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Biomedical subjects

D Chevet

Publications and source records attributed to D Chevet.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Extracapillary glomerulonephritis].

Extracapillary glomerulonephritis is characterized by cell proliferation within the urinary space of 50% of the glomeruli, where it covers more than 50% of the filtration chamber, associated with acute or rapidly progressive renal failure. It is a model of curable human renal failure. Extracapillary cell proliferation is an elementary lesion which may complicate any glomerulopathy and many systemic diseases, or appear to be primary. Its clinical manifestations may be extremely marked in some systemic diseases, but they may be minimal and delay a diagnosis which rests entirely on renal biopsy. An early renal biopsy commands the prognosis which depends on the finding of young cellular crescents that respond to treatment before fibrous transformation sets in. Experiments in animals and man suggest that cell proliferation results from rupture of the capillary walls and from the production of polymerized fibrin in the urinary space. This is followed by a cascade of reactions, with increased synthesis of local mediators issued from resident and invasive glomerular cells. These data constitute the basis of modern therapies, such as emboli of methylprednisolone, plasma exchange and immunodepressive drugs, aimed not only at a possible aetiological treatment but also at the cell proliferation itself. The use of such treatments, whose risks must be carefully weighted, has transformed the prognosis of extracapillary glomerulonephritis, since almost 50% of the cases the kidneys survive at 5 years.

Glomerulonephritis, Membranoproliferative↗
PubMed1990

Impairment of jacalin binding to serum IgA in IgA nephropathy.

A test was set up to analyze the direct binding of serum IgA to the lectin jacalin. Under the testing conditions, jacalin bound to both IgA subclasses and reacted similarly with monomeric and polymeric IgA. A jacalin index was defined to quantify serum IgA binding to this lectin. The jacalin index appeared significantly lower in IgA nephropathy than in controls. This may be related to abnormal IgA glycosylation, which could explain, at least in part, the mesangial deposition responsible for the renal disease.

Adolescent↗
PubMed1990

Linkage study of a large family with autosomal dominant polycystic kidney disease with reduced expression. Absence of linkage to the PKD 1 locus.

We describe a large three generation family with autosomal dominant polycystic kidney disease (PKD). Ultrasonographic screening of 60 family members revealed 20 individuals, whose age ranged from ten to eighty years, with one or several cysts in only one kidney and 7 individuals with cysts in both kidneys. Transmission of unilateral cysts seems to be autosomal dominant, although there are some generation gaps. Linkage studies with several markers of the PKD1 locus on the short arm of chromosome 16 showed no linkage with the disease. Lod scores for linkage between the disease and the most informative marker 3'HVR were computed using different penetrance models and several hypotheses concerning the clinical status of individuals with unilateral renal cysts. Results varied from Z = 1.31 to Z = -21.47 (theta = 0). Smith's test of heterogeneity gave a conditional probability of non-linkage between 0.9 and 1.0. We conclude that this family presents a form of autosomal dominant PKD with reduced penetrance and no linkage to the PKD1 locus on the short arm of chromosome 16. Other hypotheses, such as the existence of two distinct hereditary diseases in this large family, or neomutation in one branch of the family associated with a high frequency of isolated renal cysts, are also considered.

Family↗
PubMed1990

Acute renal failure following collective intoxication by Cortinarius orellanus.

Twenty-six young men with no previous medical history all ingested mushroom soup, exclusively made with Cortinarius orellanus. They were hospitalized 10-12 days after the incident. On admission, 12 patients presented with acute tubulointerstitial nephritis with acute renal failure; 8 required haemodialysis. In addition to symptomatic treatment, 9 patients were given corticosteroids. In this group of 12 patients, 8 recovered rapidly, and the other 4 suffered from chronic renal failure for several months. In the other group of 14 patients, initial leukocyturia was observed in 12 cases, although renal function remained normal during a one-year follow-up. Hepatic acetylation and hydroxylation tests performed after 6 months in 22 patients did not provide any explanation for the strong individual sensitivity to the renal toxicity of this fungus.

Acute Kidney Injury↗
PubMed1990

[Anti-basement-membrane antibody mediated, rapidly progressive, glomerulonephritis. Diagnostic and therapeutic strategy based on a retrospective study of 14 cases].

Fourteen cases of anti-GBM antibody-induced RPGN were evaluated retrospectively in terms of renal function improvement and therapeutic risks. Nine men and 5 women (mean age: 55.3 years) were observed over a 9 year period; in three patients, hemoptysis was associated with renal disease (Goodpasture's syndrome). Most of these patients had received combinations of steroid therapy (ST), immunosuppressive drugs (IS) and plasma exchanges (PE). Age, duration of symptoms prior to diagnosis, initial renal function, therapeutic modalities and complications were assessed according to renal outcome: 9 patients (group A, "non-responders") remained on dialysis irrespective of the treatment administered; 5 patients (group B, "responders") recovered renal function. Complications, especially infections, were twice as frequent in group A. Two of the 4 recorded deaths were related to the disease or the treatment. Analysis of clinical and pathological values at the time of entry into the study for both groups indicated that oliguria/anuria, serum creatinine greater than 500 mumol/l and greater than 50% crescents, when associated, were factors predictive of poor renal outcome; in these patients, dialysis may be required except in cases of pulmonary hemorrhage. In all other patients, treatment with ST, IS and PE is recommended. Active hemoptysis necessitates pulse steroids or PE; if absent, further tests (carbon monoxide uptake, bronchoalveolar lavage, lung biopsy) are indicated before use of aggressive therapy.

Adrenal Cortex Hormones↗
PubMed1988

[Interstitial nephropathies in sarcoidosis. Effect of corticosteroid therapy and long-term evolution. Retrospective study of 22 cases].

Interstitial Nephritis (IN) with or without epithelioid granulomas is the most frequent form of renal impairment in sarcoidosis. Nevertheless, few studies have provided conclusions about its treatment and long-term outcome. We report 22 cases collected over a 20-year period in 9 nephrologic departments of the west of France. We discuss the criteria which permit sarcoidosis to be distinguished from other causes, particularly of IN drugs. Twenty patients were treated with corticoids. In 18 the result could be evaluated on at least 12 months. In 11 there was a decrease of plasma creatinine (Pc) and in 8 of these cases this decrease reached 50%. Of the 12 who were followed from 1 to 17 years, 4 obtained a reduction of Pc of at least 50%. These improvements occurred even in patients whose Pc was initially higher than 300 mumol/l. Only 2 patients reached end-stage renal failure and hemodialysis within the observation period, one as early as the first month, the other after 6 years. Five relapses were observed after stopping treatment but 4 responded again favorably upon resumption. Two patients who received no treatment at all nevertheless had stabilization or improvement of their renal function with a follow-up of 5 years for one case. It may be concluded that the long-term prognosis of sarcoidosis IN can be fairly good but there is no proof that it depends mainly on corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMed1984

[Quantification of separate renal function using Tc 99m DTPA and Tc 99m DMSA. Correlations between individual isotopic data and creatinine clearance].

The purpose of this prospective study (30 controls and 100 renal patients) is to compare one to each other the values of renal function measured with: 1--the DTPA 99mTc , 2--the DMSA 99mTc , and 3--the creatinine clearance. After the control values being established, correlations are done for the whole group (n = 130) between the creatinine clearance, the DTPA 99mTc clearance and the fixation rate of the DMSA 99mTc . The correlations obtained are:--Clcr Versus Cldtpa = 0,91.--Clcr Versus % Dmsa = 0,90. - Cldtpa Versus % Dmsa = 0,93. and indicate the two isotopic tests performed give similar quantitative results than creatinine clearance. Camera and computer allow to measure the separate renal function one by one, the two isotopic test giving similar values for each kidney. The results of these studies give a good concordance with the observed diseases, except for partial renal artery stenosis. The pyelic retention of DMSA 99mTc product, in condition of ureteral compression, gives a potential overestimation of this test and is a matter to debate. The extreme simplicity and facility of DMSA 99mTc procedures make this investigation accessible to any patient and give excellent morphological and functional tests. DTPA 99mTc clearances--global and separate kidney--give a more sensitive approach than DMSA 99mTc does because vascular captation , elimination rates could be focused. DTPA 99mTc procedure is to be used in patients with transplanted kidney, silent IVP kidney, contrast media contraindication or for exploring glomerular clearance without urine collection.

Adolescent↗
PubMed1983

Serum angiotensin-converting enzyme levels in patients with chronic renal failure.

Disagreement concerning serum angiotensin-converting enzyme (ACE) levels in patients with chronic renal failure has been observed in recent reports. Because ACE is considered as a useful tool for the diagnosis and management of sarcoidosis, and because chronic renal failure may be associated with sarcoidosis, the present work was designed to reinvestigate the possible changes of serum angiotensin-converting enzyme activity in a series of 36 non-hemodialysed consecutive patients with chronic non-sarcoid renal failure. Enzyme activity was significantly lower (p less than 0.004) in the patients (15.8 +/- 5.0 units/ml, mean value +/- 1 SD) than in 47 healthy controls (20.2 +/- 7.6 units/ml, mean value +/- 1 SD). Serum angiotensin-converting enzyme and creatinine clearance values were significantly correlated in these patients (p less than 0.0002). These results indicate that, in non-hemodialysed patients with chronic renal failure, serum angiotensin-converting enzyme levels may not be useful in establishing the diagnosis of sarcoidosis.

Adolescent↗
PubMed1982

[Glomerulonephritis in Henoch-Schoenlein purpura. Anatomo-clinical correlations and immunopathological study of twenty-five cases. (author's transl)].

Twenty-five observations (children and adults) of glomerulo-nephritis secondary to Schoenlein-Henoch purpura were studied retrospectively. Histological studies done early in the course of the disease-less than one year after the first attack-enabled us to made, in function of the evolution, clinical and pathological correlations using the method of Levy et al. The intensity of the clinical signs at the time of biopsy appeared proportional to the degree of cellular proliferation whether it was endo or extracapillary form; it is much more difficult to define when mesangial proliferation predominates or in the absence of proliferation. In addition to the usual immunopathological abnormalities, this study found that IgE plasma concentration was frequently elevated. Thus, IgE may play a role in the pathogenesis of this systemic disease.

Adolescent↗