Acute renal failure after influenza vaccination: a case report.

A fifty-three years old surgeon had acute renal failure consisting with acute tubulo-interstizial nephropaty twelve days after influenza vaccination; he was on statin therapy since one month. He was given steroidal therapy and fully recovered two weeks apart. This is the fourth case report of acute renal failure after influenza vaccination in patients on statins therapy. The case we describe could account for a underestimated, even if very rare, phenomenon.

[Use of dual energy X-ray absorptiometry (DEXA) in the determination of total body water in patients undergoing chronic dialysis]. / Impiego della dual energy X-ray absorptiometry (DEXA) per la determinazione dell'acqua corporea totale nei pazienti in trattamento dialitico cronico.

In order to assess Total Body Water (TBW), three methods are compared, in 18 patients on regular dialysis treatment: DEXA, Bioimpedance Analysis (BIA) and urea Kinetic Volume (V urea). The mean difference between gravimetric weight and Total Body Mass (TBM) DEXA is closed (1.04 kg, SD of differences 0.4 kg). The mean difference between delta pre-post HD gravimetric weight loss (2.6 kg) and delta pre-post TBM DEXA is--0.03 kg (SD 0.28). TBW measured with the three methods are (Liters): TBW DEXA = 31.2 (SD 5.2), TBW BIA = 29.7 (SD 5.2), TBW V urea = 29.1 (SD 4.8). TBW comparisons between the three methods are (Liters): TBW DEXA-TBW BIA = mean 1.5 (SD 3.8), r = 0.73. TBW DEXA-TBW V urea = mean 2.1 (SD 2.2), r = 0.88. TBW BIA-TBW V urea = mean 0.6 (SD 3.6), r = 0.80. Hydration index of lean body mass, calculated by assuming V urea as standard, is 0.69 (SD 0.05), range 0.62-0.77, in agreement with others studies. In conclusion DEXA, a useful method for body composition and nutritional status assessing, represents a new tool for measuring hydration status, combined with others TBW evaluation formulas (BIA or V urea).

Follow-up of nerve conduction in chronic uremic patients during hemodialysis.

We studied to evolution of nerve conduction during hemodialysis following 21 patients with chronic renal failure. Mean motor nerve conduction velocity (MCV) was significantly different at hemodialysis onset and 3 years later for both common peroneal nerve (44.5 and 41.0 m./sec.) and ulnar nerve (52.5 and 47.1 m./sec.). MCV decreased more in patients with low Kt/V (a depuration index) than in those with high Kt/V.

[High-efficiency hemodialysis. Review of the literature and initial clinical experience]. / L'emodialisi ad alta efficienza. Revisione della letteratura e prime esperienze cliniche.

A literature review allows us to distinguish two types of high efficiency therapy: HED (high efficiency dialysis), with low ultrafiltration coefficient membranes, and HFD (high flux dialysis), with high ultrafiltration coefficient membranes. Data reported show an unchanged hematochemical with the same, or better, treatment tolerance, but there are few data on hydrosaline balance (and correlate hypertension) and middle moleculas removal. Finally we report the experience of our centre in 59 months of treatment in four patients.

Scant reliability of Co/Ct ratio in urea kinetic formulas.

The ratio initial/final urea value is used in urea kinetic formulas. To assess its reliability we employed mass balances and urea clearances to study 15 hemodialysis treatments divided in several parts. The mass balances clearly indicated urea disequilibrium. In the first phases of dialysis, urea extraction, measured by dialysate collection, was lower than the corresponding change in urea pool, whereas in the later phases the opposite occurred. On account of this lack of equilibrium, clearances bases on the Co/Ct ratio (K2) are less reliable than standard clearances derived from total dialysate collection (K1): in the first quarter of dialysis, K2 is greater than K1 (p less than 0.01), while in the 3rd and 4th quarters it is lower. The comparison of clearances in a cumulative way showed a significant fall in K2 (p less than 0.01) while K1 remained stable. From a practical point of view, aberrations induced by non monocompartmental urea behaviour are negligible, and do not invalidate the usefulness of the single-pool Gotch model in clinical practice. However, at least in experimental work, the limits of urea kinetic formulas must be taken into account.

Transcellular disequilibrium and intradialytic catabolism reduce the reliability of urea kinetic formulas.

To elucidate the limits of single-pool models as regard aberrations induced by urea transcompartmental disequilibrium during urea kinetics, mass balances and fractional clearances were studied, and original formulas developed to calculate urea clearance and distribution volume. In the early dialytic phases, aberrations were more evident, with low kinetic volume (VK) values and kinetic clearance (KK) values double those obtained by dialysate collection (KDC). Over the whole session, both VDC and VK were underestimated (9.9 and 8.2%), compared with anthropometric data (VA). In 3 patients, the comparison of VA and VDC, and the behavior of effective body water clearance (KE), agreed with the hypothesis of dialysis-induced catabolism. Both disequilibrium and hypercatabolism can affect the reliability of the single-pool urea kinetic model; because of overlap, their effects are difficult to separate, and became particularly important in high-efficiency dialysis. A modified model, using V and CtET as input is suggested in order to establish the most appropriate dialysis prescription for uremia therapy.

Central and peripheral involvement in hemodialysed subjects: neurophysiological and nephrological relationships.

Nerve conduction velocity and visual evoked potential studies were conducted in 31 patients with chronic renal failure undergoing periodic hemodialysis. The results indicate damage to the central nervous system, such as delayed P100 wave, even in the absence of clinical signs, and to the peripheral nervous system, such as distal sensorimotor neuropathy. The degree of peripheral involvement correlates with the duration of dialysis and with some blood chemistry values but not with the evoked potential parameters. There is no correlation between central and peripheral nervous damage, which presumably points to a difference in pathogenesis.

[Diabetic nephropathy. Review of the current status and practical considerations concerning etiopathogenetic, clinical and therapeutic aspects]. / La nefropatia diabetica. Rassegna di attualità e considerazioni pratiche di ordine etiopatogenetico, clinico e terapeutico.

Reference is made to personal research and clinical experience, coupled with a select bibliography, in a survey of the most significant current knowledge with regard to diabetic nephropathy, designed for the nonspecialist practitioner and intended to enable him to update his knowledge without plunging into details, and to quickly decide what measures he should adopt in his daily practice. Questions of histopathology and aetiopathogenesis are examined, together with the relations between proteinuria, hypertension, renal function, and diabetic nephropathy. The clinical profile and progress of the disease are illustrated. Lastly, an account is given of the conventional modes of treatment, and of the still partly unsatisfactory results offered by more recent forms of replacement therapy (dialysis and transplantation).