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E Renoult

Publications and source records attributed to E Renoult.

At least 55 records · Page 3Linked to original sources
PubMed1995

Elevated body lead burden from drinking water in end-stage chronic renal failure.

Delta aminolaevulinic acid dehydratase (ALA-D) who assayed in 66 patients with end-stage renal failure who live in a region where there is a high risk of lead poisoning from drinking water (Vosges mountains). Sixty patients received dialysis and six underwent renal transplantation. Results were compared to those obtained in 366 control subjects with normal renal function hospitalized in a department of Internal Medicine and living in the same geographical area. The ALA-D level was significantly lower in dialysed patients (0.40 +/- 20) than in controls (0.57 +/- 0.31) (P = 0.0014). Transplant recipients had ALA-D levels comparable to subjects with normal renal function (0.59 +/- 0.37). In this high-risk population an EDTA test was performed in 74 subjects (with normal renal function and 17 dialysis patients in combination with haemofiltration for the latter patients. In the two study groups a negative correlation was found between ALA-D and the amount of lead chelated during the 24 h following administration of EDTA (r = -0.77 and -0.88 respectively). In subjects who live in an area of endemic lead poisoning, the incidence of elevated body lead burden from drinking water was similar in the group with normal renal function and in the group of dialysed patients (18.6 and 8.3% respectively). This study shows (i) that in dialysis patients, measurement of ALA-D represents an accurate screening test for lead overload, provided that the lower threshold of normal is lowered from 0.40 to 0.20, and (ii) that diagnosis and treatment are possible by administering EDTA in conjunction with haemofiltration or CAPD.

Aged↗
PubMed1994

[Mesangial IgA deposits nephropathy].

Idiopathic IgA nephropathy of Berger's disease is characterized by prominent and diffuse IgA deposits in the mesangium. In many countries, it is the most common type of primary chronic glomerulonephritis. Typically, it is revealed by recurrent episodes of gross hematuria in association with ENT infection, but it can progress insidiously with microscopic hematuria and proteinuria. Serum IgA levels are increased in about 50% of cases. IgA nephropathy is not a minor condition: 20% of patients develop end-stage chronic renal failure 10 years after diagnosis and 50% after 20 years. IgA nephropathy can recur in a transplanted kidney suggesting that this disease is a systemic disorder although it has a remarkable tropism for the kidney. Even though many points remain to be elucidated, its pathogenesis appears to be linked to a genetic factor responsible for a lymphocyte dysfunction and an acquired environmental factor such as penetration of an antigen via the mucosa which may give rise to an excessive and inappropriate IgA immune response with the deposition of IgA in the mesangium and the development of progressive renal alterations. No treatment has been shown to be effective but tonsillectomy advised in case of a recurrent tonsillar focal infection is most often accompanied by a decrease in the incidence of gross hematuria. Corticosteroid therapy can be of benefit in cases involving a nephrotic syndrome associated with minimal glomerular lesions. In all cases, control of possible hypertension is of value in slowing the progression of this disease.

Adolescent↗
PubMed1994

Renal transplantation in patients over sixty years of age.

The aim of this study was to analyze whether old age affects the outcome of renal transplantation. Data were presented on all 337 renal allografts performed from January 1, 1987 to November 30, 1992 in the department of Nephrology and Urology, University Hospital of Nancy. Of these, 32 (9.5%) were performed in patients over 60 years old at the time of transplantation (mean duration of follow-up 22.3 +/- 17.1 months). No significant difference was noted in patient and graft survivals between the two groups at 36 months (respectively 83.8% and 76.1% in elderly patients; 96% and 82.8% in younger recipients). In the older group, all grafts were lost due to death (2/5) or nephrectomy (3/5) with a functional transplant (3/5) whereas chronic rejection accounted for the majority of graft loss in the younger group (23/43, p < 0.05). Episodes of acute rejection occurred with a very low incidence in elderly patients (15.6%). Infections were infrequent in this group and did not represent serious complications. Functional rehabilitation and quality of life were as good in elderly as in younger recipients. These results suggest that renal transplantation is an acceptable form of treatment for patients older than 60 years with end-stage renal disease in the absence of obvious contraindication.

Adult↗
PubMed1994

[Acute postoperative renal insufficiency in renal transplantation. Incidence and risk factors].

Delayed renal function (DFG) is known to influence both the short and long-term outcome of transplanted kidneys. Data collected retrospectively on all 129 cadaveric renal transplants performed between January 1991 and January 1993 within a single center were analyzed. 42 (32.55%) cases of acute renal failure (ARF) occurred during the immediate postoperative period and 28 patients required dialysis. When compared with immediate good allograft function, DGF was associated with previous failed transplant (7/15 vs 35/114, p = 0.01), donor age (39.2 +/- 13 vs 30.1 +/- 12 years, p = 0.01), and episodes of collapsus of the donor (11/25 vs 31/104, p < 0.01). The graft function of the recipient was not correlated with the serum creatinine of the donor. There was no apparent relationship between the cold ischemia or the anastomosis time and the occurrence of DGF. One-year patient and graft survival were similar in the two groups (respectively for the group ARF and without ARF: 96.4% and 96.5%; 88.8% and 89%), but patients with DGF had higher serum creatinine values at 12 months post DGF (185.6 +/- 44.8 mumol/l vs 157.5 +/- 30.8 mumol/l, p = 0.06). This study suggests that DGF is related to the characteristics of the donor graft and is more frequently encountered in previously transplanted recipients.

Acute Kidney Injury↗
PubMed1994

[Carcinoma of the native kidney in patients with renal transplantation. A French multicenter study].

A study was undertaken to investigate the development of carcinoma in patients' own kidneys after renal transplantation. Twenty carcinomas were diagnosed among 16,755 patients grafted from 1952 to February 1993. It was possible to collect data for 17 detected carcinomas. These tumours developed in 17 patients, 14 male and 3 female, aged 31 to 64 years old. They appeared an average of 40 (range 1-204) months after transplantation. The maintenance treatment consisted of cyclosporine in 15 recipients. Four patients demonstrated clinical signs. The other 13 carcinomas were diagnosed as an incidental finding on ultrasound (n = 10), at autopsy (n = 1) or by examination of kidneys from nephrectomy (n = 2). In the patient group with incidental diagnosis, tumors were larger than 4 cm in 3 out of the 9 cases studied; they were confined to the kidney in 5 cases and lymph node invasion or renal vein involvement were noted in 1 case. Distant metastases were present in 3 symptomatic patients and in 1 "incidental" case. Except for tumours discovered on nephrectomies or autopsy, a nephrectomy was performed in all cases. Death occurred 1 to 12 months after diagnosis in the recipients with metastatic tumours. A colic carcinoma was diagnosed 6 months after nephrectomy in one patient. The other 11 patients are doing well as the immunosuppressive treatment is being continued.

Adult↗
PubMed1994

[Lymphoproliferative lesions localized in the renal graft. A French multicenter study].

Thirty-two French transplant centers participated in the study of lymphoproliferative disease (LPD) confined to the renal allograft. For the period from 1952 to February 1993, 16 cases were recognized from 16,755 renal transplant recipients. The mean age of the patients was 44 years (range 19-67 years). Fourteen of these recipients received anti-lymphocyte globulin as induction therapy and 13 received cyclosporine as their maintenance immunosuppressive treatment. Acute rejection was reported in 9 cases and was treated with methylprednisolone in 6 cases and with mono- or polyclonal antibodies for 3 episodes. The mean interval from transplantation to development of LPD was 14 months (range, 1-144 months). Most of the patient (12/15) showed symptoms. Renal failure was noted in 7 recipients. Renal ultrasound demonstrated hydronephrosis in 4 cases, a hilar mass in 5 cases, a mass lesion within the graft in 2 cases. Pathological examination showed a high grade malignant lymphoma with extensive necrosis and atypical large cells. Immunohistochemical study was consistent with B-cell lymphoma in all of the 8 cases analyzed and monotypia was noted in 4 cases. The presence of Epstein-Barr virus genome in the LPD was demonstrated in 5 of the 6 cases studied. Nine patients were managed with discontinuation of immunosuppression and transplant nephrectomies. Four patients died. The remaining recipients are alive with no evidence of recurrence after 25 months (range 3-68 months).

Adult↗
PubMed1992

[Polycythemia after kidney transplantation].

Between 1971 and 1990, 251 kidney transplanted patients with a well functioning graft were evaluated to determine the frequency of post-transplant erythrocytosis (PTE). Thirty-one patients (13 percent) developed polycythaemia 10.6 +/- 10 months after transplantation. Thromboembolic complications occurred in 22 percent of the cases. The frequency of PTE was higher in males than in females (sex ratio: 7.2 vs 2.1; P < 0.05). Patients with renal dysplasia had a lower incidence of PTE (3 vs 22 percent; P < 0.05) as did those who had been treated with azathioprine (9.4 vs 19 percent; P < 0.05). None of the patients treated with recombinant erythropoietin before transplantation developed PTE during a mean follow-up of 15.1 +/- 4.5 months. The majority of polycythaemic patients had normal erythropoietin levels. These results show that there is an erythropoietin-independent proliferation due to an increased sensitivity of erythroid progenitors or to an erythroid stem cell stimulation by cytokines.

Adult↗
PubMed1992

[Incidence of hepatitis C virus in kidney transplantation recipients].

The investigation was carried on 122 waiting renal transplantation hospitalized patients. Detection of HCV antibodies was done before transplantation and after renal transplantation. HCV antibodies were detected by immunosorbent assay (ELISA) for C 100-3 protein of HC virus (Lab. ORTHO). Positive results were checked by a second test (immunoblot RIBA II) to detect antibodies against C100-3, 5-1-1, C33, C22 proteins of HCV genome. Before transplantation, 112 patients were negative and 10 positive. After transplantation, 104 were checked: 103 had identical serology (93- and 10+); only one patient has shown a seroconversion six months after the transplantation, demonstrating the late apparition of HCV antibodies, but immunological status of donor was unknown. Renal transplantation does not seem a risk factor of HCV contamination: only 1 seroconversion on 122 patients or 0.8%: near percentage of French blood donors (0.68%). The percentage of positivity HCV before transplantation (9%) answered with that of European hemophils (5 to 20%). Second generation tests demonstrate a better sensibility and specificity than the first.

Alanine Transaminase↗
PubMed1992

[Urinary tract infections during the 1st month after kidney transplantation].

The incidence and the predisposal factors of urinary tract infections (UTI) in the first month post-transplant were studied in 255 kidney transplantations (252 patients). UTI episodes were demonstrated in 73.7% of the grafts. The most common organisms were: Escherichia coli (35.8%), Staphylococcus (33.6%), Streptococcus D (11.2%), Klebsiella (5.3%). The infectious episodes were recurrent in 39% of the cases. The majority of the UTIs were asymptomatic but 7% of the infections led to septicaemia. Etiology of end-stage renal disease, pre-graft binephrectomy, asymptomatic vesicoureteral reflux into the patient's own kidneys, type of immunosuppressive treatment, acute tubular necrosis, rejection episodes, urological complications, coexistent other infections were not predisposal factors. Bacteriuria was more frequent in female than in male patients. The incidence of UTI was found to be statistically increased with history of UTI preoperatively (p = 0.039) and the use of ureteral catheter (p = 0.018). Occurrence of UTI was less common when the donor was treated by antibiotics before brain death (p-0.025). These results provide additional support for regular monitoring of urine cultures in the first month post-transplant. They should help to identify means of reduction of this infectious risk.

Adult↗
PubMed1991

Reoperation for secondary hyperparathyroidism in chronic renal failure.

From 1972 to 1987, 112 parathyroidectomy (PTX) operations were carried out in 105 haemodialysis or transplant patients by the same surgeon. Twelve had to be reoperated on (19 operations in all) for persistent (9 cases) or recurrent (3 cases) hyperparathyroidism. In six patients morphological tests (echography and technetium-thallium scintigraphy) contributed usefully by detecting parathyroid masses. Repeated surgery was finally effective in nine cases.

Adult↗