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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

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

Tuberculosis among Chronic Hemodialysis Patients: A Senegalese Single Center Experience

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Open Journal of Nephrology 2015年第4期5卷 117-122页

作者： Mouhamadou Moustapha Cisse Rachid el kabouss Yaya kane Sidy Mouhamed Seck Ahmed Tall Lemrabott Maria Faye el hadji fary ka Ansoumana Diatta Abdou Niang Boucar Diouf Nephrology Department of Teaching Hospital Aristide le Dantec Dakar Senegal Department of Nephrology Assane Seck University Ziguinchor Senegal Department of Nephrology Gaston Berger University Saint Louis Senegal

Summary: Tuberculosis is a common infectious disease in chronic hemodialysis due to alteration of the immune system associated with chronic kidney disease. The objectives of this study are to determine the prevalence of tuberculosis in chronic hemodialysis patients and to identify its diagnostic and therapeutic difficulties. Methods and patients: This was a descriptive retrospective study over a period of 20 years (1994-2014). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Aristide Le Dantec University Teaching Hospital in Dakar which clinical symptoms and laboratory favor tuberculosis. Results: Of 258 chronic hemodialysis patients treated in Hospital Aristide Le Dantec hemodialysis center, 29 cases (11.4%) of tuberculosis disease are diagnosed. The mean age is 43.21 ± 12.48 years, and the sex-ratio is 0.8. The median time to onset of tuberculosis after initiation of hemodialysis is 22.86 ± 28.86 months. The diagnosis of tuberculosis is sure only in 17% of cases. Extra-pulmonary sites are found in 79% of cases. The average duration of treatment is 9.39 ± 1.64 months (6 - 13 months). Various treatment protocols are adopted. Mortality is 21%, 50% due to disseminated tuberculosis. Conclusion: The diagnosis of tuberculosis in the chronic hemodialysis patients is often difficult due to the atypical symptoms, the frequency of extra-pulmonary location and the lack of evidence of sure diagnosis.

关键词： Tuberculosis Hemodialysis Dakar

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

Evaluation of the Therapeutic Management of Hypercalcemia in Myeloma at the Nephrology Department of Louis Pasteur Hospital of Chartres: About 8 Cases

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Open Journal of Nephrology 2022年第4期12卷 403-409页

作者： Modou Ndongo Babacar Ndiaye Nestor Nankeu Abou Sy Houyem Attia Fatiha Lahouel Djillali Ziane Berroudja Tayeb Bensalem Sid Ali Toufik Benyaghla Catherine Albert Sidy Mohamed Seck el hadji fary ka Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec Hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France Department of Nephrology Dialysis of Ouakam Military Hospital Dakar Senegal

Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur hospital of Chartres. Patients and Methods: We carried a retrospective study of patients treated for myeloma-related hypercalcemia between January 1, 2019 to December 31, 2021. The clinical, paraclinical, therapeutic and evolutive characteristics were studied. Results: Eight patients were included in this study with a median age of 67 years [41 - 85] and a sex ratio (M/F) of 1. A quarter of patients were known with chronic kidney disease. Four patients (50%) had symptoms of hypercalcemia. Biologically, the mean hemoglobin was 9.8 ± 2.7 g/dl, all patients had an acute kidney injury with a mean creatinine level of 364.1 ± 173.3 mmol/l, a mean serum calcium of 3.42 ± 0.59 mmol/l and three quarter of patients had bone lesions. Five patients (62.5%) were rehydrated with a mean volume of saline of 2700 ± 836.7 ml/24h. Seven patients (87.5%) received biphosphonates and none received diuretics. The mean normalization time of the serum calcium was 5 days. Conclusion: Hypercalcemia is frequent in malignancy and represents a poor prognosis factor of the disease. A well-conducted therapeutic strategy allows rapid normalization.

关键词： Hypercalcemia Myeloma Treatment Malignancy Neoplasia

Calcific Uremic Arteriolopathy or Calciphylaxis in a Hemodialysis Patient: Case Study and Review of the Literature

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Open Journal of Nephrology 2022年第3期12卷 303-310页

作者： Modou Ndongo Nestor Nankeu Josephine Nkok Helene Messet Fabrice Tiako Mamadou Mouctar Diallo Misylias Bouaoud Attia Houyem Fatiha Lahouel Djillali Ziane Berroudja Tayeb Bensalem Sid Ali Toufik Benyaghla Catherine Albert Sidy Mohamed Seck el hadji fary ka Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec Hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France Department of Nephrology Dialysis of Ouakam Military Hospital Dakar Senegal

Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hyperalgesic ischemic skin lesions. Several risk factors have been identified, mainly warfarin treatment, mineral and bone disorders (MBD), inflammation and malnutrition. In the evocative forms, the diagnosis is made based upon the physical examination finding of classic painful ulcerated lesions that are covered by a black eschar. Skin biopsy, due to the risk of aggravation and delayed healing, is only performed in case of doubt diagnosis. The therapeutic attitude due to the lack of solid randomized studies is based on expert consensus and requires a multidisciplinary approach. We report here the case of a patient with CUA revealed in the form of multiple ulcerative-necrotic skin lesions associated with pressure sores and arterial wounds.

关键词： Calcific Uremic Arteriolopathy Calciphylaxis Hemodialysis

Renal Disease among HIV Positive Patients in Senegal

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Open Journal of Nephrology 2017年第4期7卷 101-106页

作者： Khodia Fall Mouhamadou Moustapha Cissé Ahmed Tall Lemrabott Maria Faye Mouhamed Cherif Dial Atoumane Faye Seynabou Fall Moustapha Faye Alex Keita Mansour Mbengue Seynabou Diagne Niakhaleen Keita Bacary Ba Abdou Niang Boucar Diouf el hadji fary ka Nephrology and Hemodialysis Department CHU Aristide Le Dantec Dakar Senegal Cytology and Histopathology Department Grand-Yoff General Hospital Dakar Senegal Internal Medicine Department CHU Aristide Le Dantec Dakar Sénégal

Introduction: Renal disease (RD) in human immunodeficiency virus (HIV) infection is a decisive turning point in the development and prognosis of this disease. In Africa, the prevalence varies between 2.5% and 48.6%. In Senegal, little data are available in the literature. The objective of our study was to describe the epidemiological, clinical, paraclinical, therapeutic and progressional aspects in patients living with HIV (PLWHIV). Patients and methods: This was a retrospective, descriptive and analytical study carried out over a 10-year period in the Department of Internal Medicine and Nephrology at the Aristide Le Dantec Hospital in Dakar, Senegal. We included all 15-year old and above PLHIV with available CD4 count and viral load. Results: Out of 248 PLHIV, 32 had kidney disease (KD), which means a hospital prevalence of 12.9%. The mean age was 51.22 ± 10 years (extremes of 36 and 77 years) with a sex ratio (male/female) of 1.28. Renal signs were dominated by glomerular nephropathy syndrome. It was present at 80%. Tubulo-interstitial nephropathy syndrome and chronic uremic syndrome accounted for 6.25% and 3.1% of cases, respectively. Renal function Impairment was present in 21 patients with 18 cases of acute kidney injury (85.7%) and 3 cases of chronic renal failure (14.3%), including 2 in stage 5 of chronic kidney disease. Renal biopsy (RB) was indicated and performed in 20 (62.5%) patients with glomerular signs in 12 patients (60%). Glomerular lesions were dominated by focal and segmental glomerulosclerosis (FSGS) in 6 cases, membraneous nephropathy (MN) in 4 cases and minimal change disease (MCD) in 2 cases. Tubulo-interstitial and vascular lesions were present in 45% and 12.5% of cases, respectively. In highly active antiretroviral therapy (HAART), 12 (37.5%) patients had total remission, 9 (28.12%) had partial remission. One (3.12%) death from severe metabolic acidosis on chronic renal failure was deplored. Conclusion: This study illustrates the high preval

关键词： Kidney Disease HIV HIVAN Senegal

Non-Infectious Complications of Peritoneal Dialysis in Senegal

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Open Journal of Nephrology 2020年第1期10卷 43-49页

作者： Ahmed Tall Lemrabott Maria Faye Moustapha Faye Abdoul Hassane Sanlé Traoré Mouhamadou Moustapha Cissé Khodia Fall Yaya kane Zeinabou Maiga Moussa Tondi Mansour Mbengue Bacary Ba Niakhalee Keita Seynabou Diagne Abdou Niang Boucar Diouf el hadji fary ka Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Department of Nephrology Thies University Thies Senegal Internal Medicine and Nephrology Assane Seck University Ziguinchor Senegal Department of Nephrology and Haemodialysis Faculty of Sciences and Health of the Abdou Moumouni University of Niamey Niamey Niger

Introduction: Senegal has pioneered the implementation of peritoneal dialysis (PD) in West Africa, practicing it since 2004. Non-infectious complications are a significant cause of failure of this technique and the transfer of patients to haemodialysis. The aim of this study was to determine the prevalence and the different types of non-infectious complications in our context. Patients and Methods: This was a 5-year, descriptive, retrospective study of patients on chronic peritoneal dialysis for more than 3 months. Results: During the study period, 75 patients were included. The prevalence of non-infectious complications was 88%, including 45.3% mechanical complications and 76% metabolic complications. Catheter migration was the most common mechanical complication (55.9%), followed by catheter blockage (23.5%). Metabolic complications were dominated by hypoalbuminemia (76.3%). Dyslipidaemia and hypokalaemia affected more than 50% of patients, occurring in 59.3% and 56.9% of cases, respectively. Conclusion: In our study, non-infectious complications related to PD were frequent and varied. They remain a significant cause of technical failure. Mechanical complications are often the cause of permanent transfer to haemodialysis.

关键词： Peritoneal Dialysis Non-Infectious Complications Catheter Migration Hypoalbuminemia Hypokalaemia

Late Diagnosis of Congenital Optic Disc Abnormalities

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Open Journal of Ophthalmology 2024年第3期14卷 229-235页

作者： Aïssatou Aw Soda Mbaye Jean Pierre Diagne Sy el hadji Malick Alassane Ba Aly Mbara ka Serigne Sohibou Gaye Ousmane Ndiaga Senghor Lamine Ndiaye Mouhamed Ndiaye el Hadj Abdellahi Seyid Papa Amadou Ndiaye Ophthalmology Department of Abass NDAO Hospital Cheikh Anta Diop University Dakar Senegal

Purpose: To show epidemiological and imaging aspects of congenital optic disc abnormalities diagnosed late. Method: It was a retrospective study, including all patients with congenital optic disc abnormalities diagnosed at a late age between January 2020 and October 2022 at the eye center of Abass Ndao Hospital. Complete ophthalmological examination was performed with eye imaging according to the cases. Results: 09 patients (10 eyes) were diagnosed with congenital optic disc abnormalities. The mean age was 29 years, with a sex ratio of 0.8. Three patients had consulted for unilateral decreased visual acuity since childhood, two for sudden vision loss and in four cases the diagnosis was fortuitous. Visual acuity was ranged from 1/200 to 20/20. Fundus examination showed myelinated retinal nerve fibers in four eyes, optic disc pit in three eyes including two complicated by maculopathy, two cases of morning glory syndrome and a case of pseudoduplication of the optic disc. Optical coherence tomography, ocular ultrasound B and OCT-Angiography were performed according to the cases. Conclusion: Congenital optic disc abnormalities are often diagnosed late. They are potentially amblyogenic and complications are not rare, worsening the visual prognosis. Their screening should be systematic by ophthalmological examination in newborns.

关键词： Myelinated Nerves Fibers Optic Disc Pit Morning Glory Syndrome Pseudoduplication Optic Disc