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  1. Article ; Online: Kidney transplantation in patients with previous renal cancer: a critical appraisal of current evidence and guidelines.

    Frascà, Giovanni M / Brigante, Fabiana / Volpe, Alessandro / Cosmai, Laura / Gallieni, Maurizio / Porta, Camillo

    Journal of nephrology

    2018  Volume 32, Issue 1, Page(s) 57–64

    Abstract: Due to the increasing occurrence of renal cell carcinoma (RCC) in the general population and the high prevalence of chronic kidney disease among cancer patients, many people with a previous RCC may eventually require renal replacement therapy including ... ...

    Abstract Due to the increasing occurrence of renal cell carcinoma (RCC) in the general population and the high prevalence of chronic kidney disease among cancer patients, many people with a previous RCC may eventually require renal replacement therapy including kidney transplantation. They should accordingly be evaluated to assess their life expectancy and the risk that the chronic immunosuppressive therapy needed after grafting might impair their long-term outcome. Current guidelines on listing patients for renal transplantation suggest that no delay is required for subjects with small or incidentally discovered RCC, while the recommendations for patients who have been treated for a symptomatic RCC or for those with large or invasive tumours are conflicting. The controversial results reported by even recent studies focusing on the cancer risk in kidney graft recipients with a prior history of malignancy do not help to clarify the doubts arising in everyday clinical practice. Several tools, including integrated scoring systems, are currently available to assess the prognosis of patients with a previous RCC and, although they have not been validated in subjects receiving long-term immunosuppressive drugs, they can be used to identify patients suitable to be listed for grafting. Among these, the Leibovich score is currently the most widely used as it has proved simple and reliable enough and helps categorize renal transplant candidates. According to this system, subjects with a score from 0 to 2 are at low risk and may be listed without delay, while those with a score of 6 or higher should be excluded from grafting. In addition, other factors have an established positive prognostic value, including chromophobe or clear cell papillary tumour, or G1 grade cancer; on the contrary, medullary or Bellini's duct carcinoma or those with sarcomatoid dedifferentiation at histological examination should be excluded. All other patients would be better submitted to careful individual evaluation by an Oncologist before being listed for renal transplantation, pending studies specifically focusing on cancer risk evaluation in people already treated for malignancy receiving long-term immunosuppressive therapy.
    MeSH term(s) Carcinoma, Renal Cell/diagnosis ; Carcinoma, Renal Cell/epidemiology ; Carcinoma, Renal Cell/therapy ; Evidence-Based Medicine ; Graft Survival/drug effects ; Humans ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use ; Kidney Neoplasms/diagnosis ; Kidney Neoplasms/epidemiology ; Kidney Neoplasms/therapy ; Kidney Transplantation/adverse effects ; Practice Guidelines as Topic ; Prevalence ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/surgery ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
    Chemical Substances Immunosuppressive Agents
    Language English
    Publishing date 2018-10-16
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-018-0542-y
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  2. Article ; Online: Controversia: il trapianto renale ABO-incompatibile.

    Maggiore, Umberto / Frascà, Giovanni M / Pugliese, Maria Stefania / Tognarelli, Giuliana

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

    2013  Volume 30, Issue 2

    Abstract: The widespread worldwide implementation of ABO-incompatible kidney transplantation (ABOi KT) programs have increased the chances of gaining access to kidney transplantation. In Italy the practice of ABOi KT has somewhat lagged behind that practiced in ... ...

    Title translation ABO-incompatible kidney transplantion.
    Abstract The widespread worldwide implementation of ABO-incompatible kidney transplantation (ABOi KT) programs have increased the chances of gaining access to kidney transplantation. In Italy the practice of ABOi KT has somewhat lagged behind that practiced in many other European Countries. Even though some Italian Transplant Centers have recently started ABOi KT programs, most of them appear still reluctant in adopting this procedure. In this paper, nephrologists from two different Italian Transplant Centers express their contrasting point of view concerning specific issues related to ABOi KT. The first issue concerns the safety and efficacy of ABOi KT and how it compares with HLA-incompatible kidney transplantation. The second concerns to what extent does ABOi KT be adopted, whenever a paired kidney exchange program is available. The third issue regards the indications or contraindications of ABOi KT in specific patient categories. The last issue is about the economical sustainability of ABOi KT programs nowadays. The different point of views of the discussants are summarized in the context of the most recent available evidence.
    MeSH term(s) BK Virus ; Blood Group Incompatibility/immunology ; Contraindications ; Graft Rejection ; Graft Survival ; Graft vs Host Disease/etiology ; Graft vs Host Disease/immunology ; Humans ; Isoantibodies/biosynthesis ; Italy ; Kidney Transplantation/adverse effects ; Kidney Transplantation/economics ; Kidney Transplantation/standards ; Polyomavirus Infections/etiology ; Polyomavirus Infections/immunology ; Postoperative Complications/epidemiology ; Postoperative Complications/immunology ; Risk ; Tissue Donors/supply & distribution ; Tissue and Organ Procurement/organization & administration ; Tissue and Organ Procurement/standards ; Treatment Outcome ; Tumor Virus Infections/etiology ; Tumor Virus Infections/immunology
    Chemical Substances Isoantibodies
    Language Italian
    Publishing date 2013-03
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 1237110-5
    ISSN 1724-5990 ; 0393-5590
    ISSN (online) 1724-5990
    ISSN 0393-5590
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  3. Article ; Online: Il percorso diagnostico della sindrome di Alport e della malattia a membrane basali sottili.

    Frascà, Giovanni Maria / Taruscia, Domenica / Nastasi, Valentina / Balestra, Emilio / Pugliese, Stefania / Mazzucchelli, Roberta

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

    2015  Volume 32 Suppl 64

    Abstract: Diagnosis of Alport syndrome or Thin basement membrane disease is suggested first of all by the clinical picture, the presence of neurisensorial hypoacusia and/or ocular abnormalities, and the family history which should be as accurate as possible ... ...

    Title translation Diagnosis of Alport syndrome.
    Abstract Diagnosis of Alport syndrome or Thin basement membrane disease is suggested first of all by the clinical picture, the presence of neurisensorial hypoacusia and/or ocular abnormalities, and the family history which should be as accurate as possible involving the largest number possible of family members to recognize the transmission modalities, i.e. X-linked or autosomal. Renal biopsy remains the main tool to confirm the diagnosis and requires electron microscopy observation and collagen IV alpha chains investigation on renal tissue by means of specific antibodies. Skin biopsy is a useful and less invasive tool in families with X-linked Alport syndrome and can substitute renal biopsy in childhood as well as in patients with contraindication to renal biopsy. Confocal microscopy is mandatory to reduce the risk of false negative results in patients with segmental expression of alpha chains. Genetic analysis is at present indicated for studying subjects at risk for family planning or possible kidney donation but new techniques (Next Generation Sequencing) might increase their use in clinical practice.
    MeSH term(s) Hematuria/diagnosis ; Humans ; Nephritis, Hereditary/diagnosis
    Language Italian
    Publishing date 2015
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 1237110-5
    ISSN 1724-5990 ; 0393-5590
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  4. Article ; Online: Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study.

    Castaldo, Pasqualina / Frascà, Giovanni M / Brigante, Fabiana / Ferrante, Luigi / Magi, Simona / Pavani, Marianna / Skrami, Edlira / Giuseppetti, Gian Marco / Polonara, Gabriele / Amoroso, Salvatore

    European radiology

    2019  Volume 29, Issue 7, Page(s) 3927–3934

    Abstract: Objectives: To estimate the incidence of contrast-induced acute kidney injury (CI-AKI) after intravenous (iv) iodinated contrast material (ICM) exposure.: Methods: This prospective cohort study included all consecutive patients who underwent ... ...

    Abstract Objectives: To estimate the incidence of contrast-induced acute kidney injury (CI-AKI) after intravenous (iv) iodinated contrast material (ICM) exposure.
    Methods: This prospective cohort study included all consecutive patients who underwent radiological investigations using low-osmolar iopamidol 370 mg/ml in a regional hospital over a period of 36 months, without any exclusion criteria. The estimated glomerular filtration rate (eGFR) was evaluated using the MRDR equation before (2-10 days) and after (24-36 h) radiological investigations. CI-AKI was defined as a ≥ 25% decrease in eGFR from baseline. CI-AKI incidence was estimated using a binomial distribution. The association between CI-AKI and demographic and clinical characteristics was modeled using logistic regression.
    Results: The study included 1541 patients with a median age of 68 (1st-3rd quartiles 58-76) years with various comorbidities, 30% of whom had pre-existing CKD. Patients affected by stage III or IV chronic kidney disease (CKD) received an infusion of 0.9% normal saline (1.0-1.5 ml/kg/h) before and after iso-osmolar iodixanol administration. CI-AKI was observed in 33 patients (2.1%, 95% CI 1.5-3.0). The logistic regression analysis showed that antibiotic and statin therapies were significantly associated with CI-AKI. The probability of developing CI-AKI decreased by 80% in patients taking statins (OR = 0.20, 95% CI 0.03; 0.68) and increased approximately three times in patients with antibiotic therapy compared with those who did not take statins and antibiotics (OR = 2.92, 95% CI 1.21; 6.36).
    Conclusions: Our data suggest that low-osmolar iopamidol carries a low incidence of nephrotoxicity, even in subjects with various comorbid conditions or reduced renal function.
    Key points: • IV administration of ICM carries a low incidence of nephrotoxicity, which was transient in observed patients. • Statin therapy is negatively associated with AKI in patients exposed to ICM. • Pre-existing impairment of renal function is not associated with AKI in patients exposed to ICM.
    MeSH term(s) Acute Kidney Injury/chemically induced ; Acute Kidney Injury/epidemiology ; Administration, Intravenous ; Aged ; Contrast Media/administration & dosage ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Iopamidol/administration & dosage ; Iopamidol/adverse effects ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Prospective Studies ; Triiodobenzoic Acids/administration & dosage ; Triiodobenzoic Acids/adverse effects
    Chemical Substances Contrast Media ; Triiodobenzoic Acids ; iodixanol (HW8W27HTXX) ; Iopamidol (JR13W81H44)
    Language English
    Publishing date 2019-04-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-019-06147-2
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  5. Article ; Online: Il danno renale da farmaci antivirali.

    Frasca', Giovanni M / Balestra, Emilio / Tavio, Marcello / Morroni, Manrico / Manarini, Gloria / Brigante, Fabiana

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

    2012  Volume 29 Suppl 56, Page(s) S109–14

    Abstract: Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nephrotoxicity. The need of combining several drugs, the fragility of the patients treated, and ... ...

    Title translation Renal toxicity of antiviral drugs.
    Abstract Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nephrotoxicity. The need of combining several drugs, the fragility of the patients treated, and the high susceptibility of the kidney are all factors contributing to renal injury. Many pathogenetic mechanisms are involved in the nephrotoxicity of antiviral drugs, including drug interaction with transport proteins in the tubular cell; direct cytotoxicity due to a high intracellular drug concentration; mitochondrial injury; and intrarenal obstruction or stone formation due to the low solubility of drugs at a normal urinary pH. As a result, various clinical pictures may be observed in patients treated with antiviral drugs, ranging from tubular dysfunction (Fanconi syndrome, renal tubular acidosis, nephrogenic diabetes insipidus) to acute renal failure (induced by tubular necrosis or crystal nephropathy) and kidney stones. Careful attention should be paid to prevent renal toxicity by evaluating the glomerular filtration rate before therapy and adjusting the drug dosage accordingly, avoiding the combination with other nephrotoxic drugs, and monitoring renal parameters on a regular basis while treating patients.
    MeSH term(s) Antiviral Agents/adverse effects ; Humans ; Kidney Diseases/chemically induced ; Kidney Diseases/diagnosis ; Kidney Diseases/therapy
    Chemical Substances Antiviral Agents
    Language Italian
    Publishing date 2012-09
    Publishing country Italy
    Document type English Abstract ; Journal Article
    ZDB-ID 1237110-5
    ISSN 1724-5990 ; 0393-5590
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  6. Article ; Online: Preface: 34th Congress of the Italian Transplantation Society (SITO).

    Risaliti, Andrea / Frascà, Giovanni / Testasecca, Duilio / Benedetti, Antonio / Tavio, Marcello / Lorenzini, Ivano / Vivarelli, Marco

    Transplantation proceedings

    2011  Volume 43, Issue 4, Page(s) 949

    MeSH term(s) Congresses as Topic ; Humans ; Immunosuppressive Agents/adverse effects ; Italy ; Organ Transplantation/adverse effects ; Treatment Outcome
    Chemical Substances Immunosuppressive Agents
    Language English
    Publishing date 2011-05
    Publishing country United States
    Document type Editorial ; Introductory Journal Article
    ZDB-ID 82046-5
    ISSN 1873-2623 ; 0041-1345
    ISSN (online) 1873-2623
    ISSN 0041-1345
    DOI 10.1016/j.transproceed.2011.04.003
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  7. Article ; Online: m-TOR inhibitors may be useful in the treatment of encapsulating peritoneal sclerosis (EPS).

    Frascà, Giovanni Maria / D'Arezzo, Mario / Ricciatti, Anna Maria / Balestra, Emilio / Taruscia, Domenica / Nastasi, Valentina / Goteri, Gaia

    Journal of nephrology

    2014  Volume 27, Issue 5, Page(s) 587–590

    Abstract: Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis, often occurring after patients have been shifted to haemodialysis or undergone renal transplantation. EPS is still associated with high ... ...

    Abstract Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis, often occurring after patients have been shifted to haemodialysis or undergone renal transplantation. EPS is still associated with high morbidity and mortality but, although various treatment modalities have been tried, the optimal therapy is still debated. The present paper reports a 16-year-old patient who developed EPS 6 months after shifting to haemodialysis and, following adhesiolysis, was successfully treated with a combination of steroids, tamoxifen and everolimus, this last drug chosen for its antiproliferative effect through mammalian target of rapamycin (mTOR) inhibition and its ability to block vascular endothelial growth factor and neoangiogenesis. EPS progressively improved and the patient successfully underwent renal transplantation 5 years later. The case suggests that, in view of their mechanism of action, mTOR inhibitors should be considered as an immunosuppressive agent after renal transplantation in patients at risk and merit investigation in future trials on this condition.
    MeSH term(s) Adolescent ; Biopsy ; Everolimus ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation ; Male ; Peritoneal Dialysis/adverse effects ; Peritoneal Fibrosis/diagnosis ; Peritoneal Fibrosis/drug therapy ; Peritoneal Fibrosis/enzymology ; Peritoneal Fibrosis/etiology ; Protein Kinase Inhibitors/therapeutic use ; Sirolimus/analogs & derivatives ; Sirolimus/therapeutic use ; TOR Serine-Threonine Kinases/antagonists & inhibitors ; TOR Serine-Threonine Kinases/metabolism ; Tomography, X-Ray Computed ; Treatment Outcome
    Chemical Substances Immunosuppressive Agents ; Protein Kinase Inhibitors ; Everolimus (9HW64Q8G6G) ; MTOR protein, human (EC 2.7.1.1) ; TOR Serine-Threonine Kinases (EC 2.7.1.1) ; Sirolimus (W36ZG6FT64)
    Language English
    Publishing date 2014-02-12
    Publishing country Italy
    Document type Case Reports ; Journal Article
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-014-0052-5
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  8. Article ; Online: Transplantation of kidneys with tumors.

    Frascà, Giovanni M / D'Errico, Antonia / Malvi, Deborah / Porta, Camillo / Cosmai, Laura / Santoni, Matteo / Sandrini, Silvio / Salviani, Chiara / Gallieni, Maurizio / Balestra, Emilio

    Journal of nephrology

    2016  Volume 29, Issue 2, Page(s) 163–168

    Abstract: The shortage of donors in the face of the increasing number of patients wait-listed for renal transplantation has prompted several strategies including the use of kidneys with a tumor, whether found by chance on harvesting from a deceased donor or ... ...

    Abstract The shortage of donors in the face of the increasing number of patients wait-listed for renal transplantation has prompted several strategies including the use of kidneys with a tumor, whether found by chance on harvesting from a deceased donor or intentionally removed from a living donor and transplanted after excision of the lesion. Current evidence suggests that a solitary well-differentiated renal cell carcinoma, Fuhrman nuclear grade I-II, less than 1 cm in diameter and resected before grafting may be considered at minimal risk of recurrence in the recipient who, however, should be informed of the possible risk and consent to receive such a graft.
    MeSH term(s) Donor Selection ; Humans ; Kidney Neoplasms/complications ; Kidney Neoplasms/diagnosis ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Kidney Transplantation/adverse effects ; Kidney Transplantation/methods ; Neoplasm Grading ; Neoplasm Recurrence, Local ; Risk Assessment ; Risk Factors ; Tissue Donors/supply & distribution ; Treatment Outcome ; Tumor Burden ; Waiting Lists
    Language English
    Publishing date 2016-04
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-015-0249-2
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  9. Article: Il trapianto da vivente in Italia e in Europa.

    Frascà, Giovanni M / Gaffi, G / Taruscia, D / D'Arezzo, M / Benozzi, L / Sagripanti, S

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

    2009  Volume 26, Issue 4, Page(s) 443–451

    Abstract: Renal transplantation from a living donor shows a better graft and patient survival when compared with cadaver donor grafts. Moreover, since surgery can be planned in advance when a living donor is available, the time spent on dialysis while awaiting ... ...

    Title translation Renal transplantation from living donor in Italy and Europe.
    Abstract Renal transplantation from a living donor shows a better graft and patient survival when compared with cadaver donor grafts. Moreover, since surgery can be planned in advance when a living donor is available, the time spent on dialysis while awaiting transplantation can be greatly reduced and dialysis treatment can be completely avoided in some cases. Only few risks for the donor have been reported as a consequence of nephrectomy, both in the short and long term. Nevertheless, despite these advantages, the number of living donor renal transplants carried out in Europe each year varies greatly from country to country and is particularly low in Spain and Italy. Several factors account for these differences, mainly the effectiveness of the organ procurement system, which could make people reluctant to living donation, and doctors' and patients' limited knowledge about living donor transplants. Nephrologists have the responsibility to identify patients eligible for transplant early in the course of the disease, and to inform them and their relatives about living donor transplantation, enabling them to make informed choices among the various treatment options in end-stage renal disease.
    MeSH term(s) Europe ; Humans ; Italy ; Kidney Transplantation/statistics & numerical data ; Living Donors/statistics & numerical data ; Nephrology ; Risk Factors
    Language Italian
    Publishing date 2009-07
    Publishing country Italy
    Document type English Abstract ; Journal Article
    ZDB-ID 1237110-5
    ISSN 0393-5590
    ISSN 0393-5590
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  10. Article ; Online: Renal cancer in kidney transplanted patients.

    Frascà, Giovanni M / Sandrini, Silvio / Cosmai, Laura / Porta, Camillo / Asch, William / Santoni, Matteo / Salviani, Chiara / D'Errico, Antonia / Malvi, Deborah / Balestra, Emilio / Gallieni, Maurizio

    Journal of nephrology

    2015  Volume 28, Issue 6, Page(s) 659–668

    Abstract: Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by ... ...

    Abstract Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.
    MeSH term(s) Calcineurin Inhibitors/therapeutic use ; Carcinoma, Renal Cell/diagnosis ; Carcinoma, Renal Cell/epidemiology ; Carcinoma, Renal Cell/mortality ; Carcinoma, Renal Cell/therapy ; Early Detection of Cancer ; Humans ; Immunosuppressive Agents/therapeutic use ; Incidence ; Kidney Diseases, Cystic/epidemiology ; Kidney Neoplasms/diagnosis ; Kidney Neoplasms/epidemiology ; Kidney Neoplasms/mortality ; Kidney Neoplasms/therapy ; Kidney Transplantation/adverse effects ; Kidney Transplantation/statistics & numerical data ; Polycystic Kidney, Autosomal Dominant/epidemiology ; TOR Serine-Threonine Kinases/antagonists & inhibitors
    Chemical Substances Calcineurin Inhibitors ; Immunosuppressive Agents ; MTOR protein, human (EC 2.7.1.1) ; TOR Serine-Threonine Kinases (EC 2.7.1.1)
    Language English
    Publishing date 2015-12
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-015-0219-8
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    ab Jg. 2022: Lesesaal (EG)

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