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We report the observation of a patient who presented with post-transplant Kaposi's sarcoma after a delay of eight months with a dual cutaneous and palatal localisation. The reduction in immunosuppressive treatment and the introduction of Rapamune® allowed good clinical progress initially with regression of the skin lesions. He subsequently presented later a skin relapse with visceral localisation. Chemotherapy was conducted based on weekly paclitaxel infusions allowing partial remission and maintenance of renal graft function with good clinical tolerance.

Resume Introduction Les nephropathies interstitielles aigues englobent un groupe de maladies renales heterogenes sur les plans clinique et etiologique. L’objectif de cette etude etait d’analyser les particularites etiologiques des nephropathies interstitielles aigues prouvees histologiquement et d’identifier les principaux facteurs predictifs du pronostic renal. Methodes Il s’agit d’une etude retrospective, descriptive et analytique, qui a inclus les patients ayant une nephropathie interstitielle aigue isolee prouvee histologiquement, suivis dans notre service de 1980 a 2018. Un mauvais pronostic renal a ete defini par l’absence de recuperation de la fonction renale de base ou par la survenue d’un debit de filtration glomerulaire inferieur a 60 mL/min/1,73 m2 parmi les patients n’ayant pas d’insuffisance renale chronique connue. Resultats Nous avons collige 65 cas de nephropathie interstitielle aigue. L’âge moyen de nos patients etait de 41,3 ± 16 ans, avec une predominance feminine (78 %). L’etiologie immuno-allergique etait la plus frequente (29 %), dominee par les anti-inflammatoires non steroidiens et les antibiotiques. Le pronostic renal etait defavorable dans 21 cas (32 %). Les facteurs independants predictifs du pronostic renal etaient, en analyse multivariee : un pourcentage de glomerules scleroses superieur a 15 % (p = 0,004), l’absence d’un œdeme interstitiel (p ˂ 0,001), le non-recours a la corticotherapie (p = 0,02) et un delai d’instauration de la corticotherapie superieur a 21 jours (p = 0,02). Conclusion Les causes immuno-allergiques representent actuellement l’etiologie la plus frequente des nephropathies interstitielles aigues. Le pronostic renal est souvent favorable, mais l’evolution peut se faire vers l’insuffisance renale chronique en cas de retard diagnostique et therapeutique. Dans notre etude, le recours a la corticotherapie etait associe a un meilleur pronostic renal.

Left ventricular hypertrophy is the most prevalent cardiac abnormality in hemodialysis patients. The diagnosis of this abnormality is possible by electrocardiogram and/or echocardiography. Our study aimed to assess the prevalence of left ventricular hypertrophy in hemodialysis patients and the accuracy of different electrocardiographic criteria.This was a cross-sectional retrospective study including 60 hemodialysis patients between 2017 and 2018. A left ventricular mass index higher than 115g/mThis was a cohort of 60 patients composed of 27 men and 33 women with a mean age 52.6±15,8years. Hypertension was the most common cardiovascular risk factor (82 %). The prevalence of left ventricular hypertrophy at echography was 65 %. Prevalence of left ventricular hypertrophy at electrocardiographic varied across the different criteria ranging from 5 % (R wave in DI) to 32 % (Perugia score). The highest left ventricular hypertrophy prevalence at electrocardiographic was found with the five following criteria: Perugia score (32 %), Peguero-Lo Presti index (28 %), Sokolow-Lyon index, Cornell index, Framingham-adjusted Cornell voltage (17 %). Sensitivity was ranged from 5 % (R in DI, Gubner-Ungerleider index, and product) to 41 % (Perugia score). The specificity of most criteria was ≥90 % except for the Perugia score (85 %). The sensitivity, specificity, postitive and negative productive values and left ventricular hypertrophy prevalence using the five most accurate criteria combined were respectively 48, 90, 70.28, 77.85 and 33 %. Hypertension, duration of HD, arteriovenous fistula, interdialytic weight gain, systolic blood pressure, hemoglobin9g/dL and hyperparathyroidism were significantly associated with left ventricular hypertrophy.The prevalence of left ventricular hypertrophy detected by echocardiography was high. All electrocardiographic criteria had a low sensibility and a high specificity in the diagnostic of echocardiographic left ventricular hypertrophy. To improve the accuracy of electrocardiographic criteria, it is necessary to combine several electrocardiographic criteria and not often focused on a single classic electrocardiographic index.

Background and Aims Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly. Method We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017. Results We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l. AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF. Conclusion AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.

The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed., Graphical abstract

Acute interstitial nephritis represents a clinically and etiologically heterogeneous group of kidney diseases. The aim of our study was to explore the main causes of biopsy-proven acute interstitial nephritis and to identify predictive factors of renal outcome.We conducted a retrospective monocentric study which included patients with biopsy proven AIN, followed in our department during the period between 1980 and 2018. The non-recovery of kidney function or an estimated glomerular filtration rate˂60 mL/min/1.73 mA total of 65 acute interstitial nephritis patients were enrolled. The mean age of patients was 41.3±16 years with a female predominance (78%). Drug-induced etiology was the most common (29%). The most frequent culprit drugs in our study were NSAID followed by antibiotics. The renal prognosis was unfavorable in 21 cases (32%). The independent predictive factors for renal outcome were : a percentage of sclerotic glomeruli greater than 15% (P=0.004), absence of interstitial edema (P˂0.001), non-use to corticosteroid therapy (P=0.02) and a delay in initiating corticosteroid therapy greater than 21 days (P=0.02).Drugs currently represent the most common cause of acute interstitial nephritis. The renal prognosis is often favorable, but the progression can be towards chronic renal failure in the event of diagnostic and therapeutic delay. Our data suggest a beneficial influence of steroids on the outcome of acute interstitial nephritis.

We report the observation of a patient who presented with post-transplant Kaposi's sarcoma after a delay of eight months with a dual cutaneous and palatal localisation. The reduction in immunosuppressive treatment and the introduction of Rapamune® allowed good clinical progress initially with regression of the skin lesions. He subsequently presented later a skin relapse with visceral localisation. Chemotherapy was conducted based on weekly paclitaxel infusions allowing partial remission and maintenance of renal graft function with good clinical tolerance.

Background and Aims Mesangial deposits Ig A was described the first time in 1968 by Berger and Hinglais. It remains the most common primary glomerulonephritis worldwide. It is often idiopathic but can also be secondary. The aim of our study is to describe the epidemiologic characteristics, the incidence and the anatomopathological features of 501 IgA nephropathy (IgA N) patients. Method It is a retrospective mono-centric study including patients having IgA N in the renal biopsy done in our department among a period of 17 years. Results We analyzed data of 8427 patients who underwent renal biopsy. 81% had glomerular nephropathy with 7.3% (501) IgA N. A male-to-female ratio of 2.27. The average age was 28.7 years. IgA N was primary in 80.2% cases and secondary in 17.8% cases. The most frequent secondary IgA N was rheumatoid purpura (74.8%). There was a male predominance in Berger‘s disease as well as in rheumatoid purpura. Berger’s disease was more common in adults, whereas rheumatoid purpura was more common in children. The main indication of renal biopsy was proteinuria with hematuria in 23.2% of cases and nephrotic syndrome in 23.8%. The association of non-nephrotic proteinuria, hematuria, arterial hypertension and renal injury was found in 9.3% whereas isolated macroscopic hematuria only in 6.4% of cases. According to HAAS classification, HAAS 3 was the most frequent. OXFORD classification used only from 2010, and M1, S1, E0, T0 and M1, S1, E0, T2 were the most frequent. Glomerular lesions were associated to tubulo interstitial and vascular lesions in 48.2% of cases. Conclusion IgA nephropathy is the most common glomerular disease and a frequent cause of end stage renal disease. Because of a clear increase of it’s incidence in our country and the delay in the diagnosis, a systematic screening of urines is needed in our country as it’s done in Singapore and Japan.

Background and Aims The increase in life expectancy has led to increasing numbers of elderly patients in all medical disciplines, particularly in nephrology. Idiopathic membranous nephropathy (IMN) is common in the elderly and can lead to significant morbidity and mortality because of the complication of nephrotic syndrome (NS) and immunosuppressive therapy. The aim of this study is to analyze the diagnostic, therapeutic and evolutionary approach of IMN in elderly patiets. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Results Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery were dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (39.28%) and elevated creatinine level in 9 cases (32.14%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone (group 1), three patients received corticosteroid with mycofenolate mofetil (group 2) and one patient received corticosteroid with ciclosporin (group3). Fourteen patients received only symptomatic treatment (group 4). We noted partial remission in group 3, however complete remission in 37.5%, 14.28% and 12.5% from respectively group 1, group 4 and group 2. The side effects of immunosuppressive therapy were infectious complication in 8 patients (28.5%), osteoporosis in 3 patients (10.7%) and Steroid diabetes in one case. The side effects of NS were thrombotic complication in 5 patients (17.85%). Two patients had presented coronary syndrome and two other patients had presented hepatitis C. Two cases of death were noted whose etiology was pulmonary infection in one patient and undeterminate etiology in the other case. Conclusion Treatment of IMN in older patients has unique challenges, reducing the need for renal replacement therapy. Most studies report that the elderly respond to therapy with rates comparable with younger patients but in the other hand elderly are more susceptible to side effects of immunosuppressive therapy.

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 The aging of the population and the increase in life expectancy have led to increasing numbers of elderly patients so greater numbers of elderly patients with chronic kidney diseases are surviving longer. Membranous nephropathy (MN) is the most important cause of glomerular disease in older patients (≥65 years). The aim of this study is to describe the epidemiological and clinical profile of elderly patients with MN and to analyze the diagnostic and management approach. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Results Thirty patients were collected. The mean age was 69.43 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 83.3% of cases. Sixteen patients were smokers (55.3%), 5 ethyl patients (16.7%), diabetes was present in 3 patients (10%) and hypertension in 11 patients (36.7%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery was dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (36.7%) and elevated creatinine level in 9 cases (30%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (67.6%), anasarca in 7 cases (23.3%), proteinuria in all cases and hematuria in 20 cases (66.6%). Biology revealed nephrotic syndrome (NS) in 28 cases (87.11%), hypercholesterolemia in 23 cases (76.6%), high serum creatinine in 14 cases (46.6%) with an average creatinine level of 123,85 µmol/l, anemia in 17 cases (56.6%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Twenty-two patients had idiopathic MN (IMN) and 2 patients had secondary MN. In fact, MN was associated with multiple myeloma in one case and secondary to hepatitis B in other case. Symptomatic treatment was indicated in all patients. Patients with secondary MN received etiopathogenic treatment. For the IMN, immunosuppressive therapy started early for 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone, three patients received corticosteroid with mycofenolate mofetil and one patient received corticosteroid with ciclosporin. We noted complete remission in 6 patients and end renal stage disease in 5 patients. Conclusion In studies of glomerular disease in the elderly, MN was the most common cause of NS. The clinical presentation is similar in older and younger patients, but older patients more often present with kidney failure and severe NS.

Background and Aims Idiopathic membranous nephropathy (IMN) is increasingly seen in older patients but little is known about its treatment and outcomes at long term follow up. The objective of this work is to study the renal survival of IMN in elderly as well as prognostic factors. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables. Results Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). The clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone, three patients received corticosteroid with mycofenolate mofetil and one patient received corticosteroid with ciclosporin. Fourteen patients received only symptomatic treatment. We noted complete remission in 6 patients (21.42%) and end renal stage disease in 5 patients (17.85%). Our study showed that treatment with angiotensin receptors blockers was associated with better renal survival with a statistically significant difference, (p = 0.011). A reduced kidney function at presentation, tubule-interstitial disease and interstitial fibrosis and tubular atrophy were associated with poor survival with a statistically significant result (p = 0.012) (p=0,011) respectively. Conclusion IMN is the most common cause of nephrotic syndrome in elderly patients and it has the same risk for progression as in younger individuals. Decrements in glomerular filtration rate, increased risk for comorbidities, vascular disease and change in pharmacokinetics justify special attention to treatment decisions in elderly individuals with IMN.

Background and Aims Systemic Lupus Erythematosus (SLE) is associated with an increased risk of cardiovascular morbidity and cardiovascular mortality. The risk of cardiovascular events is 1.3–2.7 times higher in SLE patients than in the general population, and even higher in patients with lupus nephritis (LN). Traditional risk factors as well as SLE-specific and treatment-related factors all contribute to the increased risk of cardiovascular disease. The primary aim of the present study was to evaluate cardiovascular risk factors, morbidity and mortality in patients with LN. Method This is a retrospective study of patients over the age of 16, with LN proved by kidney biopsy and followed up in our department over a period of 17 years. The diagnosis of lupus was made according to criteria of The American College of Rheumatology revised in 1997. Demographic, clinical and para-clinical data were collected from medical observations. Results We collected 155 women and 19 men with a sex ratio F / H of 8.2. The mean age at the time of the discovery of LN was 32.6 years [15-45 years]. Overall median follow-up time was 81.2 months. Renal symptomatology was dominated by proteinuria noted in all patients with an average proteinuria at 3.3 g / 24h, associated to a nephrotic syndrome in 68% of patients, hematuria was present in 69% of patients and renal failure was present in half of cases with an average serum creatinine of 110 µmol / l. At the time of diagnosis of LN, hypertension was noted in 48.9% of cases, diabetes in 2.8% of cases and obesity in 57.4% of cases with an index average body mass of 28.5 Kg / m2. Smoking was reported in 17.2% of the cases. The average cholesterol level was 5,5±2,1 mmol/l, the average triglycerid level was 2,5±1,1 mmol/. Antiphospholipid syndrome was found in 14.9% of cases. We performed 243 renal biopsies with 174 initial and 69 iterative biopsies. The histological lesions were polymorphic dominated by LN class IV (54.3%), arteriolosclerosis was observed in 47.7% and lesions of thrombotic microangiopathy in 29.8%. Corticosteroid therapy was prescribed in all patients combined with immunosuppressive therapy in 54.6% of cases. The overall survival of the patients at 10 years was 85%. During follow-up, cardiovascular complications found in our series were mainly strokes (6.3%) and coronary insufficiency (5.2%) and transient ischemic attack (6.9%). After a univariate analysis, the additional cardiovascular risk factors identified in our study were antiphospholipid syndrome (p = 0.01), renal failure (p = 0.01), long-term corticosteroid therapy (p = 0.009), the chronicity of the disease (evolution of lupus> 10 years) (p = 0.014), proliferative forms (p=0.001), arteriolosclerosis (p=0.0002) and lesions of thrombotic microangiopathy (p=0.018). Survival in patients without cardiovascular risk factors was better (96% vs 88%). Conclusion In conclusion, in addition to traditional risk factors SLE patients have several disease related risk factors that explain increase cardiovascular disease. A careful control for this risk factors is essential to continuously improve survival in SLE.

Introduction L’insuffisance renale aigue (IRA) est une complication redoutable chez le diabetique. Elle est multifactorielle. L’objectif de notre travail est de decrire le profil clinico-biologique, etiologique et evolutif de l’IRA chez les diabetiques. Materiels et methodes Nous avons mene une etude retrospective sur deux ans. Elle a inclus 37 diabetiques hospitalises pour IRA definie selon la classification AKIN. Resultats Vingt quatre hommes et 13 femmes. L’âge moyen etait de 66,7 ans. Une hypertension arterielle et une insuffisance cardiaque associee etait notee dans respectivement 15 et 3 cas. L’IRA etait decouverte de facon systematique dans 16 cas et devant des signes d’uremie aigue et une oligo-anurie dans respectivement 14 et 7 cas. Elle etait classee AKIN 1,2 et 3 dans respectivement 9, 12 et 16 cas. La biologie avait revele une uree moyenne a 21,1 mmol/l, une creatininemie moyenne a 289,3 μmol/l et une hyperkaliemie dans 17 cas. L’IRA de type organique dominait la serie avec 22 cas. L’hemodialyse etait realisee dans un seul cas. Une evolution favorable etait notee dans 27 cas, vers l’insuffisance renale chronique dans 7 cas et le deces dans 3 cas. Discussion Les principaux facteurs de risques de survenue d’une IRA chez les diabetiques sont l’existence d’une alteration prealable de la fonction renale, l’âge des patients, l’utilisation concomitante de medicaments nephrotoxiques ou susceptibles d’interferer avec les mecanismes physiologiques de protection et d’autoregulation du debit sanguin renal.

Introduction Les granulomatoses renales (GR) sont des maladies rares qui peuvent etre en rapport avec de nombreuses etiologies. Description L’objectif de cette etude etait d’analyser les caracteristiques cliniques et les differentes etiologies de ces granulomatoses. Methodes Il s’agit d’une etude retrospective portant sur les observations de GR recensees dans un service de Medecine sur une periode de 40 ans (entre 1979 et 2019). La GR est definie par la presence d’au moins un granulome identifie sur la ponction biopsie renale (PBR). Resultats Nous avons identifie 30 cas de nephrite granulomateuse a partir de 3125 PBR. Dans la population etudiee, l’âge moyen etait de 49,37 ans [19-79 ans] avec une predominance feminine de 77 %. Des signes generaux etaient presents dans 73 % des cas. L’insuffisance renale etait severe avec une clairance de la creatinine moyenne de 21 ml/min associee a une proteinurie dans 67,9 % des cas et a une hematurie microscopique dans 80 % des cas. Des signes ORL ont ete observes dans 40 % des cas. A la PBR, 56,7 % des patients ayant une nephrite tubulo-interstitielle. Les etiologies sont dominees par la cause medicamenteuse (20 %), la sarcoidose (20 %), et la vascularite a ANCA (20 %). Une vascularite a ANCA associee a une tuberculose urinaire a ete observee dans 1 cas. Une corticotherapie a ete prescrite dans 76 % des cas. L’evolution etait marquee par une amelioration de la fonction renale avec une clairance de la creatinine moyenne de 34,6 ml/min apres 6 mois de suivi. La severite de l’atteinte renale a necessite le recours a la dialyse chronique dans 42,9 % des cas et c’est surtout en rapport avec une cause medicamenteuse (33 % des patients qui ont passe en dialyse). Une patiente a beneficie d’une transplantation renale. Conclusion Au terme de ce travail nous avons deduit qu’une cause medicamenteuse doit etre systematiquement recherchee devant une GR et qu’elle peut etre de mauvais pronostic.

Introduction Le syndrome hemolytique et uremique (SHU) est une affection frequente chez l’enfant et rare chez l’adulte definie par l’association d’une thrombopenie, d’une anemie hemolytique et d’une atteinte renale secondaire a des lesions de microangiopathie thrombotique (MAT). Les formes typiques surviennent apres un episode de diarrhee en rapport avec une infection par une enterobacterie pathogene. En l’absence de diarrhee il peut etre secondaire a certaines maladies ou en rapport avec une anomalie de regulation de la voie alterne du complement. Description L’objectif de notre etude etait d’etudier les particularites cliniques et le pronostic renal du SHU sans diarrhee survenant chez l’adulte. Methodes Etude descriptive retrospective portant sur les patients pris en charge dans notre service pour un SHU sans diarrhee sur une periode de 20 ans. Resultats Nous avons inclus 15 patients. Le sex-ratio etait de ½ avec une predominance masculine. L’âge moyen etait de 38,6 ans (extremes : 17–63 ans). Des cephalees ont ete rapportees dans 8 cas en rapport avec une HTA maligne avec une retinopathie hypertensive. La pression arterielle moyenne etait de 186/110 mmHg. Le taux moyen de creatinine serique etait de 880 μmol/L (extremes : 72–1900). Le dosage de l’haptoglobine realise chez 4 patients etait bas dans 2 cas. Le complement serique etait consomme dans 8 cas. Le SHU etait en rapport avec un deficit en facteur H dans 2 cas, une toxemie gravidique dans 1 cas, infectieux dans 1 cas, et de cause inconnue dans le reste des cas. La duree d’hospitalisation etait en moyenne de 1,1 mois avec des extremes allant de 15 jours a 4 mois. Quatre patients ont necessite au cours de leur hospitalisation un sejour dans une unite de soins intensifs. Le traitement a associe une corticotherapie a la dose de 1 mg/kg/j associee a des echanges plasmatiques 11 dans 3 cas. Apres un suivi moyen de 6 mois, l’evolution etait favorable dans 6 cas avec recuperation de la fonction renale. Douze patients ont garde une insuffisance renale chronique avec recours a l’hemodialyse definitive dans 9 cas. Trois patients ont beneficie d’une transplantation renale. L’HTA etait equilibree dans 11 cas. Un deces a ete note secondaire a un œdeme aigu des poumons. Conclusion Le pronostic du SHU s’est ameliore par les echanges plasmatiques. La corticotherapie et les immunosuppresseurs sont indiques dans les formes refractaires ou a rechute. L’insuffisance renale chronique sequellaire est observee dans 20 a 65 % des cas. En cas d’insuffisance renale terminale, la transplantation renale est possible mais le risque de recidive est important dans les formes hereditaires.

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 L’insuffisance renale chronique peut perturber le metabolisme des lipoproteines plasmatiques ainsi que le metabolisme phosphocalcique. Materiels et methodes Il s’agit d’une etude retrospective incluant 88 hemodialyses chroniques. Les parametres etudies etaient : Le taux d’hemoglobine, la calcemie, la phosphoremie, la parathormone PTH, les triglycerides, le cholesterol total, le cholesterol des lipoproteines de haute densite, le cholesterol des lipoproteines de faible densite. Resultats Notre population etait repartie 44 femmes et 44hommes d’âge moyen de 53,7 ± 14,3 ans. La duree moyenne en hemodialyse etait de 47,5 ± 45,5 mois. La nephropathie initiale predominante etait la nephropathie glomerulaire (37,5) % suivi de la nephropathie vasculaire (31,81). Sur le plan biologique l’hemoglobine moyenne etait de9,85 ± 1,46 g/dL, la calcemie moyenne de 2,05 ± 0,27 mmol/L, la phosphoremie moyenne de 1,6 ± 0,68 mmol/L avec une PTH moyenne de 601 ± 549. La dyslipidemie avait une prevalence de 36,36 % avec un taux moyen de CT de 4,27 ± 1,04 g/L et de TG de 1,61 ± 0,84 g/L. Le ratio cholesterol des lipoproteines de faible densite/cholesterol des lipoproteines de haute densite, etait de 2,95, ce qui est relativement abaisse par rapport a la valeur seuil de 3,5.Les mesures hygieno-dietetiques etaient prescrites chez tous nos patients et seulement 6,81 % de nos patients hemodialyses etaient sous statine. Conclusion La dyslipidemie et le desordre phosphocalcique sont frequents chez les hemodialyses chroniques et constituent un facteur de risque surajoute et modifiable d’atteinte cardio-vasculaire.

Introduction Le but de cette etude est de comparer l’effet de l’hemodialyse et de la dialyse peritoneale DP sur le metabolisme lipidique chez des patients diabetiques atteints d’insuffisance renale chronique terminale. Materiels Etude observationnelle transversale menee chez 26 patients diabetiques, 9 patients (H/F : 5/4 ; 54 ± 12 ans) hemodialyses HD depuis 1 a 5 ans, 17 patients (H/F : 10/7 ; 61 ± 8 ans) traites par dialyse peritoneale automatisee, depuis 3 a 20 mois. Resultats Une diminution des concentrations seriques en triglycerides est observee chez les patients HD compares aux DP. Aucune difference significative des concentrations seriques en cholesterol total n’est notee chez les patients diabetiques HD compares aux patients en DP. Les valeurs sont de 4,95 ± 1,32 et 4,65 ± 1,29 mmol/L respectivement, chez les HD et DP. Une diminution de −15 % des concentrations seriques en cholesterol-HDL etait observee chez les diabetiques en DP. Les valeurs etaient de 0,69, 0,41 et 0,94 ± 0,13, respectivement, chez les DP et HD. Une augmentation significative de 22 % des concentrations seriques en cholesterol-LDL est observee chez les patients HD compares aux patients en DP. Les concentrations seriques en albumine sont elevees de 34 % chez les patients HD, les valeurs etaient de 32,95 ± 3,25 et 49,78 ± 11,18 g/L respectivement, chez les DP et HD. Conclusion Il n’y a pas de difference entre le bilan lipidique chez les diabetiques hemodialyses compares a ceux en DP. Ces anomalies representent un facteur de risque cardiovasculaire pouvant contribuer aux complications a long terme du dialyse.