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1.
Nutrients ; 12(9)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32887293

RESUMO

Oxalate is both a plant-derived molecule and a terminal toxic metabolite with no known physiological function in humans. It is predominantly eliminated by the kidneys through glomerular filtration and tubular secretion. Regardless of the cause, the increased load of dietary oxalate presented to the kidneys has been linked to different kidney-related conditions and injuries, including calcium oxalate nephrolithiasis, acute and chronic kidney disease. In this paper, we review the current literature on the association between dietary oxalate intake and kidney outcomes.

3.
J Nephrol ; 2020 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918723

RESUMO

RATIONALE AND OBJECTIVE: Kidney stones are a common condition in the general population, however, high-quality evidence for its management is scarce. We propose the creation of an international network with the aim of sharing practice patterns and patient data towards an improvement of our knowledge of the disease. STUDY DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: An online survey was circulated through several scientific societies. Items were grouped into six domains. Each center's overall score (OS) was also calculated. ANALYTICAL APPROACH: Chi square and Mann-Whitney tests were performed for differences across centers. RESULTS: The countries that contributed most were Italy (8.6%), Turkey (6.6%), France and Spain (6.1%). Some type of nutritional work-up was implemented in 62% of centers. A DEXA scan was performed by 46% of centers, whereas some kind of acidification test was performed by 25% of centers. Most centers (80%) implemented blood investigations at least at baseline. With regard to 24-h urine exams, 7 out of 16 were performed by at least 50% of centers. Information on stone composition was collected by 58% of centers. The OS was significantly higher among higher-volume centers compared with lower-volume centers (p = 0.002). Significant differences between EU and non-EU centers were found. LIMITATIONS: Cross-sectional design; no validation on information. CONCLUSIONS: Our survey highlights the potential for the creation of a network of centers that could share information in a common database for observational research and for enrollment of patients in interventional trials.

4.
Intern Emerg Med ; 2020 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-32776204

RESUMO

Aim of our study was to analyze the association between serum sodium (Na) variability and acute kidney injury (AKI) development. We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 1, 2010 and December 31, 2014 with inclusion of adult patients with ≥ 2 Na and ≥ 2 serum creatinine measurements. We included only patients with ≥ 2 Na measurements before AKI development. The outcome of interest was AKI. The exposures of interest were hyponatremia, hypernatremia and Na fluctuations before AKI development. Na variability was evaluated using the coefficient of variation (CV). Multivariable Cox proportional hazards and logistic regression models were fitted to obtain hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the exposures of interest and AKI. Overall, 56,961 patients met our inclusion criteria. During 1541 person-years of follow-up AKI occurred in 1450 patients. In multivariable hazard models, patients with pre-existent dysnatremia and those who developed dysnatremia had a higher risk of AKI compared with patients with normonatremia. Logistic models suggested a higher risk for AKI in the 3rd (OR 1.41, 95% CI 1.18, 1.70, p < 0.001) and 4th (OR 1.53, 95% CI 1.24, 1.91, p < 0.001) highest quartiles of Na CV with a significant linear trend across quartiles (p trend < 0.001). This association was also independent from Na highest and lowest peak value. Dysnatremia is a common condition and is positive associated with AKI development. Furthermore, high Na variability might be considered an independent early indicator for kidney injury development.

5.
Dis Markers ; 2020: 8848225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670436

RESUMO

Background: Urolithiasis is the process of stone formation in the urinary tract. Its etiology is only partly known, and efficient therapeutic approaches are currently lacking. Metabolomics is increasingly used in biomarkers discovery for its ability to identify mediators of relevant (patho)physiological processes. Amino acids may be involved in kidney stone formation. The aim of the present study was to investigate the presence of an amino acid signature in stone former urine through a targeted metabolomic approach. Methods: A panel of 35 amino acids and derivatives was assessed in urines from 15 stone former patients and 12 healthy subjects by UPLC-MS. Partial Least Squares Discriminant Analysis (PLS-DA) was used to define amino acid profiles of cases and controls. Results and Discussion. Our approach led to the definition of a specific amino acid fingerprint in people with kidney stones. A urinary amino acid profile of stone formers was characterized by lower levels of α-aminobutyric acid, asparagine, ethanolamine, isoleucine, methionine, phenylalanine, serine, tryptophan, and valine. Metabolomic analysis may lend insights into the pathophysiology of urolithiasis and allow tracking this prevalent condition over time.

6.
J Nephrol ; 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32514990

RESUMO

Kidney stone disease is a common condition with a high recurrence rate and elevated costs. Despite the well-known positive effects of high fluid intake, there are little data about the roles of water composition and timing of ingestion during the day. This study examines the effect of two different waters [calcium-bicarbonate water (CBW) and oligomineral water (OW)] consumed at different times during the day on urine composition in a group of healthy volunteers. In a cross-over randomized trial, 12 healthy volunteers were assigned to a different sequence of four combined interventions (1 L of water consumed during fasting and 1 L of water consumed with meals): CBW/OW; OW/CBW; CBW/CBW; OW/OW. Participants were instructed to follow the same diet and to avoid smoking, caffeine and other beverages during the day of intervention, and to collect their urine every 2 h during the day, followed by a single overnight collection. The relative supersaturation for calcium oxalate was higher for CBW/CBW compared with all other interventions, while relative supersaturation for calcium phosphate was lower for the combination OW/CBW with meals. Urinary excretion of oxalate was lower in all interventions including CBW, while no significant differences were found for urinary calcium. Water composition and timing of ingestion have complex and interacting effects on lithogenic risk. Depending on individual characteristics, a strategy involving either OW or a mix of CBW during meals and OW outside of meals could be effective in modulating the lithogenic profile.Trial registered at clinicaltrial.gov: Protocol ID NCT03447847.

8.
Clin J Am Soc Nephrol ; 15(7): 1007-1014, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32527945

RESUMO

BACKGROUND AND OBJECTIVES: Nephrolithiasis is a common health problem in autosomal dominant polycystic kidney disease (ADPKD) and significantly contributes to patient morbidity. Recently, Tolvaptan has been introduced for the treatment of ADPKD, but whether it is associated with alterations of the urinary lithogenic risk profile remains unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted an analysis of participants enrolled in the Bern ADPKD registry, a prospective observational cohort study. Twenty-four-hour urine analyses were performed at baseline and then at yearly follow-ups. Relative supersaturation ratios for calcium oxalate, brushite, and uric acid were calculated with the program EQUIL2. Unadjusted and multivariable mixed-effects linear regression models, adjusted for age, sex, body mass index, eGFR, net acid excretion, and height-adjusted total kidney volume, were used to assess the association of Tolvaptan with urinary parameters relevant for kidney stone formation. The maximum individual follow-up time was 3 years, median follow-up time 1.9 years, and cumulative follow-up time 169 years. RESULTS: In total, 125 participants (38 with and 87 without Tolvaptan treatment) were included in the analysis. In multivariable analysis, Tolvaptan treatment was associated [adjusted estimate of the difference between Tolvaptan and no Tolvaptan; 95% confidence interval (CI)] with lower urine relative supersaturation ratios for calcium oxalate (-0.56; 95% CI, -0.82 to -0.3; P<0.001), brushite (-0.33; 95% CI, -0.54 to -0.11; P=0.004), and uric acid (-0.62; 95% CI, -0.88 to -0.37; P<0.001), and with higher urine citrate in mmol/mmol creatinine per day (0.25; 95% CI, 0.05 to 0.46; P=0.02) and calcium in mmol/mmol creatinine per day (0.31; 95% CI, 0.09 to 0.53; P=0.006) excretion. In addition, Tolvaptan treatment was associated with lower net acid excretion in mEq/mmol creatinine per day (-0.54; 95% CI, -0.90 to -0.17; P=0.004) and higher net gastrointestinal alkali absorption in mEq/mmol creatinine per day (0.57; 95% CI, 0.26 to 0.88; P<0.001). CONCLUSIONS: Tolvaptan treatment is associated with a significantly improved urinary lithogenic risk profile in patients with ADPKD.

9.
Arch Ital Urol Androl ; 92(1): 30-33, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32255319

RESUMO

OBJECTIVE: Obesity has been associated with an increased risk of kidney stone formation. The presence of obesity is due to an imbalance between energy intake and energy consumption resulting from physical activity and resting metabolic rate. The purpose of this meta-analysis was to assess the differences in dietary energy intake levels between patients developing urinary stones versus healthy individuals. MATERIALS AND METHODS: Medline/PubMed and EMBASE databases search was performed using the terms "urolithiasis", "kidney stones*", "calcul*", "energy", "calor*", "intake", "food", "kilojoule/kjoule", "Kilocal*/kcal" from January 1st, 2000, and were assessed as up to date on September 30th, 2019. RESULTS: After having screened 1.782 records, four studies were included in the meta-analysis. The total population was 467.063, including 453.078 healthy men and/or women and 13.985 men and/or women affected by nephrolithiasis. When energy intake data were pooled irrespective of the sex of participants, mean calory intake values were significantly higher in nephrolithiasis patients, compared to healthy individuals. The mean difference (MD) was 39.16 kcal (95% CI 18.53 to 59.78, p = 0.0002, random-effects model, inverse-variance weighing). The odds ratio for this comparison - calculated from the standardized mean difference - is significant (OR = 1.946; 95% CI: 1.869 to 5.561). CONCLUSIONS: Patients affected by urolithiasis show a significantly higher energy intake in various patient populations (USA, China and Korea) including subjects of both sexes. The relevance of this finding should be confirmed by studies in populations showing different and diverse dietary patterns, and by evaluating energy consumption linked to physical activity and metabolic rate in renal stone formers.

10.
Am J Clin Nutr ; 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32271884

RESUMO

BACKGROUND: Diet plays an important role in kidney stone formation. Several individual components have been associated with the risk of kidney stone formation, but there is limited evidence regarding the role of healthful dietary patterns. OBJECTIVE: To prospectively study the association between adherence to the Mediterranean diet and the risk of incident kidney stones. METHODS: We conducted a longitudinal study using 3 different cohorts: the Health Professionals Follow-up Study (n = 42,902 men), the Nurses' Health Study I (n = 59,994 women), and the Nurses' Health Study II (n = 90,631 women). We assessed diet every 4 y using an FFQ and calculated adherence to a Mediterranean diet using the alternate Mediterranean diet score (aMED). A subgroup of 6077 participants provided ≥1 24-h urine sample, and urinary solute excretion was analyzed. We used Cox proportional hazards regression to examine the independent association between the aMED and incidence of kidney stones, adjusting for potential confounders. We used adjusted linear regression models to study the relation between aMED and urine composition. RESULTS: During 3,316,633 person-years of follow-up, 6576 cases of incident kidney stones were identified. For participants in the highest aMED score category, the risk of developing a kidney stone was between 13% and 41% lower compared with participants in the lowest score (pooled HR: 0.72, 95% CI: 0.59, 0.87; P value for trend <0.001). A higher aMED score was associated with higher urinary citrate, magnesium, oxalate, phosphate, uric acid, volume, and pH, and lower urinary sodium, resulting in lower supersaturation for calcium oxalate, calcium phosphate, and uric acid. CONCLUSION: Adherence to a Mediterranean diet is associated with a lower risk of developing a kidney stone.

11.
Nutrients ; 12(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32183500

RESUMO

Nephrolithiasis is a common medical condition influenced by multiple environmental factors, including diet. Since nutritional habits play a relevant role in the genesis and recurrence of kidney stones disease, dietary manipulation has become a fundamental tool for the medical management of nephrolithiasis. Dietary advice aims to reduce the majority of lithogenic risk factors, reducing the supersaturation of urine, mainly for calcium oxalate, calcium phosphate, and uric acid. For this purpose, current guidelines recommend increasing fluid intake, maintaining a balanced calcium intake, reducing dietary intake of sodium and animal proteins, and increasing intake of fruits and fibers. In this review, we analyzed the effects of each dietary factor on nephrolithiasis incidence and recurrence rate. Available scientific evidence agrees on the harmful effects of high meat/animal protein intake and low calcium diets, whereas high content of fruits and vegetables associated with a balanced intake of low-fat dairy products carries the lowest risk for incident kidney stones. Furthermore, a balanced vegetarian diet with dairy products seems to be the most protective diet for kidney stone patients. Since no study prospectively examined the effects of vegan diets on nephrolithiasis risk factors, more scientific work should be made to define the best diet for different kidney stone phenotypes.

12.
BMC Nephrol ; 21(1): 23, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992222

RESUMO

BACKGROUND: Estimating CKD prevalence is difficult. Information on CKD prevalence is rather scanty in Italy and available figures come from surveys in selected geographical areas. Administrative data have been already demonstrated to be an effective tool in estimating the epidemiological burden of diseases, however there is limited experience in literature as far as CKD is concerned. METHODS: The aim of this study is to develop an algorithm based on regional Health Administrative Databases to identify individuals with CKD and provide estimates of disease prevalence in Lazio Region (Italy); about 5.500.000 inhabitants in 2017. A population-level analysis based on a record-linkage strategy using data from Health Administrative Databases has been applied in Lazio Region. CKD cases were identified between January 1, 2012 and December 31, 2017 using Outpatient Specialist Service Information System, Hospital Discharge Registry, Ticket Exemption Registry and Drug Dispensing Registry. Age-specific and standardized prevalence rates were calculated by gender. CKD cases were classified as higher and lower severity. RESULTS: The algorithm identified 99,457 individuals with CKD (mean age 71 years, 55.8% males). The exclusive contributions of each regional source used were: 35,047 (35.2%) from Outpatient Specialist Service Information System, 27,778 (27.9%) from Hospital Discharge Registry, 4143 (4.2%) from Ticket Exemption Registry and 463 (0.5%) from Drug Dispensing Registry; 5.1% of cases were found in all databases. The standardized prevalence rate at December 31, 2017 was 1.76, 2.06% for males and 1.50% for females. The prevalence increased with age, rising from 0.33% (age 0-18) up to 14.18% (age 85+) among males and from 0.25% up to 8.18% among females. The proportion of CKD individuals with lower severity disease was 78.7% in both genders. CONCLUSIONS: The proposed algorithm represents a novel tool to monitor the burden of CKD disease, that can be used by the regional government to guide the development and implementation of evidence-based pathways of care for CKD patients. The high prevalence of people with CKD of lower severity should be carefully considered in order to promote diagnosis and optimal management at early stages.

13.
Urolithiasis ; 48(5): 403-408, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31980850

RESUMO

Due to the difficulty of collecting 24-h urines in the stone-forming patient, some authors have suggested other types of urine collection, but their usefulness is not yet well studied. The objective of this study is to evaluate the variation of urinary supersaturation (SS) throughout the day and to analyze whether timed urine collections offer accurate information. 48 urine samples were collected from 12 young adults. Each 24-h urine was collected on 7 2-h urine fractions and a 10-h overnight sample. Solute concentrations and SS for calcium oxalate (CaOx), calcium phosphate (CaP), and uric acid (UA) were determined. Linear regression and relative importance of predictors were used to determine the percentage of R2 attributed to each timed collection (individual SS). 43 24-h urine samples were included in the study. The highest SS values were: for CaOx, night period and first morning urine; for CaP, between 2 and 6 pm and at night; for UA, between 8 am and 12 pm. For CaOx, the SS from the samples between 8 pm and 8 am accounted for more than 40% of the R2; for CaP, the results were more equally distributed throughout the day, and for UA, the SS values from 12 to 4 pm accounted for more than 45% of the observed variability. In conclusion, urinary SS varies throughout the day, being higher for CaOx and CaP at night, and in the early morning for UA. For CaOx and UA, the overnight and 12-4 pm urine samples, respectively, contribute most to the variability observed in the SS of 24-h urine.

14.
Intern Emerg Med ; 15(2): 273-280, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31388894

RESUMO

The aim of this observational retrospective cohort study was to analyze the association between hyperchloremia and serum chloride variation with in-hospital acute kidney injury (AKI) and mortality in a general, no-ICU hospitalized population. We performed a retrospective study on inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of adult patients with at least two values available for chloride, sodium and creatinine. Hyperchloremia was defined as serum chloride concentration ≥ 108 mmol/L (moderate hyperchloremia: chloremia between 108-110 mmol/L, severe hyperchloremia: chloremia > 110 mmol/L). According to the time of onset of the electrolyte disturbance, hyperchloremia was then classified as hospital acquired (HA) and community acquired (CA). In patients with HA-hyperchloremia, chloride variation (ΔCl) was calculated. In-hospital AKI was defined according to creatinine kinetics criteria occurring 48 h after hospital admission. Logistic regression analysis was used to evaluate the association between the exposures of interest and in-hospital AKI and mortality. A total of 24,912 hospital admissions met the inclusion criteria. Regression analyses showed that only severe HA-hyperchloremia was associated with increased risk of in-hospital AKI [odds ratio (OR) 2.60, 95% confidence interval (CI) 1.58, 4.30, p value < 0.001] and death (OR 3.89, 95% CI 2.11, 7.18, p value < 0.001). With increasing ΔCl, the OR of in-hospital AKI increased progressively (p value for trend = 0.005). In conclusion, severe hyperchloremia is an independent predictor for in-hospital AKI and mortality; HA-hyperchloremia is more detrimental for patient outcome; higher ΔCl from hospital admission is associated with increased risk of AKI.

16.
Kidney Blood Press Res ; 44(5): 1306-1312, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31597132

RESUMO

INTRODUCTION: Dent's disease is a rare X-linked recessive disorder that manifests in childhood or early adulthood and can lead to end-stage renal disease (ESRD). It occurs in males, who are hemizygous. In patients who develop ESRD, a deceased donor kidney transplant cures the disease. Females are obligate carriers of the mutated gene, and some show a mild Dent's disease phenotype. There may be reason for concern when considering a female obligate carrier (i.e., the mother) for kidney donation because of the risk of kidney function deterioration. CASE PRESENTATION: We describe the first successful kidney transplantation involving a patient with type 1 Dent's disease and ESRD given a kidney by an obligate carrier of the gene mutation, his mother. CONCLUSIONS: After careful assessment of the female obligate carriers, intrafamilial kidney donation in Dent's disease type 1 is feasible. No deteriorating renal function in the donor was observed.


Assuntos
Doença de Dent/terapia , Transplante de Rim/métodos , Criança , Feminino , Humanos , Doadores Vivos , Masculino , Mães
17.
Ann Ist Super Sanita ; 55(3): 205-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553311

RESUMO

BACKGROUND: The combination of infrared spectroscopy and morphological analysis significantly improves the urinary stone analysis. In addition to common urinary stones, it is not unusual to encounter spurious or factitious stones that, if not appropriately identified, can lead to errors in the diagnosis. In this study, we show the importance of Infrared Spectroscopy and the morphological analysis, for determining the presence of drugs crystals or atypical components in the calculi. METHODS: 1041 urinary stones were analyzed by morphocostitutional analysis, in addition the rare stones were analyzed by chemical spot test analysis. RESULTS: Among 1041 calculi analyzed, 1018 had a known composition, 23 samples were stones with rare composition or fake urinary stones. CONCLUSIONS: Infrared spectroscopy (FT-IR), allows to identify, theoretically, any substance, including drug-containing calculi or calculi with unusual composition and identify false stones. This is mandatory to treat patients affected by urolithiasis with a personalized clinical approach.


Assuntos
Cálculos Urinários/química , Cálculos Urinários/ultraestrutura , Cristalização , Humanos , Microscopia , Espectrofotometria Infravermelho , Espectroscopia de Infravermelho com Transformada de Fourier
18.
Am J Kidney Dis ; 74(6): 736-741, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31543288

RESUMO

RATIONALE & OBJECTIVE: The intestinal microbiome may affect urinary stone disease by modulating the amount of oxalate absorbed from the intestine and subsequently excreted in urine. This study sought to explore the association between antibiotics, which alter the intestinal microbiota, and risk for urinary stone disease. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 5,010 women in the Nurses' Health Study (NHS) I and II who had collected 24-hour urine samples. EXPOSURES: Use of antibiotics during the age range of 40 to 49 (NHS II), 40 to 59 (NHS I), and 20 to 39 years (both cohorts). OUTCOMES: Incident symptomatic urinary stone disease; urine composition. ANALYTICAL APPROACH: Cause-specific hazards regression adjusted for age, body mass index, comorbid conditions, thiazide use, and dietary factors. Follow-up was censored at the time of asymptomatic kidney stones, cancer, or death. RESULTS: Cumulative use of antibiotics for a total of 2 or more months during the age range of 40 to 49 years (NHS II) and 40 to 59 years (NHS II) was associated with significantly higher risk for developing incident stones compared with no use (pooled HR, 1.48; 95% CI, 1.12-1.96). Similar results were found for the period of 20 to 39 years (pooled HR, 1.36; 95% CI, 1.00-1.84). Results were unchanged after excluding participants who reported urinary tract infection with their stone event or as the most common reason for antibiotic use. Urine composition was generally similar across antibiotic groups except for marginally lower urine pH and citrate values among those taking antibiotics for 2 or more months. LIMITATIONS: Observational design; lack of information for type of antibiotic used; relatively large span of time between antibiotic use and urine collection. CONCLUSIONS: Use of antibiotics for more than 2 months in early adulthood and middle age is associated with higher risk for urinary stone disease in later life.


Assuntos
Antibacterianos/efeitos adversos , Cálcio/urina , Microbioma Gastrointestinal/efeitos dos fármacos , Nefrolitíase/induzido quimicamente , Nefrolitíase/epidemiologia , Adulto , Distribuição por Idade , Antibacterianos/uso terapêutico , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Incidência , Modelos Logísticos , Pessoa de Meia-Idade , Nefrolitíase/fisiopatologia , Inquéritos Nutricionais , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Urinálise , Adulto Jovem
19.
Diabetes Care ; 42(10): 1939-1945, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31371431

RESUMO

OBJECTIVE: Peripheral artery disease (PAD) is one of the most relevant complications of diabetes. Although several pharmacological and revascularization approaches are available for treating patients with diabetes and PAD, an endovascular approach is often associated with postprocedural complications that can increase the risk for acute limb ischemia or amputation. However, no definitive molecular associations have been described that could explain the difference in outcomes after endovascular treatment in patients with diabetes, PAD, and chronic limb-threatening ischemia (CLTI). RESEARCH DESIGN AND METHODS: We evaluated the relationship between the levels of the main cytokines associated with diabetic atherosclerosis and the outcomes after endovascular procedures in patients with diabetes, PAD, and CLTI. RESULTS: A total of 299 patients with below-the-knee occlusive disease who were undergoing an angioplasty procedure were enrolled. The levels of key cytokines-osteoprotegerin (OPG), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP)-were measured, and major adverse limb events (MALE) and major adverse cardiovascular events (MACE) were assessed 1, 3, 6, and 12 months after the procedure. There was a linear trend from the lowest to the highest quartile for each cytokine at baseline and incident MALE. A linear association was also observed between increasing levels of each cytokine and incident MACE. Receiver operating characteristics models were constructed using clinical and laboratory risk factors, and the inclusion of cytokines significantly improved the prediction of incident events. CONCLUSIONS: We demonstrated that elevated OPG, TNF-α, IL-6, and CRP levels at baseline correlate with worse vascular outcomes in patients with diabetes, PAD, and CLTI undergoing an endovascular procedure.

20.
Case Rep Nephrol ; 2019: 9264824, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31360562

RESUMO

Background: Atypical hemolytic uremic syndrome (aHUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Mutations in CFI gene coding for complement regulation factors and in THBD gene coding for endothelial cell receptor thrombomodulin could predispose to the disease and hypertension can trigger the onset. Case Presentation: A 51-year-old female patient who had received kidney transplant eighteen years ago presented with hypertensive peak and hemolysis pattern. Normal ADAMTS13 levels as well as negative culture and serology for Shiga-toxin excluded, respectively, thrombotic thrombocytopenic purpura (TTP) and typical HUS caused by Shiga toxin-producing Escherichia coli (STEC-HUS). In suspicion of aHUS, we administered eculizumab and hemodialysis sessions were started as the patient showed severe renal failure. After an initial response, the patient developed cerebral hemorrhage. After last eculizumab administration, according to hematological parameters, an unsatisfactory response was observed: given the worsening clinical scenario, we withdrew eculizumab. Pathogenic mutations in CFI and THBD genes were found. After eculizumab reinitiation, looking at hemolysis indexes, we observed a suboptimal response as well as an otherwise adequate renal one: renal graft function was recovered despite persistence of hemolysis signs, after 6 months on regular dialysis. Conclusion: For the first time, we report an aHUS case in which a peculiar combination of mutations in CFI and THBD is found. We describe the importance of continuing eculizumab despite deterioration of patient's clinical conditions.

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