Nephrologie & therapeutique最新文献

{"title":"Recent data on atypical hemolytic uremic syndrome associated with pregnancy, kidney transplantation or hypertensive emergency","authors":"Khalil El Karoui","doi":"10.1684/ndt.2024.83","DOIUrl":"10.1684/ndt.2024.83","url":null,"abstract":"<p><p>Les microangiopathies thrombotiques (MAT) sont un groupe hétérogène de pathologies caractérisées à différents degrés par une anémie hémolytique mécanique, une thrombopénie et une occlusion microvasculaire histologique. Les MAT peuvent se compliquer de multiples atteintes d’organe, principalement neurologiques et néphrologiques (définissant alors le syndrome hémolytique et urémique). La classification fondée sur la physiopathologie de la maladie a mis en évidence l’importance de la dérégulation de la voie alterne du complément dans les SHU atypiques (SHUa) (non-liés aux infections). Cependant, la physiopathologie et le traitement de nombreuses formes de SHUa dans des contextes spécifiques (tels que la grossesse, la transplantation rénale ou l’urgence hypertensive) restent mal caractérisés. Dans cet article, nous reprenons les avancées diagnostiques et thérapeutiques récentes dans ces trois formes de SHUa aux contextes spécifiques. Nous montrons les spécificités de ces formes et décrivons les enjeux actuels et futurs de leur prise en charge.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"277-284"},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918448","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":"“Junior Doctors” in Nephrology in France: first feedback","authors":"Emmanuelle Vial, Mickael Bobot, Jean-Philippe Bertocchio, Charlotte Lohéac, Grégoire Bon, Mathilde Roussel, Paule Chaillet-Poirier, Valentin Maisons","doi":"10.1684/ndt.2024.87","DOIUrl":"https://doi.org/10.1684/ndt.2024.87","url":null,"abstract":"<p><p>Medical education in France has undergone several major reforms in recent years. In 2017, the reform of the third cycle of medical studies was implemented. This particularly affected nephrology. The reform introduced a new status of “junior doctor”. Its main objective is to ensure the transition from intern to senior doctor.\u0000The “Syndicat National des Internes de Néphrologie” (SNIN) conducted a survey to take stock of this new status in our specialty. The respondents were contacted through their city referents.\u0000We received 53 completed questionnaires from Nephrology junior-doctors with an average age of 29 years from all over France. The choice of assignment was satisfactory in 93% of cases. The activity of these juniors-doctors was mainly oriented towards clinical nephrology or was mixed, with the possibility of own consultations for almost all residents. The on-call or nightshift activity of the junior-doctors was mainly concentrated in their home department, with only one third of them working as substitute. Their weekly working hours were substantial (mostly between 45 and 65 hours/week), with a significant number exceeding the legal limit. Overall, supervision was considered satisfactory. Very few residents had time for research or theorical-learning, although some gave lessons and received training mainly through conferences. Progress in performing renal biopsies was substantial, in contrast to central venous catheter placement and peritoneal dialysis management, where progress was judged to be weak.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"240-250"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366983","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":"Malformative uropathies in children: epidemiological, clinical, therapeutic and evolutive aspects in an ivoirian hospital setting","authors":"Emmanuella Bouah-Kamon, Assamala Marielle Sophie Ehile-Kacou, Gnenefoly Diarrassouba, Tanoh Kassi François Eboua, Evelyne Lasme-Guillao","doi":"10.1684/ndt.2024.88","DOIUrl":"10.1684/ndt.2024.88","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital anomalies of the kidney and the urinary tract are a major cause of chronic kidney failure in children. Prevalence in paediatrics varies according to studies. The data being rare in the ivorian context, this study aims to describe these defects' epidemiological, clinical, therapeutic and evolutionary aspects in children in a reference hospital setting.</p><p><strong>Methods: </strong>We performed a retrospective and descriptive study held in the Yopougon's Teaching Hospital Pediatric Nephrology Unit from December 1st 2008 to December 31st 2020. It involved 152 children aged 0 to 15 years, admitted to the unit, with a congenital anomaly of the kidney and the urinary tract diagnosed with radiology.</p><p><strong>Results: </strong>Socio-demographic characteristics: congenital anomalies of the kidney and urinary tract's prevalence was 11%. The median age at admission was 36 months. The median age at diagnosis of malformative uropathy was 17.5 months. The sex ratio (M/F) was 2.3. Clinical characteristics: posterior urethra valves were the most common malformative uropathy (38%). Malformative uropathy was associated with other defects in 4% of cases. The antenatal diagnosis involved 24% of patients. The average gestational age of discovery was 32 weeks of amenorrhea. In the postnatal period, abdominal pain was the main circumstance for discovery (39%). Therapeutic characteristics: surgery was indicated in 58% of patients and performed in 64% of cases. Evolutionary characteristics: evolution was better in patients who had received surgical treatment (asymptomatic in 83% of cases, occurrence of urinary tract infection in 35% of cases and chronic renal failure in 23% of cases). 72% of the study population was lost.</p><p><strong>Conclusion: </strong>In Côte d'Ivoire, malformatives uropathies are late-discovered and are dominated by posterior urethra valves. Knowledge and management of these renal and urinary tract defects deserve to be improved through the development of antenatal diagnosis and training of practitioners in early recognition of clinical signs. The high rate of lost patients must be reduced by the implementation of an active patients' follow-up system.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"260-268"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366990","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":"Novelties for the management of cytomegalovirus after kidney transplantation","authors":"Nassim Kamar, Olivier Marion, Arnaud Del Bello","doi":"10.1684/ndt.2024.84","DOIUrl":"10.1684/ndt.2024.84","url":null,"abstract":"<p><p>Cytomegalovirus (CMV) infection is the main opportunistic infection observed after kidney transplantation. Despite the use of prevention strategies, CMV disease still occurs, especially in high-risk patients (donor seropositive/recipient seronegative). Patients may develop complicated CMV, i.e. recurrent, refractory or resistant CMV infection. CMV prevention relies on either universal prophylaxis or preemptive therapy. In high-risk patients, universal prophylaxis is usually preferred. Currently, valganciclovir is used in this setting. However, valganciclovir can be responsible for severe leucopenia and neutropenia. A novel anti-viral drug, letermovir, has been recently compared to valganciclovir. It was as efficient as valganciclovir to prevent CMV disease and induced less hematological side-effects. It is still not available in France in this indication. Recent studies suggest that immune monitoring by ELISPOT or Quantiferon can be useful to determine the duration of prophylaxis. Other studies suggest that prophylaxis may be skipped in CMV-seropositive kidney-transplant patients given mTOR inhibitors.\u0000Refractory CMV is defined by the lack of decrease of CMV DNAemia of at least 1 log10 at 2 weeks after effective treatment. In case of refractory CMV infection, drug resistant mutations should be looked for. Currently, maribavir is the gold standard therapy for refractory/resistant CMV. At eight weeks therapy and eight weeks later, it has been shown to be significantly more effective than other anti-viral drugs, i.e. high dose of ganciclovir, foscarnet or cidofovir. However, a high rate of relapse was observed after ceasing therapy. Hence, other therapeutic strategies should be evaluated in order to improve the sustained virological rate.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"269-276"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366995","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":"Novelties for the management of cytomegalovirus after kidney transplantation","authors":"Nassim Kamar, Olivier Marion, Arnaud Del Bello","doi":"10.1684/ndt.2024.84","DOIUrl":"10.1684/ndt.2024.84","url":null,"abstract":"<p><p>Cytomegalovirus (CMV) infection is the main opportunistic infection observed after kidney transplantation. Despite the use of prevention strategies, CMV disease still occurs, especially in high-risk patients (donor seropositive/recipient seronegative). Patients may develop complicated CMV, i.e. recurrent, refractory or resistant CMV infection. CMV prevention relies on either universal prophylaxis or preemptive therapy. In high-risk patients, universal prophylaxis is usually preferred. Currently, valganciclovir is used in this setting. However, valganciclovir can be responsible for severe leucopenia and neutropenia. A novel anti-viral drug, letermovir, has been recently compared to valganciclovir. It was as efficient as valganciclovir to prevent CMV disease and induced less hematological side-effects. It is still not available in France in this indication. Recent studies suggest that immune monitoring by ELISPOT or Quantiferon can be useful to determine the duration of prophylaxis. Other studies suggest that prophylaxis may be skipped in CMV-seropositive kidney-transplant patients given mTOR inhibitors.\u0000Refractory CMV is defined by the lack of decrease of CMV DNAemia of at least 1 log10 at 2 weeks after effective treatment. In case of refractory CMV infection, drug resistant mutations should be looked for. Currently, maribavir is the gold standard therapy for refractory/resistant CMV. At 8 weeks therapy and 8 weeks later, it has been shown to be significantly more effective than other anti-viral drugs, i.e. high dose of ganciclovir, foscarnet or cidofovir. However, a high rate of relapse was observed after ceasing therapy. Hence, other therapeutic strategies should be evaluated in order to improve the sustained virological rate.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"269-276"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918447","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 translation and adaptation of the KDIGO nomenclature for kidney function and disease","authors":"Olivier Bonny, Ibtissam Arbaoui, Denis Fouque, Aghiles Hamroun, Michel Jadoul, Bénédicte Stengel, François Babinet, Isabelle Binet, Pascaline Faure, Luc Frimat, François Kaze, Hélène Lazareth, Yves Poulin, Daniel Schiltz, Anne Stinat, Cécile Vandevivère, Serge Quérin","doi":"10.1684/ndt.2024.86","DOIUrl":"https://doi.org/10.1684/ndt.2024.86","url":null,"abstract":"<p><p>A harmonized medical nomenclature that is accessible to the lay people is crucial to raising awareness of insidious health problems such as chronic kidney disease and facilitating communication between healthcare professionals. This article presents the proposals of a French-speaking working group for the translation and adaptation into French of the nomenclature for renal function and disease that resulted from a KDIGO consensus conference published in English in 2020. In particular, the working group recommends abandoning terms that used to correspond in French to “chronic renal failure”, “acute renal failure”, “end-stage renal failure”, “uremia”, “cadaveric donor” and “microalbuminuria”, in favor of French equivalents of “chronic renal disease”, “acute kidney injury”, “renal failure”, “uremic syndrome”, “deceased donor” and “albuminuria”. Arguments against the former and in favor of the latter are presented. Other equivalents of English terms from the KDIGO nomenclature are presented in a Table, and an Appendix presents equivalents proposed in German and Spanish by other authors. We hope that our proposals will be well received by healthcare professionals as well as by their patients and the public.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"285-300"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366987","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":"Difelikefalin and treatment of severe pruritus associated with chronic kidney disease Real-life retrospective study in a dialysis center","authors":"Rémi Brasme, Claire Cartery, Marlène Goubet, Marie-Flore Hennino, Nathalie Maisonneuve","doi":"10.1684/ndt.2024.78","DOIUrl":"https://doi.org/10.1684/ndt.2024.78","url":null,"abstract":"<p><strong>Introduction: </strong>Difelikefalin is to date the first and only specific treatment to be approved for the treatment of moderate-to-severe chronic kidney disease-associated pruritus (CKD-aP) in adult patients on hemodialysis.</p><p><strong>Patients and methods: </strong>This was a retrospective, single-center, real-life study in hemodialysis patients with CKD-aP treated with difelikefalin. The primary objective was to evaluate the evolution of the intensity of pruritus during treatment with difelikefalin using the Worst Itch Intensity-Numerical Rating Scale (WI-NRS). Adult patients were included if they had been on hemodialysis for at least 3 months and were suffering from moderate to severe CKD-aP (objectified by the WI-NRS score) for which difelikefalin had been prescribed.</p><p><strong>Results: </strong>11 patients (7 men and 4 women; mean age, 63.8 years) with a mean (SD) weekly dialysis time of 13 h (2.4) were included. The mean hemodialysis duration was 5 (3.6) years and the mean pruritus duration was 4.3 (3.2) years. At inclusion, on-going treatments of CKD-aP were emollients in all patients and antihistamines in 9 patients. The mean WI-NRS score was 7.4 (1.1) at initiation of difelikefalin. At last assessment after a median follow-up of 9.0 months, the mean change of WI-NRS score was -5.1 (2.9) and 82% of patients had a decrease ≥ 3 points. Mild to moderate adverse reactions to difelikefalin were reported in 4 patients, all of whom recovered without sequelae.</p><p><strong>Conclusion: </strong>These results show that difelikefalin, prescribed according to its therapeutic indication, is effective in the treatment of CKD-aP under real-life conditions, outside the controlled conditions of a clinical trial.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"251-259"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366986","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":"Recent data on atypical hemolytic uremic syndrome associated with pregnancy, kidney transplantation or hypertensive emergency","authors":"Khalil El Karoui","doi":"10.1684/ndt.2024.83","DOIUrl":"10.1684/ndt.2024.83","url":null,"abstract":"<p><p>Thrombotic microangiopathies (TMA) are a heterogeneous group of disorders characterized to varying degrees by mechanical hemolytic anemia, thrombocytopenia and histological microvascular occlusion. TMA can be complicated by multiple organ disorders, mainly neurological and nephrological (defining the hemolytic uremic syndrome, HUS). Classification based on disease pathophysiology has highlighted the importance of dysregulation of the alternative complement pathway in atypical (non-infection-related) HUS. However, the pathophysiology and treatment of many forms of aHUS in specific contexts (such as pregnancy, renal transplantation or hypertensive emergencies) remain poorly characterized. In this article, we review recent diagnostic and therapeutic advances in these three forms of aHUS in specific contexts. We show the specificities of these forms and describe the current and future challenges of their management.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 4","pages":"277-284"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366954","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":"Management of immunosuppressive therapy after functional renal graft failure: results of a practice survey of French-speaking nephrologists","authors":"Cyril Garrouste, Marine Freist, Mathilde Prezelin-Reydit, Antoine Bouquegneau, Thomas Fournier, Betoul Schvartz, Antoine Thierry, Virginie Paumier Sanson, Valentin Mayet, Bruno Pereira, Christophe Mariat","doi":"10.1684/ndt.2024.79","DOIUrl":"10.1684/ndt.2024.79","url":null,"abstract":"<p><p>The management of patients with kidney transplant failure (KTF) remains a complex process involving multiple stakeholders. A working group of the Transplantation Commission of the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) conducted a survey on the management of immunosuppressants (IS) after KTF among nephrologists at transplant centres and general nephrologists in France, Switzerland and Belgium between March and June 2023.\u0000We analysed 232 replies from 58 nephrologists at transplant centres and 174 general nephrologists, aged 43.6 (+10.6) years. In the first three months following KTF, nephrologists reported discontinuing antimetabolite, calcineurin inhibitor (CNI) and corticosteroid treatment in 83%, 39.9% and 25.8% of cases respectively. Conversely, some nephrologists reported that they were continuing to use CNI (14%) and corticosteroids (19.1%) on a long-term basis. The patient’s comorbidities associated with the discontinuation of IS treatment are cancer and opportunistic infections as KT’s complications and presence of diabetes mellitus at KTF, whereas humoral rejection encourages the IS to be maintained. Transplantectomy is proposed by nephrologists most often for graft intolerance syndrome (86.5%), more rarely to discontinue IS (17.6%) or in the absence of plans of new transplantation (9.3%). In multivariate analyses, the presence of a protocol in the centre facilitated the management of IS by the general nephrologists.\u0000The management of IS after AFG by French-speaking nephrologists is heterogeneous. Specific prospective studies are needed to establish new best practice recommendations, based on more robust evidence, which could encourage better adherence by nephrologists.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 3","pages":"193-202"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452544","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":"Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study","authors":"Laurence Pautret, Anne-Céline Galle, Anne Radiguet, Catherine Thibault, Ludivine Videloup, Sonia Guillouët, Thierry Lobbedez, Patrick Henri, Maxence Ficheux, Clémence Béchade","doi":"10.1684/ndt.2024.82","DOIUrl":"10.1684/ndt.2024.82","url":null,"abstract":"<p><strong>Introduction: </strong>We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses.</p><p><strong>Materials: </strong>All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible.</p><p><strong>Results: </strong>Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled.</p><p><strong>Discussion: </strong>The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 3","pages":"185-192"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452545","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}