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International audience; BACKGROUND AND AIMS: Patients with inflammatory bowel diseases (IBD) are exposed to drug-related nephrotoxicity and kidney-related extra-intestinal manifestations (EIMs). Patients should be monitored but guidance is lacking in current international recommendations. The objective of the Kidney Function Monitoring in Inflammatory Bowel Disease (MONITORED) initiative was to achieve an expert consensus about monitoring kidney function in IBD. METHODS: A literature review was first conducted. Then, an expert consensus meeting, involving 28 attendees representing French-speaking gastroenterologists and nephrologists, was held as part of an academic initiative on May 28, 2021. An anonymous Delphi process was used to discuss and vote on statements. Agreement was defined as at least 75% of participants voting for any one statement. RESULTS: Experts reached consensus on 11 criteria for referral to the nephrologist. Concerning kidney function monitoring, participants unanimously validated the use of serum creatinine with estimation of the glomerular filtration rate via the MDRD or CKD-EPI equations. A blood ionogram and a urine sample with measurement of a protein-to-creatinine ratio were also broadly agreed validated. Experts recommended performing this monitoring at IBD diagnosis, prior introducing a new treatment, and annually for EIMs screening and evaluation of treatment tolerance. An evaluation 3 months after starting mesalamine and then every 6 months was felt necessary, while for biologics an annually monitoring was deemed sufficient. CONCLUSION: The MONITORED consensus proposed guidelines on how to monitor kidney function in IBD. These recommendations should be considered in clinical practice to preserve kidney function and ensure the best approach to our patients.

Hypercalciuria is the main risk factor for recurrent calcium urolithiasis. The goal of our study is to determinate how useful an oral calcium load test is for stone formers to classify different forms of hypercalciuria in pathogenetic categories defined as renal or absorptive according to the current knowledge. Between June 2013 and February 2016, a prospective study was carried out on 117 documented recurrent hypercalciuric stone formers undergoing an oral calcium load test modified from the original description by Pak. After 2 days of calcium-restricted diet, urine and blood were analyzed at baseline and 120 min after receiving orally 1 g of calcium. Total and ionized calcium, parathyroid hormone from serum and urine calcium and creatinine were assessed in order to divide patients in three groups as previously described: resorptive, absorptive, and renal hypercalciuria. This allowed the identification of 19, 39, 34 and 33 patients with normocalcemic primary hyperparathyroidism (NPHPT), renal hypercalciuria aka renal calcium leak (RCL), absorptive hypercalciuria (AH) and unidentified cause, respectively. Patients with NPHPT (who required parathyroidectomy) experienced a lower PTH decrease (41.41 ± 12.82 vs. 54.06 ± 13.84% p 0.01), higher beta-crosslaps, as well as lower TmP/GFR and distal third radius bone mineral density. RCL resulted in increased fasting urine calcium-to-creatinine ratio (Uca/Cr), i.e., 0.37 mmol/mmol), without hyperparathyroidism. AH was diagnosed by the presence of ΔUCa/Cr 0.60 mmol/mmol between baseline and 120 min without any other anomaly. For all remaining patients, results were inconclusive due to the lack of sufficient increase in serum calcium or because the cause of lithogenesis could not be clearly identified. The oral calcium load test is useful in nearly 80% of patients by identifying the different forms of hypercalciuria causing urolithiasis and by guiding treatment, including parathyroid surgery.

Resume En 2017, la reforme du 3e cycle des etudes medicales a pose les bases de 3 nouvelles phases dans la formation des medecins : « socle », « approfondissement » et « mise en responsabilite ». Cette derniere a ete particulierement discutee puisqu’elle semble tres proche du statut d’assistant specialiste. La nephrologie, qui a toujours ete une discipline tres attractive, s’est vue maintenir sa maquette a 4 ans de formation lorsque de nombreuses autres specialites ont vu une augmentation de leur duree initiale. Une mobilisation generale de la specialite a amene a s’interroger sur les differents aspects de cette maquette. A travers 3 questionnaires menes conjointement entre les associations representatives des jeunes nephrologues et des nephrologues titulaires, nous avons interroge les principaux concernes afin de connaitre leurs souhaits actuels et ce qu’ils connaissaient de la reforme. Ces resultats originaux montrent un fort mecontentement de l’ensemble de la profession, quelle que soit la generation interrogee, mais aussi une volonte globale de modification de la formation. Une majorite de la communaute nephrologique s’accorde sur la necessite de l’extension de la maquette a 5 annees ; les plus jeunes sont egalement demandeurs de davantage de souplesse dans la formation via la creation d’options et de formations specialisees transversales. Dans tous les cas, les associations representatives des nephrologues doivent agir conjointement afin de porter leur voix et de diffuser l’information sur cette reforme.

Resume La maladie de Fabry est une maladie genetique systemique due a un deficit enzymatique en α-galactosidase A, provoquant une accumulation de sphingolipides dans les lysosomes. Il s’agit d’une maladie rare et peu connue. L’objectif de cette etude etait de decrire la formation des nephrologues, d’evaluer leurs connaissances ainsi que leurs habitudes de depistage et de prise en charge de cette maladie. Les reponses de 152 nephrologues ont ete analysees. Seulement 22 % suivent des patients atteints de maladie de Fabry et 18 % en ont deja fait le diagnostic eux-memes. Une majorite d’entre eux (76 %) juge leur formation insuffisante : ils connaissent les symptomes de facon incomplete. Les moyens deja mis en œuvre autour de la pathologie (associations, bases de recueil, etc.) semblent egalement insuffisants. Certaines indications de traitement sont mal maitrisees, notamment en ce qui concerne l’insuffisance renale terminale ; les principaux fournisseurs d’informations sont les industriels du medicament. Le calcul d’un score de competence a montre que l’atteinte renale est mal connue (moins de 50 % de reponses correctes) et seuls 50 % des medecins connaissent la conduite a tenir pour le depistage et la confirmation de la maladie. Une partie des interroges (65 %) connait bien les symptomes, les indications du traitement ainsi que les generalites de la maladie, mais des ameliorations restent a attendre. La maladie de Fabry demeure une maladie meconnue, pour laquelle il existe des outils diagnostiques precoces et des armes therapeutiques permettant de limiter la survenue des complications. La communaute nephrologique doit s’investir en termes de formations concernant les symptomes, le depistage et la prise en charge de cette maladie rare.

Resume Rationnel L’impact de l’insuffisance renale chronique (IRC) sur l’elan vital des patients non dialyses est mal connu, et la perception des patients peut etre differente de celle des medecins. Methodes Un auto-questionnaire a ete adresse a 1282 nephrologues et un second auto-questionnaire en « miroir » a ete transmis aux patients (stade 3, 4 ou 5) par leur nephrologue. Les donnees ont ete recueillies de facon prospective et anonyme. Resultats Au total, 261 nephrologues et 172 patients ont participe. Soixante-six pour cent des patients decrivaient un effet deletere de l’IRC sur leur qualite de vie (egalement identifie par les nephrologues) : impact evalue comme important pour 22 % vs 27 %, modere ou inconstant pour 44 % vs 47 %, faible ou nul pour 34 % vs 31 %, respectivement pour les patients et les nephrologues. La perception des facteurs favorisant un meilleur elan vital etait egalement differente, les nephrologues sous-estimant leur role (soutien psychologique) : l’optimisme et les encouragements des nephrologues etaient majeurs pour le maintien de l’elan vital pour 60 % des patients vs 20 % des nephrologues (p Conclusion Les nephrologues ont une connaissance relative de l’impact de l’IRC sur l’elan vital des patients atteints d’une IRC non dialyses, mais il existe des differences de perception. Elle pourrait etre amelioree au cours d’une formation specifique.

Acid-base regulation is essential to maintain homeostasis in humans. Carbonic acid/bicarbonate (H2CO3/HCO3-) couple is the most predominant extracellular buffer to keep plasma pH within a physiological range. The ability to (re)generate such a buffer is a key milestone that necessitates to understand a precise physiology of both renal tubule and digestive tract. Here, we first reviewed renal and digestive cycles of bicarbonate in physiology. We also reviewed pathological findings where acid-base disequilibrium is involved and nutritional and/or alkali therapy could be necessary. Secondly, data from clinical trials were synthesized. Alkali therapy, oral and parenteral, from mineral-based water, masterful preparations or pharmaceutics drugs, is regularly used in a wide range of clinical findings, even if supporting data are (often) of a low level of evidence. Bicarbonate is primarily used during contrast-induced nephropathy, metabolic acidosis in chronic kidney disease or nephrolithiasis in which alkaline urine is necessary. Cast nephropathy, rhabdomyolysis and tumor lysis syndrome make usually physicians prescribe alkali therapy even if this prescription is only supported by physiopathological data without any proven clinical results. Finally, bicarbonate is essential in the composition of dialysate in both hemodialysis and peritoneal dialysis.

Introduction Peu d’informations existent sur la prise en charge de l’hypoparathyroidie chronique en vie reelle. Notre objectif est d’etudier l’adequation des pratiques (suivi et objectifs du traitement) avec les recommandations internationales. Description Nous utilisons les donnees d’un sous-groupe (118 medecins et 107 patients, entre 09/2016 et 12/2019) de la e-cohorte francaise Epi-Hypo (> 1100 patients) et celles d’une enquete en ligne (110 ePatients, 11/2019). Les participants devaient etre : – medecin prenant en charge des patients avec hypoparathyroidie chronique ; – patient participant a la cohorte Epi-Hypo ; – patient de l’association Hypoparathyroidisme France (ePatients). Methodes Nous comparons les habitudes de prescriptions rapportees par les medecins participant a l’etude aux reponses des ePatients et aux resultats renseignes dans la cohorte Epi-Hypo pour la meme periode. Nous analysons ces resultats par rapport aux dernieres recommandations internationales. Resultats Endocrinologues et nephrologues representent 89 % des medecins mais d’autres specialites sont aussi impliquees. L’association vitamine D active/sels de calcium est donnee a 58-59 % des patients. La majorite (85-87 %) des medecins suit la calcemie au moins 2 fois/an a l’etat stable. Les recommandations internationales conseillent de controler les symptomes, les valeurs de calcemie, de phosphatemie et de calciurie : un controle simultane de tous ces facteurs est rapporte par 32 % des ePatients et 26 % des medecins. La majorite (80 %) des ePatients rapportent que leurs symptomes sont insuffisamment controles par le traitement en cours alors que leur suivi est similaire a ceux dont les symptomes sont controles. Leur traitement est similaire en dehors des sels de magnesium qu’ils recoivent plus frequemment que les autres. Conclusion De nombreuses specialites sont impliquees dans la prise en charge des patients avec hypoparathyroidie chronique en France : les recommandations devraient tous les cibler car l’adherence est encore faible. De nouveaux traitements sont necessaires pour mieux controler les symptomes.

Introduction Les recommandations internationales pour le diagnostic de SIAD n’ont pas retenu le test de charge hydrique par manque de donnees publiees. Notre objectif est d’evaluer l’interet de realiser un test de charge hydrique chez les patients avec un antecedent d’hyponatremie. Description Nous analysons retrospectivement les donnees de patients adresses en service specialise (Physiologie, HEGP, Paris). Ils ont recu une charge hydrique orale de 20 mL/kg en 30 minutes. Le diagnostic de SIAD est retenu si la natremie (PNa) est Methodes Nous comparons les donnees de patients ayant un SIAD avec PNa Resultats Parmi les 174 patients analyses, 21 (12 %) sont consideres comme normaux, 80 (46 %) ont un SIAD et 72 (42 %) une hyponatremie liee a une autre cause. Parmi les patients avec SIAD, 41 % sont ‘normonatremiques’ (PNa ≥ 135 mM) a jeun (apres 12 heures de restriction hydrique) : leurs donnees demographiques ne different pas des patients hyponatremiques a jeun. Leur PNa diminue en cours de test mais reste superieure a celle des patients hyponatremiques a jeun (132 ± 2 vs 127 ± 3 mM, p Conclusion Realisee en conditions calibrees (a jeun), la biologie ne permet pas le diagnostic de SIAD dans 41 a 63 % des cas. Le test de charge hydrique permet d’identifier un groupe de patients avec une anomalie d’excretion de l’eau, possiblement une forme plus moderee de SIAD.

Nephrolithiasis is a very common (prevalence around 10 to 12% in France) and recurrent disorder. Nephrolithiasis is associated to chronic kidney disease and is responsible for 2 to 3% of cases of end-stage renal disease, mainly if it is associated to nephrocalcinosis or to a monogenic disorder (1.6% of nephrolithiasis in adults, among them 1% of cystinuria). To understand the underlying pathophysiological processes, stone analysis (morphology and using infrared spectrophotometry) as well as minimal biological assessment including urine crystal research are required. The calcic nephrolithiasis is the more frequent subtype (>80%). Its medical treatment relies on simple dietary rules: non-alkaline hyperdiuresis>2 liters/day, calcium intake normalization (1 gram per day divided between the three principal meals), normalization of sodium (6 to 7 grams per day) and protein intake (1g/kg of theoretical body weight/day), and eviction of foods rich in oxalate. In case of persistent hypercalciuria (>0.1mmol/kg of theoretical body weight/day on free diet), a thiazide diuretic can be started while being aware to correct iatrogenic decrease in plasma potassium and urine citrate excretion. Measurement of bone mineral density must systematically be performed in patients with high 24 h-urinary calcium excretion. The medical treatment of uric acid nephrolithiasis relies on alkaline hyperdiuresis (goal of urine pH: 6.2 to 6.8). The use of allopurinol is justified only if urine uric acid is over 4mmol/day. Thanks to a well-managed preventive medical treatment, one can expect to stop the activity of nephrolithiasis in more than 80% of cases, making it one of the most accessible renal pathologies to preventive medical treatment.

Familial hypocalciuric hypercalcemia (FHH) is a genetically heterogeneous condition resembling primary hyperparathyroidism (PHPT) but not curable by surgery; FHH types 1, 2, and 3 are due to loss-of-function mutations of the CASR, GNA11, or AP2S1 genes, respectively.This study aimed to compare the phenotypes of patients with genetically proven FHH types 1 or 3 or PHPT.This was a mutation analysis in a large cohort, a cross-sectional comparison of 52 patients with FHH type 1, 22 patients with FHH type 3, 60 with PHPT, and 24 normal adults.There were no interventions.Abnormalities of the CASR, GNA11, and AP2S1 genes, blood calcium, phosphate, and PTH concentrations, urinary calcium excretion were measured.In 133 families, we detected 101 mutations in the CASR gene, 68 of which were previously unknown, and in 19 families, the three recurrent AP2S1 mutations. No mutation was detected in the GNA11 gene. Patients with FHH type 3 had higher plasma calcium concentrations than patients with FHH type 1, despite having similar PTH concentrations and urinary calcium excretion. Renal tubular calcium reabsorption levels were higher in patients with FHH type 3 than in those with FHH type 1. Plasma calcium concentration was higher whereas PTH concentration and urinary calcium excretion were lower in FHH patients than in PHPT patients. In patients with FHH or PHPT, all data groups partially overlapped.In our population, AP2S1 mutations affect calcium homeostasis more severely than CASR mutations. Due to overlap, the risk of confusion between FHH and PHPT is high.

Introduction Hyperphosphatemia and cardiovascular mortality are associated particularly with end-stage renal disease. Available therapeutic strategies (i.e., diet restriction, calcium [or not]-based phosphate binders, calcimimetics) are associated with extrarenal blood purification. Compartmentalization of phosphate limits its depuration during hemodialysis. Several studies suggest that plasmatic pH is involved in the mobilization of phosphate from intracellular to extracellular compartments. Consequently, the efficiency of modified bicarbonate conductivity to purify blood phosphate was tested. Methods Ten hemodialysis patients with chronic hyperphosphatemia (>2.1 mmol/L) were included in the two three-sessions-per week periods. Bicarbonate concentration was fixed at 40 mmol/L and 30 mmol/L in the first and second periods, respectively. Phosphate depuration was evaluated by phosphate mobilization clearance (KM ). Findings Although bicarbonatemia was lower during the second period (21.0 ± 2.7 vs. 24.4 ± 3.1 mmol/L, P

Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians' education (especially young nephrologists) on mineral-based alkaline waters should be intensified.

Hyponatremia could be defined as a public health topic: too many patients are concerned in both hospitalized and general populations; hyponatremia induces lots of clinical outcomes and a great economic burden. Its pathophysiology involves thirst regulation (hypotonic water intakes) and losses regulation (through the kidney under vasopressin control). Diagnostic approach should insure that hyponatremia reflects hypo-osmolality and hypotonicity: first, a false hyponatremia should be ruled out, then a non-hypotonic one. Next step is clinic: extracellular status should be evaluated. When increased, any edematous status should be evoked: heart failure, liver cirrhosis or nephrotic syndrome. When decreased, any cause of extracellular dehydration should be evoked: natriuresis could help distinguishing between renal (adrenal insufficiency, diuretics use or salt-losing nephropathy) or extrarenal (digestive mostly) etiologies. When clinically normal, a secretion of inappropriate antidiuretic hormone (SIADH) should be evoked, once hypothyroidism or hypoadrenocorticism have been ruled out. Therapy depends on the severity of the clinical impact. From extracellular rehydration, through fluid restriction, the paraneoplastic and heart failure-induced SIADH benefit from a new class of drug, available among the therapeutic strategies: aquaretics act through antidiuretic hormone receptor antagonism (vaptans). Their long-term benefits still have to be proven but it is a significant step forward in the treatment of hyponatremias.

Introduction La creatinine est un metabolite de la creatine, un derive d’acide amine d’origine musculaire. Les principales formules d’estimation du debit de filtration glomerulaire (DFG) utilisent la valeur de creatininemie et dependent donc de la masse musculaire. La myosite a inclusions est une myopathie acquise responsable d’une amyotrophie. Elle touche exclusivement les sujets âges, une population ou l’incidence des nephropathies est elevee. Notre objectif est de tester si l’estimation du DFG grâce a la creatininemie mesestime le DFG chez les patients atteints de myosites a inclusions. Patients et methodes Chez 20 patients suivis dans le service de medecine interne de l’hopital Pitie-Salpetriere, Paris, le DFG a ete simultanement mesure par la clairance renale du 51Cr-EDTA (DFGm) et estime (DFGe) par les formules MDRD, CKD-EPI creatinine et CKD-EPI cystatine C. La creatininemie a ete mesuree par technique enzymatique (CrE) et les urines des 24 heures ont ete recueillies la veille de l’examen. La composition corporelle (masse maigre appendiculaire non osseuse) a ete mesuree par absorptiometrie biphotonique a rayons X (DXA), exprimee en Z-score pour chaque patient. Resultats Huit hommes et 12 femmes âges de 65 ± 9 ans ont ete inclus. Leur masse maigre appendiculaire moyenne se situait dans les valeurs basses de la normale −1,85 [−2,50 ; −1,18] DS. La valeur de CrE etait situee dans les valeurs basses 43,5 μM [35,3–56,8]. Le DFGm etait 78 ± 18 mL/min/1,73 m2, 8 patients (40 %) avaient une maladie renale chronique selon les criteres KDIGO 2012 dont 4 avec un DFG Discussion Chez les patients etudies ayant une masse musculaire dans les valeurs basses de la normale, l’estimation du DFG utilisant la creatininemie ou la cystatine C est biaisee, en particulier avec la formule du MDRD. Ce biais de mesure empeche le diagnostic et le classement de la maladie renale chronique chez ces patients. L’utilisation des formules d’estimation du DFG dans la myosite a inclusions peut entrainer un retard dans la prise en charge de la maladie renale chronique mais egalement des surdosages pour les medicaments a elimination renale. Dans notre population, en utilisant un seuil de DFG estime par le CKD-EPI creatinine de 100 mL/min/1,73 m2, la sensibilite pour depister une maladie renale chronique stade ≥ 3 est de 100 %, la specificite de 87,5 % (Chi2 = 11,67). De maniere etonnante, le biais entre les DFG estimes et mesures n’etaient pas statistiquement correles avec la masse maigre appendiculaire exprimee en Z-score. Cela s’explique probablement par la faible taille de l’echantillon, mais peut etre egalement par la qualite du muscle qui n’est pas prise en compte par cette mesure contrairement a la mesure de la masse musculaire par IRM (resultats en cours d’analyse). Conclusion Au cours de la myosite a inclusions, le DFG est largement surestime par les formules habituelles malgre une masse musculaire moderement inferieure aux valeurs normales. Les formules d’estimation du DFG ne permettent pas de depister les insuffisances renales chroniques de facon satisfaisante dans cette population. Nous proposons qu’une mesure du DFG soit realisee chez les patients atteints de myosite a inclusion en cas de DFG estime par le CKD-EPI creatinine

Introduction Hyperphosphatemia and cardiovascular mortality are associated particularly with end-stage renal disease. Available therapeutic strategies (i.e., diet restriction, calcium [or not]-based phosphate binders, calcimimetics) are associated with extrarenal blood purification. Compartmentalization of phosphate limits its depuration during hemodialysis. Several studies suggest that plasmatic pH is involved in the mobilization of phosphate from intracellular to extracellular compartments. Consequently, the efficiency of modified bicarbonate conductivity to purify blood phosphate was tested. Methods Ten hemodialysis patients with chronic hyperphosphatemia (2.1 mmol/L) were included in the two three-sessions-per week periods. Bicarbonate concentration was fixed at 40 mmol/L and 30 mmol/L in the first and second periods, respectively. Phosphate depuration was evaluated by phosphate mobilization clearance (K

Slowing the progression of chronic kidney diseases needs new efficient treatments. Aldosterone classically acts on the distal nephron: it allows sodium reabsorption, potassium secretion and participates to blood volume control. Recently, new targets of aldosterone have been described including the heart and the vasculature but also non-epithelial kidney cells such as mesangial cells, podocytes and renal fibroblasts. The pathophysiological implication of aldosterone and its receptor, the mineralocorticoid receptor has been demonstrated ex vivo in cell culture and in vivo in experimental animal models with kidney damages such as diabetic and hypertensive kidney nephropathies, chronic kidney disease and glomerulopathies. The beneficial effects of the pharmacological antagonists of the mineralocorticoid receptor are independent of the hypertensive effect of aldosterone, indicating that blocking the activation of the mineralocorticoid receptor in these non-classical renal targets may be of clinical importance. Several clinical studies now report benefit and safety when using spironolactone or eplerenone, the currently available mineralocorticoid receptor antagonists, in patients with kidney diseases. In this review, we discuss the recent results reported in experimental and clinical research in this domain.

Slowing the progression of chronic kidney diseases (CKDs) requires new and effective treatment approaches. Aldosterone classically acts on the distal nephron: it facilitates sodium reabsorption, potassium secretion, and participates in blood pressure control. Recently, new targets of aldosterone have been described including the heart and the vasculature, and other kidney cells such as mesangial cells, podocytes, and renal fibroblasts. The pathophysiological implications of increased mineralocorticoid receptor (MR) expression and activation (either dependent on aldosterone or direct ligand-independent activation) and its blockade have been illustrated with ex vivo in cell cultures and in vivo in experimental animal models of CKD, including diabetic and hypertensive nephropathies, and glomerulopathies. The beneficial effects of the MR antagonists are independent of the hypertensive effect of aldosterone, indicating that blocking the activation of the MR may have unique clinical importance. Several studies have reported efficacy and safety studies with spironolactone or eplerenone in patients with kidney diseases. In this review, we discuss the recent results reported in experimental and clinical research in this field, and emphasize the direct activation of the MR that can occur in pathological states associated with CKD, even in the absence of increased circulating levels of aldosterone.

Several alternative anticoagulation drugs are now available for patients with heparin induced thrombocytopenia type II (HIT II). However, their indication is not yet reaching a consensus. Moreover, some of them have not yet their marketing approval. The importantly use in hemodialyzed patients should be taken with caution since most of them are excreted by the kidneys. The use of fondaparinux, which exerts high anti-Xa activity, is not well documented. We report here our experience on the use of fondaparinux in an hemodialyzed patient with HIT II, not only as anticoagulation during hemodialysis sessions but also as interdialytic anticoagulation locking solution of her central venous catheter. The use of fondaparinux seems to us simple enough (even if its ready-for-use syringe requires adjustments to deliver the required doses) and its efficacy, safety and economic cost lead us to think that it is an indication of choice for an alternative anticoagulation in hemodialyzed patients with HIT II. Control prospective trials should be performed in order to confirm the preliminary favourable data and to support the proposal of marketing approval in this indication.

Introduction La qualite de vie des patients insuffisants renaux chroniques (IRC) non dialyses est alteree mais peu d’informations ont ete publiees sur ce sujet. L’enquete MAEVA avait pour objectif d’evaluer cet element clinique et de croiser les regards du nephrologue et du patient sur la prise en charge globale des patients non dialyses en France. Patients et methodes Un auto-questionnaire a ete adresse par courrier a 1282 nephrologues exercant en France. Un second auto-questionnaire en « miroir » a ete transmis aux patients IRC (stades 3, 4 ou 5) par l’intermediaire de leur nephrologue. Les donnees ont ete recueillies prospectivement et anonymement. Resultats Entre fevrier et aout 2015, 261 nephrologues et 172 patients ont repondu a l’enquete. Selon les nephrologues interroges, l’elan vital du patient IRC a un impact direct sur sa qualite de vie (67 % tout a fait d’accord et 33 % plutot d’accord). Les principaux facteurs favorisant cet elan vital sont : l’optimisme et les encouragements de l’entourage (74 %) et le maintien d’une activite sociale et professionnelle (71 %). Les patients s’accordent avec leurs nephrologues sur l’importance de ces facteurs qui recueillent respectivement 55 % et 49 % des reponses. Pour les patients, l’element majeur dans le maintien de leur elan vital est l’optimisme et les encouragements de leur nephrologue (60 % vs 20 % pour les nephrologues, p Discussion Le role du nephrologue est essentiel dans le maintien de l’elan vital et de la qualite de vie du patient insuffisant renal. La bonne representativite des repondants est a ponderer par un probable biais de selection : les reponses a ce questionnaire proviennent peut-etre des patients et des nephrologues entretenant une tres bonne relation. Conclusion Cette premiere enquete nationale souligne l’interet d’evaluer l’elan vital et la qualite de vie du patient IRC non dialyse par un questionnaire adapte qui pourrait etre rempli en amont de chaque consultation.

Introduction L’administration de bicarbonate est utilisee dans le ralentissement de la perte de fonction renale, le traitement de certaines maladies lithiasiques renales et d’autres indications : nephrologues et urologues sont les premiers acteurs de leur prise en charge. Peu d’informations sont disponibles sur les determinants de la prescription des eaux bicarbonatees. L’objectif de cette etude est d’evaluer les habitudes de leurs prescriptions. Materiels et methodes Une enquete prospective a ete realisee aupres de nephrologues et urologues francais. Les donnees demographiques, d’exercice medical et des connaissances ont ete analysees. Resultats Les repondants (n = 249) etaient sans distinction de genre mais principalement des nephrologues (81 %). La majorite (54 %) indique prescrire le traitement pour de courtes periodes ( Discussion Malgre la courte periode d’administration (4 mois), la participation a ete importante. La representation importante de nephrologues ne modifie pas les resultats principaux qui devraient etre confirmes au cours de nouvelles enquetes nationales. Conclusion Cette premiere etude montre que les medecins specialistes prescrivent d’autant plus qu’ils croient a l’efficacite des eaux bicarbonatees. La perception de leur efficacite par les prescripteurs est influencee par les retours positifs des patients (mais pas le retour negatif), les incitant a renouveler cette prescription.

Introduction Actuellement, la nephrologie est l’une des specialites medicales les plus prisees par les internes en France. Cependant, aucune evaluation de leur satisfaction concernant leur formation n’a ete publiee. Materiels et methodes Un questionnaire anonyme a ete diffuse par Internet a l’ensemble des internes de nephrologie, concernant leur satisfaction envers leur formation a differentes echelles (nationale, interregionale et locale). Resultats Entre aout et octobre 2015, 189 internes (56 %) se sont prononces. L’indice de satisfaction (variant de 0 a 4) moyen etait de 2,61 ± 0,6, traduisant un bon niveau de satisfaction. Les repondants trouvaient leur formation theorique de bonne ou de tres bonne qualite a l’echelle nationale, interregionale et locale dans 99 %, 85 % et 58 % des cas, respectivement. En analyse univariee, l’indice de satisfaction etait associe au fait d’etre interne en Ile-de-France (p = 0,04), a la qualite de l’enseignement national (p = 0,01) et a la quantite d’enseignement au niveau national, interregional ou local (p = 0,04, p = 0,008 et p Discussion Les resultats de cette premiere enquete nationale aupres des internes de nephrologie mettent en evidence l’importance et la disparite de la formation locale au sein de la formation initiale en nephrologie, meme si la satisfaction au niveau national et interregional est jugee bonne voire tres bonne. Conclusion Les internes de nephrologie se considerent globalement satisfaits de leur formation meme s’il existe quelques disparites locales.