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Parathyroidectomy in Chronic haemodialysis in the Nephrology and haemodialysis department 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 135-143页

作者： Saharé Fongoro Hamadoun Yattara Seydou Sy Magara Samaké Djénèba Diallo Moctar Coulibaly Fatoumata Modjéré Doumbia Djibril Samaké Moustapha Tangara Alkaya Touré Atabième Kodio Nouhoum Coulibaly Nephrology and haemodialysis department of the University Hospital Centre of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the Fousseyni Daou Hospital in Kayes Kayes Mali Nephrology Unit of the Mali Gavardo Hospital in Sébénikoro Bamako Mali ORL Unit Reference Health Center of the Municipality V Bamako Bamako Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mo

关键词： Chronic Renal Failure Secondary Hyperparathyroidism Dialysis Parathyroidectomy

Interest of Beta-2-Microglobilin Plasma Assay in Iterative haemodialysis in the Nephrology and haemodialysis department of University Teaching Hospital of Point G, Bamako, Mali

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Open Journal of Nephrology 2020年第4期10卷 282-289页

作者： Saharé Fongoro Magara Samaké Seydou Sy Hamadoun Yattara Djénèba Diallo Jacques Coulibaly Moctar Coulibaly Aboubacar Sidiki Fofana Atabième Kodio Djénéba Maiga Aboudou M. Dolo Moustapha Tangara Nouhoum Coulibaly Brahima Dégoga Ibrahima Koné Nephrology and haemodialysis department of the University Teaching Hospital of Point-G Bamako Mali Faculty of Medicine of Bamako Bamako Mali Nephrology Unit of the Fousseyni DAOU Hospital in Kayes Kayes Mali Nephrology Unit of Ségou Hospital Ségou Mali Nephrology Unit of the Mali GAVARDO Hospital of Sébénicoro Bamako Mali Nephrology Unit of Sikasso Hospital Sikasso Mali Nephrology Unit of Somino DOLO Hospital in Mopti Mopti Mali

Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. Materials and Methods: This was a prospective and descriptive study from January 1st, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. Results: We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P Conclusion: Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.

关键词： Chronic Hemodialysis Beta-2-Microglobulin Carpal Tunnel Syndrome

Digestive Pathologies during Chronic Renal Failure in the Nephrology and haemodialysis department 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 41-48页

作者： Magara Samaké Seydou Sy Hamadoun Yattara Moctar Coulibaly Mamadou Badou Sanogo Aboubacar Sidiki Fofana Aboudou Messoum Dolo Djénéba Maiga Djénéba Diallo Atabieme Kodio Bakary Diarra Karamoko Djiguiba Djibril Sy Saharé Fongoro Nephrology Unit of the Fousseyni DAOU Hospital Kayes Mali Nephrology and haemodialysis department of the CHU of Point G Bamako Mali Faculty of Medicine of Bamako University of Bamako Bamako Mali Nephrology Unit of Mali GAVARDO Hospital Bamako Mali Nephrology Unit of the Sikasso Regional Hospital Sikasso Mali Nephrology Unit of the Mother and Child Hospital The Luxembourg Bamako Mali Internal Medicine Service of the University Hospital Center of Point G Bamako Mali

Introduction: Chronic kidney disease (CKD) is the progressive and irreversible loss of kidney function. It exposes to many complications, among which, digestive complications. In Mali, we do not have data on the prevalence of digestive pathologies in people with chronic renal failure, hence the interest of this study. Objective: To determine the prevalence of digestive pathologies and to describe their manifestations during chronic renal failure. Patients and Methods: This was a prospective cross-sectional study conducted from September 2016 to August 2017, a period of 12 months. Included were patients hospitalized in our department with CKD who received digestive endoscopy and/or liver serology. Results: Seventy-one patients underwent digestive endoscopy with oesogastroduodenal fibroscopy (60 patients), rectoscopy (6 patients) and anoscopy (5 patients), i.e. 15.9% of those hospitalized. The mean age of the patients was 48 ± 14 years with extremes of 15 and 84 years. The sample consisted of 59.2% men versus 40.8% women, for a sex ratio of 1.5. The functional signs are in order of frequency: vomiting (72.4%), anorexia (51.3%) and epigastralgia (48.7%). Terminal CKD by creatinine clearance accounted for 88.2% of cases, of which 47.4% were monitored by hemodialysis. Hepatitis C virus infection was present in 21.3% of cases, hepatitis B (18%) and HIV (7.5%). Endoscopic examinations were represented by fibroscopy (84.5%), rectoscopy (8.5%) and anuscopy (7%). The fibroscopic lesions were respectively gastric (96.8%), duodenal (14.1%) and esophageal (12.5%). They were dominated by gastritis (40.5%), duodeno-gastric reflux (16.4%), pyloric gap (12.6%). Rectoscopy found 4 cases of hemorrhoids, 2 cases of rectitis and no lesions were observed at anuscopy. Conclusion: The prevalence of these digestive manifestations and the endoscopic lesions encountered indicate the importance of digestive endoscopy and the performance of hepatic serologies in chronic renal failure patients with digestive symptoms and/or treated by hemodia

关键词： Chronic Renal Failure Digestive Signs Mali

Prevalence of Types of Arterial Hypertension in Pregnant Women at the Maternity Ward of the Centre Médical Communal Les Flamboyants Conakry Guinea

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Open Journal of Nephrology 2023年第3期13卷 234-245页

作者： Amadou Yaya Diallo Kadiatou Mamadou Bobo Barry Mamadou Malal Diallo Soriba Bangoura Bangoura Diallo Fatoumata Binta Oury Diallo Mamadou Yacine Bah Aly Traoré Mohamed Lamine Kaba department of Nephrology and haemodialysis CHU Donka Conakry Guinea Centre Médical Communal les Flamboyants Conakry Guinea

Introduction: Arterial hypertension (AH) during pregnancy is defined as systolic blood pressure greater than or equal to 140 mm Hg and/or diastolic blood pressure greater than or equal to 90 mm Hg on two (2) successive visits separated by at least 4 hours in a woman who has been at rest for 10 to 15 minutes in the seated position and then in the left lateral decubitus position. The aim of this study was to determine the prevalence and types of arterial hypertension among pregnant women in the maternity ward of the CMC les Flamboyants. Methods: This was a prospective descriptive study lasting six (6) months, from 1 October 2021 to 31 March 2022, of all pregnant women and/or parturients admitted to the maternity ward of the CMC les Flamboyants with a resting blood pressure (BP) greater than or equal to 140/90 mm Hg during the study period. Results: During the study period, we recorded 707 cases of pregnant and/or parturient women, 50 (7.07%) of whom were hypertensive. The average age of the patients was 29 years, with extremes of 18 and 41 years. The 20 - 29 age group was the most affected, with 26 cases (52%). Headache, dizziness and oedema of the lower limbs were constant in all cases. The risk factors for arterial hypertension were dominated by familial hypertension in 19 cases (38%), multiple gestures in 17 cases (34%) and a history of gestational hypertension in 16 cases (32%). Gestational age between 28 and 36 weeks’ amenorrhoea was the most common, with 20 cases (40%). Type I hypertension was most common on admission, with 34 cases (68%), followed by type II hypertension, with 8 cases (16%). Pre-eclampsia was the most frequent maternal complication with 27 cases (54%) followed by eclampsia with 15 cases (30%). Fetal distress was the most frequent fetal complication, 19 cases (38%), followed by death in utero 9 cases (18%). Conclusion: Compliance with consultation programmes and correct patient follow-up could help reduce maternal-foetal complications.

关键词： Hypertension Pregnant Women Maternity Unit Conakry Guinea

Renal Failure of Lithiasis Origin: Frequency and Management in the Nephrology and haemodialysis department of the Point G University Hospital in Mali

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Open Journal of Nephrology 2022年第3期12卷 276-292页

作者： Seydou Sy Magara Samaké Aboubacar Sidiki Fofana Atabieme Kodio Oligue Prudence Oman Djibril Sy Hamadoun Yattara Djénèba Diallo Sah Dit Baba Coulibaly Nouhoum Coulibaly Modi Sidibé Alkaya Touré Moustapha Tangara Mamadou Lamine Diakité Assétou Soukho Kaya Saharé Fongoro 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 Fousseyni Daou Hospital in Kayes Kayes Mali National Center for Scientific and Technological Research (CNRST) Bamako Mali department of Internal Medicine University Teaching Hospital of Point-G Bamako Mali department of Urology University Teaching Hospital of Point-G Bamako Mali

Background: The term urinary lithiasis (UL) from the Greek “lithos” refers to the disease characterised by the result of abnormal precipitation of normal constituents of the urine within the urinary tract. The aim of this work was to determine the frequency of obstructive renal failure (ORF) of lithiasis origin and to describe the therapeutic indications. Methods: This was a retrospective prospective study in patients hospitalised in the nephrology department of Point G University Hospital for ORF of lithiasis origin over a 26-month period from 1 January 2018 to 1 February 2020 inclusive. Results: Among 1898 hospitalized patients, 32 met the inclusion criteria, i.e. a frequency of 1.7%. The male sex was 68.75% with a sex ratio of 2.2. The mean age was 48.38 ± 13.423 years with extremes of 20 and 65 years. Dysuria and urinary bilharzia were the main uro-nephrological antecedents, accounting for 25% of the cases each. Pain syndrome was the main functional sign, accounting for 100%. Ultrasound of the urinary tract (n = 28) showed stones in 92.85%. These stones were bilateral in 22.22% of cases. The dilatation was pyelocalic in 14 cases (51.8%). The uroscanner showed a pyelic location of the stones in both kidneys;42.1% on the right and 33.3% on the left. Hydronephrosis was the most common dilatation: 37.8% on the right and 29.7% on the left. Renal lithiasis was complicated by acute kidney injury (ARI) in 17 cases (53.1%) versus 15 cases (46.9%) of chronic kidney disease (CKD). Urethral catheter was the means of drainage in 24 (75%) followed by nephrostomy in 8 cases (25%). Nephrolithotomy accounted for 9.4% of cases. The case fatality rate was 28.12% (9 cases). Deaths occurred in the context of uraemic coma 6 cases and cardiorespiratory arrest 3 cases. Conclusions: The management of urinary lithiasis complicated by renal failure calls for the correction of hydrolytic disorders, drainage of the excretory tract and treatment of the stone, of which percutaneous nephrolithotomy seems to be the modality of choice.

关键词： Renal Failure Urinary Lithiasis Nephrology University Teaching Hospital of Point-G

Acute Renal Failure in COVID-19 Patients in Intensive Care at the CHU du Point G in Mali

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Open Journal of Nephrology 2023年第4期13卷 385-394页

作者： Diallo Boubacar Coulibaly Nouhoum Dicko Hammadoun Berthe Modibo Beye Seydina Alioune Niangado Rokiatou Bassirou Keita Mohamed Coulibaly Youssouf department of Anaesthesia-Resuscitation and Emergencies CHU Point G Bamako Mali department of Nephrology and haemodialysis CHU Point G Bamako Mali

Introduction: SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) causes an acute respiratory disease with interstitial and alveolar pneumonia, which can affect several organs including the kidneys [1] [2] [3]. As Mali is no stranger to this pandemic, we report our experience of the management of cases of kidney failure observed in the COVID-19 intensive care unit at the Point G University Hospital Centre (CHU). The aim of this work was to characterise acute renal failure in COVID-19 patients in intensive care, describing the management methods used and determining the vital prognosis. Materials and Methods: This was a retrospective descriptive study, covering an 18-month period from April 2020 to September 2021. We included all patients admitted to the COVID-19 intensive care unit on the basis of a positive RT-PCR and/or the presence of ground-glass images on thoracic computed tomography. Results: We selected 232 patients admitted for COVID-19. Acute Renal Failure (ARF) developed in 71 patients (30.6%). The stages of AKI according to KDIGO were Stage 1 in 28.2%, Stage 2 in 18.3% and Stage 3 in 53.5%. The mean age was 63.96 years, with a standard deviation of 16.6, and males accounted for the majority (71.8%). Organic ARF was found in 80.3% of cases. Risk factors and comorbidities for ARF included advanced age (60.6%), male sex (71.8%), hypertension (52.1%), diabetes (21.1%), invasive mechanical ventilation (71.8%) and septic shock (56.3%). Extra renal purification (haemodialysis) was used in 29.6% of patients. Admission to intensive care ranged from 7 days to 14 days in 43.7% of cases. More than half the patients (52.1%) were in critical condition on admission. Death occurred in 76.1% of patients. Conclusion: ARF appears to occur more frequently in patients with severe COVID-19. It is associated with a poor prognosis.

关键词： COVID-19 Acute Renal Failure Intensive Care Unit

Pegylated-interferon alpha 2a treatment for chronic hepatitis C in patients on chronic haemodialysis

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World Journal of Gastroenterology 2006年第26期12卷 4191-4194页

作者： Ioan Sporea Alina Popescu Roxana ■irli Ovidiu Golea CameliaTotolici Mirela Dǎnilǎ Corina Vernic department of Gastroenterology and Hepatology University of Medicine and Pharmacy "Victor Babes" Timisoara Romania department of haemodialysis and Renal Transplantation County Hospital Timisoara Romania department of Medical Informatics University of Medicine and Pharmacy "Victor Babes" Timisoara Romania

瞄准：评估反应到 pegylated 干扰素高山哈在长期的血液透析上的长期的丙肝病人的 2a。方法：有长期的 C 肝炎的十个病人在这研究被注册。所有为超过 6 瞬间，积极 antiHCV 抗体和积极 PCR HCV-RNA 增加了 aminotransferases。我们管理... 详细信息

瞄准：评估反应到 pegylated 干扰素高山哈在长期的血液透析上的长期的丙肝病人的 2a。方法：有长期的 C 肝炎的十个病人在这研究被注册。所有为超过 6 瞬间，积极 antiHCV 抗体和积极 PCR HCV-RNA 增加了 aminotransferases。我们管理了木钉干扰素高山哈 2a 为 48 wk 的 180 microg/wk。在治疗的 12 wk 以后，我们评估了生物化学、早的 virological 反应(EVR ) 。在治疗的结束，我们在我们评估了的治疗的结束以后评估了生物化学的反应和 24 wk 持续 virological 反应(SVR ) 。我们在治疗期间监视了副作用。结果：二个病人在治疗的开始的 12 wk 放弃了并且 2 在治疗的开始的 12 wk 以后。在治疗的 12 wk 以后， 7 从 8 个病人有生物化学的反应和 EVR， 1 有生物化学的反应但是坚持的病毒血。我们不得不在 2 种情况中把 pegylated 干扰素的剂量归结为 135 mug/wk。三(50%) 从 6，病人们在治疗的结束以后有 SVR 24 wk。Intention-to-treat 分析证明 3 从 10 个病人(30%) 有 SVR。副作用发生在大多数病人(像流感的症候群，血小板减少或 leucopoenia ) ，但是他们没强加治疗的中止。结论：在有木钉干扰素高山的治疗的 12 wk 以后哈在有长期的 C 肝炎的长期的血液透析上的病人的 2a (40 ku ) ， EVR 在 87.5% 被获得(7/8 ) 盒子。SVR 在完成了治疗的 48 wk 的 50% 盒子(3/6 病人) 中被完成。

关键词：慢性丙型肝炎血液透析生物化学治疗

Revaccination after Acute Kidney Injury Associated with Prior COVID-19 Vaccination: Case Report

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Advances in Infectious Diseases 2024年第1期14卷 196-205页

作者： Senyo Tagboto Laurette Geldenhuys department of Internal Medicine Yarmouth Regional Hospital Yarmouth Canada department of Medicine Dalhousie University Halifax Canada department of Internal Medicine University of Health and Allied Sciences Ho Ghana department of Pathology Dalhousie University Halifax Canada department of Pathology and Laboratory Medicine Central Zone Nova Scotia Health Halifax Canada

Background: Acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been difficult because of the uncertainty of the consequences of doing so, and the absence of publications to help determine whether revaccination may be considered safe or not. Purpose: We present a case report of a 59-year-old Canadian man who developed severe acute kidney injury associated with moderate proteinuria following his first COVID-19 vaccine with the Moderna vaccine (an mRNA vaccine). He required haemodialysis for 2 weeks, which was initiated when his creatinine reached 1002 μmol/l. A kidney biopsy showed changes consistent with acute tubular necrosis. The patient was cautioned that repeat vaccination might result in further kidney injury which might be irreversible. However, he badly wanted to attempt a second COVID-19 vaccination, to facilitate a family vacation across several countries in Europe, at a time when travel restrictions were in place in many countries for persons who had not completed a course of vaccines. Method: Following deliberations, the patient chose to try a different type of Covid-19 vaccine. On this occasion, he was vaccinated with the Novavax vaccine (a subunit COVID-19 vaccine). Following this, close monitoring of his urine to detect proteinuria and blood testing for acute kidney injury were carried out on days 1, 3, 7, and 60 after vaccination. Furthermore, a year after his repeat vaccination, his kidney function and urinalysis were again assessed. Result and Conclusions: The patient did not develop acute kidney injury or worsening proteinuria following repeat vaccination. It remains unclear if acute kidney injury with proteinuria is caused by Covid-19 vaccination, or simply an incidental association. This case report suggests that it is may be reasonable for patients with acute kidney injury after COVID-19 vaccination to consider trying a different type of vaccine. In

关键词： Covid-19 Vaccination Acute Kidney Injury Proteinuria haemodialysis Revaccination

Correlation between DKK-1 Level and Bone Density Status in Children on Maintenance haemodialysis

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Open Journal of Nephrology 2024年第1期14卷 48-61页

作者： Manal Abd El-Salam Marwa Mohamed Anwar Rasha Mahmoud Gouda Naglaa Abou El Fattah Nadia Youssef Riad department of Pediatrics Faculty of Medicine (For Girls) Al-Azhar University Cairo Egypt department of Internal Medicine Faculty of Medicine (For Girls) Al-Azhar University Cairo Egypt department of Clinical Pathology National Heart Institute Cairo Egypt

Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This study aimed to evaluate the serum DKK-1 level as a bone marker in children with CKD who undergo regular hemodialysis (HD). Subjects and Methods: This case-control study involved 40 children with CKD on HD and 40 healthy children as controls. The study measured serum DKK-1 levels and performed a dual-energy X-ray absorptiometry scan (DEXA) in line with routine laboratory investigations. Results: There was a significant increase in the serum level of DKK-1 in the patient group compared to the control group. The DKK-1 levels were 2540.65 (2215.4 - 2909.2) pg/ml and 1110.45 (885.45 - 1527.65) pg/ml, respectively, with a p-value of less than 0.001. In the hemodialysis group, 25 patients (62.5%) had low bone mineral density (BMD) with a Z-score of under -2.0. Eighteen of these patients had low BMD in both the neck of the femur and lumbar spines. Additionally, there was a significant increase in serum DKK-1 level in patients with low BMD (2567.35 (2303.8 - 3108.1) pg/ml) compared to patients with normal BMD (2454 (1859 - 2820) pg/ml) (p = 0.041). There was also a significant positive correlation between DKK1 level and phosphorus, alkaline phosphatase, and Parathormone serum levels. In conclusion, the study indicates a clear correlation between DKK-1 and BMD in children undergoing maintenance hemodialysis. DKK1 is a promising biomarker for CKD-MBD.

关键词： DKK-1 Children haemodialysis Bone Density Status