Albuminuria in diabetic patients: How to measure it?-a narrative review

peer reviewedDiabetes is the leading cause of chronic kidney disease (CKD) and end stage renal disease (ESRD) worldwide. Glomerular filtration rate (GFR) and urine albumin to creatinine ratio (ACR) define the severity of CKD and predict cardiovascular outcomes of patients with CKD. ACR is preferred over protein to creatinine ratio (PCR) because of a greater sensitivity for low level of proteinuria, higher reproducibility in between laboratories and better cardiovascular risk stratification. Interventions aiming at decreasing ACR [such as use of renin-angiotensin-aldosterone system (RAAS) or more recently, sodium glucose cotransporter type 2 inhibitors (SGLT2is)] slow down the rate of progression of CKD. Therefore, global recommendations state that ACR needs to be assessed at least once a year, ideally on an early morning void, in patients with diabetes or CKD. However, quantification of urinary albumin is not standardized yet and heterogeneity in the laboratory methods available or expression of albuminuria may lead to misinterpretation of ACR. Pre-analytical considerations such as characterisation of the urinary sediment is also important as abnormalities (infection or haematuria) may interfere with the ACR. Moreover, atypical features such as an active sediment, fast progression of albuminuria or decline in GFR, short duration of diabetes, absence of diabetic retinopathy, nephrotic syndrome, must lead to further investigation since non-diabetic renal disease is not rare in patients with diabetes and might benefit from targeted therapeutics. Nephrologists and diabetologists should be aware of these limitations when interpreting the results in order to offer incisive and adequate therapeutic management

Response to "About the estimation of albuminuria based on proteinuria results".

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COVID-19 inside dialysis units

peer reviewedAu cours des derniers mois, la COVID-19 a été au centre des préoccupations et de l’attention de chacun. Les patients dialysés, et surtout ceux hémodialysés en centre, représentent une population particulièrement à risque de contamination vu la nécessité de se rendre à l’hôpital plusieurs fois par semaine et compte tenu de leur fragilité intrinsèque liée au statut de malade rénal chronique, un âge souvent plus avancé, et de nombreuses comorbidités. Ils ont donc un risque de développer une infection grave et potentiellement mortelle. Dès lors, la stratégie de prévention est d’une importance capitale pour ces patients.COVID-19 has been the center of global attention and concern for the last months. Patients undergoing dialysis and especially those treated at the hospital are likely to be infected, due to their mandatory presence at the hospital several times a week and due to their intrinsic fragility in regard of chronic kidney disease, often an older age, and the presence of many associated comorbidities. Thereby, patients with chonic kidney disease treated by haemodialysis have higher odds of a more severe COVID19 infection with a high mortality rate. Prevention is thus a high priority for these patients

How I explore… a proteinuria

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Urinary strips for proteins: easy to do but difficult to read!

International audienceUrine is an easily accessible biological fluid. This availability makes it tempting for a direct analysis of urinary parameters by physicians. Urinary proteins, that are interesting markers for several pathologies, are detected by urinary strips, rapidly and at a low cost. However, to ensure an optimal use of urinary strips, one may be familiar to their characteristics and their limits. This paper details the available urinary strips used for the detection of urinary proteins and urinary albumin, as well as their analytical performances in clinical conditions such as pregnancy, chronic renal disease, diabetes or for the screening of general populations.La facilité d’accès à l’urine des patients rend tentante l’analyse directe par les praticiens des constituants urinaires, qui peuvent leur apporter des renseignements utiles, et cela rapidement et à coût restreint. C’est le cas des protéines urinaires, que l’on peut dépister grâce à l’utilisation des bandelettes réactives. Cependant, afin d’exploiter de façon optimale les renseignements apportés par les bandelettes urinaires, il faut prendre le temps de connaître leurs caractéristiques ainsi que les limites à leur utilisation. Cet article présente de façon détaillée les différentes bandelettes urinaires utilisées pour la mise en évidence de protéines et d’albumine dans les urines, ainsi que leurs performances analytiques dans les situations cliniques où elles sont fréquemment utilisées : grossesse, maladie rénale chronique, diabète, dépistage de masse

Rare complication of a dog bite: Capnocytophaga species bacteremia followed by an hemolytic uremic syndrome

editorial reviewedDog bites are a frequent reason for medical consultation. These can be responsible for severe infectious complications. Bacteria of the genus Capnocytophaga species are Gram-negative bacilli commonly found in the oral cavity of certain animals such as dogs and cats. Following a dog bite or wound contamination with animal spit, these bacteria can cause local (cellulitis), systemic and invasive manifestations (bacteremia, endocarditis, meningitis) or lead to rare and dreadful complications such as thrombotic microangiopathies. The identification of Capnocytophaga is slow due to their specific characteristics and their culture conditions. The treatment of Capnocytophaga species infections is based on antibiotic therapy with amoxicillin - clavulanic acid as the first choice. Although different types of Capnocytophaga have been described, C. Canimorsus appears to be associated with a higher rate of atypical complications. Here is the description of an immunocompetent patient who presented with C. Canimorsus bacteremia complicated by hemolytic uremic syndrome following a dog bite.Les morsures de chien représentent un motif fréquent de consultation. Celles-ci peuvent entraîner des complications infectieuses graves. Les bactéries du genre Capnocytophaga species sont des bacilles Gram négatif fréquemment retrouvés dans la cavité buccale de certains animaux comme les chiens et les chats. à la suite d’une morsure canine ou d’une contamination de plaie par de la salive animale, ces bactéries peuvent provoquer des manifestations locales (cellulite), systémiques et invasives (bactériémie, endocardite, méningite) ou entraîner des complications rares et redoutables comme les microangiopathies thrombotiques. L’identification des Capnocytophaga est lente de par leurs caractéristiques propres et leurs conditions de mise en culture. Le traitement des infections à Capnocytophaga species repose sur une antibiothérapie par amoxicilline-acide clavulanique en première intention. Bien que différents types de Capnocytophaga aient été décrits, C. Canimorsus semble associé à un taux plus élevé de complications atypiques. Nous décrivons ici le cas d’une patiente immunocompétente ayant présenté une bactériémie à C. Canimorsus compliquée d’un syndrome hémolytique et urémique dans les suites d’une morsure de chien