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

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

Parameters to Assess Nutritional Status in a Moroccan Hemodialysis Cohort

Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with increased mortality and morbidity in affected patients. The aim of this study was to determine the prevalence of malnutrition and correlate the methods of nutritional assessment.Methods: We evaluated the nutritional status of 40 prevalent HD patients by subjective global assessment (SGA) score, anthropometrics [body mass index (BMI), arm circumference (AC), triceps skin-fold thicknesses (TSF), arm muscle circumference (AMC)], biochemical tests [normalized protein equivalent to total nitrogen appearance (nPNA), and pre-dialysis serum albumin and serum prealbumin levels] and bio-electrical impedance (BEI) analysis to estimate body composition [lean tissue index (LTI) and fat tissue index (FTI)].Results: The study assessed 40 patients (20 males and 20 females) with a mean age of 50.7±16.5 years. The prevalence of malnutrition according to the different methods ranged from 5 % to 65%. There were highly significant gender-specific differences in AMC (p < 0.001) and TSF (p < 0.001). The BEI revealed a highly significant difference in LTI (p < 0.001) but no difference in FTI (p = 0.14) according to gender. There was a positive correlation between LTI and both serum albumin (r = 0.37; p = 0.018) and serum prealbumin (r = 0.53; p < 0.001). Also, there was a significant positive correlation between FTI and BMI (r = 0.59; p < 0.001), AC (r = 0.44; p = 0.004) and TSF (r = 0.61; p < 0.001).Conclusion: Our data suggest that BEI analysis provides a useful means of assessing nutritional status and was correlated with anthropometrics and biochemical findings.Keywords: Anthropometric Measurements; Bioelectrical Impedance; Hemodialysis; Malnutrition; Subjective Global Assessmen

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

Bisalbuminemia during remission of nephrotic syndrome

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome

Effect of the quality of water used for dialysis on the efficacy of hemodialysis: A single-center experience from Morocco

The quality of the water used for dialysis has been suggested as a factor causing inflammation in patients on hemodialysis (HD). We therefore conducted this study to identify the effect of quality of the water on nutritional state, inflammation and need for human recombinant erythropoietin (EPO) in patients undergoing HD at Agadir, Morocco. This prospective study included patients on HD for at least one year. The water treatment was done according to the standard protocol, which was followed by additional enhancement of ultrafiltration using an additional polysulfone filter (diasafe, Fresenius, Bad Homburg, Germany) before the dialyser. Water was monitored regularly during the study period to ensure acceptable levels of bacterial count as well as endotoxin levels. Various parameters including dry weight, systolic and diastolic blood pressure (PA) before and after an HD session, need for human recombinant EPO, levels of hemoglobin (Hb), albumin, ferritin, C-reactive protein (CRP), and the dose of dialysis delivered (Kt/V) were measured first at the beginning of the study and thereafter, in the third, sixth and 12 th months of the study. The study involved 47 patients, and after 12 months of the study, an improvement in median dry weight (1.2 kg, P = 0017) and a simultaneous median reduction of 20.7 IU/kg/week of EPO, with an in-crease of the median level of Hb, was noted. The results of our study suggest that by improving the biocompatibility of HD with the use of good quality water, patients acquire a better nutritional, inflammatory and hematologic status

Characteristics of intradialytic hypotension: Experience of agadir center-morocco

We report in this retrospective study the experience of our hemodialysis (HD) center in the incidence of intradialytic hypotension (IDH) over 18 months. We first studied the de-mographic, clinical, biological and morphological data of our 52 HD patients and compared the characteristics of patients with frequent IDH and those without. We found that factors signi-ficantly associated with IDH include diabetes, left ventricular hypertrophy, impaired diastolic function, weight gain and high ultrafiltration rates. Despite these results, further larger studies are required to confirm them