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1.
Rev Med Suisse ; 20(863): 436-440, 2024 Feb 28.
Artigo em Francês | MEDLINE | ID: mdl-38415730

RESUMO

Kidney stone is one of the most frequent disorders of the urinary tract. Once the stone has passed, the management should be oriented on prevention. If changes in lifestyle and diet should be implemented in a true therapeutic education of the patient, prescription of drugs has been recently challenged by the NOSTONE trial. This randomized controlled trial did not show any benefit of hydrochlorothiazide in the prevention of recurrence of kidney stone event in patients with calcium-containing stone. Therefore, prescription of thiazide in the sole purpose of decreasing kidney stone recurrence should be limited and the risk/benefit of this treatment should be carefully balanced for each case.


La maladie rénale lithiasique est une des affections les plus fréquentes de l'axe urinaire. Une fois l'expulsion du calcul obtenue, la prise en charge est orientée sur la prévention. Si les modifications diététiques et comportementales doivent être implémentées dans le cadre d'une véritable éducation thérapeutique, la prescription de traitements médicamenteux préventifs est remise en question par l'étude NOSTONE. Cette étude randomisée contrôlée n'a pas montré de bénéfice de l'hydrochlorothiazide dans la prévention de la récidive des calculs à contenu calcique. Dès lors, la prescription de thiazide en monothérapie dans le but de diminuer les récidives de calculs doit être limitée et le risque/bénéfice soigneusement évalué dans chaque cas.


Assuntos
Cálculos Renais , Humanos , Hidroclorotiazida/uso terapêutico , Cálculos Renais/prevenção & controle , Estilo de Vida , Prescrições , Tiazidas , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Rev Med Suisse ; 19(821): 680-685, 2023 Apr 05.
Artigo em Francês | MEDLINE | ID: mdl-37017350

RESUMO

Anti-glomerular basement membrane disease is a rare disease. In its classical presentation it associates rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage, linked to the presence of antibodies targeting type IV collagen in the glomerular and alveolar basal membrane. Anti-GBM disease warrants prompt medical management to limit permanent kidney damage and mortality. Treatment includes plasma exchanges to quickly remove pathogenic antibodies and immunosuppressants to stop their production. This article reviews the pathogenesis and current treatments.


La maladie des anticorps anti-membrane basale glomérulaire (anti-MBG) est une entité rare. Dans sa présentation classique, elle associe une glomérulonéphrite rapidement progressive et une hémorragie alvéolaire diffuse liée à des anticorps dirigés contre le collagène de type IV des membranes basales glomérulaire et alvéolaire. Les pronostics rénal et vital sont engagés. Le traitement doit être prompt et comprend des plasmaphérèses visant à éliminer les anticorps pathogéniques ainsi qu'une immunosuppression destinée à supprimer leur production. Cet article passe en revue la pathogénie et les traitements actuels.


Assuntos
Doença Antimembrana Basal Glomerular , Humanos , Doença Antimembrana Basal Glomerular/diagnóstico , Doença Antimembrana Basal Glomerular/terapia , Autoanticorpos , Hemorragia/etiologia , Imunossupressores/uso terapêutico
3.
Rev Med Suisse ; 19(821): 674-679, 2023 Apr 05.
Artigo em Francês | MEDLINE | ID: mdl-37017349

RESUMO

Within the group of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides, granulomatosis with polyangiitis (GPA) is the most frequent. The incidence is around 10 to 20 cases/million/year. Clinical manifestations are varied, with ENT, lungs and kidneys most frequently involved. ANCA are pathogenic by triggering neutrophil activation, which leads to vascular damage. Detection of ANCA is most helpful in establishing the diagnosis, but serology may be negative in GPA limited to the airways. Diagnostic work-up and therapy require a multidisciplinary approach. Treatment includes an induction and maintenance phase, combining corticosteroids and immunosuppressive drugs. It aims at limiting the risk of relapses, which is important in GPA, and at reducing corticosteroids toxicity.


La granulomatose avec polyangéite (GPA) fait partie des vasculites associées aux anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA). La maladie touche principalement la sphère ORL, les poumons et les reins. Son incidence est de 10 à 20 cas/million/année. Les ANCA sont pathogéniques en induisant une activation des polynucléaires neutrophiles, entraînant des lésions endothéliales. Le diagnostic est facilité par la détection des ANCA, qui peuvent cependant être absents dans les formes ORL limitées. La prise en charge est multidisciplinaire. Le traitement comprend une phase d'induction et une autre de maintien de la rémission, associant corticostéroïdes et immunosuppresseurs. L'objectif du traitement est de limiter le risque important de rechute et de réduire la toxicité des corticostéroïdes.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Granulomatose com Poliangiite , Humanos , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/terapia , Granulomatose com Poliangiite/complicações , Anticorpos Anticitoplasma de Neutrófilos/uso terapêutico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Imunossupressores/uso terapêutico , Corticosteroides/uso terapêutico
4.
Blood ; 136(19): 2103-2117, 2020 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-32808006

RESUMO

Pregnancy and postpartum are high-risk periods for different forms of thrombotic microangiopathy (TMA). However, the management of pregnancy-associated TMA remains ill defined. This report, by an international multidisciplinary working group of obstetricians, nephrologists, hematologists, intensivists, neonatologists, and complement biologists, summarizes the current knowledge of these potentially severe disorders and proposes a practical clinical approach to diagnose and manage an episode of pregnancy-associated TMA. This approach takes into account the timing of TMA in pregnancy or postpartum, coexisting symptoms, first-line laboratory workup, and probability-based assessment of possible causes of pregnancy-associated TMA. Its aims are: to rule thrombotic thrombocytopenic purpura (TTP) in or out, with urgency, using ADAMTS13 activity testing; to consider alternative disorders with features of TMA (preeclampsia/eclampsia; hemolysis elevated liver enzymes low platelets syndrome; antiphospholipid syndrome); or, ultimately, to diagnose complement-mediated atypical hemolytic uremic syndrome (aHUS; a diagnosis of exclusion). Although they are rare, diagnosing TTP and aHUS associated with pregnancy, and postpartum, is paramount as both require urgent specific treatment.


Assuntos
Proteína ADAMTS13/metabolismo , Complicações na Gravidez/fisiopatologia , Microangiopatias Trombóticas/diagnóstico , Microangiopatias Trombóticas/terapia , Gerenciamento Clínico , Feminino , Humanos , Agências Internacionais , Gravidez , Relatório de Pesquisa , Microangiopatias Trombóticas/etiologia , Microangiopatias Trombóticas/metabolismo
5.
Rev Med Suisse ; 18(771): 370-378, 2022 Mar 02.
Artigo em Francês | MEDLINE | ID: mdl-35235260

RESUMO

High level albuminuria and the nephrotic syndrome are pathognomonic of glomerular renal disease and must be distinguished from other high-level proteinuria. Causes of the nephrotic syndrome are numerous and its clinical significance requires diagnostic rigor to propose targeted treatment and prevent possible complications and renal functional decline. A nephrotic syndrome can also be an early expression of potentially severe non-renal medical conditions. It should be considered in any patient with edema, regardless of age and comorbidities.


L'albuminurie de fort débit et le syndrome néphrotique sont pathognomoniques d'une atteinte rénale glomérulaire et doivent être distingués des autres protéinuries de fort débit. Les causes du syndrome néphrotique sont nombreuses et sa signification clinique impose une rigueur diagnostique afin de proposer un traitement ciblé et de prévenir d'éventuelles complications et un déclin fonctionnel rénal. Un syndrome néphrotique peut être aussi l'expression plus ou moins précoce d'affections médicales non rénales éventuellement sévères et évolutives. Il faut donc y penser chez tout patient qui présente des œdèmes, quels que soient son âge et ses comorbidités.


Assuntos
Nefropatias , Síndrome Nefrótica , Albuminúria/complicações , Albuminúria/etiologia , Humanos , Rim , Síndrome Nefrótica/complicações , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/terapia , Proteinúria/complicações , Proteinúria/etiologia
8.
Rev Med Suisse ; 16(N° 691-2): 842-844, 2020 Apr 29.
Artigo em Francês | MEDLINE | ID: mdl-32348049

RESUMO

During the actual pandemic of COVID-19, it has become clear that the virus causing this devastating disease, SARS-CoV2, targets not only the lungs but also other organs. In this article, we discuss the known or suspected interactions between the virus and the kidneys, as well as their clinical presentations. We also discuss how the pandemic has altered the activities of nephrologists and the logistics of a Swiss dialysis center.


Au cours de la pandémie de COVID-19, nombre de spécialistes se questionnent sur les interactions du virus avec différents tissus et organes au-delà de l'atteinte pulmonaire. Pour diverses raisons, l'effervescence a aussi gagné le néphrologue. Ce bref article présente les différents aspects de l'interaction virus-rein, l'impact de la pandémie sur les activités néphrologiques et tente de répondre à quelques questions d'actualité.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Nefropatias , Rim/virologia , Pandemias , Pneumonia Viral/complicações , COVID-19 , Infecções por Coronavirus/diagnóstico , Humanos , Nefropatias/virologia , Nefrologistas , Pneumonia Viral/diagnóstico , SARS-CoV-2
9.
Rev Med Suisse ; 16(716): 2272-2278, 2020 Nov 25.
Artigo em Francês | MEDLINE | ID: mdl-33237645

RESUMO

Rhabdomyolysis is defined by myalgia, potentially painful myoedema and muscular weakness due to death of muscular fiber in the striated muscle. Frequent etiologies include physical effort, intoxication (alcohol, drugs and medication) and physical trauma. Depletion of myocyte' s adenosine triphosate (ATP) leads to an increase in intracellular calcium and myocyte death. Diagnosis relies on creatine kinase (CK) levels. The clinical spectrum of rhabdomyolysis includes an asymptomatic increased amount of CK as well as severe, life threatening complications such as acute renal failure and electrolyte disorders. Treatment is based on prevention and addressing complications.


La rhabdomyolyse, définie comme étant les conséquences de la destruction du muscle strié, se caractérise par l'association de myalgies, d'un myo-œdème éventuellement douloureux et d'une faiblesse musculaire. Parmi les étiologies fréquentes, on peut citer l'effort, les causes toxiques (alcool et médicament) et traumatiques. Elle résulte d'un épuisement de l'adénosine triphosphate du myocyte, menant à une augmentation du calcium intracellulaire et à sa destruction. Le diagnostic repose sur le dosage de la créatine kinase (CK). Le spectre de la rhabdomyolyse englobe une élévation asymptomatique des CK, mais aussi des complications redoutables telles qu'une insuffisance rénale aiguë sévère ou des troubles électrolytiques pouvant mettre en jeu le pronostic vital. Le traitement est centré sur la prévention et la prise en charge de ces complications.


Assuntos
Rabdomiólise/complicações , Rabdomiólise/terapia , Prevenção Secundária , Injúria Renal Aguda/complicações , Injúria Renal Aguda/prevenção & controle , Humanos , Músculo Esquelético , Mialgia/complicações , Rabdomiólise/diagnóstico , Rabdomiólise/prevenção & controle
10.
Rev Med Suisse ; 16(683): 399-403, 2020 Feb 26.
Artigo em Francês | MEDLINE | ID: mdl-32129016

RESUMO

Recently, comprehension of immune mechanisms involved in anti-tumor responses has permitted the development of new oncologic drugs called immune checkpoint inhibitors. These drugs act by restoring anti-tumor responses. With their increasing use, we note a rise in the incidence rate of immune related adverse events, which can affect many organs. Renal toxicity, more precisely tubulointerstitial nephritis, is still not well understood but an emerging complication.


Récemment, la compréhension des mécanismes immuns impliqués dans la réponse antitumorale a permis de développer de nouveaux traitements oncologiques, les inhibiteurs de points de contrôle immunitaires. L'action de ceux-ci repose sur une rupture des mécanismes de tolérance immune envers la tumeur. Avec leur développement, on observe l'apparition d'effets indésirables d'un nouveau genre, s'apparentant à une autoimmunité et touchant différents systèmes. La toxicité rénale, sous la forme d'une néphrite tubulo-interstitielle, est une complication encore méconnue mais émergeante.


Assuntos
Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Nefrite Intersticial/induzido quimicamente , Humanos
11.
Rev Med Suisse ; 16(684): 451-454, 2020 Mar 04.
Artigo em Francês | MEDLINE | ID: mdl-32134224

RESUMO

In the face of hypertriglyceridemia, the potential causes must be assessed to choose the best medical therapeutic option. In cases of secondary hypertriglyceridemia, physicians should use treatments targeting the pathophysiological mechanisms underlying the lipid disorder. Lifestyle interventions are the cornerstone of an effective treatment, to achieve controlled glycemia, blood pressure and weight loss. Only in cases where these measures are insufficient, fibrates can be trialed although their clinical benefit is controversial, with special caution when combined with statins (risk of rhabdomyolysis). Plasmapheresis or intravenous insulin therapy are only used in severe situations after a multidisciplinary decision process in the hospital setting. The clinical case presented here reminds us to assess hypertriglyceridemia in the face of any acute pancreatitis.


Les causes d'une hypertriglycéridémie doivent être explorées pour choisir la meilleure approche thérapeutique. En cas d'hypertriglycéridémie secondaire, il est préférable de cibler le mécanisme physiopathologique du désordre lipidique. Les mesures hygiéno-diététiques restent la clé de voûte du traitement, pour atteindre un bon contrôle glycémique, tensionnel et pondéral. Uniquement en cas d'échec, les fibrates peuvent être évoqués bien que leur bénéfice clinique soit controversé, avec une attention particulière en cas de bithérapie par statine et fibrate (risque de rhabdomyolyse). La plasmaphérèse ou l'insulinothérapie intraveineuse sont réservées aux situations sévères et décidées avec les différents spécialistes en milieu hospitalier. Le cas clinique présenté ici est un rappel que l'hypertriglycéridémie devrait être recherchée devant toute pancréatite aiguë.


Assuntos
Hipertrigliceridemia/complicações , Hipertrigliceridemia/terapia , Pancreatite/complicações , Doença Aguda , Humanos , Insulina/administração & dosagem , Insulina/uso terapêutico , Plasmaferese
13.
Rev Med Suisse ; 15(639): 427-431, 2019 Feb 20.
Artigo em Francês | MEDLINE | ID: mdl-30785675

RESUMO

Prescribing intravenous fluids in a hospital setting is a task that each clinician has to endorse in an everyday practice. This task is universal to the point that it is often undervalued, or even neglected during clinical teaching. However, one shouldn't underestimate the risks related to excessive fluid administration, of which the clinician often doesn't know the exact composition. Literature about persistent fluid overload in hospital is scarce. This complex condition should however be given the attention it deserves. Indeed, it seems to be associated with increased costs and an excess in morbidity and even mortality.


La prescription des solutions hydroélectrolytiques est une tâche dont tout médecin clinicien en milieu hospitalier doit s'acquitter. Cette tâche est à tel point universelle qu'elle est malheureusement souvent banalisée, voire négligée au cours de l'enseignement clinique. Pourtant, on ne saurait sous-estimer les risques associés à une administration excessive de solutions dont le contenu précis est souvent mal connu du prescripteur. Même si la littérature sur le sujet de l'hypervolémie persistante à l'hôpital est rare, celle-ci est associée à une augmentation des coûts et à un excès de morbidité, voire de mortalité.


Assuntos
Hidratação , Humanos , Infusões Intravenosas , Pacientes Internados
14.
Rev Med Suisse ; 14(626): 2025-2029, 2018 Nov 07.
Artigo em Francês | MEDLINE | ID: mdl-30422423

RESUMO

Acid-base disorders, and metabolic acidosis in particular, are frequently encountered in critical care typically in shock states, metabolic diseases decompensations or intoxications. Their systematic and careful evaluation frequently helps identifying underlying disease and guide clinical management. In most instances, therapy should focus on the underlying disease. Symptomatic treatment of metabolic acidosis is controversial and rarely indicated. This review focuses on the main causes of metabolic acidosis and their diagnostic approach.


Les troubles acido-basiques et l'acidose métabolique (AM) en particulier sont très fréquemment rencontrés aux soins intensifs, notamment dans les états de choc, les décompensations de maladies métaboliques ou les intoxications. L'analyse systématique et minutieuse de ces anomalies permet souvent d'orienter le diagnostic de la maladie sous-jacente et de guider la prise en charge clinique. Le traitement est généralement celui de la cause sous-jacente. Le traitement symptomatique de l'AM est, par contre, largement controversé et rarement indiqué. Cet article propose de rappeler les différentes causes d'AM et leur approche diagnostique.


Assuntos
Acidose , Cuidados Críticos , Choque , Humanos
15.
BMC Nephrol ; 18(1): 81, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-28249613

RESUMO

BACKGROUND: Regional citrate anticoagulation (RCA) is proposed for various extracorporeal purification techniques to overcome the risk of bleeding that might result from systemic anticoagulation. Yet, no individualized treatment protocol has been proposed for therapeutic plasma exchange (TPE) so far. The objective of this study was to assess the determinants of blood citrate concentration needed and to develop an individualized RCA protocol useful for clinical practice. METHODS: The study population included 14 patients who underwent a total of 47 TPE sessions. Citrate was infused pre-plasmafilter. Post-plasmafilter and systemic plasma ionized calcium concentrations were measured at standardized time intervals. An algorithm was proposed for the supplementation of calcium. During the discovery phase, citrate was infused at a fixed starting rate, and adapted accordingly to obtained post-plasmafilter ionized calcium levels. Using a mathematical approach, an algorithm was thereafter developed for individualized prescriptions of citrate. RESULTS: Pre-treatment values of hematocrit and plasma ionized calcium were the main determinants of the required rate of citrate infusion. These can be integrated into a final equation enabling to individualize the prescription. A prefilter ionized calcium concentration between 0.24 and 0.33 mmol/l prevented coagulation of the extracorporeal circuit. Significant hypocalcemia occurred in 8.5% of treatments. There were no significant acid-base disturbances. CONCLUSION: We propose a new protocol, which enables for the first time to individualize the prescription of regional citrate anticoagulation during TPE, in an efficient manner. The immediately obtained regional anticoagulation protects against both the risk of coagulation of the membrane and the exposure to an excess of citrate.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Anticoagulantes/administração & dosagem , Cálcio/administração & dosagem , Ácido Cítrico/administração & dosagem , Rejeição de Enxerto/terapia , Hemorragia/prevenção & controle , Troca Plasmática/métodos , Microangiopatias Trombóticas/terapia , Adulto , Idoso , Algoritmos , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Rev Med Suisse ; 13(551): 462-467, 2017 Feb 22.
Artigo em Francês | MEDLINE | ID: mdl-28714647

RESUMO

During the last ten years, significant advances have been made in the field of monoclonal gammopathy-associated renal diseases. These have consisted in a better recognition of their pathological and clinical significations and correlation. Furthermore, therapeutic advances have allowed improving the prognosis of B-cell monoclonal proliferations and of the related renal complications. In the peculiar case of the multiple myeloma with severe renal failure requiring dialysis, one can now expect better survival and chance of recovering renal function.


Au cours des dix dernières années, la prise en charge des maladies rénales associées aux gammapathies monoclonales a connu d'importants progrès. Ceux-ci ont consisté en une caractérisation pathologique plus précise des lésions rénales et une meilleure compréhension de leur signification clinique. En parallèle, les progrès thérapeutiques des proliférations monoclonales de la cellule B ont permis d'améliorer le pronostic de celles-ci et des atteintes rénales associées. Dans le cas particulier du myélome multiple, les patients souffrant d'insuffisance rénale sévère peuvent aujourd'hui bénéficier, avec peu de restrictions, de plusieurs nouveaux traitements efficaces. Cela autorise de meilleurs espoirs de survie et de récupération de la fonction rénale.


Assuntos
Nefropatias/etiologia , Nefropatias/terapia , Paraproteinemias/complicações , Paraproteinemias/terapia , Humanos
18.
Rev Med Suisse ; 12(507): 393-7, 2016 Feb 24.
Artigo em Francês | MEDLINE | ID: mdl-27039604

RESUMO

Many conditions can lead to acute renal failure. Some of them are intrinsic renal diseases whose natural history cannot be anticipated. On the other hand, others correspond to external aggressions driven by various hemodynamic or toxic events. To some extent, these can be partially prevented by relatively simple measures. The recognition of these situations which may benefit from a preventive strategy can significantly reduce morbidity or mortality associated with the incidence of acute renal failure.


Assuntos
Injúria Renal Aguda/prevenção & controle , Serviços Preventivos de Saúde/métodos , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Meios de Contraste/efeitos adversos , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/epidemiologia , Traumatismo por Reperfusão/complicações , Traumatismo por Reperfusão/epidemiologia
19.
Rev Med Suisse ; 12(507): 398-403, 2016 Feb 24.
Artigo em Francês | MEDLINE | ID: mdl-27039605

RESUMO

Nephrology emergencies are not the most frequent in the emergency room but they often generate some diagnostic and therapeutic problems. Most common renal emergencies are due most often to acute renal failure whatever the cause, electrolytes disturbances, hypertensive crisis and less frequently intoxications or acute decompensation of chronic kidney diseases. The goal of this paper is to review some of these clinical situations both in the diagnostic and therapeutic perspective but essentially to discuss when the nephrologist should be called in the emergency room so that the coordination of care is optimal for the patients.


Assuntos
Emergências , Serviço Hospitalar de Emergência , Encaminhamento e Consulta , Insuficiência Renal/terapia , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Hiperpotassemia/terapia , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Insuficiência Renal/complicações , Insuficiência Renal/diagnóstico , Índice de Gravidade de Doença , Recursos Humanos
20.
Kidney Int ; 98(1): 232, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32437769

Assuntos
Coronavirus , Rim
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