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Nephrology Dialysis Transplantation, Volume 38, Issue Supplement_1, June 2023, gfad063d_5129,
Published: 14 June 2023


Background and Aims

We know that lung and kidney are intimately related from a functional standpoint, both in physiological conditions and in diseases. The close relationship between lung and kidney (kidney-lung link) is evidence of a homeostatic connection between all organs and systems in an attempt to maintain the body system balance. In a recent review [1] we emphasized the importance to search for the clinical signs of a disease not only in the primary affected organ but also in organ functionally related.


For this purpose we examined 81 hemodialyzed patients, with a mean age of 66.6 ± 13 years (28 f and 53 M), undergoing hemodialysis treatment (mean dialysis: 96 ± 34 months), with regard to smoking habits (47 non-smokers and 34 smokers with an average of 19.8 cigarettes per day: pack / years: 33.4 ± 2.9). Pulmonary function test (PFT) and clinical signs were evaluated. we excluded 6 patients (4 males and 2 females) in the smoking group with obstructive spirometric pattern (detected by a FEV1.0/FVC ratio lower than 70 absolute value), so that the final non-smoking group consisted of 47 patients and the smoking-group by 28 smokers: both groups matched for anthropomorphic data.


The mean values of PFT were globally no different between smokers with normal PFT and non smokers are summarized in Table 1: Although the never-smoking group was nearly twice as large as the smokers, and PFT were similar and normal, respiratory symptoms were predominant: daily cough (49 yes; 26 no); chronic phlegm (51 yes; 24 no).


in dialysis patients, cough and phlegm are common symptoms, regardless of smoking and spirometric values. Probably these results are the consequence of synergistic effects between lungs and kidneys, as recently demonstrated [2]. Hence the need to evaluate dialysis patients from the clinical-functional point of view of both, kidneys and lungs, in order to evaluate the appropriate, personalized, therapeutic strategy according to the last evidences of the literature [3].


1. Satta E et al. Kidney and lung in pathology: mechanisms and clinical implications. Multidiscip Respir Med. 2022 17(2):819.
2. Polverino F et al. A pilot study linking endothelial injury in lungs and kidneys in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017 195(11):1464–76.
3. Polverino F et al. Metformin: experimental and clinical evidence for a potential role in emphysema treatment. Am J Respir Crit Care Med. 2021 204(6):651–66.

Lipodystrophies from Insulin Injection: An Update of the Italian Consensus Statement of AMD-OSDI Study Group on Injection Technique

by Sandro Gentile 1,2,*ORCID, Ersilia Satta 1, Giuseppina Guarino 1,2 and Felice Strollo 3 ORCID on behalf of the AMD-OSDI Study Group on Injection Technique


The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how to prevent them and minimize their effects, thus contributing to complete rehabilitation. Experts and scientific societies have produced consensus documents and recommendations to spread the culture of LH and its complications among clinicians. However, they should go deeper into LH detection methods. This short article analyzes the recent literature on the best way to explore and find more or less evident LH lesions by using a structured and validated clinical methodology to benefit the many clinicians without access to technological equipment such as ultrasonography. This text also aims to bring awareness that since the last published recommendations on injection techniques, new needles for insulin injection, more technologically advanced and suitable for specific populations, have come to market but still need a thorough evaluation.

1 Nefrocenter Research, 84013 Cava dè Tirreni, Italy
2 Department of Internal Medicine, Campania University “Luigi Vanvitelli”, 80138 Naples, Italy
3 Endocrinology and Diabetes Department, IRCCS, San Raffaele Pisana, 00163 Rome, Italy

*Author to whom correspondence should be addressed.
Diabetology 2023, 4(1), 119-127;

Insulin-induced lipohypertrophy and factors affecting it in children and adolescents with type 1 diabetes mellitus: Review of the literature from the past 12 years: An appraisal and extension to adult subjects

 Felice Strollo 1, Ersilia Satta 2, Luisa Borgia 4 and Sandro Gentile 2, 3, * 

1 Department of Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Via Val Cannuta, 247, I-00166, Italy.
2 Research Department of Nefrocenter Research, Via XXV Lulio 160, Cava de Tirreni, I-84013 (Salerno), Italy.
3 Department of Internal Medicine, Luigi Vanvitelli University of Campania, Via Pansini, 5 – I-80131 Naples, Italy.
4 Department of Life and Environmental Sciences, Marche Polytechnic University, Piazza Roma,22 I-60121 Ancon, Italy.



Our research group has dealt with injection-induced lip hypertrophy (IILH) in insulin-treated subjects for over a decade, focusing on causes and consequences, education, prevention and treatment, comorbidities, and related complications. Stimulated by an excellent Review that recently appeared on the pages of this Journal, we want to contribute insight into IILH. This brief Commentary underlines some key concepts on how to identify, prevent and cure them, pointing out salient aspects derived from our research to provide the scientific community with an as complete as possible overview of evidence-based knowledge and highlight the need for further experimental insights. 

Keywords: Diabetes mellitus; Insulin injection; Injection technique; Lipodystrophy; Lipohypertrophy 

World Journal of Advanced Research and Reviews, 2023, 17(01), 596–604 Article DOI: 

Insulin Injection-Related Skin Lipodystrophies: Blemish or Pathology?

Felice Strollo 1, Ersilia Satta 2 and Sandro Gentile 2,3,*

1 Endocrinology and Diabetes, IRCCS San Raffaele Pisana, I-00163 Rome, Italy
2 Nefrocenter Research & Nyx Start-Up, I-80030 Naples, Italy
3 Department of Internal Medicine, Luigi Vanvitelli University of Campania, I-50138 Naples, Italy

* Correspondence:



Abstract: The number of adult individuals with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. The main local complications of insulin injection are lipohypertrophies (LHs), i.e., subcutaneous nodules consisting of aggregates of macro-adipocytes and fibrin. These nodules result from errors repeatedly made by patients while injecting insulin. Despite being very common, LH lesions/nodules due to incorrect insulin injection techniques are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Identifying LHs is crucial, especially in elderly and frail subjects, because they may eventually result in poor diabetes control due to associated unpredictable insulin release patterns. Raising awareness of the adequate detection of LHs and their clinical consequences is crucial and urgent. A call to action is required on this topic at all levels of undergraduate and postgraduate education.

Keywords: diabetes; insulin; injection technique; lipohypertrophy