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Background: Chronic kidney disease is a worldwide public health issue which is associated with an increased risk of end-stage renal failure and cardiovascular disease. Systemic inflammation exists during chronic renal failure. Recent researches have highlighted the pivotal role of inflammation between renal and cardiovascular disease. The aim of our study is to determine the inflammatory profile of the patient suffering from chronic kidney disease and the influence of hemodialysis on this profile. Methods: We carried out a cross sectional study on 93 patients in the Nephrology Department at Hedi Chaker University Hospital, Sfax, South of Tunisia. Among those patients, 72 patients underwent hemodialysis and 21 patients had chronic kidney disease at stage 3. Clinical data and antecedents were collected. Biological samples were taken after informing the patients and taking their consent. Biological data consisted in lipid profile, albumin rate, hemoglobin rate, uric acid concentration and the usual markers of inflammation noting sedimentation rate, C - reactive protein and orosomucoid. Results: Hemodialysis group of the 72 patients had mean hemodialysis vintage of 54.6 ± 43 months. The inflammatory profile was worse in hemodialysis patients compared to chronic kidney disease patients. Both sedimentation rate, C - reactive protein and orosomucoid were higher in hemodialysis group than in chronic kidney disease group with 71 ± 35.3 mm vs. 42.1 ± 15.5 mm (p < 0.05); 14.6 ± 28.7 mg/l vs. 6.7 ± 8 mg/l (p = 0.02); 1.3 ± 0.7g/l vs. 0.9 ± 0.4 g/l (p = 0.01), respectively. Conclusion: Inflammation increases in dialysis patient. It deserves the nephrologist’s consideration in order to minimize its harmful effects. The monitoring of inflammation markers must be integrated into the nephrologist’s medical practice.

BACKGROUND AND AIMS Fasting during Ramadan is religiously obligatory for Muslims, who account for 1.8 billion of the world's population (24%). The lifestyle habits of Muslims significantly change during Ramadan. The objective of this study is to determine the incidence of hospital admissions for electrolyte disturbances comparatively during Ramadan and the month before and to review the risk factors in a Tunisian population specimen. METHOD We carried out a retrospective study on the hospitalizations for hydroelectrolytic troubles in the nephrology department during Ramadan, i.e. April 2021 (group 1) and one a month earlier, i.e. March 2021 (group 2). RESULTS We have collected 14 patients for group 1 and 9 patients for group 2. The incidence of hospitalizations due to electrolytic disorders amounted to 46.6% for group 1 versus 20.9% for group 2. During Ramadan, the most frequently occurring ionic disorders were hyperkalemia in 71.4% (n = 10), hyponatremia in 21.4% of cases (n = 3) and hypernatremia in 7.1% of cases (n = 1). As compared with group 2, the ionic abnormalities encountered outside the month of youth were hyperkalemia in 66.6% of cases (n = 6), hyponatremia associated with hyperkalemia in 22.2% of cases (n = 2) and hypokalemia in 11.1% of cases (n = 1). All cases of hyponatremia were of depletion in group 1, hyperkalemia was due to dietary error with chronic renal failure, and hypernatremia was secondary to hydrosodic wasting. By reviewing the factors predisposing to develop hydrolytic disorders, we find a higher frequency in group 1 of hypertensive patients (78.5%), chronic kidney failure (35.7%), heart failure and diabetes (28% each) compared with group 2, six patients had hypertension (66.6%), three chronic kidney failure patients (33.3%), one diabetic patient (1.1%) and no patient had heart failure. CONCLUSION At the end of this study, we note that despite the occurrence of the month of Ramadan in spring and the tempered weather, the incidence of ion disorders remains high in a population at risk. Therefore, a strategy of nutritional and behavioral education during the Ramadan month is recommended, with the necessity of a close biological follow-up. This educational therapy must be individualized and specific for each individual patient, and adaptations of the medication are most required to avoid the development of ion disorders.

Background and Aims Sleep disturbances are more common in patients with chronic renal failure and on dialysis than in the general population. They affect their mental health and quality of life. The objective of this study was to evaluate the sleep disorders of patients on peritoneal dialysis (PD). Method We report the results of a descriptive cross-sectional study in 27 patients on PD in order to assess the quality of sleep in these patients and its relation with mental health and quality of life. Sleep quality was performed using the Pittsburgh Sleep Quality Index (PSQI) to assess origin and extent of sleep disorders. Anxiety-depressive disorders were assessed using the HAD (Hospital anxiety and depression) scale. The quality of life (QOL) measurement was performed by the SF36 and KDQoL. Results We included 15 men and 12 women with an average age of 45.74 years (21–77). Eleven patients were on automated peritoneal dialysis (APD) and 16 patients on continuous ambulatory peritoneal dialysis (CAPD). The mean duration of dialysis was 45.77 ± 25 months. Poor quality of sleep was reported in 14 patients. The mean PSQI was 7.22 ± 4.87. The most affected components were sleep duration and usual sleep efficiency. Depression was objectified in 22.22% of patients and 26% of patients had anxiety. Impaired quality of sleep was associated with decreased quality of life. The components of the physical dimension of quality of life: limitation due to physical condition, physical pain were significantly lower in dialysis patients with good quality of sleep (p=0.014, p= 0.033 respectively) The mental dimension component of QOL of SF36: relationship to others, limitation due to mental condition was also lower in patients with sleep disturbances (p=0.039, p= 0.036 respectively). Symptoms and problems, as well as the effects and the burden of kidney disease were not associated with poor quality of sleep. Impaired sleep quality was also not significantly associated with depression or anxiety in our series. Conclusion Sleep disturbances are common in PD patients and are associated with decreased quality of life. Therefore, they must be taken into account in the therapeutic measures recommended in order to improve the quality of life of these patients and reduce morbidity and mortality.

Background and Aims Mesangiocapillary glomerulonephritis (MCGN) is a rare kidney disease with a poor prognosis. Several factors have been described associated with poor renal prognosis. The contribution of alpha smooth muscle actin (α-SMA), which is involved in renal fibrogenesis, has been demonstrated in assessing the prognosis of several glomerular diseases, but few studies have concerned the MCGN. The aim of our study is to determine the epidemiologic profile, to identify prognostic factors and to evaluate the contribution of α-SMA in predicting the prognosis the MCGN. Method Our study is retrospective over a period of 16 years (January 1996- December 2011) including all cases of primary MCGN aged more than 15 years, collected at the nephrology department of the university hospital Hedi Chaker Sfax. We reviewed available renal biopsies for the study of the expression of α-SMA by immunohistochemistry. Results We collected 118 cases of primary MCGN, with mean age of 45 ± 19 years. The incidence of MCGN has decreased from 10 cases / year between 1996 and 1999 to 5 cases / year between 2008 and 2011. 78.8 % of patients had renal failure at the moment of diagnosis. The study of the expression of α-SMA by immunohistochemistry was made in 16 cases. After a mean follow-up of 51.9 ± 44 months, progression to end stage renal failure (ESRF) was observed in 43.5% of cases. Poor prognostic factors were initial renal failure and sclerotic glomeruli (respectively p at 0,04 and 0,03), but interstitial fibrosis degree was not a prognosis predictor parameter while important interstitial expression of α-SMA was a marker of the evolution to ESRF (p = 0.03). Conclusion MCGN has significantly declined over recent years due to improve of socio-economic conditions. The presence of renal failure and sclerotic glomeruli at diagnosis were associated with a poor prognosis. The interstitial expression of α-SMA may be a useful marker to predict the progression of primary MCGN even before the installation of fibrosis.

L’amylose rénale est une complication rare au cours de la maladie de Still de l’adulte. Nous rapportons 3 observations d’amylose rénale parmi une série de 33 cas de maladie de Still de l’adulte. Il s’agit de 3 patientes d’âge moyen de 43 ans (extrême: 33 et 58 ans). Le diagnostic de maladie de Still a été retenu devant une polyarthrite fébrile (3 cas) associée à une éruption cutanée fugace (1 cas), un syndrome inflammatoire biologique en l’absence de toute cause infectieuse, inflammatoire ou néoplasique. Toutes ont été traitées par une corticothérapie associée secondairement au méthotrexate devant une polyarthrite destructrice (2 cas) et devant une récidive (1 cas). Une amylose rénale était survenue 4,9 ans après la maladie de Still (extrême: 33 mois et 7ans). L’amylose était révélée par un syndrome néphrotique (3 cas), associé à une insuffisance rénale (1 cas). Le diagnostic a été posé par une ponction biopsie rénale (3 cas) concluant à une amylose AA (2 cas) et non typée (1 cas). Tous les malades ont reçu la colchicine. L’évolution était favorable chez une patiente alors que les deux autres ont évolué vers l’insuffisance rénale chronique. L’amylose rénale est une atteinte inhabituelle de la maladie de Still de l’adulte. Une fois installée, elle peut engager le pronostic vital.