- Email: [email protected]
Control of hypertension during postpartum acute renal failure
09 - Kidney booklet on kidney transplantation, brochures on drug interactions, explanatory images and interactive maps. We organized information meetings to sensitize patients. This educational program has been appreciated by patients. A future evaluation of its impact on knowledge and observance is required. This ETP implemented in our service represents a considerable step forward in the management of kidney transplant patients. However, a well-structured program, led by a multidisciplinary team, must be implemented for ensuring the effectiveness and safety of treatment. Disclosure of interest The author declares that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.090
Work medicine and high blood pressure Sonia Karma 1,∗ , Mohamed Khalil Boussema 2 , Lilia Lamouchi 3 , Sonia Slaoui 5 , Fatma Boussema 4 1 Samu O1, Tunis, Tunisia 2 Center Of Traumatology And Major Burns, Ben Arous, Tunis, Tunisia 3 Regional Hospital Of Kheredine, Tunis, Tunisia 4 Hospital Habib Thameur, Tunis, Tunisia 5 Tunis, Tunisia ∗ Corresponding author. The etiological diagnosis of hypertension is rare. The purpose of the study is to think of a key body and a treatable etiology, especially in connection with a toxic renal damage; and this; following exposure in the workplace. Material and methods Thirteen young workers in contact with lead in its different forms and have headaches, dizziness, a buzz of ears, abdominal colic, an asthenia, constipation, pale, hematuria, the polynevrites.. That same worker got a visit of hiring and is controlled on a regular basis, knowing that any other cause of HTA has been sought and eliminated. Results Thirteen 3 workers of average age of 37 years (from 28 to 48 years); 6 are welders (contact aves lead); 3 are the mechanics (in contact with the metal); 2 work in electric electric cable manufacturing industries; 2 in factories manufacturing dental amalgams (in lead-based). The average duration of work and exposure is 8 H/day during 5-7 years. The signs leading to consult are urinary, digestive, neuro sensory signs, or general signs. Clinical examination shows: blood pressure numbers in lying and standing and two arms. The requested additional tests came back normal: the research of toxic has been requested; blood center high and in 9 cases, cadminemie and cadmiurie high in 2 case, other investigations: a renal ultrasound, a scanner and a review by magnetic nuclear resonance, finally a kidney biopsy has made in 7 cases which showed lesions tubulo-interstitial and glomerular with presence of gold in the cells of the proximal convoluted tube. Hospitalization was necessary in all cases, a support with a distance from the workplace and chelators were given. Conclusion The role of the doctor absolutely fundamental in the diagnosis and prevention of these arterial hypertensions of toxic origin. Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.091
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Diabetic nephropathy: Clinical aspects and risk factors Ramla Mizouri ∗ , Hajer Zahra , Imen Sebai , Marwa Khiari , Fatma Boukhayatia , Khadija Ben Naceur , Yousra Hatira , Aroua Temssek , Faika Ben Mami National Institute of Nutrition of Tunis, Service A, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (R. Mizouri) Introduction Diabetic nephropathy is a serious complication and a turning point in diabetics. The aim of this work was to study the prevalence of diabetic nephropathy and the factors influencing its occurrence in diabetics. Methods Our descriptive and analytical study was conducted in 80 diabetic patients hospitalized in our department. Patients benefited from careful clinical examination, standard biological assessments and a diabetic impact assessment. Results We included 80 patients with type 2 diabetes. The mean age was 58.12 ± 9.2 years, the duration of diabetes progression was 10 ± 6.4 years, HbA1c = 10.9 ± 3.09%. Sixty-eight % of the patients had social coverage was noted. Non-compliance with treatment was reported in 38.6% of patients. Diabetes was complicated by nephropathy and retinopathy in 32% and 39% of patients, respectively. At the discovery of nephropathy, the age was 51.6 ± 7 years. Initially, the stage of this diabetic nephropathy was represented by micro albuminuria (32% of cases), proteinuria (21%) and moderate renal insufficiency (19%). Hypertension was present in 53% of the patients, 42% of whom were uncontrolled. The analytical study evidenced a positive association between the presence of nephropathy and the following factors: age, duration of diabetes and poor blood pressure control. Conclusion We emphasize the importance of early detection of diabetic nephropathy at the stage of microalbuminuria in order to introduce nephron-protective treatment aiming to reduce progression to renal failure. Disclosure of interest The author have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.092
Control of hypertension during postpartum acute renal failure Ferielle Saada Department of nephrology, CHU Saadna Abdennour, Sétif, Algeria E-mail address: [email protected] Background Arterial hypertension (HT) is a major health problem in Algeria due to its high frequency, delayed diagnosis and multiple maternal-fetal complications. Associated with HT during post-partum (PP), the acute kidney failure (AKF) is the leading cause of morbidity and mortality. Purpose We aimed: — to determine the incidence of AKF associated with severe high blood pressure during post-partum; — to identify factors favoring the occurrence of pregnancy-related HT and 3/to establish the etiologies of AKF. Methods Our retrospective study included 48 patients during post-partum presenting HT and AKF, admitted in the department of nephrology from January 2013 to December 2016. Results In our hospital, 13000 deliveries and 2500 caesarean sections are performed every year; average patients’ age: 30.1; 71% of patients were multiparous. The incidence of AKF was 0.74‰ of deliveries (one AKF/1343), 41% had a pregnancy medical followup. HT occurred in 87% of cases. The creatinin level was > 35 mg/L in 45% of cases. Etiologies: HELLP syndrome (20 cases), acute tubular necrosis (16 cases), cortical necrosis (2 cases). Triple antihypertensive therapy was taken by 14 patients, 43% had dialysis, 13
e370 patients recovered normal kidney function in less than 10 days and 3 patients remained on chronic dialysis. Discussion AKF complicates 1 delivery/1300; it needs dialysis in 1case/8000; these percentages are higher than those reported in the literature (1 AKF/4000 deliveries and hemodialysis for 1/15000 patients). HELLP syndrome is the most common cause of pregnancyrelated AKF (41.6%), occurring before 38 amenorrhea weeks (AW). Acute tubular necrosis is the second cause, it occurs after 38 AW, is secondary to bleeding, infectious complications and nephrotoxic drugs; HT is volume dependent and requires dialysis. Favoring factors are multiple pregnancies, increased maternal age, obesity and long delay of care of pregnancy toxemia because of lack of regular monitoring. Conclusion HT associated with post-partum AKF is relatively frequent, secondary to HELLP syndrome and tubular necrosis. The prognosis depends on the early diagnosis and treatment and on the preventive measures during the pregnancy (self-measurement of blood pressure monitoring or ambulatory measurement of blood pressure, screening for proteinuria and uric acid analysis). Disclosure of interest The author declares that she has no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.093
Hypertension of the old subject followed in nephrology R. Sari-Hamidou , Badia Saidi , Anissa Kameche , Ikram Basaid , Mustapha Benmansour We aimed: — to determine the frequency of high blood pressure in the elderly at different stages of chronic renal failure and;
09 - Kidney — to evaluate the antihypertensive therapeutic treatment in a nephrology environment. Patients and methods The patients were recruited in the consultation of nephrology; we included hypertensive subject aged of more than 65 years old followed by nephrologists. 292 patients were included: 53% women and 47% men, with an average age of 76.52 ± 6.45 years [66-97]. The average duration of the follow-up was 1.69 ± 0.94 years [1—5]. The duration of arterial hypertension was more than 10 years in 55% of cases. The patients were at different stages of renal failure: chronic incipient, chronic renal failure 4%, moderate 54% and severe to terminal renal failure 42%. Results Several pathologies were associated with arterial hypertension, namely: 50.3% of patients were diabetic, 39.2% had a cardiovascular pathology (22% AC/FA, 16% valve pathology, 31% heart failure, 31% IDM% sequels), 36% of patients had dyslipidemia and 25% had neoplasia. Antihypertensive quadritherapy was needed in 4% of cases, triple therapy in 22% of cases, dual therapy in 50% and single therapy in 24% of patients. The diuretics of the loop represents the most prescribed therapeutic class (63%), followed by blockers of the renin angiotensin system (47.5%), calcium channel blockers (24%), while the beta-blockers (23%) were often prescribed by the cardiologist. Conclusion Older patients with renal pathology are often hypertensive. Hypertensive therapeutic management must be adequate to slowdown the progression of chronic renal failure as well as the worsening of other associated pathologies. Disclosure of interest The authors declare that they have no competing of interest. https://doi.org/10.1016/j.acvdsp.2019.05.094
Work medicine and high blood pressure Sonia Karma 1,∗ , Mohamed Khalil Boussema 2 , Lilia Lamouchi 3 , Sonia Slaoui 5 , Fatma Boussema 4 1 Samu O1, Tunis, Tunisia 2 Center Of Traumatology And Major Burns, Ben Arous, Tunis, Tunisia 3 Regional Hospital Of Kheredine, Tunis, Tunisia 4 Hospital Habib Thameur, Tunis, Tunisia 5 Tunis, Tunisia ∗ Corresponding author. The etiological diagnosis of hypertension is rare. The purpose of the study is to think of a key body and a treatable etiology, especially in connection with a toxic renal damage; and this; following exposure in the workplace. Material and methods Thirteen young workers in contact with lead in its different forms and have headaches, dizziness, a buzz of ears, abdominal colic, an asthenia, constipation, pale, hematuria, the polynevrites.. That same worker got a visit of hiring and is controlled on a regular basis, knowing that any other cause of HTA has been sought and eliminated. Results Thirteen 3 workers of average age of 37 years (from 28 to 48 years); 6 are welders (contact aves lead); 3 are the mechanics (in contact with the metal); 2 work in electric electric cable manufacturing industries; 2 in factories manufacturing dental amalgams (in lead-based). The average duration of work and exposure is 8 H/day during 5-7 years. The signs leading to consult are urinary, digestive, neuro sensory signs, or general signs. Clinical examination shows: blood pressure numbers in lying and standing and two arms. The requested additional tests came back normal: the research of toxic has been requested; blood center high and in 9 cases, cadminemie and cadmiurie high in 2 case, other investigations: a renal ultrasound, a scanner and a review by magnetic nuclear resonance, finally a kidney biopsy has made in 7 cases which showed lesions tubulo-interstitial and glomerular with presence of gold in the cells of the proximal convoluted tube. Hospitalization was necessary in all cases, a support with a distance from the workplace and chelators were given. Conclusion The role of the doctor absolutely fundamental in the diagnosis and prevention of these arterial hypertensions of toxic origin. Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.091
e369
Diabetic nephropathy: Clinical aspects and risk factors Ramla Mizouri ∗ , Hajer Zahra , Imen Sebai , Marwa Khiari , Fatma Boukhayatia , Khadija Ben Naceur , Yousra Hatira , Aroua Temssek , Faika Ben Mami National Institute of Nutrition of Tunis, Service A, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (R. Mizouri) Introduction Diabetic nephropathy is a serious complication and a turning point in diabetics. The aim of this work was to study the prevalence of diabetic nephropathy and the factors influencing its occurrence in diabetics. Methods Our descriptive and analytical study was conducted in 80 diabetic patients hospitalized in our department. Patients benefited from careful clinical examination, standard biological assessments and a diabetic impact assessment. Results We included 80 patients with type 2 diabetes. The mean age was 58.12 ± 9.2 years, the duration of diabetes progression was 10 ± 6.4 years, HbA1c = 10.9 ± 3.09%. Sixty-eight % of the patients had social coverage was noted. Non-compliance with treatment was reported in 38.6% of patients. Diabetes was complicated by nephropathy and retinopathy in 32% and 39% of patients, respectively. At the discovery of nephropathy, the age was 51.6 ± 7 years. Initially, the stage of this diabetic nephropathy was represented by micro albuminuria (32% of cases), proteinuria (21%) and moderate renal insufficiency (19%). Hypertension was present in 53% of the patients, 42% of whom were uncontrolled. The analytical study evidenced a positive association between the presence of nephropathy and the following factors: age, duration of diabetes and poor blood pressure control. Conclusion We emphasize the importance of early detection of diabetic nephropathy at the stage of microalbuminuria in order to introduce nephron-protective treatment aiming to reduce progression to renal failure. Disclosure of interest The author have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.092
Control of hypertension during postpartum acute renal failure Ferielle Saada Department of nephrology, CHU Saadna Abdennour, Sétif, Algeria E-mail address: [email protected] Background Arterial hypertension (HT) is a major health problem in Algeria due to its high frequency, delayed diagnosis and multiple maternal-fetal complications. Associated with HT during post-partum (PP), the acute kidney failure (AKF) is the leading cause of morbidity and mortality. Purpose We aimed: — to determine the incidence of AKF associated with severe high blood pressure during post-partum; — to identify factors favoring the occurrence of pregnancy-related HT and 3/to establish the etiologies of AKF. Methods Our retrospective study included 48 patients during post-partum presenting HT and AKF, admitted in the department of nephrology from January 2013 to December 2016. Results In our hospital, 13000 deliveries and 2500 caesarean sections are performed every year; average patients’ age: 30.1; 71% of patients were multiparous. The incidence of AKF was 0.74‰ of deliveries (one AKF/1343), 41% had a pregnancy medical followup. HT occurred in 87% of cases. The creatinin level was > 35 mg/L in 45% of cases. Etiologies: HELLP syndrome (20 cases), acute tubular necrosis (16 cases), cortical necrosis (2 cases). Triple antihypertensive therapy was taken by 14 patients, 43% had dialysis, 13
e370 patients recovered normal kidney function in less than 10 days and 3 patients remained on chronic dialysis. Discussion AKF complicates 1 delivery/1300; it needs dialysis in 1case/8000; these percentages are higher than those reported in the literature (1 AKF/4000 deliveries and hemodialysis for 1/15000 patients). HELLP syndrome is the most common cause of pregnancyrelated AKF (41.6%), occurring before 38 amenorrhea weeks (AW). Acute tubular necrosis is the second cause, it occurs after 38 AW, is secondary to bleeding, infectious complications and nephrotoxic drugs; HT is volume dependent and requires dialysis. Favoring factors are multiple pregnancies, increased maternal age, obesity and long delay of care of pregnancy toxemia because of lack of regular monitoring. Conclusion HT associated with post-partum AKF is relatively frequent, secondary to HELLP syndrome and tubular necrosis. The prognosis depends on the early diagnosis and treatment and on the preventive measures during the pregnancy (self-measurement of blood pressure monitoring or ambulatory measurement of blood pressure, screening for proteinuria and uric acid analysis). Disclosure of interest The author declares that she has no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.093
Hypertension of the old subject followed in nephrology R. Sari-Hamidou , Badia Saidi , Anissa Kameche , Ikram Basaid , Mustapha Benmansour We aimed: — to determine the frequency of high blood pressure in the elderly at different stages of chronic renal failure and;
09 - Kidney — to evaluate the antihypertensive therapeutic treatment in a nephrology environment. Patients and methods The patients were recruited in the consultation of nephrology; we included hypertensive subject aged of more than 65 years old followed by nephrologists. 292 patients were included: 53% women and 47% men, with an average age of 76.52 ± 6.45 years [66-97]. The average duration of the follow-up was 1.69 ± 0.94 years [1—5]. The duration of arterial hypertension was more than 10 years in 55% of cases. The patients were at different stages of renal failure: chronic incipient, chronic renal failure 4%, moderate 54% and severe to terminal renal failure 42%. Results Several pathologies were associated with arterial hypertension, namely: 50.3% of patients were diabetic, 39.2% had a cardiovascular pathology (22% AC/FA, 16% valve pathology, 31% heart failure, 31% IDM% sequels), 36% of patients had dyslipidemia and 25% had neoplasia. Antihypertensive quadritherapy was needed in 4% of cases, triple therapy in 22% of cases, dual therapy in 50% and single therapy in 24% of patients. The diuretics of the loop represents the most prescribed therapeutic class (63%), followed by blockers of the renin angiotensin system (47.5%), calcium channel blockers (24%), while the beta-blockers (23%) were often prescribed by the cardiologist. Conclusion Older patients with renal pathology are often hypertensive. Hypertensive therapeutic management must be adequate to slowdown the progression of chronic renal failure as well as the worsening of other associated pathologies. Disclosure of interest The authors declare that they have no competing of interest. https://doi.org/10.1016/j.acvdsp.2019.05.094