Hyperchloremia is not associated with AKI or death in septic shock patients: results of a post hoc analysis of the “HYPER2S” trial

International audienceBackgroundRecent data suggest that hyperchloremia induced by fluid resuscitation is associated with acute kidney injury (AKI) and mortality, particularly in sepsis. Experimental studies showed that hyperchloremia could affect organ functions. In patients with septic shock, we examined the relationship between serum chloride concentration and both renal function and survival.MethodsPost hoc analysis of the “HYPER2S” trial database (NCT01722422) including 434 patients with septic shock randomly assigned for resuscitation with 0.9% or 3% saline. Metabolic parameters were recorded up to 72 h. Metabolic effects of hyperchloremia (> 110 mmol/L) were studied stratified for hyperlactatemia (> 2 mmol/L). Cox models were constructed to assess the association between chloride parameters, day-28 mortality and AKI.Results413 patients were analysed. The presence of hyperlactatemia was significantly more frequent than hyperchloremia (62% versus 71% of patients, respectively, p = 0.006). Metabolic acidosis was significantly more frequent in patients with hyperchloremia, no matter the presence of hyperlactatemia, p < 0.001. Adjusted risk of AKI and mortality were not significantly associated with serum chloride, hyperchloremia, maximal chloremia and delta chloremia (maximal-H0 [Cl]).ConclusionsDespite more frequent metabolic acidosis, hyperchloremia was not associated with an increased risk for AKI or mortality

Intravenous immunoglobulin therapy in kidney transplant recipients with de novo DSA: Results of an observational study.

Approximately 25% of kidney transplant recipients develop de novo anti-HLA donor-specific antibodies (dnDSA) leading to acute antibody-mediated rejection (ABMR) in 30% of patients. Preemptive therapeutic strategies are not available.We conducted a prospective observational study including 11 kidney transplant recipients. Inclusion criteria were dnDSA occurring within the first year after transplant and normal allograft biopsy. All patients were treated with high-dose IVIG (2 g/kg 0, 1 and 2 months post-dnDSA). The primary efficacy outcome was incidence of clinical and subclinical acute ABMR within 12 months after dnDSA detection as compared to a historical control group (IVIG-).Acute ABMR occurred in 2 or 11 patients in the IVIG+ group and in 1 of 9 patients in the IVIG- group. IVIG treatment did not affect either class I or class II DSA, as observed at the end of the follow-up. IVIG treatment significantly decreased FcγRIIA mRNA expression in circulating leukocytes, but did not affect the expression of any other markers of B cell activation.In this first pilot study including kidney allograft recipients with early dnDSA, preemptive treatment with high-dose IVIG alone did not prevent acute ABMR and had minimal effects on DSA outcome and B cell phenotype

Recurrent Hemolytic and Uremic Syndrome Induced by Escherichia Coli.

International audienceA widespread belief is that typical hemolytic and uremic syndrome (HUS) does not recur. We report the case of a patient infected twice with raw milk taken from his own cow and containing a Shiga toxin-producing Escherichia coli O174:H21 that induced recurrent HUS causing severe renal and cerebral disorders. A genomic comparison of the human and bovine Shiga toxin-producing Escherichia coli O174:H21 isolates revealed that they were identical. Typical HUS may recur. Since milk from this animal was occasionally distributed locally, thereby posing a serious threat for the whole village, this particular cow was destroyed

Clinical characteristics of treatment groups.

<p>Clinical characteristics of treatment groups.</p

At the time of <i>de novo</i> DSA (biopsy #1).

<p>At the time of <i>de novo</i> DSA (biopsy #1).</p

Blood leukocyte phenotypes and gene expression before and after IVIG treatment.

<p>Blood leukocyte phenotypes and gene expression before and after IVIG treatment.</p

Evolution of the DSA characteristics and lesion histology from the time of <i>dn</i>DSA detection (biopsy #1) to the time of the second biopsy (biopsy #2).

<p>1.A: Evolution of class I and class II DSA characteristics (number, MFI max and MFI sum). The evolution of all DSA characteristics was similar in the IVIG+ and the IVIG- group. DSA characteristics were also similar in the IVIG+ <i>vs</i>, IVIG- group, at both time points tested. 1.B: Evolution of chronic histologic lesions (ci, ct, cv and ah) as defined in Banff’13 updated classification. No histological differences were found between biopsy #1 and #2, in either the IVIG+ or IVIG- groups. The IVIG+ and control groups were also similar at both time points.</p

Intravenous immunoglobulin therapy in kidney transplant recipients with <i>de novo</i> DSA: Results of an observational study

<div><p>Background</p><p>Approximately 25% of kidney transplant recipients develop <i>de novo</i> anti-HLA donor-specific antibodies (<i>dn</i>DSA) leading to acute antibody-mediated rejection (ABMR) in 30% of patients. Preemptive therapeutic strategies are not available.</p><p>Methods</p><p>We conducted a prospective observational study including 11 kidney transplant recipients. Inclusion criteria were <i>dn</i>DSA occurring within the first year after transplant and normal allograft biopsy. All patients were treated with high-dose IVIG (2 g/kg 0, 1 and 2 months post-<i>dn</i>DSA). The primary efficacy outcome was incidence of clinical and subclinical acute ABMR within 12 months after <i>dn</i>DSA detection as compared to a historical control group (IVIG-).</p><p>Results</p><p>Acute ABMR occurred in 2 or 11 patients in the IVIG+ group and in 1 of 9 patients in the IVIG- group. IVIG treatment did not affect either class I or class II DSA, as observed at the end of the follow-up. IVIG treatment significantly decreased FcγRIIA mRNA expression in circulating leukocytes, but did not affect the expression of any other markers of B cell activation.</p><p>Conclusions</p><p>In this first pilot study including kidney allograft recipients with early <i>dn</i>DSA, preemptive treatment with high-dose IVIG alone did not prevent acute ABMR and had minimal effects on DSA outcome and B cell phenotype.</p></div