Sarah Zimner-Rapuch

Acute renal failure associated with the new BRAF inhibitor vemurafenib: A case series of 8 patients

Vemurafenib is a BRAF inhibitor that has become the cornerstone of metastatic or inoperable melanoma therapy since its approval in 2011 in the United States and 2012 in Europe. This targeted therapy has shown impressive results in terms of increased progression‐free and overall survival as compared to dacarbazine. The safety profile did not include any renal manifestations at that time.

Malaria Prophylaxis in Patients with Renal Impairment

Malaria is an endemic and potentially lethal disease transmitted by the protozoan parasite Plasmodium. It is currently endemic in more than 100 countries, which are visited by 125 million international travellers every year. For dialysis and renal insufficiency patients it becomes increasingly easier to travel to these countries thanks to the recent advances in renal replacement therapy. However, the pharmacokinetics of some prophylactic agents in malaria are altered, which may modify the effectiveness and safety of such treatments and the way they should be prescribed. Clinicians should be aware of these alterations which require subsequent dosage adjustments. This review provides recommendations on the use of antimalarial drugs, alone or in combination, in patients with renal impairment. These recommendations depend on the prevalence of Plasmodium falciparum chloroquine resistance, as defined by the WHO. Furthermore, fixed-dose combinations cannot be used in patients with creatinine clearance below 60 mL/min since the tablets available do not allow appropriate dosage adjustment for each drug. Chloroquine and proguanil require dosage adjustments, while atovaquone, doxycycline and mefloquine do not.

Néphrotoxicité des médicaments

Resume Les effets renaux des medicaments se manifestent par divers mecanismes et peuvent potentiellement toucher toutes les parties du rein. Il existe six types d’atteintes renales induites par les medicaments: les atteintes prerenales ; les nephropathies tubulaires ; les nephropathies interstitielles ; les nephropathies glomerulaires ; les nephropathies vasculaires et les nephropathies obstructives, telles que les cristalluries, les insuffisances renales aigues secondaires a des rhabdomyolyses, etc. La nephrotoxicite des medicaments survient principalement chez des patients ayant des facteurs de risque sous-jacents, pouvant rendre le rein plus fragile aux effets iatrogenes. On distingue les facteurs de risque lies au patient (âges extremes, hypovolemie, insuffisance renale chronique preexistante…), ceux lies au rein et ceux lies au traitement (posologie non adaptee, nephrotoxicite cumulee, diuretiques, anti-inflammatoires non steroidiens…). La connaissance des facteurs de risque et des mecanismes de nephrotoxicite sont la base d’une meilleure prevention et egalement d’une meilleure prise en charge de ces patients.

Évaluation de la fonction rénale chez le patient atteint de cancer

The evaluation of renal function in patients with cancer is necessary. Measuring the actual glomerular filtration rate of the patient is the gold standard. This is usually done using a measure of the renal clearance of a marker of glomerular filtration rate (inulin) or a radio-marker (EDTA Chrome 51, (51)Cr-EDTA). However, these measures are complex and very constraining for the patient and in terms of organization and equipment. It is possible to estimate renal function by calculation. There are in the literature many evaluation formulae available. However, it is essential to use a tool reliable enough to determine an appropriate estimate of renal function, and adjust the doses of treatment if necessary. The choice of the abreviated MDRD (aMDRD) formula is so far the recommended option in oncology.

Pulmonary Hypertension: Use of Oral Drugs in Patients with Renal Insufficiency

Pulmonary hypertension (PH) is a progressive, fatal pulmonary circulatory disease that is characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. PH has been reported to be highly prevalent in patients with chronic kidney disease, and especially among end-stage renal disease patients undergoing haemodialysis. However, only few data are available on drug dosage adjustment to renal function for those drugs that are commonly used in the treatment of PH. We reviewed the literature and gathered information, although sparse, to propose guidelines for using these drugs in renal insufficiency patients.