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Contribution to the Study of Diabetic Kidney Disease in a Sub-Saharan Environment: An Example of the Aristide Le Dantec University Hospital in Dakar

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Open Journal of Nephrology 2023年第4期13卷 339-348页

作者： Ahmed Tall Lemrabott Maria Faye Niakhaleen Keita Seynabou Diagne Moustapha Faye Bacary Ba abdou niang El Hadji Fary Ka Nephrology Department Aristide Le Dantec University Hospital Dakar Senegal Nephrology Department Dalal Jamm National Hospital Center Dakar Senegal

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.

关键词： Diabetic Kidney Disease (DKD) Microalbuminuria Diabetic Nephropathy

Pulmonary Hypertension in Chronic Hemodialysis Patients at Aristide Le Dantec University Hospital

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Open Journal of Nephrology 2022年第1期12卷 93-100页

作者： Maria Faye Ahmed Tall Lemrabott Niakhaleen Keita Moustapha Faye Romina Ghassani Mansour Mbengue Bacary Ba Seynabou Diagne abdou niang El Hadj Fary Ka Nephrology Department Aristide Le Dantec University Hospital Dakar Senegal Cheikh Anta Diop University Dakar Senegal Nephrology Department Dalal Jamm Hospital Dakar Senegal

Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p = 0.015), as well as dilation of the inferior vena cava (p = 0.048).

关键词： Pulmonary Hypertension Chronic Hemodialysis Patients Transthoracic Doppler Ultrasound Dakar

Pathological Fractures in Chronic Hemodialysis Patients in a Teaching Hospital in Senegal: Prevalence and Associated Risk Factors

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Open Journal of Nephrology 2023年第3期13卷 211-219页

作者： Ahmed Tall Lemrabott Baratou Coundoul Niakhaleen Keita Maria Faye Moustapha Faye Mansour Mbengue Bacary Ba Seynabou Diagne abdou niang El Hadji Fary Ka Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Department of Nephrology Dalal Jamm National Hospital Center Dakar Senegal Dialysis Center National Hospital Center of Pikine Pikine Senegal

Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are available on the subject in sub-Saharan Africa. The objective of this work was to evaluate the prevalence of pathological fractures in our chronic hemodialysis patients, to analyze their clinical aspects and to determine the factors associated with their occurrence. Patients and Methods: We conducted a retrospective, descriptive and analytical study over 9 years (January 1, 2011, to December 31, 2020) based on the medical records of chronic hemodialysis patients at the CHU Aristide Le Dantec. The diagnosis of pathological fracture was retained in front of any fracture occurring spontaneously or following minimal trauma and confirmed by X-ray. Results: Nineteen cases of pathological fractures were collected with a hospital prevalence of 19.39%. The mean age was 53.32 ± 13.94 years with a sex ratio of 0.36. The average seniority in dialysis was 84.16 ± 29.88 months. Among these patients, one had had 3 episodes of fractures and another 6 episodes. The circumstances of occurrence of the fractures were the fall in 63% of the cases, spontaneously in 37% of the cases. The predominant site of fractures was the femoral neck (47.38% cases). Female gender (p 5 years (p = 0.049), gait disturbances prior to the fracture (p = 0.001), positive CRP (p = 0.028) and the presence of vascular calcifications (p = 0.002) were significantly associated with the occurrence of pathological fractures. Conclusion: This study has identified the factors associated with the occurrence of pathological invoices in hemodialysis patients in our context. These fractures are often associated with the lack of regular biological follow-up due to the low socioeconomic level of our patients.

关键词： Pathological Fractures CKD-MBD Hyperparathyroidism Osteomalacia Adynamic Bone Disease Chronic Hemodialysis

Acute Renal Failure in the Elderly in the Nephrology Department of Aristide Le Dantec Hospital in Senegal: About 45 Cases

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Open Journal of Nephrology 2023年第4期13卷 451-463页

作者： Arlette Géraldine Nguea Ndjame Ameth Dieng Vincent Ebenezer Ngamby Mamadou Coume El Hadji Fary Ka Maria Fall Ahmed Tall Lemrabott Mouhamadou Moustapha Cisse abdou niang Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Central Hospital of Yaoundé Yaoundé Cameroon Health Sciences Training and Research Unit University of Thiès Thiès Senegal Regional Hospital of Thiès Thiès Senegal Faculty of Medicine Pharmacy and Odontology Cheikh Anta Diop University Dakar Senegal National University Hospital of Fann Dakar Senegal Aristide Le Dantec Hospital Dakar Senegal Dalal Jamm National University Hospital of Guédiawaye Dakar Senegal

Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.

关键词： Acute Renal Failure Elderly Epidemiology

Infectious Complications in Lupus Nephritis and Associated Factors: A Multicenter Study

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Open Journal of Nephrology 2021年第4期11卷 506-515页

作者： Mansour Mbengue Myriam Mezouari Seynabou Diagne abdou niang Dalal Jamm Hospital Dakar Senegal Pikine Hospital Dakar Senegal

Introduction: The prevalence of infections in patients with systemic lupus erythematosus ranges from 26% to 78%. Patients with systemic lupus erythematosus are particularly susceptible to infections due to a dysfunction of immune response and the immunosuppressive therapy. Patients and method: We carried out this study with the aim of describing the prevalence of infections in lupus nephritis and determining the associated risk factors. This was a multi-center, observational, retrospective, descriptive and analytical study over a 10-year period from November 1, 2010 to October 31, 2020. The study was carried out in the nephrology departments of six hospitals in Dakar. Results: During the study period, 98 patients were included. The mean age was 32.32 ± 11.33 years with a sex ratio of 0.21. Among the included patients, fifty-four (55.1%) had at least one infectious episode, of which 53.7% had 1 infection, 24.1% had 2 infectious episodes and 22.2% had 3 infectious episodes. The overall incidence was 55.1 infections per 100 patient-years. 57.2% of these infectious episodes occurred within the first six months after the lupus was diagnosed. The main sites of infection were urinary (30.7%), gastrointestinal (22.0%) and pleuropulmonary (16.5%). The incriminated germ was a bacterium in 78.18% of cases, a virus in 5.46%, a parasite in 9.09 and a fungus in 7.27. The most frequently germ found was Escherichia coli (29.09%). The evolution was marked by recovery in 93.4% of cases. Deaths occurred in 15 patients of which 33.3% were related to infections. Factor significantly associated with the onset of infection in multivariate analysis was the presence of a proliferative class of lupus nephritis (p = 0.013). Conclusion: Infections were common during lupus nephritis. The presence of a proliferative class was risk factors for infection.

关键词： Lupus Nephritis Infection Proliferative Class

Focal Segmantal Glomerulosclerosis: Epidemiological, Clinico-Biological, Pathological, Etiological, Therapeutic and Evolutionary Profiles in Dakar

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Open Journal of Nephrology 2023年第2期13卷 174-195页

作者： Pierre Eric Gandzali Ngabe Djibrilla Bonkano Baoua Aida Habi Yabana Lengani Hamadoun Yattara Adama Kama Yatte Richard Loumingou Lemrabott Tall Elhadji Fary Ka abdou niang Boucar Diouf Department of Nephrology and Hemodialysis General Teaching Hospital Brazzaville Republic of the Congo Department of Nephrology and Hemodialysis Amirou Boubacar Diallo National Hospital Niamey Niger Department of Nephrology and Hemodialysis Yalgado Ouedraogo Ouagadougou Burkina Faso Department of Nephrology and Hemodialysis General Teaching Hospital POINT G Bamako Mali Department of Nephrology Dialysis and Kydney Transplantation ARISTIDE LE DANTEC Hospital Dakar Senegal

Introduction: Focal Segmental Glomerulosclerosis (FSGS) corresponds to a clinicopathological syndrome, manifested by generally abundant proteinuria associated with hyaline deposits on part of certain glomeruli and sparing other glomeruli, with effacement of the pedicels. The general objective was to determine the prevalence of FSGS, and to give its profiles;epidemiological, clinical, biological, pathological, etiological, therapeutic and evolutionary of FSGS. Materials and Methods: This is a retrospective analytical study over a period of six years extending from January 1, 2010 to December 31, 2015 patients aged 16 or over who were hospitalized or received consultations during the study period for primary or secondary segmental and focal hyalinosis. Patients whose records were incomplete or unusable were not included in the study. Results: We have 16.54% with 158 cases of FSGS out of 6945 patients received and/or hospitalized. Of the 955 kidney biopsies distributed, the incidences of HSF were;10.15%;14.04%;15%;17.64%;20.11%;19.58% respectively in 2010;2011;2012;2013;2014 and 2015, i.e. an annual increase of around 1.25%. Renal-type edemas were found in 93.3%, the first reason for hospitalization. And ninety-six people had impaired kidney function, or 61%. The average of 24-hour proteinuria was 6.4 ± 3.69 g/24 hours. The extremes were 0.37 and 18.50 g/24h. Patients had nephrotic proteinuria in 84.86%. Non-specific FSGS or NOS (Not Other Specificities) was found in 62 cases or 39.24%, collapsing FSGS in 48 cases or 30.40%. FSGS with found causes was associated with fibrosis in 5/35 cases. Collapsing FSGSs followed by NOS FSGSs were the most corticosteroid-resistant. The evolution of the FSGS reveals that every 8 months the proteinuria decreases by half. Conclusion: Segmental and focal hyalinosis requires histological confirmation and the epidemiological, clinico-biological, etiological, therapeutic and evolutionary profiles depend on the histological (pathological) t

关键词： Proteinuria Corticotherapy Focal Segmantal Glomerulosclerosis Senegal

Chronic Kidney Disease in Sub-Saharan Africans: A Study of 462 Patients

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Open Journal of Nephrology 2021年第1期11卷 114-122页

作者： Mbengue Mansour Ba Djenaba Lemrabott Tall Ahmed Cissé Mouhamadou Moustapha niang abdou Department of Nephrology Dalal Jamm University Hospital Dakar Senegal Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Department of Nephrology El Hadji Amadou Sakhir Ndiéguéne Hospital Thiés Senegal

Chronic kidney disease is a global public health problem due to its increasing prevalence as well as its main risk factors such as hypertension and diabetes. However, in Africa, few studies have been done on chronic kidney disease. The aim of our study is to describe the epidemiological, clinical, paraclinical and therapeutic aspects of chronic kidney disease. It was a retrospective and descriptive study carried out from the first of January 2004 to the 31st of December 2013 at Principal hospital in Dakar. Records of any patient aged 18 and over with chronic kidney disease were included. Chronic kidney disease was defined according to the KDIGO 2012 recommendations. Among the 8873 patient records used during our study, 462 presented with chronic kidney disease, which was a hospital prevalence of 5.2%. The sex ratio was 1.61. The mean age of the patients was 58.37 ± 19.97 years. There were 75.32% of the patients who were aged 50 and over. The mean serum creatinine was 49.14 ± 56.83. The mean glomerular filtration rate was 27.47 ± 19.86 ml/min/1.73 m2. Chronic renal failure was diagnosed in 92% of patients, including 34.9% in the end-stage of the renal disease. The mean proteinuria was 3.07 ± 4.92 g/24 h. Leukocyturia was present in 34.17% of patients. Hematuria was present in 25% of patients. Hypertension and diabetes were the most common causes, found in 61.25% and 35.93% of patients, respectively. Hemodialysis was performed in 49 patients. Peritoneal dialysis was performed in 2 patients. One patient had undergone a kidney transplant. This study establishes the relatively high prevalence of chronic kidney disease and its risk factors including hypertension and diabetes. It also reveals the late diagnosis of chronic kidney disease in our pa

关键词： Chronic Kidney Disease Hypertension Diabetes

Surgical Treatment of the Upper Urinary Tract Lithiasis at the Urology Department of the Hopital General Idrissa Pouye

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Open Journal of Urology 2024年第5期14卷 290-300页

作者： Mouhamadou Moustapha Mbodji Mohamed Jalloh Medina Ndoye abdou Fall Cheikh Gassama Babou Sakho Serigne Mbacké Ndiaye Moussa Sene abdourahmane Diallo Issa Labou Lamine niang Department of Urology and Andrology Hopital General Idrissa Pouye Dakar Senegal

Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.

关键词： Endo-Urology Open Surgery Renal Lithiasis Ureteral Lithiasis URO-CT Scan

Quality of Life of Patients on Peritoneal Dialysis in Dakar: A Senegalese Single Centre Experience

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Open Journal of Nephrology 2016年第2期6卷 37-42页

作者： Kane Yaya Cisse Mouhamadou Moustapha Seck Sidy Mohamed Lemrabott Ahmed Tall Faye Maria Hounsounou Christian Diallo Kalilou Ka El Hadji Fary niang abdou Diouf Boucar Nephrology and Internal Medicine Department of Assane Seck University Ziguinchor Senegal Nephrology Department of Teaching Hospital Aristide Le Dantec Dakar Senegal Nephrology Department of Gaston Berger University Saint-Louis Senegal

Introduction: Measuring the quality of life (QOL) in recent years has become an indispensable tool in monitoring patients suffering from chronic diseases. We conducted this study to assess QOL of patients undergoing peritoneal dialysis in Dakar, and to identify associated factors. Patients and Methods: This is a cross-sectional study which was carried out from 10 to 30 June, 2011 in the peritoneal dialysis unit at university hospital in Dakar. We included all patients with end-stage renal disease (ESRD) of any age, who were on PD since at least six months and who gave their consent. The QOL was assessed using the Kidney Disease Quality of Life Short-Form 1.2 (KDQoL-SF). Results: Sixteen patients were included with a mean age of 50.25 ± 13.48 years and a sex-ratio of 1.27. Considering SF-36, the overall mean score (SMG) was 60.11 ± 15.96 with a Mean Physical Component Summary Scale of 53.66 ± 16.98 and a Mental Component Summary Scale of 70.85 ± 6.14. Concerning the KDQoL-SF, the global mean score was 61.83 ± 19.35 with a mean physical score of 50.55 ± 16.52 and a mean mental score of 62.52 ± 21.53. The mean dialysis specific dimension score was 62.52 ± 21.53 and the mean mental health score was 85.93 ± 12.06. Age, weight, level of instruction and social support were correlated with a worse QOL. Conclusion: This study showed an alteration of our PD patients’ QOL, particularly in their physical health. However, the number of patients included in the study is not enough to permit a formal conclusion.

关键词： Quality of Life Peritoneal Dialysis Dakar