[Acute tubular necrosis in kidney transplantation]

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. 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. We retrospectively studied the frequency of ATN, its causes and its impact on patient and graft survival in 255 kidney transplanted patients between1986-2006. 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 micromol / l. Eight patients had creatinine

[First case of subcutaneous dematophytosis in a Tunisian renal transplant patient]

Dermatophytes are keratinophilic and usually infect the corneal layer of the epidermis and appendages On the occasion of immunosuppression, such as solid organ transplant, they can invade deeper tissues or cause an infection of the skin and subcutaneous disseminated. To report the first observation of subcutaneous dematophytosis in a Tunisian renal transplant patient. A 29-year-old man had an erythematous lesion of 2 cm at the front of the left leg. He was treated with prednisone and tacrolimus. The skin lesion was has been neglected. The outcome was the occurrence of oozing whose mycological examination showed numerous hyphae and culture was positive for Microsporum canis. Initial treatment was voriconazole, but an interaction with tacrolimus has shortened the duration of treatment to 1 month. Three months later, the lesion became deeper, and then a biopsy was performed. The mycological examination showed the same appearance, previously described. The patient was put on fluconazole by adjusting the doses of tacrolimus and then underwent surgical excision of the lesions. The evolution after 4 months of antifungal treatment was favorable. The increasing incidence of immunosuppressive therapy has given rise to unusual clinical forms of invasive and sometimes serious fungal agents whose pathogenicity is usually limited. Clinicians should be mindful of superficial fungal infections of the skin in a renal transplant patient

CD86 +1057G>a polymorphism and susceptibility to acute kidney allograft rejection

CD86 is a costimulatory molecule that participates in the regulation of T-cell lymphocytes activation. Thus, we examined a genetic marker on the CD86 gene in kidney transplant outcome. In our retrospective study, 168 kidney allograft recipients were genotyped by direct sequencing. Patients were classified into 2 groups of 29 human leukocyte antigen [HLA]-identical haplotype allograft recipients and 139 recipients showing one or more mismatches in the HLA haplotype. Forty-five patients [26.8%] developed at least 1 acute rejection [AR] episode, 7 in the first and 38 in the second group. Acute rejection was associated with the presence anti-HLA antibodies before transplantation [P=.03]. The AA genotype and A allele at position+1057 in the CD86 gene were more frequent in patients without AR [9.75% and 28.5%, respectively] compared with those showing an AR [2.22% and 23.3%, respectively]. This difference was statistically significant in the anti-HLA-positive recipients, as AA frequency was 31.3% in non-AR patients and zero in AR ones [P=.04] and A allele frequency was 46.9% and 20.8%, respectively [P=.04]. Patients bearing AA genotype reached a higher graft survival time [9.84 years] than those carrying GA [8.21 years, P=.32] or GG [7.61 years, P=.72] genotypes. These results suggest that AA genotype and A allele of CD86+1057G>A polymorphism may confer a protection against acute kidney allograft rejection in Tunisian patients

[Hepatitis viral C in kidney transplantation: comparison study between two Maghrebin centers: Casablanca and Tunis]

Hepatitis viral C [HVC] is relatively frequent among kidney transplants. It is responsible for a morbi-mortality that compromises the results of transplantation in the medium and long term. To evaluate and to compare the prevalence of HVC, 172 kidney transplant adult patients were investigated in two Maghrebian centers at Casablanca [G1]: 57 Moroccan patients and Tunisia [G2]:.115 Tunisian patients. The impact of the HVC infection for a morbi-mortality was concerned only the Tunisian recipient patients: 20 kidney recipients having antibodies anti-VHC and positive HVC-RNA [Cases] which were matched in age, sex and date of the kidney graft, to 20 kidney transplant patients anti-HVC and VHCRNA negative [Controls]. The anti-VHC antibodies were detected by ELISA: Innogenetics and their positivity were confirmed by RIBAII. The ARN-VHC was analyzed by RT-PCR INNO-LiPA HCV II amplification of Innogenetics. The prevalence of hepatitis C is similar for the two groups: 19.3% among Moroccan kidney transplants and 20.9% among Tunisians. The infection by the HVC was often active and the detection of viral RNA was found in 91.7% of the G2 patients against 50% among G1 patients. The genotype 1b is the most prevalent; it is found in 59% of the patients. The frequency of HVC among our kidney transplant patients is particularly determined by the duration and the mode of dialysis. In fact, 22.1% of the patients treated by hemodialysis are VHC [+] against 5,6% patients treated by peritoneal dialysis. Also, the average duration of the dialysis is 58,8 months for HVC [+] patients against 33.5 months for HVC [-] [p<0.0001] patients. The frequency of the chronic rejection of the graft is higher in the G2, but it is similar in Tunisian patients with or without antibodies anti-HVC. In the G1, this frequency is statistically higher among positive HVC transplant patients compared to the negative HVC grafted patients [p<0.05]. The case-control study emphasizes the frequency of the proteinuria, the renal insufficiency, the mellitensis diabetes and the polyglobulinemia among patients HCV [+]; however the differences between the two groups remain statistically non significant. The total rate of the hospitalizations is 26 per 100 patients per year in the HCV [+] group against 17 for the HCV [-]. The average duration of hospitalizations is 72 days among HCV [+] patients against 30.2 days for the controls [p<0.05]. The averages of survival of the patients and of the controls were similar 11.6 +/- 5.6 years for transplant patient HCV [+] against 11.2 +/- 5.5 years for the controls. The actuarial curves of the patients were not different for the patients having antibodies anti-HCV positive or negative. The blood and nosocomial modes of contamination of HVC infection explain their higher frequency in this population at risk. The mortality and the morbidity of the renal transplant patients infected by the HCV seem to be higher compared to the uninfected patients. A further study by large population should be carried out to confirm these results

Hypertension arterielle reno-vasculaire: interet de la scintigraphie renale

A case of severe refractory hypertension in a 22-year-old male is reported. Captopril renal scintigraphy shows features suggesting stenosis of the right renal artery which is confirmed by renal arteriography. Revascularization, by percutaneous transluminal angioplasty, has resulted in a best control of blood pressure