<html><head><base href="x-msg://3/"></head><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; ">bonsoir<div><br><div>chez cette réunionnaise la mesure de la natriurèse des 24h me parait un bonne première approche</div><div><br></div><div>paul finielz</div><div>CHU St Pierre de la Reunion<br><div><div>Le 24 févr. 2016 à 21:16, SERET Guillaume a écrit :</div><br class="Apple-interchange-newline"><blockquote type="cite"><span class="Apple-style-span" style="border-collapse: separate; font-family: Helvetica; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; font-size: medium; "><div lang="FR" link="blue" vlink="purple"><div class="WordSection1" style="page: WordSection1; "><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">Bonjour,<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">La biologie n’est pas en faveur d’un hyperaldo primaire, sous réserve effectivement de l’absence de traitement diurétique ou BSRA à ce moment-là.<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">Sur les doppler, les index de résistance parenchymateux sont-ils élevés ?<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">Comment est la natriurèse ?<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">TSH ?<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">Pas d’argument pour une sclérodermie ou une MAT ?<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">De mémoire s’il y avait un déficit en 11Bhydroxy… rénine et aldo seraient freinées<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); ">Amicalement,<o:p></o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><b><span style="font-size: 11pt; font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); ">Docteur Guillaume SERET<o:p></o:p></span></b></div><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); ">Centre de Santé Médical Néphrologique<o:p></o:p></span></div><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); ">ECHO – Pôle Santé Sud<o:p></o:p></span></div><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); ">34 rue de Guetteloup CS 91622<o:p></o:p></span></div><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); ">72016 LE MANS cedex 2<o:p></o:p></span></div><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); ">02.43.78.38.79<o:p></o:p></span></div><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(31, 73, 125); "><o:p> </o:p></span></p><div><div style="border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; border-top-style: solid; border-top-color: rgb(181, 196, 223); border-top-width: 1pt; padding-top: 3pt; padding-right: 0cm; padding-bottom: 0cm; padding-left: 0cm; "><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><b><span style="font-family: Tahoma, sans-serif; ">De :</span></b><span style="font-family: Tahoma, sans-serif; "><span class="Apple-converted-space"> </span>Renaliste [mailto:renaliste-bounces@nephrodial.org]<span class="Apple-converted-space"> </span><b>De la part de</b><span class="Apple-converted-space"> </span>CAROLE DEPRELE<br><b>Envoyé :</b><span class="Apple-converted-space"> </span>mercredi 24 février 2016 16:25<br><b>À :</b><span class="Apple-converted-space"> </span>'Liste de discussion des néphrologues francophones'<br><b>Objet :</b><span class="Apple-converted-space"> </span>[Renaliste] HTA<o:p></o:p></span></div></div></div><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><o:p> </o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Bonjour j’aimerais vos conseils pour une patiente de 41 ans d’origine réunionnaise qui présente une HTA sévère (220/100) y compris en auto mesure à domicile (180/90). Pas d’antécédent en dehors d’une HTA et d’un diabète gestationnel en 2006.</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Taille 154, poids 65.5</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Pas de céphalées ni de flush.</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Potassium à 3.88. MDRD 54 pas de protéinurie</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Doppler des artères rénales pas de sténose vérifié à plusieurs reprises car avait augmenté dans 1 premier temps sa créat sous ARA2.</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Pas de rétinopathie diabétique</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Cardiopathie hypertensive avec HVG importante</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Echo abdo : RAS</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Aldo couché 387pmol/L debout 1991 après freination 1191</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Rénine couché 23.7ng/l, debout 131.7 après freination 70</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Rapport aldo/rénine couché 16.3 debout 15.1 après freination 17</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Bilan immuno à la recherche d’un éventuel lupus négatif</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Efficacité dans un premier temps de l’association diurétiques ARA2 mais avec dégradation de la fonction rénale. Reprise des ARA2 à plus petite dose après contrôle doppler : inefficace.</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Je suppose qu’elle prend correctement son traitement mais je ne peux pas en être certaine.</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">J’essaye les antialdostérones mais comment avancer dans le diagnostic étiologique ? Hospitalisation pour vérifier l’observance ? Déficit en 11B hydroxydeshydrogénase ? Autre mutation génétique ? La quelle ? D’autres idées seraient bien venues….</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 11pt; ">Merci</span><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><em><span style="font-family: Arial, sans-serif; ">Dr Carole DEPRELE</span></em><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><em><span style="font-family: Arial, sans-serif; ">service de néphrologie - dialyse</span></em><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><em><span style="font-family: Arial, sans-serif; ">CLIN - Agence de Biomedecine</span></em><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><em><span style="font-family: Arial, sans-serif; ">CH ARDECHE NORD</span></em><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><em><span style="font-family: Arial, sans-serif; ">BP 119</span></em><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "><em><span style="font-family: Arial, sans-serif; ">07103 ANNONAY CEDEX</span></em><o:p></o:p></p><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 35.45pt; font-size: 10pt; font-family: Arial, sans-serif; "> <o:p></o:p></p><div style="margin-top: 0cm; margin-right: 0cm; margin-left: 0cm; margin-bottom: 0.0001pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 12pt; font-family: 'Times New Roman', serif; "><br></span><strong><span style="font-size: 18pt; font-family: Webdings; ">P</span></strong><strong><span style="font-size: 8pt; font-family: 'Trebuchet MS', serif; ">Afin de contribuer au respect de l'environnement, merci de n'imprimer ce mail qu'en cas de nécessité</span></strong><span style="font-size: 12pt; font-family: 'Times New Roman', serif; "><o:p></o:p></span></div><p class="MsoNormal" style="margin-top: 6pt; margin-right: 0cm; margin-left: 0cm; margin-bottom: 12pt; text-indent: 0cm; font-size: 10pt; font-family: Arial, sans-serif; "><span style="font-size: 12pt; font-family: 'Times New Roman', serif; "><o:p> </o:p></span></p></div><br>Ce message et toutes les pieces jointes (ci-apres le message) sont etablis a l'intention exclusive de ses destinataires et sont confidentiels. Si vous recevez ce message par erreur, merci de le detruire et d'en avertir immediatement l'expediteur. Toute utilisation de ce message non conforme a sa destination, toute diffusion ou toute publication, totale ou partielle, est interdite, sauf autorisation expresse. L'internet ne permettant pas d'assurer l'integrite de ce message, l'ECHO decline toute responsabilite au titre de ce message, dans l'hypothese ou il aurait ete modifie.<span class="Apple-converted-space"> </span><br>_______________________________________________<br>Renaliste mailing list<br><a href="mailto:Renaliste@nephrodial.org" style="color: blue; text-decoration: underline; ">Renaliste@nephrodial.org</a><br><a href="http://nephrodial.org/cgi-bin/mailman/listinfo/renaliste" style="color: blue; text-decoration: underline; ">http://nephrodial.org/cgi-bin/mailman/listinfo/renaliste</a><br></div></span></blockquote></div><br></div></div></body></html>