Int. J. Mol. Sci.

To face the increasing demand for organ transplantation, currently the development of tissue engineering appears as the best opportunity to effectively regenerate functional tissues and organs. However, these approaches still face the lack of an efficient method to produce an efficient vascularization system. To answer these issues, the formation of an intra-volume channel within a three-dimensional, scaffold free, mature, and cell-covered collagen microfibre is here investigated through laser-induced cavitation. An intra-volume channel was formed upon irradiation with a near-infrared, femtosecond laser beam, focused with a high numerical aperture lens. The laser beam directly crossed the surface of a dense and living-cell bilayer and was focused behind the bilayer to induce channel formation in the hydrogel core while preserving the cell bilayer. Channel formation was assessed through confocal microscopy. Channel generation inside the hydrogel core was enhanced by the formation of voluminous cavitation bubbles with a lifetime longer than 30 s, which also improved intra-volume channel durability. Twenty-four hours after laser processing, cellular viability dropped due to a lack of sufficient hydration for processing longer than 10 min. However, the processing automation could drastically reduce the cellular mortality, this way enabling the formation of hollowed microfibres with a high density of living-cell outer bilayer

Néphrologie & Thérapeutique

Les inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT2) constituent une avancée considérable dans la prise en charge des patients diabétiques, des patients insuffisants cardiaques et des patients ayant une maladie rénale chronique (MRC). Des études contrôlées randomisées ont montré une réduction significative du risque cardiovasculaire chez des patients diabétiques de type 2 ou insuffisants cardiaques à fraction d’éjection altérée. Ces études retrouvaient une diminution de la dégradation de la fonction rénale, inspirant des études contrôlées randomisées chez des patients MRC : CREDENCE, DAPA-CKD et EMPA-KIDNEY. Les iSGLT2 sont associés à une diminution de l’évolution de la MRC vers la suppléance, de la pente de DFG et de l’albuminurie. Chez les patients MRC protéinuriques avec ou sans diabète, les études DAPA-CKD et EMPA-KIDNEY ont démontré l’effet néphroprotecteur. Cet effet ne semble pas être retrouvé pour les patients non protéinuriques. Pour les autres néphropathies, des études complémentaires sont nécessaires pour confirmer les premiers résultats chez les patients protéinuriques non diabétiques de type 2. L’indication des iSGLT2, en association aux bloqueurs du SRAA à doses maximales tolérées, paraît donc indéniable dans une optique de néphroprotection optimale chez les patients MRC diabétiques de type 2 ou albuminuriques ou insuffisants cardiaques. Leur prescription doit se faire en adjonction des traitements et des mesures de néphroprotection et de cardioprotection conventionnels. La tolérance est bonne. Cependant, une éducation et une surveillance particulière concernant les risques infectieux génitaux et d’acidocétose euglycémique (patients diabétiques) doivent être mises en place. Ainsi, l’arsenal thérapeutique pour les patients MRC s’étoffe, permettant d’envisager une personnalisation des traitements en fonction de la néphropathie sous-jacente.Inhibitors of sodium glucose co-transporter type 2 (iSGLT2) constitute a considerable advance in the management of patients with diabetes, heart failure and with chronic kidney disease (CKD). Randomized controlled studies have shown a significant reduction of cardiovascular risk in diabetic type 2 and/or heart failure with reduced ejection fraction patients. These studies observed a risk reduction of worsening nephropathy, leading to randomized controlled studies in CKD patients : CREDENCE, DAPA-CKD and EMPA-KIDNEY. iSGLT2 are associated with a slower progression toward end-stage kidney disease, a lower slope of GFR and a lower rate of albuminuria. In CKD patients with proteinuria either diabetic or not, the DAPA-CKD and the EMPA-KIDNEY studies have demonstrated a nephroprotective effect. This effect has not been found for patients without proteinuria. For the other nephropathies, further studies are required to confirm results obtained in patients without type 2 diabetes and macroalbuminuria. Therefore, the indication of iSGLT2, with appropriate dose of RAS inhibitor, seems undeniable to an optimal nephroprotection in CKD patients with type 2 diabetes and/or albuminuria and/or heart failure. They must be prescribed in addition to conventional nephroprotective and cardioprotective treatments and care. Side effects are limited. However, special education and monitoring concerning risks of genital infection and euglycemic ketoacidosis (diabetic patients) must be taken in mind. The therapeutic arsenal for CKD patients is expanding, leading to consider a personalized care according to the underlying nephropathy

Cahiers de Nutrition et de Diététique

Augmenter l’apport en végétaux, fruits, légumes, et diminuer les apports d’origines animale caractérisent les régimes à base de plantes. Les régimes végétariens (VG) et méditerranéens (MD) sont associés, en population générale, à une diminution de la survenue de la maladie rénale chronique (MRC). Cela peut être la conséquence de la diminution de l’hyperfiltration rénale par les protéines végétales, mais aussi de la diminution des comorbidités cardiovasculaires (diabète de type II, hypertension artérielle, syndrome métabolique). Chez les patients MRC, de nombreuses études s’intéressant à ces régimes retrouvent une diminution du risque de progression de la MRC. Il existe aussi un meilleur contrôle des complications liées à la MRC : acidose métabolique, troubles phosphocalciques, toxines urémiques et inflammation chronique. Cela s’accompagne d’une diminution de la morbidité et de la mortalité des patients MRC. Parallèlement, les risques d’hyperkaliémie et de dénutrition protéino-énergétique ne semblent pas limitants. De plus, ils sont en accord avec les recommandations établies chez les patients MRC. Cela place les régimes VG et MD comme des prescriptions alimentaires de choix chez les patients MRC.Increase the intake of plants, vegetables, fruits and decrease in animal intake characterize plant-based diet (PBD). Vegetarian diet (VG) and Mediterranean diet (MD) in general population are associated with lower incident chronic kidney disease (CKD). It may be in relation with a reduction in glomerular hyperfiltration and of cardiovascular comorbidities (diabetes mellitus, arterial hypertension, metabolic syndrome). Considering CKD patients, there are numerous evidence for an association between these diet patterns and slower CKD progression. In addition, VG and MD are associated with better management of CKD complications: better control of metabolic acidosis and calcium and phosphate homeostasis, reduction in uremic toxins and chronic inflammation. PBD is associated with a diminution of morbidity and mortality amongst CKD population. Hyperkaliemia and protein energy wasting conditions are not limiting introduction of these dietary patterns. Furthermore, PBD are in accordance with CKD nutritional recommendations. For these reasons, VG and MD should occupy a prominent place in CKD medical nutrition therapy

Cah Nutr Diet

La maladie rénale chronique (MRC) est une maladie fréquente, pouvant évoluer de manière progressive et irréversible vers le stade où un traitement de suppléance par dialyse ou transplantation rénale s’avère nécessaire. La dénutrition est une complication fréquente de la MRC et est associée à un sur-risque d’hospitalisation et de mortalité. Une surveillance diététique par le néphrologue et/ou un diététicien doit être réalisée régulièrement quel que soit le stade de la MRC. L’évaluation doit être multiple, se basant sur les données anthropométriques, la composition corporelle, des données biologiques et des enquêtes diététiques. Dans le but de ralentir la progression de la MRC et d’améliorer la qualité de vie, chez les patients stables métaboliquement présentant une MRC de stades 3b à 5, non dialysés, les apports en protéines doivent être réduits à 0,55–0,60 g/kg/j ou 0,3–0,4 g/kg/j associée à une supplémentation en céto-analogues, sous couvert d’apports caloriques suffisants entre 25 à 35 kcal/kg/j. Chez les patients dialysés, les apports en protéines doivent en revanche être augmentés entre 1,0 et 1,2 g/kg/j avec des apports caloriques identiques entre 25 à 35 kcal/kg/j. Une supplémentation orale doit être envisagée en première intention en cas de dénutrition ou d’apports caloriques insuffisants.Chronic kidney disease (CKD) is a common condition that can progressively and irreversibly progress to a stage where renal replacement therapy by dialysis or kidney trans-plantation is required. Protein-energy wasting (PEW) is a frequent complication in CKD patients and is associated with an increased hazard of hospitalisation and mortality. Dietary monitoring by the nephrologist and/or a dietician must be conducted regularly, whatever the stage of the disease. The assessment should be multiple, based on anthropometric data, body composition, biological data and dietary surveys. In order to slow CKD progression and improve quality of life in metabolically stable patients with CKD stages 3b to 5, not on dialysis, protein intake should be reduced to 0.55-0.60 g/kg/d or 0.3-0.4 g/kg/d in combination with keto-acid ana-logs, with adequate caloric intake of 25-35 kcal/kg/d. However, in dialysis patients, protein intake should be increased to 1.0-1.2 g/kg/d with the same caloric intake of 25-35 kcal/kg/d. Oral supplementation should be considered in first intention in cases of PEW or insufficient caloric intake.(c) 2022 Societe francaise de nutrition. Published by Elsevier Masson SAS. All rights reserved

Radiological Characteristics of Renal Lesions During Tuberous Sclerosis Complex: Impact of Mechanistic Target of Rapamycin Inhibitor Treatment

International audienceNo abstract availabl

Nephrol Dial Transplant

BACKGROUND: While opportunistic infections are a frequent and challenging problem in kidney transplant recipients, their long-term epidemiology remains hardly known. METHODS: Opportunistic infections were recorded in 1144 recipients transplanted in our center between 2004 and 2015. Incidence rates and baseline risk factors were determined using joint frailty models. RESULTS: After a median follow-up of 5.6 years, 544 opportunistic infections occurred in 373/1144 (33%) patients, dominated by viral infections (396/544, 72%), especially CMV syndromes and diseases (213/544, 39%). A third of the infected patients experienced at least 2 opportunistic infections. The incidence of opportunistic infections was 10 times higher during the first year post-transplantation than afterwards (34.7 infections for 100 patient-years vs. 3.64). Opportunistic infections associated with the age of the donor (pé=é0.032), the age of the recipient (pé=é0.049), the CMV serostatus (pé<é10-6), a higher class II HLA mismatch (pé=é0.032), and an induction treatment including rabbit anti-thymocyte globulins (pé=é0.026). Repeated opportunistic infections associated with each other (pé<é10-6) and with renal death (pé<é10-6). CONCLUSION: Opportunistic infections occur with a 2-period incidence pattern and many susceptible patients suffer from repeated episodes. This knowledge may help tailor new prevention and follow-up strategies to reduce the burden of opportunistic infections and their impact on transplantation outcome

Description of a multidisciplinary model of care in a French cohort of adult patients with tuberous sclerosis complex

BackgroundTuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder. Due to the various manifestations of TSC and their potential complications, a multidisciplinary care approach is recommended by consensus guidelines.ObjectivesOur study aimed to give a complete description of our TSC adult cohort and to evaluate the multidisciplinary and interdisciplinary management model.MethodsData on each adult patient diagnosed with TSC, including disease manifestations, interventions and outcomes, were collected at baseline and updated annually. A multidisciplinary TSC approach with all the recommended explorations was carried out annually.Results90 patients were enrolled in Centre Hospitalier Universitaire de Bordeaux, between January 2000 and September 2018. Median age of patients at inclusion was 37 years (range, 27–47) and 20 years old at diagnosis of TSC. Regarding the occurrence of TSC manifestations, 97% of the patients had cutaneous lesions, 89% had neurological manifestations, 83% had renal manifestations and 100% had dental lesions with pits. More than half the patients had sclerotic bone lesions (68%), TSC-associated neuropsychiatric disorders (64%) and lymphangioleiomyomatosis (59%). A TSC multidisciplinary approach was developed including a global follow-up and an evaluation of TSC targeting organs, according to the recommendations. A satisfaction survey revealed global and entire satisfaction of patients with TSC.ConclusionWe obtained an accurate description of a cohort of adult patients with TSC. Our multidisciplinary approach model allowed us to provide optimal management of patients with TSC with a high level of patient satisfaction