Campylobacter Colitis as a Trigger for Atypical Hemolytic Uremic Syndrome: About One Case

We present the case of a 17-year-old Caucasian male whose condition featured acute renal failure, anemia, and deep thrombocytopenia after five consecutive days of diarrhea. Campylobacter coli was identified in stool cultures and, although the direct role of this germ in the pathogenesis of hemolytic uremic syndrome (HUS) remains uncertain to this day, initial presentation was considered broadly consistent with typical HUS. However, the patient showed no signs of spontaneous recovery over time. While secondary investigations showed no abnormalities in ADAMTS13 activity or in the alternate pathway of complement, patient’s condition deteriorated. Worsening kidney failure required emergency renal replacement therapy and was followed by cardiac involvement in the form of acute heart failure. Given this unfavorable development, blood samples were drawn to look for mutations in the alternate complement pathway, and eculizumab therapy was initiated without further delay, allowing prompt improvement of cardiac function and recovery of diuresis. Upon discharge, the patient still had to undergo intermittent dialysis, which would later be withdrawn. Genetic analysis ultimately confirmed the presence of a complement factor H mutation associated with a high risk of disease recurrence, indicating long-term continuation of eculizumab therapy

Icodextrine : quels arguments pour et contre son utilisation comme agent osmotique en dialyse péritonéale ?

L’icodextrine est un polymère de glucose dérivé de l’amidon qui est utilisé comme agent osmotique en dialyse péritonéale. Son grand poids moléculaire limite fortement son absorption sanguine et permet donc de l’utiliser dans des stases longues, puisqu’il y a très peu de dissipation du gradient osmotique. Ses bénéfices sont nombreux : optimisation de l’ultrafiltration et donc du contrôle de la surcharge hydro-sodée, notamment chez des patients anuriques, hyperperméables ou en cas de péritonite infectieuse, épargne glucidique avec moins de complications métaboliques et meilleure préservation de la membrane péritonéale, meilleure biocompatibilité. Toutefois, il possède également des effets secondaires qu’il ne faut pas méconnaître : allergies, cas de péritonite aseptique, déplétion hydro-sodée trop intense, passage sanguin d’icodextrine et de ses dérivés (notamment le maltose), avec risque d’erreurs de dosage de la glycémie capillaire et augmentation modérée de l’osmolalité plasmatique. C’est pourquoi son utilisation est actuellement limitée à une stase longue quotidienne au maximum. Malgré cela, plusieurs centres l’utilisent dans plus d’une stase quotidienne, notamment chez des patients en grande perte d’ultrafiltration ou chez qui l’épargne glucidique est essentielle. Ces patients semblent tirer des bénéfices de cette utilisation intensifiée d’icodextrine sans présenter plus d’effets indésirables. Une grande étude multicentrique (DIDo) est actuellement en cours pour tester l’efficacité et la sécurité de l’utilisation d’icodextrine dans deux échanges quotidiens chez des patients âgés et incidents en dialyse péritonéale. Par ailleurs, l’icodextrine est aussi utilisé combiné à du glucose en stase longue (ultrafiltration bimodale) avec des résultats très prometteurs en termes d’ultrafiltration et d’épargne glucidique.[Icodextrin: What arguments for and against its use as an osmotic agent in peritoneal dialysis] Icodextrin is a glucose polymer derived from starch that is used as an osmotic agent in peritoneal dialysis. Its high molecular weight limits blood absorption and is useful for long dwell since there is few osmotic gradient dispersal. Its benefits are numerous: ltrafiltration optimization and better salt and water control especially in anuric patients with a high peritoneal permeability and also in case of infectious peritonitis, glucose sparing with less metabolic complications and a better preservation of peritoneal membrane, better biocompatibility. However it should not be forgotten that icodextrin has also side effects that must be known: allergies, cases of aseptic peritonitis, overintense water and salt depletion, lymphatic absorption of icodextrin and its metabolites (including maltose) with a risk of false capillary glucose rate estimation and a moderate increase in plasma osmolality. That is why it is not recommended now to use more than one daily icodextrin dwell. Nevertheless, several dialysis units use icodextrin in more than one daily dwell, especially in patients with an important ultrafiltration loss or in those in whom glucose sparing is essential. It seems to profit them with no more side effects. A large multicenter trial is in progress to test the efficacy and safety of icodextrin dwell twice a day in elder incident patients in peritoneal dialysis (DIDo). Moreover, icodextrin is also used combined with glucose in a long dwell (bimodal ultrafiltration) with encouraging results in terms of ultrafiltration and glucose sparing

Exome data reanalysis solved case in undetermined nephropathy with detection of TULP3- truncating variant

International audienc

Early Withdrawal Effects in a Heavy Cannabis Smoker During Hemodialysis

International audienceno abstrac

Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature

<div><p>Although post-transplant lymphoproliferative disorder (PTLD) is the second most common type of cancer in kidney transplantation (KT), plasma cell neoplasia (PCN) occurs only rarely after KT, and little is known about its characteristics and evolution. We included twenty-two cases of post-transplant PCN occurring between 1991 and 2013. These included 12 symptomatic multiple myeloma, eight indolent myeloma and two plasmacytomas. The median age at diagnosis was 56.5 years and the median onset after transplantation was 66.7 months (2–252). Four of the eight indolent myelomas evolved into symptomatic myeloma after a median time of 33 months (6–72). PCN-related kidney graft dysfunction was observed in nine patients, including six cast nephropathies, two light chain deposition disease and one amyloidosis. Serum creatinine was higher at the time of PCN diagnosis than before, increasing from 135.7 (±71.6) to 195.9 (±123.7) μmol/l (p = 0.008). Following transplantation, the annual rate of bacterial infections was significantly higher after the diagnosis of PCN, increasing from 0.16 (±0.37) to 1.09 (±1.30) (p = 0.0005). No difference was found regarding viral infections before and after PCN. Acute rejection risk was decreased after the diagnosis of PCN (36% before versus 0% after, p = 0.004), suggesting a decreased allogeneic response. Thirteen patients (59%) died, including twelve directly related to the hematologic disease. Median graft and patient survival was 31.7 and 49.4 months, respectively. PCN after KT occurs in younger patients compared to the general population, shares the same clinical characteristics, but is associated with frequent bacterial infections and relapses of the hematologic disease that severely impact the survival of grafts and patients.</p></div

Characteristics of plasma-cell neoplasias after kidney transplantation.

<p>Characteristics of plasma-cell neoplasias after kidney transplantation.</p

Evolution of serum creatinine after kidney transplantation, combined with the occurrence of asymptomatic or symptomatic PCN, hemodialysis and death for each patient.

<p>Evolution of serum creatinine (μmol/l) over time (in years) after kidney transplantation, for each patient. Patients were classified in six groups, and approximate time of diagnosis of SMM (smoldering multiple myeloma), symptomatic PCN (plasma-cell neoplasia), hemodialysis and death were added. MM: Multiple Myeloma. MGRS: Monoclonal Gammapathy of Renal Significance. LCDD: Light Chain Deposition Disease.</p

Time to onset of plasma cell neoplasia after kidney transplantation.

<p>Time to onset of plasma cell neoplasia after kidney transplantation.</p

Bacterial infections before and after the diagnosis of plasma-cell neoplasia after kidney transplantation.

<p><b>A:</b> The annual rate of bacterial infections was compared for each patient before and after the diagnosis of PCN during the kidney transplantation period. (*** = p<0.001). <b>B:</b> Type (x axis) and number (y axis) of bacterial infections during the follow-up of PCN. PCN: plasma cell neoplasia.</p