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Chemouny JM, Sannier A, Hanouna G, Raimbourg Q, Daugas É, Vigneau C, Vrtovnsik F. [Criteria to indicate kidney biopsy in type 2 diabetic patients with proteinuria: Survey among French nephrologists]. Nephrol Ther 2019; 15:524-531. [PMID: 31718993 DOI: 10.1016/j.nephro.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/11/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022]
Abstract
Diabetic nephropathy is usually a presumptive diagnosis based on clinical and biological evidence. Renal biopsies are performed in diabetic patients with atypical findings evoking non-diabetic renal disease who could benefit from specific therapies. French speaking nephrologists were asked which criteria they retain to indicate renal biopsy in patients with type 2 diabetes and albuminuria>0.5g/day or equivalent through an online anonymous questionnaire. Among the suggested criteria were absence of diabetic retinopathy, hematuria, rapid decrease in GFR, short diabetes duration or rapid raise of proteinuria. 188 people answered the poll among whom interns (12%), fellows (13%), university hospital practitioners (26%), general hospital practitioners (24%), practitioners in a non-profit organization (13%), practitioners on private activity (10%), multi-modal practitioners (3%) and people without clinical activity (2%). Increasing proteinuria was retained as an indication criterion for renal biopsy by 51% of respondents, nephrotic syndrome by 56% of respondents, absence of diabetic retinopathy by 57% of respondents, short diabetes duration by 65% of respondents, rapid GFR decline by 75% of respondents and hematuria by 78% of respondents. These data highlight the high diversity of opinions on this topic and their discrepancies with guidelines and current literature regarding the association between non-diabetic renal disease and clinical and biological features. The lack of adhesion of nephrologists to guidelines was especially noteworthy regarding the absence of diabetic retinopathy. These results emphasize the need for studies focusing on biopsy indication criteria in patients with type 2 diabetes.
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Affiliation(s)
- Jonathan Maurice Chemouny
- Service de néphrologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Faculté de médecine, université Rennes 1, 2, avenue du professeur Léon-Bernard, CS 34317, 35043 Rennes cedex, France; Institut Micalis, Inra, AgroParisTech, university Paris-Saclay, domaine de Vilvert, 78352 Jouy-en-Josas cedex, France.
| | - Aurélie Sannier
- Laboratoire d'anatomopathologie et de cytologie, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France
| | - Guillaume Hanouna
- Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France; Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - Quentin Raimbourg
- Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - Éric Daugas
- Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France; Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Inserm 1149, Center for research on inflammation (CRI), 16, rue Henri-Huchard, 75018 Paris, France
| | - Cécile Vigneau
- Service de néphrologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Faculté de médecine, université Rennes 1, 2, avenue du professeur Léon-Bernard, CS 34317, 35043 Rennes cedex, France; IRSET-UMR 1085, 9, avenue du professeur Léon-Bernard, 35000 Rennes, France
| | - François Vrtovnsik
- Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France; Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Inserm 1149, Center for research on inflammation (CRI), 16, rue Henri-Huchard, 75018 Paris, France
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Chemouny JM, Sannier A, Hanouna G, Champion L, Vrtovsnik F, Daugas E. Malakoplakia as a cause of severe hypercalcemia through ectopic 25-hydroxyvitamin D3 1-alpha-hydroxylase expression: A case report. Medicine (Baltimore) 2018; 97:e12090. [PMID: 30290590 PMCID: PMC6200547 DOI: 10.1097/md.0000000000012090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Malakoplakia is a rare disease characterized by the presence of nongranulomatous macrophage infiltration. In most cases, it affects the urinary tract. Malakoplakia can cause acute kidney injury when it is localized in the kidneys. PATIENT CONCERNS Here, we report the case of a 65-year-old female patient with renal malakoplakia responsible for hypercalcemia. During her initial assessment, she was also diagnosed 25-OH vitamin D insufficiency, for which she was prescribed oral cholecalciferol. Three months later, she developed severe hypercalcemia with normal 25-OH vitamin D and parathyroid hormone levels and high 1,25-dihydroxyvitamin D levels. DIAGNOSES After a superimposed granulomatous disease was excluded, malakoplakia cells were suspected to be responsible for the abnormal 25-hydroxyvitamin D3 1-alpha-hydroxylase activity, which was confirmed by immunohistochemistry. INTERVENTIONS Cholecalciferol was stopped, the patient was rehydrated with intravenous physiological saline, and prednisone was initiated to decrease the enzyme activity. OUTCOMES Six months later, she displayed normal serum calcium, 25-OH vitamin D and 1,25-dihydroxyvitamin D levels. LESSONS This case illustrates that malakoplakia may exhibit ectopic 25-hydroxyvitamin D3 1-alpha-hydroxylase activity and cause severe hypercalcemia upon vitamin D supplementation. Therefore, such supplementation should not be given in malakoplakia patients without an actual deficiency and requires careful monitoring of serum calcium.
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Affiliation(s)
- Jonathan Maurice Chemouny
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
- Université Paris Diderot, Sorbonne Paris Cité
| | - Aurélie Sannier
- Université Paris Diderot, Sorbonne Paris Cité
- Laboratoire d’anatomopathologie et de cytologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Guillaume Hanouna
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
| | | | - Francois Vrtovsnik
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
- Université Paris Diderot, Sorbonne Paris Cité
| | - Eric Daugas
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
- Université Paris Diderot, Sorbonne Paris Cité
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