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Introduction: Chronic Kidney Disease (CKD) is a major global public health problem. In Congo, we have very few studies on it. Patients and Methods: We carried out an analytical cross-sectional study with retrospective data collection including patients aged 18 to 49 years, hospitalized for CKD in the nephrology department of University Hospital of Brazzaville, during the period from January 1, 2016 to August 31, 2020. The variables considered were socio-demographic, clinical, paraclinical, therapeutic and evolutionary. The statistical test used was Pearson’s chi-square test. Results: CKD in those under 50 represented 21.1% of admissions and 35.6% of CKD. The mean age was 35.9 ± 8.4 years. There was a male predominance with a sex ratio of 1.27. Hypertension was the most common comorbidity (49.2%), followed by HIV (13.6%) and diabetes mellitus (13.2%). Stage 5 CKD was most prevalent (82.7%). Indeterminate kidney disease was in the order of 55.9%. The low socioeconomic level (74.9% of cases) hampered the achievement of dialysis in 66.3% of patients for whom this treatment was indicated. Failure to perform dialysis significantly influenced the occurrence of death (p-value = 0.005). Conclusion: CKD is common among people under 50 and more affects males with a high mortality rate due to lack of access to dialysis. The main causes are hypertension and HIV.

Purpose End-stage renal disease patients (ESRD) generally complain about a poor quality of life (QOL). The current study aims to describe and compare ESRD patients' QOL according to dialysis modalities (hemodialysis [HD] and peritoneal dialysis [PD]). Methods This is a cross-sectional study, conducted in dialysis facilities of a Moroccan university hospital, during October 2018. All adult ESRD patients, treated either by HD or PD for more than 3 months and agreeing to participate, were included. Medical data were collected using a questionnaire, whereas the QOL data were collected using the Kidney Disease Quality of Life Short Form (KDQOL SF v 1.3) scale previously validated in dialectal Arabic. The patients' characteristics and QOL data were compared between dialysis modalities (HD vs. PD), using a linear regression, before and after adjustment on several demographic and medical factors as well as a propensity score created to reduce the effect of confounding factors related to the choice of the treatment. Results Out of the 91 included patients (50.5% of men, median age 52.0 (IQR [36.5; 62.0]) years), 71 were on HD and 20 were on PD. The highest subscale score, for all participants, was the social support's one with a median of 83.3 (IQR [66.7; 100]), and the lowest one was the kidney disease burden with a median of 25.0 (IQR [0.00; 46.9]). The univariate analysis showed that the Physical Component Score (PCS), the cognitive function, and the dialysis staff encouragement were better in PD patients (p = 0.03, p = 0.04, and p = 0.007, respectively), while the multiple linear regression indicates that the PCS, the dialysis Staff encouragement, and the patient's satisfaction subscores decreased within patients on HD compared with those on PD (p = 0.01, p = 0.03, and p = 0.02, respectively) and that the burden of the kidney disease and the work status subscores increased within patients on HD against those on PD (p = 0.007 and p = 0.04, respectively). Conclusion This study showed a significant difference between dialysis modalities in some sides of quality of life.

Background and Aims The Chronic kidney disease (CKD), like many chronic illnesses, is invariably associated with various psychiatric conditions and poorer quality of life. This study aims to assess the prevalence of depression and anxiety among CKD patient and their determinant factors. Method this is a cross sectional single center study in a Moroccan university hospital. Patients aged ≥ 18 years old and followed for more than one year were included. The data was collected using a questionnaire for sociodemographic and clinical information and the Hospital anxiety and depression scale (HADS) to assess depression and anxiety prevalence. After the description of the population’s characteristics, the statistical analysis aimed to assess the association between depression and anxiety disorders and the estimated glomerular filtration rate before and after adjustment on several confounding factors. Results 88 patients were included (63.6% of them were women, the mean age was 61.8±14.0 years), 21 were on stage 3, 46 were on stage 4, and 21 were on stage 5 of the CKD. The median of depression sub-score was 5.00[2.00; 10.0], the median of anxiety sub-score was 6.00[4.00; 9.00], and the median of the global score was 11.0[7.00; 20.0], 22.0% of included patients had depression and 22.0% had anxiety. Both depression and anxiety scores were associated to eGFR before and after adjustment (p= 0.001, p Conclusion This study showed that depression and anxiety are strongly related to the CKD progression, which should motivate both doctors and nurses to improve their psychological care toward CKD patients.

Background and Aims Chronic kidney disease (CKD) is a leading public health problem in Morocco, its consequences and costs have implications for public health policy. The present study aimed to estimate the social cost of CKD before the start of renal replacement therapy in a Moroccan region. Method A cross-sectional cost of illness study, using bottom-up approach was performed at the department of nephrology in university hospital of Fez during 2020, among stages 3 to 5 CKD patients, followed up for at least one-year. The analyzed costs include the following annual expenditures: hospitalizations, outpatient visits, day care hospital, drugs, laboratory tests, imaging, and medical specialized acts. Non-medical costs such as transportation and indirect costs like loss of productivity were also assessed. Determinants of CKD cost were identified by univariate analysis using t test, ANOVA or non-parametric tests, p < 0.05 is the level of statistical significance. Results Eighty-eight patients were included (63.6% women, mean age: 61.8±14.0 years), 76.1% were on CKD stage 4 or 5. The estimated annual social cost of CKD was 2231,12 US$ (95% CI, 1676,09-2793,93 US$). The direct cost accounted for 99,5% (direct medical cost: 91,2%, direct non-medical cost: 8,3%), and the indirect cost accounted for 0,5 % of the social cost. Hospitalizations, diagnosis and treatments represented the main expenses of the direct medical cost (32,2%, 29,7%, 32,2% respectively). The social cost components were not significantly different between CKD stages. Conclusion The cost of CKD in its early stages still lower than the cost of renal replacement therapy, which brings the light on the necessity of secondary prevention of CKD to postpone or prevent the progression toward ESRD.

L´objectif de ce travail était de rappeler aux praticiens cette complication des fluoroquinolones, la tendinopathie. Il s´agit d´un effet secondaire rare mais, qui peut être source de handicap fonctionnel. Une femme de 79 ans, hémodialysée depuis 11 années avait présenté une douleur soudaine de la cheville gauche et une impotence fonctionnelle relative du membre homolatéral au 5ejour d´une automédication par la ciprofloxacine. Elle avait comme comorbidités, une gonarthrose chronique, une hyperparathyroïdie secondaire et une cardiopathie ischémique. Le diagnostic de tendinopathie achilléenne bilatérale et d´une rupture achilléenne gauche étaient retenus sur la base des arguments cliniques, confortés par l´échographie achilléenne. La responsabilité de la ciprofloxacine était évaluée à l´aide de la méthode française d´imputabilité des effets inattendus ou toxiques des médicaments. La prise en charge était chirurgicale suivie d´une rééducation fonctionnelle avec une évolution satisfaisante. La fréquence des tendinopathies liées aux fluoroquinolones varie de 15 à 20 accidents pour 100 000 sujets traités dont un tiers de cas sont compliqués de rupture tendineuse. L´incidence est liée à l´âge, avec un âge de prédilection > 60 ans impliquant le vieillissement tissulaire. La péfloxacine et la ciprofloxacine sont les molécules les plus incriminées. Le délai d´apparition des symptômes noté à cinq jours dans cette observation corrobore avec la littérature. Nous avons retrouvé certains facteurs favorisants connus à savoir: insuffisance rénale chronique, dialyse, corticothérapie, hypolipémiant (statine). La présentation clinique est classique, suffisante pour poser le diagnostic. La localisation est majoritairement achilléenne. Elle est bilatérale dans 40 à 66%. La rupture tendineuse est la principale complication. La prise en charge est chirurgicale. Elle permet de rétablir l´anatomie et de prévenir le handicap fonctionnel préjudiciable. Nous rapportons un effet secondaire rare mais, potentiellement grave, lié aux fluoroquinolones et, qui expose à un handicap fonctionnel. L´âge avancé, l´insuffisance rénale chronique, l´hémodialyse chronique, la prise concomitante de statine et de corticoïde sont des facteurs traditionnels favorisants retrouvés ici. Les hémodialysés constituent une population à risque pour qui une surveillance même à distance d´un traitement à base de ces molécules revêt un intérêt non négligeable.

Background Various alterations of hypothalamic-pituitary-adrenal axis function have been described in patients with chronic renal failure. Nevertheless, controversial evidences were stated about the association between adrenal function deficiency (AD) and hemodialysis (HD). Purpose The goal of this paper was to estimate indirect indices of the adrenal gland dysfunction which is potentially influenced by oxidative stress (OS) that still generates brain plasticity and reorganization of the functional control. Methods Two male patients undergoing HD by the synthetic Helixone membrane for more than 6 months at the HD Center of the University Hospital of Fez, Fez, Morocco, were recruited. They underwent identical assessment immediately before and after the full HD session; this consisted of a blood ionogram revealing rates of sodium and calcium, and brain blood oxygenation level-dependent functional MRI (BOLD-fMRI) using a motor paradigm in block design. Results The blood ionogram revealed hypercalcemia and hyponatremia in both patients. Both biological assessment and BOLD-fMRI study results revealed a high level of OS that induced activation of a significantly large brain volume area suggesting the occurrence of possible brain plasticity and functional control reorganization induced by free radicals and enhanced by AD. Conclusion The occurrence of brain plasticity and functional control reorganization was demonstrated in both patients studied who were undergoing HD by BOLD-fMRI with a notable sensitivity; this plasticity is induced by elevated OS occasioned by HD technique itself and probably amplified by AD. Similar results were found in a previous study performed on the same patients undergoing HD by a polysulfone membrane.

Nous nous sommes permis d' étudier les aspects épidémiologiques, cliniques et évolutifs des amyloses rénales, et d'identifier les facteurs de mauvais pronostic. Il s'est agi d'une étude rétrospective, ayant porté sur tous les patients hospitalisés entre janvier 2013 et décembre 2014, pour une amylose rénale. Le diagnostic était confirmé par la ponction-biopsie rénale ou par la biopsie des glandes salivaires accessoires. Vingt-cinq patients étaient colligés dont 17 hommes et huit femmes; âgés en moyenne de 47,2 ±18 ans. La fréquence hospitalière et le taux d'incidence étaient respectivement de 2,4% et 12,5 cas/an. A l'admission le syndrome néphrotique était retrouvé dans 100% et l'insuffisance rénale dans 68%. La protéinurie était ≥6g/24h dans 60%. Les autres manifestations étaient digestives (n=14), cardiaques (n=10) et l'hypotension artérielle (n=11). Les maladies infectieuses et inflammatoires étaient les principales causes retrouvées (60%). La tuberculose représentait à elle seule 20%. Après un suivi moyen de 219,5 jours, l'insuffisance rénale chronique était notée dans 16 cas (64%) dont 11 cas au stade terminal (44%). Six patients étaient décédés. L'insuffisance rénale au diagnostic, l'aggravation de la fonction rénale et la réhospitalisation étaient corrélées au risque d'insuffisance rénale chronique terminale (p: 0,03-0,04). L'atteinte cardiaque, la réhospitalisation et un débit de protéinurie ≥6g/24h étaient les facteurs associés au risque de décès (p< 0,03). L'insuffisance rénale, l'atteinte cardiaque, le débit de protéinurie ≥6g/24h et la réhospitalisation constituent les principaux facteurs de mauvais pronostic retrouvés dans cette cohorte.

Background: Patients at end stage renal failure require hemodialysis, a process that contributes to oxidative stress, where the quality of hemodialysis membrane plays a key role. Aim of the Study: We sought to investigate the effect of two different hemodialysis membranes (Helixone® vs Polysulfone®) on several blood biologic and oxidative stress parameters. Patients and Methods: Among 86 patients of our hemodialysis facility at the University Hospital, 12 patients were included in the study according to inclusion and exclusion criteria. Patients used Polysulfone® membrane in a first step of the study, then they switched to Helixone® membrane. Original Research Article Errasfa et al.; JAMPS, 7(1): 1-7, 2016; Article no.JAMPS.24141 2 Under the two kinds of membranes, we measured routine biologic parameters, and preand postdialysis plasma oxidative stress parameters (malondialdehyde and Total Anti-Oxidant Activity, as assessed respectively, by the method of thiobarbituric acid, and an anti-oxidant activity commercial kit). Results: With both Polysulfone® and Helixone® dialyzers, there was an important and significant increase of malondialdehyde upon a single hemodialysis session, however, the increase of malondialdehyde concentration was significantly reduced with Helixone® dialyzer as compared to Polysulfone® one. Plasma total anti-oxidant activity was reduced significantly upon a single hemodialysis session with both dialyzers, however, such a reduction was significantly higher with Polysulfone® (28% reduction) than with Helixone® (11.7% reduction) dialyzer. The levels of other routine blood parameters related to the performance of dialysis process (urea, uric acid, creatinine) under both dialyzers were similar. Conclusion: Hemodialysis-associated oxidative stress, as assessed by MDA concentration and plasma total anti-oxidant activity, seems to be significantly reduced with Helixone® dialyzer when compared to Polysulfone® dialyzer. This difference may bring positive impact on hemodialysisassociated side effects on cardiovascular and cerebrovascular systems.

Acute kidney injury (AKI) is a rare but life-threatening complication of pregnancy. The aim of this paper is to study the characteristics of acute AKI in pregnancy and to emphasize on its management modalities in Moroccan hospitals. This is a national prospective study performed over six months from July 1 to December 31 2010 on AKI developing in pregnant patients, both preand post-partum period. Patients with pre-existing kidney disease were excluded from the study. Outcome was considered unfavorable when complete recovery of renal function was not achieved and/or maternal death occurred. Forty-four patients were included in this study. They were 29.6 ± 6 years old and mostly illiterate (70.6%). Most AKI occurred in the post-partum period, with 66% of the cases occurring in those who did not receive antenatal care. The main etiologies were pre-eclampsia (28 cases), hemorrhagic shock (six cases) and septic events (five cases). We noted three cases of acute fatty liver, one case of obstructive kidney injury and one case of lupus nephritis. Hemodialysis was necessary in 17 (38.6%) cases. The outcome was favorable in 29 patients. The maternal mortality rate was 11.4%. Two poor prognostic factors were identified: Age over 38 years and sepsis. AKI is a severe complication of pregnancy in developing countries. Its prevention necessitates the improvement of the sanitary infrastructure and the establishment of the obligatory antenatal care.

In the treatment of end-stage renal disease, kidney transplantation (KT) is the best and most cost-effective alternative with regard to both prognosis and quality of life. To identify the proportion and the characteristics of kidney transplant candidates who can be considered eligible, a total of 2066 hemodialysis patients were investigated as part of the ARTEMIS (Attitude toward Renal Transplantation and Eligibility among dialysis patients in a Moroccan Interregional Survey) study. We investigated all patients receiving hemodialysis in the 39 centers of four Moroccan departments. The mean age was 52.9 years and the mean duration of hemodialysis was 55.3 months. Fifty-eight percent of our patients were considered eligible for KT; 18.2% had an absolute contraindication and 23.8% had one or more relative contraindications. When compared with eligible patients (n = 1200) in the univariate analysis, those ineligible were significantly older (61 years vs. 51, P < 0.0001), had no residual diuresis (59.8% vs. 49.1%, P < 0.0001), were more often diabetic (25.1% vs. 11.9%, P < 0.0001) and hypertensive (54.5% vs. 45.8%, P < 0.0001), and their median dialysis duration was longer (61 months vs. 51, P < 0.0001). In the multivariate models, eligibility remained associated with young age, less term of dialysis and residual diuresis. Adequate control of cardiovascular risk factors before dialysis and early referral for transplantation might help to improve eligibility of the renal transplant candidates.

La calcinose pseudotumorale (CPT) est une affection caracterisee par le depot de cristaux de phosphate de calcium dans les tissus mous periarticulaires, realisant de volumineuses masses calcifiees. Bien que la physiopathogenie des CPT ne soit pas totalement elucidee, l'augmentation du produit phosphocalcique au-dela du seuil de precipitation ainsi que l'hyperparathyroidie severe, semble y jouer un role determinant. Le role favorisant de microtraumatismes articulaires repetes est egalement evoque. Chez les sujets dialyses, la frequence de la CPT est estimee entre 0,5 et 7% selon les series. Son traitement demeure controverse. L'exerese chirurgicale est souvent recommandee. Nous rapportons un cas de CPT survenue chez un patient hemodialyse. Il s'agit d'un patient âge de 56 ans, en hemodialyse chronique depuis 9 ans pour une nephropathie indeterminee. Le patient presente depuis 6 mois des douleurs d'aggravation progressive au niveau de la hanche droite, avec des difficultes de mobilisation de l'articulation en regard. Le scanner alors realise montre une masse calcifiee, a contours polylobes, mesurant 8,6 x 7,6 x 5,9cm, presentant des rapports tres etroits avec le nerf grand sciatique, ce qui explique probablement le tableau clinique tres douloureux. Le bilan biologique montre un produit phosphocalcique eleve et une hyperparathyroidie. L'exerese chirurgicale est jugee difficile vu les rapports de la tumeur avec les elements vasculo-nerveux. Notre observation illustre les difficultes diagnostique et therapeutique de la CPT. L'existence de cette affection peu frequente nous parait devoir etre rappelee, afin de l'evoquer rapidement chez un patient hemodialyse chronique devant toute masse periarticulaire calcifiee d'allure tumorale.

Hydatidosis is a parasitic infection caused by the larval stage of Echinococcus granulosus. Renal hydatic cyst is unusual. It may fistulize into the urinary excretory system, requiring specific management. The aim of our study was to highlight the diagnostic and therapeutic specificity of this pathology in patients on chronic hemodialysis among whom diuresis is not always preserved, in order to focus attention on hydaturia and to give an indication to diagnosis. We report the case of a 47-year old patient with a 4-year history of hemodialysis due to glomerular nephropathy detected at the final stage. Moreover, the patient had a 6-month histoiry of impaired general condition associated with right lower back pain, without fever. Abdominal CT scan showed right kidney measuring 13.4cm, with important ureteropyelocaliceal dilation, pushing the renal parenchyma associated with renal pelvis measuring 4.3cm, without detectable lithiasic obstacle. However, it showed membranous cyst at the level of the lower right renal polar parenchyma, measuring approximately 76.5 x 54 mm, contacting the renal pelvis, also containing a few membranes. The patient underwent thorough interview revealing the presence of hydaturia in the few drops of residual diuresis. Given that the patient had end stage chronic renal failure and that he was under renal replacement therapy, therapeutic approach was based on total nephrectomy.

L'apport de la ponction biopsie rénale (PBR) dans le diagnostic, le choix thérapeutique et l'évaluation pronostique des néphropathies est considérable. Aucune étude marocaine n'a évalué la pratique et l'apport de la PBR. Notre objectif est d'étudier les indications de la PBR, déterminer la fréquence des maladies rénales identifiées par PBR dans notre région et de faire une confrontation entre les données clinico-biologiques et le diagnostic historique. Notre étude menée entre Janvier 2009 et Décembre 2012, est rétrospective. Nous avons inclus tous les patients du service de Néphrologie du CHU Hassan II de Fès ayant bénéficié d'une biopsie de reins natifs. 522 PBR ont été réalisées. Nous avons exclu 8 biopsies devant le manque de renseignements et avons donc retenu 514. L'âge moyen des patients au moment de la PBR est de 39 ±17 ans (3-82 ans). Le sex ratio est de 0,9. Le syndrome néphrotique est le diagnostic clinique le plus fréquent à tous les âges (58,2%). Les néphropathies glomérulaires représentent 94,2% des maladies rénales diagnostiquées, leur distribution varie selon l'âge des patients. La PBR a confirmé le premier diagnostic suspecté cliniquement dans 40,65 % des cas, alors qu'elle a révélé un diagnostic inattendu chez 22,5% d'entre eux. Le diagnostic syndromique permet d'orienter vers la maladie rénale la plus probable et de guider les thérapeutiques urgentes en attendant les résultats de la PBR. Mais il ne peut en aucun remplacer la PBR qui reste le gold standard.Pan African Medical Journal 2016; 24

Sclerodermic renal crisis is defined as a severe arterial hypertension or rapidly progressive glomerulonephritis in a sclerodermic patient, associated with anuria due to no other cause but systemic sclerodermia. It constitutes a rare and dangerous complication. The renal prognosis can be effectively improved by converting enzyme inhibitors, allowing a better arterial hypertension control. However, the associated mortality remains high, a follow up must be instaured in order to prevent the apparition of renal lesions in all sclerodermic patients. We report a case of rapidly progressive renal failure with hypertension in a patient with no previous problems, which preceded the development of scleroderma diffuse cutaneous form. The biopsy showed a microangiopathy in the context of scleroderma renal crisis. The evolution was marked by the presence of chronic renal insufficiency which necessitated the dialysing start.

We present two cases of renal lymphoma revealed by acute renal failure (ARF), which remains a rare clinical entity. Case 1 was a 29-year-old man with an ARF. The diagnosis was a primitive kidney immunophenotype B lymphoma. The patient died after three courses of chemotherapy due to rapid spread lymphoma. The second case was a high-grade renal lymphomatous infiltration, with an unusual computer tomography image of two large kidneys compressing the stomach. Death happened early before initiating therapy. In both cases the diagnosis has been established by renal pathology. Early diagnosis is a key component of therapeutic success, however, the rapid spread of lymphoma worsened renal and vital prognosis.

Background Cytomegalovirus (CMV) infection is associated with a significant rate of morbidity after organ transplantation. The genetic factors influencing its occurrence have been little investigated. IL-12 plays a crucial role in anti-infectious immune responses, especially by stimulating IFNgamma production. An A-to-C single nucleotide polymorphism (SNP) within the 3'-untranslated region of the IL-12p40 gene has been characterized and was reported to be both functionally and clinically relevant. However, the impact of this single nucleotide polymorphism on events after organ transplantation has never been reported. Methods In this study, we investigated the impact of the 3'-untranslated region polymorphism on the occurrence of CMV infection in 469 kidney recipients transplanted at the University Hospital of Tours between 1995 and 2005. The polymorphism was genotyped using the restriction fragment length polymorphism method and CMV infection was determined by pp65 antigenemia. Results Multifactorial Cox regression analysis demonstrated that the presence of the C allele was an independent risk factor for CMV infection (OR=1.52, P=0.043), the risk being even higher when study was restricted to patients with positive CMV serological status before the graft and who did not receive any CMV prophylaxis (OR=1.88, P=0.028). Conclusions This study identified a new genetic risk factor for CMV reactivation after kidney transplantation. The results of our study suggest that C carriers might especially benefit from CMV prophylaxis.

Resume Introduction La glomerulonephrite extramembraneuse (GEM) lupique pure expose a un risque de developper une insuffisance renale terminale, et peut etre fatale. Son traitement immunosuppresseur est peu codifie. Nous decrivons la forme initiale de la GEM lupique dans notre centre et precisons son evolution en fonction du traitement immunosuppresseur choisi. Methodes Etude retrospective incluant toutes les GEM lupiques pures hospitalisees dans le service de nephrologie de Rabat entre 1994 et 2005. Resultats La GEM lupique pure est retrouvee chez 18 patients, soit 16,7 % de nos 108 cas de nephropathies lupiques. L’âge moyen des patients etait de 29 ± 2,1 ans (17–52), avec un sex ratio de 2H/16F. Le suivi moyen etait de 54 ± 31 mois (3–130). La presentation clinique initiale etait marquee sur le plan renal par la presence d’une proteinurie, nephrotique dans 11 cas. La creatininemie etait de 18,6 ± 3,9 mg/L. Une leucocyturie etait observee dans 12 cas (67 %) et une hematurie microscopique dans 8 cas (44 %). Les atteintes extrarenales etaient cutanees (14 cas), articulaires (14 cas), hematologiques (8 cas), cardiaques (6 cas) et neurologiques (4 cas). Les patients ont ete traites par corticotherapie seule (groupe 1 : 7 cas) ou associee au cyclophosphamide en cas d’insuffisance renale ou d’atteinte neurologique (groupe 2 : 11 cas). Onze cas ont connu une remission complete, 7 une remission partielle. Quatre rechutes ont ete observees, dont 3 dans le groupe 2. La creatininemie moyenne a 3 ans etait comparable dans les 2 groupes. Quatre deces de cause extrarenale ont ete observes. Un seul cas d’evolution vers l’insuffisance renale chronique terminale a ete observe dans le groupe 2. Discussion La forme initiale de la GEM lupique est variable. Le cyclophosphamide permet une evolution favorable en cas d’insuffisance renale avancee d’emblee, mais il n’evite pas la survenue de complications letales, notamment neurologiques.

La néphrocalcinose se définit par la présence anormale dans le parenchyme rénal de dépôts calciques pouvant résulter de différentes affections. Nous rapportons le cas d'un nourrisson de 7 mois chez qui nous avons diagnostiqué une hypercalcémie compliquée par une néphrocalcinose secondaire à une tuberculose miliaire aggravée par l'intoxication à la vitamine D améliorée sous hyperhydratation, furosémide et glucocorticoïdes. A travers ce travail, nous insistons sur l'intérêt de la recherche d'une hypercalcémie devant toute infection tuberculeuse, de la prise en charge rapide et adaptée sans oublié d'interrompre la supplémentation en vitamine D.

Fasting during Ramadan is prohibited when an individual′s health is endangered. Little work has been published in this direction in patients with chronic kidney disease (CKD). We aimed to evaluate the impact of fasting during Ramadan on the renal function of patients with CKD, adjusting for the initial degree of renal impairment. We prospectively studied 60 patients with CKD (35 females; mean age 45.6 ± 15.8 years). All study patients were older than 15 years, being followed-up at the nephrology clinic for more than six months, having a stable CKD during the preceding six months and who had fasted during Ramadan the previous year. Patients who had a medical contra-indication for fasting were excluded from the study [severe or resistant arterial hypertension, insulin-requiring diabetes, acute renal failure (ARF), active renal disease, repetitive urolithiasis or terminal chronic renal failure]. Statistical analysis was performed in collaboration with the epidemiology lab at the Fez Medical School using the SPSS software version 17. Three of the study patients developed ARF in the first week and four of them at the end of the month of the study period. The risk of developing ARF was significantly higher for patients with baseline creatinine clearance of

Le syndrome des jambes sans repos (SJSR) ou syndrome d'impatience musculaire est un trouble moteur caractérisé par des sensations désagréables dans les jambes. Les causes sont mal connues et sa fréquence est estimée entre 25% et 75% chez les hémodialysés. Il s'agit d'une étude transversale monocentrique menée au centre d'hémodialyse du CHU Hassan II de Fès (hôpital Al Ghassani) entre décembre 2012 et janvier 2013. Nous avons défini le syndrome de jambes sans repos selon la définition de l'international restless legs study group de 2003 reposant sur 4 critères essentiels au diagnostic. L'international restless legs syndrome scale (IRLES) a été coté par un même néphrologue pour mesurer la sévérité du syndrome des jambes sans repos. 84 hémodialysés ont répondu au questionnaire avec 41,7% de cas de SJSR dont 6,6% de formes graves. Nous avons retrouvé une association entre le SJSR et la carence martiale p(0,018), la néphropathie initiale p(0,041), l'HTA p(0,026) et le sexe féminin p(0,024). Dans notre série, il ressort que la carence martiale et l'HTA sont les principaux facteurs de risque modifiables de ce syndrome chez nos patients. Les facteurs traditionnels comme le tabagisme, l'âge supérieur à 50 ans et la dialyse inadéquate ne sont pas associés à ce trouble dans notre série.

The liver biopsy has long been the "gold standard" for assessing liver fibrosis in patients with hepatitis C. It’s an invasive procedure which is associated with an elevated bleeding, especially in chronic hemodialysis patients. Main goal is to assess liver fibrosis in chronic hemodialysis with HCV by Fibroscan and by biological scores (APRI, Forns and Fib-4), and to measure the correlation between these tests. Cross-sectional study including all chronic hemodialysis patients with hepatitis C virus, in two public hemodialysis centers of Fez. All patients were evaluated for liver fibrosis using noninvasive methods (FibroScan and laboratory tests). Subsequently, the correlation between different tests has been measured. 95 chronic hemodialysis were studied, twenty nine patients (30.5%) with chronic hepatitis C. The average age was 52.38 ± 16.8 years. Nine liver fibrosis cases have been concluded by forns score. Fibroscan has objectified significant fibrosis in 6 cases. On the other side APRI has objectified sgnifivant fibrosis only in 3 cases. The Fib-4 showed severe fibrosis in five cases. The results have been most consistent between APRI and Fib-4, followed by Fibroscan and Forns, then APRI and FibroScan.Key words: APRI, fib4, fibroscan, forns, hepatitis C virus, liver fibrosis, chronic hemodialysis

la correction et la stabilité du taux d'hémoglobine est un objectif majeur du traitement de l'anémie chez les hémodialysés chroniques. Toutefois, la cible d'hémoglobine > 11g/dl fixée par les recommandations demeure difficile à atteindre dans notre contexte. Le but de cette étude est d'évaluer la réponse au traitement par CERA (continuous erythropoietin receptor activator) chez une population d'hémodialysés chroniques naïfs de tout traitement par agent stimulant de l'érythropoïèse et étudier les différents facteurs associés à une mauvaise réponse au traitement. Il s'agit une étude prospective mono centrique faite au sein d'une population d' hémodialysés chroniques. Ont été inclus les patients en hémodialyse depuis plus de 12 mois, naïfs de tout traitement par agent stimulant de l'érythropoïèse (ASE) et ayant un taux d'hémoglobine(Hb) < 10g/dl. L'administration régulière de la CERA et l'ajustement des doses ont été faits selon les recommandations. L'évaluation de la réponse, en fin de traitement, a porté sur l'atteinte ou non d'un taux d'hémoglobine cible > 11g/dl. Sur 87 patients en hémodialyse périodique, 22 (25,3%) sont naïfs de tout traitement par ASE. Il s'agit de 13 hommes et 9 femmes avec un âge moyen de 46 ± 19 ans et une ancienneté en hémodialyse de 67 ± 59 mois. Le taux initial d'hémoglobine est de 7,8 ± 1,3 g/dl. Au bout de 4 mois de traitement régulier par la CERA, le taux final d'Hb est de 10,9 ± 2,1g/dl et 63,6% des patients ont atteint la cible d'Hb > 11g/dl. La dose moyenne de CERA à la fin de l'étude est de 0,89 ± 0,35 µg/kg/15j. L'analyse des facteurs prédictifs montre que la réponse finale dépend du taux d'Hb initial (p=0,002).En effet, quand le taux d'Hb initial est > 8 g/dl, le taux de réponse est de 88% vs 46% lorsque le taux d'Hb < 8g/dl (p

Resume L'hemodialyse periodique ne peut se resumer a ses seules complications somatiques ni a la technicite de son traitement. But de l'etude. – Etablir le lien entre la satisfaction des criteres de dialyse adequate et le profil psychologique des hemodialyses. Patients et methodes. – Etude transversale sur 93 patients adultes en hemodialyse au centre de dialyse de l'hopital Ibn-Sina de Rabat en avril 2003. Trois tests ont ete realises par un psychiatre. Il s'agit d'une echelle d'evaluation psychiatrique globale (BPRS) et des echelles de depression et d'anxiete de Hamilton. Nous avons aussi etudie les caracteres anthropometriques, les comorbidites, le deroulement des seances de dialyse et les criteres de dialyse adequate suivants : volume extracellulaire, retention azotee, nutrition, equilibre phosphocalcique, potassique et acidobasique, anemie et etat inflammatoire. Resultats. – La prevalence de la depression et de l'anxiete est d'environ 2/3 des cas. Ces deux pathologies sont correlees entre elles et avec le sexe feminin et les antecedents de diabete. De plus, les pressions arterielles, la prise de poids interdialytique, l'albuminemie, la creatininemie en predialyse, et la serologie de l'hepatite virale C sont correlees au score de depression. Conclusion. – La poursuite de cette etude recherchera les effets de la therapeutique psychiatrique sur la qualite de dialyse.

Tumoral calcinosis is an uncommon and severe complication of hemodialysis therapy. The most important pathogenic factor involved in uremic tumoral calcinosis is an increase in calcium-phosphorus product, not necessarily related to hyperparathyroidism. We report here a patient on hemodialysis who presented with increasing multifocal and uncommon sites of massive calcifications. The patient was examined, and a diagnosis of uremic tumor calcinosis was made. The patient was treated with the noncalcemic phosphate binder sevelamer, a strict diet, multiple hemodialysis sessions per week, and a low calcium dialysate, with improvement on biological findings a decrease in the volume of some tumors on his fingers and a global stable disease. Some nodes in hands and feet disappeared; in other sites, their diameter was reduced, and the largest nodule decreased from 5- to 2-cm diameter.

Patients undergoing hemodialysis therapy develop serious osteoarticular diseases. The treatment is based on prevention. The aim of our study is to determine the frequency and the associated factors to the rheumatic manifestations in hemodialysis patients. A cross-sectional study was conducted, including all hemodialysed patients in our dialysis unit. Information was obtained from patients' symptoms, examination findings, and biological and radiological signs. The frequency of symptoms was 70% in our patients. It was proportional to the duration of hemodialysis and number of hemodialysis sessions per week. Early transplantation is of course a plausible solution, but other therapies such as improved dialysis must be considered.

L'infection urinaire est l'infection nosocomiale la plus fréquente. Elle constitue un véritable problème de santé publique par la surmortalité et le surcoût qu'elle entraîne. L'objectif de notre étude est de déterminer l'incidence et le profil des IU nosocomiales dans un service de Néphrologie. Etude rétrospective sur dossier de tous les patients hospitalisés dans notre service durant l'année 2011, ayant bénéficié d'un examen cytobactériologique des urines. Ont été exclus, tous les patients admis avec une IU connue ou active. 325 dossiers ont été retenus. L'incidence de l'IU nosocomiale était de l'ordre de 16,9%. La durée moyenne d'hospitalisation était de 14,1±10,15 jours. 30% de nos patients ont été transférés du service des urgences. 80% des IU nosocomiales étaient compliquées. Le germe responsable était E.Coli dans 2/3 des cas dont 14,5% était à E.Coli sécrétrice de bétalactamases à spectre étendu. L’évolution après traitement était favorable chez 90,7%. En analyse multivariée, les facteurs de risque pour contracter une IU nosocomiale étaient le sexe féminin; le sondage urinaire et l'antécédent d'IU à répétition. Nos résultats rejoignent ceux de la littérature concernant les facteurs de risque liés à la survenue de l'IU nosocomiale, la fréquence des infections à entérobactéries, et l’émergence de souches résistantes. Une Surveillance microbiologique et une évaluation de la résistance aux antibiotiques constituent une ligne de défense pour faire face à l'accentuation de nouvelles souches bactériennes de plus en plus résistantes aux antibiotiques rendant les options thérapeutiques très limitées.

INTRODUCTION: Le diabete represente la premiere cause de mortalite par insuffisance renale au Maroc. Sa prevalence selon l'Enquete Nationale sur la Population et la Sante Familiale de 2011 est de 3,3% [1]. Le but de ce travail est de determiner la prevalence et d'etudier le profil clinique des diabetiques en hemodialyse chronique au Maroc. METHODES: Il s'agit d'une etude transversale multicentrique incluant 2066 hemodialyses chroniques dans les 39 centres d'hemodialyse de quatre regions marocaines. RESULTATS: La prevalence du diabete en hemodialyse est 21,6 %. L'âge moyen 59±13,2 ans (26-87). Le sex-ratio est de 1,9. L'IMC moyen est de 24,5 ± 4,4 kg/m2 (15-41). 42 patients sont porteurs d´une hepatite virale. La duree moyenne en HD est 39,3± 67 mois. 57 % des patients gardent une diurese residuelle versus 43% chez les non diabetiques. Par rapport a ces derniers, nous avons note plus d'HTA (64% versus 45%), plus de complications cardiovasculaires (23% versus 12%), un âge plus avance a l'initiation de l'hemodialyse (55,5 versus 47 ans) et un taux de FAV proximales plus important. CONCLUSION: La prevalence des diabetiques en hemodialyse est relativement elevee au Maroc sans tenir compte des patients qui ne beneficient pas d'epuration extra-renale pour des raisons socio-economiques. Le taux eleve de mortalite est imputable au retard et/ou a l'absence de la prise en charge nephrologique des diabetiques. Dans nos regions ou le systeme sanitaire dispose de faible moyen, l'accent doit etre mis sur le depistage precoce de la nephropathie chez le diabetique.

Le syndrome du canal carpien (SCC) regroupe l'ensemble des signes et symptômes liés à la compression du nerf médian dans le canal carpien. Cette manifestation de l'amylose à béta2-microglobuline est une complication fréquente de l'hémodialyse au long cours. L'objectif de ce travail est d'analyser les caractéristiques du SCC et de déterminer les facteurs liés à sa survenue chez les hémodialysés chroniques.Nous rapportons une étude transversale monocentrique, menée au 3ème trimestre de l'année 2009, portant sur les patients adultes hémodialysés chroniques au service de Néphrologie-Hémodialyse au CHU de Fès. 59 patients ont accepté de participer à l'étude. Leurs âge moyen est de 48 ± 15 ans avec un sex-ratio de 0,9. Ils bénéficient tous de l'hémodialyse intermittente à raison de 10 à 12 heures par semaine, par une membrane de dialyse en polysulfone à basse perméabilité. La durée moyenne en hémodialyse est de 83 ± 6,5 mois. La prévalence du SCC dans notre centre est de 30,5%. L'électromyogramme (EMG) a confirmé la suspicion clinique du SCC chez 11 patients et a diagnostiqué un SCC chez 8 patients asymptomatiques. La comparaison statistique entre les deux groupes de patients avec et sans SCC a démontré que la survenue de ce syndrome est liée à: l'âge actuel, l'âge avancé à la mise en hémodialyse, le sexe féminin, l'excès pondéral, et l'abord vasculaire. Le SCC est une complication fréquente de l'hémodialyse chronique. L'amélioration de la qualité de dialyse permettrait de réduire le risque de survenue du SCC.Pan African Medical Journal 2013; 14:19

Introduction. Acute kidney injury (PRAKI) continues to be common in developing countries. The aim of this paper is to study AKI characteristics in pregnancy and identify the factors related to the unfavorable evolution.Methods. This prospective study was conducted in the University Hospital Hassan II of Fez, Morocco, from February 01, 2011 to January 31, 2012. All patients presenting PRAKI were included.Results. 37 cases of PRAKI were listed. Their ages varied from 20 to 41 years old, with an average of 29.03 ± 6.3 years and an average parity of 1.83. High blood pressure was the most common symptom (55.6%). Thirty-nine percent were oliguric. PRAKI occurred during the 3rd trimester in 66.6% of the cases and 25% of the cases in the postpartum. Hemodialysis was necessary in 16.2% of cases. The main causes were preeclampsia, hemorrhagic shocks, and functional, respectively, in 66.6%, 25%, and 8.3% of the cases. The outcome was favorable, with a complete renal function recovery for 28 patients. Poor prognosis was related to two factors: age over 38 years and advanced stage of AKI according to RIFLE classification.Conclusion. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation.

L'association Kaposi–myelome multiple est extremement rare. Nous rapportons, le cas d'un patient âge de 76 ans suivi dans notre formation pour un myelome a immunoglobuline A kappa stade III-B selon Durie et Salmon. Ceci a ete associe a des lesions cutanees dont la biopsie cutanee etait en faveur d’une maladie de Kaposi. La serologie de l’herpes virus humain de type 8 (HHV8) est revenue positive. Une radiotherapie sur les lesions etait refusee par le patient. L'evolution etait marquee par une alteration de l'etat general. Le patient ayant refuse la radiotherapie et toute prise en charge therapeutique est decedee deux mois plus tard. Nous rapportons, a notre connaissance, le 18eme cas mondial de maladie de Kaposi associee a un Kahler chez un patient HHV8 positif. C'est une association exceptionnelle rendant probable le role pathogenique de HHV8 dans le developpement du myelome.

International audience; Alagille syndrome (AGS; Online Mendelian Inheritance in Man no. 118450) is a multisystem autosomal dominant disorder with highly variable expression characterized by chronic cholestasis caused by a paucity of interlobular bile ducts, skeletal abnormalities, peculiar facies, ocular abnormalities, and cardiovascular disorders. AGS is diagnosed almost exclusively in children in the setting of predominant liver manifestations or, more rarely, in their adult relatives. We report 2 patients in whom AGS was diagnosed in adulthood during the workup of renal disease in the absence of a well-defined familial history. Renal disease caused by AGS probably is underdiagnosed in adult patients.

The contribution of renal biopsy (RB) is of major importance in the management of many renal diseases in children. Specific indications for performing biopsy in children include steroid-resistant nephrotic syndrome (NS) and secondary nephropathies. The aim of our study was to report the common histological varieties of kidney diseases in children in Morocco. In this retrospective and descriptive study, we included all renal biopsies performed in patients under 16 years in the Department of Pediatrics of Hassan II University Hospital, Fez, Morocco from July 2009 to December 2013. Biopsy samples without glomeruli and those with less than five glomeruli or repeat biopsies on the same patient were excluded from our study. We performed 112 RBs during this period; the average age at the time of RB was 10.05 ± 4 years and the sex-ratio was 1.07. The indications for RB were NS with hematuria and/or renal failure (RF) in 32.1%, active urinary sediment in 21.4%, isolated NS in 15.2%, RF in 13.4% and steroid-resistant NS in 10.7% of cases. Primary nephropathies represented 59.8% of cases, with a predominance of minimal change disease (MCD) seen in 40.2% of the cases. Secondary nephropathies accounted for 27.7% of the cases, with a predominance of lupus nephritis (11.6%), followed by Henoch-Schonlein purpura nephritis (6.2% of cases) and post-streptococcal glomerulonephritis (3.6%). There was one case of hepatitis B virus-associated membranous glomerulonephritis. Chronic glomerulonephritis accounted for 12.5% of the cases. Vascular and tubulo-interstitial nephritis were rare. Our study confirmed that primary glomerular nephropathy was the most common renal disease in children. The most common lesion was MCD. Secondary nephropathies were less frequent, with a predominance of lupus nephritis.

Auteur(s) : Bahaa Hadj Sadek, Fatima Zahra Batta, Kenza Benzakour, Mohammed Arrayhani, Tarik Sqalli Houssaini CHU Hassan II, Service de Nephrologie-dialyse-transplantation renale, Fes, Maroc Observation Le patient etait âge de 69 ans, diabetique sous insuline, hypertendu traite, hemodialyse depuis 9 ans par une fistule radiale gauche. Les premieres seances d'hemodialyse ont ete realisees par catheter femoral droit. Ce patient se plaignait depuis [...]