Hemoglobin level variability in hemodialysis patients treated with epoetin-ß during 1 year.

AIM: This analysis was performed to assess the prevalence and the factors associated with hemoglobin (Hb) variability during treatment with erythropoiesis-stimulating agents (ESA) in France. METHODS: Hb variability was evaluated in a subgroup of hemodialysis (HD) patients of the French cohort DiaNE. Eligible patients had received epoetin-ß at least 6 months before entering DiaNE, 12 months during DiaNE and had no missing monthly Hb measurements. Up and down excursions (Hb variations > 1.5 g/dl with duration > 8 weeks) were assessed. RESULTS: Of the 499 patients evaluated in this analysis, 295 (59%) had Hb levels inside the target range of 11 - 13 g/dl at baseline. The number of patients with constantly stable Hb level inside the target range decreased from baseline to 27.5% at 6 months and 10.8% at 12 months. More than 70% of patients experienced Hb variability. The number of excursions was 1.7 ± 0.8 per patient/year. The amplitude of up excursions was 2.8 ± 1.0 g/ dl with a duration of 14.7 ± 4.7 weeks. The amplitude of down excursions was 2.6 ± 0.9 g/dl with a duration of 14.5 ± 4.6 weeks. The main factors associated with Hb variability were number of epoetin-ß dose changes, adverse events and iron therapy changes. CONCLUSION: Hb variability is frequent in French ESA-treated HD patients and closely related to practices. Further efforts are needed to improve anemia management.

[Treatment of an asthmatic patient on dialysis and awaiting transplantation with anti-IgE]. / Traitement par anti-IgE d'un patient asthmatique, dialysé et greffé.

INTRODUCTION: Omalizumab, a monoclonal antibody to IgE, is a possible treatment for severe, uncontrolled allergic asthma. CASE REPORT: A severe asthmatic patient with renal insufficiency and on dialysis was awaiting transplantation. The asthma was uncontrolled with poor respiratory function. He received anti IgE treatment with omazilumab with immediate clinical improvement and his renal transplant was performed satisfactorily. CONCLUSION: Anti-IgE treatment can improve severe, uncontrolled allergic asthmatic patients allowing, in this case, transplantation without further respiratory problems.

Nephrotic syndrome associated with chronic lymphocytic leukemia: an immunological and pathological study.

Three patients with B chronic lymphocytic leukemia and the nephrotic syndrome had atypical membranous glomerulonephritis or lobular membranoproliferative glomerulonephritis with subepithelial and subendothelial deposits containing IgG1 kappa, IgG1 lambda or IgM and IgG by immunofluorescence, respectively. A monoclonal cryoglobulin was intermittently found in the serum in one case. In two patients, kidney deposits were made of organized microtubular structures. Intracytoplasmic immunoglobulin inclusions in the two patients' lymphocytes showed a very similar electron microscopic pattern. The immunologic phenotype of leukemic lymphocytes was analogous in the three cases (with expression of CD2) and suggestive of a late maturation step. A complete remission of the nephrotic syndrome was observed after therapy with chlorambucil (and prednisone). These observations suggest a direct role of monoclonal immunoglobulins in kidney disease.

[The nephrotoxicity of the methicillin-gentamycin combination. Apropos of 5 cases]. / La néphrotoxicité de l'association méthicilline-gentamycine. A propos de 5 observations

Interstitial nephritis with acute renal failure was observed in 5 cases out of 6 treated by the association of methicillin and gentamycin, wheras no case, was observed when each of these antibodies was used separately. The mechanisms which might explain the potentialisation of these two drugs are discussed.

Pheochromocytoma in a long-term hemodialysis patient.

A right adrenal tumor was found incidentally by renal echography in a 25-year-old man, who had been on hemodialysis for 4 years. Inquiry and clinical examination suggested pheochromocytoma, which was confirmed by plasma catecholamine measurements. Subsequent adrenalectomy was uneventful. Although hypertension, headache, and diaphoresis are common symptoms in a dialyzed patient, pheochromocytoma has to be eliminated in the presence of this clinical triad.

[Acute renal failure in the course of occupational lead intoxication. Chelation therapy responsability (author's transl)]. / Insuffisance rénale aiguë au cours d'un saturnisme professionnel. Responsabilité du traitement chélateur.

In a patient with occupational plumbism and a normal kidney function, EDTA therapy (1 g/24 h) resulted in a massive lead excretion (15 000 microgram/24 h) together with acute renal failure. A direct nephrotoxic effect of EDTA was excluded: after renal function returned to normal, EDTA could be subsequently readministered at progressively increasing doses (250 mg to 1 g/24 h) without any renal dysfunction. These findings strongly suggest a close relationship between the burden of lead mobilized by EDTA and the acute renal failure. This case can be classified as acute lead nephropathy of which only a few instances have been reported in the literature. The interest of monitoring lead excretion during chelation therapy is particularly emphasized.

Renal involvement in Behçet's disease. Case report and review of the literature.

A female patient has suffered from Behçet's disease (BD) for 15 years. During one recurrent episode proteinuria and microscopic hematuria were discovered. Renal biopsy revealed focal segmental glomerulopathy with IgA deposits. Renal involvement in BD is uncommon and includes amyloidosis, crescentic glomerulonephritis and IgA nephropathy. BD is a cause of secondary IgA nephropathy. Immunologic features of the two diseases, particularly increased serum IgA, are reviewed.