Profil de la péricardite en dialyse péritonéale : à propos de 5 cas

Les complications cardiovasculaires sont fréquentes chez les patients sous dialyse péritonéale, parmi lesquelles les péricardites aiguës constituent une manifestation rare. Un diagnostic et une prise en charge précoces et appropriés des péricardites aigues sont cruciaux pour prévenir les complications graves telles que la tamponnade cardiaque. Bien que les traitements anti-inflammatoires soient souvent efficaces, une attention particulière doit être portée aux effets indésirables, en particulier chez les patients présentant une insuffisance rénale. Des études supplémentaires sont nécessaires pour mieux comprendre les mécanismes sous-jacents et optimiser les stratégies thérapeutiques pour cette population de patients. Nous allons présenter à partir de cet article cinq cas cliniques de péricardites aiguës parmi 239 patients en dialyse péritonéale

Repeat peritonitis in peritoneal dialysis : A cohort study

Introduction: The understanding of the pathophysiological mechanisms of repeat peritonitis, defined as the occurrence of peritonitis more than 4 weeks after the end of appropriate antibiotic treatment for a previous episode involving the same germ, remains limited. Methods: We studied the outcomes of 26 episodes of repeat peritonitis between 2006 and 2024 (Repeat Group) and compared them with 23 episodes of relapsing peritonitis (Relapse Group) and 84 episodes of peritonitis preceded by 4 weeks or more by another episode with a different organism (Control Group). Results: The majority of cases of repeat peritonitis are caused by gram-positive organisms (65.5%), predominantly Staphylococcus aureus (38.5%), whereas most episodes of relapsing peritonitis are culture-negative (69.5%), followed by gram-negative bacilli episodes (17.4%). Exit site infection is significantly associated with PD peritonitis. Gram-positive cocci are responsible for 95.5% of exit site infections, mainly due to Staphylococcus aureus. In the Repeat Group, 14 (66%) patients achieved primary response, and 10 (47%) of them reached complete cure. After the first episode of repeat peritonitis, 3 (14%) patients had their catheter removed and were transferred to long-term hemodialysis. ; however, the risk of developing relapsing peritonitis was 4.7%, and recurrent peritonitis was 9.5%. Conclusion: The definition of repeat peritonitis is clear. Despite a favorable outcome with antibiotic treatment, the risk of further episodes of peritonitis remains high, threatening the time on peritoneal dialysis therapy and the life of the patient.

COVID-19 and hospital activity: experience of the Nephrology Department of Ibn Sina Hospital-Rabat

Abstract The COVID-19 pandemic has led to a major health crisis, responsible for a very high morbidity in the world. This context represented an organizational challenge and required an adaptation of health services. The purpose of this study is to evaluate the activity of the Nephrology Department of Ibn Sina Hospital of Rabat during the period of confinement of the COVID-19 pandemic. Material and methods Retrospective study of hospitalization, dialysis and consultation activities in the nephrology, and dialysis and kidney transplantation department, during the period of confinement in Morocco from March 12 to June 16, 2020. Results We have identified, for the considered period of three months, 65 patients hospitalized in the nephrology department versus 218 patients during the 3 months preceding the start of confinement in Morocco, which corresponds to a decrease of 70%. The mean age of the patients was 50 ± 16 years with a male predominance. Kidney biopsy was performed in 14 patients. Lupus nephritis was found in 5 patients. Twelve patients received a bolus of methylprednisolone, 7 patients required intravenous cyclophosphamide, and only 1 patient was treated with rituximab. One-hundred twenty-nine patients underwent dialysis, and 554 patients benefited from telemedicine during this period. Conclusion Data collected in this study highlights that the global pandemic due to COVID-19 had a great impact on the activity of our department. The continuity of care for our patients has been ensured by the implementation of telemedicine and the reorganization of our hospital activity

Successful pregnancy in peritoneal dialysis: a case report

Introduction: Conception in dialysis patients is a rare event. In peritoneal dialysis (PD), it is exceptional due to the technique’s short half-life, as these are young women who are often waiting for a transplant project. Clinical observation: We report a case of successful pregnancy conducted exclusively on peritoneal dialysis in a patient on PD for 2 years with preserved residual renal function. At the beginning of pregnancy, our patient was on continuous ambulatory peritoneal dialysis (CAPD), and at 12 weeks of amenorrhea (WA), we indicated automated peritoneal dialysis (APD) for better fluid and sodium depletion and adequate dialysis. The delivery was programmed at 35 WA per caesarian section, which gave birth to a newborn weighing 3.5 kg and with an Apgar index of 10/10. CAPD was resumed 2 weeks later. After 4 years of follow-up, the child is in good health, and our patient is on APD. Discussion: In peritoneal dialysis, pregnancy remains a rare but possible event. It requires regular adaptation of the prescription of dialysis and a close clinical and biological follow-up to improve the maternal-fetal prognosis. Conclusion: Successful pregnancy in PD requires multidisciplinary care. The prognosis has improved thanks to advances in the technique (APD, extrarenal) and the introduction of erythropoietin. However, the data are insufficient, and more recent studies on larger numbers are needed