Multiple Venous Thromboses and Renal Failure in Behcet's Disease: A Case Report and Review of the Literature.

Behcet's disease (BD) is a systemic condition of unknown etiology, characterized by a wide clinical polymorphism. Vascular involvement in BD is rare and can be revealing in many cases. We present an advanced case of BD with multiple venous thromboses associated with urgent dialysis-dependent end-stage chronic renal failure. This case highlights the complexity of managing BD, emphasizing the challenges associated with multiple thromboses and the crucial importance of early diagnosis to optimize the management of this systemic disease.

Effectiveness of Narrowband Ultraviolet Light in Chronic Kidney Disease-Associated Pruritus.

INTRODUCTION:  Chronic kidney disease-associated pruritus (CKDaP) is a prevalent and challenging symptom in individuals suffering from advanced chronic kidney disease (CKD). Its underlying mechanism remains inadequately understood, leading to a limited array of unsatisfactory therapeutic interventions. Despite various attempts, identifying the most effective treatment remains inconclusive. Nevertheless, there is a growing interest in employing ultraviolet phototherapy, particularly for non-responsive patients, although its efficacy is not definitively established. To investigate the potential benefits of narrowband ultraviolet B (NB-UVB) phototherapy on individuals experiencing CKDaP, we report our experience with NB-UVB light in management of CKDaP in dialysis patients. MATERIALS AND METHODS: The study group consisted of patients with end-stage chronic kidney disease who underwent hemodialysis. These patients received dermatological consultations and follow-ups for itching. They were all unresponsive to the conventional treatment (emollients and antihistamines). Screening laboratory examinations, including complete blood count, liver function test, thyroid function, electrolytes, and others, were also arranged to exclude systemic etiologies. The main potential pruritogens were dosed: calcium, phosphate, and parathyroid hormone. Itch intensity was evaluated with a numerical rating scale (0-10), based on the worst level of itching in the past two weeks. They had sessions of NB-UVB light (311 nm, TL01) twice per week. After UVB exposure, patients were advised to use topical emollients. A questionnaire was employed to document the extent, intensity, frequency, and sleep disruption experienced to evaluate the efficiency of the treatment, using a scale from 0 to 10.  Results: In a group of 38 patients, the average age of the patients was 56 years (16-80); 63.2% were female and 36.8% were male. Median duration of pruritus was 4.7 years, and that of dialysis was 8.4 years. Pruritus was intermittent and diffuse in most cases, localized to the arteriovenous fistula site in two cases, and exacerbated by heat in all cases. Itch intensity was evaluated with a numerical rating scale (0-10) based on the worst level of itching in the past two weeks and showed a moderate average score (5/10). Xerosis was found in 63%, and scratch lesions such as excoriation in 34%. NB-UVB phototherapy was used twice per week on nonconsecutive days, with protection of the genital area and also the eyes using UVB-blocking goggles. The initial dose was 0.4 J/cm2 and further doses were introduced according to the erythema response until a maximum of 2 J/cm2. No sunburn, hyperpigmentation, or blistering was noted. Emollients were maintained in patients with xerosis. Average number of sessions was 13 (6-24) and reduction of itch intensity was observed starting from the sixth session. Total improvement was obtained at the end of treatment duration except for three patients who required additional sessions. One patient had recurrence one year later.  Conclusion: In conclusion, phototherapy represents a significant advancement in the treatment options for CKD-associated pruritus. Its positive impact on reducing itching and improving the quality of life for many patients is undeniable. However, to fully unlock its potential, ongoing research is needed to optimize dosing, understand relapse mechanisms, and identify the patients who will benefit most from this therapy.

Access to kidney transplantation for patients with end-stage renal failure in Maghreb countries: state of art and recommendations / Accès à la transplantation rénale des patients en insuffisance rénale chronique terminale dans les pays du Maghreb : état des lieux et recommandations

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.

Nous présentons un état des lieux de l'activité de transplantation rénale dans les pays du Maghreb à partir des données du 9e Colloque France-Maghreb (Paris, 20 et 21 mai 2022). Pour l'Algérie, le Maroc et la Tunisie, l'incidence de l'insuffisance rénale chronique terminale est respectivement de 120, 130 et 130 par million d'habitants, sa prévalence de 626, 900 et 833 par million d'habitants et la part des patients porteurs d'un greffon fonctionnel est de 10,3, 1,8 et 8,5 % avec un nombre annuel de transplantations de 6,5, 0,9 et 7,7 par million d'habitants. La transplantation avec donneur vivant représente 99 % des transplantations en Algérie, 93 % au Maroc et 80 % en Tunisie. En conclusion, l'accès à la transplantation reste faible dans les pays du Maghreb. Toutes les modalités (donneur vivant avec élargissement du cercle des donneurs, donneurs décédés) doivent être développées. Des recommandations ont été émises pour soutenir cette activité.

Smoking in chronic hemodialysis patients: prevalence and cardiovascular morbidity / Tabagisme chez les patients hémodialysés chroniques : prévalence et morbidité cardiovasculaire

Introduction: Smoking is common in chronic hemodialysis patients who are characterized by a high cardiovascular risk. Patients & methods: This is a multicenter cross-sectional study over a period of 4 months, from July 2021 to October 2021, in the Agadir province. Results: Among the 245 patients interviewed, 9,4% were current smokers and 16,7% were former smokers. Compared to non-smoking patients, former and current smokers were predominantly male, had more comorbidities, higher diastolic blood pressure, higher mean ultrafiltration rate and more antihypertensive treatments. In multivariate analysis, active smoking was significantly associated with the presence of cardiovascular disease. Conclusion: Smoking is an important and modifiable cardiovascular risk factor in chronic hemodialysis patients.

Introduction: Le tabagisme est fréquent chez les patients hémodialysés chroniques qui sont caractérisés par un risque cardiovasculaire élevé. L'objectif de notre étude était de déterminer la prévalence du tabagisme et le risque cardiovasculaire associé chez les patients hémodialysés chroniques. Patients et méthodes: Il s'agit d'une étude transversale multicentrique sur une période de 4 mois, de juillet à octobre 2021, dans la province d'Agadir. Résultats: Parmi les 245 patients interrogés, 9,4 % étaient des tabagiques actuels et 16,7 % étaient des anciens tabagiques. En comparaison aux patients non tabagiques, les fumeurs anciens et actuels avaient plus de comorbidités, une pression artérielle diastolique plus élevée, une ultrafiltration moyenne plus importante et un plus grand nombre de traitements antihypertenseurs. En analyse multivariée, le tabagisme actif était significativement associé à la présence d'une maladie cardiovasculaire. Conclusion: Le tabagisme représente un facteur de risque cardiovasculaire important et modifiable chez les patients hémodialysés chroniques.

[Use of the TestObs mobile application for the evaluation of therapeutic adherence in chronic hemodialysis patients: Technological monitoring model of treatment adherence and determining factors]. / Utilisation de l'application mobile TestObs pour l'évaluation de l'observance thérapeutique dans une population d'hémodialysés chroniques : modèle de monitoring technologique de l'adhérence au traitement et ses facteurs déterminants.

INTRODUCTION: Non-adherence behaviors are very common in chronic hemodialysis patients, it is estimated that only one patient out of two complies with medical prescriptions, these behaviors are associated with a higher risk of morbidity and adverse events as well as increased expenses for health systems. The aim of our study was to assess adherence to long-term prescribed medications in chronic hemodialysis patients, using a mobile application named TestObs, as well as to determine the main factors influencing medication adherence. METHODS: We conducted a prospective descriptive study, between January and June 2019. We developed a mobile application named TestObs, downloadable on playstore for android devices, which assesses with the Girerd questionnaire, the adherence to the main medications taken by chronic hemodialysis patients. We included adult patients, with a duration of dialysis of more than 6 months, all patients who downloaded TestObs, tested their adherence to their medication by answering the questionnaire. We created a web-based platform, where data was collected from the application and then analyzed and tabulated. Regarding the statistical analysis, the normal distribution of the variables was studied by the Kolmogorov-Smirnov test, the analysis of the qualitative variables used the Pearson's Chi2 and Fisher's statistical test, the Hosmer Lemeshow test was used to examine the quality of the final logistic regression model. RESULTS: We collected 90 adult chronic hemodialysis patients, 51 of them (56%) were selected to enter the study. We found good compliance in 46.15% of patients, minor noncompliance in 32.87%, and noncompliance in 20.98%. In multivariate analysis, the factors influencing adherence were the presence of other comorbidities (diabetes and vision problems) and the number of pills per day. DISCUSSION: In this study, we report treatment adherence problems in 53.85% of patients, our results are close to the data reported in hemodialysis patients in the literature, different factors influence the quality of treatment adherence, in our study poly-medication and the presence of other comorbidities were the statistically significant determinants. The new technology assessment instruments were used in hemodialysis patients and were able to provide real-time monitoring of adherence behaviors. CONCLUSION: We believe that mobile health technologies hold promise for assessing and improving medication adherence in hemodialysis patients, so we suggest that TestObs represents an accessible and free of charge tool, based on a validated questionnaire, that can allow patients to benefit from new technologies for medical monitoring, and may eventually constitute an interventional program to improve medication adherence; however, this technological tool should not replace traditional therapeutic education; prior targeting of non-adherent patients and an optimal combination of several tools can help improve adherence in these patients.

HLA-identical living related kidney transplantation: Outcomes of a national multicenter study.

OBJECTIVES: The kidney prognosis of HLA-identical seems theoretically very interesting with the lowest risk of acute rejection after that of identical twins. Objectives were to determine the prevalence of acute rejection and various complications in a cohort of HLA-identical living-related kidney transplant. METHODS: A retrospective, multicenter study was conducted in seven university centers in Morocco, which included all recipients of an HLA-identical living-related kidney transplant performed between 1990 and 2019. RESULTS: Data on 68 HLA-identical living-related kidney transplants were collected. The donors were siblings in 89.7%, the parents in 7.3%, and identical twins in 3% of cases. 53.6% of all recipients were under 35 years old, and 59.4% of them were male. 39.7% of all donors were under 35 years old, and 47% of them were male. 48.5% of HLA-identical living-related kidney transplants were performed before the year 2000. 18 kidney transplant biopsies were performed on 16 kidney transplant recipients. Seven episodes of acute rejection occurred in six patients, 8.8% of the whole cohort (n = 68). Two cases of acute rejection among the seven were related to poor adherence, cessation of immunosuppressive therapy, and loss of medical follow-up by these patients. These two patients were 20 years old at the time of kidney transplantation. The global kidney transplant survival was 66.7% versus 91.9% (P = 0.04) in the two patient groups having developed acute rejection and not having developed acute rejection, respectively. CONCLUSIONS: Acute rejection is a real threat to HLA-identical kidney transplant recipients. Therefore, it seems very important to codify the immunosuppressive regimen and to adopt a minimal and effective treatment.

[Effect of a hemodialysis patient education on fluid control and dietary]. / Impact de l'éducation du patient en hémodialyse sur le respect des mesures diététiques et sur la restriction aux liquides.

INTRODUCTION: Most chronic hemodialysis patients do not adhere to diet and fluid restrictions, source of clinical complications in the medium and long term, in some cases fatal, this study was conducted to investigate the effect of the training program given to these patients on their adherence to diet and fluid restrictions. MATERIALS AND METHODS: The study was conducted with 50 people, split into 2 groups, set up on a control group with 25 people. No education program has been set up, and the second group with 25 people assigned to the intervention having received an education program. Data were collected using the sociodemographic characteristics questionnaire, dialysis diet and fluid non-adherence questionnaire (DDFQ), and fluid control in hemodialysis patients scale (FCHPS). RESULTS: The measurements made at the end of the education program revealed a statistically significant difference in favor of the intervention group in terms of the mean values for the patients interdialytic weight gain (kg), ultrafilration volume and diastolic blood pressure. Similarly, the means of the scores for the 4 items of the DDFQ questionnaire revealed a statistically significant difference in favor of the intervention group concerning: the frequency of non-adherence to the diet, the degree of non-adherence to the diet, the frequency of non-adherence to liquid restriction and the degree of non-adherence to liquid restriction. CONCLUSION: This monocentric work shows that the establishment of an educational program has a positive impact on patients adherence to dietary measures and restriction of fluids.

Medicinal plants and renal failure: A case-control study.

AIMS: Medicinal plants contain many active constituents that can cause adverse effects on kidneys that are often unrecognized. The aim of our work was to study the association between the regular use of medicinal plants and the risk of chronic renal failure in hospitalized patients in four departments of Mohammed VI University Hospital. MATERIALS AND METHODS: A case-control study was performed from January 2018 to December 2018. The cases were patients with a first-time diagnosis of chronic renal failure and without family history of kidney diseases or pre-existing renal disease. One control was matched to each case for age, gender, date of entry, and history of hypertension or diabetes. RESULTS: 208 patients were recruited. Among 104 cases, 42 patients (40.4%) regularly used medicinal plants compared to 18.3% in the group of controls (OR: 1.3; 95% CI; p < 0.001). Multivariate analysis showed that the regular use of medicinal plants was significantly associated with the risk of chronic renal failure (OR: 3.05; 95% CI; p < 0,001). Also a total of 52 plant species representing 29 plant families were reported in our study. Dominant plant families were represented by the Lamiaceae followed by the Apiaceae. CONCLUSION: Regular use of medicinal plants increases the risk of chronic kidney failure. Therefore, we need active measures to regulate this sector.

Nonuremic calciphylaxis in a patient with multiple myeloma and rheumatoid arthritis.

Calciphylaxis is a rare and highly morbid condition that has continued to challenge the medical community since its early descriptions in the scientific literature many decades ago. Calciphylaxis predominantly affects patients with chronic kidney disease treated by dialysis but is also described in patients with normal kidney function. We report a rare case of a patient who presented with calciphylaxis associated with multiple myeloma and rheumatoid arthritis. With a better understanding of its pathophysiology, more effective therapies are being developed.

Knowledge of Chronic Hemodialysis Patients on Kidney Transplantation in Morocco.

BACKGROUND: Kidney transplantation (KT) is the optimal treatment for chronic end-stage renal failure. However, it is experiencing a huge delay in Morocco, and the lack of information on this alternative treatment could contribute to this delay. The purpose of our work is to evaluate the knowledge of hemodialysis (HD) on renal transplantation and to propose sensitization and information strategies. METHODS: This is a multicenter study conducted in 4 hemodialysis centers in Marrakesh from November to December 2017. An individual questionnaire was submitted to 310 patients concerning sociocultural status, willingness to be transplanted, the main benefits and risks of renal transplantation, knowledge of religious attitudes toward organ donation and transplantation, cost, and survival of the KT. RESULTS: Of the 310 patients, 56% were men, with a mean age of 49.43 ± 10.3 years. The mean duration of hemodialysis was 6.7 ± 5.3 years. Only 18% were in school, and 57% had moderate economic status. Of the 310 respondents, 71% said they wanted to be transplanted, and 15.5% believed that Islam was unfavorable by encouraging them to accept the fate that God chose for them. The rest were afraid of multiple complications and returning to dialysis. However, 41.7% thought transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation provided a better quality of life. CONCLUSIONS: Raising the awareness of hemodialysis patients and their families is essential to promote KT in Morocco.

A "double-seropositive" Vasculitis for antiglomerular basement membrane antibodies and antineutrophil cytoplasmic antibody, and multiple myeloma, all three with simultaneous diagnosis of renal involvement, common pathophysiology, or pure coincidence? first case in the World.

The combination of Goodpasture's disease and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is not exceptional. However, to the best of our knowledge, their association with multiple myeloma (MM) with kidney involvemen thas not been described. We report probably the first case of double-seropositive vasculitis for antiglomerular basement membrane (GBM) antibodies and ANCA associated with MM with renal involvement. A 60- year-old-female presented with severe acute kidney injury. Three months earlier, she had a history of bone pain. Blood workup found a creatinine of 1100 µmol/L and a C-reactive protein of 60 mg/L. Anti-GBM antibodies returned positive at 400 U/mL and pANCA positive at 380 U/mL. Plasma protein immunofixation found a monoclonal immunoglobulin G (IgG) KAPPA peak; the myelogram found a 10% plasmocytosis. On the day 4 of hospitalization, the patient presented with alveolar hemorrhage. The renal biopsy showed diffuse crescentic glomerulo-nephritis with linear glomerular deposits of IgG, with kappa light chain cast nephropathy. The association between vasculitis and malignant blood disease is very rare; the pathophysiology of this association remains unclear. It would seem interesting to look for possible ANCA or anti- GBM activity carried by the monoclonal immunoglobulin.

[Calcific uremic arteriolopathy in hemodialysis patient, review of literature through five cases reports]. / L'artériolopathie urémique calcifiante de l'hémodialysé chronique, revue de la littérature à travers cinq cas cliniques.

Calcific uremic arteriolopathy, also called calciphylaxis, is a rare and severe disorder that presents with skin ischemia and necrosis, sometimes it presents with systemic necrosis, the process is secondary to the obliteration of the arterioles first by sub-intimal calcium deposits and then by thrombosis. These lesions can often lead to death due to infectious complications and comorbidities such as diabetes, obesity, arteritis, diffuse vascular calcifications, heart disease and undernutrition. The diagnosis is suggested by the characteristic ischemic skin lesions and their distribution, often bilateral and painful, associeted with calcific uremic arteriolopathy risk factors (phosphocalcic abnormalities, anti-vitamin K). The presence of radiological vascular calcifications is highly suggesting the diagnosis, but remains not very specific. The indication of skin biopsy is rare and reserved for difficult diagnoses. The goals of treatment are: reduce the extension of calcification and treatment of mineral and bone metabolism disorders of end-stage renal disease, dialysis adequacy, local treatment of skin lesions, tissue oxygenation, pain management, discontinuation and contraindication of medications that may contribute to the disorder. We propose to discuss it from a review of the literature and illustrate it with five clinical cases.

[Renal failure revealing multiple myeloma with preexisting lesions on radiological images]. / Insuffisance rénale révélant un myélome multiple avec des lésions radiologiques historiques.

The study involved a 54-year old female patient admitted with severe renal failure. She had a 1-month history of progressive stage II dyspnoea associated with chest pain, bone pain and anuria. Clinical examination showed hypertension (160/80mmHg), glomerular disease (urinary protein excretion 2+, blood 2+ and diuresis 300 cc). Pleuropulmonary examination showed diffuse bilateral lower-chest crackling sounds. Laboratory tests objectified severe renal failure with creatinine level 107mg, urea 1.65g/l, hyperkalaemia 7.8 mmol/l, CRP value 78mg/l, normochromic normocytic anemia with hemoglobin concentration 5.7g/dl and leukocytosis 13570 without thrombocytopenia, hyperprotidemia 144g/l, normal serum albumin concentration 33g/l, hypercalcemia 116mg/l and hyperphosphataemia 120mg/l. Serum protein electrophoresis showed monoclonal gamma globulin peak 60 g/l. Immunoelectrophoresis of plasma proteins showed IgG kappa gammapathy. Bence-Jones protein urine test was negative. Myelogram showed plasmocytosis 10%. Profile skull x-rays objectified multiple pre-existing geodes. The patient underwent CDT1 protocol with dexamethazone thalidomide 100 mg and oral endoxan.

Central retinal vein occlusion in a patient on hemodialysis secondary to antiphospholipid syndrome: Case report.

Central retinal vein occlusion (CRVO) is one of the most common retinal vascular disease. Macular edema associated is responsible of the major decrease in visual acuity. The main causes often implicated are high blood pressure and diabetes. Other etiologies should be sought including CRVO secondary to antiphospholipid syndrome (APS). This rare etiology is associated with a poor prognosis when late diagnosed. Owing to the high associated mortality, early diagnosis and prompt treatment are necessary. We describe a case of APS complicated by a catastrophic antiphospholipid syndrome in a patient who presented a decrease visual acuity.

Hemodialysis safety: Evaluation of clinical practice.

Hemodialysis (HD) safety has become a clinical priority; therefore, the use of checklists for making the dialysis session safe is now widely adopted. The aim of our study was to assess different shortcomings in the clinical practice of nurses working in different Moroccan dialysis centers and to discuss the interest of using such checklists. This cross-sectional study was performed in 13 chronic HD centers. Clinical practice of nurses was evaluated through checklists used in European outpatient dialysis units. We noted several deficiencies mainly related to the clinical evaluation of dialysis patients and to aspects related to hygiene and protection measures against contamination. Optimal safety of dialysis sessions requires the use of simple and reproducible means that improve clinical skills of the health staff.

[Organ donation after death in Moroccan population]. / Don d'organes issus de donneurs décédés et population marocaine.

INTRODUCTION: Morocco stays far behind other countries in the domain of organ donation and transplantation. Improving the knowledge of Moroccan students, about organ donation and transplantation, can be a key factor in the development of transplant activity. The aim of this study is to evaluate the knowledge, attitudes and beliefs of students concerning organ donation and transplantation. MATERIALS AND METHODS: The opinion survey was conducted in Marrakech city, with four high education structures with a pre-established questionnaire. The survey questions answered four main themes, which are: the evaluation of knowledge, the opinion and attitude of citizen, the explanation of refusal and the propositions to encourage organ donation in Morocco. RESULTS: Hundred percent of surveyed subjects answered the questionnaire. Among them, 40.3% were men. The middle age was 21.5 years. Out of 503 surveyed students, 89.4% were aware of organ transplant in Morocco. A quarter of students believed that removal and transplant acts were realized just in public health establishments, which have the authorization. Two persons out of 3 were able to identify transplantable organs and tissues. More than half accepted to donate their organs after death. The religious reason was in the head list of refusal determinants of organ donation after death, with a prevalence of 39.7%. CONCLUSION: Young Moroccans have limited knowledge relating to organ donation. The development of this therapy needs to establish an adequate project of information and motivation of general population.

Outcome assessment of pregnancy-related acute kidney injury in Morocco: A national prospective study.

Acute kidney injury (AKI) is a rare but life-threatening complication of pregnancy. The aim of this paper is to study the characteristics of acute AKI in pregnancy and to emphasize on its management modalities in Moroccan hospitals. This is a national prospective study performed over six months from July 1 to December 31 2010 on AKI developing in pregnant patients, both preand post-partum period. Patients with pre-existing kidney disease were excluded from the study. Outcome was considered unfavorable when complete recovery of renal function was not achieved and/or maternal death occurred. Forty-four patients were included in this study. They were 29.6 ± 6 years old and mostly illiterate (70.6%). Most AKI occurred in the post-partum period, with 66% of the cases occurring in those who did not receive antenatal care. The main etiologies were pre-eclampsia (28 cases), hemorrhagic shock (six cases) and septic events (five cases). We noted three cases of acute fatty liver, one case of obstructive kidney injury and one case of lupus nephritis. Hemodialysis was necessary in 17 (38.6%) cases. The outcome was favorable in 29 patients. The maternal mortality rate was 11.4%. Two poor prognostic factors were identified: Age over 38 years and sepsis. AKI is a severe complication of pregnancy in developing countries. Its prevention necessitates the improvement of the sanitary infrastructure and the establishment of the obligatory antenatal care.

[Lupus nephritis: frequency, histological forms and predictors of renal disease]. / La néphropathie lupique: fréquence, forms histologiques et facteurs prédictifs de l'atteinte rénale.

BACKGROUND: Lupus nephritis is a common and serious damage in systemic lupus erythematosus. The aim of our study is to define the frequency and to identify the predictors of lupus nephritis in patients with systemic lupus erythematosus. METHODS: multicenter retrospective study on all systemic lupus erythematosus patients followed between 2005 and 2012. We analyzed the epidemiological, clinical and biological presentation at admission and during follow-up. We have identified two groups of patients: group 1 involving systemic lupus erythematosus without renal disease, group 2 : patient with lupus nephritis. RESULTS: We collected 105 patients including 100 women, 41 (39%) with lupus nephritis occurred after a period of 30±10 months of development of lupus. 4 patients (3%) were initially presented with acute renal failure requiring hemodialysis. The pathological findings of renal biopsy is respectively: class IV, III and II in 19 patients (63.3%), 4 patients (13.3%), and 4 patients (13.3%). Our patients with lupus nephritis received various treatment regimens: 38 patients (92.7%) received corticosteroids and combined with cyclophosphamide in 33 (80.5%) cases. Only young age, anemia and antinuclear antibodies were correlated with the risk of occurrence of renal damage. Predictors of the severity of lupus nephritis were the short time of occurrence of renal and renal failure. CONCLUSION: Lupus nephritis in our series is characterized by a severity of the clinical and biological explained by the frequency of proliferative forms, hence the necessity for early and adequate management.