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Barratt J, Lafayette R, Kristensen J, Stone A, Cattran D, Floege J, Tesar V, Trimarchi H, Zhang H, Eren N, Paliege A, Rovin BH, Karl A, Losisolo P, Trimarchi H, Hoyos IG, Lampo MG, Monkowski M, De La Fuente J, Alvarez M, Stoppa D, Chiurchiu C, Novoa PA, Orias M, Barron MB, Giotto A, Arriola M, Cassini E, Maldonado R, Dionisi MP, Ryan J, Toussaint N, Luxton G, Peh CA, Levidiotis V, Francis R, Phoon R, Fedosiuk E, Toropilov D, Yakubtsevich R, Mikhailova E, Bovy C, Demoulin N, Hougardy JM, Maes B, Speeckaert M, Laurin LP, Barbour S, Masse M, Hladunewich M, Reich H, Cournoyer S, Tennankore K, Barbour S, Lv J, Liu Z, Wang C, Li S, Luo Q, Ni Z, Yan T, Fu P, Cheng H, Liu B, Lu W, Wang J, Chen Q, Wang D, Xiong Z, Chen M, Xu Y, Wei J, Pai P, Chen L, Rehorova J, Maixnerova D, Safranek R, Rychlik I, Hruby M, Makela S, Vaaraniemi K, Ortiz F, Alamartine E, Daroux M, Cartery C, Vrtovsnik F, Serre JE, Stamellou E, Vielhauer V, Hugo C, Budde K, Otte B, Nitschke M, Ntounousi E, Boletis I, Papagianni A, Goumenos D, Stylianou K, Zermpala S, Esposito C, Cozzolino MG, Viganò SM, Gesualdo L, Nowicki M, Stompor T, Kurnatowska I, Kim SG, Kim YL, Na KR, Kim DK, Kim SH, Porras LQ, Garcia ER, Pamplona IA, Segarra A, Goicoechea M, Fellstrom B, Lundberg S, Hemmingsson P, Guron G, Sandell A, Chen CH, Tokgoz B, Duman S, Altiparmak MR, Ergul M, Maxwell P, Mark P, McCafferty K, Khwaja A, Cheung CK, Hall M, Power A, Kanigicherla D, Baker R, Moriarty J, Mohamed A, Aiello J, Canetta P, Ayoub I, Robinson D, Thakar S, Mottl A, Sachmechi I, Fischbach B, Singh H, Mulhern J, Kamal F, Linfert D, Rizk D, Wadhwani S, Sarav M, Campbell K, Coppock G, Luciano R, Sedor J, Avasare R, Lau WL. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int 2023; 103:391-402. [PMID: 36270561 DOI: 10.1016/j.kint.2022.09.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [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: 07/01/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
The therapeutic potential of a novel, targeted-release formulation of oral budesonide (Nefecon) for the treatment of IgA nephropathy (IgAN) was first demonstrated by the phase 2b NEFIGAN trial. To verify these findings, the phase 3 NefigArd trial tested the efficacy and safety of nine months of treatment with Nefecon (16 mg/d) versus placebo in adult patients with primary IgAN at risk of progressing to kidney failure (ClinicalTrials.gov: NCT03643965). NefIgArd was a multicenter, randomized, double-blind, placebo-controlled two-part trial. In Part A, 199 patients with IgAN were treated with Nefecon or placebo for nine months and observed for an additional three months. The primary endpoint for Part A was 24-hour urine protein-to-creatinine ratio (UPCR) after nine months. Secondary efficacy outcomes evaluated included estimated glomerular filtration rate (eGFR) at nine and 12 months and the UPCR at 12 months. At nine months, UPCR was 27% lower in the Nefecon group compared with placebo, along with a benefit in eGFR preservation corresponding to a 3.87 ml/min/1.73 m2 difference versus placebo (both significant). Nefecon was well-tolerated, and treatment-emergent adverse events were mostly mild to moderate in severity and reversible. Part B is ongoing and will be reported on later. Thus, NefIgArd is the first phase 3 IgA nephropathy trial to show clinically important improvements in UPCR and eGFR and confirms the findings from the phase 2b NEFIGAN study.
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Affiliation(s)
- Jonathan Barratt
- College of Medicine Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Richard Lafayette
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | - Daniel Cattran
- Division of Nephrology, Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, Rheinisch Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Vladimir Tesar
- Department of Nephrology, 1st School of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Hernán Trimarchi
- Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Necmi Eren
- Department of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Alexander Paliege
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Brad H Rovin
- Division of Nephrology, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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Teisseyre M, Beyze A, Perrochia H, Szwarc I, Bourgeois A, Champion C, Chenine L, Serre JE, Broner J, Aglae C, Pernin V, Le Quintrec M. C5b-9 Glomerular Deposits Are Associated With Poor Renal Survival in Membranous Nephropathy. Kidney Int Rep 2022; 8:103-114. [PMID: 36644365 PMCID: PMC9831938 DOI: 10.1016/j.ekir.2022.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Membranous nephropathy (MN) is the first cause of nephrotic syndrome in patients without diabetes. Its prognosis is variable, and treatment remains controversial because of potential toxicity. Currently, there is no reliable prognostic marker common to all etiologies of MN and routinely available to predict the disease course and guide therapeutic management. Despite the major role of complement in the glomerular damage of MN, its prognostic impact has never been studied. We investigated the frequency and prognostic impact of glomerular deposition of C5b-9 in MN. Methods We retrospectively selected adults diagnosed with MN (primary or secondary) at Montpellier University Hospital between December 2004 and December 2015. To be included, all patients were required to have complete medical data and a kidney tissue sample for further immunohistochemistry. We performed PLA2R1, C4d, and C5b-9 staining by immunohistochemistry. Results Sixty-four adults were included: 45 with primary MN and 19 with secondary MN. C4d was positive in the glomeruli of 61 adults (95.3%). Twenty-nine adults (45.3%) had glomerular deposition of C5b-9. Patients with glomerular deposition of C5b-9 had more severe nephrotic syndrome on diagnosis and lower remission and renal survival rates than adults without. Conclusion C5b-9 glomerular staining is a powerful and easily accessible tool for stratifying adults according to their renal prognosis. The efficacy of complement inhibitors should be tested in adults with glomerular deposition of C5b-9.
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Affiliation(s)
- Maxime Teisseyre
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Anaïs Beyze
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Hélène Perrochia
- Department of Pathology, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Ilan Szwarc
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Alexis Bourgeois
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Coralie Champion
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Leila Chenine
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jean-Emmanuel Serre
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jonathan Broner
- Department of Internal Medicine, Caremeau Hospital, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Cédric Aglae
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Vincent Pernin
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France,Correspondence: Moglie Le Quintrec, Department of Nephrology, Dialysis and Transplantation, University of Montpellier, Institute of Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale U1183, Centre Hospitalier Universitaire de Montpellier–Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
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Trusson R, Brunot V, Larcher R, Platon L, Besnard N, Moranne O, Barbar S, Serre JE, Klouche K. Short- and Long-Term Outcome of Chronic Dialyzed Patients Admitted to the ICU and Assessment of Prognosis Factors: Results of a 6-Year Cohort Study. Crit Care Med 2020; 48:e666-e674. [PMID: 32697507 DOI: 10.1097/ccm.0000000000004412] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Data about end-stage kidney disease patients admitted to the ICU are scarce, dated, and mostly limited to short-term survival. The aim of this study was to assess the short- and long-term outcome and to determine the prognostic factors for end-stage kidney disease patients admitted to the ICU. DESIGN Prospective observational study. SETTING Medical ICUs in two university hospitals. PATIENTS Consecutive end-stage kidney disease patients admitted in two ICUs between 2012 and 2017. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Renal replacement therapy variables, demographic, clinical, and biological data were collected. The requirement of mechanical ventilation and vasopressive drugs were also collected. In-ICU and one-year mortality were estimated and all data were analyzed in order to identify predictive factors of short and long-term mortality. A total of 140 patients were included, representing 1.7% of total admissions over the study period. Septic shock was the main reason for admission mostly of pulmonary origin. Median Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score were at 63 and 6.7, respectively. In-ICU, hospital, and 1-year mortality were 41.4%, 46.4%, and 63%, respectively. ICU mortality was significantly higher as compared with ICU control group non-end-stage kidney disease (25% vs 41.4%; p = 0.005). By multivariate analysis, the short-term outcome was significantly associated with nonrenal Sequential Organ Failure Assessment score, and with the requirement of mechanical ventilation or/and vasoconstrictive agents during ICU stay. One-year mortality was associated with increased dialysis duration (> 3 yr) and phosphatemia (> 2.5 mmol/L), with lower albuminemia (< 30 g/L) and nonrenal Sequential Organ Failure Assessment greater than 8. CONCLUSIONS End-stage kidney disease patients presented frequently severe complications requiring critical care that induced significant short- and long-term mortality. ICU and hospital mortality depended mainly on the severity of the critical event reflected by Sequential Organ Failure Assessment score and the need of mechanical ventilation and/or catecholamines. One-year mortality was associated with both albuminemia and phosphatemia and with prior duration of chronic dialysis treatment, and with organ failure at ICU admission.
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Affiliation(s)
- Rémi Trusson
- Department of Intensive Care Medicine, University Hospital, Nimes, France
| | - Vincent Brunot
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Laura Platon
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Noémie Besnard
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Olivier Moranne
- Nephrology-Dialysis-Apheresis Unit, University Hospital, Nimes, France
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University of Montpellier, Montpellier, France
| | - Saber Barbar
- Department of Intensive Care Medicine, University Hospital, Nimes, France
| | - Jean-Emmanuel Serre
- Department of Nephrology, Lapeyronie University Hospital, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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Fournier MC, Foucher Y, Blanche P, Legendre C, Girerd S, Ladrière M, Morelon E, Buron F, Rostaing L, Kamar N, Mourad G, Garrigue V, Couvrat-Desvergnes G, Giral M, Dantan E, Blancho G, Branchereau J, Cantarovich D, Chapelet A, Dantal J, Deltombe C, Figueres L, Garandeau C, Giral M, Gourraud-Vercel C, Hourmant M, Karam G, Kerleau C, Meurette A, Ville S, Kandell C, Moreau A, Renaudin K, Cesbron A, Delbos F, Walencik A, Devis A, Amrouche L, Anglicheau D, Aubert O, Bererhi L, Legendre C, Loupy A, Martinez F, Sberro-Soussan R, Scemla A, Tinel C, Zuber J, Eschwege P, Frimat L, Girerd S, Hubert J, Ladriere M, Laurain E, Leblanc L, Lecoanet P, Lemelle JL, Hériot LE, Badet L, Brunet M, Buron F, Cahen R, Daoud S, Fournie C, Grégoire A, Koenig A, Lévi C, Morelon E, Pouteil-Noble C, Rimmelé T, Thaunat O, Delmas S, Garrigue V, Le Quintrec M, Pernin V, Serre JE. Dynamic predictions of long-term kidney graft failure: an information tool promoting patient-centred care. Nephrol Dial Transplant 2019; 34:1961-1969. [DOI: 10.1093/ndt/gfz027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/18/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Informing kidney transplant recipients of their prognosis and disease progression is of primary importance in a patient-centred vision of care. By participating in decisions from the outset, transplant recipients may be more adherent to complex medical regimens due to their enhanced understanding.
Methods
We proposed to include repeated measurements of serum creatinine (SCr), in addition to baseline characteristics, in order to obtain dynamic predictions of the graft failure risk that could be updated continuously during patient follow-up. Adult recipients from the French Données Informatisées et VAlidées en Transplantation (DIVAT) cohort transplanted for the first or second time from a heart-beating or living donor and alive with a functioning graft at 1 year post-transplantation were included.
Results
The model was composed of six baseline parameters, in addition to the SCr evolution. We validated the dynamic predictions by evaluating both discrimination and calibration accuracy. The area under the receiver operating characteristic curve varied from 0.72 to 0.76 for prediction times at 1 and 6 years post-transplantation, respectively, while calibration plots showed correct accuracy. We also provided an online application tool (https://shiny.idbc.fr/DynPG).
Conclusion
We have created a tool that, for the first time in kidney transplantation, predicts graft failure risk both at an individual patient level and dynamically. We believe that this tool would encourage willing patients into participative medicine.
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Affiliation(s)
- Marie-Cécile Fournier
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Paul Blanche
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS « Centaure », Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Lionel Rostaing
- Nephrology, Dialysis, and Organ Transplantation Department, Rangueil University Hospital and University Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Nephrology, Dialysis, and Organ Transplantation Department, Rangueil University Hospital and University Paul Sabatier, Toulouse, France
| | - Georges Mourad
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Grégoire Couvrat-Desvergnes
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
- Department of Nephrology, Dialysis and Transplantation, Departmental Hospital of Vendée, La Roche-sur-Yon, France
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
- Centre d’Investigation Clinique en Biothérapie, Nantes, France
| | - Etienne Dantan
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
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Goutaudier V, Perrochia H, Mucha S, Bonnet M, Delmas S, Garo F, Garrigue V, Lepreux S, Pernin V, Serre JE, Szwarc I, Merville P, Ramounau-Pigot A, René C, Visentin J, Morgan BP, Frémeaux-Bacchi V, Mourad G, Couzi L, Le Quintrec M. C5b9 Deposition in Glomerular Capillaries Is Associated With Poor Kidney Allograft Survival in Antibody-Mediated Rejection. Front Immunol 2019; 10:235. [PMID: 30906289 PMCID: PMC6418012 DOI: 10.3389/fimmu.2019.00235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
C4d deposition in peritubular capillaries (PTC) reflects complement activation in antibody-mediated rejection (ABMR) of kidney allograft. However, its association with allograft survival is controversial. We hypothesized that capillary deposition of C5b9-indicative of complement-mediated injury-is a severity marker of ABMR. This pilot study aimed to determine the frequency, location and prognostic impact of these deposits in ABMR. We retrospectively selected patients diagnosed with ABMR in two French transplantation centers from January 2005 to December 2014 and performed C4d and C5b9 staining by immunohistochemistry. Fifty-four patients were included. Median follow-up was 52.5 (34.25-73.5) months. Thirteen patients (24%) had C5b9 deposits along glomerular capillaries (GC). Among these, seven (54%) had a global and diffuse staining pattern. Twelve of the C5b9+ patients also had deposition of C4d in GC and PTC. C4d deposits along GC and PTC were not associated with death-censored allograft survival (p = 0.42 and 0.69, respectively). However, death-censored allograft survival was significantly lower in patients with global and diffuse deposition of C5b9 in GC than those with a segmental pattern or no deposition (median survival after ABMR diagnosis, 6 months, 40.5 months and 44 months, respectively; p = 0.015). Double contour of glomerular basement membrane was diagnosed earlier after transplantation in C5b9+ ABMR than in C5b9- ABMR (median time after transplantation, 28 vs. 85 months; p = 0.058). In conclusion, we identified a new pattern of C5b9+ ABMR, associated with early onset of glomerular basement membrane duplication and poor allograft survival. Complement inhibitors might be a therapeutic option for this subgroup of patients.
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Affiliation(s)
- Valentin Goutaudier
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Hélène Perrochia
- Department of Pathology, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Simon Mucha
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Marie Bonnet
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Sylvie Delmas
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Florian Garo
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Valérie Garrigue
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Sébastien Lepreux
- Department of Pathology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Pernin
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France.,INSERM U1183, Institute for Regenerative Medicine and Biotherapy, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Jean-Emmanuel Serre
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Ilan Szwarc
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France.,UMR CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Annie Ramounau-Pigot
- Department of Immunology, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Céline René
- Department of Immunology, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Jonathan Visentin
- UMR CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France.,Department of Immunology and Immunogenetics, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Bryan Paul Morgan
- School of Medicine, Systems Immunity Research Institute, Cardiff University, Cardiff, United Kingdom
| | | | - Georges Mourad
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France.,UMR CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Moglie Le Quintrec
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France.,INSERM U1183, Institute for Regenerative Medicine and Biotherapy, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
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Brunot V, Serre JE, Mourad G, Klouche K, Pernin V. Heparin-free renal replacement therapy for chronic hemodialyzed patients at high risk for bleeding: a comparison of on-line predilution hemodiafiltration with conventional hemodialysis. Hemodial Int 2018; 22:463-473. [PMID: 29745004 DOI: 10.1111/hdi.12668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/18/2017] [Revised: 02/12/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND In chronic hemodialysis patients with high risk of bleeding, optimal anticoagulation of the extracorporeal circuit is challenging. Heparin-free hemodialysis (HD) with heparin-coated AN69ST dialyzer is now considered as a good option and recommended by experts. Predilutional hemodiafiltration (HDF) may represent also a feasible alternative but has been poorly investigated. In this study, our aim was to evaluate the performance of on-line automated predilution heparin-free HDF as compared to conventional heparin-free HD with a heparin-coated membrane. METHODS We prospectively studied chronic hemodialysis patients at high risk of bleeding consecutively admitted to hospital who underwent heparin-free renal replacement therapy (RRT) in our nephrology department. During 1 year, we routinely used heparin-free HD and on-line HDF in these settings. By using a propensity score, we compared HDF to HD regarding to session failure and efficiency. RESULTS One hundred and seventy-nine patients were included in the study. Clotting phenomena necessitating premature termination of RRT sessions were encountered in 19% of them. After propensity score matching, the comparison of 77 HD and 77 HDF sessions showed no significant differences in duration of the sessions and in dialyzer clotting. By multivariate analysis, a blood flow less than 250 mL/min and recent surgery were the only parameters associated with extracorporeal circuit thrombosis. CONCLUSION Heparin-free on-line predilutional HDF is a safe and effective technique for chronic hemodialysis patients with increased bleeding risk. The use of an automatic substitution volume that avoids filters hemoconcentration and of a blood flow above 250 mL/min strongly contribute to the observed performance. Further studies are, however, intended to confirm these results.
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Affiliation(s)
- Vincent Brunot
- Department of Nephrology, Dialysis, and Transplantation, Univ Montpellier, CHU Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Jean-Emmanuel Serre
- Department of Nephrology, Dialysis, and Transplantation, Univ Montpellier, CHU Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Georges Mourad
- Department of Nephrology, Dialysis, and Transplantation, Univ Montpellier, CHU Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Univ Montpellier, CHU Montpellier, Lapeyronie Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | - Vincent Pernin
- Department of Nephrology, Dialysis, and Transplantation, Univ Montpellier, CHU Montpellier, Lapeyronie Hospital, Montpellier, France
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Goutaudier V, Szwarc I, Serre JE, Pageaux GP, Argilés À, Ribstein J. Primary sclerosing cholangitis: a new cause of distal renal tubular acidosis. Clin Kidney J 2016; 9:811-813. [PMID: 27994859 PMCID: PMC5162411 DOI: 10.1093/ckj/sfw085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/17/2016] [Indexed: 11/24/2022] Open
Abstract
We describe the first case of distal renal tubular acidosis (dRTA) associated with primary sclerosing cholangitis. A 26-year-old Lao-Thai male patient presented with severe jaundice, metabolic acidosis and hypokalaemia. He was diagnosed of dRTA. Liver transplantation resulted in correction of electrolyte disturbances and hyperbilirubinaemia. A fludrocortisone-furosemide test revealed normal urinary acidification, demonstrating no residual dRTA. This observation suggests that dRTA may be an early manifestation of bilirubin-associated nephropathy or the consequence of an immune mechanism.
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Affiliation(s)
- Valentin Goutaudier
- Department of Nephrology, Dialysis and Transplantation, Hôpital Lapeyronie, University of Montpellier Medical School, Montpellier, France
| | - Ilan Szwarc
- Department of Nephrology, Dialysis and Transplantation, Hôpital Lapeyronie, University of Montpellier Medical School, Montpellier, France
| | - Jean-Emmanuel Serre
- Department of Nephrology, Dialysis and Transplantation, Hôpital Lapeyronie, University of Montpellier Medical School, Montpellier, France
| | - Georges-Philippe Pageaux
- Department of Hepato-Gastro-Enterology and Liver Transplantation, Hôpital Saint Eloi, University of Montpellier Medical School, Montpellier, France
| | - Àngel Argilés
- SAS RD - Nephrology, Montpellier, France; Department of Nephrology and Dialysis Saint-Guilhem, Sète, France
| | - Jean Ribstein
- Department of Hypertension and Internal Medicine, Hôpital Lapeyronie, University of Montpellier Medical School, Montpellier, France
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8
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Serre JE, Michonneau D, Bachy E, Noël LH, Dubois V, Suberbielle C, Kreis H, Legendre C, Mamzer-Bruneel MF, Morelon E, Thaunat O. Maintaining calcineurin inhibition after the diagnosis of post-transplant lymphoproliferative disorder improves renal graft survival. Kidney Int 2014; 85:182-90. [DOI: 10.1038/ki.2013.253] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 04/15/2013] [Accepted: 05/09/2013] [Indexed: 12/28/2022]
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Assil S, Bolze PA, Boukhali M, Cariou C, Chauveau L, Chuvin N, Dhondt K, Ducuing A, Dupont JB, Grandin C, Jarre G, Le Douce J, Lebrun D, Lechenet FOX, Luther N, Milivojevic M, Pérès É, Plantamura É, Sanlaville A, Schwob A, Seggio M, Serre JE, Thiébaut PA, Tirmarche S, Tshilenge KT, Vandamme C, Verlhac P, Vinera J, Mahieux R, Journo C. [Human retrovirus XMRV: The end of an exciting story?]. Virologie (Montrouge) 2011; 15:222-234. [PMID: 36151672 DOI: 10.1684/15-4.2011.17299] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Viruses represent an important cause of cancer in humans: infections are estimated to account for close to one cancer case out of five.With the ongoing discovery of new infectious agents, this number should be raising in the near future. In 2006, the discovery of a new _-retrovirus in prostate cancer biopsies launched an intense research activity: could this new xenotropic MLV-related virus (XMRV) be the cause of prostate cancer? Five years later, the initial enthusiasm of retrovirologists has dramatically diminished. One by one, arguments favouring the hypothesis of human infection with XMRV are being refuted. The aim of this review article is to present the discovery of XMRV and to analyze recent data arguing against its existence in humans. A synthetic interpretation of XMRV literature will then be suggested.
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Affiliation(s)
- Sonia Assil
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Pierre-Adrien Bolze
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Myriam Boukhali
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Carine Cariou
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Lise Chauveau
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Nicolas Chuvin
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Kévin Dhondt
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Antoine Ducuing
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Jean-Baptiste Dupont
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Clément Grandin
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Guillaume Jarre
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Juliette Le Douce
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Diane Lebrun
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Franc Ois-Xavier Lechenet
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Natascha Luther
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Milica Milivojevic
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Éléonore Pérès
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Émilie Plantamura
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Amélien Sanlaville
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Aurélien Schwob
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Maxime Seggio
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Jean-Emmanuel Serre
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Pierre-Alain Thiébaut
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Samantha Tirmarche
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Kizito-Tshitoko Tshilenge
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Céline Vandamme
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Pauline Verlhac
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Jennifer Vinera
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France
| | - Renaud Mahieux
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France, Oncogenèse rétrovirale, Inserm U758, 46, allée d'Italie, 69007 Lyon, France, École normale supérieure de Lyon, 46, allée d'Italie, 69007 Lyon, France, IFR 128 biosciences Lyon-Gerland, Lyon, France
| | - Chloé Journo
- École normale supérieure de Lyon, département de biologie, master biosciences, 46, allée d'Italie, 69007 Lyon, France, Oncogenèse rétrovirale, Inserm U758, 46, allée d'Italie, 69007 Lyon, France, École normale supérieure de Lyon, 46, allée d'Italie, 69007 Lyon, France, IFR 128 biosciences Lyon-Gerland, Lyon, France
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