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The objectives of this study were to perform bioelectrical impedance analysis before and after heart transplantation with comparison to healthy subjects. Eight patients (7 men, 1 woman) before (day 0) and after transplantation (day 3, 7, 12, 15, and 180) and 24 healthy controls, matched for sex, age, and body mass were studied. Data collection included bioelectrical impedance analysis (resistance, reactance, and estimates of body water), clinical, and laboratory measurements. Compared with controls, patients had at baseline significantly higher reactance, not significantly different resistance, body weight, total body water, and intra- to extracellular water ratio. After surgery, for reactance, there was an acute decrease followed by a slow, progressive increase up to normal level by day 15. Resistance and body weight did not significantly change; the intra- to extracellular water ratio significantly decreased with stable total body water. Changes in reactance are the main effects induced on bioelectrical impedance by heart transplantation. Acutely, there is a large decrease which likely reflects changes both in water distribution and in cell membrane function. The late changes more likely reflect the shift of body water from the extra- to the intracellular space with stable total body water.

BACKGROUND: Recent studies have indicated that the implementation of international guidelines for the management of renal patients is suboptimal in Italy. The Italian Society of Nephrology (SIN) decided to undertake a multicentre study to obtain a clear picture of clinical policies on chronic kidney disease (CKD) in Italy. METHODS: A 76-item structured questionnaire, designed to evaluate the organization of clinical care, was administered to the director of each participating centre, within the context of a large observational trial in 100 Italian nephrology centres, collecting information on newly diagnosed CKD patients (K/DOQI stage 3-5) on conservative treatment. This paper reports the questionnaire results related to management of anaemia and bone metabolism disorders; assessment of renal function; creation of a vascular access for dialysis and referral of patients to a nephrologist. RESULTS: Clinical policies at the centre level deviated from guideline recommendations in 70% (timing of vascular access creation) to 25% (assessment of iron deficiency) of centres. Assessment of renal function differed from the recommended approach in 30% of centres; clinical policies related to anaemia and bone disease did not coincide with guideline standards in 50 and 40% of centres, respectively. Directors of renal unit estimates indicate that the creation of a vascular access occurs very late in 38% of patients and that referral to a nephrologist is late in approximately 40% of cases. CONCLUSION: This survey in Italy highlights important deviations of clinical policies at the centre level from guideline recommendations.

“… if too much salt is added in foods the pulse hardens”. This statement appearing in the Yellow Emperor Textbook of Internal Medicine (c2500 BC) indicates that a causal relation between sodium intake and blood pressure was already taken for granted in Ancient China some 4,500 years ago. Therefore our contemporary understanding that healthy diets are basically low in sodium has historical roots which finally attracted the interest of scientists of the twentieth century who provided controlled evidence that Kempner’s rice diets reduced blood pressure because of their low sodium content. With that demonstration sodium restriction was identified as an effective treatment for hypertension to be controlled by continuous monitoring of urinary sodium over time. The list of papers on blood pressure profiles in people from low and high salt culture, going from populations with virtually no sodium intake to population with excessive sodium intake has widened the cultural horizons. This allowed Page to suggest in 1980 that “when all individuals of a population ingest small amounts of sodium, blood pressure does not increase with age and hypertension is virtually absent. When all members of the populations are ingesting large amount of sodium a high percentage develop hypertension. Between these extremes the relationship between blood pressure and sodium intake is difficult to perceive because of wide variation in genetic susceptibility and other type of “noise” introduced by other variables. The relationship, nevertheless, probably is present in all populations. A moderate reduction in sodium intake to 70 mmol/day would do no harm, and might do a great deal of good”. Further advancement was achieved by learning that a small addition of sodium to the milk in feeding newborn babies significantly increased their blood pressure within short time. Finally clinical trials in the last decade have shown a reduction in blood pressure following a restriction in sodium intake in non-hypertensive persons ingesting typical American meals and have fixed at 65 mmol per day the ideal target of sodium intake. Although there are still reports and personal views not foreseeing benefits in blood pressure control by associating sodium restriction to antihypertensive drugs, there is good evidence of additive blood pressure lowering when sodium restriction is the associated with diuretics, ACE-inhibitors and beta-adrenergic blockers and Angiotensin II receptor blockers. However a reduction of sodium intake does not impact blood pressure readings in hypertensive patients receiving calcium-channel blockers.

Background: Protein intake is considered a determinant of glomerular ltration rate (GFR). Urinary urea (U-urea) is an objective marker of protein intake. This population-based study investigated cross-sectionally and longitudinally the association of U-urea as index of protein intake with GFR indexed by serum creatinine (S-cr) and estimated GFR (eGFR). Methods: Data were collected about overnight U-urea, S-cr, eGFR, and other variables in 1,522 men and women aged 45-64 year who participated in the Gubbio Study (baseline). Age, S-Cr, and eGFR were re-assessed after 12-year follow-up in 1,144 of the 1,425 surviving participants. Results: Mean±SD of U-urea was 17.0±7.1 mmol/h corresponding to an estimated daily protein intake of 71.5±29.8 g/d. U-urea associated inversely with S-cr and directly with eGFR in cross-sectional quartile analyses (P

Background: Exposure to microgravity results in alterations of renal function, uid redistribution and bone loss which contributes to the potential risk of renal stone formation. Hypercalciuria is recognized as a condition predisposing to calcium nephrolitiasis and long-term space ights cause bone loss coupled to a rise of urinary calcium excretion. Methods: AQP2 excretion was measured by ELISA in urines collected from healthy volunteers participating at the studies. Results: We recently demonstrated that high calcium delivery to the collecting duct reduces local Aquaporin 2 (AQP2) mediated water reabsorption under vasopressin action, thus limiting the maximal urinary concentration and reducing calcium saturation. To analyze alteration of renal water handling during microgravity, we evaluated two ground-based analog of space ight, thermoneutral water immersion and bed rest. AQP2 excretion and diuresis were measured in two separated studies mimicking acute adaptation (6 hours water immersion) or chronic adaptation (35 days bed rest) to microgravity. Water immersion resulted in a signi cant increase in urinary output apparently not related to AQP2 alteration and manly due to reduced vasopressin secretion. On the other hand 35 days bed rest resulted in an increase in urinary calcium, which coincided with a signi cant decrease in AQP2 excretion (645±7.4 fmol/ml to 569±10.3 fmol/ml), which is expected to result in urine dilution reducing the risk of calcium saturation. Conclusions: Our data indicate that calciuria and water balance have to be strictly controlled during microgravity and long-term bed rest as key elements for the risk of kidney stone formation.

This is the second issue of Annales Kinesiologiae reporting research presented at the International Meeting on Living the space – The space a Human Habitat, which took place in Naples on December 1–2, 2011. During the event, Space emerged as the target of men curiosity, creativity, intelligence and hard work, a place where to realize man’s most audacious dreams. The meeting organized by the Italian Institute for Philosophical Studies, the Second University of Naples, the University of Salerno, the University Federico II in Naples and the Italian Space Agency discussed the hot topics of this enterprise, which appears capable to solve man’s problems here on Earth.

Problems in health care systems are present on a planetary scale due to a discrepancy between scarce resources and vast needs. These are mainly generated by the aging of the population. Everywhere in the world, state health care agencies simply reduce the quantity and eventually the quality of available services. This approach is unacceptable, at least in Europe, where health care is a legal right, granted from birth to death. This paper departs from the poor support available nowadays for clinical research and the trivial investments on prevention, and hypothesizes a new approach based on clinical research and prevention which, in the long term, would generate a just, efficient, sustainable health care system stemming from patients' needs. This is discussed from various viewpoints. It emerges that there is a need to switch the focus of health systems away from cures towards prevention and as well as a need for better translational research. It is of note that in France such a program based on clinical research and prevention was launched in 2008. Problems in health care systems are present on a planetary scale due to a discrepancy between scarce resources and vast needs. These are mainly generated by the aging of the population. Everywhere in the world, state health care agencies simply reduce the quantity and eventually the quality of available services. This approach is unacceptable, at least in Europe, where health care is a legal right, granted from birth to death. This paper departs from the poor support available nowadays for clinical research and the trivial investments on prevention, and hypothesizes a new approach based on clinical research and prevention which, in the long term, would generate a just, efficient, sustainable health care system stemming from patients' needs. This is discussed from various viewpoints. It emerges that there is a need to switch the focus of health systems away from cures towards prevention and as well as a need for better translational research. It is of note that in France such a program based on clinical research and prevention was launched in 2008.

Nowadays, there is a renewed interest in bone changes in experimental and clinical nephrology. However, the need for understanding the peculiarity of bone can be traced back to the 5th century BC, when Empedocles of Acragas put forward a theory of a world made of air, water, fire, and earth governed by love and hate. By observing the various body tissues, he strove to demonstrate that they consisted of 4 elements assembled with different mathematical ratios (logos). Blood is considered the most perfect tissue, because the ratio between elements is one. Bone is a very unusual tissue because it is made of 2 parts of earth, 2 parts of water, and 4 parts of fire. This kind of reasoning could be considered the first cry in the birth of quantitative chemistry. Nowadays, there is a renewed interest in bone changes in experimental and clinical nephrology. However, the need for understanding the peculiarity of bone can be traced back to the 5th century BC, when Empedocles of Acragas put forward a theory of a world made of air, water, fire, and earth governed by love and hate. By observing the various body tissues, he strove to demonstrate that they consisted of 4 elements assembled with different mathematical ratios (logos). Blood is considered the most perfect tissue, because the ratio between elements is one. Bone is a very unusual tissue because it is made of 2 parts of earth, 2 parts of water, and 4 parts of fire. This kind of reasoning could be considered the first cry in the birth of quantitative chemistry.

The work was devised to compare measurements of glomerular filtration rate (GFR) by technetium-99m-dietlyl-enetriaminepentacetic acid (99mTc-DTPA) renogram to those by creatinine clearance (measured and predicted by Cockroft and Gault) and by inulin clearance. A total number of 65 individuals were enrolled: 15 healthy controls and 50 patients with renal disease. Compared to inulin clearance used as the gold standard, 99mTc-DTPA overestimated at low and underestimated at high GFRs. 99mTc-DTPA measurements were less precise than creatinine clearance except for individuals with GFR > 100 ml/min x 1.73 m2. Measured creatinine clearance had the highest correlation coefficient with inulin clearance, 99mTc-DTPA clearance the lowest. In correlation analyses, 81.5% of the interindividual variability for measured creatinine clearance could be explained by true differences in inulin clearance; this value dropped to 59.1 and 57.4% for predicted creatinine clearance and 99mTcDTPA, respectively. In patients with GFR < 25 ml/min x 1.73 m2, all 99mTc-DTPA measurements were out of the 95% confidence interval for the inulin measurement. It can be inferred that 99mTc-DTPA clearance from the renogram is less precise than measured and predicted creatinine clearance.

Background and aims The prognostic role of LDL in non-dialysis chronic kidney disease (CKD) is still undefined. We addressed this question in a multicenter prospective study including patients referred to nephrologist for management. Methods and results 1306 patients with CKD stage III–V were studied at basal visit in 79 Italian nephrology clinics in 2004–2006, and then followed for survival analyses. Study endpoints were incident cardiovascular -CV events (fatal and major non-fatal) and renal events (start of renal replacement therapy or eGFR halving). Mean age was 67.6 ± 11.8 years, male 65%, diabetes 25%, CV disease 27%, and eGFR 35.8 ± 12.5 mL/min/1.73 m 2 . LDL was 119 ± 40 mg/dL, with high levels in 50.1% and 82.8% defined on the basis of the individual CV risk profile estimated according to ATPIII 2001 and ESC 2012 guidelines (LDL 100 to 160, and >70 or >100 mg/dL, respectively). Over a median follow up of 2.87 years, 178 CV and 181 renal events occurred. At multivariable Cox analyses, CV risk linearly increased with higher LDL (hazard ratio-HR per 40 mg/dL higher LDL: 1.20, 95% confidence intervals-CI 1.03–1.39); risk doubled when considering high LDL defined according to ESC 2012 (HR 2.37, 95%CI 1.39–4.03) while this association was not significant when considering the higher threshold levels of ATPIII 2001 (HR 1.10, 95%CI 0.82–1.49). No association emerged between LDL and renal risk. Conclusion In non-dialysis CKD patients, CV risk increases linearly with higher LDL and is more than doubled when considering the lower threshold values currently indicated for defining optimal LDL level.

Background: Urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) have been used separately to provide information about cardiovascular risk. We analyzed whether UAE and eGFR used together provide complementary information. Methods: We analyzed UAE, eGFR, cardiovascular risk factors, and incidence of cardiovascular disease in 1665men and women of the Gubbio Population Study (aged 45-64 years). We designated UAE in the highest decile as high (18.6 μg/min in men and15.7 μg/min in women) and eGFR in the lowest decile as low (64.20 mL/min/1.73m2 in men and 57.90 mL/min/1.73 m2 in women). Results: Kidney dysfunction defined using both markers was more frequent than using 1 marker (UAE alone or eGFR alone) (P.001) because high UAE and low eGFR clustered in different individuals and were weakly associated with each other (P=.12). The hazard ratio (HR) for incident cardiovascular disease was elevated for both markers, independently of each other (HR for high UAE, 2.15; 95% confidence interval [CI], 1.33-3.49; HR for low eGFR, 2.14; 95% CI, 1.32-3.48). Kidney dysfunction defined by both markers predicted cardiovascular disease independently of sex, age, hypertension, hypercholesterolemia, smoking, diabetes mellitus, prior cardiovascular disease, left ventricular hypertrophy, and obesity (HR, 1.50; 95% CI, 1.05-2.14). The discriminant power of dysfunction defined by both markers was statistically significant (area under the receiver operating characteristic curve, 0.569 [P=.02]) and slightly higher than what was found with 1 marker of diabetes mellitus, prior cardiovascular disease, left ventricular hypertrophy, and obesity. Conclusions: High UAE and low eGFR provide complementary information in defining kidney dysfunction because they cluster in different individuals. Concomitant evaluation of both markers should be considered to adequately assess kidney dysfunction and cardiovascular risk.

Patients with advanced heart failure commonly develop simple or mixed acid-base disturbances. The altered acid-base homeostasis can occur as a consequence of the heart failure itself, the therapeutic interventions, or associated conditions. The present study examined acid-base disorders in patients with heart failure who received successful heart transplantation. The information collected should provide light on the determinants of acid-base disorders in this patient population. Seventy status 2 UNOS (United Network Organ Sharing) patients listed for heart transplantation were enrolled in this study. All patients received loop diuretics, spironolactone, ACE inhibitors, carvedilol and digitalis as needed. Patients were studied again at discharge after transplantation, under cyclosporine, azathioprine, steroids, loop diuretics and ACE inhibitors. After heart transplantation, a significant increase of ejection fraction from 19.7 ± 0.63 to 53.6 ± 0.9% (p < 0.0001) occurred along with a concomitant reduction of central venous pressure (p < 0.0001) from 12.6 ± 0.20 to 6.9 ± 0.21 mm Hg. Before heart transplantation there was high-normal pH (7.43 ± 0.009), slight loss of hydrogen ions (35.4 ± 0.4 nmol/l), slightly reduced pCO2 (37.6 ± 1.1 mm Hg). After heart transplantation a stability of blood pH and hydrogen ion concentrations was found but bicarbonate increased significantly (p < 0.02) from 24.2 ± 0.61 to 26.2 ± 0.51 mmol/l and pCO2 from 37.6 ± 1.1 to 39.3 ± 0.7 mm Hg (p < 0.05). Plasma renin activity averaged 3.80 ± 0.6 pg/ml before heart transplantation and 2.82 ± 0.4 pg/ml after (p < 0.01). Aldosterone concentration averaged 380 ±15 pg/ml before heart transplantation and 280 ± 10 pg/ml after (p < 0.01). These data suggest that in patients before heart transplantation there is a mixed acid-base imbalance that includes respiratory alkalosis and metabolic alkalosis. After transplantation the recovery of the abnormal circulatory status erased the initial respiratory alkalosis but metabolic alkalosis persisted and accounted for a further rise in plasma bicarbonate.

This article starts with a concise synopsis of the history of edema. The role of underfilling, overflow, antidiuretic hormone, and acquaporins is subsequently discussed. Emphasis is given to the use of diuretics in edematous patients. The role and risks of albumin infusion are illustrated. The new hypothesis of pulse reverse osmosis is discussed. The final section deals with the measurement of colloid osmotic pressure in the clinical setting. Copyright © 2001 by W.B. Saunders Company.

The long-term risk of end-stage renal disease is high in persons with isolated systolic hypertension, that is, those with an elevation of pulse pressure and not of diastolic pressure. Other data suggest that pulse pressure is a predictor of the hypertension-induced organ damage. Microalbuminuria is considered an early sign of glomerular damage caused by hypertension. The study shows the relationship of pulse pressure and isolated systolic hypertension to microalbuminuria in nondiabetic subjects.This is a cross sectional analysis for a population sample of 677 men and 890 women, aged 45 to 64 years, who were without diabetes mellitus and macroalbuminuria. Data collection included: overnight urinary albumin and creatinine excretion; fasting plasma glucose, cholesterol, and creatinine; creatinine clearance; and blood pressure, weight, height, medical history, and smoking habit. Pulse pressure was calculated as systolic minus diastolic pressure. Isolated systolic hypertension was defined as systolic pressureor =140 mm Hg in persons not on antihypertensive drugs and with diastolic pressure90 mm Hg. Microalbuminuria was defined as urinary albumin excretionor =20 microg/min.Pulse pressure and isolated systolic hypertension were significantly related to urinary albumin excretion and the prevalence of microalbuminuria in univariate and multivariate analyses. Controlling for gender and other variables, the risk of microalbuminuria was 1.71 with a 15 mm Hg higher pulse pressure (95% CI, 1.31 to 2.22) and 4.95 in the presence of isolated systolic hypertension (95% CI, 3.15 to 7.76).In nondiabetic, middle-aged adults, pulse pressure and isolated systolic hypertension are directly related to microalbuminuria, independent of diastolic pressure and other correlates.