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Néphrologie & Thérapeutique

Philippe Gatault, Marc Hazzan, Dany Anglicheau, Bruno Moulin
Following the publication of the ministerial action plan setting goals for the next five years, we performed a survey regarding the human resources and work organizations in the French renal transplant centers (n=33) on behalf of French speaking society of nephrology dialysis and transplantation (SFNDT). While the renal transplantation activity has been raising last years, we describe that the most active centers frequently resorted to an on-site nephrology guard and a surgeon dedicated to the transplantation activity, whereas only eight centers have a non restricted access to an operating room...
August 25, 2018: Néphrologie & Thérapeutique
Charlotte Dumas De La Roque, Christian Combe, Claire Rigothier
Idiopathic nephrotic syndrome represents up to 30% of adult glomerulopathies. However, its prognosis according to remission, relapse and renal failure remains unchanged since the 80s and prediction remains difficult. Physiopathology of adult idiopathic nephrotic syndrome is complex and multifactorial, including immunologic and environmental factors and a putative permeability-circulating factor, still unknown. In this point of view, we propose to summarize actual knowledge about idiopathic minimal change disease and focal and segmental glomerulosclerosis physiopathology...
August 24, 2018: Néphrologie & Thérapeutique
Corentin Tanné, Pascal Roy, Émilie Frobert, Anita Duncan, Audrey Laurent, Pierre Cochat
Cytomegalovirus is common in adult recipients (prevalence of 40-90%). Children are typically seronegative but immunosuppression may prone to primary-infection or viral reactivation, with potentially severe consequences. CMV infection incidence in pediatric kidney transplant recipients has seldom been investigated. The aim of our study was to evaluate the incidence and timing of CMV infection during the first year after renal transplantation. We assembled a retrospective cohort of 136 children who had received a kidney transplant between 2003 and 2014 with a year follow-up...
June 7, 2018: Néphrologie & Thérapeutique
Thierry Petitclerc, François Gaillard
Setting dialysate sodium allows to adequately adjust sodium balance and plasma sodium at the end of dialysis session. In accordance with the set-point theory based on the concept of restoring cellular hydration, an adequate target for plasma sodium at the end of the session could be the value of predialysis plasma sodium concentration (isonatric hemodialysis). Some recently available dialysis monitors provide an on-line value of plasma-water conductivity usually converted in on-line natremia. There are different modalities of isonatric hemodialysis depending on whether the online value of natremia is used or not...
June 7, 2018: Néphrologie & Thérapeutique
Lola Sitruk, Cécile Couchoud, Maryvonne Hourmant, Philippe Tuppin, Marie-Alice Macher, Camille Legeai
The aim of this study was to describe the drug dispensing of maintenance immunosuppression treatment in 2014 for patients who received a kidney transplant in 2012, based on the data of the French national health insurance and to compare those results with the information collected in the national database for kidney recipients. For each patient, are considered all drugs dispensing with their dates of issue, the molecules and their presentations (number of pills and dosage). Among 2463 transplanted adults in 2012, 73% have received tacrolimus monohydrate, 59% mycophenolate mofetil, 54% prednisone and 20% cyclosporin in 2014...
June 7, 2018: Néphrologie & Thérapeutique
Claire Trivin-Avillach, Éric Thervet
Chronic kidney disease (CKD) is associated with significant infectious complications leading to adverse health outcomes. This increased susceptibility to infection can be related to the nephropathy itself as observed in nephrotic syndrome, to the treatment especially in situations requiring immunosuppressive drugs or related to dialysis. Despite a less effective response to vaccination, some data emphasize similar benefits from immunization among people with CKD to the general population. However, some situations encountered in nephrology require adaptation of immunization practices...
June 7, 2018: Néphrologie & Thérapeutique
Fateme Shamekhi Amiri
Subcellular organelles consist of smaller substructures called supramolecular assemblies and these in turn consist of macromolecules. Various subcellular organelles have critical functions that consist of genetic disorders of organelle biogenesis and several metabolic disturbances that occur during non-genetic diseases e.g. infection, intoxication and drug treatments. Mitochondrial damage can cause renal dysfunction as ischemic acute renal injury, chronic kidney disease progression. Moreover, mitochondrial dysfunction is an early event in aldosterone-induced podocyte injury and cardiovascular disease due to oxidative stress in chronic kidney disease...
June 7, 2018: Néphrologie & Thérapeutique
M Jalbert, A Mignot, A-S Gauchez, A-C Dobrokhotov, J Fourcade
INTRODUCTION: Hypercalcemia is not a rare event and can lead to severe consequences. Its main etiologies are primary hyperparathyroidism and neoplasic conditions. The iatrogenic etiology by vitamin D intoxication is more rarely found. CASE PRESENTATION: A 76-year-old finish woman comes to the emergency room for chest pain. Her medical history is impossible to specify due to the language barrier and initial confusion. She has severe hypercalcaemia (4.14mmol/L), renal insufficiency, cardiac arrhythmia later complicated by an ischemic cardiac episode...
June 2018: Néphrologie & Thérapeutique
Pablo Antonio Ureña-Torres, Mario Cozzolino, Jordi Bover
Secondary hyperparathyroidism (SHPT) is one of the most frequent and deleterious complication of chronic kidney disease (CKD). SHPT is also one of the principal components of the now called CKD-mineral and bone disorders (MBD) syndrome. It is usually prevented and treated by vitamin D derivatives. However, the rationale for the prescription of vitamin D sterols in those patients is still a matter of hotly debates, mainly because of unsatisfactory results from numerous observational and not well-controlled studies...
June 2018: Néphrologie & Thérapeutique
Philippe Tuppin, Antoine Bessou, Camille Legeai, Cécile Vigneau, Cécile Couchoud
The objective of this study was to describe the management of patients undergoing renal transplantation in 2013 and over the following two years on the basis of healthcare consumption data. The National Health Insurance Information System was used to identify 1876 general scheme beneficiaries undergoing a first isolated renal transplantation (median age: 53 years; men 63%). Overall, 1.2% of patients died during the transplantation hospital stay (>65 years 3.3%) and 87% of patients had a functional graft at 2 years...
June 2018: Néphrologie & Thérapeutique
Cherif Dial, Kwame Doh, Ibou Thiam, Mariam Faye, Gisèle Woto-Gaye
INTRODUCTION: Burkitt's lymphoma (BL) is an exceptional cause of acute renal failure (ARF). The origin of the tumor clone may be lymphoid follicles secondary to renal Epstein-Barr virus (EBV) infection. With the presentation of this clinical case, the pathogenesis, diagnostic criteria and evolution of this extremely rare affection will be discussed. OBSERVATION: A 4-year-old patient with a recent history of acute osteomyelitis of the right thigh presented an ARF without indications of post-infectious glomerulonephritis...
June 2018: Néphrologie & Thérapeutique
Benjamin Savenkoff, Fleuria Flechon-Meibody, Éric Goffin
Icodextrin is a glucose polymer derived from starch that is used as an osmotic agent in peritoneal dialysis. Its high molecular weight limits blood absorption and is useful for long dwell since there is few osmotic gradient dispersal. Its benefits are numerous: ltrafiltration optimization and better salt and water control especially in anuric patients with a high peritoneal permeability and also in case of infectious peritonitis, glucose sparing with less metabolic complications and a better preservation of peritoneal membrane, better biocompatibility...
June 2018: Néphrologie & Thérapeutique
Yves Dimitrov, Thierry Hannedouche, François Chantrel, Julien Ott, Marc Kribs, Alexandre Klein, Olivier Imhoff, Thierry Krummel
The relationship between specialist physician and primary care physician (PCP) has been poorly evaluated in France. We have studied the application of a specialist's recommendation by the PCP. Vaccination against hepatitis B in patients with chronic renal failure was the follow-up marker. After consultation, the nephrologist wrote in his report to the PCP that the vaccination was recommended. At the next nephrological consultation, the patient was asked if the PCP had proposed vaccination. The clinical, biological characteristics and history of the patients were recorded as well as number and location of the PCP consultations...
June 2018: Néphrologie & Thérapeutique
Philippe Chauveau, Catherine Lasseur, Céline Nodimar, Mathilde Prezelin-Reydit, Stanislas Trolonge, Christian Combe, Michel Aparicio
The acid production of endogenous origin depends mainly on the metabolism of the food and varies with the nature of these. Of the order of 1mEq/kg/day for contemporary food in industrialized countries, it is reduced by more than one third among vegetarians and close to neutrality among vegans. The dietary acid load is eliminated by the normal kidneys, thus maintaining the acid-base equilibrium. In the setting of CKD, it will overflow the capacities of the nephrons, generating a retention of H+ ions, promoting subclinical acidosis...
June 2018: Néphrologie & Thérapeutique
Jean-Philippe Bertocchio, Thierry Baranger, Myriam Isnard-Rouchon, Philippe Zaoui, Christiane Mousson, Gibert Deray
RATIONALE: The impact of chronic kidney disease (CKD) on vital impetus is poorly documented in patients not undergoing renal dialysis and discrepancies can be observed between patients and physicians in perception of QoL and impact of the disease. METHODS: A self-questionnaire was sent to 1282 French nephrologists and a mirrored self-questionnaire was given to patients (CKD stage 3, 4 or 5) by their nephrologist. Data were collected prospectively and anonymously...
June 2018: Néphrologie & Thérapeutique
Bayen Maalej, Mona Ben Amor, Manel Jallouli, Manel Weli, Mohamed Charfi, Yassine Abdelkefi, Olfa Chakroun, Khaoula Kamoun, Jamil Hachicha, Noureddine Rekik, Taher Gargah, Lamia Gargouri, Abdelmajid Mahfoudh
AIM: Post-streptococcal glomerulonephritis (PSGN) is a frequent cause of acute nephritis in children. This study aimed to describe the epidemiology, clinical characteristics and outcomes of PSGN and look for predictor's factors of severity. METHODS: A 12-year retrospective review of case notes and laboratory data was conducted at a department of pediatrics, pediatric emergency and intensive care, Hedi Chaker Hospital. RESULTS: One hundred seventy eight children were treated for PSGN with a mean age of 7...
May 4, 2018: Néphrologie & Thérapeutique
Tomek Kofman, Julie Oniszczuk, Philippe Lang, Philippe Grimbert, Vincent Audard
Recurrence of glomerular disease after renal transplantation is a frequent cause of graft loss. Incidence, risk factors and outcome of recurrence are widely due to the underlying glomerular disease. Graft biopsy analysis is required to confirm the definitive diagnosis of recurrence and to start an appropriate therapy that, in some cases, remains challenging to prevent graft failure. Increased use of protocol biopsy and recent advances in our understanding of the pathogenesis of some glomerular diseases with the identification of some relevant biomarkers provide a unique opportunity to initiate kidney-protective therapy at early stages of recurrence on the graft...
May 2018: Néphrologie & Thérapeutique
Hassan Izzedine
Drug-induced nephrotoxicity (DIN) remains a current problem with economic and medical consequences. It affects all nephron segments. Recovery of renal function is based on the identification of risk factors, early diagnosis of renal disease, rapid (if possible) cessation of the causative agent and, in some cases, adjunctive therapy. Prevention is based on identification of early markers of DIN, correction of risk factors, initial assessment of renal function for adequate dosage adjustment and exclusion of other nephrotoxic factors...
May 2018: Néphrologie & Thérapeutique
Monlet Cy Guei, Kouamé Hubert Yao, Delphine Amelie Lagou, Pessa Nawo Albert Coulibaly, Amidou Sawadogo, Mohamed Ibrahim Alex Moudachirou, Weu Melanie Tia, Serge Didier Konan, Sery Diopoh, Ibrahim Cherif, Kan Clément Ackoundou-N'Guessan, Dazé Appolinaire Gnionsahe
Purple urine-bag syndrome is a rare condition that occurs in patients with indwelling urinary catheters carried over a long period and frequently associated with a urinary tract infection. It is characterized by the appearance of a violet coloration of the probe and/or the urine collection bag. We report the first case in West Africa that occurred in a 47-year-old woman in uremic encephalopathy and carrier of a urinary catheter, which presented a violet color of the tubing and urine-bag associated with a urinary tract infection...
May 2018: Néphrologie & Thérapeutique
Imen Mezni, Pierre Galichon, Mohammed Mongi Bacha, Yi-Chun Xu-Dubois, Imen Sfar, David Buob, Sabrina Benbouzid, Rim Goucha, Yousr Gorgi, Ezzedine Abderrahim, Mondher Ounissi, Karine Dahan, Nacera Ouali, Alexandre Hertig, Isabelle Brocheriou, Aly Raies, Taieb Ben Abdallah, Éric Rondeau
Renal allograft loss is most often a chronic process, irrespective of the mechanism at stake. In this prospective study, we studied the expression of epithelial to mesenchymal transition (EMT) markers vimentin and β-catenin by immunohistochemistry in the surveillance biopsy and measured the mRNA encoding vimentin (VIM), CD45, GAPDH and uroplakin 1a (UPK) by quantitative PCR in urinary cells in 75 renal transplant patients. The aim is to establish a simple screening test for chronic renal allograft dysfunction...
May 2018: Néphrologie & Thérapeutique
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