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Biomedical subjects

J M Halimi

Publications and source records attributed to J M Halimi.

34 records · Page 2Linked to original sources
PubMed1996

Nephrotic syndrome associated with chronic lymphocytic leukemia resistant to immunosuppressive drugs: remission obtained by splenectomy.

Chronic lymphocytic leukemia is a common disease in the elderly but is rarely associated with a nephrotic syndrome. The rarity of this association suggests that leukemic cells may have certain properties or features that may lead to the development of glomerulonephritis. Effective medical treatment of the leukemia may not necessarily allow regression of the nephrotic syndrome; however, the effects of splenectomy on nephrotic proteinuria when associated to chronic lymphocytic leukemia have never been evaluated. We report the case of a 50-year-old male with stage C CD5+ chronic lymphocytic leukemia associated with a nephrotic syndrome due to Type I membranoproliferative glomerulonephritis. Chlorambucil and prednisone were unable to control the leukemia and the nephrotic range proteinuria, and were discontinued because of poor hematologic tolerance. A splenectomy immediately resulted in a spectacular remission of both chronic lymphocytic leukemia and the nephrotic syndrome. Spleen lymphocytes were collected and tested in quantitative flow cytometry for the expression of the main B cell associated markers. They did not exhibit any particular immunophenotypic pattern. This report of a remission of a glomerulonephritis associated with chronic leukemia following splenectomy is evidence of a possible relationship between the two diseases.

Glomerulonephritis, Membranoproliferative↗
PubMed1996

[Endothelial dysfunction and cardiac performance in untreated hypertension].

Similar to endothelial modulation of vascular tone, nitric oxide (NO) released from the coronary and endocardial endothelium may modulated LV performance with an improvement of LV diastolic distensibility. The aim of the present study was to assess a potential relationship between endothelial function and LV performance in essential hypertension. Thirty-nine normotensive subjects (NT) and 46 never treated hypertensive patients (HT) were grouped according to the renal vasodilatatory response to infusion of L-arginine (30 g within 60 min). HT patients responders to L-arginine (n = 19) were defined by an increased > or = 5% of renal plasma flow (RPF) estimated by the clearance of I-Hippuran. LV mass index and afterload-corrected fractional shortening were determined by echocardiography. Mitral peak early (E) and late (A) diastolic flow velocity were assessed by Doppler. Results of ANOVA were (means +/- SD): [table: see text] In HT patients E/A was positively correlated with %RPF (r = 0.27; p < 0.01) and negatively correlated with age (r = -0.52 p < 0.01) and systolic BP (r = -0.36 p < 0.01). In multiple regression analysis the relation between E/A and %RPF was dependent of age. This results confirm that aging and hypertension are the main determinants of the alteration of LV diastolic function. The link between these factors may be the endothelium which abnormal regulatory function secondary to aging and HT may be associated to an impairment of NO dependent LV relaxation.

Adult↗
PubMed1995

Albuminuria predicts renal functional outcome after intervention in atheromatous renovascular disease.

BACKGROUND: Atheromatous renovascular disease is increasingly recognized as a cause of renal failure; however, the benefit of intervention on renal function outcome cannot be clearly anticipated. OBJECTIVE: To identify reliable predictor(s) of renal functional outcome after revascularization in patients with atheromatous renovascular disease. DESIGN: The effect of percutaneous transluminal renal angioplasty (n = 5) or surgery (n = 18) on glomerular filtration rate ([99mTc]-diethylene triaminopenta-acetic acid clearance) and renal haemodynamics was prospectively assessed in 23 patients with atheromatous renovascular disease (unilateral occlusion in five, unilateral stenosis in four, stenosis of a single kidney in five, unilateral occlusion associated with contralateral stenosis in six, bilateral stenosis in three). Renal function was altered in 18 patients. RESULTS: At early follow-up study (5 +/- 1 months) after intervention, glomerular filtration rate improved (i.e. increased by more than 15%) in six patients, deteriorated in five and remained unchanged in 12 patients. The change in glomerular filtration rate associated with intervention was inversely correlated with the pre-intervention level of urinary albumin excretion and positively with the change in effective renal plasma flow after intervention. Stepwise regression analysis showed that pre-intervention urinary albumin excretion was the only predictor of the glomerular filtration rate response to intervention. At late follow-up study (32 +/- 6 months, n = 13), glomerular filtration rate was stable compared with early follow-up determination in non-proteinuric patients whereas it had deteriorated further in proteinuric patients. CONCLUSION: In patients with atheromatous renovascular disease, albuminuria may be considered as a marker of pre-existing intra-renal vascular and glomerular damage and a reliable predictor of renal functional outcome after intervention.

Adult↗
PubMed1995

[Left ventricular hypertrophy and left atrial morphology in untreated hypertensive patients].

The level of arterial pressure is not the sole determinant of cardiac and vascular adaptation to hypertension. In order to identify other factors (such as preload) we categorized by echocardiography, 55 never treated hypertensive patients and 39 age and gender-matched normal subjects, according to values of relative wall thickness and left ventricular mass index. Normal left ventricular anatomy was found in 63% hypertensives, whereas among hypertensives 7% had "concentric left ventricular remodeling", 16% concentric left ventricular hypertrophy and 14% had eccentric left ventricular hypertrophy. Systolic left atrial area (LA) was obtained from the four-chamber views. Mitral peak early diastolic (E) and late diastolic (A) flow velocity was assessed by Doppler. Because clinical characteristics such age and sex differed among the 5 groups only results of ANCOVA were reported (means +/- SD). [table: see text] We conclude that eccentric left ventricular hypertrophy may be associated with a parallel increase of left atrial area. Thus the association of an increase of cardiac volume in hypertensive patients with normal diastolic function suggest that volume overload may modulate the effect of arterial pressure on cardiac morphology.

Adult↗
PubMed1995

[Preservation of renal function by revascularization in renovascular disease].

Renovascular disease is the leading cause of surgically-curable arterial hypertension and one of the few cause of reversible chronic renal failure, but its exact prevalence remains unknown. Progression of atheromatous disease occurs in 50% of cases and it may result in bilateral stenosis (25%) or total occlusion (15%). By now, the main aim of renal revascularization is retrieval of impaired function or prevention of renal failure rather than control of hypertension. However, renal functional deterioration may result from cholesterol embolism or glomerulosclerosis in addition to ischemia. Correction of post-proximal stenosis is obtained by both surgery and percutaneous angioplasty. In favor of angioplasty are a higher acceptability and a modestly better cost-benefit ratio. Surgery may be preferred when the stenosis is proximal, complex or associated with aortic disease; in addition, analysis of published (mostly uncontrolled) series suggest that beneficial renal functional outcome is slightly better following surgery. Importantly, both diagnosis and prognosis of ischemic nephropathy are difficult to establish. Various predictors of recovery (renal size, renal vein renin ratio, alteration in scintigrams, angiography or biopsy) were shown to fail on an individual basis. Further controlled studies based on reliable methods of measuring renal function are warranted.

Angioplasty, Balloon↗
PubMed1995

Albuminuria in untreated patients with primary aldosteronism or essential hypertension.

AIM: The determinants and significance of urinary albumin excretion have been studied in normal subjects and in hypertensive patients; however, they are unknown in patients with primary aldosteronism. PATIENTS AND METHODS: From a population of 114 patients with documented primary aldosteronism, we selected 23 never-treated patients (12 males, 11 females; 11 tumoral, 12 non-tumoral) and compared them to patients with never-treated essential hypertension with low renin (supine plasma renin activity <1 ng/ml per h, n = 23) or normal renin (supine plasma renin activity between 1 and 4 ng/ml per h, n = 23), matched for age, body mass index, mean arterial pressure, renal function and known duration of hypertension. RESULTS: The patients with primary aldosteronism had lower serum potassium and higher plasma aldosterone concentrations than those with essential hypertension. Urinary albumin and beta2-microglobulin excretion were greater in untreated patients with primary aldosteronism than in those with low- or normal-renin essential hypertension. Among the patients with essential hypertension, the renin activity was not a determinant of albuminuria. CONCLUSIONS: These findings indicate that primary aldosteronism is associated with excessive urinary albumin excretion. This albuminuria could be due to impairment of proximal tubular reabsorption caused by hypokalemic nephropathy and/or by high levels of circulating aldosterone; however, it could be an indicator of target-organ damage associated with primary aldosteronism.

Albuminuria↗
PubMed1994

[Left ventricular performance and morphologic myocardial changes in untreated hypertensive patients].

Left ventricular contractile performance and geometric adaptation to hypertension were investigated in 255 patients with untreated essential hypertension and 160 normotensive subjects by M-mode echocardiography. Because all "ejection-phase" measurements are affected by changes in afterload, ventricular performance was estimated at the operating level of systolic wall stress by the afterload-corrected fractional shortening. Mitral regurgitation was excluded in all patients by Doppler echocardiography. Patients were categorized according to values of end-diastolic relative wall thickness and left ventricular mass index. Among hypertensive patients, ventricular mass and relative wall thickness were normal in 44%, whereas 20% had increase relative wall thickness with normal ventricular mass "concentric remodeling", 22% had concentric hypertrophy (increase both ventricular mass and relative wall thickness) and 14% had increased ventricular mass with normal relative wall thickness (eccentric hypertrophy). Arterial pressure and body mass index were higher in patients with concentric hypertrophy. Left ventricular contractile performance paralleled ventricular geometry, with a decrease of the afterload-corrected fractional shortening in the group with concentric remodeling and hypertrophy, whereas systolic function was normal in the eccentric group despite higher level of systolic wall stress. This study suggests a strong dependence of left ventricular mass with chamber size and myocardial contractility. Thus arterial pressure was not the sole determinant of left ventricular hypertrophy in essential hypertension. The respective role of this factors remains to be determined.

Adaptation, Physiological↗
PubMed1993

[Patterns of left ventricular adaptation to arterial hypertension].

The level of arterial pressure is not the sole determinant of cardiac adaptation to hypertension. In order to identify other factors (such as preload as well as neuro-humoral factors) we categorized by M-mode echocardiography, 192 never treated patients with mild to moderate hypertension of short duration, according to values of end-diastolic relative wall thickness (RWT) and left ventricular mass index (LVMI). Mitral regurgitation was excluded in all patients by Doppler echocardiography. Among hypertensive patients, LVMI and RWT were normal in 43% (group 1), whereas 20% had increase RWT with normal LVMI "concentric remodeling" (group 2), 24% had concentric hypertrophy (increase both LVMI and RWT) (group 3) and 13% had increased LVMI with normal RWT (eccentric hypertrophy) (group 4). Results presented as means +/- SD. [table: see text] In addition the acute response after ACE-inhibition (captopril 50 mg) of mean arterial pressure was significantly attenuated in group 4 when compared with group 1. These results suggest that the effect of arterial pressure on the heart may be modulated by volume overload (low PRA and high CI) in hypertensive patients with eccentric LV hypertrophy with normal LV function.

Adaptation, Physiological↗
PubMed1991

[Functional reversibility of chronic cyclosporine nephrotoxicity in patients after kidney transplantation].

The long term use of cyclosporin in renal transplant recipients may be complicated by chronic nephrotoxicity, evidenced by renal functional deterioration and suggestive histological lesions. In 11 renal transplant recipients treated with cyclosporin since 28 +/- 5.8 months, we reduced (n = 6) or stopped (n = 5) this drug after chronic nephrotoxicity was diagnosed. Five months later, we conducted hemodynamic studies and observed significant increases in renal plasma flow (I131 hippuran clearance from 239.5 +/- 106 to 327 +/- 50 ml/min/1.73 m2) and glomerular filtration rate (DTPA-TC clearance from 43 +/- 15 to 67 +/- 10 ml/min/1.73 m2) and a decrease in renal vascular resistances. We suggest that cyclosporin-associated chronic nephrotoxicity is accompanied by some degree of reversible vasoconstriction, or that histological lesions, particularly cyclosporin arteriolopathy, can disappear after cyclosporin withdrawal.

Chronic Disease↗
PubMed1991

The greater renin system. Its prorenin-directed vasodilator limb. Relevance to diabetes mellitus, pregnancy, and hypertension.

A greater renin system is proposed. Evidence is presented that a greater renin system exists that has both vasodilator and vasoconstrictor properties. Vasodilator activity is induced by prorenin, vasoconstrictor activity by renin. Our model is based on evidence that both prorenin and renin have the capacity to generate angiotensin and that angiotensin causes vasodilation at high concentrations and vasoconstriction at low concentrations. In our model, prorenin acts only at particular target sites while renin of renal origin acts via the general circulation. Prorenin's designation as a biosynthetic precursor implies lack of intrinsic catalytic activity whereas in fact it can become reversibly active. Activation may occur in vivo at binding sites without cleavage of the prosequence. In this framework, prorenin should be more aptly called renin I and circulating active renin, renin II. In our model, the role of renin I (prorenin) is to generate localized high concentrations of angiotensin II, eg, in the afferent arteriole of the kidney and in other vital organs, causing regional dilation by rendering tissues insensitive (tachyphylactic) to the vasoconstrictor effect of circulating angiotensin II or by releasing vasodilator substances. The role of renin II (active renin) is to constrict resistance vessels and the efferent arteriole of the kidney, thereby raising blood pressure, maintaining glomerular filtration rate, and enabling more blood flow to those organs that selectively bind prorenin. This twin control system is ideally designed to maintain blood flow to vital organs.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗
PubMed1990

Effect of different calcium antagonists on transcapillary fluid shift.

Chronic treatment with dihydropyridines, and to a lesser extent other calcium antagonists, often results in peripheral edema without fluid retention. The possibility that calcium antagonists affect extracellular fluid volume partition was tested by comparing the effects of nicardipine (Nic), diltiazem (Dil) and Vehicle (Veh) on hematocrit and plasma protein concentration in anephric anesthetized rats. In response to a 45 min infusion of Nic (0.1 or 1 micrograms/kg/min) and Dil (10 or 100 micrograms/kg/min), blood pressure decreased by 4 or 21%, and 4 or 19%, respectively, whereas hematocrit increased only with both doses of Nic (5.3 +/- 0.2 and 5.5 +/- 0.2%). Plasma protein concentration also increased significantly, although slightly, in the Nic group. The possibility of protein extravasation was then assessed using Evans blue dye as a marker. The drug-induced extravasation of dyed albumin in skeletal and cardiac muscles, but not other organs, was significantly increased following Nic, as compared to Dil or Veh. These observations suggest that two structurally different calcium antagonists used at equihypotensive doses may exert different effects on extracellular fluid partition.

Animals↗
PubMedDate not supplied

Albuminuria in normals and essential hypertension.

The prevalence and determinants of urinary albumin excretion rate (AER) were assessed in lean and overweight normotensive subjects (NT) and patients with essential hypertension (EH). In NT and EH, the presence of overweight was associated with a significant exacerbation of AER. In the normotensive population, AER was higher in subjects with a positive family history of hypertension. An important role for smoking was observed in the hypertensive population; in fact, the prevalence of microalbuminuria (MA) was almost twofold in lean hypertensive smokers when compared to nonsmokers. Among other determinants of AER, a major influence of systolic arterial pressure, urinary excretion of urea (an estimate of protein intake), and high-density lipoprotein (HDL) cholesterol (inversely correlated with AER) was observed mainly in lean EH patients. The significance of microalbuminuria is unclear. Is it a marker of cardiovascular risk and/or a predictor of the future development of renal disease in EH?

Adolescent↗
PubMedDate not supplied

Delayed graft function: risk factors, consequences and parameters affecting outcome-results from MOST, A Multinational Observational Study.

BACKGROUND: Delayed graft function (DGF) is a common complication after renal transplantation, and may affect graft function. The aim of this analysis was to evaluate risk factors for DGF, as well as parameters and events influencing graft function after DGF. We analyzed data collected in an ongoing international, prospective; observational study, the Neoral-MOST (Multinational Observational Study in renal Transplantation), and included in the analysis all patients with cadaveric kidney transplants for whom renal function at 1 year posttransplantation was documented (N = 8950). Logistic regression was used to evaluate the risk factors for DGF occurrence, and multifactorial analysis of variance (ANCOVA) to assess the relevance of different factors for GFR at 1 year. RESULTS: Higher donor age, longer CIT, male recipients, Caucasian recipients, high recipients body mass index, and PRA were all associated with a higher risk for DGF. Renal function of former DGF kidneys at 1 year was lower in kidneys of elder donors, or which had experienced rejection or CMV infection. Variations of the maintenance regimen at 1 year posttransplantation were not associated with better graft function. Multifactorial analysis showed donor age and acute rejection as significant independent factors. CONCLUSIONS: Most factors increasing the risk for DGF or having a negative impact on renal function at 1 year in grafts with DGF are predetermined. Additional posttransplant damage by acute rejection was associated with further reductions in GFR. Preventing acute rejection is an important step in achieving optimal function of DGF grafts.

Adult↗
PubMedDate not supplied

[Larger waist circumference is a predictive factor for the occurrence of microalbuminuria in a non-diabetic population].

Obesity and insulin resistance are directly associated with the presence of microalbuminuria. However, the prospective relationship between abdominal adiposity and the occurrence of micro-albuminuria has been little studied in a non-diabetic population. From the DESIR cohort, we examined whether waist circumference was associated with the incidence of micro-albuminuria at 6 years (D6). The study evaluated 2738 non-diabetic subjects without micro-albuminuria at inclusion who were then followed prospectively. At 6 years, 254 individuals (9.3%) had developed pathological micro-albuminuria (> or =20 mg/l) measured at micturation. In both sexes, the incidence of micro-albuminuria was associated with increased waist circumference and blood pressure, but not with blood glucose levels, lipid parameters or body mass index. Subjects with a higher waist circumference at inclusion were at a higher risk of having micro-albuminuria at 6 years compared to those with a normal waist circumference. Logical regression analysis showed that waist circumference as a continuous value, or greater than 94 cm for males and 88 cm for females, were predictive factors for the incidence of micro-albuminuria, after adjustment for age, hypertension, ACE inhibitor usage, fibrinogen, and blood glucose level. Abdominal adiposity is thus linked in both sexes to the development of microalbuminuria, which underlines the importance of measuring waist circumference when assessing risk factors for renal lesions in non-diabetic hypertensives.

Adiposity↗