Papers by Giuseppe Cannella
PubMed, Jul 1, 2002
The high prevalence of left ventricular hypertrophy (LVH) among hemodialysis patients may be a co... more The high prevalence of left ventricular hypertrophy (LVH) among hemodialysis patients may be a consequence of inadequate diagnosis and treatment of arterial hypertension (AH). AH is not adaquately controlled in hemodialysis patients probably due to an underestimation of the effective BP load due to the unreliability of clinical BP readings in this population. Furthermore, BP reduction induced by dialysis ultrafiltration is not an acceptable criterion for discontinuing antihypertensive therapy, particularly when LVH coexists. Indeed, the few available interventional studies have demonstrated that strict BP control, together with anemia correction and dialysis adequacy improvement, can induce significant regression of the LVH of hemodialysis patients. Moreover, the decrease of SBP, particularly as a result of ACE-inhibitor therapy, is the most important predictor of LVH regression. Finally the use of ABPM and of echocardiography are recommended for correctly detecting an underlying AH and for tailoring and monitoring the effectiveness of antihypertensive therapy in dialysis patients with LVH.
PubMed, Oct 19, 2006
Therapy with i.v. calcitriol (CLT), that had been the mainstay of the cure of severe secondary hy... more Therapy with i.v. calcitriol (CLT), that had been the mainstay of the cure of severe secondary hyperparathyroidism (SHPT) for many years, is often hindered by the occurrence of hypercalcemia, that requires discontinuation of the drug with consequent rebounding of the parathyroid hormone (PTH) oversecretion. To circumvent this shortcoming, CLT-analogs with less calcemic effects with respect to CLT have been developed. One of these analogs, paracalcitol (PCLT), proved to be at least as powerful as CLT in decreasing serum PTH, but it still remains endowed with some calcemic effect as the parent compound. Meanwhile, calcimimetics (CaMs) drugs targeting the calcium-sensing receptors on the PTG, have been marketed woldwide. Cinacalcet (CNC) is a CaM endowed with the unique prerogative to significantly decrease serum PTH while also decreasing serum calcium. Thus, one may attempt to speculate that CaMs may completely replace vitamin D derivatives from the therapeutic arena. Uremic patients, however, suffer from severe deprivation of biological vitamin D effects, that puts them in need of highly dosed vitamin D in order to both ameliorate their bone status and to preserve their general and cardiovascular health. Thus, a combination therapy with PCLT, which has a significant patient-survival advantage over CLT, and CNC seems to be more appropriate than only-one-drug based therapy for SHPT. Such a combination will hopefully result in a better control of SHPT, avoidance of cumbersome hypercalcemia and higher life expectancy for uremic patients than ever before.
European Journal of Clinical Pharmacology, May 1, 1983
To evaluate the role of adrenergic mechanisms in the acute response of renin to furosemide, plasm... more To evaluate the role of adrenergic mechanisms in the acute response of renin to furosemide, plasma renin activity (PRA) and plasma catecholamine concentrations were measured for 3 h after i.v. administration of furosemide 1 mg/kg to 8 patients with mild essential hypertension. Furosemide induced a prompt and long-lasting increase in renin, with PRA more than doubled at all times. The increase in PRA within the first 30 rain paralleled the peak increases in urinary water and sodium flow rates, and significant decreases in plasma volume and central venous pressure. There was no change in plasma catecholamine concentrations. Plasma noradrenaline was increased significantly at 60 min and adrenaline at 90 rain, once furosemide had induced a marked loss of body-fluid and-65% decrease in central venous pressure. Both catecholamines remained elevated until the end of the study, whereas urinary water and sodium flow rates had returned to their pre-treatment values by 150 min. Mean blood pressure was essentially unchanged throughout the study, whereas heart rate increased significantly after 90 min. The findings suggest that in mildly hypertensive patients adrenergic mechanisms are not involved in the initial renin response to furosemide, but they come into play later, probably as a result of reflex sympathetic activation triggered by marked volume depletion.
http://isrctn.org/>, Jan 18, 2013
http://isrctn.org/>, Jan 21, 2013
Nephrology Dialysis Transplantation, Mar 1, 1996
The reasons for failure of phosphate control in uremic taken have been recently reviewed [1-4]. B... more The reasons for failure of phosphate control in uremic taken have been recently reviewed [1-4]. Briefly, what patients and the therapeutic interventions that can be
PubMed, Nov 1, 1990
14 cases of transplant glomerulopathy have been observed in 254 specimen taken from 152 renal all... more 14 cases of transplant glomerulopathy have been observed in 254 specimen taken from 152 renal allografted patients. Lesions have been studied at light, immunofluorescence and ultrastructural level. Following morphological parameters have been evaluated by semiquantitative method: focal mesangial sclerosis, mesangial matrix, mesangial cellularity, glomerular basement membrane thickening, double contours and crescents. Intermediate and advanced stages prevailed with the evidence of capillary aneurysms in 2 out 14 cases. Electron microscopy showed thickening of the glomerular basement membrane with finely lamellar and electron lucent thickening of the lamina rara interna. Transplant glomerulopathy lesions need differential diagnosis with thrombotic microangiopathy and can be considered equivalent of chronic vascular rejection.
American Journal of Noninvasive Cardiology, 1990
To evaluate the extent to which opposing changes in circulating blood volume might influence atri... more To evaluate the extent to which opposing changes in circulating blood volume might influence atrial dimensions and left ventricular performance, 11 dialyzed uremic patients with normal baseline left ventricular contractile indices were studied immediately before and after body fluid removal by ultrafiltration and again when they had returned to their original fluid-overloaded state (48 h later). Atrial and left ventricular dimensions were measured by two-dimensional echocardiography, and total blood volume by 131 I-labelled serum albumin, on every occasion
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
A novel lymphoproliferative disorder producing plasma cell expansion in the affected organ with f... more A novel lymphoproliferative disorder producing plasma cell expansion in the affected organ with fibrotic or sclerosing changes, known as ''IgG4-related disease'', was defined in Japan by Umehara's group in 2010. We present the first case reported in Italy. In 2007, a 63-year-old man presented with epigastric pain and elevated serum lipase levels. Computed tomography of the abdomen revealed a Kuttner's tumor of the pancreas. The patient underwent a biliary-enteric anastomosis, and biopsy of the pancreas revealed massive infiltration of lymphocytes and plasma cells. The patient was diagnosed with chronic sclerosing pancreatitis. After one year, he began to show signs of sicca syndrome and at the same time developed progressive renal failure. Immunological tests revealed hypocomplementemia, and the renal biopsy specimen showed diffuse interstitial inflammation. The infiltrate was composed of lymphocytes, while infiltrating plasma cells showed immunoreactivity to...
Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
Giornale italiano di cardiologia, 1990
Cytogenetic and Genome Research, 1982
Canadian Journal of Physiology and Pharmacology, 1987
Three types of antihuman atrial natriuretic peptide antiserum were obtained. From the study of cr... more Three types of antihuman atrial natriuretic peptide antiserum were obtained. From the study of cross-reactivity to human atrial natriuretic peptide fragments, it was suggested that antisera-1, -2, and -3 are mostly specific to 1–28, 5–25, and the ring structure, respectively. The estimated values of this hormone were significantly lower in the order of antisera-1, -2, and -3. Moreover, high performance liquid chromatographic study showed that various types of fragments of atrial natriuretic peptide exist in human plasma. These findings suggested that the highly specific antiserum to 1–28 human atrial natriuretic peptide such as antiserum-1 should be used to estimate the 1–28 human atrial natriuretic peptide levels in human plasma. From the study by using antiserum-1, it was concluded that the plasma human atrial natriuretic peptide increased in essential hypertensives, and in patients with primary aldosteronism, chronic renal failure, and malignant hypertension. Regarding the pathop...
Clinical journal of the American Society of Nephrology : CJASN, Jan 20, 2015
The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but... more The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older (≥65 years, n=1005) and younger (<65 years, n=2878) patients. Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified. Older patients had higher baseline prevalence of diabetes mellitus and CV comorbidity. Annualized rat...
Nephrology Dialysis Transplantation, 1996
Journal of The American Society of Nephrology, Apr 1, 2006
The partial correction of ESRD anemia by recombinant human erythropoietin (EPO) has resulted both... more The partial correction of ESRD anemia by recombinant human erythropoietin (EPO) has resulted both in generalized improvement in quality of life and physical activity and in reduced mortality and hospitalization rate. The question remains as to whether normalizing hemoglobin (Hgb) is desirable in patients with chronic kidney disease (CKD). This review provides an analysis and commentary on the available reports and, for the most part, randomized, controlled trials on the topic. In dialysis patients, normalization of Hgb is associated with improved quality of life and exercise capacity but not with reduced mortality and hospitalization rate. Moreover, no significant changes in the degree of left ventricular hypertrophy have been demonstrated. By contrast, an increased mortality rate has been reported for hemodialysis patients with overt cardiovascular disease (CVD) when randomly assigned to normal hematocrit by EPO. Data regarding patients who have CKD but are not yet on renal replacement therapy are scarce, and the effects of EPO on renal disease progression require further elucidation through controlled trials. The conclusion that can be drawn from the available studies is that Hgb >11 g/dl is the minimum required to achieve improved quality of life in patients with CKD, whereas values >12 g/dl are not recommended for patients with overt CVD. Finally, Hgb normalization might reasonably be restricted to a selected population of younger, employed, and active individuals, provided that they do not have CVD.
American Journal of Kidney Diseases, Oct 1, 2002
In addition to the absolute magnitude of left ventricular (LV) mass (LVM), the geometric pattern ... more In addition to the absolute magnitude of left ventricular (LV) mass (LVM), the geometric pattern of the left ventricle might help explain the different tendency toward LV hypertrophy (LVH) regression seen under effective therapy in chronic hemodialysis patients. Forty-five hemodialyzed uremic subjects, 17 patients with concentric LVH and 28 patients with eccentric LVH, were followed up with yearly echocardiography over 3 years while on monotherapy with angiotensin-converting enzyme (ACE) inhibitors. Predialysis blood pressure (BP) and percentage of interdialytic weight gain recorded during the month the echocardiographic study was performed were retrieved and averaged. Any adverse cardiovascular events occurring during the 3-year follow-up period also were recorded. Significant regression of LVH (P = 0.0028) was observed in the group as a whole during the 3 years on ACE-inhibitor therapy, mainly accounted for by a reduction in pulse pressure (PP; r = 0.45; P = 0.0017). After subgrouping patients according to LV geometry, an LVM reduction was observed only in the 17 patients with concentric LVH (P = 0.0003), whereas no difference was detected in subjects with eccentric LVH despite the same degree of BP reduction and hemoglobin level and Kt/V increases in both groups. Moreover, a greater incidence of cardiovascular events was observed in patients with eccentric LVH than in those with concentric LVH during the 3-year follow-up period. The most important finding of this study is that eccentric LVH seems to be less responsive to ACE-inhibitor treatment and is associated with a greater incidence of adverse cardiovascular events compared with concentric LVH. Furthermore, the decrease in PP appears to be the main predictor of LVH regression in chronic hemodialysis patients on ACE-inhibitor therapy.
Kidney International, Oct 1, 1993
ABSTRACT There have been no studies of the possibility of reversing the left ventricular hypertro... more ABSTRACT There have been no studies of the possibility of reversing the left ventricular hypertrophy (LVH) of chronically hemodialyzed hypertensive uremics (HDH) with long-term antihypertensive therapy. We have measured left ventricular sizes of eight (6 male, 2 female, aged 29 to 61 years) HDH with M-mode echocardiography, before and 12, 18 and 24 months after the start of a combined antihypertensive therapy which included ACE-inhibitors, beta-blockers and calcium-antagonists. Pre-treatment values for mean blood pressure (MBP), 116.6 +/- 2.9 mm Hg, end diastolic diameter (EDD), 62.6 +/- 6.6 mm, interventricular septum (IVS), 14.2 +/- 3.0 mm, and left ventricular mass index (LVMi), 239 +/- 61 g/m2, were all significantly higher than those for nine sex- and age-matched hemodialyzed normotensive subjects (HDN) with comparable hemoglobin (Hb) levels. During the antihypertensive treatment, both the systolic and diastolic BP decreased steadily (P = 0.0001; P = 0.0003; ANOVA) and significantly by the third month (P &lt; 0.05; P &lt; 0.01), reaching levels comparable to those of the HDN group after 12 months. At this time the LVMi (204 +/- 67) and the IVS (13.1 +/- 2.7), although both significantly lower than baseline, were still higher than in the HDN group, while the EDD was similar. After 24 months, however, both the IVS (12.3 +/- 3.1) and the LVMi (161 +/- 65) were no longer different from those of the HDN group.(ABSTRACT TRUNCATED AT 250 WORDS)
International Journal of Artificial Organs, Jul 1, 1998
According to the U.S. Renal Data System (1) and to the EDTA registry, cardiac deaths account for ... more According to the U.S. Renal Data System (1) and to the EDTA registry, cardiac deaths account for nearly 50% of all deaths in the dialysis population (2). This figure has changed very little in the past years despite the amazing decrease in cardiovascular mortality occurring in the general non-uremic population in that time, so that the actual incidence of cardiovascular death in uremics is up to twenty times higher than in non-uremic subjects. What are the reasons for this grim situation? Definitive answers to this question would have a tremendous clinical impact. However, while waiting for the answer, an in-depth analysis concerning the causes of this potentially fatal disease would help us to better understand why its severity has remained so surprisingly dismal.
Uploads
Papers by Giuseppe Cannella