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Chronic kidney disease is often encountered in clinical practice, affecting between 8 and 16% of the world's population. Screening for CKD represents a major challenge for patients, given the increase in morbidity and mortality associated with the disease, as well as a public health issue in terms of slowing the progression to end-stage renal failure, which requires costly replacement treatments (dialysis and transplantation). The new KDIGO guidelines suggest aiming for optimal control of the cardiovascular risk factors associated with chronic kidney disease, in particular with the help of emerging treatments such as SGLT2 inhibitors. This article summarises the latest nephroprotection recommendations for primary care physicians., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Xenotransplantation could be an inexhaustible source of organs and change the life of end-stage kidney disease patients with reduction of morbidity and mortality. Through genetic engineering it is now possible to reduce the risk of hyperacute and acute graft rejection and improve the overall immune compatibility between two different species. Some experiments have already brought promising perspectives. Nevertheless, there are still difficulties to overcome. The risk of animal-related infectious diseases, ethnic limitations, safety, and applicability of large-scale xenotransplantation should be assessed. We still need to improve the technical aspects and define the purpose of these procedures: definitive replacement or temporary solution?, Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by recurrent arterial and venous thromboembolic events. Renal complications occur in 3 % of patients. Renal artery stenosis is the most common, and APS-related nephropathy is the predominant microvascular complication. APS nephropathy has heterogeneous manifestations ranging from hematuria and non-nephrotic range proteinuria to hypertension and multi-organ failure caused by catastrophic antiphospholipid antibody syndrome. Anticoagulation and thromboprophylaxis are key to management. Immunosuppression has been used with some success but lacks randomized controlled trial validation for their use., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

Molecules such as sparsentan and budesonide look promising to treat proteinuric IGA nephropathy. SLGT2 inhibitors have a prominent place in nephroprotection and could be used in the treatment of acute kidney injury due to heart failure as well. High volume hemodiafiltration compared to hemodialysis improves survival in dialysis patients. Lessening dialysate temperature does not improve hemodynamic stability during the dialysis session. Sodium bicarbonate does not seem to protect renal function in renal transplant patients. SGLT2 inhibitors may have a beneficial effect in these patients in terms of nephroprotection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In nephrology, rare disorders are frequently encountered. In children, about 60% of the renal disorders are rare, with congenital abnormalities of the kidney and urinary tract disorders (CAKUT), being highly prevalent. In adults, about 22% of the disorders leading to renal replacement therapies are rare and include glomerulonephritis and genetic disorders. Rarity may preclude the rapid and extensive access to care for patients suffering of renal disorders, especially in Switzerland, which is small and fragmented. Only collaborative network and access to databases, shared resources and to specific competence may help patient management. Lausanne and Geneva University Hospitals have started specialized outpatient clinics for rare renal disorders several years ago and are part of national and international networks., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic kidney disease (CKD) has a high prevalence in Cameroon and will become an important public health problem. Its management must be comprehensive, starting with CKD prevention to the implementation of renal replacement therapies best suited to the needs of patients and resources available in Cameroon. Practical interventions involving nephrology departments in both Africa and Europe can contribute to an improved management of CKD in Africa. The current collaboration between the Geneva University Hospitals and the Yaoundé teaching hospitals is a convincing example. It includes a clinical trial on the treatment of metabolic acidosis linked to CKD, assistance with the placement of hemodialysis catheters by sonography and the initiation of a kidney transplantation program with living donors., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Severe cases of IGA nephropathy might benefit from corticosteroid therapy. Inflimidase may be a promising treatment of Goodpasture disease. SGLT2 inhibitors and acetazolamide act synergistically with loop diuretics in the treatment of acute cardiac failure. In hemodialysis, use of lung ultrasound to determine the ultrafiltration seems to decrease hospitalizations due to acute heart failure but does not reduce patient-centered outcomes. Icodextrin may mitigate the loss of ultrafiltration in PD patients who are carriers of the Aquaporin I promotor TT genotype. MICA-antibodies have an impact on the risk of graft rejection. Xenotransplantation may become a reality., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Finerenone is a new mineralocorticoid receptor antagonist with a different structure, volume of distribution and half-life compared to spironolactone. This drug has been tested in two large, randomized trials including diabetic patients with chronic kidney disease (in terms of glomerular filtration rate and albuminuria) and already treated by renin-angiotensin system blockade. Results are positive on hard renal- and cardiac endpoints. Risk of hyperkalaemia is higher than with placebo but is considered as acceptable. An open question that will be tested in further studies is the role of finerenone in the context of a treatment by gliflozins, drugs that also showed cardiorenal protection., Competing Interests: Pierre Delanaye et Sophie de Seigneux déclarent des conflits d’intérêts avec AstraZeneca et Bayer.

Acute interstitial nephritis is characterized by renal inflammation and interstitial edema. The clinical presentation is pauci-symptomatic and often non-specific. Acute interstitial nephritis typically presents with acute renal failure, alone or with fever, eosinophilia, hematuria, sterile pyuria and small range proteinuria. An early diagnosis is crucial to prevent the morbidity and mortality associated with renal function decline. The most frequent etiology of this disease is drug-induced. A kidney biopsy is not systematically required to establish the diagnosis. It should be considered in the absence of renal function improvement 5 to 7 days after withdrawal of the causal agent. Although the benefits of glucocorticoid treatment have not been proven to date, its use may be associated with a better kidney function recovery., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Major advances in the treatment of nondiabetic chronic nephropathy and ANCA associated-renal vasculitis were published within the past two years. A new formula for assessing GFR was developed that does not take ethnicity into account. For hemodialysis patients, hemodiafiltration does not diminish uremic neuropathy. In hemodialysis patients, DOACs induce less bleeding than K vitamin antagonists. Weaning of steroids should be more rapid in some transplant patients. COVID-19 vaccination is less effective in dialysis and transplant patients and will necessitate a third dose., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

SGLT2 inhibitors (SGLT2i) will change the clinical practice of nephrology with their therapeutic cardiorenal and antidiabetic properties. By inhibiting proximal tubular sodium and glucose reabsorption, these new drugs decrease intraglomerular pressures. Over the last 5 years several breakthrough studies have demonstrated the SGLT2i protective effects on outcomes such as cardiovascular mortality, hospital admission for heart failure, sustained decreases in eGFR in patients with diabetic nephropathy and the development of ESKD. With the new DAPA-CKD study revealing protective effects of SGLT2i in CKD patients without diabetes, therapeutic recommendations will now have to evolve towards including these drugs in the chronic management of all most proteinuric CKD patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

IgA nephropathy is the most common primary glomerulopathy worldwide. However, it remains underdiagnosed because of its clinical heterogeneity. Its diagnosis is currently based on kidney biopsy and there are no clinically validated serological tests. Its pathogenesis is based on an anomaly in the glycosylation of type A immunoglobulins and a progression punctuated by multiple triggering events (hits). The conservative approach of using corticosteroid therapy and/or more selective immunosuppression in certain clinical situations remains the state-of-the-art treatment. New therapeutic perspectives seem promising but must be validated., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Impact of gliflozines in the treatment of non-diabetic nephropathies and cardiac failure has lately been demonstrated. Tolvaptan has now been recognized in Switzerland as a treatment of hyponatremia. In hemodialysis, some progress has been made in the management of dysfunctional arterio-venous fistulas. A glimmer of hope in the treatment of uremic pruritus? Conservative management of a stable coronary heart disease is also advocated in patients with end-stage kidney disease. Therapy with immune cells may either minimize or remove the need for immunosuppression in renal transplant patients. A new predictive score combining several markers can predict long-term graft failure., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Cheap and easy to access, ethylene glycol is used in the synthesis of antifreezes. Intoxication has potentially irreversible morbid consequences. Ingestion of a small amount can lead to death. Due to its ubiquitous distribution and potential complications, it is of paramount importance for the practitioner to recognize its manifestations and metabolic complications in order to implement its therapy in partnership with the nephrologist and the intensivist. A successful treatment depends on rapid and multidisciplinary management, as reviewed in this article., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Impact of gliflozines and rituximab in the treatments of diabetic and membranous nephropathies respectively has been confirmed. Roxadustat may be the new promising treatment of renal anemia. Long-acting erythropoietins may be associated with a higher death rate than short-acting ones in hemodialysis patients. Kidneys of HCV-seropositive donors can be proposed to any wait-listed patient for renal transplantation. Immunosupression minimizing the use of calcineurin inhibitors may be achieved with an everolimus-based protocol., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Crystalloid-type solutions are currently recommended for volume resuscitation. Although historically considered as « physiological saline », NaCl 0.9 % has a high concentration of sodium and chloride that can lead to metabolic acidosis and impaired renal function when large volumes are used. Recent evidence confirms that use of low-chloride crystalloids (so-called balanced solutions) could reduce the occurrence of renal failure and should be preferred during high volume resuscitation., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Diabetic nephropathy is a leading cause of chronic kidney disease and dialysis. We know that a good diabetes control slows the progression of kidney disease, but the risk of hypoglycemia is greater in patients with chronic kidney disease and contributes to their mortality. Chronic kidney disease and diabetes are major cardiovascular risk factors with additive effects. Decreasing cardiovascular mortality is a major aim in chronic kidney disease. The ideal antidiabetic molecule in these patients should reduce the risk of dialysis, reduce cardiovascular mortality and carry no risk of hypoglycaemia. This article aims to summarize for the general practician the nephrological implications of new antidiabetic drugs and their use in chronic kidney disease patients., Competing Interests: Les auteurs n’ont pas déclaré de conflit d’intérêts en relation avec cet article.

Metformin is the first line therapy for patients with diabete type 2. However, the molecule is known to be responsible for lactic acidosis through its inhibition of the mitochondrial respiratory chain complex, a pathology called MALA (metformin associated lactic acidosis). This complication has been widely discussed in the literature because its development is usually the result of a multifactorial and complex process. As the mortality of MALA is potentially high, a good knowledge of the physiopathology, existing treatments and predisposing factors is necessary for the primary care physician., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Major advances in the treatment of ANCA associated-renal vasculitides, IGA nephropathy and renal autosomal dominant polycystic disease were published within the past year. There is neither clear benefit of early initiation of renal replacement therapy in the intensive care unit nor with the use of chloride-poor solutions to prevent kidney failure. Maintenance parenteral iron supplementation in hemodialysis patients is neither associated with infectious nor cardiovascular risks. Cognitive decline may be more associated with hemodialysis than peritoneal dialysis. In transplantation, the persistence of complement-binding donor-specific antibodies after treatment is predictor of graft loss. Tocilizumab is a promising treatment for chronic antibody-mediated rejection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic kidney disease (CKD) usually goes unrecognized for patients until late symptomatic stages. In preterminal CKD, extrarenal substitution methods are usually presented to patients. This is felt like a breakdown, implying major modifications of everyday life. Acquisition of health literacy is necessary for patients with CKD to become autonomous and increase their empowerment toward the disease. Therapeutic education in nephrology plays a major role in improving the care of CKD patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

New antidiabetic drugs which slow effectively the course of diabetic nephropathy are now available. There is no benefit of prophylactic hydratation to prevent contrast nephropathy in patients with moderate chronic kidney disease. In elderly hemodialysis patients, hemodiafiltration seems better tolerated than conventional hemodialysis, although there is a similar dialysis-induced myocardial stress with both methods. Role of de novo donor-specific antibodies is better characterized, which may subsequently lead to new treatments of graft rejection.

Hyperphosphatemia is a late complication of chronic kidney disease (CKD). It is a major non-traditional cardiovascular risk factor in CKD. The management of hyperphosphatemia is based on restriction of phosphate intake, phosphate binders and dialysis. Phosphate binders are divided into calcium-based and non-calcium-based binders. Recent evidence suggest restricting the dose of calcium-based phosphate binders because of the associated increased mortality in compared to non-calcic ones. New treatments are under development such as inhibitors of kidney or intestinal phosphate absorption. These therapies could improve patients' compliance.

The first treatment which slows the course of polycystic kidney disease is now available in Switzerland. There is no benefit of immunosuppression when treating IgA nephropathy. Rituximab has been proved effective in the treatment of membranous nephropathy. When to start renal replacement therapy in acute kidney injury ? The debate still continues. In selected patients with end-stage renal failure, starting with twice a week hemodialysis is a desirable option. Peritoneal dialysis can be considered in frail patients. Better being transplanted with a HLA-incompatible living donor than to be on the waiting list. Immunosuppression without a calcineurin inhibitor is a potential immunologic hazard even for stable transplants. Long-term results of belatacept-based immunosuppression instead of cyclosporin showed better graft and patient survival but more acute rejection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Suspected renal inherited disorders are regularly evaluated in nephrology consultations both in adults and children. A positive family history and/or a typical phenotype should lead to genetic investigations. A confirmatory diagnosis integrated in a multidisciplinary genetic counseling approach gives patient guidance for further pregnancy. It also allows physician to better stratify disease risk and indicates treatment in some cases. The time to diagnosis and costs have been dramatically reduced thanks to next generation sequencing in several cases of complex inherited nephrologic syndromes.

Sodium chloride 0.9%, often incorrectly called physiological saline, contains higher concentration of chloride compared to plasma. It is known that the administration of sodium chloride 0.9% can cause hyperchloremic metabolic acidosis in a reproducible manner. The elevated chloride concentration in 0.9% NaCl solution can also adversely affect renal perfusion. This effect is thought to be induced by hyperchloremia that causes renal artery vasoconstriction. For these reasons, the use of 0.9% NaCl solution is raising attention and some would advocate the use of a more "physiological" solution, such as balanced solutions that contain a level of chloride closer to that of plasma. Few prospective, randomized, controlled trials are available today and most were done in a perioperative setting. Some studies suggest that the chloride excess in 0.9% NaCl solution could have clinical consequences; however, this remains to be established by quality randomized controlled trials.

Isotonic saline and buffered crystalloid solutions may carry an equivalent risk of acute kidney injury in critically ill patients. In hemodialyzed patients, highly dialyzable beta-blockers are less cardioprotective than non-dialyzable beta-blockers, cooling the dialyzate may protect their cerebral white matter and too much parenteral iron may be deleterious. A promising treatment for amyloid deposits is underway. A well tolerated treatment for hyperkalemia has emerged. Low serum magnesium and diminished phosphaturia may be associated with an increased risk of chronic kidney disease. Moderate hyponatremia should be considered as a serious public health problem.

ANCA-associated vasculitis are systemic disorders characterized by inflammation predominantly involving small vessels. They are the most frequent cause of rapidly progressive glomerulonephritis in the elderly. They originate from complex interactions between genes and environment, resulting in autoimmunity and the generation of antibodies directed against neutrophil cytoplasmic antigens (ANCA), which may have pathogenic potential. Immunosuppressant agents, particularly cyclophosphamide, have considerably improved the prognosis, but infectious complications and relapses remain frequent. Recently, rituximab has been shown to be a good alternative to cyclophosphamide to induce remission. Additional knowledge should result in better clinical outcomes, minimizing side effects.

Vasopressin antagonists show for the first time a beneficial effect on ADPKD cyst growth and renal function in a large cohort of patients. In ANCA vasculitis, the 18 months follow-up of Rituximab treatment for induction confirms the safety and efficacy of this therapeutic option. Two studies brought some answers to what is the more appropriate intravenous fluid strategy to decrease the incidence of acute kidney injury in critically ill patients. Regarding mortality in dialysed patients, inconclusive results about the use of calcimimetics to decrease cardiovascular mortality have been reported but there is good evidence that hemodiafiltration with high ultrafiltration volume can decrease significantly the mortality in these

Diabetes has a constantly growing prevalence and leads to a number of complications such as diabetic nephropathy. A systematic screening and an adapted management are needed to limit the renal and also the cardiovascular complications linked to diabetic nephropathy. An adequate glycemic and tensional control and control of proteinuria are the priority in the care of diabetic nephropathy. Other aspects such as phospho-calcium balance, lipid panel or lifestyle changes are also important and therefore a multidisciplinary approach is essential. A better understanding of the physiopathology may lead to even more effective treatments in the future. We resume in this article the actual management of a patient suffering from diabetic nephropathy and the future treatment perspectives.

Pathological proteinuria is a sign of renal disease, either tubular or glomerular. Proteinuria is considered as a major renal and cardiovascular risk factor Screening, and quantification of proteinuria is part of the care of chronic kidney disease (CKD) patients, but also of high renal risk patients and high cardiovascular risk patients. CKD is now classified according to estimated GFR and proteinuria to improve prediction of adverse events. in this article, we summarize the pathophysiology of proteinuria, its clinical qualification and implications.

Kidney transplant recipients are a growing population in ambulatory care. Medical follow up after the first post transplant year requires a tight collaboration between transplant centers, primary care physicians and community nephrologists. Although kidney transplantation is the treatment of choice for patients in end stage renal failure, no major improvement has been seen in long-term patient and graft survivals. Mortality of kidney transplant recipients remains higher than that of the general population, due to the high incidence of cardiovascular disease, infection and malignancies related to progressive renal failure and also to immunosuppressive treatment. We review here the optimal ambulatory medical care needed by these patients after the first post transplant year.