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  1. Article ; Online: [The Outpatient Activity of the Onconephrology Clinic of Cremona in the First Semester of 2023].

    Foramitti, Marina / Boni, Francesca / Marchi, Gianluca / Cosmai, Laura / Malberti, Fabio

    Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia

    2024  Volume 41, Issue 1

    Abstract: Despite the rapidly growing area of onconephrology in the last decade, nephropathic patients have been rarely involved in clinical trials of cancer therapy, particularly in the case of chronic kidney disease (CKD) stage 4 (CKD4) or stage 5 (CKD5). We ... ...

    Abstract Despite the rapidly growing area of onconephrology in the last decade, nephropathic patients have been rarely involved in clinical trials of cancer therapy, particularly in the case of chronic kidney disease (CKD) stage 4 (CKD4) or stage 5 (CKD5). We could offer better therapeutic opportunities to our patients thanks to the Onconephrology Clinic and the Multidisciplinary group, in which a dedicated team of specialists guarantees the highest level of possible care. In this paper, we analysed the activity of the first Italian OnconephrologyClinic, twelve years after its foundation. We studied retrospectively a cohort of 174 patients referred to our center in the last six months (from 11/01/2023 to 12/07/2023), with a total of 262 visits (40 first visits). We highlight a prevalence of moderated or advanced kidney disease, in contrast with the literature, which is probably the result of a transversal II level clinic with different specialists involved. Furthermore, in patients with a prolonged follow-up, we observed a progressive better attention to every kidney involvement, particularly in patients in active cancer therapy, by the oncologist colleagues. We observed a reduction of treatment withdrawals due to kidney toxicity, thanks to a multidisciplinary approach and experienced-based management. On the other side, we highlight also a delayed addressing of patients with acute kidney injury (AKI), which often results in chronic kidney damage. This could be related to a delayed identification of the reduced renal function, which is difficult to correctly value in patients with cancer.
    MeSH term(s) Humans ; Retrospective Studies ; Outpatients ; Renal Insufficiency, Chronic ; Acute Kidney Injury/therapy ; Neoplasms
    Language Italian
    Publishing date 2024-02-28
    Publishing country Italy
    Document type English Abstract ; Journal Article
    ZDB-ID 1237110-5
    ISSN 1724-5990 ; 0393-5590
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  2. Article: Treatment of immobilization-related hypercalcaemia with denosumab.

    Malberti, Fabio

    Clinical kidney journal

    2012  Volume 5, Issue 6, Page(s) 491–495

    Language English
    Publishing date 2012-11-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfs133
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  3. Article: Erratum: Treatment of immobilization-related hypercalcaemia with denosumab.

    Malberti, Fabio

    Clinical kidney journal

    2012  Volume 6, Issue 1, Page(s) 124

    Abstract: This corrects the article on p. 491 in vol. 5, PMID: 26069790.]. ...

    Abstract [This corrects the article on p. 491 in vol. 5, PMID: 26069790.].
    Language English
    Publishing date 2012-11-29
    Publishing country England
    Document type Published Erratum
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sft013
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  4. Article ; Online: Hyperphosphataemia: treatment options.

    Malberti, Fabio

    Drugs

    2013  Volume 73, Issue 7, Page(s) 673–688

    Abstract: Hyperphosphataemia can be induced by three main conditions: a massive acute phosphate load, a primary increase in renal phosphate reabsorption, and an impaired renal phosphate excretion due to acute or chronic renal insufficiency. Renal excretion is so ... ...

    Abstract Hyperphosphataemia can be induced by three main conditions: a massive acute phosphate load, a primary increase in renal phosphate reabsorption, and an impaired renal phosphate excretion due to acute or chronic renal insufficiency. Renal excretion is so efficient in normal subjects that balance can be maintained with only a minimal rise in serum phosphorus concentration even for a large phosphorus load. Therefore, acute hyperphosphataemia usually resolves within few hours if renal function is intact. The most frequent cause of chronic hyperphosphataemia is chronic renal failure. Hyperphosphataemia in chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Lowering the phosphate load and maintaining serum phosphorus levels within the normal range are considered important therapeutic goals to improve clinical outcomes in CKD patients. Treatment consists of diminishing intestinal phosphate absorption by a low phosphate diet and phosphate binders. In CKD patients on dialysis an efficient dialysis removal of phosphate should be ensured. Dietary restriction of phosphorus while maintaining adequate protein intake is not sufficient to control serum phosphate levels in most CKD patients; therefore, the prescription of a phosphate binder is required. Aluminium-containing agents are efficient but no longer widely used because of their toxicity. Calcium-based salts are inexpensive, effective and most widely used, but there is now concern about their association with hypercalcaemia, parathyroid gland suppression, adynamic bone disease, and vascular and extraosseous calcification. The average daily dose of calcium acetate or carbonate prescribed in the randomised controlled trials to control hyperphosphataemia in dialysis patients ranges between 1.2 and 2.3 g of elemental calcium. Such doses are greater than the recommended dietary calcium intake and can lead to a positive calcium balance. Although large amounts of calcium salts should probably be avoided, modest doses (<1 g of elemental calcium) may represent a reasonable initial approach to reduced serum phosphorus levels. A non-calcium-based binder can then be added when large doses of binder are required. At present, there are three types of non-calcium-based phosphate binders available: sevelamer, lanthanum carbonate and magnesium salts. Each of these compounds is as effective as calcium salts in lowering serum phosphorus levels depending on an adequate prescribed dose and adherence of the patient to treatment. Sevelamer is the only non-calcium-containing phosphate binder that does not have potential for systemic accumulation and presents pleiotropic effects that may impact on cardiovascular disease. In contrast, lanthanum carbonate and magnesium salts are absorbed in the gut and their route of excretion is biliary for lanthanum and urinary for magnesium. There are insufficient data to establish the comparative superiority of non-calcium binding agents over calcium salts for such important patient-level outcomes as all-cause mortality and cardiovascular end points. Moreover, full adoption of sevelamer and lanthanum by government drug reimbursement agencies in place of calcium salts would lead to a large increase in health-care expenditure. Therefore, the choice of phosphate binder should be individualised, considering the clinical context, the costs, and the individual tolerability the concomitant effects on other parameters of mineral metabolism, such as serum calcium and parathyroid hormone, besides those on serum phosphorus.
    MeSH term(s) Chelating Agents/adverse effects ; Chelating Agents/therapeutic use ; Humans ; Hyperphosphatemia/complications ; Hyperphosphatemia/diet therapy ; Hyperphosphatemia/drug therapy ; Hyperphosphatemia/etiology ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/diet therapy ; Kidney Failure, Chronic/drug therapy
    Chemical Substances Chelating Agents
    Language English
    Publishing date 2013-04-28
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 120316-2
    ISSN 1179-1950 ; 0012-6667
    ISSN (online) 1179-1950
    ISSN 0012-6667
    DOI 10.1007/s40265-013-0054-y
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  5. Article ; Online: When a nephrology ward becomes a COVID-19 ward: the Cremona experience.

    Malberti, Fabio / Pecchini, Paola / Marchi, Gianluca / Foramitti, Marina

    Journal of nephrology

    2020  Volume 33, Issue 4, Page(s) 625–628

    MeSH term(s) Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/mortality ; Coronavirus Infections/therapy ; Hospitals ; Humans ; Middle Aged ; Nephrology ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/mortality ; Pneumonia, Viral/therapy ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-05-19
    Publishing country Italy
    Document type Editorial
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-020-00743-y
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  6. Article ; Online: Prevenzione delle comorbilita' nell'uremico in dialisi: alterazioni metaboliche e rischio cardiovascolare.

    Malberti, Fabio

    Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia

    2012  Volume 29 Suppl 58, Page(s) S61–7

    Abstract: Cardiovascular events are the main cause of morbidity and mortality in uremic patients on renal replacement therapy. Traditional cardiovascular risk factors such as dyslipidemia and hypertension as well as risk factors specific to uremia such as calcium ... ...

    Title translation Prevention of cardiovascular comorbidities in uremic patients on chronic dialysis: metabolic derangements and cardiovascular risk.
    Abstract Cardiovascular events are the main cause of morbidity and mortality in uremic patients on renal replacement therapy. Traditional cardiovascular risk factors such as dyslipidemia and hypertension as well as risk factors specific to uremia such as calcium and phosphate metabolism derangements are involved in the development and progression of the cardiovascular alterations. In this review the results of prospective randomized trials that evaluated the effects on cardiovascular morbidity and mortality of lowering serum cholesterol and phosphate levels and controlling secondary hyperparathyroidism are critically reexamined. A recent trial of 9270 patients with chronic kidney disease documented a significant reduction of major atherosclerotic events by lowering LDL cholesterol by 39 mg/dL on average with sinvastatin plus ezetimibe over nearly 5 years. No significant reduction in mortality rate was documented by lowering serum phosphate levels with sevelamer rather than calcium-containing phosphate binders. Treatment of secondary hyperparathyroidism with cinacalcet plus lowdose vitamin D seems to attenuate the progression of vascular calcification.
    MeSH term(s) Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/prevention & control ; Humans ; Hypercholesterolemia/etiology ; Hypercholesterolemia/prevention & control ; Hyperparathyroidism/etiology ; Hyperparathyroidism/prevention & control ; Hyperphosphatemia/etiology ; Hyperphosphatemia/prevention & control ; Prospective Studies ; Renal Dialysis ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/metabolism ; Renal Insufficiency, Chronic/therapy ; Risk Factors ; Uremia/complications ; Uremia/metabolism ; Uremia/therapy
    Language Italian
    Publishing date 2012-11
    Publishing country Italy
    Document type English Abstract ; Journal Article ; Review
    ZDB-ID 1237110-5
    ISSN 1724-5990 ; 0393-5590
    ISSN (online) 1724-5990
    ISSN 0393-5590
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  7. Article ; Online: [Staphylococcus-associated glomerulonephritis without IgA deposits: a case report].

    Tonoli, Michela / Foini, Paolo / Marchi, Gianluca / Ungari, Marco / Fisogni, Simona / Malberti, Fabio

    Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia

    2022  Volume 39, Issue 3

    Abstract: Staphylococcus-associated glomerulonephritis (SAGN) represents a possible version of parainfectious glomerulonephritis and is a pathological entity that's now constantly increasing in developed countries. It is known how bacterial infections can be a ... ...

    Abstract Staphylococcus-associated glomerulonephritis (SAGN) represents a possible version of parainfectious glomerulonephritis and is a pathological entity that's now constantly increasing in developed countries. It is known how bacterial infections can be a possible trigger for various type of glomerulonephritis with clinical onset and evolution comparable to the ones observed in parainfectious glomerulonephritis. Furthermore, in clinical practice the identification and isolation of the pathogenic microorganism responsible for the development of parainfectious glomerulonephritis is not always possible. Therefore, in those cases in which SAGN is suspected, it is often necessary to recur to kidney biopsy in order to come to as much as possible correct diagnosis. Historically, according to scientific literature, the most distinctive anatomopathological feature of SAGN is represented by predominant or codominant mesangial IgA deposits, sometimes associated with C3 deposits. These findings make the differential diagnosis between SAGN and IgA nephropathy often necessary. However, many reports describe how SAGN can also be characterized by a varying spectrum of immunological deposits. In some cases, for example, IgA deposits can be absent and in some other cases it is described a net dominance of C3 deposits. In this case, it becomes extremely important to exclude a possible occurrence of C3 glomerulopathy (C3GN), considering how different are the therapeutic approach and the prognostic implications associated to it. However, the differential diagnosis between SAGN and C3GN can be very hard. Here's a case report about a patient who has been hospitalized into our Unit after developing a form of Staphylococcus Aureus associated glomerulonephritis which presented atypical anatomopathological features.
    MeSH term(s) Glomerulonephritis/complications ; Glomerulonephritis/diagnosis ; Glomerulonephritis, IGA/complications ; Glomerulonephritis, IGA/diagnosis ; Humans ; Immunoglobulin A ; Staphylococcal Infections/complications ; Staphylococcal Infections/diagnosis ; Staphylococcus
    Chemical Substances Immunoglobulin A
    Language Italian
    Publishing date 2022-06-20
    Publishing country Italy
    Document type Case Reports
    ZDB-ID 1237110-5
    ISSN 1724-5990 ; 0393-5590
    ISSN (online) 1724-5990
    ISSN 0393-5590
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  8. Article ; Online: Vitamina D nativa nei pazienti con malattia renale cronica non in trattamento dialitico

    Fabio Malberti

    Giornale di Clinica Nefrologia e Dialisi, Vol 25, Iss

    2013  Volume 2

    Abstract: Il sistema ormonale della vitamina D è classicamente implicato nella regolazione dell'omeostasi calcica e del metabolismo osseo. L'esistenza di recettori per la vitamina D in organi e tessuti non coinvolti direttamente nella regolazione del metabolismo ... ...

    Abstract Il sistema ormonale della vitamina D è classicamente implicato nella regolazione dell'omeostasi calcica e del metabolismo osseo. L'esistenza di recettori per la vitamina D in organi e tessuti non coinvolti direttamente nella regolazione del metabolismo minerale e la capacità di molte cellule di sintetizzare la forma attiva di vitamina D dal precursore circolante hanno fatto supporre che la vitamina D possa avere altri effetti oltre ai classici effetti sul metabolismo minerale. Il deficit di vitamina D induce lo sviluppo di patologie ossee ed è un importante fattore di rischio per lo sviluppo di neoplasie, malattie autoimmuni e malattie cardiovascolari. In questa rassegna vengono esaminati i risultati dei principali studi randomizzati che hanno utilizzato la supplementazione con vitamina D nella popolazione generale e nei pazienti con insufficienza renale cronica.
    Keywords Vitamina D ; Colecalciferolo ; Calcifediolo ; Iperparatiroidismo ; Fratture ossee ; Internal medicine ; RC31-1245 ; Diseases of the genitourinary system. Urology ; RC870-923
    Language Italian
    Publishing date 2013-05-01T00:00:00Z
    Publisher AboutScience Srl
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article: Terapia dell'iperfosforemia nei pazienti in trattamento dialitico: ruolo dei chelanti del fosforo.

    Malberti, Fabio

    Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia

    2010  Volume 27 Suppl 52, Page(s) S47–54

    Abstract: Hyperphosphatemia is a characteristic feature of chronic kidney disease-mineral and bone disorder (CKD-MBD). Phosphorus excess is an independent risk factor for cardiovascular morbidity and mortality in patients with advanced CKD. The keystones of ... ...

    Title translation Management of hyperphosphatemia in dialysis patients: the role of phosphate binders.
    Abstract Hyperphosphatemia is a characteristic feature of chronic kidney disease-mineral and bone disorder (CKD-MBD). Phosphorus excess is an independent risk factor for cardiovascular morbidity and mortality in patients with advanced CKD. The keystones of hyperphosphatemia treatment are reduction of dietary phosphorus, use of phosphate binders, and optimized phosphorus removal via dialysis. Several phosphate binders have been approved for use; all share a common functionality in that they bind phosphorus and reduce the amount absorbed in the gastrointestinal lumen. In the past, treatment with oral phosphate binders was intended to prevent symptomatic secondary hyperparathyroidism. More recently, achieving tighter control of markers associated with abnormal mineral metabolism has become a specific therapeutic objective. This therapeutic shift has been driven by several factors: observational data that link disordered mineral metabolism with adverse clinical outcomes; concern about vascular calcification, which is also associated with adverse outcomes and may correlate with exposure to calcium-based phosphatebinding agents; and, perhaps, the availability of new therapeutic agents. In this article we review the rationale for treatment with oral phosphate binders, discuss evidence that supports the use of the available agents, and suggest an approach for clinical practice.
    MeSH term(s) Chelating Agents/therapeutic use ; Humans ; Hyperphosphatemia/drug therapy ; Phosphates/metabolism ; Renal Dialysis
    Chemical Substances Chelating Agents ; Phosphates
    Language Italian
    Publishing date 2010-11
    Publishing country Italy
    Document type English Abstract ; Journal Article
    ZDB-ID 1237110-5
    ISSN 0393-5590
    ISSN 0393-5590
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