Search

ABSTRACTDiabetes is the leading cause of end-stage kidney disease (ESKD), accounting for approximately 50% of patients starting dialysis. However, the management of these patients at the stage of chronic kidney disease (CKD) remains poor, with fragmented care pathways among healthcare professionals (HCPs). Diagnosis of CKD and most of its complications is based on laboratory evidence. This article provides an overview of critical laboratory evidence of CKD and their limitations, such as estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), Kidney Failure Risk Equation (KFRE), and serum potassium. eGFRis estimated using the CKD-EPI 2009 formula, more relevant in Europe, from the calibrated dosage of plasma creatinine. The estimation formula and the diagnostic thresholds have been the subject of recent controversies. Recent guidelines emphasized the combined equation using both creatinine and cystatin for improved estimation of GFR. UACRon a spot urine sample is a simple method that replaces the collection of 24-hour urine. Albuminuria is the preferred test because of increased sensitivity but proteinuria may be appropriate in some settings as an alternative or in addition to albuminuria testing. KFREis a new tool to estimate the risk of progression to ESKD. This score is now well validated and may improve the nephrology referral strategy. Plasma or serum potassiumis an important parameter to monitor in patients with CKD, especially those on renin-angiotensin-aldosterone system (RAAS) inhibitors or diuretics. Pre-analytical conditions are essential to exclude factitious hyperkalemia. The current concept is to correct hyperkalemia using pharmacological approaches, resins or diuretics to be able to maintain RAAS blockers at the recommended dose and discontinue them at last resort. This paper also suggests expert recommendations to optimize the healthcare pathway and the roles and interactions of the HCPs involved in managing CKD in patients with diabetes.

ABSTRACTAdolescents brought before the justice system are frequently perceived as a social group that is representative of a form of hegemonic masculinity combining deviance, violence, and risk-taking. However, in-depth analysis of legal case files in a juvenile court in France shows the ambivalence of these young men's masculinities. Even though certain actions and certain situations might seem to relate to a form of hegemonic masculinity, it is important to place them in the broader context of the marginalization of youths from lower-class backgrounds, who make up the overwhelming majority of cases dealt with by juvenile justice. Moreover, certain case files show that these adolescents embody certain forms of vulnerability and modes of self-presentation that directly counter the notion of hegemonic masculinity. The research presented in this article encourages a more complex analysis of deviant adolescent masculinities, by examining the homogenizing logics at work in the justice system, which tend to wrongly reduce these adolescents' trajectories to fixed and homogeneous demonstrations of masculinity.