868 results on '"C. Ponticelli"'
Search Results
2. The pharmacology of old and new agents for specific therapy of primary glomerular diseases
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Richard J. Glassock and C. Ponticelli
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Primary (chemistry) ,business.industry ,Medicine ,Bioinformatics ,business ,Glomerular diseases - Abstract
A wide variety of pharmacologic agents having diverse mechanisms of action and potential adverse events are widely used in treatment of primary glomerular diseases. However, the indications for treating specific disease entities still represent a matter of controversy and discussion among nephrologists. Indeed, randomized controlled trials are relatively few in number and are often small, underpowered, and of short duration. Conversely, drugs such as glucocorticoids (GCs) and cytotoxic agents may exert beneficial effects in some glomerular diseases, but may also be responsible for disquieting adverse events that can discourage their use in patients with indolent glomerulonephritis. Recently, a number of biological agents have been developed to spare the use of potentially toxic agents while targeting the immune cells implicated in the pathogenesis of glomerular diseases. Thus far, however, many of them have failed to find a role in the clinical management of glomerular diseases. This chapter reports the main characteristics of the pharmacological classes of immunosuppressive agents that may be used in primary glomerular diseases.
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- 2019
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3. Infection-related and renal-limited glomerulonephritis
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C. Ponticelli, Gabriella Moroni, Richard J. Glassock, and Lee Hebert
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business.industry ,Immunology ,medicine ,Glomerulonephritis ,urologic and male genital diseases ,medicine.disease ,business - Abstract
This chapter covers the infection-related glomerulonephritides, which encompass a wide swath of epidemic and endemic diseases. Bacteria, fungi, protozoa, nematodes, helminths and viruses all contribute to the glomerular disease burden. Most of these have numerous and varied extra-renal manifestations and are commonly classified as secondary glomerular diseases. However, a few have mainly or exclusively renal involvement and can be classified within the rubric of primary glomerular disease. This group of glomerular diseases is characterized by intraglomerular inflammation and cellular proliferation resulting from immunological events triggered by a variety of organisms. This chapter discusses the prototypical renal-limited forms of infection-related glomerulonephritis.
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- 2019
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4. Causes of late transplant failure in cyclosporine-treated kidney allograft recipients
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Valentina Binda, Piergiorgio Messa, Giuseppe Montagnino, Francesco Cosa, Evaldo Favi, Francesca Raffiotta, Gabriella Moroni, C. Ponticelli, Lucia Sacchi, and Silvana Quaglini
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Nephrology ,Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Physiology ,medicine.medical_treatment ,Calcineurin Inhibitors ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Malignancy ,Gastroenterology ,Risk Assessment ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Treatment Failure ,Retrospective Studies ,Creatinine ,Proteinuria ,business.industry ,Graft Survival ,Immunosuppression ,Hepatitis C ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Transplantation ,chemistry ,Cyclosporine ,Female ,medicine.symptom ,business ,Mace ,Immunosuppressive Agents - Abstract
There is little information about very long-term outcomes of kidney allograft recipients exposed to calcineurin inhibitors. In this single-centre retrospective study with 20-year follow-up, we analyzed data from 644 patients who underwent primary renal transplantation between 1983 and 1993. Participants were treated with a cyclosporine-based immunosuppressive scheme and had allograft function at 1 year. After 20 years, 15.2% patients died, 39.7% experienced allograft loss, 26.8% were alive with a functioning transplant, and 18.2% were lost to follow-up. Cardiovascular disease (30.8%), malignancy (26.6%) and infection (17.0%) were the main causes of death. Age, new-onset proteinuria > 1 g/day, major acute cardiovascular event (MACE), and malignancy were independent predictors of mortality at time-dependent multivariate analysis. Chronic rejection (63.3%), recurrent glomerulonephritis (14.0%), and nonspecific interstitial fibrosis/tubular atrophy (13.2%) were the leading cause of allograft loss. Basal disease, hepatitis C, difference between 1 year and nadir serum creatinine, new-onset proteinuria > 1 g/day, and MACE were independent predictors of transplant failure. Among patients with 20-year allograft function, we recorded the following complications: hypertension (85%), malignancy (13%), diabetes (9%), and cardiovascular disease (9%). Median serum creatinine and proteinuria were 1.4 mg/dL and 0.6 g/day, respectively. Prolonged use of cyclosporine may expose to several dose-related adverse events and may contribute to the development of allograft dysfunction but it does not necessarily cause relentless, progressive transplant failure if patients are carefully and consistently monitored during the follow-up.
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- 2019
5. New-Onset Diabetes after Kidney Transplantation
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Evaldo Favi, C. Ponticelli, and Mariano Ferraresso
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Medicine (General) ,medicine.medical_specialty ,mTOR inhibitor ,medicine.medical_treatment ,Calcineurin Inhibitors ,Population ,kidney transplantation ,Review ,Type 2 diabetes ,Tacrolimus ,R5-920 ,new-onset diabetes after transplantation ,cardiovascular disease ,Risk Factors ,Internal medicine ,Diabetes mellitus ,calcineurin inhibitor ,Diabetes Mellitus ,Humans ,Medicine ,education ,Kidney transplantation ,education.field_of_study ,immunosuppression ,diabetes ,business.industry ,Insulin ,steroid ,Immunosuppression ,General Medicine ,medicine.disease ,Transplantation ,NODAT ,Diabetes Mellitus, Type 2 ,renal allograft ,business ,Immunosuppressive Agents - Abstract
New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, whilst the modifiable factors include peri-operative stress, hepatitis C or cytomegalovirus infection, vitamin D deficiency, hypomagnesemia, and immunosuppressive medications such as glucocorticoids, calcineurin inhibitors (tacrolimus more than cyclosporine), and mTOR inhibitors. The most worrying complication of NODAT are major adverse cardiovascular events which represent a leading cause of morbidity and mortality in transplanted patients. However, NODAT may also result in progressive diabetic kidney disease and is frequently associated with microvascular complications, eventually determining blindness or amputation. Preventive measures for NODAT include a careful assessment of glucose tolerance before transplantation, loss of over-weight, lifestyle modification, reduced caloric intake, and physical exercise. Concomitant measures include aggressive control of systemic blood pressure and lipids levels to reduce the risk of cardiovascular events. Hypomagnesemia and low levels of vitamin D should be corrected. Immunosuppressive strategies limiting the use of diabetogenic drugs are encouraged. Many hypoglycemic drugs are available and may be used in combination with metformin in difficult cases. In patients requiring insulin treatment, the dose and type of insulin should be decided on an individual basis as insulin requirements depend on the patient’s diet, amount of exercise, and renal function.
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- 2021
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6. Reversible acute renal failure from gross haematuria due to glomerulonephritis: not only in IgA nephropathy and not associated with intratubular obstruction
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A. Scalia, Michael J. Mihatsch, Giovanni B. Fogazzi, C. Ponticelli, Enrico Imbasciati, and Gabriella Moroni
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Transplantation ,Creatinine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,urogenital system ,Urology ,Renal function ,Glomerulonephritis ,medicine.disease ,urologic and male genital diseases ,Nephropathy ,chemistry.chemical_compound ,chemistry ,Nephrology ,Edema ,Immunology ,medicine ,Renal biopsy ,medicine.symptom ,business ,Nephritis ,Acute tubular necrosis - Abstract
Seven patients with acute renal failure due to gross haematuria caused by glomerulonephritis are described. Gross haematuria lasting 4-40 days led to acute impairment of renal function of variable severity (peak plasma creatinine 1.3-12 mg/dl) and duration. While partial recovery of renal function occurred in all patients within few days, complete remission was observed only some months later. Three patients had IgA nephropathy (2 the primary form and 1 nephritis secondary to Schonlein-Henoch purpura), two patients had acute postinfectious glomerulonephritis, and two others had focal necrotizing (pauci-immune) glomerulonephritis. The glomerular changes seen in the renal biopsy were not enough to explain per se the renal function impairment. Tubular changes, however, were severe and consisted of tubular necrosis, erythrocyte casts, erythrocyte phagocytosis by tubular cells, accompanied by interstitial damage (oedema, red-cell extravasation, and inflammatory infiltrates). Study of the renal biopsies by immunofluorescence revealed no retrodiffusion of Tamm-Horsfall protein into the glomerular Bowman's space, a sign of obstructed tubular flow in any case. It is concluded that acute renal failure due to gross haematuria in glomerulonephritic patients may not occur only in IgA nephropathy, as reported so far, and is not associated with intratubular obstruction.
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- 2017
7. Synthetic pharmacotherapy for lupus nephritis
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G. Moroni and C. Ponticelli
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Cyclophosphamide ,medicine.medical_treatment ,Lupus nephritis ,03 medical and health sciences ,0302 clinical medicine ,Therapeutic index ,Pharmacotherapy ,immune system diseases ,Medicine ,Humans ,Lupus Erythematosus, Systemic ,Pharmacology (medical) ,In patient ,030212 general & internal medicine ,skin and connective tissue diseases ,Adverse effect ,030203 arthritis & rheumatology ,Pharmacology ,Immunosuppression Therapy ,business.industry ,Immunosuppression ,General Medicine ,medicine.disease ,Lupus Nephritis ,Immunology ,business ,Complication ,Immunosuppressive Agents ,medicine.drug - Abstract
Introduction: Lupus nephritis is a frequent complication and a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE).Area covered: The main characteristics and mechanisms of action of the synthetic drugs more frequently used in lupus nephritis are described. Possible strategies aimed to reduce the potential adverse events without affecting efficacy are reported.Expert opinion: Many synthetic immunosuppressive drugs used in lupus nephritis have a low therapeutic index. Good knowledge of their pharmacologic characteristics, mechanisms of action, and drug-to-drug interactions, coupled with a strategy aimed to increase immunosuppression in the active phases of SLE while reducing the dosage in quiescent periods can reduce the iatrogenic morbidity while maintaining efficacy. Biologic agent may allow to reduce the use or the dosage of synthetic immunosuppressive drugs.
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- 2017
8. A Randomized Trial of Everolimus and Low-dose Cyclosporine in Renal Transplantation: With or Without Steroids?
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Mario Carmellini, Giuseppe Paolo Segoloni, C. Ponticelli, Paolo Rigotti, Giacomo Colussi, Sergio Stefoni, Silvio Sandrini, and Giuseppe Tisone
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Adult ,Male ,medicine.medical_specialty ,Randomization ,Urology ,Methylprednisolone ,Cyclosporine ,Drug Therapy, Combination ,Everolimus ,Female ,Glucocorticoids ,Humans ,Immunosuppressive Agents ,Intention to Treat Analysis ,Kidney Transplantation ,Middle Aged ,Prospective Studies ,Sirolimus ,Treatment Failure ,law.invention ,Drug Therapy ,Randomized controlled trial ,law ,medicine ,Clinical endpoint ,Kidney transplantation ,Settore MED/14 - Nefrologia ,Transplantation ,Intention-to-treat analysis ,business.industry ,medicine.disease ,Surgery ,Regimen ,Combination ,business ,medicine.drug - Abstract
This multicenter, randomized, prospective, controlled trial (EVIDENCE study) aimed to determine short-term effects of early steroid withdrawal in renal transplant patients initially treated with everolimus, low-dose cyclosporine (CsA), and steroids. Patients were randomized to standard triple therapy with CsA, everolimus twice daily and steroids (group A), steroid-free immunosuppression (group B), or triple therapy once daily (group C). However, since patient enrollment was slower than expected, group C randomization was prematurely discontinued. The primary end point was treatment failure rate (composite end point of death, graft loss, biopsy-proven acute rejection, and loss to follow-up) between randomization and month 12. Patients evaluable for the primary end point included 139 randomized patients. According to intention-to-treat analysis, 2.8% of patients in group A and 14.7% in group B experienced treatment failure (95% upper confidence limit 19.7%). As this was higher than the predefined noninferiority limit of 10%, noninferiority could not be proved. No conclusive statements can be made on noninferiority of the steroid withdrawal regimen vs the standard regimen in these patients. Additional studies with longer follow-up are required to determine the efficacy of steroid-free immunosuppression in renal transplant recipients receiving everolimus.
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- 2014
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9. CKD LAB METHODS, PROGRESSION & RISK FACTORS 2
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M. Onuigbo, N. Agbasi, M. J. Wu, K. H. Shu, E. Kugler, E. Cohen, I. Krause, E. Goldberg, M. Garty, J. Jansen, I. E. De Napoli, C. M. Schophuizen, M. J. Wilmer, H. A. Mutsaers, L. P. Heuvel, D. W. Grijpma, D. Stamatialis, J. G. Hoenderop, R. Masereeuw, A. H. Van Craenenbroeck, E. M. Van Craenenbroeck, K. Van Ackeren, C. J. Vrints, V. Y. Hoymans, M. M. Couttenye, M. Erkmen Uyar, E. Tutal, Z. Bal, O. Guliyev, S. Sezer, L. Liu, C. Wang, K. Tanaka, A. Kushiyama, K. Sakai, S. Hara, Y. Ubara, Y. Ohashi, Y. Kunugi, S. Kawazu, K. Untersteller, S. Seiler, K. S. Rogacev, I. E. Emrich, C. S. Lennartz, D. Fliser, G. H. Heine, T. Hoshino, S. Ookawara, H. Miyazawa, Y. Ueda, K. Ito, Y. Kaku, K. Hirai, H. Mori, I. Yoshida, S. Kakuta, N. Hayama, M. Amemiya, H. Okamoto, S. Inoue, K. Tabei, P. Campos, C. Dias, J. Baptista, A. L. Papoila, A. Ortiz, L. Inchaustegui, K. Soto, K. H. Moon, S. Yang, D.-Y. Lee, H. W. Kim, B. Kim, C. Isnard Bagnis, A. Guerraoui, F. Zenasni, L. Idier, P. Chauveau, A. Cerqueira, J. Quelhas-Santos, M. Pestana, J.-Y. Choi, D.-C. Jin, Y.-J. Choi, W.-Y. Kim, S.-A. Nam, J.-H. Cha, V. Cernaro, S. Loddo, A. Lacquaniti, A. Romeo, G. Costantino, G. Montalto, D. Santoro, D. Trimboli, C. A. Ricciardi, V. Lacava, M. Buemi, A. M. Zawada, R. Obeid, J. Geisel, G. C. Meneses, G. Silva Junior, M. F. B. Costa, H. S. Goncalves, E. F. Daher, A. B. Liborio, A. M. C. Martins, R. Ekart, N. Hojs, S. Bevc, R. Hojs, C. S. Lim, J. H. Hwang, H. J. Chin, S. Kim, D. K. Kim, J. H. Park, S. J. Shin, S. H. Lee, B. S. Choi, S. Lemoine, M. Panaye, L. Juillard, L. Dubourg, A. Hadj-Aissa, F. Guebre-Egziabher, A. P. F. Vieira, A. X. Couto Bem, M. P. Alves, G. Stefan, C. Capusa, S. Stancu, D. Margarit, L. Petrescu, E. D. Nedelcu, G. Mircescu, A. Szarejko-Paradowska, J. Rysz, C.-C. Hung, H.-C. Chen, V. Ristovska, L. Grcevska, M. A. Podesta, F. Reggiani, D. Cucchiari, S. Badalamenti, C. Ponticelli, G. Graziani, N. Nouri-Majalan, S. Moghadasimousavi, Z. Eshaghyeh, S. Greenwood, P. Koufaki, H. Maclaughlin, R. Rush, B. M. Hendry, I. C. Macdougall, T. Mercer, and H. Cairns
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Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,medicine ,Intensive care medicine ,business - Published
- 2014
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10. Hydroxychloroquine in systemic lupus erythematosus (SLE)
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C. Ponticelli and Gabriella Moroni
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0301 basic medicine ,Drug ,medicine.medical_specialty ,media_common.quotation_subject ,Lupus nephritis ,03 medical and health sciences ,0302 clinical medicine ,Retinal Diseases ,Pregnancy ,Internal medicine ,medicine ,Animals ,Humans ,Lupus Erythematosus, Systemic ,Pharmacology (medical) ,Antimalarial Agent ,skin and connective tissue diseases ,media_common ,030203 arthritis & rheumatology ,Systemic lupus erythematosus ,business.industry ,Hydroxychloroquine ,General Medicine ,medicine.disease ,Organ damage ,030104 developmental biology ,Antirheumatic Agents ,Immunology ,Female ,business ,Complication ,Retinopathy ,medicine.drug - Abstract
Hydroxychloroquine (HCQ) is an alkalinizing lysosomatropic drug that accumulates in lysosomes where it inhibits some important functions by increasing the pH. HCQ has proved to be effective in a number of autoimmune diseases including systemic lupus erythematosus (SLE). Areas covered: In this review the mechanisms of action, the efficacy, and the safety of HCQ in the management of patients with SLE have been reviewed. HCQ may reduce the risk of flares, allow the reduction of the dosage of steroids, reduce organ damage, and prevent the thrombotic effects of anti-phospholipid antibodies. The drug is generally safe and may be prescribed to pregnant women. However, some cautions are needed to prevent retinopathy, a rare but serious complication of the prolonged use of HCQ. Expert opinion: HCQ may offer several advantages not only in patients with mild SLE but can also exert important beneficial effects in lupus patients with organ involvement and in pregnant women. The drug has a low cost and few side effects. These characteristics should encourage a larger use of HCQ, also in lupus patients with organ involvement.
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- 2016
11. Fetal Toxicity of Immunosuppressive Drugs in Pregnancy
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Gabriella Moroni and C. Ponticelli
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0301 basic medicine ,medicine.medical_specialty ,lcsh:Medicine ,Intrauterine growth restriction ,Review ,Organ transplantation ,Miscarriage ,03 medical and health sciences ,0302 clinical medicine ,medicine ,autoimmune diseases ,Intensive care medicine ,030203 arthritis & rheumatology ,Pregnancy ,Fetus ,business.industry ,lcsh:R ,organ transplantation ,General Medicine ,medicine.disease ,neoplasia ,Low birth weight ,030104 developmental biology ,Toxicity ,pregnancy ,medicine.symptom ,business ,Drugs in pregnancy - Abstract
Women affected by autoimmune diseases, organ transplantation, or neoplasia need to continue immunosuppressive treatment during pregnancy. In this setting, not only a careful planning of pregnancy, but also the choice of drugs is critical to preventing maternal complications and minimizing the fetal risks. Some immunosuppressive drugs are teratogenic and should be replaced even before the pregnancy, while other drugs need to be managed with caution to prevent fetal risks, including miscarriage, intrauterine growth restriction, prematurity, and low birth weight. In particular, the increasing use of biologic agents raises the question of their compatibility with reproduction. In this review we present data on the indication and safety in pregnancy of the most frequently used immunosuppressive drugs.
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- 2018
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12. Calcineurin Inhibitors in Renal Transplantation Still Needed but in Reduced Doses: A Review
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M.P. Scolari, C. Ponticelli, Ponticelli C, and Scolari MP.
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Graft Rejection ,medicine.medical_specialty ,Drug Administration Schedule ,Organ transplantation ,law.invention ,Safety-Based Drug Withdrawals ,RENAL TRANSPLANTATION ,Randomized controlled trial ,law ,medicine ,Humans ,IMMUNOSUPPRESSIVE THERAPY ,Everolimus ,Randomized Controlled Trials as Topic ,Sirolimus ,Transplantation ,CALCINEURIN INHIBITORS ,business.industry ,Drug Synergism ,Mycophenolic Acid ,Kidney Transplantation ,Surgery ,CNI WITHDRAWAL ,Calcineurin ,surgical procedures, operative ,Renal transplant ,Toxicity ,Cyclosporine ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Despite their contribution in the success of organ transplantation, calcineurin inhibitors (CNIs) may be responsible for frequent and severe side effects that can affect graft survival and life expectancy. In this article, we have reviewed registry studies and randomized controlled trials (RCTs) that seek to avoid, withdraw, or minimize CNIs in renal transplant recipients. Attempts to completely avoid CNIs by administering mycophenolate mofetil (MMF) and/or sirolimus (SRL) have resulted in increased risks of rejection and side effects, with small advantage to improve renal graft function. Early withdrawal of CNIs after transplantation using administration of MMF can improve graft function but may be associated with a greater risk of acute or chronic rejection and graft failure. RCTs in which CNIs were replaced a few months after transplantation by SRL reported improved graft function among SRL-treated patients, but such a treatment was complicated by iatrogenic toxicity. Late replacement of CNIs with SRL did not produce a particular advantage and again was complicated by more frequent side effects. On the basis of these trials, it seems that CNI elimination can trigger rejection or side effects. Recent RCTs showed that minimization of CNI doses in association with everolimus does not increase the risk of rejection, allows one to obtain good graft function, and is well tolerated. Such an approach seems therefore preferable to complete elimination of CNIs with substitution of the current immunosuppressive drugs.
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- 2010
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13. Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome : Workshop recommendations
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Peter Heering, Atholl Johnston, Norishige Yoshikawa, C. Ponticelli, Manuel Praga, Takao Saito, Patrick H. Nachman, Dan Cattran, Alain Meyrier, G. Choukroun, Peter F. Hoyer, and Efstathios Alexopoulos
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Nephrology ,medicine.medical_specialty ,Nephrotic Syndrome ,Urology ,urologic and male genital diseases ,Education ,Focal segmental glomerulosclerosis ,Membranous nephropathy ,Internal medicine ,Humans ,Medicine ,Minimal change disease ,Evidence-Based Medicine ,medicine.diagnostic_test ,business.industry ,Nephrosis, Lipoid ,membranous nephropathy ,Glomerulonephritis ,medicine.disease ,focal and segmental glomerulosclerosis ,clinical practice ,cyclosporin ,Surgery ,minimal change disease ,Practice Guidelines as Topic ,Cyclosporine ,idiopathic nephrotic syndrome ,Renal biopsy ,business ,Nephrotic syndrome ,Immunosuppressive Agents ,Kidney disease - Abstract
Management of idiopathic glomerular disease associated with nephrotic syndrome (INS) remains controversial and one of the most complex areas relates to utilization of the drug cyclosporin. This is despite its demonstrated effectiveness in several histologic types of the INS in randomized controlled trials. Cyclosporin is effective in inducing remission of proteinuria in approximately 80% of steroid-sensitive cases of minimal change disease (MCD). Cyclosporin is also effective in both the induction of remission and long-term preservation of renal function in steroid-dependent/-resistant MCD and steroid-resistant focal segmental glomerulosclerosis (FSGS). The overall response rate in FSGS is lower than in MCD, and long-term therapy (>12 months) may be required to both achieve remission and sustain it. Cyclosporin therapy is also of benefit in reducing proteinuria in 70–80% of patients with steroid-resistant membranous nephropathy (MGN). In MGN, the maximum benefit is often delayed compared to MCD (>12 weeks). Cyclosporin is generally well tolerated and safe. The major concern remains the nephrotoxicity, but with careful monitoring of the patient's renal function; minimizing the maintenance dose and utilizing repeat renal biopsy in those receiving long-term therapy, this risk can be minimized. The algorithms have been developed derived from the best evidence in the literature in each of the histologic types to help provide a guide to the integration of cyclosporin into the management of INS for the practicing nephrologist.
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- 2007
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14. A randomized exploratory trial of steroid avoidance in renal transplant patients treated with everolimus and low-dose cyclosporine
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B Iorio, Francesco Paolo Schena, Maria Laura Cossu, Sergio Stefoni, Maurizio Salvadori, G Corbetta, Paolo Altieri, C. Ponticelli, Paolo Rigotti, Silvio Sandrini, Giuseppe Montagnino, Mario Carmellini, Montagnino G, Sandrini S, Iorio B, Schena FP, Carmellini M, Rigotti P, Cossu M, Altieri P, Salvadori M, Stefoni S, Corbetta G, and Ponticelli C.
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Adult ,Male ,Basiliximab everolimus and cyclosporine immunosuppression: cyclosporine ,Early steroid withdrawal ,Everolimus ,Kidney transplant ,Steroid free ,medicine.medical_specialty ,Basiliximab ,medicine.medical_treatment ,Urology ,Renal function ,Internal medicine ,Multicenter trial ,medicine ,Humans ,Glucocorticoids ,Sirolimus ,Transplantation ,business.industry ,Middle Aged ,medicine.disease ,Ciclosporin ,Kidney Transplantation ,Settore MED/18 - Chirurgia Generale ,Endocrinology ,Nephrology ,Cyclosporine ,Prednisone ,Female ,Hemodialysis ,business ,Immunosuppressive Agents ,Kidney disease ,medicine.drug - Abstract
BACKGROUND: Everolimus and cyclosporine exhibit synergistic immunosuppressive activity when given in combination. In this randomized trial, we explored whether the use of everolimus associated with low-dose cyclosporine could allow an early avoidance of steroids in de novo renal transplant recipients. METHODS: In this exploratory multicenter trial, 65 out of 133 patients treated with basiliximab (days 0 and 4), everolimus 3 mg/day and cyclosporine were randomized to stop steroids on the seventh post-transplant day (group A), whereas the remaining 68 continued low-dose steroid treatment (group B). RESULTS: During the follow-up, 30 patients of group A (46%) resumed steroids. According to the intention-to-treat analysis, the 3-year graft survival rate was 95% in group A and 87% in group B (P = ns). There were more biopsy-proven rejections in group A, the difference being of borderline significance (32% vs 18%; P = 0.059). After 3 years, mean creatinine clearance was 52.3 +/- 17.1 ml/min in group A and 52.2 +/- 21.5 ml/min in group B. It was similar in the group A patients who experienced rejection (49.8 +/- 14.7 ml/min) and those who did not (53.6 +/- 18.3 ml/min; P = 0.319). Mean serum cholesterol and triglyceride levels were, respectively, less than 250 mg/dl and less than 200 mg/dl in both groups, without any significant difference. Vascular thrombosis (0 vs 11.7%; P = 0.0043) was more frequent in group B. CONCLUSIONS: Treatment based on everolimus and low-dose cyclosporine allowed excellent renal graft survival and stable graft function at 3 years. An early discontinuation of steroids increased the risk of acute rejection, but was associated with a better graft survival in the long-term. However, it was well tolerated only by 54% of patients.
- Published
- 2007
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15. The long-term outcome of 93 patients with proliferative lupus nephritis
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C. Ponticelli, Beniamina Gallelli, Piergiorgio Messa, Giovanni Banfi, Silvana Quaglini, and Gabriella Moroni
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Lupus nephritis ,Gastroenterology ,chemistry.chemical_compound ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,Survival analysis ,Dialysis ,Transplantation ,Kidney ,Creatinine ,Systemic lupus erythematosus ,business.industry ,Remission Induction ,Prognosis ,medicine.disease ,Lupus Nephritis ,Survival Analysis ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,chemistry ,Nephrology ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business ,Kidney disease - Abstract
Background. Few data are available about the verylong-term outcome of patients with proliferative lupusnephritis.Methods. Ninety-three Italian patients with biopsy-proven proliferative lupus nephritis (15 with class III, 9with class IIIþV, 64 with class IV and 5 with classIVþV) followed for a median follow-up of 15 years ina single renal unit were considered for this observa-tional study. Patients were treated with an inductiontreatment consisting of high doses of corticosteroidsplus immunosuppressive agents in the more severecases. This treatment was repeated in the event of arenal flare. Then corticosteroids and immunosuppres-sive agents were reduced to the minimal effective dosefor maintenance.Results. Renal survival including death was 97% at10 years and 82% at 20 years. At the last follow-upvisit, 59 patients were in complete renal remission,18 were in partial renal remission, four patients hadchronic renal insufficiency, six had entered end-stagerenal disease and six patients had died.At multivariate analysis the lack of achievement ofcomplete renal remission and the occurrence ofnephritic flares were significantly correlated bothwith the risk of doubling plasma creatinine and deathor dialysis. Those patients who entered complete renalremission had significantly less probability of develop-ing nephritic flares.Conclusion. The long-term prognosis of Caucasianpatients with proliferative lupus nephritis may bebetter than usually thought. Favorable factors forgood long-term outcome are the achievement ofcomplete renal remission, the absence of nephriticflares and their complete reversibility after therapy.Keywords: immunosuppressive therapy; long-termrenal survival; lupus nephritis
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- 2007
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16. Hepatitis C Virus Infection and Rituximab Therapy after Renal Transplantation
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C. Ponticelli, Maria Rosaria Campise, Fabrizio Fabrizi, A. Elli, G. Montagnino, Giovanni Banfi, Patrizia Passerini, Paul Martin, and Antonio Tarantino
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Hepatitis C virus ,Biomedical Engineering ,Medicine (miscellaneous) ,Antineoplastic Agents ,Bioengineering ,Hepacivirus ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Monoclonal antibody ,Gastroenterology ,Biomaterials ,Pathogenesis ,Antibodies, Monoclonal, Murine-Derived ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,hemic and lymphatic diseases ,Internal medicine ,Humans ,Medicine ,Cause of death ,Immunosuppression Therapy ,030203 arthritis & rheumatology ,business.industry ,Antibodies, Monoclonal ,Cancer ,General Medicine ,Hepatitis C ,Hepatitis C, Chronic ,medicine.disease ,Kidney Transplantation ,Lymphoproliferative Disorders ,Transplantation ,Immunology ,RNA, Viral ,Female ,Rituximab ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Background. Rituximab, a chimeric monoclonal antibody, has been successfully given in various diseases including HCV-associated mixed cryoglobulinemia. However, only preliminary data exists on its efficacy and safety after renal transplantation. Methods. We report on a renal transplant recipient with chronic hepatitis C who received rituximab therapy for gastric cancer. Four rituximab infusions of 375 mg/m2 were given. Results. Rituximab therapy was complicated by cholestatic hepatitis C with very high HCV RNA levels; liver insufficiency occurred. The patient developed bacterial pneumoniae and respiratory insufficiency was the cause of death. Although other mechanisms cannot be excluded, we found that rituximab therapy was implicated in the pathogenesis of cholestatic hepatitis C in our patient. Conclusions. We suggest that rituximab therapy may be associated with significant side effects. More experience has to be accumulated before any conclusions on efficacy and safety of rituximab therapy after RT can be drawn.
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- 2007
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17. Bicarbonate Dialysis
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A. Salvadeo, A. Cantaluppi, S. Segagni, S. Casati, F. Galli, G. Graziani, F. Poggio, E. Petrella, A. Citterio, G. Bovio, and C. Ponticelli
- Published
- 2015
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18. Ciclosporin in Cadaveric Renal Transplants
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Giuseppe Montagnino, C. Ponticelli, F. Egidi, Luisa Berardinelli, A. Vegeto, E. Rivolta, Antonio Tarantino, and A. De Vecchi
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Ciclosporin ,business ,Cadaveric spasm ,Surgery ,medicine.drug - Published
- 2015
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19. Causes of Arterial Hypertension in Kidney Transplantation
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Giuseppe Montagnino and C. Ponticelli
- Subjects
Nephrology ,medicine.medical_specialty ,business.industry ,Internal medicine ,Pathophysiology of hypertension ,medicine ,Cardiology ,business ,medicine.disease ,Kidney transplantation - Published
- 2015
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20. Ciclosporin Alone or Associated with Steroid for Immunosuppression of Cadaveric Renal Transplants?
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A. De Vecchi, Antonio Tarantino, F. Egidi, Luisa Berardinelli, C. Ponticelli, E. Rivolta, and Giuseppe Montagnino
- Subjects
Nephrology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,medicine ,Urology ,Immunosuppression ,Ciclosporin ,business ,Cadaveric spasm ,medicine.drug ,Steroid - Published
- 2015
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21. Treatment of Diffuse Proliferative Lupus Nephritis
- Author
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Gabriella Moroni, C. Ponticelli, and Giovanni Banfi
- Subjects
business.industry ,Immunology ,Lupus nephritis ,Medicine ,business ,medicine.disease ,Anti-SSA/Ro autoantibodies - Published
- 2015
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22. The Long-Term Prognosis of Renal Transplantation in Patients With Lupus Nephritis
- Author
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Pier Luigi Meroni, Beniamina Gallelli, Piergiorgio Messa, Silvana Quaglini, Giovanni Banfi, Giuseppe Montagnino, Francesca Poli, C. Ponticelli, Gabriella Moroni, and Francesca Tantardini
- Subjects
Adult ,Graft Rejection ,Male ,Risk ,Nephrology ,medicine.medical_specialty ,Lupus nephritis ,Infections ,Gastroenterology ,Nephropathy ,chemistry.chemical_compound ,Postoperative Complications ,Recurrence ,immune system diseases ,Internal medicine ,medicine ,Humans ,Thrombophilia ,Life Tables ,skin and connective tissue diseases ,Creatinine ,Systemic lupus erythematosus ,business.industry ,Graft Survival ,Thrombosis ,Hepatitis C, Chronic ,Prognosis ,medicine.disease ,Kidney Transplantation ,Lupus Nephritis ,Surgery ,Transplantation ,Treatment Outcome ,Italy ,chemistry ,Hypertension ,Antibodies, Antiphospholipid ,Female ,business ,Nephritis ,Immunosuppressive Agents ,Follow-Up Studies ,Kidney disease - Abstract
Background: Few data are available about the long-term outcome of renal transplantation in patients with systemic lupus erythematosus (SLE). Methods: Between June 1982 and 2004, a total of 33 adults with lupus nephritis received 35 kidney allografts. Outcomes of these grafts and those of 70 controls matched for age, sex, and donor source who underwent transplantation during the same period were compared. Results: Mean follow-up after renal transplantation was 91 ± 59 months for patients with lupus and 90 ± 64 months for controls. Actuarial 15-year patient (80% versus 83%) and death-censored graft survival rates (69% versus 67%) were not significantly different between patients with lupus and controls. Risks for acute and chronic rejection, arterial hypertension, and infection were not different between the 2 groups. Mean serum creatinine levels also were similar in the 2 groups at the last follow-up visit. Intravascular thrombotic events occurred in 9 patients with SLE (26%) and 6 controls (8.6%; P = 0.038). In the SLE group, 6 of 7 antiphospholipid (aPL) antibody-positive versus 3 of 17 aPL antibody-negative patients experienced thrombotic events (P = 0.015). Recurrence of lupus nephritis was documented in 3 renal grafts (8.6%), but no graft was lost because of recurrent lupus nephritis. Conclusion: Long-term patient and graft survival probabilities were similar in patients with SLE and matched controls. The risk for thrombotic complications was greater in patients with SLE, particularly aPL-positive patients. Nephritis recurred in less than 10% of patients with SLE and did not influence graft survival.
- Published
- 2005
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23. Renal transplantation in lupus nephritis
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C. Ponticelli and Gabriella Moroni
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Graft Rejection ,medicine.medical_specialty ,Treatment outcome ,Lupus nephritis ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Recurrence ,medicine ,Humans ,Kidney transplantation ,030203 arthritis & rheumatology ,business.industry ,medicine.disease ,Kidney Transplantation ,Lupus Nephritis ,Dermatology ,Transplantation ,Treatment Outcome ,Cardiovascular Diseases ,Immunology ,Antibodies, Antiphospholipid ,business ,Immunosuppressive Agents - Abstract
Most patients with systemic lupus erythematosus (SLE) are suitable candidates for renal transplantation. However, a number of them may present some disease-related problems. As cardiovascular disease is a leading cause of morbidity and mortality in SLE patients, a careful pretransplant cardiovascular screening is recommended. A search for antiphospholipid antibodies is also useful as the presence of these antibodies can cause an early graft thrombosis. The risk of recurrence of SLE nephritis after transplantation may range between 2 and 30%. In most cases recurrence is characterized by mild histologic lesions. Only rarely does it lead to graft failure. Postransplant immunosuppression does not differ from that used routinely. Whenever possible, a steroid-free immunosuppression should be scheduled to prevent iatrogenic toxicity in patients who have already received long-term steroid treatment. The results of kidney transplantation largely depend on the clinical conditions at transplantation. In patients with poor clinical status or receiving an aggressive immunosuppression it is advisable to postpone the transplant. When some selection criteria are respected, the results of renal trasplantation in SLE patients are at least as good as in other transplant recipients.
- Published
- 2005
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24. Pregnancy after lupus nephritis
- Author
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Gabriella Moroni and C. Ponticelli
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medicine.medical_specialty ,media_common.quotation_subject ,Lupus nephritis ,Fertility ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Sex hormone-binding globulin ,Pre-Eclampsia ,Rheumatology ,Pregnancy ,immune system diseases ,Humans ,Medicine ,skin and connective tissue diseases ,Prospective cohort study ,media_common ,030203 arthritis & rheumatology ,Autoimmune disease ,Fetus ,biology ,business.industry ,Obstetrics ,Pregnancy Outcome ,medicine.disease ,Lupus Nephritis ,Pregnancy Complications ,Immunology ,Antibodies, Antiphospholipid ,biology.protein ,Female ,business - Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects primarily women, commonly in their reproductive years but does not influence fertility. For these reasons, the clinician has often to face the many problems of pregnancy in patients with SLE including the influence of SLE on fetal outcome and that of pregnancy on SLE. As there is increasing evidence of an important role of sex hormones in immunity, the influence of pregnancy on SLE is probably due to the changes in sex hormone levels during pregnancy that are more important than in any other period of life. Early reports emphasized a high fetal and maternal risk in particular in patients with lupus nephritis. However in the same period the prognosis of lupus nephritis was poor, so it was difficult to know whether pregnancy actually influenced the prognosis of the disease. More recent prospective studies indicate that pregnancy is safe for the majority of mothers if it is planned when SLE is quiescent. Instead, although fetal risk has been progressively reduced in the last 40 years, it continues to be higher than that occurring in pregnancies of healthy women. In particular the presence of antiphospholipid antibodies considerably worsen the fetal outcome.
- Published
- 2005
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25. Angiotensin-Converting Enzyme Inhibitors and Kidney Protection: The AIPRI Trial
- Author
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G. Janin, Eberhard Ritz, M. Motolese, Pietro Zucchelli, Johannes F.E. Mann, D. Alberti, C. Ponticelli, G. Maschio, and F. Locatelli
- Subjects
Pharmacology ,Kidney ,Creatinine ,medicine.medical_specialty ,biology ,business.industry ,medicine.medical_treatment ,Urology ,Renal function ,Benazepril ,Angiotensin-converting enzyme ,urologic and male genital diseases ,medicine.disease ,Surgery ,chemistry.chemical_compound ,medicine.anatomical_structure ,chemistry ,ACE inhibitor ,medicine ,biology.protein ,Renal replacement therapy ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Kidney disease - Abstract
A protective effect of angiotensin-converting enzyme (ACE) inhibitors has been shown in patients with diabetic nephropathy but has not been clearly established in nondiabetic renal disease. A multicenter European study was designed to determine whether the ACE inhibitor benazepril was safe and effective in protecting residual renal function in patients with various renal diseases and mild to moderate renal failure. The trial involved 583 patients from 49 centers in Italy, France, and Germany. The patients were randomized to receive benazepril or placebo plus other antihypertensive agents, the target being a diastolic blood pressure of less than 90 mm Hg. Thirty-one patients in the benazepril group and 57 patients in the placebo group reached the end point [the time elapsed from entry to (a) doubling of serum creatinine (SCr) concentrations and (b) start of renal replacement therapy; p < 0.001 at 3 years]. The associated reduction in the relative risk of reaching the end point was 53% in benazepril-treated patients, with actuarial renal survival probability significantly better at 3 years. The best survival of renal function was observed in patients with chronic glomerular diseases and proteinuria greater than 1.0 g/24 h. Benazepril is effective in slowing the rate of progression and improving the survival of renal function in patients with renal diseases of various origins. This protective effect is associated with a clinically relevant decrease in both blood pressure and proteinuria.
- Published
- 1999
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26. Flares in lupus nephritis: Incidence, impact on renal survival and management
- Author
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G Moroni and C Ponticelli
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Lupus nephritis ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Recurrence ,immune system diseases ,Internal medicine ,Severity of illness ,medicine ,Humans ,skin and connective tissue diseases ,Survival rate ,030203 arthritis & rheumatology ,Kidney ,business.industry ,Incidence ,Incidence (epidemiology) ,Immunosuppression ,medicine.disease ,Lupus Nephritis ,Survival Rate ,medicine.anatomical_structure ,business ,Renal survival ,Nephritis ,Follow-Up Studies - Abstract
One of the characteristics of systemic lupus erythematosus (SLE) is the large inter-and intra-individual variability of the clinical course. Lupus nephritis is no exception. Some patients with kidney involvement may show rapid progression to renal failure, others may enter complete and stable remission after adequate therapy while a number of other patients, with similar clinical and histological pattern at presentation, may alternate periods of clinical quiescence with renal exacerbations of different severity. In this paper we focus on the incidence, the prognostic significance and the treatment of renal flares in patients with SLE nephritis.
- Published
- 1998
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27. Skeletal Complications after Renal Transplantation
- Author
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A. Aroldi and C. Ponticelli
- Subjects
business.industry ,030232 urology & nephrology ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,General Medicine ,030204 cardiovascular system & hematology ,Bioinformatics ,Biomaterials ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Medicine ,business - Published
- 1998
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28. Peritoneal dialysis in nondiabetic patients older than 70 years: Comparison with patients aged 40 to 60 years
- Author
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Massimo Maccario, C. Ponticelli, C Castelnovo, A. Scalamogna, A. De Vecchi, and M Braga
- Subjects
Adult ,Male ,medicine.medical_specialty ,Patient Dropouts ,medicine.medical_treatment ,Nutritional Status ,Peritonitis ,Peritoneal dialysis ,Catheters, Indwelling ,Peritoneal Dialysis, Continuous Ambulatory ,Risk Factors ,Internal medicine ,medicine ,Humans ,Survival rate ,Dialysis ,Survival analysis ,Aged ,Retrospective Studies ,Dialysis adequacy ,business.industry ,Continuous ambulatory peritoneal dialysis ,Age Factors ,Retrospective cohort study ,Bacterial Infections ,Middle Aged ,Surgery ,Hospitalization ,Survival Rate ,Nephrology ,Quality of Life ,Female ,Complication ,business - Abstract
In all industrial countries, the number of elderly patients who need dialysis has increased in recent years. In the present study, we retrospectively analyzed two different age groups of nondiabetic peritoneal dialysis patients treated at the same unit by the same team of physicians and nurses with the same protocols. However, our purpose was to study possible differences in technique and survival rates, causes of dropout, complications, hospitalization rate, and everyday needs between the two groups. The results of 63 consecutive nondiabetic patients older than 70 years treated with continuous ambulatory peritoneal dialysis (CAPD) were compared with those of 86 nondiabetic patients aged 40 to 60 years treated during the same period. Patient survival was significantly worse in the elderly patients, but the observed to expected survival ratio with respect to age was similar. Technique survival was comparable in the two groups. Total hospitalization was 5,501 days (32 d/yr) in the elderly patients and 4,511 days (18 d/yr; P < 0.05) in the younger group. The peritonitis rate was 0.52 episodes/patient-year in the elderly patients and 0.37 episodes/patient-year in the younger patients (P < 0.002). The exit site infection rate was similar in the two groups (0.30 episodes/yr v0.29 episodes/yr). Other complications related to CAPD did not differ between the elderly and younger patients. Rehabilitation and biochemical data after 1 year of CAPD were similar in the two groups of patients. After 1 year of treatment, 12% of the younger patients and 43% of the elderly patients (P < 0.005) needed a partner for dialysis. Twenty-nine of 39 (74%) of the elderly patients and 30 of 53 (57%) of the younger patients considered their lifestyle acceptable after 1 year of dialysis. Thirty-four of 39 (87%) of the elderly patients and 32 of 53 (60%) of the younger patients (P < 0.02) rated their physical and social state after rehabilitation as better or comparable to that they had before terminal uremia.
- Published
- 1998
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29. Paucisymptomatic presentation of a systemic monoclonal disease: diagnostic and therapeutic problems
- Author
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C. Ponticelli and G. B. Fogazzi
- Subjects
Male ,Transplantation ,Pathology ,medicine.medical_specialty ,business.industry ,Disease ,Middle Aged ,Kidney ,medicine.disease ,Dermatology ,Immunoglobulin kappa-Chains ,Nephrology ,Hypergammaglobulinemia ,Monoclonal ,medicine ,Humans ,Presentation (obstetrics) ,business ,Kidney disease - Published
- 1997
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30. Progressive improvement of patient and renal survival and reduction of morbidity over time in patients with lupus nephritis (LN) followed for 20 years
- Author
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Piergiorgio Messa, Beniamina Gallelli, Silvana Quaglini, C. Ponticelli, Gabriella Moroni, and Giovanni Banfi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nephrotic Syndrome ,Time Factors ,Adolescent ,Lupus nephritis ,Hematocrit ,Gastroenterology ,Methylprednisolone ,chemistry.chemical_compound ,Young Adult ,Life Expectancy ,Rheumatology ,Internal medicine ,Outcome Assessment, Health Care ,Medicine ,Humans ,In patient ,Renal Insufficiency ,Glucocorticoids ,Creatinine ,medicine.diagnostic_test ,business.industry ,Patient survival ,medicine.disease ,Lupus Nephritis ,Surgery ,Survival Rate ,chemistry ,Italy ,Kidney Failure, Chronic ,Female ,business ,Renal survival ,Nephrotic syndrome ,medicine.drug ,Follow-Up Studies - Abstract
Whether the long-term patient and renal survival of those diagnosed with lupus nephritis (LN) has improved over the decades is still debated. Eighty-nine patients diagnosed between 1968 and 1990 entered this study and their outcome was evaluated after 20 years. At presentation 54% of patients had class IV LN, 39.3% had renal insufficiency and 59.5% had nephrotic syndrome. Patients were divided into two groups: Group 1 consisted of 30 patients diagnosed between 1968 and 1980; Group 2 consisted of 59 patients diagnosed between 1981 and 1990. In Group 1 patient survival at 20 years was 84% versus 95% in Group 2 ( p = 0.05). Survivals without end-stage renal failure were respectively 75% and 84% at 20 years ( p = 0.05). Survivals without severe infection at 20 years were 44% in Group 1 and 66.5% in Group 2 ( p = 0.02). Survivals without cardiovascular events at 20 years were: 53% in Group 1 and 90% in Group 2 ( p = 0.005). At presentation, patients in Group 1 had higher serum creatinine (1.96 vs 1.15 mg/dl, p = 0.01), higher activity index (8 vs 5.5, p = 0.01), lower hematocrit (31% v s6%, p = 0.008) and lower serum C4 levels ( p = 0.04) than Group 2 patients. Patients in Group 1 also received less frequent methylprednisolone pulses (43% v s81%, p = 0.0006). In Italian patients with LN, long-term life expectancy and renal survival progressively improved over the decades, while morbidity progressively declined. An earlier referral and refinement of therapy achieved this goal.
- Published
- 2013
31. Focal segmental glomerular sclerosis. To treat or not to treat?
- Author
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C. Ponticelli
- Subjects
Transplantation ,medicine.medical_specialty ,Pediatrics ,business.industry ,MEDLINE ,Glomerulosclerosis ,Glomerulonephritis ,medicine.disease ,Therapeutic trial ,Focal Glomerulonephritis ,Surgery ,Nephrology ,medicine ,business ,Nephrotic syndrome - Published
- 1995
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32. Comparison of Three Different Tests for Assessment of Hepatitis C Virus in Dialysis Patients
- Author
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A. Scalamogna, A. De Vecchi, Giovanna Lunghi, C Castelnovo, Giorgio Graziani, A. Grancini, G. Como, and C. Ponticelli
- Subjects
Male ,Hepatitis C virus ,medicine.medical_treatment ,Immunoblotting ,030232 urology & nephrology ,Viremia ,Enzyme-Linked Immunosorbent Assay ,Genome, Viral ,Hepacivirus ,medicine.disease_cause ,Polymerase Chain Reaction ,Sensitivity and Specificity ,Virus ,Peritoneal dialysis ,Flaviviridae ,03 medical and health sciences ,0302 clinical medicine ,Peritoneal Dialysis, Continuous Ambulatory ,Renal Dialysis ,medicine ,Humans ,Aspartate Aminotransferases ,030212 general & internal medicine ,Probability ,Hepatitis ,biology ,business.industry ,Alanine Transaminase ,General Medicine ,Hepatitis C Antibodies ,Middle Aged ,medicine.disease ,biology.organism_classification ,Virology ,Hepatitis C ,Cross-Sectional Studies ,Nephrology ,DNA, Viral ,Female ,Hemodialysis ,business ,Viral hepatitis - Abstract
Objective To evaluate the relationship between hepatitis C virus antibodies (HCV-Ab) and viremia and to compare the prevalence of HCV-Ab and HCV viremia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Design Cross-sectional study. Setting Dialysis unit of a nephrology division in a public university hospital. Patients All dialysis patients who came for routine clinic visits during the study period. None denied informed consent. Forty-eight patients on HD and 79 on CAPD were examined. Intervention Blood samples were tested by second generation enzyme-Iinked immunosorbent assay (ELISA II) and recombinant immunoblot assay (RIBA II) to look for HCV-Ab and by the polymerase chain reaction (PCR) to look for HCV viremia. Results ELISA II was positive in 52% of HD patients and in 14% of CAPD patients. RIBA II was positive in 48% of HD patients and in 11% of CAPD patients. HCV viremia was positive by PCR in 41.6% of HD patients and in 12% of CAPD patients. Two of these PCR-positive patients did not show HCV-Ab by ELISA II and RIBA II. The sensitivity and specificity of ELISA II were 93% and 92%, the sensitivity and specificity of RIBA II were 86% and 94%. Conclusions Our data confirm a higher prevalence of HCV viremia in HD than in CAPD patients. The absence of Ab against virus C in 2 patients positive with PCR might be due to recent HCV infection or to weak virus replication or to a poor immune response.
- Published
- 1995
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33. Porokeratosis and immunosuppression
- Author
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Pier Luca Bencini, Ramon Grimalt, Ruggero Caputo, C. Ponticelli, and Antonio Tarantino
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hyperkeratosis ,Dermatology ,Group A ,Group B ,Immunocompromised Host ,Immunopathology ,medicine ,Humans ,Family history ,Immunosuppression Therapy ,integumentary system ,business.industry ,Immunosuppression ,medicine.disease ,Porokeratosis ,Surgery ,Sunlight ,Female ,Skin cancer ,business ,Follow-Up Studies - Abstract
Immunosuppression may favour the development of disseminated superficial porokeratosis (DSP). We report the clinical features and the outcome of DSP in 24 patients receiving immunosuppressive treatment (group A), and compare the characteristics of the disease with those of 13 immunocompetent patients with DSP (group B). The two groups were similar with regard to age, sex, area of skin involvement and mean follow-up. There was a family history of DSP in only two patients in group A, compared with five patients in group B (P = 0.03). The skin type, based on the tanning response to sunlight, was not significantly different between the two groups. Two of the 24 patients in group A had high sun exposure, compared with five of the 13 patients in group B (P = 0.03). Moreover, 10 patients in group A and 11 in group B (P = 0.01) exhibited worsening of the disease after exposure to sunlight, usually during the summertime. These observations appear to support the hypothesis that sun exposure is not always essential for the development of porokeratosis in immunosuppressed patients. None of our patients developed skin cancer in porokeratotic lesions during the follow-up period.
- Published
- 1995
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34. A RANDOMIZED TRIAL COMPARING TRIPLE-DRUG AND DOUBLE-DRUG THERAPY IN RENAL TRANSPLANTATION
- Author
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G. Montagnino, A. Tarantino, G. Banfi, A. Aroldi, B. Cesana, and C. Ponticelli
- Subjects
Transplantation - Published
- 1994
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35. Cyclosporin in Idiopathic Nephrotic Syndrome
- Author
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C. Ponticelli
- Subjects
Adult ,medicine.medical_specialty ,Nephrotic Syndrome ,medicine.drug_class ,Nephrosis ,Immunology ,Kidney ,Toxicology ,Gastroenterology ,Focal segmental glomerulosclerosis ,Prednisone ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Child ,Pharmacology ,Proteinuria ,Glomerulosclerosis, Focal Segmental ,business.industry ,Nephrosis, Lipoid ,Glomerulosclerosis ,General Medicine ,medicine.disease ,Surgery ,Creatinine ,Cyclosporine ,Corticosteroid ,medicine.symptom ,business ,Complication ,Nephrotic syndrome ,medicine.drug - Abstract
Idiopathic nephrotic syndrome encompasses two main forms of glomerular diseases, minimal change nephropathy and focal segmental glomerulosclerosis. Minimal change nephropathy is a disease of children which generally responds to corticosteroids. After remission, however, many patients show frequent relapses or steroid dependency. In these patients, cyclosporine may obtain remission of proteinuria in 80% of cases, although relapse usually occurs when the drug is stopped. Focal glomerulosclerosis is generally resistant to corticosteroids. Under cyclosporine some 40% of patients may attain complete or partial remission of the nephrotic syndrome particularly if low-dose prednisone is associated. Relapse of proteinuria usually occurs after stopping the drug. As cyclosporine may expose to chronic nephrotoxicity some guidelines should be followed to prevent this complication: - the doses should not exceed 5 mg/Kg/day - they should be adjusted whenever an increase in plasma creatinine of > or = 30% over the baseline values occurs - treatment should be stopped if there is no response within 3 months - a careful monitoring of patient under the supervision of a clinician trained with the use of cyclosporine is necessary. The term idiopathic nephrotic syndrome (INS) defines the association of a nephrotic syndrome with non specific glomerular lesions, in the absence of immune complex deposition (1). On the basis of renal histology two main types of INS are recognized: minimal change nephropathy (MCN) and focal and segmental glomerular sclerosis (FSGS).
- Published
- 1993
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36. Once-a-day administration of everolimus, cyclosporine, and steroid after renal transplantation: a review of the rationale
- Author
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G. Corbetta and C. Ponticelli
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Urology ,Intestinal absorption ,Drug Administration Schedule ,Adrenal Cortex Hormones ,Medicine ,Humans ,Everolimus ,Kidney transplantation ,Antibacterial agent ,Sirolimus ,Transplantation ,Evidence-Based Medicine ,business.industry ,medicine.disease ,Ciclosporin ,Kidney Transplantation ,Surgery ,Regimen ,Intestinal Absorption ,Cyclosporine ,Corticosteroid ,Patient Compliance ,business ,Immunosuppressive Agents ,medicine.drug ,Follow-Up Studies - Abstract
The Evidence study (EVerolImus once-a-Day rEgimen with Neoral versus Corticosteroid Elimination) sought to compare once-a-day administration with steroid withdrawal versus twice-daily administration among de novo kidney transplant recipients treated with everolimus, cyclosporine, and steroids. This article describes the study design and rationale of once-daily administration and steroid withdrawal among recipients of de novo kidney transplants treated with everolimus and cyclosporine.
- Published
- 2010
37. Uremic Pruritus: A Review
- Author
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Pier Luca Bencini and C. Ponticelli
- Subjects
medicine.medical_specialty ,Uremic pruritus ,business.industry ,Pruritus ,medicine ,Humans ,medicine.disease ,business ,Dermatology ,Pathophysiology ,Uremia ,Surgery - Published
- 1992
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38. Acute Tubular Necrosis Caused by Gross Hematuria in a Patient with Focal and Segmental Necrotizing Glomerulonephritis
- Author
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C. Ponticelli, Giovanni Banfi, and Giovanni B. Fogazzi
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Erythrocytes ,Biopsy ,urologic and male genital diseases ,Necrotizing glomerulonephritis ,Focal Glomerulonephritis ,Gross hematuria ,Hemoglobins ,Necrosis ,Glomerulonephritis ,Phagocytosis ,Renal Dialysis ,medicine ,Humans ,Purpura ,Acute tubular necrosis ,Hematuria ,medicine.diagnostic_test ,business.industry ,Fibrinogen ,Complement C3 ,Acute Kidney Injury ,medicine.disease ,Kidney Tubules ,Renal biopsy ,Complication ,business ,Systemic vasculitis - Abstract
We describe a patient with gross hematuria, severe renal failure and symptoms suggestive of systemic vasculitis. Renal biopsy showed very focal and segmental necrotizing glomerulonephritis without crescents. A few C3 deposits were seen by immunofluorescence. The tubular lesions, on the contrary, were very severe, consisting of tubular cell necrosis and ruptured tubular basement membrane, associated with large numbers of intraluminal erythrocytes and erythrocytic casts. After gross hematuria had cleared, renal function slowly recovered. Because of biopsy findings and clinical course, acute renal failure in this patient was considered to be due to the tubular lesions caused by gross hematuria.
- Published
- 1992
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39. Alkylating Agents and Purine Analogues in Primary Glomerulonephritis with Nephrotic Syndrome
- Author
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Patrizia Passerini and C. Ponticelli
- Subjects
Purine ,Alkylating Agents ,medicine.medical_specialty ,Nephrotic Syndrome ,medicine.medical_treatment ,Purine analogue ,Pharmacology ,chemistry.chemical_compound ,Glomerulonephritis ,Internal medicine ,Azathioprine ,Humans ,Medicine ,Transplantation ,Chemotherapy ,Primary (chemistry) ,business.industry ,Nephrosis, Lipoid ,medicine.disease ,Endocrinology ,chemistry ,Nephrology ,business ,Nephrotic syndrome ,Immunosuppressive Agents - Published
- 1991
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40. Prolactin, thymulin and zinc in chronic hemodialysis: effect of renal transplant
- Author
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Eugenio Mocchegiani, C. Beretta, C. Ponticelli, Giovanni Faglia, A. Vegeto, Nicola Fabris, L. Berardinelli, P. Travaglini, Emma Togni, and F. Egidi
- Subjects
Graft Rejection ,Male ,Thymic Factor, Circulating ,Time Factors ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Thymic Factor ,chemistry.chemical_compound ,uremia ,Endocrinology ,Prolactin ,renal transplant ,thymulin ,zinc ,Adolescent ,Adult ,Biomarkers ,Creatinine ,Cyclosporins ,Female ,Humans ,Kidney Transplantation ,Middle Aged ,Monitoring, Physiologic ,Predictive Value of Tests ,Thyrotropin-Releasing Hormone ,Zinc ,Renal Dialysis ,Circulating ,Kidney transplantation ,Kidney ,Diabetes and Metabolism ,medicine.anatomical_structure ,Hemodialysis ,hormones, hormone substitutes, and hormone antagonists ,endocrine system ,medicine.medical_specialty ,Monitoring ,Thymulin ,TRH stimulation test ,Internal medicine ,medicine ,Physiologic ,business.industry ,medicine.disease ,Uremia ,chemistry ,business - Abstract
The interrelationships between PRL, thymulin and Zn, were studied in 25 patients with chronic renal failure (CRF) undergoing kidney transplantation and immunosuppressed with cyclosporine A (CsA). The possible role of serum PRL levels in predicting allograft rejection was also investigated. Before the kidney transplant serum PRL levels were significantly higher than in normals (mean ± SE, 28.3 ± 7.1 vs 7.5 ± 0.6 μ/l p < 0.001) and their response to TRH (200 μg iv) was impaired (mean Δ% at peak, 45.4 ± 9.5 vs + 641 ± 47.5, p < 0.001). After kidney transplantation a dramatic decrease in serum PRL concentrations was observed in all patients, followed by a slight upward trend in the following two weeks, while TRH test administered on 3rd, 7th and 14th day, induced a progressive increase in serum PRL responses (Δ% at peak, 201 ± 43.3, 220 ± 37.1 and 305 ± 15.5, respectively). No difference in serum PRL patterns was observed between patients with (8 cases) and without (17 cases) clinical features and kidney fine needle biopsies suggestive of rejection. Basal serum Zn levels of patients with CRF (18.1 ± 0.6 /gmmol/l) were similar to those observed in normals (17.7 ± 0.2 μmol/l) and without any correlation with serum PRL levels. A decrement in serum Zn was recorded during CsA infusion and on the first day after the surgery, followed by a sligth and slow upward trend. Basal serum thymulin titers were low [2.92 ± 0.18 (1/log2)], were further reduced after CsA infusion [1.68 ± 0.15 (1/log2)] and returned to the pre-transplant levels in the two weeks after grafting. In conclusion, a) the renal transplant induced a rapid normalization of serum PRL levels and a gradual improvement of TRH-stimulated PRL secretion, b) serum PRL levels were not predictive of kidney rejection, and c) no correlation was found between serum PRL and thymulin and Zn.
- Published
- 1990
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41. Long-Term Incidence of Peritonitis in CAPD Patients Treated by the Y Set Technique: Experience in a Single Center
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A. De Vecchi, A. Scalamogna, C. Ponticelli, L. Guerra, and Claudia Castelnovo
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Clinical Trials as Topic ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Continuous ambulatory peritoneal dialysis ,Peritonitis ,Retrospective cohort study ,Bacterial Infections ,medicine.disease ,Single Center ,Surgery ,Peritoneal dialysis ,Peritoneal Dialysis, Continuous Ambulatory ,Ambulatory ,medicine ,Humans ,Kidney Failure, Chronic ,Diabetic Nephropathies ,business ,Complication ,Retrospective Studies - Abstract
Our experience of peritonitis in 156 patients over an 8-year period represents 186 episodes of peritonitis and 4,964 patient-months of CAPD. The incidence of peritonitis was significantly greater (1 episode every 8.6 patient-months) when the Oreopoulos technique was used and dropped to 1 episode every 43.3 patient-months when the Y set system was used. Of the 109 patients using the Y set system, 88 (80.7%) never had episodes of peritonitis, whereas only 7 (16.7%) of the 42 patients using the Oreopoulos technique were free of peritonitis. For 23 patients shifted from the Oreopoulos to the Y set technique, the incidence of peritonitis dropped from 1/9.8 to 1/35.2 episodes/patient-months.
- Published
- 1990
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42. The long-term prognosis of renal transplant in patients with systemic vasculitis
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Beniamina Gallelli, Piergiorgio Messa, Giuseppe Montagnino, Claudio Pozzi, Silvana Quaglini, C. Ponticelli, Giovanni Banfi, A. Torri, Francesca Poli, and Gabriella Moroni
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Male ,Vasculitis ,medicine.medical_specialty ,Time Factors ,Urinary system ,medicine.medical_treatment ,Biopsy ,Kidney ,Risk Factors ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Dialysis ,Retrospective Studies ,Transplantation ,business.industry ,Graft Survival ,Immunosuppression ,Middle Aged ,medicine.disease ,Prognosis ,Kidney Transplantation ,Surgery ,Kidney Failure, Chronic ,Female ,Hemophagocytosis ,business ,Kidney disease ,Systemic vasculitis ,Follow-Up Studies - Abstract
Little information is available about the long-term outcome of renal transplantation in patients with systemic vasculitis (SV). We compared the outcomes of 19 renal transplant recipients with SV with those of 38 controls matched for time of transplantation, age, gender and source of donor. The mean post-transplant follow-up was 58 +/- 57 months for vasculitic patients and 61 +/- 49 months for controls. The actuarial 10-year patient survival was 87% in vasculitic patients and 90% in controls, death-censored graft survival were 84% and 100%, respectively. The risks of acute and chronic rejection, and arterial hypertension were not significantly different between the two groups. Infection was significantly more frequent in vasculitic patients (74% vs. 34%; p = 0.01). Seven patients (36.8%) had a recurrence of vasculitis in mean 45 months after renal transplant (0.076/patients/year). After recurrence, one patient had an irreversible humoral rejection, another died from hemophagocytosis and another restarted dialysis 1 year later. Long-term patient and renal allograft survival in vasculitic patients was good. Although graft function recovered in most relapsers after reinforcement of immunosuppression, one patient died and two lost graft function.
- Published
- 2007
43. A randomized study comparing three cyclosporine-based regimens in cadaveric renal transplantation: results at 7 years
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F Mastrangelo, Marco Castagneto, P Altieri, V. Cambi, G.B Piredda, A Tarantino, U. Valente, C Ponticelli, G P Segoloni, Stefano Federico, F Pisani, M Salvadori, G Rizzo, M Messina, Mario Carmellini, L. Arisi, G. Montagnino, and Maria Laura Cossu
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Adult ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Azathioprine ,law.invention ,Pharmacotherapy ,Randomized controlled trial ,law ,medicine ,Humans ,Survival rate ,Aged ,Transplantation ,business.industry ,Graft Survival ,Immunosuppression ,Middle Aged ,Ciclosporin ,Kidney Transplantation ,Surgery ,Survival Rate ,Clinical trial ,Creatinine ,Cyclosporine ,Drug Therapy, Combination ,Steroids ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
AFTER the worldwide adoption of cyclosporine (CsA) for maintenance immunosuppression, a striking improvement in renal transplant survival has been obtained. Recipients of first cadaver allografts commonly achieve 1-year graft survival approaching 90% with low patient mortality. Yet, in spite of the large experience accumulated with CsA, we still do not know which CsA-based protocol is better in the long-term. Although CsA was administered alone in clinical transplantation at the beginning of its use, steroid-free immunosuppression has not been accepted in most transplant centers because of the risk of nephrotoxicity associated with the large dose of CsA required for successful immunosuppresion and the increased risk of acute rejection, which could expose patients to chronic graft dysfunction in the long term. The results obtained using an association between CsA and steroids (double therapy) or CsA, steroids, and azathioprine (triple therapy) did not show any significant differences in either the patient or graft survival rates or in the incidence of drug-related complications. We recently reported the results of a randomized trial simultaneously comparing the three treatment schemes. We have now reanalyzed the data by extending the follow-up at 7 years after transplantation.
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- 1998
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44. Optimization of cyclosporine therapy in renal transplantation
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C. Ponticelli
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medicine.medical_specialty ,Urology ,Administration, Oral ,Biological Availability ,Renal function ,Nephropathy ,Nephrotoxicity ,medicine ,Humans ,Kidney transplantation ,Transplantation ,Kidney ,medicine.diagnostic_test ,business.industry ,Graft Survival ,medicine.disease ,Kidney Transplantation ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Renal blood flow ,Cyclosporine ,Drug Therapy, Combination ,Emulsions ,Renal biopsy ,business ,Immunosuppressive Agents - Abstract
It is well recognized that CsA is a potentially nephrotixic drug. CsA can induce a dose-dependent intrarenal vasoconstriction with reduced renal plasma flow and glomerular filtration rate. These functional abnormalities are reversible, even after months of CsA. However, CsA can also be responsible of morphologic lesions that are usually dosedependent. The tubular lesions, such as megamythocondria, isometric vacuolization, and calcification, are reversible. More severe is the so-called CsA-arteriolopathy, which affects the afferent arterioles and is characterized by mucinoid thickening of the arteriolar wall or by a nodular hialynosis of the intima. This arteriolopathy may be reversible if CsA is stopped, but in many cases it heralds the appearance of interstitial fibrosis with irreversible progression to renal failure. The nephrotoxicity of CsA has been considered as a main limit for a prolonged renal allograft survival. The retrospective data of the United Network for Organ Sharing seem to support this concern, since the half-life of cadaveric renal transplants was reported to range around 7 years both in the years between 1975 and 1979 when CsA was not available and between 1985 and 1990 when most transplant units used CsA. On the other hand, a number of studies reported that the most common cause of late graft failure in CsA-treated renal transplants was not represented by chronic toxicity but by chronic rejection, which was often triggered by the use of insufficient doses of CsA. To evaluate the long-term impact of CsA on graft survival we retrospectively examined our own series of renal transplants treated with CsA and functioning for at least 6 months. In 632 CsA-treated primary renal allografts followed for 68 6 40.6 months, the graft half-life was 19.9 years (standard error [SE] 22.5), and the pure graft half-life was 24.8 years (SE 30.99). Chronic rejection (83%), recurrence of glomerulonephritis (10%), and vascular thrombosis (5%) accounted for graft losses that occurred after the sixth month. Only one case of well documented CsA nephropathy was responsible for late graft failure. To assess the impact of long-term CsA on renal function, we studied 121 cadaveric renal transplant recipients with their allograft still functioning after 10 years of uninterrupted CsA administration. The mean creatinine clearance was 59 6 14.9 mL/min at 1 year after transplantation and was 57 6 25.3 mL/min at 10 years. Only 11 patients doubled their plasma creatinine from the first to the tenth year. The mean systolic (136 6 20 mmHg) and diastolic (87 6 11 mmHg) blood pressure values were within normal values at the tenth year. At 10 years, 104 patients (86%) versus 96 (80%) at 1 year received antihypertensive therapy. Proteinuria more than 1 g per day was found in 23 patients. All of them received a renal biopsy that showed chronic rejection in 15 cases, de novo membranous glomerulonephritis in 3, and recurrence of primary glomerulonephritis in 5. In conclusion, the prolonged use of CsA does not impede but rather favors a long-term allograft survival. At least in expert hands, the prolonged administration of CsA does not produce progressive attrition of renal function. The main cause of late graft failure remains chronic rejection that can be favored by the use of doses of CsA too low for maintenance.
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- 1998
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45. Withdrawal of steroids from a cyclosporine-based regimen: pro
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C Ponticelli
- Subjects
Graft Rejection ,medicine.medical_specialty ,medicine.drug_class ,Urology ,Adrenal Cortex Hormones ,Humans ,Medicine ,Immunosuppression Therapy ,Transplantation ,Kidney ,business.industry ,Incidence ,Graft Survival ,Ciclosporin ,Kidney Transplantation ,Surgery ,Survival Rate ,Regimen ,medicine.anatomical_structure ,Cyclosporine ,Corticosteroid ,Drug Therapy, Combination ,Controlled Clinical Trials as Topic ,business ,Immunosuppressive Agents ,medicine.drug - Published
- 1998
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46. Immediate graft function positively affects long-term outcome of renal allografts from older but not from younger donors
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Mario Scalamogna, Giovanni Tripepi, Piergiorgio Messa, Luisa Berardinelli, Brigida Brezzi, Donata Cresseri, Francesca Poli, and C. Ponticelli
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Adult ,medicine.medical_specialty ,Multivariate analysis ,Urinary system ,medicine.medical_treatment ,chemistry.chemical_compound ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Kidney transplantation ,Dialysis ,Retrospective Studies ,Transplantation ,Creatinine ,business.industry ,Incidence (epidemiology) ,Age Factors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,Surgery ,Treatment Outcome ,chemistry ,business - Abstract
There is disagreement about the impact of delayed graft function (DGF) on renal allograft outcome. This may depend on several variables including the age of the donor. We evaluated whether DGF could have different effects in recipients of kidneys from donors aged more than 60 years versus well-matched recipients of younger kidney donors. Patients were retrospectively subdivided into 3 groups. Immediate graft function (IGF), DGF without dialysis (DGF-ND), DGF requiring dialysis (DGF-D). DGF-ND and DGF-D occurred more frequently among 198 older than 198 younger donors (P = .016 and P = .044, respectively). The 5-year patient (96% vs 93%) and pure graft (96% vs 89%) survivals were significantly better in younger recipients, while the incidence of acute rejection was similar. After a mean follow-up of 66 +/- 44 months in older donor recipients, the graft survival was significantly better among IGF than patients in the DGF-ND (P = .046) or DGF-D (P = .003) groups. Instead, in younger recipients there was no difference in graft survival between IGD and DGF-ND. Only patients with DGF-D showed a significantly worse outcome. Upon multivariate analysis of older donors, their recipients, showed the pattern of graft function recovery to be the only variable associated with allograft outcome. Instead in younger donor recipients, acute rejection and time on dialysis were the main variables associated with a poor outcome. In older donor recipients, DGF was an independent variable associated with a poor graft outcome. In younger donor recipients, duration of dialysis and rejection were the most important predictors of poor graft outcomes.
- Published
- 2006
47. Steroid-sparing strategies
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C. Ponticelli
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medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Organ transplantation ,Drug Administration Schedule ,law.invention ,Randomized controlled trial ,law ,Prednisone ,Adrenal Cortex Hormones ,Multicenter trial ,medicine ,Humans ,Randomized Controlled Trials as Topic ,Immunosuppression Therapy ,Transplantation ,Everolimus ,business.industry ,Immunosuppression ,Kidney Transplantation ,Surgery ,Corticosteroid ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Corticosteroids have represented the mainstay for immunosuppression since the beginning of organ transplantation. However, these agents may be responsible of a number of invalidating and even life-threatening side effects. After the introduction of cyclosporine, some randomized trials have been attempted to avoid or withdraw corticosteroids. Meta-analyses of these studies showed that acute rejection was more frequent in patients who eliminated steroids than in patients who continued steroids. However, although graft survival was not affected by steroid avoidance, an increased risk of graft failure was reported in patients with late withdrawal of steroids. Only one multicenter trial provided a long-term follow-up of patients treated with the old formulation of cyclosporine. That study showed that, in spite of a higher incidence of rejection, in patients with an early avoidance of steroids, the 9-year graft survival rate was similar to that observed in patients given cyclosporine and steroids but with reduced risks of cardiovascular, ocular, and bone complications. A more recent study with everolimus and low-dose cyclosporine showed that the 3-year patient and graft survival rates were similar in patients who stopped steroids within 1 week after transplantation and in patients who continued low doses of prednisone. The available data indicate that an early elimination of corticosteroids is feasible today in many renal transplant recipients. A steroid-sparing strategy may reduce the side effects and improve the compliance of transplant recipients.
- Published
- 2006
48. Diffusion of HCV through peritoneal membrane in HCV positive patients treated with continuous ambulatory peritoneal dialysis
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Maurizio Sampietro, C. Ponticelli, C Castelnovo, Giovanna Lunghi, Mariadele Cantù, A. Orlandi, A. De Vecchi, and Noemi Corbetta
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Adult ,Male ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Hepacivirus ,Gastroenterology ,Peritoneal dialysis ,Diffusion ,Liver disease ,Peritoneal Dialysis, Continuous Ambulatory ,Internal medicine ,Ascites ,medicine ,Ascitic Fluid ,Humans ,Dialysis ,Aged ,Uremia ,Aged, 80 and over ,Hepatitis ,Transplantation ,business.industry ,Peritoneal fluid ,Continuous ambulatory peritoneal dialysis ,Hepatitis C Antibodies ,Middle Aged ,medicine.disease ,Hepatitis C ,Nephrology ,Immunology ,RNA, Viral ,Female ,Peritoneum ,medicine.symptom ,business - Abstract
Purpose of the Study. We evaluated the pres- (2,3) and to the length of HD treatment (4-6 ). Nosocomial spread of HCV in HD units has been ence of HCV in the peritoneal euents of viraemic patients treated with continuous ambulatory peritoneal suggested by several authors (7-9) and a direct demon- stration that HCV can pass into dialysis fluids, albeit dialysis (CAPD) to evaluate the risk of transmitting the infection with this procedure. at low concentration, has been provided (10 ). In patients treated with continuous ambulatory peri- Procedure. Fifteen of 81 CAPD patients ( 18.5%) had anti-HCV antibodies and eight were viraemic. At toneal dialysis (CAPD) the prevalence of HCV markers is lower than in HD, ranging from 2 to 15% (11-16 ). the beginning of CAPD two of the viraemic patients had ascites with a clinical picture of chronic active The presence of HCV in peritoneal dialysis euent has been investigated by few authors with conflicting hepatitis and cirrhosis. Peritoneal dialysates were col- lected after an overnight exchange with 1.36% glucose results (15,17,18 ), and at present the prevalence of HCV-RNA positivity in peritoneal dialysate, the deter- and after a 4-h exchange with 3.86% glucose. Fluids from the overnight exchange were spun to obtain minants influencing its presence, and its relevance as a potential source of infection are not well defined. a cellular pellet and the supernatant 100-fold concentrated. In this study we evaluated the presence of HCV in the peritoneal euents of CAPD patients with HCV Results. No viral genome could be detected in uncon- centrated samples and in cellular pellets, while HCV- viraemia in order to evaluate the risk of transmitting the infection with this procedure. RNA at low titre was detected in concentrated dialys- ates from the two patients with active liver disease. Conclusions. Our findings confirm that HCV may Subjects and methods be present in the CAPD euent of some patients; however, the titre of virus in the euent was extremely Eighty-one CAPD patients ( 45 males, 36 females, age range low, at the limit of detection of the PCR assay. 23-85 years, median 63 years) were investigated for the Peritoneal fluids originating from patients with HCV presence of HCV antibodies and HCV-RNA in serum. These associated severe liver disease may be a potential source patients had been on CAPD for 1-145 months (median 27 ) of infection. performing 4-5 exchanges per day, 1.5 or 2 l each, using dierent double-bag disconnect systems (Baxter Y set
- Published
- 1997
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49. Risk factors associated to kidney stones in primary hyperparathyroidism
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Paolo Beck-Peccoz, C. Ponticelli, A. Aroldi, Leonardo Vicentini, G. B. Fogazzi, Anna Spada, Andrea A. Baccarelli, Cristina Eller-Vainicher, and Sabrina Corbetta
- Subjects
Male ,medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Calcium oxalate ,Urology ,Urine ,Kidney ,Severity of Illness Index ,chemistry.chemical_compound ,Kidney Calculi ,Endocrinology ,Risk Factors ,Internal medicine ,medicine ,Humans ,Hypercalciuria ,Aged ,Cholecalciferol ,Hyperparathyroidism ,Oxalates ,Calcium Oxalate ,business.industry ,Kidney metabolism ,Middle Aged ,medicine.disease ,Urinary calcium ,chemistry ,Kidney stones ,Calcium ,Female ,business ,Primary hyperparathyroidism - Abstract
Nephrolithiasis is the most important clinical manifestation of primary hyperparathyroidism (PHPT), although nowadays this disorder is often asymptomatic. Clinical or biochemical differences between PHPT patients with and without nephrolithiasis have not been clearly identified in most of the previous studies. The aim of the study was to investigate clinical and biochemical parameters in kidney stone former (SF) and non-stone former (NSF) patients with PHPT in order to identify potential risk factors. Serum and plasma samples from 55 consecutive patients (43 females, 12 males) with PHPT were collected after overnight fasting; 24-h urine collection and a fresh sample of urine for sediment analysis were obtained from all patients. Clinical data were recorded in all. Out of 55 patients, 22 had kidney stones, which were symptomatic in 73%. SFs showed circulating PTH, total and ionized calcium, 1,25 dihydroxyvitamin D3, urinary calcium excretion and 24-h urine oxalate levels significantly higher than NSFs. Hypercalciuria was often concomitant with massive quantities of calcium oxalate crystals in urine sediment. Hypercalciuria and relatively high oxaluria were associated with stone formation with an odds ratio (OR) of 4.0 and 7.0, respectively, which rose to 33.5 when they coexisted. Hypomagnesuria and hypocitraturia were common in at least one third of all PHPT patients, but they were not associated to an increased OR. As expected, they were positively correlated with urine calcium excretion, suggesting that calcium, magnesium and citrate are commonly regulated at renal level. In conclusion, hypercalciuria, higher oxalate excretion and severe PHPT are associated with kidney stones in PHPT.
- Published
- 2005
50. [HCV-related liver disease in hemodialysis population: clinical and biochemical characteristic]
- Author
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F, Fabrizi, P, Martin, G, Lunghi, L, Guerra, A F, De Vecchi, and C, Ponticelli
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Male ,Renal Dialysis ,Humans ,Hepatitis C, Chronic ,Middle Aged - Abstract
Hepatitis C virus (HCV) infection remains frequent among patients on maintenance dialysis. It has been claimed that infrequent and slight abnormalities in serum aminotransferase activity could occur in dialysis patients with HCV. We describe a 61-year-old male patient on maintenance dialysis who acquired HCV by a nosocomial route. The natural history of HCV in this patient over 8 yrs featured frequent and high increases in serum aminotransferase and gamma-glutamyl transpeptidase (gamma-GT) levels. In December 2001, serum GOT and GPT were, respectively, 965 and 1294 UI/L; gamma-GT activity was 241 UI/L. HCV genotype was 2a/2c; median HCV RNA values in serum were 2.3 x 10⁵ UI/mL (range, 1.14 x 10⁴ to 4.6 x 10⁵ UI/mL). Total bilirubin, serum albumin, and colinesterase levels remained normal over the entire follow-up. Liver biopsy was not performed and interferon (IFN) therapy was not given. Currently, biochemical liver tests (GOT/GPT/gamma-GT) are in the upper range of normal values and the patient remains viremic. Efficacy and tolerability of initial monotherapy with IFN for chronic hepatitis C among dialysis patients are briefly discussed. Further studies are warranted to define the optimal anti-viral regimen for chronic hepatitis C in the dialysis population.
- Published
- 2004
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