Nephrology as a full-blown specialty was born in the middle of th 20th century with the advent of kidney replacement therapy. As regards knowledge of kidney diseases, decisive steps forward were introduction of percutaneous kidney biopsy (with examination by immunofluorescence staining and electron microscopy), as well as investigation of individual nephron function by micropuncture and more recently molecular biology techniques. As regards therapy, nephrology benefited the tremendous development of phamacology with the advent of diuretics, hypotensive agents and immunosuppressive drugs. But the revolution of the time was actually the invention of hemodialysis and peritoneal dialysis as well as the first success of kidney transplantation, allowing a rapidly growing number of patients worldwide to survive renal insufficiency for decades. Access to renal replacement therapy gave rise to novel ethical issues, which has been the foundation of medical bioethics.
The adult phenotype of tuberous sclerosis of Bourneville (TSB) differs from the typical triad, usually found in children, namely epilepsy, mental retardation, and cutaneous angiofibromas. Recurrent spontaneous pneumothorax episodes may thus be a clinical presentation, secondary to pulmonary cystic lesions present in 40% of TSB women. Based on a clinical case as illustration, we recall the diagnostic criteria of TSB and pulmonary lymphangiomyomatosis (LAM), along with recommendations for treatment and follow-up.
Louise Ghosez (1), Christian Davin (2), Karim Bochouari (3), David Guery (4), Isabelle Paris (4), Ides Colin (4), Pol Vincent (3)Published in the journal : January 2019Category : Endocrinologie et Nutrition
Thyrotoxic hypokalemic periodic paralysis is rare, especially in Caucasians. Affected patients have muscle weakness secondary to hypokalemia associated with hyperthyroidism. We report the case of a 23-year-old patient who was admitted to the emergency department for sudden-onset tetraparesis without any trauma. Tetraparesis was accompanied by severe hypokalemia. Etiologic investigations have led to the diagnosis of Graves' disease. Hypokalemic periodic paralysis is a rare neuromuscular complication of hyperthyroidism. It originates from hypokalemia secondary to intracellular transfer caused by both Na+/K+ ATPase pump overstimulation and abnormal potassium efflux due to a mutation in the potassium efflux channel. The clinical management consists in conservative potassium supplementation and administration of ß-blockers. The neuromuscular deficit is transient and reverses rapidly after the correction of hyperthyroidism.
Pheochromocytoma is a rare cause of Cushing’s syndrome (<0.5% of cases) due to ectopic ACTH secretion. This condition proves very challenging regarding both diagnosis and treatment. Our case report illustrates the necessity of a thorough endocrinological investigation for all adrenal incidentalomas, particularly in the presence of clinical symptoms indicative of excessive hormonal secretion. We also show that Cushing’s syndrome secondary to ectopic ACTH secretion displays some typical characteristics as compared to the more common pituitary Cushing’s disease. Furthermore, we conducted a literature review regarding Cushing’s syndrome due to ectopic ACTH secretion from pheochromocytomas.
Déborah Debois (1), Liliane Marot (1), Eric Van Den Neste (2), Alessandra Camboni (3), Isabelle Tromme (1)Published in the journal : January 2019Category : Dermatology
We here briefly summarize the “PEAUse dermatologique” meeting organized in February 2018 by the Department of Dermatology of the Saint-Luc University Clinics and dedicated to cutaneous lymphomas. Professor E. Van Den Neste presented the most frequent cutaneous lymphomas, their treatments, as well as several clinical cases from the Department of Hematology. Professor A. Camboni focused on the histological aspects.
Lilas Al Zein1, Cécile Yelnik2, Juliette Woessner2, Angélique Lemaire-Olivier2, Marc Lambert2, Pierre-Yves Hatron2Published in the journal : January 2019Category : Internal Medicine
Idiopathic capillary leak syndrome or Clarkson’s disease is a rare and potentially life-threatening condition. This condition presents with recurrent crises, characterized by the abrupt onset of generalized edema with relative hypovolemia associated with paradoxical hypoalbuminemia and elevated hematocrit levels. This almost pathognomonic clinical and biological presentation should remind us of the diagnosis, after excluding secondary causes of capillary leaks, and lead to initiating prompt supportive treatment in a specialized department, in an effort to avoid critical care and associated complications. This article describes the clinical characteristics of the disease and current knowledge about its physiopathology, natural history, and long-term prognosis, while highlighting the efficacy of first-line prophylactic therapy using intravenous immunoglobulins (IVIg) for relapse prevention, designed to avoid progression into a more severe form with gloomy prognosis.
Liver cirrhosis is commonly encountered in general practice. Although cirrhosis can result from various causes, it most often has a toxic (alcohol), metabolic (nonalcoholic steatohepatitis [NASH]), or infectious (hepatitis B and C) origin. The initial evaluation includes a blood test and an abdominal ultrasound. The diagnosis can be confirmed with non-invasive quantification of fibrosis, using either biological markers (FibroTest®) or transient elastography (FibroScan®). A liver biopsy is only rarely required. Therapeutic management of cirrhosis involves the treatment of the underlying disease, along with the management of complications. Complete alcohol abstinence, weight loss, and the control of risk factors, such as the metabolic syndrome, are some examples. In case of confirmed cirrhosis, abdominal ultrasound and alpha-fetoprotein measurements should be performed every 6 months to screen for hepatocarcinoma. It is also recommended to conduct a gastroscopy every 2-3 years to assess the presence of esophageal varices.
Martin Buysschaert, Vanessa Preumont (1)Published in the journal : January 2019Category : Diabétologie
Suliqua® is a new fixed-ratio combination product of the basal insulin glargine 100U/mL and the GLP-1 receptor agonist lixisenatide. This article sought to analyze the recent literature to better identify the product’s potential advantages in general and more particularly, in comparison to basal insulin, and to clarify its precise place in the treatment algorithm for Type 2 diabetes in Belgium.
This paper aimed to review the clinical data on dapagliflozin (Forxiga®) treatment in the light of the recent DECLARE-TIMI 58 trial results. This study involving Type 2 diabetic patients, either with or without prior macroangiopathy, has demonstrated cardiovascular benefits in terms of the primary efficacy outcome, namely a composite of cardiovascular death and hospitalization for heart failure. Moreover, the study has revealed a lower risk for renal disease progression.
Pamela El Nemnom (1), Marie Baeck (1), Claire Dachelet (2), Liliane Marot (1)Published in the journal : December 2018Category : Dermatology
We have herein reported on the “PEAU’se dermatologique” meeting conducted at the Cliniques universitaires Saint- Luc on November 13, 2017, while being focused on bullous skin disease. After a brief reminder of the clinical lesions for each condition, the anatomopathological characteristics were specified, with the latest updates about their treatment provided. The newest update concerned rituximab that will now be reimbursed in the context of complicated bullous skin disease.