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Biomedical subjects

P Zucchelli

Publications and source records attributed to P Zucchelli.

At least 19 recordsLinked to original sources
PubMed1992

Methylprednisolone plus chlorambucil as compared with methylprednisolone alone for the treatment of idiopathic membranous nephropathy. The Italian Idiopathic Membranous Nephropathy Treatment Study Group.

BACKGROUND AND METHODS: Treatment with methylprednisolone and chlorambucil may protect renal function and increase the chance of remission of the nephrotic syndrome in patients with idiopathic membranous nephropathy. To determine whether similar results might be obtained with methylprednisolone alone, we compared the effects of methylprednisolone and chlorambucil with those of methylprednisolone alone in 92 patients with the nephrotic syndrome caused by idiopathic membranous nephropathy. The patients were randomly assigned to receive either alternating one-month courses of methylprednisolone and then chlorambucil for a total of six months (group 1) or methylprednisolone alone for six months at the same cumulative dosage (group 2). RESULTS: Four of the 45 patients in group 1 (9 percent) and 1 of the 47 in group 2 (2 percent) stopped treatment because of side effects. At one, two, and three years, the percentage of patients who did not have the nephrotic syndrome was significantly higher in group 1 than in group 2. It was 58, 54, and 66 percent, respectively, in group 1, as compared with 26, 32, and 40 percent in group 2 (P = 0.002, 0.029, and 0.011). By year 4, the difference was no longer statistically significant: 62 percent of the patients in group 1 and 42 percent of those in group 2 did not have the nephrotic syndrome (P = 0.102). The patients in group 1 were in remission longer than those in group 2 (P = 0.008). CONCLUSIONS: In patients with the nephrotic syndrome caused by idiopathic membranous nephropathy, treatment with methylprednisolone and chlorambucil for six months induces an earlier remission of the nephrotic syndrome than methylprednisolone alone, but the difference may diminish with time.

Adolescent↗
PubMed1992

Long-term comparison between captopril and nifedipine in the progression of renal insufficiency.

To verify the hypothesis that angiotensin-converting enzyme (ACE) inhibitors possess a unique renoprotective effect in progressive chronic renal disease, we decided to compare the effects of an ACE inhibitor and a calcium antagonist on both hypertension and the progression of non-diabetic renal insufficiency in a long-term study. A four-year, multicenter, prospective, randomized trial was conducted on 142 hypertensive patients (pts) with established chronic renal failure from six Italian nephrology departments. They were on standard antihypertensive therapy with a low-protein diet and underwent twice-monthly surveillance for a one year pre-randomization period. After that year, 121 pts were randomly allocated to captopril or slow-release nifedipine therapies for a three-year study period. The progression of renal insufficiency was monitored every two months. Blood pressure control was significantly better after randomization than during the year of standard antihypertensive therapy. The progression rate before randomization (BR) was definitely higher before than after randomization (AR): Creatinine clearance (CCr) change BR = -0.46 +/- 0.45 ml/min/month, creatinine clearance change AR = -0.23 +/- 0.43 ml/min/month (P less than 0.01). After randomization, the mean blood pressure values were virtually the same throughout the three year period of the study in the two groups treated by captopril (group I), or nifedipine (group II).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Immunohistochemical distinction between amyloidosis and fibrillar glomerulopathy.

Six patients with glomerulonephritis and glomerular proteinaceous deposits constituted by fibrillar ultrastructures similar to those of amyloid but lacking the Congo red tinctorial affinity characterizing amyloid were studied. Clinically, these patients had proteinuria and hematuria; in addition, three patients had hypertension and one renal failure. Protein deposits in their kidney biopsy sections were evaluated by immunofluorescence, immunoperoxidase, and immunoelectron microscopic (protein A-gold) techniques, using antibodies against IgG, IgA, IgM, C3, C1q, fibrinogen, immunoglobulin kappa and lambda light chains, and against amyloid fibril proteins of different types, including AA, A lambda, A kappa, and AF. By immunofluorescence and immunoperoxidase, in all cases the deposits stained intensely with antibodies against IgG, C3, and kappa and lambda light chains; one case also showed C1q immunoreactivity. By contrast, none stained with antibodies against various amyloid fibril proteins. Immunoelectron microscopic findings corroborated this data, indicating that the nonamyloid fibrillar deposits studied are antigenically distinct from known amyloid deposits and that they contain IgG-derived material.

Amyloid↗
PubMed1992

Renal function at hospital admission as a prognostic factor in adult hemolytic uremic syndrome. The Italian Registry of Haemolytic Uremic Syndrome.

The clinical records of adult patients with a diagnosis of hemolytic uremic syndrome were retrospectively reviewed with the aim of evaluating the long-term outcome of renal function. The setting is the Italian Registry of Haemolytic Uraemic Syndrome, with which 13 Nephrology Centers have participated. Clinical and laboratory data of 43 patients with hemolytic uremic syndrome were evaluated. The mean age at onset was 34.3 +/- 18.3 yr. Men and women were equally affected. No seasonal trend in presentation was observed. In 20 patients, hemolytic uremic syndrome was primitive, whereas in 23, it was associated with another disease (cancer, preeclampsia, malignant hypertension, vasculitides). Gastrointestinal symptoms were the most frequently observed prodromes. Thirty (70%) patients required dialysis during the acute phase of the disease. Six patients died during the acute phase of the disease, and one died later after discharge (overall mortality, 16%). After 1 yr of follow-up, 11 (26%) patients had recovered a normal renal function, 14 (33%) had hypertension and/or renal insufficiency, and 11 (26%) were on regular dialysis. When prognostic factors of survival and recovery of renal function were considered, it was found that older age was associated with higher mortality in the acute phase, whereas severe renal involvement at the onset of the disease (as expressed by elevated serum creatinine) was associated with a long-term unfavorable prognosis.

Adolescent↗
PubMed1992

A new catheter to prevent exit-site infection in peritoneal dialysis.

In order to prevent exit-site infection, we studied a new Tenckhoff-derived catheter, named the "Malpighi catheter," capable of avoiding sinus tract formation. The outer cuff of this new device is 3.5 cm long and is deliberately positioned half-extruded; in fact, half of the cuff remains outside the skin exit-site. The implantation technique is identical to that of the standard two-cuff Tenckhoff catheter. We implanted eight Malpighi catheters in 5 CAPD and 3 IPD patients. The observation period was 146 patient-months (range 14-23, M +/- SD 18.2 +/- 3.3). We observed excellent adhesion between the outer cuff and surrounding tissue. Actually, by pulling the catheter the skin around the half-extruded cuff becomes cone-shaped, with the cone's apex tightly stuck to cuff and the sinus tract disappearing completely. Only one case of exit-site infection by Staphylococcus aureus and two cases of ulcer of the skin beneath the external part of the half-extruded cuff were observed. These complications were resolved completely. No catheter needed to be removed and there were no leakages. The histological study of the cuff showed a good infiltration of the dacron cuff by fibrous tissue. On the grounds of our preliminary experience, we believe that the absence of the sinus tract, the formation of an efficient mechanical and bacterial barrier and the reduction of exit-site infection incidence are all factors that encourage further research.

Aged↗
PubMed1992

Lymphocyte release of soluble IL-2 receptors in patients with minimal change nephropathy.

Minimal change nephrotic syndrome has been reported to be a lymphocyte-mediated disorder. It has been suggested that the secretion of lymphokine(s) is involved in the pathogenesis of MCN and in determining proteinuria. The presence of a soluble form of IL-2 receptor (sIL-2R) has been previously described in the sera of patients with some autoimmune disorders. In this work, we report the detection of high sIL-2R levels, both in the plasma (mean value 844 +/- 436 U/ml versus normal value 276 +/- 86 U/ml) and urine of patients with MCN during the nephrotic phase alone. Instead, when the patients achieve stable remission, sIL-2R levels decrease to within normal values (mean value 332 +/- 272 U/ml). Furthermore, during the nephrotic syndrome we observed a significant inverse relationship between sIL-2R plasma levels and the mitogenic response to PHA (p less than 0.005). Since sIL-2R exerts a down-modulation on T-proliferative expansion, sIL-2R might represent one of the inhibitory serum factors extensively reported in the serum of patients with MCN-induced nephrotic syndrome.

Adolescent↗
PubMed1991

Hydrothorax in a PD patient: successful treatment with intrapleural autologous blood instillation.

An 80-year-old female developed massive right hydrothorax at the start of an IPD program. Peritoneal dialysis was interrupted and after complete evacuation of the pleural effusion, 40 ml of the patient's blood was infused into the right pleural cavity. For the first 2 days the patient maintained the Fowler position. Three weeks later, IPD was recommended, but pleural effusion reappeared early on. Infusion of a further 40 ml of the patient's blood was repeated after another pleural evacuation and the dialysis was again stopped for another 3-week period. Subsequently, IPD was restarted with only one-liter exchanges and the patient kept in the Fowler position during the dialysis sessions. After three weeks, standard IPD was started with the patient supine and two-liter exchanges. Hydrothorax did not re-appear and so far (12-month follow-up) no pleural effusion has been noticed. The patient feels well on IPD. Blood instillation was painless and caused one-day fever on the first time only. Pleurodesis achieved with autologous blood is a very safe, simple and effective way of treating hydrothorax in PD patients.

Aged↗
PubMed1990

A haemodynamic study of hypotension during haemodialysis using electrical bioimpedance cardiography.

Continuous recording of beat-to-beat changes in haemodynamic parameters such as arterial pressure, heart rate, stroke volume, cardiac output, and total peripheral resistance, was done in 52 uraemic patients. The study was performed during the haemodialysis session, using a system combining a personal computer, an arterial pressure recorder, and an electrical bioimpedance cardiography monitor. Forty-six episodes of dialysis-induced hypotension occurred in 26 patients. Systolic arterial pressure and total peripheral resistance decreased by -39.3 +/- 2% and -36.3 +/- 4% respectively during acute hypotension; in contrast, there was an increase in cardiac output (+13.9 +/- 6.7%), while heart rate and stroke volume did not change significantly. It was possible to distinguish two types of collapse on the basis of heart rate behaviour: the classic 'tachycardiac' collapse with heart rate increase and stroke volume decrease, and the so-called 'bradycardiac' collapse with a paradoxical reduction in heart rate and an increase in stroke volume. 'Bradycardiac' collapses were observed in 54% of the cases. The administration of atropine in one patient resulted in an immediate increase in heart rate. The development of bradycardia and hypotension during haemodialysis seems to be related to a sudden parasympathetic vagal overactivity and could be attributed to the Bezold-Jarish reflex.

Adult↗
PubMed1990

Glomerulonephritis with organized deposits: a new clinicopathological entity? Light-, electron-microscopic and immunofluorescence study of 12 cases.

Twelve cases of glomerulonephritis in patients without systemic diseases, displaying organized glomerular deposits, were reported. Microfibrils (11-30 nm diameter) were found in 9 patients and microtubules (20-35 nm diameter) in the other 3. Histochemical stainings for amyloid were always negative. By light microscopy, mesangial proliferative, membranous and membranoproliferative patterns were seen in 5, 3 and 4 patients, respectively. By immunofluorescence, granular deposits, mainly of IgG and C3, were found in all cases, either in the mesangium or in the mesangium and in the capillary walls. A second biopsy was performed in 2 patients. The number of hyaline glomeruli was increased, but the general pattern of glomerular changes remained unchanged. The commonest clinical findings were hypertension, microhematuria and proteinuria, often of nephrotic range. At variance to what is reported in the literature, 2 pediatric cases were found as well, and the overall prognosis (mean follow-up 54.3 months) was mostly favorable. The diagnostic relevance of these findings is pointed out, but further investigations are needed, before suggesting a new clinicopathological entity.

Actin Cytoskeleton↗
PubMed1990

Acetate-free biofiltration: hemodiafiltration with base-free dialysate.

Bicarbonate dialysis has several clinical advantages compared to conventional acetate hemodialysis. However, the use of bicarbonate in the dialysate requires complicated hardware with considerable maintenance and servicing. We have developed a new dialysis technique, a modification of hemodiafiltration, called acetate-free biofiltration (AFBF), with no base replacement agents in the dialysate and with the infusion of bicarbonate solution in postdilution fluid. This study consisted of two parts, an acute phase (8 dialysis patients) and a chronic phase (4 patients) lasting up to 12 months. In the first phase we evaluated the effects of different amounts of infused bicarbonate (from 751 to 1,002 mEq per session) on acid-base balance. The best correction of uremic acidosis was obtained with the infusion of 900-1,000 HCO3 mEq during a 3-hour AFBF. There was a significant (p less than 0.0001) positive correlation between infused and gained bicarbonate. In the chronic part, 880-910 HCO3 mEq was infused per session and there was an increase in mean pretreatment plasma bicarbonate from 18.1 +/- 2.2 upon starting to 22.8 +/- 0.4 mEq/l by the end of the 12-month period. A very low incidence of intradialytic hypotension and stable serum chemistries were achieved with this technique as compared with standard hemodialysis despite a reduction of 3 h in weekly treatment time. AFBF is an easy-to-use, safe alternative to bicarbonate dialysis thanks to the absence of pyrogen reactions and comparatively low-cost maintenance.

Acid-Base Imbalance↗
PubMed1990

Paired filtration dialysis: optimizing depurative efficiency with separate convection and diffusion processes.

To overcome reciprocal interaction between convection and diffusion occurring in hemodiafiltration, we separated the two processes in a new dialysis technique called paired filtration dialysis (PFD). In this technique, convection and diffusion take place separately on two capillary membranes: a polysulfone hemofilter and a hemophan dialyzer. The depurative effectiveness of PFD with respect to small (blood urea nitrogen, creatinine, uric acid, phosphate) and large (beta 2-microglobulin) molecules was acutely assessed in 6 patients on maintenance acetate hemodialysis. Despite a 3-hour treatment time, a high mass removal of small and large solutes was found in PFD without high ultrafiltration rates or blood flows in excess of 300 ml/min. There was no significant difference in solute removal between the two different depurative sequences adopted in PFD, i.e., convection followed by diffusion or vice versa. A significant reduction in beta 2-microglobulin serum levels was observed in both PFD modes. Twenty patients, on a 12-month period of 3-hour PFD treatment, maintained an unaltered metabolic, clinical, and acid-base status, and cardiovascular stability was not affected. PFD thus provides excellent depurative results, along with simple technical features that are particularly useful in treating patients with high depurative needs and yet are unable to tolerate high-flux techniques.

Adult↗