[Takotsubo cardiomyopathy recurrence in patient with chronic kidney disease: case report and literature review]. / Recidiva di cardiomiopatia Takotsubo in paziente con insufficienza renale cronica: analisi di un caso clinico e revisione della letteratura.

Takotsubo cardiomyopathy (CT) is a syndrome characterized by an acute and transient left ventricular dysfunction, electrocardiographic abnormalities suggestive of acute coronary syndrome, chest pain and/or dyspnea, left ventricular mid-apical segments akinesia and normal coronary angiography. It is mainly observed in postmenopausal women after an intense physical or mental stress. The course is usually favourable but sometimes severe complications occur. The recurrence rate is 2-10%. We present the case of a recurrence of CT in a female, 79 years old, with hypertension, diabetes, chronic kidney disease (CKD) stage 3 who was admitted to the emergency room for dyspnea and vomiting. The electrocardiogram (ECG) showed a sinusal rhythm and T wave inversion in the pre-cordial leads and the echocardiogram a typical feature of CT with depressed left ventricular systolic function (FE). The ECG ranged quickly with atrial fibrillation rhythm, followed by a major hypokinetic arrhythmia with advanced atrio-ventricular block which indicated the need for a temporary pacemaker placement. The patient was oligouric, with severe renal failure, hyponatremia, hyperkalemia and metabolic acidosis. A continuous renal replacement therapy (CRRT) was started. On the seventh day improvement in urine output, electrolyte and acid base imbalance and FE normalization occurred. The renal function improved gradually, but after 36 months, persisted CKD stage 4. The case report describes the development of a cardiorenal syndrome type 1 induced by CT recurrence and effectiveness of CRRT in the management of acute heart failure. It also suggests a potential role played by CKD as a risk factor in the onset and recurrence of CT.

[Horseshoe kidney: not a simple fusion anomaly]. / Rene a ferro di cavallo: non è una semplice anomalia di fusione. Analisi di due casi clinici e revisione della letteratura.

The horseshoe kidney is a congenital anatomical defect of the kidney that occurs in 0,25% of the population and is generally characterized by the fusion of the lower poles of the two kidneys through an isthmus and to which may be associated with urogenital and renal vascular anomalies. Asymptomatic in 1/3 of the cases and, most of time, accidentally discovered during a radiological examination, promotes nephrolithiasis, ureteropelvic junction obstruction, hydronephrosis, vesicoureteral reflux and pyelonephritis. We report two cases of patients with kidney horseshoe, characterized by the abrupt onset of a septic state with oligo-anuric acute renal failure, electrolyte and acid-base abnormalities, rapid decay of the general conditions, with detection of nephrolithiasis, hydronephrosis and acute pyelonephritis and whose clinical management resulted in a significant and synergistic nefro-urology involvment. The kidney horseshoe not represent so only a simple fusion anomaly but rather an important anatomical condition that, once diagnosed, it would be worthy of a careful clinical, radiological and laboratory surveillance, in order to prevent the potential complications that may be also particularly severe.

Bladder neck disease and kidney damage.

Primary bladder neck obstruction (PBNO) was first described in men by Marion in 1933. The precise cause of PBNO has not been clearly elucidated. This paper review the theories on etiology, clinical presentation, diagnostic evaluation and treatments for PBNO. Also this paper focuses on management of patients with complications like acute urine retention, hydroureteronephrosis and severe renal failure. The treatment options for men and women with PBNO include careful clinical evaluation, pharmacotherapy with alpha-blockers and surgical intervention.