P. Jungers - Academia.edu (original) (raw)
Papers by P. Jungers
EMC - Traité de médecine AKOS, 2006
Annales de medecine interne
ABSTRACT
La Revue du praticien, Jan 28, 2001
Every patient with end-stage renal failure, at any age and whatever the type of renal disease, is... more Every patient with end-stage renal failure, at any age and whatever the type of renal disease, is a legitimate candidate to maintenance dialysis. Contraindications are infrequent and based purely on medical considerations, such as profound and irremediable alteration of physical and/or mental condition. In patients regularly managed dialysis is decided electively on the basis of laboratory criteria in the absence of clinical uremic manifestations other than fatigue, anorexia or nausea. The most widely accepted criterion is a level of creatinine clearance estimated by the Cockcroft-Gault formula between 7 and 10 mL/min/1.73 m2. Psychological preparation of the patient to dialysis is essential and should not be delayed until the advanced stage. Medical preparation involves prophylactic vaccination against virus B hepatitis and creation of a native arteriovenous fistula when hemodialysis is the scheduled option. Every patient should receive in time clear and complete information on the...
Long-Term Hemodialysis, 1995
Long-Term Hemodialysis, 1995
Long-Term Hemodialysis, 1995
Clinical immunology and immunopathology, 1978
... REFERENCES l. Patel, R., Mickey, MR, and Terasaki, P. L, Brit. Med. J. 2, 424, 1969. ... 58, ... more ... REFERENCES l. Patel, R., Mickey, MR, and Terasaki, P. L, Brit. Med. J. 2, 424, 1969. ... 58, Inserm, Paris, 1976. 22. Zinkernagel, RM, and Doherty, PC, Nature (London) 251, 547, 1974. References. 1. R. Patel, MR Mickey and PI Terasaki. Brit. Med. J., 2 (1969), p. 424. ...
Urological Research, 2007
The presence and role of heavy metals in urinary stones is debated. We investigated the distribut... more The presence and role of heavy metals in urinary stones is debated. We investigated the distribution of trace heavy metals in 78 calculi of well-deWned composition by means of microXuorescence X analysis using synchrotron radiation. Seven elements were identiWed, the most abundant being Zn and Sr which together accounted for 91% of the heavy metal content of stones. The other heavy metals were Fe, Cu, Rb, Pb and Se. Zn and Sr were virtually conWned to calcium-containing stones, whereas only trace amounts were found in uric acid or cystine stones. Among calcium stones, Zn and Sr were more abundant in calcium phosphate than in calcium oxalate stones and, in the latter, in weddellite than in whewellite stones. Fe, Cu and Rb were much less abundant and also found mainly in calcium stones. Pb was signiWcantly less abundant than in previous studies, thus suggesting a rarefaction of Pb in the environment, and appreciable amounts of Se were found only in cystine stones. In conclusion, the pre-ponderance of Zn and Sr, both bivalent ions, in calciumcontaining stones suggests a substitution process of calcium by metal ions with similar charge and radius rather than a contribution of the metals to stone formation. Further studies are needed to examine the relationships between urine concentration in calcium or other solutes and the amount of Zn and Sr in calcium stones.
Nephron Physiology, 2004
Morphoconstitutional analysis of urinary calculi, i.e. morphologic examination combined with Four... more Morphoconstitutional analysis of urinary calculi, i.e. morphologic examination combined with Fourier transform infrared spectroscopy (FTIR), is of decisive interest for the diagnosis of rare but severe inherited or acquired stone diseases such as cystine, 2,8-dihydroxyadenine, xanthine, struvite, ammonium urate or drug-containing calculi as well as primary hyperoxalurias. In the absence of early diagnosis and proper management, these diseases may lead to progressive loss of renal function. Among common forms of calcium oxalate (CaOx) stones, predominant CaOx monohydrate (whewellite) is mainly associated with hyperoxaluric conditions whereas predominant CaOx dihydrate (weddellite) is mainly associated with hypercalciuria, and this distinction is of interest to orient metabolic evaluation and preventive measures. Crystalluria examination, also based on morphology and FTIR, is a valuable diagnostic method when no stone is available for analysis. Presence of specific crystals (cystine, 2,8-dihydroxyadenine, struvite, ammonium urate) is diagnostic by itself. In all types of nephrolithiasis, serial crystalluria determination appears as a simple, cheap and reliable method to evaluate the risk of stone formation and assess the effectiveness of preventive measures. Determination of urinary crystal volume was in our experience a useful tool in the management of patients with cystinuria or primary hyperoxaluria in the post-transplantation period. In conclusion, both accurate morphologic and FTIR analysis of stones and serial crystalluria determination should be more largely used, in view of their value in the diagnosis and management of renal stone formers.
Nephrology Dialysis Transplantation, 1999
status in chronic renal failure. Indeed, we described Oxidative stress in uraemia syndrome for th... more status in chronic renal failure. Indeed, we described Oxidative stress in uraemia syndrome for the first time, the presence in the plasma of haemodialysed patients high levels of oxidized proteins that Considerable evidence has accumulated that chronic we designated AOPPs [11]. Since oxidative damage to uraemia is associated with a multifactorial immunoproteins modifies the spectroscopic characteristics of inflammatory syndrome, which occurs early in the proteins, for example through the oxidation of arocourse of renal failure, is accentuated with the progresmatic amino acid residues, we studied spectral characsion of uraemia and culminates in maintenance dialysis teristics in plasma fractionated by size exclusion therapy [1,2]. Besides the dysregulation in the balance chromatography. We pointed out two UV-visible peaks between pro-inflammatory cytokines and their inhibof absorbance at 340 nm in plasma from haemodiaitors which has been described in uraemic patients lysed patients which were absent in controls. These [3,4], a disturbance in the balance between oxidants two peaks, corresponding to a molecular mass of 60 and antioxidants has also been pointed out. The and 600 kDa, were called low molecular weighthaemodialysis setting could be considered as a human (LMW ) and high molecular weight-(HMW ) AOPPs, model of oxidative stress since blood-dialyser interrespectively. action triggers circulating neutrophils to produce a Interestingly, formation of AOPPs could be induced large amount of reactive oxygen species, including in control plasma by chlorinated oxidants such as superoxide anion, hydrogen peroxide, hydroxyl radical, chloramines or hypochlorous acid. Of note, the in vitro and hypochlorous acid [5,6 ] which are partially scavformation of AOPPs was much lower when proteins enged by plasma components. However, due to a were submitted to H 2 O 2 compared to identical concenprofound deficiency in antioxidant systems, this scavtrations of chlorinated oxidants. Moreover, the formaenging potential is likely to be overwhelmed and tion of AOPPs using purified human serum albumin chronic oxidative stress will thus take place [7,8]. was clearly correlated to the concentration of chlorin-Moreover, one of the features of uraemia is the presated oxidant added, thus demonstrating that AOPP ence of signs of oxidative stress before haemodialysis, resulted from the interaction between such oxidants thus emphasizing the importance of evaluating the and plasma proteins. physiopathological role of oxidative stress with respect
Nephrology Dialysis Transplantation, 2005
Nephrology Dialysis Transplantation, 1996
European Journal of Clinical Pharmacology, 1994
We have studied the effect of renal impairment on the pharmacokinetics of oxcarbazepine, its acti... more We have studied the effect of renal impairment on the pharmacokinetics of oxcarbazepine, its active monohydroxy-metabolite (which predominates in plasma), their glucuronides, and the inactive dihydroxy-metabolite after a single oral dose of oxcarbazepine (300 mg). Six subjects with normal renal function and 20 patients with various degrees of renal impairment participated. The mean areas under the plasma concentration-time curves of oxcarbazepine and its monohydroxy-metabolite were 2-2.5-times higher in patients with severe renal impairment (CLCR < 10 ml.min-1) than in healthy subjects. The apparent elimination half-life of the monohydroxy-metabolite [19 (SD 3) h] in these patients was about twice that in healthy subjects. The effect of renal impairment on the plasma concentrations of glucuronides was more marked. The renal clearances of the unconjugated monohydroxy-metabolite and its glucuronides (the main compounds recovered in urine) correlated well with creatinine clearance. The maximum target dose in patients with slight renal impairment (CLCR > 30 ml.min-1) should not be changed. In patients with moderate renal impairment (CLCR 10-30 ml.min-1) it should be reduced by 50%. In patients with severe renal impairment (CLCR < 10 ml.min-1), the glucuronides of oxcarbazepine and its monohydroxy-metabolite are likely to accumulate during repeated administration, and dosage adjustment of oxcarbazepine in these patients could not be proposed from this single administration study.
Artificial Organs, 1978
The tolerance to high levels of ultrafiltration that has been observed when using a RP-6 dialyzer... more The tolerance to high levels of ultrafiltration that has been observed when using a RP-6 dialyzer with polyacrylonitrile membrane and a closed batch dialysate delivery system has led the authors to put patients on a free sodium and fluid intake. Eight patients were put on such a diet for six months. They have been dialyzed four to five hours, three times per week, on a RP-6-Rhodial 75. The mean intersession weight gain was 4.29+/-0.18 Kg after three days for a mean predialytic body weight of 63.55+/-2.54 Kg. Mean predialytic blood pressure was 1.38+/-4 mmHg for systolic pressure and 82+/-5 mmHg for diastolic pressure. Mean ultrafiltrate volume was 4.86+/-0.36 liters which corresponds to a sodium output of 661.3+/-49.5 mEq. Total plasma protein and hematocrit increased 18.8+/-3.34% and 19.13+/-3.22%, respectively, when the pre and post-dialytic values were compared. No clinical sign of fluid overload (dyspnea, edema, etc.) was noted in these patients. Cardiothoracic index remained in the normal range. This tolerance is due, possibly, to the high sodium concentration (145 mEq/L) in the dialysate. The free sodium and water diet may contribute to a better rehabilitation.
La Nouvelle presse médicale
The authors report a case of acute lithium poisoning, of double interest by virtue of its acciden... more The authors report a case of acute lithium poisoning, of double interest by virtue of its accidental origin and the fact that the patient suffered from chronic uraemia treated by intermittent haemodialysis, without residual diuresis. Neurological involvement consisted of a succession of dysarthria, behaviour disturbance, extra-pyramidal hypertonia and finally coma with respiratory difficulties. A favourable outcome was obtained by daily haemodialysis which made possible the elimination of almost all the lithium introduced into the body.
Radiology
Renal biopsies were performed in 211 patients which 10 days of excretory urography or renal arter... more Renal biopsies were performed in 211 patients which 10 days of excretory urography or renal arteriogrpahy in which diatrizoate, iothalamate or ioxithalamate had been used. In 47 renal specimens, osmotic nephrosis of the proximal tubular cells was found. Previous renal function had been normal in 10 patients, moderately impaired in 19, and severely impaired in 18. Tubular atrophy and/or necrosis was associated with histological features in 29 of 47 patients. Diffuse osmotic nephrosis was more often found in patients biopsied soon after roentgenography and also with severe renal insufficiency, but was not necessarily associated with declining renal function. The mechanism(s) by which contrast media may induce osmotic nephrosis remains unclear.
Advances in nephrology from the Necker Hospital
Five hundred patients with acute renal failure were admitted to the Department of Nephrology of N... more Five hundred patients with acute renal failure were admitted to the Department of Nephrology of Necker Hospital between 1966 and 1970; 279 of them were treated before and 221 after beginning systematic prophylactic hemodialysis. The frequency of complications and the survival rate between both groups were compared. No significant improvement was obtained in patients with severe pre-existing diseases or extensive extrarenal lesions; such patients usually died from nonuremic complications before, or despite, dialysis. However, adequate treatment of severe septic shock, when present, was an important factor in improving the immediate outcome. Early and frequent dialysis significantly reduced the frequency and intensity of uremic symptoms such as gastrointestinal hemorrhage. The mortality due to gastrointestinal bleeding decreased from 14% before to 5% after prophylactic hemodialysis. The number of deaths due to septicemia was also substantially lowered from 24 to 12%. Overall mortality was reduced from 42 to 29%. The mortality rate decreased significantly in all categories of patients, particularly in surgical cases (from 54 to 38%) and in traumatic cases (55 to 33%). Simultaneously, the better use of antibiotic therapy, better prophylaxis of sepsis, and better nutritional care were important factors in the overall improvement in prognosis.
L'atteinte cardiovasculaire (CV) est devenue un sujet majeur de préoccupation pour le néphrologue... more L'atteinte cardiovasculaire (CV) est devenue un sujet majeur de préoccupation pour le néphrologue car elle constitue la principale cause de morbidité et de mortalité chez les patients atteints d'insuffisance rénale chronique, dialysés ou au stade prédialytique. La mortalité de cause CV est de trois à vingt fois plus élevée chez les dialysés que dans la population générale de même âge. Une prévalence élevée de comorbidité CV est présente dès le début du traitement de suppléance et elle est prédictive de la mortalité ultérieure en dialyse. En effet, l'atteinte CV se développe bien avant le début de la dialyse, car ses facteurs de risque sont présents dès le stade débutant de l'insuffisance rénale. Toutefois, l'atteinte CV peut être prévenue, ou du moins atténuée, par un traitement précoce et régulier de ces facteurs de risque au cours de la période prédialytique.
EMC - Traité de médecine AKOS, 2006
Annales de medecine interne
ABSTRACT
La Revue du praticien, Jan 28, 2001
Every patient with end-stage renal failure, at any age and whatever the type of renal disease, is... more Every patient with end-stage renal failure, at any age and whatever the type of renal disease, is a legitimate candidate to maintenance dialysis. Contraindications are infrequent and based purely on medical considerations, such as profound and irremediable alteration of physical and/or mental condition. In patients regularly managed dialysis is decided electively on the basis of laboratory criteria in the absence of clinical uremic manifestations other than fatigue, anorexia or nausea. The most widely accepted criterion is a level of creatinine clearance estimated by the Cockcroft-Gault formula between 7 and 10 mL/min/1.73 m2. Psychological preparation of the patient to dialysis is essential and should not be delayed until the advanced stage. Medical preparation involves prophylactic vaccination against virus B hepatitis and creation of a native arteriovenous fistula when hemodialysis is the scheduled option. Every patient should receive in time clear and complete information on the...
Long-Term Hemodialysis, 1995
Long-Term Hemodialysis, 1995
Long-Term Hemodialysis, 1995
Clinical immunology and immunopathology, 1978
... REFERENCES l. Patel, R., Mickey, MR, and Terasaki, P. L, Brit. Med. J. 2, 424, 1969. ... 58, ... more ... REFERENCES l. Patel, R., Mickey, MR, and Terasaki, P. L, Brit. Med. J. 2, 424, 1969. ... 58, Inserm, Paris, 1976. 22. Zinkernagel, RM, and Doherty, PC, Nature (London) 251, 547, 1974. References. 1. R. Patel, MR Mickey and PI Terasaki. Brit. Med. J., 2 (1969), p. 424. ...
Urological Research, 2007
The presence and role of heavy metals in urinary stones is debated. We investigated the distribut... more The presence and role of heavy metals in urinary stones is debated. We investigated the distribution of trace heavy metals in 78 calculi of well-deWned composition by means of microXuorescence X analysis using synchrotron radiation. Seven elements were identiWed, the most abundant being Zn and Sr which together accounted for 91% of the heavy metal content of stones. The other heavy metals were Fe, Cu, Rb, Pb and Se. Zn and Sr were virtually conWned to calcium-containing stones, whereas only trace amounts were found in uric acid or cystine stones. Among calcium stones, Zn and Sr were more abundant in calcium phosphate than in calcium oxalate stones and, in the latter, in weddellite than in whewellite stones. Fe, Cu and Rb were much less abundant and also found mainly in calcium stones. Pb was signiWcantly less abundant than in previous studies, thus suggesting a rarefaction of Pb in the environment, and appreciable amounts of Se were found only in cystine stones. In conclusion, the pre-ponderance of Zn and Sr, both bivalent ions, in calciumcontaining stones suggests a substitution process of calcium by metal ions with similar charge and radius rather than a contribution of the metals to stone formation. Further studies are needed to examine the relationships between urine concentration in calcium or other solutes and the amount of Zn and Sr in calcium stones.
Nephron Physiology, 2004
Morphoconstitutional analysis of urinary calculi, i.e. morphologic examination combined with Four... more Morphoconstitutional analysis of urinary calculi, i.e. morphologic examination combined with Fourier transform infrared spectroscopy (FTIR), is of decisive interest for the diagnosis of rare but severe inherited or acquired stone diseases such as cystine, 2,8-dihydroxyadenine, xanthine, struvite, ammonium urate or drug-containing calculi as well as primary hyperoxalurias. In the absence of early diagnosis and proper management, these diseases may lead to progressive loss of renal function. Among common forms of calcium oxalate (CaOx) stones, predominant CaOx monohydrate (whewellite) is mainly associated with hyperoxaluric conditions whereas predominant CaOx dihydrate (weddellite) is mainly associated with hypercalciuria, and this distinction is of interest to orient metabolic evaluation and preventive measures. Crystalluria examination, also based on morphology and FTIR, is a valuable diagnostic method when no stone is available for analysis. Presence of specific crystals (cystine, 2,8-dihydroxyadenine, struvite, ammonium urate) is diagnostic by itself. In all types of nephrolithiasis, serial crystalluria determination appears as a simple, cheap and reliable method to evaluate the risk of stone formation and assess the effectiveness of preventive measures. Determination of urinary crystal volume was in our experience a useful tool in the management of patients with cystinuria or primary hyperoxaluria in the post-transplantation period. In conclusion, both accurate morphologic and FTIR analysis of stones and serial crystalluria determination should be more largely used, in view of their value in the diagnosis and management of renal stone formers.
Nephrology Dialysis Transplantation, 1999
status in chronic renal failure. Indeed, we described Oxidative stress in uraemia syndrome for th... more status in chronic renal failure. Indeed, we described Oxidative stress in uraemia syndrome for the first time, the presence in the plasma of haemodialysed patients high levels of oxidized proteins that Considerable evidence has accumulated that chronic we designated AOPPs [11]. Since oxidative damage to uraemia is associated with a multifactorial immunoproteins modifies the spectroscopic characteristics of inflammatory syndrome, which occurs early in the proteins, for example through the oxidation of arocourse of renal failure, is accentuated with the progresmatic amino acid residues, we studied spectral characsion of uraemia and culminates in maintenance dialysis teristics in plasma fractionated by size exclusion therapy [1,2]. Besides the dysregulation in the balance chromatography. We pointed out two UV-visible peaks between pro-inflammatory cytokines and their inhibof absorbance at 340 nm in plasma from haemodiaitors which has been described in uraemic patients lysed patients which were absent in controls. These [3,4], a disturbance in the balance between oxidants two peaks, corresponding to a molecular mass of 60 and antioxidants has also been pointed out. The and 600 kDa, were called low molecular weighthaemodialysis setting could be considered as a human (LMW ) and high molecular weight-(HMW ) AOPPs, model of oxidative stress since blood-dialyser interrespectively. action triggers circulating neutrophils to produce a Interestingly, formation of AOPPs could be induced large amount of reactive oxygen species, including in control plasma by chlorinated oxidants such as superoxide anion, hydrogen peroxide, hydroxyl radical, chloramines or hypochlorous acid. Of note, the in vitro and hypochlorous acid [5,6 ] which are partially scavformation of AOPPs was much lower when proteins enged by plasma components. However, due to a were submitted to H 2 O 2 compared to identical concenprofound deficiency in antioxidant systems, this scavtrations of chlorinated oxidants. Moreover, the formaenging potential is likely to be overwhelmed and tion of AOPPs using purified human serum albumin chronic oxidative stress will thus take place [7,8]. was clearly correlated to the concentration of chlorin-Moreover, one of the features of uraemia is the presated oxidant added, thus demonstrating that AOPP ence of signs of oxidative stress before haemodialysis, resulted from the interaction between such oxidants thus emphasizing the importance of evaluating the and plasma proteins. physiopathological role of oxidative stress with respect
Nephrology Dialysis Transplantation, 2005
Nephrology Dialysis Transplantation, 1996
European Journal of Clinical Pharmacology, 1994
We have studied the effect of renal impairment on the pharmacokinetics of oxcarbazepine, its acti... more We have studied the effect of renal impairment on the pharmacokinetics of oxcarbazepine, its active monohydroxy-metabolite (which predominates in plasma), their glucuronides, and the inactive dihydroxy-metabolite after a single oral dose of oxcarbazepine (300 mg). Six subjects with normal renal function and 20 patients with various degrees of renal impairment participated. The mean areas under the plasma concentration-time curves of oxcarbazepine and its monohydroxy-metabolite were 2-2.5-times higher in patients with severe renal impairment (CLCR < 10 ml.min-1) than in healthy subjects. The apparent elimination half-life of the monohydroxy-metabolite [19 (SD 3) h] in these patients was about twice that in healthy subjects. The effect of renal impairment on the plasma concentrations of glucuronides was more marked. The renal clearances of the unconjugated monohydroxy-metabolite and its glucuronides (the main compounds recovered in urine) correlated well with creatinine clearance. The maximum target dose in patients with slight renal impairment (CLCR > 30 ml.min-1) should not be changed. In patients with moderate renal impairment (CLCR 10-30 ml.min-1) it should be reduced by 50%. In patients with severe renal impairment (CLCR < 10 ml.min-1), the glucuronides of oxcarbazepine and its monohydroxy-metabolite are likely to accumulate during repeated administration, and dosage adjustment of oxcarbazepine in these patients could not be proposed from this single administration study.
Artificial Organs, 1978
The tolerance to high levels of ultrafiltration that has been observed when using a RP-6 dialyzer... more The tolerance to high levels of ultrafiltration that has been observed when using a RP-6 dialyzer with polyacrylonitrile membrane and a closed batch dialysate delivery system has led the authors to put patients on a free sodium and fluid intake. Eight patients were put on such a diet for six months. They have been dialyzed four to five hours, three times per week, on a RP-6-Rhodial 75. The mean intersession weight gain was 4.29+/-0.18 Kg after three days for a mean predialytic body weight of 63.55+/-2.54 Kg. Mean predialytic blood pressure was 1.38+/-4 mmHg for systolic pressure and 82+/-5 mmHg for diastolic pressure. Mean ultrafiltrate volume was 4.86+/-0.36 liters which corresponds to a sodium output of 661.3+/-49.5 mEq. Total plasma protein and hematocrit increased 18.8+/-3.34% and 19.13+/-3.22%, respectively, when the pre and post-dialytic values were compared. No clinical sign of fluid overload (dyspnea, edema, etc.) was noted in these patients. Cardiothoracic index remained in the normal range. This tolerance is due, possibly, to the high sodium concentration (145 mEq/L) in the dialysate. The free sodium and water diet may contribute to a better rehabilitation.
La Nouvelle presse médicale
The authors report a case of acute lithium poisoning, of double interest by virtue of its acciden... more The authors report a case of acute lithium poisoning, of double interest by virtue of its accidental origin and the fact that the patient suffered from chronic uraemia treated by intermittent haemodialysis, without residual diuresis. Neurological involvement consisted of a succession of dysarthria, behaviour disturbance, extra-pyramidal hypertonia and finally coma with respiratory difficulties. A favourable outcome was obtained by daily haemodialysis which made possible the elimination of almost all the lithium introduced into the body.
Radiology
Renal biopsies were performed in 211 patients which 10 days of excretory urography or renal arter... more Renal biopsies were performed in 211 patients which 10 days of excretory urography or renal arteriogrpahy in which diatrizoate, iothalamate or ioxithalamate had been used. In 47 renal specimens, osmotic nephrosis of the proximal tubular cells was found. Previous renal function had been normal in 10 patients, moderately impaired in 19, and severely impaired in 18. Tubular atrophy and/or necrosis was associated with histological features in 29 of 47 patients. Diffuse osmotic nephrosis was more often found in patients biopsied soon after roentgenography and also with severe renal insufficiency, but was not necessarily associated with declining renal function. The mechanism(s) by which contrast media may induce osmotic nephrosis remains unclear.
Advances in nephrology from the Necker Hospital
Five hundred patients with acute renal failure were admitted to the Department of Nephrology of N... more Five hundred patients with acute renal failure were admitted to the Department of Nephrology of Necker Hospital between 1966 and 1970; 279 of them were treated before and 221 after beginning systematic prophylactic hemodialysis. The frequency of complications and the survival rate between both groups were compared. No significant improvement was obtained in patients with severe pre-existing diseases or extensive extrarenal lesions; such patients usually died from nonuremic complications before, or despite, dialysis. However, adequate treatment of severe septic shock, when present, was an important factor in improving the immediate outcome. Early and frequent dialysis significantly reduced the frequency and intensity of uremic symptoms such as gastrointestinal hemorrhage. The mortality due to gastrointestinal bleeding decreased from 14% before to 5% after prophylactic hemodialysis. The number of deaths due to septicemia was also substantially lowered from 24 to 12%. Overall mortality was reduced from 42 to 29%. The mortality rate decreased significantly in all categories of patients, particularly in surgical cases (from 54 to 38%) and in traumatic cases (55 to 33%). Simultaneously, the better use of antibiotic therapy, better prophylaxis of sepsis, and better nutritional care were important factors in the overall improvement in prognosis.
L'atteinte cardiovasculaire (CV) est devenue un sujet majeur de préoccupation pour le néphrologue... more L'atteinte cardiovasculaire (CV) est devenue un sujet majeur de préoccupation pour le néphrologue car elle constitue la principale cause de morbidité et de mortalité chez les patients atteints d'insuffisance rénale chronique, dialysés ou au stade prédialytique. La mortalité de cause CV est de trois à vingt fois plus élevée chez les dialysés que dans la population générale de même âge. Une prévalence élevée de comorbidité CV est présente dès le début du traitement de suppléance et elle est prédictive de la mortalité ultérieure en dialyse. En effet, l'atteinte CV se développe bien avant le début de la dialyse, car ses facteurs de risque sont présents dès le stade débutant de l'insuffisance rénale. Toutefois, l'atteinte CV peut être prévenue, ou du moins atténuée, par un traitement précoce et régulier de ces facteurs de risque au cours de la période prédialytique.