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Biomedical subjects

G Moroni

Publications and source records attributed to G Moroni.

At least 37 records · Page 2Linked to original sources
PubMed1996

Soluble transferrin receptor in the study of fetal erythropoietic activity.

In order to evaluate fetal erythropoiesis we measured red blood cells, hemoglobin, hematocrit, serum transferrin receptor (sTfR), and iron status parameters in fetuses undergoing percutaneous umbilical blood sampling, and in normal newborns at term. We found high levels of sTfR in fetuses and newborns as compared with normal adults (3,149 +/- 181 vs. 1,881 +/- 137 ng/ml, P < 0.00001). Concentrations of sTfR correlate with gestational age and red blood cell numbers (r = 0.441, P < 0.001; r = 0.366, P = 0.06). sTfR concentrations do not show correlation with iron status parameters. The increased sTfR concentration is consistent with the fact that fetal life is characterized by cell proliferation and tissue growth. sTfR concentration correlates with gestational age and numbers of red blood cells, and can therefore be considered a good indicator of fetal erythropoiesis. It is conceivable that, during intrauterine life, sTfR expression is independent from iron status. sTfR determination will help in reaching a better understanding of some aspects of fetal physiology, and will help elucidate the physiopathology of fetal hematological diseases.

Erythrocyte Count↗
PubMed1996

Extracapillary glomerulonephritis and renal amyloidosis.

We report three patients with well-documented renal amyloidosis who developed rapidly progressive renal failure. Renal biopsies from all three patients showed crescentic glomerulonephritis imposed on renal amyloidosis. All patients were treated with intravenous high-dose methylprednisolone pulses combined with immunosuppressive agents and oral corticosteroids. Partial recovery of renal function was obtained in two patients. For the third patient, treatment had to be stopped after a few days because of a septic arthritis. Renal function continued to deteriorate, and the patient had to be placed on regular hemodialysis. We conclude that extracapillary glomerulonephritis may occasionally complicate a preexisting renal amyloidosis and may be reversible if recognized early and treated appropriately.

Aged↗
PubMed1996

"Nephritic flares" are predictors of bad long-term renal outcome in lupus nephritis.

We retrospectively analyzed the courses of 70 patients with lupus nephritis followed for 5 to 30 years (median 127 months). Patients survival was 100% at 10 years and 86% at 20 years. The probability of not reaching the end point (persistent doubling of plasma creatinine) was 85% at 10 years and 72% at 20 years. A multivariate analysis of variables at presentation showed that male sex (P = 0.005) and hematocrit lower than 36% (P = 0.01) were associated with the end point (relative risk 7.5 and 14). We then analyzed for the role of renal flare-ups, defined either as a rapid increase in plasma creatinine or by an increase in proteinuria. Patients with renal flares of any type had more probabilities of reaching the end point than patients who never had flares (P = 0.03; relative risk 6.8). The hazard of the end point was 27 times higher in patients with flares along with rapid increased in plasma creatinine than in patients without flares or with flares with proteinuria alone (P < 0.00001). This hazard was higher when plasma creatinine did not return to the basal levels within two months after treatment (P < 0.00001).

Adult↗
PubMed1995

Reversible acute renal failure from gross haematuria due to glomerulonephritis: not only in IgA nephropathy and not associated with intratubular obstruction.

Seven patients with acute renal failure due to gross haematuria caused by glomerulonephritis are described. Gross haematuria lasting 4-40 days led to acute impairment of renal function of variable severity (peak plasma creatinine 1.3-12 mg/dl) and duration. While partial recovery of renal function occurred in all patients within few days, complete remission was observed only some months later. Three patients had IgA nephropathy (2 the primary form and 1 nephritis secondary to Schönlein-Henoch purpura), two patients had acute postinfectious glomerulonephritis, and two others had focal necrotizing (pauci-immune) glomerulonephritis. The glomerular changes seen in the renal biopsy were not enough to explain per se the renal function impairment. Tubular changes, however, were severe and consisted of tubular necrosis, erythrocyte casts, erythrocyte phagocytosis by tubular cells, accompanied by interstitial damage (oedema, red-cell extravasation, and inflammatory infiltrates). Study of the renal biopsies by immunofluorescence revealed no retrodiffusion of Tamm-Horsfall protein into the glomerular Bowman's space, a sign of obstructed tubular flow in any case. It is concluded that acute renal failure due to gross haematuria in glomerulonephritic patients may not occur only in IgA nephropathy, as reported so far, and is not associated with intratubular obstruction.

Acute Kidney Injury↗
PubMed1995

Cardiologic abnormalities in patients with long-term lupus nephritis.

To assess the cardiological status of patients with long-term lupus nephritis we evaluated 30 patients (mean age 43 +/- 11 years) with lupus nephritis lasting from at least 10 years (mean 15 +/- 5 years). At the time of cardiological evaluation the mean plasma creatinine was 132.6 +/- 11.1 mumol/l and in 28 patients lupus had been quiescent for at least 3 years. Fourteen patients (46.6%) showed one or more cardiac abnormalities: 10 had valvular lesions (1 verrucous endocarditis, 9 thickening and stiffness of one or more valves)--4 patients had regional myocardial akinesis as a consequence of a previous cardiac infarct (one had valvular abnormalities too). One patient had pulmonary hypertension probably secondary to pulmonary vasculitis. No patient had pericarditis. These cardiac abnormalities proved to be statistically correlated with the number of ARA criteria (p = 0.045), the number of lupus flares (p = 0.004), the serum levels of cholesterol (p = 0.04) and of triglycerides (p = 0.025) as well as the duration of hypercholesterolemia (p = 0.005) and of hypertriglyceridemia (p = 0.007). In conclusion, in patients with long-term lupus nephritis cardiac lesions are frequent. The main lesions are non-verrucous valvulopathy (probably a consequence of healing verrucous endocarditis) and cardiac infarct (caused by an accelerated atherosclerosis). On the contrary cardiac lesions caused by active lupus as pericarditis, myocarditis and verrucous endocarditis are rare.

Adult↗
PubMed1994

Renal replacement therapy in cryoglobulinaemic nephritis.

Seventeen patients with nephritis due to mixed cryoglobulinaemia were submitted to regular haemodialysis in 11 and continuous ambulatory peritoneal dialysis in six after 145 +/- 55 months from the onset of the disease. Four patients with very poor clinical conditions died within 6 months from the beginning of dialysis. The other 13 patients were followed for a mean period of 78.7 +/- 41.6 months. The actuarial survival rate was 65% at 5 years. Both clinical and immunological signs of mixed cryoglobulinaemia reduced during dialysis but a long-lasting burn out was observed only in one patient. Two patients received a kidney graft. Mixed cryoglobulinaemia nephritis recurred in both of them respectively 5 and 10 months after transplantation. One patient lost his graft 13 months after transplantation because of chronic rejection. The other one still has a functioning kidney 48 months after renal transplantation. The life expectancy with dialysis for mixed cryoglobulinaemia patients is similar to that of patients with standard primary renal disease but some few patients with severe disease at the beginning of dialysis have a poor prognosis. Nephritis may recur after renal transplantation but this does not preclude per se a favourable course in the long term.

Actuarial Analysis↗
PubMed1993

Lupus membranous nephropathy: long-term outcome.

The follow-up of 42 patients affected by lupus membranous nephropathy (LMN) is reported and compared with that of 43 patients affected by diffuse proliferative lupus glomerulonephritis (DPGN), who were the object of a previous study. According to the WHO classification, the patients were subdivided into two groups: pure LMN (Va + Vb class) and LMN with superimposed proliferative lesions (Vc + Vd class). Antiphospholipid antibodies (APA) and lupus anticoagulant were tested in 23 subjects. All the patients were treated with corticosteroids, which were associated to cytotoxic drugs in 28 cases. Although a higher number of complete remissions was obtained in patients with pure LMN, the difference between the 2 groups was not significant (7/26 vs 1/16). At 10 years kidney survival was 93% in all LMN patients with no significant differences between the 2 groups. This 10-year kidney survival rate is very similar to that previously observed by us for DPGN (91%). The WHO histological classification and the chronicity index did not identify the patients who reach end-stage renal failure. Eight patients suffered from thrombotic manifestations which were the cause of death in two cases. Fourteen of the 20 patients studied presented echocardiographic abnormalities. A statistically significant association was found between the occurrence of cardiovascular complications and APA levels. The effectiveness of treatment in LMN remains controversial. We suggest, however, that adequate therapy may significantly improve the prognosis of lupus nephritis thus reducing the differences in the outcome of SLE patients having different histological WHO classes. Cardiovascular illness represents a frequent and severe late complication.

Adult↗
PubMed1992

Red cell and plasma ferritin in a group of normal fetuses at different ages of gestation.

Plasma and cell ferritin were determined in 47 normal fetuses at different gestational ages in order to evaluate fetal iron status. Plasma ferritin shows an increase during pregnancy (17.7 micrograms/l-mean geometrical value of fetuses between 18 and 20 weeks; 56.8 micrograms/l mean geometrical value of fetuses between 32 and 35 wk) and significantly correlates to hemoglobin and number of red blood cells. Red cell ferritin, too, increases throughout pregnancy (from 92.7 ag/cell to 265 ag/cell) and shows a better correlation to hemoglobin and number of red blood cells. Experimental evidence has been provided showing that the placenta takes up ferritin and is important in iron storage and transport (even against a concentration gradient). Our data support this theory and suggest a situation of positive balance between iron uptake and utilization during intrauterine life.

Erythrocytes↗
PubMed1992

Clinical status of patients after 10 years of lupus nephritis.

Little information is available about the clinical status and outcome of patients with a long history of lupus nephritis. We have reviewed the dossiers of 25 patients (23 women and two men) who have been monitored by our Unit for more than 10 years after the diagnosis of lupus nephritis. At presentation the mean age was 28.5 +/- 10.33 (SD) years, the mean plasma creatinine was 136.1 +/- 144.7 (SD) nmol/l, the mean proteinuria was 3.02 +/- 2.7 (SD) g/day. At initial renal biopsy 18 patients showed diffuse proliferative glomerulonephritis, six patients showed membranous glomerulonephritis and one showed focal proliferative glomerulonephritis. All patients but one were treated with corticosteroids and 18 were also given immunosuppressive agents. At the last observation (16 +/- 4.6 (SD) years after presentation), 19 patients have normal plasma creatinine (11 of them show proteinuria less than 0.2 g/day) and six patients show increased plasma creatinine (mean 203.3 +/- 61.9 (SD) mmol/l). Eleven patients have been without any treatment for 88 +/- 64 (SD) months. The incidence of lupus flare-ups fell significantly after the tenth year (0.31/patient/year between 0 and 10 versus 0.11 between years 11 and 27; p = 0.01). No case of pericarditis or cerebritis occurred after the tenth year. Only one case of cerebral thrombosis occurred before the tenth year, but ten severe atherosclerotic cardiovascular and cerebrovascular complications were seen after the tenth year (two cardiac infarcts, three angina pectoris, four cerebral thrombosis, one cerebral haemorrhage). Two cases of cancer (thyroid and lung) occurred after the tenth year. The professional rehabilitation was good in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Chronic dialysis in patients with systemic amyloidosis: the experience in northern Italy.

The clinical outcome of 61 patients with renal amyloidosis treated with chronic dialysis was reviewed. Eighteen patients, 4 with primary or AL amyloidosis and 14 with reactive or AA amyloidosis, died within one month from starting treatment. The other 43 patients were treated with dialysis for 3 to 199 months and are the object of this study. Sixteen patients had AL amyloidosis and 27 had AA amyloidosis. Thirty-five patients were treated with hemodialysis (HD) for a mean period of 40 +/- 47 months and 8 were treated with continuous ambulatory peritoneal dialysis (CAPD) for 20 +/- 15 months. Patient survival rate at 1 and 5 years was 68% and 30% respectively. There was no difference in survival rate between patients treated with HD and those treated with CAPD, while patients younger than 45 had a better 5-year survival rate. Twenty four (60%) patients achieved a satisfactory rehabilitation with dialysis. At the last follow-up, 15 patients (14 on HD, 1 on CAPD) were alive 61 +/- 58 months after starting dialysis. Twenty-eight patients died after 30 +/- 20 months. The main causes of death were: cardiovascular accident (11), stroke (3), sepsis (5) and cachexia (5). The most important extra-renal complications of amyloidosis were related to cardiovascular involvement (heart failures, arrhythmias, hypotension) and gastrointestinal involvement (malabsorption). Intra-dialytic hypotension in patients on HD and peritonitis in patients on CAPD were the main problems related to dialytic procedure. his study confirms that life expectancy and the quality of life of dialysis patients with systemic amyloidosis are poorer than those of general dialysis population.(ABSTRACT TRUNCATED AT 250 WORDS)

Amyloidosis↗
PubMed1987

Long-term prognosis of diffuse lupus nephritis.

The follow-up of 43 patients with diffuse proliferative lupus nephritis is reported. After histological diagnosis, all patients were treated with 3 intravenous high-dose methylprednisolone pulses and then with low-dose oral steroids and 31 with cytotoxic drugs. Renal and extra-renal exacerbations were also treated with intravenous high-dose steroids. Patients were followed for 1 to 13 years. At 10 years the patient survival rate was 87% and the kidney survival rate was 79%. If 3 extra-renal deaths are excluded, the actuarial 10-year kidney survival rate is 91%. At present, 21 patients do not show any renal abnormalities, 13 patients have normal plasma creatinine but proteinuria, 3 patients have stable renal function impairment, 2 patients have worsening of their renal function, 1 is on regular dialysis. The other 3 patients died (from cardiac failure, cerebral hemorrhage and a car accident). The incidence of flare-ups was low (0.1 episodes per year). Severe side effects were rare in this series. It is concluded that the long-term prognosis of diffuse lupus nephritis is becoming considerably better. Therapy based on a short course of intravenous high-dose methylprednisolone and on a maintenance regimen with low doses of steroid and cytotoxic agents can contribute to preserving renal function while avoiding severe side effects.

Administration, Oral↗
PubMed1986

Acid-base balance and respiratory response during biofiltration with polyacrylonitrile membrane.

To further elucidate the mechanisms responsible for the hypoxemia we studied ventilation, pulmonary gas exchanges, blood gas pressures and exchanges of CO2-T, CO2-D and HCO-3 in six patients during AD and BD on 1 m2 cuprophan filter and during BF on 1.2 m2 polyacrylonitrile filter. Blood passing through the dialyzer lost 172.8 mM/h of CO2-T in AD, 149.2 mM/h in BF and gained 25.6 mM/h in BD. In AD VE, VA and PaO2 decreased significantly after 30 and 60 min., in BF for the whole duration of dialysis. PoO2 showed a significant decrease both in AD and BF after 60 min. In AD PaCO2 was significantly reduced after 120 and 180 min. All the above parameters remained unchanged in BD. VCO2 remained unchanged in all. VCO2 and R decreased both in AD and BF. However, when VCO2 was corrected for CO2 loss across the dialyzer, overall CO2 loss (ventilated plus filtered) and R returned to basal values. In AD, HCO-3 and pH fell in the first 120 min., while in BD and BF they increased from the beginning of dialysis. In AD hypoventilation, hypoxemia and inadequate correction of acid-base balance were due to the loss of HCO-3 across the filter. In BF also hypoventilation and hypoxemia were due to the loss of HCO-3 across the filter but the acid-base balance was adequately corrected by HCO-3 reinfusion. In BD, there was HCO-3 gain across the filter which induced a gradual correction of acid-base balance without impairment of ventilation.

Acid-Base Equilibrium↗