[Surgical treatment for primary aldosteronism]. / Rôle de la chirurgie dans l'hyperaldostéronisme primaire.

Primary aldosteronism is the most common cause of secondary hypertension in the middle-aged population. A high level of suspicion is required, due to the higher morbidity and mortality associated with damage to target organs (heart, brain, vessels, kidneys) than with essential hypertension. Screening involves 3 phases: detection, confirmation and detection of lateralization if surgery is an option. The choice of treatment will depend on the cause and the patient's wishes and may be either medical (mineralocorticoid receptor antagonists) or surgical (unilateral adrenalectomy). Both treatment options reduce the risk of cardiovascular morbidity and mortality if blood pressure is well controlled.

L'hyperaldostéronisme primaire est la cause la plus fréquente d'hypertension artérielle secondaire dans la population d'âge moyen. Un haut niveau de suspicion doit être de mise en raison d'une morbimortalité liée aux atteintes d'organes cibles (cœur, cerveau, vaisseaux, reins) plus élevée que lors d'hypertension artérielle essentielle. Le dépistage se fait en 3 phases : détection, confirmation et recherche de latéralisation si une chirurgie est envisageable. Le choix du traitement va dépendre de la cause et des désirs du patient et peut être médicamenteux (antagonistes des récepteurs des minéralocorticoïdes) ou chirurgical (surrénalectomie unilatérale). Les deux options thérapeutiques diminuent le risque de morbimortalité cardiovasculaire si la tension artérielle est bien contrôlée.

[Gender differences in chronic kidney diseases : myth or reality ?] / Inégalité homme-femme face aux maladies rénales chroniques : mythe ou réalité ?

Chronic kidney disease (CKD) concerns about 10 % of the population in Switzerland. Epidemiological studies suggest that women are less prone to the development of CKD than men, and progress less rapidly to end stage renal disease. This protection seems lost when entering menopause. The reasons for this finding may stem from hormonal, structural or hemodynamic differences, yet the precise underlying mechanisms are so far incompletely understood. Some animal studies suggest a potentially beneficial effect of estrogen therapy, mainly in diabetes, yet data in humans are lacking. This article provides an overview of epidemiological data and the different hypotheses concerning gender differences in CKD, and discusses the eventual benefits of estrogen therapy to retard CKD progression.

L'insuffisance rénale chronique (IRC) touche environ 10 % de la population adulte en Suisse. Les études épidémiologiques suggèrent que les femmes préménopausées seraient plutôt protégées contre l'IRC et progresseraient moins vite vers l'insuffisance terminale. Plusieurs hypothèses ont été émises, tels un effet réno-protecteur des œstrogènes, ou encore des conditions hémodynamiques et / ou structurelles rénales plus favorables. Des études animales suggèrent un effet potentiellement bénéfique d'une thérapie par œstrogènes, principalement chez les animaux diabétiques. Chez l'homme, ce sujet n'a pas encore été assez étudié et nécessite d'être approfondi. Cet article a pour but de revoir les données épidémiologiques, les hypothèses en vigueur et l'éventuelle efficacité d'une thérapie œstrogénique pour ralentir la progression de l'IRC.

Inferior vena cava thrombosis as a possible cause of nephrotic-range proteinuria: two case reports.

BACKGROUND: Nephrotic-range proteinuria is a common reason for nephrological consultation in clinical practice. The differential diagnosis is wide, and generally focuses on different forms of glomerulonephritis, but other causes should not be overlooked, as illustrated in this article. CASE PRESENTATIONS: We report two female patients with nephrotic-range proteinuria. In the first case, a 46 year old Caucasian patient who suffered from extreme obesity (Body mass index (BMI) 77 kg/m2), acute kidney injury and nephrotic-range proteinuria were discovered during an emergency consultation for acute abdominal pain. The second patient (aged 52, also Caucasian) developed stage 4 chronic kidney disease and nephrotic proteinuria (protein/creatinine ratio 1821 g/mol) after accidental rupture of the inferior vena cava during a gastric bypass operation. On split-urine collection, both had a much higher degree of proteinuria during the day than during the night, compatible with orthostatic proteinuria. At further work-up, inferior vena cava thrombosis was diagnosed in both patients, whereas renal veins were patent. DISCUSSION: After simple anticoagulation in the first case, and anticoagulation plus endovascular recanalization in the second, there was almost complete resolution of the orthostatic proteinuria and a strong improvement of the estimated glomerular filtration rate in both patients. These cases highlight that nephrotic-range proteinuria can be linked to inferior vena cava thrombosis, and that a split-urine collection may also be very useful in the diagnostic work-up of proteinuria in adults.