[Hematologic and immunologic signs of lupus: the experience of the hospital of Dakar]. / Les manifestations hématologiques et immunologiques de la maladie lupique: l'expérience du centre hospitalo-universitaire de Dakar.

INTRODUCTION: The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immune pathology, characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The circumstances of discovery are variable and polymorphic. The hematologic signs and the immunological disorders constitute criteria of diagnosis of lupic disease. METHODOLOGY: It is a multicentric retrospective study from January 1, 1997 to September 30, 2006. Patients were followed up in Internal medicine of Dakar. We appreciate the hematologic and immunological aspects appreciate their prognosis prevalence and their implications with the course the lupic disease. RESULTS: 142 lupic patients were included with 125 women and 17 men; the sex ratio is 0.13. The average age was 34 years with extremes of 6 and 72 years. Our patients had hematologic manifestations average in 32,4 % of the cases and immunological in 76,8 % of the cases. The immunological tests showed the presence, of antinuclear antibodies in 97,9 % of the cases, of native antibody anti-DNA in 45,7 % of the cases, the anti-ECT in 86,95 % (with the anti-RNP in 78,3 % of the cases, anti-Sm in 56,5 % and of anti-SSA in 87 % of the cases). Antibodies anti-DNA and anti-ECT were associated with the hematologic demonstrations respectively in 92,0 % and 95 % of the cases (p = 0,08). Total survival in 96 % of the cases is estimated to 7 years. CONCLUSION: The circumstances of discovery of the lupic disease are variable. The hematologic signs constitute criteria diagnosis of lupic disease. The accessibility of the hematologic and immunological assessment is necessary for an early diagnosis and an early treatment.

Sickle cell disease and the kidney.

Despite the frequency of sickle cell disease (SCD) in the West African population, the renal changes and outcome associated with it have been poorly characterized. We retrospectively studied 22 renal patients; 19 heterozygous sickle cell trait (AS) and three homozygous (SS) evaluated between 1996-2002. The mean age was 43 years (range from 19-69 years). The observed nephropathies included chronic glomerulonephritis (CGN) in eight (36.3%) cases, advanced chronic renal failure (CRF) in seven (31.8%), chronic tubulointerstitial nephropathy (CTIN) in four cases (18.1%), post-infectious acute glomerulonephritis (AGN) in two(9.1%) cases and pregnancy related nephropathy in one (4.5%) case. Renal biopsy was performed in five (22.7%) patients (three AS and two SS patients); the findings included membranoproliferative glomerulonephritis (MPGN), CTIN, focal and segmental glomerulosclerosis (FSGS) and membranous glomerulonephritis. We conclude that there are various renal abnormalities associated with SCD and optimal management needs early diagnosis and multidisciplinary follow-up.