Giornale di Clinica Nefrologica e Dialisi

New biomarkers in kidney transplant

Maurizio Salvadori — 2024-11-21

Recently, new interesting and important novel biomarkers have allowed the evidence based medicine to move to a new field called precision medicine. In particular, this apply to organ transplantation and to the diagnosis of rejection.

Among these novel biomarkers are the study of donor-derived cell-free DNA when present in the blood of the recipients, the study of gene expression profiling again in the recipient, and the study of several urinary cytokines. All these novel biomarkers have several advantages over the old biomarkers. Indeed, they are non-invasive, are able to detect renal damage before the appearance of histological abnormalities, and are able to distinguish antibody-mediated rejection from cell-mediated rejection. The aim of this study is to identify the most recent findings on these biomarkers and to describe their utility and their limitations in particular in the field of kidney acute rejection.

Sustainability and dialysis: The 4 main points for a green dialysis

Federica Lima — 2024-10-16

Dialysis represents a big challenge for the environmental sustainability, because it is bound to high consumption of water and electricity, hazardous waste incineration and subsequent greenhouse gas emissions. In recent years, it has been recognized the urgent need to preserve our environment together with the people’s health, starting from making dialysis greener. This awareness has led to a new paradigm in the history of dialysis, the concept of Green Nephrology. The Italian Society of Nephrology published in 2020 a Position Statement with ten affordable actions with the aims to increase awareness, propose joint actions and coordinate industrial/social interactions. Starting from these, there are four key points to pave the way for environmental sustainability: 1) Sustainable technologies (i.e., machines, filters, water treatment systems, acid concentrates, lighter materials, electronic patient record); 2) Green dialysis centers; 3) Environmental improvement projects, using tools to define targets and their monitoring; 4) Nursing role, as the nurse is the main environmental sustainability promoter. To achieve Green Nephrology a partnership between all the stakeholders of the healthcare system is necessary. Since the growing awareness of the problem and the existence of ways to solve it, it’s time to act and the effective way to do this is to implement all the solutions provided in this article in an immediate future.

Extracorporeal renal replacement treatment and environmental sustainability: the point of view of the technology manufacturer

Alessandro Corsi — 2024-10-09

Healthcare contributes significantly to resource depletion and greenhouse gas emissions; this is because the production, transportation, use and waste disposal of the necessary products are involved.

Since renal replacement treatment has a big impact in this context, all the community involved in this sector should have a clear policy and a full awareness on the conservation of the environment and its sustainability.

The products of HD technologies are looking forward the future to take part in this awareness.

Advanced CKD and gender: a multi-perspective and multi-dimensional vision

Anna Laura Fantuzzi — 2024-03-08

Chronic kidney disease (CKD) is present in approximately 7% of the population in the world: several studies have highlighted socio-cultural discrimination, to the detriment of women, in referral to specialist nephrological care and access to dialysis and transplantation. Globally, gender discrimination limits the possibility of access to education and medical care and the involvement in clinical trials. Women on dialysis have different comorbidities than men; the choice to follow a predialysis process and the subsequent orientation towards dialysis treatment are certainly influenced by gender as is the choice of dialysis access. As regards kidney transplantation, women are more likely to offer themselves as donors rather than to be beneficiaries. Conventional knowledge supports the belief that there are gender differences in the acquisition, preparation and consumption of food; for this reason it is essential to consider the variables that come into play when defining and agreeing treatment paths, in particular in taking care of people with chronic diseases such as CKD.

Percorsi diagnostico-terapeutici condivisi nel territorio sardo in nefrologia e dialisi. Oristano, 29-30 Novembre-1 Dicembre 2023

2024-05-06

No abstract

Nutritional therapy in chronic kidney disease

Antonio Santoro — 2024-03-04

Dietary-Nutritional Therapy (DNT) is an essential component of the conservative management of patients with chronic kidney disease (CKD) as it helps to maintain the optimal nutritional status and to prevent and/or correct symptoms and complications of CKD. Moreover, it allows adherent patients to delay the onset of dialysis, leading to an improved quality of life and cost savings for both patients and the community. Through a survey, we aimed to evaluate how personalized diets were assessed, administered, and experienced by CKD patients. A questionnaire was administered to 180 patients from 4 Nephrology Centers in Lombardy (Italy) regarding their CKD and nutritional therapy. It showed that 73% of patients received dietary prescriptions. In 40% of cases, dietary prescriptions were administered in dedicated clinics and were valued as much as pharmacological ones. Most diets prescribed were low-protein diets (0.8 g protein per kg of body weight), although some included very low protein diets supplemented with keto analogues. Unfortunately, after the initial prescription, the monitoring of the adherence to nutritional therapy is not particularly frequent. In conclusion, our survey suggests that while patients in different Nephrology Centers receive proper dietary prescriptions and follow-ups, there is space for improvement with positive implications for CKD progression, delaying dialysis therapy.

Abstracts 42nd SIAN ITALIA National Congress. Nephrological nursing: role, skills and sustainability, Riccione 6-8 May 2024

2024-05-05

No abstract

#AIRPforlife

Luisa Sternfeld Pavia — 2024-04-30

No abstract

Voice of the patients

Luisa Sternfeld Pavia — 2024-04-30

No abstract

Supporting couples with polycystic kidney disease in a preimplantation genetic diagnosis process

Daniela Zuccarello — 2024-04-30

Preimplantation diagnosis process for couples with polycystic kidney disease involves several steps: genetic and gynecological counseling, in vitro fertilization (IVF/ICSI), embryo biopsy, genetic analysis, selection of healthy embryos and implantation.

The importance of preimplantation diagnosis for couples affected by polycystic kidney disease (PKD) lies in several key factors:

1. prevention of inherited disease: PKD is a genetic disorder with a high likelihood of being passed from parent to offspring. Preimplantation diagnosis offers couples the opportunity to identify and avoid passing on the disease to their children;

2. family planning options: by undergoing preimplantation diagnosis, couples can make better decisions about their family planning options. They can select embryos that do not carry the PKD gene mutation and reduce the risk of having a child affected by the disease;

3. emotional burden reduction: PKD can lead to significant emotional burdens for affected individuals and their families. Preimplantation diagnosis provides a proactive approach to avoid these burdens by preventing the transmission of the disease to next generations;

4. enhanced reproductive choices: with preimplantation diagnosis, couples have a greater control over their reproductive choices. They can pursue assisted reproductive techniques such as in vitro fertilization (IVF) while simultaneously minimizing the risk of passing on PKD to their offspring;

5. improved pregnancy outcomes: by selecting embryos that are free of the PKD gene mutation, couples increase the likelihood of having a healthy pregnancy and a child free of the disease. It can lead to improved pregnancy outcomes and the birth of healthy children. Overall, preimplantation diagnosis offers hope and empowerment to couples affected by PKD by providing them with the means to build a family while minimizing the risk of passing the disease to next generations.

Customization of hormone therapy in women with autosomal dominant polycystic kidney disease (ADPKD): actionable strategies and future perspectives

Martina Catania — 2024-04-30

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetically inherited kidney disease and the fourth leading cause of renal replacement therapy worldwide. It is characterized by the development of multiple cysts in the kidneys and in other organs, the increase in renal volume and the progressive loss of renal function. ADPKD outcome seems to be sensitive to hormonal fluctuations, particularly those of sex hormones. Despite the limited literature available, this review presents the first comprehensive overview of contraception and hormonal replacement therapy in women with ADPKD, delving into the risks and benefits associated with different contraceptive methods, including hormonal, intrauterine devices, and non-hormonal approaches. It also explores personalized strategies for contraception based on the severity of renal disease and the presence of comorbidities.

Although the protective role of female sex hormones in slowing the progression of renal failure is acknowledged, hormonal therapy in women with ADPKD remains intricate and challenging due to its potential impact on liver disease progression. Women with ADPKD typically experience a slower progression of renal disease compared to men, largely influenced by hormonal dynamics.

This literature review underscores the importance of a multidisciplinary assessment and a thorough patient discussion to identify the most suitable contraceptive method for each woman affected by polycystic kidney disease.

Supporting complexity: the psychologist’s role in multidisciplinary management of polycystic kidney disease

Sara Farinone — 2024-04-30

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease. It is characterized by the formation of cysts in kidneys. This condition has a significant impact on people’s lives. It causes not only physical suffering but also psychological suffering. People with ADPKD may experience psychological distress, depending on their personal and health conditions. The inability to accept or adapt to the disease and its resulting changes causes individuals difficulties that appear in different levels of their lives: intrapersonal, interpersonal, social, and occupational.

In the context of ADPKD, the psychologist is involved both at clinical and research levels. The psychologist has a crucial role in supporting patients by assessing how they react to the disease, to its related limitations, and to the resulting disabilities.

The proposal of psychological support, considered as an intervention instrument, is helpful both at the diagnostic stage and in follow-up, as the disease worsens. The support aims to encourage acceptance and adaptation to the disease, process changes, and physical and mental consequences.

Green nephrology: for a sustainable nephrology

Marco Lombardi — 2024-10-07

Kidney health management during pregnancy: a dialogue between patients and healthcare professionals

Anna Laura Fantuzzi — 2024-09-12

Pregnancy in patients with chronic kidney disease (CKD) represents a significant challenge for nephrologists and healthcare professionals involved in the care pathway, especially in advanced stages of the disease and during dialysis. From an epidemiological standpoint, the exact percentage of women with CKD who become pregnant is unknown. It is estimated that stages 1 and 2 of kidney disease (where kidney function is still preserved or mildly impaired with persistent albuminuria) affect up to 3% of women of childbearing age (20-39 years), while stages 3-5 (glomerular filtration rate < 60 mL/min) affect about 1 out of 150 women of childbearing age. However, due to reduced fertility, these women often experience spontaneous miscarriages in the early months of pregnancy, and 1 out of 750 faces complications in her offspring.

As a result, managing pregnancy in CKD patients requires special attention, considering various clinical aspects including the reciprocal influence between the disease and pregnancy, the need to adjust therapies, the modification of treatments, and the high risk of maternal and fetal complications. An appropriate nutritional approach is also a crucial phase in this process, as nutritional status significantly influences maternal and fetal health. In this article, developed through questions posed to physicians and the case manager during routine care, we do not intend to address the entire complex issue linking kidney disease to pregnancy outcomes. Instead, we aim to provide updated answers to various topics of interest for the multidisciplinary team to safeguard the health of both mother and child.

Infective complications in the renal transplant recipients

Giuseppina Rosso — 2024-02-26

Infections remain a common complication of solid-organ transplantation and are a major factor of morbidity and mortality in renal transplant recipients.

The incidence of infection in renal transplant patients is directly related to the net immunosuppressive effect achieved and the duration of the administration of immunosuppressive therapy.

The major types of infections can be categorized according to the time post-transplant during which they occur: in the first month after transplantation post-surgical bacterial infections and in the period from one to four months post-transplant opportunistic infections, overall cytomegalovirus; late infections, beyond 6-12 months, are community-acquired infections.

Opportunistic infections (like Pneumocystis carini, Listeria monocytogenes, and Aspergillus fumigatus) most frequently occur in the first 12 months post-transplant and can be modulated by prior exposures and the use of prophylaxis.