WHY AND HOW SHOULD THE RENAL RISK OF PATIENTS WITH TYPE 2 DIABETES BE ASSESSED ? In patients with type 2 diabetes, regular screening for chronic kidney disease is essential, using estimated glomerular filtration rate and...WHY AND HOW SHOULD THE RENAL RISK OF PATIENTS WITH TYPE 2 DIABETES BE ASSESSED ? In patients with type 2 diabetes, regular screening for chronic kidney disease is essential, using estimated glomerular filtration rate and the albuminuria/creatinuria ratio. Use of the KDIGO matrix (kidney disease: improving global outcomes) and KFRE score (kidney failure risk equation) enables fine stratification of renal risk, leading to appropriate referral to specialized nephrology consultations. The general practitioner, as a key player, can initiate a lifestyle adjustments and appropriate treatments from the very first signs. This early management can delay the progression to renal failure and reduce cardiovascular risk, thus optimizing specialized resources and patients' quality of life.
WHY AND HOW SHOULD THE CARDIOVASCULAR RISK OF PATIENTS WITH TYPE 2 DIABETES BE ASSESSED ? Patients with type 2 diabetes have a two to four fold increased risk of developing atherosclerotic disease, heart failure, and atr...WHY AND HOW SHOULD THE CARDIOVASCULAR RISK OF PATIENTS WITH TYPE 2 DIABETES BE ASSESSED ? Patients with type 2 diabetes have a two to four fold increased risk of developing atherosclerotic disease, heart failure, and atrial fibrillation. Diabetes is also a major risk factor for chronic kidney disease, which in turn, is associated with an elevated risk of cardiovascular disease. The combination of diabetes with other cardiovascular risk factors and/or comorbidities further increases not only the likelihood of major cardiovascular events but also cardiovascular and all-cause mortality. Cardiovascular risk stratification in patients with type 2 diabetes is essential for guiding appropriate management. Several risk scores have been incorporated into the recommendations of various scientific societies, including the SCORE2-Diabetes model.
LIFESTYLE MODIFICATIONS IN TYPE 2 DIABETES: YES, BUT HOW ? Management of type 2 diabetes relies above all on sustainable lifestyle changes, including physical activity, diet, therapeutic education and psychological suppo...LIFESTYLE MODIFICATIONS IN TYPE 2 DIABETES: YES, BUT HOW ? Management of type 2 diabetes relies above all on sustainable lifestyle changes, including physical activity, diet, therapeutic education and psychological support. These approaches must be personalized and integrated into a comprehensive treatment plan. Adapted physical activity, a real treatment, requires prior assessment and can be prescribed within a structured framework. Dieticians must provide individualized support for diets, avoiding restrictive diets. Therapeutic patient education, although sometimes difficult to access, encourages autonomy and commitment. Digital tools, local resources and professionals trained in education can make this possible. Psychological support, though often neglected, is essential. To be effective, this strategy requires going beyond theoretical discourse and proposing concrete solutions, adapted to the realities of each patient, by mobilizing available local resources.
PHARMACOLOGICAL MANAGEMENT OF NON-INSULIN-TREATED TYPE 2 DIABETES: PRACTICAL IMPLEMENTATION OF HAS GUIDELINES. French health authorities' guidelines for type 2 diabetes were updated in May 2024. These guidelines provide...PHARMACOLOGICAL MANAGEMENT OF NON-INSULIN-TREATED TYPE 2 DIABETES: PRACTICAL IMPLEMENTATION OF HAS GUIDELINES. French health authorities' guidelines for type 2 diabetes were updated in May 2024. These guidelines provide a framework for the appropriate positioning of various therapeutic options in the management of type 2 diabetes. Lifestyle modifications and metformin remain the first-line treatment. A paradigm shift introduced by these new recommendations emphasizes the need to prioritize cardiovascular and renal status over glycemic control when initiating therapy. Consequently, these guidelines recommend early use of SGLT2 inhibitors (sodium-glucose co-transporter 2 inhibitors) or GLP-1 receptor agonists in patients requiring secondary cardiovascular prevention. In cases of chronic kidney disease or heart failure, SGLT2 inhibitors are preferred, followed by GLP-1 receptor agonists.
KIDNEY XENOTRANSPLANT, A REAL ALTERNATIVE TO TRANSPLANTATION? Renal xenotransplantation involves transplanting a kidney from an animal species, primarily pigs, into a human recipient to address organ shortage. Recent adv...KIDNEY XENOTRANSPLANT, A REAL ALTERNATIVE TO TRANSPLANTATION? Renal xenotransplantation involves transplanting a kidney from an animal species, primarily pigs, into a human recipient to address organ shortage. Recent advances, particularly in genetic editing, have improved immune tolerance and reduced the risk of hyperacute rejection. Several compassionate-use transplants have been performed on human patients. A major concern remains the potential transmission of porcine endogenous retroviruses (PERV), although no replication has been observed in humans. Other challenges include physiological compatibility, long-term graft survival, and ethical acceptance. Additionally, the cost of developing genetically modified organs raises economic questions. Despite these obstacles, xenotransplantation represents a promising solution to the organ donation crisis and could eventually revolutionize kidney transplantation.
METHODS OF CEREBRAL STIMULATION IN PSYCHIATRY. Psychiatric disorders are a frequent reason for consultation, accounting for 15% of general medical visits. Some patients have severe disorders, meaning they have a signific...METHODS OF CEREBRAL STIMULATION IN PSYCHIATRY. Psychiatric disorders are a frequent reason for consultation, accounting for 15% of general medical visits. Some patients have severe disorders, meaning they have a significant impact on their daily functioning. Others have treatment-resistant disorders, defined as an insufficient response to at least two antidepressant treatments prescribed at an adequate dosage for a sufficient length of time. Some symptoms are inacessible to pharmacological treatment. Because of their systemic action, pharmacological therapies may expose patients to adverse metabolic or neurological effects. Brain stimulation is a new therapeutic approach that helps mitigate systemic adverse effects through its focal action. Various brain stimulation techniques are used in routine clinical practice in France (electroconvulsive therapy) or within the research field (rTMS: repetitive transcranial magnetic stimulation, TDCS: transcranial direct-current stimulation, DBS: deep brain stimulation, and VNS: vagus nerve stimulation).
VIRAL HEPATITIS AND PREGNANCY. The event of pregnancy, the risks of obstetrical complications and vertical transmission will vary according to the type of viral hepatitis. Hepatitis A is transmitted via feacal-oral trans...VIRAL HEPATITIS AND PREGNANCY. The event of pregnancy, the risks of obstetrical complications and vertical transmission will vary according to the type of viral hepatitis. Hepatitis A is transmitted via feacal-oral transmisson, is generally mild, but may increase the risk of obstetric complications. Hepatitis B, the most common, can be transmitted from mother to child, particularly during delivery. Its management includes prenatal screening and antiviral treatment to prevent vertical transmission. Hepatitis C is mainly blood-borne. Hepatitis D superinfects those with HBV, with limited treatment options during pregnancy. Hepatitis E, common in low-income countries, is severe particularly in the third trimester, and may lead to fulminant hepatitis. Mother-to-child transmission is rare for all these viruses, and breastfeeding is generally permitted.
LOW PHOSPHOLIPIDASSOCIATED CHOLELITHIASIS (LPAC) SYNDROME. LPAC (low phospholipid-associated cholelithiasis) syndrome is a rare genetic form of intrahepatic cholelithiasis, associated in 30% to 50% of cases with a pathog...LOW PHOSPHOLIPIDASSOCIATED CHOLELITHIASIS (LPAC) SYNDROME. LPAC (low phospholipid-associated cholelithiasis) syndrome is a rare genetic form of intrahepatic cholelithiasis, associated in 30% to 50% of cases with a pathogenic variant of the phospholipid transporter MDR3 (multidrug resistance protein 3). Clinical presentation of LPAC syndrome is similar to that of common cholelithiasis, but young adult onset of symptoms (before the age of 40) and recurrence of biliary symptoms after cholecystectomy are highly suggestive of the syndrome. Ultrasound of the liver is key for diagnosis, showing intrahepatic microlithiasis in the form of ductal comet-tail images or microspots. Ursodeoxycholic acid (UDCA), at a dose of 5 to 15 mg/kg/d, is the reference treatment. Endoscopic treatment of lithiasis of the common main bile duct and/ or the main hepatic ducts is sometimes necessary.
THROMBOTIC MICROANGIOPATHIES. The syndrome of thrombotic microangiopathy (TMA) is defined by the combination of mechanical hemolytic anemia, consumptive thrombocytopenia, and organ failure secondary to microvascular obst...THROMBOTIC MICROANGIOPATHIES. The syndrome of thrombotic microangiopathy (TMA) is defined by the combination of mechanical hemolytic anemia, consumptive thrombocytopenia, and organ failure secondary to microvascular obstruction by microthrombi. TMAs include thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome and require specific therapies that have significantly improved the prognosis ; post-infectious HUS (including shigatoxin-associated HUS), and secondary TMAs that occur in specific contexts (infection, neoplasia, transplantation, autoimmune disease, medication or toxin exposure, severe hypertension, etc.). The main etiological entities, their pathophysiology, clinical phenotypes, and appropriate management, are reviewed below, with a focus on situations requiring specific and urgent treatment.