Sexual disorder in hemodialysis patients

To identify the sexual problems, to assess their prevalence and to determine the various factors involved in their occurrence in patients on hemodialysis for at least 6 months. Fifty hemodialysis patients consulting in the dialysis unit of the nephrology department of the University Hospital Hedi Chaker of Sfax [Tunisia], during the period from 1 June to 30 August 2012, were included in this study, The Hospital Anxiety and Depression Scale [HADS] was used to evaluate anxiety and depression. The patients' quality of life was assessed by Kidney Disease Quality of Life [KDQoL]. Patients' mean age was 51.2 years. The average of hemodialysis period was 6,73 years. After the beginning of hemodialysis, 26% of patients were sexually inactive and 62% reported a decrease of their sexual activity. The prevalence of sexual dysfunction was 86.48%. Mean age of 55 years or greater was significantly correlated with risk of sexual disorders. These disorders were also positively correlated with personal medical history, some nephropathy data, a hemodialysis period greater than or equal to 1 year, depression, anxiety and impaired quality of life. The prevalence of sexual dysfunction in hemodialysis patients is high and many factors were involved in their occurrence. A collaborative effort between nephrologists, psychiatrists and sexologists before dialysis, seems to be essential

Depression in chronic hemodialysis patients: About 106 cases

Depression is the most common psychiatric disorder in chronic hemodialysis patients and is associated with mortality. To evaluate the prevalence of the depression in patients undergoing chronic hemodialysis, and to identify the correlated factors. The study population included 106 patients on chronic hemodialysis. The Hospital-Anxiety and Depression Scale was used to diagnosis depression. The prevalence of the depression among the patients surveyed was 46.2%. Among 8 factors correlated with the depression at the univariate analysis, only 2 factors were still strongly correlated at the multivariate analysis: professional inactivity [OR = 6.54; p = 0.01] and anxiety [OR = 1 ., 5; p = 0.00]. According to our study, professional inactivity and/or anxiety should make looking for depression in order to optimize the management of the patients on chronic hemodialysis

[Nephrotic syndrome in diabetis: evolution and prognosis about 35 cases]

The objective of our study was to evaluate the prognostic factors in the nephritic diabetic syndrome and its evolution. We realized a retrospective study of 35 cases of diabetic patients hospitalized between 1985 and 1999 who presented with a nephrotic syndrome. They included 17 females and 18 males, their mean age was 43 years [extremes: 18-77 years] and the mean duration of their diabetes was 10 years [extreme: 0-25 years]. The diabetes was insulin-dependent [type1] in 19 cases and non insulin-dependent [type 2] in 16 cases. Retinopathy and neuropathy were presents in 88% and 83% of the cases respectively. Nephrotic syndrome was secondary to a diabetic nephropathy in 26 cases [74%] and to a non-diabetic nephropathy in 9 cases [26%]. The mean follow-up was 4 years for 22 patients. Evolution was marked by a rapid decline of the renal function in 14 cases [63.6%]. Factors of bad prognosis seem to be the following: male sex [11 cases out of 14; 78,5%], type 1 diabetes [10 cases out of 14; 71,4%], poorly controlled hypertension [10 cases on 12; 83,3%], smoking [5 cases out of 14; 35,7%], hyperlipidemia [11 cases out of 14; 78,5%] and nephropathy caused by the diabetic condition [11 cases out of 14; 78,5%]. Control of these risk factors is thus important to prevent the progression of nephrotic syndrome

syndrome neprotique idiopathique corticoresistant de l'enfant. Etude de 14 observations

Cortico-resistent nephrosis represent 10% of idiopathic nephrosis in nephrosis in children and progresses in almost half of the cases to end-stage renal failure. 14 cases of cortico-resistant idiopathic nephrotic syndrome, collected over a period of 13 years [1990 - 2002], are reported. This study involved 10 boys and 4 girls, aged 8 years on average. A history of allergy was present in two cases. Two other children had a family history of cortico-resistant nephrosis [CRN]. Consanguinity was found in 6 patients. The diagnosis of cortico-resistant idiopathic nephrotic syndrome [CRINS] was suggested by oedema in all cases. Two patients had a transitory high blood pressure and 5 others had a macroscopic hematuria associated with oedema. Laboratory studies confirmed the diagnosis of nephrotic syndrome, which was severe in 10 cases, and revealed a transitory renal insufficiency in 5 cases, a hyperlipidemia in 3 cases and signs of hyperaldosteronism in 12 cases. Renal biopsy practised in all patients shaved small glomerular lesions in 6 cases, a focal and segmental hyalinosis in 8 cases, one of which was associated with chronic tubulo-interstitial lesions. Treatment was based on alkylanting agents in 11 cases [cyclophosphamide in 6 cases and chlorambucil in 5 cases] and cyclosparine in 6 cases. 4 years later on average, the course was marked by complete remission in one case, relapse of the nephrotic syndrome in 3 cases, persistant CRINS without end-stage renal failure in 4 cases and progression to end-stage renal failure in 4 cases