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Biomedical subjects

A Meyrier

Publications and source records attributed to A Meyrier.

At least 55 records · Page 3Linked to original sources
PubMed1994

Pharmacokinetics of rilmenidine in patients with chronic renal insufficiency and in hemodialysis patients.

The pharmacokinetics of rilmenidine (1 mg orally) was studied in 3 groups of patients with stable chronic renal insufficiency. This was an open, single-blind study following a single administration, and after 15 days of treatment. Group 1 included 11 patients with a creatinine clearance between 15 and 80 mL/min. Group 2 included 17 patients with a creatinine clearance < 15 mL/min. Group III included 10 hemodialysis patients. In patients with chronic renal failure, total plasma clearance and renal clearance of rilmenidine decreased; terminal half-life was 30-42 hours, which is clearly longer than previous values achieved in healthy volunteers. After repeated administration (1 mg daily in group 1, 1 mg every other day in group 2, 1 mg at the end of each dialysis session in group 3), the area under the curve was significantly increased, corresponding to drug accumulation. The steady state was reached after 6 days in patients in group 1 and after 8 days in patients in group 2. The pharmacokinetics of rilmenidine was linear since the terminal elimination half-life and renal clearance were not significantly different after single and repeated administration of rilmenidine. A positive correlation was found between rilmenidine total plasma clearance and creatinine clearance, and between rilmenidine renal clearance and creatinine clearance. Mean rilmenidine hemodialysance was 85 mL/min, that is, 26% of the rilmenidine renal clearance value achieved in healthy volunteers (330 mL/min). Thus, the following dosage schedule can be proposed. In patients whose creatinine clearance ranges between 15 and 80 mL/min, a 1 mg dose every day can be recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Long-term renal tolerance of cyclosporin A treatment in adult idiopathic nephrotic syndrome. Collaborative Group of the Société de Néphrologie.

Repeat renal biopsies and serial serum creatinine measurements were done in 36 adults who were treated for steroid-dependent or -resistant idiopathic nephrotic syndrome with 5.54 +/- 0.81 mg/kg/day of cyclosporin A (CsA). Pre-CsA renal biopsy (RB1) had been carried out 11.6 +/- 12.2 months prior to CsA treatment. It showed minimal glomerular changes (MCD) in 22, and 1 to 16 glomeruli with lesions of focal segmental glomerulosclerosis (FSGS) per biopsy in 14. Pretreatment serum creatinine levels were (mumol/liter) 97.6 +/- 39.4 and were higher in FSGS (117.1 +/- 48.3) than in MCD (85.2 +/- 26.9; P < 0.04). Repeat biopsy (RB2) was done after 19.6 +/- 15.2 months (6 to 78) of CsA treatment. At this time, in 15 patients the minimal glomerular lesions observed on RB1 were unchanged, whereas in 7 patients lesions of FSGS were now visible. In patients with FSGS on RB1 and RB2, serum creatinine at the end of CsA treatment was 130.6 +/- 60.1 mumol/liter, significantly greater (P = 0.022) than the corresponding levels in the subset with MCD (87.3 +/- 24.8). The contrast between the remarkable stability of renal function in the patients with MCD and the worsening of renal function in the subgroup with FSGS was explained in the latter by an aggravation of renal histologic lesions, with a greater number of glomeruli with FSGS, of obsolescent glomeruli, and of interstitial fibrosis/infiltrates. This aggravation of the primary renal disease was observed in some cases where CsA had obtained partial or even complete remission. Few of the tubular lesions and of vascular changes were typical of CsA toxicity but rather suggested development of the primary renal disease. In contrast, although some increase in the degree of tubulointerstitial lesions was observed on RB2, the rating of such lesions was much less severe in patients whose renal biopsy showed persistently normal glomeruli after exposure to CsA. Overall, the most severe interstitial/vascular lesions were observed in patients treated with the highest CsA dosages, and the "cut-off" of dosage safety appeared to be 5.5 mg/kg/day. Two patients died during the study period. Long-term surveillance of the extant 34 patients showed that 8, all of whom had FSGS, evolved to end-stage renal failure due to progression of their primary renal disease after ending CsA treatment. Four patients were failures of CsA and returned to conventional therapy. CsA treatment was continued for 12 to 60 months in fourteen patients who achieved remission.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Drooping upper eyelids and polycystic kidney disease.

Over the last 26 yr, 33 cases and/or families of patients with autosomal dominant polycystic kidney disease (ADPKD) and a particular appearance of the eyes have been observed. ADPKD was unremarkable and in most cases had led to the usual slow development of end-stage renal failure. The facial feature concerned the upper eyelid, which drooped obliquely over the eyeball with a fold hiding the upper segment of the iris (blepharochalasis). The aspect was so typical that the diagnosis of ADPKD was suggested on first contact with new renal patients. All affected patients were white, of various origins, including French, Polish, Scandinavian, Italian, and Spanish. In retrospect, drooping eyelids had been present in the parents and/or grandparents who had died of renal failure, with or without an established diagnosis of ADPKD. In order to disclose the cosegregation of blepharochalasis with ADPKD, the screening of its prevalence in a well-circumscribed region with a catchment population of 410,000 was undertaken. The facial feature was found in 24 (32%) of 75 ADPKD families. Family transmission was confirmed in those kindreds, because at least two members suffered from ADPKD. Cosegregation was sought by analyzing family group photographs taken over several generations, the oldest member of which was born in 1973. All members with blepharochalasis had died of renal failure or are presently being followed up for ADPKD. A bibliographic search showed that the association of ocular and/or eyelid deformities and various inborn renal diseases is far from rare, suggesting a simultaneous event in the embryonic timetable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Nephrotoxicity of iodine contrast media].

In the late seventies, iodinated contrast agents (ICA) were considered to be a major cause of acute iatrogenic renal failure. Over the last decade new contrast agents have been synthesized, nonionic and less hyperosmolar. Analysis of 25 series published between 1975 and 1989 does not allow precise evaluation of the incidence of acute renal failure due to ICAs. This incidence varies from 3.7 to 70% of cases according to the series, with an average figure of 10.2%. Such discrepancies stem from different definitions of renal failure, as well as varying criteria adopted for defining "nephrotoxicity", high-risk patients and the better safety of new, nonionic and less hyperosmolar agents. The pathophysiology of ICA nephrotoxicity was mainly studied in laboratory animal models. Three main factors are involved in an inducing ICA-mediated decrease in glomerular filtration rate: reduction of the renal plasma flow, a direct cytotoxic effect on renal tubular cells and erythrocyte alteration leading to intrarenal sludge. Excluding dysglobulinemias with urinary excretion of immunoglobulin light chains, which represent a special case of maximum nephrotoxicity, 4 main risk factors of renal toxicity have been identified in nondiabetic subjects: previous renal failure with serum creatinine levels greater than 140 mumol per liter, extracellular dehydration, age over 60 and use of high doses of ICA and/or repeated ICA injections before serum creatinine levels return to baseline. Diabetes does not seem to represent a serious risk factor, except in patients with diabetic glomerulosclerosis. Ongoing treatment with nonsteroidal antiinflammatory drugs (NSAID) potentiates the hazards of renal failure. Preventive measures for avoiding ICA nephrotoxicity are threefold: maintain or restore adequate hydration with saline infusion, stop NSAID treatment several days before ICA administration, and allow a 5 day interval before repeating contrast media injections. New, nonionic and moderately hyperosmolar contrast agents appear to be much less nephrotoxic than conventional ICAs in laboratory animals and in high-risk patients. It is advisable to select such contrast media for investigating high-risk patients. This approach was recently substantiated in well designed, randomized clinical studies which included more than 2,000 patients.

Acute Kidney Injury↗
PubMed1994

[Antihypertensive action of indapamide in hypertension of chronic renal failure].

Indapamide, a molecule with moderate diuretic effect, is an efficient antihypertensive drug. Blood pressure control is mostly explained by a direct action on peripheral vascular resistance. This action on peripheral resistances, as opposed to that on sodium balance, has rarely been indisputably substantiated. In order to dissociate its diuretic effect from its activity on peripheral resistances, we undertook a study on the efficacy of adding indapamide to the antihypertensive regimen of 12 patients suffering from chronic renal failure complicated by hypertension, and in whom control of high blood pressure had not been achieved with one to four antihypertensive drugs, plus furesemide in case of overhydration. Renal insufficiency was defined by serum creatinine levels of (m +/- SD) 271 +/- 171 mumol/l and a glomerular filtration rate of 36.7 +/- 18.6 ml/min. Before indapamide was introduced, blood pressure was 172.4 +/- 23.1 mmHg/109.6 +/- 9.55 mmHg. After 1 to 6 months of treatment, blood pressure was normalised. Systolic BP was 141.6 +/- 19 mmHg (p < 0.001) and diastolic BP was 89.7 +/- 8.6 mmHg (p < 0.001). Absence of diuretic effect and/or of modification of water and electrolytes was verified by the stability of body weight and serum electrolytes. At end point, body weight, electrolytes and renal function were unchanged. This study confirms that indapamide exerts an antihypertensive effect by lowering peripheral vascular resistances and not by diminishing the volume of extracellular fluid. Indapamide can be listed among antihypertensive agents that are advisable in the treatment of high blood pressure in patients with chronic renal insufficiency. Its antihypertensive effect in such patients is independent of any natriuretic action.

Ambulatory Care↗
PubMed1993

[Clinical description of acute pyelonephritis].

Acute pyelonephritis is frequent. Its usual signs and symptoms comprise renal pain, fever, inflammation, and presence of germs and leukocytes in the urine. Primary acute E. coli pyelonephritis is frequent in the young female and in most cases is a benign condition. Atypical pyelonephritis may be painless, or without high fever, or lacking bacterial growth in the urine owing to previous inappropriate treatment. Severe pyelonephritis is mainly observed in diabetic, alcoholic or immunocompromised patients. In occasional cases, a common form of pyelonephritis may develop to formation of a renal abscess requiring drainage. When secondary to urinary tract abnormalities, pyelonephritis may be complicated with septicaemia and can induce early and severe renal tissue damage. This form warrants early urological treatment. The common pyelonephritis of the young female without previous history of febrile urinary tract infection requires little imaging. Conversely, extensive uroradiological workup is mandatory in the very young and the elderly, in the male, when treatment is not rapidly effective or in case or early relapse. In some cases, pyelonephritis leads to the development of cortical scars, the long-term prognosis of which remains to be determined.

Abscess↗
PubMed1993

[Rapidly progressive glomerulonephritis of infectious origin].

Among 64 patients who presented with glomerulonephritis of infectious origin, 17 cases (26%) of crescentic glomerulonephritis were studied retrospectively. Five patients had bacterial endocarditis and the identified primary infections were cutaneous or oropharyngeal. At the time of diagnosis, 15 patients had acute nephritic syndrome, 3 were anuric and only 2 had normal renal function. Despite symptomatic treatment, the prognosis in these patients was poor: 5 died of infectious disease, 3 are definitively on dialysis and 7 suffer from chronic renal failure. Initiation of immunosuppressive regimens prior to the development or irreversible renal lesions could possibly improve renal prognosis, but entail the risk of life threatening infections in such patients.

Adult↗
PubMed1993

[Hypokalemia without arterial hypertension by licorice poisoning].

We report a case of chronic intoxication with glycyrrhizinic acid, at a dosage of 1000 to 1500 mg per month over a period of 11 months, in a former alcoholic. This intoxication was revealed by profound hypokalaemia and rhabdomyolysis. However, blood pressure remained constantly normal. Analysis of the literature shows that liquorice intoxication, which blocks renal 11 beta-hydroxysteroid dehydrogenase evolves more frequently as isolated hypokalaemia than as a picture of pseudo-primary hyperaldosteronism accompanied with hypertension. Hypokalaemia with urinary potassium wasting and without hypertension should therefore lead to considering liquorice intoxication, which can be confirmed by disclosing shut-off of the renin-angiotensin-aldosterone axis, and by the increase of the urinary ratio of [cortisol metabolites (5 alpha tetrahydrocortisol + 5 beta tetrahydrocortisol)]/[cortisone metabolite (5 beta tetrahydrocortisol)] together with increase of urinary free cortisol excretion.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed1992

Minimal change nephrotic syndrome revealing solid tumors.

In 2 patients with the nephrotic syndrome, unsuspected solid tumors were found. One was a small cell lung carcinoma, accompanied with the syndrome of inappropriate ADH secretion. The other was a cancer of the breast with lymph node and bone metastases. In both, renal biopsy showed minimal change disease without immune complex deposits. There are only 14 other reported cases of paraneoplastic lipoid nephrosis complicating solid tumors. Such cases lead to the discussion on the respective roles of tumor cell gene product(s) inducing proteinuria and of lymphokine secretion by lymphocytes directed against the tumor itself. Cancer should be considered as a possible etiology of the minimal change nephrotic syndrome in the adult.

Breast Neoplasms↗
PubMed1992

Diagnosis and drug treatment of acute pyelonephritis.

The term pyelonephritis, which denotes infection of the renal pelvis and of the renal tissue, covers a spectrum of entities, the gravity and hence treatment of which depend upon the organism, its sensitivity to antibiotics, the presence or absence of urinary tract obstruction, and the host's background. The common form affects young females, is due to uropathogenic but multisensitive strains of Escherichia coli, and is easily treated by a 10- to 20-day course of antibiotic(s). In males, children and immunocompromised patients, renal and urinary tract imaging is necessary to determine the cause of the infection, the severity of the lesions and thus to guide the duration of treatment, which comprises antibiotic combinations for several weeks. Pyelonephritis during pregnancy may be serious, and treatment is restricted to certain antibiotics. Aminoglycosides, amino- or carboxypenicillins (alone or associated with clavulanic acid), ureidopenicillins (e.g. mezlocillin, piperacillin), fluoroquinolones (e.g. ciprofloxacin, ofloxacin, pefloxacin), cephalosporins, monobactams (e.g. aztreonam), carbapenems (e.g. imipenem) and the combination of trimethoprim plus a sulphonamide [e.g. cotrimoxazole (trimethoprim/sulfamethoxazole)] offer a wide choice of bactericidal agents which may be used for the treatment of pyelonephritis. However, the selection among them also depends on availability, antimicrobial spectrum, tolerance and cost.

Female↗
PubMed1992

[Acute renal insufficiency associated with lymphoma. A new case].

We report on a case of acute renal failure secondary to relapse of a centrocytocentroblastic non-Hodgkin's lymphoma. Twenty-seven cases of acute renal failure due to lymphomatous infiltration of the kidneys have been so far reported. The clinical presentation is non-specific; the size of the kidneys appears normal or enlarged; diagnosis is confirmed by renal biopsy and/or CT scan examination. Chemotherapy and/or radiotherapy sometimes lead to dramatic improvement of renal function. However, prognosis is poor, mostly due to lymphomatous evolution.

Acute Kidney Injury↗
PubMed1991

[Glomerulonephritis of infectious origin].

Glomerulonephritis may complicate infections due to various microorganisms. These microorganisms are bacterial, fungal, viral or parasitic. Considerable clinical and experimental evidence has accumulated to indicate that glomerular injury is due to in situ immune complex deposition. In France, renal lesions are more often due to focal skin infection and sinus or visceral abscesses, with or without endocarditis, rather than to pharyngeal streptococcal infection. Staphylococcal infections are a frequent cause, especially in intravenous illicit drug users. Recovery requires suppression of the infective agent. However, in severe forms, after initial acute glomerular damage the evolution may be characterized by the development of chronic glomerulonephritis.

Glomerulonephritis↗
PubMed1991

[Diagnosis of acute pyelonephritis. Contribution of modern imaging].

Intravenous pyelography (IVP) is a common procedure in acute pyelonephritis (APN). In fact, IVP is unable to show the extent of the renal tissue lesions. It only determines the patency of the urinary tract, thus ruling out secondary (i.e. surgical) APN. Modern imaging comprises ultrasonography, CT scan with injection of contrast medium, and cortical scintigraphy using GH or DMSA technetium. These investigations, used separately or in combination, are of considerable interest in the diagnosis, treatment and follow up of acute infections of the upper urinary tract. Such infections entail more severe sequelae (cortical scars) than previously thought.

Acute Disease↗
PubMed1991

Hemolytic-uremic syndrome with anticardiolipin antibodies revealing paraneoplastic systemic scleroderma.

Lupus anticoagulant was present in this case of paraneoplastic scleroderma revealed by hemolytic-uremic syndrome, suggesting that the autoantibody played a significant role in the sequence of events leading to anuria. Reviewing the literature we found several observations of paraneoplastic scleroderma, and in other series cases of scleroderma-linked (and in rare instances cancer-linked) antiphospholipid autoantibodies. Search for antiphospholipid antibodies should be considered in patients with systemic scleroderma as well as in patients with metastatic cancer. Presence of such procoagulant autoantibodies might predict future complications and should influence treatment strategy.

Aged↗