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Cardiac screening is recommended to prevent cardiovascular death after renal transplantation. This retrospective observational study illustrates the results of application of a cardiac assessment algorithm in a series of 558 renal transplant candidates at a single center in Turin, Italy. A dipyridamole-stress sestamibi myocardial scintiscan (DMS) performed in 302/558 (54.1%) cases was positive in 52 (17.2%), negative in 200 (66.2%), borderline in 16 (5.3%), and with signs of previous necrosis in 34 (11.4%). Coronary lesions detected by angiography in 48.1% of the 52 positives were treated medically (13.5%) or by percutaneous/surgical procedure (34.6%). Coronary lesions were detected in 14.1% of asymptomatic population subgroup. The minor and major cardiovascular event rates and the cardiovascular death rate were 1.9%, 0%, and 0%, respectively, in positive DMS group (high-cardiological risk) vs. 10%, 4.5%, and 3.5% in the negatives (p > 0.5; n.s.). It is suggested that not increased cardiovascular event or deaths rates in the high-risk group reflect early coronary lesion detection and correction. Since 55.9% of cardiovascular events or deaths occurred in the negative group more than 24 months after the DMS, its mandatory repetition every two yr after a negative finding is recommended. [ABSTRACT FROM AUTHOR]

Polyomavirus BK (BKV) reactivation can occur in immunodeficient patients. Few studies on BKV infection in patients with systemic lupus erytematosus (SLE) nephritis are available. Aim of this study was to analyse the prevalence of BKV infection by quantifying viral load and to investigate the association with clinical and histological parameters indicating duration, type and activity of SLE. BKV-DNA was evaluated by polymerase chain reaction in serum (sBKV) and urine (uBKV) specimens from 40 patients with SLE nephritis and 29 healthy controls. Renal function, urinary activity, clinical index of SLE activity [SLE Disease Activity Index (SLEDAI) score], CD4+/CD8+ ratio, histological classes and duration of SLE nephritis were compared according to the BKVDNA-positivity. sBKV was present in 15% of SLE patients and in 13.8% of controls; uBKV in 32% of SLE patients and in 17.2% of controls. There was no significant difference in terms of kidney function, urinary activity, SLEDAI score, presence of anti-dsDNA antibodies, CD4+/CD8+ ratio and BKV viremia and/viruria, as well as there was no significant correlation between SLEDAI score, anti-dsDNA antibodies titers and median viral load. Duration of nephropathy tended to be shorter in patients with BKV viremia and/or viruria; proteinuria/creatininuria ratio tended to be higher in patients with positive sBKV and uBKV. BKV-DNA-positivity tended to be more frequent in patients treated with an immunosuppressive agent versus those on steroid treatment. Reactivation of BKV infection can occur in patients with SLE, although prevalence data do not significantly differ from those obtained in the control group. The trend toward an association between BKV infection and degree of proteinuria and less duration of SLE nephritis could indicate a major susceptibility to develop BKV infection in more active phases of the disease. The role of BKV reactivation in terms of clinical parameters and histological pattern, as well as the role of therapeutic protocols in the onset of BKV reactivation and, conversely, the therapeutic implication of BKV reactivation in SLE patients remain to be defined and should be addressed in further studies on a larger number of patients. [ABSTRACT FROM AUTHOR]

Objective. Three main tests are commonly employed for the measurement of proteinuria: the dipstick test, the urinary protein/creatinine ratio (P/C) and the 24‐h urine collection. The aim of this study was to evaluate the correlation between these methods, comparing linear regression and ROC curve data. Material and methods. A total of 297 consecutive outpatients with different renal diseases were included in the study. Twenty‐four‐hour proteinuria was considered the reference test. Results. A high degree of correlation was observed between all the tests ( p [ABSTRACT FROM AUTHOR]

Background: CTLA-4/CD28-B7 and CD40-CD40L interactions constitute two key costimulatory pathways in lymphocyte signalling during experimental allograft rejection. Studies on the expression of these molecules in human transplant rejection are still lacking. [ABSTRACT FROM PUBLISHER]

CAPD outcomes were compared between a group of 301 diabetic patients (mean age±SD, 58.9±12.7 years, 55.8% males) and a group of 1689 non-diabetic patients (mean age±SD 57.8±14.8 years, 55.9% males) treated in 30 centres participating in the Italian Cooperative Peritoneal Dialysis Study Group from 1980 to 1989, with follow-up observation periods of 444 years (mean±SD, 1.48± 1.24) and of 3502 years (mean±SD, 2.07± 1.91) respectively. CAPD was the first modality for 87.2% of diabetics and 78.1% of non-diabetics (≪0.001). The percentage of patients who needed a partner for CAPD was 45.9% in diabetics and 30.2% in non-diabetics (<0.00l). In diabetics compared with non-diabetics, cardiovas cular diseases and cachexia were nearly twice and infections other than peritonitis more than three times as frequent in causing death. In diabetics, survival was significantly worse (<0.0001) and the relative risk of death 2.13 times higher (<0.001). The technique survival and the relative risk of drop out were not significantly different in the two groups. Clinical problems were the most important cause of drop-out among diabetics. The probability and relative risk of drop-out due to peritonitis, as well as of the first peritonitis episode, were not significantly different between the two groups and between diabetics using or not using intraperitoneal insulin. Days per patient year of hospitalization, excluding the first, were 18.4 in diabetics and 14.3 in non diabetics. CAPD-related problems caused hospitalization in a similar way in the two groups. In conclusion, compared to non-diabetics on CAPD, diabetics on the same treatment showed more clinical problems that account for a higher need of partner, death, and hospitalization and are the first reason for technique failure; on the other hand, problems closely related to the CAPD technique seem to occur with the same frequency in the two groups. [ABSTRACT FROM PUBLISHER]

Survival has been defined as an index of adequacy of dialysis. These hard data are the basis for comparing results obtained by different schedules or policies. The aim of the study was to assess mortality rate recorded within a system of tailored dialysis (1–6 dialysis per week in out-of-hospital settings: home hemodialysis, self- and limited care dialysis). Data recorded in a single center (1998–2003) were compared with data gathered in the Registry of Dialysis and Transplantation in the whole Region (1998–2000). Out-of-hospital dialysis unit is active since 1971, in which a new program integrating self- and limited care and home dialysis started since 1998. Incident dialysis patients starting renal replacement therapy within the program and all further patients starting dialysis in the Region in the same period were compared in an historical prospective cohort study. 55 patients in the Unit and further 1443 patients in the whole Region started RRT since 1998. Main features of 55 patients were 32 males 23 females; median age 51 years, range 20–76; 72.7% displaying at least 1 comorbid factor. Throughout the period gross mortality rate was 4/125 patient-years in the Center. Kaplan–Meier curves showed a 1-year survival of 100% vs. 91%, respectively, in the Center and in the whole Region, and a 2-year survival of 95.5% vs. 76.6%, respectively, in the Center and in the whole Region (p = 0.001). The main demographic features were remarkably different in both settings (for the whole Region median age 66 years, range 2.2–101, at least 1 comorbidity in 56.9% of patients). In an attempt to correct for the different baseline characteristics, a multivariate Cox regression analysis was performed. The whole model resulted in statistically significant value (p = 0.000) and an increasing mortality risk resulted for age at starting dialysis, diabetes, and collagenopathy. In conclusion, tailored, high-efficiency dialysis policy may allow superior survival results. A longer follow up is needed to confirm our approach; in larger cohorts, the finding of a low mortality rate in a relatively young population with high comorbidity may underline the need to review our current concepts on dialysis adequacy. [ABSTRACT FROM AUTHOR]