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Abstract Background In Morocco, medical research ethics training was integrated into the medical curriculum during the 2015 reform. In the same year, a law on medical research ethics was enacted to protect individuals participating in medical research. These improvements, whether in the reform or in the enactment of the law, could positively impact the knowledge of these researchers and, consequently, their attitudes and practices regarding medical research ethics. The main objective of this work is to assess Moroccan physicians’ knowledge, attitudes, and practices at the beginning of their careers (interns and residents) in medical research ethics. Patients and methods This is a multicenter cross-sectional study conducted in 2021 among Moroccan physicians. Three scores were created and validated to assess physicians’ level of knowledge, attitudes, and practices regarding research ethics. A descriptive analysis was carried out, followed by a univariate analysis and a multivariate analysis using multivariate binary logistic regression to study the factors associated with the different calculated scores. Results A total of 924 physicians were included in the study, with an average age of 27.8 ± 2.2 years. 40.7% had a high medical research ethics knowledge score, and 68.8% had good attitudes. These two scores were positively associated with age and were statistically higher in residents and in physicians who had received training in medical research ethics during their medical curriculum. Only 29,9% of physicians who had participated in research studies had adequate practices with medical research ethics. This score was statistically higher in residents and in physicians who had heard about research ethics. Conclusion A genuine introduction to ethics in the medical curriculum is essential to enhance researchers’ knowledge, attitudes, and practices. This, in turn, can lead to an increase in both the quantity and quality of research conducted in Morocco.

Phytotherapy, which involves the use of plant extracts and natural compounds for medicinal purposes, is indeed a promising alternative for managing urinary lithiasis. Many plants have been studied for their potential to prevent and treat kidney stones, and they may offer a more natural and potentially less harmful approach compared to conventional treatments. Additionally, phytotherapy may be more cost-effective. The aim of the present study was to investigate the antilithic potential of extracts and essential oils of Saussurea costus (Falc) Lipsch in two in vivo models, one on ethylene glycol-induced calcium oxalate crystal formation and the other to assess the effects of these extracts on magnesium oxide-induced struvite crystal formation. The experiment involved the administration of different doses of aqueous and ethanolic extracts of S. costus (200 and 400 mg/kg) and essential oils (25 and 50 mg/kg) to male Wistar rats, followed by the evaluation of various physiological, biochemical and histopathological parameters. The results demonstrated that the administration of S. costus essential oils and extracts had significant effects on the rats, influencing body weight, urine volume, crystal deposition, cytobacteriological examination of urine, and serum biochemical parameters. Histopathological examinations revealed varying impacts on the kidneys and livers of the treated rats. The findings suggest that S. costus extracts and essential oils may hold promise in inhibiting calcium oxalate crystal formation in vivo and influencing various physiological and biochemical parameters in rats. Overall, the 200 mg/kg ethanolic extract of S. costus demonstrated antilithiatic efficacy, did not exhibit signs of toxicity and reduced the number of crystals in the kidneys. Furthermore, the study did not find a significant effect on reducing struvite crystals.

Objective: Urolithiasis disease is a severe pathology causing painful bleeding in patients and can lead to kidney failure. Current treatments are limited, expensive, invasive with side effects and requires new alternatives, especially those based on natural products. This work aimed to determine the in vivo antilithiasis effect of hydroalcoholic extract (E.PG) and infusion (I.PG) of the Punica granatum L. plant, as well as their antibacterial capacity against the strains responsible of urinary tract infection such as: E. coli, P. Mirabilis, K. pneumoniae and S. Aureus. Methods: A curative protocol was followed, which consisted of inducing calcium oxalate lithiasis in rats by ethylene glycol (75%) and ammonium chloride (1%) solutions. After 15 days of oxalocalcic lithiasis induction, plant extracts were administered to rats at two different doses (200 and 400 mg/kg/day), with potassium citrate (Cit.K) used as a positive control. Water intake, urine volume, pH and body weight were measured with crystalluria and histopathological examinations of the kidneys performed. The antibacterial activity was studied by the disk diffusion method and the minimum inhibitory concentration (MIC) method. The checkerboard technique was used to determine the interactions between the two extracts. Results: The results found show a significant effectiveness of the Punica granatum L. extracts, especially the infusion in preventing the formation, development and calcium oxalate crystals deposition. In fact, crystalluria revealed an important diuresis with the presence of a very low crystals number (

The prevalence of diabetes mellitus (DM) among patients requiring renal replacement therapy (RRT) has been on the rise worldwide, with DM now being the primary cause of end-stage renal disease (ESRD) in roughly one-third of RRT initiations. Although renal transplantation is the optimal treatment for ESRD, its limited availability has led to in-center hemodialysis (HD) being widely used as the default RRT modality in many countries. However, peritoneal dialysis (PD) may offer a superior option for diabetic patients due to its slower ultrafiltration rate, which can help mitigate the dialysis-induced hypotension and coronary ischemia that are associated with extracorporeal circulation during HD. Despite these advantages, unfounded concerns about technique failure and increased complication rates have discouraged some clinicians from recommending PD as a first-line RRT for diabetic patients. We conducted a retrospective study comparing the incidence of complications and technique survival rates between diabetic and non-diabetic patients undergoing PD at a dialysis unit in Morocco. Our findings reveal that, diabetic patients undergoing PD experienced no significant difference in technique survival or incidence of complications compared to their non-diabetics. Nevertheless, only a small proportion (17.5%) of patients in our PD unit was diabetic, suggesting a need to improve access to PD for diabetic patients with ESRD.

Urolithiasis is the most painful and frequent urological disease of the urinary tract. This study is the first in Morocco that aimed to determine the relationship between the urinary stone's composition and the biochemical analysis of blood and daily urine.A total of 154 urinary stones from lithiasis patients was collected between December 2009 and July 2015 at the Hassan II University Hospital in Fez-Morocco. The stones were analysed morphologically and chemically, blood and urine biochemical parameters were established and the relationship between these latter and the stones composition was determined.The stones analysis shows that more than 63% of stones are calcium oxalate, infection stones were more common in patients under 16 years of age. Twenty-two percent of patients had a higher creatinine level and 13% of them had hypercalciuria. However, uric acid stone (UA) patient's group were older than those of whewellite (Wh) group (p = 0.004). The blood creatinine level was significantly high in the UA and weddellite (Wd) groups (p = 0.032), and a significant difference between the two groups, Wh and Wd, for the Calciuria/Creatininuria ratio (p = 0.032). The Principal Component Analysis (PCA) showed a correlation between 24-hour uricuria, 24-hour urine, 24-hour diuresis, 24-hour creatinine, and natriuresis on the one hand, and with calciuria, 24-hour calciuria and BMI on the other hand.These results show the probable effect of different biochemical parameters of urine and blood in certain stones types formation, and presents a contribution to understand the urolithiasis risk factors in order to limit the recurrence of kidney stones and long-term complications

In Morocco, the thermo-mineral water of Sidi Hrazem (SH) is widely used to eliminate kidney stones. In fact, no affirmative study has investigated the ability of mineral water to dissolve any type of urinary calculi. The current study investigated the in vitro anti-urolithiatic activity of Sidi Hrazem mineral water against calcium oxalate monohydrate (COM) calculi. In this respect, 15 small fragments of calcium oxalate monohydrate stones were randomly divided into five groups. The first and second groups were exposed to distilled water and Cystone ® (1g/L) respectively. The third and fourth groups were put in contact with the water of the upper source fountain and the lower source, respectively. The last group was placed in Sidi Hrazem marketed water. The dissolution capacity was evaluated by calculating the stones’ percentage dissolution after a stay in the experimental medium for eight weeks. The two fountains of SH mineral water showed a significant reduction of stone masses. Moreover, the upper source (SHU) and the lower source (SHL) fountains have been able to reduce the masses of calculi with a percentage dissolution of 26.94 % and 24.41 %, respectively. Negative and positive control groups showed a percentage dissolution of 12% and 40.96 %, respectively. Observation, at the mesoscopic scale, revealed a difference in the texture of the surface. Sidi Hrazem mineral water is capable of dissolving calcium oxalate stones. In effect, to complete this study and confirm its results, it is necessary to conduct laboratory analysis on this water to detect the factor responsible for its actions towards this type of gravel or other types of stones.

Saussurea costus (Falc) Lipsch is a traditional herb used to treat kidney stone problems because it contains several molecules used to treat this health problem, such as quercitrin. Infectious stones are the most painful of all urinary tract disorders, with ammonium phosphate (struvite) and carbapatite stones being the most common, caused by a bacterial infection with urease activity. These stones are treated with antibiotics, but antibiotic resistance is on the rise. The current study investigated the anti-urolithic activities of S. costus aqueous and ethanolic extracts of against struvite crystals synthesized using microscopic crystallization and turbidimetric methods, respectively. The utilized methods indicated that the ethanolic extract of this plant has a significant inhibitory effect on struvite crystallization, with a percentage inhibition of (87.45 ± 1.107) (p < 0.001) for a concentration of 1 mg mL−1 and a decrease in the number of struvite crystals, reaching values less than 100/mm3. For the number of struvite crystals inhibited by cystone, we found a value of 400/mm3 and with the aqueous extract we found 700/mm3. The antibacterial activity of the plant extracts studied was examined against several urease-producing bacteria, and this activity was evaluated by qualitative and quantitative evaluation methods; the highest minimum inhibitory concentration was seen in the ethanolic extract, with an MIC of 50 mg mL−1 for Staphylococcus aureus followed by an MIC of 200 mg mL−1 for Klebsiella pneumoniae. It showed a minimal bactericidal concentration (MBC) against S. aureus and K. pneumoniae (>50 mg mL−1 and >200 mg mL−1, respectively). Furthermore, to determine the extract’s anti-inflammatory activity, in vivo anti-inflammatory activity was investigated in rats. The results show that at a dose of 400 mg kg−1, the ethanolic extract has a maximum edema inhibition of 66%.

A wide range of biological properties and a potent therapeutic and prophylactic effect on chronic diseases are all present in Argania spinosa L. press cake. The aim of this research is to valorize the anticrystallization properties against calcium oxalate crystals of Argania spinosa L. press cake fractions and identify its bioactive components. Chemical species identification was performed using GC–MS analysis. The turbidimetric model was used to investigate crystallization inhibition in vitro. Infrared spectroscopy technique was used to characterize the synthesized crystals. Furthermore, both DPPH and FRAP methods were used to assess antioxidant activity. The results show that the fractions are equally important in crystallization inhibition percentages of calcium oxalate crystals. For saponin and polyphenol fractions, the inhibition percentages are in the orders of 83.49% and 82.83%, respectively. The results of the antioxidant activity by DPPH method show that the two fractions are equally important in the elimination of free radicals; the inhibition percentages were 77.87 ± 4.21 and 89.92 ± 1.39 for both polyphenols and saponins, respectively. FRAP method showed that the absorbance increases proportionally with concentration, and the absorbance are almost similar for both fractions and reach maximum values in the orders of 0.52 ± 0.07 and 0.42 ± 0.03, respectively, for saponins and polyphenols. These findings demonstrate that both fractions are rich in bioactive chemicals and have an anticrystallization capacity, allowing them to be employed for the curative and prophylactic effects against urolithiasis.

The plant Saussurea costus (Falc) Lipsch has many biological activities and a strong curative and preventive power against a variety of diseases including cancer, diabetes, and hemorrhoids. In the current study, phytochemical screening was carried out as well as an investigation of the antilithiatic and antioxidant activities of aqueous and ethanolic extracts of this plant. The results showed that aqueous and ethanolic extracts were effective in reducing cystine stone mass and that the aqueous extract of Saussurea costus (Falc) Lipsch had the highest percentage of dissolution (6.756 ± 1.024) (p < 0.05). A turbidimetric method and a crystallization test were used to evaluate the antilithiatic activity of an aqueous and ethanolic extract of this plant on calcium oxalate crystallization. The results of these methods revealed that the ethanolic extract of this plant has a significant inhibitory effect on calcium oxalate crystallization, with a percentage inhibition of (91.017 ± 0.299) (p < 0.05) for a concentration of 2 mg mL−1. The DPPH method revealed that the ethanolic extract of Saussurea costus (Falc) Lipsch with a concentration of (IC50 = 0.12325 mg mL−1) had the highest IC50, whereas the FRAP method revealed that the aqueous extract of Saussurea costus (Falc) Lipsch with a concentration of 300 µg mL−1 has the most significant reducing power with (OD = 0.56 ± 0.05). These findings indicate that aqueous and ethanolic extracts of Saussurea costus (Falc) Lipsch had a significant effect on whewellite and weddellite and a greater free radical scavenging effect but had no effect on cystine dissolution.

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

Ethnobotanical studies have reported the traditional medicinal uses of Acacia senegal (L.) Willd. and Argania spinosa (L.) Skeels against kidney stone formation and other chronic kidney diseases. The present work is undertaken to study the litholytic activity and the inhibiting activity of calcium oxalate crystallization by bioactive compounds identified in Argania spinosa (L.) Skeels press-cake (residue of Argan oil) and in Acacia senegal (L.) Willd. The litholytic activity was studied in vitro on cystine and uric acid stones using a porous bag and an Erlenmeyer glass. The study of the inhibiting activity of calcium oxalate crystallization, was based on temporal measurements of the optical density, registered at a 620 nm wavelength for 30 min using an ultraviolet–visible spectrophotometer. The silylation method was performed to identify phytochemicals, followed by gas chromatography coupled with mass spectrophotometry (GC/MS) analysis. The results show significant litholytic activity of Argania Spinosa press-cake hydro-ethanolic extract on uric acid and cystine stones, respectively, with dissolution rates (DR) of 86.38% and 60.42% versus 3.23% and 9.48% for the hydro-ethanolic extract of Acacia senegal exudate. Furthermore, the percentages of nucleation inhibition are 83.78% and 43.77% (p ˂ 0.05) for Argania spinosa and Acacia senegal, respectively. The results point to the detection of 17 phytochemicals in Argania spinosa press-cake extract, the majority of which are phenolic acids and have potent anti-urolithiatic action.

The hemodialysis technique, used worldwide for patients with chronic kidney disease, is considered as a treatment with a high economic and ecological impact, especially for water consumption. Getting ultrapure water for the preparation of the dialysate to clean patient’s blood from toxins leads to high volumes of salt-enriched water that directly goes to sewage. The aim of this work is to propose operating conditions for electrodialysis to allow the reuse of reverse osmosis (RO) rejects. We first performed a parametric study to evaluate the influence of different parameters, such as flow rates, initial concentration, and applied voltage on the demineralization rate (DR) and specific energy consumption (SPC) with a NaCl model solution. The optimal conditions for desalination (i.e., a potential of 12 V, and flow rate of 20 L·h−1) were then successfully applied to real samples collected from a dialysis center with total dissolved salts concentration of about 1.4 g/L (conductivity of 2.0 mS·cm−1). We demonstrated that the choice of adequate conductivity targets allowed meeting the physico-chemical requirements to obtain water re-usable for either rehabilitation swimming pool, manual or machine washing of instruments before sterilization or irrigation. Saving this water could contribute in the reduction of the environmental impact of hemodialysis.

Objective The interest of our work is to identify the objective parameters that can improve the subjective parameters of the well-being of the patients and to share the experience of the care in our center. Kt / V urea and KDQOL SF 36 scale (Kidney Disease Quality of Life short form 36)were used. Material and methods This is a single-center cross-sectional study conducted in October 2018 among patients treated with peritoneal dialysis, followed for at least six months in the Nephrology Department of Fez University Hospital (Morocco). The quality of life was assessed using the SF-36 (short form) version of the Kidney Disease Quality of Life (KDQOL) scale in its validated Arabic dialect version (1). We used the KDQOL-SF36 results as quantitative variables related to obtaining a Kt / V> 1.7. Results This study included 17 adult patients on peritoneal dialysis of which 35.3% are on automated peritoneal dialysis (APD) and 64.7% are on continuous ambulatory peritoneal dialysis (CAPD). The mean age is 40.8 ± 5 years and the sex ratio is 9H / 8F. In bivariate analysis, we found a significant relationship between dialysis dose and social support. This result could be explained by better adherence in patients with better social support. Conclusion Efforts must be made to achieve the adequacy goals, without losing sight of patients’ quality of life. There is also a need for further studies that include more patients and study other parameters such as clinical evaluation, residual renal function and ultrafiltration. .

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

The present study is focused on the experimental verification of the efficiency of Arbutus unedo L. leaves against the crystallization of calcium oxalate. The inhibition of crystallization has been studied in vitro with the absence and the presence of the different concentrations of the infusion and hydroalcoholic extract of the plant. This study consists of measuring, using a UV-Visible spectrophotometer, the temporal evolution of the optical density at λ = 620 nm corresponding to the crystals formation. The latter have been characterized by microscopic observation using an optical microscope, and by Fourier Transform Infrared Spectroscopy (FT-IR). The results suggest a greater effectiveness of the plant infusion with respect to the hydroalcoholic extract against crystallization or nucleation at percentages of 69.41 ± 0.24 or 19.76 ± 0.27% and at 93.92 ± 2.61 and 45.16 ± 3.06% against the aggregation, for both the infusion and the hydroalcoholic extract respectively. A. unedo leaves is a very promising and effective remedy against the crystallization of calcium oxalate and especially in the aggregation stage.

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

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

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

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

L'hydatidose est une parasitose liée au développement de la forme larvaire d'Echinococcus granulosus. Le kyste hydatique rénal constitue une localisation inhabituelle. Il peut se fistuliser dans les voies excrétrices urinaires et nécessiter alors une prise en charge spécifique. Nous présentons ici un cas témoignant de la spécificité diagnostique et thérapeutique de cette pathologie chez les patients en hémodialyse chronique, chez qui la diurèse n'est pas toujours conservée pour témoigner de l'hydaturie et orienter le diagnostic. Il s'agit donc d'un patient de 47 ans, en hémodialyse depuis 4 ans pour une néphropathie glomérulaire découverte au stade terminal. Le patient présente depuis 6 mois une altération de l'état général avec des lombagies droites, sans fièvre. La TDM abdominale montre un rein droit mesurant 13,4cm, siège d'une importante dilatation urétéro-pyélo-calicielle laminant le parenchyme rénal, avec un pyélon mesuré à 4,3cm, sans obstacle lithiasique visible. Cependant on individualise au niveau polaire inférieur droit, une formation kystique contenant des membranes, mesurant approximativement 76,5 x 54mm, communiquant avec le pyélon qui contient également quelques membranes. Un interrogatoire plus laborieux a révélé la présence d'une hydaturie sur les quelques gouttes de diurèse résiduelle. Vu que le patient est en insuffisance rénale chronique terminale en traitement de suppléance, le choix thérapeutique s'est porté sur une néphrectomie totale.

La calcinose pseudotumorale (CPT) est une affection caractérisée par le dépôt de cristaux de phosphate de calcium dans les tissus mous périarticulaires, réalisant de volumineuses masses calcifiées. Bien que la physiopathogénie des CPT ne soit pas totalement élucidée, l'augmentation du produit phosphocalcique au-delà du seuil de précipitation ainsi que l'hyperparathyroïdie sévère, semble y jouer un rôle determinant. Le rôle favorisant de microtraumatismes articulaires répétés est également évoqué. Chez les sujets dialysés, la fréquence de la CPT est estimée entre 0,5 et 7% selon les séries. Son traitement demeure controversé. L'exérèse chirurgicale est souvent recommandée. Nous rapportons un cas de CPT survenue chez un patient hémodialysé. Il s'agit d'un patient âgé de 56 ans, en hémodialyse chronique depuis 9 ans pour une néphropathie indéterminée. Le patient présente depuis 6 mois des douleurs d'aggravation progressive au niveau de la hanche droite, avec des difficultés de mobilisation de l'articulation en regard. Le scanner alors réalisé montre une masse calcifiée, à contours polylobés, mesurant 8,6 x 7,6 x 5,9cm, présentant des rapports très étroits avec le nerf grand sciatique, ce qui explique probablement le tableau clinique très douloureux. Le bilan biologique montre un produit phosphocalcique élevé et une hyperparathyroïdie. L'exérèse chirurgicale est jugée difficile vu les rapports de la tumeur avec les éléments vasculo-nerveux. Notre observation illustre les difficultés diagnostique et thérapeutique de la CPT. L'existence de cette affection peu fréquente nous paraît devoir être rappelée, afin de l'évoquer rapidement chez un patient hémodialysé chronique devant toute masse périarticulaire calcifiée d'allure tumorale.

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

Nous rapportons le cas d'un patient âgé de 47 ans, suivi depuis vingt ans pour une psychose maniaco-dépressive sous lithium admis dans un tableau de trouble de conscience après une tentative de suicide au lithium (30 comprimés de Téralitheé LP 400, forme galénique retard correspondant à 12 g de carbonate de lithium), bien amélioré cliniquement après trois séances d'hémodialyse. Cette observation illustre l'intérêt thérapeutique de l'hémodialyse au cours des intoxications volontaires au lithium sous sa forme retard même après une semaine de la prise et l'insuffisance thérapeutique d'une seule séance d'hémodialyse.

Kaposi′s sarcoma (KS) is widely reported to develop after renal transplantation and is induced by activation of a latent human herpes virus 8. We report the clinical features and outcome of a 50-year-old woman who presented with KS 18 weeks after starting immuno-suppressive therapy for vasculitis. She had positive-titer IgG antibody to human herpes virus 8. Cyclophosphamide pulses were interrupted, and prednisone was decreased gradually to 10 mg/day. Skin lesions showed important regression with stabilization of the general state and renal function. Eight months later, the patient presented with a diffuse cutaneous KS that required the discontinuation of steroids. Within 1 month, her general status and renal function deteriorated, and she died with a disseminated intravascular coagulation syndrome.

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

la correction et la stabilité du taux d'hémoglobine est un objectif majeur du traitement de l'anémie chez les hémodialysés chroniques. Toutefois, la cible d'hémoglobine = 11g/dl fixée par les recommandations demeure difficile à atteindre dans notre contexte. Le but de cette étude est d'évaluer la réponse au traitement par CERA (continuous erythropoietin receptor activator) chez une population d'hémodialysés chroniques naïfs de tout traitement par agent stimulant de l'érythropoïèse et étudier les différents facteurs associés à une mauvaise réponse au traitement. Il s'agit une étude prospective mono centrique faite au sein d'une population d' hémodialysés chroniques. Ont été inclus les patients en hémodialyse depuis plus de 12 mois, naïfs de tout traitement par agent stimulant de l'érythropoïèse (ASE) et ayant un taux d'hémoglobine(Hb) = 10g/dl. L'administration régulière de la CERA et l'ajustement des doses ont été faits selon les recommandations. L'évaluation de la réponse, en fin de traitement, a porté sur l'atteinte ou non d'un taux d'hémoglobine cible = 11g/dl. Sur 87 patients en hémodialyse périodique, 22 (25,3%) sont naïfs de tout traitement par ASE. Il s'agit de 13 hommes et 9 femmes avec un âge moyen de 46 , 19 ans et une ancienneté en hémodialyse de 67 , 59 mois. Le taux initial d'hémoglobine est de 7,8 , 1,3 g/dl. Au bout de 4 mois de traitement régulier par la CERA, le taux final d'Hb est de 10,9 , 2,1g/dl et 63,6% des patients ont atteint la cible d'Hb = 11g/dl. La dose moyenne de CERA à la fin de l'étude est de 0,89 = 0,35 =g/kg/15j. L'analyse des facteurs prédictifs montre que la réponse finale dépend du taux d'Hb initial (p=0,002).En effet, quand le taux d'Hb initial est = 8 g/dl, le taux de réponse est de 88% vs 46% lorsque le taux d'Hb = 8g/dl (p=0,05). L'anémie est une complication majeure chez les hémodialysés chroniques. La réponse au traitement dépend de la précocité de la prise en charge.

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

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

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

INTRODUCTION: Les complications cardio-vasculaires sont la principale cause de mortalité et de morbidité chez les patients hémodialysés chroniques. Le but de cette étude est de décrire les différentes atteintes cardiaques à l'échocardiographie transthoracique et de dégager les facteurs associés aux principales atteintes. METHODES: Etude transversale monocentrique incluant des patients adultes hémodialysés depuis plus d'un an et ayant bénéficié d'une échocardiographie transthoracique durant l'année 2012. Notre étude descriptive puis analytique a porté sur l'analyse des données démographiques, cliniques, biologiques et échocardiographiques. RESULTATS: 50 patients ont été colligés, 32 femmes et 18 hommes. Leur âge moyen est de 55 , 14 ans avec une ancienneté moyenne en hémodialyse de 93 , 55 mois. Les anomalies échocardiographiques retrouvées sont dominées par l'hypertrophie ventriculaire gauche chez 56 % des patients et les valvulopathies chez 80%. Les calcifications valvulaires ont été notées dans 14% des cas, une dilatation du ventricule gauche dans 12%, une hypertension artérielle pulmonaire dans 10% et une péricardite dans 6% des cas. Une seule dysfonction du ventricule gauche a été notée et la fraction d'éjection systolique moyenne est de 68,9 , 9,5%. L'analyse statistique de variance des différentes anomalies montre que l'hypertrophie ventriculaire gauche est positivement corrélée à l'hypertension artérielle (p=0,046) et que les pressions artérielles moyennes systoliques (p=0,005) et diastoliques (p=0,035) sont significativement plus élevées chez les patients avec une hypertrophie du ventricule gauche. CONCUSION: Les anomalies échocardiographiques sont fréquentes chez les hémodialysés chroniques notamment l'hypertrophie ventriculaire gauche qui est fortement liée à la présence d'une hypertension artérielle.

INTRODUCTION: Le diabète représente la première cause de mortalité par insuffisance rénale au Maroc. Sa prévalence selon l'Enquête Nationale sur la Population et la Santé Familiale de 2011 est de 3,3% [1]. Le but de ce travail est de déterminer la prévalence et d'étudier le profil clinique des diabétiques en hémodialyse chronique au Maroc. METHODES: Il s'agit d'une étude transversale multicentrique incluant 2066 hémodialysés chroniques dans les 39 centres d'hémodialyse de quatre régions marocaines. RESULTATS: La prévalence du diabète en hémodialyse est 21,6 %. L'âge moyen 59,13,2 ans (26-87). Le sex-ratio est de 1,9. L'IMC moyen est de 24,5 4,4 kg/m2 (15-41). 42 patients sont porteurs d'une hépatite virale. La durée moyenne en HD est 39,3, 67 mois. 57 % des patients gardent une diurèse résiduelle versus 43% chez les non diabétiques. Par rapport à ces derniers, nous avons noté plus d'HTA (64% versus 45%), plus de complications cardiovasculaires (23% versus 12%), un âge plus avancé à l'initiation de l'hémodialyse (55,5 versus 47 ans) et un taux de FAV proximales plus important. CONCLUSION: La prévalence des diabétiques en hémodialyse est relativement élevée au Maroc sans tenir compte des patients qui ne bénéficient pas d'épuration extra-rénale pour des raisons socio-économiques. Le taux élevé de mortalité est imputable au retard et/ou à l'absence de la prise en charge néphrologique des diabétiques. Dans nos régions où le système sanitaire dispose de faible moyen, l'accent doit être mis sur le dépistage précoce de la néphropathie chez le diabétique.

Hepatitis B virus infection is an uncommon cause of acute glomerulonephritis. We present a case of acute glomerulonephritis revealing a chronic viral hepatitis B. A 45 year-old man was admitted in the nephrology department of Hassan II university hospital (Fez, Morocco) for nephritic syndrome with advanced acute kidney injury. The investigations have revealed viral hepatitis B with a positive HBV-DNA and Others viral serology tests were negative. Renal biopsy showed a diffuse and global endocapillary proliferation without extra-capillary proliferation; and global deposits of C3 and Ig G On immunofluorescence. There wasn't any other infectious cause. We thus retained the diagnosis of hepatitis B virus-associated acute glomerulonephritis. He was given entecavir and corticosteroids. Three months later, the evolution was marked by the normalization of renal function, negativity of proteinuria and HBV DNA became undetectable. There was no relapse of glomerulonephritis and HBV viral load was still negative after one year follow-up.

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