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Joseph A, Harel S, Mesnard L, Rafat C, Knapp S, Rumpler A, Philipponnet C, Barba C, Rebibou JM, Buob D, Hertig A, Vargaftig J, Halimi JM, Arnulf B, Bretaud AS, Joly B, Grangé S, Coppo P. Carfilzomib-associated thrombotic microangiopathy: clinical features and outcomes. Nephrol Dial Transplant 2024:gfae096. [PMID: 38658194 DOI: 10.1093/ndt/gfae096] [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: 04/26/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS Carfilzomib, a new proteasome inhibitor indicated for patients with relapsed/refractory myeloma, has been associated with cases of thrombotic microangiopathy (CFZ-TMA). The role of variants in the complement alternative pathway and therapeutic potential of complement blockade with eculizumab remain to be determined. METHODS We report 37 cases of CFZ-TMA recorded in the French reference center for TMA with their clinical characteristics, genetic analysis and outcome according to treatments. RESULTS A trigger was identified in more than half of cases, including 8 influenza and 5 SARS-CoV-2 cases. All patients presented with acute kidney injury (AKI) (KDIGO stage 3 in 31 (84%) patients) while neurological (n=13, 36%) and cardiac damage (n=7, 19%) were less frequent. ADAMTS13 and complement activity were normal (n= 28 and 18 patients tested) and no pathogenic variant in the alternative complement pathway was found in 7 patients tested.TMA resolved in most (n=34, 94%) patients but 12 (44%) still displayed stage 3 AKI at discharge. Nineteen (51%) patients were treated with therapeutic plasma exchange, 14 (38%) patients received corticosteroids and 18 (50%) were treated with eculizumab. However none of these treatments demonstrated a significant impact on outcomes. CONCLUSION This study is the largest case series of CFZ-TMA since its approval in 2012. Patients present with severe AKI and experience frequent sequelae. Complement variants and blockade therapy do not seem to play a role in the pathophysiology and prognosis of the disease.
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Affiliation(s)
- Adrien Joseph
- Service de Médecine intensive réanimation, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stéphanie Harel
- Service d'immuno-hématologie, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Laurent Mesnard
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
- UMR_S1155, INSERM, Sorbonne Université, Paris, France
| | - Cédric Rafat
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Silène Knapp
- Service d'immuno-hématologie, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Rumpler
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'hématologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Carole Philipponnet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie, dialyse et transplantation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Christophe Barba
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie et Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Jean-Michel Rebibou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | - David Buob
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'anatomo-pathologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Alexandre Hertig
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de néphrologie, Hôpital Foch, Suresnes, France
| | - Jacques Vargaftig
- Service d'hématologie, Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
| | - Jean-Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau ; Hôpital Clocheville, Centre Hospitalier Universitaire de Tours, Tours, France et EA4245 T2i, Hôpital Trousseau, CHRU de Tours, Université de Tours, Tours, France
| | - Bertrand Arnulf
- Service d'immuno-hématologie, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne-Sophie Bretaud
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Bérangère Joly
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'Hématologie Biologique, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie, dialyse et transplantation, Centre Hospitalier Universitaire de Rouen, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'Hématologie, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
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Serre J, Doreille A, Raymond L, Suc G, Bobot M, Dancer M, Rafat C, Mesnard L. Diagnostic yield of exome sequencing in early onset hypertensive nephropathy in adults. Am J Nephrol 2024:000538173. [PMID: 38471460 DOI: 10.1159/000538173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Hypertensive nephrosclerosis (HN) ranks as one of the most frequent causes of chronic kidney disease (CKD), but its very existence has repeatedly been called into question, especially in young adults. Its diagnostic framework is established chiefly on non-specific clinical criteria and its defining histopathological set of features are in fact shared by numerous other conditions. Genetic testing based on exome sequencing (ES) has emerged as a comprehensive tool to detect Mendelian diseases in timely fashion in nephrology with a significant number of re-established diagnoses. The aim of this study was to investigate the diagnostic yield of ES in patients with a clinical diagnosis of hypertensive nephropathy. METHOD Since September 2018, ES has been readily available as part of the routine diagnostic work-up in our institution. The indication of ES includes hypertensive nephropathy of early onset (i.e., < 45 years old). We retrospectively collected the ES data performed in the context of hypertensive nephropathy in our institution between September 2018 and February 2021. RESULTS A total of 128 patients were sequenced in the context of hypertensive nephropathy with early onset. The chief indications of ES were an early onset of CKD (47%), family history of kidney disease (8%), or both (18%). We detected diagnostic variants in 19 of the 128 patients (15%) encompassing a total of 13 different monogenic disorders. The diagnostic yield of ES was lower in patients of African ancestry (diagnostic yield of 7% versus 30% in non-African ancestry patients, p<0.001). CONCLUSIONS The high diagnostic yield of ES (15%) in a population of patients thought to have HN casts further doubts on the validity of the existing diagnosis criteria, including histological criteria, supposed to characterize the condition. This was especially true in patients with no African ancestry where ES positivity reached 30%.
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Thizy G, Flahault A, Scemla A, Roux O, Jarraud S, Lebeaux D, Pouchot J, Gautier-Vargas G, Malvezzi P, Murris M, Vuotto F, Girerd S, Pansu N, Antonini T, Elkrief L, Barrou B, Besch C, Blot M, Boignard A, Brenier H, Coilly A, Gouezel C, Hannah K, Housssel-Debry P, Jouan J, Lecuyer H, Limelette A, Luyt CE, Melloni B, Pison C, Rafat C, Rebibou JM, Savier E, Schvartz B, Scatton O, Toure F, Varnous S, Vidal P, Savoye E, Ader F, Lortholary O, Lanternier F, Lafont E. Legionnaires Disease in Solid Organ Transplant Recipients: A Decade-Long Nationwide Study in France. Chest 2024; 165:507-520. [PMID: 37839586 DOI: 10.1016/j.chest.2023.09.033] [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: 05/19/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. RESEARCH QUESTION What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients? STUDY DESIGN AND METHODS In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. RESULTS One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54 of 57), ground-glass opacity in 63% of patients (36 of 57), macronodules in 21% of patients (12 of 57), and cavitation in 8.8% of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P = .047), lymphopenia (P = .014), respiratory symptoms (P = .010), and pleural effusion (P = .039). The 30-day and 12-month mortality rates were 8% (8 of 101) and 20% (19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P = .022). INTERPRETATION LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.
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Affiliation(s)
- Guillaume Thizy
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Adrien Flahault
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Anne Scemla
- Service de Transplantation Rénale, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Roux
- Service d'Hépatologie, Hôpital Beaujon, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Sophie Jarraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France
| | - David Lebeaux
- Unité Mobile d'Infectiologie, Service de Microbiologie, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gabriela Gautier-Vargas
- Service de Néphrologie et Transplantation, Hôpital Civil, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Paolo Malvezzi
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Université de Grenoble, la Tronche, France
| | - Marlene Murris
- Service de Pneumologie-Consultation Mucoviscidose, Pôle Voies Respiratoires, CHU de Toulouse-Hôpital Larrey, Université de Toulouse, Toulouse, France
| | - Fanny Vuotto
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Lille, Université de Lille, Lille, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nathalie Pansu
- Service de Maladies Infectieuses et Tropicales, CHU Gui de Chauliac, Université de Montpellier, Montpellier, France
| | - Teresa Antonini
- Service d'Hépatologie, Hôpital Universitaire Croix-Rousse, Lyon, France; Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Laure Elkrief
- Service d'Hépatologie, CHRU de Tours, Hôpital Trousseau, Université de Tours, Chambray-lès-Tours, France
| | - Benoit Barrou
- Département d'Urologie, Néphrologie et Transplantation, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Besch
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Mathieu Blot
- Département de Maladies Infectieuses, Centre Hospitalo-Universitaire de Dijon-Bourgogne, Université de Bourgogne, France
| | - Aude Boignard
- Service de Cardiologie, CHU de Grenoble, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Henri Brenier
- Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Université Paris-Saclay, Villejuif, France
| | - Corentin Gouezel
- Service d'Anesthésie et Réanimation de Chirurgie Cardiaque, Hôpital Bichat, Université Paris Cité, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Kaminski Hannah
- Service de Néphrologie, Transplantation Dialyse, Aphérèses, CHU de Bordeaux, Hôpital Pellegrin, Université de Bordeaux, Bordeaux, France
| | - Pauline Housssel-Debry
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Jerome Jouan
- Service de Chirurgie Cardiaque, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Hervé Lecuyer
- Service de Microbiologie Clinique, Hôpital Necker Enfants-Malades, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Limelette
- Laboratoire de Microbiologie, Hôpital Robert Debré, CHU de Reims, Université de Reims, Reims, France
| | - Charles Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Boris Melloni
- Service de Pathologie Respiratoire, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Christophe Pison
- Service de Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologique et Rein Aigu, Hôpital Tenon, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Michel Rebibou
- Service de Néphrologie, Transplantation Hémodialyse, CHU, Université de Dijon, Dijon, France
| | - Eric Savier
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Transplantation Hépatique, CHU Pitié-Salpêtriere, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Betoul Schvartz
- Service de Néphrologie, Hémodialyse, Transplantation Rénale, CHU de Reims, Université de Reims, Reims, France
| | - Olivier Scatton
- Service de Chirurgie Digestive Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fatouma Toure
- Service Néphrologie, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Shaida Varnous
- Service de Chirurgie Cardiaque et Thoracique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Vidal
- Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emilie Savoye
- Organ and Tissue Procurement and Transplantation Department, French Biomedicine Agency, Saint Denis La Plaine, France
| | - Florence Ader
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France; Service de Maladies Infectieuses et Tropicales, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Universitaire Croix-Rousse, Lyon, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuel Lafont
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Zafrani L, Canet E, Walter-Petrich A, Joly-Laffargue B, Veyradier A, Faguer S, Bigé N, Calvet L, Mayaux J, Grangé S, Rafat C, Poulain C, Klouche K, Perez P, Pène F, Pichereau C, Duceau B, Mariotte E, Chevret S, Azoulay E. Magnesium sulphate in patients with thrombotic thrombocytopenic purpura (MAGMAT): a randomised, double-blind, superiority trial. Intensive Care Med 2023; 49:1293-1304. [PMID: 37867165 DOI: 10.1007/s00134-023-07178-6] [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: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate supplementation on TTP recovery. METHODS In this multicenter, randomised, double-blind, controlled, superiority study, we enrolled adults with a clinical diagnosis of TTP. Patients were randomly allocated to receive magnesium sulphate (6 g intravenously followed by a continuous infusion of 6 g/24 h for 3 days) or placebo, in addition to the standard treatment. The primary outcome was the median time to platelet normalisation (defined as a platelet count ≥ 150 G/L). Efficacy and safety were assessed by intention-to-treat. RESULTS Overall, we enrolled 74 participants, including one who withdrew his/her consent. Seventy-three patients were further analyzed, 35 (48%) allocated to magnesium sulphate and 38 (52%) to placebo. The median time to platelet normalisation was 4 days (95% confidence interval [CI], 3-4) in the magnesium sulphate group and 4 days (95% CI 3-5) in the placebo group. The cause-specific hazard ratio of response was 0.93 (95% CI 0.58-1.48, p = 0.75). The number of patients with ≥ 1 serious adverse reactions was similar in the two groups. By day 90, four patients in the magnesium sulphate group and two patients in the placebo group had died (p = 0.42). The most frequent adverse event was low blood pressure occurring in 34% in the magnesium sulphate group and 29% in the placebo group (p = 0.80). CONCLUSION Among patients with TTP, the addition of magnesium sulphate to the standard of care did not result in a significant improvement in time to platelet normalisation.
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Affiliation(s)
- Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France.
- INSERM U944, Saint-Louis Research Institute, University of Paris Cité, Paris, France.
| | - Emmanuel Canet
- Department of Medical Intensive Care Unit, Nantes University Hospital, Nantes University, Nantes, France
| | - Anouk Walter-Petrich
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, INSERM S 717, Paris, France
| | - Bérangère Joly-Laffargue
- Service d'Hématologie Biologique, Lariboisière Hospital and EA3518, Institut de Recherche Saint-Louis, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie Biologique, Lariboisière Hospital and EA3518, Institut de Recherche Saint-Louis, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, National Reference Center for Rare Kidney Diseases, University Hospital of Toulouse, INSERM UMR 1297 (I2MC), Toulouse, France
| | - Naïke Bigé
- Department of Medical Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Laure Calvet
- Department of Medical Intensive Care Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Mayaux
- Department of Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Steven Grangé
- Department of Nephrology, Rouen University Hospital, Rouen, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Coralie Poulain
- Department of Nephrology Internal Medicine Dialysis Transplantation, Amiens University Medical Center, F-80054, Amiens, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie University Hospital, Montpellier, France
| | - Pierre Perez
- Medical Intensive Care Unit, Brabois Hospital, Vandoeuvre Les Nancy, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, University of Paris Cité, Cochin Institute, INSERM U1016, CNRS UMR8104, Paris, France
| | - Claire Pichereau
- Department of Intensive Care Unit, Poissy Saint Germain en Laye Hospital, Poissy, France
| | - Baptiste Duceau
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Eric Mariotte
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, INSERM S 717, Paris, France
| | - Elie Azoulay
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
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Rafat C, Doreille A, Dancer M, Werion A, Benoist JF, Raymond L, Mesnard L. Genetic screening in thrombotic microangiopathy: a plea for methylmalonic aciduria with cobalamine C deficiency detection. Clin Kidney J 2023; 16:2299-2301. [PMID: 37915912 PMCID: PMC10616482 DOI: 10.1093/ckj/sfad094] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Cédric Rafat
- Service des soins intensifs, Cliniques universitaires Saint Luc, Brussels, Belgium
- French Intensive Renal Network, France
- Centre national de Référence des Microangiopathies Thrombotiques
| | - Alice Doreille
- Service des soins intensifs, Cliniques universitaires Saint Luc, Brussels, Belgium
- Faculté de médecine, Sorbonne Université, Paris, France
- French Intensive Renal Network, France
| | - Marine Dancer
- Faculté de Pharmacie, Université Paris Saclay, France
| | - Alexis Werion
- Service des soins intensifs, Cliniques universitaires Saint Luc, Brussels, Belgium
- Faculté de médecine, Université Catholique de Louvain, Belgium
| | - Jean-François Benoist
- Service des explorations fonctionnelles, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique – Hôpitaux de Paris, France
- Faculté de Pharmacie, Université Paris Saclay, France
| | - Laure Raymond
- Département de génétique, Eurofins Biomnis, Lyon, France
| | - Laurent Mesnard
- Service des soins intensifs, Cliniques universitaires Saint Luc, Brussels, Belgium
- Faculté de médecine, Sorbonne Université, Paris, France
- French Intensive Renal Network, France
- Centre national de Référence des Microangiopathies Thrombotiques
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Nobile G, Doreille A, Raymond L, Robert T, Dancer M, Mesnard L, Rafat C. Role of the I416L Variant of Complement Factor I in Thrombotic Microangiopathy Among Patients of African Ancestry. Kidney Int Rep 2023; 8:2136-2140. [PMID: 37849999 PMCID: PMC10577482 DOI: 10.1016/j.ekir.2023.07.027] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Giulio Nobile
- Service de Soins Intensifs Néphrologique et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Alice Doreille
- Service de Soins Intensifs Néphrologique et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
- France Intensive Renal Network, Paris, France
| | - Laure Raymond
- Département de génétique, Eurofins Biomnis, Lyonm France
| | - Thomas Robert
- Faculté de médecine, Sorbonne Université, Paris, France
- Service de Néphrologie, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Marine Dancer
- Département de génétique, Eurofins Biomnis, Lyonm France
| | - Laurent Mesnard
- Service de Soins Intensifs Néphrologique et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
- France Intensive Renal Network, Paris, France
- Centre National de Référence de la Microangiopathie Thrombotique
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologique et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- France Intensive Renal Network, Paris, France
- Centre National de Référence de la Microangiopathie Thrombotique
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Mousseaux C, Tang E, Tristant M, Luque Y, Frochot V, Mesnard L, Bazin D, Rafat C, Buob D, Letavernier E. The Case | Acute kidney injury following infective endocarditis. Kidney Int 2023; 104:863-864. [PMID: 37739623 DOI: 10.1016/j.kint.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Cyril Mousseaux
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France.
| | - Ellie Tang
- INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maxime Tristant
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Yosu Luque
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France
| | - Vincent Frochot
- Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurent Mesnard
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France
| | - Dominique Bazin
- Laboratoire de Chimie Physique, Centre National de la Recherche Scientifique, Université Paris Sud, Orsay, France
| | - Cédric Rafat
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - David Buob
- INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France; Service d'Anatomo-Pathologie, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emmanuel Letavernier
- INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France; Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
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8
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Bureau C, Rafat C, Taupin JL, Malard S, Mesnard L, François H, Petit-Hoang C, Ouali N, Hertig A, Jamme M, Buob D, Rondeau E, Galichon P, Luque Y. Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study. Transpl Int 2023; 36:11212. [PMID: 37680645 PMCID: PMC10481532 DOI: 10.3389/ti.2023.11212] [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: 01/23/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Abstract
Whether immunoadsorption (IADS) as part of desensitization protocols could facilitate deceased donor kidney transplantation (KT) in highly sensitized (HS) patients remains to be proven. We retrospectively analyzed our IADS based desensitization protocol for deceased donor KTs between 2013 and 2018. Fifteen HS patients (age 52 years [40-56]) were included. Waiting time before IADS was 6 years [5-10] and the interval between IADS initiation and KT was 5 months [1-12] for the 14 transplanted patients. Nine patients had prior KT. Calculated panel reactive antibody decreased significantly during the protocol (99.3% [92.5-99.9] vs. 79.4% [56.7-81.9]; p = 0.004). Death-censored graft survival was 85.7% at 1 and 2 years post-transplantation. One-year median plasma creatinine level was 135 µmol/L [111-202]. Six developed active antibody mediated rejection (ABMR) at 1 year, with a median delay of 13 days [11-26]. Eight patients developed severe infections, including two fatal outcomes. Finally, compared to 93% of patients who received desensitization receiving a KT, only 43% of a control with similar characteristics underwent transplantation. However, no difference was found in overall probability of being alive with a functioning graft at the end of follow-up. The results indicate that our IADS-based desensitization strategy was not effective due to a high rate of ABMR and severe infectious complications which pose a challenge to its universalization.
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Affiliation(s)
- Côme Bureau
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
| | - Cédric Rafat
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
| | - Jean Luc Taupin
- Assistance Publique-Hôpitaux de Paris, Laboratoire Régional d’Histocompatibilité, Hôpital Saint Louis, Paris, France
| | - Stéphanie Malard
- Assistance Publique-Hôpitaux de Paris, Laboratoire Régional d’Histocompatibilité, Hôpital Saint Louis, Paris, France
| | - Laurent Mesnard
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
| | - Hélène François
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
| | - Camille Petit-Hoang
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
| | - Nacera Ouali
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
| | - Alexandre Hertig
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
| | - Matthieu Jamme
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
| | - David Buob
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service d’Anatomie et Cytologie Pathologiques, Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
| | - Pierre Galichon
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
| | - Yosu Luque
- Assistance Publique – Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Paris, France
- Sorbonne Université, CoRaKid Inserm UMR_S1155, Paris, France
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9
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Schwarz C, Morel A, Matignon M, Grimbert P, Rondeau E, Ouali N, François H, Mesnard L, Petit-Hoang C, Rafat C, Dahan K, Luque Y. Hepatitis B Virus Reactivation in Kidney Transplant Recipients Treated With Belatacept. Kidney Int Rep 2023; 8:1531-1541. [PMID: 37547512 PMCID: PMC10403656 DOI: 10.1016/j.ekir.2023.05.005] [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: 12/28/2022] [Revised: 04/30/2023] [Accepted: 05/08/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Hepatitis B virus (HBV) reactivation in kidney transplant recipients has been reported in 3% to 9% of anti-HBc antibody (HBcAb)-positive HBs antigen (HBsAg)-negative patients. It has not been studied in patients receiving belatacept, a selective costimulation blocker. Methods We performed a retrospective study of all transplant recipients receiving belatacept in 2 kidney transplantation centers in France. Among HBcAb-positive patients, we analyzed HBV reactivation rate, outcomes, and risk factors. Results A total of 135 patients treated with belatacept were included: 32 were HBcAb-positive and 2 were HBsAg-positive. Seven patients reactivated HBV (21.9% of HBcAb-positive patients), including 5 HBsAg-negative patients (16.7% of HBcAb-positive HBsAg-negative patients). Reactivation occurred 54.8 (± 70.9) months after transplantation. One patient presented with severe hepatitis and 1 patient developed cirrhosis. There was no significant difference in survival between patients that reactivated HBV and patients that did not: 5-year patient survival of 100% (28.6; 100) and 83.4% (67.6; 100), respectively (P = 0.363); and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively (P = 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation. Conclusion HBV reactivation rate was high in patients treated with belatacept when compared with previous transplantation studies. HBV reactivation did not impact survival. Further studies are needed to confirm these results. A systematic antiviral prophylaxis for these patients should be considered and evaluated.
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Affiliation(s)
- Chloë Schwarz
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Antoine Morel
- Service de Néphrologie, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France
| | - Marie Matignon
- Service de Néphrologie, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France
| | - Philippe Grimbert
- Service de Néphrologie, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France
| | - Eric Rondeau
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Unité CoRaKid, Inserm, UMR_S1155, Paris, France
| | - Nacera Ouali
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Hélène François
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Unité CoRaKid, Inserm, UMR_S1155, Paris, France
| | - Laurent Mesnard
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Unité CoRaKid, Inserm, UMR_S1155, Paris, France
| | - Camille Petit-Hoang
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Cédric Rafat
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Karine Dahan
- Néphrologie et Dialyses, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Yosu Luque
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Unité CoRaKid, Inserm, UMR_S1155, Paris, France
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10
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Hamza A, El-Sissy C, Yousfi N, Martins PV, Rafat C, Masliah-Planchon J, Frémeaux-Bacchi V, Mesnard L. The absence of CFHR3 and CFHR1 genes from the T2T-CHM13 assembly can limit the molecular diagnosis of complement-related diseases. Eur J Hum Genet 2023; 31:730-732. [PMID: 37032353 PMCID: PMC10325998 DOI: 10.1038/s41431-023-01350-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Abderaouf Hamza
- Department of Genetics, Institut Curie, PSL Research University, Paris, France
| | - Carine El-Sissy
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nadhir Yousfi
- Unité Mixte de Recherche S1155, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Paula Vieira Martins
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
| | | | - Véronique Frémeaux-Bacchi
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité Mixte de Recherche S1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche des Cordeliers, Paris, France
| | - Laurent Mesnard
- Unité Mixte de Recherche S1155, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Faculté de Médecine, Sorbonne Université, Paris, France.
- Institut des Sciences du Calcul et des Données, Sorbonne Université, Paris, France.
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11
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Bay P, Buob D, Modot T, Gabarre P, Doreille A, Rafat C. Antineoplastic drug-induced immune hemolytic anemia resulting in acute kidney injury: lesson for the clinical nephrologist. J Nephrol 2023:10.1007/s40620-023-01600-4. [PMID: 37017925 DOI: 10.1007/s40620-023-01600-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Pierre Bay
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Soins intensifs néphrologiques et rein aigu, Paris, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris (AP-HP), 1 Rue Gustave Eiffel, 94010, Créteil, France
- UPEC (Université Paris Est), INSERM, Unité U955, équipe 18, 94010, Créteil, France
| | - David Buob
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Anatomie et cytologie pathologiques, Paris, France
| | - Thomas Modot
- Etablissement Français du Sang, Ile de France, Hôpital Saint Antoine, Paris, France
| | - Paul Gabarre
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Saint Antoine, Réanimation Médicale, Paris, France
| | - Alice Doreille
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Soins intensifs néphrologiques et rein aigu, Paris, France
| | - Cédric Rafat
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Soins intensifs néphrologiques et rein aigu, Paris, France.
- Soins intensifs néphrologiques et Rein Aigu (SinRA), Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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12
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Doreille A, Lombardi Y, Dancer M, Lamri R, Testard Q, Vanhoye X, Lebre AS, Garcia H, Rafat C, Ouali N, Luque Y, Izzedine H, Esteve E, Cez A, Petit-Hoang C, François H, Marchal A, Letavernier E, Frémeaux-Bacchi V, Boffa JJ, Rondeau E, Raymond L, Mesnard L. Exome-First Strategy in Adult Patients With CKD: A Cohort Study. Kidney Int Rep 2023; 8:596-605. [PMID: 36938085 PMCID: PMC10014383 DOI: 10.1016/j.ekir.2022.12.007] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Exome sequencing (ES) has widened the field of nephrogenomics in adult nephrology. In addition to reporting the diagnostic yield of ES in an adult cohort study, we investigated the clinical implications of molecular diagnosis and developed a clinical score to predict the probability of obtaining positive result. Methods From September 2018 we have used ES to prospectively perform a first-tier liberal exploration of adult nephropathies of unknown origin and/or when a genetic kidney disease was clinically suggested. We also analyzed copy number variant using the same assay. Results Molecular diagnosis was made in 127 of 538 patients sequenced (diagnostic yield: 24%), comprising 47 distinct monogenic disorders. Eight of these monogenic disorders (17% [8/47]) accounted for 52% of genetic diagnoses. In 98% (n = 125/127) of the patients, the genetic information was reported to have major clinical implications. We developed a 4-value clinical score to predict the probability of obtaining a molecular diagnosis (area under the receiver operating characteristics curve [AUC] 0.726 [95% confidence interval: 0.670-0.782]) (available at http://allogenomics.com/score). Conclusion This study reinforces the role of ES as a first-tier exploration for adult chronic kidney disease patients in whom phenotypes are often poor and atypical. Although external validation is required, our clinical score could be a useful tool for the implementation of nephrogenomics in adults.
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Affiliation(s)
- Alice Doreille
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
| | - Yannis Lombardi
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
| | | | | | | | | | - Anne-Sophie Lebre
- Service de génétique, Pole de biologie, Hôpital Maison Blanche, CHU Reims, Reims, France
- Département de Génétique, hôpital Pité Salpétrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Hugo Garcia
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Cédric Rafat
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Nacera Ouali
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Yosu Luque
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
| | - Emmanuel Esteve
- Faculté de médecine, Sorbonne Université, Paris, France
- Department of Nephrology, hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Alexandre Cez
- Department of Nephrology, hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Camille Petit-Hoang
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Hélène François
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
- Inserm UMR_S1155, Paris, France
| | - Armance Marchal
- Faculté de médecine, Sorbonne Université, Paris, France
- Department of Nephrology, hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Emmanuel Letavernier
- Faculté de médecine, Sorbonne Université, Paris, France
- Department of Nephrology, hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
- Inserm UMR_S1155, Paris, France
| | - Véronique Frémeaux-Bacchi
- Immunology Department, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Jean-Jacques Boffa
- Faculté de médecine, Sorbonne Université, Paris, France
- Department of Nephrology, hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
- Inserm UMR_S1155, Paris, France
| | - Eric Rondeau
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
- Inserm UMR_S1155, Paris, France
| | | | - Laurent Mesnard
- Soins Intensifs Néphrologiques et Rein Aigu, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
- Inserm UMR_S1155, Paris, France
- Institut des Sciences du Calcul et des Données, Sorbonne Université, Paris, France
- Centre Maladie Rare MAHREA, hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
- Correspondence: Laurent Mesnard, Soins Intensifs Néphrologiques et Rein Aigu (SINRA), Département de Néphrologie, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
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13
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Desnos C, D'Huy A, Rech JS, Rafat C, Gibelin A. Dialysis-induced hypereosinophilia in the ICU. J Nephrol 2023; 36:311-313. [PMID: 36396844 PMCID: PMC9672608 DOI: 10.1007/s40620-022-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Cyrielle Desnos
- Médecine Intensive Réanimation, Hôpital Tenon (Assistance Publique-Hôpitaux de Paris), Paris, France.
- Sorbonne Université, Paris, France.
| | - Augusta D'Huy
- Médecine Intensive Réanimation, Hôpital Tenon (Assistance Publique-Hôpitaux de Paris), Paris, France
- Sorbonne Université, Paris, France
| | - Jean Simon Rech
- Sorbonne Université, Paris, France
- Service de médecine interne, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cédric Rafat
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| | - Aude Gibelin
- Médecine Intensive Réanimation, Hôpital Tenon (Assistance Publique-Hôpitaux de Paris), Paris, France
- Sorbonne Université, Paris, France
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Terrier B, Richert L, Pugnet G, Aumaître O, Moranne O, Diot E, Karras A, Bonnet F, De Moreuil C, Hachulla E, Le Gallou T, Lebas C, Maurier F, Rafat C, Samson M, Augusto J, Janssen C, Quéméneur T, Batteux F, Launay O. Stratégies innovantes de vaccination anti-pneumococcique par rapport au schéma standard chez les patients atteints de vascularites associées aux ANCA recevant du rituximab : essai contrôlé randomisé multicentrique (PNEUMOVAS). Rev Med Interne 2022. [PMCID: PMC9724759 DOI: 10.1016/j.revmed.2022.10.089] [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: 12/12/2022]
Abstract
Introduction Les patients recevant des glucocorticoïdes et du rituximab (RTX) présentent un risque accru d’infections, en particulier d’infections invasives à pneumocoque. Les réponses vaccinales au virus de la grippe, au Streptococcus pneumoniae et au SARS-CoV-2 sous traitement par RTX sont fortement altérées. Chez les patients atteints de maladies auto-immunes recevant de tels traitements, en particulier ceux atteints de vascularites associées aux ANCA (AAV), il est donc nécessaire de développer des stratégies vaccinales anti-pneumococciques améliorées pour augmenter la réponse immunitaire et la protection vaccinale. Patients et méthodes Cet essai multicentrique de phase 2, randomisé, ouvert, a comparé deux stratégies innovantes de vaccin anti-pneumococcique « renforcées » au schéma de vaccination standard chez des patients atteints de VAA recevant un traitement par RTX. Des patients adultes atteints de VAA nouvellement diagnostiquée ou en rechute, présentant une maladie active (BVAS ≥ 3) et devant recevoir du RTX comme traitement d’induction (375 mg/m2/semaine pendant 4 semaines consécutives), ont été randomisés avec un rapport 1:1:1 dans trois bras parallèles : schéma standard associant une dose de vaccin pneumococcique conjugué 13-valent (PCV13) au jour 0 suivie d’une dose de vaccin non conjugué 23-valent (PPV23) au mois 5 (M5) (bras 1) ; double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose de PPV23 à M5 (bras 2) ; ou 4 doses de PCV13 au jour 0 suivies d’une dose de PPV23 à M5 (bras 3). Le critère d’évaluation principal était la réponse immunitaire à M6 contre les 12 sérotypes de pneumocoque communs aux vaccins PCV13 et PPV23, classée selon quatre catégories ordonnées de réponse : réponse positive en anticorps contre 0–3, 4–6, 7–9 ou 10–12 sérotypes. Une réponse positive par sérotype était définie par un titre ELISA d’IgG spécifiques ≥ 1 μg/mL et une augmentation de deux fois par rapport au jour 0. Le critère d’évaluation primaire a été analysé dans un modèle de régression logistique à chances proportionnelles avec une correction de Bonferonni pour les 2 bras innovants. Les critères d’évaluation secondaires étaient les réactions locales et systémiques sollicitées 7 jours après chaque vaccination et tout événement indésirable lié ou pouvant être lié à l’immunisation vaccinale. Résultats Quatre-vingt-quinze participants ont été analysés dans la population modifiée en intention de traiter (âge moyen 60 ± 16,6 ans, 50 % d’hommes, 74 personnes atteintes d’une maladie nouvellement diagnostiquée, 66 d’une granulomatose avec polyangéite et 29 d’une polyangéite microscopique, BVAS moyen 15,3 ± 6,9), dont 30 affectés au bras 1, 32 au bras 2 et 33 au bras 3. À M6, une réponse immunitaire contre 0–3, 4–6, 7–9 ou 10–12 sérotypes était observée chez 83,3 %, 13,3 %, 3,3 % et 0 % dans le bras 1 ; 56,3 %, 28,1 %, 15,6 % et 0 % dans le bras 2 ; et 60,6 %, 33,3 %, 6,1 % et 0 % dans le bras 3. Les patients du bras 2 étaient significativement plus susceptibles de se trouver dans une catégorie de réponse supérieures par rapport au régime standard après ajustement sur l’âge, avec un odds ratio proportionnel (pOR) de 4,1 (IC97,5 % : 1,1–15,9, p = 0,018), tandis que le bras 3 montrait une tendance non significative à améliorer les réponses vaccinales (pOR : 3,1, IC97,5 % : 0,8–11,9, p = 0,062). Une analyse de sensibilité sur une population per-protocole excluant les patients ayant subi des vaccinations ou des prises de sang hors des délais donnait des estimations concordantes. Les réactions locales et/ou systémiques dans les 7 jours après chaque vaccination, et tout événement indésirable lié ou possiblement lié à la vaccination au cours des 6 premiers mois, sont survenus en plus grand nombre avec les schémas renforcés mais étaient principalement des réactions locales de grade 1 ou 2. Aucun événement indésirable grave lié à la vaccination n’a été observé. Au cours du suivi, 8 poussées de vascularite sont survenues chez 6 patients, en médiane 87 jours après la dernière vaccination : un patient dans le bras 1, 2 dans le bras 2, et 3 dans le bras 3. Conclusion Chez les patients atteints de VAA recevant un traitement par RTX, une stratégie innovante de vaccination anti-pneumococcique renforcée, basée sur une double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose unique de PPV23 à M5, améliore significativement les réponses en anticorps contre Streptococcus pneumoniae par rapport au schéma standard.
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Affiliation(s)
- B. Terrier
- Médecine interne, hôpital Cochin, rue du Faubourg-Saint-Jacques, Paris,Auteur correspondant
| | | | - G. Pugnet
- Service de médecine interne, CHU Toulouse Purpan, Toulouse
| | - O. Aumaître
- Médecine interne, CHU Gabriel-Montpied, Clermont-Ferrand
| | - O. Moranne
- Néphrologie, hôpital de jour de Nîmes, Nîmes
| | - E. Diot
- Médecine interne, CHU de Tours, Tours
| | - A. Karras
- Néphrologie, HEGP, 15, rue Louis-Blanc, 75015 Paris
| | - F. Bonnet
- Médecine interne, hôpital Saint-André, Bordeaux
| | - C. De Moreuil
- Service de médecine interne, CHU Brest Centre de Formation, Brest
| | | | - T. Le Gallou
- Médecine interne, centre hospitalier universitaire de Rennes, Rennes
| | - C. Lebas
- Néphrologie, CHU de Lille, Lille
| | - F. Maurier
- Service de médecins interne, hôpital Belle-Isle, Metz
| | - C. Rafat
- Urgences néphrologiques et transplantation rénale, hôpital Tenon, AP–HP, Paris
| | - M. Samson
- Médecine interne et immunologie clinique, centre hospitalier universitaire F.-Mitterrand Dijon-Bourgogne, Dijon
| | | | - C. Janssen
- Maladies infectieuses, CH Annecy Genevois, Épagny Metz-Tessy
| | - T. Quéméneur
- Néphrologie-médecine interne, centre hospitalier de Valenciennes, Valenciennes
| | - F. Batteux
- Laboratoire d’immunologie, hôpital Cochin, Paris
| | - O. Launay
- Fédération d’infectiologie, hôpital Cochin, Paris
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Lahens A, Saad R, Doreille A, Mesnard L, Rafat C, Paques M. Évaluation de la rétinographie au lit du malade par le néphrologue à l’admission des patients hospitalisés pour urgence hypertensive. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.373] [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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16
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Rafat C, Doreille A. Could Plasmodium falciparum-related kidney disease stand as another example of interferonopathy? Kidney Int 2022; 102:669-670. [PMID: 35988939 DOI: 10.1016/j.kint.2022.06.009] [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: 05/27/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Cédric Rafat
- Soins Intensifs Néphrologiques, Hôpital Tenon, Assistance-Publique des Hôpitaux de Paris, Paris, France.
| | - Alice Doreille
- Soins Intensifs Néphrologiques, Hôpital Tenon, Assistance-Publique des Hôpitaux de Paris, Paris, France; Université Paris Sorbonne, Paris, France
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17
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Rafat C, Zaworski J, Doreille A, Frochot V, Gaudry S, Daudon M, Luque Y, Letavernier E. MO367: Non-Invasive Diagnosis of Vancomycin-Induced Acute Kidney Injury Using Urine Microscopy. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac135.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Vancomycin stands out both as being a potent cause of AKI (V-AKI) and as one of the most universally prescribed antimicrobial drugs. From a pathophysiological standpoint, it was hitherto believed that V-AKI stemmed from the intracellular accumulation of vancomycin in the proximal tubule, which elicits oxidative stress and ultimately translates in cell apoptosis. Recently, a study has shown that vancomycin in the setting of overt drug overdose, can co-precipitate with uromodulin causing microspheric obstructive aggregates in the tubular lumen both in experimental models and in patients [1]. Further documentation of this novel mechanism has been hindered by the need to procure kidney tissue so as to perform ad hoc immunostaining. Furthermore, it remains to be proven that the presence of vancomycin microspheres represents a reliable marker for V-AKI. Urine based vancomycin-immunostaining may represent a valuable non-invasive approach.
METHOD
The urine of patients presenting with vancomycin overdose determined by plasma trough levels >15 mg/L along with acute kidney injury (according to KDIGO guidelines) were subjected to light microscopic urinalysis. Whenever microscopic urinalysis yielded the presence of casts, immunostaining was performed. Briefly, a pellet of urine was spread on a slide and immunostaining performed with a specific anti-vancomycin antibody (Abbot 6E-4421, 1/1000) prior to repeat microscopic examination. Infrared spectrophotometry was performed to ascertain the nature of the casts by comparing the spectrum to a reference vancomycin spectrum.
Patients were deemed to have V-AKI whenever at least one vancomycin positive cast was observed following immunostaining.
The urine of control patients was subjected to the same procedure: they were defined as patients exposed to vancomycin with or without vancomycin overdose but with no AKI.
RESULTS
A total of 5 patients with vancomycin overdose KDIGO stage 3 AKI were found to exhibit casts with positive vancomycin immunostaining (Fig. 1). On light microscopic urinalysis, vitreous casts devoid of refringence after polarization could be observed in each case. Upon infrared spectrophotometry, the casts displayed a Fourier transform spectrum consistent with vancomycin.
In three of the cases, V-AKI was considered the sole or primary cause of AKI. The patient displayed abundant and markedly stained casts upon anti-vancomycin immunostaining (Fig. 1A). Overt and massive vancomycin overdosing was evidenced in all cases. In one case, the patient concurrently received piperacillin-tazobactam and in another case the patient was exposed to iodinated contrast media. The renal function course was favourable with full recovery in all three instances.
In two cases, competing causes of AKI were either evidenced or not. In one case, the patient displayed septic shock which indicated vancomycin therapy. In another case, the patient was suspected to have immunoallergic intersititial nephritis. The patients exhibited rare casts with only faint staining (Fig. 1B). In both cases, vancomycin overdose could not be documented. V-AKI was deemed a possible concurrent cause of AKI.
None of the 5 control patients yielded casts after light microscopic urinalysis.
CONCLUSION
Vancomycin cast detection on urine microscopy is feasible and can be enhanced by a straightforward immunostaining technique and represents a unique opportunity for a non-invasive diagnosis of V-AKI. Further studies are required to refine diagnostic criteria-based urine immunostaining detection. They also needed to determine whether detection of V-AKI merely reflects impaired vancomycin urinary excretion in the setting of AKI or can be regarded as a sensitive and specific marker of vancomycin-induced tubular obstruction and injury.
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Affiliation(s)
- Cédric Rafat
- Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Soins intensifs Néphrologiques et Rein Aigu, Paris, France
| | - Jérémy Zaworski
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) S 1155, Paris, France
| | - Alice Doreille
- Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Paris, France
| | - Vincent Frochot
- Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
| | - Stéphane Gaudry
- Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, Médecine Intensive et Réanimation, Bobigny, France
| | - Michel Daudon
- Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
| | - Yosu Luque
- Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, Paris, France
| | - Emmanuel Letavernier
- Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
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Serre J, Rafat C, Raymond L, Dancer M, Werion A, Nobile G, Bobot M, Rondeau E, Mesnard L, Doreille A. FC030: Diagnostic Yield of Exome Sequencing in Hypertensive Nephropathy. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac101.002] [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
Hypertensive nephrosclerosis ranks as one of the most frequent causes of chronic kidney disease (CKD) worldwide and is deemed to be especially prevalent among patients of African ancestry [1]. The very existence of hypertensive nephropathy has been called into question, especially in young adults. Its diagnostic framework is based on non-specific clinical criteria, and its histopathological features are in fact unspecific.
Genetic testing with exome sequencing (ES) has emerged as a comprehensive tool to detect Mendelian diseases in nephrology with a significant number of post-hoc re-established diagnoses [2]. Nevertheless, ES has yet to be incorporated into the diagnostic workup of patients with hypertensive nephropathy consistently.
This study aimed to investigate the diagnostic yield of ES in patients with a clinical diagnosis of hypertensive nephropathy.
METHOD
Since September 2018, ES is readily available as part of the routine diagnostic workup in our institution. The indication of ES includes hypertensive nephropathy of early onset (i.e. <45 years old). We retrospectively collected the ES performed in the context of hypertensive nephropathy [3] in our institution between September 2018 and February 2021.
RESULTS
A total of 128 patients were sequenced in the context of hypertensive nephropathy with early-onset. Women were 29 (22.7%), the mean age was 43 (35; 51) years and 60% of them were patients of African ancestry. The main indications of ES was an early onset of CKD (47%), a family history of kidney disease (8%) or both (18%). We detected diagnostic variants (ACM class 4/5) in 22 of the 128 patients (17.2%) encompassing a total of 16 different monogenic disorders. Two diseases accounted for more than half of the genetic diagnoses: nephronophthisis (n = 7, 32%) and Alport syndrome (n = 5, 23%). Complement variation did not account for a significant part of the diagnosis.
The diagnostic yield of ES was lower in patients of African ancestry (diagnostic yield of 10.4% versus 27.4% in the non-African ancestry patients; P = 0.01). Co-segregation data was lacking in patients of African ancestry, with significantly more ES performed in singleton (96% compared with 76% in non-African ancestry patients; P < 0.001).
In addition to disease reclassification, genetic diagnosis enabled guidance for family counseling (n = 11, 50% of positive patients) and thus helped for potential related donor selection for transplantation. In the whole cohort, ES results modified the therapeutic in 6 patients (5%) and ruled out potential recurrence in the graft in 10 patients (8%).
CONCLUSION
Physicians should be wary of tentative diagnosis of nephrosclerosis, especially in patients of non-African ethnic background. Instead, it should prompt genetic investigations, which overturned the initial diagnosis in 17% of the cases. The lower diagnostic yield of ES in patients of African ancestry in our cohort might partly be due to the lack of available co-segregation data, as well as the underrepresentation of subjects of African ancestry in the reference genome.
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Affiliation(s)
- Justine Serre
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
| | - Cédric Rafat
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
- French Intensive care Renal Network, Paris, France
| | | | | | - Alexis Werion
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
| | - Giulio Nobile
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
| | - Mickaël Bobot
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
| | - Eric Rondeau
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
- French Intensive care Renal Network, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
| | - Laurent Mesnard
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
- French Intensive care Renal Network, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
| | - Alice Doreille
- Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Service de Soins Intensifs Néphrologique et Rein Aigu, Paris, France
- French Intensive care Renal Network, Paris, France
- Faculté de médecine, Sorbonne Université, Paris, France
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Nobile G, Doreille A, Raymond L, Robert T, Villie P, Mesnard L, Rafat C. MO043: Role of the I416L variant of complement factor I in the occurrence of thrombotic microangiopathy among patients of African ancestry. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac062.024] [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
Complement dependent hemolytic and uremic syndrome (c-HUS) predisposes to hypertensive crisis and chronic hypertension. Reciprocally, hypertensive crisis may precipitate thrombotic microangiopathy (TMA) via endothelial shear stress. Patients of African ancestry have long been recognized for their predisposition to both chronic hypertension and chronic kidney disease (CKD). Yet, despite growing evidence meant to bridge the divide between the complement alternative pathway and hypertensive crisis [1] (i) c-HUS is only known to account for a small fraction of the cases of malignant HTA (5%) [2] or TMA (4%) [3] (ii) complement genetic investigations in the population of African ancestry are sparse. Recently, the I416L CFI variant, which is specific to patients of African ancestry, has been classified as likely pathogenic (https://databases.lovd.nl/shared/variants/0000521158#00005040). By running a query through the BIOMNIS genetic databank, we sought to identify and provide a phenotypic description of the patients carrying the I416L CFI variant.
METHOD
All samples were sequenced at the BIOMNIS center (Lyon, France) using the Illumina platform and subsequently processed via the in-center bioinformatics pipeline. The BIOMNIS genetic databank compiles a total of 2886 whole exome sequencing (WES) nationwide (single unrelated patients) for renal (n = 1200) and non-renal indications (n = 1686). Once patients were recognized to carry the I416 variant, deidentified clinical data was provided by the attending nephrologist.
RESULTS
Among 1686 WES performed for non-renal indications, three unrelated patients harbored the I416L variant. Out of the 1200 WES performed for renal indications, we identified eight unrelated patients carrying the I416L CFI variant. All patients were of African Ancestry and were heterozygous for the variant, including five males with median age of 38.5 years. They all shared a common history remarkable for hypertension of early onset at median of 33 years [21–38]. None of these patients were acknowledged to have c-HUS prior to WES. In six cases, the kidney disease was undetermined. Four patients experienced TMA: three during bouts of malignant hypertension with concurrent biological TMA. One of them exhibited signs of TMA on biopsy with superimposed signs of malignant nephrosclerosis and another on a kidney transplant. Three patients disclosed genetic risk factor for kidney disease including Apol1 pathogenic variants (G1 and/or G2) (n = 2) and URAT1-related pathogenic variant (n = 1). Five patients had at least one additional risk factor for renal disease. All but one patient progressed to CKD including end-stage CKD on four instances with a median follow-up of 6.5 years. One patient presented with TMA following kidney transplantation. Only one patient whose hypertensive crisis manifested as preeclampsia and HELLP was free of CKD on last follow-up.
CONCLUSION
C-HUS may go unrecognized or mimic vascular nephropathy. These results make a case for a streamlined genotyping of patients, especially patients of African ancestry with a history of hypertension of early onset. Additional triggers acting as second ‘hits’ such as hypertension, pregnancy or genetic and non-genetic renal risk factors may aggravate the course of kidney disease. Yet, further investigations are warranted to appreciate the true clinical significance of this variant as it entails momentous therapeutic and medico-economic implications, most notably the use of anti-C5 therapy.
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Affiliation(s)
- Giulio Nobile
- Tenon Hospital, Nephrology Intensive Care Unit, Paris, France
| | - Alice Doreille
- Tenon Hospital, Nephrology Intensive Care Unit, Paris, France
| | | | - Thomas Robert
- Hospitals Academics De Marseille, Service de Néphrologie, Marseille, France
| | - Patricia Villie
- Nephrologie et Dialyse SELARL, Nephrologie et Dialyse, Saint-Denis, France
| | - Laurent Mesnard
- Tenon Hospital, Nephrology Intensive Care Unit, Paris, France
| | - Cédric Rafat
- Tenon Hospital, Nephrology Intensive Care Unit, Paris, France
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Uhlin F, Szpirt W, Kronbichler A, Bruchfeld A, Soveri I, Rostaing L, Daugas E, Lionet A, Kamar N, Rafat C, Mysliveček M, Tesař V, Fernström A, Kjellman C, Elfving C, McAdoo S, Mölne J, Bajema I, Sonesson E, Segelmark M. Endopeptidase Cleavage of Anti-Glomerular Basement Membrane Antibodies in vivo in Severe Kidney Disease: An Open-Label Phase 2a Study. J Am Soc Nephrol 2022; 33:829-838. [PMID: 35260419 PMCID: PMC8970456 DOI: 10.1681/asn.2021111460] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/12/2021] [Accepted: 02/01/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prognosis for kidney survival is poor in patients presenting with circulating anti-glomerular basement membrane (GBM) antibodies and severe kidney injury. It is unknown if treatment with an endopeptidase that cleaves circulating and kidney bound IgG can alter the prognosis. METHODS An investigator-driven phase 2a one-arm study (EudraCT 2016-004082-39) was performed in 17 hospitals in five European countries. A single dose of 0.25 mg/kg of imlifidase was given to 15 adults with circulating anti-GBM antibodies and an eGFR <15 ml/min per 1.73m2. All patients received standard treatment with cyclophosphamide and corticosteroids, but plasma exchange only if autoantibodies rebounded. The primary outcomes were safety and dialysis independency at 6 months. RESULTS At inclusion, ten patients were dialysis dependent and the other five had eGFR levels between 7 and 14 ml/min per 1.73m2. The median age was 61 years (range 19-77), six were women, and six were also positive for anti-neutrophil cytoplasmic antibodies. Then 6 hours after imlifidase infusion, all patients had anti-GBM antibodies levels below the reference range of a prespecified assay. At 6 months 67% (ten out of 15) were dialysis independent. This is significantly higher compared with 18% (nine out of 50) in a historical control cohort (P<0.001, Fisher's exact test). Eight serious adverse events (including one death) were reported, none assessed as probably or possibly related to the study drug. CONCLUSIONS In this pilot study, the use of imlifidase was associated with a better outcome compared with earlier publications, without major safety issues, but the findings need to be confirmed in a randomized controlled trial.Clinical Trial registration number: EUDRACT 2016-004082-39 https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-001377-28/results.
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Affiliation(s)
- Fredrik Uhlin
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Wladimir Szpirt
- Department of Nephrology P, Københavns universitet, Copenhagen, Denmark
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Annette Bruchfeld
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Inga Soveri
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, EriCHU Grenoble-Alpes, Grenoble, France
| | - Eric Daugas
- Nephrology Service, Hôpital Bichat, Université de Paris, Paris, France
| | - Arnaud Lionet
- Neohrology service, Centre Hospitalier Regional, Lille University, Lille, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Université Paul Sabatier, Toulouse, France
| | - Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Marek Mysliveček
- Department of Nephrology, Charles University and General University Hospital, Prague, Czech Republic
| | - Vladimír Tesař
- Department of Nephrology, Charles University and General University Hospital, Prague, Czech Republic
| | - Anders Fernström
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | | | - Stephen McAdoo
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Johan Mölne
- Department of Laboratory Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ingeborg Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Mårten Segelmark
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden .,Department of Clinical Sciences, Lund University, Lund, Sweden
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21
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Nezam D, Porcher R, Grolleau F, Morel P, Titeca-Beauport D, Faguer S, Karras A, Solignac J, Jourde-Chiche N, Maurier F, Sakhi H, El Karoui K, Mesbah R, Carron PL, Audard V, Ducloux D, Paule R, Augusto JF, Aniort J, Tiple A, Rafat C, Beaudreuil S, Puéchal X, Gobert P, Massy Z, Hanrotel C, Bally S, Martis N, Durel CA, Desbuissons G, Godmer P, Hummel A, Perrin F, Néel A, De Moreuil C, Goulenok T, Guerrot D, Grange S, Foucher A, Deroux A, Cordonnier C, Guilbeau-Frugier C, Modesto-Segonds A, Nochy D, Daniel L, Moktefi A, Rabant M, Guillevin L, Régent A, Terrier B. Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges. J Am Soc Nephrol 2022; 33:628-637. [PMID: 35074934 PMCID: PMC8975074 DOI: 10.1681/asn.2021060771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 06/08/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
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Affiliation(s)
- Dorian Nezam
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Raphaël Porcher
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - François Grolleau
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - Pauline Morel
- Service de dialyse et aphérèse, AURA Paris Plaisance, Paris, France
| | | | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’organes, Hôpital Rangueil, Toulouse, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - François Maurier
- Hôpital Belle-Isle, Groupe Hospitalier Associatif UNEOS, Metz, France
| | - Hamza Sakhi
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Rafik Mesbah
- Service de Néphrologie, Centre Hospitalier, Boulogne-sur-mer, France
| | | | - Vincent Audard
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Didier Ducloux
- Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, France
| | - Romain Paule
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | | | - Julien Aniort
- Service de Néphrologie, Dialyse et Transplantation rénale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Aurélien Tiple
- Service de Néphrologie, CHU Jacques Lacarin, Vichy, France
| | - Cédric Rafat
- Unité de Néphrologie, Transplantation Rénale, Hôpital Tenon (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Séverine Beaudreuil
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Pierre Gobert
- Service de Médecine Interne et Immunologie clinique, Clinique Rhône Durance, Avignon, France
| | - Ziad Massy
- Département de Néphrologie, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Catherine Hanrotel
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital La Cavale Blanche, Brest, France
| | - Stéphane Bally
- Service de Néphrologie Dialyse, Centre Hospitalier Métropole Savoie, Chambery, France
| | | | - Cécile-Audrey Durel
- Service de Médecine, Interne Hôpital Edouard Herriot, Hospices civils de Lyon, France
| | | | - Pascal Godmer
- Service de Médecine Interne, CHBA site de Vannes, Vannes, France
| | - Aurélie Hummel
- Service de Néphrologie et Transplantation Rénale, Hôpital Necker-Enfants Malades (Assistance Publique des Hôpitaux de Paris), Paris, France
| | | | - Antoine Néel
- Service de Médecine Interne, CHU de Nantes, France
| | | | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Dominique Guerrot
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Steven Grange
- Service de Réanimation médicale, CHU Charles Nicolle, Rouen, France
| | - Aurélie Foucher
- Service de Médecine Interne, CHU site Sud Saint-Pierre, Saint-Pierre, France
| | - Alban Deroux
- Service de Médecine Interne, CHU de Grenoble, France
| | - Carole Cordonnier
- Service d’anatomie et de cytologie pathologiques, Hôpital Nord, CHU d’Amiens, France
| | - Céline Guilbeau-Frugier
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Anne Modesto-Segonds
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Dominique Nochy
- Service d’Anatomie et Cytologie Pathologiques, Hôpital Européen Georges Pompidou (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Laurent Daniel
- Service d’Anatomie et cytologie pathologiques, Hôpital La Timone (APHM), Marseille, France
| | - Anissa Moktefi
- Assistance Publique des Hôpitaux de Paris, Department of Pathology, Groupe Hospitalier Henri-Mondor 94010 Creteil, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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22
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Dauvergne M, Buob D, Rafat C, Hennino MF, Lemoine M, Audard V, Chauveau D, Ribes D, Cornec-Le Gall E, Daugas E, Pillebout E, Vuiblet V, Boffa JJ. Renal diseases secondary to interferon-β treatment: a multicentre clinico-pathological study and systematic literature review. Clin Kidney J 2021; 14:2563-2572. [PMID: 34950468 PMCID: PMC8690152 DOI: 10.1093/ckj/sfab114] [Citation(s) in RCA: 2] [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: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background The spectrum of interferon-β (IFN-β)-associated nephropathy remains poorly described and the potential features of this uncommon association remain to be determined. Methods In this study we retrospectively analysed the clinical, laboratory, histological and therapeutic data of patients with biopsy-proven renal disease in a context of IFN-β treatment administered for at least 6 months. Results Eighteen patients (13 women, median age 48 years) with biopsy-proven renal disease occurring during IFN-β therapy were included. The median exposure to IFN-β (14 patients were treated with IFN-β1a and 4 patients with IFN-β1b) was 67 months (range 23–165 months). The clinical presentation consists in hypertension (HT; 83%), malignant HT (44%), proteinuria (protU) >1 g/g (94%), reduced renal function (78%), biological hallmark suggesting thrombotic microangiopathy (TMA; 61%), oedematous syndrome (17%) or nephritic syndrome (11%). The pathological findings included typical features of isolated TMAs in 11 cases, isolated focal segmental glomerulosclerosis (FSGS) lesions in 2 cases and 5 cases with concomitant TMA and FSGS lesions. An exploration of the alternative complement pathway performed in 10 cases (63%) did not identify mutations in genes that regulate the complement system. The statistical analysis highlighted that the occurrence of IFN-β-associated TMA was significantly associated with Rebif, with a weekly dose >50 µg and with multiple weekly injections. In all cases, IFN-β therapy was discontinued. Patients with TMA lesions received other therapies, including corticosteroids (44%), eculizumab (13%) and plasma exchanges (25%). At the end of a 36-month median follow-up, persistent HT and persistent protU were observed in 61% and 22% of patients, respectively. Estimated glomerular filtration rate <60 mL/min/1.73 m2 was present in 61% of patients. Conclusions IFN-β-associated nephropathy must be sought in the case of HT and/or protU onset during treatment. When TMA and/or FSGS are observed on renal biopsy, early discontinuation of IFN-β is essential.
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Affiliation(s)
- Maxime Dauvergne
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service de Néphrologie et Dialyses, Paris, France
| | - David Buob
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Cédric Rafat
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Marie-Flore Hennino
- Centre Hospitalier de Valenciennes, Service de Néphrologie, Valenciennes, France
| | - Mathilde Lemoine
- CHU de Rouen, Service de Néphrologie, Dialyse et Transplantation, Rouen, France
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Créteil, France
| | - Dominique Chauveau
- CHU Rangueil, Département de Néphrologie et Transplantation d'Organes et Centre de Référence Maladies Rénales Rares SORARE, Toulouse, France
| | - David Ribes
- CHU Rangueil, Département de Néphrologie et Transplantation d'Organes et Centre de Référence Maladies Rénales Rares SORARE, Toulouse, France
| | | | - Eric Daugas
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat, Service de Néphrologie, Paris, France
| | - Evangéline Pillebout
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service de Néphrologie, Paris, France
| | - Vincent Vuiblet
- Département de Néphro-Pathologie, Unité de Pathologie, CHU Reims, Reims, France
| | - Jean-Jacques Boffa
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service de Néphrologie et Dialyses, Paris, France
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23
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Doreille A, Buob D, Bay P, Julien M, Riviere F, Rafat C. Renal Involvement in Eosinophilic Granulomatosis With Polyangiitis. Kidney Int Rep 2021; 6:2718-2721. [PMID: 34622111 PMCID: PMC8484126 DOI: 10.1016/j.ekir.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/25/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Alice Doreille
- Assistance Publique Hôpitaux de Paris, Nephrology Intensive Care Unit, Tenon Hospital, Paris, Île de France, France.,Sorbonne Université Paris, Ile de France, France
| | - David Buob
- Sorbonne Université Paris, Ile de France, France.,Assistance Publique-Hôpitaux de Paris, Pathology Department, Tenon Hospital, Paris, Île-de-France, France
| | - Pierre Bay
- Assistance Publique Hôpitaux de Paris, Nephrology Intensive Care Unit, Tenon Hospital, Paris, Île de France, France
| | - Marie Julien
- Assistance Publique Hôpitaux de Paris, Nephrology Intensive Care Unit, Tenon Hospital, Paris, Île de France, France
| | - Frédéric Riviere
- Hôpital d'Instruction des Armées Percy, Pulmonology Department, Clamart, Île de France, France
| | - Cédric Rafat
- Assistance Publique Hôpitaux de Paris, Nephrology Intensive Care Unit, Tenon Hospital, Paris, Île de France, France
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24
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Doreille A, Godefroy R, Martzloff J, Delthombe C, Luque Y, Mesnard L, Hazzan M, Tsimaratos M, Rondeau E, Hourmant M, Moulin B, Robert T, Rafat C. French nationwide survey of undocumented ESRD migrant patient access to scheduled hemodialysis and kidney transplantation. Nephrol Dial Transplant 2021; 37:393-395. [PMID: 34586407 DOI: 10.1093/ndt/gfab275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alice Doreille
- Sorbonne Université, Paris, France.,Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Raphaël Godefroy
- Service de Néphrologie, Assistance Publique - Hôpitaux de Marseille (AP-HM), France
| | | | | | - Yosu Luque
- Sorbonne Université, Paris, France.,Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Laurent Mesnard
- Sorbonne Université, Paris, France.,Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Marc Hazzan
- Service de Néphrologie, CHU de Lille, France
| | - Michel Tsimaratos
- Service de Néphropédiatrie, Assistance Publique - Hôpitaux de Marseille (AP-HM), France
| | - Eric Rondeau
- Sorbonne Université, Paris, France.,Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | | | - Bruno Moulin
- Service de Néphrologie, CHU de Strasbourg, France.,Université de Strasbourg, France
| | - Thomas Robert
- Service de Néphrologie, Assistance Publique - Hôpitaux de Marseille (AP-HM), France.,Université de Marseille, France
| | - Cédric Rafat
- Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), France
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25
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Beydon M, Rodriguez C, Karras A, Cez A, Rafat C, Jourde-Chiche N, Fain O, Philipponnet C, Puéchal X, Dossier A, Dupin N, Levy D, Aureau I, Guillevin L, Terrier B. Bartonella and Coxiella infections presenting as systemic vasculitis: case series and review of literature. Rheumatology (Oxford) 2021; 61:2609-2618. [PMID: 34500468 DOI: 10.1093/rheumatology/keab691] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/27/2021] [Revised: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Coxiella and Bartonella sp. display particular tropism for endothelial or endocardial tissues and an abnormal host response to infections with induced autoimmunity. We aimed, through a case series combined with a comprehensive literature review, to outline characteristics of Coxiella and Bartonella infections presenting as systemic vasculitis. METHODS We retrospectively included cases of definite Coxiella and Bartonella infections presenting with vasculitis features and performed a comprehensive literature review. RESULTS Six cases of Bartonella infections were added to 18 cases from literature review. Causative pathogens were mainly B. henselae. Bartonella infection mimicked anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis in 83% with PR3-ANCA and presented as cryoglobulinemic vasculitis in 8%. Glomerulonephritis was present in 92%, and 88% had endocarditis. Complement fractions were low in 82% and rheumatoid factor positive in 85%. Kidney biopsies showed cell proliferation, mostly crescentic, with pauci-immune glomerulonephritis in 29%. Outcome was favorable, with the use of antibiotics alone in one third. Five cases of Coxiella infections were added to 16 from literature review. Sixteen had small-vessel vasculitides, mainly cryoglobulinemia vasculitis in 75%. One patient had polyarteritis nodosa-like vasculitis and four large-vessel vasculitis. Outcome was good except for one death. A highly sensitive next generation sequencing analysis on 3 Coxiella and 2 Bartonella-related vasculitides biopsies did not find any bacterial DNA. CONCLUSION Coxiella and Bartonella are both able to induce vasculitis but display distinct vasculitis features. Bartonella mimics PR3-ANCA-associated vasculitis in the setting of endocarditis, whereas Coxiella may induce vasculitis involving all vessel sizes.
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Affiliation(s)
- Maxime Beydon
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Rodriguez
- Departement de Virologie, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Alexandre Karras
- Unité de Néphrologie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, F-75006, France
| | - Alexandre Cez
- Service de néphrologie et dialyse, Hôpital Tenon (AP-HP), Paris, France
| | - Cédric Rafat
- Service des urgences Néphrologiques et Transplantation rénale, Assistance Publique-Hôpital de Paris, Paris, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France
| | - Olivier Fain
- Département de Médecine interne, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carole Philipponnet
- Département de néphrologie et de dialyse CHU Clermont Ferrand, Clermont Ferrand, France
| | - Xavier Puéchal
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Service de médecine interne, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Dupin
- Département de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dan Levy
- Service de rhumatologie, CHU Strasbourg, Strasbourg, France
| | - Inès Aureau
- Service de médecine interne, Centre Hospitalier de Pau, Pau, France
| | - Loïc Guillevin
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, F-75006, France
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26
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Rafat C, Zaworski J, Luque Y, Daudon M, Doreille A, Mesnard L, Letavernier E. Évaluation non invasive de la néphropathie à la vancomycine : description d’une nouvelle technique immunohistochimique urinaire. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Rasmussen C, Abitbol V, El Karoui K, Bourrier A, Paule R, Vuitton L, Maurier F, Laharie D, Fuméry M, Agard C, Collins M, Nancey S, Rafat C, Kervegant AG, Queyrel-Moranne V, Moulis G, Pigneur B, Régent A, Gay C, Morbieu C, Durel CA, Ducloux D, Aubin F, Voicu M, Joher N, Szwebel T, Martinez-Vinson C, Koch S, Guillevin L, Peyrin-Biroulet L, Terrier B. IgA Vasculitis in Patients with Inflammatory Bowel Disease: new insights into the role of TNF-α blockers. Rheumatology (Oxford) 2021; 61:1957-1965. [PMID: 34427590 DOI: 10.1093/rheumatology/keab662] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Association of IgA vasculitis (IgAV) and inflammatory bowel diseases (IBD) is rarely described, mainly during anti-TNF-α therapy. We aimed to describe the association of IgAV and IBD. METHODS We retrospectively analyzed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form. RESULTS Forty-three cases were included. IBD (mainly Crohn's disease (CD) in 58%) preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4-15.4) years. In these 38 patients, at IgAV diagnosis, 5 (13%) had active IBD and 28 (74%) were treated with anti-TNF-α for a median duration of 31.5 (IQR 19-56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in 6 (16%), cyclophosphamide in 6 (16%), and anti-TNF-α were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-α blockers were stopped, vs 23% in patients pursuing it. Conversely, 5 (33%) had IBD flare or complication after anti-TNF-α cessation vs 1 (8%) in those continuing biologics. Anti-TNF-α were resumed in 6 (40%), with subsequent IgAV relapse in 4 (67%). CONCLUSIONS This large cohort suggests that TNF-α blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-α was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-α was associated with IBD remission but vasculitis relapse.
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Affiliation(s)
- Camille Rasmussen
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
| | - Vered Abitbol
- Department of Gastroenterology, Hopital Cochin, APHP-CUP, Paris
| | | | - Anne Bourrier
- Department of Gastroenterology, Hôpital Saint-Antoine, AP-HP, Paris
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes
| | | | | | | | | | | | - Michael Collins
- Department of Gastroenterology, Hopital Bicêtre, AP-HP, Le Kremlin-Bicêtre
| | | | - Cédric Rafat
- Department of Nephrology, Hôpital Tenon, AP-HP, Paris
| | | | | | | | - Bénédicte Pigneur
- Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker, AP-HP
- Université de Paris, Paris
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | - Claire Gay
- Department of Gastroenterology, CHRU, Besançon
| | - Caroline Morbieu
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | - Cécile Audrey Durel
- Department of Internal Medicine, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon
| | | | | | - Mickaela Voicu
- Department of Internal Medicine, CHRU Besançon, Besançon
| | - Nizar Joher
- Department of Nephrology, Hôpital Henri Mondor, AP-HP, Créteil
| | - Tali Szwebel
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
| | | | | | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | | | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
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Mohamadou I, Buob D, Rabant M, Pichon J, Gaudry S, Luque Y, Rondeau E, Brocheriou I, Rafat C. The Case | Acute kidney injury associated with chronic myelomonocytic leukemia. Kidney Int 2021; 99:495-496. [PMID: 33509365 DOI: 10.1016/j.kint.2020.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Inna Mohamadou
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France.
| | - David Buob
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France
| | - Marion Rabant
- Assistance Publique des Hôpitaux de Paris - Université Paris-Descartes, Paris, France
| | - Jérémy Pichon
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France
| | - Stéphane Gaudry
- Assistance Publique des Hôpitaux de Paris - Université Paris XIII, Paris, France
| | - Yosu Luque
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France
| | - Eric Rondeau
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France
| | - Isabelle Brocheriou
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France
| | - Cédric Rafat
- Assistance Publique des Hôpitaux de Paris - Sorbonne Université, Paris, France
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29
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Travert B, Rafat C, Mariani P, Cointe A, Dossier A, Coppo P, Joseph A. Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management. Toxins (Basel) 2021; 13:306. [PMID: 33925836 PMCID: PMC8145702 DOI: 10.3390/toxins13050306] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 01/28/2023] Open
Abstract
Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a form of thrombotic microangiopathy secondary to an infection by an enterohemorrhagic E. coli. Historically considered a pediatric disease, its presentation has been described as typical, with bloody diarrhea at the forefront. However, in adults, the clinical presentation is more diverse and makes the early diagnosis hazardous. In this review, we review the epidemiology, most important outbreaks, physiopathology, clinical presentation and prognosis of STEC-HUS, focusing on the differential features between pediatric and adult disease. We show that the clinical presentation of STEC-HUS in adults is far from typical and marked by the prevalence of neurological symptoms and a poorer prognosis. Of note, we highlight knowledge gaps and the need for studies dedicated to adult patients. The differences between pediatric and adult patients have implications for the treatment of this disease, which remains a public health threat and lack a specific treatment.
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Affiliation(s)
- Benoit Travert
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France; (B.T.); (A.D.)
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 75012 Paris, France; (C.R.); (P.C.)
| | - Cédric Rafat
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 75012 Paris, France; (C.R.); (P.C.)
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France
| | - Patricia Mariani
- Service de Microbiologie, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France; (P.M.); (A.C.)
| | - Aurélie Cointe
- Service de Microbiologie, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France; (P.M.); (A.C.)
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France; (B.T.); (A.D.)
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 75012 Paris, France; (C.R.); (P.C.)
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 75012 Paris, France; (C.R.); (P.C.)
- Service d’Hématologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
| | - Adrien Joseph
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 75012 Paris, France; (C.R.); (P.C.)
- Médecine Intensive Réanimation, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
- Centre de Recherche des Cordeliers, Équipe Labellisée par la Ligue Contre le Cancer, Inserm U1138, Université de Paris, Sorbonne Université, 75006 Paris, France
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30
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Durel CA, Sinico RA, Teixeira V, Jayne D, Belenfant X, Marchand-Adam S, Pugnet G, Gaultier J, Le Gallou T, Titeca-Beauport D, Agard C, Barbet C, Bardy A, Blockmans D, Boffa JJ, Bouet J, Cottin V, Crabol Y, Deligny C, Essig M, Godmer P, Guilpain P, Hirschi-Santelmo S, Rafat C, Puéchal X, Taillé C, Karras A. Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA): a multicentric retrospective study of 63 biopsy-proven cases. Rheumatology (Oxford) 2021; 60:359-365. [PMID: 32856066 DOI: 10.1093/rheumatology/keaa416] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by asthma, hypereosinophilia and ANCA positivity in 40% of patients. Renal involvement is rare and poorly described, leading to this renal biopsy-proven based study in a large EGPA cohort. METHODS We conducted a retrospective multicentre study including patients fulfilling the 1990 ACR criteria and/or the 2012 revised Chapel Hill Consensus Conference criteria for EGPA and/or the modified criteria of the MIRRA trial, with biopsy-proven nephropathy. RESULTS Sixty-three patients [27 women, median age 60 years (18-83)] were included. Renal disease was present at vasculitis diagnosis in 54 patients (86%). ANCA were positive in 53 cases (84%) with anti-MPO specificity in 44 (83%). All patients had late-onset asthma. Peripheral neuropathy was present in 29 cases (46%), alveolar haemorrhage in 10 (16%). The most common renal presentation was acute renal failure (75%). Renal biopsy revealed pauci-immune necrotizing GN in 49 cases (78%). Membranous nephropathy (10%) and membranoproliferative GN (3%) were mostly observed in ANCA-negative patients. Pure acute interstitial nephritis was found in six cases (10%); important interstitial inflammation was observed in 28 (44%). All patients received steroids with adjunctive immunosuppression in 54 cases (86%). After a median follow-up of 51 months (1-296), 58 patients (92%) were alive, nine (14%) were on chronic dialysis and two (3%) had undergone kidney transplantation. CONCLUSION Necrotizing pauci-immune GN is the most common renal presentation in ANCA-positive EGPA. ANCA-negative patients had frequent atypical renal presentation with other glomerulopathies such as membranous nephropathy. An important eosinophilic interstitial infiltration was observed in almost 50% of cases.
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Affiliation(s)
- Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils De Lyon, Lyon, France
| | - Renato A Sinico
- Department of Medicine and Surgery, Universita di Milano-Biococca, Milano, Italy
| | - Vitor Teixeira
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - David Jayne
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Xavier Belenfant
- Department of Nephrology, Centre Hospitalier Intercommunal André Grégoire, Montreuil
| | | | - Gregory Pugnet
- Department of Internal Medicine, Hôpital Purpan, Toulouse
| | | | - Thomas Le Gallou
- Department of Internal Medicine, CHRI Rennes Site Hôpital Sud, Rennes
| | | | - Christian Agard
- Department of Internal Medicine, CHU de Nantes Site Hôtel Dieu-HME, Nantes
| | | | - Antoine Bardy
- Department of Internal Medicine, Centre Hospitalier Moulins-Yzeure, Moulins, France
| | - Daniel Blockmans
- Department of General Internal Medicine, KU Leuven, Leuven, Belgium
| | | | - Julien Bouet
- Department of Nephrology, CHPC Site Cherbourg, Cherbourg Octeville
| | - Vincent Cottin
- National Coordinating Reference Centre for Rare Pulmonary Diseases, Hôpital Louis Pradel, Hospices Civils De Lyon, University Claude Bernard Lyon 1, Lyon
| | - Yoann Crabol
- Department of Internal Medicine, CHBA Site de Vannes, Vannes
| | - Christophe Deligny
- Department of Rheumatology and Internal Medicine, CHU Martinique, Hôpital P. Zobda-Quitman, Fort-de-France
| | - Marie Essig
- Department of Nephrology, Hopital Ambroise Paré, Boulogne-Billancourt
| | - Pascal Godmer
- Department of Internal Medicine, CHBA Site de Vannes, Vannes
| | - Philippe Guilpain
- Department of Internal Medicine-Multi-Organ Diseases, Montpellier University-Saint Eloi Hospital, Montpellier
| | | | - Cédric Rafat
- Department of Nephrology, Hôpital Tenon AP-HP, Paris
| | | | | | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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31
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Doreille A, Raymond L, Lebre AS, Linster C, Saraeva Lamri R, Karras A, Khayat R, Michel PA, Buob D, Luque Y, Rafat C, Mesnard L. Nephronophthisis in Young Adults Phenocopying Thrombotic Microangiopathy and Severe Nephrosclerosis. Clin J Am Soc Nephrol 2021; 16:615-617. [PMID: 33268504 PMCID: PMC8092057 DOI: 10.2215/cjn.11890720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alice Doreille
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France,Sorbonne Université, Paris, France
| | | | - Anne-Sophie Lebre
- Centre Hospitalier et Universitaire de Reims, Hôpital Maison Blanche, Pole de biologie, Service de génétique, Reims, France
| | - Charel Linster
- Service de Néphrologie, Hôpital Européen Georges Pompidou, 20 Rue Leblan, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, 20 Rue Leblan, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Rateb Khayat
- Service de Néphrologie et Dialyses, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Pierre-Antoine Michel
- Service de Néphrologie et Dialyses, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - David Buob
- Sorbonne Université, Paris, France,Service d'Anatomo-Pathologie, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France,Institut National de la Santé et de la Recherche Médicale UMR_S1155, Hôpital Tenon, 4 Rue de la Chine, 75020, Paris, France
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France,Sorbonne Université, Paris, France,Institut National de la Santé et de la Recherche Médicale UMR_S1155, Hôpital Tenon, 4 Rue de la Chine, 75020, Paris, France
| | - Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Laurent Mesnard
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4 Rue de la Chine, Assistance Publique–Hôpitaux de Paris, Paris, France,Sorbonne Université, Paris, France,Institut National de la Santé et de la Recherche Médicale UMR_S1155, Hôpital Tenon, 4 Rue de la Chine, 75020, Paris, France,Institut des Sciences du Calcul et des Données, Campus Pierre et Marie Curie, Batiment Esclangon, Sorbonne Université, 4 Place Jussieu, Cedex 05, Paris, France
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Lépine MS, Goua V, Debouverie OS, Giraud C, Rafat C, Thonier V, Masmouhi BE, Ndour CT, Huguet-Jacquot S, Mailloux A, Cortey A, Jouannic JM, Maisonneuve E. Multidisciplinary management of anti-PP1P k or anti-P alloimmunization during pregnancy: A new case with anti-P and a literature review. Transfusion 2021; 61:1972-1979. [PMID: 33811650 DOI: 10.1111/trf.16384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/14/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Red blood cell alloimmunization is the first cause of fetal and neonatal anemia. Alloimmunizations with anti-PP1Pk or anti-P can cause recurrent miscarriages and hemolytic disease of the fetus and newborn in the 2nd and 3rd trimesters of pregnancy. We report on a pregnant patient immunized with anti-P and a history of recurrent miscarriages. CASE REPORT This P2 k (GLOB:-1; P1PK:-1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non-reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti-P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti-P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required. DISCUSSION AND REVIEW OF THE LITERATURE The P and Pk antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P1 k (GLOB:-1; P1PK:1,3), P2 k (GLOB:-1; P1PK:-1,3), or Tj(a-)/p (GLOB:-1; P1PK:-1,-3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported. CONCLUSION Immunizations to P and PP1Pk antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti-PP1Pk or anti-P fetomaternal incompatibilities.
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Affiliation(s)
- Marlène Sohier Lépine
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Valérie Goua
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Odile Souchaud Debouverie
- Department of Internal Medicine, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Christine Giraud
- Department of Hematology, Poitiers University Hospital, Poitiers University, Poitiers, France.,Établissement Français du Sang (EFS), Poitiers, France
| | - Cédric Rafat
- Department of Nephrology and Kidney Transplantation, Tenon Hospital, Paris, France
| | - Vincent Thonier
- Centre National de Référence pour les Groupes Sanguins (CNRGS), Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
| | | | - Cécile Toly Ndour
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Stéphanie Huguet-Jacquot
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Agnès Mailloux
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Anne Cortey
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Emeline Maisonneuve
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
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de Nattes T, Saad R, Buob D, Verney C, Doreille A, Luque Y, Mesnard L, Pâques M, Rafat C. Retinal Arteriolar Occlusions and Exudative Retinal Detachments in Malignant Hypertension: More Than Meets the Eye. Am J Hypertens 2021; 34:30-33. [PMID: 32840289 DOI: 10.1093/ajh/hpaa138] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malignant hypertension is macrovascular and microvascular endothelial injury responsible for multiple organ damage. Considering the anatomical and functional homologies between the posterior pole of the eye and the kidney, ophthalmological explorations may inform clinicians on the mechanisms underpinning concurrent kidney injury in this condition. More specifically, we investigated whether the wall-to-lumen ratio (WLR) of retinal arterioles measured by adaptive optics ophthalmoscopy could be correlated to WLR of kidney arterioles as determined by pathology. We sought to estimate the incidence of retinal arteriole occlusion a supposedly uncommon complication of malignant hypertension. METHODS All patients hospitalized in our renal Intensive Care Unit for malignant hypertension between 2016 and 2019 were referred to ophthalmological examinations. RESULTS Twenty-seven patients were included. Median retinal WLR was 0.39 [0.31-0.47] and was correlated with initial systolic (r = 0.56, P = 0.003) and mean blood pressure (r = 0.46, P = 0.02) upon admission. The retinal WLR was not correlated to renal pathological findings, as assessed by juxtaglomerular WLR (r = 0.38, P = 0.2), ratio of glomerulosclerosis (r = -0.39, P = 0.2), or tubulointerstitial fibrosis (r = -0.45, P = 0.08). Retinal WLR was not associated with neurological or cardiovascular end-organ damage. Branch retinal artery occlusion was detected in 18.5% of patients and exudative retinal detachment (ERD) in 29.6% of patients, without any significant correlation with canonical signs of retinal hypertension including optic disc swelling. CONCLUSIONS In the setting of malignant hypertension, we failed to demonstrate a significant relationship between WLR and other meaningful end-organ injuries. However, branch retinal artery occlusion and ERD may have been hitherto underestimated.
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Affiliation(s)
- Tristan de Nattes
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
- Nephrology—Kidney Transplant Unit, Rouen University Hospital, Rouen, France
| | - Rana Saad
- Department of Ophthalmology, PARIS Group, Quinze-Vingts Hospital, Paris, France
- Institut hospitalo-universitaire FOReSIGHT, Hôpital des Quinze-Vingts, Paris, France
| | - David Buob
- Pathology Department, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charles Verney
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Alice Doreille
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Laurent Mesnard
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Michel Pâques
- Department of Ophthalmology, PARIS Group, Quinze-Vingts Hospital, Paris, France
- Institut hospitalo-universitaire FOReSIGHT, Hôpital des Quinze-Vingts, Paris, France
| | - Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
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Meibody F, Jamme M, Tsatsaris V, Provot F, Lambert J, Frémeaux-Bacchi V, Ducloy-Bouthors AS, Jourdain M, Delmas Y, Perez P, Darmian J, Wynckel A, Rebibou JM, Coppo P, Rafat C, Rondeau E, Frimat L, Hertig A. Post-partum acute kidney injury: sorting placental and non-placental thrombotic microangiopathies using the trajectory of biomarkers. Nephrol Dial Transplant 2021; 35:1538-1546. [PMID: 30805631 DOI: 10.1093/ndt/gfz025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/19/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Among the severe complications of preeclampsia (PE), acute kidney injury (AKI) is problematic if features of thrombotic microangiopathy (TMA) are present. Although a haemolysis enzyme liver low-platelets syndrome is considerably more frequent, it is vital to rule out a flare of atypical haemolytic and uraemic syndrome (aHUS). Our objective was to improve differential diagnosis procedures in post-partum AKI. METHODS A total of 105 cases of post-partum AKI, admitted to nine different regional French intensive care units from 2011 to 2015, were analysed. Analysis included initial and final diagnosis, renal features, haemostasis and TMA parameters, with particular focus on the dynamics of each component within the first days following delivery. A classification and regression tree (CART) was used to construct a diagnostic algorithm. RESULTS AKI was attributed to severe PE (n = 40), post-partum haemorrhage (n = 33, including 13 renal cortical necrosis) and 'primary' TMA (n = 14, including 10 aHUS and 4 thrombotic thrombocytopenic purpura). Congruence between initial and final diagnosis was low (63%). The dynamics of haemoglobin, haptoglobin and liver enzymes were poorly discriminant. In contrast, the dynamic pattern of platelets was statistically different between primary TMA-related AKI and other groups. CART analysis independently highlighted the usefulness of platelet trajectory in the diagnostic algorithm. Limitations of this study include that only the most severe cases were included in this retrospective study, and the circumstantial complexity is high. CONCLUSION Trajectory of platelet count between admission and Day 3 helps to guide therapeutic decisions in cases of TMA-associated post-partum AKI. Our study also strongly suggests that during the post-partum period, there may be a risk of transient, slowly recovering TMA in cases of severe endothelial injury in women without a genetic mutation known to induce aHUS.
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Affiliation(s)
- Fleuria Meibody
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Matthieu Jamme
- Sorbonne Université, Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpital de Paris (APHP), Hôpital Tenon, Paris, France
| | - Vassilis Tsatsaris
- APHP, Department of Obstetrics and Gynecology, Port-Royal Maternity, University Hospital Center Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Paris, France
| | - François Provot
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Claude-Huriez Hospital, CHRU de Lille, Lille, France.,French Reference Center for Thrombotic Microangiopathies, APHP, Hôpital Saint-Antoine, Paris, France
| | - Jérôme Lambert
- Biostatistics Department, Saint Louis Teaching Hospital, APHP, Paris, France
| | | | | | - Mercédès Jourdain
- Intensive Care Unit, Pôle de Réanimation, University of Lille, CHU Lille, U1190, Lille, France
| | - Yahsou Delmas
- French Reference Center for Thrombotic Microangiopathies, APHP, Hôpital Saint-Antoine, Paris, France.,Department of Nephrology Transplantation-Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Pierre Perez
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France.,French Reference Center for Thrombotic Microangiopathies, APHP, Hôpital Saint-Antoine, Paris, France
| | - Julien Darmian
- Department of Intensive Care, Centre Hospitalier Régional Metz-Thionville, Ars-Laquenexy, France
| | - Alain Wynckel
- Department of Nephrology, Centre Hospitalier Universitaire, Reims, France
| | | | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies, APHP, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, Hematology, APHP, Hôpital Saint-Antoine, Paris, France
| | - Cédric Rafat
- Sorbonne Université, Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpital de Paris (APHP), Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Sorbonne Université, Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpital de Paris (APHP), Hôpital Tenon, Paris, France.,French Reference Center for Thrombotic Microangiopathies, APHP, Hôpital Saint-Antoine, Paris, France
| | - Luc Frimat
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Alexandre Hertig
- Sorbonne Université, Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpital de Paris (APHP), Hôpital Tenon, Paris, France
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Rafat C, Garcia H, Grangé S. [Acute renal failure and cancer treatment]. Rev Prat 2021; 71:216-222. [PMID: 34160987] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
"Acute renal failure and cancer treatment The interplay between cancer and acute kidney injury is intricate. Cancer, as much as therapies developed against it, may be responsible for acute kidney injury. Tumor lysis syndrome stems from the synergetic effects of anti-tumoral therapies in combination with the specific characteristics of the underlying tumor. Intra-tubular methotrexate precipitation is characterized by extra-renal clinical manifestations due to delayed renal drug clearance: prophylactic therapy based on optimized hydration and avoidance of nephrotoxic drugs represent the cornerstone of its management whereas rescue therapy relies on folinic acid substitution and enzyme-based therapy. Thrombotic microangiopathy is likely to result either from the cancer per se or treatments targeting the cancer. Gemcitabine stands as one the drug well acknowledged for eliciting thrombotic microngioapathy with potentially devastating consequences so that eculizumab has been contemplated as a possible therapy, on a case to case basis. Finally, it should be kept in mind that acute kidney injury in the setting of cancer represents a severe complication in the course of the disease."
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Affiliation(s)
- Cédric Rafat
- "Département de néphrologie, hôpital Tenon, AP-HP, Sorbonne Université, Paris, France."
| | - Hugo Garcia
- "Unité néphrologie, groupe hospitalier La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France."
| | - Steven Grangé
- "Service de réanimation médicale, CHU de Rouen, Rouen, France."
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Mousseaux C, Rafat C, Letavernier E, Frochot V, Kerroumi Y, Zeller V, Luque Y. Acute Kidney Injury After High Doses of Amoxicillin. Kidney Int Rep 2020; 6:830-834. [PMID: 33732998 PMCID: PMC7938081 DOI: 10.1016/j.ekir.2020.11.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/16/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cyril Mousseaux
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, France
- UMR_S1155, INSERM, Sorbonne Université, Paris, France
- Correspondence: Cyril Mousseaux, Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France.
| | - Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, France
| | - Emmanuel Letavernier
- UMR_S1155, INSERM, Sorbonne Université, Paris, France
- Laboratoire des Lithiases, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, France
| | - Vincent Frochot
- UMR_S1155, INSERM, Sorbonne Université, Paris, France
- Laboratoire des Lithiases, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections-Ostéo-Articulaires Complexes, GH Diaconesses Croix Saint Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections-Ostéo-Articulaires Complexes, GH Diaconesses Croix Saint Simon, Paris, France
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, France
- UMR_S1155, INSERM, Sorbonne Université, Paris, France
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Rasmussen C, Abitbol V, El Karoui K, Bourrier A, Paule R, Koch S, Maurier F, Laharie D, Aubin F, Fumery M, Peyrin-Biroulet L, Rafat C, Queyrel V, Moulis G, Pigneur B, Régent A, Morbieu C, Guillevin L, Terrier B. Vascularites à IgA associées aux maladies inflammatoires chroniques de l’intestin : étude observationnelle multicentrique rétrospective de 43 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.048] [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: 11/17/2022]
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Vigneron C, Jamme M, Schurder J, Joseph A, Rondeau E, Lefèvre G, Ridel C, Rafat C. Efficacy and tolerance of sustained low-efficiency dialysis with calcium-free citrate-containing dialysate anticoagulation. Clin Kidney J 2020; 14:1025-1026. [PMID: 33777385 PMCID: PMC7986335 DOI: 10.1093/ckj/sfaa128] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Clara Vigneron
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Matthieu Jamme
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Juliet Schurder
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Adrien Joseph
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Eric Rondeau
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Guillaume Lefèvre
- Laboratoire de Biochimie, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Ridel
- Centre d'hémodialyse et d'aphérèse, AURA Paris Plaisance, Paris, France
| | - Cédric Rafat
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
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Tardieu L, Lortholary O, Lanternier F, Scemla A, Rafat C. Cryptococcose chez les patients transplantés rénaux : étude multicentrique rétrospective cas-témoins. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.033] [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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Rafat C, Luque Y. Eculizumab and aHUS: Spotlight on Patient-Centered Care. Kidney Int Rep 2020; 5:1123-1125. [PMID: 32779641 PMCID: PMC7403734 DOI: 10.1016/j.ekir.2020.06.007] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cédric Rafat
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| | - Yosu Luque
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
- Inserm, UMR_S1155, Sorbonne Université, Paris, France
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Schwarz C, Brehon A, Mousseaux C, Luque Y, Senet P, Mariani P, Mohamadou I, Zafrani L, Frémeaux-Bacchi V, Rondeau E, Buob D, Rafat C. Ockham's razor defeated: about two atypical cases of hemolytic uremic syndrome. BMC Nephrol 2020; 21:269. [PMID: 32652955 PMCID: PMC7353709 DOI: 10.1186/s12882-020-01926-2] [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: 02/07/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022] Open
Abstract
Background Medical investigation is a favorite application of Ockham’s razor, in virtue of which when presented with competing hypotheses, the solution with the fewest assumptions should be privileged. Hemolytic uremic syndrome (HUS) encompasses diseases with distinct pathological mechanisms, such as HUS due to shiga-like toxin-producing bacteria (STEC-HUS) and atypical HUS, linked to defects in the alternate complement pathway. Other etiologies such as Parvovirus B19 infection are exceptional. All these causes are rare to such extent that we usually consider them mutually exclusive. We report here two cases of HUS that could be traced to multiple causes. Cases presentation Case 1 presented as vomiting and diarrhea. All biological characteristics of HUS were present. STEC was found in stool (by PCR and culture). After initial remission, a recurrence occurred and patient was started on Eculizumab. Genetic analysis revealed the heterozygous presence of a CFHR1/CFH hybrid gene. The issue was favorable under treatment. In case 2, HUS presented as fever, vomiting and purpura of the lower limbs. Skin lesions and erythroblastopenia led to suspect Parvovirus B19 primo-infection, which was confirmed by peripheral blood and medullar PCR. Concurrently, stool culture and PCR revealed the presence of STEC. Evolution showed spontaneous recovery. Conclusions Both cases defy Ockham’s razor in the sense that multiple causes could be traced to a single outcome; furthermore, they invite us to reflect on the physiopathology of HUS as they question the classical distinction between STEC-HUS and atypical HUS. We propose a two-hit mechanism model leading to HUS. Indeed, in case 1, HUS unfolded as a result of the synergistic interaction between an infectious trigger and a genetic predisposition. In case 2 however, it is the simultaneous occurrence of two infectious triggers that led to HUS. In dissent from Ockham’s razor, an exceptional disease such as HUS may stem from the sequential occurrence or co-occurrence of several rare conditions.
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Affiliation(s)
- Chloe Schwarz
- Service d'urgences néphrologiques et transplantation rénale, hôpital Tenon, Paris, France.
| | - Alice Brehon
- Service de dermatologie, hôpital Tenon, Paris, France
| | - Cyril Mousseaux
- Service d'urgences néphrologiques et transplantation rénale, hôpital Tenon, Paris, France
| | - Yosu Luque
- Service d'urgences néphrologiques et transplantation rénale, hôpital Tenon, Paris, France
| | | | | | - Inna Mohamadou
- Service d'urgences néphrologiques et transplantation rénale, hôpital Tenon, Paris, France
| | - Lara Zafrani
- Service de Médecine Intensive et Réanimation, hôpital Saint Louis, Paris, France
| | | | - Eric Rondeau
- Service d'urgences néphrologiques et transplantation rénale, hôpital Tenon, Paris, France
| | - David Buob
- Service d'anatomopathologie, hôpital Tenon, Paris, France
| | - Cédric Rafat
- Service d'urgences néphrologiques et transplantation rénale, hôpital Tenon, Paris, France
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Mousseaux C, Joly BS, Mohamadou I, Arrestier R, Hertig A, Rafat C. Severe HELLP syndrome masquerading as thrombocytopenic thrombotic purpura: a case report. BMC Nephrol 2020; 21:204. [PMID: 32471388 PMCID: PMC7260815 DOI: 10.1186/s12882-020-01865-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/06/2019] [Accepted: 05/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background Thrombotic microangiopathies (TMAs) occurring in the postpartum period may be difficult to manage. They present as the combination of mechanical hemolytic anemia and consumption thrombocytopenia due to endothelial dysfunction. The cause of this endothelial aggression can be multiple: thrombocytopenic thrombotic purpura (TTP), HELLP syndrome, antiphospholipid syndrome, atypical hemolytic and uremic syndrome or acute fatty liver of pregnancy. TTP results from a severe deficiency of ADAMTS13, which is a protease cleaving specifically von Willebrand factor chiefly produced by liver cells. There are two main causes, the production of anti-ADAMTS13 auto-antibodies and, more rarely, a genetic deficiency in ADAMTS13. First-line treatment is based on plasma exchange. HELLP syndrome occurs in the third trimester of pregnancy usually in association with preeclampsia and represents a form of TMA characterized by damage to the sinusoidal capillaries of the liver. Prompt delivery is the main treatment. We present a case illustrating the challenges in discriminating between different postpartum TMAs, with a focus on the distinction between TTP and HELLP syndrome. Specifically, we highlight how acute liver failure (ALF) stemming from HELLP may lead to TTP with a spectacular response to plasma exchanges. Case A 28-year-old, 33 + 4 weeks pregnant woman presented with severe preeclampsia complicated by ALF in the setting of partial liver necrosis, disseminated intravascular coagulation, microangiopathic hemolytic anemia and acute kidney injury. Greatly diminished levels of ADAMTS13 (< 5%) activity and neurological impairment suggested an initial diagnosis of thrombotic thrombocytopenic purpura (TTP). Therapeutic plasma exchange (TPE) was initiated and complete renal, neurological, hematological and hepatic recovery was observed. Secondary TTP induced by ALF due to HELLP syndrome was the final diagnosis. Conclusion Our case addresses the overlapping nature of postpartum TMAs and raises the possibility that HELLP-induced ALF may constitute an additional mechanism resulting in TTP, thereby opening a possible indication for TPE.
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Affiliation(s)
- Cyril Mousseaux
- Department of Nephrology, CHU Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.
| | - Bérangère S Joly
- Hematology Laboratory, French Reference Center for Thrombotic Microangiopathies, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Inna Mohamadou
- Department of Nephrology, CHU Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Romain Arrestier
- Department of Nephrology, CHU Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Alexandre Hertig
- Department of Nephrology, CHU Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Cédric Rafat
- Department of Nephrology, CHU Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
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Amoura A, Moktefi A, Halfon M, Karras A, Rafat C, Gibier JB, Gleeson PJ, Servais A, Argy N, Maillé P, Belenfant X, Gueutin V, Delpierre A, Tricot L, El Karoui K, Jourde-Chiche N, Houze S, Sahali D, Audard V. Malaria, Collapsing Glomerulopathy, and Focal and Segmental Glomerulosclerosis. Clin J Am Soc Nephrol 2020; 15:964-972. [PMID: 32444394 PMCID: PMC7341769 DOI: 10.2215/cjn.00590120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/14/2020] [Accepted: 04/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Malaria, a potentially life-threatening disease, is the most prevalent endemic infectious disease worldwide. In the modern era, the spectrum of glomerular involvement observed in patients after malarial infections remains poorly described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We therefore performed a retrospective multicenter study to assess the clinical, biologic, pathologic, and therapeutic characteristics of patients with glomerular disease demonstrated by kidney biopsy in France within 3 months of an acute malaria episode. RESULTS We identified 23 patients (12 men), all but 1 of African ancestry and including 10 patients with concomitant HIV infection. All of the imported cases were in French citizens living in France who had recently traveled back to France from an endemic area and developed malaria after their return to France. Eleven patients had to be admitted to an intensive care unit at presentation. Plasmodium falciparum was detected in 22 patients, and Plasmodium malariae was detected in 1 patient. Kidney biopsy was performed after the successful treatment of malaria, a mean of 24 days after initial presentation. At this time, all patients displayed AKI, requiring KRT in 12 patients. Nephrotic syndrome was diagnosed in 17 patients. Pathologic findings included FSGS in 21 patients and minimal change nephrotic syndrome in 2 patients. Among patients with FSGS, 18 had collapsing glomerulopathy (including 9 patients with HIV-associated nephropathy). In four patients, immunohistochemistry with an antibody targeting P. falciparum histidine-rich protein-2 demonstrated the presence of the malaria antigen in tubular cells but not in podocytes or parietal epithelial cells. An analysis of the apoL1 risk genotype showed that high-risk variants were present in all seven patients tested. After a mean follow-up of 23 months, eight patients required KRT (kidney transplantation in two patients), and mean eGFR for the other patients was 51 ml/min per 1.73 m2. CONCLUSIONS In patients of African ancestry, imported Plasmodium infection may be a new causal factor for secondary FSGS, particularly for collapsing glomerulopathy variants in an APOL1 high-risk variant background.
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Affiliation(s)
- Ariane Amoura
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France.,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| | - Anissa Moktefi
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France.,Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
| | - Matthieu Halfon
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Service de Néphrologie, Paris, France
| | - Alexandre Karras
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Néphrologie, Paris, France.,Faculté de Médecine Paris-Descartes, Université de Paris, Paris, France
| | - Cédric Rafat
- Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Jean-Baptiste Gibier
- University of Lille, Centre Hospitalier Universitaire de Lille, Institut de Pathologie, Centre de Biologie Pathologie, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1172, Lille, France
| | - Patrick J Gleeson
- Institut National de la Santé et de la Recherche Médicale U1149, Immunoreceptors and Renal Immunopathology Laboratory, Université Diderot, Paris, France.,Royal College of Physicians of Ireland, Division of Nephrology, Dublin, Republic of Ireland
| | - Aude Servais
- Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Paris, France
| | - Nicolas Argy
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Laboratoire de Parasitologie-Mycologie Médicale, Centre National de Référence du Paludisme, Paris, France.,Institut pour la Recherche et le Développement, Université de Paris, Faculté de Pharmacie, Mère et enfant en milieu tropical Unité Mixte de Recherche 261, Paris, France
| | - Pascale Maillé
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
| | - Xavier Belenfant
- Groupe Hospitalier Grand Paris Nord Est, Hôpital André Grégoire, Service de Néphrologie-Dialyse, Montreuil, France
| | - Victor Gueutin
- Association pour l'Utilisation du Rein Artificiel, Service de Néphrologie-Dialyse, Association pour l'Utilisation du Rein Artificiel Paris Plaisance, Paris, France
| | - Alexia Delpierre
- Hôpital Duchenne, Service de Néphrologie et Médecine Interne, Boulogne sur Mer, France
| | - Leila Tricot
- Hôpital Foch, Service de Néphrologie, Transplantation Rénale et Dialyse, Suresnes, France
| | - Khalil El Karoui
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France.,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| | - Noémie Jourde-Chiche
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institut national de recherche pour l'agriculture, l'alimentation et l'environnement, Centre de recherche en CardioVasculaire et Nutrition, Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Sandrine Houze
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Laboratoire de Parasitologie-Mycologie Médicale, Centre National de Référence du Paludisme, Paris, France.,Institut pour la Recherche et le Développement, Université de Paris, Faculté de Pharmacie, Mère et enfant en milieu tropical Unité Mixte de Recherche 261, Paris, France
| | - Dil Sahali
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France.,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France .,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
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Joseph A, Cointe A, Mariani Kurkdjian P, Rafat C, Hertig A. Shiga Toxin-Associated Hemolytic Uremic Syndrome: A Narrative Review. Toxins (Basel) 2020; 12:E67. [PMID: 31973203 PMCID: PMC7076748 DOI: 10.3390/toxins12020067] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [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: 12/29/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 01/28/2023] Open
Abstract
The severity of human infection by one of the many Shiga toxin-producing Escherichia coli (STEC) is determined by a number of factors: the bacterial genome, the capacity of human societies to prevent foodborne epidemics, the medical condition of infected patients (in particular their hydration status, often compromised by severe diarrhea), and by our capacity to devise new therapeutic approaches, most specifically to combat the bacterial virulence factors, as opposed to our current strategies that essentially aim to palliate organ deficiencies. The last major outbreak in 2011 in Germany, which killed more than 50 people in Europe, was evidence that an effective treatment was still lacking. Herein, we review the current knowledge of STEC virulence, how societies organize the prevention of human disease, and how physicians treat (and, hopefully, will treat) its potentially fatal complications. In particular, we focus on STEC-induced hemolytic and uremic syndrome (HUS), where the intrusion of toxins inside endothelial cells results in massive cell death, activation of the coagulation within capillaries, and eventually organ failure.
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Affiliation(s)
- Adrien Joseph
- Department of Nephrology, AP-HP, Hôpital Tenon, F-75020 Paris, France; (A.J.); (C.R.)
| | - Aurélie Cointe
- Department of Microbiology, AP-HP, Hôpital Robert Debré, F-75019 Paris, France; (A.C.); (P.M.K.)
| | | | - Cédric Rafat
- Department of Nephrology, AP-HP, Hôpital Tenon, F-75020 Paris, France; (A.J.); (C.R.)
| | - Alexandre Hertig
- Department of Renal Transplantation, Sorbonne Université, AP-HP, Hôpital Pitié Salpêtrière, F-75013 Paris, France
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Nezam D, Morel P, Faguer S, Karras A, Aniort J, Titeca-Beauport D, Solignac J, Ducloux D, Rafik M, Carron P, Rafat C, Gobert P, Nochy D, Audard V, Maurier F, Martis N, Jourde-Chiche N, Régent A, Guillevin L, Terrier B. Impact de la biopsie rénale pour prédire la réponse aux échanges plasmatiques au cours des vascularites associées aux ANCA. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.057] [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: 10/25/2022]
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Mousseaux C, Dupont A, Rafat C, Ekpe K, Ghrenassia E, Kerhuel L, Ardisson F, Mariotte E, Lemiale V, Schlemmer B, Azoulay E, Zafrani L. Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients. Ann Intensive Care 2019; 9:133. [PMID: 31776814 PMCID: PMC6881488 DOI: 10.1186/s13613-019-0606-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/01/2019] [Accepted: 11/13/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Severe hypercalcemia (HCM) is a common reason for admission in intensive-care unit (ICU). This case series aims to describe the clinical and biological features, etiologies, treatments, and outcome associated with severe HCM. This study included all patients with a total calcemia above 12 mg/dL (3 mmol/L) admitted in two ICUs from January 2007 to February 2017. RESULTS 131 patients with HCM were included. HCM was related to hematologic malignancy in 58 (44.3%), solid tumors in 29 (22.1%), endocrinopathies in 16 (12.2%), and other causes in 28 (21.3%) patients. 108 (82.4%) patients fulfilled acute kidney injury (AKI) criteria. Among them, 25 (19%) patients required renal replacement therapy (RRT). 51 (38.9%) patients presented with neurological symptoms, 73 (55.7%) patients had cardiovascular manifestations, and 50 (38.1%) patients had digestive manifestations. The use of bisphosphonates (HR, 0.42; 95% CI, 0.27-0.67; P < 0.001) was the only treatment significantly associated with a decrease of total calcemia below 12 mg/dL (3 mmol/L) at day 5. ICU and Hospital mortality rates were, respectively, 9.9% and 21.3%. Simplified Acute Physiologic Score (SAPS II) (OR, 1.05; 95% CI 1.01-1.1; P = 0.03) and an underlying solid tumor (OR, 13.83; 95% CI 2.24-141.25; P = 0.01) were two independent factors associated with hospital mortality in multivariate analysis. CONCLUSIONS HCM is associated with high mortality rates, mainly due to underlying malignancies. The course of HCM may be complicated by organ failures which are most of the time reversible with early ICU management. Early ICU admission and prompt HCM management are crucial, especially in patients with an underlying solid tumor presenting with neurological symptoms.
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Affiliation(s)
- Cyril Mousseaux
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France.
| | - Axelle Dupont
- Biostatistics Department, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Cédric Rafat
- Nephrology Department, Tenon Hospital, Assistance Publique-Hopitaux de Paris, Paris Sorbonnes University, Paris, France
| | - Kenneth Ekpe
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Etienne Ghrenassia
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Lionel Kerhuel
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Fanny Ardisson
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Benoît Schlemmer
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France
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Rafat C, Luque Y. IdeS in anti-glomerular basement membrane disease: Is this the new deal? Kidney Int 2019; 96:1068-1070. [PMID: 31648697 DOI: 10.1016/j.kint.2019.08.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022]
Abstract
IdeS, a proteinase from Streptococcus pyogenes, cleaves IgG antibodies with a unique specificity. Herein, the authors report the dramatic efficacy of IdeS on the levels of anti-glomerular membrane autoantibodies in 3 three patients with Goodpasture disease refractory to standard therapy. The levels of anti-glomerular membrane autoantibodies were reduced to near-zero levels within 2 hours of the injection. However, all patients ultimately required permanent hemodialysis as a result of the late intervention in the course of the disease.
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Affiliation(s)
- Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France.
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Sorbonne Université, Inserm, UMR_S1155, F-75020, Paris, France
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48
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Affiliation(s)
- Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.,Sorbonne Université, Inserm, Paris, France
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Joseph A, Rafat C, Zafrani L, Mariani-Kurkdjian P, Veyradier A, Hertig A, Rondeau E, Mariotte E, Azoulay E. Early Differentiation of Shiga Toxin-Associated Hemolytic Uremic Syndrome in Critically Ill Adults With Thrombotic Microangiopathy Syndromes. Crit Care Med 2019; 46:e904-e911. [PMID: 29979220 DOI: 10.1097/ccm.0000000000003292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Thrombotic microangiopathy syndromes are a heterogeneous group of severe diseases that often require ICU admission. Prompt initiation of targeted therapies is required for atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, whereas there is no specific consensus therapy for Shiga toxin-associated hemolytic uremic syndrome. We sought to compare the characteristics of Shiga toxin-associated hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura patients at admission in the ICU to allow early differentiation of Shiga toxin-associated hemolytic uremic syndrome from other thrombotic microangiopathy syndromes and help to tailor initial treatment. DESIGN Retrospective cohort study. SETTING Two ICUs part of the French reference center for thrombotic microangiopathy syndromes. PATIENTS Adult patients presenting with features of thrombotic microangiopathy syndromes. Other causes than Shiga toxin-associated hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS From September 2003 to January 2017, 236 thrombotic microangiopathy syndrome patients were admitted, including 12 Shiga toxin-associated hemolytic uremic syndrome, 21 atypical hemolytic uremic syndrome, and 91 thrombotic thrombocytopenic purpura. Shiga toxin-associated hemolytic uremic syndrome patients were older than other thrombotic microangiopathy syndromes patients (64 yr [interquartile range, 50-72 yr] vs 42 yr [31-54 yr]; p = 0.007) and presented with more frequent digestive symptoms (92% vs 42%; p < 0.001), especially nonbloody diarrhea and vomiting. Biologically, Shiga toxin-associated hemolytic uremic syndrome patients displayed higher fibrinogen (490 mg/dL [460-540 mg/dL] vs 320 mg/dL [240-410 mg/dL]; p = 0.003) and creatinine levels (2.59 mg/dL [2.12-3.42 mg/dL] vs 1.26 mg/dL [0.61-1.90 mg/dL]; p < 0.001), and less marked anemia (hemoglobin level, 9.7 g/dL [8.7-11.9 g/dL] vs 7.7 g/dL [6.3-9.1 g/dL]; p < 0.001). Forty-two percent (n = 5) required renal replacement therapy, and 83% (n = 10) were treated with plasma exchange before the distinction from other thrombotic microangiopathy syndromes could be made. CONCLUSIONS Adult Shiga toxin-associated hemolytic uremic syndrome patients are older, present more frequently with digestive symptoms and display higher hemoglobin and fibrinogen levels than other thrombotic microangiopathy syndromes. However, overlap across the three thrombotic microangiopathy syndromes remains substantial, putting forward the need to implement early plasma therapy until thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome can be ruled out.
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Affiliation(s)
- Adrien Joseph
- Medical Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Cédric Rafat
- Department of Renal Intensive Care and Transplantation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France.,French Reference Center for Thrombotic MicroAngiopathies, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,French Reference Center for Thrombotic MicroAngiopathies, Paris, France.,Paris Diderot Sorbonne University, Paris, France
| | - Patricia Mariani-Kurkdjian
- National Associated Reference Laboratory for Escherichia coli, Microbiology Department, Hôpital Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Agnès Veyradier
- French Reference Center for Thrombotic MicroAngiopathies, Paris, France.,Paris Diderot Sorbonne University, Paris, France.,Hematology Department and Research Unit EA3518, Institute of Hematology, Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Hertig
- Department of Renal Intensive Care and Transplantation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France.,French Reference Center for Thrombotic MicroAngiopathies, Paris, France.,Sorbonne Universités, UPMC Université Paris 6, Paris, France
| | - Eric Rondeau
- Department of Renal Intensive Care and Transplantation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France.,French Reference Center for Thrombotic MicroAngiopathies, Paris, France.,Sorbonne Universités, UPMC Université Paris 6, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,French Reference Center for Thrombotic MicroAngiopathies, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,French Reference Center for Thrombotic MicroAngiopathies, Paris, France.,Paris Diderot Sorbonne University, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS) INSERM, Paris, France
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50
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Mousseaux C, Dobosziewicz H, Rafat C, Frochot V, Letavernier E, Mercadal L, Brocheriou I, Buob D, Mesnard L, Luque Y. Nouvelle approche sur le mécanisme de la toxicité rénale de l’amoxicilline : à propos de deux cas et un modèle expérimental. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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