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Article ; Online: Sodium-not harmful?

Deschênes, Georges

2020 Volume 35, Issue 9, Page(s) 1771–1776

Abstract: Background: The temporality between the mandated reduction of salt in processed food and the decrease of death from stroke and ischemic heart disease, the association of hypertension, and cardiovascular disease led many public health organizations to ... ...

Abstract	Background: The temporality between the mandated reduction of salt in processed food and the decrease of death from stroke and ischemic heart disease, the association of hypertension, and cardiovascular disease led many public health organizations to recommend reducing dietary sodium to a maximum of 2300 mg per day. It turns out that some nuances can be brought about to this universally shared belief. Methods & results: Indeed, consideration of health outcomes instead of only blood pressure as a surrogate marker of cardiovascular disease and prognosis gave contradictory results whereas low sodium intake is associated to an excess of death and cardiovascular events. Conclusions: Accordingly, sodium intake should be adapted to individual risk factors, and evidence is still clearly lacking to support indiscriminate recommendations in healthy people. By contrast, a restricted sodium diet is certainly useful in patients with chronic kidney disease exposed to salt retention, and by reciprocity, low sodium diet must be absolutely avoided in all patients presenting renal or extra renal sodium wasting where sodium depletion is a life-threatening condition.
Language	English
Publishing date	2020-05-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-019-04356-x
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Article ; Online: How to improve response to rituximab treatment in children with steroid-dependent nephrotic syndrome: answer to Drs. Fujinaga and Nishino.

Hogan, Julien / Deschenes, Georges

Pediatric nephrology (Berlin, Germany)

2018 Volume 34, Issue 2, Page(s) 361–362

MeSH term(s)	B-Lymphocytes ; Child ; Humans ; Nephrotic Syndrome ; Recurrence ; Rituximab
Chemical Substances	Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2018-11-07
Publishing country	Germany
Document type	Letter ; Comment
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-018-4133-x
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Article ; Online: Obinutuzumab in Frequently Relapsing and Steroid-Dependent Nephrotic Syndrome in Children.

Dossier, Claire / Bonneric, Stéphanie / Baudouin, Véronique / Kwon, Thérésa / Prim, Benjamin / Cambier, Alexandra / Couderc, Anne / Moreau, Christelle / Deschenes, Georges / Hogan, Julien

Clinical journal of the American Society of Nephrology : CJASN

2023 Volume 18, Issue 12, Page(s) 1555–1562

Abstract: Background: B-cell depletion with rituximab induces sustained remission in children with steroid-dependent or frequently relapsing nephrotic syndrome. However, most patients relapse after B-cell recovery, and some patients do not achieve B-cell ... ...

Abstract	Background: B-cell depletion with rituximab induces sustained remission in children with steroid-dependent or frequently relapsing nephrotic syndrome. However, most patients relapse after B-cell recovery, and some patients do not achieve B-cell depletion. Obinutuzumab is a second-generation anti-CD20 antibody designed to overcome such situations in B-cell malignancies and was recently reported to be safe and effective in other autoimmune diseases affecting the kidneys. Methods: We retrospectively report 41 children with steroid-dependent or frequently relapsing nephrotic syndrome treated with a single low-dose infusion of obinutuzumab at Robert-Debre Hospital between April 2018 and December 2020. Participants were treated because of rituximab resistance or relapse after rituximab and received a single infusion of 300 mg/1.73 m 2 obinutuzumab with cessation of oral immunosuppressors within 2 months. Results: B-cell depletion was achieved in all participants and lasted a median of 8.3 months (interquartile range, 6.4-11.1), a duration exceeding that for last rituximab treatment. At 12 and 24 months, 92% (38/41) and 68% (28/41) of patients, respectively, were in sustained remission. Mild infusion reactions occurred in five participants (12%) and neutropenia in nine (21%). No significant decrease in IgG level was reported during treatment, and whereas IgM levels decreased in 34 patients (83%), they were normal at last follow-up in 32 (78%). Conclusions: These results identified low-dose obinituzumab as a promising treatment option in children with steroid-dependent or frequently relapsing nephrotic syndrome, including those resistant to rituximab. The tolerance profile of obinutuzumab was similar to that of rituximab, but hemogram and immunoglobulin levels should be monitored.
MeSH term(s)	Child ; Humans ; Rituximab/adverse effects ; Nephrotic Syndrome/drug therapy ; Retrospective Studies ; Steroids/therapeutic use ; Recurrence ; Immunosuppressive Agents/adverse effects ; Treatment Outcome
Chemical Substances	Rituximab (4F4X42SYQ6) ; obinutuzumab (O43472U9X8) ; Steroids ; Immunosuppressive Agents
Language	English
Publishing date	2023-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.0000000000000288
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Article: The Struggling Odyssey of Infantile Primary Hyperoxaluria.

Guillaume, Adrien / Chiodini, Benedetta / Adams, Brigitte / Dahan, Karin / Deschênes, Georges / Ismaili, Khalid

Frontiers in pediatrics

2021 Volume 9, Page(s) 615183

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2021-04-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2021.615183
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Article ; Online: Treating the idiopathic nephrotic syndrome: are steroids the answer?

Deschênes, Georges / Dossier, Claire / Hogan, Julien

Pediatric nephrology (Berlin, Germany)

2018 Volume 34, Issue 5, Page(s) 777–785

Abstract: The use of steroids in idiopathic nephrotic syndrome is the major discovery of the twentieth century in the field of pediatric nephrology. At onset of the twenty-first century, steroids remain the first line of treatment at first flare. All the protocols ...

Abstract	The use of steroids in idiopathic nephrotic syndrome is the major discovery of the twentieth century in the field of pediatric nephrology. At onset of the twenty-first century, steroids remain the first line of treatment at first flare. All the protocols to treat the first flare are similar by a common sequence including a first phase of daily prednisolone/prednisone at a dose of 60 mg/m
MeSH term(s)	Child ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination/methods ; Glucocorticoids/administration & dosage ; Humans ; Immunosuppressive Agents/administration & dosage ; Nephrotic Syndrome/drug therapy ; Nephrotic Syndrome/immunology ; Prednisolone/administration & dosage ; Prednisone/administration & dosage ; Recurrence ; Remission Induction/methods ; Secondary Prevention/methods ; Treatment Outcome
Chemical Substances	Glucocorticoids ; Immunosuppressive Agents ; Prednisolone (9PHQ9Y1OLM) ; Prednisone (VB0R961HZT)
Language	English
Publishing date	2018-06-04
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-018-3963-x
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Article ; Online: Asymptomatic bacteriuria in pediatric kidney transplant recipients: to treat or not to treat? A retrospective study.

Bonnéric, Stéphanie / Maisin, Anne / Kwon, Theresa / Deschênes, Georges / Niel, Olivier

Pediatric nephrology (Berlin, Germany)

2019 Volume 34, Issue 6, Page(s) 1141–1145

Abstract: Background: Urinary tract infections (UTI) are common infectious complications in kidney transplant recipients (KTR); asymptomatic bacteriuria (AB) is also frequent. It is unclear whether treatment of AB reduces subsequent UTI in KTR; no guideline is ... ...

Abstract	Background: Urinary tract infections (UTI) are common infectious complications in kidney transplant recipients (KTR); asymptomatic bacteriuria (AB) is also frequent. It is unclear whether treatment of AB reduces subsequent UTI in KTR; no guideline is available in pediatric KTR. In this retrospective study, we analyzed the incidence of AB in pediatric KTR and the impact of screening and treating AB on the onset of subsequent UTI. Methods: Thirty-seven pediatric patients were included. Inclusion criteria were the occurrence of one or more episodes of AB between 2 and 24 months post-renal transplantation. Primary outcome was the cumulative incidence of acute pyelonephritis (APN) or lower urinary tract infections (LUTI) occurring between 2 and 24 months post-renal transplantation. Results: Thirty-seven patients presented 171 AB episodes. One hundred sixty-four AB episodes were untreated (95.9%); among them, 150 episodes (91.5%) were not followed by a clinical infection. Ten episodes (6.1%) led to APN, and 4 (2.4%) to LUTI. There were 53 episodes of APN: 10 (18.9%) after untreated AB and 43 (81.1%) de novo. There were 11 episodes of LUTI: 4 (36.4%) after untreated AB and 7 (63.6%) de novo. Multi-drug resistant bacteria were present in 27% of the patients and in 20% of patients with pre-existing uropathy. Conclusions: Our results are not in favor of systematic treatment of AB in pediatric KTR. Notably, limitation of antibiotic treatment is an urgent and important health issue in this population, in order to reduce multi-drug resistant bacteria emergence.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Bacteriuria/drug therapy ; Bacteriuria/epidemiology ; Bacteriuria/etiology ; Child ; Female ; Humans ; Incidence ; Kidney Transplantation/adverse effects ; Male ; Postoperative Complications/drug therapy ; Postoperative Complications/epidemiology ; Pyelonephritis/epidemiology ; Retrospective Studies ; Transplant Recipients ; Urinary Tract Infections/epidemiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-02-28
Publishing country	Germany
Document type	Journal Article
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-019-04204-y
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Article ; Online: Variability of diagnostic criteria and treatment of idiopathic nephrotic syndrome across European countries.

Deschênes, Georges / Vivarelli, Marina / Peruzzi, Licia

European journal of pediatrics

2017 Volume 176, Issue 5, Page(s) 647–654

Abstract: The aim of the surveys conducted by the Idiopathic Nephrotic Syndrome Working Group of the ESPN was to study the possible variability of treatment in Europe at different stages of the disease by means of questionnaires sent to members of the Working ... ...

Abstract	The aim of the surveys conducted by the Idiopathic Nephrotic Syndrome Working Group of the ESPN was to study the possible variability of treatment in Europe at different stages of the disease by means of questionnaires sent to members of the Working Group. Four surveys have been completed: treatment of the first flare, treatment of the first relapse and the issue of steroid dependency, use of rituximab, and the management of steroid-resistant patients. A uniform treatment of the first flare was applied in only three countries, and ten additional centers have adopted one of the three main protocols. Reported treatment of the first relapse was relatively uniform, whereas the use of additional immunosuppressants in steroid dependency was widely variable. Rituximab had already been used in hundreds of patients, although the formal evidence of efficiency in steroid dependency was relatively recent at the time of the survey. The definition of steroid resistance was variable in the European centers, but strikingly, the first-line treatment was uniform throughout the centers and included the combination of prednisone plus calcineurin antagonists. Conclusion: The variability in the approach of idiopathic nephrotic syndrome is unexpectedly large and affects treatment of the first flare, strategies in the case of steroid dependency, as well as the definitions of steroid resistance. What is Known: • Steroids and immunosuppressants are the universal treatment of idiopathic nephrotic syndrome. What is New: • The variability of treatments and strategy of treatment in European centers of pediatric nephrology.
Language	English
Publishing date	2017-05
Publishing country	Germany
Document type	Journal Article
ZDB-ID	194196-3
ISSN	1432-1076 ; 0340-6199 ; 0943-9676
ISSN (online)	1432-1076
ISSN	0340-6199 ; 0943-9676
DOI	10.1007/s00431-017-2891-2
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Article ; Online: Idiopathic nephrotic syndrome: the EBV hypothesis.

Dossier, Claire / Jamin, Agnès / Deschênes, Georges

Pediatric research

2016 Volume 81, Issue 1-2, Page(s) 233–239

Abstract: Steroid sensitive nephrotic syndrome is marked by a massive proteinuria and loss of podocytes foot processes. The mechanism of the disease remains debated but recent publications suggest a primary role of Epstein-Barr Virus (EBV). EBV replication in the ... ...

Abstract	Steroid sensitive nephrotic syndrome is marked by a massive proteinuria and loss of podocytes foot processes. The mechanism of the disease remains debated but recent publications suggest a primary role of Epstein-Barr Virus (EBV). EBV replication in the peripheral blood is found in 50% of patients during the first flare of the disease. The genetic locus of steroid sensitive nephrotic syndrome was also identified as influencing antibodies directed against EBNA1. EBV is able to establish, latent benign infection in memory B cells that display phenotypes similar to antigen-selected memory B cells. Consistently, memory B cells reconstitution after rituximab infusion is a predictor of the relapse of proteinuria. We suggest that a specific anti-EBNA1 antibody internalized in the podocytes via the neonatal Fc receptor might cross-react with a major protein present in the same cell trafficking compartment. The diversion of this major podocyte protein in the urinary space and the subsequent depletion is supposed to result in podocyte damages with loss of foot processes and massive proteinuria. Immunosuppression of B cells and subsequent clearance of anti-EBNA1 antibodies would lead to a restoration of the normal level of the protein allowing recovery of proteinuria and of normal podocyte morphology.
MeSH term(s)	Adolescent ; B-Lymphocytes/cytology ; Child ; Child, Preschool ; Epstein-Barr Virus Nuclear Antigens/chemistry ; Herpesvirus 4, Human ; Humans ; Immunoglobulins/chemistry ; Immunologic Memory ; Infant ; Kidney Glomerulus/immunology ; Kidney Glomerulus/virology ; Models, Theoretical ; Nephrotic Syndrome/immunology ; Nephrotic Syndrome/virology ; Podocytes/cytology ; Proteinuria/virology ; Steroids/therapeutic use
Chemical Substances	Epstein-Barr Virus Nuclear Antigens ; Immunoglobulins ; Steroids ; EBV-encoded nuclear antigen 1 (O5GA75RST7)
Language	English
Publishing date	2016-09-28
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	4411-8
ISSN	1530-0447 ; 0031-3998
ISSN (online)	1530-0447
ISSN	0031-3998
DOI	10.1038/pr.2016.200
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Article ; Online: Steroid therapy in children with IgA nephropathy.

Cambier, Alexandra / Boyer, Olivia / Deschenes, Georges / Gleeson, James / Couderc, Anne / Hogan, Julien / Robert, Thomas

Pediatric nephrology (Berlin, Germany)

2019 Volume 35, Issue 3, Page(s) 359–366

Abstract: IgA nephropathy (IgAN) is one the most common primary glomerulonephritis in children and adolescents worldwide, with 20% of children developing end-stage kidney disease (ESKD) within 20 years of diagnosis. There is a need for treatment guidelines, ... ...

Abstract	IgA nephropathy (IgAN) is one the most common primary glomerulonephritis in children and adolescents worldwide, with 20% of children developing end-stage kidney disease (ESKD) within 20 years of diagnosis. There is a need for treatment guidelines, especially for steroids in children with primary IgAN, since the STOP-IgA trial casts doubts on the use of steroids in adults with intermediate risk. Pediatricians are prone to prescribe steroids in addition to renin-angiotensin system blockade (RASB) when proteinuria is > 0.5 g/l, eGFR deteriorates < 70 ml/min/1.73 m
MeSH term(s)	Adolescent ; Age Factors ; Biopsy ; Child ; Consensus ; Glomerular Filtration Rate/immunology ; Glomerulonephritis, IGA/complications ; Glomerulonephritis, IGA/drug therapy ; Glomerulonephritis, IGA/immunology ; Glomerulonephritis, IGA/pathology ; Glucocorticoids/therapeutic use ; Humans ; Immunosuppression/adverse effects ; Immunosuppression/methods ; Immunosuppression/standards ; Immunosuppressive Agents/therapeutic use ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/immunology ; Kidney Failure, Chronic/pathology ; Kidney Failure, Chronic/prevention & control ; Kidney Glomerulus/immunology ; Kidney Glomerulus/pathology ; Kidney Glomerulus/physiopathology ; Practice Guidelines as Topic ; Treatment Outcome
Chemical Substances	Glucocorticoids ; Immunosuppressive Agents
Language	English
Publishing date	2019-02-18
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-018-4189-7
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Article ; Online: Quality of life in children with severe forms of idiopathic nephrotic syndrome in stable remission-A cross-sectional study.

Roussel, Aphaia / Delbet, Jean-Daniel / Micheland, Laurianne / Deschênes, Georges / Decramer, Stephane / Ulinski, Tim

Acta paediatrica (Oslo, Norway : 1992)

2019 Volume 108, Issue 12, Page(s) 2267–2273

Abstract: Aim: Severe forms of idiopathic nephrotic syndrome (INS) require immunosuppressive therapy: oral treatment or intravenous therapy (rituximab, RTX). The main objective was to describe quality of life (QOL) in these specific patients.: Methods: Cross- ... ...

Abstract	Aim: Severe forms of idiopathic nephrotic syndrome (INS) require immunosuppressive therapy: oral treatment or intravenous therapy (rituximab, RTX). The main objective was to describe quality of life (QOL) in these specific patients. Methods: Cross-sectional, multicentre, observational study analysed QOL using a standardised questionnaire in children from 7 to 17 years, with a steroid-dependent or steroid-resistant INS in stable remission. The questionnaire consisted of 30 questions concerning physical and emotional well-being, self-esteem, family, friends, school and disease resulting in a global score of 0-100. Results: A total of 110 patients with a mean age of 11.6 years from three French paediatric nephrology centres were included. A total of 71 patients had oral immunosuppressive treatment, 27 had RTX, and 12 had both. 13.6% of patients had a steroid-resistant INS. The mean number of relapses was 5.8. Seventy-eight patients answered the questionnaire. The global score in the whole study population was 74.7; 72.6 in the RTX group, 76.2 in the oral drugs group, (P = 0.49). The results of sub-dimension 'school' were statistically lower in RTX group (61.6 ± 19.5) compared with oral drugs group (71.4 ± 16; P = 0.02). Conclusion: Global QOL score was high in 'difficult-to-treat' patients with INS in stable remission on oral immunosuppressive or RTX treatment.
MeSH term(s)	Adolescent ; Child ; Cross-Sectional Studies ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Nephrotic Syndrome/drug therapy ; Nephrotic Syndrome/psychology ; Quality of Life
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2019-07-15
Publishing country	Norway
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.14912
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