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Palermo, Italy

Urea-Torres P.,Nephrology Dialysis | Metzger M.,French Institute of Health and Medical Research | Metzger M.,University Paris - Sud | Haymann J.P.,Hopital Tenon | And 20 more authors.
American Journal of Kidney Diseases | Year: 2011

Background: Vitamin D (25 hydroxyvitamin D [25(OH)D]) deficiency is common in patients with chronic kidney disease (CKD). Neither the relation of this deficiency to the decrease in glomerular filtration rate (GFR) nor the effects on CKD mineral and bone disorders (MBD) are clearly established. Study Design: Cross-sectional analysis of baseline data from a prospective cohort, the NephroTest Study. Setting & Participants: 1,026 adult patients with all-stage CKD not on dialysis therapy or receiving vitamin D supplementation. Predictors: For part 1, measured GFR (mGFR) using 51Cr-EDTA renal clearance; for part 2, 25(OH)D deficiency at <15 ng/mL. Outcomes & Measurements: For part 1, 25(OH)D deficiency and several circulating MBD markers; for part 2, circulating MBD markers. Results: For part 1, the prevalence of 25(OH)D deficiency was associated inversely with mGFR, ranging from 28%-51% for mGFR <60-<15 mL/min/1.73 m 2. It was higher in patients of African origin; those with obesity, diabetes, hypertension, macroalbuminuria, and hypoalbuminemia; and during winter. After adjusting for these factors, ORs for 25(OH)D deficiency increased from 1.4 (95% CI, 0.9-2.3) to 1.4 (95% CI, 0.9-2.1), 1.7 (95% CI, 1.1-2.7), and 1.9 (95% CI, 1.1-3.6) as mGFR decreased from 45-59 to 30-44, 15-29, and <15 (reference, <60) mL/min/1.73 m 2 (P for trend = 0.02). For part 2, 25(OH)D deficiency was associated with higher age-, sex-, and mGFR-adjusted ORs of ionized calcium level <1.10 mmol/L (2.6; 95% CI, 1.2-5.9), 1,25 dihydroxyvitamin D concentration <16.7 pg/mL (1.8; 95% CI, 1.3-2.4), hyperparathyroidism (1.8; 95% CI, 1.3-2.4), and serum C-terminal cross-linked collagen type I telopeptides concentration >1,000 pg/mL (1.6; 95% CI, 1.0-2.6). It was not associated with hyperphosphatemia (phosphate >1.38 mmol/L). Limitations: Cross-sectional analysis of the data prevents causal inferences. Conclusions: 25(OH)D deficiency is related independently to impaired mGFR. Both mGFR decrease and 25(OH)D deficiency are associated with abnormal levels of circulating MBD biomarkers. © 2011 National Kidney Foundation, Inc.

Li Cavoli G.,Nephrology Dialysis | Passantino R.,Pathologic Anatomy | Ferrantelli A.,Nephrology Dialysis | Tralongo A.,Nephrology Dialysis | And 6 more authors.
BioImpacts | Year: 2015

Introduction: The metabolic syndrome (MS) encompasses many metabolic abnormalities and the insulin resistance is considered as one of the most significant denominators. The chronic kidney disease (CKD) is an emerging health problem but only few patients would reach the end stage renal disease. There exists an increasing strong association between MS and CKD, but up until now the link between MS and CKD is unclear and there are few studies regarding the renal histology in MS. Methods: We describe an acute tubulointerstitial nephritis case, due to both infective and pharmacological aetiology, overlapping relevant histological changes (focal segmental glomerulosclerosis [FSG], hyaline arteriosclerosis) in a patient with MS and previously normal renal function. Despite the severe vascular finding (elevated renal arterial resistive index), the patient recovered a normal renal function. Results: We reviewed the kidney pathological studies in MS and analyzed the principal renal histological images of glomerulomegaly, segmental glomerulosclerosis, and obesity-related glomerulopathy. Conclusion: Despite the strong association, the renal involvement in MS has not been proven. A greater knowledge of the combination of histological renal changes in MS can help to understand the pathophysiological mechanism(s) of MS. © 2015 The Author(s).

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