Efficacy of Growth Hormone Treatment in Children With Chronic Kidney Disease: Tunisian Experience.

OBJECTIVE: To study the effect of using recombinant human growth hormone (rhGH) in growth retarded children with chronic kidney disease (CKD). METHODS: This was a non-randomized controlled study over 2 years including children in CKD stages 4-5 suffering from growth retardation. Children were divided into rhGH-treated or non-rhGH treated groups. RESULT: A total of 70 children (35 in each group) were enrolled. While the mean (SD) height of 35 children with CKD had increased from 109.5 (26) cm to 116 (26) cm (mean growth velocity 6.5 cm/year; P=0.09) prior to rhGH therapy, the same was found to increase from 116 (26) cm at the start of therapy to 125 (25) cm after one year of therapy (P=0.02). CONCLUSIONS: Therapy with rhGH was helpful in catch-up growth in Tunisian children with CKD.

[Inherited kidney stones: A nephrology center experience]. / Lithiase urinaire héréditaire : expérience d'un service de néphrologie.

INTRODUCTION: Genetic factors must be considered in etiological diagnosis of urinary lithiasis. The aim of this study was to determine clinical, metabolic characteristics and the progression of hereditary urinary lithiasis in our patients. METHODS: A retrospective study was conducted between 2008 and 2018 and 60 patients were included. Patients were referred to our department from pediatrics departments to be followed-up in adulthood in 9 cases, for etiological investigation in 42 cases and for chronic renal failure in 9 cases. RESULTS: Thirty-five men and twenty-five women were enrolled in this study with a M/F sex ratio equal to 1.4. The mean age at the time of diagnosis of the hereditary character of the urinary lithiasis was 28.6years (3months-63years). The average delay between the onset of the lithiasis disease and the etiological diagnosis was 8years (0-42years). We noted 31 cases of cystinuria, 18 cases of primary hyperoxaluria type 1 with two mutations (I244T in 14 cases, 33-34 Insc in 23 cases) and 11 cases of renal tubulopathy. Fourteen patients were affected with chronic renal failure, of which five were in the end-stage renal disease. Crystalluria was positive in 62% of cases. The morpho-constitutional analysis of stones was performed in 37 cases and it contributed to the diagnosis in 29 cases. After an average follow-up of 16years, we noted normal renal function in 42 cases, chronic renal failure in 7 cases, hemodialysis in 10 cases all with primary hyperoxaluria and transplantation in 1 case. CONCLUSION: The etiological diagnosis of hereditary urinary lithiasis in our study was made with considerable delay. Cystinuria was the most frequent etiology and primary hyperoxaluria was the most serious affection. LEVEL OF EVIDENCE: 4.

Impact of Interleukin-17F Gene Polymorphisms in Outcome of Kidney Transplantation in Tunisian Recipients.

BACKGROUND: Genetic polymorphisms of interleukin (IL)-17F, associated with functional and/or quantitative change in this glycoprotein, have been described as predisposing to various autoimmune diseases. The proinflammatory IL-17 has some roles in renal transplantation. In this context, the relationship between the most common IL-17F polymorphisms with acute renal allograft rejection susceptibility in Tunisian renal recipients has been investigated. METHODS: We examined 93 renal transplant recipients who were enrolled and classified as follows: GI, 48 transplant recipients who developed at least one episode of acute rejection; and GII, 45 controls, kidney recipients who also were followed for at least 1 year and had stable renal function. Single nucleotide polymorphisms (SNPs) of IL-17F gene, including -1507 C/T (rs18889570), 7384 A/G (rs2397084), 7469 C/T (rs11465553), and 7489 A/G (rs763780), were evaluated using direct sequencing. RESULTS: No statistically significant association of the IL-17F SNPs studied with the onset of acute rejection was observed. However, AA genotype on 7489A/G SNP showed anti-HLA antibodies less than other genotypes and a higher graft survival time (P = .017). CONCLUSION: The AA genotype on 7489A/G SNP of IL-17F and the A allele might be associated with a lower risk of acute rejection with better graft survival.

End-stage renal disease in Tunisian infants: Etiology and outcome.

End stage renal disease (ESRD) in infants has particular features in terms of etiologies and therapeutic modalities. The aim of our study is to describe the etiologies and the ESRD outcomes among Tunisian infants. This retrospective study was conducted over 15 years (from January 1998 to December 31, 2013) in the Pediatric Department at Charles Nicolle Hospital. In total, 157 pediatric patients had ESRD. The mean incidence was 4.25 million children. The study involved 24 infants; the sex ratio was equal to 2. The mean age at diagnosis of ESRD was 8 months (range, 1-21 months). Growth retardation was noticed in 14 patients. The main causes were Congenital Anomalies of the Kidneys and Urinary Tract (9 infants) and hereditary renal disease (9 infants). All patients were treated with peritoneal dialysis; 16 infants presented peritonitis. Mortality rate was about 28%. The leading causes of death were cardiovascular diseases and infections.

[Henoch Schonlein nephrites in children : clinical features and outcome : about 34 cases]. / La néphropathie du purpura rhumatoïde de l'enfant ; étude clinique et évolutive

AIM: To describe epidemiological, clinical, histological aspects, treatment and outcome of Henoch-Schönlein nephrits in children. METHODS: A retrospective study was conducted on medical data of 34 patients with Henoch-Schönlein nephritis From January 1, 1996 to December 31, 2010 in the Pediatric Department of Charles Nicolle Hospital. RESULTS: Nephritis occured in 68,7%. The average patient age was 7 years 2 months and sex ratio was 0,6. Microscopic hematuria was noted in 23,5%, moderate proteinuria with or without hematuria was observed in 20,5%. Nephrotic syndrome was noted in 29,5%; nephritic syndrome was associated to nephritic syndrome in 23,5%. Isolated hypertension was noted in one patient. Follow-up was 2 years 6 months. Remission was noted in 26 cases (76,4%) , minor urinary abnormalities in 7 cases (20,5%) and renal active disease in one case. Relapse was observed in 6 cases. CONCLUSION: Our study was characterized by the predominance of severe renal manifestations and low grade histological aspects as well as favourable outcome in most 90% of cases.

Malformative uropathies and kidney transplantation.

INTRODUCTION: Malformative uropathies are a frequent cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Medical management of urinary tract infections and advances in surgical reconstruction procedures resulted in good outcomes of kidney transplantation among these patients. The aim of this article was to describe the epidemiological profiles and outcomes of patients who underwent transplantation for ESRD related to malformative uropathies. PATIENTS AND METHODS: Among 493 kidney recipients at our center from 1986 to 2009, 47 had malformative uropathies as the cause of ESRD. We retrospectively studied the incidence of acute rejection episodes, acute tubular necrosis, as well as patient and graft survivals, comparing these results to those observed in patients without malformative uropathies using chi-square tests for qualitative parameters and nonpaired Student t tests for continuous variables. Log-rank tests were used for comparisons of survival curves. RESULTS: The 47 patients, representing 9.53% of our kidney transplant recipients, included 27 men and 20 women (sex ratio=1.35) with an overall mean age of 27.6±9.1 years (range, 10-49). The common etiology was vesico-ureteral reflux (78.7%). Hemodialysis was the main RRT modality (68%) with a median duration of 41 months. Also, 82.9% of patients received transplants from living donors. Acute tubular necrosis occurred in 4 of these (8.5%) versus 22.06% of the other patients (P=.03). Acute rejection episodes were observed in 13 of these patients (27.6%) versus 23.1% of the other patients (P=not significant [NS]). After a cumulative follow-up period of 3744 months (median, 41.8 months), 5 patients had died (1.6 death/y/100 patients) and 5 had lost their allografts and returned to dialysis (1.6 case/y/100 patients). Graft survival rates at 1, 5, and 10 years were 97.8%, 93.2%, and 79.9%, which were comparable with 95.9%, 87.6%, and 78.9% among the other patients, respectively (P=NS). Patient survival rates at 1, 5, and 10 years were 100%, 88.5%, and 82.6% versus 96%, 87.6%, and 79.6%, respectively (P=NS). CONCLUSION: Kidney transplantation in patients with malformative uropathies is increasingly frequent. The incidence of acute rejection episodes as well as patient and graft survivals were comparable with those of subjects without malformative uropathies.

[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.

Adrenocortical oncocytoma: a case report and review of literature.

Oncocytic tumors of the adrenal gland are uncommon. Most of these oncocytomas are benign and nonfunctioning. We report the case of functioning adrenocortical located in the right adrenal gland in a 6-year-old girl who presented with pseudoprecocious puberty and elevation of the estradiol level. She had an adrenalectomy. The tumor was small and composed predominantly of oncocytes. No criteria of malignancy were found. A discussion of this case and a review of the literature on this entity are presented.