[Variations of troponin T in chronic hemodialysis patients: study of 52 cases]. / Variation de la troponine Tc chez les hémodialyses chroniques: etude a propos de 52 cas.

BACKGROUND: Patients with severe renal dysfunction have unexplained elevated serum concentrations of cardiac troponin T. AIM: Study the frequency of elevated cTnT in hemodialysis patients and investigated whether cTnT is elevated. METHODS: The patient population consisted of 52 patients on maintenance hemodialysis and 20 healthy subjects. cTnT was measured before and after hemodialysis by using immunoenzymatic method. cTnT were undetectable in 7 cases(< 0.01 ng/ml) and higher than normal range (up to 0.1 ng/ml) in 9 cases. 32 cases have a level of cTnT > 0.01 and < 0.1 ng/ml. In addition, TnTc levels are significantly associated with cardiac dysfunction (p < 0.05) and inflammation (p 0.01). RESULTS: After hemodialysis sessions, TnTc was less than 0.01 ng/1 in 11 patients (21.2%), between 0.01 and 0.1 ng/ml in 32 subjects (61.5%) and greater than 0.1 ng/ml in 9 subjects (17.3%). In the control group, only 1 subject (5%) had a rate of TnTc between 0.01 and 0.1 ng/ml, whereas it was less than 0.01 ng/ml for all others. We aim a statistically significant positive correlation between the rate of TnTc and heart failure (p < 0.05) on the one hand and serum CRP (p < 0.01) on the other. CONCLUSION: The causes of elevated cTnT levels in hemodialysis patients was multiple: cardiac dysfunction, left ventricular dysfunction and inflammation.

[Cystine lithiasis: retrospective study about 25 cases]. / La lithiase cystinique : etude rétrospective à propos de 25 cas.

INTRODUCTION: cystinuria is a severe form of renal which is exposed the patient at multiple recurrent. OBJECTIVE: Report and identify the clinical and biochemical characteristic of cystinuria in Tunisian region. METHODS: It is a study of 25 cases of cystinuria, concerning at 16 adults and 9 children from 1995 to 2006. Cystinuria is recognized on the basis of spectrophotometric analysis of the stones (24/1586), by study of urinary crystals completed with brands test (5 cases) or by the two types of explorations. RESULTS: the frequence of cystinuria is 1.5% (25/1586). 89% stones were renal and 23% were bilateral. The stones have a diameter between 15/30 mm and classified type V at morphology. CONCLUSION: Our data will improve the management based on early diagnosis, regular follow up and respect of dietetic rules.

[Urinary calculi in children: contribution of anamnesis, biological exploration and physical analysis of calculi to the etiological diagnosis]. / La lithiase urinaire de l'enfant: contributions de l'anamnèse, de l'exploration biologique et de l'analyse physique des calculs au diagnostic étiologique.

BACKGROUND: It is always of importance to define the cause of urinary calculi disease in children to prevent recurrence and possible impairing of renal function. Nevertheless, etiology is not always easy to prove and must be deduced from both clinical and biological arguments. PATIENTS AND METHODS: The aim of this prospective study including 39 Tunisian children with urinary stones was to identify etiology and stone risk factors and detail the part of clinical and biological data and results of physical analysis of stones in determining the cause of the stone. RESULTS: In 31 cases among 39, clinical and biological data were not sufficient to identify clearly the stone etiology. When considering the structure and stone composition, the cause of the stone could be determined in 97.4% of the cases. An inherited disease was found responsible for the stone in 11 children, urinary tract infection in 13 cases, idiopathic hypercalciuria in nine cases and a nutritional deficiency disease in seven cases. In one case, polycystic kidney disease with metabolic risk factors could explain the stone process. No precise etiology was found in one case. Among infection stones, struvite stones could be related to urea-splitting bacteria while other calculi, containing whitlockite and protein matrix could be related to other micro-organisms. Earlier severe chronic diarrhoea episodes were noted in six among seven children presenting stones with a nucleus mainly composed of ammonium urate. CONCLUSION: Clinical data, biological data from both urine and blood of the patients and also the structure and composition of the stones are needed to identify the cause of urinary calculi. Such a procedure could provide the stone etiology in most cases.