Nephrologie & therapeutique最新文献

Introduction: Primary hyperoxalurias (PH) are rare and serious genetic diseases. Their prognosis is improved with early medical management. However, diagnosis often occurs at the end-stage of renal failure. To understand this delay, collecting real-world data on the clinical practices of nephrologists may be helpful.

Materials and methods: Between October 2021 and October 2022, a retrospective survey was conducted in France among 76 nephrologists to assess management practices for patients with chronic kidney disease (CKD) of unknown aetiology, associated with urinary lithiasis and/or nephrocalcinosis. Data on patient profiles, tests conducted, diagnoses considered, and management of suspected PH cases were collected.

Results: 97% of patients (n = 386/400) underwent a renal examination, 92% (n = 370/400) a thorough urinary check-up, and 65% (n = 260/400) had an interpretable oxaluria value from a 24-hour urine sample (Uox24h). Of these 260 patients, 50% (n = 130/260) had Uox24h > 500 µmol/24 h: 23% (n = 30/130) were suspected of PH by the nephrologists, and 15% (n = 19/130) were referred for genotyping. Considering all criteria, 52 patients were suspected of PH (42% of whom did not have Uox24h > 500 µmol/24 h), and 33% (n = 17/52) were not referred for genotyping.

Discussion: The survey highlights nephrologists' adherence to recommendations for prescribing biological tests. However, in cases of hyperoxaluria or suspected PH, genotyping was not always prescribed. The barriers to this prescription need further exploration.

Acute kidney injury is a common drug adverse reaction and may concerned antibiotics. We report a case of an acute renal failure due to amoxicillin occurring twice in the same patient. Two mechanisms have been described for amoxicillin, with an immuno-allergic origin observed in our case. The diagnosis, supported by kidney biopsy, was confirmed by rechallenge with this patient.

Introduction: Primary hyperoxalurias (PH) are rare and serious genetic diseases. Their prognosis is improved with early medical management. However, diagnosis often occurs at the end-stage of renal failure. To understand this delay, collecting real-world data on the clinical practices of nephrologists may be helpful.

Materials and methods: Between October 2021 and October 2022, a retrospective survey was conducted in France among 76 nephrologists to assess management practices for patients with chronic kidney disease (CKD) of unknown aetiology, associated with urinary lithiasis and/or nephrocalcinosis. Data on patient profiles, tests conducted, diagnoses considered, and management of suspected PH cases were collected.

Results: 97% of patients (n = 386/400) underwent a renal examination, 92% (n = 370/400) a thorough urinary check-up, and 65% (n = 260/400) had an interpretable oxaluria value from a 24-hour urine sample (Uox24h). Of these 260 patients, 50% (n = 130/260) had Uox24h > 500 µmol/24 h: 23% (n = 30/130) were suspected of PH by the nephrologists, and 15% (n = 19/130) were referred for genotyping. Considering all criteria, 52 patients were suspected of PH (42% of whom did not have Uox24h > 500 µmol/24 h), and 33% (n = 17/52) were not referred for genotyping.

Discussion: The survey highlights nephrologists' adherence to recommendations for prescribing biological tests. However, in cases of hyperoxaluria or suspected PH, genotyping was not always prescribed. The barriers to this prescription need further exploration.

Introduction: Iron deficiency (ID) is common in patients with chronic kidney disease (CKD) but remains under-diagnosed and its prognosis poorly documented in the absence of anemia. The aim of the study was to assess the relationship between ID and the risk of major adverse outcomes in patients with CKD.

Methods: Using data from the French Chronic Kidney Disease - Renal Epidemiology and Information Network (CKD-REIN) cohort which included and followed over five years, 3,033 patients with CKD stages 2 to 5 CKD, we estimated the prevalence of ID, defined by a ferritin level < 100 μg/L and/or a transferrin saturation < 20%, and associated hazard ratios (HR) of kidney failure with replacement therapy, kidney failure defined by an eGFR < 15 mL/min per 1.73 m2 or initiation of kidney replacement therapy, all-cause mortality, and death or hospitalization for heart failure.

Results: Baseline prevalence of ID in the cohort (66% men; mean age 67 ± 13 years) was 50% (48-52). Mean hemoglobin was 13 ± 1.7 g/dL, and only 31% of patients with ID also had a hemoglobin < 12 g/dL. In 2,803 patients with CKD stages 2-4 at baseline, ID was associated with significant increased risk of kidney failure, and of kidney failure with replacement therapy, with HRs adjusted for confounders and hemoglobin level of 1.22 (1.03-1.45) and 1.57 (1.27-1.94), respectively. Adjusted HRs for all-cause mortality and hospitalization or death for heart failure, were 1.31 (1.04-1.66) and 1.38 (1.07-1.80), respectively.

Conclusion: This study shows that ID is significantly associated with the risk for kidney failure, all-cause mortality, and heart failure, independent of the presence of anemia.

Introduction: Sleep and mood disorders are common in hemodialysis, but the effect of light therapy remains unknown in this population.

Methods: We conducted a randomized, controlled, open-label pilot trial comparing two group of either 30 minutes of light therapy three times a week, or no exposure. The primary endpoint was change in sleep quality (PSQI) after five weeks of light therapy, with change in mood (DASS-21) as a secondary endpoint. We added the description of the same criteria in a prospective, non-randomized, real-life post-trial cohort.

Study results: We included 28 analyzable patients in the pilot study. Light therapy had no significant effect on PSQI reduction (p = 0.496). There was a trend towards a reduction in depression (-6.2 [95% CI, -12.5 to -0.05], p = 0.058). In the real-life cohort, out of 27 patients, 12 had a significant reduction in depression score (≥ 6 points).

Discussion: Light therapy performed in hemodialysis three times a week appears to have no effect on sleep quality, but could reduce depressive states. The technique is easy to implement, well tolerated and inexpensive. A multicenter randomized trial against the sham device will be needed to validate its effect on depression.

Introduction: Congenital anomalies of the kidney and the urinary tract are a major cause of chronic kidney failure in children. Prevalence in paediatrics varies according to studies. The data being rare in the ivorian context, this study aims to describe these defects' epidemiological, clinical, therapeutic and evolutionary aspects in children in a reference hospital setting.

Methods: We performed a retrospective and descriptive study held in the Yopougon's Teaching Hospital Pediatric Nephrology Unit from December 1st 2008 to December 31st 2020. It involved 152 children aged 0 to 15 years, admitted to the unit, with a congenital anomaly of the kidney and the urinary tract diagnosed with radiology.

Results: Socio-demographic characteristics: congenital anomalies of the kidney and urinary tract's prevalence was 11%. The median age at admission was 36 months. The median age at diagnosis of malformative uropathy was 17.5 months. The sex ratio (M/F) was 2.3. Clinical characteristics: posterior urethra valves were the most common malformative uropathy (38%). Malformative uropathy was associated with other defects in 4% of cases. The antenatal diagnosis involved 24% of patients. The average gestational age of discovery was 32 weeks of amenorrhea. In the postnatal period, abdominal pain was the main circumstance for discovery (39%). Therapeutic characteristics: surgery was indicated in 58% of patients and performed in 64% of cases. Evolutionary characteristics: evolution was better in patients who had received surgical treatment (asymptomatic in 83% of cases, occurrence of urinary tract infection in 35% of cases and chronic renal failure in 23% of cases). 72% of the study population was lost.

Conclusion: In Côte d'Ivoire, malformatives uropathies are late-discovered and are dominated by posterior urethra valves. Knowledge and management of these renal and urinary tract defects deserve to be improved through the development of antenatal diagnosis and training of practitioners in early recognition of clinical signs. The high rate of lost patients must be reduced by the implementation of an active patients' follow-up system.

Medical education in France has undergone several major reforms in recent years. In 2017, the reform of the third cycle of medical studies was implemented. This particularly affected nephrology. The reform introduced a new status of “junior doctor”. Its main objective is to ensure the transition from intern to senior doctor.The “Syndicat National des Internes de Néphrologie” (SNIN) conducted a survey to take stock of this new status in our specialty. The respondents were contacted through their city referents.We received 53 completed questionnaires from Nephrology junior-doctors with an average age of 29 years from all over France. The choice of assignment was satisfactory in 93% of cases. The activity of these juniors-doctors was mainly oriented towards clinical nephrology or was mixed, with the possibility of own consultations for almost all residents. The on-call or nightshift activity of the junior-doctors was mainly concentrated in their home department, with only one third of them working as substitute. Their weekly working hours were substantial (mostly between 45 and 65 hours/week), with a significant number exceeding the legal limit. Overall, supervision was considered satisfactory. Very few residents had time for research or theorical-learning, although some gave lessons and received training mainly through conferences. Progress in performing renal biopsies was substantial, in contrast to central venous catheter placement and peritoneal dialysis management, where progress was judged to be weak.