Taoufiq Aatif

Chronic kidney disease is a global public health problem. Emphasis has been placed on uremic peripheral neuropathy (PN) in nondiabetic chronic hemodialysis (HD) patients. This complication could affect the quality of life. We aimed to determine the prevalence and risk factors of PN. This was a cross-sectional study. Evaluation of PN was made by clinical examination and electroneuromyogram. The prevalence of PN was 30.3%. The most common symptoms were paresthesia and burning. Neuropathic pain was symmetrical in the majority of cases and localized to the lower limb (60%). All patients had axonal type PN. In univariate analysis, the risk factors for PN were advanced age (P = 0.012), hypertension (P = 0.007), ischemic heart disease (P = 0.036), high C-reactive protein (microinflammation) (P = 0.002), low urea reduction ratio (P = 0.013), and high ß2 microglobulin (P = 0.002). Since PN is common in nondiabetic chronic HD patients, it becomes necessary to diagnose it and correct its risk factors.

Stevens-Johnson syndrome is a rare mucocutaneous disorder. It constitutes, together with toxic epidermal necrolysis (Lyell), opposite forms of a spectrum of diseases usually resulting from an adverse reaction to drugs. We report the case of a 67-year-old woman from Morocco who developed Stevens-Johnson syndrome after receiving methotrexate. The evolution was marked by death due to hemodynamic complications. Stevens-Johnson syndrome is a serious condition, with mortality in 10-34% of cases. Management consists in identifying and stopping the responsible drug, and maintaining hemodynamic and respiratory stability, care of skin lesions and pain relief. The use of prognostic scores can assist in management of some complicated cases. Methotrexate is a commonly prescribed drug because of its efficacy and cost-effectiveness/ease of administration. Therefore, physicians should be aware of the consequences of its use, with particular attention to patients with chronic renal failure in whom dosages should be adapted to renal function. This drug should not be used in end-stage patients because of its poor tolerance Received: June 18th, 2023 Accepted: November 13th, 2024 https://dx.doi.org/10.4314/aamed.v18i1.14

COVID-19 is a disease related to an RNA virus, SARS-CoV-2, that affects the respiratory system with a great variability of expression. All the other systems can be affected. Renal involvement is common during COVID-19 and is associated with high morbidity and mortality. The exact mechanism is not well understood, but the virus could directly or indirectly affect the kidney. The common renal impairment is acute kidney injury (AKI) related to acute tubular necrosis (ATN). The other damages are mainly represented by proximal tubulopathy, and COVAN (COVID-19-associated nephropathy), occurring on a pathogenic variant of apolipoprotein L1 (APOL1), a thrombotic microangiopathy (TMA) by endothelial dysfunction and exacerbation or triggering a glomerular disease after vaccination against SARS-CoV-2. Renal involvement should be systematically sought in any patient hospitalized for COVID-19. Appropriate support and follow-up of COVID-19 patients with renal impairment are mandatory.

Mood disorders are common in end-stage renal disease (ESRD) and may increase morbidity and mortality in adults on chronic hemodialysis (HD), affecting their quality of life (QOL). We aimed to investigate the prevalence of and factors associated with anxiety and depression in ESRD patients on chronic HD. Thirty-nine HD patients were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) questionnaire. The HADS scores were correlated with demographic, clinical, and laboratory parameters. According to the HADS scores, depression and anxiety were found, respectively, in 11 (28.2%) and in nine (23.1%) patients. Both depression and anxiety were found in four (10.3%) patients. The average depression score was 7.4 ± 4.2; the average anxiety score was 7.7 ± 4.6. The depression score correlated significantly with the number of medications (r = 0.46, P = 0.003) and phosphatase alcalin (r = −0.37; P = 0.022); the anxiety score correlated significantly with the number of medications only (r = 0.36, P = 0.022). The risk factors associated with anxiety were age [odds ratio (OR) = 1.12; 95% confidence interval (CI): 1.01–1.2; P = 0.025] and sleep disturbances (OR = 6.74; 95% CI: 1.49–30.4; P = 0.016), and only diabetes was a risk factor associated with depression (OR = 4.4; 95% CI: 1.94–16.9; P = 0.009). The screening and management of depression and anxiety would improve the QOL of patients on chronic HD.

Introduction: Cardiovascular disease represents the leading cause of death in chronic hemodialysis (HD) patients; in this field, abdominal aortic calcifications (AAC) which represent a predictor of cardiovascular events are associated with cardiovascular morbidity and mortality. Objectives: The purpose of our study is to determine the prevalence and factors associated with AAC. Patients and Methods: This cross-sectional study including 40 chronic HD patients for more than six months having benefited from screening for AAC by profile abdominal x-ray without preparation. The AAC were evaluated according to the Kauppila score (ScK). Demographic, biological and radiological data were collected and then analyzed to assess the prevalence of AAC. Patients were divided into two groups according to ScK, highly calcified (ScK ≥12) and slightly or moderately calcified (ScK <12), in order to determine the associated factors to severe AAC. Results: The mean age was 58 ± 16 years, 55% were women, and the median of HD duration is 82 months. The prevalence of AAC was 65% and the median score of AAC was four. Patients with highly AAC (ScK ≥12) represented 27.5% of population and slightly or moderately AAC (ScK <12) represented 72.5%. The factors associated with severe AAC retained in the univariate analysis were age (P=0.029), phosphoremia (P=0.027), duration of dialysis (P=0.047) and calcemia (P=0.035). Only duration of dialysis (P=0.042), age (P=0.018) and phosphoremia (P=0.044) remained statistically significant in multivariate. Conclusion: AAC are associated with advanced age, long duration of dialysis, and phosphocalcic balance abnormalities. Profile abdominal x-ray without preparation is currently recommended by the KDIGO (kidney disease improving global outcomes) for early detection and follow-up of vascular calcifications on HD, which should be considered for any patient.

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury, possibly with increasing incidence over recent years; therefore, epidemiological studies provide important information for clinical practice and investigations. The aim of this retrospective study was to describe the clinical features and outcome of patients with biopsy-proven AIN in a region of Morocco. All native renal biopsies (January 2008 to December 2017) on adults were reviewed, but only AIN cases were analyzed. Of the 407 renal biopsies performed in this period, 30 patients were included. The mean age of the patients was 47.1 ± 16.7 years; female gender was preponderant (60%). At the time of biopsy, the serum creatinine level was 33.9 ± 11.8 mg/L. The classic triad of fever, skin rash, and eosinophilia occurred in three (10%) patients. The common causes of AIN were drugs in 13 (43.3%) patients followed by autoimmune diseases in 11 (33.3%) patients. At six months postbiopsy, 26.7%, 33.3%, and 40% had partial, complete, and no recovery, respectively. In this study, a good outcome was associated with autoimmune diseases (P = 0.02) and with a higher intensity of interstitial edema (P = 0.01). However, a presence of a granuloma (P = 0.04), a higher percentage of interstitial fibrosis (P P P = 0.14).This information provides a contribution toward understanding the epidemiology of acute renal failure in Africa, with implications in planning future prospective studies.

Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe illness related to hypersensitivity syndrome characterized by fever, skin rash, lymph node enlargement, hematological abnormalities, especially eosinophilia and atypical lymphocytosis, and single or multiple organ involvement. The syndrome is difficult to diagnose in view of its clinical heterogeneity and long latency period within 8 weeks after start treatment. We report a case of DRESS syndrome in a 64-year-old man, induced by allopurinol treatment for asymptomatic hyperuricemia, started 8 weeks earlier but stopped only 3 days after because of the onset of rash. The diagnosis was retained due to combining of interstitial nephritis with the clinical findings of fever, skin rash, cervical lymphadenopathy, eosinophilia, and reactivation of human herpesviruses specifically HHV-6. The glucocorticoids were started to relieve hypersensitivity. Five days later, the patient became afebrile, and the rash improved significantly. However, interstitial nephritis with renal function impairment progressed to severe azotemia, and even anuria requiring hemodialysis. Allopurinol-induced DRESS syndrome is associated with significant mortality, and care must, therefore, be exercised when given this drug.

Background: Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for detection of systemic bacterial infections in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The aim of this study was to assess the influence of HD membrane permeability to PCT serum levels in noninfected HD patients on maintenance HD. Methods: In a prospective comparative study, we measured PCT serum levels and C reactive protein (CRP) before and after HD in 36 sessions (18 sessions of HD with low-flux = Group L; and 18 sessions with high flux membranes = Group H), in 18 chronic HD patients without history of infection. Results: Sessions of HD by high-flux membranes (Group H) displayed median PCT values that were significantly decreased after dialysis (0.21 ng/mL [0.13-0.41] vs. 0.18 ng/mL [0.10-0.24], p <0.001) but median PCT significantly increased after HD sessions by low-flux membranes (Group L) (0.21 ng/mL [0.14-0.33] vs. 0.25 ng/mL [0.14-0.36]; p = 0.008). CRP values were significantly increased after HD in both groups. CRP correlated with PCT values only in group H before HD (r = 0.49; p = 0.36). Conclusions: PCT represents a useful diagnostic marker for systemic bacterial infection. However, there is a need for specific reference ranges to be developed in patients with renal failure undergoing HD; also, PCT serum levels must be interpreted according to the HD membrane permeability.