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

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

作者： Mansour Mbengue Myriam Mezouari seynabou diagne Abdou Niang Dalal Jamm Hospital Dakar Senegal Pikine Hospital Dakar Senegal

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

关键词： Lupus Nephritis Infection Proliferative Class

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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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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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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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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

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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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Biermer Disease: Initial Presentation and Follow-Up of 66 Patients in Internal Medicine Department in Senegal

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International Journal of Clinical Medicine 2016年第9期7卷 585-591页

作者： seynabou Fall Nafissatou diagne Oulimata-Dior Diop Boundia Djiba Fatou-Samba-Diago Ndiaye Abdoulaye Pouye Clinical Haematology Unit of Internal Medicine Department Aristide Le Dantec University Teaching Hospital Dakar Senegal Internal Medicine Department Aristide Le Dantec University Teaching Hospital Dakar Senegal

Pernicious anemia in black people, is little known. Through this study we assess its diagnostic and evolutive aspects, and compare vitamin therapy B12 intramuscular and oral. Sixty six Biermer disease patients followed (January 2000-June 2014) at Internal Medicine Department of Aristide Le Dantec University Teaching Hospital (Senegal) are included. They were 26 men and 46 women (gender ratio: 0.65), who had a mean age of 47.84 years ± 15.25 years. Patients consulted for anemia (65 cases), acquired melanodermia (36 cases), gastrointestinal symptoms (30 cases), peripheral neuropathy (27 cases), venous thrombosis (2 cases), acute depression (1 case). Macrocytosis was observed in 52 cases. The mean hemoglobin in the vitamin B12 intramuscular group (52 patients) or oral group (14 patients) was the inclusion: 6.55 g/dl ± 3.12 g/dl vs 6.52 g/dl ± 2.18 g/dl (p = 0.04);and at day 8 treatment: 8.69 g/dl ± 2.49 g/dl vs 8.85 g/dl ± 1.9 g/dl (p = 0.43). Neurological and vascular presentations are unusual in contrast to macrocytic anemia. Oral administration of vitamin B12, simple and effective should be recommended in country with limited resources.

关键词： Pernicious Anemia Intramuscular Vitamin B12 Oral Vitamin B12 Senegal

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Pernicious Anemia Associated Autoimmune Diseases in a Sub Saharian African Internal Medicine Service

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Open Journal of Internal Medicine 2014年第3期4卷 59-63页

作者： Abdoulaye Pouye seynabou Fall Dieng Daher Abdoukarim Oumar Fatou Samba Diago N’Diaye Nafissatou diagne Sakho Atoumane Faye Souhaibou N’Dongo Medical Clinic 1 University Teaching Hospital Aristide le Dantec/Cheikh Anta Diop University of Dakar Dakar Senegal

Introduction: Pernicious anemia is an autoimmune disease. It is characterized by the presence of an autoimmune atrophic gastritis and various autoantibodies that lead to a vitamin B12 deficiency responsible for a macrocytic anemia. It is frequently associated with other specific or non-organ- specific autoimmune diseases. We report six patients with pernicious anemia associated with other autoimmune diseases. Patients and Results: There were six patients (4 females/2 males), mean age of 39.67 years. In all cases it was found macrocytic anemia. The average Hb was 6.08 g/dl and the average MGV: 110.67 fl. Bone marrow aspiration was performed in all patients. Megaloblastosis compatible with a lack of vitamin B12 or folic acid was constant. Determination of serum vitamin B12 was low in all cases while folic acid levels were within standards. Immuno- logically it was found in all patients, a positivity of anti-intrinsic factor antibody and/or anti- parietal cells antibody at rates up to 67 times over normal ranges. Pernicious anemia was associated with autoimmune thyroid dysfunction in 4 patients. It was two cases of Hashimoto thyroiditis at hypothyroidic phase (high TSHus, thyréoperoxydase anti-antibody positive (over 10 N) in both cases and Graves’ disease in the two other cases. Pernicious anemia was associated with a syndrome of primary antiphospholipid antibody in a case. Furthermore pernicious anemia was found in a patient autoimmune type 1 diabetes with strongly positive anti -GAD antibodies and rheumatoid arthritis by retaining it in the diagnosis of multiple autoimmune syndrome. Conclusion: These cases illustrate the existence of the association of pernicious anemia with other autoimmune diseases in our context. This should encourage practitioners to seek hided autoimmune diseases when they consider the diagnosis of pernicious anemia.

关键词： Pernicious Anemia Auto-Immune Diseases Auto Immune Thyroid Dysfunction Multiple Auto-Immune Syndrome

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