10 research outputs found
Inhibiteurs du systÚme rénine-angiotensine au cours de la COVID-19 : protecteurs ou dangereux ?
La COVID-19 est liĂ©e de prĂšs au systĂšme rĂ©nine-angiotensine (SRA), puisque la pĂ©nĂ©tration du SARS-CoV-2 dans les cellules se fait via lâenzyme de conversion de lâangiotensine 2 (ACE2). LâACE2 tire son nom dâune homologie de sĂ©quence avec lâangiotensin-converting enzyme1 (ACE1) qui clive lâAng I en Ang II et est inhibĂ©e par les IEC qui en revanche nâinhibent pas lâACE2. LâACE2 clive lâAng II en Ang (1-7) et lâAng I en Ang (1-9), qui est ensuite convertie en Ang (1-7) par lâACE1. LâAng (1-7) sâoppose aux actions de lâAng II. Lâinfection par le SARS-CoV-2 entraine une baisse de lâACE-2, internalisĂ© pour permettre au virus dâentrer dans les cellules. Ceci a pour consĂ©quence une dĂ©rĂ©gulation de lâĂ©quilibre entre lâAng II et lâAng (1-7), entrainant une augmentation de lâinflammation, une endothĂ©lite avec une dysfonction endothĂ©liale, responsable dâun phĂ©notype vasculaire pro-thrombotique, et une fibrose tissulaire accĂ©lĂ©rĂ©e. AprĂšs une inquiĂ©tude initiale, il a Ă©tĂ© montrĂ© que les bloqueurs du SRA ne favorisent ni lâinfection par le SARS-CoV-2, ni en aggravent le pronostic. Il est donc recommandĂ© par toutes les sociĂ©tĂ©s savantes de ne pas arrĂȘter les IEC ou ARA2 chez les patients atteints de COVID-19, en dehors des indications dâarrĂȘt classiques (insuffisance rĂ©nale aigĂŒe, dĂ©shydratation sĂ©vĂšre, Ă©tat de choc). Il reste Ă Ă©lucider un Ă©ventuel effet bĂ©nĂ©fique chez les patients initialement sans indication pour un traitement par IEC ou ARA2 atteints de COVID-19
When patients died fried in their bath. Nightmare, fantasy and reality of alienist medicine in France in the 19th and 20th centuries
Lymphomas with kidney involvement: the French multicenter retrospective LyKID study.
The LyKID study is a nationwide survey in France of lymphoma patients with renal involvement based on biopsy and/or imaging, to evaluate its impact on disease outcome and renal function. A total of 87 adult cases of B or T-cell lymphomas were retrospectively analyzed. Interstitial topography was observed in most of the kidney biopsies (54/66; 80%). Kidney failure (glomerular filtration rate <60 mL/min/1.73 m <sup>2</sup> ) was present in 47% of patients and was associated with non-significantly different outcome. After lymphoma treatment, 44% of patients had persistent chronic kidney failure (CKF); kidney failure at diagnosis was the only parameter associated with CKF in multivariate analysis. DLBCL (diffuse large B-cell lymphomas) represented half of the series, with noticeably CNS (central neurological system) relapse in 17% patients, while fewer than one of two patients had received CNS prophylaxis. To our knowledge, the LyKID study represents the largest published non-autopsy lymphoma series with renal involvement