[Muscular metastases from renal cell carcinoma]. / Métastases musculaires des carcinomes à cellules rénales.

Renal cell carcinoma can metastasize to several locations but rarely in muscles. However, this possibility must never be overlooked because muscle metastases may occur a very long time after the initial nephrectomy. So the post-operative follow-up, according to the recommendations, with thoraco-abdomino-pelvic imaging (computed tomography or nuclear magnetic resonance) allowing to detect metastases, including muscle metastases in the trunk, does not have to neglect the metastases located in the members. This search is based upon a thorough clinical examination, completed by targeted imaging in case of symptoms and/or palpable mass.

[Watermelon stomach: Chronic renal failure and/or imatinib?]. / Watermelon stomach : insuffisance rénale chronique et/ou Glivec(®) ?

Watermelon stomach or gastric antral vascular ectasia (GAVE) syndrome is an uncommon cause of sometimes severe upper gastro-intestinal bleeding. Essentially based on a pathognomonic endoscopic appearance, its diagnosis may be unrecognised because mistaken with portal hypertensive gastropathy, while treatment of these two entities is different. Its etiopathogeny remains still unclear, even if it is frequently associated with different systemic illnesses as hepatic cirrhosis, autoimmune disorders and chronic renal failure. The mechanism inducing these vascular ectasia may be linked with mechanical stress on submucosal vessels due to antropyloric peristaltic motility dysfunction modulated by neurohormonal vasoactive alterations. Because medical therapies are not very satisfactory, among the endoscopic modalities, argon plasma coagulation seems to be actually the first-line treatment because the most effective and safe. However, surgical antrectomy may be sometimes necessary. Recently GAVE syndrome appeared as a new adverse reaction of imatinib mesylate, one of the tyrosine kinase inhibitors used in chronic myeloid leukemia, and we report here the observation of such a pathology in one patient treated at the same time by haemodialysis and by imatinib mesylate for chronic myeloid leukemia.

[Crystalluria in ethylene glycol intoxication]. / La cristallurie dans l'intoxication à l'éthylène glycol.

When seen, some habits of calcium oxalate monohydrate crystals (whewellite) are so typical of ethylene glycol intoxication that they may be helpful for its diagnosis when circumstances are not clearly established.

[Bariatric surgery, calcium oxalate urinary stones and oxalate nephropathy]. / Chirurgie bariatrique, lithiase oxalo-calcique et insuffisance rénale par néphropathie oxalique.

Bariatric surgery is now recognized as a sure and effective way for weight reduction in morbid obesity. However some procedures induce intestinal malabsorption leading to enteric hyperoxaluria. So bariatric surgery could place these patients not only at risk for nephrolithiasis but also for oxalate induced nephropathy and chronic renal failure. Because of the growing incidence of obesity worldwide, physicians and patients should be aware of such potential complications. There is no mean to discuss this treatment because of its spectacular efficiency on obesity and its comorbidities. But it is necessary to choose the surgical technique according to the risk factors of the patients. Following surgery, preventive treatment strategies are indicated, such as modified dietary lifestyle and specific drugs as we suggested to limit or even avoid these complications. However observance could fail in the long term. In case of oxalate nephropathy, surgery may be proposed to restore the intestinal tract but with the risk of overweight relapse. To illustrate this matter, we report here significant observations of three patients, which, having successfully benefited from the same bariatric surgery, have presented lithiasic complications for two of them and oxalate nephropathy leading to chronic renal failure and hemodialysis for the third.

[Use of fondaparinux during hemodialysis in heparin-induced thrombocytopenia. About a new observation]. / Intérêt du fondaparinux (Arixtra(®)) en hémodialyse dans les thrombopénies induites par l'héparine de type II (TIH II). À propos d'une nouvelle observation.

Several alternative anticoagulation drugs are now available for patients with heparin induced thrombocytopenia type II (HIT II). However, their indication is not yet reaching a consensus. Moreover, some of them have not yet their marketing approval. The importantly use in hemodialyzed patients should be taken with caution since most of them are excreted by the kidneys. The use of fondaparinux, which exerts high anti-Xa activity, is not well documented. We report here our experience on the use of fondaparinux in an hemodialyzed patient with HIT II, not only as anticoagulation during hemodialysis sessions but also as interdialytic anticoagulation locking solution of her central venous catheter. The use of fondaparinux seems to us simple enough (even if its ready-for-use syringe requires adjustments to deliver the required doses) and its efficacy, safety and economic cost lead us to think that it is an indication of choice for an alternative anticoagulation in hemodialyzed patients with HIT II. Control prospective trials should be performed in order to confirm the preliminary favourable data and to support the proposal of marketing approval in this indication.

[Renal diseases in cystic fibrosis]. / Mucoviscidose et rein.

Patients with cystic fibrosis (CF) show a continuing improvement in their life expectancy thanks to advances in knowledge of this disorder, allowing better multidisciplinary routine monitoring and earlier therapeutic interventions. Likewise, more than of 40% of these patients are adults and CF is no more only a pediatric disease. Due to their higher life expectancy, CF patients present new and unusual complications that were not recorded before. Among them, some renal disorders have to be added to the CF-related renal diseases. They are due to frequent and prolonged exposure to various potentially nephrotoxic factors that need to be taken into account early enough in order to avoid renal failure : essentially risk factors for kidney stones formation, bacterial infections with their associated immune complexes diseases, nephrotoxic effects of antibiotics, diabetes mellitus. Because we observed a case of IgA glomerulonephritis in a 35-year-old patient with cystic fibrosis, we have searched about all these renal consequences due to this affection and here report them.

[Ophthalmic manifestations in Wegener's granulomatosis. Review of literature about an observation]. / Manifestations ophtalmologiques de la granulomatose de Wegener. Revue de la littérature à propos d'une observation.

Wegener's granulomatosis mainly affects the upper respiratory tract, the lungs and the kidneys but many other organs and tissues may be affected, as well including any eye structures. Ocular and orbital structures involvement is frequently encountered, sometimes inaugural, with or without obvious systemic manifestations, sometimes leading to visual loss. The most frequent ophthalmic lesions are inflammatory orbital disease, (necrotising) scleritis with or without keratopathy, episcleritis, conjunctivitis and even conjunctival ulcer, nasolacrimal ducts obstruction, uveitis, retinal vasculitis and even central retinal vascular occlusion, optic neuritis. These ocular lesions result either from extensive granulomatous inflammation or from focal vasculitis. These complications need to be recognized as soon as possible so that an early diagnosis may allow the appropriate treatment meant to keep both visual and even general prognosis.

[Digestive adverse effects due to sodium polystyrene sulfonate (Kayexalate) in dialysis patients]. / Complications digestives du polystyrène sulfonate de sodium (Kayexalate) (KXL) chez le dialysé

Administered to reduce hyperkaliema in patients with chronic renal failure, sodium polystyrene sulfonate (Kayexalate) can cause digestive complications. The most severe complication could be the intestinal necrosis or perforation. In the present report, we evoke these complications and illustrate them with some pictures from personal observations.

[A rare cause of peripheral edema: exudative lymphocytic gastritis induced hypoprotidemia]. / Une cause rare d'oedèmes: l'hypoprotidémie de la gastrite lymphocytaire exsudative.

Diagnosis of edema secondary to hypoprotidemia but without nutritional, renal, hepatic or cardiac cause, must consider exudative digestive disease, of which the lymphocytic gastritis, as the authors report here a new observation diagnosed in a 73 year-old woman. Gastroscopy reveals varioliform gastritis and biopsy demonstrates diffuse infiltration of the gastric epithelium by lymphocytes, making of it a real histopathologic entity among the gastropathies. Etiology and pathogeny remain still unknown but proton pump gastric inhibitors are an effective treatment.

[HemoCue: preliminary considerations about its use in hemodialysis]. / Réflexions préliminaires à l'utilisation de l'HemoCue en hémodialyse.

HemoCue Hb 201+ is a portable photometric analyser providing easy, rapid and accurate determination of hemoglobin from arterial, venous or capillary blood. It is worth that dialysis units have knowledge of its use for a close hematologic monitoring of their patients and a judicious management of erythropoietin (EPO). For the autodialysis <> centers, it allows a flexibility that private laboratories cannot have in daily practice. Therefore authors present this device and the evaluation they obtained from 148 hemoglobin measures. Then they expose the advantages and the indications of its use.

[Dental problems and their management in uraemic patients]. / Pathologie buccodentaire et sa prise en charge chez les insuffisants rénaux chroniques.

Bad dental status is very often observed in hemodialyzed patients due to the fact of a frequent poor oral hygiene and, in addition of the traditional risk factors, the consequences of uraemic state and its treatment. However , among such immunodepressed patients, oral and dental lesions represent a risk of septic complications. Moreover some works point out the prevalence of inflammation and denutrition due to dental lesions in the uraemic population, with potential atherosclerosis. Therefore, in order to anticipate all these adverse effects and to restore their mouth to health, patients have to be encouraged to have regularly a full dental evaluation and correction if not elimination of all potential sources of infection and other complications. To ensure the best treatment, a close collaboration has to be established with dental practitioners who must be aware and convinced of the complexity of such patients: immunodepression due to uraemic state and sometimes to drug therapy; importance of prophylactic antibiotic therapy surrounding dental cares; cautions to hemostasis circumstances; adjusted use of some medications. To illustrate this matter, we report here a study involving 96 hemodialyzed patients who were investigated by panoramic radiography and clinical cross- examination about their dental complaints and habits. We then expose our practices and detail our collaboration with their dentists in establishing a plan of dental treatment.

[Be careful in using flecainide by hemodialyzed patients]. / Attention à l'emploi de la flécaïnide chez l'hémodialysé.

Cardiac arrhythmias are frequent by hemodialyzed patients and may lead to the prescription of antiarrhythmic drugs among which flecainide. However there is for this latter a wide interindividual variability in the dose-plasma concentration relationship because of a genetically controlled polymorphic metabolism. That explains why it is not possible to adjust dose only to renal clearance. It becomes even more difficult at hemodialysis stage, especially if hepatic insufficiency and/or certain medications join to it. So this antiarrhythmic drug has to be cautiously initiated and plasma concentrations have to be carefully monitored to avoid side effects, sometimes crippling as in our observation, sometimes as cardiac complications.

[Fungal sinusitis from endodontic origin. Some reflexions about an observation by an hemodialyzed patient]. / Sinusites fongiques d'origine dentaire. A propos d'une observation chez un hémodialysé chronique.

About an observation of aspergillus sinusitis in an hemodialyzed patient, correlation between chronic maxillary sinusitis, its aspergillus origin and previous dental treatments is emphasized. Eventual severe complications then evolved in immunocompromised patients justify having the knowledge of this possible pathology in hemodialyzed and transplanted patients.

[Renal lesions in tuberous sclerosis]. / Atteinte rénale dans la sclérose tubéreuse.

Renal tumours, in tuberous sclerosis, are mainly benign and correspond to angiomyolipomas, multiple and bilateral, sometimes enormous with an hemorrhagic risk, frequently associated with cysts of variable size and number and seldom with high metastatic carcinomas. Chronic renal failure is rare and related to focal glomerulosclerosis secondary to hyperfiltration due to nephronic reduction owing to surgery or to tumour invasion, in particular cysts. Data about 65 patients with tuberous sclerosis and chronic renal failure were collected thanks to a national survey. They were females in 63.1% of cases, with a mean age of 29, 2 years at the time of the diagnosis of tuberous sclerosis, revealed in near half of cases by renal involvement. There were angiomyolipomas in 23.1% of cases, cysts in 18.5%, both in 53.8% and malignancies in 12.3%. All but one of the 48 patients with end stage renal failure were treated by dialysis; 20 were transplanted, with good results.

[Fluoroquinolone induced acute renal failure. General review about a case report with crystalluria due to ciprofloxacin]. / Les insuffisances rénales aiguës aux quinolones. Revue générale à propos d'une observation avec cristallisation liée à la ciprofloxacine.

A 58 year-old woman developed an acute renal failure very quickly after ingestion of two 500 mg tablets of ciprofloxacin, without any other identifiable risk factor. Renal biopsy was performed. No sign of acute interstitial nephritis was observed but tubular lesions were found, accompanied by deposits of a brown-yellowish substance identified by infrared microscopy as a ciprofloxacin salt. The outcome was favourable. This observation gives the opportunity to remind the different forms of quinolone-induced renal injury and to discuss the possible ways for preventing renal side-effects related to the quinolone use.

[Tumorlike muscular sarcoidosis with hypercalcemia and acute renal failure]. / Pseudotumeur musculaire avec hypercalcémie et insuffisance rénale aiguë révélant une sarcoïdose.

At the end of assessment of an hypercalcemia with acute renal failure in a seventy year-old man, is discovered a tumorlike muscular sarcoidosis of both thighs whose steroid treatment quickly proves effective. Rarity of such forms urges us to report this observation which allows to remind that, in case of a suggestive picture of sarcoidosis, it is necessary to look minutely for any muscular abnormality.