Background/Aims: First-line immunosuppression with the B-cell depleting antibody rituximab reduced proteinuria and induced remission of the disease in patients with nephrotic syndrome (NS) secondary to idiopathic membranous nephropathy (IMN). Here we evaluated whether rituximab is equally effective in patients who failed to respond to previous immunosuppressive treatment. Methods: This academic, matched-cohort study, compared 2-year outcomes of 11 consecutive IMN patients who received second-line rituximab therapy for NS persisting or relapsing after previous treatment with steroids alone or combined with alkylating agents, cyclosporine, or immunoglobulin G, with those of 11 age- (±5 years), gender- and proteinuria- (±1 g/24h) matched reference patients given first-line rituximab therapy. Results: Patients’ and reference patients’ baseline characteristics were similar. Compared to baseline, 24-hour proteinuria similarly declined at 1 and 2 years post-rituximab (by 50.5 ± 25.1% and 60.9 ± 17.4% in patients and by 52.7 ± 31.5% and 69.4 ± 40.4% in reference patients, respectively; p < 0.01 for all comparisons vs. baseline). 8 patients and 7 reference patients achieved full (3 vs. 2) or partial (5 per cohort) proteinuria remission. Hypoalbuminemia and hyperlipidemia normalized in both groups. Self-limited infusion-related reactions occurred in 1 subject per cohort. Conclusion: Rituximab reduced proteinuria in IMN patients with no or only transientresponse to unselective immunosuppression as effectively and safely as in patients without previous immunosuppression.

The physiological processes occurring during adolescence, often so abrupt, threaten the permanence of the previously constructed sense of identity, questioning the patterns and representations that had governed the relations of the teenager with his body and with his relational systems. Although puberty is not only reduced to sexual transformations, definitions centered mainly on this aspect can be found in the literature. In fact, pubertal development is the acquisition disclosure index of adult reproductive capacity

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L'articolo propone una rassegna della letteratura relativa agli effetti a breve e lungo termine del divorzio coniugale sui figli adulti e giovani adulti. La ricerca internazionale relativa alle conseguenze del divorzio sul benessere psicologico dei figli ha spesso trascurato l'impatto che l'evento separativo e i cambiamenti ad esso connessi possono avere sulla vita e sulle scelte dei figli adulti. Il vissuto del sentirsi "intrappolati" nel conflitto coniugale sembra avere esiti a lungo termine e influenzare differentemente la relazione con il padre e con la madre. L'articolo, attraverso un'esemplificazione clinica, si concentra anche sulle conseguenze del divorzio sulla qualità delle relazioni di coppia dei figli adulti e propone alcune tipologie di intervento.