A clinicopathologic study of thrombotic microangiopathy in IgA nephropathy.

Thrombotic microangiopathy (TMA) occurs in IgA nephropathy, but its clinical significance is not well described. We retrospectively examined a series of 128 patients diagnosed with IgA nephropathy between 2002 and 2008 who had a mean follow-up of 44±27 months. In our series, 53% presented with lesions of TMA, acute or organized, in arteries and/or arterioles. Among patients with TMA, 4% were normotensive, 25% had controlled hypertension, and 71% had uncontrolled hypertension. Of those with uncontrolled hypertension, 26% had malignant hypertension. Histologically, the group with TMA had a significantly greater percentage of sclerotic glomeruli and worse tubulointerstitial fibrosis than those of the group without TMA. However, a significant minority of patients had near-normal histology, with minimal tubular atrophy (20%) and/or <20% interstitial fibrosis (24%). TMA rarely occurred in the absence of significant proteinuria. During follow-up, a doubling of serum creatinine or ESRD occurred in all patients with laboratory evidence of TMA, in 42% of those with morphologic evidence but no laboratory evidence of TMA, and in 11% of those without TMA. In summary, lesions of TMA are frequent in IgA nephropathy and may occur in normotensive patients with near-normal renal histology. Although the pathophysiologic mechanisms involved remain undetermined, the current study rules out severe hypertension or advanced renal disease as sole causes.

Renal biopsy practice in France: results of a nationwide study.

BACKGROUND: Although several risk factors associated with complications after renal biopsy (RB) have been identified, the gold standard for RB procedures remains to be defined. Practices vary widely among nephrologists, depending on personal experience and the availability of particular techniques. The purpose of our study was to depict the main aspects of the practice of RB in adults in France. METHODS: Members of the Société de Néphrologie in France were asked to participate in a questionnaire survey on RB procedures. RESULTS: Eighty-eight nephrologists from 74 units (27 in teaching hospitals, 35 in public general hospitals and 12 in private centres) participated in our study. Native kidney and graft biopsies were performed in 73 and 35 units, respectively. RB activity was highly variable among units, ranging from several hundred to <10 per year. Transjugular renal biopsy was judged to be smoothly accessible in 28 out of 73 units (38.4%). Significant variations in practices were observed regarding patient information before RB, assessment of haemorrhagic risk factors, management of patients with antiplatelet agents and haemorrhagic risk factors, and radiological guidance. Early discharge (<12 h) was the rule in 3 (4.1%) units for native kidney biopsies and in 10 (28.6%) units for graft biopsies. CONCLUSIONS: Our study is the first to provide a representative picture of 'everyday' RB practices in a country. Important variations in procedures were observed. Our study may represent a preliminary step for the elaboration of guidelines for all aspects of RB practices.

[Position statements regarding usage of biosimilars of Epoetins. Position paper of the Société de néphrologie, Société francophone de dialyse, and Société de néphrologie pédiatrique]. / Recommandations d'utilisation des biosimilaires de l'érythropoïétine (EPO). Propositions de la Société de néphrologie, de la Société francophone de dialyse et de la Société de néphrologie pédiatrique.

The European patents for epoetin alpha recently expired. Biosimilars (i.e. "a medicine which is similar to a biological medicine that has already been authorized" [EMEA 2007]) of epoetins have thus been released on the market in Europe. Because of the complexity of the processes that are required to produce medicinal products containing biotechnology-derived proteins as active substances and to characterize the physicochemical properties of these compounds, the guidelines that have been developed for generic drugs cannot be used for approval of biosimilar products. The EMEA guidelines do not answer all questions that have been raised for the development of biosimilars, and in some cases, decisions will have to be taken at a national level. This is why the Society of Nephrology (Société de néphrologie), the French-speaking Society of Dialysis (Société francophone de dialyse) and the Pediatric Society of Nephrology (Société de néphrologie pédiatrique) established guidelines for the usage of biosimilar epoetins concerning approval, identification, substitution of an innovator drug, post-marketing surveillance, extension of indication and pharmacovigilance plan.

[Choice of a dialysis method for patients with kidney failure]. / Choix d'une méthode de dialyse par les malades insuffisants rénaux.

The principal options for treatment of end-stage renal disease are hospital, out-center, self-or home hemodialysis or continuous ambulatory or automated peritoneal dialysis. Hemodialysis and peritoneal dialysis were long considered competitive methods, but they have become complementary and the same patient can use them successively at different life stages. The choice of technique usually depends on family, personal, social and work factors, rather than the medical situation. The healthcare team provides guidance to the patient in making this choice. The choice of treatment is optimal when the referral is early.

[Efficacy and acceptability of rilmenidine in a population of 2 738 hypertensive diabetic patients]. / Efficacité et acceptabilité de la rilmenidine dans une population de 2 738 hypertendus diabétiques.

CONTEXT: Despite the constant enrichment of the pharmacopoeia, the normalizing of blood pressure in hypertensive diabetic patients remains difficult. OBJECTIVE: To assess the efficacy and acceptability of rilmenidine in first intention in hypertensive diabetics. METHODS: In a population of 18 235 hypertensive patients, the sub-population of diabetic patients was followed-up in an open study over one year. These patients were initially treated with 1 mg/day of rilmenidine with the possibility of adapting the dose - increasing to 2 mg/d and association with a second or even third anti-hypertensor, left to the discretion of the physician - when the diastolic blood pressure remained strictly greater than 90 mmHg. RESULTS: The complete blood pressure data over a period of 12 months were obtained in 2 311 patients out of 2 738 (84.4%). After 12 months' treatment, 75.9% of the 2 311 patients were normalized by the monotherapy with rilmenidine (diastolic blood pressure<90 mmHg according to the recommendations in force at the time of the study). The clinical acceptability was good and comparable to that obtained in the general population of 18 235 hypertensive patients. The biological parameters remained stable. CONCLUSION: This pharmaco-epidemiological assessment demonstrates, in conditions of current practice, the anti-hypertensive efficacy and acceptability of rilmenidine in hypertensive diabetics, therefore confirming its place in the therapeutic arsenal of these patients.

[Renal biopsy practice: results of a French study and recommendations]. / Pratique de la biopsie rénale: résultat d'une enquête en France, revue de la littérature et recommandations.

BACKGROUND: Although several risk factors associated with complications after renal biopsy (RB) have been identified, recommendations for RB procedures are still lacking. Our working group, appointed by the scientific commission of the Société de néphrologie in France, aimed to depict the main aspects of the practice of RB in adults in France, before establishing some guidelines. METHODS: Members of the Société de néphrologie in France were asked to participate to a questionnaire survey on RB procedures. RESULTS: Eighty-eight nephrologists from 74 units (27 in teaching hospitals, 35 in public general hospitals, and 12 in private centers) participated in our study. Native kidney and graft biopsies were performed in 73 and 35 units, respectively. RB activity was highly variable among units, ranging from several hundred to less than ten per year. Transjugular RB was judged to be smoothly accessible in 28 out of 73 units (38.4%). Significant variations in practices were observed regarding patient information before RB, assessment of hemorrhagic risk factors, care of patients with antiplatelet agents and hemorrhagic risk factors, and radiological guidance. Early discharge (<12 hours) was the rule in three (4.1%) units for native kidney biopsies and in ten (28.6%) units for graft biopsies. CONCLUSIONS: Our study is the first to provide a representative picture of "everyday" RB practices in a country. Consensual recommendations on all points mentioned are provided here.