[Neprhrotic syndrome in a patient with rheumatoid arthritis treated with adalimumab: a case report]. / Sindrome nefrosica in paziente con artrite reumatoide trattato con adalimumab: descrizione di un caso clinico.

The pathogenetic role of TNFalpha in inflammatory diseases has been known for a long time and has modified the therapeutic approach towards this pathology. All over the word, about 400.000 patients have been treated with biological anti-TNF alpha drugs. Particular attention has been taken for the safety of their use. We describe a case of 60 year old man affected by rheumatoid arthritis who has developed nephrotic syndrome with histological pattern typical of systemic lupus erythematosus-like syndrome, without autoantibodies.

[Early diagnosis and prevention of renal disease: collaboration between nephrologists and general practitioners]. / Diagnosi precoce e prevenzione delle nefropatie: collaborazione integrata con i medici di medicina generale.

Our outpatient clinic activity has taught us that a working relationship between general practitioners (GPs) and nephrologists may improve the definition of the diagnostic-therapeutic course for the benefit of the patient. We have therefore contacted the 7 teams comprising 104 GPs and pediatricians working in the area of the Agnelli Hospital in Pinerolo (132,000 inhabitants in 1,404 square kilometers) to assess the possibility of improving and strengthening the collaboration between GPs and nephrologists. The starting point was a direct telephone link aimed at dealing with patients' kidney problems in real time, evaluating history and clinical data, establishing the best timing of treatment, and defining the diagnostic and therapeutic options. The initiative was welcomed at all team meetings and it stimulated further requests for collaboration. One of the main requests was for simple clinical guidelines to deal with the most frequent clinical nephrological issues. This is the program we are carrying out: 1) We have established consulting hours during which GPs can call nephrologists at the hospital to discuss the best diagnostic-therapeutic approach for individual kidney patients. 2) We have identified diseases of common interest (isolated urinary abnormalities; hypertension; nephrotoxicity; abnormal renal function; chronic renal failure; urinary infections; kidney stones). 3) We have planned to draw up clinical guidelines. 4) We will discuss each draft with the team of GPs. On the basis of the gathered suggestions, we will prepare a final version of the guidelines to be sent to the GPs and pediatricians of our area.

Verapamil versus amlodipine in proteinuric non-diabetic nephropathies treated with trandolapril (VVANNTT study): design of a prospective randomized multicenter trial.

Angiotensin converting enzyme inhibitors (ACEI) are the most effective antiproteinuric agents and should be used as first-line drugs in both diabetic and non-diabetic proteinuric nephropathies. The role of calcium channel blockers (CCB) is much more controversial. In diabetic patients verapamil and diltiazem seem more effective than dihydropyridines in reducing urinary protein excretion, and have additive effects with ACEI, but little is available on chronic treatment of non-diabetic nephropathies for non-dihydropyridine CCBs. To test whether the combination of verapamil 180 mg or amlodipine 5 mg with trandolapril 2 mg reduces urinary protein excretion more than trandolapril 2 mg alone, we planned a prospective, randomized, double-blind, multicenter trial. The secondary aims are to evaluate the effects of both treatments on the selectivity of proteinuria and check their safety. Consecutive patients aged between 18 and 70 years with non-diabetic proteinuria > or =2 g/24 h and plasma creatinine < 3 mg/dl or creatinine clearance > or = 20 ml/min are asked to participate. After a four-week run-in during which previous antihypertensive therapy is withdrawn, a single dose of trandolapril 2 mg is given once a day in open conditions for four weeks. At the end of this period patients are randomly assigned to receive once a day, in a double blind fashion, either trandolapril 2 mg and verapamil 180 mg [plus a placebo], or trandolapril 2 mg plus amlodipine 5 mg. They are monitored after one, two, five and eight months.

[Utilization of EPO in CAPD]. / Utilizzo dell'EPO in CAPD.

From January 1988 to September 1990 14 uremic patients in CAPD underwent EPO therapy in the Nephrology and Dialysis Unit of the "E. Agnelli" Hospital in Pinerolo. Intravenous routes were used in 5 patients and subcutaneous routes in the remaining 9 patients, with a unified dose of 4000 IU/three times a week. Both methods were equally efficacious in achieving the set target: partial correction of anemia together with an improvement in the patients' well-being. The most frequent side-effect was increased blood pressure, above all in those patients with pre-existing hypertension. Satisfactory control was achieved by adjusting anti-hypertensive therapy. Low EPO doses, administered via a subcutaneous route once and twice a week (mean dose: 61.6 +/- 35.8 IU/kg/week), allowed hemoglobin values to be maintained at previous levels. On these grounds the method could also be used for patients in hemodialysis.

Treatment of anaemia in CAPD patients with recombinant human erythropoietin.

EPO is an effective therapy of anaemia in CAPD patients. Monitoring serum iron level during EPO therapy is essential. Hypertension is frequently seen in patients with EPO therapy.