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1.
G Ital Nefrol ; 39(2)2022 Apr 21.
Artigo em Italiano | MEDLINE | ID: mdl-35470998

RESUMO

Creating an arteriovenous fistula (AVF) is complicated by the gradual increase in the average age of patients initiating chronic haemodialysis treatment and by the greater prevalence of pathologies that impact the cardiovascular system. In the past, the choice of which vessels to use for the creation of the AVF was essentially based on the physical examination of the upper limbs. Current international guidelines suggest that a colour doppler ultrasound (DUS) should be performed to complete the physical examination. Similarly, vascular ultrasound is fundamental in the post-operative phase for appropriately monitoring the access. We have conducted a retrospective analysis on the use of DUS in clinical practice in our centre, in order to determine the repercussions on vascular access survival. To this end, we identified three phases, according to the methods that were used for pre-operative vascular evaluation and monitoring of the AVF, that saw the progressive integration of clinical and ultrasound parameters. The analysis of the data highlighted a statistically significant higher rate of survival for all vascular accesses, evaluated as a whole, and for distal AVFs, in the third phase, despite a greater percentage of patients over 75 (48% vs 28%). In conclusion, we believe that an approach integrating clinical and ultrasound evaluation is indispensable to identify the most suitable AVF site and guarantee its efficiency over time.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Diálise Renal/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia , Grau de Desobstrução Vascular
2.
G Ital Nefrol ; 31(4)2014.
Artigo em Italiano | MEDLINE | ID: mdl-25098465

RESUMO

The Piedmont Group of Clinical Nephrology compared the activity of 18 nephrology centers in Piedmont and Aosta Valley as regards acute pielonephritis (APN). Data from more than 500 cases per year of APN were examined. The microbial spectrum of APN consists mainly of Escherichia coli and Klebsiella pneumoniae. Diagnosis was based on both clinical and radiological criteria in most of the centers (computed tomography-CT o Magnetic Resonance Imaging-MRI). In four centers diagnosis was made with the radiological criteria and in one center only with the clinical features. CT and MRI were performed in about 47% and 44% of cases respectively. Urine culture was positive in 22 up to 100% of cases. The most commonly used antibiotics were fluoroquinolones (ciprofloxacin or levofloxacin) and ceftriaxone (50% of centers) or amoxicillin/clavulanic acid (25% of centers). In 75% of the centers, patients received a combination of two antibiotics (aminoglycoside in 22% of them ). In 72% of the centers, almost 50% of the patients were re-examined, while 38.8% of centers re-examined all the patients. Renal ultrasound was inappropriate to identify abscesses. The mean of patients in whom renal abscesses were detected by CT or MRI was 18.2%. The analysis shows a high variability in the way of diagnosing and treating APN in Piedmont and Aosta Valley regions. This suggests that even if APN is a frequent pathological condition, practical recommendations are required.


Assuntos
Abscesso Abdominal , Infecções Bacterianas , Nefropatias/microbiologia , Pielonefrite , Infecções Urinárias , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/tratamento farmacológico , Doença Aguda , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Feminino , Humanos , Itália , Nefropatias/diagnóstico , Nefropatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico
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