Diarrhea induced by high doses of nicotinamide in dialysis patients.
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Antacids↗
Biomedical subjects
J M Krzesinski
Publications and source records attributed to J M Krzesinski.
Why the MDRD equation should not be used in patients with normal renal function (and normal creatinine values)?
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Creatinine↗
[News in the management of calcium and phosphorus metabolism disorders for patient treated by hemodialysis].
Bone metabolism is very frequently disturbed in end stage renal failure hemodialyzed, with secondary hyperparathyroidism development but also serious potential cardiovascular consequences. New treatments will be available very soon in Europe such as new phosphate binders, vitamin D2 analogues or calcimimetics to fight against such medical diseases, with the hope of less risk for vascular complications. The real place of such new medical opportunities needs to be determined. Moreover, studies with morbidity and mortality end-points are waited before estimating the real importance of these new therapeutic tools.
Calcium↗
[News about phosphorus metabolism].
Phosphorus is mainly present in the serum as phosphate which is the principal intracellular anion, essential for the organism, in particular through its role in the production of ATP. In plasma, only inorganic phosphorus (Pi) is measured. In this article, we will review new information about the regulation of Pi at the intestinal, osseous and mainly renal levels. The various cotransporters sodium-phosphorus (Na-Pi) will also be examined and the molecular regulation mechanisms approached. Finally, illustration of Pi physiology will be given through various clinical examples.
Bone and Bones↗
[Blood pressure variability].
Blood pressure variability is a physiological phenomenon influenced by many internal and external factors. This variability could be also influenced by pathological conditions such as arterial hypertension. Two forms must be mainly distinguished: the blood pressure variability at long but also short-term. The latter could only be studied by continuous recordings. From the initial invasive intraarterial approach, it can nowadays be explored by a non invasive system of beat to beat recordings using the infrared photo plethysmography (the FINAPRES system). In this paper, some important questions will be treated such as the interest of measuring blood pressure variability, its cardiovascular prognosis and how therapeutic tools can be applied when it is increased?
Animals↗
[Hyperkalemia: the new killer?].
Hyperkalemia is now commonly observed due to several associated factors such as old age, diabetes, congestive heart failure, renal insufficiency and drugs such as spironolactone used to improve cardiac function. Moreover, the easily prescribed new antiinflammatory drugs COX2 selective inhibitors in these patients lead to a very acute risk for vital hyperkalemia development. This review insists on the prevention of such potentially reversible disorder.
Humans↗
[Hypertension due to primary aldosteronism].
Primary aldosteronism is a rare cause of hypertension. However, its incidence seems to be underestimated. It is important to identify this syndrom since the disease is potentially curable. In the present paper, we depict different forms of primary aldosteronism as well as the diagnostic procedures. When the diagnosis is suspected (hypertension associated to spontaneous or diuretic-induced hypokaliemia), the more efficient screening test is the determination of the aldosteron/renin ratio. Saline infusion or posture tests can thereafter confirm the diagnosis. Differential diagnosis between bilateral and unilateral forms of primary aldosteronism can be made by CT-scanner and the response of aldosterone to the posture test. Such a complex assessment leads to the identification of patients who can be surgically treated. This treatment consists in a unilateral adrenalectomy which can be realised by laparoscopy.
Aldosterone↗
[Polyomavirus BK infection in renal transplant recipients].
Beside acute rejection or immunosuppressive therapy toxicity, infection by Polyomavirus BK, usually not aggressive in immunoactive patients, has emerged as an important factor affecting graft function in renal transplant recipients. Indeed, one of the most important complications of BK infection is nephropathy. Viral replication in the urinary tract as assessed by the presence of "decoy cells", or by a positive PCR for BK virus has been detected in up to half of the recipients but only 5% will present nephropathy which is usually the only sign. The most common risk factors for this emerging new cause are new immunosuppressive drugs and rejection episodes. The gold standard to diagnose BK nephropathy is immunohistochemical staining for large T antigen in graft biopsy specimens. Urine cytology examination and DNA BK PCR are used as a screening test. The prognosis in BK nephropathy has been considered to be poor. The early reduction of immunosuppression can improve the prognosis and perhaps also cidofovir or leflunomide use.
Adult↗
Effect of haemodialysis on acoustic shear wave propagation in the skin.
BACKGROUND: Diverse skin alterations may develop in patients under chronic haemodialysis. Among them, signs of premature photo-ageing have been described. AIM: To assess alterations in the physical properties of skin consistent with ageing effects and with cutaneous fluid exchanges during haemodialysis sessions. METHODS: In the first part of the study, 45 haemodialysed patients were compared to 45 age-, sex- and body-mass-index-matched healthy subjects. In the second part of the study, skin of 30 haemodialysed patients was assessed immediately before and after a haemodialysis session. The speed of ultrasound shear wave propagation was measured in each subject. Series of 16 multidirectional resonance running time measurements (RRTM) were performed on the forehead and/or the volar forearm. They were averaged for each subject. The corresponding intra-individual coefficients of variation were calculated as an estimate of the skin mechanical anisotropy. RESULTS: In both haemodialysed patients and their matched controls, RRTM values were significantly higher on the forearms than on the forehead. By contrast, no significant difference was found in RRTM values that could be ascribed to chronic haemodialysis. However, RRTM values were significantly increased as an immediate and probably transient effect of haemodialysis sessions. In healthy subjects, ageing was associated with increased RRTM values. CONCLUSION: Chronic haemodialysis does not appear to influence significantly the functional expression of the dermal ageing process. Subtle fluid movements occurring in the skin during haemodialysis sessions can be assessed by measuring non-invasively the speed of ultrasound shear wave propagation in the skin.
Adult↗
[Guidelines for the management of arterial hypertension in general practice].
Guidelines for the management of arterial hypertension are regularly updated. This article summarizes the last international guidelines in this field published last year. The decision to initiate an antihypertensive treatment will not only depend on blood pressure levels, but also on global cardiovascular risk assessment.
Humans↗
[The drug of the month: a new antihypertensive association: Preterax, low doses of ACE inhibitor and thiazide in the same pill].
Preterax is the first fixed very- low - dose combination of an angiotensin--converting enzyme inhibitor and a diuretic for first line treatment of hypertension. Its antihypertensive efficacy is remarkable due to the presence of 2 drugs with additional effects. The tolerance is also excellent, with adverse effects similar to placebo. The 24 h blood pressure control is maintained. If necessary, the dose can be doubled (BiPreterax). The medical practitioner must keep in mind that it is an association of perindopril 2 mg and indapamide 0.625 mg with their own contra-indications. These low dose associations are now recommended as one of the 2 options to initiate an antihypertensive drug treatment, with the hope of an improvement in the percentage of well controlled blood pressure in the hypertensive population. Let us remember that the blood pressure target to be reached is at least < 140/90 mmHg. Up till now, no antihypertensive class has demonstrated a superiority over the others. Only the blood pressure fall magnitude is important to prevent cardiovascular complications.
Drug Combinations↗
[The drug of the month: Olmesartan medoxomil].
Olmesartan medoxomil (Belsar, Olmetec) developed by Sankyo Pharma and proposed by Sankyo Pharma but also Menarini is a new angiotensin II ATI receptor blocker. Its indication is the treatment of hypertension. Olmesartan is indeed an antihypertensive agent with an efficacy dependent on the dose from 10 to 40 mg. It is taken once a day, because of a long duration of action. This prodrug has a dual elimination pathway (biliary and renal). The contraindications are the same as for the other sartans. One of its main advantage, besides its rapidly observed efficacy to lower high blood pressure, is its relatively low cost within this family. It has also cardiovascular and renal protective effects. The recommended usual dosage is 20 mg/day.
Antihypertensive Agents↗
[How to explore... insipidus polyuropolydipsia syndrome].
The finding of a polyuropolydispsic syndrome should prompt a complete biological investigation of its etiology. If polyuria can be a minor sign as in psychiatric disorder, it can also be the first manifestation of diabetes mellitus but also central diabetes insipidus, the latter linked to cerebral tumors, metastases in the hypothalamus, granulomatous disease, but also nephrogenic diabetes insipidus such as chronic renal disease or autoimmune disease. Intracellular dehydration is the major risk in case of a polyuropolydipsic syndrome. Prognosis depends on the capacity to maintain water balance through an intact thirst mechanism. After a brief review of the majority of causes of diabetes insipidus, we propose a diagnosis algorithm to easily make the diagnosis.
Diabetes Insipidus↗
[Image of the month. Pancreatic cancer and ivory vertebra].
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Adenocarcinoma↗
[Clinical study of the month. Which initial antihypertensive? Results from the ALLHAT trial].
Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is still controversial. The "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial" (ALLHAT) should give such an answer. It is a randomised, double-blind, trial designed to determine whether treatment with either a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. A total of 33,357 participants aged 55 years or older with mild to moderate hypertension and at least 1 other CHD risk factor were randomly assigned to receive chlorthalidone (12.5 to 25 mg/day; n = 15,255), amlodipine (2.5 to 10 mg/day; n = 9,048) or lisinopril (10 to 40 mg; n = 9,054). The primary outcome combined both fatal CHD and non-fatal myocardial infarction, analyzed by intent-to-treat. Secondary outcomes were all-causes mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure and peripheral arterial disease). Chlorthalidone was slightly more effective in reducing systolic pressure while amlodipine reduced slightly more effectively diastolic blood pressure. After a mean follow up of 4.9 years, no differences were observed between the three treatments regarding both the primary outcome and the total mortality. Secondary outcomes were similar when comparing amlodipine vs chlorthalidone. A moderately higher 6-year incidence rate of clinically detected heart failure was observed with amlodipine, but without significant influence on mortality. For lisinopril vs chlorthalidone, lisinopril had slightly higher 6-year rates of combined CVD, stroke and heart failure. In conclusion, thiazide-type diuretics are superior in preventing one or more major forms of CVD and offer the advantage to be cheaper. They should be preferred for first-step antihypertensive therapy. However, to reach the recommended blood pressure target, most patients should receive a combination of antihypertensive compounds. Such a combination should always comprise a diuretic agent, in absence of contra-indications.
Antihypertensive Agents↗
[Evaluation of glomerular filtration rate in clinical practice].
Glomerular filtration rate (GFR) is the most frequently used parameter to evaluate the renal function. GFR may be estimated with serum creatinine, creatinine clearance based on 24 hours urine collection or Cockcroft formula. All these methods have bias. Other approaches have thus been proposed. The limitations and advantages of isotopic methods and recent mathematical approaches (MDRD formula) are reviewed.
Chromium Radioisotopes↗
[Abnormalities in serum magnesium concentration].
Magnesium (Mg) therapy is often proposed against stress and to correct asthenia. Thus our aim has been to review the role of Mg, the mechanisms of its homeostasis before detailing the clinical presentations and etiologies of hypo- and hypermagnesemia and their exploration. Hypomagnesemia frequently occurs but is clinically rarely recognized without biological serum ionic determinations because causing atypical signs miming those of other ion deficiencies. Hypermagnesemia is uncommon but often occurs in the presence of renal insufficiency especially with excess of Mg administration.
Humans↗
[Can arterial hypertension be prevented?].
Prevalence of arterial hypertension is growing, in particular due to population ageing. Hypertension is a major risk factor for cardiovascular morbidity and mortality. Prevention is conceivable on a theoretical basis by reduction or, if possible, prevention of excess weight, diet modifications, increased physical activity among other means. To be efficient, prevention should include an early detection of patients at risk and a long term assessment of efficacy requiring many efforts from both patients and physicians.
Diet↗