Renal Volume in ADPKD Patient Evaluation.

The clinical manifestations of ADPKD are related to the growth of renal cysts. Renal volume has been recognised as the biomarker that is able to identify those patients at risk of complications (hypertension and haematuria) and at risk of progression to End Stage Renal Disease (ESRD). Recently, several scores have been introduced to predict the evolution of ADPKD. The Mayo Clinic Group developed a classification based on renal volume as measured by CT or MRI and corrected for age and height (Ht-TKV); this allowed predicting the evolution of the disease, but it has not been fully validated so far. In addition, it is used to identify patients labelled as "fast progressors" and eligible for Tolvaptan therapy according to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) recommendations. We studied 80 patients who underwent MRI and had been classified as ADPKD typical form (class 1A-1E). A significant correlation between renal volume, hypertension, and low GFR was found (p < 0.005). A progressive increase in disease severity has been found across the different Mayo classes; 41.2% were eligible for Tolvaptan therapy. The results demonstrate that the Mayo method is easy to perform and provides valid information in order to identify with rapidly progressing disease.

Nonvitamin K-dependent oral anticoagulants (NOACs) in chronic kidney disease patients with atrial fibrillation.

Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15-49ml/min) and those on dialysis.

IgA nephropathy: multivariate statistical analysis aimed at predicting outcome.

BACKGROUND: Several risk factors of IgA nephropathy (IgAN) have been identified, but their importance in predicting outcome is still controversial. METHODS: We conducted a retrospective study on 119 patients (pts) with IgAN. All had a follow-up of over five years (mean 134+/-56 months). For each patient we recorded age, 24h proteinuria, hematuria, renal function (RF), arterial hypertension (AH) and histological features. Multivariate analysis was done for predictive purposes (segmentation, using Chi-squared Automatic Interaction Detection-CHAID). RESULTS: AH at the time of renal biopsy was the principal and independent predicting factor: 30/50 (60%) hypertensive pts had serum creatinine > or =1.5 mg/dL at the end of follow-up compared to 9/69 (13%) pts with normal blood pressure. Age was a further predictive parameter: 21/28 (75%) pts with AH and age over 39 years had reduced RF at the last examination. In this subgroup, 18/19 (95%) with evidence of tubulo-interstitial lesions showed a decline of RF. CONCLUSIONS: AH and age alone are significant prognostic factors; tubulo-interstitial lesions are an additional pointer to poor outcome in these pts. The algorithm obtained with segmentation analysis may be a guideline for prognosis in single patients with IgA nephropathy.