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The present study aims at valorizing Moroccan Henna (Lawsonia inermis) by developing healing formulations for cosmetic and therapeutic uses. For such a goal, the plant was collected from three locations in southeastern Morocco (Alnif, Tafraoute Sidi Ali and Tazarine). Phytochemical analysis of Henna leaves was performed by determining phenolic compound contents, and flavonoids and tannins in it, through its aqueous extracts. Then, specific formulations were prepared using aqueous extracts of L. inermis to assess their in vivo wound healing potential in Swiss albino mice used as animal models. Results disclosed that phenolic compounds (13.48%), as well as flavonoid (9.25%) and tannin (2.57%) contents are higher in Henna leaf extracts from Alnif, while Tazarine Henna aqueous extract was found to be richer in saponins (0.32%). Exclusion chromatographic analysis on Sephadex G50 gel corroborates the obtained results and shows that Lawsone levels (Henna coloring agent) are higher in Henna collected from Alnif. Aqueous Henna leaf extracts, at a dose of 10% in petroleum jelly, have been assessed for their ability to heal induced burns in mice. Healing monitoring, carried-out with Henna extracts on mice batches and those of two control batches (mice batch treated with petroleum jelly alone and batch treated with petroleum jelly containing 1% (flamazine), showed a great reduction in burnt surface with an accentuated contraction percentage (CP) and complete re-epithelialization duration (CRD) at 21 days in the 3 studied Henna-based formulations. These findings suggest the interest of potential development of Henna-based formulations, as a source of phenolic compounds, for further dermatological, cosmetic and therapeutic applications.

Zucchini (Cucurbita pepo) and watermelon (Citrulus lanatus) rank among the most cultivated cucurbits in Morocco. These crops are prone to infection with a wide range of viral diseases responsible f...

Pimpinella anisum (anise) is a dense vegetal matrix with considerable amounts of bioactive components known for its pharmacological properties. The optimization of extraction constitutes an important key to improving efficacy and avoiding wasting time. Within this framework, the present study was designed to select the most appropriate extractor solvent mixture to extract phenolic and flavonoids using Mixture Design Methodology. The concerned responses were the total phenolic content (TPC), total flavonoid content (TFC) and antioxidant ability examined by 2,2-diphenyl-l-picrylhydrazyl (DPPH) assay. Before mixture design optimization, a screening of solvents was conducted on ten polar and nonpolar solvents to choose the best solvents that give a maximum of total phenolic compounds. This first step has shown that water, ethanol and methanol were the best-used solvents. Later, an augmented centroid design investigated the solvent system’s optimization. The results of simultaneous optimization have shown that the ternary mixture containing 44% of water, 22% of ethanol and 34% of methanol was the most appropriate for simultaneous maximization of TPC, TFC and antioxidant activity with 18.55 mg GAE/g, 7.16 mg QE/g and 0.56 mg/mL, respectively. Our results have shown that using mixture design as an optimization technique was an excellent way to choose the most suitable mixture to extract bioactive compounds, which may represent a promising method of multi-purpose extraction, especially in the pharmaceutical and food sectors.

Background The lockdown of COVID-19 (Coronavirus Disease 2019) is associated with several stressful factors that can negatively affect peoples' sleep quality and mental health. Objectives: We conducted this study to evaluate sleep disorders and psychological impact associated with the spread of the COVID-19 and the lockdown on the Moroccan population. We also aimed to study the effects of respondents' beliefs and attitudes about sleep on sleep disorders, anxiety-related symptoms, and depressive symptoms. Material and Methods We used a questionnaire enclosing respondents' sociodemographic information, five psychological and behavioral tests including Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), Hamilton Anxiety Rating Scale (HARS) and Beck Depression Inventory (BDI) test. Results Our results highlighted widespread false beliefs about sleep and the prevalence of sleep disorders, anxiety, and depression-related symptoms within the Moroccan population. Nearly 82.3% of respondents revealed false beliefs about sleep. Furthermore, we confirmed a strong positive correlation between knowledge and attitudes about sleep and the prevalence of sleep disorders, anxiety, and depression-related symptoms. However, we found no significant difference in the prevalence of sleep and psychological disorders, between healthcare workers and other professions workers. Conclusion Our study revealed a high prevalence of sleep disorders, anxiety, and depressive symptoms in the Moroccan population during the COVID-19 lockdown period. Moreover, false beliefs on sleep understanding were prevalent and were presenting a risk factor leading to sleep disorders, anxiety, and depressive symptoms., Highlights • High prevalence of sleep disorders, anxiety, and depressive signs were found in COVID-19 pandemic and lockdown. • A False believes on sleep concepts were assessed and were presenting a risk factor of sleep disorders, anxiety, and depression. • A program of sensitization should be initiated to fight against false sleep beliefs. • Valuing protection procedures of health workers and all high-risk people. • Offer better access to provided psychological support through dedicated setup.

In this study, we aimed to evaluate planted Henna in three sites in Morocco, namely, Alnif, Tafraoute Sidi Ali, and Tazzarine. Morphometric study shows that Tafraoute Sidi Ali Henna variety has highest geometric and weight parameters (length of 27.48 mm, width of 10.92 mm, specific mass of 25.1 mg/leaf, leaf area of 51, 53 mm2, and rib’s number of 9.41) when compared to Alnif and Tazzarine varieties. On the other hand, biochemical analysis shows that Tazzarine Henna variety, in the first rank, is characterized by high levels of total sugars (11.27 g/100 g), reducing sugars (5.59 g/100 g), proteins (4.4 g/100g), lipids (3.05 g/100g), phenolic compounds (31.9 g/100 g), flavonoids (5.68 g/100 g), and tannins (5.5 g/100 g). Chromatographic study shows that Tazzarine Henna variety is rich in monocyclic and polycyclic phenolic compounds. Climatic conditions analysis shows that the morphometric and biochemical diversity is related to hydrous and thermal profiles of studied sites. As a conclusion of this work, we can recommend the use of morphometric analysis and phytochemical and chromatographic analysis to determine the quality of Henna in Morocco and elsewhere.

Due to its balanced composition in basic nutrients, its richness in vitamins and in minerals, camel milk has a special place in the daily diet of southern populations. The present study aimed at examining some physicochemical and biochemical characteristics of camel milk (Camelus dromedarius) in Morocco. To achieve this aim, three batches of samples of camel milk were collected from various regions (Dakhla, Errachida, and Fès-Meknes) undergoing physicochemical and biochemical analyses. Results showed that Moroccan camel milk is characterized by slight hydronium potential (pH=6.5), low Dornic acidity (15°D), low density (1.029 kg/l), and high content of ashes (8.06 g/l). Likewise, samples had a high content of macronutrients (Fats: 34.09 g/l; Proteins: 32.4 g/l; Sugar: 49.8 g/l) and micronutrients (Vitamin C: 27.53 mg/l; Flavonoids: 29.05 mg EQ/l: total phenolic compounds: 35.45mg GAE/l). In this respect, working on multiple specimens from different Moroccan regions highlighted an analytical diversity from the south to the north. Comparative study of samples from numerous territories all over the world has confirmed this diversity. North African milk is characterized by high content of proteins, fats, and sugar. On the other hand, oriental milk is peculiarized by high vitamin C content.

The present work is a continuation of our research for a better understanding of the ecological organization of beetles in the mobile sand dunes of north-eastern Morocco. This study is spread over 400km ² of dunes from Guercif (north) to Merzouga (Sahara), and also the following sites : north-east Missour, Midelt, Aïn Beni Methar, Tendrara, Rich, Boulman, Bouârfa, Boudnib and Erfoud. The highest density of coleoptera is recorded in Figuig, Tendrara, Bouârfa. On the other hand, the lowest densities are measured in Guercif, Aïn Beni Methar, Bouânane and Rich. Diversity and evenness were low overall. We distinguish a first group of sites, consisting of Tendrara, Bouârfa to Missour, Aïn Beni Methar and Guercif, where the assemblage is more bal- anced due to the mediterranean climatic influence, a rather rich and abundant vegetation allowing the establishment a higher diversity of coleoptera. A second group of sites (Bouânane, Midelt, Rich and Figuig) is characterized by lower diversity and evenness. The third group of sites, located in the south (Erfoud, Merzouga and Boudnib) have assemblages with low diversity and very low eveness composed of a few specialized species. These assemblages are directly dependent on extremely harsh conditions., Le présent travail constitue la suite de nos recherches pour une meilleure connaissance de l’organisation écologique des groupements des coléoptères des dunes mobiles du Maroc oriental et de la frange septentrionale occidentale du Sahara. Cette zone s’étend sur 400 km ² , des dunes de Guercif au nord, à celles de Merzouga (Sahara), en passant par les dunes des stations suivantes : nord-est de Missour, Midelt, Aïn Beni Methar, Tendrara, Rich, Boulmane, Bouârfa, Boudnib et Erfoud. Les plus fortes densités de la faune sabulicole sont enregistrées à Figuig, Tendrara et Bouârfa. À l’inverse, les plus faibles densités sont relevées à Guercif, Aïn Beni Mathar, Bouânane et Rich. La variation des paramètres de la diversité et de l’équitabilité nous a permis de distinguer, dans l’ensemble, des valeurs globales assez faibles à très faibles, quelle que soit la station. Il s’agit donc de peuplements peu diversifiés et dominés par quelques espèces. Ces peuplements, comme le milieu qui les héberge, sont spécialisés. Nous avons ainsi distingué un premier groupe de stations (Tendrara, Bouârfa, NE Missour, Aïn Beni Methar et Guercif) où les peuplements sont les plus diversifiés et équilibrés. Cela est dû au climat sous influence méditerranéenne, à végétation assez riche et abondante qui permet l’installation d’un bon nombre d’espèces contribuant à leur tour à l’établissement d’une bonne valeur de la diversité. Un deuxième groupe de stations (du «centre » : Bouânane, Midelt, Rich et Figuig) est caractérisé par une diversité et une équitabilité plus faibles. Dans les stations du sud (Erfoud, Boudnib et Merzouga), les peuplements sont peu diversifiés et dominés par quelques espèces spécialisées. Ces peuplements, sont sous la dépendance directe des facteurs de milieux extrêmement rigoureux., Bouraada Khalid, Chavanon Guy, Essafi Mariam, El Ghadraoui Lahsen, Benjelloun Meryem. Diversité écologique du peuplement de coléoptères des écosystèmes dunaires mobiles de la frange septentrionale et de la région orientale du Maroc. In: Ecologia mediterranea, tome 42 n°1, 2016. pp. 39-50.

Objectif L’ampleur de la somnolence diurne excessive (SDE) reste meconnue au Maroc. Cette etude a comme objectifs d’evaluer la prevalence de la SDE, ses facteurs determinants et repercussions sur le rendement chez les travailleurs d’un centre d’appel de Fes. Methodes Il s’agit d’une etude transversale a visee descriptive et analytique concernant 322 travailleurs d’âge moyen de 27,9 ans et comprenant un auto-questionnaire sur les troubles du sommeil et les conditions de travail avec les echelles Epworth (en arabe marocaine), de fatigue Pichot, d’anxiete depression HAD, et de Berlin. Resultats La prevalence de la SDE selon l’echelle d’Epworth est de 19,3 %. L’analyse bivariee montre que la prevalence de la SDE est plus elevee (entre 24,9 % et 56,2 %) en cas de : debut du travail avant 8 h AM, difficulte a rester attentif, fatigue au travail, le bruit monotone, conditions de travail degradees, rendement insatisfaisant, de vie familiale degradee, un score anxiete eleve, un score de depression eleve, ou un score de Pichot≥22 (34,6 %). On trouve une SDE nettement plus elevee chez les ronfleurs 39,4 % et ceux avec un score de Berlin positif 42,9 %. L’analyse multi variee montre que les principaux facteurs de risque impliques dans la SDE sont les conditions de travail notamment la difficulte a rester attentif OR = 3,39 et la fatigue au travail OR = 9,82. Les travailleurs les moins somnolents ont un rendement superieur aux attentes OR = 0,35. Conclusion Notre etude souligne la prevalence tres elevee de la SDE chez les travailleurs du centre d’appel avec comme facteur determinant principal les conditions de travail.

Water is a vital aspect of hemodialysis. During the procedure, large volumes of water are used to prepare dialysate and clean and reprocess machines. This report evaluates the technical and economic feasibility of recycling hemodialysis wastewater for irrigation uses, such as watering gardens and landscape plantings. Water characteristics, possible recycling methods, and production costs of treated water are discussed in terms of the quality of the generated wastewater. A cost-benefit analysis is also performed through comparison of intended cost with that of seawater desalination, which is widely used in irrigation.

BACKGROUND Increased QT dispersion (QTd) has been associated with an increased risk for ventricular arrhythmias and sudden death in the general population and in various clinical states. METHODS We investigated the impact of hemodialysis (HD) on QT, QTd, and T-wave amplitude in subjects with end-stage renal failure. Data on 49 patients on chronic HD were studied. The QT, QTd, and the sum of amplitude of T waves (SigmaT) in millimetre in the 12 ECG leads, along with a host of other ECG parameters, body weight, blood pressure, heart rate, electrolytes, and hemoglobin/hematocrit were measured before and immediately after HD. RESULTS QT decreased (380.9 +/- 38.4-363.5 +/- 36.8 ms, P = 0.001), the QTc did not change (406.2 +/- 30.8-405.4 +/- 32.2 ms, P = 0.8), the QTd increased (31.3 +/- 14.6-43.9 +/- 18.6 ms, P = 0.003), and the SigmaT decreased (32.3 +/- 15.7-25.9 +/- 12.6 mm, P = 0.0001) after HD. There was no correlation between the change in QTd and the changes in serum cations, heart rate, the subjects' weight, T-wave duration, and SigmaT. However, the change in QTc correlated inversely with the change in serum Ca(++) (r =-0.339, P = 0.021). CONCLUSION QTd increased, the SigmaT decreased, and the QTc and T-wave duration remained stable, after HD. The QTd increase, although may be real, could also reflect measurement errors stemming from the decrease in the amplitude of T waves (as shown recently), imparted by HD; this requires clarification, to use QTd in patient on HD.

Objectif Cette etude a comme objectifs d’evaluer la prevalence de la SDE, ses facteurs determinants, evaluer le role du travail poste, et l’impact de la SDE sur le rendement. Methodes Il s’agit d’une etude transversale a visee descriptive et analytique concernant 300 travailleurs d’âge moyen de 28 ans (23–46 ans) et comprenant un auto-questionnaire sur les troubles du sommeil et les conditions de travail avec les echelles Epworth (version arabe marocaine), et de Berlin. Le taux de participation totale de 100 %. Parmi le personnel, 64,7 % sont des travailleurs postes. Resultats La prevalence de la SDE est de 30 %. L’analyse bivariee montre une prevalence de SDE significativement plus elevee en cas de : âge > 30 ans (52,4 %), duree de sommeil 48 h (35,2 %), repetition des actes dans le travail (39,5 %), necessite d’attention (37,5 %), bruit monotone (38,9 %), ronflement (46,4 %), score de Berlin positif (82,6 %) et conditions de travail degradees (43,5 %). La SDE est significativement plus elevee en cas de rendement insatisfaisant (60 %) et de vie affective et familiale degradee (43,5 %). L’analyse multivariee montre que les principales etiologies de la SDE sont le ronflement (OR = 2,63), la forte probabilite du SAOS selon le Berlin (OR = 5,36) et le travail poste (OR = 1,24). Elle a montre aussi que la SDE est un facteur determinant dans le rendement insatisfaisant (OR = 3,16). Conclusion Notre etude souligne la prevalence tres elevee de la SDE chez personnel medical et paramedical de notre CHU et le role determinant du travail poste et des troubles respiratoires du sommeil et les repercussions sur le rendement.

Brown tumors, or osteoclastomas, are erosive bony lesions arising as a complication of hyperparathyroidism (HPT). In patients with end-stage renal disease (ESRD), brown tumors are classic skeletal manifestations usually seen in severe forms of secondary HPT. However, involvement of the spine is considered extremely rare. We report a long-term hemodialysis case, in which cauda equina compression developed due to a sacral brown tumor. A decompressive surgery and subtotal parathyroidectomy were indicated to preserve neurologic function, and to ensure remineralization of the lesion. This case illustrates that, though rare, brown tumors should be considered in uremic patients with neurological symptoms. Emergent decompressive surgery is required to remove pressure on neurological structures and to stabilize the spine.

SUMMARY: Background: The prevalence of valve calcification (VC) in end-stage renal disease patients is high and information regarding risk factors is scarce. Our aims were to determine the prevalence of VC in our maintenance haemodialysis (HD) population and to examine some possible aetiologic factors for its occurrence. Methods: We studied 90 patients (47 women) on maintenance HD for more than 12 months. An M-mode two-dimensional echocardiogram was carried out to evaluate mitral, aortic VC and ventricular geometry. We calculated mean daily calcium intake for the phosphate intestinal chelaing in the previous year to echocardiogram date and also mean values from previous year of Ca, PO4, Ca × PO4, parathyroid hormone, lipide profile, nutritional and inflammatory marquers. Finally consumption of calcium and alfacalcidol was also noted. Results: Thirty-six patients (40%) presented with VC. Patients with VC were older and showed higher levels of serum calcium (92.00 ± 7.54 vs 89.27 ± 6.86 mg/L, P = 0.04), phosphorus (69.70 ± 18.33 vs 44.90 ± 12.43 mg/L, P

Resume Les tumeurs brunes, ou osteoclastomes, sont des lesions osseuses erosives compliquant une hyperparathyroidie (HPT). Chez les patients au stade d'insuffisance renale chronique terminale, les tumeurs brunes sont des manifestations squelettiques classiques, en general presentes dans les formes d'hyperparathyroidie secondaires severes. Cependant, l'atteinte rachidienne est extremement rare. Nous rapportons le cas d'un patient hemodialyse qui a developpe une compression de la queue-de-cheval causee par une tumeur brune sacree. Une decompression chirurgicale associee a une parathyroidectomie subtotale ont ete necessaires afin de preserver la fonction neurologique et d'assurer une remineralisation de la lesion. Ce cas illustre le fait que meme rares, les tumeurs brunes doivent etre evoquees en cas de signes neurologiques chez un patient uremique. Une chirurgie decompressive en urgence peut etre necessaire pour lever la compression des structures neurologiques et stabiliser le rachis.

Summary Papillary thyroid carcinoma (PTC) is known to occur in association with primary hyperparathyroidism (HPT). A combination of secondary HPT and PTC is a rare event, and of pathogenetic interest. We report two long-term hemodialysis patients in whom invasive PTC was diagnosed at the time of parathyroidectomy for a medically uncontrolled HPT. We suggest that the association of simultaneous pathology of the thyroid and parathyroid glands should be always considered in uremic patients with secondary HPT. A common oncogenic stimulus may have been involved.

Shortages of water could become a major obstacle to public health and development. Currently, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) estimate that 1.1 billion people lack access to a water supply and 2.6 billion people lack adequate sanitation. The global health burden associated with these conditions is staggering, with an estimated 1.6 million deaths every year from diseases associated with lack of access to safe drinking water, inadequate sanitation and poor hygiene. In this paper we review the impact of water shortages on health and human development.

Water conservation refers to reducing the usage of water and recycling of wastewater for different purposes such as irrigation, laundry and sanitation. As water scarcity increases worldwide, dialysis facilities should be focused on salvaging water. However, most of them still ignorantly discard to the sewer huge volumes of this reusable resource. This article reviews the current water conservation techniques in hemodialysis and the potential benefits drawn when using this technology.

Background: Water treatment systems are susceptible to microbial contaminations and periodical disinfection procedures are mandatory to obtain results requested from international standards. According to the Association for the Advancement of Medical Instrumentation, ozone is the most effective method to destroy microorganisms, and to prevent, reduce or remove the biofilm. This study aims to review the literature on the application of ozone in the disinfection of water treatment systems for hemodialysis. Methods: Data were obtained from databases (Ovid MEDLINE, Cochrane, EMBASE, and others). Results: Ozone is quite effective in killing bacteria and degrading endotoxins and biofilm, with efficacy being concentration- and time-dependent. However, being a strong oxidant, appropriately compatible materials should be used. Also ozone production should be monitored and its level in ambient air should also be checked periodically to maintain a contamination air standard of 0.1 ppm. Conclusion: Ozone appears to be promising in hemodialysis. However, further investigations are necessary to approve its wider use.

Marked enlargement of the jaws is a rare complication of renal osteodystrophy. This report describes a localized enlargement of the mandible due to a brown tumor in a patient undergoing chronic hemodialysis. Literature on jaw involvement in secondary hyperparathyroidism is reviewed.

The purpose of the study was to assess the efficiency of a goal-oriented therapeutic strategy in lowering blood pressure and reducing the need for antihypertensive medications in 168 patients undergoing long-term hemodialysis.Patients were managed initially by achieving optimal dry weight. After reduction of the dry weight, patients with uncontrolled arterial hypertension were dialyzed using a 1.25 mmol/L calcium concentration buffer.The predialysis mean arterial blood pressure (PDBP) was 127.4/74.2 mmHg for the total population. Fifty (29.76%) of the total study population were hypertensive. Of them, 88% (44 patients) were receiving antihypertensive drugs, while the others were not on such medications. Twenty patients (40% of the hypertensives) were receiving one antihypertensive drug, 17 (34%) were receiving two antihypertensive drugs, while 7 patients (14%) were receiving three or more drugs. There was a significant increase in the number of patients with good control of PDBP in the second data collection [45 patients (90%)] compared to the first data collection of 40 patients (80%). Similarly, there was a significant reduction in the number of patients with uncontrolled PDBP in the second data collection (5 patients (10%) compared to the first data collection of 10 patients (20%). The average blood pressure in the first data collection was 137.2/76.3 and 167.4/87.1 mmHg in the controlled and uncontrolled blood pressure groups respectively. In the second data collection, the average blood pressure was 136.4/75.1 and 161.6/86.3 mmHg in the controlled and uncontrolled groups respectively.Therapeutic approach using combination of dry weight reduction and dialysis with low calcium dialysate provides acceptable long-term results in patients with arterial hypertension and reduces the need for antihypertensive medication.

Complications of transurethral resection of the prostate (TURP) related to hypotonicity and hypervolemia were well described in the literature. However acute renal failure, known to be a clinical presentation of some TURP syndromes was less discussed.We report a case of oliguric acute renal failure as a major complication after TURP, with a discussion of a possible mechanism for the disorder.The mechanism by which renal failure developed in our patient is not entirely clear, but most likely is due to hemolysis. Other factors such as hemodynamic alterations, hypotension and rabdomyolisis are also suspected based on analysed data.We believe that a detailed evaluation before and after TURP will allow to reduce the incidence of this abnormality and to prevent its occurrence.

Objetivo: Las complicaciones de la resección transuretral de próstata (RTUP) relacionadas con la hipotonía y la hipervolemia fueron descritas bien en la literatura. La insuficiencia renal aguda, es una forma de presentación clínica que puede surgir en el curso de la resección transuretral de próstata, y que fue poco discutida. Métodos. Presentamos un caso de insuficiencia renal aguda oligúrica como importante complicación después de la RTUP, con una discusión de un posible mecanismo para el desorden. Resultados. En nuestro paciente, el mecanismo por el cual se produjo el fallo renal no está claro, aunque posiblemente fuese debido a una hemólisis. Otros factores etiológicos, tales como la alteración hemodinámica, hipotensión, o rabdomiolisis fueron implicadas en base a los datos analíticos. Conclusiones. Creemos que una evaluación detallada en el transcurso de una RTUP, pueden ayudar a minimizar la incidencia y prevenir esta anormalidad.

Chronic lead nephropathy occurs as a result of years of lead exposure. Nowadays, with the induction of high standards for industrial hygiene, symptomatic lead intoxication has become extremely rare. We report a case of chronic lead nephropathy in a 59-year-old man who worked in a battery-recycling unit and was diagnosed with plumbism during a regular health screening few years ago. The diagnosis was suggested by the following findings: serum creatinine 160 microg/L, creatinine clearance 46 ml/min, daily urine protein excretion 0.1 g, uric acid 9.7 mg/dl, blood lead 9.2 microg/dl, and a urinary excretion of 850 microg lead/72 h after a mobilisation test by a Na2-Ca-EDTA chelating agent. Renal ultrasound showed bilateral borderline small kidneys. The kidney biopsy revealed moderate focal atrophy, loss of proximal tubules, and prominent interstitial fibrosis. The patient was prescribed angiotensin-converting-enzyme inhibitors to slow the progression of renal insufficiency and control the blood pressure. Hyperuricemia was also treated and controlled. During the regular follow-up, renal function remained stable with no proteinuria. A high index of suspicion for lead intoxication in chronic kidney disease patients should be practiced, especially in patients with hyperuricemia. Chelation of lead urinary excretion is helpful in the diagnosis of this disease.

Ehlers-Danlos syndrome (EDS), a heterogeneous disease of the connective tissues, is diagnosed by a triad of symptoms that include skin hyperextensibility, joint hypermobility and connective tissue fragility. Nephronophtisis (NPH) is an autosomal recessive interstitial nephritis leading to terminal renal insufficiency around puberty. The occurrence of these two rare diseases together is unusual. A review of the literature discloses no case of this association. We report here on a 16-year-old man with undiagnosed EDS, who was referred to our hospital because of renal insufficiency, history of polyuria and polydipsia. Renal ultrasound showed normal kidney size, with a lack of corticomedullary differentiation. Renal biopsy specimen disclosed chronic tubulointerstitial nephritis resembling NPH. Further evaluation identified hypermobile joints and hyperextensible skin, which led to the diagnosis of the EDS. These data suggest that patients with EDS need to be evaluated carefully for the presence of renal anomalies.