ABSTRACT La fréquence de l’insuffisance rénale chez les patients atteints de cancer n‘est pas pré... more ABSTRACT La fréquence de l’insuffisance rénale chez les patients atteints de cancer n‘est pas précisément définie. Trois-cent seize patients ont été inclus sur une période d’un mois, indépendamment de leur pathologie (outre leur cancer), de leur traitement, ou de tout autre critère. L’estimation de la fonction rénale par le calcul de la clairance de la créatinine avec la formule de Cockcroft et Gault a montré que 28 % des patients avaient un débit de filtration glomérulaire estimé de moins de 80 mL/min. Pour 23 % d’entre-eux la clairance de la créatinine était comprise entre 80 et 50 mL/min et elle était inférieure à 50 mL/min pour 5 % d’entre eux. L’insuffisance rénale est donc fréquente chez les patients atteints de cancer puisque presque un tiers de ces patients présente une insuffisance rénale. Par ailleurs, la disponibilité de l’information relative à l’adaptation de la posologie des médicaments anticancéreux chez les patients insuffisants rénaux a été évaluée pour les 10 médicaments les plus prescrits aux patients de l’étude. Seuls les RCP de 1 et de 2 médicaments dans le Vidal® et le Physicians Desk Reference® respectivement donnent une information complète à ce sujet d’où l’intérêt de se reporter à d’autres sources bibliographiques pour obtenir cette information.
Chronic kidney disease is a progressive disease which has become a real public health issue. In p... more Chronic kidney disease is a progressive disease which has become a real public health issue. In patients with renal disease, drugs pharmacokinetics may be altered. The handling of drugs requires a special attention in these patients. Indeed, there is a risk of accumulation and drug overdose if dosage is not adjusted to the stage of renal insufficiency. Thus, to achieve a dosage adjustment knowing how to evaluate renal function is absolutely necessary. Different formulae are available including the Cockcroft and Gault formula aMDRD and CKD-EPI. In patients with cardiac issues, it appears that the CKD-EPI formula is that of choice in terms of clinical risk stratification. However, some summaries of product characteristics (SmPC) of drugs used in cardiology, such as Dabigatran(®), mention the need to use the Cockcroft-Gault, less accurate than aMDRD and CKD-EPI, in order to adjust the dose in patients with impaired renal function. Standardization of recommendations is necessary to limi...
Renal insufficiency is a common disease, in the general population as well as in some specific di... more Renal insufficiency is a common disease, in the general population as well as in some specific diseases such as HIV infection or cancer. The vast majority of medicines require a dosage adjustment in case of renal dysfunction, it is thus of a crucial importance to know how to evaluate appropriately renal function, on one hand, but also to have access to reliable information sources on how to handle the drugs in such cases. Most often, the Summary of Drug Characteristics (SmPC) only provides partial information, which may even be false in some cases as compared to the most recent data from the literature. However, some information sources exist, reliable, updated, and easily accessible.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2006
We report the case of an association of IgA nephropathy and tuberculosis with superimposed vascul... more We report the case of an association of IgA nephropathy and tuberculosis with superimposed vasculitis lesions on the renal biopsy. Three previous cases of the same association are discussed. The nephropathy had a favorable course in all of these cases on antituberculous treatment only. Tuberculosis is another infection related to IgA nephropathy.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2005
PPAR-gamma ligands, including thiazolidinediones, have recently become clinically available for t... more PPAR-gamma ligands, including thiazolidinediones, have recently become clinically available for treating insulin-resistant diabetes mellitus. Accumulating evidence suggests that these drugs not only significantly improve insulin sensitivity but also may have antiproteinuric effects in genetically obese diabetic rodents and patients with type II diabetes and diabetic nephropathy. Moreover, troglitazone reduced expression of ECM proteins and transforming growth factor-beta in glomeruli from streptozotocin-induced diabetic rats. Many other properties including antiproteinuric, hemodynamic, and antihypertensive effects in insulin-dependent diabetes mellitus suggest that PPAR-gamma ligands might have a direct, beneficial renal effect, independent of their capacity to improve glucose tolerance. Besides their antidiabetic effects, thiazolidinediones have been shown to lower blood pressure in diabetic patients with hypertension and patients with diabetic nephropathy through multiple mechani...
PPARgamma nuclear receptors are mainly expressed in adipose tissue. However, they are also expres... more PPARgamma nuclear receptors are mainly expressed in adipose tissue. However, they are also expressed in renal glomerular tissue and in vascular walls, thus participating through various and complex mechanisms, to glomerular and vascular sclerosis and to nephropathy development and progression. Studies carried out with glitazones, pharmacological agonists of nuclear receptor PPARgamma, in experimental models, either in vitro, or in vivo in animal models, have demonstrated their favourable effects on arterial blood pressure and on prevention and/or progression of diabetic nephropathy. The few clinical studies conducted in type 2 diabetic patients to assess these effects, are also in favor of a beneficial effect of glitazones on blood pressure and nephropathy in these patients. Thus, it appears extremely important and fully justified to conduct specific studies in patients with type 2 diabetes, with the aim to establish and to better characterize these effects in various clinical condi...
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2003
HIV patients are at a high risk for nephrotoxicity (HIV-induced nephrotoxicity, HIVAN). As a resu... more HIV patients are at a high risk for nephrotoxicity (HIV-induced nephrotoxicity, HIVAN). As a result, renal insufficiency, tubular dysfunction and renal-related biological disorders are frequently observed in those patients. However, in some cases those defects or anomalies in renal function may be related to antiviral therapies rather than the disease itself. This article reviews the incidence, presentation, prevention and management of antiviral drug-induced renal dysfunction.
Résumé: Les multiples modifications pathophysiologiques secondaires à l’insuffisance rénale entra... more Résumé: Les multiples modifications pathophysiologiques secondaires à l’insuffisance rénale entraînent des modifications du profil pharmacocinétique des médicaments en agissant sur l’absorption, la distribution et l’élimination des principes actifs. Des modifications de la pharmacodynamie des médicaments ont également été mises en évidence. Nous ne traiterons ici que des modifications pharmacocinétiques liées à l’insuffisance rénale. Le but de cet article est de
Background: Abacavir is a potent, novel 2′-deoxyguanosine analogue reverse transcriptase inhibito... more Background: Abacavir is a potent, novel 2′-deoxyguanosine analogue reverse transcriptase inhibitor (NRTI) which effectively suppresses HIV-1 replication. To date, there is no pharmacokinetic study in patients with renal impairment. Methods: Five HIV-1-infected patients with various degrees of renal dysfunction (creatinine clearance 60, 40, 25, 20 and 1 haemodialyzed patient) were evaluated after being treated for at least 2 months with multi-antiretroviral therapy including abacavir. After an overnight fast, the subjects received their abacavir dosage (600 or 300 mg). Blood samples were withdrawn and plasma concentrations determined. A nonparametric pharmacokinetic analysis was then performed. The dialysability of abacavir was also evaluated. Results: Time of maximum plasma concentration (Tmax) was constant among the subjects with a mean value of 0.7 ± 0.27 h (range 0.33–1). Maximum plasma concentration (Cmax) ranged from 2.76 to 4.15 mg/l (mean 3.44 ± 0.59). The elimination half-li...
Contrast medium (CM)-induced nephropathy (CIN), defined as acute renal failure after administrati... more Contrast medium (CM)-induced nephropathy (CIN), defined as acute renal failure after administration of CM when alternative causes of renal damage have been excluded, is the third leading cause of acute renal injury necessitating hospitalization. However, the pathophysiology of CIN is complex and not fully understood. Gadolinium chelates, originally introduced as intravenous CM for magnetic resonance imaging and regarded as nonnephrotoxic, have been recommended to replace iodinated contrast agents in patients at risk for acute renal failure. Since then, some gadolinium-based CM have been reported to be associated with CIN, especially in patients with advanced renal disease. However, the biochemical and physicochemical properties of the gadolinium-chelates that are responsible for such nephrotoxicity have not been clearly defined, and the issue of gadolinium-induced nephrotoxicity remains controversial. This review surveys the literature with the purpose of clarifying the renal effects of gadolinium-based CM in patients with renal insufficiency.
ABSTRACT La fréquence de l’insuffisance rénale chez les patients atteints de cancer n‘est pas pré... more ABSTRACT La fréquence de l’insuffisance rénale chez les patients atteints de cancer n‘est pas précisément définie. Trois-cent seize patients ont été inclus sur une période d’un mois, indépendamment de leur pathologie (outre leur cancer), de leur traitement, ou de tout autre critère. L’estimation de la fonction rénale par le calcul de la clairance de la créatinine avec la formule de Cockcroft et Gault a montré que 28 % des patients avaient un débit de filtration glomérulaire estimé de moins de 80 mL/min. Pour 23 % d’entre-eux la clairance de la créatinine était comprise entre 80 et 50 mL/min et elle était inférieure à 50 mL/min pour 5 % d’entre eux. L’insuffisance rénale est donc fréquente chez les patients atteints de cancer puisque presque un tiers de ces patients présente une insuffisance rénale. Par ailleurs, la disponibilité de l’information relative à l’adaptation de la posologie des médicaments anticancéreux chez les patients insuffisants rénaux a été évaluée pour les 10 médicaments les plus prescrits aux patients de l’étude. Seuls les RCP de 1 et de 2 médicaments dans le Vidal® et le Physicians Desk Reference® respectivement donnent une information complète à ce sujet d’où l’intérêt de se reporter à d’autres sources bibliographiques pour obtenir cette information.
Chronic kidney disease is a progressive disease which has become a real public health issue. In p... more Chronic kidney disease is a progressive disease which has become a real public health issue. In patients with renal disease, drugs pharmacokinetics may be altered. The handling of drugs requires a special attention in these patients. Indeed, there is a risk of accumulation and drug overdose if dosage is not adjusted to the stage of renal insufficiency. Thus, to achieve a dosage adjustment knowing how to evaluate renal function is absolutely necessary. Different formulae are available including the Cockcroft and Gault formula aMDRD and CKD-EPI. In patients with cardiac issues, it appears that the CKD-EPI formula is that of choice in terms of clinical risk stratification. However, some summaries of product characteristics (SmPC) of drugs used in cardiology, such as Dabigatran(®), mention the need to use the Cockcroft-Gault, less accurate than aMDRD and CKD-EPI, in order to adjust the dose in patients with impaired renal function. Standardization of recommendations is necessary to limi...
Renal insufficiency is a common disease, in the general population as well as in some specific di... more Renal insufficiency is a common disease, in the general population as well as in some specific diseases such as HIV infection or cancer. The vast majority of medicines require a dosage adjustment in case of renal dysfunction, it is thus of a crucial importance to know how to evaluate appropriately renal function, on one hand, but also to have access to reliable information sources on how to handle the drugs in such cases. Most often, the Summary of Drug Characteristics (SmPC) only provides partial information, which may even be false in some cases as compared to the most recent data from the literature. However, some information sources exist, reliable, updated, and easily accessible.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2006
We report the case of an association of IgA nephropathy and tuberculosis with superimposed vascul... more We report the case of an association of IgA nephropathy and tuberculosis with superimposed vasculitis lesions on the renal biopsy. Three previous cases of the same association are discussed. The nephropathy had a favorable course in all of these cases on antituberculous treatment only. Tuberculosis is another infection related to IgA nephropathy.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2005
PPAR-gamma ligands, including thiazolidinediones, have recently become clinically available for t... more PPAR-gamma ligands, including thiazolidinediones, have recently become clinically available for treating insulin-resistant diabetes mellitus. Accumulating evidence suggests that these drugs not only significantly improve insulin sensitivity but also may have antiproteinuric effects in genetically obese diabetic rodents and patients with type II diabetes and diabetic nephropathy. Moreover, troglitazone reduced expression of ECM proteins and transforming growth factor-beta in glomeruli from streptozotocin-induced diabetic rats. Many other properties including antiproteinuric, hemodynamic, and antihypertensive effects in insulin-dependent diabetes mellitus suggest that PPAR-gamma ligands might have a direct, beneficial renal effect, independent of their capacity to improve glucose tolerance. Besides their antidiabetic effects, thiazolidinediones have been shown to lower blood pressure in diabetic patients with hypertension and patients with diabetic nephropathy through multiple mechani...
PPARgamma nuclear receptors are mainly expressed in adipose tissue. However, they are also expres... more PPARgamma nuclear receptors are mainly expressed in adipose tissue. However, they are also expressed in renal glomerular tissue and in vascular walls, thus participating through various and complex mechanisms, to glomerular and vascular sclerosis and to nephropathy development and progression. Studies carried out with glitazones, pharmacological agonists of nuclear receptor PPARgamma, in experimental models, either in vitro, or in vivo in animal models, have demonstrated their favourable effects on arterial blood pressure and on prevention and/or progression of diabetic nephropathy. The few clinical studies conducted in type 2 diabetic patients to assess these effects, are also in favor of a beneficial effect of glitazones on blood pressure and nephropathy in these patients. Thus, it appears extremely important and fully justified to conduct specific studies in patients with type 2 diabetes, with the aim to establish and to better characterize these effects in various clinical condi...
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2003
HIV patients are at a high risk for nephrotoxicity (HIV-induced nephrotoxicity, HIVAN). As a resu... more HIV patients are at a high risk for nephrotoxicity (HIV-induced nephrotoxicity, HIVAN). As a result, renal insufficiency, tubular dysfunction and renal-related biological disorders are frequently observed in those patients. However, in some cases those defects or anomalies in renal function may be related to antiviral therapies rather than the disease itself. This article reviews the incidence, presentation, prevention and management of antiviral drug-induced renal dysfunction.
Résumé: Les multiples modifications pathophysiologiques secondaires à l’insuffisance rénale entra... more Résumé: Les multiples modifications pathophysiologiques secondaires à l’insuffisance rénale entraînent des modifications du profil pharmacocinétique des médicaments en agissant sur l’absorption, la distribution et l’élimination des principes actifs. Des modifications de la pharmacodynamie des médicaments ont également été mises en évidence. Nous ne traiterons ici que des modifications pharmacocinétiques liées à l’insuffisance rénale. Le but de cet article est de
Background: Abacavir is a potent, novel 2′-deoxyguanosine analogue reverse transcriptase inhibito... more Background: Abacavir is a potent, novel 2′-deoxyguanosine analogue reverse transcriptase inhibitor (NRTI) which effectively suppresses HIV-1 replication. To date, there is no pharmacokinetic study in patients with renal impairment. Methods: Five HIV-1-infected patients with various degrees of renal dysfunction (creatinine clearance 60, 40, 25, 20 and 1 haemodialyzed patient) were evaluated after being treated for at least 2 months with multi-antiretroviral therapy including abacavir. After an overnight fast, the subjects received their abacavir dosage (600 or 300 mg). Blood samples were withdrawn and plasma concentrations determined. A nonparametric pharmacokinetic analysis was then performed. The dialysability of abacavir was also evaluated. Results: Time of maximum plasma concentration (Tmax) was constant among the subjects with a mean value of 0.7 ± 0.27 h (range 0.33–1). Maximum plasma concentration (Cmax) ranged from 2.76 to 4.15 mg/l (mean 3.44 ± 0.59). The elimination half-li...
Contrast medium (CM)-induced nephropathy (CIN), defined as acute renal failure after administrati... more Contrast medium (CM)-induced nephropathy (CIN), defined as acute renal failure after administration of CM when alternative causes of renal damage have been excluded, is the third leading cause of acute renal injury necessitating hospitalization. However, the pathophysiology of CIN is complex and not fully understood. Gadolinium chelates, originally introduced as intravenous CM for magnetic resonance imaging and regarded as nonnephrotoxic, have been recommended to replace iodinated contrast agents in patients at risk for acute renal failure. Since then, some gadolinium-based CM have been reported to be associated with CIN, especially in patients with advanced renal disease. However, the biochemical and physicochemical properties of the gadolinium-chelates that are responsible for such nephrotoxicity have not been clearly defined, and the issue of gadolinium-induced nephrotoxicity remains controversial. This review surveys the literature with the purpose of clarifying the renal effects of gadolinium-based CM in patients with renal insufficiency.
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Papers by Gilbert Deray