Search PubMed⌕ Search

Biomedical subjects

L Esposito

Publications and source records attributed to L Esposito.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Combined use of tacrolimus and sirolimus in de novo renal transplant patients: current data.

The concomitant use of calcineurin inhibitors (CNIs) with mTOR inhibitors, that is, either sirolimus (SRL) or everolimus (ERL), in de novo renal transplant patients is still debated. Prescription of full doses of cyclosporine A (CsA) with either SRL or ERL in that population leads to impaired renal function and hyperlipidemia compared with a regimen using mycophenolate mofetil (MMF) with CsA. The current data for the use of SRL doses, ranging from 0.5 to 2 mg/d, or SRL troughs ranging from 8 to 12 ng/mL with conventional doses of tacrolimus, are associated with reduced renal function, higher blood pressure, and an increase in serum lipids compared with MMF/tacrolimus therapy.

Blood Pressure↗
PubMedDate not supplied

[Acute and chronic effects of standard hemodialysis and soft hemodiafiltration on interdialytic serum phosphate levels].

INTRODUCTION: The dialytic management of hyper-phosphoremia, which is inadequate because of insufficient intra-dialytic removal of phosphate (P), is further limited by PDR-P, i.e. the significant increase in serum P levels during the early postdialytic period. Patients and methods. To investigate the effects of enhanced P removal by haemodiafiltration on the inter-dialytic phosphoremia, we studied 12 uremic patients that were switched, with cross-over randomised modality, to a single session of standard hemodialysis (HD) and hemodiafiltration (HDF) (Acute Study). Blood samples were obtained before the treatment, at the end (T0), after 30, 60, 90 and 120 minutes, and at 24, 48 and 68 hours. During both dialytic treatments the whole effluent dialysate was collected to evaluate the intradialytic removal of P. Thereafter, patients were randomised to receive either HD or HDF for three months, in the presence of constantly similar Kt/V, food intake and dose of phosphate binder (Chronic Study). RESULTS: Acute Study. Compared to HD, P removal in HDF was about 44% greater in the presence of identical predialytic P levels (6.0+/-0.2 and 5.9+/-0.4 mg/dl) and Kt/V (1.35+/-0.06 and 1.34+/-0.05); however, the inter-dialytic decline of serum P levels did not differ (-50+/-3% versus -42+/-3%, p=0.098). In HDF, PDR-P was faster (30 min versus 90 min) and better (at T120: +69+/-6% versus +31+/-4%, p<0.001). The higher P levels were maintained throughout the inter-dialytic period whereas Ca x P changed in parallel. Chronic Study. During the three months, pre-dialytic serum P diminished in HDF (from 5.8+/-0.2 to 4.4+/-0.3 mg/dl, p<0.05), while it remained unchanged in HD. A similar pattern of changes was detected in Ca x P. CONCLUSIONS: Enhancement of P removal, acutely amplifies the extent of PDR-P, but allows better control of Ca-P homeostasis in the medium term. This effect is likely to be dependent on the enhanced mobilisation of phosphate from a deep compartment.

Adult↗
PubMedDate not supplied

IgA glomerulonephritis in Wiskott-Aldrich syndrome.

Renal morphology was evaluated in 2 siblings with Wiskott-Aldrich syndrome (WAS) aged 12 and 4 years. They gave a typical history of recurrent episodes of respiratory infection and presented with microhematuria of glomerular origin and proteinuria. The study disclosed a membranoproliferative glomerulonephritis with IgA mesangial deposition in the elder child, while immunofluorescence was negative in the younger. The data indicate that (1) a specific nephropathy does not exist in WAS and (2) the IgA nephropathy is the result of recurrent infections and of related formation of IgA immune complexes scarcely removed by a deficient reticuloendothelial system. This view is consistent with presenting features in WAS (microhematuria, episodes of macrohematuria, proteinuria, Henoch-Schönlein syndrome) and with the fact that it takes years to develop as indicated by the negativity of immunofluorescence in the younger patient.

Child↗
PubMedDate not supplied

Home health case management: rural caregiving.

Providing home health services to a rural population can be a challenge to the home health nurse. Resources are limited in the rural environment as compared with the more populated urban areas. To fill the gap between the needs of the patients and available healthcare resources, informal networks are developed within the patient's support system. These informal networks are often made up of family members, friends, and relatives. The home health nurse has multiple tasks to complete when assisting/enabling the patients and families to become independent in the care required. The use of a three-model approach in home health practice (Collaborative Practice Model, Multisystem Model, and Family Caregiving Model) can produce a system in which a high quality of care is given to the rural population, thereby meeting the needs of the community and patient.

Aged↗