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Papers by Michel Jadoul

Transplant International, Jun 13, 2023

Clinical Kidney Journal, 2021

Clinical Kidney Journal, 2021

Cinacalcet and, more recently, etelcalcetide revolutionized the treatment of chronic kidney disea... more Cinacalcet and, more recently, etelcalcetide revolutionized the treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney transplant (KT) usually improves CKD–MBD. However, a significant proportion of KT recipients have high serum calcium levels, not requiring any treatment. We report two patients previously treated with etelcalcetide who developed severe (>3.3 mmol/L) hypercalcaemia in the early post-KT course, requiring parathyroidectomy. Pathological studies showed parathyroid adenomas and hyperplasia. One patient had a graft biopsy showing numerous intratubular calcium phosphate crystals. These observations should prompt pharmacovigilance studies and careful follow-up of KT recipients previously treated with etelcalcetide.

Nephrology Dialysis Transplantation, 2017

Demographic (age, gender), clinical (height, weight, last mean 3-month pre-dialysis systolic and ... more Demographic (age, gender), clinical (height, weight, last mean 3-month pre-dialysis systolic and diastolic blood pressures) data were collected from patient files. Also last 3month laboratory data (calcium, phosphorus, parathormon, LDL cholesterol) collected from patient files calculated mean values. Blood samples for trace elements were collected into tubes with EDTA and stored at À20 C until assay and quantified by inductively coupled plasma mass-spectrometry (ICP-MS). Coronary artery calcification (CAC) was assessed by multi-detector computed tomography and evaluated by the same person from radiology department. RESULTS: The serum levels of selenium and uranium were significantly lower and levels of lithium, magnesium, aluminum, nickel, strontium, cadmium, tin, platinum, lead ve thallium were significantly higher in hemodialysis patients compared to controls. The mean value of CAC score was 347,67 6 822,35 (range 0-4224, median: 29,6). The level of cadmium was found statistically higher in the patients with high CAC scores (> median value) compared to the patients with low CAC scores (< median value). However we did not find any significance in correlations between CAC scores and trace element levels (for selenium r=-0,303, P=0,061). CONCLUSIONS: The levels of trace elements are altered by chronic hemodialysis. Especially cadmium was found higher in patients with high CAC scores. We believe that studies with more subjects will give information to us about this association.

Nephrology Dialysis Transplantation, 2017

associated with subsequent CKD progression, in order to help determine which patients should be r... more associated with subsequent CKD progression, in order to help determine which patients should be referred at this stage. Additionally, we investigated the association of CKD stage 3 progression with morbidity and overall mortality. METHODS: We conducted a patient-level, retrospective, cohort analysis of all patients referred to a nephrology clinic over a 6 month period. Patients with CKD stage 3 and at least one year follow-up were included. CKD progression was defined as an eGFR (CKD-EPI) decline superior to 10% per year (approximately 5 years until reaching CKD stage 5) or the need for chronic RRT. Baseline covariates included demographics, comorbid conditions and laboratory values. Univariate and multivariate analysis were employed to determine independent predictors of CKD progression and mortality. RESULTS: Out of the 282 patients referred to the nephrology clinic, 81(29%) met the inclusion criteria (mean age: 70.9 years; 31 male). Mean follow-up was 3.761.2 years. 20 (24.7%) met the criteria for CKD progression and 17 (21%) died. In univariate analysis, CKD progression was associated with higher albuminuria (387.2 vs 30.5 mg/gr, p=0.006). No significant association was found for all other baseline covariates. Nevertheless, trends were found for higher prevalence of congestive heart failure (50.0% vs 27.9%, p=0.068) and lower statin use (50.0% vs 70.5%, p=0.094). In multivariate logistic regression analysis, albuminuria over 300 mg/gr [Odds ratio (OR) 4.07, 95% CI 1.3-12.6, p=0.015], presence of congestive heart failure (OR 4.4, 95% CI 1.3-15.3, p=0.018) and lower age (OR per 1 year decrease 1.05, 95% CI 1.00-1.09, p=0.032) were associated with CKD progression. The possible association with statin use was not confirmed. By multivariate cox-regression analysis CKD progression was associated with a higher mortality risk (OR 4.5, 95% CI 1.6-12.6, p=0.004). CONCLUSIONS: Our study suggests that younger patients, patients with macroalbuminuria and patients with congestive heart failure are at increased risk for rapid CKD stage 3 progression. Larger studies are needed to verify if this or other criteria may be useful in guiding which CKD stage 3 patients should be referred to a nephrology clinic.

Nephrology Dialysis Transplantation, 2015

Annals of Internal Medicine, 2019

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 clinical practice guideli... more Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in chronic kidney disease (CKD) is an extensive update of KDIGO's 2008 guideline on HCV infection in CKD. This update reflects the major advances since the introduction of directacting antivirals (DAAs) in the management of HCV infection in the CKD population. Methods: The KDIGO work group tasked with developing the HCV and CKD guideline defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence previously summarized by the evidence review team. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to appraise the quality of evidence and rate the strength of the recommendations. Searches of the English-language literature were conducted through May 2017 and were supplemented with targeted searches for studies of DAA treatment and with abstracts from nephrology, hepatology, and transplantation conferences. A review process involving many stakeholders, subject matter experts, and industry and national organizations informed the guideline's final modification. Recommendation: The updated guideline comprises 66 recommendations. This synopsis focuses on 32 key recommendations pertinent to the prevention, diagnosis, treatment, and management of HCV infection in adult CKD populations.

BMC Nephrology, 2021

Background Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been con... more Background Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been conducted in urban settings. They relied on GFR estimated from serum creatinine alone and on the inexpensive, convenient urinary dipstick to assess proteinuria. The dipstick for proteinuria has not been directly compared with the gold standard albumin-to-creatinine ratio (ACR) in a large-sized study in SSA. We hereby assessed the influence of rural versus urban location on the level, interpretation, and diagnostic performance of proteinuria dipstick versus ACR. Methods In a cross-sectional population-based study of CKD in both urban ( n = 587) and rural ( n = 730) settings in South-Kivu, Democratic Republic of Congo (DRC), we assessed the prevalence, performance (sensitivity, specificity, positive predictive value and negative predictive value) and determinants of a positive dipstick proteinuria as compared with albuminuria (ACR). Albuminuria was subdivided into: A1 (< 30 mg/g creatini...

Kidney International, 2020

Journal of the American Society of Nephrology, 2021

Significance Statement Membranous nephropathy (MN) results from antibodies targeting an antigen i... more Significance Statement Membranous nephropathy (MN) results from antibodies targeting an antigen in the glomerular basement membrane (GBM). The target antigens identified so far include PLA2R, THSD7A, NELL1, SEMA3B, and EXT1/EXT2. Using laser microdissection and mass spectrometry analysis, the authors identified a novel protein, protocadherin 7 (PCDH7), that is present in the GBM of a subset of patients with MN who are negative for all of the known antigens associated with MN. PCDH7 shows granular GBM staining and colocalizes with Ig in the GBM. Furthermore, antibodies to PCDH7 were detected in both the serum and kidney biopsy tissue from individuals with PCDH7-associated MN but not from controls. These findings suggest that PCDH7-associated MN defines a distinct type of MN. Background Membranous nephropathy (MN) results from deposition of antigen-antibody complexes along the glomerular basement membrane (GBM). PLA2R, THSD7A, NELL1, and SEMA3B account for 80%–90% of target antigens i...

Nephrology Dialysis Transplantation, 2017

Medicine, May 1, 2017

Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, ... more Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, the prevalence and determinants of hyperoxaluria in chronic pancreatitis patients as well as its association with renal function decline have not been investigated. We performed an observational study. Urine oxalate to creatinine ratio was assessed on 2 independent random urine samples in consecutive adult patients with chronic pancreatitis followed at the outpatient clinic from March 1 to October 31, 2012. Baseline characteristics and annual estimated glomerular filtration rate (eGFR) change during follow-up were compared between patients with hyper-and normo-oxaluria. A total of 48 patients with chronic pancreatitis were included. The etiology of the disease was toxic (52%), idiopathic (27%), obstructive (11%), autoimmune (6%), or genetic (4%). Hyperoxaluria (defined as urine oxalate to creatinine ratio >32 mg/g) was found in 23% of patients. Multivariate regression analysis identified clinical steatorrhea, high fecal acid steatocrit, and pancreatic atrophy as independent predictors of hyperoxaluria. Taken together, a combination of clinical steatorrhea, steatocrit level >31%, and pancreatic atrophy was associated with a positive predictive value of 100% for hyperoxaluria. On the contrary, none of the patients with a fecal elastase-1 level >100 mg/g had hyperoxaluria. Longitudinal evolution of eGFR was available in 71% of the patients, with a mean follow-up of 904 days. After adjustment for established determinants of renal function decline (gender, diabetes, bicarbonate level, baseline eGFR, and proteinuria), a urine oxalate to creatinine ratio >32 mg/g was associated with a higher risk of eGFR decline. Hyperoxaluria is highly prevalent in patients with chronic pancreatitis and associated with faster decline in renal function. A high urine oxalate to creatinine ratio in patients with chronic pancreatitis is best predicted by clinical steatorrhea, a high acid steatocrit, and pancreatic atrophy. Further studies will need to investigate the mechanisms of renal damage in chronic pancreatitis and the potential benefits of therapies reducing oxaluria. Abbreviations: CP = chronic pancreatitis, eGFR = estimated glomerular filtration rate, SD = standard deviation, UOCR = urinary oxalate to creatinine ratio, UPCR = urinary protein to creatinine ratio.

Kidney International Reports, 2020

Background: The prevalence of chronic kidney disease (CKD) in African American individuals is hig... more Background: The prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear. Methods: In a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD-Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m 2 and/or albuminuria (albumin-to-creatinine ratio $30 mg/g). Results: A total of 1317 participants aged 41.1 AE 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18-22.3), diabetes mellitus (4.3%; 95% CI, 3.2-5.4) and obesity (8.9%; 95% CI, 7.4-10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05-0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m 2 was 5.4% (95% CI, 4.2-6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1-8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2-14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04-1.07]), urban residence (aOR 1.86 [1.18-2.95]), female sex (aOR 1.66 [1.04-2.66]), hypertension (aOR 1.90 [1.15-3.12]), diabetes (aOR 2.03 [1.02-4.06]), and HIV infection (10.21 [2.75-37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding. Conclusion: Overall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).

Clinical Journal of the American Society of Nephrology, 2020

Kidney International, 2021

N early 700 million persons worldwide have chronic kidney disease (CKD), and the burden falls dis... more N early 700 million persons worldwide have chronic kidney disease (CKD), and the burden falls disproportionately upon socially disadvantaged and other vulnerable groups. 1 In many regions, persons with lower socioeconomic status have a higher prevalence of CKD, limited access to treatment, and poorer outcomes. 2-5 Early

Clinical Nephrology – Case Studies, 2019

Background: Restless legs syndrome (RLS) is not a rare condition in patients on long-term dialysi... more Background: Restless legs syndrome (RLS) is not a rare condition in patients on long-term dialysis. Pramipexole is a small molecule used in the treatment of idiopathic and uremic RLS. Although some information concerning the efficacy and safety of pramipexole in uremic patients is available, data concerning the pharmacokinetics of pramipexole in hemodialysis (HD) are lacking. Following the occurrence of accidental pramipexole intoxication in a chronic HD patient, we were concerned about the efficacy of HD in removing pramipexole. Our aim was thus to assess plasma pramipexole concentrations and pramipexole clearance in a stable chronic HD patient without any residual kidney function. Materials and methods: Our patient was a 63-year-old man on chronic HD for 5 years who had been treated uneventfully with oral pramipexole for uremic RLS since then. During a routine 4-hour high-flux HD session, blood, ultrafiltrate, and dialysate samples were collected every hour to determine pramipexole concentrations over time. Results: Pramipexole blood concentrations ranged from 12.1 to 23.9 µg/L. Pramipexole reduction ratio was 32.5%. Mean dialytic clearance of pramipexole was 76.8 mL/min. Postdialysis rebound was 5.6%. Conclusion: In the absence of any side effect, pramipexole blood concentrations at steady state were 2-to 4-fold higher than those observed in subjects with normal kidney function. Like other drugs with a high volume of distribution, pramipexole was poorly removed by HD. Therefore, HD is not recommended as a treatment option for pramipexole intoxication in patients with a glomerular filtration rate superior to 30 mL/ min/1.73m².

Medicine, 2016

Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis character... more Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis characterized by abrupt onset of hypertension, thrombotic microangiopathy, and kidney injury. The mechanisms of the disease remain ill-defined, but a growing body of evidence suggests that activation of the complement system may be involved. Here, we report the case of a patient presenting with severe SRC and strong evidence of complement activation, both in serum and in the kidney, in the absence of genetic defect of the complement system. Immunofluorescence studies on kidney biopsy showed significant deposits of C1q and C4d in the endothelium of renal arterioles, pointing toward activation of the classical pathway. Because of the dramatic clinical and histological severity, and the lack of response to early treatment with angiotensin-converting enzyme inhibitors, calcium channel blockers and plasma exchange, the patient was treated with the specific C5 blocker eculizumab.Contrarily to conventio...

Journal of The American Society of Nephrology, 2003

... Record Details. Record ID, 313213. Record Type, conference. Author, R SARAN; S SATAYATHUM; No... more ... Record Details. Record ID, 313213. Record Type, conference. Author, R SARAN; S SATAYATHUM; Norbert Lameire [801000154550] - Ghent University; A SAITO; T AKIBA; M JADOUL; N GINSBERG; BW GILLESPIE; M KEEN; EW YOUNG; S RAJAGOPALAN. ...

Age and Ageing, Mar 31, 2011

Hemodialysis International, May 14, 2015

Background-Due to multiple comorbidities, hemodialysis (HD) patients are prescribed many oral med... more Background-Due to multiple comorbidities, hemodialysis (HD) patients are prescribed many oral medications, including phosphate binders (PBs), often resulting in a high "pill burden". Methods-Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we assessed associations between PB pill burden, patient-reported PB non-adherence, and levels of serum phosphorus (SPhos) and parathyroid hormone (PTH), using standard regression analyses. The study included data collected from 5,262 HD patients from dialysis units participating in the DOPPS in 12 countries. Results-PB prescription ranged from a mean of 7.4 pills/day in the United States (US) to 3.9 pills/day in France. About half of the patients were prescribed at least 6 PB pills/day, and 13% were prescribed at least 12 PB pills/day. Overall, the proportion of patients who reported skipping PBs at least once in the past month was 45% overall, ranging from 33% in Belgium to 57% in the US. There was a trend toward greater PB non-adherence and a higher number of prescribed PB pills/day. Non-adherence to PB prescription was associated with high SPhos (>5.5 mg/dL) and PTH (> 600 pg/mL).

Transplant International, Jun 13, 2023

Clinical Kidney Journal, 2021

Clinical Kidney Journal, 2021

Cinacalcet and, more recently, etelcalcetide revolutionized the treatment of chronic kidney disea... more Cinacalcet and, more recently, etelcalcetide revolutionized the treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney transplant (KT) usually improves CKD–MBD. However, a significant proportion of KT recipients have high serum calcium levels, not requiring any treatment. We report two patients previously treated with etelcalcetide who developed severe (>3.3 mmol/L) hypercalcaemia in the early post-KT course, requiring parathyroidectomy. Pathological studies showed parathyroid adenomas and hyperplasia. One patient had a graft biopsy showing numerous intratubular calcium phosphate crystals. These observations should prompt pharmacovigilance studies and careful follow-up of KT recipients previously treated with etelcalcetide.

Nephrology Dialysis Transplantation, 2017

Demographic (age, gender), clinical (height, weight, last mean 3-month pre-dialysis systolic and ... more Demographic (age, gender), clinical (height, weight, last mean 3-month pre-dialysis systolic and diastolic blood pressures) data were collected from patient files. Also last 3month laboratory data (calcium, phosphorus, parathormon, LDL cholesterol) collected from patient files calculated mean values. Blood samples for trace elements were collected into tubes with EDTA and stored at À20 C until assay and quantified by inductively coupled plasma mass-spectrometry (ICP-MS). Coronary artery calcification (CAC) was assessed by multi-detector computed tomography and evaluated by the same person from radiology department. RESULTS: The serum levels of selenium and uranium were significantly lower and levels of lithium, magnesium, aluminum, nickel, strontium, cadmium, tin, platinum, lead ve thallium were significantly higher in hemodialysis patients compared to controls. The mean value of CAC score was 347,67 6 822,35 (range 0-4224, median: 29,6). The level of cadmium was found statistically higher in the patients with high CAC scores (> median value) compared to the patients with low CAC scores (< median value). However we did not find any significance in correlations between CAC scores and trace element levels (for selenium r=-0,303, P=0,061). CONCLUSIONS: The levels of trace elements are altered by chronic hemodialysis. Especially cadmium was found higher in patients with high CAC scores. We believe that studies with more subjects will give information to us about this association.

Nephrology Dialysis Transplantation, 2017

associated with subsequent CKD progression, in order to help determine which patients should be r... more associated with subsequent CKD progression, in order to help determine which patients should be referred at this stage. Additionally, we investigated the association of CKD stage 3 progression with morbidity and overall mortality. METHODS: We conducted a patient-level, retrospective, cohort analysis of all patients referred to a nephrology clinic over a 6 month period. Patients with CKD stage 3 and at least one year follow-up were included. CKD progression was defined as an eGFR (CKD-EPI) decline superior to 10% per year (approximately 5 years until reaching CKD stage 5) or the need for chronic RRT. Baseline covariates included demographics, comorbid conditions and laboratory values. Univariate and multivariate analysis were employed to determine independent predictors of CKD progression and mortality. RESULTS: Out of the 282 patients referred to the nephrology clinic, 81(29%) met the inclusion criteria (mean age: 70.9 years; 31 male). Mean follow-up was 3.761.2 years. 20 (24.7%) met the criteria for CKD progression and 17 (21%) died. In univariate analysis, CKD progression was associated with higher albuminuria (387.2 vs 30.5 mg/gr, p=0.006). No significant association was found for all other baseline covariates. Nevertheless, trends were found for higher prevalence of congestive heart failure (50.0% vs 27.9%, p=0.068) and lower statin use (50.0% vs 70.5%, p=0.094). In multivariate logistic regression analysis, albuminuria over 300 mg/gr [Odds ratio (OR) 4.07, 95% CI 1.3-12.6, p=0.015], presence of congestive heart failure (OR 4.4, 95% CI 1.3-15.3, p=0.018) and lower age (OR per 1 year decrease 1.05, 95% CI 1.00-1.09, p=0.032) were associated with CKD progression. The possible association with statin use was not confirmed. By multivariate cox-regression analysis CKD progression was associated with a higher mortality risk (OR 4.5, 95% CI 1.6-12.6, p=0.004). CONCLUSIONS: Our study suggests that younger patients, patients with macroalbuminuria and patients with congestive heart failure are at increased risk for rapid CKD stage 3 progression. Larger studies are needed to verify if this or other criteria may be useful in guiding which CKD stage 3 patients should be referred to a nephrology clinic.

Nephrology Dialysis Transplantation, 2015

Annals of Internal Medicine, 2019

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 clinical practice guideli... more Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in chronic kidney disease (CKD) is an extensive update of KDIGO's 2008 guideline on HCV infection in CKD. This update reflects the major advances since the introduction of directacting antivirals (DAAs) in the management of HCV infection in the CKD population. Methods: The KDIGO work group tasked with developing the HCV and CKD guideline defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence previously summarized by the evidence review team. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to appraise the quality of evidence and rate the strength of the recommendations. Searches of the English-language literature were conducted through May 2017 and were supplemented with targeted searches for studies of DAA treatment and with abstracts from nephrology, hepatology, and transplantation conferences. A review process involving many stakeholders, subject matter experts, and industry and national organizations informed the guideline's final modification. Recommendation: The updated guideline comprises 66 recommendations. This synopsis focuses on 32 key recommendations pertinent to the prevention, diagnosis, treatment, and management of HCV infection in adult CKD populations.

BMC Nephrology, 2021

Background Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been con... more Background Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been conducted in urban settings. They relied on GFR estimated from serum creatinine alone and on the inexpensive, convenient urinary dipstick to assess proteinuria. The dipstick for proteinuria has not been directly compared with the gold standard albumin-to-creatinine ratio (ACR) in a large-sized study in SSA. We hereby assessed the influence of rural versus urban location on the level, interpretation, and diagnostic performance of proteinuria dipstick versus ACR. Methods In a cross-sectional population-based study of CKD in both urban ( n = 587) and rural ( n = 730) settings in South-Kivu, Democratic Republic of Congo (DRC), we assessed the prevalence, performance (sensitivity, specificity, positive predictive value and negative predictive value) and determinants of a positive dipstick proteinuria as compared with albuminuria (ACR). Albuminuria was subdivided into: A1 (< 30 mg/g creatini...

Kidney International, 2020

Journal of the American Society of Nephrology, 2021

Significance Statement Membranous nephropathy (MN) results from antibodies targeting an antigen i... more Significance Statement Membranous nephropathy (MN) results from antibodies targeting an antigen in the glomerular basement membrane (GBM). The target antigens identified so far include PLA2R, THSD7A, NELL1, SEMA3B, and EXT1/EXT2. Using laser microdissection and mass spectrometry analysis, the authors identified a novel protein, protocadherin 7 (PCDH7), that is present in the GBM of a subset of patients with MN who are negative for all of the known antigens associated with MN. PCDH7 shows granular GBM staining and colocalizes with Ig in the GBM. Furthermore, antibodies to PCDH7 were detected in both the serum and kidney biopsy tissue from individuals with PCDH7-associated MN but not from controls. These findings suggest that PCDH7-associated MN defines a distinct type of MN. Background Membranous nephropathy (MN) results from deposition of antigen-antibody complexes along the glomerular basement membrane (GBM). PLA2R, THSD7A, NELL1, and SEMA3B account for 80%–90% of target antigens i...

Nephrology Dialysis Transplantation, 2017

Medicine, May 1, 2017

Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, ... more Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, the prevalence and determinants of hyperoxaluria in chronic pancreatitis patients as well as its association with renal function decline have not been investigated. We performed an observational study. Urine oxalate to creatinine ratio was assessed on 2 independent random urine samples in consecutive adult patients with chronic pancreatitis followed at the outpatient clinic from March 1 to October 31, 2012. Baseline characteristics and annual estimated glomerular filtration rate (eGFR) change during follow-up were compared between patients with hyper-and normo-oxaluria. A total of 48 patients with chronic pancreatitis were included. The etiology of the disease was toxic (52%), idiopathic (27%), obstructive (11%), autoimmune (6%), or genetic (4%). Hyperoxaluria (defined as urine oxalate to creatinine ratio >32 mg/g) was found in 23% of patients. Multivariate regression analysis identified clinical steatorrhea, high fecal acid steatocrit, and pancreatic atrophy as independent predictors of hyperoxaluria. Taken together, a combination of clinical steatorrhea, steatocrit level >31%, and pancreatic atrophy was associated with a positive predictive value of 100% for hyperoxaluria. On the contrary, none of the patients with a fecal elastase-1 level >100 mg/g had hyperoxaluria. Longitudinal evolution of eGFR was available in 71% of the patients, with a mean follow-up of 904 days. After adjustment for established determinants of renal function decline (gender, diabetes, bicarbonate level, baseline eGFR, and proteinuria), a urine oxalate to creatinine ratio >32 mg/g was associated with a higher risk of eGFR decline. Hyperoxaluria is highly prevalent in patients with chronic pancreatitis and associated with faster decline in renal function. A high urine oxalate to creatinine ratio in patients with chronic pancreatitis is best predicted by clinical steatorrhea, a high acid steatocrit, and pancreatic atrophy. Further studies will need to investigate the mechanisms of renal damage in chronic pancreatitis and the potential benefits of therapies reducing oxaluria. Abbreviations: CP = chronic pancreatitis, eGFR = estimated glomerular filtration rate, SD = standard deviation, UOCR = urinary oxalate to creatinine ratio, UPCR = urinary protein to creatinine ratio.

Kidney International Reports, 2020

Background: The prevalence of chronic kidney disease (CKD) in African American individuals is hig... more Background: The prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear. Methods: In a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD-Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m 2 and/or albuminuria (albumin-to-creatinine ratio $30 mg/g). Results: A total of 1317 participants aged 41.1 AE 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18-22.3), diabetes mellitus (4.3%; 95% CI, 3.2-5.4) and obesity (8.9%; 95% CI, 7.4-10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05-0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m 2 was 5.4% (95% CI, 4.2-6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1-8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2-14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04-1.07]), urban residence (aOR 1.86 [1.18-2.95]), female sex (aOR 1.66 [1.04-2.66]), hypertension (aOR 1.90 [1.15-3.12]), diabetes (aOR 2.03 [1.02-4.06]), and HIV infection (10.21 [2.75-37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding. Conclusion: Overall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).

Clinical Journal of the American Society of Nephrology, 2020

Kidney International, 2021

N early 700 million persons worldwide have chronic kidney disease (CKD), and the burden falls dis... more N early 700 million persons worldwide have chronic kidney disease (CKD), and the burden falls disproportionately upon socially disadvantaged and other vulnerable groups. 1 In many regions, persons with lower socioeconomic status have a higher prevalence of CKD, limited access to treatment, and poorer outcomes. 2-5 Early

Clinical Nephrology – Case Studies, 2019

Background: Restless legs syndrome (RLS) is not a rare condition in patients on long-term dialysi... more Background: Restless legs syndrome (RLS) is not a rare condition in patients on long-term dialysis. Pramipexole is a small molecule used in the treatment of idiopathic and uremic RLS. Although some information concerning the efficacy and safety of pramipexole in uremic patients is available, data concerning the pharmacokinetics of pramipexole in hemodialysis (HD) are lacking. Following the occurrence of accidental pramipexole intoxication in a chronic HD patient, we were concerned about the efficacy of HD in removing pramipexole. Our aim was thus to assess plasma pramipexole concentrations and pramipexole clearance in a stable chronic HD patient without any residual kidney function. Materials and methods: Our patient was a 63-year-old man on chronic HD for 5 years who had been treated uneventfully with oral pramipexole for uremic RLS since then. During a routine 4-hour high-flux HD session, blood, ultrafiltrate, and dialysate samples were collected every hour to determine pramipexole concentrations over time. Results: Pramipexole blood concentrations ranged from 12.1 to 23.9 µg/L. Pramipexole reduction ratio was 32.5%. Mean dialytic clearance of pramipexole was 76.8 mL/min. Postdialysis rebound was 5.6%. Conclusion: In the absence of any side effect, pramipexole blood concentrations at steady state were 2-to 4-fold higher than those observed in subjects with normal kidney function. Like other drugs with a high volume of distribution, pramipexole was poorly removed by HD. Therefore, HD is not recommended as a treatment option for pramipexole intoxication in patients with a glomerular filtration rate superior to 30 mL/ min/1.73m².

Medicine, 2016

Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis character... more Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis characterized by abrupt onset of hypertension, thrombotic microangiopathy, and kidney injury. The mechanisms of the disease remain ill-defined, but a growing body of evidence suggests that activation of the complement system may be involved. Here, we report the case of a patient presenting with severe SRC and strong evidence of complement activation, both in serum and in the kidney, in the absence of genetic defect of the complement system. Immunofluorescence studies on kidney biopsy showed significant deposits of C1q and C4d in the endothelium of renal arterioles, pointing toward activation of the classical pathway. Because of the dramatic clinical and histological severity, and the lack of response to early treatment with angiotensin-converting enzyme inhibitors, calcium channel blockers and plasma exchange, the patient was treated with the specific C5 blocker eculizumab.Contrarily to conventio...

Journal of The American Society of Nephrology, 2003

... Record Details. Record ID, 313213. Record Type, conference. Author, R SARAN; S SATAYATHUM; No... more ... Record Details. Record ID, 313213. Record Type, conference. Author, R SARAN; S SATAYATHUM; Norbert Lameire [801000154550] - Ghent University; A SAITO; T AKIBA; M JADOUL; N GINSBERG; BW GILLESPIE; M KEEN; EW YOUNG; S RAJAGOPALAN. ...

Age and Ageing, Mar 31, 2011

Hemodialysis International, May 14, 2015

Background-Due to multiple comorbidities, hemodialysis (HD) patients are prescribed many oral med... more Background-Due to multiple comorbidities, hemodialysis (HD) patients are prescribed many oral medications, including phosphate binders (PBs), often resulting in a high "pill burden". Methods-Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we assessed associations between PB pill burden, patient-reported PB non-adherence, and levels of serum phosphorus (SPhos) and parathyroid hormone (PTH), using standard regression analyses. The study included data collected from 5,262 HD patients from dialysis units participating in the DOPPS in 12 countries. Results-PB prescription ranged from a mean of 7.4 pills/day in the United States (US) to 3.9 pills/day in France. About half of the patients were prescribed at least 6 PB pills/day, and 13% were prescribed at least 12 PB pills/day. Overall, the proportion of patients who reported skipping PBs at least once in the past month was 45% overall, ranging from 33% in Belgium to 57% in the US. There was a trend toward greater PB non-adherence and a higher number of prescribed PB pills/day. Non-adherence to PB prescription was associated with high SPhos (>5.5 mg/dL) and PTH (> 600 pg/mL).