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Introduction Interstitial inflammation and peritubular capillaritis are observed in many diseases on native and transplant kidney biopsies. A precise and automated evaluation of these histological criteria could help stratify patients’ kidney prognoses and facilitate therapeutic management. Methods We used a convolutional neural network to evaluate those criteria on kidney biopsies. 423 kidney samples from various diseases were included. 83 kidney samples were used for the neural network training, 106 for comparing manual annotations on limited areas to automated predictions, and 234 to compare automated and visual gradings. Results The Precision, the Recall, and the F-score for leukocyte detection were respectively 81%, 71% and 76%. Regarding peritubular capillaries detection the Precision, the Recall, and the F-score were respectively 82%, 83%, and 82%. There was a strong correlation between the predicted and observed grading of total inflammation, as for the grading of capillaritis (r = 0.89 and r = 0.82 respectively, all p Conclusion We developed a tool using deep learning that scores the total inflammation and capillaritis, demonstrating the potential of artificial intelligence in kidney pathology.

BACKGROUND AND OBJECTIVES: The prognosis of patients undergoing kidney tumor resection or kidney donation is linked to many histologic criteria. These criteria notably include glomerular density, glomerular volume, vascular luminal stenosis, and severity of interstitial fibrosis/tubular atrophy. Automated measurements through a deep-learning approach could save time and provide more precise data. This work aimed to develop a free tool to automatically obtain kidney histologic prognostic features. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 241 samples of healthy kidney tissue were split into three independent cohorts. The “Training” cohort (n=65) was used to train two convolutional neural networks: one to detect the cortex and a second to segment the kidney structures. The “Test” cohort (n=50) assessed their performance by comparing manually outlined regions of interest to predicted ones. The “Application” cohort (n=126) compared prognostic histologic data obtained manually or through the algorithm on the basis of the combination of the two convolutional neural networks. RESULTS: In the Test cohort, the networks isolated the cortex and segmented the elements of interest with good performances (>90% of the cortex, healthy tubules, glomeruli, and even globally sclerotic glomeruli were detected). In the Application cohort, the expected and predicted prognostic data were significantly correlated. The correlation coefficients r were 0.85 for glomerular volume, 0.51 for glomerular density, 0.75 for interstitial fibrosis, 0.71 for tubular atrophy, and 0.73 for vascular intimal thickness, respectively. The algorithm had a good ability to predict significant (>25%) tubular atrophy and interstitial fibrosis level (receiver operator characteristic curve with an area under the curve, 0.92 and 0.91, respectively) or a significant vascular luminal stenosis (>50%) (area under the curve, 0.85). CONCLUSION: This freely available tool enables the automated segmentation of kidney tissue to obtain prognostic histologic data in a fast, objective, reliable, and reproducible way.

Background Although the MEST-C classification is among the best prognostic tools in immunoglobulin A nephropathy (IgAN), it has a wide interobserver variability between specialized pathologists and others. Therefore we trained and evaluated a tool using a neural network to automate the MEST-C grading. Methods Biopsies of patients with IgAN were divided into three independent groups: the Training cohort (n = 42) to train the network, the Test cohort (n = 66) to compare its pixel segmentation to that made by pathologists and the Application cohort (n = 88) to compare the MEST-C scores computed by the network or by pathologists. Results In the Test cohort, >73% of pixels were correctly identified by the network as M, E, S or C. In the Application cohort, the neural network area under the receiver operating characteristics curves were 0.88, 0.91, 0.88, 0.94, 0.96, 0.96 and 0.92 to predict M1, E1, S1, T1, T2, C1 and C2, respectively. The kappa coefficients between pathologists and the network assessments were substantial for E, S, T and C scores (kappa scores of 0.68, 0.79, 0.73 and 0.70, respectively) and moderate for M score (kappa score of 0.52). Network S and T scores were associated with the occurrence of the composite survival endpoint (death, dialysis, transplantation or doubling of serum creatinine) [hazard ratios 9.67 (P = .006) and 7.67 (P Conclusions This work highlights the possibility of automated recognition and quantification of each element of the MEST-C classification using deep learning methods.

Leukocyte immunoglobulin-like receptors (LILRs) are a family of inhibitory or stimulatory receptors expressed by immune cell types belonging to both myeloid and lymphoid lineage. Several members of the LILR family recognize major histocompatibility complex class I and thus play important roles in a range of clinical situations including pregnancy. Moreover, paired immunoglobulin-like receptors (PIRs), the murine orthologs of LILRs, are implicated in experimental transplant allorecognition by monocytes and contribute to the induction of donor-specific monocyte-memory. After non-self recognition, activating PIRs are transiently overexpressed at the surface of monocytes and participate in donor-specific monocyte recruitment, leading to graft rejection in vivo. In the present study, we mapped LILR expression and also their respective reported ligands at single cell level in the renal allograft and circulating cells in the context of kidney transplant rejection. Recipient-derived monocytes were shown to infiltrate the donor tissue and to differentiate into macrophages. We thus also investigate LILR expression during in vitro monocyte-to-macrophage differentiation in order to characterize the myeloid population that directly contribute to allorecognition. Altogether our results emphasize non-classical monocytes and CD68+ M1 macrophages as key players in LILRs-ligand interaction in kidney transplantation.

Immune senescence is associated with age-related diseases (i.e. infectious disease, cardiovascular diseases and cancers). Chronic kidney disease patients die prematurely when compared with general population, because of a higher occurrence of infections, cardiovascular events and cancer. These diseases are commonly observed in the elderly population and frequently associated with immune senescence. Indeed, chronic kidney disease causes a premature aging of the T lymphocyte compartment, widely related to a decrease in thymic function, a phenomenon that plays a key role in the onset of age-related diseases in chronic kidney disease patients. The degree of immune senescence also influences patients' outcome after renal transplantation, particularly the risk of acute rejection and infections. Partial reversion of pre-transplant immune senescence is observed for some renal transplant patients. In conclusion, to reduce the increasing incidence of morbidity and mortality of chronic kidney disease patients, a better knowledge of uremia-induced immune senescence would help to pave the way to build clinical studies and promote innovative therapeutic approaches. We believe that therapeutic reversion and immune senescence prevention approaches will be part of the management of chronic kidney disease patients in the future.

This study sought to identify risk factors for acute kidney injury (AKI) from pre-operative variables in a population of subjects aged over 65. Eligible patients were aged 65 years or over who underwent scheduled non-cardiac, non-ambulatory surgery. Patients with a diagnosis of AKI recorded in the hospital’s databases were considered since cases, from which 300 patients with no diagnosis of AKI, were drawn at random as controls. In total, 81 cases of post-operative AKI and 239 controls were identified. The incidence of post-operative AKI was 2.87%. Pre-operative creatinine level (p = 0.0001), a history of respiratory insufficiency (p = 0.04), prior vascular surgery (p = 0.0001) and abdominal surgery (p = 0.03) were associated with an increased risk of AKI after surgery. These four variables calculated a score and developed a nomogram for predicting occurrence of post-operative AKI. A history of renal disease was associated with increased risk of post-operative AKI, predominantly in cases of vascular or abdominal surgery.

Background The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute kidney injury following SARS-CoV-2 infection has recently been described in the literature, with elevated mortality rates. Furthermore, patients with pre-existing chronic kidney disease, infected by SARS-CoV-2, should be monitored carefully. Here, we report the case of a 69-year-old patient with splenic marginal zone lymphoma, suffering from longstanding chronic kidney disease following SARS-CoV-2 infection. Case presentation A 69-year-old male patient previously diagnosed with pulmonary embolism and splenic marginal zone lymphoma (Splenomegaly, Matutes 2/5, CD5 negative and CD23 positive), was admitted to the hospital with shortness of breath, fever and asthenia. A nasopharyngeal swab test was performed in addition to a CT-scan, which confirmed SARS-CoV-2 infection. Blood creatinine increased following SARS-CoV-2 infection at 130 μmol/l, with usual values at 95 μmol/l. The patient was discharged at home with rest and symptomatic medical treatment (paracetamol and hydration), then readmitted to the hospital in August 2020. A kidney biopsy was therefore conducted as blood creatinine levels were abnormally elevated. Immunodetection performed in a renal biopsy specimen confirmed co-localization of SARS-CoV2 nucleocapsid and protease 3C proteins with ACE2, Lewis x and sialyl-Lewis x antigens in proximal convoluted tubules and podocytes. Co-localization of structural and non-structural viral proteins clearly demonstrated viral replication in proximal convoluted tubules in this chronically ill patient. Additionally, we observed the co-localization of sialyl-Lewis x and ACE2 receptors in the same proximal convoluted tubules. Reverse Transcriptase-Polymerase Chain Reaction test performed on the kidney biopsy was negative, with very low Ct levels (above 40). The patient was finally readmitted to the haematology department for initiation of chemotherapy, including CHOP protocol and Rituximab. Conclusions Our case emphasizes on the importance of monitoring kidney function in immunosuppressed patients and patients suffering from cancer following SARS-CoV-2 infection, through histological screening. Further studies will be required to decipher the mechanisms underlying chronic kidney disease and the putative role of sialyl-Lewis x and HBGA during SARS-CoV-2 infection.

Systemic sclerosis (SSc) is a multisystem autoimmune fibrosing disease affecting the connective tissue. It particularly affects the skin, notably with skin thickening, but SSc is also characterized by the involvement of many other organs, such as the lungs, the gastrointestinal tract, or the musculoskeletal tissues. One of the most life-threatening situations associated with SSc is scleroderma renal crisis (SRC), which classically associates a hypertensive crisis with oliguric acute kidney injury due to an acute thrombotic microangiopathy.1, 2 In some cases, the diagnosis of this disease can be delayed by atypical presentation such as systemic sclerosis sine scleroderma and/or the presence of rare antibodies. Here we report a case of a histologically confirmed SRC in a patient with systemic sclerosis sine scleroderma and anti-PM/Scl antibodies (Table 1). Table 1 Teaching points

Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.

Background Patients with chronic kidney disease (CKD) are more prone to develop premature age-related diseases. Data on immune senescence are scarce in CKD populations, except in end-stage renal disease and dialysis. We designed a longitudinal prospective study to evaluate immune senescence at different CKD stages and its influence on CKD patient outcomes. Methods Clinical and biological data collections were performed on 222 patients at different CKD stages [1–2 (n = 85), 4 (n = 53) and 5 (n = 84)]. Immune senescence biomarkers were measured by cytometry on T cells (CD28, CD57, CD45RA, CD31, γH2A.X) or by quantitative polymerase chain reaction [relative telomere length (RTL)] on peripheral blood mononuclear cells and analysed according to CKD stages and outcomes. Results CKD was associated with an increase in immune senescence and inflammation biomarkers, as follows: low thymic output (197 ± 25 versus 88 ± 13 versus 73 ± 21 CD4+CD45RA+CD31+ T cells/mm3), an increased proportion of terminally differentiated T cells (CD8+CD28−CD57+) (24 ± 18 versus 32 ± 17 versus 35 ± 19%) restricted to cytomegalovirus-positive patients, telomere shortening (1.11 ± 0.36 versus 0.78 ± 0.24 versus 0.97 ± 0.21 telomere:single copy ratio) and an increase in C-reactive protein levels [median 2.9 (range 1.8–4.9) versus 5.1 (27–9.6) versus 6.2 (3.4–10.5) mg/L]. In multivariate analysis, shorter RTL was associated with death {hazard ratio [HR] 4.12 [95% confidence interval (CI) 1.44–11.75]}. Low thymic output was associated with infections [HR 1.79 (95% CI (1.34–9.58)] and terminally differentiated CD8+ T-cell expansion with a risk of cardiovascular events [CEs; HR 4.86 (95% CI 1.72–13.72)]. Conclusion CKD was associated with premature immune ageing. Each of these alterations increased the risk of specific age-related diseases, such as RTL and death, thymic function and infections and terminally differentiated CD8+ T-cell expansion and CEs.

Introduction La maladie Coronavirus disease 2019 (COVID-19) est associée à une morbidité et une mortalité importante chez les patients hémodialysés. Ces patients présentent une altération du fonctionnement du système immunitaire. Description Nous avons souhaité évaluer la réponse humorale au vaccin à ARN messager par Pfizer chez les patients hémodialysés ainsi que les facteurs y étant associés. Méthodes Il s’agit d’une étude observationnelle monocentrique. Nous avons inclus 58 patients qui avaient reçu les deux injections de Pfizer-BioNTech, avec un intervalle de 21 jours. Une sérologie SARS-CoV-2 a été réalisée le premier jour de la vaccination et un mois après la seconde injection. La technique utilisée au cours de ce test biologique est la technique Abbott quantifiant le nombre d’IgG (immunoglobulines gamma) se fixant à la protéine S (spike) du virus. Le seuil de positivité de la sérologie est 50 AU/mL (unités arbitraires par millilitre). Nous avons étudié différentes variables cliniques et biologiques. Résultats La majorité des hémodialysés est capable de produire des anticorps dirigés contre le SARS-CoV-2, puisque 96 % (n = 56/58) ont obtenu une sérologie positive. Le taux médian d’IgG est de 1690 (531–3921) UA/mL. D’après la corrélation de Spearman, le taux d’anticorps est significativement associé à l’âge, la normalized catabolic rate (nPCR) et au taux de lymphocytes. Dans le modèle de régression linéaire, une meilleure réponse vaccinale est associée à la nPCR (coefficient bêta: 0.29, 95% CI (0.05, 0.53), p

Immune senescence is associated with age-related diseases (i.e. infectious disease, cardiovascular diseases and cancers). Chronic kidney disease patients die prematurely when compared with general population, because of a higher occurrence of infections, cardiovascular events and cancer. These diseases are commonly observed in the elderly population and frequently associated with immune senescence. Indeed, chronic kidney disease causes a premature aging of the T lymphocyte compartment, widely related to a decrease in thymic function, a phenomenon that plays a key role in the onset of age-related diseases in chronic kidney disease patients. The degree of immune senescence also influences patients' outcome after renal transplantation, particularly the risk of acute rejection and infections. Partial reversion of pre-transplant immune senescence is observed for some renal transplant patients. In conclusion, to reduce the increasing incidence of morbidity and mortality of chronic kidney disease patients, a better knowledge of uremia-induced immune senescence would help to pave the way to build clinical studies and promote innovative therapeutic approaches. We believe that therapeutic reversion and immune senescence prevention approaches will be part of the management of chronic kidney disease patients in the future.

Fusobacterium nucleatum is a common oral commensal bacterium capable of severe invasive infections. We report a case of a diffuse bilateral pneumopathy with F. nucleatum-positive blood culture successfully treated by common antibiotics in a patient receiving eculizumab for a drug-induced thrombotic microangiopathy (TMA). It is the first described case of a severe F. nucleatum-associated infection in a patient undergoing terminal complement inhibitor therapy. We suggest providing preventive dental care before eculizumab initiation.

Background End-stage renal disease (ESRD) causes premature ageing of the immune system. However, it is not known whether hemodialysis (HD) and peritoneal dialysis (PD) similarly affect the T cell system. Methods The aim of our study was to analyse whether dialysis modality may mitigate ESRD-induced immune senescence. We explored a large population of patients (675 ESRD patients) and both confirmed and refined the results in a second cohort (84 patients). Results HD patients exhibited higher inflammatory monocytes counts (44/mm3 (1–520) vs 36/mm3 (1–161); p = 0.005). Patients on HD also had higher frequency of CD8 T cells (24% (7–61) vs 22% (8–42); p = 0.003) and reduced CD4/CD8 ratio. Such results were confirmed in the second cohort. Moreover, both CD4 + CD57 + CD28- (3.25% (0–38.2) vs 1.05% (0–28.5); p = 0.068) and CD8 + CD57 + CD28- (38.5% (3.6–76.8) vs 26.1 (2.1–46.9); p = 0.039) T cells frequencies were increased in HD patients. Telomere length did not differ according to dialysis modality, but was inversely related to ferritin levels (r = − 0.33; p = 0.003). There was a trend towards higher telomerase activity in PD patients (11 ± 13 vs 6 ± 11; p = 0.053). Thymic function was not different in PD and HD patients. Patients on PD before transplantation had a higher risk of acute rejection after kidney transplantation (HR, 1.61; 95%CI, 1.02 to 2.56; p = 0.041). Conclusions More pronounced inflammation with hemodialysis may induce premature aging of the immune system. This observation correlates with a lower risk of acute kidney rejection in patients previously on HD. Clinical consequences in patients maintained on dialysis should be determined. Trial registration Trial registration: NCT02843867, registered July 8, 2016.

International audience; Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, defined by the association of idiopathic acute TINU. The aim of our work was to determine the characteristics of adult TINU syndrome in France, and to assess factors (including treatment) influencing medium-term prognosis.We conducted a nationwide study including 20 French hospitals. Clinical, laboratory, and renal histopathologic data of 41 biopsy-proven TINU syndromes were retrospectively collected. The patients were diagnosed between January 1, 1999 and December 1, 2015.Twenty-five females and 16 males were included (F/M ratio: 1.6:1). The median age at disease onset was 46.8 years (range 16.8-77.4) with a median serum creatinine level at 207 μmol/L (range 100-1687) and a median estimated glomerular filtration rate (eGFR) at 27 mL/min per 1.73 m (range 2-73). Twenty-nine patients (71%) had a bilateral anterior uveitis and 24 (59%) had deterioration in general health at presentation. Moderate proteinuria was found in 32 patients (78%) (median proteinuria 0.52 g/24 h; range 0.10-2.10), aseptic leukocyturia in 25/36 patients (70%). The evaluation of renal biopsies revealed 41 patients (100%) with an acute tubulointerstitial nephritis, 19/39 patients (49%) with light to moderate fibrosis and 5 patients (12%) with an acute tubular necrosis. Thirty-six patients (88%) were treated with oral corticosteroids. After 1 year of follow-up, the median eGFR was 76 mL/min per 1.73 m (range 17-119) and 32% of the patients suffered from moderate to severe chronic kidney disease. Serum creatinine (P

Introduction Le tubulointerstitial nephritis and uveitis (TINU) syndrome est une maladie rare definie par l’association d’une nephrite tubulointerstitielle aigue idiopathique a une uveite. L’objectif de cette etude etait de connaitre les caracteristiques du TINU syndrome de l’adulte ainsi que son pronostic a moyen terme et les facteurs l’influencant (dont le traitement). Patients et methodes Vingt centres hospitaliers ont participe a cette etude observationnelle retrospective. Les patients avaient un diagnostic porte entre le premier janvier 1999 et le premier decembre 2015. Les donnees etaient recoltees tout au long du suivi medical du patient. Resultats Quarante et un patients ont ete inclus (25 femmes, 16 hommes, ratio de 1,6 :1). L’âge median a la declaration de la maladie etait de 46,8 ans (16,8 a 77,4) avec une creatininemie mediane de 207 μmol/L (100 a 1687) et un debit de filtration glomerulaire (DFG) median de 27 mL/min/1,73 m 2 (2 a 73). Apres une annee de suivi, le DFG median etait de 76 mL/min/1,73 m 2 (17 a 119) et 69 % des patients adultes souffraient d’insuffisance renale chronique. Les facteurs initiaux associes a une degradation du DFG un an plus tard etaient : l’âge eleve, la creatininemie elevee et la bicarbonatemie basse. Aucun marqueur anatomo-pathologique renal initial n’etait associe au pronostic renal. Durant la premiere annee, 40 % des patients recidivaient leur uveite. La corticotherapie generale etait associee a une diminution des recidives d’uveites, mais n’avait pas d’effet statistiquement significatif sur le DFG. Discussion Nous avons rapporte dans ce travail la plus grande serie de cas adultes de TINU syndrome publiee a ce jour (environ 170 cas adultes de TINU syndrome avaient ete decrits). Nous avons decrit leurs caracteristiques clinico-pathologiques, biologiques, leurs traitements et leur pronostic a moyen terme. Conclusion Dans cette etude, plus de deux tiers des patients souffraient d’insuffisance renale chronique apres une annee de suivi. Ce travail suggere aussi que la corticotherapie orale serait efficace dans le traitement des atteintes ophtalmologiques du TINU syndrome.

Introduction Les patients en insuffisance renale chronique (IRC) presentent plus prematurement des pathologies associees au vieillissement (infections, evenements cardiovasculaires [ECV]). Les donnees sur le lien entre IRC et immunosenescence (IS) restent parcellaires principalement limitees au stade d’IRC terminale et de dialyse. Nous avons conduit une etude prospective pour evaluer la presence d’une IS a differents stades d’IRC ainsi que l’impact sur la survenue d’evenements cliniques (deces, infections, ECV). Patients et methodes Nous avons realise l’analyse de biomarqueurs d’IS et releve les evenements cliniques sur 222 patients a different stade d’IRC (I [n = 85], IV [n = 53], et V [n = 83]) sur une periode de 547 ± 265 jours. Les biomarqueurs d’IS comprenaient un immunophenotypage lymphocytaire realise par cytometrie (CD3, CD4, CD28, CD57, CD45RA, CD31, γH2A.X), une mesure de la longueur des telomeres (RTL) et la quantification de l’expression de KLOTHO lymphocytaire par qPCR ainsi que la mesure de marqueurs de l’inflammation. Resultats L’IRC etait associee a une inflammation ainsi qu’a une diminution de la thymopoiese (201 ± 26 vs. 89 ± 13 vs. 72 ± 21 recent thymic emigrant/mm3), une augmentation de la proportion de lymphocyte T au stade terminal de differentiation (24 ± 18 % vs. 32 ± 17 % vs. 36 ± 18 %) principalement chez les CMV positifs, une attrition telomerique (RTL 1,11 ± 0,36 vs. 0,78 ± 0,24 vs. 0,97 ± 0,21) et une hyperexpression lymphocytaire du gene KLOTHO. En analyse multivariee, des telomeres longs etaient protecteur vis-a-vis du risque de deces (HR : 0,04 ; IC95 % [0,01–0,55]). Une thymopoiese diminuee etait associe au risque de survenue d’infection (HR : 1,79 ; IC95 % [1,18–2,71]) et l’expansion de lymphocyte T (LT) au stade terminal de differentiation au risque de survenue d’ECV (HR : 2,02 ; IC95 % [1,15–3,55]). Discussion Ces resultats confirment l’existence d’un lien entre IS acceleree, uremie, des le stade IV, et inflammation. C’est la premiere fois qu’il est decrit une association entre un parametre d’IS (attrition telomerique, thymopoiese, LT au stade terminal de differentiation) et la survenue d’evenements cliniques (deces, infections, EVC) chez les patients IRC. Conclusion Certains parametres d’IS prematuree induite par l’uremie sont associes au risque de survenue d’evenements cliniques comme le deces, les episodes infectieux et les ECV.