A nephrotic syndrome of tropical origin: case report and short review of the aetiology.

We present a case of nephrotic syndrome in a 38-year-old man of Ivorian origin. In the search of the cause of his illness an infection with Plasmodium malariae (P. malariae) was diagnosed by serology and by microscopy of a Giemsa thin blood smear which revealed rare gametocytes of P. malariae. Proteinuria significantly diminished within three months after antimalarial treatment. Antibodies against Schistosoma were detected as well. Examination of kidney biopsy revealed a discrete mesangioproliferative glomerulonephritis. This case highlights that a thorough history-taking may be essential and that infectious diseases should be included in the differential diagnostic thinking process when a nephrotic syndrome is diagnosed.

[The role of psychological interventions in dialysis: an exploratory study]. / Intérêt des interventions psychologiques en dialyse : étude exploratoire.

Patients suffering from end-stage renal disease (ESRD) have a very reduced quality of life accompanied by a severe emotional distress (high worries-anxiety-depression). However, in Belgium, no regular psychological intervention is proposed to dialyzed patients. Our objective is to show that psychological intervention can significantly decrease the emotional distress of patients with ESRD. Eleven sessions of structured interventions are proposed to ESRD patients. Eligibility criteria are to be major, to not present confusion or/and dementia, to have been on dialysis treatment for at least 3months, to have obtained 14 or more on HAD-scale. Interventions carry on the management of anxious and depressive symptoms and of the disease itself. This constitutes three independent modules. Questionnaires are filled in by the patients at various stages to evaluate the anxiety and the depression (HADS), the worries (Penn State) and the quality of life (KDQoL-SF). Results for the 47 ESRD patients show a significant reduction of the scores of anxiety, depression and worries and a significant growth of quality of life. In parallel, a decrease in the serum calcium-phosphorus product analyzed before dialysis has been noted.

[Cardiac amyloidosis]. / Le cas clinique du mois. Amyloïdose cardiaque de type AL: a propos d'un cas.

We present a case of a 54-year-old female presenting with renal failure and, two years later, heart failure, both due to primary systemic amyloidosis. The case gives us the opportunity to review the litterature on the topic.

[Choosing a modality for renal replacement therapy]. / Quelles méthodes de suppléance au stade de l'insuffisance rénale chronique terminale?

End-stage renal disease is a real public health problem. The late referral of patients with chronic renal failure may adversely affect outcomes of dialysed patients and include an additional cost for the society. In this article, the authors review end-stage renal disease in Belgium, and then describe the different modalities of renal replacement therapy currently available: hemodialysis, peritoneal dialysis and kidney transplantation.

[Clinical case of the month. A recurrent chylothorax in Bourneville tuberous sclerosis]. / Le cas clinique du mois. Un chylothorax récidivant dans un contexte de sclérose tubéreuse de Bourneville.

Bourneville's disease, first described in 1862, is a phacomatosis that is either autosomal dominant or sporadic. Its typical clinical signs include mental retardation, epilepsy and cutaneous adenomas. The pulmonary form is rare, less than 1%, and is secondary to occlusion of the bronchus, vascular and lymphatics by immature smooth muscle cells. Chylothorax may appear in more than 50% of all cases. No guidelines currently exist for treatment of recurrent chylothorax. However, several possibilities are described in the literature.

[Does dopamine play a role in renal anomaly in sodium excretion, a marker for hereditary predisposition to arterial hypertension?]. / Anomalie rénale de l'excrétion sodée, un marqueur de la prédisposition héréditaire à l'hypertension artérielle, rôle de la dopamine?

Since Dahl's observation, a renal defect os sodium excretion is proposed as one of pathogenetic mechanism of hypertension (HTA). Our study has tried to verify this concept in 20 young normotensives with (n = 12) and without (n = 8) familial predisposition to HTA, allowing to test the genetic transmission of such potential renal abnormality of sodium balance. Each people was submitted to 3 different Na diet (20, 170 and 340 mM NaCl) each for 1 week. At each visit, blood pressure, vascular resistances, biological values were determined at rest (plasma renin activity, creatinine clearance, 24 hours before the test, catecholamines, aldosterone and ion urinary excretion). Then 1 liter of isotonic saline was perfused in 30 minutes with measures of blood pressure and 3 hours urinary dopamine and Na excretion. During the low and medium Na diets, but not during the high Na diet, the natriuresis and dopamine excretion were lower in the 3 hour urine collection in patients with a family history of HTA (p less than 0.02 and p less than 0.005, respectively). No other clinical or biological difference was noted between the 2 groups. Thus, genetic hypertensive predisposition seems to be characterized by a lower Na excretion during acute Na loading in normal or depleted Na diet, linked to an impaired urinary dopamine excretion. These findings suggest that the defect responsible for the susceptibility to sodium intake is at the kidney level. Some dopamine agonists would be of great therapeutical value in treating such patients when blood pressure begins to rise.

[Does ambulatory blood pressure measurement allow a better definition of arterial hypertension?]. / La mesure ambulatoire de la pression artérielle permet d'améliorer la définition de l'hypertension artérielle.

The lack of effect of treatment of mild hypertension on the coronary heart disease has motivated researches for a better diagnosis of hypertension. One of the approaches presently under study uses the recording of ambulatory blood pressure using semi-automatic devices. The usefulness of these apparatus is however restricted by the lack of reference values recorded in normotensive control patients. We have recorded ambulatory blood pressure (PAA) in 24 normotensives, 22 untreated hypertensives and 45 treated hypertensive patients, and compared the data obtained to the blood pressure recorded during medical examination (PAC). If a good correlation is usually observed between PAA and PAC, very large and unpredictable discordances are frequently observed. No correlation is found between the difference PAA-PAC and the variability of PAA. This variability does not fully explain the difference observed between PAA and PAC. This variability expressed in mmHg increases with age and the level of BP. Ambulatory BP appears to be a very reproducible value which may allow to improve the definition of hypertension and there-fore the cardiovascular risk.