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Zaworski J, Gnemmi V, Bataille P, Hachulla E, Glowacki F, Gibier JB, Daroux M, Ratsimbazafy A, Bitton L, Humez S, Guincestre T, Béhal H, Azar R, Hoffmann M, Cardon G, Bourdon F, Lemoine C, Auxenfant E, Copin MC, Vandenbussche C, Quéméneur T. Early Renal Recovery after the First Flare of Pauci-Immune Glomerulonephritis. Am J Nephrol 2022; 53:59-68. [PMID: 35038711 DOI: 10.1159/000520285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Renal involvement is a severe manifestation of antineutrophil cytoplasmic antibody-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after the first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in the eGFR between diagnosis and the follow-up at 3 months (ΔeGFRM0-M3). METHODS This was a retrospective study over the period 2003-2018 of incident patients in the Nord-Pas-de-Calais (France). The primary outcome was the ΔeGFRM0-M3. RESULTS One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs. 28 ± 26 mL/min/1.73 m2, p < 0.001), with a ΔeGFRM0-M3 of 12 ± 19 mL/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs. 40 ± 24 mL/min/1.73 m2, p = 0.003). The factors significantly associated with the ΔeGFRM0-M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in the eGFR was 2.90 ± 0.06 mL/min/1.73 m2 for every 10-point gain in the percentage of cellular crescents. CONCLUSIONS Early renal recovery after the first flare of pauci-immune glomerulonephritis occurred mainly in the first 3 months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.
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Affiliation(s)
- Jérémy Zaworski
- Department of Nephrology and Internal Medicine, Hospital of Valenciennes, Valenciennes, France
| | - Viviane Gnemmi
- Department of Pathology, Pathology Institute, Lille University Hospital (CHU), Lille, France
| | - Pierre Bataille
- Department of Nephrology, Hospital of Boulogne-Sur-Mer, Boulogne-sur-Mer, France
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | | | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Lille University Hospital (CHU), Lille, France
| | - Maïté Daroux
- Department of Nephrology, Hospital of Boulogne-Sur-Mer, Boulogne-sur-Mer, France
| | | | - Laura Bitton
- Department of Pathology, Pathology Institute, Lille University Hospital (CHU), Lille, France
| | - Sarah Humez
- Department of Pathology, Pathology Institute, Lille University Hospital (CHU), Lille, France
| | | | - Hélène Béhal
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Raymond Azar
- Department of Nephrology, Hospital of Dunkerque, Dunkerque, France
| | - Maxime Hoffmann
- Department of Nephrology, Hôpital Privé La Louvière de Lille, Lille, France
| | | | - Franck Bourdon
- Department of Nephrology, Clinique du Bois, Lille, France
| | - Corinne Lemoine
- Department of Nephrology, Clinique privé de Bois-Bernard, Bois-Bernard, France
| | - Eric Auxenfant
- Department of Internal Medicine, Centre Hospitalier de Roubaix, Roubaix, France
| | - Marie-Christine Copin
- Department of Pathology, Pathology Institute, Lille University Hospital (CHU), Lille, France
| | - Cyrille Vandenbussche
- Department of Nephrology and Internal Medicine, Hospital of Valenciennes, Valenciennes, France
| | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, Hospital of Valenciennes, Valenciennes, France
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Bonnard G, Chraibi N, Benaoum J, Burda G, Cherkaoui A, Macnamara E, Wayolle N, Vinsonneau C, Ratsimbazafy A. Insuffisance rénale aiguë avec insuffisance rénale préexistante : encore un intérêt à la biopsie rénale ? Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bonnard G, Benaoum J, Bui Nguyen L, Burda G, Cherkaoui A, Chraibi N, Flamme C, Ratsimbazafy A, Wayolle N, Macnamara E. Peut-on prévenir les complications post-biopsie rénale en insuffisance rénale aiguë ? Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Meyer L, Ulrich M, Ducloux D, Garrigue V, Vigneau C, Nochy D, Bobrie G, Ferlicot S, Colombat M, Boffa JJ, Clabault K, Mansour J, Mousson C, Azar R, Bacri JL, Dürrbach A, Duvic C, El Karoui K, Hoffmann M, Lionet A, Panescu V, Plaisier E, Ratsimbazafy A, Guerrot D, Vrigneaud L, Valleix S, François H. Organ Transplantation in Hereditary Fibrinogen A α-Chain Amyloidosis: A Case Series of French Patients. Am J Kidney Dis 2020; 76:384-391. [PMID: 32660897 DOI: 10.1053/j.ajkd.2020.02.445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Fibrinogen A α-chain amyloidosis (AFib amyloidosis) is a form of amyloidosis resulting from mutations in the fibrinogen A α-chain gene (FGA), causing progressive kidney disease leading to kidney failure. Treatment may include kidney transplantation (KT) or liver-kidney transplantation (LKT), but it is not clear what factors should guide this decision. The aim of this study was to characterize the natural history and long-term outcomes of this disease, with and without organ transplantation, among patients with AFib amyloidosis and various FGA variants. STUDY DESIGN Case series. SETTING & PARTICIPANTS 32 patients with AFib amyloidosis diagnosed by genetic testing in France between 1983 and 2014, with a median follow-up of 93 (range, 4-192) months, were included. RESULTS Median age at diagnosis was 51.5 (range, 12-77) years. Clinical presentation consisted of proteinuria (93%), hypertension (83%), and kidney failure (68%). Manifestations of kidney disease appeared on average at age 57 (range, 36-77) years in patients with the E526V variant, at age 45 (range, 12-59) years in those with the R554L variant (P<0.001), and at age 24.5 (range, 12-31) years in those with frameshift variants (P<0.001). KT was performed in 15 patients and LKT was performed in 4. In KT patients with the E526V variant, recurrence of AFib amyloidosis in the kidney graft was less common than with a non-E526V (R554L or frameshift) variant (22% vs 83%; P=0.03) and led to graft loss less frequently (33% vs 100%). Amyloid recurrence was not observed in patients after LKT. LIMITATIONS Analyses were based on clinically available historical data. Small number of patients with non-E526V and frameshift variants. CONCLUSIONS Our study suggests phenotypic variability in the natural history of AFib amyloidosis, depending on the FGA mutation type. KT appears to be a viable option for patients with the most common E526V variant, whereas LKT may be a preferred option for patients with frameshift variants.
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Affiliation(s)
- Lara Meyer
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Nephrology, Université Paris Descartes, Paris
| | - Marc Ulrich
- Department of Nephrology, Hôpital Jean Bernard, Valenciennes, France
| | - Didier Ducloux
- Department of Nephrology, Centre Hospitalier Universitaire de Besançon, France
| | - Valérie Garrigue
- Department of Nephrology, Hôpital Lapeyronie, Montpellier, France
| | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, France
| | - Dominique Nochy
- Departments of Pathology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, France
| | - Guillaume Bobrie
- Departments of Hypertension, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, France
| | - Sophie Ferlicot
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, Department of Pathology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Magalie Colombat
- Department of Pathology, Centre Hospitalier Universitaire de Toulouse, France
| | - Jean-Jacques Boffa
- Department of Nephrology and Dialysis, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | | | | | - Christiane Mousson
- Department of Nephrology, Centre Hospitalier Unversitaire de Dijon, France
| | - Raymond Azar
- Department of Nephrology, Centre Hospitalier de Dunkerque, France
| | - Jean-Louis Bacri
- Department of Nephrology, Hôpital Jean Bernard, Valenciennes, France
| | - Antoine Dürrbach
- Department of Nephrology, Dialysis and Transplantation, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre
| | - Christian Duvic
- Department of Hemodialysis Clinique de Choisy, Le Gosier, Guadeloupe
| | | | - Maxime Hoffmann
- Department of Nephrology and Dialysis, Hôpital Privé La Louvière, Groupe Ramsay Générale de Santé, Lille
| | - Arnaud Lionet
- Department of Nephrology, and Transplantation, Centre Hospitalier Régional et Universitaire de Lille, France
| | - Victor Panescu
- Department of Nephrology and Hemodialysis, Polyclinique de Gentilly, Gentilly, France
| | - Emmanuelle Plaisier
- Department of Nephrology and Dialysis, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | | | - Dominique Guerrot
- Department of Nephrology and Dialysis, Centre Hospitalier Bois Guillaume, Rouen
| | - Laurence Vrigneaud
- Department of Nephrology and Dialysis, Hôpital Privé La Louvière, Groupe Ramsay Générale de Santé, Lille
| | - Sophie Valleix
- Department of Genetic Necker Hospital, AP-HP, Université Paris Descartes, Paris AP-HP, France.
| | - Hélène François
- Department of Nephrology and Transplantation, Hôpital Tenon, Sorbonne Université, Paris, France.
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Bonnard G, Fages V, Burda G, Cherkaoui A, Houze L, Ratsimbazafy A, Macnamara E. Faut-il dépister et traiter systématiquement une carence en vitamine C en hémodialyse ? Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gnemmi V, Verine J, Vrigneaud L, Glowacki F, Ratsimbazafy A, Copin MC, Dewilde A, Buob D. Microvascular inflammation and acute tubular necrosis are major histologic features of hantavirus nephropathy. Hum Pathol 2015; 46:827-35. [PMID: 25791582 DOI: 10.1016/j.humpath.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/31/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
Hantavirus nephropathy (HVN) is an uncommon etiology of acute renal failure due to hantavirus infection. Pathological features suggestive of HVN historically reported are medullary interstitial hemorrhages in a background of acute interstitial nephritis (AIN). However, interstitial hemorrhages may be lacking because of medullary sampling error. This emphasizes that other pathological criteria may be of interest. We performed a retrospective clinicopathological study of 17 serologically proven HVN cases with renal biopsy from 2 nephrology centers in northern France. Histologic analysis was completed by immunohistochemistry with anti-CD3, anti-CD68, and anti-CD34 antibodies. Three control groups were not related to hantavirus infection: acute tubular necrosis (ATN) of ischemic or toxic etiology and AIN were used for comparison. Renal biopsy analysis showed that almost all HVN cases with medullary sampling (9/10) displayed interstitial hemorrhages, whereas focal hemorrhages were detected in 2 of the 7 "cortex-only" specimens. ATN was common, as it was present in 15 (88.2%) of 17 HVN cases. By contrast, interstitial inflammation was scarce with no inflammation or only slight inflammation, representing 15 (88.2%) of 17 cases. Moreover, HVN showed inflammation of renal microvessels with cortical peritubular capillaritis and medullary vasa recta inflammation; peritubular capillaritis was significantly higher in HVN after comparison with ischemic and toxic ATN controls (P = .0001 and P = .003, respectively), but not with AIN controls. Immunohistochemical studies highlighted the involvement of T cells and macrophages in renal microvascular inflammation related to HVN. Our study showed that microvascular inflammation, especially cortical peritubular capillaritis, and ATN are important histologic features of HVN.
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Affiliation(s)
- Viviane Gnemmi
- Department of Pathology, CHRU Lille, 59037 Lille, France; Université Lille Nord de France, 59000 Lille, France.
| | - Jérôme Verine
- Department of Pathology, Hopital Saint-Louis, 75475 Paris Cedex 10, France
| | - Laurence Vrigneaud
- Department of Nephrology, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France
| | - François Glowacki
- Université Lille Nord de France, 59000 Lille, France; Department of Nephrology, Hôpital Huriez, CHRU Lille, rue Michel Polonovski, 59037 Lille, France
| | - Anderson Ratsimbazafy
- Department of Nephrology, Centre Hospitalier de Bethune, Rue Delbecque, 62660 Beuvry Bethune, France
| | - Marie-Christine Copin
- Department of Pathology, CHRU Lille, 59037 Lille, France; Université Lille Nord de France, 59000 Lille, France
| | - Anny Dewilde
- Université Lille Nord de France, 59000 Lille, France; Department of Virology, CHRU Lille, 59037 Lille, France
| | - David Buob
- Department of Pathology, Hôpital Tenon, 75020 Paris, France
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Ratsimbazafy A, Vancleenputte P, Provot F. Traitement par éculizumab dans le cas d’un syndrome hémolytique et urémique secondaire à un cancer. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ratsimbazafy A, Bonne JF, Skalli A, Tournoys MH, Perard A, Coquart J, Bonnard G, Wajsbrot Houze L, Mac Namara E. Résultats du dépistage des maladies rénales au cours de la semaine du rein 2010 dans les centres hospitaliers de Lens et Béthune. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ravelomanana T, Rabeatoandro S, Randrianaivo N, Ratsimbazafy A, Raobijaona H, Barennes H. [Is oral rehydration with nasogastric tube more efficient than rehydration with spoon? Preliminary study in children with non-severe dehydration in Joseph-Raseta-Befelatanana Hospital, Madagascar]. Bull Soc Pathol Exot 2010; 103:90-95. [PMID: 20306334 DOI: 10.1007/s13149-010-0048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 02/02/2010] [Indexed: 05/29/2023]
Abstract
Since its recommendation by WHO, Oral Rehydration Solutions (ORS) contributed in reducing the rate of mortality due to acute gastroenteritis. In Madagascar, the rate of lethality imputed to gastroenteritis is about 3%. Rehydration can be performed either by using spoons which reliability is unsure because of parents' potential inobservance and child's refusal, or by nasogastric tube. The nasogastric tube may resolve these obstacles at the hospital. We realized a preliminary study to evaluate the efficacy and the safety of nasogastric tube and spoon administration of the ORS in rehydration of child with moderate post-gastroenteritis dehydration. This is an open comparative study realized in the Pediatric Unit at the Joseph-Raseta-Befelatanana Hospital from the 21 January to 21 May 2008. Main outcomes was the proportion of rehydrated children at 4 hours, other were: failure at 8 hours, duration and volume of SRO, side effects. Fifty-three children from 4-month to 4-year old among 1306 patients were recruited and forty-seven patients were included. Nine patients failed (4 children received ORS by spoon and 5 children by nasogastric tube). The use of spoon was more effective: 62.5% of the patients were rehydrated at the fourth hour versus 39.3% in nasogastric tube group (P = 0.04). Making debit constant presents difficulties in rehydration with nasogastric tube (44.4 %). Tolerance of nasogastric tube is generally good but 16.7% children get out their tube during this study. No ORS' inhalation was observed with both routes. No false passage or tube or ORS rejection was recorded in both techniques. This study shows that using spoon to rehydrate is more effective for the rehydration of moderate dehydration. The use of nasogastric tube needs more surveillance.
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Affiliation(s)
- T Ravelomanana
- Service de pédiatrie, Hôpital Joseph-Raseta-de-Befelatanana, CHU d'Antananarivo, BP 14 bis, Antananarivo, 101, Madagascar
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Rubin B, Martin EP, Arnaud J, Delsol G, Plesner T, Ratsimbazafy A, Llobera R, Holm B, Mariame B. Expression and signal transduction of T-cell antigen receptor (TCR)/CD3 complexes on fresh or in vitro expanded T lymphocytes from patients with Hodgkin's and non-Hodgkin's lymphomas. Scand J Immunol 1997; 45:715-25. [PMID: 9201313 DOI: 10.1046/j.1365-3083.1997.d01-452.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
T-cell responses against soluble antigens, alloantigens and mitogens are frequently diminished in patients with certain types of cancer. In the present study, the authors investigated possible mechanisms for the partial T-cell immunodeficiency in patients with Hodgkin's or non-Hodgkin's lymphomas. It was found that T-cells from lymphoma patients had significantly reduced proliferative responses to EBV-transformed B-cell lines and to anti-TCR/CD3 MoAb; a 30-50% reduction of cells expressing membrane T-cell receptor (TCR) complexes; and a significantly reduced signal transduction function. Long-term in vitro culture conditions were developed to expand T cells in TCR/CD3-dependent or TCR/CD3-independent manners. With such methods, it was found that the decreased T-cell responses in patients with Hodgkin's and non-Hodgkin's lymphomas appeared to be an intrinsic T-cell defect (not at the antigen presenting cell level), and the T-cell responses could be recovered after only a few days in culture. Thus, it is suggested that the T-cell response-defect in Hodgkin or non-Hodgkin lymphoma patients is a reversible phenomenon, dependent on the patient's tumour-bearing environment.
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MESH Headings
- B-Lymphocytes/immunology
- B-Lymphocytes/virology
- Cell Line, Transformed
- Cell Transformation, Viral/immunology
- Herpesvirus 4, Human
- Hodgkin Disease/immunology
- Hodgkin Disease/pathology
- Humans
- Lymphocyte Activation
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/pathology
- Multigene Family/immunology
- Receptor-CD3 Complex, Antigen, T-Cell/biosynthesis
- Receptor-CD3 Complex, Antigen, T-Cell/genetics
- Receptor-CD3 Complex, Antigen, T-Cell/immunology
- Signal Transduction/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- T-Lymphocytes/pathology
- Tumor Cells, Cultured
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Affiliation(s)
- B Rubin
- Centre d'Immunopathologie et de Génétique Humaine, CNRS UPR 8291, Toulouse, France
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