Sandrine Lemoine | University of Lyon (original) (raw)
Papers by Sandrine Lemoine
Nephrology Dialysis Transplantation, 2021
Background and Aims Maintenance of a cortico-medullary concentration gradient (CMG) required for ... more Background and Aims Maintenance of a cortico-medullary concentration gradient (CMG) required for urine concentration, is one of most important tubular function. However, we are lacking of functional tubular parameters to explore this function. The only tool available to assess it currently, is urinary osmolarity that is an indirect and nonspecific maker of CMG. In this study, we explore the ability of 23NaMRI in measuring 1) the dynamics of CMG for the first time compared to urinary osmolarity after a water load 2) the CMG in kidney disease. Method We conducted an exploratory pilot study for 10 healthy controls with water load then 5 cardiorenal patients with kidney disease. 1) Healthy controls were asked to be fasting since midnight. Urines sample were collected to measure fasting osmolarity and a first MRIscan were performed to acquire baseline anatomical and sodium images. Once the baseline was completed, healthy participants were asked to ingest water (15 mL/kg) within 15 minute...
Progrès en Urologie, 2017
Frontiers in Medicine, 2021
Background: Moderate therapeutic hypothermia (TH) is a well-recognized cardio-protective strategy... more Background: Moderate therapeutic hypothermia (TH) is a well-recognized cardio-protective strategy. The instillation of fluid into the peritoneum provides an opportunity to deliver moderate hypothermia as primary prevention against cardiovascular events. We aimed to to investigate both cardiac perfusion consequences (overall blood flow and detailed assessment of perfusion heterogeneity) and subsequently simulate the associated arrhythmic risk for patients undergoing peritoneal dialysis (PD) induced TH.Methods: Patients underwent high resolution myocardial perfusion scanning using high resolution 256 slice CT scanning, at rest and with adenosine stress. The first visit using the patient's usual PD regimen, on the second visit the same regime was utilized but with cooled peritoneal dialysate at 32°C. Myocardial blood flow (MBF) was quantified from generated perfusion maps, reconstructed in 3D. MBF heterogeneity was assessed by fractal dimension (FD) measurement on the 3D left ventr...
Hemodialysis International, 2020
Hemodialysis (HD) induces myocardial stunning and is associated with adverse cardiovascular outco... more Hemodialysis (HD) induces myocardial stunning and is associated with adverse cardiovascular outcomes. Intradialytic hypotension is a modifiable determinant of myocardial stunning. Magnesium (Mg) is reported to be valuable in maintaining intradialytic blood pressure, which potentially would protect against demand myocardial ischemia. This study aimed to compare high vs. low dialysate Mg effects on intradialytic hemodynamics and HD‐induced myocardial stunning.
Annales d'Endocrinologie, 2020
Rare diseases of phosphate/calcium metabolism correspond to a wide and heterogeneous spectrum of ... more Rare diseases of phosphate/calcium metabolism correspond to a wide and heterogeneous spectrum of diseases. Recent knowledge in physiology and genetics has made it possible to better characterize them and to propose attractive therapeutic approaches based on the underlying pathophysiology. These diseases are often at the interface between nephrology and endocrinology. In this spirit of a multidisciplinary care, each specialty can bring its own critical point of view and its own specificities to improve patient care. The objective of this manuscript is to "read" with a nephrologist's point of view the main frameworks of diseases of phosphate/calcium metabolism, to illustrate the three crucial messages of nephro-protection sent to endocrinologists. First, calciuria must be interpreted both in absolute value (concentration hypercalciuria) and in ratio (flow hypercalciuria). Second, renal monitoring of therapies inducing hypercalciuria on kidneys with normal renal function (e.g. active vitamin D analogs or teriparatide) should be systematic. Last, hyperphosphatemia, often latent in hypoparathyroidism and pseudo-hypoparathyroidism, should be detected and at least benefit from dietary measures, in the context of Western diets rich in phosphate hidden in food additives.
Kidney International, 2020
Progrès en Urologie, 2018
American journal of nephrology, Jan 27, 2018
Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal... more Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Our study is one of the largest series of ...
Diabetes care, Jan 2, 2018
Chronic kidney disease is associated with higher morbidity and mortality in patients with diabete... more Chronic kidney disease is associated with higher morbidity and mortality in patients with diabetes. A low-protein diet is recommended to slow diabetic nephropathy progression because each protein load leads to renal hemodynamic variations. The aim of our study was to evaluate whether the advanced glycation end products (AGE) content of a protein load is responsible for the protein-induced renal hemodynamic variations in humans. Ten healthy subjects were assigned to a high-protein (1 g/kg) low-AGE (3,000 kU AGE) versus high-AGE (30,000 kU AGE) meal. Renal perfusion, oxygen consumption, and oxygen content were measured before and 120 min after each meal. Renal perfusion (3.2 ± 0.5 vs. 3.8 ± 0.4 mL/min/g ( = 0.0002) and oxygen consumption (0.3 ± 0.04 vs 0.4 ± 0.08 min, = 0.005) increased significantly after the high-AGE meal compared with the low-AGE meal. Our results suggest that the AGE content of a protein load is responsible for renal hemodynamic modifications. Therefore, preventio...
Nephrologie & therapeutique, 2017
In nephrology, some diseases begin specifically during childhood; however, they must be known by ... more In nephrology, some diseases begin specifically during childhood; however, they must be known by adult nephrologists so that to ensure continuity and homogeneity for their management. The aim of this review is therefore to propose a brief overview of the main pediatric diseases, for which a specific knowledge is warranted, and notably pediatric idiopathic nephrotic syndrome, cystinosis, primary hyperoxaluria and hereditaries tubulopathies.
American journal of kidney diseases : the official journal of the National Kidney Foundation, Jan 7, 2017
We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, ... more We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome diagnosed at age 11 years with a biopsy-proven kidney involvement that progressed to end-stage renal disease at age 21 years. Mutations of mitochondrial DNA (mtDNA) are maternally inherited and lead to mitochondrial cytopathies with predominant neurologic manifestations: psychomotor retardation, epilepsy, ataxia, neuropathy, and myopathy. Given the ubiquitous nature of mitochondria, cellular dysfunction can also appear in tissues with high metabolic turnover; thus, there can be cardiac, digestive, ophthalmologic, and kidney complications. Mutations in the MT-ATP6 gene of mtDNA have been shown to cause NARP syndrome without renal involvement. We report a patient who had NARP syndrome diagnosed at age 11 years in whom glomerular proteinuria was present very early after diagnosis. Although neurologic manifestations were stable over time, he developed...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 8, 2018
There are many different ways to measure glomerular filtration rate (GFR) using various exogenous... more There are many different ways to measure glomerular filtration rate (GFR) using various exogenous filtration markers, each having their own strengths and limitations. However, not only the marker, but also the methodology may vary in many ways, including the use of urinary or plasma clearance, and, in the case of plasma clearance, the number of time points used to calculate the area under the concentration-time curve, ranging from only one (Jacobsson method) to eight (or more) blood samples. We collected the results obtained from 5106 plasma clearances (iohexol or 51Cr-ethylenediaminetetraacetic acid (EDTA)) using three to four time points, allowing GFR calculation using the slope-intercept method and the Bröchner-Mortensen correction. For each time point, the Jacobsson formula was applied to obtain the single-sample GFR. We used Bland-Altman plots to determine the accuracy of the Jacobsson method at each time point. The single-sample method showed within 10% concordances with the m...
European Urology Supplements, 2016
Nephrology Dialysis Transplantation, 2017
activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and plasmin-antiplasmin complex (PAP) ... more activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and plasmin-antiplasmin complex (PAP) in an uremic group were significantly higher than in control group (p<0.05; p<0.0001). The markers of oxidative stress (H2O2), inflammation (high-sensitive C-reactive protein) and monocyte-to-macrophage transition (neopterin) were significantly augmented in CKD compared to controls (p<0.05; p<0.0001). AA levels were positively correlated both with CKD markers and uPA, suPAR, as well as PAI-1 (p<0.05, r0.3), and negatively correlated with levels of tPA and this result was also statistically significant (p<0.05, r0.3). In addition, the levels of AA correlated positively with neopterin and inversely with the levels of Trp. The concentrations of AA were independently associated with tPA levels in CKD. Moreover, we found an inverse correlation between AA and some hematological and biochemical parameters. CONCLUSIONS: The results demonstrate a strong relationship between AA and fibrinolytic activity and capacity in the uremic milieu. It provides a new idea that tryptophan metabolites from the kynurenine pathway can play an important role in the occurrence of thrombotic events in CKD patients.
Néphrologie & Thérapeutique, 2017
Néphrologie & Thérapeutique, 2015
American journal of nephrology, 2016
Cystatin C is considered an alternative to creatinine to estimate glomerular filtration rate (GFR... more Cystatin C is considered an alternative to creatinine to estimate glomerular filtration rate (GFR). However, studies have reported that increased adiposity is associated with a higher level of circulating cystatin C questioning the performance of estimation of GFR using cystatin C in obese subjects. We prospectively included 166 obese stages 1-5 chronic kidney disease (CKD) patients between 2013 and 2015. GFR was measured with a reference method without (measured GFR [mGFR]) and with adjustment to body surface area (mGFRr) and estimated (eGFR) or de-indexed eGFR using the Chronic Kidney Disease and Epidemiology (CKD-EPI) equation using creatinine (CKD-EPIcreat), cystatin (CKD-EPIcyst) and the combination of cystatin and creatinine (CKD-EPIcyst-creat). The biases between mGFR and de-indexed CKD-EPIcyst-creat were significantly lower than de-indexed CKD-EPIcreat (p = 0.001). Accuracies were significantly better with de-indexed CKD-EPIcyst-creat compared to CKD-EPIcreat and CKD-EPIcyst...
PLoS medicine, 2016
Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical condi... more Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (int...
Néphrologie & Thérapeutique, 2013
Nephrology Dialysis Transplantation, 2021
Background and Aims Maintenance of a cortico-medullary concentration gradient (CMG) required for ... more Background and Aims Maintenance of a cortico-medullary concentration gradient (CMG) required for urine concentration, is one of most important tubular function. However, we are lacking of functional tubular parameters to explore this function. The only tool available to assess it currently, is urinary osmolarity that is an indirect and nonspecific maker of CMG. In this study, we explore the ability of 23NaMRI in measuring 1) the dynamics of CMG for the first time compared to urinary osmolarity after a water load 2) the CMG in kidney disease. Method We conducted an exploratory pilot study for 10 healthy controls with water load then 5 cardiorenal patients with kidney disease. 1) Healthy controls were asked to be fasting since midnight. Urines sample were collected to measure fasting osmolarity and a first MRIscan were performed to acquire baseline anatomical and sodium images. Once the baseline was completed, healthy participants were asked to ingest water (15 mL/kg) within 15 minute...
Progrès en Urologie, 2017
Frontiers in Medicine, 2021
Background: Moderate therapeutic hypothermia (TH) is a well-recognized cardio-protective strategy... more Background: Moderate therapeutic hypothermia (TH) is a well-recognized cardio-protective strategy. The instillation of fluid into the peritoneum provides an opportunity to deliver moderate hypothermia as primary prevention against cardiovascular events. We aimed to to investigate both cardiac perfusion consequences (overall blood flow and detailed assessment of perfusion heterogeneity) and subsequently simulate the associated arrhythmic risk for patients undergoing peritoneal dialysis (PD) induced TH.Methods: Patients underwent high resolution myocardial perfusion scanning using high resolution 256 slice CT scanning, at rest and with adenosine stress. The first visit using the patient's usual PD regimen, on the second visit the same regime was utilized but with cooled peritoneal dialysate at 32°C. Myocardial blood flow (MBF) was quantified from generated perfusion maps, reconstructed in 3D. MBF heterogeneity was assessed by fractal dimension (FD) measurement on the 3D left ventr...
Hemodialysis International, 2020
Hemodialysis (HD) induces myocardial stunning and is associated with adverse cardiovascular outco... more Hemodialysis (HD) induces myocardial stunning and is associated with adverse cardiovascular outcomes. Intradialytic hypotension is a modifiable determinant of myocardial stunning. Magnesium (Mg) is reported to be valuable in maintaining intradialytic blood pressure, which potentially would protect against demand myocardial ischemia. This study aimed to compare high vs. low dialysate Mg effects on intradialytic hemodynamics and HD‐induced myocardial stunning.
Annales d'Endocrinologie, 2020
Rare diseases of phosphate/calcium metabolism correspond to a wide and heterogeneous spectrum of ... more Rare diseases of phosphate/calcium metabolism correspond to a wide and heterogeneous spectrum of diseases. Recent knowledge in physiology and genetics has made it possible to better characterize them and to propose attractive therapeutic approaches based on the underlying pathophysiology. These diseases are often at the interface between nephrology and endocrinology. In this spirit of a multidisciplinary care, each specialty can bring its own critical point of view and its own specificities to improve patient care. The objective of this manuscript is to "read" with a nephrologist's point of view the main frameworks of diseases of phosphate/calcium metabolism, to illustrate the three crucial messages of nephro-protection sent to endocrinologists. First, calciuria must be interpreted both in absolute value (concentration hypercalciuria) and in ratio (flow hypercalciuria). Second, renal monitoring of therapies inducing hypercalciuria on kidneys with normal renal function (e.g. active vitamin D analogs or teriparatide) should be systematic. Last, hyperphosphatemia, often latent in hypoparathyroidism and pseudo-hypoparathyroidism, should be detected and at least benefit from dietary measures, in the context of Western diets rich in phosphate hidden in food additives.
Kidney International, 2020
Progrès en Urologie, 2018
American journal of nephrology, Jan 27, 2018
Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal... more Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Our study is one of the largest series of ...
Diabetes care, Jan 2, 2018
Chronic kidney disease is associated with higher morbidity and mortality in patients with diabete... more Chronic kidney disease is associated with higher morbidity and mortality in patients with diabetes. A low-protein diet is recommended to slow diabetic nephropathy progression because each protein load leads to renal hemodynamic variations. The aim of our study was to evaluate whether the advanced glycation end products (AGE) content of a protein load is responsible for the protein-induced renal hemodynamic variations in humans. Ten healthy subjects were assigned to a high-protein (1 g/kg) low-AGE (3,000 kU AGE) versus high-AGE (30,000 kU AGE) meal. Renal perfusion, oxygen consumption, and oxygen content were measured before and 120 min after each meal. Renal perfusion (3.2 ± 0.5 vs. 3.8 ± 0.4 mL/min/g ( = 0.0002) and oxygen consumption (0.3 ± 0.04 vs 0.4 ± 0.08 min, = 0.005) increased significantly after the high-AGE meal compared with the low-AGE meal. Our results suggest that the AGE content of a protein load is responsible for renal hemodynamic modifications. Therefore, preventio...
Nephrologie & therapeutique, 2017
In nephrology, some diseases begin specifically during childhood; however, they must be known by ... more In nephrology, some diseases begin specifically during childhood; however, they must be known by adult nephrologists so that to ensure continuity and homogeneity for their management. The aim of this review is therefore to propose a brief overview of the main pediatric diseases, for which a specific knowledge is warranted, and notably pediatric idiopathic nephrotic syndrome, cystinosis, primary hyperoxaluria and hereditaries tubulopathies.
American journal of kidney diseases : the official journal of the National Kidney Foundation, Jan 7, 2017
We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, ... more We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome diagnosed at age 11 years with a biopsy-proven kidney involvement that progressed to end-stage renal disease at age 21 years. Mutations of mitochondrial DNA (mtDNA) are maternally inherited and lead to mitochondrial cytopathies with predominant neurologic manifestations: psychomotor retardation, epilepsy, ataxia, neuropathy, and myopathy. Given the ubiquitous nature of mitochondria, cellular dysfunction can also appear in tissues with high metabolic turnover; thus, there can be cardiac, digestive, ophthalmologic, and kidney complications. Mutations in the MT-ATP6 gene of mtDNA have been shown to cause NARP syndrome without renal involvement. We report a patient who had NARP syndrome diagnosed at age 11 years in whom glomerular proteinuria was present very early after diagnosis. Although neurologic manifestations were stable over time, he developed...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 8, 2018
There are many different ways to measure glomerular filtration rate (GFR) using various exogenous... more There are many different ways to measure glomerular filtration rate (GFR) using various exogenous filtration markers, each having their own strengths and limitations. However, not only the marker, but also the methodology may vary in many ways, including the use of urinary or plasma clearance, and, in the case of plasma clearance, the number of time points used to calculate the area under the concentration-time curve, ranging from only one (Jacobsson method) to eight (or more) blood samples. We collected the results obtained from 5106 plasma clearances (iohexol or 51Cr-ethylenediaminetetraacetic acid (EDTA)) using three to four time points, allowing GFR calculation using the slope-intercept method and the Bröchner-Mortensen correction. For each time point, the Jacobsson formula was applied to obtain the single-sample GFR. We used Bland-Altman plots to determine the accuracy of the Jacobsson method at each time point. The single-sample method showed within 10% concordances with the m...
European Urology Supplements, 2016
Nephrology Dialysis Transplantation, 2017
activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and plasmin-antiplasmin complex (PAP) ... more activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and plasmin-antiplasmin complex (PAP) in an uremic group were significantly higher than in control group (p<0.05; p<0.0001). The markers of oxidative stress (H2O2), inflammation (high-sensitive C-reactive protein) and monocyte-to-macrophage transition (neopterin) were significantly augmented in CKD compared to controls (p<0.05; p<0.0001). AA levels were positively correlated both with CKD markers and uPA, suPAR, as well as PAI-1 (p<0.05, r0.3), and negatively correlated with levels of tPA and this result was also statistically significant (p<0.05, r0.3). In addition, the levels of AA correlated positively with neopterin and inversely with the levels of Trp. The concentrations of AA were independently associated with tPA levels in CKD. Moreover, we found an inverse correlation between AA and some hematological and biochemical parameters. CONCLUSIONS: The results demonstrate a strong relationship between AA and fibrinolytic activity and capacity in the uremic milieu. It provides a new idea that tryptophan metabolites from the kynurenine pathway can play an important role in the occurrence of thrombotic events in CKD patients.
Néphrologie & Thérapeutique, 2017
Néphrologie & Thérapeutique, 2015
American journal of nephrology, 2016
Cystatin C is considered an alternative to creatinine to estimate glomerular filtration rate (GFR... more Cystatin C is considered an alternative to creatinine to estimate glomerular filtration rate (GFR). However, studies have reported that increased adiposity is associated with a higher level of circulating cystatin C questioning the performance of estimation of GFR using cystatin C in obese subjects. We prospectively included 166 obese stages 1-5 chronic kidney disease (CKD) patients between 2013 and 2015. GFR was measured with a reference method without (measured GFR [mGFR]) and with adjustment to body surface area (mGFRr) and estimated (eGFR) or de-indexed eGFR using the Chronic Kidney Disease and Epidemiology (CKD-EPI) equation using creatinine (CKD-EPIcreat), cystatin (CKD-EPIcyst) and the combination of cystatin and creatinine (CKD-EPIcyst-creat). The biases between mGFR and de-indexed CKD-EPIcyst-creat were significantly lower than de-indexed CKD-EPIcreat (p = 0.001). Accuracies were significantly better with de-indexed CKD-EPIcyst-creat compared to CKD-EPIcreat and CKD-EPIcyst...
PLoS medicine, 2016
Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical condi... more Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (int...
Néphrologie & Thérapeutique, 2013