[ rare cause of pruritis in a haemodialysed patient]

Uremic pruritus is frequent in patients undergoing hemodialysis. It's multifactorial secondary in most cases to metabolic complications related to uremia. We report a rare cause of pruritis in an haemodialysed patient. It's a 48-year-old woman in periodic haemodialysis during 17 years. She suffered from generalized pruritus associated with psychiatric disturbance without neurologic deficits. CT scan and magnetic resonance imaging revealed extensive, diffuse and bilateral involvement of the white matter. The diagnosis of large low grade B cell lymphoma was confirmed by the histologic examination of stereotactic biopsy which leads to early intracranial hemorrhage and death. Before attributing pruritus to renal failure, one should exclude other causes such as the NHL even rarely reported especially when it associated with psychiatric disturbances. CT scan and magnetic resonance imaging contribuate to diagnosis

[Lupus nephritis and pregnancies about 43 cases]

In lupus nephritis, pregancies can be associated with worsening of nephropathy and several other maternal and foetal complications. We analyzed in this retrospective study on a period of 30 years, maternal and fetal outcome of 43 pregancies occuring in 21 women treated for lupus nephritis. Pregnancies were sudivided in 2 groups: G1 including 17 pgnancies that underwent with proteinuria>1g/24 hours and/or high blood pressure and/or creatinemia>140 micro mol. G2 including 26 pregnancies underwent in absence of all these factors during at least 3 months. Renal flares occured in 17 pregnancies [G1: 34, 6%NS] with renal function impairement in II cases [G1: 41, 7%, G2:15, 3%, p: 0, 01] and preeclampsia in 14 pregnancies [G1 :57, 3%, G2: 42, 7%NS]. Fetal loss occured in 8 cases [G1 29, 4%G2: 11%, p=0, 01]. Among live births there were 17 preterm deliveries [G1 62%, G2 63%NS]. We found that pregnant women with Iupus nephritis remain at high risk of relapses and prematurity. Renal function impairement and fetal loss are more freqnent when lupus nephritis is active at conception. Close monitoring of these patients and planification of pregnancies reduces these complications

[Indications, complications and cost of internal jugular catheters in hemodialysed patients: study of 533 cases]

Central venous catheters for hemodialysis are very useful as blood accesses when arteriovenous fistulas [AVF] are not available. The aim of this study is to analyse the clinical impact of internal jugular catheters [IJC] in hemodialysed patients and to assess their economic consequences. It is a prospective study realised from July 1998 to March 2002 including 533 hemodialysed patients without functional AVF: 280 males and 253 females aged between 17 and 87 years [mean age: 54.1 +/- 15 years]. Single lumen polyurethane Vygon were used. All catheters were placed using Seldinger procedure and the posterior route of Jernigan which is more comfortable for patient. Indications of IJC placement were new hemodialysed patients without AVF in 73.5% cases and no functional AVF in 26.5% cases. During the period of the study, IJC was placed in 533 patients. We failed to place the IJC at the first attempt in 42 patients but we succeded in placing it on the controlateral side. During IJC placement, we observed 50 [9.4%] cases of accidental puncture of carotid artery. The median duration use of IJC was 41 days [extreme: to 413 days]. IJC were removed mainly because of the use of AVF in 469 [88%] cases and the catheter infection in 41[77%] cases. Bacteriological analysts were made only for 25 patients: staphylococci were identified in 16 cases and catheter cultures were negative in the 9 other cases. All patients were treated with antibiotics. Outcome was favourable for 39 of them and we had 2 deaths by septicemia. The IJC cost was 44,287 Tunisian Dinars [DT] coresponding to 31.633 ' including 10125 DT [7,232'] for infectious treatment. The use of IJC is frequent in our center with a high rate of infectious complications which increased the hemodialysis cost. The realisation of AVF. in patients with chronic renal failure before the beginning of hemodialysis, is the best way to limit the use of catheters