Disease severity of proliferative lupus nephritis in Maghrebians.

Objective To study the influence of Maghrebian ethnicity on lupus nephritis. Methods We retrospectively reviewed the files of a cohort of 194 patients with proliferative lupus nephritis followed in seven lupus centres belonging to three groups: Europeans living in Belgium/France (E; n = 111); Maghrebians living in Europe, in casu Belgium/France (ME; n = 43); and Maghrebians living in Morocco (MM; n = 40). Baseline presentation was compared between these three groups but complete long-term outcome data were available only for E and ME patients. Results At presentation, the clinical and pathological characteristics of lupus nephritis did not differ between E, ME and MM patients. Renal relapses were more common in ME patients (54%) than in E patients (29%) ( P < 0.01). Time to renal flare and to end-stage renal disease was shorter in ME patients compared to E patients ( P < 0.0001 and P < 0.05, respectively). While proteinuria measured at month 12 accurately predicted a serum creatinine value of less than 1 mg/dl at 7 years in E patients, this was not the case in the ME group, in whom serum creatinine at month 12 performed better. Conclusion Despite a similar disease profile at onset, the prognosis of lupus nephritis is more severe in Maghrebians living in Europe compared to native Europeans, with a higher relapse rate.

Fanconi syndrome induced by tenofovir: A case report.

Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor discovered in the USA in 2001. It is currently the treatment of choice for patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus. Its antiretroviral efficacy and good tolerance are responsible for the higher frequency of prescriptions compared with other nucleoside analogs. However, it can induce acute renal toxicity causing impairment of the proximal tubular function of the kidney. This is highly dependent on factors such as associated co-prescription didanosine or a protease inhibitor "boosted" with ritonavir, preexisting renal insufficiency, low body weight, or presence of associated diabetes. In contrast, long-term renal toxicity remains highly debated. Some studies describe a decrease in estimated glomerular filtration rate during prolonged treatment with TDF. Others reported renal safety even during prolonged use. The differences between patients enrolled in the different studies, the measured parameters and their interpretation could explain these discrepancies. We describe a case of a patient infected with HIV, who presented with Fanconi syndrome with acute renal failure six months after starting antiretroviral treatment including tenofovir.

Profile of living related kidney donors: a single center experience.

The living related donor still represents the unique source for renal transplantation in Morocco. Since 1986, 127 living related potential donors have been evaluated and 100 patients have been transplanted at the Ibn Rochd UHC in Casablanca. We retrospectively studied the potential donors and determined their profile and the exclusion criteria. The mean age at the time of donation was 37 ± 11 years (range 18-66 years) and 60% of donors were women. The predominant sources of donors were sisters, brothers and mothers of recipients in 34%, 31% and 24% respectively. Forty three percent of them were married, 20% housewives and 17% unemployed. In addition, 37% were illiterate, 45% school graduates, and 18% university graduates. Donors and recipients were incomplete HLA match in 72.7%, identical in 19% and different in 8.3%. The cross matching test was negative in all cases. The mean plasma creatinine was 0.8 ± 0.1 mg/dL with mean creatinine clearance of 103.16 ± 18.18 mL/min.

[Kidney transplantation in a patient with haemophilia A]. / Transplantation rénale chez un patient hémophile A.

A 37-year-old patient with moderate haemophilia A and end-stage renal disease underwent kidney transplantation in the University Hospital Ibn Rochd of Casablanca (Morocco). He received factor VIII replacement therapy perioperatively and until the 21st day postoperation. So, the activity rates of Factor VIII was higher than or equal to 80 % in the day of intervention and two to three days later, then between 30 and 60 % until healing. The evolution of the patient to 28 months post-transplantation is marked by a good renal function without episode of rejection or bleeding complications. The heavy surgical interventions are possible in patients with haemophilia, but depend on good replacement therapy in peri- and postoperation.

Comparison of prevention methods of intradialytic hypotension.

Our study evaluates the effectiveness of the different methods of prevention of intradialytic hypotension (IDH). We studied 16 hemodialysis patients who developed IDH at Ibn Rochd University Hospital. Each patient underwent three standard sessions with cellulose diacetate dialysers and bicarbonate dialysate with calcium concentration of 1.75 mmol/L and sodium (Na) concentration of 140 mmol/L, with dialysate temperature (T) of 37 degrees C. Then the patients were subjected to five successive sessions, each time using one of the following protocols: fixed Na dialysate concentration at 144 mmol/L, Na ramping from 152 to 138 mmol/L, one hour of ultrafiltration (UF) alone followed by three hours of standard dialysis session, dialysis with standard dialysate at T o C, or a combination of Na ramping and cold dialysate. Twelve (78%) patients underwent two sessions of HD per week of five hours each. The mean systolic blood pressure (SAP) in the interdialytic period was 110.7 (100.1-125.5) mmHg; two patients underwent anti-hypertensive treatment. The combination of ramping Na and cold dialysate as well as the cold dialysate were associated with fewer episodes of hypotension in comparison with the standard dialysate. We conclude that the combination modulation of Na and cold dialysate as well as the cold dialysate are the most effective techniques to decrease the number of IDH episodes and the average number of interventions.

Diabetic nephropathy in hemodialysis patients in casablanca.

Diabetes is the main cause of end-stage renal disease (ESRD) in the developed countries and its prevalence and incidence have been constantly increasing over the years. To determine the prevalence and profile of diabetic nephropathy in our ESRD population, we retrospectively studied 564 hemodialysis patients in ten dialysis units in Casablanca. The mean age was 49 +/-16.2 years. The diabetic nephropathy came at the third rank with a prevalence of 13.5% behind chronic glomerulonephritis (21.8%) and hypertensive nephropathy (14.7%). Almost 74% of our diabetics were type 2. From the time of diagnosis the type 2 diabetics reached the ESRD earlier than the type 1 diabetics with a mean period of 15.1 +/- 7 years and 18.8 +/- 5 years, respectively; however, the difference was not statistically significant. There was at least another microangiopathic complication in 95.4% of the patients and macroangiopathic complication in 82%. The median hemoglobin A1C in all patients was higher than normal value. We conclude that ESRD is a serious complication of diabetes, which is constantly increasing. The appropriate management of diabetes and a multidisciplinary approach are necessary to avoid it or at least delay its occurrence.

[Extramembranous glomerulonephritis and myelodysplastic syndrome]. / Glomérulonéphrite extramembraneuse et syndrome myélodysplasique.

Membranous glomerulonephritis (MGN) is the main cause of nephrotic syndrome in adults and is usually idiopathic. We report a case of nephrotic MGN associated with a myelodysplastic syndrome (MDS) in a 43 year old man. The initial treatment consisted of oral corticosteroids (1 mg/kg/day). Within 3 months proteinuria decreased from 22.4 g/day to 3.96 g/day and the blood cell count was normalized. Renal biopsy disclosed type I MGN. Ponticelli's protocol was started with a favorable effect: negative proteinuria, normal blood cell count and normal bone marrow cellularity. The association between MGN and MDS is quite rate. The possible links between the two conditions are reviewed.