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Gioacchino Li Cavoli,1 Giuseppe Mulè,2 Mario Giuseppe Vallone,3 Flavia Caputo1 1Nephrology, Dialysis and Renal Transplant Department, Civico and Di Cristina Hospital, Palermo, Italy; 2Internal Medicine, Cardiovascular and Renal Diseases Department, University of Palermo, Palermo, Italy; 3Radiology Department, Civico and Di Cristina Hospital, Palermo, Italy Abstract: Takayasu arteritis (TA) is a chronic vasculitis disease of unknown etiology. Clinically significant renal disease is relatively common, and renovascular hypertension is the major renal problem. The assessment of TA activity is usually challenging because vascular inflammation may progress to fixed vascular injury without findings of active disease. Until now, the best therapeutic options have not been identified. This review highlights the current perspectives of renal involvement in TA. Keywords: arteritis, kidney involvement, large vessel vasculitis

Introduction: The metabolic syndrome (MS) encompasses many metabolic abnormalities and the insulin resistance is considered as one of the most significant denominators. The chronic kidney disease (CKD) is an emerging health problem but only few patients would reach the end stage renal disease. There exists an increasing strong association between MS and CKD, but up until now the link between MS and CKD is unclear and there are few studies regarding the renal histology in MS. Methods: We describe an acute tubulointerstitial nephritis case, due to both infective and pharmacological aetiology, overlapping relevant histological changes (focal segmental glomerulosclerosis [FSG], hyaline arteriosclerosis) in a patient with MS and previously normal renal function. Despite the severe vascular finding (elevated renal arterial resistive index), the patient recovered a normal renal function. Results: We reviewed the kidney pathological studies in MS and analyzed the principal renal histological images of glomerulomegaly, segmental glomerulosclerosis, and obesity-related glomerulopathy. Conclusion: Despite the strong association, the renal involvement in MS has not been proven. A greater knowledge of the combination of histological renal changes in MS can help to understand the pathophysiological mechanism(s) of MS.

Objective: In relation to chronological and dialytic age, we have studied for 6 months the quality of life (QoL) of 56 stable subjects on peritoneal dialysis (PD), and also nutritional, immunological, and dialytic efficiency factors, com- pared to psychological tests. Methods: We divided the patients (pts) into 4 age groups: G1 (up to 49 years), G2 (50–59 years), G3 (60–69 years), G4 (over 70 years). Age-based dialysis in months (m) in 3 groups: 1–12 m, 13–36 m, 37– 90 m. Clinical parameters: nutritional, immunological, and dialytic efficiency values: albumin, Hb, WBC, ferritin, C3, C4, BMI, IgG, IgA, IgM, C-reactive pro- tein (CRP), CA125, Ca19-9, GFR, Kt/V, CCL, PTH. Psychometric tests: SF-36, POMS, MHLCS, MPSS, COPE. Results: In all pts during the observations is detected: significant worsening of SF-36 AF (0.04) and SF-36 AS (0.02) and MHLC internal (0.05), that shows the tendency of pts to personally manage their health condition; decrease of GFR (0.00) and CCL Tot (0.00); increase of Ca19-9 (0.01); decrease of Kt/V close to significance (0.07); increase of C3 close to significance (0.07); an increase of BMI close to significance (0.06). Chronological age (yrs): G1 (up to 49): worsening levels of depression and anxiety (POMS) almost significant (0.07). Decrease of GFR values close to significance (0.07). G2 (up to 59): worsening of SF-36 AS (0.07), increased levels of anxiety and tension at the POMS (0.03), of research support-help (COPE; 0.05), of PCR (0.04), C3 (0.00), and IgM (0.04). G3 (60–69): increase of PCR (0.02) and Alb (0.04), no significant increase in BMI. G4 (over 70): no significant changes in studied parameters. Dialytic age (m): 1–12: increase of Ca19-9 (0.05), C3 (0.01), and PTH (0.04); 13–36: worsening of SF-36-AF (0, 05); 37–90: increase of C3 (0.01) and PTH (0.04). Conclusions: Our study suggests that PD pts, especially those of G2 and dialytic age 13–36 months, implement a worse QoL compared to the physical capabilities and the impact of pain (SF-36, POMS). Proinflammatory indices (C3, Ca19-9, PCR, PTH) vary with dialytic age, prob- ably for the current poor biocompatibility of PD. With the support of family and life expectancy, pts over 70 years are the only group without significant changes, confirming that the PD treatment is more convenient at this age.

Psychological eating disorders – anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder – are an increasing public health problem with severe clinical manifestations: hypothermia, hypotension, electrolyte imbalance, endocrine disorders and kidney failure; they are of interest to nephrologists, but pathophysiological mechanisms in determining the renal involvement are still unclear. We describe pathophysiology, histological features and clinical manifestations of the most frequent psychological eating disorders: AN and BN. Regarding AN, we analyze the recent literature, and identify 3 principal pathways towards renal involvement: chronic dehydration-hypokalemia, nephrocalcinosis and chronic rhabdomyolysis. Regarding BN, we describe the correlation between obesity and many proinflammatory cytokines, chemokines, growth factors and adipokines, having potential metabolic and hemodynamic effects on the kidney and an important role in the pathogenesis of obesity-related renal injury, independently of hypertension and diabetes.