References of "Krzesinski, Jean-Marie"
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See detailDiabetes and the kidney disease risk
Krzesinski, Jean-Marie ULg

Conference (2017, April 26)

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See detailIgG4-related membranous glomerulonephritis and generalized lymphadenopathy without pancreatitis: a case report
HUART, Justine ULg; GROSCH, Stéphanie ULg; BOVY, Christophe ULg et al

in BMC Nephrology (2017), 18

Abstract Background: IgG4-related disease is a recently described pathologic entity. This is the case of a patient with nephrotic syndrome and lymphadenopathy due to IgG4-related disease. Such a kidney ... [more ▼]

Abstract Background: IgG4-related disease is a recently described pathologic entity. This is the case of a patient with nephrotic syndrome and lymphadenopathy due to IgG4-related disease. Such a kidney involvement is quite peculiar and has only been described a few times recently. Renal biopsy showed a glomerular involvement with membranous glomerulonephritis in association with a tubulo-interstitial nephropathy. Moreover, the patient was not suffering from pancreatitis. Case presentation: The patient is a middle-aged man of Moroccan origin. He has developed recurrent episodes of diffuse lymphadenopathies, renal failure and nephrotic syndrome. Renal biopsies showed membranous glomerulonephritis. Discussion and conclusion: The diagnostic approach of this atypical presentation is discussed in this case report as well as diagnostic criteria, therapeutic strategies, biomarkers and pathophysiology of IgG4-related disease. IgG4-related membranous glomerulonephritis is a well-established cause of membranous glomerulonephritis. It must be sought after in every patient with a previous diagnosis of IgG4-related disease and in every patient with this histological finding on renal biopsy. Corticoids are still the first-line treatment of IgG4-related disease. New therapeutic strategies are needed to avoid glucocorticoids long term side-effects. Interestingly, the patient was prescribed cyclophosphamide in addition to glucocorticoids for an immune thrombocytopenia. This treatment had a very good impact on his IgG4-related disease. [less ▲]

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See detailManagement of hypertension in renal transplant patients
Krzesinski, Jean-Marie ULg

Conference (2017, March 31)

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See detailintravenous administration of mesenchymal stream cells modulates renal lipid metabolism in rats
ERPICUM, Pauline ULg; Rowart, Pascal ULg; POMA, Laurence ULg et al

Conference (2017, March 16)

Mesenchymal stromal cells (MSC) have been shown to attenuate renal ischemia/reperfusion (I/R) injury in rodents. Still, the mechanisms of such a nephroprotection remain unclear. Here, rats were ... [more ▼]

Mesenchymal stromal cells (MSC) have been shown to attenuate renal ischemia/reperfusion (I/R) injury in rodents. Still, the mechanisms of such a nephroprotection remain unclear. Here, rats were intravenously infused with MSC (1.5x10^6 cells in 1 ml saline; MSCD-7 group, n=6) or equivalent volume of saline (SD-7 group, n=6) 7 days before kidney sampling. High-throughput RNA sequencing technology was used to compare transcriptomic renal profiles, using TopHat and Cufflinks open-source software tools. A total of 494 and 256 genes were found to be significantly (q-value <.05) down- and up-regulated in mscd-7 versus sd-7 groups, respectively. Hierarchical cluster analysis by “david” “webgestalt” softwares highlighted that the metabolic pathways mostly affected msc included adipogenesis, insulin signalling, fatty acid (fa) biosynthesis, il-6 b-cell receptor il-3 pathway nuclear receptors involved lipid me- tabolism. Real-time qpcr immunoblotting analyses confirmed pivotal enzymes of fa biosynthesis were significantly downregulated group, whereas expression ppar alpha, a transcription factor oxidation, was induced msc. Additional- ly, fat />CD36 – a key regulator of membrane uptake of FA – was increased in MSCD-7 kidneys, with a preferential localization in proximal tubules (PT). As a whole, our data suggest that MSC infusion causes critical modifications of lipid metabolism, including (i) down-regulation of FA biosynthesis; (ii) activation of PPAR alpha pathway, and (iii) prioritization of FA as sources of energy in PT cells, which may eventually prevent lipid peroxidation and attenuate renal I/R damage. [less ▲]

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See detailHTA et cholestérol : prise en charge intégrée - Cas cliniques
Krzesinski, Jean-Marie ULg

Conference (2017, February 18)

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See detailL'hypertension artérielle dans tous ses états
Krzesinski, Jean-Marie ULg

Scientific conference (2017, January 24)

HTA : définition, physiopathologie, conséquences et traitement. Comment gérer une élévation des chiffres tensionnels en 2017? Comment pratiquer l'automesure? Quel traitement proposer?

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See detailThe added value of plasma or urinary NGAL concentrations in clinical practice
Gregoire, Emilien ULg; Claisse, Guillaume; GUIOT, Julien ULg et al

Poster (2017, January 13)

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See detailLe medicament du mois BIPRESSIL(R) : Premiere association fixe bisoprolol et perindopril arginine.
GACH, Olivier ULg; FALQUE, Bertrand ULg; CANIVET, Antoine ULg et al

in Revue Médicale de Liège (2017), 72(5), 260-265

In patients suffering from systemic arterial hypertension, coronary artery disease, or heart failure, beta-blockers and angiotensin-convertase enzyme inhibitors play a major therapeutic and preventive ... [more ▼]

In patients suffering from systemic arterial hypertension, coronary artery disease, or heart failure, beta-blockers and angiotensin-convertase enzyme inhibitors play a major therapeutic and preventive role. Coronary artery disease remains the leading cause of mortality in industrialized countries. Unless adapted preventive strategy, notably pharmacological interventions, cardiovascular events in these patients remain high. One reason for this relative failure is represented by non-adherence to treatment. A treatment consisting in an association in one pill of several different molecules should confer a higher treatment compliance and thus efficacy. This article describes the characteristics of the first available dual association between a cardioselective beta-blocker agent, bisoprolol, and an angiotensin-convertase enzyme inhibitor, perindopril arginine. [less ▲]

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See detailImpact of the type of dialysis membranes on the circulating concentration of markers of vitamin D metabolism.
Cavalier, Etienne ULg; Torres, Pablo U.; Dubois, Bernard E. et al

in International Journal of Artificial Organs (2017)

INTRODUCTION: Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend vitamin D supplementation in hemodialyzed patients to monitor 25(OH)-vitamin D 25(OH)D levels. However, patient-to ... [more ▼]

INTRODUCTION: Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend vitamin D supplementation in hemodialyzed patients to monitor 25(OH)-vitamin D 25(OH)D levels. However, patient-to-patient inconsistency can be observed in response to the treatment. In this study, we aimed to evaluate the impact of the dialysis membrane on 25(OH)D, albumin (Alb) and vitamin D-binding protein (VDBP), the major players of vitamin D transport and storage. MATERIAL AND METHODS: Alb (Cobas), VDBP (R&D) and 25(OH)D (liquid chromatography-tandem mass spectrometry) were measured in 75 patients before and after a 4-hour dialysis session. Ten dialysis membranes were used: FX10, FX80, FX800, BK-2.1F, BG-2.1U, Rexeed 15 A, Rexeed 21 A, TS 1.8 SL and TS 2.1 SL manque la ELISIO 21H. Accordingly, 13 patients were dialyzed with membranes possessing high adsorption and high cut-off properties (BK), 17 with membranes possessing high adsorption but usual cut-off properties (BG) and all the remaining 45 patients with polysufone (PS) membranes with usual adsorptive and cut-off properties. Among these 45 patients treated with PS, we compared those treated by classical dialysis (HD) (n = 14) and hemodiafiltration (HDF) (n = 31). Results were corrected for total extracellular volume to take into consideration the hemoconcentration after dialysis. RESULTS: The 3 analytes showed a decreased concentration after the dialysis session. The decrease of ALB, VDBP and 25(OH)D was similar with the adsorptive (BG) and PS membranes. However, patients treated with adsorptive and high cut-off membrane (BK) presented a significantly higher decrease values of Alb (-9.6%[-15.1; -7.5]), of VDBP (-20.6%[-36.6; -17.2] and 25(OH)D (-17%[-27.3; -12.3]) compared to other membranes (BG and PS).When we limited our study to PS membranes, we did not observe any significant difference between the HD or HDF modalities in the decrease for any of the studied parameters. CONCLUSIONS: A significant loss of Alb, VDBP and 25(OH)D occurs after a dialysis session. This loss is significantly more important when patients are dialyzed with high adsorption and high cut-off dialysis membranes. [less ▲]

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See detailImplications of the calcium-sensing receptor in ischemia/reperfusion.
Paquot, Francois; Huart, Justine; Defraigne, Jean-Olivier ULg et al

in Acta Cardiologica (2017), 72(2), 125-131

The calcium-sensing receptor (CaSR) is a G protein-coupled receptor (GPCR) which was first isolated from bovine parathyroid glands. Its complex structure has been well characterized, which helped to ... [more ▼]

The calcium-sensing receptor (CaSR) is a G protein-coupled receptor (GPCR) which was first isolated from bovine parathyroid glands. Its complex structure has been well characterized, which helped to better understand its function. The CaSR activity can be modulated by various ligands, either activators (also called "calcimimetics") or inhibitors (or "calcilytics"). The main role of the CaSR concerns Ca2+ homeostasis. In bone, intestine and kidney, the CaSR acts as a sensor for extracellular ionized Ca2+ concentration ([Ca2+]e) to keep it stable. Such a homeostatic function is well illustrated by human inherited diseases caused by mutations in CASR gene, characterized by Ca2+ balance disturbances. Interestingly, the CaSR is also expressed in numerous tissues which are not directly involved in Ca2+ regulation. There, the CaSR has been implicated in regulatory pathways, including cell proliferation, differentiation and apoptosis. Moreover, recent observations suggest that the CaSR may be involved in ischaemia/reperfusion (I/R) cascades. In cardiomyocytes, the expression and activation of the CaSR are significantly induced at the time of I/R, which induces apoptotic pathways. Likewise, the activation of the CaSR in I/R in brain, liver and kidney has been associated with increased cell death and aggravated structural and functional damage. The present review summarizes these observations and hypothesizes a novel therapeutic option targeting the CaSR in I/R. [less ▲]

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See detailFibrillation auriculaire et anticoagulation chez le patient hémodialysé : une décision difficile
DELANAYE, Pierre ULg; BOUQUEGNEAU, Antoine ULg; DUBOIS, Bernard ULg et al

in Néphrologie & Thérapeutique (2017)

Cardiovascular mortality of hemodialysis patients remains a major problem. The prevalence and incidence of atrial fibrillation in this population are more important than in the general population. The ... [more ▼]

Cardiovascular mortality of hemodialysis patients remains a major problem. The prevalence and incidence of atrial fibrillation in this population are more important than in the general population. The indication of antivitamin K therapy (AVK) in this context of atrial fibrillation must be weighted against the increased risk of bleeding. Unfortunately, and contrary to the general population, an indication of anticoagulation based on embolic or hemorrhagic risk scores is not as clearly established in the hemodialysis population. No prospective randomized study has investigated the benefit/risk balance of anticoagulant treatment in hemodialysis subjects. This article is a review of the current literature on this topic, showing the prevalence of thromboembolic but also bleeding events in the hemodialysis population. The impact of AVK treatment in this specific population is also reviewed. To the best of our knowledge, the indication of treatment must be individualized. [less ▲]

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See detailThe closure of arteriovenous fistula in kidney transplant recipients is associated with an acceleration of kidney function decline
WEEKERS, Laurent ULg; VANDERWECKENE, Pauline ULg; pottel, hans et al

in Nephrology Dialysis Transplantation (2017)

ABSTRACT Background. The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, the impact of AVF closure on renal function in kidney ... [more ▼]

ABSTRACT Background. The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, the impact of AVF closure on renal function in kidney transplant recipients (KTRs) remains unknown. Methods. From 2007 to 2013, we retrospectively categorized 285 KTRs into three groups: no AVF (Group 0, n = 90), closed AVF (Group 1, n = 114) and left-open AVF (Group 2, n = 81). AVF closure occurred at 653 ± 441 days after kidney transplantation (KTx), with a thrombosis:ligation ratio of 19:95. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. Linear mixed models calculated the slope and intercept of eGFR decline versus time, starting at 3 months post-KTx, with a median follow-up of 1807 days (95% confidence interval 1665–2028). Results. The eGFR slope was less in Group 1 (−0.081 mL/min/ month) compared with Group 0 (−0.183 mL/min/month; P = 0.03) or Group 2 (−0.164 mL/min/month; P = 0.09). Still, the eGFR slope significantly deteriorated after (−0.159 mL/min/month) versus before (0.038 mL/min/month) AVF closure (P= 0.03). Study periods before versus after AVF closure were balanced to a mean of 13.5 and 12.5 months, respectively, with at least 10 observations per patient (n = 99). Conclusions. In conclusion, a significant acceleration of eGFR decline is observed over the 12 months following the closure of a functioning AVF in KTRs. [less ▲]

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See detailNon-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients, part II: omics analyses of urine and blood samples
Erpicum, Pauline ULg; HANSSEN, Oriane ULg; WEEKERS, Laurent ULg et al

in Clinical Kidney Journal (2017)

Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, the full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ... [more ▼]

Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, the full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene-expression profiling and omics analyses of blood and urine samples. Most imaging techniques, such as contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leucocytes may be detectable by 18F-fluorodeoxyglucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3ε, CXCL10 and 18S RNA levels, have been identified. None of these approaches has yet been adopted in the clinical follow-up of KTRs, but standardization of analysis procedures may help assess reproducibility and comparative diagnostic yield in large, prospective, multicentre trials. [less ▲]

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See detailFACILITER L'ADHÉRENCE AU TRAITEMENT IMMUNOSUPPRESSEUR CHEZ LES TRANSPLANTÉS DU REIN- TEST D'UN SYSTEME DE COACHING PAR SMARTPHONE
Saint-Remy, Annie ULg; Spiroux, Marie; WEEKERS, Laurent ULg et al

Poster (2016, December 08)

Facilitate adherence to immunosuppressive treatment in kidney transplant recipients – test of a coaching system with smartphone application A.Saint-Remy, M. Spiroux, L. Weekers, C. Bonvoisin, JM ... [more ▼]

Facilitate adherence to immunosuppressive treatment in kidney transplant recipients – test of a coaching system with smartphone application A.Saint-Remy, M. Spiroux, L. Weekers, C. Bonvoisin, JM. Krzesinski Introduction: Nonadherence to immunosuppressants is a determining cause of graft loss. The present study tested during 1 month, the usefulness and the effectiveness of a coaching system using smartphone application (the Transplant Smartcoach®) on adherence in kidney transplant recipients. Methodology: The sample included 51 patients (28m/23w) transplanted for 1 year at least, mean age 52±12 years, mean graft survival 3.7±1 years. Each patient had a smartphone configured with its detailed treatment. Using the smartphone application, patient had to notify daily the intake of each tablet into a 2-hour window. If no notification was performed 1 hour later than the scheduled time of intake, the patient was contacted by a nurse to remind him to take medications. Results: 90 % of patients were treated with Tacrolimus and 10 % with cyclosporine, associated with mycophenolic acid (41 %) or mycophenolate mofetil (49 %), 41 % had corticosteroids. Whatever was the immunosuppressant, a perfect adherence (medications taken at the scheduled time) was observed on average in 53 % of the morning monthly intakes. There was no difference in adherence rates between the morning intakes of Advagraf ® (once/day) and Prograft® (2 times/day), a decrease of perfect adherence was identified with the evening intake of Prograft® (53 % vs 44%; P=0.07) and the one of Myfortic® (P=0.03) with consequently an increased frequency of nurse’s recalls. Adherence was lower in younger patients and in those still working. The complexity of treatment (many drugs intake/day) and the respect for time intervals between drug intakes were the major barriers to adherence. When compared to the one measured before using the Smartcoach, the variability (coefficient of variation, %) of the Tacrolimus trough level decreased by 32.6 % (P=0.027) in the 3 to 6 months following the test. Conclusion: patients appreciated the ease and usefulness of the coaching system with smartphone application to help medication adherence. Coupled with therapeutic education of the patients, that tool deserves to be used notably in newly transplanted patients and when a worrying decrease in adherence is observed to help them in the management of a rigorous adherence which should contribute to graft survival. [less ▲]

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See detailComment mesurer correctement la PA chez les patients hémodialysés?
VANDERWECKENE, Pauline ULg; SAINT-REMY, Annie ULg; KRZESINSKI, Jean-Marie ULg

Poster (2016, December)

Objectifs : Le contrôle de la pression artérielle (PA) chez le patient hémodialysé (HD) est un enjeu majeur en raison des résultats controversés sur les risques cardiovasculaires qui y sont associés ... [more ▼]

Objectifs : Le contrôle de la pression artérielle (PA) chez le patient hémodialysé (HD) est un enjeu majeur en raison des résultats controversés sur les risques cardiovasculaires qui y sont associés. Cependant, la mesure de la PA dans cette population est difficile à appréhender au vu de sa grande variabilité. L’exactitude des mesures péridialytiques (enregistrées dans l’unité d’HD pendant la séance) est souvent remise en question. L’objectif de notre étude est d’établir la contribution et la concordance entre deux techniques de mesure ambulatoire pour détecter la PA non contrôlée chez ces patients HD. Il s’agit du monitoring ambulatoire interdialytique de 44h (MAPA) et de l’automesure au domicile (HBPM) pendant une durée variable de 3, 5 et 7 jours. Méthodologie : 43 patients hémodialysés chroniques (H=28, F = 15), avec une moyenne de 68,3±13 ans ont réalisé une MAPA de 44h (Spacelabs 90207), de la fin d’une séance d’HD au début de la suivante, immédiatement suivie par une automesure de 7 jours (Omron M6). Les mesures péridialytiques étaient la moyenne des PA pré-dialyse ou post-dialyse enregistrées sur 2 semaines (6 séances d’HD). L’hypertension était définie par une PA égale ou supérieure à 140/90 mmHg pour la PA pré-HD, 130/80 mmHg pour la PA post-HD, 130/80 mmHg pour la MAPA de 44 h et 135/85 mmHg pour l’HBPM. Résultats : Nous avons constaté de bonnes corrélations entre la MAPA et l’HBPM pour le diagnostic de l’hypertension chez le patient HD. Comparées aux PA péridialytiques, les 2 techniques ambulatoires ont permis d’identifier la même proportion d’hypertension masquée et d’hypertension de la blouse blanche (25%). La plus grande précision de diagnostic sur le status tensionnel est retrouvée pour les plus longues périodes d’enregistrement (44h pour la MAPA et 7 jours pour l’HBPM). Les plus courtes périodes étaient mieux tolérées par les patients mais moins précises pour détecter l’hypertension. L’automesure était plus appréciée que la MAPA de 44h. Conclusion : La MAPA et l’automesure ont permis d’identifier un quart de patients avec un phénotype particulier d’hypertension, qui n’aurait pas été classé correctement en se fiant uniquement aux mesures péridialytiques. L’automesure devrait être recommandée en première ligne chez le patient HD (au moins une semaine/mois). Cependant, la MAPA fournit des informations uniques comme la PA nocturne et pourrait être proposée, idéalement une fois par an, chez tous les patients. [less ▲]

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See detailAssociation entre taux circulants de matrix-gla protéine et rigidité artérielle en transplantation rénale.
Dinic, Miriana; Maillard, Nicolas; DELANAYE, Pierre ULg et al

Conference (2016, December)

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See detailHow to measure accurately blood pressure in hemodialysis patients?
VANDERWECKENE, Pauline ULg; SAINT-REMY, Annie ULg; KRZESINSKI, Jean-Marie ULg

Conference (2016, October 29)

Objective : Blood pressure (BP) control in chronic hemodialysis (HD) patients is a major challenge and could explain the controversial results about its cardiovascular risk. Our study aimed to assess the ... [more ▼]

Objective : Blood pressure (BP) control in chronic hemodialysis (HD) patients is a major challenge and could explain the controversial results about its cardiovascular risk. Our study aimed to assess the contribution of two ambulatory techniques of measurements compared with office BP (OBP): ambulatory monitoring during a maximum of 44h interdialytic period (ABPM) and home blood pressure (HBPM) during a variable period of days in prevalent HD patients. Methodology : 43 prevalent chronically HD patients (M=28; F=15), mean age 68.3±13 years were submitted to a 44h monitoring of BP (Spacelabs 90207) from the end of an HD session to 10 minutes before the next session, immediately followed by a 7days HBPM (Omron M6). Office BP was the mean of pre-dialysis BP or post-dialysis-BP recorded over 2 weeks (6 HD sessions). Hypertension was defined as BP equal or higher than 140/90 mmHg for pre-HD, 130/80 mmHg for post-HD, 130/80 mmHg for 44 h ABPM and 135/85 mmHg for HBPM. Results : Good correlations were noted between ABPM and HBPM for the diagnosis of hypertension in HD patients. Both ambulatory techniques give the same proportion of masked hypertension and white coat hypertension compared with OBP (25%). The best diagnostic precision was noted for the longest periods of recordings (44h for ABPM and 7days for HBPM). Shorter periods were more practical for the patients but less precise for high BP identification. HBPM was more appreciated than ABPM by the patients Conclusion : ABPM and HBPM identified a quarter of patients with a particular phenotype of hypertension not correctly classified by OBP. HBPM should be first recommended in HD (at least 1 week/month). As ABPM provides unique information for nocturnal BP, it could be proposed 1 time/year in all patients. [less ▲]

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