Nephrologie & therapeutique最新文献

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.

Given the current climate stakes, implementing an ecological approach in nephrology departments and dialysis centers has become essential. Hemodialysis, which has a significant environmental impact, was the first activity to be targeted, with an assessment of its carbon footprint followed by best practice recommendations issued by the Green Nephrology Group of the Francophone Society for Nephrology, Dialysis, and Transplantation (SFNDT). Future areas of focus include completing studies on all dialysis modalities and addressing other domains such as transplantation, kidney disease prevention, and appropriate care. Knowledge of the carbon footprint of medications opens the way for eco-prescription, adding a new criterion to guide prescribing choices. This shift cannot take place without the involvement of patients.

Introduction: Renal replacement therapy (RRT) ensures the survival of patients with end-stage renal disease. It requires vascular access, such as an arteriovenous fistula or a tunneled central venous catheter. Catheters are inserted by different specialists using different techniques.

Materials and methods: We conducted a practice survey on tunneled catheter placement in France developed by the French Intensive Renal Network (FIRN) commission. A comprehensive questionnaire was distributed via social networks to all dialysis centers in France.

Results: Given the low response rate from other facilities, only responses from university hospitals were analyzed. Tunneled catheters are inserted by nephrologists in 68% of French university hospitals, of which only 20% use fluoroscopy for right jugular and femoral placement, and 40% for left jugular placement. The procedure is most often performed outside the operating room, in a dedicated room. Of the centers studied, 19% use antibiotic prophylaxis. The average time to insertion is around 48 hours for nephrologists, compared to 1 to 2 weeks for other specialists. Serious complications are rare but do occur and can be life-threatening. Anticoagulation and dual antiplatelet therapy are discontinued for this procedure. A few centers use tunneled catheters in acute renal failure and for plasma exchange.

Conclusion: Our survey shows that nephrologists place tunneled dialysis catheters in the majority of French university hospitals, enabling rapid access to the procedure. This procedure is often performed without fluoroscopy but under ultrasound guidance. Fluoroscopy remains the gold standard. Echocardiography, being less invasive than fluoroscopy, could improve guidance and enable early diagnosis of serious complications. The rest of the survey presents the various types of practices observed and could serve as a basis for developing best practice recommendations.

The working group of the Francophone Society of Nephrology, Dialysis, and Transplantation (SFNDT) recently published a guide for the reasoned adaptation of therapies (ART) in nephrology, which takes up the legal framework of the Claeys–Leonetti Law (2016) and highlights the specificities of palliative care in the context of a long-term chronic illness. In this literature review—drawing from both medical research and the humanities and social sciences—we offer a complementary perspective on the complex decision-making process from dialysis withdrawal to death (DWD), in the sense of sociologist and philosopher Edgard Morin’s concept of complex thought. Quantitative studies, both national and international, highlight the role of cultural differences between countries as well as the influence of legal frameworks on DWD, but other factors are also at play. Patient characteristics associated with DWD as well as differences in regional practices are identified. Qualitative studies and research in the humanities and social sciences further explore the experiences of caregivers, marked by uncertainty and complexity, as decisions unfold among patients, families or caregivers, and health care professionals. This literature review serves as a foundation for an ongoing mixed methods study on the variability of DWD practices in France.