Zouhir Oualim

A model to predict optimal dialysate flow.

Diffusive clearance depends on blood (Qb) and dialysate flow (Qd) rates and the overall mass transfer area coefficient (KoA) of the dialyzer. In this article we describe a model to predict an appropriated AutoFlow (AF) factor (AF factor = Ratio Qd/Qb), that is able to provide adequate Kt/V for hemodialysis patients (HDP), while consuming lower amounts of dialysate, water and energy during the treatment. We studied in vivo the effects of three various Qd on the delivered dose of dialysis in 33 stable HDP. Hemodialysis was performed at Qd of 700 mL/mn, 500 mL/mn, and with AF, whereas specific dialysis prescriptions (treatment time, blood flow rate [Qb], and type and size of dialyzer) were kept constant. The results showed that increasing the dialysate flow rate more than the model of AF predicted had a small effect on the delivered dose of dialysis. The Kt/V (mean ± SD) was 1.52 ± 0.16 at Qd 700, 1.50 ± 0.16 at Qd 500, and 1.49 ± 0.15 with AF. The use of the AF function leads to a significant saving of dialysate fluid. The model predicts the appropriate AF factor that automatically adjusts the dialysate flow rate according to the effective blood flow rate of the patient to achieve an appreciable increase in dialysis dose at the lowest additional cost.

Mycophenolate Mofetil Associated with Progressive Multifocal Leukoencephalopathy with Successful Outcome

The use of mycophenolate mofetil (MMF) is known to be associated with progressive multifocal leukoencephalopathy (PML). We report a case of PML in a patient receiving MMF, who showed improvement upon discontinuation of the drug. He was restarted on MMF, following which he went into coma. He showed prompt recovery upon stopping the drug again and made full recovery without any residual neurological deficit. This case is being reported to further highlight this neurological side-effect of MMF.

The Kt/V by ionic dialysance: Interpretation limits.

The availability of hemodialysis machines equipped with online clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume (V) is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods. A total of 35 patients were studied. Ionic dialysance was measured by conductivity monitoring. The second-generation Daugirdas formula was used to calculate the Kt/V single-pool (Kt/VD). Values of V to allow comparison between OCM and blood-based Kt/V were determined using Watson formula (VWa), bioimpedance spectroscopy (Vimp), and blood-based kinetic data (Vukm). Comparison of Kt/Vw ocm calculated by the ionic dialysance and Vw (Kt/Vw ocm) with Kt/VD shows that using VW leads to significant systematic underestimation of dialysis dose by 24%. Better agreement between Kt/V ocm and Kt/VD was observed when using Vimp and Vukm. Bio-impedancemetry and the indirect method using the second-generation Daugirdas equation are two methods of clinical interest for estimating V to ensure greater agreement between OCM and blood-based Kt/V.

Insuffisance rénale aiguë révélant une hypothyroïdie auto-immune

Although the clinic picture is often indicative of muscle manifestations in patients with hypothyroidism, signs and symptoms of this condition are variable from simple elevation of serum muscle enzymes with myalgia, muscle weakness, cramps to rhabdomyolysis with acute renal failure which remains a rare event. Thyroid hormones affect the function of almost every body organ, and thyroid dysfunction produces a wide range of metabolic disturbances. Hypothyroidism is associated with significant effects on the kidney which the pathophysiology seems to be multifactorial, but the exact mechanisms remain poorly understood. Hypothyroidism as a cause of renal impairment is usually overlooked, leading to unnecessary diagnostic procedures. The main objective of our observation is to report a case of acute renal failure revealing an autoimmune hypothyroidism in which thyroid hormone substitution led to a significant improvement in muscular, thyroid and renal disorders.

Bisalbuminemia during remission of nephrotic syndrome.

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome.

Assessment of dialysis adequacy guidelines implementation in a developing country.

Dialysis adequacy has been shown to have a significant impact on patient survival, but there are few data concerning the adequacy of the delivered hemodialysis dose in developing countries. To describe the level of implementation of dialysis practice guidelines in a dialysis center in Morocco, we retrospectively reviewed our 1-year experience of managing chronic hemodialysis patients (CHP), from May 2009 to May 2010. Demographic and biochemical data were collected, and the percentage of patients achieving targets recommended by the NKF-KDOQI guidelines were calculated. Our data suggests that dialysis units in a developing country can achieve current guidelines targets for dialysis adequacy, however, our results are not generalizable to all dialysis centers in Morocco.

Pyélonéphrite emphysémateuse sur rein unique : revue de la littérature à propos d’un cas

INTRODUCTION Emphysematous pyelonephritis is a rare and severe form of acute pyelonephritis. It is defined as the presence of gas-producing bacteria in the kidney and in peri-nepheretic areas. We report a case of emphysematous pyelonephritis on a single kidney associated with urolithiasis. OBSERVATION A 44-year-old woman, with a history of diabetes and chronic renal failure, presented with left renal colic, anuria, fever and worsening of general state. The diagnosis of emphysematous pyelonephritis was confirmed by CT scan. The treatment was based on antibiotheray, adapted to the renal function, insulinotherapy and urine drainage by a double J stent. The evolution was favourable. DISCUSSION Emphysematous pyelonephritis is an uncommon infection, generally affecting female diabetic patients. CT scan is mandatory to confirm diagnosis. CONCLUSION Even if it is rare, emphysematous pyelonephritis is associated with a high mortality in the absence of a rapid and effective treatment.

L’insomnie chez l’hémodialysé chronique : prévalence et facteurs de risque

éale. Tous ces patients ont eu une échographie cervicale associée un dosage des hormones thyroïdiennes. ésultats.– Cinquante-quatre patients étaient inclus dont 1 femmes (57,4 %) et 23 hommes (42,6). L’âge moyen était e 43 ± 12 ans et l’ancienneté moyenne en dialyse était de 40 ± 48 mois. L’échographie cervicale était normale chez 1 patients (38,9 %), alors qu’elle a révélé un goitre hétéro-multi odulaire chez 5 femmes (9,25 %), des nodules thyroïdiens isoéhogène chez 4 patients (7,4 %) et hypoéchogène chez 7 patients 13 %), des micronodules chez 3 patients (5,55 %), et des images ystiques hétérogènes chez 9 patients (16,6 %). Les calcifications hyroïdiennes sont présentes chez 5 patients (9,3 %) et un nodule arathyroïdien chez une seule femme. Sur le plan hormonal, tous es dialysés étaient en euthyroïdie. iscussion.– Le goitre est plus observé chez les hémodialysés chroiques (50 %), et surtout si la durée de dialyse est supérieure à un n. onclusion.– Chez le dialysé, il existe une forte prévalence des anoalies morphologiques de la thyroïde qui peuvent être identifiées acilement par l’échographie.

Profil lipidique dans l’insuffisance rénale chronique au stade d’hémodialyse : étude marocaine

Introduction : le metabolisme des lipoproteines chez les hemodialyses chroniques est perturbe. Les anomalies lipidiques qui en decoulent sont fortement atherogenes et constituent, entre autres, un des facteurs de l’atherosclerose acceleree et de la maladie cardiovasculaire. Objectif : etudier les variations quantitatives des parametres lipidiques chez les hemodialyses chroniques suivis dans une structure hospitaliere marocaine. Population d’etude et methode : nous avons compare les parametres lipidiques entre un groupe de 30 hemodialyses chroniques de notre centre et un groupe de 30 sujets temoins. Les parametres etudies ont ete : les triglycerides (TG), le cholesterol total (CT), le cholesterol des lipoproteines de faible densite (C-LDL), le cholesterol des lipoproteines de haute densite (C-HDL) et l’index d’atherogenicite (IA = CT/C-HDL). Resultats : nous avons constate une augmentation significative des triglycerides seriques (TG) chez le groupe des hemodialyses par rapport au groupe temoin. Concernant le metabolisme du cholesterol, l’anomalie la plus significative a ete une diminution du taux du cholesterol des lipoproteines de haute densite (C-HDL). L’index d’atherogenicite (IA) etait significativement plus eleve. Le cholesterol total et le cholesterol des lipoproteines de faible densite (C-LDL) n’ont pas montre d’augmentation significative. Dans le groupe des hemodialyses, la prevalence de la dyslipidemie etait elevee (80 %). L’alteration la plus frequente etait la diminution du C-HDL (70 %), l’elevation des TG (33,3 %) et l’elevation du C-LDL (23,3%) ; dans la moitie des cas il y avait une alteration de deux a trois parametres lipidiques. L’IA etait eleve (≥ 5) dans 33,3 % des cas. Conclusion : la prevalence de la dyslipidemie est elevee chez les hemodialyses chroniques, les anomalies les plus caracteristiques sont l’elevation des triglycerides et la baisse du cholesterol des lipoproteines de haute densite. Afin d’instaurer une strategie de prevention du risque cardiovasculaire, l’amelioration de ces anomalies lipidiques doit etre stricte chez les hemodialyses chroniques.