1
|
Morello W, Budelli S, Bernstein DA, Montemurro T, Montelatici E, Lavazza C, Ghio L, Edefonti A, Peruzzi L, Molino D, Benetti E, Gianoglio B, Mehmeti F, Catenacci L, Rotella J, Tamburello C, Moretta A, Lazzari L, Giordano R, Prati D, Montini G. First clinical application of cord blood mesenchymal stromal cells in children with multi-drug resistant nephrotic syndrome. Stem Cell Res Ther 2022; 13:420. [PMID: 35986374 PMCID: PMC9389735 DOI: 10.1186/s13287-022-03112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022]
Abstract
Background and objectives Children with multi-drug resistant idiopathic nephrotic syndrome (MDR-INS) usually progress to end-stage kidney disease with a consistent risk of disease recurrence after transplantation. New therapeutic options are needed for these patients. Mesenchymal stromal cells (MSCs) are multipotential non-hematopoietic cells with several immunomodulatory properties and growing clinical applications. Cord blood-derived MSC have peculiar anti-inflammatory and immunosuppressive properties. We aimed at assessing safety and efficacy of cord-blood-derived MSCs (CB-MSCs) in children with MDR-INS. Design, setting, participants Prospective, open-label, single arm phase I–II pilot study. Pediatric patients with MDR-INS, resistant to at least two lines of therapy, were enrolled. Allogenic CB-MSCs were administered intravenously on days 0, 14, and 21 at a dose of 1.5 × 106 cells/kg. Patients were followed for at least 12 months. The primary outcomes were safety and toxicity. The secondary outcome was remission at 12 months evaluated by urinary protein/urinary creatinine ratio (uPr/uCr). Circulating regulatory T cells (Tregs) were monitored. Results Eleven pediatric patients with MDR-INS (10 females, median age 13 years) resistant to a median of 3 previous lines of therapy were enrolled. All patients completed the CB-MSC infusion schedule. No patient experienced any infusion-related adverse event or toxicity. Nine patients were assessable for efficacy. At the 12 months follow-up after the treatment, the median uPr/uCr did not change significantly from baseline (8.13 vs. 9.07; p = 0.98), while 3 patients were in partial or complete remission. A lower baseline uPr/uCr was a predictor of remission (2.55 vs. 8.74; p = 0.0238). Tregs count was not associated with CB-MSCs therapy. Conclusions CB-MSCs are safe and may have a role in the immunosuppressive therapy of pediatric patients with MDR-INS. This preliminary experience paves the way toward further phase II studies addressing MSC efficacy in immune-mediated kidney diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-03112-7.
Collapse
|
2
|
Pasini A, Bertulli C, Casadio L, Corrado C, Edefonti A, Ghiggeri G, Ghio L, Giordano M, La Scola C, Malaventura C, Maringhini S, Mastrangelo AP, Materassi M, Mencarelli F, Messina G, Monti E, Morello W, Puccio G, Romagnani P, Montini G. Childhood Idiopathic Nephrotic Syndrome: Does the Initial Steroid Treatment Modify the Outcome? A Multicentre, Prospective Cohort Study. Front Pediatr 2021; 9:627636. [PMID: 34307246 PMCID: PMC8295604 DOI: 10.3389/fped.2021.627636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background: A great majority of children with idiopathic nephrotic syndrome will relapse after successful treatment of the initial episode. The possibility that different steroid dosing regimens at onset, adjusted for risk factors, can reduce the rate of relapse represents an interesting option to investigate. Objectives: To evaluate the effect of the initial steroid regimen, adjusted for time to remission (TTR), on the frequency of relapses and steroid dependence, and to verify the influence of prognostic factors on disease course. Methods: A multicentre, prospective, cohort study. Children with nephrotic syndrome, with TTR ≤ 10 days (Group A), were given a 20-week prednisone regimen (2,828 mg/m2) and those with a TTR >10 days, a 22-week regimen (3,668 mg/m2) (Group B). Previously published retrospective data from the same centers were also evaluated. Main outcomes were: relapse rate, number of frequent relapsers + steroid dependent children and total prednisone dose after induction. Results: 143 children were enrolled. Rate of relapsed subjects (77 vs. 79%) and frequent relapsers + steroid dependent subjects (40 vs. 53%) did not differ between Groups A and B, or between the retrospective and prospective cohorts. The cumulative prednisone dose taken after the induction treatment was similar in both groups and in the retrospective and prospective cohorts. TTR was not associated with relapse risk. Age at onset and total serum protein were significantly lower in relapsing patients. At ROC analysis, the best cut-off was 5.3 years for age at onset and 4.2 g/dL for total serum protein. According to these cut-offs, older children with higher total serum protein had a higher relapse free survival rate (58%) than younger children with lower total serum protein (17%). Conclusions: TTR was not found to be a prognostic factor of relapse; because of this, different steroid regimens, adjusted for TTR, did not modify the relapse rate in any relevant measure. Conversely, younger age and low total serum protein were independent predictors of relapse risk, however this outcome was not modified by higher prednisone regimens. Clinical Trial Registration:https://www.ClinicalTrials.gov/, identifier: NCT01386957 (www.nefrokid.it).
Collapse
Affiliation(s)
- Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Bertulli
- Nephrology and Dialysis Unit, Department of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Casadio
- Unità Operativa Complessa of Paediatrics and Neonatology, Local Health Authority of Romagna, Ravenna, Italy
| | - Ciro Corrado
- Pediatric Nephrology Unit, Children's Hospital “G. Di Cristina”, A.R.N.A.S. “Civico”, Palermo, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milan, Italy
| | - GianMarco Ghiggeri
- Division of Nephrology, Dialysis, Transplantation, Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Luciana Ghio
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Giordano
- Nephrology Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Malaventura
- Section of Pediatrics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvio Maringhini
- Pediatric Nephrology Unit, Children's Hospital “G. Di Cristina”, A.R.N.A.S. “Civico”, Palermo, Italy
| | - Antonio P. Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Messina
- Nephrology Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Elena Monti
- Specialty School of Paediatrics - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Paola Romagnani
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milan, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | | |
Collapse
|
3
|
Vai S, Broggi F, Colombo C, Ghio L, Edefonti A, Corona F, Nebbia G, Bianchi ML. Bone density as indicator of fracture risk in children with chronic diseases. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
4
|
Turolo S, Edefonti A, Ghio L, Testa S, Morello W, Montini G. CYP and SXR gene polymorphisms influence in opposite ways acute rejection rate in pediatric patients with renal transplant. BMC Pediatr 2020; 20:246. [PMID: 32450827 PMCID: PMC7249618 DOI: 10.1186/s12887-020-02152-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background We evaluated the role of CYP3A5, ABCB1 and SXR gene polymorphisms in the occurrence of acute kidney rejection in a cohort of pediatric renal transplant recipients. Methods Forty-nine patients were genotyped for CYP3A5, ABCB1 and SXR polymorphisms and evaluated with tacrolimus through levels in a retrospective monocenter study. Results Patients with the A allele of CYP3A5 treated with tacrolimus had a higher risk of acute rejection than those without the A allele, while patients carrying the homozygous GG variant for SXR A7635GG did not show any episode of acute rejection. Conclusion Genetic analysis of polymorphisms implicated in drug metabolism and tacrolimus trough levels may help to forecast the risk of acute rejection and individualize drug dosage in children undergoing renal transplantation.
Collapse
Affiliation(s)
- Stefano Turolo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico UOC Nefrologia Dialisi e Trapianto pediatrico, Via della, Commenda 9, 20122, Milan, Italy.
| | - Alberto Edefonti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico UOC Nefrologia Dialisi e Trapianto pediatrico, Via della, Commenda 9, 20122, Milan, Italy
| | - Luciana Ghio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico UOC Nefrologia Dialisi e Trapianto pediatrico, Via della, Commenda 9, 20122, Milan, Italy
| | - Sara Testa
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico UOC Nefrologia Dialisi e Trapianto pediatrico, Via della, Commenda 9, 20122, Milan, Italy
| | - William Morello
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico UOC Nefrologia Dialisi e Trapianto pediatrico, Via della, Commenda 9, 20122, Milan, Italy
| | - Giovanni Montini
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico UOC Nefrologia Dialisi e Trapianto pediatrico, Via della, Commenda 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Edefonti A, Picca M, Damiani B, Garavaglia R, Loi S, Ardissino G, Marra G, Ghio L. Prevalence of Malnutrition Assessed by Bioimpedance Analysis and Anthropometry in Children on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100211] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and to determine the prevalence of malnutrition in this population, in short- and long-term PD duration, using anthropometric and BIA-derived indices.PatientsEighteen children treated with automated PD (11 males, 7 females; mean age 8.7 ± 4.7 years).DesignEighteen patients were studied using anthropometry and BIA at the start (t0) and after 6 months (t1) of PD, 15 of these patients at 12 months (t2), and 8 at 24 months (t3) of PD. Midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA) were calculated from anthropometric measures according to Frisancho (FrisanchoAR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981; 34:2540–5.). The bioelectrical measures of resistance (R) and reactance (Xc) were obtained directly from the impedance signal; phase angle (PA) and distance (D) were calculated using mathematical formulas. Nutritional status was assessed by anthropometric measurements and BIA-derived indices, expressed as standard deviation scores (SDS), and by a score system based on BIA and anthropometric parameters. The percentage of children with values of anthropometric and BIA-derived indices below the 3rd percentile or between the 3rd and 25th percentiles, and the percentage of children with scores of 7 – 12 and 4 – 6 were calculated in order to detect patients with severe or moderate derangement of nutritional status.ResultsThe mean SDS values of Xc, PA, and D significantly improved ( p = 0.05, p = 0.001, p = 0.02) during the first 6 months of PD and remained almost stable during the following months. The SDS values of the anthropometric indices were less compromised than those of the BIA-derived indices, particularly at the start of dialysis. By 6 months, the percentages of children with values of BIA and anthropometric indices below the 3rd percentile had decreased. The percentages of patients with moderate and severe derangement of BIA and anthropometric indices remained substantially unchanged after 12 months. However, at 24 months, the percentage of patients with moderate derangement of BIA indices increased. All these findings were confirmed by the nutritional score system.ConclusionBIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD. The prevalence of malnutrition, high at the commencement of PD, decreases during the first year of treatment but not over the long term.
Collapse
Affiliation(s)
- Alberto Edefonti
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Marina Picca
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Beatrice Damiani
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Rosanna Garavaglia
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Silvana Loi
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Gianluigi Ardissino
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Giuseppina Marra
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Luciana Ghio
- Pediatric Renal Unit, 2nd Department of Pediatrics, University of Milan Medical School, Milan, Italy
| |
Collapse
|
6
|
Edefonti A, Picca M, Consalvo G, Ghio L, Damiani B, Dal Col A, Galato R. Prescription and Assessment of Tidal Peritoneal Dialysis Delivery with a Specific Equilibration Test. Perit Dial Int 2020. [DOI: 10.1177/089686089601600311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To propose a simplified equilibration test specific for tidal peritoneal dialysis (TPD) that will overcome the inconveniences of the measurement of TPD peritoneal solute clearances through whole dialysate collection. This will enable the prediction of peritoneal creatinine and urea clearances, the suitability of patients for TPD, and routine assessment of TPD delivery. Design In a prospective study, patients had a standardized TPD run, and dialysate-to-plasma (DIP) ratios for creatinine and urea were calculated at various TPD and peritoneal equilibration test (PET) time points and on total TPD dialysate. Solute clearances were estimated and measured, and correlation coefficients were obtained among all these variables. Setting Dialysis unit of a pediatric nephrology department and patients’ homes. Patients Eleven pediatric patients with end-stage renal disease in stable clinical conditions treated with TPD. Interventions Dialysate and blood sample collections. Main Outcome Measures DIP ratios for creatinine and urea at the fifth and seventh TPD exchanges, at 15–,30–,60, and 120-minute PETtimes, and on total TPD dialysate and TPD peritoneal creatinine and urea clearances. Results Correlation coefficients between PET -derived and total TPD dialysate-derived DIP ratios, and those between PET -derived and measured creatinine and urea clearances were more significant at the 120-minute PET time point compared with the other PET time points. Best correlations were obtained at the fifth and seventh TPD exchanges. DIP ratios for creatinine and urea of the fifth and seventh TPD exchanges correlated significantly with the DIP ratios calculated from total TPD dialysate. A significant correlation was also found between peritoneal creatinine and urea clearances on total dialysate volume (measured clearances) and those derived from the dialysate collection of the fifth and seventh TPD exchanges (estimated clearances) -that based on the seventh exchange being slightly more significant. Moreover, the estimated clearances derived from the seventh exchange were within 10% of the measured value in 90.9% of patients both for creatinine and urea. Conclusion The significant correlation between measured and estimated peritoneal creatinine and urea clearances and the low percentage of underestimates of measured clearances obtained using the seventh TPD exchange-derived indices confirm the accuracy of the DIP ratios for creatinine and urea derived from any exchange after the fifth (preferably the seventh) of a standardized TPD run in estimating peritoneal creatinine and urea clearances. This method could represent a simple and accurate means for prescribing TPD and routinely assessing TPD delivery.
Collapse
|
7
|
Edefonti A, Picca M, Galato R, Guez S, Giani M, Ghio L, Damiani B, Dal Col A, Santerarno C. Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s65] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively. There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.
Collapse
Affiliation(s)
| | - Marina Picca
- Department of Pediatrics II, University of Milano, Italy
| | | | - Sophie Guez
- Department of Pediatrics II, University of Milano, Italy
| | - Marisa Giani
- Department of Pediatrics II, University of Milano, Italy
| | - Luciana Ghio
- Department of Pediatrics II, University of Milano, Italy
| | | | | | | |
Collapse
|
8
|
Edefonti A, Picca M, Paglialonga F, Loi S, Grassi MR, Ardissino G, Marra G, Ghio L, Fossali E. A Novel Objective Nutritional Score for Children on Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To establish a novel nutritional score based on a series of objective parameters capable of detecting protein-calorie malnutrition in children being treated with chronic peritoneal dialysis (CPD), to test the score in a healthy pediatric population, and to apply it to children on CPD to evaluate their nutritional status. Study Population 264 healthy school children (mean age 8.69 ± 3.26 years, range 3.05 – 14.98 years) and 29 patients treated with CPD for 1.75 ± 1.02 years (mean age 10.54 ± 6.28 years, range 2.8 – 15.24 years). Methods Nutritional status was evaluated by means of three sets of measurements: anthropometric (A1 and A2) and bioimpedance analysis (BIA) measurements. Anthropometry included two sets of measures: set A1 consisted of height (H), weight (W), and body mass index (BMI); set A2 consisted of midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA). The BIA measurements included reactance, phase angle, and distance. All parameters are expressed as standard deviation scores (SDS). Tanner's, Rolland–Cachera's, and Frisancho's data were used as references for H, W, BMI, MAMC, AMA, and AFA; personal data obtained from 551 healthy boys and girls were used for the BIA indices. The nine anthropometry and BIA parameters were given scores of 1 to 5: 5 = > 0 SDS, 4 = ≤ 0 and > –1 SDS, 3 = ≤ –1 and > –2 SDS, 2 = ≤ –2 and > –3 SDS, and 1 = ≤ –3 SDS. Average scores were established for each of A1, A2, and BIA, and then summed to obtain the anthropometry–BIA nutrition (ABN) score. To establish the cutoff value between normal nutritional status and malnutrition, the method was first applied to the 264 healthy children; distribution percentiles were calculated for each area score and the ABN score. The ABN score corresponding to the 3rd percentile was considered the limit of normality and then applied three times to the 29 children on CPD, for a total of 87 nutritional assessments. Results The score corresponding to the 3rd percentile in the population of healthy children was 10.33. Among the CPD-treated children, 41.4% of the ABN scores were higher than 10.33 (indicating a state of normal nutrition) and 58.6% were lower (indicating various degrees of malnutrition). Severe malnutrition was found in only 1.1% of the cases. The values of all nine A1, A2, and BIA parameters, as well as serum albumin levels, were significantly higher in patients with an ABN score > 10.33 than in those with a score < 10.33. Conclusion The ABN score is a simple and objective method of assessing, in clinical practice, the nutritional status of children on CPD.
Collapse
Affiliation(s)
- Alberto Edefonti
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Marina Picca
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Fabio Paglialonga
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Silvana Loi
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Maria Rosa Grassi
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Gianluigi Ardissino
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Giuseppina Marra
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Luciana Ghio
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Emilio Fossali
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| |
Collapse
|
9
|
Andreetta B, Verrina E, Sorino P, Edefonti A, Perfumo F, Bassi S, Ghio L, Cattarelli D, Coppo R, Rinaldi S, Capasso G, Zanon GF, Zacchello G. Complications Linked to Chronic Peritoneal Dialysis in Children after Kidney Transplantation: Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s118] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Our objective was to evaluate the infectious complications of the post-transplant period attributable to the persistence of catheter and other complications when chronic peritoneal dialysis (CPD) was performed posttransplantation. The design was a retrospective study, and the setting was an Italian registry of pediatric chronic peritoneal dialysis. There were 86 pediatric renal transplants (9/86 from living related donors, 2/86 simultaneous liver and kidney transplantation for oxalosis). Six of 86 transplants were lost at follow-up. Mean age of the children (n = 80) at transplantation was 9.3 years (range:1.7–21 years). They had been on CPD for a mean period of 1.7 years (range: 0.2 -4.6 years). During CPD, 67 peritonitis episodes (80% related to exit-site and/or tunnel infections) were observed, with an incidence of peritonitis of one episode per 16 months CPD. The mean safe interval of peritonitis and/ or exit-site or tunnel infection was 208 days (range: 36 1897 days). The mean time of catheter removal was 80.3 days (range: 0 216 days) post-transplantation. During the first month post-transplantation, one episode of peritonitis secondary to a sepsis occurred in one child. No other episodes of peritonitis or exit-site and/or tunnel infections were observed. Two of 80 children returned to CPD (at four and at 12 months, respectively) because of persistent allograft failure. Furthermore, 12 patients were on CPD because of temporary graft failure. In all these patients the pretransplant peritoneal dialysis (PD) catheter was utilized, with no complications. These data show that the persistence of the PD catheter after kidney transplantation has produced no infections or other complications. What is more, the catheter was safely utilized during acute rejection or primary allograft nonfunction.
Collapse
Affiliation(s)
| | - Enrico Verrina
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Palma Sorino
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Alberto Edefonti
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | | | - Sergio Bassi
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Luciana Ghio
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | | | - Rosanna Coppo
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Stefano Rinaldi
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Giovanni Capasso
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | | | | |
Collapse
|
10
|
Turolo S, Edefonti AC, Morello W, Syren ML, De Cosmi V, Ghio L, Tamburello C, Demarco EA, Berrettini A, Manzoni G, Agostoni C, Montini G. Persistent Abnormalities of Fatty Acids Profile in Children With Idiopathic Nephrotic Syndrome in Stable Remission. Front Pediatr 2020; 8:633470. [PMID: 33585371 PMCID: PMC7875014 DOI: 10.3389/fped.2020.633470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022] Open
Abstract
Steroid-sensitive nephrotic syndrome is an immunological disorder mediated by still poorly defined circulating factor(s) that target the podocyte and damage the filtration barrier. Fatty acids (FA) have several biological roles and, in particular, are strictly involved in cell to cell communication, inflammatory processes and regulation of lymphocyte pools. Studies of FAs during INS have been mainly focused on biochemical changes during the phase of proteinuria; while no information is available about FA profile in patients with idiopathic nephrotic syndrome (INS) on stable remission. Aim of this study is to assess differences in blood FA profile between pediatric patients with INS during the phase of stable remission. Blood fatty acid profile of 47 pediatric patients on stable remission and 47 matched healthy controls were evaluated with gas chromatography. Patients with INS on stable remission had significantly higher levels of PUFA and omega-6 than controls (40.17 vs. 37.91% and 36.95 vs. 34.79%), lower levels of SFA and MUFA. Considering the single fatty acids, levels of omega-6 18:2n6 linoleic acid and omega-6 20:4n6 arachidonic acid were significantly higher in patients with INS than in controls (23.01 vs. 21.55%, p-value 0.003 and 10.37 vs. 9.65%, p-value 0.01). Moreover, patients with INS showed lower levels of SFA 14:0 (0.74 vs. 0.92%) and 18:0 (10.74 vs. 11.74%) and MUFA 18:1n9 oleic acid (18.50 vs. 19.83%). To the best of our knowledge this is the first study assessing FAs profile in children with INS in stable remission. In a population of 47 patients, we were able to demonstrate a higher blood level of linoleic and arachidonic acid, and consequently of omega-6 and PUFA, compared to controls. Persistently higher than normal levels of either linoleic or arachidonic acid, could be viewed as candidate biomarker for a state of risk of relapse in children with idiopathic nephrotic syndrome.
Collapse
Affiliation(s)
- Stefano Turolo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto C Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marie-Louise Syren
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luciana Ghio
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Tamburello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika A Demarco
- Pediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
11
|
Morello W, Puvinathan S, Puccio G, Ghiggeri GM, Dello Strologo L, Peruzzi L, Murer L, Cioni M, Guzzo I, Cocchi E, Benetti E, Testa S, Ghio L, Caridi G, Cardillo M, Torelli R, Montini G. Post-transplant recurrence of steroid resistant nephrotic syndrome in children: the Italian experience. J Nephrol 2019; 33:849-857. [PMID: 31617157 PMCID: PMC7381476 DOI: 10.1007/s40620-019-00660-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
Background Steroid resistant nephrotic syndrome (SRNS) is a frequent cause of end stage renal disease in children and post-transplant disease recurrence is a major cause of graft loss. Methods We identified all children with SRNS who underwent renal transplantation in Italy, between 2005 and 2017. Data were retrospectively collected for the presence of a causative gene mutation, sex, histology, duration of pre-transplant dialysis, age at onset and transplant, HLA matching, recurrence, therapy for recurrence, and graft survival. Results 101 patients underwent a first and 22 a second renal transplant. After a median follow-up of 58.5 months, the disease recurred on the first renal transplant in 53.3% of patients with a non-genetic and none with a genetic SRNS. Age at transplant > 9 years and the presence of at least one HLA-AB match were independent risk factors for recurrence. Duration of dialysis was longer in children with relapse, but did not reach statistical significance. Overall, 24% of patients lost the first graft, with recurrence representing the commonest cause. Among 22 patients who underwent a second transplant, 5 suffered of SRNS recurrence. SRNS relapsed in 5/9 (55%) patients with disease recurrence in their first transplant and 2 of them lost the second graft. Conclusions Absence of a causative mutation represents the major risk factor for post-transplant recurrence in children with SRNS, while transplant can be curative in genetic SRNS. A prolonged time spent on dialysis before transplantation has no protective effect on the risk of relapse and should not be encouraged. Retransplantation represents a second chance after graft loss for recurrence.
Collapse
Affiliation(s)
- William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, via della Commenda, 9, 20122, Milan, Italy
| | - Sairaj Puvinathan
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, via della Commenda, 9, 20122, Milan, Italy
| | - Giuseppe Puccio
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, via della Commenda, 9, 20122, Milan, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis, and Transplantation, Scientific Institute for Research and Health Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luca Dello Strologo
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Hospital-University of Padova, Padua, Italy
| | - Michela Cioni
- Division of Nephrology, Dialysis, and Transplantation, Scientific Institute for Research and Health Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabella Guzzo
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Enrico Cocchi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Hospital-University of Padova, Padua, Italy
| | - Sara Testa
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, via della Commenda, 9, 20122, Milan, Italy
| | - Luciana Ghio
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, via della Commenda, 9, 20122, Milan, Italy
| | - Gianluca Caridi
- Division of Nephrology, Dialysis, and Transplantation, Scientific Institute for Research and Health Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Massimo Cardillo
- North Italy Transplant program (NITp), UOC Coordinamento Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosanna Torelli
- North Italy Transplant program (NITp), UOC Coordinamento Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, via della Commenda, 9, 20122, Milan, Italy.
| |
Collapse
|
12
|
Cuzzoni E, Franca R, De Iudicibus S, Marcuzzi A, Lucafò M, Pelin M, Favretto D, Monti E, Morello W, Ghio L, La Scola C, Mencarelli F, Pasini A, Montini G, Decorti G, Stocco G. MIF plasma level as a possible tool to predict steroid responsiveness in children with idiopathic nephrotic syndrome. Eur J Clin Pharmacol 2019; 75:1675-1683. [PMID: 31463578 DOI: 10.1007/s00228-019-02749-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Idiopathic nephrotic syndrome (INS) is the most frequent form of childhood nephrotic syndrome. Steroids represent the best therapeutic option; however, inter-individual differences in their efficacy and side effects have been reported. To date, there is no way to predict patients' resistance and/or dependence. Alterations in the cytokine profile of INS patients might contribute to proteinuria and glomerular damage and affect drug sensitivity. METHODS The cytokine plasma levels were measured in 21 INS children at diagnosis to investigate the association among cytokines pattern and clinical response. Patients were selected on the basis of their clinical response: 7 steroid sensitive (SS), 7 dependent (SD), and 7 resistant (SR). Significant results were then analyzed in 41 additional pediatric INS patients. RESULTS Within the 48 cytokines analyzed, macrophage migration inhibitory factor (MIF) was a good predictor of steroid response. Indeed, SR patients showed significantly higher MIF plasma levels compared with all others (p = 0.022; OR = 4.3, 95%CI = 1.2-25.4): a cutoff concentration of MIF > 501 pg/ml significantly discriminated SR patients (sensitivity = 85.7%, specificity = 71.4%). On the contrary, SD patients showed lower MIF plasma levels compared with others (p = 0.010; OR = 0.12, 95%CI = 9.2 × 10-3-6.7 × 10-1). Significant results were confirmed in the entire cohort. CONCLUSIONS Our comprehensive cytokine analysis indicates that assessing MIF plasma levels at diagnosis could predict response to glucocorticoids in children with INS.
Collapse
Affiliation(s)
- Eva Cuzzoni
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Raffaella Franca
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, 34127, Italy
| | - Sara De Iudicibus
- Institute for Maternal Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Annalisa Marcuzzi
- Institute for Maternal Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marianna Lucafò
- Institute for Maternal Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Pelin
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Diego Favretto
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, 34127, Italy
| | - Elena Monti
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Sant'Orsola, Bologna, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luciana Ghio
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Sant'Orsola, Bologna, Italy
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Sant'Orsola, Bologna, Italy
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Sant'Orsola, Bologna, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuliana Decorti
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, 34127, Italy.
- Institute for Maternal Health - IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
13
|
Turolo S, Edefonti A, Morello W, Agostoni C, Manco V, Pires Marafon D, Grassi MR, Ghio L, Syren ML, Montini G. FP813N3 AND N6 PUFA CORRELATE WITH PROTEINURIA IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefano Turolo
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Edefonti
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - William Morello
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | - Luciana Ghio
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | |
Collapse
|
14
|
Pasini A, Benetti E, Conti G, Ghio L, Lepore M, Massella L, Molino D, Peruzzi L, Emma F, Fede C, Trivelli A, Maringhini S, Materassi M, Messina G, Montini G, Murer L, Pecoraro C, Pennesi M. The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse. Ital J Pediatr 2017; 43:41. [PMID: 28427453 PMCID: PMC5399429 DOI: 10.1186/s13052-017-0356-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
This consensus document is aimed at providing an updated, multidisciplinary overview on the diagnosis and treatment of pediatric nephrotic syndrome (NS) at first presentation. It is the first consensus document of its kind to be produced by all the pediatric nephrology centres in Italy, in line with what is already present in other countries such as France, Germany and the USA. It is based on the current knowledge surrounding the symptomatic and steroid treatment of NS, with a view to providing the basis for a separate consensus document on the treatment of relapses. NS is one of the most common pediatric glomerular diseases, with an incidence of around 2-7 cases per 100000 children per year. Corticosteroids are the mainstay of treatment, but the optimal therapeutic regimen for managing childhood idiopathic NS is still under debate. In Italy, shared treatment guidelines were lacking and, consequently, the choice of steroid regimen was based on the clinical expertise of each individual unit. On the basis of the 2015 Cochrane systematic review, KDIGO Guidelines and more recent data from the literature, this working group, with the contribution of all the pediatric nephrology centres in Italy and on the behalf of the Italian Society of Pediatric Nephrology, has produced a shared steroid protocol that will be useful for National Health System hospitals and pediatricians. Investigations at initial presentation and the principal causes of NS to be screened are suggested. In the early phase of the disease, symptomatic treatment is also important as many severe complications can occur which are either directly related to the pathophysiology of the underlying NS or to the steroid treatment itself. To date, very few studies have been published on the prophylaxis and treatment of these early complications, while recommendations are either lacking or conflicting. This consensus provides indications for the prevention, early recognition and treatment of these complications (management of edema and hypovolemia, therapy and prophylaxis of infections and thromboembolic events). Finally, recommendations about the clinical definition of steroid resistance and its initial diagnostic management, as well as indications for renal biopsy are provided.
Collapse
Affiliation(s)
- Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit with Dialysis, AOU G. Martino, Messina, Italy
| | - Luciana Ghio
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda, IRCCS Ospedale Maggiore, Policlinico Milano, Milan, Italy
| | - Marta Lepore
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda, IRCCS Ospedale Maggiore, Policlinico Milano, Milan, Italy
| | - Laura Massella
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Licia Peruzzi
- City of the Health and the Science of Turin Health Agency, Regina Margherita Children’s Hospital, Turin, Italy
| | - Francesco Emma
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Carmelo Fede
- Pediatric Nephrology and Rheumatology Unit with Dialysis, AOU G. Martino, Messina, Italy
| | - Antonella Trivelli
- Division of Nephrology, Dialysis, Transplantation, and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Silvio Maringhini
- Pediatric Nephrology Unit, Children’s Hospital ‘G. Di Cristina’, A.R.N.A.S. ‘Civico’, Palermo, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | - Giovanni Messina
- Nephrology Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Giovanni Montini
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda, IRCCS Ospedale Maggiore, Policlinico Milano, Milan, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy
| | | | - Marco Pennesi
- Institute of Maternal and Child Health IRCCS “Burlo Garofolo”, Department of Pediatrics, Trieste, Italy
| |
Collapse
|
15
|
Dello Strologo L, Murer L, Guzzo I, Morolli F, Pipicelli AMV, Benetti E, Longo G, Testa S, Ricci A, Ginevri F, Ghio L, Cardillo M, Piazza A, Nanni Costa A. Renal transplantation in sensitized children and young adults: a nationwide approach. Nephrol Dial Transplant 2017; 32:191-195. [PMID: 27742824 DOI: 10.1093/ndt/gfw369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/18/2016] [Indexed: 11/14/2022] Open
Abstract
Background High levels of preformed anti-HLA antibodies dramatically diminish renal transplant outcomes. Most desensitization programmes guarantee good intermediate outcomes but quite disappointing long-term prognosis. The search for a fully compatible kidney increases time on the waiting list. Methods In February 2011, a nationwide hyperimmune programme (NHP) was begun in Italy: all available kidneys are primarily proposed to highly sensitized patients with a panel reactive antibody above 80%. In this manuscript, we evaluate the outcome of paediatric patients transplanted with this approach. Results Twenty-one patients were transplanted. Complete data are available for 20 patients. Mean age at transplantation was 14.5 years [standard deviation (SD) ± 5.5)]. Mean time on the waiting list was 29.3 months (SD ± 27.5). Median follow-up was 29.2 months (range: 11.2-59.3). The average number of HLA mismatches in these patients was 2.3 versus 3.7 in 48 standard patients transplanted in the same period (P < 0.001). Only one graft was lost. Two cases of humoral rejection occurred and were successfully treated. No cellular rejection was reported. Median creatinine clearance was 84, 88, 77 and 77 mL/min/1.73 m 2 respectively 1, 6, 12 and 24 months after transplant. Conclusions Transplantation of sensitized patients avoiding prohibited antigens is feasible, at least in a selected cohort of patients. In order to be able to further improve this approach, which in our opinion is very successful, it would be necessary to expand the donor pool, possibly increasing the number of countries participating in the programme. In this series, time on the waiting list did not increase significantly. This allocation policy should ideally lead to an outcome comparable to that expected in standard patients, which is particularly desirable in young patients who have the longest life expectancy. Since long-term results of desensitization programmes are not (yet) convincing, we suggest that these programmes should be reserved for selected cases where compatible organs cannot be found within a reasonable time span.
Collapse
Affiliation(s)
- Luca Dello Strologo
- Nephrology and Transplant Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, AziendaOspedaliera-University of Padova, Padova, Italy
| | - Isabella Guzzo
- Nephrology and Transplant Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federica Morolli
- Nephrology and Transplant Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, AziendaOspedaliera-University of Padova, Padova, Italy
| | - Germana Longo
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, AziendaOspedaliera-University of Padova, Padova, Italy
| | - Sara Testa
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Ricci
- Italian National Transplant Centre, Italian National Institute of Health (ISS), Rome, Italy
| | | | - Luciana Ghio
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Cardillo
- Organ and Tissue Transplant Immunology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonina Piazza
- National Research Council, IFT Unit of Rome S. Camillo Hospital, Regional Transplant Center Lazio (CRTL), S. Camillo Hospital, Rome, Italy
| | - Alessandro Nanni Costa
- Italian National Transplant Centre, Italian National Institute of Health (ISS), Rome, Italy
| |
Collapse
|
16
|
Turolo S, Edefonti A, Lepore M, Ghio L, Cuzzoni E, Decorti G, Pasini A, Materassi M, Malaventura C, Pugliese F, Montini G. SXR rs3842689: a prognostic factor for steroid sensitivity or resistance in pediatric idiopathic nephrotic syndrome. Pharmacogenomics 2016; 17:1227-1233. [PMID: 27377607 DOI: 10.2217/pgs-2016-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM of the study was to analyse the impact of SXR rs3842689 polymorphism on the response to corticosteroids in pediatric idiopathic nephrotic syndrome. PATIENTS & METHODS 66 children (56 steroid-sensitive, ten steroid-resistant) were studied for SXR gene polymorphism distribution. RESULTS Steroid sensitive patients accounted for 96% of cases with In/In polymorphism, but only for 53% of cases with Del/Del polymorphism At odds ratio analysis, Del/Del represented a clear risk factor of steroid resistance (OR: 20.57; p = 0.009), while In/In was a favourable prognostic factor of steroid sensitivity. CONCLUSION The analysis of SXR polymorphism is a promising tool to predict both the favourable response to corticosteroids and the risk of developing steroid resistance.
Collapse
Affiliation(s)
- Stefano Turolo
- Pediatric Nephrology & Dialysis, Milano. Fondazione IRCCS Cà Grande Ospedale Maggiroe Policlinico, Italy
| | - Alberto Edefonti
- Pediatric Nephrology & Dialysis, Milano. Fondazione IRCCS Cà Grande Ospedale Maggiroe Policlinico, Italy
| | - Marta Lepore
- Pediatric Nephrology & Dialysis, Milano. Fondazione IRCCS Cà Grande Ospedale Maggiroe Policlinico, Italy
| | - Luciana Ghio
- Pediatric Nephrology & Dialysis, Milano. Fondazione IRCCS Cà Grande Ospedale Maggiroe Policlinico, Italy
| | - Eva Cuzzoni
- Università degli Studi di Trieste Dipartimento di Scienze della Vita, Trieste, Friuli-Venezia Giulia, Italy
| | - Giuliana Decorti
- Università degli Studi di Trieste Dipartimento di Scienze della Vita, Trieste, Friuli-Venezia Giulia, Italy
| | - Andrea Pasini
- Università degli Studi di Bologna Azienda Ospedaliera Sant/'Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | | | - Cristina Malaventura
- Università degli Studi di Ferrara, Medical Science Ferrara, Emilia-Romagna, Italy
| | - Fabrizio Pugliese
- Agenzia sanitaria e sociale regionale Regione Emilia-Romagna, Ravenna, Emilia-Romagna, Italy
| | - Giovanni Montini
- Pediatric Nephrology & Dialysis, Milano. Fondazione IRCCS Cà Grande Ospedale Maggiroe Policlinico, Italy.,Università degli Studi di Milano, Department of Clinical Sciences and Community Health, Milan, Italy
| |
Collapse
|
17
|
Cuzzoni E, De Iudicibus S, Stocco G, Favretto D, Pelin M, Messina G, Ghio L, Monti E, Pasini A, Montini G, Decorti G. In vitro sensitivity to methyl-prednisolone is associated with clinical response in pediatric idiopathic nephrotic syndrome. Clin Pharmacol Ther 2016; 100:268-74. [PMID: 27007551 DOI: 10.1002/cpt.372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/10/2016] [Accepted: 03/14/2016] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate the in vitro steroid sensitivity as a predictor of clinical response to glucocorticoids in childhood idiopathic nephrotic syndrome (INS). Seventy-four patients (median age 4.33, interquartile range [IQR] 2.82-7.23; 63.5% male) were enrolled in a prospective multicenter study: in vitro steroid inhibition of patients' peripheral blood mononuclear cell proliferation was evaluated by [methyl-(3) H] thymidine incorporation assay at disease onset (T0) and after 4 weeks (T4) of treatment. Steroid dependence was associated with increased in vitro sensitivity at T4 assessed both as drug concentration inducing 50% of inhibition (IC50 ; odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.24-0.85; P = 0.0094) and maximum inhibition at the highest drug concentration (Imax ; OR = 1.13, 95% CI = 1.02-1.31; P = 0.017). IC50 > 4.4 nM and Imax < 92% at T4 were good predictors for optimal clinical response. These results suggest that this test may be useful for predicting the response to glucocorticoid therapy in pediatric INS.
Collapse
Affiliation(s)
- E Cuzzoni
- PhD, School in Sciences of Reproduction and Development, University of Trieste, Trieste, Italy
| | - S De Iudicibus
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - G Stocco
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - D Favretto
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - M Pelin
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - G Messina
- Policlinico Giovanni XIII di Bari, Bari, Italy
| | - L Ghio
- Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Monti
- Nephrology and Dialysis Unit, Department of Pediatrics, Bologna, Italy
| | - A Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Bologna, Italy
| | - G Montini
- Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Decorti
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | |
Collapse
|
18
|
Bella R, Dolci M, Ferraresso M, Ticozzi R, Ghio L, Rizzo J, Signorini L, Villani S, Elia F, Ferrante P, Delbue S. Human herpesvirus-6 and polyomaviruses DNAemia in children and young adult patients after kidney transplantation. Future Virol 2015. [DOI: 10.2217/fvl.15.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aims: Human herpesvirus-6 (HHV-6) and polyomaviruses (HPyV) establish latency and reactivate in immunocompromised hosts. The prevalence of their infections was investigated in pediatric and young adult kidney transplant recipients. Materials & methods: Blood was obtained from 83 patients. Quantitative real-time polymerase chain reactions were conducted to quantify HHV-6 and HPyV loads; nested PCR and reverse transcriptase-PCR assays were conducted to differentiate HHV-6A from 6B and to evaluate the presence of transcripts. Results: HHV-6 and HPyV DNAemia were detected in 19.3 and 18.1% patients, respectively. No association between HHV-6 and HPyV DNA presence, age of patients and time from transplant was observed. Conclusion: HHV-6 infection in immunosuppression setting was as common as those of HPyVs that are commonly recognized as opportunistic agents.
Collapse
Affiliation(s)
- Ramona Bella
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Maria Dolci
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Mariano Ferraresso
- Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy
- Division of Kidney Transplantation, Fondazione Ca’ Granda-Ospedale Maggiore IRCCS, Milan, Italy
| | - Rosalia Ticozzi
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Luciana Ghio
- Division of Kidney Transplantation, Fondazione Ca’ Granda-Ospedale Maggiore IRCCS, Milan, Italy
- Nephrology, Dialysis & Transplantation Unit, Clinica Pediatrica De Marchi, Milan, Italy
| | - Jacopo Rizzo
- Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy
| | - Lucia Signorini
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Sonia Villani
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Francesca Elia
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Pasquale Ferrante
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| |
Collapse
|
19
|
Brugnolo A, De Carli F, Accardo J, Amore M, Bosia LE, Bruzzaniti C, Cappa SF, Cocito L, Colazzo G, Ferrara M, Ghio L, Magi E, Mancardi GL, Nobili F, Pardini M, Rissotto R, Serrati C, Girtler N. An updated Italian normative dataset for the Stroop color word test (SCWT). Neurol Sci 2015; 37:365-72. [PMID: 26621362 DOI: 10.1007/s10072-015-2428-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/20/2015] [Indexed: 11/25/2022]
Abstract
The Stroop color and word test (SCWT) is widely used to evaluate attention, information processing speed, selective attention, and cognitive flexibility. Normative values for the Italian population are available only for selected age groups, or for the short version of the test. The aim of this study was to provide updated normal values for the full version, balancing groups across gender, age decades, and education. Two kinds of indexes were derived from the performance of 192 normal subjects, divided by decade (from 20 to 90) and level of education (4 levels: 3-5; 6-8; 9-13; >13 years). They were (i) the correct answers achieved for each table in the first 30 s (word items, WI; color items, CI; color word items, CWI) and (ii) the total time required for reading the three tables (word time, WT; color time, CT; color word time, CWT). For each index, the regression model was evaluated using age, education, and gender as independent variables. The normative data were then computed following the equivalent scores method. In the regression model, age and education significantly influenced the performance in each of the 6 indexes, whereas gender had no significant effect. This study confirms the effect of age and education on the main indexes of the Stroop test and provides updated normative data for an Italian healthy population, well balanced across age, education, and gender. It will be useful to Italian researchers studying attentional functions in health and disease.
Collapse
Affiliation(s)
- A Brugnolo
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy.
| | - F De Carli
- Institute of Bioimaging and Molecular Physiology, National Research Council, Genoa, Italy
| | - J Accardo
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - M Amore
- Clinical Psychiatry, DINOGMI University of Genoa, Genoa, Italy
| | - L E Bosia
- Clinical Neurology, IRCCS San Martino-IST, Genoa, Italy
| | - C Bruzzaniti
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - S F Cappa
- Division of Neuroscience, IUSS Pavia, San Raffaele Scientific Institute, Milan, Italy
| | - L Cocito
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - G Colazzo
- C.H. La Palmosa, Accueil de Jour Alzheimer, Centre Hospitalier La Palmosa, Menton Division of Neuroscience, Menton, France
| | - M Ferrara
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - L Ghio
- Clinical Psychiatry, DINOGMI University of Genoa, Genoa, Italy
| | - E Magi
- Clinical Psychiatry, DINOGMI University of Genoa, Genoa, Italy
| | - G L Mancardi
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - F Nobili
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - M Pardini
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy
| | - R Rissotto
- Clinical Neurology, IRCCS San Martino-IST, Genoa, Italy
| | - C Serrati
- Clinical Neurology, IRCCS San Martino-IST, Genoa, Italy
| | - N Girtler
- Clinical Neurology, DINOGMI University of Genoa, Genoa, Italy.,Clinical Psychology and Psychotherapy Unit, IRCCS San Martino-IST, Genoa, Italy
| |
Collapse
|
20
|
Lepore M, Testa S, Groppali E, Beretta C, Ramondetta M, Ghio L. SP882BORTEZOMIB FOR THE TREATMENT OF RENAL CHRONIC ANTIBODY MEDIATED REJECTION IN PEDIATRIC AGE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv203.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Edefonti A, Ghio L, Bettinelli A, Paterlini G, Giani M, Nebbia G, Aniasi A, Cattarelli D. Unconjugated hyperbilirubinemia due to ciclosporin administration in children with nephrotic syndrome. Contrib Nephrol 2015; 67:121-4. [PMID: 3208520 DOI: 10.1159/000415387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- A Edefonti
- Clinica Pediatrica G. e D. De Marchi, Università di Milano, Italia
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Ghio L, Bianchi ML, Cecchetti V, Soldati L, Ortolani S, Bacchini M, Edefonti A, Sereni F. Free cytosolic calcium in children with idiopathic hypercalciuria. Contrib Nephrol 2015; 67:67-70. [PMID: 3208535 DOI: 10.1159/000415376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- L Ghio
- Clinica Pediatrica G. e D. De Marchi-Università Milano, Italia
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Mihatsch MJ, Imbasciati E, Fogazzi G, Giani M, Ghio L, Gaboardi F. Ultrastructural lesions of Henoch-Schönlein syndrome and IgA nephropathy: similarities and differences. Contrib Nephrol 2015; 40:255-63. [PMID: 6499456 DOI: 10.1159/000409759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
24
|
Ferraresso M, Turolo S, Belingheri M, Tirelli AS, Cortinovis I, Milani S, Edefonti A, Ghio L. Relationship between mRNA expression levels of CYP3A4, CYP3A5 and SXR in peripheral mononuclear blood cells and aging in young kidney transplant recipients under tacrolimus treatment. Pharmacogenomics 2015; 16:483-91. [DOI: 10.2217/pgs.15.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim: The activity of several key enzymes involved in the metabolism of many drugs is subject to change closely related to the age of patients. This possibility must also be considered in the case of tacrolimus, the most important calcineurins inhibitor, which is widely used in pediatric kidney transplantation. As well as in the liver and intestine, some of the enzymes involved in the metabolism of tacrolimus were also isolated in the peripheral blood mononuclear cells (PBMCs), where also appear to play an important regulatory action. Therefore, the influence of some external factors on the expression of specific mRNA can be determined noninvasively. Patients & methods: The correlation between the levels of mRNA specific for key enzymes SXR, CYP3A and ABCB1 involved in the metabolism of tacrolimus was evaluated in PBMCs obtained from a selected population of 29 young kidney transplant recipients. A possible correlation between the expression of these specific mRNAs and tacrolimus pharmacokinetics was also investigated. Results: The patients’ age and their blood concentrations of SXR mRNA were directly correlated with the expression of CYP3A4, CYP3A5 mRNAs, but not of ABCB1 mRNA in the PBMCs. tacrolimus-normalized daily dose was strongly correlated with patient's age and multivariable regression indicates the CYP3A4-specific mRNA as the sole independent variable influencing tacrolimus concentration-to-dose ratio. Conclusion: Aging and SXR mRNA significantly affect the expression of CYP3A4- and CYP3A5-specific mRNA as measured by their concentration in PBMC. Original submitted 17 November 2014; Revision submitted 6 February 2015
Collapse
Affiliation(s)
- Mariano Ferraresso
- Department of Clinical Sciences & Community Health, University of Milan, Via F. Sforza 35, 20122 Milan, Italy
- Division of Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S., Milan, Italy
| | - Stefano Turolo
- Division of Pediatric Nephology & Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S. Milan, Italy
| | - Mirco Belingheri
- Division of Pediatric Nephology & Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S. Milan, Italy
| | - Amedea Silvia Tirelli
- Laboratory of Clinical Chemistry & Microbiology, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S., Milan, Italy
| | - Ivan Cortinovis
- Division of Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S., Milan, Italy
- Unit of Statistics & Biometry, Campus Cascina Rosa, Milan, Italy
| | - Silvano Milani
- Division of Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S., Milan, Italy
- Unit of Statistics & Biometry, Campus Cascina Rosa, Milan, Italy
| | - Alberto Edefonti
- Division of Pediatric Nephology & Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S. Milan, Italy
| | - Luciana Ghio
- Division of Pediatric Nephology & Kidney Transplantation, Ca' Granda Foundation, Ospedale Maggiore, I.R.C.C.S. Milan, Italy
| |
Collapse
|
25
|
Paglialonga F, Ardissino G, Consolo S, Ghio L, Belingheri M, Testa S, Biasuzzi A, Edefonti A. Plasma-exchange in pediatric patients: a single-center experience. Minerva Pediatr 2014; 69:113-120. [PMID: 25411940 DOI: 10.23736/s0026-4946.16.04152-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Plasma-exchange (PEX) has been well described in pediatrics, but most of the current indications are derived from adult experience. Aim of the study was to review the PEX treatments in our Unit over a six-year period. METHODS Three hundred and seventy-seven PEX sessions were performed in 38 patients (median age 12.1 years, range 0.6-20.5). Double-needle and single-needle PEX combined with hemodialysis and PEX combined with ultrafiltration were performed in 9, 1 and 3 patients respectively. The most common indications to PEX were atypical hemolytic uremic syndrome (aHUS, 9 patients), focal segmental glomerulosclerosis (FSGS, 9 cases), antibody mediated rejection (AMR) in renal transplant (rTx) recipients (8 patients) and hyperimmunization in patients waiting for rTx (4 cases). RESULTS We treated five patients with aHUS on native kidneys with PEX only, with complete remission in 4/6 recurrences; PEX was also successfully used to prevent HUS relapse in three patients undergoing rTx. Only one partial remission was obtained in four patients with FSGS on native kidneys, by means of treatment protocols based on PEX and immunosuppressants; conversely, a partial remission was observed in 6/6 patients with recurrence of FSGS on rTx. Immunosuppressive protocols combined with PEX proved useful in sensitized cadaveric rTx recipients (2/4 successfully transplanted), but failed in 6 patients with chronic AMR. As regards complications, two severe adverse reactions occurred: an anaphylactic shock after the use of albumin and an abdominal hemorrhage. CONCLUSIONS PEX is a relatively safe procedure in children. Pediatric patients with aHUS, recurrent FSGS and sensitized rTx recipients seem to benefit from treatment strategies including PEX.
Collapse
Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Gianluigi Ardissino
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Consolo
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luciana Ghio
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirco Belingheri
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Testa
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonietta Biasuzzi
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Edefonti
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
26
|
Esposito S, Mastrolia MV, Ghio L, Paglialonga F, Terranova L, Scala A, Edefonti A, Principi N. Influenza immunization in hemodialyzed or kidney transplanted adolescents and young adults. Expert Rev Vaccines 2014; 13:1059-66. [DOI: 10.1586/14760584.2014.935768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
27
|
Ferraresso M, Belingheri M, Ginevri F, Murer L, Dello Strologo L, Cardillo M, Parodi A, Ghirardo G, Guzzo I, Innocente A, Ghio L. Three-yr safety and efficacy of everolimus and low-dose cyclosporine in de novo pediatric kidney transplant patients. Pediatr Transplant 2014; 18:350-6. [PMID: 24802342 DOI: 10.1111/petr.12261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Abstract
The three yr results of a multicenter trial in de novo pediatric KT treated with a proliferative signal inhibitor and low dose CNI are presented. Thirty-seven children (9.1 ± 5 yr old) received basiliximab, cyclosporine A (CyA C2:1400 ng/mL), (MMF C0:1.5-3 μg/mL), and prednisone. Three wk later everolimus was started (C0:5-10 ng/mL), CyA was reduced (C2:600 ng/mL after 90 days 300 ng/mL), and MMF discontinued. During the three-yr period patient and graft survivals were 96%. One patient died for causes unrelated to the immunosuppression. Cumulative acute rejection rate including protocol and indication biopsies was 21.9%. None of the patients had signs of chronic humoral rejection. Incidence of dnDSA was 5%, 11%, and 22% at one, two, and three yr post-transplant, respectively. Mean glomerular filtration rate measured at one yr and three yr post-transplant was 105.5 ± 31 and 110.7 ± 27 mL/min/1.73 m(2), respectively. A growth velocity of 7.7 ± 6.7 cm/yr was achieved with positive catch-up growth. No malignancy or post-transplant lymphoproliferative diseases were diagnosed. In conclusion, the treatment based on basiliximab induction, everolimus, low-dose cyclosporine, and low-dose prednisone leads to good long-term efficacy in de novo pediatric KT recipients.
Collapse
Affiliation(s)
- Mariano Ferraresso
- Department of Medical Science and Community Health, University of Milan, Milan, Italy; Division of General and Vascular Surgery, St. Joseph Hospital, Multimedica I.R.C.C.S., Milan, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Belingheri M, Lazzari L, Parazzi V, Groppali E, Biagi E, Gaipa G, Giordano R, Rastaldi MP, Croci D, Biondi A, Rebulla P, Edefonti A, Ghio L. Allogeneic mesenchymal stem cell infusion for the stabilization of focal segmental glomerulosclerosis. Biologicals 2013; 41:439-45. [PMID: 24135082 DOI: 10.1016/j.biologicals.2013.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/20/2013] [Accepted: 09/11/2013] [Indexed: 12/21/2022] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is the most frequent acquired renal condition resulting in end stage kidney disease in children. We describe a cell therapy treatment with human allogeneic bone marrow mesenchymal stem cells (MSC) in a 13-year-old patient developing recurrent FSGS after renal transplantation, which was not responding to conventional therapy. This treatment relied on the following measurements:clinical and laboratory evaluation of renal function, proteome array, biopsy, short tandem repeat assay. Before MSC treatment, the patient needed weekly plasmapheresis to achieve proteinuria-to-creatininuria ratio below 5. After three MSC infusions without adverse events, the patient has a stable renal function and the proteinuria target was reached without plasmapheresis. In addition, some circulating inflammatory factors decreased and their levels were still low after one year. This is the first report of an MSC treatment in an FSGS patient. Even though different factors may have contributed to the clinical results, after MSC infusion a stable reduction in the serum level of several inflammatory factors has been registered and the patient does not need anymore plasmapheresis to keep proteinuria under control. In addition, this encouraging single case let us identify some putative efficacy biomarkers that could be of clinical interest in chronic kidney diseases.
Collapse
Affiliation(s)
- Mirco Belingheri
- Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Ferraresso M, Belingheri M, Turolo S, Ghio L, Tirelli AS, Grillo P, Lepore M, Edefonti A. Long-term effects of ABCB1 and SXR SNPs on the systemic exposure to cyclosporine in pediatric kidney transplant patients. Pharmacogenomics 2013; 14:1605-13. [DOI: 10.2217/pgs.13.148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Cyclosporine is characterized by a wide interindividual variability in its pharmacokinetics. The objective of this study was to evaluate the effects of ABCB1 and SXR SNPs on cyclosporine exposure in a group of kidney transplant patients followed up from childhood to adulthood. Patients & methods: Recipients were genotyped for ABCB1 C1236T, G2677T/A and C3435T, and for SXR RS3842689 and A7635G. Dose-adjusted trough levels and weight-adjusted daily doses were compared among patients according to allelic status by a generalized estimation equation approach that allows longitudinal data analyses. Results: A genotype-dependent effect was found in all ABCB1 genotypes and in one of the SXR SNPs. This effect was particularly evident for the TT genotype of the ABCB1 G2677T/A SNP, the TT genotype of the ABCB1 C3435T SNP and for heterozygotes of the deletion of 6 bp in the promoter region of SXR. Conclusion: The presence of specific ABCB1 and SXR SNPs could significantly affect cyclosporine exposure during a kidney transplant patient’s development from childhood to adulthood in a time-dependent fashion. Original submitted 3 May 2013; Revision submitted 25 July 2013
Collapse
Affiliation(s)
- Mariano Ferraresso
- Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy
- Division of General & Vascular Surgery, St Joseph Hospital, 20122, Milan, Italy
| | - Mirco Belingheri
- Division of Pediatric Nephology & Kidney Transplantation, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| | - Stefano Turolo
- Laboratory of Clinical Chemistry & Microbiology, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| | - Luciana Ghio
- Division of Pediatric Nephology & Kidney Transplantation, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| | - Amedea Silvia Tirelli
- Laboratory of Clinical Chemistry & Microbiology, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| | - Paolo Grillo
- Epidemiology Unit, Department of Occupational & Environmental Health, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| | - Marta Lepore
- Division of Pediatric Nephology & Kidney Transplantation, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| | - Alberto Edefonti
- Division of Pediatric Nephology & Kidney Transplantation, Ca’ Granda Foundation, Ospedale Maggiore, IRCCS, Milan, Italy
| |
Collapse
|
30
|
Ginevri F, Nocera A, Comoli P, Innocente A, Cioni M, Parodi A, Fontana I, Magnasco A, Nocco A, Tagliamacco A, Sementa A, Ceriolo P, Ghio L, Zecca M, Cardillo M, Garibotto G, Ghiggeri GM, Poli F. Posttransplant de novo donor-specific hla antibodies identify pediatric kidney recipients at risk for late antibody-mediated rejection. Am J Transplant 2012; 12:3355-62. [PMID: 22959074 DOI: 10.1111/j.1600-6143.2012.04251.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The emerging role of humoral immunity in the pathogenesis of chronic allograft damage has prompted research aimed at assessing the role of anti-HLA antibody (Ab) monitoring as a tool to predict allograft outcome. Data on the natural history of allografts in children developing de novo Ab after transplantation are limited. Utilizing sera collected pretransplant, and serially posttransplant, we retrospectively evaluated 82 consecutive primary pediatric kidney recipients, without pretransplant donor-specific antibodies (DSA), for de novo Ab occurrence, and compared results with clinical-pathologic data. At 4.3-year follow up, 19 patients (23%) developed de novo DSA whereas 24 had de novo non-DSA (NDSA, 29%). DSA appeared at a median time of 24 months after transplantation and were mostly directed to HLA-DQ antigens. Among the 82 patients, eight developed late/chronic active C4d+ antibody-mediated rejection (AMR), and four C4d-negative AMR. Late AMR correlated with DSA (p < 0.01), whose development preceded AMR by 1-year median time. Patients with DSA had a median serum creatinine of 1.44 mg/dL at follow up, significantly higher than NDSA and Ab-negative patients (p < 0.005). In our pediatric cohort, DSA identify patients at risk of renal dysfunction, AMR and graft loss; treatment started at Ab emergence might prevent AMR occurrence and/or progression to graft failure.
Collapse
Affiliation(s)
- F Ginevri
- Pediatric Nephrology, Istituto G. Gaslini, Genova, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Delbue S, Ferraresso M, Elia F, Belingheri M, Carloni C, Signorini L, Carluccio S, Dallari S, Ghio L, Ferrante P. Investigation of polyomaviruses replication in pediatric patients with nephropathy receiving rituximab. J Med Virol 2012; 84:1464-70. [PMID: 22825826 DOI: 10.1002/jmv.23339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rituximab is a chimeric monoclonal antibody reacting with the CD20 antigen on B cells. It has been proposed as treatment for the idiopathic nephrotic syndrome, recurrent idiopathic nephropathy, and focal segmental glomerulosclerosis refractory to steroids. Rituximab influences T-cell immunity and may predispose the patients to opportunistic infections, such as progressive multifocal leukoencephalopathy caused by the polyomavirus JC (JCV). The risk of latent viruses infections/reactivations in pediatric patients receiving monoclonal antibodies is not well known yet. In this longitudinal 6-month study, the effects of rituximab on JCV and BK virus (BKV) replication have been investigated. Blood, serum, and urine samples have been collected monthly from 11 pediatric patients (mean age: 11 years) with the idiopathic nephrotic syndrome and recurrent idiopathic nephropathy, under rituximab therapy. JCV and BKV real-time PCRs and sequencing of the viral protein 1 and the non-coding control region have been conducted. The same investigations have been undertaken on samples collected from eight pediatric patients (controls, mean age: 6 years), with idiopathic nephrotic syndrome or focal segmental glomerulosclerosis, treated with conventional chemotherapy. JCV was detected in the urine of one patient (9%), and one control (12.5%); BKV was found in the urine of 7/11 patients (63.6%) and 2/8 controls (25%) and in blood samples from four patients. No significant difference was found in the mean viral loads and in the viral molecular characterizations between the two groups. The polyomaviruses replication was not associated with rituximab therapy in children.
Collapse
Affiliation(s)
- Serena Delbue
- Foundation Ettore Sansavini, Health Science Foundation, Lugo, Ravenna, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Ferraresso M, Turolo S, Belinghieri M, Tirelli AS, Grillo P, Groppali E, Edefonti A, Ghio L. The potential of steroids and xenobiotic receptor polymorphisms in forecasting cyclosporine pharmacokinetic variability in young kidney transplant recipients. Pediatr Transplant 2012; 16:658-63. [PMID: 22765024 DOI: 10.1111/j.1399-3046.2012.01751.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The steroids and xenobiotics receptor (SXR) up-regulates the expression and the synthesis of key enzymes in CyA metabolism. In this study, we examined the possible interactions between CyA exposure and SXR polymorphisms during the first year after renal transplantation. The study involved 66 pediatric renal transplant recipients (25 women and 41 men, mean age 13.9 ± 7.4 yr). All patients were genotyped for two sequence variations in the NR1I2 gene: g.-205_-200delGAGAAG and 7635 A>G. CyA trough levels and CyA weight-adjusted daily dose were recorded at 30, 90, 180, and 360 days after transplantation and compared between the different genotypes. A third newly discovered SXR polymorphism was characterized and also included in the study. CyA trough levels and CyA weight-adjusted daily dose were comparable on four time points throughout the first year post-transplant in all three groups. GEE showed a significant reduction in weight-adjusted CyA daily dose in patients carrying the deletion of 6 bp in SXR with a significant group-by-time effect that persisted also when analysis was corrected for age, prednisone dose, and acute rejection episodes. In our group of patients, only the g.-205_-200delGAGAAG SXR polymorphism was able to influence the metabolism of CyA continuously, during the first year after transplantation.
Collapse
Affiliation(s)
- Mariano Ferraresso
- Department of Clinical Sciences and Community Health, University of Milan Medical School, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Ziprani C, Selle V, Palazzi B, Capretta F, Ghio L, Flora ME, Baldo V. Is Venice an ideal habitat for Legionella pneumophila? J Prev Med Hyg 2012; 53:152-156. [PMID: 23362621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Legionella bacterium manifests itself in Legionnaire's disease and Pontiac fever, it is mainly found and transmitted by aerosol produced in cooling towers, water distribution plants and medical equipment, and it affects mainly elder persons in poor health. METHODS The population of Venice Local Health Unit was divided in two areas of study and the incidence of legionellosis in residents of Venice historical centre (Distretto Sanitario 1) and in residents of the mainland and coastal areas (Distretti Sanitari 2, 3, 4) was calculated. The cases were those notified to the Public Health Unit by law, and the population of residents was that of the eligible for health care in the archives of the Local Health Unit. Only cases of legionellosis in residents who had not travelled in the 10 days previous of the onset of disease, and not related to nosocomial clusters were considered. The standardized incidence ratio was then calculated and confidence interval were defined by Poisson distribution. RESULTS Given the population of the two areas, 59801 in Distretto Sanitario 1 and 237555 in Distretti 2, 3, 4, the raw incidence of disease is respectively 87 per 100000 and 20 per 100000 in time 2002-2010. The standardized incidence ratio for the population of Distretto Sanitario 1 vs the remaining population is 4.3. DISCUSSION The difference in risk of getting the disease in this two residential areas geographically very close, is probably related to the different buildings' characteristics, old and difficult to maintain in Venice historical centre.
Collapse
Affiliation(s)
- C Ziprani
- Hygiene and Public Health Service, Department of Prevention, AULSS 12 of Venice
| | | | | | | | | | | | | |
Collapse
|
34
|
Magnasco A, Ravani P, Edefonti A, Murer L, Ghio L, Belingheri M, Benetti E, Murtas C, Messina G, Massella L, Porcellini MG, Montagna M, Regazzi M, Scolari F, Ghiggeri GM. Rituximab in children with resistant idiopathic nephrotic syndrome. J Am Soc Nephrol 2012; 23:1117-24. [PMID: 22581994 DOI: 10.1681/asn.2011080775] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Idiopathic nephrotic syndrome resistant to standard treatments remains a therapeutic dilemma in pediatric nephrology. To test whether the anti-CD20 monoclonal antibody rituximab may benefit these patients, we conducted an open-label, randomized, controlled trial in 31 children with idiopathic nephrotic syndrome unresponsive to the combination of calcineurin inhibitors and prednisone. All children continued prednisone and calcineurin inhibitors at the doses prescribed before enrollment, and one treatment group received two doses of rituximab (375 mg/m(2) intravenously) as add-on therapy. The mean age was 8 years (range, 2-16 years). Rituximab did not reduce proteinuria at 3 months (change, -12% [95% confidence interval, -73% to 110%]; P=0.77 in analysis of covariance model adjusted for baseline proteinuria). Additional adjustment for previous remission and interaction terms (treatment by baseline proteinuria and treatment by previous remission) did not change the results. In conclusion, these data do not support the addition of rituximab to prednisone and calcineurin inhibitors in children with resistant idiopathic nephrotic syndrome.
Collapse
Affiliation(s)
- Alberto Magnasco
- Division of Nephrology, Dialysis and Transplantation and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Largo G. Gaslini 5, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Ferraresso M, Turolo S, Ghio L, Tirelli AS, Belingheri M, Villa R, Groppali E, Edefonti A. Association between CYP3A5 polymorphisms and blood pressure in kidney transplant recipients receiving calcineurin inhibitors. Clin Exp Hypertens 2011; 33:359-65. [PMID: 21851254 DOI: 10.3109/10641963.2011.561896] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract Renal cytochrome P450 3A5 (CYP3A5) has been associated with blood pressure (BP) control in humans. We investigated whether CYP3A5 polymorphisms are associated with post- transplant hypertension in a selected population of kidney recipients receiving calcineurin inhibitors. Ninety-two kidney transplant recipients receiving cyclosporine (CyA) or tacrolimus (Tac) were genotyped for CYP3A5 polymorphisms, and the association between the CYP3A5 alleles (*1,*3) and hypertension on post-operative day (POD) 6 and POD 180 was verified, with multiple regression being used to identify the putative co-variates that may predict the extent and severity of hypertension in transplant recipients at different post-transplant times. The CYP3A5*1 carriers had higher systolic (SBP) and diastolic blood pressure (DBP) in both the immediate and delayed post-transplant period when adjusted for anti-hypertensive medication (POD 6: SBP = 161 ± 23 vs. 140 ± 23 mmHg; DBP = 120 ± 15 vs. 87 ± 14 mmHg, p < 0.05. POD 180: SBP = 136 ± 16 vs. 129 ± 14 mmHg; DBP = 89 ± 15 vs. 80 ± 15 mmHg, p < 0.05). The severity of hypertension between the CYP3A5*1 carriers and noncarriers on POD 6 was documented by the significantly different distribution of hypertension classes, but this was not confirmed on POD 180. The CYP3A5 genotype was the only independent variable affecting mean arterial pressure. The results of this study show that CYP3A5 polymorphisms are associated with the severity and degree of hypertension in kidney transplant recipients receiving calcineurin inhibitors regardless of the time of recording. However, the role of concomitant medications such as steroids with strong CYP3A5 inducing activity, should be taken into account.
Collapse
Affiliation(s)
- Mariano Ferraresso
- Department of General Surgery, University of Milan Medical School, Saint Joseph Hospital, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
The aim of this study is to gain insight into the individual experiences of patients who attempt suicide in order to better understand the reasons for and emotions behind a suicide attempt, thus also gaining insight, through the patients' own input, into the risk and protective factors which might influence possible repeat attempts and the attitude towards the assistance they receive. Two focus groups were conducted involving 17 participants, all hospitalized at the time of research for attempting suicide. The patients proved themselves competent, even expert in indicating reasons for, risk factors of and prevention strategies for suicide. The main findings suggest that the relational factor represents a key point both as a trigger for the suicide attempt and for promoting the communication of the intent or for preventing a repeat suicide attempt, as interpersonal relationships and an empathic environment were, in essence, what was perceived as therapeutic and protective and enabled the expression of thoughts and self-understanding. Accordingly psychotherapy, non-specific relationship 'monitoring' after discharge and tutored self-help groups have been suggested. Feasibility and implementing methods as well as the role of the nurse for such interventions were discussed.
Collapse
Affiliation(s)
- L Ghio
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy.
| | | | | | | | | | | |
Collapse
|
37
|
Ghio L, Natta W, Barbato A, Marcenaro M, Gotelli S, Jones PB, Parabiaghi A. Schizophrenia trial participation: perceived inclusion barriers and beliefs about antipsychotics. Pharmacopsychiatry 2011; 44:123-8. [PMID: 21710401 DOI: 10.1055/s-0031-1277147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient recruitment is the universal rate-limiting factor for randomized controlled trials (RCTs) in all medical specialties. This study examined the opinions on perceived inclusion barriers and beliefs about antipsychotics of a group of psychiatrists participating in a pragmatic RCT on antipsychotic drugs in schizophrenia (the GiSAS trial). METHODS A survey of all clinicians working in the trial recruiting centers was performed exploring factors associated to the respondents' opinions. RESULTS Of 465 clinicians, 278 (59.8%) responded to the questionnaire. Respondents (n=278) were mainly influenced by clinical and trial-related barriers (89%). Factors such as work setting and antipsychotic prescription choices appeared to be related to perceived inclusion barriers. Most respondents believed in the superiority of SGAs (62.9%), one-third indicating drug company representatives as the most important source of information; this was related to further optimism towards SGAs. CONCLUSIONS Respondents were affected mainly by system-related barriers, whereas personal barriers were given less weight. The influence of industry-mediated information could have affected opinions on SGAs and the lack of uncertainty about antipsychotics attitudes towards trial participation.
Collapse
Affiliation(s)
- L Ghio
- Departments of Neuroscience Ophthalmology, and Genetics University of Genoa, Genoa, Italy
| | | | | | | | | | | | | |
Collapse
|
38
|
Ravani P, Magnasco A, Edefonti A, Murer L, Rossi R, Ghio L, Benetti E, Scozzola F, Pasini A, Dallera N, Sica F, Belingheri M, Scolari F, Ghiggeri GM. Short-term effects of rituximab in children with steroid- and calcineurin-dependent nephrotic syndrome: a randomized controlled trial. Clin J Am Soc Nephrol 2011; 6:1308-15. [PMID: 21566104 DOI: 10.2215/cjn.09421010] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Prednisone and calcineurin inhibitors are the mainstay therapy of idiopathic nephrotic syndrome (INS) in children. However, drug dependence and toxicity associated with protracted use are common. Case series suggest that the anti-CD20 monoclonal antibody rituximab (RTX) may maintain disease remission. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This open-label randomized controlled trial was powered to show that a strategy based on RTX and lower doses of prednisone and calcineurin inhibitors was noninferior to standard doses of these agents in maintaining 3-month proteinuria as low as baseline or up to 1 g/d greater (noninferiority margin). Participants were stratified by the presence of toxicity to prednisone/calcineurin inhibitors and centrally assigned to add RTX (Mabthera, 375 mg/m(2) intravenously) to lower doses of standard agents or to continue with current therapy alone. The risk of relapse was a secondary outcome. RESULTS Fifty-four children (mean age 11 ± 4 years) with INS dependent on prednisone and calcineurin inhibitors for >12 months were randomized. Three-month proteinuria was 70% lower in the RTX arm (95% confidence interval 35% to 86%) as compared with standard therapy arm (intention-to-treat); relapse rates were 18.5% (intervention) and 48.1% (standard arm) (P = 0.029). Probabilities of being drug-free at 3 months were 62.9% and 3.7%, respectively (P < 0.001); 50% of RTX cases were in stable remission without drugs after 9 months. CONCLUSIONS Rituximab and lower doses of prednisone and calcineurin inhibitors are noninferior to standard therapy in maintaining short-term remission in children with INS dependent on both drugs and allow their temporary withdrawal.
Collapse
Affiliation(s)
- Pietro Ravani
- Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Ginevri F, Dello Strologo L, Guzzo I, Belingheri M, Ghio L. [Kidney transplant from living donors in children?]. G Ital Nefrol 2011; 28:15-25. [PMID: 21341241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A living-donor kidney transplant offers a child at the terminal stages of renal disease better functional recovery and quality of life than an organ from a deceased donor. Before starting the procedure for a living-donor transplant, however, it is necessary to establish if it is really safe. There are diseases, such as focal segmental glomerulosclerosis, atypical HUS and membranoproliferative glomerulonephritis with dense deposits, for which living donation is not recommended given the high incidence of recurrence of the disease but also the frequent loss of the graft. Regarding the selection of the donor, an increased risk of acute rejection has been reported for donors older than 60-65 years and a worsening of the renal outcome if the donor's weight is equal to or less than the recipient's. Finally, it is necessary to take into consideration that complications may arise in the donor both in the perioperative period and in the long term. In conclusion, kidney transplant from a living donor is a natural choice within the pediatric setting. The parents, usually young and highly motivated to donate, are the ideal donors. However, although the risks associated with donation are minimal, they are not totally absent, and consequently it is mandatory to follow standardized procedures according to the guidelines issued by the Centro Nazionale Trapianti.
Collapse
Affiliation(s)
- Fabrizio Ginevri
- Medicina Clinica e Sperimentale dei Trapianti, U.O.C. Nefrologia, Istituto G. Gaslini, Genova, Italy.
| | | | | | | | | |
Collapse
|
40
|
Guldbrand D, Goetzsche O, Eika B, Watanabe N, Taniguchi M, Akagi T, Koide N, Sano S, Orbovic B, Obrenovic-Kircanski B, Ristic S, Soskic LJ, Alhabshan F, Jijeh A, Abo Remsh H, Alkhaldi A, Najm HK, Gasior Z, Skowerski M, Kulach A, Szymanski L, Sosnowski M, Wang M, Siu CW, Lee K, Yue WS, Yan GH, Lee S, Lau CP, Tse HF, O'connor K, Rosca M, Magne J, Romano G, Moonen M, Pierard LA, Lancellotti P, Floria M, De Roy L, Blommaert D, Jamart J, Dormal F, Lacrosse M, Arsenescu Georgescu C, Mizariene V, Bucyte S, Bertasiute A, Pociute E, Zaliaduonyte-Peksiene D, Baronaite-Dudoniene K, Sileikiene R, Vaskelyte J, Jurkevicius R, Dencker M, Thorsson O, Karlsson MK, Linden C, Wollmer P, Andersen LB, Catalano O, Perotti MR, Colombo E, De Giorgi M, Cattaneo M, Cobelli F, Priori SG, Ober C, Iancu Adrian IA, Andreea Parv PA, Cadis Horatiu CH, Ober Mihai OM, Chmielecki M, Fijalkowski M, Galaska R, Dubaniewicz W, Lewicki L, Targonski R, Ciecwierz D, Puchalski W, Koprowski A, Rynkiewicz A, Hristova K, La Gerche A, Katova TZ, Kostova V, Simova Y, Kempny A, Diller GP, Orwat S, Kaleschke G, Kerckhoff G, Schmidt R, Radke RM, Baumgartner H, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Kiotsekoglou A, Govind SC, Gadiyaram V, Moggridge JC, Govindan M, Gopal AS, Ramesh SS, Brodin LA, Saha SK, Ramzy IS, Lindqvist P, Lam YY, Duncan AM, Henein MY, Craciunescu IS, Serban M, Iancu M, Revnic C, Popescu BA, Alexandru D, Rogoz D, Uscatescu V, Ginghina C, Careri G, Di Monaco A, Nerla R, Tarzia P, Lamendola P, Sestito A, Lanza GA, Crea F, Giannini F, Pinamonti B, Santangelo S, Perkan A, Vitrella G, Rakar S, Merlo M, Della Grazia E, Salvi A, Sinagra G, Scislo P, Kochanowski J, Piatkowski R, Roik M, Postula M, Opolski G, Castillo J, Herszkowicz N, Ferreira C, Lonnebakken MT, Staal EM, Nordrehaug JE, Gerdts E, Przewlocka-Kosmala M, Orda A, Karolko B, Bajraktari G, Lindqvist P, Gustafsson U, Holmgren A, Henein MY, Frattini S, Faggiano P, Zilioli V, Locantore E, Longhi S, Bellandi F, Faden G, Triggiani M, Dei Cas L, Seo SM, Jung HO, An SH, Jung SY, Park CS, Jeon HK, Youn HJ, Chung WB, Kim JH, Uhm JS, Mampuya W, Brochu MC, Do DH, Essadiqi B, Farand P, Lepage S, Daly MJ, Monaghan M, Hamilton A, Lockhart C, Kodoth V, Maguire C, Morton A, Manoharan G, Spence MS, Streb W, Mitrega K, Nowak J, Duszanska A, Szulik M, Kalinowski M, Kukulski T, Kalarus Z, Calvo Iglesias FE, Solla-Ruiz I, Villanueva-Benito I, Paredes-Galan E, Bravo-Amaro M, Iniguez-Romo A, Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Demiroglu IC, Aytekin S, Enache R, Piazza R, Muraru D, Roman-Pognuz A, Popescu BA, Calin A, Leiballi E, Antonini-Canterin F, Ginghina C, Nicolosi GL, Ridard C, Bellouin A, Thebault C, Laurent M, Donal E, Sutandar A, Siswanto BB, Irmalita I, Harimurti G, Saxena A, Ramakrishnan S, Roy A, Krishnan A, Misra P, Bhargava B, Poole-Wilson PA, Loegstrup BB, Andersen HR, Poulsen SH, Klaaborg KE, Egeblad HE, Gu X, Gu XY, He YH, Li ZA, Han JC, Chen J, Mansencal N, Mitry E, Rougier P, Dubourg O, Villarraga H, Adjei-Twum K, Cudjoe TKM, Clavell A, Schears RM, Cabrera Bueno F, Molina Mora MJ, Fernandez Pastor J, Linde Estrella A, Pena Hernandez JL, Isasti Aizpurua G, Carrasco Chinchilla F, Barrera Cordero A, Alzueta Rodriguez FJ, De Teresa Galvan E, Gaetano Contegiacomo GC, Francesco Pollice FP, Paolo Pollice PP, Gu X, Gu XY, He YH, Li ZA, Kontos MC, Shin DH, Yoo SY, Lee CK, Jang JK, Jung SI, Song SI, Seo SI, Cheong SS, Peteiro J, Perez-Perez A, Bouzas-Mosquera A, Pineiro M, Pazos P, Campo R, Castro-Beiras A, Gaibazzi N, Rigo F, Sartorio D, Reverberi C, Sitia S, Tomasoni L, Gianturco L, Ghio L, Stella D, Greco P, De Gennaro Colonna V, Turiel M, Sitia S, Tomasoni L, Cicala S, Magagnin V, Caiani E, Turiel M, Kyrzopoulos S, Tsiapras D, Domproglou G, Avramidou E, Voudris V, Wierzbowska-Drabik K, Lipiec P, Chrzanowski L, Roszczyk N, Kupczynska K, Kasprzak JD, Sachpekidis V, Bhan A, Gianstefani S, Reiken J, Paul M, Pearson P, Harries D, Monaghan MJ, Dale K, Stoylen A, Saha SK, Kodali V, Toole R, Govind SC, Moggridge JC, Kiotsekoglou A, Gopal AS, Raju P, Mcintosh RA, Silberbauer J, Baumann O, Patel NR, Sulke N, Trivedi U, Hyde J, Venn G, Lloyd G, Wejner-Mik P, Lipiec P, Wierzbowska K, Kasprzak JD, Lowenstein JA, Caniggia C, Garcia A, Amor M, Casso N, Lowenstein Haber D, Porley C, Zambrana G, Daru V, Deljanin Ilic M, Ilic S, Kalimanovska Ostric D, Stoickov V, Zdravkovic M, Paraskevaidis I, Ikonomidis I, Parissis J, Papadopoulos C, Stasinos V, Bistola V, Anastasiou-Nana M, Gudin Uriel M, Balaguer Malfagon JR, Perez Bosca JL, Ridocci Soriano F, Martinez Alzamora N, Paya Serrano R, Ciampi Q, Pratali L, Della Porta M, Petruzziello B, Villari B, Picano E, Sicari R, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Sutherland GR, Bijnens B, Myrmel T, Andersen M, Gustafsson F, Secher NH, Brassard P, Jensen AS, Hassager C, Madsen PL, Moller JE, Mampuya W, Brochu MC, Coutu M, Do DH, Essadiqi B, Farand P, Greentree D, Normandin D, Lepage S, Brun H, Dipchand A, Koopman L, Fackoury CT, Truong S, Manlhiot C, Mertens L, Baroni M, Mariani M, Chabane HK, Berti S, Ripoli A, Storti S, Glauber M, Scopelliti PA, Antongiovanni GB, Personeni D, Saino A, Tespili M, Jung P, Mueller M, Jander F, Sohn HY, Rieber J, Schneider P, Klauss V, Agricola E, Slavich M, Stella S, Ancona M, Oppizzi M, Bertoglio L, Melissano G, Margonato A, Chiesa R, Cejudo Diaz Del Campo L, Mesa Rubio D, Ruiz Ortiz M, Delgado Ortega M, Villanueva Fernandez E, Lopez Aguilera J, Toledano Delgado F, Pan Alvarez-Ossorio M, Suarez De Lezo Cruz Conde J, Lafuente M, Butz T, Meissner A, Lang CN, Prull MW, Plehn G, Trappe HJ, Nair SV, Lee L, Mcleod I, Whyte G, Shrimpton J, Hildick Smith D, James PR, Slikkerveer J, Appelman YEA, Veen G, Porter TR, Kamp O, Colonna P, Ten Cate FJ, Bokor D, Daponte A, Cocciolo M, Bona M, Sacchi S, Becher H, Chai SC, Tan PJ, Goh YS, Ong SH, Chow J, Lee LL, Goh PP, Tong KL, Kakihara R, Naruse C, Hironaka H, Tsuzuku T, Ozawa K, Tomaszuk-Kazberuk A, Sobkowicz B, Malyszko J, Malyszko JS, Kalinowski M, Sawicki R, Hirnle T, Dobrzycki S, Mysliwiec M, Musial WJ, Mathias W, Kowatsch I, Saroute ALR, Osorio AFF, Sbano JCN, Ramires JAF, Tsutsui JM, Sakata K, Ito H, Ishii K, Sakuma T, Iwakura K, Yoshino H, Yoshikawa J, Shahgaldi K, Lopez A, Fernstrom B, Sahlen A, Winter R, Kovalova S, Necas J, Amundsen BH, Jasaityte R, Kiss G, Barbosa D, D'hooge J, Torp H, Szmigielski CA, Newton JD, Rajpoot K, Noble JA, Kerber R, Becher H, Koopman LP, Slorach C, Chahal N, Hui W, Sarkola T, Manlhiot C, Bradley TJ, Jaeggi ET, Mccrindle BW, Mertens L, Staron A, Gasior Z, Jasinski M, Wos S, Sengupta P, Wierzbowska-Drabik K, Chrzanowski L, Kasprzak JD, Hayat D, Kloeckner M, Nahum J, Dussault C, Dubois Rande JL, Gueret P, Lim P, King GJ, Brown A, Ho E, Amuntaser I, Bennet K, Mc Elhome N, Murphy RT, Cooper RM, Somauroo JD, Shave RE, Williams KL, Forster J, George C, Bett T, George KP, D'andrea A, Riegler L, Cocchia R, Golia E, Gravino R, Salerno G, Citro R, Caso PIO, Bossone E, Calabro' R, Crispi F, Bijnens B, Figueras F, Bartrons J, Eixarch E, Le Noble F, Ahmed A, Gratacos E, Shang Q, Yip WK, Tam LS, Zhang Q, Lam YY, Li CM, Wang T, Ma CY, Li KM, Yu CM, Dahlslett T, Helland I, Edvardsen T, Skulstad H, Magda LS, Florescu M, Ciobanu A, Dulgheru R, Mincu R, Vinereanu D, Luckie M, Chacko S, Nair S, Mamas M, Khattar RS, El-Omar M, Kuch-Wocial A, Pruszczyk P, Szmigielski CA, Szulc M, Styczynski G, Sinski M, Kaczynska A, Bajraktari G, Vela Z, Haliti E, Hyseni V, Olloni R, Rexhepaj N, Elezi S, Henein MY, Onaindia JJ, Quintana O, Cacicedo A, Velasco S, Alarcon JJ, Morillas M, Rumoroso JR, Zumalde J, Lekuona I, Laraudogoitia Zaldumbide E, Haliti E, Bajraktari G, Poniku A, Ahmeti A, Elezi S, Henein MY, Duncan RF, Mccomb JM, Pemberton J, Lord SW, Leong D, Plummer C, Macgowan G, Grubb N, Leung M, Kenny A, Prinz C, Voigt JU, Zaidi A, Heatley M, Abildstrom SZ, Hvelplund A, Berning J, Saha SK, Toole R, Govind S, Kiotsekoglou A, Brodin L, Gopal A, Castaldi B, Di Salvo G, Santoro G, Gaio G, Palladino MT, Iacono C, Pacileo G, Russo MG, Calabro R, Wang YS, Dong LL, Shu XH, Pan CZ, Zhou DX, Sen T, Tufekcioglu O, Ozdemir M, Tuncez A, Uygur B, Golbasi Z, Kisacik H, Delfino L, De Leo FD, Chiappa LC, Abdel Ghani B, Schiavina R, Salvade P, Morganti A, Bedogni F, Mahia P, Gutierrez L, Pineda V, Garcia B, Otaegui I, Rodriguez JF, Gonzalez MT, Descalzo M, Evangelista A, Garcia-Dorado D, Bruin De- Bon HACM, Van Den Brink RBA, Surie S, Bresser P, Vleugels J, Eckmann HM, Samson DA, Bouma BJ, Dedobbeleer C, Antoine M, Remmelink M, Unger P, Roosens B, Hmila I, Hernot S, Droogmans S, Van Camp G, Lahoutte T, Muyldermans S, Cosyns B, Feltes G, Serra V, Azevedo O, Barbado J, Herrera J, Rivera A, Paniagua J, Valverde V, Torras J, Arriba G, Christodoulides T, Ioannides M, Simamonian K, Yiangou K, Myrianthefs M, Nicolaides E, Dedobbeleer C, Pandolfo M, Unger P, Kleijn SA, Aly MFAA, Terwee CB, Van Rossum AC, Kamp O, Delgado V, Shanks M, Siebelink HM, Sieders A, Lamb H, Ajmone Marsan N, Westenberg J, De Roos A, Schuijf JD, Bax JJ, Anwar AM, Nosir Y, Chamsi-Pasha H, Tschernich HD, Seeburger J, Borger M, Mukherjee C, Mohr FW, Ender J, Obase K, Okura H, Yamada R, Miyamoto Y, Saito K, Imai K, Hayashida A, Watanabe N, Yoshida K. Poster session III * Friday 10 December 2010, 08:30-12:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
41
|
Belingheri M, Comoli P, Locatelli F, Baldanti F, Martina V, Giani M, Ferraresso M, Cro L, Edefonti A, Ghio L. Successful medical treatment of EBV smooth muscle tumor in a renal transplant recipient. Pediatr Transplant 2010; 14:E101-4. [PMID: 19659510 DOI: 10.1111/j.1399-3046.2009.01213.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
EBV is associated with various malignancies in patients with acquired or induced immune impairment. EBV-SMT is very uncommon in immunocompromised patients, and a kidney localization has been described only anecdotally. We report the case of a 17-yr-old kidney transplant recipient diagnosed as having an EBV-SMT inside the renal graft, which was successfully managed by minimizing isolated immunosuppression.
Collapse
Affiliation(s)
- Mirco Belingheri
- Pediatric Nephrology Unit, Clinica De Marchi, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Berardinelli L, Raiteri M, Ghio L, Messa PG, Montagnino G. The role of immunosuppression in malignancies among 351 pediatric renal transplant patients. Transplant Proc 2010; 42:1166-8. [PMID: 20534251 DOI: 10.1016/j.transproceed.2010.03.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The incidence of de novo malignancies over a 38 year experience in 351 children ranging in age from 2 to 18 years was investigated among subjects prescribed various immunosuppressive protocols. There were 14 children (3.98%) who showed de novo malignancies, namely, 4.86 cancers for every 1000 graft-function years (GFYs). Among patients who had grafts functioning for >10 years, 7.4% suffered from cancer. Nine patients survive without a recurrence at a mean of 12.5 +/- 6.6 years including 6 with graft function. Among group I who were treated with pre-calcineurin inhibitor (CNI) therapy 3 (3.8%) children (1 male and 2 females) developed a malignancy at a mean of 15.2 +/- 11.9 years posttransplant (range, 7-35), for 4.65 cancers every 1000 GFYs. Two of them survive with functioning grafts. Among group II, who were treated by CNIs there were 273 children including 24 retransplants. Group II showed 11 malignancies (4.0%), for 5.04 malignancies for every 1000 GFYs. The incidence of cancer was similar in the 2 groups, undergoing different immunosuppressive regimens; however, the malignancies in the CNI- group were more precocious, compared with those of the conventionally-treated cohort.
Collapse
Affiliation(s)
- L Berardinelli
- General Surgery and Kidney Transplantation Unit, Policlinico University Hospital IRCCS, Milan, Italy.
| | | | | | | | | |
Collapse
|
43
|
Esposito S, Meregalli E, Daleno C, Ghio L, Tagliabue C, Valzano A, Serra D, Galeone C, Edefonti A, Principi N. An open-label, randomized clinical trial assessing immunogenicity, safety and tolerability of pandemic influenza A/H1N1 MF59-adjuvanted vaccine administered sequentially or simultaneously with seasonal virosomal-adjuvanted influenza vaccine to paediatric kidney transplant recipients. Nephrol Dial Transplant 2010; 26:2018-24. [PMID: 20974645 PMCID: PMC7313880 DOI: 10.1093/ndt/gfq657] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background. The aim of this study was to investigate the immunogenicity, safety and tolerability of the 2009 A/H1N1 MF59-adjuvanted influenza vaccine, administered sequentially or simultaneously with the seasonal 2009–10 virosomal-adjuvanted influenza vaccine, to paediatric kidney transplant recipients. Methods. Thirty-two children and adolescents with transplanted kidneys and 32 age- and gender-matched healthy controls were randomized 1:1 to receive the pandemic vaccine upon enrolment and the seasonal vaccine 1 month later (16 transplant recipients and 16 healthy controls), or to receive the two vaccines simultaneously upon enrolment (16 transplant recipients and 16 healthy controls). Results. When the pandemic vaccine was administered sequentially to the seasonal vaccine, it was significantly less immunogenic in the patients than in the controls (P < 0.05); when it was administered together with the seasonal vaccine, the immune response of both patients (P < 0.05) and controls (P < 0.05) was significantly greater than when it was administered sequentially. Seroconversion rates and the geometric mean titres of all of the seasonal antigens were significantly lower in the patients, regardless of the type of vaccine administration (P < 0.05). Simultaneous administration was associated with a better immune response against A/H1N1 and A/H3N2 antigens in both patients and controls, and did not increase the mild local and systemic reactions. No impact on renal function was observed. Conclusions. Paediatric kidney transplant recipients have a lower immune response to the pandemic influenza A/H1N1 MF59-adjuvanted and seasonal virosomal-adjuvanted influenza vaccines than healthy controls. The simultaneous administration of the two vaccines seems to increase immune response to both pandemic and seasonal A/H1N1 and A/H3N2 antigens, and has the same safety profile as that of the pandemic vaccine administered sequentially to the seasonal vaccine.
Collapse
Affiliation(s)
- Susanna Esposito
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Artifoni L, Benetti E, Centi S, Negrisolo S, Ghiggeri GM, Ginevri F, Ghio L, Edefonti A, Brambilla C, Cagni N, Murer L. The impact of eNOS, MTR and MTHFR polymorphisms on renal graft survival in children and young adults. Nephrol Dial Transplant 2009; 24:2931-7. [PMID: 19349296 DOI: 10.1093/ndt/gfp161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The main cause of reduced long-term graft survival is chronic allograft injury. Cardiovascular risk factors such as hyperhomocysteinaemia, accumulation of asymmetric dimethylarginine, increased oxidative stress and decreased production of nitric oxide seem to play an important role. Functional polymorphisms of the endothelial isoform of nitric oxide synthase (NOS) gene cause an alteration in nitric oxide production. Nitric oxide levels, and thus oxidative stress, are also influenced by hyperhomocysteinaemia. METHODS We carried out a genetic analysis of endothelial nitric oxide synthase (eNOS) 894G>T, methionine synthase (MTR) 2756A>G and methylenetetrahydrofolate reductase (MTHFR) 677C>T/1298A>C in 268 renal allograft recipient/donor (D/R) matches, with respect to long-term graft survival. RESULTS While MTHFR 677C>T/1298A>G and MTR 2756A>G polymorphism distribution in both recipients (R) and donors (D) showed no significant difference between matches with loss of graft function and those with long-term graft survival, the frequency of the eNOS 894TT genotype of donors was significantly increased (P = 0.040) in matches with better graft survival. The multivariate analysis identified the eNOS 894 genotype and clinically acute rejection episodes as independent risk factors for graft loss (P = 0.0406 and P = 0.0093, respectively). CONCLUSIONS The association between eNOS 894G>T polymorphism of donors and graft survival seems to suggest a role for this gene in chronic allograft injury; however, further studies are needed to confirm this hypothesis.
Collapse
Affiliation(s)
- Lina Artifoni
- Department of Paediatrics, University of Padua, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ghio L, Ferraresso M, Zacchello G, Murer L, Ginevri F, Belingheri M, Peruzzi L, Zanon F, Perfumo F, Berardinelli L, Tirelli S, Dello Strologo L, Fontana I, Valente U, Cardillo M, Edefonti A. Longitudinal evaluation of mycophenolic acid pharmacokinetics in pediatric kidney transplant recipients. The role of post-transplant clinical and therapeutic variables. Clin Transplant 2009; 23:264-70. [DOI: 10.1111/j.1399-0012.2008.00932.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Turiel M, Sitia S, Tomasoni L, Cicala S, Viganò SM, Menegotto A, Martina V, Bodini BD, Bacchiani G, Ghio L, Cusi D. Subclinical impairment of coronary flow velocity reserve assessed by transthoracic echocardiography in young renal transplant recipients. Atherosclerosis 2008; 204:435-9. [PMID: 19059594 DOI: 10.1016/j.atherosclerosis.2008.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 09/29/2008] [Accepted: 09/30/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND In renal transplant recipients (RTR) an increased risk to develop cardiovascular injury is present. Transthoracic Doppler echocardiographic assessment of coronary flow velocity reserve (CFVR), a sensitive and minimally invasive technique, was recently employed to detect both macrovascular and microvascular coronary artery disease (CAD) in different clinical settings. The prevalence of coronary involvement in young adult RTR is still unknown. The aim of the study was to investigate the presence of early cardiovascular damage in asymptomatic young adult RTR. METHODS Transthoracic Doppler echocardiographic-derived CFVR and common carotid intima-media thickness (IMT) were assessed in 25 asymptomatic young adult RTR (mean age 25.7+/-7.0 years; range 17.3-43.9) without CAD and 25 healthy controls. RESULTS CFVR was lower in young adult RTR compared to controls (2.8+/-0.6 vs. 3.5+/-0.8; P<0.001), meanwhile left ventricular wall motion and common carotid IMT were comparable in both groups. We found a negative correlation between CFVR and age (r=-0.50; P=0.018) and months on dialysis (r=-0.54; P<0.01). CONCLUSIONS Young adult RTR showed a reduced CFVR reflecting an impaired coronary microcirculation, which is significantly related to the age and duration of dialysis; coronary microvascular damage is detectable in the absence of changes in common carotid IMT. Non-invasive evaluation of CFVR by transthoracic stress echocardiography could be a reliable method for identification of early coronary microvascular involvement in young adult RTR.
Collapse
Affiliation(s)
- Maurizio Turiel
- Cardiology Unit, Department of Health Technologies, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Biggioggero M, Bianchi ML, Limonta C, Vai S, Ghio L, Colombo C, Edefonti A, Corona F, Nebbia G, Morandi L, Colombini A. 7.6 Long-term treatment with glucocorticoids and low bone mass: a longitudinal study in 266 children and adolescents. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334172 DOI: 10.1186/1546-0096-6-s1-s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
48
|
Tirelli S, Ferraresso M, Ghio L, Meregalli E, Martina V, Belingheri M, Mattiello C, Torresani E, Edefonti A. The effect of CYP3A5 polymorphisms on the pharmacokinetics of tacrolimus in adolescent kidney transplant recipients. Med Sci Monit 2008; 14:CR251-CR254. [PMID: 18443548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND CYP3A5 gene polymorphism has been shown to influence tacrolimus (TAC) blood concentration and dose requirement in adult kidney transplant patients. The aim was to analyze retrospectively the modification induced by CYP3A5 gene polymorphism on TAC's pharmacokinetic parameters obtained from 26 adolescents receiving TAC as their main immunosuppressive drug. MATERIAL/METHODS The adolescent kidney transplant patients were genotyped for CYP3A5*3 and grouped accordingly. TAC dose, blood levels, and dose-normalized TAC blood concentration and volume of distribution obtained at different post-transplant periods during the first post-transplant year were correlated with the corresponding genotype. RESULTS During the first three months post-transplant, heterozygotes (CYP3A5*1/*3) displayed a lower TAC blood concentration than homozygotes (CYP3A5*3/*3) (at 1 month: 7.8+/-2.1 vs. 13.4+/-6 ng/ml, p=0.007) despite a therapeutic monitoring strategy. Between 3-12 months post-transplant, TAC blood concentration was comparable between the two groups, but a two-fold increase in the daily drug dose was necessary for the heterozygotes (at 6 months: 0.23+/-0.1 vs. 0.13+/-0.06 mg/kg, p=0.04). The dose-normalized TAC concentration [(ng/ml)/(mg/kg)] was significantly lower in patients displaying the CYP3A5*1/*3 polymorphism (at 2 weeks: 33+/-2.16 vs. 71.1+/-37.8, p=0.01; 6 months: 35.4+/-12.9 vs. 85.2+/-58.9, p=0.01). At the same time, the volume of distribution of the drug in the latter group was distinctly increased for the entire post-transplant year (at 6 months: 1.79+/-0.42 vs. 0.73+/-0.5 l/kg, p=0.001). CONCLUSIONS The great influence of CYP3A5 on the pharmacokinetics and pharmacodynamics of TAC in young transplant recipients suggests the need for pre-transplant screening of this polymorphism to improve TAC therapy.
Collapse
Affiliation(s)
- Silvia Tirelli
- Laboratory of Clinical Pathology, Maggiore Hospital Policlinico, Mangiagalli and Regina Elena Foundation, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ardissino G, Viganò S, Testa S, Daccò V, Paglialonga F, Leoni A, Belingheri M, Avolio L, Ciofani A, Claris-Appiani A, Cusi D, Edefonti A, Ammenti A, Cecconi M, Fede C, Ghio L, La Manna A, Maringhini S, Papalia T, Pela I, Pisanello L, Ratsch IM. No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy--report from the ItalKid Project database. Nephrol Dial Transplant 2007; 22:2525-30. [PMID: 17526542 DOI: 10.1093/ndt/gfm237] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic kidney diseases (CKD) tend to progress to end-stage renal failure (ESRF). As it has been demonstrated that angiotensin-converting enzyme inhibitors (ACEi) have a renoprotective effect in adults with proteinuric disease and may be effective in reducing hyperfiltration and proteinuria, they are also frequently used as anti-progression agents in paediatric patients with CKD despite the lack of data confirming their role in the nephropathies peculiar to children. The aim of this study was to investigate whether patients with hypodysplastic CKD (the most common cause of ESRF in children) treated with ACEi show a significantly slower decline in creatinine clearance (Ccr). METHODS The analysis was based on the information available in the database of the ItalKid Project, a nationwide, population-based registry of chronic renal insufficiency (CRI) in children in Italy. Of the 822 patients with CRI due to hypodysplasia, we selected those who had been continuously treated with ACEi; the control patients were identified from the same diagnostic group and matched for gender, age and baseline Ccr. RESULTS Progression was analysed as the slope of Ccr in a total of 164 patients: 41 cases and 123 matched controls. There were no significant between-group differences in blood pressure, duration of follow-up or pre-study slope of Ccr (-0.31+/-2.26 vs -0.33+/-3.58 ml/min/1.73 m2/year; P=NS). After an average of 4.9+/-2.3 years, the mean slope of Ccr was 40% lower in the ACEi-treated cases in comparison to controls (-1.08+/-2.08 vs -1.80+/-4.42 ml/min/1.73 m2/year), however, this difference was not statistically significant (P=0.31). CONCLUSIONS We conclude that ACEi treatment does not significantly modify the naturally progressive course of hypodysplastic nephropathy in children and further studies are necessary before such treatment is routinely proposed for anti-progression purposes in children with CKD.
Collapse
Affiliation(s)
- Gianluigi Ardissino
- Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Via Commenda 9,I-20122 Milano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Belingheri M, Ghio L, Sala A, Menni F, Trespidi L, Ferraresso M, Berardinelli L, Rossi G, Edefonti A, Parini R. Combined liver-kidney transplantation in glycogen storage disease Ia: a case beyond the guidelines. Liver Transpl 2007; 13:762-4. [PMID: 17457869 DOI: 10.1002/lt.21147] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Glycogen storage disease type Ia (GSD Ia) is a rare metabolic disorder due to hepatic glucose-6-phosphatase deficiency. Although great progress has been made in managing affected patients, severe hypoglycemia, lactic acidosis, hyperlipidemia, hepatic cytolysis, and impaired kidney function are frequent. Liver transplantation is the only radical treatment, for which the main indications are hepatic adenomatosis, hepatocellular carcinoma, or severe hepatic dysfunction. We present the case of a patient with end-stage renal disease without focal hepatic lesions and with moderate hepatic metabolic control, and we explain how combined liver-kidney transplantation (LKT) made it possible to correct the metabolic defects responsible for the impaired glucose homeostasis, liberalize the diet, and give birth to a healthy child after an uneventful pregnancy. Patients with end-stage renal disease that resulted from GSD Ia should be considered for LKT even in the absence of hepatic lesions with the aim of improving their quality of life.
Collapse
Affiliation(s)
- Mirco Belingheri
- Pediatric Nephrology Unit, Maggiore Policlinico Hospital, Mangiagalli and Regina Elena Foundation, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|