Bilateral native kidney neoplasia detected by ultrasound in functionning renal allograft recipient.

We report the case of bilateral renal clear cell carcinoma in the native kidney, occurring fouryears after renal transplantation. Renal Doppler duplex sonography revealed large solid bilateral neoformation. Total-body computed tomography confirmed the presence of bilateral kidney lesions and also showed the presence of concomitant gross dyscariocinetic lesion of left hemotorax. The patient underwent bilateral native nephrectomy and the histological diagnosis was renal cell carcinoma. Subsequent left upper lobectomy revealed necrotic keratinizing squamous cell carcinoma. Then, the patients was switched tacrolimus to everolimus treatment and mycophenolate mofetil was reduced.

Circadian blood pressure patterns and blood pressure control in patients with chronic kidney disease.

BACKGROUND AND AIMS: Hypertension is a major risk factor for chronic kidney disease (CKD), and CKD progression is associated with suboptimal blood pressure (BP) control. Here we evaluate the impact of CKD on the attainment of BP control and the circadian BP profile in older subjects. METHODS: In this observational study, we studied 547 patients referred to the hypertension clinic, of whom 224 (40.9%) had CKD. Blood pressure (BP) control and circadian BP patterns were evaluated by 24-hour ambulatory BP monitoring. Circadian BP variability was measured as the within-subject SD of BP, the percentage of measurements exceeding normal values, hypotension, and dipping status. RESULTS: The attainment of adequate BP control was similar in subjects with or without CKD (around 31%). Logistic regression analysis indicated that CKD was not a determinant of adequate BP control (OR 1.004; 95% CI 0.989-1.019; p = 0.58). Patients with CKD presented as twice as higher prevalence of reverse dipper (night-time peak) for systolic BP and episodes of hypotension during daytime, independently of BP control. CONCLUSIONS: Knowledge of the circadian pattern of BP in hypertensive subjects with CKD could inform better than attainment of BP target about risky condition for CKD progression and cognitive decline and allow a more personalized antihypertensive treatment.

Atherosclerosis, dyslipidemia, and inflammation: the significant role of polyunsaturated Fatty acids.

Phospholipids play an essential role in cell membrane structure and function. The length and number of double bonds of fatty acids in membrane phospholipids are main determinants of fluidity, transport systems, activity of membrane-bound enzymes, and susceptibility to lipid peroxidation. The fatty acid profile of serum lipids, especially the phospholipids, reflects the fatty acid composition of cell membranes. Moreover, long-chain n-3 polyunsatured fatty acids decrease very-low-density lipoprotein assembly and secretion reducing triacylglycerol production. N-6 and n-3 polyunsatured fatty acids are the precursors of signalling molecules, termed "eicosanoids," which play an important role in the regulation of inflammation. Eicosanoids derived from n-6 polyunsatured fatty acids have proinflammatory actions, while eicosanoids derived from n-3 polyunsatured fatty acids have anti-inflammatory ones. Previous studies showed that inflammation contributes to both the onset and progression of atherosclerosis: actually, atherosclerosis is predominantly a chronic low-grade inflammatory disease of the vessel wall. Several studies suggested the relationship between long-chain n-3 polyunsaturated fatty acids and inflammation, showing that fatty acids may decrease endothelial activation and affect eicosanoid metabolism.