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Hajj E, Awouters M, Mosca M, Flammier S, Rachedi S, Bacchetta J, De Mul A, Ranchin B. Health-related quality of life in paediatric patients on peritoneal dialysis: Data from a tertiary centre. Perit Dial Int 2024:8968608241241177. [PMID: 38632671 DOI: 10.1177/08968608241241177] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Kidney failure has a negative impact on both children and families' quality of life (QOL). We evaluated the burden of home peritoneal dialysis (PD) using two local questionnaires and the French version of PedsQL3.0 end-stage kidney disease module and family impact module. Data are expressed as median (min-max). We reviewed the charts of 12 patients, at a median age of 8.8 (1.2-16.7) years, undergoing maintenance PD for 8 (1-42) months. Parathyroid hormone and haemoglobin levels were 215 (17-606) ng/L and 117 (104-141) g/L, respectively. Patients were taking 7 (3-10) different medications, corresponding to 9 (4-17) doses per day. The PD fluid volume per cycle was 1035 (723-1348) mL/m2 with a dwell duration of 75 (60-90) min and 6 (5-9) cycles per night. On a 2-week period, there were 2 (1-11) alarms per night resulting in 2 (0-8) times waking up and getting out of the bed for the parent(s); families were late 1 (0-11) times for school or parent's work. The time spent to connect and disconnect the cycler to the patient was 30 (12-46) min per day. QOL score on child self-report was correlated positively with weight percentile for age (R = 0.857; p = 0.014) and negatively with the number of siblings (R = -0.917; p = 0.004). The children QOL was evaluated higher by self-report scores: 77 (59-87) than by parent-proxy report scores: 53 (29-74), respectively (p = 0.028). PD children/teenagers and their caregivers can feel overwhelmed by the daily home therapy. Self-report and parent-proxy report QOL were significantly different, and it is questionable whether the parent-proxy report QOL relies rather on parents' own QOL.
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Affiliation(s)
- Elias Hajj
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Marijke Awouters
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Melodie Mosca
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Est, Université de Lyon, France
| | - Sacha Flammier
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Sarra Rachedi
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Justine Bacchetta
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Est, Université de Lyon, France
- INSERM, UMR 1033, Université de Lyon, France
| | - Aurelie De Mul
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Bruno Ranchin
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
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Pautonnier J, Goutte S, Dubourg LD, Bacchetta J, Ranchin B, Rabilloud M, Sanlaville D. Creatinine levels in French children with Down syndrome up to ten years old. Eur J Pediatr 2024; 183:1953-1957. [PMID: 38319403 DOI: 10.1007/s00431-024-05460-3] [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: 11/02/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
Assess creatinine levels in French children with Down syndrome (DS) on the basis of the relationship between creatinine levels and age. The study included 279 children with DS aged 0 to 10 years who had been regularly monitored between 2004 and 2021 in a single genetics department and who had had at least one creatinine measurement. The creatinine level curves were established by estimating the median and the quantiles of order 2.5 and 97.5% according to age. A Generalized Additive Model for Location, Scale, and Shape was used. The results showed higher creatinine levels in children with DS than in children from the general population. Conclusion: The present results allow to propose an original chart of creatinine levels according to age in French children with DS, which should help optimize their medical management and improve the early detection of renal diseases. What is Known: • Creatinine is a product of muscle breakdown and depends on muscle mass and children with Down syndrome have muscle and growth characteristics that differ from those of the general paediatric population. • Serum creatinine values in Japanese children with DS are higher than those of children from the general Japanese population. What is New: • Creatinine values in French children with DS are higher than those of children from the general French population. • The proposed original chart for creatinine values according to age, specifically designed for individuals up to 10 years old, should serve for further investigation, prevention, and follow-up of children with DS.
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Affiliation(s)
- Joanna Pautonnier
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon, France.
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France.
- Universite Claude Bernard Lyon 1, F-69100, Villeurbanne, France.
| | - Sylvie Goutte
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Génétique, Bron, France
| | - Laurence Derain Dubourg
- Universite Claude Bernard Lyon 1, F-69100, Villeurbanne, France
- CNRS UMR 5305, Lyon, France
- Hospices Civils de Lyon, Hôpital E. Herriot, Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, F-69003, Lyon, France
| | - Justine Bacchetta
- Universite Claude Bernard Lyon 1, F-69100, Villeurbanne, France
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
- Universite Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Damien Sanlaville
- Universite Claude Bernard Lyon 1, F-69100, Villeurbanne, France
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Génétique, Bron, France
- Faculté de Médecine Lyon Sud Charles Mérieux, Université de Lyon, Lyon, France
- CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, 69008, Lyon, France
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Gu H, Azukaitis K, Doyon A, Erdem S, Ranchin B, Harambat J, Lugani F, Boguslavskyi A, Cansick J, Finlay E, Gilbert R, Kerecuk L, Lunn A, Maxwell H, Morgan H, Shenoy M, Shroff R, Subramaniam P, Tizard J, Tse Y, Simpson J, Chowienczyk P, Schaefer F, Sinha MD. Decline in Left Ventricular Early Systolic Function with Worsening Kidney Function in Children with Chronic Kidney Disease: Insights from the 4C and HOT-KID Studies. J Am Soc Echocardiogr 2024; 37:356-363.e1. [PMID: 37993063 DOI: 10.1016/j.echo.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/18/2023] [Revised: 09/27/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Adults with childhood-onset chronic kidney disease (CKD) have an increased risk of cardiovascular disease. First-phase ejection fraction (EF1), a novel measure of early systolic function, may be a more sensitive marker of left ventricular dysfunction than other markers in children with CKD. OBJECTIVE To examine whether EF1 is reduced in children with CKD. METHODS Children from the 4C and HOT-KID studies were stratified according to estimated glomerular filtration rate (eGFR). The EF1 was calculated from the fraction of left ventricular (LV) volume ejected up to the time of peak aortic flow velocity. RESULTS The EF1 was measured in children ages 10.9 ± 3.7 (mean ± SD) years, 312 with CKD and 63 healthy controls. The EF1 was lower, while overall ejection fraction was similar, in those with CKD compared with controls and decreased across stages of CKD (29.3% ± 3.7%, 23.5% ± 4.5%, 19.8% ± 4.0%, 18.5% ± 5.1%, and 16.7% ± 6.6% in controls, CKD 1, 2, 3, and ≥ 4, respectively, P < .001). The relationship of EF1 to eGFR persisted after adjustment for relevant confounders (P < .001). The effect size for association of measures of LV structure or function with eGFR (SD change per unit change in eGFR) was greater for EF1 (β = 0.365, P < .001) than for other measures: LV mass index (β = -0.311), relative wall thickness (β = -0.223), E/e' (β = -0.147), and e' (β = 0.141) after adjustment for confounders in children with CKD. CONCLUSIONS Children with CKD exhibit a marked and progressive decline in EF1 with falling eGFR. This suggests that EF1 is a more sensitive marker of LV dysfunction when compared to other structural or functional measures and that early LV systolic function is a key feature in the pathophysiology of cardiac dysfunction in CKD.
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Affiliation(s)
- Haotian Gu
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Jerome Harambat
- Pediatric Nephrology Unit, Department of Pediatrics, Centre de Référence Maladies Rénales Rares, Bordeaux University Hospital, Bordeaux, France
| | - Francesca Lugani
- Division of Nephrology, Dialysis, Transplantation, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrii Boguslavskyi
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Janette Cansick
- Department of Paediatrics, Medway Maritime Hospital, Medway, United Kingdom
| | - Eric Finlay
- Department of Paediatric Nephrology, Leeds General Infirmary, Leeds, United Kingdom
| | - Rodney Gilbert
- Department of Paediatric Nephrology, Southampton General Hospital, Southampton, United Kingdom
| | - Larissa Kerecuk
- Department of Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Heather Maxwell
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, United Kingdom
| | - Pushpa Subramaniam
- Department of Paediatrics, St Georges Hospital, Tooting, London, United Kingdom
| | - Jane Tizard
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, United Kingdom; Department of Paediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom.
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Ranchin B, Bidault V, Zekre F, DeMul A, Sanlaville D, Bacchetta J. Kidney and urological involvement in Down syndrome: frequent, underestimated, but associated with impaired quality of life and risk of kidney failure. Pediatr Nephrol 2024; 39:347-355. [PMID: 37386331 DOI: 10.1007/s00467-023-05986-y] [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: 02/16/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/01/2023]
Abstract
Patients with Down syndrome (DS) are at risk of multiorgan dysfunction; kidney and urological impairment are common. This is due to a likely increased risk of congenital kidney and urological malformations (odds ratio of 4.5 compared to the general population in one study), more frequent associated comorbidities at risk of kidney dysfunction (such as prematurity in 9-24% of children, intrauterine growth retardation or low birth weight in 20%, and congenital heart disease in 44%), and more frequent lower urinary tract dysfunction (reported in 27-77% of children with DS). If present, malformations and comorbidities at risk of kidney dysfunction warrant regular kidney monitoring in addition to their treatment. Serum creatinine in children with DS has been shown to be higher than in the general population and asymptomatic hyperuricemia is reported in 12-33% of children or young adults with DS. Moreover cryptorchidism and testicular cancer are also more common and should be detected by clinical examination. Thus, persons with DS at risk of presenting kidney and urological impairment should be identified by prenatal ultrasonography, comorbidities at risk of kidney sequelae considered, and during regular medical follow-up, clinically examined and questioned to diagnose testicular anomalies and lower urinary tract dysfunction. This is of importance as such kidney and urological impairments are associated with impaired quality of life and mental health, and risk of kidney failure.
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Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France.
| | - Valeska Bidault
- Service de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Franck Zekre
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Aurelie DeMul
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Damien Sanlaville
- Service de Génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Sud Charles Mérieux, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
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Ranchin B, Schmitt CP, Warady BA, Hataya H, Jones J, Lalji R, Licht C, Mosca M, Stronach L, Vidal E, Walle JV, Shroff R. Technical requirements and devices available for long-term hemodialysis in children-mind the gap! Pediatr Nephrol 2023:10.1007/s00467-023-06233-0. [PMID: 38141144 DOI: 10.1007/s00467-023-06233-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023]
Abstract
Children requiring long-term kidney replacement therapy are a "rare disease" cohort. While the basic technical requirements for hemodialysis (HD) are similar in children and adults, key aspects of the child's cardiovascular anatomy and hemodynamic specifications must be considered. In this article, we describe the technical requirements for long-term HD therapy for children and the devices that are currently available around the world. We highlight the characteristics and major technical shortcomings of permanent central venous catheters, dialyzers, dialysis machines, and software available to clinicians who care for children. We show that currently available HD machines are not equipped with appropriately small circuits and sensitive control mechanisms to perform safe and effective HD in the youngest patients. Manufacturers limit their liability, and health regulatory agencies permit the use of devices, only in children according to the manufacturers' pre-specified weight limitations. Although registries show that 6-23% of children starting long-term HD weigh less than 15 kg, currently, there is only one long-term HD device that is cleared for use in children weighing 10 to 15 kg and none is available and labelled for use in children weighing less than 10 kg anywhere in the world. Thus, many children are being treated "off-label" and are subject to interventions delivered by medical devices that lack pediatric safety and efficacy data. Moreover, recent improvements in dialysis technology offered to adult patients are denied to most children. We, in turn, advocate for concerted action by pediatric nephrologists, industry, and health regulatory agencies to increase the development of dedicated HD machines and equipment for children.
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Affiliation(s)
- Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France.
- Centre de référence des maladies rénales rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France.
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Bradley A Warady
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Hiroshi Hataya
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
- Department of Pediatrics, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Joanne Jones
- Queensland Children's Hospital, University of Queensland, Brisbane, Australia
| | - Rowena Lalji
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Christoph Licht
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Nephrology and Research Institute, Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Melodie Mosca
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Lynsey Stronach
- University College London Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Enrico Vidal
- Pediatric Nephrology Unit, Department for Woman and Child's Health, University-Hospital of Padua, Padua, Italy
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital and Institute of Child Health, London, UK
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Mosca M, Kouajip-Mabou A, De Mul A, Rachedi S, Bacchetta J, Ranchin B. Daily practice evaluation of the paediatric set of a next-generation long-term haemodialysis machine. Pediatr Nephrol 2023; 38:3863-3866. [PMID: 37099185 DOI: 10.1007/s00467-023-05943-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/07/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND From 2006 to 2020, 24% of children starting haemodialysis in France weighed < 20 kg. Most new-generation long-term haemodialysis machines do not propose paediatric lines anymore but Fresenius has validated two devices for use in children above 10 kg. Our aim was to compare the daily use of these two devices in children < 20 kg. METHODS Retrospective single-center evaluation of daily practice with Fresenius 6008® machines, and low-volume paediatric sets (83 mL), as compared to 5008® machines with paediatric lines (108 mL). Each child was treated randomly with both generators. RESULTS A total of 102 online haemodiafiltration sessions were performed over 4 weeks in five children (median body weight 12.0 [range 11.5-17.0] kg). Arterial aspiration and venous pressures were maintained respectively over - 200 mmHg and under 200 mmHg. For all children, blood flow and volume treated per session were lower with 6008® vs. 5008® (p < 0.001), median difference between the two devices being 21%. In the four children treated in post-dilution mode, substituted volume was lower with 6008® (p < 0.001, median difference: 21%). Effective dialysis time was not different between the two generators; however, the difference between total duration of session and dialysis effective time was slightly higher (p < 0.05) with 6008® for three patients, due to treatment interruptions. CONCLUSION These results suggest that children between 11 and 17 kg should be treated with paediatric lines on 5008® if possible. They advocate for modification of the 6008 paediatric set to decrease resistance to blood flow. The possibility to use 6008® with paediatric lines in children below 10 kg deserves further studies.
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Affiliation(s)
- Melodie Mosca
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, European Rare Kidney Disease Reference Network Center, 59 Boulevard Pinel, 69677, Bron Cedex, Lyon, France
| | - Alida Kouajip-Mabou
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, European Rare Kidney Disease Reference Network Center, 59 Boulevard Pinel, 69677, Bron Cedex, Lyon, France
| | - Aurelie De Mul
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, European Rare Kidney Disease Reference Network Center, 59 Boulevard Pinel, 69677, Bron Cedex, Lyon, France
| | - Sarra Rachedi
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, European Rare Kidney Disease Reference Network Center, 59 Boulevard Pinel, 69677, Bron Cedex, Lyon, France
| | - Justine Bacchetta
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, European Rare Kidney Disease Reference Network Center, 59 Boulevard Pinel, 69677, Bron Cedex, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
- UMR 1033, Faculté de Médecine Lyon Est, INSERM, Université de Lyon, Lyon, France
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, European Rare Kidney Disease Reference Network Center, 59 Boulevard Pinel, 69677, Bron Cedex, Lyon, France.
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7
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Paglialonga F, Shroff R, Zagozdzon I, Bakkaloglu SA, Zaloszyc A, Jankauskiene A, Gual AC, Consolo S, Grassi MR, McAlister L, Skibiak A, Yazicioglu B, Puccio G, Edefonti A, Ariceta G, Aufricht C, Holtta T, Klaus G, Ranchin B, Schmitt CP, Snauwaert E, Stefanidis C, Walle JV, Stabouli S, Verrina E, Vidal E, Vondrak K, Zurowska A. Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study. Pediatr Nephrol 2023; 38:3389-3399. [PMID: 36988689 DOI: 10.1007/s00467-023-05932-y] [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: 11/17/2022] [Revised: 02/06/2023] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis. METHODS Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa). Primary outcomes were systolic blood pressure and diastolic blood pressure standard deviation scores (SBP and DBP SDS), obtained by 24-h ambulatory blood pressure monitoring or office BP according to age, and interdialytic weight gain (IDWG). RESULTS Forty-one patients (31 HD), with a median age of 13.3 (IQR 5.2) years, were enrolled. Twelve patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.7) mEq/kg/day. Median total Na intake was 1.5 (1.1) mEq/kg/day, corresponding to 60.6% of the maximum recommended daily intake for healthy children. Median uNa and sNaB were 0.6 (1.8) mEq/kg/day and 0.9 (1.7) mEq/kg/day, respectively. The strongest independent predictor of sNaB in the cohort was urine output. In patients receiving HD, sNaB correlated with IDWG, pre-HD DBP, and first-hour refill index, a volume index based on blood volume monitoring. sNaB was the strongest predictor of IDWG in multiple regression analysis (β = 0.63; p = 0.005). Neither SBP SDS nor DBP SDS correlated with sNaB. CONCLUSIONS Na intake is higher than uNa in children on dialysis, and medications may be an important source of Na. sNaB is best predicted by urine output in the population, and it is a significant independent predictor of IDWG in children on HD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Ilona Zagozdzon
- Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland
| | | | - Ariane Zaloszyc
- Department of Pediatric Nephrology, Hopital de Hautepierre, Strasbourg, France
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Alejandro Cruz Gual
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Silvia Consolo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Maria Rosa Grassi
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Louise McAlister
- University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Aleksandra Skibiak
- Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Burcu Yazicioglu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion, University of Palermo, Palermo, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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8
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Zhang C, Bartosova M, Marinovic I, Schwab C, Schaefer B, Vondrak K, Ariceta G, Zaloszyc A, Ranchin B, Taylan C, Büscher R, Oh J, Mehrabi A, Schmitt CP. Peritoneal transformation shortly after kidney transplantation in pediatric patients with preceding chronic peritoneal dialysis. Nephrol Dial Transplant 2023; 38:2170-2181. [PMID: 36754369 DOI: 10.1093/ndt/gfad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The unphysiological composition of peritoneal dialysis (PD) fluids induces progressive peritoneal fibrosis, hypervascularization and vasculopathy. Information on these alterations after kidney transplantation (KTx) is scant. METHODS Parietal peritoneal tissues were obtained from 81 pediatric patients with chronic kidney disease stage 5 (CKD5), 72 children on PD with low glucose degradation product (GDP) PD fluids, and from 20 children 4-8 weeks after KTx and preceding low-GDP PD. Tissues were analyzed by digital histomorphometry and quantitative immunohistochemistry. RESULTS While chronic PD was associated with peritoneal hypervascularization, after KTx vascularization was comparable to CKD5 level. Submesothelial CD45 counts were 40% lower compared with PD, and in multivariable analyses independently associated with microvessel density. In contrast, peritoneal mesothelial denudation, submesothelial thickness and fibrin abundance, number of activated, submesothelial fibroblasts and of mesothelial-mesenchymal transitioned cells were similar after KTx. Diffuse peritoneal podoplanin positivity was present in 40% of the transplanted patients. In subgroups matched for age, PD vintage, dialytic glucose exposure and peritonitis incidence, submesothelial hypoxia-inducible factor 1-alpha abundance and angiopoietin 1/2 ratio were lower after KTx, reflecting vessel maturation, while arteriolar and microvessel p16 and cleaved Casp3 were higher. Submesothelial mast cell count and interleukin-6 were lower, whereas transforming growth factor-beta induced pSMAD2/3 was similar as compared with children on PD. CONCLUSIONS Peritoneal membrane damage induced with chronic administration of low-GDP PD fluids was less severe after KTx. While peritoneal microvessel density, primarily defining PD transport and ultrafiltration capacity, was normal after KTx and peritoneal inflammation less pronounced, diffuse podoplanin positivity and profibrotic activity were prevalent.
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Affiliation(s)
- Conghui Zhang
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Iva Marinovic
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Betti Schaefer
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Karel Vondrak
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | - Gema Ariceta
- Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, Spain
| | - Ariane Zaloszyc
- Department of Pediatrics 1, University Hospital of Strasbourg, Strasbourg, France
| | - Bruno Ranchin
- Service de Néphrologie Pédiatrique, Hôpital Femme Mere Enfant, Lyon, France
| | - Christina Taylan
- Pediatric Nephrology, Children's and Adolescent's Hospital, University Hospital of Cologne, Cologne, Germany
| | - Rainer Büscher
- Pediatric Nephrology, University Children's Hospital, Essen, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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9
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Bacchetta J, Schmitt CP, Bakkaloglu SA, Cleghorn S, Leifheit-Nestler M, Prytula A, Ranchin B, Schön A, Stabouli S, Van de Walle J, Vidal E, Haffner D, Shroff R. Diagnosis and management of mineral and bone disorders in infants with CKD: clinical practice points from the ESPN CKD-MBD and Dialysis working groups and the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2023; 38:3163-3181. [PMID: 36786859 PMCID: PMC10432337 DOI: 10.1007/s00467-022-05825-6] [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: 08/05/2022] [Revised: 10/19/2022] [Accepted: 11/09/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Infants with chronic kidney disease (CKD) form a vulnerable population who are highly prone to mineral and bone disorders (MBD) including biochemical abnormalities, growth retardation, bone deformities, and fractures. We present a position paper on the diagnosis and management of CKD-MBD in infants based on available evidence and the opinion of experts from the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis working groups and the Pediatric Renal Nutrition Taskforce. METHODS PICO (Patient, Intervention, Comparator, Outcomes) questions were generated, and relevant literature searches performed covering a population of infants below 2 years of age with CKD stages 2-5 or on dialysis. Clinical practice points (CPPs) were developed and leveled using the American Academy of Pediatrics grading matrix. A Delphi consensus approach was followed. RESULTS We present 34 CPPs for diagnosis and management of CKD-MBD in infants, including dietary control of calcium and phosphate, and medications to prevent and treat CKD-MBD (native and active vitamin D, calcium supplementation, phosphate binders). CONCLUSION As there are few high-quality studies in this field, the strength of most statements is weak to moderate, and may need to be adapted to individual patient needs by the treating physician. Research recommendations to study key outcome measures in this unique population are suggested. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Justine Bacchetta
- Reference Center for Rare Renal Diseases, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, Pediatric Nephrology Rheumatology and Dermatology Unit, Hopital Femme Mère Enfant, Boulevard Pinel, 69677 Bron, France
- INSERM 1033 Research Unit, Lyon, France
- Lyon Est Medical School, Université Claude Bernard, Lyon 1, Lyon, France
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Sevcan A. Bakkaloglu
- Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey
| | - Shelley Cleghorn
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Maren Leifheit-Nestler
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Pediatric Research Center, Hannover, Germany
| | - Agnieszka Prytula
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Ranchin
- Reference Center for Rare Renal Diseases, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, Pediatric Nephrology Rheumatology and Dermatology Unit, Hopital Femme Mère Enfant, Boulevard Pinel, 69677 Bron, France
| | - Anne Schön
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Pediatric Research Center, Hannover, Germany
| | - Stella Stabouli
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Johan Van de Walle
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Enrico Vidal
- Pediatric Nephrology Unit, University-Hospital of Padova, Padua, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Pediatric Research Center, Hannover, Germany
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
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10
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Sugianto RI, Grabitz C, Bayazit A, Duzova A, Thurn-Valsassina D, Memaran N, Doyon A, Canpolat N, Kaplan Bulut I, Azukaitis K, Obrycki Ł, Anarat A, Büscher R, Caliskan S, Harambat J, Lugani F, Ozcakar ZB, Paripović D, Ranchin B, Querfeld U, Schaefer F, Schmidt BM, Melk A. Stricter Blood Pressure Control Is Associated With Lower Left Ventricular Mass in Children After Kidney Transplantation: A Longitudinal Analysis of the 4C-T Study. Hypertension 2023; 80:1900-1908. [PMID: 37462031 PMCID: PMC10424823 DOI: 10.1161/hypertensionaha.123.21187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND We assessed the effect of blood pressure (BP) control on left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH). METHODS Ninety-six patients (64 males) ≥9 months post-kidney transplantation from the 4C-T (Cardiovascular Comorbidity in Children with Chronic Kidney Disease and Transplantation) study were analyzed longitudinally (mean follow-up, 2.6±1.3 years). Cumulative systolic blood pressure (SBP)/diastolic BP exposure was calculated as a time-averaged area under the curve and categorized: ≤50th, 50th to ≤75th, 75th to ≤90th, and >90th percentile (pct). We performed adjusted linear and logistic mixed models for LVMI and LVH, respectively. RESULTS At baseline, LVMI was 49.7±12.7g/m2.16 with 64% (n=61) kidney transplantation recipients displaying LVH. Compared with patients with cumulative SBP exposure >90th pct, patients with cumulative SBP of 50th to ≤75th showed a significant LVMI reduction of -5.24g/m2.16 (P=0.007). A similar tendency was seen for cumulative SBP≤50th (β=-3.70 g/m2.16; P=0.067), but patients with cumulative SBP of 75th to ≤90th pct showed no reduction. A post hoc analysis in patients with cumulative SBP≤75th revealed that median SBP exposure was at 57.5th pct. For cumulative diastolic BP, a significant LVMI reduction was seen in all 3 categories ≤90th pct compared with patients >90th pct. Patients with cumulative SBP of ≤50th or 50th to ≤75th pct showed 79% or 83% lower odds of developing LVH, respectively. Patients with cumulative diastolic BP ≤50th showed a tendency of 82% lower odds for LVH (95% CI, 0.03-1.07). CONCLUSIONS Stricter BP control led to regression of LVMI and LVH. Our data suggest a BP target below the 60th pct, which needs to be substantiated in a randomized controlled trial.
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Affiliation(s)
- Rizky I. Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Aysun Bayazit
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey (A.B., A.A.)
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey (A. Duzova)
| | - Daniela Thurn-Valsassina
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Anke Doyon
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany (A. Doyon, F.S.)
| | - Nur Canpolat
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Turkey (N.C., S.C.)
| | - Ipek Kaplan Bulut
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey (I.K.B.)
| | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Lithuania (K.A.)
| | - Łukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, the Children’s Memorial Health Institute, Warsaw, Poland (L.O.)
| | - Ali Anarat
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey (A.B., A.A.)
| | | | - Salim Caliskan
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Turkey (N.C., S.C.)
| | - Jérôme Harambat
- Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux, France (J.H.)
| | | | - Zeynep B. Ozcakar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University Medical School, Turkey (Z.B.O.)
| | - Dušan Paripović
- Department of Nephrology, University Children’s Hospital, School of Medicine, University of Belgrade, Serbia (D.P.)
| | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon & Université de Lyon, France (B.R.)
| | - Uwe Querfeld
- Charité Children’s Hospital, Berlin, Germany (U.Q.)
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany (A. Doyon, F.S.)
| | - Bernhard M.W. Schmidt
- Department of Nephrology and Hypertension (B.M.W.S.), Hannover Medical School, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
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11
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Battista J, De Luca D, Eleni Dit Trolli S, Allard L, Bacchetta J, Bouhamri N, Enoch C, Faudeux C, Guichoux J, Javouhey E, Kolev K, Regiroli G, Ranchin B, Bernardor J. CARPEDIEM® for continuous kidney replacement therapy in neonates and small infants: a French multicenter retrospective study. Pediatr Nephrol 2023; 38:2827-2837. [PMID: 36625933 DOI: 10.1007/s00467-022-05871-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/10/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Cardio-Renal Pediatric Dialysis Emergency Machine (CA.R.P.E.D.I.E.M.®) device is a continuous kidney replacement therapy (CKRT) equipment dedicated to neonates and small infants. This study aimed to assess the effectiveness, feasibility, outcomes, and technical considerations relating to CARPEDIEM® use. METHODS This retrospective multicenter study included 19 newborns and six infants receiving CARPEDIEM® in five French pediatric and neonatal intensive care units. Laboratory parameters were collected at the initiation and end of the first CARPEDIEM® session. Results are presented as median [IQR] (range). RESULTS At initiation, age was 4 days [2-13] (1-1134) with a body weight of 3.3 kg [2.5-4] (1.3-11.1). Overall, 131 sessions and 2125 h of treatment were performed. Treatment duration per patient was 42 h [24-91] (8-557). Continuous veno-venous hemofiltration (CVVH) was performed in 20 children. Blood flow rate was 8 mL/kg/min [6-9] (3-16). The effluent flow rate for CVVH was 74 mL/kg/h [43-99] (28-125) and net ultrafiltration (UF) 6 mL/kg/h [2-8] (1-12). In the five children treated by hemodialysis, the blood and dialysate flow rates were 6 mL/kg/min [5-7] (4-7) and 600 mL/h [300-600] (120-600), respectively, while session duration was 8 h [6-12] (2-24). Most infants required a catheter between 4.5 and 6.5 French. Hemodynamic instability with a need for volume replacement occurred in 31 sessions (23%). Thrombocytopenia was observed in 29 sessions (22%). No hemorrhage occurred; all the patients survived the sessions, but only eight patients (32%) were alive at hospital discharge. CONCLUSIONS These data confirm that the use of CARPEDIEM® is safe and effective in critically ill neonates and infants. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Jennifer Battista
- Department of Pediatric Nephrology, Archet 2, CHU de Nice, Hôpital Archet, 151 Route Saint-Antoine de Ginestière, 06200, Nice, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, and the Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Sergio Eleni Dit Trolli
- Department of Intensive Care and Neonatal Medecine, CHU de Nice, Hôpital Archet, Nice, France
| | - Lise Allard
- Pediatric Nephrology Unit, Reference Center for Rare Renal Diseases, SORARE, Bordeaux University Hospital, Bordeaux, France
| | - Justine Bacchetta
- Reference Center for Rare Renal Diseases, Pediatric Nephrology-Rheumatology-Dermatology Unit and INSERM 1033 Unit, Hospices Civils de Lyon, Femme Mere Enfant Hospital, Lyon 1 University, Bron, France
| | - Nourredine Bouhamri
- Pediatric Intensive Care Unit, Hôpital Louis Pradel, Lyon 1 University, Lyon, France
| | - Carole Enoch
- Pediatric Nephrology, Internal Medicine and Rheumatology, Southwest Renal Rare Diseases Centre (SORARE), University Children's Hospital, Toulouse, France
| | - Camille Faudeux
- Department of Pediatric Nephrology, Archet 2, CHU de Nice, Hôpital Archet, 151 Route Saint-Antoine de Ginestière, 06200, Nice, France
| | - Julie Guichoux
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Etienne Javouhey
- Paediatric Intensive Care Unit, Mother and Children University Hospital, Hospices Civils de Lyon, Bron, France
| | - Karine Kolev
- Paediatric Intensive Care Unit, Mother and Children University Hospital, Hospices Civils de Lyon, Bron, France
| | - Giulia Regiroli
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, and the Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Bruno Ranchin
- Reference Center for Rare Renal Diseases, Pediatric Nephrology-Rheumatology-Dermatology Unit and INSERM 1033 Unit, Hospices Civils de Lyon, Femme Mere Enfant Hospital, Lyon 1 University, Bron, France
| | - Julie Bernardor
- Department of Pediatric Nephrology, Archet 2, CHU de Nice, Hôpital Archet, 151 Route Saint-Antoine de Ginestière, 06200, Nice, France.
- Reference Center for Rare Renal Diseases, Pediatric Nephrology-Rheumatology-Dermatology Unit and INSERM 1033 Unit, Hospices Civils de Lyon, Femme Mere Enfant Hospital, Lyon 1 University, Bron, France.
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12
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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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13
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Speer T, Schunk SJ, Sarakpi T, Schmit D, Wagner M, Arnold L, Zewinger S, Azukaitis K, Bayazit A, Obrycki L, Kaplan Bulut I, Duzova A, Doyon A, Ranchin B, Caliskan S, Harambat J, Yilmaz A, Alpay H, Lugani F, Balat A, Arbeiter K, Longo G, Melk A, Querfeld U, Wühl E, Mehls O, Fliser D, Schaefer F. Urinary DKK3 as a biomarker for short-term kidney function decline in children with chronic kidney disease: an observational cohort study. Lancet Child Adolesc Health 2023; 7:405-414. [PMID: 37119829 DOI: 10.1016/s2352-4642(23)00049-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Childhood-onset chronic kidney disease is a progressive condition that can have a major effect on life expectancy and quality. We evaluated the usefulness of the kidney tubular cell stress marker urinary Dickkopf-related protein 3 (DKK3) in determining the short-term risk of chronic kidney disease progression in children and identifying those who will benefit from specific nephroprotective interventions. METHODS In this observational cohort study, we assessed the association between urinary DKK3 and the combined kidney endpoint (ie, the composite of 50% reduction of the estimated glomerular filtration rate [eGFR] or progression to end-stage kidney disease) or the risk of kidney replacement therapy (ie, dialysis or transplantation), and the interaction of the combined kidney endpoint with intensified blood pressure reduction in the randomised controlled ESCAPE trial. Moreover, urinary DKK3 and eGFR were quantified in children aged 3-18 years with chronic kidney disease and urine samples available enrolled in the prospective multicentre ESCAPE (NCT00221845; derivation cohort) and 4C (NCT01046448; validation cohort) studies at baseline and at 6-monthly follow-up visits. Analyses were adjusted for age, sex, hypertension, systolic blood pressure SD score (SDS), BMI SDS, albuminuria, and eGFR. FINDINGS 659 children were included in the analysis (231 from ESCAPE and 428 from 4C), with 1173 half-year blocks in ESCAPE and 2762 in 4C. In both cohorts, urinary DKK3 above the median (ie, >1689 pg/mg creatinine) was associated with significantly greater 6-month eGFR decline than with urinary DKK3 at or below the median (-5·6% [95% CI -8·6 to -2·7] vs 1·0% [-1·9 to 3·9], p<0·0001, in ESCAPE; -6·2% [-7·3 to -5·0] vs -1·5% [-2·9 to -0·1], p<0·0001, in 4C), independently of diagnosis, eGFR, and albuminuria. In ESCAPE, the beneficial effect of intensified blood pressure control was limited to children with urinary DKK3 higher than 1689 pg/mg creatinine, in terms of the combined kidney endpoint (HR 0·27 [95% CI 0·14 to 0·55], p=0·0003, number needed to treat 4·0 [95% CI 3·7 to 4·4] vs 250·0 [66·9 to ∞]) and the need for kidney replacement therapy (HR 0·33 [0·13 to 0·85], p=0·021, number needed to treat 6·7 [6·1 to 7·2] vs 31·0 [27·4 to 35·9]). In 4C, inhibition of the renin-angiotensin-aldosterone system resulted in significantly lower urinary DKK3 concentrations (least-squares mean 12 235 pg/mg creatinine [95% CI 10 036 to 14 433] in patients not on angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers vs 6861 pg/mg creatinine [5616 to 8106] in those taking angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers, p<0·0001). INTERPRETATION Urinary DKK3 indicates short-term risk of declining kidney function in children with chronic kidney disease and might allow a personalised medicine approach by identifying those who benefit from pharmacological nephroprotection, such as intensified blood pressure lowering. FUNDING None.
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Affiliation(s)
- Thimoteus Speer
- Department of Internal Medicine 4, Nephrology, Goethe-University, Frankfurt, Germany; Else Kroener Fresenius Center for Nephrological Research, Goethe-University, Frankfurt, Germany
| | - Stefan J Schunk
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tamim Sarakpi
- Department of Internal Medicine 4, Nephrology, Goethe-University, Frankfurt, Germany
| | - David Schmit
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Martina Wagner
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Ludger Arnold
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stephen Zewinger
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun Bayazit
- Department of Pediatric Nephrology, Cukurova University, Adana, Turkey
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Ipek Kaplan Bulut
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Salim Caliskan
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Jerome Harambat
- Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Alev Yilmaz
- Pediatric Nephrology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Harika Alpay
- Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Francesca Lugani
- Pediatric Nephrology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Ayse Balat
- Department of Pediatric Nephrology, Gaziantep University, Gaziantep, Turkey
| | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Germana Longo
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, Azienda Ospedaliera-University of Padova, Padova, Italy
| | - Anette Melk
- Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Uwe Querfeld
- Department of Pediatrics, Division of Gastroenterology, Nephrology and Metabolic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Otto Mehls
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Saarland University Medical Center, Homburg/Saar, Germany; DiaRen, Homburg/Saar, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany.
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Mosca M, Bacchetta J, Chamouard V, Rascle P, Dubois V, Paul S, Mekki Y, Picard C, Bertholet-Thomas A, Ranchin B, Sellier-Leclerc AL. IVIg therapy in the management of BK virus infections in pediatric kidney transplant patients. Arch Pediatr 2023; 30:165-171. [PMID: 36907728 DOI: 10.1016/j.arcped.2023.01.005] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/23/2022] [Accepted: 01/15/2023] [Indexed: 03/12/2023]
Abstract
BK virus-associated nephropathy (BKPyVAN) induces kidney allograft dysfunction. Although decreasing immunosuppression is the standard for managing BK virus (BKPyV) infection, this strategy is not always effective. The use of polyvalent immunoglobulins (IVIg) may be of interest in this setting. We performed a retrospective single-center evaluation of the management of BKPyV infection in pediatric kidney transplant patients. Among the 171 patients who underwent transplantation between January 2010 and December 2019, 54 patients were excluded (combined transplant n = 15, follow-up in another center n = 35, early postoperative graft loss n= 4). Thus, 117 patients (120 transplants) were included. Overall, 34 (28%) and 15 (13%) transplant recipients displayed positive BKPyV viruria and viremia, respectively. Three had biopsy-confirmed BKPyVAN. The pre-transplant prevalence of CAKUT and HLA antibodies was higher among BKPyV-positive patients compared to non-infected patients. After the detection of BKPyV replication and/or BKPyVAN, the immunosuppressive regimen was modified in 13 (87%) patients: either by decreasing or changing the calcineurin inhibitors (n = 13) and/or switching from mycophenolate mofetil to mTor inhibitors (n = 10). Starting IVIg therapy was based on graft dysfunction or an increase in the viral load despite reduced immunosuppressive regimen. Seven of 15(46%) patients received IVIg. These patients had a higher viral load (5.4 [5.0-6.8]log vs. 3.5 [3.3-3.8]log). In total, 13 of 15 (86%) achieved viral load reduction, five of seven after IVIg therapy. As long as specific antivirals are not available for the management of BKPyV infections in pediatric kidney transplant patients, polyvalent IVIg may be discussed for the management of severe BKPyV viremia, in combination with decreased immunosuppression.
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Affiliation(s)
- M Mosca
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France.
| | - J Bacchetta
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France
| | - V Chamouard
- Hospices Civils de Lyon, Hôpital Louis Pradel, Unité d'Hémostase Clinique, Université Claude Bernard Lyon 1, Bron Cedex F-69677, France
| | - P Rascle
- Hospices Civils de Lyon, OMEDIT Rhône-Alpes, Bron Cedex F-69677, France
| | - V Dubois
- EFS Auvergne Rhône Alpes, laboratoire HLA, Décines Cedex F- 69151, France
| | - S Paul
- EFS Auvergne Rhône Alpes, laboratoire HLA, Décines Cedex F- 69151, France
| | - Y Mekki
- Hospices Civils de Lyon, Groupement hospitalier Nord, Laboratoire de virologie, Lyon Cedex F-69003
| | - C Picard
- Institut de Pathologie Multisite, Site Est, Hospices Civils de Lyon, Lyon, France
| | - A Bertholet-Thomas
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France
| | - B Ranchin
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France
| | - A L Sellier-Leclerc
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France
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15
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Ranchin B, Schmitt CP, Warady B, Craig JC, Licht C, Hataya H, Vidal E, Walle JV, Shroff R. Devices for long-term hemodialysis in small children – a plea for action. Kidney Int 2023; 103:1038-1040. [PMID: 36990213 DOI: 10.1016/j.kint.2023.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
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16
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Paglialonga F, Monzani A, Prodam F, Smith C, De Zan F, Canpolat N, Agbas A, Bayazit A, Anarat A, Bakkaloglu SA, Askiti V, Stefanidis CJ, Azukaitis K, Bulut IK, Borzych-Dużałka D, Duzova A, Habbig S, Krid S, Licht C, Litwin M, Obrycki L, Ranchin B, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Vidal E, Yilmaz A, Fischbach M, Schaefer F, Schmitt CP, Edefonti A, Shroff R. Nutritional and Anthropometric Indices in Children Receiving Haemodiafiltration vs Conventional Haemodialysis - The HDF, Heart and Height (3H) Study. J Ren Nutr 2023; 33:17-28. [PMID: 35870690 DOI: 10.1053/j.jrn.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The "HDF-Heart-Height" study showed that haemodiafiltration (HDF) is associated with improved growth compared to conventional haemodialysis (HD). We report a post-hoc analysis of this study assessing the effect of extracorporeal dialysis therapies on nutritional indices. METHODS 107 children were included in the baseline cross-sectional analysis, of whom 79 (43 HD, 36 HDF) completed the 12-month follow-up. Height (Ht), optimal 'dry' weight (Wt), and body mass index (BMI) standard deviations scores (SDS), waist-to-hip ratio, des-acyl ghrelin (DAG), adiponectin, leptin, insulin-like growth factor-1 (IGF-1)-SDS and insulin were measured. RESULTS The levels of nutritional indices were comparable between HDF and HD patients at baseline and 12-month. On univariable analyses Wt-SDS positively correlated with leptin and IGF-1-SDS, and negatively with DAG, while Ht-SDS of the overall cohort positively correlated with IGF1-SDS and inversely with DAG and adiponectin. On multivariable analyses, higher 12-month Ht-SDS was inversely associated with baseline DAG (beta = -0.13 per 500 higher; 95%CI -0.22, -0.04; P = .004). Higher Wt-SDS at 12-month was positively associated with HDF modality (beta = 0.47 vs HD; 95%CI 0.12-0.83; P = .01) and inversely with baseline DAG (beta = -0.18 per 500 higher; 95%CI -0.32, -0.05; P = .006). Growth Hormone (GH) treated patients receiving HDF had higher annualized increase in Ht SDS compared to those on HD. CONCLUSIONS In children on HD and HDF both Wt- and Ht-SDS independently correlated with lower baseline levels of the anorexygenic hormone DAG. HDF may attenuate the resistance to GH, but further studies are required to examine the mechanisms linking HDF to improved growth.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alice Monzani
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Colette Smith
- Institute of Global Health, University College London, London, UK
| | - Francesca De Zan
- University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | | | - Ayse Agbas
- Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | | | | | | | | | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | | | | | | | | | | | | | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | | | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | - Manish D Sinha
- Kings College London Evelina London Children's Hospital, London, UK
| | | | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Italy
| | - Alev Yilmaz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | | | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
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17
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Sugianto RI, Memaran N, Schmidt BMW, Doyon A, Thurn-Valsassina D, Alpay H, Anarat A, Arbeiter K, Azukaitis K, Bayazit AK, Bulut IK, Caliskan S, Canpolat N, Duzova A, Gellerman J, Harambat J, Homeyer D, Litwin M, Mencarelli F, Obrycki L, Paripovic D, Ranchin B, Shroff R, Tegtbur U, Born JVD, Yilmaz E, Querfeld U, Wühl E, Schaefer F, Melk A. Response to the commentary "Modeling pulse wave velocity trajectories-challenges, opportunities, and pitfalls". Kidney Int 2022; 102:938-939. [PMID: 36150766 DOI: 10.1016/j.kint.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Rizky I Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Anke Doyon
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Thurn-Valsassina
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Harika Alpay
- Medical Faculty, Marmara University, Istanbul, Turkey
| | - Ali Anarat
- Department of Pediatrics, Faculty of Medicine, Adana, Turkey
| | - Klaus Arbeiter
- Department of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun K Bayazit
- Department of Pediatrics, Faculty of Medicine, Adana, Turkey
| | - Ipek K Bulut
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Salim Caliskan
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Jerome Harambat
- Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Denise Homeyer
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Mieczyslaw Litwin
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dusan Paripovic
- Department of Nephrology, Children's Hospital, University of Belgrade, Belgrade, Serbia
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Rukshana Shroff
- Department of Pediatric Nephrology, Great Ormond Street Hospital, London, UK
| | - Uwe Tegtbur
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ebru Yilmaz
- Department of Pediatric Nephrology, Sanliurfa Children's Hospital, Sanliurfa, Turkey
| | | | - Elke Wühl
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
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18
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Dao M, Decramer S, Llanas B, Chauveau D, Nobili F, Ranchin B, Rieu P, Knebelmann B, Hummel A, Servais A. Devenir à l’âge adulte des patients suivis pour un syndrome de Lowe. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.194] [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: 10/14/2022]
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Bernard J, Sellier-Leclerc AL, Demède D, Chamouard V, Ranchin B, Bacchetta J. Rituximab as induction therapy in pediatric kidney transplantation: A single-center experience in four patients. Pediatr Transplant 2022; 26:e14329. [PMID: 35655369 DOI: 10.1111/petr.14329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/09/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The anti-CD20 rituximab is often used in the treatment of children with steroid-resistant nephrotic syndrome or EBV-induced post-transplant lymphoproliferative disorder. This single-center series reports the use of rituximab as induction therapy in pediatric kidney transplantation. METHODS Four children who received rituximab as induction therapy for kidney transplantation since 2016 were retrospectively analyzed. Clinical and laboratory data were extracted from medical records. RESULTS The patients (2 boys and 2 girls) were aged from 6.1 to 11.9 years and were treated with rituximab on the day of the transplantation procedure; all the transplants came from deceased donors. In all patients, rituximab was used because of positive EBV viral loads before kidney transplantation. Viral loads remained undetectable for the first 6 months after the transplantation procedure and remained below the 4.5 log threshold thereafter. After a median follow-up of 2.3 years, none of the patients displayed rejection or de novo donor-specific antibodies; the glomerular filtration rate remained above 70 ml/min/1.73 m2 . No post-transplant lymphoproliferative disorder was observed. CONCLUSION The results suggest that rituximab can be used as induction therapy to prevent EBV replication and its complications in case of positive viral load prior to kidney transplantation.
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Affiliation(s)
- Josselin Bernard
- Pediatric Department, University Hospital of Nantes, Nantes, France.,Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hôpital Femme Mère Enfant, Rare Disease Networks ORKID and ERK-Net, Hospices Civils de Lyon, Bron, France
| | - Anne-Laure Sellier-Leclerc
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hôpital Femme Mère Enfant, Rare Disease Networks ORKID and ERK-Net, Hospices Civils de Lyon, Bron, France
| | - Delphine Demède
- Pediatric Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Valérie Chamouard
- Pharmacy Department, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Bruno Ranchin
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hôpital Femme Mère Enfant, Rare Disease Networks ORKID and ERK-Net, Hospices Civils de Lyon, Bron, France
| | - Justine Bacchetta
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hôpital Femme Mère Enfant, Rare Disease Networks ORKID and ERK-Net, Hospices Civils de Lyon, Bron, France.,Pediatric Surgery Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.,Pharmacy Department, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France.,Lyon Est Medical School, Lyon 1 University, Lyon, France
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Bedin M, Boyer O, Servais A, Li Y, Villoing-Gaudé L, Tête MJ, Cambier A, Hogan J, Baudouin V, Krid S, Bensman A, Lammens F, Louillet F, Ranchin B, Vigneau C, Bouteau I, Isnard-Bagnis C, Mache CJ, Schäfer T, Pape L, Gödel M, Huber TB, Benz M, Klaus G, Hansen M, Latta K, Gribouval O, Morinière V, Tournant C, Grohmann M, Kuhn E, Wagner T, Bole-Feysot C, Jabot-Hanin F, Nitschké P, Ahluwalia TS, Köttgen A, Andersen CBF, Bergmann C, Antignac C, Simons M. Human C-terminal CUBN variants associate with chronic proteinuria and normal renal function. J Clin Invest 2022; 132:161852. [PMID: 35642643 PMCID: PMC9151686 DOI: 10.1172/jci161852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hummel A, Oniszczuk J, Kervella D, Charbit M, Guerrot D, Testa A, Philipponnet C, Chauvet C, Guincestre T, Brochard K, Benezech A, Figueres L, Belenfant X, Guarnieri A, Demoulin N, Benetti E, Miglinas M, Dessaix K, Morelle J, Angeletti A, Sellier-Leclerc AL, Ranchin B, Goussard G, Hudier L, Bacchetta J, Servais A, Audard V. Idiopathic nephrotic syndrome relapse following SARS-CoV-2 vaccination: a series of 25 cases. Clin Kidney J 2022; 15:1574-1582. [PMID: 35979142 PMCID: PMC9129143 DOI: 10.1093/ckj/sfac134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several cases of idiopathic nephrotic syndrome (INS) relapse following the administration of coronavirus disease 2019 (COVID-19) vaccines have recently been reported, raising questions about the potential relationship between the immune response to COVID-19 vaccination and INS pathogenesis. Methods We performed a retrospective multicentre survey describing the clinical and biological characteristics of patients presenting a relapse of INS after COVID-19 vaccination, with an assessment of outcome under treatment. Results We identified 25 patients (16 men and 9 women) presenting a relapse within 1 month of a COVID-19 vaccine injection. The glomerular disease was of childhood onset in half of the patients and most patients (21/25) had received at least one immunosuppressive drug in addition to steroids for frequently relapsing or steroid-dependent nephrotic syndrome (NS). All patients were in a stable condition at the time of injection and 11 had no specific treatment. In five patients, the last relapse was reported >5 years before vaccine injection. The Pfizer-BioNTech (BNT162b2) vaccine was used in 80% of the patients. In 18 cases, INS relapse occurred after the first injection, a mean of 17.5 days after vaccination. A second injection was nevertheless administered in 14 of these patients. Five relapses occurred after administration of the second dose and two relapses after the administration of the third dose. All but one of the patients received steroids as first-line treatment, with an additional immunosuppressive agent in nine cases. During follow-up, complete remission was achieved in 21 patients, within 1 month in 17 cases. Only one patient had not achieved at least partial remission after 3 months of follow-up. Conclusions This case series suggests that, in rare patients, COVID-19 vaccination may trigger INS relapse that is generally easy to control. These findings should encourage physicians to persuade their patients to complete the COVID-19 vaccination schedule.
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Affiliation(s)
- Aurélie Hummel
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique » (SNI), Paris, France
| | - Julie Oniszczuk
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare SNI, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalo Universitaire (CHU) Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche (UMR) 1064, INSERM, Université de Nantes, Nantes, France
| | - Marina Charbit
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie pédiatrique, Centre de référence MARHEA, centre de référence SNI, Institut Imagine, Université de Paris, Paris, France
| | - Dominique Guerrot
- Department of Nephrology, Hemodialysis and Transplantation, Rouen University Hospital, Rouen, France
- Normandy University, UNIROUEN, INSERM U1096, Rouen, France
| | - Angelo Testa
- E.C.H.O. (Expansion Centre Hémodialyse de l'Ouest) Site Confluent REZE, France
| | - Carole Philipponnet
- Service Nephrologie Dialyse et Transplantation rénale CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Chauvet
- Service de Néphrologie, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Thomas Guincestre
- Service de Néphrologie, Centre Hospitalier de Roubaix, Roubaix, France
| | - Karine Brochard
- Service de Néphrologie-Rhumatologie-Médecine Interne pédiatrique, Centre de Référence des Maladies rénales Rares du Sud-Ouest (SORARE), Hôpital des enfants, Toulouse, France
| | - Ariane Benezech
- Service de Néphrologie-Rhumatologie-Médecine Interne pédiatrique, Centre de Référence des Maladies rénales Rares du Sud-Ouest (SORARE), Hôpital des enfants, Toulouse, France
| | - Lucile Figueres
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalo Universitaire (CHU) Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche (UMR) 1064, INSERM, Université de Nantes, Nantes, France
| | - Xavier Belenfant
- Groupe Hospitalier Grand Paris Nord Est, Hôpital André Grégoire, Service de Néphrologie-Dialyse, Montreuil, France
| | | | - Nathalie Demoulin
- Nephrology Division, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Marius Miglinas
- Nephrology Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kathleen Dessaix
- Université de Montpellier, Service de Nephrologie, CHU Montpellier, Hôpital Lapeyronie, Montpellier, France
| | - Johann Morelle
- Nephrology Division, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, Transplantation, IRCCS Giannini Gaslini Children's Hospital, Via Gerolamo Gaslini 5, Genova, Italy
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Guillaume Goussard
- Service de Néphrologie et Transplantation CHU Poitiers, Poitiers, France
| | - Laurent Hudier
- Service de Néphrologie, Centre Hospitalier Broussais, Saint Malo, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Aude Servais
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique » (SNI), Paris, France
| | - Vincent Audard
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare SNI, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
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22
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Ajiri R, Burgmaier K, Akinci N, Broekaert I, Büscher A, Dursun I, Duzova A, Eid LA, Fila M, Gessner M, Gokce I, Massella L, Mastrangelo A, Miklaszewska M, Prikhodina L, Ranchin B, Ranguelov N, Rus R, Sever L, Thumfart J, Weber LT, Wühl E, Yilmaz A, Dötsch J, Schaefer F, Liebau MC. Phenotypic Variability in Siblings with Autosomal Recessive Polycystic Kidney Disease. Kidney Int Rep 2022; 7:1643-1652. [PMID: 35812281 PMCID: PMC9263410 DOI: 10.1016/j.ekir.2022.04.095] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Autosomal recessive polycystic kidney disease (ARPKD) is a rare monogenic disorder characterized by early onset fibrocystic hepatorenal changes. Previous reports have documented pronounced phenotypic variability even among siblings in terms of patient survival. The underlying causes for this clinical variability are incompletely understood. Methods We present the longitudinal clinical courses of 35 sibling pairs included in the ARPKD registry study ARegPKD, encompassing data on primary manifestation, prenatal and perinatal findings, genetic testing, and family history, including kidney function, liver involvement, and radiological findings. Results We identified 70 siblings from 35 families with a median age of 0.7 (interquartile range 0.1–6.0) years at initial diagnosis and a median follow-up time of 3.5 (0.2–6.2) years. Data on PKHD1 variants were available for 37 patients from 21 families. There were 8 patients from 7 families who required kidney replacement therapy (KRT) during follow-up. For 44 patients from 26 families, antihypertensive therapy was documented. Furthermore, 37 patients from 24 families had signs of portal hypertension with 9 patients from 6 families having substantial hepatic complications. Interestingly, pronounced variability in the clinical course of functional kidney disease was documented in only 3 sibling pairs. In 17 of 20 families of our cohort of neonatal survivors, siblings had only minor differences of kidney function at a comparable age. Conclusion In patients surviving the neonatal period, our longitudinal follow-up of 70 ARPKD siblings from 35 families revealed comparable clinical courses of kidney and liver diseases in most families. The data suggest a strong impact of the underlying genotype.
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Affiliation(s)
- Ramona Ajiri
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nurver Akinci
- Department of Pediatric Nephrology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ilse Broekaert
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anja Büscher
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Ismail Dursun
- Department of Pediatric Nephrology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Loai Akram Eid
- Department of Pediatric Nephrology, Dubai Kidney Center of Excellence, Dubai Hospital, Dubai, United Arab Emirates
| | - Marc Fila
- Pediatric Nephrology Unit, CHU Arnaud de Villeneuve-Université de Montpellier, Montpellier, France
| | - Michaela Gessner
- Department of General Pediatrics and Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Ibrahim Gokce
- Division of Pediatric Nephrology, Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital—IRCCS, Rome, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Larisa Prikhodina
- Department of Inherited and Acquired Kidney Diseases, Veltishev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de référence maladies rénales rares, Bron, France
| | - Nadejda Ranguelov
- Department of Pediatrics, Saint-Luc Academic Hospital, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Rina Rus
- Division of Nephrology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Lale Sever
- Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz Thorsten Weber
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Alev Yilmaz
- Pediatric Nephrology Department, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Jörg Dötsch
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Max Christoph Liebau
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
- Correspondence: Max Christoph Liebau, Department of Pediatrics, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
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23
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Ndongo A, Ranchin B, Cartier R, Bertholet-Thomas A, Bacchetta J, Cochat P. Are plasma proteins a valid alternative for assessing nephrotic syndrome in children from low-income countries? Arch Pediatr 2022; 29:263-266. [DOI: 10.1016/j.arcped.2022.02.009] [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] [Received: 09/12/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 12/23/2022]
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24
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Ranchin B, Mosca M, Bacchetta J. Hémodiafiltration : particularités pédiatriques. Nephrol Ther 2022. [DOI: 10.1016/s1769-7255(22)00036-0] [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: 11/26/2022]
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25
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Madden I, Baudouin V, Charbit M, Ranchin B, Roussey G, Novo R, Garaix F, Decramer S, Fila M, Merieau E, Vrillon I, Zaloszyc A, Hogan J, Harambat J. National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines. Front Pediatr 2022; 10:1057352. [PMID: 36589153 PMCID: PMC9800817 DOI: 10.3389/fped.2022.1057352] [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: 09/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is one of the most frequent opportunistic infections in kidney transplant (KT) recipients and is a risk factor for patient and graft survival after KT. Center-to-center variation, optimal prevention and treatment strategies in pediatric KT are currently unknown. This survey aimed to assess current CMV prevention and treatment strategies used among French pediatric KT centers. METHODS A web-based survey was sent to all 13 French pediatric kidney transplantation centers. RESULTS Twelve (92%) centers responded to the survey. All centers used prophylaxis for the donor-positive/recipient-negative (D+/R-) group. For R + patients, 54% used prophylaxis, 37% used a pre-emptive strategy. In the low-risk group, D-/R-, 50% used a pre-emptive approach and 50% had no specific prevention strategy. The antiviral used by all centers for prophylaxis was valganciclovir (VGCV). The duration of prophylaxis varied from 3 to 7 months and the duration of viral load monitoring varied from 6 months to indefinitely. No center used a hybrid/sequential approach. For the treatment of CMV DNAemia, VGCV or intravenous GCV were used. Therapeutic drug monitoring of VGCV was performed in 5 centers (42%). Five centers reported drug resistance. Eight centers (67%) administered VGCV during the treatment of acute graft rejection. CONCLUSIONS There is uniformity in CMV management in some areas among pediatric KT centers in France but not in others which remain diverse and are not up to date with current guidelines, suggesting unnecessary variation which could be reduced with better evidence to inform practice.
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Affiliation(s)
- Iona Madden
- Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Marina Charbit
- Pediatric Nephrology Unit, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hospices Civils de Lyon, Lyon, France
| | - Gwenaëlle Roussey
- Pediatric Nephrology Unit, Nantes University Hospital, Nantes, France
| | - Robert Novo
- Pediatric Nephrology Unit, Lille University Hospital, Lille, France
| | - Florentine Garaix
- Pediatric Nephrology Unit, AP-Hôpitaux de Marseille, Marseille, France
| | - Stéphane Decramer
- Pediatric Nephrology Unit, Toulouse University Hospital, Toulouse, France
| | - Marc Fila
- Pediatric Nephrology Unit, Montpellier University Hospital, Montpellier, France
| | - Elodie Merieau
- Pediatric Nephrology Unit, Tours University Hospital, Tours, France
| | - Isabelle Vrillon
- Pediatric Nephrology Unit, Nancy University Hospital, Nancy, France
| | - Ariane Zaloszyc
- Pediatric Nephrology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Julien Hogan
- Pediatric Nephrology Unit, Robert Debré Hospital, APHP, Paris, France
| | - Jérôme Harambat
- Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France
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26
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Sugianto RI, Memaran N, Schmidt BMW, Doyon A, Thurn-Valsassina D, Alpay H, Anarat A, Arbeiter K, Azukaitis K, Bayazit AK, Bulut IK, Caliskan S, Canpolat N, Duzova A, Gellerman J, Harambat J, Homeyer D, Litwin M, Mencarelli F, Obrycki L, Paripovic D, Ranchin B, Shroff R, Tegtbur U, Born JVD, Yilmaz E, Querfeld U, Wühl E, Schaefer F, Melk A. Insights from the 4C-T Study suggest increased cardiovascular burden in girls with end stage kidney disease before and after kidney transplantation. Kidney Int 2021; 101:585-596. [PMID: 34952099 DOI: 10.1016/j.kint.2021.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/23/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 01/09/2023]
Abstract
Mortality in children with kidney failure is higher in girls than boys with cardiovascular complications representing the most common causes of death. Pulse wave velocity (PWV), a measure of vascular stiffness, predicts cardiovascular mortality in adults. Here, PWV in children with kidney failure undergoing kidney replacement therapy was investigated to determine sex differences and potential contributing factors. Two-hundred-thirty-five children (80 girls; 34%) undergoing transplantation (150 pre-emptive, 85 with prior dialysis) having at least one PWV measurement pre- and/or post-transplantation from a prospective cohort were analyzed. Longitudinal analyses (median/maximum follow-up time of 6/9 years) were performed for PWV z-scores (PWVz) using linear mixed regression models and further stratified by the categories of time: pre-kidney replacement therapy and post-transplantation. PWVz significantly increased by 0.094 per year and was significantly higher in girls (PWVz +0.295) compared to boys, independent of the underlying kidney disease. During pre-kidney replacement therapy, an average estimated GFR decline of 4ml/min/1.73m2 per year was associated with a PWVz increase of 0.16 in girls only. Higher diastolic blood pressure and low density lipoprotein were independently associated with higher PWVz during pre-kidney replacement therapy in both sexes. In girls post-transplantation, an estimated GFR decline of 4ml/min/1.73m2 per year pre-kidney replacement therapy and a longer time (over 12 months) to transplantation were significantly associated with higher PWVz of 0.22 and of 0.57, respectively. PWVz increased further after transplantation and was positively associated with time on dialysis and diastolic blood pressure in both sexes. Thus, our findings demonstrate that girls with advanced chronic kidney disease are more susceptible to develop vascular stiffening compared to boys, this difference persist after transplantation and might contribute to higher mortality rates seen in girls with kidney failure.
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Affiliation(s)
- Rizky I Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Anke Doyon
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Thurn-Valsassina
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Harika Alpay
- Medical Faculty, Marmara University, Istanbul, Turkey
| | | | - Klaus Arbeiter
- Pediatric Nephrology, University Children's Hospital, Vienna, Austria
| | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Salim Caliskan
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Nur Canpolat
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Jerome Harambat
- Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Denise Homeyer
- Institute for Sport Medicine, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon & Université de Lyon, Lyon, France
| | | | - Uwe Tegtbur
- Institute for Sport Medicine, Hannover Medical School, Hannover, Germany
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ebru Yilmaz
- Sanliurfa Children's Hospital, Sanliurfa, Turkey
| | | | - Elke Wühl
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
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27
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Fischer DC, Smith C, De Zan F, Bacchetta J, Bakkaloglu SA, Agbas A, Anarat A, Aoun B, Askiti V, Azukaitis K, Bayazit A, Bulut IK, Canpolat N, Borzych-Dużałka D, Duzova A, Habbig S, Krid S, Licht C, Litwin M, Obrycki L, Paglialonga F, Rahn A, Ranchin B, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Stefanidis CJ, Vidal E, Yilmaz A, Fischbach M, Schaefer F, Schmitt CP, Shroff R. Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional Hemodialysis in Children: The HDF, Hearts and Heights (3H) Study. Kidney Int Rep 2021; 6:2358-2370. [PMID: 34514197 PMCID: PMC8418977 DOI: 10.1016/j.ekir.2021.06.025] [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: 05/23/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
Background Patients on dialysis have a high burden of bone-related comorbidities, including fractures. We report a post hoc analysis of the prospective cohort study HDF, Hearts and Heights (3H) to determine the prevalence and risk factors for chronic kidney disease-related bone disease in children on hemodiafiltration (HDF) and conventional hemodialysis (HD). Methods The baseline cross-sectional analysis included 144 children, of which 103 (61 HD, 42 HDF) completed 12-month follow-up. Circulating biomarkers of bone formation and resorption, inflammatory markers, fibroblast growth factor-23, and klotho were measured. Results Inflammatory markers interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein were lower in HDF than in HD cohorts at baseline and at 12 months (P < .001). Concentrations of bone formation (bone-specific alkaline phosphatase) and resorption (tartrate-resistant acid phosphatase 5b) markers were comparable between cohorts at baseline, but after 12-months the bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio increased in HDF (P = .004) and was unchanged in HD (P = .44). On adjusted analysis, the bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio was 2.66-fold lower (95% confidence interval, −3.91 to −1.41; P < .0001) in HD compared with HDF. Fibroblast growth factor-23 was comparable between groups at baseline (P = .52) but increased in HD (P < .0001) and remained unchanged in HDF (P = .34) at 12 months. Klotho levels were similar between groups and unchanged during follow-up. The fibroblast growth factor-23/klotho ratio was 3.86-fold higher (95% confidence interval, 2.15–6.93; P < .0001) after 12 months of HD compared with HDF. Conclusion Children on HDF have an attenuated inflammatory profile, increased bone formation, and lower fibroblast growth factor-23/klotho ratios compared with those on HD. Long-term studies are required to determine the effects of an improved bone biomarker profile on fracture risk and cardiovascular health.
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Affiliation(s)
| | - Colette Smith
- Pediatric Nephrology Unit, Institute of Global Health, University College London, London, UK
| | - Francesca De Zan
- Pediatric Nephrology Unit, University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Justine Bacchetta
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | | | - Ayse Agbas
- Pediatric Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ali Anarat
- Pediatric Nephrology Unit, Cukurova University, Adana, Turkey
| | - Bilal Aoun
- Pediatric Nephrology Unit, Armand Trousseau Hospital, Paris, France
| | - Varvara Askiti
- Pediatric Nephrology Unit, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Karolis Azukaitis
- Pediatric Nephrology Unit, Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun Bayazit
- Pediatric Nephrology Unit, Cukurova University, Adana, Turkey
| | - Ipek Kaplan Bulut
- Pediatric Nephrology Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Nur Canpolat
- Pediatric Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Ali Duzova
- Pediatric Nephrology Unit, Hacettepe University, Ankara, Turkey
| | - Sandra Habbig
- Pediatric Nephrology Unit, University Hospital Cologne, Cologne, Germany
| | - Saoussen Krid
- Pediatric Nephrology Unit, Hôpital Necker-Enfants Malades, Paris, France
| | - Christoph Licht
- Pediatric Nephrology Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mieczyslaw Litwin
- Pediatric Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Pediatric Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Fabio Paglialonga
- Pediatric Nephrology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anja Rahn
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | - Charlotte Samaille
- Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire Lille, Lille, France
| | - Mohan Shenoy
- Pediatric Nephrology Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Manish D Sinha
- Pediatric Nephrology Unit, Kings College London Evelina London Children's Hospital, London, UK
| | | | | | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Alev Yilmaz
- Pediatric Nephrology Unit, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | | | - Franz Schaefer
- Pediatric Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Claus Peter Schmitt
- Pediatric Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Rukshana Shroff
- Pediatric Nephrology Unit, University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
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Driollet B, Bayer F, Kwon T, Krid S, Ranchin B, Launay L, Couchoud C, Harambat J, Leffondré K. Social deprivation at initiation of kidney replacement therapy in the pediatric population. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.283] [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: 11/28/2022]
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Matrat L, Bacchetta J, Ranchin B, Tanné C, Sellier-Leclerc AL. Pediatric atypical hemolytic-uremic syndrome due to auto-antibodies against factor H: is there an interest to combine eculizumab and mycophenolate mofetil? Pediatr Nephrol 2021; 36:1647-1650. [PMID: 33774745 DOI: 10.1007/s00467-021-05025-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/19/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atypical hemolytic and uremic syndrome (aHUS), a thrombotic micro-angiopathy (TMA) caused by deregulation in the complement pathway, is sometimes due to the presence of anti-complement factor H (CFH) auto-antibodies. The "standard" treatment for such aHUS combines plasma exchange therapy and immunosuppressive drugs. Eculizumab, a monoclonal antibody that blocks the terminal pathway of the complement cascade, could be an interesting alternative in association with an immunosuppressive treatment for maintenance regimen. CASE-DIAGNOSIS/TREATMENT We report on two children, diagnosed with mildly severe aHUS due to anti-CFH antibodies, who were treated with the association eculizumab-mycophenolate mofetil (MMF). Neither side effects nor relapses were observed during the 3 years of follow-up; MMF was even progressively tapered and withdrawn successfully in one patient. CONCLUSIONS The association of eculizumab and MMF appears to be an effective and safe option in pediatric cases of aHUS due to anti-CFH antibodies of mild severity.
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Affiliation(s)
- Lucie Matrat
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron Cedex, France.
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron Cedex, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | - Corentin Tanné
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron Cedex, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France.,Service de pédiatrie et néonatalogie, médecine du sport, hôpitaux du pays du Mont-Blanc, Sallanches, France
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron Cedex, France.
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30
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Zhang C, Bartosova M, Schaefer B, Herzog R, Cerkauskiene R, Vondrak K, Oh J, Klaus G, Zaloszyc A, Ariceta Iraola MG, Ranchin B, Bayazit AK, Testa S, Taylan C, Vande Walle J, YAP YOKCHIN, Büscher R, Drozd D, Zarogiannis SG, Kratochwill K, Schmitt C. FC 102PD INDUCED ARTERIOLAR AND PERITONEAL PATHOMECHANISMS ARE PARTIALLY REVERSED AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab135.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Due to the unphysiological composition of PD fluids, chronic peritoneal dialysis (PD) induces progressive peritoneal fibrosis, hypervascularization, and vasculopathy. The evolution of the PD membrane and vasculopathy following kidney transplantation (KTx) is largely unknown.
Method
Arteriolar and peritoneal tissues were obtained from 107 children with chronic kidney disease (CKD5), 72 children on PD (treated with neutral pH PD fluids, with low glucose degradation product content, GDP) and 21 children, who underwent KTx 4-5 weeks after a median 21 months of PD. Specimen underwent standardized digital quantitative histomorphometry. Molecular mechanisms were studied in omental arterioles microdissected from surrounding fat by multi-omics followed by Gene Set Enrichment Analysis (GSEA); key findings were validated in parietal tissues of independent, matched cohorts by quantitative immunohistochemistry (n=15/group).
Results
Arteriolar transcriptome and proteome GSEA revealed suppression of leucocyte migration and T-cell activation / secretory pathways regulation, of sprouting angiogenesis biological processes and of epithelial proliferation and cell cycle after KTx as compared to PD. Lipid / fatty acid metabolism, autophagy and ATP synthesis pathways were activated.
Transcriptome analysis including KTx, PD and CKD5 specifically attributed regulation of arteriolar lipid and fatty acid metabolism to transplantation and comprised 140 transcripts; their regulation was confirmed on the proteome level. Hub gene fatty acid synthase was identified by protein interaction analysis (string-db.org). 15 arteriolar genes activated by PD were inactivated after KTx and included glucose metabolisms and cytoskeleton related transcripts. 24 transcripts and 10 corresponding proteins induced by PD were still active after KTx and associated with biological processes related to TGF-ß signaling, fibrosis and mineral absorption.
In line with arteriolar multi-omics findings, peritoneal hypervascularization induced by chronic PD was reversed after Tx to CKD5 level. CD45 positive tissue infiltrating leucocytes count was reduced by 40% and was independently associated with microvessel density in multivariable analysis including PD vintage, daily GDP exposure and recent KTx. Peritoneal lymphatic vessel density, submesothelial thickness, activated fibroblast, fibrin deposit, macrophage and EMT cell counts remained unchanged after KTx compared to PD. Arteriolar lumen to vessel ratios (a marker of vasculopathy) were similar in both groups.
Vessel-homeostasis-related proteins in independent, matched cohorts demonstrated increased caspase-3 abundance in peritoneal arterioles after KTx. Arteriolar VEGF-A, thrombospondin, angiopoietin1/2, and hypoxia-inducible factor-1 (HIF-1a) were unchanged, while submesothelial HIF-1a and angiopoietin1/2 were decreased after Tx, favoring vessel maturation. The abundance of the key driver of fibrosis, TGF-ß-effector pSMAD2/3, was unchanged in the peritoneum and arterioles after Tx.
Conclusion
Our multi-omics analyses of fat covered omental arterioles, not directly exposed to PD fluids, demonstrate inhibition of PD induced immune response and angiogenesis pathways, of glucose metabolism and cytoskeleton regulation to levels similar as seen in children with CKD5. Arteriolar lipid and fatty acid metabolism is selectively altered after KTx. Reversal of low GDP PD induced hypervascularization and inflammation of the parietal peritoneum after KTx, mirror molecular changes in omental arterioles, while profibrotic activity persists after KTx in omental arterioles and in the parietal peritoneum.
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Affiliation(s)
- Conghui Zhang
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Maria Bartosova
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Betti Schaefer
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Rebecca Herzog
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | | | - Karel Vondrak
- University Hospital Motol, Department of Pediatrics, Prague, Czech Republic
| | - Jun Oh
- University Medical Center Hamburg-Eppendorf, Department of Pediatric Nephrology, University Children's Medical Clinic, Germany
| | - Günter Klaus
- University Hospital of Giessen and Marburg, KfH Pediatric Kidney Center, Marburg, Germany
| | - Ariane Zaloszyc
- University Hospital of Strasbourg, Department of Pediatrics 1, Strasbourg, France
| | | | - Bruno Ranchin
- Hôpital Femme Mere Enfant, Service de Néphrologie Pédiatrique, lyon, France
| | | | - Sara Testa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology and Dialysis Unit, Milano, Italy
| | - Christina Taylan
- University Hospital of Cologne, Pediatric Nephrology, Children‘s and Adolescent’s Hospital, Germany
| | - Johan Vande Walle
- Ghent University Hospital, Pediatric Nephrology, Department of Pediatrics, Belgium
| | - YOKCHIN YAP
- Hospital Kuala Lumpur, Department of Pediatrics, Malaysia
| | - Rainer Büscher
- University Children`s Hospital, Pediatric Nephrology, Essen, Germany
| | - Dorota Drozd
- Jagiellonian University Medical College, Krakow, Poland
| | - Sotirios G Zarogiannis
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Germany
- University of Thessaly, Department of Physiology, Faculty of Medicine, Larissa, Greece
| | - Klaus Kratochwill
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | - Claus Schmitt
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
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Tram N, Cheyssac É, Toumi C, Laurent A, Bertholet-Thomas A, Viremouneix L, Bacchetta J, Ranchin B. Disseminated bartonellosis in a child with steroid-dependent nephrotic syndrome receiving mycophenolate mofetil monotherapy. Nephrol Ther 2021; 17:463-465. [PMID: 33985919 DOI: 10.1016/j.nephro.2021.02.002] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
Cat scratch disease, usually a benign infectious disease, may develop as multisystem disease with multiorgan involvement, particularly in immunocompromised patients. We report on a patient who developed disseminated bartonellosis while receiving mycophenolate mofetil monotherapy treating steroid-dependent nephrotic syndrome, highlighting that severe infection can be observed in those patients. Therefore, this category of patients should be cautious when having contact with kittens and receives proper prevention advice.
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Affiliation(s)
- Nathalie Tram
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Élodie Cheyssac
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Chadia Toumi
- Service des maladies infectieuses pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Audrey Laurent
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Aurélia Bertholet-Thomas
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Loïc Viremouneix
- Service d'imagerie médicale, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Justine Bacchetta
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Faculté de médecine Lyon Est, Université de Lyon, Lyon, France
| | - Bruno Ranchin
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
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Burgmaier K, Brinker L, Erger F, Beck BB, Benz MR, Bergmann C, Boyer O, Collard L, Dafinger C, Fila M, Kowalewska C, Lange-Sperandio B, Massella L, Mastrangelo A, Mekahli D, Miklaszewska M, Ortiz-Bruechle N, Patzer L, Prikhodina L, Ranchin B, Ranguelov N, Schild R, Seeman T, Sever L, Sikora P, Szczepanska M, Teixeira A, Thumfart J, Uetz B, Weber LT, Wühl E, Zerres K, Dötsch J, Schaefer F, Liebau MC. Refining genotype-phenotype correlations in 304 patients with autosomal recessive polycystic kidney disease and PKHD1 gene variants. Kidney Int 2021; 100:650-659. [PMID: 33940108 DOI: 10.1016/j.kint.2021.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 08/14/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a severe disease of early childhood that is clinically characterized by fibrocystic changes of the kidneys and the liver. The main cause of ARPKD are variants in the PKHD1 gene encoding the large transmembrane protein fibrocystin. The mechanisms underlying the observed clinical heterogeneity in ARPKD remain incompletely understood, partly due to the fact that genotype-phenotype correlations have been limited to the association of biallelic null variants in PKHD1 with the most severe phenotypes. In this observational study we analyzed a deep clinical dataset of 304 patients with ARPKD from two independent cohorts and identified novel genotype-phenotype correlations during childhood and adolescence. Biallelic null variants frequently show severe courses. Additionally, our data suggest that the affected region in PKHD1 is important in determining the phenotype. Patients with two missense variants affecting amino acids 709-1837 of fibrocystin or a missense variant in this region and a null variant less frequently developed chronic kidney failure, and patients with missense variants affecting amino acids 1838-2624 showed better hepatic outcome. Variants affecting amino acids 2625-4074 of fibrocystin were associated with poorer hepatic outcome. Thus, our data expand the understanding of genotype-phenotype correlations in pediatric ARPKD patients and can lay the foundation for more precise and personalized counselling and treatment approaches.
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Affiliation(s)
- Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Rare Diseases, University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany
| | - Leonie Brinker
- Department of Pediatrics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Florian Erger
- Center for Rare Diseases, University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany; Institute of Human Genetics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Bodo B Beck
- Center for Rare Diseases, University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany; Institute of Human Genetics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | | | - Carsten Bergmann
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany; Renal Division, Department of Medicine, University Freiburg Medical Center, Freiburg, Germany
| | - Olivia Boyer
- Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, APHP, Paris University, Paris, France
| | - Laure Collard
- Reference centre pediatric nephrology, Clinique de l'Espérance, Montegnee, Belgium
| | - Claudia Dafinger
- Department of Pediatrics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Marc Fila
- Pediatric Nephrology Unit, CHU Arnaud de Villeneuve-Université de Montpellier, Montpellier, France
| | - Claudia Kowalewska
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Bärbel Lange-Sperandio
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Djalila Mekahli
- PKD Research Group, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Ludwig Patzer
- Department of Pediatrics, Children's Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Larisa Prikhodina
- Department of Inherited and Acquired Kidney Diseases, Research Clinical Institute for Pediatrics n.a. acad. Y. E. Veltishev, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de référence maladies rénales rares, Bron, France
| | - Nadejda Ranguelov
- Department of Pediatrics, Université Catholique de Louvain Medical School, Saint-Luc Academic Hospital, Brussels, Belgium
| | - Raphael Schild
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Tomas Seeman
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany; Department of Pediatrics, University Hospital Motol, 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Lale Sever
- Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Przemyslaw Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Ana Teixeira
- Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Uetz
- KfH Center of Pediatric Nephrology, Children's Hospital Munich Schwabing, Munich, Germany
| | - Lutz Thorsten Weber
- Department of Pediatrics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Rare Diseases, University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Zerres
- Institute of Human Genetics, RWTH University Hospital Aachen, Aachen, Germany
| | - Jörg Dötsch
- Department of Pediatrics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Rare Diseases, University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Max Christoph Liebau
- Department of Pediatrics, University Hospital Cologne and University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Rare Diseases, University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
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Ranchin B, Maucort-Boulch D, Bacchetta J. Big data and outcomes in paediatric haemodialysis: how can nephrologists use these new tools in daily practice? Nephrol Dial Transplant 2021; 36:387-391. [PMID: 33257930 DOI: 10.1093/ndt/gfaa225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Delphine Maucort-Boulch
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France.,Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France.,INSERM 1033, LYOS, Prévention des Maladies Osseuses, Lyon, France
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34
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Gaillard S, Roche L, Lemoine S, Deschênes G, Morin D, Vianey-Saban C, Acquaviva-Bourdain C, Ranchin B, Bacchetta J, Kassai B, Nony P, Bodénan E, Laudy V, Rouges C, Zarrabian S, Subtil F, Mercier C, Cochat P, Bertholet-Thomas A. Adherence to cysteamine in nephropathic cystinosis: A unique electronic monitoring experience for a better understanding. A prospective cohort study: CrYSTobs. Pediatr Nephrol 2021; 36:581-589. [PMID: 32901297 DOI: 10.1007/s00467-020-04722-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/20/2020] [Revised: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In nephropathic cystinosis (NC), adherence to cysteamine remains challenging; poor adherence is worsening the disease progression with a decline of kidney function and increase of extrarenal morbidities. Our objective was to describe adherence to cysteamine in NC patients, using electronic monitoring systems. METHODS Patients with confirmed NC, aged > 4 years and receiving oral cysteamine (short acting or delayed release formulation as standard of care) from 3 French reference centers, were included. Adherence to treatment was primarily assessed as the percentage of days with a good adherence score, adherence score rating from 0 (poor) to 2 (good). A descriptive analysis was performed after 1-year follow-up. RESULTS Seventeen patients (10 girls, median age: 13.9 (5.4-33.0) years) were included. Median age at diagnosis was 17.0 (3.0-76.9) months and age at start of cysteamine was 21.0 (15.5-116.3) months. Median daily dose of cysteamine was 1.05 (0.55-1.63) g/m2/day. Over the year, the median percentage of days with a good adherence score was 80 (1-99)% decreasing to 68 (1-99)% in patients > 11 years old. The median of average number of hours covered by treatment in a day was 22.5 (6.1-23.9) versus 14.9 (9.2-20.5) hours for delayed release versus short acting cysteamine. CONCLUSION Our data are the first describing a rather good adherence to cysteamine, decreasing in adolescents and adults. We described a potential interest of the delayed release formulation. Our data highlight the need for a multidisciplinary approach including therapeutic education and individualized approaches in NC patients transitioning to adulthood. Graphical abstract.
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Affiliation(s)
- Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France. .,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.
| | - Laurent Roche
- Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, F-69324, Lyon, France
| | - Sandrine Lemoine
- Service de Néphrologie, Dialyse, Hypertension artérielle, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Georges Deschênes
- APHP, Hôpital Robert Debré, Service de néphrologie pédiatrique, Paris, France
| | - Denis Morin
- CHU Montpellier, Service de néphrologie et endocrinologie pédiatrique, Montpellier, France
| | - Christine Vianey-Saban
- Hospices Civils de Lyon, Service Biochimie et Biologie Moléculaire, UF Maladies Héréditaires du Métabolisme, F-69500, Bron, France
| | - Cécile Acquaviva-Bourdain
- Hospices Civils de Lyon, Service Biochimie et Biologie Moléculaire, UF Maladies Héréditaires du Métabolisme, F-69500, Bron, France
| | - Bruno Ranchin
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
| | - Justine Bacchetta
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
| | - Behrouz Kassai
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France.,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
| | - Patrice Nony
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France.,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
| | - Eurielle Bodénan
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France
| | - Valérie Laudy
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France.,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
| | - Cécile Rouges
- CHU Montpellier, Centre d'Investigation Clinique, Inserm CIC 1411, F-69500, Bron, Montpellier, France
| | - Setareh Zarrabian
- Centre d'Investigation Clinique - CIC 1426 Hôpital Robert Debre - Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Fabien Subtil
- Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, F-69324, Lyon, France
| | - Catherine Mercier
- Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, F-69324, Lyon, France
| | - Pierre Cochat
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
| | - Aurélia Bertholet-Thomas
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
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Ranchin B, Plaisant F, Demède D, Guillebon J, Javouhey E, Bacchetta J. Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed. Acta Paediatr 2021; 110:781-788. [PMID: 33373057 DOI: 10.1111/apa.15539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/21/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022]
Abstract
AIM Our aim was to look at the technical, ethical and global issues related to neonatal dialysis. METHODS We performed a PubMed research on manuscripts published from March 2010 to March 2020 and retrospectively reviewed all neonates who received dialysis in our French paediatric and neonatal intensive care units from April 2009 to March 2019. RESULTS Dialysis is performed on neonates with pre-existing renal diseases, acute kidney injuries or inborn errors of metabolism. It is required in 0.5%-1% of neonates admitted to the neonatal intensive care units. Peritoneal dialysis and extracorporeal blood purification are both feasible, with more complications, but the results are close to those obtained in older infants, at least in children without multi-organ dysfunction. Novel haemodialysis machines are being evaluated. Ethical issues are a major concern. Multidisciplinary teams should consider associated comorbidities, risks of permanent end-stage renal disease and provide parents with full and neutral information. These should drive decisions about whether dialysis is in child's best interests. CONCLUSION Neonatal dialysis is technically feasible, but ethically challenging, and short-term and long-term data remain limited. Prospective studies and dialysis registries would improve global management and quality of life of these patients at risk of chronic kidney disease.
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Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Franck Plaisant
- Service de Néonatologie et réanimation néonatale Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Delphine Demède
- Service de Chirurgie Pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Jean‐Marie Guillebon
- Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Etienne Javouhey
- Service de Réanimation pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
- Faculté de Médecine Lyon Est Université de Lyon Lyon France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
- Faculté de Médecine Lyon Est Université de Lyon Lyon France
- INSERM UMR 1033 Faculté de Médecine Lyon Est Université de Lyon Lyon France
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Eibensteiner F, Ritschl V, Stamm T, Cetin A, Schmitt CP, Ariceta G, Bakkaloglu S, Jankauskiene A, Klaus G, Paglialonga F, Edefonti A, Ranchin B, Shroff R, Stefanidis CJ, Vandewalle J, Verrina E, Vondrak K, Zurowska A, Alper SL, Aufricht C. Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base - a European multicentre mixed methods study. BMJ Open 2021; 11:e043015. [PMID: 33597140 PMCID: PMC7893209 DOI: 10.1136/bmjopen-2020-043015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES In a previously published Delphi exercise the European Pediatric Dialysis Working Group (EPDWG) reported widely variable counteractive responses to COVID-19 during the first week of statutory public curfews in 12 European countries with case loads of 4-680 infected patients per million. To better understand these wide variations, we assessed different factors affecting countermeasure implementation rates and applied the capability, opportunity, motivation model of behaviour to describe their determinants. DESIGN We undertook this international mixed methods study of increased depth and breadth to obtain more complete data and to better understand the resulting complex evidence. SETTING This study was conducted in 14 paediatric nephrology centres across 12 European countries during the COVID-19 pandemic. PARTICIPANTS The 14 participants were paediatric nephrologists and EPDWG members from 12 European centres. MAIN OUTCOME MEASURES 52 countermeasures clustered into eight response domains (access control, patient testing, personnel testing, personal protective equipment policy, patient cohorting, personnel cohorting, suspension of routine care, remote work) were categorised by implementation status, drivers (expert opinion, hospital regulations) and resource dependency. Governmental strictness and media attitude were independently assessed for each country and correlated with relevant countermeasure implementation factors. RESULTS Implementation rates varied widely among response domains (median 49.5%, range 20%-71%) and centres (median 46%, range 31%-62%). Case loads were insufficient to explain response rate variability. Increasing case loads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher governmental strictness and positive media attitude towards countermeasure implementation were associated with higher implementation rates. CONCLUSIONS COVID-19 countermeasure implementation by paediatric tertiary care centres did not reflect case loads but rather reflected heterogeneity of local rules and of perceived resources. These data highlight the need of ongoing reassessment of current practices, facilitating rapid change in 'institutional behavior' in response to emerging evidence of countermeasure efficacy.
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Affiliation(s)
- Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Wien, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Asil Cetin
- Research Platform Data Science, University of Vienna, Vienna, Austria
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Sevcan Bakkaloglu
- Division of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Günter Klaus
- Department of Pediatric Nephrology, KfH Children's Kidney Center, Marburg, Germany
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, London, UK
| | | | - Johan Vandewalle
- Department of Pediatric Nephrology, Utoped, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy
| | - Karel Vondrak
- Department of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic
| | - Aleksandra Zurowska
- Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Bacchetta J, Bernardor J, Garnier C, Naud C, Ranchin B. Hyperphosphatemia and Chronic Kidney Disease: A Major Daily Concern Both in Adults and in Children. Calcif Tissue Int 2021; 108:116-127. [PMID: 31996964 DOI: 10.1007/s00223-020-00665-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/21/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
Hyperphosphatemia is common in chronic kidney disease (CKD). Often seen as the "silent killer" because of its dramatic effect on vascular calcifications, hyperphosphatemia explains, at least partly, the onset of the complex mineral and bone disorders associated with CKD (CKD-MBD), together with hypocalcemia and decreased 1-25(OH)2 vitamin D levels. The impact of CKD-MBD may be immediate with abnormalities of bone and mineral metabolism with secondary hyperparathyroidism and increased FGF23 levels, or delayed with poor growth, bone deformities, fractures, and vascular calcifications, leading to increased morbidity and mortality. The global management of CKD-MBD has been detailed in international guidelines for adults and children, however, with difficulties to obtain an agreement on the ideal PTH targets. The clinical management of hyperphosphatemia is a daily challenge for nephrologists and pediatric nephrologists, notably because of the phosphate overload in occidental diets that is mainly due to the phosphate "hidden" in food additives. The management begins with a dietary restriction of phosphate intake, and is followed by the use of calcium-based and non-calcium-based phosphate binders, and/or the intensification of dialysis. The objective of this review is to provide an overview of the pathophysiology of hyperphosphatemia in CKD, with a focus on its deleterious effects and a description of the clinical management of hyperphosphatemia in a more global setting of CKD-MBD.
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Affiliation(s)
- Justine Bacchetta
- Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence Des Maladies Rénales Rares, Centre de Référence Des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677, Bron Cedex, France.
- Université de Lyon, Lyon, France.
- INSERM 1033 Research Unit, Lyon, France.
| | - Julie Bernardor
- Unité de Néphrologie pédiatrique, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Charlotte Garnier
- Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence Des Maladies Rénales Rares, Centre de Référence Des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677, Bron Cedex, France
| | - Corentin Naud
- Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence Des Maladies Rénales Rares, Centre de Référence Des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677, Bron Cedex, France
| | - Bruno Ranchin
- Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence Des Maladies Rénales Rares, Centre de Référence Des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677, Bron Cedex, France
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Bouhanick B, Sosner P, Brochard K, Mounier-Véhier C, Plu-Bureau G, Hascoet S, Ranchin B, Pietrement C, Martinerie L, Boivin JM, Fauvel JP, Bacchetta J. Hypertension in Children and Adolescents: A Position Statement From a Panel of Multidisciplinary Experts Coordinated by the French Society of Hypertension. Front Pediatr 2021; 9:680803. [PMID: 34307254 PMCID: PMC8292722 DOI: 10.3389/fped.2021.680803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Hypertension is much less common in children than in adults. The group of experts decided to perform a review of the literature to draw up a position statement that could be used in everyday practice. The group rated recommendations using the GRADE approach. All children over the age of 3 years should have their blood pressure measured annually. Due to the lack of data on cardiovascular morbidity and mortality associated with blood pressure values, the definition of hypertension in children is a statistical value based on the normal distribution of blood pressure in the paediatric population, and children and adolescents are considered as having hypertension when their blood pressure is greater than or equal to the 95th percentile. Nevertheless, it is recommended to use normative blood pressure tables developed according to age, height and gender, to define hypertension. Measuring blood pressure in children can be technically challenging and several measurement methods are listed here. Regardless of the age of the child, it is recommended to carefully check for a secondary cause of hypertension as in 2/3 of cases it has a renal or cardiac origin. The care pathway and principles of the therapeutic strategy are described here.
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Affiliation(s)
- Béatrice Bouhanick
- Service d'Hypertension Artérielle et Thérapeutique, CHU Rangueil, CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Philippe Sosner
- Centre Médico-Sportif MON STADE, Paris, France.,Hôpital Hôtel-Dieu, APHP, Centre de Diagnostic et de Thérapeutique, Paris, France.,Laboratoire MOVE (EA 6314), Université de Poitiers, Faculté des Sciences du Sport, Poitiers, France
| | - Karine Brochard
- Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Claire Mounier-Véhier
- Institut Cœur-Poumon, Médecine Vasculaire et HTA, CHU, Université Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins Lille, Lille, France
| | - Geneviève Plu-Bureau
- Unité de Gynécologie Médicale, AP-HP, Hôpital Port-Royal, Université de Paris, Paris, France
| | - Sébastien Hascoet
- Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Filières Maladies Rares ORKID et ERK-Net, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | | | - Laetitia Martinerie
- Centre de Reference des Maladies Rares de la Croissance et du Développement, Université de Paris, Endocrinologie et Diabétologie Pédiatrique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - Jean Marc Boivin
- Département de Médecine Générale, Université de Lorraine, Inserm CIC-P Pierre Drouin Vandœuvre-Lès-Nancy, Vandœuvre-lès-Nancy, France
| | - Jean Pierre Fauvel
- Service de Néphrologie Hospices Civils, Hôpital Edouard Herriot, Lyon, France.,UMR CNRS 5558, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Filières Maladies Rares ORKID et ERK-Net, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
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Dachy A, Bacchetta J, Sellier-Leclerc AL, Bertholet-Thomas A, Demède D, Cochat P, Nobili F, Ranchin B. Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres. Nephrol Ther 2020; 16:424-430. [PMID: 33177015 DOI: 10.1016/j.nephro.2020.08.002] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little data are available for infants who started renal replacement therapy before 6 months of age. Because of extra-renal comorbidities and uncertain outcomes, whether renal replacement therapy in neonates is justified remains debatable. METHODS We performed a retrospective analysis of all patients who began chronic peritoneal dialysis below 6 months between 2007 and 2017 in two tertiary centres. Results are presented as median (min;max). RESULTS Seventeen patients (10 boys) were included (8 prenatal diagnoses, 6 premies), with the following diagnoses: congenital anomalies of kidney and urinary tract (n=9), oxalosis (n=5), congenital nephrotic syndrome (n=2) and renal vein thrombosis (n=1). Five patients had associated comorbidities. At peritoneal dialysis initiation, age was 2.6 (0.1;5.9) months, height-standard deviation score (SDS) -1.3 (-5.7;1.6) and weight-SDS -1.4 (-3.6;0.6). Peritoneal dialysis duration was 12 (2;32) months, and at peritoneal dialysis discontinuation height-SDS was -1.0 (-4.3;0.7) weight-SDS -0.7 (-3.2;0.2), parathyroid hormone 123 (44;1540) ng/L, and hemoglobin 110 (73;174) g/L. During the first 6 months of peritoneal dialysis, the median time of hospitalisation stay was 69 (15;182) days. Ten patients presented a total of 27 peritonitis episodes. Reasons for peritoneal dialysis discontinuation were switch to hemodialysis (n=6), transplantation (n=6), recovery of renal function (n=2) and death (n=1). After a follow-up of 4.3 (1.7;10.3) years, 12 patients were transplanted, 2 patients were still on peritoneal dialysis, 2 patients were dialysis free with severe chronic kidney disease and 1 patient had died. Seven patients displayed neurodevelopmental delay, of whom five needed special schooling. CONCLUSION We confirm that most infants starting peritoneal dialysis before 6 months of age will be successfully transplanted and will have a favourable growth outcome. Their quality of life will be impacted by recurrent hospitalisations and neurodevelopmental delay is frequent.
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Affiliation(s)
- Angélique Dachy
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Justine Bacchetta
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Inserm, UMR 1033, faculté de médecine Lyon est, université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Faculté de médecine Lyon est, université de Lyon, Lyon, France
| | - Anne-Laure Sellier-Leclerc
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Aurélia Bertholet-Thomas
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Delphine Demède
- Service de chirurgie pédiatrique, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Pierre Cochat
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Inserm, UMR 1033, faculté de médecine Lyon est, université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Faculté de médecine Lyon est, université de Lyon, Lyon, France
| | - François Nobili
- Service de néphrologie pédiatrique, centre hospitalier régional universitaire de Besançon, Besançon, France
| | - Bruno Ranchin
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
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Bernardor J, Flammier S, Ranchin B, Gaillard S, Platel D, Peyruchaud O, Machuca-Gayet I, Bacchetta J. Inhibition of Osteoclast Differentiation by 1.25-D and the Calcimimetic KP2326 Reveals 1.25-D Resistance in Advanced CKD. J Bone Miner Res 2020; 35:2265-2274. [PMID: 32598518 DOI: 10.1002/jbmr.4122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 12/20/2022]
Abstract
Active vitamin D analogs and calcimimetics are the main therapies used for treating secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD). Peripheral blood mononuclear cells of 19 pediatric patients with CKD1-5D and 6 healthy donors (HD) were differentiated into mature osteoclasts with receptor activator of NF-κB ligand (RANKL) and macrophage colony-stimulating factor (M-CSF). The effects of single or combined treatment with active vitamin D (1.25-D) and/or calcimimetic KP2326 were evaluated on osteoclastic differentiation and osteoclastic-mediated bone resorption. Although 1.25-D inhibited osteoclastic differentiation, a significant resistance to 1.25-D was observed when glomerular filtration rate decreased. A significant albeit less important inhibitory effect of KP2326 on osteoclastic differentiation was also found both in cells derived from HD and CKD patients, through a putative activation of the Erk pathway. This inhibitory effect was not modified by CKD stage. Combinatorial treatment with 1.25-D and KP2326 did not result in synergistic effects. Last, KP2326 significantly inhibited osteoclast-mediated bone resorption. Both 1.25-D and KP2326 inhibit osteoclastic differentiation, however, to a different extent. There is a progressive resistance to 1.25-D in advanced CKD that is not found with KP2326. KP2326 also inhibits bone resorption. Given that 1.25-D has no effect on osteoclastic resorption activity and that calcimimetics also have direct anabolic effects on osteoblasts, there is an experimental rationale that could favor the use of decreased doses of 1.25-D with low doses of calcimimetics in SHPT in dialysis to improve the underlying osteodystrophy. However, this last point deserves confirmatory clinical studies. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Julie Bernardor
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.,Faculté de Médecine, Université de Nice Sophia Antipolis, Nice, France
| | - Sacha Flammier
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Ségolène Gaillard
- INSERM CIC 1407, CNRS UMR 5558 and Service de Pharmacotoxicologie Clinique, Hospices Civils de Lyon, Bron, France
| | - Diane Platel
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Olivier Peyruchaud
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Irma Machuca-Gayet
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Justine Bacchetta
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.,Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
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41
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Holle J, Kirchner M, Okun J, Bayazit AK, Obrycki L, Canpolat N, Bulut IK, Azukaitis K, Duzova A, Ranchin B, Shroff R, Candan C, Oh J, Klaus G, Lugani F, Gimpel C, Büscher R, Yilmaz A, Baskin E, Erdogan H, Zaloszyc A, Özcelik G, Drozdz D, Jankauskiene A, Nobili F, Melk A, Querfeld U, Schaefer F. Serum indoxyl sulfate concentrations associate with progression of chronic kidney disease in children. PLoS One 2020; 15:e0240446. [PMID: 33108385 PMCID: PMC7591021 DOI: 10.1371/journal.pone.0240446] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
The uremic toxins indoxyl sulfate (IS) and p-cresyl sulfate (pCS) accumulate in patients with chronic kidney disease (CKD) as a consequence of altered gut microbiota metabolism and a decline in renal excretion. Despite of solid experimental evidence for nephrotoxic effects, the impact of uremic toxins on the progression of CKD has not been investigated in representative patient cohorts. In this analysis, IS and pCS serum concentrations were measured in 604 pediatric participants (mean eGFR of 27 ± 11 ml/min/1.73m2) at enrolment into the prospective Cardiovascular Comorbidity in Children with CKD study. Associations with progression of CKD were analyzed by Kaplan-Meier analyses and Cox proportional hazard models. During a median follow up time of 2.2 years (IQR 4.3-0.8 years), the composite renal survival endpoint, defined as 50% loss of eGFR, or eGFR <10ml/min/1.73m2 or start of renal replacement therapy, was reached by 360 patients (60%). Median survival time was shorter in patients with IS and pCS levels in the highest versus lowest quartile for both IS (1.5 years, 95%CI [1.1,2.0] versus 6.0 years, 95%CI [5.0,8.4]) and pCS (1.8 years, 95%CI [1.5,2.8] versus 4.4 years, 95%CI [3.4,6.0]). Multivariable Cox regression disclosed a significant association of IS, but not pCS, with renal survival, which was independent of other risk factors including baseline eGFR, proteinuria and blood pressure. In this exploratory analysis we provide the first data showing a significant association of IS, but not pCS serum concentrations with the progression of CKD in children, independent of other known risk factors. In the absence of comorbidities, which interfere with serum levels of uremic toxins, such as diabetes, obesity and metabolic syndrome, these results highlight the important role of uremic toxins and accentuate the unmet need of effective elimination strategies to lower the uremic toxin burden and abate progression of CKD.
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Affiliation(s)
- Johannes Holle
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité –Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Okun
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, Center of Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Aysun K. Bayazit
- Department of Pediatric Nephrology, Cukurova University School of Medicine, Adana, Turkey
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children`s Memorial Health Institute, Warsaw, Poland
| | - Nur Canpolat
- Division of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ipek Kaplan Bulut
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Bron, France
| | - Rukshana Shroff
- Division of Pediatric Nephrology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Cengiz Candan
- Pediatric Nephrology, Göztepe Educational and Research Hospital, Istanbul, Turkey
| | - Jun Oh
- Pediatric Nephrology, UKE University Children´s Hospital, Hamburg, Germany
| | - Günter Klaus
- Pediatric Nephrology, KfH and University of Marburg, Marburg, Germany
| | | | - Charlotte Gimpel
- Department of Internal Medicine IV, University Medical Center & Faculty of Medicine–University of Freiburg, Breisgau, Germany
| | - Rainer Büscher
- Pediatric Nephrology, University Children´s Hospital, Essen, Germany
| | - Alev Yilmaz
- Pediatric Nephrology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Esra Baskin
- Pediatric Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Hakan Erdogan
- Department of Pediatric Nephrology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ariane Zaloszyc
- Division of Pediatric Nephrology, Hopital de Hautepierre, Strasbourg, France
| | - Gül Özcelik
- Pediatric Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Dorota Drozdz
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Francois Nobili
- Service de Pédiatrie 2, Centre Hospitalier Universitaire de Besançon, Besancon, France
| | - Anette Melk
- Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Uwe Querfeld
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center of Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Rãchişan AL, Dubois V, Ranchin B, Sellier-Leclerc AL, Bertholet Thomas A, Cochat P, Bacchetta J. Eplet incompatibility in pediatric renal transplantation. Pediatr Transplant 2020; 24:e13721. [PMID: 32388894 DOI: 10.1111/petr.13721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/26/2019] [Revised: 08/13/2019] [Accepted: 04/05/2020] [Indexed: 11/29/2022]
Abstract
Eplet incompatibility appears to be a better predictor of the de novo appearance of DSA post-Tx than HLA antigen matching in adults. We evaluated the HLA Matchmaker® software (version 2.1) in our pediatric cohort to predict the appearance of DSA post-Tx. We included 70 pediatric patients (26 girls, 10 living donors, mean age 11.2 ± 3.9 years) after a first R-Tx (January 2010-August 2016), without prior immunization, having complete HLA typing (A, B, C, DRB1 and DQB1) and DSA follow-up for at least one year. The mean of HLA and eplet incompatibilities was 4.7 ± 1.3 and 15.5 ± 6.1, respectively, with a correlation coefficient r2 between these two variables of 0.34 (P < .001). The eplet load was 12.8 ± 5.0 in living donors vs 15.9 ± 6.2 in deceased donors (P = NS), 12.6 ± 6.1 in preemptive R-Tx (n = 14) vs 16.3 ± 5.9 for non-preemptive R-Tx (P = .04). Seven patients (10%) developed DSA during the 3.5 ± 1.2 years post-Tx. The eplet load was 13.7 ± 5.5 for those who developed DSA vs 15.7 ± 6.1 for the others (P = NS). In our single-center series of pediatric R-Tx with good HLA matching and lower eplet load than previously published series, eplet incompatibilities do not predict the development of DSA. The question of the HLA matching requirement and the daily interest of the HLA Matchmaker® software to help select the grafts remain open.
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Affiliation(s)
- Andreea Liana Rãchişan
- Department of Pediatrics II, University of Medicine & Pharmacy «Iuliu Hatieganu», Cluj-Napoca, Romania
| | - Valerie Dubois
- Department of Immunology, Hospice Civils de Lyon, Lyon, France
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France
| | | | | | - Pierre Cochat
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France
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43
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Bedin M, Boyer O, Servais A, Li Y, Villoing-Gaudé L, Tête MJ, Cambier A, Hogan J, Baudouin V, Krid S, Bensman A, Lammens F, Louillet F, Ranchin B, Vigneau C, Bouteau I, Isnard-Bagnis C, Mache CJ, Schäfer T, Pape L, Gödel M, Huber TB, Benz M, Klaus G, Hansen M, Latta K, Gribouval O, Morinière V, Tournant C, Grohmann M, Kuhn E, Wagner T, Bole-Feysot C, Jabot-Hanin F, Nitschké P, Ahluwalia TS, Köttgen A, Andersen CBF, Bergmann C, Antignac C, Simons M. Human C-terminal CUBN variants associate with chronic proteinuria and normal renal function. J Clin Invest 2020; 130:335-344. [PMID: 31613795 DOI: 10.1172/jci129937] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 04/29/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUNDProteinuria is considered an unfavorable clinical condition that accelerates renal and cardiovascular disease. However, it is not clear whether all forms of proteinuria are damaging. Mutations in CUBN cause Imerslund-Gräsbeck syndrome (IGS), which is characterized by intestinal malabsorption of vitamin B12 and in some cases proteinuria. CUBN encodes for cubilin, an intestinal and proximal tubular uptake receptor containing 27 CUB domains for ligand binding.METHODSWe used next-generation sequencing for renal disease genes to genotype cohorts of patients with suspected hereditary renal disease and chronic proteinuria. CUBN variants were analyzed using bioinformatics, structural modeling, and epidemiological methods.RESULTSWe identified 39 patients, in whom biallelic pathogenic variants in the CUBN gene were associated with chronic isolated proteinuria and early childhood onset. Since the proteinuria in these patients had a high proportion of albuminuria, glomerular diseases such as steroid-resistant nephrotic syndrome or Alport syndrome were often the primary clinical diagnosis, motivating renal biopsies and the use of proteinuria-lowering treatments. However, renal function was normal in all cases. By contrast, we did not found any biallelic CUBN variants in proteinuric patients with reduced renal function or focal segmental glomerulosclerosis. Unlike the more N-terminal IGS mutations, 37 of the 41 proteinuria-associated CUBN variants led to modifications or truncations after the vitamin B12-binding domain. Finally, we show that 4 C-terminal CUBN variants are associated with albuminuria and slightly increased GFR in meta-analyses of large population-based cohorts.CONCLUSIONCollectively, our data suggest an important role for the C-terminal half of cubilin in renal albumin reabsorption. Albuminuria due to reduced cubilin function could be an unexpectedly common benign condition in humans that may not require any proteinuria-lowering treatment or renal biopsy.FUNDINGATIP-Avenir program, Fondation Bettencourt-Schueller (Liliane Bettencourt Chair of Developmental Biology), Agence Nationale de la Recherche (ANR) Investissements d'avenir program (ANR-10-IAHU-01) and NEPHROFLY (ANR-14-ACHN-0013, to MS), Steno Collaborative Grant 2018 (NNF18OC0052457, to TSA and MS), Heisenberg Professorship of the German Research Foundation (KO 3598/5-1, to AK), Deutsche Forschungsgemeinschaft (DFG) Collaborative Research Centre (SFB) KIDGEM 1140 (project 246781735, to CB), and Federal Ministry of Education and Research (BMB) (01GM1515C, to CB).
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Affiliation(s)
| | - Olivia Boyer
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France.,Department of Pediatric Nephrology and
| | - Aude Servais
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France.,Department of Nephrology, Necker Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Yong Li
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Marie-Josephe Tête
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
| | - Alexandra Cambier
- Department of Pediatric Nephrology and Transplantation, Robert-Debré Hospital, APHP, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology and Transplantation, Robert-Debré Hospital, APHP, Paris, France
| | - Veronique Baudouin
- Department of Pediatric Nephrology and Transplantation, Robert-Debré Hospital, APHP, Paris, France
| | | | | | - Florie Lammens
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | | | - Bruno Ranchin
- Department of Pediatric Nephrology, Hospices Civils de Lyon, Bron, France
| | - Cecile Vigneau
- Centre Hospitalier Universitaire de Rennes, INSERM U1085 IRSET-9, Rennes, France
| | - Iseline Bouteau
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | | | - Tobias Schäfer
- Renal Division, University Medical Center Freiburg, Freiburg, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Disease, Hannover Medical School, Hannover, Germany
| | - Markus Gödel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B Huber
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Günter Klaus
- Department of Child and Adolescent Medicine, University Medical Center Marburg-Giessen, Marburg, Germany
| | - Matthias Hansen
- KfH-Nierenzentrum für Kinder und Jugendliche und Clementine-Kinderhospital, Frankfurt, Germany
| | - Kay Latta
- KfH-Nierenzentrum für Kinder und Jugendliche und Clementine-Kinderhospital, Frankfurt, Germany
| | - Olivier Gribouval
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
| | | | - Carole Tournant
- Department of Genetics, Necker Hospital, APHP, Paris, France
| | - Maik Grohmann
- Center for Human Genetics, Bioscientia, Ingelheim, Germany.,Center for Human Genetics, Mainz, Germany
| | - Elisa Kuhn
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Timo Wagner
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Christine Bole-Feysot
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, Paris, France.,Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Université de Paris, Paris, France
| | - Fabienne Jabot-Hanin
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, Paris, France.,Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Université de Paris, Paris, France
| | - Patrick Nitschké
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, Paris, France.,Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Université de Paris, Paris, France
| | | | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Carsten Bergmann
- Center for Human Genetics, Bioscientia, Ingelheim, Germany.,Center for Human Genetics, Mainz, Germany.,Renal Division, Department of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Corinne Antignac
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France.,Department of Genetics, Necker Hospital, APHP, Paris, France
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44
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Bernardor J, Flammier S, Ranchin B, Gaillard S, Platel D, Peyruchaud O, Machuca-Gayet I, Bacchetta J. MO058INHIBITION OF OSTEOCLAST DIFFERENTIATION BY 1.25-D AND THE CALCIMIMETIC KP2326 REVEALS 1.25-D RESISTANCE IN ADVANCED CKD. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa140.mo058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Active vitamin D analogs and calcimimetics are cornerstones for managing secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD). Their direct effects on bone cells remain to be determined.
Method
Peripheral blood mononuclear cells (PBMCs) of 19 pediatric CKD patients and 6 healthy donors (HD) were differentiated into osteoclasts in presence of M-CSF and RANKL. Effect of combined or single treatment with active vitamin D (1.25-D) and/or the calcimimetic KP2326 were evaluated onto osteoclast differentiation and osteoclast mediated bone resorption.
Results
1.25-D inhibited osteoclastic differentiation, a significant resistance to 1.25-D was observed when CKD worsens. A significant albeit less important inhibitory effect of KP2326 on osteoclastic differentiation was also found both in cells derived from HD and CKD patients, through an activation of the Erk pathway. This inhibitory effect was not modified by CKD stage. Combinatorial treatment with 1.25-D and KP2326 did not result in synergistic effects. Last, KP2326 significantly inhibited human osteoclast-mediated bone resorption.
Conclusion
Both 1.25-D and KP2326 inhibit osteoclastic differentiation, however to a different extent. Whilst 1.25-D has no significant effect on bone resorption, KP2326 inhibits bone resorption. Recent data showed that calcimimetics also have a direct anabolic effect on bone, through the stimulation of osteoblastic differentiation and mineralization in human mesenchymal stem cells in vitro. All these results provide a strong rationale for a global positive effect of calcimimetics on bone remodeling. Calcimimetics also significantly decrease FGF23 levels. In the setting of global systematic deleterious effects of high FGF23 levels in CKD, and keeping in mind that active vitamin D analogs stimulate FGF 23 production, all these data could favor the use of decreased doses of 1.25-D with low-doses of calcimimetics in SHPT in dialysis, the combination of these two therapies already being proposed in the 2017 K-DIGO guidelines.
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Affiliation(s)
- Julie Bernardor
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Lyon, France
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de Référence des Maladies Rénales Rares, Lyon, France
- Unité de Nice Sophia Antipolis, Faculté de Médecine, Nice, France
| | - Sacha Flammier
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Lyon, France
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de Référence des Maladies Rénales Rares, Lyon, France
| | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de Référence des Maladies Rénales Rares, Lyon, France
| | - Segolene Gaillard
- INSERM CIC 1407, CNRS UMR 5558, Service de Pharmacotoxicologie Clinique, Hospices Civils de Lyon, Bron, France
| | - Diane Platel
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Lyon, France
| | - Olivier Peyruchaud
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Lyon, France
| | - Irma Machuca-Gayet
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Lyon, France
| | - Justine Bacchetta
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Lyon, France
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de Référence des Maladies Rénales Rares, Lyon, France
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de Référence des Maladies Rares du Calcium et du Phosphate, Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
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Boyer O, Baudouin V, Bérard É, Biebuyck-Gougé N, Dossier C, Guigonis V, Audard V, Klifa R, Leroy V, Ranchin B, Roussey G, Samaille C, Tellier S, Vrillon I. [Vaccine recommendations for children with idiopathic nephrotic syndrome]. Nephrol Ther 2020; 16:177-183. [PMID: 32278737 DOI: 10.1016/j.nephro.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022]
Abstract
The specific treatment of idiopathic nephrotic syndrome is based on corticosteroid therapy and/or steroid-sparing immunosuppressive agents in children who are steroid-dependant or frequent relapsers (60-70 %). Patients have an increased infectious risk not only related to the disease during relapses (hypogammaglobulinemia and urinary leakage of opsonins) but also to treatments (corticosteroids or immunosuppressive agents) in period of remission. Vaccination is therefore particularly recommended in these patients. Potential vaccine risks are ineffectiveness, induction of vaccine disease and relapse of idiopathic nephrotic syndrome. Only live vaccines expose to the risk of vaccine disease: they are in general contra-indicated under immunosuppressive treatment. The immunogenicity of inactivated vaccines is reduced but persists. The immunogenic stimulus of vaccination may in theory trigger a relapse of the nephrotic syndrome. Nevertheless, this risk is low in the literature, and even absent in some studies. The benefit-risk ratio is therefore in favor of vaccination with respect to the vaccination schedule for inactivated vaccines, with wide vaccination against pneumococcus and influenza annually. Depending on the context and after expert advice, immunization with live vaccines could be discussed if residual doses/levels of immunosuppressive treatments are moderate and immunity preserved.
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Affiliation(s)
- Olivia Boyer
- Service de néphrologie pédiatrique, centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, hôpital Necker-Enfants-malades, institut Imagine, université de Paris, 149, rue de Sèvres, 75015 Paris, France.
| | - Véronique Baudouin
- Service de néphrologie pédiatrique, centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, hôpital Robert-Debré, institut Imagine, université de Paris, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - Étienne Bérard
- Service de néphrologie pédiatrique, CHU de Nice, Archet 2, 151, route Saint-Antoine de Ginestière, CS 23079, 06202 Nice cedex 3, France
| | - Nathalie Biebuyck-Gougé
- Service de néphrologie pédiatrique, centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, hôpital Necker-Enfants-malades, institut Imagine, université de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - Claire Dossier
- Service de néphrologie pédiatrique, centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, hôpital Robert-Debré, institut Imagine, université de Paris, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - Vincent Guigonis
- Département de pédiatrie, hôpital Mère-Enfant, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
| | - Vincent Audard
- Inserm U955, service de néphrologie et transplantation, centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, université Paris-Est Créteil, CHU Henri Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Roman Klifa
- Service de néphrologie pédiatrique, centre de référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, hôpital Necker-Enfants-malades, institut Imagine, université de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - Valérie Leroy
- Service de néphrologie pédiatrique, CHU La Réunion, Site Félix Guyon, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - Bruno Ranchin
- Service de néphrologie pédiatrique, centre de référence néphrogone, CHU de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - Gwenaëlle Roussey
- Clinique médicale pédiatrique, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes, France
| | - Charlotte Samaille
- Service de néphrologie pédiatrique, hôpital Jeanne de Flandre, centre hospitalo-universitaire de Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - Stéphanie Tellier
- Service de néphrologie-rhumatologie-médecine interne pédiatrique, centre de référence des Maladies rénales rares du Sud-Ouest (SORARE), hôpital des enfants, 330, avenue de Grande-Bretagne, 31300 Toulouse, France
| | - Isabelle Vrillon
- Service de médecine infantile, secteur de néphrologie pédiatrique, hôpital d'Enfants de Brabois, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Belot A, Rice GI, Omarjee SO, Rouchon Q, Smith EMD, Moreews M, Tusseau M, Frachette C, Bournhonesque R, Thielens N, Gaboriaud C, Rouvet I, Chopin E, Hoshino A, Latour S, Ranchin B, Cimaz R, Romagnani P, Malcus C, Fabien N, Sarda MN, Kassai B, Lega JC, Decramer S, Abou-Jaoude P, Bruce IN, Simonet T, Bardel C, Rollat-Farnier PA, Viel S, Reumaux H, O'Sullivan J, Walzer T, Mathieu AL, Marenne G, Ludwig T, Genin E, Ellingford J, Bader-Meunier B, Briggs TA, Beresford MW, Crow YJ. Contribution of rare and predicted pathogenic gene variants to childhood-onset lupus: a large, genetic panel analysis of British and French cohorts. Lancet Rheumatol 2020; 2:e99-e109. [PMID: 38263665 DOI: 10.1016/s2665-9913(19)30142-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a rare immunological disorder and genetic factors are considered important in its causation. Monogenic lupus has been associated with around 30 genotypes in humans and 60 in mice, while genome-wide association studies have identified more than 90 risk loci. We aimed to analyse the contribution of rare and predicted pathogenic gene variants in a population of unselected cases of childhood-onset SLE. METHODS For this genetic panel analysis we designed a next-generation sequencing panel comprising 147 genes, including all known lupus-causing genes in humans, and potentially lupus-causing genes identified through GWAS and animal models. We screened 117 probands fulfilling American College of Rheumatology (ACR) criteria for SLE, ascertained through British and French cohorts of childhood-onset SLE, and compared these data with those of 791 ethnically matched controls from the 1000 Genomes Project and 574 controls from the FREX Consortium. FINDINGS After filtering, mendelian genotypes were confirmed in eight probands, involving variants in C1QA, C1QC, C2, DNASE1L3, and IKZF1. Seven additional patients carried heterozygous variants in complement or type I interferon-associated autosomal recessive genes, with decreased concentrations of the encoded proteins C3 and C9 recorded in two patients. Rare variants that were predicted to be damaging were significantly enriched in the childhood-onset SLE cohort compared with controls; 25% of SLE probands versus 5% of controls were identified to harbour at least one rare, predicted damaging variant (p=2·98 × 10-11). Inborn errors of immunity were estimated to account for 7% of cases of childhood-onset SLE, with defects in innate immunity representing the main monogenic contribution. INTERPRETATION An accumulation of rare variants that are predicted to be damaging in SLE-associated genes might contribute to disease expression and clinical heterogeneity. FUNDING European Research Council.
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Affiliation(s)
- Alexandre Belot
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France; CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.
| | - Gillian I Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sulliman Ommar Omarjee
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Quentin Rouchon
- Data Mining and Modelling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Eve M D Smith
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Marion Moreews
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Maud Tusseau
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Cécile Frachette
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France; CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Raphael Bournhonesque
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Nicole Thielens
- University of Grenoble Alpes, CNRS, CEA, IBS, F-38000 Grenoble, France
| | | | - Isabelle Rouvet
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Emilie Chopin
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Akihiro Hoshino
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM UMR 1163, Paris, France
| | - Sylvain Latour
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM UMR 1163, Paris, France; University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Bruno Ranchin
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France
| | - Rolando Cimaz
- Rheumatology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Paula Romagnani
- Nephrology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Christophe Malcus
- Service d'Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France
| | - Nicole Fabien
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Marie-Nathalie Sarda
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Behrouz Kassai
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, Hospices Civils de Lyon & Université Lyon 1, 69677, Bron, France
| | - Jean-Christophe Lega
- Internal Medicine Unit, CHLS, Hospices Civils de Lyon, Pierre Benite, Université de Lyon 1, Lyon, France
| | - Stéphane Decramer
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre De Référence des Maladies Rénales Rares du Sud Ouest & Inserm U1048, France
| | - Pauline Abou-Jaoude
- Department of Paediatric Nephrology, St George Hospital, University Medical Center, Beirut, Lebanon
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Simonet
- Department of Biostatistics-bioinformatics, Hospices Civils de Lyon, 69677, Bron, France
| | - Claire Bardel
- Department of Biostatistics-bioinformatics, Hospices Civils de Lyon, 69677, Bron, France; CNRS UMR5558, Biometry and evolutionary biology lab, Lyon University, Lyon 1 University, F-69622 Villeurbanne, France
| | - Pierre Antoine Rollat-Farnier
- CNRS UMR5558, Biometry and evolutionary biology lab, Lyon University, Lyon 1 University, F-69622 Villeurbanne, France
| | - Sebastien Viel
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | | | - James O'Sullivan
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thierry Walzer
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Anne-Laure Mathieu
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Gaelle Marenne
- Inserm, Univ Brest, EFS, UMR 1078, GGB, F-29200 Brest, France
| | - Thomas Ludwig
- Inserm, Univ Brest, EFS, UMR 1078, GGB, F-29200 Brest, France; CHU Brest, Brest, France
| | | | - Jamie Ellingford
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Brigitte Bader-Meunier
- Paediatric Rheumatology and Immunology Unit, Necker Hospital, Imagine Institution, Paris, France
| | - Tracy A Briggs
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael W Beresford
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Yanick J Crow
- Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Paris, France; Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Paris, France; Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Bedin M, Boyer O, Servais A, Li Y, Villoing-Gaudé L, Tête MJ, Cambier A, Hogan J, Baudouin V, Krid S, Bensman A, Lammens F, Louillet F, Ranchin B, Vigneau C, Bouteau I, Isnard-Bagnis C, Mache CJ, Schäfer T, Pape L, Gödel M, Huber TB, Benz M, Klaus G, Hansen M, Latta K, Gribouval O, Morinière V, Tournant C, Grohmann M, Kuhn E, Wagner T, Bole-Feysot C, Jabot-Hanin F, Nitschké P, Ahluwalia TS, Köttgen A, Andersen CBF, Bergmann C, Antignac C, Simons M. Human C-terminal CUBN variants associate with chronic proteinuria and normal renal function. J Clin Invest 2020. [PMID: 31613795 DOI: 10.1172/jci12937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
BACKGROUNDProteinuria is considered an unfavorable clinical condition that accelerates renal and cardiovascular disease. However, it is not clear whether all forms of proteinuria are damaging. Mutations in CUBN cause Imerslund-Gräsbeck syndrome (IGS), which is characterized by intestinal malabsorption of vitamin B12 and in some cases proteinuria. CUBN encodes for cubilin, an intestinal and proximal tubular uptake receptor containing 27 CUB domains for ligand binding.METHODSWe used next-generation sequencing for renal disease genes to genotype cohorts of patients with suspected hereditary renal disease and chronic proteinuria. CUBN variants were analyzed using bioinformatics, structural modeling, and epidemiological methods.RESULTSWe identified 39 patients, in whom biallelic pathogenic variants in the CUBN gene were associated with chronic isolated proteinuria and early childhood onset. Since the proteinuria in these patients had a high proportion of albuminuria, glomerular diseases such as steroid-resistant nephrotic syndrome or Alport syndrome were often the primary clinical diagnosis, motivating renal biopsies and the use of proteinuria-lowering treatments. However, renal function was normal in all cases. By contrast, we did not found any biallelic CUBN variants in proteinuric patients with reduced renal function or focal segmental glomerulosclerosis. Unlike the more N-terminal IGS mutations, 37 of the 41 proteinuria-associated CUBN variants led to modifications or truncations after the vitamin B12-binding domain. Finally, we show that 4 C-terminal CUBN variants are associated with albuminuria and slightly increased GFR in meta-analyses of large population-based cohorts.CONCLUSIONCollectively, our data suggest an important role for the C-terminal half of cubilin in renal albumin reabsorption. Albuminuria due to reduced cubilin function could be an unexpectedly common benign condition in humans that may not require any proteinuria-lowering treatment or renal biopsy.FUNDINGATIP-Avenir program, Fondation Bettencourt-Schueller (Liliane Bettencourt Chair of Developmental Biology), Agence Nationale de la Recherche (ANR) Investissements d'avenir program (ANR-10-IAHU-01) and NEPHROFLY (ANR-14-ACHN-0013, to MS), Steno Collaborative Grant 2018 (NNF18OC0052457, to TSA and MS), Heisenberg Professorship of the German Research Foundation (KO 3598/5-1, to AK), Deutsche Forschungsgemeinschaft (DFG) Collaborative Research Centre (SFB) KIDGEM 1140 (project 246781735, to CB), and Federal Ministry of Education and Research (BMB) (01GM1515C, to CB).
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Affiliation(s)
| | - Olivia Boyer
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
- Department of Pediatric Nephrology and
| | - Aude Servais
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
- Department of Nephrology, Necker Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Yong Li
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Marie-Josephe Tête
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
| | - Alexandra Cambier
- Department of Pediatric Nephrology and Transplantation, Robert-Debré Hospital, APHP, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology and Transplantation, Robert-Debré Hospital, APHP, Paris, France
| | - Veronique Baudouin
- Department of Pediatric Nephrology and Transplantation, Robert-Debré Hospital, APHP, Paris, France
| | | | | | - Florie Lammens
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | | | - Bruno Ranchin
- Department of Pediatric Nephrology, Hospices Civils de Lyon, Bron, France
| | - Cecile Vigneau
- Centre Hospitalier Universitaire de Rennes, INSERM U1085 IRSET-9, Rennes, France
| | - Iseline Bouteau
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | | | - Tobias Schäfer
- Renal Division, University Medical Center Freiburg, Freiburg, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Disease, Hannover Medical School, Hannover, Germany
| | - Markus Gödel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B Huber
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Günter Klaus
- Department of Child and Adolescent Medicine, University Medical Center Marburg-Giessen, Marburg, Germany
| | - Matthias Hansen
- KfH-Nierenzentrum für Kinder und Jugendliche und Clementine-Kinderhospital, Frankfurt, Germany
| | - Kay Latta
- KfH-Nierenzentrum für Kinder und Jugendliche und Clementine-Kinderhospital, Frankfurt, Germany
| | - Olivier Gribouval
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
| | | | - Carole Tournant
- Department of Genetics, Necker Hospital, APHP, Paris, France
| | - Maik Grohmann
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
- Center for Human Genetics, Mainz, Germany
| | - Elisa Kuhn
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Timo Wagner
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Christine Bole-Feysot
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, Paris, France
- Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Université de Paris, Paris, France
| | - Fabienne Jabot-Hanin
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, Paris, France
- Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Université de Paris, Paris, France
| | - Patrick Nitschké
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, Paris, France
- Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Université de Paris, Paris, France
| | | | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Carsten Bergmann
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
- Center for Human Genetics, Mainz, Germany
- Renal Division, Department of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Corinne Antignac
- Laboratory of Hereditary Kidney Disease, Imagine Institute, INSERM U1163, Université de Paris, Paris, France
- Department of Genetics, Necker Hospital, APHP, Paris, France
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Eibensteiner F, Ritschl V, Ariceta G, Jankauskiene A, Klaus G, Paglialonga F, Edefonti A, Ranchin B, Schmitt CP, Shroff R, Stefanidis CJ, Walle JV, Verrina E, Vondrak K, Zurowska A, Stamm T, Aufricht C. Rapid response in the COVID-19 pandemic: a Delphi study from the European Pediatric Dialysis Working Group. Pediatr Nephrol 2020; 35:1669-1678. [PMID: 32418146 PMCID: PMC7230035 DOI: 10.1007/s00467-020-04584-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 was declared a global health emergency. Since children are less than 1% of reported cases, there is limited information to develop evidence-based practice recommendations. The objective of this study was to rapidly gather expert knowledge and experience to guide the care of children with chronic kidney disease during the COVID-19 pandemic. METHODS A four-round multi-center Delphi exercise was conducted among 13 centers in 11 European countries of the European Pediatric Dialysis Working Group (EPDWG) between March, 16th and 20th 2020. Results were analyzed using a mixed methods qualitative approach and descriptive statistics. RESULTS Thirteen COVID-19 specific topics of particular need for guidance were identified. Main themes encompassed testing strategies and results (n = 4), changes in use of current therapeutics (n = 3), preventive measurements of transmission and management of COVID-19 (n = 3), and changes in standard clinical care (n = 3). Patterns of center-specific responses varied according to regulations and to availability of guidelines. CONCLUSIONS As limited quantitative evidence is available in real time during the rapid spread of the COVID-19 pandemic, qualitative expert knowledge and experience represent the best evidence available. This Delphi exercise demonstrates that use of mixed methodologies embedded in an established network of experts allowed prompt analysis of pediatric nephrologists' response to COVID-19 during this fast-emerging public health crisis. Such rapid sharing of knowledge and local practices is essential to timely and optimal guidance for medical management of specific patient groups in multi-country health care systems such as those of Europe and the US.
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Affiliation(s)
- Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d’ Hebron, Barcelona, Spain
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Günter Klaus
- Department of Pediatric Nephrology, KfH Children’s Kidney Center, Marburg, Germany
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg, Germany
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital for Children NHS Foundation Trust, and Institute of Child Health, London, UK
| | | | - Johan Vande Walle
- Department of Pediatric Nephrology, Utoped, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy
| | - Karel Vondrak
- Department of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic
| | - Aleksandra Zurowska
- Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Bacchetta J, Ginhoux T, Bernoux D, Dubourg L, Ranchin B, Roger C. Assessment of mineral and bone biomarkers highlights a high frequency of hypercalciuria in asymptomatic healthy teenagers. Acta Paediatr 2019; 108:2253-2260. [PMID: 31215071 DOI: 10.1111/apa.14907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/05/2019] [Revised: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Assessment of mineral metabolism is complex in paediatrics. METHODS We assessed the evolution of the main mineral and bone biomarkers (total/bone alkaline phosphatase ALP/BAP, β-crosslaps, osteocalcin, sclerostin, C-terminal and intact FGF23) in 100 healthy teenagers (10-18 years, 50 boys). RESULTS At a mean age of 13.7 ± 2.2 years, phosphatemia, tubular phosphate reabsorption, ALP and BAP significantly decreased along puberty in both genders, whilst parathyroid hormone (PTH), 25-vitamin D (25D), FGF23, plasma calcium and urinary calcium were not modified. In girls, osteocalcin, β-crosslaps and sclerostin significantly decreased at the end of puberty. Calciuria above the crystallisation threshold (>3.8 mmol/L) and urinary calcium/creatinine ratio >0.7 mmol/mmol were found in 39% and 6% of subjects, respectively. Multivariable analyses showed that renal function and PTH were significant predictors of calciuria and urinary calcium/creatinine, whilst 25D remained a predictor only of urinary calcium/creatinine ratio. CONCLUSION Using the most recent assays, this study provides data for mineral/bone biomarkers across puberty and highlights the risk of hyper-calciuria in apparent asymptomatic healthy teenagers, not related to calcium intake but rather to 25D. Future studies are required to dissect the underlying mechanisms increasing calciuria and prevent nephrolithiasis as early as during childhood.
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Affiliation(s)
- Justine Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hôpital Femme Mère Enfant Bron France
- Faculté de Médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- INSERM UMR 1033 Lyon France
| | - Tiphanie Ginhoux
- EPICIME‐CIC 1407 de Lyon, Inserm Service de Pharmacotoxicologie CHU‐Lyon Bron France
| | - Delphine Bernoux
- EPICIME‐CIC 1407 de Lyon, Inserm Service de Pharmacotoxicologie CHU‐Lyon Bron France
- Service d'Endocrinologie, Diabétologie et Métabolisme pédiatriques Hôpital Femme Mère Enfant Bron France
| | - Laurence Dubourg
- Faculté de Médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale Groupement Hospitalier Edouard Herriot Hospices Civils de Lyon Lyon France
- Laboratory of Tissue Biology and Therapeutic Engineering UMR 5305 CNRS University Lyon 1 Lyon France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hôpital Femme Mère Enfant Bron France
| | - Christelle Roger
- Laboratoire de Biochimie et Biologie Moléculaire Groupe Hospitalier Sud Hospices Civils de Lyon Lyon France
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50
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Broenen E, Ranchin B, Besmond C, Freychet C, Fouilhoux A, Perouse de Montclos T, Ville D, Bacchetta J. RMND1 mutations in two siblings: Severe renal hypoplasia but different levels of extrarenal abnormality severity: The ethics of decision making. Arch Pediatr 2019; 26:377-380. [PMID: 31506229 DOI: 10.1016/j.arcped.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Mutations in the RMND1 gene, causing defects in the mitochondrial respiratory chain, result in a very heterozygous phenotype. Currently there are 36 cases reported in the literature. We report two siblings from a non-consanguineous family who were severely affected by a compound heterozygous RMND1 mutation that had not been described previously and were treated differently for their end-stage renal disease. We summarize all previous published cases and focus on the importance of extrarenal comorbidities in the context of therapeutic decision making (renal replacement therapy) and its ethical relevance.
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Affiliation(s)
- E Broenen
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - B Ranchin
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - C Besmond
- Inserm UMR1163, institut imagine, génétique translationnelle, université de Paris, 75015 Paris, France
| | - C Freychet
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - A Fouilhoux
- Centre de référence des maladies métaboliques héréditaires, hôpital femme-mère-enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - T Perouse de Montclos
- Service de cardiologie pédiatrique, hôpital Louis-Pradel, hospices civils de Lyon, 69677 Bron cedex, France
| | - D Ville
- Service de neurologie pédiatrique, hôpital femme-mère-enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - J Bacchetta
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 69677 Bron cedex, France; Faculté de médecine Lyon Est, université Lyon 1, 69373 Lyon cedex 08, France.
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