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Articles by P Ravani
Total Records ( 4 ) for P Ravani
  G Caridi , M Gigante , P Ravani , A Trivelli , G Barbano , F Scolari , M Dagnino , L Murer , C Murtas , A Edefonti , L Allegri , A Amore , R Coppo , F Emma , T De Palo , R Penza , L Gesualdo and G. M. Ghiggeri

Background and objectives: Mutations in nephrin (NPHS1) and podocin (NPHS2) genes represent a major cause of idiopathic nephrotic syndrome (NS) in children. It is not yet clear whether the presence of a single mutation acts as a modifier of the clinical course of NS.

Design, setting, participants, & measurements: We reviewed the clinical features of 40 patients with NS associated with heterozygous mutations or variants in NPHS1 (n = 7) or NPHS2 (n = 33). Long-term renal survival probabilities were compared with those of a concurrent cohort with idiopathic NS.

Results: Patients with a single mutation in NPHS1 received a diagnosis before those with potentially nongenetic NS and had a good response to therapies. Renal function was normal in all cases. For NPHS2, six patients had single heterozygous mutations, six had a p.P20L variant, and 21 had a p.R229Q variant. Age at diagnosis and the response to drugs were comparable in all NS subgroups. Overall, they had similar renal survival probabilities as non-NPHS1/NPHS2 cases (log-rank 2 0.84, P = 0.656) that decreased in presence of resistance to therapy (P < 0.001) and in cases with renal lesions of glomerulosclerosis and IgM deposition (P < 0.001). Cox regression confirmed that the only significant predictor of dialysis was resistance to therapy.

Conclusions: Our data indicate that single mutation or variant in NPHS1 and NPHS2 does not modify the outcome of primary NS. These patients should be treated following consolidated schemes and have good chances for a good long-term outcome.

  P Ravani , R Gaggi , C Rollino , M Santostefano , N Stabellini , L Colla , N Dallera , S Ravera , S Bove , P Faggiano and F. Scolari

Background and objectives: Atheroembolic renal disease (AERD) can require dialytic support. Because anticoagulation may trigger atheroembolization, peritoneal dialysis may be preferred to hemodialysis. However, the effect of dialysis modality on renal and patient outcomes in AERD is unknown.

Design, settings, participants, & measurements: A subcohort of 111 subjects who developed acute/subacute renal failure requiring dialysis was identified from a larger longitudinal study of AERD. The main exposure of interest was dialysis modality (peritoneal versus extracorporeal therapies). Logistic regression was used to study the probability of renal function recovery. Times from dialysis initiation to death were studied using Cox's regression.

Results: Eighty-six patients received hemodialysis and 25 received peritoneal dialysis. The probability of renal function recovery was similar by dialysis modality (25% among hemodialysis patients and 24% among peritoneal dialysis patients; P = 0.873). During follow-up, 58 patients died, 14 among peritoneal patients and 44 among hemodialysis patients (P = 0.705). In multivariable analysis, gastrointestinal tract involvement and use of statins maintained an independent effect on the risk of patient death.

Conclusions: This study does not support the notion that one dialysis modality is superior to the other. However, the observational nature of the data precludes any firm conclusions.

  P Ravani , P Parfrey , J MacRae , M James , R Quinn , F Malberti , G Brunori , S Mandolfo , M Tonelli , B Hemmelgarn , B Manns and B. Barrett

Background and objectives: Comparing outcomes of arteriovenous grafts and fistulas is challenging because the pathophysiology of access dysfunction and failure rate profiles differ by access type. Studying how risks vary over time may be important.

Design, setting, participants, & measurements: Longitudinal data from 535 incident hemodialysis patients were used to study the relationship between access type and access survival, without (semiparametric Cox modeling) and with specification of the underlying hazard function (parametric Weibull modeling).

Results: The hazard for failure of fistulas and grafts declined over time, becoming proportional only after 3 months from surgery, with a graft versus fistula hazard ratio of 3.2 (95% confidence interval 1.9 to 5.3; Cox and Weibull estimation) and time ratio of 0.11 (i.e., the estimated access survival time was approximately one tenth shorter in grafts; 95% confidence interval 0.04 to 0.28; Weibull estimation only). Considering the entire observation period, grafts had slower hazard decline (P < 0.001) with shorter median survival times than fistulas (8.4 versus 38.3 months; Weibull regression only).

Conclusions: Parametric models of arteriovenous access survival may provide relevant information about temporal risk profiles and predicted survival times.

  S Andrulli , A Turrin , M. C Bigi , P Ravani , A Trinchieri and F. Locatelli

The twinkling in colour Doppler images is created by a rapidly changing series of coloured horizontal bars that appear beyond the reflex surfaces. Spectral analyses show a typically rectangular time/velocity wave diagram, and an uncomfortably high-pitched audio signal saturates the echo system. The twinkling can be detected in the calcified areas of various tissues and is usually interpreted as an artefact; however, this report describes two cases suggesting that it may be valuable for the early diagnosis and follow-up of kidney stones. This observation may have important diagnostic, epidemiological and clinical implications.

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