“It is a silent organ that gives no signal”. In 2021, 20 received a transplant

John Mosconi – new director of the Department of Specialized Medicine in Forlì and Cesena, which includes the operating units of endocrinology and metabolic diseases, gastroenterology and digestive endoscopy, infectious diseases and nephrology of the “Morgagni-Pierantoni” and “Bufalini” hospitals of Cesena and Mercurial Hospital Pneumology – is director of the Nephrology and Dialysis Unit in Forlì and Cesena. Nephrology is a branch of internal medicine characterized by multiple aspects of care that evolve according to the degree of functional impairment and the characteristics of the person being treated.

Kidney disease, which affects about 10% of the population, often causes no symptoms. And it is only when the kidneys are not working properly that it is possible to realize that something is wrong and that something needs to be done. “Chronic kidney disease is on the increase in Italy and in the world as an expression of the complication of other diseases, such as diabetes, arterial hypertension and cardiovascular diseases – begins Dr. Mosconi -. The kidney is progressively affected, with signs of progressive renal insufficiency. Great attention must therefore be paid to these populations at risk”.

In the most serious cases, integrated dialysis and transplant programs are therefore important, allowing full social and professional reintegration. “It is important to underline, in other contexts, the importance of the specialized branch which concerns the management of patients with acute problems for different causes, such as acute renal failure, who can benefit from treatment temporary artificial replacement by dialysis to return, once the pathology at the origin of the functional impairment has been cured, to a normal life”.

Doctor Mosconi, how does the kidney communicate the onset of a problem?
The kidneys are unfortunately often silent organs with few symptoms. Apart from cases that can be shared with urology, such as renal colic and stones, the kidney hardly shows any striking signs of trouble. In fact, advanced renal failure is often identified in patients who have been asymptomatic for many years. Sometimes leg swelling can occur due to problems with protein loss or an inability to eliminate fluid overload.

How is kidney behavior monitored?
Kidney function is assessed by measuring plasma creatinine and calculating glomerular filtration volume. An important screening test is that of the urine, in particular the evaluation of proteinuria which is a pathological element. The extent of proteinuria is correlated with the possible evolution of renal damage. When there is kidney disease, it is necessary to identify its functional level, studying the possible biochemical alterations that kidney disease involves in its evolution.

Does kidney disease have any distinctions?
Acute can affect any age group, chronic usually occurs in elderly patients and is classified into five stages. Up to “stage 4” it is oligo-symptomatic, but significant alterations such as anemia and calcium-phosphorus balance can still be determined in the body, which can then affect the patient’s life.

Which categories are most at risk?
Dysmetabolic, diabetic, cardiovascular and hypertensive patients. To these must be added all those who suffer from systemic diseases, in particular immunological, which can affect organisms at any age, such as lupus. In addition, the nephrologist’s attention should also be directed to families predisposed to the transmission of genetic diseases, for example, adult polycystic kidney.

What are the therapies?
The therapeutic path is evaluated according to the degree of renal insufficiency. Initially, there is a collaborative relationship between general practitioner and nephrologist, based on a shared and structured diagnostic and therapeutic assistance pathway. In the initial phases, the nephrologist offers therapeutic treatment and the general practitioner adapts the problems to the existing problems. Shared management from the initial stages has slowed the progression of kidney damage to the most advanced forms through the use of antiproteinurics, diet, optimal control of risk factors ( pressure, glycemic and lipid control). As the renal damage progresses, the patient is taken care of by the nephrology and dialysis structures, which follow the functional evolution and identify, if necessary, the possible possibilities of artificial substitution treatment. in the most advanced phases (hemodialysis, peritoneal dialysis and kidney transplantation). ).

Some figures of the activity of your operational unit?
On average, 7 to 8,000 nephrology visits are performed per year. Patients with more advanced renal insufficiency who have a clinical picture that can be treated with medical treatment and who still do not need dialysis are 250 between Forlì and Cesena. On the other hand, about 290 patients are currently on dialysis, while in the whole territory of Ausl Romagna there are about a thousand with a prevalence of 700 to 800 patients per million inhabitants. Also in the region of Forlì and Cesena, there are more than 200 patients followed on an outpatient basis who are living thanks to a transplant with normal kidney function.

How many new cases per year require dialysis treatment?
Every year it can be estimated that in Romagna around 200 to 220 patients may need to start dialysis treatment, in practice 160 to 175 new patients per million inhabitants.

How many have received a transplant in the past year?
In 2021, 20 patients from our province of Forlì-Cesena underwent kidney transplantation in one of the Italian transplant sites, most of them in Bologna. Five of them received a kidney from a living donor. We are very satisfied with these figures obtained thanks to intense patient preparation work by the doctors and nurses in the operating room. It is the nephrologies of the territory like ours that establish the transplant programs, study the patients then send them to the transplant sites for the final judgment of suitability, registration on the waiting lists of donors of cadavers or feasibility of living programs, when there are potential donors. In our operating room, 42 people are currently being treated with dialysis on the waiting list for transplant sites. These figures should be compared to national data; in Italy there are around 6,500 people waiting for a transplant compared to a transplant activity of around 2,000 operations per year.

How to prevent kidney disease?
Kidney diseases, as I mentioned earlier, are frequent in patients with other pathologies, so the first activity concerns the annual control and screening of people suffering from diabetes, hypertension and cardiovascular problems (not to mention to name just a few, editor’s note). An important element is to follow a correct lifestyle, trying to be as less sedentary as possible and avoiding dietary errors, in particular an excess of salt. When we talk about prevention, we must also avoid taking medication, if they are not recommended and prescribed, avoid protein supplements and potentially toxic substances such as certain painkillers which are not strictly indicated. This concept also applies to young people.

Nutrition advice?
Nutrition is defined by the degree of renal failure. When kidney failure occurs, the diet we prescribe is generally normocaloric and progressively lower in animal protein. The amount of protein is reduced through foods such as starches, pasta, and bread, supplemented with a-protein products, with a low protein count inside. It is important to maintain the correct caloric load in order to avoid malnutrition. In practice, in chronic renal failure, from stage 3, we tend to prescribe a low-protein diet.

And the water consumption?
Basically, there is the concept that the kidney needs water, especially during periods of increased sweating and physical exertion. In healthy subjects, it is recommended to drink at least 1.5 liters of water a day, always remembering the importance of fruits and vegetables which are foods rich in water.

What about kidney disease?
Water intake should be modulated according to renal function and excretion capacity. In case of comorbidities, such as heart failure, fluid intake should be limited. The dialysis patient, for example, must avoid an excess of liquids because diuresis is practically absent; the amount of water accumulates in the body and must then be artificially eliminated by dialysis.

Risk of death?
In a patient with renal insufficiency, the risk of death from cardiovascular disease gradually increases as renal function is impaired, up to ten times higher than that of the general population.


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