Result of 10 Years of Experience in Echo-Guided Kidney Biopsy Punctures in the Nephrology Department of the Martigues Hospital Center, France

Introduction: Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. Objectives: To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. Methodology: This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. Results: The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. Conclusion: Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.

Centropontine Myelinolysis after Conservative Correction of Hyponatremia: A Case Report and Review of Contributing Factors

Introduction: Centropontine myelinolysis (CPM) is a rare pathology, a delayed neurological complication corresponding to massive demyelination of the protrusion. Its exact pathogenesis is poorly understood. Rapid correction of sodium hyponatremia has been implicated as a potent causative factor. We report a case of CPM despite a priori conservative correction of hyponatremia with a favorable course in a 61-year-old alcoholic-smoker diabetic. Case Presentation: A 61-year-old man with chronic alcoholism presented to the emergency department (D0) with physical asthenia and anorexia. He was treated for severe hyponatremia at 104 mmol/L by careful rehydration with saline before being transferred to a nephrological hospital. Magnetic resonance imaging (MRI) performed at D14 for locked-in syndrome showed osmotic demyelination syndrome (Figure 1). The evolution was favorable after 3 months of rehabilitation marked by a progressive and clear improvement of clinical signs. Conclusion: This observation suggests an evaluation of the benefit/risk ratio of the short-term prognosis of profound hyponatremia with that of the metabolic stress induced by a still too rapid correction. Particular attention should be paid to diabetic patients in the context of chronic alcoholism or nutritional deficiencies.