1,355,774 research outputs found
Correction to: Phase-contrast magnetic resonance imaging to assess renal perfusion: a systematic review and statement paper, in "Magnetic Resonance Materials in Physics, Biology and Medicine", 33 (2020), 1, pp. 3-21, doi: 10.1007/s10334-019-00772-0
No full textThe article Phase‐contrast magnetic resonance imaging to assess renal perfusion: a systematic review and statement paper, written by Giulia Villa, Steffen Ringgaard, Ingo Hermann, Rebecca Noble, Paolo Brambilla, Dinah S. Khatir, Frank G. Zöllner, Susan T. Francis, Nicholas M. Selby, Andrea Remuzzi and Anna Caroli, was originally published electronically on the publisher’s internet portal on 17 August 2019 without open access
Ci curano o ci curiamo? Il malato tra crisi economica e responsabilità indivduale
No full textIn medicina si sono realizzati più cambiamenti negli ultimi cinquanta anni che nei secoli precedenti. Le scoperte della medicina hanno modificato profondamente l'aspettativa di vita, che dagli inizi del Novecento a oggi è raddoppiata, pur con enormi disparità tra le diverse zone del mondo. Nei paesi sviluppati, ma anche in quelli emergenti, le malattie infettive non sono più le cause principali di morte, oggi costituite da malattie croniche e tumori. Se lo straordinario sviluppo delle conoscenze ha reso disponibili terapie sofisticate, ha determinato anche l'esplodere del costo dei sistemi sanitari dei paesi sviluppati, che paventano ora l'insostenibilità delle conquiste della medicina. Tanto meno possono trarre vantaggio da queste conquiste molti paesi poveri che non hanno i mezzi per accedere a terapie innovative.
Su questi e altri aspetti i più autorevoli scienziati italiani hanno raccontato e descritto quelle che saranno le principali sfide che attendono la nostra società. Gli articoli scritti da Giuseppe Remuzzi sul Corriere della Sera sono uno stimolo alla riflessione. Antonio Maturo ha invece fornito l'inquadramento sociologico.
L'inequità nell'accesso alle cure è oggi uno dei problemi morali più importanti posti alla coscienza di quanti lavorano per la salute dell'uomo
A novel interpretation of the role of von Willebrand factor in thrombotic microangiopathies based on platelet adhesion studies at high shear rate flow
No full textClinical manifestations of thrombotic microangiopathles (TMA) are secondary to platelet aggregation and thrombotic occlusion of the microvasculature of the affected organs. Abnormalities in von Willebrand factor (vWF) in these patients were considered instrumental in promoting the process leading to microvascular thrombosis. We evaluated the capacity of plasma in these patients to induce adhesion of normal platelets and thrombus formation under conditions of controlled fluid shear stress. We also studied vWF multimeric distribution to establish whether abnormalities of this glycoprotein correlate with platelet adhesion and thrombus formation. Plasma from patients in the acute phase and remission showed the same capacity to induce platelet adhesion and thrombus formation at a low level of shear rate (600 sec-1) as plasma from control subjects. At a high shear rate (1,500 sec-1), platelet adhesion and thrombus dimensions were significantly increased (P < 0.05) by plasma from patients with TMA compared with controls. The capacity to enhance thrombus formation at high shear stress was present during the acute phase and disease remission and did not correlate with the presence of unusually large vWF multimers. Increased thrombus formation with patient plasma is completely normalized by blocking the interaction of vWF with the platelet receptors, glycoprotein (GP)Ib and GPIIb-IIIa, suggesting that the phenomenon is completely mediated by vWF. Our results suggest the possibility of an intrinsically altered vWF molecule in these patients that is probably more effective than normal vWF in mediating platelet adhesion and thrombus formation. (C) 2000 by the National Kidney Foundation, Inc
ACE inhibition induces regression of proteinuria and halts progression of renal damage in a genetic model of progressive nephropathy
No full textExperimental data consistently indicate that renal disease progression is fully prevented in proteinuric glomerulopathies by long-enough angiotensin-converting enzyme (ACE) inhibition therapy. Whether regression of established proteinuria to normal can be achieved is, however, ill defined. The current study was designed with the aim to clarify whether ACE inhibition may induce regression of established proteinuria and renal structural damage in MWF rats, a genetic model of progressive proteinuria and renal injury. Animals treated with the ACE inhibitor lisinopril from 20 weeks of age (time when proteinuria is already important) and age-matched untreated rats were followed for 10 weeks. ACE inhibition normalized systolic blood pressure and progressively reduced proteinuria (from 172 ± 79 to 81 ± 23 mg/24 hours). In these animals, a highly significant correlation was obtained between baseline proteinuria and antiproteinuric response. At variance in untreated rats, proteinuria showed a marked increase in the 10-week follow-up period (from 165 ± 57 to 325 ± 86 mg/24 hours). Lisinopril prevented the progression of renal damage, as documented by a significantly lower incidence of glomeruli affected by sclerotic lesions (P < 0.01) than in untreated animals after the 10-week study period. Kidney tissue damage was comparable in lisinopril-treated rats and in untreated animals at 20 weeks of age, indicating that structural changes were arrested by the treatment. Thus, in proteinuric MWF rats, late-onset ACE inhibition normalized blood pressure, effectively and progressively restored high protein excretion rate toward normal values, and arrested progression of tissue damage
Renal bioengineering with scaffolds generated from rat and pig kidneys
No full textBackground: Chronic kidney disease (CKD) is a global public health issue with an estimated prevalence of 8-16% worldwide. End-stage renal disease eventually develops every year in 0.15-0.2% of patients with overt CKD, and renal replacement therapy (RRT) with dialysis or transplantation is required. Although approximately 2 million people worldwide are currently on RRT to sustain life, this likely represents less than 10% of those who need it. The kidney transplant approach is also seriously impaired by limited graft survival and by the scarce availability of donors. Innovative tissue-engineering strategies have been recently proposed to overcome these challenges. It is anticipated that these novel approaches will also be cost-effective in the long term. Although the initial setup of these innovative technologies could be quite expensive, there would be a single application for each patient, with no additional costs thereafter, compared to the lifelong costs of dialysis or immunosuppressive medications required for transplantation. One of the most innovative tools currently being investigated in experimental models is based on the idea of using decellularized kidneys to engineer a new functional organ as a potential future treatment option for end-stage renal disease. Summary: In the last 5 years, several interesting observations have been reported regarding the possibility of using an acellular matrix from the whole kidney and the attempt to recellularize this scaffold using stem or differentiated cells. This review provides an overview of the decellularization methods tested so far and their effects on the resulting extracellular matrix structure and composition. In addition, we also discuss methods recently described by us and others for the perfusion of kidney scaffolds for recellularization. Key Messages: Despite difficulties in achieving the import goal of kidney engineering in the laboratory, we discuss the problems with and limits of the experimental results obtained so far and point out the strategies that need to be adopted in order for this line of research to advance
Angiotensin-Converting Enzyme Inhibition Ameliorates the Defect in Glomerular Size Selectivity in Hyponatremic Hypertensive Syndrome
No full textThe glomerular size-selective properties in a patient with “hyponatremic hypertensive syndrome” were investigated before and after administration of the angiotensin-converting enzyme inhibitor enalapril. Hyponatremic hypertensive syndrome is a rare condition of renovascular hypertension characterized by electrolyte anbormalities (hyponatremia, hypokalemia), polyuria, and high renin activity. In this patient a marked increase in urinary protein excretion was observed. Treatment with enalapril normalized BP, corrected electrolyte abnormalities, and reduced proteinuria. Glomerular filtration rate (GFR), renal plasma flow (RPF), and the clearance of neutral dextrans of graded sizes were measured before and after 6 months of enalapril (20 mg/d) administration. Theoretical analysis of dextran and inulin clearance data with a model of glomerular size selectivity were adopted to separate effects of hemodynamic changes on macromolecule filtration from changes of intrinsic membrane selective properties. After enalapril urinary protein excretion decreased, GFR was unchanged and RPF almost doubled. Fractional clearance values of dextran molecules were markedly elevated in comparison with the corresponding values measured in a group of normal controls and were normalized by enalapril. Theoretical calculation of membrane pore characteristics showed that enalapril treatment reduced the radius of all membrane pores by approximately 1 nm. Altogether these results indicate that enalapril normalized glomerular filtration of neutral macromolecules and circulating proteins in a human condition of angiotensin II-induced proteinuria. Enalapril effectively restored glomerular size-selective function, reducing dimensions of membrane pores, independently of its effect on renal hemodynamics. © 1989, National Kidney Foundation, Inc.. All rights reserved
Recellularization of Kidney Scaffold With Stem Cells
No full textRenal transplantation is the ideal method for restoring renal function in patients affected by end-stage renal disease. However, the shortage of donor organs and the increasing number of patients waiting for a transplant create a need to develop renal replacement therapy as an alternative to traditional organ transplantation. The potential of decellularized scaffolds derived from native organs has been evolved as a promising approach in regenerative medicine for translating functional organ replacements. However, anatomical complications make kidney regeneration difficult. Here, we review recent advances in the field of kidney regeneration describing how the type of cells and the source of cells used to repopulate the three-dimensional extracellular matrix scaffold are critical to the eventual functionality of the bioengineered organs. Moreover, we present a thorough review of the current literature of whole kidney recellularization
Vitamin D, insulin resistance, and renal disease
No full textChonchol and Scragg report the results of a population study on levels of 25-hydroxyvitamin D in patients with renal dysfunction. They demonstrate that these patients do not show vitamin D deficiency unless renal function is severely affected (GFR<29 mL/min/1.73m2), while vitamin D and renal function loss are independently associated with insulin resistance. These data provide more solid evidence than previous available studies on small patient groups, and pose new questions about the mechanisms responsible for progressive renal disease as well as potential effects of vitamin D supplementation
Gianni Remuzzi (1894-1951). L'onestà della scultura
No full textIl volume rappresenta il primo catalogo ragionato dedicato allo scultore bergamasco Gianni Remuzzi che fu allievo di Angelo Zanelli a Roma, nella metà degli anni Venti e maestro d'Accademia, tra gli altri, di Piero Brolis, Stefano Locatelli e Ferruccio Guidotti
Pharmacological and clinical profile of valsartan
No full textThe development of angiotensin II (Ang II) receptor antagonists is one of the latest advances in the pharmacological treatment of hypertension and other related diseases. Since the antagonism of angiotensin biological activity has been shown to represent a potent way to favorably affect systemic hypertension, its use is becoming more and more widespread among clinical practice. Besides the originally developed inhibitors of angiotensin II converting enzyme, today molecules that are effective in selectively blocking the type I angiotensin II receptor are available. In this report we describe the main characteristics of one of these compounds, the angiotensin receptor antagonist valsartan, in terms of pharmacological profile as well as efficacy and tolerability. The main purpose is to provide a comprehensive description of the knowledge gained during several years of experimental and clinical studies that can be useful for guidance during the choice for treatment of hypertension, as well as to obtain other potential beneficial effects of this drug on progressive organ damage related to hypertension
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