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Grati R, Ariba YB, Labidi J. Immunoglobulin G4-Related Kidney Disease. Saudi J Kidney Dis Transpl 2022; 33:175-184. [PMID: 36647992 DOI: 10.4103/1319-2442.367812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an emerging fibro-inflammatory condition known to involve potentially every organ system in the body, especially the kidneys, and is characterized by interstitial nephritis, obstructive nephropathy, and in rare cases, glomerular nephropathy. In this article, we report two cases of IgG4-RD with renal manifestations, hospitalized in the Department of Internal Medicine of the Principal Military Hospital of Instruction of Tunis. In conclusion, the clinical course of IgG4-related kidney disease varies widely and it can sometimes be difficult to diagnosis. A multidisciplinary approach can be useful. Early diagnosis and appropriate therapy are very important.
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Affiliation(s)
- Raouya Grati
- Department of Nephrology, Principal Military Hospital of Instruction, Tunis, Tunisia
| | - Yosra Ben Ariba
- Department of Nephrology, Principal Military Hospital of Instruction, Tunis, Tunisia
| | - Jannet Labidi
- Department of Nephrology, Principal Military Hospital of Instruction, Tunis, Tunisia
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Omrane M, Ben Ariba Y, Ouertani I, Labidi J. MO233RENAL ARTERY STENOSIS: DO NOT FORGET INHERITED THROMBOPHILIA. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.00111] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Inherited thrombophilia can be defined as a genetically determined predisposition to develop thromboembolic complications. Inherited prothrombotic risk factors include antithrombin deficiency, protein C and protein S deficiencies, activated protein C resistance due to Leiden factor V mutation, inherited hyperhomocysteinemia, prothrombin G20210A variant, dysfibrinogenemia and elevated factor VIII levels.
Method
We report the case of a patient with history of bilateral renal artery stenosis who presented with renal artery bypass thrombosis related to an inherited thrombophilia.
Results
We report a case of 40-year-old male patient who presented with extremely high blood pressure and hypokalemia without other biological abnormalities. The duplex ultrasound showed bilateral renal stenosis with chronic occlusion of the right renal artery and a tight stenosis of the left renal artery estimated at 50%. Renal angiography confirmed the bilateral stenosis, associated to a small right kidney. Renal scintigraphy with DMSA showed normal left renal function and right renal function estimated at 2%. The therapeutic decision was to perform an aorto-renal bypass surgery by the saphenous vein.After renal artery bypass the blood pressure improved markedly, maintaining this result at 12 months follow-up at clinical examination and duplex ultrasound. One year later, the patient presented with high blood pressure. The duplex ultrasound showed a stenosis of the bypass with a double stenosis of the left aorto renal bypass on renal angioscanner. The patient underwent angioplasty of the venous bridge with implantation of 2 stents with improvement of blood pressure after angioplasty. Six months later, the patient presented an unbalanced blood pressure, the ultrasound control with a vascular Doppler showed a stenosis at the stent. The antihypertensive treatment was increased, a thrombophilia balance was requested concluding a combined protein C and protein S deficiency.
Conclusion
An etiological assessment should be carried out systematically in the event of thrombosis occurring before the age of 40 or in the case of iterative venous or arterial thrombosis. A genetic study where appropriate and a family screening are then recommended.
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Affiliation(s)
- Marwa Omrane
- Military Hospital of Instruction of Tunis, Nephrology, Tunis, Tunisia
| | - Yosra Ben Ariba
- Military Hospital of Instruction of Tunis, Nephrology, Tunis, Tunisia
| | - Imen Ouertani
- Military Hospital of Instruction of Tunis, Nephrology, Tunis, Tunisia
| | - Jannet Labidi
- Military Hospital of Instruction of Tunis, Nephrology, Tunis, Tunisia
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Ariba YB, Achouch S, Omrani M, Ourteni I, Labidi J. Two Peculiarities of the Nutcracker Syndrome: Rare Association with Multiples Thrombosis and Successful Medical Treatment (Pentoxifylline). Saudi J Kidney Dis Transpl 2020; 31:1129-1133. [PMID: 33229780 DOI: 10.4103/1319-2442.301182] [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: 11/04/2022] Open
Abstract
The nutcracker syndrome (NCS) is a rare condition characterized by the entrapment of the left renal vein between the superior mesenteric artery and the aorta. Clinically, it presents with hematuria, flank pain, and symptoms of pelvic venous congestion. It is more frequent in females. Conservative treatment is usually proposed children but in adults, NCS has to be treated by surgical or endovascular methods. Drug therapy is not proposed for the treatment of NCS. We report a case of a young patient who presented with recurrent gross hematuria. Our patient was treated with pentoxifylline three times daily and anti-coagulation, with a favorable outcome.
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Affiliation(s)
- Yosra Ben Ariba
- Department of Nephrology, Military Hospital of Tunisia, Monfleury, Tunis, Tunisia
| | - Sonia Achouch
- Department of Nephrology, Military Hospital of Tunisia, Monfleury, Tunis, Tunisia
| | - Marwa Omrani
- Department of Nephrology, Military Hospital of Tunisia, Monfleury, Tunis, Tunisia
| | - Imen Ourteni
- Department of Nephrology, Military Hospital of Tunisia, Monfleury, Tunis, Tunisia
| | - Jannet Labidi
- Department of Nephrology, Military Hospital of Tunisia, Monfleury, Tunis, Tunisia
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Abstract
We describe a case of toxocariasis as a rare cause of nephrotic syndrome in an adult woman. This rare association was confirmed by elevated Toxocara-specific immunoglobulin M titers. Renal biopsy was not done because of prolonged activated partial thromboplastin time. Our patient was treated with prednisone and albendazole. These treatments resulted in partial remission of renal symptoms as well as the abatement of the Toxocariasis infection. The relationship between toxocariasis infection and glomerular disease is still unclear. In the literature, exceptional renal impairment secondary to toxocariasis have been described, especially in children. To the best of our knowledge, this is the second case of nephrotic syndrome associated with toxocariasis in adults.
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Affiliation(s)
- Yosra Ben Ariba
- Department of Internal Medicine, Military Hospital of Tunis, Montfleury, Tunis, Tunisia
| | - Rim Abid
- Department of Internal Medicine, Military Hospital of Tunis, Montfleury, Tunis, Tunisia
| | - Riadh Battikh
- Department of Internal Medicine, Military Hospital of Tunis, Montfleury, Tunis, Tunisia
| | - Bassem Louzir
- Department of Internal Medicine, Military Hospital of Tunis, Montfleury, Tunis, Tunisia
| | - Jannet Labidi
- Department of Internal Medicine, Military Hospital of Tunis, Montfleury, Tunis, Tunisia
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Labidi J, Selmi Y, Ariba YB, Elloumi Z, Othmani S. A case of abdominal aortic thrombosis associated with the nephrotic syndrome. Saudi J Kidney Dis Transpl 2019; 28:174-177. [PMID: 28098122 DOI: 10.4103/1319-2442.198246] [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: 11/04/2022] Open
Abstract
Thromboembolic disease is an important and frequent complication in patients with the nephrotic syndrome (NS), and the consequences are often severe. Usually, the venous system is affected. Arterial thrombosis has rarely been reported and occurs mainly in children. We report the case of a 27-year-old man with a history of NS due to focal and segmental glomerulosclerosis resistant to steroids and cyclosporine, admitted for bilateral pain in the calves. Aortogram revealed a suspended thrombus in the abdominal aorta just below the origin of the renal arteries with embolism into the left tibioperoneal trunk and the right anterior tibial artery. Endarterectomy was performed followed by systemic heparinization with a good outcome. Arterial thrombosis is rare and must be prevented.
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Affiliation(s)
- Jannet Labidi
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, Tunis, Tunisia
| | - Yosra Selmi
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, Tunis, Tunisia
| | - Yosra Ben Ariba
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, Tunis, Tunisia
| | - Zied Elloumi
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, Tunis, Tunisia
| | - Saleh Othmani
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, Tunis, Tunisia
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Ariba YB, Labidi J, Elloumi Z, Selmi Y, Othmani S. Acute tubulointerstitial nephritis and uveitis syndrome: A report on four adult cases. Saudi J Kidney Dis Transpl 2017; 28:162-166. [PMID: 28098119 DOI: 10.4103/1319-2442.198241] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, generally presenting in children and young women. The interstitial nephritis may precede, follow, or develop concurrent to the uveitis. We report the clinical features and outcomes of four adult patients, aged 41-70 years with the TINU syndrome.
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Affiliation(s)
- Yosra Ben Ariba
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, 1008 Tunis, Tunisia
| | - Jannet Labidi
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, 1008 Tunis, Tunisia
| | - Zied Elloumi
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, 1008 Tunis, Tunisia
| | - Yosra Selmi
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, 1008 Tunis, Tunisia
| | - Salah Othmani
- Department of Internal Medicine, Tunisian Military Hospital, Montfleury, 1008 Tunis, Tunisia
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Labidi J, Ariba YB, Chargui S, Bousetta N, Louzir B, Othmani S. Retroperitoneal fibrosis: A retrospective review of clinical presentation, treatment and outcomes. Saudi J Kidney Dis Transpl 2015; 26:816-22. [PMID: 26178567 DOI: 10.4103/1319-2442.160226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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
Retroperitoneal fibrosis (RPF) is a rare disease and has a high risk of developing chronic kidney disease (CKD). This retrospective study was carried out with the objective to study the epidemiological, clinical and therapeutic characteristics of RPF and identify the risk factors associated with its progression to CKD. All 30 cases (24 males and five females) of RPF admitted from January 1985 to December 2013 in the Military Hospital of Tunis were included in this study. The mean age was 50.5 years. Presentation was with lower back pain, acute renal failure and inflammatory syndrome in 93%, 56% and 43% of the cases, respectively. Sixteen patients (54%) had a creatinine clearance <60 mL/min at the time of diagnosis. Erythrocyte sedimentation rate and C-reactive protein of >30 mm/h and 10 mg/L were observed in 56% and 53% of cases, respectively. The abdominal computed tomography scan showed ureterohydronephrosis in 63% of the cases. Classes I, II and III according to Scheel's radiological classification were found in, respectively, 16%, 13% and 70% of cases. Biopsy of RPF was performed in 20% of the cases, and all showed an inflammatory infiltrate without signs of vasculitis. RPF was idiopathic in 85% of the cases. Oral corticosteroid therapy was started for all patients. After a mean follow-up time of 53.2 months, an initial favorable response was noted in 76% of the cases. Fifty-three percent of the patients have presented one or more relapses during follow-up and 20% progressed to CKD. Most relapses were successfully treated by corticosteroids; only five patients had required additional immunosuppressive therapy. Two patients died. Elevated creatinine at diagnosis, high urea, clearance of creatinine lower than 60 mL/min and the use of ureteral stents were identified as risk factors for development of CKD.
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Affiliation(s)
- Jannet Labidi
- Service de Médecine Interne, Hôpital Militaire Principal d'Instruction de Tunis, Tunis, Tunisia
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