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Labidi J, Harzallah A, Kaab BB, Mami I, Agrebi S, Azzabi A, Chargui S, Hadj-Brahim M, Hammouda M, Azaiez S, Tlili S, Lajili O, Antit H, Hasni Y, Chenik S, Chelbi F, Rais L, Skhiri H. Prevalence of chronic kidney disease in Tunisian diabetics: the TUN-CKDD survey. BMC Nephrol 2024; 25:67. [PMID: 38403649 PMCID: PMC10895808 DOI: 10.1186/s12882-024-03501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND In Tunisia, the prevalence of diabetes mellitus increased from 15.5% on 2016 to 23% by 2023. While Chronic Kidney Disease (CKD) stills the most dreaded complications of diabetes, studies on the prevalence of chronic kidney disease non-dialysis diet are scarce. The aim of this study was to assess the prevalence of chronic kidney disease among the Tunisian diabetic population based on investigators' specialty, demographic criteria (gender, age, duration of diabetes and geographic distribution) and diagnosis criteria (albuminuria and/or eGFR). METHODS This observational, multicentric, and cross-sectional study enrolled all diabetic subjects from all regions of Tunisia with at least 3 months of follow-up before the inclusion date, from 09 January to 08 February 2023. CKD diagnosis was established based on the KDIGO guidelines. The study was carried out at medical departments and ambulatory clinics of different healthcare providers. Baseline data were collected by investigators using an electronic case report form (eCRF). Continuous variables were described by means, median, standard deviation, and quartiles. Categorical data were tabulated in frequencies and percentages. RESULTS The overall prevalence of CKD among the 10,145 enrolled patients with diabetes mellitus was 38.7% with a 95%CI [37.8-39.6%]. 50.9% were male, with a mean age of 67.5 (± 11.3) years. The mean diabetes duration was 16.1 years (± 8.9). The highest CKD prevalence was noted among nephrologists (82.2%), while it was similar between the cardiologists and the primary care physicians (30.0%). CKD prevalence was highest among males (43.0% versus 35.1%) and increased proportionally with patients' age and diabetes duration. CKD was more frequent in the Mid-East Area when compared to other regions (49.9% versus 25.3 to 40.1% in other regions). Albuminuria was present within 6.6% of subjects with CKD, and it was found an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² within 13.3% of subjects wit h CKD. 18.9% had both criteria. CONCLUSIONS In Tunisia, CKD among diabetics had a prevalence of 38.7%, approaching European prevalence. The prevalence discrepancy worldwide of CKD can be improved with a larger population size and by implementing standardized practices.
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Affiliation(s)
- Jannet Labidi
- Department of Nephrology, Military Hospital of Instruction of Tunis, Tunis, Tunisia.
| | - Amel Harzallah
- Department of Nephrology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Badereddine Ben Kaab
- Department of Nephrology, Internal Security Force Hospital of La Marsa, Tunis, Tunisia
| | - Ikram Mami
- Department of Nephrology, La Rabta Hospital of Tunis, Tunis, Tunisia
| | - Sahar Agrebi
- Department of Nephrology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Awatef Azzabi
- Department of Nephrology, Sahloul Hospital of Sousse, Sousse, Tunisia
| | - Soumaya Chargui
- Department of Nephrology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mayssa Hadj-Brahim
- Department of Nephrology, Tahar Sfar Hospital of Mahdia, Mahdia, Tunisia
| | - Mouna Hammouda
- Department of Nephrology, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
| | | | - Syrine Tlili
- Department of Nephrology, La Rabta Hospital of Tunis, Tunis, Tunisia
| | - Olfa Lajili
- National Institute of Nutrition, Tunis, Tunisia
| | - Hela Antit
- Basic Care Center of Ezzahra, Ben Arous, Tunisia
| | - Yosra Hasni
- Department of Endocrinology, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Sarra Chenik
- Department of Cardiology, Military Hospital of Tunis, Tunis, Tunisia
| | - Farhat Chelbi
- Department of Internal Medicine, Regional Hospital of Gafsa, Gafsa, Tunisia
| | - Lamia Rais
- Department of Nephrology, La Rabta Hospital of Tunis, Tunis, Tunisia
| | - Habib Skhiri
- Tunisian Association of Nephrology, Dialysis, and Transplantation, Tunis, Tunisia
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Harzallah A, Abid H, Hajji M, Agrebi S, Ben Hamida F, Chargui S, Abderrahim E. Renal AA amyloidosis revealing extramedullary plasmocytoma. Nephrol Ther 2023; 19:594-599. [PMID: 38073243 DOI: 10.1684/ndt.2023.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Introduction Solitary plasmacytoma is a rare, localized malignancy. Bone localizations are the most common. Extramedullary plasmacytomas are much rarer. They are most often in the upper respiratory tract and can be complicated by amyloidosis. Here is an original report of a mediastinal extramedullary plasmacytoma revealed by type AA renal amyloidosis. Case presentation We present the case of a 52-year-old patient with mediastinal extramedullary plasmocytoma diagnosed by renal failure due to type AA renal amyloidosis. Treatment was based on surgery with chemotherapy based on prednisone and melphalan. The patient presented end-stage renal failure that required hemodialysis at discharge. Conclusion Extramedullary plasmacytoma is a rare tumour that may be associated with amyloidosis, usually type AL. To our knowledge, its association with AA amyloidosis has not been reported in the literature. Treatment is based on surgery combined with radiotherapy or chemotherapy.
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Affiliation(s)
- Amel Harzallah
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hanen Abid
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Meriam Hajji
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Sahar Agrebi
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Soumaya Chargui
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Ezzedine Abderrahim
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
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Hadhri A, Agrebi S, Chargui S, Hamdi Z, Ben Hamida F, Harzallah A, Abderrahim E. Pronostic rénal de la Glomérulonéphrite aiguë post infectieuse chez l’adulte. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Mahrsia C, Harzallah A, Chargui S, Hajji M, Agrbi S, Sallemi N, Hedri H, Hmida FB, Gorsane I, Abdelrahim E. Impact de la vaccination anti-COVID-19 sur la morbidité et la mortalité chez les insuffisants rénaux chroniques. Nephrol Ther 2022. [PMCID: PMC9441525 DOI: 10.1016/j.nephro.2022.07.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hadhri A, Agrebi S, Chargui S, Hamdi Z, Hamida FB, Harzallah A, Abderrahim E. Changement du profil clinicobiologique de la glomérulonéphrite aiguë post-infectieuse chez l’adulte. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hadhri A, Agrebi S, Chargui S, Hamdi Z, Hamida FB, Harzallah A, Abderrahim E. Pronostic rénal de la glomérulonéphrite aiguë post-infectieuse chez l’adulte. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Othman IB, Harzallah A, Hajji M, Chargui S, Sallemi N, Kaaroud H, Hamida FB, Abderrahim E. La néphropathie oxalique : une cause rare d’insuffisance rénale aiguë chez un diabétique. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chargui S, Houli R, Ounissi M, Ben Hamida F, Harzallah A, Abderrahim E. Gitelman syndrome, hypomagnesemia, and venous thrombosis: An intriguing association. Clin Case Rep 2022; 10:e05542. [PMID: 35280096 PMCID: PMC8894579 DOI: 10.1002/ccr3.5542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Among salt‐wasting tubulopathies' complications, venous thrombosis is one of the rarest. We report a case of a young woman with Gitelman syndrome (GS). She presented a deep venous thrombosis in her leg and was treated with heparin with favorable outcomes. We retained hypomagnesemia as the cause of the thrombosis.
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Affiliation(s)
- Soumaya Chargui
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
- Research Laboratory of Renal Pathology LR00SP01 Charles Nicolles Hospital Tunis Tunisia
| | - Rawnak Houli
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
| | - Mondher Ounissi
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
| | - Fethi Ben Hamida
- Research Laboratory of Renal Pathology LR00SP01 Charles Nicolles Hospital Tunis Tunisia
| | - Amel Harzallah
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
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Bouafif H, Chargui S, Harzallah A, Aouidia R, Ouinissi M, Goucha R, Ben hamida F, Abderrahim E. POS-516 RENAL GRANULOMATOSIS ASSOCIATED WITH ANCA VASCULITIS: CLINICAL, HISTOLOGICAL AND EVOLUTIONARY CHARACTERISTICS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Bettaieb A, Gaied H, Bacha M, Hajji M, Chargui S, Goucha R, Ben Hamida F, Abderrahim E. POS-766 A RARE ASSOCIATION: PHLEGMASIA CERULEA DOLENS AND SARS COV 2 INFECTION IN A KIDNEY TRANSPLANT RECIPIENT. Kidney Int Rep 2022. [PMCID: PMC8854984 DOI: 10.1016/j.ekir.2022.01.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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11
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Chargui S, Braiek N, Bacha MM, Harzallah A, Hedri H, Ouinissi M, Abderrahim E. Overall of kidney transplant recipients with a pretransplantation cancer history. Clin Case Rep 2021; 9:e04810. [PMID: 34532051 PMCID: PMC8435231 DOI: 10.1002/ccr3.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/15/2021] [Accepted: 08/22/2021] [Indexed: 12/02/2022] Open
Abstract
No significant morbidity from recurrence cancer and no development of secondary type of cancers in pre-existing malignancies. We must be careful about risk of rejection.
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Affiliation(s)
- Soumaya Chargui
- Department of Internal Medicine ACharles Nicolle’s HospitalTunisTunisia
- University of Medicine TunisTunisTunisia
- Research Laboratory of Renal Pathology LR00SP01TunisTunisia
| | - Nesrine Braiek
- Department of Internal Medicine ACharles Nicolle’s HospitalTunisTunisia
| | | | - Amel Harzallah
- Department of Internal Medicine ACharles Nicolle’s HospitalTunisTunisia
| | - Hafedh Hedri
- Department of Internal Medicine ACharles Nicolle’s HospitalTunisTunisia
| | - Mondher Ouinissi
- Department of Internal Medicine ACharles Nicolle’s HospitalTunisTunisia
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Malki abidi M, Aoudia R, Chargui S, Gorsane I, Jerbi M, Gaied H, Ben abdallah T, Goucha R, Ben hamida F. MO403ACUTE KIDNEY INJURY IN ELDERLY: EPIDEMIOLOGICAL, CLINICAL AND ETIOLOGICAL FEATURES. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab082.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly.
Method
We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017.
Results
We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l.
AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF.
Conclusion
AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.
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Affiliation(s)
- Mouna Malki abidi
- charles nicolle hospital, nephrology, dialysis and renal transplantation department, tunis, Tunisia
- research Laboratory LR00SP01, nephrology, dialysis and renal transplantation, tunis, Tunisia
| | - Rajaa Aoudia
- charles nicolle hospital, nephrology, dialysis and renal transplantation department, tunis, Tunisia
| | - Soumaya Chargui
- charles nicolle hospital, nephrology, dialysis and renal transplantation department, tunis, Tunisia
| | - Imen Gorsane
- charles nicolle hospital, nephrology, dialysis and renal transplantation department, tunis, Tunisia
| | - Mouna Jerbi
- mongi slim hospital, nephrology, dialysis and renal transplantation department, marsa, Tunisia
| | - Hanen Gaied
- mongi slim hospital, nephrology, dialysis and renal transplantation department, marsa, Tunisia
| | - Taieb Ben abdallah
- charles nicolle hospital, nephrology, dialysis and renal transplantation department, tunis, Tunisia
| | - Rym Goucha
- mongi slim hospital, nephrology, dialysis and renal transplantation department, marsa, Tunisia
| | - Fethi Ben hamida
- charles nicolle hospital, nephrology, dialysis and renal transplantation department, tunis, Tunisia
- research Laboratory LR00SP01, nephrology, dialysis and renal transplantation, tunis, Tunisia
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Harzallah A, Chargui S, Hajji M, Barbouch S, Ounissi M, Gorsane I, Ben Hamida F. MO231INFECTIVE ENDOCARDITIS IN CHRONIC KIDNEY DISEASE: CLINICAL AND OUTCOME’S FEATURES. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.00109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Infective endocarditis complicating chronic kidney disease is associated with high morbidity and mortality among this population particularly exposed to bacteremia.The aim of our study was to study the clinical and evolutionary features of infective endocarditis among patients with chronic renal failure.
Method
It is a retrospective and descriptive study including patients with chronic kidney disease hospitalized in our department, whom presented an infective endocarditis confirmed by modified DUKE criteria
Results
13 patients were included aged meanly of 42.69 years [27-63 years] with a sex-ratio of 0.85. Twelve were in end stage renal disease with an average duration of dialysis of 52 months [1-180 months] and in stage 5 in one case. At the time of diagnosis, vascular access was fistula in one case and a central venous catheter in 11 cases. The catheter was simple in 3 cases and tunnelled in eight cases. The circumstances of discovery were fever in 12 cases associated with an alteration of the general state with asthenia in 10 cases. Low blood pressure was present in seven cases. At biology, the mean hemoglobin level was 8.28 g/dl [6.1-10.8 g/dl]. Leukocytosis was noted in 8 cases. Mean albuminemia was 30.61g/l [24-41g/l]. Albuminemia below 35 g/l was objectified in 6 cases. Major causative organisms were Staphylococcus species in 10 cases. Trans-thoracic echography shows vegetation in 11 cases with an average size of 17.4 mm [6-37 mm] and aortic annular abscess in 2 cases. Antibiotherapy was conducted in all cases. Complications were frequent, including congestive heart failure in 2 cases, secondary septic localisations in 3 cases, hemoptysis in one case and valve perforation in 2 cases. Five patients underwent surgery after a mean delay of 32.75 days [6-47 days]. Death occurred in 8 cases.
Conclusion
Infective endocarditis is severe during chronic kidney failure and more frequent among patients on dialysis by catheter. It is associated with high morbidity and mortality. Management of central venous catheter must be enhanced. Treatment must be early to improve the prognosis of this complication.
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Affiliation(s)
- Amel Harzallah
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Mariem Hajji
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Samia Barbouch
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Fethi Ben Hamida
- Charles Nicolle Hospital, Laboratory of Renal pathology LR00SP01, Tunis, Tunisia
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Abstract
Myocardial perforation is an uncommon but potentially life-threatening complication of pacemaker and implantable cardioverter-defibrillator. Myocardial perforation may be acute, subacute or chronic when it occurs within 24 hours of the device insertion; between 1 day and 30 days; and more than 30 days after implantation. This complication may occur in 1.7%-7% of patients. However, subacute myocardial perforation is rare and affects 0.5%-1.2% of patients. We report the case of an 85-year-old patient with a pacemaker failure 10 days after implantation due to a subacute myocardial perforation caused by an active fixation ventricular lead. Transthoracic echocardiography showed penetration of the ventricular lead through the right ventricular apex into the pericardium without any pericardial effusion. We confirmed myocardial perforation by a CT scan. We referred her to the surgery ward where she was successfully managed.
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Affiliation(s)
- Emna Allouche
- Cardiology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medecine, University of Tunis El Manar, Tunis, Tunisia
| | - Soumaya Chargui
- Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia .,Research Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Marwa Fathi
- Cardiology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Leila Bezdah
- Cardiology Department, Charles Nicolle Hospital, Tunis, Tunisia
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OUERTANI I, Chargui S, Omrane M, Aouidia R, Harzallah A, Goucha R, Ben Abdallah T. POS-126 RENAL THROMBOTIC MICROANGIOPAHTY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chargui S, Hamdi Z, Harzallah A, Mbarek M, Houili R, Ouinissi M, Ben Abdallah T. POS-137 PREDICTIVE FACTORS OF CHRONIC KIDNEY FAILURE IN POST-INFECTIOUS ACUTE GLOMERULONEPHRITIS IN ADULTS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chargui S, Hamdi Z, Harzallah A, Mbarek M, Houili R, Ouinissi M, Ben Abdallah T. POS-136 ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN ADULTS: EPIDEMIOLOGICAL PROFILE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chargui S, mhedhbi B, harzallah A, mbarek M, ouinissi M, Ben Abdallah T. POS-441 NEPHROCALCINOS IN ADULTS: EPIDIMIOLOGICAL PROFILE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Harzallah A, Ounissi M, Hajji M, Chargui S, Hedri H, Abderrahim E, Ben Hamida F, Bacha M, Ben Abdallah T. [Successful treatment with paclitaxel of a visceral relapse of post-transplant Kaposi's sarcoma]. Nephrol Ther 2021; 17:132-136. [PMID: 33563572 DOI: 10.1016/j.nephro.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/23/2020] [Accepted: 10/11/2020] [Indexed: 10/22/2022]
Abstract
We report the observation of a patient who presented with post-transplant Kaposi's sarcoma after a delay of eight months with a dual cutaneous and palatal localisation. The reduction in immunosuppressive treatment and the introduction of Rapamune® allowed good clinical progress initially with regression of the skin lesions. He subsequently presented later a skin relapse with visceral localisation. Chemotherapy was conducted based on weekly paclitaxel infusions allowing partial remission and maintenance of renal graft function with good clinical tolerance.
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Affiliation(s)
- Amel Harzallah
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie.
| | - Mondher Ounissi
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Meriem Hajji
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Soumaya Chargui
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Hafedh Hedri
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Ezzeddine Abderrahim
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Fathi Ben Hamida
- Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Mongi Bacha
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Taieb Ben Abdallah
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
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Abstract
Renal involvement in mantle cell lymphoma (MCL) is rare. We present the case of a man followed for MCL presented with acute kidney injury and positive antineutrophil cytoplasmic antibody (ANCA) type anti proteinase 3 (PR3). He was treated as for a rapidly progressing glomerulonephritis with cyclophosphamide and methylprednisolone followed by oral prednisone. Renal biopsy revealed diffuse endocapillary proliferation and segmental extracapillary proliferation in four glomeruli. Immunohistochemistry confirmed the renal invasion of lymphomatous cells. He started improving his renal function shortly after starting treatment. The coexistence of renal MCL infiltration, extracapillary proliferation and ANCA positive is exceptional.
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Affiliation(s)
- Bilel Mhedhbi
- Internal Medecine Department, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Soumaya Chargui
- Internal Medecine Department, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia .,Research Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Amel Harzallah
- Internal Medecine Department, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia.,Research Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Rim Goucha
- Research Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia.,Nephrology department, University Hospital Center Mongi Slim, La Marsa, Tunis, Tunisia
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21
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Hadded S, Harzallah A, Chargui S, Hajji M, Kaaroud H, Goucha R, Ben Hamida F, Gorsane I, Ben Abdallah T. [Etiologies and prognostic factors of acute interstitial nephritis]. Nephrol Ther 2021; 17:114-119. [PMID: 33485789 DOI: 10.1016/j.nephro.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Acute interstitial nephritis represents a clinically and etiologically heterogeneous group of kidney diseases. The aim of our study was to explore the main causes of biopsy-proven acute interstitial nephritis and to identify predictive factors of renal outcome. METHODS We conducted a retrospective monocentric study which included patients with biopsy proven AIN, followed in our department during the period between 1980 and 2018. The non-recovery of kidney function or an estimated glomerular filtration rate˂60 mL/min/1.73 m2 were considered as a worse renal outcome. RESULTS A total of 65 acute interstitial nephritis patients were enrolled. The mean age of patients was 41.3±16 years with a female predominance (78%). Drug-induced etiology was the most common (29%). The most frequent culprit drugs in our study were NSAID followed by antibiotics. The renal prognosis was unfavorable in 21 cases (32%). The independent predictive factors for renal outcome were : a percentage of sclerotic glomeruli greater than 15% (P=0.004), absence of interstitial edema (P˂0.001), non-use to corticosteroid therapy (P=0.02) and a delay in initiating corticosteroid therapy greater than 21 days (P=0.02). CONCLUSION Drugs currently represent the most common cause of acute interstitial nephritis. The renal prognosis is often favorable, but the progression can be towards chronic renal failure in the event of diagnostic and therapeutic delay. Our data suggest a beneficial influence of steroids on the outcome of acute interstitial nephritis.
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Affiliation(s)
- Sarra Hadded
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie.
| | - Amel Harzallah
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle-de-Tunis, boulevard du 9 avril 1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Soumaya Chargui
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle-de-Tunis, boulevard du 9 avril 1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Mariem Hajji
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle-de-Tunis, boulevard du 9 avril 1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Hayet Kaaroud
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle-de-Tunis, boulevard du 9 avril 1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Rim Goucha
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle-de-Tunis, boulevard du 9 avril 1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Fathi Ben Hamida
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle-de-Tunis, boulevard du 9 avril 1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Imen Gorsane
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de médecine A, hôpital Charles-Nicolle-de-Tunis, boulevard du 9-avril-1938, 1007 Tunis, Bab Saâdoun, Tunisie; Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisie
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Abid H, Harzallah A, Chargui S, Ounissi M, Kaaroud H, Ben Hmida F, Gorsane I, Ben Abdallah T. Pronostic rénal du syndrome hémolytique et urémique de l’adulte. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Breik N, Jerbi M, Aoudia R, Chargui S, Guaied H, Gorsane I, Goucha R, Benabdallah T. P0246MEMBRANOUS NEPHROPATHY IN THE ELDERLY : EPIDEMIOLOGY, DIAGNOSIS AND MANAGEMENT. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
The aging of the population and the increase in life expectancy have led to increasing numbers of elderly patients so greater numbers of elderly patients with chronic kidney diseases are surviving longer. Membranous nephropathy (MN) is the most important cause of glomerular disease in older patients (≥65 years). The aim of this study is to describe the epidemiological and clinical profile of elderly patients with MN and to analyze the diagnostic and management approach.
Method
We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study.
Results
Thirty patients were collected. The mean age was 69.43 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 83.3% of cases. Sixteen patients were smokers (55.3%), 5 ethyl patients (16.7%), diabetes was present in 3 patients (10%) and hypertension in 11 patients (36.7%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery was dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (36.7%) and elevated creatinine level in 9 cases (30%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (67.6%), anasarca in 7 cases (23.3%), proteinuria in all cases and hematuria in 20 cases (66.6%). Biology revealed nephrotic syndrome (NS) in 28 cases (87.11%), hypercholesterolemia in 23 cases (76.6%), high serum creatinine in 14 cases (46.6%) with an average creatinine level of 123,85 µmol/l, anemia in 17 cases (56.6%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Twenty-two patients had idiopathic MN (IMN) and 2 patients had secondary MN. In fact, MN was associated with multiple myeloma in one case and secondary to hepatitis B in other case. Symptomatic treatment was indicated in all patients. Patients with secondary MN received etiopathogenic treatment. For the IMN, immunosuppressive therapy started early for 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone, three patients received corticosteroid with mycofenolate mofetil and one patient received corticosteroid with ciclosporin. We noted complete remission in 6 patients and end renal stage disease in 5 patients.
Conclusion
In studies of glomerular disease in the elderly, MN was the most common cause of NS. The clinical presentation is similar in older and younger patients, but older patients more often present with kidney failure and severe NS.
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Affiliation(s)
- Nessrine Breik
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
| | - Mouna Jerbi
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Raja Aoudia
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Hanen Guaied
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Rim Goucha
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Taieb Benabdallah
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
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Melek K, Trabelsi R, Ounissi M, Chargui S, Jerbi M, Gaid H, Hedri H, Harzallah A, Ben abdallah T, Goucha R. P0457MALE LUPUS NEPHRITES: WHAT ABOUT RISK FACTORS FOR RENAL FAILURE ? EXPERIENCE OF ONE DEPARTMENT. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The occurrence of renal involvement during the clinical course of systemic lupus erythematous (SLE) is generally considered to be the most important factor influencing the prognosis in terms of morbidity and mortality. The factors influencing prognosis in lupus nephritis (LN) are variable in literature. The aim of our study was to analyze the clinicopathological correlations, and risk factors associated with renal failure in male patients with LN.
Method
We retrospectively studied all male patients with kidney biopsy-proven lupus nephritis (LN) treated in our department during the period between 1979 and 2016. Looking for predictive factors related to renal prognosis, we analyzed clinical, biological and histological data by multivariate analysis using the comparison of the survival rates by the log-rank test.
Results
We collected 41 native renal biopsies showing LN. Patients were aged 32.17 years (17-65 years) at the time of diagnosis of LN. Diagnosis of SLE was made according to the criteria of the American College of Rheumatology. The most common clinical presentation was nephrotic syndrome (61%), and the most frequent pathological finding in sediment was proteinuria (85%). At the time of diagnosis, 17% of patients had hypertension and 39 % of patients had an eGFR under than 60 ml/min/1.73 m2. LN was of class I, II, III, IV and V in 7.5%, 12.5%, 27.5%, 47.5% and 41.5% of the cases, respectively. Fourteen patients developed end-stage renal failure. The presence of hematuria, renal failure at the time of diagnosis, nephrotic syndrome, low complement, proliferative glomerulonephritis (class IV), high activity index score of LN and thrombotic microangiopathy were significantly associated with poor renal prognosis with (p=0.0053), (p=0.0002), (p=0.0186), (p=0.0287), (p=0.0005), (p=0.058), (p=0.0117), respectively.
Conclusion
Renal failure at the time of diagnosis and active proliferative lesions should be diagnosed and treated as soon as possible because they influence the renal prognosis in lupus man.
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Affiliation(s)
| | - Raja Trabelsi
- Charles Nicolle Hospital, Nephrology, Tunis, Tunisia
| | | | | | - Mouna Jerbi
- Mongi SLim Hospital, Nephrology, La Marsa, Tunisia
| | - Hanen Gaid
- Mongi SLim Hospital, Nephrology, La Marsa, Tunisia
| | - Hafedh Hedri
- Charles Nicolle Hospital, Nephrology, Tunis, Tunisia
| | | | | | - Rim Goucha
- Mongi SLim Hospital, Nephrology, La Marsa, Tunisia
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Amiri ML, Trabelsi R, Ounissi M, Chargui S, Jerbi M, Gaied H, Hedri H, Gorsane I, Ben abdallah T, Goucha R. P0507ANTI-GLOMERULAR BASEMENT MEMBRANE DISEASE. ABOUT 32 CASES. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Anti-Glomerular basement membrane disease « anti-GBM » is a rare autoimmune disease. It most often results in a rapidly progressive glomerulonephritis syndrome associated with intra-alveolar hemorrhage. The diagnostic confirmation is histological, by the demonstration of linear deposits of immunoglobulins (IgG) along the glomerular basement membrane. The aim of our study was to describe its epidemiological, clinical, biological, immunological, histological, and evolutionary characteristics and to identify the different prognostic factors for predicting patient survival and renal survival.
Method
It was a retrospective, descriptive and analytical study including patients over 16 years old with anti-GBM disease proved by kidney biopsy and followed up over a period of 32 years (January 1985 to July 2017), in Internal Medicine Department of Charles Nicolle Hospital of Tunis.
Results
We collected 32 patients with a sex ratio H/F = 1.13. The mean age at diagnosis was 42 years old with extremes of 18 to 81 years old. The most frequent extra-renal manifestations were pulmonary (53%), neurological (12.5%) and ocular (6%) manifestations. Hematuria associated with proteinuria was constantly found.
The latter was nephritic in 31% of patients. All patients had renal insufficiency on admission, oligo-anuric in 60% of cases. The use of extra-renal treatment at admission was necessary in 75% of patients. On the immunological level, the search for anti-MBG antibodies, performed in 20 patients, was positive in 65% of cases. All our patients had undergone a renal biopsy puncture with direct immunofluorescence study.
Diffuse extra-capillary glomerulonephritis was observed in 93% of patients.
Corticotherapy was initiated in 27 cases, associated with plasma exchange in 21 cases and cyclophosphamide in 17 cases. Nine of our patients died in the first year. Renal outcome was marked by partial remission in 2 cases and end-stage renal failure in 19 cases. In univariate analysis, an age greater than 60 years and the occurrence of respiratory distress were predictors of death.
Oligo-anuria and need dialysis on admission were predictive factors for progression to end-stage renal failure.
Conclusion
Anti-GBM disease is a serious illness. Current therapeutic modalities have significantly improved patient survival. These must be intensive and rapid in order to hope for a favorable renal evolution whose prognosis remains reserved.
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Affiliation(s)
| | - Raja Trabelsi
- charles Nicolle hospital, Nephrology, tunis, Tunisia
| | | | | | - Mouna Jerbi
- Mongi slim Hospital, Nephrology, tunis, Tunisia
| | | | - Hafedh Hedri
- charles Nicolle hospital, Nephrology, tunis, Tunisia
| | - Imen Gorsane
- charles Nicolle hospital, Nephrology, tunis, Tunisia
| | | | - Rim Goucha
- Mongi slim Hospital, Nephrology, tunis, Tunisia
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26
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Omrane M, Aoudia R, Ounissi M, Chargui S, Jerbi M, Gaied H, Hidri H, Harzallah A, Ben Abdallah T, Goucha R. P0278CARDIOVASCULAR RISK FACTORS AND THE LONG TERM OUTCOME OF LUPUS NEPHRITIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Systemic Lupus Erythematosus (SLE) is associated with an increased risk of cardiovascular morbidity and cardiovascular mortality. The risk of cardiovascular events is 1.3–2.7 times higher in SLE patients than in the general population, and even higher in patients with lupus nephritis (LN). Traditional risk factors as well as SLE-specific and treatment-related factors all contribute to the increased risk of cardiovascular disease. The primary aim of the present study was to evaluate cardiovascular risk factors, morbidity and mortality in patients with LN.
Method
This is a retrospective study of patients over the age of 16, with LN proved by kidney biopsy and followed up in our department over a period of 17 years. The diagnosis of lupus was made according to criteria of The American College of Rheumatology revised in 1997. Demographic, clinical and para-clinical data were collected from medical observations.
Results
We collected 155 women and 19 men with a sex ratio F / H of 8.2. The mean age at the time of the discovery of LN was 32.6 years [15-45 years]. Overall median follow-up time was 81.2 months. Renal symptomatology was dominated by proteinuria noted in all patients with an average proteinuria at 3.3 g / 24h, associated to a nephrotic syndrome in 68% of patients, hematuria was present in 69% of patients and renal failure was present in half of cases with an average serum creatinine of 110 µmol / l. At the time of diagnosis of LN, hypertension was noted in 48.9% of cases, diabetes in 2.8% of cases and obesity in 57.4% of cases with an index average body mass of 28.5 Kg / m2. Smoking was reported in 17.2% of the cases. The average cholesterol level was 5,5±2,1 mmol/l, the average triglycerid level was 2,5±1,1 mmol/. Antiphospholipid syndrome was found in 14.9% of cases. We performed 243 renal biopsies with 174 initial and 69 iterative biopsies. The histological lesions were polymorphic dominated by LN class IV (54.3%), arteriolosclerosis was observed in 47.7% and lesions of thrombotic microangiopathy in 29.8%. Corticosteroid therapy was prescribed in all patients combined with immunosuppressive therapy in 54.6% of cases. The overall survival of the patients at 10 years was 85%. During follow-up, cardiovascular complications found in our series were mainly strokes (6.3%) and coronary insufficiency (5.2%) and transient ischemic attack (6.9%). After a univariate analysis, the additional cardiovascular risk factors identified in our study were antiphospholipid syndrome (p = 0.01), renal failure (p = 0.01), long-term corticosteroid therapy (p = 0.009), the chronicity of the disease (evolution of lupus> 10 years) (p = 0.014), proliferative forms (p=0.001), arteriolosclerosis (p=0.0002) and lesions of thrombotic microangiopathy (p=0.018). Survival in patients without cardiovascular risk factors was better (96% vs 88%).
Conclusion
In conclusion, in addition to traditional risk factors SLE patients have several disease related risk factors that explain increase cardiovascular disease. A careful control for this risk factors is essential to continuously improve survival in SLE.
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Affiliation(s)
- Marwa Omrane
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Raja Aoudia
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Mouna Jerbi
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
| | - Hanene Gaied
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
| | - Hafedh Hidri
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Amel Harzallah
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | | | - Rim Goucha
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
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Felah E, Samia B, Mariem H, Ben amor S, Chargui S, Trabelsi R, Karoui C, Hedri H, Goucha R, Ounissi M, Ben Hmida F, Ben abdallah T. P1528EPIDEMIOLOGICAL SURVEY OF A POPULATION UNDERGOING URGENT HEMODIALYSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
Urgent hemodialysis is a very common situation in nephrology and is burdened with high morbidity and mortality. The aim of this work is to study the epidemiological, etiological, clinico-biological and indications of dialysis emergencies, the parameters of the session and the potential complications.
Method
This is a descriptive study conducted over a period of 12 months (January – December 2017), including all patients who have been admitted to the nephrology department for urgent management in hemodialysis.
Results
Our study collected a total of 318 patients (sex ratio =1.52), the mean age 60.54 ± [18-95 years]. Patients came mainly from the emergency department (69.8%). 40.9 % of the patients were diabetic and 66,4 % hypertensive, 15.1% had coronary artery disease. Among patients, 80.9% had chronic renal insufficiency, of which 29.6% were end-stage (28% hemodialysis and 1.6% peritoneal dialysis). Urgent hemodialysis was undertaken for threatening hyperkalemia in 58.2% of cases, a poorly tolerated uremic syndrome in 50.8% acute pulmonary edema (APO) in 36.5% of cases, and anuria greater than 12h were the indication in 44.4% of cases and a severe metabolic acidosis in 11.3% of cases.
The average duration of the session was 3 hours. Ultrafiltration was necessary in 63.7% of the cases. The blood access was a femoral catheter in 80.6% of the cases. Blood transfusion was indicated in 13.8% of cases. Main complications were dominated by symptomatic arterial hypotension in 12.9% requiring stopping the session in half of cases hypoglycemia in 6.9%, neurological disorder in 6.6% chest pain in 3.5 %. After a year of follow up care, overall mortality was 40% in this population. On multivariate analysis, age (p=0.006) and neurological state according to the glasgow score (p=0.01) were retained as independent factors of mortality in this population.
Conclusion
A greater prevalence of urgent hemodialysis is observed in our country testifying to the accessibility of this method of extrarenal replacement. Hyperkalemia, uremic syndrom and PAO are the main indications for urgent hemodialysis. Early diagnosis, prompt and relevant management of these patients will determine their prognoses in the short and medium term.
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Affiliation(s)
- Eya Felah
- Charles Nicolle Hospital. Tunis, Tunisia., Department of Nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Barbouch Samia
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Hajji Mariem
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Shedha Ben amor
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Raja Trabelsi
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Cyrine Karoui
- Mahmoud Matri Hospital, Nephrology and dialysis departement, Tunis, Tunisia
| | - Hafedh Hedri
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Rym Goucha
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Fethi Ben Hmida
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Taieb Ben abdallah
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
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28
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Omrane M, Aoudia R, Ounissi M, Chargui S, Jerbi M, Gaied H, Hidri H, Gorsane I, Ben Abdallah T, Goucha R. P0488IG A NEPHROPATHY: ANALYSIS OF 501 BIOPSY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Mesangial deposits Ig A was described the first time in 1968 by Berger and Hinglais. It remains the most common primary glomerulonephritis worldwide. It is often idiopathic but can also be secondary. The aim of our study is to describe the epidemiologic characteristics, the incidence and the anatomopathological features of 501 IgA nephropathy (IgA N) patients.
Method
It is a retrospective mono-centric study including patients having IgA N in the renal biopsy done in our department among a period of 17 years.
Results
We analyzed data of 8427 patients who underwent renal biopsy. 81% had glomerular nephropathy with 7.3% (501) IgA N. A male-to-female ratio of 2.27. The average age was 28.7 years. IgA N was primary in 80.2% cases and secondary in 17.8% cases. The most frequent secondary IgA N was rheumatoid purpura (74.8%). There was a male predominance in Berger‘s disease as well as in rheumatoid purpura. Berger’s disease was more common in adults, whereas rheumatoid purpura was more common in children. The main indication of renal biopsy was proteinuria with hematuria in 23.2% of cases and nephrotic syndrome in 23.8%. The association of non-nephrotic proteinuria, hematuria, arterial hypertension and renal injury was found in 9.3% whereas isolated macroscopic hematuria only in 6.4% of cases. According to HAAS classification, HAAS 3 was the most frequent. OXFORD classification used only from 2010, and M1, S1, E0, T0 and M1, S1, E0, T2 were the most frequent. Glomerular lesions were associated to tubulo interstitial and vascular lesions in 48.2% of cases.
Conclusion
IgA nephropathy is the most common glomerular disease and a frequent cause of end stage renal disease. Because of a clear increase of it’s incidence in our country and the delay in the diagnosis, a systematic screening of urines is needed in our country as it’s done in Singapore and Japan.
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Affiliation(s)
- Marwa Omrane
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Raja Aoudia
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Mouna Jerbi
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
| | - Hanene Gaied
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
| | - Hafedh Hidri
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | | | - Rim Goucha
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
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Felah E, Samia B, Mariem H, Ben amor S, Chargui S, Amiri ML, Trabelsi R, Goucha R, Ben Hmida F, Ounissi M, Ben abdallah T. P0318HYPERKALEMIA: EPIDEMIOLOGY AND MANAGEMENT. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Hyperkalemia is a dreadful biological event that can immediately compromise the vital prognosis. Etiologies are many and varied. The aim of our study is to better characterize the epidemiological and clinical aspects of this disorder in order to establish adequate diagnostic and therapeutic strategies in order to intervene effectively and in the shortest possible time.
Methods
Cross-sectional study carried out over a period of 12 months [January-December 2017] including all emergency calls for hyperkalemia greater than 5.5 mmol / l and undergoing hemodialysis in the nephrology department.
Results
We collected 185 patients (Sex ratio= 1.43) aged on average 61.8 ± 16.1 years [18-94 years].
70.3% had serum potassium between 5.5 and 7 mmol / l and 29.7% greater than 7. Patients mainly came from emergencies in 71.4% of cases. Main symptoms consisted in oligoanuria, vomiting, chest pain, and febrile syndrome in 38.9%, 10.8%, %, and 5.9% of cases, respectively. Of these patients, 76.2% are known to be chronic renal failure whose 29.7% are in chronic dialysis. Acute renal failure (ARF) was diagnosed in 30.3% of patients. Of these, 39.4% were functional AKI, 41% were obstructive and organic AKI in 19.6% of cases. Mean serum potassium was 6.7 ± 0.9mmol / l [5.5-11] associated with metabolic acidosis in 52.4% of cases. Mean serum creatinine was 988umol /l[184-3270]. The electrical signs of hyperkalemia were noted in 40% (n = 74) of patients: large T in 28.6% of cases, atrioventricular block (AVB) in 3.8% of cases including a 3rd BAV degree in 1.6% of cases, QRS wide in 11.4% of cases and sinus bradycardia in 7% of cases, Ventricular Extrasystoles and a branch block found respectively in 3.2% of cases. 30.8% (n = 57) of the patients were under hyperkalaemic treatment. In fact, 27 % of patients took a blocker of the renin-angiotensin system, 7% were on aldoactone, 13.5% of patients on þetabloquant,1.6 % of whom were on kaleoride and / or admitted to intensive care and infused with KCl. Medical treatment was started urgently in 42.7 % of cases and included the administration of twenty ml 10% ca gluconate that was given intravenously over 5-10minutes, insulin with glucose ,sodium polystyrene sulfate (Kayexalete) and salbutamol, sodium bicarbonate indicated for severe metabolic acidosis (pH<7.20). Overall mortality was 21.1% of cases .
Conclusion
Hyperkalemia remains a frequent metabolic disorder. Renal failure and acidosis were the main factors associated to hyperkalemia in our study. The clinical and therapeutic subtleties must be known by any caregiver in order to effectively mitigate the harmful effects of this disorder, mainly in the cardiac function.
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Affiliation(s)
- Eya Felah
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Barbouch Samia
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Hajji Mariem
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Shedha Ben amor
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Mohamed lotfi Amiri
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Raja Trabelsi
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Rym Goucha
- Monji Slim Hospital Marsa Tunis, Nephrology and dialysis departement, Tunis, Tunisia
| | - Fethi Ben Hmida
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
| | - Taieb Ben abdallah
- Charles Nicolle Hospital. Tunis, Tunisia., Departement of nephrology and Laboratory of kidney pathology LR00SP01, Tunis, Tunisia
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Breik N, Jerbi M, Aoudia R, Chargui S, Guaied H, Gorsane I, Goucha R, Benabdallah T. P0314TREATMENT AND OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN ELDERLY PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
The increase in life expectancy has led to increasing numbers of elderly patients in all medical disciplines, particularly in nephrology. Idiopathic membranous nephropathy (IMN) is common in the elderly and can lead to significant morbidity and mortality because of the complication of nephrotic syndrome (NS) and immunosuppressive therapy. The aim of this study is to analyze the diagnostic, therapeutic and evolutionary approach of IMN in elderly patiets.
Method
We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software.
Results
Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery were dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (39.28%) and elevated creatinine level in 9 cases (32.14%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone (group 1), three patients received corticosteroid with mycofenolate mofetil (group 2) and one patient received corticosteroid with ciclosporin (group3). Fourteen patients received only symptomatic treatment (group 4). We noted partial remission in group 3, however complete remission in 37.5%, 14.28% and 12.5% from respectively group 1, group 4 and group 2. The side effects of immunosuppressive therapy were infectious complication in 8 patients (28.5%), osteoporosis in 3 patients (10.7%) and Steroid diabetes in one case. The side effects of NS were thrombotic complication in 5 patients (17.85%). Two patients had presented coronary syndrome and two other patients had presented hepatitis C. Two cases of death were noted whose etiology was pulmonary infection in one patient and undeterminate etiology in the other case.
Conclusion
Treatment of IMN in older patients has unique challenges, reducing the need for renal replacement therapy. Most studies report that the elderly respond to therapy with rates comparable with younger patients but in the other hand elderly are more susceptible to side effects of immunosuppressive therapy.
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Affiliation(s)
- Nessrine Breik
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
| | - Mouna Jerbi
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Raja Aoudia
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Hanen Guaied
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Rim Goucha
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Taieb Benabdallah
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
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Breik N, Jerbi M, Aoudia R, Chargui S, Guaied H, Gorsane I, Goucha R, Benabdallah T. P0472RENAL OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN ELDERLY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Idiopathic membranous nephropathy (IMN) is increasingly seen in older patients but little is known about its treatment and outcomes at long term follow up. The objective of this work is to study the renal survival of IMN in elderly as well as prognostic factors.
Method
We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables.
Results
Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). The clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone, three patients received corticosteroid with mycofenolate mofetil and one patient received corticosteroid with ciclosporin. Fourteen patients received only symptomatic treatment. We noted complete remission in 6 patients (21.42%) and end renal stage disease in 5 patients (17.85%). Our study showed that treatment with angiotensin receptors blockers was associated with better renal survival with a statistically significant difference, (p = 0.011). A reduced kidney function at presentation, tubule-interstitial disease and interstitial fibrosis and tubular atrophy were associated with poor survival with a statistically significant result (p = 0.012) (p=0,011) respectively.
Conclusion
IMN is the most common cause of nephrotic syndrome in elderly patients and it has the same risk for progression as in younger individuals. Decrements in glomerular filtration rate, increased risk for comorbidities, vascular disease and change in pharmacokinetics justify special attention to treatment decisions in elderly individuals with IMN.
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Affiliation(s)
- Nessrine Breik
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
| | - Mouna Jerbi
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Raja Aoudia
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Hanen Guaied
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Rim Goucha
- Mongi Slim Hospital, Department of Nephrology, La Marsa, Tunisia
- Charles Nicolle Hospital, Research Laboratory of Kidney Diseases (LR00SP01), Tunis, Tunisia
| | - Taieb Benabdallah
- Charles Nicolle Hospital, Department of Nephrology, Dialysis and Transplantation, Tunis, Tunisia
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Omrane M, Aoudia R, Ounissi M, Chargui S, Jerbi M, Gaied H, Hidri H, Harzallah A, Ben Abdallah T, Goucha R. P0418LUPUS NEPHRITIS: A MONOCENTRIC STUDY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Systemic lupus erythematosus is a multi-visceral autoimmune disease. Renal involvement is one of the most common and serious manifestations of this disease. The histological lesions are highly polymorphic and the renal biopsy remains crucial for the therapeutic management of lupus nephritis (LN). The aim of our investigation was to study the epidemiological, clinical, biological and histological characteristics, outcomes and to evaluate the therapeutic protocols used for lupus nephritis’ treatment and to identify predictive factors of renal prognosis in patients with lupus nephritis.
Method
It was a retrospective study including patients over 16 years old with lupus nephritis proved by kidney biopsy and followed up over a period of 17 years in our department.
Results
We collected 155 women and 19 men with a sex ratio F / H of 8.2. The mean age at the time of the discovery of LN was 32.6 years with a maximum between 15 years and 45 years. The most frequent extra-renal manifestations were articular and dermatological manifestations (79%). Renal symptomatology was dominated by proteinuria noted in all patients, associated to a nephrotic syndrome in 68% of patients. At the time of diagnosis of LN, hematuria was present in 69% of patients and renal failure was present in half of cases. Immunologically, antinuclear antibody were positive in 89.1% of cases, anti DNA positive in 73.4% of cases, anti Sm positive in 79.8% of cases and Antiphospholipids were positive in 50% of cases, associated with an antiphospholipid syndrome in 14.9% of cases. We performed 243 renal biopsies with 174 initial and 69 iterative biopsies. The histological lesions were polymorphic dominated by LN class IV (36.6%) isolated or associated with LN class V (17.7%). All patients received a corticosteroid for induction or maintenance treatment. It was associated with immunosuppressive treatment according to different treatment regimens. The median duration of follow-up was 81.2 months. Renal outcome was marked by complete and sustained remission in 36.7% of cases, incomplete remission with chronic kidney disease in 34.5% of cases, chronic renal failure in 28.7% of cases. At univariate analysis, we identified the young age below 35 years at the time of the discovery of LN, the male sex, increased serum creatinine at the time of biopsy, proliferative forms, the presence of histological signs of chronicity and lesions of thrombotic microangiopathy as predictive factors of poor renal outcomes.
Conclusion
Lupus nephritis is one of the most common and serious manifestations of Systemic lupus erythematosus. The generalization of renal biopsy, the use of early codified therapeutic protocols and regular monitoring and evaluation of disease activity according to the appropriate scores can improve management and survival of patients with renal impairment.
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Affiliation(s)
- Marwa Omrane
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Raja Aoudia
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Mouna Jerbi
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
| | - Hanene Gaied
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
| | - Hafedh Hidri
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | - Amel Harzallah
- Charles Nicole Hospital, Internal medicine A, Tunis, Tunisia
| | | | - Rim Goucha
- Mongi Slim Hospital, Nephrology, La Marsa, Tunisia
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DAOUD H, Harzallah A, Karray R, Chargui S, Kaaroud H, Goucha R, Ben Hmida F, Ben Abdallah T. SUN-447 MORBIDITY AND MORTALITY OF SICKLE CELL DISEASE PATIENTS WITH CHRONIC KIDNEY DISEASE. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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KARRAY R, Harzallah A, Chargui S, Kaaroud H, Ben Hamida F, Ben Nacef I, Khiari K, Ounissi M, Ben Abdallah T. SUN-173 HYPERTENSION BEFORE AND AFTER TREATMENT OF CONN’S ADENOMA. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Jerbi PhD M, Aoudia R, Rahali I, Gaied H, Chargui S, Gorsane I, Goucha R, Ben Abdallah T. SUN-166 THROMBOTIC MICROANGIOPATHY IN KIDNEY DISEASE: SEVERAL ETIOLOGIES. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cheikh M, Chargui S, Ben Hmida F, Ben Abdallah T. Évaluation de l’observance thérapeutique chez les patients hémodialysés chroniques. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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37
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Chargui S, Bouam A, Vittoz N, Hanafi L, Housset P, Pardon A, Ziliotis M, Caudwell V. La ciclosporine : son efficacité dans le traitement de la glomérulonéphrite extra-membraneuse primitive chez la femme enceinte ? Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chargui S, Zammouri A, Allouch E, Zaouia K, Bensalem A, Agrebi S, Ouechetati W, Benhamida F, Elyounsi F, Bazdah L, Benabdallah T. SP558Echocardiographic Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis : Prevalence and Risk Factors of left ventricular hypertrophy and valvular calcifications. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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39
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Ben Ariba Y, Haddad S, Guediche N, Chargui S, Ben Abdelhafidh N, Riadh B, Louzir B, Labidi J. Fibrose rétropéritonéale : approche diagnostique et thérapeutique : expérience d’un service de médecine interne. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Felah E, Aouidia R, Jaziri F, Chargui S, Gaied H, Jerbi M, Ounissi M, Ben Hamida F, Goucha R, Ben Abdallah T. La glomérulonéphrite membranoproliférative type 1 : à partir de 563 biopsies rénales : étude épidémiologique, clinicobiologique et étiologique. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Felah E, Barbouch S, Amiri L, Najjar MH, Aoudia R, Harzallah A, Chargui S, Ounissi M, Abdallah TB, Hamida FB. Épidémiologie de l’insuffisance rénale aiguë et modalités thérapeutiques urgentes. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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42
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Hadded S, Chargui S, Aouadia R, Jerbi M, Ben Hamida F, Ben Abdallah T. Le traitement chirurgical de l’hyperparathyroïdie secondaire à l’insuffisance rénale chronique. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Ben Nessira S, Barbouche S, Chargui S, Grati R, Ben Amor S, Hedri H, Goucha R, Ben Hmida F, Ben Abdallah T. Myélome multiple : étude descriptive de 211 cas. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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44
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Hadded S, Hajji M, Ghezal E, Cheikh M, Agrbi S, Chargui S, Ben Hamida F, Barbouch S, Ben Abdallah T. Les caractéristiques épidémiocliniques et biologiques de la prise en charge des patients en hémodialyse chronique à Tunis : étude monocentrique de 84 cas. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aoudia R, Azaiez S, Jaziri F, Chaabouni E, Chargui S, Gaied H, Jerbi M, Bacha MM, Ounissi M, Hedri H, Ben Abdallah T, Goucha R. SP055LIGHT CHAIN DEPOSITS DISEASE FROM 19 KIDNEY BIOPSIES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raja Aoudia
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Seif Azaiez
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Fatima Jaziri
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Emna Chaabouni
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Soumaya Chargui
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | | | - Mouna Jerbi
- Nephrology, Mongi Slim Hospital, Tunis, Tunisia
| | - Mohamed Mongi Bacha
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Mondher Ounissi
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Hafedh Hedri
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Nephrology and Laboratory of Renal Pathology, LR00SP01 Charles Nicolle Hospital, Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Rym Goucha
- Nephrology, Mongi Slim Hospital, Tunis, Tunisia
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Mesbahi T, Barbouch S, Cherni N, Chargui S, Aoudia R, Bacha M, Elyounsi F, Ben Hamida F, Gorsane I, Ben Abdallah T. Hyperkaliémie aux urgences : une cause de décès silencieuse. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hajji M, Harzallah A, Kaaroud H, Jerbi M, Chargui S, Younsi FE, Hamida FB, Abdallah TB. [Exhaustion of vascular capital in patients on hemodialysis: what will be the outcome?]. Pan Afr Med J 2017; 25:237. [PMID: 28293353 PMCID: PMC5337301 DOI: 10.11604/pamj.2016.25.237.10665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/02/2016] [Indexed: 11/11/2022] Open
Abstract
Despite advances in the treatment of chronic renal failure, vascular access remains the weakest link in renal replacement therapy (RRT) and the leading cause of morbidity in patients on hemodialysis We report the case of a young female patient with chronic renal insufficiency secondary to vascular nephropathy on periodic hemodialysis and whose vascular capital was early exhausted due to iterative thromboses in arteriovenous fistulas and failure in peritoneal dialysis. Protein C deficiency was objectified. The patient underwent tunneled hemodialysis catheter insertion at the level of the right atrium via a right anterolateral thoracotomy with cannulation of the inferior vena cava, with poor functional outcome after three months of use. Since then she has been dialyzed using puncture of the external jugular veins.
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Affiliation(s)
- Meriam Hajji
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Amel Harzallah
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hayet Kaaroud
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Mona Jerbi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Soumaya Chargui
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi El Younsi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie; Faculté de Médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
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Zaghbi N, Ben Ariba Y, Chargui S, Boussetta N, Louzir B, Laabidi J, Othmani S. Fibroses rétropéritonéales : profil épidémiologique, clinique, étiologique, thérapeutique et évolutif. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ben Hamida S, Chargui S, Habli I, Jouini H, Ounissi M, Ben Abdallah T. Quand la dialyse péritonéale est le dernier recours. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Hajji M, Chargui S, Zammouri A, Aouadia R, Ben Abdelghani K, Ben Hamida F, Barbouche S, Ben Abdallah T. Atteinte cutanée au cours des vascularites pauci-immunes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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