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Macher MA, Mongi Bacha M, Soualmia A, Laouad I, Sfar I, Jacquelinet C, Meçabih F, Younous S, Bayar R, Ziadi J, Nebab AEK, Barry N, Nouvellon H, Gozzerino A, Durin L, Ben Abdallah T, Tsimaratos M. Access to kidney transplantation for patients with end-stage renal failure in Maghreb countries: state of art and recommendations. Nephrol Ther 2024; 20:30-40. [PMID: 38314548 DOI: 10.1684/ndt.2024.62] [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: 02/06/2024]
Abstract
We present an overview of kidney transplantation activity in the Maghreb countries, based on data from the 9th Colloque France-Maghreb (Paris, May 20 and 21, 2022). For Algeria, Morocco and Tunisia, the incidence of end stage renal failure is respectively 120, 130 and 130 per million inhabitants, its prevalence 626, 900 and 833 per million inhabitants and the part of patients with a functional graft of 10.3, 1.8 et 8.5% with an annual number of transplants of 6.5, 0.8 and 8.7 per million inhabitants. Living donor transplants account for 99% of transplants in Algeria, 93% in Morocco and 80% in Tunisia. In conclusion, access to transplantation remains low in the Maghreb countries. All the modalities (living donor with enlargement of the circle of donors, deceased donors) must be further developed. Recommendations were issued to support activity.
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Affiliation(s)
| | | | - Amel Soualmia
- Experte à l’Agence nationale des greffes, Centre régional médico-chirurgical, Blida, Algérie
| | - Inass Laouad
- CHU Mohamed V, service de néphrologie, hémodialyse et transplantation rénale, Marrakech, Maroc
| | - Imen Sfar
- Hôpital Charles Nicolle, service d’immunologie, Tunis, Tunisie
| | | | - Fateh Meçabih
- Institut Pasteur d’Algérie, Faculté de pharmacie d’Alger, Algérie
| | - Said Younous
- CHU Mohamed V, service d’anesthésie réanimation, Marrakech, Maroc
| | - Rached Bayar
- Hôpital Mongi Slim, service de chirurgie viscérale, Sidi Daoud La Marsa, Tunis, Tunisie
| | - Jalel Ziadi
- Hôpital La Rabta, service de chirurgie cardiovasculaire, Jebbari, Tunis, Tunisie
- Centre national pour la promotion de la transplantation d’organes (CNPTO), Bab Saadoun, Tunis, Tunisie
| | | | - Naïma Barry
- Agence de la biomédecine, La Plaine Saint-Denis, France
| | | | | | - Laurent Durin
- Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Taieb Ben Abdallah
- Hôpital Charles Nicolle, service de médecine interne A, Tunis, Tunisie
- Centre national pour la promotion de la transplantation d’organes (CNPTO), Bab Saadoun, Tunis, Tunisie
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Aissi W, Kaffel N, Bardi R, Sfar I, Gorgi Y, Ben Abdallah T, Gargah T, Ziadi J. Knowledge and Attitudes Toward Organ Donation Among Tunisian Adults: Results of a National Survey. EXP CLIN TRANSPLANT 2024; 22:224-228. [PMID: 38385402 DOI: 10.6002/ect.mesot2023.p56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Attitudes and knowledge toward organ donation can influence a person's willingness to donate. The aim of this study was to assess attitudes and knowledge regarding organ donation among Tunisian adults. MATERIALS AND METHODS We conducted a crosssectional survey at the national level from January 23 to February 15, 2017, among 1026 Tunisian adults. We used a standardized questionnaire to collect data by phone call. We performed statistical analyses with Stata software (version 11). RESULTS The study included 495 male and 531 female participants. Forty-one percent of participants were 18 to 30 years old. In total, 81.7% had heard about organ donation. Fewer than half of respondents (47.8%) were aware that organ donation is regulated. In total, 80.7% accepted to donate their organs after death, and 32.2% had mentioned their opinion to relatives or friends. Only 1% had added their donor status on their national identity cards. CONCLUSIONS Tunisian adults seem to have positive attitudes regarding organ donation. However, the proportion of respondents who included their donor status on their national identity cards was low. It is important to enhance information and education on organ donation in an effort to mitigate the shortage of organs.
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Affiliation(s)
- Wafa Aissi
- From the National Center for the Promotion of Organ Transplantation and the Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Badrouchi S, Bacha MM, Ahmed A, Ben Abdallah T, Abderrahim E. Predicting long-term outcomes of kidney transplantation in the era of artificial intelligence. Sci Rep 2023; 13:21273. [PMID: 38042904 PMCID: PMC10693633 DOI: 10.1038/s41598-023-48645-w] [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] [Received: 01/16/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023] Open
Abstract
The ability to accurately predict long-term kidney transplant survival can assist nephrologists in making therapeutic decisions. However, predicting kidney transplantation (KT) outcomes is challenging due to the complexity of the factors involved. Artificial intelligence (AI) has become an increasingly important tool in the prediction of medical outcomes. Our goal was to utilize both conventional and AI-based methods to predict long-term kidney transplant survival. Our study included 407 KTs divided into two groups (group A: with a graft lifespan greater than 5 years and group B: with poor graft survival). We first performed a traditional statistical analysis and then developed predictive models using machine learning (ML) techniques. Donors in group A were significantly younger. The use of Mycophenolate Mofetil (MMF) was the only immunosuppressive drug that was significantly associated with improved graft survival. The average estimated glomerular filtration rate (eGFR) in the 3rd month post-KT was significantly higher in group A. The number of hospital readmissions during the 1st year post-KT was a predictor of graft survival. In terms of early post-transplant complications, delayed graft function (DGF), acute kidney injury (AKI), and acute rejection (AR) were significantly associated with poor graft survival. Among the 35 AI models developed, the best model had an AUC of 89.7% (Se: 91.9%; Sp: 87.5%). It was based on ten variables selected by an ML algorithm, with the most important being hypertension and a history of red-blood-cell transfusion. The use of AI provided us with a robust model enabling fast and precise prediction of 5-year graft survival using early and easily collectible variables. Our model can be used as a decision-support tool to early detect graft status.
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Affiliation(s)
- Samarra Badrouchi
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
- Laboratory of Kidney Transplantation Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia.
| | - Mohamed Mongi Bacha
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Kidney Transplantation Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Abdulaziz Ahmed
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Taieb Ben Abdallah
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Kidney Transplantation Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzedine Abderrahim
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Charfi R, Bacha MM, Ben Fadhal M, Ferchichi K, El Jebari H, Gaies E, Klouz A, Abderrahim E, Ben Hamida F, Ben Abdallah T, Trabelsi S, Gorgi Y, Sfar I. The effects of the CYP3A5*3 variant on tacrolimus pharmacokinetics and outcomes in Tunisian kidney transplant recipients. Tunis Med 2023; 101:738-744. [PMID: 38465753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Tacrolimus, exhibits interindividual pharmacokinetic variability and a narrow therapeutic index. The influence of the CYP3A5 6986A>G single nucleotide polymorphism (SNP) on this variability remains a topic of debate. AIM To assess the impact of the aforementioned SNP on tacrolimus area under curve (AUC0-12h), adverse drug reactions (ADRs), and kidney graft outcomes. METHODS Blood samples were collected from Tunisian kidney transplants over a five-year period during either the early (<3 months) or late (>3 months) post-transplant phases. Through blood concentration (C0) and AUC0-12h of tacrolimus were measured. Patients were prospectively followed to assess graft outcomes. Polymerase chain reaction of restriction fragment length polymorphism was used for CYP3A5 6986A>G genotyping. RESULTS Fifty Tunisian kidney recipients receiving tacrolimus were enrolled in the study. Acute and chronic graft rejections were observed in eight and three patients, respectively. Twenty-one patients (42%) reported ADRs. C0 and AUC0-12h, showed a significant difference between CYP3A5*1 carriers (mean C0=4 ng.mL-1 and AUC0-12h=94.37 ng.h.mL-1) and CYP3A5*3/3 or poor metabolizers carriers (mean C0=7.45 ng.mL-1; AUC0-12h=151.27 ng.h.mL-1) (p=0.0001; p=0.003, respectively). Supratherapeutic tacrolimus levels were significantly more common in poor metabolizers (p=0.046; Odds-ratio =1.3; confidence interval 95% [1.12-1.66]). The impact of SNP was significant on C0, AUC0-12h, C0/Dose and AUC0-12h/Dose, only in the late phase (p=0.01, 0.002, 0.012, 0.003 respectively). CONCLUSION CYP3A5*3 variant was significantly associated with tacrolimus pharmacokinetics but had no impact on graft outcomes.
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Affiliation(s)
- Rim Charfi
- University of Tunis El Manar, Faculty of de Medicine of Tunis. National Centre Chalbi Belkahia of Pharmacovigilance, Department of clinical pharmacology, Research Laboratory of Clinical and Experimental Pharmacology (LR16SP02), 1006 Tunis, Tunisia
| | - Mohamed Mongi Bacha
- Charles Nicolle hospital -Department of nephrology and internal medicine, Research Laboratory of Renal Pathology (LR00SP01), 1006 Tunis, Tunisie
| | - Myriam Ben Fadhal
- Charles Nicolle hospital -Department of immunology, Research Laboratory of Immunology of Renal Transplantation and Immunopathology (LR03SP01), 1006 Tunis, Tunisia
| | - Khouloud Ferchichi
- University of Tunis El Manar, Faculty of de Medicine of Tunis. National Centre Chalbi Belkahia of Pharmacovigilance, Department of clinical pharmacology, Research Laboratory of Clinical and Experimental Pharmacology (LR16SP02), 1006 Tunis, Tunisia
| | - Hanene El Jebari
- University of Tunis El Manar, Faculty of de Medicine of Tunis. National Centre Chalbi Belkahia of Pharmacovigilance, Department of clinical pharmacology, Research Laboratory of Clinical and Experimental Pharmacology (LR16SP02), 1006 Tunis, Tunisia
| | - Emna Gaies
- University of Tunis El Manar, Faculty of de Medicine of Tunis. National Centre Chalbi Belkahia of Pharmacovigilance, Department of clinical pharmacology, Research Laboratory of Clinical and Experimental Pharmacology (LR16SP02), 1006 Tunis, Tunisia
| | - Anis Klouz
- University of Tunis El Manar, Faculty of de Medicine of Tunis. National Centre Chalbi Belkahia of Pharmacovigilance, Department of clinical pharmacology, Research Laboratory of Clinical and Experimental Pharmacology (LR16SP02), 1006 Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Charles Nicolle hospital -Department of nephrology and internal medicine, Research Laboratory of Renal Pathology (LR00SP01), 1006 Tunis, Tunisie
| | - Fathi Ben Hamida
- Charles Nicolle hospital -Department of nephrology and internal medicine, Research Laboratory of Renal Pathology (LR00SP01), 1006 Tunis, Tunisie
| | - Taieb Ben Abdallah
- Charles Nicolle hospital -Department of nephrology and internal medicine, Research Laboratory of Renal Pathology (LR00SP01), 1006 Tunis, Tunisie
| | - Sameh Trabelsi
- University of Tunis El Manar, Faculty of de Medicine of Tunis. National Centre Chalbi Belkahia of Pharmacovigilance, Department of clinical pharmacology, Research Laboratory of Clinical and Experimental Pharmacology (LR16SP02), 1006 Tunis, Tunisia
| | - Yosr Gorgi
- Charles Nicolle hospital -Department of immunology, Research Laboratory of Immunology of Renal Transplantation and Immunopathology (LR03SP01), 1006 Tunis, Tunisia
| | - Imen Sfar
- Charles Nicolle hospital -Department of immunology, Research Laboratory of Immunology of Renal Transplantation and Immunopathology (LR03SP01), 1006 Tunis, Tunisia
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Hajji M, Jebali H, Chaabouni E, Mzoughi K, Zairi I, Kraiem S, Raies L, Hamida FB, Fatma LB, Zouaghi MK, Abdallah TB. Contrast media-induced nephropathy in Tunisia: prospective case-control study with cardio-nephrological monitoring. Pan Afr Med J 2023; 45:144. [PMID: 37808435 PMCID: PMC10559155 DOI: 10.11604/pamj.2023.45.144.30749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction vascular opacification using iodinated contrast media (ICM) is often the primary diagnostic and therapeutic approach. However, the risk of post-injection nephrotoxicity of ICM is significantly higher in patients with underlying nephropathy. This study aimed to determine the incidence of Contrast Media Induced Nephropathy (CMIN) and identify predictive factors for its occurrence in patients from a cardiology department. Methods our prospective study involved 158 patients who underwent coronary angiography or angioplasty at the cardiology department between December 2017 and May 2018. Two types of ICM were used in our study: Iopromide and Iohexol. All patients received either physiological serum (9‰) or bicarbonate serum (14‰) intravenously for hydration. We defined impaired renal function as an increase in creatinine ranging from 10 to 26 µmol/L, while CMIN was defined as an increase in serum creatinine exceeding 26.5 µmol/L. We investigated the factors associated with CMIN using logistic regression analysis. Results the mean age of our patients was 60 ± 11 years (range: 29-82), with a predominance of men 63.9% (n=101). The most common cardiovascular risk factors were tobacco (36.1%, n = 57), diabetes (48.1%, n =76), hypertension (55%, n = 87). Pre-procedural creatinine averaged 81.1 ± 47.3 µmol / L with extremes ranging from 39 to 600 µmol / L. The median Mehran risk score was 3.2 (range: 0- 15). The interventional cardiology act consisted of coronary angiography in 86.2% (n=136) of cases, coronary angioplasty in 2.5% (n=4) of cases. We used iohexol and iopromide in 57.6% (n=91) and 42.4% (n=67) of cases, respectively. The overall incidence of CMIN was 9.5% (n=9). The multivariable regression analysis identified 4 risk factors independently linked to the occurrence of CMIN which were Pre-existing renal failure (OR: 6.05, 95%CI [1.23-29.62], p = 0.026), anemia (OR: 0.043, CI [1.03-8.96], p = 0.043), the toxic dose of PC (OR: 4.7, CI [1.28-17.7], p=0.02), and at a Mehran score = 11 (OR: 3.7, CI [0.88-15.6], p=0.036). Conclusion the most effective approach for CMIN is prevention, which focuses on addressing modifiable risk factors to minimize the risk especially in patients with pre-existing renal failure.
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Affiliation(s)
- Meriam Hajji
- Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hela Jebali
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Emna Chaabouni
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Khadija Mzoughi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ihssen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sondos Kraiem
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Lamia Raies
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Lilia Ben Fatma
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Mohammed Karim Zouaghi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Badrouchi S, Bacha MM, Hedri H, Ben Abdallah T, Abderrahim E. Toward generalizing the use of artificial intelligence in nephrology and kidney transplantation. J Nephrol 2022; 36:1087-1100. [PMID: 36547773 PMCID: PMC9773693 DOI: 10.1007/s40620-022-01529-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
With its robust ability to integrate and learn from large sets of clinical data, artificial intelligence (AI) can now play a role in diagnosis, clinical decision making, and personalized medicine. It is probably the natural progression of traditional statistical techniques. Currently, there are many unmet needs in nephrology and, more particularly, in the kidney transplantation (KT) field. The complexity and increase in the amount of data, and the multitude of nephrology registries worldwide have enabled the explosive use of AI within the field. Nephrologists in many countries are already at the center of experiments and advances in this cutting-edge technology and our aim is to generalize the use of AI among nephrologists worldwide. In this paper, we provide an overview of AI from a medical perspective. We cover the core concepts of AI relevant to the practicing nephrologist in a consistent and simple way to help them get started, and we discuss the technical challenges. Finally, we focus on the KT field: the unmet needs and the potential role that AI can play to fill these gaps, then we summarize the published KT-related studies, including predictive factors used in each study, which will allow researchers to quickly focus on the most relevant issues.
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Affiliation(s)
- Samarra Badrouchi
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia ,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Mongi Bacha
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia ,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Laboratory of Kidney Transplantation Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia ,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia ,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Laboratory of Kidney Transplantation Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzedine Abderrahim
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia ,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Abbassi IM, El Euch M, Jaziri F, Kefi A, Hamida FB, Turki S, Abdelghani KB, Abdallah TB. Tuberculose laryngée isolée de l´adulte: localisation extra pulmonaire exceptionnelle: a case clinique. Pan Afr Med J 2022; 43:9. [DOI: 10.11604/pamj.2022.43.9.21014] [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] [Received: 11/17/2019] [Accepted: 10/29/2020] [Indexed: 11/11/2022] Open
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Gorsane I, Zammouri A, Hajji M, Sallemi N, Aoudia R, Barbouch S, Ben Abdallah T. [Renal involvement in sarcoidosis: Prognostic and predictive factors]. Nephrol Ther 2021; 18:52-58. [PMID: 34756825 DOI: 10.1016/j.nephro.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 07/07/2020] [Revised: 08/15/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease that primarily affects the respiratory system and lymphatic vessels. Renal involvement is rare, poorly studied and found in less than 10% of cases. The objective of our study was to identify factors of poor renal prognosis and predictive factors of renal involvement during sarcoidosis. METHODS It's a retrospective study including patients hospitalized in our department for sarcoidosis with renal involvement over a period of 40 years. To study renal survival, we identified two groups of patients with renal manifestations of sarcoidosis by following their evolution: group A (n=26) represents those with renal remission or deterioration of renal function but without progression to end-stage renal disease and group B (n=8) those with progression to end-stage renal disease. To detect the predictive factors of end-stage renal disease in patients with sarcoidosis, we compared the clinical and paraclinical characteristics of our patients (group 1) to those of 44 patients with sarcoidosis without renal impairment followed in our department during the same period (group 2). RESULTS Renal involvement was observed in 34 patients hospitalized for sarcoidosis (43.6%). There were 28 women and 6 men with a sex ratio of 0,21. The mean age at diagnosis of sarcoidosis was 47.1 years. The median time from sarcoidosis diagnosis to renal disease was 2 months (range 1-72). Tubulointerstitial nephropathy was the most frequent renal manifestation observed in 24 patients (70.6%). Hypercalcemia and hypercalciuria were found in 52.9% and 46.4% respectively. Renal failure was noted in 25 patients (73.5%). Corticosteroid therapy was initiated in 33 patients (97%) associated with immunosuppressive therapy in 3 cases. Predictive factors of end-stage renal disease were advanced age at diagnosis of nephropathy (P=0.007), comorbidities (P=0.002), multi-organ involvement (P=0.041), initial renal failure (P=0.013), interstitial fibrosis (P=0.006) and renal granulomas (P=0.007). Predictive factors of renal impairment during sarcoidosis were multi-organ involvement, inflammatory syndrome and hypercalcemia. CONCLUSION Renal envolvement, although rare during sarcoidosis, can influence the prognosis hence the great interest of its early detection to prevent progression to end-stage renal failure.
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Affiliation(s)
- Imen Gorsane
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie.
| | - Asma Zammouri
- Service de néphrologie, hôpital régional Houmt-Souk, Djerba, Tunisie
| | - Meriem Hajji
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Nadaa Sallemi
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Raja Aoudia
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Samia Barbouch
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
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Mesbahi T, Barbouch S, Najjar M, Fattoum S, Jebali H, Trabelsi R, Bacha MM, Smaoui W, Karoui C, Hamida FB, Hedri H, Rais L, Ounissi M, Zouaghi MK, Abdallah TB. End-stage renal disease at dialysis initiation: Epidemiology and mortality risks during the first year of hemodialysis. Saudi J Kidney Dis Transpl 2021; 32:1407-1417. [PMID: 35532711 DOI: 10.4103/1319-2442.344761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Chronic kidney disease (CKD) treated by hemodialysis (HD) is a worldwide major public health problem. Its incidence is getting higher and higher, leading to an alarming social and economic impact. The survival of these patients is significantly low, especially during the first year of treatment. The purpose of our study was to identify the epidemiological and clinico-biological characteristics of patients at the HD initiation and to reveal the predictive factors of mortality at three months and one year of HD. This is a prospective, analytical, and descriptive study dealing with 229 patients with an end-stage renal disease (ESRD), followed up in the Nephrology Department of Charles Nicolle Hospital and La Rabta Hospital in Tunisia, that was started HD between January and June 2017. A multivariate logistic regression analysis allowed us to identify the independent predictors of mortality at three months and one year. The average age was 60.2 ± 15.3 years, with a gender ratio of 1.41. Seventy-eight percent of patients had more than two comorbidities, 59% had diabetes, and 88% had hypertension. Diabetic nephropathy was the leading etiology of kidney disease (48.9%), while 11% of nephropathies were of unknown etiology. Only 58% were early referred to a nephrologist. The average glomerular filtration rate at HD initiation was 6.06 ± 2.33 mL/min/1.73 m2. Hypocalcemia and hyperphosphatemia were noted, respectively, in 60.8% and 84.9% of cases. Anemia was objectified in 98.6% of cases. HD was started in an emergency in 56.8% of cases. One of the most urgent indications was acute pulmonary edema (APE) for 43.8% of patients. Only 10.5% of patients had functional arteriovenous fistula at the dialysis initiation. Patients were hemodialyzed one, two, or three sessions per week, respectively, in 23.2%, 26.6%, and 50.2% of cases. The crude mortality rate was 25% and 13% in, respectively, one year and three months of HD. On multivariate analysis, we identified heart failure and insufficient dialysis dose per week as predictive factors of mortality at the 1st year of HD. C-reactive protein more than 21 mg/L, insufficient dialysis per week, modified Charlson Comorbidity Index less than 6, and APE at the dialysis initiation were identified as predictive factors of three-month mortality. Despite the short period of study, this work revealed the alarming conditions of patients at HD initiation. This critical situation is due to the delay in CKD diagnosis, the late nephrologist referral, and the lack of preparation before HD initiation.
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Affiliation(s)
- Tasnim Mesbahi
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Najjar
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Safa Fattoum
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Jebali
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Raja Trabelsi
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Wided Smaoui
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Cyrine Karoui
- Department of Nephrology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Fethi Ben Hamida
- Department of Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Lamia Rais
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Mondher Ounissi
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
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Gorsane I, Ayed TB, Hajji M, Barbouch S, Abdallah TB. Nephrotic syndrome in elderly: Etiologies, management, and prognosis. Saudi J Kidney Dis Transpl 2021; 32:1388-1396. [PMID: 35532709 DOI: 10.4103/1319-2442.344759] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
The elderly population has significantly increased in the world. Nephrotic syndrome (NS) is one manifestation of glomerular nephropathy in the elderly. The objective of our study is to determine NS particularities in the elderly and to identify the factors predicting progression to chronic end-stage renal disease (ESRD). This is a retrospective and descriptive study, carried out between January 1, 1975 and December 31, 2017. It includes participants aged 65 years old or over hospitalized for NS. A multivariate study was carried out and the dependent variable was the evolution to ESRD. We studied 115 patients with an average age of 71 ±5 years (65-83) and a sex ratio (male/female) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/L (3-19.5). NS was impure in 89.5% of patients. Renal biopsy was performed in 45 patients (39.13%). NS was secondary in 65.2% of cases mainly to amyloidosis (35.6%). Idiopathic nephropathy was dominated by membranous nephropathy (9.5%). Treatment was etiopathogenic in only 18 patients (15.6%). At the end of follow-up, 15.8% of patients achieved complete or partial remission and 56.6% progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD: uremia >17 mmol/L [adjusted odds ratio (aOR) = 33.2 (1.3-837.7); P <0.05],, phosphoremia ≥1.6 mmol/L [aOR = 22.1 (1.8-266.5); P <0.05], serum potassium ≥4.3 mmol/L (aOR = 24.7 (2.4, 251.5); P <0.01], extra-renal signs [aOR = 38.9 (2.4-634.3); P = 0.01], secondary nephropathy [aOR = 74 (3.1-1788.2); P <0.01] and membranoproliferative glomerulonephritis [aOR = 48 (1.4-1675.5); P <0.05]. The protective factors were hemoglobinemia ≥9.3 g/dL [aOR = 0.007 (0-0.2); P <0.01], kidneys well differentiated [0.032 (0.003-0.4); P<0.01] and treatment with two diuretics [aOR = 0.03 (0.00-30.4); P <0.01]. It is important to recognize the spectrum of kidney diseases in the elderly to improve the progression factors to ESRD.
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Affiliation(s)
- Imen Gorsane
- Department of Nephrology, Dialysis and Transplantation, Charles Nicolle Hospital; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tasmime Ben Ayed
- Department of Nephrology, Dialysis and Transplantation, Charles Nicolle Hospital; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Meriam Hajji
- Department of Nephrology, Dialysis and Transplantation, Charles Nicolle Hospital; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Samia Barbouch
- Department of Nephrology, Dialysis and Transplantation, Charles Nicolle Hospital; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Nephrology, Dialysis and Transplantation, Charles Nicolle Hospital; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Achouch S, Barbouch S, Hajji M, Cherni N, Ounissi M, Gorsane I, Hedri H, Goucha R, Ben Abdallah T, Amel H, Ben Hmida F. MO719PERITONEAL DIALYSIS IN ELDERLY PATIENTS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab101.0041] [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
Peritoneal Dialysis (PD) is now often being initiated in older patients. The benefits of this modality of dialysis have been well demonstrated in the literature. The aim of our study was to analyse the epidemiological and clinical profile of the elderly patients and to determine predictive factors of mortality
Method
It was a retrospective study including 51 case defined as patients ≥65-year-old, treated by PD in the Internal Medicine Department of the Charles Nicolle hospital during the period between 1986 and 2020.
Results
Fifty one patients were enrolled in the study. Their mean age was 71,6 ± 5,4 years [65 - 86]. There were 32 men (62, 7%) and 19 women (37,2%) . The method of initiation was the PD in 53, 84%. Diabetic and vascular nephropathy was the first cause of End-Stage Renal Disease in 56% and 19,6%. The mean Charlson score was 5,5 ± 1,4 [3-9]. The mean age when using PD was 70.8 ± 6 years [54-86]. Autonomous and active patients were detected in 29.4%. Diabetes mellitus, hypertension and coronary artery disease was observed in 58,8%, 29,4% and 15.7% of patients. In our study, 82.35% started on automated PD (APD) and 17,6% on continuous ambulatory PD (CAPD). The rate of mortality was 53%.
Switching modality from PD to hemodialysis occurred in 29,4% of cases. A univariate logistic regression identified a coronary artery disease as significantly associated with increased mortality (HR=2,1 [1-2,1, IC 95%](p=0.035)).
Conclusion
Elderly patients on dialysis face many issues but can have continued success with PD when they have adequate care and support. The control of the morbidities such as coronary artery disease is important to decrease the rate of mortality in patients using this modality of dialysis.
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Affiliation(s)
- Sonia Achouch
- Tunisia, nephrology and research department, tunis, Tunisia
| | | | - Meriam Hajji
- Tunisia, nephrology and research department, tunis, Tunisia
| | - Nadia Cherni
- Tunisia, nephrology and research department, tunis, Tunisia
| | - Mondher Ounissi
- Tunisian, nephrology and research department, tunis, Tunisia
| | - Imen Gorsane
- Tunisia, nephrology and research department, tunis, Tunisia
| | - Hafedh Hedri
- Tunisia, nephrology and research department, Tunis, Tunisia
| | - Rim Goucha
- Tunisia, nephrology and research department, Tunisia
| | | | | | - Fethi Ben Hmida
- Tunisia, nephrology and research department, tunisia, Tunisia
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12
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Fattoum S, Bacha MM, Mosbehi T, Braiek N, Abderrzhim E, Ben Hmida F, Ben Abdallah T. MO1000MAINTENANCE IMMUNOSUPPRESSIVE THERAPY IN PREVENTION OF ACUTE REJECTION AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab111.0024] [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
Acute rejection (AR) is a redoubtable immunological complication after kidney transplantation (KT). Maintenance immunosuppressive treatment (IS) is a corner stone in prevention of AR. The aim of this study was to define the role of different maintenance IS in preventing AR.
Method
It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR).
Results
All patients received low dose of corticosteroids (CS) in their IS.
Calcineurin inhibitors (CI) were not prescribed in first intention in 33,3% of groups A patients versus 13,2% in group B. Cyclosporin A (CsA) was prescribed in first intention in 57,4% of group A patients versus 45,7% in group B. Tacrolimus was prescribed in first intention in 9,3% of group A patients versus 41,1% in group B (p<0,0001).
All patients received Atimetabolite (AM) in their IS. In first intention, Azathioprin was prescribed in 73,6 % of group A patients and Mycophenolate Mofetil (MMF) was prescribed in 78,6% of group B patients (<0,0001).
In first intention, maintenance IS consisted in low dose corticosteroids (CS) associated with AM in 13,5% of our patients. CI was associated to CS and AM in 86,5% of patients. Tritherapy was significantly more used than biotherapy in group A (p<0,0001). Different associations used were CS+Aza, CS+MMF, CS+AZA+CsA, CS+MMF+CsA or CS+MMF+ Tac. From group A, 74,8% of patients received CS+AZA or Cs+AZA+CsA. And from group B, 75,8% of patients received CS+MMF+CsA or CS+MMF+Tac.
Conclusion
Maintenance IS therapy must be well chosen according to immunological risk in order to prevent AR.
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Affiliation(s)
- Safa Fattoum
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
| | | | - Tasnim Mosbehi
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
| | - Nesrine Braiek
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
| | | | - Fethi Ben Hmida
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
- Charles Nicolles Hospital, Kidney pathology laboratory lrsp001, Tunis, Tunisia
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13
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Fattoum S, Bacha MM, Mosbahhi T, Braiek N, Abderrahim E, Ben Hmida F, Ben Abdallah T. MO970GRAFT OUTCOME AFTER ACUTE REJECTION: A CASE CONTROL STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab110.0049] [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
Although Acute rejection (AR) is a complication associated with the early period after kidney transplantation (KT), its complications are mostly seen after a long term. The aim of this study was to evaluate graft outcome after AR.
Method
It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR).
Results
AR was responsible of immediate loss of 2 grafts. Chronic graft dyfonction was more frequent in group A (44,1% versus 17,4%, p<0,0001). Creatininemia levels were significantly higher at 3, 6 months, 1 year and 2 years (respectively p =0,0113 ; <0,0001 ; 0,0003 and 0,0172) after KT. The percentage of patients having creatinine levels > 130 µmol/l was higher in group A at 3, 6 months, 1 year, 2 years, 3 years and 5 years (respectively p =0,0186 ; 0,001 ; <0,0001 ; 0,0115 ; 0,0073 and 0,0255).
Graft survival was better in group B (p<0,0001). In group A, AR recurrence was responsible of a worser survival (p<0,0001). Over time, graft survival improved in the 2 groups. Complete functional recovery survival was similar to graft with no rejection but with impared graft function. The worst graft survival was noted if the functional recovery was absent.
Conclusion
Even if graft outcome after AR has improved over time, its deleterious effect is still inevitable. So AR must be prevented in order to enhance graft outcome.
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Affiliation(s)
- Safa Fattoum
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
| | | | - Tasnim Mosbahhi
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
| | - Nesrine Braiek
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
| | | | - Fethi Ben Hmida
- Charles Nicolles Hospital, Internal Medecine A, Tunis, Tunisia
- Charles Nicolles Hospital, Kidney pathology laboratory lrsp001, Tunisia
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14
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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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15
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Jerbi M, Ghabi H, Gaied H, Khadhar M, Aoudia R, Goucha R, Ben Abdallah T. Deep vein thrombosis: An unusual way of revealing microscopic polyangiitis. Deep vein thrombosis in microscopic polyangiitis. Clin Case Rep 2021; 9:618-622. [PMID: 33598213 PMCID: PMC7869375 DOI: 10.1002/ccr3.3606] [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: 06/20/2020] [Revised: 10/25/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
Unexplained deep vein thrombosis may justify screening for antineutrophil cytoplasmic antibody-associated vasculitis as it can be an unusual presentation of this disease.
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Affiliation(s)
- Mouna Jerbi
- Department of NephrologyFaculty of Medicine TunisMongi Slim Hospital, MarsaUniversity of Tunis El ManarTunisTunisia
| | - Hiba Ghabi
- Department of NephrologyFaculty of Medicine TunisLa Rabta HospitalUniversity of Tunis El ManarTunisTunisia
| | - Hanene Gaied
- Department of NephrologyFaculty of Medicine TunisMongi Slim Hospital, MarsaUniversity of Tunis El ManarTunisTunisia
| | - Mariem Khadhar
- Department of NephrologyFaculty of Medicine TunisMongi Slim Hospital, MarsaUniversity of Tunis El ManarTunisTunisia
| | - Raja Aoudia
- Department of NephrologyFaculty of MedicineCharles Nicolle HospitalUniversity of Tunis El ManarTunisTunisia
| | - Rim Goucha
- Department of NephrologyFaculty of Medicine TunisMongi Slim Hospital, MarsaUniversity of Tunis El ManarTunisTunisia
| | - Taieb Ben Abdallah
- Department of NephrologyFaculty of MedicineCharles Nicolle HospitalUniversity of Tunis El ManarTunisTunisia
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16
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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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17
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Jerbi M, El Fatmi R, Gaied H, Belloumi D, Torjemane L, Aoudia R, Goucha R, Abdallah TB, Othman TB. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits: Successful treatment for new and rare entity. Clin Case Rep 2021; 9:80-85. [PMID: 33489136 PMCID: PMC7813026 DOI: 10.1002/ccr3.3439] [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: 06/20/2020] [Revised: 09/12/2020] [Accepted: 10/03/2020] [Indexed: 12/04/2022] Open
Abstract
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits is a new disorder with undefined treatment modalities. We propose cyclophosphamide-bortezomib-dexamethasone and autologous stem cell transplantation as a therapeutic protocol.
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Affiliation(s)
- Mouna Jerbi
- Department of NephrologyMongi Slim HospitalLa MarsaTunisia
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
| | - Rym El Fatmi
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
| | - Hanene Gaied
- Department of NephrologyMongi Slim HospitalLa MarsaTunisia
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
| | - Dorra Belloumi
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
| | - Lamia Torjemane
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
| | - Raja Aoudia
- Department of NephrologyCharles Nicolle HospitalTunisTunisia
| | - Rim Goucha
- Department of NephrologyMongi Slim HospitalLa MarsaTunisia
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
| | - Taieb Ben Abdallah
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of NephrologyCharles Nicolle HospitalTunisTunisia
| | - Tarek Ben Othman
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
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18
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Jerbi M, Sayhi M, Gaied H, Hedri H, Aoudia R, Goucha R, Abdallah TB. Renal Thrombotique microangiopathy: An unusual renal involvement in Niemann-Pick disease type B. Clin Case Rep 2020; 8:3316-3321. [PMID: 33363925 PMCID: PMC7752378 DOI: 10.1002/ccr3.3408] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
Renal involvement in Niemann-Pick disease type B is very rare. Kidney check-up and renal biopsy should be performed in any patient presented with hypertension and kidney disease. Histology identifies the lesion, the prognosis, and guide treatment.
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Affiliation(s)
- Mouna Jerbi
- Nephrology DepartmentCHU Mongi SlimLa MarsaTunisia
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Mariem Sayhi
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
- Medicine A DepartmentCharles Nicolle HospitalTunisTunisia
| | - Hanene Gaied
- Nephrology DepartmentCHU Mongi SlimLa MarsaTunisia
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Hafedh Hedri
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
- Medicine A DepartmentCharles Nicolle HospitalTunisTunisia
| | - Raja Aoudia
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
- Medicine A DepartmentCharles Nicolle HospitalTunisTunisia
| | - Rim Goucha
- Nephrology DepartmentCHU Mongi SlimLa MarsaTunisia
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Taieb Ben Abdallah
- Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
- Medicine A DepartmentCharles Nicolle HospitalTunisTunisia
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19
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Dhaouadi T, Abdellatif J, Trabelsi R, Gaied H, Chamkhi S, Sfar I, Goucha R, Ben Hamida F, Ben Abdallah T, Gorgi Y. PLA2R antibody, PLA2R rs4664308 polymorphism and PLA2R mRNA levels in Tunisian patients with primary membranous nephritis. PLoS One 2020; 15:e0240025. [PMID: 33002091 PMCID: PMC7529277 DOI: 10.1371/journal.pone.0240025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Primary membranous nephritis (PMN) is an autoimmune disease induced by the deposit of antibodies (Ab) to the phospholipase receptor A2 receptor (PLA2R) on podocytes. In this context, we aimed to assess the relationships between anti-PLA2R Ab, PLA2R rs4664308 SNP, PLA2R mRNA levels and PMN susceptibility and outcome. METHODS Sixty-eight PMN patients, 30 systemic lupus erythematosus (SLE) patients with secondary MN and 30 healthy control subjects served for anti-PLA2R Ab measurement by ELISA and PLA2R rs4664308 SNP genotyping by a commercial real-time PCR. Twenty patients with tubulo-interstitial nephritis (TIN) were used as controls for renal PLA2R mRNA quantification in PMN patients from kidney biopsies. PLA2R mRNA quantification was carried-out by real-time PCR after RNA extraction. RESULTS Forty-three (63.2%) PMN patients received initial therapy consisting of alternating monthly cycles of corticosteroids and cyclophosphamide. Twelve (17.6%) patients had resistant PMN to initial therapy and were consecutively treated by cyclosporine or tacrolimus. Anti-PLA2R Ab were positive in 54 (79.4%) PMN patients, while all SLE patients and controls were negative, p<0.0001. Moreover, anti-PLA2R Ab levels were significantly higher in PMN patients (134.85 [41.25-256.97] RU/ml) than in SLE patients (3.35 [2.3-4.35] RU/ml) and controls (2 [2-2.3]), p<0.0001. Consequently, a ROC curve showed for 100% specificity a sensitivity of 94.1% at a threshold of 2.6 RU/ml. Besides, Anti-PLA2R antibodies levels were significantly associated to non-remission; p = 0.002. The rs4664308*A wild-type allele was significantly more frequent in PMN patients (0.809) than in controls (0.633) and SLE patients (0.65); p = 0.008, OR [95% CI] = 2.44 [1.24-4.82] and p = 0.016, OR [95% CI] = 2.27 [1.15-4.5], respectively. Renal PLA2R mRNA levels were significantly higher in PMN patients (218.29 [66.05-486.07]) than in TIN patients (22.09 [13.62-43.34]), p<0.0001. Moreover, PLA2R mRNA levels were significantly higher in non-remission patients (fold-factor vs. partial remission = 2.46 and fold-factor vs. complete remission = 12.25); p = 1.56 10E-8. In addition, PLA2R mRNA and anti-PLA2R Ab levels were significantly correlated, Spearman Rho = 0.958, p<0.0001. CONCLUSION Anti-PLA2R Ab and renal PLA2R mRNA could be useful markers for PMN outcome predicting. The PLA2R rs6446308 SNP is associated with PMN susceptibility in Tunisians.
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Affiliation(s)
- Tarak Dhaouadi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
- * E-mail:
| | - Jihen Abdellatif
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Raja Trabelsi
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hanene Gaied
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Sameh Chamkhi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Imen Sfar
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Rym Goucha
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yousr Gorgi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
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20
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Fraj A, El Euch M, Jaziri F, Kefi A, Abdelghani KB, Turki S, Abdallah TB. Acquired Bartter Syndrome in Primary Sjögren Syndrome. Saudi J Kidney Dis Transpl 2020; 31:1144-1147. [PMID: 33229783 DOI: 10.4103/1319-2442.301185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal tubular involvement in Sjögren's syndrome (SS) often described with renal tubular acidosis, nephrogenic diabetes insipidus, or rarely with Fanconi syndrome. SS presenting with clinical features of Bartter's syndrome or Gitelman's syndrome is rare. We report a case of a female patient who presented an acquired Bartter syndrome with a primary SS.
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Affiliation(s)
- Aya Fraj
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mounira El Euch
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Asma Kefi
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Sami Turki
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
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21
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Zammouri A, Barbouch S, Najjar M, Aoudia R, Jaziri F, Kaaroud H, Hedri H, Abderrahim E, Goucha R, Hamida FB, Harzallah A, Abdallah TB. Tubulointerstitial nephritis due to sarcoidosis: Clinical, laboratory, and histological features and outcome in a cohort of 24 patients. Saudi J Kidney Dis Transpl 2020; 30:1276-1284. [PMID: 31929274 DOI: 10.4103/1319-2442.275471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal involvement is rare in systemic sarcoidosis. Among renal manifestations, tubulointerstitial nephritis (TIN) is the most commonly reported finding. We conducted the current study to investigate the clinical, laboratory, and histological features and to analyze the outcome of TIN due to sarcoidosis. We present a retrospective, single-center study of patients followed for sarcoidosis and presenting with TIN related to this systemic disease. Twenty-four patients were assessed (22 females/2 males). The mean age at diagnosis of TIN was 46.3 years. Extrarenal manifestations were dominated by thoracic involvement (95.8%), peripheral lymph nodes (54.2%), and skin lesions (33.3%). The mean proteinuria level was 0.68 g/24 h. Renal failure was diagnosed in 83.3% of cases with a median estimated glomerular filtration rate at 14.3 mL/min/1.73 m2. Nine patients presented with hypercalcemia and 12 patients with hypercalciuria. Renal biopsy was performed in 58.3% of cases. Six of the 14 patients presented with noncaseating granulomatous interstitial nephritis and eight with interstitial nephritis without granuloma. Granulomatous infiltration of renal parenchyma was complicated by vasculitis in two cases. Corticosteroid therapy was used in all patients. On follow-up analysis, four patients progressed to end-stage renal disease (ESRD) after a mean duration at 45.5 months. In the remaining patients, kidney function statistically significantly improved after one month of treatment compared to the time when the diagnosis was initially established (P = 0.031). We found that the predictive factors of progression to ESRD were multiorgan involvement (P = 0.032), advanced fibrosis F3 (P = 0.0006), and extensive interstitial granulomas (P = 0.007) and these were independently correlated with ESRD. Corticosteroid therapy seems to be effective in sarcoid TIN, but some degree of persistent renal failure is possible which can be predicted from both histologic findings and initial response to steroid therapy.
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Affiliation(s)
- Asma Zammouri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- Department of Nephrology; Laboratory Department of Renal Pathology Research (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Najjar
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raja Aoudia
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Nephrology; Laboratory Department of Renal Pathology Research (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Nephrology; Laboratory Department of Renal Pathology Research (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Amel Harzallah
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Nephrology; Laboratory Department of Kidney Transplantation, Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
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22
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Gorsane I, Ayed TB, Aoudia R, Kaaroud H, Hamida FB, Harzallah A, Abdallah TB. Simultaneous acute pancreatitis and angioedema associated with angiotensin-converting enzyme inhibitor. Saudi J Kidney Dis Transpl 2020; 30:1479-1484. [PMID: 31929301 DOI: 10.4103/1319-2442.275498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEI) are commonly prescribed drugs for blood pressure (BP) control and renal protection. The use of ACEI is not associated with an increased risk of acute pancreatitis and ACEI-induced angioedema is rare. A 36-year-old woman presented with vomiting, headache, and aphasia. Her BP was 220/100 mm Hg. urine analysis revealed proteinuria (2+), hematuria (3+). Serum creatinine level was at 1125 μmol/L. She had anemia with 6.1 g/dL of hemoglobin and thrombocytopenia (61,000/mm3). Renal histology revealed lesions of thrombotic microangiopathy. The diagnosis of atypical hemolytic uremic syndrome was made by the complement factor I deficiency. Plasma exchanges could not be done. She was placed on peritoneal dialysis for renal insufficiency. We introduced an ACE (captopril) for the treatment of high BP. Twelve-hours after taking the first dose, she experienced severe epigastric pain and two episodes of vomiting. Serum lipase was 560 IU/L, and abdominal computed tomography showed Stage B pancreatitis. Twenty-four hours later, the patient developed marked edema of the neck region without dyspnea or dysphonia. Cervical ultrasound revealed the infiltration of the subcutaneous tissues. Captopril was stopped with the progressive disappearance of the edema. Serum lipase was 350 IU/L and then normalized at the end of the 4th day. Clinicians should be careful about widely used drugs and their side effects. ACEI can cause potentially life-threatening complications such as angioedema and acute pancreatitis. Possibly, there could be a common mechanism for the onset of pancreatitis and angioedema under ACEI.
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Affiliation(s)
- Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University; Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Tasnime Ben Ayed
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Raja Aoudia
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Amel Harzallah
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University; Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
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23
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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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24
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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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25
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Omrane M, Aoudia R, Ounissi M, Sellami N, Jerbi M, Gaied H, Kaaroud H, Harzallah A, Ben Abdallah T, Goucha R. P0132DIAGNOSIS OF HYPEROXALURIA FROM RENAL BIOPSY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0132] [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
Crystal-induced kidney disease refers to kidney injury caused by intratubular crystal deposition. The most common forms of crystalline nephropathy encountered in renal pathology are nephrocalcinosis and oxalate nephropathy. The purpose of our study is to determine the epidemiological and clinical characteristics of hyperoxaluria diagnosed from renal biopsy.
Method
We retrospectively reviewed all kidney biopsy specimens evaluated at renal pathology laboratory, from 1976 to 2019. The biopsy specimens were received from multiple medical department and medical centers. We studied 8900 biopsy specimens and we were focused on patients whose diagnosis of hyperoxaluria was made from renal biopsy
Results
We identified 25 cases (15 children and 10 adults) with a sex ratio H / F of 0.9. Mean age at diagnosis was 17.2 years old [4 months-73 years old]. Most patients were offspring of consanguineous mating (14 of 25) with intermarriage of first-degree cousins being the most common pattern. A family history of chronic kidney disease was found in 13 patients: indeterminated nephropathy (n = 6) and renal stone (n = 5) and primary hyperoxaluria (n=2). Among our patients, five had a history of urolithiasis. One patient had a history of chronic diarrhea related to Crohn's disease and one patient had a history of cephalic pancreatectomy and ileal resection. Initial symptoms and signs were dominated by renal failure (n = 25) with mean creatinine of 789.5 μmol / l [306-1832μmol / l], associated with proteinuria in 10 patients and hematuria in 11 patients. Arterial hypertension was present in 4 patients. Oligo anuria was reported in 4 patients without dilation of the urinary excretory pathways. In our patients, the diagnosis of crystalin nephropathy was revealed by renal biopsy. In one case, the diagnosis was made after renal transplant. In 4 cases the diagnosis was made by postmortem kidney biopsy. In all cases, the kidney biopsy specimen showed extensive intratubular crystal deposition and tubulointerstitial mononuclear cell infiltration with features of tubular injury and interstitial fibrosis. Examination of histologic slides showed colorless refractile crystals of polygonal appearance. Multicolored birefringence under polarized light identified these crystals as calcium oxalate. After different investigations (genetic and biological analysis), the diagnosis of hyperoxaluria was confirmed. Hyperoxaluria was primary in 23 patients and secondary in 2 patients.
Conclusion
Hyperoxaluria is a rare condition, often serious, involving renal prognosis and sometimes life-threatening, especially in early-onset forms. Early diagnosis and treatment should be done as soon as possible to slow the progression to end-stage renal failure. In patients with renal insufficiency, the diagnosis of hyperoxaluria is difficult. Renal biopsy can help when clinical and radiological data are not sufficient.
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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
| | - Nada Sellami
- 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
| | - Hayet Kaaroud
- 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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Omrane M, Aoudia R, Ounissi M, Najar M, Jerbi M, Gaied H, Barbouche S, Gorsane I, Ben Abdallah T, Goucha R. P0167HYPERTENSION IN PATIENTS WITH LUPUS NEPHRITIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0167] [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
Hypertension is a common manifestation during systemic lupus erythematosus (SLE). Its mechanism is multifactorial and microthromboses of renal arterioles seem to be the most important mechanism. The objective of our study is to identify the histological and evolutionary characteristics of patients with lupus nephritis (LN) presenting with hypertension.
Method
A retrospective study of 85 patients followed for LES with lupus nephritis documented by a renal biopsy collected in 17 years and presenting with hypertension.
Results
Among 174 patients with LN, eighty-five (48.58%) are hypertensive. A sex ratio F / H of 6.08. The mean age of LN diagnosis was 36.4 years old [13 -75 years old]. The average time to onset of hypertension was 25.8 months [0-204 months]. Malignant hypertension was present in 12% of patients. Antiphospholipid Antibody Syndrome (APLS) was found in 35.3% of cases. Renal biopsy showed LN class II in 2 cases, class III in 8 cases, class IV in 43 cases, class V isolated in 8 cases and class VI in 3 cases. Vascular lesions were arteriolosclerosis in 40% of cases and thrombotic microangiopathy (TMA) lesions in 17.6% of cases. The treatment was essentially based on blockers of the renin angiotensin system, either as monotherapy or in combination with calcium channel blockers, beta blockers or central antihypertensives. The evolution was marked by the occurrence of cerebrovascular accidents associated in 7 cases with APLS and coronary artery disease in 2 cases. Renal evolution was marked by total and durable remission in 27.5%, chronic renal disease in 31.7%, and end-stage renal failure in 40.8% of cases. Blood pressure was balanced in 40,5 % of cases and unbalanced in 59,5% of cases.
Conclusion
In our lupus patients, hypertension was common, associated with severe glomerular and vascular lesions and a rather severe renal prognosis.
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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
| | - Mariem Najar
- 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
| | - Samia Barbouche
- 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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Ben ayed T, Gorsane I, Trabelsi R, Ounissi M, Ben Abdallah T. P0435PREDICTORS OF RENAL SURVIVAL IN ELDERLY NEPHROTIC SYNDROME. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0435] [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
With increasing longevity, the numbers of elderly patients presenting with renal diseases including glomerular disease are increasing. Nephrotic syndrome (NS) is a common presentation of glomerular disease in the elderly. We performed this study to assess predictors of renal survival in this population.
Method
A retrospective study including one hundred and six patients aged 65 years or more hospitalized for NS in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016.
A multivariate study was carried out, the dependent variable being the evolution towards end-stage renal disease (ESRD).
Results
We studied 106 patients with an average age of 70 ± 4.5years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.6 [3-19.5 g/l], the mean albumin level was 20 ± 5.6g/l and the mean protidemia was 50 ± 6.9 g/l. Nephrotic syndrome was impure in 89.6 % of patients with high blood pressure in 70.5 % of cases, hematuria ≥2 + in 34.7% of cases and renal failure in 88.4 % of cases. The renal biopsy was performed in 41 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (27 %). NS was secondary in 63.2 % of cases mainly to amyloidosis (35.8 %) and diabetes (19.8 %). Idiopathic nephropaty was dominated by membranous nephropathy (11.3 %) and primitive membranoproliferative glomerulonephritis (MPGN) (6.6 %). At the end of follow-up, 35 % of patients achieved complete or partial remission and 58.5 % progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD uremia ≥ 17 mmol/l (ORa =33.2 [1.3 - 837.7]; p<0.05), phosphoremia ≥ 1.6 mmol/l (ORa=22.1 [1.8-266.5]; p<0.05), potassium concentration ≥ 4.3mmol/l (ORa=24.7 [2.4,251.5]; p<0.01), extra-renal signs (ORa=38,9 [2.4 - 634.3]; p: 0.01), secondary nephropathy (ORa=74 [3.1 - 1788.2]; p<0.01) and MPGN (ORa=48[1.4 - 1675.5]; p<0.05). The protective factors were hemoglobinemia ≥ 9.3g/dl (ORa=0.007 [0 - 0.2]; p<0.01), kidneys well differentiated on ultrasound (ORa=0.032 [0.003 - 0.4]; p<0.01) and treatment with two diuretics (ORa=0.03 [0.003 - 0.4]; p<0.01).
Conclusion
Elderly NS was characterized by a poor prognosis, in particular secondary to delayed and non-uniform treatment strategies, hence the need for rising physician awarness about this decease and consultation on a standardized treatment strategies.
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Affiliation(s)
- Tasnim Ben ayed
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Raja Trabelsi
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
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Ben ayed T, Gorsane I, Trabelsi R, Ounissi M, Ben Abdallah T. P0465NEPHROTIC SYNDROME IN ELDERLY PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0465] [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
Nephrotic syndrome (NS) is one of the manifestations of acute or chronic glomerular nephropathy in the elderly. Our study objective was to determine the particularities of NS in the elderly.
Method
This is a retrospective study, carried out in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. This study included subjects aged 65 years old or over hospitalized for NS.
Results
We studied 115 patients with an average age of 71 ± 5 years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/l [3-19.5 g/l], the mean albumin level was 20 ± 6g/l and the mean protidemia was 50.6 ± 6.9 g/l. Nephrotic syndrome was impure in 89.5 % of patients with high blood pressure in 54 % of cases, hematuria ≥2 + in 30% of cases and renal failure in 82.7 % of cases. Renal biopsy was performed in 45 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (24.5 %). NS was secondary in 65.2 % of cases mainly to amyloidosis (35.6 %) and diabetes (19 %). Idiopathic nephropaty was dominated by membranous nephropathy (9.5 %) and primitive primitive (MPGN) (4.3 %). The treatment was symptomatic for 84.4% of patients. Corticosteroids and/or immunosuppressive treatment have been used for 15.6% of patients. At the end of follow-up, 35.3 % of patients achieved complete or partial remission and 56.6 % progressed to ESRD.
Conclusion
Elderly NS was characterized by a poor prognosis due to delayed cosultation and non-uniform treatment strategies. Multicentric study in order to identify different action axes could improve the prognosis of this disease. Multicentric study in order to identify different action axes could improve the prognosis of this disease.
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Affiliation(s)
- Tasnim Ben ayed
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Raja Trabelsi
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), 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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30
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Affiliation(s)
- Fredric O. Finkelstein
- Hospital of St. Raphael Yale University Renal Research Institute New Haven, Connecticut, USA
| | | | - Roberto Pecoits-Filho
- Tunisia Center for Health and Biological Sciences Pontifícia Universidade Católica do Paraná Curitiba, Brazil
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31
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Oueslati I, Ounissi M, Talbi E, Azaiez S, Bacha MM, Ben Abdallah T. Prevalence and risk factors of hypogonadism in men with chronic renal failure. Tunis Med 2020; 98:138-143. [PMID: 32395803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM To determine the prevalence and the risk factors of hypogonadism in men with chronic renal failure (CRF). METHODS We conducted a cross sectional analysis in 48 men with CRF. Total testosterone, prolactin, and gonadotropins were measured in all patients. Hypogonadism was defined by a low level (<10 nmol/l) or a low normal level (10-14 nmol/l) of total testosterone. RESULTS The mean age was 53.31±10.22 years. Renal impairment was mild, moderate, severe and at end stage in 9,14,4 and 21 patients, respectively. Nineteen patients had been undergoing extra-renal purification. The average of total testosterone was 13.44±6.17 nmol/L. It was lower in patients with diabetic nephropathy (p=0.004). Hypogonadism was diagnosed in 22 patients (46 %). In this group, gonadotropins were normal in 21 cases and elevated in only one case. Hyperprolactinemia was retained in six patients. Type 2 diabetes (OR: 3.96; p=0.02) and diabetic nephropathy (OR=4.26; p=0.01) were the only risk factors of hypogonadism in our patients. CONCLUSION Our results had demonstrated a high prevalence of hypogonadism in males with chronic renal failure. This hormone disorder was associated with type 2 diabetes and diabetic nephropathy.
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Aoudia R, Bacha MM, Ounissi M, Gaied H, Jerbi M, Abderrahim E, Abdallah TB, Goucha R. Monoclonal gammopathy of renal significance with light-chain deposition disease in kidney transplantation. Saudi J Kidney Dis Transpl 2019; 30:1161-1165. [PMID: 31696857 DOI: 10.4103/1319-2442.270274] [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: 11/04/2022] Open
Abstract
Light-chain deposition disease (LCDD) reoccurs almost invariably after renal transplantation, leading to early graft loss. We report a case of LCDD with monoclonal gammopathy of renal significance diagnosed in the post-transplant period in a 28-year-old male and we discuss the diagnostic and therapeutic challenges in the clinical course.
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Affiliation(s)
- Raja Aoudia
- Department of Internal Medicine A, Laboratory of Renal Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Mohamed Mongi Bacha
- Department of Internal Medicine A, Laboratory of Renal Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Mondher Ounissi
- Department of Internal Medicine A, Laboratory of Renal Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Hanene Gaied
- Department of Nephrology, Mongi Slim Hospital, La Marsa; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Mouna Jerbi
- Department of Nephrology, Mongi Slim Hospital, La Marsa; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Ezzedine Abderrahim
- Department of Internal Medicine A, Laboratory of Renal Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Internal Medicine A, Laboratory of Renal Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
| | - Rim Goucha
- Department of Nephrology, Mongi Slim Hospital, La Marsa; Faculty of Medecine, University Tunis El Manar, Tunis, Tunisia
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Gaied H, Bacha MM, Mesbahi T, Ounissi M, Aoudia R, Jerbi M, Jones M, Ksantini M, Rammeh S, Hedri H, Goucha R, Abdallah TB. Mycophenolate Mofetil-induced Oral Ulcerations in a Kidney Transplant Recipient. Curr Drug Saf 2019; 15:73-76. [PMID: 31660841 DOI: 10.2174/1574886314666191011153609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/07/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Mycophenolate Mofetil (MMF) is an immunosuppressive drug usually used in kidney transplants to prevent rejection. It has various adverse effects such as leucopenia, anemia, diarrhea but Mouth ulcers are rarely reported. METHOD We present a case report of MMF-induced mouth ulcers in an African patient. CASE REPORT A 41-year-old African-male patient has painful oral ulcers which developed 5 months after kidney transplantation. The immunosuppressive maintenance regimen comprised Steroids, Tacrolimus and MMF. RESULT These ulcers were firstly related to a fungic or viral infection so the patient was prescribed Fluconazole and Aciclovir without any improvement. Then, Tacrolimus blood level was checked and it was in a therapeutic range. Finally, we decide to stop MMF and the ulcers healed quickly. DISCUSSION Oral ulcers are frequently seen complications in immunosuppressant patient but are rarely described with MMF. These ulcers can become large and very painful and degrade patient's life quality. So when infections causes are excluded, we have to keep in mind that these ulcers can be a drug adverse effect.
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Affiliation(s)
- Hanène Gaied
- Department of Nephrology, Mongi Slim Hospital, La Marsa, Tunisia.,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Mohamed Mongi Bacha
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Tasnim Mesbahi
- Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mondher Ounissi
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raja Aoudia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mouna Jerbi
- Department of Nephrology, Mongi Slim Hospital, La Marsa, Tunisia.,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Mariem Jones
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Ksantini
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Soumaya Rammeh
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Department of Nephrology, Mongi Slim Hospital, La Marsa, Tunisia.,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.,Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
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El Euch M, Hentati O, Mahfoudhi M, Bani W, Hamida FB, Jaziri F, Abdelghani KB, Turki S, Abdallah TB. Extensive sphenoid chordoma mimicking a prolactinoma. Pan Afr Med J 2019; 33:138. [PMID: 31558936 PMCID: PMC6754828 DOI: 10.11604/pamj.2019.33.138.12897] [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: 05/29/2017] [Accepted: 02/02/2019] [Indexed: 11/11/2022] Open
Abstract
The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.
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Affiliation(s)
- Mounira El Euch
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Olfa Hentati
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Madiha Mahfoudhi
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Wifak Bani
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | | | - Sami Turki
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
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Harzallah A, Kaaroud H, Boubaker K, Barbouch S, Goucha R, Hamida FB, Abdallah TB. Acute kidney injury with granulomatous interstitial nephritis and vasculitis revealing sarcoidosis. Saudi J Kidney Dis Transpl 2019; 28:1157-1161. [PMID: 28937078 DOI: 10.4103/1319-2442.215120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is an inflammatory disease that affects mostly the lungs and lymph glands. Renal involvement is rare and especially vasculitis. We report a case who presented an acute kidney failure and had sarcoidosis with vasculitis and nodular splenic involvement. A 35-year-old woman presenting a Lofgren syndrome was hospitalized for acute renal failure with cervical lymphadenopathy without other clinical findings. Laboratory data disclosed elevated angiotensin converting enzyme serum level. Abdominal ultrasound showed a multinodular spleen. Renal histology revealed granulomatous interstitial nephritis with necrotizing vasculitis. Outcome was favorable after the institution of high dose corticosteroids along with cyclophosphamide. Renal involvement is rare in sarcoidosis. However, the diagnostic delay should be avoided to improve the outcome.
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Affiliation(s)
- Amel Harzallah
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Karima Boubaker
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Laboratory of Renal Pathology LRSP001, Charles Nicolle Hospital, Tunis, Tunisia
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Gorsane I, Ben Hamida S, Ben Hamida F, Ounissi M, Harzallah A, Ben Abdallah T. Peritoneal dialysis in diabetes patients. Tunis Med 2019; 97:1017-1020. [PMID: 32173851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Peritoneal dialysis (PD) is a renal replacement therapy (RRT) in end stage kidney disease patients with several advantages and disadvantages. AIM To evaluate the epidemiological, clinical, biological and outcome of diabetic patients in PD in our service and to determine the factors influencing overall survival and technique. METHODS This was a retrospective study that included 90 diabetic patients supported on PD in our Department of Nephrology and Internal Medicine A in Charles Nicolle Hospital of Tunis from 1983 to 2016. RESULTS There were 90 patients with mean age of 57 years. The sex ratio M/W was 1.3. Diabetes was type 2 in 84.44%. Complications were decreased ultrafiltration (26.66%), displacement of the catheter (20%), umbilical hernia (3.33%), malnutrition (2.22%) and peritonitis (45.55%). The number of peritonitis was 1 episode every 38.64 patient months. Transfer to hemodialysis was indicated in 37.78% of cases. Death occurred in 33 patients. Causes were cardiovascular (21.11%), septic shock (10%) and complicated peritonitis (5.55%). A statistically significant correlation was found between patient survival and death from cardiovascular events (p = 0.048), type 2 diabetes and high peritoneal permeability (p = 0.033) and technical survival and systolic arterial pressure> 139.5mmHg (p = 0.01). Overall survival at 5 years was 66% and technical survival was 28%. CONCLUSION PD is an interesting way of RRT in diabetic patients. Good control of diabetes complications and those of PD technique is essential to increase survival.
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Mesbahi T, Barbouch S, Sallami N, Najjar M, Kaaroud H, Hedri H, Goucha R, Ben Hamida F, Ounissi M, Ben Abdallah T. SP130KIDNEY INVOLVEMENT IN MALIGNANT LYMPHOMA. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp130] [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)
| | | | | | | | | | | | - Rim Goucha
- Charles Nicolle Hospital, Tunis, Tunisia
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Mesbahi T, Barbouch S, Sallami N, Najjar M, Kaaroud H, Hedri H, Goucha R, Ben Hamida F, Ounissi M, Ben Abdallah T. SP139SEVERE INFECTION IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp139] [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
Affiliation(s)
| | | | | | | | | | | | - Rim Goucha
- Charles Nicolle Hospital, Tunis, Tunisia
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El Euch M, Bouaziz R, Jaziri F, Fraj E, Kefi A, Abdelghani KB, Turki S, Mahfoudhi M, Abdallah TB. Prolonged fever and intra-cardiac thrombosis revealing Behçet's disease. J Med Vasc 2019; 44:295-298. [PMID: 31213303 DOI: 10.1016/j.jdmv.2019.04.005] [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] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prolonged fever (PF) is a challenging problem for physicians since it can be the first manifestation of a large variety of pathologies. Exceptionally, intra-cardiac thrombus (ICT) could explain PF and reveal Behçet's disease (BD). We are reporting a 45-year-old man with BD who has these unusual manifestations. CASE REPORT A 45-year-old man presented with PF and inflammatory biological syndrome during a few months. Echocardiography showed an inhomogeneous and mobile mass in the left auricle. During his hospitalization, the patient had multiple oral aphtosis. The angioscanner showed a sacciform aneurysm of the coeliac trunk. The diagnosis of BD was retained and he was treated with high doses of steroids and cyclophosphamide with a favorable follow-up. CONCLUSION The search for BD should be systematic in view of any suggestive manifestation of severe cardiovascular complications like ICT especially in a young adult man from a high endemicity region.
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Affiliation(s)
- Mounira El Euch
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia.
| | - Rahma Bouaziz
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Eya Fraj
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Asma Kefi
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Khaoula Ben Abdelghani
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Sami Turki
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Madiha Mahfoudhi
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
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Kaaroud H, Bettaieb A, Kharroubi NH, Ghabi H, Abdallah TB, Hamida AB, Talbi M, Baccouche H, Marrakchi O, Bouzidi K, Ayed H, Cherif M, Chebil M. [77] Adult urinary lithiasis and chronic renal insufficiency in 32 cases. Arab J Urol 2019. [DOI: 10.1016/j.aju.2018.10.030] [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: 10/28/2022] Open
Affiliation(s)
| | | | | | - Hiba Ghabi
- Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Athi Ben Hamida
- Laboratory of Kidney Pathology – LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mna Talbi
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hanene Baccouche
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Olfa Marrakchi
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Kahna Bouzidi
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Haroun Ayed
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Cherif
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Chebil
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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Harzallah A, Kaaroud H, Laadhari N, Goucha R, Abderrahim E, Turki S, Hmida FB, Barbouch S, Abdallah TB. [Renal prognosis of IgA vasculitis nephritis in adult patients: a monocentric study of 25 cases]. Pan Afr Med J 2019; 31:9. [PMID: 30923593 PMCID: PMC6431421 DOI: 10.11604/pamj.2018.31.9.10594] [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: 08/25/2016] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
La néphropathie de la vascularite à IgA conditionne le pronostic de cette affection chez l’adulte. Le but de notre étude était d’étudier les caractéristiques cliniques de cette atteinte rénale chez l’adulte et d’identifier les facteurs de pronostic rénal. Il s’agit d’une étude monocentrique rétrospective portant sur les patients ayant une vascularite à IgA (purpura rhumatoïde) (critères de l’EULAR) avec une atteinte rénale prouvée histologiquement et classée selon la classification de Pillebout. Nous avons analysé la survie rénale et identifier les facteurs de pronostic rénal. Vingt cinq patients ont été inclus (genre ratio M/F = 2,57) d’âge moyen au diagnostic du purpura rhumatoïde de 35,76 ans. Un purpura était présent dans 100% des cas avec une atteinte articulaire dans 28%. Une insuffisance rénale était présente dans 44% des cas. La classification histologique la plus fréquente était la classe II. Une rémission clinique a été observée dans 44% des cas et une évolution vers le stade terminal de l’insuffisance rénale chronique dans 36% des cas. La survie rénale à 195 mois était de 57%. Les facteurs pronostiques identifiés étaient l’atteinte digestive (p = 0,022), l’insuffisance rénale initiale (p = 0,0004), la classification glomérulaire (p = 0001) et la sévérité des lésions histologiques, le traitement par bloqueurs du système rénine angiotensine (p = 0,01) et les échanges plasmatiques (p = 0,03). Notre étude montre que l’atteinte rénale au cours des vascularites à IgA peut être relativement sévère avec un mauvais pronostic rénal. L’identification des facteurs pronostiques cliniques et histologiques pourrait guider l’élaboration d’études thérapeutiques prospectives.
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Affiliation(s)
- Amel Harzallah
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hayet Kaaroud
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Narjess Laadhari
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie
| | - Rim Goucha
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Ezzeddine Abderrahim
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Sami Turki
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Fethi Ben Hmida
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Samia Barbouch
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
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Hajji M, Barbouch S, Harzallah A, Hedri H, Kaaroud H, Abderrahim E, Goucha R, Hamida FB, Gorsane I, Abdallah TB. Clinical study on autosomal dominant polycystic kidney disease among North Tunisians. Saudi J Kidney Dis Transpl 2019; 30:175-184. [PMID: 30804279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disease, which usually manifests in adulthood. It is characterized by the development of multiple cysts in the kidneys and many other extrarenal manifestations. We aimed to determine the factors that contribute to the progression of ADPKD to end-stage renal disease (ESRD). In a retrospective multicentric study, we reviewed the records of 569 patients with ADPKD, hospitalized at a nephrology department or followed up at the outpatient department of university and regional hospitals, covering the north and center of the country, during the period 1969-2016. The mean age of the study patients was 48.54 ± 13.68 years and 14% were young adults (<40 years). There were 272 female and 297 male patients (sex ratio: male/female = 1.09). A family history of ADPKD was found in 43.7% of cases. Renal symptoms were dominated by loin pain, renal failure, hypertension, and hematuria, seen in, respectively, 51.9%, 48.2%, 29.1%, and 24.6% of the patients. The median serum creatinine level was 459 μmol/L (range: 47-2454), and hypertension had preceded the onset of ADPKD in 28.8% of cases. Extrarenal manifestations consisted of urologic complications (54.6%), liver cysts (43.5%), cardiac involvement (31.9%), cerebral aneurysms (12.9%), and gastrointestinal involvement (9.4%). ESRD occurred in 43.1% after a mean follow-up of 47 months (range: 0-384). Risk factors for poor renal prognosis were age >40 years (P = 0.009), hematuria (P = 0.034), hemoglobin >14 g/dL (P = 0.0013), high uric acid level (P = 0.001), and leukocyturia (P = 0.02). Death occurred in 59 cases (10.3%), mostly caused by infections (44.1%). In our study, ADPKD was lately diagnosed in most cases. Family screening is important, which will enable early detection and management of the complications associated with ADPKD.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A; Laboratory of Renal Pathology - LR00S001, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Samia Barbouch
- Department of Medicine A; Laboratory of Renal Pathology - LR00S001, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Amel Harzallah
- Department of Medicine A, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Medicine A, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ezzedine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rim Goucha
- Laboratory of Renal Pathology - LR00S001, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fathi Ben Hamida
- Laboratory of Renal Pathology - LR00S001, Charles Nicolle Hospital, Tunis, Tunisia
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital; Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Hajji M, Ben Fatma L, Kaaroud H, Abdelmoula J, Zouaghi MK, Ben Abdallah T. Management of urolithiasis in living kidney donors. Tunis Med 2019; 97:140-144. [PMID: 31535706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Kidney donors with asymptomatic stones were previously excluded from the kidney donation list because of a potential increased morbidity risk for both the recipient and the donor. Currently, recent studies tend to consider these risks as overestimated. AIM The aim of this study was to analyze our experience in the management of urolithiasis in potential donors. METHODS We conducted a retrospective analysis during the period (2008-2015). We included donors with urilithiasis or a family history of urolithiasis whom had urinary biochemical analysis of urolithiasis. We identified the exact location, size, and anatomy of the kidney bearing the stone were identified. RESULTS Among 252 potentially proposed living kidney donors (LKD) in two renal transplantation centers, we noted urinary lithiasis in 8 patients (3.17%). The mean age was 40,12±20 years old with a sex-ratio M/F at 0,3. We noted urinary lithiasis on radiographs in one case, on echographs in one case and on computerized tomography kidney angiography in 5 cases. All are not obese and without any medical history. In one case, there was no lithiasis detected but chemical urinary analysis was performed because of family renal stone history. We performed a 24-hours urine test, and examined PH, calcium and oxalate. The urine analysis, showed acidic pH and hypercalciuria in all cases associated to weddelite in 3 cases, hyperoxaluria in all cases. In one case, we noted vitamin D deficiency related hyperparathyroidism. Renal transplantation has been achieved in two cases. After a mean follow up of 11,25 months [range :27-84], no urological complications were noted. CONCLUSION Urinary lithiasis may occur in proposed living kidney donors and may not contraindicate this donation.
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El Euch M, Kaabar MY, Bouaziz R, Mahfoudhi M, Jaziri F, Kefi A, Ben Abdelghani K, Turki S, Guermazi S, Ben Abdallah T. Successful resolution of Hemophagocytic lymphohistiocytosis associated to brucellosis in the adult. Tunis Med 2018; 96:458-461. [PMID: 30430494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hemophagocyticlymphohistocytosis (HLH) is a proliferation of histiocytes with importanthemophagocytosisoccurring in different organs such as the spleen and the bone marrow. HLH is now increasingly diagnosed in the context of infections, malignancies and connective tissue diseases. Although brucellosis is an endemic infection in Tunisia, its association with HLH is a very rare condition which should be considered in patients with splenomegaly and cytopenia. Here, we describe brucellosis associated HLH in a 31 year-old man. The patient was admitted to our hospital with fever, sweating, and fatigue. Physical and laboratory findings revealed splenomegaly, pancytopenia, elevated serum transaminases, triglycerides, lactate dehydrogenase, and ferritin, and bone marrow hemophagocytosis. The Brucella agglutination test was positive. The patient improved after treatment with Rifampin and doxycyclin.
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Felah E, Aouidia R, Jaziri F, Chargui S, Gaied H, Jerbi M, Goucha R, Ben Abdallah T. SP058MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS : RETROSPECTIVE EPIDEMIOLOGICAL STUDY OF 574 RENAL BIOPSIES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp058] [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)
- Eya Felah
- Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raja Aouidia
- Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Hanene Gaied
- Nephrology, Monji Slim Marsa Hospital, Tunis, Tunisia
| | - Mouna Jerbi
- Nephrology, Monji Slim Marsa Hospital, Tunis, Tunisia
| | - Rym Goucha
- Nephrology, Monji Slim Marsa Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology, Research Laboratory of Renal Pathology lr00sp01, Tunis, Tunisia
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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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Jerbi M, Sayhi M, Gaied H, Aoudia R, Ben Hmida F, Ben Abdallah T, Goucha R. SP106TUBEROUS SCLEROSIS COMPLEX: RENAL ASSESSMENT. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp106] [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
Affiliation(s)
- Mouna Jerbi
- Nephrology, Faculty of Medecine Tunis TUNISIA , University TUNIS El Manar, Tunis, Tunisia
- Nephrology, Laboratory of Renal Pathology -LR00SP01, Tunis, Tunisia
- Nephrology, Mongi Slim Hospital, Marsa, Tunisia
| | - Mariem Sayhi
- Internal Medecine A, Charles Nicolle Hospital, tunis, Tunisia
| | - Hanene Gaied
- Nephrology, Laboratory of Renal Pathology -LR00SP01, Tunis, Tunisia
- Nephrology, Mongi Slim Hospital, Marsa, Tunisia
| | - Raja Aoudia
- Internal Medecine A, Charles Nicolle Hospital, tunis, Tunisia
- Nephrology, Laboratory of Renal Pathology -LR00SP01, Tunis, Tunisia
| | - Fathi Ben Hmida
- Nephrology, Laboratory of Renal Pathology -LR00SP01, Tunis, Tunisia
- Internal Medecine A, Charles Nicolle Hospital, tunis, Tunisia
| | | | - Rym Goucha
- Nephrology, Mongi Slim Hospital, Marsa, Tunisia
- Nephrology, Laboratory of Renal Pathology -LR00SP01, Tunis, Tunisia
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Dhaouadi T, Chahbi M, Haouami Y, Sfar I, Abdelmoula L, Ben Abdallah T, Gorgi Y. IL-17A, IL-17RC polymorphisms and IL17 plasma levels in Tunisian patients with rheumatoid arthritis. PLoS One 2018; 13:e0194883. [PMID: 29584788 PMCID: PMC5870983 DOI: 10.1371/journal.pone.0194883] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/12/2018] [Indexed: 01/13/2023] Open
Abstract
Background Interleukin-17 (IL-17), a cytokine mainly secreted by Th17 cells, seems to play a significant role in the pathogenesis of rheumatoid arthritis (RA). Functional genetic polymorphisms in IL-17 and its receptor genes can influence either qualitatively or quantitatively their functions. Therefore, we aimed to study the impact of IL17-A and IL17RC polymorphisms on plasma level of IL-17 and RA susceptibility and severity. Methods In this context, IL-17A*rs2275913 and IL-17RC*rs708567 polymorphisms were investigated together with the quantification of IL17 plasma level in 115 RA patients and 91 healthy control subjects matched in age, sex and ethnic origin. Results There were no statistically significant associations between IL-17A and IL-17RC studied polymorphisms and RA susceptibility. In contrast, IL-17A plasma levels were significantly higher in patients (55.07 pg/ml) comparatively to controls (4.75 pg/ml), p<10E-12. A ROC curve was used to evaluate the performance of plasma IL-17 in detecting RA. Given 100% specificity, the highest sensitivity of plasma IL-17A was 61.7% at a cut-off value of 18.25 pg/ml; p < 10E-21, CI = [0.849–0.939]. Analytic results showed that the IgM-rheumatoid factor and anti-CCP antibodies were significantly less frequent in patients with the IL-17RC*A/A genotype than those carrying *G/G and *G/A genotypes; p = 0.013 and p = 0.015, respectively. Otherwise, IL-17 plasma levels’ analysis showed a significant association with the activity of RA (DAS28≥5.1 = 74.71 pg/ml vs. DAS28<5.1 = 11.96 pg/ml), p<10E-6. Conclusion IL-17A*rs2275913 (G/A) and IL-17RC*rs708567 (G/A) polymorphisms did not seem to influence RA susceptibility in Tunisian population. This result agrees with those reported previously. Plasma IL-17A level seems to be predictive of severe RA occurrence.
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Affiliation(s)
- Tarak Dhaouadi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
- * E-mail:
| | - Mayssa Chahbi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Youssra Haouami
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Imen Sfar
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Leila Abdelmoula
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Yousr Gorgi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
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Kaaroud H, Harzallah A, Najjar M, Chtioui NH, Cherif M, Ayed H, Kerkeni W, Bouzouita A, Chebil M, Talbi E, Baccouch H, Benzarti A, Abdelmoula J, Benhamida F, Ben Abdallah T. Nephrolithiasis in living kidney donor: experience of nephrologists. Tunis Med 2018; 96:97-100. [PMID: 30324973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Living kidney donation for transplantation has become common practice. The decisions to accept a donor with nephrolithiasis are becoming frequent. AIM The aim of our study was to report our experience in the living donor kidney with asymptomatic lithiasis. METHODS Over a period of 4 years from 2009 to 2013 we collected 18 cases. From the clinical, metabolic and radiological data, we have determined the etiology of urolithiasis in our patients and established, after a literature review, a decision tree of kidney donation. RESULTS Our study included 10 women and 8 men with a mean age of 43 years. The nephrolithiasis was discovered incidentally during radiological assessment through the urinary tract without preparation in 1 case, the abdominal ultrasound in 6 cases and the abdominal CT scan in 11 cases. The donation of kidney in our study was performed in 1 case and disqualified in the others cases especially for metabolic abnormalities. In the single couple donor-recipient, after a follow up of 5 years; we have not identified adverse side effects either in the donor or in the recipient patient. CONCLUSION In living donors with nephrolithiasis the final decision of renal transplantation must be based on the confrontation between the clinical, biological and radiological data. Metabolic disorders constituted the mainly contraindication of kidney donation in our patients.
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Mezni I, Galichon P, Mongi Bacha M, Xu-Dubois YC, Sfar I, Buob D, Benbouzid S, Goucha R, Gorgi Y, Abderrahim E, Ounissi M, Dahan K, Ouali N, Hertig A, Brocheriou I, Raies A, Ben Abdallah T, Rondeau É. Urinary mRNA analysis of biomarkers to epithelial mesenchymal transition of renal allograft. Nephrol Ther 2018; 14:153-161. [PMID: 29325696 DOI: 10.1016/j.nephro.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/11/2017] [Revised: 07/14/2017] [Accepted: 09/17/2017] [Indexed: 01/30/2023]
Abstract
Renal allograft loss is most often a chronic process, irrespective of the mechanism at stake. In this prospective study, we studied the expression of epithelial to mesenchymal transition (EMT) markers vimentin and β-catenin by immunohistochemistry in the surveillance biopsy and measured the mRNA encoding vimentin (VIM), CD45, GAPDH and uroplakin 1a (UPK) by quantitative PCR in urinary cells in 75 renal transplant patients. The aim is to establish a simple screening test for chronic renal allograft dysfunction. We found that the value of the mRNA of vimentin and CD45 relative to the uroplakin 1a (UPK) mRNA is correlated with the score in vimentin immunostaining in routine biopsies. These biomarkers could be used as a noninvasive tool to monitor the renal graft fibrogenesis. This test could be used for early detection of fibrotic diseases of the kidney transplant.
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Affiliation(s)
- Imen Mezni
- Sorbonne universités, université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia.
| | - Pierre Galichon
- Sorbonne universités, université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Mohammed Mongi Bacha
- Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia; Service de médecine interne A, EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - Yi-Chun Xu-Dubois
- Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de santé publique, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Imen Sfar
- Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - David Buob
- Sorbonne universités, université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service d'anatomie pathologique, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Sabrina Benbouzid
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Rim Goucha
- Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia; Service de médecine interne A, EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - Yousr Gorgi
- Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - Ezzedine Abderrahim
- Service de médecine interne A, EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - Mondher Ounissi
- Service de médecine interne A, EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - Karine Dahan
- Service de néphrologie et dialyses, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Nacera Ouali
- Urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Alexandre Hertig
- Sorbonne universités, université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Brocheriou
- Sorbonne universités, université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service d'anatomie pathologique, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Aly Raies
- Laboratoire des microorganismes et biomolécules actives, faculté des sciences de Tunis, université de Tunis El-Manar, 20, rue de Tolède, 2092 Tunis, Tunisia
| | - Taieb Ben Abdallah
- Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia; Service de médecine interne A, EPS Charles-Nicolle, boulevard du 9-Avril-1938, 1006 Tunis, Tunisia
| | - Éric Rondeau
- Sorbonne universités, université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR_S1155, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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