Facteurs pronostiques de l'infarctus rénal

Soixante-treize infarctus rénaux survenus sur une période de 15 ans ont été analysés de manière rétrospective. Les étiologies étaient principalement la fibrillation atriale et la dissection de l'artère rénale. Un débit de filtration glomérulaire abaissé au diagnostic était le principal risque d'insuffisance rénale à long terme. La nécessité de dialyse au diagnostic était un facteur de risque de mortalité. Le volume de l'infarctus n'apparaissait pas comme un facteur de risque d'insuffisance rénale chronique secondaire.We retrospectively reviewed the course of 73 Acute Renal Infarction in a 15-years period. Etiologies were mainly embolism from atrial fibrillation and renal artery dissection. Low-GFR at diagnosis was the major risk factor for long-term renal insufficiency. Dialysis dependence at diagnosis was a risk factor for mortality. Volume of infarction did not seem to be a risk factor for long-term renal insufficiency.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Acute renal infarction: long-term renal outcome and prognostic factors

International audienceIntroduction Acute renal infarction is a rare occurence, whose prognosis and long-term outcomes remain poorly studied. This study evaluated whether clinical and radiological features at diagnosis can be associated with the long-term outcomes (blood pressure, kidney function and mortality). Methods We retrospectively analyzed the demographic, clinical, biological and radiological data of patients with acute renal infarction hospitalized at Rennes University Hospital between 1997 and 2017 (n= 94). Results Patients were followed-up for a median of 60 months. At time of diagnosis of acute renal infarction median age was 53 years, 45% of the patients had acute hypertension, and 31% had Acute Kidney Injury (AKI) requiring dialysis in seven patients. The median Lactate DeHydrogenase (LDH) level was 977 IU/mL. The median extent of kidney damage was 14%, with left renal involvement in 51% of patients. At 60 months of follow-up, 66% of patients had developed Chronic Kidney Disease (CKD) stage 3 or higher, and 55% had hypertension since diagnosis. Age, acute development of hypertension and AKI at diagnosis were associated with long-term CKD (stage 3 or higher) in multivariate analyses, but the extent of kidney damage was not. During the follow-up, 21% of patients died, and only age resulted as a predisposing factor. No tested factor was correlated with long-term hypertension. Discussion Age, acute development of hypertension, and AKI were correlated with long term CKD, whereas no factor was correlated with long-term hypertension after acute renal infarction. [GRAPHICS]

Anti-VEGF Therapy Induces Proteinuria through Endothelial Disorganization Leading to Nephrin Decrease in Podocytes

Background: VEGF is involved in cancer development by stimulating neo-angiogenesis and tumor proliferation. Anti-angiogenic therapies, especially tyrosine kinase inhibitors such as sunitinib, have significantly improved cancer prognosis. Nevertheless, renal side effects, such as proteinuria and thrombotic microangiopathy, have been reported. The underlying physiopathological mechanisms remain unclear, but animal models and clinical similarities with preeclampsia suggest that such therapies affect the function of the endothelial and&nbsp; &nbsp; pithelial layers of the glomerular basement membrane, with activation of the endothelin&nbsp; ignaling system and loss of glomerular slit diaphragm integrity.The aim of this in vitro study&nbsp; as to determine sunitinib effects on normal podocytes and glomerular endothelial cells.Methods: The glomerular microvascular endothelial (GMVEC) and human glomerular&nbsp; isceral epithelial (hGVE) cell lines were incubated with various doses of sunitinib. The MTT Cell Proliferation Assay was used to assess cell proliferation. Expression of nephrin (a major slit diaphragm protein) and endothelin was evaluated by immunofluorescence or western blotting assays.Results: Sunitinib inhibited GMVEC and hGVE cell proliferation in a dose-dependent manner. In GMVEC cells, endothelin transcription and secretion were increased after incubation with sunitinib. Conversely, in hGVE cells, sunitinib did not affect nephrin expression. However, conditioned medium from GMVEC cells incubated with sunitinib modified nephrin expression when added to the culture medium of hVGE cells. This effect was inhibited by pre-incubating hGVE cells with an endothelin inhibitor.Conclusion: This study suggests an indirect toxicity of sunitinib on podocytes through endothelin. Therefore, sunitinib-induced renal side effects could be controlled with endothelin inhibitors.</p

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed