Acute Tubulo-interstitial Nephritis with Positive Anti-Neutrophil Cytoplasmic Antibodies

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis involving the kidney usually comprises pauci-immune, necrotizing glomerulonephritis with crescents. Mononuclear tubulo-interstitial infiltrates are common in ANCA associated vasculitis, but these have usually been described in conjunction with glomerulitis. Acute tubulo-interstitial nephritis (ATIN) is a common cause of acute kidney injury that is most frequently induced by drugs or infections. Idiopathic ATIN has rarely been reported in association with the presence of a positive ANCA. These two entities seem to share a common immunological basis.Case report: We report a 75 years-old male patient who presented with acute kidney injury and his serum tested positive for p-ANCA by indirect immunofluoresence with a titer of 1/320. Testing by ELISA demonstrated anti-myeloperoxidase (MPO) specificity with a level of 28.8 IU/mL. His kidney biopsy showed features of ATIN with no glomerular involvement. Treatment with corticosteroids led to improvement of his kidney function and serology for ANCA became negative. In this case report ATIN seems to be associated with ANCA positivity, in the absence of other obvious causes for the acute tubulo-interstitial insult.Conclusion: ATIN can be associated with positive ANCA without features of renal-limited vasculitis or systemic vasculitis. This can occur in the absence of drug exposure. The outcome in our case was favorable with corticosteroid therapy.Key words: ANCA; Acute Tubulo-interstitial Nephritis; Pathogenesi

Myelodysplastic syndrome and extracapillary glomerulonephritis: is there a link?

Introduction: The association of myelodysplastic syndrome and extracapillary glomerulonephritis is exceptional. Only two other cases have been reported.Reported case: A 52-year-old patient with a history of myelodysplastic syndrome developed rapidly progressive glomerulonephritis. Renal biopsy identified extracapillary glomerulonephritis.Discussion: The association of myelodysplastic syndrome with glomerulopathy is rare and often regarded as fortuitous. Only a few cases are described in literature on the subject. A relationship between the two diseases is possible but the causal link between these two diseases remains unknown.Conclusion: The notion that myelodysplastic syndrome may be associated with various glomerular nephropathies involves looking for renal disease in this haematologic disorder

Scleroderma Renal Crisis Precipitated by Steroid Treatment in Systemic Lupus Erythematosus and Scleroderma Overlap Syndrome

Introduction: Connective tissue disorders can overlap in various ways. Patients may present with features of more than one specific disease without satisfying the diagnostic criteria and thereafter evolve into a specific disease entity. Occasionally, patients may fulfil simultaneouslythe diagnostic crateria of two or more diseases. Several cases of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap syndrome have been reported. SLE patients often develop lupus nephritis, the treatment of which is based on immunosuppression with corticosteroids (CS) and cytotoxic drugs. However, the use of high dose of CS has been associated with scleroderma renal crisis (SRC) in patient with SSc.Case report: a 43-year-old woman presented to the nephrology department of the Military hospital in Rabat, Morocco, in August 2011 with progressive dyspnea and oliguria. She was diagnosed as SLE and scleroderma overlap syndrome based on clinical and serologicalmarkers. Renal biopsy showed lupus nephritis. Immunosuppression consisting of high-dose steroid and cyclophosphamide pulses was given. There was response to treatment but 15 days later the course of the disease was complicated by scleroderma renal crisis evidencedby elevated blood pressure, deteriorating kidney function, hemolysis and thrombocytopenia. The patient was treated with perindopril and rapid reduction of steroid doses. This was followed by correction of hemolysis and thrombocytopenia. Two months later, the patient was off dialysis, but had chronic renal insufficiency with an estimated GFR of 25 ml/minute.Conclusion: This report describes the occurrence of SRC in a patient with lupus nephritis and SSc/SLE overlap syndrome who was treated by CS andcyclophosphamide

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

Enabling geo-design: Evaluating the capacity of 3D city model to support thermal design in building

Enabling geo-design: Evaluating the capacity of 3D city model to support thermal design in buildin

Applying Sodium Profile with or without Ultrafiltration Profile Failed to Show Beneficial Effects on the Incidence of Intra- dialytic Hypotension in Susceptible Hemodilaysis Patients

Introduction: Intra-dialytic hypotension (IDH) is a common complication during hemodialysis (HD) treatment. Previous studies have reportedthat modulating dialysate sodium concentration combined or not with modulation of ultrafiltration (UF) rate may reduce the incidence of IDH. The aim of the present study was to evaluate the effect of sodium and UF profiles on the occurrence of intra-dialytic complications and dialysis quality.Methods: From a total of 64 patients, we selected 18 patients who suffered from recurrent IDH. Every patient received ten HD sessions utilizing each of the following treatments: (1) Control: constant sodium concentrationand UF rates. (2) Sodium and UF profiles: a linearly decreasing sodium concentration combined with a linearly decreasing UF rate. (3) Sodium profile:decreasing sodium concentration with constant UF rate.Results: Fourteen patients completed the study protocol. The incidence of IDH, mean inter-dialytic weight gain and the delivered dialysis dose were not different between the three treatments. However, symptomatic episodes of IDH were more commonand pre-dialysis systolic bloodpressure was higher during the second and third treatment modalities compared to controls. Isolated sodium profile was associated with more malaise and less achievement of target session duration compared to the other two treatments. Isolated sodium profile was associated withless achievement of target UF while combined sodium and UF profiles were associated with more achievement of target UF compared to controls.Conclusion: Our results indicate that sodium profile with or without UF profile does not have a beneficial effect on the incidence of IDH, achievement of target session duration or the delivered dialysis dose

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

Assessment and Management of Atopic Dermatitis in Primary Care Settings

An increasingly common chronic inflammatory skin condition is atopic dermatitis (AD). It exhibits severe itching as well as recurring eczematous lesions. New difficulties for treatment selection and approach occur with the expansion of available therapy alternatives for healthcare professionals and patients.  The article highlights recent developments in scientific research on atopic dermatitis diagnosis and assessment that have led to the identification of novel therapeutic targets and the development of targeted therapies, both of which have the potential to completely change the way AD is treated, particularly in a primary care setting

Synergistic effect p-phenylenediamine and n,n diphenylthiourea on the electrochemical corrosion behaviour of mild steel in dilute acid media

Electrochemical studies of the synergistic effect of p-phenylenediamine and n,n diphenylthiourea (TPD) as corrosion inhibitor of mild steel in dilute sulphuric and hydrochloric acid through weight loss and potentiodynamic polarization at ambient temperature were performed. Experimental results showed the excellent performance of TPD with an optimal inhibition efficiency of 88.18 and 93.88 %in sulphuric and 87.42 and 87.15 %in hydrochloric acid from both tests at all concentration studied. Polarization studies show the compound to be a mixed-type inhibitor. Adsorption of deanol on the steel surface was observed to obey the Langmuir and Frumkin isotherm models. X-ray diffractometry confirmed the absence of corrosion products and complexes. Optical microscopy confirmed the selective inhibition property of TPD to be through chemical adsorption on the steel surfac