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Chronic kidney disease (CKD) treated by hemodialysis (HD) is a worldwide major public health problem. Its incidence is getting higher and higher, leading to an alarming social and economic impact. The survival of these patients is significantly low, especially during the first year of treatment. The purpose of our study was to identify the epidemiological and clinico-biological characteristics of patients at the HD initiation and to reveal the predictive factors of mortality at three months and one year of HD. This is a prospective, analytical, and descriptive study dealing with 229 patients with an end-stage renal disease (ESRD), followed up in the Nephrology Department of Charles Nicolle Hospital and La Rabta Hospital in Tunisia, that was started HD between January and June 2017. A multivariate logistic regression analysis allowed us to identify the independent predictors of mortality at three months and one year. The average age was 60.2 ± 15.3 years, with a gender ratio of 1.41. Seventy-eight percent of patients had more than two comorbidities, 59% had diabetes, and 88% had hypertension. Diabetic nephropathy was the leading etiology of kidney disease (48.9%), while 11% of nephropathies were of unknown etiology. Only 58% were early referred to a nephrologist. The average glomerular filtration rate at HD initiation was 6.06 ± 2.33 mL/min/1.73 m

Background and Aims Nephrotic syndrome (NS) is one of the manifestations of acute or chronic glomerular nephropathy in the elderly. Our study objective was to determine the particularities of NS in the elderly. Method This is a retrospective study, carried out in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. This study included subjects aged 65 years old or over hospitalized for NS. Results We studied 115 patients with an average age of 71 ± 5 years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/l [3-19.5 g/l], the mean albumin level was 20 ± 6g/l and the mean protidemia was 50.6 ± 6.9 g/l. Nephrotic syndrome was impure in 89.5 % of patients with high blood pressure in 54 % of cases, hematuria ≥2 + in 30% of cases and renal failure in 82.7 % of cases. Renal biopsy was performed in 45 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (24.5 %). NS was secondary in 65.2 % of cases mainly to amyloidosis (35.6 %) and diabetes (19 %). Idiopathic nephropaty was dominated by membranous nephropathy (9.5 %) and primitive primitive (MPGN) (4.3 %). The treatment was symptomatic for 84.4% of patients. Corticosteroids and/or immunosuppressive treatment have been used for 15.6% of patients. At the end of follow-up, 35.3 % of patients achieved complete or partial remission and 56.6 % progressed to ESRD. Conclusion Elderly NS was characterized by a poor prognosis due to delayed cosultation and non-uniform treatment strategies. Multicentric study in order to identify different action axes could improve the prognosis of this disease. Multicentric study in order to identify different action axes could improve the prognosis of this disease.

Background and Aims Anti-Glomerular basement membrane disease « anti-GBM » is a rare autoimmune disease. It most often results in a rapidly progressive glomerulonephritis syndrome associated with intra-alveolar hemorrhage. The diagnostic confirmation is histological, by the demonstration of linear deposits of immunoglobulins (IgG) along the glomerular basement membrane. The aim of our study was to describe its epidemiological, clinical, biological, immunological, histological, and evolutionary characteristics and to identify the different prognostic factors for predicting patient survival and renal survival. Method It was a retrospective, descriptive and analytical study including patients over 16 years old with anti-GBM disease proved by kidney biopsy and followed up over a period of 32 years (January 1985 to July 2017), in Internal Medicine Department of Charles Nicolle Hospital of Tunis. Results We collected 32 patients with a sex ratio H/F = 1.13. The mean age at diagnosis was 42 years old with extremes of 18 to 81 years old. The most frequent extra-renal manifestations were pulmonary (53%), neurological (12.5%) and ocular (6%) manifestations. Hematuria associated with proteinuria was constantly found. The latter was nephritic in 31% of patients. All patients had renal insufficiency on admission, oligo-anuric in 60% of cases. The use of extra-renal treatment at admission was necessary in 75% of patients. On the immunological level, the search for anti-MBG antibodies, performed in 20 patients, was positive in 65% of cases. All our patients had undergone a renal biopsy puncture with direct immunofluorescence study. Diffuse extra-capillary glomerulonephritis was observed in 93% of patients. Corticotherapy was initiated in 27 cases, associated with plasma exchange in 21 cases and cyclophosphamide in 17 cases. Nine of our patients died in the first year. Renal outcome was marked by partial remission in 2 cases and end-stage renal failure in 19 cases. In univariate analysis, an age greater than 60 years and the occurrence of respiratory distress were predictors of death. Oligo-anuria and need dialysis on admission were predictive factors for progression to end-stage renal failure. Conclusion Anti-GBM disease is a serious illness. Current therapeutic modalities have significantly improved patient survival. These must be intensive and rapid in order to hope for a favorable renal evolution whose prognosis remains reserved.

Background and Aims Hyperkalemia is a dreadful biological event that can immediately compromise the vital prognosis. Etiologies are many and varied. The aim of our study is to better characterize the epidemiological and clinical aspects of this disorder in order to establish adequate diagnostic and therapeutic strategies in order to intervene effectively and in the shortest possible time. Methods Cross-sectional study carried out over a period of 12 months [January-December 2017] including all emergency calls for hyperkalemia greater than 5.5 mmol / l and undergoing hemodialysis in the nephrology department. Results We collected 185 patients (Sex ratio= 1.43) aged on average 61.8 ± 16.1 years [18-94 years]. 70.3% had serum potassium between 5.5 and 7 mmol / l and 29.7% greater than 7. Patients mainly came from emergencies in 71.4% of cases. Main symptoms consisted in oligoanuria, vomiting, chest pain, and febrile syndrome in 38.9%, 10.8%, %, and 5.9% of cases, respectively. Of these patients, 76.2% are known to be chronic renal failure whose 29.7% are in chronic dialysis. Acute renal failure (ARF) was diagnosed in 30.3% of patients. Of these, 39.4% were functional AKI, 41% were obstructive and organic AKI in 19.6% of cases. Mean serum potassium was 6.7 ± 0.9mmol / l [5.5-11] associated with metabolic acidosis in 52.4% of cases. Mean serum creatinine was 988umol /l[184-3270]. The electrical signs of hyperkalemia were noted in 40% (n = 74) of patients: large T in 28.6% of cases, atrioventricular block (AVB) in 3.8% of cases including a 3rd BAV degree in 1.6% of cases, QRS wide in 11.4% of cases and sinus bradycardia in 7% of cases, Ventricular Extrasystoles and a branch block found respectively in 3.2% of cases. 30.8% (n = 57) of the patients were under hyperkalaemic treatment. In fact, 27 % of patients took a blocker of the renin-angiotensin system, 7% were on aldoactone, 13.5% of patients on þetabloquant,1.6 % of whom were on kaleoride and / or admitted to intensive care and infused with KCl. Medical treatment was started urgently in 42.7 % of cases and included the administration of twenty ml 10% ca gluconate that was given intravenously over 5-10minutes, insulin with glucose ,sodium polystyrene sulfate (Kayexalete) and salbutamol, sodium bicarbonate indicated for severe metabolic acidosis (pH Conclusion Hyperkalemia remains a frequent metabolic disorder. Renal failure and acidosis were the main factors associated to hyperkalemia in our study. The clinical and therapeutic subtleties must be known by any caregiver in order to effectively mitigate the harmful effects of this disorder, mainly in the cardiac function.

Background and Aims Urgent hemodialysis is a very common situation in nephrology and is burdened with high morbidity and mortality. The aim of this work is to study the epidemiological, etiological, clinico-biological and indications of dialysis emergencies, the parameters of the session and the potential complications. Method This is a descriptive study conducted over a period of 12 months (January – December 2017), including all patients who have been admitted to the nephrology department for urgent management in hemodialysis. Results Our study collected a total of 318 patients (sex ratio =1.52), the mean age 60.54 ± [18-95 years]. Patients came mainly from the emergency department (69.8%). 40.9 % of the patients were diabetic and 66,4 % hypertensive, 15.1% had coronary artery disease. Among patients, 80.9% had chronic renal insufficiency, of which 29.6% were end-stage (28% hemodialysis and 1.6% peritoneal dialysis). Urgent hemodialysis was undertaken for threatening hyperkalemia in 58.2% of cases, a poorly tolerated uremic syndrome in 50.8% acute pulmonary edema (APO) in 36.5% of cases, and anuria greater than 12h were the indication in 44.4% of cases and a severe metabolic acidosis in 11.3% of cases. The average duration of the session was 3 hours. Ultrafiltration was necessary in 63.7% of the cases. The blood access was a femoral catheter in 80.6% of the cases. Blood transfusion was indicated in 13.8% of cases. Main complications were dominated by symptomatic arterial hypotension in 12.9% requiring stopping the session in half of cases hypoglycemia in 6.9%, neurological disorder in 6.6% chest pain in 3.5 %. After a year of follow up care, overall mortality was 40% in this population. On multivariate analysis, age (p=0.006) and neurological state according to the glasgow score (p=0.01) were retained as independent factors of mortality in this population. Conclusion A greater prevalence of urgent hemodialysis is observed in our country testifying to the accessibility of this method of extrarenal replacement. Hyperkalemia, uremic syndrom and PAO are the main indications for urgent hemodialysis. Early diagnosis, prompt and relevant management of these patients will determine their prognoses in the short and medium term.

Background and Aims The occurrence of renal involvement during the clinical course of systemic lupus erythematous (SLE) is generally considered to be the most important factor influencing the prognosis in terms of morbidity and mortality. The factors influencing prognosis in lupus nephritis (LN) are variable in literature. The aim of our study was to analyze the clinicopathological correlations, and risk factors associated with renal failure in male patients with LN. Method We retrospectively studied all male patients with kidney biopsy-proven lupus nephritis (LN) treated in our department during the period between 1979 and 2016. Looking for predictive factors related to renal prognosis, we analyzed clinical, biological and histological data by multivariate analysis using the comparison of the survival rates by the log-rank test. Results We collected 41 native renal biopsies showing LN. Patients were aged 32.17 years (17-65 years) at the time of diagnosis of LN. Diagnosis of SLE was made according to the criteria of the American College of Rheumatology. The most common clinical presentation was nephrotic syndrome (61%), and the most frequent pathological finding in sediment was proteinuria (85%). At the time of diagnosis, 17% of patients had hypertension and 39 % of patients had an eGFR under than 60 ml/min/1.73 m2. LN was of class I, II, III, IV and V in 7.5%, 12.5%, 27.5%, 47.5% and 41.5% of the cases, respectively. Fourteen patients developed end-stage renal failure. The presence of hematuria, renal failure at the time of diagnosis, nephrotic syndrome, low complement, proliferative glomerulonephritis (class IV), high activity index score of LN and thrombotic microangiopathy were significantly associated with poor renal prognosis with (p=0.0053), (p=0.0002), (p=0.0186), (p=0.0287), (p=0.0005), (p=0.058), (p=0.0117), respectively. Conclusion Renal failure at the time of diagnosis and active proliferative lesions should be diagnosed and treated as soon as possible because they influence the renal prognosis in lupus man.

Background and Aims With increasing longevity, the numbers of elderly patients presenting with renal diseases including glomerular disease are increasing. Nephrotic syndrome (NS) is a common presentation of glomerular disease in the elderly. We performed this study to assess predictors of renal survival in this population. Method A retrospective study including one hundred and six patients aged 65 years or more hospitalized for NS in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. A multivariate study was carried out, the dependent variable being the evolution towards end-stage renal disease (ESRD). Results We studied 106 patients with an average age of 70 ± 4.5years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.6 [3-19.5 g/l], the mean albumin level was 20 ± 5.6g/l and the mean protidemia was 50 ± 6.9 g/l. Nephrotic syndrome was impure in 89.6 % of patients with high blood pressure in 70.5 % of cases, hematuria ≥2 + in 34.7% of cases and renal failure in 88.4 % of cases. The renal biopsy was performed in 41 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (27 %). NS was secondary in 63.2 % of cases mainly to amyloidosis (35.8 %) and diabetes (19.8 %). Idiopathic nephropaty was dominated by membranous nephropathy (11.3 %) and primitive membranoproliferative glomerulonephritis (MPGN) (6.6 %). At the end of follow-up, 35 % of patients achieved complete or partial remission and 58.5 % progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD uremia ≥ 17 mmol/l (ORa =33.2 [1.3 - 837.7]; p Conclusion Elderly NS was characterized by a poor prognosis, in particular secondary to delayed and non-uniform treatment strategies, hence the need for rising physician awarness about this decease and consultation on a standardized treatment strategies.

Introduction La microangiopathie thrombotique (MAT) serait frequente au cours de la nephropathie a IgA (NIgA), jusqu’a 53 % de prevalence. La presence de MAT influence-t-elle la valeur pronostique du score MESTC ? Description Nous avons selectionne les cas de NIgA biopsies entre1995 et 2017. Nous avons inclus les patients âges de plus de 16 ans ayant au moins une lesion de MAT a leur biopsie renale. Les NIgA secondaires et les vascularites a IgA ont ete exclues. Methodes Le test Chi2 a ete utilise pour l’etude d’association du MESTC avec la dialyse [IC = 95 %, p Resultats Cinquante dossiers ont ete inclus : âge = 34 ans ± 10 ; proteinurie = 3,2 g/24H ± 1,8 ; clairance creatinine mediane = 23 mL/min/1,73 m2. Des lesions M1, E1, S1, T1, T2, C1 et C2 ont ete observees respectivement dans 60 %, 8 %, 88 %, 16 %, 70 %, 10 % et 14 % des cas. Le score cumule MESTC etait egal a un, deux, trois, quatre, cinq, six et sept respectivement dans 8 %, 12 %, 30 %, 32 %, 8 %, 10 % et 0 % des cas. La dialyse etait significativement associee a : la fibrose interstitielle (T1 ou T2) (p = 0,02 ; RR = 8,3) en particulier T2 (p Fig. 1 ). Conclusion Le score cumule MESTC et la presence de lesion T2 sont des elements pronostiques eventuels en cas de NIgA primitive avec MAT.

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.

Introduction Le plasmocytome solitaire est une tumeur maligne rare localisee. Les localisations osseuses sont les plus frequentes. Les plasmocytomes extra-medullaires (PEM) sont beaucoup plus rares. Ils sont localises le plus souvent au niveau des voies respiratoires superieures. Description Nous rapportons une observation de PEM mediastinal revele par une insuffisance renale en rapport avec amylose renale de type AA. Methodes A propos d’un cas d’une amylose renale AA compliquant un PEM. Resultats Patient âge de 52 ans aux antecedents d’ulcere gastrique complique d’hemorragie digestive et d’hypertension arterielle sous inhibiteur calcique depuis 2 ans, hospitalise pour prise en charge d’une insuffisance renale avancee. A l’examen, sa PA etait a 160/100 mmHg avec une tumefaction bilaterale des 2 genoux. A la biologie, il avait une insuffisance renale (creatinine a 536 μmol/L), une anemie normochrome normocytaire aregenerative (hemoglobine a 8 g/dL), un bilan phosphocalcique normal (calcemie a 2,28 mmol/, phosphoremie a 1,97 mmol/L et PTH a 185 pg/mL) et une proteinurie de 24 h a 0,4 g/24 h. L’electrophorese des proteines seriques a objective une hypergammaglobulinemie a 26 g/L. L’immunoelectrophorese des protides a montre une gammapathie monoclonale de type immunoglobulines A Kappa. Le dosage des chaines legeres libres seriques a montre une elevation des chaines Kappa avec un ratio Kappa/Lambda eleve a 90. L’echographie renale a montre des reins de taille normale avec une bonne differenciation corticomedullaire. A la radiographie thoracique, il existait un elargissement mediastinal avec la presence d’une opacite retro-cardiaque. Le scanner thoracique a objective la presence d’une volumineuse masse tissulaire heterogene mediastinale moyenne lateralisee a droite, non infiltrante de 11,2 cm de grand axe. La radiographie du squelette n’a pas montre de lesions osteolytiques. Le myelogramme etait normal avec un taux de plasmocytes a 2 %. L’analyse histologique de la biopsie osteomedullaire a montre une mœlle de richesse normale. Il a beneficie d’une tumorectomie chirurgicale de la masse thoracique retrouvant a l’examen anatomopathologique la presence d’une proliferation a differenciation plasmocytaire avec un abondant depot de substance amyloide evoquant en premier lieu un plasmocytome. L’histologie renale a montre une amylose renale de type AA. Le diagnostic d’un PEM secretant complique d’une amylose renale AA a ete retenu. Le traitement a comporte une chimiotherapie a base de melphalan et dexamethasone. Sur le plan renal, le patient est au stade d’insuffisance renale terminale necessitant le recours a l’hemodialyse chronique. Conclusion Le PEM est une tumeur rare pouvant se compliquer d’une amylose le plus souvent de type AL. Son association a une amylose AA n’a pas ete rapportee a notre connaissance dans la litterature. Le traitement est base surtout sur la chirurgie associee a une radiotherapie ou chimiotherapie.

Introduction La prevalence de la microangiopathie thrombotique (MAT) au cours de la nephropathie a IgA (NIgA) varie beaucoup selon les etudes (de 1,5 a 53 %). Deux etudes recentes viennent de l’evaluer a 20 %. Description Nous avons determine la prevalence et l’incidence annuelle de la MAT au cours de la NIgA primitive dans un centre de reference et nous avons degage les caracteristiques epidemiologiques en cas de MAT. Methodes Nous avons selectionne les dossiers de tous les adultes biopsies et suivis a notre centre pour NIgA primitive de 1995 a 2017. Ont ete exclus de cette etude, les patients suivis pour moins de 3 mois et chez qui une NIgA secondaire n’a pas ete elimine. Nous avons ensuite etudie les dossiers des patients ayant au moins une lesion de MAT a la biopsie renale. Resultats En 22 ans, le diagnostic de NIgA a ete porte chez 519 patients, dont 238 suivis a notre centre. Il s’agissait d’une NIgA primitive dans 186 cas, associee a une lesion de MAT dans 50 cas ; soit une prevalence de la MAT au cours de la NIgA primitive de 26,8 %. L’incidence etait de 2,5 cas/an, elle augmente a 3,5 cas/an a partir de 2005. Le groupe avec MAT avait un âge moyen de 34 ans [18-63] et un sexe ratio H/F de 1,94. Vingt huit pourcent des patients etaient issus d’un mariage consanguin, 50 % etaient tabagiques, 30 % avaient un niveau socio-economique bas et 38 % etaient depourvus de couverture sanitaire. La survie renale moyenne etait de 2,5 ans avec une mediane egale a un an. Conclusion La MAT est une lesion frequente au cours de la NIgA primitive. Une etude de l’impact clinique et pronostique d’une telle lesion est necessaire pour pouvoir discuter de leur eventuelle place dans la classification d’Oxford.

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.

Introduction La nephropathie tubulo-interstitielle immuno-allergique est une cause frequente d’insuffisance renale aigue. Elle est devenue la premiere etiologie des nephrites interstitielles aigues. Methodes Le but de ce travail etait d’etudier les caracteristiques cliniques, histologiques et evolutives des nephropathies immuno-allergiques. Il s’agit d’une etude retrospective sur une periode de 38 ans (1980–2018). Nous avons inclus tous les patients ayant une nephropathie tubulo-interstitielle aigue prouvee histologiquement dont l’etiologie etait une cause immuno-allergique. Resultats obtenus ou attendus Nous avons collige 19 cas. L’âge moyen etait de 36,5 ans (17–73 ans). Il s’agissait de 5 hommes et 14 femmes. La duree moyenne d’exposition au medicament en cause etait de 6,5 jours(3–14 jours). Cliniquement, une alteration de l’etat general a ete notee dans 12 cas, une fievre dans 10 cas et un rash cutane dans 7 cas. Deux patients uniquement avaient une oligurie. La creatinemie moyenne a la decouverte de la nephropathie etait de 648 umol/l. La triade classique (fievre-rash cutane-hyper-eosinophilie) n’etait presente que chez 6 malades. La ponction biopsie renale a montre la presence d’un infiltrat inflammatoire interstitiel qui etait lymphoplasmocytaire dans 9 cas. Il etait fait essentiellement par des monocytes dans 4 cas, des polynucleaires eosinophiles dans 4 cas, et il etait polymorphe chez 2 patients. Les lesions tubulaires associees etaient representees par une necrose tubulaire aigue dans 5 cas, une tubulite dans 4 cas et une atrophie tubulaire dans 3 cas. L’arret du traitement suspect a ete indique pour tous les patients. Une corticotherapie orale a ete indiquee chez 10 malades. Apres un suivi moyen de 4,2 ans, une remission renale a ete obtenue chez 11 patients,6 patients avaient une insuffisance renale chronique dont 2 patients etaient en hemodialyse chronique, un malade etait perdu de vue et 2 patients etaient decedes. Conclusion La nephropathie immuno-allergique est une cause sous-estimee d’insuffisance renale aigue. L’interet de la corticotherapie reste un sujet de controverse.

Introduction La nephropathie tubulaire et interstitielle avec uveite (NITU syndrome) est une atteinte auto-immune rare. Depuis sa description pour la premiere fois il y a 40 ans, environ 200 cas ont ete publies. Methodes Le but de ce travail etait d’etudier les caracteristiques cliniques, histologiques et evolutives du NITU syndrome. Il s’agit d’une etude retrospective sur une periode de 38 ans :1980–2018. On a inclus touts les patients ayant une nephropathie interstitielle aigue prouvee histologiquement dont le tableau clinico-biologique etait compatible avec le diagnostic de NITU syndrome. Resultats obtenus ou attendus Nous avons collige 13 patients. L’âge moyen etait de 34,2 ans (16–52 ans). Il s’agissait de 11 femmes et 2 hommes. La decouverte de l’atteinte renale et de la l’atteinte oculaire etait concomitante chez la majorite des patients (9/15). Douze patients avaient une uveite anterieure et un patient avait une panuveite. L’examen ophtalmologique a montre une synechie irido-cristallinienne dans 3 cas et une hyalite dans 1 cas. Une alteration de l’etat general et un syndrome inflammatoire biologique etaient presents dans respectivement 9 cas et 10 cas. Tous les patients avaient une insuffisance renale avec une creatinemie moyenne a 579 umol/l. La ponction biopsie renale a confirme le diagnostic de nephrite interstitielle aigue. L’infiltrat inflammatoire etait fait essentiellement par des monocytes dans 8 cas ; et il etait lymphoplasmocytaire dans 5 cas. Un œdeme interstitiel ainsi que des lesions de fibrose etaient presents dans respectivement 10 et 4 cas. Tous les patients ont eu un traitement local par corticoides pour l’uveite associe a une corticotherapie orale (0,5 a 1 mg/kg/jour). L’evolution etait favorable avec uniquement 2 cas de recidives d’uveite. Une recuperation renale complete a ete observee chez tous les patients. Conclusion Le NITU syndrome est une entite rare. Ses manifestations cliniques renales et ophtalmologiques peuvent etre severes ; mais le pronostic est generalement favorable sous corticotherapie.

The aircrew rostering problem belongs to the class of NP-Hard combinatorial optimization problems. It consists on constructing individual rosters through the distribution of planned pairings among available crew members in airline industries. In that purpose, several approaches were proposed through adapting imposed constraints to both the requirements and the internal regulations of each airline company. This paper deals with balancing three main objective functions per flight crew member. These objectives are the amount of flight hours, the total layover of all the assigned rotations and the destinations' occurrences. To do so, a new multi-objective linear model is stated and an implementation of an adapted genetic algorithm is illustrated. Testing the algorithm on real-life data provided by the national Tunisian airline company TunisAir proved the efficiency of our approach.

In Supply Chain Management, several costs should be taken into account. They cover all of the holding, purchasing, ordering and transportation. Minimizing costs may be done through considering each cost separately or all of them simultaneously. In this paper, we focus on the ordering problem. In a cooperative context, two major fundamental relations were studied: the first one considers the possible coalitions between the retailers, while the second one studies the assignment between suppliers and coaltions. Our contribution is based on a comparative study of two noteworthy methods of the well-known Game Theory, Nash equilibrium and the Core solutions in an attempt to find the optimal one. To do so, an application is developed to conduct the comparison.

Introduction La microangiopathie thrombotique est un syndrome anatomo-clinique qui consiste en l’association d’une anemie hemolytique, d’une thrombopenie peripherique et des lesions thrombotiques des micro-vaisseaux. Patients et methodes Nous avons etudie les dossiers de 7 patients greffes renaux de l’unite de transplantation renale de l’hopital Charles Nicolle. Nos sept patients avaient tous une MAT revelee par la ponction biopsie du greffon. L’objectif de notre travail etait de preciser les caracteristiques etiologiques, anatomo-cliniques et therapeutiques de cette atteinte renale ainsi que l’evolution de la maladie et ses repercussions sur la survie du greffon. Resultats Nos sept patients receveurs avaient un âge moyen de 31,4 ans, alors que celui des donneurs etait de 50 ans. La nephropathie initiale etait vasculaire dans 3 cas et indeterminee dans 4 cas. Concernant la compatibilite HLA, les donneurs et les receveurs etaient semi-identiques dans 6 cas et aucune identite n‘a ete retrouvee dans un cas. Le traitement d’induction dans tous les cas etait compose d’une corticotherapie, du serum anti-lymphocytaire et du Micofenolate Mofetil (MMF). Le traitement d’entretien etait a base de Corticoides/MMF/Ciclosporine dans 5 cas et Corticoides/MMF/Tacrolimus dans 2 cas. Sur le plan etiologique, la MAT etait secondaire aux anticalcieurines dans 4 cas et a un rejet aigu dans un cas. L’evolution etait marquee par le retour en hemodialyse dans 4 cas, la stabilisation des chiffres de creatinemie dans un cas et une normalisation de la fonction renale dans 2 cas. Discussion Selon la litterature, l’âge jeune du receveur et l’âge avance du donneur representent des facteurs de risques de la MAT de novo ce qui a ete demontre par notre serie. Nous avons constate egalement que le delai moyen de survenue de la MAT par rapport a la transplantation renale etait de 20 mois chez nos patients. Cette notion n’a pas ete retrouvee dans la litterature puisqu’il a ete rapporte que le risque de MAT est plus eleve dans les trois premiers mois apres la greffe. Conclusion La MAT du transplante est une lesion histologique qui peut survenir soit comme une recidive ou une lesion de novo. Quel que soit son origine, elle augmente souvent le risque de perte du greffon et de la mortalite des patients.

Introduction L’endocardite sur catheter de Canaud est une situation frequente et grave chez les patients hemodialyses. Sa prise en charge doit etre rapide et souvent multidisciplinaire. Observation Nous rapportons le cas d’une patiente âgee de 36 ans suivie pour un lupus erythemateux systemique decouvert a l’âge de 20 ans. Elle a ete mise en hemodialyse apres 7 ans d’evolution. Elle a beneficie de la pose d’un catheter de Canaud pour epuisement du capital veineux. La patiente a presente apres un an une endocardite de la valve tricuspide avec a l’echographie cardiaque une vegetation de 8 mm mobile et friable. Les hemocultures etaient positives a Pseudomonas et a Klebsiella. Le catheter a ete enleve au cinquieme jour de l’infection. La patiente a recu une antibiotherapie pour une duree de 2 mois changee a plusieurs reprises devant des germes multiresistants. Au dixieme jour, nous avons isole un Candida albicans. Une echographie a objective une augmentation de la taille de la vegetation a 15 mm. Une TDM thoracique realisee devant une detresse respiratoire a objective des emboles septiques pulmonaires. Elle a subi une chirurgie a cœur ouvert avec plastie valvulaire. Le bilan infectieux a isole un C. famata multiresistant. La patiente a developpe une embolie pulmonaire causant son deces. Discussion L’endocardite sur catheter de Canaud presente chez les malades hemodialyses des particularites cliniques, biologiques et radiologiques. L’immunodepression due a l’insuffisance renale, d’une part, et a une maladie auto-immune sous-jacente, d’autre part, peut favoriser le developpement de germes multiresistants difficiles a traiter. Conclusion L’endocardite sur catheter de Canaud est une infection grave. Nephrologues, cardiologues et infectiologues doivent collaborer pour une therapeutique adaptee.