Search PubMed⌕ Search

Biomedical subjects

J M Suc

Publications and source records attributed to J M Suc.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Nephro-angiosclerosis in the graft: impact on graft survival. Study of 33 cases].

UNLABELLED: When early kidney transplant biopsies showed benign hypertensive nephrosclerosis, i.e. hyalin arteriosclerosis and/or interlobular arteries intimal thickening, they are thought to be of donor origin. Between 1987 and 1992, 439 cadaveric renal transplantations have been performed in our department: amongst them 97, i.e. 22% patients underwent a graft biopsy before the end of the first post transplant month (13 +/- 9.5 days). To ascertain if findings of early renal biopsy was predictive of eventual clinical outcome we analyzed renal function and blood pressure (BP) in the short and mid term. Nephrosclerosis lesions were found in 33 cases (group I) and were absent in the remaining 64 cases (group II). The 2 groups were not statistically different according to the time on dialysis, the recipient's age, the HLA matching, the cold ischemia time. The only statistically significant difference was the donor's age: 39.1 +/- 7 years in group I vs 26.9 +/- 8 years in group II (p = 0.0001). Delayed graft function was not different in the 2 groups (13 +/- 9 days group I vs 11 +/- 6 days group II). On the other hand, 30% of group I, patients required hemodialysis (9.8% in group II; p < 0.005). The incidence in graft rejection episodes was similar in both groups (50%) as well as surgical complications. Renal function was assessed by creatinine clearance at 1 and 2 years and at last follow-up visit (mean follow-up: 50.5 +/- 44 months in group I and 46.9 +/- 24 months in group II; p = Ns): it was similar in both groups (see table). The prevalence of hypertension (HTA) was significantly higher in group I than in group II at two years and last follow-up (*: p < 0.005). [table: see text] CONCLUSIONS: The age of donor is of importance in determining nephrosclerosis of the graft observed on early biopsies. Donor-related nephrosclerosis is a risk factor for the recipient of developing HTA without impairment of graft function in the mid term. In the context of early nephrosclerosis, the occurrence of acute rejection episode(s) is detrimental for the graft function.

Adult↗
PubMed1994

[Guillain-Barré syndrome associated with cytomegalovirus infection after kidney transplantation].

The Guillain-Barré syndrome associated with cytomegalovirus infection is a recognized entity of unknown pathogenesis. We observed two characteristic cases with acute polyradiculoneuropathy which occurred after renal transplantation. Both patients fulfilled the diagnostic criteria for Guillain-Barré syndrome: tetraparesis with diffuse areflexia and moderate sensorial signs, high protein level in cerebrospinal fluid without cellular reaction, slow or blocked nerve conduction and partial cure after several months delay. In two-thirds of such cases, the syndrome follows an episode of infection. Cytomegalovirus has been recognized as a possible association. The demyelinating polyradiculoneuropathy induced by cytomegalovirus has been reported essentially in immunodepressed patients infected with the human immunodeficiency virus in whom a pathogenic role for cytomegalovirus in peripheral nerves has been suggested. In our two cases, the cytomegalovirus infection occurred before onset of the acute polyradiculoneuropathy. In both cases, specific IgM antibodies and clear IgG positivization occurred before the first signs of neurological impairment even though neither the virus nor specific antibodies could be concomitantly detected in the cerebrospinal fluid. Despite the frequency of cytomegalovirus infections in transplant recipients, to our knowledge, only 9 cases of Guillain-Barré syndrome after transplantation have been reported and the exact mechanism remains to be ascertained. These two cases suggest that the onset of the Guillain-Barré syndrome after renal transplantation was closely related to cytomegalovirus infection. Adequate measures should be taken to quickly diagnose such cases in order to instore rapid treatment for the polyradiculoneuropathy. In addition, this particular situation of post-transplantation onset might help better understand the exact role of cytomegalovirus infection in the Guillain-Barré syndrome.

Cytomegalovirus Infections↗
PubMed1994

[Systemic embolism of cholesterol crystals].

Systemic cholesterol crystal emboli (SCCE) are no longer a rare complication of severe atheroma. Sixty-year old men, with many vascular problems are typically involved. SCCE, released from atheromatous ulcerated "plaques", invade one or more arteriolar beds. Clinical presentation is polymorphic: skin, muscle, kidney, digestive tract and other abdominal organs, retina, bone narrow ... may be embolized. SCCE are associated with triggering conditions: vascular surgery, anticlotting agents and fibrinolysis, femoral retrograd catheterization by radiologists or cardiologists. This last factor is presently predominant. Clinical signs depend on atheroma localization, intensity and repetition of embols and topography of arteriolar beds susceptible to be embolized: livedo reticularis, acute renal failure with high blood pressure, limbs or abdominal pain, periarteritis nodosa-like syndrome. Diagnosis is based on the discovery of ocular fundi (cholesterol crystals in arterioles) and evidence of cholesterol crystals in various biopsies: skin, muscle, kidneys. Prognosis and curative treatment are poor. Mortality is greater than 80% in systemic forms. Surgical palliative treatment was recently proposed (bypass). Prevention is essential: triggering manipulations i.e. retrograd femoral catheterism have to be avoided by radiologists or cardiologists in exposed patients. In high risk atheromatous patients symptomatic treatment including repetitive dialysis is able to induce significative survival.

Embolism, Cholesterol↗
PubMed1994

Henoch-Schönlein purpura in a patient with diabetic nephropathy.

A 46-year-old man presented with Henoch-Schönlein purpura and diabetic nephropathy. At 30 years of age, the patient had presented with an acute and severe nephritic syndrome with severe renal impairment. The renal function returned to normal 6 months after this first attack. At the age of 38 years, the patient was diagnosed as having type II diabetes and was treated with diet alone. At 44 years of age, a renal biopsy was performed because of proteinuria and hematuria. In this renal biopsy, mesangial expansion, medial arterial hyperplasia, and focal interstitial fibrosis were found to be present. Mesangial and subendothelial deposits of immunoglobulin A (IgA) were demonstrated by immunofluorescence. At 45 years of age, cutaneous vasculitis appeared, and at 47 years of age, the patient presented with necrotic purpura, non-insulin-dependent diabetes, renal impairment, proteinuria, and hematuria. A skin biopsy demonstrated leukocytoclastic skin vasculitis with IgA deposits in the arterial walls. A second renal biopsy was performed that showed diabetic glomerulosclerosis associated with a marked vascular and interstitial fibrosis. Mesangial and subendothelial deposits of IgA and C3 and linear IgG deposits along the glomerular basement membranes were demonstrated by immunofluorescence. Electron microscopy showed that the glomerular basement membranes were thickened; a fusion of foot processes was observed and electron-dense deposits were present in the widened mesangium. In summary, we describe a patient with a history of ancient glomerulonephritis who presented with an IgA mesangial nephropathy consistent with Henoch-Schönlein purpura associated with diabetic glomerulosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 2↗
PubMed1994

Renal functional reserve in cyclosporin-treated recipients of kidney transplant.

The aims of this study were to determine whether renal functional reserve (RFR) is still present in cyclosporin-treated renal transplant recipients, and to examine the relationship between RFR and proximal reabsorption. A serial study was carried out in 12 renal allograft recipients (R) with good renal graft function at 20 +/- 2.5 days (S1) and at 7.6 +/- 0.4 months (S2) post-transplantation, and the results were compared to those in eight subjects who had undergone unine-phrectomy (one-kidney controls: UNx.C) and in 12 healthy volunteers (two-kidney controls: 2K.C). R and C were in similar sodium and protein balance and with similar plasma renin and aldosterone levels. R had normal serum creatinine level on moderate doses of cyclosporin (whole blood cyclosporin concentration: 212 +/- 20 and 125 +/- 20 ng/ml at S1 and S2, respectively). Eight one-hour clearance periods were performed prior to, during and following a three-hour i.v. infusion of a mixture of 20 l-amino acids (Azonutril 25, 4.5 mg amino acids/kg/min). Baseline glomerular filtration rate (GFR) was lower in recipients at S1 and S2 (55 +/- 5 and 54 +/- 4 ml/min/1.73 m2, respectively) than in UNx.C and 2K.C (72 +/- 4 and 113 +/- 4 ml/min/1.73 m2, respectively, P < 0.05 and 0.001). Amino acid infusion elicited significant GFR increases in controls as well as in recipients in spite of higher renal vascular resistances (RVR). The greater measured increase in GFR, which represented RFR, was 18 +/- 3 and 28 +/- 2 ml/min/1.73 m2 in UNx.C and 2K.C, respectively (P < 0.001), and 17 +/- 3 ml/min/1.73 m2 in R at both S1 and S2 (P < 0.001). Contrary to both UNx and 2K controls, the acute hyperfiltration in R at S1 and S2 occurred with a significant increase in effective renal plasma flow, no alteration in filtration fraction and a large decrease (approximately 20 and 17%) in RVR while no correlation could be detected between the RFR and baseline GFR. Baseline lithium clearance, used as a marker of overall proximal fluid delivery (CLi), was significantly lower, whereas baseline fractional excretion of lithium (FELi) was significantly higher in R at S1 and S2 and in UNx.C (41 +/- 4, 40 +/- 3 and 38 +/- 3%, respectively) than in 2K.C (31 +/- 2%, P < 0.05). Consistent and significant increase in CLi, FELi and absolute proximal reabsorption occurred both in R at S1 and S2 and in UNx and 2K controls during elicitation of RFR.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

Pharmacokinetics of carboplatin in a patient suffering from advanced ovarian carcinoma with hemodialysis-dependent renal insufficiency.

Pharmacokinetics of carboplatin were determined in a patient suffering from advanced ovarian cancer with total hemodialysis-dependent chronic renal failure undergoing 3 consecutive cycles of chemotherapy. Dosage was adjusted to reach active AUC (area under the plasma concentration versus time curve) of ultrafilterable carboplatin. A hemodialysis, performed 24 h after administration results in a decrease of 20% of ultrafilterable carboplatin AUC. The relative dialysis efficacy of ultrafilterable carboplatin was great: 84 +/- 3%. The chemotherapy regimen consisted of carboplatin-cyclophosphamide combination for 6 cycles every 4 weeks. After treatment completion, the patient showed a complete response and remains disease free 16 months after the end of the treatment. Carboplatin-based chemotherapy can be given to patients undergoing chronic hemodialysis without life-threatening toxicity with a dialysis performed 24 h after the administration and with a dose adjustment of carboplatin to reach a AUC of 6 mg/ml.min for untreated patients. In these conditions, response in platinum-sensitive tumors can be obtained.

Aged↗
PubMed1994

Renal oncocytoma in transplant patients: report of 2 cases.

We report on 2 cases of renal oncocytoma occurring in a liver transplant patient and in a kidney allograft recipient, respectively, during the posttransplant period. This neoplasm has never been reported in transplant patients; its relationship with long-term immunosuppressive therapy is questioned.

Adenoma, Oxyphilic↗
PubMed1993

Immunolocalization of renal kallikrein-like substance in rat urinary bladder.

The renal origin of kallikrein is now clearly established. However, the presence of kallikrein in urine raises questions about a possible physiological role of this enzyme at the urinary level. We have already demonstrated the presence of kallikrein-like substance in rat ureter. For establishing the continuity of the presence of kallikrein-like substance along the urinary tract we have studied the localization of immunoreactive kallikrein-like substance in urinary bladder of the normal rat by immunohistochemical methods for light- and electron-microscopy, using an antibody against rat urinary kallikrein. By light microscopy, kallikrein-like substance was found to be associated with the lamina propria, which is the connective tissue component which constitutes one layer of the bladder wall. Weak staining was present in the smooth-muscle layer. By immuno-electron microscopy, kallikrein-like substance was localized in fibroblasts which were present in the connective tissue and which penetrated into the layer of smooth muscle; immunoreactivity was observed in endoplasmic reticulum, Golgi apparatus and free polyribosomes. Immunolabelling was demonstrated in no other part of the wall bladder and in no other cellular component. The continuity of the presence of kallikrein-like substance from the kidney to the urinary bladder gives new indications concerning the significance of this system in renal physiology.

Animals↗
PubMed1993

Renal immunolocalization of kallikrein in cisplatin nephrotoxicity in rats.

Treatment of rats with cisplatin (4 mg kg-1 body wt i.p. injection) induced variations of urinary kallikrein excretion (UKE). Three phases were observed: a transient increase of UKE one day after injection, followed by a decrease up to 10 days suggesting an altered biosynthesis and a recovery phase with return to normal control values, 21 days after injection. Early morphological lesions were observed in proximal tubule cells on day 1; severe changes and tubular necrosis were observed in the following days. Less marked changes were also present in distal tubules but the vacuolated and desquamated cells appeared in the lumen of the tubules. By immunocytochemical methods, kallikrein was observed in connecting tubule cells, but also in some proximal tubule cells and along the endothelial side of the glomerular basement membrane and urinary space of glomeruli. An intense labelling was present in desquamated epithelial cells in dilated lumen of tubules. This study provides evidence of the presence of immunoreactive kallikrein in the glomerulus, already reported during acute failure, and confirms the use of urinary kallikrein measurements as a useful non-invasive index to assess a possible nephrotoxic effect at the distal level.

Animals↗
PubMed1993

Renal biopsy in the elderly.

314 patients, aged 65 years or older, were biopsied because of a history of renal disease. In 203 patients, glomerular disease was diagnosed with one fourth having systemic disease and the remaining primary glomerulonephritis. 90 patients had tubulointerstitial disease, and 21 patients showed prominent vascular pathology. In a comparison with patients of younger age groups, it appeared that amyloidosis, membranous nephropathy, vasculitis and diabetes had a significantly higher incidence in the elderly. Main glomerular syndromes such as nephrotic syndrome and rapidly progressive glomerulonephritis imply to be managed appropriately. Glomerulosclerosis was found in high frequency, either as an isolated feature or associated with other lesions. Glomerulosclerosis seemed to be ischemic in origin and seems to represent a distinct entity as a cause of pathology in the elderly.

Age Factors↗
PubMed1993

Rapidly progressive glomerulonephritis associated with bacterial endocarditis: efficacy of antibiotic therapy alone.

A 65-year-old woman presented rapidly progressive glomerulonephritis with purpura and mitral insufficiency. Blood cultures grew Streptococcus mitis. By light microscopy, the renal biopsy revealed necrotizing glomerulonephritis 56% associated with cellular crescents and tubulointerstitial changes. By immunofluorescence, deposits of IgM and C3 were found to be present in the mesangium. Electron-microscopic study showed subendothelial and intramembranous deposits. Treatment with antibiotics alone resulted in renal recovery with disappearance of proteinuria, circulating immune complexes and cryoglobulinemia. A 2nd renal biopsy, performed after 3 months, showed segmental sclerosis and tubulointerstitial lesions. Eight months after the first hospitalization, cardiac insufficiency occurred. Four years later, a valve replacement was performed. No abnormal serum creatinine, serum creatinine clearance or urinalysis levels were present. These data suggest that rapidly progressive glomerulonephritis associated with bacterial endocarditis may be treated by antibiotics alone and result in normal and stable renal function.

Aged↗
PubMed1993

Renal morphological changes after sinoaortic denervation in dogs.

The present study investigates morphological renal lesions in sinoaortic-denervated dogs 1 (n = 6) and 18 (n = 5) months after sinoaortic denervation compared with sham-operated controls (n = 8). After 1 month, a marked hyalinization and moderate thickening of the media of arterioles and small interlobular arteries were observed. These changes associated with edema and intimal thickening led to a narrowing of the lumen. In glomeruli, increase of mesangial matrix was focally present in all cases and associated with mesangial proliferation. In four of six cases, some glomeruli appeared retracted, with a large urinary space. A focal area of interstitial fibrosis occurred in just one case. After 18 months, similar but more pronounced vascular lesions were present, with marked hyperplasia of the media. Glomerular changes were characterized by mesangial lesions associated with focal glomerular sclerosis and thickening of Bowman's capsule. Tubulointerstitial lesions were more prominent in this group, with the presence of tubular epithelial changes and casts. Focal interstitial fibrosis, infiltrates, or both were demonstrated in all cases. These morphological lesions were associated with an increase in arterial blood pressure, proteinuria, and natriuresis and a decrease in urinary kallikrein. These results show that chronic sinoaortic denervation in dogs is associated with renal lesions similar to those observed in other well-established experimental and clinical hypertensive states.

Animals↗