Introduction: Kidney injury is common in the course of lupus and affects the functional and vital prognosis. The risk of progression to end-stage renal failure can reach 40% to 60%. Thus we carried out this work for the purpose of an evaluation of the renal and vital prognosis and to deduce the factors of poor prognosis. Patients and method: This was a retrospective, descriptive and analytical study conducted over a period of 10 years from January 1, 2007 to December 31, 2016, performed in the Nephrology Department of Aristide Le Dantec Hospital in Dakar. Patients with lupus nephritis were included. The studied parameters were epidemiological, clinical, paraclinical and progression. We had done a crossover of the patients to look for the factors of poor renal and vital prognosis. Results: Out of 93 cases of lupus patients, 64 were included, a prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men, a sex ratio of 0.23. Class III was found in 24 cases (37.5%), Class IV in 20 cases (31.25%), Class V in 15 cases (23.4%), Class II in 4 cases (6.25%) and Class I in 1 case (1.6%). The combination of corticosteroids and immunosuppressants was used in 56.25% of cases. After a follow-up of six months, 19 patients were in complete remission, 21 had resistance and 9 had partial remission. Of the 21 patients who had resistance, 8 were in chronic renal failure. Death was observed in 5 patients and the causes were in 3 patients: pulmonary embolism, bacterial meningitis and pulmonary tuberculosis. The cause of death was unknown in 2 patients. The factors of poor renal prognosis were lymphopenia, the presence of anti-native DNA antibodies, nephrotic syndrome, microscopic hematuria, tubular atrophy and interstitial fibrosis. Risk factors affecting renal survival were the presence of native anti-DNA antibodies, microscopic hematuria, leukocyturia and the presence of a proliferative class. The factors of poor prognosis were renal failure, lymphopenia, nephrotic syndrome, glo

Conclusions: This case demonstrated the necessity of multiple immunomodulatory therapies for severe AAV. Treatment of relapses remains challenging especially for frequent relapses which required intensification of immunosuppressive regimen.Trimethoprim-sulfamethoxazole as PJP prophylaxis was evidencebased recommendation, which could also reduce the risk of relapse in GPA. Macrolide antibiotics are used primarily for prevention of bronchiectasis exacerbations as per European Respiratory Society guidelines. Anti-inflammatory effect of macrolide was well known in the literature, however macrolide effect on the autoimmune conditions has not been previously described.Previous studies suggested that bronchiectasis is highly prevalent in AAV, which was shown to be responsive to immunosuppression. There are no guidelines for using antibiotics for prevention in GPA with lower airway involvement. Thus this appears to be the first time in literature, macrolide antibiotics have been shown to be effective in suppressing flare ups of GPA. We think this strategy may be worth looking at if bronchiectasis or lower airway involvement exists prior to the onset of GPA.Introduction: Crescentic glomerulonephritis (CGN) is a diagnostic and therapeutic emergency. There are many causes of type 2 CGN. The objective of our study is to determine the characteristics of the infection related CGN (ICGN). Methods: This is a retrospective study between 1990 and 2015 including patients with infectious origin ICGN. We determined the demographic, clinico biological, histological, therapeutic and evolutive parameters. Results: We collected 20 patients. Mean of age was 40 AE 19,8ans (range de16-77ans).sex ratio was 3. The onset was sudden in 70% of cases. A rapidly progressive GN (RPGN), nephritic syndrom, nephritic syndrome were observed respectively in 50%, 25% and 25%. Mean plasma creatinine was 884 AE 498mmol / L. Cryoglobulinemia was positive in 20% of cases. Mean crescentic glomerulis was The 56 AE 39%. The infection was endocarditis, a skin infection, an ORL infection, dental abscesses, purulent pericarditis, pulmonary focus and acute pyelonephritis and septic arthritis in respectively 25%, 20%, 10%, 5%, 15%, 15%, 15% and 15%. The therapeutic management required the use of emergency hemodialysis in 11 patients (55%). All patients received antibiotic therapy. 40% of patients received corticosteroids and 25% received corticosteroids plus cyclophosphamide. Death occurred in 25% ofpatients, ESRF was observed in 55% and partial or total improvement of renal function was observed in 10% of cases. Conclusions: ICGN are rarely described in occidental literature. The most common causes as shown in our series are endocarditis and deep infections. Treatment is controversial combination antibiotic therapy alone or combined with corticosteroid therapy or even immunosuppressant and plasmapheresis.

Conclusions: This case demonstrated the necessity of multiple immunomodulatory therapies for severe AAV. Treatment of relapses remains challenging especially for frequent relapses which required intensification of immunosuppressive regimen.Trimethoprim-sulfamethoxazole as PJP prophylaxis was evidencebased recommendation, which could also reduce the risk of relapse in GPA. Macrolide antibiotics are used primarily for prevention of bronchiectasis exacerbations as per European Respiratory Society guidelines. Anti-inflammatory effect of macrolide was well known in the literature, however macrolide effect on the autoimmune conditions has not been previously described.Previous studies suggested that bronchiectasis is highly prevalent in AAV, which was shown to be responsive to immunosuppression. There are no guidelines for using antibiotics for prevention in GPA with lower airway involvement. Thus this appears to be the first time in literature, macrolide antibiotics have been shown to be effective in suppressing flare ups of GPA. We think this strategy may be worth looking at if bronchiectasis or lower airway involvement exists prior to the onset of GPA.

No abstract

No abstract