Search

Secondary renal amyloidosis (RA) is the most common type of renal involvement in ankylosing spondylitis (AS). We assessed the epidemiologic and clinico-biological profile of AS patients with RA, to analyze treatment modalities and prognostic aspects, and to determine predictive factors of RA during AS. This was a retrospective study including 13 cases of RA among 212 cases who presented with AS, during the period from 1978 to 2006. The median age of the patients at the time of diagnosing AS was 47 years (range: 19-67). There were 11 males and two females. RA onset was diagnosed after a mean follow-up of 144.6 months (range: 10-505) from the AS diagnosis. We noted erosive peripheral arthritis, lumbar stiffness with bamboo spine, and coxitis in 23.1%, 76.9%, and 30.8% of cases, respectively. Nephrotic syndrome was found in eight patients (61.5%). At the time of diagnosing RA, six patients had renal failure. Amyloid deposits were histologically proven by salivary gland biopsy in six cases (46.1%) and by renal biopsy in seven cases (53.8%). Four patients received a long-course treatment with colchicine but with a good outcome only in two cases. In our series, AS was more severe among patients with RA. Four predictive factors of RA were identified: smoking (P = 0.04), erosive peripheral arthritis (P = 0.002), bamboo spine (P = 0.001), and biologic indicators of inflammation (P = 0.0001). High erythrocyte sedimentation rate was identified as the only independent risk factor of RA during AS (P = 0.0001). Renal function as well as urinalysis should be monitored at regular intervals to detect early renal involvement during AS.

Autosomal recessive polycystic kidney disease (ARPKD) is the most common childhood-onset ciliopathy. Intracranial aneurysms (ICA) are a serious complication of autosomal dominant polycystic kidney disease (ADPKD). However, there are only three reports about ICA in an adult patient with ARPKD. We describe a rare case of a 29-year-old man with ARPKD presenting with subarachnoid hemorrhage secondary to a ruptured intracranial aneurysm. The diagnosis of ARPKD was at the age of eight years based on typical ultrasonography findings with polycystic kidneys and liver disease. Magnetic resonance cholangiography showed a nonobstructive dilatation of intrahepatic bile ducts. Liver biopsy showed hepatic fibrosis. None of the family members was affected. At the age of 15 years, he had progressed to end-stage kidney disease, and hemodialysis was started. The patient had always a severe arterial hypertension. At the age of 29 years, he complained of headaches with an uncontrolled hypertension and disturbance of consciousness, computed tomography angiography showed subarachnoid hemorrhage and multiple cerebral aneurysms. Early neurologic screening of intracranial aneurysm should be recommended in ARPKD like in ADPKD patients.

Patient: Male, 70 Final Diagnosis: IgG4 RD Symptoms: Jaundice Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Type 1 autoimmune pancreatitis (AIP), also known as lymphoplasmacytic sclerosing pancreatitis (LPSP), is a rare cause of chronic pancreatitis, characterized by a fibro-inflammatory process. However, patients with AIP may have a good response to corticosteroid therapy. We describe a Tunisian patient with AIP that was confirmed to be an IgG4-related disease (IgG4-RD). Case Report: We describe a case of a 70-year-old man who was admitted to hospital for obstructive jaundice and abdominal pain. Serum liver function tests were abnormal and upper abdominal computed tomography (CT) imaging showed diffuse pancreatic swelling and strictures of the main pancreatic duct without any focal lesion. Pancreatico-biliary magnetic resonance imaging (MRI) showed a thickened rim surrounding the pancreatic duct Serum IgG4 levels were elevated, resulting in a diagnosis of IgG4-related AIP. The patient showed a good clinical, biochemical, and radiological response following steroid therapy in combination with azathioprine. Conclusions: The diagnostic workup of IgG4-RD is complex and usually requires a combination of clinical examination, imaging, and serological analysis. As this case report has demonstrated, IgG4-RD should be considered in patients who present with pancreatitis or AIP, because of the favorable response to steroid therapy, particularly when treatment is initiated early.

The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.

Background: Drug-induced acute kidney injury is a common situation in clinical practice. Many treatments are involved and they are even more aggressive when associated with a predisposing factor such as diabetes. We aimed to investigate clinical features of acute drug-induced kidney injury in diabetics in order to clarify renal prognosis. Methods: This was a descriptive and analytical retrospective study including diabetics who presented drug-induced acute kidney injury, conducted in our department during the period from 1986 to 2015. Acute kidney injury was classified according to Kidney Disease Improving Global Outcomes criteria. We analyzed medical records of patients. Results: 31 patients were included with mean age of 65.41 years and gender ratio M/F at 0.93. Diabetes was type 2 in 97% of cases. Mean previous creatinine clearance was 39.33 ml/min/1.73 m2. Drugs involved were blockers of renin-angiotensin system (35%), aminoglycosides (16%), non-steroidal anti-inflammatory (16%), diuretics (13%), lipid-lowering agents (10%), rifampicin (6%) and ifosfamide (3%). Extracellular dehydration was present in nine cases (29%). Main drug combinations were with diuretics in 16 cases (52%) and with ACE inhibitor or ARB in eight cases (26%). Oligo anuria was observed in 5 cases (16%). Proteinuria with urine strips was objectified in 25 cases (81%). Acute kidney injury was grade 3 in 24 cases (77%), grade 2 in three cases (10%) and grade 1 in four cases (13%). Renal survival at 102 months was 57%. Identified renal prognosis factors were serum phosphorus >1.47 mmol/l (p = 0.01), proteinuria at urine strips (p = 0.042), dehydration (p = 0.013), oral antidiabetic treatment (p = 0.038), intravenous rehydration (p = 0.021) and insulin (p = 0.006). Conclusion: Drug-induced acute kidney injury is potentially serious in diabetics. Prevention is essential to improve the prognosis of this renal damage.

A phosphate binder combining calcium and magnesium offers an interesting therapeutic option to control hyperphosphatemia in dialysis patients. We investigated the effectiveness and tolerance of calcium acetate-magnesium carbonate (Ca-Mg). This is a 16-week prospective study including 16 dialysis patients. After an initial two-week washout period, serum phosphorus (sPho) ≥1.8 mmol/L, serum calcium (sCa) ≤2.6 mmol/L, and serum magnesium ≤1.5 mmol/L were the main inclusion criteria. The initial dose of Ca-Mg depended on sPho level and was titrated for every two weeks to have a sPho ≤ 1.8 mmol/L. A second two-week washout period followed the 12 weeks of treatment. Ca-Mg significantly reduced the mean sPho levels from 2.14 to 1.75 mmol/L by the end of the 12-week treatment period (P

Background: Behcet’s disease is a vasculitis affecting several organs. A renal involvement is rarely described. It is most of the time about a renal amyloidosis. Patients and methods: It is a descriptive retrospective study concerning the patients followed in our department for a Behcet’s disease having presented a renal amyloidosis. Results: It is about 4 men with average age of 38.25 years old. The renal involvement was revealed after an average delay of 5.7 years by a nephrotic syndrome in all cases. A renal insufficiency was noted in 3 cases with an average serum creatinine of 587 μmol/l (127 - 1490). The type of the amyloidosis was AA in 2 cases. The treatment contained colchicines in every case. The evolution was marked by the worsening of the renal function leading to end stage renal disease in 3 cases. Death occurred in 1 case and one patient lost to follow up. Discussion: Renal amyloidosis can complicate the evolution of a Behcet’s disease. It occurs generally 1 to 10 years after the beginning of the disease. Once installed, it evolves generally towards the chronic renal insufficiency and can condition the forecast of this affection. Conclusion: Amyloidosis is a rare complication of the Behcet’s disease. Its screening is so desirable to improve the renal prognosis of these patients.

BackgroundPrimary membranous nephritis (PMN) is an autoimmune disease induced by the deposit of antibodies (Ab) to the phospholipase receptor A2 receptor (PLA2R) on podocytes. In this context, we aimed to assess the relationships between anti-PLA2R Ab, PLA2R rs4664308 SNP, PLA2R mRNA levels and PMN susceptibility and outcome.MethodsSixty-eight PMN patients, 30 systemic lupus erythematosus (SLE) patients with secondary MN and 30 healthy control subjects served for anti-PLA2R Ab measurement by ELISA and PLA2R rs4664308 SNP genotyping by a commercial real-time PCR. Twenty patients with tubulo-interstitial nephritis (TIN) were used as controls for renal PLA2R mRNA quantification in PMN patients from kidney biopsies. PLA2R mRNA quantification was carried-out by real-time PCR after RNA extraction.ResultsForty-three (63.2%) PMN patients received initial therapy consisting of alternating monthly cycles of corticosteroids and cyclophosphamide. Twelve (17.6%) patients had resistant PMN to initial therapy and were consecutively treated by cyclosporine or tacrolimus. Anti-PLA2R Ab were positive in 54 (79.4%) PMN patients, while all SLE patients and controls were negative, pConclusionAnti-PLA2R Ab and renal PLA2R mRNA could be useful markers for PMN outcome predicting. The PLA2R rs6446308 SNP is associated with PMN susceptibility in Tunisians.

The arteriovenous fistula (AVF) is the vascular access of the first choice for hemodialysis (HD). Studies on patency of AVF and its affecting factors reveal a high risk for access failure. The aim of this study was to assess the primary and secondary AVF patency and their determinant factors. It was a retrospective, descriptive study conducted in the HD facility of the Nephrology Department in Rabta University Hospital. We included AVF created before December 2009 in end-stage renal disease (ESRD) patients. The end of the follow-up was fixed in December 2013. We included 126 AVFs created in 111 patients; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had peripheral vascular disease. The primary patency rates were 78% at one year and 42% at five years. The secondary patency rates were 80% at one year and 69% at five years. Multivariate analysis revealed that the factors affecting the primary patency of AVF were: the use of jugular catheter for longer than three months (odds ratio (OR):1.91, P = 0.044) and a C-reactive protein >5 mg/L (OR: 1.7, P = 0.049). Aging (>65 years) (OR: 2.46, P = 0.042), referral time to a nephrologist

Endocarditis is one of the most prevalent forms of cardiac involvement in patients with lupus, as it is considered as one a life-threatening complication. Libman-Sacks endocarditis is common. Infective endocarditis can also cause complications within immunocompromised patients. The aim of this study is to determine particularities of endocarditis in patients with lupus and to look for distinguishing features between infectious or immunological origin. A retrospective study was conducted on patients with lupus presenting endocarditis. Lupus was diagnosed according to the American college of rheumatology criteria. The diagnosis of endocarditis was made based on the modified Duke criteria. The present case report studies seven cases of endocarditis. Six of these patients are women and the other one is a man. They are aged meanly of 29.4 years (extremes: 20-36). Fever was present in all the cases with a new cardiac murmur in six cases and a modification of its intensity in one case. Biologic inflammatory syndrome was present in six cases. Cardiac ultrasound performed in six cases made the diagnosis of endocarditis which involved the left heart valves in five cases and the right heart valves in one case. Valvular insufficiency was identified in six patients. The valve involvement was mitral in two cases, mitro-aortic in two others, aortic in the fifth one and tricuspid in the sixth one. Endocarditis was infectious in 4 cases, thanks to positive blood culture. The germs identified were gram negative bacilli in two cases, anaerobic organism in one case and gram positive cocci in one case. Candida albicans was isolated in one case. Libman-Sacks endocarditis was objectified in three cases. A combination of Libman-Sacks endocarditis with infectious endocarditis was diagnosed in one case. The treatment consisted of antibiotics in four cases with surgery in two cases. The outcome was favorable in five cases and fatal in the two others. Endocarditis in lupus can be infectious or Libman-Sacks endocarditis. These two conditions share several clinical features. The only distinctive argument remains positive blood culture. The treatment should be initiated as early as possible to limit the valve damage and improve the outcome.

Transurethral resection of the prostate is currently the gold standard for the surgical treatment of the benign prostatic hyperplasia. This surgery may lead transurethral resection of the prostate (TURP) syndrome and in some cases, acute tubular necrosis can develop. We report a patient who developed hyponatremia, hemolysis and oliguric acute renal failure as a major complication following TURP using glycine as irrigating fluid.A 64-year-old man was admitted for a prostate resection procedure. Physical examination revealed a healthy elderly man. Preoperative laboratory data showed serum sodium 140 mEq/L, blood urea nitrogen (BUN) 0.6 g/L, creatinine 0.7 mg/dL and hemoglobin 12.9 g/dL. Few hours after, the patient becomes incoherent and developed oliguria, nausea and vomiting. The laboratory data revealed rapidly elevating BUN and creatinine levels (BUN 2.4 g/L; creatinine 6.1 mg/dL), the serum sodium concentration decreased by 14 meq/L. A decreased hemoglobin level (7.4 g/dL) with an elevated lactate dehydrogenase level (665 U/L) was observed. Renal ultrasonography was normal. The diagnosis of acute tubular necrosis complicating TURP syndrome was retained. The hyponatremia was slowly corrected to 132 mmol/L by diuresis and fluid restriction. The renal function recovered after four hemodialysis sessions. Using glycine as an irrigant for TURP may cause hyponatremia, hemolysis and also acute renal failure, especially in patients with longer resection time. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.

Survival benefits of renal transplantation over dialysis therapy are well established for patients with end-stage renal disease (ESRD). Transition from one treatment modality to another is common. Understanding the differences in outcomes with the various renal replacement therapies will help nephrologists to provide best advice for dialysis patients. The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. An overview of the various issues related to dialysis modality on kidney transplantation outcomes is discussed in this topic review. These include allograft and recipient survival, the impact of dialysis vintage and choice of dialysis modality on transplant outcomes.

La sarcoïdose est une granulomatose multi viscérale d'étiologie inconnue qui peut revêtir des tableaux cliniques et radiologiques diverses. Les localisations cérébrales bien que rares, peuvent se présenter sous forme pseudo-tumorale trompeuse. Nous rapportons l'observation d'un jeune adulte Tunisien hospitalisé pour hypertension intracrânienne en rapport avec une lésion pseudotumorale radiologique qui a révélé une sarcoïdose systémique.

Celiac disease (CD) is an autoimmune disease affecting multiple organs. It often presents as gastrointestinal manifestations associated with malabsorption. However, serosa involvement uncommonly reveals this enteropathy, making the diagnosis difficult. We here report the case of JA, aged 63 years, admitted to hospital to detect the cause of malabsorption syndrome associated with polyserositis signs including pleurisy, pericarditis, ascites and hydrocephalus. The diagnosis of CD was based on endoscopic signs without serology tests. Patient's evolution was partially favorable, due to lack of compliance with a gluten-free diet. Our study reports the first case of CD revealed by polyserositis. CD should be suspected in patients with malabsorption syndrome, in the absence of evocative signs.

In Tunisia, data assessing the status of mineral and bone disorders (MBD) among dialysis patients is scarce. In order to address this gap in the literature, we sought to conduct this observational study including 4868 patients from 108 hemodialysis facilities nationwide, aiming to: (i) report parameters of MBD during the first quarter 2006, (ii) determine the levels of compliance with the recommendations of the Kidney Disease Outcome Quality Initiative (K/ DOQI), and (iii) compare these levels of compliance with those of Dialysis Outcomes and Practice Patterns Study (DOPPS). Mean serum phosphorus, calcium, calcium- phosphorus product and intact parathyroid hormone (iPTH) concentrations were respectively 1.74 mmol/L, 2.28 mmol/L, 3.95 mmol²/l² and 254 pg/ml. MBD’s measures were met the K/DOQI’s guidelines in 44.1% of cases for serum phosphorus, 42.5% of cases for serum calcium, 68.6% of the cases for calcium phosphorus product, 20.2% of cases for iPTH and 3.3% of cases for these four parameters taken together. These results were comparable to those observed in the DOPPS study. The most phosphate binder prescribed was calcium carbonate (91.2% of cases) with high average daily dose (superior to 1500 mg in 45.8% of cases). Sevelamer and aluminum salt were prescribed respectively in 0.5% and 0.10% of patients. The only active vitamin D available in Tunisia was alfacalcidol; it was prescribed in 49.7% of patients with a mean weekly dose of 4.04 μg. A calcium dialysate bath of 1.75; 1.50 and 1.25 mmol/L were prescribed respectively in 80.2%, 14.7% and 5.1% of cases. This is the first exhaustive study reporting MBD abnormalities in Tunisia and, to our knowledge, in Africa. A second study was stated in January

We report clinical and renal histological data, treatment modalities and outcome of 43 Tunisian children with biopsy-proven lupus nephritis seen over a 23-year period. There were 39 girls and 4 boys with a mean age of 12.5 years at diagnosis of lupus nephritis and followed for a mean period of 77 months. Renal symptoms included urinary abnormalities in all patients, hypertension in 40% of cases, nephrotic syndrome in 60% of cases and renal failure in 25% of cases. Class IV and class III nephritis were observed in 48.8 % and 30.2 % respectively. Corticosteroids were used in all cases, associated to immunosuppressive therapy in 23%. Overall survival was 86% at 5 years and 74% at 10 and 15 years. Renal survival was 83% at 5 and 10 years and 63% at 15 years. Initial renal failure and tubulointerstitial fibrosis were significantly increased risk for the development of end-stage renal disease in our study group. Renal histological findings provide the basis for treatment recommendations. Timely performed renal biopsy is greatly needed to accurately determine the prognosis and to guide treatment in children lupus nephritis.

Tunnelled catheter endocarditis is a frequent and sever situation among hemodialysis patients. The management should be fast and multidisciplinary. Case report: We report the case of a 36 year old woman with a history of systemic erythematous lupus, discovered at the age of twenty. She profited from a tunneled catheter because of exhaustion of her venous capital. One year later, the patient had an endocarditis of the tricuspid valve. An echocardiogram demonstrated mobile and friable 8 mm vegetation in the tricuspid valve. Blood cultures were positive for pseudomonas and klebsiella. The catheter was removed at the fifth day of the infection. The patient received antibiotic treatment which was changed on several occasions in front of multiresistant strains. Ten days later, the blood culture showed Candida albicans. The echocardiogram demonstrated an increase of the size of the vegetation to 15 mm. A chest CT carried out in front of a respiratory distress showed pulmonary septic emboli. Tricuspid valve replacement was performed. Culture of native valve was positive for multiresistant candida famata. The patient developed a pulmonary embolism causing her death. Discussion: Endocarditis with permanent catheter is a severe situation with high mortality and poor prognosis among hemodialysis patients. Immune suppression due to a renal failure and auto immune disease can support the development of multiresistant strains difficult to treat. Conclusion: Endocarditis on tunneled catheter is a serious infection. Nephrologists, cardiologists and infectiologists must collaborate in order to provide adequate therapy.

Angiotensin-converting enzyme inhibitors (ACEI) are commonly prescribed drugs for blood pressure (BP) control and renal protection. The use of ACEI is not associated with an increased risk of acute pancreatitis and ACEI-induced angioedema is rare. A 36-year-old woman presented with vomiting, headache, and aphasia. Her BP was 220/100 mm Hg. urine analysis revealed proteinuria (2+), hematuria (3+). Serum creatinine level was at 1125 μmol/L. She had anemia with 6.1 g/dL of hemoglobin and thrombocytopenia (61,000/mm3). Renal histology revealed lesions of thrombotic microangiopathy. The diagnosis of atypical hemolytic uremic syndrome was made by the complement factor I deficiency. Plasma exchanges could not be done. She was placed on peritoneal dialysis for renal insufficiency. We introduced an ACE (captopril) for the treatment of high BP. Twelve-hours after taking the first dose, she experienced severe epigastric pain and two episodes of vomiting. Serum lipase was 560 IU/L, and abdominal computed tomography showed Stage B pancreatitis. Twenty-four hours later, the patient developed marked edema of the neck region without dyspnea or dysphonia. Cervical ultrasound revealed the infiltration of the subcutaneous tissues. Captopril was stopped with the progressive disappearance of the edema. Serum lipase was 350 IU/L and then normalized at the end of the 4th day. Clinicians should be careful about widely used drugs and their side effects. ACEI can cause potentially life-threatening complications such as angioedema and acute pancreatitis. Possibly, there could be a common mechanism for the onset of pancreatitis and angioedema under ACEI.

La maladie cœliaque (MC) représente une maladie auto immune touchant plusieurs organes. Elle est souvent révélée par des manifestations digestives avec une malabsorption biologique. Cependant, l’atteinte des séreuses peut exceptionnellement révéler cette entéropathie rendant le diagnostic difficile. Il s’agit du patient JA âgé de 63 ans admis pour exploration de syndrome de malabsorption avec des signes de polysérite à type de pleurésie, péricardite, ascite et hydrocéphalie. Le diagnostic de MC a été porté devant des signes endoscopiques sans arguments sérologiques. L’évolution était partiellement favorable à cause de la mauvaise adhésion au régime sans gluten. Notre observation est le premier cas rapporté d’une polysérite révélant la MC qui devrait être évoquée devant tout syndrome de malabsorption en l’absence de signes évocateurs.

Malnutrition is a common problem among hemodialysis patients. This factor leads to increased morbidity and mortality. This study evaluates the nutritional status of patients on dialysis and analyses the various parameters used for assessing malnutrition. It is a cross-sectional study of 35 patients aged 18 years and up who have undergone dialysis three days a week for more than a year. The following were analysed: overall subjective assessment technique, Body Mass Index, anthropometric data and biological parameters (serum albumin, serum cholesterol, rate of alkaline reserves and C-reactive protein levels) with a dietary three-day survey. Analysis of food survey data was performed using the software Bilnut. The patients’ average age was 46.7 years with a sex ratio of 1.18. Average waist size was 92.7±16.68 cm. Average arm circumference was 27.2±5.6 cm and average calf circumference was 32.03±5.87 cm. Malnutrition was found in 48% of cases according to SGA. Average BMI was 24.4 kg/m2. It was less than 23 Kg/m2 in 48% of cases. Average serum albumin concentration was 33.6 g/l and average CRP level was 6.16 mg/l. The average energy intake (Kcal/Kg/day) was 30.87±11.92 the day of dialysis, 27.98±9.31 on a resting day and 29.93±9.42 on another day and the average protein intake (g/kg/day) was 1.02±0.44 the day of dialysis, 0.94±0.36 a resting day and 1.04±0.36 on the other day. Malnutrition was frequent among our patients. The assessment of nutritional status in patients on dialysis requires simultaneous combination of several clinical, biologic and dietetic markers. Dietary management is mainly based on food survey regularly established.

Renal complications in Graves' disease are rare and may be related either to the disease itself or secondary to antithyroid drugs.We report 6 cases of renal damage in patients with Graves' disease treated with Benzylthiouracil collected over a period of 14 years.There were 6 women with a mean age of 37.86 ± 14.25 years. All patients developed renal vasculitis associated with ANCA. The signs were dominated by renal proteinuria and renal failure associated with hematuria in all cases. The lung involvement was the most common extrarenal manifestation occurred in 4 patients (alveolar hemorrhage in 2 cases, lymphocytic alveolitis in 1 case and pleurisy in 1 case). The benzylthiouracil was discontinued in 3 patients still under treatment. Corticosteroid therapy was used alone or in combination with cyclophosphamide in all cases. Plasmapheresis sessions were made during the alveolar hemorrhage. A complete remission was obtained in one case and incomplete remission in 2 cases. The other 3 patients required chronic hemodialysis. One patient died of sepsis.The possibility of renal impairment in antithyroid drugs treated Graves' disease requires monitoring to detect urinary abnormalities in order to early initiate therapy and improve patient's outcome.

Malgré les progrès réalisés dans le traitement de l’insuffisance rénale chronique, l’accès vasculaire reste le maillon faible dans la thérapie de suppléance extrarénale et la principale source de morbidité chez les patients hémodialysés. Nous rapportons l’observation d’une jeune patiente ayant une insuffisance rénale chronique secondaire à une néphropathie vasculaire en hémodialyse périodique, confrontée précocement à un épuisement de son capital vasculaire, en raison de thromboses itératives des fistules artério-veineuses et l’échec de la dialyse péritonéale. Un déficit en protéine C a été objectivé. Elle a bénéficié de la mise en place d’un cathéter tunnelisé au niveau de l’oreillette droite par thoracotomie antéro-latérale droite à travers la veine cave inférieure non fonctionnel au bout de trois mois de son utilisation. Elle est depuis dialysée par ponction des veines jugulaires externes.

We will study the epidemiologic, clinical, biological, therapeutic, prognostic characteristics and predictive factors of development of nephropathy in ankylosing spondylitis patients. We retrospectively reviewed the medical record of 32 cases with renal involvement among 212 cases of ankylosing spondylitis followed in our service during the period spread out between 1978 and 2006. The renal involvement occurred in all patients a mean of 12 years after the clinical onset of the rheumatic disease. Thirty-two patients presented one or more signs of renal involvement: microscopic hematuria in 22 patients, proteinuria in 23 patients, nephrotic syndrome in 11 patients and decreased renal function in 24 patients (75%). Secondary renal amyloidosis (13 patients), which corresponds to a prevalence of 6,1% and tubulointerstitial nephropathy (7 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (4 patients). Seventeen patients evolved to the end stage renal disease after an average time of 29.8 ± 46 months. The average follow-up of the patients was 4,4 years. By comparing the 32 patients presenting a SPA and renal disease to 88 with SPA and without nephropathy, we detected the predictive factors of occurred of nephropathy: tobacco, intense inflammatory syndrome, sacroileite stage 3 or 4 and presence of column bamboo. The finding of 75% of the patients presented a renal failure at the time of the diagnosis of renal involvement suggests that evidence of renal abnormality involvement should be actively sought in this disease.

Cette étude a pour objectif d'évaluer la fréquence des facteurs de risque cardiovasculaires au cours du lupus et de préciser leur prévalence. Etude rétrospective portant sur 250 patients ayant un lupus, diagnostiqué selon les critères de l'ACR, hospitalisés entre 1970 et 2013. Les données cliniques et para cliniques ont été recueillies à partir des observations médicales. Il s'agit de 228 femmes et 22 hommes d'âge moyen au diagnostic du lupus de 30, 32 ans (extrêmes: 16-69). La durée moyenne du suivi des patients était de 64 mois (extrêmes: 7 jours- 382mois). Quatre vingt dix patients (36%) étaient hypertendus, 74% avaient une hypercholestérolémie et 22% étaient diabétiques. Pour les autres facteurs de risque cardiovasculaire traditionnels, un âge > 50 ans a été retrouvé dans 40% des cas, le sexe masculin dans 8% des cas, l'obésité dans 76% des cas et le tabagisme dans 11% des cas. Les facteurs de risque surajoutés sont représentés par la présence des anticorps antiphospholipides (47% des cas), la néphropathie lupique (49% des cas), l'insuffisance rénale (42% des cas), la corticothérapie au long cours (74% des cas) et la chronicité de la maladie dans 35% des cas. Les complications cardiovasculaires retrouvées dans notre série étaient: les accidents vasculaires cérébraux (2%) et l'insuffisance coronarienne (5,6%). Devant l'importance du risque cardiovasculaire au cours du lupus, une surveillance rapprochée des facteurs de risque cardio-vasculaires semble primordiale chez les lupiques.

Disturbed kidney function is a common complication after bone marrow transplantation. Recently, attention has been given to immune-mediated glomerular damage related to graft versus host disease (GVHD). We describe a 19-year-old woman who developed membranous glomerulonephritis after bone marrow transplantation (BMT). Six months later, she developed soft palate, skin and liver lesions considered to be chronic GVHD. Fifteen months after undergoing BMT, this patient presented with nephrotic syndrome. A renal biopsy showed mem-branous glomerulonephritis associated with a focal segmental glomerulosclerosis. She was started on corticosteroid treatment with good outcome.

Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 74 patients with ESRD (38 males, 36 females), maintained either on chronic HD (n= 50) or chronic PD (n= 24) and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy) and C reactive protein (CRP) were measured. When compared to a healthy popu-lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A (Apo A), CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C), Apo B, albumin (ALB). A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe-rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio-vascular risk in dialysis patients.

Acute rejection episodes (AREs) are a major determinant of renal allograft survival. The incorporation of new immunosuppressive agents explains, at least partially, the improvement seen in the results of transplantation in recent years. The objectives of this study are to analyze the incidence and severity of AREs, their risk factors and their influence on graft and patient survival. We retrospectively studied 280 kidney transplants performed in adults at the Charles Nicolle Hospital, Tunis, between 1986 and 2004. The diagnosis of ARE was based on clinical data and response to treatment. Allograft biopsies were performed in ten cases. The treatment of AREs consisted of pulse methylprednisolone and anti-thymocyte globulin. There were 186 males (66.4%) and 94 females (33.6%), and their mean age was 31 ± 8.9 years. Overall, the 280 study patients experienced a total of 113 AREs. Of them, 85 had only one ARE, 28 had two to three and none had more than three AREs. A total of 68 AREs were completely re-versible, 42 were partially reversible while three could not be reversed with treatment. The mean inci-dence of AREs was 40.4%. The incidence was > 45% between 1986 and 1997, decreased to 20.5% between 1998 and 2000 and to 9% between 2001 and 2004. Graft survival rates in patients with and without AREs were respectively 91% and 93% at three years, 82% and 90% at five years and 73% and 83% at 10 years. We found a decrease in the incidence of AREs in recent years in our study patients, and this was related to the introduction of sensitized cross-match and the newer immunosuppressive agents, particularly MMF. Additionally, AREs had a deleterious impact on late graft survival in our study population.

Cette étude a pour objectif d’évaluer la fréquence des facteurs de risque cardiovasculaires au cours du lupus et de préciser leur prévalence. Etude rétrospective portant sur 250 patients ayant un lupus, diagnostiqué selon les critères de l'ACR, hospitalisés entre 1970 et 2013. Les données cliniques et para cliniques ont été recueillies à partir des observations médicales. Il s'agit de 228 femmes et 22 hommes d’âge moyen au diagnostic du lupus de 30, 32 ans (extrêmes: 16-69). La durée moyenne du suivi des patients était de 64 mois (extrêmes: 7 jours- 382mois). Quatre vingt dix patients (36%) étaient hypertendus, 74% avaient une hypercholestérolémie et 22% étaient diabétiques. Pour les autres facteurs de risque cardiovasculaire traditionnels, un âge > 50 ans a été retrouvé dans 40% des cas, le sexe masculin dans 8% des cas, l'obésité dans 76% des cas et le tabagisme dans 11% des cas. Les facteurs de risque surajoutés sont représentés par la présence des anticorps antiphospholipides (47% des cas), la néphropathie lupique (49% des cas), l'insuffisance rénale (42% des cas), la corticothérapie au long cours (74% des cas) et la chronicité de la maladie dans 35% des cas. Les complications cardiovasculaires retrouvées dans notre série étaient: les accidents vasculaires cérébraux (2%) et l'insuffisance coronarienne (5,6%). Devant l'importance du risque cardiovasculaire au cours du lupus, une surveillance rapprochée des facteurs de risque cardio-vasculaires semble primordiale chez les lupiques.

This is a retrospective cohort study over 20 years (1990–2013) that included all patients with biopsy-proven lupus nephritis (LN) followed up at our nephrology department. We aimed to determine the clinicobiologic predictors of flare-up of LN. Flare was defined as an increase in systemic lupus erythematosus (SLE) disease activity index (SLEDAI) score of at least four points. Clinical manifestations and laboratory parameters were assessed and the SLEDAI score was determined for each patient. We included patients with SLE who fulfilled at least four of the American College of Rheumatology criteria for the classification of SLE. A total of 249 patients including 227 females and 22 males with a median age at diagnosis of 34.32 years (range 16–69) were studied. The mean follow-up duration was 122.4 ± 27 months. Renal symptoms included hypertension in 40%, nephrotic syndrome in 30%, and renal failure in 69.4% of the cases. Class IV and class III nephritis (ISN/RPS) were observed in 44.9% and 24% of the patients, respectively. On univariate analysis, flare predictors were age

Introduction L’hyperoxalurie primitive de type 1 (HP1) est une maladie hereditaire autosomique recessive caracterisee par un desordre metabolique lie a un deficit en alanine glyoxylate aminotransferase. Il en resulte une accumulation d’oxalate de calcium dans les differents tissus particulierement le parenchyme renal et le tissu osseux. Patients et methodes Nous avons mene une etude retrospective a propos de 22 patients atteints d’HP1 durant une periode de 30 ans allant de 1985 jusqu’a 2014. Resultats Les patients sont repartis en 11 hommes et 11 femmes. L’âge moyen au moment du diagnostic est de 25,27 ans. Les circonstances de decouverte sont dominees par l’insuffisance renale chronique. Seulement 2 patients etaient asymptomatiques, depistes par l’enquete familiale. La symptomatologie clinique etait dominee par les douleurs lombaires et coliques nephretiques. La nephrocalcinose etait presente chez tous les patients, objectivee par echographie renale. Au moment du diagnostic, 95,4 % des malades avaient une insuffisance renale dont 68,1 % au stade terminal. Le diagnostic positif etait dans la plupart des cas uniquement radiologique. La confirmation biologique (Oxalurie, rapport Oxalurie/Creaturie, analyse biochimique de calcul) n’a ete pratiquee que dans 45,3 % des cas, l’histologie renale dans 36,3 % des cas et l’etude genetique dans seulement 9,09 % des cas. Discussion Le diagnostic d’HP1 chez l’adulte est fait dans la majorite des cas au stade d’insuffisance renale chronique avec une evolution rapide vers le stade terminal. Ceci peut etre du a un defaut d’interpretation et de prise en charge de symptomes precoces de la maladie. Les explorations doivent etre poussees afin de pouvoir depister precocement les cas familiaux. Conclusion L’HP1 est une maladie metabolique grave vu les difficultes therapeutiques. Cependant, pour eviter le recours a un traitement aussi lourd, les efforts doivent porter sur un diagnostic precoce et un traitement preventif codifie.

Resume Introduction La povidone iodee est un antiseptique largement utilise surtout en usage cutane. Malgre son innocuite, des cas d’insuffisance renale aigue rentrant dans le cadre d’une toxicite a l’iode ont ete rapportes. Observation Une femme âgee de 37 ans, sans antecedents particuliers etait suivie pour une sterilite primaire de 4 ans. Elle a eu, dans le cadre de l’exploration de cette sterilite, une hysteroscopie avec opacification par de la povidone iodee. En post operatoire immediat, une insuffisance renale aigue oligurique s’est developpee. Apres traitement par diuretiques et 5 seances d’epuration extra renale, l’evolution etait favorable avec declenchement de la diurese a J18 suivi d’une normalisation de la fonction renale. Discussion La toxicite a l’iode est plus importante quand la povidone iodee est administree in situ au contact des muqueuses. L’insuffisance renale aigue est a type de necrose tubulaire aigue comme chez cette patiente. En l’absence d’autre cause, cette insuffisance renale aigue a ete rattachee a la povidone iodee. Conclusion L’insuffisance renale aigue secondaire a la toxicite a l’iode reste possible surtout si la povidone iodee est administree au contact des muqueuses. L’evolution est en general favorable apres l’arret du contact avec cet agent et le traitement symptomatique.

The acute tubular necrosis (ATN) is common after kidney transplantation. Acute tubular necrosis (ATN) is multifactorial and represents one of the main causes of the delayed graft function. Its impact on graft and patients survival is documented.To study the prevalence of the ATN in kidney transplanted patients, the acute rejection rate and their impact on the graft and the patient survival.We retrospectively studied the frequency of ATN, its causes and its impact on patient and graft survival in 255 kidney transplanted patients between 1986-2006.Thirty-nine patients had ATN (15.29%). They are 25 men and 14 women with mean age of 30.1 ± 12.6 years (8-61) followed for an average of 98 ± 61.76 months. The majority was treated by hemodialysis (79.48%) and half of them were transplanted from kidney of deceased donor. All patients received anti lymphocyte serum and the majority anticalcineurins (69.23%). The outcome was favorable in 26 patients (66.66%) with recovery of diuresis and normalization of renal function after 6 weeks on average. An acute rejection was diagnosed in 21 patients (53.48%). The mean creatinine at 1, 5 and 10 years was 135.3, 159.9 and 121.4 μmol / l. Eight patients had creatinine ² 130 μmol / l at 10 years. Ten patients died from infectious and cardiovascular causes. By comparing the 2 groups ATN + and ATN - we found a statistically significant correlation between ATN and cold ischemia (10 ± 10.9 vs 1.2 ± 4.7 hours, p0.0001) and the interval between the start of dialysis and transplantation (42.18 ± 38.44 vs. 31.1 ± 25.2 months, p= 0.02). No statistical correlation was found between the ATN and gender, age of recipient and donor, warm ischemia, acute rejection, chronic rejection and graft and patient survival at 1, 5 and 10 years.The ATN is more common among transplanted patients from deceased donors. It had good evolution in the majority of cases and it's correlated to cold ischemia and duration of dialysis. Finally, it has no impact on patients and graft survival.

We will study the epidemiologic, clinical, biological, therapeutic, prognostic characteristics and predictive factors of development of nephropathy in ankylosing spondylitis patients. We retrospectively reviewed the medical record of 32 cases with renal involvement among 212 cases of ankylosing spondylitis followed in our service during the period spread out between 1978 and 2006. The renal involvement occurred in all patients a mean of 12 years after the clinical onset of the rheumatic disease. Thirty-two patients presented one or more signs of renal involvement: microscopic hematuria in 22 patients, proteinuria in 23 patients, nephrotic syndrome in 11 patients and decreased renal function in 24 patients (75%). Secondary renal amyloidosis (13 patients), which corresponds to a prevalence of 6,1% and tubulointerstitial nephropathy (7 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (4 patients). Seventeen patients evolved to the end stage renal disease after an average time of 29.8 ± 46 months. The average follow-up of the patients was 4,4 years. By comparing the 32 patients presenting a SPA and renal disease to 88 with SPA and without nephropathy, we detected the predictive factors of occurred of nephropathy: tobacco, intense inflammatory syndrome, sacroileite stage 3 or 4 and presence of column bamboo. The finding of 75% of the patients presented a renal failure at the time of the diagnosis of renal involvement suggests that evidence of renal abnormality involvement should be actively sought in this disease.