Retroperitoneal fibrosis in the military hospital of Morocco

Retroperitoneal fibrosis (RPF) is a rare disease. It is characterized by the presence of fibro-inflammatory tissue involving retroperitoneal structures. The usual mode of presentation of this disease is with lumbar pain, kidney failure, and a biological inflammatory syndrome. The aim of our study is to describe the diagnostic, etiologic, therapeutic aspects and outcomes of RPF in a nephrology unit in Morocco. Twelve cases of RPF were included in our study. The mean age was 57 ± 10 years (32.70). Nine patients were male and three were female. Symptoms were highly variable, dominated by pain that was present in all patients. Venous compressive signs were described in four patients (33.3%), anuria in one patient (8.3%), and hematuria in two patients (16.6%). Laboratory examinations found an inflammatory syndrome in all patients and renal failure in nine patients (75%), with a mean serum creatinine at 35 mg/L ± 8.5. Diagnosis was suspected on the ultrasound data and confirmed by computed tomography or magnetic resonance imaging. RPF was idiopathic in nine patients (75%). It was secondary to aortic aneurysm in one patient (8.3%), Riedel's thyroiditis in one patient (8.3%), and drug induced in another patient (8.3%). All patients received surgical treatment along with corticosteroids. At six months, remission was achieved in nine patients, whereas three others had steroid resistance. These patients were treated by mycophenolate mofetil (MMF) at a dose of 2 g/day; two of them had intestinal intolerance to MMF and thus were treated by tamoxifen at a dose of 40 mg/day. At 24 months, they stabilized their renal function with incomplete regression of the fibrotic plate. No cases of recurrence were observed during the study period.

Peritoneal dialysis in a Moroccan center: Prevalence and complications

Abstract : Introduction: Peritoneal dialysis (PD) is as effective as hemodialysis and often provides a better quality of life for patients. Despite this, the replacement therapy remains little established in our country with a prevalence of less than 1% of patients with end-stage renal disease. The objective of this work is to report the development and complications of PD in our center. Patients and methods: This is a retrospective study including all patients on PD between October 2008 and March 2019. We noted their demographic and clinical data at their initiation in peritoneal dialysis and we followed their evolution to discuss infectious and mechanical complications as well as the causes of PD exit. Results: During the study period, 456 patients were admitted for end-stage renal disease. Among these patients, only 28 (6.1%) were put on PD including two diabetics. Their average age was 37.7 years with a sex ratio of 0.8. The average body surface area was 1.59 m² with an average residual renal function of 6.05 ml / min. PD was chosen as the first intention in 20 patients while 8 patients were on hemodialysis. The evolution was marked by a median survival of the technique of 18.5 months characterized by 8 episodes of peritonitis in 4 patients corresponding to a rate of 1 episode over 56 months. Regarding mechanical complications, we noted 9 omentum aspirations, 1 leak in one case and 1 umbilical hernia requiring surgical recovery in a patient. Out of 28 patients, 17 discharges were identified; 10 patients (67%) were transferred to hemodialysis, 4 died and only 3 patients (18%) were transplanted. The final transfer to hemodialysis was related to mechanical complications in 5 cases, loss of ultrafiltration in one case, repeated hydro-sodium overload in one case, peritonitis in one case and social reasons in two cases. Conclusion: PD is an effective technique which preserves residual renal function and quality of life but its prevalence remains low in the order of 6% of patients treated for end-stage renal disease. The complications are dominated in our context by the mechanical complications main cause of final transfer in hemodialysis.

The impact of blood flow rate on dialysis dose and phosphate removal in hemodialysis patients

The inadequacy of dialysis and hyperphosphatemia are both associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. The aim of this study was to determine the effect of increasing BFR on dialysis dose and phosphate removal. Forty-four patients were included in a cross-sectional study. Each patient received six consecutive dialysis sessions as follows: three consecutive sessions with a BFR of 250 mL/min, followed by three others with BFR of 350 mL/min without changing the other dialysis parameters. Patients' body weight was recorded, and blood samples (serum urea and phosphate) were collected before and after each dialysis session. For assessing the efficacy of dialysis, urea reduction ratio (URR), Kt/VDiascan (Kt by Diascan and V by Watson), Kt/V Daugirdas (Daugirdas 2^nd generation), equilibrated Kt/V, and phosphate reduction rate (PRR) were used. The increase of BFR by 100 mL/min resulted in a significant increase of URR, Kt/V _Diascan, Kt/V_Daugirdas, equilibrated Kt/V, and PRR: URR; 75.41 ± 5.60; 83.51 ± 6.12; P <0.001), (Kt/V_Diascan; 1.28 ± 0.25; 1.55 ± 0.15; P <0.001), (Kt/V_Daugirdas; 1.55 ± 0.26; 2.10 ± 0.61; P = 0.001), equilibrated Kt/V; 1.40 ± 0.19; 1.91 ± 0.52; P = 0.001), and (PRR; 50.32 ± 12.22; 63.66 ± 13.10; P = 0.010). Adequate dialysis, defined by single-pool Kt/V ≥1.4, was achieved using two different BFRs: 250 and 350 mL/min, respectively, in 73% and 100% of the cases. Increasing the BFR by 40% is effective in increasing dialysis dose and phosphate reduction rate during high-flux HD. The future prospective studies are needed to evaluate the impact of increasing BFR on phosphate removal using the total amount of phosphate removed, and also evaluate the cardiovascular outcome of phosphate reduction and dialysis improvement.

Bacteremia and thrombotic complications of temporary hemodialysis catheters: Experience of a single center in Morocco

Background: The use of central venous catheters is essential in hemodialysis care, but it is associated with infectious and thrombotic complications. The aim of this study is to determine rates and risk factors of hemodialysis catheter-related bacteremia and thrombotic complications from a Moroccan single center to set prevention policies. Materials and methods: The trial was designed as a prospective observational study including all patients who required a temporary hemodialysis catheter more than 48 h. Baseline demographic and clinical data including age, sex, causes of kidney failure, comorbidities, indication for insertion, catheter insertion sites, and duration of use were collected. Patients were followed up since the insertion of catheter to its removal. Results: A total of 126 hemodialysis catheters were inserted at different sites in 93 patients for the following reasons: the absence of vascular access in patients with end-stage renal disease in 55 cases (43.65%), vascular access dysfunction or infection in 45 cases (35.71%), and acute kidney injury in 26 (20.63%). During follow-up, 15 catheters (11.9%) were complicated by bacteremia, resulting in a rate of 6.68 per 1000 catheter days. Risk factors associated with catheter-related bacteremia were diabetes (odds ratio [OR] =26.018; P = 0.017) and advanced age (OR = 1.105; P = 0.045). Causative microorganisms were dominated by coagulase-negative staphylococci in 46.66%. Twenty-four thrombotic complications (19.04%) were documented with an incidence of 10.69/1000 catheter-days. Among these complications, 18 were dysfunction of catheter (14.28%, 8.01/1000 catheter-days) and 6 were vein thrombosis (4.76%, 2.67/1000 catheter-days). Lower serum albumin levels was the unique risk factor (OR = 0.801; P = 0.042). Conclusions: Early diagnosis of chronic kidney disease and creation of arteriovenous fistula may lower the incidence of catheter use in hemodialysis.

Membranoproliferative glomerulonephritis associated with a human immunodeficiency virus infection

Type 1 membranoproliferative glomerulonephritis (MPGN) is an uncommon manifestation of human immunodeficiency virus (HIV)-associated renal disease in patients coinfected with hepatitis C virus. We report a case of MPGN characterized by nephrotic syndrome associated with HIV without hepatitis C coinfection. The patient had a favorable response to highly active antiretroviral therapy and angiotensin-converting enzyme inhibitors. Recognition of the MPGN lesion in HIV infection devoid of hepatitis C coinfection must be considered.

Angio-embolization of a renal pseudoaneurysm complicating a percutaneous renal biopsy: a case report

We report the treatment of a bleeding renal pseudoaneurysm by angio-embolization. A 21 years old woman developed macroscopic haematuria following renal biopsy. Renal angio-scan showed a 1.4 cm renal pseudoaneurysm in the left kidney. The presence of pseudoaneurysm was confirmed by selective renal angiography. Successful embolization was performed using gelatine sponge particles.

[Pregnancy in chronic hemodialysis]

La survenue d'une grossesse en hémodialyse chronique (HDC) est rare, mais depuis la description du premier cas par Confortini en 1971, plusieurs observations ont été rapportées. L'hémodialyse a considérablement amélioré la fertilité de ces patientes. Nous rapportons l'expérience de douze grossesses survenues entre 1999 et 2014, chez douze patientes d’âge médian 34 ans (22-44), en hémodialyse (HD) depuis 40 mois (3-72), l’âge gestationnel moyen de diagnostic est de 16 semaines d'aménorrhée, la grossesse était compliquée dans 50% des cas par un hydramnios. Le terme moyen est de 35 semaine d'aménorrhée (SA) et l'accouchement a été réalisé dans 90% des grossesses par voie basse. Le poids moyen des nouveau-nés est de 1800g. De telles grossesses sont à haut risque du fait de la fréquence des complications. Elles devraient être contrôlées par les équipes multidisciplinaires, et la consultation prénatal ne devrait pas être négligée. L'objectif de ce travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de la confronter aux données de la littérature.