Translation, cultural adaptation and validation of the kidney disease quality of life-short form 1.3 in an African country.

BACKGROUND: The impact of dialysis on patient quality of life has been recognized as an important outcome measure. The Dialysis Outcomes and Practice Patterns Study compared quality of life in 4 continents [1], but very scarce information is available about dialysis patients' quality of life in Africa. The objective of this study was to translate the Kidney Disease Quality of Life-Short Form (KDQOL-SF) into Moroccan and measure its psychometric properties. METHODS: The questionnaire was first translated into Moroccan by 2 independent translators, and then 2 backward translations into English were performed after pretesting in 10 dialysis patients. The final questionnaire was then administered to 80 dialysis patients. Reliability was estimated by internal consistency and test-retest reliability. Validity was assessed using known group comparisons and correlations between overall health rating and scales scores. RESULTS: Some activities were substituted since they were not common in Morocco. All subscales had a Cronbach α above the recommended value except for 3 scales. All of the items showed good test-retest reliability. Correlation of items within subscales was higher than that of items outside subscales in 87% of cases. Regarding construct validity, all KDQOL-SF scales had significant correlation with overall health rating except for sexual function and dialysis staff encouragement. Furthermore, the questionnaire could be used to discriminate between subgroups of the patients. CONCLUSIONS: The psychometric properties of the KDQOL-SF resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF as a measure of quality of life of patients having hemodialysis in Morocco.

Ten years of renal transplantation in a Moroccan hospital: results and constraints.

INTRODUCTION: Renal transplantation (RT) offers several advantages to end-stage renal disease (ESRD) patients, such as a better quality of life and economic benefits. This study sought to report a 10-year experience of RT in a developing country as well as the barriers to its improvement. PATIENTS AND METHODS: The retrospective study included 67 patients who underwent a first RT from a related living donor (RLD) between June 1998 and December 2008. We noted pretransplantation donor and recipient parameters as well as the results and barriers to RT promotion in our country. RESULTS: The mean overall age of our patients including 43 males (64.1%) and 24 females (35.8%) was 30 ± 9.6 years. Teenagers from 13 to 18 years of age represented 9% of the recipients. Immediate failure was observed in 5 cases due to vascular thrombosis (n = 3) or hyperacute rejection (n = 2). Graft and patient survival rates at 1 year were 92.6% and 97%, respectively. CONCLUSION: The limited number of RT in our country may be explained by the lack of both human and material resources as well as the limited pool of living donors. Nonetheless, the economic gain subsequent to RT should encourage promotion of this treatment mainly through dissemination of information.

Post-transplantation diabetes mellitus.

To determine the prevalence of post-kidney transplantation diabetes (PTDM) and to assess its risk factors, we retrospectively studied 92 non-diabetic kidney transplant patients. The immunosuppressive drugs used to prevent rejection included prednisone, a calcineurin inhibitor (cyclosporine or tacrolimus) and an antimetabolite (azathioprine or mycofenolate mofetil). Diabetes was defined according to the WHO criteria and the American Diabetes Association. The mean age of our patients was 35.8 ± 10.5 years, and there was a clear male predominance (56 men and 36 women). The graft was from living related donor in 71/92 (76%) patients. The prevalence of diabetes in post-kidney transplant was 15.2%. The factors increasing the occurrence of PTDM included advanced age, high doses of steroids and cyclosporine. Management of PTDM included diet modification, oral anti-diabetic and insulin. We conclude that the prevalence of PTDM is significant in our transplant population and risk factors for its development are multiple and require aggressive multifaceted management.

[Cardiovascular calcifications in hemodialysis patients. Prevalence and risk factors]. / Calcifications cardiovasculaires chez l'hémodialysé chronique. Prévalence et facteurs de risque.

OBJECTIVES: Cardiovascular diseases are the leading cause of morbidity and mortality in chronic hemodialysed patients. The aim of our study was to determine the prevalence of cardiovascular calcifications in dialysed patients and to evaluate their risk factors. METHODS: We did a transversal study in 86 chronically hemodialysed patients in the hemodialysis department, Ibn Sina university hospital (Rabat). All patients, 44 men and 42 females, mean age 42 +/- 15.5 years were hemodialysed for more than one year. FINDINGS: The prevalence of cardiovascular calcifications was 24.5%. Chronic hemodialysed patients with cardiovascular calcifications were older (50.5 years +/- 15.4 vs 39 years +/- 14.6; p = 0.003). They had a long hemodialysis duration (81 months +/- 51 vs 59 months +/- 43; p = 0.05) and a higher calcium plasmatic concentration (2.27 +/- 0.15 vs 2.1 +/- 0.19 mmol/l; p = 0.03). We noted a male gender predominance (sex ratio M/W = 18/3 vs 26/39; p = 0.0002). Multivariate analysis showed, as an independent predictor of cardiovascular calcifications, the old age (p = 0.01). Cardiovascular calcifications seem uncommon in our hemodialysis patients. Older age, longer hemodialysis duration and male gender are risk factors. The use of low doses of calcium carbonate, vitamin D and low milk products diet may explain this low prevalence.

[Rosai-Dorfman disease revealed by renal failure: case report]. / Maladie de Rosaï-Dorfman révélée par une insuffisance rénale: à propos d'un cas.

We report a case of Rosaï-Dorfman Disease revealed by renal failure in a 43 years old patient. Clinical presentation included abdominal lymphadenopathy and general status deterioration. Diagnosis was established by histopathological examination of the node which revealed sinusal lymphohistiocytosis. Treatment combined prednisone and cyclophosphamide and was effective with regression of renal failure. We will review the diagnostic criteria and the prognosis of this disorder of unknown etiology.

[Bilateral anterior uveitis and acute tubulointerstitial nephritis (TINU syndrome). A case report]. / Uvéite antérieure bilatérale et néphrite tubulo-interstitielle aiguë (TINU syndrome). A propos d'un cas.

We describe a case of TINU Syndrome. A 17 year-old girl presented four weeks after an acute tubulo-interstitial nephritis with renal failure a bilateral anterior uveitis. Renal function improved spontaneously. Investigation failed to reveal systemic or infectious diseases. The treatment with oral and topical corticosteroids was successful for the uveitis.

Cyclosporine bone remodeling effect prevents steroid osteopenia after kidney transplantation.

BACKGROUND: It is well established that prednisone above 7.5 mg/day may induce osteopenia in association with decreased bone formation. In contrast, the effect of cyclosporine on bone remodeling and bone mineral density (BMD) is controversial. Multiple confounding factors explain this controversy, especially after renal transplantation. METHODS: Fifty-two renal transplanted patients never exposed to aluminum while on dialysis were selected because they had no rejection and no hypercalcemia for 24 months while being treated with low dose prednisone/cyclosporine A (daily dose at 10 mg and 4.8 mg/kg, respectively, beyond 3 months). Bone remodeling markers (BRMs; plasma osteocalcin, bone and total alkaline phosphatases for formation, and urinary pyridinolines for resorption) were sequentially measured together with plasma creatinine, intact parathyroid hormone (PTH) and 25 OH vitamin D and cyclosporine from day 0 to 24 months. BMD was measured at 3, 6, 12, and 24 months by quantitative computerized tomography (QCT) at the lumbar spine and by double-energy x-ray absorptiometry (DEXA) at this site, as well as at the femoral neck, radius shaft, and ultradistal (UD) radius. RESULTS: Plasma concentrations of creatinine, PTH, and 25 OH vitamin D initially decreased and stabilized beyond three months at 137 micromol/L, 1.5 the upper limit of normal (ULN) and 11 ng/mL, respectively. All BRM increased significantly above the ULN at six months and then decreased. The BMD Z score at three months was low at all sites measured by DEXA and QCT. Follow-up measurements showed stability of absolute value and of Z score at all sites measured by DEXA. A comparison of the lumbar QCT Z score, which was available in 42 patients at 3 and 24 months, showed an increase in 28 and a decrease in 14, so that the increase for the whole group was significant (P < 0.04). Compared with patients with a decreased Z score, those with an increased Z score had significantly higher cyclosporine and lower prednisone dosages and a greater BRM increase at six months, whereas age, sex ratio, and plasma creatinine, PTH and 25 OH vitamin D were comparable and stable from months 3 through 24. The mean trough level of cyclosporine for the first six months was positively correlated to osteocalcin and total alkaline phosphatase increase at six months, and both bone formation and resorption marker increases were significantly correlated to the lumbar QCT Z score increase at 24 months. CONCLUSIONS: Combined low-dose prednisone and cyclosporine immunosuppression are associated with a stabilization of BMD measured at all sites with DEXA 3 to 24 months after renal transplantation and with a prevention of age-related loss of vertebral trabecular bone, as shown by the significant increase in lumbar spine QCT Z score. It is suggested that cyclosporine, together with the decrease of prednisone dosage but independent of renal function, PTH, and vitamin D status, contributes to a transient stimulation of bone remodeling at six months, which counterbalances the deleterious effect of prednisone on bone formation and BMD.

[Long-term stability of bone mineral density in patients with renal transplant treated with cyclosporine and low doses of corticoids. Protective role of cyclosporine?]. / Stabilité à long terme de la densité minérale osseuse des transplantés rénaux sous ciclosporine et faibles doses de corticoïdes. Rôle protecteur de la ciclosporine?

OBJECTIVES: Cyclosporine has been thought to have a deleterious effect on bone in transplant recipients because of high turnover osteopenia observed in humans after transplantation. However, varying confounding factors such as renal and parathyroid function, cumulative steroid doses and previous exposure to aluminium, also play a role and hinder interpretation of the cyclosporine effect on bone mineral density (BMD). PATIENTS AND METHODS: A 2-year prospective study was conducted to measure BMD starting 3 months after transplantation and bone remodeling markers from the first post-transplantation day in 52 kidney recipients with no prior exposure to aluminum. None of the patients experienced rejection and at 3 months all had good stable renal function (serum creatinine 137 mumol/l) and mildly elevated parathyroid hormone levels (1.5 times the upper limit of normal). All patients were given the same low dose steroid treatment (10 mg/day) and at 6 months cyclosporine was decreased from 7 to 4.8 mg/kg/day. RESULTS: BMD measured by double energy X-ray absorptiometry, (DEXA) and expressed in Z score, was moderately decreased at 3 months for the vertebrae (-1.40), the femoral neck (-1.34) and the ultradistal radius (-0.95) which have predominantly cancellous bone and was significantly less decreased (p < 0.05) for the lower third of the radius (-0.6) which is mainly cortical bone. BMD measurements were comparable at 6, 12 and 24 months. When measured by axial computerized tomography (ACT) BMD of the vertebrae showed a non-significant increase of Z score from -1.37 to -1.19 at 2 years. Bone remodeling markers was observed up to month 6 (from month 3 for osteocalcine and from month 1 for total and bone alkaline phosphatase and urinary pyridinoline), then returned to baseline levels at 2 years in parallel with decreased cyclosporine dosage. The increase of vertebral BMD measured by ACT at 1 year was correlated both to cyclosporine dose at 1 year and to bone alkaline phosphatase at 6 months. CONCLUSION: Our data confirm the presence of moderate osteopenia 3 months after transplantation, predominantly in trabecular bone, logically linked to the initial high doses of corticosteroids. The long-term stability of BMD measured by DEXA and the correlation of vertebral BMD increase measured by ACT with cyclosporine dose and bone alkaline phosphate suggest that cyclosporine had a beneficial immunosuppressor effect by stimulating bone remodeling and thus counterbalancing the suppressive effect of corticosteroids.