[Pathogenic factors in calcium oxalate stones: Epidemiological investigation]. / Recherche de facteurs lithogènes au cours des lithiases oxalo-calciques : enquête épidémiologique.

INTRODUCTION: Calcium oxalate stones are the most common urolithiasis. Changes in dietary habits, socio-economic and health status of populations explain its progression. The aim of our study was to determine metabolic factors leading to lithiasis and clarify its causes. PATIENTS AND METHODS: This is a retrospective study of 100 patients with calcium oxalate stones identified by morpho-constitutional study, collected in our department over a period of 5 years (2008-2013). We analyzed clinical, radiological and metabolic data. RESULTS: They were 73 men and 27 women (gender ratio: 2.7), aged meanly of 44.8 years. Dietary survey revealed inadequate calcium intake in 87% of cases. Urinary abnormalities were hypocitraturia (34%), hypomagnesuria (32%) and outflow hypercalciuria (21%). Crystalluria was positive in 44% of cases. Whewellite was the most common crystalline form. Calculi were bilateral (53%), renal (85%) and mainly collected after urological procedures (74%). Infrared analysis showed that 81% of stones have a heterogeneous composition. Pure Whewellite or combined with other compounds was the most frequent (31%). Idiopathic calcium oxalate lithiasis was the most common etiology (69%). Among secondary etiologies, diabetes was most frequently found (10%). CONCLUSION: Our epidemiological study of calcium oxalate stones has allowed us to identify the high frequency of food hyperoxaluria partly explained by a low calcium intake and a diet rich in oxalate phytotherapy. LEVEL OF EVIDENCE: 4.

Primary hyperoxaluria in infants.

The infantile form of primary hyperoxaluria type-1 (PH-1) is characterized by a rapid progression to the end-stage renal disease (ESRD) due to both increased oxalate load and reduced glomerular filtration rate. In the literature, data on this form are limited. The purpose of this study is to analyze retrospectively the clinical, biological, and radiological features of children who were diagnosed with PH-1 during the 1(st) year of life. We reviewed the records of all children with PH-1 diagnosed and followed-up at our department between January 1995 and December 2013. Among them, only infants younger than 12 months of age were retrospectively enrolled in the study. Fourteen infants with the median age of two months were enrolled in the study. At diagnosis, 11 patients had ESRD. All patients had nephrocalcinosis and two of them had calculi. The diagnosis was established in nine patients on the basis of the positive family history of PH-1, bilateral nephrocalcinosis, and quantitative crystalluria. In four patients, the diagnosis was made with molecular analysis of DNA. Kidney biopsy contributed to the diagnosis in one patient. During follow-up, two patients were pyridoxine sensitive and preserved renal function. Seven among 11 patients who had ESRD died, four patients are currently undergoing peritoneal dialysis. Children with infantile PH and ESRD are at high risk of early death. Peritoneal dialysis is not a treatment of choice. Combined liver-kidney transplantation is mandatory.

Increased urinary type II collagen C-telopeptide levels in Tunisian patients with knee osteoarthritis.

UNLABELLED: Osteoarthritis is characterized by a progressive degeneration of articular cartilage and loss of joint function. Clinical assessment of osteoarthritis is hampered by the lack of accurate measures of disease and disease progression, especially during the early stage. BACKGROUND: To investigate urinary C-telopeptide fragments of type II collagen (CTX-II) levels in knee osteoarthritis in the Tunisian population compared with controls and to assess the association between this biomarker and radiological signs. METHODS: One hundred and twenty five female patients with knee osteoarthritis, aged 53.6 +/- 7.6 years with disease duration of 3.6 +/- 3.8 years and 57 female age-matched controls underwent Lyon Schuss X-ray exams. Two experienced readers independently measured the joint space width (JSW) and classified each knee for severity using the Kellgren/Lawrence scale. The urinary concentration of CTX-II was measured by a competitive ELISA. RESULTS: The levels of urinary CTX-II were significantly higher in knee osteoarthritis patients compared with controls (323.98 vs 218.04 microg/mol creatinine). A weak and non significant association between the CTX-II level and JSW was found. The significant correlations were observed between age and CTX-II in both groups and between BMI and CTX-II only in controls. CONCLUSIONS: Analysis of CTX-II in urine samples of Tunisian patients with knee osteoarthritis provided a sensitive method to detect increased degradation of collagen type II in patients with osteoarthritis.

[Study of cardiovascular risk factors in Tunisian patients with recent type 2 diabetes]. / Étude des facteurs de risque cardiovasculaire chez le diabétique de type 2 Tunisien récemment découvert.

OBJECTIVE: To study the frequency of silent myocardial ischemia (SMI) in Tunisian patients with recent type 2 diabetes and identify cardiovascular risk factors directly in relation with SMI. PATIENTS AND METHODS: One hundred and twenty diabetics and sixty healthy people have benefited from blood sampling, electrocardiogram and exercise test. RESULTS: The frequency of SMI was 21% in diabetics and 3% in healthy people (P=0.01). Obesity and hypertension were higher in diabetics than in healthy people (P=0.001 and P<10(-4)). Using unvaried analysis for risk factors with the presence of SMI in diabetics, we found that age greater than 60 yrs, male sex, sedentary and smoking were significantly correlated with SMI; respectively P=0.004, 0.01, 0.009 and 0.03. The SMI was found in 37% of diabetics with high blood pressure vs 8% in diabetics with normal blood pressure and was correlated with hypertriglyceridemia, hypoHDLemia and microalbuminuria. Patients with SMI had at least two cardiovascular risk factors apart from diabetes among those: age greater or equal to 60 yrs, male sex, smoking, hypertension, dyslipidemia and family history of early coronaropathy. Chronic inflammation and hyperhomocysteinemia were significantly correlated to SMI; OR=4.2 and 3.8. In addition, SMI was found in one diabetic over three who had bad glycemic control. Using multivariate analysis, only age greater or equal to 60 yrs, smoking, hypertension, hyperhomocysteinemia and hypertriglyceridemia were risk factors directly in relation with SMI in type 2 diabetes. CONCLUSION: The assessment of global cardiovascular risk from the moment of discovering type 2 diabetes and the early screening of SMI should be necessary.

[Biochemical and molecular diagnosis of primary hyperoxaluria type 1: Tunisian study about 15 cases]. / Diagnostic biochimique et moléculaire de l'hyperoxalurie primaire de type 1: étude tunisienne à propos de 15 cas.

BACKGROUND: The primary type 1 hyperoxaluria (HP1) is the most frequent and severe form of the primary hyperoxaluriae. It is related to an enzymatic deficit in alanine glyoxylate aminotransferase (AGT). It is a recessive autosomic disease. Rare in Europe, it is responsible for 13% of the end stage renal failure in the Tunisian child. AIM: The aim of this work is to evaluate the biological and molecular examinations contributing with the early diagnosis and the follow-up of the HP1 patients and to test their response to pyridoxin. PATIENTS AND METHODS: A prospective study of 15 children who have oxaluria lower than 500 µmol/l and normal renal function is carried out. The cristalluria study, oxaluria and the glycolate-glycerate urinary ratio were carried out on all the patients. The so-called mutation maghrebean T853 (Ile244 Thr) was detected by direct sequencing of the exon 7 gene AGXT. The response to pyridoxin was tested among 13 patients. RESULTS: The oxaluria concentration was greater or equal to 1000 µmol/l in nine cases (60%) and ranging between 600 and 1000 µmol/l in the remaining cases. The oxaluria flow was significantly high depending on the age. The glycolaturia was high among eight patients (57%). In 61,5% of the cases, the most frequent crystalline species was whewellite (C1). The "maghrebin" mutation was identified in nine patients at the heterozygous state, showing 25% allelic frequency. The response to pyridoxin was observed in the 13 tested cases. CONCLUSION: The HP1 is frequent in our country from where the need for an early diagnosis. The use of simple biochemical tools such as the study of the cristalluria, the morphological analysis of stones and the oxaluria allow to direct the diagnosis towards a HP1, confirmed by the glycolaturia determination. The molecular biology is required in the atypical forms.

[Variations of troponin T in chronic hemodialysis patients: study of 52 cases]. / Variation de la troponine Tc chez les hémodialyses chroniques: etude a propos de 52 cas.

BACKGROUND: Patients with severe renal dysfunction have unexplained elevated serum concentrations of cardiac troponin T. AIM: Study the frequency of elevated cTnT in hemodialysis patients and investigated whether cTnT is elevated. METHODS: 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(< 0.01 ng/ml) and higher than normal range (up to 0.1 ng/ml) in 9 cases. 32 cases have a level of cTnT > 0.01 and < 0.1 ng/ml. In addition, TnTc levels are significantly associated with cardiac dysfunction (p < 0.05) and inflammation (p 0.01). RESULTS: 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. CONCLUSION: The causes of elevated cTnT levels in hemodialysis patients was multiple: cardiac dysfunction, left ventricular dysfunction and inflammation.

[Urinary stones in Tunisian children, based on series of 187 cases]. / La lithiase urinaire chez l'enfant tunisien. Etude à propos de 187 cas.

OBJECTIVE: The aim of this study is to define epidemiologic and structural particularities of urinary stones in Tunisian children. PATIENT AND METHODS: Between 1995 to 2007, 187 stones of Tunisian children were studied. Structural analysis was performed by infrared spectrophotometry. RESULTS: We analyzed 187 stones from 122 boys and 65 girls. Their age ranged from two months to 18 years. Our study shows a male predominance with a sex ratio of 1,88. Stones were renal in 64.8%, ureteral in 20.6% and 14.6% were vesical. Whewellite was the main component (49,2% of stones) with a female predominance. Among phosphatic stones, carbapatite was in the lead (10.7%) followed by struvite (7%), which predominate in male. CONCLUSION: The epidemiological profile of urinary stones in children in Tunisia is situated between that observed in developed countries and that observed in developing countries.

[Metabolic syndrome: pathophysiology and impact on lithogenesis]. / Syndrome métabolique: physiopathologie et impact sur la lithogenèse.

In our societies, the increase of the frequency of the diseases of overweight, in particular obesity, diabetes type 2 and metabolic syndrome, coincides with that of the urinary lithiasis. Like the lithiasic disease, the metabolic syndrome or syndrome X is multi-factor. Several epidemiological studies were interested in research of a physiopathological relation between the various components of this syndrome (obesity, arterial hypertension, diabetes, dyslipemy) and lithogenesis. During the metabolic syndrome, resistance to insulin and the defect of renal ammoniogenesis constitute the principal disorders supporting lithogenesis. The defect of renal ammoniogenesis armature by the resistance of the renal cells to insulin involves a urinary hyperacidity which supports the crystallization of the uric acid responsible for the formation of uric or mixed uric acid/oxalate stones.

[Effect of physical activity on bone turnover in young boys]. / Effet de l'activité physique sur le remodelage osseux chez des jeunes garçons.

AIMS: To evaluate the effect of the physical activity on bone turnover in young male soccer players at the Tanner's stage of 1-2. MATERIAL AND METHODS: 61 young soccer players (13,4 +/- 0,3 years old) who actively participated in soccer since 3,7 +/- 0,7 years were compared to 60 age and sex- matched non active subjects. Bone mineral density (BMD) of whole body, and in specific skeleton sites, fatty body mass (FBM) and lean body mass (LBM) were determined by a dual energy X-ray absorptiometry (DXA). Total plasma alkaline phosphatase (ALP) and plasma bone alkaline phosphatase (BALP), plasma osteocalcin (OC) and plasma collagen type I cross-linked C-telopeptide (CTX) were measured. RESULTS: BMD of the whole body and at the lumbar spine (L2-L4), femoral, lower limbs and LBM were significantly higher in young soccer players than in controls. The biochemical markers of bone turnover: ALP (6,7%), BALP (8,9%), OC (3%) and CTX (3,1%) were not significantly higher in sportsmen than in controls. The calcium was significantly higher in sportsmen than in controls. CONCLUSION: These results suggest that soccer practice induced an increase of bone mass in boys. The increase in the level of bone turnover evaluated by the new biochemical markers was not significant in the sportsmen.

Vitamin D deficiency in Tunisia.

This study seeks to estimate the status of serum 25-hydroxyvitamin D [25(OH)D] in a healthy section of the population in Tunisia and to compare the achieved results with other published data. A transverse descriptive inquiry was carried out between January and March 2002. Three hundred and eighty-nine subjects aged 20-60 years were included in the study. A questionnaire was used to investigate clinical characteristics: sunlight exposure to ultraviolet light and, for women, parity, breast feeding, whether or not they wore the veil, and menopause. A dietary investigation estimated calcium and vitamin D intake. Morning fasting blood was collected from each subject for the measurement of the following parameters: serum calcium, phosphorus, albumin, alkaline phosphatase, 25(OH)D, parathyroid hormone (PTH). Hypovitaminosis D was defined by a cut-off of 37.5 nmol/l. The population studied was largely female, for the greater part housewives. The accumulated prevalence of hypovitaminosis D was 47.6%, increasing with age. Hypovitaminosis is highly prevalent in women (P<0.001). Multiparity, menopause, wearing the veil, and calcium and vitamin D dietary intake are factors associated with hypovitaminosis D (P<0.05). Analysis of logistic regression shows that only multiparity and vitamin D dietary intake are independent predictive factors. The status of serum 25(OH)D in Tunisia resembles that in southern European countries rather than in Middle Eastern countries. Insufficient vitamin D diet intake, higher parity and wearing the veil explain this deficiency in Tunisia. Dietary enrichment or supplementation by vitamin D and a more outdoor lifestyle, especially for older people, should be seriously considered as a way to reduce this deficiency in Tunisia.

[Epidemiologic data in renal lithiasis in adults]. / Données épidémiologiques de la lithiase rénale chez l'adulte.

The morpho-costitutional analysis of 574 urinary lithiasis emitted by tunisean adults permitted to define an épidemiology's profile. This resemble to the épidemiology's profile of under-developed conry: Amore raised frequency of the renal lithiasis at the man than at the woman with a sec ratio of 2.4. An average age of +14 years with a peak to 4th decade in 2 sexes. The upper localitation of the calculi is founded in 94% cases. The fréquency of the relapses, the mode of expulsion and the size of calculi are différent of those published in the litérature. Probably because the time of study which last 4 years is too short, so it don't enable us to find a result like the literature. The surgery is the mode of most fréquent élimination (51%). This s dû to the présence great size calculi in our popûlation and to the récent introduction of the lithotritie in our country.

[Urinary lithiasis of medical origin]. / Les lithiases urinaires d'origine médicamenteuse.

Analysis of 22,510 urinary calculi between January 1991 to July 2000 performed by infrared spectroscopy allows for separation of drug-induced urolithiasis into two categories: first, the drugs physically embedded in the stone (n = 238; 1.0 per cent), notably indinavir monohydrate (n = 126; 52.9 per cent), followed by triamterene (n = 43; 18.1 per cent), sulphonamides (n = 29; 12.2 per cent) and amorphous silica (n = 24; 10.1 per cent); second, the category of metabolic nephrolithiasis induced by drugs (n = 140; 0.6 per cent), involving mainly calcium and vitamin D supplementation (n = 56; 40.0 per cent) and carbonic anhydrase inhibitors (n = 33; 23.6 per cent). Composition of the stone depended not only on the inducer drug but also on the metabolic state of the patient. Today, drug-induced stones comprise about 1.6 per cent of all calculi in France. Physical analysis and therapeutic history recall of such patients are the keys to diagnosis. Medical care is based on drug avoidance or dose adjustment with increased diuresis and, if necessary, change in urinary pH.

Urolithiasis in Tunisian children: a study of 120 cases based on stone composition.

The composition of urinary stones in children depends on socioeconomic conditions and hygiene, geographical area, and dietary habits. We analyzed urinary stones from 120 consecutive Tunisian children (81 males, 39 females) aged 5 months to 15 years. The stone was located in the upper urinary tract in 91 cases (76%). Stone analysis included both a morphological examination and an infrared analysis of the nucleus and the inner and peripheral layers. The main components of bladder calculi were whewellite (69%) and struvite (22%), whereas the main component of upper urinary tract calculi was whewellite (67%). The nucleus of bladder stones was composed of ammonium urate (45%), struvite (28%), cystine (10%), and carbapatite (7%). The nucleus of kidney and ureteral calculi was mainly composed of ammonium urate (38%), whewellite (24%), carbapatite (13%), or struvite (11%). Based on stone composition, urinary tract infection was involved in the nucleation or growth of a third of calculi. Endemic urolithiasis involving simultaneous nutritional, metabolic, and infectious factors, and defined by its nucleus composed of ammonium urate without struvite, represented 40% of cases. Exclusive metabolic factors - including genetic diseases such as primary hyperoxaluria, cystinuria, and hypercalciuria - were responsible for less than 25% of cases.

[Urinary calculi in children: contribution of anamnesis, biological exploration and physical analysis of calculi to the etiological diagnosis]. / La lithiase urinaire de l'enfant: contributions de l'anamnèse, de l'exploration biologique et de l'analyse physique des calculs au diagnostic étiologique.

BACKGROUND: It is always of importance to define the cause of urinary calculi disease in children to prevent recurrence and possible impairing of renal function. Nevertheless, etiology is not always easy to prove and must be deduced from both clinical and biological arguments. PATIENTS AND METHODS: The aim of this prospective study including 39 Tunisian children with urinary stones was to identify etiology and stone risk factors and detail the part of clinical and biological data and results of physical analysis of stones in determining the cause of the stone. RESULTS: In 31 cases among 39, clinical and biological data were not sufficient to identify clearly the stone etiology. When considering the structure and stone composition, the cause of the stone could be determined in 97.4% of the cases. An inherited disease was found responsible for the stone in 11 children, urinary tract infection in 13 cases, idiopathic hypercalciuria in nine cases and a nutritional deficiency disease in seven cases. In one case, polycystic kidney disease with metabolic risk factors could explain the stone process. No precise etiology was found in one case. Among infection stones, struvite stones could be related to urea-splitting bacteria while other calculi, containing whitlockite and protein matrix could be related to other micro-organisms. Earlier severe chronic diarrhoea episodes were noted in six among seven children presenting stones with a nucleus mainly composed of ammonium urate. CONCLUSION: Clinical data, biological data from both urine and blood of the patients and also the structure and composition of the stones are needed to identify the cause of urinary calculi. Such a procedure could provide the stone etiology in most cases.

[Lipid evolution during normal pregnancy]. / Evolution des lipides au cours de la grossesse normale.

We analyzed the relationship between the evolution of pregnancy and the amplitude of the lipid disorders in order to evaluate their chronologic transformations. This research concerned 83 pregnancies aged between 19-40 years during the 3 periods of gestation and 31 healthy control women in the same range of age. Our results showed an increased triglyceride in the 2nd period and an earlier decrease of both, cholesterol, phospholipid and apolipoproteins. These parameters showed a progressive increase of their blood concentrations during the 2nd and the 3rd period of pregnancy, in an other hand we evidenced a good correlation between gestational aged and these variations i.e.: triglyceride and mother's weight; this phenomenon could suggest an eventual role of the nutrition and the hygienic habitude in the lipid metabolism. The correlation between our observed lipid disorders and the mother's age or the parity were not significant.

[Iron status and pregnancy in Tunisian women]. / Statut martial et grossesse en Tunisie.

PIP: The authors studied hematological and iron status in 83 pregnant, Tunisian women during each trimester of pregnancy, and compared them with a group of 31 control women of childbearing age. The incidence of anemia (hemoglobin 11 g/100 ml) was 2-3 times higher among the pregnant women that the controls. In the group of pregnant women, the proportion of women with iron deficiency (serum ferritin 12 mcg/1) gradually increased, from 65% in the 1st trimester to 83% in the 2nd, and 95% in the 3rd. Over 1/2 of the controls (52%) were also found to have iron deficiency. In view of the risks relating to anemia and the possible repercussions of iron deficiency on the maternal and fetal health, systematic iron supplementation is recommended during the 3rd trimester of pregnancy. (author's modified)^ieng