Alfredo Capuano

Salt Intake and Renal Outcome in Patients with Progressive Renal Disease

Experimental studies suggest that salt intake plays a critical role in the progressive glomerular filtration rate (GFR) loss of established renal disease; however, this issue has never been addressed in humans. To this aim, we have retrospectively analyzed the clinical data of patients with chronic renal failure (CRF), in whom a low-protein diet was prescribed, over a period of about 3 years. On the basis of the daily urinary sodium output, the patients were divided into two groups: a group of patients constantly ingesting >200 mEq NaCl/day (high sodium intake, HSD, n = 30) and a group in which salt intake was <100 mEq/day (low sodium intake, LSD, n = 27). Patients taking diuretics or ACE inhibitors were excluded. At baseline, the LSD group, as compared to the HSD group, was characterized by significantly lower creatinine clearance (24 ± 2 vs. 28 ± 2 ml/min) and higher proteinuria (2.9 ± 0.3 vs. 1.5 ± 0.2 g/day). Despite the presence of these risk factors for progression, and a similar control of blood pressure (the average of the mean arterial pressure during follow-up was 111 ± 2 mm Hg in LSD and 107 ± 2 mm Hg in HSD), the LSD patients showed a better renal outcome: in this group, as compared to HSD, the GFR decline was lower (0.25 ± 0.07 vs. 0.51 ± 0.09 ml/min/month, p < 0.05), and proteinuria did not change while it markedly increased in HSD. During follow-up, LSD patients also ingested a significantly lower amount of protein. This study therefore suggests that efficacious salt restriction in CRF patients improves the outcome of renal disease independent from its antihypertensive effects.

Immunomodulatory Effect of Continuous Venovenous Hemofiltration during Sepsis: Preliminary Data

Introduction. Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many pro- and anti-inflammatory mediators, such as interleukin-6 (IL-6), play a strategic role in septic syndrome. Continuous renal replacement therapy (CRRT) removes in a nonselective way pro- and anti-inflammatory mediators. Objective. To investigate the effects of continuous venovenous hemofiltration (CVVH) as an immunomodulatory treatment of sepsis in a prospective clinical study. Methods. High flux hemofiltration (Qf = 60 ml/Kg/hr) was performed for 72 hr in thirteen critically ill patients suffering from severe sepsis or septic shock with acute renal failure (ARF). IL-6 gene expression was measured by real-time PCR analysis on RNA extracted from peripheral blood mononuclear cell before beginning of treatment (T0) and after 12, 24, 48, and 72 hours (T1–4). Results. Real-time PCR analysis demonstrated in twelve patients IL-6 mRNA reduction after 12 hours of treatment and a progressive increase after 24, 48, and 72 hours. Conclusions. We suggest that an immunomodulatory effect might exist during CVVH performed in critically ill patients with severe sepsis and septic shock. Our data show that the transcriptional activity of IL-6 increases during CVVH.

Preeclampsia in women with chronic kidney disease.

Objective: Women with chronic kidney disease have an increased risk of developing preeclampsia and its severe complications. Currently, there are no assessments available in order to quantify such risk. The aim of the study is to establish the incidence of superimposed preeclampsia in women with chronic kidney disease according to Serum creatinine (SCr) level. Methods: Pregnant women with chronic kidney disease were retrospectively identified from January 2000 to July 2010. We defined two groups according to SCr: Group 1: SCr ≤ 125 µmol/l; Group 2: SCr > 125 µmol/l. Incidence of preeclampsia, early preeclampsia (delivery <34 weeks), gestational age (GA) at diagnosis and delivery outcome were assessed. Results: Ninety-three nephropatic women were considered for the analysis. Group 2 (n = 14) compared with Group 1 (n = 79) had an increased incidence of preeclampsia (78.6% vs. 25.3%; p < 0.0001), an increased rate of pregnancy complications as early preeclampsia (82% vs. 38%; p < 0.03), a lower GA at diagnosis (29 ± 2 vs. 33 ± 1 weeks; p < 0.04) and a lower GA at delivery (30 ± 2 weeks vs. 34 ± 1; p < 0.04). Conclusion: Women with chronic kidney disease and an increased creatinine threshold have a high risk of developing preeclampsia and delivering preterm.

Human plasma ultrafiltrate purification by membrane distillation: process optimisation and evaluation of its possible application on-line

Membrane distillation may represent an innovative tool to ameliorate treatment of uraemia by allowing the purification of the blood ultrafiltrate and the re-injection of the purified water to the patients. The optimisation of the overall process in terms of energetic requirements, membrane area, and operating conditions has been made in order to propose a clinical application of the technique.

Hemodialysis related interleukin-2 receptor release by peripheral blood mononuclear cells.

To evaluate the effects of hemodialysis treatment on the spontaneous cell release of interleukin-2 receptor (IL-2R), we studied 19 hemodialyzed patients (HD), 9 non hemodialyzed patients with chronic uremia (UR, glomerular filtration rate: 8.4 +/- 1.8 ml/min), and 8 healthy control subjects (C). We measured the release of IL-2R in the supernatant of peripheral blood mononuclear cells (PBMC) cultured for 24 hrs in Iscoves medium as well as the plasma levels of IL-2R. A significant increase of IL-2R release was detected in the supernatant of PBMC harvested from HD patients (32.4 +/- 2.4 and 34.2 +/- 5.6 U/3 x 10(6) PBMC daily before and after HD, respectively) as compared with UR (16.6 +/- 5.2 U/3 x 10(6) PBMC daily) and C (21.4 +/- 3.8 U/3 x 10(6) PBMC daily). Similarly, IL-2R plasma levels were significantly higher in HD (378.5 +/- 164.6 U/ml) than in UR (189.5 +/- 89.3 U/ml) and C (11.2 +/- 2.68 U/ml). To summarize, the current study demonstrates: a) an enhancement of spontaneous IL-2R cell release in HD patients; b) an increase of sIL-2R plasma levels in UR patients possibly related to reduced metabolism and/or urinary excretion, because it was not associated with high IL-2R cell release; and c) a further increment of IL-2R systemic levels in HD likely secondary to the high cell release of IL-2R. Therefore, a chronic T cell activation with increased release of IL-2R secondary to the dialysis procedure is suggested.

Multimodal treatment of calcific uraemic arteriolopathy (calciphylaxis): a case series

Background This is an incident series of five dialysis patients with late-diagnosed calcific uraemic arteriolophathy (CUA), severe uncontrolled hyperparathyroidism and infected skin ulcerations. Methods A multimodal intervention was based on wound care, antibiotics, surgical debridement, sodium thiosulphate and cinacalcet and associated with regression of skin disease in four cases after varying treatment time periods ranging from 4 to 33 months. Results Multimodal treatment including sodium thiosulphate and cinacalcet was associated with very favourable local outcomes and survival. This series further confirms that the diagnosis of CUA is rarely made at the nodular, non-ulcerative phase of the disease. Conclusions This series contributes to the build-up of case series reporting on the treatment of CUA, and will hopefully serve as a basis of well-conceived comparative effectiveness studies investigating the value of the combined interventions applied so far in this severe condition.

Hemodialysis does not affect ventricular–arterial coupling beyond the reduction of blood pressure and preload

blood pressure and preload Laura Sasso , Alfredo Capuano , Maristella Minco , Antonella Paglia , Flora Pirozzi , Bruno Memoli , Guido Carlomagno , Mario Petretta , Domenico Bonaduce a,⁎ a Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Division of Internal Medicine, Federico II University, Naples, Italy b Department of Pathology, Division of Nephrology, Federico II University, Naples, Italy

Renal Radiology and Acute Renal Failure

Patients with ARF require early diagnosis of the type of ARF and of the exclusion of surgically correctable causes such as renal artery occlusion or urinary tract obstruction.

Is Malnutrition a Clinically Evident Condition in Patients Undergoing Hemodialysis

Several studies have indicated that patients undergoing hemodialysis (HD) may develop protein-energy malnutrition (1,2). However, few attempts have been made to assess if wasting may occur in HD patients even when they appear healthy by a simple clinical examination. The purpose of this study was to evaluate the occurrence of malnutrition in a selected group of healthy patients considered in good nutritional status by clinical judgement.

Relationship Between Physical Activity and Nutritional Status in Patients on Maintenance Hemodialysis

Gutman and coworkers have recently reported that only 60% of non-diabetic patients on maintenance hemodialysis are capable of physical activity beyond caring for themselves and even fewer are able to work outside home (1). Other common characteristics of dialysis patients which may directly affect rehabilitation are malnutrition and psychic depression.