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Fage N, Quéméneur T, Riou J, Boud'hors C, Desouche A, Vinatier E, Samoreau C, Coindre JP, Djema A, Henry N, Gnemmi V, Copin MC, Piccoli GB, Vandenbussche C, Augusto JF, Brilland B. A predictive mortality score in ANCA-associated renal vasculitis. Nephrol Dial Transplant 2024:gfae035. [PMID: 38327221 DOI: 10.1093/ndt/gfae035] [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] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Several scores have been developed to predict mortality at ANCA-Associated Vasculitis (AAV) diagnosis. Their prognostic value in Caucasian patients with kidney involvement (AAV-GN) remains uncertain as none have been developed in this specific population. We aimed to propose a novel and more accurate score specific for them. METHODS This multicentric study included patients diagnosed with AAV-GN since January 2000 in 4 nephrology Centers (recorded in the Maine-Anjou AAV-GN Registry). Existing scores and baseline characteristics were assessed at diagnosis before any therapeutic intervention. A multivariable analysis was performed to build a new predictive score for death. Its prognosis performance (AUROC and C-index) and accuracy (Brier score) was compared to existing scores. 185 patients with AAV-GN from the RENVAS registry were used as a validation cohort. RESULTS 228 patients with AAV-GN from the Maine-Anjou registry were included to build the new score. It included the 4 components most associated with death: age, history of hypertension or cardiac disease, creatinine, and hemoglobin levels at diagnosis. 194 patients had all the data available to determine the performance of the new score and existing scores. The new score performed better than the previous ones in the development and in the validation cohort. Among the scores tested, only FFS (Five-Factor Score) and JVAS (Japanese Vasculitis Activity Score) had good performance in predicting death in AAV-GN. CONCLUSIONS This original score, named DANGER (Death in ANCA Glomerulonephritis -Estimating the Risk), may be useful to predict the risk of death in AAV-GN patients. Validation in different populations is needed to clarify its role in assisting clinical decisions.
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Affiliation(s)
- Nicolas Fage
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
- Laboratoire MITOVASC UMR INSERM 1083 - CNRS 6015, Université d'Angers, Angers, France
| | - Thomas Quéméneur
- Nephrology and Internal Medicine Department, Hospital of Valenciennes, Valenciennes, France
| | - Jérémie Riou
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, CHU Angers, Angers, France
| | - Charlotte Boud'hors
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Alice Desouche
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Emeline Vinatier
- Laboratoire d'Immunologie et Allergologie, CHU Angers, Angers, France
- Univ Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
| | - Clément Samoreau
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | | | - Assia Djema
- Service de Néphrologie-Dialyse, Centre Hospitalier de Cholet, Cholet, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse, Centre Hospitalier de Laval, Laval, France
| | - Viviane Gnemmi
- Service d'anatomopathologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marie-Christine Copin
- Univ Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
- Département de pathologie cellulaire et tissulaire, Université d'Angers, CHU Angers, Angers, France
| | | | - Cyrille Vandenbussche
- Nephrology and Internal Medicine Department, Hospital of Valenciennes, Valenciennes, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
- Univ Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
- Univ Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
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2
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Brilland B, Boud'hors C, Wacrenier S, Blanchard S, Cayon J, Blanchet O, Piccoli GB, Henry N, Djema A, Coindre JP, Jeannin P, Delneste Y, Copin MC, Augusto JF. Kidney injury molecule 1 (KIM-1): a potential biomarker of acute kidney injury and tubulointerstitial injury in patients with ANCA-glomerulonephritis. Clin Kidney J 2023; 16:1521-1533. [PMID: 37664565 PMCID: PMC10468750 DOI: 10.1093/ckj/sfad071] [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: 05/23/2022] [Indexed: 09/05/2023] Open
Abstract
Background Kidney injury molecule 1 (KIM-1) is a transmembrane glycoprotein expressed by proximal tubular cells, recognized as an early, sensitive and specific urinary biomarker for kidney injury. Blood KIM-1 was recently associated with the severity of acute and chronic kidney damage but its value in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis with glomerulonephritis (ANCA-GN) has not been studied. Thus, we analyzed its expression at ANCA-GN diagnosis and its relationship with clinical presentation, kidney histopathology and early outcomes. Methods We assessed KIM-1 levels and other pro-inflammatory molecules (C-reactive protein, interleukin-6, tumor necrosis factor α, monocyte chemoattractant protein-1 and pentraxin 3) at ANCA-GN diagnosis and after 6 months in patients included in the Maine-Anjou registry, which gathers data patients from four French Nephrology Centers diagnosed since January 2000. Results Blood KIM-1 levels were assessed in 54 patients. Levels were elevated at diagnosis and decreased after induction remission therapy. KIM-1 was associated with the severity of renal injury at diagnosis and the need for kidney replacement therapy. In opposition to other pro-inflammatory molecules, KIM-1 correlated with the amount of acute tubular necrosis and interstitial fibrosis/tubular atrophy (IF/TA) on kidney biopsy, but not with interstitial infiltrate or with glomerular involvement. In multivariable analysis, elevated KIM-1 predicted initial estimated glomerular filtration rate (β = -19, 95% CI -31, -7.6, P = .002). Conclusion KIM-1 appears as a potential biomarker for acute kidney injury and for tubulointerstitial injury in ANCA-GN. Whether KIM-1 is only a surrogate marker or is a key immune player in ANCA-GN pathogenesis remain to be determined.
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Affiliation(s)
- Benoît Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
- Univ. Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
| | - Charlotte Boud'hors
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
- Service de Néphrologie, Centre Hospitalier du Mans, Le Mans, France
| | - Simon Blanchard
- Univ. Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
- Laboratoire d'Immunologie et d'Allergologie, CHU d'Angers, Angers, France
| | - Jérôme Cayon
- Univ. Angers, SFR ICAT, PACeM (Plateforme d'Analyse Cellulaire et Moléculaire), Angers, France
| | - Odile Blanchet
- Centre de Ressources Biologiques, BB-0033-00038, CHU Angers, Angers, France
| | | | - Nicolas Henry
- Service de Néphrologie-Dialyse, Centre Hospitalier de Laval, Laval, France
| | - Assia Djema
- Service de Néphrologie-Dialyse, Centre Hospitalier de Cholet, Cholet, France
| | | | - Pascale Jeannin
- Univ. Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
- Laboratoire d'Immunologie et d'Allergologie, CHU d'Angers, Angers, France
| | - Yves Delneste
- Univ. Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
- Laboratoire d'Immunologie et d'Allergologie, CHU d'Angers, Angers, France
| | - Marie-Christine Copin
- Univ. Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
- Département de pathologie, Université d'Angers, CHU Angers, Angers, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
- Univ. Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
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3
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Samoreau C, Piccoli GB, Martin C, Gatault P, Vinatier E, Bridoux F, Riou J, Desouche A, Jourdain P, Coindre JP, Wacrenier S, Guibert F, Henry N, Blanchet O, Croué A, Djema A, Pouteau LM, Copin MC, Beauvillain C, Subra JF, Augusto JF, Brilland B. Association between kinetic of Anti-Neutrophil Cytoplasmic Antibody (ANCA), renal survival and relapse risk in ANCA-glomerulonephritis. Nephrol Dial Transplant 2022; 38:1192-1203. [PMID: 36043422 DOI: 10.1093/ndt/gfac240] [Citation(s) in RCA: 1] [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: 02/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anti-neutrophil cytoplasmic antibody (ANCA) kinetic in ANCA-associated vasculitis with glomerulonephritis (AAV-GN) has been suggested to be associated with AAV relapse. Few studies focused on its association with renal prognosis. Thus, we aimed to investigate the relationship between i) ANCA specificity and evolutive profile, and ii) renal outcomes. METHODS This multicentric retrospective study included patients diagnosed with ANCA-GN since 01/01/2000. Patients without ANCA at diagnosis and with fewer than 3 ANCA determinations during follow-up were excluded. We analyzed eGFR variation, renal-free and relapse-free survival according to three ANCA profiles (negative, recurrent, persistent) and to ANCA specificity (MPO or PR3). RESULTS Over a follow-up of 56 [34-101] months, a median of 19 [13-25] ANCA determinations were performed for the 134 included patients. Patients with a recurrent/persistent ANCA profile had a lower relapse-free (p = 0.019) survival and tended to have a lower renal survival (p = 0.053) compared to those with negative ANCA profile. Patients with a recurrent/persistent MPO-ANCA profile had the shortest renal survival (p = 0.015) and those with recurrent/persistent PR3-ANCA profile had the worst relapse-free survival (p = 0.013) compared to other profiles. The negative ANCA profile was associated with a greater eGFR recovery. In multivariate regression analysis, it was an independent predictor of a two-fold increase of eGFR at 2-year (OR = 6.79, 95% CI [1.78, 31.4], p = 0.008). CONCLUSION ANCA kinetic after ANCA-GN diagnosis is associated with outcomes. MPO-ANCA recurrence/persistence identifies patients with a lower potential of renal recovery and a higher risk of kidney failure, while PR3-ANCA recurrence/persistence identifies patients with a greater relapse risk. Thus, ANCA kinetic may help identify patients with a smoldering disease.
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Affiliation(s)
- Clément Samoreau
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | | | - Cécile Martin
- Service de Néphrologie-Dialyse-Transplantation, CHU de Poitiers, Poitiers, France
| | - Philippe Gatault
- Service de Néphrologie-Dialyse-Transplantation, CHU de Tours, Tours, France
| | - Emeline Vinatier
- Laboratoire d'Immunologie et Allergologie, CHU Angers, Angers, France.,Université d'Angers, Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
| | - Frank Bridoux
- Service de Néphrologie-Dialyse-Transplantation, CHU de Poitiers, Poitiers, France
| | - Jérémie Riou
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, CHU Angers, Angers, France
| | - Alice Desouche
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Pierre Jourdain
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | | | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie-Dialyse, Centre Hospitalier du Mans, Le Mans, France
| | - Fanny Guibert
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie-Dialyse, Centre Hospitalier de Cholet, Cholet, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie-Dialyse, Centre Hospitalier de Laval, Laval, France
| | - Odile Blanchet
- Centre de Ressources Biologiques, BB-0033-00038, CHU Angers, Angers, France
| | - Anne Croué
- Département de pathologie cellulaire et tissulaire, Université d'Angers, CHU Angers, Angers, France
| | - Assia Djema
- Service de Néphrologie-Dialyse, Centre Hospitalier de Cholet, Cholet, France
| | - Lise-Marie Pouteau
- Service de Néphrologie-Dialyse, Centre Hospitalier de Cholet, Cholet, France
| | - Marie-Christine Copin
- Université d'Angers, Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France.,Département de pathologie cellulaire et tissulaire, Université d'Angers, CHU Angers, Angers, France
| | - Céline Beauvillain
- Laboratoire d'Immunologie et Allergologie, CHU Angers, Angers, France.,Université d'Angers, Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
| | - Jean-François Subra
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Université d'Angers, Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Université d'Angers, Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Université d'Angers, Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
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4
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Brilland B, Boud'hors C, Copin MC, Jourdain P, Henry N, Wacrenier S, Djema A, Samoreau C, Coindre JP, Cousin M, Riou J, Croue A, Saint-André JP, Subra JF, Piccoli GB, Augusto JF. Assessment of Renal Risk Score and Histopathological Classification for Prediction of End-Stage Kidney Disease and Factors Associated With Change in eGFR After ANCA-Glomerulonephritis Diagnosis. Front Immunol 2022; 13:834878. [PMID: 35392077 PMCID: PMC8981524 DOI: 10.3389/fimmu.2022.834878] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The “Renal Risk Score” (RRS) and the histopathological classification have been proposed to predict the risk of end-stage kidney disease (ESKD) in ANCA-associated glomerulonephritis (ANCA-GN). Besides, factors associated with kidney function recovery after ANCA-GN onset remain to be more extensively studied. In the present study, we analyzed the value of the RRS and of the histopathological classification for ESKD prediction. Next, we analyzed factors associated with eGFR change within the first 2 years following ANCA-GN diagnosis. Materials and Methods We included patients from the Maine–Anjou ANCA-associated vasculitis registry with at least 6 months of follow-up. The values of ANCA-GN, histopathological classification, and RRS, and the factors associated with eGFR variations between ANCA-GN diagnosis and 2 years of follow-up were assessed. Results The predictive values of the histopathological classification and RRS were analyzed in 123 patients. After a median follow-up of 42 months, 33.3% patients developed ESKD. The predictive value of RRS for ESKD was greater than that of the histopathological classification. Determinants of eGFR variation were assessed in 80/123 patients with complete eGFR measurement. The median eGFR increased from ANCA-GN diagnosis to month 6 and stabilized thereafter. The only factor associated with eGFR variation in our study was eGFR at ANCA-GN diagnosis, with higher eGFR at diagnosis being associated with eGFR loss (p<0.001). Conclusion The RRS has a better predictive value for ESKD than the histopathological classification. The main determinant of eGFR variation at 2 years was eGFR at ANCA-GN diagnosis. Thus, this study suggests that eGFR recovery is poorly predicted by histological damage at ANCA-GN diagnosis.
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Affiliation(s)
- Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | - Charlotte Boud'hors
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | - Marie-Christine Copin
- Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France.,Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Pierre Jourdain
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse, CH de Laval, Laval, France
| | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Service de Néphrologie-Dialyse, CH du Mans, Le Mans, France
| | - Assia Djema
- Service de Néphrologie-Dialyse, CH de Cholet, Cholet, France
| | - Clément Samoreau
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | | | - Maud Cousin
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jeremie Riou
- Micro et Nanomedecines Translationnelles, MINT, Université d'Angers, Unité Mixte de Recherche (UMR) Institut National de la Santé Et de la Recherche Médicale (INSERM) 6021, Unité Mixte de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 6021, Angers, France.,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Anne Croue
- Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jean-Paul Saint-André
- Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jean-François Subra
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | | | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
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5
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Ronsin C, Chaba A, Suchanek O, Coindre JP, Kerleau C, Garandeau C, Houzet A, Cantarovich D, Dantal J, Blancho G, Giral M, Couvrat-Desvergnes G, Ville S. Incidence, risk factors and outcomes of kidney and liver cyst infection in kidney transplant recipient with autosomal dominant polycystic kidney disease. Kidney Int Rep 2022; 7:867-875. [PMID: 35497795 PMCID: PMC9039903 DOI: 10.1016/j.ekir.2022.01.1062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction Methods Results Conclusion
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6
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Martis N, Jamme M, Bagnis-Isnard C, Pouteil-Noble C, Presne C, Vigneau C, Grangé S, Burtey S, Coindre JP, Wynckel A, Hamidou MA, Kanouni T, Azoulay E, Hié M, Chauveau D, Veyradier A, Rondeau E, Coppo P. Systemic autoimmune disorders associated with thrombotic microangiopathy: A cross-sectional analysis from the French National TMA registry: Systemic autoimmune disease-associated TMA. Eur J Intern Med 2021; 93:78-86. [PMID: 34175183 DOI: 10.1016/j.ejim.2021.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
CONTEXT The management of systemic auto-immune diseases (SAID) -associated thrombotic microangiopathies (TMA) [SAID-TMA] remains debated. OBJECTIVES To provide a demographic, clinical and therapeutic picture of SAID-TMA. METHODS A cross-sectional analysis was conducted on adult patients presenting with SAID and TMA from the French National TMA Registry over a 20-year period. Clinical features were extracted and compared to those from a historical cohort of atypical haemolytic and uremic syndrome (aHUS) patients. RESULTS Forty-one patients with SAID-TMA were compared to 78 patients with aHUS from a historical cohort. Connective tissue diseases (CTD) were systemic lupus erythematosus (n=18), primary Sjögren's syndrome (n=7), systemic sclerosis (n=11), mixed CTD (n=2) and 2 cases of vasculitides, including 7 overlapping forms and 8 cases of primary antiphospholipid syndromes (APLS). Patients with SAID-TMA generally had pre-existing chronic kidney failure (OR= 3.17, 95%CI: 1.204 to 7.923; p= 0.016) compared to aHUS patients, though creatinine levels were significantly lower (216 [IQR, 108-334] µmol/L vs. 368 [IQR, 170-722] µmol/L; p= 0.002). Patients were less likely to recover if renal replacement therapy was needed at onset (OR= 0.07; 0.02 to 0.34; p <0.0005). Two patients died. Thirty patients responded to immunosuppressive treatment and complete remission was achieved in 25 cases. By contrast, therapeutic plasma exchange (TPE) did not have an early effect on TMA features at Day-7 nor Day-15 (p >0.05). CONCLUSION The management of SAID-TMA implies an early initiation of immunosuppressive drugs for flares of the associated SAID, whereas TPE seem ineffective. KEY MESSAGES.
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Affiliation(s)
- Nihal Martis
- Internal Medicine Department, University Hospital of Nice; Côte d'Azur University, Nice, France; French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France.
| | - Matthieu Jamme
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, C.H. Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | | | - Claire Pouteil-Noble
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Édouard Herriot Hospital, Lyon, France
| | - Claire Presne
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Sud, Amiens, France
| | - Cécile Vigneau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; University of Rennes, University Hospital of Rennes - Inserm, EHESP, Institut de recherche en santé, Environnement et Travail - UMR_S 1085, F-35000 Rennes, France
| | - Steven Grangé
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Intensive Care Unit, C.H.U Rouen, Rouen, France
| | - Stéphane Burtey
- Nephrology Department, C.H.U. de la Conception, Marseille, France
| | | | - Alain Wynckel
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Maison Blanche, Reims Cedex, France
| | - Mohamed A Hamidou
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Hôtel Dieu Hospital, Nantes, France
| | - Tarik Kanouni
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Therapeutic Apheresis Department, C.H.U de Montpellier, Montpellier, France
| | - Elie Azoulay
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | - Miguel Hié
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Chauveau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Rangueil Hospital, Toulouse, France
| | - Agnès Veyradier
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haemostasis Department, Lariboisière Hospital, Paris, France
| | - Eric Rondeau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Tenon Hospital, Paris, France
| | - Paul Coppo
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haematology Department, Saint-Antoine Hospital, Paris, France; Sorbonne University, Paris, France.
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7
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Grall M, Daviet F, Chiche NJ, Provot F, Presne C, Coindre JP, Pouteil-Noble C, Karras A, Guerrot D, François A, Benhamou Y, Veyradier A, Frémeaux-Bacchi V, Coppo P, Grangé S. Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre. BMC Nephrol 2021; 22:267. [PMID: 34284729 PMCID: PMC8293501 DOI: 10.1186/s12882-021-02470-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/07/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gemcitabine is a broadly prescribed chemotherapy, the use of which can be limited by renal adverse events, including thrombotic microangiopathy (TMA). METHODS This study evaluated the efficacy of eculizumab, a monoclonal antibody targeting the terminal complement pathway, in patients with gemcitabine-induced TMA (G-TMA). We conducted an observational, retrospective, multicenter study in 5 French centres, between 2011 and 2016. RESULTS Twelve patients with a G-TMA treated by eculizumab were included. The main characteristics were acute renal failure (100%), including stage 3 acute kidney injury (AKI, 58%) and renal replacement therapy (17%), hypertension (92%) and diffuse oedema (83%). Eculizumab was started after a median of 15 days (range 4-44) following TMA diagnosis. A median of 4 injections of eculizumab was performed (range 2-22). Complete hematological remission was achieved in 10 patients (83%) and blood transfusion significantly decreased after only one injection of eculizumab (median of 3 packed red blood cells (range 0-10) before treatment vs 0 (range 0-1) after one injection, P < 0.001). Two patients recovered completely renal function (17%), and 8 achieved a partial remission (67%). Compared to a control group of G-TMA without use of eculizumab, renal outcome was more favourable. At the end of the follow up, median eGFR was 45 vs 33 ml/min/1.73m2 respectively in the eculizumab group and in the control group. CONCLUSIONS These results suggest that eculizumab is efficient on haemolysis and reduces transfusion requirement in G-TMA. Moreover, eculizumab may improve renal function recovery.
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Affiliation(s)
- Maximilien Grall
- Medical Intensive Care Unit, Rouen University Hospital, 37 boulevard Gambetta, 76031, Rouen Cedex, France
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
| | - Florence Daviet
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Conception University Hospital, APHM, Marseille, France
| | - Noémie Jourde Chiche
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Conception University Hospital, APHM, Marseille, France
| | - François Provot
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Lille University Hospital, Lille, France
| | - Claire Presne
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Amiens University Hospital, Amiens, France
| | - Jean-Philippe Coindre
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Le Mans General Hospital, Le Mans, France
| | - Claire Pouteil-Noble
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, E. Herriot Hospital, Lyon I university, Lyon, France
| | - Alexandre Karras
- Department of Nephrology, Georges Pompidou Hospital, APHP, Paris, France
| | | | - Arnaud François
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Ygal Benhamou
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Agnès Veyradier
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Biological Hematology, Lariboisière University Hospital, APHP, Paris, France
| | - Véronique Frémeaux-Bacchi
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of immunology, Georges Pompidou Hospital, APHP, Paris, France
| | - Paul Coppo
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Hematology, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 boulevard Gambetta, 76031, Rouen Cedex, France.
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France.
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8
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Crochette R, Ravaiau C, Perez L, Coindre JP, Piccoli GB, Blanchi S. Incidence and Risk Factors for Acute Kidney Injury during the Treatment of Methicillin-Sensitive Staphylococcus aureus Infections with Cloxacillin Based Antibiotic Regimens: A French Retrospective Study. J Clin Med 2021; 10:2603. [PMID: 34204743 PMCID: PMC8231553 DOI: 10.3390/jcm10122603] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cloxacillin has been associated with the occurrence of acute kidney injury (AKI). The incidence of this complication in the literature is low (2.5-3.5%) and probably underestimated, since most studies were done by selecting the presence of AKI in discharge codes. OBJECTIVES The primary goal was to define the incidence of AKI in patients with a methicillin-sensitive Staphylococcus aureus infection treated with cloxacillin based antibiotic regimens. The secondary goals were to identify the risk factors associated with this complication and to describe the characteristics of AKI. PATIENTS AND METHODS We carried out a retrospective study. The inclusion criteria were adult patients hospitalized in a medical department at the Le Mans Hospital between 1 July 2012 and 1 July 2019 with a diagnosis of methicillin-sensitive Staphylococcus aureus infection treated with cloxacillin. RESULTS One hundred twenty-three patients were included in the study. Forty-two patients (34.2%) developed AKI. In the multivariate analysis, age, the use of diuretics and the presence of endocarditis were independently associated with AKI. Age was associated with an OR of 4.38 (p = 0.002) for patients older than 75, being treated with diuretics was associated with an OR of 2.94 (p = 0.036) for loop diuretics and an OR of 3.05 (p = 0.027) for non-loop diuretics; type of infection was associated with an OR of 3.42 (p = 0.012) for endocarditis. CONCLUSIONS The occurrence of AKI is frequent during cloxacillin based antibiotic regimens for methicillin-sensitive Staphylococcus aureus infections. Being older than 75, being treated with diuretics and the presence of endocarditis were the main risk factors for AKI in our population.
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Affiliation(s)
- Romain Crochette
- Department of Nephrology, Le Mans General Hospital, 72000 Le Mans, France; (C.R.); (J.-P.C.); (G.B.P.)
| | - Camille Ravaiau
- Department of Nephrology, Le Mans General Hospital, 72000 Le Mans, France; (C.R.); (J.-P.C.); (G.B.P.)
| | - Lucia Perez
- Department of Infectious Diseases, Le Mans General Hospital, 72000 Le Mans, France; (L.P.); (S.B.)
| | - Jean-Philippe Coindre
- Department of Nephrology, Le Mans General Hospital, 72000 Le Mans, France; (C.R.); (J.-P.C.); (G.B.P.)
| | - Giorgina Barbara Piccoli
- Department of Nephrology, Le Mans General Hospital, 72000 Le Mans, France; (C.R.); (J.-P.C.); (G.B.P.)
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10124 Torino, Italy
| | - Sophie Blanchi
- Department of Infectious Diseases, Le Mans General Hospital, 72000 Le Mans, France; (L.P.); (S.B.)
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9
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Wacrenier S, Riou J, Jourdain P, Guibert F, Henry N, Djema A, Coindre JP, Crochette R, Cousin M, Croue A, Subra JF, Piccoli G, Augusto JF, Brilland B. Lymphopenia at diagnosis of ANCA-vasculitis with renal involvement is correlated with severity and renal prognosis. Nephrol Dial Transplant 2021; 37:1078-1087. [PMID: 33856482 DOI: 10.1093/ndt/gfab158] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lymphopenia is commonly observed in autoimmune diseases, where it has been associated with disease activity or prognosis. However, in ANCA-associated vasculitis (AAV) only few, small-scale studies have been targeted to this issue. Research has not yet focused on AAV with renal involvement (AAV-RI) patients. Thus, the aim of this study was to analyze the association between lymphocyte counts and outcomes in a large cohort of AAV-RI patients. METHODS We used the Maine-Anjou AAV registry that retrospectively gathers data on consecutive patients affected by AAV in four French Nephrology Centers, recorded since January 2000. We analyzed clinical, biological, and histological data at diagnosis of AAV-RI. Risk factors for end-stage kidney disease (ESKD) were analyzed. Event-free survival was also assessed. RESULTS Among the 145 patients included in the study, those with lymphopenia at diagnosis had a lower renal function at baseline (eGFR 13 mL/min vs 26 mL/min, p = 0.002) and were more likely to require kidney replacement therapy (51% vs 25%, p = 0.003). Lymphopenia was correlated with histological lesions and especially with the percentage of sclerotic glomeruli (p = 0.0027). ESKD-free survival was lower in lymphopenic patients (p < 0.0001). In multivariate Cox analysis, lymphopenia was an independent risk factor for ESKD (HR 4.47 (95% confidence interval: [2.06-9.72], p < 0.001). CONCLUSION Lymphopenia correlates with the severity of AAV glomerulonephritis at diagnosis and predicts poor renal outcome. In this view, lymphopenia could be used as a simple and cost-effective biomarker to assess renal prognosis at AAV-RI diagnosis.
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Affiliation(s)
- Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie, Centre Hospitalier du Mans, Le Mans, France
| | - Jérémie Riou
- Micro et Nanomédecines Translationnelles, MINT, Université d'Angers, UMR INSERM 6021, UMR CNRS 6021, Angers, France.,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Pierre Jourdain
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Fanny Guibert
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie, Centre Hospitalier de Cholet, Cholet, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie, Centre Hospitalier de Laval, Laval, France
| | - Assia Djema
- Service de Néphrologie, Centre Hospitalier de Cholet, Cholet, France
| | | | - Romain Crochette
- Service de Néphrologie, Centre Hospitalier du Mans, Le Mans, France
| | - Maud Cousin
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Anne Croue
- Département de pathologie cellulaire et tissulaire, Université d'Angers, CHU Angers, Angers, France
| | - Jean-François Subra
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Giorgina Piccoli
- Service de Néphrologie, Centre Hospitalier du Mans, Le Mans, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
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10
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Jourdain P, Brilland B, Medhioub O, Caron J, Samoreau C, Djema A, Gansey R, Coindre JP, Cousin M, Garnier AS, Henry N, Wacrenier S, Riou J, Piccoli GB, Augusto JF. Incidence and Temporal Trend in Risk Factors of Severe Infections in ANCA-Glomerulonephritis Patients. Kidney Int Rep 2021; 6:1161-1165. [PMID: 33912765 PMCID: PMC8071615 DOI: 10.1016/j.ekir.2020.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pierre Jourdain
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France
| | - Ouassim Medhioub
- Micro et Nanomedecines Translationnelles, MINT, Université d'Angers, UMR INSERM 6021, UMR CNRS 6021, Angers, France
| | - Jeanne Caron
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Clément Samoreau
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Assia Djema
- Service de Néphrologie-Dialyse, CH de Cholet, Cholet, France
| | - Renaud Gansey
- Service de Néphrologie-Dialyse, CH de Laval, Laval, France
| | | | - Maud Cousin
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Anne Sophie Garnier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie-Dialyse, CH de Laval, Laval, France
| | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,Service de Néphrologie-Dialyse, CH du Mans, Le Mans, France
| | - Jeremy Riou
- CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France.,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, 49100 Angers, France
| | - Giorgina Barbara Piccoli
- Service de Néphrologie-Dialyse, CH de Laval, Laval, France.,Department of Clinical and Biological Sciences University of Torino, Italy
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.,CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France
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11
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Henry N, Brilland B, Wacrenier S, Djema A, Garnier AS, Gansey R, Coindre JP, Besson V, Duveau A, Subra JF, Cousin M, Piccoli GB, Augusto JF. Incidence and Risk Factors of Venous Thromboembolic Events in Patients with ANCA-Glomerulonephritis: A Cohort Study from the Maine-Anjou Registry. J Clin Med 2020; 9:E3177. [PMID: 33007967 PMCID: PMC7599765 DOI: 10.3390/jcm9103177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/03/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Introduction: The incidence of venous thromboembolisms (VTE) has not been extensively analyzed in patients with antineutrophil cytoplasmic antibody (ANCA)-glomerulonephritis (ANCA-GN). Thus, the aim of the present study was to assess the frequency and the risk factors of VTE in patients with ANCA-GN. (2) Methods: Patients from the Maine-Anjou ANCA-associated vasculitis (AAV) registry with a biopsy showing pauci-immune glomerulonephritis were included. VTE events, site, and interval from AAV diagnosis were analyzed. (3) Results: 133 patients fulfilled the inclusion criteria of the study and were analyzed. VTE episodes were diagnosed in 23/133 (17.3%) patients at a median delay of 3 months from ANCA-GN diagnosis. Patients with VTE had lower serum albumin (p = 0.040), were less frequently on statin therapy (p = 0.009) and had less frequently proteinase-3 (PR3)-ANCAs (p = 0.078). Univariate analysis identified higher age (p = 0.022), lower serum albumin (p = 0.030), lack of statin therapy (p = 0.009), and rituximab treatment (p = 0.018) as significant risk factors of VTE. In multivariate analysis, only lack of statin therapy (HR 4.873; p = 0.042) was significantly associated with VTE. (4) Conclusion: Patients with ANCA-GN are at high risk of VTE, especially within the first months following AAV diagnosis. Our results suggest that statin therapy is associated with a lower risk of VTE in ANCA-GN patients.
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Affiliation(s)
- Nicolas Henry
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
- CHU d’Angers, Université d’Angers, INSERM U1232, CRCINA, 49000 Angers, France
| | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
- Service de Néphrologie-Dialyse, CH du Mans, 72000 Le Mans, France; (J.-P.C.); (G.B.P.)
| | - Assia Djema
- Service de Néphrologie-Dialyse, CH de Cholet, 49300 Cholet, France;
| | - Anne Sophie Garnier
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
| | - Renaud Gansey
- Service de Néphrologie-Dialyse, CH de Laval, 53000 Laval, France;
| | - Jean-Philippe Coindre
- Service de Néphrologie-Dialyse, CH du Mans, 72000 Le Mans, France; (J.-P.C.); (G.B.P.)
| | - Virginie Besson
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
| | - Agnès Duveau
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
| | - Jean-François Subra
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
- CHU d’Angers, Université d’Angers, INSERM U1232, CRCINA, 49000 Angers, France
| | - Maud Cousin
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
| | | | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d’Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France; (N.H.); (B.B.); (S.W.); (A.S.G.); (V.B.); (A.D.); (J.-F.S.); (M.C.)
- CHU d’Angers, Université d’Angers, INSERM U1232, CRCINA, 49000 Angers, France
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12
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Zuber J, Frimat M, Caillard S, Kamar N, Gatault P, Petitprez F, Couzi L, Jourde-Chiche N, Chatelet V, Gaisne R, Bertrand D, Bamoulid J, Louis M, Sberro Soussan R, Navarro D, Westeel PF, Frimat L, Colosio C, Thierry A, Rivalan J, Albano L, Arzouk N, Cornec-Le Gall E, Claisse G, Elias M, El Karoui K, Chauvet S, Coindre JP, Rerolle JP, Tricot L, Sayegh J, Garrouste C, Charasse C, Delmas Y, Massy Z, Hourmant M, Servais A, Loirat C, Fakhouri F, Pouteil-Noble C, Peraldi MN, Legendre C, Rondeau E, Le Quintrec M, Frémeaux-Bacchi V. Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes after Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic Syndrome. J Am Soc Nephrol 2019; 30:2449-2463. [PMID: 31575699 DOI: 10.1681/asn.2019040331] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 04/01/2019] [Accepted: 08/26/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Atypical hemolytic uremic syndrome (HUS) is associated with high recurrence rates after kidney transplant, with devastating outcomes. In late 2011, experts in France recommended the use of highly individualized complement blockade-based prophylaxis with eculizumab to prevent post-transplant atypical HUS recurrence throughout the country. METHODS To evaluate this strategy's effect on kidney transplant prognosis, we conducted a retrospective multicenter study from a large French nationwide registry, enrolling all adult patients with atypical HUS who had undergone complement analysis and a kidney transplant since January 1, 2007. To assess how atypical HUS epidemiology in France in the eculizumab era evolved, we undertook a population-based cohort study that included all adult patients with atypical HUS (n=397) between 2007 and 2016. RESULTS The first study included 126 kidney transplants performed in 116 patients, 58.7% and 34.1% of which were considered to be at a high and moderate risk of atypical HUS recurrence, respectively. Eculizumab prophylaxis was used in 52 kidney transplants, including 39 at high risk of recurrence. Atypical HUS recurred after 43 (34.1%) of the transplants; in four cases, patients had received eculizumab prophylaxis and in 39 cases they did not. Use of prophylactic eculizumab was independently associated with a significantly reduced risk of recurrence and with significantly longer graft survival. In the second, population-based cohort study, the proportion of transplant recipients among patients with ESKD and atypical HUS sharply increased between 2012 and 2016, from 46.2% to 72.3%, and showed a close correlation with increasing eculizumab use among the transplant recipients. CONCLUSIONS Results from this observational study are consistent with benefit from eculizumab prophylaxis based on pretransplant risk stratification and support the need for a rigorous randomized trial.
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Affiliation(s)
- Julien Zuber
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France; .,French Study Group of Atypical Hemolytic Uremic Syndrome, France
| | - Marie Frimat
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU Lille, University of Lille, Lille, France
| | - Sophie Caillard
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, The University Hospitals of Strasbourg, Strasbourg, France
| | - Nassim Kamar
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Organ Transplantation, CHU Rangueil, INSERM (Institut National de la Santé et de la Recherche Médicale) U1043, IFR-BMT (Institut Fédératif de Recherche Bio-Médicale de Toulouse), University Paul Sabatier, Toulouse, France
| | - Philippe Gatault
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Tours, Tours, France
| | | | - Lionel Couzi
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Bordeaux, Bordeaux University, CNRS-UMR (Centre National de la Recherche Scientifique-Unité Mixte de Recherche) 5164, Bordeaux, France
| | - Noemie Jourde-Chiche
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology, C2VN, INSERM, INRA (Institut National de la Recherche Agronomique), CHU de Marseille, Aix-Marseille University, Marseille, France
| | - Valérie Chatelet
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,University Center of Kidney Diseases, CHU de Caen, Caen, France
| | - Raphael Gaisne
- Department of Nephrology and Kidney Transplantation, CHU de Nantes, Nantes, France
| | - Dominique Bertrand
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Rouen, Rouen, France
| | - Jamal Bamoulid
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHRU de Besançon, Besançon, France
| | - Magali Louis
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Dijon, Dijon, France
| | - Rebecca Sberro Soussan
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France.,French Study Group of Atypical Hemolytic Uremic Syndrome, France
| | - David Navarro
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France.,Department of Nephrology and Kidney Transplantation, Curry Cabral Hospital, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Pierre-Francois Westeel
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU d'Amiens, Amiens, France
| | - Luc Frimat
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Nancy, Nancy, France
| | - Charlotte Colosio
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Reims, Reims, France
| | - Antoine Thierry
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Poitiers, Poitiers, France
| | - Joseph Rivalan
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Rennes, Rennes, France
| | - Laetitia Albano
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Nice, Nice, France
| | - Nadia Arzouk
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU Pitié-Salpétrière, Paris, France
| | - Emilie Cornec-Le Gall
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Brest, Brest, France
| | - Guillaume Claisse
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Saint Etienne, St-Etienne, France
| | - Michelle Elias
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, Kremlin-Bicêtre Hospital, Paris, France
| | - Khalil El Karoui
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, Henri-Mondor Hospital, Créteil, France
| | - Sophie Chauvet
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology, Georges Pompidou European Hospital, Paris, France
| | - Jean-Philippe Coindre
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology, Hospital Center du Mans, Le Mans, France
| | - Jean-Philippe Rerolle
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Limoges, Limoges, France
| | - Leila Tricot
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CH de Foch, Suresnes, France
| | - Johnny Sayegh
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Angers, Angers, France
| | - Cyril Garrouste
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Christophe Charasse
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology, CH du St Brieuc, St Brieuc, France
| | - Yahsou Delmas
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Bordeaux, Bordeaux University, CNRS-UMR (Centre National de la Recherche Scientifique-Unité Mixte de Recherche) 5164, Bordeaux, France
| | - Ziad Massy
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology, CHU Ambroise-Paré, Boulogne-Billancourt, France
| | - Maryvonne Hourmant
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Nantes, Nantes, France
| | - Aude Servais
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France.,French Study Group of Atypical Hemolytic Uremic Syndrome, France
| | - Chantal Loirat
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology, University Hospital Robert Debré, Paris, France
| | - Fadi Fakhouri
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Nantes, Nantes, France
| | - Claire Pouteil-Noble
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Lyon, Lyon, France
| | - Marie-Noelle Peraldi
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU St Louis, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France.,French Study Group of Atypical Hemolytic Uremic Syndrome, France
| | - Eric Rondeau
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU Tenon, Paris, France; and
| | - Moglie Le Quintrec
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Department of Nephrology and Kidney Transplantation, CHU de Montpellier, Montpellier, France
| | - Véronique Frémeaux-Bacchi
- French Study Group of Atypical Hemolytic Uremic Syndrome, France.,Cordelier Research Center, INSERM UMRS 1138, Paris, France
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Sofronie AC, Kooij I, Bursot C, Santagati G, Coindre JP, Piccoli GB. Full normalization of severe hypertension after parathryoidectomy - a case report and systematic review. BMC Nephrol 2018; 19:112. [PMID: 29751781 PMCID: PMC5948802 DOI: 10.1186/s12882-018-0900-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/19/2017] [Accepted: 04/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background Although the relationship between hyperparathyroidism and hypertension has been described for decades, the role of hyperparathyroidism in hypertension in dialysis is still unclear. Following the case of a severely hypertensive dialysis patient, in which parathyroidectomy (PTX) corrected the metabolic imbalance and normalized blood pressure (BP), we tried to contextualize our observation with a systematic review of the recent literature on the effect of PTX on BP. Case presentation A dialysis patient, aged 19 years at the time of this report, with chronic kidney disease (CKD) from childhood; he was an early-preterm baby with very low birth weight (910 g), and is affected by a so-far unidentified familial nephropathy. He started dialysis in emergency at the age of 17. Except for low-dose Bisoprolol, he refused all chronic medication; hypertension (165–200/90–130 mmHg) did not respond to attainment of dry weight (Kt/V > 1.7; BNP 70–200 pg/ml pre-dialysis). He underwent subtotal PTX 1 year after dialysis start; after PTX, his blood pressure stabilized in the 100–140/50–80 range, and is normal without treatment 5 months later. Conclusion Our patient has some peculiar features: he is young, has a non-immunologic disease, poor compliance to drug therapy, excellent dialysis efficiency. His lack of compliance allows observing the effect of PTX on BP without pharmacologic interference. The prompt, complete and long-lasting BP normalization led us to systematic review the current literature (Pubmed, Embase, Cochrane Collaboration 2000–2016) retrieving 8 case series (194 cases), and one case report (3 patients). The meta-analysis showed a significant, albeit moderate, improvement in BP after PTX (difference: systolic BP -8.49 (CI 2.21–14.58) mmHg; diastolic BP -4.14 (CI 1.45–6.84) mmHg); analysis is not fully conclusive due to lack of information on anti-hypertensive agents. The 3 cases reported displayed a sharp reduction in BP after PTX. In summary, PTX may have a positive influence on BP control, and may result in complete correction or even hypotension in some patients. The potential clinical relevance of this relationship warrants prospective large-scale studies.
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Affiliation(s)
| | - Isabelle Kooij
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy
| | - Claude Bursot
- Nuclear Medicine, Centre Hospitalier Le Mans, Le Mans, France
| | | | | | - Giorgina Barbara Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy. .,Nephrology Centre Hospitalier Le Mans, 194 Avenue Rubillard 72000, Le Mans, France.
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14
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Piccoli GB, Sofronie AC, Coindre JP. The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions. BMC Med Ethics 2017; 18:61. [PMID: 29121886 PMCID: PMC5680775 DOI: 10.1186/s12910-017-0219-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022] Open
Abstract
Background Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Case presentation Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. Conclusions An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy. .,Nephrology, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
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15
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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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16
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Fakhouri F, Delmas Y, Provot F, Barbet C, Karras A, Makdassi R, Courivaud C, Rifard K, Servais A, Allard C, Besson V, Cousin M, Châtelet V, Goujon JM, Coindre JP, Laurent G, Loirat C, Frémeaux-Bacchi V. Insights From the Use in Clinical Practice of Eculizumab in Adult Patients With Atypical Hemolytic Uremic Syndrome Affecting the Native Kidneys: An Analysis of 19 Cases. Am J Kidney Dis 2014; 63:40-8. [DOI: 10.1053/j.ajkd.2013.07.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/16/2013] [Indexed: 01/06/2023]
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17
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Beloncle F, Buffet M, Coindre JP, Munoz-Bongrand N, Malot S, Pène F, Mira JP, Galicier L, Guidet B, Baudel JL, Subra JF, Tanguy-Schmidt A, Pourrat J, Azoulay E, Veyradier A, Coppo P. Splenectomy and/or cyclophosphamide as salvage therapies in thrombotic thrombocytopenic purpura: the French TMA Reference Center experience. Transfusion 2012; 52:2436-44. [DOI: 10.1111/j.1537-2995.2012.03578.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Demy M, Varache N, Coindre JP, Dernis E, Puéchal X. Recurrent and fatal pancytopenia due to repeated colchicine self administration. Eur J Intern Med 2009; 20:e116-7. [PMID: 19712830 DOI: 10.1016/j.ejim.2008.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
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