[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

[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