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Hajji M, Saied S, Mami I, Khadhar Y, Ben Ayed T, Gorsane I, Ben Hamida F, Ziadi J, Zouaghi MK, Abderrahim E. The Tunnelled Atrial Catheter: A Promising Solution for Vascular Capital Depletion in Dialysis despite Associated Thrombi. Case Rep Nephrol 2024; 2024:5219914. [PMID: 38525052 PMCID: PMC10959585 DOI: 10.1155/2024/5219914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/12/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Longer survival in dialysis led to a higher incidence of vascular access complications and failure. With the limited access to kidney transplantation programs and peritoneal dialysis, exhaustion of vascular access for hemodialysis is an increasingly common situation. Among the available options, atrial tunneled dialysis catheter (ATDC) has been reported as an effective vascular access in this population. Methodology. We report the experiences of two nephrology centers in Tunis with ATDC as an ultimate vascular access for dialysis. Case Reports. Two patients with exhausted vasculature underwent ATDC insertion in 2020 and 2022, respectively, as a vascular access of last resort. Both patients underwent CRBI, which resolved with favorable outcomes. One case was complicated by post-operative thrombosis and was successfully treated with thrombolysis. Both patients are currently on dialysis via their ATDC with a catheter patency of 29 months. Conclusion ATDC is a life-saving and safe vascular access in cases of depleted vasculature. Little more than 50 cases have been reported in the literature during the last 30 years. As the frequency of vasculature exhaustion is expected to increase, preservation of veinous access in patients at risk of chronic kidney disease have never been more crucial.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Kidney Pathology LR00SP01, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Salah Saied
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ikram Mami
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Yassine Khadhar
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Cardiac and Vascular Surgery, La Rabta Hospital, Tunis, Tunisia
| | - Tasnim Ben Ayed
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Kidney Pathology LR00SP01, Tunis, Tunisia
| | - Jalel Ziadi
- Department of Cardiac and Vascular Surgery, La Rabta Hospital, Tunis, Tunisia
| | | | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Meriam H, Kaaroud H, Karray R, Ben Hamida F, Bouzid K, Abderrahim E. Recurrent Urolithiasis Revealing Primary Hyperparathyroidism in a Nephrology Department. Case Rep Nephrol 2024; 2024:1265364. [PMID: 38419822 PMCID: PMC10901575 DOI: 10.1155/2024/1265364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Urinary lithiasis constitutes a recurrent pathology affecting a relatively young population. The risk of progression to chronic renal failure and the cost of treatment are the most important issues. Primary hyperparathyroidism (PHPT) is responsible for urolithiasis and nephrocalcinosis in 7% of patients, and it represents the 7th cause of urolithiasis in Tunisia. Unfortunately, it remains an underdiagnosed pathology although it is curable. We aim to determine the clinical, biological, therapeutic, and evolutionary particularities of urinary lithiasis associated with PHPT in a nephrology setting. Methods This is a monocentric, retrospective, descriptive study which took place in our nephrology department during the period from January 2010 to January 2023. Ten patients were included. All of them underwent blood and urine tests and a morphoconstitutional study of the urinary stones if possible. Results The median age at diagnosis of PHPT was 42 years (34-54). The median time from the onset of kidney stones to the diagnosis of PHPT was 6.2 years (1-17). The male/female gender ratio was 0.66. Five patients had hypertension, two patients had obesity, one patient had diabetes, and three patients had urinary tract infections. Kidney stones were bilateral in eight cases and unilateral in two cases. Nine patients underwent urological intervention: surgery in 5 cases associated with nephrectomy in one case, extracorporeal lithotripsy in 4 cases, and percutaneous nephrolithotomy in two cases. The diagnosis of PHPT was retained with high or uncontrolled PTH associated with hypercalcemia in 8 cases and normocalcemic PHPT was found in 2 patients. Two patients had parathyroid adenoma and one patient had mediastinal adenoma. Radiology exploration was normal for the others patients. Surgery was performed in 7 patients and histology revealed an adenoma in 5 cases and hyperplasia in one case. The predominant urinary risk factors in our study were hypercalciuria in 6 cases and insufficient diuresis in 4 cases. Conclusion This study underlines the role of the nephrologist in the exploration of urinary lithiasis and the prevention of recurrences, especially as PHPT is a curable aetiology of urolithiasis and affects a relatively young population. The determination of the epidemiological profile of patients with stones associated with primary PHPT and lithogenic risk factors allows the primary and secondary prevention of stone formation.
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Affiliation(s)
- Hajji Meriam
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Rahma Karray
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Kahena Bouzid
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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Harzallah A, Abid H, Hajji M, Agrebi S, Ben Hamida F, Chargui S, Abderrahim E. Renal AA amyloidosis revealing extramedullary plasmocytoma. Nephrol Ther 2023; 19:594-599. [PMID: 38073243 DOI: 10.1684/ndt.2023.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Introduction Solitary plasmacytoma is a rare, localized malignancy. Bone localizations are the most common. Extramedullary plasmacytomas are much rarer. They are most often in the upper respiratory tract and can be complicated by amyloidosis. Here is an original report of a mediastinal extramedullary plasmacytoma revealed by type AA renal amyloidosis. Case presentation We present the case of a 52-year-old patient with mediastinal extramedullary plasmocytoma diagnosed by renal failure due to type AA renal amyloidosis. Treatment was based on surgery with chemotherapy based on prednisone and melphalan. The patient presented end-stage renal failure that required hemodialysis at discharge. Conclusion Extramedullary plasmacytoma is a rare tumour that may be associated with amyloidosis, usually type AL. To our knowledge, its association with AA amyloidosis has not been reported in the literature. Treatment is based on surgery combined with radiotherapy or chemotherapy.
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Affiliation(s)
- Amel Harzallah
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hanen Abid
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Meriam Hajji
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Sahar Agrebi
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Soumaya Chargui
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Ezzedine Abderrahim
- Service de médecine A, Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de pathologie rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
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Hajji M, Barbouch S, Kaaroud H, Ben Abdelghani K, Ben Hamida F, Harzallah A, Abderrahim E. Uncovering the Spectrum of Hemophagocytic Lymphohistiocytosis: A Nephrology Department's Analysis of 14 Cases. Clin Med Insights Case Rep 2023; 16:11795476231210137. [PMID: 37920369 PMCID: PMC10619340 DOI: 10.1177/11795476231210137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/10/2023] [Indexed: 11/04/2023]
Abstract
Introduction Hemophagocytic lymphohistiocytosis (HLH) is a disease of multi-organ dysfunction due to excessive immune activation causing widespread inflammation and tissue destruction. It is a severe condition associated with high morbidity and mortality. Early identification is crucial for prompt treatment. The objective of this case series is to underscore the intricacy of managing HLH in individuals with renal dysfunction. Methods This is a retrospective study of patients diagnosed with HLH in a nephrology department over a period of 30 years. We retrospectively reviewed the medical files by applying the Revised HLH-2004 criteria. Results Among the 14 female patients included, the mean age was 45.2 years (range 23-78). Nine patients presented with sudden onset of fever and chills. Physical examination revealed purpura in 3 cases, hepatomegaly and splenomegaly in 6 and 5 cases respectively, and peripheral lymphadenopathy in 1 case. Hemorrhagic complications were observed in 5 cases, hypertriglyceridemia in 9 cases, and hyperferritinemia in all cases. Hypothyroidism was observed in all cases, and impaired renal function was detected in 11 of them, with 5 experiencing it as a result of lupus nephritis, and 1 case attributed to pre-eclampsia. Hemophagocytosis was confirmed through sternal puncture in 11 cases. Treatment involved etiological therapy with corticosteroids and immunosuppressants and/or anti-infectives. Intravenous immunoglobulins were administered in 6 cases, while 2 cases required coagulation factor transfusions. Unfortunately, 9 patients did not survive. Conclusion The study highlights the need for increased awareness and prompt recognition of HLH, particularly in patients with associated renal complications.
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Affiliation(s)
- Meriam Hajji
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Nephropathology LR00SP01, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
| | - Samia Barbouch
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Nephropathology LR00SP01, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Nephropathology LR00SP01, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
| | - Khaoula Ben Abdelghani
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Nephropathology LR00SP01, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
| | - Amel Harzallah
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Nephropathology LR00SP01, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis University El Manar, Tunis, Tunisia
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Hajji M, Jebali H, Chaabouni E, Mzoughi K, Zairi I, Kraiem S, Raies L, Hamida FB, Fatma LB, Zouaghi MK, Abdallah TB. Contrast media-induced nephropathy in Tunisia: prospective case-control study with cardio-nephrological monitoring. Pan Afr Med J 2023; 45:144. [PMID: 37808435 PMCID: PMC10559155 DOI: 10.11604/pamj.2023.45.144.30749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction vascular opacification using iodinated contrast media (ICM) is often the primary diagnostic and therapeutic approach. However, the risk of post-injection nephrotoxicity of ICM is significantly higher in patients with underlying nephropathy. This study aimed to determine the incidence of Contrast Media Induced Nephropathy (CMIN) and identify predictive factors for its occurrence in patients from a cardiology department. Methods our prospective study involved 158 patients who underwent coronary angiography or angioplasty at the cardiology department between December 2017 and May 2018. Two types of ICM were used in our study: Iopromide and Iohexol. All patients received either physiological serum (9‰) or bicarbonate serum (14‰) intravenously for hydration. We defined impaired renal function as an increase in creatinine ranging from 10 to 26 µmol/L, while CMIN was defined as an increase in serum creatinine exceeding 26.5 µmol/L. We investigated the factors associated with CMIN using logistic regression analysis. Results the mean age of our patients was 60 ± 11 years (range: 29-82), with a predominance of men 63.9% (n=101). The most common cardiovascular risk factors were tobacco (36.1%, n = 57), diabetes (48.1%, n =76), hypertension (55%, n = 87). Pre-procedural creatinine averaged 81.1 ± 47.3 µmol / L with extremes ranging from 39 to 600 µmol / L. The median Mehran risk score was 3.2 (range: 0- 15). The interventional cardiology act consisted of coronary angiography in 86.2% (n=136) of cases, coronary angioplasty in 2.5% (n=4) of cases. We used iohexol and iopromide in 57.6% (n=91) and 42.4% (n=67) of cases, respectively. The overall incidence of CMIN was 9.5% (n=9). The multivariable regression analysis identified 4 risk factors independently linked to the occurrence of CMIN which were Pre-existing renal failure (OR: 6.05, 95%CI [1.23-29.62], p = 0.026), anemia (OR: 0.043, CI [1.03-8.96], p = 0.043), the toxic dose of PC (OR: 4.7, CI [1.28-17.7], p=0.02), and at a Mehran score = 11 (OR: 3.7, CI [0.88-15.6], p=0.036). Conclusion the most effective approach for CMIN is prevention, which focuses on addressing modifiable risk factors to minimize the risk especially in patients with pre-existing renal failure.
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Affiliation(s)
- Meriam Hajji
- Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hela Jebali
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Emna Chaabouni
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Khadija Mzoughi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ihssen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sondos Kraiem
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Lamia Raies
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Lilia Ben Fatma
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Mohammed Karim Zouaghi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Nephrology Department, La Rabta Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Meriam H, Bettaieb A, Kaaroud H, Ben Hamida F, Gargeh T, Mrad R, Bouzid K, Abderrahim E. Primary Hyperoxaluria Type 1: Clinical, Paraclinical, and Evolutionary Aspects in Adults from One Nephrology Center. Int J Nephrol 2023; 2023:2874414. [PMID: 37521011 PMCID: PMC10372328 DOI: 10.1155/2023/2874414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Primary hyperoxaluria type 1 (PH1) is a rare and inherited condition of urolithiasis. The aim of our study was to analyze clinical, paraclinical, and evolutionary aspects of PH1 in adult patients in our Nephrology department. Methods We conducted a retrospective single-center study between 1990 and 2021. We collected patients followed for PH1 confirmed by genetic study and/or histopathological features of renal biopsy and morphoconstitutional analysis of the calculi. Results There were 25 patients with a gender ratio of 1.78. The median age at onset of symptoms was 18 years. A delay in diagnosis more than 10 years was noted in 13 cases. The genetic study found the I244T mutation in 17 cases and 33-34 InsC in 4 cases. A kidney biopsy was performed in 5 cases, on a native kidney in 4 cases and on a graft biopsy in one case. The analysis of calculi was done in 10 cases showing type Ic in 2 cases. After a median follow-up of 13 years (1 year-42 years), 14 patients progressed to end-stage chronic renal failure (ESRD). The univariate study demonstrated a remarkable association with progression to ESRD in our population (44% vs. 56%) RR = 13.32 (adjusted ORs (95% CI): 2.82-62.79) (p < 0.01). Conclusion Progression to ESRD was frequent in our series. Early diagnosis and adequate management can delay such an evolution.
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Affiliation(s)
- Hajji Meriam
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Asma Bettaieb
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
- Department of Nephrology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Taher Gargeh
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ridha Mrad
- Department of Genetics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Kahena Bouzid
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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Ferjani M, El Euch M, Boumediene M, Jrad M, Hamida FB, Turki S, Gargah T. Tuberculosis and Takayasu arteritis: a case report. J Med Case Rep 2023; 17:306. [PMID: 37455309 DOI: 10.1186/s13256-023-04037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Takayasu arteritis is a rare and chronic granulomatous vasculitis that affects the large vessels. Takayasu arteritis targets the aorta and its branches and is still of unknown etiology. It often affects female patients under 50 years of age. A relationship between Takayasu arteritis and tuberculosis has been suggested for a long time. CASE PRESENTATION We report a severe case of Takayasu arteritis in a 10-year-old Tunisian child revealed by renovascular hypertension with concomitant pulmonary tuberculosis. CONCLUSIONS Our patient is among only a few cases of Takayasu arteritis published worldwide affecting young infants and adolescents, which underlines the strong relationship between Takayasu arteritis and tuberculosis.
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Affiliation(s)
- Maryem Ferjani
- Pediatric Department, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mounira El Euch
- Internal Medicine Department "A", Research Laboratory of Kidney Diseases (LR00SP01), Boulevard 9 Avril, Bab Souika, 1006, Tunis, Tunisia.
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Mariem Boumediene
- Department of Imaging, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mariem Jrad
- Department of Imaging, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Internal Medicine Department "A", Research Laboratory of Kidney Diseases (LR00SP01), Boulevard 9 Avril, Bab Souika, 1006, Tunis, Tunisia
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sami Turki
- Internal Medicine Department "A", Research Laboratory of Kidney Diseases (LR00SP01), Boulevard 9 Avril, Bab Souika, 1006, Tunis, Tunisia
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tahar Gargah
- Pediatric Department, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
- Medicine Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Hajji M, Kaaroud H, Ben Hamida F, Abderrahim E. Decoding Hypercalcemia and Renal Stones in a Young Adult: Could it be Dent's Disease? Clin Med Insights Case Rep 2023; 16:11795476231182591. [PMID: 37435354 PMCID: PMC10331178 DOI: 10.1177/11795476231182591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023]
Abstract
Dent's disease is a rare genetic kidney disorder characterized by proximal tubular dysfunction, nephrocalcinosis, recurrent nephrolithiasis, and chronic kidney disease. Hypercalcemia is a rare finding in this disease. In this report, we present a case of possible Dent's disease in a young adult male with hypercalcemia and chronic kidney disease. The diagnosis was evoked based on the presence of low-molecular-weight proteinuria, kidney stones, and renal failure. This case underscores the significance of considering Dent's disease as a potential diagnosis, even in patients with chronic renal disease who exhibit hypercalcemia. It also emphasizes the importance of regular monitoring and management of patients with this condition to prevent further complications.
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Affiliation(s)
- Meriam Hajji
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Kidney Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine de Tunis Université Tunis El Manar, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Kidney Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine de Tunis Université Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Laboratory of Kidney Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medecine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine de Tunis Université Tunis El Manar, Tunis, Tunisia
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Hajji M, Gorsane I, Badrouchi S, Litaiem N, Rammeh S, Ben Hamida F, Abderrahim E. Systemic lupus erythematosus presenting as lupus erythematosus tumidus and lupus nephritis: a case report. J Med Case Rep 2023; 17:242. [PMID: 37312164 DOI: 10.1186/s13256-023-03981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Lupus nephritis and lupus erythematosus tumidus (LET) are uncommon manifestations of systemic lupus erythematosus (SLE), and their coexistence as the initial presentation of SLE is exceedingly rare. Here, we report such a case, emphasizing the diagnostic challenges and therapeutic implications of this unusual association. CASE REPORT A 38-year-old North African woman presented in Nephrology department with a history of lower extremity edema, fatigue, and weight loss of 3 kg in 4 weeks. Physical examination revealed LET lesions on the chest and the Neck. Laboratory investigations showed lymphopenia, low C3 and C4 complement levels, positive antinuclear antibodies, anti-dsDNA antibodies, and anti-SSA/Ro antibodies. Renal function tests showed normal serum creatinine and nephrotic proteinuria. Renal biopsy revealed Class V lupus nephritis. Skin biopsy confirmed the diagnosis of LET, with the presence of lymphohistiocytic infiltrates and dermal mucin. The patient was diagnosed with SLE based on the 2019 EULAR/ACR criteria and treated with prednisone (1 mg/kg/day) and hydroxychloroquine. She showed significant improvement in her cutaneous and renal symptoms at 6 and 12 months follow-up. CONCLUSION The rarity of the coexistence of LET and lupus nephritis as the initial manifestation of SLE, especially in the North African population, underscores the need for further research to elucidate the immunopathogenic mechanisms and prognostic factors associated with this association.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia.
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia.
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Samaraa Badrouchi
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Noureddine Litaiem
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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10
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Hajji M, Neji M, Agrebi S, Nessira SB, Hamida FB, Barbouch S, Harzallah A, Abderrahim E. Incidence and challenges in management of hemodialysis catheter-related infections. Sci Rep 2022; 12:20536. [PMID: 36446808 PMCID: PMC9709051 DOI: 10.1038/s41598-022-23787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
Catheter-related infections (CRI) are a major cause of morbidity and mortality in chronic hemodialysis (HD) patients. In this paper, we share our experience with CRI in HD patients. We recorded 49 cases of CRI among 167 patients during a period of 40 months (January 2018-April 2021). The incidence of CRI was 3.7 per 1000 catheter-days. The revealing symptoms were dominated by fever or chills (90%). Inflammatory signs were observed in 74% of cases with respectively concurrent exit-site (51%) and tunnel infection (6%). The biological inflammatory syndrome was found in 74% of patients (average CRP level = 198.9 mg/l). Blood cultures were performed in all cases and were positive in 65% of cases. Thirteen patients have been diagnosed with Infection complications, which were respectively infective endocarditis in 7 cases, septic arthritis in 3 cases, infective myositis in one case, cerebral thrombophlebitis in 1 case and mediastinitis in 1 case. The death occurred in eleven patients, it was due to septic shock in 9 cases, pulmonary embolism in one case and neurologic alterations related to cerebral thrombophlebitis. The mean seniority in HD was 16.5 months in the group with CRI and 3.7 months in the group without CRI (p < 0.04). We did not notice significant difference in mortality between tunnelled and non-tunnelled catheters. CRI does not seem to be more severe in patients with diabetes. Duration of use of the HD catheter (p < 0.007) and ferritin level (p < 0.0001) were independent factors that predispose to CRI in our population.
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Affiliation(s)
- Meriam Hajji
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Manel Neji
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sahar Agrebi
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Saoussen Ben Nessira
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Amel Harzallah
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzedine Abderrahim
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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11
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Chargui S, Houli R, Ounissi M, Ben Hamida F, Harzallah A, Abderrahim E. Gitelman syndrome, hypomagnesemia, and venous thrombosis: An intriguing association. Clin Case Rep 2022; 10:e05542. [PMID: 35280096 PMCID: PMC8894579 DOI: 10.1002/ccr3.5542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Among salt‐wasting tubulopathies' complications, venous thrombosis is one of the rarest. We report a case of a young woman with Gitelman syndrome (GS). She presented a deep venous thrombosis in her leg and was treated with heparin with favorable outcomes. We retained hypomagnesemia as the cause of the thrombosis.
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Affiliation(s)
- Soumaya Chargui
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
- Research Laboratory of Renal Pathology LR00SP01 Charles Nicolles Hospital Tunis Tunisia
| | - Rawnak Houli
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
| | - Mondher Ounissi
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
| | - Fethi Ben Hamida
- Research Laboratory of Renal Pathology LR00SP01 Charles Nicolles Hospital Tunis Tunisia
| | - Amel Harzallah
- Internal Medicine (A) Department Charles Nicolles Hospital Tunis Tunisia
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12
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Ferjani M, El Euch M, Hammi Y, Sayari T, Naija O, Ben Hamida F, Turki S, Gargah T. Systemic lupus erythematosus‐related acute pancreatitis: An exceptional form with severe exocrine and endocrine pancreatitic failure in a Tunisian child. Clin Case Rep 2022; 10:e05423. [PMID: 35169471 PMCID: PMC8832166 DOI: 10.1002/ccr3.5423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/26/2022] Open
Abstract
Acute pancreatitis may be the first manifestation in systemic lupus erythematosus or occur during evolution. It is a rare complication, which is often associated with other visceral manifestations. Outcome is usually favorable but can be serious. We report a case of a 17‐year‐old girl with a past history of systemic lupus erythematosus who developed acute pancreatitis revealed by abdominal pain. Elevated serum amylase and lipase levels and pancreatic enlargement on tomography confirmed the diagnosis. Although high‐dose corticosteroid was prescribed, the patient died from a refractory diabetic ketoacidosis.
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Affiliation(s)
- Maryem Ferjani
- Pediatrics department Tunis Tunisia
- University of Tunis El Manar Tunis Tunisia
| | - Mounira El Euch
- University of Tunis El Manar Tunis Tunisia
- Internal medicine department « A » Tunis Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01) Charles Nicolle hospital of Tunis Tunis Tunisia
| | - Yousra Hammi
- Pediatrics department Tunis Tunisia
- University of Tunis El Manar Tunis Tunisia
| | - Taha Sayari
- Pediatrics department Tunis Tunisia
- University of Tunis El Manar Tunis Tunisia
| | - Ouns Naija
- Pediatrics department Tunis Tunisia
- University of Tunis El Manar Tunis Tunisia
| | - Fethi Ben Hamida
- University of Tunis El Manar Tunis Tunisia
- Internal medicine department « A » Tunis Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01) Charles Nicolle hospital of Tunis Tunis Tunisia
| | - Sami Turki
- University of Tunis El Manar Tunis Tunisia
- Internal medicine department « A » Tunis Tunisia
| | - Tahar Gargah
- Pediatrics department Tunis Tunisia
- University of Tunis El Manar Tunis Tunisia
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13
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Tlili S, Fatma LB, Mami I, Ghabi H, Kaab B, Wided S, Krid M, Beji S, Rais L, Hamida FB, Jebali H, Zouaghi MK. Readmissions to kidney transplantation department: incidence, causes and risk factors. Pan Afr Med J 2022; 41:305. [PMID: 35855044 PMCID: PMC9250673 DOI: 10.11604/pamj.2022.41.305.31067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION hospital readmission after kidney transplantation is an important metric for health care quality, which associated with increased morbidity, costs and transition-of-care errors. It is influenced by population demographics and the comprehensiveness of the healthcare system. The aim of this study was to evaluate incidence causes and risk factors associated with hospital readmission within the first year after transplantation. METHODS all patients undergoing kidney transplantation at a single center over a ten-year period were analyzed via retrospective chart review. A multivariable logistic regression analysis was performed to identify associated factors. RESULTS in 86 patients, the incidence of unplanned readmissions within the first year was 68.6% (n = 59). The main reasons for HR were infection (33%), renal events (32%), surgical complications (16%), and metabolic disturbances (9%). In univariate analyses, hospital readmission was associated with Dyslipidemia p=0.04; OR=2.6; 95% CI= [1.93-13.17], anemia p=0.011; OR=4.5; 95% CI = [1.33-15.6], hemodialysis p=0,012; OR=4.8 ; 95% CI= [1.3-18.5], new onset diabetes after transplantation p=0.05 ; OR=3.5 ; 95% CI= [1.6-13,80], medical history of cardiomyopathy p=0,016 ; OR=6.4 ; 95% CI = [5.4-7.5]. While independent risk factors were: hemodialysis vintage and cardiomyopathy. There was no difference in one-year patient survival and death-censored graft survival in HR group and non-HR group. CONCLUSION hospital readmissions severely affect a patient's physical and mental well-being after kidney transplantation, which is also independently associated with morbidity. Our study showed that risk factors associated with hospital readmission often reflect pretransplant comorbidity.
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Affiliation(s)
- Syrine Tlili
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Lilia Ben Fatma
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
- Corresponding author: Lilia Ben Fatma, Department of Nephrology, La Rabta Hospital, Jabbari, 1007, Tunis, Tunisia.
| | - Ikram Mami
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Hiba Ghabi
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Badreddine Kaab
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Smaoui Wided
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Madiha Krid
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Soumaya Beji
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Lamia Rais
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
| | - Fethi Ben Hamida
- Research Laboratory in Renal Pathology LR00SP01, Medicine School of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hela Jebali
- Department of Nephrology, la Rabta Hospital, Jabbari, 1007, Tunis, Tunisia
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14
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Hajji M, Barbouch S, Goucha R, Hamida FB, Gorsane I, Abderrahim E. 30 years of experience with anti-neutrophil cytoplasmic antibody glomerulonephritis in Charles Nicolle Hospital-Tunisia: a retrospective cohort study. Pan Afr Med J 2022; 42:84. [PMID: 36034042 PMCID: PMC9379431 DOI: 10.11604/pamj.2022.42.84.27914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/02/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction antineutrophil cytoplasmic antibodies (ANCA) associated Glomerulonephritis (GN) is rare but a life-threatening disease especially, particularly in patients with advanced renal failure at presentation. This study aims to evaluate the epidemiological, clinical and histopathological features of renal involvement and investigate factors associated with ESRD. Methods patients with renal biopsy-proven ANCA associated glomerulonephritis were included retrospectively over a thirty years period. The renal survival, defined as time to reach ESRD, was evaluated based on clinical parameters, histopathological classification as well as the renal risk score. Results a total of 65 patients with crescentic GN were included in the study. The mean age was 47.9 years ± 22.4 years (range: 18-78) with an M/F sex ratio at 1.13. Hematuria, proteinuria and oliguria were found in respectively 100%, 81.5% and 56.2% of cases. Sixty patients (92.3%) had renal failure at presentation, and 30 patients (46%) required initial hemodialysis (HD) therapy. The pattern of glomerular injury was categorized as mixed in 43.7% of cases, sclerotic in 34.3%, crescentic in 16.6%, and focal class in 6%. Regarding renal risk score, patients were classified in the category low risk, intermediate risk and high risk with respectively 16.9%, 44.6% and 38.4%. All patients received corticosteroids and immunosuppressive treatment. Complete, partial remission and relapses were noted in respectively 15.3%, 18% and 72% of cases. Factors associated with ESRD were serum creatinine level >500 μmol/l (P=0,0016), CRP level >60 mg/l (P = 0,0013), interstitial fibrosis (P=0,0009) and glomerulosclerosis> 10% of total glomeruli (P=0,001). The survival rate was 89%, 60.9% and 32.8% at respectively 1, 5 and 10 years. Death occurred in 10 cases (15%) caused mostly by infections (40%). Initial serum creatinine level>140 μmol/l (P=0,02), alveolar hemorrhage (P=0.001) and infections (P=0,0001) were associated with mortality. Conclusion in our cohort of ANCA GN, confirms the data showing improved patient survival but constantly high relapse risk. In addition, we observed that ANCA GN classification was predictive, as the risk of progressing to ESRD increased with the ascending category of focal, crescentic, mixed and sclerotic GN.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of renal pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
- Corresponding author: Meriam Hajji, Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia.
| | - Samia Barbouch
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of renal pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Rim Goucha
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of renal pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of renal pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of renal pathology LR00SP01, Charles Nicolle Hospital, Bab Saadoun, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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15
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Abbassi IM, El Euch M, Jaziri F, Kefi A, Hamida FB, Turki S, Abdelghani KB, Abdallah TB. Tuberculose laryngée isolée de l´adulte: localisation extra pulmonaire exceptionnelle: a case clinique. Pan Afr Med J 2022; 43:9. [DOI: 10.11604/pamj.2022.43.9.21014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 10/29/2020] [Indexed: 11/11/2022] Open
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16
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Mami I, Ghzel E, Abida R, Hlaoui F, Jebali H, Rais L, Beji S, Hamida FB, Fatma LB, Zouaghi K. Anti-glomerular basement membrane disease with intense nephrotic syndrome: a new case report. Pan Afr Med J 2021; 39:243. [PMID: 34659616 PMCID: PMC8498661 DOI: 10.11604/pamj.2021.39.243.30461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Anti-glomerular basement membrane (anti-GBM) disease was usually described as a small vessel vasculitis presenting with acute kidney injury, haematuria and non-nephrotic proteinuria. We report a case of anti-GBM disease revealed by an intense nephrotic syndrome. The urinary protein level was 12g/day. Renal biopsy only showed crescent glomerulonephritis with linear staining of IgG in direct immunofluorescence without other glomerulonephritis. Immunoglobulin G (IgG) anti-GBM antibody titer was elevated.
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Affiliation(s)
- Ikram Mami
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Emna Ghzel
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Rym Abida
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department B of Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fadwa Hlaoui
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hela Jebali
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Lamia Rais
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Soumaya Beji
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory in Renal Pathology, Medicine School of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Lilia Ben Fatma
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Karim Zouaghi
- Department of Nephrology, Dialysis and Kidney Transplantation, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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17
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Mesbahi T, Barbouch S, Najjar M, Fattoum S, Jebali H, Trabelsi R, Bacha MM, Smaoui W, Karoui C, Hamida FB, Hedri H, Rais L, Ounissi M, Zouaghi MK, Abdallah TB. End-stage renal disease at dialysis initiation: Epidemiology and mortality risks during the first year of hemodialysis. Saudi J Kidney Dis Transpl 2021; 32:1407-1417. [PMID: 35532711 DOI: 10.4103/1319-2442.344761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Chronic kidney disease (CKD) treated by hemodialysis (HD) is a worldwide major public health problem. Its incidence is getting higher and higher, leading to an alarming social and economic impact. The survival of these patients is significantly low, especially during the first year of treatment. The purpose of our study was to identify the epidemiological and clinico-biological characteristics of patients at the HD initiation and to reveal the predictive factors of mortality at three months and one year of HD. This is a prospective, analytical, and descriptive study dealing with 229 patients with an end-stage renal disease (ESRD), followed up in the Nephrology Department of Charles Nicolle Hospital and La Rabta Hospital in Tunisia, that was started HD between January and June 2017. A multivariate logistic regression analysis allowed us to identify the independent predictors of mortality at three months and one year. The average age was 60.2 ± 15.3 years, with a gender ratio of 1.41. Seventy-eight percent of patients had more than two comorbidities, 59% had diabetes, and 88% had hypertension. Diabetic nephropathy was the leading etiology of kidney disease (48.9%), while 11% of nephropathies were of unknown etiology. Only 58% were early referred to a nephrologist. The average glomerular filtration rate at HD initiation was 6.06 ± 2.33 mL/min/1.73 m2. Hypocalcemia and hyperphosphatemia were noted, respectively, in 60.8% and 84.9% of cases. Anemia was objectified in 98.6% of cases. HD was started in an emergency in 56.8% of cases. One of the most urgent indications was acute pulmonary edema (APE) for 43.8% of patients. Only 10.5% of patients had functional arteriovenous fistula at the dialysis initiation. Patients were hemodialyzed one, two, or three sessions per week, respectively, in 23.2%, 26.6%, and 50.2% of cases. The crude mortality rate was 25% and 13% in, respectively, one year and three months of HD. On multivariate analysis, we identified heart failure and insufficient dialysis dose per week as predictive factors of mortality at the 1st year of HD. C-reactive protein more than 21 mg/L, insufficient dialysis per week, modified Charlson Comorbidity Index less than 6, and APE at the dialysis initiation were identified as predictive factors of three-month mortality. Despite the short period of study, this work revealed the alarming conditions of patients at HD initiation. This critical situation is due to the delay in CKD diagnosis, the late nephrologist referral, and the lack of preparation before HD initiation.
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Affiliation(s)
- Tasnim Mesbahi
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Najjar
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Safa Fattoum
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Jebali
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Raja Trabelsi
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Wided Smaoui
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Cyrine Karoui
- Department of Nephrology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Fethi Ben Hamida
- Department of Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Lamia Rais
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Mondher Ounissi
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
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Harzallah A, Chargui S, Hajji M, Barbouch S, Ounissi M, Gorsane I, Ben Hamida F. MO231INFECTIVE ENDOCARDITIS IN CHRONIC KIDNEY DISEASE: CLINICAL AND OUTCOME’S FEATURES. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.00109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Infective endocarditis complicating chronic kidney disease is associated with high morbidity and mortality among this population particularly exposed to bacteremia.The aim of our study was to study the clinical and evolutionary features of infective endocarditis among patients with chronic renal failure.
Method
It is a retrospective and descriptive study including patients with chronic kidney disease hospitalized in our department, whom presented an infective endocarditis confirmed by modified DUKE criteria
Results
13 patients were included aged meanly of 42.69 years [27-63 years] with a sex-ratio of 0.85. Twelve were in end stage renal disease with an average duration of dialysis of 52 months [1-180 months] and in stage 5 in one case. At the time of diagnosis, vascular access was fistula in one case and a central venous catheter in 11 cases. The catheter was simple in 3 cases and tunnelled in eight cases. The circumstances of discovery were fever in 12 cases associated with an alteration of the general state with asthenia in 10 cases. Low blood pressure was present in seven cases. At biology, the mean hemoglobin level was 8.28 g/dl [6.1-10.8 g/dl]. Leukocytosis was noted in 8 cases. Mean albuminemia was 30.61g/l [24-41g/l]. Albuminemia below 35 g/l was objectified in 6 cases. Major causative organisms were Staphylococcus species in 10 cases. Trans-thoracic echography shows vegetation in 11 cases with an average size of 17.4 mm [6-37 mm] and aortic annular abscess in 2 cases. Antibiotherapy was conducted in all cases. Complications were frequent, including congestive heart failure in 2 cases, secondary septic localisations in 3 cases, hemoptysis in one case and valve perforation in 2 cases. Five patients underwent surgery after a mean delay of 32.75 days [6-47 days]. Death occurred in 8 cases.
Conclusion
Infective endocarditis is severe during chronic kidney failure and more frequent among patients on dialysis by catheter. It is associated with high morbidity and mortality. Management of central venous catheter must be enhanced. Treatment must be early to improve the prognosis of this complication.
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Affiliation(s)
- Amel Harzallah
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Soumaya Chargui
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Mariem Hajji
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Samia Barbouch
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
| | - Fethi Ben Hamida
- Charles Nicolle Hospital, Laboratory of Renal pathology LR00SP01, Tunis, Tunisia
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19
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Dhaouadi T, Abdellatif J, Trabelsi R, Gaied H, Chamkhi S, Sfar I, Goucha R, Ben Hamida F, Ben Abdallah T, Gorgi Y. PLA2R antibody, PLA2R rs4664308 polymorphism and PLA2R mRNA levels in Tunisian patients with primary membranous nephritis. PLoS One 2020; 15:e0240025. [PMID: 33002091 PMCID: PMC7529277 DOI: 10.1371/journal.pone.0240025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Primary membranous nephritis (PMN) is an autoimmune disease induced by the deposit of antibodies (Ab) to the phospholipase receptor A2 receptor (PLA2R) on podocytes. In this context, we aimed to assess the relationships between anti-PLA2R Ab, PLA2R rs4664308 SNP, PLA2R mRNA levels and PMN susceptibility and outcome. METHODS Sixty-eight PMN patients, 30 systemic lupus erythematosus (SLE) patients with secondary MN and 30 healthy control subjects served for anti-PLA2R Ab measurement by ELISA and PLA2R rs4664308 SNP genotyping by a commercial real-time PCR. Twenty patients with tubulo-interstitial nephritis (TIN) were used as controls for renal PLA2R mRNA quantification in PMN patients from kidney biopsies. PLA2R mRNA quantification was carried-out by real-time PCR after RNA extraction. RESULTS Forty-three (63.2%) PMN patients received initial therapy consisting of alternating monthly cycles of corticosteroids and cyclophosphamide. Twelve (17.6%) patients had resistant PMN to initial therapy and were consecutively treated by cyclosporine or tacrolimus. Anti-PLA2R Ab were positive in 54 (79.4%) PMN patients, while all SLE patients and controls were negative, p<0.0001. Moreover, anti-PLA2R Ab levels were significantly higher in PMN patients (134.85 [41.25-256.97] RU/ml) than in SLE patients (3.35 [2.3-4.35] RU/ml) and controls (2 [2-2.3]), p<0.0001. Consequently, a ROC curve showed for 100% specificity a sensitivity of 94.1% at a threshold of 2.6 RU/ml. Besides, Anti-PLA2R antibodies levels were significantly associated to non-remission; p = 0.002. The rs4664308*A wild-type allele was significantly more frequent in PMN patients (0.809) than in controls (0.633) and SLE patients (0.65); p = 0.008, OR [95% CI] = 2.44 [1.24-4.82] and p = 0.016, OR [95% CI] = 2.27 [1.15-4.5], respectively. Renal PLA2R mRNA levels were significantly higher in PMN patients (218.29 [66.05-486.07]) than in TIN patients (22.09 [13.62-43.34]), p<0.0001. Moreover, PLA2R mRNA levels were significantly higher in non-remission patients (fold-factor vs. partial remission = 2.46 and fold-factor vs. complete remission = 12.25); p = 1.56 10E-8. In addition, PLA2R mRNA and anti-PLA2R Ab levels were significantly correlated, Spearman Rho = 0.958, p<0.0001. CONCLUSION Anti-PLA2R Ab and renal PLA2R mRNA could be useful markers for PMN outcome predicting. The PLA2R rs6446308 SNP is associated with PMN susceptibility in Tunisians.
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Affiliation(s)
- Tarak Dhaouadi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
- * E-mail:
| | - Jihen Abdellatif
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Raja Trabelsi
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hanene Gaied
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Sameh Chamkhi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Imen Sfar
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Rym Goucha
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yousr Gorgi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
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20
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Zammouri A, Barbouch S, Najjar M, Aoudia R, Jaziri F, Kaaroud H, Hedri H, Abderrahim E, Goucha R, Hamida FB, Harzallah A, Abdallah TB. Tubulointerstitial nephritis due to sarcoidosis: Clinical, laboratory, and histological features and outcome in a cohort of 24 patients. Saudi J Kidney Dis Transpl 2020; 30:1276-1284. [PMID: 31929274 DOI: 10.4103/1319-2442.275471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal involvement is rare in systemic sarcoidosis. Among renal manifestations, tubulointerstitial nephritis (TIN) is the most commonly reported finding. We conducted the current study to investigate the clinical, laboratory, and histological features and to analyze the outcome of TIN due to sarcoidosis. We present a retrospective, single-center study of patients followed for sarcoidosis and presenting with TIN related to this systemic disease. Twenty-four patients were assessed (22 females/2 males). The mean age at diagnosis of TIN was 46.3 years. Extrarenal manifestations were dominated by thoracic involvement (95.8%), peripheral lymph nodes (54.2%), and skin lesions (33.3%). The mean proteinuria level was 0.68 g/24 h. Renal failure was diagnosed in 83.3% of cases with a median estimated glomerular filtration rate at 14.3 mL/min/1.73 m2. Nine patients presented with hypercalcemia and 12 patients with hypercalciuria. Renal biopsy was performed in 58.3% of cases. Six of the 14 patients presented with noncaseating granulomatous interstitial nephritis and eight with interstitial nephritis without granuloma. Granulomatous infiltration of renal parenchyma was complicated by vasculitis in two cases. Corticosteroid therapy was used in all patients. On follow-up analysis, four patients progressed to end-stage renal disease (ESRD) after a mean duration at 45.5 months. In the remaining patients, kidney function statistically significantly improved after one month of treatment compared to the time when the diagnosis was initially established (P = 0.031). We found that the predictive factors of progression to ESRD were multiorgan involvement (P = 0.032), advanced fibrosis F3 (P = 0.0006), and extensive interstitial granulomas (P = 0.007) and these were independently correlated with ESRD. Corticosteroid therapy seems to be effective in sarcoid TIN, but some degree of persistent renal failure is possible which can be predicted from both histologic findings and initial response to steroid therapy.
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Affiliation(s)
- Asma Zammouri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- Department of Nephrology; Laboratory Department of Renal Pathology Research (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Najjar
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raja Aoudia
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Nephrology; Laboratory Department of Renal Pathology Research (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Nephrology; Laboratory Department of Renal Pathology Research (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Amel Harzallah
- Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Nephrology; Laboratory Department of Kidney Transplantation, Immunology and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
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21
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Gorsane I, Ayed TB, Aoudia R, Kaaroud H, Hamida FB, Harzallah A, Abdallah TB. Simultaneous acute pancreatitis and angioedema associated with angiotensin-converting enzyme inhibitor. Saudi J Kidney Dis Transpl 2020; 30:1479-1484. [PMID: 31929301 DOI: 10.4103/1319-2442.275498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEI) are commonly prescribed drugs for blood pressure (BP) control and renal protection. The use of ACEI is not associated with an increased risk of acute pancreatitis and ACEI-induced angioedema is rare. A 36-year-old woman presented with vomiting, headache, and aphasia. Her BP was 220/100 mm Hg. urine analysis revealed proteinuria (2+), hematuria (3+). Serum creatinine level was at 1125 μmol/L. She had anemia with 6.1 g/dL of hemoglobin and thrombocytopenia (61,000/mm3). Renal histology revealed lesions of thrombotic microangiopathy. The diagnosis of atypical hemolytic uremic syndrome was made by the complement factor I deficiency. Plasma exchanges could not be done. She was placed on peritoneal dialysis for renal insufficiency. We introduced an ACE (captopril) for the treatment of high BP. Twelve-hours after taking the first dose, she experienced severe epigastric pain and two episodes of vomiting. Serum lipase was 560 IU/L, and abdominal computed tomography showed Stage B pancreatitis. Twenty-four hours later, the patient developed marked edema of the neck region without dyspnea or dysphonia. Cervical ultrasound revealed the infiltration of the subcutaneous tissues. Captopril was stopped with the progressive disappearance of the edema. Serum lipase was 350 IU/L and then normalized at the end of the 4th day. Clinicians should be careful about widely used drugs and their side effects. ACEI can cause potentially life-threatening complications such as angioedema and acute pancreatitis. Possibly, there could be a common mechanism for the onset of pancreatitis and angioedema under ACEI.
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Affiliation(s)
- Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University; Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Tasnime Ben Ayed
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Raja Aoudia
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Amel Harzallah
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University; Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, Tunisia
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22
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Zouaghi MK, Lammouchi MA, Hassan M, Rais L, Krid M, Smaoui W, Jebali H, Kheder R, Hamida FB, Moussa FB, Fatma LB, Beji S. Determinants of patency of arteriovenous fistula in hemodialysis patients. Saudi J Kidney Dis Transpl 2019; 29:615-622. [PMID: 29970738 DOI: 10.4103/1319-2442.235183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The arteriovenous fistula (AVF) is the vascular access of the first choice for hemodialysis (HD). Studies on patency of AVF and its affecting factors reveal a high risk for access failure. The aim of this study was to assess the primary and secondary AVF patency and their determinant factors. It was a retrospective, descriptive study conducted in the HD facility of the Nephrology Department in Rabta University Hospital. We included AVF created before December 2009 in end-stage renal disease (ESRD) patients. The end of the follow-up was fixed in December 2013. We included 126 AVFs created in 111 patients; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had peripheral vascular disease. The primary patency rates were 78% at one year and 42% at five years. The secondary patency rates were 80% at one year and 69% at five years. Multivariate analysis revealed that the factors affecting the primary patency of AVF were: the use of jugular catheter for longer than three months (odds ratio (OR):1.91, P = 0.044) and a C-reactive protein >5 mg/L (OR: 1.7, P = 0.049). Aging (>65 years) (OR: 2.46, P = 0.042), referral time to a nephrologist <6 months before onset of ESRD (OR: 2.87, P = 0.015), absence of an antiplatelet therapy (OR: 4.47, P = 0.005), and serum phosphorus <45 mg/L (OR: 2.07, P = 0.045) were the significant impairing risk factors for secondary AVF patency. Our study suggests that early referral and creation of AVF and maturation before ESRD as well as its adequate monitoring are essential for maintaining patency.
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Affiliation(s)
- Mohamed Karim Zouaghi
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Mohamed Ali Lammouchi
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Mohanad Hassan
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Lamia Rais
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Madiha Krid
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Wided Smaoui
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Hela Jebali
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Rania Kheder
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Research Laboratory of Renal Pathology LR00SP01, Tunis Medical School, Tunis el Manar University, Tunis, Tunisia
| | - Fatma Ben Moussa
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Lilia Ben Fatma
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
| | - Soumaya Beji
- Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia
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23
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El Euch M, Hentati O, Mahfoudhi M, Bani W, Hamida FB, Jaziri F, Abdelghani KB, Turki S, Abdallah TB. Extensive sphenoid chordoma mimicking a prolactinoma. Pan Afr Med J 2019; 33:138. [PMID: 31558936 PMCID: PMC6754828 DOI: 10.11604/pamj.2019.33.138.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 02/02/2019] [Indexed: 11/11/2022] Open
Abstract
The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.
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Affiliation(s)
- Mounira El Euch
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Olfa Hentati
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Madiha Mahfoudhi
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Wifak Bani
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | | | - Sami Turki
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Internal Medicine Department « A », University of Tunis El Manar, Tunis, Tunisia
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24
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El Ati Z, Lamia R, Cherif J, Jbali H, Fatma LB, Mami I, Khedher R, Smaoui W, Krid M, Hamida FB, Beji S, Zouaghi MK. Thalidomide-induced bronchiolitis obliterans organizing pneumonia in a patient with multiple myeloma. Saudi J Kidney Dis Transpl 2019; 30:974-977. [PMID: 31464258 DOI: 10.4103/1319-2442.265477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thalidomide, which is an angiogenesis inhibitor and immunomodulator that reduces tumor necrosis factor-alpha, has regained value in the treatment of multiple myeloma. Serious pulmonary complications due to thalidomide use remain relatively uncommon. We describe a case of bronchiolitis obliterans organizing pneumonia (BOOP) due to thalidomide. A 51-year-old man with IgG lambda myeloma was treated with thalidomide and dexamethasone. Seven days after the beginning of chemotherapy, the patient presented a fever and a persistent cough. Auscultation revealed crackles in both pulmonary bases. The chest X-ray showed a diffuse bilateral alveolar-interstitial syndrome. Computed tomography scan revealed bilateral pulmonary involvement, with bilateral interstitial alveolar infiltration and ground-glass pattern consolidations. Pulmonary infection, malignant tumor, and lung involvement of multiple myeloma were excluded through various tests. Thalidomide-induced BOOP was suspected, and the drug was withdrawn and replaced by Melphalan. The patient had complete resolution of his symptoms and radiologic pulmonary involvement on discontinuation of the drug. In the absence of other etiologies, physicians should be cognizant of this potential complication in patients receiving thalidomide who present with respiratory symptoms.
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Affiliation(s)
- Zohra El Ati
- Department of Hemodialysis, Tahar Sfar Hospital, Mahdia, Faculty of Medicine, Monastir University, Monastir, Tunisia
| | - Rais Lamia
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Jouda Cherif
- Department of Pneumology, La Rabta Hospital, Tunis, Tunisia
| | - Hela Jbali
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | | | - Ikram Mami
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Rania Khedher
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Wided Smaoui
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Madiha Krid
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Soumaya Beji
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia
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25
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Helal I, Handous I, Khadhar M, Bezzine H, Hamida FB, Abdallah TB. Ruptured intracranial aneurysm and recessive polycystic kidney Disease: A Rare Association. Saudi J Kidney Dis Transpl 2019; 30:982-984. [PMID: 31464260 DOI: 10.4103/1319-2442.265479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is the most common childhood-onset ciliopathy. Intracranial aneurysms (ICA) are a serious complication of autosomal dominant polycystic kidney disease (ADPKD). However, there are only three reports about ICA in an adult patient with ARPKD. We describe a rare case of a 29-year-old man with ARPKD presenting with subarachnoid hemorrhage secondary to a ruptured intracranial aneurysm. The diagnosis of ARPKD was at the age of eight years based on typical ultrasonography findings with polycystic kidneys and liver disease. Magnetic resonance cholangiography showed a nonobstructive dilatation of intrahepatic bile ducts. Liver biopsy showed hepatic fibrosis. None of the family members was affected. At the age of 15 years, he had progressed to end-stage kidney disease, and hemodialysis was started. The patient had always a severe arterial hypertension. At the age of 29 years, he complained of headaches with an uncontrolled hypertension and disturbance of consciousness, computed tomography angiography showed subarachnoid hemorrhage and multiple cerebral aneurysms. Early neurologic screening of intracranial aneurysm should be recommended in ARPKD like in ADPKD patients.
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Affiliation(s)
- Imed Helal
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Insaf Handous
- Department of Medicine A (M8), Charles Nicolle Hospital, Tunis, Tunisia
| | - Meriam Khadhar
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hamida Bezzine
- Department of Medicine A (M8), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Taib Ben Abdallah
- Department of Medicine A (M8), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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26
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Harzallah A, Kaaroud H, Boubaker K, Barbouch S, Goucha R, Hamida FB, Abdallah TB. Acute kidney injury with granulomatous interstitial nephritis and vasculitis revealing sarcoidosis. Saudi J Kidney Dis Transpl 2019; 28:1157-1161. [PMID: 28937078 DOI: 10.4103/1319-2442.215120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is an inflammatory disease that affects mostly the lungs and lymph glands. Renal involvement is rare and especially vasculitis. We report a case who presented an acute kidney failure and had sarcoidosis with vasculitis and nodular splenic involvement. A 35-year-old woman presenting a Lofgren syndrome was hospitalized for acute renal failure with cervical lymphadenopathy without other clinical findings. Laboratory data disclosed elevated angiotensin converting enzyme serum level. Abdominal ultrasound showed a multinodular spleen. Renal histology revealed granulomatous interstitial nephritis with necrotizing vasculitis. Outcome was favorable after the institution of high dose corticosteroids along with cyclophosphamide. Renal involvement is rare in sarcoidosis. However, the diagnostic delay should be avoided to improve the outcome.
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Affiliation(s)
- Amel Harzallah
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Karima Boubaker
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Laboratory of Renal Pathology LRSP001, Charles Nicolle Hospital, Tunis, Tunisia
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El Euch M, Haddad S, Mahfoudhi M, Hamida FB, Jaziri F, Abdelghani KB, Turki S, Abdallah TB. [Celiac disease in adult patients revealed by polyserositis: about a case]. Pan Afr Med J 2018. [PMID: 29515723 PMCID: PMC5837179 DOI: 10.11604/pamj.2017.28.105.10878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Celiac disease (CD) is an autoimmune disease affecting multiple organs. It often presents as gastrointestinal manifestations associated with malabsorption. However, serosa involvement uncommonly reveals this enteropathy, making the diagnosis difficult. We here report the case of JA, aged 63 years, admitted to hospital to detect the cause of malabsorption syndrome associated with polyserositis signs including pleurisy, pericarditis, ascites and hydrocephalus. The diagnosis of CD was based on endoscopic signs without serology tests. Patient's evolution was partially favorable, due to lack of compliance with a gluten-free diet. Our study reports the first case of CD revealed by polyserositis. CD should be suspected in patients with malabsorption syndrome, in the absence of evocative signs.
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Affiliation(s)
- Mounira El Euch
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie
| | - Souha Haddad
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie
| | - Madiha Mahfoudhi
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie.,Laboratoire de Recherche des Maladies Rénales (LR00SP01), Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie.,Laboratoire de Recherche des Maladies Rénales (LR00SP01), Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fatima Jaziri
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie
| | | | - Sami Turki
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie
| | - Taïeb Ben Abdallah
- Service de Médecine Interne « A » Hôpital Charles Nicolle, Tunis, Tunisie
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Euch ME, Hddad S, Mahfoudhi M, Maktouf H, Ben Hamida F, Jaziri F, Ben Abdelghani K, Turki S, Ben Abdallah T. A Case of Type 1 Autoimmune Pancreatitis (AIP), a Form of IgG4-Related Disease (IgG4-RD). Am J Case Rep 2017; 18:822-825. [PMID: 28736430 PMCID: PMC5539804 DOI: 10.12659/ajcr.904263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/28/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Type 1 autoimmune pancreatitis (AIP), also known as lymphoplasmacytic sclerosing pancreatitis (LPSP), is a rare cause of chronic pancreatitis, characterized by a fibro-inflammatory process. However, patients with AIP may have a good response to corticosteroid therapy. We describe a Tunisian patient with AIP that was confirmed to be an IgG4-related disease (IgG4-RD). CASE REPORT We describe a case of a 70-year-old man who was admitted to hospital for obstructive jaundice and abdominal pain. Serum liver function tests were abnormal and upper abdominal computed tomography (CT) imaging showed diffuse pancreatic swelling and strictures of the main pancreatic duct without any focal lesion. Pancreatico-biliary magnetic resonance imaging (MRI) showed a thickened rim surrounding the pancreatic duct Serum IgG4 levels were elevated, resulting in a diagnosis of IgG4-related AIP. The patient showed a good clinical, biochemical, and radiological response following steroid therapy in combination with azathioprine. CONCLUSIONS The diagnostic workup of IgG4-RD is complex and usually requires a combination of clinical examination, imaging, and serological analysis. As this case report has demonstrated, IgG4-RD should be considered in patients who present with pancreatitis or AIP, because of the favorable response to steroid therapy, particularly when treatment is initiated early.
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Affiliation(s)
- Mounira El Euch
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Souha Hddad
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Madiha Mahfoudhi
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Maktouf
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Khaoula Ben Abdelghani
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Sami Turki
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Taïeb Ben Abdallah
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
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Mami I, Harzallah A, Kaaroud H, Aoudia R, Hamida FB, Goucha R, Abdallah TB. Nondiabetic renal disease in patients with type 2 diabetes. Saudi J Kidney Dis Transpl 2017; 28:842-850. [PMID: 28748887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Diabetic nephropathy (DN) is one of the major complications of type 2 diabetes mellitus (T2DM). The diagnosis of DN is mostly clinical. Kidney biopsy is indicated only if nondiabetic renal disease (NDRD) is suspected. This study is aimed to assess the prevalence of NDRD and to determine predictor and prognostic factors of DN, NDRD. It was a retrospective analytic study including T2DM patients in whom renal biopsies were performed at our department from 1988 to 2014. Seventy-five patients were included. Mean age was 52.7 years with sex ratio at 1.56. Renal biopsy findings were isolated NDRD in 33 cases, NDRD superimposed on DN in 24 cases, and isolated DN in 18 cases. Most common NDRD found were focal segmental glomerulosclerosis (21%) and membranous nephropathy (19%). Multivariate analysis showed that the absence of ischemic heart disease [odds ratio (OR) = 0.178, 95% confidence interval (CI) = 0.041-0.762], absence of peripheral vascular disease (OR = 0.173, 95% CI = 0.045-0.669), and presence of hematuria (OR = 7.200, 95%CI = 0.886-58.531) were independent predictors of NDRD. 24 patients reached end-stage renal disease 55% in DN group, 16% in DN associated to NDRD group, and 30% in NDRD group. The prevalence of NDRD found in our study confirmed usefulness of renal biopsy in patients with T2DM, especially in those without degenerative complications, hypertension, and insulin therapy.
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Affiliation(s)
- Ikram Mami
- Department of Medecine A, Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Amel Harzallah
- Department of Medecine A, Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medecine A, Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Raja Aoudia
- Department of Medecine A, Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Faculty of Medicine, University of Tunis El Manar; Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Faculty of Medicine, University of Tunis El Manar; Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Medecine A, Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Harzallah A, Kaaroud H, Hajji M, Mami I, Goucha R, Hamida FB, Barbouch S, Abdallah TB. Predictive factors of mortality in a tunisian cohort with systemic lupus erythematosus. Saudi J Kidney Dis Transpl 2017; 28:792-798. [PMID: 28748881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Mortality in systemic lupus erythematosus (SLE) has decreased with the advent of immunosuppressive therapy and the development of hemodialysis. This study aims to evaluate the survival rate, factors of poor prognosis, and causes of death in SLE in a Tunisian series. The records of all SLE patients followed up in a single center during 1974-2014 were reviewed. The causes of death were identified. Prognostic factors of survival were analyzed by multivariate analysis using the comparison of the survival rates by the log-rank test. Two hundred ninety-nine patients with SLE were included (274 women, 25 men) aged meanly of 27.52 years at diagnosis. The death occurred in 50 cases (16.7%). The mean age at death was 28.46 years (14-69 years). The patient survival rates at 5, 10, and 20 years were 83.8%, 78.6%, and 56.7%, respectively. The leading causes of death were active SLE (50%) and infectious complications (36%). Independent factors of poor prognosis identified by multivariate analysis were myocarditis (P = 0.029), splenomegaly (P = 0.0015), and worsening of renal function (P = 0.004). Remission was identified as a protective factor (P = 0.047). Our study shows that renal disease remains the primary cause and the main predictor of death in SLE, which is consistent with the literature data.
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Affiliation(s)
- Amel Harzallah
- Department of Medicine A; Department of Laboratory of Kidney Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A; Department of Laboratory of Kidney Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mariem Hajji
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Ikram Mami
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Rim Goucha
- Department of Laboratory of Kidney Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Laboratory of Kidney Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Samia Barbouch
- Department of Medicine A; Department of Laboratory of Kidney Pathology - LR00SP01, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
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Jebali H, Hajji M, Rais L, Hamida FB, Beji S, Zouaghi MK. Clinicopathological findings and outcome of lupus nephritis in Tunisian children: a review of 43 patients. Pan Afr Med J 2017; 27:153. [PMID: 28904681 PMCID: PMC5567971 DOI: 10.11604/pamj.2017.27.153.10915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 05/16/2017] [Indexed: 12/02/2022] Open
Abstract
We report clinical and renal histological data, treatment modalities and outcome of 43 Tunisian children with biopsy-proven lupus nephritis seen over a 23-year period. There were 39 girls and 4 boys with a mean age of 12.5 years at diagnosis of lupus nephritis and followed for a mean period of 77 months. Renal symptoms included urinary abnormalities in all patients, hypertension in 40% of cases, nephrotic syndrome in 60% of cases and renal failure in 25% of cases. Class IV and class III nephritis were observed in 48.8 % and 30.2 % respectively. Corticosteroids were used in all cases, associated to immunosuppressive therapy in 23%. Overall survival was 86% at 5 years and 74% at 10 and 15 years. Renal survival was 83% at 5 and 10 years and 63% at 15 years. Initial renal failure and tubulointerstitial fibrosis were significantly increased risk for the development of end-stage renal disease in our study group. Renal histological findings provide the basis for treatment recommendations. Timely performed renal biopsy is greatly needed to accurately determine the prognosis and to guide treatment in children lupus nephritis.
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Affiliation(s)
- Hela Jebali
- Nephrology Departement, La Rabta Hospital, Tunis, Tunisia
| | - Meriam Hajji
- Nephrology Departement, La Rabta Hospital, Tunis, Tunisia
| | - Lamia Rais
- Nephrology Departement, La Rabta Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Laboratory of Kidney pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Soumaya Beji
- Nephrology Departement, La Rabta Hospital, Tunis, Tunisia
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Barbouch S, Hajji M, Jaziri F, Harzallah A, Fellah E, Hedri H, Hamida FB, Abdelghani KB, Abdallah TB. Association between autosomal dominant polycystic kidney disease and autoimmune diseases: A simple coincidence or more? Saudi J Kidney Dis Transpl 2017; 28:441-444. [PMID: 28352038 DOI: 10.4103/1319-2442.202772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Samia Barbouch
- Department of Medicine A, Charles Nicolle Hospital; Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Amel Harzallah
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Eya Fellah
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital; Laboratory of Renal Pathology LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
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Hajji M, Harzallah A, Kaaroud H, Jerbi M, Chargui S, Younsi FE, Hamida FB, Abdallah TB. [Exhaustion of vascular capital in patients on hemodialysis: what will be the outcome?]. Pan Afr Med J 2017; 25:237. [PMID: 28293353 PMCID: PMC5337301 DOI: 10.11604/pamj.2016.25.237.10665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/02/2016] [Indexed: 11/11/2022] Open
Abstract
Despite advances in the treatment of chronic renal failure, vascular access remains the weakest link in renal replacement therapy (RRT) and the leading cause of morbidity in patients on hemodialysis We report the case of a young female patient with chronic renal insufficiency secondary to vascular nephropathy on periodic hemodialysis and whose vascular capital was early exhausted due to iterative thromboses in arteriovenous fistulas and failure in peritoneal dialysis. Protein C deficiency was objectified. The patient underwent tunneled hemodialysis catheter insertion at the level of the right atrium via a right anterolateral thoracotomy with cannulation of the inferior vena cava, with poor functional outcome after three months of use. Since then she has been dialyzed using puncture of the external jugular veins.
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Affiliation(s)
- Meriam Hajji
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Amel Harzallah
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hayet Kaaroud
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Mona Jerbi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Soumaya Chargui
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi El Younsi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie; Faculté de Médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
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Rais L, El Ati Z, Ben Fatma L, Kheder R, Jebali H, Smaoui W, Krid M, Ben Hamida F, Ben Moussa F, Beji S, Zouaghi MK. Acute tubular necrosis following transurethral resection of the Prostate using Glycine as irrigating fluid. Tunis Med 2017; 95:139-141. [PMID: 29424875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Transurethral resection of the prostate is currently the gold standard for the surgical treatment of the benign prostatic hyperplasia. This surgery may lead transurethral resection of the prostate (TURP) syndrome and in some cases, acute tubular necrosis can develop. We report a patient who developed hyponatremia, hemolysis and oliguric acute renal failure as a major complication following TURP using glycine as irrigating fluid.A 64-year-old man was admitted for a prostate resection procedure. Physical examination revealed a healthy elderly man. Preoperative laboratory data showed serum sodium 140 mEq/L, blood urea nitrogen (BUN) 0.6 g/L, creatinine 0.7 mg/dL and hemoglobin 12.9 g/dL. Few hours after, the patient becomes incoherent and developed oliguria, nausea and vomiting. The laboratory data revealed rapidly elevating BUN and creatinine levels (BUN 2.4 g/L; creatinine 6.1 mg/dL), the serum sodium concentration decreased by 14 meq/L. A decreased hemoglobin level (7.4 g/dL) with an elevated lactate dehydrogenase level (665 U/L) was observed. Renal ultrasonography was normal. The diagnosis of acute tubular necrosis complicating TURP syndrome was retained. The hyponatremia was slowly corrected to 132 mmol/L by diuresis and fluid restriction. The renal function recovered after four hemodialysis sessions. Using glycine as an irrigant for TURP may cause hyponatremia, hemolysis and also acute renal failure, especially in patients with longer resection time. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.
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Hamida FB, Barbouche S, Helal I, Mondher O, Fatma LB, Smaoui W, Gharbi C, Karoui C, Kheder A, Maiz HB, Abdallah TB. Mineral and Bone Status in Tunisian Maintenance Hemodialysis Patients: The National Bone and Mineral Metabolism Observatory. Nephrol Ther 2017. [DOI: 10.4172/2161-0959.1000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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El Euch M, Mahfoudhi M, Skouri W, Hamida FB, Jaziri F, Abdelghani KB, Turki S, Abdallah TB. Pseudotumeur cérébrale révélant une sarcoïdose. Pan Afr Med J 2017. [PMID: 29515731 PMCID: PMC5837164 DOI: 10.11604/pamj.2017.28.113.10471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La sarcoïdose est une granulomatose multi viscérale d'étiologie inconnue qui peut revêtir des tableaux cliniques et radiologiques diverses. Les localisations cérébrales bien que rares, peuvent se présenter sous forme pseudo-tumorale trompeuse. Nous rapportons l'observation d'un jeune adulte Tunisien hospitalisé pour hypertension intracrânienne en rapport avec une lésion pseudotumorale radiologique qui a révélé une sarcoïdose systémique.
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Affiliation(s)
- Mounira El Euch
- Service de Médecine Interne «A» Hôpital Charles Nicolle, Tunis, Tunisie
| | - Madiha Mahfoudhi
- Service de Médecine Interne «A» Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de Recherche des Maladies Rénales (LR00SP01), Hôpital Charles Nicolle, Tunis, Tunisie Faculté de Médecine de Tunis, Tunisie
| | - Wafa Skouri
- Service de Médecine Interne «A» Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Service de Médecine Interne «A» Hôpital Charles Nicolle, Tunis, Tunisie
- Laboratoire de Recherche des Maladies Rénales (LR00SP01), Hôpital Charles Nicolle, Tunis, Tunisie Faculté de Médecine de Tunis, Tunisie
| | - Fatima Jaziri
- Service de Médecine Interne «A» Hôpital Charles Nicolle, Tunis, Tunisie
| | | | - Sami Turki
- Service de Médecine Interne «A» Hôpital Charles Nicolle, Tunis, Tunisie
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Helal I, Elkateb H, Hedri H, Hajri M, Hamida FB. Efficacy and safety of calcium acetate-magnesium carbonate in the treatment of hyperphosphatemia in dialysis patients. Saudi J Kidney Dis Transpl 2016; 27:1162-1167. [PMID: 27900961 DOI: 10.4103/1319-2442.194604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A phosphate binder combining calcium and magnesium offers an interesting therapeutic option to control hyperphosphatemia in dialysis patients. We investigated the effectiveness and tolerance of calcium acetate-magnesium carbonate (Ca-Mg). This is a 16-week prospective study including 16 dialysis patients. After an initial two-week washout period, serum phosphorus (sPho) ≥1.8 mmol/L, serum calcium (sCa) ≤2.6 mmol/L, and serum magnesium ≤1.5 mmol/L were the main inclusion criteria. The initial dose of Ca-Mg depended on sPho level and was titrated for every two weeks to have a sPho ≤ 1.8 mmol/L. A second two-week washout period followed the 12 weeks of treatment. Ca-Mg significantly reduced the mean sPho levels from 2.14 to 1.75 mmol/L by the end of the 12-week treatment period (P <0.006). Two weeks after the completion of the Ca-Mg study, the mean sPho levels increased to 2.2 mmol/L. The mean sCa levels did not significantly change during the Ca-Mg trial. The mean serum intact parathyroid hormone declined significantly from 446 pg/mL at the beginning of the study to 367 pg/mL at the end of the 12-week treatment period (P = 0.0002). Digestive tolerance was good in all patients which allowed good compliance. There were no episodes of hypercalcemia. However, six patients had a moderate hypermagnesemia (21 episodes) requiring adjustment of treatment dose. The Ca-Mg proved to be effective in the control of hyperphosphatemia in dialysis patients with good clinical and biological tolerance. Thus, in patients with hypercalcemia or poor tolerance to calcium carbonate, Ca-Mg might be a good alternative.
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Affiliation(s)
- Imed Helal
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hanene Elkateb
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hafedh Hedri
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Malika Hajri
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A (M8); Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Khadhar M, Helal I, Goucha R, Ben Hamida F, Abderrahim E, Ben Abdallah T. MP134IDIOPATHIC MINIMAL CHANGE NEPHROTIC SYNDROME IN ADULTS: FREQUENCY AND PREDICTORS FACTORS OF RELAPSES. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw185.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khadhar M, Helal I, Goucha R, Ben Hamida F, Abderrahim E, Ben Abdallah T. MP151IDIOPATHIC MINIMAL CHANGE DISEASE IN ADULTS: LONG TERM RISK FACTORS FOR CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw185.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Azaiez S, Barbouch S, Harzallah A, Jaziri F, Aoudia R, Gorsane I, Ben Hamida F, Ben Abdelghani K, Ben Abdallah T. MP104MULTIPLE MYELOMA AND RENAL IMPAIRMENT. A SERIES OF 162 PATIENTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw183.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kaaroud H, Oueslati I, Harzallah A, Ben Nacef I, Khiari K, Ben Hamida F. Benzylthiouracil induced ANCA associated glomerulonephritis in patients with graves' disease. Tunis Med 2015; 93:696-701. [PMID: 27126427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Renal complications in Graves' disease are rare and may be related either to the disease itself or secondary to antithyroid drugs. AIM We report 6 cases of renal damage in patients with Graves' disease treated with Benzylthiouracil collected over a period of 14 years. METHODS There were 6 women with a mean age of 37.86 ± 14.25 years. All patients developed renal vasculitis associated with ANCA. The signs were dominated by renal proteinuria and renal failure associated with hematuria in all cases. The lung involvement was the most common extrarenal manifestation occurred in 4 patients (alveolar hemorrhage in 2 cases, lymphocytic alveolitis in 1 case and pleurisy in 1 case). The benzylthiouracil was discontinued in 3 patients still under treatment. Corticosteroid therapy was used alone or in combination with cyclophosphamide in all cases. Plasmapheresis sessions were made during the alveolar hemorrhage. A complete remission was obtained in one case and incomplete remission in 2 cases. The other 3 patients required chronic hemodialysis. One patient died of sepsis. CONCLUSION The possibility of renal impairment in antithyroid drugs treated Graves' disease requires monitoring to detect urinary abnormalities in order to early initiate therapy and improve patient's outcome.
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Ramdani B, Khemri D, Ben Hamida F, Sqalli T, Boulahia Y, Ben Fatma L, Laouad I, Benziane A, Mongi Bacha M, Zouaghi K, El Hassan Trabelsi M, Couchoud C. [Consideration on the implementation of a registry of renal transplant recipients and a registry of living donors in the Maghreb countries]. Nephrol Ther 2015; 11:521-4. [PMID: 26387885 DOI: 10.1016/j.nephro.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Benyounès Ramdani
- Service de néphrologie, CHU Ibn Rochd, quartier des Hôpitaux, 20100 Casablanca, Maroc
| | - Dalila Khemri
- Service de néphrologie, CHU Mustapha Pacha, place du 1(er)-Mai-1945, Sidi M'Hamed, 16000 Alger, Algérie
| | - Fethi Ben Hamida
- Laboratoire de recherche de pathologie rénale (LR00SP01), service de néphrologie, CHU Charles-Nicolle, boulevard du 9-Avril, 1006 Tunis, Tunisie
| | - Tarik Sqalli
- Service de néphrologie, CHU Hassan II, BP 1835 Atlass, Fès, Maroc
| | - Younes Boulahia
- Service de néphrologie, hôpital central de l'armée, BP 244 Kouba, Alger, Algérie
| | - Lilia Ben Fatma
- Service de néphrologie, CHU La Rabta, BP 1007 Jabbari, Tunis, Tunisie
| | - Inass Laouad
- Service de néphrologie, CHU Mohammed VI, Marrakech, Maroc
| | - Ali Benziane
- Service de néphrologie, CHU Beni-Messous, 16206 Alger, Algérie
| | - Mohamed Mongi Bacha
- Service de néphrologie, CHU Charles-Nicolle, boulevard du 9-Avril, 1006 Tunis, Tunisie
| | - Karim Zouaghi
- Laboratoire de recherche de pathologie rénale (LR00SP01), service de néphrologie, CHU La Rabta, BP1007 Jabbari, Tunis, Tunisie
| | - Mohamed El Hassan Trabelsi
- Direction des hôpitaux et des soins ambulatoires, ministère de la Santé, avenue Oqda, Agdal, Rabat, Maroc
| | - Cécile Couchoud
- Registre REIN, agence de la biomédecine, 1, avenue du Stade-de-France, Saint-Denis La Plaine, France.
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Zammouri A, Imed H, Malika H, Hafedh H, Imen G, Hamida FB, Taieb BA. Hyperoxalurie primitive chez l’adulte : à propos de 22 cas. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mami I, Harzallah A, Khadhar M, Barbouch S, Kaaroud H, Goucha R, Ben Hamida F, Ben Abdallah T. SP116NON DIABETIC RENAL DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv188.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Harzallah A, Hajji M, Kaaroud H, Ben Hamida F, Ben Abdallah T. Facteurs de risque cardiovasculaires au cours du lupus systémique. Pan Afr Med J 2015; 22:367. [PMID: 27022427 PMCID: PMC4789257 DOI: 10.11604/pamj.2015.22.367.7611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
Cette étude a pour objectif d’évaluer la fréquence des facteurs de risque cardiovasculaires au cours du lupus et de préciser leur prévalence. Etude rétrospective portant sur 250 patients ayant un lupus, diagnostiqué selon les critères de l'ACR, hospitalisés entre 1970 et 2013. Les données cliniques et para cliniques ont été recueillies à partir des observations médicales. Il s'agit de 228 femmes et 22 hommes d’âge moyen au diagnostic du lupus de 30, 32 ans (extrêmes: 16-69). La durée moyenne du suivi des patients était de 64 mois (extrêmes: 7 jours- 382mois). Quatre vingt dix patients (36%) étaient hypertendus, 74% avaient une hypercholestérolémie et 22% étaient diabétiques. Pour les autres facteurs de risque cardiovasculaire traditionnels, un âge > 50 ans a été retrouvé dans 40% des cas, le sexe masculin dans 8% des cas, l'obésité dans 76% des cas et le tabagisme dans 11% des cas. Les facteurs de risque surajoutés sont représentés par la présence des anticorps antiphospholipides (47% des cas), la néphropathie lupique (49% des cas), l'insuffisance rénale (42% des cas), la corticothérapie au long cours (74% des cas) et la chronicité de la maladie dans 35% des cas. Les complications cardiovasculaires retrouvées dans notre série étaient: les accidents vasculaires cérébraux (2%) et l'insuffisance coronarienne (5,6%). Devant l'importance du risque cardiovasculaire au cours du lupus, une surveillance rapprochée des facteurs de risque cardio-vasculaires semble primordiale chez les lupiques.
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Affiliation(s)
- Amel Harzallah
- Hôpital Charles Nicolle, Médecine interne A, Tunis, Tunisie
| | - Mariem Hajji
- Hôpital Charles Nicolle, Médecine interne A, Tunis, Tunisie
| | - Hayet Kaaroud
- Hôpital Charles Nicolle, Médecine interne A, Tunis, Tunisie
| | - Fethi Ben Hamida
- Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
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Barbouch S, Gaied H, Abdelghani KB, Goucha R, Lakhal A, Torjemen L, Hamida FB, Abderrahim E, Maiz HB, Adel K. Chronic graft versus host disease and nephrotic syndrome. Saudi J Kidney Dis Transpl 2014; 25:1062-4. [PMID: 25193909 DOI: 10.4103/1319-2442.139941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Disturbed kidney function is a common complication after bone marrow transplantation. Recently, attention has been given to immune-mediated glomerular damage related to graft versus host disease (GVHD). We describe a 19-year-old woman who developed membranous glomerulonephritis after bone marrow transplantation (BMT). Six months later, she developed soft palate, skin and liver lesions considered to be chronic GVHD. Fifteen months after undergoing BMT, this patient presented with nephrotic syndrome. A renal biopsy showed membranous glomerulonephritis associated with a focal segmental glomerulosclerosis. She was started on corticosteroid treatment with good outcome.
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Affiliation(s)
- Samia Barbouch
- Department of Nephrology and Laboratory of Renal Pathology, LR00S001, Hôpital Charles Nicolle, Tunis, Tunisia
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Barbouch S, Cherif M, Ounissi M, Karoui C, Mzoughi S, Hamida FB, Abderrahim E, Bozouita A, Abdalla T, Kheder A. Urinary tract infections following renal transplantation: a single-center experience. Saudi J Kidney Dis Transpl 2013; 23:1311-4. [PMID: 23168875 DOI: 10.4103/1319-2442.103586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Urinary tract infection (UTI) is the most frequent infectious complication among renal transplant recipients and a frequent cause of bacteremia, sepsis and acute graft failure. To evaluate the incidence, risk factors, type of pathogens and long-term effect of UTIs on graft and patient survivals in our center, we performed a retrospective cohort study reviewing the medical records of patients who received a renal transplant at our center from June 1986 to December 2009, excluding patients who lost their grafts in the first month due to arterial or veins thrombosis and acute antibody-mediated rejection. We studied 393 kidney-transplanted recipients; at least one UTI occurred in 221 (53.69%) patients during the follow-up period. The most frequent pathogens isolated in urine culture were Escherichia coli (n = 39, 18.4%) and Klebsiella pneumonia (n = 31, 14.6%). When patients with UTIs were compared with those without UTIs, female gender and use of mycophenolate mofetil or azathioprine seemed to be risk factors for UTIs on univariate analysis. However, female gender was the only independent risk factor on multivariate analysis RR = 1.964 (1.202-3.207), P = 0.007. This study confirmed that UTIs remain a major problem in renal transplant recipients, and female gender was the only independent risk factor.
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Affiliation(s)
- Samia Barbouch
- Research Laboratory of Immunology-LR03SP01, Charles Nicoles Hospital, Tunis, Tunisia.
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Samia B, Hazgui F, Abdelghani KB, Hamida FB, Goucha R, Hedri H, Taarit CB, Maiz HB, Kheder A. Atteinte rénale au cours de la spondylarthrite ankylosante. Nephrol Ther 2012; 8:220-5. [DOI: 10.1016/j.nephro.2011.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/29/2022]
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Ounissi M, Gargah T, Barbouch S, Boubaker K, Cherif M, Bacha MM, Abderrahim E, Ben Hamida F, Lakhoua R, Ben Abdallah T, Kheder A. [Acute tubular necrosis in kidney transplantation]. Tunis Med 2012; 90:463-467. [PMID: 22693087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The acute tubular necrosis (ATN) is common after kidney transplantation. Acute tubular necrosis (ATN) is multifactorial and represents one of the main causes of the delayed graft function. Its impact on graft and patients survival is documented. AIMS To study the prevalence of the ATN in kidney transplanted patients, the acute rejection rate and their impact on the graft and the patient survival. METHODS We retrospectively studied the frequency of ATN, its causes and its impact on patient and graft survival in 255 kidney transplanted patients between 1986-2006. RESULTS Thirty-nine patients had ATN (15.29%). They are 25 men and 14 women with mean age of 30.1 ± 12.6 years (8-61) followed for an average of 98 ± 61.76 months. The majority was treated by hemodialysis (79.48%) and half of them were transplanted from kidney of deceased donor. All patients received anti lymphocyte serum and the majority anticalcineurins (69.23%). The outcome was favorable in 26 patients (66.66%) with recovery of diuresis and normalization of renal function after 6 weeks on average. An acute rejection was diagnosed in 21 patients (53.48%). The mean creatinine at 1, 5 and 10 years was 135.3, 159.9 and 121.4 μmol / l. Eight patients had creatinine ² 130 μmol / l at 10 years. Ten patients died from infectious and cardiovascular causes. By comparing the 2 groups ATN + and ATN - we found a statistically significant correlation between ATN and cold ischemia (10 ± 10.9 vs 1.2 ± 4.7 hours, p <0.0001) and the interval between the start of dialysis and transplantation (42.18 ± 38.44 vs. 31.1 ± 25.2 months, p= 0.02). No statistical correlation was found between the ATN and gender, age of recipient and donor, warm ischemia, acute rejection, chronic rejection and graft and patient survival at 1, 5 and 10 years. CONCLUSION The ATN is more common among transplanted patients from deceased donors. It had good evolution in the majority of cases and it's correlated to cold ischemia and duration of dialysis. Finally, it has no impact on patients and graft survival.
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Helal I, Goucha R, Hamida FB, Elyounsi F, Maiz HB, Kheder A. Renal AA amyloidosis in a patient with hereditary complete complement C4 deficiency. Saudi J Kidney Dis Transpl 2011; 22:1008-1011. [PMID: 21912034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Hereditary complete C4 deficiency has until now been reported in 30 cases only. A disturbed clearance of immune- complexes probably predisposes these individuals to systemic lupus erythematosus, other immune- complex diseases and recurrent microbial infections. We present here a 20- year- old female with hereditary complete C4 deficiency. Renal biopsy demonstrated renal AA amyloidosis. This unique case further substantiates that deficiency of classical pathway components predisposes to the development of recurrent microbial infections and that the patients may develop AA amyloidosis. Furthermore, in clinical practice, the nephrotic syndrome occurring in a patient with hereditary complete complement C4 deficiency should lead to the suspicion of renal AA amyloidosis.
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Affiliation(s)
- Imed Helal
- Department of Internal Medicine A and Laboratory of Kidney Pathology 02, Charles Nicolle Hospital, Tunis, Tunisia.
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