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Centropontine Myelinolysis after Conservative Correction of Hyponatremia: A Case Report and Review of Contributing Factors

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Open Journal of Nephrology 2022年第2期12卷 187-194页

作者： aboubacar sidiki Fofana Magara Samaké Sah dit Baba Coulibaly Seydou Sy Atabième Kodio Moctar Coulibaly Christophe Bouaka Ghassan Alchahin Hermione Deudjeu Youmbissie Hamadoun Yattara Nouhoum Coulibaly Saharé Fongoro Nephrology Unit Fousseyni Daou Hospital in Kayes Kayes Mali National Center for Scientific and Technological Research (CNRST) Bamako Mali Nephrology Unit Somino Dolo Hospital in Mopti Mopti Mali Nephrology and Hemodialysis Department University Teaching Hospital of Point-G Bamako Mali Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technologies of Bamako Bamako Mali Nephrology Unit Mali Gavardo Hospital Bamako Mali Nephrology and Hemodialysis Department Martigues Hospital Martigues France Medical Imaging Department Martigues Hospital Martigues France

Introduction: Centropontine myelinolysis (CPM) is a rare pathology, a delayed neurological complication corresponding to massive demyelination of the protrusion. Its exact pathogenesis is poorly understood. Rapid correction of sodium hyponatremia has been implicated as a potent causative factor. We report a case of CPM despite a priori conservative correction of hyponatremia with a favorable course in a 61-year-old alcoholic-smoker diabetic. Case Presentation: A 61-year-old man with chronic alcoholism presented to the emergency department (D0) with physical asthenia and anorexia. He was treated for severe hyponatremia at 104 mmol/L by careful rehydration with saline before being transferred to a nephrological hospital. Magnetic resonance imaging (MRI) performed at D14 for locked-in syndrome showed osmotic demyelination syndrome (Figure 1). The evolution was favorable after 3 months of rehabilitation marked by a progressive and clear improvement of clinical signs. Conclusion: This observation suggests an evaluation of the benefit/risk ratio of the short-term prognosis of profound hyponatremia with that of the metabolic stress induced by a still too rapid correction. Particular attention should be paid to diabetic patients in the context of chronic alcoholism or nutritional deficiencies.

关键词： Centropontine Myelinolysis Hyponatremia Alcoholism

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Estimation of Glomerular Filtration Rate: Which Formula to Apply in G-Spot Subjects Aged 1 - 17 Years?

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Open Journal of Nephrology 2021年第3期11卷 397-402页

作者： Hamadoun Yattara Djibril Mamadou Couliblay Nouhoum Coulibaly Pamela Samiza Seydou Sy Arboncana Maiga Djeneba Diallo Moustapha Tanagra Alkaya Touré Magara Samaké Niagalé Diakité aboubacar sidiki Fofana Ibrahim Izetiengou Maiga Sahare Fongoro Nephrology and Hemodialysis Department of the Point G University Hospital Bamako Mali Medical biology Laboratory Service of the Point G University Hospital Bamako Mali Nephrology Department of the Regional Hospital of Kayes Kayes Mali

Introduction: Morbidity and mortality in paediatric practice is dominated in Africa by malaria, diarrhoeal diseases and acute respiratory infections. Aim: In order to evaluate the Glomerular Filtration Rate (GFR) with the formulas commonly used by medical laboratories, we proposed to undertake this study. Patients and Method: This was a descriptive, prospective and cross-sectional study conducted at the PA and KA medical biology laboratory in Bamako Hamdalaye ACI 2000 in collaboration with the medical biology and hospital hygiene laboratory service at the Point G University Hospital. Results: During the study period, we recruited 360 subjects, 189 of whom were male (52.5%) and 171 female (47.5%). The mean age was 8.75 ± 4.8 years with extremes of 1 and 17 years. Subjects aged 15 to 17 years were the most numerous. The reference means GFR of the subjects according to age was with the SCHWARTZ formula 179.16 ± 50.47 with extremes of 173.93 and 184.39;with CKD-Epi 37.63 ± 11.25 with extremes of 36.46 and 38.79;with MAYO 107.87 ± 18.11 with extremes of 105.99 and 109.75 and MDRD 350.83 ± 251.15 with extremes of 324.79 and 376.86. Conclusion: The Mayo formula showed a better distribution around the mean than other formulas for estimating the glomerular filtration rate.

关键词： Glomerular Filtration Rate Reference Value Young Subjects

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Result of 10 Years of Experience in Echo-Guided Kidney Biopsy Punctures in the Nephrology Department of the Martigues Hospital Center, France

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Open Journal of Nephrology 2021年第2期11卷 144-155页

作者： aboubacar sidiki Fofana Magara Samaké Seydou Sy Sah Dit Baba Coulibaly Christophe Bouaka Ghassan Alchahin Delphine Haussaire Simona Dorina Boncila Hamadoun Yattara Moctar Coulibaly Atabième Kodio Modi Sidibe Saharé Fongoro Nephrology Unit of the Fousseyni DAOU Hospital Kayes Mali Nephrology and Hemodialysis Department of the University Teaching Hospital of Point-G Bamako Mali Faculty of Medicine and Odontostomatology of the University of Sciences Techniques and Technologies of Bamako Bamako Mali Nephrology Unit of Somino DOLO Hospital Mopti Mali Nephrology and Hemodialysis Department of the Martigues Hospital Martigues France Nephrology Unit of Mali Gavardo Hospital Sébénikoro Bamako Mali

Introduction: Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. Objectives: To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. Methodology: This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. Results: The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. Conclusion: Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.

关键词： Renal Puncture Biopsy Nephrology Martigues Hospital Center

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Prevalence of Cardiovascular Risk Factors in Chronic Hemodialysis Patients at the University Hospital Center of Point G in Bamako, Mali

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Open Journal of Nephrology 2020年第2期10卷 125-134页

作者： Seydou Sy Magara Samaké Moctar Coulibaly Massama Konaté Djénèba Diallo Hamadoun Yattara aboubacar sidiki Fofana Atabieme Kodio Modi Sidibé Nouhoum Coulibaly Alkaya Touré Djibril Sy Moustapha Tangara Saharé Fongoro Nephrology and Haemodialysis Department of the CHU of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the Fousseyni DAOU Hospital of Kayes Kayes Mali Nephrology Unit of Mali GAVARDO Hospital Bamako Mali Cardiology Department of Mali Hospital Bamako Mali Internal Medicine Service at the University Hospital Center of Point G Bamako Mali

Introduction: A cardiovascular risk factor (FDRCV) is defined as a physiological, pathological or environmental attribute or characteristic that results in an increased likelihood of developing cardiovascular disease in the individual in whom it is detected. The objective of this study was to determine the prevalence of cardiovascular risk factors in hemodialysis patients on hemodialysis at the University Hospital of Point G. Patients and Methods: This was a cross-sectional descriptive study with prospective data collection from March 3, 2009 to March 5, 2010 (13 months). Included were all patients with end-stage renal disease (ESRD) receiving chronic hemodialysis in the Nephrology and Hemodialysis Department of the University Hospital of Point G during the study period. Results: Eighty-eight patients were enrolled. The M/F sex ratio was 1.26. The mean age was 41.32 years with extremes of 17 and 81 years. The classic cardiovascular risk factors in order of frequency were: hypertension (90.9%), sedentary lifestyle (71.6%), male sex (54.5%), age ≥ 55 years (21.6%), obesity (13.6%), diabetes (8%), tobacco (8%), alcohol (3.4%). Cardiovascular risk factors related to CKD were: anemia (98.9%), phosphocalcic disorders (85.2%), arteriovenous fistula (AVF) (80%), lipid abnormalities (36.5%), hydrosodium inflation (29.5%). Predominant cardiovascular complications were hypertensive heart disease (62.5%), acute pulmonary oedema (APO) (50%), rhythm disorders (23.9%), coronary insufficiency (18.2%). The mortality rate was 17%. Conclusion: Cardiovascular risk factors are frequent in chronic hemodialysis. They contribute to the excess mortality of these patients. Adequate management of these risk factors can slow down serious cardiovascular complications and reduce the risk of mortality in this fragile population.

关键词： Cardiovascular Risk Factors Haemodialysis Mali

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Epidemiological, Clinical and Echocardiographic Aspects of Non-Obstructive Hypertrophic Cardiomyopathy in the Nephrology and Haemodialysis Department of the POINT G University Hospital

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Open Journal of Nephrology 2023年第2期13卷 81-90页

作者： Hamadoun Yattara Nouhoum Coulibaly Yohana Koné Atabieme Kodio Seydou Sy aboubacar sidiki Fofana Abdou Messoum Dolo Djenebou Maiga Magara Samaké Alkaya Touré Abdoul Karim Traoré Mahamadoun Kougouliba Moustapha Tangara Sahare Fongoro Point G University Hospital Bamako Mali Sikasso Regional Hospital Sikasso Mali Kayes Regional Hospital Kayes Mali Segou Regional Hospital Segou Mali Faculty of Medicine and Odontostomatology University of Science Technique and Technologies of Bamako Bamako Mali

Introduction: LVH is the earliest cardiovascular abnormality in CKD. It is a significant risk factor for mortality and cardiovascular morbidity in patients with chronic kidney disease. The objective of this study was to investigate non-obstructive hypertrophic cardiomyopathy in CKD patients hospitalised in the nephrology and haemodialysis department of the POINT G University Hospital. Methods: This is a prospective study carried out from January 1, 2021 to December 31, 2021 and concerned chronic renal failure patients with non-obstructive hypertrophic cardiomyopathy. Results: During our study, we recorded 89 cases of non-obstructive hypertrophic cardiomyopathy, a prevalence of 42.8%. The sex ratio was 1.2 in favour of men. The average age of the patients was 45 ± 14.4 years with extremes of 16 and 78 years. The risk factors frequently found were anaemia (100%) and hypertension (92.1%). The clinical picture was dominated by the left heart failure syndrome (66.3% of cases). The different types of echocardiographic hypertrophy found were concentric (72%), eccentric (18%) and septal hypertrophy (10%). Conclusion: Non-obstructive hypertrophic cardiomyopathy is the early cardiovascular abnormality encountered in CKD. It is associated with cardiovascular risk factors such as hypertension, anaemia and phosphocalcic disorders.

关键词： LVH Risk Factor Chronic Renal Failure Echocardiography

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Small Cell Lymphoma of the Gastrocnemius Muscle: A Case Report

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Surgical Science 2023年第4期14卷 303-308页

作者： Abdoul Kadri Moussa Layes Touré Kalifa Coulibaly Mahamadou Diallo Mamadou Bassirou Traoré Cheick Oumar Sanogo Laurent Désiré Ndzié Essomba Madani Ly aboubacar sidiki Ndiaye Safiatou A. Touré Bakarou Kamaté Orthopedics-Traumatology Department Gabriel Touré University Hospital Bamako Mali Orthopedics-Traumatology Department of Sikasso’s University Hospital Sikasso Mali Orthopedics-Traumatology Department of Kati’s University Hospital Kati Mali Medical Oncology Department of Mother-Child Luxembourg University Hospital Bamako Mali Medical Imaging Service Faculty of Medicine and Odontostomatology Bamako Mali Anatomy-Cytology-Pathology Department of the Point G University Hospital Bamako Mali

Introduction: The primary localization of non-Hodgkin lymphoma of the muscle is rare. Only the biopsy allows the certainty diagnosis. The aim was to report a first case of small cell lymphoma of the gastrocnemius in Mali and to do a review of the literature. Clinical Observation: It was about a 34-year-old woman who consulted 3 months after the onset of symptoms for swelling and pain in the left calf. On clinical examination there was a hard, painful and warm mass in the left calf, with paresthesias in the tibial nerve territory associated with partial functional impotence of the leg. The ultrasound revealed a hyper echogenic and heterogeneous non-vascularized mass of the left gastrocnemius muscle measuring 65 × 45 × 40 mm non-vascularized on color Doppler and pulsed in favor of myositis. Magnetic resonance imaging (MRI) concluded in a well-limited heterogeneous cystic mass in the left gastrocnemius muscle respecting the bone of benign appearance: remodeled Baker’s cyst? Considering the radioclinical unconformity, thoraco-abdominal CT was performed and revealed pulmonary metastasis. The biopsy carried out concluded with a small cell lymphoma of the gastrocnemial muscle. Marginal resection was performed associated with adjuvant chemotherapy. The advancement at 9 months was satisfactory.

关键词： Small Cell Lymphoma Marginal Muscle Gastrocnemius Excision Adjuvant Chemotherapy Evolution Mali

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Erectile Dysfunction in Chronic Hemodialysis Patients at the University Hospital Center of Point-G in Mali

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Open Journal of Clinical Diagnostics 2020年第1期10卷 29-40页

作者： Seydou Sy Magara Samaké Hamadoun Yattara Moctar Coulibaly Ibrahima Koné aboubacar sidiki Fofana Djénèba Diallo Atabieme Kodio Modi Sidibé Nouhoum Coulibaly Alkaya Touré Djibril Sy Moustapha Tangara Saharé Fongoro Nephrology and Haemodialysis Department of the CHU of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the Fousseyni DAOU Hospital of Kayes Kayes Mali Nephrology Unit of Mali GAVARDO Hospital Bamako Mali Nephrology Unit of the Regional Hospital of Mopti Mopti Mali Internal Medicine Service at the University Hospital Center of Point G Bamako Mali

Introduction: Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse. The frequency of erectile dysfunction in patients with kidney failure is estimated at 50% to 70%. The objective of this work was to determine the frequency of sexual dysfunction in chronic hemodialysis patients, to evaluate the psycho-social impact and to describe hormonal disturbances. Patients and Methods: This was a descriptive prospective study carried out from 3 April to 31 August 2017 in the nephrology and haemodialysis department of the Point G University Hospital. She has been interested in men over the age of 18 who have been on chronic hemodialysis for more than a year. Sexual dysfunction was assessed using the questionnaire: International Index of Erectile Function (IIEF-5). Results: Sixty-five patients were included. Forty-six (70.8%) had severe (30.8%), moderate (13.8%) and mild (26.2%) ED. 56.9% of patients had libido disorders, with decreased sexual desire (38.5%);absent sexual desire (18.5%). Sexual desire was normal in 43.1% of patients. Sexual activity was absent in 20 patients (30.8%). Sexual rigidity was reduced in 28 patients (43.1%) and normal in 24 patients (36.9%). The mean age of our patients was 42.55 years with a median age of 40 years and extremes of 23 and 74 years. Eighty percent were married. Nine patients (13.8%) were using sildenafil-based medications. Antihypertensives were prescribed in 93.9% and erythropoietin in 30.8% of patients. The main impact groups were anxiety (53.8%), fear of failure (27.7%), insomnia (7.7%) and anxiety (6.1%). And defence mechanisms included: understanding (54.7%);isolation (24.6%);repression (7.7%);quarrel (7.7%);and divorce in 1 case (1.5%). The occurrence of ED was related to hypotestosterolemia (p = 0.030), and between low libido and testosterone (p = 0.001). Nutritional status was satisfactory in 78.4% of our patients. Moderate and at and severe undernutrition was

关键词： Erectile Dysfunction Renal Failure Dialysis Mali

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有机磷农药对马里农业的神经毒性：“毒死蜱在棉花地区的发言毒性和小鼠行为分析”

有机磷农药对马里农业的神经毒性：“毒死蜱在棉花地区的发言毒性...

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作者： sidiki COULIBALY 华中师范大学

学位级别：硕士

有机磷农药是世界上使用最广泛的杀虫剂,在马里它们具有广泛的毒性作用,并且一直是世界各地关注的焦点。有机磷农药在有效控制病虫害的同时,对环境安全以及人群健康构成了一定威胁。研究表明,有机磷农药对生物最主要的毒性为神经毒性,... 详细信息

有机磷农药是世界上使用最广泛的杀虫剂,在马里它们具有广泛的毒性作用,并且一直是世界各地关注的焦点。有机磷农药在有效控制病虫害的同时,对环境安全以及人群健康构成了一定威胁。研究表明,有机磷农药对生物最主要的毒性为神经毒性,包括对神经系统神经递质及其受体以及相关酯酶的活性改变、迟发性神经毒性及神经发育毒性等毒性作用。虽然临床和流行病学研究已经确定了其对人类发育毒性的各种形式,但这些研究被发现是还不够深入。同时由于人类神经发育时间长,要完全研究其对神经系统的发育毒性。往往需要几年或更长时间。其次,由于社会和环境因素的复杂性(例如,环境中可能有其他化学品也可能产生发育影响),也可能影响实验结果。因此,有必要使用体内动物模型和体外模型,以确定该产品的发育毒性并了解其机制,因为这些模型具有提供更多结果的优点,但也比流行病学研究更好地控制环境条件。本工作是对有机磷农药对哺乳动物的发育毒性的研究成果之一。我们首先通过调查研究的观点,系统研究了有机磷农药对马里地区人民疾病健康状况的调查;其次我们利用小鼠为实验对象,妊娠后期和孕期,通过母乳喂养,让小鼠暴露不同剂量的毒死蜱(0.2mg/kg、1mg/kg和5mg/kg/每天)。两周后对成年动物进行行为和一些生化指标测试。我们发现,有机磷农药能够导致小鼠运动能力损伤,损伤小鼠的探究能力,导致短期和长期的空间记忆障碍,增加焦虑水平(上升的加迷宫),也给出抑郁的迹象,减少自发的火车头的活动(莫里斯水迷宫)。通过对生物机制的研究,深化了对行为测试的研究。因此,这些实验也证实了毒死蜱启动了几种发展恶化的机制。此外,在成年小鼠产生焦虑并与围生期接触亚毒性剂量的CPF有关的情况下,焦虑症与乙醜胆碱受体功能的改变有关。我们所做的有机磷农药发育毒性研究采用小鼠模型(MUS粘液),并测量了围产期慢性亚毒性暴露所产生的成人持续性行为障碍。这一模式证实了在马里农业领域进行的初步研究。

关键词：记忆有机磷农药神经毒性行为机制焦虑抑郁

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Ultrasound Causes of Female Infertility at the Fertilia Medical Clinic in Bamako

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Open Journal of Medical Imaging 2023年第3期13卷 107-113页

作者： Mamadou Dembele Alassane Kouma Ilias Guindo Zoumana Cheick Berete Souleymane Sanogo Mamadou N'diaye Brahima Doumbia Oncoumba Diarra Ousmane Traore Issa Cisse aboubacar sidiki N’ Diaye Badiougou Doucoure Youssouf Yalcouye Adama Diaman Keita Siaka Sidibe Radiology Department Faculty of Medicine and Odonto-Stomatology of Bamako (FMOS) Bamako Mali Radiology Unit Fertilia Medical Clinic Bamako Mali Department of Education and Research in Public Health (DERSP) FMOS Bamako Mali

Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.

关键词： Ultrasound Female Infertility Myomas Polycystic Ovaries Hydrosalpinx

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Epidemiological and Clinical Profile of Patients Undergoing Primary Nephrological Consultation at the Fousseyni DAOU Hospital in Kayes, Mali

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Open Journal of Nephrology 2022年第1期12卷 142-153页

作者： Magara Samaké Seydou Sy aboubacar sidiki Fofana Hamadoun Yattara Sah Dit Baba Coulibaly Djénéba Diallo Nanko Doumbia Moctar Coulibaly Kodio Atabieme Djénéba Maiga Aboudou Messoum Dolo Nouhoum Coulibaly Saharé Fongoro Nephrology Unit Fousseyni DAOU Hospital Kayes Mali National Center for Scientific and Technological Research (CNRST) Bamako Mali Nephrology and Hemodialysis Department Point G Teaching Hospital Bamako Mali Faculty of Medicine of Bamako University of Bamako Bamako Mali Nephrology Unit Somine DOLO Hospital Mopti Mali Department of Medicine Mali Hospital Bamako Mali Nephrology Unit Mali GAVARDO Hospital Sebenicoro Bamako Mali Nephrology Unit Sikasso Hospital Sikasso Mali

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 c

关键词： Primary Consultation Nephrology Kayes Mali

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