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Biomedical subjects

Gilbert Deray

Publications and source records attributed to Gilbert Deray.

At least 91 records · Page 5Linked to original sources
PubMed2003

Drug-induced Fanconi's syndrome.

Fanconi's syndrome (FS) was first described by Lignac in 1924. Associated with numerous varieties of inherited and acquired conditions, FS is characterized by a generalized transport defect in the proximal tubules, leading to renal losses of glucose, phosphate, calcium, uric acid, amino acids, bicarbonates, and other organic compounds. Cardinal symptoms of the syndrome are hyperaminoaciduria, glucosuria in the face of a normal serum glucose level, and phosphate wasting. Other symptoms may be associated, such as defects in bicarbonate reabsorption; renal acidification; urate reabsorption; urinary concentration; potassium conservation; reabsorption of sodium, calcium, and low-molecular-weight proteins; and secretion of p-aminohippuric acid. Acquired renal tubular defects resulting in FS also have been described in association with many exogenous agents, whether administered or accidentally ingested. This review concentrates on drug-induced FS.

Alcoholism↗
PubMed2002

Bone mineral density and fracture prevalence in long-term kidney graft recipients.

BACKGROUND: Renal transplantation triggers an early bone loss that increases the subsequent risk of osteoporosis and fractures. Little is known about the long-term outcome of bone status and fracture prevalence several years after transplantation. Therefore, we conducted a cross-sectional evaluation of bone status to find out the frequency and predictors of osteoporotic fractures in late kidney graft patients. METHODS: Changes in spinal, hip, and total body bone mineral density were assessed using a DEXA Hologic QRD 1000 scanner, and fractures were quantified in all kidney graft patients presenting for routine evaluation with a minimal follow-up of 5 years after transplantation (with a mean follow-up 8.5+/-3.1 years). We measured biochemical markers of bone metabolism and collected clinical and dietary intake data. RESULTS: Fifty-nine renal graft recipients were enrolled in the study within 9 months. Osteoporosis, according to the World Health Organization definition, was observed in 31 patients (53% of the total population) and fractures occurred in 26 patients (44% of the total population and 51.6% of patients with osteoporosis). Femoral neck bone mineral density was positively correlated with patient's weight and cyclosporin current dosage. Steroid cumulative dosage correlated only to lumbar spine Z score. Dietary calcium, serum 25 hydroxyvitamin D, parathyroid hormone, and urinary N-telopeptides excretion were normal. CONCLUSIONS: These data emphasize the substantial prevalence of osteoporosis and fractures among very long-term kidney graft recipients. Therapeutic intervention in these patients is urgently needed.

Adrenal Cortex Hormones↗
PubMed2002

Clinical review: use of vancomycin in haemodialysis patients.

Following intravenous administration, vancomycin is poorly metabolized and is mainly excreted unchanged in urine. Total body clearance is thus dependent on the kidney, and is correlated with glomerular filtration rate and creatinine clearance. Accumulation of vancomycin in patients with renal insufficiency may therefore occur, and this may lead to toxic side effects if dosage is not modified according to the degree of renal failure. Furthermore, vancomycin easily diffuses through dialysis membranes. The aim of the present review is to establish guidelines for handling this drug in such patients. We indicate how and when plasma concentrations of vancomycin should be determined in dialysis patients.

Anti-Bacterial Agents↗
PubMed2002

Renal function after aortic stent-grafting including coverage of renal arterial ostia.

Considerable experience has been gained with endoluminal stent-graft techniques for the treatment of infrarenal aortic aneurysms. The inclusion of uncovered suprarenal stents eases the treatment of cases with a short, angulated, or bottlenecked proximal neck. However, few data have been published on the effect of a stent-graft crossing renal artery ostia on long-term renal function. We therefore retrospectively analyzed the influence of intra-aortic stent-grafts, including suprarenal fixation on long-term renal function. Thirty-nine patients who received a Gianturco Z stent across renal artery ostia as part of a made-to-measure stent-graft treating an infrarenal aortic aneurysm were evaluated at 6 (all patients) and 30 months (15 patients) after surgery. Renal function evaluation included serum creatinine level, creatinine clearance using the Cockcroft-Gault formula, and renal tomography. Initial technical success was achieved in all patients. There were no minor or major complications. Mean serum creatinine levels were 1.16 +/- 0.25, 1.12 +/- 0.28, and 1.24 +/- 0.25 mg/dL before and 6 and 30 months after endoluminal stent-graft performance, respectively (P = not significant [NS]). Mean creatinine clearances were 60.3 +/- 19.7, 63 +/- 23, and 60.6 +/- 17.5 mL/min before and 6 and 30 months after endoluminal stent-graft performance, respectively (P = NS). Only two patients (5%) had a decrease in glomerular filtration rate greater than 20% at 6 months. Both patients had renal insufficiency before endovascular grafting. Renal function was stable in all patients at 30 months' follow-up. We suggest that renal function is unaffected by coverage of renal arterial ostia with Gianturco Z stents.

Aged↗
PubMed2002

Primary chronic interstitial nephritis in Crohn's disease.

BACKGROUND & AIMS: In Crohn's disease, cases of interstitial nephritis with renal failure have been reported in connection with the use of mesalamine. METHODS: We observed 4 patients with severe interstitial nephritis proven by examination of kidney biopsy specimens. Renal failure was discovered before or simultaneously with the diagnosis of Crohn's disease, and patients were not treated with mesalamine. Impairment of renal function progressed to end-stage renal failure in 3 of the 4 patients. RESULTS: Our results show that the kidney can be an extraintestinal target of Crohn's disease. CONCLUSIONS: Several unanswered questions remain concerning the frequency of interstitial nephritis in patients with Crohn's disease, as well as the exact role of mesalamine in the development of chronic interstitial nephritis.

Adult↗
PubMed2002

Angiotensin-converting enzyme inhibitor-induced syndrome of inappropriate secretion of antidiuretic hormone: case report and review of the literature.

Seventeen cases of severe hyponatremia induced by angiotensin-converting enzyme (ACE) inhibitor therapy have been reported in the literature. The mechanism of severe hyponatremia induced by ACE inhibitor is not clear. A 60-year-old white man with a history of idiopathic dilated cardiomyopathy was treated with enalapril, 20 mg daily, that had been started 2 weeks before heart transplantation. The serum sodium level was 138 mmol/L before initiation of enalapril therapy and 127 mmol/L just before cardiac surgery. In the post-heart transplantation period, enalapril therapy was withdrawn for the perianesthesia period, and the serum sodium level increased from 127 to 140 mmol/L. One month later, viral myocarditis developed in the patient and enalapril was reintroduced at 20 mg daily. Two weeks later, natremia decreased. Enalapril was discontinued. Three days later the serum sodium level rose to 140 mmol/L. Severe symptomatic hyponatremia induced by the syndrome of inappropriate secretion of antidiuretic hormone should be considered a rare but possible complication associated with ACE inhibitor therapy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

Amphotericin B nephrotoxicity.

The use of amphotericin B limited by dose-dependent nephrotoxicity. Elevated creatinine associated with amphotericin B is not only a marker for renal dysfunction, but is also linked to an increase in hospital costs and a substantial risk for the use of haemodialysis and a higher mortality rate. Therefore, amphotericin B nephrotoxicity is not a benign complication and its prevention is essential. Several manipulations have been proposed to minimize amphotericin B-induced nephrotoxicity. Mannitol and frusemide administration are reported to be protective based on anecdotal observational reports. Small prospective and randomized trials do not suggest a protective effect. Three new formulations have been developed in attempts to improve both efficacy and tolerability: amphotericin B in a lipid complex (ABLC; Abelcet); amphotericin B colloidal dispersion; and liposomal amphotericin B (AmBisome). Three prospective randomized studies have clearly shown that AmBisome is less nephrotoxic than amphotericin B. In a double-blind randomized trial significantly fewer patients receiving AmBisome had nephrotoxic effects. This significant reduction in azotaemia was also observed among subgroups of patients receiving concomitant therapy with nephrotoxic agents. Moreover, there were fewer patients with hypokalaemia in the group receiving AmBisome. A recent multicentre double-blind study has shown that AmBisome (3 or 5 mg/kg/day) has a better safety profile than Abelcet (5 mg/kg). Patients in both AmBisome treatment groups experienced less chills/rigors, less nephrotoxicity based on a doubling of serum creatinine, and fewer toxic reactions resulting in discontinuation of therapy. In conclusion, amphotericin B nephrotoxicity is observed frequently. It clearly increases patient mortality. Nephrotoxicity must be recognized early, based on tubular abnormalities and a mild increase in serum creatinine. Its prevention relies on the detection and suppression of risk factors and the use of AmBisome.

Acute Kidney Injury↗
PubMed2002

Ionic dialysance vs urea clearance in the absence of cardiopulmonary recirculation.

BACKGROUND: Several studies have shown a slight discrepancy between ionic dialysance (D) and dialyser urea clearance (UK), even in the absence of access recirculation. As it has been suggested that this discrepancy could be due to the cardiopulmonary recirculation, we studied the relationship between these two parameters in a particular dialysis setting without cardiopulmonary recirculation. METHODS: Paired measurement of urea clearance and ionic dialysance were performed in five patients without arterio-venous access who were dialysed via an internal jugular vein twin catheter. Fifty paired measurements were used for statistical analysis. Vascular access recirculation was assessed by an ultrasound dilution technique. The measured value of ionic dialysance was corrected (D(0)) for the effect of vascular access recirculation and was compared with instant urea clearance calculated from the dialysate side. RESULTS: The difference between the paired measurements of D(0) and UK (n=50) was equal to 0.6+/-16.9 ml/min (NS). With a statistical power of 90% and taking into account this standard deviation, this study might have shown a difference of at least 10.9 ml/min. The correlation was highly significant (P<0.0001). The discrepancy of the two parameters varied with dialysis efficiency, with a decreasing D(0):UK ratio for the higher dialysis efficiency. CONCLUSIONS: Compared with our previous results obtained in patients dialysed on arterio-venous access and performed with similar methods, the relationship between D(0) and UK is modified. This difference between D(0) and UK gets lower in patients dialysed on central catheters and this variance is in accordance with that expected when the influence of the cardiopulmonary recirculation on the measurement of ionic dialysance is taken into account. The limits of agreement (+/-2 SD) between D(0) and UK (+/-34 ml/min, Bland-Altman analysis) were higher than expected and raised questions about the accuracy of the measurement of each parameter via a central venous catheter.

Arteriovenous Shunt, Surgical↗
PubMed2002

Long-term renal effects of low-dose cyclosporine in uveitis-treated patients: follow-up study.

Cyclosporine (CsA), a widely used immunosuppressive drug, is an effective treatment of sight-threatening posterior idiopathic uveitis. CsA's main side effect is nephrotoxicity. The aim of this single-center prospective cohort study (conducted in a tertiary care teaching hospital in Paris, France) was to assess the long-term renal tolerance of a low-dose CsA treatment in patients with previously healthy kidneys on clinical, biologic, and pathologic criteria. Forty-one patients treated with 4.3 +/- 1.6 mg/kg body wt per day CsA for 44.9 +/- 3.6 mo were included. Mean follow-up was 55.4 +/- 0.2 mo. BP, CsA trough level, and renal function were prospectively monitored together with blood urea, creatinine clearance, GFR, and effective renal plasma flow. Eleven patients underwent serial kidney biopsies before and after 2 yr of a 4 +/- 0.9 mg/kg daily CsA treatment. Sustained low-dose CsA treatment induced a significant increase in plasma creatinine (P < 0.0001), a significant decrease in creatinine clearance (P < 0.0001), and isotopic GFR (P < 0.0001) over time. The highest dose induced more severe alterations in any of the renal parameters than the lowest dose. Prevalence of hypertension was particularly high. Histopathologic data showed significant interstitial fibrosis (P < 0.003) and tubular atrophy (P < 0.003) after 2 yr. Low-dose long-term CsA treatment induces significant renal impairment and a high incidence of hypertension. Our study suggests that lowering daily dosage may prevent CsA-induced nephrotoxicity if a daily dose of < or =3 mg/kg is used. Whether once established it is reversible is still prospective, although the occurrence of interstitial fibrosis in the kidney would argue against reversibility.

Adult↗
PubMed2002

Detection of vascular access stenosis by measurement of access blood flow from ionic dialysance.

BACKGROUND/AIM: The measurement of the vascular access blood flow rate (Q(a)) in chronic hemodialyzed patients was proposed to predict access thrombosis. We have recently presented a new method based on the measurements of ionic dialysance at normal and reversed positions of the blood lines. We evaluate the reliability of the measurement of Q(a) by this method in detecting significant access stenoses. METHODS: Twenty-five patients on chronic hemodialysis and having a vascular access cannulated with two needles were studied. The Q(a) was evaluated by the Diascan ionic dialysance (Q(a-id)) method and by the ultrasound dilution technique (Q(a-us); Transonic) during the same dialysis session. The measurements were available for 23 patients. In addition, the patients had ultrasonography of their fistula followed by angiography, if a stenosis was detected. RESULTS: Q(a-id) and Q(a-us) were not significantly different, showing a difference in Q(a) at 32 +/- 469 ml/min. Q(a-id) was significantly different between patients with or without stenosis (508 +/- 241 vs. 1,125 +/- 652 ml/min, p < 0.05). Among patients with a Q(a) <500 ml/min by Q(a-id), 5 had a stenosis detected by ultrasonography (sensitivity 83%), and 3 had no stenosis (false-positive rate 18%). Of these 3 patients, 2 had a thrombotic event at 1 and 3 months, suggesting that a more sensitive detection of stenosis for this range of Q(a) is needed and that a Q(a) <500 ml/min has a higher power to predict thromboses than a stenosis by ultrasonography. CONCLUSIONS: The measurement of the access flow rate by the Q(a-id) method has a clinical relevance to the detection of vascular access stenosis. An intervention program based on the Q(a-id) has to be evaluated.

Arterio-Arterial Fistula↗