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Objectives: A renal extracapsular hypoechoic rim was previously recognized and interpreted as a typical sonographic finding of renal failure. Subsequently it was hypothesized that the hypoechoic rim could be produced by a state of sodium retention and oedema caused by nephropathy but not necessarily associated with renal failure. In order to get this cleared we performed a retrospective analysis of 80 renal ultrasound examinations, carried out at our center, in 41 of which it was found a renal extracapsular hypoechoic rim. Materials and methods: For each patient we recorded the glomerular filtration rate, the diameters in the longitudinal axis, the resistive indexes and the cortical thickness of each kidney, the possible presence and thickness of the hypoechoic rim and yet the possible coexistence of diabetes mellitus, proteinuria and clinical signs of fluid overload as peripheral oedema, distended jugular veins, ascites, increased caliber and reduced respiratory excursion of the vena cava. Results: The F value calculated to assess the weight/influence on the hypoechoic rim of each of the variables showed as all variables, except the sex, significantly weighed on the hypoechoic rim although the greatest weight was reached by a glomerular filtration rate < 60 ml/min/1.73 m 2 and a renal cortical thickness between 7 and 12 mm. The hypoechoic rim was found only when cortical thickness was between 7 and 12 mm while it was absent if the cortical thickness was less than 7 or greater than 12 mm. We also found numerous cases of sidedness of the hypoechoic rim. Conclusions: It is our opinion that in case of unilateral finding of an hypoechoic rim, the association between the hypoechoic rim and the cortical thinning is consistent and therefore more accurate than the correlation between the presence of the hypoechoic rim and the reduction of the glomerular filtration rate.KEY WORDS: Renal ultrasonography; Renal extracapsular hypoechoic rim; Cortical thinning; Kidney failure; Retrospective analysis. interpreted renal extracapsular hypoechoic rim as an ultrasound finding exclusive of patients with renal impairment because they didn't find any trace of it in any of 172 kidney ultrasound scans performed in patients who had no clinical or laboratory signs of kidney failure. Subsequently Haddad et al. (2) by a series of only 9 patients advanced the hypothesis that the renal extracapsular hypoechoic rim could be constituted by a transudate that may occur in patients suffering from a state of sodium retention and oedema resulting from some form of nephropathy although not necessarily associated with renal impairment. However, Haddad et al. (2) observed the hypoechoic rim also in patients affected by parenchymal renal disease but without renal failure. In order to find more evidence to settle, if possible, this different interpretations we performed a retrospective analysis of 41 renal ultrasound examinations, carried out over the last six months at our center and reporting the presence of an unilateral or bilateral renal extracaps...

Patients undergoing hemodialysis often present with a reduced response to anti-hepatitis B virus (anti-HBV) vaccination. The soluble form of CD40 (sCD40) is elevated in hemodialysis patients and this has been shown to correlate with lack of response to anti-HBV vaccination. Due to its high molecular weight, conventional dialyzers cannot clear sCD40. Previous studies have demonstrated, that dialysis membranes in polymethylmethacrylate (PMMA) can reduce the levels of sCD40. We have studied the effect of dialysis with PMMA membranes in patients who were non-responders to anti-HBV vaccination after a complete cycle of vaccinations. Interestingly, we found that significantly more patients in the PMMA group were able to mount a response to vaccination, compared to the control group (P = 0.04). Materials and Methods PatientsPatients were included in this study if they had been on maintenance thrice-weekly dialysis treatment and had undergone at least one complete cycle of anti-hepatitis B virus vaccination (20 mg Fendrix, administered at 0, 1, 2 and 6 months) and were non-responders (e.g. anti-HBV antibody titre <10 UI/L). Patients were excluded from this study if they had undergone dialysis treatment with PMMA dialyzers prior to enrolment and/or if they had active neoplasia. All patients gave their informed consent to participate in the study. Following enrolment, patients were randomized into two groups, a control group that continued on the same dialysis treatment as previously, and a treatment group that was shifted to dialysis with PMMA series BK-F (1.3 to 2.1 m 2 ). The treatment with PMMA continued until after the administration of the fourth vaccination. Patients underwent thrice-weekly dialysis for three months and were then administered the fourth vaccination dose. Immune response was evaluated hereafter. Laboratory parametersSerum levels of sCD40 were measured every four weeks by enzyme-linked immunosorbent assay (ELISA) during the 12 weeks of study and again 4 weeks after anti-hepatitis B virus vaccination. ELISA was performed essentially as described by Contin et al.[2], all samples were measured in duplicates and the mean concentration was calculated. Blood urea nitrogen (BUN) concentrations, Kt/V and C-reactive protein (CRP) were evaluated every four weeks.

calculi, hypercalciuria, bone loss and fractures [10]. In any case, nephrolithiasis, the aspect that concerns us here, is the most common complication of PHPT, occurring in 15-20% of patients with the hypercalcemic form [11] and even the normocalcemic form seems burdened with a similar high prevalence of nephrolithiasis (18.2% according to Amaral et al.) [12]. Subclinical nephrolithiasis has also been described in patients with the asymptomatic form, and indeed subclinical nephrocalcinosis and nephrolithiasis are

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