Clinical Research Center for Rare Diseases Aldo e Cele Dacco

Ranica, Italy

Clinical Research Center for Rare Diseases Aldo e Cele Dacco

Ranica, Italy

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Cravedi P.,Clinical Research Center for Rare Diseases Aldo e Cele Dacco | Cravedi P.,Mario Negri Institute for Pharmacological Research | Sharma S.K.,BP Koirala Institute of Health Science | Bravo R.F.,Hospital Juan XXIII | And 22 more authors.
BMJ Open | Year: 2012

Objective: To assess the prevalence of microalbuminuria and kidney dysfunction in lowincome countries and in the USA. Design: Cross-sectional study of screening programmes in five countries. Setting: Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005-2008) Bangladesh and Georgia. Participants: General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and highrisk subjects in Bangladesh (n=1518) and Georgia (n=1549). Primary and secondary outcome measures: Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m 2 and microalbuminuria (defined as urinary albumin creatinine ratio values of 30-300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data. Results: The prevalence of eGFR<60ml/min/1.73 m2 was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m2 were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively. Conclusions: Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease.


Cravedi P.,Clinical Research Center for Rare Diseases Aldo e Cele Dacco | Cravedi P.,Mario Negri Institute for Pharmacological Research | Brusegan V.,Clinical Research Center for Rare Diseases Aldo e Cele Dacco | Brusegan V.,Mario Negri Institute for Pharmacological Research | And 5 more authors.
Pharmaceuticals | Year: 2010

We have studied the effects of add-on spironolactone treatment (100 mg/day) in 11 patients with idiopathic membranous nephropathy (IMN) and >3 gm proteinuria/day despite angiotensin converting enzyme (ACE) inhibitor therapy titrated to asystolic/diastolic blood pressure <120/80 mmHg. Blood pressure, 24-hour urinary protein excretion, and creatinine clearance were measured prior to, after two months of combined therapy, and after a 2-month withdrawal period of spironolactone. While systolic and diastolic blood pressure decreased significantly after spironolactone therapy, proteinuria did not improve. Serum potassium increased significantly as well, with three patients requiring resin-binding therapy. Thus, spironolactone seems to have no additional antiproteinuric effects over ACE inhibitor therapy in patients with IMN and nephrotic syndrome and carries the risk of significant hyperkalemia. © 2010 by the authors.

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