Features and outcomes of lupus nephritis in Morocco: analysis of 114 patients.

BACKGROUND: There is wide variation in clinical presentation and outcome of lupus nephritis (LN) among different ethnic groups. Few data for LN exist on North Africans, especially those from Morocco. The aim of our study was to review retrospectively the features and outcome of LN in Moroccan patients. PATIENTS AND METHODS: We performed a single-center retrospective study. A total of 114 patients with LN were included. All patients met American Rheumatism Association criteria. LN was classified according to the International Society of Nephrology/Renal Pathology Society classification. We adopted previously defined outcome criteria for LN. RESULTS: There were 101 females and 13 males, with a mean age of 29.9 years. At first presentation, we noted hypertension in 33%, hematuria in 76%, nephrotic syndrome in 53%, and renal failure in 60% of cases. Renal biopsy revealed predominant proliferative classes in more than 80% of patients. Patients received different regimens mainly based on intravenous cyclophosphamide. After a mean follow-up of 22 months, remission occurred in 45.5%, relapses in 82%, end-stage renal failure in 21%, and death in 16% of cases. Infection and neurological and cardiovascular diseases were the most frequent causes of death. CONCLUSION: LN seems to be severe in our study, with a predominance of proliferative forms, severe renal manifestations, and poor renal and overall survival.

Urinary tract infections in renal allograft recipients from living related donors.

Urinary tract infection (UTI) remains the most common infectious complication in renal transplant recipients. We aimed in our study to describe the epidemiological patterns and evaluate the favouring factors of UTI in our renal allograft recipients. We evaluated retrospectively all the UTIs in 47 kidney recipients transplanted from living-related kidney donors in Rabat University Hospital, Morocco, from January 1998 to December 2005. The mean follow-up was 28+/-19 months. The mean age of the patients was 32+/-10 years with a male/female ratio of 1.35/1. Twenty patients (42%) suffered at least one UTI episode. UTIs were asymptomatic in 70% of the patients, while manifested as acute pyelonephritis in 17% and uncomplicated acute bacterial cystitis in 13%. UTI episodes occurred in 68% of the patients during the first 3 months post-kidney transplantation with a recurrence rate of 55%, and all the patients experienced a favourable course. Gram-negative bacilli were the principally isolated agents; E. Coli was found in 60% of the patients and Klebsiella in 30%. UTI was more common in females (p=0.04) and cases of post transplantation vesicoureteral reflux (p=0.03). The graft survival rate at the end of the study was comparable for both UTI and non-UTI groups.

Predictors of hyperparathyroidism in renal transplant recipients.

The changes in parathyroid hormone secretion after successful renal transplantation remain to be clearly elucidated. Our study was aimed at identifying the predictors of hyperparathyroidism in renal transplant recipients. A retrospective single center study involving 37 renal transplant recipients, with a follow-up of at least one year, was performed. All transplants were performed using kidneys from living related donors. The average age of the study patients was 30 +/- 10 years, with a male-female ratio of 1.31. The mean duration on hemodialysis (HD) prior to transplantation was 25 +/- 18 months. All the grafts but one, were functional after a mean follow-up of 41 +/- 21 months. We noted a rapid reduction of the mean parathyroid hormone (iPTH) level from 383 +/- 265 pg/ml before transplantation to 125 +/- 67 pg/ml at one year and 108 +/- 66 pg/ml at two years after transplantation (p = 0.01). Bivariate analysis revealed that the level of iPTH obtained during follow-up correlated with the duration on HD (p = 0.03), the serum creatinine at 24-months (p = 0.013), and to the level of iPTH in the first year post-transplantation (p = < 0.001). Other clinical or laboratory parameters were not predictive of hyperparathyroidism after kidney transplantation. Linear regression showed that only the serum creatinine at 24-months independently correlated with the level of iPTH at last follow-up (p = 0.02). Our study suggests that short duration on HD and a functional graft are the main predictors of correction of hyperparathyroidism after renal transplantation.

Hypertension in related living donor renal allograft recipients.

Cardiovascular morbidity and mortality are extremely high in all stages of renal failure. Arterial hypertension remains a major problem even after renal transplantation. We studied retrospectively the hypertension patterns in recipients of renal allografts from living donors from January 1998 to December 2004. The mean age of the patients was 29.3 +/- 9.4 (range 13 - 54) years, with a male predominance (62%). Among 42 of the study patients, 40 (95%) were hypertensive at 3 months after transplantation with a slightly decreasing prevalence at 6 and 12 months to 84% and 85%, respectively. During dialysis period, 59.5% of the patients were hypertensive. The allografts were left kidneys with only one artery in 40 patients and right kidneys with 2 arteries in 2 patients. Graft renal artery stenosis (RAS) was documented by Doppler ultrasound in 13 (32.5%) cases. Three patients improved following transluminal angioplasty with stenting. The control of the hypertension required the use of at least two anti-hypertensive drugs in 56% of patients. On an average follow-up of 30 (1 - 78) months, no cardio-vascular event was reported and all the allografts remained functional. We conclude that hypertension is prevalent in the living renal allografts recipients. The etiology is multifactorial and careful management is mandatory to protect the renal function and the cardiovascular system.

[Initial presentation and course of lupus membranous glomerulonephritis]. / Forme initiale et évolution de la glomérulonéphrite extramembraneuse lupique pure.

INTRODUCTION: Lupus membranous nephropathy (MN) is associated with a substantial risk of developing end-stage renal disease and may thus be fatal. There is currently no consensus about specific immunosuppressive treatment. We describe the presentation of lupus MN and its course according to type of immunosuppressive treatment. PATIENTS AND METHODS: This retrospective study included all patients with lupus MN (only, not associated with any proliferative nephropathy) hospitalized in the nephrology unit of Ibn Sina University Hospital in Rabat from 1994 through 2005. RESULTS: MN was found in 18 patients, 16.7% of our patients with lupus. The average age at first admission of these 18 was 29+/-2.1 years (17-52), with a sex ratio of 0.12. The mean follow-up period was 54+/-31 months (3-130). The initial clinical presentation of MN was marked by the presence of proteinuria, nephrotic in 11 cases. Mean serum creatinine was 18.6+/-3.9 mg/L. Leukocyturia was noted in 12 cases (67%) and microscopic hematuria in 8 cases (44%). Extrarenal signs were cutaneous (14 cases), articular (14 cases), hematologic (8 cases), cardiac (6 cases) and neurological (4 cases). Patients were treated by corticosteroids only (group 1=7 cases) or by corticosteroids combined with cyclophosphamide in cases of renal insufficiency or neurological signs (group 2=11 cases). Complete remission occurred in 11 cases, and partial remission in the others. Four relapses were observed, including three in group 2. Mean serum creatinine blood levels were comparable in the 2 groups. Four patients died of extrarenal causes. Only one patient, in group 2, progressed to end-stage renal disease. CONCLUSION: The initial presentation of lupus MN is variable. Cyclophosphamide has favorable renal effects, but does not prevent lethal complications, especially neurological complications.