T. Sqalli

Pregnancy-Related Acute Kidney Injury: Experience of the Nephrology Unit at the University Hospital of Fez, Morocco

Introduction. Acute kidney injury (PRAKI) continues to be common in developing countries. The aim of this paper is to study AKI characteristics in pregnancy and identify the factors related to the unfavorable evolution. Methods. This prospective study was conducted in the University Hospital Hassan II of Fez, Morocco, from February 01, 2011 to January 31, 2012. All patients presenting PRAKI were included. Results. 37 cases of PRAKI were listed. Their ages varied from 20 to 41 years old, with an average of 29.03 ± 6.3 years and an average parity of 1.83. High blood pressure was the most common symptom (55.6%). Thirty-nine percent were oliguric. PRAKI occurred during the 3rd trimester in 66.6% of the cases and 25% of the cases in the postpartum. Hemodialysis was necessary in 16.2% of cases. The main causes were preeclampsia, hemorrhagic shocks, and functional, respectively, in 66.6%, 25%, and 8.3% of the cases. The outcome was favorable, with a complete renal function recovery for 28 patients. Poor prognosis was related to two factors: age over 38 years and advanced stage of AKI according to RIFLE classification. Conclusion. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation.

Calcinose pseudo-tumorale chez un hémodialysé chronique

Pseudotumoral calcinosis (PTC) is characterized by calcium phosphate crystal deposition in periarticular soft tissues leading to the development of large calcified masses. Although PTC physiopathogeny is not completely clear, the increase in calcium-phosphorus product beyond the threshold value for precipitation as well as severe hyperparathyroidism seem to play a determining role. PTC may even cause recurrent minor joint traumas. In patients on hemodialysis, the frequency of PTC is estimated between 0.5 and 7%, according to case series. Its treatment is controversial. Surgical resection is often recommended. We here report a case of PTC in a patient on haemodialysis. The study involved a 56-year old patient on chronic haemodialysis for 9 years due to indeterminate nephropathy. The patient had suffered from gradual worsening of pain at the level of the right hip associated with difficulties in joint mobilization over the last 6 months. CT scan showed multiple lobed calcified mass, measuring 8.6 x 7.6 x 5.9cm, located very closely to the sciatic nerve, which probably explained the very painful physical symptoms. Laboratory tests showed high phosphocalcic product and hyperparathyroidism. Surgical resection was difficult due to the closeness of the tumor to vasculo-nervous elements. Our study highlights the diagnostic and therapeutic difficulties of PTC. This uncommon disease should be suspected in patients on chronic hemodialysis with periarticular calcified mass suggesting tumor.

Kyste hydatique rénal fistulisé dans les voies urinaires chez un hémodialysé chronique

Hydatidosis is a parasitic infection caused by the larval stage of Echinococcus granulosus. Renal hydatic cyst is unusual. It may fistulize into the urinary excretory system, requiring specific management. The aim of our study was to highlight the diagnostic and therapeutic specificity of this pathology in patients on chronic hemodialysis among whom diuresis is not always preserved, in order to focus attention on hydaturia and to give an indication to diagnosis. We report the case of a 47-year old patient with a 4-year history of hemodialysis due to glomerular nephropathy detected at the final stage. Moreover, the patient had a 6-month histoiry of impaired general condition associated with right lower back pain, without fever. Abdominal CT scan showed right kidney measuring 13.4cm, with important ureteropyelocaliceal dilation, pushing the renal parenchyma associated with renal pelvis measuring 4.3cm, without detectable lithiasic obstacle. However, it showed membranous cyst at the level of the lower right renal polar parenchyma, measuring approximately 76.5 x 54 mm, contacting the renal pelvis, also containing a few membranes. The patient underwent thorough interview revealing the presence of hydaturia in the few drops of residual diuresis. Given that the patient had end stage chronic renal failure and that he was under renal replacement therapy, therapeutic approach was based on total nephrectomy.