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Ariceta G, Santos F, López Muñiz A, Hermida A, Matoses ML, Ventura A, Martin-Moreno PL, González E, Acuña L, Giner E, Vara J. Switching from immediate- to extended-release cysteamine in patients with nephropathic cystinosis: from clinical trials to clinical practice. Clin Kidney J 2024; 17:sfae049. [PMID: 38633840 PMCID: PMC11022652 DOI: 10.1093/ckj/sfae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 04/19/2024] Open
Abstract
Background The purpose of this study is to evaluate the effectiveness and safety of switching from immediate-release (IR) to extended-release (ER) cysteamine in patients with nephropathic cystinosis (NC) in Spain. Methods We conducted an observational, retrospective, multicentre study in NC patients who received IR cysteamine for at least 12 months, switched to ER cysteamine, and received it for at least 6 months before inclusion. Results Data were collected from nine patients (four children, five adults) 36 months before and after the switch. Despite the highly selected population, an improvement in growth, particularly in children and a significant reduction in hospitalization days was observed. A decrease in halitosis, body odour and gastrointestinal effects was reported in most of the patients who suffered before the switch, and the use of proton pump inhibitors (PPIs) decreased in some patients. The estimated glomerular filtration rate (eGFR) remained stable in patients with preserved kidney function. No significant changes in white blood cell (WBC) cystine levels were observed after the switch. There was no significant difference in the cysteamine dose received. However, some patients were receiving <50% of the recommended dose of cysteamine before and after the switch and showed elevated levels of WBC cystine. Conclusions Switching from IR to ER cysteamine in clinical practice reduces hospital stays, improves nutritional status and growth in paediatric patients and could help to enhance treatment tolerability by reducing side effects. Furthermore, the dosing of ER cysteamine could promote therapeutic compliance and positively affect the quality of life of the NC population.
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Affiliation(s)
- Gema Ariceta
- Paediatric Nephrology Department, Hospital Vall d’Hebrón, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Santos
- Paediatric Nephrology Department, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Andrés López Muñiz
- Nephrology Department, Complejo Hospitalario Universitario de la Coruña, A Coruña, Spain
| | - Alvaro Hermida
- Department of Internal Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Luisa Matoses
- Paediatric Nephrology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Ana Ventura
- Nephrology Department, Hospital Universitario La Fe, Valencia, Spain
| | | | - Esther González
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Laura Acuña
- Medical Department, Chiesi España S.A.U., Barcelona, Spain
| | - Elisa Giner
- Medical Department, Chiesi España S.A.U., Barcelona, Spain
| | - Julia Vara
- Paediatric Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
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2
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Levtchenko E, Servais A, Hulton SA, Ariceta G, Emma F, Game DS, Lange K, Lapatto R, Liang H, Sberro-Soussan R, Topaloglu R, Das AM, Webb NJA, Wanner C. Expert guidance on the multidisciplinary management of cystinosis in adolescent and adult patients. Clin Kidney J 2022; 15:1675-1684. [PMID: 36003666 PMCID: PMC9394719 DOI: 10.1093/ckj/sfac099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Cystinosis, a rare autosomal recessive lysosomal storage disorder, results in an abnormal accumulation of the amino acid cystine in multiple organs and tissues of the body. Renal symptoms typically develop in the first few months of life, with extra-renal manifestations becoming apparent over the next 10–20 years, which require coordinated multidisciplinary care. Here, we describe a consensus-based guidance to support the management of adolescents and adults living with cystinosis. The programme was led by a Steering Committee (SC) of six experts in the management of patients with cystinosis, who identified a list of 15 key questions reflecting the multi-organ effects of cystinosis. An Extended Faculty (EF) of eight additional specialists was invited to answer the questions via an online digital platform using a quasi-Delphi approach. The consolidated answers were summarized into recommendations. Where evidence was lacking, recommendations were developed using collective expert consensus. The EF was asked to agree/disagree with the clinical recommendations. The expert-agreed clinical recommendations provide guidance that considers both renal and extra-renal systems. The topics covered are advice on fertility and family planning, consideration of the nervous, muscular, ophthalmic, cardio-respiratory, endocrine, dermatological and gastrointestinal systems, as well as guidance on dental care, diet, lifestyle, and improving quality of life and psychological well-being. In summary, this work outlines recommendations and a checklist for clinicians with a vision for improving and standardizing the multidisciplinary care for patients with cystinosis.
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Affiliation(s)
| | - Aude Servais
- Nephrology and Transplantation Department, Hôpital Necker Enfants Malades APHP, Paris, France
| | - Sally A Hulton
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, B4 6NH, Birmingham, UK
| | - Gema Ariceta
- Paediatric Nephrology Department, University Hospital Vall d'Hebron, Professor of Paediatrics, The Autonomous University of Barcelona, Barcelona, Spain
| | - Francesco Emma
- Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - David S Game
- Department of Renal Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Risto Lapatto
- Department of Pediatrics, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hong Liang
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU ForeSight, Paris, France; Inserm-DHOS CIC 1423CHNO des Quinze-Vingts, IHU ForeSight, Paris, France; Inserm, U968; UPMC, université Paris 06, UMR_S968, institut de la vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anibh M Das
- Clinic for Paediatric Kidney-, Liver- and Metabolic Diseases, Hannover, Germany
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Hamed DH, Halim RMA, El Attar MM, Soliman NA, Osman HM. Pulmonary dysfunction in children with Cystinosis: single center study, original article. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00098-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cystinosis is a rare autosomal recessive disorder involving lysosomal storage of the amino acid cystine due to a defect in the membrane transport protein, cystinosin. The disease results in intracellular accumulation of cystine in all organs and tissues.
Pulmonary complications targeting the respiratory system occurs commonly in adults who have not received lifelong cysteamine therapy. The respiratory insufficiency is fatal at adulthood. However, little is known about the pulmonary dysfunction in children.
The study included 15 nephropathic cystinosis children to evaluate the pulmonary complications through detailed history taking, clinical examination, chest radiograph and Pulmonary function test (Impulse oscillometry {IOS}).
Results
Out of the cohort of 15 cystinosis patients, 13 patients did not show symptoms suggestive of chest affection. While 1 patient had recurrent Aspiration and 1 patient had history of pneumonia requiring hospital admission. All patients showed normal respiratory rate for age, normal breath sound and normal Chest X-ray finding apart from conical chest configuration.
IOS done showed small airway disease in 12 patients, decreased compliance in 2 patients, while only 1patient had normal IOS.
Conclusion
Small airway affection was detected in most of cystinosis children by means of IOS in spite of the absence of chest manifestations and suggestive history which highlight the importance of respiratory assessment and follow up of cystinosis patients not only by history, and examination but most important pulmonary function tests.
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Puertas Sanjuan A, Parramón-Teixidó CJ, Hernandez-Perez S, Frick MA, Cabañas Poy MJ. Persistent dyselectrolytemia in a neonate induced by liposomal amphotericin B. A case report. Front Pediatr 2022; 10:1099305. [PMID: 36704126 PMCID: PMC9871557 DOI: 10.3389/fped.2022.1099305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Nephrotoxicity is the most frequent serious adverse effect associated with amphotericin B deoxycholate treatment, for this reason, in recent years it has been relegated from routine clinical practice and replaced by the new liposomal formulations that have less nephrotoxicity. Nevertheless, dyselectrolytemia are a frequent adverse effect of the use of liposomal amphotericin B that usually are resolved with the withdrawal of the drug. CASE PRESENTATION We present a preterm neonate of 25 weeks gestation, with preserved renal function and most electrolytes within normal limits for gestational age except for mild hyponatremia in the first month of life. Due to an infection of the central nervous system and growth of Candida albicans, he required treatment with endovenous liposomal amphotericin B as well as intrathecal amphotericin B deoxycholate showing severe hydroelectrolyte disturbances and clinical worsening compatible with possible tubulopathy showing hypokalemia and severe hyponatremia a few days after starting treatment that persisted over time even after withdrawal of both drugs. Subsequently to the main alterations described, hypomagnesemia, hypophosphatemia, glycosuria and tubular proteinuria were also observed. Calcium levels remained stable after amphotericin B administration and did not require supplementation. In preterm or low birth weight newborns who present unjustified, severe and difficult to correct hydroelectrolyte disturbances despite the usual treatment, a possible tubulopathy should be considered, whether hereditary, primary or secondary to toxins or drugs. WHAT IS NEW AND CONCLUSION We present the first case reported in a neonate in whom dyselectrolithemia has been maintained over time after withdrawal of liposomal amphotericin B.
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Affiliation(s)
| | | | | | - Marie Antoinette Frick
- Infectious Pathology and Immunodeficiency Unit of Pediatrics, Vall d'Hebron Hospital Universitari, Barcelona, Spain
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5
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Abstract
Cystinosis is a rare inheritable lysosomal storage disorder characterized by cystine accumulation throughout the body, chronic kidney disease necessitating renal replacement therapy mostly during adolescence, and multiple extra-renal complications. The majority of male cystinosis patients are infertile due to azoospermia, in contrast to female patients who are fertile. Over recent decades, the fertility status of male patients has evolved from a primary hypogonadism in the era before the systematic treatment with cysteamine to azoospermia in the majority of cysteamine-treated infantile cystinosis patients. In this review, we provide a state-of-the-art overview on the available clinical, histopathological, animal, and in vitro data. We summarize current insights on both cystinosis males and females, and their clinical implications including the potential effect of cysteamine on fertility. In addition, we identify the remaining challenges and areas for future research.
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Kowalczyk M, Toro MD, Rejdak R, Załuska W, Gagliano C, Sikora P. Ophthalmic Evaluation of Diagnosed Cases of Eye Cystinosis: A Tertiary Care Center's Experience. Diagnostics (Basel) 2020; 10:diagnostics10110911. [PMID: 33171856 PMCID: PMC7695142 DOI: 10.3390/diagnostics10110911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background: We aimed to identify diagnosed cases of ocular cystinosis and describe clinical, epidemiological and therapeutic characteristics. Methods: This is a descriptive and retrospective case series. All patients underwent a full check-up examination every 4–6 months by ophthalmologists, nephrologists and other required specialists. Results: Of the seven cases, six (85.7%) were females and one (14.2%) was male. The infantile nephropathic form of cystinosis was observed in five patients and the juvenile nephropathic form in two patients. No patients with the ocular form of cystinosis were identified. Corneal cystine crystals (CCC) were found in all analyzed patients. Severe ocular and general complications of the disease that had been standing for years, connected to the infantile nephropathic form, delayed diagnosis or inappropriate treatment, were observed only in two patients. All patients received topical therapy. No adverse events related to the therapy were observed. Conclusions: Cystinosis is a rare, progressive disease. Early diagnosis and treatment prevent serious complications from numerous systemic organs. Patients require constant systematic monitoring by various specialists.
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Affiliation(s)
- Malgorzata Kowalczyk
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland; (M.K.); (R.R.)
| | - Mario Damiano Toro
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland; (M.K.); (R.R.)
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
- Correspondence: ; Tel.: +48-608-047-052; Fax: +48-81-532-61-49
| | - Robert Rejdak
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland; (M.K.); (R.R.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20954 Lublin, Poland;
| | - Caterina Gagliano
- Ophthalmology Clinic, San Marco Hospital, University of Catania, 95123 Catania, Italy;
| | - Przemyslaw Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, 20079 Lublin, Poland;
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Kuczborska K, Gozdowska J, Lewandowska D, Grenda R, Gałązka Z, Nazarewski S, Durlik M. Therapeutic Problems and Pregnancy in a Patient With Infantile Nephropathic Cystinosis: A Case Report. Transplant Proc 2019; 51:545-547. [PMID: 30879586 DOI: 10.1016/j.transproceed.2018.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cystinosis is a rare genetic disorder characterized by the abnormal accumulation of cystine in the lysosomes of various tissues and organs leading to their dysfunction. The most common type is the infantile nephropathic cystinosis which without treatment leads to renal failure and before the introduction of cysteamine was the cause of death before puberty. CASE PRESENTATION A 27-year-old female patient with infantile cystinosis developed end-stage renal disease at the age of 10. The first kidney transplantation from patient's father was carried out at the age of 12. The recurrent urinary tract infections led to the graft failure after 6 years. Following the removal of right appendages due to the ovarian tumor, the patient underwent the second kidney transplantation from her mother at the age of 19. After the transplantation, the cysteamine treatment was irregular due to limited availability of the medicine. When it became regular in 2017 the patient did not tolerate full doses. Despite elevated blood levels of cystine and the removal of right appendages, the patient naturally became pregnant in August 2017. Except for recurrent urinary tract infections, the renal parameters remained normal throughout the entire pregnancy. However, in the 32nd week of gestation, due to preeclampsia a caesarean section was performed. A healthy daughter was born, 1400/41 and with a 9 point Apgar score. CONCLUSIONS Due to the possibility of treatment with cysteamine and kidney transplantations, patients with cystinosis live longer and their quality of life improves. These female patients can even naturally become pregnant and give birth to healthy children.
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Affiliation(s)
- K Kuczborska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - J Gozdowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - D Lewandowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - R Grenda
- Department of Nephrology, Kidney Transplantation, and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Z Gałązka
- Department of General and Endocrinological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - S Nazarewski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Biswas S, Gaviria M, Malheiro L, Marques JP, Giordano V, Liang H. Latest Clinical Approaches in the Ocular Management of Cystinosis: A Review of Current Practice and Opinion from the Ophthalmology Cystinosis Forum. Ophthalmol Ther 2018; 7:307-322. [PMID: 30242621 PMCID: PMC6258572 DOI: 10.1007/s40123-018-0146-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Indexed: 12/27/2022] Open
Abstract
Cystinosis, a rare autosomal recessive disease caused by intracellular cystine accumulation, occurs in an estimated 1/100,000-200,000 live births. Ocular non-nephropathic cystinosis is typically diagnosed during adulthood, when patients present with corneal crystal deposition and no systemic involvement. Due to the rarity of the condition, diagnosis is often delayed and can have a significant impact on the overall prognosis of the disease. Early diagnosis is therefore imperative to ensure successful treatment and improve quality of life, as most of its clinical manifestations can be prevented or delayed. Early detection strategies and practical approaches for the ocular management of cystinosis were discussed during the Ophthalmology Cystinosis Forum, a 1-day meeting held in Berlin, Germany during June 2017. Recommendations for early detection comprise ophthalmic assessment, including self- and clinician-assessed recording of photophobia, and visual acuity, slit-lamp examination and tonometry ophthalmic examinations. In vivo confocal microscopy and anterior segment optical coherence tomography were highlighted as valuable techniques in evaluating cystine crystals in the cornea, in vivo and non-invasively. The mainstay of ocular cystinosis treatment is the cystine-depleting aminothiol cysteamine. Indeed, early treatment with and strict adherence to cysteamine therapy has a considerable impact on the long-term prognosis of ocular cystinosis. In rare diseases such as ocular cystinosis, standardised guidelines and recommendations for detection, patient care and follow-up assessments are essential. Such guidelines provide a support tool for healthcare professionals caring for ocular cystinosis patients. Multidisciplinary teams (MDTs) are essential for delivering gold standard care and improving quality of life for patients and their families. This review paper highlights current early detection policies, clinical treatment strategies and practical approaches for the ocular management of cystinosis, including implementing a cystinosis MDT. Additionally, discussions of the Ophthalmology Cystinosis Forum held in 2017 are summarised. FUNDING: Orphan Europe. Plain language summary available for this article.
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Affiliation(s)
- Susmito Biswas
- Manchester Royal Eye Hospital and Manchester Academic and Health Sciences Centre, Manchester, UK
| | - Martha Gaviria
- University Hospital San Vicente Foundation, Medellín, Colombia
| | - Luísa Malheiro
- Ophthalmological Department, Centro Hospital Universitário do Porto, Porto, Portugal
| | | | | | - Hong Liang
- Quinze-Vingts National Ophthalmology Hospital, Paris, France.
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Houem I, Fagnoul S, Nortier J, Ghisdal L, Bienfait L, Rasquin F, Sava R, Simon I. Cystinose juvénile révélée au stade d’insuffisance rénale chronique terminale. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Bertholet-Thomas A, Berthiller J, Tasic V, Kassai B, Otukesh H, Greco M, Ehrich J, de Paula Bernardes R, Deschênes G, Hulton SA, Fischbach M, Soulami K, Saeed B, Valavi E, Cobenas CJ, Hacihamdioglu B, Weiler G, Cochat P, Bacchetta J. Worldwide view of nephropathic cystinosis: results from a survey from 30 countries. BMC Nephrol 2017; 18:210. [PMID: 28673276 PMCID: PMC5496396 DOI: 10.1186/s12882-017-0633-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 06/21/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nephropathic cystinosis is a rare inherited metabolic disorder leading to progressive renal failure and extra-renal comorbidity. The prognosis relies on early adherence to cysteamine treatment and symptomatic therapies. Developing nations [DiN] experience many challenges for management of cystinosis. The aim of this study was to assess the management characteristics in DiN compared with developed nations [DeN]. METHODS A questionnaire was sent between April 2010 and May 2011 to 87 members of the International Pediatric Nephrology Association, in 50 countries. RESULTS A total of 213 patients were included from 41 centres in 30 nations (109 from 17 DiN and 104 from 13 DeN). 7% of DiN patients died at a median age of 5 years whereas no death was observed in DeN. DiN patients were older at the time of diagnosis. In DiN, leukocyte cystine measurement was only available in selected cases for diagnosis but never for continuous monitoring. More patients had reached end-stage renal disease in DiN (53.2 vs. 37.9%, p = 0.03), within a shorter time of evolution (8 vs. 10 yrs., p = 0.0008). The earlier the cysteamine treatment, the better the renal outcome, since the median renal survival increased up to 16.1 [12.5-/] yrs. in patients from DeN treated before the age of 2.5 years of age (p = 0.0001). However, the renal survival was not statistically different between DeN and DiN when patients initiated cysteamine after 2.5 years of age. The number of transplantations and the time from onset of ESRD to transplantation were not different in DeN and DiN. More patients were kept under maintenance dialysis in DiN (26% vs.19%, p = 0.02); 79% of patients from DiN vs. 45% in DeN underwent peritoneal dialysis. CONCLUSIONS Major discrepancies between DiN and DeN in the management of nephropathic cystinosis remain a current concern for many patients living in countries with limited financial resources.
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Affiliation(s)
- Aurélia Bertholet-Thomas
- Centre de référence des maladies rénales rares Néphrogones, hôpital Femme–Mère–Enfant, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
| | - Julien Berthiller
- 0000 0001 2163 3825grid.413852.9Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France
- Epidémiologie, Pharmacologie, Investigation Clinique CIC 1407 Inserm, Information médicale, Mère-Enfant–Bron, Bron, France
- 0000 0001 2150 7757grid.7849.2Université Lyon 1, Equipe d’Accueil 4129, Lyon, France
| | - Velibor Tasic
- Medical School, University Children’s Hospital, Skopje, Macedonia
| | - Behrouz Kassai
- 0000 0001 2163 3825grid.413852.9Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France
- Epidémiologie, Pharmacologie, Investigation Clinique CIC 1407 Inserm, Information médicale, Mère-Enfant–Bron, Bron, France
- 0000 0001 2150 7757grid.7849.2Université Lyon 1, Equipe d’Accueil 4129, Lyon, France
| | | | - Marcella Greco
- 0000 0001 0727 6809grid.414125.7Division of Nephrology and Dialysis, Children’s Hospital Bambino Gesù, IRCCS, Roma, Italy
| | - Jochen Ehrich
- 0000 0000 9529 9877grid.10423.34Children’s Hospital, Hannover Medical School, Hannover, Germany
| | | | - Georges Deschênes
- 0000 0004 1788 6194grid.469994.fService de néphrologie pédiatrique, Hôpital Robert Debré, Université Sorbonne Paris, Paris, France
| | - Sally-Ann Hulton
- 0000 0004 0399 7272grid.415246.0Birmingham Children’s Hospital, Birmingham, England
| | - Michel Fischbach
- 0000 0004 0593 6932grid.412201.4Service de néphrologie pédiatrique, Hôpital Hautepierre, Strasbourg, France
| | - Kenza Soulami
- Pediatric Nephrology, 295 Bd Abdelmoumen, Casablanca, Morocco
| | | | - Ehsan Valavi
- 0000 0000 9296 6873grid.411230.5Department of Nephrology, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Gabrielle Weiler
- 0000 0000 9402 6172grid.414148.cDivision of nephrology, Children’s hospital of Eastern Ontario, Ottawa, Canada
| | - Pierre Cochat
- Centre de référence des maladies rénales rares Néphrogones, hôpital Femme–Mère–Enfant, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
| | - Justine Bacchetta
- Centre de référence des maladies rénales rares Néphrogones, hôpital Femme–Mère–Enfant, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
- Centre de référence des maladies rénales rares - Néphrogones, Hôpital Femme–Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France
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Pinxten AM, Hua MT, Simpson J, Hohenfellner K, Levtchenko E, Casteels I. Clinical Practice: A Proposed Standardized Ophthalmological Assessment for Patients with Cystinosis. Ophthalmol Ther 2017; 6:93-104. [PMID: 28477325 PMCID: PMC5449308 DOI: 10.1007/s40123-017-0089-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/26/2022] Open
Abstract
Cystinosis is a rare autosomal recessive disease with an incidence of approximately 1 case per 100,000–200,000 live births. Over the years, gaining in-depth knowledge of the disease has led to vast improvement in patient life expectancy. However, debilitating, extra-renal manifestations such as eye disease, in particular corneal crystal deposition and its associated photophobia, still occur frequently, regardless of patient age and notwithstanding the increased implementation of systemic therapy. Ophthalmological assessment has not yet been standardized. The aim of this article was to provide clear recommendations for ophthalmological assessment during follow-up of patients with cystinosis to improve quality and regularity of ophthalmological care and thereby minimize ophthalmological complications. A literature search was performed to assess previous and current recommendations on examinations to conduct during follow-up of patients with cystinosis. Multidisciplinary cystinosis clinics were set up in collaboration with the Department of Ophthalmology and the Department of Pediatric Nephrology to allow patients to be seen by a nephrologist, an ophthalmologist and other specialists on the same day. Based on the results of these multidisciplinary clinics the standardized clinical ophthalmological assessment was drafted. This is a protocol for follow-up, describing the approach taken regarding ophthalmological follow-up of patients with cystinosis, considering the different types of the disease and the time since diagnosis. Standard examination includes history, visual acuity, tonometry and slit-lamp examination, with fundus photography performed at diagnosis and annually thereafter. Confocal microscopy is the imaging modality of choice, while anterior segment optical coherence tomography (OCT) is a good alternative. Finally, posterior segment OCT for imaging of the macular region and optic nerve should be conducted on an annual basis.
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Affiliation(s)
- Anne-Marie Pinxten
- Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium.
| | - Minh-Tri Hua
- Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - Jennifer Simpson
- Department of Ophthalmology, School of Medicine, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA
| | | | - Elena Levtchenko
- Department of Pediatric Nephrology, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Louvain, Belgium
| | - Ingele Casteels
- Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
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Liu Z, Chen Y, Lin Z, Shi X. Ophthalmic clues to the endocrine disorders. J Endocrinol Invest 2017; 40:21-25. [PMID: 27568184 DOI: 10.1007/s40618-016-0532-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/12/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Eye is a vital sense organ and reflects the physical and mental wellbeing of a person. Detailed examination of the eye is an essential part in the clinical evaluation of patients with any systemic disorder. The interaction between ophthalmologists and endocrinologists is often limited to Graves' ophthalmopathy and diabetic retinopathy. However, there are many ophthalmic manifestations, which are characteristically seen in endocrine disorders. In this review, we shall discuss the ocular manifestations of the endocrine syndromes excluding the Graves' ophthalmopathy and diabetic retinopathy. METHODS We performed a PubMed search of articles published in English showing the ophthalmic features in the endocrine disorders. Relevant cited articles were also retrieved. RESULTS Most of the publications included in the review were case reports and review articles. Many endocrine disorders have characteristic manifestations pertaining to the various structures of the eye. The involvement is seen from the external structures of the eye to the inner most layers of the retina. Many ocular-endocrine syndromes also exist with characteristic clues to the clinical diagnosis. CONCLUSION The endocrinologists need to be aware of these ocular signs that help in the early diagnosis of the underlying disorder. A syndromic approach is essential in the diagnosis of endocrinopathy in patients presenting with ophthalmic features.
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Affiliation(s)
- Z Liu
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China
| | - Y Chen
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China
| | - Z Lin
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China
| | - X Shi
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China.
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Raina R, Wang J, Krishnappa V. Structured Transition Protocol for Children with Cystinosis. Front Pediatr 2017; 5:191. [PMID: 28913329 PMCID: PMC5583154 DOI: 10.3389/fped.2017.00191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022] Open
Abstract
The transition from pediatric to adult medical services has a greater impact on the care of adolescents or young adults with chronic diseases such as cystinosis. This transition period is a time of psychosocial development and new responsibilities placing these patients at increased risk of non-adherence. This can lead to serious adverse effects such as graft loss and progression of the disease. Our transition protocol will provide patients, families, physicians, and all those involved a structured guide to transitioning cystinosis patients. This structured protocol depends on four areas of competency: Recognition, Insight, Self-reliance, and Establishment of healthy habits (RISE). This protocol has not been tested and therefore challenges not realized. With a focus on medical, social, and educational/vocational aspects, we aim to improve transition for cystinosis patients in all aspects of their lives.
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Affiliation(s)
- Rupesh Raina
- Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, United States.,Department of Nephrology, Cleveland Clinic Akron General, Akron, OH, United States
| | - Joseph Wang
- University of Nebraska Medical Center, Omaha, NE, United States.,Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Vinod Krishnappa
- Department of Nephrology, Cleveland Clinic Akron General, Akron, OH, United States
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Transición coordinada del paciente con cistinosis desde la medicina pediátrica a la medicina del adulto. Nefrologia 2016; 36:616-630. [DOI: 10.1016/j.nefro.2016.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/10/2016] [Indexed: 11/22/2022] Open
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