ABSTRACT
OBJECTIVE: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a heterogeneous inherited disease characterized by renal and extrarenal manifestations with progressive fluid-filled cyst development leading to end-stage renal disease. Our aim was to evaluate the prevalence of obstructive urological disease in ADPKD patients and possible associations with endothelial dysfunction, nutritional, metabolic and inflammatory markers. PATIENTS AND METHODS: The study included ADPKD patients and control group, who carried out uroflowmetry, an assessment of renal function, metabolic and nutritional parameters and an evaluation of endothelial dysfunction and atherosclerotic markers, such as Renal Resistive Index (RRI), Intima-Media Thickness (IMT) and Flow-Mediated Dilation (FMD). RESULTS: We enrolled 37 ADPKD patients (20 males with 51.0 ± 14.3 years) and 34 control group (18 males with 60.7 ± 14.4 years). We showed a significant reduction in Max Flow Rate (Qmax) (p ≤ 0.001), age (p = 0.006), FMD (p = 0.023) and Voiding Volume (p = 0.053), in addition to a significant increase in Voiding Time and Diastolic Blood Pressure (p ≤ 0.001, p = 0.049; respectively) in ADPKD patients with respect to control group. Moreover, we found a negative correlation between Qmax and creatinine (r= -0.44, p = 0.007), RRI (r= -0.49, p ≤0.001) and intact Parathyroid Hormone (r = -0.329, p = 0.046), while we found a positive correlation between Qmax and MDRD (r = 0.327, p = 0.048) and between Voiding Time and serum uric acid (r= 0.34, p = 0.039) in ADPKD patients with respect to control group. CONCLUSIONS: In our study, we showed an elevated prevalence of urological functional diseases in ADPKD patients; therefore, we suggest to include uroflowmetry in the assessment of these patients, considering the non-invasiveness, repeatability and low cost of the exam. An early intervention could slow down the progression of renal damage and an early screening of the main cardiovascular risk factors could reduce the high morbidity and mortality in ADPKD patients.
Subject(s)
Kidney Failure, Chronic/etiology , Polycystic Kidney, Autosomal Dominant/physiopathology , Rheology/methods , Urologic Diseases/physiopathology , Adult , Aged , Atherosclerosis/metabolism , Biomarkers/blood , Cardiovascular Diseases/prevention & control , Carotid Intima-Media Thickness/statistics & numerical data , Case-Control Studies , Cross-Sectional Studies , Disease Progression , Early Diagnosis , Endothelium/physiopathology , Female , Humans , Kidney/physiopathology , Kidney Function Tests/methods , Male , Middle Aged , Polycystic Kidney, Autosomal Dominant/blood , Polycystic Kidney, Autosomal Dominant/complications , Prevalence , Rheology/economics , Uric Acid/blood , Urologic Diseases/diagnosis , Urologic Diseases/epidemiologyABSTRACT
A multicentric study was carried out on 384 patients (231 males, mean age 28.3 years; 153 females, mean age 40.8 years) previously treated with extracorporeal shock wave lithotripsy for recurrent idiopathic calcium urolithiasis. Patients were selected and submitted to different types of high fluid intake treatment (oligomineral water with a calcium content of 15 mg/l vs. tap water with a calcium content ranging between 55 and 130 mg/l) to evaluate stone recurrence and to identify any potential risk factors. During follow-up (range 14-34 months, mean 19 months) 44 (23%) of the 192 patients treated with tap water presented recurrence versus 32 (17%) of the 192 patients treated with Fiuggi mineral water, the difference in incidence between the two groups being 6%. Of the possible predictors of recurrence, evaluated at the beginning of follow-up and analyzed in a multivariate statistical study, the 24-hour diuresis and calciuria were seen to be directly related to the recurrence.
Subject(s)
Calcium/analysis , Lithotripsy , Urinary Calculi/chemistry , Urinary Calculi/therapy , Water/administration & dosage , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Risk FactorsABSTRACT
In the last ten years the diagnostic and therapeutical approach to ureteral neoplasms and stones changed their feature, due to improvement of the ureteroscopy. The passage through flexible to rigid and finally semirigid ureteroscopes permitted reduction of invasiveness with higher results. The positive changes to the energy sources, in regard to cost-benefit, it was versus ballistic energy. Ureteroscopy should now be considered as a simple and safe technique, with minimal morbidity and invasiveness and also short operative times.
Subject(s)
Endoscopy/trends , Ureteral Calculi/surgery , Ureteral Neoplasms/surgery , Ureteroscopy/trends , Cost-Benefit Analysis , Endoscopes , Endoscopy/economics , Evaluation Studies as Topic , Humans , Lithotripsy/economics , Lithotripsy/instrumentation , Lithotripsy/methods , Retrospective Studies , Ureteral Calculi/diagnosis , Ureteral Neoplasms/diagnosis , Ureteroscopes , Ureteroscopy/economicsABSTRACT
Idiopathic retroperitoneal fibrosis (RPF) is characterized by the development of a fibrotic mass surrounding the abdominal aorta and its branches, of unknown aetiology. Several immunological mechanisms can be operative in the pathogenesis of RPF. Based on this assumption we treated a patient affected by idiopathic RPF with low-dose methotrexate (MTX) therapy. To our knowledge this is the first example of the effectiveness and safety of a long-term low-dose MTX treatment in the post-surgical management of RPF.
