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Background: Native arteriovenous fistula is the preferred vascular access in term of functionality, efficiency and complication rate. Nevertheless, research continues to seek strategies to reduce the risk of neointimal hyperplasia and hemodynamic modification. The aim of the study was to evaluate the impact on hemodynamic of the VasQ device in arteriovenous fistulae creation. Methods: The analysis included patients who underwent to fistula creation with or without implantation of the VasQ device between May and September 2019. The hemodynamic parameters were evaluated pre-operatively and at a follow-up of 1, 3, 6 months. The patency and complication rate were evaluated. Results: Fifteen VasQ devices were implanted during 30 arteriovenous fistula surgery. The baseline patients features were similar between groups (VasQ treated/control). At baseline, preoperative arterial flow was similar; radial artery diameter at surgical site was 3.4 ± 0.8 mm in treated and 2.8 ± 0.5 mm in the control group. The mean arterial flow at 1 month was 480 ± 210 mL/min in treated and 561 ± 27 mL/min in the control group. At 3 months the mean arterial flow in treated was 645 ± 143 mL/min versus 824 ± 211 mL/min ( p = 0.02) in the control group; at 6 months the arterial flow was 714 ± 146 mL/min versus 810 ± 194 mL/min ( p = 0.05) in control group. The cardiac output flow at 6 months in the treated group was 4458 ± 928 mL/min versus 5599 ± 1355 mL/min ( p = 0.05) in the control group. At 6 months the primary patency was 73% and 80% and the secondary patency 80% and 86% in treated compared to the control group, respectively. No VASQ device complications were recorded. Conclusion: The analysis of these data suggested that using VasQ device could be protective against the hemodynamic modification that occur during arteriovenous fistulae creation.

The efficacy of antiplatelet treatment with aspirin in the primary prevention of major cardiovascular events was questioned during 2018, following a new series of trials that we summarize here in a quick synoptic overview. The three studies involved are the ASPREE trial, the ASCEND study and the ARRIVE trial. These studies all have a double-blind randomized design, and 100 mg/day aspirin was administered with an intention-to-treat approach and against placebo. Age of the enrolled patients, prevalence of diabetes mellitus and geographical location of other studies are just some of the elements analyzed here, in addition to the different problems of cardiovascular events. The ASPREE study observed a marginal reduction of cardiovascular events with the use of aspirin, by approximately 5% with a confidence interval at risk of insignificancy. On the other hand, the increased risk of a hemorrhagic event appeared to be rather robust, resulting between 18% and 62%. The ASCEND study observed a reduction in cardiovascular events of around 12%, offset by an increase in the risk of major bleeding between 9% and 52%. The ARRIVE study did not detect any incidence of major cardiovascular events, while the risk of major bleeding appeared to even double. The evidences of the current literature push us to review a widespread conviction among professionals who fight the war against cardiovascular disease every day: the prescription of aspirin in the primary prevention can no longer happen systematically, and every single prescription need care between benefits and dangers connected to the treatment.

Cardiovascular disease is the main cause of morbidity and mortality in patients with chronic kidney disease (CKD) affected by a series of risk factors (hypertension, anemia, left ventricular hypertrophy, cardiac failure, and dyslipidemia). The combined presence of these factors raises the cardiovascular risk in CKD patients considerably compared with that of the general population. Nephrologists can play a role in preventing and treating these risk factors and thereby delaying the development of CKD. In preventing CKD, nephrologists who practice ultrasound techniques should have basic know-how of echocardiography so that they can screen CKD patients for early referral to a cardiologist. Echocardiography is a noninvasive ultrasound technique that requires adequately trained doctors to perform it. Nephrologists who practice it need to obtain good training and postgraduate certification of competence in echocardiography. These nephrologists should team up with cardiologists rather than replace them, and at the same time be aware that they possess the basic knowledge to manage cardiovascular disease in CKD patients.

La fistola entero-vescicale è una rara complicanza di varie malattie inflammatorie e di patologie tumorali, prevalentemente a carico del colon. La causa più frequente è rappresentata dalla diverticolite del colon-sigma. Descriviamo qui il caso di una fistola entero-vescicale comparsa in un paziente portatore di trapianto renale da donatore cadavere, esordita con i segni della pielonefrite acuta e della pneumaturia, secondaria a diverticolite del sigma pauci-sintomatica. L'ecografia del graft e della relativa via urinaria evidenziava rene di aspetto globoso con multiple aree ipoecogene parenchimali, idroureteronefrosi di II grado, presenza di fine materiale iperecogeno intrapelvico, uretere e vescica con pareti diffusamente ispessite. Veniva quindi eseguita uro-TC che confermava la pielonefrite acuta del graft ed evidenziava la presenza di livelli idroaerei in vescica e di una fistola fra sigma e parete laterale sinistra della vescica, in presenza di numerosi diverticoli del colon. La terapia antibiotica mirata con ciprofloxacina e teicoplanina, determinava significativo recupero delle condizioni generali e progressivo miglioramento del quadro clinico e laboratoristico. Successivamente, il paziente veniva sottoposto a resezione del sigma e sutura della breccia vescicale, con totale risoluzione della sintomatologia.

Le infezioni delle vie urinarie costituiscono un problema clinico frequente in tutte le età. L'ecografìa è uno strumento prezioso nella diagnosi e nel management delle infezioni, consentendo di diagnosticare rapidamente complicanze e fattori predisponenti. Questa review passa in rassegna gli aspetti ecografìci delle infezioni della vescica, della prostata, delle vesci-cole seminali, dei didimi, degli epididimi e dello scroto, fornendo un pratico strumento di consultazione rapida al nefrologo.

I pazienti affetti da malattia renale cronica possono andare incontro a tutta una serie di patologie che colpiscono il pericardio ma, sicuramente, alcune entità nosologiche sono più frequenti di altre. Gli ultimi decenni hanno assistito, per fortuna nostra e dei nostri pazienti, a un netto miglioramento per quanto concerne i protocolli terapeutici per i pazienti nefropatici e le forme tipiche di pericardite uremica, così frequenti negli anni passati, sono ormai uno sbiadito ricordo. È tuttora frequente osservare pazienti con versamento pericardico (idiopatico, ovvero secondario a malattie sistemiche), soprattutto per quanto concerne i pazienti sottoposti a trattamenti depurativi extracorporei ed i pazienti che iniziano il trattamento dialitico in condizioni di emergenza/urgenza (ad esempio, pazienti affetti da scompenso cardiaco congestizio); il versamento pericardico viene schematicamente classificato in lieve, moderato e severo in base all'interessamento più o meno globale del pericardio. Meno frequenti sono gli episodi di pericardite acuta (anch'essa idiopatica o secondaria), spesso su base virale, neoplasticae/o immunologica (vedi pazienti trapiantati in terapia immunosoppressiva). Le forme di pericardite costrittiva sono più rare a documentarsi in corso di malattia renale cronica e, in genere, rappresentano lo stadio finale di diverse patologie sistemiche: l'esito finale è, in genere, la fibrosi pericardica. (Cardionephrology)

Primary and secondary Prevention of arterial hyPertension: nePhrologist's Point of view abstract. Nephroangiosclerotic chronic kidney disease's primary and secondary prevention is actually based on blood pressure control and reduction of proteinuria. In proteinuric patients, blood pressure control has to be obtained by blocking renin-angiotensin axis, even in patients with moderate to severe chronic kidney disease. Combination therapy with angiotensin converting enzyme inhibitor (ACEi) drugs and angiotensin II receptor blockers (ARB) doesn't imply addictive protective effects. It could be tested in selected patients with proteinuria levels above 1 g/day. Combination therapy with ACEi and anti-aldosteronic agents seems to be promising but we need more multicentric trials.

non disponibile (Cardionephrology)

In un recente lavoro apparso su Journal of Clinical Investigation, Chen et al illustrano in maniera affascinante il ruolo cruciale dell’eritropoietina nel mantenimento della “stabilita vascolare” (1) . I nostri Autori hanno condotto uno studio dal disegno estremamente elegante sul ruolo dell’eritropoietina nella retinopatia del pre-termine. Tale patologia e caratteristica dei neonati pre-maturi, esposti ad elevate tensioni atmosferiche di ossigeno. Tale insulto induce inizialmente la vaso-obliterazione del network vascolare retinico, come risposta adattativa che tenderebbe a ridurre l’eccessivo apporto di ossigeno. A tale fase segue paradossalmente una condizione di ipossia periferica, un imponente stimolo alla neoangiogenesi, che conduce a fenomeni di massiva, disordinata angio-proliferazione patologica, assai simile a quanto si osserva nella retinopatia diabetica. L’EPO ha mostrato di svolgere un ruolo centrale nelle singole fasi della malattia. All’iniziale iperossia si associa la soppressione dei livelli tissutali di mRNA per EPO. Ne consegue quindi l’impoverimento del network micro vascolare della retina, per vaso obliterazione e ridotta neoIntroduzione

Anemia is a common complication associated with congestive heart failure (CHF) and chronic kidney disease (CKD), and is often reported as a component of the cardiorenal syndrome (CRS). The triad an...

Congestion represents a crucial clinical component of both heart failure and cardiorenal syndrome and it has been postulated to modulate heart and kidney cross-link. Diuretic therapy is a corner stone in the treatment patients with heart failure, and renal replacement therapies are mainly used for patients with refractory heart failure who have not reached the worst stages of renal disfunction. Peritoneal dialysis is a home-based therapeutic modality providing both solute clearance and ultrafiltration, together with relief from congestion in decompensated heart failure patients. The following review will focus on sodium removal in refractory decompensated heart failure patients undergoing peritoneal dialysis. (Cardionephrology)

Galectin-3 is a 32- to 35-kDa member of the galectin family of b-galactoside-binding lectins, which is characterized by a carbohydrate recognition domain. Through its carbohydrate-binding function, it regulates cell growth, differentiation, and inflammation. It also plays a complex, context-dependent role in the kidneys. During the development, it promotes nephrogenesis and is strongly expressed in the ureteric bud and its derivatives. An increase in the concentration of galectin-3 has been reported to be associated with fibrosis of the kidneys. Elevated levels of plasma galectin-3 are also associated with increased risks of rapid renal function decline, incident chronic kidney disease, and progressive renal impairment, and also with cardiovascular endpoints, infection, and all-cause mortality in patients with renal function impairment. This review discusses a general survey on galectin-3 expressions in nephrogenesis, kidney injury in animal models, clinical renal diseases, and renal transplantation and t...

In this review we analyze the cardiorenal effects of hyperuricemia and try to answer the eternal question of whether it is or is not to be considered a true risk factor in addition to a well-established marker of cardiovascular, cerebrovascular and renal risk.

Vitamin D represents the precursor of calcitriol, crucial for bone and mineral metabolism. The high prevalence of vitamin D deficiency and the detection of vitamin D receptor (VDR) both in the heart and vessels have focused the interest on potential cardiovascular effects of vitamin D.Although several experimental data showed the protective role of vitamin D, on the other hand vitamin D “overdose” can contribute to heart and vascular calcification.Meta-analyses of randomized-controlled trials (RCTs) underlined the association of vitamin D deficiency and increased cardiovascular morbidity and mortality but no significant improvements on cardiovascular outcomes are provided by the supplementation of vitamin D.The following review provides an update on pathophysiology of vitamin D and vitamin D receptor (VDR) discussing on the association with cardiovascular risk factors and disease and on the role of vitamin D supplementation in preventing cardiovascular disease in chronic kidney disease (CKD) patients.

Cardiovascular disease (CV) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The increase in cardiac complications in patients with CKD has encouraged ...

Chronic hyperkalemia in cardiorenal patients: Q&A for the cardio-nephrologists.Chronic hyperkalemia is a serious medical condition often present in patients with chronic kidney disease (CKD) and he...

In Part One of this two-part series, the clinical and epidemiological aspects of the cardiorenal anemia syndrome (CRAS) were discussed. Anemia is a complication frequently associated with chronic heart failure (CHF) and chronic kidney disease (CKD). Part Two of this review focuses on the diagnostic elements of anemia in cardiorenal syndrome (CRS). Bone marrow biopsy remains the gold standard for the assessment of iron (Fe) stores. However, many other laboratory tests are available, both biochemical and hematological, that are less invasive, more practical and useful for the diagnosis and gradation of iron deficiency (ID). Biochemical tests are based on Fe metabolism and allow the identification of ID before the onset of anemia. Hematologic examinations, on the other hand, based on the morphologic characteristics of the red blood cells are more readily available. New tests are currently available for ID diagnosis before anemia is present. All of these tests are used to determine the type and cause of anemia in a patient with CRS. Unfortunately, there is no single test capable of establishing the diagnosis of ID with or without anemia, but it is necessary to resort to a combination of assessments adapted to the patient’s specific clinical situation. Indeed, every assessment aimed at evaluating the iron profile expresses a different aspect of each compartment of the total body Fe (deposit, transport, metabolic-functional, etc.). Using the various available tests improves diagnostic specificity and enhances differential diagnosis. (Cardionephrology)

Is peritoneal ultrafiltration a useful therapeutic alternative in diuretic resistant heart failure, even in patients with preserved glomerular filtration rate?Some recent clinical trials, here briefly analysed, reported the positive effects of peritoneal ultrafiltration on NYHA class, hospitalization rates and quality of life of decompensated patients.Why this technique has so little fortune among Nephrologists?