Publications by authors named "Fiaccadori E"

Introduction: Mucosal inflammation is involved in the pathophysiology of immunoglobulin-A nephropathy (IgAN); however, peripheral immune phenotype analyses of patients with IgAN often do not include unconventional T cells, the major subset in mucosal immunity.

Methods: We measured serum total IgA, galactose-deficient IgA1 (gd-IgA1), secretory IgA (SIgA), B cell-activating factor (BAFF), and A proliferation-inducing ligand (APRIL) in 66 patients with IgAN and 30 healthy controls (HCs). We also quantified the total IgA and gd-IgA1 in stool supernatant along with the same coated on bacteria.

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Background: Sustained-Low Efficiency Dialysis (SLED) is an increasingly used Kidney Replacement Therapy (KRT) modality in critically ill patients. This study was aimed at evaluating the safety and efficacy of simplified Regional Citrate Anticoagulation (RCA) for SLED using new hemodialysis equipment.

Methods: The 8-hour SLED sessions were performed with a Surdial X Nipro hemodialysis machine and a cellulose triacetate filter.

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Acute kidney injury (AKI) is a complex clinical syndrome characterized by a rapid decline in kidney function, often resulting in complex metabolic and hormonal derangements. A major concern in managing AKI patients is the development of protein energy wasting (PEW), a condition marked by loss of lean body mass and negative impact on overall health outcomes. Additionally, the need of Kidney Replacement Therapy (KRT) for the most severe forms of AKI may further increase the risk of PEW, with a substantial impact on fluid and metabolic balance.

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  • * Despite the known association with complement activation, evidence shows that microvascular inflammation and endothelial damage can occur independently of this system, particularly in late AMR (>6 months post-transplant).
  • * The review discusses differences in mechanisms and clinical features between early and late AMR, suggesting that treatment strategies should reflect these variations in underlying inflammatory processes and complement activation levels.
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Cholesterol crystal embolism (CCE) is an underrecognized multisystemic disease caused by the displacement of cholesterol crystals from atheromatous aortic plaques to distal vascular beds, leading to ischemic injury of target organs, particularly the kidneys, i.e., atheroembolic renal disease (ARD).

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  • Antibody-mediated rejection (AMR) is a major cause of long-term kidney transplant failure, even with advancements in immunosuppressive therapies.
  • * A case is described where late active AMR progressed to severe chronic active AMR, treated with a multidrug approach.
  • * The current treatment options and understanding of AMR, including the role of donor-specific antibodies and various therapeutic strategies, highlight a need for improved guidelines based on stronger evidence.*
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  • Gastrointestinal severe adverse events like ulceration and perforation have been linked to polystyrene sulfonate and sevelamer, especially in patients with chronic kidney disease, but the exact cause is unclear.* -
  • A meta-analysis of existing research found that polystyrene sulfonate is significantly more likely to cause severe issues such as necrosis or perforation compared to sevelamer (p < 0.001).* -
  • The findings indicate that while sevelamer may cause inflammation or ulceration, polystyrene sulfonate is more strongly associated with severe outcomes, including a higher risk of death (p < 0.001).*
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Key Points: We conducted a clinical, genetic, and pathological analysis on 64 cases from 39 families with TRPC6-associated podocytopathy (TRPC6-AP). Analysis of 37,542 individuals excluded a major contribution of loss-of-function variants to TRPC6-AP, legitimating current drug discovery approaches. This study identifies key features of disease that can help intervention studies design and suggests similarities between TRPC6-AP and primary FSGS.

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  • Understanding the significance of kidney disease (KD) in hospitalized patients, this guideline aims to provide evidence-based nutritional recommendations due to the metabolic and nutritional impacts of acute (AKD) and chronic kidney disease (CKD).
  • The guideline development involved a systematic review of literature from 1999 to 2020, leading to over 30 recommendations on assessing nutritional status, identifying at-risk patients, and integrating nutrition with kidney replacement therapy (KRT) through a consensus process.
  • The conclusion emphasizes the diverse nutritional needs of patients with KD, advocating for personalized nutrition strategies to prevent underfeeding and overfeeding, and offering practical advice for daily clinical practice.
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IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. IgAN causes end-stage kidney disease (ESKD) in 30-40% of all cases. The activation of the complement system by pathological circulating IgAs, which is often associated with low serum C3 levels (LowC3), seems to play a crucial role.

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  • The study examines the necessity of treatment with intravenous steroids versus clinical follow-up for kidney transplant recipients diagnosed with "borderline" acute T-cell mediated rejection (TCMR).
  • Researchers followed 59 patients over 12 months, comparing the groups receiving treatment (TRT) and those with simple clinical follow-up (F-UP), measuring trends in renal function through estimated glomerular filtration rate (eGFR).
  • Results showed that while the TRT group initially had lower kidney function, they reached comparable eGFR levels to the F-UP group after 12 months, indicating that treatment may be beneficial in cases with indication biopsies.
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Background: Estimation of muscle mass is a pivotal component in the diagnosis of protein-energy wasting and sarcopenia. While bioimpedance spectroscopy is a widely  accepted technique for the assessment of lean tissue related to the diagnosis of sarcopenia, to date skeletal muscle ultrasound (US) has not gained full acceptance for this purpose. The aim of this study was to assess the predictive value for mortality of the indexed thickness of the quadriceps vastus intermedius, as measured by US, compared to lean tissue index as estimated by bioimpedance spectroscopy, both combined with handgrip strength in a group of patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD).

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  • The study focuses on critically ill patients with Sars-Cov-2 pneumonia, examining how muscle mass and fat infiltration (myosteatosis) relate to patient mortality in the ICU.
  • Researchers conducted a retrospective analysis of 110 patients, measuring muscle and fat areas using chest CT scans and found a significant link between the levels of myosteatosis and higher mortality rates.
  • The findings suggest that assessing myosteatosis through CT scans can serve as an important prognostic marker for predicting outcomes in these patients.
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African Americans have a significantly higher risk of developing chronic kidney disease, especially focal segmental glomerulosclerosis -, than European Americans. Two coding variants (G1 and G2) in the APOL1 gene play a major role in this disparity. While 13% of African Americans carry the high-risk recessive genotypes, only a fraction of these individuals develops FSGS or kidney failure, indicating the involvement of additional disease modifiers.

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Background: Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease.

Methods: We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival.

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The use of dabigatran in patients with non-valvular atrial fibrillation (AF) has widely increased in the last decades, due to its positive effects in terms of safety/efficacy. However, because of the risk of major bleeding, a great degree of attention has been suggested in elderly patients with multiple comorbidities. Notably, dabigatran mainly undergoes renal elimination and dose adjustment is recommended in patients with Chronic Kidney Disease (CKD).

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Black Americans have a significantly higher risk of developing chronic kidney disease (CKD), especially focal segmental glomerulosclerosis (FSGS), than European Americans. Two coding variants (G1 and G2) in the gene play a major role in this disparity. While 13% of Black Americans carry the high-risk recessive genotypes, only a fraction of these individuals develops FSGS or kidney failure, indicating the involvement of additional disease modifiers.

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Sepsis-Associated Acute Kidney Injury is a life-threatening condition leading to high morbidity and mortality in critically ill patients admitted to the intensive care unit. Over the past decades, several extracorporeal blood purification therapies have been developed for both sepsis and sepsis-associated acute kidney injury management. Despite the widespread use of extracorporeal blood purification therapies in clinical practice, it is still unclear when to start this kind of treatment and how to define its efficacy.

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Background & Aims: Sarcopenia is prevalent in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), and is associated with poor outcomes, while obesity may be protective. Sarcopenic obesity is associated with increased frailty, morbidity and mortality in the general population. Myosteatosis, i.

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