Chronic kidney disease consecutive to chemotherapy for chondroblastic osteosarcoma: A report on 6 pediatric cases

BackgroundThe management of osteosarcoma in children and adolescents is based on poly-chemotherapy including several nephrotoxic drugs (e.g. ifosfamide, methotrexate, and cisplatinum). Chronic renal toxicity is a frequent complication but stage 5 chronic kidney disease requiring dialysis is rare. We report here a series of six pediatric patients with osteosarcoma displaying chronic kidney disease after chemotherapy.Case-diagnosis/treatmentWe retrospectively reviewed the medical charts, mainly for clinical history, timing between chemotherapy and development of tubulopathy and CKD, type of therapies and global evolution (chronic dialysis and further renal transplantation, n = 2; death, n = 1). Notably, all patients suffered from chondroblastic osteosarcoma.ConclusionsAdvanced chronic kidney disease can be a complication of osteosarcoma management that could more frequently lead to dialysis and further transplantation. It would be interesting to identify specific risk factors of such renal toxicity. The chondroblastic sub-type may be associated with such susceptibility, but this needs to be confirmed.     

Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

BackgroundLittle data are available for infants who started renal replacement therapy before 6 months of age. Because of extra-renal comorbidities and uncertain outcomes, whether renal replacement therapy in neonates is justified remains debatable.MethodsWe performed a retrospective analysis of all patients who began chronic peritoneal dialysis below 6 months between 2007 and 2017 in two tertiary centres. Results are presented as median (min;max).ResultsSeventeen patients (10 boys) were included (8 prenatal diagnoses, 6 premies), with the following diagnoses: congenital anomalies of kidney and urinary tract (n = 9), oxalosis (n = 5), congenital nephrotic syndrome (n = 2) and renal vein thrombosis (n = 1). Five patients had associated comorbidities. At peritoneal dialysis initiation, age was 2.6 (0.1;5.9) months, height-standard deviation score (SDS) −1.3 (−5.7;1.6) and weight-SDS −1.4 (−3.6;0.6). Peritoneal dialysis duration was 12 (2;32) months, and at peritoneal dialysis discontinuation height-SDS was −1.0 (−4.3;0.7) weight-SDS −0.7 (−3.2;0.2), parathyroid hormone 123 (44;1540) ng/L, and hemoglobin 110 (73;174) g/L. During the first 6 months of peritoneal dialysis, the median time of hospitalisation stay was 69 (15;182) days. Ten patients presented a total of 27 peritonitis episodes. Reasons for peritoneal dialysis discontinuation were switch to hemodialysis (n = 6), transplantation (n = 6), recovery of renal function (n = 2) and death (n = 1). After a follow-up of 4.3 (1.7;10.3) years, 12 patients were transplanted, 2 patients were still on peritoneal dialysis, 2 patients were dialysis free with severe chronic kidney disease and 1 patient had died. Seven patients displayed neurodevelopmental delay, of whom five needed special schooling.ConclusionWe confirm that most infants starting peritoneal dialysis before 6 months of age will be successfully transplanted and will have a favourable growth outcome. Their quality of life will be impacted by recurrent hospitalisations and neurodevelopmental delay is frequent.     

Variables linked to hepatitis B vaccination success in non-dialyzed chronic kidney disease patients: Use of a bayesian model

BackgroundHepatitis B vaccination is recommended for chronic kidney disease (CKD) patients before starting dialysis. We performed an analyis aimed to describe the clinical and biological parameters related to the success of vaccination in CKD patients before starting dialysis.MethodsWe extracted data of 170 non-dialyzed patients who were offered hepatitis B vaccination from a register. They received a first vaccination of 40 μg followed by boosters after one, two and six months. Patients were considered protected if their hepatitis B antibody level was > 10 IU/L, three months apart. A logistic regression and a Bayesian model were used to describe the relationships between variables and the success of vaccination.ResultsVaccination protected 50.6% of the patients. Model adjustment to the data was higher using the Bayesian model compared to the logistic regression (with area under the ROC curve of 0.955 ± 0.007 vs 0.775 ± 0.066 respectively). The Bayesian model's robustness studied using a 10 fold cross validation showed a percentage of misclassified subjects of 12.4 ± 1.8%, a sensitivity of 87.7 ± 0.3%, a specificity of 87.5 ± 0.3%, a positive predictive value of 87.8 ± 0.3% and negative predictive value of 87.4 ± 0.2%. As classified by the Bayesian model, the variables most related to successful vaccination were, in descending order: age, eGFR, protidemia, albuminemia, cause of renal failure, gender, previous vaccination and weight.ConclusionThe Bayesian network confirmed that both kidney function and nutritional status of patients are important factors to explain the success of vaccination against hepatitis B in CKD patients before dialysis. For research purposes, before an external validation, the network can be used online at www.hed.cc/?s=Bhepatitis&n=ReseauhepatiteBsup10.neta.     

Ultrasonographic renal volume measurements in early autosomal dominant polycystic disease: Comparison with CT-scan renal volume calculations

PurposeTo investigate the correlation and concordance between the ellipsoid volume calculated by ultrasonography measurements (Vol3DUS) and the reference kidney volume measured by CT (VolTDM) in early autosomal dominant polycystic kidney disease (ADPKD).Materials and methodsProspective study of the correlation and concordance of renal volumes in 24 patients with early ADPKD (48 kidneys analysed separately), with calculation of Vol3DUS using the formula for an ellipsoid in three different manners and VolTDM measurement by manual contouring. Calculations of correlation coefficients (r) and coefficients of intra-class correlation (ICC) with confidence intervals at 95%.ResultsThe US volume was strongly correlated with the CT volume by using the maximum width in a transverse section (r = 0.83) with a mean Vol3DUS = 692 ± 348 ml [180; 2069]. The most reproducible ultrasonography measurement was the height. When the kidney volume exceeded 800 ml, US underestimated the volume. However, the median error was −57.5 ml [−1090; 183] and 85% of the Vol3DUS calculated differed by more than 5% from the reference measurement.ConclusionThe correlation between the US calculated volumes and the CT volumes was strong. However, the median error with ellipsoid US volume was too high to detect a small renal variation in early ADPKD.     

The application of neutrophil gelatin-related lipid delivery protein in evaluation of renal function,nutrition, anemia and inflammation in patients with CKD

ObjectiveTo investigate the role of neutrophil gelatinase-associated lipocalin in the evaluation of renal function, nutrition, anemia and inflammation in patients with chronic kidney diseases.Materials and methodsA total of 302 patients with chronic kidney diseases were selected, and their clinical data, blood neutrophil gelatinase-associated lipocalin levels, renal function, nutrition, anemia, inflammation and calcium, and phosphorus metabolism were analyzed.ResultSerum neutrophil gelatinase-associated lipocalin level increased with the progression of chronic kidney diseases. Higher neutrophil gelatinase-associated lipocalin levels were observed in patients with chronic kidney diseases stage 3b compared with healthy individuals (P < 0.05), while the patients with chronic kidney diseases stage 5 showed higher levels compared with other chronic kidney diseases stages (P < 0.01). Moreover, the ROC curve showed that neutrophil gelatinase-associated lipocalin had a better diagnostic performance from the chronic kidney diseases stage 3b to 5 (P < 0.05). In addition, the serum neutrophil gelatinase-associated lipocalin levels in patient with chronic kidney diseases were negatively correlated with body mass index, number of red blood cells, hemoglobin, transferrin, the estimatedglomerular filtration rate (eGFR), serum calcium (P < 0.01); and were positively correlated with mean arterial blood pressure, blood BUN, SCr and alpha 1 microglobulin, beta 2 microglobulin, urinary inhibition C, homocysteine, PTH levels, neutrophils ratio, free serum ferritin and c-reactive protein (P < 0.01); while no significant correlation was found with gender, and age (P > 0.05).ConclusionSerum neutrophil gelatinase-associated lipocalin levels are closely related to renal function injury, inflammatory response and anemia-related indicators in patients with chronic kidney diseases, and thus could be used as a diagnostic biomarker for evaluating the degree of renal injury and related complications in patients with chronic kidney diseases.     

Inverse association between bone microarchitecture assessed by HR-pQCT and coronary artery calcification in patients with end-stage renal disease

It is a matter of debate whether vascular calcification and bone loss are simultaneously occurring but largely independent processes or whether poor bone health predisposes to vascular calcification, especially in patients with kidney disease. Here we investigated the association between the changes of microarchitecture in weight bearing bone and the extent of coronary artery calcification in patients with chronic renal failure.The bone microarchitecture of the tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT), bone mineral density using dual X-ray absorptiometry (DXA) of the lumbar spine, femoral neck and distal radius as well as coronary artery calcification using multi-slice CT and reported as Agatston score were measured in 66 patients with end-stage renal disease on chronic hemodialysis. Markers of bone turnover, vitamin D status and intact parathyroid hormone (iPTH) were assessed.CAC score was found to be < 100 in 39% and ≥ 100 in 61% of patients. The median [95% CI] total CAC score was 282 [315–2587]. By univariate analysis, significant correlations between CAC and age (R = 0.52, p < 0.001), weight (R = 0.3, p < 0.01) and serum cross laps (CTX, R = − 0.39, p < 0.01) were found, and parameters of bone microarchitecture were numerically but not significantly lower in patients with CAC scores ≥ 100. In multivariate analysis stratifying for gender and correcting for age, tibial density (D_tot) and bone volume/total volume (BV/TV) were significantly lower in patients with CAC scores ≥ 100 (p < 0.05 for both).Low trabecular bone volume and decreased cortical bone density are associated with coronary artery calcification in dialysis patients.     

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.     

Profil épidémiologique et clinique,et survie à 90 jours des patients incidents en hémodialyse chronique au cours de la pandémie à SARS-CoV2 au Cameroun : expérience de l’hôpital général de Douala

BackgroundThe effect of COVID-19 pandemic on end stage renal disease patient who should initiated dialysis are limited in Sub-Saharan Africa is unknown. We sought to describe the epidemiologic and clinical profile of newly admitted patient in chronic haemodialysis during the COVID-19 pandemic in Cameroon and evaluate their survival between 90 days of dialysis initiation.Material and methodWe conducted a cohort study of 6 months from April to October 2020. End stage renal disease patients newly admitted in the haemodialysis facility of the General Hospital of Douala were included. Patients with confirmed or suspected COVID-19 were identified. Socio-demographic, clinical and biological data at dialysis initiation as well as mortality between the 90 days of dialysis initiation were registered.ResultsA total of 57 incident patients were recorded from April to October 2020 with a monthly mean of 9.5 patients. The mean age was 46.95 ± 13.12 years. Twenty-four COVID-19 were identified with a frequency of 49% among emergency admission. Pulmonary œdema (79.2% vs. 42.4%; P = 0.006) and uremic encephalopathy (83.4% vs. 53.6%; P = 0.022) were more common in COVID-19. The overall survival at 90 days was 48% with a tendency to poor survival among COVID-19 and patients with low socioeconomic level. In Cox regression, low socioeconomic level increase the risk of instant death by 3.08.ConclusionSARS-CoV2 seem to increase nephrology emergency and poor survival in haemodialysis at 90 days.     

Soin nutritionnel et amélioration clinique dans un service de néphrologie : une approche pilote multidisciplinaire

Malnutrition is an independent factor associated with morbi-mortality in chronic kidney disease. It is particularly common and may increase during hospitalization.ObjectivesTo measure nutritional and physical performance evolution as well as patients’ physical autonomy during a hospitalization in a university hospital renal ward. Treatments were adjusted according to different diagnoses (nutritional care, body composition, physical activity) along with a multidisciplinary approach. In this way, it can show the impact of this care on nutritional status of the patient.DesignRegardless of their nutritional status and kidney disease (acute or chronic kidney disease, chronic hemodialysis), patients were included at day 0, within 2 days from admission; nutritional interventions and measurements were assessed on day 7, day 14 and day 21. The study was run from December 2011 till June 2012, and 48 patients were included.ResultsOn admission, patients had a low energy intake (20.9 ± 8.6 kcal/kg/day). This intake was improved by means of a dietetic intervention (28.1 ± 6.5 kcal/kg/day after two weeks of hospitalization, 29 ± 6.1 kcal/kg/day after three weeks and 29 ± 8.4 kcal/kg/day after four weeks). Seventy-three percent of the hospitalized patients were malnourished, among them 91% had a decreased serum albumin (26.8 ± 6.6 g/L). Weight and muscle mass (measured by impedancemetry) were maintained, prealbumin increased by 16.5 mg/L after two weeks (n = 48; P = 0.61), 27.8 mg/L after three weeks (n = 31; P = 0.018), 52.3 mg/L after four weeks (n = 13; P = 0.002) and albuminemia by 1.8 g/L (n = 13 patients monitoring four weeks; P = 0.13). Both physical autonomy (assessed with Test moteur minimum) and muscle strength (Hand Grip Test) were significantly improved.ConclusionA systematic screening of wasting and a multidisciplinary care improved nutritional status and physical ability of patients hospitalized in a renal ward.     

Elucidation of effect of spinopelvic parameters in degenerative disc disease

IntroductionThis study aims to find out if there is any relationship between disc pathology and spinopelvic morphology, respectively.MethodsA total of 152 patients who complained about low back pain were assessed retrospectively. Patients were divided into three groups based on the presence of disc pathology: non-degenerative (ND) (n = 34), degenerative disc disease (DDD) (n = 80), and lumbar disc herniation (LDH) (n = 38). Spinopelvic parameters were measured on the lateral standing radiographs using Surgimap® Software. The degree of degeneration of each disc was evaluated using T2-weighted images according to the Pfirmann classification. Correlation analyses were performed.ResultsNo significant difference was observed between the three groups in terms of sagittal spinal and pelvic parameters. Age and BMI were positively correlated with DDD and LDH. PI and proximal lombar lordosis (PLL) were the only effective variables in predicting DDD. PT and distal lumbar lordosis (DLL) were found to be effective variables in predicting LDH. PI and PT values in patients with L1, L2, and L3 DDD were statistically significantly higher than those without degeneration (P < 0.05). Although there were no statistical differences between PI and PT values (P > 0.05), DLL values in L4 and L5 DDD patients were significantly lower than those without degeneration (P = 0.041; P = 0.046; P < 0.05).ConclusionsThe sagittal morphology of the spine directly influences the extent of lumbar disc degeneration. As the values of PI and PT increase, disc degeneration tends to occur at higher levels (L1-2-3). Disc degeneration at lower levels (L4-5) was associated with low DLL levels.Level of evidenceLevel III, retrospective study.     

Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

BackgroundReports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution. The results of the surgical treatment are described and the potential risk factors associated with the rupture are analyzed.MethodsOur study consisted of retrospective analysis of patient's charts. Clinical and laboratory findings of the operated group were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture.ResultsBetween 1998 and 2010, six ESRD patients with 11 spontaneous ruptures of the quadriceps tendon were treated at our institution. On postoperative evaluation all patients were able to walk without crutches after six months of follow-up, and there were no new ruptures. Positive serology for Hepatitis C was present in two cases (33%) but in none of the controls (p = 0.034). Mean serum levels of intact parathormone (iPTH) and alkaline phosphatase were both higher in cases (p = 0.013 and p = 0.034, respectively). In contrast, mean serum levels of albumin, ferritin and haemoglobin were all lower in cases (p = 0.008, p = 0.043 and p = 0.016, respectively).ConclusionReconstructive surgery is a good way to restore knee function in ESRD patients with quadriceps tendon ruptures. Our cases exhibited higher levels of iPTH and alkaline phosphatase than control patients, reinforcing the role of secondary hyperparathyroidism in tendon weakening. They also had a higher frequency of hepatitis C and lower levels of albumin and haemoglobin compared to controls, possibly implicating chronic inflammation as a potential risk factor for tendon rupture.     

QuiPO : qui administre les EPO en prédialyse ?

IntroductionErythropoiesis Stimulating Agents (ESA) are largely prescribed before dialysis stage to chronic kidney disease patients. In accordance to current international guidelines, lots have been made by pharmacological companies in order to improve self management of ESAs: subcutaneaous administration, pencil devices, mutidose cartridges, low injection volume, very fine needles, once a month injections but none is currently known on the percentage of patients who actually do self administration of ESAs.Patients and methodsWe conducted a simple prospective questionnaire study in different nephrology departments in France, on pre-dialysis patients. Questionnaires have been fulfilled by randomly selected French nephrologists during visits with outpatients treated by ESA. Costs have been evaluated by ESA and nurse visit direct costs in euros and compared by a Wilcoxon test.ResultsWithin 6 months, 143 questionnaires of outpatients have been completed. The characteristics of the population are as followed: 53% men, mean age 66.4 ± 16.9 y/o, 38.6% of diabetics, mean estimated Glomerular Filtration Rate (eGFR by MDRD formula) 22.8 ± 11.6 mL/min/1.73 m². ESAs are prescribed as follow: Aranesp^® (50.3%), Mircera^® (36.3%), NeoRecormon^® (10.5%), Eprex^® (2.1%) and Retacrit^® (0.7%). ESA self administration concerns only 24.8% of the patients their while most of the patients (70.2%) ask a nurse for injection without any differences between ESAs (P = 0.24), sex (P = 0.81) or presence of diabetes (P = 0.78). ESA self administration is more frequent for working patients (56.8% versus 34.7%; P = 0.0002). Moreover, for 86.7% of the patients, nurse comes at home and in 60% of the cases only for this injection. Finally, 42% of the patients feel improvement as soon as a couple of hours after injection whatever ESA used (0–45 days). In addition, mean haemoglobin level is 11.4 ± 1.3 g/dL, mean ferritinemia is 229 ± 211 UI/mL. Non surprisingly, nurse injection regimen is more expensive than self injection (P = 0.0016).DiscussionThis simple questionnaire shows that despite efforts made to improve ESA self administration, a minority of patients are in fact proceeding to ESA self administration. Asking for a nurse, does not help patient to be independent, and increases health cost. Efforts have to be made in order to help patients for ESA self administration.     

High preoperative C-reactive protein values predict poor survival in patients on chronic hemodialysis undergoing nephrectomy for renal cancer

ObjectivesPrevious studies have reported that elevated pretreatment C-reactive protein (CRP) levels are associated with poor outcome in various malignancies, including renal cell carcinoma (RCC), in the general population. However, there is no evidence of such an association in dialysis patients. Therefore, the aim of this study is to evaluate the prognostic significance of preoperative serum CRP levels in patients with RCC related to end-stage renal disease (ESRD) requiring hemodialysis (HD).Materials and methodsWe evaluated 315 patients with ESRD requiring HD who underwent nephrectomy for RCC as the first-line treatment at our hospital from 1982 to 2013. Complete patient- and tumor-specific characteristics as well as preoperative CRP levels were assessed. We defined a serum CRP level >0.5 mg/dl as elevated and divided these patients into 2 groups according to their preoperative CRP levels (CRP≤0.5 and >0.5 mg/dl). The median follow-up was 51 months.ResultsPreoperative CRP levels were elevated in 75 patients (23.8%). The Kaplan-Meier 5-year cancer-specific survival rates were 95.2% and 69.9% in patients with CRP levels≤0.5 and>0.5 mg/dl, respectively (P<0.0001). Multivariate analysis identified preoperative CRP level as an independent predictor for cancer-specific survival, along with a pathological TNM stage and tumor grade (CRP>0.5: hazard ratio = 3.47; 95% CI: 1.35–9.18; P = 0.0098). The concordance index of multivariable base models increased after including the preoperative CRP levels.ConclusionsPreoperative serum CRP level might be an independent predictor of postoperative survival in patients with RCC related to ESRD requiring HD. Its routine use, together with the TNM classification and tumor grade, could allow better risk stratification and risk-adjusted follow-up of these patients.     

The effect of self-care education through teach back method on the quality of life in hemodialysis patients

BackgroundSelf-care education can play an important role in improving the quality of life in hemodialysis patients.PurposeThe purpose of this study was to determine the effect of self-care education with teach back method on the quality of life in hemodialysis patients.MethodsIn this pre- and post-test clinical trial, 45 patients with end-stage renal disease undergoing hemodialysis at Sina hospital in Tehran were included. Patient education was done with teach back method. The duration of training were 3 sessions and the time of each session lasted from 45 minutes to one hour. To collect data from patients, a demographic questionnaire was used and to assess the quality of life of patients, kidney disease quality of life-short form before and after education was used. A significant level of 5% was determined.ResultsThe mean age of patients was 58.49 ± 9.97 years. Among the dimensions of quality of life before education, the highest score was for physical role (64.24 ± 7.68) and the lowest was related to job status (28.33 ± 11.06). After training, the most score was related to emotional role (71.15 ± 2.84) and the least was related to job status (43.87 ± 11.54). A significant difference between the quality of life at before and after education was seen (P = 0.000).ConclusionThis study showed that self-care education through teach back method improves the quality of life in hemodialysis patients. Therefore, it is recommended that nurses in the hemodialysis unit implement self-care education through teach back method as an important task.     

Étiologies et facteurs pronostiques des néphropathies interstitielles aiguës

IntroductionAcute interstitial nephritis represents a clinically and etiologically heterogeneous group of kidney diseases. The aim of our study was to explore the main causes of biopsy-proven acute interstitial nephritis and to identify predictive factors of renal outcome.MethodsWe conducted a retrospective monocentric study which included patients with biopsy proven AIN, followed in our department during the period between 1980 and 2018. The non-recovery of kidney function or an estimated glomerular filtration rate ˂ 60 mL/min/1.73 m² were considered as a worse renal outcome.ResultsA total of 65 acute interstitial nephritis patients were enrolled. The mean age of patients was 41.3 ± 16 years with a female predominance (78%). Drug-induced etiology was the most common (29%). The most frequent culprit drugs in our study were NSAID followed by antibiotics. The renal prognosis was unfavorable in 21 cases (32%). The independent predictive factors for renal outcome were : a percentage of sclerotic glomeruli greater than 15% (P = 0.004), absence of interstitial edema (P ˂ 0.001), non-use to corticosteroid therapy (P = 0.02) and a delay in initiating corticosteroid therapy greater than 21 days (P = 0.02).ConclusionDrugs currently represent the most common cause of acute interstitial nephritis. The renal prognosis is often favorable, but the progression can be towards chronic renal failure in the event of diagnostic and therapeutic delay. Our data suggest a beneficial influence of steroids on the outcome of acute interstitial nephritis.     

Screening for celiac disease in patients with osteoporosis

ObjectiveWhether patients with osteoporosis should be screened for celiac disease is controversial. The objective of this study was to measure the prevalence of asymptomatic celiac disease in a cohort of patients with osteoporosis.MethodsWe studied 140 patients (133 postmenopausal women and 7 men) aged 40–75 years (mean age, 62.9 ± 9.4 years) with primary osteoporosis diagnosed by absorptiometry (spine or hip T-score <?2.5 SD). We routinely measured serum and urinary calcium, serum phosphate, alkaline phosphatase, 25-OH-vitamin D3, and IgG and IgA antigliadin antibodies. Patients with positive antigliadin antibody tests were tested for antitransglutaminase antibodies.ResultsA history of fractures were noted in 52 (37%) patients, with 57 peripheral and 54 vertebral fractures overall. Vitamin D deficiency was found in 60 (43%) patients. IgG antigliadin antibodies were positive in 11 (8%) patients, IgA antigliadin antibodies in 11 (8%) patients, and both antibodies in 4 (3%) patients. Antitransglutaminase antibodies were negative in all patients. No significant differences in laboratory test or absorptiometry results were found between patients with versus without IgA antigliadin antibodies. The T-score at the spine was nonsignificantly lower in patients with than without IgG antigliadin antibodies (?3.17 ± 0.49 and ?2.82 ± 0.77, P = 0.076).ConclusionWe found no excess risk of celiac disease in our cohort of patients with osteoporosis. Despite the small sample size, our results cast doubt on the need for celiac-disease screening in osteoporotic patients who have no gastrointestinal symptoms.     

Divergences (et convergences) de perceptions entre patients et néphrologues de l’impact de l’insuffisance rénale chronique non terminale sur l’élan vital en France : résultats de l’enquête MAEVA

RationaleThe impact of chronic kidney disease (CKD) on vital impetus is poorly documented in patients not undergoing renal dialysis and discrepancies can be observed between patients and physicians in perception of QoL and impact of the disease.MethodsA self-questionnaire was sent to 1282 French nephrologists and a mirrored self-questionnaire was given to patients (CKD stage 3, 4 or 5) by their nephrologist. Data were collected prospectively and anonymously.ResultsA total of 261 nephrologists and 172 patients participated in the survey. Sixty-six percent of patients reported a negative impact of the disease on their quality of life, which is also identified by nephrologists: important impact 22% vs 27%, mild or inconstant 44% vs 47%, mild or absent 34% vs 31% in patients and nephrologists, respectively. They had different perceptions about factors contributing to vital force; in particular, nephrologists underestimated their key role in psychological support. Indeed, the optimism and encouragements of nephrologists were considered to be a key factor of vital force for 60% of patients vs 20% of nephrologists (P < 0,001). During consultations, nephrologists were primarily focused on biological abnormalities and adherence to treatment while mood or sexual disorders were rarely investigated. The main objective of treatment was to maintain a normal life for patients and to delay dialysis for nephrologists.ConclusionNephrologists have a relative knowledge of CKD impact on the vital impetus of patients, but there are differences of perception. It could be improved through specific trainings.     

Cisatracurium dose–response relationship in patients with chronic liver disease

ObjectiveCisatracurium is approximately 3 times more potent than atracurium, devoid of histamine release and cardiovascular side effects and mainly eliminated by Hofmann degradation. Patients with liver disease exhibit abnormal response to most of muscle relaxants. This study was designed to evaluate the dose–response of cisatracurium in patients with mild–moderate liver impairment in comparison with healthy subjects.MethodsEighty ASA physical status I–II patients of both sexes, scheduled for elective surgical procedures under general anesthesia, were divided according to their preoperative hepatic status and laboratory investigations into two groups; Group I (control group with normal liver functions, n = 40) and Group II (Liver dysfunction group, Child-Pugh Score A or B, n = 40). The dose–response curve was constructed, ED₅₀ and ED₉₅ were estimated.ResultsThe preoperative laboratory parameters showed statistically significant differences between the two groups regarding serum albumin, total bilirubin, ALT, AST, PT, PC and INR. The operative data showed statistically insignificant difference between the two groups regarding the 1st dose response (p = 0.152), the estimated ED₈₀ (p = 0.886) and the calculated 2nd dose (p = 0.886) and statistically significant differences between the two groups regarding the 2nd dose response (p = 0.006), the measured ED₅₀ (p = 0.010) and the measured ED₉₅ (p = 0.001). In conclusion, the measured ED₅₀ and ED₉₅ through two-dose dose–response curve technique were clinically insignificant from using the single-dose technique. The dose–response curve of cisatracurium in patients with chronic liver disease was clinically insignificant in comparison with healthy subjects.