Epidemiology of end-stage renal failure in Reunion Island (results from the registry of the Indian Ocean Society of Nephrology).

BACKGROUND: End-stage renal disease (ESRD) on long-term dialysis is a substantial problem in Reunion because of the high incidence and prevalence of this disease due to non-insulin-dependent diabetes mellitus (NIDDM) and systemic arterial hypertension. SUBJECTS AND METHODS: In 1996 the renal study group of the Indian Ocean Society of Nephrology established a regional registry of end-stage renal failure (ESRD) on long-term dialysis. The present report summarizes data obtained from this registry. RESULTS: In 1996, there were 125 patients who were initiated on long-term dialysis, 657 patients on dialysis with a mean age 52 +/- 17 years, and 110 patients with a functioning kidney graft. The incidence rate of ESRD was 188 per million population (p.m.p.) and the prevalence rate of this pathology was 1155 p.m.p. The sex ratio (F/M) was 1.4/1. The two most common causes of ESRD were NIDDM in 33.6% and systemic arterial hypertension in 27.5%. The mean Kt/V value was 1.47 +/- 0.23 and the mortality rate was 8.1% per year. CONCLUSION: The results demonstrate high incidence and prevalence rates of ESRD mainly as a result of NIDDM and systemic arterial hypertension.

High-dose alfacalcidol improves anaemia in patients on haemodialysis.

BACKGROUND: Alfacalcidol is efficient for treating secondary hyperparathyroidism in patients on maintenance haemodialysis (HD). Little is known about the direct impact of high-dose alfacalcidol on anaemia in end-stage renal failure. We therefore carried out a prospective study over 18 months to examine the direct effect of high-dose alfacalcidol on erythropoiesis in erythropoietin (rHuEpo)-dependent anaemic patients on HD for more than 6 months with moderate hyperparathyroidism. STUDY DESIGN: Twelve patients received oral alfacalcidol at a dosage of 6-7 micrograms per week and calcium carbonate during the first 12 months, calcium carbonate without alfacalcidol during the next 3 months, and again alfacalcidol and calcium carbonate during the last 3 months. Criteria for selection were haemoglobin < 10 g/dl, iPTH > 250 pg/ml, transferrin saturation (TS) > 25%, S-ferritin > 300 micrograms/l, and S-aluminium < 40 micrograms/l. RESULTS: Haemoglobin (Hb) and reticulocyte counts increased during the first phase, decreased and returned to a baseline prior to starting vitamin D treatment in the second phase, and again increased when alfacalcidol was reintroduced, whereas iPTH decreased during the first 3 months of the first phase and then remained stable, as did S-calcium, which increased during the first 3 months and then remained constant. S-phosphate increased during the first and third phases, and decreased during the second phase. Two patients during the first phase and one patient during the third phase presented hypercalcaemia; requiring a temporary discontinuation of alfacalcidol. CONCLUSION: High-dose alfacalcidol is efficient in anaemic patients with moderate hyperparathyroidism on maintenance HD and has a direct effect on erythropoietic cells regardless of serum calcium and iPTH levels.

Splice-mediated insertion of an Alu sequence in the COL4A3 mRNA causing autosomal recessive Alport syndrome.

Alport syndrome is a mainly X-linked hereditary disease of basement membranes characterized by progressive renal failure, deafness, and ocular lesions. The alpha 3(IV) and alpha 4(IV) collagen genes have been recently shown to be involved in the less frequent autosomal recessive form. When screening lymphocyte COL4A3 mRNAs from Alport patients, we found a mutant whose transcripts were disrupted by a 74 bp insertion at the junction of exons IV or V and VI. The insertion derives from an antisense Alu element in COL4A3 intron V, which has been spliced into the alpha 3(IV) mRNA due to a G to T transversion activating a cryptic acceptor splice site in this Alu element. There is complete segregation of this mutation with the disease in the family. Our findings provide the first evidence for the pathogenic role of abnormal splicing of COL4A3. Moreover, we demonstrate the superiority of mutation screening at the mRNA level to detect a hitherto poorly recognized mutation mechanism in humans, splice-mediated insertion of an Alu fragment into a coding sequence.

[Temporary vascular access in Reunion]. / Abord vasculaire temporaire à la Réunion.

The high proportion of diabetic patients is partly responsible for the high frequency of chronic renal failure in Reunion. The confection and maintenance of an arterio-venous fistule is a major problem in those patients. We report herein our experience with temporary vascular access by internal jugular vein catherization with subcutaneous tunnelization using silastic catheters. The mean duration of utilisation of these accesses is 107 days for diabetic patients and 98 days for nondiabetic patients. The major complication observed is sepsis (18.36%). Diabetes mellitus which represent a traditional risk factor does not seem to be responsible here, the climatic and hygienic conditions prevailing in this part of the world could be a contributing factor. Nevertheless, we find the utilisation of these catheters a suitable solution during the waiting period because it is an easy operation, of the good quality of the material used and the comfort brought to the patient.

[Voluntary chloralose poisoning]. / Intoxication volontaire par le chloralose.

The authors report 114 cases of acute poisoning by rodenticides (chloralose). The clinical symptoms associate coma, myoclonic jerks and bronchorrhea. Metabolic acidosis is a common finding. Despite the initial gravity, the prognosis of chloralose intoxication is excellent, provided that a symptomatic treatment is instituted early.