Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to the onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these two factors have an as...Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to the onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these two factors have an association with the new incidence of CKD. Methods: Study design is a cohort study. A total of 14,485 participants were eligible for the cross-sectional analysis on UA levels and the prevalence of Mets. Among those individuals, 8,223 participants without CKD and 4,839 without Mets were eligible for the longitudinal analysis of the new incidence of CKD. Parameters monitored were body mass index, systolic and diastolic blood pressure, serum creatinine concentration, estimated glolerular filtration rate, lipid profiles, plasma glucose, HbA1c. The primary predictor was the level of UA and Mets to explain the newly-developed CKD. The observation period was 4 years. Results: In a cross-sectional analysis, higher UA levels were associated with the greater prevalence of Mets. In addition, UA levels were associated with the numbers of the Mets constituents in both genders. In a longitudinal analysis, higher UA levels were associated with the greater rate of CKD and the greater incidence of Mets. In addition, the incidence of CKD at year 4 was influenced by the presence of hyperuricemia, but not by that of the Mets. The odd ratio (OR) to predict the CKD incidence was 1.42 (95% confidence intervals (CI), 0.52 to 3.78) in the presence of Mets alone, 2.10 (95% CI, 1.36 to 3.23) in the presence of hyperuricemia alone, and 3.56 (95% CI, 1.55 to 8.21) in the presence of both. Conclusion: Hyperuricemia has a greater association with the incidence of CKD than Mets does. Hyperuricemia complicated by Mets is additionally detrimental.展开更多
Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (F...Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.展开更多
Background: Diabetes insipidus (DI) is a rare disorder characterized by inappropriate polyuria and hypo-osmolar urine. It is caused by inadequate production of antidiuretic hormone, in response to hypothalamic osmorec...Background: Diabetes insipidus (DI) is a rare disorder characterized by inappropriate polyuria and hypo-osmolar urine. It is caused by inadequate production of antidiuretic hormone, in response to hypothalamic osmoreceptor-stimulation, from the pituitary gland (central DI) or resistance to its action at terminal distal convoluted tubules and collecting ducts (nephrogenic DI). Most cases of nephrogenic DI are caused by drugs, especially chronic lithium use. The Case: A 46-year-old man manifested such a disorder 8 months following d-Penicillamine (d-P) therapy for cystinuria. The drug was discontinued and the patient was managed conservatively with high fluid intake, diet low in protein and salt as well as alkalization of urine with Urolyte U to a pH > 7.5. Six weeks later, such side effect disappeared. Our patient had developed such phenomenon: a) without significant liver or renal disease to account for cumulative toxicity, and b) with a conventional dosage range of d-P. Such isolated toxicity indicates inherited a predisposition to this side effect. Conclusion: DI is a potential side effect of d-P therapy that is nephrogenic in site, transient in prognosis and an isolated phenomenon likely to reflect genetic predisposition.展开更多
<strong>Introduction:</strong> Obstructive renal failure (ORF) or obstructive uropathy is defined by the simultaneous presence of impaired renal function and urinary excretory tract dilatation on medical i...<strong>Introduction:</strong> Obstructive renal failure (ORF) or obstructive uropathy is defined by the simultaneous presence of impaired renal function and urinary excretory tract dilatation on medical imaging. It accounts for 2% to 10% of the causes of acute renal failure (ARF). <strong>Objective:</strong> To determine the prevalence and etiologies of ORF in the nephrology department of the University Hospital Center of Point G. <strong>Methodology:</strong> This was a descriptive study with retrospective data collection conducted from January 1, 2017 to June 30, 2018. All patients hospitalized with renal failure due to urinary tract obstruction were included. The parameters studied were age, gender, etiology, type of renal impairment, procedures performed, surgical outcomes of the procedure, pre-and post-management creatinine levels. Information on these clinical and paraclinical variables was collected from individual hospitalization and patient follow-up records. <strong>Results:</strong> Among 1133 patients, 83 had obstructive renal failure, a prevalence of 7.32%. The sex ratio was 1.86. The mean age was 48.99 ± 6.81 years with extremes of 7 and 102 years. Signs suggestive of lower urinary tract obstruction were, in order of frequency: dysuria (50.6%), urinary burns (44.6%), urinary frequency (44.6%), pollakiuria (44.6%), macroscopic hematuria (25.3%), low back pain (21.6%), total anuria (18.1%). The etiologies were dominated by lithiasis 36 cases (43.4%), tumours 32 cases (38.55%) followed by sequelae of bilharziasis 12 cases (14.50%). <strong>Conclusion:</strong> Obstructive renal failure is becoming more and more common. The etiology is essentially of lithiasic and tumor origin. It must be treated early to allow total or partial recovery of renal function.展开更多
Background: Previous studies have shown that reduced renal plasma flow (RPF) may play a role in progression of renal disease in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan, a vasopressin 2 antagoni...Background: Previous studies have shown that reduced renal plasma flow (RPF) may play a role in progression of renal disease in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan, a vasopressin 2 antagonist, reduces growth of total kidney volume and slows the decrease in estimated glomerular filtration rate (eGFR) in ADPKD. The purpose of this randomized, cross-over, double-blind, placebo-controlled study was to investigate if acute tolvaptan treatment increases RPF in ADPKD patients. Methods: Eighteen ADPKD patients (chronic kidney disease stages I-III) were investigated twice (min. 10 days apart) after acute treatment with either tolvaptan 60 mg or placebo. Two hours after treatment RPF and GFR were estimated by Technetium-99m diethylenetriamine penta-acetic acid (99-mTc-DTPA) renography. During the examination day, central and brachial blood pressures (BP) were measured using Mobil-O-Graph? PWA. We also measured plasma concentrations of vasopressin (p-AVP), renin (PRC), angiotensin II (p-AngII) and aldosterone (p-Aldo), urine excretion of aquaporin 2 (u-AQP2), urine output (OU), urine osmolality (u-Osm) and fractional excretion of sodium (FENa). Results: 99-mTc-DTPA renography showed a similar RPF (673 ± 262 ml/min after tolvaptan vs. 650 ± 209 ml/min after placebo, p = 0.571) and GFR (78 ± 26 ml/min after tolvaptan vs. 79 ± 21 ml/min after placebo p = 0.774) after tolvaptan and placebo treatment. P-AVP and UO increased and u-Osm decreased after tolvaptan and remained unchanged during placebo. Systolic BP tended to decrease during renography during tolvaptan. Very small or insignificant changes were seen in PRC, p-AngII and p-Aldo. Conclusions: Acute tolvaptan treatment did not change renal hemodynamics in ADPKD.展开更多
Introduction: Cardio-renal syndrome (CRS) is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one organ can lead to acute or chronic dysfunction of the other. In Africa, ...Introduction: Cardio-renal syndrome (CRS) is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one organ can lead to acute or chronic dysfunction of the other. In Africa, particularly in C?te d’Ivoire, the incidence of cardio-renal syndrome is not precisely known. The aim of this study was to assess the frequency of CRS and to contribute to a better understanding of the condition in the medical department of the Abidjan Heart Institute. Materials and Methods: We conducted a prospective analytical study including all patients with heart failure hospitalised in the medicine department of the Abidjan Heart Institute from March to October 2020. Data were analysed using SPSS software version 22. Results: We included 111 patients in the study. The incidence of CRS was 64%, with a predominance of males (sex ratio 1.8). The mean age was 53 ± 15 years. Patients’ medical history was dominated by hypertension (56.8%), diabetes (15%), dyslipidaemia (18%), obesity (17.1%) and smoking (14.4%). The main causes of heart failure were dilated cardiomyopathy (22.8%) and ischaemic heart disease (21.4%). Symptomatology was mainly congestive heart failure (42.8%). Mean evaluated clearance (MDRD) was 39.9 ± 17.1 ml/min/m<sup>2</sup>. Doppler echocardiography showed a decrease in left ventricular ejection fraction in 74.3% of patients. Factors statistically associated with the occurrence of cardio-renal syndrome were: age > 60 years (p = 0.04), diabetes (p = 0.03), arterial hypertension (p = 0.001) and Hb Conclusion: The cardio-renal syndrome is a reality and marks an important point in the evolution of cardiac and renal diseases. It is highly frequent in the medical department of the Abidjan Heart Institute, as well as a high rate of CKD.展开更多
<strong>Aim:</strong> The objectives of this study are to determine the epidemiology of biopsy-proven glomerular disease (GD) in Central Queensland and the effect of a severe cyclone on its incidence and c...<strong>Aim:</strong> The objectives of this study are to determine the epidemiology of biopsy-proven glomerular disease (GD) in Central Queensland and the effect of a severe cyclone on its incidence and clinical phenotype. <strong>Background:</strong> Central Queensland (CQ) has a relatively high incidence of kidney disease. Since its biopsy service commenced in 2005, there have been no data on biopsy-proven GD. It has been suggested that GD incidence changes around times of natural disasters. In February 2015, the CQ region was affected by a category 5 Cyclone Marcia. This provides an opportunity to explore possible environmental triggers of GD. <strong>Methods:</strong> This was a single-centre retrospective observational study on biopsy-proven kidney disease in CQ. All kidney biopsies performed between January 2005 and December 2019 were included. Patients with biopsy-proven GD during 3 years before and after Cyclone Marcia (from 2012 to 2018) were analysed. <strong>Results:</strong> 170 native kidney biopsies occurred during the 15 years. The number of annual biopsies steadily increased from 7 to 16. The most common biopsy-proven kidney disease was IgA Nephropathy (27%) followed by diabetic nephropathy (20%). GD comprised 64% of biopsies. Unlike other GD, the incidence of ANCA-associated vasculitis (AAV) significantly increased after cyclone (one pre- and eight post-cyclone, P value = 0.039). The majority of AAV cases occurred in the first year after the cyclone. <strong>Conclusion:</strong> Kidney biopsies in CQ provide important epidemiological data on biopsy-proven kidney disease. Cyclones have a possible effect on the incidence and clinical phenotype of ANCA associated vasculitis.展开更多
C3 glomerulopathy is a disease including both dense deposit disease and C3 glomerulonephritis has an estimated prevalence of 2 to 3 per million. Originally, these pathologies were defined as glomerular pathology chara...C3 glomerulopathy is a disease including both dense deposit disease and C3 glomerulonephritis has an estimated prevalence of 2 to 3 per million. Originally, these pathologies were defined as glomerular pathology characterized by accumulation of C3 with absent or scanty immunoglobulin deposition. The keystone defect in both of these pathologies is the unregulated hyperactivity of alternative complement pathway. Specifically, in C3 glomerulopathy patients, there exists a prolongation of C3 cleavage which causes the uncontrolled alternative pathway activation. Many treatments have been investigated for treating C3 glomerulopathy to little or no avail, including calcineurin inhibitors, plasmapharesis, and anti-CD20 monoclonal antibodies. The next logical step is exploring the efficacy of anti-C5 monoclonal antibody therapy in C3 glomerulopathies to target the specific pathophysiology of this particular disease. Eculizumab is an anti-C5 monoclonal antibody that blocks the terminal step of complement activation. This drug has proven to be an effective treatment in other nephrologic pathologies that are caused by complement dysregulation. Here in this paper we discuss and present various case studies and clinical trials available that experiment with Eculizumab in patients with either dense deposit disease or C3 glomerulonephritis. In most of these patients, treatment with Eculizumab has demonstrated clinical and biochemical improvements in kidney function. These results provide encouraging evidence that suggest Eculizumab as a promising therapy for patients with C3 glomerulopathy and warrant that more extensive clinical trials can be designed as a next step.展开更多
Aim: To study the functional dyspepsia in chronic hemodialysis patients of CNHU-HKM of Cotonou. Methods: This descriptive, analytical and cross-sectional study ran from 1 September 2013 to 28 February 2014 in the Univ...Aim: To study the functional dyspepsia in chronic hemodialysis patients of CNHU-HKM of Cotonou. Methods: This descriptive, analytical and cross-sectional study ran from 1 September 2013 to 28 February 2014 in the University Clinic of Nephrology Dialysis of CNHU-HKM of Cotonou. It included all chronic renal failure patients on hemodialysis for at least 9 months prior to the survey. After identifying the patients with upper gastrointestinal disorders, we had submitted to clinical Rome III criteria for functional dyspepsia. Upper endoscopy was performed in patients with clinical criteria of functional dyspepsia. Clinical factors associated, paraclinical and therapeutic were sought by logistic regression in univariate analysis. Data were analyzed using EPI DATA version 3.1. Results: 1) One hundred and thirty-one haemodialysis patients had participated in the study (sex ratio: 1.5, average age 49.6 ± 12.4 years). 2) The prevalence was 71.8% for upper gastrointestinal disorders, 64.9% for dyspeptic syndrome and 1.5% for functional dyspepsia. 3) They were associated to clinical criteria of functional dyspepsia of Roma III, the presence of high blood pressure, hypocalcaemia, treatment with calcic inhibitors and iron supplementation. Conclusion: Functional dyspepsia is uncommon in hemodialysis. The search of an organic cause is imperative for every dyspepsia.展开更多
Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, ac...Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.展开更多
Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the man...Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.展开更多
Goal: By describing the epidemiology of chronic hemodialysis patients in the single hemodialysis unit of Burkina Faso, we want to contribute to the prevention and improvement of chronic renal failure management (CRF) ...Goal: By describing the epidemiology of chronic hemodialysis patients in the single hemodialysis unit of Burkina Faso, we want to contribute to the prevention and improvement of chronic renal failure management (CRF) in this country. Patients and Methods: A descriptive cross-sectional study was conducted in the hemodialysis unit of the University Hospital Center Yalgado Ouedraogo (UHC-YO) during the period from February 12 to May 15, 2015. The patients who started hemodialysis in this unit and were treated for at least three months were included in this study. The sociodemographic and clinical data were collected. The statistical significance was defined for a probability (p ≤ 0.05). Results: One hundred and seventy-two patients (71.2% of the 240 patients of the unit) have been included. The sex ratio was 1.6. The average age was 45.2 ± 12.4 years old. The presumed causes of CRF have been identified in 134 cases (77.9%). The most frequent were hypertensive nephropathy (65 cases;48.5%), chronic glomerulonephritis (41 cases;30.6%;including 11 viral origin and 16 with history of recurrent otorhinolaryngologic infections and/or urinary schistosomiasis). Hemodialysis began in an emergency context in 118 cases (68.6%). The average duration of hemodialysis was 29.4 ± 28.4 months. Conclusion: The main suspected causes of CRF were hypertension and chronic glomerulonephritis. The origin of the latter seemed more often infectious. Prevention of CRF in Burkina Faso should be focused on that of hypertension and infectious diseases.展开更多
Coexistence of chronic kidney disease (CKD) and chronic heart failure (CHF) define a recently recognized clinical entity known as cardio-renal syndrome. Sufficient evidence suggests that the two pathological condition...Coexistence of chronic kidney disease (CKD) and chronic heart failure (CHF) define a recently recognized clinical entity known as cardio-renal syndrome. Sufficient evidence suggests that the two pathological conditions share common pathogenic etiology which is not yet fully defined. Superimposed anaemia is a common finding among patients suffering from cardio-renal syndrome. The combination of CKD, CHF and anaemia increase the probability of death by 6 times compared to normal individuals. Early attempts to restore anaemia either by iron supplementation, erythropoiesis stimulating agents (ESAs) or combination of the two have reported to improve quality of life, morbidity and mortality especially among patients treated by cardiologists. Recent publications of well controlled epidemiological studies failed to prove convincing beneficial effect of the above mentioned therapy moreover skepticism has raised concerning the safety of restoring anaemia among patients with cardio-renal syndrome as well as used medications. There are still unresolved problems concerning the definition of anaemia, by means of hemoglobin level among these patients, the target hemoglobin level and the therapeutic regimen of ESAs administration and iron supplementation. We need much more evidence in order to define an effective and safe treatment strategy correcting anaemia among patients with cardio-renal syndrome.展开更多
Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and dialysis admission. Few studies are available in Sub-Saharan Africa. The objective of this work was to study the epidemiolog...Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and dialysis admission. Few studies are available in Sub-Saharan Africa. The objective of this work was to study the epidemiological, clinical, diagnostic and therapeutic characteristics of DKD in our context. Patients and Methods: We conducted an observational, exhaustive and retrospective study focusing on diabetic patients seen in consultation or hospitalized in the Nephrology Department of at the Aristide Le Dantec University Hospital in Dakar during a period of 5 years from January 1, 2017 to December 31, 2021. Results: Of 4735 patients seen during the study period, 491 had DKD, i.e. a hospital prevalence of 10.36%. The average age was 59.1 ± 11.4 years with a sex ratio of 0.95. Type 2 diabetes predominated with 93.4%. The average duration of diabetes was 11.5 ± 7.6 years. Diabetes was associated with high blood pressure in 78.81% of cases, dyslipidemia in 23.2% of cases, active smoking in 6.7% of cases and obesity in 1.6% of cases. Renal failure was the main reason for referral 72.3%. One hundred and forty-eight patients (30.1%) had uncontrolled diabetes. Macroalbuminuria was found in 64.8% and microalbuminuria in 18.7% of cases. One hundred and eighty-five patients (37.7%) were in Stage V of kidney disease and 137 patients were in Stage III (18.1% in Stage IIIb and 9.8% in Stage IIIa). Diabetic nephropathy was the main etiology at 61.30%. Nephropathy was mixed (diabetic and hypertensive) in 18.12 cases. Renin-angiotensin-aldosterone system (RAAS) blockers were prescribed in 83.5% of patients. Conclusion: The different etiologies encountered during the study show the diversity of diabetic kidney disease. Diabetic nephropathy is not the only kidney damage that can occur in diabetics in our context.展开更多
Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the explorati...Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. <strong>Materials and Methods:</strong> This was a prospective and descriptive study from January 1<sup>st</sup>, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. <strong>Results:</strong> We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P < 0.001). The mortality rate was 6%. <strong>Conclusion:</strong> Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.展开更多
Context: Human immunodeficiency virus (HIV) infected children are at risk of developing chronic kidney disease defined by decreased glomerular filtration rate and or proteinuria. Studies on the prevalence of and risk ...Context: Human immunodeficiency virus (HIV) infected children are at risk of developing chronic kidney disease defined by decreased glomerular filtration rate and or proteinuria. Studies on the prevalence of and risk factors for proteinuria among HIV-infected children in sub-Saharan Africa are scarce and in Cote d’Ivoire, there is paucity of reported data. We determined the prevalence of and the risk factors for proteinuria among HIV-infected Ivorian children in both ART (antiretroviral therapy)-na?ve and ART-exposed children. Method: It was a cross-sectional bi-centric study, conducted from July 2013 to April 2014. Each child’s urine was tested for proteinuria and microalbuminuria using multi test strips and mitral test, respectively. Proteinuria was defined as of significant of 1+ and above on the dipstick or the presence of microalbuminuria ≥ 20 mg/l. Results: Of the 155 HIV-infected children enrolled, there were 78 boys. Sixty seven point seven percent were treated with antiretroviral and 74.1% had treatment duration of less than 5 years. In the first dipstick test, the prevalence of proteinuria was 29% which persisted in 9.7% after 24 hour urinary protein examination. It was significantly different between the 2 groups treated and na?ve (2.8% versus 24%). The advanced CDC clinical stage emerged as the main independent determinant of proteinuria. Conclusion: Proteinuria is common in HIV-infected Ivorian children. Screening for proteinuria in HIV-infected children will help in early and treatment, and thus prevention and progression to chronic kidney disease to end-stage kidney disease.展开更多
Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Several therapeutic interventions for the treatment of diabetic nephropathy hav...Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Several therapeutic interventions for the treatment of diabetic nephropathy have been developed and implemented over the past few decades with some degree of success. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are therefore urgently needed. Recently, several novel therapeutic strategies have been explored in treating DN patients including Islet cell transplant, Aldose reductase inhibitors, Sulodexide (GAC), Protein Kinase C (PKC) inhibitors, Connective tissue growth factor (CTGF) inhibitors, Transforming growth factor-beta (TGF-β) inhibitors and bardoxolone. The benefits and risks of these agents are still under investigation. This review aims to summarize the utility of these novel therapeutic approaches.展开更多
Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodial...Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodialysis patients in Lomé. Patients and Method: Cross-sectional study was conducted from August 1 to 31, 2021 in hemodialysis patients at the Sylvanus Olympio University Hospital to obtain their opinion on the anti-COVID-19 vaccination. Results: One hundred and twenty-three patients on regular hemodialysis were interviewed;their mean age was 45 years [37 - 55.5 years]. The average number of years patients were on dialysis was 3 years [2 - 5 years]. The general opinion on vaccination was mostly unfavorable (59.3%). Reasons given included: doubts about the quality of the vaccine (49.6%), fear of side effects (51.2%), alarming messages on social networks (36.5%) and doubts about the efficacy of the vaccines (33.3%). Only half of the patients in favor of vaccination were already vaccinated at the time of the survey. The main motivations for getting vaccinated were dominated by: fear of developing a severe form of COVID-19 if infected (32.5%), frailty due to age (19.5%) and medical history (15.4%). Social networks (72.3%), television (60.1%), family and friends (55.2%) were the main sources of information for patients about COVID-19 vaccination. Conclusion: Hemodialysis patients are mostly septic to anti-COVID-19 vaccination.展开更多
Introduction: Patients with chronic diseases, especially kidney diseases, frequently use the health care system and free dialysis policies are being implemented in many countries in Africa. This study aimed to evaluat...Introduction: Patients with chronic diseases, especially kidney diseases, frequently use the health care system and free dialysis policies are being implemented in many countries in Africa. This study aimed to evaluate access to care for patients with chronic kidney disease (CKD) in northern region of Saint-Louis. Methodology: In a cross-sectional survey, we included non-dialyzed CKD patients aged ≥20 years who attended outpatient nephrology clinic at University Hospital of Saint-Louis between January 1st and January 31st 2018. Access to care was measured using a questionnaire that integrated dimensions such as availability, geographic and financial accessibility, convenience, acceptability, effectiveness of care and quality of information. Socio-demographic and clinical data were also collected and analyzed with Epi Info 7. Results: Among 97 surveyed patients, 90 were included (response rate of 92.8%). Patients’ mean age was 35.2 years (20 - 89 years) and 55% were male. Only 30% of patients had health coverage either by the government, or private insurance or community health insurance. Access to care was rated as globally low by 73% of participants. However, we noticed some variations according to dimensions of access. Geographical accessibility and convenience of delivered care were good for the majority of patients, while financial access and acceptability of care were considered as very limited. Bivariate analysis showed that acceptability and effectiveness of care were linked to CKD stage while the quality of patients’ information was correlated with their educational level. Furthermore, health coverage was also associated with financial accessibility of care but not with its availability. Conclusion: This study showed that access to care is poor for majority of patients with CKD in Saint-Louis. Identification of the main barriers will help define appropriate strategies to achieve universal access to quality renal care.展开更多
<strong>Introduction:</strong> Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to ma...<strong>Introduction:</strong> Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. <strong>Objective:</strong> To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. <strong>Results:</strong> We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. <strong>Conclusion:</strong> Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.展开更多
文摘Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to the onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these two factors have an association with the new incidence of CKD. Methods: Study design is a cohort study. A total of 14,485 participants were eligible for the cross-sectional analysis on UA levels and the prevalence of Mets. Among those individuals, 8,223 participants without CKD and 4,839 without Mets were eligible for the longitudinal analysis of the new incidence of CKD. Parameters monitored were body mass index, systolic and diastolic blood pressure, serum creatinine concentration, estimated glolerular filtration rate, lipid profiles, plasma glucose, HbA1c. The primary predictor was the level of UA and Mets to explain the newly-developed CKD. The observation period was 4 years. Results: In a cross-sectional analysis, higher UA levels were associated with the greater prevalence of Mets. In addition, UA levels were associated with the numbers of the Mets constituents in both genders. In a longitudinal analysis, higher UA levels were associated with the greater rate of CKD and the greater incidence of Mets. In addition, the incidence of CKD at year 4 was influenced by the presence of hyperuricemia, but not by that of the Mets. The odd ratio (OR) to predict the CKD incidence was 1.42 (95% confidence intervals (CI), 0.52 to 3.78) in the presence of Mets alone, 2.10 (95% CI, 1.36 to 3.23) in the presence of hyperuricemia alone, and 3.56 (95% CI, 1.55 to 8.21) in the presence of both. Conclusion: Hyperuricemia has a greater association with the incidence of CKD than Mets does. Hyperuricemia complicated by Mets is additionally detrimental.
文摘Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.
文摘Background: Diabetes insipidus (DI) is a rare disorder characterized by inappropriate polyuria and hypo-osmolar urine. It is caused by inadequate production of antidiuretic hormone, in response to hypothalamic osmoreceptor-stimulation, from the pituitary gland (central DI) or resistance to its action at terminal distal convoluted tubules and collecting ducts (nephrogenic DI). Most cases of nephrogenic DI are caused by drugs, especially chronic lithium use. The Case: A 46-year-old man manifested such a disorder 8 months following d-Penicillamine (d-P) therapy for cystinuria. The drug was discontinued and the patient was managed conservatively with high fluid intake, diet low in protein and salt as well as alkalization of urine with Urolyte U to a pH > 7.5. Six weeks later, such side effect disappeared. Our patient had developed such phenomenon: a) without significant liver or renal disease to account for cumulative toxicity, and b) with a conventional dosage range of d-P. Such isolated toxicity indicates inherited a predisposition to this side effect. Conclusion: DI is a potential side effect of d-P therapy that is nephrogenic in site, transient in prognosis and an isolated phenomenon likely to reflect genetic predisposition.
文摘<strong>Introduction:</strong> Obstructive renal failure (ORF) or obstructive uropathy is defined by the simultaneous presence of impaired renal function and urinary excretory tract dilatation on medical imaging. It accounts for 2% to 10% of the causes of acute renal failure (ARF). <strong>Objective:</strong> To determine the prevalence and etiologies of ORF in the nephrology department of the University Hospital Center of Point G. <strong>Methodology:</strong> This was a descriptive study with retrospective data collection conducted from January 1, 2017 to June 30, 2018. All patients hospitalized with renal failure due to urinary tract obstruction were included. The parameters studied were age, gender, etiology, type of renal impairment, procedures performed, surgical outcomes of the procedure, pre-and post-management creatinine levels. Information on these clinical and paraclinical variables was collected from individual hospitalization and patient follow-up records. <strong>Results:</strong> Among 1133 patients, 83 had obstructive renal failure, a prevalence of 7.32%. The sex ratio was 1.86. The mean age was 48.99 ± 6.81 years with extremes of 7 and 102 years. Signs suggestive of lower urinary tract obstruction were, in order of frequency: dysuria (50.6%), urinary burns (44.6%), urinary frequency (44.6%), pollakiuria (44.6%), macroscopic hematuria (25.3%), low back pain (21.6%), total anuria (18.1%). The etiologies were dominated by lithiasis 36 cases (43.4%), tumours 32 cases (38.55%) followed by sequelae of bilharziasis 12 cases (14.50%). <strong>Conclusion:</strong> Obstructive renal failure is becoming more and more common. The etiology is essentially of lithiasic and tumor origin. It must be treated early to allow total or partial recovery of renal function.
文摘Background: Previous studies have shown that reduced renal plasma flow (RPF) may play a role in progression of renal disease in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan, a vasopressin 2 antagonist, reduces growth of total kidney volume and slows the decrease in estimated glomerular filtration rate (eGFR) in ADPKD. The purpose of this randomized, cross-over, double-blind, placebo-controlled study was to investigate if acute tolvaptan treatment increases RPF in ADPKD patients. Methods: Eighteen ADPKD patients (chronic kidney disease stages I-III) were investigated twice (min. 10 days apart) after acute treatment with either tolvaptan 60 mg or placebo. Two hours after treatment RPF and GFR were estimated by Technetium-99m diethylenetriamine penta-acetic acid (99-mTc-DTPA) renography. During the examination day, central and brachial blood pressures (BP) were measured using Mobil-O-Graph? PWA. We also measured plasma concentrations of vasopressin (p-AVP), renin (PRC), angiotensin II (p-AngII) and aldosterone (p-Aldo), urine excretion of aquaporin 2 (u-AQP2), urine output (OU), urine osmolality (u-Osm) and fractional excretion of sodium (FENa). Results: 99-mTc-DTPA renography showed a similar RPF (673 ± 262 ml/min after tolvaptan vs. 650 ± 209 ml/min after placebo, p = 0.571) and GFR (78 ± 26 ml/min after tolvaptan vs. 79 ± 21 ml/min after placebo p = 0.774) after tolvaptan and placebo treatment. P-AVP and UO increased and u-Osm decreased after tolvaptan and remained unchanged during placebo. Systolic BP tended to decrease during renography during tolvaptan. Very small or insignificant changes were seen in PRC, p-AngII and p-Aldo. Conclusions: Acute tolvaptan treatment did not change renal hemodynamics in ADPKD.
文摘Introduction: Cardio-renal syndrome (CRS) is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one organ can lead to acute or chronic dysfunction of the other. In Africa, particularly in C?te d’Ivoire, the incidence of cardio-renal syndrome is not precisely known. The aim of this study was to assess the frequency of CRS and to contribute to a better understanding of the condition in the medical department of the Abidjan Heart Institute. Materials and Methods: We conducted a prospective analytical study including all patients with heart failure hospitalised in the medicine department of the Abidjan Heart Institute from March to October 2020. Data were analysed using SPSS software version 22. Results: We included 111 patients in the study. The incidence of CRS was 64%, with a predominance of males (sex ratio 1.8). The mean age was 53 ± 15 years. Patients’ medical history was dominated by hypertension (56.8%), diabetes (15%), dyslipidaemia (18%), obesity (17.1%) and smoking (14.4%). The main causes of heart failure were dilated cardiomyopathy (22.8%) and ischaemic heart disease (21.4%). Symptomatology was mainly congestive heart failure (42.8%). Mean evaluated clearance (MDRD) was 39.9 ± 17.1 ml/min/m<sup>2</sup>. Doppler echocardiography showed a decrease in left ventricular ejection fraction in 74.3% of patients. Factors statistically associated with the occurrence of cardio-renal syndrome were: age > 60 years (p = 0.04), diabetes (p = 0.03), arterial hypertension (p = 0.001) and Hb Conclusion: The cardio-renal syndrome is a reality and marks an important point in the evolution of cardiac and renal diseases. It is highly frequent in the medical department of the Abidjan Heart Institute, as well as a high rate of CKD.
文摘<strong>Aim:</strong> The objectives of this study are to determine the epidemiology of biopsy-proven glomerular disease (GD) in Central Queensland and the effect of a severe cyclone on its incidence and clinical phenotype. <strong>Background:</strong> Central Queensland (CQ) has a relatively high incidence of kidney disease. Since its biopsy service commenced in 2005, there have been no data on biopsy-proven GD. It has been suggested that GD incidence changes around times of natural disasters. In February 2015, the CQ region was affected by a category 5 Cyclone Marcia. This provides an opportunity to explore possible environmental triggers of GD. <strong>Methods:</strong> This was a single-centre retrospective observational study on biopsy-proven kidney disease in CQ. All kidney biopsies performed between January 2005 and December 2019 were included. Patients with biopsy-proven GD during 3 years before and after Cyclone Marcia (from 2012 to 2018) were analysed. <strong>Results:</strong> 170 native kidney biopsies occurred during the 15 years. The number of annual biopsies steadily increased from 7 to 16. The most common biopsy-proven kidney disease was IgA Nephropathy (27%) followed by diabetic nephropathy (20%). GD comprised 64% of biopsies. Unlike other GD, the incidence of ANCA-associated vasculitis (AAV) significantly increased after cyclone (one pre- and eight post-cyclone, P value = 0.039). The majority of AAV cases occurred in the first year after the cyclone. <strong>Conclusion:</strong> Kidney biopsies in CQ provide important epidemiological data on biopsy-proven kidney disease. Cyclones have a possible effect on the incidence and clinical phenotype of ANCA associated vasculitis.
文摘C3 glomerulopathy is a disease including both dense deposit disease and C3 glomerulonephritis has an estimated prevalence of 2 to 3 per million. Originally, these pathologies were defined as glomerular pathology characterized by accumulation of C3 with absent or scanty immunoglobulin deposition. The keystone defect in both of these pathologies is the unregulated hyperactivity of alternative complement pathway. Specifically, in C3 glomerulopathy patients, there exists a prolongation of C3 cleavage which causes the uncontrolled alternative pathway activation. Many treatments have been investigated for treating C3 glomerulopathy to little or no avail, including calcineurin inhibitors, plasmapharesis, and anti-CD20 monoclonal antibodies. The next logical step is exploring the efficacy of anti-C5 monoclonal antibody therapy in C3 glomerulopathies to target the specific pathophysiology of this particular disease. Eculizumab is an anti-C5 monoclonal antibody that blocks the terminal step of complement activation. This drug has proven to be an effective treatment in other nephrologic pathologies that are caused by complement dysregulation. Here in this paper we discuss and present various case studies and clinical trials available that experiment with Eculizumab in patients with either dense deposit disease or C3 glomerulonephritis. In most of these patients, treatment with Eculizumab has demonstrated clinical and biochemical improvements in kidney function. These results provide encouraging evidence that suggest Eculizumab as a promising therapy for patients with C3 glomerulopathy and warrant that more extensive clinical trials can be designed as a next step.
文摘Aim: To study the functional dyspepsia in chronic hemodialysis patients of CNHU-HKM of Cotonou. Methods: This descriptive, analytical and cross-sectional study ran from 1 September 2013 to 28 February 2014 in the University Clinic of Nephrology Dialysis of CNHU-HKM of Cotonou. It included all chronic renal failure patients on hemodialysis for at least 9 months prior to the survey. After identifying the patients with upper gastrointestinal disorders, we had submitted to clinical Rome III criteria for functional dyspepsia. Upper endoscopy was performed in patients with clinical criteria of functional dyspepsia. Clinical factors associated, paraclinical and therapeutic were sought by logistic regression in univariate analysis. Data were analyzed using EPI DATA version 3.1. Results: 1) One hundred and thirty-one haemodialysis patients had participated in the study (sex ratio: 1.5, average age 49.6 ± 12.4 years). 2) The prevalence was 71.8% for upper gastrointestinal disorders, 64.9% for dyspeptic syndrome and 1.5% for functional dyspepsia. 3) They were associated to clinical criteria of functional dyspepsia of Roma III, the presence of high blood pressure, hypocalcaemia, treatment with calcic inhibitors and iron supplementation. Conclusion: Functional dyspepsia is uncommon in hemodialysis. The search of an organic cause is imperative for every dyspepsia.
文摘Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.
文摘Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.
文摘Goal: By describing the epidemiology of chronic hemodialysis patients in the single hemodialysis unit of Burkina Faso, we want to contribute to the prevention and improvement of chronic renal failure management (CRF) in this country. Patients and Methods: A descriptive cross-sectional study was conducted in the hemodialysis unit of the University Hospital Center Yalgado Ouedraogo (UHC-YO) during the period from February 12 to May 15, 2015. The patients who started hemodialysis in this unit and were treated for at least three months were included in this study. The sociodemographic and clinical data were collected. The statistical significance was defined for a probability (p ≤ 0.05). Results: One hundred and seventy-two patients (71.2% of the 240 patients of the unit) have been included. The sex ratio was 1.6. The average age was 45.2 ± 12.4 years old. The presumed causes of CRF have been identified in 134 cases (77.9%). The most frequent were hypertensive nephropathy (65 cases;48.5%), chronic glomerulonephritis (41 cases;30.6%;including 11 viral origin and 16 with history of recurrent otorhinolaryngologic infections and/or urinary schistosomiasis). Hemodialysis began in an emergency context in 118 cases (68.6%). The average duration of hemodialysis was 29.4 ± 28.4 months. Conclusion: The main suspected causes of CRF were hypertension and chronic glomerulonephritis. The origin of the latter seemed more often infectious. Prevention of CRF in Burkina Faso should be focused on that of hypertension and infectious diseases.
文摘Coexistence of chronic kidney disease (CKD) and chronic heart failure (CHF) define a recently recognized clinical entity known as cardio-renal syndrome. Sufficient evidence suggests that the two pathological conditions share common pathogenic etiology which is not yet fully defined. Superimposed anaemia is a common finding among patients suffering from cardio-renal syndrome. The combination of CKD, CHF and anaemia increase the probability of death by 6 times compared to normal individuals. Early attempts to restore anaemia either by iron supplementation, erythropoiesis stimulating agents (ESAs) or combination of the two have reported to improve quality of life, morbidity and mortality especially among patients treated by cardiologists. Recent publications of well controlled epidemiological studies failed to prove convincing beneficial effect of the above mentioned therapy moreover skepticism has raised concerning the safety of restoring anaemia among patients with cardio-renal syndrome as well as used medications. There are still unresolved problems concerning the definition of anaemia, by means of hemoglobin level among these patients, the target hemoglobin level and the therapeutic regimen of ESAs administration and iron supplementation. We need much more evidence in order to define an effective and safe treatment strategy correcting anaemia among patients with cardio-renal syndrome.
文摘Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and dialysis admission. Few studies are available in Sub-Saharan Africa. The objective of this work was to study the epidemiological, clinical, diagnostic and therapeutic characteristics of DKD in our context. Patients and Methods: We conducted an observational, exhaustive and retrospective study focusing on diabetic patients seen in consultation or hospitalized in the Nephrology Department of at the Aristide Le Dantec University Hospital in Dakar during a period of 5 years from January 1, 2017 to December 31, 2021. Results: Of 4735 patients seen during the study period, 491 had DKD, i.e. a hospital prevalence of 10.36%. The average age was 59.1 ± 11.4 years with a sex ratio of 0.95. Type 2 diabetes predominated with 93.4%. The average duration of diabetes was 11.5 ± 7.6 years. Diabetes was associated with high blood pressure in 78.81% of cases, dyslipidemia in 23.2% of cases, active smoking in 6.7% of cases and obesity in 1.6% of cases. Renal failure was the main reason for referral 72.3%. One hundred and forty-eight patients (30.1%) had uncontrolled diabetes. Macroalbuminuria was found in 64.8% and microalbuminuria in 18.7% of cases. One hundred and eighty-five patients (37.7%) were in Stage V of kidney disease and 137 patients were in Stage III (18.1% in Stage IIIb and 9.8% in Stage IIIa). Diabetic nephropathy was the main etiology at 61.30%. Nephropathy was mixed (diabetic and hypertensive) in 18.12 cases. Renin-angiotensin-aldosterone system (RAAS) blockers were prescribed in 83.5% of patients. Conclusion: The different etiologies encountered during the study show the diversity of diabetic kidney disease. Diabetic nephropathy is not the only kidney damage that can occur in diabetics in our context.
文摘Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. <strong>Materials and Methods:</strong> This was a prospective and descriptive study from January 1<sup>st</sup>, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. <strong>Results:</strong> We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P < 0.001). The mortality rate was 6%. <strong>Conclusion:</strong> Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.
文摘Context: Human immunodeficiency virus (HIV) infected children are at risk of developing chronic kidney disease defined by decreased glomerular filtration rate and or proteinuria. Studies on the prevalence of and risk factors for proteinuria among HIV-infected children in sub-Saharan Africa are scarce and in Cote d’Ivoire, there is paucity of reported data. We determined the prevalence of and the risk factors for proteinuria among HIV-infected Ivorian children in both ART (antiretroviral therapy)-na?ve and ART-exposed children. Method: It was a cross-sectional bi-centric study, conducted from July 2013 to April 2014. Each child’s urine was tested for proteinuria and microalbuminuria using multi test strips and mitral test, respectively. Proteinuria was defined as of significant of 1+ and above on the dipstick or the presence of microalbuminuria ≥ 20 mg/l. Results: Of the 155 HIV-infected children enrolled, there were 78 boys. Sixty seven point seven percent were treated with antiretroviral and 74.1% had treatment duration of less than 5 years. In the first dipstick test, the prevalence of proteinuria was 29% which persisted in 9.7% after 24 hour urinary protein examination. It was significantly different between the 2 groups treated and na?ve (2.8% versus 24%). The advanced CDC clinical stage emerged as the main independent determinant of proteinuria. Conclusion: Proteinuria is common in HIV-infected Ivorian children. Screening for proteinuria in HIV-infected children will help in early and treatment, and thus prevention and progression to chronic kidney disease to end-stage kidney disease.
文摘Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Several therapeutic interventions for the treatment of diabetic nephropathy have been developed and implemented over the past few decades with some degree of success. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are therefore urgently needed. Recently, several novel therapeutic strategies have been explored in treating DN patients including Islet cell transplant, Aldose reductase inhibitors, Sulodexide (GAC), Protein Kinase C (PKC) inhibitors, Connective tissue growth factor (CTGF) inhibitors, Transforming growth factor-beta (TGF-β) inhibitors and bardoxolone. The benefits and risks of these agents are still under investigation. This review aims to summarize the utility of these novel therapeutic approaches.
文摘Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodialysis patients in Lomé. Patients and Method: Cross-sectional study was conducted from August 1 to 31, 2021 in hemodialysis patients at the Sylvanus Olympio University Hospital to obtain their opinion on the anti-COVID-19 vaccination. Results: One hundred and twenty-three patients on regular hemodialysis were interviewed;their mean age was 45 years [37 - 55.5 years]. The average number of years patients were on dialysis was 3 years [2 - 5 years]. The general opinion on vaccination was mostly unfavorable (59.3%). Reasons given included: doubts about the quality of the vaccine (49.6%), fear of side effects (51.2%), alarming messages on social networks (36.5%) and doubts about the efficacy of the vaccines (33.3%). Only half of the patients in favor of vaccination were already vaccinated at the time of the survey. The main motivations for getting vaccinated were dominated by: fear of developing a severe form of COVID-19 if infected (32.5%), frailty due to age (19.5%) and medical history (15.4%). Social networks (72.3%), television (60.1%), family and friends (55.2%) were the main sources of information for patients about COVID-19 vaccination. Conclusion: Hemodialysis patients are mostly septic to anti-COVID-19 vaccination.
文摘Introduction: Patients with chronic diseases, especially kidney diseases, frequently use the health care system and free dialysis policies are being implemented in many countries in Africa. This study aimed to evaluate access to care for patients with chronic kidney disease (CKD) in northern region of Saint-Louis. Methodology: In a cross-sectional survey, we included non-dialyzed CKD patients aged ≥20 years who attended outpatient nephrology clinic at University Hospital of Saint-Louis between January 1st and January 31st 2018. Access to care was measured using a questionnaire that integrated dimensions such as availability, geographic and financial accessibility, convenience, acceptability, effectiveness of care and quality of information. Socio-demographic and clinical data were also collected and analyzed with Epi Info 7. Results: Among 97 surveyed patients, 90 were included (response rate of 92.8%). Patients’ mean age was 35.2 years (20 - 89 years) and 55% were male. Only 30% of patients had health coverage either by the government, or private insurance or community health insurance. Access to care was rated as globally low by 73% of participants. However, we noticed some variations according to dimensions of access. Geographical accessibility and convenience of delivered care were good for the majority of patients, while financial access and acceptability of care were considered as very limited. Bivariate analysis showed that acceptability and effectiveness of care were linked to CKD stage while the quality of patients’ information was correlated with their educational level. Furthermore, health coverage was also associated with financial accessibility of care but not with its availability. Conclusion: This study showed that access to care is poor for majority of patients with CKD in Saint-Louis. Identification of the main barriers will help define appropriate strategies to achieve universal access to quality renal care.
文摘<strong>Introduction:</strong> Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. <strong>Objective:</strong> To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. <strong>Results:</strong> We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. <strong>Conclusion:</strong> Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.
