Profil des insuffisants rénaux chroniques diabétiques à l’initiation de l’hémodialyse au service de néphrologie et dialyse de l’hôpital militaire de Rabat, Maroc

Le diabète constitue une cause fréquente d'insuffisance rénale chronique terminale (IRCT) dans le monde. Ce travail présente une étude clinique rétrospective dont le but est de décrire le profil clinico-biologique des patients diabétiques en IRCT, de le comparer aux patients non-diabétiques au stade d'IRCT, et de suivre l'évolution de leurs abords vasculaires, afin d'en déduire des conclusions sur une prise en charge particulière des patients diabétiques. Les paramètres cliniques et biologiques concernant les patients mis en hémodialyse dans notre formation entre le 01 janvier 2006 et le 31 décembre 2011, ont été recueilli et analysés. Nous avons procédé à l'étude comparative des patients en fonction de l'existence ou non d'une néphropathie diabétique, et nous nous sommes intéressés à l'évolution de leurs abords vasculaires. Il s'agit de 207 patients insuffisants rénaux chroniques, dont 86 diabétiques. Le groupe des patients diabétiques était moins suivi avant la mise en hémodialyse (3,66 mois vs. 6,32 mois), avec une prise beaucoup plus importante d'antihypertenseurs (1,87 vs. 1,14, p<0,001). L'échec des abords vasculaires était plus important chez les patients diabétiques (45% vs. 27%, p=0,006), avec une survie moyenne plus faible de leurs abords vasculaires (509 vs 753 jours, p=0,003). L'étude comparative des taux d'hémoglobine, de parathormone intacte, d'albuminémie et de C-réactive protéine, entre le groupe de patients diabétiques et non diabétiques était non significative. Notre étude soulève le problème du suivi néphrologique chez les diabétiques, pourtant censés être mieux suivis, et son retentissement sur l'avenir de leurs abords vasculaires.Key words: Diabète, insuffisance rénale chronique, hémodialys

Glomérulonéphrite extra-membraneuse et syndrome myélodysplasique: une association rare

Les syndromes myélodysplasiques peuvent s’accompagner de maladies auto-immunes. L’atteinte rénale au cours de ces syndromes est rare. Dans ce cas, les glomérulopathies prédominent cette atteinte. La glomérulonéphrite extra-membraneuse est exceptionnellement reportée en association avec un syndrome myélodysplasique. Nous rapportons dans ce papier le cas d’une patiente présentant une glomérulonéphrite associée à une anémie révélant un syndrome myélodysplasique de faible risque. Dans la lumière de ce cas, nous faisons une courte revue de la littérature des cas précédemment publiés et nous discutons le lien pathogénique entre ces deux entités

Actinobacillose (Shigellose) équine: à propos des premiers cas observés au Maroc

La septicémie néonatale due àActinobacillus equ uli (Actinobacillose, Shigellose) a été diagnostiquée chez deux poulains. Cliniquement, les animaux étaient faibles et refusaient de téter. Histo-pathlogiquement, de multiples micro-abcès ont été observés au niveau des reins, du foie, des glandes surrénales et du poumon. Actinobacillus equuli a été isolé à partir de certains organes.Equine actinobaciIIosis (Shigellosis): report of first cases in MoroccoN eonatal septicemia caused by Actinobacillus equuli (Actinobacillosis, Shigellosis) was diagnosed in two foals. Clinically the animaIs were weak, depressed and refused to nurse. Pathologically, multiple microabceses were observed in kidneys, adrenals, liver and lungs. Actinobacillus equuli was isolated from several organs

Adverse Effects of a Clinically Relevant Dose of Hydroxyurea Used for the Treatment of Sickle Cell Disease on Male Fertility Endpoints

Two experiments were conducted to determine: 1) whether the adult male transgenic sickle cell mouse (Tg58 × Tg98; TSCM), exhibits the patterns of reproductive endpoints (hypogonadism) characteristic of men with sickle cell disease (SCD) and 2) whether hydroxyurea (HU) exacerbates this condition. In Experiment 1, blood samples were collected from adult age-matched TSCM and ICR mice (ICRM) (N = 10/group) for plasma testosterone measurements. Subsequently, mice were sacrificed, testes excised and weighed and stored spermatozoa recovered for the determination of sperm density, progressive motility and percentage of spermatozoa with normal morphology. In experiment 2, adult male TSCM were orally treated with 25 mg HU/kg body weight/day for 28 or 56 days. Control mice received the vehicle for HU (saline) as described above. At the end of the treatment periods, blood samples were collected for quantification of circulating testosterone. Subsequently, mice were sacrificed, testes and epididymides were recovered and weighed and one testis per mouse was subjected to histopathology. Stored spermatozoa were recovered for the determination of indices of sperm quality mentioned in Experiment 1. Testis weight, stored sperm density, progressive motility, percentage of spermatozoa with normal morphology and plasma testosterone concentrations of TSCM were significantly lower by 40, 65, 40, 69 and 66%, respectively than those of ICRM. These data indicate that adult TSCM used in this study suffered from hypogonadism, characteristically observed among adult male SCD patients. In Experiment 2, HU treatment significantly decreased testis weight on day 28, (0.09 ± 0.004g) that was further decreased on day 56 (0.06 ± 0.003g; treatment x time interaction) compared with controls (day 28, 0.15 ± 0.01g; day 56, 2, 0.16 ± 0.01g). Concomitant with a 52% shrinkage (P<0.001) in area of testes in 56 days of HU treatment, testes from HU-treated TSCM exhibited significant atrophic degeneration in the seminiferous tubules compared with controls. Furthermore, treated TSCM had only Sertoli cells and cell debris remaining in most of the seminiferous tubules in comparison with controls. Leydig cell prominence and hyperplasia were more evident (P<0.05) in the steroidogenic compartments of testes of HU-treated TSCM compared with controls. However, plasma testosterone concentrations were reduced by HU treatment (P<0.05; treatment x time interaction) compared with controls on the two time periods studied. Epididymides from HU-treated TSCM sustained a 25% shrinkage (P<0.05), along with 69 (P<0.005) and 95% reduction (P<0.005), in stored sperm density and sperm progressive motility (treatment x time interaction P<0.05), respectively on day 56 of treatment compared with controls. These data demonstrate that TSCM used in this study exhibited SCD-induced hypogonadism, thus authenticating their use for studying the effect of HU on male reproductive endpoints observed in SCD patients. Secondarily, our data show that HU treatment exacerbated the already SCD-induced hypogonadism to gonadal failure

CS38-39-40 : an anchor region inside the telomeric gene desert flanking the HoxD cluster

In the telomeric gene desert flanking the murine HoxD cluster, a 20 kb conserved region (CS38-39-40) is characterized by the presence of two ncRNAs. We analyzed their transcriptional profiles during limb development, in serial deletions affecting the HoxD cluster, enabling us to highlight competition between gene promoters for enhancers. We also analyzed 3D reallocations of CS38 (and other key loci), when duplicating the region between the two TADs (isolating the two flanking gene deserts from each other). Our experiments showed the presence of a strong boundary inside the cluster, responsible of the segregation in two TADs as well as the existence of two different territories in the limb; proximal and distal. Since CS38-39-40 is also characterized by the presence of three strong CTCF binding sites, likely to be responsible of anchor and enhancer capacities of this region, our work focused in a second time on establishing a line lacking the CTCF1a (located in CS38)

Late-onset choreoathetotic syndrome following heart surgery in adults with end-stage renal disease

Choreoathetotic syndrome is a rare complication of open cardiac surgery that is seen usually in children after surgery for congenital cardiac anomalies. Here, we report two cases of adult patients with end-stage renal disease (ESRD) on regular hemodialysis who developed acute choreoathetotic syndrome few days after cardiac surgeries under cardiopulmonary bypass (CPB). Improvement was seen after an interval with complete resolution in one case. Investigations of the cause have been noncontributory. Long CPB time seems to be the main identified risk factor in these cases. One of the unusual features of our adult cases was the existence of ESRD. To the best of our knowledge, this is the first time this complication is described in association with ESRD although the role of this comorbidity in these cases is uncertain

Complete remission of nephrotic syndrome secondary to amyloid a amyloidosis in patient with inactive Crohn's disease after treatment by infliximab

Secondary amyloidosis Amyloid A (AA) is an infrequent but a severe complication of Crohn's disease (CD). This complication results from the activity of the underlying inflammation disease to form amyloid fibril deposits in tissues. We present a case of a 34-year-old female patient with CD treated by azathioprine with inactive disease for three years and who developed a nephrotic syndrome secondary to AA amyloidosis. The treatment by infliximab for one year leads to a complete remission of the nephrotic syndrome. In this case, this complication occurred while the patient was clinically well, with biological and endoscopic markers showing an inactive or only mildly active disease. Infliximab could be a useful tool for a successful treatment of amyloidosis secondary to CD

Lupus Nephritis Emerging During Remission of Minimal Change Disease

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Insomnia in hemodialysis patients: A multicenter study from morocco

Previous studies have shown that insomnia is a common sleep disorder in patients with end-stage renal disease. This study aims to determine the prevalence and risk factors of insomnia in our chronic hemodialysis (HD) patients. This is a cross-sectional study conducted in three HD units in Morocco. To assess the prevalence of insomnia, we used a specific questionnaire. Patients complaining of difficulty in falling asleep and/or nocturnal awakenings occurring seven nights a week during the last month were included in the group “insomnia;” the other patients were used as controls. Clinical, biological, and dialysis data were recorded for each patient. Sleep disorders and their subjective causes were also identified. Eighty-nine percent of questioned patients admitted to having sleep disturbances of different degrees. Insomnia was significantly associated with female gender and time of dialysis. Age, body mass index, inter-dialytic weight gain, and blood pressure were similar between the two groups, as well as dialytic parameters and drug use. There was no significant difference in the values of plasma creatinine, urea, hemoglobin, parathyroid hormone, calcium, phosphorus, C-reactive protein, and albumin between the groups. Disorders most frequently encountered in patients with insomnia were waking up at night (90%), difficulty falling asleep (60%), and daytime sleepiness (60%). The restless legs syndrome was seen in half of these patients. The main reported causes of insomnia were anxiety and/or depression (70%) and bone pain (67%). Insomnia is common in HD patients and is frequently associated with other disorders of sleep. Female sex and duration on dialysis are the two risk factors found in our study. Insomnia does not appear related to any biochemical or dialysis parameters. Increased attention should be given to the management of dialysis patients regarding the diagnosis and management of insomnia and associated sleep disorders