[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

[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