ABSTRACT
"Renal toxicity of antineoplasic agents Renal toxicity of antineoplasic agents is a common complication faced by oncologists and nephrologists whose incidence depends on therapeutic classes used and patient's comorbidities. Nephrotoxicity is variable, according to mecanisms, chronology and potential reversibility. Besides acute kidney injury and/or chronic kidney disease, clinical features include several urinary abnormalities (mainly proteinuria). The onset of renal toxicity may directly compromise vital prognosis and may lead to the interruption of medications affecting cancer-specific mortality. Nephrotoxicity prevention (when feasible) and rapid diagnosis are essential to optimize cancer-patient medical care."
Toxicité rénale des anticancéreux La toxicité rénale des anticancéreux est une complication à laquelle les oncologues et les néphrologues sont fréquemment confrontés, dont l'incidence est liée aux classes de molécules utilisées et aux comorbidités des patients. Cette toxicité est variable dans ses mécanismes, sa chronologie et son éventuelle réversibilité. Les atteintes cliniques incluent, outre l'insuffisance rénale aiguë et/ou chronique, divers troubles hydroélectrolytiques ainsi que des anomalies urinaires (en premier lieu une protéinurie). La survenue d'une toxicité rénale peut directement compromettre le pronostic vital mais également conduire à l'interruption d'anticancéreux améliorant la survie oncologique. La prévention (quand elle est possible) et l'identification rapide de toute toxicité rénale sont donc indispensables afin d'optimiser la prise en charge du patient cancéreux.
Subject(s)
Acute Kidney Injury , Antineoplastic Agents , Drug-Related Side Effects and Adverse Reactions , Neoplasms , Renal Insufficiency, Chronic , Acute Kidney Injury/chemically induced , Antineoplastic Agents/adverse effects , Humans , Neoplasms/drug therapyABSTRACT
Primary membranous nephropathy (PMN) is characterized by antibodies to the podocyte, but little is known about B- and T-cell populations and their response to rituximab is controversial. To help resolve this we compared 33 lymphocyte subpopulations and 27 cytokines/chemokines in 25 patients with severe PMN and 27 age-matched healthy individuals. At baseline, patients had a significantly increased percentage of naive B-cells with significantly decreased switched and non-switched memory B-cells. There was a significantly decreased percentage of natural killer (NK) cells with an increase in the CD56brightCD16-/lo NK subset. There were a significantly decreased percentage of regulatory T cells, together with an increased plasma concentration of TNF-alpha, IL-5 and IL-2RA. We then investigated 16 patients at eight days and three and six months after treatment with rituximab added to supportive therapy compared to nine patients with supportive therapy alone. After rituximab, B-cell recovery was still incomplete at six months, with persistent alterations of B-cell subsets, a significant increase of both T-regulatory (Treg) cells and NK cells, and a significant decrease of both the CD56brightCD16-/lo NK subset and TNF-alpha levels. The patients who clinically responded to rituximab had a significantly lower percentage of Tregs at baseline compared to non-responders and a significantly increased percentage at day eight. Tregs remained unchanged in non-responders and in patients treated with supportive therapy alone. Thus, evaluation of Tregs might be useful for predicting early response to rituximab.
Subject(s)
B-Lymphocyte Subsets/drug effects , Glomerulonephritis, Membranous/drug therapy , Immunosuppressive Agents/therapeutic use , Killer Cells, Natural/drug effects , Rituximab/therapeutic use , T-Lymphocytes, Regulatory/drug effects , Adult , Aged , Autoantibodies/blood , B-Lymphocyte Subsets/immunology , B-Lymphocyte Subsets/metabolism , Biomarkers/blood , CD4 Lymphocyte Count , CD56 Antigen/blood , Female , GPI-Linked Proteins/blood , Glomerulonephritis, Membranous/blood , Glomerulonephritis, Membranous/diagnosis , Glomerulonephritis, Membranous/immunology , Humans , Immunophenotyping , Immunosuppressive Agents/adverse effects , Interleukin-2 Receptor alpha Subunit/blood , Interleukin-5/blood , Killer Cells, Natural/immunology , Killer Cells, Natural/metabolism , Male , Middle Aged , Paris , Phenotype , Predictive Value of Tests , Receptors, IgG/blood , Rituximab/adverse effects , Severity of Illness Index , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/metabolism , Time Factors , Treatment Outcome , Tumor Necrosis Factor-alpha/bloodSubject(s)
Anticoagulants/adverse effects , Antitubercular Agents/adverse effects , Cyclosporine/adverse effects , Hemorrhage/chemically induced , Heparin/adverse effects , Immunosuppressive Agents/adverse effects , Phenindione/analogs & derivatives , Postoperative Complications/chemically induced , Rifampin/adverse effects , Vitamin K/antagonists & inhibitors , Aged , Anticoagulants/therapeutic use , Antitubercular Agents/administration & dosage , Comorbidity , Cyclosporine/administration & dosage , Drug Substitution , Drug Therapy, Combination , Female , Hemorrhage/drug therapy , Heparin/therapeutic use , Humans , Immunosuppressive Agents/administration & dosage , Kidney Transplantation , Lung Diseases, Interstitial/chemically induced , Pericarditis/chemically induced , Phenindione/adverse effects , Phenindione/pharmacology , Phenindione/therapeutic use , Polypharmacy , Postoperative Complications/drug therapy , Sirolimus/adverse effects , Venous Thrombosis/drug therapy , Vitamin K/therapeutic useABSTRACT
We report the case of a 70-year-old woman who developed life-threatening arrhythmia as a result of acute and severe hypokalaemia, which she developed after consuming large quantities of a liquorice-rich herb tea. She had no previous heart condition. We also discuss the legislative discrepancy in both the USA and in Europe, whereby consumers are warned about the risk of chronic hypertension whenever they buy a product containing liquorice, yet the risk of hypokalaemia may not be mentioned at all.
