Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur...Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur hospital of Chartres. Patients and Methods: We carried a retrospective study of patients treated for myeloma-related hypercalcemia between January 1, 2019 to December 31, 2021. The clinical, paraclinical, therapeutic and evolutive characteristics were studied. Results: Eight patients were included in this study with a median age of 67 years [41 - 85] and a sex ratio (M/F) of 1. A quarter of patients were known with chronic kidney disease. Four patients (50%) had symptoms of hypercalcemia. Biologically, the mean hemoglobin was 9.8 ± 2.7 g/dl, all patients had an acute kidney injury with a mean creatinine level of 364.1 ± 173.3 mmol/l, a mean serum calcium of 3.42 ± 0.59 mmol/l and three quarter of patients had bone lesions. Five patients (62.5%) were rehydrated with a mean volume of saline of 2700 ± 836.7 ml/24h. Seven patients (87.5%) received biphosphonates and none received diuretics. The mean normalization time of the serum calcium was 5 days. Conclusion: Hypercalcemia is frequent in malignancy and represents a poor prognosis factor of the disease. A well-conducted therapeutic strategy allows rapid normalization.展开更多
The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of s...The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.展开更多
Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hype...Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hyperalgesic ischemic skin lesions. Several risk factors have been identified, mainly warfarin treatment, mineral and bone disorders (MBD), inflammation and malnutrition. In the evocative forms, the diagnosis is made based upon the physical examination finding of classic painful ulcerated lesions that are covered by a black eschar. Skin biopsy, due to the risk of aggravation and delayed healing, is only performed in case of doubt diagnosis. The therapeutic attitude due to the lack of solid randomized studies is based on expert consensus and requires a multidisciplinary approach. We report here the case of a patient with CUA revealed in the form of multiple ulcerative-necrotic skin lesions associated with pressure sores and arterial wounds.展开更多
Introduction: Multiple myeloma is a haematological malignancy characterised by monoclonal plasma cell proliferation in the bone marrow, which synthesises a serum and/or urinary monoclonal protein, associated with one ...Introduction: Multiple myeloma is a haematological malignancy characterised by monoclonal plasma cell proliferation in the bone marrow, which synthesises a serum and/or urinary monoclonal protein, associated with one or more manifestations including (anaemia, hypercalcaemia, bone lesions, renal failure). The aim of our work was to determine the prevalence, clinico-biological, histological and therapeutic manifestations of renal damage during multiple myeloma. Methodology: This is a retrospective descriptive study spread over a period of 2 years from 01 January 2020 to 31 December 2021 carried out in the nephrology department of the louis pasteur hospital of the CH of Chartres. All patients treated for multiple myeloma with renal involvement were included, whether the renal involvement was revelatory or diagnosed during the follow-up of the multiple myeloma. Results: We collected 20 cases of myeloma. Renal involvement was present in 19 cases (95%). The mean age was 68.78 ± 10.77 years with extremes ranging from 44 to 82 years. Males were more prevalent, with an M/F sex ratio of 3.75. The most common antecedent condition was hypertension in 14 cases (73.7%) and diabetes in 4 cases (21.1%). The circumstances of discovery were renal failure in 16 cases (84.2%), followed by bone pain in 6 cases (31.6%). Renal involvement was dominated by renal failure in 18 cases (94.7%), hypercalcaemia in 14 cases (73.7%), para protein in 9 cases (47.4%), haematuria and leukocyturia in 5 cases (26.3%). On plasma protein electrophoresis, 11 cases (57.9%) had kappa light chain multiple myeloma, 8 cases (42.1%) had lambda light chain multiple myeloma. We noted 9 cases (69%) of myelomatous cylinder nephropathy at renal biopsy, Randall’s disease in 2 cases (15%), AL amyloidosis and acute tubular necrosis in 1 case (8%). First-line chemotherapy treatment was dominated by the combination of Velcade, cyclophosphamide and dexamethasone in 5 cases (79%). Conclusion: Renal involvement in myeloma is still common;it may be isolated and precede the first signs of myeloma by several months;the most common histological forms are myelomatous cylinder nephropathy and Randall’s disease.展开更多
文摘Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur hospital of Chartres. Patients and Methods: We carried a retrospective study of patients treated for myeloma-related hypercalcemia between January 1, 2019 to December 31, 2021. The clinical, paraclinical, therapeutic and evolutive characteristics were studied. Results: Eight patients were included in this study with a median age of 67 years [41 - 85] and a sex ratio (M/F) of 1. A quarter of patients were known with chronic kidney disease. Four patients (50%) had symptoms of hypercalcemia. Biologically, the mean hemoglobin was 9.8 ± 2.7 g/dl, all patients had an acute kidney injury with a mean creatinine level of 364.1 ± 173.3 mmol/l, a mean serum calcium of 3.42 ± 0.59 mmol/l and three quarter of patients had bone lesions. Five patients (62.5%) were rehydrated with a mean volume of saline of 2700 ± 836.7 ml/24h. Seven patients (87.5%) received biphosphonates and none received diuretics. The mean normalization time of the serum calcium was 5 days. Conclusion: Hypercalcemia is frequent in malignancy and represents a poor prognosis factor of the disease. A well-conducted therapeutic strategy allows rapid normalization.
文摘The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.
文摘Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hyperalgesic ischemic skin lesions. Several risk factors have been identified, mainly warfarin treatment, mineral and bone disorders (MBD), inflammation and malnutrition. In the evocative forms, the diagnosis is made based upon the physical examination finding of classic painful ulcerated lesions that are covered by a black eschar. Skin biopsy, due to the risk of aggravation and delayed healing, is only performed in case of doubt diagnosis. The therapeutic attitude due to the lack of solid randomized studies is based on expert consensus and requires a multidisciplinary approach. We report here the case of a patient with CUA revealed in the form of multiple ulcerative-necrotic skin lesions associated with pressure sores and arterial wounds.
文摘Introduction: Multiple myeloma is a haematological malignancy characterised by monoclonal plasma cell proliferation in the bone marrow, which synthesises a serum and/or urinary monoclonal protein, associated with one or more manifestations including (anaemia, hypercalcaemia, bone lesions, renal failure). The aim of our work was to determine the prevalence, clinico-biological, histological and therapeutic manifestations of renal damage during multiple myeloma. Methodology: This is a retrospective descriptive study spread over a period of 2 years from 01 January 2020 to 31 December 2021 carried out in the nephrology department of the louis pasteur hospital of the CH of Chartres. All patients treated for multiple myeloma with renal involvement were included, whether the renal involvement was revelatory or diagnosed during the follow-up of the multiple myeloma. Results: We collected 20 cases of myeloma. Renal involvement was present in 19 cases (95%). The mean age was 68.78 ± 10.77 years with extremes ranging from 44 to 82 years. Males were more prevalent, with an M/F sex ratio of 3.75. The most common antecedent condition was hypertension in 14 cases (73.7%) and diabetes in 4 cases (21.1%). The circumstances of discovery were renal failure in 16 cases (84.2%), followed by bone pain in 6 cases (31.6%). Renal involvement was dominated by renal failure in 18 cases (94.7%), hypercalcaemia in 14 cases (73.7%), para protein in 9 cases (47.4%), haematuria and leukocyturia in 5 cases (26.3%). On plasma protein electrophoresis, 11 cases (57.9%) had kappa light chain multiple myeloma, 8 cases (42.1%) had lambda light chain multiple myeloma. We noted 9 cases (69%) of myelomatous cylinder nephropathy at renal biopsy, Randall’s disease in 2 cases (15%), AL amyloidosis and acute tubular necrosis in 1 case (8%). First-line chemotherapy treatment was dominated by the combination of Velcade, cyclophosphamide and dexamethasone in 5 cases (79%). Conclusion: Renal involvement in myeloma is still common;it may be isolated and precede the first signs of myeloma by several months;the most common histological forms are myelomatous cylinder nephropathy and Randall’s disease.
