Review article: nucleos(t)ide analogues in patients with chronic hepatitis B virus infection and chronic kidney disease.

BACKGROUND: The treatment of chronic hepatitis B (CHB) in patients with chronic kidney disease (CKD) is based on nucleoside (lamivudine, telbivudine, entecavir) or nucleotide (adefovir, tenofovir) analogues (NAs), but it may be complex and the information is scarce. Entecavir and tenofovir represent the currently recommended first-line NAs for NA-naive CHB patients, while tenofovir is the NA of choice for CHB patients with resistance to nucleosides. AIM: To review the efficacy and safety of NAs in adult CHB patients with CKD and to provide reasonable recommendations for their optimal management. METHODS: Literature search in PubMed/Medline and manual search of relevant articles, reviews and book chapters. RESULTS: NAs are cleared by kidneys and their dosage should be adjusted in patients with creatinine clearance <50 mL/min. There are concerns about nephrotoxic potential of the nucleotides, particularly adefovir, while improvements of creatinine clearance have been reported under telbivudine. Most existing data in CHB patients with CKD are for lamivudine and, less frequently, for other NAs, mostly entecavir. Besides CHB, NA should be used in case of immunosuppressive therapy in any HBsAg-positive patient with CKD including renal transplant (RT) recipients and in anti-HBs-positive recipients of kidney grafts from HBsAg-positive donors. CONCLUSIONS: Chronic hepatitis B patients with chronic kidney disease receiving nucleoside analogues should be followed carefully for treatment efficacy and renal safety. Despite the absence of strong data, entecavir and telbivudine seem to be the preferred options for nucleoside analogue-naive CHB patients with chronic kidney disease, depending on viraemia and severity of renal dysfunction. More studies are certainly needed in this setting.

Nephrolithiasis-related end stage renal disease.

There is graded association between episodes of kidney stones and chronic kidney disease, and the prevalence of nephrolithiasis leading to end stage renal disease (ESRD), although low, is still unavoidable. The marginal causes of nephrolithiasis-related ESRD continue to be metabolic and infection stones. Few lines of investigation account for a higher risk of ESRD in stone formers than in general population, being influenced by hypertension, diabetes, dyslipidemia, gout and recurrent urinary tract infections. Moreover, the risk for ESRD seems to be higher among women over 50 years old who presented more than one episodes of renal colic. However, the evaluation of these studies is limited by the fact that most of them are retrospective, mainly originating from single centre experiences. Additional work on consistent and active patient surveillance will hopefully give information about the association between kidney stones and ESRD, clarifying also the diagnostic dilemmas that have been reported worldwide. This paper addresses the current data for nephrolithiasis-associated ESRD, an interesting topic, the awareness of which should be enhanced.

Correlation of depressive symptoms and olfactory dysfunction in patients on hemodialysis.

BACKGROUND AND AIM: A possible link between depression and olfactory dysfunction has been suggested in the literature, in research projects using the olfactory bulbectomy model. In human studies using a syndrome-oriented approach, such an association has not been reported consistently. The aim of the study was to test the association of olfactory dysfunction with depression using a symptom-oriented approach.Paients and methods: Twenty eight end-stage renal failure patients took part in this project. The patients olfactory identification ability was tested with the University of Pennsylvania Smell Identification Test (UPSIT). Immediately before olfactory testing, the subjects completed the Zung self-rating scale, which provides data on symptoms of depression in this group of patients. RESULTS: The mean value of the number of mistakes made in the olfactory identification ability (UPSIT test) by the total sample was 14.0±4.5, with a range 6-22. Half of the symptoms seem to bear an influence on the olfactory identification performance. Patients experiencing decreased libido and dissatisfaction exhibited significantly reduced olfactory function, as contrasted to those not experiencing these symptoms. The above results remain practically unaltered even after taking into account such probable confounding factors as age, sex, olfactory detection threshold and duration of illness. CONCLUSION: These findings support previous evidence indicating that olfactory dysfunction may be related to specific depressive symptoms in humans. The present findings also suggest that the symptom-oriented approach is an effective research tool for the elucidation of such clinical issues. The need for further research in this field is pointed out.