[Vascular calcifications in chronic kidney disease]. / Le calcificazioni vascolari nella malattia renale cronica.

Vascular calcifications are associated with increased cardiovascular morbidity and mortality. Their prevalence is higher in patients with chronic kidney disease than in the general population and they are linked not only to classical risk factors such as hypertension, diabetes, dyslipidemia and smoking but also to derangements in mineral metabolism and to chronic inflammation. The development of vascular calcifications is an active phenomenon that is linked to an imbalance between promoting and inhibitory factors. They affect also young patients on dialysis and it is therefore necessary to recognize them at an early stage. The distinction between intima and media calcification can be important for a different therapeutic approach. There are a number of devices for the identification of vascular calcifications, including x-ray imaging, ultrasonography and computerized technologies. The purpose of this paper is to show the advantages and disadvantages of ultrasonography in comparison to other tools for the diagnosis of vascular calcifications.

Hormonal strategies for fertility preservation in patients receiving cyclophosphamide to treat glomerulonephritis: a nonrandomized trial and review of the literature.

BACKGROUND: Prepubertal patients receiving chemotherapy are relatively resistant to cyclophosphamide-induced germinal cell alterations. We studied the possible protective effect of testosterone and triptorelin to inhibit gonadal activity in men and women receiving cyclophosphamide, respectively. STUDY DESIGN: Nonrandomized trial. SETTING & PARTICIPANTS: 28 consecutive patients, 11 men and 17 women, from a university medical center with various forms of glomerulonephritis, treated with cyclophosphamide. INTERVENTION: Men received cyclophosphamide plus testosterone; women were divided into 2 groups: 13 patients (group A) received cyclophosphamide plus triptorelin; 4 (group B) received only cyclophosphamide. OUTCOMES & MEASUREMENTS: Serum follicle-stimulating hormone (FSH) and serum luteinizing hormone levels and, in addition, sperm counts and testosterone levels in men and estradiol levels in women were measured before and after treatment with cyclophosphamide. RESULTS: All 10 men became azoospermic or severely oligospermic during treatment; after 12 months, all except 1 had a normal sperm count and FSH levels were normal. In women during cyclophosphamide therapy, amenorrhea occurred in all patients. After cessation of therapy, all women in group A started to menstruate regularly, and at the end of follow-up, ovulatory cycles were demonstrated in all women. Hormone levels showed no significant changes throughout the observation period. Six women conceived, and the pregnancies were brought to term successfully without complications. In group B, all 4 women developed sustained amenorrhea; serum FSH and luteinizing hormone levels at the end of therapy and follow-up were significantly higher with respect to baseline; estradiol levels at the end of follow-up were significantly lower compared with baseline and corresponding values in group A. LIMITATIONS: The substudy in men is uncontrolled, the substudy in women is nonrandomized. CONCLUSIONS: The study suggests a protective effect of testosterone and triptorelin against cyclophosphamide-induced gonadal damage in men and women with various forms of kidney disease, respectively.