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This article, written by several authors, describes the birth and early development of the nephrology at Molinette Hospital in Torino, Italy. In particular, it supplies important information on Antonio Vercellone, very motivated and innovative clinician and one of the fathers of Italian nephrology, and on Giuseppe Piccoli, his right-hand man and then his successor. This article also shows the strong professional and human engagement that was requested to the young doctors who, in the early Sixties and Seventies of the past century, had chosen to devote their professional lives to the patients with kidney diseases: from endless workdays without schedules to the anguish caused by the shortage of artificial kidneys to the cure of very fragile and unfortunate patients, and much more., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

This interview describes the numerous and important contributions that Vito Cagli, who was born in Ancona in 1926, has given to the Italian Nephrology and to other fields of Medicine. These contributions, that are very poorly known today, were produced especially in the years in which Cagli worked as deputy director of the Centre for the Investigation and Treatment of Hypertension and Renal Diseases at Policlinico Hospital Umberto I in Rome. This interview also describes the early phase of Italian Nephrology before the introduction in our country of renal biopsy and of hemodialysis., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

This article describes the birth and development of the Renal Immunopathology Group of the Italian Society of Nephrology. It collects the stories of nephrologists and pathologists who, since the early Seventies up to the first decade of this century, devoted their professional lives to the study of renal pathology with a strong personal involvement, characterized by enthusiasm, commitment, ability, strong spirit of cooperation, and friendship. All this enabled the Group to: propose the criteria for a standardized histological and immuno-histological examination of renal biopsies and reporting; produce several multicenter studies, whose results were also published in important international journals; to set up a national registry of renal biopsies; to organize a number of courses, some of which were associated with the publication of monographs, on various renal diseases. This article also traces the history of renal pathology in Italy from the second half of the Sixties - when young Italian nephrologists and pathologists from different institutions moved to French laboratories to learn new techniques to apply to renal biopsies - up to the present days. It also shows us how Italian renal pathology has been an essential tool for the development of the nephrological clinical practice and the advancement of scientific research., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

This article retraces the nephrological life of Giovanni Barbiano di Belgiojoso, which started in the late 1960s. Since the beginning renal pathology was his main interest and he was among the pioneers who introduced in Italy the use of immunofluorescence technique in the examination of renal biopsies. Over the years Barbiano di Belgiojoso has carried out, often in cooperation with other nephrological groups, many clinico-pathological studies on a wide spectrum of glomerular diseases. He also played a key role in the foundation and in the activities of the "Group of Renal Immunopathology" of the Italian Society of Nephrology., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

This article collects the personal stories of the young doctors who in the early sixties contributed to the birth and development of the Croff pavilion at the Policlinico Hospital in Milan. Inaugurated on October 19, 1964, this has been the first institute in Italy entirely devoted to patients with kidney diseases. Since its inception, it has significantly contributed to the progress of nephrology thanks to important and pioneering investigations in the main fields of our specialty, which still continue nowadays. The different stories reported here follow the chronological order in which the young doctors arrived at Croff, each story representing a personal narrative that interweaves and integrates that of others. This gives rise to a vivid many-voiced account, from which emerge not only the figures of these young doctors, but also those of patients, nurses, and laboratory technicians., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Objectives: In spite of the introduction of automated systems for urinary sediment analysis, microscopy examination remains the gold standard, and it is more than ever important to perform it with a good and reliable quality. External Quality Assessment (EQA) programs on urinary sediment are rare. The present paper provides an analysis of results from 2001 to date of the EQA Italian program which involves today 230 laboratories., Methods: The program includes four surveys per year. Participants are asked the identification and clinical associations of urinary sediment particles, shown as phase contrast microscopy images in the website of the Center of Biomedical Research (CRB) (2 surveys), and the diagnosis of clinical cases presented by both images and a short clinical history (2 surveys). The results of each survey are then scored and commented. In 20 years, 298 images were presented: 90 cells (9 types), 23 lipids (5 types), 87 casts (21 types), 53 crystals (14 types), 22 microorganisms (5 types), and 23 contaminants (9 types). Moreover, 27 clinical cases, covering a wide spectrum of conditions with different degrees of complexity, were presented to participants., Results: Identification: among urinary particle categories, the correct identification rate (obtained for each particle from the sum of correct + partially correct answers) was very high for micro-organisms (mean ± SD: 96.2 ± 3.5%), high for lipids (88.0 ± 11.8%) and crystals (87.0 ± 16.5%) followed, in decreasing order, by cells (82.1 ± 15.9%), casts (81.8 ± 14.8%), and contaminants (76.7 ± 22.1%). Clinical associations (n=67): the rate of correct answers was 93.5 ± 5.7% ranging from 75.0 to 100% for all but one clinical association (i.e., acute glomerulonephritis: 55.4%). Clinical cases: throughout surveys, due to the overall rate of particle misidentification, only 59.8 ± 17.1%, (range 32.5-88.7%) of participants achieved access to clinical diagnosis. Of these, 88.7 ± 10.6% (range 59.9-99.3%) were able to indicate the correct diagnosis., Conclusions: Our program can be used as a tool to improve the identification of urine particles and the knowledge of their clinical meaning and to encourage specialists of laboratory medicine to correlate urinary findings with other laboratory data and the clinical history, an aspect that improves the value of the day by day work., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

This paper by Mauro Sasdelli describes the dawn and the development of nephrology first in Bologna, where Sasdelli studied in the nineteen-sixties, and later in Arezzo; the author tells us of the dedication, the enthusiasm, the hard work of all involved, but also of their conflicts and banter. The paper describes the important contributions to nephrology made by prominent personalities such as Domenico Campanacci, Vittorio Bonomini and Pietro Zucchelli, not only at a local level but also more broadly. Finally, text and images of this "personal history" can also be read as the integration of an article published on this same journal in 2016, "The dawn of Nephrology and Dialysis in Bologna with Vittorio Bonomini and Pietro Zucchelli" (Giornale Italiano di Nefrologia, vol. 33, n. 4)., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

This paper, written by Professor Rosario Maiorca, describes the everyday professional life in the institutes of Clinica Medica and subsequently of Patologia Medica at Parma University in the second half of the fifties and in the first years of the sixties of the past century. Those institutes and that period, which have been very important for the birth of Nephrology in Italy, have already been described, from the historical standpoint, in an Italian monograph on the history of our specialty for the period 1957-2007. The present paper adds to that chapter an insight of "real life", with a lively description of the wide and passionate clinical and scientific activities of the young doctors in training and of the personality, greatly stimulating and altruistic, of their "Masters"., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Background: Isolated microscopic hematuria is a condition characterized by the presence in the urine of an "abnormal" number of erythrocytes in the absence of proteinuria. Several studies have been published on this condition, but with heterogeneous inclusion criteria and variable outcomes at follow-up. In this retrospective study, we describe a selected and homogenous cohort of patients who presented with isolated microscopic hematuria of glomerular origin., Methods: We included in the study patients with isolated microscopic hematuria of glomerular origin (> 1 erythrocyte/high power field at 400× and ≥ 40% dysmorphic erythrocytes and/or ≥ 5% acanthocytes and proteinuria ≤ 150 mg/24 h) with a follow-up of > 60 months from the first documentation of microscopic hematuria., Results: Forty-two patients (M 12, F 30, age at presentation 14-68 years, eGFR < 60 ml/min/1.73 m 2 : 1 patient) were included. During a medium term follow-up, microscopic hematuria was persistent in 25 patients (59.5%), transiently absent in 17 (40.5%), always glomerular in 16 patients (38.1%), and occasionally non-glomerular in 26 (61.9%); proteinuria, observed in 16 patients (38.1%), was always transient and < 500 mg/24 h. At the end of a follow-up of 181.8 ± 97.9 (median 168) months, only 2 patients (4.8%) had eGFR < 60 ml/min/1.73 m 2 , one of whom had reduced eGFR already at presentation., Conclusions: This study on a small but selected and homogeneous cohort of patients with isolated microscopic hematuria of glomerular origin demonstrates that urinary features can transiently change over time and that the renal outcome is good.

Background: Manual microscopy still represents the gold standard for urinary sediment (US) examination. We report the results obtained in the period 2012-2015 by the EQA Italian program on US, which today involves about 260 laboratories., Methods: The program includes four surveys per year. In two surveys, participants are asked to supply identification and clinical association of US particles. In two other surveys, they are asked to supply the diagnosis of clinical cases, presented with images, some key laboratory findings and a short clinical history. Sixty-six images of US particles (21 cells, 2 lipids, 21 casts, 10 crystals, 3 microorganisms, 15 contaminants) and seven clinical cases were presented., Results: The correct identification rate for each category of particles, in decreasing order, was: micro-organisms (mean±SD: 92.4%±4.5%), lipids (92.0%±1.8%), casts (82.8%±8.8%), crystals (79.4%±29.8%), cells (77.3%±13.5%), and contaminants (70.9%±22.2%). For 13 particles, a correct clinical association was indicated by 91.5%±11.7% of participants, while it was 52.7% for particles associated with urinary tract infection. For clinical cases, due to a high rate of particles misidentification, only 44.3%±10.1% of participants achieved access to clinical diagnosis, which was then correctly indicated by 92.5%±5.3% of them., Conclusions: The results of the EQA program confirm that, while some US particles are well known in terms of identification, clinical association and clinical meaning, others particles still are not, and this represents an important reason to encourage EQA programs on US.

Background: EQA programs on urinary sediment are rare. We describe an EQA Italian program which started in 2001 and involves today more than 300 laboratories., Methods: The program, which started with a questionnaire about the methodological aspects on urinary sediment, includes today four surveys per year. These ask the participants the identification and clinical associations of urinary sediment particles shown by colour images (surveys 1 and 3) and the diagnosis of clinical cases presented by both images and a short clinical history (surveys 2 and 4). The results of each survey are then scored and commented., Results: Questionnaire (participants = 287): most methodological aspects were not dealt with properly., Identification: cells, lipids, casts and some contaminants were poorly known. However, when 27 particles were presented for the second time and 16 particles for the third time, the correct identification rate for most of them increased significantly. Clinical associations (No presented = 16): a correct answer was indicated by > or = 84% of participants for all particles but one. Clinical cases (No presented=4): lowest correct identification for urine contamination from genital secretion (77.3%), highest for ureteric stone (94.4%)., Conclusions: Our program shows that EQA programs are both useful and needed., (Copyright 2010 Elsevier B.V. All rights reserved.)

The monograph Semeiologia funzionale del rene (Functional semiology of the kidney) by Giovanni Gigli (1913-1988) and Sergio Giovanetti (1924-2000), published in 1953, was the first systematic survey on the subject to appear in Italy. Besides the classical renal function tests (urinalysis, BUN measurement, urea clearance), the book recounts the many new techniques that were introduced into clinical practice in that period as a result of the great advances in the field of renal physiology (e.g., glomerular filtration rate, renal plasma and blood flow, tubular water reabsorption, maximum tubular excretion and reabsorption capacity, filtration fraction). In addition, it describes the utility and pitfalls of such tests in a wide spectrum of kidney diseases, but especially in different types of glomerulonephritis, of which the two authors had collected a personal cohort of 48 patients. Today, the monograph by Gigli and Giovannetti shows the difficulties and uncertainties encountered in the evaluation of kidney diseases in a period in which renal biopsy was yet to become the widely used technique it is today.

Background: Urinary microscopy is difficult to teach. This paper describes a 1-day course on urine microscopy, which was based on both theoretical and practical sessions at the microscope, during which real urine samples were examined., Methods: The course was based on: a) an introductory presentation with slides on the main components of urinary sediments and their clinical correlates; b) examination of fixed urine samples under the guidance of two experts; and c) the use of two microscopes, each equipped with a co-observation device for up to 15 observers., Results: Throughout 2005, four courses were held in four Italian towns. Altogether, there were 97 participants (20-27 per course) from 75 laboratories, all graduates with wide but variable experience in the field. During each course, 17-22 urinary sediment components were shown by both bright-field and phase-contrast microscopy and, when indicated, by polarized light. Tests set before and after the course showed a significant improvement (p<0.01) in the identification of erythrocyte subtypes, epithelial cells, fatty components, various types of casts and drug crystals. A questionnaire conducted with participants by phone several months after the course demonstrated that 51.6% and 32.3% of laboratories have introduced or formally requested phase-contrast and polarized-light microscopy, respectively; 45.2% have changed the terminology for urinary epithelial cells; and 87.1% have identified for the first time urinary sediment components that were not recognized or not considered before the course., Conclusions: Our course demonstrates that it is possible to improve the teaching of urinary microscopy.

Background: There are few studies concerning the clinical problems of patients from developing countries undergoing dialysis in European countries. This retrospective study aimed to describe the main clinical features of a group of these patients who happened to be on maintenance dialysis in our unit., Methods: Analysis of the clinical features at presentation and at follow-up of a group of patients from developing countries who entered chronic dialysis in our unit over an 8 year period., Results: From April 1994 to December 2001, 12 patients (eight males and four females, mean age 38.2 +/- 7.9 yrs) from developing countries (the Philippines (n=5); Egypt (n=4); Morocco (n=1); Mauritius (n=1); Sri-Lanka (n=1)) entered maintenance dialysis in our unit (six hemodialysis (HD) patients, six continuous ambulatory peritoneal dialysis (CAPD) patients). The cause of renal failure was severe/very severe hypertension in five patients (four of whom presented with very advanced end-stage renal disease (ESRD)), chronic glomerulonephritis in four patients, amyloidosis, type 2 diabetic nephropathy, and unknown causes in three patients. After a mean follow-up of 45.3 +/- 32.0 months (median 33, range 18-111), five patients continued on HD, two patients were on CAPD, whilst four patients received a renal transplant and one patient a renal and liver transplant. An important feature of our patients was the high infection rate (67%), such as tuberculosis (n=3), B and/or C viral hepatitis (n=4) and schistosomiasis (n=1). Of note were the clinical problems that developed after visits to the patients' native countries, during which the patients were dialyzed locally. After 5/20 visits (25%), three patients experienced a worsening of anemia (four incidences) and active hepatitis C development (one incidence)., Conclusions: Our study demonstrates that patients from developing countries on maintenance dialysis differ from our local Italian dialysis population in several respects. These are young age, causes of renal failure, frequently late referral, high infection rates, and the clinical complications due to patients' visits to their native countries.

Carlo L. Rovida (1844-1877) was an Italian physician who graduated in Pavia (1866) and worked in Milan (1868) and Turin (1874), where he ran the Institute of Clinical Medicine at the university. Between 1870 and 1876 Rovida published several studies on the nature of urinary casts, which can still be considered valid today. He distinguished two main types of casts, i.e., "colorless" (hyaline) and "yellowish" (waxy). By painstaking microscopic observation of the urine, performed mainly by microchemical techniques, and histological examination of the kidneys, he came to the conclusion that both types of casts were produced by tubular cells. In addition, he found that the colorless casts were composed of a unique protein, which was different from any other protein known at the time, and which he called "cilindrina" (cylindrine). Instead, Rovida found that the yellowish casts contain a different, ill-defined protein, which was also present in the lateral and basal membrane of the tubular cells. Rovida should be remembered today because his views were much ahead of the prevailing theories of the time, which considered the casts as coagulated fibrin (a view sustained mainly in Germany) or as elements derived from either tubular degeneration or tubular production (a view sustained mainly in the United Kingdom and Sweden); his results concerning the site of production of hyaline casts and their unique nature were confirmed 90 years later, in the early 1960s, when it was demonstrated that these casts are made of Tamm-Horsfall glycoprotein, a protein which is produced by the cells of Henle's loop; and his conclusions about the special nature of waxy casts were also correct. In fact, even though the true composition of these casts is still not yet totally clear, there is now evidence that they contain a substance different from Tamm-Horsfall protein. Rovida is also a paradigm of how the progress of science is strictly dependent on the development of technology. In fact, it was only when appropriate techniques (e.g., electrophoresis, immunoelectrophoresis, and immunofluorescent microscopy) became available that the nature of casts could be defined with certainty., (Copyright 2002 S. Karger AG, Basel)

Background: Percutaneous renal biopsy, based on the use of an aspiration needle and the patient in the sitting position, was first described by Iversen and Brun in 1951. In 1954, Kark and Muehrcke described the use of the cutting Vim-Silverman needle on patients in the prone position, with a substantial improvement in the rate of success. The 1961 CIBA Foundation Symposium on renal biopsy marked the coming of age of this technique. During the 1950s in Italy, several individuals played a part in promoting and developing percutaneous renal biopsy. Because this pioneer work has received insufficient attention, we describe the contributions of Italians to the early introduction of this technique., Methods: The Italian and international literature about percutaneous renal biopsy of the period 1951 through 1965 was reviewed. In addition, structured interviews with surviving members of the Italian researchers who first used renal biopsy were conducted., Results: The first renal biopsies in Italy were performed in 1951 in Pisa by the group of Ernico Fiaschi (1913-1989). In their hands, renal biopsy became a tool to investigate the pathogenesis of renal diseases in particular, while simultaneously using the early application of immunofluorescence and electron microscopy. In 1954, Pietro Leonardi (1914-1991) and Arturo Ruol (born 1924) introduced renal biopsy in Padova; they used this technique extensively and published one of the first monographs on the subject. In 1957, Vittorio Bonomini (born 1928) introduced renal biopsy in Bologna, and in subsequent years used this technique to focus on the study of pyelonephritis., Conclusions: Our historical research shows that Italian groups were among the first to use and develop percutaneous renal biopsy both as a clinical tool and an investigative tool. This article gives international credit to their work.