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Pulmonary-renal syndrome refers to the combination of elevated plasma creatinine concentration and/or abnormal urinalysis with diffuse alveolar hemorrhage, and involves both an urgent diagnostic approach and care. We report the case of a 24-year-old man presenting with diffuse alveolar hemorrhage as well as a nephritic syndrome associating kidney failure, moderate hypertension, hematuria and selective glomerular proteinuria. The initial high suspicion of anti-glomerular basement membrane (GBM) disease or ANCA-associated vasculitis justified intravenous pulse-corticotherapy in association with plasma exchange. Renal biopsy was remarkable for an IgA nephropathy, lesions of active thrombotic microangiopathy (TMA) and a positive staining for complement factor C4d. Because anti-GBM and ANCA antibodies returned negative, plasma exchange was discontinued, but oral corticosteroids were maintained to prevent alveolar hemorrhage recurrence. In the absence of renal function recovery, hemodialysis was initiated. TMA lesions are frequently seen in IgA nephropathy and are associated with a poorer prognosis. Complement activation seems to be involved in the development of those lesions and contributes to disease progression. Conversely, alveolar hemorrhage in the setting of IgA nephropathy is uncommon. It is thought to result from non-specific mucosal hemorrhage, an immune complex mediated basement membrane damage and an IgA-mediated capillaritis against basement membrane antigens.

RATIONALE & OBJECTIVE: Membranous nephropathy (MN) is characterized by the deposition of immune complexes along glomerular basement membranes. M-Type phospholipase A2 receptor (PLA2R), thrombospondin type 1 domain-containing 7A (THSD7A), exostosin 1 and 2 (EXT1/2), and neural epidermal growth factor-like 1 protein (NELL-1) have been identified as established or potential podocyte antigens in MN. We investigated the association of podocyte antigen staining with MN clinical phenotype and outcomes. STUDY DESIGN: Multicenter retrospective cohort study. SETTING & PARTICIPANTS: 177 consecutive patients with MN unrelated to lupus erythematosus, identified after screening of 3,875 native kidney biopsies performed in the Belgian UCLouvain Kidney Disease Network from 2000 through 2018. PREDICTOR: Positive immunostaining for podocyte antigens on archived kidney biopsy samples. OUTCOMES: Association with different phenotypes (baseline characteristics of patients and pathologic findings on kidney biopsy), time to cancer and to kidney failure. ANALYTICAL APPROACH: Kaplan-Meier estimates and Cox regression analyses to assess time to cancer and kidney failure. RESULTS: 177 patients were followed up for a median of 4.0 (IQR, 1.3-8.0) years. Diagnosis of PLA2R-positive (PLA2R+), THSD7A+, and double-negative (PLA2R-/THSD7A-) MN was made in 117 (66.1%), 6 (3.4%), and 54 (30.5%) patients, respectively. Progression to kidney failure was similar in all groups. Although the number of patients with THSD7A+MN was small, they showed a higher incidence (50%) and increased risk for developing cancer during follow-up (adjusted HR, 5.0 [95% CI, 1.4-17.9]; P=0.01). 8% and 5% of patients with double-negative MN stained positively for EXT1/2 and NELL-1, respectively. Most patients with EXT1/2+MN were women, had features of systemic autoimmunity, and showed glomerular C1q deposits. LIMITATIONS: Retrospective design; small number of patients in the THSD7A group; lack of evaluation of immunoglobulin G

Hypoparathyroidism, deafness and renal dysplasia (HDR) syndrome is a rare autosomal dominant disorder, secondary to mutations in the GATA-3 gene. Due to its wide range of penetrance and expressivity, the disease may not always be recognized. We herein describe clinical and genetic features of patients with HDR syndrome, highlighting diagnostic clues.

L'augmentation de la demande alimentaire, la préservation de l'environnement et la volatilité des prix agricoles ne sont que quelques‐uns des nombreux défis auxquels fait face l'agriculture d'aujourd'hui. Des voix s'élèvent et pointent le travail du sol conventionnel comme un des responsables de la dégradation du sol (Lal, 2002). Pour y remédier, des systèmes de cultures basés sur la réduction de l’intensité du travail du sol voient le jour au XXème siècle, remettant en cause le labourage ancestral (Schneider et al., 2010). Efficaces pour réduire les pertes de sol par érosion, ces techniques culturales sans labour sont régulièrement citées comme augmentant le stock de carbone organique du sol (West et Wilfred, 2002 ; Lal, 2002). Qualifiées de "non‐labour" dans le jargon agricole, ces travaux du sol ne présentent toutefois pas que des avantages. Ainsi, la réduction du travail du sol doit souvent être combinée à une utilisation de produits phytosanitaires pour limiter les repousses des adventices (Toussaint, 2010). Sans être la panacée, ces techniques fournissent cependant une alternative compatible avec les exigences économiques et environnementales de notre société (Lal et al., 2007). Cette étude est l’aboutissement de deux années de recherches érigées autour d’un questionnement sur les raisons d'avoir recours au non‐labour dans nos régions. Au carrefour entre monde agricole et scientifique, l'étude de l'effet des pratiques culturales sur le carbone organique du sol (COS) et sur la sensibilité du sol à l’érosion tente d'en apprendre plus sur ce "non‐labour", au centre d'un débat permanent entre détracteurs et fervents défenseurs de la charrue. L'objectif de ce travail est d'évaluer l'impact des techniques culturales sur l'évolution de la teneur en COS sur les terres en culture ainsi que sur la sensibilité à l’érosion évaluée au travers de mesures de stabilité des agrégats. En pratique, il s'agit de catégoriser les différents types de travail du sol et de les confron

BACKGROUND AND OBJECTIVE. Severe hypoxaemia due to acute respiratory distress syndrome (ARDS) still cause a high mortality rate in spite of the improvement of therapeutic measures. In these severely hypoxaemic patients, Extracorporeal Membrane Oxygenation (ECMO) may be a good additional therapeutic option. However, inter-hospital transfer of patients who need an ECMO can be very dangerous because extreme hypoxaemia or hemodynamic instability may be associated with cerebral hypoxia and death. In this work, we report our experience mobile ECMO system initiated in the referal hospital to secure the transfer, considering 2 groups of patients : first, patients with cardiac failure and ARDS, and secondly, patients with ARDS due to influenza A/H1N1. MATERIAL AND METHODS. Our database was retrospectively analyzed and we report on 18 consecutive patients transferred to our hospital under ECMO assistance. 3 of them required this technique because of cardiocirculatory failure unresponsive to best therapy, 12 others because of ARDS due to various causes and the last 3 because of ARDS specifically due to influenza A/H1N1 pneumonia. Percutaneous veno-venous (VV; n = 14) or veno-arterial (VA; n = 4) ECMO support consisted in a single membrane oxygenator and a centrifugal pump. RESULTS. The transfer of all patients was feasible thanks to a systemic oxygenation and hemodynamic status improvement by the ECMO, after a median door to door transfer time of 73 minutes (range: 26 - 105 minutes) in the first group and 96 minutes (90 - 115 minutes) in the second group. No significant complication was noted during the transfer except a transient loss of electric power supply. In the first group, PaO2/FiO2 improved from 57.2 mmHg (26 - 88 mmHg) to 219 mmHg (47 - 390 mmHg), and from 62.7 mmHg (54-74 mmHg) to 254 mmHg (126-334 mmHg) in the second group, respectively before and after the initiation of ECMO. The mean weaning length for the ECMO system was 7 days in the first group and 19 days in

Nous décrivons deux cas d’infection à Pasteurella multocida. Chez le premier patient, il s’agissait d’une arthrite de l’épaule droite après griffure de chat au niveau de l’avant-bras homolatéral. La deuxième patiente était admise pour choc septique avec bactériémie dont la porte d’entrée était une plaie de la jambe souillée par la salive d’un chat. À propos de ces deux observations, une brève revue des infections à Pasteurella multocida est proposée.