Evolutive profile of hemodialysis vascular accesses Hemodialysis accesses.

INTRODUCTION: Arterio-venous fistula (AVF) is the first-choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative. AIM: To evaluate indications of KT and AVF and their predictive factors of complications. METHODS: It's a retrospective multicentric study interesting KT and AVF in patients treated by hemodialysis, in the Kef Governorate in north-western Tunisia, during the period from 01/07/18 to 31/12/18. RESULTS: We included 288 AVF and 148 KT that were created on 205 patients. The average age was 58.14 years, the sex ratio was 1.5. Hypertensive patients and diabetics represented respectively 83.9% and 27.3% of the population. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait for AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity and tunneled type of KT as contributing factors. KT infection was occuring in 39.2% of cases. It was promoted by prolonged duration of use and hemoglobin level < 8g/dl. The use of antiseptic lock reduced infections' risk (p=0.011). For AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). Survival rate was 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), anterior AVF creation (p=0.011), AVF grafts (p=0.016), and anticoagulant therapy (p=0.0001). Antiplatelet therapy improved AVF patency (p=0.02). CONCLUSION: Much remained to be done to reduce KT complications, creation of AVF on time and prevention of their complications.

A case of abdominal aortic thrombosis associated with the nephrotic syndrome.

Thromboembolic disease is an important and frequent complication in patients with the nephrotic syndrome (NS), and the consequences are often severe. Usually, the venous system is affected. Arterial thrombosis has rarely been reported and occurs mainly in children. We report the case of a 27-year-old man with a history of NS due to focal and segmental glomerulosclerosis resistant to steroids and cyclosporine, admitted for bilateral pain in the calves. Aortogram revealed a suspended thrombus in the abdominal aorta just below the origin of the renal arteries with embolism into the left tibioperoneal trunk and the right anterior tibial artery. Endarterectomy was performed followed by systemic heparinization with a good outcome. Arterial thrombosis is rare and must be prevented.

Acute tubulointerstitial nephritis and uveitis syndrome: A report on four adult cases.

Acute tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, generally presenting in children and young women. The interstitial nephritis may precede, follow, or develop concurrent to the uveitis. We report the clinical features and outcomes of four adult patients, aged 41-70 years with the TINU syndrome.