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Dent’s disease (DD) involves nephrocalcinosis, urolithiasis, hypercalciuria, LMW proteinuria, and renal failure in various combinations. Males are affected. It is caused by mutations in the chloride channel CLCN5 gene. It has been suggested that DD is underdiagnosed, occurring in less overt forms, apparently without family history. A possible approach to this problem is to search for CLCN5 mutations in patients who may have a high prevalence of mutations: end-stage renal disease (ESRD) patients with previous calcium, struvite, or radio-opaque (CSR) stones. We looked for CLCN5 mutations in 25 males with ESRD–CSR stones selected from all of the patients (1,901 individuals, of which 1,179 were males) of 15 dialysis units in the Veneto region. One DD patient had a new DD mutation (1070 G>T) in exon 7. The new polymorphism IVS11–67 C>T was detected in intron 11 in one patient and one control. We also found 28 females with ESRD and stone history, and seven more males with ESRD and non-CSR stones. The prevalence of stone formers among dialysis patients in our region was 3.2%, much lower than the prevalence observed in older studies. Struvite stones continue to play a major role in causing stone-associated ESRD .

We compared the efficacy and safety of apheresisand reinfusion of concentrated ascites (ARCA) versustotal paracentesis plus intravenous albumin (PARA) in aprospective trial on cirrhotic patients with tense ascites. Twenty-four patients wererandomized to either ARCA (N = 12) or PARA (N = 12), andfollowed for two years. Sex, age, Child's class, andrenal and liver function were similar in the two groups. The times of the procedures were 2.7 ±1.0 (ARCA) vs 2.2 ± 1.1 (PARA) hr, with removalof 8.8 ± 3.5 (ARCA) and 6.9 ± 3.4 (PARA)liters of ascites and intravenous infusion of 59.8± 35.2 (ARCA) and 42.5 ± 20.5 (PARA) g of albumin. Both procedures were safe.Biochemical signs of coagulative disturbances having noclinical relevance were observed after ARCA, with anincrease in prothrombin time (P = 0.005) and serum FSP (P = 0.02). No significant changes in renalfunction, serum albumin, or plasma and urinaryelectrolytes were shown. Plasma renin activity increasedafter PARA (P = 0.02) and plasma atrial natriureticfactor increased after ARCA (P = 0.008), although nodifferences were observed in diuresis in the immediatefollow-up. During the long-term follow-up, patientsurvival and recurrence of tense ascites were the same in both groups. We conclude that apheresis andreinfusion of concentrated ascites are as safe andeffective as total paracentesis with albumin infusionfor the treatment of tense ascites in cirrhoticpatients.

OLT is an effective therapeutic option for end-stage liver disease and survival rates are encouraging. Disagreement however exists as to whether OLT should be provided to patients with alcoholic cirrhosis. The aim of the study was to evaluate long-term results (recidivism to alcohol consumption, incidence of acute rejection, survival) in patients transplanted for ALD.

It has recently been described that kappa-opioid receptor agonists inhibit antidiuretic hormone secretion and promote water excretion in humans and experimental animals. The aim of this study was to evaluate the aquaretic efficacy of the kappa-opioid receptor agonist RU 51599 in conscious cirrhotic rats with ascites and water retention.In protocol 1, arterial pressure, heart rate, and renal water metabolism were measured in basal conditions and then were measured for 120 minutes after the administration of Ringer's solution (n = 8; 0.4 mL) or RU 51599 (n = 7; 1 mg/kg). In protocol 2, plasma antidiuretic hormone concentration was measured (n = 6) before and 60 minutes after administration of RU 51599 (1 mg/kg). In protocol 3, the effect of RU 51599 (n = 9; 1 mg/kg) was compared with that of the V2-receptor antagonist SKF 100398 (n = 9; 30 micrograms/kg).RU 51599 administration induced a profound diuretic and aquaretic effect without altering arterial pressure and heart rate. In protocol 2, the kappa-opioid agonist reduced by about 50% plasma antidiuretic hormone levels (from 6.6 +/- 0.9 to 3.4 +/- 0.6 pg/mL; P0.05). Finally, the improvement in renal water metabolism induced by RU 51599 was similar to that produced by the V2-receptor antagonist.RU 51599 has a potent aquaretic effect in cirrhotic rats with water retention, suggesting that kappa-opioid receptor agonists may be useful for the treatment of water retention and dilutional hyponatremia in cirrhosis.