Kaposi Sarcoma after Kidney Transplant: A Clinical Case Report

Kaposi sarcoma is a neoplasm caused by human herpesvirus 8 (HHV8) that most commonly affects immunosuppressed patients. The skin is the most affected area, but other sites can be involved such as the lung, digestive tract and lymph nodes. The classical presentation involves a violaceous skin lesion that can be small or hidden, leading to a delay in diagnosis. We report a clinical case of a kidney transplant patient, who presented, 14 months after kidney transplant, with unilateral edema of the inferior member and cutaneous rash misdiagnosed and taken initially for erysipelas. The diagnosis of Kaposi’s sarcoma was retained, on a lymph node biopsy of an inguinal adenopathy. The evolution was marked by a local and general improvement after systemic chemotherapy, reducing Tacrolimus and discontinuation of Mycophenolate mofetil. Graft function remained stable during the follow-up.

Cerebral Glioblastoma in Renal Transplant Recipient: A Case Report

Cancers is a leading cause of mortality among transplant recipients. The most common cancers are skin tumors. Glioblastoma is the most frequent brain tumor in adults aged 45 - 70 years. It accounts for 12% - 15% of all intracranial tumors. It is characterized by its rapid development and poor prognosis. We report the case of a cerebral glioblastoma in a kidney transplant recipient. Clinical case: Mr G.R, 44 years old caucasian patient who underwent kidney transplantation. Immunosuppressive treatment included cyclosporine, mycophenolate mofetil and methylprednisolone. Creatinine levels after transplantation remained stable at 11 mg/L (96.8 μmol/l) with an estimated glomerular filtration rate (eGFR) of 77 ml/min/1.73m2 after a 15 years of follow-up. A grade IV right fronto-callossal cerebral glioblastoma was diagnosed in our patient. EBV PCR was negative. Therefore, he underwent 25 sessions of radiotherapy combined with oral chemotherapy using temozolomide. One month later, the patient died due to cerebral edema with subfalcine herniation. Conclusion: This is a case of cerebral glioblastoma in a kidney transplant recipient, a population considered at risk for tumor development due to immunosuppressive treatment. This emphasizes the need for a lifelong surveillance and, more importantly a better balance between graft function preservation and the risks associated with immunosuppressants.

Echerichia coli Infection—Associated Glomerulonephritis in a Kidney Transplant Patient: A Case Report

Post infectious Glomerulonephritis (PIGN) in renal allograft is a rare entity. Only a few Cases have been described in the literature. The post streptococcal glomerulonephritis is the classic example in native kidney. A wide variety of organism has been associated with PIGN in renal allograft such as Staphylococcus, Cytomegalovirus and Polyomavirus. We describe one case of Infection associated glomerulonephritis due to Echericha Coli, developed 5 years after kidney transplantation, in 47 years old female patient. The Clinical presentation was characterized by a peripheral edema and high blood pressure, and biological tests showed a nephrotic syndrome, an acute kidney injury, a consumption of Complement fractions. The renal biopsy revealed a diffuse endocapillary cell proliferation with preponderant deposits of C3. Total recovery was achieved 4 months after Methyprednisolone pulse and Cyclophasphamid with antimicrobial treatment.

Renal Profile of Patients with Cardiorenal Syndrome: Nephrology and Cardiology Department Experience of the University Hospital IBN SINA of Rabat

Introduction: Cardio-renal syndrome (CRS) is a complex pathophysiological entity affecting the heart and kidneys in which acute or chronic dysfunction of one organ can induce acute or chronic dysfunction of the other organ. Five types of CRS have been described. Methods: The study explored the prevalence and types of Cardiorenal Syndrome (CRS) at CHU Ibn Sina in Rabat. Over a year, 120 CRS patients were assessed, excluding those with end-stage chronic renal failure. We analyzed the epidemiological, clinical, therapeutic and evolutionary profile of these patients. Results: The average age of our patients is 67.8 ± 12 years, with extremes ranging from 39 years to 92 years. The sex ratio is 1.35. The different types of CRS types (1, 2, 4 and 5) were noted respectively in 28.4%, 20.8%, 5%, 45.8%, however, we did not note patients having CRS type 3. On the renal level, we noted acute renal failure (ARF) in 51.6% of patients, of whom 61.3% had functional ARF and 38.7% presented with acute tubular necrosis. Chronic renal failure (CRF) is found in 48.4% of cases, of which 39% are at stage III and 61% are at stage IV. The etiology of CKD is dominated by hypertensive nephropathy (72.4%) followed by diabetic nephropathy (60.3%). Therapeutically diuretics are administered in 51% of our patients. We used hemodialysis in 9.1% of patients who are resistant to diuretics. Vasoactive drugs are used in 9.5% of our patients. Mortality risk factors for patients with CRS are significantly related to advanced age, long hospital stay, type 1 CRS, re-hospitalization, acute pulmonary edema (APE), use of hemodialysis, right heart failure (RHF), valvulopathy and hemodynamic instability (OR = 1.15, p = 0.01;OR = 4.5, p = 0.03;OR = 5.2, p = 0.019;p Conclusion: CRS type 5 was most common, with hypertension and diabetes being primary causes of Chronic Kidney Disease. Mortality factors were linked to acute pulmonary edema, hemodialysis, right heart failure, valvulopathy, and re-hospitalization.

Tuberculosis of Exceptional Location in a Haemodialysis Patient

Background: Chronic haemodialysis patients present a lack of immunity responsible for a high incidence of tuberculosis of atypical and non-pulmonary localizations. Observation: We present a clinical case of a haemodialysis patient that presents an isolated localisation of prostate tuberculosis. He had no clinical signs but had laboratory findings of inflammatory syndrome and high Prostatic Antigen (PSA) level. The diagnosis was made by histopathologic study of the piece of prostatectomy. The patient received a six-month treatment with an initial two-month phase involving four anti-tuberculosis drugs (Rifampicin, Isoniazid, Ethambutol and Pyrazinamid) followed by a four-month maintenance phase involving two drugs (Isoniazid and Rifampicin). All drugs were adapted to his dialysis condition. We noticed no side effects of drugs. Conclusion: Clinical signs of prostatic tuberculosis are not specific, mainly made of an obstructive symptom. The diagnosis of prostatic tuberculosis is based on a bundle of clinical and biological arguments. Koch Bacilli (KB) can rarely be found in urine or sperm. In haemodialysis patient, it can be masked by non specific aspect of inflammatory syndrome. The management must be adjusted and a close following up of side effects is necessary.