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Kidney stone disease is a common condition with a high recurrence rate and elevated costs. Despite the well-known positive effects of high fluid intake, there are little data about the roles of water composition and timing of ingestion during the day. This study examines the effect of two different waters [calcium-bicarbonate water (CBW) and oligomineral water (OW)] consumed at different times during the day on urine composition in a group of healthy volunteers. In a cross-over randomized trial, 12 healthy volunteers were assigned to a different sequence of four combined interventions (1 L of water consumed during fasting and 1 L of water consumed with meals): CBW/OW; OW/CBW; CBW/CBW; OW/OW. Participants were instructed to follow the same diet and to avoid smoking, caffeine and other beverages during the day of intervention, and to collect their urine every 2 h during the day, followed by a single overnight collection. The relative supersaturation for calcium oxalate was higher for CBW/CBW compared with all other interventions, while relative supersaturation for calcium phosphate was lower for the combination OW/CBW with meals. Urinary excretion of oxalate was lower in all interventions including CBW, while no significant differences were found for urinary calcium. Water composition and timing of ingestion have complex and interacting effects on lithogenic risk. Depending on individual characteristics, a strategy involving either OW or a mix of CBW during meals and OW outside of meals could be effective in modulating the lithogenic profile. Trial registered at clinicaltrial.gov: Protocol ID NCT03447847.

Several evidences support the hypothesis that patients affected by autosomal dominant polycystic kidney disease (ASPKD) show a sympathetic renal hyperactivity. Nevertheless, no morphological evidences are available yet. Therefore, the aim of the study was to demonstrate that an increase in sympathetic renal artery innervation was present in the ADPKD patients by using histological methods. In addition, here we correlated the sympathetic renal artery innervation with the evolutionary state of ADPKD (increase in volume of kidney, onset of chronic renal failure and hypertension). To this end, peri-adventitial innervation of renal arteries was studied using morphological methods from 49 patients in total: 29 underwent surgical nephrectomies for ADPKD and 20 non-dialysis patients (CTRL group) undergoing nephrectomy for other diseases. Nerve density (number of nerves per mm2) was evaluated in the peri-adventitial tissue in a concentric ring that was located within 2 mm from the beginning of the adventitia by using immunohistochemistry. The total nerve density was significantly increased in the ADPKD group (1.26 ± 0.82 × mm2) as compared to controls (0.78 ± 0.40 × mm2) (p = 0.02). Hypertensive patients with ADPKD showed a greater nerve density than control hypertensives. However, the increase in renal sympathetic innervation in the ADPKD patients was found to be independent of hypertension, resistance to antihypertensive therapy, age, sex and kidney volume, as demonstrated by the uni and multivariate analysis. In conclusion, our study better clarifies the effect of sympathetic hyperactivity in the progression of polycystic disease.

When medical therapy is unable to achieve biochemical control of secondary hyperparathyroidism, parathyroidectomy (PTX) is indicated, fortunately in a minority of patients. Thus, data on PTX prevalence and biochemical control are limited and, in particular in Italy, date back to 1999. We designed a prospective, observational and multicenter study to collect data from dialysis units distributed throughout the Italian regions. Clinical data were collected with a dedicated data sheet. From January to December 2010, 149 Centers serving a total of 12,515 patients provided data on 528 living PTX cases (PTX prevalence = 4.2%). Prevalence was higher in hemo- than in peritoneal dialysis (4.5 vs. 1.9%, X2 = 21.52; p

Hyperhomocysteinemia (hHcy) is a risk factor in the progression of chronic kidney disease (CKD). In type 2 diabetes (T2D), hHcy is strongly associated with increased risk of cardiovascular disease. Vitamin B12 and folic acid supplementation have been reported to lower homocysteine (tHcy) levels, but no data on plasma tHcy, cysteine (Cys), folate and vitamin B12 levels in T2D-CKD patients are reported.tHcy and Cys levels were analyzed in 178 T2D-CKD patients by high performance liquid chromatography (HPLC) with fluorescence detection. In addition, we determined folate and vitamin B12 levels using a chemiluminescence method.tHcy and Cys levels were increased in T2D patients, and this rise positively correlated with the CKD stage (P0.001). Folate levels were comparable to controls at various CKD stages, whereas vitamin B12 levels were lower, except at stage IV. We did not find any correlation between B-vitamins and levels of tHcy and Cys, regardless of the CKD stage.This is the first study reporting tHcy, Cys and B-vitamins status in T2D-CKD patients. Although limited to our cohort of 178 patients, our findings could be helpful in clarifying the conflicting literature regarding B-vitamins supplementation. Further studies are necessary before any Hcy-lowering therapy can be safely established in T2D-CKD subjects.