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D Forget

Publications and source records attributed to D Forget.

12 recordsLinked to original sources
PubMed1995

Influence of pregnancy on the course of primary chronic glomerulonephritis.

According to some nephrologists, pregnancy has damaging effects on renal function in primary glomerulonephritis, but the evidence is conflicting. We evaluated the effect of pregnancy on the occurrence of end-stage renal failure (ESRF) in 360 patients with various histological forms of primary glomerulonephritis but with normal renal function (serum creatinine < or = 0.11 mmol/L) at presentation. In actuarial analyses, overall ESRF-free survival did not significantly differ between women who became pregnant after clinical onset of renal disease (n = 171) and those who did not conceive (n = 189). Furthermore, in a case-control study pregnancy did not emerge as a risk factor for progression to ESRF (odds ratio 1.15 [95% CI 0.61-2.18]), whereas the type of glomerulonephritis and hypertension were major determinants. We conclude that pregnancy does not affect the course of renal disease in patients who have normal renal function at conception.

Adult↗
PubMed1992

Supplemented low-protein diets protect the rat kidney without causing undernutrition.

Low-protein diets supplemented with keto-analogues and essential amino acid (KA-EAA) mixtures or with EAA have been widely used to retard renal deterioration without affecting nutrition. These assumptions have recently been challenged in clinical studies and rest on little or no experimental data. The effects of EAA and KA-EAA supplementations have not been compared. We compared three groups of rats with subtotal nephrectomy that were fed (1) a 16% casein reference (R) diet, (2) a 6% casein plus EAA (A) diet, or (3) a 6% casein plus KA-EAA (K) diet with KA as amino acid salts. The three diets had the same energy and mineral contents, and they induced comparable growth. The two supplements had the same nitrogen content. The only difference found until month 3 was higher proteinuria and plasma urea levels in group R rats. Renal biopsies performed at month 3 showed more severe glomerular sclerosis and tubular changes in R rats than in A and K rats. From months 3 through 7, R rats developed higher plasma creatinine levels than did A and K rats (final median values: 167, 106, and 83 mumol/L; p < 0.04), had more proteinuria (232, 56, and 84 mg/day), and showed greater mortality rates. At the time the rats were killed, 2 R, 6 A, and 5 K rats had survived while receiving the diets. Examination of the remnant kidneys, regardless of time of death, showed that renal lesions were significantly worse in R than in A and K rats, with sclerosis affecting more than 50% of the glomeruli in 7 of 13 R, 4 of 14 A, and 4 of 15 K rats, and less than 25% glomeruli in 2 of 13 R, 10 of 14 A, and 10 of 15 K rats (A and K vs R: p < 0.03). In conclusion, restriction of nonessential amino acids compensated by EAA or by KA-EAA mixtures retards renal damage without affecting growth, but no real benefit of KA or EAA has been observed.

Amino Acids, Essential↗
PubMed1991

Specific controversies concerning the natural history of renal disease in pregnancy.

Whether or not pregnancy adversely affects the natural course of underlying primary renal disease, and whether fetal outcome is influenced by the type of renal disease per se are controversial issues. We retrospectively analyzed the fetal and maternal outcome in 148 women with various, biopsy-proven histological types of primary chronic glomerulonephritis (GN), including IgA GN (52 patients), membranous GN ([MGN] 20 patients), membranoproliferative type 1 GN ([MPGN] 58 patients), focal and segmental glomerulosclerosis ([FSGS] 13 patients), and minimal change nephrotic syndrome ([MCNS] 22 patients), who were pregnant (with a total of 290 pregnancies) after the clinical onset of GN, and in 104 women with reflux nephropathy (with a total of 254 pregnancies). Fetal outcome was poor in the presence of uncontrolled hypertension, nephrotic range proteinuria, and/or impaired renal function at conception or early in gestation, whatever the type of renal disease. An accelerated, more rapid than expected, worsening of maternal renal function was observed in five GN patients of whom four (two IgA, two MPGN) had serum creatinine (Scr) levels greater than 160 mumol/L (1.8 mg/dL) early in gestation, and in five patients with reflux nephropathy whose Scr at conception ranged from 180 to 490 mumol/L (2.0 to 5.5 mg/dL).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

[Fetal and maternal risk of pregnancy in women with primary chronic glomerulonephritis].

This review focuses on the reciprocal influence of underlying primary glomerular disease on fetal outcome and of pregnancy on the course of maternal nephropathy, based on most recent data in the literature and on a personal series of 240 pregnancies in 122 women with biopsy-proven chronic glomerulonephritis (CGN) followed at Necker Hospital. The first part analyzes the fetal outcome in the various histopathologic types of CGN and points out the major influence as risk factors for fetal outcome, of the presence of nephrotic syndrome, high blood pressure and/or impaired renal function at conception. The second part deals with the debated problem of the influence of pregnancy on maternal renal disease. It has become evident that pregnancy has no deleterious effect per se on the course of maternal disease when renal function is normal or near normal at conception, whereas an accelerated course is often observed when plasma creatinine is in excess of 0.18 mmol/l at conception, whatever the type of CGN. In the third part are described preconception counselling and the practical rules of maternal and fetal surveillance.

Female↗
PubMed1987

Pregnancy in IgA nephropathy, reflux nephropathy, and focal glomerular sclerosis.

Fetal outcome was retrospectively studied in 217 pregnancies observed during the past two decades in 93 patients, 34 suffering from IgA nephropathy (IgAGN, 69 pregnancies), 53 from reflux nephropathy (RN, 137 pregnancies), and six from focal glomerular sclerosis (FGS, 10 pregnancies). Overall incidence of live births was 175 in 217 (81%). Fetal loss, corrected for induced abortions, was 10 in 66 (15%) in IgAGN, 18 in 129 (14%) in RN, and 2 in 10 in FGS. Renal failure and hypertension preexisting prior to conception or developing early in pregnancy were the most important factors associated with unsuccessful fetal outcome whereas urinary tract infection had limited effects in RN patients. Influence of pregnancy on the course of maternal renal disease was evaluated in the same groups of patients. An abnormally rapid deterioration of renal function was observed in three of the women with IgAGN and in one of the RN patients (with an additional case among 46 further female RN patients) but in none in the FGS group. All five women experiencing functional deterioration had a serum creatinine (SCr) level of greater than or equal to 200 mumol/L (2.3 mg/dL) and hypertension at conception. Hypertension in pregnancy was highly predictive of recurrence of hypertension in subsequent pregnancy and of the remote development of permanent hypertension in IgAGN patients. We conclude that when renal function is preserved, pregnancy is usually successful and no deleterious effects on maternal renal disease are to be expected in patients with IgAN, RN, and probably FGS.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1987

Reflux nephropathy and pregnancy.

Reflux nephropathy is one of the most frequent renal diseases encountered in women of childbearing age. Patients with severe bilateral atrophy are the most likely to develop proteinuria, hypertension, focal glomerular sclerosis and progressive chronic renal failure, and those with persistent vesicoureteral reflux are the most likely to suffer recurrent pyelonephritic episodes. Often the disease is clinically latent and first manifests itself in pregnancy, mainly by urinary tract infection but also by proteinuria, hypertension, pre-eclampsia or renal failure. Pregnancy is most often successful and uneventful whenever renal function is normal or near normal and hypertension is absent at conception. Urinary tract infection accounts for frequent morbidity but rarely results in fetal mortality. By contrast, when renal function is significantly impaired, that is in patients whose plasma creatinine concentration is in excess of 0.18-0.20 mmol/l at conception, especially when hypertension is also present, there is clearly a high risk of severe fetal growth retardation or intrauterine death. Moreover, there is a striking risk of rapid worsening of renal function and hypertension, with accelerated progression towards end-stage renal failure. Thus, women with reflux nephropathy should attempt to conceive before the plasma creatinine concentration has reached 0.18 mmol/l, and patients with values higher than these should be clearly advised of the high risk for both the pregnancy and the progression of the disease.

Female↗