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Drug-Induced Acute Kidney Injury in Diabetes Mellitus

Open Journal of Nephrology 2016年第4期6卷 176-187页

作者： Amel Harzallah hayet kaaroud Mariem Hajji Fethi Ben Hamida K. Khiari I. Gorsane Taieb Ben Abdallah Department of Medicine A Charles Nicolle Hospital Tunis Tunisia Faculty of Medicine University of Tunis El Manar Tunis Tunisia Laboratory of Renal Pathology LR00SP01 Charles Nicolle Hospital Tunis Tunisia

Background: Drug-induced acute kidney injury is a common situation in clinical practice. Many treatments are involved and they are even more aggressive when associated with a predisposing factor such as diabetes. We aimed to investigate clinical features of acute drug-induced kidney injury in diabetics in order to clarify renal prognosis. Methods: This was a descriptive and analytical retrospective study including diabetics who presented drug-induced acute kidney injury, conducted in our department during the period from 1986 to 2015. Acute kidney injury was classified according to Kidney Disease Improving Global Outcomes criteria. We analyzed medical records of patients. Results: 31 patients were included with mean age of 65.41 years and gender ratio M/F at 0.93. Diabetes was type 2 in 97% of cases. Mean previous creatinine clearance was 39.33 ml/min/1.73 m2. Drugs involved were blockers of renin-angiotensin system (35%), aminoglycosides (16%), non-steroidal anti-inflammatory (16%), diuretics (13%), lipid-lowering agents (10%), rifampicin (6%) and ifosfamide (3%). Extracellular dehydration was present in nine cases (29%). Main drug combinations were with diuretics in 16 cases (52%) and with ACE inhibitor or ARB in eight cases (26%). Oligo anuria was observed in 5 cases (16%). Proteinuria with urine strips was objectified in 25 cases (81%). Acute kidney injury was grade 3 in 24 cases (77%), grade 2 in three cases (10%) and grade 1 in four cases (13%). Renal survival at 102 months was 57%. Identified renal prognosis factors were serum phosphorus >1.47 mmol/l (p = 0.01), proteinuria at urine strips (p = 0.042), dehydration (p = 0.013), oral antidiabetic treatment (p = 0.038), intravenous rehydration (p = 0.021) and insulin (p = 0.006). Conclusion: Drug-induced acute kidney injury is potentially serious in diabetics. Prevention is essential to improve the prognosis of this renal damage.

关键词： Renal Failure Nephrotoxicity Drugs

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Mortality in Kidney Transplantation

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Open Journal of Nephrology 2015年第2期5卷 25-28页

作者： Karima Boubaker Madiha Mahfoudhi Amel Gaieb Battikh hayet kaaroud Ezzeddine Abderrahim Taieb Ben Abdallah Adel Kheder Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

It’s a retrospective study whose aim was to evaluate the incidence and the mortality in a popula-tion including 329 patients who received first kidney transplants from a living donor in 269 cases and cadaveric donor in 60 cases at Internal Medicine A department between June 1986 and December 2003. Aetiologies of mortality in our kidney transplant recipients were determined. There were 157 males and 75 females having an average age of 30.8 years. After a period of follow-up of 5.64 years, 51 patients (21.98%) died. Aetiologies of mortality were multiple and were known in approximately 98% of cases. Infections were observed in 25 cases. Cancer was observed in 7 cases (13.72%). Patient survival was not affected by gender, donor age or cause of donor death. Infections represent the major cause of mortality in our patients even many years after kidney transplantation. The maximum of death occurred in the 8th year after kidney transplantation.

关键词： Kidney Transplantation Aetiology Mortality

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Epidemiological, Clinical and Follow-Up Data in a Series of Thirteen Renal Insufficiencies Complicating Sarcoidosis

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Open Journal of Clinical Diagnostics 2015年第2期5卷 50-53页

作者： Madiha Mahfoudhi Imen Gorsane Amel Gaieb Battikh Sami Turki hayet kaaroud Rym Goucha Fathi Ben Hamida Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle HospitalTunisTunisia Research Unit of Kidney Diseases(LR00SP01) Charles Nicolle HospitalTunisTunisia

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It’s a retrospective study implicating 13 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and the interest of considering sarcoidosis diagnosis in case of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 13 women with an average age of 41 years. Biological investigations showed an abnormal normocalcemia in 8 cases, a hypercalcemia in 5 cases, a hypercalciuria in 11 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 540 umol/L. The renal echography was normal in all patients. The kidney biopsy performed in all patients showed tubulo-interstitial nephritis. The extra-renal signs were: pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymphadenopathy in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 3 cases and a polyarthritis in 6 cases. Six patients benefited from hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis should be made rapidly in order to avoid end stage renal failure.

关键词： Sarcoidosis Acute Renal Failure Interstitial Nephritis Granuloma

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Amyloïdosis Complicating Behcet’s Disease

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Open Journal of Clinical Diagnostics 2016年第3期6卷 42-46页

作者： Amel Harzallah hayet kaaroud El Jery Mariem Hajji Ikram Mami Rim Goucha Sami Turki Fethi Ben Hamida Madiha Mahfoudhi Taieb Ben Abdallah Department of Medicine A Charles Nicolle Hospital Tunis Tunisia Faculty of Medicine University of Tunis El Manar Tunis Tunisia Laboratory of Renal Pathology LR00SP01 Charles Nicolle Hospital Tunis Tunisia

Background: Behcet’s disease is a vasculitis affecting several organs. A renal involvement is rarely described. It is most of the time about a renal amyloidosis. Patients and methods: It is a descriptive retrospective study concerning the patients followed in our department for a Behcet’s disease having presented a renal amyloidosis. Results: It is about 4 men with average age of 38.25 years old. The renal involvement was revealed after an average delay of 5.7 years by a nephrotic syndrome in all cases. A renal insufficiency was noted in 3 cases with an average serum creatinine of 587 μmol/l (127 - 1490). The type of the amyloidosis was AA in 2 cases. The treatment contained colchicines in every case. The evolution was marked by the worsening of the renal function leading to end stage renal disease in 3 cases. Death occurred in 1 case and one patient lost to follow up. Discussion: Renal amyloidosis can complicate the evolution of a Behcet’s disease. It occurs generally 1 to 10 years after the beginning of the disease. Once installed, it evolves generally towards the chronic renal insufficiency and can condition the forecast of this affection. Conclusion: Amyloidosis is a rare complication of the Behcet’s disease. Its screening is so desirable to improve the renal prognosis of these patients.

关键词： Amyloidosis Prognosis Behcet’s Disease

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