Predictor factors for renal outcome in renal artery stenosis

BACKGROUND

Atherosclerotic ischemic renal disease is a frequent cause of end-stage renal failure. Correction of renal artery stenosis (RAS) may fail to stabilize or improve renal function.

AIMS OF THE STUDY

Carotid and aortic Intima media thickness (IMT), resistance renal resistance index (RI), arterial blood pressure (BP), serum creatinine (SCr), creatinine clearance (CrCl), proteinuria and uricemia were considered as possible predictive factors and measured before renal-artery stenosis correction and during 12 months follow-up.

MATERIALS AND METHODS

we performed an observational study on a total of 55 patients to find predictive factors of the outcome of renal function after renal percutaneous transluminal angioplasty and stenting (RPTAs).

RESULTS

We found that uricemia, proteinuria and IR were higher at baseline in patients who worsened renal function after revascularization.

CONCLUSIONS

The identification of predictive factors (uricemia; proteinuria and RI) of chronic kidney disease (CKD) progression in patients with RAS undergone revascularization could be useful to predict renal long term outcome and to select patients that really could benefit of this.

Primary stenting for renal fibromuscular-dysplastic stenosis: a case report

Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vascular disease that has been reported in renal and internal carotid arteries and in almost every arterial bed, primarily affecting young to middle-aged people, mainly female individuals. These patients may be asymptomatic or may present with hypertension. A 29 year-old hypertensive woman was referred for a renal color Doppler ultrasound (CDU) scan because of a suspicion of renovascular hypertension and we revealed the presence of three separate stenosis on the right renal artery. Digital selective angiography (DSA) and percutaneous transluminal angioplasty (PTA) were performed but an incomplete dilation of the vessel was obtained. Because of the suboptimal result, it was decided to stent the lesions during two different procedures. Percutaneous transluminal renal angioplasty is the primary treatment of renal FMD, but should not be excluded primary stent implantation as an alternative technique to surgical revascularization.

Epidemiological study on knowledge, attitudes and behaviour of health care workers with respect to HIV infection

To analyse knowledge, perception of risk, attitudes and behaviour towards HIV infection among health workers in two hospitals in the North-East of Italy, we sent all health care workers who were working in direct contact with patients an anonymous self-administered questionnaire covering personal and occupational data, perception and knowledge of risk, behaviour in routine activities, attitudes towards and care of HIV patients. The response rate was 70.06%. The perception of the risk of acquiring HIV infection was influenced by occupational qualification, by work unit and by having cared for a HIV-positive patient. Scientific knowledge about transmissibility of HIV infection was poor and 11.3% of the staff did not know the Universal Precautions. 28.3% behaved correctly in recapping needles, but with patients considered not at risk 29.9% did not use any protection in drawing venous blood. A significant portion of staff showed low willingness to care for HIV-positive patients. We found a high mean perception of the risk of contracting HIV infection through occupational exposure; health workers overestimated the specific risk and wrong behavioural attitudes persisted. To conclude, more attention should be paid to educational programs for health workers.