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Background. Automatic systems for stabilizing blood pressure (BP) during dialysis are few and only control those variables indirectly related to BP. Due to complex BP regulation under dynamic dialysis conditions, BP itself appears to be the most consistent input parameter for a device addressed to preventing dialysis hypotension (DH). Methods. An automatic system (ABPS, automatic blood pressure stabilization) for BP control by fluid removal feedback regulation is implemented on a dialysis machine (Dialog Advanced, Braun). A fuzzy logic (FL) control runs in the system, using instantaneous BP as the input variable governing the ultrafiltration rate (UFR) according to the BP trend. The system is user-friendly and just requires the input of two data: critical BP (individually defined as the possible level of DH risk) and the highest UFR applicable (percentage of the mean UFR). We evaluated this system’s capacity to prevent DH in 55 RDT hypotension-prone patients. Sessions with (treatment A) and without (treatment B) ABPS were alternated one-by-one for 30 dialysis sessions per patient (674 with ABPS vs 698 without). Results. Despite comparable treatment times and UF volumes, severe DH appeared in 8.3% of sessions in treatment A vs 13.8% in treatment B (� 39%, P ¼ 0.01). Mild DH fell non-significantly (� 12.3%). There was a similar percentage of sessions in which the planned body weight loss was not achieved and dialysis time was prolonged. Conclusions. In conclusion, FL may be suited to interpreting and controlling the trend of a determined multi-variable parameter like BP. The medical knowledge of the patient and the consequent updating of input parameters depending on the patient’s clinical conditions seem to be the main factors for obtaining optimal results.

BACKGROUND The aim of this multicentre collaborative study was to compare the progression of renal disease in children and adults with Henoch-Schonlein purpura (HPS) nephritis selected on the basis of IgA-dominant renal deposits and biopsy material available for review. METHODS The analysis was performed in 152 patients (95 adults and 57 children or = 1 year up to 20 years (4.9 +/- 3.4 years in adults and 4.8 +/- 3.9 years in children). RESULTS Renal histology and clinical presentation were similar in both age groups: crescents were found in 36% of adults and 34.6% of children (in only 2.7% of adults and 1.9% of children involving > 50% of glomeruli), nephrotic-range proteinuria in 29.5% of adults and 28.1% of children and functional impairment in 24.1% of adults and 36.9% of children. The outcome was similar for both age groups (remission, 32.5% of adults and 31.6% of children; renal function impairment, 31.6% of adults and 24.5% of children). Endstage renal disease was observed in 15.8% of adults and in 7% of children. Renal function survival at 5 years was not significantly different in the two groups (85% in adults and 95% in children) and at 10 years it was approximately 75% in both groups. None of the children died and adult survival was 97% at 5 years. In adults at presentation, renal function impairment (P < 0.02) as well as proteinuria higher than 1.5 g/day (P < 0.02) and hypertension (P < 0.001) were negative prognostic factors. Multivariate analysis stressed the main statistical relevance of proteinuria (relative risk 2.37, P < 0.02). Conversely, in children no definite level of proteinuria, hypertension or other data were found to be associated with poor prognosis. CONCLUSIONS Among patients with a clinical presentation which warrants renal biopsy, HSP nephritis has a similar prognosis in children and adults. The evolution is more predictable in adults than in children.

We report a case of membranous lupus nephritis with a previous history of long-standing nephrotic syndrome which developed an acute renal failure due to bilateral renal-vein thrombosis superimposed on a calcified thrombus of the inferior vena cava eight years after the diagnosis. The occurrence of acute renal-vein thrombosis is a possible but rarely described complication of systemic lupus erythematosus. The presence of a calcified thrombus of the inferior vena cava has been described in only one adult patient until now. An aggressive thrombolytic therapy with urokinase permitted the fresh thrombus to be dissolved with a marked improvement in renal function.

We retrospectively studied 82 consecutive patients with idiopathic membranous nephropathy accepted at two separate Renal Services. These patients had nephrotic syndrome at presentation and had been followed up for at least 10 years. The duration of the disease before renal biopsy ranged between 1 and 18 months. Forty-nine patients never received treatment (non-treated group) whereas 33 patients (treated group) received corticosteroids (and cytotoxic agents). The two groups were age and sex matched. There was no difference in clinical findings or in outcome between the two Renal Services. A complete and sustained remission of proteinuria was observed in about 25% of patients, and there was a significant difference (P less than 0.01) between the treated and non-treated group (mean value 39.1% vs 14.3%). Forty-four per cent of the non-treated patients and 24.2% of the treated ones developed chronic renal failure or renal death during a mean potential follow-up of 14 years. Non-renal death was recorded in 19.5% of the patients. The staging of the capillary wall lesion represented a very important prognostic index. We confirm, therefore, that idiopathic membranous nephropathy with nephrotic syndrome is frequently a progressive disease. Corticosteroids (and cytotoxic drugs) seem to be of some benefit in interfering with the natural course of the disease.