Search

Finerenone, a new nonsteroidal mineralocorticoid receptor antagonist, showed a significant reduction in a primary composite renal outcome in FIDELIO-DKD and a significant reduction in a primary composite cardiovascular outcome in FIGARO-DKD in patients with type 2 diabetes (T2D) and a chronic kidney disease (CKD). In a subsequent analysis that combined these two clinical trials (FIDELITY), the reduction becomes statistically significant when compared to placebo for both outcomes, with a hazard ratio of 0.86 (95 % confidence interval 0.78-0.95; P = 0.0018) for the cardiovascular outcome and 0.77 (0.67-0.88; P = 0.0002) for the renal outcome. Furthermore, all renal events occurred less frequently with finerenone than with placebo, including the progression to end-stage CKD independently of the baseline levels of glomerular filtration rate and albuminuria and regardless of associated medications (including gliflozins). The safety profile was excellent. However, a significant increase in serum potassium level was observed. Even if it is less pronounced than the increase usually seen with spironolactone, the risk of hyperkalemia requires some caution regarding both patient selection and monitoring. Finerenone (Kerendia®) is indicated in the treatment of CKD with albuminuria in adult patients with T2D. In Belgium, it is reimbursed with conditions in combination with a renin-angiotensin blocker.

Résumé La vitamine D et ses analogues actifs font partie du traitement de base contre l’hyperparathyroïdie secondaire (HPTS) chez les patients avec une maladie rénale chronique (MRC). Toutefois, la justification de la prescription de ces analogues actifs de la vitamine D dans la MRC est souvent remise en question du fait d’un nombre réduit et ancien d’essais cliniques contrôlés randomisés prouvant la supériorité de ce traitement contre placebo, notamment sur des critères durs. Il n’existe pas non plus d’essais cliniques comparant tête-à-tête les différents analogues actifs de la vitamine D. La supplémentation en vitamine D nutritionnelle, ainsi que les activateurs du récepteur de la vitamine D (VRDA) font également l’objet d’un intérêt croissant en tant que stratégie de prévention et de traitement de l’HPTS, ainsi qu’en raison de ses effets bénéfiques sur le système immunitaire, la sensibilité à l’insuline, le contrôle de l’inflammation, de l’albuminurie et de l’hypertrophie ventriculaire gauche. Cependant, d’autres études contrôlées sont nécessaires afin de répondre aux nombreuses questions ouvertes et des incertitudes relatives aux effets des VDRA et de la vitamine D nutritionnelle sur des critères durs, tels que le risque de fracture squelettique et de mortalité, ainsi que pour comparer les VDRA aux calcimimétiques dans le contexte de la MRC. Le présent article revisite ces interrogations tout en se concentrant sur les questions ouvertes que les néphrologues devraient se poser avant de débuter un traitement par vitamine nutritionnelle ou par un VDRA. Secondary hyperparathyroidism (SHPT) is one of the most frequent and deleterious complication of chronic kidney disease (CKD). SHPT is also one of the principal components of the now called CKD-mineral and bone disorders (MBD) syndrome. It is usually prevented and treated by vitamin D derivatives. However, the rationale for the prescription of vitamin D sterols in those patients is still a matter of hotly debates, mainly because of unsatisfactory results from numerous observational and not well-controlled studies. Scanty clinical data on head-to-head comparisons between the multiple vitamin D sterols are currently available. Moreover, there is crescent expectations on nutritional vitamin D, as well as vitamin D receptor activators (VDRA), regarding their putative pleiotropic effects even in CKD patients, and the promising effects of VDRA against proteinuria and myocardial hypertrophy in diabetic CKD cohorts. Nevertheless, additional randomized controlled trials (RCT) are needed to answer to many open questions and incertitude considering the effect of nutritional vitamin D and VDRA on hard end points including the risk of skeletal fractures and of mortality in CKD patients. RCT comparing VDRA to calcimimetics in the control of SHPT are also needed in dialysis patients. The present review will visit these open questions that nephrologists should ask before starting a treatment by nutritional vitamin D or VDRA. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Introduction Le cyclophosphamide (CYP) a été utilisé pendant plus de 40 ans chez les patients atteints de syndrome néphrotique cortico-sensible (SNCS) à rechutes fréquentes (SNRF) ou présentant une corticodépendance (SNCD). Cependant, le succès à long terme du traitement par le CYP est difficile à prédire. Les objectifs de cette étude sont de déterminer les résultats à long terme du CYP et d’identifier les facteurs associés à une rémission prolongée. Méthodes Nous avons étudié rétrospectivement les données de 50 patients atteints de syndrome néphrotique idiopathique, traités par cyclophosphamide orale et suivis dans le service de pédiatrie depuis 8 ans. Les facteurs associés à une survie sans rechute ont été évalués par une analyse univariée. Résultats L’âge médian au moment de diagnostic était de 4,3 ans, et la médiane de suivi était de 1,7 an, l’âge médian au début du CYP était de 8 ans. Les patients ont reçu une dose cumulative médiane de 168 mg/kg. La rémission après CYP a été obtenue chez 38 % des patients. Le délai médian de l’arrêt de la corticothérapie depuis le traitement était de 3 mois. La survie cumulée sans rechute était de 56 % (28 patients), 52 % (26 patients), 48 % (24 patients), 38 % (19 patients), à 6 mois, 1 an, 2 ans, et plus de 2 ans respectivement. En analyse univariée, la survie sans rechute était associée à l’âge au début du traitement par CYP (la médiane était de 5 mois pour un âge < 8 ans et 41 mois pour un âge ≥ 8 ans ; p = 0,049), à la lésion histologique (6 mois pour LGM, 2 mois pour HSF ; p = 0,009), et semble être associée au type de syndrome néphrotique (36 mois pour SNRF, 4 mois pour SNCD et SNCR ; p = 0,068). L’âge au moment du diagnostic, le sexe et la dose cumulée de CYP n’ont pas d’association statistiquement significative. Conclusion Nos résultats suggèrent qu’une courte durée de CYP orale reste un traitement de deuxième ligne intéressant. En outre, des essais bien conçus sont nécessaires afin d’évaluer l’efficacité d’autres agents épargneurs de corticoïdes. Introduction Cyclophosphamide (CYP) has been used for over 40 years in patients with steroid-sensitive nephrotic syndrome (NSSS) presenting frequent relapses (NSRF) or steroid dependence (NSSD). However, the long-term success of treatment with cyclophosphamide is difficult to predict. The objectives of this study are to determine long-term outcomes of cyclophosphamide and identify the factors associated with sustained remission. Methods We retrospectively studied the data from 50 patients with idiopathic nephrotic syndrome, treated by oral cyclophosphamide and followed at service of pediatric for more than 8 years for idiopathic nephrotic syndrome and related factors for survival without relapse were evaluated by univariate analysis. Results The median age at the time of diagnosis was 4.3 years, and median follow-up time was 1.7 years with the median of 8 years at the first use of CYC. Patients had received a median cumulative dose of 168 mg/kg. At the end of follow-up, 38% of patients entered into remission after using CYC while 62% failed to respond and further relapses then occur. The median time of stopping corticosteroid therapy was three month. The survival without relapse was respectively 56% (28 patients), 52% (26 patients), 48% (24 patients), and 38% (19 patients), at 6 months, one year, two years and more than two years. In univariate analysis, the survival without relapse was related to the age at the moment of starting the therapy par CYC (the median was 5 months for an age < 8 years and 41 months for an age ≥ 8 years; P = 0.049), the type of nephrotic syndrome [36 months for SNRF, 4 months for NSSD and nephrothic syndrome steroid resistant (NSSR); P = 0.068], and the histological lesion (6 months for diffuse mesangial proliferation, 2 months for segmental glomerulosclerosis; P = 0.009). The age at the moment of diagnosis, the sex and the cumulative dose of CYC did not have significant influence. Conclusion The results presented in this study suggest the use of oral cyclophosphamide for short period remain second line effective therapy. Further well-designed trials are required to evaluate the efficacy of other steroid-sparing agents. [ABSTRACT FROM AUTHOR]

The inhibition of the renin-angiotensin system represents the first preventive treatment of the chronic kidney disease (CKD), especially in presence of albuminuria. Recently, sodium-glucose cotransporter type 2 inhibitors (SGLT2i, gliflozins) demonstrated a nephroprotective effect, first in patients with type 2 diabetes at cardiovascular risk, then in diabetic patients with CKD assessed by a reduction of the glomerular filtration rate (GFR) and albuminuria (CREDENCE with canagliflozin), and finally in patients with CKD and albuminuria, with or without diabetes (DAPA-CKD with dapagliflozin). EMPA-KIDNEY study compared the effects of empagliflozin 10 mg/day versus placebo in patients with CKD, with or without diabetes. In comparison with the two previous renal studies, this clinical trial randomised patients with a lower GFR (78 % of patients with GFR inferior to 45 mL/min/1.73 m²) and a lower level of albuminuria (20 % of patients without pathological albuminuria). EMPA-KIDNEY demonstrated a reduction by 28 % (p inferior to 0.001) of the primary composite outcome (progression of CKD or cardiovascular death) and of several renal endpoints, including the shift to terminal CKD (-33 %), independently of the presence of diabetes, and with a tolerance profile comparable to what is already known. EMPA-KIDNEY results reinforce the use of SGLT2is, in general, and of empagliflozin, in particular, in a broader population with CKD and, thus, the indication of this pharmacological class in nephrology in combination with inhibitors of the renin-angiotensin system.

Introduction. Albuminuria, an important marker of kidney damage, is still insufficiently studied in sub-Saharan Africa. By this study, we want to know the epidemiology of albuminuria in the town of Kaya in Burkina Faso.Methods. We conducted a cross-sectional study in the town of Kaya. Simple random sampling was done. It concerned all households with children 5-15 years old of urban area of the town of Kaya. Selected children or their parents were interviewed. Anthropometric measurements and urinary samples were performed. Results. Two hundred six children (113 girls and 93 boys) participated in the study. Albuminuria was found in 18 children whether 8.7% of cases. The mean systolic and diastolic blood pressures of children with albuminuria (107.2 ± 13.6 and 74.7 ± 11.4 mm Hg) were not significantly different from those of children without albuminuria (110.3 ± 14 and 73.1 ± 11.5 mmHg). Sociodemographic factors were not associated with the occurrence of albuminuria in children. Discussion. The prevalence of albuminuria in the strip involved nearly a tenth of children, which is important. Conclusion. The results of this study are a first population database of kidney disease in the country. The study should be completed by the identification of cases of persistent albuminuria in this population. [ABSTRACT FROM AUTHOR]

Résumé: Le syndrome néphrotique associe une forte albuminurie à une hypo-albuminémie et des anomalies du métabolisme des lipides, ces anomalies étant dues à des altérations des glomérules rénaux, primitives ou secondaires à des maladies générales, comme le diabète, les connectivites et certaines infections ou toxicités. La clinique est dominée par les œdèmes, mais le syndrome néphrotique peut s’aggraver avec le développement d’une hypertension artérielle, d’une insuffisance rénale, d’infections ou de thromboses. Le diagnostic repose sur la clinique et l’analyse des protéines urinaires (protéinurie des 24h, électrophorèse des protéines urinaires, dosage de l’albumine urinaire, immuno-fixations) en miroir de l’analyse des protéines sériques (électrophorèse, dosage de l’albumine sérique, immuno-fixations), bilans auxquels il faudra ajouter l’étude des lipides sériques (cholestérol total et LDL, triglycérides) et la détermination du débit de filtration glomérulaire par des dosages de créatinine. Les glomérulonéphrites primaires (sans étiologie évidente) devront être explorées par l’étude anatomopathologique de la ponction biopsique rénale, qui peut montrer des altérations glomérulaires plus ou moins graves et étendues avec parfois des dépôts d’immunoglobulines, de protéines du complément ou d’immuns complexes. Les formes infantiles sont généralement bénignes et répondent bien à la corticothérapie ; à l’inverse, chez l’adulte les atteintes sont plus souvent étendues et prolifératives, aggravant le pronostic rénal jusqu’à l’insuffisance rénale terminale candidate à la transplantation. Un syndrome néphrotique peut être découvert par la détection d’une protéinurie à la bandelette au cours des dépistages systématiques comme en médecine scolaire ou du travail, ou encore chez la femme enceinte où ce syndrome est fréquent en fin de grossesse. Une atteinte glomérulaire sera aussi recherchée chez les diabétiques, les patients atteints de lupus systémique, de purpura rhumatoïde ou d’amylose, ainsi que dans les cancers et leucémies, sans négliger les causes infectieuses et les causes iatrogènes de syndrome néphrotique. [Copyright &y& Elsevier]

Résumé: Introduction: L’albuminurie pathologique (>30mg/g) et/ou le débit de filtration glomérulaire bas (eDFG bas<60mL/min/1,73m2) constituent des facteurs de risque rénaux majeurs et augmentent le risque cardiovasculaire. À l’inverse, la relation entre risque coronarien et anomalies rénales et l’interaction avec la pression artérielle (PA) mal contrôlée est mal décrite dans la littérature. Patients et méthodes: Nous avons réalisé une étude transversale chez des patients de 40ans et plus ayant passé un examen de santé dans 11 centres IRSA entre 2006 et 2010. Les patients ont rempli un questionnaire, eu des prélèvements biologiques et un examen clinique. L’eDFG (MDRD) et l’albuminurie ont été mesurés, et le risque d’évènement coronarien à dix ans (selon Laurier) a été calculé. Résultats: La population était composée de 118 314 patients, dont 96 400 sans antécédent cardiovasculaire. Les patients avec un risque coronarien supérieur à 15 % avaient un sur-risque de eDFG inférieur à 60 (2,26 [1,82–2,78]) et d’albuminurie (OR : 6,87 [5,58–8,44]) versus ceux dont le risque était inférieur à 5 %. L’association entre risque rénal et classes d’hypertension était continue : les sujets ayant une PA supérieure ou égale à 180/110 avaient un OR de 7,75 [6,69–8,96] d’albuminurie pathologique, et de 1,33 [1,09–1,60] de eDFG inférieur à 60 (versus ceux à PA normale). Conclusion: Dans la population française, 9,1 % des patients ont un risque coronarien supérieur à 10 % à dix ans. Ce risque est associé à des anomalies de la fonction rénale. La relation entre risque coronarien et risque rénal, ainsi que la relation entre PA et risque rénal, sont continues et doses dépendantes. [ABSTRACT FROM AUTHOR]

Problematic and Objective: Masked arterial hypertension (MHTN) is a recently described entity that is associated with the same cardiovascular risk as permanent hypertension. Its prevalence is more frequent in patients with diabetes. The objective of this study is to assess the value of systematic screening for MHTN by 24-hour blood pressure monitoring in a population of type 2 diabetic patients by estimating its prevalence and looking for predictive factors of MHTN in this population., Methods: Through a prospective study, we recruited normotensive type 2 diabetics for clinical measurement, in whom we systematically searched for MHTN by performing an ambulatory blood pressure measurement (ABPM). The diagnosis of MHTN is established if: mean daytime BP ≥ 135/85 mmHg and / or, mean nighttime BP ≥ 120/70 mmHg and / or, mean 24 hour BP ≥ 130/80 mmHg. We then compared the two populations of MHTN (G1) and normotensive (G2) on clinical and laboratory parameters and we assessed end-organ damage in order to identify the predictive factors of MHTN., Results: We recruited 53 patients whose mean age was 55.3 ± 8.4 years (range 35-72 years) with a female predominance (53%). The duration of diabetes was on average 8.7 ± 3.9 years with extremes between 2 and 17 years. The average BMI of our patients was 28.2 ± 5.3 Kg/m2. Overweight was found in almost half of our patients (47.2%). Obesity was found in 32.1% of cases. Metabolic syndrome was found in 64.2% of patients. In our study, the prevalence of HTAM in type 2 diabetics was 64%. We also found that MHTN was more often nocturnal (58.5%) and occurred mainly in non-dipper patients. Left ventricular hypertrophy, microalbuminuria and arterial stiffness evidenced by pulse pressure greater than 60mmHg were more common in the MHTN group. For the predictive factors of MHTN, we were able to collect in univariate analysis the following factors: duration of diabetes, fasting blood sugar, weight and microalbuminuria. In multivariate analysis, the predictive factors that emerged in our study are poor glycemic control (HbA1c ≥7%), high BMI and duration of diabetes., Conclusion: MHTN should be sought in diabetics because it allows a better assessment of the cardiovascular risk, in particular by identifying end-organ damage., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Abstract: The aim of this work was to evaluate the influence of dietary sodium restriction on metabolic and renal changes associated with insulin resistance. At 8weeks of age, rats received either a diet containing 60% fructose with or without sodium or a standard diet for 12weeks. The insulin resistance and albuminuria induced by the high fructose diet were associated with a fibrosis and increase in oxidative stress in the kidney. The low salt diet prevented insulin resistance, renal fibrosis and albuminuria induced by the fructose diet. These beneficial effects on the kidney were associated with a decrease in kidney NADPH oxidase activity. Oxidative status is probably one of the major targets of the favourable effect of salt restriction on renal changes associated with insulin resistance, without excluding the involvement of other mechanisms. [Copyright &y& Elsevier]

Abstract: Aim: Increased urinary albumin-excretion is a cardiovascular risk factor. The metabolic syndrome is associated with an increased risk of chronic kidney disease, cardiovascular disease and mortality. The aim of this prospective study was to explore the combined associations of microalbuminuria and metabolic syndrome with the risk of incident cardiovascular disease. Methods: The present study involved 78 patients with metabolic syndrome between May 1 and July 30 in 2009 from cardiology clinic of military hospital in Marrakech. They were followed for 1 year. The metabolic syndrome was defined according to the criteria of International Diabetes Federation (IDF). Microalbuminuria was defined as a urinary albumin excretion of 30 to 300mg/d. Results: The mean age was 56 years old. The prevalence of microalbuminuria was 38%. There was a significantly positive correlation between the number of components of the metabolic syndrome and the corresponding prevalence of microalbuminuria. Incidence rates of cardiovascular events were higher in the positive microalbuminuria group than the group without microalbuminuria, the difference was significant for composite criteria but not for each one probably because of the small size of effective and limited duration. Conclusions: There is a strong relationship between microalbuminuria and the metabolic syndrome. Microalbuminuria accounts for the increased risk of cardiovascular disease in patients with metabolic syndrome. [Copyright &y& Elsevier]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The objective of this review is to analyze the relationship between moderate decrease in renal function and cardiovascular (CV) risk and to discuss the potential mechanisms of this association. Prevalence of chronic kidney disease (CKD) is increasing in developed countries. Several studies have shown that a moderate fall in glomerular filtration (GFR) or the presence of microalbuminuria is associated with an increase in CV risk, independently of the traditional CV risk factors. Mechanisms are probably multiple and could include anemia, calcium/phosphate metabolism, inflammation, but also large arteries function. In order to achieve primary or secondary prevention of CV risk, DFG should be estimated from serum creatinine and microalbuminuria should be assessed in every high risk subject. The finding of CKD implies optimal management of all traditional CV risk factors. Future studies are needed in order to evaluate the efficacy and safety of specific therapeutic approach to reduce CV risk in CKD. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Multicystic kidney disease (MCKD) is the most common form of Congenital Abnormality of Kidney and Urinary Tract (CAKUT). This anomaly of renal development is characterized by unilateral enlarged cystic formations and fibrous dysplastic parenchyma. The long-term prognosis is usually good; however because of reduced nephron mass, an early prevention of cardiovascular risk and nephrotoxicity is recommended. A lifelong follow-up of blood pressure, serum creatinine and microalbuminuria seems logical as well as in other patients with a single kidney. MCKD is usually diagnosed during pregnancy so that parents often question about long-term prognosis and follow-up. Therefore, we propose an information sheet for parents. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recent populationbased studies suggest that chronic kidney disease (CKD) with low glomerular filtration rate is frequent. Elderly, patients with diabetes or cardiovascular disease are at higher risk of CKD. As CKD symptoms are scarce, prevention of anticancer drugs nephrotoxicity and active screening for renal abnormalities are essential. As the success of modern cancer treatment requires repeated drugs delivery, the cumulative risk of CKD linked with multiple causes is still increasing. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Nephrologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Microalbuminuria is a strong marker for progressive renal damage and an increased risk of mortality, especially from cardiovascular disease, in patients with type 1 or type 2 diabetes and hypertension. The benefits of blood pressure reduction in patients with diabetes and hypertension are well known and a range of treatments have been shown to be effective in reducing the microalbuminuria associated with diabetic hypertension. The PREMIER study compared the effects of 12 months' therapy daily with a combination treatment consisting of an ACE inhibitor (2 mg perindopril) plus a diuretic (0.625 mg indapamide) with those of daily ACE inhibitor monotherapy with 10 mg enalapril, in patients with type 2 diabetes and hypertension. The decreases in systolic and diastolic blood pressure produced by a low-dose combination perindopril/indapamide (PER/IND) (14.8 and 8.8 mm Hg, respectively) were significantly greater (systolic = −3.0 mm Hg [95% CI, −5.6, -0.4], p = 0.012 and diastolic = −1.5 mm Hg [95% CI, −3.0, −0.10], p = 0.019) than those produced by enalapril (12.3 and 7.3 mm Hg, respectively). The albumin excretion rate (AER) decreased significantly more with PER/IND (−42% [95% CI, −50% to −33%]) than with enalapril (−27% [95% CI, −37% to −16%]) giving an adjusted additional decrease of 24% (95% CI, −38% to −8%, p=0.002) for PER/IND. The effect of PER/IND on AER was independent of its effect on blood pressure. Recent guidelines recommend that combination therapy with a diuretic and an ACE inhibitor should be initiated early in diabetic hypertension. The results of the PREMIER study validate these recommendations and show that combination treatments such as PER/IND should be viewed as the most appropriate treatment for patients with diabetes and hypertension, particularly those with microalbuminuria. [ABSTRACT FROM AUTHOR]

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Both renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i, gliflozins) reduce the risk of heart failure and of progressing towards end-stage renal disease, especially in patients with type 2 diabetes (T2D). Positive results reported in patients with T2D have been confirmed in people without diabetes. These two pharmacological classes now occupy a privileged place in international guidelines, in diabetology, cardiology and nephrology. The present article describes similarities and differences between these two types of medications. It emphasizes the importance of combining both approaches in order to optimize the cardiovascular and renal prognosis, while maintaining a good safety profile.

Abstract: Management of acute pyelonephritis has long been discussed. The French drug agency (Agence Française de Sécurité Sanitaire des Produits de Santé [AFSSAPS]) has published guidelines for clinical practice in 2007: two to four days of initial parenteral antibiotic therapy followed by oral antibiotics, for a total duration of 10 to 14 days. However, recent data are conflictable and oral antibiotic therapy may be sufficient in some cases. Clinical trials on oral therapy of acute pyelonephritis in selected groups of children are currently ongoing. We suggest following AFSSAPS recommendations in clinical practice until the results of such trials become available. In the future, we can speculate that antibiotic therapy may be reduced in some low risk patients, keeping in mind that around 15% of children with acute pyelonephritis will develop renal scars which may lead to hypertension and microalbuminuria in adulthood. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by recurrent spontaneous episodes of hypovolaemic shock due to marked plasma shifts from the intravascular to the extravascular space. It presents as the characteristic triad of hypotension, haemoconcentration and hypoalbuminemia. Case report: We describe a patient with SCLS with recurrent lipothymia who presented first with delayed oedema that was thought to be due to orlistat treatment. On the second episode the patient was seen with a pulmonary hypertension when plasma came back into vessels. On the third time the characteristic triad led to the diagnosis of SCLS. Discussion: SCLS should be considered in the differential diagnosis of recurrent hypovolemic shock without identifiable cause. Nevertheless, symptoms may be restricted to sole lipothymia or transient oedema or delayed hypoalbuminemia rendering the diagnosis difficult. [Copyright &y& Elsevier]

Sodium-glucose cotransporter type 2 inhibitors (iSGLT2 or gliflozins) exert their antidiabetic action through a specific renal mechanism, by inhibiting tubular glucose reabsorption. These agents have proven their efficacy to reduce major cardiovascular events and hospitalisation for heart failure, but also the progression of chronic kidney disease (CKD), in patients with type 2 diabetes (T2DM) at high risk, independently of glucose control. While the glucose-lowering effect of iSGLT2 is decreasing with the decline of estimated glomerular filtration rate (eGFR), both cardiovascular and renal protections remain present until an eGFR as low as 30 ml/min/1,73 m². These effects were demonstrated in several meta-analyses and in two trials specifically dedicated to renal outcomes in patients with CKD and macroalbuminuria : CREDENCE with canagliflozin and Dapa-CKD with dapagliflozin. In addition, Dapa-CKD showed similar positive results whatever the presence or absence of T2DM. Safety profile of SGLT2is among patients with CKD is good and similar to that of patients with normal renal function. These favourable findings led to a privileged place of SGLT2i in recent international guidelines promoted by diabetologists, cardiologists and nephrologists. Current restrictive criteria for the prescription and reimbursement of SGLT2i in Belgium according to eGFR level (initiation only if eGFR superior to 60 and interruption if eGFR inferior to 45 ml/min/1.73 m²) should be enlarged very soon owing to convincing results of published controlled trials.

Objectives: The objective of this study was to assess the prevalence of albuminuria in sickle cell disease patients at the Campus University Hospital of Lome., Patients and Method: Albuminuria was assessed by the urinary albumin-to-creatinine ratio (UACR) in sickle cell disease individuals who attended the outpatient consultation in their steady state., Results: The prevalence of albuminuria was 21% (14/67). Albuminuria was more frequent (32% vs 13%, p=0,054) and occurred earlier (6 years vs 21 years) among the 28 SS/Sβ 0 -thalassemia sickle-cell diseases individuals than the 39 SC ones. Albuminuria was associated with high counts of leukocytes (p=0.033) and neutrophils (p=0.008). It was negatively correlated with hemoglobin level (p=0.032) and positively with LDH (p=0.002), SGOT (p=0.002), leukocytes (p=0.003), neutrophils (p< 0.001) and thrombocytes (p=0.010) counts for all sickle cell patients without statistical confirmation for each sickle cell phenotype apart from neutrophils in SS/Sβ 0 -thalassemia. Defining albuminuria as an UACR greater than 20 mg/g had a specificity of 100% and a sensibility and 90% when the UACR was compared to the 24-hours urines albumin quantification., Conclusion: The assessment of albuminuria should begin at age 5 years in SS/Sβ 0 -thalassemia sickle-cell anemia patients and from 20 years old in SC patients by the UACR.