[Examination of Urinary Sediment in a Patient with Lupus-Like HIV-Associated Immune Complex Kidney Disease (HIVICK) - Case Report and Review of the Literature].

Renal involvement is very common in patients with HIV infection. The phenotype varies from the most frequently "collapsing" variant of focal and segmental glomerulosclerosis (FSGS) to "lupus-like HIV-immune complex kidney disease" (HIVICK). The latter is characterized by a histological picture that recalls lupus nephropathy. Through a clinical case, we underline the importance of urinary sediment analysis in patients with suspected glomerulopathy. Findings such as the characteristic cells that show the typical appearance of Herpes virus (HSV) infection or LE cells have significantly supported the diagnosis of HIVICK. In light of the present observations, we suggest systematically carrying out a cytological examination of the urinary sediment to confirm diagnostic hypotheses of rare pathologies.

[Collapsing Glomerulopathy Secondary to Anabolic Steroids for Bodybuilding: A Case Series].

The abuse of anabolic androgenic steroids (AAS) for competitive (and non-competitive) purposes for bodybuilding practice is increasingly common. The consequences of these substances on the various organs are only partially known. Cases of FSGS following the use of AAS have been reported in the literature, even with evolution to ESKD. We describe three cases of bodybuilding athletes who presented alterations in renal function indices after taking AAS for a long time. Three renal biopsies were performed with histological diagnosis of FSGS collapsing variant. We examine the lesions observed on histological examination. Two athletes had rapid progression of renal disease requiring replacement therapy. The third one continues conservative treatment for chronic renal failure. We discuss the risks related to the intake of doping substances and how bodybuilders are exposed to different causes of kidney damage: anabolic steroids, supplements, and a high-protein diet.

[Anti-MBG crescentic glomerulonephritis with negative immunofluorescence: case report and literature review].

Anti-glomerular basement membrane (anti-GBM) antibody disease is a rapidly progressive glomerulonephritis characterized by (i) positivity to anti-GBM in serum reacting with a specific antigen present in type IV collagen at both the glomerular and alveolar levels (ii) presence of crescent on light microscopy and positivity to linear deposits of IgG and C3 on immunofluorescence. In the classic variant, the clinic is that of a nephro-pneumological syndrome but there are variants. Rarely, the glomerular damage is pauci-immune. We describe a case of a variant in which there is anti-MBG positivity in serum but negative immunofluorescence and offer a review of the literature and potential treatments.

[Inflammation in kidney diseases].

The term "inflammation" is certainly one of the oldest medical terms still in use. However, its meaning has changed over the centuries. This work gives a historical and critical review of the concept of inflammation, with special reference to kidney diseases. Over time the definition of inflammation has shifted from a pure collection of symptoms to a histopathological definition, characterized by the tissue "inflammatory infiltrates" and different subcategories according to the cell type involved. The advantages of this classification are the generally good response to corticosteroids (with only a few exceptions) and the availability of specific drugs for each inflammatory infiltrate. Finally, a "molecular" definition of inflammation has arisen, where the inflammatory infiltrates make room to a plethora of plasma mediators. The authors show that the use of plasma biomarkers as a tool to define inflammatory state leads to net inflation of the number of "inflammatory" diseases - an effect that shows clearly in the field of nephrology.

Interaction between phosphorus and parathyroid hormone in non-dialysis CKD patients under nephrology care.

BACKGROUND: Whether the traditional treatment of chronic kidney disease (CKD)-mineral and bone disorder is effective in the setting of tertiary nephrology care is an unexplored question. We evaluated phosphate, calcium and PTH levels during the first year of nephrology care and the prognostic role of month-12 levels in non-dialysis patients referred prior to availability of the novel P binders. METHODS: We studied a historical cohort of consecutive patients with CKD stage 3-5 at referral (baseline), and after 6 and 12 months of nephrology care; thereafter, patients were followed for renal survival (time to death or end-stage renal disease). RESULTS: At month 12, versus baseline, we detected a larger implementation of dietary protein restriction (P = 0.001), vitamin D and P binder (P < 0.0001 for both). Mean serum P remained unchanged (4.02 ± 0.77, 4.01 ± 0.79, 4.10 ± 0.85 mg/dL at baseline, month 6 and 12, respectively) with only 18, 16 and 21 % patients showing uncontrolled serum P at the three study visits. Similarly, calcium levels were unchanged and within the target in most cases. Conversely, intact PTH increased from 102 pg/mL (interquartile range 67-139) to 113 (68-179), P = 0.015, with 59, 60 and 53 % patients showing high values at the three study visits. During the subsequent follow-up (31 months), 96 renal deaths occurred. Cox analysis evidenced a significant prognostic role of the interaction P × PTH (P = 0.002), that is, the risk of renal death associated with serum P increased in the presence of higher PTH. CONCLUSIONS: In patients under nephrology care, P and PTH should be considered in concert to optimize risk stratification for renal death.

[Chronic kidney dysfunction in the elderly patient: physiological process or disease?]. / Disfunzione renale nell'anziano: processo fisiologico o malattia?

The last few years have seen a steady rise in numbers of patients with chronic kidney disease (CKD), mainly because of the increased prevalence of older patients. Today, most new diagnoses of CKD are made in patients belonging to the large subgroup of subjects aged 65 years or over, who often present with mild-to-moderate CKD. Given the recent rise in numbers of elderly CKD patients referred to American renal clinics, the American Society of Nephrology has recently endorsed a study group dedicated to this group of patients, Geriatric Nephrology, with the aim of increasing knowledge on CKD in the elderly and subsequently improving the clinical management of older patients. Indeed, several questions remain open and further studies are required to clarify diagnostic criteria for 'true' CKD in the elderly and the associated 'real' clinical implications in terms of hard outcomes. This review aims to address a hot topic through evaluation of the most recent and influential studies regarding the relationship between ageing and CKD.

Survey of hidden costs of dialysis in Italian for-profit and not-for-profit centers.

BACKGROUND: Chronic dialysis exposes patients to several procedures that may influence lifestyle and quality of life. These hidden costs, however, have never been evaluated. AIM AND METHODS: To compare the costs related to diagnostic and therapeutic procedures between not-for-profit (nFP) and for-profit (FP) dialysis care systems, we mailed to Italian nephrology units a questionnaire on modalities of medical prescriptions and reservations, waiting time for tests and modalities of drugs distribution. RESULTS: 247 centers (42%) replied to the questionnaire: 177 nFP (72%) and 70 FP (28%). The response rate was 54% of nFP and 26% of FP centers. All centers provided hemodialysis (in satellite units, 42% nFP and 14% FP, p<0.001; at home, 23% nFP and 1% FP, p<0.001). Peritoneal dialysis was offered by 60% nFP and 6% FP (p<0.001). Centers provided dialysis care for 15,294 patients, 85% in nFP and 15% in FP. At least 1 general practitioner prescription for dialysis, diagnostic tests, specialist consultations and drugs, was requested to patients in 50% of nFP and 95% of FP centers (p<0.001). Reservations for tests and specialist visits were made by patients in 6% of nFP and 20% of FP centers (p<0.001). In nFP and FP centers, waiting time for tests was 2 vs. 4 days for lung x-ray (p<0.01), 7 vs. 11 days for gastroscopy (p<0.05) and 14 vs. 13 days for echocardiography (NS). Erythropoietin, phosphate binders and nutritional supplements, were supplied by patients in 7%, 46% and 37% of nFP centers, and 86%, 86% and 90% of FP centers (p<0.001). CONCLUSIONS: The dialysis care system charges patients a high hidden cost, represented by procedures related to dialysis. Higher costs and reduced choice of treatment modalities may characterize the for-profit dialysis system.