[ tunneled catheter for haemodialysis: about 52 cases]

Background: Vascular access is a basic and essential tool required for performing renal replacement therapy in end stage renal disease

Aim: To study the indications of tunneled catheter [KTT] in hemodialysis [HD], identify complications related to the use of KTT and contributing factors, assess the survival and performance of the technique

Introduction: The making of a vascular access is an angular piece for adequate HD and in good conditions. In this context the KTT may be an alternative

Methods: A retrospective study of 52 KTT placed in 49 patients collected in the department of Nephrology Dialysis and Renal Transplantation in RABTA Tunis between 2008 and 2011

Results: The average age of our patients was 55.58 years +/- 13.5 years, their Sex ratio was 0.79. The Thirty of our patients were diabetic, 46.2% had hypertension and 21.2% had underlying cardiac disease. The mean duration of HD was 1111.35 days or 37 months. The most common indication of KTT was the absence of arteriovenous fistula in 65.4% of cases, other indications were: short survival [30.7%], the exhaustion of venous capital [34.6%], mediacalcosis [34.6%] and immunosuppression [36.5%]. The right internal jugular vein was the choice of insertion site with 78.8%. The overall incidence of immediate complications was 19.2%. Among our patients, 31.4% had a dysfunction. The period of HD represent the risk factor for dysfunction KTT [p = 0.006].An infectious complication was observed in 29% of cases. The median time to onset of infection was 190.83 days. Staphylococcus was isolated in 40% of cases. The average duration of use of KTT was 238 days. The only single factor determining the survival of KTT was the number of KTT put in the same patient

Conclusion:More than a quarter of the population are dialyzed through a catheter. Despite concerted efforts, much remains to be done for the confection at time of a permanent vascular access

Histopathological spectrum of childhood idiopathic steroid-resistant nephrotic syndrome in Tunisia

In children, renal biopsy is routinely required in the management of idiopathic steroid-resistant nephrotic syndrome particularly prior to starting nephrotoxic immunosuppressive agents. To investigate the correlations between the results of initial renal biopsy in Tunisian children with idiopathic steroid-resistant nephrotic syndrome and the subsequent response to cyclosporine-prednisolone combination. We conducted a retrospective study of children with idiopathic steroid-resistant nephrotic syndrome over the period 2002- 2009. Data on clinico-biological features, histological diagnosis and response to cyclosporine-prednisolone were collected. Thirty patients were enrolled, of whom 16 had focal segmental glomerulosclerosis, eight had minimal change disease and six had diffuse mesangial proliferation. Complete Remission was achieved in 15 patients [50%]. Nine patients [30%] went into partial remission. Only six patients presented no response [20%]. No statistically significant relationship between the different pathological types and the response to CsA-prednisone was found. In our study, two important facts were noted: 1] the predominant histopathological subtype was the focal segmental glomerulosclerosis; 2] a high remission rate was achieved in our patients using a combined cyclosporine-prednisolone treatment regimen. This response is not dependent on the histological type

[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

[ 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

[Renal amyloidosis during behcet's disease. study of one case]

Amyloidosis in Bethel's disease is rare and has a poor outcome. Report a new case. We report a case of a 38-year-old tunisian woman who presented with Behcet's disease and nephrotic syndrome. Renal biopsy showed amyloid deposition consistent with AA type. She had not any associated disease that might be an additional cause of secondary amyloidosis. She was treated by colchicine. After 3 years, proteinuria had disappeared and persisted negative 11 years after the diagnosis. A second renal biopsy showed the persistence of amyloidosis. As amyloidosis is one of the prognostic factors affecting survival in Behcet's disease, patients with this disease should be screened for amyloidosis. Administration of colchicine to these patients may be beneficial

[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