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Return to Dialysis after Kidney Graft Failure

Open Journal of Nephrology 2024年第2期14卷 240-252页

作者： Ikram Ftaimi Soukaina Sakab Manal Chattahi Tarik Bouattar Loubna Benamar rabia bayahia Naima Ouzeddoun Service de Nphrologie-Dialyse-Transplantationrnale CHU Ibn Sina Rabat Universit Mohammed V Rabat Morocco

Introduction: The transition period from renal transplantation to dialysis is associated with high morbidity and mortality. The aim of this study is to describe the clinical and paraclinical characteristics, therapeutic management and evolutionary profile of patients returning to dialysis after kidney graft failure. Material and Methods: This was a retrospective, descriptive study conducted in the Nephrology-Dialysis-Renal Transplant Department at university hospital IbnSina between January 1998 and December 2021. We included all renal transplant recipients who had experienced kidney graft dysfunction and returned to dialysis. Patients with a follow-up after return to dialysis of less than 1 year were excluded. Results: Among 166 renal transplant recipients, 20 returned to dialysis after a median renal graft life of 85.5 months [42 - 186], corresponding to a prevalence of 12%. The mean age of our patients was 38.7 ± 11.9 years, with a M/F sex ratio of 2.3. Dialysis was initiated urgently in 10 patients (50%). Hemodialysis was the most commonly used modality (75%). Central venous catheterization was used in 35% of cases, including tunneled catheters. General condition is impaired in all patients, with persistent hypertension in 70% of cases. Mean uremia was 2.35 ± 0.8 g/l, mean creatinine 116 ± 48.3 mg/l, giving a mean GFR of 5.1 ± 2.2 ml/min. Mean albuminemia was 32.9 ± 6 g/l and mean hemoglobinemia 8.6 ± 1.9 g/dl. During the first year of follow-up, none of the patients died. However, 13 patients required hospitalization, with a mean length of stay of 15 days. Eight patients were hospitalized for infections and 5 for renal graft intolerance syndrome. After a mean follow-up of 22 months, 6 patients were detransplanted following graft necrosis. Conclusion: Return to dialysis after RT is fraught with a high rate of complications. The management of these patients must be optimized to improve their vital prognosis and quality of life.

关键词： Kidney Graft Failure Dialysis Detransplantation Immunosuppression

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Infective Endocarditis in Hemodialysis: Descriptive Study

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Open Journal of Nephrology 2022年第1期12卷 133-141页

作者： Nisrine Hikki Kaoutar Benraiss Mina Agrou Naima Ouzeddoun rabia bayahia Loubna Benamar Department of Nephrology-Dialysis-Renal Transplantation CHU Ibn-Sina Rabat Morocco Mohammed V University Rabat Morocco

Introduction: Infective endocarditis (IE) is a complication associated with high mortality in chronic hemodialysis patients. The aim of our study is to describe the clinical, radiological, microbiological characteristics, and risk factors of mortality in hemodialysis patients with infective endocarditis. Methods: A retrospective study from November 2019 to November 2021 including hemodialysis patients with IE hospitalized in Ibn Sina hospital center in Rabat. Results: Eighteen hemodialysis patients were included. Mean age was 49.5 ± 18 years, sex ratio was 0.8. Catheters were the access sites most commonly used (72.3%). Median duration of hemodialysis was 12 [6;24] months. Staphylococcus species is major causative bacteria in 60%. The mitral valve was the most commonly affected (44%). Frequent complications including valve insufficiency (50%), septic embolism (66.7%). Four patients underwent surgery and eight died during hospitalization (44.5%). Mitral localization of vegetation was the only factor significantly associated with mortality in our study (P Conclusion: The catheter was the most commonly used access site compared to the arteriovenous fistula. This confirms that it’s the vascular access of choice for his low rate of infectious complication compared to the catheter.

关键词： Catheters Endocarditis Hemodialysis Mortality Septic Emboli

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Pleuroperitoneal Leak in Peritoneal Dialysis: A Series of 10 Cases

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Open Journal of Nephrology 2021年第3期11卷 403-411页

作者： Anissa Benjaafar Manal Chattahi Kaoutar Sebti Tarek Bouattar Naima Ouzeddoun rabia bayahia Loubna Benamar Nephrology Department Ibn Sina Hospital Mohammed V University Rabat Morocco

Pleuroperitoneal Leak (PPL) is a rare, but serious complication of Peritoneal Dialysis (PD). It is the result of congenital or acquired communication between the 2 peritoneal and pleural cavities, and is often linked to high Intra-Abdominal Pressures (IAP). Its diagnosis is clinical, radiological and biological. In this article, we report 10 cases of PPL identified over a period of 13 years (2006-2019), that is to say, a prevalence of 5%. We suspected the diagnosis of FPP in front of dyspnea alone in 5 cases (50%), dyspnea associated with cough in 4 cases (40%). Catheter migration was reported in 5 patients (50% of cases). None of our patients presented with peritonitis before FPP. The pleurisy was right in 7 patients (70%). The exploratory puncture of the Pleural Fluid (PF) was performed in 3 patients, and which showed results consistent with the PD fluid. The drop in infusion volumes was required in 4 patients (40%) with an increase in the number of daily exchanges of CAPD with IVs ranges from 1200 - 1500 ml. PD was suspended in 6 patients (60%) for an average of 40 days (21 days - 60 days), 2 withdrawals from the technique were reported after the 2nd recurrence (20%). PD was stopped straight away in 1 patient with a hypo-permeable peritoneum with unsatisfactory residual renal function and a second who freely chose to stay in HD. The clinical cases presented show the great variability of FPP in terms of clinical and radiological presentation and therapeutic management, and focus on the significant risk of a transient or permanent withdrawal from the technique. According to literature data, Video-assisted thoracoscopic surgery appears to be promising in the event of failure of conservative treatment, and will thus prolong the survival of the technique.

关键词： Pleuroperitoneal Leaks Peritoneal Dialysis Dyspnea High Intra-Abdominal Pressures Technique Survival

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Renal Involvement in Sarcoidosis

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Open Journal of Nephrology 2023年第2期13卷 161-173页

作者： Safae Boughlala Latifa Driouch Imane Saidi Sara Elmaakoul Naima Ouzeddoun rabia bayahia Loubna Benamar Department of Nephrology-Dialysis-Renal Transplantation CHU Ibn-Sina Mohammed V University Rabat Morocco

Introduction: Sarcoidosis is a granulomatous systemic disease. Renal damage is rare but it can evolve to chronic renal failure (CRF). The aim of our work is to describe the clinical, paraclinical, histological and evolutionary profile of renal involvement during sarcoidosis and to identify the progression factors leading to CRF. Materials and Methods: This is a retrospective descriptive study from January 2009 to December 2022. We collected the medical records of patients with sarcoidosis and renal involvement. To study the progression factors leading to CRF we identified two groups of patients: the group with normal renal function and the group that developed CRF. Results: We included in our study 17 patients with renal sarcoidosis. Their mean age was 45 ± 14.7 years and the sex ratio was 0.4. Renal involvement is revealing of sarcoidosis in 76% of cases. Renal failure was diagnosed in 88% of patients. Proteinuria was positive in 76.5% of cases, leukocyturia in 59% of patients and hematuria in 41% of patients. Renal biopsy was performed in 15 patients showing tubulointerstitial nephropathy in all biopsies. Epithelioid and gigan-to-cellular granuloma without caseous necrosis was found in 46% of cases. Associated glomerular involvement such as segmental and focal hyalinosis was found in 2 patients. Corticosteroid therapy was initiated in 88% of patients for a median duration of 15 months. Normalization of renal function was achieved in 41% of patients, while 59%, i.e. 10 patients, retained a CRF, including 2 who were on dialysis. We showed a statistically significant relationship between the evolution towards CRF and the presence of interstitial fibrosis > 25%. Conclusion: Despite its rarity, renal involvement can be revealing of sarcoidosis, which can condition the prognosis and lead to CRF. Its detection allows an early diagnosis and treatment.

关键词： Sarcoidosis Renal Failure Tubulointerstitial Nephritis Granuloma Corticoids

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Systemic Capillary Leak Syndrome Secondary to COVID-19 Infection: Case Report

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Open Journal of Nephrology 2023年第3期13卷 226-233页

作者： Mariam El Galiou N’mili Manal Benamar Loubna Ouzeddoun Naima bayahia rabia Madani Naoufel Bouattar Tarik Department of Nephrology Dialysis and Transplantation Ibn Sina University Hospital Center Faculty of Medicine and Pharmacy Mohamed V University Rabat Morocco Department of Emergency Medicine Ibn Sina University Hospital Center Faculty of Medicine and Pharmacy Mohamed V University Rabat Morocco

Introduction: Systemic capillary leak syndrome (SCLS) is an increasingly recognized rare syndrome. Its diagnosis is suggested by the occurrence of edema with arterial hypotension, hemoconcentration, and paradoxical hypoalbuminemia. SCLS can be idiopathic (Clarkson syndrome) or secondary. Secondary SCLS (SSCLS) is mainly triggered by infections (especially viruses), drugs (antitumor therapy), malignancies, and inflammatory diseases. We report a case of systemic capillary leak syndrome secondary to the COVID-19 infection. Observation: A 74-year-old chronic smoker with no particular history was initially admitted to the intensive care unit (ICU) with a picture of respiratory distress secondary to a COVID-19 infection with favorable evolution, hence his transfer to the emergency services. On Day 8 of hospitalization, following the installation of arterial hypotension, not responding to filling, associated with hypoalbuminemia, and generalized edematous syndrome, and in the absence of any other explanation for this clinical picture, a SCLS secondary to COVID-19 infection was suggested. On the balance sheet, after the discovery of acute renal failure, serum creatinine went from 7.9 mg/l to 16.6 mg/l with microalbuminuria at 420 mg/24h and leukocyturia at 20 elements/mm3 without germ-evoked tubulointerstitial nephritis (TIN) secondary to a viral infection with COVID-19. The evolution was marked by the spontaneous regression of the edema and the normalization of the blood pressure figures. Discussion: The classic triad combining hypotension, hemoconcentration, and hypoalbuminemia suggests the diagnosis of SCLS once all other causes of shock have been ruled out. Hemoconcentration is less constant in SSCLS than in ISCLS. This is the case with our patient. The exact pathophysiological process of SCLS is largely unknown. Viral infections are the most common infectious cause of SCLS. The kidneys are the second-most common organs affected by the SARS-Cov-2 coronavirus

关键词： Hemoconcentration Low Blood Pressure COVID-19 Tubulointerstitial Nephritis

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Tuberculosis of Exceptional Location in a Haemodialysis Patient

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Open Journal of Nephrology 2019年第1期9卷 35-39页

作者： Moussokoro Hadja Koné Ibtissam Fares Imane Houem Loubna Benamar Naima Ouzeddoun rabia bayahia Tarik Bouattar Unit of Nephrology Dialysis and Renal Transplant CHU Ibn Sina Faculty of Medicine and Pharmacy Mohammed V University Rabat Morocco

Background: Chronic haemodialysis patients present a lack of immunity responsible for a high incidence of tuberculosis of atypical and non-pulmonary localizations. Observation: We present a clinical case of a haemodialysis patient that presents an isolated localisation of prostate tuberculosis. He had no clinical signs but had laboratory findings of inflammatory syndrome and high Prostatic Antigen (PSA) level. The diagnosis was made by histopathologic study of the piece of prostatectomy. The patient received a six-month treatment with an initial two-month phase involving four anti-tuberculosis drugs (Rifampicin, Isoniazid, Ethambutol and Pyrazinamid) followed by a four-month maintenance phase involving two drugs (Isoniazid and Rifampicin). All drugs were adapted to his dialysis condition. We noticed no side effects of drugs. Conclusion: Clinical signs of prostatic tuberculosis are not specific, mainly made of an obstructive symptom. The diagnosis of prostatic tuberculosis is based on a bundle of clinical and biological arguments. Koch Bacilli (KB) can rarely be found in urine or sperm. In haemodialysis patient, it can be masked by non specific aspect of inflammatory syndrome. The management must be adjusted and a close following up of side effects is necessary.

关键词： Tuberculosis Prostatitis Dialysis Inflammatory Syndrome

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