164 research outputs found
Correction to: Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis (Journal of Nephrology, (2021), 34, 1, (63-73), 10.1007/s40620-020-00774-5)
No full textThe article Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis, written by Simonetta Genovesi, Luca Porcu, Giorgio Slaviero, Gavino Casu, Silvio Bertoli, Antonio Sagone, Monique Buskermolen, Federico Pieruzzi, Giovanni Rovaris, Alberto Montoli, Jacopo Oreglia, Emanuela Piccaluga, Giulio Molon, Mario Gaggiotti, Federica Ettori, Achille Gaspardone, Roberto Palumbo, Francesca Viazzi, Marco Breschi, Maurizio Gallieni, Gina Contaldo, Giuseppe D’Angelo, Pierluigi Merella, Fabio Galli, Paola Rebora, Mariagrazia Valsecchi, and Patrizio Mazzone, was originally published electronically on the publisher’s internet portal on 6 June 2020 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 10 July 2020 to © The Author(s) 2020 and this article is licensed under a Creative Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The original article has been updated
Blood pressure reduction and RAAS inhibition in diabetic kidney disease: therapeutic potentials and limitations
No full textDiabetic kidney disease (DKD) affects approximately one-third of patients with diabetes and taking into consideration the high cardiovascular risk burden associated to this condition a multifactorial therapeutic approach is traditionally recommended, in which glucose and blood pressure control play a central role. The inhibition of renin–angiotensin–aldosterone RAAS system represent traditionally the cornerstone of DKD. Clinical outcome trials have demonstrated clinical significant benefit in slowing nephropathy progression mainly in the presence of albuminuria. Thus, international guidelines mandate their use in such patients. Given the central role of RAAS activity in the pathogenesis and progression of renal and cardiovascular damage, a more profound inhibition of the system by the use of multiple agents has been proposed in the past, especially in the presence of proteinuria, however clinical trials have failed to confirm the usefulness of this therapeutic approach. Furthermore, whether strict blood pressure control and pharmacologic RAAS inhibition entails a favorable renal outcome in non-albuminuric patients is at present unclear. This aspect is becoming an important issue in the management of DKD since nonalbuminuric DKD is currently the prevailing presenting phenotype. For these reasons it would be advisable that blood pressure management should be tailored in each subject on the basis of the renal phenotype as well as related comorbidities. This article reviews the current literature and discusses potentials and limitation of targeting the RAAS in order to provide the greatest renal protection in DKD
Image-processing technique to measure pig activity in response to climatic variation in a pig barn
No full textIn the past decades, the increasing scale of intensive pig farms led farmers to use automatic tools to monitor the welfare and health of their animals. Visual observation and manual monitoring, usually practiced in small-scale farms, is unreliable in large-scale husbandry, and is expensive and time consuming. Environmental parameters are crucial information for the efficient management of piggery buildings, as they have a significant effect on production efficiency, health and welfare of confined animals. The aim of the present study was to evaluate the relationship between pig activity and environmental parameters in a pig building by means of image analysis. The barn for 350 fattening pigs was open-space, mechanically ventilated and subdivided into 16 pens with fully slatted floor. The room was equipped to monitor the ventilation rate, internal and external temperature and relative humidity every minute. For the experiments, two adjacent pens were selected, each 5.9 by 2.6 m, with ∼16 pigs in each. Pigs were continuously monitored during 30 days using an infrared-sensitive CCD camera that was mounted 5 m above the floor. Recorded data were processed in real time by Eyenamic, an innovative software that continuously and automatically registers the behaviour of a group of animals, intended as the activity and occupation indices of the pigs. A preliminary virtual subdivision of the two pens in four zones (two zones for each pen) was performed to evaluate differences in activity/occupation indices in 'front' and 'back' zones of the pen. Recorded images were visually observed in the laboratory to estimate pig activity type in relation to the indices calculated by Eyenamic software. The occupation index showed higher values (up to 0.75 units) in Zones 1 and 4 placed near the corridor. There was a significant relation between pig occupation index measured in the two pens and ventilation rate, temperature and humidity. The interaction between ventilation and humidity and temperature and humidity significantly affected pig movements during the day. Pigs tended to stay in the part of the pen far from the external wall, where air velocity was higher, probably because this is a 'central zone' in the barn, characterised by a reasonable air movement (∼0.30 m/s). On the contrary, the part of the pen nearest to the external wall, characterised by a humid floor surface and by a limited air speed, was occupied by animals at the trough mainly during feeding times and for defecation and urination
Apparent treatment resistant hypertension, blood pressure control and the progression of chronic kidney disease in patients with type 2 diabetes
No full text<b><i>Background/Aims:</i></b> Apparent treatment resistant hypertension (aTRH) is highly prevalent in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The impact of aTRH and achievement of recommended blood pressure (BP) values on the rate of glomerular filtration rate (eGFR) loss in CKD patients is poorly known. To assess the role of aTRH and time-updated BP control (BPC) on the progression of CKD in patients with T2D and hypertension (HT) in real life clinical practice. <b><i>Methods:</i></b> Clinical records from a total of 2,778 diabetic patients with HT and stage 3 CKD (i.e. baseline eGFR values between 30 and 60 ml/min) and regular visits during a four-year follow-up were analyzed. The association between BPC (i.e. 75% of visits with BP &#x3c;140/90 mmHg) and eGFR loss (i.e. a &#x3e;30% reduction from baseline) or worsening of albuminuria status over time was assessed. <b><i>Results:</i></b> At baseline 33% of patients had aTRH. Over the 4-year follow-up, 20% had a &#x3e;30% eGFR reduction. Patients with aTRH had an increased risk of eGFR loss &#x3e;30% (OR 1.31; P&#x3c;0.007). In patients with aTRH, BPC was associated with a 79% (P=0.029) greater risk of eGFR reduction despite a 58% (P=0.001) lower risk of albuminuria status worsening. In non-aTRH, no association was found between BPC and renal outcome. <b><i>Conclusion:</i></b> In patients with stage 3 CKD the presence of aTRH entails a faster loss of eGFR. More effective prevention of aTRH should be implemented as this condition is associated with a burden of risk not modifiable by tight BP reduction.</jats:p
METABOLIC SYNDROME AND MICROALBUMINURIA PREDICT RENAL OUTCOME IN NON DIABETIC PATIENTS WITH PRIMARY HYPERTENSION: THE MAGIC STUDY Author(s):Source: JOURNAL OF HYPERTENSION Volume: 28 Supplement: A Pages: E25-E26 Published: JUN 2010
No full textNatural history and risk factors for diabetic kidney disease in patients with T2D: lessons from the AMD-annals
No full textThe Associazione Medici Diabetologi (AMD) annals initiative is an ongoing observational survey promoted by AMD. It is based on a public network of about 700 Italian diabetes clinics, run by specialists who provide diagnostic confirmation and prevention and treatment of diabetes and its complications. Over the last few years, analysis of the AMD annals dataset has contributed several important insights on the clinical features of type-2 diabetes kidney disease and their prognostic and therapeutic implications. First, non-albuminuric renal impairment is the predominant clinical phenotype. Even though associated to a lower risk of progression compared to overt albuminuria, it contributes significantly to the burden of end-stage renal disease morbidity. Second, optimal blood pressure control provides significant but incomplete renal protection. It reduces albuminuria but there may be a J curve phenomenon with eGFR at very low blood pressure values. Third, hyperuricemia and diabetic hyperlipidemia, namely elevated triglycerides and low HDL cholesterol, are strong independent predictors of chronic kidney disease (CKD) onset in diabetes, although the pathogenetic mechanisms underlying these associations remain uncertain. Fourth, the long-term intra-individual variability in HbA1c, lipid parameters, uric acid and blood pressure plays a greater role in the appearance and progression of CKD than the absolute value of each single variable. These data help clarify the natural history of CKD in patients with type 2 diabetes and provide important clues for designing future interventional studies
Acoustic-reward learning as a method to reduce the incidence of aggressive and abnormal behaviours among newly mixed piglets
No full textThe aim of the study was to test whether aggressive actions among piglets could be redirected by an automatically generated sound signal followed by a sweet food reward. Per round, four litters of 25-day-old piglets (BHZP breed) were trained 5 times per day over 8 days to expect a sweet feed reward from a dog feeder after hearing a specific sound. In total 144 piglets in 14 entire litters were trained in five trials. At the end of the training 71% of the piglets were around the feeder 5 s after the feeder sound. After the training period, the piglets were weaned and mixed in two pens, 12 piglets per pen. During 2 days (3 h/day) after mixing two observers (one per pen) hidden behind a wooden wall activated the feeder when aggressive or abnormal behaviour started. A total of 616 aggressive events and 31 incidences of abnormal behaviour (ear biting) were used for the analysis. The logistic regression showed that the type of behaviour had a significant effect on the piglets' response to the feeder sound (P < 0.001). The results showed the possibility of interruption of the aggressive behaviours such as head thrust [odds ratio (OR) ≤ 0.43], jump on other (OR ≤ 0.56) or attack with bite (OR ≤ 0.61). Ear biting was very unlikely to continue (OR ≤ 0.55). The risk of continuing elevated aggression level behaviours was doubled in the event of chasing (OR ≤ 2.16) and the risk that fight would continue after the feeder sound was released was 7 times higher (OR ≤ 7.89). Categorical analysis showed a significant effect (<0.001) of the time intervals t ≤ 1 s and 1 s < t ≤ 3 s on interruption of aggression by the feeder sound release. The piglets' response to the feeder sound differed significantly between the experimental days (P < 0.001). On the second day of mixing, the feeder sound interrupted 74.9% of aggressive events, compared with 33.7% on the first day. The results suggest that acoustic-reward treatment can distract pigs from performing certain aggressive behaviours and ear biting in piglets when properly applied in time
Impact of CVOTs in primary and secondary prevention of kidney disease
No full textType 2 diabetes mellitus is the leading cause of end stage renal disease worldwide. Diabetic kidney disease, whose main clinical manifestations are albuminuria and decline of glomerular filtration rate, affects up to 40% of patients. Sodium Glucose cotransporter-2 inhibitors (SGLT2-is) and Glucagon-like peptide-1 receptor agonists (GLP-1ras) are new classes of anti-hyperglycemic drugs which have demonstrated to improve renal outcome. Renal benefits of both SGLT2-is and GLP-1ras are acknowledged from data of large randomized phase III clinical trials conducted to assess their cardiovascular safety. In this review, we will focus on renal results of major cardiovascular outcome trials, and we will describe direct and indirect mechanisms through which they confer renal protection
Increased serum uric acid levels are associated to renal arteriolopathy and predict poor outcome in IgA nephropathy
No full textBackground and aims: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a leading cause of end stage renal disease (ESRD). In addition to classical progression factors, other atherosclerosis-related factors, including hyperuricemia (HU), have been associated to the renal progression of IgAN. Increased serum uric acid (SUA) levels are well known to be concomitant of cardiovascular and kidney diseases, and have been proposed to be implicated in the development of arteriolar damage (AD). The aim of the present study was to explore the correlation between SUA levels, renal damage and its implication for outcome in IgAN patients. Methods and results: Clinical, laboratory and histologic data of 145 patients with biopsy proven IgAN were collected and retrospectively analyzed to determine the correlation between SUA levels, renal damage and the primary outcome (death or ESRD). Biopsy-proven AD was defined by the presence of arteriolar hyalinosis and/or intimal thickening. HU, defined as the highest SUA gender-specific tertile, was >7.7 mg/dl for males and >6.2 mg/dl for females. The prevalence of AD increased with the increase in the SUA level tertiles (p = 0.02). At logistic regression analysis SUA was independently related to the presence of AD (OR 1.75 [95%CI 1.10–2.93], p = 0.03). HU and AD had a synergic impact on progression of IgAN. Patients having both AD and HU, showed a reduced survival free from the primary outcome as compared to those having only one risk factor or neither (p = 0.01). Conclusions: SUA levels are independently associated with AD and poor prognosis in patients with IgAN
Real-time monitoring tool for pig welfare
No full textRecently, the support for improving animal welfare in livestock farming has been increased in the EU. The objective of this research is to develop an automatic camera-based system for continuously monitoring of the pigs' behaviour in a contactless way in order to understand the effect of environment on pigs. Therefore, a measure for the activity level calculated from camera images was proposed. The activity index was calculated for the group of pigs as the fraction of the floor space in the pen that contained motion in between two subsequent camera images. Finally, the effect of environment enrichment and its induced behaviour on the activity level of pigs is quantified. This suggests that in these experimental conditions, the increase in the activity level following the introduction of the environment enrichments accounted for 34.3% of the total activity level
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