La prise en charge de l'insuffisance rénale chronique avant la dialyse

in Revue Médicale de Liège (2009), 64(2), 79-85

Chronic renal failure is usually a silent disease until its late stage, especially in elderly people. Screening for such disease is particularly useful in hypertensive diabetic patients above 50 years ... [more ▼]

Chronic renal failure is usually a silent disease until its late stage, especially in elderly people. Screening for such disease is particularly useful in hypertensive diabetic patients above 50 years. The causes are indeed often vascular or metabolic (directly or not directly linked to diabetes mellitus). Other less frequent causes are yet possible. The search for the right diagnosis of renal insufficiency is always requested to apply the appropriate treatment, combined with medical measures for secondary and tertiary prevention. This review will give general advices to avoid the development of renal disease (stages 3 and 4) or its progression, and also insist on the potential nephrotoxic effects of some drugs. [less ▲]

L'hémofiltration on-line peut-elle modifier la progression de l'athérosclérose et les calcifications vasculaires chez les patients hémodialysés?

Conference (2009, January 28)

Influence de la largeur des pores des membranes utilisées au cours de l’hémofiltration et du débit d’ultrafiltration sur la clairance plasmatique de l’interleukine 6 dans un modèle porcin de choc septique.

in Réanimation (2009), 18(1), 037

Indexing Glomerular Filtration Rate for Body Surface Area: Myth and Reality

in Krüger, E.; Hahn, K. (Eds.) Nephrology Dialysis Transplantation (2009)

Les sartans, une arme de choix dans le traitement de l'hypertension artérielle (6)

in Journal de Cardiologie [= JDC] = Tijdschrift voor Cardiologie [= TVC] (2009), 319

Le Pr Jean-Marie Krzesinski (Ulg) souligne que la situation en matière d'hypertension artérielle dans notre pays ne s'est pas tellement améliorée ces dernières années.

Estimation du debit de filtration glomérulaire chez le patient obese: performances des équations basées sur la créatinine et la cystatine C

in Néphrologie & Thérapeutique (2009), 5(5), 003

How to treat hypertension in blacks: review of the evidence

in Acta Clinica Belgica (2009), 64(6), 466-476

Abstract : Presentation, response to therapy, and clinical outcome differ according to race for patients with hypertension. Black patients have a higher prevalence and earlier onset of hypertension than ... [more ▼]

Abstract : Presentation, response to therapy, and clinical outcome differ according to race for patients with hypertension. Black patients have a higher prevalence and earlier onset of hypertension than other ethnic groups, with poorer prognosis than white patients. Blacks are more likely to be salt-sensitive, and to have a low plasma renin activity than are whites. They are at much greater risk of developing cardiovascular and renal complications. Despite many advances in the understanding and treatment of cardiovascular diseases, black patients continue to have increased morbidity and mortality from the end-organ complications of hypertension. The explanations for these observations remain incompletely understood, but genetic differences, added to socio-economic and environmental factors, have been proposed to explain this disparity. The first therapeutic approach is to decrease salt and increase potassium intakes. Diuretics (thiazides and potassium-sparing agents) and calcium channel blockers constitute the first antihypertensive drug choices. The angiotensin-converting-enzyme inhibitors, the angiotensin II receptor blockers and beta-blockers appear to be less effective in blacks with regard to uncomplicated hypertension, especially in older people, but addition of a small dose of diuretic improves their efficacy. These combinations are preferred among patients whith chronic kidney disease or heart failure. The goal for blood pressure target is the same in blacks as it is in whites, being a blood pressure of less than 140/90 mmHg in uncomplicated hypertension and less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease. [less ▲]

Prevalence of chronic kidney disease in Kinshasa: results of a pilot study from the Democratic Republic of Congo

in Nephrology Dialysis Transplantation (2009), 24(1), 117-122

Abstract Background. The burden of chronic kidney disease (CKD) in sub-Saharan Africa is unknown. The aim of this study was to investigate the prevalence and the risk factors associated with CKD in ... [more ▼]

Abstract Background. The burden of chronic kidney disease (CKD) in sub-Saharan Africa is unknown. The aim of this study was to investigate the prevalence and the risk factors associated with CKD in Kinshasa, the capital of the Democratic Republic of Congo (DRC). Methods. In a cross-sectional study, 503 adult residents in 10 of the 35 health zones of Kinshasa were studied in a randomly selected sample. Glomerular filtration rate was estimated using the simplified Modification of Diet in Renal Disease Study equation (eGFR) and compared with the Cockcroft–Gault equation for creatinine clearance. The associations between health characteristics, indicators of kidney damage (proteinuria) and kidney function (<60 ml/min/1.73 m2) were examined. Results. The prevalence of all stages of CKD according to K/DOQI guidelines was 12.4% [95% confidence interval (CI), 11.0–15.1%]. By stage, 2% had stage 1 (proteinuria with normal eGFR), 2.4% had stage 2 (proteinuria with an eGFR of 60–89 ml/min/1.73 m2), 7.8% had stage 3 (eGFR, 30–59 ml/min/1.73 m2) and 0.2% had stage 5 (eGFR < 15 ml/min/1.73 m2). Hypertension and age were independently associated with CKD stage 3. The prevalences of major non-communicable diseases considered in this study were 27.6% (95% CI, 25.7–31.3%) for hypertension, 11.7% (95% CI, 10.3–14.4%) for diabetes mellitus and 14.9% (95% CI, 13.3–17.9%) for obesity. Hypertension was also independently associated with proteinuria. Conclusion. More than 10% of the Kinshasa population exhibits signs of CKD, which is affecting adults in their productive years. Risk factors for CKD, including hypertension, diabetes and obesity, are increasing. These alarming data must guide current and future healthcare policies to meet the challenge raised by CKD in this city and hopefully in the whole country. [less ▲]

Mesure du débit de filtration glomérulaire aux soins intensifs basée sur l’iohexol : clairance plasmatique ou urinaire ?

in Réanimation (2009), 18(1), 112

Indexation du debit de filtration glomerulaire par la surface corporelle : mythe et realite

in Néphrologie & Thérapeutique (2009), 5(7), 614-22

Indexing glomerular filtration rate (GFR) for body surface area (BSA) is often realized without arising any questions. However, physiological basis for such an indexation are very poor. Indeed, indexing ... [more ▼]

Indexing glomerular filtration rate (GFR) for body surface area (BSA) is often realized without arising any questions. However, physiological basis for such an indexation are very poor. Indeed, indexing GFR for BSA to avoid variation due to differences in body size necessarily implies that GFR is a linear function of BSA and that the intercept of this linear function is zero. Moreover, when GFR is indexed for BSA, the relation indexed GFR-BSA must completely disappear. These physiological prerequisites are not found for BSA indexation. We will review the history of this indexation and will underline errors and defaults. Different equations to estimate BSA exist and will be discussed. The choice of "1.73m(2)" will be also criticized. Moreover, indexing GFR for BSA has little impact on GFR results in "normal" body size population. Nevertheless, this indexation will have strong consequences in very lean (such as anorexia) and in obese patients. We will discuss possible alternatives proposed to substitute for BSA indexation. [less ▲]