A. Kaddous

Introduction La prevalence des femmes en âge de procreer porteuses d’une insuffisance renale chronique est en progression. La grossesse est envisageable chez ces femmes mais n’est pas denuee de risques. Nous presentons une etude retrospective portant sur 14 femmes ayant fait une grossesse sur insuffisance renale chronique. Patients et methodes Etude retrospective sur une periode de 5 ans (2010–2014). Nous avons inclus 14 femmes ayant fait une grossesse sur insuffisance renale chronique (clairance de la creatinine entre 60 et 20 mL/min en debut de grossesse). Nous avons analyse les donnees cliniques et biologiques pendant et apres la grossesse et l’evolution mutuelle de la fonction renale et de la grossesse. Les resultats ont ete analyses en fonction de la presence ou non d’une HTA ou d’une proteinurie en debut de grossesse, et la clairance de la creatinine en debut de grossesse. Resultats Treize femmes atteintes d’IRC ont mene 14 grossesses, l’âge moyen des patientes etait 31,5 ans. Quatre interruptions therapeutiques de grossesse (28 %) et 3 avortements spontanes (22 %), contre 7 grossesses qui ont eu une issue favorable (50 %). Lorsqu’une HTA etait presente en debut de grossesse le taux de grossesses avec issue favorable descend a 33 %. Lorsqu’une proteinurie superieure a 500 mg/24 h est presente en debut de grossesse le taux de grossesses avec issue favorable descend a 43 %. Lorsque la clairance de la creatinine en debut de grossesse est inferieure a 30 mL/min le taux de grossesses avec issue favorable est 25 %. Discussion L’issue de la grossesse depend de plusieurs facteurs (HTA, proteinurie, stade de l’IRC). La grossesse influence aussi l’evolution de l’insuffisance renale puisque 35 % des patientes ont degrade leur fonction renale de facon durable. Conclusion La grossesse chez les patientes atteintes d’IRC reste une grossesse a haut risque necessitant une programmation et un suivi regulier avec correction de tous les facteurs de risque.

Dyslipidemia, oxidative stress (OS) and inflammation increase the risk of cardiovascular disease in chronic renal failure (CRF) patients. The aim of this study was to evaluate the effect of nutritional advice on dyslipidemia and biomarkers in CRF patients. 40 CRF patients with dyslipidemia, hypertriglyceridemia and/or hypercholesterolemia were randomly assigned to either the control or the intervention group. The intervention group received nutritional advice adapted to a Mediterranean diet (MD). Patients were assessed at baseline (T0) and after 30 (T1), 60 (T2) and 90 (T3) days for dietary intake and biomarkers. In the intervention group compared to the control group, TG concentrations were decreased by 26% at T3 (p < 0.05), TC concentrations were diminished by 14% at T2 and by 35% at T3 (p < 0.05). A decrease in LDL-C was noted at T2 and T3 (p < 0.05). The TC/HDL-C ratio was diminished at T1, T2 and T3 (p < 0.05). The apo A-I/apo B ratio was elevated at T3 (p < 0.05). HDL-C, apo A-I, apo B concentrations and the TC/LDL-C ratio were similar in the both groups at T1, T2 and T3. Creatinine, urea, glomerular filtration rate (GFR), urate, iron and bilirubin values remained unchanged in both groups. Haemoglobin concentrations were elevated at T1 (p < 0.05). Increased albumin values were observed at T2 (p < 0.05). CRP concentrations were decreased by 29% at T1 (p < 0.05) and 40% (p < 0.01) at T3. Fibrinogen (p < 0.01) concentrations were decreased at T3. In the intervention group compared to control group (p < 0.01), TBARS values were decreased by 16% at T2 and 21% at T3 (p < 0.05). In this study, we demonstrate that the nutritional management of CRF patients before dialysis based on the MD improves food consumption, reduces dyslipidemia and protects against lipid peroxidation and inflammation, allowing patients to enter dialysis with an acceptable nutritional and cardiovascular state.

To evaluate pro-inflammatory cytokines, homocysteinemia and markers of oxidative status in the course of chronic renal failure. One hundred and two patients (male/female: 38/64; age: 45±07 years) with chronic renal failure were divided into 4 groups according to the National Kidney Foundation classification. They included 28 primary stage renal failure patients, 28 moderate stage renal failure, 28 severe stage renal failure and 18 end stage renal failure. The inflammatory status was evaluated by the determination of pro-inflammatory cytokines (tumor necrosis factor-α, interleukin-1β, interleukin-6) and total homocysteine. Pro-oxidant status was assessed by assaying thiobarbituric acid reactive substances, hydroperoxides, and protein carbonyls. Antioxidant defence was performed by analysis of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase. Inflammatory markers were elevated in the end stage renal failure group compared to the other groups (P<0.001). Indeed, an increase in thiobarbituric acid reactive substances, hydroperoxides and protein carbonyls was noted in the end stage renal failure group in comparison with the other groups (P<0.001), while the levels of antioxidants enzymes activity were decreased in the study population (P<0.001). Impaired renal function is closely associated with the elevation of inflammatory markers leading to both increased markers of oxidative stress and decreased antioxidant defense.