Nephrologie & Therapeutique最新文献

{"title":"Pathophysiology of ANCA vasculitis","authors":"Jean-François Augusto,&nbsp;Benoit Brilland","doi":"10.1684/ndt.2023.29","DOIUrl":"https://doi.org/10.1684/ndt.2023.29","url":null,"abstract":"<p><p>ANCA vasculitides (AAV) are autoimmune diseases responsible for damage to small-size vessels. Three entities are distinguished from clinical, histological and biological criteria: micropolyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). The neutrophil-ANCA couple is central to the pathophysiology of AAV. The mechanisms that lead to the breakdown of tolerance to myeloperoxidase or proteinase-3 remain hypothetical, however, probably multifactorial, occurring on a predisposing genetic background. The understanding of the injury mechanisms involved in AAV has made great progress thanks to the study of a murine model of immunization against myeloperoxidase. This work has made it possible to show the central role of the PNN in vivo, which are activated under sterile conditions, under the effect of the ANCAs which recognize the self-antigen expressed on their surface. Understanding the role of the alternative complement pathway and in particular that of C5a, a powerful anaphylatoxin, was a major advance. C5a acts as an amplifying factor for PNN activation and blocking its receptor (C5aR) prevents the occurrence of vasculitis lesions in the mouse model. These discoveries led to therapeutic trials in humans highlighting the interest of blocking C5aR and validating this therapeutic strategy. It should be emphasized that the AAV study model is, above all, an anti-MPO model and that the mechanisms involved in anti-PR3 ANCA or ANCA negative vasculitis remain very hypothetical. Finally, the mechanisms that account for the heterogeneity relating to the presentation or severity of AAV remain poorly understood.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 S1","pages":"1-9"},"PeriodicalIF":0.7,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10084381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive conservative care for the management of advanced chronic kidney disease: overview and perspectives","authors":"Aghiles Hamroun,&nbsp;François Glowacki","doi":"10.1684/ndt.2023.28","DOIUrl":"https://doi.org/10.1684/ndt.2023.28","url":null,"abstract":"<p><p>Comprehensive “conservative care” is defined as any active therapeutic procedure for the management of stage 5 chronic kidney disease without recourse to dialysis. This therapeutic option is discussed in elderly, frail patients whose anticipated life expectancy is reduced with dialysis. The decision for conservative management primarily relies on an informed choice by the patient and his caregivers. This holistic approach, focused on quality of life, requires a multidisciplinary approach. The goals are to slow the progression of kidney disease, prevent complications, anticipate the risks of decompensation, provide support for the patient and his caregivers to maintain the best possible quality of life at home. This article describes the principles of conservative management, highlights various barriers to this care pathway, and proposes potential solutions.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 S1","pages":"1-9"},"PeriodicalIF":0.7,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of immunology: immune response to vaccination and limits","authors":"Étienne Brochot","doi":"10.1684/ndt.2023.27","DOIUrl":"https://doi.org/10.1684/ndt.2023.27","url":null,"abstract":"<p><p>Advances over the past 50 years in the field of vaccination and the exploration of the immune response offer positive prospects for the prevention of infectious diseases. However, there is still a long way to go to improve the efficacy and safety of vaccination for transplant recipients or immunocompromised patients in the broad sense. In these populations, the benefit/risk balance of vaccination is even more pronounced in favor than that of the general population. Thus, consistently generating data in these populations is of great importance but can be disrupted by various human, technical and financial factors. In this text, we will attempt to describe some of these limitations for the immune response to vaccination and its exploration, especially in transplant recipients.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 S1","pages":"1-6"},"PeriodicalIF":0.7,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardio-renal syndrome: what’s new in 2023?","authors":"Valentin Maisons,&nbsp;Mouad Hamzaoui,&nbsp;Mélanie Hanoy,&nbsp;Théo Pezel,&nbsp;Dominique Guerrot,&nbsp;Dorian Nezam","doi":"10.1684/ndt.2023.15","DOIUrl":"https://doi.org/10.1684/ndt.2023.15","url":null,"abstract":"<p><p>Cardiac and renal pathologies lead to a high morbidity and mortality rate. The cardio-renal syndrome is characterized by the coexistence of renal and cardiac dysfunction and represents a polymorphic situation that is often complex to understand. This is a common occurrence that constitutes a real public health problem. In this review article, we propose to review the current state of knowledge on this syndrome by focusing on the main physiopathological, epidemiological, clinical and therapeutic aspects.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 2","pages":"121-138"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9926924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bee venom: an unusual cause of acute kidney injury","authors":"Aboubacar Sidiki Fofana,&nbsp;Magara Samaké,&nbsp;Seydou Sy,&nbsp;Sah Dit Baba Coulibaly,&nbsp;Abdoulaye Cissé,&nbsp;Moctar Coulibaly,&nbsp;Modi Sidibé,&nbsp;Bakary Sayon Keita,&nbsp;Hamadoun Yattara,&nbsp;Saharé Fongoro","doi":"10.1684/ndt.2023.19","DOIUrl":"https://doi.org/10.1684/ndt.2023.19","url":null,"abstract":"<p><strong>Introduction: </strong>Bee sting venom is generally well tolerated. However, some rare cases of massive stings can lead to anaphylactic shock and even renal failure. This observation is the illustration of a case of acute kidney injury secondary to bee stings in a 64-year-old black african subject.</p><p><strong>Case presentation: </strong>A 64-year-old man without a known medical history was referred to the emergency department of the Fousseyni Daou hospital in Kayes (Mali) for disturbed consciousness 4 hours after massive stings from a bee swarm. Renal failure with serum creatinine level at 752,2 µmol/L was documented on day 3 in a context of total anuria. The patient was transferred to a nephrology unit and biology confirmed renal failure associated with intravascular haemolysis and rhabdomyolysis. The kidneys were of normal size and well differentiated. The diagnosis of severe acute kidney injury due to massive envenomation induced by bee venom was evoked. The evolution was favourable, with normalization of renal function at D26 after 5 sessions of haemodialysis in parallel with transfusions of packed red blood cells.</p><p><strong>Conclusion: </strong>A massive bee attack should be considered a medical emergency because of the organic damage it can inflict. The renal prognosis depends on the number of stings, and especially on the delay and the quality of the treatment. Early initiation of dialysis treatment reduces mortality.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 2","pages":"139-144"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially inappropriate medications and anticholinergic and sedative burden in older community-dwelling patients with advanced chronic kidney disease","authors":"Maryline Jaffuel,&nbsp;Frederic Gervais,&nbsp;Julien Vernaudon,&nbsp;Marie-Anne Cerfon,&nbsp;Pierre Krolak-Salmon,&nbsp;Christelle Mouchoux,&nbsp;Teddy Novais","doi":"10.1684/ndt.2023.6","DOIUrl":"https://doi.org/10.1684/ndt.2023.6","url":null,"abstract":"<p><strong>Objective: </strong>Regarding older patients, multiple chronic conditions lead to the intake of multiple medications, involving a higher risk of adverse drug events. In older patients with advanced chronic kidney disease, the medication exposure was poorly explored. The aim of this study was to describe the use of potentially inappropriate medications and medications with anticholinergic and sedative properties in older community-dwelling patients with advanced chronic kidney disease.</p><p><strong>Methods: </strong>An observational study was conducted in a geriatric day-care unit. All patients aged over 65 years with advanced chronic kidney disease, defined by estimated glomerular filtration rate < 20 mL/min/1.73 m2 or estimated glomerular filtration rate > 20 mL/min/1.73 m2 with rapid progression, and referred by nephrologist for pretransplant comprehensive geriatric assessment, were included in the study. Potentially inappropriate medications were identified using the EU(7)-PIM list, and he anticholinergic and sedative drug exposure was measured using the Drug Burden Index.</p><p><strong>Results: </strong>Overall, 139 patients were included in the study (mean age 74.4 ± 3.3 years, 32.4% females, 61.9% on dialysis). Potentially inappropriate medications were used by 74.1% (103/139) of patients and were mainly represented by proton pump inhibitors, alpha-1-blockers and central antihypertensive drugs. Regarding anticholinergic and / or sedative medications, 79.9% (111/139) of older patients were exposed.</p><p><strong>Conclusion: </strong>In older community-dwelling patients with advanced chronic kidney disease, the prevalence of potentially inappropriate medication exposure and anticholinergic and sedative exposure was high. Interventions focusing on deprescription of these inappropriate medications should be conducted in this specific population.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 2","pages":"89-98"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9716953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney biopsy in subsaharan Africa","authors":"K J N'Dah,&nbsp;W M Tia,&nbsp;D A Lagou,&nbsp;M C Guei,&nbsp;A D Abouna,&nbsp;I Touré,&nbsp;K H Oka,&nbsp;Aar Kobenan,&nbsp;S Diopo,&nbsp;S Delma,&nbsp;I Cherif,&nbsp;E Amékoudi,&nbsp;B S Ouattara,&nbsp;K H Yao,&nbsp;N C Ackoundou,&nbsp;K L Adonis,&nbsp;G V Yao,&nbsp;D A Gnionsahié,&nbsp;Mijm Diomandé","doi":"10.1684/ndt.2023.9","DOIUrl":"https://doi.org/10.1684/ndt.2023.9","url":null,"abstract":"<p><strong>Materials and methods: </strong>We carried out a retrospective and descriptive study on biopsies examined between January 2015 and December 2019, in the pathological departments of University Teaching Hospital of Bouaké and Cocody-Abidjan. The KB came from four countries (Côte d'Ivoire, Togo, Guinea-Conakry and Burkina Faso). Optical microscopy and/or direct immunofluorescence techniques were used. All biopsy samples including epidemiological, clinical and pathological data and an optical microscopy and/or direct immunofluorescence study were included. The parameters studied were indications for KB, epidemiological profile, clinic, proteinuria and pathological aspects.</p><p><strong>Results: </strong>Over the study period, we collected 179 KB, i.e. 35.8 KB/year. The mean age of the patients was 32.9 ±13.8 years (range 11-70 years). The sex ratio (M/F) was 1.03. Pure nephrotic syndrome was the main indication (64.2 %, n = 115) for KB, followed by impure nephrotic syndrome (11.7 %, n = 21), acute renal failure (ARF) (7.8 %, n = 14) and rapidly progressive glomerulonephritis (RPGN) (7.8 %, n = 14). Glomerulonephritis (GN) occurred in 86 % (n = 158), vascular nephropathy in 11.7 % (n = 21) and tubulointerstitial nephritis in 2.2 % (n = 4). The nephropathies were preferentially focal segmental glomerulosclerosis (34.6 %, n = 62), nephroangiosclerosis (10.6 %, n = 19), membranous GN (10 %, n = 18), post-infectious GN (8.9 %, n = 16) and lupus GN (7.3 %, n = 13).</p><p><strong>Conclusion: </strong>The KB is an essential step in the diagnosis of nephropathies. Focal segmental glomerulosclerosis is frequent in our study. The establishment of a Kidney registry would allow better knowledge of renal pathologies in sub-Saharan Africa.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 2","pages":"99-108"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9927383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy after kidney transplantation: Ibn Sina Rabat University hospital experience","authors":"Latifa Driouch, Asmaa Azzouzi, Naima Ouzeddoun, Loubna Benamar, Rabia Bayahia, Tarik Bouattar","doi":"10.1684/ndt.2023.2","DOIUrl":"10.1684/ndt.2023.2","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplantation (KT) restores the fertility of women with end-stage kidney disease (ESKD), thus offering them the possibility of having children. However, pregnancy after kidney transplantation is associated with high maternal-fetal morbidity. The purpose of this work is to report the experience of our service in pregnancies in kidney transplant recipients.</p><p><strong>Materials and methods: </strong>We retrospectively studied the records of transplant recipients who had one or more pregnancies after KT. We analyzed clinical (blood pressure, weight gain, oedema, duration of pregnancy, obstetric complication) and biological (creatinine, urinary albumin excretion) parameters.</p><p><strong>Results: </strong>Between 1998 and 2020, twenty-one pregnancies occurred in 12 transplant recipients. The average age of patients at the time of conception was 29 ± 5 years with a delay between KT and pregnancy of 43 ± 29 months. Seven pregnancies began with arterial hypertension (HTA) controlled under treatment, proteinuria before conception was negative in all pregnancies and renal function was normal with an average creatinine level of 10.1 ± 1,27 mg/L. Prior to pregnancy, immunosuppression regimens were based on anticalcineurin (n = 21) combined either with mycophenolate mofetil (MMF) (n = 10) or azathioprine (n = 8) or alone (n = 3). Immunosuppression regimens were all associated with corticosteroid therapy. Three months before conception, MMF was relayed by azathioprine in seven pregnancies, on the other hand three other unplanned pregnancies, started under MMF. During pregnancy, the appearance of proteinuria greater than 0,5 g/24 h was noted in three pregnancies in the third trimester. Pregnancy hypertension was found in three pregnancies, one of which progressed to pre-eclampsia. As for renal function, it remained stable with an average creatinine level of 10,3 mg/l in the 3rd trimester. Two cases of acute pyelonephritis were noted. No episode of acute rejection was noted during and 3 months after pregnancy. The delivery was performed by caesarean section in 44.4 %, after an average term of 37 week of amenorrhea ± 2.04 with three cases of prematurity. The average birth weight was 3 110 g ± 450 g. There was one case of spontaneous abortion and two cases of fetal death in utero. After post-partum, renal function remained stable in five patients. In six cases, there was impaired renal function either by acute rejection or secondary to chronic allograft nephropathy.</p><p><strong>Conclusion: </strong>In our department, a quarter of transplant recipients were able to carry a pregnancy with a rate of 89 % of successful pregnancies. Pregnancy after KT requires special planning and monitoring. A multidisciplinary collaboration between transplant nephrologist, gynecologist and pediatrician is necessary by referring to the recommendations.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 1","pages":"109-120"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9517566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Living donor, first choice].","authors":"Michel Tsimaratos, François Kerbaul","doi":"10.1684/ndt.2023.21","DOIUrl":"10.1684/ndt.2023.21","url":null,"abstract":"","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 2","pages":"81-82"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9706933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for promoting living kidney donation in France in 2023","authors":"Christophe Mariat,&nbsp;François Gaillard,&nbsp;Thomas Fournier,&nbsp;Clémentine Rabate,&nbsp;Émilie Pincon,&nbsp;Justine Bacchetta,&nbsp;Manon Aurelle,&nbsp;Antoine Bouquegneau","doi":"10.1684/ndt.2023.20","DOIUrl":"https://doi.org/10.1684/ndt.2023.20","url":null,"abstract":"<p><p>Kidney transplantation from living donors is particularly under-developed in France in comparison with the US and most European countries. Among others, the lack of a proactive and evidence-based communication from French health providers is a potential cause that has been overlooked thus far. With this as a backdrop, the SFNDT Commission of transplantation has elaborated a 10 points-call for promoting living kidney transplantation in France in 2023 with the aims at (1) providing the entire nephrology community with a scientific rationale and (2) strenghtening the conviction of health providers, patients, and their relatives regarding the relevance of this modality of kidney transplantation.</p>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"19 2","pages":"83-88"},"PeriodicalIF":0.7,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9409034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}