Retinopathy, hematuria, and diabetic nephropathy

We have retrospectively analyzed the incidence of diabetic nephropathy in 21 diabetic patients who underwent renal biopsy between 1985 and 1995 for microscopic hematuria and/or proteinuria >2.5 g/day without retinopathy. Diabetic nephropathy was observed in 13 of 21 patients (62%). 50% of our patients with diabetic nephropathy had hematuria, the incidence being higher in type I as compared with type II diabetic patients (30 vs. 20%). Diabetic nephropathy without retinopathy but with hematuria was noted in 5 of 13 patients, and diabetic nephropathy without retinopathy and hematuria was also noted in 5 of 13 patients. We suggest from our retrospective analysis that renal-retinal diabetic syndrome really exists.     

How and when to search for a renal artery atheromatous stenosis in diabetic patients?

The prevalence of RAAS in non-insulin-dependent diabetic patients ranges from 17 to 44%. The prevalence increases exponentially in the presence of several risk factors such as severe arterial hypertension, severe renal insufficiency, macroangiopathy, smoking, and insulin requirement. In diabetic patients, RAAS should be investigated in patients with severe arterial hypertension, repeated pulmonary oedemas, and renal insufficiency without any clear etiology associated with a mild proteinuria and/or with a renal insufficiency secondary to the administration of angiotensin converting enzyme inhibitors or angiotensin II receptors antagonists. Asymmetrical size of the kidneys should also prompt the physician with a suspicion of RAAS. There are several specific criteria, that may confirm the suspicion of a RAAS. Renal arteriography is still the goal standard for diagnosing renal artery stenosis.     

Pharmacokinetics of sunitinib in hemodialysis

Clear-cell renal carcinoma is the most common cancer of thekidney [1]. Up to 30% of patients with renal-cell carcinomapresent with metastatic disease [2, 3] and recurrence developsin 40% of affected patients treated for a localized tumor [2,4]. Long-term dialysis is a risk factor since prevalence inhemodialysis and renal transplant patients is 40–100 timeshigher than in the general population [6, 7]. Sunitinib is anorally administered inhibitor of tyrosine kinase targeting thevascular endothelial growth factor receptor and the platelet-derivedgrowth factor receptor. Sunitinib given as first-line treatmentin metastatic renal-cell carcinoma has shown clinical activityin a phase     

Sorafenib treatment and intracaval neoplastic thrombosis regression

Sir, Up to 10% of patients with renal clear cell carcinoma (RCC)have intracaval neoplastic extension (ICNE). Caval thrombectomyis associated with a 7.5% early mortality and requires a multidisciplinarysurgical team, with the use of cardiopulmonary bypass (CPB).Furthermore, this surgical option has not revealed