Un syndrome néphrotique chez un patient porteur d’une polyarthrite rhumatoïde : à propos d’un cas

A fifty-one years-old patient with a history of rheumatoid arthritis of recent diagnosis is hospitalized for exploration of a rapidly progressive anasarca state. First analysis discovered an impure nephrotic syndrome (acute renal failure, hematuria) and massive glomerular proteinuria. Auto-medication by nonsteroidal anti-inflammatory drug was revealed. Renal biopsy showed minimal glomerular disease and acute tubular necrosis. Corticosteroid use permitted a normalization of proteinuria and renal recovery was obtained. Literature review showed renal impairment occurring in rheumatoid polyarthritis. Minimal glomerular disease is rare but can be associated with rheumatoid arthritis. This disease, associated with the use of nonsteroidal anti-inflammatory drug, may be responsible of the patient condition.     

Association between acute graft pyelonephritis and kidney graft survival: A single-center observational study

The association between acute graft pyelonephritis (AGPN) and graft failure in kidney transplant recipients (KTR) remains controversial. In this single-center observational study, we aimed to assess the incidence of AGPN as a time-dependent posttransplantation event. We also examined the association between the diagnosis of AGPN and graft outcomes. In total, we evaluated 1480 patients who underwent kidney transplantation between January 2007 and December 2017. During a median follow-up of 5.04 years, we observed 297 AGPN episodes that occurred in 158 KTR. To evaluate the association between AGPN and clinical outcomes, we performed Cox proportional hazards regression analyses in which AGPN was entered as a time-dependent covariate. AGPN was independently associated with an increased risk of graft loss (hazard ratio = 1.66; 95% confidence interval [CI]: 1.05−2.64, p < .03) and a persistently decreased eGFR (fixed effect on intercept: −2.29 ml/min/1.73 m²; 95% CI: from −3.23 to −1.35, p < .01). However, neither mortality nor biopsy-proven acute rejection was found to correlate with AGPN. Moreover, recurrent AGPN episodes did not appear to have an additive detrimental impact on graft loss. These data represent a promising step in understanding whether AGPN prevention may decrease the risk of graft loss in KTR.     

DNASE1L3 deficiency,new phenotypes,and evidence for a transient type I IFN signaling

Journal of Clinical Immunology - Deoxyribonuclease 1 like 3 (DNASE1L3) is a secreted enzyme that has been shown to digest the extracellular chromatin derived from apoptotic bodies, and DNASE1L3...     

Accuracy of a portable international normalized ratio monitor for patients receiving a low molecular weight heparin as a bridge pending full oral anticoagulant efficacy

Background

Point of care (POC) devices measuring the international normalized ratio (INR) are accurate for patients with stable disease, but their efficiency has not been prospectively assessed during the “bridging period” when patients are receiving a low molecular weight heparin (LMWH) on top of a vitamin K antagonist (VKA) until the target INR is reached.

Methods

188 dual INR measurement using the POC (INR_POC) and the laboratory (INR_lab) at the same time were consecutively determined : 69 in patients receiving LMWH + VKA (bridging group) and 119 in patients receiving only a VKA (control group). INRpoc was compared to INR_lab.

Results

Test strip failure rate was higher in the bridging group than in the control group (29% vs 4% ; p < 0,001).In successful tests, POC accuracy was not modified by LMWH administration: the correlation coefficients between POC and lab INR values for the bridging group and the control group were 0,81 and 0,87 respectively, and the relative measure of divergence (RMD = INR_lab - INR_poc / INR_lab) was lower in the bridging group than in the control group (4 ± 7% vs 10 ± 14%; p = 0,02). Finally, clinically relevant agreement between POC and laboratory was of 90% in the bridging group and 92.1% in the control group (p = 0.6).

Conclusion

With the POC used (INRatio), in patients receiving LMWH when the POC gives a result, it is as accurate as in patients not receiving a LMWH.     

Restoration of alpha(1,2) fucosyltransferase activity decreases adhesive and metastatic properties of human pancreatic cancer cells

The expression of alpha(1,2) fucosyltransferases that catalyze the fucose transfer to galactose of the N-acetyl(iso)lactosamine chain is decreased in human metastatic pancreatic cancer cells. alpha(2,3) Sialyltransferases catalyze the transfer of sialic acid to the same substrate to form, with alpha(1,3/1,4) fucosyltransferases, sialyl-Lewis a and sialyl-Lewis x determinants on cell surface that are involved in pancreatic metastatic invasion. The aim of this study was to determine whether this decrease of alpha(1,2) fucosyltransferase expression can favor the alpha(2,3) sialyltransferase activity to form metastatic sialyl-Lewis antigens. Restoration of alpha(1,2) fucosyltransferase activity in the human pancreatic cancer cell line BxPC-3 was obtained by selecting stable transfectants expressing FUT1. Overexpression of FUTI in BxPC-3 cells resulted in a substantial reduction of sialyl-Lewis antigen expression that correlated with an increase of expression of Lewis y and H-type antigens on cell surface. The modified oligosaccharide structures were preferentially restricted to three major glycoproteins, which could in part be related to mucin-type glycoproteins. The reduction of sialyl-Lewis antigen expression was associated with an inhibition of adhesive properties to E-selectin and a decrease of gastrointestinal metastatic power of BxPC-3 cells after xenograft transplantation into nude mice. This study provides evidence that the expression level of alpha(1,2) fucosyltransferase may regulate the expression of sialyl-Lewis a and sialyl-Lewis x antigens and consequently could play an important role in metastatic properties of human pancreatic cancer cells.