Tuberculosis in hemodialysis.

Chronic uremia puts patients at increased risk of infectious complications, in particular, tuberculosis. In this prospective study, we analyzed the clinical, paraclinical, and therapeutic features as well as outcome for all patients on chronic hemodialysis with tuberculosis from January 2010 through August 2012. Sixty-one patients were admitted for bacterial infections, 23% of them for tuberculosis. Fever was present in 71% of cases, and CRP elevated in all cases. The tuberculin skin test was positive in only 2 of 9 cases, and Mycobacterium tuberculosis isolated in 2 of 10 cases. Histological evidence was obtained in 7 of 9 cases. Plain radiographs and computed tomography evoked tuberculosis. The location was extrapulmonary in 71% of cases. Chemotherapy for tuberculosis was based on a quadruple therapy for 10 patients and triple therapy for 3. The outcome was favorable in 11 patients and fatal for 3. Tuberculosis is much more common in hemodialysis patients than in the general population. The telltale signs are nonspecific. Prognosis is closely linked to early diagnosis and treatment.

Posterior reversible encephalopathy syndrome in a hypertensive patient with renal failure.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and neuroimaging entity characterized by headache, visual field deficits, changes in mentation and seizures, and by typical neuro-imaging features such as areas of sub-cortical edema, occasionally cortical, involving predominantly the occipital and parietal lobes of both hemispheres. Hypertension, uremia, immunosuppressive drugs neurotoxicity, preeclampsia or eclampsia, renal disease, and sepsis are the most common etiologies of PRES. Less common, it has been described in the setting of autoimmune disease. We report a case of PRES which was associated with hypertensive crisis in a patient with renal failure. Antihypertensive therapy and hemodialysis resulted in complete recovery.

[Screening and risk factors of cardiac calcification in hemodialysis: contribution of ultra-fast multi-slice scanner and transthoracic echocardiography]. / Dépistage et facteurs de risque des calcifications cardiaques chez l'hémodialysé : apport du scanner multi-coupe ultra-rapide et de l'échocardiographie transthoracique.

INTRODUCTION: Cardiovascular disease is the first leading cause of death in hemodialysis patients. In this population, cardiovascular calcifications occur at an earlier age and progress faster than in general population. PATIENTS AND METHODS: In order to determine the prevalence and risk factors of cardiac calcifications, 49 patients on chronic hemodialysis were screened in the coronary arteries and cardiac valves by the 64 multi-slice ultra-fast CT and the transthoracic echocardiography. Different clinical and biological parameters were studied by the SPSS 10.0 statistical software to determine risk factors. RESULT: Cardiac calcifications were identified in 81.6% of cases in at least one of the two studied sites. The coronary artery involvement was more common than valvular and concerned 69.4% of cases. The mean Agatston coronary artery calcium score (ACACS) was 331.1 and 522.2 in coronary patients and was correlated to alteration of systolic function of LV (r=-0.287, P=0.045). The severity of CACS was positively correlated with age (r=0.332, P=0.02). Coronary calcifications were associated with cardiovascular risk common to those of the general population (age, male sex, systolic blood pressure, diabetes, history of ischemic heart disease), but also to a lesser quality of dialysis. Valvular calcifications were present in 49% of cases and were correlated with left ventricular hypertrophy (P=0.006). The exclusive involvement of the aortic valve was the most common valvular abnormality. Phosphocalcic and lipid parameters, levels of hemoglobin, CRP and uric acid did not predisposed to cardiac calcifications in our patients. DISCUSSION: In hemodialysis patients, the pathogenesis of cardiovascular calcification is complex and cannot be attributed to a passive process. This process involves several factors that can promote or inhibit calcification. The new multi-slice ultra-fast scanner is a very sensitive method for topographic and quantitative assessment of coronary calcification and is a better alternative to invasive techniques. CONCLUSION: Our study confirms the high prevalence of cardiac calcification in hemodialysis, and highlights the importance of early screening and treatment of predisposing factors.

[Prevalence and risk factors of hepatitis C virus infection in patients on hemodialysis: results of a Moroccan study]. / Prévalence et facteurs de risque de l'hépatite virale C en hémodialyse : résultats d'une étude marocaine.

INTRODUCTION: Infection with the hepatitis C virus (HCV) is the leading cause of chronic hepatitis in patients on hemodialysis. The objective of this study was to determine the prevalence of infection with this virus and its main risk factors among chronic hemodialysis patients treated at the Mohammed V military teaching hospital in Rabat, Morocco. PATIENTS AND METHODS: Retrospective study of 141 patients with chronic end-stage kidney disease receiving hemodialysis between April 2010 and September 2012, including testing for anti-HCV antibodies and HCV RNA. RESULTS: The prevalence of HCV assessed by PCR in chronic hemodialysis patients treated at our hospital was 12.1%. Risk factors associated with this prevalence included duration of hemodialysis and transfusions. CONCLUSION: The prevalence of HCV among patients receiving hemodialysis in Morocco is gradually declining and the most important risk factors (transfusions and duration of hemodialysis) are becoming progressively less important.

[Diagnosis and evaluation of hepatitis C virus among haemodialysis patients]. / Diagnostic et evaluation de l'hépatite virale C chez I'hémodialysé.

Hepatitis C is a health problem worldwide. The World Health Organization estimates that 3% of world's population is infected with hepatitis C virus (HCV). In haemodialysis patients, the prevalence reaches 80% in some countries. In Morocco, HCV prevalence is 32% according to the Moroccan register of dialysis. The natural history of hepatitis C infection in chronic haemodialysis patients is characterized by a silent evolution. There are different methods to diagnose HCV and they are becoming increasingly sensitive. There are indirect tests for antibodies to HCV: these are reproducible but false negatives are common and there is direct testing of viral RNA: this is more sensitive but not always available and is more expensive. The use of these tests has been categorized through new recommendations from learned societies. However, the evaluation of liver disease is still controversial and liver biopsy remains the gold standard. This paper reviews the approaches for diagnosing and evaluating hepatitis C in haemodialysis patients.

Diagnosis and evaluation of hepatitis C virus among haemodialysis patients

Hepatitis C is a health problem worldwide. The World Health Organizion world's population is infected with hepatitis C virus [HCV]. In haemodialysis patients, the prevalence reaches 80% in some countries. In Morocco/ HCV prevalence is 32% according to the Moroccan register of dialysis. The natural history of hepatitis C infection in chronic haemodialysis patients is characterized by a silent evolution. There are different methods to diagnose HCV and they are becoming increasingly sensitive. There are indirect tests for antibodies to HCV: these are reproducible but false negatives are common and there is direct testing of viral RNA: this is more sensitive but not always available and Is more expensive. The use of these tests has been categorized through new recommendations from learned societies. However, the evaluation of liver disease is still controversial and liver biopsy remains the gold standard. This paper reviews the approaches for diagnosing and evaluating hepatitis C in haemodialysis patients

Glomerular diseases in the Military Hospital of Morocco: Review of a single centre renal biopsy database on adults.

Epidemiological studies provide useful information for clinical practice and investigations. This report aimed to determine glomerular diseases frequencies in a region of Morocco. All native renal biopsies (January 2000 to December 2007) on adults were reviewed, but only glomerular diseases were analyzed. The diagnosis of each case was based on histological, immunopathological and clinical features. We have performed 171 renal biopsies in 161 patients (101 males and 60 females), the mean age was (range) 40.4 ±15 years (16-72). Clinical indications that lead to renal biopsy were: nephrotic syndrome (60.3%), renal failure of unknown aetiology (31.6%), asymptomatic urinary abnormalities (6.2%) and nephritic syndrome(1.9%). Primary glomerular diseases were reported in 84 patients (52%). The most common histological lesion was minimal change disease (26%). Idiopathic membranous glomerulopathy was the second most common lesion (23%) followed by membranoproliferative glomerulonephritis (17%), IgA nephropathy (12%), focal and segmental glomerulosclerosis (9.4%) and crescentic glomerulonephritis (6%). Secondary glomerular diseases were reported in 53 patients (33%). Lupus nephritis was the secondary glomerular disease most frequent (45%) followed by amyloïdosis (19%), diabetic nephropathy (15%), and Good pasture's syndrome (7.6%). The most common complications of the procedure were pain at biopsy site in 4%, gross hematuria in 11.1%, perirenal hematoma in 5% and hematuria requiring nephrectomy in 0.6% patients. Minimal change disease was the most frequent primary glomerulopathy and lupus nephritis was the most frequent secondary glomerulopathy in our group. The reasons for these findings are unclear. This information is an important contribution to the understanding the prevalence of renal diseases in North Africa.

[Non-diabetic renal disease in type II diabetes mellitus patients in Mohammed V Military Hospital, Rabat, Morocco]. / La néphropathie non diabétique chez les patients diabétiques de type 2 à l'hôpital militaire Mohammed V de Rabat (Maroc).

The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients (37.5%); IgA nephropathy was the most frequent non-diabetic renal disease (half of non-diabetic renal diseases). Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group (16.7% versus 80.0%, P = 0024), duration of diabetes was a shorter (4.5 versus 15.5 years, P = 0.022) and diabetic retinopathy was absent (100% versus 40%, P = 0.026). There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephrotic syndrome and microscopic haematuria.

Predictors of early vascular-access failure in patients on hemodialysis.

Vascular access management is key and critical in the successful management of hemodialysis patients, and an arteriovenous fistula (AVF) is considered the access of choice. This study was conducted between January 2007 and October 2009 at the Military Hospital in Rabat. Data on 115 patients who underwent 138 AVFs were retrospectively studied. Wrist AVF was the most common site of use. The primary course was uncomplicated in 63% of the patients, while primary failure occurred in 23.9% of the patients. Presence of diabetes was the most important risk factor for primary failure.

The Kt/V by ionic dialysance: Interpretation limits.

The availability of hemodialysis machines equipped with online clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume (V) is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods. A total of 35 patients were studied. Ionic dialysance was measured by conductivity monitoring. The second-generation Daugirdas formula was used to calculate the Kt/V single-pool (Kt/VD). Values of V to allow comparison between OCM and blood-based Kt/V were determined using Watson formula (VWa), bioimpedance spectroscopy (Vimp), and blood-based kinetic data (Vukm). Comparison of Kt/Vw ocm calculated by the ionic dialysance and Vw (Kt/Vw ocm) with Kt/VD shows that using VW leads to significant systematic underestimation of dialysis dose by 24%. Better agreement between Kt/V ocm and Kt/VD was observed when using Vimp and Vukm. Bio-impedancemetry and the indirect method using the second-generation Daugirdas equation are two methods of clinical interest for estimating V to ensure greater agreement between OCM and blood-based Kt/V.

Non-diabetic renal disease in type II diabetes mellitus patients in Mohammed V military hospital, Rabat, Morocco

The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients [37.5%]; IgA nephropathy was the most frequent non-diabetic renal disease [half of non-diabetic renal diseases]. Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group [16.7% versus 80.0%, P = 0024], duration of diabetes was a shorter [4.5 versus 15.5 years, P = 0.022] and diabetic retinopathy was absent [100% versus 40%, P = 0.026]. There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephritic syndrome and microscopic haematuria

Characteristics of intradialytic hypotension: experience of Agadir Center-Morocco.

We report in this retrospective study the experience of our hemodialysis (HD) center in the incidence of intradialytic hypotension (IDH) over 18 months. We first studied the demographic, clinical, biological and morphological data of our 52 HD patients and compared the characteristics of patients with frequent IDH and those without. We found that factors significantly associated with IDH include diabetes, left ventricular hypertrophy, impaired diastolic function, weight gain and high ultrafiltration rates. Despite these results, further larger studies are required to confirm them.

Settling velocity of particulate pollutants from combined sewer wet weather discharges.

Settling velocities of TSS and of particulate pollutants (COP, PDCO, PTKN, PCu, PPb, PZn, PPAH) measured on a wide range of wet weather flow (WWF) samples collected at different levels of the Parisian combined sewer system are reported. The recorded V30 (0.01 to 0.1 mm s(-1)) and V50 (0.09 to 0.6 mm s(-1)) values exceed by a factor 10 those of dry weather sewage and also exceed the values measured for pavement runoff. These values lie however often below the 0.28 mm s(-1) reference value considered in France for the design of WWF settling facilities. A decrease in settleability is observed between a small upstream catchment and larger scaled downstream catchments. The settling behaviour of particulate pollutants varies depending on the considered parameter and can differ significantly from the TSS behaviour, due to a non homogeneous distribution of micropolluants over the different classes of particles. PZn and PTKN appear far less settleable than TSS, whereas PPAH show higher settleability.

[Non-secreting myeloma associated with nephrotic syndrome]. / Myélome non excrétant révélé par un syndrome néphrotique.

The non-secreting myeloma is a rare form of myeloma. Its association with a nephrotic syndrome is exceptional. The observation which we report below described the history of a 66 years old patient who presents a non-secreting myeloma revealed by a nephrotic syndrome. Various assumptions on the mechanism of no excretion were put forth. Nevertheless, several points are to be elucidated as for the pathogenesis of the association non-secreting myeloma and nephrotic syndrome.

Spatial variability of characteristics and origins of urban wet weather pollution in combined sewers.

An experimental on-site observatory of urban pollutant loads in combined sewers was created in the centre of Paris to quantify and characterise the dry and wet weather flow in relation to spatial scale. Eight rainfall events were studied from April 2003 to May 2004. Samples were analysed for suspended solids, organic matter, nitrogen and heavy metals. Results confirm the extent of wet weather pollution. They have shown the relative homogeneity of SS and organic matter characteristics from one urban catchment area to another. Two groups of heavy metals were identified. The first one concerns Cu, which has a higher concentration in wet weather flow (WWF) than in dry weather flow (DWF), and runoff. The second includes Cd, Pb and Zn, where higher concentrations were measured in urban runoff than in WWF and DWF. A first evaluation of contribution of wastewater, urban runoff and sewer deposit erosion sources to wet weather pollution was established and has highlighted the contribution of wastewater and sewer deposits to this pollution. However, it has shown that sewer deposit erosion remains an important source of wet weather pollution at different spatial scales.