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Cardiac Decompensation after Dilatation of an Arteriovenous Fistula Stenosis: A Case Report

Open Journal of Nephrology 2022年第4期12卷 369-374页

作者： Modou Ndongo sid ali toufik benyaghla Fabrice Tiako Mamadou Mouctar Diallo Misylias Bouaoud Houyem Attia Fatiha Lahouel Djillali Ziane Berroudja Nestor Nankeu Tayeb Bensalem Catherine Albert Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France

The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.

关键词： Arteriovenous Fistula Stenosis Hyperflow Hemodialysis Cardiotoxic

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

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

作者： Modou Ndongo Babacar Ndiaye Nestor Nankeu Abou Sy Houyem Attia Fatiha Lahouel Djillali Ziane Berroudja Tayeb Bensalem sid ali toufik benyaghla Catherine Albert sidy Mohamed Seck El Hadji Fary Ka Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec Hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France Department of Nephrology Dialysis of Ouakam Military Hospital Dakar Senegal

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

关键词： Hypercalcemia Myeloma Treatment Malignancy Neoplasia

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

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

作者： Modou Ndongo Nestor Nankeu Josephine Nkok Helene Messet Fabrice Tiako Mamadou Mouctar Diallo Misylias Bouaoud Attia Houyem Fatiha Lahouel Djillali Ziane Berroudja Tayeb Bensalem sid ali toufik benyaghla Catherine Albert sidy Mohamed Seck El Hadji Fary Ka Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec Hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France Department of Nephrology Dialysis of Ouakam Military Hospital Dakar Senegal

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

关键词： Calcific Uremic Arteriolopathy Calciphylaxis Hemodialysis

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Kidney Damage in Multiple Myeloma: Clinical, Biological, Histological and Therapeutic Aspects at the Chartres Hospital Center

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Open Journal of Nephrology 2024年第4期14卷 518-528页

作者： Mamadou Mouctar Diallo Amadou Yaya Diallo Fara André Sandouno Nestor Nankeu Kadiatou Mamadou Bobo Barry Fabrice Tiacko Modou Ndongo sid ali toufik benyaghla Attia Houyem Catherine Albert Djilali Ziane Berroudja Fatiha Lahouel Fousseny Diakité Mohamed Lamine Kaba Alpha Oumar Bah Department of Nephrology and Haemodialysis CHU Donka Conakry Guinea Department of Nephrology Dialysis Chartres Hospital Center Le Coudray France

Introduction: Multiple myeloma is a haematological malignancy characterised by monoclonal plasma cell proliferation in the bone marrow, which synthesises a serum and/or urinary monoclonal protein, associated with one or more manifestations including (anaemia, hypercalcaemia, bone lesions, renal failure). The aim of our work was to determine the prevalence, clinico-biological, histological and therapeutic manifestations of renal damage during multiple myeloma. Methodology: This is a retrospective descriptive study spread over a period of 2 years from 01 January 2020 to 31 December 2021 carried out in the nephrology department of the louis pasteur hospital of the CH of Chartres. All patients treated for multiple myeloma with renal involvement were included, whether the renal involvement was revelatory or diagnosed during the follow-up of the multiple myeloma. Results: We collected 20 cases of myeloma. Renal involvement was present in 19 cases (95%). The mean age was 68.78 ± 10.77 years with extremes ranging from 44 to 82 years. Males were more prevalent, with an M/F sex ratio of 3.75. The most common antecedent condition was hypertension in 14 cases (73.7%) and diabetes in 4 cases (21.1%). The circumstances of discovery were renal failure in 16 cases (84.2%), followed by bone pain in 6 cases (31.6%). Renal involvement was dominated by renal failure in 18 cases (94.7%), hypercalcaemia in 14 cases (73.7%), para protein in 9 cases (47.4%), haematuria and leukocyturia in 5 cases (26.3%). On plasma protein electrophoresis, 11 cases (57.9%) had kappa light chain multiple myeloma, 8 cases (42.1%) had lambda light chain multiple myeloma. We noted 9 cases (69%) of myelomatous cylinder nephropathy at renal biopsy, Randall’s disease in 2 cases (15%), AL amyloidosis and acute tubular necrosis in 1 case (8%). First-line chemotherapy treatment was dominated by the combination of Velcade, cyclophosphamide and dexamethasone in 5 cases (79%). Conclusion: Renal involvement in myeloma i

关键词： Multiple Myeloma Renal Involvement Chartres Hospital

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