Peritonitis is one of the most serious complications of peritoneal dialysis (PD). The most common microbial causes of PD-associated peritonitis are Gram-positive pathogens. However, unusual microorganisms may be involved in this type of infection, such as Campylobacter fetus. Here, we report a case of C. fetus peritonitis in a 60-year-old woman undergoing continuous ambulatory PD. This patient was admitted to the nephrology department with a history of fatigue, abdominal pain, diarrhea, vomiting, and fever. A bacteriological examination of the PD effluent revealed a cloudy liquid containing 900 leukocytes/mm3 with 75% polymorphonuclear neutrophils. C. fetus was obtained in a pure culture. Antibiotic susceptibility testing was performed. A favorable outcome was noted after treatment with amoxicillin or clavulanic acid and amikacin. Thus, an accurate bacteriological diagnosis of PD-associated peritonitis requires optimal culture methods to improve the isolation of fastidious microorganisms such as Campylobacter and therefore guide appropriate antibiotic therapy.

Calcific uremic panniculitis is a rare cutaneous calcinosis on the spectrum of calciphylaxis. It mainly affects patients with end-stage renal disease (ESRD). The mortality rate is high, approaching 50% of cases. We report the case of a patient on chronic hemodialysis with secondary hyperparathyroidism who developed calcific panniculitis. The diagnosis was clinical: bluish subcutaneous nodules in the abdomen with rapid extension to the lower limbs and even the back, which quickly became necrotic. X-rays of the abdomen and lower limbs showed rounded calcifications in the fatty tissue. The evolution was rapidly fatal and the patient died of septic shock following superimposed infection of the lesions. Calcific uremic panniculitis is an increasingly rare fatal complication associated with ESRD and secondary hyperparathyroidism. The treatment remains poorly understood and difficult to apply, hence the importance of preventing this complication.

Long-term immunosuppression can lead to malignant tumors after kidney transplant. In this case study, we report a rare case of breast cancer occurring in a man after 33 years of kidney transplant. This 55-year-old kidney transplant patient presented with a right breast mass. The biopsy showed an infiltrating carcinoma. The immunohistochemical study was positive for estrogen. The patient underwent a right mastectomy with axillary dissection. Chemotherapy based on docetaxel and radiotherapy was started. Adjuvant treatment with tamoxifen and a switch from azathioprine to sirolimus were conducted. Follow-up showed that the patient died 24 months after presentation. Through this case, we emphasize the importance of vigilance about this rare cancer, often diagnosed at a late stage, which can negatively affect prognosis. Screening for risk factors is crucial.

Objective: Arterial hypertension is common in hemodialysis patients of which physiopathology is multifactorial. Moreover, it is associated with an increased risk of cardiovascular disease and a higher mortality. Fluid overload is the main contributing factor. Few studies have assessed the interpretation of parameters obtained through bioelectrical impedance (BIA) for the management of these patients. Design and method: we conducted a cross-sectional study at the Hemodialysis Center of Hedi Chaker in Sfax, Tunisia. Multifrequency bioimpedance analysis (BIA) was used to assess the hydration status which is performed at the end of the dialysis session. Results: Our study included 29 patients, with a mean age of 46.8 years (21-78 years) and an average dialysis vintage of 92.4 months. Male predominance was noted with a sex ratio of 1.06. Forty-eight percent of patients were hypertensive. Twenty-three percent of patients were on triple antihypertensive therapy, 13.3% were on dual therapy, and 16.7% were on monotherapy. Hypertension was essential in 64.2% of cases, renin-dependent in 14.2%, and volume-dependent in 21.6% of cases. Twenty-point seven percent (20.7%) of patients were in fluid overload, with an average overhydration of 0.9 liters. The impedance measurements were consistent with the data from cardiac ultrasound. The diameter of the inferior vena cava was significantly correlated with overload (p=0.01). However, there is no correlation between pulmonary arterial hypertension (HTAP) and the hyperhydration (p=0.4). Conclusions: Bio-impedancemetry is a valuable and simple tool at the patient's bedside for the dry weight estimation and the proper management of volume status in chronic hemodialysis patients, and consequently, blood pressure control.

Objective: High blood pressure is widespread among individuals undergoing hemodialysis and is considered a significant contributor to the elevated cardiovascular mortality observed in this population. The aim of our study was to assess the prevalence of HTN and investigate its contributing factors. Design and method: This is a retrospective descriptive and analytic study conducted within our hemodialysis unit, including 70 patients. For each participant, the following clinical data were collected: age, gender, personal medical history, initial nephropathy, dialysis vintage, and evolution Results: Our study revealed a hypertension (HTN) prevalence of 51,4%. Among them, 63,9% were male, resulting in a sex ratio of 1,76. The mean age was 49.1 years (range: 21-86 years). undetermined nephropathy was the predominant initial nephropathy (39%). The average blood pressure of hypertensive patients was 159 mmHg for systolic (142-189 mmHg). Diabetic patients were more hypertensive with no statistically significant difference. Hypertensive patients exhibited a larger waist circumference, lower hemoglobin levels, and a lower left ventricular ejection fraction (LVEF) with no statistically significant difference. hypertensive patients were more prone to cardio vascular events such Cerebrovascular Accidents (2% of patients), transient ischemic attacks (2% of patients), and coronary artery disease (11% of patients). Conclusions: In summary, our study emphasizes the importance of investigating hypertension and its related factors, aiming to contribute insights for better cardiovascular health management.

Purpose: The present study aimed to investigate for the first time the effects of melatonin (MEL) intake on oxidative stress and cellular damage during intradialytic exercise (IEX).Methods: Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized crossover trial. Participants performed four HD sessions in four different conditions: (Exercise (EX)-MEL), (EX-Placebo (PLA)), (Control (C)-MEL), and (C-PLA). 3 mg of MEL or PLA were taken 60 min before starting exercise, or at the equivalent time in the C conditions. Blood samples were taken before HD (T0), immediately after the end of IEX (T1), 60 min after IEX (T2), or at the corresponding times in the C conditions to measure free radicals damage, antioxidant biomarkers, as well as biomarkers of muscle and liver damage.Results: Malondialdehyde and Advanced Oxidation Protein Products decreased in (C-MEL) (p < 0.05, d = 2.19; p < 0.01, d = 0.99, respectively) at T2 compared to T0. Catalase and total thiol levels increased in (C-MEL) (p < 0.01, d = 1.51; p < 0.01, d = 1.56, respectively) and in (EX-MEL) (p = 0.01, d = 1.28; p < 0.01, d = 1.52, respectively) at T1 compared to T0. Total bilirubin levels increased in (EX-MEL) and (C-MEL) at T2 compared to T0 (p < 0.001, d = 2.77; p < 0.001, d = 1.36, respectively), but only at T2 compared to T1 in (EX-MEL) (p < 0.001, d = 1.67). In all conditions, uric acid levels decreased at T1 compared to T0 and at T2 compared to T1, while biomarkers of muscle and liver damage remained unchanged.Conclusion: This pilot study is the first to show that MEL ingestion, alone or combined with IEX, could improve oxidant-antioxidant balance during HD.

Objective: Plasma renin and aldosterone assays are useful in clinical practice for the aetiological assessment of arterial hypertension (hypertension) and / or a disturbance of the electrolyte balance. The objective of our work is to describe the main indications exploration of the renin aldosterone system, its results, its diagnostic and etiological impact. Design and method: We conducted a retrospective study of 40 patients who received a renin / aldosterone dosage, collected in the Nephrology department at the Hédi Chaker CHU in Sfax for a period of 6 years from January 2014 until December 2020. Results: These are 21 women and 19 men with a sex ratio of 1.1. Hypertension was present in 82.5% of cases. The dosage indication was: hypertension with hypokalaemia in 52.5%, hypertension in young subjects in 20%, resistant hypertension and hypertension with incidentaloma in each 7, 5% of cases, and incidentaloma without HTA in each 5% of cases and in one case hypokalaemia without HTA. Aldosterone was elevated in 52.5% of cases. Renin was normal in 67.5% of cases, low in 25% and high in 7.5% of cases. The aldosterone / renin ratio was normal in 60% of cases, elevated, decreased and invalid in respectively 27.5%, 2.5% and 10%. The etiological investigation revealed: primary hyperaldosteronism in 42.5% of cases secondary to a Conn adenoma in 20% of cases, to adrenal hyperplasia in 17.5% of cases and with normal imaging in 5% of cases. Secondary hyperaldosteronism was confirmed in association with Liddle syndrome and renal artery stenosis in 2.5% of cases each. The other etiologies were pheochromocytoma in 12.5% of cases, Takayusu’s disease, tubulopathy in 2.5% of cases each. The dosage was non-contributory in 7.5% of cases and normal in 25% of cases. Conclusions: The exploration of the renin angiotensin aldosterone system has several indications, mainly in hypertension with hypokalaemia. It can help make the etiological diagnosis and guide therapeutic management.

In the study, we observed that patients with SRA inhibitors experienced less cardio-vascular related death, although it is not enough to conclude its cardioprotective status. Larger studies need to be carried to unveil its utility among haemodialysis patients.

Leishmaniasis is a zoonosis acquired from the bite of a sandfly that introduces the amastigote forms of leishmania into the bloodstream. It is a frequent infection in the countries of the Mediterranean basin and in Tunisia, where it is rife in an endemo-epidemic mode. However, it is rare after kidney transplantation. It constitutes a challenge due to the diagnostic difficulty, the variability and the polymorphism of the clinical picture in immunocompromised patients. We report seven observations of cutaneous leishmaniasis after kidney transplantation through which we try to identify diagnostic and therapeutic difficulties. (c) 2022 Societe francophone de nephrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Type1 primary hyperoxaluria is an infrequent autosomal recessive metabolic disease characterized by the accumulation of calcium oxalate in the kidney, which leads to end stage renal disease. In fact, the diagnosis of this disease is mandatory in order to avoid graft loss.AIM:To assess the incidence of primary hyperoxaluria and to develop the diagnostic value of bone marrow infiltration by calcium oxalate in uremic stone former patients.METHODS:This study was conducted on a cohort of stone former patients identified in the south of Tunisia over a period of 18 years. Baseline characteristics were recorded. Clinical and laboratory data were collected on chart review. Secondary forms of hyperoxaluria were excluded. Bone marrow aspirate was performed in uremic patients from this cohort because early hyperoxaluria was suspected. Diagnostic accuracy of this test relating to sensitivity, specificity, positive predictive value and negative predictive value were also calculated.RESULTS:A cohort of 31 patients comprising 17 male patients and 14 female patients were identified. During this time of diagnosis, the patient's ages ranged from 9 to 57 years old and 22 of them (70%) unfortunately died. Bone marrow aspirate was safely done in 16 uremic patients. It was positive in 12 patients and negative in 4 patients. Sensitivity, specificity, positive predictive value and negative predictive value were respectively 85%, 100%, 100% and 50%.CONCLUSION:The bone marrow examination represents both an easy and a worldwide feasible solution for the diagnosis of oxalosis, which affords an early diagnosis.

La leishmaniose est une zoonose acquise suite à la piqûre d’un phlébotome qui introduit les formes amastigotes de la leishmania dans la circulation sanguine. Il s’agit d’une infection fréquente dans les pays du bassin méditerranéen et en Tunisie, où elle sévit selon le mode endémo-épidémique. Cependant, elle est rare après transplantation rénale. Elle constitue un challenge en raison de la difficulté diagnostique, la variabilité et le polymorphisme du tableau clinique chez les immunodéprimés. Nous rapportons sept observations de leishmaniose cutanée après transplantation rénale, à travers lesquelles nous essayons de relever les difficultés diagnostiques et thérapeutiques.

Peritonitis is an important cause of morbidity and technique failure in peritoneal dialysis. Herein, we report peritonitis related to Acinetobacter lwoffi in two patients on peritoneal dialysis. The first case is a 63-year-old patient treated by automated peritoneal dialysis admitted with abdominal pain. The peritoneal effluent White Blood Cells count consisted of 280 cells/mm3. Then culture identified a multisensitive Acinetobacter lwoffi. Treatment with ceftazidime and ciprofloxacin had been started. The control dialysate culture was sterile after three weeks. The second patient is a 59-year-old female admitted because of diffuse abdominal pain and cloudy dialysate. The peritoneal effluent White Blood Cells count consisted of countless leukocytes, with predominantly polynuclear and culture identified Acinetobacter lwoffi. He received intraperitoneal ceftazidim and amikacin for three weeks. The control dialysate was sterile. Acinetobacter lwoffi is a rare cause of peritonitis and it can be treated successfully with early recognition and appropriate antibiotic therapy based on culture instead of catheter removal.

Objective: Myocardial ischemia is an acute condition that, if not treated in a timely manner, produces the loss of heart tissue which can lead to heart failure or death of the patients. Our group has studied fibrates, exogenous ligands of PPAR, as an alternative to reduce processes associated with inflammation and we interested to know the exogenous ligand effect over damage in the cardiac tissue by RAS system. To study the effect of PPAR alpha ligand; clofibrate, on renin angiotensin system and on the structural morphology of the heart in myocardial infarcted subjects. Design and method: Male Wistar rats were separated in two groups: 1.- Sham, 2.- Myocardial infarct by coronary artery ligation. Seven days after, the rats were subdivided in vehicle (Vh)- or clofibrate treatment (Clof 100 mg/kg/day) administered for seven more days. At the end of the treatment (14 days in total), serum and left ventricle were analyzed. Results: Angiotensin converting enzyme (ACE), AT1 receptor and Ang II decreased in MI-Clof vs. MI-Vh, whereas non-classic RAS system components: ACE2, AT2 receptor, bradykinin, and Ang-(1–7) augmented in MI-Clof with respect to MI-Vh. VEGF also raised in clofibrate-treated animals. Clofibrate treatment preserved the structure of the sarcomere (fiber). Conclusions: Clofibrate treatment to MI rats exerts an antifibrotic effect and augmented the expression of non-classical axis of RAS system.

Abstract Introduction Anemia is an almost constant complication in patients with end stage renal disease. In contrast, primary polycythemia is extremely rare, with only a few cases that have been reported in the literature. We report in this work a rare association of thrombophilia and acquired polycythemia in a chronic hemodialysis patient. Observation This is a 47-year-old man, non-smoking, hypertensive, with CKD in hemodialysis since 2015 secondary to undetermined nephropathy. The change in the patient's condition on hemodialysis was marked by the occurrence of repeated thrombosis of these arteriovenous fistulas(AVFs), including exploration that revealed a coagulation factor V mutation, hence his initiation of antivitamin K. The patient initially presented with severe anemia at the start of the extra renal purification , the average hemoglobin (Hb) level between 2015 and 2018 was 7.4 g / dl thus requiring the use of iron supplementation (IV iron) and stimulating agents erythropoiesis (ESA). In february 2019, erythropoietin requirements were reduced due to the increase in Hb levels and then stopped in April 2019. The Hb level continued to increase to reach 16.8 g / dl in february 2020 without receiving ESAs or iron supplements. From where an etiological investigation was initiated to search for the origin of this polycythemia going up to the genetic study for the JAK2V617F mutation which came back positive. Furthermore, gas scans, chest x-rays and abdominal ultrasounds are normal, hence polycythemia vera was retained in this patient. For fear of losing his AVF, the patient underwent intermittent phlebotomies during dialysis associated with the prescription of IEC and his Hb level rose to 14.5g / dl. Conclusion Primary erythrosis remains rare in dialysis, the pathophysiological mechanism of which remains poorly understood. Iterative phlebotomies remain the solution sometimes coupled with the prescription of IEC.

Abstract Background and Aims Pruritus is a common symptom in chronic hemodialysis patients, its intensity varies from patient to patient and which plays a major role in impairing their quality of life. Its pathophysiology is poorly understood and its management remains a challenge. The main objective of our study is to estimate the frequency of pruritus in our population and its impact on their quality of life. Material and methods This is a cross-sectional study involving 53 patients carried out in the dialysis unit of the CHU Hédi chaker in sfax. The DLQI (Dermatology Life Quality Index), the Pittsburgh Sleep Quality Index (PSQI) and the verbal analogue scale to specify the intensity of pruritus were used to assess the impact of pruritus on quality of life. Results The mean age of our patients was 48 ± 28 years with a predominance of men (60%). The mean duration on hemodialysis was 5.4 years. The prevalence of pruritus was 28% of cases. Pruritus affects 75% of the body surface in 90% of patients, an intensity greater than or equal to 5 in 93.33% of cases on an intensity scale of 0 to 10, the impact was moderate on the quality of life according to the DLQI in 66.66% of the cases, 86.66% of the patients presented a nocturnal recrudescence of the pruritus, and an alteration of the quality of sleep was present in 73.33% of the cases according to the PSQI. The Comparison of the groups with (G1) or without pruritus (G2) showed the predominance of hyperposphoraemia in the first group with averages of 1.92mmol / l and 1.4mmol / l respectively in G1 and G2 Conclusion Pruritus remains the most frequent complaint for hemodialysis patients, which in our patients was linked mainly to hyperposphoraemia requiring optimization of phosphorus chelators and hemodialysis measures.

Abstract Background and Aims Infectious complications represent the leading cause of death among the dialysis population, prompting early diagnosis and increased vigilance. Neutrophil-to-lymphocyte and platelets-to-lymphocyte ratios are newly emerging as more accessible and simple markers for the detection of the onset of infections. The objective of our study is to prove the value of these markers in the diagnosis of infections in hemodialysis patients. Method This is a cross-sectional study spread over one year including 85 chronic hemodialysis patients with duration of at least 6 months. patients with hemopathies, tumors, or with a history of hospitalization during the 3 months before the study were excluded. CRP was used as a biomarker of infections and N / L; P / L ratios were calculated to study the correlation between the two biomarkers. Based on the literature reviews, the threshold of the N / L ratio and the P / L ratio admitted for our stydy were respectively : > = 2.5 and > = 150. Results The mean age of our patients was 49 ± 19 years with a predominance of women (55%) .The average duration in hemodialysis was 67.2 months. An infectious complication was noted in 22% of our patients whose distribution was as follow: 4% as a pulmonary infection with 3 coronavirus cases, 6% a sepsis, one case of abscess of the nephrectomy compartment.The median value of the CRP was 37±10mg/l We found a positive correlation between the 2 ratios associated (RNL and RPL) and infection with (p = 0.03) . We noted throw this study that patients with both high ratios RPL> 150 and RNL> 2.5 have significantly elevated values of CRP. Conclusion N/L and P/L ratios are easy-to-calculate markers that are of great benefit to the hemodialysis population. We have shown through this study the existence of a positive correlation between the N/L and P/L ratios and the occurrence of infections in hemodialysis patients. We therefore encourage the use of this ratios to be included as markers to detect infections occurence.

The pandemic coronavirus infection (COVID-19), like the general population, has affected the care and outcomes of hemodialysis (HD) patients. Their high vulnerability is due to their comorbidities and circumstances limiting physical distancing during dialysis and therefore increases the risk of being exposed to COVID-19 infection. This study aims to report clinical particularities of covid-19 infection in our HD 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.

Abstract Background and Aims Sleep disturbances are more common in patients with chronic renal failure and on dialysis than in the general population. They affect their mental health and quality of life. The objective of this study was to evaluate the sleep disorders of patients on peritoneal dialysis (PD). Method We report the results of a descriptive cross-sectional study in 27 patients on PD in order to assess the quality of sleep in these patients and its relation with mental health and quality of life. Sleep quality was performed using the Pittsburgh Sleep Quality Index (PSQI) to assess origin and extent of sleep disorders. Anxiety-depressive disorders were assessed using the HAD (Hospital anxiety and depression) scale. The quality of life (QOL) measurement was performed by the SF36 and KDQoL. Results We included 15 men and 12 women with an average age of 45.74 years (21–77). Eleven patients were on automated peritoneal dialysis (APD) and 16 patients on continuous ambulatory peritoneal dialysis (CAPD). The mean duration of dialysis was 45.77 ± 25 months. Poor quality of sleep was reported in 14 patients. The mean PSQI was 7.22 ± 4.87. The most affected components were sleep duration and usual sleep efficiency. Depression was objectified in 22.22% of patients and 26% of patients had anxiety. Impaired quality of sleep was associated with decreased quality of life. The components of the physical dimension of quality of life: limitation due to physical condition, physical pain were significantly lower in dialysis patients with good quality of sleep (p=0.014, p= 0.033 respectively) The mental dimension component of QOL of SF36: relationship to others, limitation due to mental condition was also lower in patients with sleep disturbances (p=0.039, p= 0.036 respectively). Symptoms and problems, as well as the effects and the burden of kidney disease were not associated with poor quality of sleep. Impaired sleep quality was also not significantly associated with depression or anxiety in our series. Conclusion Sleep disturbances are common in PD patients and are associated with decreased quality of life. Therefore, they must be taken into account in the therapeutic measures recommended in order to improve the quality of life of these patients and reduce morbidity and mortality.