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Frimat M, Gnemmi V, Stichelbout M, Provôt F, Fakhouri F. Pregnancy as a susceptible state for thrombotic microangiopathies. Front Med (Lausanne) 2024; 11:1343060. [PMID: 38476448 PMCID: PMC10927739 DOI: 10.3389/fmed.2024.1343060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Pregnancy and the postpartum period represent phases of heightened vulnerability to thrombotic microangiopathies (TMAs), as evidenced by distinct patterns of pregnancy-specific TMAs (e.g., preeclampsia, HELLP syndrome), as well as a higher incidence of nonspecific TMAs, such as thrombotic thrombocytopenic purpura or hemolytic uremic syndrome, during pregnancy. Significant strides have been taken in understanding the underlying mechanisms of these disorders in the past 40 years. This progress has involved the identification of pivotal factors contributing to TMAs, such as the complement system, ADAMTS13, and the soluble VEGF receptor Flt1. Regardless of the specific causal factor (which is not generally unique in relation to the usual multifactorial origin of TMAs), the endothelial cell stands as a central player in the pathophysiology of TMAs. Pregnancy has a major impact on the physiology of the endothelium. Besides to the development of placenta and its vascular consequences, pregnancy modifies the characteristics of the women's microvascular endothelium and tends to render it more prone to thrombosis. This review aims to delineate the distinct features of pregnancy-related TMAs and explore the contributing mechanisms that lead to this increased susceptibility, particularly influenced by the "gravid endothelium." Furthermore, we will discuss the potential contribution of histopathological studies in facilitating the etiological diagnosis of pregnancy-related TMAs.
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Affiliation(s)
- Marie Frimat
- CHU Lille, Nephrology Department, Univ. Lille, Lille, France
- Inserm, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | | | | | - François Provôt
- CHU Lille, Nephrology Department, Univ. Lille, Lille, France
| | - Fadi Fakhouri
- Service of Nephrology and Hypertension, CHUV and University of Lausanne, Lausanne, Switzerland
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Béranger N, Coppo P, Tsatsaris V, Boisseau P, Provôt F, Delmas Y, Poullin P, Vanhoorelbeke K, Veyradier A, Joly BS. Management and follow-up of pregnancy-onset thrombotic thrombocytopenic purpura: the French experience. Blood Adv 2024; 8:183-193. [PMID: 38039511 PMCID: PMC10805644 DOI: 10.1182/bloodadvances.2023011972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT Pregnancy-onset thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening disease of which diagnosis and management requires experienced multidisciplinary teams. The mechanisms responsible for a deficiency in the disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13 (ADAMTS13) leading to pregnancy-onset TTP may be congenital or acquired, and studying ADAMTS13 conformation could be of interest. The differential diagnosis between TTP and other pregnancy-associated thrombotic microangiopathies (TMA) is often challenging. Our retrospective multicenter study highlights the significance and the challenges associated with pregnancy-onset TTP and childbirth in terms of diagnosis, obstetric management, and follow-up aspects. Among 1174 pregnancy-onset TMA enrolled in the French Registry for TMA from 2000 to 2020, we identified 108 pregnancy-onset TTP: 52 immune-mediated TTP (iTTP, 48.1%), 27 acquired TTP of unidentified mechanism (uTTP, 25%), and 29 congenital TTP (cTTP, 26.9%). Data show that maternal outcome is good (survival rate: 95%) and fetal outcome is linked to the gestational age at the onset of the disease (survival rate: 75.5%). Three distinct entities with different natural histories emerged: pregnancy-onset iTTP appears similar to idiopathic iTTP, with an open ADAMTS13 conformation, and is marked by a relapse risk independent of subsequent pregnancies; pregnancy-onset uTTP appears to have a different pathophysiology with an unexpected open ADAMTS13 conformation and a very low relapse risk independent of subsequent pregnancies; finally, pregnancy-onset cTTP is characterized by the necessity of pregnancy as a systematic and specific trigger and a need for prophylactic plasmatherapy for subsequent pregnancies. This trial was registered at www.clinicaltrials.gov as #NCT00426686, and at the Health Authority and the French Ministry of Health (P051064/PHRC AOM05012).
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Affiliation(s)
- Nicolas Béranger
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris.Nord, Université Paris Cité, Paris, France
- EA-3518, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Paul Coppo
- Service d’Hématologie, Centre de référence des microangiopathies thrombotiques, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
| | - Vassilis Tsatsaris
- Maternité Port Royal, Hôpital Cochin, FHU PREMA, Assistance Publique-Hôpitaux de Paris.Centre, Université de Paris, Paris, France
- INSERM UMR-S 1139, Physiopathologie et pharmacotoxicologie placentaire humaine, Université de Paris, Paris, France
| | | | | | - Yahsou Delmas
- Service de Néphrologie, CHU de Bordeaux, Bordeaux, France
| | - Pascale Poullin
- Service d’Hémaphérèse, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Agnès Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris.Nord, Université Paris Cité, Paris, France
- EA-3518, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Bérangère S. Joly
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris.Nord, Université Paris Cité, Paris, France
- EA-3518, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
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Hamroun A, Prouteau C, Lenain R, Roger C, Bauters A, Zawadzki C, Subtil D, Gibier JB, Stichelbout M, Coppo P, Lionet A, Maanaoui M, Hazzan M, Provôt F. The challenging follow-up of pregnancy in women with known thrombotic thrombocytopenic purpura: a single-center experience of a preemptive management protocol. J Nephrol 2023; 36:2519-2529. [PMID: 37816989 DOI: 10.1007/s40620-023-01790-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/30/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Although thrombotic thrombocytopenic purpura frequently affects women of childbearing age, there is no clear recommendation for the management of subsequent pregnancies in women with established thrombotic thrombocytopenic purpura. METHODS This single-center, retrospective, observational study included all women with hereditary thrombotic thrombocytopenic purpura or immune thrombotic thrombocytopenic purpura who had had at least one subsequent pregnancy after thrombotic thrombocytopenic purpura diagnosis between 2003 and 2022. The strategy comprised weekly surveillance of platelet count during pregnancy (and quarterly monitoring of ADAMTS13 activity) for women with immune thrombotic thrombocytopenic purpura, without any routine prophylactic treatment. In case of thrombocytopenia < 150,000/mm3 (with or without hemolysis relapse), women with hereditary thrombotic thrombocytopenic purpura systematically received plasma infusions twice weekly until platelet count normalized. RESULTS A total of 13 patients were included (7 with hereditary thrombotic thrombocytopenic purpura and 6 with immune thrombotic thrombocytopenic purpura, with 20 planned pregnancies (11 and 9, respectively). All pregnancies resulted in live births, and all mothers survived. There was a marked improvement in pregnancy terms in the hereditary thrombotic thrombocytopenic purpura group compared to index pregnancies (37 [35;39] versus 31 [24;38] weeks, p = 0.037) and birth weights (3265 [3029;3410] versus 2160 [1240;2705] grams, p = 0.016), with need for plasma support mostly starting during the third trimester (5/7 patients, 7/11 pregnancies). A single hereditary thrombotic thrombocytopenic purpura relapse occurred, with rapid resolution after plasma support intensification. There were no relapses in the immune thrombotic thrombocytopenic purpura group, with ADAMTS13 activity systematically above 40% during all monitored pregnancies. CONCLUSION These real-life data support the feasibility of a preemptive approach to pregnancy monitoring in women with known thrombotic thrombocytopenic purpura who undergo active surveillance within a multidisciplinary network.
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Affiliation(s)
- Aghiles Hamroun
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
- UMR1167 RID-AGE, Inserm, Institut Pasteur de Lille, Lille University, 59000, Lille, France
| | - Camille Prouteau
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
| | - Rémi Lenain
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
| | - Camille Roger
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
| | - Anne Bauters
- Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, CHU Lille, Lille University, Lille, France
| | - Christophe Zawadzki
- Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, CHU Lille, Lille University, Lille, France
| | - Damien Subtil
- CHU Lille, Hôpital Jeanne de Flandre, Lille University, 59000, Lille, France
- Lille University, EA 2694 Santé Publique, Épidémiologie Et Qualité Des Soins, F-59000, Lille, France
| | - Jean-Baptiste Gibier
- Regional and University Hospital Center of Lille, Department of Pathology, Pathology Institute, Lille University, 59037, Lille, France
| | - Morgane Stichelbout
- Regional and University Hospital Center of Lille, Department of Pathology, Pathology Institute, Lille University, 59037, Lille, France
| | - Paul Coppo
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France
- Hematology Department, Saint-Antoine Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Arnaud Lionet
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
| | - Mehdi Maanaoui
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
- Inserm, CHU Lille, Institut Pasteur Lille, Lille University, U1190, EGID, F-59000, Lille, France
| | - Marc Hazzan
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France
| | - François Provôt
- Department of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Lille University Hospital Center of Lille, 59000, Lille, France.
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Laboux T, Lenain R, Visentin J, Flahaut G, Chamley P, Provôt F, Top I, Kerleau C, Labalette M, Choukroun G, Couzi L, Blancho G, Hazzan M, Maanaoui M. Impact of Preformed Donor-Specific Anti-HLA-Cw and Anti-HLA-DP Antibodies on Acute Antibody-Mediated Rejection in Kidney Transplantation. Transpl Int 2023; 36:11416. [PMID: 38076227 PMCID: PMC10698113 DOI: 10.3389/ti.2023.11416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023]
Abstract
Given the risk of rejection, the presence of preformed donor specific antibodies (DSA) contraindicates transplantation in most allocation systems. However, HLA-Cw and -DP DSA escape this censorship. We performed a multicentric observational study, in which the objective was to determinate risk factors of acute antibody-mediated rejection (aABMR) in recipients transplanted with preformed isolated Cw- or DP-DSA. Between 2010 and 2019, 183 patients were transplanted with a preformed isolated Cw- or DP-DSA (92 Cw-DSA; 91 DP-DSA). At 2 years, the incidence of aABMR was 12% in the Cw-DSA group, versus 28% in the DP-DSA group. Using multivariable Cox regression model, the presence of a preformed DP-DSA was associated with an increased risk of aABMR (HR = 2.32 [1.21-4.45 (p = 0.001)]) compared with Cw-DSA. We also observed a significant association between the DSA's MFI on the day of transplant and the risk of aABMR (HR = 1.09 [1.08-1.18], p = 0.032), whatever the DSA was. Interaction term analysis found an increased risk of aABMR in the DP-DSA group compared with Cw-DSA, but only for MFI below 3,000. These results may plead for taking these antibodies into account in the allocation algorithms, in the same way as other DSA.
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Affiliation(s)
- Timothée Laboux
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM U1167, RID-AGE, University of Lille, Lille, France
| | - Rémi Lenain
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM UMR 1246 – SPHERE, Nantes University, Tours University, Nantes, France
| | - Jonathan Visentin
- Department of Immunology and Immunogenetics, CHU Bordeaux, Bordeaux, France
- ImmunoConceEpT, CNRS UMR5164, Inserm ERL U1303, University of Bordeaux, Bordeaux, France
| | - Gauthier Flahaut
- Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France
- EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Paul Chamley
- Department of Nephrology, CH Roubaix, Roubaix, France
| | - François Provôt
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
| | - Isabelle Top
- Department of Immunology-HLA, CHU Lille, University of Lille, Lille, France
| | - Clarisse Kerleau
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, ITUN, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Myriam Labalette
- Department of Immunology-HLA, CHU Lille, University of Lille, Lille, France
- INSERM UMR1286, INFINITE, University of Lille, Lille, France
| | - Gabriel Choukroun
- Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France
- EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Lionel Couzi
- ImmunoConceEpT, CNRS UMR5164, Inserm ERL U1303, University of Bordeaux, Bordeaux, France
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Gilles Blancho
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, ITUN, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Marc Hazzan
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
| | - Mehdi Maanaoui
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM U1190, EGID, Institut Pasteur Lille, CHU Lille, University of Lille, Lille, France
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5
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Neuman L, Joseph A, Bouzid R, Lescroart M, Mariotte E, Ederhy S, Tuffet S, Baudel JL, Benhamou Y, Galicier L, Grangé S, Provôt F, Neel A, Pène F, Delmas Y, Presne C, Poullin P, Wynckel A, Perez P, Barbet C, Halimi JM, Chatelet V, Rebibou JM, Ojeda-Uribe M, Vigneau C, Mesnard L, Veyradier A, Azoulay E, Coppo P, Chabriat H. Predictors of acute ischemic cerebral lesions in immune-mediated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. J Neurol 2023; 270:5023-5033. [PMID: 37392208 DOI: 10.1007/s00415-023-11830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND The immune form of thrombotic thrombocytopenic purpura (iTTP) and the hemolytic and uremic syndrome (HUS) are two major forms of thrombotic microangiopathy (TMA). Their treatment has been recently greatly improved. In this new era, both the prevalence and predictors of cerebral lesions occurring during the acute phase of these severe conditions remain poorly known. AIM The prevalence and predictors of cerebral lesions appearing during the acute phase of iTTP and Shiga toxin-producing Escherichia coli-HUS or atypical HUS were evaluated in a prospective multicenter study. METHODS Univariate analysis was performed to report the main differences between patients with iTTP and those with HUS or between patients with acute cerebral lesions and the others. Multivariable logistic regression analysis was used to identify the potential predictors of these lesions. RESULTS Among 73 TMA cases (mean age 46.9 ± 16 years (range 21-87 years) with iTTP (n = 57) or HUS (n = 16), one-third presented with acute ischemic cerebral lesions on magnetic resonance imagery (MRI); two individuals also had hemorrhagic lesions. One in ten patients had acute ischemic lesions without any neurological symptom. The neurological manifestations did not differ between iTTP and HUS. In multivariable analysis, three factors predicted the occurrence of acute ischemic lesions on cerebral MRI: (1) the presence of old infarcts on cerebral MRI, (2) the level of blood pulse pressure, (3) the diagnosis of iTTP. CONCLUSION At the acute phase of iTTP or HUS, both symptomatic and covert ischemic lesions are detected in one third of cases on MRI. Diagnosis of iTTP and the presence of old infarcts on MRI are associated with the occurrence of such acute lesions as well as increased blood pulse pressure, that may represent a potential target to further improve the therapeutic management of these conditions.
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Affiliation(s)
- Lisa Neuman
- Centre NeuroVasculaire Translationnel, Centre de Référence CERVCO, Département de Neurologie, Hôpital Lariboisière, GHU AP-HP Nord, Université de Paris, Paris, France
| | - Adrien Joseph
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Raïda Bouzid
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
| | - Mickael Lescroart
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Eric Mariotte
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Stéphane Ederhy
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Department of Cardiology, Saint-Antoine Hospital, GRC N° 27, Sorbonne Université, AP-HP, 75012, Paris, France
| | - Sophie Tuffet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Department of Clinical Pharmacology, Clinical Research Platform of East of Paris (Unité de Recherche Clinique (URCEST), Centre de Recherche Clinique (CRCEST), Centre de Ressources Biologiques (CRB.APHP-SU), Hôpital Saint Antoine, AP-HP, Paris, France
| | - Jean-Luc Baudel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Département de Médecine Interne, Hôpital Universitaire de Rouen, Université de Normandie, Rouen, France
- Service de Réanimation Médicale, CHU Charles Nicolle, Rouen, France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'Immunologie Clinique, CHU Saint-Louis, Université de Paris, Paris, France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Médicale, CHU Charles Nicolle, Rouen, France
| | - François Provôt
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Albert-Calmette, Lille, France
| | - Antoine Neel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Médicale, CHU Hôtel-Dieu, Nantes, France
| | - Frédéric Pène
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de médecine intensive-réanimationHôpital Cochin, APHP Centre &, Université de Paris, Paris, France
| | - Yahsou Delmas
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, CHU de Bordeaux, Bordeaux, France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Nord, Amiens, France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'hémaphérèse et d'autotransfusion, Hôpital la Conception, Marseille, France
| | - Alain Wynckel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - Pierre Perez
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Polyvalente, CHU de Nancy, Nancy, France
| | - Christelle Barbet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpitaux Bretonneau et Clocheville, Tours, France
| | - Jean-Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpitaux Bretonneau et Clocheville, Tours, France
| | - Valérie Chatelet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Université, Caen, France
| | - Jean-Michel Rebibou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, CHU de Dijon, Dijon, France
| | - Mario Ojeda-Uribe
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'Hématologie et de Thérapie Cellulaire, Groupe Hospitalier Region Mulhouse-Sud-Alsace (GHRMSA), Mulhouse, France
| | - Cécile Vigneau
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Inserm, EHESP, Irset (Institut de Recherche en SantéEnvironnement et Travail)-UMR_S 1085, Université de Rennes, CHU Rennes, 35000, Rennes, France
| | - Laurent Mesnard
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Biochimie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP, Paris, France.
- Service d'Hématologie, Centre National de Référence des Microangiopathies Thrombotiques, AP-HP.6 and Sorbonne-Université, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138, Paris, France.
| | - Hugues Chabriat
- Centre NeuroVasculaire Translationnel, Centre de Référence CERVCO, Département de Neurologie, Hôpital Lariboisière, GHU AP-HP Nord, Université de Paris, Paris, France
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6
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Laboux T, Maanaoui M, Allain F, Boulanger E, Denys A, Gibier JB, Glowacki F, Grolaux G, Grunenwald A, Howsam M, Lancel S, Lebas C, Lopez B, Roumenina L, Provôt F, Gnemmi V, Frimat M. Hemolysis is associated with altered heparan sulfate of the endothelial glycocalyx and with local complement activation in thrombotic microangiopathies. Kidney Int 2023:S0085-2538(23)00327-7. [PMID: 37164260 DOI: 10.1016/j.kint.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 05/12/2023]
Abstract
The complement system plays a key role in the pathophysiology of kidney thrombotic microangiopathies (TMA), as illustrated by atypical hemolytic uremic syndrome. But complement abnormalities are not the only drivers of TMA lesions. Among other potential pathophysiological actors, we hypothesized that alteration of heparan sulfate (HS) in the endothelial glycocalyx could be important. To evaluate this, we analyzed clinical and histological features of kidney biopsies from a monocentric, retrospective cohort of 72 patients with TMA, particularly for HS integrity and markers of local complement activation. The role of heme (a major product of hemolysis) as an HS-degrading agent in vitro, and the impact of altering endothelial cell (ECs) HS on their ability to locally activate complement were studied. Compared with a positive control, glomerular HS staining was lower in 57 (79%) patients with TMA, moderately reduced in 20 (28%), and strongly reduced in 37 (51%) of these 57 cases. Strongly reduced HS density was significantly associated with both hemolysis at the time of biopsy and local complement activation (C3 and/or C5b-9 deposits). Using primary endothelial cells (HUVECs, Glomerular ECs), we observed decreased HS expression after short-term exposure to heme, and that artificial HS degradation by exposure to heparinase was associated with local complement activation. Further, prolonged exposure to heme modulated expression of several key genes of glycocalyx metabolism involved in coagulation regulation (C5-EPI, HS6ST1, HS3ST1). Thus, our study highlights the impact of hemolysis on the integrity of endothelial HS, both in patients and in endothelial cell models. Hence, acute alteration of HS may be a mechanism of heme-induced complement activation.
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Affiliation(s)
- Timothée Laboux
- University Lille, CHU Lille, Nephrology Department, Lille, France; University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Lille, France.
| | - Mehdi Maanaoui
- University Lille, CHU Lille, Nephrology Department, Lille, France; University Lille, Inserm, Institut Pasteur de Lille, U1190 - EGID, Lille, France
| | | | - Eric Boulanger
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Lille, France
| | - Agnès Denys
- University Lille, CNRS, UMR 8576 - UGSF, Lille, France
| | - Jean-Baptiste Gibier
- Univ. Lille, Pathology Department, F-59000, Lille, France; University Lille, Inserm, US1172, Lille, France
| | | | - Gaëlle Grolaux
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Lille, France
| | - Anne Grunenwald
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Mike Howsam
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Lille, France
| | - Steve Lancel
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Lille, France
| | - Céline Lebas
- University Lille, CHU Lille, Nephrology Department, Lille, France
| | | | - Lubka Roumenina
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - François Provôt
- University Lille, CHU Lille, Nephrology Department, Lille, France
| | - Viviane Gnemmi
- Univ. Lille, Pathology Department, F-59000, Lille, France; University Lille, CNRS, Inserm, U9020-UMR-S 1277, Lille, France
| | - Marie Frimat
- University Lille, CHU Lille, Nephrology Department, Lille, France; University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Lille, France.
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7
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Laboux T, Maanaoui M, Allain F, Gibier JB, Lopez B, Denys A, Grolaux G, Lebas C, Provôt F, Lancel S, Hazzan M, Boulanger E, Gnemmi V, Frimat M. MO071: Hemolysis is Associated with Altered Heparan Sulfate of Endothelial Glycocalyx And with Local Complement Activation in Thrombotic Microangiopathies. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac063.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The complement system plays a key role in the pathophysiology of renal thrombotic microangiopathies (TMA), as illustrated by atypical hemolytic uremic syndrome (HUS) characterized by a high rate of mutations in complement proteins. However, complement abnormalities are not fully sufficient to drive to TMA lesions. Among other suspected pathophysiological actors, we hypothesize that the alteration of heparan sulfate (HS) of endothelial glycocalyx—a cell membrane glycoaminoglycans and glycoproteins matrix able of regulating complement by binding factor H—may play a significant role.
METHOD
We recorded clinical and histological features in native kidney biopsies from a monocentric retrospective cohort of 72 TMA-patients. Glomerular HS integrity and local complement activation markers (C3 and C5b9 staining) were analyzed by immunofluorescence (IF) and immunohistochemistry. Using an in vitro endothelial cells model (human umbilical vein endothelial cells, HUVECs), we studied the impact of heme exposure (30’, 37°C)—a major product of hemolysis—on endothelial HS integrity by IF and flow cytometry (FCM). Heme-induced HS disruption was studied by slot blot of HS core-protein Syndecan (SDC) 1 and 4 in cells supernatant. Artificial enzymatic degradation of HS was achieved after exposure of HUVECs to a combination of heparinases I, II and III (30', 37°C), and we studied its effect on the ability of the HS-free cell membrane to locally activate complement by analyzing C3b deposition by IF and FCM, and the release of complement anaphylatoxins C3a and soluble attack complex membrane s-C5b9 in the cell supernatants by ELISA. The HS remodeling process induced by heme exposure (16 h, 37°C) were indirectly analyzed via a transcriptional profiling of the expression of the key enzymes involved in HS synthesis by RT–qPCR.
RESULTS
Glomerular HS staining decreased in 57 TMA-patients (79%), moderately (2+) or strongly (0–1+) in 20 (28%) and 37 (51%) cases, respectively. Reduced HS density was significantly associated with hemolysis at the time of biopsy (P = 0.008) and local complement activation (C3d and/or C5b-9 deposits, P < 0.001). Hemolysis at the time of biopsy was associated with more severe glomerular TMA lesions (P = 0.025), the presence of vascular thrombi (P = 0.007) and local complement activation (C3d and/or C5b-9 deposits, P = 0.006). On endothelial cells (HUVECs), we confirmed that HS expression was decreased after heme exposure in IF and FCM (P < 0.01). Coherently, HS core-proteins SDC-1 and 4 were significantly increased in HUVECs supernatant (P < 0.05), suggesting a negative heme-driven impact on HS integrity. Artificial HS degradation increased C3b membrane deposition on HUVECs on average ∼ 3 fold by FCM and ∼ 10 by IF, and we observed an increased release of complement C3a and s-C5b9 in cells supernatant (P < 0.05). Finally, we showed that prolonged exposure to heme induced a decreased of genic expression of C5-Epimerase and an increase in 6-OST1 and 3-OST1 expression (P < 0.05), the very three crucial genes of HS remodeling specifically and sequentially involved in the generation of anti-thrombin pattern, the well-known key regulator of the HS/heparin-driven inhibition of coagulation.
CONCLUSION
This study highlights the impact of hemolysis on the integrity of endothelial glycocalyx HS, both in kidney biopsy of TMA-patients and in an in vitro endothelial cell model, and suggests that acute alteration of HS is a mechanism of heme-induced complement activation. The endothelial glycocalyx appears then to be an important key in the understanding of TMA and could lead to the development of therapeutics targeting its preservation and/or reconstitution, in order to better control the disease.
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Affiliation(s)
- Timothée Laboux
- Lille University Hospital, Nephrology and Kidney Transplantation, Lille, France
- University of Lille, UMR 1167-RID-AGE, Lille, France
| | - Mehdi Maanaoui
- Lille University Hospital, Nephrology and Kidney Transplantation, Lille, France
- University of Lille, UMR 1190, Lille, France
| | | | - Jean-Baptiste Gibier
- Lille University Hospital, Department of Pathology, Lille, France
- University of Lille, INSERM US1172, Lille, France
| | - Benjamin Lopez
- Lille University Hospital, Institut of Immunology, Lille, France
| | - Agnes Denys
- University of Lille, CNRS, UMR 8576, UGSF, Lille, France
| | | | - Celine Lebas
- Lille University Hospital, Nephrology and Kidney Transplantation, Lille, France
| | - François Provôt
- Lille University Hospital, Nephrology and Kidney Transplantation, Lille, France
| | - Steve Lancel
- University of Lille, UMR 1167-RID-AGE, Lille, France
| | - Marc Hazzan
- Lille University Hospital, Nephrology and Kidney Transplantation, Lille, France
| | | | - Viviane Gnemmi
- Lille University Hospital, Department of Pathology, Lille, France
- University of Lille, CNRS, U9020-UMR-S 1277, Lille, France
| | - Marie Frimat
- University of Lille, UMR 1167-RID-AGE, Lille, France
- Lille University Hospital, Nephrology and Kidney Transplantation, Lille, France
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Khedjat K, Lenain R, Hamroun A, Baes D, Top I, Labalette M, Lopez B, Van Triempont M, Provôt F, Frimat M, Gibier JB, Hazzan M, Maanaoui M. Post-Transplantation Early Blood Transfusion and Kidney Allograft Outcomes: A Single-Center Observational Study. Transpl Int 2022; 35:10279. [PMID: 35368637 PMCID: PMC8971186 DOI: 10.3389/ti.2022.10279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
The association between blood transfusion and the occurrence of de novo HLA donor specific antibodies (DSA) after kidney transplantation remains controversial. In this single-center observational study, we examined the association between early blood transfusion, i.e. before 1-month post-transplantation, and the risk of DSA occurrence, using Luminex based-methods. In total, 1,424 patients with a minimum of 1-month follow-up were evaluated between January 2007 and December 2018. During a median time of follow-up of 4.52 years, we observed 258 recipients who had at least one blood transfusion during the first month post-transplantation. At baseline, recipients in the transfused group were significant older, more sensitized against HLA class I and class II antibodies and had a higher 1-month serum creatinine. Cox proportional hazards regression analyses did not show any significant association between blood transfusion and the risk of de novo DSA occurrence (1.35 [0.86–2.11], p = 0.19), the risk of rejection (HR = 1.33 [0.94–1.89], p = 0.11), or the risk of graft loss (HR = 1.04 [0.73–1.50], p = 0.82). These data suggest then that blood transfusion may not be limited when required in the early phase of transplantation, and may not impact long-term outcomes.
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Affiliation(s)
| | - Rémi Lenain
- Department of Nephrology, CHU Lille, Lille, France.,INSERM UMR 1246 -SPHERE, Nantes University, Tours University, Nantes, France
| | - Aghilès Hamroun
- Department of Nephrology, CHU Lille, Lille, France.,Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, Inserm, Paris-Saclay University, Versailles Saint Quentin University, Villejuif, France
| | | | - Isabelle Top
- CHU Lille, Institut d'Immunologie, Bd du Professeur Jules Leclercq, Lille, France.,Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Myriam Labalette
- CHU Lille, Institut d'Immunologie, Bd du Professeur Jules Leclercq, Lille, France.,Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Benjamin Lopez
- Laboratoire de Biologie Médicale, CH Dunkerque, Dunkerque, France
| | | | | | - Marie Frimat
- Department of Nephrology, CHU Lille, Lille, France
| | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis", Lille, France
| | - Marc Hazzan
- Department of Nephrology, CHU Lille, Lille, France
| | - Mehdi Maanaoui
- Department of Nephrology, CHU Lille, Lille, France.,Univ. Lille, Inserm, CHU Lille, Institut Pasteur Lille, U1190-EGID, Lille, France
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9
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Maanaoui M, Baes D, Hamroun A, Khedjat K, Vuotto F, Faure E, Lopez B, Bouyé S, Caes T, Lionet A, Lebas C, Provôt F, Glowacki F, Gibier JB, Lenain R, Hazzan M. Association between acute graft pyelonephritis and kidney graft survival: A single-center observational study. Am J Transplant 2021; 21:3640-3648. [PMID: 34057805 DOI: 10.1111/ajt.16703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 01/25/2023]
Abstract
The association between acute graft pyelonephritis (AGPN) and graft failure in kidney transplant recipients (KTR) remains controversial. In this single-center observational study, we aimed to assess the incidence of AGPN as a time-dependent posttransplantation event. We also examined the association between the diagnosis of AGPN and graft outcomes. In total, we evaluated 1480 patients who underwent kidney transplantation between January 2007 and December 2017. During a median follow-up of 5.04 years, we observed 297 AGPN episodes that occurred in 158 KTR. To evaluate the association between AGPN and clinical outcomes, we performed Cox proportional hazards regression analyses in which AGPN was entered as a time-dependent covariate. AGPN was independently associated with an increased risk of graft loss (hazard ratio = 1.66; 95% confidence interval [CI]: 1.05-2.64, p < .03) and a persistently decreased eGFR (fixed effect on intercept: -2.29 ml/min/1.73 m2 ; 95% CI: from -3.23 to -1.35, p < .01). However, neither mortality nor biopsy-proven acute rejection was found to correlate with AGPN. Moreover, recurrent AGPN episodes did not appear to have an additive detrimental impact on graft loss. These data represent a promising step in understanding whether AGPN prevention may decrease the risk of graft loss in KTR.
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Affiliation(s)
- Mehdi Maanaoui
- Department of Nephrology, CHU Lille, Lille, France.,Université de Lille, Inserm, CHU Lille, Institut Pasteur Lille, Lille, France
| | | | - Aghilès Hamroun
- Department of Nephrology, CHU Lille, Lille, France.,Clinical Epidemiology Team, CESP, Center for Research in Epidemiology and Population Health, Inserm, Paris-Saclay University, Versailles Saint Quentin University, Villejuif, France
| | | | - Fanny Vuotto
- Service de Maladies Infectieuses, CHU Lille, Lille, France
| | - Emmanuel Faure
- Service de Maladies Infectieuses, CHU Lille, Lille, France
| | - Benjamin Lopez
- Laboratoire de Biologie Médicale, CH Dunkerque, Dunkerque, France
| | | | - Thomas Caes
- Department of Urology, CHU Lille, Lille, France
| | | | - Céline Lebas
- Department of Nephrology, CHU Lille, Lille, France
| | | | | | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Regional and University Hospital Center of Lille, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis", Lille University, Lille, France
| | - Rémi Lenain
- Department of Nephrology, CHU Lille, Lille, France
| | - Marc Hazzan
- Department of Nephrology, CHU Lille, Lille, France
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10
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Hamroun A, Lenain R, Maanaoui M, Provôt F, Ceballos-Picot I, Douillard C, Lionet A. The Case | A man with acute bilateral urolithiasis. Kidney Int 2021; 99:1029-1030. [PMID: 33745538 DOI: 10.1016/j.kint.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Aghilès Hamroun
- Lille University, Lille University Hospital Center of Lille, Nephrology Department, F-59037, Lille, France; Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, National Institute of Health and Medical Research (INSERM), Villejuif, France.
| | - Rémi Lenain
- Lille University, Lille University Hospital Center of Lille, Nephrology Department, F-59037, Lille, France
| | - Mehdi Maanaoui
- Lille University, Lille University Hospital Center of Lille, Nephrology Department, F-59037, Lille, France; INSERM U1190, Translational Research for Diabetes, Lille, France
| | - François Provôt
- Lille University, Lille University Hospital Center of Lille, Nephrology Department, F-59037, Lille, France
| | - Irène Ceballos-Picot
- Metabolic Biochemistry Laboratory, Hospital Necker Enfants Malades, APHP, University Paris Descartes, Paris, France
| | - Claire Douillard
- Medical Reference Center for Inherited Metabolic Diseases, CHU Lille, France
| | - Arnaud Lionet
- Lille University, Lille University Hospital Center of Lille, Nephrology Department, F-59037, Lille, France
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11
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Hamroun A, Gibier JB, Maanaoui M, Lionet A, Gnemmi V, Bouyé S, Fantoni JC, Averland B, Antoine C, Lenain R, Hazzan M, Provôt F. Successful Reuse of Kidney Graft After Early Recurrence of Primary Focal and Segmental Glomerulosclerosis. Am J Kidney Dis 2021; 78:897-901. [PMID: 34118304 DOI: 10.1053/j.ajkd.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/26/2021] [Indexed: 11/11/2022]
Abstract
Primary focal and segmental glomerulosclerosis (FSGS) frequently recurs after transplantation and is associated with a poor prognosis. We describe here the successful kidney graft reuse in an adult recipient, 8 months after early primary FSGS recurrence resistant to all available therapeutics. Patient 1, a 23-year-old man, followed for kidney failure secondary to primary FSGS, was first transplanted in 2018 with a deceased donor graft. Unfortunately, we observed an immediate recurrence of biopsy-proven primary FSGS. After 4 lines of treatment (intravenous cyclosporine+corticosteroids, plasma exchanges, immunoadsorption, and rituximab), the patient was still highly nephrotic and kidney function was slowly deteriorating. After approval from both the patient and the health authority (Biomedicine Agency), the graft was detransplanted 8 months after transplantation and reimplanted in patient 2, a 78-year-old nonimmunized and anephric recipient (bi-nephrectomy 2 years previously for bilateral renal carcinoma). We observed immediate kidney function and progressive resolution of proteinuria (serum creatinine of 1.2mg/dL and proteinuria of 0.1 g/d 1 year later). Biopsies performed after surgery showed persistent FSGS lesions with a decrease in overall foot-process effacement. To our knowledge, this is the first reported case showing that kidney graft transfer may still be a viable option for refractory primary FSGS several months after transplantation.
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Affiliation(s)
- Aghilès Hamroun
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France; Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, Villejuif, France.
| | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Lille University, Regional and University Hospital Center of Lille, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis," F-59037 Lille, France
| | - Mehdi Maanaoui
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France; INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Arnaud Lionet
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Viviane Gnemmi
- Department of Pathology, Pathology Institute, Lille University, Regional and University Hospital Center of Lille, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis," F-59037 Lille, France
| | - Sébastien Bouyé
- Urology, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | | | | | - Corinne Antoine
- Agence de la Biomédecine, Saint-Denis, France; Nephrology and Kidney Transplantation, Hospital Saint Louis, Paris, France
| | - Rémi Lenain
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France; INSERM UMR1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Marc Hazzan
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - François Provôt
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France
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12
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Decaestecker A, Hamroun A, Provôt F, Rondeau E, Faguer S, Deltombe C, Sallee M, Grange S, Azar R, Dimitri T, Forestier A, Rebibou JM, Cartery C. MO163FIFTY-NINE CASES OF CANCER-ASSOCIATED THROMBOTIC MICROANGIOPATHY: TYPICAL PRESENTATION AND TREATMENT. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Thrombotic microangiopathy (TMA) are a heterogeneous group of diseases characterized by mechanical hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. In patients with cancer, TMAs are frequently induced by antineoplastic drugs but may be related to the malignant disease itself. Small series have reported poor prognosis. Only chemotherapy succeeded in lengthening life expectancy, even if few reports have described efficacy of therapeutic plasma exchange (TPE) or Eculizumab. Complement regulation was not studied in these publications, as the pathophysiology was rarely explored. In this study, we investigated retrospectively 59 cases of cancer-associated TMAs, to describe characteristics at diagnosis and efficacy of treatment.
Method
We conducted a retrospective multicentric observational study including all patients with a diagnosis of cancer-associated TMA, hospitalized in nephrological intensive care units (members of the French Intensive Care Network), between 2008 and 2019. We excluded patients receiving chemotherapy known to cause TMAs. We analyzed clinical and biological characteristics at diagnosis. We reported complement analysis when available. We defined four distinct treatment groups: No treatment (N), Plasmapheresis (P), Chemotherapy with or without chemotherapy (C+P), Eculizumab with or without Chemotherapy or Plasmapheresis (E+C+P). Renal remission and global survival were compared according to treatment group.
Results
We included 59 patients admitted to intensive care units for cancer-associated TMA. Twenty patients had a past history of cancer. Fifty percent was female, and mean age was 62.8 years. The primary cancer was breast (23.7%), lung (18.6%), stomach (10.2%), and prostate (10.2%). Adenocarcinoma was the most frequent histologic subtype (47.5%). The cancer was metastatic in almost cases (89.8%). At presentation, TMA manifestations were pulmonary (57.6%), neurologic (49.2%), bone pain (30.5%), and disseminated intravascular coagulopathy (DIVC) (55.9%). Forty-one patients had a bone marrow aspiration and/or biopsy. Among them, medullar metastases were found in 20 patients (48.7%). We observed low C3 in 14.7% of cases suggesting an activation of the alternative pathway. No genetic analysis was performed. Only one patient had an undetectable ADAMTS13 <5% without inhibitory ADAMTS13 antibodies. Renal failure was seen in 28 patients whom 63.7% had severe grade 3 acute kidney injury. Renal biopsy was performed in 6 patients with severe arteriolar TMA lesions. Seventeen patients had no treatment (N), fifteen patients were treated with TPE (P), twenty patients received chemotherapy with TPE (C+P), and seven patients received Eculizumab with TPE (E). Hematological and renal remission was not significantly different between treatment groups (p=0.74 and p=0.10 respectively). Mortality was high, 52.5% at one month, 90% after one year of follow-up. The median duration of survival was 27 days [8.5;95.5] in patients who received treatment. Survival was improved in (C+P) and (E+C+P) groups, significantly (p<0.0001).
Conclusion
We report the largest series of cancer-associated TMAS since the advent of Eculizumab for the treatment of HUS. Typical presentation included old age, bone pain, dyspnea, and DIVC. These symptoms, when associated with TMA, should therefore suggest a diagnosis of cancer. Bone marrow aspiration or biopsy led to diagnosis of cancer in half of cases, and should be systematically performed to rapidly confirm diagnosis. The overall prognosis remained dramatically poor, with a mortality rate of 90% in the first year. Chemotherapy is probably the most efficient therapy to delay the death. C3 serum level was decreased in only 7 patients, suggesting that the pathophysiology of cancer-associated TMA is not linked to complement activation. As a result, neither TPE nor Eculizumab improved survival rate.
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13
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Petit V, Bonnafous P, Fages V, Gautheret-Dejean A, Engelmann I, Baras A, Hober D, Gérard R, Gibier JB, Leteurtre E, Glowacki F, Moulonguet F, Decaestecker A, Provôt F, Chamley P, Faure E, Prusty BK, Maanaoui M, Hazzan M. Donor-to-recipient transmission and reactivation in a kidney transplant recipient of an inherited chromosomally integrated HHV-6A: Evidence and outcomes. Am J Transplant 2020; 20:3667-3672. [PMID: 32428994 DOI: 10.1111/ajt.16067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/25/2023]
Abstract
Human herpesvirus (HHV)-6A can be inherited and chromosomally integrated (iciHHV-6A), and donor-to-recipient transmission has been reported in solid organ transplant. However, when HHV-6A reactivation happens after transplant, the source of HHV-6A is often not evident and its pathogenicity remains unclear. Here, we present an exhaustive case of donor-to-recipient transmission and reactivation of iciHHV-6A through kidney transplant. The absence of HHV-6A genome from the nails of the recipient excluded a recipient-related iciHHV-6A. Viral loads > 7 log10 copies/106 cells in donor blood samples and similarities of U38, U39, U69, and U100 viral genes between donor, recipient, and previously published iciHHV-6A strains are proof of donor-related transmission. Detection of noncoding HHV-6 snc-RNA14 using fluorescence in situ hybridization analysis and immunofluorescence staining of HHV-6A gp82/gp105 late proteins on kidney biopsies showed evidence of reactivation in the transplanted kidney. Because HHV-6A reactivation can be life threatening in immunocompromised patients, we provide several tools to help during the complete screening and diagnosis.
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Affiliation(s)
- Vivien Petit
- Service de Néphrologie, CHU Lille, Lille, France
| | - Pascale Bonnafous
- Sorbonne Department, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), THERAVIR Team, Paris, France
| | - Victor Fages
- Service de Néphrologie, CHU Lille, Lille, France
| | - Agnès Gautheret-Dejean
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, France.,Faculté de Pharmacie de Paris, Laboratoire de Microbiologie, Université de Paris, UMR-S 1139 (3PHM), Paris, France
| | - Ilka Engelmann
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Agathe Baras
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Didier Hober
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Romain Gérard
- Gastroenterology Department, University of Lille, CHU Lille, Lille, France
| | - Jean-Baptiste Gibier
- Centre de Biologie Pathologie, Institute of Pathology, CHU Lille, Lille, France.,University of Lille, INSERM UMR1172, Lille, France
| | - Emmanuelle Leteurtre
- Centre de Biologie Pathologie, Institute of Pathology, CHU Lille, Lille, France.,University of Lille, INSERM UMR1172, Lille, France
| | - François Glowacki
- Service de Néphrologie, CHU Lille, Lille, France.,UnivErsity of Lille, Lille, France
| | | | | | | | - Paul Chamley
- Service de Néphrologie, CHU Lille, Lille, France
| | - Emmanuel Faure
- Service de Maladies Infectieuses, CHU Lille, Lille, France.,U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, CHU Lille, UnivErsity of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Bhupesh K Prusty
- Institut für Virologie und Immunobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Mehdi Maanaoui
- Service de Néphrologie, CHU Lille, Lille, France.,University of Lille, INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, CHU Lille, Lille, France
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14
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Ville S, Ydee A, Garandeau C, Canet E, Tissot A, Cantarovich D, Frémeaux-Bacchi V, Mariani-Kurkdjian P, Provôt F, Fakhouri F. Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome in solid organ transplant recipients. Kidney Int 2020; 96:1423-1424. [PMID: 31759490 DOI: 10.1016/j.kint.2019.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Simon Ville
- Centre de Recherche en Transplantation et en Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France; Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France
| | - Amandine Ydee
- Department of Nephrology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Claire Garandeau
- Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuel Canet
- Intensive Medicine Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Adrien Tissot
- Centre de Recherche en Transplantation et en Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France; Department of Pneumology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Diego Cantarovich
- Centre de Recherche en Transplantation et en Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France; Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France
| | - Véronique Frémeaux-Bacchi
- INSERM UMR S1138, Complément et Maladies, Centre de recherche des Cordeliers, and Laboratory of Immunology, Hôpital Européen Georges Pompidou, Paris, France
| | | | - François Provôt
- Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France
| | - Fadi Fakhouri
- Centre de Recherche en Transplantation et en Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France; Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France.
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15
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Hamroun A, Lenain R, Provôt F, Maanaoui M, Lionet A. An unusual case of multiple bilateral kidney tumors. J Nephrol 2020; 34:1783-1784. [PMID: 33113122 DOI: 10.1007/s40620-020-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Aghilès Hamroun
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France. .,Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, National Institute of Health and Medical Research, Villejuif, France.
| | - Rémi Lenain
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
| | - François Provôt
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
| | - Mehdi Maanaoui
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France.,INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Arnaud Lionet
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
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16
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Pereira LCV, Ercig B, Kangro K, Jamme M, Malot S, Galicier L, Poullin P, Provôt F, Presne C, Kanouni T, Servais A, Benhamou Y, Daguindau N, Vanhoorelbeke K, Azoulay E, Veyradier A, Coppo P. Understanding the Health Literacy in Patients With Thrombotic Thrombocytopenic Purpura. Hemasphere 2020; 4:e462. [PMID: 32885148 PMCID: PMC7430230 DOI: 10.1097/hs9.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Following an acute thrombotic thrombocytopenic purpura (TTP) episode, patients are at risk for relapse, and a careful long-term follow-up is needed. Adherence to the follow-up by patients implies a good understanding of the disease. However, TTP literacy in patients is currently unknown. To explore the TTP literacy in patients and identify factors associated with poor disease understanding, a questionnaire was developed focusing on patient's characteristics, knowledge about TTP and patients’ actions in an emergency. The questionnaire was presented to 120 TTP patients in remission from the French National Registry for Thrombotic Microangiopathies. TTP literacy was low in 24%, intermediate in 43% and high in 33% of the patients. Low TTP literacy was associated with older age and low education level. Among the knowledge gaps identified, few patients knew that plasma exchange in acute phase is mandatory and has to be done daily (39%), 47% of participants did not consider themselves at risk for relapse, and 30% of women did not know that pregnancy exposes them to a greater risk of relapse. Importantly, few patients responded about life-saving actions in an emergency. Hence, the design of educational material should pay special attention to the age and education level of the target population focusing on the events leading to TTP, the importance of the emergency treatment, controllable predisposing factors for TTP development and patient attitude in an emergency.
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Affiliation(s)
- Leydi C Velasquez Pereira
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Bogac Ercig
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Kadri Kangro
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Matthieu Jamme
- Médecine Intensive Réanimation-Néphrologie, CH de Poissy Saint Germain en Laye, Poissy, Centre de Recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France
| | - Sandrine Malot
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Université Paris-Diderot, Paris, France.,National Reference Center for Castleman Disease (CRMdC), Paris, France.,EA3518, Université Paris-Diderot, Paris, France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Department of Apheresis, Regional Reference Center for Thrombotic Microangiopathy, Aix-Marseille University, CHU de Marseille-Hôpital de la Conception, Marseille, France
| | - François Provôt
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Service de Néphrologie, Hôpital Albert Calmette, Lille, France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Service de Néphrologie, Hôpital Sud, CHU Amiens, Amiens, France
| | - Tarik Kanouni
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Service d'Hématologie, CHU Saint Eloi, Montpellier, France
| | - Aude Servais
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Service de Néphrologie-Dialyse Adulte, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Service de Médecine Interne, U1096, UNIROUEN, Normandie Universitaire, Rouen, France
| | | | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,Medical ICU, Saint-Louis Hospital, AP-HP, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,service d'Hématologie Biologique, Groupe Hospitalier Saint-Louis-Lariboisière, AP-HP, Université Paris-Diderot, Paris, France.,EA3518 Recherche Clinique en Hématologie, Immunologie et Transplantation, Équipe Microangiopathies Thrombotiques, ADAMTS13 et Facteur Willebrand, Institut de Recherche Saint-Louis, Université Paris-Diderot, Paris, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France.,service d'Hématologie et Sorbonne Université, AP-HP.6, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris-Diderot, Paris, France
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17
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Laboux T, Maanaoui M, Gibier J, Ydée A, Provôt F, Boulanger E, Allain F, Hazzan M, Gnemmi V, Frimat M. Le syndrome hémolytique et urémique atypique est associé à une dégradation du glycocalyx endothélial glomérulaire et artériolaire. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Baes D, Nicolazzi P, Moulonguet F, Simphal P, Hazzan M, Maanaoui M, Provôt F. P0240ACQUIRED THROMBOTIC THROMBOCYTOPENIC PURPURA IN HIV POSITIVE PATIENTS SUCCESSFULLY TREATED WITH CAPLACIZUMAB: ABOUT TWO CASES. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Acquired thrombotic thrombocytopenic purpura (aTTP) is a thrombotic microangiopathy still nowadays associated with a high risk of death. Standards of care included at first the association of plasmatic exchanges, Rituximab and steroids. The emergence of Caplacizumab, a nanobody targeting the A1 receptor of Von Willebrand Factor (VWF), significantly changed the prognosis of the disease. Thrombocytopenia is frequent in HIV positive patients, and aTTP is frequently considered. Prevalence of HIV positive in aTTP patients ranges from less than 1% in western countries, up to more than 50% in African countries. The pathophysiology still remains partially understood, leading to the development of autoantibodies targeting the ADAMTS13 metalloprotease. For now, no specific recommendations are available, and standards of care consist in treating HIV positive patient the same as other aTTP patients. We present the first description of two HIV positive patients, successfully treated with caplacizumab.
Method
We report there two cases of black women, respectively aged 31 (Patient 1) and 52 years old (Patient 2), both positive for HIV for several years. The first one had stopped any antiviral treatment few months ago, and had a positive blood viral load of 110764 copies/ml. Her CD4+ rate was 30/mm3. The second one was under antiviral medication, with a negative viral load and a CD4+ rate of 295/mm3. Both were admitted in our department because of low platelet levels and hemolysis, associated with inflammatory triggers. Bacteriema for Streptococcus mitis was discovered on admission in Patient 1 and Patient 2, who had a long-term follow-up for Still disease, presented with a flare-up.
Results
Both patients had positive anti-ADAMTS13 autoantibodies (Patient 1: titer 42 UI/ml, Patient 2: 45 UI/ml), with undetectable ADAMTS-13 activities. They were treated with plasmatic exchanges until platelets levels reached over 150 G/L, steroids 1.5 mg/kg/j, Rituximab 375 mg/m2 at day 1, 4 and 8 and finally caplacizumab 10 mg before the 2nd plasmatic exchange and every day until the ADAMTS13 activity reached over 20%. Antiviral therapy and antibiotics were initiated in Patient 1 and antiviral therapy was maintained in Patient 2. The evolution was promptly favorable with normalization of platelets levels at Day 4 in Patient 1, and Day 15 in Patient 2. Patient 1 stopped caplacizumab at Day 12 and Patient 2 at day 17, when ADAMTS 13 reached over 20%. None of them relapsed after treatment, with a respective follow-up of 4 and 2 months.
Conclusion
Caplacizumab seems to be a safe and efficient treatment for aTTP in HIV positive patients.
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Affiliation(s)
| | | | | | | | - Marc Hazzan
- CHU Lille, Department of Nephrology, Lille, France
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19
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Affiliation(s)
- Aghiles Hamroun
- Regional and University Hospital Center of Lille, Lille, France
| | | | - François Provôt
- Regional and University Hospital Center of Lille, Lille, France
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20
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Vermandel M, Debruyne P, Beron A, Devos L, Talbot A, Legrand JF, Provôt F, Lion G. Management of Patients with Renal Failure Undergoing Dialysis During 131I Therapy for Thyroid Cancer. J Nucl Med 2020; 61:1161-1170. [PMID: 31924716 DOI: 10.2967/jnumed.119.232017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022] Open
Abstract
Radioactive iodine (131I) therapy may be used to treat thyroid cancer in end-stage renal disease patients who undergo hemodialysis. Because iodine uses predominantly renal clearance, treatment management in hemodialysis patients may be problematic, and no formal recommendations on hemodialysis currently exist. This work details our experience with treating thyroid cancer with iodine in chronic renal failure patients who require hemodialysis and details the dosimetry results obtained during treatment to ensure that the dose to the bone marrow (BM) was acceptable. Methods: We treated 6 patients in the metabolic radiotherapy unit after thyroid stimulation. Two hemodialysis sessions in the metabolic radiotherapy unit were performed at 42 and 90 h after radiopharmaceutical administration. BM toxicity was estimated with activity measurements from blood samples and with whole-body measurements that were regularly repeated during hospitalization and measured with a γ-counter. The patients underwent thyroid and hematologic monitoring to assess treatment efficacy and therapeutic toxicity in the short, medium, and long term. Results: Whole-body activity was reduced on average by 66.7% (range, 60.1%-71.5%) after the first dialysis session and by 53.3% (range, 30.4%-67.8%) after the second. The mean estimated total absorbed dose to the BM was 0.992 Gy for all patients (range, 0.431-2.323 Gy). We did not observe any significant hematologic toxicity, and the clinical, biologic, and ultrasound test results confirmed the success of ablative treatment for most patients. Conclusion: In hemodialysis patients with thyroid cancer, an 131I activity approximately 30% lower than the nominal dose appears to strike an appropriate balance between absence of BM toxicity and therapeutic efficacy. To avoid overirradiation, we recommend pretherapeutic dosimetry studies for metastatic patients to calculate the amount of activity to be administered. We also recommend dosimetry monitoring during the hemodialysis sessions performed after therapeutic dose administration and under the same conditions.
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Affiliation(s)
- Maximilien Vermandel
- Nuclear Medicine Department, Hospital Salengro, CHU de Lille, Lille, France .,Medical Physics Department, CHU de Lille, Lille, France.,Neurosurgery Department, Hospital Salengro, CHU de Lille, Lille, France.,Onco-ThAI, INSERM U1189, Université de Lille, CHU de Lille, Lille, France
| | - Pauline Debruyne
- Nuclear Medicine Department, Hospital Salengro, CHU de Lille, Lille, France
| | - Amandine Beron
- Nuclear Medicine Department, Hospital Huriez, CHU de Lille, Lille, France; and
| | - Laura Devos
- Nuclear Medicine Department, Hospital Salengro, CHU de Lille, Lille, France.,Medical Physics Department, CHU de Lille, Lille, France
| | - Antoine Talbot
- Medical Physics Department, CHU de Lille, Lille, France.,Neurosurgery Department, Hospital Salengro, CHU de Lille, Lille, France
| | | | - François Provôt
- Nephrology Department, Hospital Huriez, CHU de Lille, Lille, France
| | - Georges Lion
- Nuclear Medicine Department, Hospital Salengro, CHU de Lille, Lille, France
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21
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Hamroun A, Nitel Hadj G, Bignon A, Dharancy S, Provôt F, Lebuffe G. MELD may be more than just a prediction tool for early waitlist mortality. Am J Transplant 2020; 20:322-323. [PMID: 31566895 DOI: 10.1111/ajt.15628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Aghilès Hamroun
- Department of Nephrology, Dialysis, and Kidney Transplantation, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Gautier Nitel Hadj
- Department of Anesthesiology, Resuscitation, and Critical Care, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Anne Bignon
- Department of Anesthesiology, Resuscitation, and Critical Care, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Sébastien Dharancy
- Department of Gastroenterology, Hepatology, and Nutrition, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - François Provôt
- Department of Nephrology, Dialysis, and Kidney Transplantation, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Gilles Lebuffe
- Department of Anesthesiology, Resuscitation, and Critical Care, Lille University, Regional and University Hospital Center of Lille, Lille, France
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22
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Lenain R, Hamroun A, Lion G, Chamley P, Bui L, Lionet A, Hazzan M, Provôt F. Description of a transient proximal tubulopathy induced by amino acids perfusion in peptide receptor radionuclide therapy: A case report. Medicine (Baltimore) 2019; 98:e18478. [PMID: 31876733 PMCID: PMC6946443 DOI: 10.1097/md.0000000000018478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RATIONALE Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs is a targeted internal radiotherapy method used to treat tumors expressing somatostatin receptors. Concomitant amino acids perfusion is systematically performed in order to inhibit the proximal tubular uptake of the radionuclide and thus prevent nephrotoxicity. PATIENT CONCERNS:: a 67-year-old woman with an intestinal neuroendocrine tumor with multiple lymphadenopathies and liver metastases. The patient displayed a carcinoid syndrome with flushes including facial erythrosis and paresthesia. During the treatment, the patient exhibited emesis and severe cramps. DIAGNOSIS We describe incomplete proximal tubulopathy induced by an amino acid therapy with [177Lu]-DOTA0-Tyr3-octreotate, which was reversible after treatment discontinuation. This diagnosis relies on metabolic acidosis, hypophosphatemia due to renal loss, tubular proteinuria and generalized aminoaciduria. Serum creatinine remained stable during and after the procedure. INTERVENTIONS PRRT with radiolabeled somatostatin analog ([177Lu]-DOTA0-Tyr3-octreotate). In order to prevent PRRT induced nephrotoxicity, we used a solution of 20 amino acids including 22 g/L Lysine and 16.8 g/L Arginine. Metoclopramide was successfully used to control vomiting. During the treatment and at the time of cramps, the blood sample showed hypophosphatemia at 0.3 mmol/L justifying intravenous phosphate supplementation. The cramps disappeared after this infusion. OUTCOMES Hypophosphatemia with low TmPO4/GFR was observed as well as an increase in β2-microglobulinuria, urinary polyclonal light chains, and amino aciduria involving all amino acids. All these disturbances disappeared the day after the treatment and there was no acute kidney injury after 5 PRRT sessions. Six months after PRRT discontinuation, the patient had neither renal failure nor proximal tubulopathy. Aminoacid induced tubulopathy involves the main ligands of the megalin receptor. It has recently been demonstrated that cilastatin is a megalin inhibitor in the proximal tubule and therefore could represent an attractive alternative to amino acids for this purpose. LESSONS This case report is a description of a nephroprotective strategy in which partial, and transient tubulopathy is induced, in order to decrease proximal absorption of a tubulotoxic molecule. This little known strategy could be used to prevent proximal tubular injury caused by others megalin-mediated nephrotoxicity medication.
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Affiliation(s)
| | | | - Georges Lion
- Department of Nuclear Medicine, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Linh Bui
- Nephrology Department, Centre Hospitalier de Beuvry, Béthune, France
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Abstract
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease related to the formation of microvascular thrombosis and subsequent organ failure. The disease is accompanied with microangiopathic haemolytic anaemia, consumptive thrombocytopenia and lies on a severe deficiency in ADAMTS13, the von Willebrand factor-cleaving protease. In the acquired, immune-mediated form, this deficiency is due to the production of autoantibodies directed against the enzyme. Therapeutic plasma exchange has been used empirically for decades and still represents the cornerstone of TTP treatment. However, a better understanding of pathophysiological mechanisms underlying the disease has led these last years to the development of highly effective targeted therapies that might in the future restraint the use of therapeutic plasma exchange.
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Affiliation(s)
- Adrien Picod
- Centre national de référence des microangiopathies thrombotiques, 75000 Paris, France
| | - François Provôt
- Centre national de référence des microangiopathies thrombotiques, 75000 Paris, France; Hôpital Albert-Calmette, service de néphrologie, 59000 Lille, France
| | - Paul Coppo
- Centre national de référence des microangiopathies thrombotiques, 75000 Paris, France; Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, service d'hématologie, 75012 Paris, France; Sorbonne-Université, 75006 Paris, France.
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24
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Hamroun A, Frimat M, Beuscart JB, Buob D, Lionet A, Lebas C, Daroux M, Provôt F, Hazzan M, Boulanger É, Glowacki F. [Kidney disease care for the elderly]. Nephrol Ther 2019; 15:533-552. [PMID: 31711751 DOI: 10.1016/j.nephro.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In our aging population, kidney disease management needs to take into account the frailty of the elderly. Standardized geriatric assessments can be proposed to help clinicians apprehend this dimension in their daily practice. These tools allow to better identify frail patients and offer them more personalized and harmless treatments. This article aims to focus on the kidney diseases commonly observed in elderly patients and analyze their specific nephrogeriatric care modalities. It should be noticed that all known kidney diseases can be also observed in the elderly, most often with a quite similar clinical presentation. This review is thus focused on the diseases most frequently and most specifically observed in elderly patients (except for monoclonal gammopathy associated nephropathies, out of the scope of this work), as well as the peculiarities of old age nephrological care.
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Affiliation(s)
- Aghilès Hamroun
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Marie Frimat
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | | | - David Buob
- Service d'anatomopathologie, Centre de biologie-pathologie, CHRU de Lille, 59037 Lille, France
| | - Arnaud Lionet
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Céline Lebas
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Maïté Daroux
- Service de néphrologie, hôpital Duchenne, allée Jacques Monod, 62200 Boulogne-sur-Mer, France
| | - François Provôt
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Marc Hazzan
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Éric Boulanger
- Service de gériatrie, CHRU de Lille, 59037 Lille, France
| | - François Glowacki
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France.
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Marques C, Carvelli J, Biard L, Faguer S, Provôt F, Matignon M, Boffa JJ, Plaisier E, Hertig A, Touzot M, Moranne O, Belenfant X, Annane D, Quéméneur T, Cadranel J, Izzedine H, Bréchot N, Cacoub P, Piedrafita A, Jourde-Chiche N, Saadoun D. Prognostic Factors in Anti-glomerular Basement Membrane Disease: A Multicenter Study of 119 Patients. Front Immunol 2019; 10:1665. [PMID: 31396214 PMCID: PMC6662558 DOI: 10.3389/fimmu.2019.01665] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/03/2019] [Indexed: 01/10/2023] Open
Abstract
We report the overall and renal outcome in a French nationwide multicenter cohort of 119 patients with anti-glomerular basement membrane (anti-GBM) disease. Sixty-four patients (54%) had an exclusive renal involvement, 7 (6%) an isolated alveolar hemorrhage and 48 (40%) a combined renal and pulmonary involvement. Initial renal replacement therapy (RRT) was required in 78% of patients; 82% received plasmapheresis, 82% cyclophosphamide, and 9% rituximab. ANCA positive (28%) patients were older (70 vs. 47 years, p < 0.0001), less frequently smokers (26 vs. 54%, p = 0.03), and had less pulmonary involvement than ANCA- patients. The 5 years overall survival was 92%. Risk factors of death (n = 11, 9.2%) were age at onset [HR 4.10 per decade (1.89-8.88) p = 0.003], hypertension [HR 19.9 (2.52-157 0.2) p = 0.005], dyslipidemia [HR 11.1 (2.72-45) p = 0.0008], and need for mechanical ventilation [HR 5.20 (1.02-26.4) p = 0.047]. The use of plasmapheresis was associated with better survival [HR 0.29 (0.08-0.98) p = 0.046]. At 3 months, 55 (46%) patients had end-stage renal disease (ESRD) vs. 37 (31%) ESRD-free and 27 (23%) unevaluable with follow-up < 3 months. ESRD patients were older, more frequently female and had a higher serum creatinine level at presentation than those without ESRD. ESRD-free survival was evaluated in patients alive without ESRD at 3 months (n = 37) using a landmark approach. In conclusion, this large French nationwide study identifies prognosis factors of renal and overall survival in anti-GBM patients.
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Affiliation(s)
- Cindy Marques
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, UMR 7211, Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.,Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose, Paris, France
| | - Julien Carvelli
- Aix-Marseille Univ, APHM, C2VN, INRA 1260, INSERM 1263, CHU de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Lucie Biard
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, Paris, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - François Provôt
- Department of Nephrology, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Marie Matignon
- Department of Nephrology and Renal Transplantation, Groupe Hospitalier Henri-Mondor, AP-HP, Créteil, France
| | - Jean-Jacques Boffa
- Sorbonne Université, UPMC Université Paris 06, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Emmanuelle Plaisier
- Sorbonne Université, UPMC Université Paris 06, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Alexandre Hertig
- Sorbonne Université, UPMC Université Paris 06, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | | | - Olivier Moranne
- Service Néphrologie-Dialyses-Aphérèse, Hôpital Caremeau, CHU Nîmes, et Faculté de Médecine Université de Montpellier-nimes, Nîmes, France
| | - Xavier Belenfant
- Nephrology and Dialysis, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Djillali Annane
- General ICU, Hôpital Raymond Poincaré, AP-HP, Garches, France
| | - Thomas Quéméneur
- Department of Internal Medicine, Centre Hospitalier, Valenciennes, France
| | - Jacques Cadranel
- Chest Department and Constitutive Center for Rare Pulmonary Disease, Hôpital Tenon, AP-HP; Inflammation-Immunopathology-Biotherapy Department (DHU i2B) and Sorbonne Université, Paris, France
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
| | - Nicolas Bréchot
- Medical-Surgical Intensive Care Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Patrice Cacoub
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, UMR 7211, Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.,Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose, Paris, France
| | - Alexis Piedrafita
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, APHM, C2VN, INRA 1260, INSERM 1263, CHU de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - David Saadoun
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, UMR 7211, Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.,Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose, Paris, France
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Menne J, Delmas Y, Fakhouri F, Licht C, Lommelé Å, Minetti EE, Provôt F, Rondeau E, Sheerin NS, Wang J, Weekers LE, Greenbaum LA. Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study. BMC Nephrol 2019; 20:125. [PMID: 30971227 PMCID: PMC6456946 DOI: 10.1186/s12882-019-1314-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There are limited long-term outcome data in eculizumab-treated patients with atypical hemolytic uremic syndrome (aHUS). We report final results from the largest prospective, observational, multicenter study of patients with aHUS treated with eculizumab. METHODS Patients with aHUS who participated in any of five parent eculizumab trials and received at least one eculizumab infusion were eligible for enrollment in a long-term follow-up study. Rates of thrombotic microangiopathy (TMA) manifestations off versus on eculizumab were evaluated. Additional endpoints included change from baseline estimated glomerular filtration rate (eGFR), long-term renal outcomes, and serious targeted treatment-emergent adverse events. RESULTS Among 93 patients (0-80 years of age), 51 (55%) remained on eculizumab and 42 (45%) discontinued; for those who discontinued, 21 (50%) reinitiated therapy. Patients who reinitiated eculizumab had similar baseline clinical characteristics to patients who remained on eculizumab, with higher likelihood of genetic/autoimmune complement abnormalities, more prior TMAs, and longer disease course versus those who did not reinitiate. Mean eGFR improved rapidly and remained stable for up to 6 years on eculizumab. In patients who discontinued, there was a trend toward decreasing renal function over time from discontinuation. Additionally, off-treatment TMA manifestation rates were higher in those aged < 18 years at diagnosis, with identified genetic/autoimmune complement abnormalities, or history of multiple TMAs prior to eculizumab initiation. The safety profile was consistent with previous studies. Three definite and one possible meningococcal infections related to eculizumab were reported and resolved with treatment. Three deaths unrelated to eculizumab were reported. CONCLUSIONS The current study confirms the efficacy and safety of eculizumab in aHUS, particularly with regard to long-term renal function and TMA events. Pediatric age at disease onset and presence of genetic or autoimmune complement abnormalities are risk factors for TMA events off treatment. Overall, patients who discontinue eculizumab may be at risk for additional TMA manifestations and renal function decreases. Discontinuation of eculizumab, with careful monitoring, is an option in select patients with consideration of patient preference, organ function normalization, and risk factors for relapse, including mutational analysis, age of onset, and history of multiple TMA episodes. TRIAL REGISTRATION ClinicalTrials.gov NCT01522170 , January 31, 2012.
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Affiliation(s)
- Jan Menne
- Department of Nephrology and Hypertension, Klinik für Nieren- und Hochdruckerkrankungen, Carl Neuberg Str. 1, 30625 Hannover, Germany
| | - Yahsou Delmas
- Service de Néphrologie Transplantation Dialyse, CHU de Bordeaux, Place Amélie Raba Léon, CEDEX 33076 Bordeaux, France
| | - Fadi Fakhouri
- Department of Nephrology and Immunology, UMR 643, CHU de Nantes, 27 Rue la Pérouse, CEDEX 1 44000 Nantes, France
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Åsa Lommelé
- Alexion Pharma GmbH, Giesshübelstrasse 30, 08045 Zurich, Switzerland
| | - Enrico E. Minetti
- Department of Nephrology, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - François Provôt
- Department of Nephrology, CHU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, 4 Rue de la Chine, 75020 Paris, France
- Sorbonne Université, 15-21 Rue de l’École de Médecine, Paris, 75006 France
| | - Neil S. Sheerin
- Institute of Cellular Medicine, University of Newcastle upon Tyne, 4th Floor, William Leech Building, Newcastle upon Tyne, NE2 4HH UK
| | - Jimmy Wang
- Alexion Pharmaceuticals, Inc., 121 Seaport Boulevard, Boston, MA 02210 USA
| | - Laurent E. Weekers
- Néphrologie-Transplantation, CHU de Liège, Sart-Tilman B35, 04000 Liège, Belgium
| | - Larry A. Greenbaum
- Division of Pediatric Nephrology, Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Drive NE, Atlanta, GA 30322 USA
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Van Triempont M, Bertrand D, Varlet P, Hazzan M, Lionet A, Noël C, Provôt F. Désimmunisation HLA chez des patients hyperimmunisés en transplantation rénale : l’expérience de deux centres français. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Chamley P, Varlet P, Lionet A, Noël C, Hazzan M, Provôt F. Impact d’anticorps préformés anti-HLA-Cw et anti-HLA-DP spécifiques du donneur en transplantation rénale. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Simphal P, Lionet A, Gibier J, Gnemmi V, Gomis S, Provôt F, Glowacki F, Lebas C, Noël C, Hazzan M. Y-a-t-il un intérêt à réaliser une ponction biopsie rénale protocolaire à 3 mois après transplantation rénale ? Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Menne J, Delmas Y, Fakhouri F, Kincaid JF, Licht C, Minetti EE, Mix C, Provôt F, Rondeau E, Sheerin NS, Wang J, Weekers LE, Greenbaum LA. Eculizumab prevents thrombotic microangiopathy in patients with atypical haemolytic uraemic syndrome in a long-term observational study. Clin Kidney J 2018; 12:196-205. [PMID: 30976396 PMCID: PMC6452204 DOI: 10.1093/ckj/sfy035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 01/25/2023] Open
Abstract
Background Eculizumab, a terminal complement inhibitor, is approved for atypical haemolytic uraemic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy (TMA). Methods In five parent studies, eculizumab effectively prevented TMA and improved renal and haematologic outcomes in patients with aHUS; therefore, these patients could enrol in this long-term, prospective, observational and multicentre study. The primary endpoint was the TMA manifestation rate off and on eculizumab post-parent study. Post hoc analyses evaluated rates during labelled versus non-labelled dosing regimens, and in those with versus without identified complement abnormalities. Serious targeted treatment-emergent adverse events (TEAEs) were evaluated. Results Of 87 patients in the current study, 39 and 76 had off- and on-treatment periods, respectively; 17 (44%) with off periods reinitiated eculizumab. TMA manifestation rate per 100 patient-years was 19.9 off and 7.3 on treatment [hazard ratio (HR), 4.7; P = 0.0008]; rates were highest off treatment and lowest during labelled regimens. TMA manifestations with hospitalizations/serious AEs occurred more frequently off versus on treatment. TMA rates were higher among patients with identified complement abnormalities (HR, 4.5; P = 0.0082). Serious targeted TEAEs occurred at similar rates off and on treatment. Conclusions As expected, patients with aHUS have increased risk of TMA manifestations after discontinuation of eculizumab or in the setting of non-labelled eculizumab dosing. Collectively, results show that maintaining eculizumab treatment minimizes risk of TMA, particularly in patients with identified complement abnormalities. Future studies are needed to further characterize TMA and longer term outcomes on labelled or non-labelled eculizumab regimens and after discontinuation of treatment.
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Affiliation(s)
- Jan Menne
- Klinik für Nieren- und Hochdruckerkrankungen, Hannover, Germany
| | | | | | | | | | | | - Chris Mix
- Alexion Pharmaceuticals, Inc., New Haven, CT, USA
| | | | - Eric Rondeau
- Hôpital Tenon and Université Paris VI, Paris, France
| | - Neil S Sheerin
- Institute of Cellular Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Jimmy Wang
- Alexion Pharmaceuticals, Inc., New Haven, CT, USA
| | | | - Larry A Greenbaum
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
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31
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Bruel A, Kavanagh D, Noris M, Delmas Y, Wong EKS, Bresin E, Provôt F, Brocklebank V, Mele C, Remuzzi G, Loirat C, Frémeaux-Bacchi V, Fakhouri F. Hemolytic Uremic Syndrome in Pregnancy and Postpartum. Clin J Am Soc Nephrol 2017; 12:1237-1247. [PMID: 28596415 PMCID: PMC5544502 DOI: 10.2215/cjn.00280117] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/05/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pregnancy is associated with various forms of thrombotic microangiopathy, including hemolytic uremic syndrome. A previous small French study suggested that pregnancy-associated hemolytic uremic syndrome was to be included in the spectrum of atypical hemolytic uremic syndrome linked to complement alternative pathway dysregulation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We sought to retrospectively analyze the presentation, outcome, and frequency of complement alternative pathway gene variants in a larger international (France, United Kingdom, Italy) cohort of patients with pregnancy-associated hemolytic uremic syndrome. RESULTS Eighty-seven patients with pregnancy-associated hemolytic uremic syndrome were included. Hemolytic uremic syndrome occurred mainly during the first pregnancy (58%) and in the postpartum period (76%). At diagnosis, 56 (71%) patients required dialysis. Fifty-six (78%) patients underwent plasma exchanges, 21 (41%) received plasma infusions, and four (5%) received eculizumab. During follow-up (mean duration of 7.2 years), 41 (53%) patients reached ESRD, 15 (19%) had CKD, and 18 (28%) patients experienced hemolytic uremic syndrome relapse. Twenty-four patients (27%) received a kidney transplant and a recurrence of hemolytic uremic syndrome occurred in 13 (54%) patients. Variants in complement genes were detected in 49 (56%) patients, mainly in the CFH (30%) and CFI genes (9%). CONCLUSIONS Pregnancy-associated hemolytic uremic syndrome and atypical hemolytic uremic syndrome nonrelated to pregnancy have the same severity at onset and during follow-up and the same frequency of complement gene variants.
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Affiliation(s)
- Alexandra Bruel
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Jamme M, Raimbourg Q, Chauveau D, Seguin A, Presne C, Perez P, Gobert P, Wynckel A, Provôt F, Delmas Y, Mousson C, Servais A, Vrigneaud L, Veyradier A, Rondeau E, Coppo P. Predictive features of chronic kidney disease in atypical haemolytic uremic syndrome. PLoS One 2017; 12:e0177894. [PMID: 28542627 PMCID: PMC5436831 DOI: 10.1371/journal.pone.0177894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/04/2017] [Indexed: 11/18/2022] Open
Abstract
Chronic kidney disease (CKD) is a frequent and serious complication of atypical haemolytic uremic syndrome (aHUS). We aimed to develop a simple accurate model to predict the risk of renal dysfunction in aHUS based on clinical and biological features available at hospital admission. Renal function at 1-year follow-up, based on an estimated glomerular filtration rate < 60mL/min/1.73m2 as assessed by the Modification of Diet in Renal Disease equation, was used as an indicator of significant CKD. Prospectively collected data from a cohort of 156 aHUS patients who did not receive eculizumab were used to identify predictors of CKD. Covariates associated with renal impairment were identified by multivariate analysis. The model performance was assessed and a scoring system for clinical practice was constructed from the regression coefficient. Multivariate analyses identified three predictors of CKD: a high serum creatinine level, a high mean arterial pressure and a mildly decreased platelet count. The prognostic model had a good discriminative ability (area under the curve = .84). The scoring system ranged from 0 to 5, with corresponding risks of CKD ranging from 18% to 100%. This model accurately predicts development of 1-year CKD in patients with aHUS using clinical and biological features available on admission. After further validation, this model may assist in clinical decision making.
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Affiliation(s)
- Matthieu Jamme
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Paris, France
| | | | - Dominique Chauveau
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie-immunologie clinique, Hôpital Rangueil, Toulouse, France
| | - Amélie Seguin
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Normandy, France
| | - Claire Presne
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie - Médecine Interne, Hôpital Sud, Amiens, France
| | - Pierre Perez
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie-Immunologie, Service de Réanimation, CHU Brabois, Nancy, France
| | - Pierre Gobert
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Médecine Interne et Néphrologie, Hôpital Général Henri Duffaut, Avignon, France
| | - Alain Wynckel
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - François Provôt
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie, Hôpital Albert Calmette, Lille, France
| | - Yahsou Delmas
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie-Transplantation-Dialyse, CHU de Bordeaux, Bordeaux, France
| | - Christiane Mousson
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie, Dijon, France
| | - Aude Servais
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Néphrologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Laurence Vrigneaud
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service de Médecine interne, Néphrologie et Médecine vasculaire, Centre hospitalier de Valenciennes, Valenciennes, France
| | - Agnès Veyradier
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP, Paris, France
| | - Eric Rondeau
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Paris, France
| | - Paul Coppo
- Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint Antoine, AP-HP, Paris, France
- Service d’Hématologie, Hôpital Saint Antoine, AP-HP, Paris, France
- * E-mail:
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33
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Grall M, Azoulay E, Galicier L, Provôt F, Wynckel A, Poullin P, Grange S, Halimi JM, Lautrette A, Delmas Y, Presne C, Hamidou M, Girault S, Pène F, Perez P, Kanouni T, Seguin A, Mousson C, Chauveau D, Ojeda-Uribe M, Barbay V, Veyradier A, Coppo P, Benhamou Y. Thrombotic thrombocytopenic purpura misdiagnosed as autoimmune cytopenia: Causes of diagnostic errors and consequence on outcome. Experience of the French thrombotic microangiopathies reference centre. Am J Hematol 2017; 92:381-387. [PMID: 28133771 DOI: 10.1002/ajh.24665] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 02/02/2023]
Abstract
Thrombotic thrombocytopenic purpura (TTP) has a devastating prognosis without adapted management. Sources of misdiagnosis need to be identified to avoid delayed treatment. We studied 84 patients with a final diagnosis of severe (<10%) acquired ADAMTS13 deficiency-associated TTP from our National database that included 423 patients, who had an initial misdiagnosis (20% of all TTP). Main diagnostic errors were attributed to autoimmune thrombocytopenia, associated (51%) or not (37%) with autoimmune hemolytic anemia. At admission, misdiagnosed patients were more frequently females (P = .034) with a history of autoimmune disorder (P = .017) and had organ involvement in 67% of cases; they had more frequently antinuclear antibodies (P = .035), a low/undetectable schistocyte count (P = .001), a less profound anemia (P = .008), and a positive direct antiglobulin test (DAT) (P = .008). In multivariate analysis, female gender (P = .022), hemoglobin level (P = .028), a positive DAT (P = .004), and a low schistocytes count on diagnosis (P < .001) were retained as risk factors of misdiagnosis. Platelet count recovery was significantly longer in the misdiagnosed group (P = .041) without consequence on mortality, exacerbation and relapse. However, patients in the misdiagnosed group had a less severe disease than those in the accurately diagnosed group, as evidenced by less organ involvement at TTP diagnosis (P = .006). TTP is frequently misdiagnosed with autoimmune cytopenias. A low schistocyte count and a positive DAT should not systematically rule out TTP, especially when associated with organ failure.
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Affiliation(s)
- Maximilien Grall
- Service de Médecine Interne, Centre Hospitalier Universitaire Charles Nicolle; Rouen France
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Réanimation Médicale, Hôpital Saint-Louis, AP-HP; Paris France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Immunologie Clinique, Hôpital Saint-Louis, AP-HP; Paris France
| | - François Provôt
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Néphrologie, Hôpital Albert Calmette; Lille France
| | - Alain Wynckel
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Néphrologie, Hôpital Maison Blanche; Reims France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Hémaphérèse, Hôpital de Marseille Conception; Marseille France
| | - Steven Grange
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de réanimation médicale Centre Hospitalier Universitaire Charles Nicolle; Rouen France
| | - Jean-Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Néphrologie, Centre Hospitalier Universitaire Bretonneau; Tours France
| | - Alexandre Lautrette
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Réanimation médicale, Centre Hospitalier Universitaire Gabriel Montpied; Clermont-Ferrand France
| | - Yahsou Delmas
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire Pellegrin; Bordeaux France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Médecine Interne, Centre Hospitalier Universitaire d'Amiens Nord; Amiens France
| | - Mohamed Hamidou
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service Médecine Interne, Hôpital Hôtel-Dieu; Nantes France
| | - Stéphane Girault
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Hématologie clinique, Centre Hospitalier Universitaire Dupuytren; Limoges France
| | - Frédéric Pène
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Réanimation Polyvalente, Hôpital Cochin, AP-HP; Paris France
| | - Pierre Perez
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Réanimation, Centre Hospitalier Universitaire Brabois; Nancy France
| | - Tarik Kanouni
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Hématologie et Oncologie Médicale; Centre Hospitalier Universitaire St Eloi Montpellier France
| | - Amélie Seguin
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen; Caen France
| | - Christiane Mousson
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service de Néphrologie, Centre Hospitalier Universitaire de Dijon; Dijon France
| | - Dominique Chauveau
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Département de Néphrologie et Transplantation d'Organes; CHU Rangueil Toulouse France
| | - Mario Ojeda-Uribe
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Hématologie clinique, Centre Hospitalier Emile Muller; Mulhouse France
| | - Virginie Barbay
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Unité d'Hémostase Vasculaire, Centre Hospitalier Universitaire Charles Nicolle; Rouen France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP; Paris France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP; Paris France
| | - Ygal Benhamou
- Service de Médecine Interne, Centre Hospitalier Universitaire Charles Nicolle; Rouen France
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP; Paris France
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Brabant S, Facon A, Provôt F, Labalette M, Wallaert B, Chenivesse C. An avoidable cause of thymoglobulin anaphylaxis. Allergy Asthma Clin Immunol 2017; 13:13. [PMID: 28250777 PMCID: PMC5324248 DOI: 10.1186/s13223-017-0186-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/16/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Thymoglobulin® (anti-thymocyte globulin [rabbit]) is a purified pasteurised, gamma immune globulin obtained by immunisation of rabbits with human thymocytes. Anaphylactic allergic reactions to a first injection of thymoglobulin are rare. CASE PRESENTATION We report a case of serious anaphylactic reaction occurring after a first intraoperative injection of thymoglobulin during renal transplantation in a patient with undiagnosed respiratory allergy to rabbit allergens. CONCLUSIONS This case report reinforces the importance of identifying rabbit allergy by a simple combination of clinical interview followed by confirmatory skin testing or blood tests of all patients prior to injection of thymoglobulin, which is formally contraindicated in patients with a history of hypersensitivity to rabbit proteins.
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Affiliation(s)
- S Brabant
- Department of Allergy-Immunology, Pole de Biologie Pathologie Genetique Medicale du CHRU de Lille, Boulevard du professeur Leclercq, 59037 Lille Cedex, France
| | - A Facon
- Department of Anaesthesiology, CHU Lille, 59000 Lille, France
| | - F Provôt
- Department of Kidney Transplantation, CHU Lille, 59000 Lille, France
| | - M Labalette
- Department of Allergy-Immunology, Pole de Biologie Pathologie Genetique Medicale du CHRU de Lille, Boulevard du professeur Leclercq, 59037 Lille Cedex, France
| | - B Wallaert
- Department of Pulmonology, Allergy and Immunology, CHU Lille, 59000 Lille, France
| | - C Chenivesse
- Department of Pulmonology, Allergy and Immunology, CHU Lille, 59000 Lille, France
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Fakhouri F, Fila M, Provôt F, Delmas Y, Barbet C, Châtelet V, Rafat C, Cailliez M, Hogan J, Servais A, Karras A, Makdassi R, Louillet F, Coindre JP, Rondeau E, Loirat C, Frémeaux-Bacchi V. Pathogenic Variants in Complement Genes and Risk of Atypical Hemolytic Uremic Syndrome Relapse after Eculizumab Discontinuation. Clin J Am Soc Nephrol 2017; 12:50-59. [PMID: 27799617 PMCID: PMC5220663 DOI: 10.2215/cjn.06440616] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES The complement inhibitor eculizumab has dramatically improved the outcome of atypical hemolytic uremic syndrome. However, the optimal duration of eculizumab treatment in atypical hemolytic uremic syndrome remains debated. We report on the French atypical hemolytic uremic syndrome working group's first 2-year experience with eculizumab discontinuation in patients with atypical hemolytic uremic syndrome. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS Using the French atypical hemolytic uremic syndrome registry database, we retrospectively identified all dialysis-free patients with atypical hemolytic uremic syndrome who discontinued eculizumab between 2010 and 2014 and reviewed their relevant clinical and biologic data. The decision to discontinue eculizumab was made by the clinician in charge of the patient. All patients were closely monitored by regular urine dipsticks and blood tests. Eculizumab was rapidly (24-48 hours) restarted in case of relapse. RESULTS Among 108 patients treated with eculizumab, 38 patients (nine children and 29 adults) discontinued eculizumab (median treatment duration of 17.5 months). Twenty-one patients (55%) carried novel or rare complement genes variants. Renal recovery under eculizumab was equally good in patients with and those without complement gene variants detected. After a median follow-up of 22 months, 12 patients (31%) experienced atypical hemolytic uremic syndrome relapse. Eight of 11 patients (72%) with complement factor H variants, four of eight patients (50%) with membrane cofactor protein variants, and zero of 16 patients with no rare variant detected relapsed. In relapsing patients, early reintroduction (≤48 hours) of eculizumab led to rapid (<7 days) hematologic remission and a return of serum creatinine to baseline level in a median time of 26 days. At last follow-up, renal function remained unchanged in nonrelapsing and relapsing patients compared with baseline values before eculizumab discontinuation. CONCLUSIONS Pathogenic variants in complement genes were associated with higher risk of atypical hemolytic uremic syndrome relapse after eculizumab discontinuation. Prospective studies are needed to identify biomarkers predictive of relapse and determine the best strategy of retreatment in relapsing patients.
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Affiliation(s)
- Fadi Fakhouri
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Frimat M, Provôt F, Hertig A. In Reply to 'Risk of Tranexamic Acid for Treatment of Postpartum Hemorrhage'. Am J Kidney Dis 2016; 69:160-161. [PMID: 28007188 DOI: 10.1053/j.ajkd.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/04/2016] [Indexed: 11/11/2022]
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Tabibzadeh N, Glowacki F, Frimat M, Elsermans V, Provôt F, Lionet A, Gnemmi V, Hertig A, Noël C, Hazzan M. Long-term outcome after early cyclosporine withdrawal in kidney transplantation: ten years after. Clin Transplant 2016; 30:1480-1487. [DOI: 10.1111/ctr.12843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nahid Tabibzadeh
- CHU Lille - Service de Néphrologie - F-59000 Lille France
- Université de Lille - UMR 995, F-59000 Lille France
| | - François Glowacki
- CHU Lille - Service de Néphrologie - F-59000 Lille France
- Université de Lille - UMR 995, F-59000 Lille France
| | - Marie Frimat
- CHU Lille - Service de Néphrologie - F-59000 Lille France
- Université de Lille - UMR 995, F-59000 Lille France
| | - Vincent Elsermans
- Université de Lille - UMR 995, F-59000 Lille France
- CHU Lille - Laboratoire d'Immunologie - F-59000 Lille France
| | | | - Arnaud Lionet
- CHU Lille - Service de Néphrologie - F-59000 Lille France
| | - Viviane Gnemmi
- Université de Lille - UMR 995, F-59000 Lille France
- CHU Lille - Laboratoire d'Anatomopathologie - F-59000 Lille France
| | - Alexandre Hertig
- Urgences Néphrologiques et Transplantation Rénale; Hôpital Tenon, APHP; Paris France
- UPMC Sorbonne Université Paris 06, UMR S 1155, F-75020; Paris France
| | - Christian Noël
- CHU Lille - Service de Néphrologie - F-59000 Lille France
- Université de Lille - UMR 995, F-59000 Lille France
| | - Marc Hazzan
- CHU Lille - Service de Néphrologie - F-59000 Lille France
- Université de Lille - UMR 995, F-59000 Lille France
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Fakhouri F, Hourmant M, Campistol JM, Cataland SR, Espinosa M, Gaber AO, Menne J, Minetti EE, Provôt F, Rondeau E, Ruggenenti P, Weekers LE, Ogawa M, Bedrosian CL, Legendre CM. Terminal Complement Inhibitor Eculizumab in Adult Patients With Atypical Hemolytic Uremic Syndrome: A Single-Arm, Open-Label Trial. Am J Kidney Dis 2016; 68:84-93. [DOI: 10.1053/j.ajkd.2015.12.034] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
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Frimat M, Decambron M, Lebas C, Moktefi A, Lemaitre L, Gnemmi V, Sautenet B, Glowacki F, Subtil D, Jourdain M, Rigouzzo A, Brocheriou I, Halimi JM, Rondeau E, Noel C, Provôt F, Hertig A. Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series. Am J Kidney Dis 2016; 68:50-7. [DOI: 10.1053/j.ajkd.2015.11.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/29/2015] [Indexed: 11/11/2022]
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Mariotte E, Azoulay E, Galicier L, Rondeau E, Zouiti F, Boisseau P, Poullin P, de Maistre E, Provôt F, Delmas Y, Perez P, Benhamou Y, Stepanian A, Coppo P, Veyradier A. Epidemiology and pathophysiology of adulthood-onset thrombotic microangiopathy with severe ADAMTS13 deficiency (thrombotic thrombocytopenic purpura): a cross-sectional analysis of the French national registry for thrombotic microangiopathy. The Lancet Haematology 2016; 3:e237-45. [DOI: 10.1016/s2352-3026(16)30018-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 01/05/2023]
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Roriz M, Landais M, Desprez J, Barbet C, Azoulay E, Galicier L, Wynckel A, Baudel JL, Provôt F, Pène F, Mira JP, Presne C, Poullin P, Delmas Y, Kanouni T, Seguin A, Mousson C, Servais A, Bordessoule D, Perez P, Chauveau D, Veyradier A, Halimi JM, Hamidou M, Coppo P. Risk Factors for Autoimmune Diseases Development After Thrombotic Thrombocytopenic Purpura. Medicine (Baltimore) 2015; 94:e1598. [PMID: 26496263 PMCID: PMC4620782 DOI: 10.1097/md.0000000000001598] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Autoimmune thrombotic thrombocytopenic purpura (TTP) can be associated with other autoimmune disorders, but their prevalence following autoimmune TTP remains unknown. To assess the prevalence of autoimmune disorders associated with TTP and to determine risk factors for and the time course of the development of an autoimmune disorder after a TTP episode, we performed a cross sectional study. Two-hundred sixty-one cases of autoimmune TTP were included in the French Reference Center registry between October, 2000 and May, 2009. Clinical and laboratory data available at time of TTP diagnosis were recovered. Each center was contacted to collect the more recent data and diagnosis criteria for autoimmunity. Fifty-six patients presented an autoimmune disorder in association with TTP, 9 years before TTP (median; min: 2 yr, max: 32 yr) (26 cases), at the time of TTP diagnosis (17 cases) or during follow-up (17 cases), up to 12 years after TTP diagnosis (mean, 22 mo). The most frequent autoimmune disorder reported was systemic lupus erythematosus (SLE) (26 cases) and Sjögren syndrome (8 cases). The presence of additional autoimmune disorders had no impact on outcomes of an acute TTP or the occurrence of relapse. Two factors evaluated at TTP diagnosis were significantly associated with the development of an autoimmune disorder during follow-up: the presence of antidouble stranded (ds)DNA antibodies (hazard ratio (HR): 4.98; 95% confidence interval (CI) [1.64-15.14]) and anti-SSA antibodies (HR: 9.98; 95% CI [3.59-27.76]). A follow-up across many years is necessary after an acute TTP, especially when anti-SSA or anti-dsDNA antibodies are present on TTP diagnosis, to detect autoimmune disorders early before immunologic events spread to prevent disabling complications.
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Affiliation(s)
- Mélanie Roriz
- From the Centre hospitalier universitaire Bretonneau, Service de néphrologie, Tours (MR, CB, J-MH, FTM); Centre hospitalier universitaire Hôtel-Dieu, Service de médecine interne A, Nantes (ML, MH); Centre hospitalier de Valenciennes, Service de néphrologie, Valenciennes (JD, YD); Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, APHP (EA, LG, AW, J-LB, FP, FP, J-PM, CP, PP, TK, AS, DB, PP, DC, AV, J-MH, MH, PC, FTM, MH, PC); Université Paris Diderot, Sorbonne Paris Cité (EA, LG); Service de Réanimation Médicale, Hôpital Saint-Louis, AP-HP (EA); Service d'Immunologie Clinique, Hôpital Saint-Louis, AP-HP, Paris (LG); Service de Néphrologie, Hôpital Maison Blanche, Reims (AW); Sorbonne Université, UPMC Univ Paris 06 (J-LB); Service de Réanimation Médicale, CHU Saint-Antoine, AP-HP, Paris (J-LB); Service de Néphrologie, Hôpital Albert Calmette, Lille (FP); Service de Réanimation Polyvalente, Hôpital Cochin, AP-HP (FP, J-PM); Université Paris 5, Paris (FP, J-PM); Service de Néphrologie - Médecine Interne, Hôpital Sud, Amiens (CP); Service d'Hémaphérèse, Hôpital de Marseille Conception, Marseille (PP); Service de néphrologie-transplantation-dialyse, Hôpital Pellegrin, Bordeaux (YD); Unité d'Hémaphérèse thérapeutique, CHU de Montpellier (TK); Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen (AS); Service de Néphrologie, Dijon (CM); Service de Néphrologie, Hôpital Necker-Enfants Malades, AP-HP, Paris (AS); Service d'Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges (DB); Service de Réanimation, CHU Brabois, Nancy (PP); Service de néphrologie-immunologie clinique, hôpital Rangueil, Toulouse (DC); Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP, Paris (AV); Université Paris-Sud 11, Le Kremlin-Bicêtre (AV); Inserm U1009, Institut Gustave Roussy, Villejuif (PC); and Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Paris, France (PC)
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Benhamou Y, Baudel JL, Wynckel A, Galicier L, Azoulay E, Provôt F, Pène F, Mira JP, Presne C, Poullin P, Halimi JM, Rivière E, Kanouni T, Seguin A, Mousson C, Servais A, Bordessoule D, Perez P, Hamidou M, Chauveau D, Veyradier A, Coppo P. Are platelet transfusions harmful in acquired thrombotic thrombocytopenic purpura at the acute phase? Experience of the French thrombotic microangiopathies reference center. Am J Hematol 2015; 90:E127-9. [PMID: 25740210 DOI: 10.1002/ajh.23997] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/27/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ygal Benhamou
- Service de Médecine Interne; CHU Charles Nicolle; Rouen France
- Inserm U1096; Rouen France
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
| | - Jean-Luc Baudel
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Sorbonne Université, UPMC Univ Paris 06; Paris France
- Service De Réanimation Médicale, CHU Saint-Antoine, AP-HP; Paris France
| | - Alain Wynckel
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Néphrologie, Hôpital Maison Blanche; Reims France
| | - Lionel Galicier
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service D'immunologie Clinique; Hôpital Saint-Louis, AP-HP; Paris France
- Univ. Paris Diderot, Sorbonne Paris Cité; Paris France
| | - Elie Azoulay
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Univ. Paris Diderot, Sorbonne Paris Cité; Paris France
- Service De Réanimation Médicale, Hôpital Saint-Louis, AP-HP; Paris France
| | - François Provôt
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Néphrologie, Hôpital Albert Calmette; Lille France
| | - Frédéric Pène
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Réanimation Polyvalente, Hôpital Cochin, AP-HP; Paris France
- Université Paris 5; Paris France
| | - Jean-Paul Mira
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Réanimation Polyvalente, Hôpital Cochin, AP-HP; Paris France
- Université Paris 5; Paris France
| | - Claire Presne
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Néphrologie, Médecine Interne, Hôpital Sud; Amiens France
| | - Pascale Poullin
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service D'hémaphérèse, Hôpital De Marseille Conception; Marseille France
| | - Jean-Michel Halimi
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De néphrologie-Immunologie Clinique, Hôpital Bretonneau; Tours France
- EA 4245, Université François-Rabelais; Tours France
| | - Etienne Rivière
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Médecine Interne/Réanimation Médicale, Université Bordeaux Segalen; Bordeaux France
- Inserm U1034; Centre Hospitalier Universitaire; Bordeaux France
| | - Tarik Kanouni
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Unité D'hémaphérèse Thérapeutique; CHU De Montpellier; Montpellier France
| | - Amélie Seguin
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Réanimation Médicale; Centre Hospitalier Universitaire De Caen; Caen France
| | - Christiane Mousson
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Néphrologie; Dijon France
| | - Aude Servais
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Néphrologie; Hôpital Necker-Enfants Malades; AP-HP; Paris France
| | - Dominique Bordessoule
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service D'hématologie Clinique Et De Thérapie Cellulaire; CHU Dupuytren; Limoges France
| | - Pierre Perez
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service De Réanimation; CHU Brabois; Nancy France
| | - Mohamed Hamidou
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service Médecine Interne a; Hôpital Hôtel-Dieu; Nantes France
| | - Dominique Chauveau
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Département De Néphrologie Et Transplantation D'organes; Hôpital Rangueil; Toulouse France
| | - Agnès Veyradier
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Service D'hématologie Biologique, Hôpital Lariboisière; AP-HP; Paris France
- Université Paris-Sud 11; Le Kremlin-Bicêtre France
| | - Paul Coppo
- Centre De Référence Des Microangiopathies Thrombotiques; Hôpital Saint-Antoine, AP-HP; Paris France
- Inserm U1009; Institut Gustave Roussy; Villejuif France
- Service D'hématologie, Hôpital Saint-Antoine; AP-HP; Paris France
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Benhamou Y, Boelle PY, Baudin B, Ederhy S, Gras J, Galicier L, Azoulay E, Provôt F, Maury E, Pène F, Mira JP, Wynckel A, Presne C, Poullin P, Halimi JM, Delmas Y, Kanouni T, Seguin A, Mousson C, Servais A, Bordessoule D, Perez P, Hamidou M, Cohen A, Veyradier A, Coppo P. Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center. J Thromb Haemost 2015; 13:293-302. [PMID: 25403270 DOI: 10.1111/jth.12790] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Indexed: 08/31/2023]
Abstract
BACKGROUND Cardiac involvement is a major cause of mortality in patients with thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed, owing to subclinical injuries. Cardiac troponin-I measurement (cTnI) on admission could improve the early diagnosis of cardiac involvement and have prognostic value. OBJECTIVES To assess the predictive value of cTnI in patients with TTP for death or refractoriness. PATIENTS/METHODS The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS-13 deficiency (< 10%) and included in the registry of the French Reference Center for Thrombotic Microangiopathies. Centralized cTnI measurements were performed on frozen serum on admission. RESULTS Between January 2003 and December 2011, 133 patients with TTP (mean age, 48 ± 17 years) had available cTnI measurements on admission. Thirty-two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI level (> 0.1 μg L(-1) ) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. The main outcomes were death (25%) and refractoriness (17%). Age (P = 0.02) and cTnI level (P = 0.002) showed the greatest impact on survival. A cTnI level of > 0.25 μg L(-1) was the only independent factor in predicting death (odds ratio [OR] 2.87; 95% confidence interval [CI] 1.13-7.22; P = 0.024) and/or refractoriness (OR 3.03; 95% CI 1.27-7.3; P = 0.01). CONCLUSIONS A CTnI level of > 0.25 μg L(-1) at presentation in patients with TTP appears to be an independent factor associated with a three-fold increase in the risk of death or refractoriness. Therefore, cTnI level should be considered as a prognostic indicator in patients diagnosed with TTP.
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Affiliation(s)
- Y Benhamou
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France; Inserm U1096, Rouen, France; Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France
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Delesalle AS, Robin G, Provôt F, Dewailly D, Leroy-Billiard M, Peigné M. [Impact of end-stage renal disease and kidney transplantation on the reproductive system]. ACTA ACUST UNITED AC 2014; 43:33-40. [PMID: 25530544 DOI: 10.1016/j.gyobfe.2014.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement.
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Affiliation(s)
- A-S Delesalle
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - G Robin
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - F Provôt
- Service de néphrologie, hôpital Claude-Huriez, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - D Dewailly
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - M Leroy-Billiard
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - M Peigné
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
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Decambron M, Lionet A, Ducloy A, Jourdain M, Lessoré de Sainte Foy C, Hazzan M, Provôt F, Lemaitre L, Noël C. Intérêt pronostique de l’IRM rénale en cas d’insuffisance rénale aiguë anurique du post-partum. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Decambron M, Moktefi A, Ducloy A, Jourdain M, Frimat M, Lionet A, Buob D, Brochériou I, Noël C, Hazzan M, Hertig A, Provôt F. Microangiopathie thrombotique du postpartum et acide tranexamique. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Morgand M, Buffet M, Busson M, Loiseau P, Malot S, Amokrane K, Fortier C, London J, Bonmarchand G, Wynckel A, Provôt F, Poullin P, Vanhille P, Presne C, Bordessoule D, Girault S, Delmas Y, Hamidou M, Mousson C, Vigneau C, Lautrette A, Pourrat J, Galicier L, Azoulay E, Pène F, Mira JP, Rondeau E, Ojeda-Uribe M, Charron D, Maury E, Guidet B, Veyradier A, Tamouza R, Coppo P. High prevalence of infectious events in thrombotic thrombocytopenic purpura and genetic relationship with toll-like receptor 9 polymorphisms: experience of the French Thrombotic Microangiopathies Reference Center. Transfusion 2013; 54:389-97. [PMID: 23711330 DOI: 10.1111/trf.12263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infectious events have been reported as major environmental triggers of thrombotic thrombocytopenic purpura (TTP). We detail here the potential association between infections and TTP. STUDY DESIGN AND METHODS We recruited randomly and prospectively a cohort of 280 consecutive TTP patients during a 9-year period. Features of infection were systematically recorded. RESULTS Features consistent with an infectious event were observed in 114 patients (41%) at time of TTP diagnosis. Infectious agents were documented in 34 cases and were mainly Gram-negative bacilli. At time of diagnosis infected patients more frequently had fever (p < 0.001). Infections at diagnosis did not impact prognosis and outcome. Thirty-six percent of patients experienced an infectious event during hospitalization, which resulted in more exacerbation of TTP (p = 0.02). Infections were not overrepresented during treatment in patients who received steroids and/or rituximab. Further genetic analysis of toll-like receptor (TLR)-9 functionally relevant polymorphisms revealed that TLR-9 +2848 G and TLR-9 +1174 A genotypes were more frequent in TTP patients than in controls (p = 0.04 and p = 0.026, respectively) and more particularly in patients negative for the Class II human leukocyte antigen system susceptibility allele DRB1*11 (p = 0.001 and p = 0.002, respectively). Haplotypes estimation showed that 1174A-2848G haplotype was significantly more frequent in TTP (p = 0.004), suggesting a primary role for this haplotype variation in conferring a predisposition for acquired TTP. CONCLUSION Infections should be considered as an aggravating factor during the course of TTP. Particular polymorphisms in TLR-9 gene may represent risk factors for TTP.
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Affiliation(s)
- Marjolaine Morgand
- Service d'Hématologie, Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France; Service de Réanimation Polyvalente, Hôpitaux Universitaires de l'Est Parisien, AP-HP et UPMC Univ Paris 06, Paris, France; Inserm U1009, Institut Gustave Roussy, Villejuif, France; Laboratoire Jean Dausset d'Immunologie et d'Histocompatibilité & INSERM, AP-HP, UMRS 940, Paris, France; Service d'Immunopathologie, Service de Réanimation, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France; Service de Réanimation Médicale, Hôpital Charles Nicolle, Rouen, France; Service de Néphrologie, Hôpital Maison Blanche, Reims, France; Service de Néphrologie, Centre Hospitalier Universitaire, Lille, France; Service d'Hémaphérèse, Service de Médecine Interne, Hôpital de la Conception, Marseille, France; Service de Néphrologie, Centre Hospitalier de Valenciennes, Valenciennes, France; Service de Néphrologie- Médecine Interne, Hôpital Sud, Amiens, France; Service d'Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France; Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France; Service Médecine Interne A, Hôpital Hôtel-Dieu, Nantes, France; Service de Néphrologie, Dijon, France; Service de Néphrologie, Hôpital Pontchaillou, Rennes, France; Service de Réanimation Médicale (7HO), Hôpital Gabriel Montpied, Clermont-Ferrand, France; Service de Néphrologie et Immunologie Clinique, CHU Rangueil, Toulouse, France; Service de Réanimation Polyvalente, AP-HP, Hôpital Cochin, Université Paris 5, Paris, France; Service de Réanimation Néphrologique, Hôpital Tenon, UPMC Université Paris 06, Paris, France; Service d'Hématologie, Hôpital Emile Muller, Mulhouse, France; Service d'Hématologie Biologique, Hôpital Antoine Béclère, AP-HP, Clamart et Université Paris-Sud 11, Le Kremlin-Bicêtre, France
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Benhamou Y, Assié C, Boelle PY, Buffet M, Grillberger R, Malot S, Wynckel A, Presne C, Choukroun G, Poullin P, Provôt F, Gruson D, Hamidou M, Bordessoule D, Pourrat J, Mira JP, Le Guern V, Pouteil-Noble C, Daubin C, Vanhille P, Rondeau E, Palcoux JB, Mousson C, Vigneau C, Bonmarchand G, Guidet B, Galicier L, Azoulay E, Rottensteiner H, Veyradier A, Coppo P. Development and validation of a predictive model for death in acquired severe ADAMTS13 deficiency-associated idiopathic thrombotic thrombocytopenic purpura: the French TMA Reference Center experience. Haematologica 2012; 97:1181-6. [PMID: 22580997 DOI: 10.3324/haematol.2011.049676] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acquired thrombotic thrombocytopenic purpura is still associated with a 10-20% death rate. It has still not been possible to clearly identify early prognostic factors of death. This study involved thrombotic thrombocytopenic purpura patients with acquired severe (<10% of normal activity) ADAMTS13 deficiency and aimed to identify prognostic factors associated with 30-day death. DESIGN AND METHODS The study involved a prospective cohort of patients and was carried out between October 2000 and August 2010. A validation cohort of patients was set up from September 2010 to August 2011. Altogether, 281 (analysis cohort) and 66 (validation cohort) consecutive adult thrombotic thrombocytopenic purpura patients with acquired severe ADAMTS13 deficiency were enrolled. The study evaluated 30-day mortality after treatment initiation according to characteristics at inclusion. RESULTS Non-survivors (11%) were older (P=10(-6)) and more frequently presented arterial hypertension (P=5.10(-4)) and ischemic heart disease (P=0.013). Prognosis was increasingly poor with age (P=0.004). On presentation, cerebral manifestations were more frequent in non-survivors (P=0.018) and serum creatinine level was higher (P=0.008). The most significant independent variables determining death were age, severe cerebral involvement and LDH level 10 N or over. A 3-level risk score for early death was defined and confirmed in the validation cohort using these variables, with higher values corresponding to increased risk of early death. CONCLUSIONS A risk score for early death was defined in patients with thrombotic thrombocytopenic purpura and validated on an independent cohort. This score should help to stratify early treatment and identify patients with a worse prognosis.
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Affiliation(s)
- Ygal Benhamou
- Service de Médecine Interne, Hôpital Charles Nicolle, Rouen, France
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Glowacki F, Lionet A, Hammelin JP, Labalette M, Provôt F, Hazzan M, Broly F, Noël C, Cauffiez C. Influence of cytochrome P450 3A5 (CYP3A5) genetic polymorphism on the pharmacokinetics of the prolonged-release, once-daily formulation of tacrolimus in stable renal transplant recipients. Clin Pharmacokinet 2011; 50:451-9. [PMID: 21528942 DOI: 10.2165/11587050-000000000-00000] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Tacrolimus is metabolized by cytochrome P450 (CYP) 3A5. The objective of this study was to investigate the influence of the genetic polymorphism of CYP3A5 on the pharmacokinetics of a new modified-release, once-daily formulation of tacrolimus (Advagraf®) after a switch from the immediate-release formulation (Prograf®). PATIENTS AND METHODS This was a prospective, single-centre, open-label study in stable kidney transplant recipients. Seventeen 'expressor' patients (CYP3A5*1/*3 or *1/*1) were matched to 15 'non-expressor' patients (CYP3A5*3/*3). Exposure variables (concentrations and area under the blood concentration-time curve from 0 to 24 hours [AUC(24)]) were obtained before and 15 days after the switch. Delay since grafting was similar for both groups of patients (expressors: 49 ± 24 months; non-expressors: 45 ± 22 months). RESULTS During administration of tacrolimus as Prograf® or Advagraf®, the mean tacrolimus daily dose was significantly higher and the dose-adjusted AUC(24) was significantly lower in the expressor group. Following the switch to Advagraf®, there was a significant decrease in the dose-adjusted AUC(24) for both non-expressor (5910 ± 3019 vs 5334 ± 2668 ng·h/mL per mg/kg/day; p = 0.041) and expressor patients (3701 ± 1409 vs 3273 ± 1372 ng·h/mL per mg/kg/day; p = 0.03). In the non-expressor group, mean blood trough concentration (C(0)) was comparable for both formulations while it decreased significantly in the expressor group after the switch (8.2 ± 2.2 vs 6.3 ± 2.5 ng/mL; p = 0.02). However, a good correlation between AUC(24) and C(0) was observed for both Advagraf® and Prograf® regardless of CYP3A5 genotype. CONCLUSION Tacrolimus exposure significantly decreases after a switch from Prograf® to Advagraf®, on a milligram-for-milligram basis, in CYP3A5 expressor recipients. Consequently, these patients should be carefully monitored.
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Affiliation(s)
- François Glowacki
- Equipe d'Accueil 4483, Faculté de Médecine, Pôle Recherche, Lille, France
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50
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Bloch J, Provôt F, Noel LH, Glowacki F, Lionet A, Hazzan M, Noel C. Syndrome d’Alport et anévrismes artériels. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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