La néphrologie en Tunisie : d’hier à aujourd’hui

RésuméLa néphrologie en Tunisie fondée en 1962 par le Pr Hassouna Ben Ayed a connu un développement considérable dès 1975. De l’hôpital Charles Nicolle, elle a essaimé sur tout le territoire tunisien. Le premier laboratoire d’histopathologie rénale a vu le jour en avril 1975 permettant ainsi d’identifier le spectre des néphropathies glomérulaires et son évolution dans le temps. Le programme de traitement de l’IRCT par épuration extrarénale, initiée en 1968, a connu un développement fulgurant à partir de 1986 plaçant actuellement la Tunisie au niveau européen : incidence de 133 par million d’habitants (PMH) et prévalence de 734 PMH de dialysés. Les malades sont pris en charge par 106 néphrologues, formés en majorité en Tunisie et 253 médecins compétents en hémodialyse dans cinq services hospitalo-universitaires, deux unités dans l’hôpital militaire, 32 centres publics et 99 centres privés. Le registre national de l’IRCT est institué depuis 1986. La transplantation rénale, démarrée le 4 juin 1986 à l’hôpital Charles Nicolle par une équipe cent pour cent tunisienne, est pratiquée actuellement dans quatre autres hôpitaux universitaires. Une législation précise encadre l’hémodialyse et la transplantation rénale. Des progrès réalisés par la néphrologie en Tunisie sont certes visibles, mais nécessitent encore d’être soutenus par l’augmentation du nombre de néphrologues et l’ouverture d’autres services de néphrologie.

Professor Hassouna Ben Ayed is the founder of Tunisian nephrology. He introduced in 1962 the first artificial kidney for the treatment of acute renal failure. In 1963, the first acute peritoneal dialysis was done. Renal biopsy started in 1967 with general pathologists. A special laboratory of renal pathology was set up in 1975 with Pr H. Ben Maïz. Epidemiology of glomerular diseases, when histologically proven, was published [8]. A comprehensive program of chronic hemodialysis was started in 1968 and was developed markedly since 1975 with Pr A. El Matri. An intermittent peritoneal dialysis programme was started in 1982 and CAPD in 1983 by Pr T. Ben Abdallah. The Tunisian renal failure patient association was created in 1982 and the Tunisian society of nephrology in November 1983. A national registry for ESRD treatment is available since 1986. Since this time, the number of patients initiating renal replacement therapy (RRT) for ESRD has increased dramatically due to the extension of acceptance criteria for RRT and the increase of the elderly population. The incidence was 13 pmp in 1986 and 133 pmp in 2008. The prevalence was 48.5 pmp in 1986 and 734 pmp in 2008. From 1971 up to 1986, locally dialysed patients have been transplanted abroad, especially in France. On 4 June 1986, the local transplantation program was started at Charles Nicolle Hospital in Tunis. A national center of organ transplantation was created on 12 June 1995. At the end of 2008, there were106 nephrologists, 26 residents in nephrology and 253 doctors with a training in hemodialysis during 1 year. In university hospitals, the number of nephrology departments is five, with one unit in an army hospital and two units for pediatric nephrology. Five hospitals perform renal transplantation (Tunis: 2 – Sfax: 1 – Sousse: 1 – Monastir: 1). There are 138 centers of hemodialysis: 39 public, 99 private. Seven thousand and eighty patients were treated by HD, 127 patients underwent renal transplantation. The vast majority of these transplants have been performed using living related donors (103/127). The cost of renal replacement therapy (RRT) is taken in charge by the Ministry of Health and the national security boards. Legislation on HD was promulgated by the Tunisian government, setting rigorous and detailed rules for the implementation of new dialysis centers, as well as for the functioning of already active units (4 August 1986 – 4 April 1998). For transplantation, legislation was promulgated on 25 March 1991.