[Chronic kidney disease and antidiabetic treatment]. / Insuffisance rénale chronique et médicaments antidiabétiques.

Diabetic nephropathy is the leading cause of chronic renal failure (CRF) in Europe. About fifty percent of diabetic subjects develop microalbuminuria, which progresses towards established diabetic nephropathy in one third of patients. The treatment of type 2 diabetes in a patient with CRF is a challenge for the general practitioner, because of the accumulation of drugs and/or specific metabolites. Sulfonylureas are associated with an increased risk of hypoglycaemia. Biguanides may exceptionally cause life-threatening lactic acidosis. Glitazones have an interesting profile since they decrease microalbuminuria and blood pressure. However, their safety is not well defined in the context of CRF In the case of severe CRF, only insulin and repaglinide can be recommended.

[Hyponatremia: an unusual case report]. / Hyponatrémie: une histoire en deux temps....

Hyponatremia is a frequent finding and asks for a rapid diagnostic evaluation. We report a case of recurrent hyponatremia secondary to an adrenal insufficiency of medicamentous and tuberculous origin. This case illustrates the importance of a rapid etiologic diagnosis of hyponatremia and allows us to review adrenal insufficiency of tuberculous origin. It also stresses the danger of potential drug interactions in case of corticosteroid substitution.

Ontogeny of IGF-1 and the classical islet hormones in the turbot, Scophthalmus maximus.

The ontogeny of the endocrine pancreas of a teleost, the turbot (Scophthalmus maximus), was investigated by the use of double immunofluorescence. Clustered insulin (INS)-immunoreactive (IR) cells were observed on the first day after hatching. During the following days, the islet largely increased in size and some smaller islets appeared. All islets consisted only of INS-IR cells. Between day 5 (onset of exogenous feeding) and 7, somatostatin (SOM) and glucagon (GLUC) cells appeared. In the large (principal) islet, the SOM-IR cells intermingled with the INS-IR cells. In the secondary islets, they occurred at the periphery. The GLUC-IR cells were located at the periphery in all islets. Subsequently, two-four additional small principal islets appeared. At day 11, pancreatic polypeptide (PP)-IR cells were present in principal islets and secondary islets. Starting with day 11, in all islets, insulin-like growth factor 1 (IGF-1) immunoreactivity was localized in numerous PP-IR cells and GLUC-IR and some SOM-IR cells. It also occurred in enteroendocrine cells that seemed to contain none of the classical islet hormones. The early appearance of INS correlates with its key role in the regulation of fish protein and lipid metabolism. Islet-derived IGF-1 might inhibit the regulation of INS secretion in a paracrine manner and may be highly involved in growth-promoting processes.