Beware, polyarteritis nodosa still exists in nephrology!

International audienceRenal involvement of systemic vasculitides is an emergency in nephrology. Although it has become very rare, the diagnosis of polyarteritis nodosa must be considered in some patients. A 70-year-old patient, previously healthy, presented with acute renal failure and malignant hypertension and abundant albuminuria. Subcutaneous nodule, orchitis and mononeuritis appeared subsequently. The search for auto-immunity or viral infection was negative. Markers of thrombotic microangiopathy, present initially, resolved after blood pressure control. After a renal computed tomography with contrast medium injection was considered normal, without any micro-aneurysm, a renal biopsy was performed. It showed vascular lesions and glomerular ischemia. It was complicated by hemorragic shock after 36hours. The diagnosis of periarteritis nodosa was finally made after arterial angiography showed millimetric renal micro-aneurysms. In case of systemic vasculitis with renal involvement, periarteritis nodosa must be part of differential diagnosis, especially in case of malignant hypertension, subcutaneous nodosa and orchitis, and despite albuminuria. This implies the search for micro-aneurysms with arterial angiography, and the contraindication of renal biopsy, associated with a high risk of severe hemorrhage. Periarteritis nodosa still exists in nephrology, even without hepatitis B infection. The association of acute renal failure with medium vessel vasculitis, with negative ANCA, must alert the nephrologist and lead to arterial angiography not to renal biopsy

Effets uro-néphrologiques des produits utilisés par les usagers de drogues : revue de la littérature et enquête pharmaco-épidémiologique en France et dans la région de Marseille

International audienceA great diversification of drugs of abuse has been observed in recent years, both in the populations using them and in the types of drugs. Although dependency and psychiatric disorders associated with the abuse of these substances is well known, somatic complications, uro-nephrotoxicity in particular, are less recognized. We propose here an overview of the products used by drugs abusers in France, through the analysis of the national pharmaco-epidemiological study Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (OPPIDUM). Among the 5003 patients who participated in this survey, 84% were on prescribed psychoactive substances, with indicators of abuse in 28% of cases; more than half of these patients had also been using drugs of abuse (mainly cannabis) in the previous week. We then describe the main urological and renal toxicities of these drugs, in particular of heroin, cocaine, cannabis, ecstasy, LSD, amphetamine, new designer drugs, ketamine and opiate substitution treatment. We finally present a pharmaco-epidemiological survey of patients hospitalized for drugs complications in nephrology at the university hospital of Marseille. Between 2000 and 2015, 22 patients aged 18 to 57 years were hospitalized for renal adverse effects of drugs of abuse, such as glomerulonephritides, focal segmental glomerulosclerosis, acute kidney injury or chronic kidney disease. The somatic complications of drugs participate in their dangerousness and should be a red flag. They should be systematically reported to the addictovigilance national network to allow the improvement of information given to the patients and the medical community, and to adapt the prevention and risk reduction policies.L’abus de substances psychoactives (SPA) s’est diversifié ces dernières années, tant au niveau des populations concernées que des produits consommés. Si la dépendance et les troubles psychiatriques liés à la consommation de ces substances sont généralement connus, les complications somatiques, en particulier uro-néphrologiques, le sont moins. Nous proposons tout d’abord dans cette revue un état des lieux des SPA consommées par les usagers de drogue en France, à partir des données de l’étude nationale pharmaco-épidémiologique OPPIDUM (Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse). Parmi les 5003 patients interrogés, 84 % étaient consommateurs d’au moins une SPA médicamenteuse, avec des indicateurs d’abus dans 28 % des cas, et plus de la moitié avaient consommé une SPA non médicamenteuse (principalement du cannabis) la semaine précédente. Nous décrivons ensuite les complications urologiques et néphrologiques des principales SPA, telles que l’héroïne, la cocaïne, le cannabis, l’ecstasy, le LSD, les amphétamines, les nouveaux produits de synthèse, la kétamine et les médicaments de substitution aux opiacés. Nous présentons enfin une enquête pharmaco-épidémiologique concernant les patients hospitalisés en néphrologie adulte au CHU de Marseille pour des complications liées à l’abus de SPA. Entre 2000 et 2015, 22 patients âgés de 18 à 57 ans ont été hospitalisés pour des complications néphrologiques des SPA, telles que glomérulonéphrite aiguë, hyalinose segmentaire et focale, insuffisance rénale aiguë ou chronique. Les complications somatiques liées à l’usage des SPA participent à leur dangerosité et peuvent avoir une valeur d’alerte. Il est important que les professionnels de santé signalent au centre d’addictovigilance de leur territoire les complications sanitaires liées à l’usage des SPA, afin d’optimiser l’information donnée aux patients et aux professionnels de santé et d’adapter des programmes de prévention et de réduction des risques

Thrombotic microangiopathy associated with gemcitabine use: Presentation and outcome in a national French retrospective cohort

International audienceAims Gemcitabine has been associated with thrombotic microangiopathy (TMA). We conducted a national retrospective study of gemcitabine-associated TMA (G-TMA). Methods From 1998 to 2015, all cases of G-TMA reported to the French Pharmacovigilance Network and the French TMA Reference Center, and cases explored for complement alternative pathway abnormalities, were analysed. Results G-TMA was diagnosed in 120 patients (median age 61.5 years), after a median of 210 days of treatment, and a cumulative dose of 12 941 mg m(-2). Gemcitabine indications were: pancreatic (52.9%), pulmonary (12.6%) and breast (7.6%) cancers, metastatic in 34.2% of cases. Main symptoms were oedema (56.7%) and new-onset or exacerbated hypertension (62.2%). Most patients presented with haemolytic anaemia (95.6%) and thrombocytopenia (74.6%). Acute kidney injury was reported in 97.4% and dialysis was required in 27.8% of patients. Treatment consisted of: plasma exchange (PE; 39.8%), fresh frozen plasma (21.4%), corticosteroids (15.3%) and eculizumab (5.1%). A complete remission of TMA was obtained in 42.1% of patients and haematological remission in 23.1%, while 34.7% did not improve. The survival status was known for 52 patients, with 29 deaths (54.7%). Patients treated with PE, despite a more severe acute kidney injury, requiring dialysis more frequently, displayed comparable rates of remission, but with more adverse events. No abnormality in complement alternative pathway was documented in patients explored. Conclusion This large cohort confirms the severity of G-TMA, associated with severe renal failure and death. Oedema and hypertension could be monitored in patients treated with gemcitabine to detect early TMA. The benefit of PE or eculizumab deserves further investigation