Parathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients : Is it so simple?

in Clinica Chimica Acta (2013), 417

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase ... [more ▼]

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase (b-ALP) can be used to evaluate MBD in dialysis patients. The evidence remains moderate and based on transversal studies. <br />Methods: We retrospectively investigated the variations of PTH (ΔPTH) and b-ALP (Δb-ALP) serum concentrations over a short (6-weeks) and a long (one-year) period in a monocentric hemodialysis population. The proportion of patients reaching the critical difference (CD) (50% for PTH and 25% for b-ALP) was calculated. <br />Results: Seventy-seven patientswere included. A significant correlation between PTHand b-ALP levelswas found at baseline (r=0.51). By contrast, no correlation was observed between ΔPTH and Δb-ALP over a 6-week interval (r=0.07). The CD for PTH and b-ALP was reached by 19 and 11 patients, respectively, with 2 patients showing consistent variations of both biomarkers. One year later, measurements were repeated in 48 survivors. <br />No correlation was found between ΔPTH and Δb-ALP (r=0.27). The CD for PTH or b-ALP was reached by 24 patients and 28 patients, respectively, with 6 patients (12.5%) showing opposite results for both biomarkers. <br />Conclusion: This study shows the lack of correlation between ΔPTH and Δb-ALP over time in patients under chronic hemodialysis. [less ▲]

Le débit de filtration glomérulaire est-il un déterminant de la concentration plasmatique du NGAL aux soins intensifs ?

Poster (2012)

Parathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients: is it so simple?

Poster (2012)

Adhésion thérapeutique du patient hémodialysé

Poster (2012)

MRI preclinical detection and asymptomatic course of a progressive multifocal leucoencephalopathy (PML) under natalizumab therapy.

in Journal of Neurology, Neurosurgery & Psychiatry (2012), 83

Early detection of progressive multifocal leucoencephalopathy (PML) in the setting of natalizumab therapy currently is performed by rapid evaluation of new symptoms occurring in treated patients. The role ... [more ▼]

Early detection of progressive multifocal leucoencephalopathy (PML) in the setting of natalizumab therapy currently is performed by rapid evaluation of new symptoms occurring in treated patients. The role of MR scanning has not been investigated but holds promise since MR detection is highly sensitive for PML lesions. The authors report a case of presymptomatic PML of the posterior fossa detected by MR scans. Immediate suspension of natalizumab and plasma exchanges resulted in a rapid decline of natalizumab serum concentration. Intravenous steroids started together with plasma exchanges followed by an oral tapering course were used to minimise the immune reconstitution inflammatory syndrome. No symptoms (beyond mild headache) developed, and the repeat PCR for JC Virus (JCV) DNA detection performed 10 weeks later was negative. This case suggests that: (1) periodic brain MR scans may detect signs of presymptomatic PML in MS patients treated with natalizumab, (2) corticosteroid management of inflammatory reaction may contribute to optimal control of the immune reconstitution inflammatory syndrome routinely seen with natalizumab-associated PML and (3) early radiological detection of PML can have an excellent outcome even in a clinically critical region and despite prior immunosuppressant exposure. The potential benefit of regular MR scanning just using the T2/FLAIR modalities could be further investigated in order to detect early natalizumab-associated PML, leading to benign outcomes. [less ▲]

Are the complications of arteriovenous fistulas associated with an abnormal ankle-brachial index in hemodialysis patients?

in Acta Clinica Belgica (2010), 65-1

The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We ... [more ▼]

The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We analysed the relationship between ABI abnormal values and arteriovenous fistulas (AVF) complications such as stenosis and thrombosis among chronically hemodialysis pat ients (HD). [less ▲]

Détection et estimation du niveau de la maladie rénale chronique

in Revue Médicale de Liège (2009), 64(2), 73-78

L’insuffisance rénale voit son incidence augmenter. Un diagnostic précoce et précis est requis. Le diagnostic de l’insuffisance rénale repose sur la mesure du débit de filtration glomérulaire. Les ... [more ▼]

L’insuffisance rénale voit son incidence augmenter. Un diagnostic précoce et précis est requis. Le diagnostic de l’insuffisance rénale repose sur la mesure du débit de filtration glomérulaire. Les formules basées sur la créatinine pour déterminer ce débit ont, par rapport à la créatinine sérique seule, apporté un plus mais, dans certaines situations, elles fournissent des résultats erronés. Le recours à la mesure de la clairance de créatinine sur une récolte d’urines de 24 heures peut être, dans ces situations où les caractéristiques anthropométriques sont hors normes, utile, mais avec toujours la difficulté d’une récolte minutée correcte. Si une mesure précise du débit de filtration glomérulaire est absolument nécessaire, une méthode de référence doit être choisie telle celle au chrome EDTA ou à l’iohexol. Enfin, tout bilan néphrologique doit, outre le dosage de créatinine, comprendre au moins une analyse d’urine à la tigette. Toute positivité pour la protéinurie lors de ce test mérite de réaliser un dosage quantitatif de la protéinurie soit sur 24 heures, soit plus aisément sur un échantillon [less ▲]

Les complications des fistules artério-veineuses sont-elles associées à un Index Cheville-Bras pathologique chez le patient hémodialysé chronique ?

Poster (2009)

Analysis of factors affecting the ankle-brachial index (ABI) in hemodialysis patients (HD), a 4 year longitudinal study

Poster (2008, December 13)

Low creatine kinase MM (CK-MM) levels are strongly associated with adverse outcome in haemodialysis patients

Poster (2008, May)