Introduction: Glomerular damage during Gougerot-Sjgren syndrome is much rarer than interstitial damage, and is essentially extra-membranous and membrano-proliferative glomerulonephritis. Observation: We report the cas...Introduction: Glomerular damage during Gougerot-Sjgren syndrome is much rarer than interstitial damage, and is essentially extra-membranous and membrano-proliferative glomerulonephritis. Observation: We report the case of a 44-year-old woman with primary Sjgrens syndrome, confirmed by clinical dryness syndrome, positive anti-SSA and anti-SSB antibodies, and a salivary gland biopsy revealing grade 4 lymphocytic sialadenitis according to CHISHOLMs classification. Later, the patient developed nephrotic syndrome, along with hypertension. Renal function remained normal with a creatinine level of 9.3 mg/l, and hematuria was absent. Only antinuclear antibodies tested positive, while anti-PLA2R antibodies were negative. A renal biopsy was performed, which was complicated on the same day by hemodynamic instability with hematuria. Renal CT scan with contrast injection revealed a posterior perirenal hematoma without contrast extravasation. Additionally, bilateral renal vein thrombosis was incidentally discovered, suggesting extramembranous glomerulonephritis. The patients hemodynamic status stabilized after fluid resuscitation with isotonic saline solution (0.9%), without the need for blood transfusion. Renal biopsy confirmed extramembranous glomerulonephritis with interstitial fibrosis and minimal tubular atrophy. The initial etiological assessment was negative. The patient was started on oral corticosteroids, angiotensin-converting enzyme inhibitors, and therapeutic anticoagulation for renal vein thrombosis. The patients condition improved, with the disappearance of the syndrome and spontaneous regression of the hematoma. Discussion: The association of nephrotic syndrome and renal vein thrombosis primarily suggests glomerulopathy, in particular extra-membranous glomerulonephritis. Sjgrens syndrome can be associated with extra-membranous glomerulonephritis without being its direct cause. Like, it is possible that it is a cause of glomerulonephritis, essentially extra membranous and membrano-proliferative. Conclusion: Sjgrens syndrome is generally underestimated cause of glomerulonephritis, which should be considered in cases of extra-membranous glomerulonephritis.展开更多
Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are ...Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.展开更多
Introduction: Infective endocarditis (IE) is a complication associated with high mortality in chronic hemodialysis patients. The aim of our study is to describe the clinical, radiological, microbiological characterist...Introduction: Infective endocarditis (IE) is a complication associated with high mortality in chronic hemodialysis patients. The aim of our study is to describe the clinical, radiological, microbiological characteristics, and risk factors of mortality in hemodialysis patients with infective endocarditis. Methods: A retrospective study from November 2019 to November 2021 including hemodialysis patients with IE hospitalized in Ibn Sina hospital center in Rabat. Results: Eighteen hemodialysis patients were included. Mean age was 49.5 ± 18 years, sex ratio was 0.8. Catheters were the access sites most commonly used (72.3%). Median duration of hemodialysis was 12 [6;24] months. Staphylococcus species is major causative bacteria in 60%. The mitral valve was the most commonly affected (44%). Frequent complications including valve insufficiency (50%), septic embolism (66.7%). Four patients underwent surgery and eight died during hospitalization (44.5%). Mitral localization of vegetation was the only factor significantly associated with mortality in our study (P Conclusion: The catheter was the most commonly used access site compared to the arteriovenous fistula. This confirms that it’s the vascular access of choice for his low rate of infectious complication compared to the catheter.展开更多
文摘Introduction: Glomerular damage during Gougerot-Sjgren syndrome is much rarer than interstitial damage, and is essentially extra-membranous and membrano-proliferative glomerulonephritis. Observation: We report the case of a 44-year-old woman with primary Sjgrens syndrome, confirmed by clinical dryness syndrome, positive anti-SSA and anti-SSB antibodies, and a salivary gland biopsy revealing grade 4 lymphocytic sialadenitis according to CHISHOLMs classification. Later, the patient developed nephrotic syndrome, along with hypertension. Renal function remained normal with a creatinine level of 9.3 mg/l, and hematuria was absent. Only antinuclear antibodies tested positive, while anti-PLA2R antibodies were negative. A renal biopsy was performed, which was complicated on the same day by hemodynamic instability with hematuria. Renal CT scan with contrast injection revealed a posterior perirenal hematoma without contrast extravasation. Additionally, bilateral renal vein thrombosis was incidentally discovered, suggesting extramembranous glomerulonephritis. The patients hemodynamic status stabilized after fluid resuscitation with isotonic saline solution (0.9%), without the need for blood transfusion. Renal biopsy confirmed extramembranous glomerulonephritis with interstitial fibrosis and minimal tubular atrophy. The initial etiological assessment was negative. The patient was started on oral corticosteroids, angiotensin-converting enzyme inhibitors, and therapeutic anticoagulation for renal vein thrombosis. The patients condition improved, with the disappearance of the syndrome and spontaneous regression of the hematoma. Discussion: The association of nephrotic syndrome and renal vein thrombosis primarily suggests glomerulopathy, in particular extra-membranous glomerulonephritis. Sjgrens syndrome can be associated with extra-membranous glomerulonephritis without being its direct cause. Like, it is possible that it is a cause of glomerulonephritis, essentially extra membranous and membrano-proliferative. Conclusion: Sjgrens syndrome is generally underestimated cause of glomerulonephritis, which should be considered in cases of extra-membranous glomerulonephritis.
文摘Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.
文摘Introduction: Infective endocarditis (IE) is a complication associated with high mortality in chronic hemodialysis patients. The aim of our study is to describe the clinical, radiological, microbiological characteristics, and risk factors of mortality in hemodialysis patients with infective endocarditis. Methods: A retrospective study from November 2019 to November 2021 including hemodialysis patients with IE hospitalized in Ibn Sina hospital center in Rabat. Results: Eighteen hemodialysis patients were included. Mean age was 49.5 ± 18 years, sex ratio was 0.8. Catheters were the access sites most commonly used (72.3%). Median duration of hemodialysis was 12 [6;24] months. Staphylococcus species is major causative bacteria in 60%. The mitral valve was the most commonly affected (44%). Frequent complications including valve insufficiency (50%), septic embolism (66.7%). Four patients underwent surgery and eight died during hospitalization (44.5%). Mitral localization of vegetation was the only factor significantly associated with mortality in our study (P Conclusion: The catheter was the most commonly used access site compared to the arteriovenous fistula. This confirms that it’s the vascular access of choice for his low rate of infectious complication compared to the catheter.
