[Home Hemodialysis: new organizational models to favor the economic and environmental sustainability in the province of Belluno].

The prevalence of chronic kidney disease is 7.05% in Italy. The replacement dialysis treatments determine greenhouse gas emissions thus contributing to climate change, an important source of risk to global health. Furthermore, the percentage of the Italian Gross Domestic Product destined to public health expenditure has progressively contracted. The province of Belluno has an area of 3610 km2, with a population density of 56 people/km2, an old age index of 248.5, and offers 4 dialysis centers; however, several patients take up to 8 hours/week to commute to the dialysis center, with a consequent significant environmental and economic impact. We have investigated the Home Hemodialysis (H-HD) models, both as Assisted Home Hemodialysis (AH-HD), and as Not-assisted Home Hemodialysis (NH-HD), to evaluate their environmental and economic sustainability, and the actual impact due to their adoption by 5 patients. Thanks to AH-HD it is possible a reduction up to 3767 kg of CO2 per year, and an economic saving of € 32 456 per year. Utilizing a NH-HD treatment, it is possible a reduction of 5330 kg of CO2 per year, and a reduction in annual healthcare costs up to € 30 156 per year. Furthermore, the adoption of H-HD treatment for 5 patients allowed an effective reduction of 14 537 kg of CO2 emitted and a net economic saving of € 57 975. Therefore, we consider H-HD methods a valid option for patients living in areas with low population density, where transports have a significant impact, allowing a net reduction of CO2 equivalent emissions and a considerable saving of the health resources.

[Minimal Change Relapse During Pregnancy].

The appearance of nephrotic syndrome during pregnancy is considered an exceptional event, whose incidence is around 0.012-0.025% of all pregnancies, and it is even more rare when the cause is represented by minimal lesions glomerulonephritis. In this article we will describe the case of a patient with a histological diagnosis of glomerulonephritis with minimal lesions, tending to frequent relapses. She was in complete remission since 2013 after treatment with cyclosporine. suspended in May 2017. After few weeks she become pregnant, and the pregnancy was regular until the 23rd week. when a recurrence of nephrotic syndrome appears. She was treated with steroids bolus followed by oral steroid, and afterwards gave birth to a live fetus with spontaneous delivery at 37 weeks The few data in the literature confirm that recurrence of glomerulonephritis due to minimal lesions in pregnancy should be treated rapidly with steroids, that can induce rapid remission and protect both the pregnant than the fetus from even serious damage.