[Focusing on peritoneal dialysis adequacy]. / Adéquation en dialyse péritonéale : mise au point.

The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane.

[Drug-induced renal insufficiency. Results of consensus meetings]. / Les insuffisances rénales d'origine médicamenteuse. Résultats de réunions de consensus.

We report the conclusions of consensus meetings organized by the "Direction de la Pharmacovigilance" of Roussel Uclaf, and attended by University Hospital Nephrologists, members of the National Network of Pharmacovigilance and representatives of Roussel Uclaf Drug Monitoring Department, in order to define more accurately, as regards drug-induced renal failure, the criteria and the terminology proposed by the French method of causality assessment of adverse drug reactions.

Bartter's syndrome with normal chloride reabsorption during indomethacin treatment.

A 17-year-old male patient with Bartter's syndrome was admitted for renal function studies. This patient had persistent hypokalemia, first found at age 5; the diagnosis of Bartter's syndrome with renal hypersecretion of prostaglandins E2 and F2 alpha had been established at age 13. A congenital defect of chloride reabsorption was expected, but after 4 years of indomethacin treatment no such defect was found. Withdrawal of indomethacin for 1 week resulted in profound hypokalemia and the appearance of a chloride reabsorption defect, with an excessive urinary PGE2 and PGF2 alpha excretion, and a parallel decrease in plasma prostaglandin precursors. The cause of Bartter's syndrome in this patient seems to be renal hyperprostaglandinism.

Piridoxilate-associated nephrocalcinosis: a new form of chronic oxalate nephropathy.

Piridoxilate is an association of glyoxylic acid and pyridoxine in which pyridoxine is supposed to facilitate in vivo transformation of glyoxylic acid to glycine rather than to oxalic acid. However, it has recently been shown that long-term treatment with piridoxilate may result in overproduction of oxalic acid and in calcium oxalate nephrolithiasis. We report a patient in whom piridoxilate induced both oxalate nephrolithiasis and chronic oxalate nephropathy with renal insufficiency, an association that has not been previously described. Therefore, piridoxilate should be added to the list of chemicals responsible for chronic oxalate nephropathy.

[Interstitial nephropathies induced by meticillin: demonstration of distal tubule functional anomalies]. / Néphropathies interstitielles provoquées par la méticilline: mise en évidence d'anomalies fonctionnelles tubulaires distales.

Renal tubular dysfunction was investigated in two patients with meticillin-induced interstitial nephritis. Some degree of renal failure persisted after the acute episode in both cases. The first patient was investigated 10 weeks after the onset of the nephropathy. Nephrogenic diabetes insipidus and distal tubular acidosis were demonstrated. The second patient was investigated 7 months after the onset of the nephropathy. A major impairment in urinary concentration ability was demonstrated. Neither patient had proximal tubular dysfunction. These data show that meticillin-induced interstitial nephritis may be responsible for distal tubular abnormalities, namely nephrogenic diabetes insipidus and distal tubular acidosis, which may persist long after the onset of the nephropathy.

Prophylactic use of OKT3 monoclonal antibody in cadaver kidney recipients. Utilization of OKT3 as the sole immunosuppressive agent.

We describe the first clinical trial of OKT3, a monoclonal anti-T-cell antibody, for prevention of kidney transplant rejection. 13 patients receiving a first cadaveric kidney transplant were randomly assigned to conventional treatment with azathioprine and high-dose steroids (7 patients) or to treatment with daily injection of OKT3 alone (6 patients). The first OKT3 injection resulted in a dramatic decrease in T3+, T4+, and T8+ cells, while patients simultaneously experienced fever, chills, and diarrhea. These symptoms did not recur with subsequent injections. All six OKT3-treated patients had a rejection necessitating introduction of steroids 12.8 +/- 2.9 days after surgery. Rejection was related to appearance of anti-OKT3 antibodies leading to disappearance of detectable OKT3 in the serum. Modulating (T3-, T4+ or T3-, T8+) cells were observed in all patients but were functionally inactive. As no rejection was observed before day 9 posttransplant, despite the lack of additional immunosuppressive agents, we conclude that OKT3 is a powerful, well-tolerated immunosuppressive agent. However, it is highly immunogenic and anti-OKT3 antibodies lead to loss of clinical effectiveness in this protocol. The use of OKT3 alone for prevention of kidney graft rejection cannot be recommended until a method for reducing the effects of anti-OKT3 immunization is developed.

[Late epilepsy in cerebral cysticercosis. 2 cases confirmed by tomodensitometry]. / Epilepsie tardive de la cysticercose cérébrale. Deux cas affirmés par tomodensitométrie.

Invasion of the central nervous system by the larvae of Tenia Solium classically leads to severe illness. In some instances, however, the course is protracted and benign. The authors report on two patients with cysticercosis cerebri, revealed by delayed seizures without cerebral hypertension or any other manifestation. Computerized tomography established the diagnosis by demonstrating calcifications disseminated throughout the cerebral parenchyma. Such calcifications result from encapsulation of dead larvae. The possible diversity of the anatomic lesions caused directly or indirectly by the parasite explains why clinical manifestations are polymorphic. Diagnostic procedures are discussed.

[Biermer's disease without anemia, nor megaloblastosis. Value of the study of antibodies, vitamin assays, and the dU suppression test for the early diagnosis]. / Maladie de Biermer sans anémie, ni mégaloblastose. Intérêt de la recherche des anticorps, des dosages vitaminiques, et du test de dU suppression pour le diagnostic précoce.

In two patients, a diagnosis of pernicious anemia was made without anemia, megaloblastosis and even macrocytosis. The diagnosis of pernicious anemia was suggested by the autoimmune abnormalities which are frequently associated with this disease: goitre with anti-thyroid and anti parietal cell antibodies, and besides this, idiopathic thrombocytopenic purpura in the first patient, vitiligo in the second. The morphological abnormalities were limited to slight macrocytosis in the first patient and to hypersegmentation of polymorphonuclear leucocyte in both. Vitamin B12 deficiency was demonstrated by serum assay as well as deoxyuridine suppression test ("dU suppression"). The diagnosis was confirmed by demonstration of atrophic gastritis, failure of secretion of Intrinsic Factor and Schilling test. These observations show that the Addison-Biermer disease can be detected early in persons at high risk by looking for vitamin B12 deficiency and specific antibodies.