Le lénalidomide est un médicament immunomodulateur très souvent utilisé dans le traitement du myélome multiple. Plusieurs cas de néphrotoxicité ont été rapportés, mais peu ont été documentés ...histologiquement.
Nous rapportons un cas de néphrite interstitielle aiguë au lénalidomide chez un patient âgé de 62 ans atteint de myélome multiple, après l’administration de la seconde cure de chimiothérapie selon le protocole associant bortézomib, lénalidomide et déxaméthasone. L’évolution a été rapidement favorable après l’arrêt du lénalidomide et l’introduction d’une corticothérapie.
Le lénalidomide peut être responsable de néphrite interstitielle aiguë. Devant une insuffisance rénale aiguë au cours du traitement du myélome multiple, la néphrotoxicité des agents thérapeutiques doit également être évoquée en plus des causes d’atteintes rénales classiques. La chronologie des faits et les données histologiques sont essentielles et guident la prise en charge spécifique.
Lenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically.
We report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy.
Lenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management.
Context and objective. Malignant hypertension (MHT) is rare in developed countries, but remains a public health problem in sub-Saharan Africa. The aim of this study was to describe the ...epidemiological profile and prognostic factors of MHT in Kayes Hospital.
Methods. A retrospective study was conducted using the medical records of patients admitted at the Nephrology Unit of the Fousseyni Daou Hospital in Kayes between January 1, 2016 and June 30, 2022. Hypertensive or normotensive patients under treatment with stage II or III (according to the Kirkendall classification) hypertensive retinopathy (HR) associated with one or more other visceral impairments and having a complete medical file were included in the study.
Results. A total of 117 cases of MHT were collected out of 7011 files reviewed, 53.8% of which were men (63 cases). The mean age was 39.47 years. The mean admission blood pressure was 187/114 mmHg. HR was stage II and III in 59.8% and 40.2% of cases respectively. Renal failure was found in 93.1% of the patients (109 cases) of which 63.7% were chronic kidney disease (CDK) versus 36.7% acute kidney injury. Left ventricular hypertrophy was found in 80.4% of cases. The overall outcome of the patients was favourable in 59% (69 cases) versus 31.6% (37 cases) of death and 9.4% (11 cases) of discharge against medical advice. Factors associated with risk of death were mainly stage III HR, dyslipidaemia, end-stage CKD and hyponatremia.
Conclusion. MHT remains a public health problem in Mali and preferentially affects young subjects
Contexte et objectif. L’hypertension artérielle maligne (HTAM) est un problème de santé publique en Afrique sub-saharienne. L’objectif de cette étude était de décrire le profil épidémio-clinique et les facteurs pronostiques de l’HTAM à Fousseyni DAOU de Kayes.
Méthodes. Nous avons réalisé une étude rétrospective et descriptive du 1er janvier 2016 au 31 juin 2022 à l’unité de néphrologie de l’hôpital Fousseyni Daou de Kayes. Étaient inclus, les patients hypertendus ou normotendus sous traitement hospitalisés avec une rétinopathie hypertensive (RH) de stade II ou III (selon la classification de Kirkendall) associée à une ou plusieurs autres atteintes viscérales et ayant un dossier médical complet.
Résultats. Au total 117 cas d’HTAM ont été enregistrés sur 7011 dossiers examinés, dont 53,8% d’hommes (63 cas). L’âge moyen était de 39,47 ans. La moyenne de la pression artérielle à l’admission était de 187/114 mmHg. La RH était de stade II et III dans 59,8% et 40,2% des cas. L’insuffisance rénale était retrouvée chez 93,1% des patients (109 cas) dont 63,7% d’insuffisance rénale chronique (IRC) contre 36,7% d’insuffisance rénale aiguë (IRA). L’hypertrophie ventriculaire gauche a été retrouvée dans 80,4% des cas. L’issue globale des patients a été favorable dans 59% (69 cas) contre 31,6% (37 cas) de décès et 9,4% (11 cas) de sortie contre avis médical. Les facteurs associés au risque de décès étaient surtout la RH stade III, la dyslipidémie, l’IRC terminale et l’hyponatrémie.
Conclusion. L’HTAM reste un problème de santé publique au Mali et touche préférentiellement les sujets jeunes avec une morbi mortalité élevée.
Bee sting venom is generally well tolerated. However, some rare cases of massive stings can lead to anaphylactic shock and even renal failure. This observation is the illustration of a case of acute ...kidney injury secondary to bee stings in a 64-year-old black african subject.
A 64-year-old man without a known medical history was referred to the emergency department of the Fousseyni Daou hospital in Kayes (Mali) for disturbed consciousness 4 hours after massive stings from a bee swarm. Renal failure with serum creatinine level at 752,2 µmol/L was documented on day 3 in a context of total anuria. The patient was transferred to a nephrology unit and biology confirmed renal failure associated with intravascular haemolysis and rhabdomyolysis. The kidneys were of normal size and well differentiated. The diagnosis of severe acute kidney injury due to massive envenomation induced by bee venom was evoked. The evolution was favourable, with normalization of renal function at D26 after 5 sessions of haemodialysis in parallel with transfusions of packed red blood cells.
A massive bee attack should be considered a medical emergency because of the organic damage it can inflict. The renal prognosis depends on the number of stings, and especially on the delay and the quality of the treatment. Early initiation of dialysis treatment reduces mortality.
Bee sting venom is generally well tolerated. However, some rare cases of massive stings can lead to anaphylactic shock and even renal failure. This observation is the illustration of a case of acute ...kidney injury secondary to bee stings in a 64-year-old black african subject.
A 64-year-old man without a known medical history was referred to the emergency department of the Fousseyni Daou hospital in Kayes (Mali) for disturbed consciousness 4 hours after massive stings from a bee swarm. Renal failure with serum creatinine level at 752,2 μmol/L was documented on day 3 in a context of total anuria. The patient was transferred to a nephrology unit and biology confirmed renal failure associated with intravascular haemolysis and rhabdomyolysis. The kidneys were of normal size and well differentiated. The diagnosis of severe acute kidney injury due to massive envenomation induced by bee venom was evoked. The evolution was favourable, with normalization of renal function at D26 after 5 sessions of haemodialysis in parallel with transfusions of packed red blood cells.
A massive bee attack should be considered a medical emergency because of the organic damage it can inflict. The renal prognosis depends on the number of stings, and especially on the delay and the quality of the treatment. Early initiation of dialysis treatment reduces mortality.
Introduction: Multiple myeloma (MM) is a monoclonal proliferation of mature plasma cells. It usually occurs in people over 50 years of age with a peak in frequency at 65 years of age and less than 2% ...of patients are under 40 years of age. Case presentation: This case report is of a 38 year old black African woman with chronic kidney disease stage 5D. The IR was of glomerular origin (hypertension for 2 years, proteinuria at 4 g/24 hours, oedematous syndrome). Serum protein electrophoresis showed a beta peak at 29.7 g/l and urine protein immunoelectrophoresis showed a kappa/lambda ratio of 8.4. The myelogram showed a rich marrow with 51% plasma cells. Radiography showed multiple cystic images at the upper 1/3 of the left humeral shaft. Renal histology showed minimal glomerular damage. The diagnostic profile of IgG kappa light chain MM with CRAB criteria complicated by chronic glomerulonephritis with unorganised monoclonal immunoglobulin deposits was suggested. Management consisted of chemotherapy with bortezomib and dexamethasone for 4 cycles. The evolution under chronic dialysis was favourable after 1 year. Conclusion: MM in young adults (defined as 19-40 years of age) is rare, but it does exist. In young patients, this condition is initially not considered in the differential diagnosis and the occurrence of IR has a strong prognostic impact. Survival seems to be better in young adults than in elderly patients, which needs to be proven by a longer follow-up.
INTRODUCTIONLenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically. ...CASE PRESENTATIONWe report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy. CONCLUSIONLenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management.
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