Idiopathic Membranous Nephropathy Preceding the Onset of Rheumatoid Arthritis: a Case Report

Introduction: Membranous nephropathy (MN) in the context of rheumatoid arthritis (RA), is often an iatrogenic complication due to the nephrotoxic effects of antirheumatic drugs. Rare cases of non-iatrogenic association between these two diseases were reported in the literature.Case report: A 30-year-old female patient presented in September 2005 with nephrotic syndrome. Renal biopsy showed features consistent with MN. Search for etiology was negative, particularly lupus serology which remained negative throughout the course of her illness. Accordingly, she was diagnosed as a case of idiopathic MN. Initially, she was treated with angiotensin converting enzyme inhibitors and angiotensin receptor blockers which maintained her protein excretion below nephrotic range for two years. Her nephrotic syndrome then relapsed and was treated with steroids and chlorambucil, according to the Ponticelli protocol. A few months later, she presented with early morning joint stiffness, polyarthritis involving the small joints of the hands, and strongly positive rheumatoid factor, fulfilling the diagnostic criteria of rheumatoid arthritis (RA). Her serum creatinine remained normal and a second renal biopsy revealed the same features of MN. Her RA was treated with pulsed methylprednisolone followed by oral steroids and methotrexate resulting in remission of the joints disease and the nephrotic syndrome. Remission was maintained for the last two years up to the time of this report.Conclusion: We hereby report a case of secondary membranous nephropathy that preceded the onset of rheumatoid arthritis by three years.Keywords: Auto-immunity; Membranous nephropathy; Rheumatoid arthriti

Les complications chirurgicales de la transplantation rénale à partir du donneur vivant: expérience du CHU Ibn Sina de Rabat

Introduction: La transplantation rénale (TR) est actuellement considérée comme un traitement de choix de l’insuffisance rénale chronique terminale (IRCT). Ses résultats se sont améliorés au cours des dernières années. Cependant, les complications chirurgicales demeurent graves car elles touchent un rein unique et surviennent sur un terrain fragilisé par l’insuffisance rénale et l’immunosuppression. L’objectif de ce travail est d’évaluer la fréquence des complications chirurgicales lors de l’activité de TR au CHU Ibn Sina de Rabat, et de dégager les facteurs ayant influé l’apparition de ces complications. Méthodes : Étude rétrospective des patients transplantés rénaux à partir de donneurs vivants apparentés (DVA) de Juin 1999 à Décembre 2008 dans notre centre hospitalo-universitaire. Nous avons recensé les caractéristiques propres au receveur, au prélèvement, au donneur ainsi qu’au greffon. Les complications chirurgicales ont été colligées ainsi que leur prise en charge et évolution. Résultats: Soixante sept dossiers ont été analysés avec un suivi moyen de 55 +/- 28 mois. 38 complications chirurgicales ont été recensées : sténose des artères rénales (38,7%), lymphocèle (21%), hématome (12,7%), thrombose vasculaire (7,8%), reflux vésico-urétéral (4,8%), rupture du greffon (3,2%), calcul (1 cas), éventration (1 cas), L’analyse statistique de notre série n’a pas mis en évidence de facteurs de risque significatifs semblant influer sur l’incidence des complications chirurgicales. Conclusion: La morbidité liée aux complications chirurgicales de la TR reste élevée nécessitant un diagnostic et un traitement adéquat afin d’éviter les répercussions sur la survie des patients et des greffons

Association myélome multiple – maladie de Kaposi: à propos d’un cas

L'association Kaposi–myélome multiple est extrêmement rare. Nous rapportons, le cas d'un patient âgé de 76 ans suivi dans notre formation pour un myélome à immunoglobuline A kappa stade III-B selon Durie et Salmon. Ceci a été associé à des lésions cutanées dont la biopsie cutanée était en faveur d’une maladie de Kaposi. La sérologie de l’herpès virus humain de type 8 (HHV8) est revenue positive. Une radiothérapie sur les lésions était refusée par le patient. L'évolution était marquée par une altération de l'état général. Le patient ayant refusé la radiothérapie et toute prise en charge thérapeutique est décédée deux mois plus tard. Nous rapportons, à notre connaissance, le 18ème cas mondial de maladie de Kaposi associée à un Kahler chez un patient HHV8 positif. C'est une association exceptionnelle rendant probable le rôle pathogénique de HHV8 dans le développement du myélome

An examination of the links between corporate social responsibility (CSR) and its internal consequences

The purpose of this study is to examine the links between Corporate Social Responsibility (CSR) and its internal consequencesusing the hotel employees' CSR perception, Quality of Working Life (QWL), affective commitment, organizational citizenship behavior (OCB), and job performance. Although CSR has been widely studied from the perspective of employees, no previous study has related it to QWL in the field of hospitality research. Applying relevant theories, the study empirically substantiates the connection between the constructs and provides theoretical and practical implications. The results, drawn from data collected from hotel employees in upscale hotels in South Korea, show that hotel employees' CSR perception of the firm positively influences their QWL, affective commitment, and organizational citizenship behavior, which, in turn, enhance their job performance

Mixed cryoglobulinemia-associated Sjögren's syndrome leading to spontaneous rupture of the kidney: a case report

Intissar Haddiya,1 Hakim Hamzaoui,1 Zitouna Alhamany,2 Fatime-zohra Berkchi,1 Hakima Rhou,1 Loubna Benamar,1 Naima Ouzeddoun,1 Rabea Bayahia1 1Department of Nephrology-Dialysis-Renal Transplantation, Ibn Sina University Hospital, Rabat, Morocco; 2Department of Pathology, Rabat Children's Hospital, Ibn Sina University Hospital, Rabat, Morocco Background: Spontaneous rupture of the kidney is uncommon and is mainly caused by renal tumors. Only a few cases are caused by vasculitis. We report here the first case of spontaneous rupture of kidney resulting from mixed cryoglobulinemia. Case presentation: A 44-year-old man presented with sudden onset of fever, acute pulmonary edema, left flank abdominal pain unassociated with trauma, and rapidly progressive renal failure requiring dialysis. Computed tomography of the abdomen revealed a large perirenal hematoma of the left kidney. During conservative surgery, the patient underwent renal biopsy that showed renal vasculitis and membranoproliferative glomerulonephritis with intracapillary microthrombi. Tests were positive for mixed cryoglobulinemia caused by Sjögren's syndrome. The patient was better after immunosuppressive therapy, with the disappearance of clinical symptoms and the recovery of baseline renal function. Conclusion: We report on this case and discuss a possible link between spontaneous rupture of kidney and mixed cryoglobulinemia-associated Sjögren's syndrome. Keywords: mixed cryoglobulinemia, Sjögren's syndrome, spontaneous rupture of kidney, renal hematoma, Wünderlich syndrom