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  1. Article ; Online: Acute Kidney Injury (AKI) before and after Kidney Transplantation

    Alessandra Palmisano / Ilaria Gandolfini / Marco Delsante / Chiara Cantarelli / Enrico Fiaccadori / Paolo Cravedi / Umberto Maggiore

    Journal of Clinical Medicine, Vol 10, Iss 1484, p

    Causes, Medical Approach, and Implications for the Long-Term Outcomes

    2021  Volume 1484

    Abstract: Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some ... ...

    Abstract Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some forms of AKI may induce graft rejection, fibrosis, and eventually graft dysfunction. Therefore, various strategies have been proposed to identify conditions at highest risk of AKI-induced DGF, that can be treated by targeting the donor, the recipient, or even the graft itself with the use of perfusion machines. AKI that occurs early post-transplant after a period of initial recovery of graft function may reflect serious and often occult systemic complications that may require prompt intervention to prevent graft loss. AKI that develops long after transplantation is often related to nephrotoxic drug reactions. In symptomatic patients, AKI is usually associated with various systemic medical complications and could represent a risk of mortality. Electronic systems have been developed to alert transplant physicians that AKI has occurred in a transplant recipient during long-term outpatient follow-up. Herein, we will review most recent understandings of pathophysiology, diagnosis, therapeutic approach, and short- and long-term consequences of AKI occurring in both the donor and in the kidney transplant recipient.
    Keywords acute kidney injury ; kidney transplantation ; delayed graft function ; donor selection ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2021-04-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: The Association of New-Onset Acute Kidney Injury and Mortality in Critically Ill Patients With COVID-19 With Less Severe Clinical Conditions at Admission

    Giuseppe Regolisti / Umberto Maggiore / Francesca Di Mario / Micaela Gentile / Giuseppe Daniele Benigno / Ilaria Gandolfini / Valentina Pistolesi / Santo Morabito / Maria Barbagallo / Edoardo Picetti / Enrico Fiaccadori

    Frontiers in Medicine, Vol

    A Moderation Analysis

    2022  Volume 9

    Abstract: Acute kidney injury (AKI), electrolyte, and acid–base disorders complicate the clinical course of critically ill patients with coronavirus-associated disease (COVID-19) and are associated with poor outcomes. It is not known whether the severity of ... ...

    Abstract Acute kidney injury (AKI), electrolyte, and acid–base disorders complicate the clinical course of critically ill patients with coronavirus-associated disease (COVID-19) and are associated with poor outcomes. It is not known whether the severity of clinical conditions at admission in the intensive care unit (ICU) changes the clinical significance of AKI and/or electrolyte or acid–base disorders developing during ICU stay. We conducted a retrospective study in critically ill patients with COVID-19 to evaluate whether the severity of clinical conditions at admission in the ICU affects the impact of AKI and of serum electrolytes or acid–base status on mortality. We carried out a 28-day retrospective follow-up study on 115 critically ill patients consecutively admitted to ICU for severe COVID-19 at a tertiary care university hospital and surviving longer than 24 h. We collected baseline demographic and clinical characteristics, and longitudinal data on kidney function, kidney replacement therapy, serum electrolytes, and acid–base status. We used Cox proportional hazards multiple regression models to test the interaction between the time-varying variates new-onset AKI or electrolyte or acid–base disorders and Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission. After adjusting for age, sex, Charlson’s comorbidity index, and AKI present at ICU admission, new-onset AKI was significantly associated with 28-day mortality only in the patients in the lowest and middle SOFA score tertiles [lowest SOFA tertile, hazard ratio (HR) 4.27 (95% CI: 1.27–14.44; P = 0.019), middle SOFA tertile, HR 3.17 (95% CI: 1.11–9.04, P = 0.031), highest SOFA tertile, HR 0.77 (95% CI: 0.24–2.50; P = 0.66); P = 0.026 for interaction with SOFA as a continuous variable]. After stratifying for APACHE II tertile, results were similar [adjusted HR (aHR) in the lowest tertile 6.24 (95% CI: 1.85–21.03, P = 0.003)]. SOFA or APACHE II at admission did not affect the relationship of ...
    Keywords acute kidney injury ; electrolytes ; acid–base status ; critical illness ; COVID-19 ; Medicine (General) ; R5-920
    Subject code 610 ; 616
    Language English
    Publishing date 2022-03-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Impact of preformed T-cell alloreactivity by means of donor-specific and panel of reactive T cells (PRT) ELISPOT in kidney transplantation.

    Ilaria Gandolfini / Elena Crespo / Mukta Baweja / Marta Jarque / Chiara Donadei / Sergio Luque / Núria Montero / Anna Allesina / Laura Perin / Umberto Maggiore / Paolo Cravedi / Oriol Bestard

    PLoS ONE, Vol 13, Iss 7, p e

    2018  Volume 0200696

    Abstract: Donor-specific (d-sp) interferon gamma enzyme-linked immunosorbent spot (d-sp ELISPOT) and Panel of reactive T-cell (PRT) ELISPOT assays have been developed to detect alloreactive memory T (Tmem) cells in order to estimate the risk of acute rejection ... ...

    Abstract Donor-specific (d-sp) interferon gamma enzyme-linked immunosorbent spot (d-sp ELISPOT) and Panel of reactive T-cell (PRT) ELISPOT assays have been developed to detect alloreactive memory T (Tmem) cells in order to estimate the risk of acute rejection after kidney transplantation. Adding IL15 to the PRT assay (PRT+IL15) may uncover the presence of pathogenic alloreactive CD28-Tmem. Face-to-face comparisons of these assays have not been done yet. We performed pre-transplant d-sp ELISPOT and PRT assays (±IL15, against six B-cell lines) in 168 consecutive kidney transplant recipients and evaluated the multivariable-adjusted associations with biopsy-proven acute rejection (BPAR), de novo donor-specific antibodies (DSA), and eGFR decline over a 48-month follow-up period. D-sp ELISPOT was positive in 81 (48%) subjects, while 71 (42%) and 81 (48%) subjects displayed positive PRT and PRT+IL15, respectively. Their median [interquartile range] numerical test result was 23 [6-65], 18 [8-37], and 26 [10-45] spots/3x105 PBMCs, respectively. The number of PRT spots were weakly correlated with those of d-sp ELISPOT, but highly correlated with PRT+IL15 (rho = 0.96, P<0.001). d-sp ELISPOT, but not PRT (±IL15) was independently associated with BPAR (adjusted Odds Ratio of BPAR associated with d-sp ELISPOT positivity: 4.20 [95%CI: 1.06 to 21.73; P = 0.041]). Unlike d-sp ELISPOT, median PRT and PRT+IL15 were independently associated with higher Δ3-48month eGFR decline post-transplantation (for both assays, about -3mL/min/1.73m2 per one standard deviation unit increase in the spot number). Pre-transplant T-cell immune-monitoring using d-sp ELISPOT and PRT assays identifies kidney transplant candidates at high risk of BPAR and worse kidney allograft progression.
    Keywords Medicine ; R ; Science ; Q
    Subject code 616
    Language English
    Publishing date 2018-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients

    Giuseppe Regolisti / Umberto Maggiore / Alice Sabatino / Ilaria Gandolfini / Sarah Pioli / Claudia Torino / Filippo Aucella / Adamasco Cupisti / Valentina Pistolesi / Alessandro Capitanini / Giorgia Caloro / Mariacristina Gregorini / Yuri Battaglia / Marcora Mandreoli / Lucia Dani / Giovanni Mosconi / Vincenzo Bellizzi / Biagio Raffaele Di Iorio / Paolo Conti /
    Enrico Fiaccadori / Gruppo di Studio “Esercizio fisico nel paziente con insufficienza renale cronica” of the Società Italiana di Nefrologia

    PLoS ONE, Vol 13, Iss 4, p e

    A quantitative assessment.

    2018  Volume 0196313

    Abstract: In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff's attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this ... ...

    Abstract In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff's attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population.In this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff's attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff's attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile-Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers.Most barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 ["Feeling too old", 95% Confidence Interval: -9.4 to -0.8] and -15.6 ["Ulcers on legs and feet", 95%CI: -24.8 to -6.5]. We found a significant interaction between staff's attitude and barriers (adjusted P values ranging between 0.03 ["I do not believe that it is physician's or nurse's role providing advice on exercise to patients on dialysis"] and 0.001 ["I do not often ask patients about exercise"]). A beneficial effect of a proactive staff's attitude was evident only in patients not endorsing barriers.Barriers and non-proactive staff's attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff's attitude.
    Keywords Medicine ; R ; Science ; Q
    Subject code 616
    Language English
    Publishing date 2018-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Correction

    Giuseppe Regolisti / Umberto Maggiore / Alice Sabatino / Ilaria Gandolfini / Sarah Pioli / Claudia Torino / Filippo Aucella / Adamasco Cupisti / Valentina Pistolesi / Alessandro Capitanini / Giorgia Caloro / Mariacristina Gregorini / Yuri Battaglia / Marcora Mandreoli / Lucia Dani / Giovanni Mosconi / Vincenzo Bellizzi / Biagio Raffaele Di Iorio / Paolo Conti /
    Enrico Fiaccadori / Gruppo di Studio “Esercizio fisico nel paziente con insufficienza renale cronica” of the Società Italiana di Nefrologia

    PLoS ONE, Vol 13, Iss 6, p e

    Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

    2018  Volume 0198987

    Abstract: This corrects the article DOI:10.1371/journal.pone.0196313.]. ...

    Abstract [This corrects the article DOI:10.1371/journal.pone.0196313.].
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2018-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

    Full text online

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