BackgroundChronic kidney disease poses a growing global health concern and is linked to several complications with higher prevalence and intensity in the hemodialysis (HD) population. These complications contribute to high morbidity and mortality and are associated with poor physical function, and poor quality of life. Intradialytic exercise has emerged as a promising strategy to improve HD patients' clinically relevant outcomes.AimsAssess the effect of intradialytic exercise on the functional and metabolic status of patients undergoing HD, and on their physical performance and evaluate its safety and feasibility.MethodsThis was a pre-experimental clinical trial conducted between February and August 2024, including adult patients on maintenance HD at Sahloul University Hospital. Patients underwent a supervised intradialytic resistance training twice or three times a week, over a period of 12 weeks.. Dialysis adequacy parameters, physical function, cardiovascular parameters, as well as patients' nutritional status were assessed before and after the intervention.ResultsOur study included 21 patient with a female predominance (76.2%). The population's mean age was 44.5 ± 10.4 years. A total of five patients (23.8%) received hemodialysis twice a week, while the remaining 16 patients underwent dialysis three times a week. Over the three-month intervention, the six minutes walk test distance improved significantly with a mean paired difference of 26.4 m (p = 0.007). As for cardiovascular parameters we noted that intradialytic blood pressure decreased from 121.7 mmHg to 112 mmHg (p = 0.03). Dialysis adequacy markers also showed significant increases in creatinine reduction ratio (p = 0.04) and Urea Reduction Ratio (p = 0.04). Furthermore nutritional status showed fewer patients at risk of malnutrition and BMI shifted toward healthier ranges.ConclusionOur study results suggest that three months of intradialytic resistance exercise safely improved HD patients' care including cardiovascular state, physical function and adequacy parameters. Further research especially combining resistance and aerobic exercise is needed to expand and generalize these results.Trial registrationThe trial was retrospectively registered with the Pan African Clinical Trial Registry (PACTR202506776186443).

OBJECTIVES:Monoclonal gammopathies represent a spectrum of clinical and biological abnormalities characterized by monoclonal immunoglobulin production from plasma cell clones. In kidney transplant recipients, monoclonal gammopathies and their identification constitute a complex and multifactorial phenomenon involving immunological alterations and underlying pathologies such as multiple myeloma or lymphoproliferative diseases. MATERIALS AND METHODS:We retrospectively studied patients who underwent kidney transplant at the Nephrology Department of Sahloul University Hospital from November 1, 2007, to December 31, 2024, and who had detection of monoclonal gammopathies during follow -up. RESULTS:Among 332 kidney transplant recipients, 10 (3.0 % ) developed monoclonal gammopathies. Mean age was 42.4 years (range, 27 -58 years ), with male predominance (70 % ). Hypertension was the most frequent comorbidity (50 % ). Only 1 patient had preexisting monoclonal gammopathies before transplant. Chronic interstitial nephropathy was the most common initial nephropathy (62.5 % ). Mean time to diagnosis of monoclonal gammopathies posttransplant was 58.9 months. Serum protein electrophoresis revealed monoclonal peaks in the gamma -globulin region (70 % ), beta -1 globulin (20 % ), and beta -2 globulin (10 % ). Immunofixation showed immunoglobulin G lambda (40 % ), immunoglobulin G kappa, immunoglobulin A lambda and kappa, and isolated light chains. Proteinuria was present in 60 % and anemia in 70 % of cases. Evolution included return to hemodialysis in 3 patients, infectious complications in 4 patients, and 1 death. CONCLUSIONS:The effect of monoclonal gammopathies on kidney transplant recipients remains an evolving research domain where diagnostic and therapeutic advances play a key role in improving management of these vulnerable patients.

Renal AA amyloidosis is a rare but severe complication of inflammatory bowel disease (IBD), associated with significant renal morbidity and poor prognosis. Data remain limited, particularly in underrepresented regions such as North Africa. This study aimed to describe its clinical features, management, and renal outcomes in a multicenter cohort. We conducted a retrospective multicenter study including patients with IBD-associated renal AA amyloidosis from two tertiary nephrology centers in Tunisia between 1990 and 2022. Continuous variables are expressed as median, interquartile range (IQR) and range. Seventeen patients were included (14 Crohn’s disease, 3 ulcerative colitis). The median age was 37 years [IQR: 29.5–47; range: 19–68], with a male predominance. The median interval between IBD diagnosis and renal involvement was 3 years. All patients had heavy proteinuria, with nephrotic syndrome in 15 cases. Median serum albumin was 20.1 g/L [IQR: 9.4–23.4], and impaired renal function was observed in eight patients. Diagnosis was established by minor salivary gland biopsy (n = 10) or renal biopsy (n = 7). Treatment strategies were heterogeneous: nine patients continued prior IBD therapy, while others received colchicine (n = 5), corticosteroids (n = 2), or anti–TNF-α therapy (n = 1). Renal outcomes were poor: one patient required dialysis at baseline, and eight progressed to end-stage kidney disease over a median of 19 months [IQR: 7–37]. Renal AA amyloidosis is a severe complication of IBD with poor renal prognosis. Early detection and effective control of chronic inflammation are essential to improve outcomes.

OBJECTIVES:Living kidney donation provides substantial therapeutic benefit to recipients but may have lasting psychosocial consequences for donors. Sleep quality, which is closely linked to psychological well -being, remains insufficiently studied in North African populations. This study aimed to evaluate quality of life, self -esteem, body image, and sleep quality among living kidney donors in Tunisia. MATERIALS AND METHODS:We conducted a cross -sectional, monocentric descriptive study at the Nephrology Department of Sahloul University Teaching Hospital, Sousse, Tunisia, for the period 2007 -2024. Data were collected from medical records and standardized interviews. Quality of life was assessed via the 12 -Item Short Form Health Survey, self -esteem via the Rosenberg Self -Esteem Scale, body image via the Body Image Scale, and sleep quality via the Pittsburgh Sleep Quality Index. The study remains ongoing. RESULTS:Preliminary data from 15 living kidney donors were analyzed. The mean age was 55 years, and the female -to -male ratio was 2. The mean time since donation was 7.9 years. The mean physical and mental component scores of the 12 -Item Short Form Health Survey were 48.5 and 33.7, respectively, with approximately 30 %of donors demonstrating clinically relevant psychological distress. Self -esteem was low in 25 %, moderate in 50 %, and high in 25 % of participants. Body image impairment was moderate to severe in 70 % of donors. The mean Pittsburgh Sleep Quality Index score was 4.6; however, 27 %of participants had scores >5, indicating poor sleep quality. High follow -up dropout was observed, largely due to limited access to structured health care resources. CONCLUSIONS:Living kidney donation may be associated with persistent psychosocial vulnerability and sleep disturbances in a subset of donors. These findings highlight the importance of structured long -term psychosocial and sleep monitoring programs in resource -constrained settings.

Intradialytic hypotension (IDH) is a common complication of chronic hemodialysis, significantly impacting session tolerance and dialysis quality. This study aims to identify the factors associated with IDH and assess its influence on the biological and clinical parameters of dialysis patients. We conducted a descriptive study of 117 patients on chronic hemodialysis. Sociodemographic, clinical, and biological data were collected, including patient characteristics (age, sex, comorbidities, etc.), dialysis data (vascular access type, session frequency, residual diuresis), and biological parameters (ferritin, PTH, bicarbonates). A statistical analysis was performed to evaluate the correlations between these factors and the occurrence of IDH. Our sample was mainly composed of men (67.8%) and diabetic patients (32.2%), with a high prevalence of arterial hypertension (64.4%) and degenerative complications of diabetes (60.9%). IDH was observed in 48.3% of patients during the first month of dialysis. We observed a reduction in residual diuresis (from 54% to 17.2%) during follow-up. IDH was significantly associated with the use of a temporary catheter (present in 42.5% of patients at 3 months), the duration of diabetes (23.2 ± 9.4 years), and the use of antihypertensive treatments (52.9%). In addition, ferritin levels and PRU suggest a potential impact of IDH on the quality of purification. Our results highlight the challenges posed by IDH and the management of comorbidities in hemodialysis patients. IDH is influenced by several factors, including vascular access, diabetes, and antihypertensive treatments. Better management of these factors could improve tolerance and efficacy of dialysis, thereby reducing complications and improving the quality of life of patients.

Objectives: Urinary tract infections are the main infectious complications among kidney transplant recipients and are considered as a potential risk factor for poor graft outcomes. However, the risk factors of urinary tract infections are controversial. The purpose of our study was to estimate the incidence and predisposing factors of urinary tract infections in patients undergoing kidney transplant in our teaching hospital of Sahloul, Tunisia. Materials and Methods: We retrospectively analyzed the charts of 141 consecutive adult kidney transplants that were performed at the Department of Nephrology, University Hospital of Sahloul, Tunisia, between January 2007 and April 2016. Results: Of 141 patients, 72 (51.1%) had urinary tract infections after kidney transplant. Mean age was 32.54 +/- 12.1 years; 47.6% were male patients, and 52.4% were female patients. The average time between transplant and early urinary tract infections was 11 days (range, 1-30 days). Among our patient group, 87.8% of urinary tract infections occurred within the first 6 months posttransplant. We collected 205 episodes of urinary tract infections: 66.3% were asymptomatic bacteriuria, 10.2% acute cystitis, and 23.4% pyelonephritis. The estimated risk factors for urinary tract infection included only female sex (P < .05); older age (P = .32), longer duration of catheter (P = .34), and high body mass index (P = .46) were not correlated with urinary tract infection. Conclusions: Despite preventive measures, urinary tract infections remain an important cause of morbidity among kidney transplant recipients. In fact, more than half of kidney transplant recipients had at least 1 urinary tract infection after surgery. Female sex was statistically associated with higher risk of urinary tract infection.

Abstract Background and Aims Over the years, concerns have increased about the harmlessness of kidney donation. This is more relevant in an Arab Muslim developing country like Tunisia, where lack of cadaveric donors is continuously leading to an increase in living donor numbers. The aim of this study is to evaluate the safety of nephrectomy as well as medical and surgical outcomes among LKDs, both short and long terms. Method Longitudinal monocentric study, involving a cohort of 106 LKDs in which nephrectomies were performed between November 2007 and April 2015. Donors that attended their follow-up visits after donation as per the European Renal Best Practice group recommendations by the European Renal Disease Association were included.10 Because of the irregularity of visits, we defined visits as follows: M1=from hospital discharge to the 3rd month, M3=from the 3rd month to 6th month, M6=from the 6th month to the 1st year, Y1=from the 1st year to 2nd year, Y2=from the 2nd year to the 4th year, and Y4=4 years and more. At the time of evaluation, we looked for the presence or history of renal events (i.e., elevation of serum creatinine level or proteinuria). We also detected by periodical check- up the presence or history of other physical or biological affections such as the presence of hypertension (HTN), diabetes mellitus (DM), sugar intolerance, hyperlipidemia, or hyper-uricemia (Table 1). Results 92 donors were included in the follow-up analysis after following exclusion criteria. The mean age at the time of nephrectomy was 42.8 ± 10 years with the sex ratio 0.6. and 27% of our donors were mothers. Twenty-two percent of the donors were obese and 4% were hypertensive. The median initial glomerular filtration rate (GFR) was 105 mL/min/1.73 m2. The surgical approach was costal lumbotomy in 96% of cases and laparoscopy for four cases. The kidneys were removed from the left side in 93% of cases. Postoperative mortality was zero and early postoperative morbidity was low. The median duration of hospital stay was nine days. During follow-up, 14% attended all recommended visits. The median follow- up duration was 26 months. After two years post donation, the prevalence of HTN was 28% and obesity was 26%. The prevalence of GFR decline (50–59 mL/min) was 14% using formula by modification of diet in renal disease. None of our donors reached stage 4 or 5 CKD. Twelve had proteinuria and one donor had diabetes, a comparable prevalence of morbidities to the general population Conclusion Our results are strong arguments for harmlessness of renal donation but emphasize the importance of a careful and science-based selection process. Post donation follow-up, seemingly insufficient in our study, is the only guarantor of short- and long-term safety for donors and therefore helps to encourage the act of donating in other potential donors.

Renal transplantation (RT) is the treatment of choice for end-stage renal disease. end-stage renal disease. Patients present certain risk factors under immunosuppressive treatment (diabetes, hyper-cholesterolaemia, obesity, hyperuricaemia, hypertension). The latter remains frequent and represents a major risk factor which has a significant impact on renal graft survival of the kidney graft as well as that of the patient (pt).