Author: "Laurent Juillard" / Topic: 03 medical and health sciences - Searchworks@Jio Institute Digital Library Search Results

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53 results on '"Laurent Juillard"'

1. Reconsidering adsorption in hemodialysis: is it just an epiphenomenon? A narrative review

Author: Fitsum Guebre-Egziabher, Laurent Juillard, Nans Florens, Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and ROSSI, Sabine
Subjects: Dialysis adequacy, medicine.medical_treatment, 030232 urology & nephrology, Hemodiafiltration, 030204 cardiovascular system & hematology, Dialysis membrane, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Dialysis tubing, Hydrophobic effect, 03 medical and health sciences, 0302 clinical medicine, Adsorption, Renal Dialysis, Humans, Medicine, Renal replacement therapy, business.industry, Membranes, Artificial, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Membrane, Nephrology, Hemodialysis, Biophysics, Kidney Failure, Chronic, business, Dialysis (biochemistry)
Abstract: International audience; Since the first attempt at extracorporeal renal replacement therapy, renal replacement therapy has been constantly improved. In the field of hemodialysis, substantial efforts have been made to improve toxin removal and biocompatibility. The advent of hemodiafiltration (HDF) and, more recently, of mid cut-off membranes have contributed to management of patients with end-stage renal disease (ESRD). Although several uremic toxins have been discovered, we know little about the clinical impact of their clearance in hemodialysis patients. In addition, a great deal of progress has been made in the areas of filtration and diffusion, but the adsorptive properties of hemodialysis membranes remain under-studied. The mechanism of action of adsorption is based on the attraction between the polymer of the dialysis membrane and the solutes, through hydrophobic interactions, ionic or electrostatic forces, hydrogen bonds or van der Waals forces. Adsorption on the dialysis membrane depends on the membrane surface, pore size, structure and electric load. Its involvement in toxin removal and biocompatibility is significant, and is not just an epiphenomenon. Diffusive and convective properties cannot be improved indefinitely and high permeability membranes, despite their high performance in the clearance of many toxins, have several limitations for long-term use in hemodialysis. This review will discuss why adsorption should be reconsidered and better characterized to improve efficiency and adequacy of dialysis.
Published: 2021

2. Urinary Sodium-to-Potassium Ratio and Blood Pressure in CKD

Author: Natalia Alencar de Pinho, Jean Kaboré, Maurice Laville, Marie Metzger, Céline Lange, Christian Jacquelinet, Christian Combe, Denis Fouque, Luc Frimat, Carol Ayav, Bruce M. Robinson, Tilman Drueke, Ziad A. Massy, Bénédicte Stengel, Thierry Hannedouche, Bruno Moulin, Sébastien Mailliez, Gaétan Lebrun, Eric Magnant, Gabriel Choukroun, Benjamin Deroure, Adeline Lacraz, Guy Lambrey, Jean Philippe Bourdenx, Marie Essig, Thierry Lobbedez, Raymond Azar, Hacène Sekhri, Mustafa Smati, Mohamed Jamali, Alexandre Klein, Michel Delahousse, Séverine Martin, Isabelle Landru, Eric Thervet, Philippe Lang, Xavier Belenfant, Pablo Urena, Carlos Vela, Dominique Chauveau, Viktor Panescu, Christian Noel, François Glowacki, Maxime Hoffmann, Maryvonne Hourmant, Dominique Besnier, Angelo Testa, François Kuentz, Philippe Zaoui, Charles Chazot, Laurent Juillard, Stéphane Burtey, Adrien Keller, Nassim Kamar, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Institut de Recherche en Sciences de la Santé (IRSS), CNRST, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Agence de la biomédecine [Saint-Denis la Plaine], Service de Néphrologie Transplantation, Dialyse et Aphérèse [CHU Bordeaux], CHU Bordeaux [Bordeaux], Bioingénierie tissulaire (BIOTIS), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Arbor Research Collaborative for Health, Hôpital Ambroise Paré [AP-HP], Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Agence Nationale de la Recherche, ANR Agence Nationale de la Recherche, ANR, The CKD-REIN study is funded by the Agence Nationale de la Recherche through the 2010 «Cohortes-Investissements d’Avenir » program (ANR) and by the 2010 national Programme Hospitalier de Recherche Clinique . CKD-REIN is also supported through a public–private partnership with Amgen , Fresenius Medical Care , and GlaxoSmithKline (GSK) since 2012, Lilly France since 2013, Otsuka Pharmaceutical since 2015, Baxter and Merck Sharp & Dohme-Chibret (MSD France) from 2012 to 2017, Sanofi-Genzyme from 2012 to 2015, and Vifor Fresenius and AstraZeneca , since 2018. Inserm Transfert set up and has managed this partnership since 2011., Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Chronic Kidney Disease - Réseau Epidémiologie et Information en Néphrologie (CKD REIN), and Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, Urinary system, Population, 030232 urology & nephrology, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Gastroenterology, Excretion, 03 medical and health sciences, 0302 clinical medicine, Clinical Research, Interquartile range, Internal medicine, medicine, salt, 10. No inequality, education, sodium, education.field_of_study, business.industry, potassium, blood pressure, medicine.disease, 3. Good health, Blood pressure, Quartile, Nephrology, Albuminuria, medicine.symptom, business, chronic kidney disease, Kidney disease
Abstract: Introduction In the general population, urinary sodium-to-potassium (uNa/K) ratio associates more strongly with high blood pressure (BP) than either urinary sodium or potassium alone. Whether this is also the case among patients with chronic kidney disease (CKD) is unknown. Methods We studied the associations of spot urine sodium-to-creatinine (uNa/Cr), potassium-to-creatinine (uK/Cr), and uNa/K ratios with a single office BP reading in 1660 patients with moderate to severe CKD at inclusion in the CKD-REIN cohort. Results Patients' median age was 68 (interquartile range [IQR], 59–76) years; most were men (65%), had moderate CKD (57%), and albuminuria (72%). Mean systolic and diastolic BP was 142/78 mm Hg. Spot uNa/Cr and uNa/K ratios were positively associated with systolic, mean arterial, and pulse pressures. The mean adjusted difference in systolic BP between the highest and the lowest quartile (Q4 vs. Q1) was 4.24 (95% confidence interval [CI], 1.53–6.96) mm Hg for uNa/Cr and 4.79 (95% CI, 2.18–7.39) mm Hg for uNa/K. Quartiles of spot uK/Cr were not associated with any BP index. The higher the quartile of uNa/K, the higher the prevalence ratio of uncontrolled (Q4 vs. Q1, 1.43; 95% CI, 1.19–1.72) or apparently treatment-resistant hypertension (Q4 vs. Q1, 1.35; 95% CI, 1.14–1.60). Findings were consistent in a subset of 803 individuals with 2 BP readings. Conclusion In patients with CKD, higher urinary sodium excretion is associated with higher BP, but unlike in general population, lower potassium excretion is not. Urinary Na/K does not add significant value in assessing high BP risk, except perhaps for hypertension control assessment., Graphical abstract
Published: 2020

3. Classification of Uremic Toxins and Their Role in Kidney Failure

Author: Manish Kaushik, Peter Stenvinkel, Kianoush Kashani, Ziad A. Massy, Li Zuo, Faeq Husain-Syed, Thiago Reis, Peter J. Blankestijn, Hideki Kawanishi, Colin A. Hutchison, Raymond Vanholder, Laurent Juillard, Claudio Ronco, Mario Cozzolino, Mitchell H. Rosner, Tammy L. Sirich, University of Virginia [Charlottesville], University of Brasilia [Brazil] (UnB), Justus-Liebig-University [Gießen, Germany], Ghent University Hospital, University of Southern Queensland (USQ), Hawke's Bay District Health Board [Hastings, New Zealand], Karolinska Institutet [Stockholm], University Medical Center [Utrecht], University of Milan, Università degli Studi di Milano [Milano] (UNIMI), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université de Lyon, Mayo Clinic [Rochester], National University Hospital [Singapore] (NUH), Tsuchiya General Hospital [Hiroshima, Japan] (TGH), Hôpital Ambroise Paré [AP-HP], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Veterans Affairs Palo Alto Health Care System [Palo Alto, CA, USA], Stanford University, People's Hospital of Peking University (PEKING - PHPU), Peking University [Beijing], University of Padova Medical School, International Renal Research Institute [Vicenza, Italy] (I2RI), University of Virginia, Justus-Liebig-Universität Gießen = Justus Liebig University (JLU), Università degli Studi di Milano = University of Milan (UNIMI), People's Hospital of Peking University (PKUPH), Università degli Studi di Padova = University of Padua (Unipd), and CarMeN, laboratoire
Subjects: medicine.medical_specialty, Epidemiology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Reviews, Classification scheme, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Medicine, definition, In patient, Intensive care medicine, Dialysis, uremia, Transplantation, business.industry, Consensus conference, medicine.disease, Uremia, 3. Good health, middle molecule, [SDV] Life Sciences [q-bio], classification, Nephrology, Uremic toxins, dialysis, Hemodialysis, business, Middle molecule
Abstract: International audience; Advances in our understanding of uremic retention solutes, and improvements in hemodialysis membranes and other techniques designed to remove uremic retention solutes, offer opportunities to readdress the definition and classification of uremic toxins. A consensus conference was held to develop recommendations for an updated definition and classification scheme on the basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes. The major focus is on the removal of uremic retention solutes by hemodialysis. The identification of representative biomarkers for different classes of uremic retention solutes and their correlation to clinical symptoms and outcomes may facilitate personalized and targeted dialysis prescriptions to improve quality of life, morbidity, and mortality. Recommendations for areas of future research were also formulated, aimed at improving understanding of uremic solutes and improving outcomes in patients with CKD.
Published: 2021

4. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

Author: Jérôme Avouac, Elodie Drumez, Eric Hachulla, Raphaèle Seror, Sophie Georgin-Lavialle, Soumaya El Mahou, Edouard Pertuiset, Thao Pham, Hubert Marotte, Amélie Servettaz, Fanny Domont, Pascal Chazerain, Mathilde Devaux, Pascal Claudepierre, Vincent Langlois, Arsène Mekinian, Alexandre Thibault Jacques Maria, Béatrice Banneville, Bruno Fautrel, Jacques Pouchot, Thierry Thomas, René-Marc Flipo, Christophe Richez, Florence Aeschlimann, Christian Agard, Nassim Ait-Abdallah, Jean-David Albert, Didier Alcais, Jean-Sébastien Allain, Yannick Allanore, Blanca Amador-Borreiro, Zahir Amoura, Emma Andre, Anaïs Arbault, Jean-Benoît Arlet, Laurent Arnaud, Denis Arniaud, Herliette Arty-Hue, Lucie Atlan, Alexandra Audemard-Verger, Christine Audoin-Pajot, Victor Audren, Maxime Bach-Bunner, Hélène Bacquet-Deschryver, Brigitte Bader-Meunier, Nathalie Balandraud, Jean-Charles Balblanc, Stéphane Bally, Frédéric Banal, Pierre Barbery, Thomas Barnetche, Audre Barrelet, André Basch, Vincent Baumier, Guillaume Bayer, Sophie Bayle, Catherine Beauvais, Rudie Beinat, Véronique Belin, Rakiba Belkhir, Ruben Benainous, Alexandre Belot, Mohammed Benammar, Mathilde Benhamou, Ygal Benhamou, Ahmed Benmansour, Pascal Bennet, Brigitte Bernoux-Manat, Elise Berthet, Emilie Berthoux, Ewa Bertolini, Adrien Bigot, Aurélia Bisson-Vaivre, Gilles Blaison, Gilles Bolla, Olivier Bonidan, Christine Bonnet, Raphaël Borie, Marie Bossert, Laurence Boudou, Françoise Bouhour, Kévin Bouiller, Bastien Bouldoires, Karima Boussoualim, Eric Bouvard, Regine Brondino, Pierre Buchlin, Laurence Cabantous, Patrice Cacoub, Simon Cadiou, Maurizio Carteni, Aurélia Carbasse, Brice Castel, Pascal Cathebras, Hervé Caumont, Annalisa Celant, Benjamin Chaigne, Benoît Chaillous, Romuald Champy, Agnès Charcot, Pierre Charles, Isabelle Charlot-Lambrecht, Caroline Charpin, Emmanuel Chatelus, Bernard Chaudier, Pascale Chertok, Xavier Chevalier, Maxime Chevreau, Emilie Chotard, Delphine Chu Miow Lin, Gaëlle Clavel, Cyril Clavel-Osorio, Fleur Cohen, Gregory Cohen, Marie-Eve Colette-Cedoz, Nived Collercandy, Antoine Colombey, Chloé Comarmond, Bernard Combe, Céline Comparon, Elodie Constant, Pascal Coquerelle, Justine Corli, Clémence Corre, Nathalie Costedoat-Chalumeau, Marie Couret, Natacha Courvoisier, Fabienne Coury-Lucas, Cécile Coutarel, Fabrice Coutier, Richard Damade, Laurence Daver-Malaterre, Sarahe Dehimat, Michel Delahousse, Emilie Barrois-Delattre, Delphine Denarie, Camille Deprouw, Emanuelle Dernis, Alban Deroux, Renaud Desbarbieux, Elise Descamps, Chantal Deslandre, Marie Desmurs, Jacques Despaux, Marie Desplats, Frédérick Detree, Valérie Devauchelle-Pensec, Robin Dhote, Philippe Dieude, Yannick Dieudonne, Elisabeth Diot, Guillaume Direz, Djamal-Dine Djeddi, Sarah Douvier, Béatrice Drouet, Catherine Duc, Angélique Ducornet, Carine Dufauret-Lombard, Alain Duhamel, Cécile Dumaine, Anne-Elisabeth Dumel, Chantal Dumoulin-Richez, Agnès Duquesne, Géraldine Durand, Mariane Durandin-Truffinet, Pierre-Marie Duret, Maïka Duval, Mikaël Ebbo, Esther Ebstein, Andra Economu-Dubosc, Stéphanie Emilie, Romain Euvrard, Philippe Evon, Sylvie Fabre, Dorothée Fagedet, Meryem Farhat, Marion Fauconier, Jacques Fechtenbaum, Renaud Felten, Fanny Fernandes, Nicole Ferreira-Maldent, Elodie Feurer, Amandine Fichet, Françoise Flaisler, Nans Florens, Violaine Foltz, Elisabeth Fontanges, Jennifer Foret, Anne-Claire Fougerousse, Anne Fouque-Aubert, Catherine Foutrier-Morello, Hélène Francois-Pradier, Léa Frantzen, Pierre Fritz, Antoine Froissart, Jean Fulpin, Piera Fuzibet, Francis Gaches, Laurence Gagneux-Lemoussu, Mélanie Penhoat-Gahier, Joris Galland, Frédérique Gandjbakhch, Nicole Garnier, Thomas Garraud, Jean-François Garrot, Romain Gastaldi, Véronique Gaud-Listrat, Maud Gauthier-Prieur, Dana Georgescu, Nathalie Gerard, Elisabeth Gervais, Christelle Gibert, Eric Gibert, Ghislaine Gill, Jérôme Gillard, Mélanie Gilson, Pauline Gimonnet, Jeanine-Sophie Giraudet-Le Quintrec, Aude Giraud-Morelet, Baptiste Glace, Camille Glanowski, Bertrand Godeau, Bruno Gombert, Camille Gonnet-Gracia, Tiphaine Goulenok, Philippe Goupille, Olivier Gourmelen, Sophie Govindaraju-Audouard, Franck Grados, Martine Grall-Lerosey, Bruno Grardel, Anne Grasland, Gilles Grateau, Monica Groza, Constance Guillaud, Séverine Guillaume, Caroline Guillibert, Xavier Guillot, Philippe Guilpain, Aline Gury, Marie-Hélène Guyot, Cécile Hacquard-Bouder, Marie-Noelle Havard, Jean-Pierre Hellier, Pascal Hennequin, Basile Henriot, Julien Henry, Véronique Hentgen, Marion Hermet, Muriel Herasse, Julie Hernandez, Miguel Hie, Pascal Hilliquin, Olivier Hinschberger, Ambre Hittinger-Roux, Jan Holubar, Christophe Hudry, Serge Huguenel, Clara Jaccard, Jean-Michel, Jacquemier, Bénédicte Jamard, Catherine Jan, Sylvie Jean, Mathieu Jouvray, Pierre-Antoine Juge, Laurent Juillard, Denis Jullien, Anna Kabala, Abdelkrim Kabchou, Ludovic Karkowski, Françoise Karman, Farid Kemiche, Jérémy Keraen, Pierre Kieffer, Isabelle Kone-Paut, Abdeldajallil Koreichi, Marie Kostine, Sylvain La Batide Alanore, Pierre Lafforgue, Sophie Lahalle, Marc Lambert, Isabelle Lambrecht, Sylvain Lanot, Aurélia Lanteri, Jean-Paul Larbre, Augustin Latourte, Christian Lavigne, Sophie Le Guen Guegan, Guillaume, Le Guenno, Diane Leguy, Agnès Lebrun, Emmanuel Ledoult, Nathalie Legoupil, Erick Legrand, Charlotte Lejeune, Olivier Leloire, Christophe Leroux, Rémi Leroy, Marie Leroy-Gouix, Tifenn Leturcq, Amélie Leurs, Céline Leveque-Michaud, François-Xavier Limbach, Frédéric Liote, Anne Lohse, Pierre Lozac'h, Virginie Lucas, Aurélie Madelon, Nadine Magy-Bertrand, Matthieu Mahevas, Hélène Maillard, Thibault Maillet, Sandrine Malochet-Guinamand, Quentin Mangon, Sylvie Marchou-Lopez, Nathalie Margarit, Thierry Marhadour, Xavier Mariette, Claire Martin, Alexis Mathian, François Maurier, Frédéric Maury, Betty Mazet-Guillaume, Arnaud Mazouyez, Hassan Mazyad, Nadia Mehsen-Cetre, Ulrich Meinzer, Isabelle Melki, Laurent Messer, Corinne Miceli, Martin Michaud, Catherine Michel, Matthias Michel, Mathilde Michon, Anne-Marie Milesi-Lecat, Anna Molto, Marie Moly, Olivier Moranne, Gautier Morel, Hugo Morel, Jacques Morel, Franck Morin, Laurence Moulinier, Guillaume Moulis, Bertrand Moura, Minh Nguyen, Sabine Nicolas-Vullierme, Hubert Nielly, Gaétane Nocturne, Aurore Nottez, Henri-Olivier Ollagnon, Isabelle Pacaud-Vitoux, Anne Pagnier, Caroline Paris, Antoine Parrot, Tristan Pascart, Yasmina Pascaud-Mansour, Lætitia Paulin, Stephan Pavy, Laurent Perard, Yves-Marie Pers, Micheline Pha, Maud Pichon, Audrey Pierreisnard, Gabrielle Pizana, Sylvaine Poignant, Elsa Poix, Agnès Portier, Antoine Poulet, Samira Plassard, Grégory Pugnet, Déborah Puyraimond-Zemmour, Pierre Quartier-Dit-Maire, Marion Quenet, Viviane Queyrel, Loïc Raffray, Philippe Remy, Myriam Renard, Jessica Rene, Sabine Revuz, Bénédicte Rey, Gaëlle Richard-Colmant, Etienne Riviere, Sébastien Riviere, Sophie Robin, Julien Rohmer, Isabelle Roitg, Mélanie Romier, Michel Rolland, Mélanie Roriz, Carole Rosenberg, Linda Rossi, Olivier Roth, Sid-Ahmed Rouidi, Mathilde Roumier, Mickaël Rousiere, Clémentine Rousselin, Bénédicte Rouviere, Christian Roux, Fabienne Roux, Marielle Roux, Nicolas Roux, Diane Rouzaud, Sylvie Rozenberg, Isabelle Sacco, Fatiha Sadji, Laurent Sailler, Carine Salliot, Jean-Hugues Salmon, Alain Saraux, Jean Schmidt, Julie Seguier, Jérémie Sellam, Eric Senbel, Thomas Sene, Patricia Senet, Pascal Seve, Aurélie Sicaud, Perrine Smets, Vincent Sobanski, Christelle Sordet, Elisabeth Sornay-Rendu, Odile Souchaud-Debouverie, Lætitia Sparsa, Lionel Spielmann, Sarah Steib, Chloé Stavris, Catherine Straus, Victor Strotz, Paulina Szafors, Séverine Taffignon-Clave, Justine Simoens, Claire Theillac, Nora Tenenbaum, Benoît Thomachot, Nathalie Tieulie, Soizic Tiriau, Alice Tison, Eric Toussirot, Ludovic Trefond, Sophie Trijau, Sébastien Trouillier, Anne-Priscille Trouvin, Marie-Elise Truchetet, Marc Ulrich, Jacques Vaquier, Eric Veillard, Laurent Veillon, Guillaume Vial, Jean-François Viallard, Judith Victor, Claire Vidon, Mathias Vidon, Camille Vigne, Alexandre Virone, Ursula Warzocha, Daniel Wendling, Claude Werle, Cécile Wibaux, Alexandra Willems, Michel Wisniewski, Juliette Woessner, Bernadette Xerri-Campano, Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de médecine interne [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Tourcoing, Centre Hospitalier René Dubos [Pontoise], Assistance Publique - Hôpitaux de Marseille (APHM), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biologie Intégrative du Tissu Osseux (LBTO), Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Pitié-Salpêtrière [AP-HP], Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Saint-Antoine [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Bordeaux [Bordeaux], Composantes innées de la réponse immunitaire et différenciation (CIRID), Université Bordeaux Segalen - Bordeaux 2-Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Maladies génétiques d'expression pédiatrique (U933), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Médecine Interne = Hôpital de jour de médecine [CHU Tenon], INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biologie intégrative du tissu osseux, Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC Saint Etienne, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Nord (Saint Etienne), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Service de rhumatologie, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Médecine Interne [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de rhumatologie [CH Gustave Dron, Tourcoing], Centre Hospitalier Gustave Dron [Tourcoing], Hopital Réné Dubos, Université Paris 1 Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), and Université Paris 1 Panthéon-Sorbonne (UP1)
Subjects: medicine.medical_specialty, Immunology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, immune system diseases, law, hemic and lymphatic diseases, Internal medicine, Clinical endpoint, Immunology and Allergy, Medicine, 030212 general & internal medicine, 030203 arthritis & rheumatology, business.industry, Hazard ratio, Odds ratio, Articles, medicine.disease, Intensive care unit, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Rheumatoid arthritis, Cohort, Rituximab, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study, medicine.drug
Abstract: Summary Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases. Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609. Findings Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66–6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46–0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55–3·19, p=0·53). Interpretation Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases. Funding None.
Published: 2021

5. Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review

Author: François Gueyffier, Brigitte Grosgogeat, Emilie Kalbacher, Théo Delbove, Kerstin Gritsch, Patrice Nony, Delphine Maucort-Boulch, Laurent Juillard, Laboratoire des Multimatériaux et Interfaces (LMI), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon, Hospices Civils de Lyon (HCL), Unité de Pharmacologie Clinique et d'Essais Thérapeutiques [Lyon] (UPCET - EZUS - UNIV Lyon), Hospices Civils de Lyon (HCL)-Faculté de Médecine Laennec, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Edouard Herriot [CHU - HCL], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), and CarMeN, laboratoire
Subjects: Teeth, Physiology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Systemic inflammation, law.invention, 0302 clinical medicine, Medical Conditions, Randomized controlled trial, Oral Diseases, law, Chronic Kidney Disease, Tooth loss, Medicine and Health Sciences, Prospective Studies, 10. No inequality, Prospective cohort study, Multidisciplinary, 3. Good health, [SDV] Life Sciences [q-bio], Nephrology, Research Design, Medicine, medicine.symptom, Anatomy, Glomerular Filtration Rate, Research Article, medicine.medical_specialty, Drug Research and Development, Inflammatory Diseases, Science, Oral Medicine, Renal function, Research and Analysis Methods, 03 medical and health sciences, Internal medicine, medicine, Renal Diseases, Humans, Clinical Trials, Renal Insufficiency, Chronic, Periodontitis, Periodontal Diseases, Pharmacology, Renal Physiology, business.industry, Biology and Life Sciences, Retrospective cohort study, 030206 dentistry, medicine.disease, Randomized Controlled Trials, Jaw, Clinical Medicine, business, Digestive System, Head, Kidney disease
Abstract: Aim To assess the effect of periodontal treatment (PT) on glomerular filtration rate (GFR), systemic inflammation, or mortality in patients with chronic kidney disease (CKD). Methods A literature search was performed on PubMed and Web of Science databases on articles published until December 2019. The PRISMA guidelines were used throughout the manuscript. Results Of the total studies found, only 18 met the inclusion criteria; four retrospective and 14 prospective studies (including 3 randomized controlled trials–RCT). After PT, 3 studies investigated GFR, 2 found significant improvement; 11 (including 2 RCTs) investigated C-reactive protein levels, 9 found a significant improvement (including the 2 RCTs); 5 (including 3 RCTs) investigated Interleukine-6 level, 4 found a significant improvement (including 2 RCTs) and 2 studies evaluated mortality, one (retrospective study) found a significant difference. Conclusions Within the limitations of the present study, PT seems to improve CKD status, especially by reducing the systemic inflammation. Further RCTs are needed to confirm the results and specifically assess the influence of different types of PT in CKD patients. Taking into consideration the ability of PT to prevent further tooth loss and denutrition, early management of periodontitis is extremely important in patients with impaired renal function.
Published: 2021

6. Recommandations cliniques pratiques sur les soins péri- et postopératoires des fistules et greffes artérioveineuses pour hémodialyse chez l’adulte

Author: François Vrtovsnik, Catherine Lasseur, Philippe Chauveau, L Mercadal, Philippe Brunet, Laurent Juillard, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), AURAD Aquitaine, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Mode de vie, génétique et santé : études intégratives et transgénérationnelles (U1018 (Équipe 9)), Institut Gustave Roussy (IGR)-Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], Peri, 030232 urology & nephrology, MEDLINE, Guideline, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 3. Good health, Clinical Practice, 03 medical and health sciences, 0302 clinical medicine, Nephrology, Medicine, business, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2020

7. Two Toxic Lipid Aldehydes, 4-hydroxy-2-hexenal (4-HHE) and 4-hydroxy-2-nonenal (4-HNE), Accumulate in Patients with Chronic Kidney Disease

Author: Fitsum Guebre-Egziabher, Christophe O. Soulage, Caroline C. Pelletier, Nans Florens, Laurent Juillard, Sandrine Lemoine, Laurence Dubourg, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), ROSSI, Sabine, Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: Male, Health, Toxicology and Mutagenesis, medicine.medical_treatment, uremic toxins, 030232 urology & nephrology, lcsh:Medicine, Toxicology, medicine.disease_cause, urologic and male genital diseases, lipid aldehydes, Lipid peroxidation, chemistry.chemical_compound, 0302 clinical medicine, renal disease, oxidative stress, chemistry.chemical_classification, 0303 health sciences, Kidney, glomerular filtration rate, lipid peroxidation, Middle Aged, Blood proteins, female genital diseases and pregnancy complications, 3. Good health, Up-Regulation, [SDV.TOX] Life Sciences [q-bio]/Toxicology, medicine.anatomical_structure, [SDV.TOX]Life Sciences [q-bio]/Toxicology, lipid peroxidation by-products, Female, Hemodialysis, Polyunsaturated fatty acid, polyunsaturated fatty acids, Adult, medicine.medical_specialty, kidney, Renal function, Article, Gas Chromatography-Mass Spectrometry, 03 medical and health sciences, omega 3 fatty acids, Internal medicine, medicine, Humans, Renal Insufficiency, Chronic, 030304 developmental biology, Aged, Aldehydes, lcsh:R, medicine.disease, Endocrinology, chemistry, Case-Control Studies, Oxidative stress, Biomarkers, Kidney disease
Abstract: Lipid aldehydes originating from the peroxidation of n-3 and n-6 polyunsaturated fatty acids are increased in hemodialysis (HD) patients, a process already known to promote oxidative stress. However, data are lacking for patients with chronic kidney disease (CKD) before the initiation of HD. We prospectively evaluated the changes of plasma concentrations of two major lipid aldehydes, 4-HHE and 4-HNE, according to the decrease of glomerular filtration rate (GFR) in 40 CKD and 13 non-CKD participants. GFR was measured by inulin or iohexol clearance. Thus, 4-hydroxy-2-nonenal (4-HNE) and 4-hydroxy-2-hexenal (4-HHE) were quantitated in plasma by gas chromatography coupled with mass spectrometry and their covalent adducts on proteins were quantified by immunoblotting. On the one hand, 4-HHE plasma concentration increased from CKD stage I&ndash, II to CKD stage IV&ndash, V compared to non-CKD patients (4.5-fold higher in CKD IV&ndash, V, p &lt, 0.005). On the other hand, 4-HNE concentration only increased in CKD stage IV&ndash, V patients (6.2-fold, p &lt, 0.005). The amount of covalent adducts of 4-HHE on plasma protein was 9.5-fold higher in CKD patients than in controls (p &lt, 0.005), while no difference was observed for 4-HNE protein adducts. Plasma concentrations of 4-HNE and 4-HHE are increased in CKD IV&ndash, V patients before the initiation of hemodialysis.
Published: 2020

8. Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study

Author: Dimitri Titeca-Beauport, Vincent Audard, Laurent Juillard, Marie-Noëlle Peraldi, Jean-François Subra, Eric Thervet, Jean-Michel Halimi, Thierry Lobbedez, Gabriel Choukroun, Mathilde Tamain, Marc Hazzan, Alexandre Ganea, Maité Daroux, Thomas Quemeneur, Dominique Guerrot, Pauline Caillard, Marie Essig, François Vrtovsnik, Jean-Michel Rebibou, Cécile Vigneau, R. Makdassi, Marion Rabant, Morgane Heitz, Vincent Vuiblet, Alexandre Hertig, Adnane Lamrani, Jonchère, Laurent, CHU Amiens-Picardie, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), CHU Grenoble, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Ecotaxie, microenvironnement et développement lymphocytaire (EMily (UMR_S_1160 / U1160)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), CHU Lille, Inserm, Université de Lille, Lille Inflammation Research International Center - U 995 [LIRIC], Paris-Centre de Recherche Cardiovasculaire [PARCC (UMR_S 970/ U970)], Cardiovasculaire, métabolisme, diabétologie et nutrition [CarMeN], Institut Mondor de Recherche Biomédicale [IMRB], Université Paris Descartes - Paris 5 [UPD5], Centre de Recherche en Cancérologie Nantes-Angers [CRCNA], Centre Hospitalier Universitaire de Reims [CHU Reims], Service de Néphrologie - Hémodialyses [CHU Clermont-Ferrand], Ecotaxie, microenvironnement et développement lymphocytaire [EMily (UMR_S_1160 / U1160)], CHU Henri Mondor [Créteil], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: medicine.medical_specialty, Urinary system, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, lcsh:Medicine, Disease, Anti-Glomerular Basement Membrane Disease, Gastroenterology, survival, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Stage (cooking), Adverse effect, anti-GBM disease, 030203 arthritis & rheumatology, urogenital system, business.industry, ANCA, Mortality rate, lcsh:R, Glomerulonephritis, General Medicine, medicine.disease, infection, 3. Good health, age, [SDV] Life Sciences [q-bio], Bacteremia, business
Abstract: In patients presenting with anti-glomerular basement membrane (GBM) disease with advanced isolated kidney involvement, the benefit of intensive therapy remains controversial due to adverse events, particularly infection. We aim to describe the burden of severe infections (SI) (requiring hospitalization or intravenous antibiotics) and identify predictive factors of SI in a large cohort of patients with anti-GBM disease. Among the 201 patients (median [IQR] age, 53 [30&ndash, 71] years) included, 74 had pulmonary involvement and 127 isolated glomerulonephritis. A total of 161 SI occurred in 116 patients during the first year after diagnosis. These infections occurred during the early stage of care (median [IQR] time, 13 [8&ndash, 19] days after diagnosis) with mainly pulmonary (45%), catheter-associated bacteremia (22%) and urinary tract (21%) infections. In multivariable analysis, positive ANCA ([HR] 1.62, 95% [95% CI] 1.07&ndash, 2.44], p = 0.02) and age at diagnosis (HR [95% CI] 1.10 [1.00&ndash, 1.21], p = 0.047) remained independently associated with SI. Age-adjusted severe infection during the first three months was associated with an increased three-year mortality rate (HR [95% CI] 3.13 [1.24&ndash, 7.88], p = 0.01). Thus, SI is a common early complication in anti-GBM disease, particularly in the elderly and those with positive anti-neutrophil cytoplasmic antibodies (ANCA). No significant association was observed between immunosuppressive strategy and occurrence of SI.
Published: 2020

9. The Case | Hypokalemia and severe renal loss of sodium

Author: Philippe Froguel, Dominique Eladari, Sandrine Lemoine, Laurent Juillard, Amélie Bonnefond, Laurence Dubourg, Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP), Université Lille Nord de France (COMUE), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Biologie Tissulaire et d'ingénierie Thérapeutique UMR 5305 (LBTI), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)
Subjects: medicine.medical_specialty, Sodium, [SDV]Life Sciences [q-bio], MEDLINE, chemistry.chemical_element, Hypokalemia, 030204 cardiovascular system & hematology, Kidney, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, medicine, Humans, 030304 developmental biology, 0303 health sciences, business.industry, Acidosis, Renal Tubular, chemistry, Nephrology, Potassium, medicine.symptom, business
Published: 2019

10. Microangiopathie thrombotique secondaire à la gemcitabine : peut-on améliorer le dépistage et la prise en charge ?

Author: X. Charmetant, Laurent Juillard, Sandrine Lemoine, Thomas Fournier, Philippe Cassier, Jean-Charles Puthet, and Anne Jolivot
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Nephrology, business.industry, 030220 oncology & carcinogenesis, 030232 urology & nephrology, medicine, business, 3. Good health
Abstract: Resume La microangiopathie thrombotique est une complication rare mais grave du traitement par gemcitabine. Sa prevalence augmente du fait de l’elargissement des indications de cette chimiotherapie. Nous rapportons quatre cas pour lesquels la presentation clinicobiologique est relativement typique, associant hypertension arterielle, proteinurie et augmentation de la creatinine plasmatique. En revanche, la gravite du tableau est variable, necessitant le recours inconstant a une technique d’hemodialyse. Les strategies therapeutiques, outre l’arret systematique de la gemcitabine, ne sont pas consensuelles. Elles ont ete guidees par la gravite du tableau : echanges plasmatiques d’efficacite variable et eculizumab, qui s’est avere efficace lorsqu’il a ete utilise. Il ressort surtout que ce syndrome est compose de signes banals et frequents chez des patients recevant des chimiotherapies, comme les cytopenies et la majoration de la creatinine. Mais ces signes devraient inciter a rechercher d’autres signes plus specifiques, tels qu’une hypertension arterielle, des stigmates d’hemolyse mecanique, une proteinurie ou une hematurie, afin de reconnaitre le plus precocement possible la microangiopathie thrombotique et permettre sa prise en charge rapide, en evitant de nouvelles injections.
Published: 2017

11. Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort

Author: Nagham, Khanafer, Philippe, Vanhems, Frédéric, Barbut, Christine, Luxemburger, Clarisse, Demont, Monique, Hulin, Olivier, Dauwalder, François, Vandenesch, Laurent, Argaud, Lionel, Badet, Xavier, Barth, Malik, Bertrand, Carole, Burillon, Roland, Chapurlat, Michel, Chuzeville, Brigitte, Comte, François, Disant, Michel Henry, Fessy, Christian, Gouillat, Laurent, Juillard, Patrick, Lermusiaux, Olivier, Monneuse, Emmanuel, Morelon, Jacques, Ninet, Thierry, Ponchon, Emmanuel, Poulet, Thomas, Rimmele, and Karim, Tazarourte
Subjects: Adult, Diarrhea, Male, 0301 basic medicine, Pediatrics, medicine.medical_specialty, genetic structures, 030106 microbiology, Microbiology, Hospitals, University, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Humans, Medicine, Infection control, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Beta-Lactamase Inhibitors, Aged, Aged, 80 and over, Cross Infection, Clostridioides difficile, business.industry, Case-control study, Middle Aged, Clostridium difficile, Anti-Bacterial Agents, Infectious Diseases, Case-Control Studies, Nested case-control study, Clostridium Infections, Female, France, medicine.symptom, business, Cohort study
Abstract: Background Clostridium difficile infection (CDI) is a serious medical condition that is associated with substantial morbidity and mortality. Identification of risk factors associated with CDI and prompt recognition of patients at risk is key to successfully preventing CDI. Methods A 3-year prospective, observational, cohort study was conducted in a French university hospital and a nested case-control study was performed to identify risk factors for CDI. Inpatients aged 18 years or older, suffering from diarrhea suspected to be related to CDI, were asked to participate. Results A total of 945 patients were included, of which 233 cases had a confirmed CDI. CDI infection was more common in men (58.4%) (P = 0.04) compared with patients with diarrhea not related to C. difficile. Previous hospitalization (P
Published: 2017

12. Modélisation des transferts de phosphore pendant l’hémodialyse

Author: Laurent Juillard, Guillaume Chazot, and Sandrine Lemoine
Subjects: medicine.medical_specialty, medicine.medical_treatment, Phosphorus, 030232 urology & nephrology, chemistry.chemical_element, 030204 cardiovascular system & hematology, Phosphate, medicine.disease, 03 medical and health sciences, chemistry.chemical_compound, Hyperphosphatemia, 0302 clinical medicine, Inorganic phosphate, Endocrinology, chemistry, Nephrology, Internal medicine, medicine, In patient, Intracellular, Dialysis, Kidney disease
Abstract: Chronic kidney disease causes hyperphosphatemia, which is associated with increased cardiovascular risk and mortality. In patients with end-stage renal disease, haemodialysis allows the control of hyperphosphatemia. During a 4-h haemodialysis session, between 600 and 700mg of phosphate are extracted from the plasma, whereas the latter contains only 90mg of inorganic phosphate. The precise origin of phosphates remains unknown. The modelling of phosphorus transfers allows to predict the outcome after changes in dialysis prescription (duration, frequency) with simple two-compartment models and to describe the transfers between the different body compartments with more complex models. Work using 31P nuclear magnetic resonance spectroscopy performed in animals showed an increase in intracellular phosphate concentration and a decrease in intracellular ATP during a haemodialysis session suggesting an intracellular origin of phosphates.
Published: 2017

13. Prise en charge de la sténose athéromateuse d’artère rénale en 2016

Author: Olivier Rouvière, Antoine Millon, Thomas Fournier, Laurent Juillard, and Florence Sens
Subjects: medicine.medical_specialty, Percutaneous, Endovascular revascularization, Medical treatment, business.industry, 030232 urology & nephrology, Renal function, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, Clinical Practice, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Nephrology, medicine, Prospective cohort study, business, Intensive care medicine, Cohort study
Abstract: Endovascular revascularization as treatment of atherosclerotic renal-artery stenosis (aRAS) is controversial since 3 large and multicentric randomised trials (CORAL, ASTRAL, STAR) failed to prove the superiority of percutaneous transluminal renal-artery stenting (PTRAS) over medical treatment only (MT). However, considering the multiple bias of these trials, among which questionable inclusion criterias, these results must be extrapolated in clinical practice with caution. New pathophysiological data have been helping to understand why restoring blood flow does not necessarily lead to kidney function improvement. Today, the diagnostic approach must in one hand confirm the artery stenosis and on the other hand assess its severity and impact on the kidney. Therapeutic options still lie on the American guidelines published in 2006, since no study data can be reasonably used in everyday practice. However, particular sub-groups of patients who could benefit from revascularisation have been identified through recent cohort studies. Further prospective studies are needed in order to confirm the superiority of PTRAS in these populations. Meanwhile, multidisciplinary approach should be promoted, in order to provide the best treatment for each patient.
Published: 2017

14. Effectiveness of IHD with Adsorptive PMMA Membrane in Myeloma Cast Nephropathy: A Cohort Study

Author: Frank Bridoux, Déborah Chaintreuil, Laurent Juillard, Fitsum Guebre-Egziabher, Lionel Karlin, Florence Sens, Philip Robinson, Anne Jolivot, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, [SDV]Life Sciences [q-bio], medicine.medical_treatment, DIAGNOSED MULTIPLE-MYELOMA, 030232 urology & nephrology, Pharmacology, Bortezomib, 0302 clinical medicine, Multiple myeloma, Myeloma cast nephropathy, Cast nephropathy, Hazard ratio, Acute kidney injury, Middle Aged, CHEMOTHERAPY, IMPAIRMENT, Combined Modality Therapy, BORTEZOMIB-BASED REGIMENS, 3. Good health, Treatment Outcome, Nephrology, Hemodialysis, chains, REVERSIBILITY, 030220 oncology & carcinogenesis, HIGH CUTOFF HEMODIALYSIS, Female, LIGHT-CHAINS, Free light, medicine.medical_specialty, FREE, Urology, Nephropathy, 03 medical and health sciences, Renal Dialysis, medicine, Humans, Polymethyl Methacrylate, Glucocorticoids, Dialysis, Aged, Retrospective Studies, Chemotherapy, business.industry, Membranes, Artificial, medicine.disease, POLYMETHYLMETHACRYLATE MEMBRANE, Immunoglobulin Light Chains, business, ACUTE-RENAL-FAILURE
Abstract: Background: In patients with cast nephropathy and acute kidney injury (AKI) requiring dialysis, the reduction of serum free light chains (FLC) using chemotherapy and intensive hemodialysis (IHD) with a high cut-off filter may improve renal and patient outcomes. We evaluated the effectiveness of a combination of chemotherapy and IHD with an adsorbent polymethylmethacrylate membrane (IHD-PMMA) on renal recovery and survival. Methods: A single-center retrospective cohort-study was conducted. Between 2007 and 2014, patients with dialysis-dependent acute cast nephropathy treated with chemotherapy and IHD-PMMA were included. Patients had six 6-h hemodialysis sessions a week, until predialysis serum FLC fell below 200 mg/L, for a maximum of 3 weeks. Primary outcomes were renal recovery, defined as dialysis independence, and survival. Results: Seventeen patients were included, all with stage 3 AKI. All received chemotherapy, mostly based on bortezomib and steroids (88%). Twelve patients (71%) achieved renal recovery, usually within 60 days (92%). At 3 months, the overall hematological response rate was 57%; hematological response was maintained for at least 2 years in 86% of responders. At 6, 12, and 24 months, 76, 75, and 62% of patients were alive, respectively. Higher reduction in involved FLC by day 12 (p = 0.022) and day 21 (p = 0.003) was associated with renal recovery. Patients with FLC reduction rate >50% by day 21 experienced a lower mortality (hazard ratio 0.10, 95% CI 0.02–0.63). Conclusion: In patients with dialysis-dependent myeloma cast nephropathy, early FLC removal by IHD-PMMA combined with chemotherapy was associated with high rates of renal recovery and survival.
Published: 2017

15. Adsorption as a Contributor for Inflammatory Mediators Removal by Different Hemofiltration Membranes: A Pilot Study

Author: Nans Florens, Laurent Juillard, Benjamin Malard, and Corine Lambert
Subjects: Chemokine, biology, Chemistry, medicine.medical_treatment, 030232 urology & nephrology, Biomedical Engineering, Medicine (miscellaneous), Bioengineering, General Medicine, 030204 cardiovascular system & hematology, Pharmacology, medicine.disease, In vitro, Biomaterials, 03 medical and health sciences, 0302 clinical medicine, Membrane, Immunology, Hemofiltration, biology.protein, medicine, Tumor necrosis factor alpha, Plasminogen activator, Dialysis, Kidney disease
Abstract: Atherosclerosis is an important predictor of mortality in patients with chronic kidney disease (CKD) and is associated with a wide inflammatory response. The aim of this study is to evaluate in vitro how different membranes can remove mediators associated with this pathology in a closed loop dialysis model. We performed experimental hemofiltration in vitro using three different membrane materials. Human plasma was preliminarily incubated with various inflammatory mediators and filtered in a closed loop circulation model for 240 min. Respective concentrations of 17 different mediators were measured over time to study the removal mechanisms of each membrane, including associated removal time course. The experiment was repeated three times for the assay of tumor necrosis factor (TNF)-α to document the model variability. Means were compared using Mann–Whitney test. Most of the investigated mediators were effectively removed with the different dialysis membranes. Adsorption mechanism was mainly at the origin of the decrease in mediators circulating concentrations and was maximized in the region 10 000–20 000 Da. Especially, the HeprAN membrane showed fast removal capacities of mediators with elevated isoelectric point including complement factors and chemokines or having basic groups located in the protein periphery, plasminogen activator inhibitor (PAI-1), and TNF-α-like. The latter was further significantly removed with HeprAN and polymethylmethacrylate (PMMA) compared to polyethersulfone (PES) material (P
Published: 2016

16. Achievement of Low-Density Lipoprotein Cholesterol Targets in CKD

Author: Ziad A. Massy, Jean Ferrières, Eric Bruckert, Céline Lange, Sophie Liabeuf, Maja Velkovski-Rouyer, Bénédicte Stengel, Carole Ayav, Christian Combe, Denis Fouque, Luc Frimat, Yves-Edouard Herpe, Maurice Laville, Ziad Massy, Karine Legrand, Marie Metzger, Elodie Speyer, Bruno Moulin, Gaétan Lebrun, Éric Magnant, Gabriel Choukroun, Jean Philippe Bourdenx, Marie Essig, Raymond Azar, Mustafa Smati, Mohamed Jamali, Alexandre Klein, Michel Delahousse, Séverine Martin, Eric Thervet, Xavier Belenfant, Pablo Urena, Carlos Vela, Dominique Chauveau, Viktor Panescu, François Glowacki, Maxime Hoffmann, Maryvonne Hourmant, Dominique Besnier, Angelo Testa, Philippe Zaoui, Charles Chazot, Laurent Juillard, Stéphane Burtey, Adrien Keller, Nassim Kamar, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, Hôpital Ambroise Paré [AP-HP], Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service d'Endocrinologie, Métabolisme et Prévention des Maladies Cardio-vasculaires [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut E3M [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Agence de la biomédecine [Saint-Denis la Plaine], CHU Amiens-Picardie, Université Paris-Sud - Paris 11 (UP11), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service d’Endocrinologie, Métabolisme et Prévention des Risques Cardio-Vasculaires [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Nephrology, medicine.medical_specialty, Statin, medicine.drug_class, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, 030204 cardiovascular system & hematology, lcsh:RC870-923, lipids, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Ezetimibe, Clinical Research, cardiovascular disease, Diabetes mellitus, Internal medicine, medicine, Prospective cohort study, Kidney transplantation, low-density lipoprotein cholesterol, lipid-regulating agents, business.industry, Cholesterol, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, chronic kidney diseases, 3. Good health, chemistry, business, medicine.drug, Kidney disease
Abstract: Introduction: We describe the characteristics of patients with moderate/advanced chronic kidney disease (CKD) according to receipt of lipid-lowering therapy (LLT), and whether they achieved low-density lipoprotein cholesterol (LDL-C) targets for high- and very high-risk patients. Methods: CKD-REIN (NCT03381950), a prospective cohort study conducted in 40 nephrology clinics in France, enrolled 3033 patients with moderate (stage G3) or advanced (stage G4/G5) CKD (2013−2016) who had not been on chronic dialysis or undergone kidney transplantation. Data were collected from patients’ interviews and medical records. Patients were followed up at 1 year. Results: Among 2542 patients (mean [SD] age 67 [13] years, 34% women) with LDL-C measurements at baseline (mean [SD] LDL-C 2.7 [1.1] mmol/l; cholesterol 4.8 [1.3] mmol/l), 63% were on LLT; 24% were at high (CKD stage G3, no cardiovascular disease [CVD] or diabetes) and 74% at very high (CKD stage G3 with diabetes or CVD, or CKD stage G4/5) cardiovascular risk. Among high-risk patients, 45% of those on statin and/or ezetimibe achieved the LDL-C treatment target (
Published: 2019

17. Measurement of glomerular filtration rate in lung transplant recipients highlights a dramatic loss of renal function after transplantation

Author: Laurence Dubourg, François Parant, Sandrine Lemoine, François Philit, Jean François Mornex, Laurent Bitker, Emilie Kalbacher, Laurent Juillard, Nans Florens, Fitsum Guebre-Egziabher, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France (Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France), Infections Virales et Pathologie Comparée - UMR 754 (IVPC), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hospices Civils de Lyon (HCL), ROSSI, Sabine, Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Urology, Renal function, 030230 surgery, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, Medicine, Lung transplantation, Stage (cooking), AcademicSubjects/MED00340, measured GFR, Transplantation, Receiver operating characteristic, business.industry, Odds ratio, Original Articles, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, lung transplant, Confidence interval, female genital diseases and pregnancy complications, Nephrology, epidemiology, business, chronic kidney disease, Kidney disease
Abstract: Background Chronic kidney disease (CKD) after lung transplantation (LT) is underestimated. The aim of the present study was to measure the loss of glomerular filtration rate (GFR) 1 year after LT and to identify the risk factors for developing Stage ≥3 CKD. Methods LT patients in the University Hospital of Lyon had a pre- and post-transplantation measurement of their GFR (mGFR), and GFR was also estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Results During the study period, 111 patients were lung transplant candidates, of which 91 had a pre-transplantation mGFR, and 29 had a mGFR at 1 year after LT. Six patients underwent maintenance haemodialysis after transplantation. Mean mGFR was 106 mL/min/1.73 m2 before LT and 58 mL/min/1.73 m2 1 year after LT (P Conclusion The present study underlines the value of mGFR in the pre-LT stage and found major renal function loss after LT, and consequently two-thirds of patients have Stage ≥3 CKD at 1 year. All patients with a pre-LT mGFR
Published: 2019

18. Estimated Glomerular Filtration Rate Bias in Participants with Severe Obesity Regardless of Deindexation

Author: Fitsum Guebre-Egziabher, Sandrine Lemoine, Charlotte Brunelle, Laurence Dubourg, Caroline C Pelletier, Laurent Juillard, Gabrielle Normand, Jouve Thomas, Service de néphrologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Grenoble Alpes (UGA), Morton K. Blaustein Department of Earth and Planetary Sciences [Baltimore], Johns Hopkins University (JHU), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Laboratoire de Biologie Tissulaire et d'ingénierie Thérapeutique UMR 5305 (LBTI), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Service de néphrologie, dialyse, aphérèses et transplantation, Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Medicine (miscellaneous), urologic and male genital diseases, surgery, 0302 clinical medicine, Endocrinology, body-composition, Risk Factors, Medicine, 030212 general & internal medicine, accurate, Aged, 80 and over, Body surface area, Kidney, Nutrition and Dietetics, Data Collection, Middle Aged, female genital diseases and pregnancy complications, Obesity, Morbid, medicine.anatomical_structure, Female, Glomerular Filtration Rate, medicine.drug, Adult, medicine.medical_specialty, Adolescent, Urology, Renal function, 030209 endocrinology & metabolism, equation, serum creatinine, Young Adult, 03 medical and health sciences, Endocrinology & Metabolism, Humans, Renal Insufficiency, Chronic, Aged, Retrospective Studies, Nutrition & Dietetics, business.industry, association, kidney-disease, Retrospective cohort study, medicine.disease, Obesity, gfr, ckd, Iohexol, business, Body mass index, Kidney disease
Abstract: International audience; Objective Morbid obesity is associated with a higher independent risk of chronic kidney disease (CKD). Estimated glomerular filtration rate (eGFR) has been evaluated in a limited number of study participants with severe obesity. Methods A total of 706 measured GFR (mGFR) results from 598 participants with obesity (BMI \textgreater= 35 kg/m(2)) were retrospectively collected. The performance of the Modification of Diet in Renal Disease (MDRD) equation, Chronic Kidney Disease-Epidemiology (CKD-EPI) equation, and deindexed eGFR were compared with mGFR from the gold standard technique (inuline or iohexol), adjusted (mGFRr) or nonadjusted (mGFR) to body surface area. Absolute bias, precision, and accuracy were calculated. Results Mean mGFRr (58 +/- 31 mL/min/1.73 m(2)) was significantly different from CKD-EPI and MDRD (P \textless 0.001). Mean mGFR (nonindexed) (70 +/- 40 mL/min) was significantly higher than mGFRr (P \textless 0.001). eGFR showed important biases and low accuracies for CKD-EPI and MDRD (10.7 +/- 10.7 and 12.2 +/- 13.7 mL/min/1.73 m(2); 78% vs. 75% respectively). Deindexation worsened bias and accuracy 30% (percentage of GFR estimates within 30% of mGFRr or mGFR) between eGFR and mGFR. Conclusions eGFR overestimates mGFR and is associated with important biases and inaccuracies in patients with severe obesity, and deindexing eGFR worsens the overestimation. These findings may have important implications in examining kidney function in patients with obesity.
Published: 2019

19. Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting

Author: Thomas Fournier, Olivier Rouvière, Stéphane Luong, Florence Sens, Gabrielle Normand, Caroline C. Pelletier, Philip Robinson, Nellie Della-Schiava, Sandrine Lemoine, Laurent Juillard, Laboratoire de Chimie Moléculaire et Environnement (LCME), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Application des ultrasons à la thérapie (LabTAU), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Université Grenoble Alpes (UGA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: Male, Cardiovascular Procedures, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Blood Pressure, 030204 cardiovascular system & hematology, Pathology and Laboratory Medicine, Vascular Medicine, Cohort Studies, 0302 clinical medicine, Medicine and Health Sciences, 030212 general & internal medicine, Resistant Hypertension, Stenosis, Aged, 80 and over, Multidisciplinary, Drugs, Arteries, Middle Aged, 3. Good health, Antihypertensive Drugs, Hypertension, Renovascular, Treatment Outcome, Hypertension, Cardiology, Medicine, Female, Anatomy, Research Article, Glomerular Filtration Rate, Cohort study, medicine.medical_specialty, Science, Decision Making, Renal function, Surgical and Invasive Medical Procedures, Renal Artery Obstruction, Revascularization, 03 medical and health sciences, Signs and Symptoms, Renal Arteries, Diagnostic Medicine, Internal medicine, medicine.artery, Angioplasty, medicine, Humans, Renal artery, Antihypertensive Agents, Aged, Retrospective Studies, Pharmacology, Treatment Guidelines, Health Care Policy, business.industry, Biology and Life Sciences, Kidneys, Retrospective cohort study, Renal System, Atherosclerosis, medicine.disease, Health Care, Blood pressure, Reperfusion, Cardiovascular Anatomy, Blood Vessels, business, Angioplasty, Balloon
Abstract: International audience; BACKGROUND: In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital. OBJECTIVES: To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization. METHODS: Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity \textgreater180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected. RESULTS: Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23+/-34mmHg, p = 0.007), diastolic blood pressure (-12+/-18mmHg, p = 0.007), number of antihypertensive medications (-1.00+/-1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event. CONCLUSION: Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.
Published: 2019

20. PET C-11 acetate is also a perfusion tracer for kidney evaluation purposes

Author: Nicolas Costes, Didier Le Bars, Inés Mérida, Zacharie Irace, Sandrine Lemoine, Gabrielle Normand, Thomas Troalen, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Neurosciences précliniques, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Siemens Healthcare [France], Siemens AG [Munich], Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre d'Exploration et de Recherche Médicales par Émission de Positons (CERMEP), Université Joseph Fourier - Grenoble 1 (UJF)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant (CERMEP - imagerie du vivant), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Siemens Healthineers France collaboration program, ANR-11-EQPX-0026,LILI,Lyon - Imagerie Intégrée du Vivant : IRM-TEP hybride(2011), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), CCSD, Accord Elsevier, and Equipements d'excellence - Lyon - Imagerie Intégrée du Vivant : IRM-TEP hybride - - LILI2011 - ANR-11-EQPX-0026 - EQPX - VALID
Subjects: Cancer Research, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Renal oxidative, Revascularization, positron-emission-tomography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, renal blood-flow, In vivo, TRACER, medicine, Renal functional parameters, Radiology, Nuclear Medicine and imaging, validation, Kidney, medicine.diagnostic_test, carbon-11-acetate, Chemistry, business.industry, Acetate, Blood flow, 3. Good health, Cardiovascular physiology, [SDV] Life Sciences [q-bio], Nuclear Medicine & Medical Imaging, medicine.anatomical_structure, Positron emission tomography, 030220 oncology & carcinogenesis, PET-MRI, Molecular Medicine, Nuclear medicine, business, Radiology, Perfusion, metabolism, oxidative-metabolism, Renal perfusion
Abstract: International audience; Rationale: Renal positron emission tomography (PET) functional imaging allows non-invasive and dynamic measurements of functional and metabolic parameters. [O-15]H2O is used as a perfusion tracer, and [C-11]acetate as an oxidative metabolism in this purpose, requiring two injections to assess those fundamental parameters. Yet, in cardiac physiology study, the high first-pass myocardial extraction fraction of [C-11]acetate allowed to use its influx rate as a blood flow marker too. Since [C-11]acetate has been characterized by a 20-25% single pass renal extraction in dogs, it could be used as a potential tracer for renal perfusion. The aim of this study was to determine whether [C-11]acetate influx rate can be used as quantitative in vivo marker of kidney perfusion in human. Methods: In 10 healthy subjects, dynamic PET acquisitions were performed after [O-15]H2O and [C-11]acetate injections spaced by a 15-minute interval. As previously validated, with compartmental modeling of kinetics, renal perfusion and oxidative metabolism were estimated respectively with influx rate of [O-15]H2O and efflux rate of [C-11]acetate. Additionally, influx rate of [C-11]acetate was regressed to influx rate of [O-15]H2O. Results: Renal time activity curves of [C-11]-acetate was best fitted with a mono compartmental model compared to a bi-compartmental model (p \textless 0.0001). [C-11]acetate influx rate was significantly correlated with perfusion quantified with [O-15]H2O (r(2) = 0.37, p \textless 0.001) at baseline. This regression allowed the computation of a renal [C-11]acetate extraction fraction (EF), and further the computation of renal blood flow from its influx rate. Conclusion: In healthy subjects, over a wide range of renal perfusion, direct estimates of renal oxygen consumption as well as tissue perfusion can be obtained by PET with a single tracer [C-11]acetate. This approach needs to be validated in CKD patients, and would be of great interest to design clinical protocol aiming at evaluating ischemic nephropathies candidate to revascularization. (C) 2019 Elsevier Inc. All rights reserved.
Published: 2019

21. Twin pregnancy in a patient on chronic haemodialysis who already had three pregnancies

Author: Anne Jolivot, Pascaline M Alix, Flora Brunner, Muriel Doret, Laurent Juillard, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Adult, Male, Polyhydramnios, medicine.medical_specialty, Twin pregnancy, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Twins, 030232 urology & nephrology, Gestational Age, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Renal Dialysis, Intensive care, Diseases in Twins, medicine, Humans, Twin Pregnancy, Dialysis, Respiratory distress, Cesarean Section, business.industry, Obstetrics, Infant, Newborn, Four pregnancies, medicine.disease, 3. Good health, Pregnancy Complications, Nephrology, Pregnancy, Twin, Kidney Failure, Chronic, Gestation, Female, Hemodialysis, business, Chronic hemodialysis, Daily hemodialysis
Abstract: International audience; Pregnancy in women with end-stage renal disease is rare. Multiple pregnancies carry a high risk of complications even in healthy individuals. We report the case of a 36-year-old woman who had four pregnancies while she was on dialysis, including one twin pregnancy. The last pregnancy occurred while in the 14th year of hemodialysis. At 8 weeks of gestation (WG), ultrasonography diagnosed a dichorionic diamniotic twin pregnancy. The frequency of dialysis was increased from 3 to 6 times a week and each session lasted 4 h. At 22 WG, polyhydramnios was diagnosed. At 25 WG, the patient presented respiratory distress and was transferred to intensive care where continuous hemodialysis, non-invasive ventilation, antibiotic and tocolysis were initiated. Because of tocolysis failure, a cesarean section was performed and she delivered male twins. The two newborns weighed 790 and 870 g, respectively. To our knowledge, this is the first report of four pregnancies in hemodialysis including one twin pregnancy. The incidence of pregnancy and a better outcome in patients on hemodialysis has increased in recent years but a tight coordination between nephrologists and obstetricians is essential.
Published: 2019

22. Insuffisance rénale aiguë en périopératoire et en réanimation (à l’exclusion des techniques d’épuration extrarénale)

Author: Nicolas Lerolle, Jean-Michel Constantin, Bertrand Souweine, Laurent Jacob, Olivier Joannes-Boyau, Arnaud Garnier, Carole Ichai, Jacques Duranteau, Eric Rondeau, Emmanuel Canet, Théophille Gaillot, Christophe Clec’h, Yannick Walrave, Fabienne Tamion, Christophe Vinsonneau, Lionel Velly, Alexandre Lautrette, Laurent Muller, Didier Journois, Thomas Rimmelé, Groupe francophone de réanimation et urgences pédiatriques, Société française d'anesthésie et de réanimation, Laurent Juillard, Société française de néphrologie, Michael Darmon, Matthieu Legrand, and Fabien Armando
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, business.industry, Medicine, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, business
Published: 2016

23. Mesure des concentrations intracellulaires de phosphate inorganique et d’ATP par spectroscopie de résonance magnétique nucléaire pendant une séance d’hémodialyse chez l’insuffisant rénal chronique terminal (Étude CIPHEMO)

Author: D. Sappey-Marinier, Gabriel Kocevar, Emilie Kalbacher, M.C. Carlier, Laurent Juillard, Annie Varennes, Olivier Rouvière, Sandrine Lemoine, Gabrielle Normand, Guillaume Chazot, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant (CERMEP - imagerie du vivant), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Application des ultrasons à la thérapie (LabTAU), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM), KOCEVAR, Gabriel, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre d'Exploration et de Recherche Médicales par Émission de Positons (CERMEP), Université Joseph Fourier - Grenoble 1 (UJF)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: 03 medical and health sciences, 0302 clinical medicine, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, Nephrology, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, 030232 urology & nephrology, [INFO.INFO-IM] Computer Science [cs]/Medical Imaging, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, 030204 cardiovascular system & hematology, ComputingMilieux_MISCELLANEOUS, 3. Good health
Abstract: Introduction Au cours d’une seance d’hemodialyse (HD), il est considere que seulement 25 a 40 % du phosphate inorganique (Pi) epure provient du compartiment extra-cellulaire. Des donnees suggerent que les 60 a 75 % restants pourraient provenir du compartiment intracellulaire. En utilisant la spectroscopie par resonance magnetique du phosphore 31 (31P-MRS), une augmentation de la concentration intracellulaire en Pi durant l’HD chez le porc a ete observee dans un modele d’insuffisance renale aigue. Ce resultat conforte l’hypothese d’une origine intracellulaire du phosphate epure, sans qu’une origine osseuse n’ait pu completement etre ecartee. Le but de notre etude est de verifier si le Pi intracellulaire augmente au cours d’une seance d’hemodialyse chez les patients insuffisants renaux chroniques terminaux (IRCT) en hemodialyse chronique depuis plus de 6 mois. Patients/Materiels et methodes Onze patients IRCT ont ete inclus dans cette etude monocentrique, prospective, interventionnelle ou les concentrations intracellulaires en Pi et en ATP ont ete mesurees par 31P-MRS pendant une seance d’HD standard de 4 heures. Le bilan phosphocalcique, la PTH (debut et fin de dialyse) et la balance calcique ont egalement ete dose. Observation/Resultats Pendant l’HD, la phosphatemie chute rapidement au cours de la premiere heure (−41 %, p Discussion Au vu des resultats de la balance calcique, il apparait peu probable que le compartiment osseux participe a une liberation de phosphate dans le plasma durant l’HD. Conclusion Cette etude confirme pour la premiere fois une origine intracellulaire du phosphate epure pendant l’HD chez des patients IRCT.
Published: 2018

24. AGE Content of a Protein Load Is Responsible for Renal Performances: A Pilot Study

Author: Zacharie Irace, Thomas Troalen, Marjorie Villien, Nicolas Costes, Sandrine Lemoine, Laurent Juillard, Gabrielle Normand, Inés Mérida, Didier Le Bars, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Siemens Healthcare [France], Siemens AG [Munich], Hôpital de la Croix-Rousse [CHU - HCL], Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Glycation End Products, Advanced, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], 030209 endocrinology & metabolism, Pilot Projects, restriction, 030204 cardiovascular system & hematology, Kidney, Gastroenterology, Diabetic nephropathy, 03 medical and health sciences, Young Adult, Endocrinology & Metabolism, 0302 clinical medicine, Oxygen Consumption, Glycation, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Diabetic Nephropathies, Prospective Studies, Renal Insufficiency, Chronic, Prospective cohort study, 2. Zero hunger, Advanced and Specialized Nursing, Meal, disease, glomerular-filtration-rate, Cross-Over Studies, business.industry, reserve, Kidney metabolism, Middle Aged, medicine.disease, Crossover study, 3. Good health, Oxygen, glycation end-products, Female, Dietary Proteins, business, diet, Kidney disease
Abstract: OBJECTIVE Chronic kidney disease is associated with higher morbidity and mortality in patients with diabetes. A low-protein diet is recommended to slow diabetic nephropathy progression because each protein load leads to renal hemodynamic variations. The aim of our study was to evaluate whether the advanced glycation end products (AGE) content of a protein load is responsible for the protein-induced renal hemodynamic variations in humans. RESEARCH DESIGN AND METHODS Ten healthy subjects were assigned to a high-protein (1 g/kg) low-AGE (3,000 kU AGE) versus high-AGE (30,000 kU AGE) meal. Renal perfusion, oxygen consumption, and oxygen content were measured before and 120 min after each meal. RESULTS Renal perfusion (3.2 ± 0.5 vs. 3.8 ± 0.4 mL/min/g; P = 0.0002) and oxygen consumption (0.3 ± 0.04 vs. 0.4 ± 0.08 min−1; P = 0.005) increased significantly after the high-AGE meal compared with the low-AGE meal. CONCLUSIONS Our results suggest that the AGE content of a protein load is responsible for renal hemodynamic modifications. Therefore, prevention of diabetic nephropathy progression could aim predominantly at reducing food AGE content.
Published: 2018

25. Renal Involvement in Neuropathy, Ataxia, Retinitis Pigmentosa (NARP) Syndrome: A Case Report

Author: Laurent Juillard, Maud Rabeyrin, Marine Panaye, Fitsum Guebre-Egziabher, Philippe Petiot, Sandrine Lemoine, Elisabeth Errazuriz-Cerda, Bénédicte Mousson de Camaret, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service Néphrologie Dialyse, Hypertension Arterielle, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Service des Maladies Héréditaires du Métabolisme, Centre de Biologie et de pathologie Est-Hospices Civils de Lyon (HCL), Hôpital de la Croix-Rousse [CHU - HCL], Centre Hospitalier Universitaire [Grenoble] (CHU), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Hospices Civils de Lyon (HCL)-Centre de Biologie et de pathologie Est
Subjects: Male, Pathology, medicine.medical_specialty, Ataxia, Adolescent, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Kearns-Sayre Syndrome, Gene mutation, Young Adult, 03 medical and health sciences, Rare Diseases, 0302 clinical medicine, Renal Dialysis, Retinitis pigmentosa, medicine, Humans, Genetic Predisposition to Disease, Child, Myopathy, Dialysis, ComputingMilieux_MISCELLANEOUS, Kidney, Psychomotor retardation, medicine.diagnostic_test, business.industry, Biopsy, Needle, Mitochondrial Myopathies, Mitochondrial Proton-Translocating ATPases, medicine.disease, Immunohistochemistry, 3. Good health, Treatment Outcome, medicine.anatomical_structure, Nephrology, Disease Progression, Kidney Diseases, Renal biopsy, medicine.symptom, business, Retinitis Pigmentosa, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome diagnosed at age 11 years with a biopsy-proven kidney involvement that progressed to end-stage renal disease at age 21 years. Mutations of mitochondrial DNA (mtDNA) are maternally inherited and lead to mitochondrial cytopathies with predominant neurologic manifestations: psychomotor retardation, epilepsy, ataxia, neuropathy, and myopathy. Given the ubiquitous nature of mitochondria, cellular dysfunction can also appear in tissues with high metabolic turnover; thus, there can be cardiac, digestive, ophthalmologic, and kidney complications. Mutations in the MT-ATP6 gene of mtDNA have been shown to cause NARP syndrome without renal involvement. We report a patient who had NARP syndrome diagnosed at age 11 years in whom glomerular proteinuria was present very early after diagnosis. Although neurologic manifestations were stable over time, he developed worsening proteinuria and kidney function. He started dialysis therapy at age 21 years. Kidney biopsy confirmed the mitochondrial cytopathy histologically, with abnormal mitochondria seen on electron microscopy. The MT-ATP6 gene mutation was detected in the kidney biopsy specimen.
Published: 2018

26. Pregnancy Outcomes in French Hemodialysis Patients

Author: Fitsum Guebre-Egziabher, Sylvie Bin, Evelyne Decullier, Anne Jolivot, Marine Panaye, Gabrielle Normand, Laurent Juillard, Muriel Doret, Xiaoli Xu, Sandrine Lemoine, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: trends, Adult, medicine.medical_specialty, dialysis patients, renal-transplant recipients, medicine.medical_treatment, Birth weight, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Gestational Age, 030204 cardiovascular system & hematology, registry, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Renal Dialysis, Risk Factors, medicine, Birth Weight, Humans, Pregnancy outcomes, Dialysis, Retrospective Studies, Fetus, business.industry, Obstetrics, Cesarean Section, Infant, Newborn, Pregnancy Outcome, Gestational age, cohort, Urology & Nephrology, medicine.disease, Chronic renal insufficiency, 3. Good health, Pregnancy Complications, Catheter, Nephrology, Kidney Failure, Chronic, Female, Hemodialysis, women, France, business
Abstract: Background: Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. Methods: This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. Results: We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Conclusions: Our study is one of the largest series of pregnancies in HD patients. Despite recent progresses, these pregnancies remain at high risk, reinforcing the need for an early nephrologist-obstetrician skilled team co-management.
Published: 2018

27. Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension

Author: Laurent Juillard, Vincent Cottin, Florence Sens, Cécile Payet, Laurent Bitker, Antoine Duclos, Ségolène Turquier, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre de Recherche Cardio-Thoracique, Partenaires INRAE, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université de Lyon (COMUE), Hôpital Louis Pradel [CHU - HCL], Infections Virales et Pathologie Comparée - UMR 754 (IVPC), Institut National de la Recherche Agronomique (INRA)-École pratique des hautes études (EPHE), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL)
Subjects: Male, Physiology, [SDV]Life Sciences [q-bio], Hemodynamics, 030204 cardiovascular system & hematology, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 0302 clinical medicine, blood-pressure, Chronic kidney disease, 030212 general & internal medicine, Aged, 80 and over, glomerular-filtration-rate, Hazard ratio, Central venous pressure, Middle Aged, Urology & Nephrology, female genital diseases and pregnancy complications, 3. Good health, Nephrology, Cardiology, Female, France, Mortality/Survival, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Hypertension, Pulmonary, Cardiorenal syndrome, Renal function, equation, Heart failure, survival, serum creatinine, Pulmonary hypertension, 03 medical and health sciences, Internal medicine, medicine, Humans, Renal Insufficiency, Chronic, renal-function, Aged, business.industry, heart-failure, association, medicine.disease, mortality, business, Kidney disease
Abstract: Background: Pulmonary arterial hypertension (PAH) may lead to right heart failure and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD, GFR 2) may also adversely affect PAH prognosis. This study aimed to assess how right heart hemodynamics was associated with reduced estimated GFR (eGFR) and the association of CKD with survival in PAH patients. Methods: In a prospective PAH cohort (2003–2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients) and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated using a multivariate Cox regression model. Results: At diagnosis, mean age was 60.4 ± 16.5 years, mean pulmonary arterial pressure was 43 ± 12 mm Hg, and eGFR was 74.4 ± 26.4 mL/min/1.73 m2. CKD was observed in 52 incident patients (29%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension, and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressure. Age ≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazards ratio for death associated with CKD was 1.81 (95% confidence interval [1.01–3.25]). Conclusion: CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.
Published: 2018

28. Expanded haemodialysis: news from the field

Author: Laurent Juillard, Nans Florens, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hospices Civils de Lyon (HCL), Baxter Healthcare Corporation, ProdInra, Migration, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, 030232 urology & nephrology, Tissue membrane, Reviews, Hemodiafiltration, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Rhabdomyolysis, 03 medical and health sciences, Dialysis solutions, 0302 clinical medicine, Renal Dialysis, Dialysis Solutions, Restless Legs Syndrome, haemodialysis membrane, Medicine, Humans, Adverse effect, Intensive care medicine, Transplantation, business.industry, chronic haemodialysis, medium cut-off, Membranes, Artificial, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 3. Good health, Molecular Weight, Nephrology, HDx, business, Multiple Myeloma, uraemic toxins
Abstract: International audience; Expanded haemodialysis (HDx) has emerged as a promising solution to improve haemodialysis effectiveness. A medium cutoff membrane allows the removal of a wider range of uraemic toxins. However, little is known about the potential interesting applications of HDx therapy. Feedback from the first routine use of HDx therapy under real-life conditions in European facilities was excellent for priming and rinse back. There was no adverse event after 5191 HDx treatments. Patients suffering from itching, restless legs syndrome, persistent asthenia or malnourishment could benefit from HDx therapy. Moreover, we discuss here the promising applications in which HDx could be valuable (myeloma, rhabdomyolysis or cardiovascular diseases). This enthusiastic message is mitigated by reminding why and how prudence should be taken in the design of future HDx studies.
Published: 2018

29. Grossesse en insuffisance rénale terminale : épidémiologie, prise en charge et pronostic

Author: Fitsum Guebre-Egziabher, Laurent Juillard, Marine Panaye, Anne Jolivot, Sandrine Lemoine, Muriel Doret, and Emmanuel Morelon
Subjects: Pregnancy, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Eclampsia, business.industry, Obstetrics, medicine.medical_treatment, 030232 urology & nephrology, Intrauterine growth restriction, medicine.disease, 3. Good health, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, Nephrology, medicine, Hemodialysis, business, Kidney transplantation, Dialysis, Kidney disease
Abstract: Pregnancy in patients presenting end-stage renal disease is rare and there are currently no recommendations for the management of these patients. In hemodialysis patients, reduced fertility and medical reluctance limit the frequency of pregnancies. Although the prognosis has significantly improved, a significant risk for unfavorable maternal (pre-eclampsia, eclampsia) and fetal (pre-term birth, intrauterine growth restriction, still death) outcome still remains. Increasing dialysis dose with the initiation of daily dialysis sessions, early adaptation of medications to limit teratogenicity and management of chronic kidney disease complications (anemia, hypertension) are required. A tight coordination between nephrologists and obstetricians remains the central pillar of the care. In peritoneal dialysis, pregnancy is also possible with modification of the exchange protocol and reducing volumes.
Published: 2014

30. Dose and timing of injections for effective cyclosporine A pretreatment before renal ischemia reperfusion in mice

Author: Laurent Juillard, Maud Rabeyrin, Michel Ovize, Lionel Augeul, Delphine Baetz, Gabrielle Normand, Sandrine Lemoine, Annie Varennes, Bruno Pillot, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL), Bibliotheque Scientifique de l'Internat de LyonHospices Civils de Lyon, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, 0301 basic medicine, Critical Care and Emergency Medicine, [SDV]Life Sciences [q-bio], Drug Evaluation, Preclinical, 030232 urology & nephrology, lcsh:Medicine, Pharmacology, Kidney, Biochemistry, Vascular Medicine, Mitochondrial Membrane Transport Proteins, chemistry.chemical_compound, 0302 clinical medicine, Ischemia, Medicine and Health Sciences, lcsh:Science, Energy-Producing Organelles, ComputingMilieux_MISCELLANEOUS, Multidisciplinary, Acute Kidney Injury, Mitochondria, 3. Good health, Dose–response relationship, medicine.anatomical_structure, Creatinine, Reperfusion Injury, Cyclosporine, Cellular Structures and Organelles, Anatomy, Renal Ischemia, Research Article, Histology, Calcineurin Inhibitors, Renal function, Bioenergetics, Drug Administration Schedule, 03 medical and health sciences, medicine, Animals, Calcium Signaling, Dose-Response Relationship, Drug, Renal ischemia, Mitochondrial Permeability Transition Pore, business.industry, lcsh:R, Biology and Life Sciences, Kidneys, Cell Biology, Renal System, medicine.disease, Mice, Inbred C57BL, 030104 developmental biology, chemistry, Mitochondrial permeability transition pore, Reperfusion, lcsh:Q, Calcium, business, Reperfusion injury, Biomarkers
Abstract: International audience; BackgroundThere is experimental evidence that lethal ischemia-reperfusion injury (IRI) is largely due to mitochondrial permeability transition pore (mPTP) opening, which can be prevented by cyclosporine A (CsA). The aim of our study is to show that a higher dose of CsA (10 mg/kg) injected just before ischemia or a lower dose of CsA (3 mg/kg) injected further in advance of ischemia (1 h) protects the kidneys and improves mitochondrial function.MethodsAll mice underwent a right unilateral nephrectomy followed by 30 min clamping of the left renal artery. Mice in the control group did not receive any pharmacological treatment. Mice in the three groups treated by CsA were injected at different times and with different doses, namely 3 mg/kg 1 h or 10 min before ischemia or 10 mg/kg 10 min before ischemia. After 24 h of reperfusion, the plasma creatinine level were measured, the histological score was assessed and mitochondria were isolated to calculate the calcium retention capacity (CRC) and level of oxidative phosphorylation.ResultsMortality and renal function was significantly higher in the CsA 10 mg/kg-10 min and CsA 3mg/kg-1 h groups than in the CsA 3mg/kg-10 min group. Likewise, the CRC was significantly higher in the former two groups than in the latter, suggesting that the improved renal function was due to a longer delay in the opening of the mPTP. Oxidative phosphorylation levels were also higher 24 h after reperfusion in the protected groups.ConclusionsOur results suggest that the protection afforded by CsA is likely limited by its availability. The dose and timing of the injections are therefore crucial to ensure that the treatment is effective, but these findings may prove challenging to apply in practice.
Published: 2017

31. Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report

Author: Maud Rabeyrin, Fitsum Guebre-Egziabher, J. Kanitakis, Sandrine Lemoine, Nans Florens, Florent Valour, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Department of Infectious Diseases and Tropical Medicine, Hospices Civils de Lyon (HCL), Departement det Dermatologie, Departement de Pathologie, Centre médical universitaire de Genève (CMU), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Nephrology, Pathology, lésion cutanée, Nephrotic Syndrome, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Case Report, examen clinique, Kidney, 0302 clinical medicine, Lyme disease, Minimal change disease, 030212 general & internal medicine, Borreliosis, pathogénèse, Skin, Lyme Disease, medicine.diagnostic_test, diagnostic techniques, pathogenesis, Ceftriaxone, 3. Good health, LYME, Anti-Bacterial Agents, Renal pathology, Female, Renal biopsy, Chronic atrophic acrodematitis, medicine.medical_specialty, lyme, borreliosis, minimal change disease, chronic atrophic acrodematitis, Prednisolone, 03 medical and health sciences, Internal medicine, corticostéroïde, medicine, Humans, Glucocorticoids, Aged, business.industry, Nephrosis, Lipoid, Acrodermatitis, maladie de lyme, medicine.disease, Dermatology, Skin biopsy, Chronic Disease, Lyme, business, Nephrotic syndrome
Abstract: Background: There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis. Case presentation: A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids. Conclusion: We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.
Published: 2017

32. Cystatin C Versus Creatinine for GFR Estimation in CKD Due to Heart Failure

Author: Eric Bonnefoy, Sandrine Lemoine, Laurent Sebbag, Laurence Dubourg, Fitsum Guebre-Egziabher, Laurent Juillard, Delphine Kervella, Florence Sens, Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Urology, Renal function, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, Young Adult, 0302 clinical medicine, medicine, Humans, Prospective Studies, Young adult, Cystatin C, Renal Insufficiency, Chronic, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, Aged, Aged, 80 and over, Heart Failure, Creatinine, biology, business.industry, Follow up studies, Middle Aged, medicine.disease, chemistry, Nephrology, Heart failure, biology.protein, Female, business, Biomarkers, Follow-Up Studies, Glomerular Filtration Rate
Abstract: International audience
Published: 2017

33. Large Middle Molecule and Albumin Removal: Why Should We Not Rest on Our Laurels?

Author: Laurent Juillard and Nans Florens
Subjects: Membrane permeability, business.industry, medicine.medical_treatment, 030232 urology & nephrology, Albumin, 030204 cardiovascular system & hematology, Pharmacology, medicine.disease, Highly sensitive, 03 medical and health sciences, 0302 clinical medicine, Uremic toxins, medicine, Lack of knowledge, Hemodialysis, business, Middle molecule, Kidney disease
Abstract: Large middle molecules (LMM) are an important subclass of uremic toxins. Many of them have been linked with poor outcomes in hemodialysis (HD) patients. The onset of high-flux membranes and convective techniques allowed to dramatically improve their clearance but without a clear and undebatable reduction of mortality in HD patients. Despite the real effect on the removal of selected toxins, little is known about the influence of modern HD techniques on the global removal of uremic toxins. Mostly explained by a lack of knowledge and selective assays, LMM removal is not evaluated appropriately. The development of highly sensitive and widespread detection techniques such as mass spectrometry could increase our knowledge about the real state of their removal in HD. Nevertheless, these techniques remain cost effective and are difficult to handle. On the contrary, the improvement of LMM removal raises the question of a tolerable albumin removal. Indeed, increasing membrane permeability can significantly increase LMM removal accompanied by a higher albumin loss. However, in chronic kidney disease and particularly in HD patients, albumin can be modified, and it subsequently exerts detrimental effects. This could be avoided by the clearance of the modified forms in HD, but future efforts should be done to investigate the real impact of their removal.
Published: 2017

34. Adenine rich diet Is not a surrogate of 5/6 nephrectomy in rabbits

Author: Nans Florens, Caroline C. Pelletier, Sandrine Lemoine, Laurent Juillard, Maud Rabeyrin, Christophe O. Soulage, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Département de Néphrologie, Université Bordeaux Segalen - Bordeaux 2, Département de Pathologie, Université Libre de Bruxelles [Bruxelles] (ULB)-Institut Jules Bordet, INSERM, INSA-Lyon, ARS, Hospices Civils de Lyon, Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Université libre de Bruxelles (ULB)-Institut Jules Bordet [Bruxelles], Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, 0301 basic medicine, Pathology, medicine.medical_specialty, fasting, medicine.medical_treatment, rabbit, Renal function, Disease, Kidney, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, chronic diseases, Mice, 03 medical and health sciences, Animal model, Species Specificity, chemical nephrectomy, adénine, mental disorders, medicine, Animals, Urea, lapin, Renal Insufficiency, Chronic, business.industry, Adenine, animal model, maladie chronique, Kidney pathology, Diet, Rats, jeûne alimentaire, Disease Models, Animal, 030104 developmental biology, Creatinine, Urea blood, vitamin b 4, Rabbits, maladie rénale, Creatinine blood, business, chronic kidney disease, Glomerular Filtration Rate
Abstract: Background: Animal models are important tools needed to understand the mechanisms underlying the progression of renal disease and to implement new therapeutic approaches. A non-surgical model of chronic kidney disease (CKD) developed by chemical nephrectomy using an adenine-enriched diet has been shown to be a robust model to induce kidney failure in mice and rats. The purpose of this study was to implement an adenine diet to induce CKD in rabbits. Methods: Male New Zealand rabbits were fed for 4 weeks with a diet containing 0.75% (w/w) adenine, and renal function was assessed by measuring plasma urea and creatinine concentrations. The glomerular filtration rate (GFR) was measured using the plasmatic clearance of Iohexol. Kidney histology was performed with haematoxylin erythrosine saffron and Sirius red staining. Results: In contrast to what was observed in rodents, adenine diet failed to induce kidney failure in rabbits as is evident in the plasma concentrations of creatinine and urea and the direct measurement of GFR or histopathological studies. Conclusion: Adenine diet is not a surrogate of subtotal nephrectomy to induce kidney failure in rabbits. Several interspecies differences in metabolism and renal physiology could account for this observation.
Published: 2017

35. Course of chronic kidney disease in French patients

Author: P. Nicoud, Nicolas Janus, Philippe Vanhille, Stéphane Burtey, Thierry Hannedouche, Myriam Isnard-Rouchon, Gilbert Deray, Malik Touam, Gérard Janin, Maurice Laville, Vincent Launay-Vacher, Laurent Juillard, J.-P. Ortiz, Service ICAR, Néphrologie, Hôpital La Pitie Salpetriere, Service de Néphrologie, Centre Hospitalier de l'Université de Montréal (CHUM), AURA Chamalières, Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION )-Assistance Publique - Hôpitaux de Marseille (APHM), Polyclinique de St Roch, Service de Néphologie, Hôpital des Chanaux, Hôpitaux du Pays du Mont-Banc, AURA Paris, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montréal (UdeM)-Université de Montréal (UdeM), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION )
Subjects: Nephrology, insuffisance rénale, medicine.medical_specialty, Pediatrics, médicament, medicine, Referral, medicine.medical_treatment, dialyse, 030232 urology & nephrology, Esrd Management, Dialysis patients, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, dosage, renal insufficiency, 03 medical and health sciences, Patient referral, 0302 clinical medicine, Internal medicine, Urology and Nephrology, Dialysis, Urologie et Néphrologie, Transplantation, chronic renal insufficiency, business.industry, 030503 health policy & services, Retrospective cohort study, drug dosage management, medicine.disease, 3. Good health, Chronic dialysis, mechanical kidney, dialysis, patient, France, 0305 other medical science, business, Kidney disease
Abstract: Background: In 1998, a French survey showed that the referral of patients with chronic kidney disease to a nephrologist was delayed, resulting in many emergency initiations of dialysis. In 2009, the ORACLE study aimed to describe the renal course of dialysis patients from their first nephrology visit to their first dialysis session. Methods: The ORACLE study was a multicentre retrospective study of all patients who started chronic dialysis. Data were collected at the first nephrology visit and at the first dialysis session. Results: In total, 720 patients were included (69 centres). At the first nephrology visit, the mean Cockcroft-Gault (CG) indicator was 31.8 mL/min (22.7 in 1998) and 52.4% of patients (73% in 1998) had a CG
Published: 2017

36. Accuracy of GFR Estimation in Obese Patients

Author: Laurent Juillard, Marie-Sophie Nguyen-Tu, Sandrine Lemoine, Fitsum Guebre-Egziabher, Aoumeur Hadj-Aissa, Florence Sens, Laurence Dubourg, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, Body Surface Area, Epidemiology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Contrast Media, Kidney, Critical Care and Intensive Care Medicine, Severity of Illness Index, Body Mass Index, Hospitals, University, 0302 clinical medicine, 80 and over, Renal Insufficiency, 030212 general & internal medicine, Glomerular Filtration Rate, Aged, 80 and over, 2. Zero hunger, Body surface area, Inulin, Middle Aged, Hospitals, Nephrology, Obesity/*complications/diagnosis, Predictive value of tests, Cohort, Kidney/*physiopathology, Female, France, medicine.drug, Adult, medicine.medical_specialty, Models, Iohexol, Urology, Renal function, Models, Biological, Young Adult, 03 medical and health sciences, Predictive Value of Tests, medicine, Humans, Obesity, Renal Insufficiency, Chronic, Bland–Altman plot, Aged, University, Transplantation, business.industry, Body Weight, Chronic/complications/*diagnosis/physiopathology, Original Articles, Biological, medicine.disease, Surgery, business, Body mass index, Kidney disease
Abstract: International audience; BACKGROUND AND OBJECTIVES: Adequate estimation of renal function in obese patients is essential for the classification of patients in CKD category as well as the dose adjustment of drugs. However, the body size descriptor for GFR indexation is still debatable, and formulas are not validated in patients with extreme variations of weight. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study included 209 stages 1-5 CKD obese patients referred to the Department of Renal Function Study at the University Hospital in Lyon between 2010 and 2013 because of suspected renal dysfunction. GFR was estimated with the Chronic Kidney Disease and Epidemiology equation (CKD-EPI) and measured with a gold standard method (inulin or iohexol) not indexed (mGFR) or indexed to body surface area determined by the Dubois and Dubois formula with either real (mGFRr) or ideal (mGFRi) body weight. Mean bias (eGFR-mGFR), precision, and accuracy of mGFR were compared with the results obtained for nonobese participants (body mass index between 18.5 and 24.9) who had a GFR measurement during the same period of time. RESULTS: Mean mGFRr (51.6 +/- 24.2 ml/min per 1.73 m(2)) was significantly lower than mGFR, mGFRi, and eGFRCKD-EPI. eGFRCKD-EPI had less bias with mGFR (0.29; -1.7 to 2.3) and mGFRi (-1.62; -3.1 to 0.45) compared with mGFRr (8.7; 7 to 10). This result was confirmed with better accuracy for the whole cohort (78% for mGFR, 84% for mGFRi, and 72% for mGFRr) and participants with CKD stages 3-5. Moreover, the Bland Altman plot showed better agreement between mGFR and eGFRCKD-EPI. The bias between eGFRCKD-EPI and mGFRr was greater in obese than nonobese participants (8.7 versus 0.58, P\textless0.001). CONCLUSIONS: This study shows that, in obese CKD patients, the performance of eGFRCKD-EPI is good for GFR \textless/= 60 ml/min per 1.73 m(2). Indexation of mGFR with body surface area using ideal body weight gives less bias than mGFR scaled with body surface area using real body weight.
Published: 2014

37. Proteomic Characterization of High-Density Lipoprotein Particles from Non-Diabetic Hemodialysis Patients

Author: Frédéric Delolme, Christophe O. Soulage, Adeline Page, Fitsum Guebre Egziabher, Catherine Calzada, Nans Florens, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France (Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France), SFR Biosciences, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), grant 'Annee Recherche' from Agence Regionale de Sante (ARS) Hospices Civils de Lyon grant 'IRCT-Dialyse' from The French Society of Nephrology (Societe Francaise Nephrologie Dialyse et Transplantation, SFNDT) Institut National de la Sante et de la Recherche Medicale (Inserm)Institut National des Sciences Appliquees de Lyon (INSA-Lyon) ITMO Cancer AVIESAN (Alliance Nationale pour les Sciences de la Vie et de la Sante, National Alliance for Life Sciences and Health), Florens, Nans, Soulage, Christophe, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), CALZADA, Catherine, and École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL)
Subjects: Proteomics, [SDV]Life Sciences [q-bio], Health, Toxicology and Mutagenesis, medicine.medical_treatment, lcsh:Medicine, Apoptosis, 030204 cardiovascular system & hematology, Toxicology, medicine.disease_cause, chemistry.chemical_compound, 0302 clinical medicine, High-density lipoprotein, spectrométrie de masse, HDL cholesterol, hémodialyse chronique, protéomique, ComputingMilieux_MISCELLANEOUS, proteomic, mass spectrometry, 0303 health sciences, education.field_of_study, lipoprotéine, hemodialysis, cholestérol, Up-Regulation, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.TOX] Life Sciences [q-bio]/Toxicology, risque cardiovasculaire, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Alimentation et Nutrition, Proteome, Hemodialysis, Lipoproteins, HDL, cardiovascular risk, medicine.medical_specialty, Population, Down-Regulation, Article, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Humans, Food and Nutrition, education, Toxicologie, 030304 developmental biology, Hemostasis, Wound Healing, lipoproteins, business.industry, lcsh:R, Lipid metabolism, Lipid Metabolism, medicine.disease, Oxidative Stress, Endocrinology, chemistry, Case-Control Studies, business, Oxidative stress, Kidney disease
Abstract: Chronic kidney disease is associated with an increased cardiovascular risk, and altered biological properties of high-density lipoproteins (HDL) may play a role in these events. This study aimed to describe the HDL proteome from non-diabetic hemodialysis patients and identify potential pathways affected by the dysregulated expression of HDL proteins. HDL were sampled from nine non-diabetic hemodialysis (HD) and eight control patients. Samples were analyzed using a nano-RSLC coupled with a Q-Orbitrap. Data were processed by database searching using SequestHT against a human Swissprot database and quantified with a label-free quantification approach. Proteins that were in at least five of the eight control and six of the nine HD patients were analyzed. Analysis was based on pairwise ratios and the ANOVA hypothesis test. Among 522 potential proteins, 326 proteins were identified to be in the HDL proteome from HD and control patients, among which 10 were significantly upregulated and nine downregulated in HD patients compared to the control patients (p &lt, 0.05). Up and downregulated proteins were involved in lipid metabolism, hemostasis, wound healing, oxidative stress, and apoptosis pathways. This difference in composition could partly explain HDL dysfunction in the chronic kidney disease (CKD) population and participate in the higher cardiovascular risk observed in this population.
Published: 2019

38. Protein Kinase Cδ Deficiency Causes Mendelian Systemic Lupus Erythematosus With B Cell-Defective Apoptosis and Hyperproliferation

Author: Gillian I. Rice, Marcin Szynkiewicz, Nicole Fabien, Patrick M. Gaffney, Sarah B. Daly, James O'Sullivan, Alexandre Belot, John Brognard, Shameem Fawdar, Pierre Cochat, Anne Perrine Foray, Jill E. Urquhart, Jonathan E. Dickerson, Natalie Stephenson, Marie Therese Zabot, Josephine Mayer, Flore Rozenberg, Paul R. Kasher, Graeme C.M. Black, Yanick J. Crow, Eleanor W. Trotter, Laurent Juillard, Anne Laure Debaud, Bruno Ranchin, Christophe Malcus, Michael W. Beresford, Pierre Lebon, Jean Francois Eliaou, Nathalie Bonnefoy, Bohdan Waszkowycz, Sanjeev S. Bhaskar, Céline René, Isabelle Rouvet, Leslie G. Biesecker, and Anna A. Marusiak
Subjects: 030203 arthritis & rheumatology, 0303 health sciences, Mutation, Lupus erythematosus, Immunology, breakpoint cluster region, Biology, medicine.disease, medicine.disease_cause, 3. Good health, Immune tolerance, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, PRKCD, Rheumatology, medicine, Immunology and Allergy, Missense mutation, Pharmacology (medical), B cell, Protein kinase C, 030304 developmental biology
Abstract: Objective: Systemic lupus erythematosus (SLE) is a prototype autoimmune disease, assumed to occur due to a complex interplay of environmental and genetic factors. Rare causes of monogenic SLE have been described, providing unique insights into fundamental mechanisms of immune tolerance. Here, our objective was to identify the cause of an autosomal recessive form of SLE. Methods: We investigated three siblings from one consanguineous kindred with juvenile-onset SLE and used next generation sequencing to identify mutations in the disease-associated gene. We performed extensive biochemical, immunological and functional assays to assess the impact of the identified mutations on B cell biology. Results: We identified a homozygous missense mutation in PRKCD, encoding protein kinase delta (PKC?) in all three affected siblings. Mutation of PRKCD resulted in reduced expression and activity of the encoded protein PKC?, involved in the deletion of autoreactive B cells, leading to a resistance to BCR- and calcium-dependent apoptosis and increased B cell proliferation. Thus, as for mice deficient in PKC?, which exhibit an SLE phenotype and B cell expansion, we observed an increase of immature B cells in affected patients, and a developmental shift toward an immature phenotype of na�ve B cells. Conclusion: Our findings indicate that PKC? is crucial in regulating B cell tolerance and preventing self-reactivity in humans, and that PKC? deficiency represents a novel genetic defect of apoptosis leading to SLE. � 2013 American College of Rheumatology.
Published: 2013

39. Intracellular Phosphate Dynamics in Muscle Measured by Magnetic Resonance Spectroscopy during Hemodialysis

Author: Sandrine Lemoine, Dominique Sappey-Marinier, Thomas Fournier, Laurent Juillard, Gabriel Kocevar, Gabrielle Normand, Danielle Ibarrola, Amélie Belloi, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant (CERMEP - imagerie du vivant), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Centre d'Exploration et de Recherche Médicales par Émission de Positons (CERMEP), Université Joseph Fourier - Grenoble 1 (UJF)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: 0301 basic medicine, medicine.medical_specialty, dialysis patients, Magnetic Resonance Spectroscopy, Swine, medicine.medical_treatment, Intracellular pH, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Intracellular Space, Phosphates, calcification, 03 medical and health sciences, chemistry.chemical_compound, Hyperphosphatemia, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Extracellular, Animals, phosphorus, Muscle, Skeletal, Dialysis, calcium, Extracorporeal circulation, General Medicine, Urology & Nephrology, Phosphate, medicine.disease, 030104 developmental biology, Endocrinology, Basic Research, chemistry, Biochemistry, Nephrology, kinetics, Female, Hemodialysis, inorganic polyphosphate, metabolism, Intracellular
Abstract: International audience; Of the 600-700 mg inorganic phosphate (Pi) removed during a 4-hour hemodialysis session, a maximum of 10% may be extracted from the extracellular space. The origin of the other 90% of removed phosphate is unknown. This study tested the hypothesis that the main source of phosphate removed during hemodialysis is the intracellular compartment. Six binephrectomized pigs each underwent one 3-hour hemodialysis session, during which the extracorporeal circulation blood flow was maintained between 100 and 150 ml/min. To determine in vivo phosphate metabolism, we performed phosphorous (P-31) magnetic resonance spectroscopy using a 1.5-Tesla system and a surface coil placed over the gluteal muscle region. P-31 magnetic resonance spectra (repetition time = 10 s; echo time = 0.35 ms) were acquired every 160 seconds before, during, and after dialysis. During the dialysis sessions, plasma phosphate concentrations decreased rapidly (-30.4 %; P=0.003) and then, plateaued before increasing approximately 30 minutes before the end of the sessions; 16 mmol phosphate was removed in each session. When extracellular phosphate levels plateaued, intracellular Pi content increased significantly (11%; P\textless0.001). Moreover, beta ATP decreased significantly (P\textless0.001); however, calcium levels remained balanced. Results of this study show that intracellular Pi is the source of Pi removed during dialysis. The intracellular Pi increase may reflect cellular stress induced by hemodialysis and/or strong intracellular phosphate regulation.
Published: 2016

40. Efficacy of extracorporeal albumin dialysis for acute kidney injury due to cholestatic jaundice nephrotoxicity

Author: Florence Sens, Laurent Juillard, Maud Rabeyrin, Justine Bacchetta, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Biopsy, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Chronic liver disease, Kidney, urologic and male genital diseases, Gastroenterology, Article, Nephropathy, Nephrotoxicity, 03 medical and health sciences, Necrosis, 0302 clinical medicine, Cholestasis, Renal Dialysis, Internal medicine, Albumins, Medicine, Humans, Diabetic Nephropathies, Dialysis, Hyperbilirubinemia, medicine.diagnostic_test, business.industry, Acute kidney injury, General Medicine, Acute Kidney Injury, medicine.disease, 3. Good health, Liver Transplantation, Jaundice, Obstructive, Renal pathology, Diabetes Mellitus, Type 2, 030211 gastroenterology & hepatology, Renal biopsy, business
Abstract: International audience; We report a case of a 37-year-old man with Maturity Onset Diabetes of the Youth (MODY) type 5, admitted for an episode of cholestasis and a simultaneous acute kidney injury (AKI). Chronic liver disease was due to a mutation in the transcription factor 2 (TCF2) gene, thus highlighting the need for a close liver follow-up in these patients. AKI was attributed to a cholemic nephropathy based on the following rationale: (1) alternative diagnoses were actively ruled out; (2) the onset of AKI coincided with the onset of severe hyperbilirubinaemia; (3) renal pathology showed large bile tubular casts and a marked tubular necrosis and (4) creatinine serum dramatically decreased when bilirubin levels improved after the first sessions of extracorporeal albumin dialysis (ECAD), thus suggesting its role in renal recovery. Even though cholestasis can precipitate renal injury, the diagnosis of cholemic nephropathy could require a renal biopsy at times. Future studies should confirm the benefits of ECAD in cholemic nephropathy.
Published: 2016

41. Microaneurysms in renal angiomyolipomas: Can clinical and computed tomography features predict their presence and size?

Author: Lionel Badet, Laurent Juillard, T. Martinelli, J. Champagnac, G. Pagnoux, Christelle Melodelima, Olivier Rouvière, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Adult, Male, medicine.medical_specialty, Angiomyolipoma, Adolescent, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Computed tomography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Tuberous sclerosis, Young Adult, 0302 clinical medicine, Predictive Value of Tests, hemic and lymphatic diseases, Multidetector computed tomography, Multidetector Computed Tomography, medicine, Humans, Radiology, Nuclear Medicine and imaging, neoplasms, Aged, Retrospective Studies, Aged, 80 and over, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Retrospective cohort study, General Medicine, Digital subtraction angiography, Middle Aged, medicine.disease, Microaneurysm, Kidney Neoplasms, 3. Good health, Predictive value of tests, Lymphangioleiomyomatosis, Female, Radiology, business
Abstract: International audience; PURPOSE: To evaluate clinical and multidetector computed tomography (MDCT) features associated with the presence and size of microaneurysms in renal angiomyolipomas (AMLs). MATERIALS AND METHODS: The MDCTs and digital subtraction angiographies (DSAs) of 31 patients who had further percutaneous arterial embolization of AMLs were retrospectively reviewed. They were 22 women and 9 men (mean age, 47.7+/-27.7 years). The medical files of the included patients were reviewed for age, gender and clinical features. MDCT and DSA images were analyzed by two readers working in consensus. RESULTS: Of the 31 patients, 15 had tuberous sclerosis complex (TSC) or lymphangioleiomyomatosis (LAM). In total, the 31 patients had 54 AMLs (5 ruptured). On DSA, 28 clusters of microaneurysms were found in 17 patients (21 AMLs). Four of the five ruptured AMLs had microaneurysms. None of the 12 AMLs\textless/=40mm and 21 of the 42 AMLs\textgreater40mm had microaneurysms. Among AMLs\textgreater40mm, history of TSC/LAM (P=0.5), RENAL score (P=0.7) and relative volume of fat (P=0.11) did not significantly predict the presence of microaneurysms. Microaneurysms were significantly larger in ruptured (9.5+/-5.7mm) than non-ruptured (3.9+/-1.9mm, P=0.02) AMLs. No associations were found between the size of microaneurysms and the size of AMLs. CONCLUSION: Microaneurysms were found in no AML \textless/=40mm and in 50%of AMLs\textgreater40mm. In AMLs \textgreater40mm, history of TSC/LAM, RENAL score and relative volume of fat did not significantly predict the presence of microaneurysms.
Published: 2016

42. Cystatin C-creatinine based glomerular filtration rate equation in obese chronic kidney disease patients: Impact of deindexation and gender

Author: Chantal Bon, Caroline C Pelletier, Marine Panaye, Laurence Dubourg, Fitsum Guebre-Egziabher, Sandrine Lemoine, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Laboratoire de Biologie Tissulaire et d'ingénierie Thérapeutique UMR 5305 (LBTI), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS), Service Néphrologie Dialyse, Hypertension Arterielle, Hospices Civils de Lyon (HCL), Service Néphrologie, Dialyse, Hypertension Arterielle, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service Exploration Fonctionnelle Rénale, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CHU Tenon [APHP], and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Male, créatinine, medicine.medical_specialty, obesity, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Urology, Renal function, 030204 cardiovascular system & hematology, urologic and male genital diseases, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, cystatin C, Humans, Medicine, Prospective Studies, Renal Insufficiency, Chronic, Prospective cohort study, Cystatin C/Creatinine, Aged, Aged, 80 and over, 2. Zero hunger, Creatinine, glomerular filtration rate, biology, business.industry, Cystatine c, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, chronic kidney disease and epidemiology, obésité, chemistry, Cystatin C, Nephrology, biology.protein, Female, maladie rénale, Creatinine blood, business, cystatine c, Kidney disease
Abstract: Background: Cystatin C is considered an alternative to creatinine to estimate glomerular filtration rate (GFR). However, studies have reported that increased adiposity is associated with a higher level of circulating cystatin C questioning the performance of estimation of GFR using cystatin C in obese subjects. Methods: We prospectively included 166 obese stages 1-5 chronic kidney disease (CKD) patients between 2013 and 2015. GFR was measured with a reference method without (measured GFR [mGFR]) and with adjustment to body surface area (mGFRr) and estimated (eGFR) or de-indexed eGFR using the Chronic Kidney Disease and Epidemiology (CKD-EPI) equation using creatinine (CKD-EPIcreat), cystatin (CKD-EPIcyst) and the combination of cystatin and creatinine (CKD-EPIcyst-creat). Results: The biases between mGFR and de-indexed CKD-EPIcyst-creat were significantly lower than de-indexed CKD-EPIcreat (p = 0.001). Accuracies were significantly better with de-indexed CKD-EPIcyst-creat compared to CKD-EPIcreat and CKD-EPIcyst, respectively (p = 0.04 and 0.03). Bland and Altman plot showed a great dispersion of all formulae when patients had a GFR >60 ml/min. Interestingly, there is a gender difference; biases, precisions and accuracies of de-indexed CKD-EPIcyst-creat were significantly lower in obese women. These results may be related to a difference in the change of body composition during obesity in men versus women and in fact only waist circumference (WC) was positively and significantly correlated with cystatin C (p < 0.0001) whereas body mass index (BMI; p = 0.3) was not; bias for CKD-EPIcyst-creat was related with WC. Conclusion: Cystatin C-creatinine-based GFR equations outperform creatinine-based formula in obese CKD patients especially those with BMI ≥35 and in obese women.
Published: 2016

43. Paraneoplastic fibrillary glomerulonephritis associated with intrahepatic cholangiocarcinoma: When diagnosis of a rare kidney disease leads to successful hepatic cancer treatment

Author: Valérie Hervieu, Maud Rabeyrin, Jean-Michel Gougon, Pierre-Jean Valette, Jérôme Dumortier, Jean-Yves Scoazec, Anne Jolivot, Gabrielle Normand, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, Pathology, medicine.medical_specialty, Liver tumor, Paraneoplastic Syndromes, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Cholangiocarcinoma, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Glomerulonephritis, Biopsy, medicine, Humans, Intrahepatic Cholangiocarcinoma, Kidney, Hepatology, medicine.diagnostic_test, business.industry, Fibrillary Glomerulonephritis, Gastroenterology, Middle Aged, medicine.disease, 3. Good health, Cancer treatment, medicine.anatomical_structure, Bile Duct Neoplasms, Neoplasm Regression, Spontaneous, 030220 oncology & carcinogenesis, business, Nephrotic syndrome, Kidney disease
Abstract: International audience; A 50-year-old man presented with nephrotic syndrome. Electron microscopy analysis of a kidney biopsy specimen showed fibrillary glomerulonephritis, a rare glomerular disease, while histological analysis of a liver tumor biopsy confirmed an intrahepatic cholangiocarcinoma. The paraneoplastic nature of fibrillary glomerulonephritis is debated but after curative treatment of the hepatic nodule, remission of nephrotic syndrome was confirmed at 6-, 12- and 24-months follow-up. To our knowledge, this is the first description of a paraneoplastic fibrillary glomerulonephritis associated with a cholangiocarcinoma, supported by complete remission achieved following cancer treatment.
Published: 2015

44. De la décision du mode de prise en charge à la mise en place d’un traitement à domicile : quels challenges pour le néphrologue dans l’accompagnement du patient ?

Author: Laurent Juillard, Philippe Chauveau, and Thierry Lobbedez
Subjects: Palliative care, business.industry, media_common.quotation_subject, 030232 urology & nephrology, Context (language use), 030204 cardiovascular system & hematology, Medical care, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Nursing, Nephrology, Political science, Patient information, Health care, Home dialysis, business, Autonomy, media_common
Abstract: Since a couple of years, a new paradigm of care has taken place where the patient plays a major role in the choice of his treatment. Patient information in a context where the doctor-patient relationship has drastically changed and where knowledge is continuously growing, is a challenge for the nephrologist. For the patient who decides to undergo home dialysis, numerous questions arise during the decision-making process. How should treatment alternatives be discussed with the patient? What are the current data available on the different methods? As comfort, quality of life and level of autonomy often drive the choice of care management, home dialysis can be promoted more with appropriate assistance from both the nephrologist and the healthcare team. Cet article fait partie du numero supplement Innovations en Nephrologie realise avec le soutien institutionnel de Vifor Fresenius Medical Care Renal Pharma.
Published: 2018

45. Une nouvelle étiologie dans la lithiase calcique récidivante : la mutation hétérozygote du gène de la 24 hydroxylase

Author: A. Molin, Justine Bacchetta, N. Abid, Sandrine Lemoine, Laurent Juillard, A. Betholet-Thomas, Laurence Dubourg, and Gabrielle Normand
Subjects: 03 medical and health sciences, 0302 clinical medicine, Nephrology, 030232 urology & nephrology, 030204 cardiovascular system & hematology
Abstract: Introduction L’hypercalciurie est une cause frequente de calculs renaux. Des mutations perte de fonction bialleliques de CYP24A1, gene codant pour la vitamine D 24-hydroxylase, et identifiees recemment dans des formes d’hypercalcemie idiopathie neonatale, ont ete egalement identifiees chez des patients avec lithiase renale et/ou nephrocalcinose [1] . Bien que ces mutations a l’etat heterozygote ne soient theoriquement pas symptomatiques, nous rapportons ici 3 cas de patients lithiasiques hypercalciuriques avec mutation heterozygote de la CYP24A1. Patients/Materiels et methodes/Observation Trois patients (2 femmes/un homme), d’âge moyen 32 ± 8 ans, ont consulte pour maladie lithiasique active. Les calculs etaient constitues de weddellite ou de brushite. Le bilan phosphocalcique de base montrait : une calcemie normale a 2,34 ± 0,06 mmol/L, une PTH a 41 ± 13 ng/L (Normes 15–65) ; une 25-OH vit D a 76 ± 7 nmol/L et une 1,25-(OH)2 vit D a 225 ± 98 pmol/L. La calciurie moyenne etait de 5,33 mmol/24 h, soit 0,09 ± 0,01 mmol/kg/j apres regime optimise. La consommation sodee et proteique etait normale a 7,4 ± 1,6 g par jour et 0,9 ± 0,1 g/kg/j respectivement. Une charge calcique a ete realisee devant l’activite lithiasique importante et/ou l’hypercalciurie ( Tableau 1 ) avec une absence d’hypercalciurie resorptive et une hypercalciurie absorptive (delta Ca/creat a 0,73 n Resultats/Discussion L’association d’une 1,25-(OH)2 vit D elevee, d’une hypercalcemie a H2 et H4 de la charge calcique avec une PTH freinee a motive la recherche de mutation de la 24-hydroxylase. Il a ete identifie une mutation a l’etat heterozygote chez ces 3 patients c.1124C > T/p.(Pro375Leu), c1226T > C/p.(Leu409Ser) et c.1348T > A/p.(Phe450Ile). Il serait interessant de doser la 24-25OHD2 chez ces patients. Conclusion Les mutations heterozygotes de CYP24A1 peuvent etre identifiee chez des patients lithiasiques hypercalciuriques avec une 1,25-(OH)2 vit D elevee. Une charge calcique avec hypercalciurie absorptive et freination majeure de la PTH peut orienter la recherche d’une mutation de CYP24A1.
Published: 2018

46. Statut social des dialysés « migrants sanitaires » : étude pilote sur quatre centres de dialyse de centres hospitaliers publics

Author: Thierry Lobbedez, A. Haddj-Elmrabet, E. Kalbacher, Pierre Henri, J. Knecht, F. Chantrel, Cécile Vigneau, N. Monnier, Laurent Juillard, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: 03 medical and health sciences, 0302 clinical medicine, Nephrology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, 030204 cardiovascular system & hematology
Abstract: National audience; Introduction Depuis quelques années, les « migrants sanitaires » semblent de plus en plus nombreux en dialyse en France et leurs conditions sociales sont souvent précaires. Aucune étude ne s’est cependant jusqu’à maintenant intéressée à leur statut social qui pourtant peut conditionner de façon importante leur prise en charge médicale. Ces patients sont le plus souvent pris en charge dans des centres publics au moment de leur arrivée en France. Patients et méthodes Les médecins et les assistants sociaux de 4 centres de dialyse publics (2 à l’Est et 2 à l’Ouest de la France) ont recueilli pour les années 2013 et 2014 le nombre et les données démographiques et sociales des patients « migrants » incidents dans leur centre. Résultats On retrouve 34 patients migrants incidents en dialyse en 2013 et 2014 avec un gradient Est-Ouest (maxi 15 % des incidents 2013 dans un centre de l’Est et mini 0 % en 2013 dans un centre de l’ouest) : 24 hommes, âge moyen 44,6 ± 13,9 ans, 19/34 au moins dialysaient avant leur arrivée en France. Les pays d’origine sont : Kosovo (6), Arménie (4), Géorgie (4), Algérie (3), Cameroun (3), Tadjikistan (2), Angola (2), Russie (2), Bosnie (1), Serbie (1), Biélorussie (1), Madagascar (1), Somalie (1), Sri Lanka (1), Congo (1), et Mongolie (1). Un grand nombre de patients ont initialement un statut « Demandeurs d’Asile (DA) » ou « Étrangers Malades (EM) ». La couverture sociale est l’AME, les « soins urgents » ou la CMU après 3 mois. La plupart des patients (26/34) ne maîtrisent pas le français (besoin d’interprète pour discuter avec l’assistant social et les médecins). Une partie (9/34) habite chez des compatriotes, 9 doivent recourir au 115 et les autres vivent dans des foyers. Discussion Sur ces quatre centres, il existe de nombreux patients souvent déjà dialysés dans leur pays d’origine, venant notamment des pays de l’Est avec un fort gradient Est-Ouest en France. Leur situation sociale est précaire, rendant leur prise en charge en dialyse plus compliquée et grevant probablement leur survie. Conclusion Cette étude pilote volontairement axée sur des hôpitaux publics montre que la collaboration entre les néphrologues et les services sociaux permet de mieux préciser la situation des patients migrants dialysés
Published: 2015

47. Multiphasic effects of blood pressure on survival in hemodialysis patients

Author: Thierry Hannedouche, Hubert Roth, Thierry Krummel, Gérard M. London, Guillaume Jean, Jean-Louis Bouchet, Tilman B. Drüeke, Denis Fouque, Lahcene Attroun, Raymond Azar, Pierre Bories, Agnès Caillette-Beaudouin, Bernard Canaud, Gabriel Choukroun, Vincent Esnault, Mohamed Hammadi, Patrick Henri, Philippe Honoré, Belkacem Issad, Dominique Joly, Eric Laruelle, Gildas Le Mao, Sylvain Marchais, Benoît Vendrely, Philippe Zaoui, Larbi Aazib, Abdelhamid Abbassi, Elias Abdullah, Habib Abou-Bekr, Carine Achard-Hottelart, Geneviève Achin, Salima Ahriz-Saksi, Mahen Albadawy, Catherine Albert, Samir Albitar, Farideh Alenabi, Mahmoud Allouache, Amar Amaouche, Brahim Amara, Mounia Ammor, Kim Seng Ang, Ubald Assogba, Lynda Azzouz, Chérif Badid, Juliette Baleynaud, Evelyne Bargas, Emmanuel Baron, François Basse, Jean-Marie Batho, Marc Bauwens, Dorothée Bazin, Abdelmajid Ben Aicha, Seddik Benarbia, Larbi Bencheikh, Jean-Christophe Bendini, Djeleddine Benyakoub, Dominique Bergua, Catherine Bessin, Luc Billaux, Stéphane Billion, Haïat Bittar, Jean-Paul Bocquet, Hervé Bonarek, Claude Bonniol, Jean-Sébastien Borde, Samir Boubenider, Rémi Boudet, Waël Boudi, Loreley Boudier, Djema Bouguern, M Boukelmoune, Fatha Zohra Boukhalfa, Henri Boulanger, Philippe Bouvier, Mouloud Bouzernidj, Mohamed Brahim Bounab, José Brasseur, Laura Braun, Marie Briet, Doan Bui-Quang, Sebastien Canet, Eric Canivet, Jorge Cardozo, Carlos Cardozo, Baher Chaghouri, Mokhtar Chawki, Charles Chazot, Philippe Choulet, Pierre Clavel, Jean-Philippe Coindre, Olivier Coldefy, M.A. Colomina, François Combarnous, Christian Dabot, Djamal Dahmane, Ahmed Dahmani, Daniel Daubresse, Jean-François De Fremont, Valérie De Precigout, Françoise Dehais, M. Dehina, Caroline Delclaux, Yashou Delmas, Coralia Denicola, Jean-Philippe Devaux, Raji Diab, Zineddine Diddaoui, null Didelot, Yves Dimitrov, Assia Djema, Patrick Donnadieu, Valérie Drouillat, Olivier Drouineau, Geneviève Dumont, Philippe Dupuy, Pierre-Yves Durand, Stéphane Edet, Hamid El Ali, Khuzama El Nasser, Christian Emond, Baya Fadel, Mohamed Fakir, Jean-Paul Faucon, André Faure, Assia Ferhat-Carre, Hafedh Fessi, Rocsana Fickl, Mahammed Fodil-Cherif, Jacques Fourcade, Philippe Fournier, Rabah Fraoui, Olivier Fritz, Elke Gaboriau, Alexandre Ganea, Roula Galland, Jacqes Gaultier, Eric Gauthier, Sylvie Geffroy Guiberteau, Sandrine Genestier, Patrick Giraud, Françoise Glowacki, Christophe Goupy, Pierre Grimal, Mounir Guergour, Jean Gugliotta, Marie-Paule Guillodo, Marie-Claude Guimont, Toufic Hachache, Sabria Hacini, Imad Haddad, Mohamed Hadj-Abdelkader, Pascale Halin, Patrick Hallonet, Nasser Hamdini, Didier Hamel, Françoise Heibel, Alain Hermelin, Alim Heyani, Philippe Hiernaux, Maxime Hoffmann, Valérie Hugot, Richard Ibos, Dominque Jacq, Jean-Paul Jaulin, Philippe Jousset, Benoît Jonon, Véronique Joyeux, Laurent Juillard, Amer Kamal, Mimi Kareche Chibout, Rateb Khayat, Franklin Khazine, Karim Khellaf, Arnaud Klisnick, Yannick Knefati, A. Kolko-Labadens, Amir Kolta, Niloufar Kossari, Olivier Kourilsky, Nicolas Krayem, Marc Kribs, François Kuentz, Kristian Kunz, Christian Lamotte, Jean-Marc Lanau, Isabelle Landru, Achour Laradi, Nicole Larroumet, Olivier Lavelle, Frank Le Roy, Alejandra Lenz, Denis Lerda, Fanny Leroy, Marc Leteif, Martial Levannier, Thierry Lobbedez, Hassan Lockmane, Nathalie Longlune, Christie Lorriaux Mortuaire, Alain Lyon, Ghassan Maakaroun, Mehadji Maaz, Eric Magnant, Ghandour Majdalani, Jean-Luc Mahe, Edward Maksour, Stéphane Martin, Catherine Martinat-Calvo, Valérie Masson, Delia May, Claire Maynard, Brice Mayor, Omar Mazouz, Hocine Mehama, Dominique Mercier, Gilles Messier, Robert Milongo, Nicole Monnier, Karine Moreau, Xavier Moreau-Gaudry, Bertrand Morel, Luc Moulonguet Doleris, Alexandre Mouneimne, Catherine Mourey-Epron, Françoise Moussion, Blanca Muniz, J. Mustel, Rachida Nebbad, Fazia Nemmar, Sylvie Neuville, Tien Nguyen-Quang, Patrice Nolen, Michel Normand, Emerson N’Sembani, Jacques Ollier, Jean-Paul Ortiz, Messaoud Ouziala, Bernard Painchart, Pedro Palacin, Josette Pengloan, Franck Perrin, Bruno Perrone, Philippe Petitjean, Dominique Petregne, Jean-Baptiste Philit, Vincent Planquois, Marc Pocheville, Jacky Potier, Jean-Michel Poux, Olivier Puyoo, Catherine Quere-Maurouard, Ahmed Rachi, Anderson Ratsimbazafy, Matthieu Reberolle, Henri Renaud, Bernard Richalet, Sarah Richter, Philippe Rieu, Michel Rince, Odile Rivault, Alain Robert, Jacques Rottembourg, Philippe Rousseau, Sophie Rubens Duval, Christa Roubicek, Piotr Seniuta, Pascal Seris, Irina Shahapuni, Reda Sharobeem, Milad Shenouda, Hélène Sichez Com, Danlèle Simonin, Nadia Soltani, Marc Souid, Hadia Sow, Jean-Christophe Szelag, Catherine Taddei, Zafer Takla, Dominque Teboulle, Jean-Claude Terrat, Patrick Thomas, Adam Tifoura, Jacques Toulon, Dominique Touzard, Pablo Urena Torres, Hans Van der Pijl, Thierry Vanel, Carlos Vela, Isabelle Vernier, Cathy Verove, François Pascal Wambergue, Bassem Wehbe, Maeva Wong-Fat, Fatima Yazbeck, Djamal Yousfi, Maan Youssef, Abdelaziz Ziane, Service de néphrologie et hémodialyse [CHU de Strasbourg], CHU Strasbourg, Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble, Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Manhès, Centre de Rein Artificiel, Centre de traitement des maladies rénales, CTMR Saint-Augustin, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Européen de Nutrition pour la Santé, Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RH), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université Grenoble Alpes (UGA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: Male, medicine.medical_specialty, hypertension, Systole, medicine.medical_treatment, Population, 030232 urology & nephrology, Diastole, Blood Pressure, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Prehypertension, 03 medical and health sciences, 0302 clinical medicine, cardiovascular disease, Renal Dialysis, Risk Factors, Internal medicine, Medicine, Humans, Prospective Studies, Renal Insufficiency, Chronic, education, Aged, Aged, 80 and over, education.field_of_study, hemodialysis, business.industry, Hazard ratio, Blood Pressure Determination, Middle Aged, 3. Good health, Pulse pressure, Blood pressure, Nephrology, Cardiovascular Diseases, Aortic pressure, Cardiology, Female, Hemodialysis, France, business, Follow-Up Studies
Abstract: International audience; Dialysis patients exhibit an inverse, L- or U-shaped association between blood pressure and mortality risk, in contrast to the linear association in the general population. We prospectively studied 9333 hemodialysis patients in France, aiming to analyze associations between predialysis systolic, diastolic, and pulse pressure with all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular endpoints for a median follow-up of 548 days. Blood pressure components were tested against outcomes in time-varying covariate linear and fractional polynomial Cox models. Changes throughout follow-up were analyzed with a joint model including both the time-varying covariate of sequential blood pressure and its slope over time. A U-shaped association of systolic blood pressure was found with all-cause mortality and of both systolic and diastolic blood pressure with cardiovascular mortality. There was an L-shaped association of diastolic blood pressure with all-cause mortality. The lowest hazard ratio of all-cause mortality was observed for a systolic blood pressure of 165 mm Hg, and of cardiovascular mortality for systolic/diastolic pressures of 157/90 mm Hg, substantially higher than currently recommended values for the general population. The 95% lower confidence interval was approximately 135/70 mm Hg. We found no significant correlation for either systolic, diastolic, or pulse pressure with myocardial infarction or nontraumatic amputations, but there were significant positive associations between systolic and pulse pressure with stroke (per 10-mm Hg increase: hazard ratios 1.15, 95% confidence interval 1.07 and 1.23; and 1.20, 1.11 and 1.31, respectively). Thus, whereas high pre-dialysis blood pressure is associated with stroke risk, low pre-dialysis blood pressure may be both harmful and a proxy for comorbid conditions leading to premature death.
Published: 2015

48. Results of the HepZero study comparing heparin-grafted membrane and standard care show that heparin-grafted dialyzer is safe and easy to use for heparin-free dialysis

Author: Joan Fort Ros, Nathalie Loughraieb, Marc Dorval, Renaud Fay, Damien Thibaudin, Joëlle Cridlig, Maurice Laville, Loreto Fernandez Lorente, Frédérique Moureau, Michael Schulz, Laurent Juillard, Patrick Rossignol, Alicja Dębska-Ślizień, Joëlle Nortier, Casper F. M. Franssen, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie [Lyon], Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Association pour l'Utilisation du Rein Artificiel Région Lyonnaise (AURAL), Department of Nephrology [CHUDGLD], Dr. Georges-L.-Dumont University Hospital Centre (CHUDGLD), Nephrology Department, Vall d'Hebron University Hospital [Barcelona]-Autonomous University of Barcelona, Centre d'investigation clinique plurithématique Pierre Drouin (CIC-P), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Department of Nephrology - Dialysis and Renal Transplantation, Hôpital Erasmes, Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France (Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France), Medical University of Gdansk, Germans Trias i Pujol Hospital, Barcelona Autonomous University, Service de Néphrologie, Hôpital Nord, CHU Saint Etienne, Saint Etienne, France, Groningen University Medical Centre, Royal Liverpool and Broadgreen University Hospital NHS Trust, Hospal, Le Groupe Gambro, Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), and Autonomous University of Barcelona-Vall d'Hebron University Hospital [Barcelona]
Subjects: Male, MESH: Heparin, medicine.medical_treatment, 030232 urology & nephrology, MESH: Equipment Failure, 030204 cardiovascular system & hematology, Sodium Chloride, law.invention, No-heparin, 0302 clinical medicine, MESH: Aged, 80 and over, Randomized controlled trial, Coated Materials, Biocompatible, MESH: Coated Materials, Biocompatible, law, MESH: Renal Insufficiency, ORAL ANTICOAGULATION, MESH: Renal Dialysis, Prospective Studies, Renal Insufficiency, Prospective cohort study, anticoagulation, Saline, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, hemodialysis, MESH: Middle Aged, Néphrologie - urologie, heparin-grafted membrane, Heparin, Middle Aged, 3. Good health, Treatment Outcome, Nephrology, Hemodialysis, Equipment Failure, Female, Heparin-grafted membrane, MESH: Membranes, Artificial, MESH: Hemorrhage, medicine.drug, medicine.medical_specialty, SYSTEMIC ANTICOAGULATION, MESH: Sodium Chloride, Hemorrhage, MESH: Anticoagulants, 03 medical and health sciences, Anticoagulation, Standard care, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Renal Dialysis, REGIONAL CITRATE ANTICOAGULATION, medicine, Humans, Dialysis, Aged, no-heparin, MESH: Humans, business.industry, Anticoagulants, Médecine pathologie humaine, Membranes, Artificial, Confidence interval, Sciences biomédicales, MESH: Prospective Studies, MESH: Male, Surgery, Ingénierie biomédicale, FREE HEMODIALYSIS, HIGH-RISK, randomized controlled trial, business, MESH: Female
Abstract: Heparin is used to prevent clotting during hemodialysis, but heparin-free hemodialysis is sometimes needed to decrease the risk of bleeding. The HepZero study is a randomized, multicenter international controlled open-label trial comparing no-heparin hemodialysis strategies designed to assess non-inferiority of a heparin grafted dialyzer (NCT01318486). A total of 251 maintenance hemodialysis patients at increased risk of hemorrhage were randomly allocated for up to three heparin-free hemodialysis sessions using a heparin-grafted dialyzer or the center standard-of-care consisting of regular saline flushes or pre-dilution. The first heparin-free hemodialysis session was considered successful when there was neither complete occlusion of air traps or dialyzer, nor additional saline flushes, changes of dialyzer or bloodlines, or premature termination. The current standard-of-care resulted in high failure rates (50%). The success rate in the heparin-grafted membrane arm was significantly higher than in the control group (68.5% versus 50.4%), which was consistent for both standard-of-care modalities. The absolute difference between the heparin-grafted membrane and the controls was 18.2%, with a lower bound of the 90% confidence interval equal to plus 7.9%. The hypothesis of the non-inferiority at the minus 15% level was accepted, although superiority at the plus 15% level was not reached. Thus, use of a heparin-grafted membrane is a safe, helpful, and easy-to-use method for heparin-free hemodialysis in patients at increased risk of hemorrhage.Kidney International advance online publication, 9 July 2014; doi:10.1038/ki.2014.225., JOURNAL ARTICLE, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2014

49. Blood oxygen level–dependent measurement of acute intra-renal ischemia

Author: Brian C. Rucker, Jason A. Polzin, Juan C. Romero, J. A. Haas, David G. Kruger, Stephen J. Riederer, Lilach O. Lerman, and Laurent Juillard
Subjects: pig, medicine.medical_specialty, Pathology, Kidney Cortex, Sus scrofa, Ischemia, Renal Artery Obstruction, 030204 cardiovascular system & hematology, Renal artery stenosis, 030218 nuclear medicine & medical imaging, Renal Circulation, 03 medical and health sciences, blood oxygen level-dependent, 0302 clinical medicine, Internal medicine, medicine, Animals, Right Renal Artery, renal artery stenosis, Kidney, Kidney Medulla, Renal circulation, Renal ischemia, business.industry, Inulin, renal blood flow, medicine.disease, Magnetic Resonance Imaging, Oxygen, medicine.anatomical_structure, Nephrology, Renal blood flow, Oxyhemoglobins, Acute Disease, Cardiology, business, Glomerular Filtration Rate
Abstract: Blood oxygen level–dependent measurement of acute intra-renal ischemia.BackgroundIschemic nephropathy is a common cause of end-stage renal disease. Exploration of the mechanisms of deterioration of renal function is limited due to lack of noninvasive techniques available to study the single kidney. The Blood Oxygen Level–Dependent (BOLD) MRI method can measure deoxyhemoglobin and therefore indirectly estimates renal oxygen content, but has never been evaluated in renal artery stenosis (RAS). This study was therefore designed to test if BOLD can detect the characteristic of renal hypoxia induced by RAS.MethodsRAS was induced in 8 pigs using an occluder placed around the right renal artery. Renal blood flow (RBF) was measured continuously with an ultrasound probe. BOLD signal was measured bilaterally in the cortex and medulla (as the slope of the logarithm of MR signal) at baseline and at the lower limit of RBF autoregulation. The measurements were then repeated during six sequential graded decreases in RBF (80 to 0% of baseline) and during recovery.ResultsDuring the control period, BOLD signals were not significantly different between the right and the left kidneys. In the occluded kidney, BOLD signal of the cortex (19.3 ± 1.9/s) and the medulla (17.3 ± 2.0/s) increased during occlusion gradually and significantly (P < 0.0001) to a maximum (at total occlusion) of 33.8 ± 2.0/s (+79%) and 29.8 ± 2.3/s (+78%), respectively, and returned to baseline values during recovery.ConclusionThis study shows that the BOLD technique can noninvasively detect change in intra-renal oxygenation during an acute reduction of RBF. This study provides a strong rationale for developing the BOLD method for the detection and evaluation of renal hypoxia induced by RAS, which may be potentially applicable in humans.
Published: 2004
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50. New Dialysis Techniques

Author: Casper F. M. Franssen, Jaroslav Rosenberger, Robert S. Lockridge, Paul W. Eggers, Bernard Canaud, Nathan W. Levin, Alan S. Kliger, Stefano Stuard, Loreto Fernandez Lorente, Tom Greene, Michael V. Rocco, Brett Larive, Glenn Chertow, Attilio Di Benedetto, Damien Thibaudin, Gerald J Beck, Nathalie Loughraieb, José Ignacio Merello, John T. Daugirdas, Patrick Rossignol, Pedro Ponce, Marc Dorval, Paul W Eggers, Joëlle Cridlig, Alicja Dębska-Ślizień, Caecilia Scholz, Frédérique Moureau, Laurent Juillard, Renaud Fay, Gerald J. Beck, Robert M. Lindsay, Andreas Pierratos, Joëlle Nortier, Maurice Laville, Alan S Kliger, Daniele Marcelli, Christopher T. Chan, Michael Schulz, Erzsébet Ladányi, Tomas Jirka, Glenn M. Chertow, Joan Fort Ros, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: 030203 arthritis & rheumatology, Transplantation, medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, 03 medical and health sciences, 0302 clinical medicine, ORAL SESSION, Nephrology, Medicine, business, Dialysis (biochemistry), Intensive care medicine, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2014

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