Plasma 5-hydroxyindoleacetic acid as an endogenous index of renal plasma flow

Plasma 5-hydroxyindoleacetic acid as an endogenous index of renal plasma flow. 5-Hydroxyindoleacetic acid (5-HIAA), the major serotonin metabolite, was measured in human plasma and urine using liquid chromatography and electrochemical detection. The renal extraction of 5-HIAA was 78%, a value compatible with an almost complete extraction during a single passage of the blood through the kidney. In addition, plasma levels of 5-HIAA measured in patients with a wide range of renal function was inversely correlated (r = 0.85) with the clearance of para-aminohippuric acid (PAH). The results indicate that 5-HIAA determinations can be used as an alternative procedure to the PAH clearance method for the estimation of renal plasma flow in clinical practice

Low parathyroid hormone status induced by high dialysate calcium is an independent risk factor for cardiovascular death in hemodialysis patients

Here we studied a possible association between low parathyroid hormone (PTH) status and mortality in incident patients undergoing hemodialysis . A total of 1983 patients were included at baseline and prospectively followed for 24 months. Patients were classified according to their Kidney Disease: Improving Global Outcomes PTH status at baseline and at 12 months, and mortality evaluated at 12 to 24 months using adjusted Cox analysis. Factors potentially involved in PTH status variability between baseline and 12 months were analyzed. A decrease in serum PTH from normal or high to low values between baseline and 12 months was associated with significantly increased cardiovascular mortality at 12 to 24 months (hazard ratio, 2.03; 95% confidence interval, 1.22–3.36). For patients with high or normal baseline PTH levels, the main independent factor at 6 months for a decrease to low PTH levels at 12 months was high dialysate calcium (1.75 mmol/L), whereas prescription of non–calcium-based phosphate binders was associated with a lower risk of PTH decrease. In the high cardiovascular (CV) mortality risk subgroup of patients who acquired a low PTH status at 12 months, the main independent factor at 12 months associated with significant 12- to 24-month CV mortality was high dialysate calcium (odds ratio, 5.44; 95% CI, 2.52–11.75). Thus, patients with a serum PTH decrease to low values after 1 year of hemodialysis treatment are at high risk of short-term CV death. High dialysate calcium was an important contributor to PTH oversuppression, and continued use was associated with increased CV mortality

Safety of meglumine gadoterate (Gd-DOTA)-enhanced MRI compared to unenhanced MRI in patients with chronic kidney disease (RESCUE study)

OBJECTIVE: To prospectively compare the renal safety of meglumine gadoterate (Gd-DOTA)-enhanced magnetic resonance imaging (MRI) to a control group (unenhanced MRI) in high-risk patients. METHODS: Patients with chronic kidney disease (CKD) scheduled for MRI procedures were screened. The primary endpoint was the percentage of patients with an elevation of serum creatinine levels, measured 72 ± 24 h after the MRI procedure, by at least 25 % or 44.2 μmol/l (0.5 mg/dl) from baseline. A non-inferiority margin of the between-group difference was set at −15 % for statistical analysis of the primary endpoint. Main secondary endpoints were the variation in serum creatinine and eGFR values between baseline and 72 ± 24 h after MRI and the percentage of patients with a decrease in eGFR of at least 25 % from baseline. Patients were screened for signs of nephrogenic systemic fibrosis (NSF) at 3-month follow-up. RESULTS: Among the 114 evaluable patients, one (1.4 %) in the Gd-DOTA-MRI group and none in the control group met the criteria of the primary endpoint [Δ = −1.4 %, 95%CI = (−7.9 %; 6.7 %)]. Non-inferiority was therefore demonstrated (P = 0.001). No clinically significant differences were observed between groups for the secondary endpoints. No serious safety events (including NSF) were noted. CONCLUSION: Meglumine gadoterate did not affect renal function and was a safe contrast agent in patients with CKD. KEY POINTS: • Contrast-induced nephropathy (CIN) is a potential problem following gadolinium administration for MRI. • Meglumine gadoterate (Gd-DOTA) appears safe, even in patients with chronic kidney disease. • Gd-DOTA only caused a temporary creatinine level increase in 1/70 such patients. • No case or sign of NSF was detected at 3-month follow-up

Parasite

A 72-year-old man consulted in November 2012 for abdominal pain in the right upper quadrant. The patient had a history of suspected hepatic amebiasis treated in Senegal in 1985 and has not traveled to endemic areas since 1990. Abdominal CT scan revealed a liver abscess. At first, no parasitological tests were performed and the patient was treated with broad-spectrum antibiotics. Only after failure of this therapy, serology and PCR performed after liver abscess puncture established the diagnosis of hepatic amebiasis. The patient was treated with metronidazole and tiliquinol-tilbroquinol. Amebic liver abscess is the most frequent extra-intestinal manifestation. Hepatic amebiasis 22 years after the last visit to an endemic area is exceptional and raises questions on the mechanisms of latency and recurrence of these intestinal protozoan parasites. Un homme de 72 ans consulte en novembre 2012 pour des douleurs abdominales dans le quadrant supérieur droit. Le patient présente un antécédent probable d’abcès amibien du foie traité en 1985 au Sénégal et n’a pas voyagé en région d’endémie depuis 1990. Le scanner abdominal réalisé met en évidence un abcès hépatique. Dans un premier temps, aucun examen parasitologique n’est effectué et le patient est traité par des antibiotiques à large spectre. Suite à l’échec de ce traitement, la sérologie et la PCR réalisées après ponction de l’abcès hépatique, établissent le diagnostic d’amibiase hépatique. Le patient est traité par métronidazole et tiliquinol-tilbroquinol. L’abcès amibien du foie est la manifestation extra-intestinale de l’amibiase la plus fréquente. L’amibiase hépatique 22 ans après le dernier voyage en zone d’endémie est exceptionnelle et soulève des questions concernant les mécanismes de latence et de récurrence des protozoaires intestinaux

Fonctions glomerulaires et tubulaires au cours du diabete insulino-dependant recent

SIGLEAvailable from INIST (FR), Document Supply Service, under shelf-number : T 78591 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Critères de début de dialyse (résultats d'une cohorte prospective)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

ETUDE DE LA CLAIRANCE DU LITHIUM ENDOGENE CHEZ L'HOMME

STRASBOURG ILLKIRCH-Pharmacie (672182101) / SudocSudocFranceF

Evaluation de la fonction rénale (comparaison des performances des formules de Cockcroft-Gault et du MDRD par rapport à 351 mesures de la filtration glomérulaire par la clairance de l'inuline.)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Effet de la supplémentation en vitamine D native sur le blocage du système rénine-angiotensine-aldostérone

STRASBOURG-Medecine (674822101) / SudocSudocFranceF