Evaluation of Glomerular Filtration Rate in Clinical Practice

peer reviewedGlomerular filtration rate (GFR) is the most frequently used parameter to evaluate the renal function. GFR may be estimated with serum creatinine, creatinine clearance based on 24 hours urine collection or Cockcroft formula. All these methods have bias. Other approaches have thus been proposed. The limitations and advantages of isotopic methods and recent mathematical approaches (MDRD formula) are reviewed

Breast cancer: role of imaging procedures to detect metastases at initial staging and during routine follow-up the first 3 years after diagnosis

peer reviewedIn our region, repeated tumor staging by radiological procedures aiming to detect relapses and/or metastases from breast cancer is frequently performed. However, these procedures are not recommended by current international guidelines. We retrospectively analyzed the charts from 818 patients with a new diagnosis of breast cancer seen at CHU Liege between 2005 and 2009. We assessed the role of staging procedures at initial diagnosis and during follow-up the first 3 years after the diagnosis of breast cancer. Twenty-six patients presented with metastatic disease at diagnosis and 55 patients developed loco-regional relapses or metastases during follow-up. For asymptomatic patients, imaging procedures only detected tumor metastases or relapse without elevated tumor markers in 9 patients at initial diagnosis and 10 patients during follow-up. The diagnosis of an asymptomatic relapse and/or metastases had no positive impact on progression-free or overall survival. The anatomic extension identified patients at high risk for presenting distant metastases already at the time of initial diagnosis and the biological aggressiveness evaluated by Ki-67 was an important prognostic factor for early relapse. In view of these results, we do not recommend staging and searching for metastatic disease in asymptomatic patients presenting early stage breast cancer with low expression of the Ki-67 at the time of initial diagnosis. We also do not recommend repeated staging and searching for metastases by imaging in asymptomatic patients during routine follow-up. Staging should only be performed if a relapse is suspected during follow-up.Dans nos régions, des bilans par imagerie sont régulièrement réalisés lors du diagnostic et dans le cadre du suivi d’un cancer du sein. Cependant, cette pratique est contraire aux recommandations internationales. Nous avons évalué l’intérêt d’un bilan d’extension au diagnostic et lors du suivi, jusqu’à 3 ans après le diagnostic, de 818 patients atteints de cancer du sein pris en charge au CHU de Liège entre 2005 et 2009. Vingt-six patients présentaient des métastases au diagnostic et 55 rechutes locorégionales ou systémiques ont été observées. Pour les patients asymptomatiques, l’imagerie seule a identifié la dissémination à distance et/ou la rechute locorégionale chez 9 patients au diagnostic et 10 patients dans le cadre du suivi. La découverte d’une rechute et/ou d’une dissémination métastatique asymptomatique n’a pas eu d’impact favorable sur la survie sans progression ou la survie globale. L’extension anatomique au diagnostic identifie les patients à risque de présenter une maladie directement métastatique tandis que l’agressivité biologique, évaluée par le Ki-67, est un facteur de risque important pour la rechute précoce. Suite aux résultats obtenus, nous déconseillons de réaliser un bilan d’extension à la recherche de métastases au moment du diagnostic pour les cancers du sein asymptomatiques à un stade précoce avec un Ki-67 peu élevé. Nous déconseillons également la réalisation régulière d’un bilan d’extension par imagerie à la recherche de métastases chez les patients asymptomatiques. Un bilan est à réaliser dans le cadre du suivi uniquement si une rechute est suspectée

Cystatin C in the Evaluation of Renal Function

peer reviewedGlomerular filtration rate (GFR) is the best indicator of renal function. GFR is usually estimated by serum creatinine or the creatinine clearance calculated on urine collected over 24 hours or with the Cockcroft formula. These methods are however limited. Serum creatinine has a very poor sensitivity and urine collection is difficult. Cystatin C is a protease inhibitor produced in a constant manner by nucleated cells. This molecule is freely filtrated by the glomerule and quite completely catabolized in the proximal tubules. Its plasmatic concentration might thus be used to estimate GFR. Presently available data allow to conclude that plasmatic cystatin C is at least as good as serum creatinine to estimate GFR. It is less sensible to changes in body mass. Its determination appears more sensitive to detect early mild changes in GFR. Reference values are presently available for the different methods of determination. Cystatin C plasma level determination is more expensive than routine creatinine plasma determination. In the absence of very significant advantages, this might explain its limited use in daily clinical practice

Vision de GDF Suez sur la production d’énergie nucléaire

GDF Suez a été l’un des pionniers de l’énergie nucléaire en Europe. Il maîtrise des compétences internationalement reconnues sur toute la chaîne de valeur de cette filière de production (ingénierie, services, exploitation, maintenance, combustible, gestion des déchets, démantèlement). Il possède et exploite actuellement 7 unités en Belgique et dispose de capacités dans les centrales nucléaires françaises de Chooz et de Tricastin. GDF Suez a aujourd’hui des objectifs ambitieux en termes de développement de projets nucléaires : détenir et exploiter des centrales nucléaires de 3ème génération à l’horizon 2020, maintenir en Europe la part du nucléaire au sein d’un mix énergétique équilibré et développer hors d’Europe une capacité significative sur un certain nombre de marchés-clés. Pour atteindre ces objectifs, le groupe développe une politique active en matière de Ressources Humaines, R&ampD et Communication en matière d’énergie nucléaire

Plasmatic cystatin C for the estimation of glomerular filtration rate in intensive care units

OBJECTIVE: To compare the sensitivity of cystatin C and creatinine in detecting decreased glomerular filtration rate. DESIGN: Prospective observational study. SETTING: Medical intensive care unit at a university hospital. PATIENTS AND PARTICIPANTS: Fourteen patients hospitalised in a medical intensive care unit. INTERVENTIONS: Cystatin C and creatinine plasmatic levels were measured in 40 blood samples taken with an interval of at least 24 h. MEASUREMENTS AND RESULTS: Glomerular filtration rate was estimated by creatinine clearance using 24-h urine collection and the classical Cockcroft-Gault equation. The ability of cystatin C to detect a glomerular filtration rate under 80 ml/min per 1.73 m(2) was significantly better than that of creatinine ( p<0.05). CONCLUSIONS: Cystatin C, a new plasmatic marker of renal function, could be used to detect renal failure in intensive care in the future

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Biopsy of suspicious lesions in patients with breast cancer

peer reviewedDiscordances between hormone receptors and HER2 status in primary and metastatic breast cancer have been reported by several studies. In this context, systematic biopsies could be clinically relevant in breast cancer to confirm the biological characteristics of a suspicious lesion. In this article, illustrated by 2 case reports and based on a recent review on this topic, we discuss the clinical significance of receptor discordances and possible diagnosis of a secondary primary tumor. The role of these biopsies for the identification of new therapeutic targets is also envisaged as well as underlying mechanisms for receptors' modification like tumoral heterogeneity, clonal selection and technical artifacts

Intérêt de la cystatine C dans l’évaluation de la fonction rénale chez le patient hospitalisé aux soins intensifs.

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