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Indications for Renal Needle Biopsy and Histological Spectrum of Kidney Disease in Togo

Open Journal of Pathology 2024年第2期14卷 45-53页

作者： eyram Makafui Yoan Yawo amekoudi Badomta Dolaama Kossi Akomola Sabi Komlan Georges Tona Toyi Tchamdja Department of Nephrology Kara Teaching Hospital University of Kara Kara Togo Department of Nephrology and Hemodialysis Sylvanus Olympio Teaching Hospital University of Lomé Lomé Togo Department of Internal Medicine Kara Teaching Hospital University of Kara Kara Togo

Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephrological procedure, however, is invasive and not without potential complications. The purpose of this study was to evaluate the indications, frequency, and histological lesion profiles of renal biopsies in Togo. Materials and Methods: We conducted a descriptive cross-sectional study encompassing all renal biopsies performed in Togo from the inception of nephrology services to the present. Data were compiled from the medical records of the patients. Results: From 2015 to 2023, 68 high-quality renal biopsies were executed in Togo. The patients had an average age of 30.6 years, with a predominance of males (69.1%). The most common indication was nephrotic syndrome, accounting for 66.2% of cases. Histologically, glomerulopathies were predominant, representing 61.8% of lesions, followed by vascular nephropathies (25%) and tubulointerstitial nephropathies (13.2%). The most frequently observed primary glomerulopathy was focal segmental glomerulosclerosis (FSGS). Gross hematuria was the sole complication, occurring in 1.4% of the cases. Conclusion: RB is an evolving practice in Togo. Glomerulopathies are the most commonly observed lesions. The histological categorization of renal lesions is vital for clinicians in their diagnostic reasoning and approach.

关键词： Renal Needle Biopsies Histology Kidney Failure Epidemiology Togo

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Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo

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Open Journal of Nephrology 2024年第1期14卷 37-47页

作者： eyram Makafui Yoan Yawo amekoudi Kossi Akomola Sabi Marcel David Keoula Badomta Dolaama Sarakawabalo Assenouwe Tabana Mouzou Department of Nephrology Kara University Hospital University of Kara Kara Togo Department of Nephrology and Haemodialysis Sylvanus Olympio University Hospital University of Lome Lomé Togo Department of Anaesthesia and Intensive Care University Hospital of Kara University of Kara Kara Togo

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.

关键词： AKI Intensive Care Unit Dialysis Epidemiology Togo

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Epidemiological, Clinical and Evolutive Profile of Autosomal Dominant Polycystic Kidney Disease (ADPKD) in Togo

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Open Journal of Nephrology 2018年第4期8卷 117-123页

作者： Tsevi Yawovi Mawufemo amekoudi eyram Yoan Djagadou Kodjo Agbeko Sabi Kossi Akomola Nemi Komi Dzidzonu Kodjo Kossi Tona Komlan Georges Dolaama Badomta Attisso Eugene Hadabia D’daah Djibril Mohaman Awalou Department of Nephrology and Hemodialysis of the Sylvanus Olympio University Hospital of Lomé University of Lome Lomé Togo Internal Medicine Department of the Sylvanus Olympio University Hospital in Lome University of Lome Lomé Togo

Objective: To describe the epidemiological, clinical and evolutionary profile of ADPKD in Togo. Methods: A retrospective descriptive transversal study over a period of 8 years (2011-2018) which focused on the analysis of patients’ records diagnosed with ADPKD. The diagnosis of ADPKD was retained on the basis of the ultrasound criteria of PEI. Results: During the study period, 27 patients had polycystic kidney disease with a prevalence of 0.87%. The average age was 51.6 ± 16.4 years. There were 10 men (37%) and 17 women (63%), a sex ratio (M/F) of 0.58. The concept of family cystic kidney disease was found in 6 (22.2%) patients. The clinical presentations were dominated by arterial high blood pressure, abdominal pain and abdominal mass respectively in 77%, 63% and 63% of cases. Five patients (18.5%) had a glomerular filtration rate (GFR) greater than 90 ml/min, 17 (62.9%) had a GFR Conclusion: ADPKD is common in our department. It appears to be associated with a high rate of chronic renal failure.

关键词： Polycystic Kidney Disease CKD Togo

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Epidemiological and Clinical Characteristics of Renal Diseases Diagnosed by Biopsies in Ivory Coast

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Open Journal of Pathology 2022年第3期12卷 100-113页

作者： Kouame Justin N’Dah Weu Melanie Tia Alain Didier Abouna Ibrahiman Toure Amelie Delphine Lagou Monley Cyr Guei Ibrahim Cherif Moussa Traore eyram amekoudi Attaah Ange Rebecca Kobenan Sery Patrick Olivier Diopo Kouame Hubert Yao N’Guessan Clement Ackoundou Koffi Laurence Adonis Dazé Apolinaire Gnionsahié Mohenou Isidore Jean Marie Diomande Department of Anatomic Pathology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Anatomic Pathology University Teaching Hospital of Cocody Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Donka Conakry Guinea Department of Nephrology Sylvanus Olympio University Teaching Hospital Lomé Togo Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast Department of Pediatric Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast

Renal biopsy is an invasive procedure used to evaluate the activity and the therapeutic management of kidney disease and kidney transplantation. Objective: The aim of this study was to describe the epidemiological, clinical, and pathological features of kidney disease diagnosed by biopsy in the Ivory Coast. Materials and Methods: This was a descriptive and prospective study conducted between January 2015 and December 2018 in the Department of Anatomy and Cytology of the Pathology of Cocody (Abidjan) and Bouake. Specimens were obtained from the nephrology department of Ivory Coast and from teaching hospitals in Togo, Guinea, Burkina Faso, and Mali. Samples were analyzed according to standard renal biopsy procedures. One kidney fragment was fixed in acetic acid formalin (AAF) for optical microscopy examination. The other fragment, soaked in physiological water, was immediately sent for immunofluorescence examination. All renal pathologies were included in this study. The study parameters were frequency, age, sex, origin, occupation, clinical and biological signs, and pathological aspects with optical microscopy, and immunofluorescence. Results: 153 cases (2.23%) of kidney biopsies were examined on a total of 10,573 specimens. Ivory Coast specimens accounted for 91.5% of cases (n = 140). Nephrotic syndrome (49%) was the most common clinical sign and indication for renal biopsy, followed by acute renal failure (16.3%), chronic renal failure (19.6%), and a combination of chronic renal failure with hypertension (11.18%) and glomerulonephritis (4%). Mean proteinuria was 3.03 g/24h (range, 0.14 to 11.5 g/24h). Histologically, 90.8% (n = 139) were glomerular nephropathies, including 26.6% HIV-associated nephropathy, 17.3% focal segmental glomerulosclerosis, 13.6% nephroangiosclerosis, 11.5% post-infectious glomerulonephritis, 9.3% membranous glomerulonephritis, and 21.6% miscellaneous glomerular nephropathies (n = 30). The incidence of various tubulo-interstitial lesions was

关键词： Kidney Biopsy Disease Pathology Ivory Coast

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Focal Segmental Glomerulosclerosis in Côte d’Ivoire: Epidemiological, Clinical and Pathological Aspects

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Open Journal of Pathology 2022年第4期12卷 146-155页

作者： N’Dah Kouame Justin Tia Weu Melanie Akpro Sedy Louess De Randorphe Lagou Delphine Amélie Toure Ibrahiman Kobenan Atta Anne Rebecca Abouna Alain Didier Guei Monley Cyr Tuo Wonko-Tian Alice Oka Kouamé Hubert Diopo Sery Patrick Olivier Delma Samuel Cherif Ibrahima Traore Moussa amekoudi eyram Ouattara Belarsi Safiatou Yao Kouame Hubert Ackoundou Nguessan Clément Adonis Koffi Laurence Yao Gnangoran Victor Gnionsahie Dazé Apolinaire Mohenou Isidore Jean-Marie Diomandé Department of Anatomic Pathology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast Department of Anatomic Pathology University Teaching Hospital of Cocody Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Blaise Compaore Ouagadougou Burkina Faso Department of Anatomic Pathology University Teaching Hospital of Donka Conakry Guinea Department of Nephrology University Teaching Hospital of Sylvanus Olympio Lome Togo Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast

Focal segmental glomerulosclerosis (FSGS) is characterized histologically by hyalinosis and sclerosis of glomeruli associated or not with podocyte involvement. The objective of our work was to clarify the epidemiological aspects and histological variants of FSGS in Côte d’Ivoire. Materials and Methods: This was a descriptive retrospective study, conducted from January 2015 to December 2019 using the renal biopsy registers (RB) of the Pathological Anatomy and Cytology departments of the Teaching Hospital of Cocody and Bouake in collaboration with the Nephrology Services of Côte d'Ivoire and the sub-region. The biopsies underwent conventional histopathology and/or immunofluorescence techniques. The parameters analyzed were: frequency, age, gender, proteinuria, biopsy indications and histological aspects and the different correlations between histological aspects and socio-demographic characteristics. Results: FSGS represented 58.1% (n = 104) of glomerular nephropathies. The average age of patients was 32.1 ± 13.3 years, with extremes of 13 and 70 years. The sex ratio was equal to 1. Nephrotic syndrome (68.9%), chronic renal failure (14.3%) and acute renal failure (10.1%) were the main indications for renal biopsy (RB). The mean proteinuria at the time of diagnosis was 4 ± 3.7 g/24 h. It was massive (3.5 g/24 h) in 42.3% of patients. FSGS was primary in 29.8% (n = 31) and secondary in 70.2% (n = 73) of patients, of which 27.9% (n = 35) was due to HIV. According to the Columbia classification, 62.5% NOS type was found;23.1% collapsing type;7.7% tip lesion type;4.8% cell type and 1.9% perihilary type. Conclusion: FSGS is a complex heterogeneous entity. It affects young people in our context with a homogeneous gender distribution. Understanding its histogenesis is essential for optimal patient management.

关键词： Kidney Glomerulus Histology FSGS Côte d’Ivoire

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Hand Hygiene by Ward Staff at Dapaong Regional Hospital in Togo

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Open Journal of Nursing 2023年第2期13卷 95-112页

作者： Essohanam Tabana Mouzou Sarakawabalo Assenouwe eyram Yoan Makafui amekoudi Tchaa Hodabalo Towoezim Tchetike Pikabalo School of Health Sciences University of Kara Kara Togo Anesthesia and Intensive Care Service University Hospital of Kara Kara Togo Medical Intensive Care Service University Hospital of Kara Kara Togo Traumatology and orthopedic Service University Hospital of Kara Kara Togo Anesthesia and Intensive Care Service Sylvanus Olympio University Hospital of Lomé Lomé Togo

Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.

关键词： Hand Hygiene Care Providers Hand Washing Antiseptics Dapaong Regional Hospital

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Early Postoperative Deaths in the Surgical Intensive Care Unit of CHU-Kara

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Open Journal of Internal Medicine 2023年第1期13卷 32-50页

作者： Essohanam Tabana Mouzou Sarakawabalo Assenouwe Pikabalo Tchetike eyram Yoan Makafui amekoudi Tchaa Hodabalo Towoezim Department of Anesthesia and Intensive Care at CHU-Kara Kara Togo Anesthesia Resuscitation Service at CHU-Sylvanus Olympio in Lomé Lomé Togo Medical Resuscitation and Nephrology Department of CHU-Kara Kara Togo Trauma Service CHU-Kara Kara Togo

Aim: Review of early postoperative deaths in the surgical intensive care unit at CHU-Kara. Introduction: Surgery, one of the means of treatment of diseases, also presents risks for the patient, including early postoperative death linked to numerous risk factors. Methodology: This was a retrospective descriptive study conducted on the records of patients who died within 48 hours after surgery from November 1, 2019 to April 30, 2021. The study was conducted in the surgical intensive care unit and in the operating room. Results: Thirty-two early postoperative deaths or 2.22% out of 1442 operated with 30 deaths retained for the study. Male gender predominated (70%). The average age was 31.22 years. Farmers were more concerned (66.67%). The time to surgery was 1.6 days. ASA1 patients (40%) predominated followed by ASA IV (30%). 80% of patients were operated on as an emergency. Digestive pathologies 80% were more represented. General anaesthesia 86.66% was more practiced associating Propofol, Fentanyl, Ketamine and Atropine more frequently. The average duration of the procedures was 132.5 minutes. Intraoperative complications were associated with cardiac arrest and hemorrhage (33.34%). ASA class higher than 2, dirty surgery (46.67%), and delayed recovery (13.34%) were the incriminating risk factors. Death by hemodynamic shock and respiratory distress were the main causes 26.66%. Conclusion: Early postoperative mortality was high and involved all ages. Anesthesia and surgery, the low level of qualification of the intraoperative actors, the lesser intraoperative security;the association of anesthetic effects, the complexity of intraoperative lesions led to the increase of mortality. The combination of two or more factors was pejorative for the deaths.

关键词： Mortality Early Postoperative Surgical Resuscitation CHU-Kara Togo

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Practice of Pediatric Spinal Anesthesia in a Country with Limited Means: Example of Togo

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Open Journal of Anesthesiology 2023年第2期13卷 32-45页

作者： Essohanam Tabana Mouzou Sarakawabalo Assenouwe Pikabalo Tchetike eyram Yoan Makafui amekoudi Tchaa Hodabalo Towoezim Resuscitation Anesthesia Department at the Kara-CHU Kara Togo CHU-Sylvanus Olympio Anesthesia Resuscitation Department in Lome Lome Togo Medical Resuscitation and Nephrology Service of the CHU-Kara Kara Togo CHU-Kara Traumatology Department Kara Togo

Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.

关键词： Pediatric Surgery Spinal Anesthesia Togo

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Management of Obstructive Renal Failure in Adults at the Sylvanus Olympio University Hospital

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Open Journal of Nephrology 2021年第3期11卷 348-357页

作者： Yawovi Mawufemo Tsevi Edoé Viyomé Sewa Abago Balaka Ablavi Adani-Ifè eyram Yoan amekoudi Komi Daniel Dokouvi Department of Nephrology and Hemodialysis Sylvanus Olympio Hospital Lomé Togo Department of Urology Sylvanus Olympio Hospital Lomé Togo Department of Internal Medicine Sylvanus Olympio Hospital Lomé Togo

Background: Obstructive nephropathies are a topical issue in urology and nephrology consultations, but no study has yet been conducted on the subject in our country. Objective: Describe the epidemiological, clinical, therapeutic and evolutionary profile of obstructive nephropathies at the Sylvanus Olympio University hospital of Togo. Method: It was a descriptive and cross-sectional study with a collection of retrospective data over a period of 08 years (2012-2019) which focused on obstructive nephropathies in the Urology-Andrology, Nephrology and Internal Medicine departments at the medical clinic of CHU SO. The diagnosis of obstructive nephropathy is retained on the basis of radiological and medical imaging results. Results: The study population included 131 patients. The annual hospital frequency was 2.84 cases for 100 admissions. The mean age was 56.72 ± 17.76 years. These patients were mostly male (72.52%). The most frequent age group was 60 - 80 years. Common symptoms at presentation were loin pain (45.75%) and dysuria (25.95%). The average length of probable course of the disease before hospitalization was 636.94 ± 258.88 days (21 months). The etiologies of obstructive nephropathy were largely dominated by prostatic tumors in half of the cases (45.80%). Among these patients, 121 have presented renal failure (92.36%). The average serum creatinine at admission was 59.01 ± 21.56 mg/l. Of the 121 patients with obstructive nephropathy presenting renal failure, 54 (44.63%) had decreased their serum creatinine at the output of more than 25%. The open surgery (54.20%) was the main treatment. There was an improvement in kidney function in patients who had a shorter duration of disease progression and who did not have a history of loin pain, oliguria and that the etiologies of the disease were not tumors. Tumoral etiologies, the presence of a history of high blood pressure, oedema of the lower members,

关键词： Obstructive Nephropathy Renal Failure Etiologies Lomé (Togo)

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Emphysematous Pyelonephritis in a Black African Woman Managed with Antibiotics Alone

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Open Journal of Nephrology 2016年第4期6卷 151-156页

作者： Kossi Akomola Sabi Béfa Noto Kadou Kaza eyram Yoan amekoudi Jacques Vigan Vicko Manou Dazé Apollinaire Gnionsahe Department of Nephrology and Hemodialysis Sylvanus Olympio University Teaching Hospital Lomé Togo

Introduction: Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the renal parenchyma. This condition is characterized by the production of intrarenal and perinephric gas. In the world, the EPN is currently limited to case series reported. No cases have been described in black Africa. Aims: Related a first case of EPN diagnosed and treated in the University Hospital Center Sylvanus Olympio of Lomé in Togo. Observation: A 40 years old woman, with antecedent of diabetes presented pyelonephritis emphysematous class 2. She was treated successfully with antibiotic alone without using percutaneous drainage or nephrectomy. Conclusion: As reported in every case series, it was a young diabetic patient with a clinical features of acute pyelonephritis which CT scan had helped lay the EPN class 2 diagnosed. The germ was Klebsiella pneumoniae. She was treated with adapted antibiotic alone.

关键词： Emphysematous Pyelonephritis Africa Togo

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