High prevalence of chronic kidney disease in La Réunion island and its association with the metabolic syndrome in the non-diabetic population: La Réunion Diabetes (REDIA) Study.

AIM: To estimate the prevalence of chronic kidney disease (CKD) in La Réunion island and to investigate the link with the metabolic syndrome in the non-diabetic population. METHODS: The Réunion Diabetes (REDIA) Study included a random sample of 3600 adults aged 30-69 years. Clinical proteinuria (>200 mg/g creatinine), albuminuria (>or=30 mg/g) and estimated glomerular filtration rate (eGFR) were studied in 920 subjects, 411 of whom had diabetes and 509 who did not. Their relations with the metabolic syndrome (as defined by the US National Cholesterol Education Program Adult Treatment Panel III guidelines) were analyzed among those without diabetes. RESULTS: Age-, gender- and diabetes-standardized prevalence of CKD stage 1 or 2 (proteinuria or albuminuria with eGFR>or=60 mL/min/1.73 m2) was 13.8% and, for CKD stage 3 or more (eGFR<60 ml/min/1.73 m2), 10.7%. The adjusted odds ratios (OR) for proteinuria increased with the number of metabolic syndrome traits: 1.5 (95% confidence interval, 0.4-5.2) in non-diabetic participants with one trait compared with those with no trait, 2.0 (CI 0.6-6.6) for two traits and 4.1 (CI 1.3-12.8) for three or more; corresponding ORs for eGFR<60 ml/min/1.73 m2 were 1.9 (CI 0.8-4.5), 0.9 (CI 0.4-2.4) and 2.2 (CI 0.9-5.1), respectively. Clustering of either high blood pressure and triglyceride levels, or high triglycerides and plasma glucose, or all three, conferred the strongest associations with both clinical proteinuria and low eGFR. CONCLUSIONS: CKD prevalence is high in La Réunion island population, and the metabolic syndrome may help to target early diagnosis of CKD in non-diabetic individuals.

Renal failure in the course of reactivation of varicella-zoster virus infection in a renal transplant recipient.

Renal failure developed in a 20-year-old female renal transplant recipient in the course of reactivation of varicella-zoster virus infection. The patient was treated with acyclovir and immunosuppression was continued. The year later renal function in the transplanted kidney was satisfactory.

[Right ventricular function during the convalescence phase of posterior primary infarction]. / Fonction ventriculaire droite à la phase de convalescence d'un primo-infarctus postérieur.

Right ventricular extension is very common in inferior myocardial infarction and the resulting haemodynamic changes are well documented. The aim of this prospective study was to assess the consequences on regional and global right ventricular function at a distance from the initial episode. The study population included 32 patients (29 men and 3 women; mean age 52.7 +/- 6 years) admitted consecutively to the coronary care unit for acute inferior wall myocardial infarction with right ventricular extension (group A: 14 patients) or without (group B: 18 patients), based on the initial haemodynamic data. All patients underwent right and left cardiac catheterisation with selective biplane right and left ventriculography and coronary angiography, 2.9 +/- 1 months after the acute episode. In group A, there was a normalisation of the haemodynamic changes observed during the acute phase of myocardial infarction, complete occlusion (10 cases) or a significant residual stenosis (3 cases) of the right coronary artery proximal or immediately distal to the right marginal artery and persistence of an alteration of global right ventricular systolic function when compared with group B (increased end systolic volume: RVESV = 43 +/- 11 ml/m2 vs 35 +/- 9 ml/m2, p less than 0.02, and a decreased ejection fraction: RVEF = 49 +/- 7 p. 100 vs 57 +/- 9 p. 100, p less than 0.01, resulting from hypokinesia or akinesia of the right ventricular inferior wall; mean shortening delta R = 11 +/- 6 p. 100 vs 17 +/- 7 p. 100, p less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

[Antiarrhythmic effects of intravenous magnesium sulfate in torsade de pointes. Apropos of 6 cases]. / Effets anti-arythmiques du sulfate de magnésium intraveineux dans les torsades de pointes. A propos de 6 observations.

The antiarrhythmic properties of magnesium salts, known for many years, are periodically recalled but rarely used in daily clinical practice. They are usually used in digitalis-induced arrhythmias and are rarely indicated in other conditions; they are often reserved for cases in which a magnesium deficiency is suspected. In 6 cases of torsades de pointes, magnesium sulphate was administered at a dose 1 to 3 g by direct intravenous injection. Although hypokalaemia was a common finding, a low magnesium concentration was only found in one case. The ventricular arrhythmia regressed completely at the end of the injection in 4 cases (one after two injections). One positive but incomplete response was observed in the only case of magnesium deficiency, probably due in retrospect to inadequate dosage. Finally, one patient with very poor ventricular function had recurrence after a good initial response. The diversity of the clinical and biological findings in this series suggests a specific antiarrhythmic action of the magnesium ion, apparently independant of the correction of magnesium deficiency; experimental studies suggest that the mode of action is a direct antagonism of Mg++-K+ and/or Mg++-Ca++. Compared to usual means of treatment of torsades de pointes (isoprenaline infusion or pacing) the advantages of intravenous magnesium sulphate are clear-cut: innocuity, simplicity and rapidity of administration, and almost immediate efficacy.

[Seroepidemiological study of human leptospirosis at Reunion Island]. / Etude sero épidémiologique de la leptospirose humaine à l'île de laRéunion.

In order to evaluate the prevalence of human leptospirosis in Reunion island and to identify possible risk factors, a study was realised on a representative population sample of 3.338 persons. The prevalence of leptospirosis, diagnosed by ELISA and confirmed by Micro Agglutination Test, was 1.1%. Male predominance and higher prevalence in rainy parts of the island, were confirmed. It has not been possible to display risk factors such as housing conditions or professional exercise. The serological repartition showed not only icterohaemorrhagiae serovar, but also canicola, panama and sejroe, especially in women. These results, compared with clinical studies (showing nearly exclusive male repartition, in agricultural workers, due to icterohaemorrhagiae serovar), confirm the double look of human leptospirosis in Reunion island: clinical leptospirosis, severe, concerning males, often countrymen, due to icterohaemorrhagiae serovar, and infraclinical leptospirosis, concerning principally females, which is a domestic illness, due to other serovars.

[Sicca syndrome with severe renal insufficiency]. / Syndrome sec avec insuffisance rénale sévère.

The interstitial nephritis associated with sicca syndrome is usually symptomless or responsible for mild renal impairment. The authors report five cases in which renal failure was severe, requiring haemodialysis in two patients. The physiopathological mechanisms and the treatment of interstitial nephritis in sicca syndrome are discussed. Corticosteroids improved renal function in three of these five patients.

[Total obstruction of the anterior interventricular artery without myocardial infarction]. / Obstruction totale de l'interventriculaire antérieure sans infarctus myocardique sous-jacent.

Complete proximal occlusion of the the anterior interventricular artery was associated with the presence (group A: 31 cases) or the absence (group B: 31 cases) of transmural myocardial necrosis in the corresponding territory. The aim of this study was to define the factors which determine the development of permanent myocardial necrosis, on the basis of clinical, electrocardiographic, haemodynamic and angiographic criteria. Group B was characterised by the following features: almost all of the patients (30 out of 31) had unstable angina, for less than 2 months in half of the cases; 67% of cases presented an abnormality of ventricular repolarisation on the resting ECG, usually (54 per cent of cases) in leads V3 to V5, suggestive of isolated sub-pericardial ischaemia in half of these cases; 24 cases presented moderate regional hypokinesia in the anteroapical territory of the LV; the distal AIV artery was more clearly visualised (17 cases had a well perfused AIV artery compared with 6 in group A) and a greater number of patients obtained homocoronary interseptal re-perfusion (8 versus 2) and heterocoronary re-perfusion by distal anastomosis of the AIV artery and the PIV artery by the apex (13 versus 3) (p less than 0.05) than in group A. However, the possibility of surgery was considered to be limited (39%) on the basis of the angiographic criteria. Thus, in group B, a "phantom AIV artery syndrome" can not be distinguished from unstable angina on the basis of the clinical and electrocardiographic profile.(ABSTRACT TRUNCATED AT 250 WORDS)