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P Zucchelli

Publications and source records attributed to P Zucchelli.

At least 127 records · Page 7Linked to original sources
PubMed1987

Long-term outcome of idiopathic membranous nephropathy with nephrotic syndrome.

We retrospectively studied 82 consecutive patients with idiopathic membranous nephropathy accepted at two separate Renal Services. These patients had nephrotic syndrome at presentation and had been followed up for at least 10 years. The duration of the disease before renal biopsy ranged between 1 and 18 months. Forty-nine patients never received treatment (non-treated group) whereas 33 patients (treated group) received corticosteroids (and cytotoxic agents). The two groups were age and sex matched. There was no difference in clinical findings or in outcome between the two Renal Services. A complete and sustained remission of proteinuria was observed in about 25% of patients, and there was a significant difference (P less than 0.01) between the treated and non-treated group (mean value 39.1% vs 14.3%). Forty-four per cent of the non-treated patients and 24.2% of the treated ones developed chronic renal failure or renal death during a mean potential follow-up of 14 years. Non-renal death was recorded in 19.5% of the patients. The staging of the capillary wall lesion represented a very important prognostic index. We confirm, therefore, that idiopathic membranous nephropathy with nephrotic syndrome is frequently a progressive disease. Corticosteroids (and cytotoxic drugs) seem to be of some benefit in interfering with the natural course of the disease.

Adult↗
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↗
PubMed1987

Inorganic phosphate removal during different dialytic procedures.

In order to clarify the influence of membrane surface, membrane composition, dialysate buffer and convective transfer on the dialytic removal of inorganic phosphate (Pi), 11 uremic patients were studied. Each patient underwent 7 different dialysis techniques: conventional hemodialysis with acetate buffer and different surface or composition of the membrane, bicarbonate dialysis and a "soft" hemodiafiltration, also termed biofiltration, with post-dilution infusion of 4 liters. The treatment time was fixed at 4 hours. Our study showed that the dialyzer surface area and the ultrafiltration rate were the major factors in dialytic inorganic phosphorus (Pi) removal. The dialysate buffer does not modify dialytic Pi removal but may influence the rebound phenomenon.

Adolescent↗
PubMed1986

Clinical and morphologic evolution of idiopathic membranous nephropathy.

Twenty-five adult patients with idiopathic membranous nephropathy (IMN) and nephrotic syndrome (NS) who had participated at a long-term randomized trial with steroid and chlorambucil for six months, underwent repeated renal biopsies. The mean interval between pretreatment and the second biopsy was 41 months. Five evolutionary morphologic changes were adopted. Extensive normalization of the basement membrane (stage V) was observed in 6 of the 9 patients with complete and sustained remission. Only patients in stages I or II at admission seemed to get to reparation stage V. Persistence of NS or a partial remission was usually associated to the progression of the capillary wall lesion to stage III or IV. Our treatment schedule significantly increased the likelihood of getting to the reparation stage V.

Adolescent↗
PubMed1985

Controlled trial of methylprednisolone pulses and low dose oral prednisone for the minimal change nephrotic syndrome.

In a multicentre, randomised, prospective trial 89 patients (67 children and 22 adults) with the minimal change nephrotic syndrome were treated with three intravenous pulses of methylprednisolone followed by low dose oral prednisone for six months (group given methylprednisolone) or with high dose oral prednisone for four weeks followed by low dose oral prednisone for five months (control group). Five patients in the group given methylprednisolone and one in the control group did not respond initially. The time to response was shorter in children treated with methylprednisolone. No significant differences between the two groups were observed in the number of patients who relapsed or number of relapses per patient per year. Patients given methylprednisolone tended to relapse earlier than patients in the control group. Side effects related to treatment were significantly fewer in the group given methylprednisolone than in the control group. These data suggest that a short course of methylprednisolone pulses followed by low dose oral prednisone is only marginally less effective than a regimen of high dose oral steroids but can improve the ratio of risk to benefit associated with treatment of the minimal change nephrotic syndrome.

Administration, Oral↗
PubMed1985

B and T cell abnormalities in patients with primary IgA nephropathy.

The in vitro function of B and T cells was studied in 16 patients with primary IgA nephropathy (PIgA-N). The distribution of OKT3+ cells (total peripheral T cells) and of regulatory T cell subsets (helper OKT4+ and cytotoxic/suppressor OKT8+ cells) was evaluated and a testing for 47 HLA-A, B, C, DR, and DQ antigens was carried out in the 16. B lymphocyte IgA production, after stimulation by pokeweed mitogen in the presence of T cells from normal donors treated with mitomycin C, was significantly greater in patients than in controls. T lymphocytes from patients with PIgA-N were more efficient than T cells from controls in providing IgA specific helper activity for normal B cells. The analysis of the individual data showed that the overactivity of B cells and the T cell operational dysfunction was present in about 50% of the patients and did not correlate. No numerical imbalance between T lymphocyte subsets nor any association between lymphocyte behavior, HLA antigen distribution, and a number of clinical, laboratory, and immunohistological findings was observed. Our data, therefore, suggest that PIgA-N is an immunologically heterogeneous disease and that an IgA-specific B cell overactivity and/or overall IgA-specific T cell helper activity may be present in some patients.

Adolescent↗
PubMed1985

Effect of bromocriptine treatment on prolactin, noradrenaline and blood pressure in hypertensive haemodialysis patients.

Bromocriptine (2.5 mg/day orally) produced a significant fall in supine mean arterial pressure in nine hypertensive haemodialysis patients with high serum prolactin levels, without causing significant changes in heart rate. On bromocriptine, there was a significant decrease in the mean value of both serum prolactin and plasma noradrenaline, without significant changes in the mean value of plasma renin activity. A significant relationship was found between the changes in supine plasma noradrenaline and the changes in supine mean arterial pressure induced by bromocriptine. The increase in mean arterial pressure in response to the tilt test was greater on bromocriptine than on placebo although the changes in plasma noradrenaline were reduced by bromocriptine. Similar results were observed during the cold pressor test. These findings suggest that the arterial pressure-lowering effect of bromocriptine is related to the reduction in sympathetic out-flow. The parallel decrease in serum prolactin raises the question of the possible involvement of dopaminergic mechanisms in the development of hypertension in our patients. Moreover, bromocriptine seems to enhance the vascular response to endogenous noradrenaline.

Adult↗
PubMed1985

Failure of naloxone in reversal hemodialysis-induced hypotension.

In 5 uremic patients the role of opioid peptides in dialysis-induced hypotension was investigated through the administration of naloxone. An intravenous bolus injection of 1 mg of naloxone was administered immediately before starting a routine hemodialysis session and was repeated when the patients' systolic arterial pressure sank below 90 mm Hg. In our patients, naloxone had no effect on the resting arterial pressure or on dialysis-induced hypotension.

Blood Pressure↗