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Acute Kidney Injury in the Nephrology Department of the Brazzaville University Hospital: Epidemiological, Clinical and Evolutionary Aspects

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Open Journal of Nephrology 2024年第2期14卷 196-215页

作者： Daniel tony eyeni sinomono Gael Honal Mahoungou Eric Gabdzali Ngabé Audrey Missamou Mavi Bouloupy Richard Loumingou Department of Nephrology Brazzaville University Hospital Brazzaville Congo Department of Nephrology Adolphe Ciss General Hospital Pointe Noire Congo

Introduction: Acute kidney injury (AKI) is defined as a sudden and reversible deterioration in renal function. It is a life-threatening condition in hospitalized patients. Our objectives were to determine the prevalence of AKI in a nephrology department, list the causes, describe the evolutionary profile and identify the factors associated with death. Patients and Methods: We reviewed the records of patients hospitalised between 1 January 2016 and 31 October 2020 in the nephrology department of Brazzaville University Hospital. We included patients aged at least 18 years whose discharge diagnosis included the item AKI. Study variables were socio-demographic data, clinical and paraclinical signs, stage and type of AKI, etiology and evolutionary profile. Results: Of the 1823 patients hospitalised, 244 (13.38%) were hospitalised for AKI. Of these, 60.2% were boys and 39.8% girls, with an average age of 47 19 years. The average consultation time was 10 6.5 days. AKI was stage 3 in 69.57% of cases. It was functional, organic and obstructive in the order of 55.28%, 36.02% and 8.69%. Dialysis was indicated in 62 patients (38.51%) and performed in 24 patients (14.9%). In-hospital mortality was 27.95%, with an average hospital stay of 9.6 5.8 days. Metabolic acidosis and anemia were the main causes of death in 14.28% and 4.35% of patients respectively. Factors associated with death were male sex, socioeconomic level, coma, indication for dialysis and absence of dialysis, with a p Conclusion: AKI is more common in young adult males. Mortality is relatively low. Improving prognosis requires early management and access to dialysis.

关键词： AKI Epidemiology Diagnosis Evolution Brazzaville

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Assessment of the Level of Knowledge about Chronic Renal Failure in 271 Hypertensive Patients in Brazzaville

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Open Journal of Nephrology 2024年第1期14卷 25-36页

作者： Daniel tony eyeni sinomono Ange Niama Gaël Honal Mahoungou Éric Gandzali-Ngabé Ndinga Berline Ngoma Precieux Dalia Mboungo Richard Loumingo Department of Nephrology University Hospital Center Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Department of Public Health Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo

Background and Objectives: Chronic kidney disease (CKD) is now a global public health problem. In low- and middle-income countries such as the Congo, access to dialysis is low and inequitable. The prevention of CKD involves raising awareness among patients at risk, such as those suffering from arterial hypertension (AH), by improving their knowledge of CKD. The objectives of our work were to determine the level of knowledge about CKD among hypertensive patients and to identify the factors associated with a low level of knowledge. Methodology: We conducted a 3-month descriptive and analytical cross-sectional study from 1 August to 30 October 2023 in 3 large public hospitals in Brazzaville (capital of the Republic of Congo). We included: hypertensive patients aged 18 and over who had freely consented to participate in our study and were able to answer the questions on the survey form. Patients with known hypertension who had been followed for less than 3 years and those with known chronic renal failure were not included. Results: The mean age was 58.4 ± 14.4 years (29 - 88 years). There were 121 men and 150 women (sex ratio = 0.8). All the patients were educated;37.2% with a higher level of education and 13.6% with primary education. 24 patients (9%) had a good level of knowledge about CKD and 153 (56%) had poor knowledge. A good level of knowledge was associated with the duration of hypertension, intellectual level and the existence of associated heart disease. Conclusion: Our study reveals a significant lack of knowledge about chronic kidney disease among hypertensive patients in Brazzaville.

关键词： Knowledge Chronic Renal Failure Hypertensives Brazzaville

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Clinical, Etiological and Progressive Aspects of Acute Tubular Necrosis of Toxic Origin at the Brazzaville University Hospital Center

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Open Journal of Nephrology 2023年第4期13卷 464-471页

作者： Daniel tony eyeni sinomono Gaël Honal Mahoungou Éric Gandzali-Ngabé Berline Ndinga Précieux Ngoma Dalia Mboungou Richard Loumingou Tarik Sqalli Houssaini Department of Nephrology Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Department of Nephrology Hassan II University Hospital Center of Fes Fes Morocco

Background and Objectives: Acute tubular necrosis (ATN) is the second cause of acute kidney injury (AKI) in an intra-hospital environment. The toxic origin is avoidable. Our objectives were to determine the toxic substances at the origin of ATN at the Brazzaville University Hospital and determine the evolving aspects and the factors associated with it. Patients and Methods: We carried out a 12-month from June 20, 2022 to June 30, 2023. It was a prospective observational study in the Nephrology Department of Brazzaville University Hospital Center. The diagnosis of ATN was done in the presence of AKI occurring in the context of taking nephrotoxic substances with negative albuminuria. Cases of ATN aggravating CKD were excluded. Data analysis was done with Epi-Info 7.2 software. Results: We identified 63 cases of AKI on toxic ATN. Their average age was 47 ± 19 years with a male predominance of 60.2%. The 3 main toxicants incriminated were: herbal medicine (49.2%), Gentamycin (17.5%) and non-steroidal anti-inflammatory drugs (14.3%). An indication for hemodialysis was made in 43 patients (68.2%), the evolution was marked by a cure in 29 patients (46.1%), 10 (15.9%) became chronic kidney failure, 19 (30.1%) died, 5 (7.9%) were lost to follow-up. The main factor for non-healing is anuria (p Conclusion: The main cause of toxic ATN at Brazzaville University Hospital is herbal medicine. The death rate is high there.

关键词： Brazzaville Acute Tubular Necrosis Toxic

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Acute Renal Failure in Children at the University Hospital of Brazzaville

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Open Journal of Pediatrics 2019年第3期9卷 253-271页

作者： Engoba Moyen Verlem Bomelefa-Bomel Gaston Ekouya-Bowassa tony eyeni sinomono Aymar Pierre Gildas Oko Bertrand Fikahem Ellenga Mbolla Georges Marius Moyen Intensive Care Pediatric Department University Hospital of Brazzaville Brazzaville Congo Neonatology Department University Hospital of Brazzaville Brazzaville Congo Nephrology Department University Hospital of Brazzaville Brazzaville Congo Cardiology Department University Hospital of Brazzaville Brazzaville Congo

Introduction: Acute renal failure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: Included were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% resulted from severe dehydration. No extra-renal treatment was performed. Lethality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and severe malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, absence of an extra-renal purification center were factors associated with mortality (p Conclusion: The high prevalence of ARF and its lethality requires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.

关键词： Acute Renal Failure Child Brazzaville

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Bone Dysmorphia-Induced Blindness Following a Secondary Hyperparathyroidism: A Case Report

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Open Journal of Nephrology 2021年第4期11卷 489-494页

作者： Gael Honal Mahoungou Daniel tony eyeni sinomono Ghislain Armel Mpandzou Regis Franck Moyikoua Josue Euberma Diatewa Dinah Happhia Motoula Benedicte Diatewa Helena Botokoto Bothard Richard Loumingou Faculty of Health Sciences of Brazzaville Marien Ngouabi University Brazzaville Republic of Congo Department of Nephrology University Hospital of Brazzaville Brazzaville Republic of Congo

Introduction: Conjunctival-corneal or choroidal calcifications are frequent in SHPT, blindness is however exceptional. We report a case of blindness secondary to compressive ischemic optic neuropathy. Case Report: Mr. B.E.K., 49 years old, has a chronic renal failure secondary to unlabeled glomerular nephropathy for 17 years. He has been on chronic hemodialysis for 12 years and has had SHPT for nine years. He secondarily developed disabling segmental osteoarticular deformities associated with kyphoscoliosis, “drumstick” fingers and facial dysmorphism. Five months before admission he developed eye pain and reduced visual acuity progressing within one month to blindness. Biology noted: serum creatinine at 726 umol/l (60 - 120 umol/L), azotemia at 14.3 mmol/l (2.5 - 7.5 mmol/L), serum calcium at 2.25 (2.25 - 2.55 mmol/L), phosphatemia at 1.13 (0.8 - 1.35 mmol/L), alkaline phosphatases at 2196 (5 - 270 IU/L) and parathyroid hormone level at 2257 (10 - 60 pg/mL). Retinal angiography revealed lesions suggestive of ischemic neuropathy. The orbit CT scan with 3D coronal reconstruction revealed narrowing of the caliber of the optical channels with dystrophic thickening of the skull base and cranial vault. Cranioencephalic and orbital MRI revealed diffuse brown tumors and pre-chiasmatic optic atrophy. Discussion: The most frequent ocular complications of SHPT are conjunctival-corneal or sclero-choroidal calcifications, asymptomatic, associated with hypercalcemia. Compressive manifestations are rarer, represented mainly by an amputation of the visual field, diplopia, ptosis or blindness, as described in our patient. The main cause is osteodystrophy and brown tumors of the skull base (1% - 2%). Conclusion: This case report underlines the importance of early detection of SHPT, in order to avoid its major complications, such as blindness, especially since current preventive and curative measures have proven their

关键词： Blindness Secondary Hyperparathyroidism Bone Dysmorphism

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Epidemiological Clinical Profile of Chronic Kidney Disease in Adults under 50 at the University Hospital of Brazzaville

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Open Journal of Nephrology 2021年第3期11卷 358-369页

作者： Daniel tony eyeni sinomono Ginesse Ndinga-Okaka Sedan Gael Honal Mahoungou Eric Pierre Gandzali Ngabe Richard Moukengue Loumingou Bertrand Ellenga-Mbolla Mohamed Arrayhani Tarik Sqalli Houssain Department of Nephrology and Dialysis University Hospital of Brazzaville Brazzaville Congo Hemodialysis Unit of the Medical Center for Specialists of the 15 years old plateau of Brazzaville Brazzaville Congo Departement of Nephrology Edith Lucie Bongo General Hospital of Oyo Oyo Congo Department of Cardiology and Internal Medicine University Hospital of Brazzaville Brazzaville Congo Departement of Nephrology University Hospital Hassan II of Fez Fez Morocco

Introduction: Chronic Kidney Disease (CKD) is a major global public health problem. In Congo, we have very few studies on it. Patients and Methods: We carried out an analytical cross-sectional study with retrospective data collection including patients aged 18 to 49 years, hospitalized for CKD in the nephrology department of University Hospital of Brazzaville, during the period from January 1, 2016 to August 31, 2020. The variables considered were socio-demographic, clinical, paraclinical, therapeutic and evolutionary. The statistical test used was Pearson’s chi-square test. Results: CKD in those under 50 represented 21.1% of admissions and 35.6% of CKD. The mean age was 35.9 ± 8.4 years. There was a male predominance with a sex ratio of 1.27. Hypertension was the most common comorbidity (49.2%), followed by HIV (13.6%) and diabetes mellitus (13.2%). Stage 5 CKD was most prevalent (82.7%). Indeterminate kidney disease was in the order of 55.9%. The low socioeconomic level (74.9% of cases) hampered the achievement of dialysis in 66.3% of patients for whom this treatment was indicated. Failure to perform dialysis significantly influenced the occurrence of death (p-value = 0.005). Conclusion: CKD is common among people under 50 and more affects males with a high mortality rate due to lack of access to dialysis. The main causes are hypertension and HIV.

关键词： Chronic Kidney Disease Epidemiology Brazzaville

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Quality of Life of Chronic Kidney Disease Patients in the Republic of the Congo

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Open Journal of Nephrology 2021年第4期11卷 495-505页

作者： Gael Honal Mahoungou Daniel tony eyeni sinomono Yannick Dimi Nyanga Tanee Fomum Steve Ondziel Opara Helena Botokoto Bothard Jean Lucien Mobengo Richard Loumingou Blaise Iréné Atipo Ibara Department of Nephrology University Hospital of Brazzaville Brazzaville Republic of the Congo Faculty of Heath Sciences University Marien Ngouabi Brazzaville Republic of the Congo Department of Urology University Hospital of Brazzaville Brazzaville Republic of the Congo Department of Gastroenterology University Hospital of Brazzaville Brazzaville Republic of the Congo

Background: Chronic kidney disease could impair the quality of life of patients regardless of the stage of the disease. So far, there is no data on this subject in the Congolese population. The objective of this study was to assess the quality of life of patients with chronic kidney disease in Congo. Patients and methods: We conducted a cross-sectional, descriptive study of 91 patients followed in the department of nephrology and in dialysis centers in Brazzaville, Pointe-Noire and Oyo from July 1st to November 30th, 2020, i.e. five months. We used the Kidney disease quality of life short form health survey score (KDQOL-SF 36) to assess the quality of life of patients and a questionnaire was used to determine socio-demographic, clinical and therapeutic features. Data analysis was done on SPSS 2.2 software. Result: The average age was 51.9 ± 15 years. The sex ratio M/F was 2.03. The average time of patient follow-up was 15 months;90% of them had hypertension. The overall average score of specific dimensions was 52 ± 18;disease burden was the dimension most affected;that of the generic dimensions was 34 ± 25 with the limitation of physical activity dimension being the most affected. No patient had received psychological follow-up. Conclusion: This study indicates the value of a systematic assessment of the quality of life of patients with chronic kidney disease as well as the need for assistance for these patients in different areas of their life.

关键词： Chronic Kidney Disease Quality of Life KDQOL

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Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Chronic End-Stage Renal Failure in the Nephrology Department of the University Hospital of Brazzaville in 2023

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Open Journal of Nephrology 2024年第1期14卷 62-69页

作者： Gaël Honal Mahoungou Daniel tony eyeni sinomono Éric Ngandzali-Ngabé Soraya Ntandou Francky Ambounou Précieux Ngoma Berline Ndinga Dalhia Mboungou Héléna Botokoto Bothard Hardy Ibovi Richard Loumingou Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Department of Nephrology University Hospital of Brazzaville Brazzaville Congo

Objective: Chronic end-stage renal failure is a major public health problem in developing countries and is poorly documented. The objective of this study was to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of patients admitted for end-stage renal failure to the Department of Nephrology at the University Hospital of Brazzaville. Patients and Methods: This was a descriptive cross-sectional study collecting prospective data that took place over 10 months. We included 128 patients who were exhaustively identified. Sociodemographic, clinical, therapeutic and developmental data were collected using a standardized and pretested pre-established survey form. The EPI info software enabled the analysis and processing of the data. Results: We reported a male predominance with a sex ratio of 2.5. The median age was 50 years. The first cause found was diabetes (55%) followed by hypertension (46%). The majority of patients had a dialysis emergency and half could not be dialyzed for financial reasons. Conclusion: Our results highlighted that certain epidemiological parameters of end-stage renal failure are constantly changing, such as frequency, while others remain static, including the main etiologies, gender, and age. However, mortality continues to increase and deserves more attention.

关键词： ESRD Epidemiology Nephrology University Hospital of Brazzaville

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Factors Associated with Mortality in Diabetic Patients with End-Stage Renal Failure Starting Emergency Hemodialysis

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Open Journal of Nephrology 2024年第1期14卷 17-24页

作者： Gaël Honal Mahoungou Daniel tony eyeni sinomono Farel Elilié Mawa Ongoth Éric Ngandzali-Ngabé Nestor Andzouana Raissa Laure Mayanda Aymande Okoumou-Moko Francky Ambounou Précieux Ngoma Berline Ndinga Héléna Botokoto Bothard Hardy Ibovi Richard Loumingou Department of Nephrology University Hospital of Brazzaville Brazzaville Congo Faculty of Health Sciences University Marien Ngouabi Brazzaville Congo Department of Metabolic Diseases University Hospital of Brazzaville Brazzaville Congo

Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.

关键词： Diabetic Nephropathy Emergency Dialysis Republic of the Congo

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