Search

Radiation exposure accompanying medical imaging associates with cancer risk. Patients with recurrent or chronic diseases may be especially at risk, because they may undergo more of these procedures. The aim of this study was to assess the individual cumulative effective doses (CEDs), which quantify radiation from medical imaging procedures, in a cohort of 106 hemodialysis patients during a median follow-up of 3 years. We retrospectively calculated individual radiation exposures by collecting the number and type of radiologic procedures from hospital records. We also estimated organ doses for computed tomography procedures. The mean and median annual CEDs were 21.9 and 11.7 mSv per patient-year, respectively. The mean and median total CEDs per patient during the study period were 57.7 and 27.3 mSv, respectively. By radiation dose group, we classified 22 patients as low (<3 mSv/yr), 51 as moderate (3 to <20 mSv/yr), 22 as high (20 to <50 mSv/yr), and 11 as very high (≥50 mSv/yr). Seventeen patients had a total CED >100 mSv, a value associated with a substantial increase in risk for cancer-related mortality. Of the total CED,s 76% was a result of CT scanning. The annual CED significantly associated with age and transplant waitlist status. In summary, this study shows that a significant fraction of surviving hemodialysis patients during a 3-year period receives estimated radiation doses that may put them at an increased risk for cancer.

With 135 million cases the prevalence of diabetes mellitus (DM) is very high worldwide. Diabetic nephropathy is a major complication of DM. In many countries diabetic nephropathy has become the most frequent cause of endstage renal disease. It is believed that in diabetic patients the creation of a native vascular access (NVA) might be difficult. We evaluated 274 occurrences of NVA creation during the period January 2003 to December 2008: 68 in diabetic patients (group 1) and 206 in nondiabetics (group 2). We compared the type of NVA, primary failure, and primary patency in these groups. Age was significantly higher in diabetic patients (68 vs 64 years; p < 0.05). No statistical differences in primary failure between groups were found for any NAV. Wrist vascular access survival rates were higher in diabetic versus nondiabetic patients (56.9% vs 20.7% at 72 months). No statistical differences were observed between groups in primary patency rates for middle- and upper-arm vascular access. According to our experience diabetes does not lead to additional difficulties in the creation of permanent vascular access, provided proper physical and instrumental examination is performed. Despite the advanced age of the diabetic patients in our study, wrist vascular access showed better results in this group than in nondiabetic patients on long-term follow-up.

Background: Polyoma virus (PV) is a double-stranded DNA virus, member of the Papovaviridae family. BKV and JCV are the most studied in human pathology, whereas simian virus 40 (SV40) is pathogenic in the monkey and has been implicated in human carcinogenesis. PV is associated with renal and urinary tract pathology. The initial infection by PV occurs in childhood, probably by airways, and is usually asymptomatic. Subsequently, it remains latent in kidneys, tonsils and CNS and may reactivate in concomitance with significant T-cell dysfunction. Infection in immunocompromised patients can be clinically relevant. However, asymptomatic viruria may be detected in 0.3 % of individuals without a known history of immunodeficiency., Case Report: We describe the case of a male patient, aged 31, admitted to our Unit for arterial hypertension and urinary abnormalities. He had a history of hemorrhagic cystitis in 1996 and persistent microscopic hematuria thereafter. Renal function was normal, arterial pressure well controlled with an ACE-inhibitor; urine culture was negative and most of the immunologic and rheumatologic tests were normal, with the exception of slightly reduced levels of C3 and an inverted CD4/CD8 ratio. Serology for HCV, HBV, HIV and screening for tumor markers were negative. Renal ultrasonography displayed an increased reflectivity, as seen in medical nephropathies; no nephrolithiasis was found. Urinary cytology showed "decoy cells", as typically found in PV infection, whose presence was confirmed by n-PCR. Diagnosis at discharge from the hospital was primary arterial hypertension and urinary JCV infection. Currently, no treatment of proven efficacy against PV is available., Conclusions: We think that there is an increasing amount of evidence to include screening for PV in the diagnosis of urinary tract abnormalities of unknown origin, even in apparently immunocompetent patients. Urinary cytology, in experienced hands, may be a useful and relatively inexpensive first step diagnostic tool.

Background: The aim of the study was to value the behaviour of systolic (S) and diastolic (D) arterial pressure (AP)/24 hrs in a group of diabetic patients insulin-dependent (IDDM) and non insulin-dependent (NIDDM) with preserved renal function., Methods: We examined 65 diabetic patients (aged 39.1 +/- 23.3), 33 IDDM (aged 18.2 +/- 7.5; years of diabetes: 5.8 +/- 4.9) and 32 NIDDM (aged 60.7 +/- 11.4; years of diabetes: 7.2 +/- 7.5). In all of them we computed BMI and determined creatinine clearance, glycosylated haemoglobin A, total and HDL-associated cholesterol, triglyceridemia, middle glycemia and microalbuminuria. AP measurement was performed by 24 hrs monitoring (periodicity 15') using a Takeda 2420 measurer. Chronobiological characteristics of AP were analysed by statistical method of cosinor according to Halberg, examining if there was or not a blood pressure circadian rhythm (PCR) (p < 0.05) and its characteristics represented by the mesor, the amplitude and the acrophase. Moreover the patients were subjected to a diet with fixed contents of sodium (130 mEq/day) and afterwards we drew (every 4 hours) renin (R), aldosterone (A1) and atrial natriuretic factor (ANF) which were analysed with cosinor's method. The purpose was not to compare the two populations, not homogeneous between them and not different only for the years of diabetes, but to study their blood pressure behaviour, the rhythm, the order of the indicated hormones for possible pathogenetic connections., Results: NIDDM presented higher blood pressure values (PAS 134.2 +/- 3.5 and PAD 80.9 +/- 2 mmHg) than IDDM (PAS 116.6 +/- 1 and PAD 66.4 +/- 1.7 mmHg), still in limits of substantial normality. The acrophase was in the midday for NIDDM (PAS 11:25', PAD 12:06') and in the early afternoon for IDDM (PAS 14:15', PAD 14:06'). Analysing the trend of the AP in the single cases, PCR was present in 70% and absent in 30% of IDDM while it was persistent in 56% and disappeared in 44% of NIDDM. IDDM without PCR differed from those with it in years of diabetes (p < 0.001), body weight (p < 0.02), BMI (p < 0.01), triglyceridemia (p < 0.05), all more elevated, as well as in higher PAS and PAD (p < 0.001) and in higher concentration of ANF (p < 0.05). The same comparison was done in NIDDM. Patients without PCR were older (p < 0.025), had higher PAS (p < 0.025) and PAD (p < 0.001) and also a more activated ANF (p < 0.001)., Conclusions: This hormonal anomaly may be ascribed to a lower excretion of sodium with consequent expansion of extracellular volume due to antinatriuretic action of insulin often found at high plasmatic levels particularly in NIDDM.

In the context of metabolic alteration in dialysis patients the Authors have studied the characteristics, incidence, pathogenesis, effect of dialysis, atherogenic risk and therapeutic approach to hyperlipemia in hemodialysis patients. Hypertriglyceridemia secondary to reduced lipolytic activity is the most frequent alteration observed in hemodialytic patients (36.7% of cases). In addition, hemodialysis reduces the levels of lipoprotein in the blood whereas the atherogenic role of hyperlipemia does not appear to be as important as that of arterial hypertension and smoking. Simvastatin breaks down the lipidic fractions which are involved in atherogenesis and coronary cardiopathy, thus acting as a valuable prevention against cardiovascular involvement in dialysis.

A kinetic evaluation of dialytic methods using a diffusive-convective mechanism in comparison to the standard bicarbonate dialysis was performed in order to verify the possible therapeutic uses. The "kinetic" comparison of PFD and HDF to HBD, using equal quantities of dialysate, showed no significant change in the mention of uremic toxins of small molecular weight and a more efficient capacity to extract beta 2M by the diffusive-convective methods. The biophysical evaluation of dialysis still appears to represent the best means of defining the clearance possibilities and of identifying the most suitable technique for achieving a dialytic adequacy.

We used both the conventional test and a modified assay, the hypocryoglobulin test, to detect cryoprecipitates in 90 patients; 79 of them had different diseases in which cryoglobulins are frequently seen. For 11, type II essential mixed cryoglobulinemia had previously been diagnosed. It is still uncertain whether dilution of serum is a real help for detection of cryoglobulins. In the group of 79 patients, we found enhancement of cryoprecipitation in hypotonic sera in 33% of the cases, all with low cryocrit levels (less than 2%). In all but one of the patients with type II cryoglobulins, the hypocryocrit was equal to or lower than the cryocrit. The hypocryoglobulin test can detect a cryoprecipitate in patients with conventional cryocrits near the limits of visibility. In a few cases of cryoglobulinemic vasculitis, dilution of the serum can disclose a cryoprecipitate otherwise not visible.