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3. Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Author

Nordio, M., Reboldi, G., Di Napoli, A., Quintaliani, G., Alberici, F., Postorino, M., Aucella, F., Messa, P., Brunori, G., Bosco, M., Malberti, F., Mandreoli, M., Mazzaferro, S., Movilli, E., Ravera, M., Salomone, M., Santoro, D., Postorinolimido, M. A., Bonomini, M., Stingone, A., Maccarone, M., Di Loreto, E., Stacchiotti, L., Malandra, R., Chiarella, S., D'Agostino, F., Fuiano, G., Nicodemo, L., Bonofiglio, R., Greco, S., Mallamaci, F., Barreca, E., Caserta, C., Bruzzese, V., Galati, D., Tramontana, D., Viscione, M., Chiuchiolo, L., Tuccillo, S., Sepe, M., Vitale, F., Ciriana, E., Martignetti, V., Caserta, D., Stizzo, A., Romano, A., Iulianiello, G., Cascone, E., Minicone, P., Chiricone, D., Delgado, G., Barbato, A., Celentano, S., Molfino, I., Coppola, S., Raiola, I., Abategiovanni, M., Borrelli, S., Margherita, C., Bruno, F., Ida, M., Aliperti, E., Potito, D., Cuomo, G., De Luca, M., Merola, M., Botta, C., Garofalo, G., Alinei, P., Paglionico, C., Roano, M., Vitale, S., Ierardi, R., Fimiani, V., Conte, G., Di Natale, G., Romano, M., Di Marino, V., Scafarto, A., Meccariello, S., Pecoraro, C., Di Stazio, E., Di Meglio, E., Cuomo, A., Maresca, B., Rotaia, E., Capasso, G., Auricchio, M., Pluvio, C., Maddalena, L., De Maio, A., Palladino, G., Buono, F., Gigliotti, G., Mancini, E., La Manna, G., Storari, A., Mosconi, G., Cappelli, G., Scarpioni, R., Gregorini, M., Rigotti, A., Mancini, W., Bianco, F., Boscutti, G., Amici, G., Tosto, M., Fini, R., Pace, G., Cioffi, A., Boccia, E., Di Lullo, L., Di Zazzo, G., Simonelli, R., Bondatti, F., Miglio, L., Rifici, N., Treglia, A., Muci, M., Baldinelli, G., Rizzi, E., Lonzi, M., De Cicco, C., Forte, F., De Paolis, P., Grandaliano, Giuseppe, Cuzziol, C., Torre, V. M., Sfregola, P., Rossi, V., Fabio, G., Flammini, A., Filippini, A., Onorato, L., Vendola, F., Di Daniela, N., Alfarone, C., Scabbia, L., Ferrazzano, M., Grotta, B. D., Gamberini, M., Fazzari, L., Mene, P., Morgia, A., Catucci, A., Palumbo, R., Puliti, M., Marinelli, R., Polito, P., Marrocco, F., Morabito, S., Rocca, R., Nazzaro, L., Lavini, R., Iamundo, V., Chiappini, M., Casarci, M., Morosetti, M., Hassan, S., Firmi, G., Galliani, M., Serraiocco, M., Feriozzi, S., Valentini, W., Sacco, P., Garibotto, G., Cappelli, V., Saffioti, C., Repetto, M., Rolla, D., Lorenz, M., Pedrini, L., Polonioli, D., Galli, E., Ruggenenti, P., Scolari, F., Bove, S., Costantino, E., Bracchi, M., Mangano, S., Depetri, G., La Milia, V., Farina, M., Zecchini, S., Savino, R., Melandri, M., Guastoni, C., Paparella, M., Gallieni, M., Minetti, E., Bisegna, S., Righetti, M., Badalamenti, S., Alberghini, E., Bertoli, S., Fabbrini, P., Albrizio, P., Rampino, T., Colturi, C., Rombola, G., Lucatello, A., Guerrini, E., Ranghino, A., Lenci, F., Fanciulli, E., Santarelli, S., Damiani, C., Garofalo, D., Sopranzi, F., Santoferrara, A., Di Luca, M., Galiotta, P., Brigante, M., Manganaro, M., Maffei, S., Berto, I., Besso, L., Viglino, G., Cusinato, S., Chiarinottichiappero, D. F., Tognarelli, G., Gianoglio, B., Forneris, G., Biancone, L., Savoldi, S., Vitale, C., Boero, R., Filiberti, O., Borzumati, M., Gesualdo, L., Lomonte, C., Gernone, G., Pallotta, G., Di Paolo, S., Vernaglione, L., Specchio, A., Stallone, G., Dell'Aquila, R., Sandri, G., Russo, F., Napoli, M., Marangi, A., Morrone, L., Di Stratis, C., Fresu, A., Cicu, F., Murtas, S., Manca, O., Pani, A., Pilloni, M., Pistis, R., Cadoni, M., Contu, B., Logias, F., Ivaldi, R., Fancello, S., Cossu, M., Lepori, G., Vittoria, S., Battiati, E., Arnone, M., Rome, M., Barbera, A., Granata, A., Collura, G., Dico, C. L., Pugliese, G., Di Natale, E., Rizzari, G., Cottone, L., Longo, N., Battaglia, G., Marcantoni, C., Giannetto, G., Tumino, G., Randazzo, F., Bellissimo, L., Faro, F. L., Grippaldi, F., Urso, S., Quattrone, G., Todaro, I., Vincenzo, D., Murgo, A., Masuzzo, M., Pisacane, A., Monardo, P., Pontorierro, M., Quari, C., Bauro, A., Chimenz, R. R., Alfio, D., Girasole, F., Cascio, A. L., Caviglia, A., Tornese, F., Sirna, F., Altieri, C., Cusumano, R., Saveriano, V., La Corte, A., Locascio, G., Rotolo, U., Musso, S., Risuglia, L., Blanco, G., Minardo, G., Castellino, S., Zappulla, Z., Randone, S., Di Francesca, M., Cassetti, C. C., Oddo, G., Buscaino, G., Mucaria, F., Barraco, V. I., Di Martino, A., Rallo, D., Dani, L., Campolo, G., Manescalchi, F., Biagini, M., Agate, M., Panichi, V., Casani, A., Traversari, L., Garosi, G., Tabbi, M., Selvi, A., Cencioni, L., Fagugli, R., Timio, F., Leveque, A., Manes, M., Mennella, G., Calo, L., Fiorini, F., Abaterusso, C., Calzavara, P., Meneghel, G., Bonesso, C., Gambaro, G., Gammaro, L., Rugiu, C., Ronco, C., Nordio M., Reboldi G., Di Napoli A., Quintaliani G., Alberici F., Postorino M., Aucella F., Messa P., Brunori G., Bosco M., Malberti F., Mandreoli M., Mazzaferro S., Movilli E., Ravera M., Salomone M., Santoro D., PostorinoLimido M.A., Bonomini M., Stingone A., Maccarone M., Di Loreto E., Stacchiotti L., Malandra R., Chiarella S., D'Agostino F., Fuiano G., Nicodemo L., Bonofiglio R., Greco S., Mallamaci F., Barreca E., Caserta C., Bruzzese V., Galati D., Tramontana D., Viscione M., Chiuchiolo L., Tuccillo S., Sepe M., Vitale F., Ciriana E., Martignetti V., Caserta D., Stizzo A., Romano A., Iulianiello G., Cascone E., Minicone P., Chiricone D., Delgado G., Barbato A., Celentano S., Molfino I., Coppola S., Raiola I., Abategiovanni M., Borrelli S., Margherita C., Bruno F., Ida M., Aliperti E., Potito D., Cuomo G., De Luca M., Merola M., Botta C., Garofalo G., Alinei P., Paglionico C., Roano M., Vitale S., Ierardi R., Fimiani V., Conte G., Di Natale G., Romano M., Di Marino V., Scafarto A., Meccariello S., Pecoraro C., Di Stazio E., Di Meglio E., Cuomo A., Maresca B., Rotaia E., Capasso G., Auricchio M., Pluvio C., Maddalena L., De Maio A., Palladino G., Buono F., Gigliotti G., Mancini E., La Manna G., Storari A., Mosconi G., Cappelli G., Scarpioni R., Gregorini M., Rigotti A., Mancini W., Bianco F., Boscutti G., Amici G., Tosto M., Fini R., Pace G., Cioffi A., Boccia E., Di Lullo L., Di Zazzo G., Simonelli R., Bondatti F., Miglio L., Rifici N., Treglia A., Muci M., Baldinelli G., Rizzi E., Lonzi M., De Cicco C., Forte F., De Paolis P., Grandaliano G., Cuzziol C., Torre V.M., Sfregola P., Rossi V., Fabio G., Flammini A., Filippini A., Onorato L., Vendola F., Di Daniela N., Alfarone C., Scabbia L., Ferrazzano M., Grotta B.D., Gamberini M., Fazzari L., Mene P., Morgia A., Catucci A., Palumbo R., Puliti M., Marinelli R., Polito P., Marrocco F., Morabito S., Rocca R., Nazzaro L., Lavini R., Iamundo V., Chiappini M., Casarci M., Morosetti M., Hassan S., Firmi G., Galliani M., Serraiocco M., Feriozzi S., Valentini W., Sacco P., Garibotto G., Cappelli V., Saffioti C., Repetto M., Rolla D., Lorenz M., Pedrini L., Polonioli D., Galli E., Ruggenenti P., Scolari F., Bove S., Costantino E., Bracchi M., Mangano S., Depetri G., La Milia V., Farina M., Zecchini S., Savino R., Melandri M., Guastoni C., Paparella M., Gallieni M., Minetti E., Bisegna S., Righetti M., Badalamenti S., Alberghini E., Bertoli S., Fabbrini P., Albrizio P., Rampino T., Colturi C., Rombola G., Lucatello A., Guerrini E., Ranghino A., Lenci F., Fanciulli E., Santarelli S., Damiani C., Garofalo D., Sopranzi F., Santoferrara A., Di Luca M., Galiotta P., Brigante M., Manganaro M., Maffei S., Berto I., Besso L., Viglino G., Cusinato S., ChiarinottiChiappero D.F., Tognarelli G., Gianoglio B., Forneris G., Biancone L., Savoldi S., Vitale C., Boero R., Filiberti O., Borzumati M., Gesualdo L., Lomonte C., Gernone G., Pallotta G., Di Paolo S., Vernaglione L., Specchio A., Stallone G., Dell'Aquila R., Sandri G., Russo F., Napoli M., Marangi A., Morrone L., Di Stratis C., Fresu A., Cicu F., Murtas S., Manca O., Pani A., Pilloni M., Pistis R., Cadoni M., Contu B., Logias F., Ivaldi R., Fancello S., Cossu M., Lepori G., Vittoria S., Battiati E., Arnone M., Rome M., Barbera A., Granata A., Collura G., Dico C.L., Pugliese G., Di Natale E., Rizzari G., Cottone L., Longo N., Battaglia G., Marcantoni C., Giannetto G., Tumino G., Randazzo F., Bellissimo L., Faro F.L., Grippaldi F., Urso S., Quattrone G., Todaro I., Vincenzo D., Murgo A., Masuzzo M., Pisacane A., Monardo P., Pontorierro M., Quari C., Bauro A., Chimenz R.R., Alfio D., Girasole F., Cascio A.L., Caviglia A., Tornese F., Sirna F., Altieri C., Cusumano R., Saveriano V., La Corte A., Locascio G., Rotolo U., Musso S., Risuglia L., Blanco G., Minardo G., Castellino S., Zappulla Z., Randone S., Di Francesca M., Cassetti C.C., Oddo G., Buscaino G., Mucaria F., Barraco V.I., Di Martino A., Rallo D., Dani L., Campolo G., Manescalchi F., Biagini M., Agate M., Panichi V., Casani A., Traversari L., Garosi G., Tabbi M., Selvi A., Cencioni L., Fagugli R., Timio F., Leveque A., Manes M., Mennella G., Calo L., Fiorini F., Abaterusso C., Calzavara P., Meneghel G., Bonesso C., Gambaro G., Gammaro L., Rugiu C., and Ronco C.

Subjects
Male, Contextual analysis, medicine.medical_treatment, Population, 030232 urology & nephrology, Recursive partitioning, 030204 cardiovascular system & hematology, Rate ratio, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Classification tree, COVID-19, Renal replacement therapy, Risk Factors, Medical, Surveys and Questionnaires, Health care, medicine, Settore MED/14 - NEFROLOGIA, Humans, education, Pandemics, Societies, Medical, Female, Italy, Nephrology, education.field_of_study, business.industry, Multilevel model, Decision rule, Confidence interval, Original Article, Hemodialysis, business, Contextual analysi, Societies, Demography
Abstract

Background and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.

Published
2021

7. Pregnancy outcomes after kidney graft in Italy: are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013)

Author

Piccoli, Gb, Cabiddu, G, Attini, R, Gerbino, M, Todeschini, P, Perrino, Ml, Manzione, Am, Piredda, Gb, Gnappi, E, Caputo, F, Montagnino, G, Bellizzi, V, Di Loreto, P, Martino, F, Montanaro, D, Rossini, M, Castellino, S, Biolcati, M, Fassio, F, Loi, V, Parisi, S, Versino, E, Pani, A, Todros, T, Manna, G, Colussi, G, Biancone, L, Piredda, G, Maxia, S, Maggiore, U, Buscemi, B, Messa, P, Palladino, G, De Silvestro, L, Ronco, C, Groppuzzo, M, Gesualdo, L, Davoli, D, Cappelli, G, Postorino, M, Rocca, Ar, Dei Malatesta ML, Stratta, P, Izzo, C, Quaglia, M, Setti, G, Cancarini, Giovanni, Del Prete, D, Bonfante, L, Esposito, C, Montagna, G, Veroux, M, Santoro, D, Paloschi, V, Secchi, A, Credendino, O, Tranquilli, A, Buscicchio, G, Gammaro, L, Gernone, G, Giacchino, F, Limardo, M., Piccoli, Giorgina Barbara, Cabiddu, Gianfranca, Attini, Rossella, Gerbino, Martina, Todeschini, Paola, Perrino, Maria Luisa, Manzione, Ana Maria, Piredda, Gian Benedetto, Gnappi, Elisa, Caputo, Flavia, Montagnino, Giuseppe, Bellizzi, Vincenzo, Di Loreto, Pierluigi, Martino, Francesca, Montanaro, Domenico, Rossini, Michele, Castellino, Santina, Biolcati, Marilisa, Fassio, Federica, Loi, Valentina, Parisi, Silvia, Versino, Elisabetta, Pani, Antonello, and Todros, Tullia

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Péregnancy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, medicine, Humans, Registries, Renal replacement therapy, Kidney transplantation, Dialysis, Transplantation, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Incidence, Infant, Newborn, Pregnancy Outcome, medicine.disease, Kidney Transplantation, Kidney graft, Pregnancy Complications, Italy, Nephrology, Premature birth, Cohort, Premature Birth, Small for gestational age, Female, pregnancy, kidney transplant, immunosuppression, Transplantation, Péregnancy, business, Immunosuppressive Agents
Abstract

BACKGROUND Kidney transplantation is the treatment of choice to restore fertility to women on renal replacement therapy. Over time, immunosuppressive, support therapies and approaches towards high-risk pregnancies have changed. The aim of this study was to analyse maternal-foetal outcomes in two cohorts of transplanted women who delivered a live-born baby in Italy in 1978-2013, dichotomized into delivery before and after January 2000. METHODS A survey involving all the Italian transplant centres was carried out, gathering data on all pregnancies recorded since the start of activity at each centre; the estimated nationwide coverage was 75%. Data on cause of ESRD, dialysis, living/cadaveric transplantation, drug therapy, comorbidity, and the main maternal-foetal outcomes were recorded and reviewed. Data were compared with a low-risk cohort of pregnancies from two large Italian centres (2000-14; Torino and Cagliari Observational Study cohort). RESULTS The database consists of 222 pregnancies with live-born babies after transplantation (83 before 2000 and 139 in 2000-13; 68 and 121 with baseline and birth data, respectively), and 1418 low-risk controls. The age of the patients significantly increased over time (1978-99: age 30.7 ± 3.7 versus 34.1 ± 3.7 in 2000-13; P < 0.001). Azathioprine, steroids and cyclosporine A were the main drugs employed in the first time period, while tacrolimus emerged in the second. The prevalence of early preterm babies increased from 13.4% in the first to 27.1% in the second period (P = 0.049), while late-preterm babies non-significantly decreased (38.8 versus 33.1%), thus leaving the prevalence of all preterm babies almost unchanged (52.2 and 60.2%; P = 0.372). Babies below the 5th percentile decreased over time (22.2 versus 9.6%; P = 0.036). In spite of high prematurity rates, no neonatal deaths occurred after 2000. The results in kidney transplant patients are significantly different from controls both considering all cases [preterm delivery: 57.3 versus 6.3%; early preterm: 22.2 versus 0.9%; small for gestational age (SGA): 14 versus 4.5%; P < 0.001] and considering only transplant patients with normal kidney function [preterm delivery: 35 versus 6.3%; early preterm: 10 versus 0.9%; SGA: 23.7 versus 4.5% (P < 0.001); risks increase across CKD stages]. Kidney function remained stable in most of the patients up to 6 months after delivery. Multiple regression analysis performed on the transplant cohort highlights a higher risk of preterm delivery in later CKD stages, an increase in preterm delivery and a decrease in SGA across periods. CONCLUSIONS Pregnancy after transplantation has a higher risk of adverse outcomes compared with the general population. Over time, the incidence of SGA babies decreased while the incidence of 'early preterm' babies increased. Although acknowledging the differences in therapy (cyclosporine versus tacrolimus) and in maternal age (significantly increased), the decrease in SGA and the increase in prematurity may be explained by an obstetric policy favouring earlier delivery against the risk of foetal growth restriction.

Published
2016

8. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Author

Cabiddu, G, Castellino, S, Gernone, G, Santoro, D, Giacchino, F, Credendino, O, Daidone, G, Gregorini, G, Moroni, G, Attini, R, Minelli, F, Manisco, G, Todros, T, Piccoli, G, Pieruzzi, F, Pieruzzi, FUEG, Cabiddu, G, Castellino, S, Gernone, G, Santoro, D, Giacchino, F, Credendino, O, Daidone, G, Gregorini, G, Moroni, G, Attini, R, Minelli, F, Manisco, G, Todros, T, Piccoli, G, Pieruzzi, F, and Pieruzzi, FUEG

Abstract

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. Main results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75 % may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Published
2015

9. Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: A multicentre nationwide study 2000-12

Author

Piccoli, G, Postorino, V, Cabiddu, G, Ghiotto, S, Guzzo, G, Roggero, S, Manca, E, Puddu, R, Meloni, F, Attini, R, Moi, P, Maxia, S, Piga, A, Mazzone, L, Pani, A, Postorino, M, Castellino, S, Gernone, G, Guida, B, Calabria, S, Galliani, M, Manisco, G, Di Tullio, M, Vernaglione, L, Chiappini, M, Proietti, E, Saffiotti, S, Gangeni, C, Brunati, C, Montoli, A, Esposito, C, Montagna, G, Tata, S, Romano, P, Amatruda, O, Cervini, P, Casiraghi, E, Fabbrini, P, Pieruzzi, F, Di Benedetto, A, Alfisi, G, Heidempergher, M, Buskermolen, M, Leveque, A, Autuly, V, Giofrè, F, Alati, G, Lombardi, L, Riccio, M, Riccio, I, Stingone, A, D'Angelo, B, Lucchi, L, Stipo, L, Loi, V, Piccoli, G, Postorino, V, Cabiddu, G, Ghiotto, S, Guzzo, G, Roggero, S, Manca, E, Puddu, R, Meloni, F, Attini, R, Moi, P, Maxia, S, Piga, A, Mazzone, L, Pani, A, Postorino, M, Castellino, S, Gernone, G, Guida, B, Calabria, S, Galliani, M, Manisco, G, Di Tullio, M, Vernaglione, L, Chiappini, M, Proietti, E, Saffiotti, S, Gangeni, C, Brunati, C, Montoli, A, Esposito, C, Montagna, G, Tata, S, Romano, P, Amatruda, O, Cervini, P, Casiraghi, E, Fabbrini, P, Pieruzzi, F, Di Benedetto, A, Alfisi, G, Heidempergher, M, Buskermolen, M, Leveque, A, Autuly, V, Giofrè, F, Alati, G, Lombardi, L, Riccio, M, Riccio, I, Stingone, A, D'Angelo, B, Lucchi, L, Stipo, L, and Loi, V

Abstract

Background Pregnancy on dialysis is increasingly being reported. This study evaluates the behavioural profile of the children of mothers on dialysis and the parental stress their mothers undergo when compared with a group of mothers affected by a different chronic disease (microcythaemia) and a group of healthy control mothers. Methods Between 2000 and 2012, 23 on-dialysis mothers gave birth to 24 live-born children in Italy (23 pregnancies, 1 twin pregnancy, one of the twins deceased soon after delivery); of these, 16 mothers and 1 father (whose wife died before the inquiry) were included in the study (1 mother had died and the father was unavailable; 2 were not asked to participate because their children had died and 3 were unavailable; children: median age: 8.5, min-max: 2-13 years). Twenty-three mothers affected by transfusion-dependent microcythaemia or drepanocitosis (31 pregnancies, 32 children) and 35 healthy mothers (35 pregnancies, 35 children; median age of the children: 7, min-max: 1-13 years) were recruited as controls. All filled in the validated questionnaires: 'Child Behaviour Checklist' (CBCL) and the 'Parental Stress Index-Short Form' (PSI-SF). Results The results of the CBCL questionnaire were similar for mothers on dialysis and healthy controls except for pervasive developmental problems, which were significantly higher in the dialysis group, while microcythaemia mothers reported higher emotional and behavioural problems in their children in 8 CBCL sub-scales. Two/16 children in the dialysis and 3/32 in the microcythaemia group had pathological profiles, as assessed by T-scores (p: ns). PSI-SF indicated a normal degree of parental stress in microcythaemia subjects and healthy controls, while mothers on dialysis declared significantly lower stress, suggesting a defensive response in order to minimize problems, stress or negativity in their relationship with their child. Conclusions According to the present analysis, the emotional and behavioural o

Published
2015

10. PREGNANCY AND PROGRESSION OF IGA NEPHROPATHY: RESULTS OF AN ITALIAN MULTICENTER STUDY

Author

Limardo, M, Imbasciati, E, Ravani, P, Surian, M, Torres, D, Gregorini, G, Magistroni, R, Casellato, D, Gammaro, L, Pozzi, C, Gammaro L, Rene e. Gravidanza Collaborative Group of the Italian Society of N. e. p. h. r. o. l. o. g. y., Beati, S, Ambroso, G, Maggio, M, Del Giudice, A, De Cristofaro, V, Gallo, E, Gernone, G, Marega, A, Rustichelli, R, Cabiddu, G, Rollino, C, Fanciulli, E, Feriozzi, S, Pecchini, P, Bizzarri, D, D'Amico, M, Proietti, E, Baratelli, L, Battista Reinero, G, Garibotto, Giacomo, Rocchietti, M, Allegri, L, Dugo, M, Cirami, L, Esposito, C, Amico, L, Mariani, P, Baroli, A, Giannattasio, M, Stratta, P, Montanaro, D, Gesualdo, L, Daidone, G, Manfellotto, D, and Castellino, S.

Published
2010

11. Epidemiology of end-stage renal disease in an interregional perspective: Registries of Puglia and Basilicata, southren Italy

Author

Vitullo, F., Casino, F. G., Di Matteo, A., Di Candia, V. D., Gaudiano, V., Piras, V., Alfonso, L., Basile, C., Procaccini, D. A., Gesualdo, L., Chiarulli, G., Lomonte, C., D Ambrosio, N., Petrarulo, F., Sacchetti, A., D Agustino, F., Navarra, A., Laraia, A., Carabellese, S., Coratelli, P., Ramunni, A., Schena, F. P., Pertosa, G., Caringella, A., Depalo, T., NICOLA LATTANZI, Allegretti, A., Brandi, S., Ranieri, F., Anna, A., Muschitielllo, M., Tricarico, G., Strippoli, P., Castrignanò, E., Bozzi, M., Buongiorno, E., Lupo, N., Min, A. M., Capotorto, M., Passione, A., Di Dio, M., Manisco, G., Sozzo, E., Gidante, B., Gallucci, M., Mastrangelo, F., Chimienti, S., Perrone, F., Giordano, R., Virgilio, M., Brusasco, A., Pastore, G., Conversano, A., Giannatasio, M., Gernone, G., Stalllone, C., Pompa, G., Avanzi, C., Tasco, A., Stefanelli, G., Scatizzi, L. C., Nuzzo, V., Gaudiano, G., Bellizi, V., Lopez, T., Procida, M., Lauria, M. A., Oriente, L., Pergamo, O., Valente, V., Ianuzziello, F., Carretta, P., Ricchiuti, V., Bombini, A., and Pampaloni, M.

12. Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: A multicentre nationwide study 2000-12

Author

Piccoli, Giorgina Barbara, Postorino, Valentina, Cabiddu, Gianfranca, Ghiotto, Sara, Guzzo, Gabriella, Roggero, Simona, Manca, Eleonora, Puddu, Rosalba, Meloni, Francesca, Attini, Rossella, Moi, Paolo, Guida, Bruna, Maxia, Stefania, Piga, Antonio Giulio, Mazzone, Luigi, Pani, Aantonello, Postorino, Maurizio, 'Kidney, Pregnancy Study Group' of the 'Italian Society of Nephrology' including Castellino, Santina, Gernone, Giuseppe, Calabria, Santo, Galliani, Marco, Manisco, Gianfranco, Di Tullio, Massimo, Vernaglione, Luigi, Chiappini, Maria Grazia, Proietti, Emanuela, Saffiotti, Stefano, Gangeni, Concetta, Brunati, Chiara, Montoli, Alberto, Esposito, Ciro, Montagna, Giovanni, Tata, Salvatore, Romano, Paolo, Amatruda, Ottavio, Cervini, Paolo, Casiraghi, Erika, Fabbrini, Paolo, Pieruzzi, Federico, Di Benedetto, Attilio, Alfisi, Giuseppina, Heidempergher, Marco, Buskermolen, Monique, Leveque, Alessandro, Autuly, Valerie, Giofrè, Francesco, Alati, Giovanni, Lombardi, Luigi, Riccio, Mara, Riccio, Ivano, Stingone, Antonio, D'Angelo, Benito, Lucchi, Leonardo, Stipo, Lucia, Loi, Valentina, Piccoli, Giorgina Barbara, Postorino, Valentina, Cabiddu, Gianfranca, Ghiotto, Sara, Guzzo, Gabriella, Roggero, Simona, Manca, Eleonora, Puddu, Rosalba, Meloni, Francesca, Attini, Rossella, Moi, Paolo, Guida, Bruna, Maxia, Stefania, Piga, Antonio, Mazzone, Luigi, Pani, Antonello, Postorino, Maurizio, Piccoli, G, Postorino, V, Cabiddu, G, Ghiotto, S, Guzzo, G, Roggero, S, Manca, E, Puddu, R, Meloni, F, Attini, R, Moi, P, Maxia, S, Piga, A, Mazzone, L, Pani, A, Postorino, M, Castellino, S, Gernone, G, Guida, B, Calabria, S, Galliani, M, Manisco, G, Di Tullio, M, Vernaglione, L, Chiappini, M, Proietti, E, Saffiotti, S, Gangeni, C, Brunati, C, Montoli, A, Esposito, C, Montagna, G, Tata, S, Romano, P, Amatruda, O, Cervini, P, Casiraghi, E, Fabbrini, P, Pieruzzi, F, Di Benedetto, A, Alfisi, G, Heidempergher, M, Buskermolen, M, Leveque, A, Autuly, V, Giofrè, F, Alati, G, Lombardi, L, Riccio, M, Riccio, I, Stingone, A, D'Angelo, B, Lucchi, L, Stipo, L, and Loi, V

Subjects
Counseling, Male, dialysi, Pediatrics, medicine.medical_treatment, Child Behavior, CBCL, Kidney Failure, Renal Dialysi, Pregnancy, stre, Surveys and Questionnaires, Surveys and Questionnaire, Medicine, Chronic, Child Behavior Checklist, Child, Depression (differential diagnoses), Twin Pregnancy, Mother, Mental Disorders, Settore MED/39 - Neuropsichiatria Infantile, Italy, Nephrology, Child, Preschool, depression, Mental Disorder, Female, Case-Control Studie, Human, Adult, medicine.medical_specialty, ESRD, dialysis, microcythaemia, pregnancy, stress, Adolescent, Case-Control Studies, Humans, Infant, Kidney Failure, Chronic, Mothers, Renal Dialysis, Stress, Psychological, Stress, Preschool, Dialysis, Transplantation, business.industry, Case-control study, medicine.disease, Psychological, business
Abstract

BACKGROUND: Pregnancy on dialysis is increasingly being reported. This study evaluates the behavioural profile of the children of mothers on dialysis and the parental stress their mothers undergo when compared with a group of mothers affected by a different chronic disease (microcythaemia) and a group of healthy control mothers. METHODS: Between 2000 and 2012, 23 on-dialysis mothers gave birth to 24 live-born children in Italy (23 pregnancies, 1 twin pregnancy, one of the twins deceased soon after delivery); of these, 16 mothers and 1 father (whose wife died before the inquiry) were included in the study (1 mother had died and the father was unavailable; 2 were not asked to participate because their children had died and 3 were unavailable; children: median age: 8.5, min-max: 2-13 years). Twenty-three mothers affected by transfusion-dependent microcythaemia or drepanocitosis (31 pregnancies, 32 children) and 35 healthy mothers (35 pregnancies, 35 children; median age of the children: 7, min-max: 1-13 years) were recruited as controls. All filled in the validated questionnaires: 'Child Behaviour Checklist' (CBCL) and the 'Parental Stress Index-Short Form' (PSI-SF). RESULTS: The results of the CBCL questionnaire were similar for mothers on dialysis and healthy controls except for pervasive developmental problems, which were significantly higher in the dialysis group, while microcythaemia mothers reported higher emotional and behavioural problems in their children in 8 CBCL sub-scales. Two/16 children in the dialysis and 3/32 in the microcythaemia group had pathological profiles, as assessed by T-scores (p: ns). PSI-SF indicated a normal degree of parental stress in microcythaemia subjects and healthy controls, while mothers on dialysis declared significantly lower stress, suggesting a defensive response in order to minimize problems, stress or negativity in their relationship with their child. CONCLUSIONS: According to the present analysis, the emotional and behavioural outcome is normal in most of the children from on-dialysis mothers. A 'positive defence' in the dialysis mothers should be kept in mind when tailoring psychological support for this medical miracle.

Published
2015

13. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Author

Gianfranca, Cabiddu, Santina, Castellino, Giuseppe, Gernone, Domenico, Santoro, Franca, Giacchino, Olga, Credendino, Giuseppe, Daidone, Gina, Gregorini, Gabriella, Moroni, Rossella, Attini, Fosca, Minelli, Gianfranco, Manisco, Tullia, Todros, Giorgina Barbara, Piccoli, Lucia, Stipo, Cabiddu, G, Castellino, S, Gernone, G, Santoro, D, Giacchino, F, Credendino, O, Daidone, G, Gregorini, G, Moroni, G, Attini, R, Minelli, F, Manisco, G, Todros, T, Piccoli, G, Pieruzzi, F, Cabiddu, Gianfranca, Castellino, Santina, Gernone, Giuseppe, Santoro, Domenico, Giacchino, Franca, Credendino, Olga, Daidone, Giuseppe, Gregorini, Gina, Moroni, Gabriella, Attini, Rossella, Minelli, Fosca, Manisco, Gianfranco, Todros, Tullia, and Piccoli, Giorgina Barbara

Subjects
Counseling, Nephrology, medicine.medical_specialty, Time Factors, Best practice, medicine.medical_treatment, Peritoneal dialysis, Daily dialysi, MEDLINE, Chronic kidney disease, Daily dialysis, Dialysis efficiency, Evidence based medicine, Hemodialysis, Kidney, Kidney Function Tests, Time-to-Treatment, Predictive Value of Tests, Pregnancy, Renal Dialysis, Risk Factors, Internal medicine, Peritoneal dialysi, Humans, Medicine, Intensive care medicine, Dialysis, business.industry, Patient Selection, Body Weight, Evidence-based medicine, medicine.disease, Diet, Pregnancy Complications, Treatment Outcome, Italy, Chronic kidney disease Hemodialysis Peritoneal dialysis Dialysis efficiency Evidence based medicine Daily dialysis, Female, Kidney Diseases, Hemodialysi, business
Abstract

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. Main results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75% may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Published
2015

14. Effects of Rheopheresis in dialysis patients with peripheral artery disease and diabetic foot ulcers: A multicentric Italian study.

Author

Altobelli C, Fabiani FC, Anastasio P, Pluvio C, de Pascale E, Vernaglione L, Gernone G, Di Luca M, Bertuzzi V, Brescia P, Toffoletto P, D'Arezzo M, Brustia M, Andreana De Mauri, Chiarinotti D, Loschiavo C, Grecò M, D'Elia F, Gallo MA, Tarroni G, Di Liberato L, Perna AF, Capasso G, and Capolongo G

Subjects
Humans, Male, Aged, Female, Middle Aged, Italy, Blood Component Removal methods, Treatment Outcome, Wound Healing, Aged, 80 and over, Peripheral Arterial Disease therapy, Renal Dialysis adverse effects, Diabetic Foot therapy
Abstract

Background: Peripheral artery disease (PAD) in hemodialysis (HD) patients has a significant social impact due to its prevalence, poor response to standard therapy and dismal prognosis. Rheopheresis is indicated by guidelines for PAD treatment., Materials and Methods: Twenty-five HD patients affected by PAD stage IV Lerichè-Fontaine and ischemic ulcer 1C or 2C according to the University of Texas Wound Classification System (UTWCS), without amelioration after traditional medical therapy and/or revascularization, were selected and underwent 12 Rheopheresis sessions in 10 weeks. Improvements in pain symptoms using Numerical Rating Scale (NRS), healing ulcers and laboratory hemorheological parameters have been evaluated., Results: A clinically and statistically significant mean value reduction and of relative percentage differences between estimated marginal means (Δ), calculated at each visits, of NRS was observed, with a maximum value (-48.5%) between the first and last visit. At the end of the treatment period 14.3% of ulcers were completely healed, 46.4% downgraded, 53.6% were stable. Overall, no ulcers upgraded. A statistically significant reduction of the Δ, between the first and last visit, for fibrinogen (-16%) was also observed., Conclusion: Rheopheresis reduced overall painful symptoms; data suggest that it could heal or improve ulcers and hemorheological laboratory parameters in HD patients with PAD and ischemic ulcers resistant to standard therapies., (© 2024 The Author(s). Journal of Clinical Apheresis published by Wiley Periodicals LLC.)

Published
2024
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16. [Calcified Fibrin Sheath After Stuck Catheter Removal: Case Report and Literature Review].

Author

Taurisano M, Mancini A, D'elia F, Gernone G, and Cortese C

Subjects
Humans, Vena Cava, Superior, Renal Dialysis, Fibrin, Catheters, Indwelling adverse effects, Catheterization, Central Venous adverse effects, Central Venous Catheters adverse effects, Calcinosis
Abstract

The prevalence of central venous catheters (CVC) in hemodialysis patients is around 20-30%. In this scenario, complications related to the use of the CVC are commonly observed, requiring active management by nephrologists. These include infectious complications as well as those related to CVC malfunction. Among the latter, the formation of a fibrin sheath around the catheter linked to foreign body reaction could cause CVC malfunction in various ways. Even after the removal of the catheter, the fibrin sheath can remain inside the vascular lumen (ghost fibrin sheath) and rarely undergo calcification. We describe the clinical case of a hemodialysis patient who, following the removal of a malfunctioning, stuck CVC, presented a calcified tubular structure in the lumen of the superior vena cava, diagnosed as calcified fibrin sheath (CFS). This rare occurrence, described in the literature in 8 other cases, although rare, is certainly underdiagnosed and can lead to complications such as sepsis resulting from CFS, pulmonary embolisms, and vascular thrombosis. Therapeutic approaches should be considered only in symptomatic cases and involve an invasive surgical approach., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Published
2024

17. Chronic kidney disease, female infertility, and medically assisted reproduction: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology.

Author

Attini R, Cabiddu G, Ciabatti F, Montersino B, Carosso AR, Gernone G, Gammaro L, Moroni G, Torreggiani M, Masturzo B, Santoro D, Revelli A, and Piccoli GB

Subjects
Pregnancy, Female, Humans, Pregnancy, Twin, Kidney, Infertility, Female diagnosis, Infertility, Female etiology, Infertility, Female therapy, Nephrology, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic therapy
Abstract

Fertility is known to be impaired more frequently in patients with chronic kidney disease than in the general population. A significant proportion of chronic kidney disease patients may therefore need Medically Assisted Reproduction. The paucity of information about medically assisted reproduction for chronic kidney disease patients complicates counselling for both nephrologists and gynaecologists, specifically for patients with advanced chronic kidney disease and those on dialysis or with a transplanted kidney. It is in this context that the Project Group on Kidney and Pregnancy of the Italian Society of Nephrology has drawn up these best practice guidelines, merging a literature review, nephrology expertise and the experience of obstetricians and gynaecologists involved in medically assisted reproduction. Although all medically assisted reproduction techniques can be used for chronic kidney disease patients, caution is warranted. Inducing a twin pregnancy should be avoided; the risk of bleeding, thrombosis and infection should be considered, especially in some categories of patients. In most cases, controlled ovarian stimulation is needed to obtain an adequate number of oocytes for medically assisted reproduction. Women with chronic kidney disease are at high risk of kidney damage in case of severe ovarian hyperstimulation syndrome, and great caution should be exercised so that it is avoided. The higher risks associated with the hypertensive disorders of pregnancy, and the consequent risk of chronic kidney disease progression, should likewise be considered if egg donation is chosen. Oocyte cryopreservation should be considered for patients with autoimmune diseases who need cytotoxic treatment. In summary, medically assisted reproduction is an option for chronic kidney disease patients, but the study group strongly advises extensive personalised counselling with a multidisciplinary healthcare team and close monitoring during the chosen medically assisted reproduction procedure and throughout the subsequent pregnancy., (© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Published
2023
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18. Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology.

Author

Attini R, Cabiddu G, Montersino B, Gammaro L, Gernone G, Moroni G, Santoro D, Spotti D, Masturzo B, Gazzani IB, Menato G, Donvito V, Paoletti AM, and Piccoli GB

Subjects
Contraception, Female, Humans, Italy, Kidney, Pregnancy, Nephrology, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic therapy
Abstract

Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.

Published
2020
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19. [Screening and management of HCV-positive CKD outpatients].

Author

Gernone G, Detomaso F, Partipilo F, and Gernone S

Subjects
Antiviral Agents adverse effects, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Humans, Mass Screening, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic virology, Treatment Outcome, Antiviral Agents therapeutic use, Hepatitis C, Chronic diagnosis, Renal Insufficiency, Chronic diagnosis
Abstract

Background : Hepatitis C Virus (HCV) disease, which is commonly underdiagnosed, in addition to the well-known effects on the liver is also a risk factor for Cronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). It worsens the outcome at every stage of CKD; around 400.000 people worldwide die from HCV-related causes each year. The KDIGO 2018 Guidelines recommend that all patients be evaluated for renal disease when HCV is diagnosed and be screened for HCV when CKD is diagnosed, as the prevalence may be higher than in the general population. Effective screening is therefore necessary in order to establish early treatment. Aims of the study : We ran a systematic program of screening and management of HCV in nephropathic outpatients in order to improve Sustained Virological Response 12 weeks after the end of treatment (SVR 12) and renal functions such as GFR and proteinuria. Materials and methods : We considered outpatients not in dialysis and older than 18. The systematic, prospective observational study of HCV infection run over a period of 18 months. Results : Of 2798 nephropathic outpatients that came to our attention during this period, we identified 108 HCV-positive patients (prevalence: 3.85%). The test for HCV-RNA resulted positive in 78 patients and, after hepatological evaluation and informed consent to treatment, 51 of them underwent therapy with the new direct-acting antivirals (DAAs). 34 patients concluded the treatment during the 18-month period, all of them with 100% SVR 12. The average pre-treatment GFR was 40.5 ml/m'; after treatment resulted equal to 45 ml/m' (p=0.01). The average value of pre-treatment proteinuria was 1.18 g/24 h; it was reduced to 0.79 g/24 (p=0.015). The remaining 17 patients were still under treatment/evaluation at the end of the 18 months. Conclusions : Treatment with the new DAAs has been confirmed safe and effective and is associated with an improvement of renal functions. Systematic screening of nephropathic patients may therefore contribute to achieving the WHO target of eliminating HCV by 2030., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2020

20. [Carnitin-Palmitoyl Transferase type 2 deficiency: a rare cause of acute renal failure due to rhabdomyolysis].

Author

Detomaso F, Pepe V, Partipilo F, and Gernone G

Subjects
Acute Kidney Injury therapy, Creatine Kinase metabolism, Fatigue etiology, Fatty Acids metabolism, Fluid Therapy, Humans, Male, Mitochondria, Muscle metabolism, Myalgia etiology, Myoglobinuria complications, Recurrence, Young Adult, Acute Kidney Injury etiology, Carnitine O-Palmitoyltransferase deficiency, Physical Exertion, Rhabdomyolysis complications
Abstract

Fatty acid oxidation disorders are inborn errors of metabolism. One of the possible alterations involves the failure of the carnitin-based transport of long-chain fatty acids into the mitochondria, necessary for muscle metabolism in case of prolonged physical exertion. Three kinds of Carnitin-Palmitoyl Transferase type 2 (CPT2) deficiency have been described: a myopathic form, a severe infantile form and a neonatal form. The clinical picture is characterized by recurrent attacks of rhabdomyolysis, muscular pains and fatigue, secondary to a prolonged physical exercise and sometimes aggravated by intercurrent events. Rhabdomyolysis episodes are associated with a significant increase in creatine phosphokinase and myoglobinuria and may result in acute renal failure. Patients are usually asymptomatic during intercurrent periods. When acute renal failure from rhabdomyolysis arises after intense physical activity, it is therefore necessary to also investigate the presence of metabolic myopathies due to enzymatic deficiency., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2019

21. A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology.

Author

Cabiddu G, Spotti D, Gernone G, Santoro D, Moroni G, Gregorini G, Giacchino F, Attini R, Limardo M, Gammaro L, Todros T, and Piccoli GB

Subjects
Female, Graft Rejection prevention & control, Graft Survival, Humans, Immunosuppressive Agents administration & dosage, Immunosuppressive Agents adverse effects, Pregnancy, Pregnancy Complications etiology, Pregnancy Outcome, Risk Assessment, Risk Factors, Treatment Outcome, Kidney Transplantation adverse effects, Nephrology, Pregnancy Complications prevention & control, Time-to-Pregnancy, Transplant Recipients
Abstract

Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes "normal" or "good" kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1-2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage "non-ideal" situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial "third element".

Published
2018
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22. Correction to: A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology.

Author

Cabiddu G, Spotti D, Gernone G, Santoro D, Moroni G, Gregorini G, Giacchino F, Attini R, Limardo M, Gammaro L, Todros T, and Piccoli GB

Abstract

In the original publication of the article, the first name and last name of the authors were interchanged.

Published
2018
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24. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy.

Author

Piccoli GB, Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, Spotti D, Giacchino F, Attini R, Limardo M, Maxia S, Fois A, Gammaro L, and Todros T

Subjects
Consensus, Critical Pathways standards, Female, Humans, Italy, Patient Care Team standards, Pre-Eclampsia diagnosis, Pre-Eclampsia physiopathology, Pregnancy, Risk Factors, Treatment Outcome, Nephrologists standards, Nephrology standards, Obstetrics standards, Postnatal Care standards, Pre-Eclampsia prevention & control, Pre-Eclampsia therapy, Preventive Health Services standards, Professional Role
Abstract

Preeclampsia (PE) is a protean syndrome causing a transitory kidney disease, characterised by hypertension and proteinuria, ultimately reversible after delivery. Its prevalence is variously estimated, from 3 to 5% to 10% if all the related disorders, including also pregnancy-induced hypertension (PIH) and HELLP syndrome (haemolysis, increase in liver enzyme, low platelets) are included. Both nephrologists and obstetricians are involved in the management of the disease, according to different protocols, and the clinical management, as well as the role for each specialty, differs worldwide. The increased awareness of the role of chronic kidney disease in pregnancy, complicating up to 3% of pregnancies, and the knowledge that PE is associated with an increased risk for development of CKD later in life have recently increased the interest and redesigned the role of the nephrologists in this context. However, while the heterogeneous definitions of PE, its recent reclassification, an emerging role for biochemical biomarkers, the growing body of epidemiological data and the new potential therapeutic interventions lead to counsel long-term follow-up, the lack of resources for chronic patients and the increasing costs of care limit the potential for preventive actions, and suggest tailoring specific interventional strategies. The aim of the present position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature and to try to identify theoretical and pragmatic bases for an agreed management of PE in the nephrological setting, with particular attention to the prevention of the syndrome (recurrent PE, presence of baseline CKD) and to the organization of the postpartum follow-up.

Published
2017
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25. [Pharmacological and nutritional problems in pregnant patient on chronic dialysis].

Author

Giannattasio M, Giannattasio F, and Gernone G

Subjects
Female, Humans, Pregnancy, Drug-Related Side Effects and Adverse Reactions, Nutrition Disorders etiology, Pregnancy Complications etiology, Renal Dialysis adverse effects
Abstract

Many of information on the safety of drugs during pregnancy were obtained many years ago, before the pregnant women were excluded from the study protocols for possible fetal risks. Because randomized trials in pregnancy are complex and considered unethical. For the same reasons, there are no randomized controlled trials in pregnant women on dialysis. Moreover Compared to the normal subject, the pharmacokinetics and pharmacodynamics in these patients are influenced or by pregnancy or from dialysis techniques or from chronic uremia. Protein energy wasting PEW- is largely present in dialysis subjects. Nausea and vomiting are present in over 85% of pregnancy and may aggravate PEW. Therefore, it is necessary to adopt specific measures to prevent the PEW as well as periodic inspections of weight gain during pregnancy.

Published
2017

26. A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy.

Author

Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, Giannattasio M, Gregorini G, Giacchino F, Attini R, Loi V, Limardo M, Gammaro L, Todros T, and Piccoli GB

Subjects
Diagnosis, Differential, Evidence-Based Medicine, Female, Glomerulonephritis therapy, Humans, Hypertension, Pregnancy-Induced etiology, Maternal Death, Pre-Eclampsia diagnosis, Pregnancy, Pregnancy Complications diagnosis, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis, Pregnancy Complications therapy, Renal Insufficiency, Chronic therapy
Abstract

Pregnancy is increasingly undertaken in patients with chronic kidney disease (CKD) and, conversely, CKD is increasingly diagnosed in pregnancy: up to 3 % of pregnancies are estimated to be complicated by CKD. The heterogeneity of CKD (accounting for stage, hypertension and proteinuria) and the rarity of several kidney diseases make risk assessment difficult and therapeutic strategies are often based upon scattered experiences and small series. In this setting, the aim of this position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature, and discuss the experience in the clinical management of CKD in pregnancy. CKD is associated with an increased risk for adverse pregnancy-related outcomes since its early stage, also in the absence of hypertension and proteinuria, thus supporting the need for a multidisciplinary follow-up in all CKD patients. CKD stage, hypertension and proteinuria are interrelated, but they are also independent risk factors for adverse pregnancy-related outcomes. Among the different kidney diseases, patients with glomerulonephritis and immunologic diseases are at higher risk of developing or increasing proteinuria and hypertension, a picture often difficult to differentiate from preeclampsia. The risk is higher in active immunologic diseases, and in those cases that are detected or flare up during pregnancy. Referral to tertiary care centres for multidisciplinary follow-up and tailored approaches are warranted. The risk of maternal death is, almost exclusively, reported in systemic lupus erythematosus and vasculitis, which share with diabetic nephropathy an increased risk for perinatal death of the babies. Conversely, patients with kidney malformation, autosomal-dominant polycystic kidney disease, stone disease, and previous upper urinary tract infections are at higher risk for urinary tract infections, in turn associated with prematurity. No risk for malformations other than those related to familiar urinary tract malformations is reported in CKD patients, with the possible exception of diabetic nephropathy. Risks of worsening of the renal function are differently reported, but are higher in advanced CKD. Strict follow-up is needed, also to identify the best balance between maternal and foetal risks. The need for further multicentre studies is underlined.

Published
2016
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27. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy.

Author

Cabiddu G, Castellino S, Gernone G, Santoro D, Giacchino F, Credendino O, Daidone G, Gregorini G, Moroni G, Attini R, Minelli F, Manisco G, Todros T, and Piccoli GB

Subjects
Body Weight, Counseling, Diet, Female, Humans, Italy, Kidney Diseases diagnosis, Kidney Diseases physiopathology, Kidney Function Tests standards, Patient Selection, Peritoneal Dialysis adverse effects, Predictive Value of Tests, Pregnancy, Pregnancy Complications diagnosis, Pregnancy Complications physiopathology, Renal Dialysis adverse effects, Risk Factors, Time Factors, Time-to-Treatment, Treatment Outcome, Kidney physiopathology, Kidney Diseases therapy, Nephrology standards, Peritoneal Dialysis standards, Pregnancy Complications therapy, Renal Dialysis standards
Abstract

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion., Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000-2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips., Main Results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75% may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Published
2015
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28. [Hemoperitoneum after drop-out from peritoneal dialysis].

Author

Gernone G, Pepe V, and Giannattasio M

Subjects
Female, Humans, Middle Aged, Peritoneal Fibrosis etiology, Hemoperitoneum etiology, Peritoneal Dialysis adverse effects, Peritoneal Fibrosis complications
Abstract

A 55-years-old woman with end-stage renal disease presented on hemodialysis bloody ascitis after transfer from peritoneal dialysis. During the 8 years of peritoneal dialysis, she had exit-site infection and a culture-negative peritonitis. She was dropped-out of hemodialysis for ultrafiltration failure associated with "high" peritoneal transport. Clinic and radiologic findings was suggestive for the encapsulating peritoneal sclerosis, which was confirmed upon biopsy of the peritoneum. The patient was treated successfully with immunosuppressive. Our case is relevant, both because many clinical features that have been described must draw attention to the encapsulating peritoneal sclerosis, rare but life-threatening complication of peritoneal dialysis and because of its favorable outcome, unfortunately infrequent.

Published
2014

29. Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta-study.

Author

Piccoli GB, Clari R, Ghiotto S, Castelluccia N, Colombi N, Mauro G, Tavassoli E, Melluzza C, Cabiddu G, Gernone G, Mongilardi E, Ferraresi M, Rolfo A, and Todros T

Subjects
Diabetes Mellitus, Type 1 physiopathology, Female, Humans, Infant, Newborn, Male, Pregnancy, Pregnancy Complications metabolism, Pregnancy Outcome, Diabetes Mellitus, Type 1 complications, Diabetic Nephropathies etiology, Pregnancy in Diabetics
Abstract

Background: In the last decade, significant improvements have been achieved in maternal-fetal and diabetic care which make pregnancy possible in an increasing number of type 1 diabetic women with end-organ damage. Optimal counseling is important to make the advancements available to the relevant patients and to ensure the safety of mother and child. A systematic review will help to provide a survey of the available methods and to promote optimal counseling., Objectives: To review the literature on diabetic nephropathy and pregnancy in type 1 diabetes., Methods: Medline, Embase, and the Cochrane Library were scanned in November 2012 (MESH, Emtree, and free terms on pregnancy and diabetic nephropathy). Studies were selected that report on pregnancy outcomes in type 1 diabetic patients with diabetic nephropathy in 1980-2012 (i.e. since the detection of microalbuminuria). Case reports with less than 5 cases and reports on kidney grafts were excluded. Paper selection and data extraction were performed in duplicate and matched for consistency. As the relevant reports were highly heterogeneous, we decided to perform a narrative review, with discussions oriented towards the period of publication., Results: Of the 1058 references considered, 34 fulfilled the selection criteria, and one was added from reference lists. The number of cases considered in the reports, which generally involved single-center studies, ranged from 5 to 311. The following issues were significant: (i) the evidence is scattered over many reports of differing format and involving small series (only 2 included over 100 patients), (ii) definitions are non-homogeneous, (iii) risks for pregnancy-related adverse events are increased (preterm delivery, caesarean section, perinatal death, and stillbirth) and do not substantially change over time, except for stillbirth (from over 10% to about 5%), (iv) the increase in risks with nephropathy progression needs confirmation in large homogeneous series, (v) the newly reported increase in malformations in diabetic nephropathy underlines the need for further studies., Conclusions: The heterogeneous evidence from studies on diabetic nephropathy in pregnancy emphasizes the need for further perspective studies on this issue.

Published
2013
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30. [Are dialysis-patients a risk population for cholelithiasis? Study in an apulian population].

Author

Gernone G, Detomaso F, La Rosa R, and Giannattasio M

Subjects
Adult, Aged, Aged, 80 and over, Case-Control Studies, Female, Humans, Italy epidemiology, Kidney Failure, Chronic therapy, Male, Middle Aged, Prevalence, Renal Dialysis methods, Risk, Cholelithiasis epidemiology, Cholelithiasis etiology, Kidney Failure, Chronic complications, Renal Dialysis adverse effects
Abstract

Aim: The cholelithiasis (CL) has a 10-20% prevalence in the adult population. The end stage renal disease and dialysis would seem factors of risk since uremic patients show increased bile cholesterol, increased saturation indices and lithogenicity. Nevertheless the studies to confirm this hypothesis have furnished contradictory results. The aim of the study was to appraise prevalence of CL in dialysis-patients., Methods: The authors examined 127 patients (92 in hemodialysis and 35 in peritoneal dialysis) comparing them with a non-uremic control group (CNU) and the prevalence in the general population taking as champion the town of Castellana, near to ''S. Maria Degli Angeli'' Hospital, where, previously, an epidemiological study was performed. Sonographic examination was done with Esaote/Biomedica AU3 instrument with 3.5/5 mHz transducer. The evidence of gallstone(s) by ultrasonography or previously cholecystectomy have been considered diagnostics., Results: Gallstones were detected in 33 of the 127 dialysis-patients (25.9% prevalence). In the CNU the prevalence was 15% (P=0.046). Furthermore the comparison of prevalence of CL between dialysis-patients and the Castellana population was greater in dialysis-population considering the attended rate (13 vs 9.6) and had a greater attributable risk (35%). A global greater prevalence of CL in older patients (>60 years) showed a possible role of the increasing age as a correlated factor to the CL. Any other considered parameter has shown significant correlations., Conclusions: These results underline a greater risk of CL in the dialysis-patient.

Published
2009

31. Preeclampsia and fetal triploidy: a rarely reported association in nephrologic literature.

Author

Giannattasio M, Gernone G, Pannarale G, Gesualdo L, and Schena FP

Subjects
Adult, Diagnosis, Differential, Female, Fetal Death, Humans, Karyotyping, Pre-Eclampsia diagnosis, Pregnancy, Fetal Diseases diagnosis, Kidney pathology, Polyploidy, Pre-Eclampsia etiology
Abstract

We report a case of a healthy woman - whose previous pregnancy was uncomplicated - with early onset of hypertension, proteinuria and edema, during her second pregnancy. Ultrasound examination at 19th week of amenor rhea showed a fetus with growth retardation, corresponding to 17 weeks' gestation, ascites, cardiomegaly with serious multiple congenital anomalies. Amniocentesis for fetal karyotyping revealed 69, XXX. Because of continued elevated blood pressure, increasing proteinuria and severe lethal fetal anomalies, interruption of pregnancy was suggested. It was subsequently carried out by surgery. The patient underwent renal biopsy 10 days post-partum: histology showed the presence of the characteristic pathologic renal changes of preeclampsia. A year later, she became pregnant by the same partner. The third pregnancy was uneventful. The combination of fetal triploidy and preeclampsia may suggest a causative relationship. Clinically, most cases manifest as severe early-onset preeclampsia and must be differentiated from essential hypertension and a chronic glomerulonephritis (GN), which becomes symptomatic during pregnancy. When a fetus has triploidy, the counseling should stress the high incidence of preeclampsia; particularly when fetal anomaly is not compatible with life, it is well known that delivery of the fetus is curative in this syndrome. This information is important in counseling patients who are hesitant to terminate the pregnancy purely for a fetal abnormality, even if lethal.

Published
2002

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