Jean-Louis Vanherweghem - Academia.edu (original) (raw)
Papers by Jean-Louis Vanherweghem
American Journal of Kidney Diseases, 2002
Clinical nephrology, 1986
Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since o... more Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since one of its advantages was considered to be no damage to blood vessels. As we observed six patients with symptomatic subclavian vein thrombosis among 148 patients having received subclavian vein cannulation for hemodialysis, we systematically performed subclavian venogram in 42 asymptomatic patients selected on the basis of a history of previous subclavian vein cannulation. Venograms were performed 15.7 +/- 8.9 months after the removal of the last catheter. Eight patients (19%) had complete thrombosis or severe stenosis of the subclavian vein while six patients (14%) had minimal luminal defects. Considering together the 48 patients, the group with thrombosis or severe stenosis (group 1, n = 14) was compared with the group with minimal defects or normal venograms (group 2, n = 34). In group 1, as compared with group 2, there were more female (64% vs 32%, p = 0.02), more cannulations per vei...
La Nouvelle presse médicale
In response to ischaemic or vasoconstrictor stimuli the kidney reacts by synthesising prostagland... more In response to ischaemic or vasoconstrictor stimuli the kidney reacts by synthesising prostaglandins (PG) which modify local vascular tone. They induce a compensatory vasodilatation and direct the blood flow towards the internal cortex. It is thus not necessary to attribute a systemic role to PG in order to understand their haemodynamic action. This explains the natriuresis following the injection of PG both in the animal and in man. Nevertheless the direct effet of PG upon the tubular reabsorption of sodium remains controversial since very different experimental models lead to contradictory conclusions. Despite these disparate data, it is probable that PG are intimately involved in the pathogenesis of hypertension. A lack of PG or a deficiency in their metabolism may be responsible in essential hypertension.
Contributions to nephrology
Canadian Medical Association Journal
Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association, 1981
The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow u... more The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow up of 21 haemodialysed patients without clinical or radiological evidence of osteodystrophy. 99mTc-PPi bone scintigraphy was semi-quantitatively analysed using Fogelman's score. Patients were randomised to receive vitamin D analogues (1 alpha hydroxyvitamin D3 or dihydrotachysterol, n = 12) or to serve as controls (n = 9), both groups being given oral calcium supplements. Bone scintigraphy deteriorated in patients only on calcium therapy but not in patients treated by vitamin D-analogues. Vitamin D therapy reduced secondary hyperparathyroidism in all cases but induced rapid intoxication with normal doses in 4 of the 12 treated patients. Since intoxicated patients had significantly lower Fogelman's score than the patients who tolerated the treatment well, 99mTc-PPi bone scintigraphy is proposed as a screening test before vitamin D-analogues trials.
Pfl�gers Archiv European Journal of Physiology, 1976
The effects of acute hypercalcemia on hemodynamics and on water and sodium excretion were studied... more The effects of acute hypercalcemia on hemodynamics and on water and sodium excretion were studied on the blood-perfused isolated dog kidney. This model advantageously eliminates various factors which modify medullary osmolality and intrarenal hemodynamics, as well as collecting duct permeability. Calcium ion directly inhibits sodium reabsorption in the proximal tubule and in the ascending limb of Henle's loop, leading to increased sodium excretion rate and to decreased free water generation. The vasoconstrictive action of calcium, leading to decreased glomerular filtration rate, may mitigate the strong natriuretic effect of this ion.
Pfl�gers Archiv European Journal of Physiology, 1975
Blood-perfused isolated dog kidneys demonstrate steady increases in blood flow and in water and s... more Blood-perfused isolated dog kidneys demonstrate steady increases in blood flow and in water and sodium excretion which could be attributed to the accumulation of renal prostaglandins in the perfusing blood. This hypothesis was tested by adding indomethacin, a potent inhibitor of prostaglandins synthesis, to the perfusing blood. Indomethacin completely prevented the vasodilation observed in control kidneys, without affecting glomerular filtration rate. Urine volume was not modified but sodium excretion was enhanced while the steady free water clearance increment observed in the control kidneys was depressed by indomethacin. The sum of sodium and free water clearances which, in the absence of antidiuretic hormone, constitutes an index of the part of the filtered load of solutes which escapes proximal tubular reabsorption, was not modified by indomethacin. Finally, indomethacin partially maintained the osmotic cortico-papillary gradient which was abolished after 2 hrs perfusion in control kidneys. These data suggest that prostaglandins accumulation in the blood is probably the major cause of the vasodilation taking place in isolated blood-perfused kidneys. This vasodilation does not account for decreased proximal reabsorption but partially explains the ADH-resistant diabetes insipidus developing in the isolated kidney. Moreover, indomethacin inhibits sodium reabsorption in the ascending limb of Henle's loop and increases water transport in the collecting duct.
The Lancet, 1993
Two similar cases of rapidly progressive fibrosing interstitial nephritis in young women who foll... more Two similar cases of rapidly progressive fibrosing interstitial nephritis in young women who followed the same slimming regimen prompted us to conduct an epidemiological survey of the nephrology centres of Brussels and to further investigate the exact nature of this slimming treatment. Seven other women under the age of 50 in terminal or preterminal renal failure were admitted for dialysis in 1991 and 1992. They had all followed a slimming regimen in the same medical clinic. Renal biopsy samples in eight of the nine cases showed extensive interstitial fibrosis without glomerular lesions. Two of the patients were seen for the first time in terminal renal failure and were started immediately on dialysis. For the seven other women, the nephropathy was characterised by a rapid deterioration in renal function, with initial serum creatinine doubling within about 3 months. The clinic had specialised in slimming treatments for the previous 15 years without any problems. In May, 1990, therapy was changed, with the introduction of two Chinese herbs (Stephania tetrandra and Magnolia officinalis). In June, 1992, three of twenty-five randomly selected women who had followed the same regimen during at least 3 months from 1990 had impaired renal function. Chemical analysis of some brands of these Chinese herbs did not show nephrotoxic contaminants of fungal or plant origin (ochratoxin or aristolochic acid) or adulteration by diuretics or antiinflammatory drugs. However, the medicinal preparation of the capsules taken by patients had different alkaloid profiles from those expected in Chinese plants. The striking relation between a specific type of fibrosing interstitial nephritis in young women and a slimming treatment involving Chinese herbs adds support to the arguments against uncontrolled therapy with herbal preparations.
The Lancet, 1985
GLOMERULAR FILTRATION RESPONSE TO ACUTE PROTEIN LOAD. By - Y. Vanrenterghem, R. Verberckmoes, L. ... more GLOMERULAR FILTRATION RESPONSE TO ACUTE PROTEIN LOAD. By - Y. Vanrenterghem, R. Verberckmoes, L. Roels, P. Michielsen, Hatem Mansy, JS Tapson, J. Fernandez, S. Tapster, R. Wilkinson, Michel Dhaen...
Kidney and Blood Pressure Research, 1979
ABSTRACT
Journal of Infectious Diseases, 1987
Page 1. THE JOURNAL OF INFECTIOUS DISEASES * VOL. 156, NO. 2 * AUGUST 1987 l 1987 by The Universi... more Page 1. THE JOURNAL OF INFECTIOUS DISEASES * VOL. 156, NO. 2 * AUGUST 1987 l 1987 by The University of Chicago. All rights reserved. 0022-1899/87/5602-0020$01.00 The Role of Iron Overload in Yersinia enterocolitica ...
Journal of Endocrinological Investigation, 1993
Twenty-seven uremic patients (blood urea: 58.2 +/- 2.2 mmol/l; blood creatinine: 1,069 +/- 53 mum... more Twenty-seven uremic patients (blood urea: 58.2 +/- 2.2 mmol/l; blood creatinine: 1,069 +/- 53 mumol/l; mean +/- SE) on maintenance dialysis were investigated immediately before and after a dialysis session. Control data were obtained from 30 normal volunteers. Before dialysis, circulating levels of insulin-like growth factor I (IGF-I) were similar in anuric and nonanuric patients, averaging 305 +/- 24 micrograms/l, a value not different from that observed in normal controls (262 +/- 16 micrograms/l). IGF-I levels were not modified by dialysis. In contrast, GH values were significantly higher in uremic patients (3.6 +/- 0.6 microgram/l) than in normal controls (2.5 +/- 0.5 microgram/l) and decreased significantly after the dialysis session (0.8 +/- 0.1 microgram/l). IGF-I values were positively correlated with GH and albumin, but not with the various parameters of renal insufficiency, suggesting that in chronic renal failure, synthesis of IGF-I appears to be regulated, as in normal subjects, by growth hormone and nutritional status.
Néphrologie & Thérapeutique, 2015
Aristolochic acid nephropathy is a renal disease of toxic origin characterized by a progressive i... more Aristolochic acid nephropathy is a renal disease of toxic origin characterized by a progressive interstitial fibrosis and frequently associated with urinary tract cancer. It was initially reported in Belgium after the intake of slimming pills containing root extracts of a Chinese herb, Aristolochia fangchi. In the following decades, numerous cases have been reported worldwide, particularly in Asian countries. Several experimental models of aristolochic acid nephropathy (AAN) have been designed. They confirm the causal link between AA exposure and the onset of acute and chronic renal toxicity, as well as urinary tract cancer. These experimental models offer the opportunity to study the mechanisms of renal interstitial fibrosis and carcinogenesis. In terms of public health, the history of this nephropathy demonstrates that it is mandatory to submit all "natural medicinal products" to the same controls of efficacy, toxicity and conformity applied to the classical drugs derived from the pharmaceutical producers. Any unusual observation of renal failure and/or cancer of the urinary tract should lead to a questioning about any prior exposure to AA. The confirmation of the ingestion of AA containing compounds by phytochemical analysis is not always feasible. However, the renal biopsy remains a crucial diagnostic point through the demonstration of a hypocellular interstitial fibrosis with a decreasing corticomedullary gradient, mostly in advanced cases of kidney disease. Moreover, the detection of AA-related DNA adducts within a renal or urothelial tissue sample could confirm the prior AA exposure. The persistence of these specific DNA adducts in renal tissue is very long (up to 20 years). Finally, considering the highly carcinogenic properties of AA, a systematic endo-urological screening is absolutely necessary.
ASAIO Journal, 1990
Nineteen patients in whom it was impossible to create an arteriovenous (AV) fistula were hemodial... more Nineteen patients in whom it was impossible to create an arteriovenous (AV) fistula were hemodialyzed with adult Hickman catheters as the sole vascular access. Catheter survival was 45% at 1 year, with eight patients requiring two or three catheters for the continuation of their treatment. The probability of a patient still being dialyzed with a Hickman catheter at 1 year was 69%. The calculated risk of developing the most frequent complications was 0.07/100 catheter days for sepsis, 0.4/100 catheter days for thrombosis, and 0.06/100 catheter days for outflow obstruction. These figures seem quite acceptable, and the use of Hickman catheters as permanent vascular access is warranted in this category of difficult patient.
Clinical nephrology
Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since o... more Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since one of its advantages was considered to be no damage to blood vessels. As we observed six patients with symptomatic subclavian vein thrombosis among 148 patients having received subclavian vein cannulation for hemodialysis, we systematically performed subclavian venogram in 42 asymptomatic patients selected on the basis of a history of previous subclavian vein cannulation. Venograms were performed 15.7 +/- 8.9 months after the removal of the last catheter. Eight patients (19%) had complete thrombosis or severe stenosis of the subclavian vein while six patients (14%) had minimal luminal defects. Considering together the 48 patients, the group with thrombosis or severe stenosis (group 1, n = 14) was compared with the group with minimal defects or normal venograms (group 2, n = 34). In group 1, as compared with group 2, there were more female (64% vs 32%, p = 0.02), more cannulations per vein (1.87 +/- 0.35 vs 1.32 +/- 0.08, p less than 0.05) and more cumulative days of cannulation per vein (35.1 +/- 7.9 vs 24.4 +/- 1.1, p less than 0.001). No difference between the two groups was seen for the number of catheter infections, the number of catheters with poor flow or obstruction, the coagulation screening of the patients or the time-length between the removal of the last catheter and the venogram study. Two of the initially asymptomatic patients developed later on clinical problems related to the subclavian vein thrombosis. We conclude that the subclavian vein cannulation leads to significant damages of the vessels, excluding a whole arm, for future vascular access in some patients.
American Journal of Kidney Diseases, 2004
The use of herbal therapy has increased dramatically in past years and may lead to renal injury o... more The use of herbal therapy has increased dramatically in past years and may lead to renal injury or various toxic insults, especially in renal patients. In most countries, herbal products are not regulated as medicines. Herbal poisoning may be secondary to the presence of undisclosed drugs or heavy metals, interaction with the pharmacokinetic profile of concomitantly administered drugs, or association with a misidentified herbal species. Various renal syndromes were reported after the use of medicinal plants, including tubular necrosis, acute interstitial nephritis, Fanconi's syndrome, hypokalemia or hyperkalemia, hypertension, papillary necrosis, chronic interstitial nephritis, nephrolithiasis, urinary retention, and cancer of the urinary tract. It seems critical that caregivers be aware of the potential risk of such often underreported therapy and carefully question their patients about their use of this popular branch of alternative medicine. Am J Kidney Dis 44:1-11.
Advances in nephrology from the Necker Hospital
Liver dysfunction was observed in 33% of patients treated by hemodialysis and kidney transplantat... more Liver dysfunction was observed in 33% of patients treated by hemodialysis and kidney transplantation. Fifty-eight percent of these cases of hepatitis occurred in patients with past or present HBs antigenemia, and 77% of HBsAg-positive patients showed evidence of LD. However, during the course of a program conducted from 1969 to 1976 and involving 267 patients, the decrease in the prevalence of HBs antigenemia observed during the last two years did not lead to any reduction in LD incidence. In a small number of patients, potentially hepatotoxic drugs could be incriminated, but in our experience azathioprine never appeared to be involved. In a few patients, LD was due to granulomatous disease of the liver, such as tuberculosis and schistosomiasis. Twenty-one (7%) of the 267 patients at risk developed chronic hepatitis, which contributed to death in nine patients. In 12 cases (three deaths), this form of hepatitis occurred in HBsAg-positive patients, and in nine cases (six deaths), in HBsAg-negative patients. In three of these latter individuals, cytomegalovirus could be incriminated. Routine monthly screening for CMV in kidney recipients confirmed the high incidence of this viral infection in such patients. Studies on murine CMV infection have demonstrated that this infection can be enhanced by histoincompatible graft or by cyclophosphamide in a model that is very close to the kidney recipient. As in mice, CMV infection in kidney recipients apparently results from reactivation of a latent infection. It seems to play a major role in the LD observed and could apparently lead to chronic hepatitis and even to cirrhosis of the liver. Finally, the occurrence of LD in HBsAg-, anti-HBs- and antiCMV-negative patients would suggest the responsibility of other viruses for the pathogenesis of liver disease in patients treated by hemodialysis and kidney transplantation. Besides Epstein-Barr virus, other viruses, such as hepatitis C virus, should be thoroughly scrutinized.
American Journal of Kidney Diseases, 2002
Clinical nephrology, 1986
Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since o... more Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since one of its advantages was considered to be no damage to blood vessels. As we observed six patients with symptomatic subclavian vein thrombosis among 148 patients having received subclavian vein cannulation for hemodialysis, we systematically performed subclavian venogram in 42 asymptomatic patients selected on the basis of a history of previous subclavian vein cannulation. Venograms were performed 15.7 +/- 8.9 months after the removal of the last catheter. Eight patients (19%) had complete thrombosis or severe stenosis of the subclavian vein while six patients (14%) had minimal luminal defects. Considering together the 48 patients, the group with thrombosis or severe stenosis (group 1, n = 14) was compared with the group with minimal defects or normal venograms (group 2, n = 34). In group 1, as compared with group 2, there were more female (64% vs 32%, p = 0.02), more cannulations per vei...
La Nouvelle presse médicale
In response to ischaemic or vasoconstrictor stimuli the kidney reacts by synthesising prostagland... more In response to ischaemic or vasoconstrictor stimuli the kidney reacts by synthesising prostaglandins (PG) which modify local vascular tone. They induce a compensatory vasodilatation and direct the blood flow towards the internal cortex. It is thus not necessary to attribute a systemic role to PG in order to understand their haemodynamic action. This explains the natriuresis following the injection of PG both in the animal and in man. Nevertheless the direct effet of PG upon the tubular reabsorption of sodium remains controversial since very different experimental models lead to contradictory conclusions. Despite these disparate data, it is probable that PG are intimately involved in the pathogenesis of hypertension. A lack of PG or a deficiency in their metabolism may be responsible in essential hypertension.
Contributions to nephrology
Canadian Medical Association Journal
Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association, 1981
The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow u... more The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow up of 21 haemodialysed patients without clinical or radiological evidence of osteodystrophy. 99mTc-PPi bone scintigraphy was semi-quantitatively analysed using Fogelman's score. Patients were randomised to receive vitamin D analogues (1 alpha hydroxyvitamin D3 or dihydrotachysterol, n = 12) or to serve as controls (n = 9), both groups being given oral calcium supplements. Bone scintigraphy deteriorated in patients only on calcium therapy but not in patients treated by vitamin D-analogues. Vitamin D therapy reduced secondary hyperparathyroidism in all cases but induced rapid intoxication with normal doses in 4 of the 12 treated patients. Since intoxicated patients had significantly lower Fogelman's score than the patients who tolerated the treatment well, 99mTc-PPi bone scintigraphy is proposed as a screening test before vitamin D-analogues trials.
Pfl�gers Archiv European Journal of Physiology, 1976
The effects of acute hypercalcemia on hemodynamics and on water and sodium excretion were studied... more The effects of acute hypercalcemia on hemodynamics and on water and sodium excretion were studied on the blood-perfused isolated dog kidney. This model advantageously eliminates various factors which modify medullary osmolality and intrarenal hemodynamics, as well as collecting duct permeability. Calcium ion directly inhibits sodium reabsorption in the proximal tubule and in the ascending limb of Henle's loop, leading to increased sodium excretion rate and to decreased free water generation. The vasoconstrictive action of calcium, leading to decreased glomerular filtration rate, may mitigate the strong natriuretic effect of this ion.
Pfl�gers Archiv European Journal of Physiology, 1975
Blood-perfused isolated dog kidneys demonstrate steady increases in blood flow and in water and s... more Blood-perfused isolated dog kidneys demonstrate steady increases in blood flow and in water and sodium excretion which could be attributed to the accumulation of renal prostaglandins in the perfusing blood. This hypothesis was tested by adding indomethacin, a potent inhibitor of prostaglandins synthesis, to the perfusing blood. Indomethacin completely prevented the vasodilation observed in control kidneys, without affecting glomerular filtration rate. Urine volume was not modified but sodium excretion was enhanced while the steady free water clearance increment observed in the control kidneys was depressed by indomethacin. The sum of sodium and free water clearances which, in the absence of antidiuretic hormone, constitutes an index of the part of the filtered load of solutes which escapes proximal tubular reabsorption, was not modified by indomethacin. Finally, indomethacin partially maintained the osmotic cortico-papillary gradient which was abolished after 2 hrs perfusion in control kidneys. These data suggest that prostaglandins accumulation in the blood is probably the major cause of the vasodilation taking place in isolated blood-perfused kidneys. This vasodilation does not account for decreased proximal reabsorption but partially explains the ADH-resistant diabetes insipidus developing in the isolated kidney. Moreover, indomethacin inhibits sodium reabsorption in the ascending limb of Henle's loop and increases water transport in the collecting duct.
The Lancet, 1993
Two similar cases of rapidly progressive fibrosing interstitial nephritis in young women who foll... more Two similar cases of rapidly progressive fibrosing interstitial nephritis in young women who followed the same slimming regimen prompted us to conduct an epidemiological survey of the nephrology centres of Brussels and to further investigate the exact nature of this slimming treatment. Seven other women under the age of 50 in terminal or preterminal renal failure were admitted for dialysis in 1991 and 1992. They had all followed a slimming regimen in the same medical clinic. Renal biopsy samples in eight of the nine cases showed extensive interstitial fibrosis without glomerular lesions. Two of the patients were seen for the first time in terminal renal failure and were started immediately on dialysis. For the seven other women, the nephropathy was characterised by a rapid deterioration in renal function, with initial serum creatinine doubling within about 3 months. The clinic had specialised in slimming treatments for the previous 15 years without any problems. In May, 1990, therapy was changed, with the introduction of two Chinese herbs (Stephania tetrandra and Magnolia officinalis). In June, 1992, three of twenty-five randomly selected women who had followed the same regimen during at least 3 months from 1990 had impaired renal function. Chemical analysis of some brands of these Chinese herbs did not show nephrotoxic contaminants of fungal or plant origin (ochratoxin or aristolochic acid) or adulteration by diuretics or antiinflammatory drugs. However, the medicinal preparation of the capsules taken by patients had different alkaloid profiles from those expected in Chinese plants. The striking relation between a specific type of fibrosing interstitial nephritis in young women and a slimming treatment involving Chinese herbs adds support to the arguments against uncontrolled therapy with herbal preparations.
The Lancet, 1985
GLOMERULAR FILTRATION RESPONSE TO ACUTE PROTEIN LOAD. By - Y. Vanrenterghem, R. Verberckmoes, L. ... more GLOMERULAR FILTRATION RESPONSE TO ACUTE PROTEIN LOAD. By - Y. Vanrenterghem, R. Verberckmoes, L. Roels, P. Michielsen, Hatem Mansy, JS Tapson, J. Fernandez, S. Tapster, R. Wilkinson, Michel Dhaen...
Kidney and Blood Pressure Research, 1979
ABSTRACT
Journal of Infectious Diseases, 1987
Page 1. THE JOURNAL OF INFECTIOUS DISEASES * VOL. 156, NO. 2 * AUGUST 1987 l 1987 by The Universi... more Page 1. THE JOURNAL OF INFECTIOUS DISEASES * VOL. 156, NO. 2 * AUGUST 1987 l 1987 by The University of Chicago. All rights reserved. 0022-1899/87/5602-0020$01.00 The Role of Iron Overload in Yersinia enterocolitica ...
Journal of Endocrinological Investigation, 1993
Twenty-seven uremic patients (blood urea: 58.2 +/- 2.2 mmol/l; blood creatinine: 1,069 +/- 53 mum... more Twenty-seven uremic patients (blood urea: 58.2 +/- 2.2 mmol/l; blood creatinine: 1,069 +/- 53 mumol/l; mean +/- SE) on maintenance dialysis were investigated immediately before and after a dialysis session. Control data were obtained from 30 normal volunteers. Before dialysis, circulating levels of insulin-like growth factor I (IGF-I) were similar in anuric and nonanuric patients, averaging 305 +/- 24 micrograms/l, a value not different from that observed in normal controls (262 +/- 16 micrograms/l). IGF-I levels were not modified by dialysis. In contrast, GH values were significantly higher in uremic patients (3.6 +/- 0.6 microgram/l) than in normal controls (2.5 +/- 0.5 microgram/l) and decreased significantly after the dialysis session (0.8 +/- 0.1 microgram/l). IGF-I values were positively correlated with GH and albumin, but not with the various parameters of renal insufficiency, suggesting that in chronic renal failure, synthesis of IGF-I appears to be regulated, as in normal subjects, by growth hormone and nutritional status.
Néphrologie & Thérapeutique, 2015
Aristolochic acid nephropathy is a renal disease of toxic origin characterized by a progressive i... more Aristolochic acid nephropathy is a renal disease of toxic origin characterized by a progressive interstitial fibrosis and frequently associated with urinary tract cancer. It was initially reported in Belgium after the intake of slimming pills containing root extracts of a Chinese herb, Aristolochia fangchi. In the following decades, numerous cases have been reported worldwide, particularly in Asian countries. Several experimental models of aristolochic acid nephropathy (AAN) have been designed. They confirm the causal link between AA exposure and the onset of acute and chronic renal toxicity, as well as urinary tract cancer. These experimental models offer the opportunity to study the mechanisms of renal interstitial fibrosis and carcinogenesis. In terms of public health, the history of this nephropathy demonstrates that it is mandatory to submit all "natural medicinal products" to the same controls of efficacy, toxicity and conformity applied to the classical drugs derived from the pharmaceutical producers. Any unusual observation of renal failure and/or cancer of the urinary tract should lead to a questioning about any prior exposure to AA. The confirmation of the ingestion of AA containing compounds by phytochemical analysis is not always feasible. However, the renal biopsy remains a crucial diagnostic point through the demonstration of a hypocellular interstitial fibrosis with a decreasing corticomedullary gradient, mostly in advanced cases of kidney disease. Moreover, the detection of AA-related DNA adducts within a renal or urothelial tissue sample could confirm the prior AA exposure. The persistence of these specific DNA adducts in renal tissue is very long (up to 20 years). Finally, considering the highly carcinogenic properties of AA, a systematic endo-urological screening is absolutely necessary.
ASAIO Journal, 1990
Nineteen patients in whom it was impossible to create an arteriovenous (AV) fistula were hemodial... more Nineteen patients in whom it was impossible to create an arteriovenous (AV) fistula were hemodialyzed with adult Hickman catheters as the sole vascular access. Catheter survival was 45% at 1 year, with eight patients requiring two or three catheters for the continuation of their treatment. The probability of a patient still being dialyzed with a Hickman catheter at 1 year was 69%. The calculated risk of developing the most frequent complications was 0.07/100 catheter days for sepsis, 0.4/100 catheter days for thrombosis, and 0.06/100 catheter days for outflow obstruction. These figures seem quite acceptable, and the use of Hickman catheters as permanent vascular access is warranted in this category of difficult patient.
Clinical nephrology
Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since o... more Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since one of its advantages was considered to be no damage to blood vessels. As we observed six patients with symptomatic subclavian vein thrombosis among 148 patients having received subclavian vein cannulation for hemodialysis, we systematically performed subclavian venogram in 42 asymptomatic patients selected on the basis of a history of previous subclavian vein cannulation. Venograms were performed 15.7 +/- 8.9 months after the removal of the last catheter. Eight patients (19%) had complete thrombosis or severe stenosis of the subclavian vein while six patients (14%) had minimal luminal defects. Considering together the 48 patients, the group with thrombosis or severe stenosis (group 1, n = 14) was compared with the group with minimal defects or normal venograms (group 2, n = 34). In group 1, as compared with group 2, there were more female (64% vs 32%, p = 0.02), more cannulations per vein (1.87 +/- 0.35 vs 1.32 +/- 0.08, p less than 0.05) and more cumulative days of cannulation per vein (35.1 +/- 7.9 vs 24.4 +/- 1.1, p less than 0.001). No difference between the two groups was seen for the number of catheter infections, the number of catheters with poor flow or obstruction, the coagulation screening of the patients or the time-length between the removal of the last catheter and the venogram study. Two of the initially asymptomatic patients developed later on clinical problems related to the subclavian vein thrombosis. We conclude that the subclavian vein cannulation leads to significant damages of the vessels, excluding a whole arm, for future vascular access in some patients.
American Journal of Kidney Diseases, 2004
The use of herbal therapy has increased dramatically in past years and may lead to renal injury o... more The use of herbal therapy has increased dramatically in past years and may lead to renal injury or various toxic insults, especially in renal patients. In most countries, herbal products are not regulated as medicines. Herbal poisoning may be secondary to the presence of undisclosed drugs or heavy metals, interaction with the pharmacokinetic profile of concomitantly administered drugs, or association with a misidentified herbal species. Various renal syndromes were reported after the use of medicinal plants, including tubular necrosis, acute interstitial nephritis, Fanconi's syndrome, hypokalemia or hyperkalemia, hypertension, papillary necrosis, chronic interstitial nephritis, nephrolithiasis, urinary retention, and cancer of the urinary tract. It seems critical that caregivers be aware of the potential risk of such often underreported therapy and carefully question their patients about their use of this popular branch of alternative medicine. Am J Kidney Dis 44:1-11.
Advances in nephrology from the Necker Hospital
Liver dysfunction was observed in 33% of patients treated by hemodialysis and kidney transplantat... more Liver dysfunction was observed in 33% of patients treated by hemodialysis and kidney transplantation. Fifty-eight percent of these cases of hepatitis occurred in patients with past or present HBs antigenemia, and 77% of HBsAg-positive patients showed evidence of LD. However, during the course of a program conducted from 1969 to 1976 and involving 267 patients, the decrease in the prevalence of HBs antigenemia observed during the last two years did not lead to any reduction in LD incidence. In a small number of patients, potentially hepatotoxic drugs could be incriminated, but in our experience azathioprine never appeared to be involved. In a few patients, LD was due to granulomatous disease of the liver, such as tuberculosis and schistosomiasis. Twenty-one (7%) of the 267 patients at risk developed chronic hepatitis, which contributed to death in nine patients. In 12 cases (three deaths), this form of hepatitis occurred in HBsAg-positive patients, and in nine cases (six deaths), in HBsAg-negative patients. In three of these latter individuals, cytomegalovirus could be incriminated. Routine monthly screening for CMV in kidney recipients confirmed the high incidence of this viral infection in such patients. Studies on murine CMV infection have demonstrated that this infection can be enhanced by histoincompatible graft or by cyclophosphamide in a model that is very close to the kidney recipient. As in mice, CMV infection in kidney recipients apparently results from reactivation of a latent infection. It seems to play a major role in the LD observed and could apparently lead to chronic hepatitis and even to cirrhosis of the liver. Finally, the occurrence of LD in HBsAg-, anti-HBs- and antiCMV-negative patients would suggest the responsibility of other viruses for the pathogenesis of liver disease in patients treated by hemodialysis and kidney transplantation. Besides Epstein-Barr virus, other viruses, such as hepatitis C virus, should be thoroughly scrutinized.