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Biomedical subjects

M F Gagnadoux

Publications and source records attributed to M F Gagnadoux.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Value of cyclosporine in the treatment of the recurrence of nephrosis after renal transplantation].

From May 1992 to December 1994, 14 children with end stage renal failure secondary to steroid-resistant idiopathic nephrotic syndrome received a cadaver kidney graft. Immediate recurrence of the nephrotic syndrome occurred in four patients. In the four patients, a complete remission was observed shortly after the start of intravenous cyclosporin; two children received in addition methylprednisolone pulses for secondary rejection. Two children were still protein-free 9 and 15 months after transplantation. In the third patient, proteinuria relapsed after 9 months of complete remission and persisted in spite of the reintroduction of intravenous cyclosporin. The fourth graft was lost at 3.5 month from irreversible rejection. The creatinine clearance of the 3 functioning grafts was respectively: 73, 76 and 92 ml/mn/1.73 m2 16, 10 and 15 months after transplantation. Intravenous cyclosporin started shortly after the recurrence, maintaining blood levels between 200 and 300 ng/ml, may induce a remission in recurrent nephrotic syndrome after renal transplantation in childhood.

Child, Preschool↗
PubMed1995

[Bacterial complications of nephrotic syndrome in children].

OBJECTIVES: Evaluate bacterial infection epidemiology and pathophysiology in children with nephrotic syndrome. METHODS: From January 1983 to December 1992, 399 children with the nephrotic syndrome were admitted in 3 University Pediatric wards (Paris Enfants Malades, Lyon Edouard Herriot, Lyon Debrousse). Severe bacterial infection was diagnosed when the patient's condition has justified an intravenous antibiotherapy. RESULTS: Forty-eight bacterial infections were noted in 32 patients (8%); the infection was the first symptom of the disease in 10 patients (31%); one patient died shortly after admission. Severe bacterial infection concerned steroid-resistant nephrotic syndrome in 13 cases (41%), but only 7 out of them received immunosuppressive agents at the time of the infection. Eleven children (34%) experienced recurrent infections (1 to 6 recurrences), several of which under antibioprophylaxy. Half of the infections involved peritonitis and 50% of the identified germs were S. pneumoniae. However, peritonitis was not always related to S. pneumoniae (1 H. influenzae among 9 identified germs). CONCLUSIONS: These data demonstrate the importance of microbiological sampling and justify a first-line antibiotherapy using a third generation cephalosporin. The presentation of severe bacterial infections show that it is less a iatrogenic event than a consequence of immunological disturbances induced by the nephrotic syndrome itself, as suggested by the acquired deficiency of factor I and B. Despite recent advances in antibiotic strategies responsible for a significant reduction in the severity of such infections (1 death among 32 patients), preventive treatments are quite disappointing.

Adolescent↗
PubMed1995

Haemolytic uraemic syndrome: prognostic factors in children over 3 years of age.

Previous studies have shown that age at onset of primary haemolytic uraemic syndrome (HUS) is a feature of prognostic significance, the disease being of much better outcome in paediatric patients younger than 3 years than in older children. In an attempt to find an explanation for such a difference, we analysed the clinical and pathological features of 42 children over 3 years of age who presented with HUS between 1955 and 1990 in our department. On the basis of the presence of a prodromal diarrhoea, we divided our patients into two groups: 21 children presented with the diarrhoea-associated (typical or D+) form of HUS, whereas 21 had the non-diarrhoea-associated (atypical or D-) form. Of the 42 children, 20 (47.5%) progressed to end-stage renal failure. However, our study shows that age at onset of HUS is not a prognostic feature per se. The difference in outcome between children and infants is most likely related to the high incidence of the atypical subset of HUS in children over 3 years, a subset that is very uncommon in infants. The ominous features which characterise this form of the disease are: (1) the absence of a diarrhoeal prodrome, (2) normal urine output, (3) marked proteinuria, (4) hypertension, (5) the occurrence of relapses or recurrences and (6) the presence of widespread and severe arteriolar changes on renal biopsy. The poor prognosis of the atypical form of HUS warrants the use of fresh-frozen plasma infusions and/or plasma exchange as early as possible in the course of the disease.

Adolescent↗
PubMed1994

Endothelin-1 in children with chronic renal failure.

Endothelin-1 (ET-1) was measured after extraction from plasma of normal adults (5.9 +/- 1.9 pg/ml, n = 22), normal children (7.1 +/- 1.86 pg/ml, n = 29), non-haemodialysed children with chronic renal failure (CRF) (11.1 +/- 1.8 pg/ml), n = 10), renal graft recipients (9.5 +/- 3.4 pg/ml, n = 37), haemodialysed children 24 h after a haemodialysis session (20.02 +/- 10.9 pg/ml, n = 26) and haemodialysed children before and after a haemodialysis session (15.31 +/- 10.6 and 13.8 +/- 8.5 respectively, n = 14). A sensitive and specific radioimmunoassay was used. ET-1 was significantly higher in non-haemodialysed CRF children and in renal graft recipients than in normal children (P < 0.001 and P < 0.01, respectively) and significantly higher in haemodialysed children when compared with normal children, non-haemodialysed CRF children and renal graft recipients (P < 0.001). ET-1 concentrations were similar in normal children and normal adults. ET-1 was inversely correlated with glomerular filtration rate in non-haemodialysed CRF children (r = -0.39, P < 0.01) and positively correlated with extracellular volume in haemodialysed children (r = 0.435, P < 0.03). After haemodialysis, ET-1 increased in 6 and decreased in 8 of the 14 children studied before and after a haemodialysis session.

Adolescent↗
PubMed1994

[A review of 72 renal artery stenoses in a series of 715 kidney transplantations in children].

In a series of 715 renal transplantations performed between 1973 and 1989, 72 cases of renal artery stenosis (RAS) in 69 children (9.7%) were managed at Hôpital Necker Enfants Malades. Forty cases of RAS were treated exclusively by antihypertensive drugs. A good result was obtained in 82.5% of cases. Thirty three transluminal angioplasties (TLA) were performed in 23 children with 26 RAS. A good clinical result was obtained in 15 children with a total of 17 stenoses, corresponding to a success rate of 65%. Transluminal dilatation of anastomotic stenoses always failed. There were no cases of transplant thrombosis. Eleven RAS were operated, including 5 after failure of TLA. Eight patients (73%) obtained a clinical improvement. There were 2 postoperative thromboses. Antihypertensive treatment must be administered in every case. If medical treatment fails, and with the exception of anastomotic stenoses, TLA should be the first-line procedure, while surgery is reserved for failures of TLA and for anastomotic stenoses.

Adolescent↗
PubMed1994

[Treatment of anemia in hemodialyzed children using recombinant human erythropoietin (Eprex). Results of a French multicenter clinical trial].

Intravenous recombinant human erythropoietin (Eprex Cilag) was used in 28 hemodialyzed children, treated in 3 French paediatric centers, from November 1989 to November 1990. Transfusion dependency disappeared in all cases: the number of transfusions decreased from 7.3 unit/patient/year to 0.6 unit/pt/year. The mean haemoglobin concentration for the whole group increased from 6.6 +/- 0.8 g/dl, to 9.2 +/- 1.2 at 6 months and 9.7 +/- 0.7 g/dl at 1 year. Twenty-two out of 28 children reached the target haemoglobin value of 9.6 g/dl (6 mmol/dL) within a mean time of 16.5 weeks. Poor responses were due to either a premature withdrawal of treatment because of renal transplantation, or too low a dosage for the age. The study showed indeed that the dose requirement was significantly dependent on physical development: the mean dosage required to maintain haemoglobin concentration at the target value was 300 U/kg/week in children weighing less than 20 kg, 222 U/kg/week in 20-30 kg children, and 135 U/kg/week in those weighing more than 30 kg (p = 0.02). The only complication was an increase in blood pressure, observed in 43% of cases. The increase of anti-hypertensive medication was always successful in controlling blood pressure, and hospitalization was required in only one case. The improvement in general condition was obvious, and in several cases, the cognitive abilities seemed to improve. The growth deficit remained unchanged.

Adolescent↗
PubMed1994

[Characteristic aspects of vascular complications in renal transplantation in children].

In a series of 859 transplantations performed in children and adolescents from January 1973 to December 1992, vascular thrombosis accounted for 18% of all graft losses (2nd cause of graft failure), and 57% of early failures (within 2 months). Renal veins and arteries were equally affected. The young age of the donors and recipients constituted the main risk factor, thrombosis accounting for 40 and 37% respectively of all graft losses in donors and recipients < 5 years old. This explained the lower survival rate of these age groups after grafting, as reported in most published pediatric series. The prophylactic use of a low molecular weight heparin in high-risk grafts may help to decrease its incidence. A renal artery stenosis, located a few cm beyond the anastomosis in 2/3 of cases, was observed in 10% of grafts. Often severe hypertension (HBP) with cerebral complications, responsible for permanent sequelae in some cases, was the prominent symptom. Anti-hypertensive drug therapy was sufficient to control HBP in 40 cases out of 72, and in 10 of these, a spontaneous regression of the stenosis was remarked within a few months after repeated angiography. Transluminal angioplasty was used on 26 stenosis and was effective in 2/3 of cases; the recurrence rate, however, was 27%.

Adolescent↗
PubMed1993

Non-immunological risk factors in paediatric renal transplantation.

In paediatric renal transplantation, non-immunological risk factors account for about one-third of graft losses. Recurrence of original disease is observed mainly in primary hyperoxaluria and glomerulopathies such as steroid-resistant nephrotic syndrome and membranoproliferative glomerulonephritis. In both glomerulopathies, 20% of grafts are lost from recurrence. Vascular thrombosis is, in most series, the second cause of graft loss in children, particularly in young recipients or with young donors (under 5 years of age). Non-compliance with treatment is a common non-immunological factor in adolescent recipients, which may trigger a severe rejection process resulting in graft loss. The role of factors related to graft preservation and intra- and post-operative management (ischaemia time, delayed graft function) or to cytomegalovirus infection is less obvious in our series. Prevention of vascular thrombosis and of non-compliance is most important in order to improve the results of paediatric renal transplantation.

Adolescent↗
PubMed1993

A specific glomerular lesion of the graft: allograft glomerulopathy.

During the period from January 1973 to December 1970, 774 renal transplantations in 698 children have been performed in our Renal Unit. A total of 540 grafts have been examined both by light and immunofluorescence microscopy at least once. Recurrent glomerulonephritis was diagnosed in 62 grafts, de novo glomerulonephritis in 68 and allograft glomerulopathy (AGP) in 38. AGP was defined as a lesion affecting all glomeruli and characterized by widespread reduplication of the GBM with widening of the subendothelial space and interposition of mesangial matrix and without significant deposits by immunofluorescence. The aim of the current study is to describe the natural history of AGP and to delinate its clinical significance. At time of biopsy, an increase in serum creatinine was present in 30 patients associated with a proteinuria > or = 1 g/day in 21. During the post-transplantation course, proteinuria was present in 29 patients and associated with a nephrotic syndrome in 10 of them. With a mean follow-up of eight years seven months, two patients died, 23 lost their grafts and 13 have a functioning graft. The lesions of AGP recurred in three of the nine children who received a second graft. Thirteen of the 33 patients in whom earlier biopsies were performed showed a different pattern of involvement characterized by a prominent swelling of active endothelial and mesangial cells and a hypercellularity related to the presence of mononuclear cells both in the lumens and in the mesangial areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Old renal transplants examined by Doppler ultrasonography.

Twenty-four ultrasonography (US) studies of 21 renal transplants that had been in place for 1 to 19 (median 3) years were evaluated. The absolute resistive indices (RIs) determined during Doppler US at various arterial levels and the differences in RI between the levels did not correlate with the clinical diagnosis of chronic rejection. This study suggests that measuring RI values with Doppler US in people who received renal grafts as children does not currently contribute additional information for diagnosis or management.

Adolescent↗