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symptomatic. Symptoms included cognitive decline/visual symptoms, optic ischaemic neuropathy/ auditory symptoms, nuchal pain & shoulder discomfort, instability whilst walking associated with a very high risk of falls & fracture, profound fatigue causing a state of marked dependency & house-bound for the most part of the inter-dialytic period. She received Midodrine 10 mg TDS, Fludrocortisone 100mcg & Erythropoietin.Droxidopa was commenced, in addition to other drugs, with 1 week of cardiac monitoring-No arrhythmias were recorded & LVOT gradient did not change at a dose of 400mg pre-dialysis at 0700 hours 3 times a week.The Orthostatic Hypotension Questionnaire (OHQ) was used to assess symptoms burden & severity of hypotension before commencing Droxidopa. Symptoms Diary was maintained by the patient throughout.Results: Table1 OHQ Scores Conclusions: Droxidopa 400 mg on dialysis days was well tolerated, achieved both symptomatic improvement & better blood pressure readings, both on HD & non-HD days during 4 months of follow up. Off label use can be considered in selected cases of difficult to manage hypotension in HD population, provided close & frequent monitoring can be offered.

Introduction: Urinary tract infection (UI), is the most common cause of infectious complications in kidney transplant recipients.These infections remain suspect due to their impact on graft survival and therefore on the morbidity and mortality of this population .These can occur at any time but with the highest incidence in the first 3-6months after transplantationour aims were as follow: 1. Assess the prevalence of UI in kidney transplant recipients. 2. Identify the risk factors for UI in kidney post transplantation.3. Study the microbiological profile and therapeutic attitudes of these UIs Methods: This is a descriptive and analytical retrospective study, carried out between January 2017 and November 2019 at the renal transplant unit in the nephrology department of Fattouma Bourguiba Hospital in Monastir. we included all kidney transplant patients hospitalized during this period Results: During this period 360 patients were hospitalized, IU was diagnosed in 32 patients. The average age of our population was 35.5 AE 9.6 years with a sex ratio of 1. The prevalence of IU in kidney transplant recipients was estimated at 8.8%. The graft acute pyelonephritis was the most frequent presentation. The most incriminated germs were the bacillus gram negative (BGN) represented mainly by Klebsielle pneumonae (47.7%). The most prescribed antibiotics were carbapenemes in 34% of cases followed by third generation cephalosporin (C3G) mainly cefotaxime (21.5%). The only UI risk factor found in our study with a statistically significant p was ureteric vesic reflux complicating a kidney transplant.Conclusions: Several other risk factors have been identified in the literature not objectived in our study, their recognition is important to identify kidney transplant recipients who are more likely to develop urinary tract infections and to minimize the risk with personalized care. for example, adequate screening and prophylaxis.No conflict of interest

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