‘Renal calculi as big as eggs’: urolithiasis and chronic kidney disease of Ludovico I, Marquis of Saluzzo (1406-1475)

The Marquisate of Saluzzo (Italy) was an important and independent territory from 1125 until 1548, but reached the period of greatest splendor under the Marquis Ludovico I Del Vasto in the 15th century. His health was troubled for several years by renal stones that led him to hire a famous Genoese surgeon, Battista da Rapallo, expert in ‘extracting renal calculi as big as eggs’. Despite medical treatments, the Marquis died in 1475 at the age of 69. His contemporaries had no doubt about the cause of death: Augustinian theologian Gabriele Buccio, in the funeral oration affirmed that the renal stones were fatal to Ludovico; also, historian Ludovico Della Chiesa in 1600 wrote that the Marquis ‘obiit ex renum calculo’. Considering that a document dated 1473 reported the salary of Battista, so two years before the death of Ludovico I, we can hypothesize that the etiology of death was a chronic disease rather than an acute illness. In particular, the urolithiasis can cause the chronic kidney disease, a pathology characterized by the progressive and irreversible loss of kidney function. This case represents the first paleopathographic diagnosis of the Medieval Del Vasto family.