肾脏病学与治疗学杂志

270 samples of different types of pasta and cereal products, distributed in a nursery school canteen in Milan (Italy), were analyzed to estimate the occurrence of ochratoxin A. OTA was found in all analyzed samples (100%), 39 samples exceeded the maximum limit established by European Commission Regulation for OTA in the foodstuffs listed in the relevant category. The mean concentration of ochratoxin A in samples of pasta, intended for children (over 5 months) consumption was 0.56 μg/kg; the mean concentration in organic pasta was 0.91 μg/kg and the mean concentration detected in cereal products was 3.12 μg/kg. Considering that in European Countries wheat products are the first solid food eaten by babies from the earliest stages of weaning and in the light of the multiple and repeated international food alert notification on OTA occurrence in cereals and cereals product, surveillance should be continuous for an effective risk assessment, especially in these vulnerable groups of consumers.

Background: Serum ADMA level was high in hemodialysis patients as compared to healthy control population. Increase in ADMA levels may play a role in atherosclerosis dependent morbidity and mortality. Objective: Assessment of the relationship between serum ADMA and atherosclerosis. Patient and methods: Serum ADMA was measured using ADMA ELISA Kit; atherosclerosis was assessed by non- invasive methods including FMD and CIMT in 3 groups (50 ESRD patients undergoing hemodialysis, 25 CKD patients stage IV and 25 healthy control subjects). Results: CKD and ESRD patients on regular haemodialysis have significantly greater ADMA, CIMT and lesser FMD than do control subjects with normal renal function. Both groups of patients have higher cholesterol and triglycerides levels than do control subjects which could be related to serum ADMA. Serum albumin was reduced in haemodialysis and CKD patients; it has an inverse correlation with serum ADMA. Conclusion: Patients of CKD and haemodialysis have earlier endothelial dysfunction than do control group and this explains why they have higher incidence of cardiovascular morbidity and mortality. Integration of ADMA into currently applied risk scores still needs to be validated.

Background: Sleep disorders are common in ESRD. Residual kidney function contributes significantly to the overall health and well-being of dialysis patients. The importance of RKF in patients on peritoneal dialysis is widely known, but only a few studies have examined RKF in patients on hemodialysis. Methods: Our study aimed to evaluate sleep disorders in hemodialysis patients and the effect of residual renal function on them. A cross sectional study was conducted on 80 HD patients who were divided into 2 groups. Group I included 30 HD patients with RKF and group II included 50 HD patients without RKF. RKF (Kru) was calculated using the equation: Interdialytic urine volume x Urine urea concentration/Interdialytic period/Mean BUN. Where Mean BUN= (BUN 1 + BUN 2)/2. BUN 1 was measured after first dialysis of week and BUN 2 was measured prior to second dialysis of week. Routine laboratory investigations were done to all patients. We assessed the following sleep disorders in both group: insomnia through insomnia severity index, the restless leg syndrome through international restless leg syndrome study group (IRLSSG) and the excessive Daytime sleepiness through the Italian version of Epworth sleepiness scale. Results: In group I, 43.3% were female and 56.7% were male with mean age 40.47 ± 13.96 years and mean dialysis duration 4.38 ± 2.86 years. In group II, 38% were female and 62% were male with mean age 54.68 ± 9.36 years and mean dialysis duration 6.90 ± 3.82 years. There was highly significant difference between both groups regarding age and dialysis duration (p=0.000, 0.002 respectively). There was highly significant difference between the two groups regarding iPTH (106.71 ± 57.34 pg/ml, 175.36 ± 15.71 pg/ml, p=0.000). The prevalence of insomnia was 62% followed by IRLS 18.7% and EDS 12.5%. There was no statistically significant difference between group I and group II regarding insomnia severity index, while there was statistically significant difference between them regarding international restless limb syndrome and epworth sleepiness (p=0.040, 0.004 respectively). There was no significant correlation between Kru and total score of insomnia severity index, total score of limb syndrome and total score of epworth sleepiness scale. In our study there was positive correlation between Phosph and total score of limb syndrome (p=0.010). Also the level of iPHT was correlated with the total score of limbs syndrome and total score of Epworth sleepiness scale (p=0.027, 0.038 respectively). Conclusion: Sleep disorders are quite common in the HD patients. Patients with high level of iPTH and phosphorus are at major risk of sleep disorders. Residual kidney function is very important to control Ca, phosphorus and iPTH level but its effect on the sleep disorders is not obvious in our study.

Introduction: When faced with early urinary tract infections in infants, there is a need to do diagnostic imaging to exclude urinary tract malformations. Delayed diagnosis of this condition could lead to serious complications. Case presentation: We received a 2 months old male infant referred for better management of an acute kidney injury (AKI) with septicemia. He had a past medical history of febrile urinary tract infection. Our diagnosis was that of acute kidney injury and septicemia associated to a posterior urethral valve. The initial treatment included broad spectrum antibiotics, management of AKI complications and vesicostomy to relief the urinary obstruction prior to valve ablation. We unfortunately lost the infant on day 3 following surgery from severe refractory hyperkalemia and a uremic syndrome. Conclusion: This case is a call to clinicians' attention in low income countries to always check for urinary tract malformations when confronted with an infant presenting a febrile urinary tract infection.

Introduction: Acute kidney injury is a serious condition in critically ill patients with sepsis, in Ecuador the prevalence is about of 10% and has high undocumented mortality rate. The type of renal replacement therapy used is also very discussed in countries that have several treatment options. Many developing regions don’t have continuous treatments available for these patients. Objective: The aim of the study was to demonstrate advantages of treatment with on-line hemodiafiltration (own scheme) versus intermittent hemodialysis high flux low intensity in patients with sepsis and acute kidney injury. Primary outcomes evaluated were: mortality, vasoactive drugs, mechanical ventilation dependence and permanence at intensive care unit. Results: Cohort and tracing study in patients with sepsis and acute kidney injury. Two groups undergoing treatment for intermittent hemodialysis high flux low intensity (Group A: n 35) vs. on line hemodiafiltration (Group B: n 30). General mortality was 49.2%, (Group A: 60% vs. group B: 36.6% p=0.061). APACHE 2 and SOFA index in both groups were similar (p=0.26 and 0.98 respectively). Time intensive care unit stay (GA: 16.7; GB: 9.9 p=0.044), vasoactive drugs dependence (GA: 9; GB: 4.1 p=0.084), mechanical ventilation dependence (GA: 11.2; GB: 6.5 p=0.12). Conclusion: On line hemodiafiltration showed benefits statiscally significative in intensive care unit stay, in relation to vasoactive drugs, mechanical ventilation dependence showed beneficies but weren´t significatives. The mortality wasn't statistically significative. Results showed advantages in on line hemodiafiltration with our own scheme in critically ill patients with sepsis.