Brain natriuretic peptide variations are linked to volume status in hemodialysis patients.

AIMS: To evaluate the usefulness of monthly brain natriuretic peptide (BNP) dosage in assessing dry weight in hemodialysis patients. PATIENTS AND METHODS: Over a 2-year period, we performed in 46 hemodialysis patients monthly BNP level measurements, and adapted dry weight following the determination of variations in BNP concentrations for each month during the study period. Then we tested our approach by looking for a statistical relation between monthly alterations in BNP levels and monthly variations in the patients' weight, blood pressure, hemoglobinemia and albuminemia which are in themselves related to fluid status variations. RESULTS: Monthly BNP level variations were found to be positively correlated with monthly end-dialysis weight alterations (r = +0.24, p < 0.001), with monthly systolic and diastolic blood pressure variations before dialysis (r = +0.09, p < 0.001; r = +0.24, p < 0.001), and with systolic and diastolic blood pressure changes after dialysis (r = +0.09, p = 0.001; r = +0.25, p < 0.001). Moreover, monthly BNP level variations were negatively correlated with monthly hemoglobinemia changes (r = -0.17, p = 0.004) and with monthly albuminemia alterations (r = -0.14, p = 0.001). CONCLUSION: In a non-selected population of hemodialysis patients it was found that monthly BNP level variations were positively correlated with monthly volume status alterations as evaluated by clinical and biological criteria. BNP appears to be a useful tool for dry weight assessment despite the absence of a standardized cut-off point for BNP levels in hemodialysis patients.

Pulmonary-renal syndrome due to hemorrhagic fever with renal syndrome: an unusual manifestation of puumala virus infection in France.

The authors report about a patient who presented with acute respiratory failure, bilateral alveolar infiltrates, without signs of fluid overload, and acute renal failure. Percutaneous renal biopsy revealed acute interstitial nephritis with medulla hemorrhages. Serologic tests for Puumala virus infection were positive. Hemorrhagic fever with renal syndrome should be considered when patients present with pulmonary-renal syndrome.

[Endocrine hypertension in pregnancy]. / Hypertensions artérielles endocriniennes au cours de la grossesse.

Hypertension is a frequent complication of pregnancy and may compromise fetal and maternal outcome. Hypertension may be pregnancy-induced, essential or secondary to endocrine disorders. Most cases of endocrine hypertension are the consequence of adrenal diseases. Pheochromocytoma, hypercorticism, primary aldosteronism or glucocorticoid-remediable aldosteronism can be present or diagnosed at any term and may cause severe hypertension. The most hazardous form of endocrine hypertension during pregnancy is pheochromocytoma because it may involve paroxysmal arrhythmia and/or hypertension during labor. Clinical clues and biological tests are similar to those used in non-pregnant subjects. Tests for tumor location are limited to ultrasound and magnetic resonance scans in order to avoid maternal and fetal irradiation. Medication to prepare for pheochromocytoma surgery uses alpha- and beta-blockers. The timing of surgery depends on the term of pregnancy at the diagnosis of the tumor.

[Management of atherosclerotic renal artery stenoses]. / Prise en charge des sténoses athéroscléreuses des artères rénales.

Patients with atherosclerotic renal artery stenosis may develop hypertension, recurrent pulmonary edema and chronic renal failure, but have a much higher risk of dying from stroke or myocardial infarction than of progressing to end-stage renal disease. Indeed, atherosclerotic renal artery stenosis typically occurs in high risk patients with coexistent vascular disease elsewhere. Recent controlled trials comparing medication to revascularization have shown that only a minority of such patients can expect hypertension cure, whereas the results of trials designed to document the ability of revascularization to prevent progressive renal failure are not yet available. Revascularization should be undertaken in patients with atherosclerotic renal artery stenosis and resistant hypertension or heart failure, and probably in those with rapidly deteriorating renal function or with an increase in plasma creatinine levels during angiotensin-converting enzyme inhibition, especially if their renal resistance--index before revascularization is less than 80. With or without revascularization, medical therapy using antihypertensive agents, statins and aspirin is necessary in almost all cases.