Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in he... more Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in hemodialysis. Left ventricular hypertrophy (LVH) is an independent factor of cardiovascular morbidity and mortality. Its frequency is 60 to 80% in chronic hemodialysis patients.
complication. Aussi, elle peut être induite par certains médicaments ou certaines pathologies d'o... more complication. Aussi, elle peut être induite par certains médicaments ou certaines pathologies d'où la nécessité d'une surveillance stricte même sans insuffisance rénale. Conclusion La prise en charge de l'hyperkaliémie devrait être toujours rapide. La recherche étiologique est importante pour prévenir la récidive d'une telle complication. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
International Journal of Artificial Organs, Sep 11, 2017
Background: Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for d... more Background: Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for detection of systemic bacterial infections in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The aim of this study was to assess the influence of HD membrane permeability to PCT serum levels in noninfected HD patients on maintenance HD. Methods: In a prospective comparative study, we measured PCT serum levels and C reactive protein (CRP) before and after HD in 36 sessions (18 sessions of HD with low-flux = Group L; and 18 sessions with high flux membranes = Group H), in 18 chronic HD patients without history of infection. Results: Sessions of HD by high-flux membranes (Group H) displayed median PCT values that were significantly decreased after dialysis (0.21 ng/mL [0.13-0.41] vs. 0.18 ng/mL [0.10-0.24], p <0.001) but median PCT significantly increased after HD sessions by low-flux membranes (Group L) (0.21 ng/mL [0.14-0.33] vs. 0.25 ng/mL [0.14-0.36]; p = 0.008). CRP values were significantly increased after HD in both groups. CRP correlated with PCT values only in group H before HD (r = 0.49; p = 0.36). Conclusions: PCT represents a useful diagnostic marker for systemic bacterial infection. However, there is a need for specific reference ranges to be developed in patients with renal failure undergoing HD; also, PCT serum levels must be interpreted according to the HD membrane permeability.
Patients with end-stage renal disease (ESRD) receiving chronic hemodialysis show a high incidence... more Patients with end-stage renal disease (ESRD) receiving chronic hemodialysis show a high incidence and prevalence of cardiovascular disease of multifactorial etiology and an association between dyslipidemia and accelerated atherosclerosis. Our aim was to study lipid profiles in ESRD patients receiving dialysis regularly at our hospital (Morocco).Subjects and methods : The patient population consisted of 30 ESRD patients on maintenance haemodialysis. Matched control subjects were recruited among healthy normolipidemic patients. Concentrations of triglycerides (TG), total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C) and low-density-lipoprotein cholesterol (LDL-C) were measured. The atherogenic index (AI = TC/HDL-C ratio) was calculated. The TG, the HDL-C levels and atherogenic index were significantly higher in groups of hemodialysis patients. We saw no increase in the levels of TC and LDL-C. The prevalence of dyslipidemia in hemodialysis group was high (80%). The most frequent lipid alterations were decreased HDL-C (70%), increased TG (33,3%) and increased LDL-C (23,3%); 50% of ESRD patients have more than two different dyslipidemic findings. AI was higher (≥ 5) in 33,3% of cases. The prevalence of dyslipidemia is higher than normal in ESRD patients on maintenance hemodialysis. Classically, these patients have had low levels of HDL-C and elevated TG levels. Strict control of dyslipidemia should be part of the cardiovascular risk prevention strategy in this population.
Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with incr... more Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with increased mortality and morbidity in affected patients. The aim of this study was to determine the prevalence of malnutrition and correlate the methods of nutritional assessment. Methods: We evaluated the nutritional status of 40 prevalent HD patients by subjective global assessment (SGA) score, anthropometrics [body mass index (BMI), arm circumference (AC), triceps skin-fold thicknesses (TSF), arm muscle circumference (AMC)], biochemical tests [normalized protein equivalent to total nitrogen appearance (nPNA), and pre-dialysis serum albumin and serum prealbumin levels] and bio-electrical impedance (BEI) analysis to estimate body composition [lean tissue index (LTI) and fat tissue index (FTI)]. Results: The study assessed 40 patients (20 males and 20 females) with a mean age of 50.7±16.5 years. The prevalence of malnutrition according to the different methods ranged from 5 % to 65%. There were highly significant gender-specific differences in AMC (p<0.001) and TSF (p<0.001). The BEI revealed a highly significant difference in LTI (p<0.001) but no difference in FTI (p=0.14) according to gender. There was a positive correlation between LTI and both serum albumin (r=0.37; p=0.018) and serum prealbumin (r=0.53; p<0.001). Also, there was a significant positive correlation between FTI and BMI (r=0.59; p<0.001), AC (r=0.44; p=0.004) and TSF (r=0.61; p<0.001). Conclusion: Our data suggest that BEI analysis provides a useful means of assessing nutritional status and was correlated with anthropometrics and biochemical findings.
SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la séd... more SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la sédentarité. Cette enquête souligne le faible niveau d'activité physique de nos patients hémodialysés dont la moitié était sédentaire. Les facteurs de risque de sédentarité étaient le sexe féminin et l'âge avancé. D'où l'intérêt d'une évaluation précoce de l'activité physique chez les hémodialysés chroniques et la mise en place de programmes visant à encourager l'exercice physique.
Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe il... more Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe illness related to hypersensitivity syndrome characterized by fever, skin rash, lymph node enlargement, hematological abnormalities, especially eosinophilia and atypical lymphocytosis, and single or multiple organ involvement. The syndrome is difficult to diagnose in view of its clinical heterogeneity and long latency period within 8 weeks after start treatment. We report a case of DRESS syndrome in a 64-year-old man, induced by allopurinol treatment for asymptomatic hyperuricemia, started 8 weeks earlier but stopped only 3 days after because of the onset of rash. The diagnosis was retained due to combining of interstitial nephritis with the clinical findings of fever, skin rash, cervical lymphadenopathy, eosinophilia, and reactivation of human herpesviruses specifically HHV-6. The glucocorticoids were started to relieve hypersensitivity. Five days later, the patient became afebrile, and the rash improved significantly. However, interstitial nephritis with renal function impairment progressed to severe azotemia, and even anuria requiring hemodialysis. Allopurinol-induced DRESS syndrome is associated with significant mortality, and care must, therefore, be exercised when given this drug.
Uremic pericarditis was described by R. Bright in 1836, several factors were incriminated in the ... more Uremic pericarditis was described by R. Bright in 1836, several factors were incriminated in the occurrence of this complication in this population in particular an inadequate kidney substitution treatment. It is a retrospective study of the clinico-biological and ultrasound characteristics as well as predictive factors for surgical drainage of the pericardium, performed on 8 chronic hemodialysis patients followed in our nephrology-dialysis unit. Optimization of quality of dialysis and Drainage of the pericardium is the rule in the face of abundant effusion and signs of poor hemodynamic tolerance. Periodic cardiological monitoring, rigorous dose dialysis evaluation, fast diagnosis and treatment of any unexpected medical conditions are the pillars of prevention of uremic pericarditis.
Saudi Journal of Kidney Diseases and Transplantation, 2020
Granulomatous interstitial nephritis (GIN) is a rare cause of renal failure. Most frequent etiolo... more Granulomatous interstitial nephritis (GIN) is a rare cause of renal failure. Most frequent etiologies are sarcoidosis, drugs, granulomatosis with polyangiitis, and infections agents (particularly renal tuberculosis). The aim of this retrospective study was to evaluate the clinical features, causes, and outcomes of patients with GIN in adult patients in a region of Morocco. All native renal biopsy (January 2008 to December 2017) were reviewed, but only cases of GIN were analyzed. Eleven cases of GIN were identified in this study, constituting 2.7 % of all native renal biopsies performed on this period (n = 407). There were 7 (63.6%) women, and the average age was 44.2 ± 13.9 years. The mean serum creatinine level at the renal biopsy was 39.1 ± 20.7 mg/L. The most common etiology was sarcoidosis (45.4%, n = 5) followed by drug-induced GIN (27.2%, n = 3). A good renal outcome was reported in patients with drug-induced GIN and sarcoidosis. However, no renal recovery was described in pat...
Introduction Les maladies cardiovasculaires representent la premiere cause de deces chez les pati... more Introduction Les maladies cardiovasculaires representent la premiere cause de deces chez les patients hemodialyses chroniques, sur ce terrain. Les calcifications de l’aorte abdominale (CAA) qui representent un facteur predictif d’evenements cardiovasculaire (CV) sont associees a la morbi-mortalite CV. Description Le but de notre travail est de determiner la prevalence et les facteurs associes aux CAA. Methodes Etude transversale incluant 40 hemodialyses chroniques depuis plus de six mois ayant beneficie d’un depistage des CAA par l’ASP (radiographie abdominale sans preparation) de profil. Les CAA ont ete evaluees selon le score de Kauppila (ScK). Les donnees demographiques, biologiques et radiologiques ont ete recueillies, puis analyses grâce aux outils statistiques suivants : regression logistique simple (analyse univariee) puis multiple (analyse multivariee). Resultats L’âge moyen etait de 58 ± 16 ans, 55 % etaient des femmes, avec une mediane d’anciennete en hemodialyse de 82 mois [39,120]. La prevalence des CAA etait de 65 % et la mediane du score des CAA etait de 4 [0,13], Les patients ont ete divises en 2 groupes selon le ScK : tres calcifie (ScK ≥ 12) representait 27,5 % et peu ou moderement calcifie (ScK Les facteurs associes aux CAA severes retenus en analyse univariee etaient l’âge (p = 0,027), la phosphoremie (p = 0,029), l’anciennete en hemodialyse (p = 0,047) et la calcemie (p = 0,035) et en analyse multivariee etaient l’anciennete en hemodialyse (p = 0,042), l’âge (p = 0,018) et la phosphoremie (p = 0,044). Conclusion Les CAA sont associes a l’âge avance, a une longue duree de dialyse et a des anomalies du bilan phosphocalcique. L’ASP de profil est l’examen actuellement recommande par les KDIGO pour le depistage precoce des calcifications vasculaires en hemodialyse et leur suivi qu’il convient de considerer pour tout patient.
Cite this article: Pan Africa Medical Journal. 2020;35(2):90 DOI: 10.11604/pamj.supp.2020.35.2.24... more Cite this article: Pan Africa Medical Journal. 2020;35(2):90 DOI: 10.11604/pamj.supp.2020.35.2.24202 Received: 10 Jun 2020 Accepted: 24 Jun 2020 Published: 25 Jun 2020 Domain: Nephrology
SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la séd... more SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la sédentarité. Cette enquête souligne le faible niveau d'activité physique de nos patients hémodialysés dont la moitié était sédentaire. Les facteurs de risque de sédentarité étaient le sexe féminin et l'âge avancé. D'où l'intérêt d'une évaluation précoce de l'activité physique chez les hémodialysés chroniques et la mise en place de programmes visant à encourager l'exercice physique.
Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in he... more Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in hemodialysis. Left ventricular hypertrophy (LVH) is an independent factor of cardiovascular morbidity and mortality. Its frequency is 60 to 80% in chronic hemodialysis patients.
complication. Aussi, elle peut être induite par certains médicaments ou certaines pathologies d'o... more complication. Aussi, elle peut être induite par certains médicaments ou certaines pathologies d'où la nécessité d'une surveillance stricte même sans insuffisance rénale. Conclusion La prise en charge de l'hyperkaliémie devrait être toujours rapide. La recherche étiologique est importante pour prévenir la récidive d'une telle complication. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
International Journal of Artificial Organs, Sep 11, 2017
Background: Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for d... more Background: Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for detection of systemic bacterial infections in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The aim of this study was to assess the influence of HD membrane permeability to PCT serum levels in noninfected HD patients on maintenance HD. Methods: In a prospective comparative study, we measured PCT serum levels and C reactive protein (CRP) before and after HD in 36 sessions (18 sessions of HD with low-flux = Group L; and 18 sessions with high flux membranes = Group H), in 18 chronic HD patients without history of infection. Results: Sessions of HD by high-flux membranes (Group H) displayed median PCT values that were significantly decreased after dialysis (0.21 ng/mL [0.13-0.41] vs. 0.18 ng/mL [0.10-0.24], p <0.001) but median PCT significantly increased after HD sessions by low-flux membranes (Group L) (0.21 ng/mL [0.14-0.33] vs. 0.25 ng/mL [0.14-0.36]; p = 0.008). CRP values were significantly increased after HD in both groups. CRP correlated with PCT values only in group H before HD (r = 0.49; p = 0.36). Conclusions: PCT represents a useful diagnostic marker for systemic bacterial infection. However, there is a need for specific reference ranges to be developed in patients with renal failure undergoing HD; also, PCT serum levels must be interpreted according to the HD membrane permeability.
Patients with end-stage renal disease (ESRD) receiving chronic hemodialysis show a high incidence... more Patients with end-stage renal disease (ESRD) receiving chronic hemodialysis show a high incidence and prevalence of cardiovascular disease of multifactorial etiology and an association between dyslipidemia and accelerated atherosclerosis. Our aim was to study lipid profiles in ESRD patients receiving dialysis regularly at our hospital (Morocco).Subjects and methods : The patient population consisted of 30 ESRD patients on maintenance haemodialysis. Matched control subjects were recruited among healthy normolipidemic patients. Concentrations of triglycerides (TG), total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C) and low-density-lipoprotein cholesterol (LDL-C) were measured. The atherogenic index (AI = TC/HDL-C ratio) was calculated. The TG, the HDL-C levels and atherogenic index were significantly higher in groups of hemodialysis patients. We saw no increase in the levels of TC and LDL-C. The prevalence of dyslipidemia in hemodialysis group was high (80%). The most frequent lipid alterations were decreased HDL-C (70%), increased TG (33,3%) and increased LDL-C (23,3%); 50% of ESRD patients have more than two different dyslipidemic findings. AI was higher (≥ 5) in 33,3% of cases. The prevalence of dyslipidemia is higher than normal in ESRD patients on maintenance hemodialysis. Classically, these patients have had low levels of HDL-C and elevated TG levels. Strict control of dyslipidemia should be part of the cardiovascular risk prevention strategy in this population.
Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with incr... more Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with increased mortality and morbidity in affected patients. The aim of this study was to determine the prevalence of malnutrition and correlate the methods of nutritional assessment. Methods: We evaluated the nutritional status of 40 prevalent HD patients by subjective global assessment (SGA) score, anthropometrics [body mass index (BMI), arm circumference (AC), triceps skin-fold thicknesses (TSF), arm muscle circumference (AMC)], biochemical tests [normalized protein equivalent to total nitrogen appearance (nPNA), and pre-dialysis serum albumin and serum prealbumin levels] and bio-electrical impedance (BEI) analysis to estimate body composition [lean tissue index (LTI) and fat tissue index (FTI)]. Results: The study assessed 40 patients (20 males and 20 females) with a mean age of 50.7±16.5 years. The prevalence of malnutrition according to the different methods ranged from 5 % to 65%. There were highly significant gender-specific differences in AMC (p<0.001) and TSF (p<0.001). The BEI revealed a highly significant difference in LTI (p<0.001) but no difference in FTI (p=0.14) according to gender. There was a positive correlation between LTI and both serum albumin (r=0.37; p=0.018) and serum prealbumin (r=0.53; p<0.001). Also, there was a significant positive correlation between FTI and BMI (r=0.59; p<0.001), AC (r=0.44; p=0.004) and TSF (r=0.61; p<0.001). Conclusion: Our data suggest that BEI analysis provides a useful means of assessing nutritional status and was correlated with anthropometrics and biochemical findings.
SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la séd... more SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la sédentarité. Cette enquête souligne le faible niveau d'activité physique de nos patients hémodialysés dont la moitié était sédentaire. Les facteurs de risque de sédentarité étaient le sexe féminin et l'âge avancé. D'où l'intérêt d'une évaluation précoce de l'activité physique chez les hémodialysés chroniques et la mise en place de programmes visant à encourager l'exercice physique.
Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe il... more Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe illness related to hypersensitivity syndrome characterized by fever, skin rash, lymph node enlargement, hematological abnormalities, especially eosinophilia and atypical lymphocytosis, and single or multiple organ involvement. The syndrome is difficult to diagnose in view of its clinical heterogeneity and long latency period within 8 weeks after start treatment. We report a case of DRESS syndrome in a 64-year-old man, induced by allopurinol treatment for asymptomatic hyperuricemia, started 8 weeks earlier but stopped only 3 days after because of the onset of rash. The diagnosis was retained due to combining of interstitial nephritis with the clinical findings of fever, skin rash, cervical lymphadenopathy, eosinophilia, and reactivation of human herpesviruses specifically HHV-6. The glucocorticoids were started to relieve hypersensitivity. Five days later, the patient became afebrile, and the rash improved significantly. However, interstitial nephritis with renal function impairment progressed to severe azotemia, and even anuria requiring hemodialysis. Allopurinol-induced DRESS syndrome is associated with significant mortality, and care must, therefore, be exercised when given this drug.
Uremic pericarditis was described by R. Bright in 1836, several factors were incriminated in the ... more Uremic pericarditis was described by R. Bright in 1836, several factors were incriminated in the occurrence of this complication in this population in particular an inadequate kidney substitution treatment. It is a retrospective study of the clinico-biological and ultrasound characteristics as well as predictive factors for surgical drainage of the pericardium, performed on 8 chronic hemodialysis patients followed in our nephrology-dialysis unit. Optimization of quality of dialysis and Drainage of the pericardium is the rule in the face of abundant effusion and signs of poor hemodynamic tolerance. Periodic cardiological monitoring, rigorous dose dialysis evaluation, fast diagnosis and treatment of any unexpected medical conditions are the pillars of prevention of uremic pericarditis.
Saudi Journal of Kidney Diseases and Transplantation, 2020
Granulomatous interstitial nephritis (GIN) is a rare cause of renal failure. Most frequent etiolo... more Granulomatous interstitial nephritis (GIN) is a rare cause of renal failure. Most frequent etiologies are sarcoidosis, drugs, granulomatosis with polyangiitis, and infections agents (particularly renal tuberculosis). The aim of this retrospective study was to evaluate the clinical features, causes, and outcomes of patients with GIN in adult patients in a region of Morocco. All native renal biopsy (January 2008 to December 2017) were reviewed, but only cases of GIN were analyzed. Eleven cases of GIN were identified in this study, constituting 2.7 % of all native renal biopsies performed on this period (n = 407). There were 7 (63.6%) women, and the average age was 44.2 ± 13.9 years. The mean serum creatinine level at the renal biopsy was 39.1 ± 20.7 mg/L. The most common etiology was sarcoidosis (45.4%, n = 5) followed by drug-induced GIN (27.2%, n = 3). A good renal outcome was reported in patients with drug-induced GIN and sarcoidosis. However, no renal recovery was described in pat...
Introduction Les maladies cardiovasculaires representent la premiere cause de deces chez les pati... more Introduction Les maladies cardiovasculaires representent la premiere cause de deces chez les patients hemodialyses chroniques, sur ce terrain. Les calcifications de l’aorte abdominale (CAA) qui representent un facteur predictif d’evenements cardiovasculaire (CV) sont associees a la morbi-mortalite CV. Description Le but de notre travail est de determiner la prevalence et les facteurs associes aux CAA. Methodes Etude transversale incluant 40 hemodialyses chroniques depuis plus de six mois ayant beneficie d’un depistage des CAA par l’ASP (radiographie abdominale sans preparation) de profil. Les CAA ont ete evaluees selon le score de Kauppila (ScK). Les donnees demographiques, biologiques et radiologiques ont ete recueillies, puis analyses grâce aux outils statistiques suivants : regression logistique simple (analyse univariee) puis multiple (analyse multivariee). Resultats L’âge moyen etait de 58 ± 16 ans, 55 % etaient des femmes, avec une mediane d’anciennete en hemodialyse de 82 mois [39,120]. La prevalence des CAA etait de 65 % et la mediane du score des CAA etait de 4 [0,13], Les patients ont ete divises en 2 groupes selon le ScK : tres calcifie (ScK ≥ 12) representait 27,5 % et peu ou moderement calcifie (ScK Les facteurs associes aux CAA severes retenus en analyse univariee etaient l’âge (p = 0,027), la phosphoremie (p = 0,029), l’anciennete en hemodialyse (p = 0,047) et la calcemie (p = 0,035) et en analyse multivariee etaient l’anciennete en hemodialyse (p = 0,042), l’âge (p = 0,018) et la phosphoremie (p = 0,044). Conclusion Les CAA sont associes a l’âge avance, a une longue duree de dialyse et a des anomalies du bilan phosphocalcique. L’ASP de profil est l’examen actuellement recommande par les KDIGO pour le depistage precoce des calcifications vasculaires en hemodialyse et leur suivi qu’il convient de considerer pour tout patient.
Cite this article: Pan Africa Medical Journal. 2020;35(2):90 DOI: 10.11604/pamj.supp.2020.35.2.24... more Cite this article: Pan Africa Medical Journal. 2020;35(2):90 DOI: 10.11604/pamj.supp.2020.35.2.24202 Received: 10 Jun 2020 Accepted: 24 Jun 2020 Published: 25 Jun 2020 Domain: Nephrology
SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la séd... more SCISPO-3326; No. of Pages 7 2 H. Rafik et al. féminin étaient significativement associés à la sédentarité. Cette enquête souligne le faible niveau d'activité physique de nos patients hémodialysés dont la moitié était sédentaire. Les facteurs de risque de sédentarité étaient le sexe féminin et l'âge avancé. D'où l'intérêt d'une évaluation précoce de l'activité physique chez les hémodialysés chroniques et la mise en place de programmes visant à encourager l'exercice physique.
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