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Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease. Surgical management occurs in severe forms and/or unresponsive medical treatment. The aim of this study was to outline the indications of parathyroidectomy and its evolution after surgical approach. It was a five-year multicenter backward study in Otorhinolaryngology Department of Fann Hospital and four dialysis centers in Dakar. We include all patients with SHPT who underwent surgery. Preoperative clinical and paraclinical parameters, clinical-biological evolution, and histology findings of the resected parathyroid specimen were collected. Out of 58 patients with hyperparathyroidism, 18 patients required parathyroidectomy, corresponding to a prevalence of 31%. Mean age of patients was 46.6 ± 15.29 years and sex ratio 0.61. Mean duration on dialysis was 44.4 ± 30 months. Ten patients (55.56%) had bone pain and nine patients (50%) had joint pain. Mean serum calcium was 97.27 ± 8.66 mg/L. Mean blood phosphorus levels were 40.47 ± 9.99 mg/L. Mean iPTH rate was 1493.22 ± 1014.93 ng/mL, with a maximum of 5000 ng/mL (77N). Mean value of 25-OH Vitamin D was 32.89 ± 16.02 ng/mL. Parathyroidectomy was indicated after failure of medical treatment with persistence of a serum intact parathyroid hormone concentration above 800 μg/mL in all patients. Subtotal parathyroidectomy (7/8) was performed in 11 patients (61.1%). Two patients (11.11%) benefited from a selective parathyroidectomy (3/4). Evolution was favorable for 13 patients, corresponding to a success rate of 72.2%. It was unfavorable in five patients including one patient with hypoparathyroidism and four patients with recurrent hyperparathyroidism. Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism in developing countries.

Resume Connue depuis un peu moins d’un demi-siecle, la borreliose, ou maladie de Lyme, est une zoonose transmise par la tique. Elle est la maladie vectorielle la plus rependue en Europe et aux Etats-Unis. Le Borrelia burgdorferi sensu lato, la bacterie en cause, est dote d’un « systeme de ruse » qui lui permet de dejouer la defense immunitaire et d’implanter l’infection sur le mode chronique. Il engendre des lesions tissulaires multisystemiques mediees par la reponse inflammatoire de l’hote. L’atteinte renale est rarement rapportee et elle est mieux connue chez le chien sous l’appellation de nephrite de Lyme. Le premier cas d’atteinte renale chez l’homme est decrit en 1999 et, depuis, huit autres cas ont ete rapportes. L’atteinte est preferentiellement glomerulaire et les formes histologiques varient entre les nephropathies a depots de complexes immuns et la podocytopathie. Les mecanismes physiopathologiques semblent etre triples : depots de complexes immuns, hyperexpression podocytaire de la proteine membranaire B7-1, et infiltration renale de cellules inflammatoires. En se basant sur les connaissances accumulees sur la maladie en un peu plus de 40 ans, l’objectif de cette revue est d’etablir les hypotheses physiopathologiques de l’atteinte renale afin de mieux definir les lesions histologiques.

Known in less than half a century, borreliosis, or Lyme disease, is a zoonosis caused by the tick bite. It is the most common vector disease in Europe and the United States. Borrelia burgdorferi sensu lato, the bacterium in question, is fitted with a "cunning device" that allows it to trick the immune system and implant the infection chronically. It causes multi-system tissue damage mediated by the inflammatory response of the host. Renal involvement is rarely reported and is better known in dogs as Lyme nephritis. The first case of kidney impairment in the human being was described in 1999, and since then eight other cases have been reported. The involvement is preferentially glomerular; the histological forms vary between immune complex nephropathy and podocytopathy. The pathophysiological mechanisms appear to be triple: immune complex deposits, podocytic hyper-expression of the B7-1 membrane protein, and renal infiltration of inflammatory cells. On the basis of the accumulated knowledge of the disease in just over 40 years, this review aims at establishing the physio-pathological hypotheses of renal involvement in order to better define the histological lesions.