title: [Brown tumors in chronic hemodialysis patients].
abstract: OBJECTIVE
  Brown tumors are rare and severe manifestations of secondary hyperparathyroidism. We propose in this study: to define and illustrate brown tumors observed in our hemodialysis center; to show the frequency for 20 years in our center; to identify risk factors compared to the rest of dialysis patients; and finally to offer improved support for reducing the incidence.
  
  
  METHODS
  We conducted a retrospective and descriptive study, over a period of 20 years (1993-2013), including 311 cumulative patients which are chronic hemodialysis in our unit.
  
  
  RESULTS
  Twenty-one patients had brown tumors (6.75%). The average age was 36.1 years and the sex ratio M/F is of 0.6. The average time between the start of hemodialysis and the diagnosis of brown tumor was 87.6 months. Clinical symptoms were dominated by bone pain, found in 76.1% of cases. The most frequent locations were costal (28.5% of cases), while spinal involvement was less frequent (4.76% of cases). The location was multifocal in 57.1% of cases. The mean serum calcium was of 2.08 mmol/L, the serum phosphate of 2.25 mmol/L, alkaline phosphatase of 1709 IU/L and the average value of parathyroid hormone of 1934 pg/mL. Radiography was the key of diagnostic. Resonance magnetic imaging and computed tomography had an interest in the exploration of spinal locations and maxillo-mandibular locations. All patients underwent parathyroidectomy and it was total in one patient. Tumorectomy was necessary in three patients (14.2% of cases). The outcome was favorable in 85.7% of cases.
  
  
  CONCLUSIONS
  Our work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors.
authors.affiliation: Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de recherche d'immunologie de transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie. Electronic address: imen_gorsane@voila.fr.
authors.forename: Imen
authors.initials: I
authors.lastname: Gorsane
authors.affiliation: Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie.
authors.forename: Asma
authors.initials: A
authors.lastname: Zammouri
authors.affiliation: Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie.
authors.forename: Jihede
authors.initials: J
authors.lastname: El Meddeb
authors.affiliation: Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie.
authors.forename: Fathi
authors.initials: F
authors.lastname: Younsi
authors.affiliation: Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de biochimie clinique, hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie.
authors.forename: Ahlem
authors.initials: A
authors.lastname: Bartkiz
authors.affiliation: Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de biochimie clinique, hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie.
authors.forename: Jouida
authors.initials: J
authors.lastname: Abdelmoula
authors.affiliation: Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie.
authors.forename: Samia
authors.initials: S
authors.lastname: Barbouch
authors.affiliation: Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de recherche d'immunologie de transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie.
authors.forename: Taieb
authors.initials: T
authors.lastname: Ben Abdallah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology*; D002118:Calcium / Q000097:blood; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase; D002118:Calcium
keywords: Brown tumors; End stage renal disease; Hemodialysis; Hyperparathyroïdie secondaire; Hémodialyse; Insuffisance rénale chronique terminale; Secondary hyperparathyroidism; Tumeurs brunes