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Malaria, the disease caused byPlasmodiumparasites, causes significant mortality and morbidity. Whole parasite vaccination with pre-erythrocytic parasite stages, attenuated through sporozoite irradiation or chemo-attenuation, confers sterilizing immunity against subsequent parasite infection. This provides a rationale for the creation of whole parasite vaccines that are attenuated using gene editing. Here, we report on the creation of a novel genetically attenuated parasite (GAP) by the deletion ofPlasmodium LINUP,encoding aliver stagenuclearprotein.Epitope-tagging of LINUP in the rodent malaria parasitePlasmodium yoeliishowed LINUP expression exclusively in liver stage nuclei after the onset of exo-erythrocytic schizogony.P. yoeliiparasites with a gene deletion ofLINUP(linup—) suffered an exclusive liver stage phenotype with developmental arrested late in exo-erythrocytic schizogony. Liver stages showed incomplete segregation of nuclei and, mitochondria and apicoplast. These cellular perturbations caused a defect in exo-erythrocytic merozoite formation and a concomitant severe attenuation of liver stage-to-blood stage transition.LINUPgene deletion inPlasmodium falciparumalso caused a severe defect in late liver stage differentiation. Importantly,P. falciparum linup—liver stages showed a severe defect in parasite transitioning from liver stage to viable blood stage infection. These results suggest thatP. falciparum LINUPis a useful target for late liver stage attenuation and an additional gene deletion that can be incorporated into a late liver stage-arresting replication competent whole parasite vaccine.

Plasmodium sexual stages represent a critical bottleneck in the parasite life cycle. Gametocytes taken up in an infectious blood meal by female anopheline mosquito get activated to form gametes and fuse to form short-lived zygotes, which transform into ookinetes to infect mosquitoes.

Successful completion of the Plasmodium life cycle requires formation of mature gametocytes and their uptake by the female Anopheles mosquito vector in an infected blood meal. Inside the mosquito midgut the parasite undergoes gametogenesis and sexual reproduction.

The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients (37.5%); IgA nephropathy was the most frequent non-diabetic renal disease (half of non-diabetic renal diseases). Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group (16.7% versus 80.0%, P = 0024), duration of diabetes was a shorter (4.5 versus 15.5 years, P = 0.022) and diabetic retinopathy was absent (100% versus 40%, P = 0.026). There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephrotic syndrome and microscopic haematuria.

Diffusive clearance depends on blood (Qb) and dialysate flow (Qd) rates and the overall mass transfer area coefficient (KoA) of the dialyzer. In this article we describe a model to predict an appropriated AutoFlow (AF) factor (AF factor = Ratio Qd/Qb), that is able to provide adequate Kt/V for hemodialysis patients (HDP), while consuming lower amounts of dialysate, water and energy during the treatment. We studied in vivo the effects of three various Qd on the delivered dose of dialysis in 33 stable HDP. Hemodialysis was performed at Qd of 700 mL/mn, 500 mL/mn, and with AF, whereas specific dialysis prescriptions (treatment time, blood flow rate [Qb], and type and size of dialyzer) were kept constant. The results showed that increasing the dialysate flow rate more than the model of AF predicted had a small effect on the delivered dose of dialysis. The Kt/V (mean ± SD) was 1.52 ± 0.16 at Qd 700, 1.50 ± 0.16 at Qd 500, and 1.49 ± 0.15 with AF. The use of the AF function leads to a significant saving of dialysate fluid. The model predicts the appropriate AF factor that automatically adjusts the dialysate flow rate according to the effective blood flow rate of the patient to achieve an appreciable increase in dialysis dose at the lowest additional cost.

The use of mycophenolate mofetil (MMF) is known to be associated with progres-sive multifocal leukoencephalopathy (PML). We report a case of PML in a patient receiving MMF, who showed improvement upon discontinuation of the drug. He was restarted on MMF, following which he went into coma. He showed prompt recovery upon stopping the drug again and made full recovery without any residual neurological deficit. This case is being reported to further highlight this neurological side-effect of MMF.

We determined the prevalence of metabolic syndrome in 25 chronic haemodialysis patients in the haemodialysis centre of the Mohammed V military teaching hospital in Rabat. The mean age of the patient as was 46.5 (SD 14.8) years and mean haemodialysis duration 62.9 (SD 38.4) months. We evaluated the 5 parameters of metabolic syndrome: waist circumference, hypertriglyceridaemia, high-density lipoprotein (HDL) cholesterol, blood pressure and blood glucose. In all, 11 (44%) patients had metabolic syndrome: 7 women and 4 men. Low HDL cholesterol was found in 100% of the patients, hypertriglyceridaemia in 90.9% and hypertension in 63.6%. There were significant differences between patients with and without metabolic syndrome with regard to levels of hypertriglyceridaemia and HDL cholesterol, and waist circumference. Factors significantly associated with the presence of metabolic syndrome were abdominal obesity, and systolic hypertension and aypertriglyceri daemia.

Although the clinic picture is often indicative of muscle manifestations in patients with hypothyroidism, signs and symptoms of this condition are variable from simple elevation of serum muscle enzymes with myalgia, muscle weakness, cramps to rhabdomyolysis with acute renal failure which remains a rare event. Thyroid hormones affect the function of almost every body organ, and thyroid dysfunction produces a wide range of metabolic disturbances. Hypothyroidism is associated with significant effects on the kidney which the pathophysiology seems to be multifactorial, but the exact mechanisms remain poorly understood. Hypothyroidism as a cause of renal impairment is usually overlooked, leading to unnecessary diagnostic procedures. The main objective of our observation is to report a case of acute renal failure revealing an autoimmune hypothyroidism in which thyroid hormone substitution led to a significant improvement in muscular, thyroid and renal disorders.

Resume Introduction La pyelonephrite emphysemateuse est une forme severe et necrosante de la pyelonephrite bacterienne aigue. Elle est definie par la presence de gaz d’origine bacterienne au sein du parenchyme renal et dans les espaces perirenaux. Le but de cette observation est de rappeler les differentes caracteristiques de cette pathologie. Observation Nous rapportons un cas de pyelonephrite emphysemateuse survenant sur un rein unique, associee a une lithiase obstructive de la voie excretrice. Il s’agit d’une patiente de 44 ans, diabetique et porteuse d’une insuffisance renale chronique, hospitalisee pour colique nephretique gauche et anurie dans un contexte de fievre et d’alteration de l’etat general. Apres confirmation du diagnostic par tomodensitometrie, le traitement a consiste en une antibiotherapie adaptee a la fonction renale et un drainage des urines par montee de sonde double J. L’evolution a ete favorable. Discussion La pyelonephrite emphysemateuse est une infection rare, survenant le plus souvent chez la femme et sur un terrain de diabete. Le scanner abdominal permet la confirmation du diagnostic. Son pronostic reste redoutable. Conclusion La pyelonephrite emphysemateuse, bien que rare, est grevee d’une lourde mortalite en l’absence d’un traitement urgent et efficace.

Le profil de la morbidite et de la mortalite des maladies dans le monde entier est en train de changer, aussi bien dans les pays developpes que dans les pays emergents. Les maladies non-transmissibles et non-infectieuses [1] comme le diabete et l'hypertension arterielle sont desormais la cause principale de mortalite et de morbidite. L'insuffisance renale chronique terminale (IRCT) a ete declaree priorite majeure de sante publique dans de nombreux pays a cause d'une croissance reguliere de l'incidence et de la prevalence de l'IRCT (21-22-23) et de ses consequences medicales, sociales et economiques. Aujourd'hui, la cause principale de l'IRCT est le diabete de type 2 [2]. A la difference des pays industrialises ou l'incidence et la prevalence de l'IRCT est connue grâce a l'existence de registre nationaux, peu de donnees existent dans les pays en voie de developpement comme le Maroc, sur la progression des nouveaux cas d'IRCT [3]. L'objectif de ce travail est d’etudier les nouveaux cas d'IRCT a l'unite de nephrologie de l'hopital militaire de rabat, Maroc.

Resume Introduction. – Les thromboses veineuses posent principalement, en pratique, le probleme de leur etiologie ; quelques elements cliniques et/ou biologiques peuvent orienter dans cette recherche. Nous rapportons deux cas de thrombose veineuse ayant comme point commun une macrocytose qui a fait evoquer une hyperhomocysteinemie, probablement secondaire, par deficit en vitamine B12. Exegese. – Le premier cas concerne un patient âge de 24 ans hospitalise pour anemie severe et syndrome cave superieur. Le bilan a revele une thrombose cave superieure ainsi qu’une anemie megaloblastique, avec une note d’hemolyse, rattachee a une maladie de Biermer. Le second cas concerne un patient âge de 35 ans qui a presente deux episodes de thrombophlebite (surale droite, puis gauche), associes a une macrocytose en rapport avec une maladie de Biermer. Dans les deux cas, la thrombose est expliquee en partie par une hyperhomocysteinemie secondaire a une carence en vitamine B12. Un traitement anticoagulant, associe a un apport en vitamine B12, a permis une evolution favorable dans les deux cas. Conclusion. – La maladie de Biermer est une cause d’hyperhomocysteinemie acquise qui peut favoriser la survenue de thromboses veineuses. Il convient de l’evoquer chez tout patient presentant une thrombose veineuse sans cause evidente, principalement lorsqu’elle s’associe a une anemie macrocytaire.

The Mediterranean spotted fever is a bacterial infection caused by Rickettsia Conorii mainly around Mediterranean basin. It is often considered like a trivial infection. However, severe forms with a high morbidity and high mortality risk have been described. These forms often associate with impaired consciousness, abnormal liver function, impaired homeostasis, pneumonia and acute renal failure. Several mechanisms of renal damage during the Mediterranean spotted fever have been reported, their pathogenesis remains speculative and the prognosis is determined by the type of renal disease and on early treatment. Thus, rickettsiosis should be considered in combination of acute renal, hepatic cytolysis and thrombocytopenia, allowing rapid achievement of a specific treatment.

Epidemiological studies provide useful information for clinical practice and investigations. This report aimed to determine glomerular diseases frequencies in a region of Morocco. All native renal biopsies (January 2000 to December 2007) on adults were reviewed, but only glomerular diseases were analyzed. The diagnosis of each case was based on histological, immunopathological and clinical features. We have performed 171 renal biopsies in 161 patients (101 males and 60 females), the mean age was (range) 40.4 ±15 years (16-72). Clinical indications that lead to renal biopsy were: nephrotic syndrome (60.3%), renal failure of unknown aetiology (31.6%), asymptomatic urinary abnormalities (6.2%) and nephritic syndrome(1.9%). Primary glomerular diseases were reported in 84 patients (52%). The most common histological lesion was minimal change disease (26%). Idiopathic membranous glomerulopathy was the second most common lesion (23%) followed by membranoproliferative glomerulonephritis (17%), IgA nephropathy (12%), focal and segmental glomerulosclerosis (9.4%) and crescentic glomerulonephritis (6%). Secondary glomerular diseases were reported in 53 patients (33%). Lupus nephritis was the secondary glomerular disease most frequent (45%) followed by amyloidosis (19%), diabetic nephropathy (15%), and Good pasture's syndrome (7.6%). The most common complications of the procedure were pain at biopsy site in 4%, gross hematuria in 11.1%, perirenal hematoma in 5% and hematuria requiring nephrectomy in 0.6% patients. Minimal change disease was the most frequent primary glomerulopathy and lupus nephritis was the most frequent secondary glomerulopathy in our group. The reasons for these findings are unclear. This information is an important contribution to the understanding the prevalence of renal diseases in North Africa.

The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients (37.5%); IgA nephropathy was the most frequent non-diabetic renal disease (half of non-diabetic renal diseases). Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group (16.7% versus 80.0%, P = 0024), duration of diabetes was a shorter (4.5 versus 15.5 years, P = 0.022) and diabetic retinopathy was absent (100% versus 40%, P = 0.026). There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephrotic syndrome and microscopic haematuria.

Introduction: The association of myelodysplastic syndrome and extracapillary glomerulonephritis is exceptional. Only two other cases have been reported. Reported case: A 52-year-old patient with a history of myelodysplastic syndrome developed rapidly progressive glomerulonephritis. Renal biopsy identified extracapillary glomerulonephritis.Discussion: The association of myelodysplastic syndrome with glomerulopathy is rare and often regarded as fortuitous. Only a few cases are described in literature on the subject. A relationship between the two diseases is possible but the causal link between these two diseases remains unknown. Conclusion: The notion that myelodysplastic syndrome may be associated with various glomerular nephropathies involves looking for renal disease in this haematologic disorder.

Benign intracranial hypertension (BIH) is a syndrome characterized by the abnormal elevation of the intracranial pressure in the absence of a mass lesion or hydrocephalus, and with normal composition of the cerebrospinal fluid. We report a case of BIH in a chronic hemodialysis patient with no signs of intraocular inflammation or neurologic abnormalities. Treatment with acetazolamide followed by corticosteroids failed to improve the signs of BIH. However, after correction of the radiocephalic arteriovenous fistula of the left upper extremity, which demonstrated excessive flow, BIH symptoms completely disappeared.When managing BIH in a hemodialysis patient, consider the fistula.

We determined the prevalence of metabolic syndrome in 25 chronic haemodialysis patients in the haemodialysis centre of the Mohammed V military teaching hospital in Rabat. The mean age of the patient as was 46.5 (SD 14.8) years and mean haemodialysis duration 62.9 (SD 38.4) months. We evaluated the 5 parameters of metabolic syndrome: waist circumference, hypertriglyceridaemia, high-density lipoprotein (HDL) cholesterol, blood pressure and blood glucose. In all, 11 (44%) patients had metabolic syndrome: 7 women and 4 men. Low HDL cholesterol was found in 100% of the patients, hypertriglyceridaemia in 90.9% and hypertension in 63.6%. There were significant differences between patients with and without metabolic syndrome with regard to levels of hypertriglyceridaemia and HDL cholesterol, and waist circumference. Factors significantly associated with the presence of metabolic syndrome were abdominal obesity, and systolic hypertension and aypertriglyceri daemia.

Introduction : le metabolisme des lipoproteines chez les hemodialyses chroniques est perturbe. Les anomalies lipidiques qui en decoulent sont fortement atherogenes et constituent, entre autres, un des facteurs de l’atherosclerose acceleree et de la maladie cardiovasculaire. Objectif : etudier les variations quantitatives des parametres lipidiques chez les hemodialyses chroniques suivis dans une structure hospitaliere marocaine. Population d’etude et methode : nous avons compare les parametres lipidiques entre un groupe de 30 hemodialyses chroniques de notre centre et un groupe de 30 sujets temoins. Les parametres etudies ont ete : les triglycerides (TG), le cholesterol total (CT), le cholesterol des lipoproteines de faible densite (C-LDL), le cholesterol des lipoproteines de haute densite (C-HDL) et l’index d’atherogenicite (IA = CT/C-HDL). Resultats : nous avons constate une augmentation significative des triglycerides seriques (TG) chez le groupe des hemodialyses par rapport au groupe temoin. Concernant le metabolisme du cholesterol, l’anomalie la plus significative a ete une diminution du taux du cholesterol des lipoproteines de haute densite (C-HDL). L’index d’atherogenicite (IA) etait significativement plus eleve. Le cholesterol total et le cholesterol des lipoproteines de faible densite (C-LDL) n’ont pas montre d’augmentation significative. Dans le groupe des hemodialyses, la prevalence de la dyslipidemie etait elevee (80 %). L’alteration la plus frequente etait la diminution du C-HDL (70 %), l’elevation des TG (33,3 %) et l’elevation du C-LDL (23,3%) ; dans la moitie des cas il y avait une alteration de deux a trois parametres lipidiques. L’IA etait eleve (≥ 5) dans 33,3 % des cas. Conclusion : la prevalence de la dyslipidemie est elevee chez les hemodialyses chroniques, les anomalies les plus caracteristiques sont l’elevation des triglycerides et la baisse du cholesterol des lipoproteines de haute densite. Afin d’instaurer une strategie de prevention du risque cardiovasculaire, l’amelioration de ces anomalies lipidiques doit etre stricte chez les hemodialyses chroniques.

The authors report a case of orbital cellulitis complicating bacteremia on central catheter infection. A 51-year-old man, with a history of diabetes and end-stage renal disease, was admitted for left exophthalmos with inflammatory chemosis, fever, and worsening of his general state. The CT scan showed exophthalmos with thickening of soft tissues and infiltration of the ocular fat without collection or sinus impairment. Orbital cellulitis was diagnosed. The etiological investigations showed Staphylococcus aureus bacteremia on femoral catheter infection. Progression was favorable with antibiotics and nursing care. The authors discuss the compromised prognosis of this disease and the need for rapid diagnosis and prompt therapeutic management.

The non-secreting myeloma is a rare form of myeloma. Its association with a nephrotic syndrome is exceptional. The observation which we report below described the history of a 66 years old patient who presents a non-secreting myeloma revealed by a nephrotic syndrome. Various assumptions on the mechanism of no excretion were put forth. Nevertheless, several points are to be elucidated as for the pathogenesis of the association non-secreting myeloma and nephrotic syndrome.

Resume Introduction Les patients en insuffisance renale chronique terminale en hemodialyse sont exposes a un risque hemorragique en rapport, entre autres, avec l’anticoagulation efficace employee au cours d’une seance d’ou l’interet d’utiliser la dose minimale efficace. L’objectif de ce travail etait d’etudier l’efficacite de la predilution en hemodiafiltration avec dose reduite d’anticoagulation en comparaison avec l’hemodialyse conventionnelle dans la prevention des coagulations de circuits. Patients et methode Cette etude a ete menee chez des hemodialyses chroniques stables sans risque hemorragique majeur. Tous les patients ont ete traites en alternant deux types de traitements differents pendant dix seances : (A) hemodialyse conventionnelle, (B) hemodiafiltration en mode predilutionnel avec la moitie de la dose d’anticoagulant utilisee pendant le traitement (A). Les autres parametres dialytiques confondants ont ete maintenus constants durant l’etude. Le principal critere de jugement etait la frequence des accidents thrombotiques majeurs jugee sur un score visuel subjectif. Resultats Vingt et un patients ont ete inclus (105 seances pour chaque type de traitement). Les incidents majeurs sont survenus plus frequemment en hemodiafiltration predilutionnelle avec dose reduite d’anticoagulation ( p = 0,03). Les arrets prematures des seances etaient plus frequents en hemodiafiltration predilutionnelle, cette difference n’atteint pas le seuil de significativite ( p = 0,07). En revanche, la duree des seances etait significativement plus courte en predilution qu’en hemodialyse conventionnelle ( p = 0,03). La frequence plus elevee des incidents thrombotiques en hemodiafiltration predilutionnelle etait sans consequence sur le volume net d’ultrafiltration atteint dans les deux traitements. Conclusion La predilution en hemodiafiltration avec une dose reduite d’anticoagulation n’a pas permis de prevenir les incidents majeurs de coagulation du circuit de maniere au moins equivalente a la methode de reference.

Dialysis adequacy has been shown to have a significant impact on patient survival, but there are few data concerning the adequacy of the delivered hemodialysis dose in developing countries. To describe the level of implementation of dialysis practice guidelines in a dialysis center in Morocco, we retrospectively reviewed our 1-year experience of managing chronic hemodialysis patients (CHP), from May 2009 to May 2010. Demographic and biochemical data were collected, and the percentage of patients achieving targets recommended by the NKF-KDOQI guidelines were calculated. Our data suggests that dialysis units in a developing country can achieve current guidelines targets for dialysis adequacy, however, our results are not generalizable to all dialysis centers in Morocco.

The main issue in venous thrombotic events is their etiology. Several clinical and/or biological data can be helpful in that research. In the two cases we report here, a macrocytic anemia led to the diagnosis of probably acquired hyperhomocysteinemia.a 24-year-old man was admitted for severe anemia and a superior vena cava syndrome. Biological data showed megaloblastic anemia and mild features of blood destruction that were explained by a pernicious anemia. Second case: a 35-year-old man had two deep venous thrombotic events in one year (involving the right leg, then the left leg); biological findings showed a macrocytic mild anemia that was diagnosed as a pernicious anemia. In both of the patients, deep venous thrombosis was mainly explained by a hyperhomocysteinemia that was a consequence of vitamin B12 deficiency. The two patients improved under anticoagulant treatment combined with subcutaneous vitamin B12.Pernicious anemia can cause acquired hyperhomocysteinemia, which is considered a risk factor for deep venous thrombosis. Thus, the connectivity of these conditions should remain in the practitioner's mind, especially when thrombosis occurs along with a macrocytic anemia.

Major progress has been achieved in autosomal dominant polycystic kidney disease in the last 30 years; Progress in imaging procedures has been decisive for diagnosis (by ultasonography), management of kidney and liver complications (by CT scan), and investigation and sometimes management of intracranial aneurysms (by MRI-angiography and endovascular treatment procedures). On the other hand, progress in molecular genetics has led to the identification of PKD1 and PDK2 genes, and their respective gene products, polycystin 1 and 2. A two-hit model for cyst formation has recently been put forward. The link between the gene defects and cyst fluid formation and progression is still unknown. In addition, cystic and non-cystic lesions coexist in the disease, underlining that the primary molecular defect is located upstream of the mechanism of cyst formation.

Renal fibrosis is found in genetic kidney diseases. In some of them, fibrosis may be due to mechanisms not dependent on the gene defect. In other cases, fibrosis depends more specifically on the gene defect: e.g. in juvenile nephronophthisis where interstitial fibrosis predominates, or in Alport's syndrome where glomerulosclerosis is triggered probably by unbalanced distribution of alpha chains of type IV collagen in glomerular basement membrane. Study of genes predisposing to renal fibrosis and progression is more complex. Genes regulating the renin-angiotensin system have been considered. The DD polymorphism of the converting enzyme gene may be associated with a more rapid progression rate of renal failure in glomerular and non-glomerular diseases. This remains, however, to be confirmed in more appropriate studies.

A study has claimed that at an equal elemental calcium dose, CaCO3 was not less but equally as efficient in controlling predialysis hyperphosphatemia as calcium acetate, provided both calcium salts were ingested 5 min before meals instead of during meals because the higher acidity of the fasting gastric juice would allow for better dissociation of CaCO3. However, this study did not directly demonstrate that the efficiency of CaCO3 in controlling hyperphosphatemia was actually greater when it was administered before a meal than during a meal. To examine this point, we performed a 3 month randomized crossover trial in 12 reliable and stable patients maintained on chronic hemodialysis. Their plasma concentrations of calcium, protein, phosphate, bicarbonate, urea, and creatinine were measured before the first dialysis of each week and the amount of intact parathyroid hormone (PTH) at the beginning and at the end of each of the 3 months. Comparison of the plasma concentrations measured during the 2 modes of administration showed no significant differences in creatinine, urea, bicarbonate, or intact PTH. The mean (+/-SD) plasma concentration of PO4 was not significantly lower (1.88+/-0.50 vs. 1.74+/-0.41 mM) whereas the corrected level of plasma Ca was significantly lower (2.30+/-0.17 vs. 2.38+/-0.16 mM; p < 0.04) when CaCO3 was given before meals than during meals. In conclusion, the administration of CaCO3 before a meal does not increase its efficiency in controlling hyperphosphatemia because the level of plasma PO4 was actually slightly higher with this timing of administration whereas the comparison of the creatinine and urea levels suggested a stability of phosphate intake and the comparison of the PTH and bicarbonate levels suggested the stability of osteolysis and of the transcellular membrane shift of phosphate. Also, administration of CaCO3 before a meal is associated with significantly lower plasma corrected calcium, suggesting less absorption of calcium, which may be an advantage but only in hypercalcemic patients. There is no reason other than the prevention of its hypercalcemic effect to recommend the administration of CaCO3 just before meals rather than during meals.

Resume L’hypertension intracrânienne benigne (HICB) est un syndrome defini par une elevation anormale de la pression intracrânienne non associee a un processus expansif intracrânien ou a une hydrocephalie, avec un liquide cephalorachidien de composition normale. L’observation Nous rapportons un cas d’HICB chez une hemodialysee chronique sans signe inflammatoire intraoculaire ni d’anomalie a l’examen neurologique. Le traitement par acetazolamide puis par corticoides n’a pas ameliore les signes de l’HICB. Mais apres correction de la fistule arterioveineuse radiocephalique du membre superieur gauche, qui etait hyper debitante, les symptomes d’HICB ont totalement disparu. Conclusion Devant une HICB chez un hemodialyse, il faut penser a la fistule.