Profil épidémiologique de l’insuffisance rénale chronique terminale dans la région de Sfax

Introduction: L'insuffisance rénale chronique terminaleest un véritable problème mondial de Santé publique. En Tunisie, le coût de la prise en charge des patients dialysés pour l'année 2011 a dépassé les 90 millions de dinars (37000 Euro), soit près de 5% des dépenses globales de santé. Une meilleure connaissance du profil épidémiologique de l'insuffisance rénale chronique terminale va contribuer à l'élaboration et à l'évaluation des stratégies sanitaires visant à améliorer la prévention et la prise en charge de cette maladie. L'objectif de notre travail est de décrire le profil épidémiologique des cas incidents dans le gouvernorat de Sfax sur une période de 10 ans. Méthodes: Il s'agit d'une étude descriptive rétrospective allant de Janvier 2003 à Décembre 2012. Nous avons inclus les cas incidents d'insuffisance rénale chronique terminale dans le gouvernorat de Sfax. Résultats: Le diagnostic d'insuffisance rénale chronique terminale a été porté à 1708 cas. Il s'agit de 957 hommes et 751 femmes (sex-ratio = 1,27). L'âge moyen était de 58,4ans [10-100ans]. L'étude de l'évolution de l'âge moyen durant la période étudiée a montré une tendance vers la hausse avec un indice de corrélation positive (0,749) et p = 0,006. La principale néphropathie causale était la néphropathie diabétique (21,5%), avec une augmentation significative de sa fréquence d'une année à l'autre (un coefficient de corrélation positive (0,770) avec p = 0,009). L'hémodialyse était la technique de dialyse de choix, entreprise chez 96% des patients. Conclusion: Un registre national reste indispensable afin de mieux comprendre le profil épidémiologique de l'insuffisance rénale chronique terminale en Tunisie et de pouvoir améliorer sa prise en charge

Profiling beneficial phytochemicals in a potato somatic hybrid for tuber peels processing: phenolic acids and anthocyanins composition

The purpose of this study was to characterize the peels of a CN1 somatic hybrid obtained from two dihaploid potato lines (Cardinal H14 and Nicola H1) in terms of the health‐promoting phenolic compounds (phenolic acids and anthocyanins). The CN1 hybrid is defined by a pink tuber skin color making it different from the light‐yellow‐skinned “Spunta,” which is the most commonly grown potato cultivar in Tunisia. Oven‐dried peel samples derived from CN1 hybrid and cv. Spunta were ground, and phenolic compounds were extracted with water or methanol for quantification. Lyophilized peels were used for the phenolic acid and anthocyanin analyses. Higher total quantities of phenolic compounds were recovered in methanol extracts compared with water extracts. A slightly higher concentration of phenolic acids (100 mg/100 g DW) was obtained in the lyophilized peels extract of CN1 hybrid than in the cv. Spunta corresponding sample (83 mg/100 g DW). The profiles of the chlorogenic acid isomers were almost identical in both of CN1 hybrid and cv. Spunta. Caffeic acid (CA) and three caffeoylquinic acids (CQAs): 3‐CQA, 4‐CQA, and 5‐CQA, were identified from both genotypes, 5‐CQA being the dominant form in both potatoes. Since the CN1 hybrid has a pink skin color, its anthocyanin profile was also determined. The anthocyanin quantity in the CN1 peels was 5.07 mg/100 g DW, involving six different anthocyanins that were identified within the extract, namely, Pelargonidin‐3‐rutinoside‐5‐glucoside, peonidin‐3‐rutinoside‐5‐glucoside, coumaroyl ester of pelargonidin‐3‐rutinoside‐5‐glucoside, coumaroyl ester of peonidin‐3‐rutinoside‐5‐glucoside, feruloyl ester of pelargonidin‐3‐rutinoside‐5‐glucoside, and feruloyl ester of peonidin‐3‐rutinoside‐5‐glucoside. These results suggest that the peel waste of CN1 somatic hybrid can be considered as a promising source of high‐value compounds for food industry

Profiling beneficial phytochemicals in a potato somatic hybrid for tuber peels processing: phenolic acids and anthocyanins composition

The purpose of this study was to characterize the peels of a CN1 somatic hybrid obtained from two dihaploid potato lines (Cardinal H14 and Nicola H1) in terms of the health-promoting phenolic compounds (phenolic acids and anthocyanins). The CN1 hybrid is defined by a pink tuber skin color making it different from the light-yellow-skinned "Spunta," which is the most commonly grown potato cultivar in Tunisia. Oven-dried peel samples derived from CN1 hybrid and cv. Spunta were ground, and phenolic compounds were extracted with water or methanol for quantification. Lyophilized peels were used for the phenolic acid and anthocyanin analyses. Higher total quantities of phenolic compounds were recovered in methanol extracts compared with water extracts. A slightly higher concentration of phenolic acids (100 mg/100 g DW) was obtained in the lyophilized peels extract of CN1 hybrid than in the cv. Spunta corresponding sample (83 mg/100 g DW). The profiles of the chlorogenic acid isomers were almost identical in both of CN1 hybrid and cv. Spunta. Caffeic acid (CA) and three caffeoylquinic acids (CQAs): 3-CQA, 4-CQA, and 5-CQA, were identified from both genotypes, 5-CQA being the dominant form in both potatoes. Since the CN1 hybrid has a pink skin color, its anthocyanin profile was also determined. The anthocyanin quantity in the CN1 peels was 5.07 mg/100 g DW, involving six different anthocyanins that were identified within the extract, namely, Pelargonidin-3-rutinoside-5-glucoside, peonidin-3-rutinoside-5-glucoside, coumaroyl ester of pelargonidin-3-rutinoside-5-glucoside, coumaroyl ester of peonidin-3-rutinoside-5-glucoside, feruloyl ester of pelargonidin-3-rutinoside-5-glucoside, and feruloyl ester of peonidin-3-rutinoside-5-glucoside. These results suggest that the peel waste of CN1 somatic hybrid can be considered as a promising source of high-value compounds for food industry

La grossesse en hémodialyse chronique: à propos de 25 cas survenus dans le Sud Tunisien

Introduction: la survenue de grossesse au cours de l´hémodialyse chronique est rare. Néanmoins, avec l´évolution des techniques de dialyse, une amélioration de la fertilité est possible. Le but de notre travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de dégager les facteurs impliqués dans sa réussite. Méthodes: notre étude rétrospective a porté sur 25 grossesses spontanées survenues chez 19 patientes traitées par hémodialyse périodique dans différents centres d´hémodialyse du sud tunisien sur une période de 34 ans. Résultats: l´âge maternel de survenue de grossesse était en moyenne égal à 35,6 ans [23-44ans] avec une ancienneté moyenne en hémodialyse de 4,22 ans [1-17 ans]. Sept patientes (37%) avaient une diurèse résiduelle (>500 ml/24h). Le volume horaire hebdomadaire de dialyse était ≥16 heures par semaine dans 7 cas et ≥20 heures dans 4 cas. Le succès de la grossesse (nouveau-né survivant au moins 28 jours) était estimé à 56%. L´âge gestationnel médian était de 34 semaines d´aménorrhée [28-38 SA]. Le poids néonatal moyen est égal à 1970g [1500g-2300g]. L´étude analytique a montré une corrélation significative entre l´augmentation des heures de dialyse par semaine et la réussite de la grossesse (R= 0,59; p= 0,002). Conclusion: on souligne qu´avec une prise en charge adéquate et notamment la majoration du nombre de séances de dialyse, les complications materno-fœtales peuvent être minimisées et la balance risque-bénéfice vire vers donner la chance à une femme dialysée de devenir maman

Service de Cardiologie, Faculté de Médecine, Université Mohammed Premier, Oujda, Maroc

L’amylose rénale est une complication rare au cours de la maladie de Still de l’adulte. Nous rapportons 3 observations d’amylose rénale parmi une série de 33 cas de maladie de Still de l’adulte. Il s’agit de 3 patientes d’âge moyen de 43 ans (extrême: 33 et 58 ans). Le diagnostic de maladie de Still a été retenu devant une polyarthrite fébrile (3 cas) associée à une éruption cutanée fugace (1 cas), un syndrome inflammatoire biologique en l’absence de toute cause infectieuse, inflammatoire ou néoplasique. Toutes ont été traitées par une corticothérapie associée secondairement au méthotrexate devant une polyarthrite destructrice (2 cas) et devant une récidive (1 cas). Une amylose rénale était survenue 4,9 ans après la maladie de Still (extrême: 33 mois et 7ans). L’amylose était révélée par un syndrome néphrotique (3 cas), associé à une insuffisance rénale (1 cas). Le diagnostic a été posé par une ponction biopsie rénale (3 cas) concluant à une amylose AA (2 cas) et non typée (1 cas). Tous les malades ont reçu la colchicine. L’évolution était favorable chez une patiente alors que les deux autres ont évolué vers l’insuffisance rénale chronique. L’amylose rénale est une atteinte inhabituelle de la maladie de Still de l’adulte. Une fois installée, elle peut engager le pronostic vital

The inflammatory profile of chronic kidney disease patients

Background: Chronic kidney disease is a worldwide public health issue which is associated with an increased risk of end-stage renal failure and cardiovascular disease. Systemic inflammation exists during chronic renal failure. Recent researches have highlighted the pivotal role of inflammation between renal and cardiovascular disease. The aim of our study is to determine the inflammatory profile of the patient suffering from chronic kidney disease and the influence of hemodialysis on this profile.Methods: We carried out a cross sectional study on 93 patients in the Nephrology Department at Hedi Chaker University Hospital, Sfax, South of Tunisia. Among those patients, 72 patients underwent hemodialysis and 21 patients had chronic kidney disease at stage 3. Clinical data and antecedents were collected. Biological samples were taken after informing the patients and taking their consent. Biological data consisted in lipid profile, albumin rate, hemoglobin rate, uric acid concentration and the usual markers of inflammation noting sedimentation rate, C - reactive protein and orosomucoid.Results: Hemodialysis group of the 72 patients had mean hemodialysis vintage of 54.6 ± 43 months. The inflammatory profile was worse in hemodialysis patients compared to chronic kidney disease patients. Both sedimentation rate, C - reactive protein and orosomucoid were higher in hemodialysis group than in chronic kidney disease group with 71 ± 35.3 mm vs. 42.1 ± 15.5 mm (p < 0.05); 14.6 ± 28.7 mg/l vs. 6.7 ± 8 mg/l (p = 0.02); 1.3 ± 0.7g/l vs. 0.9 ± 0.4 g/l (p = 0.01), respectively.Conclusion: Inflammation increases in dialysis patient. It deserves the nephrologist’s consideration in order to minimize its harmful effects. The monitoring of inflammation markers must be integrated into the nephrologist’s medical practice

Tumoral calcinosis, calciphylaxis, hyperparathyroidism and tuberculosis in a dialysis patient

Tumoral calcinosis and calciphylaxis are uncommon but severe complications in ure-mic patients. They occur generally after long-term hemodialysis (HD) treatment explained by ad-vanced secondary hyperparathyroidism and longstanding high calcium phosphorus product (Ca × P). Other factors such granulomatous diseases may worsen the calcium phosphate homeostasis alterations. We report a young male patient treated by HD for 6 years who developed tuberculosis in addition to tumoral calcinosis and calciphylaxis

La péritonite chyleuse en dialyse péritonéale

Chylous peritonitis (CP) is a rare complication in patients on peritoneal dialysis. There are many reasons for this. It can occur as a result of a traumatic insertion of the peritoneal dialysis catheter or secondary to infectious or drug causes. The evolution is favorable at the elimination of the causative agent. We report 3 cases of PC occurring in 3 patients on peritoneal dialysis. In 2 patients, CP was secondary to calcium channel blockers and in 1 case associated with lymph node tuberculosis. The cessation of the causative agent allowed a clarification of the effluent dialysate. CP is a mild form of non-infectious peritonitis that is often confused with infectious peritonitis. In this article we discuss the etiologies of CPs, the pathophysiology and the conduct to be held in front of a CP.La péritonite chyleuse (PC) est une complication rare chez les patients en dialyse péritonéale. Les causes sont multiples. Elle peut survenir suite à une insertion traumatique du cathéter de dialyse péritonéale ou secondaire à des causes infectieuses ou médicamenteuses. L’évolution est favorable à l’élimination de l’agent causal. Nous rapportons 3 cas de PC survenant chez 3 patients en dialyse péritonéale. Chez 2 patients, la PC était secondaire à la prise d’inhibiteurs calciques et dans 1 cas associé à une tuberculose ganglionnaire. L’arrêt de l’agent causal a permis un éclaircissement du dialysat effluent. La PC est une forme bénigne de péritonite non infectieuse qui prête souvent à confusion avec les péritonites infectieuses. Dans cet article nous discutons les étiologies des PC, la physiopathologie et la conduite à tenir devant une PC

Poor prognostic factors of lupus nephritis

The occurrence of renal involvement during the clinical course of systemic lupus erythematous (SLE) is generally considered to be the most important factor influencing the prognosis in terms of morbidity and mortality. The factors influencing prognosis in lupus nephritis (LN) are variable in literature. Our aim was to determine predictive factors of poor prognosis in LN among our population. In this retrospective study, 82 cases of LN observed over 18 years were studied. There were 12 males and 70 females with a mean age of 26.9 ± 11 years. At presentation, the mean proteinuria was 3.9 ± 4 g/day; the nephrotic syndrome, hematuria, leukocyturia and renal failure were observed in 67.1%, 63.4%, 56.1% and 37.8% of cases, respectively. LN was of class I, II, III, IV and V in 4.9%, 13.4%, 23.2%, 50% and 8.5% of the cases, respectively. Fifteen patients developed end-stage renal failure and/or died. The presence of hypertension, renal failure, massive proteinuria and high activity index score of LN was associated with poor renal prognosis

Differential Expression of Anti-Inflammatory RNA Binding Proteins in Lupus Nephritis

Lupus nephritis (LN) is a type of immunological complex glomerulonephritis characterized by chronic renal inflammation which is exacerbated by infiltrating leukocytes and fueled by a variety of pro-inflammatory cytokines. A profound understanding of the pathogenesis of LN is necessary to identify the optimal molecular targets. The role of RNA-binding proteins (RBPs) in post-transcriptional gene regulation in the immune system is being explored in greater depth to better understand how this regulation is implicated in inflammatory and autoimmune diseases. Tristetraprolin (TTP), Roquin-1/2, and Regnase-1 are 3 RBPs that play a critical role in the regulation of pro-inflammatory mediators by gating the degradation and/or translational silencing of target mRNAs. In this study, we proposed to focus on the differential expression of these RBPs in immune cells and renal biopsies from LN patients, as well as their regulatory impact on a specific target. Herein, we highlight a novel target of anti-inflammatory treatment by revealing the mechanisms underlying RBP expression and the interaction between RBPs and their target RNAs