kidney failure

In the late of 2019, there is an outbreak of novel coronavirus disease (COVID-19) in Wuhan, China. The patients appear respiratory symptoms, fever, and cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans and is transmitted mostly via droplets or contact. People of all ages are susceptible to the virus. Up to the middle of February 2020, the number of infected persons in China is over 65,000. The case fatality rate was 2.38%, and elderly men with underlying diseases were at a higher risk of death [1].

Type 2 Diabetes Mellitus constitutes a major problem in public health worldwide. The disease poses a high risk of severe microvascular and macrovascular complications. Diabetic kidney disease is the most common cause of end-stage chronic kidney disease and contributes to the increasing morbidity and mortality associated to diabetes. Sodium-glucose contransporter-2 inhibitors (SGLT2 inhibitors) are the latest oral diabetic medications, which exhibit a great nephroprotective potential, not only by improving glycemic control, but also by glucose-independent mechanisms, such as decreasing blood pressure and other direct renal effects. We conduct a literature review based on the most recent scientific evidence with the goal to elucidate the postulated mechanisms of action of SGLT2 inhibitors in diabetic kidney disease, which are the base of the beneficial clinical effects that are seen in the condition.

Introduction: Patients with aortic stenosis often develop hypertrophy and fibrosis, regardless of symptoms. Cardiac Magnetic Resonance (CMR) represents the gold standard for the evaluation of fibrosis despite numerous limitations: cost, availability, atrial fibrillation, claustrophobia, kidney failure or inability to apnea.Purpose: The aim is to validate the role of echocardiographic parameters, such as Global Longitudinal Strain (GLS), as early markers of fibrosis. Clinical and laboratory data, particularly B-type Natriuretic Peptide (BNP), were also analyzed.Material and methods: In our study we recruited 33 patients with severe aortic stenosis, correlating echocardiographic values of GLS with the qualitative analysis of Late Gadolinium Enhancement (LGE) and the quantitative analysis of T1 mapping of CMR.Results: 70% of patients with an alteration of GLS had LGE+. Univariate logistic regression shows that the factors associated with the presence of LGE on CMR are hypertension (p = 0.043), GLS (p = 0.032), and elevated BNP values (p = 0.021); for GLS, Odds Ratio (OR) is 5 so the chance of finding fibrosis on CMR increases 5 times in presence of an altered GLS. The multivariate analysis confirms the association with impaired GLS values (p = 0.033) and hypertension (p = 0.025), but not with elevated Pro-BNP values.Conclusion: In patients with severe aortic stenosis, the association between GLS, LGE, and T1 mapping can help identify earlier those patients with structural changes caused by the disease, who could benefit from early intervention. It remains to be established how the presence of these alterations has a role in determining the intervention time and the outcome of these patients.

Background: To assess the association between neurocognitive functioning, adaptive functioning, and health-related quality of life (HRQoL), in Children and Young Adults with Severe Chronic Kidney Disease (CKD).Methods: We included patients with severe CKD (stages 4 and 5), aged 8-30 years, on different therapy modalities (pre-dialysis, dialysis, and transplanted) and healthy controls matched on age, sex, and parental education. All patients and healthy controls performed tasks to assess neurocognitive functioning (WISC/WAIS and a comprehensive neuropsychological test battery), and completed questionnaires to assess adaptive functioning (WFIRS or WHODAS) and HRQoL (PedsQL). Group differences were explored using MANCOVA. Mediation analyses were done to explore whether the relation between neurocognitive functioning and HRQoL was mediated by adaptive functioning. Results: 28 patients with severe CKD and 21 healthy matched controls were included. CKD patients had worse HRQoL (p < .001) than healthy controls. Adaptive functioning problems increased with age in the CKD patient group but not in the healthy control group (significant interaction effect: p = .024). Significant mediation effects were found, where impaired adaptive functioning mediated the relation between both low estimated Full Scale Intelligence Quotient (eFSIQ) and worse Processing Speed & Working Memory, and impaired HRQoL (eFSIQ: 95% confidence interval = .01-.58; Processing Speed & Working Memory: 95% confidence interval = 2.31-16.36).Conclusion: We found that impaired neurocognitive functioning is associated with worse HRQoL, which is conditional to impaired adaptive functioning. Especially towards young adulthood problems in adaptive functioning are more likely to be reported than when patients are younger.