Angio-embolization of a renal pseudoaneurysm complicating a percutaneous renal biopsy: a case report

We report the treatment of a bleeding renal pseudoaneurysm by angio-embolization. A 21 years old woman developed macroscopic haematuria following renal biopsy. Renal angio-scan showed a 1.4 cm renal  pseudoaneurysm in the left kidney. The presence of pseudoaneurysm was confirmed by selective renal  angiography. Successful embolization was performed using gelatine sponge particles.Key words: Angioembolization, renal pseudoaneurysm, kidne

Pneumomédiastin tardif : complication rare du cathétérisme veineux jugulaire en hémodialyse

Le cathétérisme veineux central occupe une place considérable dans le traitement de l’insuffisance rénale terminale dans l’attente de la création d’une fistule artério-veineuse. Cependant il n’est pas dénué de complications. Nous rapportons un cas de pneumomédiastin tardif révélé par un œdème aigu du poumon chez une jeune patiente en hémodialyse, et nous discutons ses particularités

Apport de la biologie dans la greffe rénale d’un donneur vivant

La greffe rénale est avant tout un projet de société, basé sur un don de générosité et de solidarité. L’activité spécifique de la transplantation rénale à partir d’un donneur vivant nécessite une étroite collaboration entre les cliniciens et les biologistes. Plus que jamais, la collaboration clinico-biologique est primordiale dans ce champ médical vue la multitude des progrès actuelles de plus en plus performants en terme de diagnostic et de suivi d’un projet de greffe

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Thromboses des artères rénales révélant un syndrome des anticorps anti phospholipides

Le syndrome des anticorps antiphospholipides est une thrombophilie définie par l'association d'un événement clinique thrombotique artériel et/ou veineux, ou obstétrical à la présence durable d'anticorps antiphospholipides. Nous rapportons le cas d'une jeune patiente admise pour une insuffisance rénale aigue sur thrombose bilatérale des artères rénales et chez qui le bilan immunologique a révélé la présence d'anticoagulant circulant de type lupique faisant retenir le diagnostic d'anticorps antiphospholipides. La prise en charge rapide de la thrombose des artères rénales par angioplastie a permis la récupération d'une fonction rénale normale

The impact of blood flow rate on dialysis dose and phosphate removal in hemodialysis patients

The inadequacy of dialysis and hyperphosphatemia are both associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. The aim of this study was to determine the effect of increasing BFR on dialysis dose and phosphate removal. Forty-four patients were included in a cross-sectional study. Each patient received six consecutive dialysis sessions as follows: three consecutive sessions with a BFR of 250 mL/min, followed by three others with BFR of 350 mL/min without changing the other dialysis parameters. Patients' body weight was recorded, and blood samples (serum urea and phosphate) were collected before and after each dialysis session. For assessing the efficacy of dialysis, urea reduction ratio (URR), Kt/VDiascan (Kt by Diascan and V by Watson), Kt/V Daugirdas (Daugirdas 2nd generation), equilibrated Kt/V, and phosphate reduction rate (PRR) were used. The increase of BFR by 100 mL/min resulted in a significant increase of URR, Kt/V Diascan, Kt/VDaugirdas, equilibrated Kt/V, and PRR: URR; 75.41 ± 5.60; 83.51 ± 6.12; P <0.001), (Kt/VDiascan; 1.28 ± 0.25; 1.55 ± 0.15; P <0.001), (Kt/VDaugirdas; 1.55 ± 0.26; 2.10 ± 0.61; P = 0.001), equilibrated Kt/V; 1.40 ± 0.19; 1.91 ± 0.52; P = 0.001), and (PRR; 50.32 ± 12.22; 63.66 ± 13.10; P = 0.010). Adequate dialysis, defined by single-pool Kt/V ≥1.4, was achieved using two different BFRs: 250 and 350 mL/min, respectively, in 73% and 100% of the cases. Increasing the BFR by 40% is effective in increasing dialysis dose and phosphate reduction rate during high-flux HD. The future prospective studies are needed to evaluate the impact of increasing BFR on phosphate removal using the total amount of phosphate removed, and also evaluate the cardiovascular outcome of phosphate reduction and dialysis improvement

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

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

La dialyse péritonéale dans un centre Marocain : prévalence et complications

Abstract&nbsp;: Introduction: Peritoneal dialysis (PD) is as effective as hemodialysis and often provides a better quality of life for patients. Despite this, the replacement therapy remains little established in our country with a prevalence of less than 1% of patients with end-stage renal disease. The objective of this work is to report the development and complications of PD in our center. Patients and methods: This is a retrospective study including all patients on PD between October 2008 and March 2019. We noted their demographic and clinical data at their initiation in peritoneal dialysis and we followed their evolution to discuss infectious and mechanical complications as well as the causes of PD exit. Results: During the study period, 456 patients were admitted for end-stage renal disease. Among these patients, only 28 (6.1%) were put on PD including two diabetics. Their average age was 37.7 years with a sex ratio of 0.8. The average body surface area was 1.59 m² with an average residual renal function of 6.05 ml / min. PD was chosen as the first intention in 20 patients while 8 patients were on hemodialysis. The evolution was marked by a median survival of the technique of 18.5 months characterized by 8 episodes of peritonitis in 4 patients corresponding to a rate of 1 episode over 56 months. Regarding mechanical complications, we noted 9 omentum aspirations, 1 leak in one case and 1 umbilical hernia requiring surgical recovery in a patient. Out of 28 patients, 17 discharges were identified; 10 patients (67%) were transferred to hemodialysis, 4 died and only 3 patients (18%) were transplanted. The final transfer to hemodialysis was related to mechanical complications in 5 cases, loss of ultrafiltration in one case, repeated hydro-sodium overload in one case, peritonitis in one case and social reasons in two cases. Conclusion: PD is an effective technique which preserves residual renal function and quality of life but its prevalence remains low in the order of 6% of patients treated for end-stage renal disease. The complications are dominated in our context by the mechanical complications main cause of final transfer in hemodialysis.Introduction: La dialyse péritonéale (DP) est une méthode de suppléance aussi efficace que l’hémodialyse et offre souvent une meilleure qualité de vie aux patients. Malgré cela, la technique reste peu implantée au Maroc avec une prévalence de moins de 1% des patients en insuffisance rénale terminale. L’objectif de ce travail est de rapporter l’évolution et les complications de la DP dans notre centre. Patients et méthodes&nbsp;: Il s’agit d’une étude rétrospective incluant tous les patients mis en DP entre octobre 2008 et mars 2019. Nous avons relevé leurs données démographiques, cliniques et biologiques à la date de leur mise en dialyse péritonéale. Nous avons suivi leur évolution pour discuter les complications infectieuses et mécaniques ainsi que les causes de transfert en hémodialyse. Résultats&nbsp;: Durant la période de l’étude, 456 patients ont été admis pour prise en charge d’insuffisance rénale terminale dont 28 mis en DP soit une prévalence de 6,1%&nbsp;; Parmi ces patients 8 étaient en hémodialyse. L’âge moyen était de 37,7 ans et la surface corporelle moyenne était de 1,59 m² avec une fonction rénale résiduelle moyenne de 6,05 ml/min. Sur le plan infectieux, nous avons répertorié 8 épisodes de péritonites chez 4 patients correspondant à un taux de 1 épisode sur 56 mois. Concernant les complications mécaniques, nous avons relevé une aspiration épiploïques chez 9 cas, 1 fuite dans un cas et 1 hernie ombilicale nécessitant une reprise chirurgicale chez une patiente. Sur 28 patients, 17 sorties ont été recensés&nbsp;; &nbsp;10 patients (67%) ont été transférés en hémodialyse, 4 décédés et seulement 3 patients (18%) ont été transplantés. Le transfert définitif en hémodialyse était en rapport avec des complications mécaniques dans 5 cas, perte d’ultrafiltration dans un cas, surcharge hydro-sodée à répétition dans un cas, une péritonite dans un cas et des raisons sociales dans deux cas. La survie médiane de la technique était de 18,5 mois. Conclusion&nbsp;: La DP est une technique efficace qui préserve la fonction rénale résiduelle et la qualité de vie mais sa prévalence reste faible de l’ordre de 6% des patients pris en charge pour insuffisance rénale terminale. Les complications sont dominées dans notre contexte par les complications mécaniques cause principale de transfert définitif en hémodialyse