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Giovanni B Fogazzi

Publications and source records attributed to Giovanni B Fogazzi.

15 recordsLinked to original sources
PubMed2004

Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial.

Proteinuria plays a causal role in the progression of IgA nephropathy (IgAN). A previous controlled trial showed that steroids are effective in reducing proteinuria and preserving renal function in patients with IgAN. The objective of this study was to evaluate the long-term effectiveness of steroids in IgAN, examine the trend of proteinuria during follow-up (starting from the hypothesis that the degree of reduction in proteinuria may influence IgAN outcome), and evaluate how histologic scores can influence steroid response. A secondary analysis of a multicenter, randomized, controlled trial of 86 adult IgAN patients who were receiving supportive therapy or intravenous methylprednisolone plus oral prednisone for 6 mo was conducted. Ten-year renal survival was significantly better in the steroid than in the control group (97% versus 53%; log rank test P = 0.0003). In the 72 patients who did not reach the end point (doubling in baseline serum creatinine), median proteinuria significantly decreased (1.9 g/24 h at baseline, 1.1 g/24 h after 6 mo, and 0.6 g/24 h after a median of 7 yr). In the 14 progressive patients, proteinuria increased from a median of 1.7 g/24 h at baseline to 2.0 g/24 h after 6 mo and 3.3 g/24 h after a median of 5 yr. Steroids were effective in every histologic class. Cox multivariate regression analyses showed that, in addition to steroids, a low baseline histologic score, a reduction in proteinuria after 6 mo, and no increase in proteinuria during follow-up all were independent predictors of a beneficial outcome. Steroids significantly reduce proteinuria and protect against renal function deterioration in IgAN. The histologic picture and proteinuria during early and late follow-up improve the prediction of outcome, but considerable variability remains outside the model.

Adrenal Cortex Hormones↗
PubMed2003

A nephrological program in Benin and Togo (West Africa).

BACKGROUND: Nephrological programs are scarce in Benin and Togo, which are two small developing countries located in West Africa. This article describes a voluntary-based nephrological program that has recently been established in one hospital in north Benin and in another in south Togo. METHODS: The program included: (1) care of patients with a renal disease; (2) improvement of urinalysis; (3) introduction of serum Na+ and K+ measurements; and (4) screening of renal diseases. This was carried from the records of patients with serum creatinine >/=2.0 mg/dL and of patients with a >/=+++ albuminuria, and the distribution to doctors of a questionnaire. RESULTS: (1) Renal patients were seen on each visit at both hospitals; most had advanced renal failure or nephrotic syndrome. However, due to the lack of major diagnostic and therapeutic facilities, the management of such patients was often difficult. (2) Urinalysis was improved through the introduction of dipsticks for the evaluation of the 10 parameters, the introduction of phase contrast microscopy, and the permanent education of two laboratory technicians. (3) The introduction of flame photometry for the measurement of serum Na+ and K+ was unsuccessful probably due to the poor quality of water and/or gas. (4) In a year, patients in the Benin hospital who had serum creatinine values >/=2.0 mg/dL represented about 3.3% and patients with >/=+++ albuminuria represented 1.0% of all admissions. The questionnaire was answered by seven physicians working in three different institutions in Benin and in one in Togo. It revealed that basic diagnostic and therapeutic facilities, such as electrolyte measurement, urine culture, renal biopsy, and dialysis are either lacking or are available only for the few patients who can afford to pay. CONCLUSIONS: Severe renal diseases are found frequently in patients of Benin and Togo. However, due to the lack of money and basic diagnostic and therapeutic facilities, these patients cannot be properly managed.

Benin↗
PubMed2003

Light chain deposition disease with renal involvement: clinical characteristics and prognostic factors.

BACKGROUND: Light chain deposition disease (LCDD) is characterized by the tissue deposition of monotypical immunoglobulin light chains (LCs). The aim of this study was to investigate its clinical characteristics and prognostic factors. METHODS: Multicenter study of LCDD with renal and patient survival analyses. RESULTS: Sixty-three cases were studied (age: 58 +/- 14.2; males: 63.5%; kappa/lambda deposition: 68/32%; underlying disorders: multiple myeloma [MM] 65%, lymphoproliferative disorders 3%, idiopathic 32%). Ninety-six percent presented with renal insufficiency (acute, 52%; chronic, 44%), and 84% with proteinuria >1 g/d. During the follow-up, 36 patients reached uremia (incidence rate: 23.7/100 patient-years) and 37 died (17.5/100 patient-years). The factors independently associated with a worse renal prognosis were age (relative risk [RR], 1.05; 95% confidence interval [CI], 1.009 to 1.086) and serum creatinine at presentation (RR, 1.24; 95% CI, 1.02 to 1.5). Those independently associated with a worse patient survival were age (RR, 1.06; 95% CI, 1.03 to 1.1), MM (RR, 2.75; 95% CI, 1.22 to 6.2), and extrarenal LC deposition (RR, 2.24; 95% CI, 1.15 to 4.35). While kappa-LC deposition was more frequently associated with nodular sclerosing glomerulopathy, histological parameters were not predictors of renal/patient prognosis. The survival of the uremic patients undergoing dialysis was similar to that of patients not reaching uremia. CONCLUSION: LCDD is characterized by renal insufficiency with proteinuria and has a severe prognosis. Apart from age, the prognostic factors identified were degree of renal insufficiency at presentation affecting the renal prognosis, underlying hematologic disorder and extrarenal LC deposition affecting the patient prognosis. Dialysis is worth performing in uremic LCDD patients.

Adrenal Cortex Hormones↗
PubMed2003

The clinical art and science of urine microscopy.

PURPOSE OF REVIEW: The examination of urine sediment is a diagnostic test which is frequently neglected by nephrologists. With this review the authors wanted to demonstrate that it can provide useful and relevant information in a wide spectrum of clinical situations. RECENT FINDINGS: The authors reviewed the main contributions dealing with urine sediment examination, published in international journals in the period from January 2002 to April 2003. After a section on methodological aspects, they described the importance of urine sediment examination in various diseases of the urinary tract. These included bladder B-lymphoma, systemic histoplasmosis, urate nephropathy, Fabry disease, myeloma cast nephropathy, giant cell arteritis, and lupus nephritis. The significance of 'decoy cells' in the urine as a marker of polyomavirus BK reactivation was also discussed, both in renal transplantation and other conditions such as solitary pancreas transplantation, chronic lymphatic leukaemia, and HIV infection. In the section devoted to urine sediment changes caused by drugs the authors dealt with leukocyturia induced by indinavir, and crystalluria, which can follow amoxycillin and acyclovir administration. Finally, they reported on the utility and limits of flow cytometry for the automated analysis of urine sediments. SUMMARY: The review of the recent literature on urine sediment examination shows that this test has important clinical implications in a large spectrum of diseases. Therefore, it should be more widely used by nephrologists.

BK Virus↗
PubMed2002

The farsighted studies of the Italian Carlo L. Rovida (1844-1877) on the nature of urinary casts.

Carlo L. Rovida (1844-1877) was an Italian physician who graduated in Pavia (1866) and worked in Milan (1868) and Turin (1874), where he ran the Institute of Clinical Medicine at the university. Between 1870 and 1876 Rovida published several studies on the nature of urinary casts, which can still be considered valid today. He distinguished two main types of casts, i.e., "colorless" (hyaline) and "yellowish" (waxy). By painstaking microscopic observation of the urine, performed mainly by microchemical techniques, and histological examination of the kidneys, he came to the conclusion that both types of casts were produced by tubular cells. In addition, he found that the colorless casts were composed of a unique protein, which was different from any other protein known at the time, and which he called "cilindrina" (cylindrine). Instead, Rovida found that the yellowish casts contain a different, ill-defined protein, which was also present in the lateral and basal membrane of the tubular cells. Rovida should be remembered today because his views were much ahead of the prevailing theories of the time, which considered the casts as coagulated fibrin (a view sustained mainly in Germany) or as elements derived from either tubular degeneration or tubular production (a view sustained mainly in the United Kingdom and Sweden); his results concerning the site of production of hyaline casts and their unique nature were confirmed 90 years later, in the early 1960s, when it was demonstrated that these casts are made of Tamm-Horsfall glycoprotein, a protein which is produced by the cells of Henle's loop; and his conclusions about the special nature of waxy casts were also correct. In fact, even though the true composition of these casts is still not yet totally clear, there is now evidence that they contain a substance different from Tamm-Horsfall protein. Rovida is also a paradigm of how the progress of science is strictly dependent on the development of technology. In fact, it was only when appropriate techniques (e.g., electrophoresis, immunoelectrophoresis, and immunofluorescent microscopy) became available that the nature of casts could be defined with certainty.

History, 19th Century↗
PubMedDate not supplied

Maintenance dialysis in patients from developing countries: the experience of an Italian center.

BACKGROUND: There are few studies concerning the clinical problems of patients from developing countries undergoing dialysis in European countries. This retrospective study aimed to describe the main clinical features of a group of these patients who happened to be on maintenance dialysis in our unit. METHODS: Analysis of the clinical features at presentation and at follow-up of a group of patients from developing countries who entered chronic dialysis in our unit over an 8 year period. RESULTS: From April 1994 to December 2001, 12 patients (eight males and four females, mean age 38.2 +/- 7.9 yrs) from developing countries (the Philippines (n=5); Egypt (n=4); Morocco (n=1); Mauritius (n=1); Sri-Lanka (n=1)) entered maintenance dialysis in our unit (six hemodialysis (HD) patients, six continuous ambulatory peritoneal dialysis (CAPD) patients). The cause of renal failure was severe/very severe hypertension in five patients (four of whom presented with very advanced end-stage renal disease (ESRD)), chronic glomerulonephritis in four patients, amyloidosis, type 2 diabetic nephropathy, and unknown causes in three patients. After a mean follow-up of 45.3 +/- 32.0 months (median 33, range 18-111), five patients continued on HD, two patients were on CAPD, whilst four patients received a renal transplant and one patient a renal and liver transplant. An important feature of our patients was the high infection rate (67%), such as tuberculosis (n=3), B and/or C viral hepatitis (n=4) and schistosomiasis (n=1). Of note were the clinical problems that developed after visits to the patients' native countries, during which the patients were dialyzed locally. After 5/20 visits (25%), three patients experienced a worsening of anemia (four incidences) and active hepatitis C development (one incidence). CONCLUSIONS: Our study demonstrates that patients from developing countries on maintenance dialysis differ from our local Italian dialysis population in several respects. These are young age, causes of renal failure, frequently late referral, high infection rates, and the clinical complications due to patients' visits to their native countries.

Adult↗
PubMedDate not supplied

Urinary sediment features in proliferative and non-proliferative glomerular diseases.

BACKGROUND: The studies on urine sediment particles in patients with glomerular diseases (GD) are few and have focused only on single urine particles. In this study, we investigated the prevalence and number of 12 urine sediment particles in two groups of patients, one with proliferative GD, and the other with non-proliferative GD. METHODS: The urine sediment of 100 consecutive patients, with a renal biopsy-proven proliferative or non-proliferative GD and marked cylindruria, were examined a few hours before renal biopsy according to a standardized method. The urine particles investigated were erythrocytes, leukocytes, renal tubular cells, lipids and hyaline, hyaline-granular, granular, waxy, erythrocytic, leukocytic, epithelial and fatty casts. RESULTS: Patients with proliferative GD (n=52) had both a significantly higher prevalence of microscopic hematuria, leukocyturia, tubular epithelial cells, erythrocytic casts, epithelial casts, and significantly higher amounts of erythrocytes,leukocytes, tubular epithelial cells/20 high power field (HPF), erythrocytic and epithelial casts. On the other hand, patients with non-proliferative GD (n=48) had significantly higher numbers of fatty casts. In proliferative GD, leukocyturia was associated with intracapillary and extracapillary proliferation, crescents and fibrinoid necrosis at renal biopsy. At discriminant analysis, the two types of GD could be identified with 80.8% sensitivity and 79.2% specificity. By multiple logistic regression analysis, patients with erythrocytes, leukocytes and erythrocytic casts in the urine had an odds ratio (OR) of 9.91 (95% confidence interval (95% CI): 1.01-97.51), 7.85 (95% CI: 2.77-22.20), and 4.33 (95% CI: 1.41-13.31), respectively, of having proliferative GD. CONCLUSIONS: Our examination of the urine sediment shows that proliferative GD and non-proliferative GD differ in many respects.

Biopsy↗
PubMedDate not supplied

Skin infection due to Alternaria species in kidney allograft recipients: report of a new case and review of the literature.

A kidney allograft recipient developed a cutaneous infection 29 months after transplantation, due to the dematiaceous fungus Alternaria infectoria on his right forearm and left leg. Since the lesions were too large to be excised, the patient was treated only with systemic itraconazole and a reduction of the immunosuppressive therapy. After 4 months, the lesions were completely healed, and no relapses were observed at follow-up of 22 months. Twenty-seven other cases of cutaneous alternariosis have been described so far in renal transplant recipients. All types of immunosuppressive treatment can be associated with Alternaria infection, for which predisposing factors are jobs with frequent contact with earth, diabetes mellitus and skin trauma. In 70% of cases the infection occurred within the first year after transplantation. More frequently the lower limbs were involved and the lesions were multiple. Alternaria alternata was the commonest causative agent, followed by Alternaria tenuissima,Alternaria infectoria and Alternaria chartarum. The treatment is far from being standardized, but the best results are obtained with the surgical excision of the lesion(s) associated with systemic antifungal therapy. Since relapses are possible, strict control of the patients over time is essential.

Alternaria↗