Biomarkers and physiolpathology in the cardiorenal syndrome
BOUQUEGNEAU, Antoine ; KRZESINSKI, Jean-Marie ; DELANAYE, Pierre et al
in Clinica Chimica Acta (2015), 443
Acute cardiorenal syndrome (CRS) corresponds to an association of acute heart failure and a worsening of renal function. The detection of acute kidney injury (AKI) unfortunately occurs at a late stage of ... [more ▼]
Acute cardiorenal syndrome (CRS) corresponds to an association of acute heart failure and a worsening of renal function. The detection of acute kidney injury (AKI) unfortunately occurs at a late stage of CRS, leading to an increased mortality of the patients. In this review, we described the pathophysiology of CRS and discussed the potential interest of biochemical biomarkers (namely creatinine, cystatin C, NGAL, KIM-1, fatty acid binding protein, Nacetyl-β-D-glucosaminidase and IL-18) that could potentially help to detect AKI earlier and thus reduce the morbi-mortality of the patients suffering from CRS. [less ▲]Detailed reference viewed: 30 (8 ULg)
Place de la vitamine D native en dialyse
DELANAYE, Pierre ; BOUQUEGNEAU, Antoine ; KRZESINSKI, Jean-Marie et al
in Néphrologie & Thérapeutique (2015), 11(1), 5-15
Chronic kidney disease is frequent and usually responsible of mineral and bone disorder. These abnormalities lead to increased morbidity and mortality. To become active, native vitamin D needs a first ... [more ▼]
Chronic kidney disease is frequent and usually responsible of mineral and bone disorder. These abnormalities lead to increased morbidity and mortality. To become active, native vitamin D needs a first hydroxylation in the liver, and a second one in the kidney. Next to its action on bone metabolism, vitamin D also possesses pleiotropic actions on cardiovascular, immune and neurological systems as well as antineoplastic activities. End-stage renal disease (ESRD) is also associated with a decrease in vitamin D activity by mechanisms including the increase of plasma phosphate concentration, secretion of FGF- 23 and decrease in 1a-hydroxylase activity. The prevalence of 25 hydroxy-vitamin D deficiency depends on the chosen cut-off value to define this lack. Currently it is well established that a patient has to be substituted when 25 hydroxy-vitamin D level is under 30 ng/mL. The use and monitoring of 1.25 hydroxy-vitamin D is still not recommended in routine practice. The goals of vitamin D treatment in case of ESRD are to substitute the deficiency and to prevent or treat hyperparathyroidism. Interest of native vitamin D in first intention is now well demonstrated. This review article describes the vitamin D metabolism and physiology and also the treatment for vitamin D deficiency in ESRD population. [less ▲]Detailed reference viewed: 18 (8 ULg)
Activation of the calcium-sensing receptor before renal ischemia/reperfusion exacerbates kidney injury
WEEKERS, Laurent ; De Tullio, Pascal ; BOVY, Christophe et al
in American Journal of Translational Research (2015), 7(1), 128-138
Activation of the calcium-sensing receptor (CaSR) by ischemia/reperfusion (I/R) favours apoptosis in cardiomyocytes, hepatocytes and neurons. Its role in renal I/R is unknown. We investigated the impact ... [more ▼]
Activation of the calcium-sensing receptor (CaSR) by ischemia/reperfusion (I/R) favours apoptosis in cardiomyocytes, hepatocytes and neurons. Its role in renal I/R is unknown. We investigated the impact of pharmacological preactivation of the CaSR on kidney structure and function in a murine model of bilateral renal 30-min ischemia and 48-hour reperfusion, and in a 6-year cohort of kidney transplant recipients (KTR). C57BL/6J mice were administered daily with CaSR agonist, R-568, or with vehicle for 48 hours. Evaluation of serum urea and creatinine levels, renal histology and urine metabolome by nuclear magnetic resonance showed that R-568 was not nephrotoxic per se. Following I/R, serum urea and creatinine levels increased higher in R-568-treated animals than in controls. Jablonski’s score was significantly greater in R-568-treated kidneys, which showed a higher rate of cell proliferation and apoptosis in comparison to controls. Next, we retrospectively identified 36 patients (10.7% of our cohort) who were treated by CaSR agonist, cinacalcet, at the time of kidney transplantation (KTx). After matching these to 61 KTR upon type of donor, cold ischemic time, residual diuresis, and donor age, we observed that delayed graft function, i.e. need for dialysis in the first week after KTx, occurred in 42 and 23% of cinacalcet-treated and control groups, respectively (p≤0.05). These data suggest that pharmacological preactivation of the CaSR before renal I/R exacerbates kidney injury. [less ▲]Detailed reference viewed: 57 (11 ULg)
Variation de la parathormone et de différents biomarqueurs osseux chez le patient hémodialysé
DELANAYE, Pierre ; ; et al
Poster (2015)Detailed reference viewed: 5 (4 ULg)
Variation of PTH and bone biomarkers in hemodialysis patients.
DELANAYE, Pierre ; ; et al
Poster (2015)Detailed reference viewed: 4 (2 ULg)
La maladie renale diabetique: prise en charge actuelle et perspectives d'avenir.
Krzesinski, Jean-Marie ; Scheen, Andre
in Revue medicale suisse (2015), 11(483), 1534-81540-2
The diabetic kidney disease is the most frequent cause of end stage renal disease in Western countries. Its detection is obtained by simultaneously measuring urinary albumin excretion and estimating ... [more ▼]
The diabetic kidney disease is the most frequent cause of end stage renal disease in Western countries. Its detection is obtained by simultaneously measuring urinary albumin excretion and estimating glomerular filtration rate through serum creatinine dosage. Many type 1 and type 2 diabetic patients can present decreased glomerular filtration rate before the occurrence of increased urinary albumin. While waiting for promising new pharmacological approaches currently evaluated in clinical trials, the best approach to stop the epidemic of diabetic nephropathy remains an early and individual multifactorial approach controlling the glucose level (without inducing hypoglycaemia), blood pressure (using a renin-angiotensin blocker), dyslipidaemia and over-weight. [less ▲]Detailed reference viewed: 40 (2 ULg)
Fluorodeoxyglucose F Positron Emission Tomography Coupled With Computed Tomography in Suspected Acute Renal Allograft Rejection.
; ; et al
in American Journal of Transplantation (2015)
Management of kidney transplant recipients (KTRs) with suspected acute rejection (AR) ultimately relies on kidney biopsy; however, noninvasive tests predicting nonrejection would help avoid unnecessary ... [more ▼]
Management of kidney transplant recipients (KTRs) with suspected acute rejection (AR) ultimately relies on kidney biopsy; however, noninvasive tests predicting nonrejection would help avoid unnecessary biopsy. AR involves recruitment of leukocytes avid for fluorodeoxyglucose F18 (18 F-FDG), thus 18 F-FDG positron emission tomography (PET) coupled with computed tomography (CT) may noninvasively distinguish nonrejection from AR. From January 2013 to February 2015, we prospectively performed 32 18 F-FDG PET/CT scans in 31 adult KTRs with suspected AR who underwent transplant biopsy. Biopsies were categorized into four groups: normal (n = 8), borderline (n = 10), AR (n = 8), or other (n = 6, including 3 with polyoma BK nephropathy). Estimated GFR was comparable in all groups. PET/CT was performed 201 +/- 18 minutes after administration of 3.2 +/- 0.2 MBq/kg of 18 F-FDG, before any immunosuppression change. Mean standard uptake values (SUVs) of both upper and lower renal poles were measured. Mean SUVs reached 1.5 +/- 0.2, 1.6 +/- 0.3, 2.9 +/- 0.8, and 2.2 +/- 1.2 for the normal, borderline, AR, and other groups, respectively. One-way analysis of variance demonstrated a significant difference of mean SUVs among groups. A positive correlation between mean SUV and acute composite Banff score was found, with r2 = 0.49. The area under the receiver operating characteristic curve was 0.93, with 100% sensitivity and 50% specificity using a mean SUV threshold of 1.6. In conclusion, 18 F-FDG PET/CT may help noninvasively prevent avoidable transplant biopsies in KTRs with suspected AR. [less ▲]Detailed reference viewed: 30 (9 ULg)
Mesenchymal Stromal Cell Therapy in Ischemia/Reperfusion Injury.
Rowart, Pascal ; ; et al
in Journal of immunology research (2015), 2015
Ischemia/reperfusion injury (IRI) represents a worldwide public health issue of increasing incidence. IRI may virtually affect all organs and tissues and is associated with significant morbidity and ... [more ▼]
Ischemia/reperfusion injury (IRI) represents a worldwide public health issue of increasing incidence. IRI may virtually affect all organs and tissues and is associated with significant morbidity and mortality. Particularly, the duration of blood supply deprivation has been recognized as a critical factor in stroke, hemorrhagic shock, or myocardial infarction, as well as in solid organ transplantation (SOT). Pathophysiologically, IRI causes multiple cellular and tissular metabolic and architectural changes. Furthermore, the reperfusion of ischemic tissues induces both local and systemic inflammation. In the particular field of SOT, IRI is an unavoidable event, which conditions both short- and long-term outcomes of graft function and survival. Clinically, the treatment of patients with IRI mostly relies on supportive maneuvers since no specific target-oriented therapy has been validated thus far. In the present review, we summarize the current literature on mesenchymal stromal cells (MSC) and their potential use as cell therapy in IRI. MSC have demonstrated immunomodulatory, anti-inflammatory, and tissue repair properties in rodent studies and in preliminary clinical trials, which may open novel avenues in the management of IRI and SOT. [less ▲]Detailed reference viewed: 35 (21 ULg)
Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification.
; Jouret, François ; et al
in BMC nephrology (2015), 16(1), 76
BACKGROUND: Adult cardiac surgery is significantly associated with the development of acute kidney injury (AKI). Still, the incidence and outcomes of AKI vary according to its definition. Our ... [more ▼]
BACKGROUND: Adult cardiac surgery is significantly associated with the development of acute kidney injury (AKI). Still, the incidence and outcomes of AKI vary according to its definition. Our retrospective monocentric study comparatively investigates the yield of RIFLE definition, which is based on the elevation of serum creatinine levels (SCr) or the reduction of urine output (UO), taking into account only one or both criteria. Pre- and per-operative risk factors for post-operative AKI were evaluated. METHODS: All adult patients undergoing cardiac surgery, with or without cardiopulmonary bypass, from April 2008 to March 2009 were included. Clinical, biological and surgical features were recorded. Baseline serum creatinine was determined as its value on day 7 before surgery. Post-operative AKI was diagnosed and scored based upon the highest serum creatinine and/or the lowest urine output. RESULTS: 443 patients (Male/Female ratio, 2.3; median age, 69y) were included, with 221 (49.9 %) developing postoperative AKI. Elevated serum creatinine (AKISCr) and oliguria (AKIUO) was observed in 9.7 % and 40.2 %, respectively. AKI patients had a significantly higher BMI and baseline SCr. In comparison to AKIUO, AKISCr mostly occurred in patients with co-morbidities, and was associated with an increased mortality at 1-year post surgery. CONCLUSIONS: The use of standard RIFLE definition of AKI in a cohort of 443 patients undergoing cardiac surgery resulted in an incidence reaching 50 %. Still, significant discrepancies were found between AKISCr and AKIUO regarding the incidence and outcomes. In line with previous reports, our data questions the utility of urine output as a criterion for AKI diagnosis and management after cardiac surgery. [less ▲]Detailed reference viewed: 36 (4 ULg)
Le traitement de l'hypertension artérielle doit être du "sur mesure"
in Revue Médicale de Liège (2015)
Hypertension has a high world-wide prevalence, affecting more than 25 % of the population; it remains the silent killer number one in cardiovascular pathology. Although lowering high blood pressure is ... [more ▼]
Hypertension has a high world-wide prevalence, affecting more than 25 % of the population; it remains the silent killer number one in cardiovascular pathology. Although lowering high blood pressure is protective, perfect control of hypertension is far from being optimal in spite of many international guidelines regularly updated according to published scientific studies. A personalized approach of hypertension management is an attractive way to improve this situation. Tools are developing (pharmacogenetics, pharmacometabolomics), but their use in daily clinical practice seems premature. At the present time, it is the physician experience which offers the best opportunity to propose the best treatment to the best patient. The management of hypertension remains a difficult task in some cases. [less ▲]Detailed reference viewed: 31 (2 ULg)
Nouveaux AntiCoagulants Oraux et risques liés à l’insuffisance rénale et à des interactions médicamenteuses
Scientific conference (2014, December 16)
Les NACO apportent une facilité apparente d’utilisation et une légère avancée en termes de résultats et de prévention de saignement. Cependant, la prudence est de mise lorsque la fonction rénale est ... [more ▼]
Les NACO apportent une facilité apparente d’utilisation et une légère avancée en termes de résultats et de prévention de saignement. Cependant, la prudence est de mise lorsque la fonction rénale est possiblement abaissée et lors d’associations médicamenteuses aux métabolismes similaires.Il est important d’estimer la filtration glomérulaire avant de prescrire les NACO (MDRD). [less ▲]Detailed reference viewed: 21 (2 ULg)
Metabolomics study of mouse kidney and urine in ischemia/reperfusion injury
JOURET, François ; Leenders, Justine ; De Tullio, Pascal et al
Poster (2014, November)Detailed reference viewed: 34 (13 ULg)
Insuffisance rénale aiguë : définition, monitorage et traitement NON dialytique
Scientific conference (2014, October 25)Detailed reference viewed: 22 (2 ULg)
La prise en charge des facteurs de risque dans le diabète de type 2 est-elle optimale?
Scientific conference (2014, October 10)Detailed reference viewed: 20 (5 ULg)
Le médicament du mois Combinaison fixe périndopril-indapamide-amlodipine (Triplixam®) pour le traitement de l’hypertension artérielle
SCHEEN, André ; LANCELLOTTI, Patrizio ; KRZESINSKI, Jean-Marie
in Revue Médicale de Liège (2014), 69(10), 565-570
Triplixam® is a fixed dose combination of three well known antihypertensive agents, with complementary activities, to control blood pressure in patients with arterial hypertension : perindopril, an ... [more ▼]
Triplixam® is a fixed dose combination of three well known antihypertensive agents, with complementary activities, to control blood pressure in patients with arterial hypertension : perindopril, an angiotensin converting enzyme inhibitor, indapamide, un diuretic whith thiazide-like effects but also specific properties, and amlodipine, a long-acting calcium antagonist of the dihydropyridine family. The potential synergic action allows better control of blood pressure with once daily administration, while limiting the incidence of adverse events. Various presentations with different dosages are available to facilitate individualized therapy. Warnings and precautions for use of every molecule should of course be respected. Such a fixed dose combination should contribute to limit clinical inertia and to improve therapeutic compliance. [less ▲]Detailed reference viewed: 201 (1 ULg)
La membrane de dialyse peut-elle avoir une influence sur le statut en vitamine D du patient?
CAVALIER, Etienne ; DUBOIS, Bernard ; BEKAERT, Anne-Catherine et al
Poster (2014, October)Detailed reference viewed: 29 (10 ULg)
Dephosphorylated-uncarboxylated Matrix Gla protein concentration is predictive of vitamin K status and is correlated with vascular calcification in a cohort of hemodialysis patients.
DELANAYE, Pierre ; KRZESINSKI, Jean-Marie ; et al
in BMC Nephrology (2014), 15
Background: Matrix Gla protein (MGP) is known to act as a potent local inhibitor of vascular calcifications. However, in order to be active, MGP must be phosphorylated and carboxylated, with this last ... [more ▼]
Background: Matrix Gla protein (MGP) is known to act as a potent local inhibitor of vascular calcifications. However, in order to be active, MGP must be phosphorylated and carboxylated, with this last process being dependent on vitamin K. The present study focused on the inactive form of MGP (dephosphorylated and uncarboxylated: dp-ucMGP) in a population of hemodialyzed (HD) patients. Results found in subjects being treated or not with vitamin K antagonist (VKA) were compared and the relationship between dp-ucMGP levels and the vascular calcification score were assessed. Methods: One hundred sixty prevalent HD patients were enrolled into this observational cohort study, including 23 who were receiving VKA treatment. The calcification score was determined (using the Kauppila method) and dp-ucMGP levels were measured using the automated iSYS method. Results: dp-ucMGP levels were much higher in patients being treated with VKA and little overlap was found with those not being treated (5604 [3758; 7836] vs. 1939 [1419; 2841] pmol/L, p <0.0001). In multivariate analysis, treatment with VKA was the most important variable explaining variation in dp-ucMGP levels even when adjusting for all other significant variables. In the 137 untreated patients, dp-ucMGP levels were significantly (p < 0.05) associated both in the uni- and multivariate analysis with age, body mass index, plasma levels of albumin, C-reactive protein, and FGF-23, and the vascular calcification score. Conclusion: We confirmed that the concentration of dp-ucMGP was higher in HD patients being treated with VKA. We observed a significant correlation between dp-ucMGP concentration and the calcification score. Our data support the theoretical role of MGP in the development of vascular calcifications. We confirmed the potential role of the inactive form of MGP in assessing the vitamin K status of the HD patients. [less ▲]Detailed reference viewed: 18 (0 ULg)
Inter-method variability in bone alkaline phosphatase measurement : clinical impact on the management of dialysis patients
CAVALIER, Etienne ; ; GADISSEUR, Romy et al
in Clinical Biochemistry (2014), 47(13-14), 1227-30
BACKGROUND: Bone-specific alkaline phosphatase (BAP) is now recommended to assess bone turnover in hemodialysis (HD) patients. However, little is known about potential variability between methods ... [more ▼]
BACKGROUND: Bone-specific alkaline phosphatase (BAP) is now recommended to assess bone turnover in hemodialysis (HD) patients. However, little is known about potential variability between methods available to measure BAP. METHODS: We measured BAP in 76 HD patients with six different assays (Beckman-Coulter Ostase IRMA, Beckman-Coulter Ostase Access, IDS iSYS Ostase, IDS Ostase enzyme immunoassay, DiaSorin Liaison Ostase and Quidel MicroVue BAP). RESULTS: We observed a high correlation between all the assays ranging from 0.9948 (IDS iSYS vs. IDS EIA) to 0.9215 (DiaSorin Liaison vs. Quidel MicroVue). However, using the regression equations, the equivalent concentration of a Beckman-Coulter Access value of 10μg/L can range from 7.7 to 14.4μg/L and of 20μg/L can range from 16.9 to 27.9μg/L with other assays. According to Beckman-Coulter Access, 13%, 50% and 37% of the patients presented BAP values ≤10, between 10 and 20 and ≥20μg/L, respectively. Discrepancies are observed when other assays are used (concordance from 10 to 100%). CONCLUSIONS: Analytical problems leading to inter-method variation should be overcome to improve the usefulness of this marker in clinical practice. According to correlation results, recalibration of BAP assays is necessary but should not be a major issue. [less ▲]Detailed reference viewed: 46 (18 ULg)