Usefulness of ambulatory blood pressure monitoring in chronic kidney disease: The moroccan experience.

Among patients with chronic kidney disease (CKD), hypertension (HTN) is very common and widely recognized to accelerate the progression of CKD and increase the risk for cardiovascular events. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting HTN than office blood pressure (BP) measurement. The goal of this study is to describe the ABPM characteristics in a group of CKD and hypertensive patients. A transversal study was conducted over a period of six months, to evaluate the ABPM patterns among a group of hypertensive patients with CKD (Group 1) and compared the data with a control group (Group 2). ABPM was performed with measurement rate every 15 min during daytime and 30 min at night. Nondipping BP patterns were defined as the absence of fall in nocturnal systolic and diastolic BP >10% of daytime values. Masked HTN was defined as controlled office BP (<140/90 mm Hg) with an elevated overall average BP by 24-h ABPM (>125/75 mm Hg), and white-coat HTN was defined as association of elevated BP readings (>140/90 mm Hg) in a clinical setting and normal 24-h average BP levels (<130/80 mm Hg). Fifty patients were included in each group. HTN was much longer in duration among hypertensive patients with CKD and frequently associated with obesity, dyslipidemia, and diabetes (64% vs. 39.60%). Positive proteinuria was present in 82% of CKD patients with HTN. CKD patients with HTN received more antihypertensive drugs than Group 2 patients. HTN was much more uncontrolled among CKD patients (60% vs. 24%), more serious with higher daytime and nighttime SBP, and loss of physiologic dipping during nighttime BP measurement (80%). Out-of-office BP monitoring by ABPM may improve the assessment and the successful management of HTN in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat HTN would facilitate research.

From headache to kidney tumor; an example of von Hippel- Lindau disease.

BACKGROUND: von Hippel-Lindau disease (VHL) is a rare genetic condition caused by the mutation of the VHL tumor suppressor gene and predisposing to various benign or malignant tumors involving mainly central nervous system (CNS) and retinal hemangioblastomas (RHB). Although considered as occult, multiple renal cysts and renal cell carcinoma (RCC) are frequent in VHL, occurring in nearly two-thirds of patients. RCC is the major neoplasm and the main cause of death in patients with this condition. CASE: In this report, we present a case of an occult kidney tumor revealed by neurological symptoms of cerebellar hemangioblastoma. CONCLUSION: Kidney tumor was diagnosed incidentally on abdominal tomography and confirmed by histopathology analysis.

Monitoring the microbiological quality of dialysate and treated water.

During hemodialysis and related therapies, removal of waste products from the blood is made possible across a semi-permeable membrane. The microbiological quality of treated water (TW) and dialysate influences a number of dialysis-related complications. This article is a review of the microbiological features of TW and dialysate fluid over a six-year period (February 2007 to December 2012) in the Dialysis Unit, 1 st Medico-Surgical Hospital, Agadir, Morocco. Installation of a water treatment unit has been followed by a protocol to check its quality periodically. Results of microbiological monitoring (microorganisms and endotoxins) were collected over a six-year period. Fifty-four samples of TW and 12 samples of dialysate fluid were analyzed for colony forming units (CFU) and endotoxin during this period. All dialysate samples were negative, while in the TW, 9.2% of the samples yielded >100/mL CFU and 16.7% yielded >0.06 EU/mL of endotoxins. These abnormal results happened especially during the first two first years. More frequent disinfection of the distribution loop was the corrective measure. To obtain high-quality water for hemodialysis, the appropriate system must be continuously monitored in order to get high microbiological quality of TW and dialysate fluid.

Late care in marathon runs leading to exertional heat stroke with multiple organ failure.

BACKGROUND: Exertional heat stroke (EHS) is still a main cause of death in sport. Many of EHS complications could have been prevented if EHS had been recognized and treated early and properly. CASE PRESENTATION: We report an unusual case of multiple organ failure caused by EHS due to intensive sportive activities in a hot environment with lack of primary care. A 35-year-old healthy sportive man was admitted in our hospital because of muscle aches and weakness as well as dark urine three days after a six hour marathon run (Agadir Semi-Marathon) in a very sunny day. Patient developed rhabdomyolysis, acute renal failure (ARF) requiring hemodialysis because of hyperkaliémia, azotémia and severe metabolic acidosis, disseminated intravascular coagulation and acute liver failure. Unfortunately, after eight days of intensive care, the patient died from septic shock and multiple organ failure. CONCLUSION: This case reminds us that, despite the advancements of knowledge in the area of EHS prevention, recognition, and treatment, knowledge has not been translated into practice.