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Biomedical subjects

Gilbert Deray

Publications and source records attributed to Gilbert Deray.

At least 73 records · Page 4Linked to original sources
PubMed2004

[Renal and cardiovascular effects of non-steroidal anti-inflammatories and selective cox 2 inhibitors].

HYPERKALIEMIA AND RENAL FAILURE: Nonsteroidal anti-inflammatory drugs (NSAIs) may induce hyperkaliemia and renal failure. With regard to these complications, the notion of a risk factor is fundamental. Selective cyclooxygenase-2 inhibitors (Cox-2) do not provide any notable advantages with regard to the incidence of hyperkaliemia and renal failure. OEDEMA AND BLOOD PRESSURE: The NSAIs provoke salt-water retention which is responsible for oedema in 2 to 5% of patients (here again the notion of a risk factor is important). The salt-water retention is implied in the increase in blood pressure and the decompensation of heart failure. It has been shown that the incidence of oedema and the increase in blood pressure was significantly reduced with celecoxib compared with rofecoxib. This might have a crucial impact on the mean and long term follow-up of cardiovascular risk in these patients. CARDIOVASCULAR RISK: The results of the VIGOR study that demonstrated an increase in risk of myocardial infarction with rofecoxib, can probably be explained by an anti-thrombotic effect of naproxene, the high dose of rofecoxib used, the type of patients included or the fact that aspirin had been contraindicated. A recent study suggested that the cardiovascular risk was greater with rofecoxib than with celecoxib and with NSAIs when the dose of rofecoxib used was greater than 25mg/day. In this case control study, the cardiovascular risk was identical with celecoxib and NSAIs, whatever the dose used, but increased with a relative risk rate of 1.7 with the doses of rofecoxib greater than 50mg/day. In cases treated with aspirin Some NSAIs can reduce the anti-aggregant effects of aspirin whereas this effect is not observed with Cox-2 selective inhibitors. Hence, the latter should be the pharmacological agents of choice in patients treated with aspirin.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Oculorenal manifestations in systemic autoimmune diseases.

Vasculitides form a heterogeneous group of diseases characterized by blood-vessel inflammation and necrosis. They have a wide spectrum of manifestations because of the involvement of arteries and other vessels of various sizes and locations. Early diagnosis and prompt treatment may decrease the morbidity and mortality associated with these disorders. Examination of the eye and kidney should be performed routinely in those diseases. This article reviews the major types of oculorenal manifestations in systemic autoimmune diseases.

Autoimmune Diseases↗
PubMed2004

Herbs and the kidney.

The use of herbal therapy has increased dramatically in past years and may lead to renal injury or various toxic insults, especially in renal patients. In most countries, herbal products are not regulated as medicines. Herbal poisoning may be secondary to the presence of undisclosed drugs or heavy metals, interaction with the pharmacokinetic profile of concomitantly administered drugs, or association with a misidentified herbal species. Various renal syndromes were reported after the use of medicinal plants, including tubular necrosis, acute interstitial nephritis, Fanconi's syndrome, hypokalemia or hyperkalemia, hypertension, papillary necrosis, chronic interstitial nephritis, nephrolithiasis, urinary retention, and cancer of the urinary tract. It seems critical that caregivers be aware of the potential risk of such often underreported therapy and carefully question their patients about their use of this popular branch of alternative medicine.

Aristolochic Acids↗
PubMed2004

The renal tolerance of low-dose adefovir dipivoxil by lamivudine-resistant individuals co-infected with hepatitis B and HIV.

BACKGROUND: Adefovir (ADV), an orally administered nucleotide analogue active against hepadnaviruses, retroviruses and herpes viruses was shown to be effective in HIV-infected patients, but the prevalence of nephrotoxicity with doses of 60-120 mg/day was considered unacceptable. Recently, lower doses of ADV were shown to be effective for the treatment of HIV-1 patients with chronic lamivudine (LAM)-resistant hepatitis B. METHODS: In a cohort of 35 patients infected with both HIV-1 and LAM-resistant hepatitis B virus, we investigated the renal tolerance of a once-daily dose of ADV 10 mg over 52 weeks. Their mean baseline creatinine clearance was within the normal range (105 +/- 3 ml/min/1.73 m(2)). No patient had significant changes in renal function or electrolyte balance secondary to ADV treatment. RESULTS: Transient increases in serum creatinine, which resolved by the end of the study were noted in two patients and three developed proteinuria, which was felt to be unrelated to ADV treatment. The cohort's mean serum phosphate level, 2.45 +/- 0.09 mg/dl at baseline, did not change significantly under treatment (2.66 +/- 0.12 mg/dl at week 52, P = NS). CONCLUSIONS: Our study shows that ADV dosed at 10 mg/day for the treatment of LAM-resistant chronic hepatitis B in patients co-infected with HIV is not associated with renal tubular dysfunction or a significant change in renal function.

Adenine↗
PubMed2004

Ear and kidney syndromes: molecular versus clinical approach.

The association between ear and kidney anomalies is not usually due to an insult to the embryo. In recent years, many essential development control genes that coordinate the assembly and function of kidney and ear have been discovered through the generation of animal mutants and have increased our understanding of the mechanisms of human oto-renal diseases. Here, we describe ear and kidney clinical syndromes and their molecular expression.

Ear↗
PubMed2004

Antiretroviral and immunosuppressive drug-drug interactions: an update.

With the introduction of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) infection has become a chronic disease with more frequent end-stage organ failures. As a result, the question of transplantation in HIV patients is raised more often. However, some of the HAART regimen medications require elimination or metabolism via the P-glycoprotein (P-gp) and multidrug-resistant protein (MRP) transporters or via the cytochrome P450 enzyme system. Since these transporters and enzymes are also responsible for the clearance of immunosuppressive drugs, drug-drug interactions are likely to occur. Indeed, profound drug-drug interactions between protease inhibitors and immunosuppressive drugs have been observed and they required reductions in drug dosage. In contrast, HAART using nucleoside or nonnucleoside reverse transcriptase inhibitors without the use of protease inhibitors has been shown to produce less significant drug-drug interactions. It is thus crucial to take into account those potential pharmacokinetic and/or pharmacodynamic drug-drug interactions in order to avoid drug toxicity or a lack of efficacy. The aim of this work was to review and synthesize the international literature on this field in order to give practical recommendations on how to manage immunosuppressive drugs in HIV patients who get transplanted and on how to handle HAART therapy in transplant-recipient patients who get infected with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Renal safety of adefovir dipivoxil in patients with chronic hepatitis B: two double-blind, randomized, placebo-controlled studies.

BACKGROUND: The incidence of adefovir dipivoxil (ADV) nephrotoxicity has been previously reported with the 60 and 120 mg daily dose in human immunodeficiency virus (HIV). We report a complete analysis on the renal tolerance of ADV at the currently approved dose of 10 mg daily for the treatment of chronic hepatitis B. METHODS: To investigate the efficacy, safety, and the tolerability of two dosing regimens of ADV (10 mg daily or 30 mg daily), two double-blind, placebo-controlled studies were performed in patients with chronic hepatitis B and compensated liver disease who were not undergoing current treatment and who had evidence of hepatitis B virus (HBV) replication. RESULTS: There was no overall median change from baseline at week 48 in serum creatinine or serum phosphorus levels in the ADV 10 mg group. In the ADV 30 mg group there was a slight increase of 0.2 mg/dL in median serum creatinine levels, and decrease of 0.1 mg/dL in serum phosphorus levels at week 48. Serum creatinine increase and hypophosphatemia were more frequently observed in patients receiving ADV 30 mg daily compared with ADV 10 mg and placebo. There were no grade 4 proteinuria, hematuria, or glycosuria events. CONCLUSION: Mild nephrotoxicity was demonstrated with the dose of 30 mg daily. Nephrotoxicity, as defined by an increase >/=0.5 mg/dL from baseline in serum creatinine or a serum phosphorus value of <1.5 mg/dL on two consecutive occasions, was not observed in patients treated with ADV 10 mg for a median follow-up period of approximately 64 weeks.

Adenine↗
PubMed2004

Achieving therapeutic targets in renal anaemia: considering cost-efficacy.

Erythropoietin treatment for anaemia in chronic kidney disease (CKD) brings important clinical benefits, but restricted healthcare budgets necessitate value-for-money therapies, requiring economic considerations also to be taken into account when selecting a treatment regimen. Subcutaneous (s.c.) administration of epoetin is effective at a lower dose than intravenous (i.v.) administration, offering the potential for substantial reductions in costs of treatment. Unlike epoetin alfa, which is contra-indicated by the s.c. route in Europe in patients with CKD, epoetin beta (NeoRecormon) can be safely and effectively given by either route. The multidose presentations of epoetin beta (Reco-Pen, multidose vials) may provide further opportunity for dose reduction. The tolerability of s.c. epoetin beta is excellent and superior compared with epoetin alfa or darbepoetin alfa. Epoetin beta given once weekly is as effective as two- or three-times weekly, and the dosing frequency can be further reduced to once every 2 weeks in patients who are stable on once-weekly dosing. Reduced dosing frequency is more convenient for the patient and may save nursing time in dialysis units. Overall, s.c. epoetin beta, compared with alternative treatments, may represent a cost-effective treatment option for anaemia management as it combines a well-established safety and efficacy record, favourable local tolerability, and the convenience of once-weekly dosing with the potential to reduce treatment costs by up to 30%.

Anemia↗
PubMed2004

Lupus nephritis: a review of the current pharmacological treatments.

Proliferative lupus glomerulonephritis World Health Organization Class III and IV patients should benefit from an induction and maintenance therapy with a combined immunosuppressive treatment. Cyclophosphamide is the main recommended drug in induction therapy for a 3- to 6-month treatment period. Refractory lupus nephritis may be considered for immunoablative cyclophosphamide treatment with or without haematopoietic CD34(+) stem-cell transplantation or rituximab. Maintenance therapy should contain either quarterly cyclophosphamide pulses, azathioprine or mycophenolate mofetil for a total treatment duration of at least 2 years. Recent studies suggested a similar efficacy of mycophenolate mofetil and cyclophosphamide in induction and maintenance therapy. This result has to be confirmed in long-term studies.

Combined Modality Therapy↗
PubMed2004

Antiretroviral drugs and the kidney: dosage adjustment and renal tolerance.

BACKGROUND: Acquired immunodeficiency syndrome (AIDS)-related kidney disorders concern 30% of those patients and can lead to end-stage renal disease (ESRD; 0.6 to 1%). Therefore, administration of antiretroviral drugs in human immunodeficiency virus (HIV) patients with nephropathy is not uncommon. AIM OF THE REVIEW: Since renal insufficiency is not uncommon among HIV-infected patients treated with antiretroviral drugs, guidelines on how to use these drugs in the pattern of an altered renal function are mandatory. This review provides such guidelines established on the basis of pharmacokinetic and clinical studies reported in the international literature. In addition, some of these drugs may be nephrotoxic. Mechanisms and clinical and/or biological manifestations are reviewed to help monitor renal tolerance in patients receiving these drugs. CONCLUSION: Antiretroviral drugs' dosage in HIV-infected patients with altered renal function should be cautiously determined. Drug dosage should not be systematically reduced since dosage adjustment is not mandatory for all therapies (ie. protease inhibitors). Furthermore, when dose reduction is necessary, pharmacokinetic and clinical data from the literature allows to establish practical guidelines on how to use these drugs in such patients.

AIDS-Associated Nephropathy↗