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Chikungunya nephropathy is an uncommon etiology of acute kidney injury, associated with the mosquito-borne chikungunya arbovirus (CHIKV). The very limited number of pathologic reports to date have only involved postmortem analyses. We here report 5 cases of acute kidney injury for which kidney biopsies were performed in patients with confirmed acute CHIKV infection, during the recent outbreak of chikungunya disease in the French West Indies. The patients ranged from 42 to 76 years of age. All of the patients developed kidney injury, 3 of whom required short-term dialysis and underwent a kidney biopsy. Analysis of kidney biopsies revealed 2 main histopathologic patterns: acute interstitial nephritis with predominant lymphoid inflammation and acute tubular injury. Epithelioid granulomas were observed in 2 cases. There were no glomerular lesions, except in biopsies from 2 patients, including 1 with a previous known primary focal segmental glomerulosclerosis. CHIKV antigen immunofluorescence microscopy revealed staining in tubular cells. In all of the cases, the short-term outcome was favorable, with recovery of kidney function., (Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Infectious complications in kidney transplant recipients (KTRs) are well studied in temperate countries but remain barely known in tropical ones. The main objective of this study was to describe infection-related hospitalizations in patients living in the Amazon, where it has never been described., Methods: All KTRs residing in French Guiana between 2007 and 2018 were included retrospectively. Infection-related hospitalizations were collected in the main medical centers of the territory., Results: Eighty-two patients were included, and 42 were infected during the study period (51%). Eighty-seven infections were identified. The main sites of infection were urinary, in 29% of cases (25/87), and pulmonary, in 22% of cases (19/87). When documented (48/87), bacterial infections were predominant (35/48), followed by viral (8/48), fungal (4/48), and parasitic infections (1/48). Endemic so-called tropical infections accounted for 6% of infections (5/87). Histoplasma capsulatum was the most commonly isolated fungus (2/4)., Conclusions: This study suggests that the spectrum of infections in KTRs in French Guiana differs little from that of temperate countries. Nevertheless, some tropical infections are described. More studies on fungal infections in KTRs should be undertaken to clarify the weight of histoplasmosis in these patients., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates. Because of its high toxicity, the European Union withdrew it from its market in 2007. The aim of this study is to analyze all cases of paraquat poisoning hospitalized in French Guiana in order to assess their incidence and main characteristics.Medical records of all paraquat intoxicated patients hospitalized from 2008 until 2015 were reviewed in this retrospective study.Demographics, clinical presentation, and laboratory data were evaluated.A total of 62 cases were reviewed. The incidence of paraquat poisoning was 3.8/100,000 inhabitants/year. There were 44 adults and 18 children younger than 16 years of age. The median ages were 31 years [18.08-75.25] in adults and 13.4 years [0.75-15.08] in children, respectively. The median duration of hospitalization was longer in children [15.5 days (1-24)] than in adults [2 days (1-30)], P < .01. The majority of cases was due to self-poisoning (84%).Children had ingested a lower quantity of paraquat [48.8 mg/kg (10-571.1)] than adults [595.8 mg/kg (6-3636.4), P = .03]. There were more deaths among adults (65%) than in children (22%), P = .004. The severity and outcome was determined primarily by the amount of paraquat ingested.In conclusion, French Guiana has the largest cohort of paraquat poisonings in the European Union. The major factor affecting the prognosis of patients was the ingested amount of paraquat. The administration of activated charcoal or Pemba, in situ, within the first hour after ingestion of paraquat is essential.

Background: Calciphylaxis is a rare and severe disease with an annual incidence of around 1 % in dialysis patients. The main study aim was to determine its incidence in Martinique, where there is a significant population of patients on dialysis., Patients and Methods: All patients diagnosed with calciphylaxis between 2006 and 2012 and living in Martinique were included, retrospectively. Social, demographic, biological, anatomic, pathological, histological and outcome data were analysed., Results: Fifteen patients were included (8 women, 7 men). The incidence of calciphylaxis in this population was about 4.62/1,000,000 inhabitants per year. All patients presented very painful skin ulcerations and necrosis, chiefly on the lower extremities in 53.3 % of cases. All patients were on haemodialysis and two had undergone renal transplantation. Fourteen of the 15 patients were presenting secondary hyperparathyroidism, 12 had hypertension, 9 peripheral arterial disease, 8 obesity and 8 diabetes mellitus. Raised calcium and phosphorus were noted in 8 patients, with hypoalbuminaemia in 9 patients. Treatment with sodium thiosulfate was given for 8 patients, and was beneficial for all after a mean duration of 3.4 months. After 6 months of follow-up, 8 of the 15 patients were cured, 1 showed improvement and 6 had died., Conclusion: To our knowledge, this is the first study to examine the incidence of calciphylaxis in the general population. The relatively large number of patients could be accounted for by the high number of comorbidities in end-stage renal disease patients in Martinique, including obesity, diabetes, hypertension and arteritis. Treatment with sodium thiosulfate was beneficial for 8 patients., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

This chapter provides a set of indicators on incident patients starting renal replacement therapy (RRT) in France between the 1st of January 2011 and the 31(st) of December 2011. Even if End-Stage Renal Disease can be found in all classes of ages, elders provide the majority of new patients (median age at RRT start: 71 years old). Those patients present a high rate of disabilities especially diabetes (41% of the new patients) and cardiovascular disabilities (>50% of the new patients) that increase with age. Considering treatment and follow-up, the first treatment remains center's hemodialysis and we do not notice any progression of self-dialysis. RRT started in emergency in 33% of the patients. This finding contrasts with the fact that 56% of patients started hemodialysis on a catheter. This, together with the major interregion variability, suggests that different strategies of management exist. Finally, the hemoglobin level at RRT start seems to be an interesting indicator of good management and follow-up since 13% of patients presenting an underprovided follow-up have a hemoglobin level under 10g/dL, whereas only 2.5% of patients with an appropriate follow-up presented such a condition., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The polymerase chain reaction (PCR) was used to search for hepatitis B virus (HBV) DNA sequences in the sera of 51 dialyzed patients (26 women, 25 men; mean age 60.5 years, range 35 to 85). Two different sets of specific primers for HBV core and surface gene sequences were synthesized and used for each sample. Controls were 90 HBV negative blood donors. Results were analyzed according to other serological markers of HBV. Among the eight HBsAg positive patients (anti-HBc+: 8/8), seven were positive for HBV DNA. Four of eight patients were vaccinated but later developed acute HBs hepatitis. The presence of HBV DNA was detected in six of 43 HBsAg negative patients (anti-HBc+: 5/6; anti-HBs+: 3 of 6; HBeAg: 0 of 6; anti-HBe: 2 of 6). These six patients were vaccinated and four of six developed mild and transient cytolytic hepatitis (3 before vaccination; 2 later). These results showed that HBsAg seronegative patients can be infectious. The role of HBV vaccination and/or the existence of variations in the structure of the viral genome is discussed.

IgG subclasses of anti-double-stranded DNA antibodies were determined in 182 patients with systemic lupus erythematosus. All isotypes were detected, but IgG1 and IgG3 were predominant (62 and 51% of the cases, respectively). An average of 64 +/- 27% was IgG1, 16 +/- 22% IgG2, 16 +/- 19% IgG3 and 4 +/- 10% IgG4. The rank order or frequency was IgG1, IgG3, IgG2 and IgG4 in patients with musculoskeletal involvement; IgG1, IgG2, IgG3 and IgG4 in those with renal complications; IgG3, IgG1, IgG2 and IgG4 in those with cutaneous involvement; and IgG1, IgG3, IgG2 and IgG4 in those with hematological manifestations. Interleukin-4 (IL-4) was detectable in 17 of 36 selected patients, as opposed to 1 of 40 normal controls. The percentage of the total autoantibody contributed by IgG1 was significantly higher (p < 0.03) in these patients than in the remainder with undetectable levels of IL-4.

A large-scale, open, nonrandomized, multicenter, 90-day study of the safety and efficacy of a thiazide diuretic and aldosterone antagonist combination (Aldactazine, 25 mg spironolactone and 15 mg altizide, 1/day) as monotherapy was performed in 946 patients with mild to moderate hypertension (diastolic blood pressure [BP] between 90 and 120 mm Hg). Adverse effects were assessed, and body weight, heart rate, serum potassium, creatinine and uric acid measurements were monitored. On day 45 of the study, BP was normalized (diastolic BP less than or equal to 90 mm Hg) in 72% of the patients. The dose was increased to 2 tablets per day in the patients whose BP did not reach normal levels. By the end of the study, BP was controlled in 83% of the patients. No significant changes were noted in body weight, heart rate or laboratory values; however, treatment had to be discontinued in 6 patients because of hypokalemia (n = 4) or elevated serum creatinine levels (n = 2). Serum uric acid levels were increased in 5.5% of patients. The rate of adverse effects, as reported by the patients, was low (5%). Thus, this study demonstrates that diuretics, especially the combination of a thiazide diuretic and aldosterone antagonist, remain a safe, effective and economical therapy for patients with mild to moderate hypertension.

Levels of testosterone, free testosterone, oestrogen, LH, FSH, prolactin were measured in 39 dialysed men. A LHRH stimulation test was performed. This study was analysed in function of the underlying renal disease, the duration of hemodialysis, and serum ferritin levels. In chronic glomerulonephritis serum gonadotrophins concentrations were significantly higher than in chronic interstitial nephritis or polycystic disease. A correlation between prolactin and ferritin was found, which may reflect the pituitary iron overload. Free testosterone levels were significantly lower in patients with gynecomastia (23-29 patients). In fact, the most direct relationship that we found with gynecomastia in dialysed men was with the free testosterone/oestrogen ratio.

In view of the part played by renal prostaglandins in the mechanisms responsible for pain in renal colic, it was worth trying to find out whether nonsteroidal anti-inflammatory agents, which inhibit prostaglandin synthesis, have an analgesic effect of their own. In a double-blind trial the effects of ketoprofen 100 mg administered intravenously alone or associated with noramidopyrine were investigated in 62 patients divided at random into two equal groups. A rapid analgesic effect was observed with no significant difference between the groups. No severe side-effects were recorded. The double-blind method made it possible to confirm that ketoprofen administered alone relieved pain in 97% of the patients (with complete sedation in 45%) and acted within 5 minutes. Owing to their effectiveness and safety nonsteroidal anti-inflammatory drugs (especially ketoprofen) may be proposed as an alternative to conventional treatments of renal colic. But because of their activity they should not be prescribed until a firm diagnosis has been made. The cause of the colic should also be rapidly determined in order to treat it as well as the pain it produces.

Serum amylase and lipase activities were studied in two groups of patients without clinical evidence of pancreatitis: 47 with stable chronic renal failure, 61 treated by haemodialysis. Amylase activity was significantly increased in 73 of 108 patients (68%) and lipase activity in 67 of 108 (62%). After dialysis, both enzymatic activities were decreased, despite of the lack of extraction by the artificial kidney. Laboratory confirmation of the diagnosis of pancreatitis is difficult in patients with chronic renal failure, and cannot be supported only by serum amylase and lipase activity measurements.

Non occlusive mesenteric ischaemia is a serious complication of maintenance haemodialysis. Its physiopathological mechanisms are controversial and its frequency is underestimated. Eight cases (in 5 patients) are reported: the clinical syndrome consisted of acute abdominal pain without evidence of shock or abdominal wall rigidity at palpation, associated with hyperleucocytosis and hyperkaliemic acidosis. The normality of the mesenteric vessels was confirmed at autopsy in one patient and during surgery in all others. Two patients were found to have caecal necrosis, 2 had diffuse necrotizing enterocolitis and 1 had necrosis of the left colon. The prognosis of this complication is sombre: 4 of our 5 patients died, including 3 who had relapsed 1, 4 and 18 months respectively after surgery (diffuse ileocolic necrosis). The usually accepted physiopathological mechanism is volaemic contraction consecutive to haemodialysis in often atheromatous subjects; however, the fact that the mesenteric infarction is not occlusive, that it occurs sometime after the end of the haemodialysis session and above all, the lack of haemodynamic changes during or immediately after the session suggest that other factors (bioincompatibility) are involved.

The pharmacokinetics of bendazac and its major metabolite, 5-hydroxybendazac, have been investigated in 15 patients with moderate to severe renal insufficiency and renal failure following a single oral dose of 500 mg bendazac-lysine. The pharmacokinetic parameters were compared to those obtained in 10 healthy adult volunteers. The rate and the extent of absorption of bendazac was not modified in the patients with moderate and severe renal insufficiency, nor was there any change in plasma tmax, Cmax, apparent elimination t1/2 and AUC. There was a significant increase in the unbound fraction of bendazac in renal failure patients undergoing haemodialysis, with a consequent increase in the apparent volume of distribution (V/F) and apparent plasma clearance (CL/F), and a decrease in plasma Cmax and AUC. Simultaneous changes of V/F and CL/F lead to an unchanged plasma t1/2 in these patients. Renal clearance (CLR) was decreased, but CL/F was not affected, since renal excretion is a minor route of elimination of bendazac. Bendazac is mostly eliminated by metabolism to 5-hydroxybendazac, in healthy subjects greater than 60% of a dose being excreted in urine as 5-hydroxybendazac and its glucuronide. In patients with renal insufficiency urinary excretion of 5-hydroxybendazac was decreased and the systemic availability of the metabolite (AUC), was increased about three-fold, irrespective of the degree of renal failure. Plasma 5-hydroxybendazac glucuronide accumulated according to the degree of renal insufficiency. Overall it can be assumed that the pharmacological effect of the drug will not be enhanced in renal failure and that the dosage regimen of bendazac-lysine in such patients need not be modified.

This report describes one case of rapidly progressive glomerulonephritis associated with amyloidosis in a 53-year-old woman with rheumatoid arthritis, successfully treated with intensive plasma exchange and immunosuppression. Amyloid deposits were present in all of 20 glomeruli in the kidney biopsy specimen and eight out of nine nonfibrosed glomeruli contained crescents. With intensive plasma exchange and immunosuppressive drugs, renal function improved, and hemodialysis was discontinued. After 2 years, renal function was stable at a moderate level of impairment, but heavy proteinuria persisted.

Medial calcification of the arteries, because of non-distensibility of the blood vessel walls, may overestimate the real intra-arterial pressure when blood pressure (BP) is measured by indirect sphygmomanometry cuff. In order to assess the best method for measuring BP, we compared direct intra-arterial measurements with indirect cuff sphygmomanometry as well as automatic oscillometric measurements in 15 hypertensive patients. Mean age +/- standard deviation (SD) was 62 +/- 9 years; all patients had medial calcifications of forearm and/or brachial arteries, and Osler's maneuver was negative in all. Ten sets of direct and indirect BP measurements were obtained for each patient. Results are expressed as mean +/- SD: (table; see text) There was no significant difference between cuff pressure and systolic intra-arterial pressure. The automatic oscillometric method underestimated systolic intra-arterial BP. Great individual variability was observed and could not be predicted clinically. Indirect diastolic BP values were greater than intra-arterial BP in all patients with the sphygmomanometer cuff and in 10 patients with the oscillometric recorder. There existed a direct relation between intra-arterial BP and differences between indirect BP measurements and intra-arterial BP as follows: intra-arterial BP was overestimated by indirect methods for values under 150 mmHg, and underestimated above 150 mmHg. In conclusion, invasive intra-arterial BP measurement seem to be necessary to distinguish between hypertensive and pseudo-hypertensive patients, in case of radiologic evidence of arterial calcification.