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BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most common renal hereditary disorder. Several authors have attempted to identify a kidney damage marker for predicting the prognosis and the effectiveness of therapy in ADPKD. AIM To identify and quantify ADPKD, through a novel magnetic resonance imaging protocol with 3 Tesla (MRI 3Tesla), the presence of parenchymal fibrotic tissue at early stage of disease, able to correlate the glomerular filtrate and to predict the loss of the renal function. METHODS A total of 15 ADPKD patients had undergone renal testing on MRI 3Tesla at T0 and were revaluated after follow up (T1) of 5 years. We have evaluated renal function, plasma aldosterone concentration (PAC), insulin resistance and surrogate markers of atherosclerosis (carotid intima-media thickness, ankle/brachial index (ABI) and left ventricular mass index (LVMI). RESULTS Our study showed a significant negative correlation between total kidney volume (TKV) and estimated glomerular filtration rate (eGFR) during observation (P < 0.02). We showed a negative correlation between eGFR with total fibrotic volume (TFV) (P < 0.04) and total perfusion volume/TKV (P < 0.02). Moreover TFV was correlated positively with PAC (P < 0.05), insulin values (P < 0.05), ABI (P < 0.05) and LVMI (P < 0.01). CONCLUSION The MRI 3Tesla, despite the high costs, could be considered as a useful and non-invasive method in the evaluation of fibrotic tissue and progression of the disease in ADPKD patients. Further clinical trials on larger groups are due to confirm the results of this pilot study, suggesting that MRI 3Tesla can be useful to evaluate the effectiveness of new therapeutic strategies.

Contagious bovine pleuropneumonia (CBPP) is a respiratory disease of cattle that is listed as notifiable by the World Organization for Animal Health. It is endemic in sub-Saharan Africa and causes important productivity losses due to the high mortality and morbidity rates. CBPP is caused by Mycoplasma mycoides subsp. mycoides ( Mmm) and is characterized by severe fibrinous bronchopneumonia and pleural effusion during the acute to subacute stages and by pulmonary sequestra in chronic cases. Additional lesions can be detected in the kidneys and in the carpal and tarsal joints of calves. Mmm infection occurs through the inhalation of infected aerosol droplets. After the colonization of bronchioles and alveoli, Mmm invades blood and lymphatic vessels and causes vasculitis. Moreover, Mmm can be occasionally demonstrated in blood and in a variety of other tissues. In the lung, Mmm antigen is commonly detected on bronchiolar and alveolar epithelial cells, in lung phagocytic cells, within the wall of blood and lymphatic vessels, inside necrotic areas, and within tertiary lymphoid follicles. Mmm antigen can also be present in the cytoplasm of macrophages within lymph node sinuses, in the germinal center of lymphoid follicles, in glomerular endothelial cells, and in renal tubules. A complete pathological examination is of great value for a rapid presumptive diagnosis, but laboratory investigations are mandatory for definitive diagnosis. The purpose of this review is to describe the main features of CBPP including the causative agent, history, geographic distribution, epidemiology, clinical course, diagnosis, and control. A special focus is placed on gross and microscopic lesions in order to familiarize veterinarians with the pathology and pathogenesis of CBPP.

Background/Aims: Cardiovascular disease is the most frequent cause of morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) patients, often before the onset of renal failure, and the pathogenetic mechanism is not yet well elucidated. The aim of the study was to identify early and noninvasive markers of cardiovascular risk in young ADPKD patients, in the early stages of disease. Methods: A total of 26 patients with ADPKD and 24 control group, matched for age and sex, were enrolled, and we have assessed inflammatory indexes, mineral metabolism, metabolic state and markers of atherosclerosis and endothelial dysfunction (carotid intima media thickness (IMT), ankle brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI), left ventricular mass index (LVMI)) and cardiopulmonary exercise testing (CPET), maximal O2 uptake (V’O2max), and O2 uptake at lactic acid threshold (V’O2@LT). Results: The ADPKD patients compared to control group, showed a significant higher mean value of LVMI, RRI, homocysteine (Hcy), Homeostasis Model Assessment-insulin resistance (HOMA-IR), serum uric acid (SUA), Cardiac-troponinT (cTnT) and intact parathyroid hormone (iPTH) (p2max, V’O2max/Kg and V’O2max (% predicted) (p2@LT, V’O2 @LT%, V’O2@LT/Kg,) (pConclusion: In our study, ADPKD patients, in the early stages of disease, showed a greater insulin resistance, endothelial dysfunction, inflammation and mineral metabolism disorders, respect to control group. Moreover, these patients presented reduced tolerance to stress, and decreased anaerobic threshold to CPET. Our results indicate a major and early cardiovascular risk in ADPKD patients. Therefore early and noninvasive markers of cardiovascular risk and CPET should be carried out, in ADPKD patients, in the early stages of disease, despite the cost implication.

BACKGROUND: Chronic kidney disease is a common condition in the general population, particularly among older adults. Renal impairment is in turn associated with metabolic and nutritional derangements and with increased risk of cardiovascular disease. AIM: To compare the metabolic, nutritional, and cardiovascular impact of reduced kidney function between patients with and without known renal disease. MATERIAL AND METHODS: We enrolled consecutive outpatients (age ≥65 years) with reduced renal function who were divided into two groups: Group A with history of renal disease and Group B with unknown renal disease. Metabolic and nutritional parameters, including involuntary body weight loss (BWL) in the previous 6 months, mineral metabolism, inflammatory indices, and left ventricular mass index (LVMI), were evaluated. RESULTS: A total of 76 patients were enrolled. Group A (n = 39, M: 24, F: 15) showed greater BWL with a significant reduction of 25-hydroxyvitamin D, transferrin, cholinesterase, albumin, and LVMI with respect to Group B (p < 0.01). Conversely, Group B (n = 37, M: 23, F: 14) showed significantly increased intact parathyroid hormone, total cholesterol, low-density lipoprotein, triglycerides, and C-reactive protein when compared to Group A (p < 0.05). CONCLUSION: The positive history of renal disease may negatively impact on several metabolic and nutritional parameters related to increased cardiovascular risk among older adults.

Listeria monocytogenes (L.m.) is an agent of serious foodborne illness. It is a major concern for the food industry, since microorganism, growing in biofilms is protected against cleaning and disinfection and is difficult to eradicate. Aim of this study was to develop a protocol to assess the ability of two flexible packaging materials, named HGP40 and GND35, submitted to corona discharge treatment, to limit the production of L.m. biofilm at 12±1°C. Two strains were selected for this study: L.m ATCC 7644 and L. m. EURL 12MOB098LM isolated from dairy products. Results suggest that both L.m. strains were able to form biofilm on packaging materials tested. The differences on HGP40 and GND35s treated and not treated surfaces were not statistically significant.

In 1914, Abel, along with Rowentree and Turner, introduced the term “plasmapheresis” whose literal meaning is “subtraction”. The first “therapeutic plasmapheresis” was performed in 1952 in a patient with multiple myeloma; in 1963, patients with paraproteinemia were treated with plasmapheresis to reduce blood hyperviscosity, as described by Salomon and Fahey. During the course of time, more specific and selective techniques were gradually introduced, allowing the use of the treatment for new clinical indications (plasma exchange, CRYO apheresis, leukapheresis, thrombocytopheresis, lymphocyte apheresis, LDL apheresis). The current indications for plasmapheresis have been defined, and periodically re-established, by two scientific American associations, the American Association of Blood Banks (AABB) and the American Society of apheresis (ASFA), based on the available evidence of efficacy of this treatment in specific diseases. In 1993, a study group for therapeutic apheresis was created within the Italian So...

Since its first use apheresis has changed, developing in terms of different materials and techniques, and has been applied to treat several types of diseases. Thus, apheresis has become a complex therapeutical device that requires particular knowledge and expertise.Overall the use of this technique has been poorly managed in Italy, as well as in Europe, since physicians cannot refer to specific guidelines for its application. The purpose of a study group created in 1993 by the Italian Nephrology Society, is to develop such guidelines and protocols with a multidisciplinary approach. This allows different specializations to bring their knowledge together in a collaboration that will not only result in the realization of a common goal, but will also allow to clarify specific aspects of their own specialty. Informed consent is a fundamental act in medicine, as it legitimates every medical action. We suggest using a standard process to obtain the consent in any case requiring apheresis.

Hypertension is commonly associated with autosomal dominant polycystic kidney disease (ADPKD), often discovered before the onset of renal failure, albeit the pathogenetic mechanisms are not well elucidated. Hyperaldosteronism in ADPKD may contribute to the development of insulin resistance and endothelial dysfunction, and progression of cardiorenal disease. The aim of study was to evaluate the prevalence of primary aldosteronism (PA) in ADPKD patients and identify some surrogate biomarkers of cardiovascular risk. We have enrolled 27 hypertensive ADPKD patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min, evaluating the renin–angiotensin–aldosterone system (RAAS), inflammatory indexes, nutritional status, homocysteine (Hcy), homeostasis model assessment-insulin resistance (HOMA-IR), mineral metabolism, microalbuminuria, and surrogate markers of atherosclerosis [carotid intima media thickness (cIMT), ankle/brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI) and left ventricular mass index (LVMI)]. Furthermore, we have carried out the morpho-functional magnetic resonance imaging (MRI) with high-field 3 T Magnetom Avanto. We have divided patients into group A, with normal plasma aldosterone concentration (PAC) and group B with PA, present in 9 (33%) of overall ADPKD patients. Respect to group A, group B showed a significant higher mean value of LVMI, HOMA-IR and Hcy (P = 0.001, P = 0.004, P = 0.018; respectively), and a lower value of FMD and 25-hydroxyvitamin D (25-OH-VitD) (P = 0.037, P = 0.019; respectively) with a higher prevalence of non-dipper pattern at Ambulatory Blood Pressure Monitoring (ABPM) (65% vs 40%, P

The natural history of urolithiasis includes the risk of recurrence and of the development of chronic kidney and/or bone disease, which is why a thorough clinical and metabolic evaluation of these patients is of the utmost importance at disease onset. This paper is aimed at identifying the type of urolithiasis, the related risk factors, and the corresponding treatment options. The diagnostic and therapeutic approach described here includes 1) accurate history taking to detect secondary nephrolithiasis and screen for the main risk factors for kidney and bone disease; 2) metabolic evaluation graded according to different complexity levels based on the severity of the disease and the presence of risk factors; 3) carrying out appropriate imaging procedures. The resulting information allows to plan treatment based either on general rules of lifestyle and diet, or on selected medical intervention, if necessary. This report, which is based on current guidelines, was produced by the Gruppo Italiano di Studio Multidisciplinare per la Calcolosi Renale. It is addressed to all professionals involved in the management of patients suffering from nephrolithiasis, first of all general practitioners, who often become involved immediately at the onset of the disease.

Nel 1914, Abel, insieme a Rowentree e Turner, ha introdotto il termine “plasmaferesi”, il cui significato letterale è “sottrazione”. La prima “plasmaferesi terapeutica” risale al 1952 in un paziente affetto da mieloma multiplo, ma, nel 1963, iniziarono le prime applicazioni cliniche per ridurre l'iperviscosità del sangue in pazienti affetti da paraproteinemia, ad opera di Salomon e Fahey. Nel tempo sono state introdotte tecniche sempre più specifiche e selettive, ampliando notevolmente le indicazioni cliniche (plasma-exchange, crioaferesi, leucoaferesi, trombocitoaferesi, linfocitoaferesi LDL aferesi). Le attuali indicazioni alla plasmaferesi vengono definite e periodicamente ristabilite da due associazioni scientifiche americane, l'American Association of Blood Banks (AABB) e l'American Society of Apheresis (ASFA), sulla base delle prove di efficacia del trattamento nelle malattie specifiche. Nel 1993 è stato costituito, nell'ambito della Società Italiana di Nefrologia, il gruppo di studio dell'aferesi terapeutica che ha il compito di sviluppare Linee Guida di riferimento per il trattamento con plasmaferesi. Il fine ultimo della terapia aferetica sarebbe quello di poter rimuovere dal circolo solo le sostanze patogene, ma l'utilizzo di tecniche di rimozione selettiva si accompagna in realtà non tanto a una maggiore capacità di estrazione della sostanza, bensì a una minore rimozione di componenti non patologiche, riducendo il rischio di infezioni, emorragie e reazioni allergiche. Tuttavia, la plasmaferesi potrebbe anche agire modulando il sistema immunitario oltre che rimuovendo le sostanze patogene. L'aferesi terapeutica è indicata in immunologia, dermatologia, ematologia, oncologia e nelle malattie dismetaboliche, neurologiche e renali ed è utilizzata anche nelle emergenze come tecnica di detossificazione sia endogena che esogena, in cui è necessaria la rimozione della sostanza patogena prima che si verifichi un danno d'organo irreversibile. La plasmaferesi terapeutica ha subito negli anni un cambiamento notevole conseguente allo sviluppo tecnologico delle apparecchiature e a un'espansione delle indicazioni. Infatti, l'innovazione tecnologica ha introdotto metodiche che permettono un trattamento più tollerabile e meno invasivo. Hemofenix utilizza la filtrazione mediante membrana attraverso un sistema di nanofiltrazione, il filtro ROSA. Hemofenix, permettendo di eseguire il trattamento con un singolo e piccolo ago e con un volume extracorporeo ridotto, circa 70 mL, potrebbe ridurre i rischi per il paziente, anche pediatrico. Ulteriori vantaggi potrebbero essere rappresentati dalla breve durata del trattamento e dalla mancata necessità di utilizzare il plasma come fluido di sostituzione, riducendo il rischio di infezioni e reazioni allergiche. Sicuramente, oltre alla sicurezza, dovrà essere valutata la reale efficacia in trial clinici randomizzati, confrontando questa metodica con le terapie aferetiche classiche.

A 7-year-old Dachshund was clinically examined because of a 10-day history of lameness in the left hind limb. On the basis of radiological and cytological findings, an osteosarcoma of the left acetabular region was suspected. The dog underwent a hemipelvectomy and osteosarcoma was diagnosed by subsequent histopathological examination. An immovable subcutaneous mass was noted on the left chest wall during the physical examination and non-septic neutrophilic inflammation was diagnosed by cytology. Forty days later, the dog showed signs of respiratory distress with an in-diameter increase of the subcutaneous mass up to 4 cm. Thoracic radiography and ultrasonography revealed pleural effusion and a lytic process in the fourth left rib. Furthermore, ultrasound examination revealed a mixed echogenic mobile structure with a diameter of around 2 cm floating within the pleural fluid of the left hemithorax close to the pericardium. The dog underwent surgery for an en bloc resection of the subcutaneous mass together with the fourth rib and the parietal pleura. Moreover, the left altered lung lobe, corresponding to the mobile structure detected by ultrasound, was removed. Based on cytological, histopathological, and immunohistochemical examinations, an invasive epithelioid pleural malignant mesothelioma was diagnosed.