Migration of guiding catheter during placement of hemodialysis femoral catheter: case report.

Migration of guiding catheter during placement of hemodialysis femoral catheter is an unusual, early and rare mechanical complication. We report here the case of a 70-year-old man, admitted for severe renal failure, uremic syndrome and hyperkalemia, requiring an extra renal purification session which was complicated by a blockage of the femoral venous catheter guide during its removal. Such a complication highlights the importance of good anatomical knowledge, good monitoring by an experienced person during central venous catheterization, and the interest in using ultrasound guidance before and after catheter placement.

Severe lupus after two years of hemodialysis: It exists and can be serious.

Progression of lupus nephropathy (LN) to end-stage renal disease is a serious complication and requires subsequent replacement therapy. Lupus disease activity is extinguished in chronic hemodialysis. We report the observation of a 35-year-old female patient, in conventionnel hemodialysis for two years (chronic glomerulonephritis), admitted to the emergency room for convulsions, left flaccid tenderness, cutaneous-mucosal pallor and altered general condition evolving since three days before her admission. we also observed a spontaneous ecchymotic lesions on the right arm. Echodoppler of the right upper extremity was in favor of a partially thrombosed aneurysm of the right brachial artery. The biological workup showed pancytopenia, the requested immunological workup showed a low complement C3, a positive level of anti-DNA antibodies. The patient was treated as severe lupus flare: Bolus of methylprednisolone, followed by oral administration, associated with Mycophenolate mofétil (MMF) at a dose of 1 g/d. The evolution was favorable on the clinical, biological and radiological levels. Systemic lupus erythematous (SLE) can occur even after several years of hemodialysis and sometimes in a severe form, pushing the clinician to think of this pathology in the presence of evocative signs.

Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis: A Prospective Study of Unplanned Initiation of Chronic Dialysis.

BACKGROUND: Peritoneal dialysis (PD) has become a well-established complementary alternative to hemodialysis (HD) as the first-line renal replacement modality. Unlike the temporary catheter for hemodialysis that can be used immediately after implementation, the PD catheter usage period remains controversial. The aim of this study was to compare the short- and long-term outcomes in patients under peritoneal dialysis according to the delay of starting the dialysis after catheter placement. METHODS: This observational prospective study was conducted over an eight-year and four-month period (from April 2014 to August 2021), including all patients treated with peritoneal dialysis for 18 months (from April 2014 to October 2015). The patients were divided into two groups according to whether the catheter was used during the first 15 days (PD-E) or 15 days after (PD-L) catheter placement. The primary outcomes were early complications (mechanical and infectious) within 90 days. Secondary outcomes included technique survival. RESULTS: Among the 36 patients included in the study, 14 started PD early (38.8%), while 22 started it 15 days after catheter placement (61.2%). The mean age between the two groups was not significantly different (41 ± 17 years vs 35 ± 16 years, p: not significant). There were no significant differences in the Charlson comorbidity index or the degree of autonomy. The incidence of infections was not significantly different between the two groups (13.6% in PD-L vs 21.4% in PD-E, p: not significant). The total number of mechanical complications was not significantly higher in the PD-E group compared to the PD-L group (42.8% vs 27.3%, respectively, p: not significant). Kaplan-Meier estimates of technique survival were comparable between the groups (log Rank: 1.908, p: 0.67). CONCLUSIONS: Our study showed no increase in the risk of complications associated with early use of the PD catheter and no difference in technique survival. PD can be used as first-line renal replacement therapy in the unplanned initiation of chronic dialysis.

[Achilles tendinopathy in a hemodialysis patient complicated by rupture of the Achilles tendon due to self-medication with ciprofloxacin: about a case]. / Tendinopathie achilléenne compliquée d´une rupture du tendon d´Achille consécutives à une automédication par la ciprofloxacine chez une hémodialysée: à propos d´un cas.

This study aims to remind clinicians of fluoroquinolone-related tendinopathies. They are rare side effects, but which can result in functional disability. We report the case of a 79-year-old woman with a 11-year history of haemodialysis who had sudden left ankle pain and functional impairment in the ipsilateral member on day 5th after self-medication with ciprofloxacin. Comorbidities included chronic gonarthrosis, secondary hyperparathyroidism and ischemic heart disease. The diagnosis of bilateral Achilles tendinopathy and rupture of the left Achilles tendon was retained due to clinical features and confirmed by ultrasound of ankles. Ciprofloxacin-associated tendon rupture was evaluated using the French method of accountability for drug unexpected side effects or toxicity. Tendon rupture management was based on surgery followed by functional rehabilitation program with satisfactory outcome. The frequency of fluoroquinolone-related tendinopathies ranges from 15 to 20 accidents per 100,000 subjects treated, a third of whom are complicated by tendon rupture. Incidence is related to age, affecting mainly people > 60 years and involving tissular aging. Pefloxacin and ciprofloxacin are the most offending molecules. In our study, the delay in the onset of symptoms on day 5 after self-medication was consistent with literature. We detected some common contributing factors including chronic renal failure, hemodialysis and the assumption of statins and corticosteroids. Fluoroquinolone-related tendinopathies are characterized by common clinical features which allow diagnosis. They mostly affect Achilles tendon. They are bilateral in 40-66% of cases. Tendon rupture is the main complication. Management is based on surgery. It allows to restore anatomy and to prevent detrimental functional disability. We here report a rare but potentially serious fluoroquinolones-related side effect, exposing the patient to the risk of functional disability. Advanced age, chronic renal failure, chronic haemodialysis, concomitant use of statins and corticosteroids are common contributing factors confirmed in this study. Hemodialysis patients constitute a population at risk; hence the importance of remote monitoring after treatment with these molecules.

[Renal amyloidoses in nephrology]. / Les amyloses rénales en néphrologie.

The purpose of this study was to investigate the epidemiological, evolutionary and clinical features of the renal amyloidosis and to identify poor prognostic factors. We conducted a retrospective study focusing on all patients hospitalized for renal amyloidosis between January 2013 and December 2014. The diagnosis was confirmed by renal puncture-biopsy or by biopsy of minor salivary glands. We collected data from 25 patients, 17 men and eight women, with an average age of 47.2 ± 18 years. Hospitalization rate and prevalence were 2.4% and 12.5 cases/year respectively. On admission, nephrotic syndrome was detected in 100% of cases and renal failure in 68% of cases. Proteinuria was ≥6g/24h in 60% of cases. Digestive symptoms (n=14), cardiac symptoms (n=10) and arterial hypotension (n=11) were the other manifestations. Infectious and inflammatory diseases were the main causes found (60%). Tuberculosis alone accounted for 20%. After a mean follow-up period of 219.5 days, chronic renal failure was found in 16 cases (64%), including 11 cases with end-stage disease (44%). Six patients died. Renal insufficiency at the time of diagnosis, the worsening of renal function and readmission were associated with a risk for chronic terminal renal failure (p: 0.03-0.04). Cardiac damage, the readmission and proteinuria ≥6g/24h were factors associated with the risk of mortality (p< 0.03). Renal failure, cardiac damage, proteinuria ≥6g/24h and readmission were the main factors for poor prognosis in this cohort.

[Renal needle biopsy in the Department of Nephrology in Fès: indications and results in 522 cases]. / Ponction biopsies rénales dans le Service de Néphrologie de Fès: indications et résultats: à propos de 522 cas.

The contribution of renal needle biopsy (RNB) to make a diagnosis, a treatment selection and a prognostic evaluation of nephropathies is significant. No Moroccan study has evaluated the practice and the contribution of RNB. Our aim was to study RNB indications, to determine the frequency of kidney diseases identified by RNB in our region and make a comparison between clinical and biological data and histological diagnosis. This is a retrospective study conducted between January 2009 and December 2012. We included all patients in the Department of Nephrology, CHU Hassan II, Fez, who underwent biopsy of native kidneys. 522 RNB were performed. We excluded 8 biopsies due to lack of informations and 514 were retained. The average age of the patients at the time of RNB was 39±17 years (3-82 years). Sex ratio was 0.9. Nephrotic syndrome was the most common clinical diagnosis to all ages (58.2%). Glomerular nephropathies represent 94,2% of diagnosed renal diseases, their distribution varies according to patients' age. RNB confirmed the first clinically suspected diagnosis in 40.65% of cases, whereas it revealed an unexpected diagnosis in 22.5% of them. Syndromic diagnosis can orient the clinician toward the most probable kidney disease and guide any emergency treatment while awaiting RNB results. But it can never replace RNB which remains the gold standard.

[Role of hemodialysis in the management of acute lithium intoxication]. / Place de l'hémodialyse dans la prise en charge de l'intoxication aiguë au lithium.

We report the case of a 47-years old patient, traited with lithium for manic-depressive psychosis over a period of twenty and admitted to hospital with a disorder of consciousness after suicide attempt with lithium overdose (ingestion of 30 tablets of Téralithe(®) LP 400, delayed action galenic forms corresponding to 12 g of lithium carbonate), clinically improved after three hemodialysis sessions. This study illustrates the therapeutic role of hemodialysis in voluntary intoxications with extended release lithium even a week after the ingestion and the therapeutic insufficiency of a single hemodialysis session.

[Improvement of tumoral calcinosis of the right hand after parathyroidectomy in a patient on chronic hemodialysis]. / Amélioration de la calcinose tumorale de la main droite après para thyroïdectomie chez un hémodialysé chronique.

Periarticular tissue calcifications are common in patients with chronic renal failure undergoing hemodialysis. We report the case of a patient on chronic hemodialysis for 10 years with significant improvement of isolated pseudotumoral calcinosis of the right hand after parathyroidectomy The aim of this study was to show the impact of parathyroidectomy on pseudotumoral calcinosis.

[Medical simulation in hemodialysis]. / Simulation médicale en hémodialyse.

INTRODUCTION: Simulation is an innovative educational tool based on learning experience in a secure environment without fear of repercussions especially in critical situations such as in emergencies. It offers great prospects in the development of dialysis training. METHODS: We report the results of an observational study comparing medical simulation to conventional training methods in the management of hemodialysis in emergency situations. We discuss afterwards the possibilities currently allowed by medical simulation in dialysis training. RESULTS: The training was beneficial (significant difference between initial and final level of knowledge) for all participants. There was no significant difference between the conventional approach, simulation training and the two combined tools. However, satisfaction rate was higher in simulation training. We observed a tendency to have better results in "active players" of the simulation compared to observers. CONCLUSION: We emphasize the importance of integrating medical simulation training in our dialysis training strategies as a complementary tool to classical teaching/learning methods.

Effects of fasting during Ramadan on renal function of patients with chronic kidney disease.

Fasting during Ramadan is prohibited when an individual's health is endangered. Little work has been published in this direction in patients with chronic kidney disease (CKD). We aimed to evaluate the impact of fasting during Ramadan on the renal function of patients with CKD, adjusting for the initial degree of renal impairment. We prospectively studied 60 patients with CKD (35 females; mean age 45.6 ± 15.8 years). All study patients were older than 15 years, being followed-up at the nephrology clinic for more than six months, having a stable CKD during the preceding six months and who had fasted during Ramadan the previous year. Patients who had a medical contra-indication for fasting were excluded from the study [severe or resistant arterial hypertension, insulin-requiring diabetes, acute renal failure (ARF), active renal disease, repetitive urolithiasis or terminal chronic renal failure]. Statistical analysis was performed in collaboration with the epidemiology lab at the Fez Medical School using the SPSS software version 17. Three of the study patients developed ARF in the first week and four of them at the end of the month of the study period. The risk of developing ARF was significantly higher for patients with baseline creatinine clearance of <60 mL/min/1.73 m 2 . However, the small sample size does not allow us to draw any firm conclusions on fasting during Ramadan in stable CKD patients. Studies on larger numbers of patients are recommended.

Eligibility for renal transplantation: a Moroccan interregional survey.

In the treatment of end-stage renal disease, kidney transplantation (KT) is the best and most cost-effective alternative with regard to both prognosis and quality of life. To identify the proportion and the characteristics of kidney transplant candidates who can be considered eligible, a total of 2066 hemodialysis patients were investigated as part of the ARTEMIS (Attitude toward Renal Transplantation and Eligibility among dialysis patients in a Moroccan Interregional Survey) study. We investigated all patients receiving hemodialysis in the 39 centers of four Moroccan departments. The mean age was 52.9 years and the mean duration of hemodialysis was 55.3 months. Fifty-eight percent of our patients were considered eligible for KT; 18.2% had an absolute contraindication and 23.8% had one or more relative contraindications. When compared with eligible patients (n = 1200) in the univariate analysis, those ineligible were significantly older (61 years vs. 51, P < 0.0001), had no residual diuresis (59.8% vs. 49.1%, P < 0.0001), were more often diabetic (25.1% vs. 11.9%, P < 0.0001) and hypertensive (54.5% vs. 45.8%, P < 0.0001), and their median dialysis duration was longer (61 months vs. 51, P < 0.0001). In the multivariate models, eligibility remained associated with young age, less term of dialysis and residual diuresis. Adequate control of cardiovascular risk factors before dialysis and early referral for transplantation might help to improve eligibility of the renal transplant candidates.

Non invasive assessment of liver fibrosis in chronic hemodialysis patients with viral hepatitis C.

The liver biopsy has long been the "gold standard" for assessing liver fibrosis in patients with hepatitis C. It's an invasive procedure which is associated with an elevated bleeding, especially in chronic hemodialysis patients. Main goal is to assess liver fibrosis in chronic hemodialysis with HCV by Fibroscan and by biological scores (APRI, Forns and Fib-4), and to measure the correlation between these tests. Cross-sectional study including all chronic hemodialysis patients with hepatitis C virus, in two public hemodialysis centers of Fez. All patients were evaluated for liver fibrosis using noninvasive methods (FibroScan and laboratory tests). Subsequently, the correlation between different tests has been measured. 95 chronic hemodialysis were studied, twenty nine patients (30.5%) with chronic hepatitis C. The average age was 52.38 ± 16.8 years. Nine liver fibrosis cases have been concluded by forns score. Fibroscan has objectified significant fibrosis in 6 cases. On the other side APRI has objectified sgnifivant fibrosis only in 3 cases. The Fib-4 showed severe fibrosis in five cases. The results have been most consistent between APRI and Fib-4, followed by Fibroscan and Forns, then APRI and FibroScan.

Pregnancy-related acute kidney injury: experience of the nephrology unit at the university hospital of fez, morocco.

Introduction. Acute kidney injury (PRAKI) continues to be common in developing countries. The aim of this paper is to study AKI characteristics in pregnancy and identify the factors related to the unfavorable evolution. Methods. This prospective study was conducted in the University Hospital Hassan II of Fez, Morocco, from February 01, 2011 to January 31, 2012. All patients presenting PRAKI were included. Results. 37 cases of PRAKI were listed. Their ages varied from 20 to 41 years old, with an average of 29.03 ± 6.3 years and an average parity of 1.83. High blood pressure was the most common symptom (55.6%). Thirty-nine percent were oliguric. PRAKI occurred during the 3rd trimester in 66.6% of the cases and 25% of the cases in the postpartum. Hemodialysis was necessary in 16.2% of cases. The main causes were preeclampsia, hemorrhagic shocks, and functional, respectively, in 66.6%, 25%, and 8.3% of the cases. The outcome was favorable, with a complete renal function recovery for 28 patients. Poor prognosis was related to two factors: age over 38 years and advanced stage of AKI according to RIFLE classification. Conclusion. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation.

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.