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Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension continues to be a topic of debate. The objectives of this study were 1) to evaluate the performance of hemodialysis center BP measurements (routine and standardized BP measurements) in the diagnosis of ambulatory BP in chronic hemodialysis patients using 44h ambulatory BP monitoring (44h-ABPM) as the reference measurement; 2) to compare the performance of standardized and routine BP measurement; and 3) to evaluate the concordance between the values measured at the hemodialysis center and the BP values at 44h-ABPM. Methods In this 23-month case control study including 56 patients followed in the hemodialysis units of Aristide Le Dantec Hospital (HALD) and Idrissa Pouye General Hospital (HOGIP), BP was measured by 3 methods: i) an automated measurement (OMRON®) carried out by health professional called routine BP measurement (RBPM) in pre and post dialysis; ii) the mean of five automated measurements in a patient isolated in a quiet room called standardized BP measurement (SBPM) before and after dialysis; iii) 44h-ABPM with the CONTEC® device. The hypertension was defined as BP ≥ 130/80 mmHg at 44h-ABPM. Results Fifty-six (56) patients including 31 men (55%) with a mean age of 45.20 ± 13.64 years were included. Thirty-one patients (55%) were hypertensive at the 44h-ABPM. Pre-dialysis SBPM was significantly better than pre-dialysis RBPM (AUC [IC 95%], 0.881 [0.778-0.984]/0.785 [0.664-0.907], p=0.02) in detecting 44h ambulatory systolic BP (SBP) ≥ 130 mmHg. Post-dialysis SBPM was also outperformed post-dialysis RBPM (0.916 [0.843-0.988]/0.874 [0.782-0.965]) in detecting 44h ambulatory SBP ≥ 130 mmHg without statistically significant difference. Pre-dialysis SBPM outperformed pre-dialysis RBPM (0.882 [0.776-0.988]/0.878 [0.781-0.975] in detecting 44h ambulatory DBP ≥ 80 mmHg without statistically significant difference. Post-dialysis SBPM also outperformed post-dialysis RBPM (0.914 [0.832-0.996]/0.848 [0.743-0.952]) in detecting 44h ambulatory DBP ≥ 80 mmHg without statistically significant difference. Hemodialysis center measurements overestimate ambulatory BP at 44h-ABPM. Conclusion Hemodialysis center measurements overestimate ambulatory BP despite excellent performance on ROC curve analysis. SBPM performs better than RBPM and in particular in the detection of a SBP ≥ 130 mmHg in the ambulatory setting. SBPM overestimates SBP less than RBPM.

Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and corticosteroid resistance and the therapeutic options are numerous and have limited effectiveness. The objective of our study was to assess our practice in this lesion. Patients and Methods: We carried out a retrospective study of patients treated for primary FSGS the period January 1, 2010 to September 30, 2018. The clinical pathological, therapeutic and evolutive characteristics were studied. Results: Fifty-eight patients were included in the study. The average age was 30.74 ± 11.35 years and the sex ratio (M/F) was 2.41. Edema was found in 86.2% and hypertension in 37.9%. The average creatinine was 20.17 ± 16.06 mg/l and the average GFR according to MDRD was 82.43 ± 69.06 ml/min/1.73 m2. The average albumin level was 15.11 ± 5.78 g/l and the 24-hour proteinuria was 7.8 ± 3.79 g/24 h. Nephrotic syndrome was the main indication for renal biopsy in 84.48% and the classic form of FSGS was found in 90.9%. The average initial corticosteroid dose was 62.68 ± 10.04 mg/d and the average duration of regression was 11.78 ± 7.40 months. Forty-five patients (77.6%) were corticosensitive (27.6% complete remission and 50% partial remission). Corticosteroid resistance was observed in 19% and corticosteroid dependence in 11.1%. The proportion of relapse was 33.3% within an average of 15.4 ± 9.1 months. Cyclosporine was no longer prescribed as a second-line treatment in 8 patients. Infectious complications were more found in 19%. Two patients had progressed to ESRD and we noted 2 death cases. The male gender was correlated with the occurrence of a relapse. However, the impact of certain factors such as hypertension, proteinuria, hematuria and GFR level has not been demonstrated. Conclusion: The evolution of primary FSGS is unpredictable, often marked by relapses, hence the interest in identifying factors associated with therapeutic responses for better management.

Les calcifications metastatiques representent une complication parfois severe de l´insuffisance renale chronique terminale. Leurs consequences cardiovasculaires ont ete associees a l´augmentation de la morbi-mortalite. Nous rapportons l´observation d´une malade presentant une hyperparathyroidie tertiaire complique de calcifications cardiovasculaires dont l´evolution a ete fatale conduisant au deces de la patiente. La prevention constitue la meilleure arme therapeutique et la parathyroidectomie (PTX) pourrait utiliser comme traitement de sauvetage.