La fibrose systémique néphrogénique: nouveau coup dur pour les insuffisants rénaux
Bibliographic record
Abstract
À ce jour, plus de 200 cas de fibrose systémique néphrogénique ont été répertoriés dans le monde et tous les cas rapportés sont survenus chez des patients atteints d'insuffisance rénale, la plupart dialysés. Nous rapportons ici l'histoire d'un patient hémodialysé chez qui la maladie a été constatée dans les mois qui ont suivi une angiorésonance magnétique des membres inférieurs. La maladie se manifeste par un épaississement de la peau et une fibrose des tendons qui mènent à des contractures articulaires qui peuvent condamner rapidement le patient au fauteuil roulant. Certains patients ont des manifestations polysystémiques parfois mortelles à type de cardiomyopathie, de fibrose pulmonaire ou d'hypertension pulmonaire. Aucun traitement n'a été démontré efficace chez une grande série de patients. On soupçonne fortement un lien entre l'exposition aux sels de gadolinium et l'apparition de la maladie chez des insuffisants rénaux, bien qu'un lien de causalité n'ait pas encore été établi. Chez un sujet atteint d'insuffisance rénale, un examen d'imagerie par résonance magnétique avec rehaussement au gadolinium ne doit être fait qu'après avoir bien évalué le rapport bénéfice/risque. Les implications quant au choix des méthodes d'imagerie à la recherche d'une néphropathie ischémique ou encore d'une atteinte aorto-iliaque avant une greffe rénale sont discutées. To date, more than 200 cases of nephrogenic systemic fibrosis have been documented worldwide. All patients have had renal failure, most of them requiring dialysis. We herein describe the course of a hemodialyzed patient who developed nephrogenic systemic fibrosis in the months following magnetic resonance angiography of the lower extremities. The disease is characterized by skin thickening and tendon fibrosis leading to joint contractures that can quickly confine the patient to a wheelchair. Systemic involvement may occur, leading to cardiomyopathy, pulmonary fibrosis, pulmonary hypertension or even death. No consistently effective therapy has been reported. An association between gadolinium exposure and the development of the disease has been found, although no causal link has yet been proven. In a patient with renal failure, magnetic resonance imaging with gadolinium enhancement should be done only after having seriously considered the risk/benefit ratio. Implications concerning the choice of imaging methods when searching for ischemic nephropathy or aorto-iliac disease before renal transplantation are discussed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".