Renal involvement in eosinophilic granulomatosis with polyangiitis

International audienceEosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss syndrome, is a small to medium-sized systemic necrotizing vasculitis characterized by eosinophil-rich tissue infiltrates and granulomatous lesions. EGPA belongs to the larger subgroup of ANCA-associated vasculitides (AAV). However, EGPA is characterized by a distinct biological and clinical presentation when compared with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). EGPA is typically characterized by late onset asthma, nasal and sinus-related symptoms, peripheral neuropathy and prominent peripheral blood eosinophilia.1 The prevalence of ANCA positivity in EGPA is about 40%, with predominant perinuclear staining, and exhibits an anti-MPO specificity in approximatively 65% of cases.1,2 Unlike GPA and MPA, where kidney involvement is a central feature, nephropathy is not considered a prominent aspect in patients with EGPA.1,3 For this reason, the nephrologist is not usually regarded as a key player in the care of EGPA patients. The case reported here dispels this misconception by demonstrating that, in selected cases, nephrological expertise may play an active role in patient management

Retinal Arteriolar Occlusions and Exudative Retinal Detachments in Malignant Hypertension: More Than Meets the Eye

International audienceBackground: Malignant hypertension is macrovascular and microvascular endothelial injury responsible for multiple organ damage. Considering the anatomical and functional homologies between the posterior pole of the eye and the kidney, ophthalmological explorations may inform clinicians on the mechanisms underpinning concurrent kidney injury in this condition. More specifically, we investigated whether the wall-to-lumen ratio (WLR) of retinal arterioles measured by adaptive optics ophthalmoscopy could be correlated to WLR of kidney arterioles as determined by pathology. We sought to estimate the incidence of retinal arteriole occlusion a supposedly uncommon complication of malignant hypertension.Methods: All patients hospitalized in our renal Intensive Care Unit for malignant hypertension between 2016 and 2019 were referred to ophthalmological examinations.Results: Twenty-seven patients were included. Median retinal WLR was 0.39 [0.31-0.47] and was correlated with initial systolic (r = 0.56, P = 0.003) and mean blood pressure (r = 0.46, P = 0.02) upon admission. The retinal WLR was not correlated to renal pathological findings, as assessed by juxtaglomerular WLR (r = 0.38, P = 0.2), ratio of glomerulosclerosis (r = -0.39, P = 0.2), or tubulointerstitial fibrosis (r = -0.45, P = 0.08). Retinal WLR was not associated with neurological or cardiovascular end-organ damage. Branch retinal artery occlusion was detected in 18.5% of patients and exudative retinal detachment (ERD) in 29.6% of patients, without any significant correlation with canonical signs of retinal hypertension including optic disc swelling.Conclusions: In the setting of malignant hypertension, we failed to demonstrate a significant relationship between WLR and other meaningful end-organ injuries. However, branch retinal artery occlusion and ERD may have been hitherto underestimated

FC030: Diagnostic Yield of Exome Sequencing in Hypertensive Nephropathy

BACKGROUND AND AIMS : Hypertensive nephrosclerosis ranks as one of the most frequent causes of chronic kidney disease (CKD) worldwide and is deemed to be especially prevalent among patients of African ancestry [1]. The very existence of hypertensive nephropathy has been called into question, especially in young adults. Its diagnostic framework is based on non-specific clinical criteria, and its histopathological features are in fact unspecific. [...

Can empathy be taught? A cross-sectional survey assessing training to deliver the diagnosis of end stage renal disease

International audienceBackground: Receiving the diagnosis of kidney failure has a major impact on patients. Yet, the way in which this diagnosis should be delivered is not formally taught within our medical curriculum. To fill this gap we set up a training course of kidney failure diagnosis delivery for nephrology trainees since 2016. This study assessed the effectiveness of this educational intervention.Methods: The primary outcome was change in the empathy score immediately after the training session and several months afterward, based on the Jefferson Scale of Physician Empathy (JSPE). Self-reported change in clinical practice was also evaluated. As control groups, we assessed empathy levels in untrained nephrology trainees (n = 26) and senior nephrologists (n = 71). Later on (>6 months) we evaluated participants’ perception of changes in their clinical practice due to the training.Results: Six training sessions permitted to train 46 trainees. Most respondents (76%) considered the training to have a durable effect on their clinical practice. Average empathy scores were not significantly different in pre-trained trainees (average JSPE: 103.7 ± 11.4), untrained trainees (102.8 ± 16.4; P = 0.81) and senior nephrologists (107.2 ± 13.6; P = 0.15). Participants’ empathy score significantly improved after the training session (112.8 ± 13.9; P = 0.003). This improvement was sustained several months afterwards (average JSPE 110.5 ± 10.8; P = 0.04).Conclusion: A single 4-hour training session can have long lasting impact on empathy and clinical practice of participants. Willingness to listen, empathy and kindness are thought to be innate and instinctive skills, but they can be acquired and should be taught

French nationwide survey of undocumented ESRD migrant patient access to scheduled hemodialysis and kidney transplantation

International audienc