[Evolution of chronic renal insufficiency patients after 10 years of dialysis]

Chronic kidney failure is a chronic disease requiring extrarenal replacement. Hemodialysis is one of the main methods of extrarenal replacement in our context in the absence of cadaveric renal transplantation. It may be temporary, pending a kidney transplant of put on peritoneal dialysis, or continued for several years or for life. To evaluate the fate of hemodialysis after a periodic long-term hemodialysis. It is a retrospective study including all the chronic hemodialysed patients for at least 10 years. We analyzed demographic, clinical and laboratory findings to describe the various complications related to the duration of hemodialysis. Among 65 chronic hemodialysed patients, 39 had a duration of hemodialysis more than 10 years. Current average age of our patients was 48 +/- 13 years with a sex ratio =0.56. The average length of hemodialysis was 15.5 +/- 5.3 years. Two-thirds of dialysis patients are 12h/week for 3 sessions /week. The adequacy of dialysis is measured by the percentage reduction of urea, which is on average 76 +/- 7%. Half of the patients had a single vascular which is still functional. Cardiac involvement is present in 24 patients [61%]. This is a left ventricular hypertrophy in 11 patients [28%], valvular disease in 18 patients [46%] and two cases of heart failure with an ejection fraction below 40%. The two-thirds of patients are anemic with a hemoglobin average of 10 +/- 2 g /dl. Secondary hyperparathyroidism was present in 21 patients [53.8%] with radiological signs of osteitis fibrosa in all patients. While 18 patients [46.2%] had an adynamic bone disease, including 8 following a subtotal parathyroidectomy. Infectious complications are frequent in particular viral hepatitis C: 24 cases [61.5%] and viral hepatitis B: 2 cases [5.1%]. Among 25 patients 13 [52%] are of childbearing age, including 2 conducted two term pregnancies giving birth to two alive newborns. The evolution of hemodialysis patients after long-term dialysis is characterized by the frequency of complications requiring appropriate care or using another method of substitution, in particular renal transplantation

[Leptospirosis and renal disease]

Leptospirosis is an infectious and contagious cosmopolitan disease caused by spirochetes [Leptospira interrogans]. The aim of this work is to describe the epidemiological, clinical, biological, therapeutic and evolutionary profil of leptospirosis. Retrospective study, collect 20 cases of leptospirosis with acute renal failure over a period of seven years, between January 2000 - December 2007. We analyzed demographic, clinical, biological, therapeutic and outcome parameters. The average age of our patients was 34 +/- 13 years with a male predominance. The febrile syndrome is the main reason for consultation. The typical icterus - hemorrhagic was observed in 14 patients [70%]. All of our patients have acute renal failure with an average serum creatinine: 82 +/- 49 [32 - 262] mg /l. Hemodialysis sessions were indicated in 8 patients [40%]. The therapeutic management includes two parts: a symptomatic management and resuscitation and etiological treatment by antibiotics. The evolution is favorable in 17 patients [85%] with normalization of renal function in 11 cases [55%] and improved it in 6 cases [30%]. However, 2 patients [10%] are at the stage of renal failure and one patient died from septic shock. In our series, leptospirosis affects the young active adult and in particular agricultural professionals. Acute renal failure due to several mechanisms: volume depletion secondary to severe deshydration, ischemia secondary glomerular capillary vasoconstriction induced by leptospirotic endotoxin or acute tubular necrosis. Leptospirosis is an infectious disease frequently responsible for serious complications especially by renal failure. It is a disease that requires early and appropriate treatment

[Assessment and follow up of living kidney donor]

It is now well established that renal transplantation from a living donor is a method of treatment of end stage renal disease that offers several benefits. In fact, it does improve patients quality of life and overall survival. This method of substitution required an evaluation period, during which several investigations will be accurately and efficiently achieved, in several steps in order to avoid unnecessary examinations. The purpose of this pre-transplant check up is to minimize donation risks and optimize the results of renal transplantation in the short and long term. It should be noted that the results of renal transplantation from living donors are always better than those from cadaveric ones, considering the quality of the grafts, since the living donors are healthy person, with normal renal function, with no marker of nephropathy, free of any cardiovascular disease. Further, the scheduled nature of renal transplantation from living donors is another factor justifying the superiority of the results of this type of kidney transplantation. Furthermore, a better survival of living kidney donors than the general population of similar age has been observed in several studies. Whereas, the risk of developing renal failure is identical to the general population

[Kidney donation from a living donor: ethic, legal and psychological aspects]

Renal transplantation is the ideal treatment for end stage renal disease patients. It does provide several obvious medical advantages and a good psychosocial adjustment, since it improves the patients quality of life and overall survival. This method of substation can be made either from cadaveric or living donor kidneys. Nonetheless, related living donor renal transplantation has a wide range of ethical issues:it must meet biomedicine principles which are conventionally autonomy respect, lack of harm, the existence of profits and the principle of justice. In addition, this kind of renal transplantation has also some psychological aspects as it should in no way come at the expense of psychological, social or familial troubles for both the donor and the recipient especially after renal donation. Moreover, there are laws governing the donation procedure on both the authorized persons to kidney donation and the contraindications of renal transplantation from a living donor. All of these ethical, psychological and legal features, impose a clear, comprehensive and neutral information to both the donor and the recipient about living donor renal transplantation benefits and problematic issues. However, no pressure should be exerted on the recipient environment and the risks associated to the donation procedure should not be exaggerated

[Pregnancy and diabetic nephropathy]

Pregnancy in women with pregestational diabetes mellitus type 1 and diabetic nephropathy has been associated with an adverse effect on the maternal and fetal outcomes. The aim of the present study is to determine the impact of pregnancy on diabetic nephropathy and to evaluate both fetal and maternal outcome. It is a retrospective study enrolling 11 pregnancies in 9 women with pregestational diabetes mellitus type 1 and diabetic nephropathy. We evaluated before and during pregnancy then 6 months after delivery, diabetic nephropaty stage by urinary albumin excretion and plasma creatinin dosage, glycemic balance by gycated hemoglobin assessment and blood pressure. We also studied obstetrical and fetal parameters especially preeclampsia occurance, term and way of delivery, fetal malformations or perinatal mortality. The mean age of our patients at pregnancy is 26.2 +/- 4.1 years old. The mean duration between diabetic nephropathy and pregnancy is 4.2 +/- 3.5 years old. Diabetic nephropathy was revealed by microalbuminuria in 9 ccases and proteinuria with renal failure in one case. Diabetic nephropathy was discovered during pregnancy in a patient with proteinuria. During pregnancy, we noticed a reappearance of microalbuminuria in four cases. After delivery, the evolution in a patient with renal failure prior to gregnancy was marked by the worsening of renal function, requiring chronic hemodialysis. These pregnancies did bear out to 9 living births and 2 fetal losses. No congenital malformation neither psychomotor retardation were noticed. Pregnancies in women with diabetic nephropathy require a multidisciplinary monitoring and intense maternal and fetal surveillance

[Dominant polycystic kidney]

It is the most common hereditary kidney disease. Its diagnosis is easy by ultrasound. To evaluate the clinical, epidemiological and evolutionary profile of dominant polycystic kidney and the various complications of the disease. A retrospective study of 200 cases of dominant polycystic kidney [1998 - 2008] with analysis of clinical, biological and ultrasound parameters. The average was 44 +/- 17 years with a sex ratio of 0.50. Hepatic localization was found in 19% of cases. 57.2% of patients had hypertension, 20.5% had repeated urinary infections and 5.4% have kidney stones. 35% of patients [70 cases] were lost and 65% of patients [130 cases] received a follow-up, including: 26.2% [35 cases] had a terminal stage renal failure, 13.8% [18 cases] have worsened the renal function during follow-up [elevation of creatinine more than 25% of baseline], 14.6% [19 cases] have maintained a stable renal and 45.4% [58 cases] have maintained normal renal function. Its insidious and progressive development to end-stage renal failure is the severity of the disease. Many prognostic factors of progression of renal failure are described in the literature and some of which are raised in our series: genetic [PKD1, PKD2], clinical [advanced age, hypertension, kidney stones] and biological [anemia and albuminuria]. In front of the severity of prognosis, the only was to the early follow up is the family screening to reduce morbidity and delay the installation of end-stage renal failure

[Peritoneal dialysis: principles, indication and limits]

Peritoneal dialysis is an extra-renal purification method that may be proposed in the first intention in end stage renal disease patients. It is a technique that uses the peritoneum as a natural membrane for the exchanges between blood and dialysis fluid into the peritoneal cavity through a permanent catheter whose proximal end is positioned in the bottom of Douglas's pouch. It represents a complementary and non competitive method with the other end stage renal disease treatments [hemodialysis and renal transplantation]. This technique is soft, and can be performed at home. It is appropriate for children, young adults and the elderly, since it allows children and adults to maintain a normal school activity, and a socio-professional life. Moreover, this technique offers a social comfort and good cardio-tolerance to the elderly

Solar risk and sun protection in adolecents

Several studies proved that sunrays intense exposure, since childhood, is a primordial environment factor which increases risk of melanoma. The aim of this study is to evaluate the knowledge of a group of students concerning the consequences of sun exposure, and to insist on the importance of information and prevention. Method: a survey was conducted on a sample of 1000 students in several schools of Casablanca. A questionnaire with 21 items with open answers was auto-filled by all the participants. there were 66,6% girls and 33,4% boys, with a mean age of 13 year-old. 38% of girls and 24% of boys were frequently exposed to the sunrays. The time of exposure was between midday and 4pm. 16% of the students knew that it is the maximal luminal intensity and requires maximal sun protection. The frequency of sunburns was high [43% of girls / 34% of boys]. Most of them exposed themselves regularly at the highest risk hours. The use of external solar photo protector was less frequent when practicing sport [16% of girls and 7% of boys]. During sport, 13% of the students knew the need to renew the application every two hours or after the bath. 54% of girls and 45% of boys knew that the clothes are the best protection.This study shows that the risk of sun exposure is badly known within teenagers and it exists a misreading of the benefit of sunscreen and of the role of clothes. Information, education of children and their families and the awareness of doctors about the solar risk are the best way to eliminate the high increase of the bad effects of the sun [melanoma, hyperpigmentation]