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R Lakhoua

Publications and source records attributed to R Lakhoua.

At least 19 recordsLinked to original sources
PubMed1999

Urolithiasis in Tunisian children: a study of 120 cases based on stone composition.

The composition of urinary stones in children depends on socioeconomic conditions and hygiene, geographical area, and dietary habits. We analyzed urinary stones from 120 consecutive Tunisian children (81 males, 39 females) aged 5 months to 15 years. The stone was located in the upper urinary tract in 91 cases (76%). Stone analysis included both a morphological examination and an infrared analysis of the nucleus and the inner and peripheral layers. The main components of bladder calculi were whewellite (69%) and struvite (22%), whereas the main component of upper urinary tract calculi was whewellite (67%). The nucleus of bladder stones was composed of ammonium urate (45%), struvite (28%), cystine (10%), and carbapatite (7%). The nucleus of kidney and ureteral calculi was mainly composed of ammonium urate (38%), whewellite (24%), carbapatite (13%), or struvite (11%). Based on stone composition, urinary tract infection was involved in the nucleation or growth of a third of calculi. Endemic urolithiasis involving simultaneous nutritional, metabolic, and infectious factors, and defined by its nucleus composed of ammonium urate without struvite, represented 40% of cases. Exclusive metabolic factors - including genetic diseases such as primary hyperoxaluria, cystinuria, and hypercalciuria - were responsible for less than 25% of cases.

Adolescent↗
PubMed1997

[Urinary calculi in children: contribution of anamnesis, biological exploration and physical analysis of calculi to the etiological diagnosis].

BACKGROUND: It is always of importance to define the cause of urinary calculi disease in children to prevent recurrence and possible impairing of renal function. Nevertheless, etiology is not always easy to prove and must be deduced from both clinical and biological arguments. PATIENTS AND METHODS: The aim of this prospective study including 39 Tunisian children with urinary stones was to identify etiology and stone risk factors and detail the part of clinical and biological data and results of physical analysis of stones in determining the cause of the stone. RESULTS: In 31 cases among 39, clinical and biological data were not sufficient to identify clearly the stone etiology. When considering the structure and stone composition, the cause of the stone could be determined in 97.4% of the cases. An inherited disease was found responsible for the stone in 11 children, urinary tract infection in 13 cases, idiopathic hypercalciuria in nine cases and a nutritional deficiency disease in seven cases. In one case, polycystic kidney disease with metabolic risk factors could explain the stone process. No precise etiology was found in one case. Among infection stones, struvite stones could be related to urea-splitting bacteria while other calculi, containing whitlockite and protein matrix could be related to other micro-organisms. Earlier severe chronic diarrhoea episodes were noted in six among seven children presenting stones with a nucleus mainly composed of ammonium urate. CONCLUSION: Clinical data, biological data from both urine and blood of the patients and also the structure and composition of the stones are needed to identify the cause of urinary calculi. Such a procedure could provide the stone etiology in most cases.

Adolescent↗
PubMed1997

[Ocular signs of primary hyperoxaluria type I].

PURPOSE: To report the results of ophthalmological examination of 14 patients with primary oxalosis of type I, and to appreciate the diagnostic value of these signs. MATERIAL AND METHODS: Fourteen patients, 7 girls and 7 boys with an average age of 8-35 years (3 months - 15 years). Ten patients had renal failure, 2 died without dialysis and eight were treated with dialysis; 5 out of 8 had hemodialysis and the duration of this treatment varied between 3 months and 3.5 years, 3 out of 8 had peritoneal dialysis. RESULTS: Visual acuity was 10/10 in 11 cases and we noted a vision of 5/10 in one eye in one case. Ocular fundus examination was normal in 7 cases. In 5 cases, it showed numerous minute white round flecks at the posterior pole and near the retinal vessels which probably correspond to deposition of calcium oxalate crystals. In one case we found a diffuse retinal pigment atrophy and in another case a sectorial papillar atrophy without loss of vision. CONCLUSION: This flecked retinopathy can occur before hemodialysis or after a few months or years of hemodialysis. There is no correlation between duration of dialysis and ocular lesions.

Adolescent↗
PubMed1997

[Primary hyperoxaluria: Tunisian experience apropos of 24 pediatric cases].

We report on 24 children (10 girls) presenting with primary hyperoxaluria. The mean age at diagnosis was 6.3 years (range: 3 months-14.8 years). The mean interval between initial symptom and diagnosis was 1.3 year. The average follow-up period was 22 months (range: 1-60 months). At the time of diagnosis the renal function was normal in 6 children, moderately altered in 1 and severely in 17. During the follow-up the renal function remained stable in 6 patients, improved in 2, deteriorated in 4. The 12 patients with end-stage renal disease at diagnosis remained unchanged. Urolithiasis were present in all patients older than 2 years, and in 1 among the 5 infants. Medullary nephrocalcinosis was observed in 3 patients in whom the renal function was preserved. Diffuse nephrocalcinosis was present in all patients with end-stage renal failure. Improvement of renal function was secondary to stone removal in 2 patients. Extracorporeal shock wave lithotripsy performed in 7 patients was efficient only in 3. In 10 patients oxalate bone disease was correlated with both renal function and dialysis duration, whereas retinal involvement noted in 6 patients was not.

Adolescent↗
PubMed1996

End-stage renal disease of the Tunisian child: epidemiology, etiologies, and outcome.

From December 1989 to December 1993, 90 children under 15 years were admitted to our department for end-stage renal disease; 9 children were less than 5 years and 28 were aged between 5 and 10 years. The sex ratio (M/F) of the children was 2.1. The estimated incidence of pediatric end-stage renal disease in Tunisia is 7 new cases per year and per million child population under 15 years. The chief etiologies of end-stage renal disease are glomerulonephritis (19%), hereditary nephropathies (29%), and malformative uropathies (13%); 26% of the end-stage renal diseases are of unknown etiologies. Our findings, compared with the European data, show a particularly high frequency of primary hyperoxaluria (13.5%) and an unusual proportion of male subjects.

Adolescent↗
PubMed1996

[Infantile forms of primary hyperoxaluria type I: apropos of 4 cases].

BACKGROUND: Approximately 10% of the cases with primary hyperoxaluria type I present before age 1 and are usually classified as neonatal primary oxaluria. CASE REPORTS: Four unrelated infants, aged 3 to 9 months, were admitted for severe renal failure due to primary hyperoxaluria type I. Other affected members were known in two of these four families but the disease was not present at the same age in each family. Echogenicity of kidneys was increased in all the patients and calcium oxalate crystals were seen in the collecting system and within the renal parenchyma. Urolithiasis was not present. Treatment of renal failure, ie, peritoneal dialysis, was uneffective in one patient and was interrupted in two others because organ transplantation was impossible. CONCLUSIONS: The infantile forms of primary hyperoxaluria type I may be rapidly complicated by severe renal failure in the absence of urolithiasis.

Female↗
PubMed1995

[Value of extracorporeal shockwave lithotripsy in primary hyperoxaluria type I].

BACKGROUND: Application of extracoporal shock wave lithotripsy (ESWL) has revolutionized the management of many types of urolithiasis, including that observed in primary hyperoxaluria where surgical attempts to remove calculi sometimes result in worsening of renal function. CASE REPORTS: Three unrelated patients aged 8, 10 and 11 years, respectively, with type I primary hyperoxaluria, suffered from recurrent bouts of abdominal pain (two patients) or anemia (one patient). Two patients had chronic renal failure. Plain abdominal films and ultrasonography showed several large bilateral stones. ESWL was applied to the three patients permitting complete removal of stones following three sessions in one patient and partial removal following four sessions in the second patient who developed infection after the first session with transitory increase in creatinemia. Several sessions of ESWL failed to fragment stones in the third patient. CONCLUSION: ESWL may represent a safe procedure for attempting stone removal in patients with primary hyperoxaluria.

Child↗
PubMed1995

[Radiological signs of type I primary hyperoxaluria].

The authors report the radiological signs observed in 14 patients between the ages of 3 months and 16 years, suffering from type I primary hyperoxaluria. Four of these patients were being treated conservatively for renal failure and ten had reached end-stage renal failure. Stones were demonstrated in 9 patients. Nephrocalcinosis was present on the plain abdominal x-ray in 6 patients before dialysis, and in all patients dialysed for more than 3 months. Bone signs characteristic of type I primary hyperoxaluria were only observed in children with end-stage renal failure. Metaphyseal dense bands were revealed in 5 patients. Metaphyseal clear bands, observed in 4 patients, occurred later and appeared to replace dense bands which moved towards the diaphysis. The other signs detected were osteosclerosis of the vertebrae and ilium (4 patients) and epiphyseal subchondral clear bands (one patient).

Adolescent↗
PubMed1995

[Etiologic factors of urinary lithiasis in Tunisian children].

Fifty-five Tunisian children with urinary stones, between the ages of 8 months and 15 years, underwent morphological and infrared spectrophotometric analysis of their stones. This study provides an approach to the aetiological profile of urinary stones in Tunisian children. The nucleus of the stones was composed of acidic ammonium urate in 48% of cases with a morphology suggestive of phosphorus deficiency associated with a history of diarrhoea. In 24% of cases, the nucleus contained struvite indicating the presence of urinary tract infection by urease-positive bacteria. The main growth factors of urinary stones were hyperoxaluria and urinary tract infection. In 5 cases, the stones were due to a hereditary lithogenic metabolic disease : cystinuria in 1 case and primary hyperoxaluria in 4 cases.

Adolescent↗
PubMed1994

A unique mutation underlying carbonic anhydrase II deficiency syndrome in patients of Arab descent.

We have investigated, in the genomic DNA of ten Tunisian patients, the presence of a splice junction mutation at the 5' end of intron 2 in the carbonic anhydrase II gene (CAII) previously described in six CAII-deficient patients presumed to be of Arab origin. All our patients were homozygous for this mutation and were mentally retarded, a characteristic feature of the phenotype of patients with an Arabic background. This mutation is found exclusively in patients with an Arabic background and thus may be confined to this ethnic group.

Acidosis, Renal Tubular↗
PubMed1994

[Successful treatment of chronic active hepatitis with high-dose intravenous immunoglobulins in agammaglobulinemia].

BACKGROUND: Rapid progression of chronic active hepatitis can occur in patients with hypogammaglobulinemia. This report describes the successful use of i.v. immunoglobulins to treat chronic hepatitis in a child with agammaglobulinemia. CASE REPORT: A 17 month-old boy was admitted because he had suffered from recurrent infections since the age of 6 months. His family history was normal. Clinical and laboratory investigations showed hepatomegaly, agammaglobulinemia with absence of IgG, IgA, IgM and IgE, absence of beta cells, normal T cells, normal T cell proliferation and normal levels of complement, elevated ALAT (70 and 200 IU/ml) and ASAT (60 and 188 IU/ml). Liver biopsy showed typical features of chronic active hepatitis. The cause of this hepatitis (B and C virus, EBV, autoimmune markers) was not found. The patient was first given gammaglobulins (80 mg/kg) every week, subcutaneously, for 9 weeks, which did not change his transaminasemia. A second course of gamma-globulins, 400 mg/kg every 3 weeks, intravenously, for 6 months, resulted in a transient normalization of transaminases for 3 months. Definitive normalization was only obtained when the patient was given i.v. gammaglobulins (400 mg/kg/week) which gave a residual level of blood IgG of 10 g/l. This apparent cessation of hepatitis activity was confirmed by a second liver biopsy. The patient is now given i.v. gammaglobulins, twice a month, producing a residual blood IgG concentration of 5 g/l. CONCLUSIONS: The activity of this chronic hepatitis is closely correlated with the residual blood IgG concentration. Gammaglobulins could help neutralize virus extra-cellularly, although the viral origin of this hepatitis has not been-demonstrated.

Agammaglobulinemia↗
PubMed1993

[Lupus in children in Tunisia].

In this study, we have analyzed the clinical and serological features related to 16 Tunisian children in whom diagnosis of systemic lupus erythematosus was made before or at the age of 15. Renal involvement was found in 75% of cases and renal biopsies have mostly revealed severe histologic patterns. All of the patients who have been followed received corticosteroids and in some cases required additional cytotoxic drugs in order to control disease activity. Five children died in a context of a renal failure. This study of childhood lupus in Tunisia confirms that the clinical course of this disease in children is often aggressive.

Adolescent↗
PubMed1993

[Non-typhoid Salmonella in pediatric patients in Tunis (Hospital Charles-Nicolle) from 1980 to 1991].

252 nontyphoidic salmonellae strains isolated from pediatrics were identified by using standard laboratory procedures and were serotyped with commercial antisera. Antibiotic susceptibility tests were performed by the agar diffusion method. Mostly isolates obtained from feces (182) and blood (67) and 89% of them from newborns and nursings. S. sér. Wien represented 75% of the isolates. The other serovars were essentially S. sér Typhimurium, S. sér Infantis and S. sér Enteritidis. All the isolates of S. sér Wien and S. sér Typhimurium were resistant to amoxicillin, carbenicillin, cephalothin, streptomycin, chloramphenicol and tetracycline from 1980. From 1987 S. sér Wien isolates developed resistance to cefotaxime and amikacin. Distribution nontyphoidic salmonellae strains according to the year was variable. Maximal isolates were in September and October. Two major epidemics were observed in this study, in 1982 and 1989. 94% of the strains determined nosocomial infections. The source of infection was established during the epidemic of 1989. The application of hygiene measures led to decline the number of isolates in 1990 and their disappearance in 1991, any strains of S. sér Wien was isolated.

Drug Resistance, Microbial↗