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In contrast to other ions, magnesium is treated as an orphan by the body: there are no hormones that have a substantial role in regulating urinary magnesium excretion, and bone, the principal reservoir of magnesium, does not readily exchange with circulating magnesium.The Mg ++ is often overlooked by physicians in the differential diagnosis because it is considered insignificant, but its role is crucial for cells function, first of all neurons and cardiomyocytes. A condition of hypocalcemia associated with hypokalemia, especially in the presence of chronic renal failure, should raise suspicion of a lack of Mg ++.We report the case of an old man of 77 year with kidney transplant for 13 years, treated with cyclosporine, and sodium mycophenolate and steroid who, for about a month, accused impaired balance and walking instability, who fell accidentally down with wrist fracture.Blood tests showed hypocalcemia and hypokalemia, and so we required dosage of serum and urinary magnesium. A significant reduction in the ion plasma concentration was seen, associated to a fraction of excretion inappropriately high in relation to the degree of hypomagnesemia.The cause of this important renal loss is likely attributable to cyclosporine, a drug that has as a side effect the inhibition of the reabsorption of Mg ++ in the distal convoluted tubule. then, oral supplementation was started (244 mg of Mg ++ ion / day), with subsequent normalization, after a few days, not only of magnesiemia, but also in serum calcium and potassium levels, and improvement of neurological symptoms.Hypomagnesaemia is common in patients with renal transplantation in therapy with calcineurin inhibitors ICN, due to the effects of such drugs on the TRPM6 transporter present in the kidney distal convoluted tubule. To prevent complications caused by chronic and severe depletion of magnesium in this particular population, we recommend periodic monitoring of magnesium plasma levels.

Patients that are followed by nephrologists from the beginning of the illness, they show a deceleration in the progression of the Chronic Kidney Disease towards dialysis and a better quality of life (less osteodystrophy, anaemia and fluids overload, better pressure management). However, in 2013 it still exists a great lack of knowledge about the professional figure of nephrologist. Residents of Nephrological School of Catania decided to conduct a survey to evaluate common knowledge of renal diseases and their treatments. The survey was conducted in two cities of Sicily. The results show that people are generally uninformed and disoriented about renal illness and their risks.

Ad oggi non è ancora stato definito un chiaro legame tra aumentati valori di PTH e mortalità cardio-vascolare. Lo studio EVOLVE è stato quindi disegnato per valutare se un regime di trattamento del sHPT con cinacalcet, in pazienti in trattamento dialitico cronico (CKD5D), fosse in grado di ridurre il rischio di mortalità e di morbidità cardiovascolare. L’endpoint primario dello studio comprendeva mortalità per tutte le cause e/o per cause cardiovascolari e il tempo al primo evento CV non fatale. Gli endpoints secondari erano: ospedalizzazioni per tutte le cause o per cause cardiovascolari, fratture ossee e paratiroidectomie. Al termine dello studio, l’analisi “Intention To Treat”(ITT) ha mostrato una riduzione del rischio relativo di raggiungere l’end point primario composito del 7%, statisticamente non significativa (Harazrd Ratio: 0.93; Intervallo di confidenza al 95% [95% CI], 0,85-1,02; P = 0,11). L’analisi ITT non tiene tuttavia conto di ciò che accade realmente durante il trial, particolarmente in termini di aderenza alla terapia.In particolare, sebbene la dimensione campionaria dello studio fosse stata accuratamente calcolata, la potenza statistica dello studio è risultata del 54%, sebbene inizialmente fosse stata programmata del 90%. La riduzione della potenza dello studio limita fortemente l’interpretazione dei risultati dello studio EVOLVE. Inoltre, l’analisi dell’end point primario composito, aggiustata per le oltre 40 caratteristiche prespecificate nel protocollo, inclusa l’età, ha mostrato una riduzione statisticamente significativa del 12%,dell’end point primario con P “nominalmente significativa”. Le analisi di sensibilità confermano i risultati delle analisi aggiustate. La “Lag Time Censoring analysis (LTCA)”, ha mostrato una riduzione del 15%, “nominalmente significativa”, del rischio relativo di mortalità o di eventi CV non fatali,nel gruppo trattato con cinacalcet quando il periodo di osservazione veniva prolungato per non più di 6 mesi nei pazienti che avevano sospeso prematuramente la terapia sperimentale. Va anche notato che la LTCA ha mostrato che l’effetto di cinacalcet tende a ridursi fino a scomparire dopo circa 12 mesi dalla sospensione del trattamento. Sebbene gli autori non documentino alcun effetto sul rischio di frattura, le analisi secondarie dello studio EVOLVE hanno mostrato una riduzione “nominalmente significativa” del 60-70% del rischio di paratiroidectomie con un profilo di sicurezza rassicurante anche nel trattamento a lungo termine ed in un’ampia popolazione. In conclusione lo studio EVOLVE si aggiunge alla lista dei trial clinici randomizzati non conclusivi in Nefrologia. Tuttavia, le analisi esplorative e di sensibilità prespecificate nel protocollo dello studio mostrano una riduzione “nominalmente significativa” del rischio CV e di paratiroidectomia se si considerano l’aderenza alla terapia e le differenze cliniche tra i gruppi trattati all’inizio dello studio (differenza di età).

To investigate the relationship between carotid atherosclerosis and some major cardiovascular risk factors in uremic patients on chronic dialysis.A cross-sectional study was carried out in 119 unselected dialysis patients (89 on hemodialysis and 30 on chronic ambulatory peritoneal dialysis, CAPD). Fasting blood sampling for serum lipids, albumin, hemoglobin, and echo-colour-Doppler evaluation of common carotid arteries were performed in all patients (during the non-dialysis day in hemodialysis patients). In hemodialysis patients BP was measured before and after dialysis; in CAPD patients home BP values were recorded during the month before the study day.Ninety-five patients had at least one plaque and 57 had at least four plaques. Thirty-eight had mild and eleven severe carotid stenosis. In multiple regression models, the mean internal diameter of carotid arteries was explained (R=0.52, P=0.0001) by systolic pressure (r=0.39), serum cholesterol (r=-0.28), age (r=0.27) and smoking (r=0.24) while the degree of carotid stenosis was predicted (R=0.39, P=0.0001) by age (r=0.36) and smoking (r=0.25). The number of atherosclerotic plaques was explained (R=0.51, P=0.0001) by age (r=0.36), smoking (r=0.25) and pulse pressure (r=0.20), serum albumin just failing to reach statistical significance (P = 0.06). However, serum albumin was a significant and independent predictor of the number of atherosclerotic plaques (r=-0.26) in hemodialysis patients (n=89). Sex, diabetes, Kt/V, duration of dialysis treatment, hemoglobin, serum calcium and phosphate did not add any predictive power to the models.In dialysis patients arterial pressure and smoking are associated with carotid atherosclerosis. Serum albumin appears to serve as an independent predictor of carotid atherosclerosis.