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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

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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

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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

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Intra-Dialytique Hypotension: Prevalence and Associated Factors in 2 Haemodialysis Centres in Senegal

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Open Journal of Nephrology 2022年第4期12卷 361-368页

作者： Ba A. Mamadou yaya kane Moustapha Faye Ameth Dieng Ba Bacary Niakhalen keita Babacar Ndiaye Modou Ndongo Sy Abou Maria Faye Ahmed Tall Lemrabott ka E. Fary Department of Nephrology Internal Medicine Faculty of Health Sciences Assane Seck University Ziguinchor Senegal Department of Nephrology ALDH Cheikh Anta Diop University Dakar Senegal

Introduction: This study aimed to assess the prevalence of Intra-dialytic hypotension (IDH) according to the European Best Practice Guidelines (EBPG) definition in relation to the number of haemodialysis sessions and the number of chronic haemodialysis patients and to identify its associated factors. Patients and Methods: We conducted an observational, multicentre and looking-forward study of descriptive and analytical purposes over a 4-week period. The study included all patients with regular chronic haemodialysis with at least two sessions per week and a duration of 180 minutes, who consented to participate in the study and were over 15 years of age. Data collection was done with pre-established forms. The following data were collected: blood pressure before each session, at 30, 60, 120, 180 and 240 minutes of each session;socio-demographic data;dialysis data;clinical, paraclinical, therapeutic data and nursing interventions. Results: The mean age of the patients was 43.84 ± 12.10 years. Among 568 haemodialysis sessions recorded in 50 patients, IDH was noted in 12 haemodialysis sessions, representing a prevalence of 2.11%. Fatigue was found in 5 sessions with IDH episodes (41.66%) followed by yawning (25%), nausea ± vomiting (16.66%) and cramps (16.66%). As nursing interventions, Trendelenburg position and normal saline administration were performed in all IDH episodes. High blood pressure, inter-dialytic weight gain greater than 3 kg, Uf/H > 10 ml/kg/H, anaemia and hypoalbuminaemia were associated with the occurrence of IDH. Conclusion: The prevalence of IDH according to the EBPG definition is low. However, it is an important cause of morbidity and mortality, especially cardiovascular involvement, and the factors associated with its presence have been clearly identified.

关键词： Intra-Dialytic Hypotension Chronic Hemodialysis Patients Dakar Ziguinchor

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Cholera in Guinea: The Implication for Safe Water Sources and Sanitations

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Open Journal of Preventive Medicine 2014年第7期4卷 535-544页

作者： keita Mamady Sylla Mafoule Department of Epidemiology and Health Statistics School of Public Health Central South University Changsha China School of Business Central South University Changsha China

Objectives: To lay stress upon the importance of adequate water and sanitation in the prevention of cholera in Guinea. Methods: The data on deaths and cases of cholera in Guinea from 2000 to 2011 were downloaded from the WHO Official website. The data on deaths and cases of cholera outbreak which occurred in Guinea from 02 February to 15 October 2012 were collected from the Guinean Ministry of Public Health. The cholera index case is confirmed by a laboratory test. Cholera cases were defined as individuals over one year old who had had watery stools with or without vomiting. Cholera incidence and case fatality rates between different areas of cholera occurrence in the country over time were computed. Results: Over the overall 12-year period (2000-2012), the case fatality rate showed a somewhat sign of slight rising trend when the incidence rates increased rapidly. During the seven consecutive years of cholera outbreaks in Guinea, between 2003 and 2009, the most affected areas were Conakry, Dubreka, Coyah, Boffa, Forécariah, Guékédou, Dalaba and Télimélé. In 2012, Cholera outbreak resulted in an incidence rate of 23.23 per 10,000 population and a case fatality ratio (CFR) of approximately 1.8%. Cases and deaths were reported in 12 prefectures out of 34: Conakry, Coyah, Forecariah, Fria, Boffa, Dubréka, Boké, Mamou, Kindia, kankan, Kerouané and Dabola. Conclusion: Cholera is an important health problem in Guinea. Any earnest attempts to improve water and sanitation alongside with promotion of good hygienic practices will likely ward off the threat of cholera in the country.

关键词： Guinea Cholera Water Sanitations Public Health

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Multiple Myeloma Secondary to HIV Infection, Revealed by Renal Failure: About a Case

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Open Journal of Nephrology 2019年第1期9卷 20-25页

作者： Mbengue Mansour Cissé Mouhamadou Moustapha Faye Maria Lemrabott Tall Ahmed Fall Khodia keita Alex Faye Moustapha Ba Bakary Diagne Seynabou keita Niakhaleen Ba Mamadou Aw Dieng Ameth Niang Abdou ka El Hadji Fary Diouf Boucar Department of Nephrology Regional Hospital Thies Senegal Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal

Multiple myeloma is on the list of neoplasia that may be associated with human immunodeficiency virus infection. It is an affection that aggravates the prognosis in these particular patients. We present the case of a patient with multiple myeloma and HIV infection, revealed by renal failure. This was a 59-year-old patient who was received to the Department of nephrology for renal failure associated with severe aregenerative pancytopenia. In etiological investigations, multiple myeloma associated with HIV1 infection was found. The evolution was unfavorable, marked by the death of the patient caused by digestive haemorrhage before the start of antiretroviral treatment and chemotherapy.

关键词： Multiple Myeloma HIV Renal Failure

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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

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Demons-Meigs Syndrome: A Case Report at the Fatick Regional Hospital

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Open Journal of Obstetrics and Gynecology 2021年第12期11卷 1735-1743页

作者： Abdoulaye Mihimit Alhassane Ismael Toure Oumar Abakar Oumar Bafode Camara Abdoulaye keita Malick Bah Ermerlindo Rodrigues Pereira Ibrahima Dara Diamé Bangaly Traore Sidy ka Ahmadou Dem Centre Hospitalier Régional de Fatick Fatick Sénégal Université de N’Djamena N’Djamena Tchad Université Cheikh Anta Diop de Dakar Dakar Sénégal Centre Hospitalier Universitaire de Fann Dakar Sénégal Hô pital Jean Paul II Conakry Guinée Centre Hospitalier Universitaire Le Dantec Dakar Sénégal

Demons-Meigs syndrome combines a benign tumor of the ovary with thoracic and abdominal effusion, it is a rare disease whose pathophysiological mechanism is not yet well understood. This rare syndrome often gives rise to fear of ovarian neoplasia due to the existence of ascites and the significant elevation of CA 125. In this observation, we report the case of Demons-Meigs syndrome diagnosed in a 36-year-old young woman who presented with pleural and peritoneal effusion syndrome with an ovarian mass and a CA 125 level = 406.6 IU/ml. Laparotomy performed revealed very abundant ascites, the uterus and tubes were healthy, no suspicious peritoneal lesions, the left ovary is healthy, a right ovarian mass of 300 × 150 mm. A right annexectomy was performed. The operative suites were simple with drying of the effusions. The control CA 125 returned to normal after 6 months of follow-up. A pathyle="font-family:Verdana;">ological anatomy result is a fibrothecoma. Demons-Meigs syndrome has a good progno

关键词： Demons-Meigs Syndrome Ovarian Tumor CA 125 Ascites Hydrothorax Senegal

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Non-Diabetic Nephropathies among Diabetic Patients of the Nephrology Department of Dakar

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Open Journal of Nephrology 2019年第2期9卷 41-48页

作者： Mame Selly Diawara M. M. Cisse N. keita y. kane S. Mahmoud A. T. Lemrabott M. A. Faye S. Diagne F. ka A. Niang B. Diouf Nephrology Department of Regional Hospital of Thies Thies Senegal Nephrology Department of Teaching Hospital Le Dantec Dakar Senegal Nephrology Department of Regional Hospital of Zinguinchor Zinguinchor Senegal

Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a N

关键词： Diabetes Diabetic Nephropathy Non-Diabetic Nephropathy Dakar

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Prognostic Aspects of Lupus Nephritis at Aristide Le Dantec University Hospital in Dakar

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Open Journal of Nephrology 2018年第4期8卷 124-132页

作者： Mbengue Mansour Faye Maria Cissé Mouhamadou Moustapha Lemrabott Tall Ahmed Fall Khodia keita Alex Faye Moustapha Ba Bakary Diagne Seynabou keita Niakhaleen Ba Mamadou Aw Dieng Ameth Motula Latou Lot Niang Abdou Diouf Boucar ka El Hadji Fary Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal

Introduction: Kidney injury is common in the course of lupus and affects the functional and vital prognosis. The risk of progression to end-stage renal failure can reach 40% to 60%. Thus we carried out this work for the purpose of an evaluation of the renal and vital prognosis and to deduce the factors of poor prognosis. Patients and method: This was a retrospective, descriptive and analytical study conducted over a period of 10 years from January 1, 2007 to December 31, 2016, performed in the Nephrology Department of Aristide Le Dantec Hospital in Dakar. Patients with lupus nephritis were included. The studied parameters were epidemiological, clinical, paraclinical and progression. We had done a crossover of the patients to look for the factors of poor renal and vital prognosis. Results: Out of 93 cases of lupus patients, 64 were included, a prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men, a sex ratio of 0.23. Class III was found in 24 cases (37.5%), Class IV in 20 cases (31.25%), Class V in 15 cases (23.4%), Class II in 4 cases (6.25%) and Class I in 1 case (1.6%). The combination of corticosteroids and immunosuppressants was used in 56.25% of cases. After a follow-up of six months, 19 patients were in complete remission, 21 had resistance and 9 had partial remission. Of the 21 patients who had resistance, 8 were in chronic renal failure. Death was observed in 5 patients and the causes were in 3 patients: pulmonary embolism, bacterial meningitis and pulmonary tuberculosis. The cause of death was unknown in 2 patients. The factors of poor renal prognosis were lymphopenia, the presence of anti-native DNA antibodies, nephrotic syndrome, microscopic hematuria, tubular atrophy and interstitial fibrosis. Risk factors affecting renal survival were the presence of native anti-DNA antibodies, microscopic hematuria, leukocyturia and the presence of a proliferative class. The factors of poor prognosis were renal f

关键词： Remission Resistance Chronic Renal Failure Lupus Nephritis

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