[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

[Calciphilaxis in chronic renal failure: 3 cases]

Calciphylaxis is a small vessel disease responsible for vascular calcification and skin necrosis. It occurs in association with chronic renal failure and has a poor prognosis. Report new cases. We report 3 cases of calciphylaxis occurred in patients with chronic renal failure secondary to interstitial nephritis in 1 case, diabetic nephropathy in 1 case and thrombotic microangiopathy in 1 case. They were 2 females a 1 man aged of 44.3 years meanly. Hyperphosphoremia and hyperparathyroidism were the essential risk factors. All patients died by sepsis. This course was precipitating by corticotherapy in 2 cases. Early recognition and treatment of risk factors is mandatory to reduce mortality in uremic patients with calciphylaxis

[Renal involvement in the Behcet's disease]

Renal involvement in the Behcet's disease is rare. The clinical features vary from urinary sediment's abnormalities to ESRD. We propose to study the clinical, biological and histological data, the therapeutic management and the prognosis of patients. We report a retrospective study including 8 patients representing 1.23% of cases. The average age of the patient was of 37 +/- 12. 35 years with a clear male prevalence. Urinary signs were discovered fortuitously by the strips in the majority of the cases after an average of 18 months. It's about proteinuria and hematuria. Renal insufficiency and hypertension were rare. Pathological study highlighted 3 cases of amyloidosis, 2 cases of IgA nephropathy, 1 case of minimal change disease, 1 case of endo and extracapillary glomerulonephritis and 1 case of interstitial nephropathy. Patients having GN were treated by corticoids and immunosuppressive agents and those having an interstitial nephropathy were treated symptomatically with good evolution in the majority of the cases. Only one patient is dead, he had amyloidosis. Prognosis depended on the precocity of the diagnosis, the histological type and the treatment. The renal involvement during Behcet's disease is rare. Amyloidosis and Ig A nephropathy are the most frequent. Treatment is still controversial

[Peritoneal dialysis in elderly]

Peritoneal dialysis is used more and more as treatment of substitution of the end stage renal disease at the old subjects of more than 65 years and its effectiveness and its good tolerance were shown. To study the epidemiological and clinical profile of these patients, the indication and the advantages of PD, the various complications, the elements of prognostic and the survival of the patients and the technique. We made a retrospective study including a series of 13 old patients of more than 65 years and treaties by PD during the period extending from the 1983/2/11 to the 2005/12/31. They are 10 men and 3 women on average of 70 +/- 3, 1 year and representing 3, 62%of the totality of the patients. The diabetic and vascular nephropathies represent the first cause of ESRD. The PD was used of first intention at 53,84%of the patients whose majority suffers from a malnutrition due to advanced age, anorexia, psychological disorders, bad dental state and uraemia. The cardiovascular complications are frequent in this age bracket explaining heavy morbidity. The pulmonary and urinary infectious complications are also frequent. The more frequent peritonitis compared to the literature, are comparable between the 2 age brackets

[Vascular trombosis of renal graft: 9 cases]

Allograft renal thrombosis can occur in 1 to 6% of cases. Many predisposing factors has been identified especially alteration of coagulation. We analyzed in this study frequency and predisposing factors of renal graft thrombosis. We report a retrospective study including 319 renal transplant recipients. Nine patients [2, 8%] presented veinous graft thrombosis in 5 cases and arterial thombosis in 4 cases. There were 6 men and 3 women aged of 30, 6 years meanly [10-56] which developed the thrombosis 6 days [1-48] after the transplantation. All patients were detransplanted after 16, 2 days and 1 patient died. Thrombosis constitute an important cause of graft loss. A perfect surgical technic and prophylactic treatment in high risk patients are necessary to reduce this complication

[Interest of bone alkaline phosphatase in hemodialysis patients]

The renal osteodystrophy represent a major complication in haemodialysis. Of this study is to evaluate the value of plasma bone-alkaline phosphatase [bAP] in the diagnosis of the type of renal osteodystrophy among hemodialysis patients and to seek a possible correlation between the bAP, total alkaline phosphatases [tAP] and the intact parathormone [iPTH]. We studied 67 chronic hemodialysis patients. Plasma bAP was determined by immunoenzymatic technic. iPTH [1-84] was measured by electrochimiluminescence. We found that bAP levels were normal 10-20 ng/ml] in 17 patients low [< 10 ng/ml] in 4 and high [> 20 ng/ml] in the 46 other patients. There is a good positive is e correlation between the plasmatic rate of bAP and the following parameters: the period of dialysis [R = 0.316, p = 0,009]. plasmatic rate of tAP [r = 0.781. p < 10[-3]] and the rate of iPTH [r = 0,650]. p < 10[-3]]. There is a good positive correlation between the plasmatic rate of bAP and the rates of the tAP and of iPTH, the correlation between bAP and the ipTh being more significant. A rate of bAP higher than 20 ng/ml had a sensitivity of 93,5% specificity of 63,3% in favour of a rate of iPTH > 400 pg/ml and consequently of the biological diagnosis of hyperparathyroidism. In addition, 4 patients have a bAP < 10 ng/ml with iPTH < 150 pg/ml evoking an adynamic osteopathy. plasma bAP provides useful information about bone remodelling in hemodialysis patients