Nephrologie & therapeutique最新文献

{"title":"Assessment of nutritional status in kidney transplant recipients aged over 70 years: A single-center retrospective study","authors":"Magali Levray, Thierry Lobbedez, Laura Brien, Nicolas Bouvier, Eve Calvar, Valérie Châtelet, Sonia Guillouët","doi":"10.1684/ndt.2026.174","DOIUrl":"10.1684/ndt.2026.174","url":null,"abstract":"<p><strong>Background: </strong>The number of kidney transplant recipients over the age of 70 is increasing. These older patients are at higher risk of malnutrition, yet data on their post-transplant nutritional status are scarce.</p><p><strong>Patients and methods: </strong>This was a single-center retrospective pilot study conducted at Caen University Hospital. It included kidney transplant recipients aged over 70 years. The objective was to assess weight change between transplant notification and the first month post-transplant.</p><p><strong>Results: </strong>In our study, 31 of 71 patients (44%) experienced weight loss ≥5% at one month (M1). Few pre-transplant factors were associated with malnutrition risk. However, weight loss during the first postoperative week was a significant predictive factor (OR: 1.82; 95% CI: 1.35–2.73; p=0.001).</p><p><strong>Conclusion: </strong>Malnutrition is an early post-transplant complication and is frequent at one month (M1) in older patients. Early prehabilitation and rehabilitation programs implemented by multidisciplinary teams (nephrologists, advanced practice nurses, dieticians, geriatricians, physiotherapists, psychologists, etc.) are essential.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 2","pages":"103-114"},"PeriodicalIF":0.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary practices and nutritional strategies after kidney transplantation: A survey of practices among specialized dietitians in France, Belgium, and Luxembourg","authors":"Stanislas Trolonge, Viridiana Grillo, Gwendoline Makalou, Mélanie Somja, Karine Moreau","doi":"10.1684/ndt.2026.178","DOIUrl":"10.1684/ndt.2026.178","url":null,"abstract":"<p><strong>Background: </strong>Nutritional management after kidney transplantation remains heterogeneous despite major metabolic, cardiovascular, and immunological implications related to immunosuppressive therapy.</p><p><strong>Objective: </strong>To describe current dietary practices and nutritional strategies implemented after kidney transplantation in France, Belgium, and Luxembourg.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted from June to July 2023 among members of the Association de diététique et nutrition en néphrologie (ADNN) and the Groupe des diététicien(ne)s de néphrologie (GDN, Belgium). The 43-item questionnaire explored consultation modalities, interprofessional coordination, adherence to nutritional recommendations, dietary prescription practices, and participation in therapeutic education programs. The survey was self-administered, and descriptive analyses were expressed as frequencies and percentages.</p><p><strong>Results: </strong>Forty-seven dietitians responded (51% from France, 47% from Belgium, 2% from Luxembourg). Most worked in dialysis (80.8%), nephrology (46.8%), or transplantation units (30%). Dietary follow-up of kidney transplant recipients was reported mainly during hospitalization (86.7%), particularly at the time of transplantation, and in outpatient consultations (73.3%) during subsequent weeks or months. Most dietitians reported following fewer than 20 transplant patients per year. Weight changes (94%), post-transplant diabetes (41%), and digestive disorders (14%) were the leading consultation motives. Balanced diets (69%), sodium restriction (56%), and reduced sugar intake (28%) were the main strategies. In the early postoperative phase, a light, then high-protein (67%) and low-microbial (53%) diet was usually prescribed. Strict food safety measures were applied in >90% of centers, typically for six months. Coordination between teams remained limited, with one third reporting no formalized protocol.</p><p><strong>Conclusion: </strong>The survey highlights the variability of dietary management after kidney transplantation and the need for standardized nutritional protocols, specific professional training, and improved inter-team coordination.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 2","pages":"116-125"},"PeriodicalIF":0.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of hypertension evaluation in a nephrology day hospital","authors":"Jean-Brieuc Jouppe, Ludivine Lebourg, Mathilde Lemoine, Steven Grange, Virginie Paumier-Sanson, Dominique Guerrot, Tristan de Nattes","doi":"10.1684/ndt.2026.176","DOIUrl":"10.1684/ndt.2026.176","url":null,"abstract":"<p><strong>Introduction: </strong>Secondary hypertension (HTN) accounts for 5–10% of HTN. The actual diagnostic yield of a comprehensive etiological work-up in nephrology-specialized centers remains poorly documented.</p><p><strong>Materials and methods: </strong>We conducted a single-center retrospective study including all patients evaluated in the day hospital program of the ESH-accredited Hypertension and Nephrology Unit at Rouen University Hospital for suspected secondary HTN, between 2018 and 2019. The standardized protocol combined clinical assessment, laboratory testing, imaging, and multidisciplinary discussion.</p><p><strong>Results: </strong>One hundred patients were included. The mean age was 46.8±14.1 years; 58% were women. The main referral reasons were young age (41%), severe HTN (30%), hypokalemia (23%), and resistant HTN (22%). A secondary cause was identified in 60% of cases: primary aldosteronism (20%), kidney disease (16%), obstructive sleep apnea (12%), obesity (12%), drug-induced HTN (9%), secondary hyperaldosteronism (5%), and pseudohyperaldosteronism (3%). Essential HTN accounted for 48% of cases. Multiple diagnoses were present in 21% of cases. Hypokalemia as a motive was associated with primary aldosteronism (48% vs. 10–17% for other motives, p=0.01). Antihypertensive treatment was modified in 72% of patients with secondary HTN vs. 65% with essential HTN (p=0.53), in accordance with current guidelines at that time. An interventional or surgical treatment was performed in 6% of cases, and 83% of patients with sleep apnea were treated with continuous positive airway pressure.</p><p><strong>Conclusion: </strong>In a nephrology-specialized ESH-accredited center, the diagnostic yield of secondary hypertension evaluation is high, with significant therapeutic implications. This supports the role of specialized nephrology centers in hypertension work-up.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 2","pages":"93-102"},"PeriodicalIF":0.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iodinated and gadolinium-based contrast agents in patients with chronic kidney disease: A review of international guidelines (SFNDT/SFR, ESUR, ACR/NKF, CAR)","authors":"Catherine Verhellen, Maxime Beringuier, Laura Labriola, Guillaume Fernandes","doi":"10.1684/ndt.2026.169","DOIUrl":"10.1684/ndt.2026.169","url":null,"abstract":"<p><strong>Introduction: </strong>The renal risks of iodinated contrast media (ICM) and the association of gadolinium-based contrast agents (GBCAs) with nephrogenic systemic fibrosis (NSF) have been recently reassessed.</p><p><strong>Methods: </strong>International guidelines (Société francophone de néphrologie, dialyse et transplantation/Société française de radiologie [SFNDT/SFR], European Society of Urogenital Radiology [ESUR], American College of Radiology/National Kidney Foundation [ACR/NKF], Canadian Association of Radiologists [CAR] 2018–2025) were reviewed, focusing on risk stratification, preventive measures, and the use of ICM and GBCAs in patients with chronic kidney disease (CKD).</p><p><strong>Results: </strong>Post-contrast acute kidney injury risk is low for eGFR ≥ 30 mL/min/1.73 m². Hydration is recommended only for eGFR < 30 mL/min/1.73 m² or first-pass intra-arterial injections. Group II GBCAs are considered safe even in advanced CKD or dialysis, with a single unconfirmed NSF case reported.</p><p><strong>Discussion: </strong>Differences between guidelines reflect their timing and limited evidence. Preventive measures should focus on the highest-risk situations.</p><p><strong>Conclusion: </strong>Clinical indication should guide imaging, which should not be delayed, and recent guidelines support a rational, risk-based approach to contrast media use.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"46-56"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcinosis cutis in a hemodialysis patient with Von Hippel-Lindau disease","authors":"Jean Bertrand, Catherine Verhellen, Maxime Beringuier, Nesrine Bitout, Inès Dufour, Léo-Paul Secco, Éric Goffin","doi":"10.1684/ndt.2026.172","DOIUrl":"10.1684/ndt.2026.172","url":null,"abstract":"<p><p>We report the case of a 52-year-old man with Von Hippel-Lindau disease who had been receiving nocturnal home hemodialysis for ten months following bilateral nephrectomy for multifocal clear cell renal carcinoma. He presented with a firm, painless subcutaneous nodule on the right anterior thigh, featuring a central crater filled with chalky-white material. Skin biopsy revealed dermal calcium deposits surrounded by a fibrous and histiocytic reaction, consistent with dystrophic calcinosis cutis. Additional nodules were palpable on the left calf and right biceps. Bilateral femur X-rays were normal. Persistent hyperphosphatemia and inadequate dialysis likely contributed to the development of these extraosseous calcifications. Management included intensification of phosphate binder therapy and increased dialysis frequency. This case illustrates the potential interplay between hereditary tumor syndromes and dialysis-related mineral metabolism disorders, highlighting the risk of severe extraosseous calcifications in such patients.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"67-70"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting together the pieces of the care pathway: The French National Health Data system and its applications in nephrology","authors":"Léa Faure, Solène M Laville, Latame Komla Adoli, Cécile Couchoud","doi":"10.1684/ndt.2026.163","DOIUrl":"10.1684/ndt.2026.163","url":null,"abstract":"<p><p>The creation of the National Health Data System aims to collect, structure, and make analyzable the various documents resulting in particular from hospitalization, outpatient care, death certificates, and disability-related measures, in order to provide a population-based, longitudinal, and consistent view of care pathways.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"58-65"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the relationship between the severity of interstitial fibrosis in diagnostic renal biopsies and disease progression in primary glomerular diseases","authors":"Kadir Intas, Fatma Ayerden Ebinc, Gülay Ulusal Okyay","doi":"10.1684/ndt.2026.171","DOIUrl":"10.1684/ndt.2026.171","url":null,"abstract":"<p><p>This single-center retrospective cohort study divided 176 adults with biopsy-proven primary glomerulonephritis (GN) between 2014 and 2021 into 4 groups based on cortical interstitial fibrosis (IF) percentage. The primary outcome was disease progression, defined as a ≥40% decline in estimated glomerular filtration rate (eGFR) and/or the need for dialysis. The secondary outcome was complete remission, defined as proteinuria <300 mg/24 hours.\u0000Baseline proteinuria and serum creatinine increased with greater IF severity, while eGFR decreased. Kaplan-Meier analysis showed a higher risk of progression in patients with severe IF. After adjusting for glomerulosclerosis, baseline eGFR, proteinuria, and treatments, IF severity remained an independent predictor of progression (HR 3.15). IF was not independently associated with achieving complete remission. Stratified analyses suggested a stronger association in immunoglobulin-A (IgA) nephropathy, while results for focal segmental glomerulosclerosis (FSGS) and membranous glomerulonephritis (MGN) were inconclusive due to limited statistical power.\u0000In summary, the severity of IF on diagnostic biopsy is a strong and independent prognostic factor for disease progression in primary glomerular diseases, supporting its routine standardized assessment to improve risk stratification and personalized patient management.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"36-45"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French nephrologists’ practices in the management of anemia and iron deficiency in chronic kidney disease","authors":"Lisa Le Gall, Yasmine Sadou, Christian Combe, Jérôme Harambat, Gabriel Choukroun, Tilman B Drüeke, Céline Lange, Natalia Alencar De Pinho, Bénédicte Stengel, Karen Leffondré, Mathilde Prezelin-Reydit","doi":"10.1684/ndt.2026.170","DOIUrl":"10.1684/ndt.2026.170","url":null,"abstract":"<p><strong>Background: </strong>Real-world practices for managing anemia and iron deficiency in chronic kidney disease appear heterogeneous and sometimes controversial. This study aimed to describe the prescribing preferences and habits of French nephrologists in this area.</p><p><strong>Methods: </strong>All nephrologists seeing patients at one of the 40 centers participating in the Chronic Kidney Disease – Renal Epidemiology and Information Network (CKD-REIN) cohort were invited to participate in two waves (2015–2016 and 2019–2020) of a practice survey. The self-administered questionnaires collected information on nephrologists’ characteristics and their management strategies for anemia and iron deficiency in patients with stage 4–5 CKD.</p><p><strong>Results: </strong>A total of 137 nephrologists participated in the first wave and 60 in the second wave. Most reported initiating treatment with erythropoiesis-stimulating agents (ESAs) when hemoglobin levels were between 9.5 and 10.5 g/dL (85% in the first wave and 96% in the second). In patients with anemia and iron deficiency, the thresholds for initiating iron therapy varied widely: for oral iron, transferrin saturation (TSAT) ranged from 10% to more than 35% and ferritin from 50 to 500 μg/L; for intravenous iron, TSAT ranged from 10 to 30% and ferritin from 50 to 500 μg/L.</p><p><strong>Conclusion: </strong>Between 2015–2016 and 2019–2020, French nephrologists’ practices for ESA management were relatively homogeneous and in line with current recommendations. In contrast, approaches to iron deficiency varied greatly among practitioners.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"15-25"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodialysis and VKAs: How INR self-monitoring and supervised administration during sessions improve anticoagulant treatment stability","authors":"Amel Ghemmour, Imane Boukhers, Onhatie Cuvillier, Laurie Gladieux, Anne Rubenstrunk, Mahen Al Badawy","doi":"10.1684/ndt.2026.167","DOIUrl":"10.1684/ndt.2026.167","url":null,"abstract":"<p><p>In chronic hemodialysis patients, optimal INR control is critical to reduce bleeding and thromboembolic risks associated with vitamin K antagonist (VKA) therapy. This study evaluates the impact of an optimized protocol combining INR self-testing and supervised VKA administration on anticoagulation quality. A monocentric observational comparative study was conducted in 24 hemodialysis patients treated with VKAs, monitored successively under two modalities: a standard protocol (SP, January–March 2024) followed by an optimized protocol (OP, July–September 2024). Three biological indicators were assessed: mean INR, intra-individual INR variability (coefficient of variation, CV), and time in therapeutic range (TTR, INR 2.0–3.0). No clinical endpoints were collected. The mean INR coefficient of variation (CV) significantly decreased from 35% under the SP to 25% under the OP (p < 0.01), reflecting a marked improvement in treatment stability, particularly among initially unstable patients. The mean TTR, moderately satisfactory under SP (63%), increased to 71% under OP, although this difference did not reach statistical significance (p > 0.05). A reduction in extreme values and a more homogeneous INR distribution were also observed. The implementation of the optimized protocol led to improved INR control by significantly reducing intra-individual variability. This improvement may provide clinical benefits, including a reduced risk of hemorrhagic or thromboembolic events. These findings support the value of enhanced monitoring strategies that combine self-testing and supervised VKA administration to improve patient safety and reinforce treatment adherence.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"27-35"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Once upon a time in nephrology - Episode 3: A brief history of preeclampsia","authors":"Nelson-Georges Dengo, Alexandre Hertig","doi":"10.1684/ndt.2026.173","DOIUrl":"10.1684/ndt.2026.173","url":null,"abstract":"<p><p>Preeclampsia is a maternal syndrome of placental origin that complicates 2–5% of pregnancies. It remains one of the leading causes of maternal mortality worldwide and is a major contributor to fetal and neonatal morbidity and mortality. It is classically defined, after 20 weeks of gestation, by the combination of arterial hypertension and proteinuria ≥ 0.3 g/24 h. In its severe form, it may induce endothelial injury consistent with thrombotic microangiopathy in the liver and kidneys and can lead to fatal posterior cerebral edema. For many years, preeclampsia was referred to as the “disease of theories,” because the link between this systemic maternal syndrome and the placenta remained elusive until 2003—nearly three centuries after François Mauriceau, surgeon at the Hôtel-Dieu in Paris and obstetrician to the court of Louis XIV, first suggested such a connection.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"22 1","pages":"5-13"},"PeriodicalIF":0.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}