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Inflammation, oxidative stress (OS), atherosclerosis and resistant hypertension (RH) are common features of chronic kidney disease (CKD) leading to a higher risk of death from cardiovascular disease. These effects seem to be modulated by impaired anti-oxidant, anti-inflammatory and reverse cholesterol transport actions of high-density lipoprotein cholesterol (HDL). HDL prevents and reverses monocyte recruitment and activation into the arterial wall and impairs endothelial adhesion molecule expression. Recently, monocyte count to HDL-cholesterol ratio (MHR) has emerged as a potential marker of inflammation and OS, demonstrating to be relevant in CKD. Our research was aimed to assess, for the first time, its reliability in RH. We performed a retrospective study on 214 patients with CKD and arterial hypertension who were admitted between January and June 2019 to our Department, 72 of whom were diagnosed with RH. MHR appeared inversely related to eGFR (ρ = − 0.163; P = 0.0172). MHR was significantly higher among RH patients compared to non-RH ones (12.39 [IQR 10.67–16.05] versus 7.30 [5.49–9.06]; P

La trasmissione dei fitoplasmi attraverso il seme è una questione dibattuta e controversa a causa della ridotta conoscenza sulle connessioni tra pianta-madre ed embrione a livello floematico. I fitoplasmi sono stati rinvenuti in diverse parti della pianta compresi gli organi riproduttivi, l’embrione ed i frutti e la produzione di semi in piante infette risulta ridotta. Recenti studi hanno evidenziato che le infezioni tardive, in particolare nelle colture erbacee, possono consentire una normale produzione di semi. Inoltre, anche in presenza di anomalie in fiori e frutti, i semi prodotti possono essere vitali e con buona capacità di germinazione. Nella sperimentazione si sono utilizzati semi di Sesamum indicum, Brassica napus, Solanum lycopersicum e Zea mays prodotti da piante-madri infette da fitoplasmi. Le piantine ottenute sono state saggiate a 40 e a 90 giorni dalla germinazione ed il 90% dei campioni di S. indicum è risultato positivo per fitoplasmi dei gruppi ribosomici 16SrI, 16SrII e 16SrXII-A sia a 40 che a 90 giorni. L'85% dei campioni di B. napus è risultato positivo per i fitoplasmi appartenenti a gruppi ribosomici 16SrI e 16SrXII-A a 40 e 90 giorni. Il 20% dei campioni di S. lycopersicum è risultato positivo per fitoplasmi dei gruppi ribosomici 16SrI e 16SrXII-A a 40 giorni dalla germinazione mentre solo il 10% è risultato positivo a 90 giorni dalla germinazione. Da queste piante di pomodoro sono state ottenute bacche i cui semi hanno dato origine a piante di seconda generazione risultate a loro volta positive (12%) a fitoplasmi appartenenti ai gruppi ribosomici 16SrI e 16SrXII-A, indicando la presenza di fitoplasmi anche nella seconda generazione di piante. Il 20% dei campioni di Z. mays è risultato positivo a fitoplasmi 16SrI e 16SrXII-A a 40 giorni dalla germinazione e il 10% è risultato ancora positivo a 90 giorni. Da alcuni di questi campioni di mais è stato eseguito l'isolamento dalle nervature, in substrato CB: da alcune piante (mais 3E, 4.5, 4E, 1.1, 1.2 e 1D), positive a 90 giorni, è stato possibile ottenere colonie di diverse dimensioni e forma, alcune delle quali sono risultate positive alla presenza di fitoplasmi 16SrI (“aster yellows”). Dai campioni di mais 3E, 4.5 e 4E si sono ottenute colonie anche da brodi mantenuti per 7 mesi a 25°C dopo l'isolamento iniziale. Dal campione di mais 3E si sono ottenute alcune colonie di piccole dimensioni poi sottoposte a passaggi di purificazione da substrato liquido a solido; anche queste colonie sono risulte positive ad “aster yellows”. Si sono ottenute colonie da almeno 3 passaggi successivi da substrato liquido a solido eseguiti ogni 5 giorni. I risultati indicano la vitalità del fitoplasma “aster yellows”, isolato da piantine di mais ottenute da seme infetto e mantenute in ambiente privo di insetti e confermano la trasmissione di fitoplasmi vitali attraverso il seme.

BACKGROUND: Parathyroidectomy (Ptx) ameliorates anemia (A) and reduces postoperative erythropoiesis-stimulating agent (ESA) requirement. The authors retrospectively evaluated the effects of successful Ptx on chronic A and ESA need in 30 2HPT patients. METHODS: From 2004 to 2009,30 anemic hemodialysis (HD) patients, affected by severe 2HPT, underwent Ptx -15 total parathyroidectomy (TP) and 15 TP + subcutaneous autoimplantation (TPai). Patients were evaluated for iPTH, hemoglobin (Hb) levels, erythrocyte count, hematocrit and erythropoietin dosing before and at 6, and 12 months after surgery. RESULTS: In every case, Ptx achieved a dramatic reduction of iPTH levels. In 26/30 cases(86.6%) an improvement of Hb levels was observed,and 27/30 (90%) patients did not need postoperative ESA treatment,irrespective of the type of surgical procedure carried out (TP or TPai). CONCLUSIONS: Successful Ptx for 2HPT of CKD determined a considerable improvement of A,reducing exogenous ESA need.In 2HPT of HD patients A is a secondary indication to surgical treatment,but we propose that this condition should be taken into more careful account, given the high costs of ESA therapy. Background: Parathyroidectomy (Ptx) ameliorates anemia (A) and reduces postoperative erythropoiesis-stimulating agent (ESA) requirement. The authors retrospectively evaluated the effects of successful Ptx on chronic A and ESA need in 30 2HPT patients. Methods: From 2004 to 2009,30 anemic hemodialysis (HD) patients, affected by severe 2HPT, underwent Ptx -15 total parathyroidectomy (TP) and 15 TP + subcutaneous autoimplantation (TPai). Patients were evaluated for iPTH, hemoglobin (Hb) levels, erythrocyte count, hematocrit and erythropoietin dosing before and at 6, and 12 months after surgery. Results: In every case, Ptx achieved a dramatic reduction of iPTH levels. In 26/30 cases(86.6%) an improvement of Hb levels was observed,and 27/30 (90%) patients did not need postoperative ESA treatment,irrespective of the type of surgical procedure carried out (TP or TPai). Conclusions: Successful Ptx for 2HPT of CKD determined a considerable improvement of A,reducing exogenous ESA need.In 2HPT of HD patients A is a secondary indication to surgical treatment,but we propose that this condition should be taken into more careful account, given the high costs of ESA therapy.

Hydrogen sulfide, (H2S), is an endogenous gas which exerts a protective function in several biological processes, including those involved in inflammation, blood pressure regulation, and energy metabolism. The enzymes involved in H2S production are cysthationine -synthetase, cysthationine -lyase and 3-mercaptopyruvate sulfurtransferase. Low plasma H2S levels have been found in chronic renal failure (CRF) in both humans and animal models. The mechanisms leading to H2S deficiency in CRF are linked to reduced gene expression of cysthationine -lyase. Intense research is currently under way to discover the link between low H2S levels, CRF progression and the uremic syndrome and to determine whether therapeutic interventions aimed at increasing H2S levels might benefit these patients.

Objective: Uremia represents a state where hyperhomocysteinemia is resistant to folate therapy, thus undermining intervention trials' efficacy. N-acetylcysteine (NAC), an antioxidant, in addition to folates (5-methyltetrahydrofolate, MTHF), was tested in a population of hemodialysis patients. Design: The study is an open, parallel, intervention study. Setting: Ambulatory chronic hemodialysis patients. Subjects: Clinically stable chronic hemodialysis patients, on hemodialysis since more than 3 months, undergoing a folate washout. Control group on standard therapy (n = 50). Intervention: One group was treated with intravenous MTHF (MTHF group, n = 48). A second group was represented by patients treated with MTHF, and, during the course of 10 hemodialysis sessions, NAC was administered intravenous (MTHF + NAC group, n = 47). Main Outcome Measure: Plasma homocysteine measured before and after dialysis at the first and the last treatment. Results: At the end of the study, there was a significant decrease in predialysis plasma homocysteine levels in the MTHF group and MTHF + NAC group, compared with the control group, but no significant difference between the MTHF group and MTHF + NAC group. A significant decrease in postdialysis plasma homocysteine levels in MTHF + NAC group (10.27 ± 0.94 μmol/L, 95% confidence interval: 8.37-12.17) compared with the MTHF group (16.23 ± 0.83, 95% confidence interval: 14.55-17.90) was present. In the MTHF + NAC group, 64% of patients reached a postdialysis homocysteine level

Few studies address alteration of sexual function in women with diabetes and chronic kidney disease (CKD). Quality of life surveys suggest that discussion of sexual function and other reproductive issues are of psychosocial assessment and that education on sexual function in the setting of chronic diseases such as diabetes and CKD is widely needed. Pharmacologic therapy with estrogen/progesterone and androgens along with glycemic control, correction of anemia, ensuring adequate dialysis delivery, and treatment of underlying depression are important. Changes in lifestyle such as smoking cessation, strength training, and aerobic exercises may decrease depression, enhance body image, and have positive impacts on sexuality. Many hormonal abnormalities which occur in women with diabetes and CKD who suffer from chronic anovulation and lack of progesterone secretion may be treated with oral progesterone at the end of each menstrual cycle to restore menstrual cycles. Hypoactive sexual desire disorder (HSDD) is the most common sexual problem reported by women with diabetes and CKD. Sexual function can be assessed in women, using the 9-item Female Sexual Function Index, questionnaire, or 19 items. It is important for nephrologists and physicians to incorporate assessment of sexual function into the routine evaluation protocols.

Several factors contribute to sexual dysfunction (SD) in patients with chronic kidney disease (CKD) and some of them are less frequent in general population. Hormonal alterations along with vascular, neurologic, and psychosocial factors and drugs contribute to the development of SD. Low levels of testosterone in men with CKD can be responsible to alterations in libido, erectile function, spermatogenesis, and sperm motility. Erectile dysfunction (ED) is the persistent inability to achieve and/or maintain an erection sufficient for satisfactory sexual intercourse. Risk factors for ED can be grouped into those that have an effect upon the vasculature, those in which the mode of action is nonvascular in nature, and age.

Background: L-Carnitine, the acyl carrier into mitochondria, is derived from trimethyllysine. The formation of the latter compound is catalyzed by an S-adenosylmethionine methyltransferase, yielding S-adenosylhomocysteine (AdoHcy), the homocysteine direct precursor, as a product. Aim of this work was to determine if exogenously administered L-propionyl carnitine affects plasma levels of homocysteine, a cardiovascular risk factor, and its active metabolite AdoHcy, in chronic renal failure patients on hemodialysis. Methods: Plasma homocysteine and AdoHcy were determined by means of HPLC separation and detection in 14 hemodialysis patients before and after two months of i.v. L-propionyl carnitine treatment. Results: No significant differences were observed in plasma concentrations of homocysteine or AdoHcy after therapy. Conclusions: Treatment with a carnitine derivative does not significantly influence the plasma concentrations of homocysteine or of its active metabolite, AdoHcy, which are involved as risk factors for cardiovascular disease in chronic hemodialysis patients. © Società Italiana di Nefrologia.

Cardiovascular disease is a very early phenomenon in the course of chronic renal failure, and increases continuously with decrease of renal function. Endothelial dysfunction seems to be a starting point in vascular changes leading to atherosclerosis and artery calcification. Endothelium, considered the largest organ in the body, has many functions. It senses mechanical and hormonal stimuli and in response the endothelial cells secrete a range of compounds which modulate vascular tone, coagulation, cell proliferation, and inflammation. The central role of endothelium in the development of vascular disease has led to identification of new relevant biomarkers and methods to estimate endothelial function and injury. Arterial stiffness, which is not an early phenomenon in endothelial dysfunction but a common complication of chronic renal failure may be evaluated through Pulse Wave Velocity and Augmentation Index obtained by pulse-wave analysis. Aortic stiffness is an independent predictor of cardiovascular morbidity and mortality in patients with hypertension. A new fascinating aspect of research in endothelial function is rising through the studies on endothelial progenitor cells. These are primitive bone marrow cells that have the ability to mature into endothelial cells and have a physiologic role in the repair of endothelial lesions.