[Loop diuretics: facts and fallacies].

Refractory edema is a clinical condition which recognises different etiologies and is characterized by decreased or absent diuretic response before the therapeutic goal is reached. Several pharmacokinetic and pharmacodynamic strategies are used in this setting, and further research is needed in order to optimize drug effectiveness.

[From kidney disease to ischemic heart disease].

Chronic kidney disease is a pathology progressively increasing in the world. Patients with renal disease have an about 20 times greater chance of dying for cardiovascular disease than to reach the stage of dialysis and, compared to general population, they have a three times greater risk of developing acute myocardial infarction. Based on these considerations, we analyzed the most important metabolic changes that occur in renal failure, predisposing to ischemic heart disease.

[Bence-Jones proteinuria and kidney's damages].

Bence-Jones proteinuria consists in monoclonal light chains into the urine. Normally kidney eliminates light chains but, when light chains are in excess, they make histological and functional lesion to tubules, glomerulus and vessels both by direct action, or lysosomal enzyme releasing or making tubular obstruction. We analyse these kidney's damages from the morphological and functional point of view.

[Contrast-induced nephropathy. Current concepts and propositions for Italian guidelines].

Contrast-induced nephropathy is an impairment in renal function following intravascular exposure to radiographic contrast media (CM). Kidney damage may be limited to an asymptomatic increase in serum creatinine or reveal itself as acute renal failure, which can require renal replacement therapy. The aim of the present review is to describe the most recent knowledge concerning this matter.

Contrast medium induced nephropathy in urological practice.

Purpose: Contrast medium induced nephropathy is the third cause of in-hospital acute renal failure. The first studies in this area were done with reference to urological practice only. Although various guidelines on the management of contrast medium induced nephropathy were provided by the European Society of Urogenital Radiology, more recently many investigators have focused their attention on contrast medium use in interventional vascular radiology and cardiology.

Contrast medium administration in the elderly patient: is advancing age an independent risk factor for contrast nephropathy after angiographic procedures?

Contrast medium-induced nephropathy (CMIN) is the third leading cause of hospital-acquired acute renal dysfunction. Even if the number of patients over 75 years of age undergoing diagnostic and/or interventional procedures and requiring administration of contrast medium (CM) is growing constantly, at present there is no definitive consensus regarding the role of advancing age and related morphologic or functional renal changes as an independent risk factor for CMIN. The authors review the evidence from recent medical literature on the definition, pathophysiology, and clinical presentation of CMIN as well as therapeutic approaches to its prophylaxis.

[Perspectives on treatment of the renal failure].

The next decade will face an increase in the number of patients affected by end-stage renal disease. In line with the growing incidence of type 2 diabetes, hypertension and old age in the general population, we can expect a dramatic increase of uremic patients needing a substitutive treatment of renal function. On the basis of the current trends, we expect an exponential growth of cardiovascular complications in both dialysis and transplant populations.

Facts and fallacies concerning the prevention of contrast medium-induced nephropathy.

Objective: The aim of this article is to extract from recent medical literature and nephrologic practice the facts and fallacies concerning the possible prophylaxis of contrast medium-induced nephropathy.

Data Sources, Study Selection, And Data Extraction: A MEDLINE/PubMed search (1985 to January 2006) was conducted, including all relevant articles investigating the pathogenesis and prevention of contrast medium-induced nephropathy from a nephrologic critical point of view.

Data Synthesis: Considerable efforts have been made to develop pharmacologic therapy for the prevention of contrast medium-induced nephropathy, especially in patients at risk, such as elderly subjects and those with preexisting renal impairment, hypovolemia, or dehydration.

[Serum concentration of some tumor markers in renal failure].

This study was undertaken to define the relationship between renal function and the blood level of some tumor markers. In order to evaluate the specificity of tumor markers in cronic renal failure the following alphaFP, CEA, NSE, SCC and beta2 microglobulin were studied in 40 adult patients, with cronic renal failure of different degrees (27 p.), in hemodialyzed patients (6 p.

[Diagnosis of the antiphospholipid antibody syndrome in clinical practice].

The diagnosis of the antiphospholipid syndrome is based on well defined clinical and serological criteria. We report the results of a two-years observational study in our hospital focusing on the number of correct diagnosis, required to identify subjects in which prophylaxis or treatment is needed.

[Differential diagnosis in hypokalemia. A case of Liddle syndrome].

A case of Liddle's syndrome showing weakness, hypertension, metabolic alkalosis and hypokalemia, identifiable as Liddle's syndrome, allows us to face the differential diagnosis among ionic dysfunctions, as primitive and secondary hyperaldosteronism, hypercorticism and pseudohyperaldosteronism. We discuss hypokalemia due to reduced potassium pool, or referable to altered ionic redistribution without losses. Concerning the treatment of important hypokalemia, we face manners and times of intravenous administration of potassium salts, potassium-sparing diuretics and supplementation per os; besides, we stress the dietetic contribution of rich in potassium foods, for the correction of the light hypokalemia and against deficit of pool referable to the long-term diuretic therapy.

[Etiopathogenesis and clinical aspects of nephrolithiasis--at present].

This paper deals of kidney stones, hard concretions that grow within the urinary tract, 71.5% of which have calcium contents. A high rate of recurrences underscores the importance of medical prevention with a variety of conservative (increased fluid intake and dietary modifications) and drug therapy (potassium citrate, potassium magnesium citrate, thiazides, allopurinol).

Cerebral imaging changes in patients with chronic renal failure treated conservatively or in hemodialysis.

Background: Nonuremic patients with apparently normal memory and behavior, studied by means of cerebral computed tomography and found to have cerebral atrophy (CA), evidenced functional intellectual deficits when they underwent psychometric testing. The finding of CA has been repeatedly reported in limited case groups of uremic patients who also demonstrated functional intellectual deficits on the basis of the same tests. This retrospective study considered all diagnostic cerebral computed tomography scans done in our department between 1981 and 1998.

[Antiphospholipid antibody syndrome].

Antiphospholipid antibodies (aPL) are an eterogeneous group of immunoglobulins, that include lupus anticoagulant and anticardiolipin antibodies. Patients with aPL are at high risk of venous and arterial thrombosis, thrombocytopenia and recurrent fetal loss. Antiphospholipid antibodies should be suspected in case of unexplained thrombophilia and prolongation of coagulation assays (aPTT); infact although such antibodies present an anticoagulant effect in vitro, in vivo the interfere with physiological anticoagulant reactions and may have a procoagulant effect.

[Amyloidosis and renal failure].

A heterogeneous group of disorders associated with abnormal extracellular deposition of fibrillar proteins is defined amyloidosis. The renal involvement may occur in the absence of a recognized underlying disease or the kidney is affected as a result of systemic amyloidosis. Even if the diagnosis can only be confirmed by demonstrating the presence of amyloid deposits in the tissues, the development of a radiolabelled serum amyloid P component as a diagnostic nuclear tracer and the reduced urinary excretion of glycosaminoglycans as a decrease in the synthesis of functioning glomeruli and trapping by amyloid fibrils allow new diagnostic insight for the future.

Hypertension as an etiopathological factor in the development of cerebral atrophy in hemodialyzed patients.

Twenty-five patients on long-term regular hemodialysis treatment (RDT) at our dialysis unit who underwent diagnostic cerebral computed tomography (CCT) participated in a study aimed at clarifying the pathogenesis of cerebral atrophy occasionally found at their original scan. The upper age limit was 55 years to exclude the physiological involutive brain changes occurring with age. Cerebral atrophy (CA), as defined morphologically (enlargement of cerebral sulci or an increased Evan's Index), was detected in all cases.

[Physiopathology, clinical aspects and prevention of renal insufficiency caused by contrast media].

Contrast-media associated nephropathy (CMAN) consists in a sudden impairment of glomerular filtration rate following exposure to radiographic contrast materials. Damage may be limited to an asymptomatic mild increase of blood creatinine, or reach the highest levels of nitrogen retention compatible with acute renal failure. Some preexisting clinical conditions or pathologies may lead to CMAN: not only renal insufficiency, diabetes mellitus, multiple myeloma, congestive heart failure and severe hypertension, but also simple dehydration and a growing series of immunologic diseases are recognized as predisposing condition.

[The L-arginine-nitric oxide system: physiology, physiopathology and clinical relevance].

In this review we describe what is known about nitric oxide (NO), focusing on its clinical significance. It is now well appreciated that NO is a pivotal endogenous messenger molecule in a variety of physiological and pathophysiological processes. In the cardiovascular system NO participates in the paracrine regulation of vascular tone, body fluid homeostasis and platelet aggregation and adhesion.

[Treatment of arterial hypertension in diabetic nephropathy. Certainties and hypotheses].

Clinical observation has long emphasized the importance of arterial hypertension in the course of diabetic nephropathy and recent studies suggest that hypertension might play a decisive pathogenetic role in the course of the disease, hence the necessity of correcting the hypertension of diabetic patients has by now been universally accepted. There is, however, still some uncertainty concerning the usefulness of acting preventively on so-called microhypertension; in other words, whether early antihypertensive drug treatment can prevent diabetic nephropathy. This paper discusses the criteria to be followed in the choice of antihypertensive medication during diabetic nephropathy giving special attention to pathophysiological considerations.