[Anticoagulation in patients with chronic renal failure]. / Anticoagulation chez l'insuffisant rénal.

Anticoagulation may be difficult to implement in patients suffering from chronic renal failure on account of platelet disorders and impaired clearance of some anticoagulant drugs. Although no adjustment of heparin and coumarin dosage is necessary, more frequent testing of coagulation pathways may be required when these drugs are used in patients with renal failure. Long-term use of LMWH should be implemented cautiously with regular testing of anti-factor Xa activity and a half-dose may be advocated in patients with a creatinine clearance < 30 ml/mn. Danaparoid and thrombin inhibitors should be used mainly in patients suffering from renal failure and heparin-induced thrombocytopenia with regular monitoring of coagulation tests.

[BMP-7 (Bone morphogenetic protein-7): a future treatment for chronic renal failure?]. / La Bone Morphogenic Protein 7 (BMP-7): un espoir dans te traitement de l'insuffisance renale chronique.

Renal fibrosis is an evolutive process frequently leading to end stage renal failure. Several studies have demonstrated the dominant and mutually antagonistic roles of two proteins from the transforming growth factor superfamily. BMP-7 has a protective effect on the kidney, by decreasing apoptosis, maintaining and restoring the epithelial phenotype and dysplaying anti-fibrotic activity. The mechanisms through which TGF beta 1 favours fibrosis are still unclear, although most of its activity appears to be due to antagonism of the effects of BMP-7. Animal studies are very encouraging, as exogenous BMP-7 has allowed stabilisation and even regression of renal fibrosis with a concomitant stabilisation or improvement of renal function. The therapeutic implications of these findings are promising.