Journal de néphrologie et thérapeutique

Introduction: This study was conducted to look for clinico-histological correlation during lupus nephritis.
Patients and method: It was a retrospective and analytical study, conducted over a period of 10 years from 01 January 2007 to 31 December 2016 in the nephrology department of Aristide Le Dantec Hospital in Dakar. Histological parameters were crossed over with demographic, clinical and biological data to search for clinico-biological and histological correlation.
Results: In a total of 93 black patients with lupus, 64 were included, giving a hospital prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men with a sex ratio of 0.23. The existence of hypertension and renal failure was correlated with the presence of a proliferative
class. Interstitial fibrosis was correlated with renal failure. A statistically significant correlation was found between the presence of interstitial infiltration and the existence of renal failure and leukocyturia. Fibrous endarteritis was correlated with renal failure and hypertension. Arteriosclerosis was associated with hypertension.
Conclusion: Proliferative classes, interstitial fibrosis, interstitial infiltration and chronic vascular lesions were correlated with severe clinico-biological manifestations. Multicentric studies are needed to support these results.

Background: Chronic kidney disease (CKD) is characterized by unfavorable cardiac and vascular remodeling. The study aimed at evaluating effects of 6-month supplementation with omega-3 on blood pressure, left ventricular geometry and function, and arterial properties in patients with CKD 1-3.

Methods: Six-month supplementation with omega-3 acids (2 g/day) was completed in 87 CKD patients, and in 27 individuals without CKD, hypertension or overt cardiovascular disease. At baseline and after supplementation, an echocardiographic examination was performed, evaluating left ventricular mass index (LVMI), left ventricular relative wall thickness (RWT), and ejection fraction (EF). Ultrasound imaging of the common carotid artery with intima media thickness (IMT), aortic pulse wave velocity measurement (PWV) and 24-hour blood pressure monitoring (ABPM) were performed. Serum concentration of omega-3 acids: eicosapentaenoic (EPA), docosahexaenoic (DHA), and alpha linolenic (ALA) was determined using gas chromatography.

Results: After six-month omega-3 supplementation, ALA concentration increased in CKD patients and in reference group, while EPA and DHA did not change. PWV and IMT values did not change significantly. Posterior wall thickness (PWd) (p=0.018) and RWT decreased (p=0.035), while LVMI and EF did not change in CKD group. ABPM did not change.

Conclusion: Supplementation with omega-3 acid resulted in beneficial left ventricular remodeling, despite the absence of changes in ABPM and arterial properties.

Trial registration: The study was registered in Clinical Trials.gov. Identifier: NCT 02147002.

Keto acids is widely used in dialysis patients with end-stage renal disease, which can effectively correct hypocalcemia, reduce blood PTH as well as blood phosphorus, and elevate blood albumin. Keto acids have a very low incidence of side effects. So far, no cases of Keto acids-induced severe hypercalcemia had been reported. The authors here present a case of continuous ambulatory peritoneal dialysis (CAPD) patient who repeatedly developed severe hypercalcemia accompanied by consciousness disturbance due to daily low-dose keto acids administration. In this case, common causes of hypercalcemia were excluded by thorough physical examination and investigations. The blood calcium concentration of this patient had reached 3.83 mmol/L, belonging to severe hypercalcemia, and the clinical manifestations of cognitive disorder required urgent treatment. After the suspension of keto acids, the serum calcium concentration returned to normal, and the peritoneal dialysis scheme resumed as normal after discharge, which could still maintain the normal calcium concentration. When the patient took the medicine again, severe hypercalcemia occurred as expected. After drug withdrawal, blood calcium backed to normal level, and blood phosphorus increased, which further confirmed that calcium and phosphorus metabolism disorder was closely related to the use of keto acids. This case here indicate that close monitoring of blood calcium, phosphorus and other indicators are needed, in order to prevent potential risk of hypercalcemia which would endanger the safety of patient's life.