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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Cher Ami,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Etant donnée la monoclonalité sérique une étude en ME (même avec IF négative) serait intéressante. Chaines légères sériques ? Moelle ?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Amicalement<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">P Deteix<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">De :</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> Renaliste [mailto:renaliste-bounces@nephrodial.org]
<b>De la part de</b> Hammelin, Jean philippe<br>
<b>Envoyé :</b> mercredi 1 juin 2016 11:56<br>
<b>À :</b> Liste des néphrologues francophones; Louis FABRE<br>
<b>Objet :</b> Re: [Renaliste] traitement HSF<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Bonjour</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Est-on sûr que cette gammapathie corresponde bien à une MGUS ?</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Recherche variant R229Q du gène NPHS2 ?</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">JP HAMMELIN<br>
DOUAI</span><o:p></o:p></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">De :</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> Renaliste [<a href="mailto:renaliste-bounces@nephrodial.org">mailto:renaliste-bounces@nephrodial.org</a>]
<b>De la part de</b> NEFTI Hamid<br>
<b>Envoyé :</b> mercredi 1 juin 2016 11:14<br>
<b>À :</b> Louis FABRE; Liste des néphrologues francophones<br>
<b>Objet :</b> Re: [Renaliste] traitement HSF</span><o:p></o:p></p>
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<p class="MsoNormal"> <o:p></o:p></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">L'IgM kappa correspond t-elle à un Waldenstrom ou autre syndrome lyphoprolifératif ? (Freelite ? bilan médullaire ? TEP ?)</span><o:p></o:p></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Ceci pourrait remettre en cause le caractère "primitif", donc le traitement.</span><o:p></o:p></p>
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<p class="MsoNormal"><strong><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">Dr Hamid NEFTI</span></strong><o:p></o:p></p>
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<p class="MsoNormal"><em><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:black">Praticien Hospitalier</span></em><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:black">Néphrologie et Dialyse</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:black">Centre Hospitalier</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:black">71 000 MACON</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"><a href="mailto:hanefti@ch-macon.fr" id="NoLP">hanefti@ch-macon.fr</a></span><o:p></o:p></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black">De :</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"> Renaliste <<a href="mailto:renaliste-bounces@nephrodial.org">renaliste-bounces@nephrodial.org</a>>
de la part de Louis FABRE <<a href="mailto:louisfabre@orange.fr">louisfabre@orange.fr</a>><br>
<b>Envoyé :</b> mercredi 1 juin 2016 10:41<br>
<b>À :</b> Listedediscussiondesnéphrologuesfrancophones<br>
<b>Objet :</b> [Renaliste] traitement HSF</span><span style="font-family:"Calibri","sans-serif";color:#212121">
</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:#212121"> </span><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Bonjour,</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Patiente, 55 ans</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Antécédents: 2013 : pneumopathie bilatérale. Tabagisme chronique, syndrome de Raynaud ancien toujours « actif »</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121"> Mai 2014 : syndrome néphrotique impur (hématurie microscopique, discrète altération de la fonction rénale). Pas de symptomatologie clinique particulière
associée.</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Bilan immunologique : ACAN positifs (1/320 homogènes) mais négatifs sur 2éme bilan.</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Ac anti DNA natifs, ANCA négatifs</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">C3 limite inférieur, C4 normal</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Diminution IgA et IgG, augmentation IgM</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Recherche cryoglobulinémie négative</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Immunoglobuline monoclonale IgM kappa, PBJ urinaire négative</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">PBR : 10 glomérules : 2: « pains à cacheter". Sur 8 : 2: lésions segmentaires: </span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">1 glomérule : augmentation dans une partie du floculus de la cellularité avec en regard hyperplasie podocytaire. </span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">2ème glomérule: augmentation matériel mésangial et cellularité en regard pole urinaire.</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Autres glomérules : légère augmentation diffuse cellularité.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="color:#212121">10% : fibrose interstitielle. IF négative.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="color:#212121">Conclusion: lésions de hyalinose segmentaire et focale.
</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="color:#212121">Mise sous corticoide et IEC à visée anti-protéinurique.</span><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Deuxième bilan demandée par la patiente (d'elle meme sur un autre établissement) (anxieuse +++) : HSF primitive. Bilan immunologique négatif. Traitement
inchangé, poursuite de la corticothérapie en cours.</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Arrét corticoide, car pas de réponse significative.</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Essai Myfortic , sans résultat positif + effets secondaires digestifs..</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">Options thérapeutiques: Ciclosporine mais IRC (stable DFG # 32) ? Rituximab ?</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">En vous remerciant </span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#212121">dr L. Fabre, CH Montluçon</span><o:p></o:p></p>
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