Nephrologie & Therapeutique最新文献

La découverte des ARN interférents a fait l’objet d’un prix Nobel de médecine et de physiologie en 2006 et a permis de faire des avancées thérapeutiques conséquentes. L’ARNsi ou Small Interfering RNA est un ARN interférent injecté au patient, d’une vingtaine de nucléotides, qui a une complémentarité parfaite avec une petite partie de l’ARNm à dégrader pour empêcher sa traduction en protéine. Les ARNsi inhibent ainsi spécifiquement l’expression d’une protéine dans un tissu ciblé (le foie principalement) grâce à la vectorisation (vecteur GalNac ciblant une protéine exprimée à la surface des hépatocytes et permettant des injections souscutanées). Le champ d’application est large et le développement très rapide puisque le 1^er traitement mis sur le marché, le patisiran, date de 2018 pour l’amylose héréditaire à transthyrétine. Ce 1^er traitement a démontré à la fois l’efficacité mais également la sécurité d’utilisation des ARNsi. Depuis se sont développés d’autres ARNsi pour des maladies telles que la porphyrie hépatique aiguë ou l’hyperoxalurie primaire. Des études sont actuellement à l’essai dans les pathologies médiées par le complément, notamment la néphropathie à IgA, et des maladies très fréquentes comme l’hypertension artérielle ou l’hypercholestérolémie.

© 2022 Publié par Elsevier Masson SAS au nom de Société francophone de néphrologie, dialyse et transplantation.

Small interfering RNA (siRNAs) are double-stranded RNAs of around 20 base pairs in length that trigger RNAi machinery, which promotes degradation of a target mRNA avoiding protein translation. SiRNAs are liver-targeted, using tris N-acetylgalactosamine (GalNAc) as the targeting ligand. This discovery received the Nobel Prize for medicine and physiology in 2006 and lead to substantial therapeutic advances. Application field and development of these siRNA has been very fast. Indeed, patisiran has been released in 2018 for hereditary transthyretin amyloidosis. This first treatment showed the security and efficacy of such a product. Since, treatments have been developed for acute hepatic porphyria and primary hyperoxaluria. The current pipeline for new siRNA development is ambitious; clinical trial are ongoing in nephrology, as in the IgA nephropathy. Frequent diseases are also targeted such as hypertension or hypercholesterolemia.

© 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.

Background

The detection and correction of iron deficiency are essential for the treatment of anemia in chronic hemodialysis patients. The aim of our study was to assess the ability of serum iron to predict hemoglobin response to intravenous iron supplementation in hemodialysis patients.

Methods

It is a retrospective study in 91 hemodialysis patients during 2016 at Clermont-Ferrand University Hospital for whom intravenous iron supplementation had been started. A responder patient was defined as an increase in hemoglobin greater than or equal to 1 g/dL/month and/or a decrease in the dose of erythropoiesis stimulating agent after two months of iron supplementation.

Results

In responding patients, serum iron was significantly lower (6.7 ± 2.7 μmol/L) compared to non-responding patients (8.9 ± 2.9 μmol/L; P < 0.001). The positive response to iron supplementation was significantly associated with low serum iron (odds ratio = 0.58 [0.42–0.81]; P = 0.002) in a logistic regression model taking into account ferritin, transferrin saturation coefficient, dose variation monthly iron and erythropoiesis stimulating agent and the duration of dialysis. The area under the receiver operating characteristic curve of serum iron, ferritin and transferrin saturation coefficient to predict the response to iron supplementation were 0.72, 0.51 and 0.64, respectively (serum iron versus ferritin [P = 0.006] and serum iron versus transferrin saturation coefficient [P = 0.04]). The sensitivity for serum iron below 7.5 μmol/L was better than that for ferritin below 86 ng/mL (P < 0.001) and the specificity for serum iron below 7.5 μmol/L was better than that for TSC less than 19% (P = 0.02).

Conclusion

Serum iron below 7.5 μmol/L can predict the success of the response to iron supplementation in chronic hemodialysis patients.

Background

Chronic kidney disease-associated pruritus is a common symptom for patients with end-stage renal disease on hemodialysis; however, its pathogenesis remains poorly understood. Chronic kidney disease-associated pruritus has been reported to be associated with skin hydration or barrier. Thus, an interaction or association may be observed between chronic kidney disease-associated pruritus, skin hydration, and skin barrier.

Purpose

This study aimed to investigate the association between chronic kidney disease-associated pruritus, skin hydration, and skin barrier in patients with hemodialysis.

Methods

This cross-sectional study was conducted between November 2018 and February 2019. It included 162 patients undergoing maintenance hemodialysis for at least 6 months. Data were collected using the 5-D Itch Scale. Skin hydration and skin barrier were measured according to stratum corneum hydration and transepidermal water loss.

Results

Pruritus occurred in 42% of patients with hemodialysis. The mean 5-D Itch Scale severity was 10.91 ± 4.5. Pearson correlation analysis revealed that pruritus significantly correlated with moisture level (r = 0.191; P = 0.01), stratum corneum hydration (r = 0.191; P = 0.01), barrier strength (r = −0.162; P = 0.04), and transepidermal water loss (r = 0.162; P = 0.04).

Conclusion

Chronic kidney disease-associated pruritus remains a serious problem in patients undergoing hemodialysis, and stratum corneum hydration and transepidermal water loss are among its causes. This study illustrates the importance of skin hydration and barrier and sensitization to chronic kidney disease-associated pruritus. Therefore, the possible risk factors of chronic kidney disease-associated pruritus must be monitored closely in patients at risk.

The present study aimed to investigate the efficacy and safety of tacrolimus for treating incipient minimal change disease in adults. The clinical data of 52 adult patients with minimal change disease of nephrotic syndrome diagnosed by renal biopsy in the First affiliated hospital of Zhengzhou University between August 2013 and August 2015 were retrospectively analyzed. According to the treatment plan, the patients were divided into a tacrolimus group and a glucocorticoid group. The efficacy and safety of tacrolimus in the treatment of minimal change disease in adult patients was analyzed and compared with that of glucocorticoids. The results revealed that the baseline characteristics of the two groups were similar (P > 0.05). At 24 weeks, there was a significant difference in serum albumin between the two groups (P < 0.01). The serum albumin levels of tacrolimus group was higher compared with the glucocorticoid group. In addition, the complete remission rates in the tacrolimus and glucocorticoid groups were 93.75 and 77.8%, respectively (P = 0.095), and the mean complete remission time was 6.33 ± 4.21 and 5.14 ± 2.45 weeks, respectively (P = 0.175). The relapse rate was 12.5 and 22.2% in the tacrolimus and glucocorticoid groups, respectively (P = 0.368). During the follow-up, in tacrolimus group, the incidence of new onset diabetes or impaired glucose tolerance, osteoporosis, infection, abnormal liver function, Cushing's syndrome, acne and gastrointestinal symptoms were significantly less than those of glucocorticoids (P < 0.05). In conclusion, tacrolimus treatment after short-time intravenous methylprednisolone is an effective treatment option with fewer adverse effects in adult onset minimal change disease.

Introduction

The distal renal tubular acidosis of children is characterized by hyperchloremic metabolic acidosis with normal anion gap, hypokalemia, hypercalciuria and nephrocalcinosis. It is secondary to the inability of alpha intercalar cells of the distal tubule to acidify urine of genetic origin.

Objective

To analyse the epidemiological aspects of distal tubular acidosis in Tunisia and study its evolutionary profile.

Patients and methods

We conducted a retrospective descriptive study involving 44 patients followed at the paediatrics department of the Charles Nicolle Hospital in Tunis for 28 years (1991–2018).

Results

The most common discovery circumstances were growth retardation (88.6%), dehydration (56.8%), ployuro-polydipsic syndrome (47.7%), vomiting (40.9%) and nephrocalcinosis (38.6%). Growth retardation was found in 52.3% of patients. Dehydration was diagnosed in 59.1% of patients on the first exam. Polyuria was constant with an average diuresis of 8 cc/kg/h. All patients had the complete form of distal renal tubular acidosis with an average alkaline reserve of 11.1 mmol/L. Nephocalcinosis was found in 77.3% associated with nepholithiasis in 22.7%. Twenty-four patients had sensorineural deafness, nine of whom had ATP6V1B1/2p13 mutation. The ATP6V0A4/7q33-34 mutation was present in two patients. We used a high alkaline treatment dose with an average maintenance dose of 8.17 mmol/kg/24 hours. In the long term, stunting persisted in 34% of patients. The mean of creatinine's clearance at the last evaluation was 89.38 mL/min/1.73 m² SC with stage 2 of chronic kidney disease in 50% of patients.

Conclusion

Distal renal tubular acidosis has long been considered a benign pathology but is responsible for a progressive decline in GFD. Adequate metabolic control is needed to stabilize kidney function.

Introduction

Non-adherence behaviors are very common in chronic hemodialysis patients, it is estimated that only one patient out of two complies with medical prescriptions, these behaviors are associated with a higher risk of morbidity and adverse events as well as increased expenses for health systems. The aim of our study was to assess adherence to long-term prescribed medications in chronic hemodialysis patients, using a mobile application named TestObs, as well as to determine the main factors influencing medication adherence.

Methods

We conducted a prospective descriptive study, between January and June 2019. We developed a mobile application named TestObs, downloadable on playstore for android devices, which assesses with the Girerd questionnaire, the adherence to the main medications taken by chronic hemodialysis patients. We included adult patients, with a duration of dialysis of more than 6 months, all patients who downloaded TestObs, tested their adherence to their medication by answering the questionnaire. We created a web-based platform, where data was collected from the application and then analyzed and tabulated. Regarding the statistical analysis, the normal distribution of the variables was studied by the Kolmogorov-Smirnov test, the analysis of the qualitative variables used the Pearson's Chi² and Fisher's statistical test, the Hosmer Lemeshow test was used to examine the quality of the final logistic regression model.

Results

We collected 90 adult chronic hemodialysis patients, 51 of them (56%) were selected to enter the study. We found good compliance in 46.15% of patients, minor noncompliance in 32.87%, and noncompliance in 20.98%. In multivariate analysis, the factors influencing adherence were the presence of other comorbidities (diabetes and vision problems) and the number of pills per day.

Discussion

In this study, we report treatment adherence problems in 53.85% of patients, our results are close to the data reported in hemodialysis patients in the literature, different factors influence the quality of treatment adherence, in our study poly-medication and the presence of other comorbidities were the statistically significant determinants. The new technology assessment instruments were used in hemodialysis patients and were able to provide real-time monitoring of adherence behaviors.

Conclusion

We believe that mobile health technologies hold promise for assessing and improving medication adherence in hemodialysis patients, so we suggest that TestObs represents an accessible and free of charge tool, based on a validated questionnaire, that can allow patients to benefit from new technologies for medical monitoring, and may eventually constitute an interventional program to improve medication adherence; however, this technological tool should not replace traditional therapeutic education; prior targeti