Introduction peritoneal dialysis (PD) is a renal replacement therapy method that offers various a... more Introduction peritoneal dialysis (PD) is a renal replacement therapy method that offers various advantages to end-stage renal disease patients. The aim of our study was to analyze patient characteristics, peritonitis and clinical outcome over a 27-year period of PD in our center. Methods retrospective study of incident patients on PD from January 1990 to December 2017. A total of 304 patients were enrolled in the study group. All patients over 15 years of age entering the dialysis program were included in the study. Patients dropping out from PD within three months were all excluded. Biochemical and demographic variables, peritonitis episodes and patient and technique survival were analyzed. Results the PD prevalence in our center was 4.5% during the study period; the mean age was 46.47 ± 18.6 years; diabetic nephropathy was the main cause of chronic kidney disease: 35.5% (n=108). Cardiovascular disease was the main cause of death: 39.6% (n=34). The peritonitis rate was 0.68 episode per patient-year. Ultrafiltration failure was the most important cause of PD withdrawal: 43% (n=60). Occurrence of peritonitis was the only independent predictor of technique failure: adjusted relative risk [aRR] 5.07, 95% CI 2.69-9.58; p<0.001. The overall non-adjusted patient survival was around 100%, 95% and less than 20% at 1, 4 and 25 years respectively basing on the Kaplan-Meier analysis. The group undergoing renal transplantation had the best survival rate. Conclusion peritonitis remains the most common complication as well as the most provider of technique failure and patient´s transfer to hemodialysis. The technique survival was better in case of absence of peritonitis. However, our series showed the superiority of hemodialysis over PD in terms of overall patient survival.
Hemophagocytic syndrome is a disorder of the mononuclear phagocytic system resulting in uncontrol... more Hemophagocytic syndrome is a disorder of the mononuclear phagocytic system resulting in uncontrolled hemophagocytosis and cytokine overproduction. We report the first case of hemophagocytic syndrome, which occurred in a pregnantfemale patient 14 years after kidney transplant who displayed an atypical presentation and who had septic shock following cytomegalovirus infection. The patient, a-39-year-old woman at 27 weeks gestation with end-stage renal disease of unknown etiology, was admitted 14 years after living-donor kidney transplant (donor was her father) with high-grade fever, cough, and pancytopenia. Her immunosuppressant regimen included tacrolimus, azathioprine, and prednisone. Initially, she was hospitalized in the intensive care unit for septic shock without an identifiable focus of infection. She received intravenous broad-spectrum antibiotics before being transferred to our department following optimization of her hemodynamic status. Hemophagocytic syndrome was suspected, and bone marrow aspirate was performed, revealing macrophages with hemophagocytic activity. We confirmed the diagnosis of hemophagocytic syndrome given the presence of more than 5 criteria. We extensively investigated the underlying cause of hemophagocytic syndrome, and we diagnosed cytomegalovirus-induced hemophagocytic syndrome in a pregnant patient receiving immunosuppressive therapy after kidney transplantation. She was treated with corticosteroids and intravenous immunoglobulin. At 31 weeks gestation, she underwent a cesarean section; the baby developed newborn respiratory distress syndrome and died despite adequate resuscitation. We administered ganciclovir for 15 days following an increased cytomegalovirus viral load after delivery, leading to complete recovery.To date, optimal therapeutic and diagnostic guidelines for pregnancy-related hemophagocytic syndrome in female kidney transplant recipients are not well defined, and both patient and allograft survival rates remain low.
Une atteinte cardiaque au cours de la myosite a inclusions n'a ete rapportee que chez deux je... more Une atteinte cardiaque au cours de la myosite a inclusions n'a ete rapportee que chez deux jeunes patients s'exprimant comme un bloc auriculo-ventriculaire. Par contre une myocardite avec troubles du rythme n'a jamais ete decrite dans la litterature. Nous rapportons l'observation d'un patient de 34 ans atteint de myopathie a predominance distale compliquee d'une myocardite revelee par des extrasystoles ventriculaires avec une issue fatale. La biopsie musculaire a revele un aspect caracteristique d'une myosite a inclusions. Bien que cette complication soit exceptionnelle et n'ait jamais ete revelee par des troubles de rythme cardiaque, sa recherche doit etre systematique car elle peut mettre en jeu le pronostic vital.
ABSTRACT Introduction et but: Le syndrome néphrotique est une entité clinico-biologique de présen... more ABSTRACT Introduction et but: Le syndrome néphrotique est une entité clinico-biologique de présentation particulière chez le sujet âgé.Le but de notre travail était d’étudier les caractéristiques des patients ayant une glomérulonéphrite extra membraneuse( GEM). Patients et méthodes : On a mené une étude rétrospective ayant inclus 37patients d’age moyen :70.3 ans présentant un syndrome néphrotique(SN) et qui étaient tous biopsiés. Résultats: Parmi tous les malades agés biopsiés pour SN, la GEM était la néphropathie glomérulaire prédominante dans notre étude ,rencontrée dans 27.02 % des cas. Nous avons décrit une prédominance masculine nette avec un sexe ratio à 4. Il est aussi à signaler que le SN était impur chez 60 % de nos malades.L’enquête étiologique a permis de conclure que la GEM est secondaire à un cancer du poumon chez 2 patients. Discussion et Conclusion : La GEM représente la cause la plus fréquente, à la fois de SN primitif et secondaire de l&#39;adulte et du sujet âgé ≥60ans. L’étude des aspects cliniques et biologiques des patients présentant une GEM a permis de déduire après comparaison de nos résultats avec la littérature , que nos patients ont le taux plasmatique moyen d’albumine le plus bas avec une moyenne à 20g/l ainsi qu’une altération de la fonction rénale plus prononcée avec une clairance de la créatinine à 45.4 ml/min/1.73 m² qui pourrait étre expliqué par une limite d’age plus élevée impliquant une baisse physiologique de la filtration glomérulaire surajoutée à la néphropathie récemment installée.Dans notre série, les patients atteints de GEM avaient le taux de protéinurie le plus élevé, avec une moyenne de 8.01 et la protéinurie la plus importante était de 27.3g/24 h, retrouvée chez un homme âgé de 67 ans L’hypercholestérolémie est présente pour tous les cas de GEM et la thrombose des veines périphériques n’était retrouvé que chez un seul patient.Chez 2 de nos malades (soit 20%),l’enquête étiologique a permis de conclure que la GEM est secondaire à un cancer du poumon alors qu’on rapporte que les causes secondaires sont à l’origine d’une GEM dans 10-20% des cas. Toutefois, en raison de la taille de notre groupe, d’autres études à effectif plus large intéressant cette tranche d’âge sont nécessaires pour confirmer les résultats de notre travail Mots clefs : Glomérulonéphrite
Saudi Journal of Kidney Diseases and Transplantation, 2013
Infections are a major determinant of outcome in kidney transplantation. Opportunistic pathogens ... more Infections are a major determinant of outcome in kidney transplantation. Opportunistic pathogens are common in kidney recipients and several organs can be affected. Central nervous system infection in transplant recipients is a medical emergency. There is limited information in the literature concerning post-transplantation cryptococcal infection. Deafness and blindness are not classic findings. We report a case of meningocerebral cryptococcosis complicated by deafness and blindness after kidney transplantation. Physicians need to consider the possibility of Cryptococcus neoformans when symptoms persist despite empiric antimicrobial therapy.
Secondary hyperparathyroidism is one of the most serious complications for long-term hemodialysis... more Secondary hyperparathyroidism is one of the most serious complications for long-term hemodialysis patients. In our department, we performed parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomy was an effective treatment for advanced renal hyperparathyroidism and that after total parathyroidectomy with forearm autograft, renal hyperparathyroidism was controllable, even when hyperparathyroidism was progressive. However, the timing of this operation was important, because skeletal deformity and vessel calcification did not improve after parathyroidectomy. There were two problems after parathyroidectomy for secondary hyperparathyroidism. One was persistent hyperparathyroidism due to supernumerary parathyroid glands, particularly those located in the mediastinum, and the other was recurrent hyperparathyroidism. From our clinical and pathohistological investigations, we suspected that the proliferation of parathyroid cells changed with the progress of renal hyperparathyroidism and we found that it was difficult to prevent enlargement of parathyroid glands and recurrence of this problem.
Objective To determine the clinico‐pathological profile of patients with emphysematous pyelonephr... more Objective To determine the clinico‐pathological profile of patients with emphysematous pyelonephritis (EPN). Patients and methods The records of 22 diabetic patients who presented with EPN were reviewed. Results EPN occurred predominantly in female diabetic patients without evidence of ureteric obstruction. The ages of the patients and the duration of the diabetes were variable. EPN occurred in insulin‐dependent as well as non‐insulin‐dependent patients. The patients presented following a prodromal illness of urinary sepsis, with an acute severe illness with symptoms and signs on the affected side. Dehydration and keto‐acidosis were common. The diagnosis was made by recognizing gas in the kidney on an X‐ray or ultrasound. Eighteen patients were subjected to emergency nephrectomy. Conclusions EPN is an uncommon, life‐threatening condition characterized by the production of intraparen‐chymal gas. We believe that vigorous resuscitation and emergency nephrectomy is the treatment of choice.
Introduction peritoneal dialysis (PD) is a renal replacement therapy method that offers various a... more Introduction peritoneal dialysis (PD) is a renal replacement therapy method that offers various advantages to end-stage renal disease patients. The aim of our study was to analyze patient characteristics, peritonitis and clinical outcome over a 27-year period of PD in our center. Methods retrospective study of incident patients on PD from January 1990 to December 2017. A total of 304 patients were enrolled in the study group. All patients over 15 years of age entering the dialysis program were included in the study. Patients dropping out from PD within three months were all excluded. Biochemical and demographic variables, peritonitis episodes and patient and technique survival were analyzed. Results the PD prevalence in our center was 4.5% during the study period; the mean age was 46.47 ± 18.6 years; diabetic nephropathy was the main cause of chronic kidney disease: 35.5% (n=108). Cardiovascular disease was the main cause of death: 39.6% (n=34). The peritonitis rate was 0.68 episode per patient-year. Ultrafiltration failure was the most important cause of PD withdrawal: 43% (n=60). Occurrence of peritonitis was the only independent predictor of technique failure: adjusted relative risk [aRR] 5.07, 95% CI 2.69-9.58; p<0.001. The overall non-adjusted patient survival was around 100%, 95% and less than 20% at 1, 4 and 25 years respectively basing on the Kaplan-Meier analysis. The group undergoing renal transplantation had the best survival rate. Conclusion peritonitis remains the most common complication as well as the most provider of technique failure and patient´s transfer to hemodialysis. The technique survival was better in case of absence of peritonitis. However, our series showed the superiority of hemodialysis over PD in terms of overall patient survival.
Hemophagocytic syndrome is a disorder of the mononuclear phagocytic system resulting in uncontrol... more Hemophagocytic syndrome is a disorder of the mononuclear phagocytic system resulting in uncontrolled hemophagocytosis and cytokine overproduction. We report the first case of hemophagocytic syndrome, which occurred in a pregnantfemale patient 14 years after kidney transplant who displayed an atypical presentation and who had septic shock following cytomegalovirus infection. The patient, a-39-year-old woman at 27 weeks gestation with end-stage renal disease of unknown etiology, was admitted 14 years after living-donor kidney transplant (donor was her father) with high-grade fever, cough, and pancytopenia. Her immunosuppressant regimen included tacrolimus, azathioprine, and prednisone. Initially, she was hospitalized in the intensive care unit for septic shock without an identifiable focus of infection. She received intravenous broad-spectrum antibiotics before being transferred to our department following optimization of her hemodynamic status. Hemophagocytic syndrome was suspected, and bone marrow aspirate was performed, revealing macrophages with hemophagocytic activity. We confirmed the diagnosis of hemophagocytic syndrome given the presence of more than 5 criteria. We extensively investigated the underlying cause of hemophagocytic syndrome, and we diagnosed cytomegalovirus-induced hemophagocytic syndrome in a pregnant patient receiving immunosuppressive therapy after kidney transplantation. She was treated with corticosteroids and intravenous immunoglobulin. At 31 weeks gestation, she underwent a cesarean section; the baby developed newborn respiratory distress syndrome and died despite adequate resuscitation. We administered ganciclovir for 15 days following an increased cytomegalovirus viral load after delivery, leading to complete recovery.To date, optimal therapeutic and diagnostic guidelines for pregnancy-related hemophagocytic syndrome in female kidney transplant recipients are not well defined, and both patient and allograft survival rates remain low.
Une atteinte cardiaque au cours de la myosite a inclusions n'a ete rapportee que chez deux je... more Une atteinte cardiaque au cours de la myosite a inclusions n'a ete rapportee que chez deux jeunes patients s'exprimant comme un bloc auriculo-ventriculaire. Par contre une myocardite avec troubles du rythme n'a jamais ete decrite dans la litterature. Nous rapportons l'observation d'un patient de 34 ans atteint de myopathie a predominance distale compliquee d'une myocardite revelee par des extrasystoles ventriculaires avec une issue fatale. La biopsie musculaire a revele un aspect caracteristique d'une myosite a inclusions. Bien que cette complication soit exceptionnelle et n'ait jamais ete revelee par des troubles de rythme cardiaque, sa recherche doit etre systematique car elle peut mettre en jeu le pronostic vital.
ABSTRACT Introduction et but: Le syndrome néphrotique est une entité clinico-biologique de présen... more ABSTRACT Introduction et but: Le syndrome néphrotique est une entité clinico-biologique de présentation particulière chez le sujet âgé.Le but de notre travail était d’étudier les caractéristiques des patients ayant une glomérulonéphrite extra membraneuse( GEM). Patients et méthodes : On a mené une étude rétrospective ayant inclus 37patients d’age moyen :70.3 ans présentant un syndrome néphrotique(SN) et qui étaient tous biopsiés. Résultats: Parmi tous les malades agés biopsiés pour SN, la GEM était la néphropathie glomérulaire prédominante dans notre étude ,rencontrée dans 27.02 % des cas. Nous avons décrit une prédominance masculine nette avec un sexe ratio à 4. Il est aussi à signaler que le SN était impur chez 60 % de nos malades.L’enquête étiologique a permis de conclure que la GEM est secondaire à un cancer du poumon chez 2 patients. Discussion et Conclusion : La GEM représente la cause la plus fréquente, à la fois de SN primitif et secondaire de l&#39;adulte et du sujet âgé ≥60ans. L’étude des aspects cliniques et biologiques des patients présentant une GEM a permis de déduire après comparaison de nos résultats avec la littérature , que nos patients ont le taux plasmatique moyen d’albumine le plus bas avec une moyenne à 20g/l ainsi qu’une altération de la fonction rénale plus prononcée avec une clairance de la créatinine à 45.4 ml/min/1.73 m² qui pourrait étre expliqué par une limite d’age plus élevée impliquant une baisse physiologique de la filtration glomérulaire surajoutée à la néphropathie récemment installée.Dans notre série, les patients atteints de GEM avaient le taux de protéinurie le plus élevé, avec une moyenne de 8.01 et la protéinurie la plus importante était de 27.3g/24 h, retrouvée chez un homme âgé de 67 ans L’hypercholestérolémie est présente pour tous les cas de GEM et la thrombose des veines périphériques n’était retrouvé que chez un seul patient.Chez 2 de nos malades (soit 20%),l’enquête étiologique a permis de conclure que la GEM est secondaire à un cancer du poumon alors qu’on rapporte que les causes secondaires sont à l’origine d’une GEM dans 10-20% des cas. Toutefois, en raison de la taille de notre groupe, d’autres études à effectif plus large intéressant cette tranche d’âge sont nécessaires pour confirmer les résultats de notre travail Mots clefs : Glomérulonéphrite
Saudi Journal of Kidney Diseases and Transplantation, 2013
Infections are a major determinant of outcome in kidney transplantation. Opportunistic pathogens ... more Infections are a major determinant of outcome in kidney transplantation. Opportunistic pathogens are common in kidney recipients and several organs can be affected. Central nervous system infection in transplant recipients is a medical emergency. There is limited information in the literature concerning post-transplantation cryptococcal infection. Deafness and blindness are not classic findings. We report a case of meningocerebral cryptococcosis complicated by deafness and blindness after kidney transplantation. Physicians need to consider the possibility of Cryptococcus neoformans when symptoms persist despite empiric antimicrobial therapy.
Secondary hyperparathyroidism is one of the most serious complications for long-term hemodialysis... more Secondary hyperparathyroidism is one of the most serious complications for long-term hemodialysis patients. In our department, we performed parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomy was an effective treatment for advanced renal hyperparathyroidism and that after total parathyroidectomy with forearm autograft, renal hyperparathyroidism was controllable, even when hyperparathyroidism was progressive. However, the timing of this operation was important, because skeletal deformity and vessel calcification did not improve after parathyroidectomy. There were two problems after parathyroidectomy for secondary hyperparathyroidism. One was persistent hyperparathyroidism due to supernumerary parathyroid glands, particularly those located in the mediastinum, and the other was recurrent hyperparathyroidism. From our clinical and pathohistological investigations, we suspected that the proliferation of parathyroid cells changed with the progress of renal hyperparathyroidism and we found that it was difficult to prevent enlargement of parathyroid glands and recurrence of this problem.
Objective To determine the clinico‐pathological profile of patients with emphysematous pyelonephr... more Objective To determine the clinico‐pathological profile of patients with emphysematous pyelonephritis (EPN). Patients and methods The records of 22 diabetic patients who presented with EPN were reviewed. Results EPN occurred predominantly in female diabetic patients without evidence of ureteric obstruction. The ages of the patients and the duration of the diabetes were variable. EPN occurred in insulin‐dependent as well as non‐insulin‐dependent patients. The patients presented following a prodromal illness of urinary sepsis, with an acute severe illness with symptoms and signs on the affected side. Dehydration and keto‐acidosis were common. The diagnosis was made by recognizing gas in the kidney on an X‐ray or ultrasound. Eighteen patients were subjected to emergency nephrectomy. Conclusions EPN is an uncommon, life‐threatening condition characterized by the production of intraparen‐chymal gas. We believe that vigorous resuscitation and emergency nephrectomy is the treatment of choice.
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