Nephrologie & therapeutique最新文献

Introduction: Type II mixed cryoglobulinemia is most commonly associated with chronic hepatitis C virus infection. The occurrence of marginal zone lymphoma as the underlying cause is rare, especially in the absence of gastric involvement.

Case report: A 63-year-old woman with hypertension and hypothyroidism initially presented with transient purpura following a urinary tract infection. Two months later, she developed acute kidney injury, proteinuria (2.3 g/24 h), and microscopic hematuria. Laboratory tests showed type II mixed cryoglobulinemia (IgM κ + IgG) with hypocomplementemia. Viral serologies, including HCV, were negative. Renal biopsy revealed membranoproliferative glomerulonephritis with IgM and IgG deposits. Blood and bone marrow immunophenotyping confirmed an extragastric marginal zone lymphoma. The patient was treated with six cycles of rituximab-bendamustine.

Results: Complete remission was achieved: recovery of renal function (creatinine 84 μmol/L at 12 months), resolution of proteinuria, improvement of anemia, and regression of splenomegaly. No relapse was observed after 18 months of follow-up.

Discussion/conclusion: This case represents a particularly rare presentation of type II mixed cryoglobulinemia revealing an extragastric marginal zone lymphoma in the absence of viral infection or gastric involvement. It contributes to the sparse literature on this uncommon association. Treatment with rituximab-bendamustine appears to be effective.

The presence of chyle in a hemodialysis catheter is a rare complication, usually observed in case of chylothorax secondary to central vein stenosis, particularly of the superior vena cava and the left brachiocephalic vein.We report the exceptional case of a 55-year-old woman in maintenance hemodialysis presenting with chyle in her left subclavian tunneled cuffed catheter during each interdialytic period, without any recent history of trauma or tumoral disease. The chest CT scan was unremarkable. The milky fluid was systematically observed by the nurses at the beginning of each hemodialysis session, before connection. The diagnosis of chyle was confirmed by a very high triglyceride concentration in the aspirated fluid, and the absence of biological and cytological arguments in favor of an infectious or tumoral pathology.A phlebography combining the opacification of the catheter and the left internal jugular vein revealed an aberrant trajectory of the catheter in an endothelial sheath, probably in communication with the outlet of the thoracic duct, which explains the leak of chyle.The removal of the tunneled catheter was followed by the insertion of a new one in the left internal jugular vein, taking a route outside the faulty endothelial sheath. This procedure resulted in complete resolution of the problem, with no recurrence at 10 months of follow-up.This is the first documented description of the presence of chyle in a tunneled catheter for hemodialysis, with no associated chylothorax nor central vein stenosis. This condition was due to a local mechanical complication, i.e., a communication between an aberrant path of the tunneled catheter within an endothelial sheath and the opening of the thoracic duct. We emphasize the importance of a complete phlebographic assessment in case of unexplained presence of chyle in a hemodialysis catheter.

Primarily a respiratory illness, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a range of extra-pulmonary involvement, including the kidneys, which are often affected. This infection has been associated with the overproduction of serum amyloid A protein, resulting in systemic AA amyloidosis. We report a case of renal AA amyloidosis presenting as a nephrotic syndrome in a patient without any underlying risk factor except COVID-19 infection. This article offers preliminary insights into a potential connection between this emerging viral disease and this complication, awaiting confirmation through future research.

Rhodococcus equi is an aerobic actinomycete initially identified in foal pneumonia and later recognized as an opportunistic human pathogen, particularly affecting immunocompromised individuals. Its incidence increased during the AIDS pandemic and with the rise of organ transplantation. Both cellular and humoral immunity contribute to host defense against R. equi, which is typically acquired through inhalation or ingestion of contaminated materials. The bacterium causes pneumonia that frequently progresses to lung cavitation, bacteremia, and potential dissemination to other organs.We report three cases of R. equi infection in renal transplant patients and review 35 previously published cases. The median age was 49 years, with a male predominance. Most patients presented with necrotizing pneumonia, often associated with bacteremia and soft tissue involvement. Treatment involved reducing immunosuppressive therapy, using bactericidal and intracellularly active antibiotics, and considering surgery when necessary. Prolonged antibiotic therapy and secondary prophylaxis are recommended. Mortality associated with this infection remains high, highlighting the need for early diagnosis and comprehensive treatment strategies.This report emphasizes the importance of considering infectious causes, such as R. equi, in the differential diagnosis of pulmonary masses in immunocompromised patients. Early diagnosis and combined antibiotic therapy are crucial. Lobectomy, though high-risk, may be required for durable infection control when antibiotic therapy is insufficient.

Chronic kidney disease and dialysis have a major impact on patients’ quality of life, affecting their physical, psychological, and social well-being. The DialiCare project, conducted in partnership with an industry stakeholder and health care professionals involved in dialysis care, aims to address these challenges through a collaborative, patient-centered approach.Structured in two phases, the project first identified the priority needs of patients and health care professionals through surveys and regional working groups. Various project proposals were then submitted to a jury made up of a patient association (France Rein), two professional associations (ANFIPA and AFIDTN), and health care professionals who had participated in the initiative. Three projects were selected. The second phase led to the cocreation of three innovative educational tools: the “Roue du prurit” (Itch Wheel), the “Évadez-vous” (“Escape”) project designed to help patients envision themselves engaging in enjoyable activities, and the “Comment se sentent nos patients” (“How Our Patients Feel”) project, a placemat designed to help patients express their emotions and experiences. These tools aim to improve communication between caregivers and patients, objectify symptoms, and promote patient autonomy.The DialiCare project illustrates the importance of a participatory approach in developing concrete solutions tailored to real-world conditions and capable of sustainably improving the quality of life for dialysis patients.

Chronic kidney disease (CKD) is now clearly defined. O nce the diagnosis is made, health care providers must establish a dialogue with the patient and include them in the decision-making process. It is essential that the patient becomes actively involved in managing their CKD on a daily basis and plays a constructive role during the various transitions that characterize the condition, in order to preserve their personal priorities and meet their expectations. Medical staff should measure symptoms, quality of life, and patient experience of care, in order to integrate these dimensions into the design of a personalized care pathway.

Chronic kidney disease (CKD) is a major public health issue, affecting around 10% of the world’s population. Its silent progression and its numerous etiologies (most commonly diabetes and vascular nephropathies) complicate early detection and management. Many patients reach kidney failure without prior nephrological care. Coordination between outpatient care (GPs, pharmacists, nurses) and specialist facilities is therefore essential to improve screening, delay the progression to dialysis, and improve patients’ quality of life.The CKD package, introduced in 2019, provides financial support to health care facilities with the aim of facilitating a multidisciplinary approach before end-stage renal diseases. It promotes a patient-centered approach, including nephrologists, nurses, dieticians, psychologists, etc. Community health care professionals play a crucial role in identifying and referring patients to specialists. Coordination with nephrologists means faster diagnosis and better support.Advanced practice nurses and nurse coordinators play a structuring role in personalized monitoring. Digital tools, remote monitoring, and artificial intelligence offer new ways for optimizing patient care.Finally, the general public’s persistent lack of knowledge about CKD calls for enhanced information campaigns. The aim of all these initiatives is to build a more fluid, anticipated, and personalized care pathway, centered on the patient’s quality of life.