C. Campieri

Posttraumatic Chyluria Due to Lymphorenal Fistula Regressed after Somatostatin Therapy

A sudden-onset chyluria after trauma was evaluated giving evidence of a lymphatic-urinary fistula in the right kidney. Treatment with somatostatin normalized the urinary pattern and the result was maintained even after the discontinuation of the therapy.

Epidemiology of Hepatitis C in a Population of Hemodialysis Patients

A search for antibodies against hepatitis C virus (HCV) was performed in 185 patients on chronic hemodialysis by means of 1st and 2nd generation ELISA tests. Immunoblot assays were performed on positive sera. This study shows a 38% prevalence of HCV-positive patients in our dialysis population according to the 2nd generation ELISA test which shows a higher specificity and sensitivity when compared to the 1st generation one (38 vs. 20%). A correlation was found between the prevalence of HCV-positive patients and how long they had been on dialysis and how many blood transfusions they had received.

Family recurrence and oligo-anuria predict uremic restless legs syndrome

Pizza F, Persici E, La Manna G, Campieri C, Plazzi G, Carretta E, Cappuccilli ML, Ferri B, Stefoni S, Montagna P. Family recurrence and oligo‐anuria predict uremic restless legs syndrome. 
Acta Neurol Scand: 2012: 125: 403–409. 
© 2011 John Wiley & Sons A/S.

Alterations of exocrine pancreas in end-stage renal disease. Do they reflect a clinically relevant uremic pancreopathy?

Serum pancreatic enzyme behavior, exocrine function, and morphology of the pancreas were studied in 28 patients with end-stage renal disease undergoing regular hemodialysis, in order to better delineate and assess the clinical relevance of the pancreatic alterations that occur in these patients. Twenty-eight healthy subjects served as controls. Initial studies included serum amylase, isoamylase, and lipase assays; fecal chymotrypsin measurement; and abdominal ultrasonography. The amylase, lipase, and chymotrypsin determinations, as well as ultrasound examination, were repeated four years later. None of the patients had clinical evidence of pancreatic disease at entry into the study, but one had had previous attacks of pancreatitis and another developed mild acute pancreatitis one month after entry. Initial mean serum enzyme levels were significantly higher in patients than in controls (amylase, pancreatic isoamylase, and lipase,P<0.001; salivary isoamylaseP<0.05). Serum amylase was raised in 16/28 patients; pancreatic isoamylase in 15/28, and lipase in 7/28; these elevations were generally mild. Mean fecal chymotrypsin was significantly lower (P<0.001) in patients than in controls: abnormally low values were found in 9/28 patients. Amylase, lipase and chymotrypsin measurements repeated after four years showed no significant difference with respect to the first study. Ultrasonographic changes were rare and mild: one patient had a small cyst in the pancreas head, another, an increase in echogenicity of the gland not related to age; these findings were unchanged at repeat examination. The results demonstrate that the frequent elevations of serum pancreatic enzymes and the rare sonographic changes found in patients undergoing hemodialysis do not generally reflect a relevant pancreopathy. However, the finding of significantly decreased fecal chymotrypsin may indicate the presence of pancreatic dysfunction in end-stage renal disease.

Normalization of Renal Function and Blood Pressure after Dissolution with Intra-Arterial Fibrinolytics of a Massive Renal Artery Embolism to a Solitary Functioning Kidney

The intra-arterial administration of fibrinolytics in a massive embolism to the renal artery of a solitary functioning kidney determined quick normalization of the severe renal failure and hypertension.

Group I nonreciprocal inhibition in restless legs syndrome secondary to chronic renal failure.

BACKGROUND Neurophysiological investigations disclosed spinal cord hyperexcitability in primary restless legs syndrome (p-RLS). Uremic RLS (u-RLS) is the most common secondary form, but its pathophysiological mechanisms remain unsettled. Aim of this study was to explore spinal cord excitability by evaluating group I nonreciprocal (Ib) inhibition in u-RLS patients in comparison with p-RLS patients and healthy subjects. METHODS Eleven u-RLS patients undergoing long-term hemodialysis treatment, nine p-RLS patients and ten healthy subjects were studied. Soleus H reflex latency (HR-L), H(max)/M(max) ratio, and Ib inhibition were evaluated. Ib inhibition was tested measuring the amplitude changes in soleus H reflex following stimulation of the synergist gastrocnemius medialis (GM) nerve at rest. Nerve conduction studies were performed in the uremic patients. RESULTS The H(max)/M(max) ratio did not differ in the three groups. The u-RLS patients showed a normal Ib inhibition comparable with the healthy group, whereas the p-RLS group had evidence of a reduced active inhibition compared with both u-RLS patients (P = 0.04) and controls (P = 0.007), prominently at 5 ms (P = 0.007) and at 6 ms (P = 0.02) of conditioning-test interval. Neurophysiological examination disclosed abnormalities ranging from higher HR-L to clear-cut polyneuropathy in most u-RLS patients. CONCLUSIONS Unlike p-RLS patients, u-RLS patients had normal Ib inhibition, suggesting a regular supraspinal control of Ib spinal interneurons. Subclinical peripheral nerve abnormalities were detected in most uremic patients. Peripherally disrupted sensory modulation may represent the major pathophysiological determinant of uremic RLS.

Guilielmus de Saliceto and His Contributions to Renal Medicine

Guilielmus, one of the most outstanding physicians of the 13th century practised a bedside teaching method and gave guidelines for diagnosing and treating diseases. Written summaries of clinical case histories were his basic didactic instruments and his practise was characterized by a high awareness of doctor-patient relations.

The Age-Old Spirit of Nephrology from the Oldest University in the World

The University of Bologna began teaching in 1088, and the Faculty of Medicine was granted the same rights as lawyers in 1288, largely due to the reputation and teaching skills of Taddeo Alderotti. Among the other famous names associated through the ages with the Bologna School of Medicine are Malpighi, Valsalva and Murri. From the earliest times in Bologna, nephrologists attempted to show an interaction of the kidney with the outer environment (astronomy and astrology) and with other organs (anatomy) and an integration of the sophisticated structures within the kidney itself (microscopy). At the turn of the 19th century, the biochemical frontier was reached, and a new teaching methodology emphasizing careful consideration of all possible differential diagnoses was developed.

THE ACADEMY OF SCIENCE OF BOLOGNA AND THE KIDNEY

The Academy of Science of Bologna, founded in 1711, played an important role in the development of medicine. Receiving the heritage of Malpighi’s and Morgagni’s researches, the academy encouraged nephrological studies, which produced articles published in its journal, the Commentarii. Since the Commentarii were widely distributed all over Europe, the nephrological research practiced in Bologna reached all the main academies of science, in a fruitful circulation of knowledge. The paper presents the nephrological contributions to the Commentarii in the 18th century, thus introducing physicians, like Domenico Galeazzi and Luigi Galvani, who were both professors at the University of Bologna and at the Academy of Science. In their work three main topics can be identified: uroscopy, anatomy of the kidney and renal pathologies.

Evans syndrome in renal transplantation: correlation between drops in platelet and red blood cell counts and rejection.

Dr. Claudio Campieri, Nephrology Institute, S. Orsola University Hospital, V. Massarenti, 9, I-40138 Bologna (Italy) Dear Sir, Immune thrombocytopenic purpura (ITP) can occur in patients with kidney transplantation in whom a ‘drop’ in platelet count can be the only clinical expression of this disease [1]. ITP can be associated with autoimmune hemolytic anemia in Evans syndrome [2]. In a transplanted patient with ITP we detected features of Evans syndrome and found a highly significant correlation between the increase in serum creatinine associated with rejection on the one hand, and platelet and RBC drops on the other hand. A 59-year-old woman who had undergone cadaveric renal transplantation in January 1979 presented a serum creatinine of 2 mg/dl while under therapy with azathio-prine 50 mg/day and prednisone 25 mg/day. In October 1995, an immune thrombocytopenic crisis with a platelet count of 80,000/ mm3 was diagnosed in the presence of direct and indirect antiplatelet antibodies. A previous drop in platelet count (50,000/mm3) dated back to June 1987 during an episode of rejection (serum creatinine up to 2.3 mg/ dl). By that time, RBC count was 2,910,000/ mm3 with a Hb of 9 g%. A cross-match was positive for HLA-A33 antigen. Enhanced antirejection therapy resolved the episode of rejection (creatinine 1.1 mg%) and increased the platelets (up to 180,000-220,000/mm3) as well as RBCs (up to 3,870,000/mm3) within 5 days. In August 1987, a thrombophlebitis of the right leg led to hospital admission associated with thrombocytopenia (60,000/ mm3) and autoimmune hemolytic anemia (3,125,000/mm3) with a positive direct and indirect Coombs’ test. In this patient we analyzed the serum creatinine values and platelet and RBC counts during 3 hospital admissions for rejection episodes and 5 hospital admissions not related to rejection (ureteral stenting, acute gastroenteritis, pulmonary infection, cyclospo-rine toxicity), as shown in table 1. Asymptomatic drops in platelet count (80,000-120,000 platelets/mm3) and hemolytic anemia ( < 3,000,000/mm3) have been detected during hospital admissions for rejection, and an enhancement in immunosup-pressive therapy either resolved the rejection or increased platelet and RBC count.