[Variation of troponin T in chronic hemodialysis patients: study about 52 cases]

Patients with severe renal dysfunction have unexplained elevated serum concentrations of cardiac troponin T. Study the frequency of elevated cTnT in hemodialysis patients and investigated whether cTnT is elevated. The patient population consisted of 52 patients on maintenance hemodialysis and 20 healthy subjects. cTnT was measured before and after hemodialysis by using immunoenzymatic method. cTnT were undetectable in 7 cases[<0.01ng/ml] and higher than normal range[up to 0.1ng/ml] in 9 cases. 32 cases have a level of cTnT >0.01 and <0.1ng/ml. In addition, TnTc levels are significantly associated with cardiac dysfunction [p<0.05] and inflammation [p<0.01]. After hemodialysis sessions, TnTc was less than 0.01 ng /1 in 11 patients [21.2%], between 0.01 and 0.1 ng / ml in 32 subjects [61.5%] and greater than 0.1 ng / ml in 9 subjects [17.3%]. In the control group, only 1 subject [5%] had a rate of TnTc between 0.01 and 0.1 ng / ml, whereas it was less than 0.01 ng / ml for all others. We aim a statistically significant positive correlation between the rate of TnTc and heart failure [p <0.05] on the one hand and serum CRP [p <0.01] on the other. The causes of elevated cTnT levels in hemodialysis patients was multiple: cardiac dysfunction, left ventricular dysfunction and inflammation

[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