Acute kidney injury (AKI) secondary to near-drowning is rarely described and poorly understood. Much of the literature on near-drowning has concentrated on the respiratory, cerebral, cardiac, and hematologic complications. Near-drowning-induced AKI is a heterogenous clinical entity. We report a case of near-drowning, which developed inisolated AKI due to acute tubular necrosis requiring dialysis.

We report the case of a 17-year-old male with an unremarkable medical history, admitted for acute nephritic syndrome associated with acute renal failure. His presentation occurred three weeks after a generalized febrile cutaneous rash that had been diagnosed as measles. Renal biopsy revealed acute glomerulonephritis (AGN) with cellular crescents; the outcome was favorable under treatment. Measles is a highly contagious disease, and a resurgence in its prevalence has been observed worldwide, including in Morocco. Although the measles virus is known to be nephritogenic and may lead to AGN, its association with glomerular involvement remains uncommon and has been infrequently documented in the medical literature.

Hypothyroidism is a rare cause of rhabdomyolysis and an even less common cause of acute kidney injury (AKI). Because the symptoms may be mild or non-specific, the diagnosis can easily be overlooked. We report the case of a 44-year-old man with no significant past medical history who was admitted after renal impairment was discovered on routine blood testing. On clinical examination, he had sinus bradycardia, puffy facies with bilateral periorbital edema, Hertoghe sign, muffled heart sounds, psychomotor slowing, and constipation. Laboratory investigations showed stage II AKI, severe rhabdomyolysis with creatine phosphokinase levels above 8,450 IU/L (reference range: <171 IU/L), and liver cytolysis. Further evaluation revealed profound hypothyroidism, with markedly elevated thyroid-stimulating hormone, very low free thyroxine, and strongly positive anti-thyroid peroxidase antibodies, consistent with autoimmune thyroiditis. Thyroid ultrasound supported the diagnosis of Hashimoto's thyroiditis, and echocardiography showed a moderate pericardial effusion without hemodynamic compromise. Because nephrotic-range proteinuria was also present, a kidney biopsy was performed and showed mainly tubulointerstitial injury with pigmented casts and tubular atrophy, associated with focal segmental glomerulosclerosis. The patient was treated with intravenous hydration and gradual levothyroxine replacement, with clear clinical improvement and progressive normalization of laboratory abnormalities. This case highlights that severe hypothyroidism may rarely present with rhabdomyolysis and AKI. It also underlines the importance of considering thyroid dysfunction in patients with unexplained rhabdomyolysis, especially when the clinical picture is not very suggestive, since early treatment can lead to a favorable outcome.

Renal cortical necrosis is the destruction of the cortical tissue resulting from renal arteriolar injury, leading to acute kidney injury. This rare condition typically manifests in neonates and pregnant or postpartum women when sepsis or pregnancy-related complications occur. Symptoms include macroscopic hematuria, flank pain, reduced urine output, fever, and the onset of uremic symptoms.We present a 38-year-old multiparous patient with no significant medical history, admitted for vaginal delivery at 37 weeks, complicated by pre-eclampsia, eclampsia, HELLP syndrome, retroplacental hematoma, and acute kidney injury requiring dialysis. She also experienced significant postpartum hemorrhage with hemodynamic instability, necessitating labile blood products and tranexamic acid administration.

Despite an increase in the incidence of kidney failure in Morocco, treatment with transplantation remains limited. Exploring the perspectives of individuals with kidney failure toward kidney transplantation is essential, as it can provide information on previously unknown barriers to care, guide public health efforts, and inform patient-provider conversations. The aim of this study was to identify knowledge, perceptions and willingness to undergo kidney transplantation among individuals with dialysis -dependent kidney failure in southern Morocco. This was a cross-sectional observational study with quasi-qualitative data conducted across seven hemodialysis centers (six urban centers and one rural center). Participant responses were collected via a face‒to‒face questionnaire and open‒ended questions from September to December 2021. The study was approved by the ethics committee located in Marrakech. Three hundred twenty-two individuals (178 men (55.3

Introduction:Bardet-Biedl syndrome (BBS) is a rare autosomal recessive disorder. Diagnosis can be established with specific symptom criteria, confirmed by genetic testing. Early detection and monitoring are crucial due to the high risk of serious organ damage in affected children. We report a case of BBS at younger age admitted to our training program for severe renal failure. Our case is the first reported observation in our country, which will contribute to scientific research in Morocco and in Africa. Case presentation:An 18-year old female born to consanguineous parents, with a history of psychomotor and reduced visual acuity. She was admitted for severe kidney disease with GFR of 5 mL/min. On clinical examination, the patient was obese, polydactyly, a dysmorphic facial appearance. The fundoscopy showed a pigmentary retinopathy and pigmentary dystrophy in both eyes. Clinical discussion:BBS is a rare genetic disorder marked by features like retinal dystrophy, obesity, polydactyly, and kidney abnormalities due to defective ciliary function. Mutations in over 21 genes are linked to the disease, with some causing more severe renal outcomes. Diagnosis is based on clinical criteria and genetic testing. Management is supportive, with renal care including dialysis or transplantation when needed. Conclusion:BBS is a multisystem disorder classified as a non-motile ciliopathy due to defects in cellular organelles (cilia), which explains its diverse clinical manifestations. The frequency of CKD secondary to BBS is variable. The particularity of our case is that BBS is a very rare cause of chronic renal failure in our practical field. It has been reported in various series that diabetic and hypertensive nephropathies are the most commonly identified, rather than genetic disorders.

Sporadic cerebral amyloid angiopathy is a common condition in the elderly, characterised by the accumulation of amyloid Aβ peptide in the walls of small cerebral arteries, leading to intracranial haemorrhage and cognitive impairment. We present the case of a 65-year-old woman admitted for sudden intracranial hypertension and severe renal failure requiring dialysis.This case illustrates an uncommon presentation of cerebral amyloid angiopathy in a patient with concurrent end-stage renal disease, highlighting the complex interplay between systemic and cerebrovascular pathology. The diagnostic challenge posed by overlapping neurological and uraemic symptoms underscores the importance of multidisciplinary evaluation in such cases.

Lerich syndrome, also known as aorto-iliac obliteration syndrome, is a specific entity among obliterative arteriopathies of the lower limbs, is defined as thrombotic occlusion of the aorto-iliac junction. We report a case of 60-yearold patient, chronic smoker with hypertension disease. He was admitted for an assessment of renal failure, in whom the diagnosis of chronic kidney disease was confirmed. Moreover, in the presence of renal asymmetry (4,9 cm) on renal ultrasound, a CT angiography was requested, confirming the diagnosis of Lerich syndrome with renal artery stenosis. A complementary assessment, including etiological one was performed, revealing no abnormalities. Therapeutically, the patient was placed on intermittent hemodialysis and curative anticoagulation. Our case represents a rare and fortuitous discovery of Lerich syndrome.

Introduction: The prevalence of anemia in chronic kidney disease and among chronic hemodialysis patients is very high and is associated with significant morbidity and mortality. The aim of this study was to determine the prevalence of anemia in chronic hemodialysis patients in the Souss-Massa region and to evaluate its management. Materials and Methods: This was a retrospective, analytical, and descriptive study conducted between July 2023 and July 2024, including chronic hemodialysis patients from the Souss-Massa region. Anemia was defined according to the 2024 Kidney Disease Improving Global Outcomes (KDIGO) guidelines as hemoglobin levels <13 g/dL in men and <12 g/dL in women. Results: A total of 1,346 patients out of 1,800 participants were included, corresponding to an anemia prevalence of 74.7%. The mean age of the patients was 57.52 ± 15.54 years, with a male-to-female ratio of 1.12. Half of the patients had been on hemodialysis for less than 5 years. The leading causes of kidney disease were diabetic nephropathy and hypertensive nephropathy in 38.8% and 16.9% of cases, respectively. The mean hemoglobin, ferritin, and transferrin saturation (TSAT) levels were 10.02 ± 1.5 g/dL, 386.42 ng/mL, and 32.61% ± 15.4, respectively. Anemia management included erythropoietin (EPO) therapy, injectable iron, and blood transfusions in 85%, 13.4%, and 20% of patients, respectively. Multivariate analysis revealed significant correlations between anemia and history of hypertension (p=0.008), hepatitis C virus infection (p<0.001), secondary hyperparathyroidism (p=0.04), prior catheter-related infectious complications (p=0.003), and chronic inflammatory syndrome (p=0.02). Discussion and Conclusion: Our study confirms a high prevalence of anemia in hemodialysis patients. Despite therapeutic advances, blood transfusion reliance remains high, increasing the risk of immunologic complications and limiting access to kidney transplantation.

Perturbations in bone and mineral metabolism associated with chronic kidney disease (CKD) present a nuanced challenge, particularly in the context of their implications for fracture susceptibility in the pediatric demographic. Despite the well-established escalation of fracture risk in adults afflicted with end-stage renal disease, the extant scientific literature addressing this phenomenon in pediatric cohorts remains notably limited.Within this framework, we present the case of a 16-year-old adolescent devoid of significant medical antecedents, admitted to our facility due to terminal chronic kidney disease of indeterminate etiology. The diagnosis was conclusively established following pronounced manifestations of mineral and bone disorders, exemplified by a bilateral fracture involving both femoral necks.

Introduction: Multiple Myeloma (MM) is a malignant and a clonal proliferation of plasma cells that secrete a monoclonal immunoglobulin or its fragment. Renal involvement is common in MM, secondary to the production of monoclonal immunoglobulins (IgM) with intrarenal deposition of light chains. This renal involvement can exacerbate the already poor prognosis due to tumor progression. The aim of our study is to describe the epidemiological, clinical, biological, therapeutic, and evolutionary aspects of renal involvement in MM. Patients and Methods: We conducted a prospective descriptive study based on the analysis of 22 cases of MM treated at the Nephrology Department of University Hospital Center of Agadir over a period of 4 years (April 2020 - March 2024). The study included all patients meeting the International Myeloma Working Group (IMWG) 2014 classification criteria. Results: The average age of our patients was 59.4 years, with a male-to-female ratio of 1.44. The average consultation delay was 2 months. Clinical manifestations were predominantly general deterioration, osteoarticular symptoms, and mucocutaneous pallor, present in the majority of our patients. Biological assessments revealed anemia in all cases, severe in half of them. Hypercalcemia was present in the majority of cases (72.7%). Hyperproteinemia was noted in 45% of patients, being significant (>100 g/L) in half of them. Hypoalbuminemia was observed in more than three-quarters of the patients. Severe renal failure was present in 77.2% of patients, with an average serum creatinine level of 66 mg/L. Infectious syndromes were found in half of the patients at admission, primarily urinary (60%) or pulmonary (40%) infections. A monoclonal peak was observed in 77.3% of patients, mainly in the gamma-globulin zone. The myelogram was significant in all cases. Immunofixation revealed a predominance of kappa light chains (62%).. Radiological osteolytic lesions were found in 77.3% of cases. All patients had high tumor mass myeloma. Kidney biopsies were not systematically performed, being done in only 2 patients. Therapeutically, chemotherapy was initiated in most patients. Dialysis was indicated in 8 cases (36.3%), and was successful in 6 out of 8 patients. Renal response was complete in 9 cases (40.9%), partial in 3 cases (13.6%), and minor in 6 cases (27.3%). Worsening renal function was observed in 4 patients (18.2%), with 2 patients progressing to chronic dialysis. Infectious complications were noted in 14 patients during their follow-up (63.6%). Hematological toxicity from chemotherapy was observed in 9 patients (40%). with a follow-up period of 22 months, 9 patients are in complete remission, 7 patients have died, and 6 patients were lost to follow-up. Discussion and Conclusion: Multiple Myeloma remains an incurable disease. However, the advent of new therapies has significantly improved its prognosis. Early diagnosis and management is essential for rapidly restoring renal function and preventing serious complications.

Introduction: It has been suggested that patients with autoimmune diseases are more likely to develop other malignancies. However, the association between lupus and multiple myeloma (MM) is still not much described in the literature. Case Report: We report the observation of a 46-year-old female patient, in premenopause, in whom the diagnosis of systemic lupus was retained (SLICC criteria 7) with cutaneous, joint, hematological, immunological, and renal involvement. The discovery of MM was suspected due to a peak in gamma globulins on plasma protein electrophoresis and confirmed by myelogram. The outcome was fatal due to septic shock before starting any immunosuppression. Discussion and Conclusion: In this literature review, 15 cases are reported on the occurrence of MM years after the diagnosis of lupus, only two cases were like our observation with a concomitant diagnosis of the 2 diseases. The management is still not codified; hence the prognosis of this association remains reserved, encouraging early detection of malignant plasma cell proliferation.

Migration of guiding catheter during placement of hemodialysis femoral catheter is an unusual, early and rare mechanical complication. We report here the case of a 70-year-old man, admitted for severe renal failure, uremic syndrome and hyperkalemia, requiring an extra renal purification session which was complicated by a blockage of the femoral venous catheter guide during its removal. Such a complication highlights the importance of good anatomical knowledge, good monitoring by an experienced person during central venous catheterization, and the interest in using ultrasound guidance before and after catheter placement.

Progression of lupus nephropathy (LN) to end-stage renal disease is a serious complication and requires subsequent replacement therapy. Lupus disease activity is extinguished in chronic hemodialysis. We report the observation of a 35-year-old female patient, in conventionnel hemodialysis for two years (chronic glomerulonephritis), admitted to the emergency room for convulsions, left flaccid tenderness, cutaneous-mucosal pallor and altered general condition evolving since three days before her admission. we also observed a spontaneous ecchymotic lesions on the right arm. Echodoppler of the right upper extremity was in favor of a partially thrombosed aneurysm of the right brachial artery. The biological workup showed pancytopenia, the requested immunological workup showed a low complement C 3 , a positive level of anti-DNA antibodies. The patient was treated as severe lupus flare: Bolus of methylprednisolone, followed by oral administration, associated with Mycophenolate mofétil (MMF) at a dose of 1 g/d. The evolution was favorable on the clinical, biological and radiological levels. Systemic lupus erythematous (SLE) can occur even after several years of hemodialysis and sometimes in a severe form, pushing the clinician to think of this pathology in the presence of evocative signs.

Background: The novel coronavirus disease COVID-19 targets mainly the respiratory system, but may in severe cases affect other organs, causing, multiorgan damage, including cardiac injury and acute kidney injury (AKI). The aim of study was to determine the prevalence of AKI and urinary sediment abnormalities in patients with COVID-19 and evaluate the associated factors and outcomes in hospitalized patients. Material and Methods: All laboratory-confirmed COVID-19 admitted to the hospital during this period were involved in the study from 1st of July to the 1st of August 2020. Patients were subjected to Kidney function tests (KFT) and complete urine analysis. Results: Eighty-six COVID-19 patients were included in the present study. The median age of the patients was 43,29 years, and 53,5 % were males. AKI developed in 17 patients (19,8%). Of these, 23,5% required renal replacement therapy (RRT), and 13,9 % patients died. 45 (51.7%) patients displayed abnormality in urinalysis, such as proteinuria, hematuria, leukocyturia and or urinary urothelial cell. Elderly patients, patients with associated comorbidities are more commonly affected. Stepwise multivariate logistic regression analyses showed that age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.006[0.95-1.06], p=0.8], diabetes mellitus (HR [95%CI]: 10,68 [1,78-64], p=0,009) and hyperleucocytosis (HR [95%CI]: 4,63 [1,01-21,1], p=0,04) were independent predictors of AKI. Conclusion: Kidney dysfunction is common among patients with COVID-19. Patients who develop AKI have bad outcomes this brings us to give more interest in urinalysis and kidney impairment in COVID-19 patients, which should be monitored regularly.

Centro-pontine myelinolysis (CPM) and extra-pontine myelinolysis (EPM), grouped together in osmotic demyelination syndrome (ODS), is a rare pathology characterized by the destruction of the myelin sheath. Rapid correction of hyponatremia remains the typical cause of this syndrome. We report the case of a patient with hyperemesis gravidarum complicated by renal failure, in whom correction of hyponatremia with 3% hypertonic saline resulted in CPM.

Digital ulcer generally reflects the presence of focal ischemia related to a microangiopathy. Etiologies are dominated by connectivites in women and by diffuse arteriopathies such as Leo-Buerger disease in men, as well as emboligenic heart disease. This article describes the case of a 46-year-old chronic hemodialysis female patient with nephroangiosclerosis, who presented a progressive onset of intermittent cyanosis of the fingertips and toes. The symptomatology was worsened by the evolution toward necrosis at the amputation stage. Etiological workup was in favor of multiple myeloma, requiring the initiation of chemotherapy.

This study aims to remind clinicians of fluoroquinolone-related tendinopathies. They are rare side effects, but which can result in functional disability. We report the case of a 79-year-old woman with a 11-year history of haemodialysis who had sudden left ankle pain and functional impairment in the ipsilateral member on day 5th after self-medication with ciprofloxacin. Comorbidities included chronic gonarthrosis, secondary hyperparathyroidism and ischemic heart disease. The diagnosis of bilateral Achilles tendinopathy and rupture of the left Achilles tendon was retained due to clinical features and confirmed by ultrasound of ankles. Ciprofloxacin-associated tendon rupture was evaluated using the French method of accountability for drug unexpected side effects or toxicity. Tendon rupture management was based on surgery followed by functional rehabilitation program with satisfactory outcome. The frequency of fluoroquinolone-related tendinopathies ranges from 15 to 20 accidents per 100,000 subjects treated, a third of whom are complicated by tendon rupture. Incidence is related to age, affecting mainly people > 60 years and involving tissular aging. Pefloxacin and ciprofloxacin are the most offending molecules. In our study, the delay in the onset of symptoms on day 5 after self-medication was consistent with literature. We detected some common contributing factors including chronic renal failure,hemodialysis and the assumption of statins and corticosteroids. Fluoroquinolone-related tendinopathies are characterized by common clinical features which allow diagnosis. They mostly affect Achilles tendon. They are bilateral in 40-66% of cases. Tendon rupture is the main complication. Management is based on surgery. It allows to restore anatomy and to prevent detrimental functional disability. We here report a rare but potentially serious fluoroquinolonesrelated side effect, exposing the patient to the risk of functional disability. Advanced age, chronic renal failure, chronic haemodialysis, concomitant use of statins and corticosteroids are common contributing factors confirmed in this study. Hemodialysis patients constitute a population at risk; hence the importance of remote monitoring after treatment with these molecules.

RESUME Introduction. La coagulation du circuit est l'une des principales causes d'arret des seances d'hemodialyse. Elle augmente le cout, la charge des soins et reduit l'efficacite de l'epuration extra renale. Notre etude avait pour objectifs de determiner l'incidence et les facteurs de risque de coagulation du circuit en hemodialyse. Materiels et methodes. Il s'agit d'une etude monocentrique, transversale, descriptive et analytique, realisee pendant un mois dans l’unite d’hemodialyse aigue du service de Nephrologie du centre hospitalo-universitaire (CHU) Hassan II de Fes. Les donnees ont ete recueillies dans les registres de suivi des seances d'hemodialyse et leur analyse faite avec les logiciels Excel 2007 et Epi Info 3.4. Resultats. 233 seances sont rapportees dans notre etude. La coagulation du circuit a ete retrouvee dans 20 seances (8,6 %). Les facteurs de risque de coagulation du circuit (p <0,05) etaient : une duree de seance superieure a deux heures, une transfusion sanguine en cours de seance, un dysfonctionnement de la voie d'abord. Des rincages du circuit avec du serum physiologique ont ete realises dans 15 seances avec circuit coagule (75%) du fait d'un risque hemorragique eleve. Conclusion. La coagulation du circuit en hemodialyse n'a pas ete pas frequente dans notre etude. L'usage des rincages du circuit avec du serum physiologique dans les situations a risque hemorragique eleve n'est pas efficace ; ainsi un accent particulier devrait etre accorde aux autres methodes anticoagulantes alternatives a l’heparine.ABSTRACTIntroduction. Circuit coagulation is one of the main causes of stopping hemodialysis sessions. It increases the cost, the burden of care and reduces the effectiveness of additional renal purification. Our study aimed to determine the incidence and assess the risk factors for coagulation of the hemodialysis circuit. Materials and methods. This was a single-center, cross-sectional, descriptive and analytical study; performed during one month in acute hemodialyse unit of the nephrology department of the University teaching Hospital Hassan II in Fes. The data were collected in the follow-up records of hemodialysis sessions and their analysis carried out with Excel 2007 and Epi Info 3.4 software. Results. 233 sessions were reported in our study. The coagulation of the circuit was found in 20 sessions (8.6%). The main risk factors for coagulation of the circuit (p <0.05) were: session duration greater than two hours, a blood transfusion during the session, a dysfunction of the approach. Rinses of the circuit with physiological serum were carried out in 15 sessions with a coagulated circuit (75%) because of a high risk of hemorrhage. Conclusion. Coagulation of the hemodialysis circuit was not frequent in our study. The use of rinsing the circuit with physiological serum in situations with a high risk of hemorrhage is not effective; thus special emphasis should be given to other anticoagulant methods alternative to heparin.