Chronic urine acidification by fludrocortisone to treat infectious kidney stones

Chronic urinary tract infections by urease-producing bacteria may increase urine pH and promote thereby the formation of recurrent kidney stones made of highly carbonated calcium phosphate apatite and struvite, a magnesium ammonium phosphate. To date, there is no safe and effective treatment decreasing urine pH on a long term. We hypothesized that fludrocortisone, a mineralocorticoid, would decrease urine pH by increasing proton secretion in the kidney collecting tubule. We report three cases of patients with kidney stone suffering from chronic urinary infection by urease-producing germs, treated by fludrocortisone on a long term. Urine pH decreased sustainably over several months and tolerance was good

Chronic urine acidification by fludrocortisone to treat infectious kidney stones

Chronic urinary tract infections by urease-producing bacteria may increase urine pH and promote thereby the formation of recurrent kidney stones made of highly carbonated calcium phosphate apatite and struvite, a magnesium ammonium phosphate. To date, there is no safe and effective treatment decreasing urine pH on a long term. We hypothesized that fludrocortisone, a mineralocorticoid, would decrease urine pH by increasing proton secretion in the kidney collecting tubule. We report three cases of patients with kidney stone suffering from chronic urinary infection by urease-producing germs, treated by fludrocortisone on a long term. Urine pH decreased sustainably over several months and tolerance was good

First investigation on microcrystalline pathologies of kidney allografts through cellular scale physicochemical techniques

AbstractTubulo-interstitial microcalcifications in renal transplant are described with a wide difference of incidence (4–78%) according to time and goal of biopsies. Currently, staining procedures are used to deduce the composition of crystals and speculate about their aetiologies. Here we test the contribution of infrared microspectroscopy (IR-MS) in understanding kidney transplant crystal deposits. First, microcalcifications observed in 118 allograft biopsies are studied by IR-MS. The Fourier transform infrared signal shows that a major proportion (92%) of calcium phosphate crystals is in the pure or mixed form. Next, we compare 50 patients with calcifications to 100 without calcifications and show persistent hyperparathyroidism and tubular cell vacuolization as circumstances of crystal deposition. Finally, the graduation level of calcification by IR-MS appears to be correlated with the graft outcome. Graft survival seems to be worse in case of high microcalcification detection by IR-MS. These preliminary data suggest IR-MS as a great tool for clinicians to diagnose, characterize, and quantify microcalcifications in kidney allografts

Caractéristiques des syndromes hémolytiques et urémiques atypiques associés à la mutation C3R161W

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Microangiopathie thrombotique en transplantation rénale (place des mutations du facteur H, facteur I et MCP ?)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

The Case | A man with acute bilateral urolithiasis

International audienc

MYH9-related disorders display heterogeneous kidney involvement and outcome

International audienceBackgroundMYH9-related diseases (MYH9-RD) are autosomal dominant disorders caused by mutations of the MYH9 gene encoding the non-muscle myosin heavy chain IIA. They are characterized by congenital thrombocytopenia, giant platelets and leucocyte inclusions. Hearing impairment, pre-senile cataract and nephropathy can also occur. We aimed to evaluate renal involvement and outcome in MYH9-RD patients followed-up by nephrologists.MethodsWe conducted a retrospective multicentre observational study of 13 patients among 9 families with MYH9 mutation diagnosed by genetic testing and immunofluorescence assay referred to nephrologists.ResultsAt initial referral, median age was 30 (range 14–76) years. Median estimated glomerular filtration rate was 66 mL/min/1.73 m2 (0–141) and two patients had already end-stage renal disease (ESRD). Renal presentation associated proteinuria (n = 12), haematuria (n = 6) and hypertension (n = 6). Three patients developed a rapid onset ESRD whereas five others had a relatively stable kidney function over a 3-year median follow-up (1–34). Extra-renal features varied widely, with hearing impairment in six patients, cataract in two and mild liver dysfunction in seven. Thrombocytopenia existed at referral in 11 patients. Time to diagnosis varied from 0 to 29 years (median 3 years). Initial diagnoses such as idiopathic thrombocytopenic purpura (n = 4) and focal segmental glomerulosclerosis (n = 1) led to corticosteroid administration (n = 4), intravenous immunoglobulins (n = 3), cyclophosphamide (n = 1) and splenectomy (n = 1).ConclusionsRenal involvement and outcome in MYH9-RD are heterogeneous. The diagnosis is often delayed and misdiagnoses can lead to unnecessary treatments. MYH9-RD should be considered in any patient with glomerular involvement associated with a low or slightly decreased platelet count and/or hearing loss and liver dysfunction

Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors

Abstract As the use of elderly kidney donors for transplantation is increasing with time, there is a need to understand which factors impact on their prognosis. No data exist on the impact of an impaired renal function (IRF) in such population. 116 kidney recipients from deceased kidney donors over 70 years were included from 2005 to 2015 in a single-center retrospective study. IRF before organ procurement was defined as a serum creatinine above 1.0 mg/dl or a transient episode of oligo-anuria. Mean ages for donors and recipients were respectively 74.8 ± 3.5 and 66.7 ± 8.0. Graft survival censored for death at 5 years was of 77%. Using a multivariate analysis by Cox model, the only predictor of graft loss present in the donor was IRF before organ procurement (HR 4.2 CI95[1.8–9.7]). IRF was also associated with significant lower estimated glomerular filtration rates up to 1 year post-transplantation. By contrast, KDPI score (median of 98 [96–100]), was not associated with the risk of graft failure. Then, IRF before kidney procurement may define a risk subgroup among very-old deceased kidney donors, in whom pre-implantatory biopsies, dual kidney transplantation or calcineurin inhibitor-free immunosuppressive regimen could help to improve outcomes

The Versatile Role of miR-21 in Renal Homeostasis and Diseases

MicroRNAs (miRNAs) are small, non-coding RNA species that control gene expression and confer robustness to biological processes. Over the last two decades, their important roles during kidney development, homeostasis and the treatment of diseases have been established, in particular during the onset and progression of various forms of acute and chronic renal disorders. In recent years, miR-21, one of the best-characterized miRNAs to date, has received much attention in renal physiology in particular given its high degree of conservation and expression in kidneys, as well as its potent pathogenic role in various debilitating renal diseases. This review summarizes the current knowledge on miR-21’s involvement in both renal homeostasis and diseases, in particular its double-edged-sword role in acute versus chronic kidney injuries. Finally, we also discuss the potential of miR-21 as a biomarker and therapeutic target in renal diseases

DE NOVO ANTI HLA ANTIBODIES AFTER KIDNEY TRANSPLANTATION: TRIGGERING FACTORS AND LONG TERM OUTCOME IN RENAL TRANSPLANT RECIPIENTS

info:eu-repo/semantics/publishe