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Percheron L, Leblanc C, Ulinski T, Fila M, Malvy D, Bacchetta J, Guigonis V, Debuisson C, Launay E, Martinez E, Morand A, Decramer S, Schanstra JP, Berry A. Pediatric urogenital schistosomiasis diagnosed in France. Pediatr Nephrol 2024; 39:1893-1900. [PMID: 38212419 DOI: 10.1007/s00467-023-06260-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Schistosomiasis affects approximately 230 million people worldwide. There is an increased incidence of schistosomiasis cases in France acquired from outside the country. This increases the risk of schistosomiasis outbreaks as observed in Corsica. Clinicians from non-endemic regions are not accustomed to diagnosing and managing this pathology. The objective of this study is to provide a better description of the clinical and paraclinical characteristics and disease evolution of affected children. METHODS Through the French Pediatric Nephrology Society and the Pediatric Infectious Pathology Group, we contacted all French pediatric centers that may have treated children with urinary schistosomiasis between 2013 and 2019. Age, sex, comorbidities, and clinical, biological, and radiological data (at discovery and follow-up) were collected retrospectively. RESULTS A total of 122 patients from 10 different centers were included. The median age was 14 years and the sex ratio M/F was 4:1. Hematuria was present in 82% of the patients while urinary tract abnormality was found in 36% of them. Fourteen patients (11%) displayed complicated forms of urinary schistosomiasis including 10 patients with chronic kidney disease. A total of 110 patients received treatment with praziquantel, which was well-tolerated and led to clinical resolution of symptoms in 98% of cases. CONCLUSION Patients with schistosomiasis present frequent kidney, urinary, or genital involvement. Systematic screening of patients returning from endemic areas is therefore recommended, especially since treatment with antiparasitic drugs is effective and well-tolerated. Enhancing medical knowledge of this pathology among all practitioners is essential to improve care and outcomes.
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Affiliation(s)
- Lucas Percheron
- Service de néphrologie, médecine interne pédiatrique, Hôpital des enfants, CHU de Toulouse, Avenue de grande Bretagne, 31000, Toulouse, France.
- Service de pédiatrie, centre hospitalier du Val d'Ariège, Foix, France.
| | - Claire Leblanc
- Service de pédiatrie générale, maladies infectieuses et médecine interne Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Tim Ulinski
- Service de néphrologie et de transplantation pédiatrique, Université pierre marie curie, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marc Fila
- Service de néphrologie endocrinologie pédiatrique, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Denis Malvy
- Service des maladies infectieuses et tropicales, Centre hospitalier universitaire, Bordeaux, France
| | - Justine Bacchetta
- Service de néphrologie rhumatologie pédiatrique, Centre hospitalier universitaire, Lyon, France
| | - Vincent Guigonis
- Service de pédiatrie générale, centre hospitalier universitaire, Limoges, France
| | - Cecile Debuisson
- Service de pédiatrie générale et de maladie infectieuse pédiatrique, Hôpital Purpan, Toulouse, France
| | - Elise Launay
- Service de pédiatrie générale et infectiologie pédiatrique, Centre hospitalier universitaire, Nantes, France
| | - Edouard Martinez
- Service de pédiatrie, Centre hospitalier universitaire, Rouen, France
| | - Aurelie Morand
- Pédiatrie spécialisée et médecine infantile, Hôpital de la Timone, AP-HM, Marseille, France
| | - Stéphane Decramer
- Service de néphrologie, médecine interne pédiatrique, Hôpital des enfants, CHU de Toulouse, Avenue de grande Bretagne, 31000, Toulouse, France
| | - Joost-Peter Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Antoine Berry
- Service de parasitologie-mycologie, Centre hospitalier universitaire de Toulouse, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse, CNRS UMR5051, INSERM UMR1291, UPS, Toulouse, France
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Cassart M, Garel C, Ulinski T, Freddy Avni E. Reversed cortico-medullary differentiation in the fetal and neonatal kidneys: an indicator of poor prognosis? Pediatr Radiol 2024; 54:285-292. [PMID: 38150104 DOI: 10.1007/s00247-023-05833-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Bilateral reversed cortico-medullary differentiation is rarely observed on fetal or neonatal renal ultrasound and is therefore a diagnostic challenge. OBJECTIVE Our purpose was to widen the differential diagnoses of fetal and neonatal nephropathies introducing reversed cortico-medullary differentiation as a clue either on obstetric US or during follow-up of hyperechoic kidneys in order to improve the management of such rare clinical situations. MATERIALS AND METHODS We retrospectively reviewed the US images of 11 patients showing bilateral reversed cortico-medullary differentiation on prenatal examination or in which this pattern developed postnatally in the follow-up of fetal hyperechoic kidneys. For each patient, a precise diagnosis was established either on clinical assessment or, when available, on histological or genetic findings. RESULTS Six fetuses displayed bilateral reversed cortico-medullary differentiation on obstetric examination, and the pattern persisted throughout pregnancy. In the five other fetuses, the kidneys appeared initially homogeneously hyperechoic; this evolved into reversed cortico-medullary differentiation during the third trimester in two cases and shortly after birth in three cases. Two pregnancies were terminated because of estimated poor prognosis. In the nine surviving neonates, four died of renal failure in the post-natal period. The clinical evolution was more favorable in the remaining five newborns. CONCLUSIONS Six different diagnoses were established in patients presenting with a reversed cortico-medullary differentiation renal pattern. This finding was associated with poor outcome in six cases. An acute prenatal diagnosis of reversed cortico-medullary differentiation improves pre- and postnatal work-up and guides counseling and genetic testing.
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Affiliation(s)
- Marie Cassart
- Department of Radiology and Fetal Medicine, Iris Hospitals South, 63 Rue J. Paquot, 1050, Brussels, Belgium.
| | - Catherine Garel
- Department of Radiology, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - E Freddy Avni
- Department of Medical Imaging, Marie Curie Civil Hospital, Charleroi, Belgium
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Mary AL, Clave S, Rousset-Rouviere C, Berard E, Boyer O, Decramer S, Fila M, Guigonis V, Cloarec S, Harambat J, Hogan J, Lahoche A, Roussey-Kesler G, Zaloszyc A, Ulinski T, Parmentier C, Delbet JD. Outcome of children with IgA vasculitis with nephritis treated with steroids: a matched controlled study. Pediatr Nephrol 2023; 38:3317-3326. [PMID: 37154959 DOI: 10.1007/s00467-023-05981-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND IgA vasculitis (IgAV) is the most common vasculitis in children. IgAV long-term prognosis depends on kidney involvement or IgA vasculitis with nephritis (IgAVN). To date, steroid treatment (oral steroids or methylprednisolone pulses) has not proven to be formally efficient. This study aimed to assess the role of steroids on IgAVN outcome. METHODS All children with IgAVN diagnosed 2000-2019 in 14 French pediatric nephrology units with minimal follow-up of 6 months were retrospectively included. Outcomes of patients treated with steroids were compared with those of a control group of untreated patients matched for age, sex, proteinuria, eGFR, and histological features. The primary endpoint was IgAVN remission defined as urine protein-to-creatinine ratio < 20 mg/mmol without impaired eGFR one year after disease onset. RESULTS A total of 359 patients with IgAVN were included with a median follow-up time of 249 days (range 43-809). One hundred eight (30%) patients received oral steroids alone, 207 (51%) patients received three methylprednisolone pulses followed by oral steroids, and 44 patients (12.5%) did not receive steroids. Thirty-two children treated with oral steroids alone were compared with 32 matched control patients who did not receive steroids. One year after disease onset, IgAVN remission proportion was not different between these two groups: 62% versus 68%, respectively. Ninety-three children treated with oral steroids alone were compared with 93 matched patients treated with three methylprednisolone pulses followed by oral corticosteroids. IgAVN remission proportion was not different between these two groups: 77% versus 73%, respectively. CONCLUSION The benefit of oral steroids alone and methylprednisolone pulses could not be established based on this observational study. Randomized controlled trials are thus required to determine the efficacy of steroids in IgAVN. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anne-Lise Mary
- Intensive Care Unit, Armand Trousseau Hospital, AP-HP, 75012, Paris, France
| | - Stéphanie Clave
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique Des Hôpitaux de Marseille, Marseille, France
| | - Caroline Rousset-Rouviere
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique Des Hôpitaux de Marseille, Marseille, France
| | - Etienne Berard
- Department of Pediatrics, Hôpital de L'Archet, University Hospital of Nice, Nice, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Necker Hospital, APHP, 75015, Paris, France
| | - Stéphane Decramer
- Department of Pediatric Nephrology, Hôpital Des Enfants, Reference Center for Rare Kidney Diseases SORARE, University Hospital of Toulouse, Toulouse, France
| | - Marc Fila
- Department of Pediatric Nephrology, Reference Center for Rare Kidney Diseases SORARE, Hôpital Arnaud-de-Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Vincent Guigonis
- Department of Pediatrics, Hôpital Mère-Enfant, University Hospital of Limoges, Reference Center for Rare Kidney Diseases SORARE, Limoges, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology and Hemodialysis, Clocheville Hospital, University Hospital of Tours, Tours, France
| | - Jérôme Harambat
- Department of Pediatrics, Hôpital Pellegrin-Enfants, University Hospital of Bordeaux, Reference Center for Rare Kidney Diseases SORARE, Bordeaux, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, APHP and French Reference Center for Rare Diseases (CRMR) Idiopathic Nephrotic Syndrome, Paris, France
| | - Annie Lahoche
- Pediatric Nephrology Unit Jeanne de Flandre Hospital, Regional University Hospital of Lille, Lille, France
| | | | - Ariane Zaloszyc
- Department of Pediatrics 1, University Hospital of Strasbourg, Strasbourg, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP and French Reference Center for Rare Diseases MARHEA, Paris, France
- Sorbonnes Université, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP and French Reference Center for Rare Diseases MARHEA, Paris, France
| | - Jean-Daniel Delbet
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP and French Reference Center for Rare Diseases MARHEA, Paris, France.
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Garnier A, Brochard K, Kwon T, Sellier-Leclerc AL, Lahoche A, Launay EA, Nobili F, Caillez M, Taque S, Harambat J, Michel-Bourdat G, Guigonis V, Fila M, Cloarec S, Djamal-Dine D, de Parscaux L, Allard L, Salomon R, Ulinski T, Frémeaux-Bacchi V, Morin C, Olivier-Abbal P, Colineaux H, Auriol F, Arnaud C, Kieffer I, Brusq C. Efficacy and Safety of Eculizumab in Pediatric Patients Affected by Shiga Toxin-Related Hemolytic and Uremic Syndrome: A Randomized, Placebo-Controlled Trial. J Am Soc Nephrol 2023; 34:1561-1573. [PMID: 37303085 PMCID: PMC10482062 DOI: 10.1681/asn.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/08/2022] [Accepted: 04/21/2023] [Indexed: 06/13/2023] Open
Abstract
SIGNIFICANCE STATEMENT Shiga toxin-related hemolytic uremic syndrome (STEC-HUS) is a serious condition, characterized by multiorgan thrombotic microangiopathy, mainly affecting children. Renal involvement is severe, with approximately half of patients requiring dialysis. So far, no specific treatment has been proven efficient in STEC-HUS. The use of eculizumab, a monoclonal antibody inhibiting terminal complement complex, has demonstrated remarkable success in atypical hemolytic uremic syndrome, but its use in uncontrolled studies to treat STEC-HUS has yielded inconsistent results. In this Phase 3 randomized, placebo-controlled trial in 100 pediatric patients with STEC-HUS, the findings did not show efficacy of eculizumab during the acute phase of the disease. However, the results indicated a reduction of renal sequelae in eculizumab-treated patients at 1-year follow-up. Larger prospective studies would be needed to further explore eculizumab as a potential treatment. BACKGROUND Shiga toxin-related hemolytic uremic syndrome (STEC-HUS) in children is a severe condition, resulting in approximately 50% of patients requiring RRT. Furthermore, at least 30% of survivors experience kidney sequelae. Recently, activation of the complement alternative pathway has been postulated as a factor in STEC-HUS pathophysiology, leading to compassionate use of eculizumab, a monoclonal antibody inhibiting the terminal complement complex, in affected patients. Given the lack of therapy for STEC-HUS, a controlled study of eculizumab efficacy in treating this condition is a priority. METHODS We conducted a Phase 3 randomized trial of eculizumab in children with STEC-HUS. Patients were randomly assigned in a 1:1 ratio to receive either eculizumab or placebo during 4 weeks. Follow-up lasted for 1 year. The primary end point was RRT duration <48 hours after randomization. Secondary endpoints included hematologic and extrarenal involvement. RESULTS Baseline characteristics were similar among the 100 patients who underwent randomization. The rate of RRT <48 hours did not differ significantly between the two groups (48% in the placebo versus 38% in the eculizumab group; P = 0.31) or in the course of ARF. The two groups also exhibited similar hematologic evolution and extrarenal manifestations of STEC-HUS. The proportion of patients experiencing renal sequelae at 1 year was lower in the eculizumab group than in the placebo group (43.48% and 64.44%, respectively, P = 0.04). No safety concern was reported. CONCLUSIONS In pediatric patients with STEC-HUS, eculizumab treatment does not appear to be associated with improved renal outcome during acute phase of the disease but may reduce long-term kidney sequelae. CLINICAL TRIALS REGISTRATIONS EUDRACT (2014-001169-28) ClinicalTrials.gov ( NCT02205541 ).
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Affiliation(s)
- Arnaud Garnier
- Department of Pediatric Nephrology, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Karine Brochard
- Department of Pediatric Nephrology, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Theresa Kwon
- Department of Pediatric Nephrology, Hôpital Robert Debré, Paris, France
| | | | - Annie Lahoche
- Department of Pediatric Nephrology, Hôpital Jeanne de Flandre, Lille, France
| | | | - François Nobili
- Department of Pediatric Nephrology, CHU Besançon, Besançon, France
| | - Mathilde Caillez
- Department of Pediatric Nephrology, Hôpital La Timone, Marseille, France
| | - Sophie Taque
- Department of Pediatric Nephrology, CHU Anne de Bretagne, Rennes, France
| | - Jerôme Harambat
- Department of Pediatric Nephrology, CHU Pellegrin, Bordeaux, France
| | | | - Vincent Guigonis
- Department of Pediatric Nephrology, Hôpital de la Mère et de l’Enfant, Limoges, France
| | - Marc Fila
- Department of Pediatric Nephrology, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology, CHRU Clocheville, Tours, France
| | | | - Loïc de Parscaux
- Department of Pediatrics and Genetics, CHU Morvan, Brest, France
| | - Lise Allard
- Department of Pediatric Nephrology, CHU Angers, Angers, France
| | - Rémi Salomon
- Department of Pediatric Nephrology, Hôpital Necker-Enfants Malades, Paris, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Hôpital Trousseau, Paris, France
| | | | | | | | | | - Françoise Auriol
- Unit of Pediatric Clinical Research, CIC1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | | | - Isabelle Kieffer
- Unit of Pediatric Clinical Research, CIC1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Clara Brusq
- Clinical Epidemiology Unit, CHU Toulouse, Toulouse, France
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Coulm B, Latour M, Beguin D, Vauzelle C, Éléfant E, Ulinski T, Marin B. [Clinical monitoring of children with in utero exposure to angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers]. Gynecol Obstet Fertil Senol 2023; 51:352-355. [PMID: 37044250 DOI: 10.1016/j.gofs.2023.04.003] [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] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023]
Abstract
Angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers are widely used to reduce high blood pressure or in other conditions such as congestive heart failure and prevention of diabetic nephropathy. To date, no teratogenic effect has been attributed to them, but in the 2nd and 3rd trimesters of pregnancy, their foetotoxicity is broadly documented: transient oligohydramnios or anamnios, associated to possible neonatal anuria and permanent renal damage, which can lead to intrauterine or neonatal death. Long-term effects among children with in utero exposure are poorly known, but the regression of an oligohydramnios might not always be associated with normal renal function after birth or later in life. This justifies seeking the advice of a pediatric nephrologistto consider the most appropriate monitoring for the child at birth and in the following weeks, and possibly beyond, even in case of normal prenatal ultrasound.
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Affiliation(s)
- Bénédicte Coulm
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Trousseau, Sorbonne université, 75012 Paris, France.
| | - Mathilde Latour
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Delphine Beguin
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Catherine Vauzelle
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Elisabeth Éléfant
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Tim Ulinski
- Service de néphrologie pédiatrique, ORIGYNE, AP-HP, Sorbonne université, hôpital Trousseau, 75012 Paris, France
| | - Benoît Marin
- Département de santé publique, centre de référence sur les agents tératogènes (CRAT), Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Trousseau, Sorbonne université, 75012 Paris, France
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6
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Avramescu M, Isnard P, Temmam S, Chevalier A, Bastard P, Attia M, Berthaud R, Fila M, Dossier C, Hogan J, Ulinski T, Leguevaques D, Louillet F, Casado EM, Halimi JM, Cloarec S, Zaloszyc A, Faudeux C, Rousset-Rouvière C, Clavé S, Harambat J, Rollot E, Simon T, Nallet-Amate M, Ranchin B, Bacchetta J, Porcheret F, Bernard J, Ryckewaert A, Jamet A, Fourgeaud J, Da Rocha N, Pérot P, Kuperwasser N, Bouazza N, Rabant M, Duong Van Huyen JP, Robert MP, Zuber J, Casanova JL, Eloit M, Sermet-Gaudelus I, Boyer O. Acute tubulointerstitial nephritis with or without uveitis: a novel form of post-acute COVID-19 syndrome in children. Kidney Int 2023; 103:1193-1198. [PMID: 36918081 PMCID: PMC10008186 DOI: 10.1016/j.kint.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Marina Avramescu
- Pediatric Nephrology, Maladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Reference Center, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Pierre Isnard
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France; Université de Paris, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1151, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8253, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France
| | - Sarah Temmam
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Agnès Chevalier
- Department of Pediatric Nephrology, Arnaud-de-Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France; Paris Cité University, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA; Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Mikael Attia
- Molecular Genetics of RNA Viruses, Department of Virology, Institut Pasteur, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 3569, Paris, France
| | - Romain Berthaud
- Pediatric Nephrology, Maladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Reference Center, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Marc Fila
- Department of Pediatric Nephrology, Arnaud-de-Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Claire Dossier
- Department of Pediatric Nephrology, Robert Debré Hospital, Paris Cité University, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology, Robert Debré Hospital, Paris Cité University, Paris, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Armand Trousseau Hospital, Paris, France
| | - Damia Leguevaques
- Department of Pediatric Nephrology, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille, France
| | | | | | - Jean-Michel Halimi
- Department of Adult Nephrology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology, Clocheville Hospital, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | - Ariane Zaloszyc
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Strasbourg, Strasbourg, France
| | - Camille Faudeux
- Department of Pediatrics, Pediatric Nephrology Unit, L'Archet Hospital, University Hospital of Nice, Nice, France
| | - Caroline Rousset-Rouvière
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Stéphanie Clavé
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Jérôme Harambat
- Department of Pediatrics, Pediatric Nephrology Unit, SoRare Reference Center, Bordeaux University Hospital, Bordeaux, France
| | - Edouard Rollot
- Department of Pediatrics, Pediatric Nephrology Unit, SoRare Reference Center, Bordeaux University Hospital, Bordeaux, France
| | - Thomas Simon
- Department of Pediatric Nephrology, SoRare Reference Center, Toulouse University Hospital, Toulouse, France
| | | | - Bruno Ranchin
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Lyon, Lyon, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Lyon, Lyon, France
| | | | - Josselin Bernard
- Pediatric Department, Nantes University Hospital, Nantes, France
| | - Amélie Ryckewaert
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Rennes, Rennes, France
| | - Anne Jamet
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
| | - Jacques Fourgeaud
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
| | - Nicolas Da Rocha
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Philippe Pérot
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Nicolas Kuperwasser
- Paris Cité University, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1151, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8253, Necker Enfants Malades Institute, Department « Croissance et Signalisation », Paris, France
| | - Naïm Bouazza
- Equipe Associée (EA) 7323, Université Paris, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France; Unité de Recherche Clinique, Hôpital Tarnier, Paris, France; Centre d'Investigation Clinique (CIC)-1419 Institut National de la Santé Et de la Recherche Médicale (Inserm), Cochin-Necker, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Matthieu P Robert
- Department of Ophthalmology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cité University, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cité University, Paris, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France; Paris Cité University, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
| | - Marc Eloit
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Isabelle Sermet-Gaudelus
- Department of Pediatric Pulmonology and Allergology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Olivia Boyer
- Pediatric Nephrology, Maladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Reference Center, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
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7
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Delbet JD, Hogan J, Parmentier C, Ulinski T, Dossier C. Successful global anti-B-cell strategy with daratumumab in a patient with post-transplant nephrotic syndrome recurrence unresponsive to immunoadsorption and obinutuzumab. Pediatr Transplant 2023:e14544. [PMID: 37226549 DOI: 10.1111/petr.14544] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/11/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Steroid-resistant nephrotic syndrome recurrence post-transplant unresponsive to immunoadsorption is a dilemma, and no reliable treatment strategy has been identified to induce remission so far. CASE PRESENTATION A 2-year-old girl presented first with idiopathic nephrotic syndrome. She did not reach remission after 30 days of oral steroids and remained resistant to steroid pulses, oral tacrolimus, IV cyclosporine, and to 30 sessions of plasma exchange. Bilateral nephrectomy was performed because of extrarenal complications. Two years later, she received an allograft from a deceased donor and idiopathic nephrotic syndrome relapsed immediately post-transplantation. She did not reach remission after immunosuppressive therapy including tacrolimus, mycophenolate mofetil, methylprednisolone pulses, daily immunoadsorption, and B-cell depletion. She received obinutuzumab 1 g/1.73 m2 injections weekly for 3 weeks and then daratumumab 1 g/1.73 m2 weekly for 4 weeks. One week after the last daratumumab infusion, urine protein/creatinine ratio began to decrease. Proteinuria was negative for the first time at Day 99. Immunoadsorption was stopped 147 days after, and she remained relapse-free at last follow-up (18 months post-transplantation). The treatment was complicated by a pneumocystis jirovecii pneumonia with a favorable outcome and persistent hypogammaglobulinemia. CONCLUSION A obinutuzumab and daratumumab combination seems to be a promising strategy in post-transplantation SRNS recurrence without response to standard treatment options.
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Affiliation(s)
- Jean-Daniel Delbet
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP, Paris, France
- French Reference Center for Rare Diseases MARHEA, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
- French Reference Center for Rare Diseases (CRMR) Idiopathic Nephrotic Syndrome, Paris, France
- Université Paris Cité, INSERM U970, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP, Paris, France
- French Reference Center for Rare Diseases MARHEA, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP, Paris, France
- French Reference Center for Rare Diseases MARHEA, Paris, France
- Sorbonne Université, Paris, France
| | - Claire Dossier
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
- French Reference Center for Rare Diseases (CRMR) Idiopathic Nephrotic Syndrome, Paris, France
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8
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Nel I, Parmentier C, Dehoux L, Minier M, Duneton C, Charbit M, Baudouin V, Bidet P, Carol A, Cheyssac E, Delbet JD, Guérin-El Khourouj V, Louillet F, Ulinski T, Delaugerre C, Carcelain G, Hogan J. Optimizing COVID-19 Vaccination Strategy in Pediatric Kidney Transplant Recipients: Humoral and Cellular Response to SARS-CoV-2 mRNA Vaccination. Transpl Int 2023; 36:11153. [PMID: 37252612 PMCID: PMC10213233 DOI: 10.3389/ti.2023.11153] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
In this retrospective cohort study, we analyze the early humoral and cellular response in 64 adolescents KTx recipients, after two or three doses of mRNA vaccine BNT162b2 against different variants of COVID-19. After 2 doses, 77.8% % of children with no history of infection had a positive humoral response with a median anti-S IgG level of 1107 (IQR, 593-2,658) BAU/mL. All the patients with a history of infection responded with a higher median IgG level (3,265 (IQR, 1,492-8,178) BAU/mL). In non-responders after 2 doses, 75% responded after a third dose with a median Ab titer at 355 (IQR, 140-3,865 BAU/mL). Neutralizing activity was significantly lower against the delta and the omicron variants compared to the wild-type strain and did not improve after a 3rd dose, while infection did provide higher levels of neutralizations against the variants. T cell specific response correlated with humoral response and no patient displayed a cellular response without a humoral response. Adolescent KTx recipients exhibit a high seroconversion rate after only two doses. A third injection, induces a response in the majority of the non-responders patients but did not counterbalance the strong decrease in neutralizing antibody activities against variants highlighting the need for boosters with specific vaccines.
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Affiliation(s)
- Isabelle Nel
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM U976, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Laurène Dehoux
- Pediatric Nephrology Department, Necker Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marine Minier
- Virology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Charlotte Duneton
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM U976, Paris, France
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marina Charbit
- Pediatric Nephrology Department, Necker Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Philippe Bidet
- Microbiology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Agnès Carol
- Microbiology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elodie Cheyssac
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Daniel Delbet
- Pediatric Nephrology Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Férielle Louillet
- Pediatric Nephrology Department, Charles Nicolle Hospital, Rouen, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Constance Delaugerre
- Virology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Guislaine Carcelain
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM U976, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
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9
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Avramescu M, Lahoche A, Hogan J, Salomon R, Roussey G, Bacchetta J, Decramer S, Ulinski T, Barbe C, Pietrement C. To biopsy or not to biopsy: Henoch-Schönlein nephritis in children, a 5-year follow-up study. Pediatr Nephrol 2022; 37:147-152. [PMID: 34224002 DOI: 10.1007/s00467-021-05086-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/19/2021] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The prognosis of Henoch-Schönlein purpura (HSP), IgA vasculitis, depends on kidney involvement. There is no consensus on the initiation of treatment for HSP nephritis (HSPN). Some centres start treatment before performing a kidney biopsy (KB) while in others, treatment is dictated by the importance of the clinical, biological and histological signs. The aim of this study was to evaluate which of these two approaches is associated with a better kidney outcome at 5-year follow-up. METHODS This multicentre, retrospective, nonrandomised study included children treated for HSPN between 2006 and 2010 in a French paediatric nephrology unit. One group had an early KB at diagnosis (before starting treatment or in the 15 following days). In the second group, initial treatment was decided without performing a KB. RESULTS Among the 107 children included, 63.5% had an early KB at diagnosis. Follow-up at 5 years was completed in 44 children (28 KB at diagnosis, 16 no KB at diagnosis). Median urine protein/creatinine at 5 years was 2.5 mg/mmol in the early biopsy diagnosis group and 12.5 mg/mmol in the non-biopsy group. An antiproteinuric treatment was given, at 5 years, to 35.7% of the early biopsy at diagnosis children and in 62.5% of the non-biopsied children. CONCLUSIONS Children with early KB at diagnosis seem to have a better renal outcome at 5 years compared to those without an early biopsy at diagnosis or biopsied later. However, this is a small patient cohort and data are missing. Further work is needed to build consensual guidelines on the management of HSPN in children.
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Affiliation(s)
- Marina Avramescu
- Service de Néphrologie Pédiatrique, AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Annie Lahoche
- Service de Néphrologie Pédiatrique, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Julien Hogan
- Service de Néphrologie Pédiatrique, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Rémi Salomon
- Service de Néphrologie Pédiatrique, AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Gwenaëlle Roussey
- Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Justine Bacchetta
- Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfants, Bron, Lyon, France
| | - Stéphane Decramer
- Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Tim Ulinski
- Service de Néphrologie Pédiatrique, AP-HP, Hôpital Universitaire Armand Trousseau, Paris, France
| | - Coralie Barbe
- Néphrologie Pédiatrique, CHU Reims, 45 rue Cognacq Jay, 51092, Reims CEDEX, France.,Centre de recherche et d'investigation clinique, CHU Reims, Reims, France
| | - Christine Pietrement
- Néphrologie Pédiatrique, CHU Reims, 45 rue Cognacq Jay, 51092, Reims CEDEX, France.
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10
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Mouche A, Parmentier C, Herbez Rea C, Kwon T, Boyer O, Delbet JD, Ulinski T. Procalcitonin serum levels in stage 5 chronic kidney disease children on hemodialysis. Pediatr Nephrol 2021; 36:2405-2409. [PMID: 33730285 DOI: 10.1007/s00467-021-04966-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/10/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infections are responsible for morbidity and mortality in children on hemodialysis (HD). Procalcitonin (PCT) is rarely used in this population, even though it is an efficient biomarker of infection and sepsis. Our aim was to study PCT baseline level in uninfected children with stage 5 chronic kidney disease (CKD 5) on HD, and determine how to use it in this population. METHODS Prospective observational study including 40 uninfected children on classical HD or hemodiafiltration (HDF) in three pediatric HD centers in the Paris region. PCT was monitored before and after three consecutive sessions within 1 week. RESULTS Median pre-dialysis PCT was 0.60 ng/mL [0.36-1.15], median post-dialysis PCT was 0.23 ng/mL [0.10-0.47], PCT reduction rate was 59.8% [37.5-75.8]. Seventy percent of pre-dialysis PCT were <1 ng/mL. Anuric patients had higher pre-dialysis PCT than those with residual urine output (0.70 [0.42-1.30] vs. 0.48 [0.30-0.93] ng/mL, p=0.01). HDF was more efficient than HD to clear PCT during sessions (reduction rate 75% [67-80] vs. 37 [31-50]), p<0.001). CONCLUSION PCT levels in pediatric HD patients without infection are higher than normal, but this increase is relatively moderate compared to massive increases of PCT in children with bacterial infections on HD. If PCT is measured after dialysis sessions, the specific technique-dependent reduction rates should be taken into consideration. Moderately increased PCT levels around 2 ng/ml should be interpreted with caution; however, higher PCT serum levels can be used to motivate rapid start of antibiotic treatment in pediatric HD patients.
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Affiliation(s)
- Antoine Mouche
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Claire Herbez Rea
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Thérèsa Kwon
- Pediatric Nephrology Unit, Robert Debré Hospital, APHP, Paris, France
| | - Olivia Boyer
- Pediatric Nephrology Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Jean Daniel Delbet
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France. .,Sorbonne Université, Paris, France.
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11
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Saïdi M, Brochériou I, Estève E, Tuffet S, Amoura Z, Miyara M, Belenfant X, Ulinski T, Rouvier P, Debiec H, Ronco P, Buob D. The Exostosin Immunohistochemical Status Differentiates Lupus Membranous Nephropathy Subsets With Different Outcomes. Kidney Int Rep 2021; 6:1977-1980. [PMID: 34307993 PMCID: PMC8258496 DOI: 10.1016/j.ekir.2021.04.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Michèle Saïdi
- Service d’Anatomie et Cytologie Pathologiques, Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
- UMRS 1155, Institut National de la Santé et de la Recherche Médicale, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Isabelle Brochériou
- UMRS 1155, Institut National de la Santé et de la Recherche Médicale, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d’Anatomie et Cytologie Pathologiques, La Pitié Salpêtrière, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuel Estève
- UMRS 1155, Institut National de la Santé et de la Recherche Médicale, Hôpital Tenon, Sorbonne Université, Paris, France
- Service de Néphrologie et Dialyses, Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Sophie Tuffet
- Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l’Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Maladies Autoimmunes et Systémiques, La Pitié Salpêtrière, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Makoto Miyara
- Service de Médecine Interne 2, Maladies Autoimmunes et Systémiques, La Pitié Salpêtrière, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Xavier Belenfant
- Service de Néphrologie-Dialyse, GHT Grand Paris Nord Est, Hôpital André Grégoire, Montreuil sous Bois, France
| | - Tim Ulinski
- Service de Néphrologie Pédiatrique, Hôpital Trousseau, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Philippe Rouvier
- Service d’Anatomie et Cytologie Pathologiques, La Pitié Salpêtrière, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Hanna Debiec
- UMRS 1155, Institut National de la Santé et de la Recherche Médicale, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Pierre Ronco
- UMRS 1155, Institut National de la Santé et de la Recherche Médicale, Hôpital Tenon, Sorbonne Université, Paris, France
| | - David Buob
- Service d’Anatomie et Cytologie Pathologiques, Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Paris, France
- UMRS 1155, Institut National de la Santé et de la Recherche Médicale, Hôpital Tenon, Sorbonne Université, Paris, France
- Correspondence: David Buob, Service d’Anatomie et Cytologie Pathologiques, Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, 4, rue de la Chine, 75970 Paris Cedex 20, France.
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12
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Cambier A, Robert T, Hogan J, Rabant M, Peuchmaur M, Boyer O, Ulinski T, Monteiro RC, Mesnard L. Rare Collagenous Heterozygote Variants in Children With IgA Nephropathy. Kidney Int Rep 2021; 6:1326-1335. [PMID: 34013111 PMCID: PMC8116726 DOI: 10.1016/j.ekir.2021.02.022] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Childhood IgA nephropathy (cIgAN) is a primary glomerulonephritis clinically characterized by microscopic hematuria and proteinuria, the presence of which may potentially overlap with Alport syndrome. Interestingly, earlier studies suggested that familial IgAN could be linked to the chromosome 2q36 region, also the coding region for collagen type 4 alpha 3/4 (COL4A3/A4). Methods To investigate a possible relationship or phenocopy between Alport syndrome and cIgAN, COL4A3, COL4A4, and COL4A5 exons were sequenced in 36 cIgAN patients. Clinical data and treatment were collected retrospectively. COL4A3/A4/A5 variants were classified according to American College of Medical Genetics and the Association for Molecular Pathology (ACMG/AMP) guidelines. Results Four of 36 cIgAN patients were affected by ACMG class 4/5 COL4A3 heterozygous variants (COL4A3-cIgAN). We found no COL4A4 or COL4A5 variant. Despite having rare and deleterious COL4A3 variants, 3 of 4 COL4A3-cIgAN children developed clinical and biologic features of active IgAN rather than Alport syndrome. Response to intensive immunosuppressive treatment was favorable, leading to a reduction of endocapillary and extracapillary proliferation lesions. High levels of immune immunoglobulin G and A (IgG/IgA) complexes, reduction of proteinuria, and gradual stabilization of estimated glomerular filtration rate (eGFR) argued against Alport syndrome. Nevertheless, COL4A3-cIgAN patients seemed predisposed to a more serious IgAN presentation compared with the non‒COL4A3-cIgAN group, with more glomerulosclerosis and a lower eGFR over time. One of the 4 patients underwent kidney transplant with subsequent IgAN recurrence. Conclusions Predisposition factors for developing serious cIgAN flare-up should be considered for cIgAN with COL4A3 pathologic heterozygous variants. COL4A3 variants, usually responsible for Alport syndrome in adults, should not automatically exclude an immunosuppressive regimen in cIgAN. Moreover, evidence of an ACMG class 4/5 COL4A3 variant in early-stage cIgAN could be a helpful tool for stratifying severity of cIgAN beyond the Oxford classification.
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Affiliation(s)
- Alexandra Cambier
- Service de néphrologie pédiatrique, APHP, Hôpital Universitaire Robert-Debré, Paris, France.,Université de Paris, Paris, France; INSERM U1149; CNRS ERL8252; Centre de recherche sur l'inflammation; Inflamex Laboratory of Excellence, Paris, France.,Inserm UMR_S1155, Paris, France.,Sorbonne Université, Paris, France.,Néphrologie pédiatrique, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Thomas Robert
- Centre de néphrologie et transplantation rénale, APHM, Hôpital Universitaire de la Conception, Marseille, France.,Aix Marseille Université, Inserm, MMG, Bioinformatic et genetics.UMRS_1251, Paris, France
| | - Julien Hogan
- Service de néphrologie pédiatrique, APHP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Marion Rabant
- Service de Pathologie, Hôpital Universitaire Hôpital Necker, APHP, Paris, France
| | - Michel Peuchmaur
- Service de Pathologie, Hôpital Universitaire Robert Debré APHP, Paris et Université Diderot, Paris, France
| | - Olivia Boyer
- Service de néphrologie pédiatrique, APHP, Hôpital Universitaire Necker, Paris, France
| | - Tim Ulinski
- Service de néphrologie pédiatrique, APHP, Hôpital Trousseau, Paris, France
| | - Renato C Monteiro
- Université de Paris, Paris, France; INSERM U1149; CNRS ERL8252; Centre de recherche sur l'inflammation; Inflamex Laboratory of Excellence, Paris, France
| | - Laurent Mesnard
- Inserm UMR_S1155, Paris, France.,Sorbonne Université, Paris, France.,Service des urgences néphrologiques et transplantation rénales, APHP, Hôpital Tenon, Paris, France.,Institut des Sciences du Calcul et des Données, Sorbonne Université, Paris, France
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13
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Sanjad SA, Ulinski T, Aoun B. Editorial: Nephrotic Syndrome in Children. Front Pediatr 2021; 9:803923. [PMID: 34900881 PMCID: PMC8651990 DOI: 10.3389/fped.2021.803923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sami A Sanjad
- Department of Pediatrics/Nephrology, American University of Beirut Med Center, Beirut, Lebanon
| | - Tim Ulinski
- Department of Pediatric Nephrology, Armand Trousseau Hospital, Paris, France
| | - Bilal Aoun
- Department of Pediatrics/Nephrology, American University of Beirut Med Center, Beirut, Lebanon
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14
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Mrad C, Coulomb-Lhermine A, Tabone MD, Ulinski T, Audry G, Irtan S. Evaluation of the nephron-sparing surgery formula in Wilms tumors. Pediatr Blood Cancer 2020; 67:e28661. [PMID: 32808461 DOI: 10.1002/pbc.28661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/11/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 01/30/2023]
Abstract
AIM Definitions of nephron-sparing surgery (NSS) procedures in Wilms tumor (WT) are not clear. The new UMBRELLA protocol offers a formula (NSS(X)-SRM(n)-PRM(n)-RRP(n%)) to better define the different NSS parameters. We aimed to assess the advantages and limits of this new formula. METHODS This retrospective monocentric study included patients operated by NSS for WT from 1975 to 2018. We reviewed the medical records and applied the NSS formula to all included patients. RESULTS Eighty kidneys were operated on 56 patients at a mean age of 19.2 months (4 days-7.5 years), with 49 partial nephrectomies and 31 tumorectomies. The assessment of the surgical resection margins (SRM) showed a doubt in six cases and one tumor breach. An intact pseudocapsule along the resection margin with no renal parenchyma was found in four cases at pathological resection margins (PRM) assessment, whereas a tumor breach was described in seven cases. Among the six patients with a surgical doubt, only one had a pathological stage III. There were no surgical doubts in the seven patients with tumor breach at pathology. At a mean follow-up of eight years (15 days-28.6 years), eight patients had elevated blood pressure levels. Ten had proteinuria. These two parameters were significantly increased in patients with a remaining renal parenchyma (RRP) of less than half of the initial total renal parenchyma. The serum creatinine level was normal for all except two patients. CONCLUSION The new NSS formula described all the crucial elements of NSS. RRP seemed essential for the evaluation of long-term renal function.
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Affiliation(s)
- Chaima Mrad
- Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Aurore Coulomb-Lhermine
- Pathology Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie-Dominique Tabone
- Pediatric Oncology Department, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Georges Audry
- Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sabine Irtan
- Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
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15
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Hogan J, Perez A, Sellier-Leclerc AL, Vrillon I, Broux F, Nobili F, Harambat J, Bessenay L, Audard V, Faudeux C, Morin D, Pietrement C, Tellier S, Djeddi D, Eckart P, Lahoche A, Roussey-Kesler G, Ulinski T, Boyer O, Plaisier E, Cloarec S, Jolivot A, Guigonis V, Guilmin-Crepon S, Baudouin V, Dossier C, Deschênes G. Efficacy and safety of intravenous immunoglobulin with rituximab versus rituximab alone in childhood-onset steroid-dependent and frequently relapsing nephrotic syndrome: protocol for a multicentre randomised controlled trial. BMJ Open 2020; 10:e037306. [PMID: 32967877 PMCID: PMC7513594 DOI: 10.1136/bmjopen-2020-037306] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Guidelines for the treatment of steroid-dependent nephrotic syndrome (SDNS) and frequently relapsing nephrotic syndrome (FRNS) are lacking. Given the substantial impact of SDNS/FRNS on quality of life, strategies aiming to provide long-term remission while minimising treatment side effects are needed. Several studies confirm that rituximab is effective in preventing early relapses in SDNS/FRNS; however, the long-term relapse rate remains high (~70% at 2 years). This trial will assess the association of intravenous immunoglobulins (IVIgs) to rituximab in patients with SDNS/FRNS and inform clinicians on whether IVIg's immunomodulatory properties can alter the course of the disease and reduce the use of immunosuppressive drugs and their side effects. METHODS AND ANALYSIS We conduct an open-label multicentre, randomised, parallel group in a 1:1 ratio, controlled, superiority trial to assess the safety and efficacy of a single infusion of rituximab followed by IVIg compared with rituximab alone in childhood-onset FRNS/SDNS. The primary outcome is the occurrence of first relapse within 24 months. Patients are allocated to receive either rituximab alone (375 mg/m²) or rituximab followed by IVIg, which includes an initial Ig dose of 2 g/kg, followed by 1.5 g/kg injections once a month for the following 5 months (maximum dose: 100 g). ETHICS AND DISSEMINATION The study has been approved by the ethics committee (Comité de Protection des Personnes) of Ouest I and authorised by the French drug regulatory agency (Agence Nationale de Sécurité du Médicament et des Produits de Santé). Results of the primary study and the secondary aims will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03560011.
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Affiliation(s)
- Julien Hogan
- Department of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Aubriana Perez
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | | | - Isabelle Vrillon
- Department of Pediatric Nephrology, Hopital Brabois enfants, Vandoeuvre-les-Nancy, France
| | - Francoise Broux
- Department of Pediatric Nephrology, University Hospital Centre Rouen, Rouen, France
| | - Francois Nobili
- Department of Pediatric Nephrology, University Hospital Centre Besancon, Besancon, France
| | - Jerome Harambat
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Lucie Bessenay
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - V Audard
- Department of Nephrology and Transplantation, Henri Mondor Hospital, APHP, Université Paris-Est, Créteil, France
| | - Camille Faudeux
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Denis Morin
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Christine Pietrement
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Reims Hôpital d'enfants, Reims, France
| | - Stephanie Tellier
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Djamal Djeddi
- Department of Paediatrics, Amiens University Hospital and University of Amiens, Amiens, France
| | - Philippe Eckart
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Annie Lahoche
- Department of Pediatric Nephrology, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - G Roussey-Kesler
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Hopital Trousseau la Roche-Guyon, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hopital Necker-Enfants Malades, Paris, France
| | | | - Sylvie Cloarec
- Department of Pediatric Nephrology, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Anne Jolivot
- Department of Nephrology, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Vincent Guigonis
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | - Veronique Baudouin
- Department of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
| | - Claire Dossier
- Department of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
| | - Georges Deschênes
- Department of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
- Université Sorbonne Paris Cité, Paris, France
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16
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Delbet JD, Parmentier C, Ulinski T. Tolvaptan therapy to treat severe hyponatremia in pediatric nephrotic syndrome. Pediatr Nephrol 2020; 35:1347-1350. [PMID: 32232633 DOI: 10.1007/s00467-020-04530-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/09/2020] [Revised: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tolvaptan is a selective oral vasopressin V2-receptor antagonist. Some data have implicated stimulation of arginine vasopressin (AVP) as an important factor in oedema formation in a rodent model of nephrotic syndrome (NS) and adult NS patients. We report case of pediatric NS with severe hyponatremia efficiently treated by tolvaptan. CASE/DIAGNOSIS - TREATMENT A 22-month-old girl presented first with NS. She remained nephrotic after a 30-day course of oral steroids. Tacrolimus was inefficient and there was no response to plasma exchanges (15 sessions on a daily basis). She had severe oedema and ascites. Thus, in addition to immunosuppressive therapy, she received diuretics, furosemide 5 mg/kg/day, and amiloride 1 mg/kg/day, and required water restriction. She was hypertensive and was treated with a full dose of calcium inhibitor (amlodipine 0.5 mg/kg/day). After2 months of treatment, serum sodium reached 116 mmol/L and urinary osmolarity 547 mosmol/L, suggesting an inappropriate AVP secretion. Tolvaptan was introduced at 0.3 mg/kg/day and progressively increased to 3 mg/kg/day on day 4, leading to a partial correction of serum sodium (130 mmol/l) and a urinary osmolarity decrease to 90 mosmol/L. Tolvaptan was then continued at the dose of 3 mg/kg/day with unchanged serum sodium, without hypernatremia or dehydration. Her weight decreased from 14.8 k to 14 k, but oedema still persisted. CONCLUSION Tolvaptan was very efficient in this case of hyponatremia associated with steroid-resistant NS. Tolvaptan should be considered in the management of therapy-resistant hyponatremia in patients with NS.
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Affiliation(s)
- Jean-Daniel Delbet
- Pediatric Nephrology Unit, Trousseau Hospital, APHP.6, DMU Origyne, Paris, France. .,Sorbonne Université, Paris, France. .,Department of Pediatric Nephrology, Armand Trousseau Hospital, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France.
| | - Cyrielle Parmentier
- Pediatric Nephrology Unit, Trousseau Hospital, APHP.6, DMU Origyne, Paris, France.,Sorbonne Université, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Unit, Trousseau Hospital, APHP.6, DMU Origyne, Paris, France.,Sorbonne Université, Paris, France
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17
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Parmentier C, Delbet JD, Decramer S, Boyer O, Hogan J, Ulinski T. Immunoglobulin serum levels in rituximab-treated patients with steroid-dependent nephrotic syndrome. Pediatr Nephrol 2020; 35:455-462. [PMID: 31705306 DOI: 10.1007/s00467-019-04398-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rituximab (RTX) is efficient in steroid-dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment. METHODS All pediatric patients (< 18 years old) of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during, and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < - 2 standard deviations for patient age. RESULTS A total of 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range [IQ 2.24-5.45] years and age at RTX introduction was 11.7 [IQ 8.6-14.2] years. Twenty-one patients had hypogammaglobulinemia before the initiation of RTX. Of the patients, 25/86 had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG levels at initiation were normal with a persisting hypogammaglobulinemia for 13 patients 1 year after B cell recovery. Patients who developed hypogammaglobulinemia were younger at RTX initiation with a median age of 8.2 years [IQ 6.3-12.4]. Among all the 46 patients with hypogammaglobulinemia during follow-up, 13 had a concomitant infection. CONCLUSIONS Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children has to be carefully evaluated and their clinical and biological follow-up should be adapted to the age-dependent risk profile for hypogammaglobulinemia.
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Affiliation(s)
- Cyrielle Parmentier
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France
- Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy, DHU i2b, Paris, France
| | - Jean-Daniel Delbet
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France
- Inflammation-Immunopathology-Biotherapy, DHU i2b, Paris, France
| | | | - Olivia Boyer
- Pediatric Nephrology Unit, Necker Hospital, APHP, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Unit, Robert-Debré Hospital, APHP, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France.
- Sorbonne University, Paris, France.
- Inflammation-Immunopathology-Biotherapy, DHU i2b, Paris, France.
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18
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Chauvet S, Berthaud R, Devriese M, Mignotet M, Vieira Martins P, Robe-Rybkine T, Miteva MA, Gyulkhandanyan A, Ryckewaert A, Louillet F, Merieau E, Mestrallet G, Rousset-Rouvière C, Thervet E, Hogan J, Ulinski T, Villoutreix BO, Roumenina L, Boyer O, Frémeaux-Bacchi V. Anti-Factor B Antibodies and Acute Postinfectious GN in Children. J Am Soc Nephrol 2020; 31:829-840. [PMID: 32034108 DOI: 10.1681/asn.2019080851] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 08/28/2019] [Accepted: 12/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The pathophysiology of the leading cause of pediatric acute nephritis, acute postinfectious GN, including mechanisms of the pathognomonic transient complement activation, remains uncertain. It shares clinicopathologic features with C3 glomerulopathy, a complement-mediated glomerulopathy that, unlike acute postinfectious GN, has a poor prognosis. METHODS This retrospective study investigated mechanisms of complement activation in 34 children with acute postinfectious GN and low C3 level at onset. We screened a panel of anticomplement protein autoantibodies, carried out related functional characterization, and compared results with those of 60 children from the National French Registry who had C3 glomerulopathy and persistent hypocomplementemia. RESULTS All children with acute postinfectious GN had activation of the alternative pathway of the complement system. At onset, autoantibodies targeting factor B (a component of the alternative pathway C3 convertase) were found in a significantly higher proportion of children with the disorder versus children with hypocomplementemic C3 glomerulopathy (31 of 34 [91%] versus 4 of 28 [14%], respectively). In acute postinfectious GN, anti-factor B autoantibodies were transient and correlated with plasma C3 and soluble C5b-9 levels. We demonstrated that anti-factor B antibodies enhance alternative pathway convertase activity in vitro, confirming their pathogenic effect. We also identified crucial antibody binding sites on factor B, including one correlated to disease severity. CONCLUSIONS These findings elucidate the pathophysiologic mechanisms underlying acute postinfectious GN by identifying anti-factor B autoantibodies as contributing factors in alternative complement pathway activation. At onset of a nephritic syndrome with low C3 level, screening for anti-factor B antibodies might help guide indications for kidney biopsy to avoid misdiagnosed chronic glomerulopathy, such as C3 glomerulopathy, and to help determine therapy.
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Affiliation(s)
- Sophie Chauvet
- Inflammation, Complement and Cancer Team, Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) S1138, Paris, France.,Departments of Nephrology and.,Paris University, Paris, France
| | - Romain Berthaud
- Paris University, Paris, France.,Department of Pediatric Nephrology, AP-HP, Necker Hospital - Sick Children, Paris, France
| | - Magali Devriese
- Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France
| | - Morgane Mignotet
- Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France
| | - Paula Vieira Martins
- Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France
| | - Tania Robe-Rybkine
- Inflammation, Complement and Cancer Team, Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) S1138, Paris, France
| | - Maria A Miteva
- Paris University, Paris, France.,INSERM U1268 Medicinal Chemistry and Translational Research, Cibles Thérapeutiques et Conception du Médicament UMR8038 Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Aram Gyulkhandanyan
- University of Paris Diderot, Sorbonne Paris Cité, Molécules Thérapeutiques In Silico, INSERM UMR S973, Paris, France
| | | | | | - Elodie Merieau
- Department of Pediatric Nephrology, Tours Hospital, Tours, France
| | - Guillaume Mestrallet
- Department of Pediatry, Villefranche sur Soane Hospital, Villefranche sur Soane, France
| | | | - Eric Thervet
- Departments of Nephrology and.,Paris University, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology, AP-HP, Robert Debré Hospital, Paris, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, AP-HP, Trousseau Hospital, Paris, France
| | - Bruno O Villoutreix
- Paris University, Paris, France.,Laboratory of cristallography and biological Nuclear magnetic resonance, UMR 8015 CNRS, Paris, France; and
| | - Lubka Roumenina
- Inflammation, Complement and Cancer Team, Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) S1138, Paris, France
| | - Olivia Boyer
- Paris University, Paris, France.,Department of Pediatric Nephrology, AP-HP, Necker Hospital - Sick Children, Paris, France.,Reference Center for Hereditary Kidney and Childhood Diseases (MARHEA), Imagine Institute, Paris, France
| | - Véronique Frémeaux-Bacchi
- Inflammation, Complement and Cancer Team, Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) S1138, Paris, France; .,Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France.,Paris University, Paris, France
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19
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Delbet JD, Geslain G, Auger M, Hogan J, Salomon R, Peuchmaur M, Deschênes G, Buob D, Parmentier C, Ulinski T. Histological prognostic factors in children with Henoch-Schönlein purpura nephritis. Pediatr Nephrol 2020; 35:313-320. [PMID: 31696358 DOI: 10.1007/s00467-019-04363-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/28/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The management of IgA vasculitis with nephritis (IgAVN) remains controversial because of the difficulty to identify prognostic factors. This study reports the prognosis of children with IgAVN in relation to histological parameters. METHODS All children with IgAVN diagnosed between 2000 and 2015 in three pediatric nephrology centers were included. The following histological parameters were analyzed: mesangial proliferation (MP), endocapillary proliferation (EP), crescents, active, or chronic tubular and interstitial lesions (TIa lesions/TIc lesions), and segmental glomerulosclerosis (GS). Clinical and biological data were collected at the time of renal biopsy. The primary endpoint was IgAVN remission defined as a proteinuria < 200 mg/l without renal failure. RESULTS One hundred fifty-nine children were included with a median age of 7.6 years. Acute glomerular or TI lesions including MP, EP, crescents, and TIa lesions were observed, respectively, in 81%, 86%, 49%, and 21% of patients. Chronic glomerular lesions including GS and TIc lesions were observed in 6 and 7% of patients. Median initial proteinuria was 330 mg/mmol, albuminemia 32 g/l, and eGFR 110 ml/min/1.73 m2. One hundred twelve (70%) patients were in remission at the end of a median follow-up of 37.4 months. Chronic lesions were significantly associated with the absence of remission in multivariate analysis, whereas EP, crescents and TIa were not associated with a poor prognosis. CONCLUSIONS Of children with IgAVN, 30% present a persistent renal disease at the end of a 3-year follow-up. Chronic histological lesions, but not EP or crescents, are associated with a bad prognosis and must be evaluated in IgAVN histological classification.
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Affiliation(s)
- Jean-Daniel Delbet
- Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. .,Sorbonne Université, Paris 6, Paris, France.
| | - Guillaume Geslain
- Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Martin Auger
- Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Julien Hogan
- Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France.,University Paris Diderot, Paris 7, Paris, France
| | - Rémi Salomon
- Pediatric Nephrology, Necker Enfants Malades, APHP, Paris, France
| | - Michel Peuchmaur
- Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France.,University Paris Diderot, Paris 7, Paris, France
| | - David Buob
- Pathology Department, Tenon Hospital, APHP, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France.,Sorbonne Université, Paris 6, Paris, France
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20
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Roussel A, Delbet J, Micheland L, Deschênes G, Decramer S, Ulinski T. Quality of life in children with severe forms of idiopathic nephrotic syndrome in stable remission-A cross-sectional study. Acta Paediatr 2019; 108:2267-2273. [PMID: 31240744 DOI: 10.1111/apa.14912] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/11/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
AIM Severe forms of idiopathic nephrotic syndrome (INS) require immunosuppressive therapy: oral treatment or intravenous therapy (rituximab, RTX). The main objective was to describe quality of life (QOL) in these specific patients. METHODS Cross-sectional, multicentre, observational study analysed QOL using a standardised questionnaire in children from 7 to 17 years, with a steroid-dependent or steroid-resistant INS in stable remission. The questionnaire consisted of 30 questions concerning physical and emotional well-being, self-esteem, family, friends, school and disease resulting in a global score of 0-100. RESULTS A total of 110 patients with a mean age of 11.6 years from three French paediatric nephrology centres were included. A total of 71 patients had oral immunosuppressive treatment, 27 had RTX, and 12 had both. 13.6% of patients had a steroid-resistant INS. The mean number of relapses was 5.8. Seventy-eight patients answered the questionnaire. The global score in the whole study population was 74.7; 72.6 in the RTX group, 76.2 in the oral drugs group, (P = 0.49). The results of sub-dimension 'school' were statistically lower in RTX group (61.6 ± 19.5) compared with oral drugs group (71.4 ± 16; P = 0.02). CONCLUSION Global QOL score was high in 'difficult-to-treat' patients with INS in stable remission on oral immunosuppressive or RTX treatment.
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Affiliation(s)
- Aphaia Roussel
- Service de Néphrologie et Dialyse Pédiatrique Hôpital Trousseau, APHP.6, and DHU i2b Paris France
| | - Jean‐Daniel Delbet
- Service de Néphrologie et Dialyse Pédiatrique Hôpital Trousseau, APHP.6, and DHU i2b Paris France
| | | | - Georges Deschênes
- Service de Néphrologie Pédiatrique Hôpital Robert Debré, AP‐HP Paris France
| | | | - Tim Ulinski
- Service de Néphrologie et Dialyse Pédiatrique Hôpital Trousseau, APHP.6, and DHU i2b Paris France
- Sorbonne Université Paris France
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21
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Ulinski T, Delbet JD. Response to "Predictors of rituximab-related neutropenia in Japanese children with steroid-dependent nephrotic syndrome". Pediatr Nephrol 2019; 34:1305-1306. [PMID: 30915547 DOI: 10.1007/s00467-019-04239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Tim Ulinski
- Department of Pediatric Nephrology, Armand-Trousseau Hospital, APHP, 26, Avenue du Docteur Arnold Netter, 75012, Paris, France. .,University Pierre and Marie Curie, Paris 6, 26, Avenue du Docteur Arnold Netter, 75012, Paris, France.
| | - Jean Daniel Delbet
- Department of Pediatric Nephrology, Armand-Trousseau Hospital, APHP, 26, Avenue du Docteur Arnold Netter, 75012, Paris, France
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22
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Frémeaux-Bacchi V, Sellier-Leclerc AL, Vieira-Martins P, Limou S, Kwon T, Lahoche A, Novo R, Llanas B, Nobili F, Roussey G, Cailliez M, Ulinski T, Deschênes G, Alberti C, Weill FX, Mariani P, Loirat C. Complement Gene Variants and Shiga Toxin-Producing Escherichia coli-Associated Hemolytic Uremic Syndrome: Retrospective Genetic and Clinical Study. Clin J Am Soc Nephrol 2019; 14:364-377. [PMID: 30674459 PMCID: PMC6419292 DOI: 10.2215/cjn.05830518] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 05/08/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Inherited complement hyperactivation is critical for the pathogenesis of atypical hemolytic uremic syndrome (HUS) but undetermined in postdiarrheal HUS. Our aim was to investigate complement activation and variants of complement genes, and their association with disease severity in children with Shiga toxin-associated HUS. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Determination of complement biomarkers levels and next-generation sequencing for the six susceptibility genes for atypical HUS were performed in 108 children with a clinical diagnosis of post-diarrheal HUS (75 Shiga toxin-positive, and 33 Shiga toxin-negative) and 80 French controls. As an independent control cohort, we analyzed the genotypes in 503 European individuals from the 1000 Genomes Project. RESULTS During the acute phase of HUS, plasma levels of C3 and sC5b-9 were increased, and half of patients had decreased membrane cofactor protein expression, which normalized after 2 weeks. Variants with minor allele frequency <1% were identified in 12 Shiga toxin-positive patients with HUS (12 out of 75, 16%), including pathogenic variants in four (four out of 75, 5%), with no significant differences compared with Shiga toxin-negative patients with HUS and controls. Pathogenic variants with minor allele frequency <0.1% were found in three Shiga toxin-positive patients with HUS (three out of 75, 4%) versus only four European controls (four out of 503, 0.8%) (odds ratio, 5.2; 95% confidence interval, 1.1 to 24; P=0.03). The genetic background did not significantly affect dialysis requirement, neurologic manifestations, and sC5b-9 level during the acute phase, and incident CKD during follow-up. However, the only patient who progressed to ESKD within 3 years carried a factor H pathogenic variant. CONCLUSIONS Rare variants and complement activation biomarkers were not associated with severity of Shiga toxin-associated HUS. Only pathogenic variants with minor allele frequency <0.1% are more frequent in Shiga toxin-positive patients with HUS than in controls.
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Affiliation(s)
- Véronique Frémeaux-Bacchi
- Service d’Immunologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Team “Complement and Disease,” Centre de recherche des Cordeliers, Sorbonne Université, INSERM, Paris, France
| | | | - Paula Vieira-Martins
- Service d’Immunologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Limou
- Institute for Transplantation in Urology and Nephrology, Centre Hospitalo-Universitaire de Nantes, Centre de Recherche en Transplantation et Immunologie, Institut National de la Santé et de la Recherche Médicale U1064, Université de Nantes, Ecole Centrale de Nantes, Nantes, France
| | | | - Annie Lahoche
- Pediatric Nephrology Department, Hôpital Jeanne de Flandre, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Robert Novo
- Pediatric Nephrology Department, Hôpital Jeanne de Flandre, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Brigitte Llanas
- Pediatric Nephrology Department, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - François Nobili
- Pediatric Nephrology Department, Centre Hospitalo-Universitaire de Besançon, Besançon, France
| | - Gwenaëlle Roussey
- Pediatric Nephrology Department, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Mathilde Cailliez
- Pediatric Nephrology Department, Centre Hospitalo-Universitaire de Marseille, Marseille, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Hôpital Trousseau, University Pierre and Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France; and
| | | | - Corinne Alberti
- Unit of Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale U1123 and Centre d'Investigation Clinique-Epidémiologie Clinique 1426, and
| | - François-Xavier Weill
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Référence des Escherichia coli, Shigella et Salmonella, Paris, France
| | - Patricia Mariani
- Laboratory of Microbiology, Escherichia coli Associated National Reference Center, Hôpital Robert Debré, University Paris Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
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23
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Delbet JD, Leclerc G, Ulinski T. Idiopathic nephrotic syndrome and rituximab: may we predict circulating B lymphocytes recovery? Pediatr Nephrol 2019; 34:529-532. [PMID: 30542932 DOI: 10.1007/s00467-018-4139-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/27/2018] [Revised: 10/12/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rituximab (RTX) has been shown to be an efficient treatment for steroid-dependent nephrotic syndrome (SDNS). A long B cell depletion period seems to improve the duration of remission. This study reports the duration of B cell depletion after each RTX infusion in patients with nephrotic syndrome. METHODS We retrospectively report the data of 22 patients with a diagnosis of a SDNS or steroid-resistant nephrotic syndrome (SRNS) and a treatment with RTX in a single center. B cell depletion duration was compared to the first B cell depletion duration and to the previous B cell depletion duration in each patient. RESULTS Twenty-two patients (5 girls) were included. Seventy-six periods of B cell depletions were compared to the first B cell depletion duration and to the preceding B cell depletion duration in the same patient. Total duration of B cell depletion was 26 (6-66) months. Individual post-RTX infusion B cell depletion duration was 5.1 (1.6-14) months. Median B cell depletion duration following the first RTX cure for children who had received 1 to 2 infusions at first cure was not statistically different of those who had received 3 to 4 infusions (p = 0.18). Comparing the B cell depletion induced by previous RTX courses and the following B cell depletion, 89.5% of patients had a similar duration within an open interval from 2 months. CONCLUSION Once the individual time interval until B cell recovery is determined, monitoring could be individualized by targeting the expected date of B cell recovery or by performing pre-emptive RTX injections.
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Affiliation(s)
- Jean Daniel Delbet
- Pediatric Nephrology, Department of Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France.,University Pierre and Marie Curie, Paris 6, Paris, France
| | - Gael Leclerc
- Pediatric Nephrology, Department of Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology, Department of Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. .,University Pierre and Marie Curie, Paris 6, Paris, France. .,DHU 2iB, Inflammation-Immunotherapy, Paris, France.
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24
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Abstract
BACKGROUND AND OBJECTIVES Immunoglobulin A vasculitis (IgAV) might develop after vaccination. However, this potential relationship is essentially based on case reports, and robust pharmaco-epidemiologic data are scarce. We aimed to investigate the effect of vaccination on short-term risk of IgAV in children. METHODS We enrolled children <18 years old with IgAV seen in 5 pediatric departments from 2011 to 2016. Data on vaccinations administered during the year preceding IgAV onset were collected from immunization records. With a case-crossover method and by using conditional logistic-regression analyses, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by comparing vaccine exposure during the 3-month "index period" immediately preceding IgAV onset to that during 3 consecutive 3-month "control" periods immediately before the index period. Stratifications by season, year of onset, infection history, age, sex, type, or number of vaccines were performed. Sensitivity analyses used 1-, 1.5-, or 2-month index and control periods. RESULTS Among 167 children (mean age: 6.7 years) enrolled, 42 (25%) received ≥1 vaccine during the year before IgAV onset. Fifteen (9%) children were vaccinated during the 3-month index period as compared with 4% to 7% during the 3 control periods. The OR for IgAV occurring within the 3 months after vaccination was 1.6 (95% CI: 0.8-3.0). Analyses of IgAV risk within 1, 1.5, or 2 months of vaccination yielded ORs of 1.4 (95% CI: 0.5-3.5), 1.4 (95% CI: 0.6-3.2), and 1.3 (95% CI: 0.6-2.6), respectively. Stratifications revealed no significant association. CONCLUSIONS Vaccination may not be a major etiological factor of childhood IgAV.
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Affiliation(s)
- Maryam Piram
- University of Paris-Sud, CESP, U1018 Institut National de la Santé et de la Recherche Médicale, Le Kremlin-Bicêtre, France; .,Department of Pediatric Rheumatology, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire de Bicêtre, Centre de Référence des Maladies Auto-Inflammatoires et des amyloses, Le Kremlin-Bicêtre, France
| | - Solange Gonzalez Chiappe
- Department of Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, ECSTRA Team, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, Paris, France
| | - Fouad Madhi
- Department of Pediatrics, Centre Hospitalier Intercommunal Creteil, Créteil, France; and
| | - Tim Ulinski
- Department of Pediatric Nephrology, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire Trousseau, Paris, France
| | - Alfred Mahr
- Department of Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, ECSTRA Team, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, Paris, France
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25
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Aoun B, Alali M, Degheili JA, Sanjad S, Vaquin C, Donadieu J, Ulinski T, Termos S. Distinctive vasculopathy with systemic involvement due to levamisole long-term therapy: a case report. J Med Case Rep 2018; 12:209. [PMID: 30008268 PMCID: PMC6047121 DOI: 10.1186/s13256-018-1728-6] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background Levamisole belongs to the antihelminthic class of drugs that are sometimes administered to patients with frequently relapsing or steroid-dependent nephrotic syndrome, owing to its steroid-sparing effects. Neutropenia and skin lesions, compatible with vasculitis, have been reported as drug complications, but they are rarely associated with any systemic involvement. Case presentation We report a case of a 9-year-old Arab boy with steroid-dependent nephrotic syndrome who was treated with levamisole after his third relapse. The drug was initially well tolerated, but mild isolated neutropenia occurred 6 months after levamisole administration. This was followed by cutaneous vasculitis of both ears and the left cheek. The patient also developed hepatosplenomegaly and anemia. Levamisole was discontinued, and his disease remained in remission. All the systemic manifestations disappeared gradually over the course of 1 month. The patient remained in remission until 1 year after levamisole withdrawal, when clinical nephrosis recurred. Conclusions Despite levamisole’s being a useful drug for maintaining remission in steroid-dependent nephrotic syndrome, patients on long-term levamisole therapy should be monitored closely to prevent serious complications that can easily be resolved by simple drug withdrawal.
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Affiliation(s)
- Bilal Aoun
- Division of Pediatric Nephrology, Department of Pediatrics, American University of Beirut, Beirut, Lebanon
| | - Mohammad Alali
- Hepatobiliary and Transplant Unit, Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sami Sanjad
- Division of Pediatric Nephrology, Department of Pediatrics, American University of Beirut, Beirut, Lebanon
| | - Claudine Vaquin
- Division of Pediatric Dermatology, Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Donadieu
- Division of Pediatric Hematology, Armand Trousseau hospital (APHP), Paris, France
| | - Tim Ulinski
- Division of Pediatric Nephrology, Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Salah Termos
- Hepatobiliary and Transplant Unit, Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait.
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26
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Lancia P, Adam de Beaumais T, Elie V, Garaix F, Fila M, Nobili F, Ranchin B, Testevuide P, Ulinski T, Zhao W, Deschênes G, Jacqz-Aigrain E. Pharmacogenetics of post-transplant diabetes mellitus in children with renal transplantation treated with tacrolimus. Pediatr Nephrol 2018; 33:1045-1055. [PMID: 29399716 DOI: 10.1007/s00467-017-3881-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/07/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post-transplant diabetes mellitus (PTDM) is a major complication of immunosuppressive therapy, with many risk factors reported in adults with renal transplantation. The objective of this study was to investigate potential non-genetic and genetic risk factors of PTDM in children with renal transplantation treated with tacrolimus. METHODS A national database was screened for patients developing PTDM within 4 years following tacrolimus introduction. PTDM was defined as glucose disorder requiring anti-diabetic treatment. PTDM patients were matched to "non-PTDM" control transplanted children according to age, gender, and duration of post-transplant follow-up. Patients were genotyped for six selected genetic variants in POR*28 (rs1057868), PPARa (rs4253728), CYP3A5 (rs776746), VDR (rs2228570 and rs731236), and ABCB1 (rs1045642) genes, implicated in glucose homeostasis and tacrolimus disposition. RESULTS Among the 98 children with renal transplantation enrolled in this multicentre study, 18 developed PTDM. None of the clinical and biological parameters was significant between PTDM and control patients. Homozygous carriers of POR*28 or wild-type ABCB1 (rs1045642) gene variants were more frequent in PTDM than in control patients with differences close to significance (p = 0.114 and p = 0.066 respectively). A genetic score based on these variants demonstrated that POR*28/*28 and ABCB1 CC or CT genotype carriers were at a significantly higher risk of developing PTDM after renal transplantation. CONCLUSION Identification of PTDM risk factors should allow clinicians to allocate the best immunosuppressant for each patient with renal transplantation, and improve care for patients who are at a higher risk.
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Affiliation(s)
- Pauline Lancia
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Tiphaine Adam de Beaumais
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Valéry Elie
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Florentine Garaix
- Department of Pediatric Nephrology, CHU La Timone, APHM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Marc Fila
- Department of Pediatric Nephrology, Arnaud de Villeneuve Hospital, 371 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - François Nobili
- Department of Pediatric Nephrology, Saint Jacques Hospital, 2 Place Saint Jacques, 25000, Besançon, France
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France
| | - Pascale Testevuide
- Department of Pediatric Nephrology, Territorial Hospital Center, Papeete, Polynésie Française, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 rue du Dr Arnold Netter, 75012, Paris, France
| | - Wei Zhao
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France.,Clinical Investigation Center CIC1426, INSERM, Robert Debré Hospital, 48 boulevard Serurier, 75019, Paris, France.,Paris Diderot University Sorbonne Paris Cité, Paris, France
| | - Georges Deschênes
- Department of Pediatric Nephrology, Robert Debré Hospital, APHP, 48 boulevard Serurier, 75019, Paris, France
| | - Evelyne Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France. .,Clinical Investigation Center CIC1426, INSERM, Robert Debré Hospital, 48 boulevard Serurier, 75019, Paris, France. .,Paris Diderot University Sorbonne Paris Cité, Paris, France.
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27
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Delbet JD, Ulinski T. Thrombotic microangiopathy and breastfeeding: where is the link? Answers. Pediatr Nephrol 2018; 33:987-989. [PMID: 28812187 DOI: 10.1007/s00467-017-3762-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jean Daniel Delbet
- Pediatric Nephrology, Armand Trousseau Hospital, Assistance publique-Hôpitaux de Paris, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France.,University Pierre and Marie Curie, Paris 6, Paris, France.,DHU 2iB (Inflammation, Immunotherapy and Biotherapy), UPMC Hospital Pitié-Salpêtrière, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology, Armand Trousseau Hospital, Assistance publique-Hôpitaux de Paris, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. .,University Pierre and Marie Curie, Paris 6, Paris, France. .,DHU 2iB (Inflammation, Immunotherapy and Biotherapy), UPMC Hospital Pitié-Salpêtrière, Paris, France.
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28
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Hogan J, Bacchetta J, Charbit M, Roussey G, Novo R, Tsimaratos M, Terzic J, Ulinski T, Garnier A, Merieau E, Harambat J, Vrillon I, Dunand O, Morin D, Berard E, Nobili F, Couchoud C, Macher MA. Patient and transplant outcome in infants starting renal replacement therapy before 2 years of age. Nephrol Dial Transplant 2018; 33:1459-1465. [DOI: 10.1093/ndt/gfy040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/21/2018] [Indexed: 01/16/2023] Open
Affiliation(s)
- Julien Hogan
- Pediatric Nephrology Department, Robert Debré University Hospital, APHP, Paris, France
- Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Justine Bacchetta
- Pediatric Nephrology Department, HFME, Lyon University Hospital, Bron, France
| | - Marina Charbit
- Pediatric Nephrology Department, Necker University Hospital, APHP, Paris, France
| | - Gwenaelle Roussey
- Pediatric Nephrology Department, Nantes University Hospital, Nantes, France
| | - Robert Novo
- Pediatric Nephrology Department, Jeanne de Flandre University Hospital, Lille, France
| | - Michel Tsimaratos
- Pediatric Nephrology Department, La Timone University Hospital, Marseille, France
| | - Joelle Terzic
- Pediatric Nephrology Department, Hautepierre University Hospital, Strasbourg, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Armand Trousseau University Hospital, APHP, Paris, France
| | - Arnaud Garnier
- Pediatric Nephrology Department, Children University Hospital, Toulouse, France
| | - Elodie Merieau
- Pediatric Nephrology Department, Tours University Hospital, Tours, France
| | - Jérôme Harambat
- Pediatric Nephrology Department, Pellegrin University Hospital, Bordeaux, France
| | - Isabelle Vrillon
- Pediatric Nephrology Department, Nancy University Hospital, Nancy, France
| | - Olivier Dunand
- Pediatric Nephrology Department, Felix Guyon University Hospital, Saint-Denis de la Réunion, France
| | - Denis Morin
- Pediatric Nephrology Department, Montpellier University Hospital, Montpellier, France
| | - Etienne Berard
- Pediatric Nephrology Department, Lenval University Hospital, Nice, France
| | - Francois Nobili
- Pediatric Nephrology Department, Saint Jacques University Hospital, Besançon, France
| | | | - Marie-Alice Macher
- Pediatric Nephrology Department, Robert Debré University Hospital, APHP, Paris, France
- Agence de la Biomédecine, La Plaine Saint-Denis, France
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29
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Dorval G, Gribouval O, Martinez-Barquero V, Machuca E, Tête MJ, Baudouin V, Benoit S, Chabchoub I, Champion G, Chauveau D, Chehade H, Chouchane C, Cloarec S, Cochat P, Dahan K, Dantal J, Delmas Y, Deschênes G, Dolhem P, Durand D, Ekinci Z, El Karoui K, Fischbach M, Grunfeld JP, Guigonis V, Hachicha M, Hogan J, Hourmant M, Hummel A, Kamar N, Krummel T, Lacombe D, Llanas B, Mesnard L, Mohsin N, Niaudet P, Nivet H, Parvex P, Pietrement C, de Pontual L, Noble CP, Ribes D, Ronco P, Rondeau E, Sallee M, Tsimaratos M, Ulinski T, Salomon R, Antignac C, Boyer O. Clinical and genetic heterogeneity in familial steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2018; 33:473-483. [PMID: 29058154 DOI: 10.1007/s00467-017-3819-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 06/25/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Familial steroid-sensitive nephrotic syndrome (SSNS) is a rare condition. The disease pathophysiology remains elusive. However, bi-allelic mutations in the EMP2 gene were identified, and specific variations in HLA-DQA1 were linked to a high risk of developing the disease. METHODS Clinical data were analyzed in 59 SSNS families. EMP2 gene was sequenced in families with a potential autosomal recessive (AR) inheritance. Exome sequencing was performed in a subset of 13 families with potential AR inheritance. Two variations in HLA-DQA1 were genotyped in the whole cohort. RESULTS Transmission was compatible with an AR (n = 33) or autosomal dominant (AD, n = 26) inheritance, assuming that familial SSNS is a monogenic trait. Clinical features did not differ between AR and AD groups. All patients, including primary (n = 7) and secondary steroid resistant nephrotic syndrone (SRNS), (n = 13) were sensitive to additional immunosuppressive therapy. Both HLA-DQA1 variations were found to be highly linked to the disease (OR = 4.34 and OR = 4.89; p < 0.001). Exome sequencing did not reveal any pathogenic mutation, neither did EMP2 sequencing. CONCLUSIONS Taken together, these results highlight the clinical and genetic heterogeneity in familial SSNS. Clinical findings sustain an immune origin in all patients, whatever the initial steroid-sensitivity. The absence of a variant shared by two families and the HLA-DQA1 variation enrichments suggest a complex mode of inheritance.
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Affiliation(s)
- Guillaume Dorval
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France. .,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.
| | - Olivier Gribouval
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Vanesa Martinez-Barquero
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Eduardo Machuca
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France
| | - Marie-Josèphe Tête
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Stéphane Benoit
- Department of Nephrology, University Hospital of Tours, Tours, France
| | - Imen Chabchoub
- Department of Pediatrics, Sfax University, Sfax, Tunisia
| | - Gérard Champion
- Department of Pediatrics, University Hospital of Angers, Angers, France
| | - Dominique Chauveau
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | - Hassib Chehade
- Department of Pediatrics, Division of Pediatric Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chokri Chouchane
- Department of Pediatrics, Monastir University, Monastir, Tunisia
| | - Sylvie Cloarec
- Department of Nephrology, University Hospital of Tours, Tours, France
| | - Pierre Cochat
- Department of Pediatric Nephrology, Claude-Bernard Lyon 1 University, Bron, France
| | - Karin Dahan
- Department of Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Jacques Dantal
- Nephrology and Immunology Department, University Hospital of Nantes, Nantes, France
| | - Yahsou Delmas
- Department of Nephrology, University Hospital of Bordeaux, Bordeaux, France
| | - Georges Deschênes
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Phillippe Dolhem
- Department of Pediatrics, Saint-Quentin Hospital, Saint-Quentin, France
| | - Dominique Durand
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | | | - Khalil El Karoui
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Michel Fischbach
- Nephrology Dialysis Transplantation Children's Unit, University Hospital Hautepierre, Strasbourg, France
| | - Jean-Pierre Grunfeld
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Vincent Guigonis
- Department of Pediatrics, University Hospital of Limoges, Limoges, France
| | | | - Julien Hogan
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France
| | - Maryvonne Hourmant
- Nephrology and Immunology Department, University Hospital of Nantes, Nantes, France
| | - Aurélie Hummel
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | - Thierry Krummel
- Department of Nephrology, University Hospital Hautepierre, Strasbourg, France
| | - Didier Lacombe
- Department of Genetics, University Hospital of Bordeaux, Bordeaux, France
| | - Brigitte Llanas
- Department of Pediatrics, University Hospital of Bordeaux, Bordeaux, France
| | - Laurent Mesnard
- Department of Nephrology and Dialysis, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France.,INSERM, UMR_S 1155, 75020, Paris, France
| | - Nabil Mohsin
- College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Patrick Niaudet
- Department of Pediatric Nephrology, Centre de référence du syndrome néphrotique idiopathique de l'enfant et l'adulte, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France
| | - Hubert Nivet
- Department of Nephrology, University Hospital of Tours, Tours, France
| | - Paloma Parvex
- Department of Pediatrics, Division of Pediatric Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Christine Pietrement
- Departement of Pediatrics, Nephrology Unit, University Hospital of Reims, Reims, France.,Faculty of Medicine, Laboratory of Biochemistry and Molecular Biology, UMR, CNRS/URCA n°7369, University of Champagne-Ardenne, Reims, France
| | - Loic de Pontual
- Department of Pediatrics, Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Claire Pouteil Noble
- Department of Nephrology and Transplantation, University Hospital of Lyon, Lyon, France
| | - David Ribes
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | - Pierre Ronco
- Department of Nephrology and Dialysis, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France.,INSERM, UMR_S 1155, 75020, Paris, France
| | - Eric Rondeau
- Department of Nephrology and Dialysis, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Marion Sallee
- Department of Nephrology and Kidney Transplantation, The Conception Hospital, Marseille, France
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France
| | - Rémi Salomon
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.,Department of Pediatric Nephrology, Centre de référence du syndrome néphrotique idiopathique de l'enfant et l'adulte, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France
| | - Corinne Antignac
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France.,Department of Genetics, Assistance Publique-Hôpitaux de Paris, Necker-Enfants malades Hospital, Paris, France
| | - Olivia Boyer
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.,Department of Pediatric Nephrology, Centre de référence du syndrome néphrotique idiopathique de l'enfant et l'adulte, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France
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Bérody S, Heidet L, Gribouval O, Harambat J, Niaudet P, Baudouin V, Bacchetta J, Boudaillez B, Dehennault M, de Parscau L, Dunand O, Flodrops H, Fila M, Garnier A, Louillet F, Macher MA, May A, Merieau E, Monceaux F, Pietrement C, Rousset-Rouvière C, Roussey G, Taque S, Tenenbaum J, Ulinski T, Vieux R, Zaloszyc A, Morinière V, Salomon R, Boyer O. Treatment and outcome of congenital nephrotic syndrome. Nephrol Dial Transplant 2018; 34:458-467. [DOI: 10.1093/ndt/gfy015] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandra Bérody
- Hôpital Necker-Enfants malades, Néphrologie pédiatrique, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris-Cité, Paris, France
| | - Laurence Heidet
- Hôpital Necker-Enfants malades, Néphrologie pédiatrique, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris-Cité, Paris, France
- Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker-Enfants Malades, Paris, France
- Inserm U1163, Imagine Institute, Paris, France
| | | | - Jérome Harambat
- Centre Hospitalier Universitaire de Bordeaux, Néphrologie pédiatrique, Bordeaux, France
| | - Patrick Niaudet
- Hôpital Necker-Enfants malades, Néphrologie pédiatrique, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris-Cité, Paris, France
- Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker-Enfants Malades, Paris, France
- Inserm U1163, Imagine Institute, Paris, France
| | - Veronique Baudouin
- Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker-Enfants Malades, Paris, France
- Hôpital Universitaire Robert Debré, Néphrologie pédiatrique, Paris, France
| | | | | | | | | | - Olivier Dunand
- CHU Felix Guyon, Pédiatrie, Saint-Denis, La Reunion, France
| | | | - Marc Fila
- Centre Hospitalier Regional Universitaire de Montpellier, Néphrologie pédiatrique, Montpellier, France
| | - Arnaud Garnier
- Centre Hospitalier Universitaire de Toulouse, Néphrologie pédiatrique, Toulouse, France
| | | | - Marie-Alice Macher
- Hôpital Universitaire Robert Debré, Néphrologie pédiatrique, Paris, France
| | - Adrien May
- Centre Hospitalier Sud Francilien, Pédiatrie, Corbeil-Essonnes, France
| | | | | | | | | | - Gwenaëlle Roussey
- Centre Hospitalier Universitaire de Nantes, Néphrologie pédiatrique, Nantes, France
| | - Sophie Taque
- Centre Hospitalier Universitaire de Rennes, Pédiatrie, Rennes, France
| | - Julie Tenenbaum
- Centre Hospitalier Regional Universitaire de Montpellier, Néphrologie pédiatrique, Montpellier, France
| | - Tim Ulinski
- Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker-Enfants Malades, Paris, France
- Hôpital Armand-Trousseau, Néphrologie pédiatrique, Paris, France
| | - Rachel Vieux
- Centre Hospitalier Universitaire de Nancy, Pédiatrie, Nancy, France
| | | | | | - Rémi Salomon
- Hôpital Necker-Enfants malades, Néphrologie pédiatrique, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris-Cité, Paris, France
- Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker-Enfants Malades, Paris, France
- Inserm U1163, Imagine Institute, Paris, France
| | - Olivia Boyer
- Hôpital Necker-Enfants malades, Néphrologie pédiatrique, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris-Cité, Paris, France
- Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker-Enfants Malades, Paris, France
- Inserm U1163, Imagine Institute, Paris, France
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Borocco C, Kone-Paut I, Grateau G, Ulinski T, Belot A, Desjonquères M, Miceli C, Karras A, Moulin B, Boffa J, Buob D, Georgin Lavialle S. Néphropathies non amyloïdes dans les maladies auto-inflammatoires : à propos de 20 cas français. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.349] [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: 11/25/2022]
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Rybak A, Maisin A, Peuchmaur M, Hogan J, Baudouin V, Ulinski T, Deschênes G, Niel O. Cytomegalovirus prophylaxis after kidney transplantation in children: Longer is better. Arch Pediatr 2017. [DOI: 10.1016/j.arcped.2017.10.006] [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: 10/18/2022]
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Reydit M, Salomon R, Macher MA, Ranchin B, Roussey G, Garaix F, Lahoche A, Decramer S, Fila M, Dunand O, Cloarec S, Vrillon I, Zaloszyc A, Ulinski T, Bérard E, Couchoud C, Leffondré K, Harambat J. Pre-emptive kidney transplantation is associated with improved graft survival in children: Data from the French renal replacement therapy registry. Arch Pediatr 2017. [DOI: 10.1016/j.arcped.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Abstract
INTRODUCTION This review focuses on the treatment of urinary tract infections (UTI) in children and in particular its recent changes. Areas covered: Acute pyelonephritis, acute cystitis and asymptomatic bacteriuria or asymptomatic infections have to be clearly distinguished. Prompt treatment is required in pyelonephritis and cystitis, but not in asymptomatic bacteriuria or infection, in order to avoid selection of more virulent strains. This concept should be considered even in immunocompromised or bedridden children. In case of pyelonephritis, there should be no delay in beginning the antibiotic treatment in order to decrease the risk of long term complication, such as renal scars. Predisposing conditions for UTI, such as voiding anomalies and urinary tract malformation should be carefully evaluated. Expert opinion: One major concern is the increasing resistance to 3rd generation cephalosporins. Therefore overconsumption in low-risk settings should be absolutely avoided. The prevalence of infections with E. coli producing extended spectrum ß-lactamase (ESBL) is increasing and pediatricians should be aware about the specific treatment options. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economic factors in different health systems.
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Affiliation(s)
- Jean Daniel Delbet
- a Pediatric Nephrology Unit , Trousseau Hospital and DHU i2B Inflammation-Immunopathology-Biotherapy , Paris , France.,b University Pierre and Marie Curie , Paris , France
| | - Mathie Lorrot
- c General Pediatrics and Infectious Diseases , Armand Trousseau Hospital , Paris , France
| | - Tim Ulinski
- a Pediatric Nephrology Unit , Trousseau Hospital and DHU i2B Inflammation-Immunopathology-Biotherapy , Paris , France.,b University Pierre and Marie Curie , Paris , France
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Delbet JD, Hogan J, Aoun B, Stoica I, Salomon R, Decramer S, Brocheriou I, Deschênes G, Ulinski T. Clinical outcomes in children with Henoch-Schönlein purpura nephritis without crescents. Pediatr Nephrol 2017; 32:1193-1199. [PMID: 28204946 DOI: 10.1007/s00467-017-3604-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Henoch-Schönlein purpura is the most common vasculitis in children. Its long-term prognosis depends on renal involvement. The management of Henoch-Schönlein purpura nephritis (HSPN) remains controversial. This study reports the prognosis of children with HSPN presenting with class 2 International Study of Kidney Disease in Children (ISKDC) nephritis. METHODS All children with HSPN class 2 diagnosed between 1995 and 2015 in four pediatric nephrology centers were included, and clinical and biological data were collected from the medical files. The primary endpoint was proteinuria remission defined as a proteinuria <200 mg/L. RESULTS Ninety-two children were included in the study with a median follow-up of 36 (6-120) months; 28% had nephrotic syndrome, 31% proteinuria >3 g/L, 52% proteinuria between 1 and 3 g/L, and 18% proteinuria <1 g/L. Forty-seven percent of patients received orally treatment with steroids alone, 37% received methylprednisolone pulses followed by steroids orally, 18% received no steroids. Although 85% reached remission during follow-up, 12% did not maintain complete remission over time so that only 75% remained in complete remission by the end of the follow-up. Univariate analysis found a higher likelihood of remission in patients with higher proteinuria at disease onset (p = 0.009). This trend was not found in the multivariate analysis after adjusting for treatments, as patients with higher proteinuria were most often treated with steroids. CONCLUSION Our study shows that one fourth of patients with HSPN class 2 remain proteinuric and thus carry the risk of developing chronic kidney disease over the long term. This finding, together with the better outcome of patients treated with steroids, is in favor of using high-dose steroids orally or IV in these patients.
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Affiliation(s)
- Jean Daniel Delbet
- Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Netter, Paris, 75012, France
- University Pierre and Marie Curie, Paris 6, Paris, France
| | - Julien Hogan
- Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
- University Paris Diderot, Paris 7, Paris, France
| | - Bilal Aoun
- Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Netter, Paris, 75012, France
| | - Iulia Stoica
- Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Netter, Paris, 75012, France
- University Pierre and Marie Curie, Paris 6, Paris, France
| | - Rémi Salomon
- Pediatric Nephrology, Necker Enfants Malades, APHP, Paris, France
| | | | - Isabelle Brocheriou
- University Pierre and Marie Curie, Paris 6, Paris, France
- Pathology Department, Tenon Hospital, APHP, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
- University Paris Diderot, Paris 7, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Netter, Paris, 75012, France.
- University Pierre and Marie Curie, Paris 6, Paris, France.
- DHU i2b, Inflammation-Immunopathology-Biotherapy, Paris, France.
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Marinozzi MC, Roumenina LT, Chauvet S, Hertig A, Bertrand D, Olagne J, Frimat M, Ulinski T, Deschênes G, Burtey S, Delahousse M, Moulin B, Legendre C, Frémeaux-Bacchi V, Le Quintrec M. Anti-Factor B and Anti-C3b Autoantibodies in C3 Glomerulopathy and Ig-Associated Membranoproliferative GN. J Am Soc Nephrol 2017; 28:1603-1613. [PMID: 28096309 DOI: 10.1681/asn.2016030343] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [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: 03/23/2016] [Accepted: 10/26/2016] [Indexed: 12/21/2022] Open
Abstract
In C3 glomerulopathy (C3G), the alternative pathway of complement is frequently overactivated by autoantibodies that stabilize the C3 convertase C3bBb. Anti-C3b and anti-factor B (anti-FB) IgG have been reported in three patients with C3G. We screened a cohort of 141 patients with C3G and Ig-associated membranoproliferative GN (Ig-MPGN) for anti-FB and anti-C3b autoantibodies using ELISA. We identified seven patients with anti-FB IgG, three patients with anti-C3b IgG, and five patients with anti-FB and anti-C3b IgG. Of these 15 patients, ten were diagnosed with Ig-MPGN. Among those patients with available data, 92% had a nephrotic syndrome, 64% had AKI, and 67% had a documented infection. Patients negative for anti-C3b and anti-FB IgG had much lower rates of infection (17 [25%] patients with C3G and one [10%] patient with Ig-MPGN). After 48 months, four of 15 (26%) positive patients had developed ESRD or died. All 15 patients had high plasma Bb levels, six (40%) patients had low levels of C3, and nine (60%) patients had high levels of soluble C5b9. In vitro, IgG purified from patients with anti-FB Abs selectively enhanced C3 convertase activity; IgG from patients with anti-C3b/anti-FB Abs enhanced C3 and C5 cleavage. IgG from patients with anti-C3b Abs stabilized C3bBb and perturbed C3b binding to complement receptor 1 but did not perturb binding to factor H. In conclusion, the prevalence of anti-C3b/anti-FB Abs and alternative pathway activation is similar in Ig-MPGN and C3G, suggesting similar pathogenic mechanisms. Identification of the underlying defect in Ig-MPGN could lead to improved treatment.
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Affiliation(s)
- Maria Chiara Marinozzi
- Team Complement and Diseases Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1138, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Lubka T Roumenina
- Team Complement and Diseases Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1138, Paris, France.,Université Paris Descartes Sorbonne Paris-Cité, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Sophie Chauvet
- Team Complement and Diseases Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1138, Paris, France
| | - Alexandre Hertig
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Néphrologie et de Transplantation rénale, Paris, France
| | - Dominique Bertrand
- Service de Néphrologie et de Transplantation rénale, Hôpital Bois Guillaume, Rouen, France
| | - Jérome Olagne
- Service de Néphrologie et de Transplantation rénale, Strasbourg, France
| | - Marie Frimat
- Service de Néphrologie et de Transplantation rénale, Lille, France
| | - Tim Ulinski
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie, Hôpital Trousseau, Paris, France
| | - Georges Deschênes
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie et de Transplantation rénale, Hôpital Robert Debré, Paris, France
| | - Stephane Burtey
- Aix Marseille université, Assistance publique-Hôpitaux de Marseille, Service de Néphrologie et de Transplantation rénale, Marseille, France
| | - Michel Delahousse
- Service de Néphrologie et Transplantation rénale, Hopital Foch, Paris, France; and
| | - Bruno Moulin
- Service de Néphrologie et de Transplantation rénale, Strasbourg, France
| | - Christophe Legendre
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie et de Transplantation rénale, Hôpital Necker, Paris, France
| | - Véronique Frémeaux-Bacchi
- Team Complement and Diseases Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1138, Paris, France; .,Assistance Publique-Hôpitaux de Paris, Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Moglie Le Quintrec
- Team Complement and Diseases Cordeliers Research Center, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1138, Paris, France; .,Service de Néphrologie et Transplantation rénale, Hopital Foch, Paris, France; and
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Dossier C, Boyer O, Ulinski T, Azib S, Madhi F, May A, Nathanson S, Orzechowski C, Simon T, Deschenes G. Évolution du SNI de l’enfant : suivi à 5 ans de la cohorte NEPHROVIR. Arch Pediatr 2016. [DOI: 10.1016/j.arcped.2016.09.025] [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: 10/20/2022]
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Joly BS, Stepanian A, Leblanc T, Hajage D, Chambost H, Harambat J, Fouyssac F, Guigonis V, Leverger G, Ulinski T, Kwon T, Loirat C, Coppo P, Veyradier A. Child-onset and adolescent-onset acquired thrombotic thrombocytopenic purpura with severe ADAMTS13 deficiency: a cohort study of the French national registry for thrombotic microangiopathy. Lancet Haematol 2016; 3:e537-e546. [PMID: 27720178 DOI: 10.1016/s2352-3026(16)30125-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura is a rare thrombotic microangiopathy, related to a severe ADAMTS13 deficiency (a disintegrin and metalloprotease with thromboSpondin type 1 repeats, member 13; activity <10% of normal). Childhood-onset thrombotic thrombocytopenic purpura is very rare and initially often misdiagnosed, especially when ADAMTS13 deficiency is acquired (ie, not linked to inherited mutations of the ADAMTS13 gene). We aimed to investigate initial presentation, management, and outcome of acquired thrombotic thrombocytopenic purpura in children. METHODS Between Jan 1, 2000, and Dec 31, 2015, we studied a cohort of patients with child-onset and adolescent-onset acquired thrombotic thrombocytopenic purpura included in the French national registry for thrombotic microangiopathies at presentation and during follow up. The inclusion criteria were: first episode before age 18 years; ADAMTS13 activity less than 10% of normal at presentation; positive anti-ADAMTS13 autoantibodies during an episode, or a recovery of ADAMTS13 activity in remission, or both. ADAMTS13 activity and anti-ADAMTS13 autoantibodies were investigated by a central laboratory, and medical records were extensively reviewed to collect clinical and biological features with a standardised form. This study is registered with ClinicalTrials.gov, number NCT00426686. FINDINGS We enrolled 973 patients with childhood-onset thrombotic microangiopathy, of whom 74 had a severe ADAMTS13 deficiency (activity <10%) at presentation. 24 patients had an inherited thrombotic thrombocytopenic purpura also known as Upshaw-Schulman syndrome and five did not have follow-up data available, thus 45 children had acquired thrombotic thrombocytopenic purpura and were included in our database at presentation. 25 (56%) patients had idiopathic disease and 20 (44%) had miscellaneous associated clinical conditions. At diagnosis, median age was 13 years (IQR 7-16, range 4 months-17 years), with a sex ratio of 2·5 girls to 1 boy. Anti-ADAMTS13 autoantibodies were positive in 37 (82%) of 45 patients (24 [96%] of 25 idiopathic cases and 13 [65%] of 20 non-idiopathic cases). 39 (87%) of 45 patients were given plasma therapy and 21 (47%) received additional rituximab. Four (9%) children died after the first thrombotic thrombocytopenic purpura episode. Long-term follow up of the 41 survivors showed that ten (24%) patients relapsed and systemic lupus erythematosus occurred in two (5%) patients. Preemptive rituximab was used in seven (17%) of 41 patients with acquired thrombotic thrombocytopenic purpura. INTERPRETATION Our study shows that child-onset and adolescent-onset acquired thrombotic thrombocytopenic purpura have specific clinical, biological and therapeutic features. Long-term follow-up is crucial to prevent relapses of the disease, to identify the occurrence of autoimmune disorders, and to evaluate consequences on social life. Child-onset and adolescent-onset acquired thrombotic thrombocytopenic purpura is a crucial diagnosis in the field of paediatric haematologic cytopenias because it is a life-threatening disease requiring a specific management. FUNDING Assistance Publique-Hôpitaux de Paris, France.
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Affiliation(s)
- Bérangère S Joly
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut Universitaire d'Hématologie-Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Alain Stepanian
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut Universitaire d'Hématologie-Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Thierry Leblanc
- Service d'Hématologie clinique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - David Hajage
- Département d'Epidémiologie et recherche clinique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Hervé Chambost
- Service d'Hématologie clinique pédiatrique, Hôpital La Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jérôme Harambat
- Service de Pédiatrie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Fanny Fouyssac
- Département d'Oncologie et d'Hématologie Pédiatriques et de Thérapie Cellulaire, CHU de Nancy, Hôpital d'Enfants, Vandoeuvre-lès-Nancy, France
| | | | - Guy Leverger
- Service d'Oncologie pédiatrique, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Tim Ulinski
- Service de Néphrologie pédiatrique, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Thérésa Kwon
- Service de Néphrologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Chantal Loirat
- Service de Néphrologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Paul Coppo
- Département d'Hématologie clinique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut Universitaire d'Hématologie-Hôpital Saint Louis, Université Paris Diderot, Paris, France.
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Hogan J, Mahjoub F, Larakeb AS, Vu Thien H, Hosany A, Bensman A, Grimprel E, Bingen E, Bonacorsi S, Ulinski T. Escherichia coli virulence patterns may help to predict vesicoureteral reflux in paediatric urinary tract infections. Acta Paediatr 2015; 104:e460-5. [PMID: 26099938 DOI: 10.1111/apa.13092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 03/11/2015] [Accepted: 06/16/2015] [Indexed: 11/29/2022]
Abstract
AIM Ultrasound and biological tools are used to predict high-grade vesicoureteral reflux, but other markers are needed to better select patients who need voiding cystography. Our aim was to determine whether studying Escherichia coli virulence factors would help to predict vesicoureteral reflux in patients with their first acute pyelonephritis. METHODS We included children presenting with E. coli-related acute pyelonephritis or cystitis. Vesicoureteral reflux was assessed by voiding cystography. Virulence factors were identified by multiplex polymerase chain reaction. Statistical analysis was performed using logistic regression and the mean c-statistic test. RESULTS We included 198 patients: 30 with cystitis and 168 with acute pyelonephritis, including 46 with vesicoureteral reflux. High-grade reflux was associated with acute pyelonephritis caused by the E. coli lacking virulence factors papGII (82% versus 47%, p < 0.001) or papC (85% versus 53%, p < 0.001) or belonging to phylogenetic group A or B1. When we added genetic data (lack of papGII, fyuA and phylogenetic groups) to classical predictors of vesicoureteral reflux (ultrasound examination, gender, age), the ability to predict high-grade reflux increased, with the c-statistic rising from 0.88 to 0.93. CONCLUSION Bacterial virulence factors and clinical factors helped to predict high-grade reflux and may help to avoid unnecessary voiding cystographies.
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Affiliation(s)
- Julien Hogan
- Service de Néphrologie et Dialyse Pédiatrique; Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); Hôpital Armand Trousseau; Paris France
| | - Farah Mahjoub
- Service de Microbiologie; Hôpital Robert Debré; AP-HP; Paris France
| | - Anis Skander Larakeb
- Service de Néphrologie et Dialyse Pédiatrique; Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); Hôpital Armand Trousseau; Paris France
| | - Hoang Vu Thien
- Service de Microbiologie; Hôpital Armand Trousseau; AP-HP; Paris France
| | - Ahmad Hosany
- Service de Pédiatrie Générale; Hôpital Armand Trousseau; AP-HP; Paris France
| | - Albert Bensman
- Service de Néphrologie et Dialyse Pédiatrique; Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); Hôpital Armand Trousseau; Paris France
- Université Pierre et Marie Curie (UMPC); Paris France
| | - Emmanuel Grimprel
- Service de Pédiatrie Générale; Hôpital Armand Trousseau; AP-HP; Paris France
- Université Pierre et Marie Curie (UMPC); Paris France
| | - Edouard Bingen
- Service de Microbiologie; Hôpital Robert Debré; AP-HP; Paris France
- Université Paris Diderot; Paris France
| | - Stéphane Bonacorsi
- Service de Microbiologie; Hôpital Robert Debré; AP-HP; Paris France
- Université Paris Diderot; Paris France
| | - Tim Ulinski
- Service de Néphrologie et Dialyse Pédiatrique; Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); Hôpital Armand Trousseau; Paris France
- Université Pierre et Marie Curie (UMPC); Paris France
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40
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Tudorache E, Azema C, Hogan J, Wannous H, Aoun B, Decramer S, Deschênes G, Ulinski T. Even mild cases of paediatric Henoch-Schönlein purpura nephritis show significant long-term proteinuria. Acta Paediatr 2015; 104:843-8. [PMID: 24946692 DOI: 10.1111/apa.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 03/23/2014] [Revised: 05/15/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
AIM Henoch-Schonlein purpura (HSP) is a common cause of paediatric renal disease in children, representing 10-15% of paediatric glomerulonephritis. This study examined the long-term outcome of biopsy-proven HSP nephritis to identify correlations between disease development and treatment. METHODS Patients from three French centres were retrospectively analysed. RESULTS We followed up 142 patients aged from 2 to 10.5 years with HSP nephritis, graded according to the International Study Group of Kidney Disease in Childhood classification. Mean (±SD) age at presentation was 7.6 ± 2.8 years. Nephrotic range proteinuria was present in 28% of patients with Grade II lesions, 60% with Grade III and 90% with Grade IV. Significant proteinuria (>0.5 g/L) was found in nine of 48 patients 3 years after renal biopsy, eight of 25 patients after 5 years and three of 14 patients after 10 years. There was no correlation between the proteinuria risk at 3, 5 or 10 years and the initial histological lesion or treatment modality. Treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was linked to lower proteinuria, especially if it was started precociously. CONCLUSION Even mild forms of HSP nephritis risk significant long-term proteinuria. Very early introduction of ACEi/ARB may improve the long-term outcome independent of histological lesions.
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Affiliation(s)
- Elena Tudorache
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
- University Pierre and Marie Curie; Paris France
| | - Christine Azema
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | - Julien Hogan
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | - Hala Wannous
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | - Bilal Aoun
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | | | - Georges Deschênes
- Department of Paediatric Nephrology; Robert-Debré Hospital; APHP; Paris France
- University Paris-Diderot; Paris France
| | - Tim Ulinski
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
- University Pierre and Marie Curie; Paris France
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41
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Mansour-Hendili L, Blanchard A, Le Pottier N, Roncelin I, Lourdel S, Treard C, González W, Vergara-Jaque A, Morin G, Colin E, Holder-Espinasse M, Bacchetta J, Baudouin V, Benoit S, Bérard E, Bourdat-Michel G, Bouchireb K, Burtey S, Cailliez M, Cardon G, Cartery C, Champion G, Chauveau D, Cochat P, Dahan K, De la Faille R, Debray FG, Dehoux L, Deschenes G, Desport E, Devuyst O, Dieguez S, Emma F, Fischbach M, Fouque D, Fourcade J, François H, Gilbert-Dussardier B, Hannedouche T, Houillier P, Izzedine H, Janner M, Karras A, Knebelmann B, Lavocat MP, Lemoine S, Leroy V, Loirat C, Macher MA, Martin-Coignard D, Morin D, Niaudet P, Nivet H, Nobili F, Novo R, Faivre L, Rigothier C, Roussey-Kesler G, Salomon R, Schleich A, Sellier-Leclerc AL, Soulami K, Tiple A, Ulinski T, Vanhille P, Van Regemorter N, Jeunemaître X, Vargas-Poussou R. Mutation Update of the CLCN5 Gene Responsible for Dent Disease 1. Hum Mutat 2015; 36:743-52. [PMID: 25907713 DOI: 10.1002/humu.22804] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 02/11/2015] [Accepted: 04/08/2015] [Indexed: 02/06/2023]
Abstract
Dent disease is a rare X-linked tubulopathy characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis and/or nephrolithiasis, progressive renal failure, and variable manifestations of other proximal tubule dysfunctions. It often progresses over a few decades to chronic renal insufficiency, and therefore molecular characterization is important to allow appropriate genetic counseling. Two genetic subtypes have been described to date: Dent disease 1 is caused by mutations of the CLCN5 gene, coding for the chloride/proton exchanger ClC-5; and Dent disease 2 by mutations of the OCRL gene, coding for the inositol polyphosphate 5-phosphatase OCRL-1. Herein, we review previously reported mutations (n = 192) and their associated phenotype in 377 male patients with Dent disease 1 and describe phenotype and novel (n = 42) and recurrent mutations (n = 24) in a large cohort of 117 Dent disease 1 patients belonging to 90 families. The novel missense and in-frame mutations described were mapped onto a three-dimensional homology model of the ClC-5 protein. This analysis suggests that these mutations affect the dimerization process, helix stability, or transport. The phenotype of our cohort patients supports and extends the phenotype that has been reported in smaller studies.
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Affiliation(s)
- Lamisse Mansour-Hendili
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Blanchard
- Faculté de Médecine, Université Paris Descartes, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'investigation clinique, Hôpital Européen Georges Pompidou, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
| | - Nelly Le Pottier
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Roncelin
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Stéphane Lourdel
- Sorbonne Universités, UPMC Université, Paris, France.,INSERM, Université Paris Descartes, Sorbonne Paris Cité, UMR S1138, Centre de Recherche des Cordeliers, CNRS ERL 8228, Paris, F-75006, France
| | - Cyrielle Treard
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France
| | - Wendy González
- Centro de Bioinformática y Simulación Molecular, Universidad de Talca, Talca, Chile
| | - Ariela Vergara-Jaque
- Centro de Bioinformática y Simulación Molecular, Universidad de Talca, Talca, Chile
| | - Gilles Morin
- Service de Génétique et Oncogénétique, Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
| | - Estelle Colin
- Département de Biochimie et Génétique, LUNAM Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Muriel Holder-Espinasse
- Département de Génétique, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Clinical Genetics, Guy's Hospital, London, United Kingdom
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares. Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Véronique Baudouin
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Stéphane Benoit
- Service de Néphrologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Etienne Bérard
- Service de Néphrologie pédiatrique, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Karim Bouchireb
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie Pédiatrique, Paris, France
| | - Stéphane Burtey
- VRCM, centre de néphrologie et transplantation rénale, Aix-Marseille Université, Marseille, France
| | - Mathilde Cailliez
- Assistance Publique Hôpitaux de Marseille, Unité de Néphrologie Pédiatrique, Hôpital La Timone, Marseille, France
| | - Gérard Cardon
- Service de Néphrologie, Centre Hospitalier de Douai, Douai, France
| | - Claire Cartery
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie et dialyse, Hôpital Tenon, Paris, France
| | - Gerard Champion
- Département de Pédiatrie, LUNAM Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Dominique Chauveau
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Toulouse, France
| | - Pierre Cochat
- Centre de Référence des Maladies Rénales Rares. Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Karin Dahan
- Département de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Renaud De la Faille
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Laurenne Dehoux
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Georges Deschenes
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Estelle Desport
- Service de Néphrologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Devuyst
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Stella Dieguez
- Nefrologia Infantil, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina
| | - Francesco Emma
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michel Fischbach
- Service de Pédiatrie, Centre Hospitalier Universitaire Hautepierre, Strasbourg, France
| | - Denis Fouque
- Departement de Néphrology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France
| | - Jacques Fourcade
- Service de Néphrology, Centre Hospitalier de Chambery, Chambery, France
| | - Hélène François
- Assistance Publique-Hôpitaux de Paris, Hôpital Kremlin Bicêtre, Service de Néphrologie, Le Kremlin-Bicêtre, France
| | - Brigitte Gilbert-Dussardier
- Centre Hospitalier Universitaire de Poitiers, Service de Génétique, EA 3808, Université de Poitiers, Poitiers, France
| | - Thierry Hannedouche
- Hôpitaux Universitaires de Strasbourg, Service de Néphrologie et Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Pascal Houillier
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,INSERM, Université Paris Descartes, Sorbonne Paris Cité, UMR S1138, Centre de Recherche des Cordeliers, CNRS ERL 8228, Paris, F-75006, France.,Assistance Publique Hôpitaux de Paris, Département de Physiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Hassan Izzedine
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Service de Néphrologie, Paris, France
| | - Marco Janner
- Department of Paediatric Endocrinology, Diabetology and Metabolism, University of Berne Children's Hospital, Berne, Switzerland
| | - Alexandre Karras
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Néphrologie, Paris, France
| | - Bertrand Knebelmann
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie adulte, Paris, France
| | - Marie-Pierre Lavocat
- Département de Pédiatrie, Centre Hospitalier Universitaire de Saint Etienne, Hôpital Nord, Saint Etienne, France
| | - Sandrine Lemoine
- Hospices Civils de Lyon, Service d'Exploration Fonctionnelle Rénale, Hôpital Edouard-Herriot, Lyon, France
| | - Valérie Leroy
- Hôpital Jeanne de Flandre, Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Chantal Loirat
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Marie-Alice Macher
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | | | - Denis Morin
- Unité de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Patrick Niaudet
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie Pédiatrique, Paris, France
| | - Hubert Nivet
- Service de Néphrologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - François Nobili
- Unité de Néphrologie Pédiatrie, Besançon, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Robert Novo
- Hôpital Jeanne de Flandre, Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurence Faivre
- Centre de Génétique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Claire Rigothier
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Remi Salomon
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie Pédiatrique, Paris, France
| | - Andreas Schleich
- Institute of Nephrology Statspital Waid Zuerich, Zuerich, Switzerland
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares. Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | | | - Aurélien Tiple
- Centre Hospitalier Universitaire Gabriel-Montpied Service de Néphrologie, Clermont-Ferrand, France
| | - Tim Ulinski
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Néphrologie et Transplantation Rénale, Hôpital Trousseau, Paris, France
| | - Philippe Vanhille
- Centre Hospitalier de Valenciennes, Service de Néphrologie et Médecine Interne, Valenciennes, France
| | - Nicole Van Regemorter
- Université Libre de Bruxelles, Hôpital Erasme Département de Génétique Médicale, Brussels, Belgium
| | - Xavier Jeunemaître
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
| | - Rosa Vargas-Poussou
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
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Kadlub N, Vazquez MP, Galmiche L, L'Herminé AC, Dainese L, Ulinski T, Fauroux B, Pavlov I, Badoual C, Marlin S, Deckert M, Leboulanger N, Berdal A, Descroix V, Picard A, Coudert AE. The calcineurin inhibitor tacrolimus as a new therapy in severe cherubism. J Bone Miner Res 2015; 30:878-85. [PMID: 25491283 DOI: 10.1002/jbmr.2431] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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] [Indexed: 11/10/2022]
Abstract
Cherubism is a rare genetic disorder characterized by extensive growth of a bilateral granuloma of the jaws, resulting in facial disfigurement. Cherubism is caused by gain-of-function mutations in the SH3BP2 gene, leading to overactivation of nuclear factor of activated T cells, cytoplasmic 1 (NFATc1)-dependent osteoclastogenesis. Recent findings in human and mouse cherubism have suggested that calcineurin inhibitors might be drug candidates in cherubism medical treatment. A 4-year-old boy with aggressive cherubism was treated with the calcineurin inhibitor tacrolimus for 1 year, and clinical, radiological, and molecular data were obtained. Immunohistologic analysis was performed to compare preoperative and postoperative NFATc1 staining and tartrate resistant acid phosphatase (TRAP) activity. Real-time PCR was performed to analyze the relative expression levels of OPG and RANKL. After tacrolimus therapy, the patient showed significant clinical improvement, including stabilization of jaw size and intraosseous osteogenesis. Immunohistologic analyses on granuloma showed that tacrolimus caused a significant reduction in the number of TRAP-positive osteoclasts and NFATc1 nuclear staining in multinucleated giant cells. Molecular analysis showed that tacrolimus treatment also resulted in increased OPG expression. We present the first case of effective medical therapy in cherubism. Tacrolimus enhanced bone formation by stimulating osteogenesis and inhibiting osteoclastogenesis.
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Affiliation(s)
- Natacha Kadlub
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS1138, Team Molecular Oral Pathophysiology, Cordeliers Research Center, University Paris-Diderot, University Paris-Descartes, and University Pierre and Marie Curie, Paris, France; Service de Chirurgie Maxillo-Faciale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Unités de Formation et de Recherche (UFR) de Médecine Paris Descartes, Université Paris V, Paris, France; Centre de Références des Malformations de la Face et de la Cavité Buccale, Paris, France; Laboratoire de Physiopathologie Orale et Moléculaire, INSERM, UMRS 872, Equipe 5, Centre de Recherche des Cordeliers, Paris, France
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43
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Berody S, Salomon R, Niaudet P, Heidet L, Baudouin V, Boudaillez B, de Parscau L, Dunand O, Flodrops H, Fila M, Garnier A, Harambat J, Louillet F, Merieau E, May A, Pietrement C, Rousset-Rouvière C, Rousset G, Tenenbaum J, Taque S, Ulinski T, Vieux R, Zaloszyc A, Antignac C, Baccheta J, Pierrepont S, Dehennault M, Boyer O. CO-58 – Syndrome néphrotique congénital: une étude multicentrique française. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30158-5] [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: 11/24/2022]
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44
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Aoun B, Ulinski T, Sanjad S, Termos S, Dahrouj M, Fakhoury H, Schmitt CP. Chronic peritoneal dialysis in Lebanese children of families with low socioeconomic status. Perit Dial Int 2015; 35:93-6. [PMID: 25700461 DOI: 10.3747/pdi.2013.00342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bilal Aoun
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université
| | - Tim Ulinski
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Sami Sanjad
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Salah Termos
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Manal Dahrouj
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Hassan Fakhoury
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Claus Peter Schmitt
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
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Sacri AS, Chambaraud T, Ranchin B, Florkin B, Sée H, Decramer S, Flodrops H, Ulinski T, Allain-Launay E, Boyer O, Dunand O, Fischbach M, Hachulla E, Pietrement C, Le Pogamp P, Stephan JL, Belot A, Nivet H, Nobili F, Guillevin L, Quartier P, Deschênes G, Salomon R, Essig M, Harambat J. Clinical characteristics and outcomes of childhood-onset ANCA-associated vasculitis: a French nationwide study. Nephrol Dial Transplant 2015; 30 Suppl 1:i104-12. [PMID: 25676121 DOI: 10.1093/ndt/gfv011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Data on anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis are scarce in children. The current study is aimed at describing the clinical features and outcomes of childhood-onset ANCA-associated vasculitis (AAV). METHODS We conducted a retrospective French multicentre study involving patients in whom AAV was diagnosed before the age of 18 years. Inclusion criteria were (i) granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) according to classification criteria of the European League Against Rheumatism/Paediatric Rheumatology European Society, and (ii) ANCA positivity. Patient and renal survival were analysed. RESULTS Among 66 children included, 80% were female, 42% had GPA and 58% MPA including renal-limited vasculitis, 67% were pANCA+ and 33% cANCA+. The mean incidence of reported cases increased to 0.45 per million children/year in the period 2006-10. Median age at diagnosis was 11.5 years, and median time to diagnosis was 1 month. Initial symptoms included fever and fatigue (79%), skin lesions (41%), arthritis (42%), pulmonary (45%) and renal involvement (88%). Clinical features were similar between GPA and MPA with the exception of upper airway impairment (28%) specific of GPA. Ninety percent of the patients achieved remission after induction treatment. After a median follow-up of 5.2 years, 4 patients (6%) died, corresponding to a mortality rate of 1.2 per 100 person-years, and 22 patients (34%) developed end-stage renal disease (ESRD). Renal survival was 74, 70 and 59% at 1, 5 and 10 years, respectively. In a multivariable Cox regression model, baseline glomerular filtration rate, ethnic origin, histopathological classification and era of treatment were associated with the occurrence of ESRD. Relapse-free survival was 57% at 5 years and 34% at 10 years of follow-up. Patient and renal outcome did not significantly differ between GPA and MPA. CONCLUSION Childhood-onset AAV is a rare disease characterized by female predominance, delayed diagnosis, frequent renal impairment and a high remission rate. Baseline GFR and new histopathological classification system are strong predictors of ESRD. Renal survival in childhood AAV has improved over time.
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Affiliation(s)
- Anne-Sylvia Sacri
- Service de Pédiatrie, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
| | - Tristan Chambaraud
- Service de Néphrologie, Hôpital Dupuytren, CHU de Limoges, Limoges, France
| | - Bruno Ranchin
- Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, CHU de Lyon, Lyon, France
| | - Benoît Florkin
- Unité d'Immunologie, Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Sée
- Service de Néphrologie Pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Decramer
- Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Hugues Flodrops
- Service de Pédiatrie, Groupe Hospitalier Saint-Pierre, CHU La Réunion, Saint Pierre, France
| | - Tim Ulinski
- Service de Néphrologie Pédiatrique, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emma Allain-Launay
- Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Dunand
- Service de Pédiatrie, Hôpital Félix Guyon, CHU La Réunion, Saint-Denis, La Réunion, France
| | - Michel Fischbach
- Service de Pédiatrie, Hôpital de Hautepierre, CHU de Strasbourg, Strasbourg, France
| | - Eric Hachulla
- Service de Médecine Interne, Hôpital Huriez, CHU de Lille, Lille, France
| | | | - Patrick Le Pogamp
- Service de Néphrologie, Hôpital Pontchaillou, CHU de Rennes, Rennes, France
| | - Jean-Louis Stephan
- Service de Pédiatrie, Hôpital Nord, CHU de Saint-Etienne, Saint Etienne, France
| | - Alexandre Belot
- Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, CHU de Lyon, Lyon, France
| | - Hubert Nivet
- Service de Néphrologie et Immunologie Clinique, Hôpital Bretonneau, CHU de Tours, Tours, France
| | - François Nobili
- Service de Pédiatrie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France
| | - Loic Guillevin
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Quartier
- Unité d'Immunologie, Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Georges Deschênes
- Service de Néphrologie Pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rémi Salomon
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Essig
- Service de Néphrologie, Hôpital Dupuytren, CHU de Limoges, Limoges, France
| | - Jérôme Harambat
- Service de Pédiatrie, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
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Hogan J, Audry B, Harambat J, Dunand O, Garnier A, Salomon R, Ulinski T, Macher MA, Couchoud C. Are there good reasons for inequalities in access to renal transplantation in children? Nephrol Dial Transplant 2014; 30:2080-7. [PMID: 25422310 DOI: 10.1093/ndt/gfu356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 06/12/2014] [Accepted: 10/09/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies in the USA and Europe have demonstrated inequalities in adult access to renal transplants. We previously demonstrate that the centre of treatment was impacting the time to be registered on the renal waiting list. In this study, we sought to ascertain the influence of patient and centre characteristics on the probability of transplantation within 1 year after registration on the waiting list for children. METHODS We included patients <18 years awaiting transplantation from the French ESRD National Registry. The effects of patient and centre characteristics were studied by hierarchical logistic regression. Centre effects were assessed by centre-level residual variance. A descriptive survey was performed to investigate differences in the centres' practices, and linear regression was used to confirm findings of different HLA compatibility requirements between centres. RESULTS The study included 556 patients treated at 54 centres; 450 (80.9%) received transplants in the year after their listing. HLA group scarcity, time of inactive status during the year, pre-emptive listing and listing after age 18 were associated with lower probabilities of transplantation. Patient characteristics explained most of the variability among centres, but patients treated in paediatric centres had a lower probability of transplantation within 1 year because of higher HLA compatibility requirements for transplants. CONCLUSIONS Although patient characteristics explained most of the inter-centre variability, harmonization of some practices might enable us to reduce some inequalities in access to renal transplantation while maintaining optimal transplant survival and chances to get a second transplant when needed.
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Affiliation(s)
- Julien Hogan
- REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Benoit Audry
- REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Jérôme Harambat
- REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France Pellegrin University Hospital, Bordeaux, France
| | | | | | | | - Tim Ulinski
- Trousseau University Hospital, Paris, France
| | - Marie-Alice Macher
- REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France Robert Debré University Hospital, Paris, France
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France
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Hogan J, Savoye E, Macher MA, Bachetta J, Garaix F, Lahoche A, Ulinski T, Harambat J, Couchoud C. Rapid access to renal transplant waiting list in children: impact of patient and centre characteristics in France. Nephrol Dial Transplant 2014; 29:1973-9. [DOI: 10.1093/ndt/gfu220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aoun B, Ulinski T, Termos S, Kalkas G, Fakhoury H, Schmitt CP. Rapid and sustained recovery of renal function with transient placement of an intrauretral nephrostomy catheter in an infant with ureteropelvic junction obstruction and acute renal failure. ACTA ACUST UNITED AC 2014; 62:54-6. [PMID: 24684127 DOI: 10.12816/0002628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) is a common, congenital urinary malformation in the pediatric age group. In most cases the diagnosis is made antenataly and resolves spontaneously. Postnatal diagnosis is made when symptoms of urinary tract infection or abdominal pain occur. We report a six-month-old girl with single kidney and known vesicoureteral reflux grade IV presenting with severe acute renal failure (ARF), requiring acute peritoneal dialysis (PD).After diagnosis of decompensated UPJO, a nephrostomy was performed, and renal function restored within seven days. UPJO was subsequently treated by open pyeloplasty. To our knowledge, this is the first case of UPJO requiring PD due to severe renal failure in a child. Children with UPJO and major morbidity of the contralateral kidney are at risk of renal failure and should therefore be followed carefully to prevent serious complications.
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Abstract
We report the case of an 11-year-old previously healthy girl who presented for microscopic hematuria and nephrotic proteinuria with normal renal function, which persisted after 6 months of steroids, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers, hydroxychloroquine, mycophenolic acid and a low-salt diet. A serum investigation suggested lupus nephritis and a renal biopsy, performed 2 weeks after the first proteinuria detection, revealed membranous lupus nephritis. We decided to perform ten sessions of daily immunoadsorption. Proteinuria decreased significantly over these ten sessions from 8 to 0.12 g/l. After the tenth immunoadsorption session, the patient received the first rituximab (RTX) infusion leading to complete B-cell depletion. The patient was maintained on ACEi associated with mycophenolic acid and hydroxychloroquine. Three RTX reinjections were performed when CD19-positive cells reappeared in peripheral blood. Despite complete B-cell recovery and positive anti-dsDNA-Ab, the patient remained in complete remission 18 months after the initial diagnosis with negative proteinuria and a normal renal function.
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Affiliation(s)
- Tim Ulinski
- Department of Pediatric Nephrology, APHP, DHU i2B Inflammation-Immunopathology-Biotherapy, Armand-Trousseau Hospital, Paris, France ; University Pierre and Marie Curie, Tenon Hospital, APHP, Paris, France
| | - Aurélie Davourie-Salandre
- Department of Pediatric Nephrology, APHP, DHU i2B Inflammation-Immunopathology-Biotherapy, Armand-Trousseau Hospital, Paris, France ; University Pierre and Marie Curie, Tenon Hospital, APHP, Paris, France
| | - Isabelle Brocheriou
- University Pierre and Marie Curie, Tenon Hospital, APHP, Paris, France ; Department of Pathology, Tenon Hospital, APHP, Paris, France
| | - Bilal Aoun
- Department of Pediatric Nephrology, APHP, DHU i2B Inflammation-Immunopathology-Biotherapy, Armand-Trousseau Hospital, Paris, France
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Lanneaux J, Davourie-Salandre A, Tudorache E, Stoica I, Aoun B, Ulinski T. Chyloperitoneum in pediatric peritoneal dialysis: rapid remission after introduction of medium-chain triglyceride-based formula. Perit Dial Int 2014; 33:333-4. [PMID: 23660612 DOI: 10.3747/pdi.2012.00181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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