33 results on '"Domenico Giannese"'
Search Results
2. Canagliflozin on top of dual renin-angiotensin system blockade in a woman with partial acquired lipodystrophy, type 2 diabetes and severely proteinuric chronic kidney disease: a case report
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Edoardo Biancalana, Giovanni Ceccarini, Silvia Magno, Valerio Ortenzi, Domenico Giannese, Ferruccio Santini, and Anna Solini
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Endocrinology, Diabetes and Metabolism - Abstract
Sodium glucose cotransporter 2 inhibitors have proven strong efficacy in reducing end-stage renal disease in patients with type 2 diabetes. We are presenting here the case of a 40-year-old woman with acquired partial lipodystrophy, type 2 diabetes and essential hypertension complicated by chronic kidney disease and proteinuria in the nephrotic range. She first came to our attention in 2012; estimated glomerular filtration rate (eGFR) was 41.5 ml/min/1.73 m2 and total proteinuria was 375 mg/24h; she was treated with dual renin angiotensin system blocking. Proteinuria significantly increased during the following years, reaching a nephrotic range (>5 g/day). A kidney biopsy revealed a tubule-interstitial involvement compatible with type 2 diabetes. Leptin replacement therapy, started in 2018, improved glycaemic control and lipid profile, also determining a reduction in insulin total daily dose. In 2019, after the publication of the CREDENCE study, canagliflozin was started on top of losartan and ramipril. After an initial, expected eGFR drop, kidney function stabilized, and albuminuria significantly reduced (from 4120 to 984 mg/24h), while serum potassium showed only minimal increase. At last follow-up (2022) total proteinuria was still reducing (510 mg/24h), while kidney function was substantially unchanged (eGFR 40 ml/min/1.73 m2). This case report suggests that, despite not recommended in international guidelines, the use of SGLT2i in combination with dual renin angiotensin system blockade should be considered in specific conditions and under close clinical monitoring.
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- 2023
3. Carfilzomib-related glomerular and tubular injury in a patient with Multiple Myeloma
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Domenico Giannese, Angelo Giovanni Bonadio, Maria Lavinia Del Giudice, Adamasco Cupisti, and Gabriele Buda
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Nephrology ,Humans ,Antineoplastic Agents ,Multiple Myeloma ,Oligopeptides - Published
- 2022
4. The risks associated with percutaneous native kidney biopsies: a prospective study
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Simeone, Andrulli, Michele, Rossini, Giuseppe, Gigliotti, Gaetano, La Manna, Sandro, Feriozzi, Filippo, Aucella, Antonio, Granata, Elisabetta, Moggia, Domenico, Santoro, Lucio, Manenti, Barbara, Infante, Angelo, Ferrantelli, Rosario, Cianci, Mario, Giordano, Domenico, Giannese, Giuseppe, Seminara, Marina, Di Luca, Mario, Bonomini, Leonardo, Spatola, Francesca, Bruno, Olga, Baraldi, David, Micarelli, Matteo, Piemontese, Giulio, Distefano, Francesca, Mattozzi, Paola, De Giovanni, Davide, Penna, Maurizio, Garozzo, Luigi, Vernaglione, Cataldo, Abaterusso, Fulvia, Zanchelli, Rachele, Brugnano, Enrica, Gintoli, Laura, Sottini, Marco, Quaglia, Gioacchino Li, Cavoli, Marco, De Fabritiis, Maria Maddalena, Conte, Massimo, Manes, Yuri, Battaglia, Francesco, Fontana, and Loreto, Gesualdo
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prospective cohort study ,Transplantation ,major complications ,Nephrology ,logistic regression ,kidney biopsy ,risk - Abstract
Background The known risks and benefits of native kidney biopsies are mainly based on the findings of retrospective studies. The aim of this multicentre prospective study was to evaluate the safety of percutaneous renal biopsies and quantify biopsy-related complication rates in Italy. Methods The study examined the results of native kidney biopsies performed in 54 Italian nephrology centres between 2012 and 2020. The primary outcome was the rate of major complications 1 day after the procedure, or for longer if it was necessary to evaluate the evolution of a complication. Centre and patient risk predictors were analysed using multivariate logistic regression. Results Analysis of 5304 biopsies of patients with a median age of 53.2 years revealed 400 major complication events in 273 patients (5.1%): the most frequent was a ≥2 g/dL decrease in haemoglobin levels (2.2%), followed by macrohaematuria (1.2%), blood transfusion (1.1%), gross haematoma (0.9%), artero-venous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), a rapid increase in serum creatinine levels (0.1%) and death (0.02%). The risk factors for major complications were higher plasma creatinine levels [odds ratio (OR) 1.12 for each mg/dL increase, 95% confidence interval (95% CI) 1.08–1.17], liver disease (OR 2.27, 95% CI 1.21–4.25) and a higher number of needle passes (OR for each pass 1.22, 95% CI 1.07–1.39), whereas higher proteinuria levels (OR for each g/day increase 0.95, 95% CI 0.92–0.99) were protective. Conclusions This is the first multicentre prospective study showing that percutaneous native kidney biopsies are associated with a 5% risk of a major post-biopsy complication. Predictors of increased risk include higher plasma creatinine levels, liver disease and a higher number of needle passes.
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- 2022
5. A Multisystem Mitochondrial Disease Caused by a Novel MT-TL1 mtDNA Variant: A Case Report
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Domenico Giannese, Vincenzo Montano, Piervito Lopriore, Claudia Nesti, Annalisa LoGerfo, Maria Adelaide Caligo, Flavio Dal Canto, Gianandrea Pasquinelli, Angelo Giovanni Bonadio, Diego Moriconi, Gabriele Siciliano, and Michelangelo Mancuso
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Neurology ,Neurology (clinical) - Abstract
Background: Mitochondrial tRNA (MTT) genes are hotspot for mitochondrial DNA mutation and are responsible of half mitochondrial disease. MTT mutations are associated with a broad spectrum of phenotype often with complex multisystem involvement and complex genotype-phenotype correlations. MT-TL1 mutations, among which the m.3243A>G mutation is the most frequent, are associated with myopathy, maternal inherited diabetes and deafness, MELAS, cardiomyopathy, and focal segmental glomerulosclerosis. Case study: Here we report the case of an Italian 49-years old female presenting with encephalomyopathy, chronic proteinuric kidney disease and a new heteroplasmic m.3274_3275delAC MT-TL1 gene mutation. Conclusions: Our case demonstrates a systemic mitochondrial disease caused by the heteroplasmic m.3274_3275delAC MT-TL1 gene mutation, not yet described in the literature. A mitochondrial disease should be suspected in case of complex multisystem phenotypes, including steroid-resistant nephrotic syndrome with multisystemic involvement.
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- 2022
6. The Impact of a Mediterranean-like Diet with Controlled Protein Intake on the Onco-Nephrological Scenario: Time for a New Perspective
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Arianna Bettiga, Francesco Fiorio, Francesca Liguori, Federico Di Marco, Giulia Quattrini, Riccardo Vago, Domenico Giannese, Andrea Salonia, Francesco Montorsi, and Francesco Trevisani
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Nutrition and Dietetics ,nutrition ,urological cancer ,kidney health ,onconephrology ,CKD ,malnutrition ,moderately controlled protein diet ,quality of life ,multidisciplinary ,Food Science - Abstract
Chronic kidney disease (CKD) represents a frequent comorbidity in cancer patients, especially for patients affected by urological cancers. Unfortunately, impaired kidney function may limit the choice of adequate oncological treatments for their potential nephrotoxicity or due to contraindications in case of a low glomerular filtration rate. For these patients, tailored nephrological and nutritional management is mandatory. The K-DIGO guidelines do not define whether the nutritional management of CKD could be useful also in CKD patients affected by urological cancer. In fact, in clinical practice, oncological patients often receive high-protein diets to avoid malnutrition. In our study, we investigated the nutritional and nephrological impact of a Mediterranean-like diet with a controlled protein intake (MCPD) on a cohort of 82 stage III-IV CKD patients. We compared two cohorts: one of 31 non-oncological CKD patients and the other of 51 oncological patients with CKD. The use of an MCPD had a favorable impact on both the oncological and non-oncological CKD patients with an amelioration in all the investigated parameters and with a better quality of life, with no cases of malnutrition or AKI.
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- 2022
7. Is high protein intake a real concern for healthy kidneys?
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Domenico Giannese, Vincenzo Panichi, and Adamasco Cupisti
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Nephrology - Published
- 2022
8. Vitamin D and Calcium Supplementation and Urolithiasis: A Controversial and Multifaceted Relationship
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Piergiorgio Messa, Giuseppe Castellano, Simone Vettoretti, Carlo Maria Alfieri, Domenico Giannese, Vincenzo Panichi, and Adamasco Cupisti
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Nutrition and Dietetics ,Food Science - Abstract
Patients with urolithiasis, and particularly those with hypercalciuria, frequently have a marked reduction of bone mineral content up to the levels of osteoporosis, with a significant increase in bone fracture risk. For these reasons, the indication to prescribe vitamin D and/or calcium supplementations is very frequent in such patients. On the other hand, both calcium supplementation, and even more vitamin D therapy, can worsen the risk of developing urolithiasis by increasing calcium, phosphate, and oxalate urinary excretion. Despite the clinical and practical relevance of this issue, the evidence on this topic is scarce and contradictory. Therefore, some concerns exist about how and whether to prescribe such supplements to a patient with a history of kidney stones. In this narrative review, we resume some pivotal pathophysiological concepts strictly related to the dealt topic, and we draw some considerations and personal opinions on the pros and cons of such prescriptions. Finally, we share with the reader our pragmatic algorithm for handling the urolithiasis risk in patients who have strong indications to be prescribed vitamin D and calcium supplementations.
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- 2023
9. Mediterranean Dietary Pattern Adjusted for CKD Patients: The MedRen Diet
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Claudia D’Alessandro, Domenico Giannese, Vincenzo Panichi, and Adamasco Cupisti
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Nutrition and Dietetics ,Food Science - Abstract
A number of studies in the general population showed that healthy dietary patterns, such as the Mediterranean Diet, can improve or prevent the development of several chronic diseases and are associated with a significant reduction in all-cause and cardiovascular mortality. The Mediterranean diet may also have favorable effects for the prevention of chronic kidney disease (CKD), but no evidence of renoprotection exists in CKD patients. The Mediterranean Renal (MedRen) diet is an adaptation of the Mediterranean diet recommendations comprising a quantitative reduction in the RDA values of protein, salt and phosphate intake for the general population. Hence, MedRen supplies 0.8 g/Kg of protein, 6 g of salt and less than 800 mg of phosphate daily. Obviously, there is a preference for products of plant origin, which contain more alkali, fibers, unsaturated fatty acids than animal-based food. The MedRen diet can be implemented easily in mild-to-moderate stages of CKD with good results, both in terms of adherence to prescriptions and metabolic compensation. In our opinion, it should be the first step of CKD stage 3 nutritional management. This paper describes the features and reports our experience in the implementation of the MedRen diet as an early nutritional approach to CKD.
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- 2023
10. Kidney Stone Prevention: Is There a Role for Complementary and Alternative Medicine?
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Adamasco Cupisti, Domenico Giannese, Claudia D’Alessandro, Alessia Benedetti, Vincenzo Panichi, Carlo Alfieri, Giuseppe Castellano, and Piergiorgio Messa
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Nutrition and Dietetics ,Food Science - Abstract
Complementary and alternative medicine (CAM) is often implemented in kidney stone patients. It consists of preparations including different ingredients, such as herbs, probiotics, and vitamins, often together with alkali, that are classified within the dietary supplementation category. The majority of dietary supplements claiming to treat or prevent kidney stones contain ingredients with conflicting or no scientific evidence to support their claims. Clinicians should advise stone formers that the effects of most supplements are unknown or unstudied in humans and that the absence of evidence does not imply absence of potential harm. Unfortunately, the CAM preparation consists of a mix of different molecules, often including alkali, with different potential mechanisms of action and, even when favorable results are reported, the role of the single molecules cannot be assessed. Despite all these concerns, CAM products remain quite popular among kidney stone patients. The scarce knowledge in this field prevents one from recommending CAM products in daily clinical practice; only a weak suggestion for their use in kidney stone patients may be reasonable.
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- 2023
11. Idiopathic Retroperitoneal Fibrosis: What Is the Optimal Clinical Approach for Long-Term Preservation of Renal Function?
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Domenico Giannese, Diego Moriconi, Adamasco Cupisti, Alessandro Zucchi, Antonio Luigi Pastore, Alchiede Simonato, Andrea Mogorovich, Francesco Claps, Riccardo Bartoletti, Giannese D., Moriconi D., Cupisti A., Zucchi A., Pastore A.L., Simonato A., Mogorovich A., Claps F., Bartoletti R., Giannese, Domenico, Moriconi, Diego, Cupisti, Adamasco, Zucchi, Alessandro, Pastore, Antonio Luigi, Simonato, Alchiede, Mogorovich, Andrea, Claps, Francesco, and Bartoletti, Riccardo
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Ureterolysis ,Obstructive uropathy ,Robot-assisted laparoscopic ureterolysis ,Urology ,Chronic kidney disease ,Idiopathic retroperitoneal fibrosi ,Idiopathic retroperitoneal fibrosis ,Urinary diversion ,Robot-assisted laparoscopic ureterolysi ,Ureterolysi ,Settore MED/24 - Urologia - Abstract
Background: The aim of this study was to investigate the long-term effects of ureteral stenting and the exact timing of stent removal in favor of surgery in patients with idiopathic retroperitoneal fibrosis (IRF). Summary: Medline research terms of “idiopathic retroperitoneal fibrosis” AND “ medical therapy” OR “ureteral stenting” OR “surgical treatment” were done. Systematic reviews and observational and clinical studies were analyzed to obtain indication regarding the objective of the study for a narrative review. Ninety-two papers were analyzed. The treatment of IRF includes the monitoring of retroperitoneal fibrotic process spread and the prevention of abdominal organs entrapment. Treatment of ureteral obstruction includes medical therapy and ureteral stenting (US) or percutaneous nephrostomy (PNS) to overcome the worsening of renal function. Up to now, the timing of US or PNS removal is not yet clear, both for the complexity of evaluating the efficacy of the medical therapy and demonstrating the resolution of obstructive nephropathy. Moreover, it is not yet clear if the long-term ureteral stent placement or PNS is able to maintain an efficient renal function. Ureterolysis with a laparoscopic robot-assisted approach is now considered as an ultimate treatment for ureteral obstruction, limiting the progression of kidney impairment and improving the quality of life of patients, although nephrologists are generally abdicant regarding the potential switch toward the surgical approach. Key Messages: Prospective studies regarding the long-term effects of US on the renal function impairment in patients with IRF should be structured to obtain adequate information on the exact timing for the surgical approach.
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- 2022
12. Diagnosis, Prevalence and Significance of Obesity in a Cohort of CKD Patients
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Diego Moriconi, Claudia D’Alessandro, Domenico Giannese, Vincenzo Panichi, and Adamasco Cupisti
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obesity ,adiposity ,anthropometry ,Endocrinology, Diabetes and Metabolism ,bio-impedance ,fatty mass ,CKD ,body mass index ,Molecular Biology ,Biochemistry - Abstract
Background: data regarding the association between obesity and morbidity/mortality in patients with chronic kidney disease (CKD) are uncertain and sometimes contradictory. The aims of our study were to determine the associations among different measures of obesity and adiposity, and the risk of all-cause mortality or dialysis entry in stage 3–5 CKD patients. Materials: this observational cohort study included 178 CKD patients followed for a median of 71 months. Biochemistry, anthropometric measures such as body mass index (BMI), waist-to-hip ratio, mid-arm muscle circumference (MAMC) and body composition by bioimpedance analysis were evaluated. Results: we found a weak agreement between BMI and other measures of adiposity. In multivariable regression analysis, all measures of obesity such as BMI, waist circumference and waist-to-height ratio were not associated with dialysis entry and/or mortality. Instead, MAMC was associated with dialysis entry HR 0.82 [95% CI: 0.75–0.89] and high FM% with mortality HR 2.08 [95% CI: 1.04–4.18]. Conclusions: in our CKD population, lower MAMC was predictive of dialysis commencing, while a higher percentage of fatty mass was a predictor of mortality. Instead, obesity, as defined by BMI, is not associated with dialysis commencing or all-cause mortality.
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- 2023
13. ANCA subclasses in IgG4-related disease and ANCA-associated vasculitis
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Paola Migliorini, Domenico Giannese, Rocco Scarmozzino, Antonio Tavoni, Donatella Sutera, Riccardo Capecchi, and Cristina Croia
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business.industry ,Immunology ,medicine ,IgG4-related disease ,ANCA-Associated Vasculitis ,General Medicine ,medicine.disease ,business - Published
- 2020
14. Processed Plant-Based Foods for CKD Patients: Good Choice, but Be Aware
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Claudia D’Alessandro, Jason Pezzica, Carolina Bolli, Alice Di Nicola, Azzurra Falai, Domenico Giannese, and Adamasco Cupisti
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Diet, Vegetarian ,Health, Toxicology and Mutagenesis ,Sodium ,Public Health, Environmental and Occupational Health ,Animals ,Fast Foods ,Humans ,food and beverages ,Renal Insufficiency, Chronic ,vegetarian diet ,vegan diet ,vegan products ,processed food ,CKD ,kidney disease ,salt intake ,additives ,preservatives ,Diet - Abstract
The beneficial effects of vegetarian diets are known in the general population and in patients with chronic kidney disease (CKD). In recent years, the market has developed a number of processed plant-based products because of several factors (lifestyle changes, ethical concerns, and sustainability). The composition in terms of nutrients, ingredients, and additives of 560 products available on the market and on online shopping sites was analyzed to understand the characteristics of these products. Processed plant-based meat substitutes have a higher content of salt (+467%), lipids (+26%), mostly unsaturated, and fiber with respect to regular animal-based ones. Protein content is lower (−40%) in plant-based products with respect to corresponding animal ones. Of the 49 additives on the label (on average 2 per product), 20 contain phosphorus, sodium, potassium, or nitrogen. Several plant-based processed products may contain elevated amounts of salt and additives, which make them not optimal for CKD patients. Although a plant-based diet remains a very important tool for CKD nutritional management, patients should be aware regarding the extra content of sodium and additives in processed plant-based products compared to animal-based processed food.
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- 2022
15. Renal Involvement in IgG4-Related Disease: From Sunlight to Twilight
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Riccardo Capecchi, Domenico Giannese, Diego Moriconi, Angelo G. Bonadio, Federico Pratesi, Cristina Croia, Maria F. Egidi, Ilaria Puxeddu, Antonio G. Tavoni, and Paola Migliorini
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Pathology ,medicine.medical_specialty ,ANCA - associated vasculitis ,retroperitoneal fibrosis ,IgG4-related disease ,membranous nephropathy ,tubulointerstitial nephritis (TIN) ,030232 urology & nephrology ,Retroperitoneal fibrosis ,03 medical and health sciences ,0302 clinical medicine ,Lymphoplasmacytic Infiltrate ,Membranous nephropathy ,Fibrosis ,parasitic diseases ,Medicine ,skin and connective tissue diseases ,Subclinical infection ,Original Research ,030203 arthritis & rheumatology ,Kidney ,lcsh:R5-920 ,integumentary system ,business.industry ,fungi ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,medicine.symptom ,business ,lcsh:Medicine (General) ,Kidney disease - Abstract
IgG4-Related Disease (IgG4-RD) is a fibroinflammatory condition characterized by a typical histopathological pattern (dense lymphoplasmacytic infiltrate with prevalent IgG4+ plasma cells and storiform fibrosis), which may involve the kidney both directly (IgG4-related kidney disease, IgG4-RKD) or indirectly, as a consequence of post-renal ureteral obstruction due to retroperitoneal fibrosis (IgG4-RD RF). The most frequent presentation of IgG4-RKD is IgG4-related tubulointerstitial nephritis (TIN), but a glomerular disease can be present, in most of the cases a membranous nephropathy. Albeit steroid-responsive, in some cases renal manifestations may lead to progressive and permanent organ damage. In this review we describe four clinical cases representative of typical and less typical renal manifestations of IgG4-RD, emphasizing a potential, subclinical, early involvement of the kidney in the disease.
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- 2020
16. P0366SAFETY OF STEROID THERAPY IN IGA NEPHROPATHY: THE CLINICAL EXPERIENCE OF 48 NEPHROLOGY UNITS IN ITALY
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Cristina Sarcina, Ivano Baragetti, Francesca Ferrario, Federico Alberici, Domenico Giannese, Elena Mancini, Claudio Pozzi, Alessandra Pola, Mario Cozzolino, Maria Carmen Luise, Anna Sara Sorrentino, Andrea Amendola, and Cristiana Rollino
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Nephrology ,Transplantation ,medicine.medical_specialty ,Leukopenia ,Proteinuria ,business.industry ,Odds ratio ,medicine.disease ,Nephropathy ,Sepsis ,Steroid therapy ,Internal medicine ,medicine ,medicine.symptom ,Adverse effect ,business - Abstract
Background and Aims Steroid therapy is efficient in inducing remission of IgA nephropathy (IgAN) and preventing end stage renal disease (ESRD) but there are concerns about their safety. The TESTING trial in particular has been stopped early because of a higher incidence of side effects than conservative treatment thus inducing a conservative therapy with RAAS (renin angiotensin antagonist system) blockers. The aim of this analysis was to evaluate the incidence of adverse events (AE) in a retrospective observational trial on the real clinical practice. Method We evaluated 1209 patients (pz) with IgAN coming from 48 Italian centers: 285 pz in RAAS blockers alone, 732 treated for 6 months with steroid and 192 with a combination of steroid and other immunosuppressants (also with RAAS blockers). The analysis was limited to the 6 months of therapy. Results The basal characteristics of the 3 groups are shown in the table below. The figure shows the frequencies of 69 adverse events related with immunosuppression: the most frequent were infections (23, 2.73% of all patients, 34.3% of all AE), impaired glycemic control (11, 0.91% of patients, 16% of all AE), severe hypertension (6, 8.7% of all AE) and leukopenia (9, 0.80% of patients, 13% of all AE). Infections were observed in 16 (2.19%) pz in steroid therapy and 7 (3.65%) pz in steroid+immunosoppressive treatment. Liver toxicity and and gastrointestinal AE were observed almost in pz receiving steroid+ immunosuppressants [1(0.14%) and 2 (1.04%) pz, respectively]. 7 pz in steroid therapy (0.96%) and 2 in steroid+ immunosuppressants experienced an impaired glycemic control. All the 9 cases of leucopenia were registered in pz in steroid+ immunosuppressants (4.69%). A slightly higher incidence of allergies was observed in the RAAS blocker group (20 cases, 0.7%). The higher rates of infections and leucopenia were observed in pz above 70 years of age (6.12%,p Conclusion the incidence of EA in our observational study is lower than that observed in the TESTING and STOP trials (5.71% vs 14.7% and 40%, respectively). The most frequent AE were almost observed in oldest subjects with impaired renal function on steroid+other immunosuppressants. Though this trial is not randomized nor controlled (RC), it considers a large cohort of pz coming from the real clinical practice of the Italian Nephrology Units and demonstrates that the significantly lower incidence of steroid related AE than that observed in some RC trials doesn’t justify the abstention from steroids in IgAN at risk of progression. Much more attention should be paid in elderly pts with severe renal dysfunction with a closer follow-up, dose adjustments and antibiotic prophilaxis.
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- 2020
17. P176 A case of lupus enteritis successfully treated with anti-TNF alpha inhibitor
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Daiana Giannini, Linda Ceccarelli, Silvia Bilia, Gloria M. Mumolo, Domenico Giannese, Riccardo Capecchi, Antonio Tavoni, and Paola Migliorini
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medicine.medical_specialty ,Systemic lupus erythematosus ,Cryptitis ,business.industry ,Azathioprine ,medicine.disease ,Gastroenterology ,Enteritis ,Internal medicine ,Necrotizing Vasculitis ,medicine ,Enteropathy ,medicine.symptom ,skin and connective tissue diseases ,Vasculitis ,Malar rash ,business ,medicine.drug - Abstract
Background Gastro-intestinal manifestations in systemic lupus erythematosus (SLE) can affect up to 40% of patients, including enteritis presenting as mesenteric vasculitis, pseudo-obstruction or protein-losing enteropathy. We present a case of lupus enteritis successfully treated with anti-TNFalpha inhibitor. Methods A 28-year-old woman was evaluated for diarrhea, abdominal pain, fever and rectal bleeding not responsive to antibiotics. She had a thirteen-year history of SLE in remission with Mycophenolate Mofetil and previous muco-cutaneous and haematologic relapses, myocarditis and end-stage renal disease (IV-class glomerulonephritis). She previously underwent multiple immunosuppressants including ciclophosphamide, cyclosporine,anti-CD20, immunoglobulins. One month before the onset of symptoms she discontinued MMF for worsening anemia. Simultaneously we reported signs of lupic flare (low C3, haemolytic anemia, lymphopenia, fever, arthralgias and malar rash). Pulse-steroids and IVIg followed by cyclosporine were initially performed with only temporary benefit. Enteric CT-scan and endoscopy revealed chronic and acute colo–rectal and gastric inflammation (cryptitis, erosions, necrosis, microgranulomas). Anti-TNFalpha inhibitor Infliximab (5 mg/kg) was added to Azathioprine 50 mg/daily. Within a month we observed clinical and serological sustained remission. Results Typically, mesenteric vasculitis involves small arteries or venules. Histological examination reveals submucosal and muscular layers infiltration and necrotizing vasculitis, with panmural predominant eosinophilic, neutrophilic or mixed infiltrate. The distinction of inflammatory bowel disease (IBD) from enteric-SLE can be challenging. In this case, an early anti-flogistic therapy may have led to uncomplete microscopic patterns not fullfilling criteria neither for enteric vasculitis nor IBD. A lupic flare with predominant gastro-enteric presentation is the most plausible hypothesis because of the infrequent association between SLE and IBD and simultaneous extra-intestinal lupic features. Abdominal involvement in a patient previously treated with high dosage cyclophosphamide (10 g) and the lack of response to azathioprine lead to the introduction of anti-TNFalpha inhibitor. Conclusion The role of TNFalpha in SLE is controversial and TNFalpha inhibitors are reported to control SLE-arthritis. Further studies are needed to evaluate their role in the management of gastro-enteric SLE.
- Published
- 2020
18. Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review
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Claudia D’Alessandro, Alessia Benedetti, Antonello Di Paolo, Domenico Giannese, and Adamasco Cupisti
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drug interaction ,Nutrition and Dietetics ,Nutrition. Foods and food supply ,food ,Appetite ,Biological Availability ,Nutritional Status ,Review ,Diet ,Food-Drug Interactions ,nutrients ,Quality of Life ,CKD ,Humans ,TX341-641 ,Kidney Diseases ,Pharmacokinetics ,medication ,Nutrition Therapy ,Nutritionists ,Energy Metabolism ,diet ,Drug interaction ,Food ,Medication ,Nutrients ,Nutritional status ,Food Science - Abstract
Drugs and food interact mutually: drugs may affect the nutritional status of the body, acting on senses, appetite, resting energy expenditure, and food intake; conversely, food or one of its components may affect bioavailability and half-life, circulating plasma concentrations of drugs resulting in an increased risk of toxicity and its adverse effects, or therapeutic failure. Therefore, the knowledge of these possible interactions is fundamental for the implementation of a nutritional treatment in the presence of a pharmacological therapy. This is the case of chronic kidney disease (CKD), for which the medication burden could be a problem, and nutritional therapy plays an important role in the patient’s treatment. The aim of this paper was to review the interactions that take place between drugs and foods that can potentially be used in renal patients, and the changes in nutritional status induced by drugs. A proper definition of the amount of food/nutrient intake, an adequate definition of the timing of meal consumption, and a proper adjustment of the drug dosing schedule may avoid these interactions, safeguarding the quality of life of the patients and guaranteeing the effectiveness of drug therapy. Hence, a close collaboration between the nephrologist, the renal dietitian, and the patient is crucial. Dietitians should consider that food may interact with drugs and that drugs may affect nutritional status, in order to provide the patient with proper dietary suggestions, and to allow the maximum effectiveness and safety of drug therapy, while preserving/correcting the nutritional status.
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- 2022
19. Introito calorico e nutrizionale in un gruppo di pazienti con trapianto di rene
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Vincenzo Bellizzi, Massimiliano Barsotti, Patrizia Calella, Domenico Giannese, and Claudia D’Alessandro
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lcsh:Internal medicine ,medicine.medical_specialty ,business.industry ,Dietary intake ,Food diary ,General Medicine ,lcsh:Diseases of the genitourinary system. Urology ,lcsh:RC870-923 ,medicine.disease ,Gastroenterology ,Obesity ,Nutrient ,Renal transplant ,Internal medicine ,medicine ,Renal allograft ,Pharmacology (medical) ,lcsh:RC31-1245 ,business ,Kidney transplantation ,Dyslipidemia - Abstract
Background and Aim: Obesity, dyslipidemia, hypertension and glucose intolerance are some of the main nutritional and metabolic problems that occur in post-transplant patients. We evaluated the daily dietary intake in renal transplant recipients to assess whether they fulfil the nutrient intake recommendations (according to the Italian recommended dietary allowances, LARN 2014). Subjects and Methods: Renal allograft recipients that were transplanted between 6 months and 5 years before this study were recruited. The daily intake of nutrients, including protein and salt, was estimated with a five-day food diary. Results: In total, 50 patients were studied (31 males and19 females); the mean patients’ age was 48.9±9.9 years, the mean age at transplant was 20.5±15.2 years (median 15.3 y) and the mean eGFR was 56.4±20.2 mL/min/1.73m2, with the eGFR terziles defined as >66.7, between 44.6 and 66.7, and
- Published
- 2018
20. Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients
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Piergiorgio Bolasco, Adamasco Cupisti, Domenico Giannese, Enrico Fiaccadori, Alice Sabatino, and Claudia D’Alessandro
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CKD ,Dietary protein ,ESKD ,Infrequent dialysis ,Nutrition ,Nutritional therapy ,Residual kidney function ,Uremic toxins ,Biomarkers ,Combined Modality Therapy ,Disease Progression ,Humans ,Kidney Failure, Chronic ,Toxins, Biological ,Treatment Outcome ,Uremia ,Diet, Protein-Restricted ,Renal Dialysis ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,030232 urology & nephrology ,Urology ,Renal function ,Protein-Restricted ,030204 cardiovascular system & hematology ,Toxicology ,Kidney Failure ,Excretion ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Toxins ,In patient ,Medical nutrition therapy ,Chronic ,End-stage kidney disease ,business.industry ,Concept Paper ,Biological ,medicine.disease ,Diet ,Medicine ,Hemodialysis ,business ,Kidney disease - Abstract
The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.
- Published
- 2021
21. Approaches to Minimize Delayed Graft Function in Renal Transplantation
- Author
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Domenico Giannese and Maria Francesca Egidi
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,medicine.disease ,Cold Ischemia Time ,Delayed Graft Function ,Surgery ,Transplantation ,medicine ,Etiology ,Effective treatment ,Intensive care medicine ,business ,Complication ,Dialysis - Abstract
Delayed graft function is a complication in the early posttransplant period that impacts the short and long-term graft outcome. It may be related to different factors that include center, recipient, or donor features. The etiology is still controversial, although different pathophysiologic mechanisms have been implicated. There is no effective treatment; however, early diagnosis and therapeutic interventions may reduce the consequence of this complication.
- Published
- 2017
22. List of Contributors
- Author
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Michael Abecassis, Ahmed Abed, Massimo Abelli, Sarwat Ahmad, Mario Alessiani, Aynaa Alsharidi, Fiorella Altruda, Gabriella Amorese, Andrea Angeletti, Mario Angelico, Roberta Angelico, Maria L. Angelotti, Robert J. Applegate, Anthony Atala, Chiara Attanasio, David Axelrod, Yanik Bababekov, Joydeep Basu, Francesca Becherucci, P. Matthew Belford, Enrico Benedetti, Valentina Benedetti, Ariela Benigni, Timothy A. Bertram, Oriol Bestard, Joshua Blake, Ugo Boggi, Lauren Brasile, Jonathan S. Bromberg, Sophie Brouard, Matthew Brovold, George W. Burke, Mirela Busic, Zeeshan Butt, Silvia Caddeo, Stefano Calzone, Josep M. Campistol, Irene Carmagnola, Fiona Carty, Diego Castanares-Zapatero, Christos E. Chadjichristos, Brooke E. Chambers, Sindhu Chandran, Christos Chatziantoniou, Ashton Chen, Linda Chen, Xiwu Chen, Valeria Chiono, Manuel Chiusa, Gaetano Ciancio, Gianluca Ciardelli, Gino Coletti, Elisabeth Coll, Christine Collienne, Robert B. Colvin, Monica Cortinovis, A. Benedict Cosimi, Paolo Cravedi, Giuseppe D’Amico, Stefano Da Sacco, Richard Danger, Jacques Dantal, Alan J. Davidson, Letizia De Chiara, Johannes W. De Fijter, Gloria de la Rosa, Francis L. Delmonico, Junhong Deng, Corinne Deurdulian, Abritee Dhal, Paolo Dionigi, Beatriz Domínguez-Gil, Marek Drozdzik, Jean-Claude Dussaule, Lauren Edgar, Maria Francesca Egidi, Hany El Hennawy, Karen English, Matthew J. Everly, Sharmila Fagoonee, Elvira Smeralda Famulari, Alan C. Farney, Marina Figliuzzi, Marialuisa Framarino-dei-Malatesta, David E. Fumo, Elena Gagliardini, Lorenzo Gallon, Sanjay K. Gandhi, Michael D. Gautreaux, Anna Geraedts, Domenico Giannese, Pier C. Giulianotti, Michael S. Goligorsky, Adam Griesemar, Josep M. Grinyó, Angelika C. Gruessner, Rainer W.G. Gruessner, Bulang He, Eliot Heher, Bing Ho, Sarah A. Hosgood, Kiyohiko Hotta, Atul Humar, H. David Humes, Giuseppe Iaria, Barbara Imberti, Juan Carlos Izpisua Belmonte, Ina Jochmans, Ravi Katari, Panagiotis Kavvadas, Tatsuo Kawai, Carlos Kengla, Tristan Keys, Amritha Kidiyoor, Kengo Kidokoro, Deepali Kumar, Michael A. Kutcher, Quirino Lai, Pierre-François Laterre, Céleste Lebbé, Christophe Legendre, Rachel Lennon, Peng Li, Jen-Jar Lin, Melissa H. Little, Xiongbing Lu, John W. Ludlow, Beatriz Mahíllo, Rosalinde Masereeuw, Rafael Matesanz, Mirjana S. Matovinovic, Benedetta Mazzinghi, Serge Cedrick Mbiandjeu Toya, Scott McEwen, Fabio Melandro, Loredana Melchiorri, Madhav C. Menon, Majid Mirzazadeh, Samantha Montag, Robert A. Montgomery, Virginie Montiel, Nuria Montserrat, Marina Morigi, Christian C. Morrill, Michel Mourad, Sean V. Murphy, Patricia Murray, Tiziana Nardo, Paolo A. Netti, Mark Nguyen, Michael L. Nicholson, John M. O’Callaghan, Linda Ohler, Giuseppe Orlando, Kenji Osafune, Tetsu Oura, Anna Peired, Andrea Peloso, Zhenzhen Peng, Norberto Perico, Laura Perin, Vittorio Perrone, Paul Persad, János Peti-Peterdi, Astgik Petrosyan, Andrea Pietrabissa, Christopher J. Pino, Jacques Pirenne, Francesco Pisani, Rutger J. Ploeg, Esteban Porrini, Ambra Pozzi, Alberto Pugliese, Luigi Pugliese, Ton J. Rabelink, Teresa Rampino, Michael A. Rees, Marlies E.J. Reinders, Andrea Remuzzi, Giuseppe Remuzzi, Anne Riquier-Brison, Raquel G. Roca, Jeffrey Rogers, Paola Romagnani, Ivy A. Rosales, Norman D. Rosenblum, Cinzia Rota, Piero Ruggenenti, Francesca Ruini, Junichiro Sageshima, Fadi El Salem, Shaifali Sandal, Veronika Sander, Ilaria Santeramo, Renato M. Santos, Minnie Sarwal, Jigesh Shah, Aneesha A. Shetty, Lorenzo Silengo, Eric Siskind, Anton Skaro, Renaud Snanoudj, Shay Soker, Andrew M. South, Goce Spasovski, Robert J. Stratta, Charles Strom, Bart Stubenitsky, Riccardo Tamburrini, Qizhi Tang, Ekamol Tantissattamo, Masayuki Tasaki, Hisham Tchelepi, Elena Ticozzelli, Opas Traitanon, Matias Trillini, Ivo Tzvetanov, María O. Valentín, Flavio Vincenti, Fabio Vistoli, Jelle Vriend, Stephen J. Walker, Jason A. Wertheim, David F. Williams, Bettina Wilm, Martijn J. Wilmer, Rebecca A. Wingert, Xavier Wittebole, Yun Xia, Christodoulos Xinaris, Kazuhiko Yamada, Takashi Yokoo, Shinya Yokote, Maarten L. Zandvliet, Roy Zent, Yuanyuan Zhang, David X. Zhao, Lihui Zhao, and Susan Y. Zhao
- Published
- 2017
23. Physical Activity in Peritoneal Dialysis: The Opinion of the Nephrologists
- Author
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Alessandro Capitanini, Caterina Cianchi, Enrico Fiaccadori, Adamasco Cupisti, Claudia del Corso, Domenico Giannese, and Roberto Corciulo
- Subjects
Nephrology ,medicine.medical_specialty ,Quality of life ,business.industry ,medicine.medical_treatment ,Internal medicine ,Emergency medicine ,Physical activity ,Medicine ,General Medicine ,business ,Peritoneal dialysis - Abstract
At the 17th national meeting of the “Peritoneal dialysis” Study Group (Italian Society of Nephrology), held in Montecatini Terme (20–22 March, 2014), 141 physicians received a questionnaire to surv...
- Published
- 2014
24. FP078LONG-TERM EFFECTS AND OUTCOME OF IDIOPATHIC RETROPERITONEAL FIBROSIS MANAGEMENT
- Author
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Teresa Lucchese, Riccardo Capecchi, Maria Francesca Egidi, Diego Moriconi, Simone Barsotti, Domenico Giannese, and Antonio Tavoni
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Medicine ,Idiopathic Retroperitoneal Fibrosis ,business ,Outcome (game theory) ,Term (time) ,Surgery - Published
- 2018
25. Long-term Functional Outcomes in Patients With a W-shaped Ileal Orthotopic Neobladder With No Antireflux Mechanism
- Author
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Andrea Minervini, Chiara Mariani, Riccardo Minervini, Michele Santarsieri, Vincenzo Ficarra, Domenico Giannese, R Pagni, and Girolamo Morelli
- Subjects
SEVERITY INDEX ,Male ,medicine.medical_specialty ,Time Factors ,Urology ,media_common.quotation_subject ,AFFERENT TUBULAR SEGMENT ,Urination ,Renal function ,Urinary incontinence ,Anastomosis ,Kidney ,UPPER URINARY-TRACT ,PAD-WEIGHING TESTS ,URETERAL REIMPLANTATION ,BLADDER SUBSTITUTES ,RADICAL CYSTECTOMY ,SYMPTOM INDEX ,DIVERSION ,COMPLICATIONS ,chemistry.chemical_compound ,Ileum ,Lower urinary tract symptoms ,Surveys and Questionnaires ,medicine ,Humans ,Nocturia ,Aged ,Upper urinary tract ,media_common ,Creatinine ,business.industry ,Urinary Reservoirs, Continent ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Continent ,chemistry ,Female ,Follow-Up Studies ,medicine.symptom ,business ,Urinary Reservoirs - Abstract
Objective To evaluate the long-term renal function, continence, and voiding function in 64 patients, surviving for 5 or more years after W-shaped ileal neobladder with a short afferent limb and refluxing ureterointestinal anastomoses. Materials and Methods Kidney morphology and function were evaluated using nuclear renography, creatinine, and glomerular filtration rate. Continence and voiding function were evaluated with a diary on frequency, voided volumes, number of pads, and with the incontinence severity index (ISI) questionnaire, the American Urological Association-Symptom Index (AUA-SI), and the American Urological Association-Symptom Problem Index. Results The renal scan showed a dilatation of the upper urinary tract in 4.8% of renoureteral units. Of the patients, 12.5% voided with intermittent or permanent catheterization. The remaining 87.5% voided spontaneously; 75% did not use pads, 12.5% used protection for safety, 7.1% 1 pad, and 5.4% more than 1 pad, during the day; during night, 55.3% did not use pads, 23.2% used protection for safety, and 12.6% and 8.9% 1 or more than 1 pad. The ISI questionnaire showed that 35.7% were fully continent, whereas 41%, 12.5%, and 10.8% had slight, moderate, and severe incontinence. The AUA-SI showed that 50% had mild, 39.3% moderate, and 10.7% severe lower urinary tract symptoms. Urinary incontinence, daytime frequency, and nocturia correlated positively with the age of patients at follow-up and negatively with voided volume. Conclusion Long-term detrimental effect on renal function of orthotopic neobladder with no antireflux anastomoses is limited. Long-term continence and voiding function results are satisfactory. The ISI questionnaire might be useful to evaluate and grade incontinence in patients with orthotopic neobladder, whereas the AUA-SI has many limitations.
- Published
- 2013
26. Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach
- Author
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Claudia Zullo, Claudia D’Alessandro, Biagio Di Iorio, Anna Bottai, Adamasco Cupisti, Massimiliano Barsotti, Domenico Giannese, and Maria Francesca Egidi
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,030232 urology & nephrology ,Renal function ,Severity of Illness Index ,Blood Urea Nitrogen ,Phosphates ,03 medical and health sciences ,Hyperphosphatemia ,0302 clinical medicine ,Patient satisfaction ,Internal medicine ,Severity of illness ,Medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Vitamin D ,Blood urea nitrogen ,Serum Albumin ,Aged ,Aged, 80 and over ,business.industry ,Tertiary Healthcare ,Case-control study ,Potassium, Dietary ,Sodium, Dietary ,Feeding Behavior ,Middle Aged ,medicine.disease ,Patient Satisfaction ,Case-Control Studies ,Hematinics ,Erythropoiesis ,Female ,Dietary Proteins ,business ,Energy Intake ,Glomerular Filtration Rate ,Research Article - Abstract
Background Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. Methods This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG). In the NTG patients the dietary interventions were assigned in order to prevent or correct abnormalities and to maintain a good nutritional status. They included manipulation of sodium, phosphate, energy and protein dietary intakes while paying special attention to each patient’s dietary habits. Results Phosphate and BUN levels were lower in the NTG than in the CG, especially in stage 4 and 5. The prevalence of hyperphosphatemia was lower in the NTG than in CG in stage 5 (13.3 % vs 53.3 %, p
- Published
- 2016
27. Hypoproteic diet in patients' community: reports from University of Pisa
- Author
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Domenico Giannese, E. Colombini, Claudia D’Alessandro, and Dott.ssa I. Evangelisti
- Subjects
National health ,medicine.medical_specialty ,Low protein ,business.industry ,General Medicine ,University hospital ,Artificial foods ,Low phosphorus diet ,Family medicine ,Educational aid ,Medicine ,In patient ,Clinical care ,business - Abstract
Nutrition is considered by the National Health Authorities as part of the clinical care process. In this perspective, the catering service of a hospital represents a powerful therapeutic and educational aid for the in-patients.The catering service of our University Hospital in Pisa is based on a collection of standardized diets with indications concerning the type of patient which they are addressed. The present paper deals with our experience in this field, and in particular with the diets for renal patients.The so called “special” diets, such as low protein (0.6 g / kg b. w. / day) low phosphorus diet, the low protein (0.7 g / kg b.w./ day) vegetarian diet and the very low protein (0.3 g / kg b. w./day) low phosphorus diet are prescribed by the doctors and developed by the dietician for the individual patient.Since its preparation, the low-protein diets have several critical points, namely processing - packaging and distribution of the diet, no customization, the low protein artificial foods).In order t...
- Published
- 2012
28. MP798CLINICAL IMPACT OF DONOR SPECIFIC ANTIBODIES IN LIVING DONOR KIDNEY TRANSPLANTATION
- Author
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Diego Moriconi, Alessandro Mazzoni, Domenico Giannese, Ugo Boggi, Maria Francesca Egidi, and Luciana Mariotti
- Subjects
Transplantation ,Nephrology ,business.industry ,Donor specific antibodies ,Immunology ,Medicine ,business ,medicine.disease ,Living donor ,Kidney transplantation - Published
- 2017
29. TO043RETROPERITONEAL FIBROSIS AND IGG4 RELATED DISEASE: TWO SIDES OF THE SAME COIN?
- Author
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Diego Moriconi, Domenico Giannese, Maria Francesca Egidi, Antonio Tavoni, Riccardo Capecchi, and Simone Barsotti
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,Fibrosis ,business.industry ,Internal medicine ,medicine ,IgG4-related disease ,medicine.disease ,business ,Gastroenterology - Published
- 2017
30. SP060SYNTHETIC ACTH TREATMENT IN PATIENTS WITH MEMBRANOUS NEPHROPATHY
- Author
-
Domenico Giannese, P Lorusso, Caterina Cianchi, Maria Francesca Egidi, and Angelo G. Bonadio
- Subjects
Transplantation ,medicine.medical_specialty ,Membranous nephropathy ,Nephrology ,business.industry ,Cosyntropin ,Urology ,medicine ,Acth treatment ,In patient ,medicine.disease ,business - Published
- 2018
31. MP208SERUM AND URINARY MARKERS OF ACUTE KIDNEY INJURY AFTER COMPLEX HEPATIC SURGERY
- Author
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Lucio Urbani, Chiara Leoni, Carlo Donadio, Giovanna Pasquariello, Domenico Giannese, Piero Buccianti, G Licitra, Antonio Lucacchini, Elena Donadio, Elisabetta Giglio, Emanuela Mangione, Laura Bozzoli, Maria Enrica Baronti, Francesco Forfori, and Laura Giusti
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Hepatic surgery ,Urinary system ,Urology ,Acute kidney injury ,Medicine ,business ,medicine.disease - Published
- 2016
32. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients
- Author
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Emilio Salotti, Maria Enrica Baronti, Adamasco Cupisti, Domenico Giannese, Alba Tavolaro, Claudia D’Alessandro, Sara Lange, and Alessandro Capitanini
- Subjects
Nephrology ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,medicine.medical_treatment ,Nutritional Status ,Physical exercise ,Disease ,lcsh:RC870-923 ,Hemodialysis, End-stage renal disease, Exercise, Physical activity ,End stage renal disease ,End-stage renal disease ,Renal Dialysis ,Internal medicine ,lcsh:Dermatology ,Medicine ,Humans ,Intensive care medicine ,Exercise ,Dialysis ,Sedentary lifestyle ,Physical activity ,business.industry ,General Medicine ,lcsh:RL1-803 ,lcsh:Diseases of the genitourinary system. Urology ,Physical activity level ,Exercise Therapy ,lcsh:RC666-701 ,Hemodialysis ,Physical therapy ,Kidney Failure, Chronic ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal “exercise team” for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.
- Published
- 2014
33. MP735LIFESTYLE AND DIETARY HABITS IN RENAL TRANSPLANTED PATIENTS
- Author
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Giovanni Tripepi, Maria Francesca Egidi, Vincenzo Bellizzi, Samar Abd ElHafeez, Giuseppe Conte, Alessandro Capitanini, Patrizia Calella, Adamasco Cupisti, Serena Torraca, Domenico Giannese, Claudia D’Alessandro, and Andrea Camocardi
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Internal medicine ,medicine ,business - Published
- 2016
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