Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
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The recent need for information has prompted this collaboration between health system epidemiologists (Basilicata) and clinicians to compare models of 'local' epidemiology in the management of diseases. The referral of patients to a nephrologist represents a working hypothesis of research- intervention. ⋯ While an improvement in health databases in the regions is underway, collaboration studies are essential for planning specific interventions for prevention and management of diabetic nephropathy to improve the use of resources in nephrology.
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Even though many organs may be involved and clinical manifestations are extremely variable, a sudden worsening of renal function after vascular surgery or invasive angiographic manoeuvres is a clue for the diagnosis of renal cholesterol crystal embolization. In rare cases the disease may also occur spontaneously during anticoagulant or thrombolytic therapy. Renal atheroembolism is becoming increasingly recognized as an important cause of renal failure particularly in elderly men, and is often associated with a bad outcome. To date there is no specific and proven useful treatment apart from a few anecdotal reports on the benefits of corticosteroids. ⋯ Despite the small number of patients studied, our experience suggests that corticosteroid treatment is an effective therapeutic option in cholesterol renal atheroembolic disease, especially in the more severe cases of acute renal failure.
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Rhabdomyolysis is known as one of the possible causes of acute renal failure and can be triggered by different situations. In recent years, Parkinson's disease emerged as a condition that can be complicated by the development of rhabdomyolysis and consequently, in some cases, of acute renal failure. We report two cases of rhabdomyolysis, one of which complicated by an oligo-anuric renal failure, which occurred in patients affected by Parkinson's disease and admitted to our Division. ⋯ Regarding the first case, the clinical conditions in which the patient was found, the simultaneous presence of fever and leukocytosis and the absence of any reasonable explanation for a hypothetical fall to the floor induced us to think that this was a case of rhabdomyolysis in the context of an akinetic hyperthermic crisis. This is a syndrome that can develop in Parkinsonian patients after discontinuance or simply reduction of therapy with dopaminergic agents and is characterized also by rhabdomyolysis. The fact that the patient was living alone would confirm this hypothesis. On the other hand, the second case of rhabdomyolysis must probably be related to the severe choreiform and dystonic movements that the patient developed in the days just prior to admission. These movements were surely caused by the increase of the substitutive therapy with Levodopa by the patient herself. In conclusion, these two clinical cases, together with others previously reported by other Authors, show how the circumstances leading to the development of acute episodes of rhabdomyolysis in Parkinson's disease can be different and, at the same time, how these circumstances are always somehow related to the treatment of the basic disease with dopaminergic drugs.