•L’insuffisance rénale est très fréquente en transplantation hépatique.•Elle impacte la morbi-mortalité en pré- et post-greffe hépatique.•La stratification du risque d’insuffisance rénale pour chaque ...patient est nécessaire.•Des mesures de prévention doivent être mises en place précocement.•La greffe combinée foie–rein doit être restreinte à certains patients ciblés.
L’insuffisance rénale concerne plus d’un tiers des patients cirrhotiques. Elle est d’origine multifactorielle et impacte fortement la morbi-mortalité de ces patients avant, mais également après, transplantation hépatique. L’amélioration de la fonction rénale en post-greffe n’est pas systématique et les transplantés hépatiques ont un risque accru de maladie rénale chronique à plus ou moins court terme. Les étiologies responsables de la dégradation de la fonction rénale sont nombreuses et se regroupent en facteurs préopératoires, comme la fonction rénale du jour de la greffe, en facteurs peropératoires et postopératoires. À l’heure actuelle, aucun consensus n’est admis sur les modalités d’évaluation du risque comme sur la prévention de l’insuffisance rénale chronique en post-transplantation. Nous proposons, dans ce travail, une revue de la littérature sur le devenir de la fonction rénale en post-greffe et les facteurs pronostiques d’insuffisance rénale chronique afin de déterminer une stratification du risque pour chaque patient. Dans un second temps, nous développons les options thérapeutiques actuelles pour prévenir au mieux la dégradation de la fonction rénale chez ces patients, et nous discutons les indications d’une greffe combinée foie–rein.
One third of cirrhotic patients present impaired kidney function. It has multifactorial causes and has a harmful effect on patients’ morbi-mortality before and after liver transplant. Kidney function does not improve in all patients after liver transplantation and liver-transplant recipients are at high risk of developing chronic kidney disease. Causes for renal dysfunction can be divided in three groups: preoperative, peroperative and postoperative factors. To date, there is no consensus for the modality of evaluation the risk for chronic kidney disease after liver transplantation, and for its prevention. In the present review, we describe the outcome of kidney function after liver transplantation, and the prognostic factors of chronic kidney disease to determine a risk stratification for each patient. Furthermore, we discuss therapeutic options to prevent kidney dysfunction in this setting, and highlight the indications of combined liver-kidney transplantation.
Abstract only
Formation of kidney stone affects approximately 1 in 11 people in the U.S., and it can develop into various adverse renal outcomes. Although American Urological Association guideline ...recommends having at least 2.5 L of urine daily by having a high fluid intake to reduce 50% of recurrence rate in stone formers, few studies have evaluated the association between urine concentration as a marker of hydration status and the risk of kidney stone formation.
PURPOSE
To identify the threshold of optimal hydration in order to classify patients as high risk for kidney stone formation.
METHODS
Total of 302 subjects from Southern France with a history of recurrent kidney stones were retrospectively included in the study (female: 40.4 %, age: 46±14 y, BMI: 25.3±5.0 kg·m
−2
). Tiselius calcium oxalate crystallization risk index (CRI) was calculated based on urinary calcium (6.42±3.60 mmol·24h
−1
), oxalate (0.36±0.14 mmol·24h
−1
), citrate (32.0±17.5 mmol·24h
−1
), and magnesium (4.31±1.74 mmol·24h
−1
) from 24 h samples. The ability of 24 h urine osmolality to classify patients as high risk for kidney stone crystallization was examined through the receiver operating characteristic (ROC) curve analysis. High risk for kidney stones crystallization was defined as CRI >1.61 and >1.18, for males and females, respectively. The correlation coefficient was also examined between 24 h urine osmolality (538±198 mOsm·kg
−1
) and 24 h urine volume (1,948±823 mL·24h
−1
) and 24 h CRI (1.23±0.71).
RESULTS
The overall accuracy for diagnosing high risk of stone formation (AUC, area under the curve) was 84.9%, with threshold of 577 mmol·kg
−1
(sensitivity: 78.4%, specificity: 81.6%) for the entire sample. When data where analyzed by gender, AUC for females was 84.6%, with cut‐off point of 501 mmol·kg
−1
(sensitivity: 83.3%, specificity: 76.0%). Males had AUC of 85.8% with thresholf of 577 mmol·kg
−1
(sensitivity: 85.5%, specificity: 77.6%). A moderate negative association was found between urine volume and urine osmolality (
r
=−0.632,
P
<0.05). Also a moderate but positive association was found between 24 h urine osmolality and Tiselius CRI index (
r
=0.638,
P
<0.05).
CONCLUSION
Urine osmolality >501 and >577 mmol·kg
−1
was assosicated with greater risk for kidney stone formation in patiens with history of recurrent kidney stone.
One third of cirrhotic patients present impaired kidney function. It has multifactorial causes and has a harmful effect on patients' morbi-mortality before and after liver transplant. Kidney function ...does not improve in all patients after liver transplantation and liver-transplant recipients are at high risk of developing chronic kidney disease. Causes for renal dysfunction can be divided in three groups: preoperative, peroperative and postoperative factors. To date, there is no consensus for the modality of evaluation the risk for chronic kidney disease after liver transplantation, and for its prevention. In the present review, we describe the outcome of kidney function after liver transplantation, and the prognostic factors of chronic kidney disease to determine a risk stratification for each patient. Furthermore, we discuss therapeutic options to prevent kidney dysfunction in this setting, and highlight the indications of combined liver-kidney transplantation.
Objective To compare the performance of the main methods used to estimate stone burden in order to improve and standardize preoperative evaluation of stone disease. Methods From January 2012 to June ...2013, a series of consecutive retrograde intrarenal stone surgery was prospectively evaluated at a single institute. All patients had a pre- and postoperative CT scan. The stone burden was estimated using 3 methods: the cumulative stone diameter (M1), Ackermann's formula (M2), and the sphere formula (M3). The predictive value of the postoperative stone-free status of these methods was then compared. Results Overall (n = 142), the stone-free rate was 64%. The three methods (M1, M2, and M3) were all predictive of stone-free status for stones <20 mm ( P = .0076, .018, and .016, respectively). However, only M2 and M3 were significant for stones >20 mm ( P = .0024 and .023). Using receiver operating characteristic curves, we found that areas under the curve were 0.73, 0.70, and 0.71 for stones below 20 mm and 0.53, 0.74, and 0.74 for stones above 20 mm for M1, M2, and M3, respectively. In multivariate analysis, M1 and M3 were both found to be independently associated with the stone-free status in the whole series ( P <.001 and .011, respectively). However, for stones above 20 mm, only M3 was significant ( P = .020). Conclusion Evaluation of the stone burden is an important predictor of the outcome of retrograde intrarenal stone surgery. For stones below 20 mm, all the three methods approximate stone burden correctly; however, for the stones above 20 mm, calculation of volume is recommended.
Objective
Familial hypocalciuric hypercalcaemia type 1 (FHH1), related to heterozygous loss‐of‐function mutations of the calcium‐sensing receptor gene, is the main differential diagnosis for primary ...hyperparathyroidism. The aim of our study was to describe clinical characteristics of adult patients living in France with a genetically confirmed FHH1.
Design and patients
This observational, retrospective, multicentre study included 77 adults, followed up in 32 clinical departments in France, with a genetic FHH1 diagnosis between 2001 and 2012.
Results
Hypercalcaemia was diagnosed at a median age of 53 years IQR: 38‐61. The diagnosis was made after clinical manifestations, routine analysis or familial screening in 56, 34 and 10% of cases, respectively, (n = 58; data not available for 19 patients). Chondrocalcinosis was present in 11/51 patients (22%), bone fractures in 8/56 (14%) and renal colic in 6/55 (11%). The median serum calcium was 2.74 mmol/L IQR: 2.63‐2.86 mmol/L, the median plasma parathyroid hormone level was 4.9 pmol/L 3.1‐7.1, and the median 24‐hour urinary calcium excretion was 2.8 mmol/24 hours IQR: 1.9‐4.0. Osteoporosis (dual X‐ray absorptiometry) or kidney stones (renal ultrasonography) were found in 6/38 patients (16%) and 9/32 patients (28%), respectively. Fourteen patients (18%) underwent parathyroid surgery; parathyroid adenoma was found in three patients (21%) and parathyroid hyperplasia in nine patients (64%). No correlation between genotype and phenotype was established.
Conclusion
This large cohort study demonstrates that FHH1 clinical characteristics can be atypical in 33 patients (43%). Clinicians should be aware of this rare differential diagnosis in order to adopt an appropriate treatment strategy.
Murine unilateral ureteral obstruction (UUO), a major model of progressive kidney disease, causes loss of proximal tubular mass and formation of atubular glomeruli. Adult C57BL/6 mice underwent a ...sham operation or reversible UUO under anesthesia. In group 1, kidneys were harvested after 7 days. In group 2, the obstruction was released after 7 days, and a physiological study of both kidneys was performed 30 days later. Renal blood flow (RBF), glomerular filtration rate (GFR), urine protein, and albumin excretion were measured after ligation of either the left or right ureter. Glomerular volume (periodic acid-Schiff), glomerulotubular integrity and proximal tubular mass (Lotus tetragonolobus lectin), and interstitial collagen (Sirius red) were measured by histomorphometry. Obstructed kidney weight was reduced by 15% at 7 days but was not different from sham after a 30-day recovery. Glomerular volume and proximal tubular area of the obstructed kidney were reduced by 55% at 7 days, but normalized after 30 days. Interstitial collagen deposition increased 2.4-fold after 7 days of UUO and normalized after release. However, GFR and RBF were reduced by 40% and urine albumin/protein ratio was increased 2.8-fold 30 days after release of UUO. This was associated with a 50% reduction in glomerulotubular integrity despite a 30-day recovery (P < 0.05 for all data). We conclude that release of 7-day UUO can arrest progression but does not restore normal function of the postobstructed kidney. Although the remaining intact nephrons have hypertrophied, glomerular injury is revealed by albuminuria. These results suggest that glomerulotubular injury should become the primary target of slowing progressive kidney disease.
Our aim was to investigate the validity of osmolality from 24-h urine collection in examining the risk for calcium-oxalate (CaOx) kidney stone formation in patients with recurrent urolithiasis. Three ...hundred and twelve subjects (males/females: 184/128) from France with a history of recurrent kidney stones from confirmed or putative CaOx origin were retrospectively included in the study (46 ± 14 years, BMI: 25.3 ± 5.0 kg·m
−2
). Tiselius’ crystallization risk index (CRI) was calculated based on urinary calcium, oxalate, citrate, magnesium, and volume from 24-h samples. The diagnostic ability of 24-h urine osmolality to classify patients as high risk for kidney stone crystallization was examined through the receivers operating characteristics analysis. High risk for CaOx crystallization was defined as CRI > 1.61 and > 1.18, for males and females, respectively. The accuracy of urine osmolality to diagnose risk of CaOx stone formation (AUC, area under the curve) for females was 84.6%, with cut-off point of 501 mmol·kg
−1
(sensitivity: 83.3%, specificity: 76.0%). Males had AUC of 85.8% with threshold of 577 mmo·kg
−1
(sensitivity: 85.5%, specificity: 77.6%). A negative association was found between 24-h urine volume and osmolality (
r
= − 0.63,
P
< 0.001). Also, a positive association was found between 24-h urine osmolality and CRI (
r
= 0.65,
P
< 0.001), as well as urea excretion with CRI (
r
= 0.37,
P
< 0.001). In conclusion, urine osmolality > 501 and > 577 mmol·kg
−1
, in female and in male, respectively, was associated with a risk for CaOx kidney stone formation in patients with a history of recurrent urolithiasis. Thus, when CaOx origin is confirmed or suspected, 24-h urine osmolality provides a simple way to define individualized target of urine dilution to prevent urine crystallization and stone formation.
Introduction
Although living kidney donation is not a high-risk surgery, there is still a need to identify situations at risk of kidney disease after uninephrectomy. Estrogens exhibit a protective ...role against various nephropathies. The aim of this study was to assess renal adaptation following nephrectomy according to menopausal status in women.
Methods
A prospective bicentric study including living women donors measured glomerular filtration rate (GFR) (inulin or
51−
Cr-EDTA clearances) and kidney volume (using CT-scan and 3-dimensional reconstruction), before and after 1-year post-uninephrectomy. Renal adaptation was compared according to menopausal status.
Results
Sixteen non-menopausal women and 18 menopausal women were included. One year following uninephrectomy, the mean decrease in GFR (global population) was − 32 ± 12 ml/min/1.73 m
2
, and the mean increase in remnant kidney volume was + 32 ± 13 cm
3
/1.73 m
2
. No significant difference was observed between the two groups for both the decrease in GFR (-32.9 ± 13.3 in non-menopausal vs − 31.5 ± 9.9 in menopausal, ml/min/1.73 m
2
,
p
= 0.84), and the increase in kidney volume (+ 36.1 ± 13.4 in non-menopausal vs + 28.1 ± 12.5 in menopausal, cm
3
/1.73 m
2
,
p
= 0.09).
Discussion
Menopausal status did not influence kidney adaptation following uninephrectomy, and in this respect is not a potential limiting factor for living kidney donation.
Graphic abstract
PDF
