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Néphrologie & Thérapeutique

Bruno Moulin, Maryvonne Hourmant
No abstract text is available yet for this article.
February 11, 2019: Néphrologie & Thérapeutique
Quentin Raimbourg, Éric Daugas
Systemic lupus erythematosus is the most characteristic of auto-immune disorders that can lead to tissue damage in many organs, including kidney. Lupus nephritis occurs in 10 to 40% of lupus patients. Its clinical hallmark is the appearance of a proteinuria as soon as a 0.5 g/g or 0.5 g/d threshold, which calls for a renal histological evaluation in order to determine the lupus nephritis severity and the need for specific therapy. More than half of renal biopsies lead to the diagnosis of active lupus nephritis-class III or class IV A according to the ISN/RPS classification-that are the most severe in regards to renal prognosis and mortality...
February 7, 2019: Néphrologie & Thérapeutique
Jean-Rodolphe Mackanga, Nalia Dibambou, Emeline-Gracia Mouendou Mouloungui, Josaphat Iba-Ba, Ulrich Davy Kombila, Patrice-Emery Itoudi Bignoumba, Inès-Flore Maganga Moussavou, Landry Missounga, Jean-Baptiste Moussavou Kombila, Jean-Bruno Boguikouma
BACKGROUND: Acquired hyponatremia is a life threatening event. Intravenous infusion of a mixture of 5% glucose and sodium solute is mainly used, but its contribution in the occurrence of acquired hyponatremia in adult, is under-investigated outside intensive care unit. OBJECTIVE: To evaluate the place of intravenous infusion of a mixture of 5% glucose and sodium in predicting acquired hyponatremia in adult polyvalent medicine service. PATIENTS AND METHODS: A case-control study have been conducted...
February 1, 2019: Néphrologie & Thérapeutique
Mabel Aoun, Randa Tabbah
Beta-blockers have numerous indications in the general population and are strongly recommended in heart failure, post-myocardial infarction and arrhythmias. In hemodialysis patients, their use is based on weak evidence because of the lack of a sufficient number of randomized clinical trials. The strongest evidence is based on two trials. The first showed better survival with carvedilol in hemodialysis patients with four sessions per week and systolic heart failure. The second found reduced cardiovascular morbidity with atenolol compared to lisinopril in mostly black hypertensive hemodialysis patients...
February 1, 2019: Néphrologie & Thérapeutique
Serigne Gueye, Sidy Mouhamed Seck, Yaya Kane, Pierre-Olivier Tosi, Souad Dahri, Clément Kounde, Ilham Algouzmari, Anna Gouin, Étienne Ged, Asma Allal, Lionel Rostaing
Known in less than half a century, borreliosis, or Lyme disease, is a zoonosis caused by the tick bite. It is the most common vector disease in Europe and the United States. Borrelia burgdorferi sensu lato, the bacterium in question, is fitted with a "cunning device" that allows it to trick the immune system and implant the infection chronically. It causes multi-system tissue damage mediated by the inflammatory response of the host. Renal involvement is rarely reported and is better known in dogs as Lyme nephritis...
January 31, 2019: Néphrologie & Thérapeutique
Mathilde Fedi, Céline Falaise, Antoine Lanot, Clarissa Von Kotze, Thomas Robert, Léa Piétri, Patrick Henri, Nicolas Delmotte, Danielle Botta, David Verhelst, Hervé Chambost, Philippe Brunet, Noémie Jourde-Chiche
Hemophilia A is an X-linked genetic hemorrhagic disorder characterized by a factor VIII deficiency. The availability of secured substitution products has led to a dramatic improvement of life expectancy in hemophiliac patients. Nowadays, adult hemophiliac patients may develop Chronic Kidney Disease (CKD) resulting from age-related comorbidities (hypertension, obesity, diabetes). In addition, the high prevalence of viral infections in this population exposes patients to an increased risk of CKD. The risk of hemorrhage in hemophiliac patients is a challenge for their clinical management, both for diagnostic procedures (kidney biopsy in particular) and for renal replacement therapy (dialysis or renal transplantation) when it is needed...
January 16, 2019: Néphrologie & Thérapeutique
Haifa Ben Romdhane, Nadia Ben Fredj, Amel Chaabane, Sana Ben Aicha, Zohra Chadly, Najeh Ben Fadhel, Naceur Boughattas, Karim Aouam
BACKGROUND: Although the once-daily regimen of aminoglycosides (AG) is considered as predominantly used by many centers, the level of evidence of Therapeutic Drug Monitoring (TDM) of AG in cases of once-daily has not been clearly defined. The objective of this study is to evaluate the impact of TDM in achievement or maintaining target serum concentrations in patients receiving once-daily administration of AG. METHODS: We performed a retrospective analysis of data from patients having received a once daily amikacin or gentamicin and underwent routine TDM...
January 16, 2019: Néphrologie & Thérapeutique
Aude Servais
Besides its efficiency, lithium has a narrow therapeutic index and can result in considerable toxicity. Among the potential side effects, two types of renal toxicity are observed: a decreased renal concentrating ability and a chronic renal failure. Lithium-induced polyuria is frequent, estimated to affect up to 40% of patients, and develops usually early. It may be irreversible, especially if the treatment has been prescribed for more than 15 years. A chronic renal failure is observed in patients treated for more than 10 to 20 years...
January 15, 2019: Néphrologie & Thérapeutique
Claire Letournel, François Babinet, Bénédicte Allard, Vincent Montecot
OBJECTIVE: The "Centre Hospitalier Francois Dunan" is located on an isolated island and ensures patients care in hemodialysis thanks to telemedicine support. Many research studies have demonstrated the importance of hemodialysis fluids composition to reduce morbidity in patients on chronic hemodialysis. The aim of this study was to identify the risks inherent in the production of dialysis fluids in a particular context, in order to set up an improvement action plan to improve risk control on the production of dialysis fluids...
January 14, 2019: Néphrologie & Thérapeutique
Charles Chazot, Baya Fadel, Mimi Kareche, Olivier Puyoo, Guillaume Jean
INTRODUCTION: Despite a better management of hyperphosphatemia in haemodialysis patients observed during the past years, most of them remain insufficiently treated and exposed to bone and cardiovascular complications that are associated with this biological abnormality. The availability of calcium-free phosphate binders among therapeutical options is confirmed to significantly reduce serum phosphate levels without the risk of excess exposure to calcium. Currently sucroferric oxyhydroxyde (SO) is the only iron-based phosphate binder available in France...
January 10, 2019: Néphrologie & Thérapeutique
Julien Aniort, Anne-Élisabeth Heng, Patrice Deteix, Bertrand Souweine, Alexandre Lautrette
The acute renal failure is common in the hospitalized patients with the incidence is increasing. This results from the aging of the population and the widespread use of nephrotoxic therapies or diagnostic techniques. The acute renal failure is associated with an increased length of stay in hospital and the short and long-term mortality. The most common histological injury is the acute tubular necrosis. Although the most of acute renal failure is recovering, recent works have shown that there is a strong association between an acute renal failure and the increased risk of developing a chronic kidney disease...
January 10, 2019: Néphrologie & Thérapeutique
Franck Fumey, Edmond Benarrous, Laurine Souquet, Brigitte Rousset, Joachim Soares, Christine Oltra-Gay, Maurice Laville
The impairment of quality of life experienced by patients treated with chronic hemodialysis results from many factors, including the care environment. Current regulations have significantly improved reception and treatment conditions for patients, but perhaps insufficient attention has been paid to the noise nuisance associated with dialysis equipment. We therefore found it useful to conduct a study on acoustic parameters in the dialysis room, and to evaluate the effects on perceived quality of life of an acoustic treatment intended to reduce the level of ambient noise...
December 11, 2018: Néphrologie & Thérapeutique
Mathilde Treffel, Jacqueline Champigneulle, Fleuria Meibody, Emmanuelle Laurain, Luc Frimat, Hélène Busby-Venner
Extraintestinal manifestations in inflammatory bowel disease involve most frequently the joints, the skin, the eyes, the liver and the biliary tract. Renal involvement is rare, and manifested as nephrolithiasis, tubulointerstitial nephritis, glomerulonephritis and amyloidosis. In patients with inflammatory bowel disease, renal disease is most frequently due to treatment nephrotoxicity and rarely as a guenine extraintestinal manifestation of inflammatory bowel disease. We are reporting a case of tubulointerstitial nephritis as an extraintestinal manifestation of Crohn's disease and we are explaining the diagnostic difficulty to distinguish this from drug-induced nephrotoxicity...
November 29, 2018: Néphrologie & Thérapeutique
Morgane Commereuc, Frédérique Schortgen
Expansion of extracellular volume is a treatment traditionally proposed to correct abnormalities of renal perfusion and prevent ischemic injury. However, vascular filling is not at risk for tissue oxygenation and renal function. The use of synthetic colloids exposes the patient to the risk of developing lesions such as osmotic nephrosis. Hyperoncotic colloids reduce glomerular filtration pressure. The nephrotoxicity of hydroxyethyl starches is now clearly established regardless of their characteristics. Colloids have never demonstrated their superiority as plasma volume expanders, they should be abandoned in favour of crystalloid solutions...
December 2018: Néphrologie & Thérapeutique
Samuel Delma, Corinne Isnard-Bagnis, Gilbert Deray, Raphaël Nail Barthelemy, Lucile Mercadal, Geoffroy Desbuissons
BACKGROUND: Calciphylaxis or calcific uremic arteriolopathy (CUA) is a cutaneous disease with ulcerations secondary to calcification of cutaneous and subcutaneous small arteries and arterioles. It is a rare but severe disease with significant morbidity and mortality affecting 1 to 4% of dialysis patients. The circumstances of occurrence are multiple. CASE: We report the case of a severe bilateral lower limb calciphylaxis in a 69-year-old, obese, hemodialysis patient with a recent diagnosis of Graves' disease complicated with hypercalcemia and cardiac arrhythmia requiring the use of vitamin K antagonist...
December 2018: Néphrologie & Thérapeutique
Gabriel Choukroun, Bruno Moulin
The objective of this review is to illustrate the interests of registries in terms of clinical research, using practical examples from the French REIN registry. In addition to their interest in terms of observation and decision-making for public health, registries may also be used to compare structures, and to evaluate causality in clinical research. Indeed, even though randomized controlled trials are the gold standard to assess causality, they may be difficult to perform, with an applicability in daily life that remains to be demonstrated since patients are highly selected patients with a very close follow-up...
November 2018: Néphrologie & Thérapeutique
Thierry Hannedouche, Denis Fouque, Dominique Joly
Metabolic complications of chronic kidney disease (CKD) are frequent; the aims of this review are to present a 2018 update for hyperkalemia, hyperphosphatemia and anemia. Hyperkalemia is defined by a plasma level above 5.0 mmol/L, after ruling out pre-analytical problems such as hemolysis. It is frequent in CKD, most often due to drugs and notably renin/ angiotensin blockers. Chronic hyperkalemia is deleterious, with an increased risk of mortality. Therapeutic strategies to decrease the incidence and severity of hyperkalemia are therefore crucial in nephrology: experts recommend to maintain the renin/angiotensin blockers as long as possible, whilst associating diuretics and potassium binders...
November 2018: Néphrologie & Thérapeutique
Philippe Chauveau, Laurent Juillard, Thierry Lobbedez
Since a couple of years, a new paradigm of care has taken place where the patient plays a major role in the choice of his treatment. Patient information in a context where the doctor-patient relationship has drastically changed and where knowledge is continuously growing, is a challenge for the nephrologist. For the patient who decides to undergo home dialysis, numerous questions arise during the decision-making process. How should treatment alternatives be discussed with the patient? What are the current data available on the different methods? As comfort, quality of life and level of autonomy often drive the choice of care management, home dialysis can be promoted more with appropriate assistance from both the nephrologist and the healthcare team...
November 2018: Néphrologie & Thérapeutique
Thierry Petitclerc
The history of dialysis, which started only half a century ago, is rich in developments and technological innovations. Thanks to scientific progress and the development of knowledge in the field of dialysis, patient survival will continue to increase and quality of life will continue to improve. More precise purification, reductions in the size and weight of equipment as well as refinement of filtration membranes are a few of the recent and current breakthroughs, and are challenges for further development. Dialysis has a world of opportunities ahead in terms of optimizing processes and new innovations, continuing the progress made in improving patient treatment conditions...
November 2018: Néphrologie & Thérapeutique
Yawovi Mawufemo Tsevi, Selda Aydin, Patrick Durez, Laura Labriola
Drug-induced sarcoidosis-like disease is a rare, but not exceptional, side effect of anti-tumor necrosis factor (anti-TNF) agents. The organs most commonly involved are lungs, skin and lymph nodes. Kidney involvement is exceptional. Histology usually reveals non-caseating granulomas. Some of the biological features usually described in sarcoidosis are very infrequent in drug-induced granulomatosis. We report a case of sarcoid-like granulomatosis manifesting as life-threatening hypercalcemia and acute kidney injury in a woman treated with etanercept for a rheumatoid arthritis...
November 2018: Néphrologie & Thérapeutique
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