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In questo studio, prendendo spunto da un caso clinico di gravidanza in una paziente affetta da nefropatia da IgA (m. di Berger), si discutono due problemi: il rischio renale materno nelle nefropatie croniche e le "indicazioni" per il cosiddetto "aborto terapeutico". Vengono sottolineate le modificazioni fisiologiche della funzione renale e della pressione arteriosa in gravidanza, la cui conoscenza è indispensabile per una corretta valutazione clinica del singolo caso. Vengono inoltre presentate la casistica personale ed una rassegna della più recente letteratura circa gli effetti della gravidanza sulla funzione renate delle pazienti nefropatiche croniche. Si conclude che la gravidanza non esercita di per sé effetti dannosi sul decorso di tali nefropatie, almeno nelle pazienti la cui funzione renale risulta vicina alla norma al momento del concepimento. La prognosi appare più riservata in caso di insufficienza renale ( creatinemia > 1.4 mg/dl). Infine vengono esposte alcune considerazioni etiche sul cosiddetto "aborto terapeutico" sottolinenado che, già a causa degli attuali progressi in campo ostetrico, nefrologico e neonatologico, l'aborto non trova più posto logico nei moderni criteri assistenziali. Viene comunque richiamata l'attenzione degli operatori sanitari nel costante magistero della Chiesa Cattolica volto a ribadire il valore e l'inviolabilità della vita umana.

We report the case of a patient with acute renal failure and nephrotic syndrome during the second trimester of an otherwise uncomplicated pregnancy. Despite pregnancy, percutaneous renal biopsy was performed to evaluate the etiology, showing Type I membranoproliferative glomerulonephritis. Two therapeutic options were considered: pregnancy termination, suggested by the gynecologists, and our proposal of starting steroid therapy, in order to reduce proteinuria and improve renal function. The patient refused pregnancy termination. She received i.v. methylprednisolone boluses, followed by maintenance oral prednisone and aspirin, with prompt acute renal failure resolution and reduced proteinuria. At Week 34 + 5 days of gestation, cesarean section was performed, without intra- and postoperative complications both for mother and newborn. Clinical maternal and fetal outcomes were excellent. One-year follow-up showed normal renal function and absence of proteinuria. Lacking guidelines concerning treatment of acute renal failure due to primary nephropathy in pregnancy, we consider this case of interest for our decision-making process and for the favorable outcome.

The time course of blood pressure in clinically healthy (pregnant and nonpregnant) women was followed by automatic ambulatory monitoring. Chronobiologic methods revealed the time course of dynamic rhythm characteristics as a function of gestational age. Differences were found between nonpregnant and pregnant women with an overall lowering during pregnancy of the rhythm-adjusted midline estimating statistic of rhythm (mesor).

Blood pressure (BP) monitoring is a clinical reality because of the availability of non-invasive automated recorders. BP 24-h patterns were explored during physiologic pregnancies in order to obtain time-qualified standards for clinical use. Non-inferential and inferential reference boundaries were computed by using chronobiometric procedures. The computed confidence limits provide a set of reference standards that serves to optimize the diagnosis of pregnancy-induced deviation in BP 24-h patterns.

Diagnosis of renal artery stenosis using echo color-Doppler is subjected to several limitations. The aim of this study was to examine if the routine use of a contrast agent could be helpful in identifying renal artery stenosis (RAS).We analysed 35 patients affected by RAS using an echo color-Doppler coupled with a contrast agent. All patients presented arterial hypertension, with a good drugs control, and mean serum creatinine of 1.8 mg/dL. All patients previously underwent angiography. RAS was at the origin of the artery in 27 patients, at the intermediate tract in 8. All patients had already been submitted to a basal echo color-Doppler.The contrast agent determined a significant increase in the average colour signal in all the subjects, and a better evaluation of the spectral waveforms, if compared to the basal examination.The results obtained showed that the contrast agent doesn't improve the diagnosis of RAS, especially in vascular origin stenosis, while it shows a real advantage in the intermediate or distal stenosis which are better visualized.

The kidney does not usually present specific lesions in cystic fibrosis (CF), although in recent years renal involvement has been reported, particularly amyloidosis and immune complex glomerulonephritis. IgA nephropathy is rare. We report four cases of IgA nephropathy out of five renal biopsies performed in the last three years in patients with CF and renal involvement and discuss the possibility of a relationship between IgA nephropathy and CF.

We have studied the functional importance of renal eicosanoids in renal hemodynamics of seven newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients by treatment with two structurally unrelated inhibitors of cyclooxygenase (i.e., piroxicam and sulindac). Glomerular filtration rate (GFR), renal plasma flow (RPF), daily urinary excretion of 6-keto-prostaglandin F1α (6-keto-PGF1α, the stable hydrolysis product of prostacyclin), and thromboxane B2 (TXB2, the stable hydrolysis product of thromboxane A2) were measured before, during, and after piroxicam (all patients) or sulindac (3 patients) treatment. Urinary excretion of 6-keto-PGF1α was significantly increased (P < .01) in diabetic patients compared with seven healthy subjects, whereas urinary excretion of TXB2 was unchanged. The baseline value of GFR was significantly (P < .01) higher in diabetic compared with normal volunteers, whereas baseline RPF was comparable in both groups. Piroxicam (20 mg/day) reduced urinary excretion of 6-keto-PGF1α and TXB2 by 65.7 ± 26 and 64.6 ± 33%, respectively. These biochemical changes were temporally associated with the ∼ 19% decrease in GFR (P < .01). A week after discontinuation of the drug, GFR and urinary excretion of 6-keto-PGF1α were still significantly (P < .05) reduced, whereas urinary excretion of TXB2 returned to control values. In contrast, urinary excretion of eicosanoids and renal function were not affected by sulindac (0.4 g/day) treatment. No functional changes were detected in healthy subjects despite a similar suppression of renal cyclooxygenase activity when they were treated with piroxicam.We conclude that altered GFR in newly diagnosed IDDM patients may depend, at least partially, on altered renal synthesis of vasodilator prostacyclin.

SUMMARY20 subjects with Morgagni-Turner's syndrome have been extensively investigated for structural or functional abnormalities of the urinary tract. This investigation was planned owing to the observation by Morgagni, who described the first case of gonadal agenesis associated with a congenital anomaly of the kidneys, and in consideration of the embryological connection between the gonadal and the excretory « Anlagen ». Moreover, to this respect, previous investigations have been very indicative. The patients were subjected to conventional X-ray examination of the urinary tract and to radionephrography with 131 I-hyppuran and, when necessary, to renal scintigraphy with 197 Hg-neohydrin. In a group of patients inulin and PAH clearances were also determined. More than half of the patients had important abnormalities: horseshoe kidneys (5 cases), pyeloureteral duplicity (3 cases), unilateral renal aplasia (2 cases), rotation of the kidneys (1 case); seven further cases showed pyelic dilatation and hypotonia associated with frankly abnormal 131 I-hyppuran nephrograms. 3 out of 4 cases, in which clearance studies were performed, showed marked reduction of glomerular filtration rate and renal plasma flow, even though conventional urography showed no pathological change. It is evident that the urinary tract is very often abnormal in this syndrome; the abnormalities are usually structural, rarely purely functional. Thus, it seems even more justified to indicate the syndrome with both the names of Morgagni and Turner.

After an introduction on the hypertensive disease of pregnancy, the paper reviews recent studies on the etiological, pathophysiological and clinical aspects of preeclampsia.

A detailed time course of changes in plasma renin activity (PRA), urinary prostaglandin (PG) E2, PGF2 alpha, thromboxane (TX) B2 and sodium excretion rates following furosemide was obtained in 7 women. PRA increased within the first 15 min and remained elevated all through the experiment. PGE2, PGF2 alpha, TXB2 and sodium increased simultaneously, reached a peak between 15 and 45 min after furosemide and declined thereafter. It is concluded that furosemide induces a generalized activation of the renal PG system temporally related to the increase of renin release and natriuresis.

Intestinal absorption of calcium was evaluated in 6 uraemic patients and in 7 control subjects by a two isotope technique exploring absorption in the four hours following ingestion of the dose. In the first two hours, calcium absorption in the patients was markedly lower than normal and was corrected by 6-10 day administration of dihydrotachysterol, 0.66 mg per day. The administration of 0.33 mg per day proved less effective. The data indicate the existence of impaired intestinal calcium absorption in chronic renal failure and reversal of the defect after DHT administration. The method of investigation appears to be a valid procedure for the study of calcium malabsorption of CRF and in the evaluation of the effect of vitamin D metabolities and analogs.

Isolated asymptomatic hematuria in the adult, i.e. hematuria and no evidence of renal or systemic disease, is a perplexing clinical problem. It is usually difficult to decide to what extent to pursue a diagnosis, especially whether to perform renal angiography or renal biopsy. An algorithm is provided to optimize detection of structural defects and intrinsic renal diseases, in an effort to avoid subjecting the patient to unnecessary invasive tests. Since the age-related recommendations of the algorithm are controversial, a discussion of renal cell carcinoma and intrinsic glomerular diseases is proffered.

Plasma renin activity may be affected by temperature during the processing of blood samples (loss of activity or cryoactivation). We measured plasma renin activity on samples maintained at room temperature up to 240 min. No significant change was found in comparison with samples maintained at 0 degrees C; similarly, no cryoactivation was observed when routine freezing procedures were employed instead of instant freezing.

Urinary kallikrein excretion was evaluated in 85 normal subjects and in 149 uncomplicated and recently diagnosed essential hypertensive patients. Moreover, the possible interrelationships between urinary kallikrein excretion and age, sex, electrolyte excretion, and plasma renin activity were examined. In patients with essential hypertension, urinary kallikrein excretion was similar to that of normal subjects. In these patients the enzyme was weakly and positively related to urinary potassium and plasma renin activity; no correlation was found with blood pressure, urinary sodium, age, or sex. In normal subjects and in patients with essential hypertension, the variables studied account for only 25% and 17%, respectively, of the variability of urinary kallikrein excretion. We conclude that the relatively short duration of hypertension in our patients may explain the unaltered values of urinary kallikrein excretion with respect to controls.

In a population sample of 333 unrelated individuals from Rome 2 variants, PHI 3-1 and PHI 5-1, were found.