[Brown tumors in chronic hemodialysis patients]. / Les tumeurs brunes chez les hémodialysés chroniques.

PURPOSE: Brown tumors are rare and severe manifestations of secondary hyperparathyroidism. We propose in this study: to define and illustrate brown tumors observed in our hemodialysis center; to show the frequency for 20 years in our center; to identify risk factors compared to the rest of dialysis patients; and finally to offer improved support for reducing the incidence. PATIENTS AND METHODS: We conducted a retrospective and descriptive study, over a period of 20 years (1993-2013), including 311 cumulative patients which are chronic hemodialysis in our unit. RESULTS: Twenty-one patients had brown tumors (6.75%). The average age was 36.1 years and the sex ratio M/F is of 0.6. The average time between the start of hemodialysis and the diagnosis of brown tumor was 87.6 months. Clinical symptoms were dominated by bone pain, found in 76.1% of cases. The most frequent locations were costal (28.5% of cases), while spinal involvement was less frequent (4.76% of cases). The location was multifocal in 57.1% of cases. The mean serum calcium was of 2.08 mmol/L, the serum phosphate of 2.25 mmol/L, alkaline phosphatase of 1709 IU/L and the average value of parathyroid hormone of 1934 pg/mL. Radiography was the key of diagnostic. Resonance magnetic imaging and computed tomography had an interest in the exploration of spinal locations and maxillo-mandibular locations. All patients underwent parathyroidectomy and it was total in one patient. Tumorectomy was necessary in three patients (14.2% of cases). The outcome was favorable in 85.7% of cases. CONCLUSION: Our work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors.

Post kidney transplantation Kaposi's sarcoma: the experience of a Mediterranean North African center.

BACKGROUND: The aim of this study was to determine the overall and specific incidences of Kaposi's sarcoma (KS) in a cohort of 568 kidney transplant recipients (KTR) in a single North African Mediterranean center. PATIENTS AND METHODS: The records of 568 patients, who underwent kidney transplantation (KT) between June 1986 and December 2013, were retrospectively reviewed. Incidence was calculated by dividing the number of the different events by the total duration of follow-up. Survival rates and cumulated frequencies of KS were calculated according to the actuarial method. RESULTS: Twelve patients developed KS corresponding to an overall prevalence of 2.1% and an annual incidence of 0.27% patient-years. Median time to diagnosis of KS was 23.3 months. Eleven patients presented with skin lesions; three had oral localizations and one had conjunctival involvement. Asymptomatic gastric localization was observed in one patient. Therapeutic management, consisting in reduction of immunosuppression in all cases and their conversion to sirolimus in four patients, resulted in complete regression of KS in seven patients. Graft loss was observed in three cases and four patients died of unrelated- KS causes. CONCLUSION: KS is the most post KT malignancy observed in our country and is characterized by a predominance of limited superficial forms.

Erectile dysfunction in hemodialysis patients.

Erectile dysfunction (ED) is a common problem seen among patients on hemodialysis (HD), but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5%) and diabetes (41.6%). The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH), follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%), the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.

Impact of the components of metabolic syndrome on survival in a group of hemodialysis.

BACKGROUND: Metabolic syndrome is defined by the combination of high blood pressure, dyslipidemia, central obesity and a state of insulin resistance. Its prevalence is high in hemodialysis. AIM: The aim of this work is to see the impact of metabolic syndrome on mortality and morbidity in our hemodialysis patients. METHODS: This is a retrospective study of 120 chronic hemodialysis patients. The metabolic syndrome was investigated according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Survival was estimated based on each parameter of the metabolic syndrome. A comparison by sex was performed for the following parameters: age, diabetes, hypertension, obesity, waist circumference, dyslipidemia, coronary artery disease and heart failure. RESULTS: Forty chronic hemodialysis patients with metabolic syndrome have been the subject of this study. The mean age was 55.97 years and the sex ratio was 1.88. Seventy percent had diabetes and 90% were hypertensive. Coronary artery disease was present in 57.5% of cases of heart failure in 52.5% of cases. There was no significant difference in 10 years survival depending on the presence of each component of the metabolic syndrome. The study by sex showed no significant difference except for hyper LDL cholesterol. CONCLUSION: Our study showed no impact of the components of metabolic syndrome on survival. There is a high prevalence of cardiovascular complications but causality with the metabolic syndrome could not be demonstrated.