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Biomedical subjects

M M Elseviers

Publications and source records attributed to M M Elseviers.

At least 37 records · Page 2Linked to original sources
PubMed1997

Prevalence and clinical expression of HCV-genotypes in haemodialysis-patients of two geographically remote countries: Belgium and Saudi-Arabia.

Hepatitis C virus is the leading cause of acute and chronic liver disease in hemodialysis patients. There are at least six major HCV-genotypes, with a well documented geographical distribution in the general population. Moreover, HCV-genotype is one of the major determinants of the therapeutic response to Interferon Alpha in affected patients. Since the therapeutic outcome in HCV-positive hemodialysis patients, especially with regard to the different HCV-genotypes, is of interest, a multicentre epidemiologic study was performed in HCV-antibody positive hemodialysis patients of two geographically remote countries, i.e. in Flanders (Belgium) and in Saudi-Arabia. 184 chronic hemodialysis patients, with a positive second or third generation Elisa assay for HCV, were tested for HCV-viremia and HCV-genotype, using a 5' untranslated region (UR) nested PCR for the detection of HCV-RNA and subsequently type-specific probes to hybridize with HCV-RNA (Inno-Lipa). Additionally, clinical data were collected by means of a standardized questionnaire, thoroughly completed by the nephrologist in charge of each respective patient. Viremia was present in 79% of the patients (146 out of 184). The prevalence of HCV-genotypes differed significantly between Belgian and Saudi-Arabian dialysis-patients. In Belgian dialysis patients HCV-genotype 1b was most prevalent (i.e. 62%), while in Saudi-Arabian patients HCV-genotypes 4, 1b, and la were present in respectively 36,4%, 31,7%, and 25,8% of the HCV-PCR positive patients. Although there were significant differences between Belgian and Saudi-Arabian dialysis patients, no clinical data showed any significant correlation with the HCV-genotype. Transaminases, determined over a six months period, showed normal average values. Doubling of the transaminases, in at least one out of six measurements over a six monthly period, occurred only in 14% (alanine aminotransferase, ALT) and 10% (aspartate aminotransferase, AST) of the patients. In Belgian dialysis patients, HCV-genotype 4 (or HCV-genotype 5) significantly correlated with a more recent start of dialysis treatment. We conclude that there is a significant different geographical prevalence of HCV-genotypes in HCV-affected hemodialysis patients. None of the different HCV-genotypes shows any particular clinical expression. Transaminases are not a sensitive marker for ongoing HCV-replication in hemodialysis patients. In Belgian dialysis patients, a changing pattern of HCV-infection is suggested, with an increasing prevalence of HCV-genotype 4 (or HCV-genotype 5) in more recent years. These data suggest possible implications for the therapeutic strategy in dialysis patients.

Adult↗
PubMed1996

Combination analgesic involvement in the pathogenesis of analgesic nephropathy: the European perspective.

Analgesic nephropathy (AN) is a chronic renal disease characterized by renal papillary necrosis and interstitial nephritis caused by excessive consumption of analgesic mixtures. In a recent study, diagnostic criteria for AN, based on a computed tomography scan investigation without contrast, were presented. The observation of a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications was found to have a high diagnostic performance. Although several case control studies and two prospective studies demonstrated the association between analgesic abuse and nephropathy, the nephrotoxicity of the different analgesic products had not been clearly established. Analgesic abuse can be defined as a daily consumption of analgesic mixtures over a several-year period. Abuse of single analgesics is rare; it has been clearly demonstrated that abusers prefer analgesic mixtures. In Belgium, the prevalence of AN was positively related to the sales of analgesic mixtures containing two analgesic components plus caffeine and/or codeine. This relationship could not be observed for analgesics containing only one analgesic component plus caffeine and/or codeine. Moreover, during a European multicenter study, nephrotoxicity of different combinations of analgesic mixtures (all containing caffeine and/or codeine) could be documented in the absence of any previous phenacetin consumption. Epidemiologic observations in Sweden, France, and Belgium regarding incidence of AN, sales figures of analgesics, and legislative measurements concerning analgesic consumption supported the previous observations.

Analgesics↗
PubMed1996

Occupational renal diseases.

There is no doubt that particular occupational exposures may induce acute renal effects. The role of occupational exposure in the development or progression of chronic renal failure, however, is still not clear. Recent epidemiological studies point towards a contributive role of particular occupational exposures in the progression of renal disease. Furthermore, some observations in the 1994-1995 literature suggest a primary or secondary role, or both, of new substances such as silicon-containing compounds in the development of anti-neutrophil cytoplasmic antibody-positive rapidly progressive glomerulonephritis and Wegener's granulomatosis. Finally, studies suggesting a particular sensitivity of the diabetic kidney towards the damaging effects of certain occupational exposures deserve confirmation.

Humans↗
PubMed1996

Incidence of analgesic nephropathy among patients undergoing renal replacement therapy in Czech Republic and Slovak Republic. The Group of Czech and Slovak Nephrologists.

BACKGROUND: The occurrence of analgesic nephropathy (AN) among renal replacement therapy patients in former Czechoslovakia is not known. Previous surveys were not based on representative samples and lacked uniform criteria for diagnosing the disease. METHODS: Incidence of AN in former Czechoslovakia was investigated in patients commencing renal replacement therapy in 24 (1/3 of all) dialysis centres from 1 January to 31 December 1992. Patients showing an unclear renal diagnosis (n = 149) were investigated with an interview and renal imaging techniques. The diagnosis of AN was withheld or rejected on the base of recently published diagnostic criteria demonstrating that a decreased renal mass of both kidneys combined with bumpy contours and/or papillary calcifications had a high performance for diagnosing AN (Nephrol Dial Transplant 1992; 7: 479-486). RESULTS: Based on the renal imaging criteria, AN was diagnosed in 30 of 328 registered patients, resulting in an AN incidence of 9.1% while the EDTA data only mentioned an incidence of 4.8% (period 1986-1989). The products most commonly abused were analgesic mixtures containing two analgesic substances combined with caffeine and/or codeine. CONCLUSIONS: AN was found to be a common disease in the Czech and Slovak Republics. The disease was diagnosed using reliable renal imaging criteria.

Adolescent↗
PubMed1996

Development and validation of new screening tests for nephrotoxic effects.

Within the framework of an European Commission-funded project, groups of industrial workers exposed to heavy metals (cadmium, mercury and lead) or solvents were studied together with corresponding control groups. Eighty-one measurements were carried out on urine and serum samples and the scientific results together with individual questionnaire information were entered into a central database. Data obtained was assessed centrally and individually in subsidiary studies. The measurable contributions were assessed either singly or in combination, of smoking, gender, metal exposure and site, to nephrotoxicity. The potential value of each test as an indicator of nephrotoxicity was then assessed on the basis of sensitivity and specificity. A number of new tests including prostaglandins and for extracellular matrix components were investigated as well as established tests for renal damage and dysfunction. The data obtained from this comprehensive study emphasises the value of noninvasive biomarkers for the early detection of nephrotoxicity due to environmental toxins. The urinary profile varied with the type of environmental/occupational toxin. By careful selection of a small panel of markers they can be used to indicate the presence of renal damage, the principal region affected, and to monitor the progress of disease and damage. Biomarkers were also used to confirm and tentatively establish safe exposure levels to nephrotoxins.

Biomarkers↗
PubMed1995

New occupational risk factors for chronic renal failure.

Occupational pollutants may have a role in development of chronic renal failure (CRF). Most epidemiological studies have been cross-sectional, limited to certain renal diagnoses, or concentrated on early transient renal effects. In a case-control study, we examined the association between CRF and occupational exposure. Occupational histories of 272 men and women with CRF (of all types) were compared with those of 272 controls matched for age, sex, and region of residence. Exposures were assessed and degree and frequency were scored independently by three industrial hygienists unaware of case/control status. Significantly increased risks of CRF were found for exposure to lead (odds ratio 2.11 [95% CI 1.23-4.36]), copper (2.54 [1.16-5.53]), chromium (2.77 [1.21-6.33]), tin (3.72 [1.22-11.3]), mercury (5.13 [1.02-25.7]), welding fumes (2.06 [1.05-4.04]), silicon-containing compounds (2.51 [1.37-4.60]), grain dust (2.96 [1.24-7.04]), and oxygenated hydrocarbons (5.45 [1.84-16.2]). The frequencies of various occupational exposures were high among patients with diabetic nephropathy. This epidemiological study confirms previously identified risk factors and suggests that additional occupational exposures, for which there is some other experimental evidence, may be important in the development of CRF. The role of grain dust and the association between occupational exposure and diabetic nephropathy merit further investigation.

Adult↗
PubMed1995

High diagnostic performance of CT scan for analgesic nephropathy in patients with incipient to severe renal failure.

Recently, well performing diagnostic criteria for analgesic nephropathy in end-stage renal failure (ESRF) patients were defined by the demonstration of a bilateral decrease in renal volume combined with either bumpy contours or papillary calcifications. In this study, the diagnostic value of computed tomography (CT) scan was compared to the previously used renal imaging techniques (sonography and conventional tomography). In a first study, a cohort of 40 analgesic abusers (defined as daily use of analgesic mixtures during at least 5 years) and 40 controls, all ESRF patients without a clear renal diagnosis, were investigated with sonography, tomography and CT scan without injection of iodinated contrast material, to search for the imaging signs of analgesic nephropathy. Using CT scan, sonography and tomography, renal size could be evaluated with comparable results while CT scan was superior in the detection of papillary calcifications (sensitivity 87%, specificity 97%). In a second controlled study of 53 analgesic abusers with a serum creatinine between 1.5 to 4 mg/dl in the absence of a clear renal diagnosis, a CT scan was performed and scored for the presence of decreased renal volume, bumpy contours and papillary calcifications. It was found that the renal image of analgesic nephropathy on CT scan in an early stage of renal failure is comparable with the observations made in ESRF patients. Particularly the demonstration of papillary calcifications showed a high sensitivity of 92% with a specificity of 100% for the early diagnosis of analgesic nephropathy.

Aged↗
PubMed1995

A long-term prospective controlled study of analgesic abuse in Belgium.

In 1991, Dubach et al clearly demonstrated an increased risk of renal morbidity and mortality after phenacetin abuse in middle aged working women. We investigated the renal effects of the abuse of several kinds of analgesics in abusers of different sex and age categories. A cohort of 200 active analgesic abusers (age range 21 to 86 years) and 200 matched controls was followed for seven years (1984 to 1992). Subjects were visited at home once a year for a short interview and a medical examination. Renal function showed a significant decrease over time in controls as well as in abusers (P < 0.001). The decrease was, however, significantly more pronounced in abusers (P < 0.001). The development of a decreased renal function was observed in 12 abusers and 2 controls resulting in a relative risk of 6.1 (95% CI: 1.4 to 25.9). Subjects showing a decreased renal function underwent a diagnostic investigation. Using validated diagnostic criteria, analgesic nephropathy could be established in 6 out of the 10 abusers who had a diagnostic workup, in the absence of any other form of renal disease.

Adolescent↗
PubMed1995

Wegener granulomatosis is associated to exposure to silicon compounds: a case-control study.

Wegener granulomatosis is a rare disease of unknown aetiology. In the majority of these patients the kidney is involved in the disease process. We performed a case-control study to evaluate the role of occupational exposure in the development of Wegener granulomatosis with renal involvement. The occupational histories of 16 cases with clearly established diagnosis of Wegener granulomatosis with renal involvement were compared with those of 32 age- and sex-matched controls. It was observed that inhalation of silicon-containing compounds such as silica and grain dust gave a nearly sevenfold risk for Wegener granulomatosis. Further epidemiological and experimental work needs to be performed in order to corroborate these findings.

Adult↗
PubMed1995

Evaluation of diagnostic criteria for analgesic nephropathy in patients with end-stage renal failure: results of the ANNE study. Analgesic Nephropathy Network of Europe.

It was found that in Belgium, renal imaging techniques, demonstrating a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications, were the only methods to reliably diagnose analgesic nephropathy (AN) in patients with end-stage renal failure. However, these criteria were selected in an area with a high prevalence of this disease (15.6% of the dialysis population at December 1990). To evaluate the criteria selected to diagnose AN in populations with lower or unknown prevalences of AN, the Analgesic Nephropathy Network of Europe (ANNE) was formed, consisting of 23 dialysis units from 14 European countries and Brazil. During 1991-1992, 598 new patients with equivocal diagnosis of renal disease (excluding biopsy-proven glomerulonephritis, polycystic disease, diabetic nephropathy and other systemic diseases) and who began renal replacement therapy in the ANNE centres were evaluated by a short questionnaire and two renal imaging techniques: sonography and either tomography or computed tomography (CT) scan. A comparison of 82 abusers (daily use of analgesic mixtures for at least 5 years) and 495 controls corroborated the excellent diagnostic performance of the renal imaging techniques for AN. We recommend the use of these renal imaging criteria in all patients without a clear renal diagnosis in order to obtain a more reliable insight into the magnitude of the AN problem in different countries.

Adult↗
PubMed1995

Impact of legislative measures on the sales of analgesics and the subsequent prevalence of analgesic nephropathy: a comparative study in France, Sweden and Belgium.

In a number of European countries (e.g. Belgium), analgesic nephropathy continues to be a highly prevalent renal disease, whereas in other countries (e.g. Sweden) the problem has been resolved after legislative measures were taken. In still other countries, e.g. France, the official prevalence of analgesic nephropathy has always been low. The aim of the present study is to detect whether specific legislation in particular countries has played a role in the prevalence of analgesic nephropathy. Hence, we compared analgesic legislation in Belgium, France and Sweden, and then compared it with the respective sales data of non-narcotic analgesics and with the prevalence data of analgesic nephropathy in the dialysis population. Each investigated country represents a different evolution pattern in the prevalence of analgesic nephropathy. This study indicates that legislation restricting the over-the-counter availability of the majority of analgesic components and resulting in the absence of analgesic mixtures--containing two analgesic substances and one potentially addictive substance--on the market, has effectively resulted in a substantially lower prevalence of analgesic nephropathy. Moreover, it shows that permissive legislation could be associated with very different sales data, depending on the marketing strategy of the pharmaceutical industry and the subsequent purchasing behaviour of the population. These findings indicate that, in order to eradicate analgesic nephropathy, there is a need to elaborate legislation that prohibits the availability of analgesic mixtures containing two analgesic components and at least one potentially addictive substance.

Analgesics↗
PubMed1994

Analgesic nephropathy in Belgium is related to the sales of particular analgesic mixtures.

Analgesic nephropathy, a chronic progressive renal disease induced by the abuse of drugs containing analgesics and potentially addictive substances (e.g. caffeine, codeine), continues to be a serious problem in Belgium. A recent investigation (1990) of Belgian dialysis patients, including 54 of the 55 dialysis centres, established that 15.6% of the patients had analgesic nephropathy, showing a small decrease in prevalence compared to the 1979 and 1984 estimates. Considerable changes were observed in the sales figures of analgesic during the period 1983-1991. Phenacetin completely disappeared from the market and single analgesics, particularly paracetamol, gained large market shares. The total sales of single analgesics slowly increased, whereas the sales of analgesic mixtures decreased from 12.5 million to 8 million packages per year. In recent years the composition of most analgesic mixtures has been reduced to a single analgesic component in combination with caffeine and/or codeine. In comparing the geographical distribution of the sales of different analgesic products (1983) with the prevalence of analgesic nephropathy (1990), a strong correlation could be observed with particular analgesic mixtures, whereas this was not the case with single analgesics. This observation suggests that a careful analysis of sales data showing a high volume of analgesic mixtures sold, containing two analgesic substances combined with potentially addictive components, is a pharmacoepidemiological indicator for the presence of analgesic nephropathy in a given population.

Adult↗