POS-009 CAPTOPRIL-INDUCED ACUTE INTERSTITIAL NEPHRITIS: A RARE ASSOCIATION

Introduction: Acute interstitial nephritis (AIN) is an important reversible cause of acute kidney injury (AKI). Its prevalence is about 6-8% in histologically proven AKI.Early diagnosis of drug-induced AKI is vital because the discontinuation of the causal treatment facilitates recovery of the renal function. Methods: We report a case of captopril-induced AIN. Results: We report the case of a 82-year-old woman with a history of untreated hypertension. She was admittedin our department for AKI. Two days before admission, Captopril was initiated for high blood pressure (BP) as well as vitamin therapy for suspicion of a sars covid 19 infection, which was ruled out by a negative pcr covid test and a normal thoracic scan. The initial physical examination showed asthenia and a BP of 160/90 mmHg. Urinary labstix was negative. The biological analysis showed AKI: creatinine rose from 80 to 230 and then to 530 µmol/l, anemia at 7 g/dl and moderate hyper eosinophilia at 700 elements/ml. A renal biopsy was not performed because of the presence of cysts, and the diagnosis of interstitial nephritis was suspected. The drug-induced origin was confirmed after having eliminated infectious and tumoral origin. The pharmacovigilance investigation incriminated captopril. Captopril was stopped and the patient was put on corticosteroids 0.5 mg/kg/d. The evolution was favorable with an improvement of the renal function (creatinine at 120 µmol/l one month later). Conclusions: Angiotensin-converting enzyme (ACE) inhibitors can cause an increase in serum creatinine or potassium levels in patients with renal failure, renal artery stenosis, heart failure, or hypovolemia, but are rarely reported to be involved as an etiology of AIN. We report one of the rare cases of captopril-induced AIN. No conflict of interest

Accès vasculaire en hémodialyse à l’ère du COVID-19

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COVID-19 chez les patients hémodialysés : facteurs associés aux formes modérées à sévères

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Covid-19 in hemodialysis patients: Clinical particularities and outcomes

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) has affected the care and outcomes of patients treated with dialysis worldwide. Patients on hemodialysis (HD) are at extremely high risk to develop COVID-19 because of their multiple co-morbidities and immunosuppression. We report throw this work the experience of our unit of HD with the covid-19 infection and its outcomes on our patients. METHOD: We conducted a prospective study since the beginning of the pandemic. We have collected 26 HD patients reached of COVID 19 disease. RESULTS: The sex ratio of our population was equal to 1,36 with female predominance. The mean age of our patients was 61, 31 614,17 years. The comorbidities noted among these patients were respectively hypertension, diabetes, heart diseases and obesity in 19, 17, 10 and 10 cases. The causal nephropathy was respectively diabetic, undetermined, glomerular and interstitial nephropathy in 13, 9, 2 and 2 cases. The major symptoms associated to the COVID 19 were respectively dyspnea, cough, asthenia, fever and chills, digestive manifestations, chest pain in 22, 19, 19, 15, 10, and 6 cases. 7 patients have been exposed to covid-19 infested person. Symptoms appeared within an average of 4,3 6 2 days. Oxygen saturation was less than 92% in 65% of the cases during hospitalization. 84% of the patients are hospitalized including one among them who required the stay in a resuscitation unit and intubation. The scannographic lesions of covid were estimated to more than 50% in 8 cases and less than 50% in 4 cases. A biological inflammatory syndrome has been noted in all of the patients with a mean CRP at 117+/-127 mg/l and the mean leucocytes count at 10248±6592 elt/mm3. Lymphopenia was noted in 14 cases with lymphocytes count less than 1500 elt/mm3. The ratio of neutrophils / lymphocytes was more than 2,5 in 12 cases. The treatment was based on oxygen, corticosteroids, antibiotics, vitamins and anticoagulation for hospitalized patients (22 patients). The mean number of HD sessions realized per patient during hospitalization was 4 6 2,3 HD sessions. The perdialytic complications noted were alteration of the state of consciousness in 3 cases and heart failure in 5 cases. The outcomes of our patients were marked by death in 38% and a recovery in 62% of the patients. Thus, the forms observed in our series are respectively moderate, severe, pauci-symptomatic and asymptomatic in 12, 10, 2 and 2 cases. CONCLUSION: We highlight throw this study the severe consequences of COVID-19 on HD patients in whom mortality reached 38%. Until the pandemic is controlled and a vaccine or a treatment are valid, we highlight the importance of the compliance with confinement and develop home dialysis among our population.

Le post-COVID en hémodialyse chronique

Introduction Durant la pandémie liée au SARS-CoV-2, les patients en hémodialyse chronique, ne pouvant être confinés, et à cause de leur immunodépression et comorbidités sont à haut risque de développer un COVID-19. Description Nous avons étudié les particularités cliniques et évolutives de la maladie chez nos patients. Méthodes Nous avons réalisé une étude rétrospective et descriptive incluant 36 patients hémodialysées chroniques infectés par SARS-CoV-2. Résultats L’âge moyen de nos patients était de 59,48±16,13 ans ;63,18 % étaient hypertendus, 41,66 % étaient diabétiques, 22,22 % avaient une insuffisance coronaire et 13,18 % avaient une dyslipidémie. La néphropathie initiale était une néphropathie interstitielle chronique dans 19,44 % des cas suivi par la néphropathie diabétique dans 16,66 % des cas. L’ancienneté en hémodialyse médiane était égale à 2 ans [0,5–23 ans]. L’accès vasculaire était une FAV pour 55,55 % des patients et un cathéter jugulaire pour 13,88 %. Le taux médian de l’hémoglobine était de 8,85g/dL [5,9–14g/dL] avant l’infection et 8,15g/dL [5,6–14,4dL/L] après. L’albuminémie, la calcémie et la phosphorémie moyennes étaient de 31,06g/L, 2,02mmol/L et 1,64mmol/L respectivement avant la maladie et de 30,7g/L, 2,14mmol/L et 2,08mmol/L respectivement après. La CRP médiane était respectivement de 13 et 12 avant et après. Les complications observées étaient une complication thromboembolique (16,66 %), une hémorragie sévère (11,11 %), un sepsis (8,3 %) et une dépendance à l’oxygène (5,55 %). Le taux de mortalité était de 33,33 %. La cause de décès était un arrêt hypoxique dans la majorité des cas (58,3 %), une poussée de la maladie dans 25 % des cas, une néoplasie dans 2,7 % des cas et un sepsis dans 2,7 % des cas. Conclusion Le COVID-19 a de lourdes conséquences sur la morbidité et la mortalité chez les hémodialysés chroniques. La prévention par l’instauration d’une stratégie de vaccination en masse et d’isolement des cas suspects rapidement.

HLA-21b polymorphism and COVID-19 infection

The interactions between NK cell receptors and HLA class I ligands conditions the education of NK cells and their response to infection. The recognition of HLA-E by the CD94:NKG2A inhibitor receptor is regulated by HLA class I molecules. The binding site of HLA-E is specific for peptides corresponding to residues -22 to -14 of the leader sequences of HLA-A, -B and -C. Methionine/threonine dimorphism at position -21 of the leader sequence of HLA-B divides the human population into three groups: M/M, M/T and T/T. Previous research shows how M/M and M/T individuals have CD94:NKG2A+ NK cells which are better educated, phenotypically more diverse and functionally more potent than those in T/T individuals. Given the important role of NK cells in the response to Coronavirus SARS CoV2 we here studied the genotypes T/T, M/T and M/M expressed by patients with moderate COVID-19 disease. Seventy-nine dialyzed patients, of whom 14 contracted COVID-19(+), were enrolled in our study. Twelve healthcare workers having experienced COVID-19 infection were also included. HLA-A and -B typing was performed using serological techniques and molecular typing. M/T polymorphism at position -21 of the leader sequence of HLA-B allotypes was compared between the two groups. The frequency of T/T, M/T and M/M genotypes in COVID- 19(+) dialyzed patients was 58%, 42% and 0%, respectively. In the group of dialyzed COVID-19(-) patients, the distribution was 63%, 28% and 9% respectively. Healthcare worker genotypes were compared against a previously published study about HLA polymorphism in our South Tunisian population (123 healthy controls). The -21B distributions were as follows: 75% T/T, 25% M/T and 0% M/M among our 12 COVID-19 healthcare workers and 64% T/T, 31% M/T and 5% M/M in healthy controls. Genotype distribution comparisons were not statistically significant. The lack of M/M genotype in patients with COVID- 19(+) supports the role of NK cells in COVID19 performance immunity.