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non disponibile, Traditionally computed tomography (CT) and more recently magnetic resonance (MR) are the imaging modalities of choice for the evaluation of peritoneum and peritoneal cavity in primary and secondary pathologic conditions. Nevertheless, ultrasound (US) also may be a valuable, accurate, safe, relatively inexpensive and readily accessible diagnostic tool to investigate the diseases that can affect the peritoneal membrane. US is able to provide quantitative information demonstrating much smaller quantities of free intraperitoneal fluid (ascites) being more sensitive than CT in this regard. Sonographic characteristics of ascites allow to detect the presence of blood, pus or neoplastic cells in echogenic fluid. Sonography is very helpful when planning and performing interventional procedures on abdominal wall such as: fine-needle aspiration, core biopsy and drainage: with modern devices lesions of less than 4 mm may be easily targeted. Ultrasonography is used in the assessment of several procedures and complications in peritoneal dialysis (PD) patients. Some of them are well documented whereas other indications are less clear. Peritoneal ultrasound fields of applications include some of the following: correct patients' enrollement, ultrasound-guided catheter's placement, potential diagnosis of exit site and tunnel infections and/ or peritonitis (both infectious and/or sclerosing) and leakage amount's assessment. The purpose of this review is to describe an US technique for optimal detection and localization of the main complications commonly encountered in patients affected by chronic kidney disease undergoing peritoneal dialysis.

Traditionally computed tomography (CT) and more recently magnetic resonance (MR) are the imaging modalities of choice for the evaluation of peritoneum and peritoneal cavity in primary and secondary pathologic conditions. Nevertheless, ultrasound (US) also may be a valuable, accurate, safe, relatively inexpensive and readily accessible diagnostic tool to investigate the diseases that can affect the peritoneal membrane. US is able to provide quantitative information demonstrating much smaller quantities of free intraperitoneal fluid (ascites) being more sensitive than CT in this regard. Sonographic characteristics of ascites allow to detect the presence of blood, pus or neoplastic cells in echogenic fluid. Sonography is very helpful when planning and performing interventional procedures on abdominal wall such as: fine-needle aspiration, core biopsy and drainage: with modern devices lesions of less than 4 mm may be easily targeted. Ultrasonography is used in the assessment of several procedures and complications in peritoneal dialysis (PD) patients. Some of them are well documented whereas other indications are less clear. Peritoneal ultrasound fields of applications include some of the following: correct patients' enrollement, ultrasound-guided catheter's placement, potential diagnosis of exit site and tunnel infections and/ or peritonitis (both infectious and/or sclerosing) and leakage amount's assessment. The purpose of this review is to describe an US technique for optimal detection and localization of the main complications commonly encountered in patients affected by chronic kidney disease undergoing peritoneal dialysis., non disponibile

In this review we analyze the cardiorenal effects of hyperuricemia and try to answer the eternal question of whether it is or is not to be considered a true risk factor in addition to a well-established marker of cardiovascular, cerebrovascular and renal risk. (Cardionephrology), non disponibile (Cardionephrology)

There is a great deal of data demonstrating a close association between chronic kidney disease (CKD) and cardiovascular disease, particularly coronary artery disease (CAD). About one half of deaths in patients with end-stage renal disease (ESRD) are of cardiovascular causes. The association between CKD and ischemic heart disease can be explained in part because both conditions are related to the traditional risk factors for atherosclerotic vascular disease. However, CKD might also have a casual role in the development and progression of CAD, with several mechanisms potentially involved. Among CAD patients, those with CKD have systematically a worse prognosis than those without CKD irrespective of the clinical presentation or the treatments applied. Current therapy is based on small trials and observational data and on the extrapolation of the strategies that have been proved useful in the general population, although many treatments that have been shown to improve the prognosis of CAD patients are underused in those with renal impairment. (Cardionephrology), non disponibile (Cardionephrology)

Contrast-enhanced ultrasonography (CEUS) is becoming an ultrasound device with many diagnostic applications. Employment of microbubbles as contrast media agents has allowed dynamic evaluation of micro- and macrovessels strengthening the characterization of ultrasonographic lesions not valuable with Power and Color Doppler analysis. CEUS does not involve ionizing radiations, then it's not harmful for kidney function. CEUS seems to be particularly helpful in distinguishing between benign cysts and malignancies according to Bosniak's classification. CEUS can also be applied to diagnose ischemic or traumatic issues, renal artery stenosis, autosomal dominant polycystic kidney disease and urinary infections or traumatic injuries and for kidney graft evaluation. Further perspectives for CEUS lie in oncology for post-ablation kidney surveillance and in nanobubbles devices., non disponibile

Contrast-enhanced ultrasonography (CEUS) is becoming an ultrasound device with many diagnostic applications. Employment of microbubbles as contrast media agents has allowed dynamic evaluation of micro- and macrovessels strengthening the characterization of ultrasonographic lesions not valuable with Power and Color Doppler analysis. CEUS does not involve ionizing radiations, then it's not harmful for kidney function. CEUS seems to be particularly helpful in distinguishing between benign cysts and malignancies according to Bosniak's classification. CEUS can also be applied to diagnose ischemic or traumatic issues, renal artery stenosis, autosomal dominant polycystic kidney disease and urinary infections or traumatic injuries and for kidney graft evaluation. Further perspectives for CEUS lie in oncology for post-ablation kidney surveillance and in nanobubbles devices., non disponibile

Ivabradine, heart failure and chronic kidney disease Incidence and prevalence of congestive heart failure are raising, especially in western countries. In Europe and in the United States it represents a disabling clinical disease for all injured people and it's accountable for the increase of hospitalization and sanitary costs. European guidelines have underlined the importance of the optimization of pharmacological treatment to improve both patients' outcomes and quality of life. SHIFT trial's results, based on the evaluation of ivabradine's efficacy if added to conventional congestive heart failure's therapy, seem to proceed in that direction. (Cardionephrology), non disponibile (Cardionephrology)

Is peritoneal ultrafiltration a useful therapeutic alternative in diuretic resistant heart failure, even in patients with preserved glomerular filtration rate? Some recent clinical trials, here briefly analysed, reported the positive effects of peritoneal ultrafiltration on NYHA class, hospitalization rates and quality of life of decompensated patients. Why this technique has so little fortune among Nephrologists? (Cardionephrology), non disponibile (Cardionephrology)

Nella mia attività clinica mi sono spesso chiesto perché due metodiche (emodialisi e dialisi peritoneale), che reputo complementari, debbano escludersi. Quale sia la ragione di tale disparità di atteggiamento si può solamente ipotizzare: la competenza in ambito peritonealistico, la maggiore incidenza di strutture private e la carenza di personale. Quale che sia la ragione, noi operatori abbiamo il dovere di fornire un servizio completo, sia dal punto di vista professionale che da quello umano, in quanto, così facendo, garantiremo ai nostri pazienti le migliori condizioni possibili per affrontare il peso della malattia., In my routine clinical practice I often asked myself why two complementary dialysis techniques (hemodialysis and peritoneal dialysis) should be in conflict. Possible explanations may refer to the competence in performing peritoneal dialysis, the dominant position of private practice hemodialysis units, and the shortage of nurses and physicians. Nevertheless we must provide complete information to our patients approaching renal replacement therapy, as to offer them the most comfortable dialysis conditions to alleviate the disease's discomfort.

Cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias, and sudden cardiac death represent main causes of morbidity and mortality in patients with chronic kidney disease (CKD). Their pathogenesis relates to the close linkage between heart and kidneys and involves both traditional and non-traditional risk factors. According to the well-established classification of cardio-renal syndrome, the cardiovascular involvement in chronic kidney disease is known as “type 4 cardiorenal syndrome” (chronic renocardiac syndrome). Uremic cardiopathy is mainly characterized by both left ventricular systolic and diastolic impairment, often associated to right heart dysfunction due to the presence of a vascular access for hemodialysis. The typical clinical picture is represented by left ventricular hypertrophy (LVH), the pathogenesis of which is multifactorial and closely linked to elevated blood pressure, vascular stiffness and atherosclerosis. The diagnosis is mainly made by ultrasound (2D and 3D echocardiography) and cardiac magnetic resonance imaging (CMRI), although echocardiography is most widely employed since it is non-invasive and cheaper than CMRI. The following chapter provides an overview of the epidemiology, pathophysiology, diagnosis, and treatment of left ventricular hypertrophy in CKD patients. (Cardionephrology), La patologia cardiovascolare rappresenta la principale causa di mortalità e morbidità nei pazienti affetti da malattia renale cronica (CKD) e malattia renale cronica terminale (ESRD). La patogenesi della malattia cardiovascolare in corso di nefropatia è multifattoriale e coinvolge fattori di rischio tradizionali e fattori di rischio collegati alla malattia renale. Come ormai universalmente accettato, l'interessamento cardiaco in corso di malattia renale cronica rientra nella cosiddetta Sindrome cardio-renale di tipo 4, la cosiddetta cardiopatia uremica caratterizzata, in primo luogo, dalla presenza di ipertrofia ventricolare sinistra, disfunzione sistodiastolica del ventricolo sinistro e, negli stadi terminali, scompenso cardiaco congestizio e cardiomiopatia dilatativa. La diagnosi di ipertrofia ventricolare sinistra (IVS) è affidata da un lato alle tecniche ecocardiografiche 2D e 3D e, dall'altra, a tecniche di imaging più sofisticate, come la risonanza magnetica cardiaca (CMRI). Scopo della review è quello di effettuare un excursus riguardante l'epidemiologia, la fisiopatologia e la diagnosi dell'ipertrofia ventricolare sinistra nei pazienti affetti da malattia renale cronica. (Cardionephrology)

In my routine clinical practice I often asked myself why two complementary dialysis techniques (hemodialysis and peritoneal dialysis) should be in conflict. Possible explanations may refer to the competence in performing peritoneal dialysis, the dominant position of private practice hemodialysis units, and the shortage of nurses and physicians. Nevertheless we must provide complete information to our patients approaching renal replacement therapy, as to offer them the most comfortable dialysis conditions to alleviate the disease's discomfort., Nella mia attività clinica mi sono spesso chiesto perché due metodiche (emodialisi e dialisi peritoneale), che reputo complementari, debbano escludersi. Quale sia la ragione di tale disparità di atteggiamento si può solamente ipotizzare: la competenza in ambito peritonealistico, la maggiore incidenza di strutture private e la carenza di personale. Quale che sia la ragione, noi operatori abbiamo il dovere di fornire un servizio completo, sia dal punto di vista professionale che da quello umano, in quanto, così facendo, garantiremo ai nostri pazienti le migliori condizioni possibili per affrontare il peso della malattia.

Atrial fibrillation represent the most common type of arrhythmia encountered in clinical practice, especially in chronic ischemic heart disease patients and in chronic kidney disease (CKD) patients, and is often correlated to increased age and related comorbidities. CKD patients often present several comorbidities, such as hypertension, diabetes, and vascular disease, and they often present arrhythmias that are usually linked to their related cardiomyopathy. During the last 2 decades, an increase in the prevalence of atrial fibrillation among CKD patients, especially those on hemodialysis treatment, was reported. (Cardionephrology), La fibrillazione atriale (FA) rappresenta la più comune forma di aritmia riscontrabile nella pratica clinica quotidiana, soprattutto nei pazienti affetti da cardiopatia ischemica cronica e da malattia renale cronica (CKD), ed è spesso correlata all’età avanzata e alla presenza di altre comorbidità, come ipertensione arteriosa, diabete mellito e vasculopatia polidistrettuale. Negli ultimi 20 anni si è assistito a un progressivo incremento dell’incidenza della fibrillazione atriale nei pazienti affetti da malattia renale cronica, soprattutto nei pazienti sottoposti al trattamento sostitutivo della funzione renale. (Cardionephrology)

The autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder in nephrology. Two genes have been implicated in the development of the disease: PKD1 on chromosome 16 (85%) and PKD2 on chromosome 4 (15%). ADPKD is clinically characterized by renal and extrarenal involvement indicated by the onset of cystic and non-cystic manifestations. Since cardiovascular complications are a leading cause of morbidity and mortality, this review aims to analyze cardiac and vascular involvement in ADPKD. Hypertension is a common early symptom, and occurs in approximately 60% of patients before renal dysfunction. The effect of hypertension on the progression to end-stage renal disease makes it the main potentially treatable risk factor in ADPKD. Also, left ventricular hypertrophy occurs frequently in these patients representing another powerful and independent risk factor for cardiovascular morbidity and mortality in ADPKD. Other abnormalities, such as biventricular diastolic dysfunction, endothelial dysfunction, and increased carotid intima-media thickness, are present even in young ADPKD patients with normal blood pressure and well-preserved renal function. Intracranial and extracranial aneurysms, as well as cardiac valvular defects, are other common cardiovascular manifestations in patients with ADPKD. Early treatment of hypertension through the use of renin-angiotensin-aldosterone system blocking agents could play a nephroprotective effect and reduce the occurrence of cardiovascular complications in ADPKD patients., La malattia autosomica dominante policistica renale (ADPKD) è la malattia genetica più comune in nefrologia. Due geni sono stati implicati nello sviluppo della malattia: PKD1 sul cromosoma 16 (85%) e PKD2 sul cromosoma 4 (15%). La ADPKD è clinicamente caratterizzata da coinvolgimento renale ed extrarenale espresso con la comparsa di manifestazioni cistiche e non cistiche. Dal momento che le complicanze cardiovascolari sono la principale causa di morbilità e mortalità, questa revisione si propone di analizzare il coinvolgimento cardiaco e vascolare in ADPKD. L'ipertensione è uno dei sintomi più frequenti e comune e si verifica in circa il 60% dei pazienti prima della comparsa di disfunzione renale. L'effetto dell'ipertensione sulla progressione verso stadi terminali della malattia renale, rende tale fattore di rischio uno dei più importanti e potenzialmente trattabili in ADPKD. L'ipertrofia ventricolare sinistra, spesso rilevata in questi pazienti, rappresenta un altro importante fattore di rischio indipendente per morbilità e mortalità cardiovascolare nella ADPKD. Altre anomalie come la disfunzione diastolica biventricolare, la disfunzione endoteliale e l'aumento dello spessore intima-media carotideo sono presenti anche in giovani pazienti con ADPKD con normale pressione sanguigna e la funzione renale ben conservata. Gli aneurismi intracranici, quelli extracranici e i difetti valvolari cardiaci sono altre manifestazioni cardiovascolari di comune riscontro nei pazienti con ADPKD. Il trattamento precoce dell'ipertensione mediante l'uso di agenti bloccanti del sistema renina-angiotensina-aldosterone potrebbe svolgere un effetto nefroprotettivo e ridurre l'insorgenza di complicanze cardiovascolari nei pazienti con ADPKD.

Frequentemente, i pazienti in trattamento emodialitico periodico vengono sottoposti a ecografia del collo per la valutazione delle ghiandole paratiroidi. Sebbene la diagnosi di iperparatiroidismo secondario (sHPT) sia essenzialmente basata sul riscontro di elevati livelli di paratormone circolante e di alterazioni dei parametri del metabolismo minerale (calcio, fosforo), l'ecografia rappresenta, indubbiamente, un prezioso strumento per la diagnosi, il follow-up clinico e la terapia del sHPT. Viceversa, vi sono una scarsità di dati relativamente alla diagnostica ecografica della tiroide e solo pochi report riguardanti la patologia nodulare tiroidea nei pazienti emodializzati. Nel presente lavoro, riportiamo il caso clinico di un giovane di 37 anni, in cui l'ecografia del collo ha messo in evidenza la presenza di una nodularità tiroidea isolata. Descriveremo il percorso diagnostico intrapreso e le definitive conclusioni istopatologiche di questo nodulo tiroideo., Very often patients with chronic kidney disease (CKD) on dialysis undergo neck ultrasonography to study parathyroid glands. Although diagnosis and treatment of secondary hyperparathyroidism (sHPT) is based on the serum levels of both the intact parathyroid hormone (iPTH) and the parameters of mineral metabolism (calcium, phosphorus), parathyroid ultrasound provides an important diagnostic tool in diagnosis, clinical follow-up, and therapeutic response of sHPT. Nevertheless there are limited data regarding the ultrasonographic evaluation of the thyroid gland, with only a few reports investigating thyroid nodules in hemodyalized patients. In the present paper we describe the case of a 37-year old male hemodyalized patient in whom ultrasound examination of the neck revealed a solitary thyroid nodule, which turned out to be different from what was initially expected.

Fabry disease is an inherited lysosomal storage disorder in which chronic accumulation of globotriaosylceramide (Gb3) induces renal, cardiac and neurological damage. Linked to chromosome X, it has an estimated incidence of one case every 55,000 male live births, up to one every 3,100. Enzyme replacement therapy is proposed as treatment of choice for this condition and is able to modify substantially the clinical history. This review is intended as a stimulus to look with the eyes of a “cardionephrologist” at this systemic cardiorenal syndrome. (Cardionephrology), La malattia di Fabry è una disfunzione lisosomiale ereditaria, nella quale l'accumulo cronico di globotriaosilceramide (Gb3) induce danno d'organo renale, cardiaco e neurologico. Trasmessa attraverso il cromosoma X, ha un'incidenza stimata che va da un caso ogni 55000 maschi nati vivi sino a uno ogni 3100. La terapia enzimatica sostitutiva si propone come trattamento di elezione di tale patologia, capace di modificarne la storia clinica in maniera sostanziale. Questa review si propone come uno stimolo a guardare con occhi da “cardionefrologi” a questa sindrome cardio-renale sistemica. (Cardionephrology)

Very often patients with chronic kidney disease (CKD) on dialysis undergo neck ultrasonography to study parathyroid glands. Although diagnosis and treatment of secondary hyperparathyroidism (sHPT) is based on the serum levels of both the intact parathyroid hormone (iPTH) and the parameters of mineral metabolism (calcium, phosphorus), parathyroid ultrasound provides an important diagnostic tool in diagnosis, clinical follow-up, and therapeutic response of sHPT. Nevertheless there are limited data regarding the ultrasonographic evaluation of the thyroid gland, with only a few reports investigating thyroid nodules in hemodyalized patients. In the present paper we describe the case of a 37-year old male hemodyalized patient in whom ultrasound examination of the neck revealed a solitary thyroid nodule, which turned out to be different from what was initially expected., Frequentemente, i pazienti in trattamento emodialitico periodico vengono sottoposti a ecografia del collo per la valutazione delle ghiandole paratiroidi. Sebbene la diagnosi di iperparatiroidismo secondario (sHPT) sia essenzialmente basata sul riscontro di elevati livelli di paratormone circolante e di alterazioni dei parametri del metabolismo minerale (calcio, fosforo), l'ecografia rappresenta, indubbiamente, un prezioso strumento per la diagnosi, il follow-up clinico e la terapia del sHPT. Viceversa, vi sono una scarsità di dati relativamente alla diagnostica ecografica della tiroide e solo pochi report riguardanti la patologia nodulare tiroidea nei pazienti emodializzati. Nel presente lavoro, riportiamo il caso clinico di un giovane di 37 anni, in cui l'ecografia del collo ha messo in evidenza la presenza di una nodularità tiroidea isolata. Descriveremo il percorso diagnostico intrapreso e le definitive conclusioni istopatologiche di questo nodulo tiroideo.