Nicolino Comi

BACKGROUND: High ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians. METHODS: Consecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 and/or proteinuria>0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of p<0.10, was used to assess the independent correlates of RI as continuous variable. RESULTS: We studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m2. From low (<0.65) to intermediate (0.65-0.70) to high (>0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels (p<0.001), diabetes (p = 0.042), CVD (p = 0.009), smoking habit (p = 0.021) and higher serum phosphorus levels (p = 0.001) were associated with higher continuous RI. Serum phosphorus showed Area Under the Curves (AUC) values of 0.714 and 0.664 for discriminating RI cut-offs of 0.70 and 0.65. CONCLUSIONS: This analysis suggests that RI is higher in CKD patients with CVD, diabetes, smoking habit and higher serum phosphorus, regardless of eGFR. Further studies are needed to verify whether higher RI indicates more complex pathway of intrarenal damage, besides and beyond kidney function.

OBJECTIVES: Kidney size has been found to be correlated with anthropometric features and kidney function. Therefore, we postulate that if the conventionally measured renal sonographic parameters (pole-to-pole length, width, and parenchymal thickness) are taken according to standardized rules and corrected for body height, their association with kidney function could be strengthened, thus helping validate renal sonographic information for a better assessment of chronic kidney disease (CKD) status. METHODS: This cross-sectional study included 72 stable adult patients with stage 1 to 4 CKD. Sonographic parameters were obtained from both kidneys and averaged, and the measurements obtained were further corrected for patients' body height. The glomerular filtration rate (GFR) was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS: Parenchymal thickness and renal length showed the highest correlation level with the GFR. This significant correlation, however, was greatly ameliorated by the correction for patients' body height (r = 0.537; P < .001; r = 0.510; P < .001, respectively). Of note, the product of these two parameters corrected for body height showed the best degree of correlation with the GFR (r = 0.560; P < .001), as confirmed by analysis of variance after subdivision of the population into CKD stage groups according to the GFR. Receiver operating characteristic curve analysis for discrimination of a GFR of less than 60 mL/min indentified the combined parameter as the one with the highest area under the curve (0.78; 95% confidence interval, 0.66-0.89), followed renal length corrected for height (area under the curve, 0.77; 95% confidence interval, 0.66-0.88). CONCLUSIONS: Correction of renal sonographic parameters for body height strengthens the degree of the correlation of renal sonography with the GFR. The improved correlation with the GFR makes renal sonography a reliable tool for a more complete assessment of patients with CKD.

The guidelines for early detection of adenocarcinoma and its precursors are controversial. Ultrasound, due to its non invasive nature, could represent a useful technique for screening patients at risk but its specificity is low. Endometrial cytology, especially by using new device, is an effective, easy, and inexpensive method for screening asymptomatic women; however, cytologic investigation shows some limits due to the scarce desquamation of endometrial cells and to the difficulty in diagnosing hyperplasia. Blind biopsy can miss the pathology in cases of focal lesions. Dilatation and curettage gives, in most cases, a certain histologic diagnosis but, requiring anesthesia and hospitalization, is not suitable for mass screening; moreover, in cases of focal lesions its sensitivity is low. Microhysteroscopy allows an atraumatic and direct investigation of the uterine cavity and could be used as a routine basis in patients with risk factors for endometrial pathology and signs of hyperestrogenism. In symptomatic patients its employment must be considered necessary for a correct and modern management of these patients. Operative hysteroscopy represents a promising way for treating hyperplastic endometrial lesions without signs of atypia, but its value in comparison with hysterectomy must be confirmed; when atypia is found, hysterectomy is the treatment of choice.

BACKGROUND: ANCA are thought to play a pathogenic role in renal vasculitis. ANCA may also be detected in patients with diseases not usually associated with renal pathology, such as ulcerative colitis. Our study was conducted to determine if the presence of ANCA in patients with ulcerative colitis is associated with renal pathology. METHODS: Eight ANCA-positive and five ANCA-negative patients with a histological and endoscopic diagnosis of active ulcerative colitis were investigated. Repeated complete urinalyses and determination of microalbuminuria and creatinine clearance were performed. Serum IgG and IgA ANCA were evaluated in all patients by indirect immunofluorescence and ELISA, and when detected the antibodies were further characterized by alpha granules preparation, myeloperoxidase, lactoferrin, and cathepsin G. RESULTS: In both ANCA-positive and ANCA-negative patients renal function was normal or near normal and urinalyses (including microalbuminuria) failed to disclose any abnormalities. ANCA exhibited a perinuclear pattern in all ANCA-positive patients. Interestingly, none of the ANCA-positive patients had antibodies to myeloperoxidase or to alpha granules which are usually found in the sera of patients with ANCA-associated vasculitis, and only one had antibodies to lactoferrin. The ANCA specificity remained undetermined in the remaining seven patients. At the end of the 1-year observation period, all ANCA-positive patients remained ANCA-positive without developing symptoms, signs or laboratory abnormalities consistent with renal involvement. CONCLUSIONS: Renal damage was not observed in ANCA-positive patients with ulcerative colitis even after 1 year of follow-up, suggesting that the ANCA found in these patients do not share the antigenic targets with the ANCA commonly found in renal vasculitis. Therefore the potential of ANCA of inducing renal lesions (if any) is dependent on their own antigenic specificity.