Abstract Background and Aims Acute post-infectious glomerulonephritis (APIGN) is a reactive immunological disease. Its prevalence in industrialized countries is declining contrasting with developed ones. It is uncommon in adults but the prognosis may be reserved. The aim of our study was to evaluate the epidemiological, clinical and histological features of APIGN as well as its prognosis. Method A retrospective and descriptive study was conducted in our department. Were included all cases of histologically proven APIGN between December 2006 and December 2017. Results We had collected 38 cases. The mean age was 37.7 ± 17.8 years. The sex ratio was 1.92. Twelve (31.6%) patients were diabetic and four of them had already a chronic kidney disease (CKD). APIGN was preceded by an infection in 27 cases with an average interval of 10 ± 5 days. The most common site of infection was the respiratory tract (15 cases). At presentation, 27 patients had nephritic syndrome and 13 had nephrotic-range proteinuria. Hematuria was observed in 97.4%, peripheral edema in 84.2% and hypertension in 73.7% of cases. Most patients (78.9%) had acute kidney injury and 10 (26.3%) patients required dialysis. Renal biopsy had shown benign acute glomerulonephritis in 31 cases and malignant form in 7 cases. An underlying nephropathy was found in 12 cases with mostly a diabetic nephropathy. Corticosteroids were used in 3 cases of benign APIGN and 5 cases of malignant form. During the follow-up, CKD was noted in 14(36.8%) patients including 7(18.4%) patients who progressed to end-stage renal disease. Poor prognostic factors were diabetes, the presence of an underlying nephropathy in the biopsy, acute kidney injury and the need for dialysis. Conclusion The APIGN is uncommon in adults, yet its prognosis may be reserved with progression to CKD.

Abstract Background and Aims Plasmapheresis (PP) have been used in kidney transplant (KT) patients for multiple immunological renal diseases. Focal segmental glomerulosclerosis (FSGS) is one of the most prevalent indication for PP. It can be used either for curative or preventive treatment of its recurrence. The aim of our study was to assess the outcomes of PP among KT patients with FSGS. Method We performed a retrospective study including all KT patients with FSGS who underwent PP during the period from December 2007 to December 2018. PP was performed using a filtration technique by a Prismaflex machine. Results Among 275 KT patients, we have identified 5 patients with FSGS who underwent PP either before or after transplantation. The mean age was 26.4 years. All patients but one received a living-donor kidney with number of mismatches between 3 and 5. All patients were under corticosteroids, mycophenolate mofetil and cyclosporine. Two patients presented recurrent FSGS within 3 days following the transplantation. Mean serum creatinine level and proteinuria before PP were 517 ±191 µmol/l and 17.7 ±7.5 g/day respectively. The PP was used basing on Canaud protocol combined to rituximab. The mean number of PP sessions was 29. Only one patient required hemodialysis. None of the patients had lost his graft. The mean serum creatinine level was 172±55 µmol/l. One patient died of septic shock. PP was used in two other patients before transplantation in order to prevent the recurrence of FSGS. They have preserved a normal kidney function after a period of follow-up (37 months and 7 years). No rejection or recurrence of FSGS was noted during the follow-up period. Another patient aged 20, underwent 5 sessions of PP on alternate days immediately after transplantation to prevent the recurrence of FSGS. His baseline serum creatinine level was at 136 µmol/l. The recurrence of his initial renal disease occurred after 21 months requiring other sessions of PP. Rituximab was tried but stopped in front of allergy reaction. His renal function remained stable. Overall, PP was well tolerated in all patients with no incident. Conclusion Recurrence of the FSGS after transplantation is a concern for nephrologists due to the difficulty of treatment. Our study shows the efficacy of plasmapheresis before kidney transplantation to prevent recurrence of FSGS.

Published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of PD in Tunisia is poor. The purpose of this study is to report long-term clinical outcomes of PD patients through a 10-year experience at a single unit. This is a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 to June 2016. All patients were followed till death, renal transplant, switch over to hemodialysis (HD) or the end of the study in June 2016. The mean age of the incident patients was 43.93 ± 16.95 years. Nineteen (10.4%) were aged >65 years and 59.3% were male. The average duration of follow-up was 27.75 ± 26.18 months. The mean duration of PD treatment was 27.75 ± 26.18 months. There were 186 episodes of peritonitis that occurred over the total study period (54 episodes during the 1st year). The overall incidence of peritonitis during the 10-year study period was 1 per 27.25 patient months. Mechanical complications were noted in 31.2% of cases. Thirty- two (17.6%) patients had catheter displacement. Only 26 cases of hemoperitoneum (14.3%) were recorded. Death occurred in 23.1% of cases. Twenty-two patients (27.5%) were transplanted; 56 patients (70%) were transferred to HD, one patient had renal recovery and one case had voluntarily interrupted PD. In Kaplan-Meier curves of residual renal function (RRF) loss, there was a significant difference between peritonitis group and peritonitis-free group (P = 0.01). Technique and patient survival were associated with diabetes with a significant difference. The main cause of technique failure was peritonitis (61.4%). Moreover, the main repertoried causes of death were cardiovascular and septic causes. The mortality of diabetic and elderly PD patients was higher than mortality in nondiabetic and nonelderly groups, respectively, in our study. Peritonitis was associated with loss of RRF and technique failure.

that did not require intervention such as blood transfusion or angiography.Major complications included hematuria or hematoma with fall of hematocrit that required blood transfusion, angiography, surgery or caused hypotension that required intervention; death.Binary logistic regression model was used to analyze the possible factors associated with complications after biopsy.RESULTS: We analyzed 345 biopsies; samples taken from patients aged from 15-81 years, of whom 61% were men.A total of 21 (6%) patients developed a complication, 4.4% minor and 1.7% major complications.There were no nephrectomy or death due to biopsy intervention.Overweight patients, those with higher creatinine, lower hemoglobin, higher blood pressure and biopsy due to AKI had higher chances to develop complications (p = 0.037, p = 0.023, p = 0.032, p = 0.002, p = 0.002, respectively).The patients' age, gender, kidney dimension, number of passes and uninterrupted aspirin therapy were not found as significant predictors of complications.In the multivariate logistic model, the obesity (OR 1.031, 95%CI:1.002-1.062), anemia (OR 0.973, 95%CI:0.951-0.996) and hypertension (OR 1.025, 95%CI:1.007-1.044) aggravated the risk of complications in biopsied patients.CONCLUSIONS: Renal biopsy is a safe procedure with a low risk of complications when strict biopsy protocol is followed.Correction of anemia and blood pressure is to be considered before biopsy.