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Biomedical subjects

J Crosnier

Publications and source records attributed to J Crosnier.

At least 19 recordsLinked to original sources
PubMed1987

[Treatment of chronic kidney failure by the keto-analogs of essential amino acids: 4 years' experience].

From June 1981 to June 1985, 22 patients with advanced chronic renal failure were treated with a preparation of ketoanalogues of essential amino acids (Ketosteril, 1 tablet/5 kg/day) combined with a protein supply of 0.4 g/kg/day. At the beginning of treatment, their mean plasma creatinine was 762 +/- 135 mumol/l and their creatinine clearance, 8.4 +/- 3.1 ml/min/1.73 m2. By the end of November, 1985, among the 20 assessable patients, 4 had been on ketoanalogues for 8 to 52 months, 9 had to be dialyzed after 4 to 20 months, 5 had died and 2 had abandoned treatment. A mean 28% decrease in plasma urea level and daily urinary urea output was observed after 1 month on ketoanalogues, and a sustained reduction in plasma creatinine was observed in 12 patients. Mean renal survival was 15.6 +/- 12 months (median: 12 months), and was longer in patients whose plasma creatinine was lower than 700 mumol/l at the beginning of treatment. The ketoanalogues were well tolerated, and no denutrition occurred. Our experience confirms the usefulness of this therapeutic approach in uremic patients and suggests that the best results would be obtained if ketoanalogues were introduced before end-stage renal failure.

Adult↗
PubMed1987

Post-surgical deterioration of renal function in primary hyperoxaluria.

Primary hyperoxaluria leading to calcium oxalate urinary stones and renal deposits occurs rarely in adults. We report three cases in whom end-stage renal failure was precipitated by urological surgery. In contrast, in one case renal stones were destroyed by extracorporeal shock-wave lithotripsy and renal function was not significantly altered. This emphasises the need for early diagnosis. This may not be easy in adult patients: urolithiasis may not be severe, radiological nephrocalcinosis may be lacking, and renal failure may develop late in life.

Adult↗
PubMed1984

Nonsteroid antiinflammatory agents as a substitute treatment for steroids in ATGAM-treated cadaver kidney recipients.

A nonsteroid antiinflammatory agent (Ibuprofen) was used in a controlled randomized study to determine its ability to replace steroids in the prophylaxis of cadaveric kidney rejection. Thirty-three cadaver kidney recipients were randomly assigned either to a control group (16 patients) receiving azathioprine, high doses of prednisolone, and antithymocyte globulin (ATGAM) for three months, or to an experimental group (17 patients) receiving azathioprine and ATGAM according to the same protocol, ibuprofen instead of steroids. The frequency of rejection was higher in the experimental group (2.18 episodes per patient) than in the control group (1.44 episodes per patient). Nevertheless, in the experimental group 5 patients had no early rejection episode, 60% of early rejections were totally reversible without steroids, and 3 patients never received steroids at all during the first year and had normal renal function and biopsies. Steroids had to be introduced in the treatment of 14 patients, but after an average period of 32.5 days after surgery OKT3+ cell level was higher in the experimental group than in the control group, but similar to the OKT3+ cell level of patients receiving conventional therapy without ATGAM. Whatever the type of treatment, an increase in the OKT4+/OKT8+ ratio was associated in most cases with increased serum creatinine values. Conversely, a decreased OKT4+/OKT8+ ratio associated with renal failure was found in cases showing biological evidence of cytomegalovirus infection.

Adult↗
PubMed1984

Azathioprine withdrawal in renal transplant recipients. A long-term follow-up.

Azathioprine (AZTP) must sometimes be discontinued in cadaveric kidney recipients. Long-term survival of patients after AZTP withdrawal is questionable, and many groups consider that maintenance treatment with AZTP is preferable to its discontinuation despite potential severe side effects. In our group AZTP had to be discontinued in 39 recipients of first renal allografts (30 cadaver kidney recipients, 9 living-related recipients) because of severe liver disease or cancer. The median follow-up period after AZTP withdrawal was 32 months, ranging from 5 to 84 months. Deterioration of renal function, which occurred in 11 (28.2%) patients, was more frequently observed in recipients of an incompatible graft (2-4 HLA-A and B mismatches (P = 0.02)). The graft survival rate of 56.9% at 10 years for the whole group of patients compares favorably with the 63.2% graft survival rate of a matched control group of 79 patients. Thus, AZTP may be discontinued whenever required without increasing the rate of graft loss.

Adolescent↗
PubMed1984

Hepatitis B vaccine: randomized trial of immunogenicity in hemodialysis patients.

In order to determine whether reinforced vaccinations improve the immune response among uremic patients, three vaccination schedules with hepatitis B surface antigen vaccine (Institut Pasteur Production) were compared. A total of 215 hemodialysis patients treated in HBV free units were randomly allocated to Group I (3 injections of 1 ml), Group II (3 injections of 2 ml) and Group III (4 injections of 1 ml). Immune response was evaluated in 204 patients. The percentages of responders within 12 months after the first injection (greater than = 10 mIU/ml on 2 successive blood specimens) were: 45.6%, 75.0% and 69.4% in Group I, Group II and Group III respectively. The geometric mean peak values of anti-HBs observed 6 months after the first injection among the responders were: 60, 192 and 268 mIU/ml respectively. One month after a booster dose given to 182 patients 14 months after the first injection, anti-HBs levels were 144, 1123, 524 mIU/ml respectively, and the frequency of patients with an anti-HBs titer greater than = 50 mIU/ml was 68%, 82% and 75% respectively. These results led us to discard the use of Protocol I for these immuno-depressed patients while it is quite satisfactory in healthy subjects; they also show that Protocol II and III give better results than Protocol I, but that they cannot be statistically differentiated. We conclude that response rates and anti HBs antibody titers can be significantly improved in chronic hemodialysis patients with reinforced vaccination protocols.

Antibodies, Viral↗
PubMed1983

Relationship between liver histopathological changes and HBsAg in 111 patients treated by long-term hemodialysis.

We studied liver biopsies performed between January 1972 and June 1980 in 111 patients receiving regular dialysis treatment. Biopsies were performed either because of suspected liver disease (61 patients) or routinely during abdominal surgery or kidney transplantation (50 patients). Repeat biopsies were done in 14 cases. Hepatitis B virus markers, assayed every 3 months during the observation period, were detected at some time in 71 patients (64%); 51 remained persistently positive. Histological examination showed normal liver in 39 cases, lobular hepatitis in 15, chronic persistent hepatitis in 36 and chronic active hepatitis in 21. All patients with chronic active hepatitis were chronic HBsAg carriers, and repeated biopsies showed aggravation only in these patients. The course was remarkably asymptomatic, with lesions leading to fibrosis despite the lack of histopathological patterns of severe necrosis and/or inflammation, which were conspicuously absent in this series.

Biopsy↗
PubMed1981

Randomised placebo-controlled trial of hepatitis B surface antigen vaccine in french haemodialysis units: II, Haemodialysis patients.

A vaccine against hepatitis B surface antigen (Institut Pasteur Production) was assessed in 138 haemodialysis patients in a placebo-controlled randomised double-blind trial. In an interim analysis, hepatitis B infections were observed in 21% of the vaccine group and 45% of the placebo group (p less than 0.02). 2 of the infections in the vaccine group and 12 of the infections in the placebo group occurred after the third injection. 60% of the vaccine recipients had an immune response. 4 months after the first injection the mean titre of anti-HBs was 120 mlU/ml.

Adult↗
PubMed1981

Randomised placebo-controlled trial of hepatitis B surface antigen vaccine in French haemodialysis units: I, Medical staff.

A vaccine against hepatitis B surface antigen (Institut Pasteur Production) was assessed in staff members from forty-eight French haemodialysis units where the risk of hepatitis B was high. Of 318 subjects who completed the protocol, 164 received three monthly injections of vaccine and 154 received corresponding injections of placebo. Hepatitis B infection was observed in 3.6% of the vaccine group and 12.3% of the placebo group (p less than 0.005). The 6 infections in the vaccine group all arose within 63 days from the first injections, whereas the 19 in the placebo group arose throughout the 12 months of follow-up. The rate of side-effects after injection did not differ in the two groups. 94% of the vaccine recipients had an immune response ( greater than 10 mIU/ml in at least 5 successive specimens). 4 months after the first injection the mean + or - 2 SE peak level of anti-HBs was 2433 + or - 1077 mIU/ml.

Clinical Trials as Topic↗
PubMed1981

Antithymocyte globulin in cadaver kidney transplantation: a randomized trial based on T-cell monitoring.

The influence of horse antihuman thymocyte globulin (ATG) on renal allograft survival was assayed between March 1977 and August 1978. Fifty consecutive patients were randomly assigned to the treatment or the control group. Patients in both groups received azathioprine and prednisolone. ATG was added in the experimental group. The daily dosage was such as to maintain the rosette-forming cell (RFC) level at 10% of baseline values. The number of renal failure episodes (RFE's)was significantly lower in the experimental group during the period (1 month) ATG was given than it was in the control group during that same period of time. Two years after transplantation, kidney survival was 79% in the ATG group and 52% in the control group. The amount of steroids necessary to control RFE's was significantly lower in the ATG group. The dosages of ATG used in the experimental group were relatively small (average daily dose, 3.08 +/- 0.26 mg/kg of body wt), and adverse reactions were mild. Blood tolerance was excellent. T-cell monitoring thus appears to be an effective method in evaluating the daily dosage of ATG.

Adolescent↗