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Imenez Silva PH, Pepin M, Figurek A, Gutiérrez-Jiménez E, Bobot M, Iervolino A, Mattace-Raso F, Hoorn EJ, Bailey MA, Hénaut L, Nielsen R, Frische S, Trepiccione F, Hafez G, Altunkaynak HO, Endlich N, Unwin R, Capasso G, Pesic V, Massy Z, Wagner CA. Animal models to study cognitive impairment of chronic kidney disease. Am J Physiol Renal Physiol 2024; 326:F894-F916. [PMID: 38634137 DOI: 10.1152/ajprenal.00338.2023] [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: 10/19/2023] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Mild cognitive impairment (MCI) is common in people with chronic kidney disease (CKD), and its prevalence increases with progressive loss of kidney function. MCI is characterized by a decline in cognitive performance greater than expected for an individual age and education level but with minimal impairment of instrumental activities of daily living. Deterioration can affect one or several cognitive domains (attention, memory, executive functions, language, and perceptual motor or social cognition). Given the increasing prevalence of kidney disease, more and more people with CKD will also develop MCI causing an enormous disease burden for these individuals, their relatives, and society. However, the underlying pathomechanisms are poorly understood, and current therapies mostly aim at supporting patients in their daily lives. This illustrates the urgent need to elucidate the pathogenesis and potential therapeutic targets and test novel therapies in appropriate preclinical models. Here, we will outline the necessary criteria for experimental modeling of cognitive disorders in CKD. We discuss the use of mice, rats, and zebrafish as model systems and present valuable techniques through which kidney function and cognitive impairment can be assessed in this setting. Our objective is to enable researchers to overcome hurdles and accelerate preclinical research aimed at improving the therapy of people with CKD and MCI.
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Affiliation(s)
- Pedro H Imenez Silva
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Marion Pepin
- Institut National de la Santé et de la Recherche Médicale U-1018 Centre de Recherche en Épidémiologie et Santé des Population, Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Department of Geriatrics, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris Université Paris-Saclay, Paris, France
| | - Andreja Figurek
- Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Eugenio Gutiérrez-Jiménez
- Center for Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique-Hopitaux de Marseille, and INSERM 1263, Institut National de la Recherche Agronomique 1260, C2VN, Aix-Marseille Universitaire, Marseille, France
| | - Anna Iervolino
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Naples, Italy
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Matthew A Bailey
- Edinburgh Kidney, Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Lucie Hénaut
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Rikke Nielsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Naples, Italy
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Hande O Altunkaynak
- Department of Pharmacology, Gulhane Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Nicole Endlich
- Department of Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany
| | - Robert Unwin
- Department of Renal Medicine, Royal Free Hospital, University College London, London, United Kingdom
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Vesna Pesic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ziad Massy
- Centre for Research in Epidemiology and Population Health, INSERM UMRS 1018, Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Villejuif, France
- Department of Nephrology, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris Université Paris-Saclay, Paris, France
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Maisons V, Duval A, Mesnard L, Frimat M, Fakhouri F, Grangé S, Servais A, Cartery C, Fauchier L, Coppo P, Titeca-Beauport D, Fage N, Delmas Y, Quérard AH, Seret G, Bobot M, Le Quintrec M, Ville S, von Tokarski F, Chauvet S, Wynckel A, Martins M, Schurder J, Barbet C, Sautenet B, Gatault P, Caillard S, Vuiblet V, Halimi JM. Assessment of epidemiology and outcomes of adult patients with kidney-limited thrombotic microangiopathies. Kidney Int 2024; 105:1100-1112. [PMID: 38431217 DOI: 10.1016/j.kint.2024.02.014] [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: 11/12/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Thrombotic microangiopathies (TMA) are usually associated with hematological features (RH-TMA). The epidemiology of TMA limited to kidneys (RL-TMA) is unclear Therefore, patients with TMA and native kidney biopsies were identified during 2009-2022 in 20 French hospitals and results evaluated. RL-TMA was present in 341/757 (45%) patients and associated with lower creatinine levels (median 184 vs 346 μmol/L) than RH-TMA. RL-TMA resulted from virtually all identified causes, more frequently from anti-VEGF treatment and hematological malignancies but less frequently from shigatoxin-associated hemolytic uremic syndrome (HUS), systemic sclerosis, gemcitabine and bacterial infection, and even less frequently when three or more causes/triggers were combined (RL-TMA: 5%; RH-TMA: 12%). RL-TMA was associated with significantly lower major cardiovascular events (10% vs 20%), kidney replacement therapy (23% vs 43%) and death (12% vs 20%) than RH-TMA during follow-up (median 28 months). Atypical HUS (aHUS) was found in 326 patients (RL-TMA: 43%, RH-TMA: 44%). Among the 69 patients with proven complement-mediated aHUS, eculizumab (anti-C5 therapy) was used in 43 (62%) (RL-TMA: 35%; RH-TMA: 71%). Among the 257 other patients with aHUS, including 51% with RL-TMA, eculizumab was used in 29 but with unclear effects of this treatment. Thus, RL-TMA represents a very high proportion of patients with TMA and results from virtually all known causes of TMA and includes 25% of patients with complement-mediated aHUS. Adverse outcomes of RL-TMA are lower compared to RH-TMA but remain significant. Anti-C5 therapy was rarely used in RL-TMA, even in proven complement-mediated aHUS, and its effects remain to be assessed.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie, CHU de Tours, Tours, France; U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France
| | - Anna Duval
- Service de Néphrologie, CHU de Strasbourg, Strasbourg, France
| | | | - Marie Frimat
- Service de Néphrologie, CHU de Lille, Lille, France
| | - Fadi Fakhouri
- Service de Néphrologie, CHU Vaudois, Lausanne, Switzerland
| | | | - Aude Servais
- Service de Néphrologie, APHP Hopital Necker, Paris, France
| | - Claire Cartery
- Service de Néphrologie, CH de Valenciennes, Valenciennes, France
| | | | - Paul Coppo
- Service d'Hématologie, Centre de référence pour les microangiopathies thrombotiques (CNR-MAT), APHP Hopital Saint-Antoine, Paris, France
| | | | - Nicolas Fage
- Service de Néphrologie, Département de médecine intensive reanimation-médecine hyperbare, CHU d'Angers, Angers, France
| | - Yahsou Delmas
- Service de Néphrologie, CHU de Bordeaux, Bordeaux, France
| | | | - Guillaume Seret
- Service de Néphrologie, Pole Santé Sud Echo Le Mans, Le Mans, France
| | - Mickaël Bobot
- Service de Néphrologie, CHU de Marseille; Aix, Marseille Université, INSERM 1263, INRAE 1260, C2VN, CERIMED, Marseille, France
| | | | - Simon Ville
- Service de Néphrologie, CHU de Nantes, Nantes, France
| | | | - Sophie Chauvet
- Service de Néphrologie, APHP Hopital Européen Georges Pompidou, Paris, France
| | | | - Manon Martins
- Service de Néphrologie, CHU de Rennes, Rennes, France
| | - Juliet Schurder
- Service de Néphrologie, CH de Saint-Malo, Saint-Malo, France
| | | | | | - Philippe Gatault
- Service de Néphrologie, CHU de Tours, U1327, INSERM, ISCHEMIA, Université de Tours, Tours, France
| | - Sophie Caillard
- U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France
| | - Vincent Vuiblet
- Service de Pathologie, Institut d'Intelligence Artificielle en Santé, CHU de Reims et Université de Reims Champagne Ardenne, Reims, France
| | - Jean-Michel Halimi
- Service de Néphrologie, CHU de Tours, U1327, INSERM, ISCHEMIA, Université de Tours, Tours, France.
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Maisons V, Lanot A, Luque Y, Sautenet B, Esteve E, Guillouet E, François H, Bobot M. Simulation-based learning in nephrology. Clin Kidney J 2024; 17:sfae059. [PMID: 38680455 PMCID: PMC11053359 DOI: 10.1093/ckj/sfae059] [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: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Simulation is a technique to replace and amplify real experiences with guided ones that evoke or replicate substantial aspects of the real world in a fully interactive fashion. In nephrology (a particularly complex specialty), simulation can be used by patients, nurses, residents, and attending physicians alike. It allows one to learn techniques outside the stressful environment of care such as central venous catheter placement, arteriovenous fistula management, learning about peritoneal dialysis, or performing a kidney biopsy. Serious games and virtual reality are emerging methods that show promise. Simulation could also be important in relational aspects of working in a team or with the patient. The development of simulation as a teaching tool in nephrology allows for maintaining high-quality training for residents, tailored to their future practice, and minimizing risks for patients. Additionally, this education helps nephrologists maintain mastery of technical procedures, making the specialty attractive to younger generations. Unfortunately, the inclusion of simulation training programmes faces occasional logistical or funding limitations that universities must overcome with the assistance and innovation of teaching nephrologists. The impact of simulation-based teaching on clinical outcomes needs to be investigated in clinical studies.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie, CHU de Tours, Tours, France
- U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France, INI-CRCT, France
| | - Antoine Lanot
- Normandie University, Unicaen, CHU de Caen Normandie, Nephrology, Côte de Nacre Caen, France
- “ANTICIPE” U1086 INSERM-UCN, Centre Francois Baclesse, 3 Av. du General Harris, Caen, France
| | - Yosu Luque
- Soins Intensifs Néphrologiques Rein Aigu, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM UMR_S1155, CORAKID, Hôpital Tenon, Paris, France
| | - Benedicte Sautenet
- Service de Néphrologie, CHU de Tours, Tours, France
- U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France, INI-CRCT, France
| | - Emmanuel Esteve
- Sorbonne Université, INSERM UMR_S1155, CORAKID, Hôpital Tenon, Paris, France
- Service Néphrologie et Dialyses, Département de Néphrologie, Hôpital Tenon, APHP, Paris, France
| | - Erwan Guillouet
- Normandie University, Unicaen, CHU de Caen Normandie, Nephrology, Côte de Nacre Caen, France
- NorSimS Simulation Center, Caen University Hospital, Caen, France
| | - Hélène François
- Sorbonne Université, INSERM UMR_S1155, CORAKID, Hôpital Tenon, Paris, France
- Service de Transplantation rénale-Néphrologie, Département de néphrologie, Hôpital Pitié Salpétrière, APHP, Paris, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France
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Bobot M, Hak JF, Casolla B, Dehondt JD, Burtey S, Doche E, Suissa L. Acute and chronic kidney dysfunction and prognosis following thrombectomy for ischemic stroke. Am J Nephrol 2024:000536493. [PMID: 38499002 DOI: 10.1159/000536493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/10/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Patients with Chronic Kidney Disease (CKD) have an increased risk of stroke and CKD seems associated with worse outcome after a stroke. The main objective of our study RISOTTO was to evaluate the influence of CKD and Acute Kidney Injury (AKI) on the clinical outcome and mortality of ischemic stroke patients after thrombolysis and/or thrombectomy. METHODS This multicenter cohort study included patients in the acute phase of ischemic stroke due to a large artery occlusion managed by thrombectomy. Functional outcome at 3 months was assessed by modified Rankin Scale (mRS). RESULTS 280 patients were included in the analysis. Fifty-nine patients (22.6%) had CKD. At 3 months, CKD was associated with similar functional prognosis (mRS 3-6: 50.0% vs. 41.7%, p=0.262) but higher mortality: 24.2% vs. 9.5%, p=0.004. In univariate analysis, patients with CKD had a higher burden of white matter hyperintensities (Fazekas 1.7±0.8 vs. 1.0±0.8, p=0.002), lower initial infarcted volume with equivalent severity, and lower recanalization success (86.4% vs. 97.0%, p=0.008) compared to non-CKD patients. Forty-seven patients (20.0%) developed AKI. AKI was associated with poorer 3-month functional outcome (mRS 3-6: 63.8% vs. 49.0%, p=0.002) and mortality: 23.4% vs. 7.7%, p=0.002. In multivariate analysis, AKI appeared as an independent risk factor for poor functional outcome (mRS 3-6: adjOR 2.79 [1.11-7.02], p=0.029) and mortality: adjOR 2.52 [1.03-6.18], p=0.043 at 3 months, while CKD was not independently associated with 3-month mortality and poor neurological outcome. CONCLUSION AKI is independently associated with poorer functional outcome and increased mortality at 3 months. CKD was not an independent risk factor for 3-month mortality or poor functional prognosis.
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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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de Laforcade L, Bobot M, Boffa JJ, Bovy C, Cartery C, Chauveau D, Gueutin V, Isnard-Bagnis C, Jourde Chiche N, Karras A, Meftah A, Müller C, Sié P, Stehlé T, Vrigneaud L, Vuiblet V, Guerrot D. Kidney biopsy for the diagnosis and treatment of kidney diseases. Recommendations from the French speaking Society of Nephrology (SFNDT) and French National Authority for Health (HAS) 2022. Nephrol Ther 2024; 20:61-80. [PMID: 38379375 DOI: 10.1684/ndt.2024.68] [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] [Indexed: 02/22/2024]
Abstract
Kidney Biopsy (KB) is a crucial diagnostic tool in the field of renal diseases and is routinely performed in nephrology departments. A previous survey conducted by the Société Francophone de Néphrologie Dialyse Transplantation (SFNDT) revealed significant disparities in clinical practices, sometimes conflicting with the existing literature and recently published recommendations. In response, the SFNDT wished to promote the development of best practice guidelines, under the auspices of the French National Authority for Health (HAS), to establish a standardized framework for performing kidney biopsies in France.
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Affiliation(s)
- Louis de Laforcade
- Service de néphrologie-dialyse, Centre hospitalier Robert Boulin, Libourne, France
| | - Mickaël Bobot
- Centre de néphrologie et transplantation rénale, Hôpital de la Conception, AP-HM, Marseille, France
- C2VN, Aix-Marseille Université, Inserm 1263, INRAE 1260, Marseille, France
| | - Jean-Jacques Boffa
- Inserm UMRS 1155, département de néphrologie, Sorbonne université, Hôpital Tenon, AP-HP, Paris, France
| | - Christophe Bovy
- Service de néphrologie, dialyse, transplantation, CHU Liège, Belgique
| | - Claire Cartery
- Centre hospitalier de Valenciennes, service de néphrologie et médecine interne, Valencienne, France
| | - Dominique Chauveau
- Département de néphrologie et transplantation d’organes, CHU Rangueil et Université Toulouse-3, Toulouse, France
| | - Victor Gueutin
- Service de néphrologie-dialyse, Centre hospitalier Monod, Flers, France
- Service de néphrologie, dialyse et transplantation, CHU Caen, France
| | | | - Noémie Jourde Chiche
- Centre de néphrologie et transplantation rénale, Hôpital de la Conception, AP-HM, Marseille, France
- C2VN, Aix-Marseille Université, Inserm 1263, INRAE 1260, Marseille, France
| | - Alexandre Karras
- Hôpital européen Georges Pompidou, service de néphrologie, AP-HP, Université Paris Cité, Paris, France
| | - Aimèle Meftah
- Centre d’hémodialyse des Alpes, Hôpital de Manosque, Manosque France
| | - Clotilde Müller
- Service de néphrologie et dialyse, Clinique Sainte-Anne, Strasbourg, France
| | - Pierre Sié
- Laboratoire d’hématologie, Hôpital Rangueil, Toulouse France
| | - Thomas Stehlé
- Université Paris Est Créteil, Inserm U955, Institut Mondor de recherche biomédicale, Créteil, France
- Hôpitaux Universitaires Henri Mondor, AP-HP, service de néphrologie et transplantation, Fédération hospitalo-universitaire « Innovative therapy for immune disorders », Créteil, France
| | | | - Vincent Vuiblet
- Département de néphro-pathologie, Unité de pathologie, CHU Reims, France
| | - Dominique Guerrot
- Service de néphrologie-dialyse-transplantation, CHU Rouen, France ; Normandie Univ, UNIROUEN, Inserm U1096, Rouen, France
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Bobot M, Lemoine S. The highlights in nephrology in 2023. Nephrol Ther 2024; 20:1-9. [PMID: 38345208 DOI: 10.1684/ndt.2024.67] [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] [Indexed: 02/15/2024]
Abstract
This article aims to summarize the “Quoi de neuf en néphrologie?” session held at the 2023 SFNDT Congress in Liège and sessions focused on updates regarding IgA nephropathy (NIgA) and ANCA-associated vasculitis. The agenda for the nephrology “Quoi de neuf en néphrologie?” session this year was to review key publications from non-nephrology journals, discussing topics such as nephroprotection, treatment of glomerulopathies (IgA and APOL1), clinical trials on arterial hypertension, urinary lithiasis, and other areas of renal physiology, including glomerular filtration rate estimation.
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Affiliation(s)
- Mickaël Bobot
- Centre de néphrologie et transplantation rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, C2VN, Inserm 1263, INRAE 1260, CERIMED, Marseille, France
| | - Sandrine Lemoine
- Hôpital Edouard Herriot, service de néphrologie, dialyse, HTA et exploration fonctionnelle rénale, Hospices civils de Lyon, MAREGE, Centre de référence maladies rénales rares, Lyon, France
- Inserm CARMEN 1060, Université de Lyon, Lyon, France
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Lefevre F, Mousseaux C, Bobot M. [What's new in hyperkalemia management?]. Rev Med Interne 2024:S0248-8663(24)00004-3. [PMID: 38220492 DOI: 10.1016/j.revmed.2024.01.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
Hyperkalemia is common in everyday clinical practice, and is a major risk factor for mortality. It mainly affects patients with chronic renal failure (CKD), diabetes or receiving treatment with inhibitors of the renin-angiotensin-aldosterone system (iRAAS). Therapeutic management aims not only to avoid the complications of hyperkalemia, but also to avoid discontinuation of cardio- and nephroprotective treatments such as iRAAS. The use of polystyrene sulfonate, widely prescribed, is often limited by patient acceptability. Recent data have cast doubt on its safety, particularly in terms of digestive tolerance. Two new potassium exchange molecules have appeared on the market: patiromer and zirconium sulfonate. Their value in clinical practice, and their acceptability in the event of prolonged prescription, remain to be demonstrated. The combination of a thiazide diuretic or an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) with iRAAS therapy in CKD, may also improve control of kalemia. At present, there are no recommendations for the positioning of the various hypokalemic treatments. The choice of these treatments must be adapted to the patient's pathologies and consider the other expected effects of these molecules.
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Affiliation(s)
- F Lefevre
- Centre de néphrologie et transplantation rénale, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - C Mousseaux
- Sorbonne université, CORAKID, Inserm UMR_S1155, hôpital Tenon, Paris, France; Soins intensifs néphrologiques-Rein Aigu, hôpital Tenon, AP-HP, Paris, France
| | - M Bobot
- Centre de néphrologie et transplantation rénale, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Aix-Marseille université, C2VN, Inserm 1263, INRAE 1260, CERIMED, Marseille, France.
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Bobot M. Cognitive impairment and the blood-brain barrier in chronic kidney disease: role of the uremic toxins. Nephrol Ther 2023; 19:607-615. [PMID: 38059844 DOI: 10.1684/ndt.2023.51] [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] [Indexed: 12/08/2023]
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of cognitive disorders, presenting as vascular dementia, compared with the general population. These cognitive disorders occur early during the course of the kidney disease and evolve in parallel with the decline in glomerular filtration rate. They affect 30 to 80 % of patients with stage 5 CKD. Kidney transplantation only partially improves cognitive impairment. In this narrative review, we summarize the epidemiology and recent clinical and experimental data on cognitive impairment in CKD and discuss the potential specific mechanisms. Among the factors associated with cognitive impairment, the accumulation of uremic toxins such as indoxyl sulfate appears to be a specific risk factor for cognitive decline. These toxins have an endothelial toxicity that can disrupt the cerebral endothelium. The rupture of the blood-brain barrier (BBB) is a mechanism implicated in several neurodegenerative pathologies and systemic diseases with cerebral tropism. Recent experimental findings in CKD indicate that disruption of the BBB appears to be an important mechanism behind cognitive impairment in CKD. In murine models of CKD, increased BBB permeability is linked to memory impairment and aryl hydrocarbon receptor activation following accumulation of circulating indoxyl sulfate. This disruption of the BBB could also have harmful consequences for stroke susceptibility and drug neurotoxicity in CKD patients.
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Affiliation(s)
- Mickaël Bobot
- Centre de néphrologie et transplantation rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, Inserm 1263, INRAE 1260, C2VN, CERIMED, Marseille, France
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Mallet J, Billiet PA, Scarton M, Benichou N, Bobot M, Chaibi K, Hertig A, Hadchouel J, Dreyfuss D, Gaudry S, Placier S. A model of hemodialysis after acute kidney injury in rats. Intensive Care Med Exp 2023; 11:97. [PMID: 38117344 PMCID: PMC10733261 DOI: 10.1186/s40635-023-00583-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent among critically ill patients. Renal replacement therapy (RRT) is often required to deal with severe complications of AKI. This technique is however associated with side effects such as hemodynamic instability and delayed renal recovery. In this study, we aimed to describe a novel model of hemodialysis in rats with AKI and depict a dialysis membrane performance. METHODS Eighteen Sprague-Dawley rats received 0.75% adenine-rich diet to induce AKI. After 2 weeks, nine underwent an arterio-venous extracorporeal circulation (ECC) (ECC group) for 2 h without a dialysis membrane on the circuit and nine received a hemodialysis session (HD group) for 2 h with an ECC circuit. All rats were hemodynamically monitored, and glomerular filtration rate (GFR) was measured by transcutaneous fluorescence after the injection of FITC-Sinistrin. Blood samples were collected at different time points to assess serum creatinine and serum urea concentrations and to determine the Kt/V. Sinistrin concentration was also quantified in both plasma and dialysis effluent. RESULTS After 2 weeks of adenine-rich diet, rats exhibited a decrease in GFR. Both serum urea and serum creatinine concentrations increased in the ECC group but remained stable in the HD group. We found no significant difference in serum creatinine and serum urea concentrations between groups. At the end of experiments, mean serum urea was 36.7 mmol/l (95%CI 19.7-46.9 mmol/l) and 23.6 mmol/l (95%CI 15.2-33.5 mmol/l) in the ECC and HD groups, respectively (p = 0.15), and mean serum creatinine concentration was 158.0 µmol/l (95%CI 108.1-191.9 µmol/l) and 114.0 µmol/l (95%CI 90.2-140.9 µmol/l) in the ECC and HD groups, respectively (p = 0.11). The Kt/V of the model was estimated at 0.23. Sinistrin quantity in the ultrafiltrate raised steadily during the dialysis session. After 2 h, the median quantity was 149.2 µg (95% CI 99.7-250.3 µg). CONCLUSIONS This hemodialysis model is an acceptable compromise between the requirement of hemodynamic tolerance which implies reducing extracorporeal blood volume (using a small dialyzer) and the demonstration that diffusion of molecules through the membrane is achieved.
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Affiliation(s)
- J Mallet
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Intensive Care Unit, Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - P-A Billiet
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - M Scarton
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique, Colombes, France
| | - N Benichou
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - M Bobot
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
- Aix Marseille Univ, INSERM 1632, INRAE 1260, C2VN, CERIMED, Marseille, France
| | - K Chaibi
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Intensive Care Unit, Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - A Hertig
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - J Hadchouel
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - D Dreyfuss
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique, Colombes, France
- Université de Paris, Paris, France
| | - S Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Intensive Care Unit, Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France.
- Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.
| | - S Placier
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
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Lafargue MC, Bobot M, Rennke HG, Essig M, Carre M, Mercadal L, Farhi J, Sakhi H, Comont T, Golbin L, Isnard P, Chemouny J, Cambier N, Laribi K, Selamet U, Riella LV, Fain O, Adès L, Fenaux P, Cohen C, Mekinian A. Chronic Myelomonocytic Leukemia Patients With Lysozyme Nephropathy and Renal Infiltration Display Markers of Severe Disease. Kidney Int Rep 2023; 8:2733-2741. [PMID: 38106568 PMCID: PMC10719588 DOI: 10.1016/j.ekir.2023.09.005] [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: 06/30/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Chronic myelomonocytic leukemia (CMML) is a hematologic disorder that is an overlap syndrome between myelodysplastic syndromes and myeloproliferative neoplasms, and can be associated with autoimmune and inflammatory diseases. This study aimed to describe kidney involvement in patients with CMML, their treatments, and outcomes. Methods We conducted a French and American multicenter retrospective study in 15 centers, identifying patients with CMML with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities. Results Sixteen patients (males, n = 14; median age 76.5 years [71.9-83]) developed a kidney disease 6 months [1.6-25.6] after the diagnosis of CMML. At the time of kidney disease diagnosis, median urinary protein-to-creatinine ratio was 2 g/g [1.25-3.4], and median serum creatinine was 2.26 mg/dl [1.46-2.68]. Fourteen patients (87.5%) underwent a kidney biopsy, and the 2 main pathological findings were lysozyme nephropathy (56%) and renal infiltration by the CMML (37.5%). Ten patients received a new treatment following the CMML-associated kidney injury. Among patients with monitored kidney function, and after a median follow-up of 15 months [9.9-34.9], 4 patients had CKD stage 3, 4 had CKD stage 4, 1 had an end-stage kidney disease. In our patient series, 2 patients evolved to an acute myeloid leukemia (AML), and 5 died. Compared with 116 CMML controls, patients who had a kidney involvement had a higher monocyte count (P < 0.001), had more CMML-1 (P = 0.005), were more susceptible to develop an AML (P = 0.02), and were more eligible to receive a specific hematologic treatment, with hydroxyurea, or hypomethylating agents (P < 0.001), but no survival difference was seen between the 2 groups (P = 0.6978). Conclusion In this cohort of patients with CMML with a kidney injury, the 2 most frequent renal complications were lysozyme-induced nephropathy and renal infiltration by the CMML. Kidney involvement should be closely monitored in patients with CMML.
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Affiliation(s)
- Marie-Camille Lafargue
- Department of Nephrology, Tenon’s Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, 13005, Marseille, France
| | - Helmut G. Rennke
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Essig
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, Université Paris-Saclay, Paris, France
| | - Martin Carre
- Service d'Hématologie, Centre Hospitalier Universitaire, Grenoble, France
| | - Lucile Mercadal
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière, Paris, France
| | | | - Hamza Sakhi
- Department of Nephrology and renal transplantation, Necker’s Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Thibault Comont
- Department of Internal Medicine, Institut universitaire du cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Léonard Golbin
- Service de Néphrologie, Dialyse et Transplantation Rénale, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Pierre Isnard
- Department of Pathology, Université Paris Cité, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jonathan Chemouny
- Hématologie Clinique, Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | - Umut Selamet
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leonardo V. Riella
- Center of Transplantation Sciences, Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Olivier Fain
- Hôpital Saint-Antoine, Service de Médecine Interne et de l'Inflammation-(DHU i2B), F-75012, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Adès
- Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Pierre Fenaux
- Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Camille Cohen
- INSERM U1151 « mechanisms and therapeutic strategies of chronic kidney diseases », Hôpital Necker, Université Paris Cité, Paris, France; Service de Néphrologie et Transplantation rénale, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Arsène Mekinian
- Hôpital Saint-Antoine, Service de Médecine Interne et de l'Inflammation-(DHU i2B), F-75012, Assistance Publique-Hôpitaux de Paris, Paris, France
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Liabeuf S, Pešić V, Spasovski G, Maciulaitis R, Bobot M, Farinha A, Wagner CA, Unwin RJ, Capasso G, Bumblyte IA, Hafez G. Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor. Clin Kidney J 2023; 16:2365-2377. [PMID: 38045996 PMCID: PMC10689135 DOI: 10.1093/ckj/sfad241] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 12/05/2023] Open
Abstract
People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood-brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics.
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Affiliation(s)
- Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Vesna Pešić
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Goce Spasovski
- Department of Nephrology, Clinical Centre “Mother Theresa”, Saints Cyril and Methodius University, Skopje, North Macedonia
| | - Romaldas Maciulaitis
- Department of Nephrology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Physiology and Pharmacology, Faculty of Medicines, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mickaël Bobot
- Aix-Marseille University, Department of Nephrology, AP-HM, La Conception Hospital, Marseille, France; C2VN Laboratory, Inserm 1263, INRAE 1260, Aix-Marseille University, Marseille, France
| | - Ana Farinha
- Department of Nephrology, Hospital de Vila Franca de Xira, Lisbon, Portugal
| | - Carsten A Wagner
- Institute of Physiology, University of Zürich, Zurich, Switzerland
| | - Robert J Unwin
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Giovambattista Capasso
- Department of Translantional Medical Sciences, University of Campania Luigi Vanvitelli , Naples, Italy
- Biogem Research Institute , Ariano Irpino, Italy
| | - Inga Arune Bumblyte
- Department of Nephrology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
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13
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Bobot M, Suissa L, Hak JF, Burtey S, Guillet B, Hache G. Kidney disease and stroke: epidemiology and potential mechanisms of susceptibility. Nephrol Dial Transplant 2023; 38:1940-1951. [PMID: 36754366 DOI: 10.1093/ndt/gfad029] [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: 11/25/2022] [Indexed: 02/10/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of both ischaemic and haemorrhagic stroke compared with the general population. Both acute and chronic kidney impairment are independently associated with poor outcome after the onset of a stroke, after adjustment for confounders. End-stage kidney disease (ESKD) is associated with a 7- and 9-fold increased incidence of both ischaemic and haemorrhagic strokes, respectively, poorer neurological outcome and a 3-fold higher mortality. Acute kidney injury (AKI) occurs in 12% of patients with stroke and is associated with a 4-fold increased mortality and unfavourable functional outcome. CKD patients seem to have less access to revascularisation techniques like thrombolysis and thrombectomy despite their poorer prognosis. Even if CKD patients could benefit from these specific treatments in acute ischaemic stroke, their prognosis remains poor. After thrombolysis, CKD is associated with a 40% increased risk of intracerebral haemorrhage (ICH), a 20% increase in mortality and poorer functional neurological outcomes. After thrombectomy, CKD is not associated with ICH but is still associated with increased mortality, and AKI with unfavourable outcome and mortality. The beneficial impact of gliflozins on the prevention of stroke is still uncertain. Non-traditional risk factors of stroke, like uraemic toxins, can lead to chronic cerebrovascular disease predisposing to stroke in CKD, notably through an increase in the blood-brain barrier permeability and impaired coagulation and thrombosis mechanisms. Preclinical and clinical studies are needed to specifically assess the impact of these non-traditional risk factors on stroke incidence and outcomes, aiming to optimize and identify potential therapeutic targets.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
| | - Laurent Suissa
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- Unité Neurovasculaire/Stroke Center, Hôpital de la Timone, AP-HM, Marseille, France
| | - Jean-François Hak
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiologie, Hôpital de la Timone, AP-HM, Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
| | - Benjamin Guillet
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiopharmacie, AP-HM, Marseille, France
| | - Guillaume Hache
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Pharmacie, Hôpital de la Timone, AP-HM, Marseille, France
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14
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Jourde-Chiche N, Bobot M, Burtey S, Chiche L, Daugas E. Weaning Maintenance Therapy in Lupus Nephritis: For Whom, When, and How? Kidney Int Rep 2023; 8:1481-1488. [PMID: 37547513 PMCID: PMC10403675 DOI: 10.1016/j.ekir.2023.05.012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023] Open
Abstract
Lupus nephritis (LN) is one of the main determinants of the severity of systemic lupus erythematosus (SLE). LN flares can lead to organ damage with chronic kidney disease (CKD) or even end-stage kidney disease (ESKD) and impair patients' survival. The "treat-to-target" strategy, which aims at obtaining and maintaining remission or low disease activity of SLE to alleviate symptoms and prevent organ damage, also refers to the control of residual activity in the kidney. But damage in SLE can also come from treatments, and toxicities related to long-term use of treatments should be prevented. This may contribute to the frequent nonadherence in patients with SLE. The de-escalation or even weaning of treatments whenever possible, or "think-to-untreat" (T2U) strategy, is to be considered in patients with LN. This possibility of treatment weaning in LN was explored in retrospective cohorts, on the basis of long-term clinical remission. It was also proposed prospectively with a kidney-biopsy-based approach, combining clinical and pathologic remission to secure treatment weaning. The WIN-Lupus trial was the first randomized controlled trial comparing the continuation to the discontinuation of maintenance immunosuppressive therapy (IST) after 2 to 3 years in patients with LN in remission. It showed a higher risk of severe SLE flares in patients who discontinued treatment, but also a possibility of weaning without flare in some patients, who need to be better identified. We propose here a narrative review of the available literature on the weaning of treatment in LN and discuss how to secure a T2U strategy.
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Affiliation(s)
- Noémie Jourde-Chiche
- Aix-Marseille Université, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, CHU Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Mickaël Bobot
- Aix-Marseille Université, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, CHU Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
- Aix-Marseille Université, CERIMED, Marseille, France
| | - Stéphane Burtey
- Aix-Marseille Université, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, CHU Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Laurent Chiche
- Hôpital Européen de Marseille, Service de Médecine interne, Marseille, France
| | - Eric Daugas
- AP-HP, Service de Néphrologie, Hôpital Bichat, Paris, France
- Université Paris Cité, INSERM U1149, Paris, France
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15
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Bureau C, Jamme M, Schurder J, Bobot M, Robert T, Couturier A, Karras A, Halimi JM, Bellenfant X, Rondeau E, Mesnard L. Nephrosclerosis in young patients with malignant hypertension. Nephrol Dial Transplant 2023; 38:1848-1856. [PMID: 36477902 DOI: 10.1093/ndt/gfac324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Nephrosclerosis is one of the histopathological consequences of severe or malignant hypertension (MH), some of the pathophysiology of which has been extrapolated from essential polygenetic arterial hypertension. Despite our recent description of unsuspected ciliopathies with MH, causes of MH in young patients with severe renal impairment are poorly understood. METHODS To refine and better describe the MH phenotype, we studied clinical and prognostic factors in young patients receiving a kidney biopsy following their first episode of MH. Patients were identified retrospectively and prospectively from eight centres over a 35-year period (1985-2020). Keywords were used to retrospectively enrol patients irrespective of lesions found on renal biopsy. RESULTS A total of 114 patients were included, 77 (67%) of whom were men, average age 34 years, 35% Caucasian and 34% African origin. An isolated clinical diagnosis of severe nephrosclerosis was suggested in only 52% of cases, with 24% primary glomerulopathies. Only 7% of patients had normal renal function at diagnosis, 25% required emergency dialysis and 21% were eventually transplanted. Mortality was 1% at the last follow-up. Independent prognostic factors significantly associated with renal prognosis (6-month dialysis) and predictive of end-stage renal disease were serum creatinine on admission {odds ratio [OR] 1.56 [95% confidence interval (CI) 1.34-1.96], P < .001} and renal fibrosis >30% [OR 10.70 (95% CI 1.53-112.03), P = .03]. Astonishingly, the presence of any thrombotic microangiopathy lesion on renal biopsy was an independent, protective factor [OR 0.14 (95% CI 0.02-0.60), P = .01]. The histopathological hallmark of nephrosclerosis was found alone in only 52% of study patients, regardless of ethnicity. CONCLUSIONS This suggests that kidney biopsy might be beneficial in young patients with MH.
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Affiliation(s)
- Côme Bureau
- Assistance Publique - Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, APHP Sorbonne Université, Hôpital Tenon, Paris, France
- French Intensive Care Renal Network, Marseille France
| | - Matthieu Jamme
- French Intensive Care Renal Network, Marseille France
- INSERM U1018, Centre de recherche en épidémiologie et santé des populations, Equipe "Rein et Cœur", Université Paris Saclay, Villejuif, France
- Ramsay Générale de Santé, Réanimation polyvalente, Hôpital privé de l'Ouest Parisien, Trappes, France
| | - Juliet Schurder
- Assistance Publique - Hôpitaux de Paris, Néphrologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Mickaël Bobot
- French Intensive Care Renal Network, Marseille France
- Centre de néphrologie et transplantation rénale, Hôpital de la conception AP-HM Marseille, Marseille, France
| | - Thomas Robert
- French Intensive Care Renal Network, Marseille France
- Centre de néphrologie et transplantation rénale, Hôpital de la conception AP-HM Marseille, Marseille, France
| | - Aymeric Couturier
- Assistance Publique - Hôpitaux de Paris, Néphrologie, Hôpital Ambroise Paré, Boulogne, France
| | - Alexandre Karras
- Assistance Publique - Hôpitaux de Paris, Néphrologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Michel Halimi
- French Intensive Care Renal Network, Marseille France
- Centre Hospitalier Régional Universitaire de Tours, Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Tours, France, EA4245, Université de Tours, Cardiovascular and Renal Clinical Trialists
| | - Xavier Bellenfant
- French Intensive Care Renal Network, Marseille France
- Centre Hospitalier Intercommunal André Grégoire, Hémodialyse et Néphrologie, Montreuil, France
| | - Eric Rondeau
- Assistance Publique - Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, APHP Sorbonne Université, Hôpital Tenon, Paris, France
- French Intensive Care Renal Network, Marseille France
- INSERM UMR1155, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Laurent Mesnard
- Assistance Publique - Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, APHP Sorbonne Université, Hôpital Tenon, Paris, France
- French Intensive Care Renal Network, Marseille France
- INSERM UMR1155, Sorbonne Université, Hôpital Tenon, Paris, France
- CNR-MAT, APHP Sorbonne Université, Paris, France
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16
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Mousseaux C, Arrestier R, Chaibi K, Braconnier A, Hocine A, Lanot A, Serre J, Bobot M. Management of severe hypercalcemia: results of the French-speaking physicians' practice survey. Nephrol Dial Transplant 2023; 38:1571-1573. [PMID: 36690350 DOI: 10.1093/ndt/gfad018] [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: 11/10/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Cyril Mousseaux
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, AP-HP, Paris, France.,INSERM UMR_S1155, CoRaKID, Hôpital Tenon, Paris, France.,Faculté de Médecine, Sorbonne Université, Paris, France
| | - Romain Arrestier
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Créteil, France
| | - Khalil Chaibi
- INSERM UMR_S1155, CoRaKID, Hôpital Tenon, Paris, France.,Faculté de Médecine, Sorbonne Université, Paris, France.,Service de Réanimation médico-chirurgicale, AP-HP, Hôpital Avicenne, Bobigny, France
| | - Antoine Braconnier
- Service de Néphrologie-Dialyse-Transplantation, Hôpital Maison Blanche, Reims, France
| | - Aldjia Hocine
- Service de Néphrologie, Clinique du Landy, Saint-Ouen, France.,Service de Néphrologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Antoine Lanot
- Service de Néphrologie, CHU de Caen Normande, Normandie Université, Caen, France.,U1086 INSERM-UCN, "ANTICIPE", Centre François Baclesse, Caen, France
| | - Justine Serre
- INSERM UMR_S1155, CoRaKID, Hôpital Tenon, Paris, France.,Faculté de Médecine, Sorbonne Université, Paris, France
| | - Mickaël Bobot
- Centre De Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France.,INSERM 1263, INRAE 1260, C2VN, Aix-Marseille Univ, CERIMED, Marseille, France
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17
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Bobot M, Jourde-Chiche N. Lupus nephritis: Is it necessary to systematically repeat kidney biopsy? Rev Med Interne 2023; 44:1-4. [PMID: 36424286 DOI: 10.1016/j.revmed.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Affiliation(s)
- M Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France; Aix-Marseille Université, C2VN, Inserm 1263, INRAE 1260, Marseille, France; CERIMED, Aix-Marseille Université, Marseille, France.
| | - N Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France; Aix-Marseille Université, C2VN, Inserm 1263, INRAE 1260, Marseille, France.
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18
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Guervilly C, Fournier T, Chommeloux J, Arnaud L, Pinglis C, Baumstarck K, Boucekine M, Valera S, Sanz C, Adda M, Bobot M, Daviet F, Gragueb-Chatti I, Forel JM, Roch A, Hraiech S, Dignat-George F, Schmidt M, Lacroix R, Papazian L. Ultra-lung-protective ventilation and biotrauma in severe ARDS patients on veno-venous extracorporeal membrane oxygenation: a randomized controlled study. Crit Care 2022; 26:383. [PMID: 36510324 PMCID: PMC9744058 DOI: 10.1186/s13054-022-04272-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/21/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ultra-lung-protective ventilation may be useful during veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe acute respiratory distress syndrome (ARDS) to minimize ventilator-induced lung injury and to facilitate lung recovery. The objective was to compare pulmonary and systemic biotrauma evaluated by numerous biomarkers of inflammation, epithelial, endothelial injuries, and lung repair according to two ventilator strategies on vv-ECMO. METHODS This is a prospective randomized controlled study. Patients were randomized to receive during 48 h either ultra-lung-protective ventilation combining very low tidal volume (1-2 mL/kg of predicted body weight), low respiratory rate (5-10 cycles per minute), positive expiratory transpulmonary pressure, and 16 h of prone position or lung-protective-ventilation which followed the ECMO arm of the EOLIA trial (control group). RESULTS The primary outcome was the alveolar concentrations of interleukin-1-beta, interleukin-6, interleukin-8, surfactant protein D, and blood concentrations of serum advanced glycation end products and angiopoietin-2 48 h after randomization. Enrollment was stopped for futility after the inclusion of 39 patients. Tidal volume, respiratory rate, minute ventilation, plateau pressure, and mechanical power were significantly lower in the ultra-lung-protective group. None of the concentrations of the pre-specified biomarkers differed between the two groups 48 h after randomization. However, a trend to higher 60-day mortality was observed in the ultra-lung-protective group compared to the control group (45 vs 17%, p = 0.06). CONCLUSIONS Despite a significant reduction in the mechanical power, ultra-lung-protective ventilation during 48 h did not reduce biotrauma in patients with vv-ECMO-supported ARDS. The impact of this ventilation strategy on clinical outcomes warrants further investigation. Trial registration Clinical trial registered with www. CLINICALTRIALS gov ( NCT03918603 ). Registered 17 April 2019.
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Affiliation(s)
- Christophe Guervilly
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Théotime Fournier
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France
| | - Juliette Chommeloux
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne, Université Hôpital Pitié- Salpêtrière, Paris, France ,grid.462844.80000 0001 2308 1657INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Laurent Arnaud
- grid.414336.70000 0001 0407 1584Laboratoire d’Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Camille Pinglis
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Karine Baumstarck
- grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Mohamed Boucekine
- grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Sabine Valera
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Celine Sanz
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Mélanie Adda
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Mickaël Bobot
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817INSERM 1263, Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Université Aix-Marseille, Marseille, France ,grid.411535.70000 0004 0638 9491Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, 13005 Marseille, France
| | - Florence Daviet
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Ines Gragueb-Chatti
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Jean-Marie Forel
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Antoine Roch
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Sami Hraiech
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France
| | - Françoise Dignat-George
- grid.414336.70000 0001 0407 1584Laboratoire d’Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille, Marseille, France ,grid.5399.60000 0001 2176 4817INSERM 1263, Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Université Aix-Marseille, Marseille, France
| | - Matthieu Schmidt
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne, Université Hôpital Pitié- Salpêtrière, Paris, France ,grid.462844.80000 0001 2308 1657INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Romaric Lacroix
- grid.414336.70000 0001 0407 1584Laboratoire d’Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille, Marseille, France ,grid.5399.60000 0001 2176 4817INSERM 1263, Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Université Aix-Marseille, Marseille, France
| | - Laurent Papazian
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13915 Marseille Cedex 20, France ,grid.5399.60000 0001 2176 4817Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005 Marseille, France ,Centre Hospitalier de Bastia, Service de Réanimation, 604 Chemin de Falconaja, 20600 Bastia, France
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19
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Bobot M, Tonon D, Peres N, Guervilly C, Lefèvre F, Max H, Bommel Y, Volff M, Leone M, Lopez A, Simeone P, Carvelli J, Chopinet S, Hraiech S, Papazian L, Velly L, Bourenne J, Forel JM. Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19. J Clin Med 2022; 11:jcm11206130. [PMID: 36294451 PMCID: PMC9604787 DOI: 10.3390/jcm11206130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p < 0.001) and D90 (p < 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307−13.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044−1.241), p = 0.003) and iNO (OR: 5.694 (1.953−16.606), p = 0.001). Prone positioning (OR: 0.234 (0.057−0.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053−0.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, 13005 Marseille, France
- Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, European Center for Medical Imaging Research (CERIMED), Campus Santé Timone, 13005 Marseille, France
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
- Correspondence: ; Tel.: +33-491-383-042
| | - David Tonon
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Conception, AP-HM, 13005 Marseille, France
| | - Noémie Peres
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Christophe Guervilly
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Flora Lefèvre
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, 13005 Marseille, France
| | - Howard Max
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Youri Bommel
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Maxime Volff
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Marc Leone
- Service d’Anesthésie-Réanimation, Hôpital Nord, AP-HM, 13005 Marseille, France
| | - Alexandre Lopez
- Service d’Anesthésie-Réanimation, Hôpital Nord, AP-HM, 13005 Marseille, France
| | - Pierre Simeone
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France
| | - Julien Carvelli
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, AP-HM, 13005 Marseille, France
- European Center for Medical Imaging Research CERIMED, Laboratoire d’imagerie Interventionnelle Ex-périmentale (LIIE), Aix-Marseille Université, Campus Santé Timone, 13005 Marseille, France
| | - Sami Hraiech
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Laurent Papazian
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Lionel Velly
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France
| | - Jérémy Bourenne
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
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Mousseaux C, Arrestier R, Serre J, Chaibi K, Braconnier A, Hocine A, Lanot A, Bobot M. Prise en charge de l’hypercalcémie sévère : résultats de l’enquête de pratique des médecins francophones MeCALICA. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.311] [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: 10/14/2022]
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21
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Bobot M, Zieleskiewicz L, Jourde-Chiche N, Von Kotze C, Ebersolt M, Dussol B, Sallée M, Chopinet S, Berland Y, Brunet P, Robert T. Erratum à : Diagnostic performance of pulmonary ultrasonography and a clinical score for the evaluation of fluid overload in haemodialysis patients [Nephrol. & Therap. 17 (1) (2021) 42–49]. Nephrol Ther 2022; 18:296. [DOI: 10.1016/j.nephro.2022.07.001] [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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22
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Bobot M, Heim X, Max H, Simeone P, Velly L, Bruder N, Forel JM, Carvelli J, Stein C, Hraiech S, Boucraut J, Gainnier M, Mege JL, Guervilly C, Jourde-Chiche N, Papazian L, Burtey S. MO333: Prevalence of COVID-Associated Renal Injury in ICU and Prognosis of Proximal Tubular Dysfunction in Acute Respiratory Distress Syndrome. Nephrol Dial Transplant 2022. [PMCID: PMC9383871 DOI: 10.1093/ndt/gfac068.043] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS During COVID-19, the renal impairment is the most frequent after lung impairment and is associated of poor prognosis particularly in the intensive care unit (ICU). In this work, we aim to assess the incidence of acute kidney injury (AKI) in COVID-19-related acute respiratory distress syndrome (ARDS) patients, the existence of an early renal dysfunction and its prognosis, and its specificity compared with patients with non-COVID ARDS. METHOD This a prospective and multicentric study led in four ICUs. Patients of 18 years and older in ICU with invasive mechanical ventilation for ARDS were enrolled. Precise evaluation of renal dysfunction markers, including urinary protein electrophoresis, was performed within 24 h after the onset of mechanical ventilation. RESULTS From March 2020 to September 2021, 131 patients in ICU for ARDS were enrolled, 98 COVID-19 ARDS and 33 ARDS from other causes. There was more tubular profile in COVID-19 patients (68% versus 24%; P = .001) and a more mixed, tubular and glomerular profile in non-COVID-19 patients (29% versus 14%; P = .001). COVID-19 patients displayed an important tubular proteinuria, tended to display more AKI (49% versus 31%; P = .07), and had a longer duration of mechanical ventilation (18 versus 10 days; P = .002) and longer ICU length of stay (23 versus 15 days; P = .013). In COVID-19 patients, tubular proteinuria was associated with poor renal prognosis with a significant association with the onset of KDIGO ≥ 2 AKI. CONCLUSION COVID-19 ARDS patients had a specific renal impairment with tubular dysfunction, which appeared to be of poor prognosis on kidney and disease evolution.
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Affiliation(s)
- Mickaël Bobot
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
- Aix-Marseille Université, C2VN, Marseille, France
| | - Xavier Heim
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Howard Max
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Pierre Simeone
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Lionel Velly
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Nicolas Bruder
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Julien Carvelli
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Claire Stein
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - José Boucraut
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Marc Gainnier
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Jean-Louis Mege
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Christophe Guervilly
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Noemie Jourde-Chiche
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Stephane Burtey
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
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23
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Bobot M, Tonon D, Peres N, Guervilly C, Lefèvre F, Carvelli J, Papazian L, Max H, Leone M, Lopez A, Bommel Y, Volff M, Velly L, Bruder N, Hraiech S, Simeone P, Bourenne J, Forel JM. MO303: Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically ill Patients With COVID-19. Nephrol Dial Transplant 2022. [PMCID: PMC9383862 DOI: 10.1093/ndt/gfac068.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Kidney failure is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe acute kidney injury (AKI) in critically ill COVID patients. METHOD Data from a prospectively collected database of consecutive patients hospitalized in six ICUs for COVID-19 was retrospectively analysed. The incidence and severity of AKI were monitored during the entire ICU stay. Patients older than 18 years hospitalized in for COVID-19-related ARDS requiring mechanical ventilation were included. RESULTS A total of 164 patients were included in the final analysis, 97 (59.1%) displayed AKI, of which 39 had severe stage 3 AKI and 21 (12.8%) requiring renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with ACEI exposure (P = .016), high blood pressure (P = .029), APACHE-II score (P = .004) and mortality at D28 (P = .008), D60 (P < .001) and D90 (P < .001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to CEI [OR: 4.238 (1.307–13.736); P = .016], APACHE II score (without age) [OR: 1.138 (1.044–1.241); P = .003] and iNO [OR: 5.694 (1.953–16.606); P = .001], protective factors were prone positioning [OR: 0.234 (0.057–0.967); P = .045] and dexamethasone [OR: 0.194 (0.053–0.713); P = .014]. CONCLUSION Dexamethasone seems to prevent the risk of severe AKI and RRT, and iNO seems associated with severe AKI and RRT in critically ill patients with COVID-19. iNO must be used with caution in COVID-19 related ARDS.
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Affiliation(s)
- Mickaël Bobot
- Assistance Publique—Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
- Aix-Marseille Université, C2VN, Marseille, France
| | - David Tonon
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Noémie Peres
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Christophe Guervilly
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Flora Lefèvre
- Assistance Publique—Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| | - Julien Carvelli
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la TImone, Marseille, France
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Howard Max
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation Polyvalente, Hôpital Nord, Marseille, France
| | - Alexandre Lopez
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation Polyvalente, Hôpital Nord, Marseille, France
| | - Youri Bommel
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Maxime Volff
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Lionel Velly
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Nicolas Bruder
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Pierre Simeone
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Jérémy Bourenne
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, 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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Solignac J, Farnault L, Robert T, Fanciullino R, Choquet S, Brunet P, Venton G, Bobot M. Successful treatment with adapted high dose methotrexate in a hemodialysis patient with primary central nervous system lymphoma: 100mg/m 2 seems sufficient. Nefrologia 2022; 42:130-134. [PMID: 36153909 DOI: 10.1016/j.nefroe.2022.02.007] [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: 01/28/2021] [Accepted: 03/05/2021] [Indexed: 06/16/2023] Open
Abstract
High dose methotrexate (HD-MTX) based chemoimmunotherapy is a central part of the standard approach to treatment of primary central nervous system lymphoma (PCNSL). Renal dysfunction leads to delayed MTX complete elimination and critical MTX concentration. Despite the recommendations, hemodialysis status should not exclude HD-MTX. We report the case of a 64 years old woman on chronic hemodialysis with PCNSL successfully treated with HD-MTX-based chemoimmunotherapy with an adjusted dose of 100mg/m2, instead of the usual dose of 3500mg/m2, and daily hemodialysis started 24h later. The patient had no significant toxicity and was in complete remission at 1 year after the end of the treatment. We argue that ESRD is not an absolute pitfall to the use of HD-MTX for hematological malignancies. Experts should consider the use of adjusted dose at 100mg/m2 as a viable therapeutic modality in ESRD patients.
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Affiliation(s)
- Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Laure Farnault
- Service d'Hématologie et Thérapie Cellulaire, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Thomas Robert
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Raphaelle Fanciullino
- Laboratoire de Pharmacologie, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Choquet
- Service d'Hématologie, Hôpital de la Pitié-Salpêtrière, Assistance-Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Geoffroy Venton
- Service d'Hématologie et Thérapie Cellulaire, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; TAGC, INSERM UMR 1090, Aix Marseille Université, Marseille, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France.
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Le Hir A, Hak JF, Gragueb-Chatti I, Bobot M. Hypocalcemia-induced seizure with Fahr's syndrome. J Nephrol 2022; 35:1047-1048. [PMID: 35133618 DOI: 10.1007/s40620-022-01260-w] [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: 12/08/2021] [Accepted: 01/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Fahr's syndrome is a rare but severe brain complication of hypoparathyroidism and its consequences. CASE PRESENTATION A 72-year-old female patient was hospitalized in intensive care unit after two generalized seizures along with a severe hypocalcemia, due to hypoparathyroidism following a thyroidectomy for benign nodules and poor compliance with calcium treatment with treatment due to cognitive disorders. Brain CT showed cortical atrophy and extensive bilateral symmetrical calcifications of the cerebellum, thalami and basal ganglia, typical of Fahr's syndrome. CONCLUSION Nephrologists should be aware Fahr's syndrome in patients with hypoparathyroidism, it is associated with an increased risk of seizures. Thus, the control of calcemia in hypoparathyroidism is important, especially in patients with brain calcifications.
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Affiliation(s)
- Anne Le Hir
- Service de Médecine Intensive Réanimation, AP-HM, Hôpital Nord, 13015, Marseille, France
| | - Jean-François Hak
- Department of Neuroradiology, APHM La Timone, LIIE, CERIMED, Aix Marseille University, Marseille, France
| | - Inès Gragueb-Chatti
- Service de Médecine Intensive Réanimation, AP-HM, Hôpital Nord, 13015, Marseille, France
| | - Mickaël Bobot
- Service de Médecine Intensive Réanimation, AP-HM, Hôpital Nord, 13015, Marseille, France.
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, 13005, Marseille, France.
- C2VN, INSERM 1263, INRAE 1260, CERIMED, Aix-Marseille University, Marseille, France.
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27
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Fedi M, Bobot M, Torrents J, Gobert P, Magnant É, Knefati Y, Verhelst D, Lebrun G, Masson V, Giaime P, Santini J, Bataille S, Brunet P, Dussol B, Burtey S, Mancini J, Daniel L, Jourde-Chiche N. Kidney biopsy in very elderly patients: indications, therapeutic impact and complications. BMC Nephrol 2021; 22:362. [PMID: 34727880 PMCID: PMC8561868 DOI: 10.1186/s12882-021-02559-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients. METHODS Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed. RESULTS 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months. CONCLUSIONS KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.
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Affiliation(s)
- Mathilde Fedi
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
| | - Mickaël Bobot
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Julia Torrents
- AP-HM, University Hospital of La Timone, Anatomical Pathology Laboratory, Marseille, France
| | - Pierre Gobert
- Rhône Durance Clinic, Medicine Department Avignon, Avignon, France
| | - Éric Magnant
- Private Hospital of Provence, Nephrology Department, Aix-en-Provence, France
| | - Yannick Knefati
- Hospital of Sainte Musse, Nephrology Department, Toulon, France
| | - David Verhelst
- Hospital Général Henri Duffaut, Nephrology Department, Avignon, France
| | - Gaëtan Lebrun
- Hospital of Aix en Provence, Nephrology Department, Aix-en-Provence, France
| | - Valérie Masson
- Polyclinic "des fleurs", Nephrology Department, Ollioules, France
| | - Philippe Giaime
- Phocaean Institute of Nephrology, Bouchard Clinic, ELSAN, Marseille, France
| | - Julien Santini
- Saint-Joseph Hospital, Nephrology Department, Marseille, France
| | - Stanislas Bataille
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- Phocaean Institute of Nephrology, Bouchard Clinic, ELSAN, Marseille, France
| | - Philippe Brunet
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Bertrand Dussol
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Stéphane Burtey
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, University Hospital of la Timone, BIOSTIC Service, Marseille, France
| | - Laurent Daniel
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, University Hospital of La Timone, Anatomical Pathology Laboratory, Marseille, France
| | - Noémie Jourde-Chiche
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France.
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France.
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Kauffmann M, Bobot M, Robert T, Burtey S, Couvrat-Desvergnes G, Lavainne F, Puéchal X, Terrier B, Quéméneur T, Faguer S, Karras A, Brunet P, Couchoud C, Jourde-Chiche N. Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis. Clin J Am Soc Nephrol 2021; 16:1665-1675. [PMID: 34750159 PMCID: PMC8729406 DOI: 10.2215/cjn.03190321] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Kidney impairment of ANCA-associated vasculitides can lead to kidney failure. Patients with kidney failure may suffer from vasculitis relapses but are also at high risk of infections and cardiovascular events, which questions the maintenance of immunosuppressive therapy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with ANCA-associated vasculitides initiating long-term dialysis between 2008 and 2012 in France registered in the national Renal Epidemiology and Information Network registry and paired with the National Health System database were included. We analyzed the proportion of patients in remission off immunosuppression over time and overall and event-free survival on dialysis (considering transplantation as a competing risk). We compared the incidence of vasculitis relapses, serious infections, cardiovascular events, and cancers before and after dialysis initiation. RESULTS In total, 229 patients were included: 142 with granulomatous polyangiitis and 87 with microscopic polyangiitis. Mean follow-up after dialysis initiation was 4.6±2.7 years; 82 patients received a kidney transplant. The proportion of patients in remission off immunosuppression increased from 23% at dialysis initiation to 62% after 5 years. Overall survival rates on dialysis were 86%, 69%, and 62% at 1, 3, and 5 years, respectively. Main causes of death were infections (35%) and cardiovascular events (26%) but not vasculitis flares (6%). The incidence of vasculitis relapses decreased from 57 to seven episodes per 100 person-years before and after dialysis initiation (P=0.05). Overall, during follow-up, 45% of patients experienced a serious infection and 45% had a cardiovascular event, whereas 13% experienced a vasculitis relapse. CONCLUSIONS The proportion of patients with ANCA-associated vasculitis in remission off immunosuppression increases with time spent on dialysis. In this cohort, patients were far less likely to relapse from their vasculitis than to display serious infectious or cardiovascular events. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN03190321.mp3.
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Affiliation(s)
- Maëlis Kauffmann
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
| | - Mickaël Bobot
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | - Thomas Robert
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
| | - Stéphane Burtey
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | | | - Frédéric Lavainne
- University hospital de Nantes, Department of Nephrology and Clinical Immunology, Nantes, France
| | - Xavier Puéchal
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Paris, France
| | - Benjamin Terrier
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Paris, France
| | - Thomas Quéméneur
- Hospital de Valenciennes, Department of Internal Medicine, Valenciennes, France
| | - Stanislas Faguer
- University hospital de Toulouse, Hôpital Rangueil, Department of Nephrology and Organ Transplantation, Centre de référence des maladies rénales rares, Institut National de la Santé et de la Recherche Médicale, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | - Alexandre Karras
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Nephrology, Paris, France
| | - Philippe Brunet
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | - Cécile Couchoud
- Agence de la Biomédecine, Registre Renal Epidemiology and Information Network, Saint-Denis, France
| | - Noémie Jourde-Chiche
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
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Beaume J, Figueres L, Bobot M, de Laforcade L, Ayari H, Dolley-Hitze T, Gueutin V, Braconnier A, Golbin L, Citarda S, Seret G, Belaïd L, Cohen R, Luque Y, Larceneux F, Seervai RNH, Overs C, Bertocchio JP. Sodium Bicarbonate Prescription and Extracellular Volume Increase: Real-world Data Results from the AlcalUN Study. Clin Pharmacol Ther 2021; 111:252-262. [PMID: 34564842 DOI: 10.1002/cpt.2427] [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] [Received: 03/23/2021] [Accepted: 09/13/2021] [Indexed: 11/11/2022]
Abstract
Oral alkalization with sodium bicarbonate (NaHCO3 ) or citrate is prescribed for conditions ranging from metabolic acidosis to nephrolithiasis. Although most nephrologists/urologists use this method routinely, extracellular volume (ECV) increase is the main feared adverse event reported for NaHCO3 . Thus far, no trial has specifically studied this issue in a real-world setting. AlcalUN (NCT03035812) is a multicentric, prospective, open-label cohort study with nationwide (France) enrollment in 18 (public and private) nephrology/urology units. Participants were adult outpatients requiring chronic (>1 month) oral alkalization by either NaHCO3 -containing or no-NaHCO3 -containing agents. The ECV increase (primary outcome) was judged based on body weight increase (ΔBW), blood pressure increase (ΔBP), and/or new-onset edema at the first follow-up visit (V1). From February 2017 to February 2020, 156 patients were enrolled. After a median 106 days of treatment, 91 (72%) patients reached the primary outcome. They had lower systolic (135 (125, 141) vs. 141 (130, 150), P = 0.02) and diastolic (77 (67, 85) vs. 85 (73, 90), P = 0.03) BP values, a higher plasma chloride (106.0 (105.0, 109.0) vs. 105.0 (102.0, 107.0), P = 0.02) at baseline, and a less frequent history of nephrolithiasis (32 vs. 56%, P = 0.02). Patients experienced mainly slight ΔBP (< 10 mmHg). The primary outcome was not associated (P = 0.79) with the study treatment (129 received NaHCO3 and 27 received citrate). We subsequently developed three different models of propensity score matching; each confirmed our results. Chronic oral alkalization with NaHCO3 is no longer associated with an ECV increase compared to citrate in real-life settings.
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Affiliation(s)
- Julie Beaume
- AVODD, HIA Sainte-Anne, Toulon, France.,Club des Jeunes Néphrologues, Paris, France
| | - Lucile Figueres
- Club des Jeunes Néphrologues, Paris, France.,DIVAT Consortium, Nantes, France.,Service de Néphrologie et d'immunologie clinique, ITUN, CHU de Nantes, Université de Nantes, Nantes, France
| | - Mickaël Bobot
- Club des Jeunes Néphrologues, Paris, France.,Centre de Néphrologie et Transplantation Rénale, Assistance Publique Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France
| | - Louis de Laforcade
- Club des Jeunes Néphrologues, Paris, France.,Service Endocrinologie-Néphrologie, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Hamza Ayari
- Renal and Metabolic Diseases Unit, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Thibault Dolley-Hitze
- Club des Jeunes Néphrologues, Paris, France.,Unité de dialyse de Saint-Malo, Fondation AUB Santé, Saint-Malo, France
| | - Victor Gueutin
- Service de Néphrologie-Dialyse, AURA Paris Plaisance, Paris, France.,Service de Néphrologie, Hôpital de La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Antoine Braconnier
- Club des Jeunes Néphrologues, Paris, France.,Service de Néphrologie, Dialyse et Transplantation Rénale, CHU Reims, Hôpital Maison Blanche, Reims, France
| | - Léonard Golbin
- Club des Jeunes Néphrologues, Paris, France.,Service de Néphrologie, Dialyse et Transplantation Rénale, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Salvatore Citarda
- Club des Jeunes Néphrologues, Paris, France.,Centre associatif lyonnais de dialyse (Calydial), Irigny, France
| | | | - Lisa Belaïd
- Unité de dialyse de Saint-Malo, Fondation AUB Santé, Saint-Malo, France
| | - Raphaël Cohen
- Renal and Metabolic Diseases Unit, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Yosu Luque
- Club des Jeunes Néphrologues, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, UMR_S1155, Sorbonne Université, Paris, France
| | - Fabrice Larceneux
- CNRS, UMR (7088), DRM, (ERMES), Université Paris-Dauphine, PSL Research University, Paris, France
| | - Riyad N H Seervai
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas, USA.,Molecular & Cellular Biology Graduate Program, Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA
| | - Camille Overs
- Association Française des Urologues en Formation, Paris, France.,Service d'Urologie, Andrologie et transplantation Rénale, CHU de Grenoble, La Tronche, France
| | - Jean-Philippe Bertocchio
- Club des Jeunes Néphrologues, Paris, France.,Service de Néphrologie, Hôpital de La Pitié-Salpêtrière, AP-HP, Paris, France
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- Club des Jeunes Néphrologues, Paris, France
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Robert T, Lano G, Resseguier N, Bobot M, Bouchouareb D, Duval A, Jaubert D, Brunet P, Bataille S, Jourde-Chiche N. Étude SeroCOVIDial : évaluation de la séroprévalence SARS-CoV2 chez les patients hémodialysés chroniques et leurs soignants après la 1re vague et avant la campagne vaccinale, une étude de cohorte. Nephrol Ther 2021. [PMCID: PMC8435305 DOI: 10.1016/j.nephro.2021.07.278] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Les patients hémodialysés chroniques (HD) constituent une population à haut risque de COVID-19 sévère, et ne peuvent rester confinés. La prévalence de l’immunisation contre le SARS-CoV-2 parmi les patients HD et les soignants, après la première vague de COVID-19 et avant la campagne de vaccination, reste inconnue. Description PHRC inter-régional, étude de cohorte prospective réalisée entre juin et décembre 2020 dans 4 grands centres de dialyse d’Aix–Marseille (dépistage systématique des symptômes et mesures d’isolement des malades infectés dès le début de la pandémie). Méthodes Séroprévalence SARS-CoV2 évaluée par test sérologique rapide (Biosynex®) chez les patients et leurs soignants en juin (M0), septembre(M3) et décembre (M6) 2020. Résultats En juin 2020, 451 patients HD et 238 soignants ont été inclus. La séroprévalence SARS-CoV2 à M0 était de 8,4 % chez les patients et 6,7 % chez les soignants. Parmi les participants immunisés, 26,3 % des patients et 6,3 % des soignants n’avaient présenté aucun symptôme de COVID-19. Parmi les participants ayant eu une infection SARS-CoV2 documentée avant M0, 87 % des patients et 90 % des soignants étaient immunisés à M0. La séroprévalence est restée stable à M3, et a augmenté à M6 lors de la 2e vague épidémique, atteignant 13,8 % des patients et 12,6 % des soignants. À M6, 38 (8,4 %) patients étaient décédés dont 9 (2 %) de COVID-19, et 12 autres ont été hospitalisés pour COVID-19. Deux patients immunisés à M0 ont présenté une COVID-19 non sévère au cours du suivi. Conclusion Dans cette large cohorte de patients HD et de soignants, la prévalence de l’immunisation SARS-CoV2 après la première vague épidémique était relativement faible, ce qui reflète probablement l’efficacité des mesures de protection mises en place. L’immunisation n’était pas toujours persistante chez les participants, et certains patients immunisés à M0 ont pu être infectés, ce qui souligne l’intérêt de la vaccination systématique de cette population.
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Chemouny J, Maisons V, Bobot M, Jourde-Chiche N, Barba C, Daniel L, Rioux-Leclerc N, Vrtovsnik F, Halimi J, Sannier A. Valeur pronostiques des lésions histologiques dans la néphropatie diabétique, une étude rétrospective. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.214] [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: 10/20/2022]
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Bobot M, Boucraut J, Max H, Simeone P, Carvelli J, Heim X, Forel J, Jourde-Chiche N, Papazian L, Burtey S. Prévalence importante et mauvais pronostic de la dysfonction tubulaire proximale au cours du SDRA COVID en réanimation : l’étude URICOV. Nephrol Ther 2021. [PMCID: PMC8435311 DOI: 10.1016/j.nephro.2021.07.145] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction La protéinurie et l’insuffisance rénale aiguë sont fréquentes au cours du COVID-19, et associées à la morbi-mortalité, mais la pathogénicité directe du SARS-CoV-2 sur le rein reste débattue. Notre objectif était d’évaluer la prévalence et la valeur pronostique de la tubulopathie proximale chez les patients en SDRA COVID en réanimation. Description Dans cette étude de cohorte prospective multicentrique, étaient inclus les patients majeurs présentant une détresse respiratoire nécessitant la ventilation mécanique avec rapport PaO2/FiO2 < 300 dans les 24 h de l’intubation. Méthodes Nous réalisions une analyse détaillée des marqueurs de dysfonction rénale avec électrophorèse des protéines urinaires (EPU) dans les 24 h de l’intubation chez 85 patients en réanimation pour un SDRA COVID. Résultats Seulement 16 (18,8 %) des patients présentaient une IRA initiale. L’uricémie était abaissée (moyenne 212 μmol/L), 87,1 % des patients présentaient une glycosurie. Une hématurie microscopique était retrouvée chez 74 (87,1 %) patients. Les rapports protéinurie/créatinine et albuminurie/créatinine étaient de 785 et 142 mg/g. L’EPU retrouvant un profil tubulaire chez 91 % des patients, avec une atteinte glomérulaire surajoutée dans chez 17 %. Il existait une fuite urinaire massive d’alpha-1-microglobuline (a1 m, 96,1 % des patients), beta-2-microglobuline (b2 m, 95,8 %), chaînes légères kappa et lambda (CLL) (100 % et 93,5 %) et Vitamine-D-Binding-Protein (87,5 %). Après un suivi moyen de 28 jours, 37 patients (43,5 %) ont développé une insuffisance rénale aiguë (13 KDIGO3, 3 nécessitant la dialyse). Les patients ayant développé une IRA KDIGO3 avaient une urémie, une créatininémie, des rapports protéinurie/créatininurie, albuminurie/créatininurie et a1 m/créatininurie significativement plus élevés et une bicarbonatémie plus basse. La dexamethasone semblait protéger de l’IRA. La survenue d’une IRA et des rapports b2 m/créatininurie et CLLl/créatininurie plus élevés était associés à la mortalité (p = 0,027, p = 0,04, p = 0,005, respectivement) (Fig. 1). Conclusion Les patients développant un SDRA au cours du COVID-19 présentent une dysfonction tubulaire proximale, précédant l’IRA, qui semble être un mécanisme important de la néphropathie COVID et pourrait être un marqueur de sévérité.
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Chopinet S, Bobot M, Reydellet L, Bollon E, Gérolami R, Decoster C, Blasco V, Moal V, Grégoire E, Hardwigsen J. Peri-operative risk factors of chronic kidney disease after liver transplantation. J Nephrol 2021; 35:607-617. [PMID: 34426948 DOI: 10.1007/s40620-021-01127-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a frequent long-term complication after liver transplantation (LT) and is associated with poor long-term survival. The aim of our study was to identify the risk factors of developing post-transplant CKD at 1 year, during the pre-operative, peri-operative, and post-LT phases. METHODS All consecutive patients who underwent primary LT between July 2013 and February 2018 were analyzed. To assess the impact of peri- and post-operative factors on renal function at 1 year we performed a propensity score matching on gender, age of the recipient, Model for End-Stage Liver Disease (MELD) score, etiology of the hepatic disease, and estimated Glomerular Filtration Rate (eGFR) at baseline. RESULTS Among the 245 patients who underwent LT, 215 had available data at one year (Y1), and 46% of them had CKD. Eighty-three patients in the CKD group and 83 in the normal renal function group were then matched. The median follow-up was 35 months (27-77). Patients with CKD at Y1 had a decreased 5-year survival compared to patients with normal renal function at one year: figures were 62% and 90%, respectively, p = 0.001. The independent predictors of CKD at Y1 were major complications (OR = 2.2, 95% CI [1.2-4.2]), p = 0.015, intensive care unit (ICU) stay > 5 days (OR = 2.2, 95% CI [1.3-5.1]), p = 0.046, ICU serum lactate level at 24 h ≥ 2.5 mmol/L (OR = 3.8 95% CI [1.1-8]), p = 0.034, need for post-LT renal replacement therapy (OR = 6.4 95% CI [1.4-25]), and MELD score ≥ 20 (OR = 2.1 95% CI [1.1-3.9]), p = 0.019. CONCLUSIONS The peri-operative period has a major impact on CKD incidence. Early recognition of patients at high risk of CKD may be critical for implementation of nephroprotective measures.
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Affiliation(s)
- Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France. .,European Center for Medical Imaging Research CERIMED/LIIE, Université Aix-Marseille, Marseille, France. .,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France.
| | - Mickaël Bobot
- Department of Nephrology, Hôpital de la Conception, Marseille, France.,C2VN, INSERM 1263 INRAE 1260 Aix-Marseille Université, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Laurent Reydellet
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Emilie Bollon
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - René Gérolami
- Department of Hepatology Gastroenterology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Claire Decoster
- Department of Hepatology Gastroenterology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Valéry Blasco
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Valérie Moal
- Department of Nephrology, Hôpital de la Conception, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Emilie Grégoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,European Center for Medical Imaging Research CERIMED/LIIE, Université Aix-Marseille, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
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Solignac J, Farnault L, Robert T, Fanciullino R, Choquet S, Brunet P, Venton G, Bobot M. Successful treatment with adapted high dose methotrexate in a hemodialysis patient with primary central nervous system lymphoma: 100mg/m 2 seems sufficient. Nefrologia 2021; 42:S0211-6995(21)00090-4. [PMID: 34353642 DOI: 10.1016/j.nefro.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
High dose methotrexate (HD-MTX) based chemoimmunotherapy is a central part of the standard approach to treatment of primary central nervous system lymphoma (PCNSL). Renal dysfunction leads to delayed MTX complete elimination and critical MTX concentration. Despite the recommendations, hemodialysis status should not exclude HD-MTX. We report the case of a 64 years old woman on chronic hemodialysis with PCNSL successfully treated with HD-MTX-based chemoimmunotherapy with an adjusted dose of 100mg/m2, instead of the usual dose of 3500mg/m2, and daily hemodialysis started 24h later. The patient had no significant toxicity and was in complete remission at 1 year after the end of the treatment. We argue that ESRD is not an absolute pitfall to the use of HD-MTX for hematological malignancies. Experts should consider the use of adjusted dose at 100mg/m2 as a viable therapeutic modality in ESRD patients.
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Affiliation(s)
- Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Laure Farnault
- Service d'Hématologie et Thérapie Cellulaire, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Thomas Robert
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Raphaelle Fanciullino
- Laboratoire de Pharmacologie, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Choquet
- Service d'Hématologie, Hôpital de la Pitié-Salpêtrière, Assistance-Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Geoffroy Venton
- Service d'Hématologie et Thérapie Cellulaire, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; TAGC, INSERM UMR 1090, Aix Marseille Université, Marseille, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France.
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Bobot M, Hache G, Moyon A, Fernandez S, Balasse L, Daniel L, Garrigue P, Brige P, Chopinet S, Dignat-George F, Brunet P, Burtey S, Guillet B. Renal SPECT/CT with 99mTc-dimercaptosuccinic acid is a non-invasive predictive marker for the development of interstitial fibrosis in a rat model of renal insufficiency. Nephrol Dial Transplant 2021; 36:804-810. [PMID: 33367913 DOI: 10.1093/ndt/gfaa374] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) increases cardiovascular risk and mortality. Renal fibrosis plays a major role in the progression of CKD but, to date, histology remains the gold standard to assess fibrosis. Non-invasive techniques are needed to assess renal parenchymal impairment and to perform the longitudinal evaluation of renal structure. Thus we evaluated renal isotopic imaging by single-photon emission computed tomography/computed tomography (SPECT/CT) with technetium-99m (99mTc)-dimercaptosuccinic acid (DMSA) to monitor renal impairment during renal insufficiency in rats. METHODS Renal insufficiency was induced by an adenine-rich diet (ARD) at 0.25 and 0.5% for 28 days. Renal dysfunction was evaluated by assaying biochemical markers and renal histology. Renal parenchymal impairment was assessed by SPECT/CT isotopic imaging with 99mTc-DMSA on Days 0, 7, 14, 21, 28, 35 and 49. RESULTS Compared with controls, ARD rats developed renal dysfunction characterized by increased serum creatinine and blood urea nitrogen, fibrosis and tubulointerstitial damage in the kidneys, with a dose-dependent effect of the adenine concentration. 99mTc-DMSA SPECT-CT imaging showed a significant decrease in renal uptake over time in 0.25 and 0.5% ARD rats compared with control rats (P = 0.011 and P = 0.0004, respectively). 99mTc-DMSA uptake on Day 28 was significantly inversely correlated with Sirius red staining evaluated on Day 49 (r = 0.89, P < 0.0001, R2 = 0.67). CONCLUSIONS 99mTc-DMSA renal scintigraphy allows a longitudinal follow-up of risk of renal fibrosis in rats. We found that the reduction of renal parenchyma in ARD rats is inversely proportional to newly formed fibrous tissue in the kidney. Our results suggest that 99mTc-DMSA renal scintigraphy may be a useful non-invasive prognostic marker of the development of renal fibrosis in animals and should be tested in humans.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France
| | - Guillaume Hache
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France.,Pharmacie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Anaïs Moyon
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France.,Service de Radiopharmacie, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Samantha Fernandez
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France
| | - Laure Balasse
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France
| | - Laurent Daniel
- C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France.,Laboratoire d'Anatomopathologie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Philippe Garrigue
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France.,Service de Radiopharmacie, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pauline Brige
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,Laboratoire d'Imagerie Interventionnelle Expérimentale, EA, 4264, Aix Marseille Université, Marseille, France
| | - Sophie Chopinet
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,Laboratoire d'Imagerie Interventionnelle Expérimentale, EA, 4264, Aix Marseille Université, Marseille, France.,Service de Chirurgie Digestive, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France
| | - Benjamin Guillet
- Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille Université, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France.,Service de Radiopharmacie, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Chemouny JM, Bobot M, Sannier A, Maisons V, Jourde-Chiche N, Ferriere E, Joly D, Vigneau C, Rioux-Leclercq N, Barba C, Daniel L, Halimi JM, Vrtovsnik F. Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study. Am J Nephrol 2021; 52:131-140. [PMID: 33780924 DOI: 10.1159/000514259] [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: 10/31/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kidney biopsies (KBs) are performed in patients with type 2 diabetes (T2D) to diagnose non-diabetic or hypertensive kidney disease (NDHKD) potentially requiring specific management compared to diabetic and or hypertensive nephropathy (absence of NDHKD). Indications for KB are based on the presence of atypical features compared to the typical course of diabetic nephropathy. In this study, we assessed the association of different patterns of atypical features, or KB indications, with NDHKD. METHODS Native KBs performed in patients with T2D were analyzed. Data were collected from the patients' records. KB indications were determined according to the presence of different atypical features considered sequentially: (1) presence of any feature suggesting NDHKD which is not among the following ones, (2) recent onset of nephrotic syndrome, (3) low or rapidly declining estimated glomerular filtration rate (eGFR), (4) rapid increase in proteinuria, (5) short duration of diabetes, (6) presence of hematuria, or (7) normal retinal examination. RESULTS Among the 463 KBs analyzed, NDHKD was diagnosed in 40% of the total population and 54, 40, 24, and 7% of the KBs performed for indications 1-4 respectively. Conversely, no patient who underwent KB for indications 5-7 displayed NDHKD. Logistic regression analyses identified eGFRCKD-EPI >15 mL/min/1.73 m2, urinary protein-to-Cr ratio <0.3 g/mmol, hematuria, HbA1c <7%, and diabetes duration <5 years as predictors of NDHKD, independently from the indication group. CONCLUSION NDHKD is frequent in T2D. Despite the association of hematuria with NDHKD, our results suggest that presence of hematuria and absence of DR are insufficient to indicate KB in the absence of concurrent atypical features. Conversely, rapid progression of proteinuria and rapid deterioration of eGFR are major signals of NDHKD.
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Affiliation(s)
- Jonathan M Chemouny
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, CIC-P 1414 (Centre d'Investigation Clinique), Univ Rennes, Rennes, France
| | - Mickaël Bobot
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Aurélie Sannier
- Laboratoire d'Anatomie et Cytologie Pathologiques, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, Paris, France
| | - Valentin Maisons
- CHU Tours, Service de Néphrologie et d'Immunologie Clinique, Tours, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Elsa Ferriere
- Service de Néphrologie, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Dominique Joly
- Service de Néphrologie, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Cécile Vigneau
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | - Nathalie Rioux-Leclercq
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | - Christophe Barba
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire, Paris, France
| | - Laurent Daniel
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Laboratoire d'Anatomopathologie, Hôpital de la Timone, Marseille, France
| | - Jean-Michel Halimi
- CHU Tours, Service de Néphrologie et d'Immunologie Clinique, Tours, France
- Université de Tours, INI-CRCT, Tours, France
| | - Francois Vrtovsnik
- Université de Paris, Paris, France
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire, Paris, France
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Scarfoglière V, Bobot M, Guilhem C, Bouchouareb D, Brunet P, Robert T. Regional anticoagulation with calcium-free dialysate containing citrate in chronic haemodialysis patients. Nephrol Dial Transplant 2021; 36:745-746. [PMID: 33326039 DOI: 10.1093/ndt/gfaa365] [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: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Violaine Scarfoglière
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Mickaël Bobot
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Cavaille Guilhem
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Dammar Bouchouareb
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France
| | - Philippe Brunet
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Thomas Robert
- Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France.,MMG, Bioinformatics & Genetics, UMR_S910, Aix-Marseille Université, Marseille, France
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de Laforcade L, Bobot M, Bellin MF, Clément O, Grangé S, Grenier N, Wynckel A, Guerrot D. [ESUR recommendations on the use of contrast media: Practice survey, review and commentary by CJN, FIRN and SFNDT]. Nephrol Ther 2021; 17:80-91. [PMID: 33551369 DOI: 10.1016/j.nephro.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/20/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
Contrast media administration is classically considered to cause or worsen kidney failure. Recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. The present work evaluates the practice of French nephrologists, and provides a commentary on these recommendations based on an updated review of the literature. We conducted survey among French nephrologists, using an electronic questionnaire distributed by the Société Francophone de Néphrologie, Dialyse et Transplantation, the French Intensive care Renal Network and the Club des Jeunes Néphrologues. 266 responses were collected. The European Society of Urogenital Radiology guidelines are poorly known among the panel of nephrologists. Their practices differ from the guidelines by the more frequent and earlier implementation of measures to prevent renal failure post contrast media. In accordance with the guidelines, hydration is prescribed as a first-line preventive measure, mainly with saline and bicarbonate. Inhibitors of the renin-angiotensin-aldosterone system are frequently discontinued before an injection of contrast media, contrary to what is recommended. In conclusion, the European Society of Urogenital Radiology guidelines, which the working group endorses, but which are still too little known and applied in clinical nephrology in France, prompt nephrologists to lift some of the restrictions on the use of PCI as well as on the continuation of ARS inhibitors before injecting PCI.
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Affiliation(s)
- Louis de Laforcade
- Service d'endocrinologie-diabétologie-néphrologie, centre hospitalier Pierre-Oudot, 30, avenue du Médipole, 38300 Bourgoin-Jallieu, France; Commission Néphrologie Clinique de la SFNDT, 24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France.
| | - Mickaël Bobot
- Commission Néphrologie Clinique de la SFNDT, 24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France; Centre de néphrologie et transplantation rénale, CHU de conception, 147, boulevard Baille, 13005 Marseille, France; Inserm 1263, Inrae 1260, C2VN, université Aix-Marseille, 27, boulevard Jean-Moulin, 13385 Marseille, France; Comité Scientifique du Club des Jeunes Néphrologues, clinique du Landy, 93400 Saint-Ouen, France
| | - Marie-France Bellin
- CEA, CNRS, Inserm, BioMaps, service de radiologie, hôpital-bicêtre Paul-Brousse, université Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Olivier Clément
- Service de radiologie, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - Steven Grangé
- Service de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; French Intensive care Renal Network,24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France
| | - Nicolas Grenier
- Service de radiologie et d'imagerie diagnostique et interventionnelle de l'adulte, CHU de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Alain Wynckel
- French Intensive care Renal Network,24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France; Service de néphrologie, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France
| | - Dominique Guerrot
- Commission Néphrologie Clinique de la SFNDT, 24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France; Service de néphrologie, hémodialyse, transplantation rénale, lithiase rénale, hypertension artérielle, unité de surveillance continue, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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de Laforcade L, Bobot M, Bellin MF, Clément O, Grangé S, Grenier N, Wynckel A, Guerrot D. Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging 2021; 102:131-139. [PMID: 33531265 DOI: 10.1016/j.diii.2021.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/29/2022]
Abstract
Contrast medium administration is classically considered to cause or worsen kidney failure, but recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. Kidney injury does not constitute a contra-indication to the administration of iodinated contrast medium, as long as the benefit-risk ratio justifies it. Intravenous hydration with 0.9% NaCl or 1.4% sodium bicarbonate is the only validated measure for the prevention of post-iodine contrast nephropathy. This is necessary for intravenous or intra-arterial administration of iodinated contrast agent without first renal pass when the glomerular filtration rate is less than 30mL/min/1.73m2, for intra-arterial administration of iodinated contrast agent with first renal passage when the glomerular filtration rate is less than 45mL/min/1.73m2, or in patients with acute renal failure. The use of iodinated contrast medium should allow the carrying out of relevant examinations based on an analysis of the benefit-risk ratio and the implementation of measures to prevent toxicity when necessary.
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Affiliation(s)
- Louis de Laforcade
- Department of Nephrology, Bourgoin-Jallieu Hospital, 38300 Bourgoin-Jallieu, France.
| | - Mickaël Bobot
- Department of Nephrology and Renal Transplantation, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Univ, 13005 Marseille, France
| | - Marie-France Bellin
- Department of Radiology, Bicêtre Hospital, APHP, University Paris-Saclay, BioMaps, 94043 Le Kremlin Bicêtre, France
| | - Olivier Clément
- Department of Radiology, Hopital Européen Georges Pompidou, AP-HP, Centre, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 76000 Rouen, France
| | - Nicolas Grenier
- Radiology Department, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Alain Wynckel
- Nephrology Department, Reims University Hospital, 51100 Reims, France
| | - Dominique Guerrot
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, 76000 Rouen, France
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Bontemps D, Brunet P, Bobot M. Pseudotumoral calcinosis in a haemodialysis patient. J Nephrol 2020; 33:1115-1116. [DOI: 10.1007/s40620-020-00827-9] [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] [Received: 07/06/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
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Chopinet S, Bobot M, Reydellet L, Bollon E, Gerolami R, Blasco V, Moal V, Gregoire E, Hardwigsen J. Insuffisance rénale chronique après transplantation hépatique : tout se joue pendant la période périopératoire ! Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maelis K, Couchoud C, Bobot M, Couvrat-Desvergnes G, Terrier B, Quemeneur T, Faguer S, Karras A, Brunet P, Jourde-Chiche N. Étude DIAVAS : comparaison de l’activité des vascularites à ANCA entre les périodes pré- et post-dialyse chez les patients du registre REIN appariés au SNDS. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.154] [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: 11/16/2022]
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Bobot M, Maisons V, Chopinet S, Bureau C, Luque Y. National survey of invasive procedural training for nephrology fellows and residents in France: from bedside mentoring to simulation-based teaching. Clin Kidney J 2020; 14:445-447. [PMID: 33564454 PMCID: PMC7857789 DOI: 10.1093/ckj/sfaa111] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mickaël Bobot
- Service de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Université, Marseille, France.,Comité Scientifique du Club des Jeunes Néphrologues, Paris, France
| | - Valentin Maisons
- Comité Scientifique du Club des Jeunes Néphrologues, Paris, France.,Service de Néphrologie et Immunologie clinique, CHRU Tours, Tours, France
| | - Sophie Chopinet
- Service de Chirurgie Digestive, Hôpital de la Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Côme Bureau
- Comité Scientifique du Club des Jeunes Néphrologues, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Yosu Luque
- Comité Scientifique du Club des Jeunes Néphrologues, Paris, France.,Service des Urgences Néphrologies et Transplantation Rénale, Hôpital Tenon, APHP, Inserm UMR_S115, Sorbonne Université, Paris, France
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Kauffmann M, Bobot M, Daniel L, Torrents J, Knefati Y, Moranne O, Burtey S, Zandotti C, Jourde-Chiche N. Parvovirus B19 infection and kidney injury: report of 4 cases and analysis of immunization and viremia in an adult cohort of 100 patients undergoing a kidney biopsy. BMC Nephrol 2020; 21:260. [PMID: 32646497 PMCID: PMC7350584 DOI: 10.1186/s12882-020-01911-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/25/2020] [Indexed: 01/25/2023] Open
Abstract
Background The seroprevalence of human Parvovirus B19 (PVB19) is 70–85% in adults worldwide. PVB19 is the etiologic agent of the fifth disease, is a cause of aplastic anemia, and can be associated with kidney injury. We aimed to describe the cases of 4 patients with kidney injury related to PVB19 primary infection, and to evaluate the seroprevalence of PVB19 and the incidence of PVB19 primary infection in patients undergoing a native kidney biopsy. Methods Cases of PVB19 infection with kidney injury were reviewed from the archives of the department of Nephrology. A systematic screening of anti-PVB19 IgG and IgM antibodies and viral DNA was performed in sera from 100 consecutive patients with a kidney biopsy in 2017–2018. Results The 4 patients with PVB19 infection-associated kidney disease displayed: one lupus-like glomerulonephritis (GN) without lupus auto-antibodies, one minimal change disease with tubular necrosis, one secondary hemolytic and uremic syndrome and one membrano-proliferative GN. In the 100 patients biopsied, 67 had elevated anti-PVB19 IgG, among whom 8 had elevated IgM, without circulating viral DNA, without any particular renal pathological pattern. One additional patient showed a seroconversion at the time of kidney biopsy, which revealed a class V lupus nephritis. Conclusion PVB19 primary infection can be associated with different kidney diseases. The seroprevalence of PVB19 among patients with a kidney biopsy is similar to the overall population, and primary infection is rarely documented (1%) after systematic screening. Whether PV19 is nephrotoxic, or triggers renal endothelial injury and immune activation, remains to be elucidated.
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Affiliation(s)
- Maëlis Kauffmann
- AP-HM, Department of Nephrology, Hopital de la Conception, Marseille, France
| | - Mickaël Bobot
- AP-HM, Department of Nephrology, Hopital de la Conception, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Campus Timone, Marseille, France
| | - Laurent Daniel
- Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Campus Timone, Marseille, France.,AP-HM, Laboratory of Pathology, Hopital de la Timone, Marseille, France
| | - Julia Torrents
- AP-HM, Laboratory of Pathology, Hopital de la Timone, Marseille, France
| | - Yannick Knefati
- Department of Nephrology, Hôpital Sainte Musse, Toulon, France
| | | | - Stéphane Burtey
- AP-HM, Department of Nephrology, Hopital de la Conception, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Campus Timone, Marseille, France
| | - Christine Zandotti
- UVE, Aix-Marseille Univ, IRD 190, Inserm 1207, IHU Méditerranée Infection and AP-HM, Marseille, France
| | - Noémie Jourde-Chiche
- AP-HM, Department of Nephrology, Hopital de la Conception, Marseille, France. .,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Campus Timone, Marseille, France.
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Greillier S, Daniel L, Caillaud C, Dussol B, Touchard G, Goujon JM, Jourde-Chiche N, Bobot M. First phenotypic description of a female patient with c.610 T > C variant of GLA: a renal-predominant presentation of Fabry disease. BMC Med Genet 2020; 21:137. [PMID: 32590976 PMCID: PMC7320597 DOI: 10.1186/s12881-020-01071-5] [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] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023]
Abstract
Background Fabry disease (FD) is an X-linked lysosomal storage disorder due to deficient alpha-galactosidase activity leading to intracellular glycosphingolipid accumulation. Multiple variants have been reported in the GLA gene coding for alpha-galactosidase, and the question of the pathogenicity of rare variants needs to be addressed, especially in patients with mild phenotypes. Case presentation The patient, a 37-year-old female, presented with a persistent proteinuria after an otherwise uncomplicated first pregnancy. Renal biopsy showed both mild mesangial IgA deposits, and a striking vacuolization of podocytes and tubular cells consistent with Fabry disease. On electron microscopy, discrete but characteristic pseudo-myelinic lamellar inclusions were observed in the podocytes’ lysosomes. A more detailed physical examination revealed an angiokeratoma, and medical history ancient acroparesthesia. There was no cardiac or cerebral involvement of Fabry disease on magnetic resonance imaging. While blood enzymatic activity of alpha-ga lactosidase was normal in this patient, lysoGb3 was elevated (3 N), and a rare heterozygous variant called c.610 T > C was documented in GLA gene. The patient was treated with an ACE inhibitor, with a rapid decrease in proteinuria. After a 5-year follow-up, her renal function has remained normal, with mild proteinuria, and normal cardiac echography. Conclusions We report and phenotypically describe the first case of a Fabry disease female patient carrying the GLA c.610 T > C variant associated with a renal-predominant clinical presentation.
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Affiliation(s)
- Sophie Greillier
- AP-HM, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille, France
| | - Laurent Daniel
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France.,AP-HM, Laboratoire d'Anatomie Pathologique, CHU de la Timone, Marseille, France
| | - Catherine Caillaud
- Laboratoire de Biochimie, Métabolomique et Protéomique, AP-HP. Centre-Université de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Bertrand Dussol
- AP-HM, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Guy Touchard
- Laboratoire d'Anatomie Pathologique, CHU de Poitiers, Poitiers, France
| | | | - Noémie Jourde-Chiche
- AP-HM, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Mickaël Bobot
- AP-HM, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille, France. .,Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France.
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Bobot M, Thomas L, Moyon A, Fernandez S, McKay N, Balasse L, Garrigue P, Brige P, Chopinet S, Poitevin S, Cérini C, Brunet P, Dignat-George F, Burtey S, Guillet B, Hache G. Uremic Toxic Blood-Brain Barrier Disruption Mediated by AhR Activation Leads to Cognitive Impairment during Experimental Renal Dysfunction. J Am Soc Nephrol 2020; 31:1509-1521. [PMID: 32527975 DOI: 10.1681/asn.2019070728] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [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: 07/23/2019] [Accepted: 03/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uremic toxicity may play a role in the elevated risk of developing cognitive impairment found among patients with CKD. Some uremic toxins, like indoxyl sulfate, are agonists of the transcription factor aryl hydrocarbon receptor (AhR), which is widely expressed in the central nervous system and which we previously identified as the receptor of indoxyl sulfate in endothelial cells. METHODS To characterize involvement of uremic toxins in cerebral and neurobehavioral abnormalities in three rat models of CKD, we induced CKD in rats by an adenine-rich diet or by 5/6 nephrectomy; we also used AhR-/- knockout mice overloaded with indoxyl sulfate in drinking water. We assessed neurologic deficits by neurobehavioral tests and blood-brain barrier disruption by SPECT/CT imaging after injection of 99mTc-DTPA, an imaging marker of blood-brain barrier permeability. RESULTS In CKD rats, we found cognitive impairment in the novel object recognition test, the object location task, and social memory tests and an increase of blood-brain barrier permeability associated with renal dysfunction. We found a significant correlation between 99mTc-DTPA content in brain and both the discrimination index in the novel object recognition test and indoxyl sulfate concentrations in serum. When we added indoxyl sulfate to the drinking water of rats fed an adenine-rich diet, we found an increase in indoxyl sulfate concentrations in serum associated with a stronger impairment in cognition and a higher permeability of the blood-brain barrier. In addition, non-CKD AhR-/- knockout mice were protected against indoxyl sulfate-induced blood-brain barrier disruption and cognitive impairment. CONCLUSIONS AhR activation by indoxyl sulfate, a uremic toxin, leads to blood-brain barrier disruption associated with cognitive impairment in animal models of CKD.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistnce Publique - Hôpitaux de Marseille, Marseille, France .,Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Laurent Thomas
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Anaïs Moyon
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France.,Service de Radiopharmacie, Assistnce Publique - Hôpitaux de Marseille, Marseille, France
| | - Samantha Fernandez
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France
| | - Nathalie McKay
- Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Laure Balasse
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France
| | - Philippe Garrigue
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France.,Service de Radiopharmacie, Assistnce Publique - Hôpitaux de Marseille, Marseille, France
| | - Pauline Brige
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Laboratoire d'Imagerie Interventionelle Expérimentale, Aix-Marseille Université, Marseille, France
| | - Sophie Chopinet
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Laboratoire d'Imagerie Interventionelle Expérimentale, Aix-Marseille Université, Marseille, France.,Service de Chirurgie générale et transplantation hépatique, Hôpital de la Timone, Assistnce Publique - Hôpitaux de Marseille, Marseille, France
| | - Stéphane Poitevin
- Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Claire Cérini
- Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistnce Publique - Hôpitaux de Marseille, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Françoise Dignat-George
- Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistnce Publique - Hôpitaux de Marseille, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France
| | - Benjamin Guillet
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France.,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France.,Service de Radiopharmacie, Assistnce Publique - Hôpitaux de Marseille, Marseille, France
| | - Guillaume Hache
- Centre Européen de recherche en Imagerie Médicale, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille, France .,Centre de Recherche en Cardiovasculaireet Nutrition, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Marseille, France.,Pharmacie, Hôpital de la Timone, Assistnce Publique - Hôpitaux de Marseille, Marseille, France
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47
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Gondouin B, Bobot M. [Kidney Transplantation]. Nephrol Ther 2020; 16:1S15-1S18. [PMID: 32241525 DOI: 10.1016/s1769-7255(20)30073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- B Gondouin
- Association Dialyse Provence Corse, 11 rue Jules Isaac 13009 MARSEILLE.
| | - M Bobot
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France; AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, 147 bld Baille, 13005 Marseille, France
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48
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Gondouin B, Bobot M. [Foundational research]. Nephrol Ther 2020; 16:1S13-1S14. [PMID: 32241524 DOI: 10.1016/s1769-7255(20)30072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- B Gondouin
- Association Dialyse Provence Corse, 11 rue Jules Isaac 13009 MARSEILLE.
| | - M Bobot
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France; AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, 147 bld Baille, 13005 Marseille, France
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49
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Gondouin B, Bobot M. Épidémiologie. Nephrol Ther 2020; 16:1S5-1S6. [DOI: 10.1016/s1769-7255(20)30070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Bobot M, Gondouin B. Dialyse. Nephrol Ther 2020; 16:1S1-1S4. [DOI: 10.1016/s1769-7255(20)30069-9] [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: 10/24/2022]
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