of this disease. Echocardiography also allowed the evolution of the pathology to be followed non-invasively without risk for such small patients. The authors underline the value of clinical data and in particular echocardiographic findings in the diagnosis and management of dilatative cardiomyopathy.

Sublingual nicardipine versus nifedipine to treat hypertensive urgencies.

Hypertensive urgencies are clinical settings in which a steady therapeutic intervention is needed, but this may be safely stretched over some hours. An appropriate antihypertensive drug to use in an urgency should show a potent but gradual effect: it should reduce BP in a short time and it should be easy to modulate the antihypertensive effect, according to individual needs. Sublingual administration is the easiest way for a therapeutical intervention in an urgency. The use of nicardipine administered sublingually was tested in comparison with nifedipine, during a hypertensive urgency, in 24 hypertensive subjects. The peak effect of nifedipine occurred within 10-20 minutes after the administration, whereas that of nicardipine occurred after 45-50 minutes; nevertheless a significant decrease both in systolic and diastolic blood pressure was already observed 20 min after nicardipine administration. The hypotensive effect of nicardipine was longer lasting than that of nifedipine. Some adverse effects were observed in the group receiving nifedipine, whereas no side effects were described by patients receiving nicardipine.