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Acute cerebral and pulmonary edema induced by hemodialysis in a dog model

Chinese Medical Journal 2008年第11期121卷 1003-1009页

作者： SHI Zhen-wei WANG Zhi-gang Department of nephrology Friendship Hospital of Capital Medical University Beijing 100050 China

Background The dialysis disequilibrium syndrome which occurs after hemodialysis. The purpose of this pulmonary edema induced by hemodialysis. s characterized by neurologic deterioration and cerebral edema study was to investigate the pathogenesis of acute cerebral and pulmonary edema induced by nemodialysis.Methods We evaluated the effects of hemodialysis on the biochemical and hemodynamic parameters of the plasma and cerebrospinal fluid, including the intracranial pressure, dry/wet ratio, and pulmonary edema index, and we also examined the pathological changes of the brain and lung tissue in dogs suffering from uremia. Results Seventy-two hours after bilateral ureteral ligation, 10 uremic dogs were hemodialyzed for 2 hours, yielding a 73.6% and 60.1% decrease in the plasma urea and creatinine, respectively, a decrease in the plasma osmolality from （359±18） mOsm/kgH2O to （304±6） mOsm/kgH2O （P 〈0.01）, a decrease in the dry/wet ratio of the lung and brain tissue, and an increase in the hemodynamic parameters （right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure）, intracranial pressure, total pulmonary resistance index, and pulmonary edema index. Moreover, the pathological examination revealed lung and brain edema in the dialyzed dogs. This group was compared to 3 control groups： 6 uremic dogs which were sham dialyzed without dialysate so that no fall in the plasma urea occurred, and 12 uremic and 12 nonuremic animals that were not dialyzed. However, the parameters mentioned above were not significantly changed among these 3 control groups. Conclusions The acute brain and lung edema in our model appeared to be primarily due to a large osmotic gradient between the plasma and the brain and lung. This is the ＂urea reverse effect＂ which promoted the osmotically-induced lung and brain swelling.

关键词： hemodialysis pulmonary edema brain edema disequilibrium syndrome

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Profile of Patients with Acute Renal Injury in N’Djamena: About 36 Cases

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Open Journal of nephrology 2017年第1期7卷 1-8页

作者： Guillaume Mahamat Abderraman Hamat Ibrahim Moussa Tondi Zeinabou Maiga Tall Ahmed Lemrabott Faye Maria Kossi Akomola Sabi Mahamat Youssouf Cisse Mouhamadou Moustapha Ka Elhaj Fary Ka Niang Abdou Diouf Boucar hemodialysis unit H&#244pital Général de Référence Nationale N’Djamena Tchad Medical Department-FSS/Université Abdou Moumouni de Niamey Service de Néphrologie et Hémodialyse H&#244pital National Lamordé de Niamey Niamey Niger nephrology service H&#244pital Aristide Le Dantec de Dakar Dakar Sénégal nephrology and hemodialysis Service CHU SO Lomé Lomé Togo

Introduction: The incidence of acute renal injury (AKI) has increased in recent decades. Acute renal failure is defined by the abrupt arrest (within hours or days) of the kidney excretory function. Oliguria (urine output 24h) is presented in about half of the cases. The circumstances of the occurrence of AKI are multiple: surgical, traumatic, obstetric, medical, often obvious. Its prognosis depends on the speed of management and the associated organ failure. The objective of this study is to describe the profile of patients in emergency hemodialysis at the nephrology unit of the National Reference General Hospital (HGRN) in N’Djamena, Chad. Methods: This was a multicenter, descriptive study in patients with acute renal failure place over a period of 12 months in the emergency departments of the 2 hospitals in N’Djamena. Defined as carriers of an AKI (RIFLE criteria), patients with: 1) Oliguria: urinary output 400 ml/24h ( 350 μmol/l or decrease of GFR by 75%. Results: Of the 311 patients admitted, 36 cases met the inclusion criteria, a frequency of 11.57%. The mean age was 34.46 years with extremes ranging from 7 to 80 years. The female sex predominated with 52.80% as sex ratio of 0.91. Isolated hypertension was noted with 38.88%. Dyspnea accounted for 41.66% of patients admitted to emergency departments. In our series, 50% of our patients had hyperthermia at admission. Oliguria was observed in 41.70% of the cases. Edema accounted for 33.33% of cases. The AKI with the “failure” criterion was 58.34% (21/36), with the criterion “injury” 25% (9 cases) and the criterion “risk” 16.66 (6 cases). AKI were organic in 83.34% (30/36). It was noted that 14 patients, 38.8% had an infectious syndrome. There were 6 patients who had (16.66%) an obstructive AKI, 5 patients (13.88%) had eclampsia, 4 patients (11.12%) had hepatoce

关键词： Acute Renal Injury hemodialysis Epidemiology Chad Component Formatting Style Styling

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Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation

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Open Journal of nephrology 2017年第1期7卷 19-23页

作者： Alpha Oumar Bah Mamadou Cellou Balde Amadou Bah Alpha Oumar Barry Departement of nephrology Donka National Hospital Conakry Guinea Departement of nephrology-hemodialysis Chiva Hospital Foix Cedex France Departement of Diabetology Donka National Hospital Conakry Guinea Departement of Reanimation Donka National Hospital Conakry Guinea

A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L;osmolarity: 390 mosmol/kg;creatinin: 300 μmol/L;glycemia > 6 g/L;transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.

关键词： Hypernatremia Hyperosmolar Coma Multiple Organ Failure Acute Renal Failure Diabetes

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Management of Obstructive Renal Failure in Adults at the Sylvanus Olympio University Hospital

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Open Journal of nephrology 2021年第3期11卷 348-357页

作者： Yawovi Mawufemo Tsevi Edoé Viyomé Sewa Abago Balaka Ablavi Adani-Ifè Eyram Yoan Amekoudi Komi Daniel Dokouvi Department of nephrology and hemodialysis Sylvanus Olympio Hospital Lomé Togo Department of Urology Sylvanus Olympio Hospital Lomé Togo Department of Internal Medicine Sylvanus Olympio Hospital Lomé Togo

Background: Obstructive nephropathies are a topical issue in urology and nephrology consultations, but no study has yet been conducted on the subject in our country. Objective: Describe the epidemiological, clinical, therapeutic and evolutionary profile of obstructive nephropathies at the Sylvanus Olympio University hospital of Togo. Method: It was a descriptive and cross-sectional study with a collection of retrospective data over a period of 08 years (2012-2019) which focused on obstructive nephropathies in the Urology-Andrology, nephrology and Internal Medicine departments at the medical clinic of CHU SO. The diagnosis of obstructive nephropathy is retained on the basis of radiological and medical imaging results. Results: The study population included 131 patients. The annual hospital frequency was 2.84 cases for 100 admissions. The mean age was 56.72 ± 17.76 years. These patients were mostly male (72.52%). The most frequent age group was 60 - 80 years. Common symptoms at presentation were loin pain (45.75%) and dysuria (25.95%). The average length of probable course of the disease before hospitalization was 636.94 ± 258.88 days (21 months). The etiologies of obstructive nephropathy were largely dominated by prostatic tumors in half of the cases (45.80%). Among these patients, 121 have presented renal failure (92.36%). The average serum creatinine at admission was 59.01 ± 21.56 mg/l. Of the 121 patients with obstructive nephropathy presenting renal failure, 54 (44.63%) had decreased their serum creatinine at the output of more than 25%. The open surgery (54.20%) was the main treatment. There was an improvement in kidney function in patients who had a shorter duration of disease progression and who did not have a history of loin pain, oliguria and that the etiologies of the disease were not tumors. Tumoral etiologies, the presence of a history of high blood pressure, oedema of the lower members,

关键词： Obstructive Nephropathy Renal Failure Etiologies Lomé (Togo)

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Epidemiological, Clinical and Evolutive Profile of Autosomal Dominant Polycystic Kidney Disease (ADPKD) in Togo

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Open Journal of nephrology 2018年第4期8卷 117-123页

作者： Tsevi Yawovi Mawufemo Amekoudi Eyram Yoan Djagadou Kodjo Agbeko Sabi Kossi Akomola Nemi Komi Dzidzonu Kodjo Kossi Tona Komlan Georges Dolaama Badomta Attisso Eugene Hadabia D’daah Djibril Mohaman Awalou Department of nephrology and hemodialysis of the Sylvanus Olympio University Hospital of Lomé University of Lome Lomé Togo Internal Medicine Department of the Sylvanus Olympio University Hospital in Lome University of Lome Lomé Togo

Objective: To describe the epidemiological, clinical and evolutionary profile of ADPKD in Togo. Methods: A retrospective descriptive transversal study over a period of 8 years (2011-2018) which focused on the analysis of patients’ records diagnosed with ADPKD. The diagnosis of ADPKD was retained on the basis of the ultrasound criteria of PEI. Results: During the study period, 27 patients had polycystic kidney disease with a prevalence of 0.87%. The average age was 51.6 ± 16.4 years. There were 10 men (37%) and 17 women (63%), a sex ratio (M/F) of 0.58. The concept of family cystic kidney disease was found in 6 (22.2%) patients. The clinical presentations were dominated by arterial high blood pressure, abdominal pain and abdominal mass respectively in 77%, 63% and 63% of cases. Five patients (18.5%) had a glomerular filtration rate (GFR) greater than 90 ml/min, 17 (62.9%) had a GFR Conclusion: ADPKD is common in our department. It appears to be associated with a high rate of chronic renal failure.

关键词： Polycystic Kidney Disease CKD Togo

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Delayed Onset Low Molecular Weight Heparin Induced Skin Necrosis on a hemodialysis Patient

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Open Journal of nephrology 2023年第2期13卷 74-80页

作者： Suzanne J. Sanchez Ruben A. Maguad Grecia P. Darunday Adult nephrology Department Perpetual Succour Hospital Cebu City Philippine

Delayed onset low molecular weight heparin induced skin necrosis is a rare adverse event. It usually occurs at the site of injection, and typically develops within 2 weeks of starting therapy. However, in our case, we presented a 62-year-old woman who is on hemodialysis twice a week. Her hemodialysis prescription included Enoxaparine 0.2 cc IV as anticoagulant. On her third month of regular hemodialysis, she developed skin necrosis on her right leg and left hand. The diagnosis was made clinically and by exclusion of other possible causes of skin necrosis in a chronic kidney disease patient, such as calciphylaxis. The most important aspect of management, in this case, is early recognition and withdrawal of its use, which were done in our patient.

关键词： Heparin Skin Necrosis hemodialysis

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Determinants and Risks Factors of Renal Failure in Patients with Heart Failure in Cardiology Department of CHU Sylvanus Olympio of Lomé(Togo)

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Open Journal of nephrology 2019年第3期9卷 65-76页

作者： Kossi Akomola Sabi Eyram Yoan Makafui Amekoudi Soudougoua Baragou Komlan Georges Tona Yaovi Afassinou Machioude Pio Béfa Noto-Kadou-Kaza Badomta Dolaama Eugene Ametepe Attisso Anani Amen Tevi Mawusse Koffi Mensah Mindessou Murielle Schyldia Bonou-Selegbe Jaques Vigan Department of nephrology and hemodialysis CHU Sylvanus Olympio Lomé Togo Department of cardiology CHU Sylvanus Olympio Lomé Togo Clinique de Néphrologie CNHU Cotonou Bénin

Introduction: The morbidity and mortality of patients with heart failure are known to increase rapidly in the presence of renal insufficiency, which is usually the cause but may be a consequence. To organize better prevention of renal failure, we undertook this study to identify the determinants of renal failure in the population of patients with heart failure. Methodology: This was a retrospective descriptive and analytical study of heart failure (HF) cases hospitalized from January 1st to December 31st, 2016, over a period for twelve (12) months at CHU Sylvanus Olympio. Patients who performed cardiac Doppler ultrasound were included in our study. Renal failure was defined as eGFR (estimated glomerular filtration rate) less than 60 ml/min/1.73m2. Multivariate logistic regression was performed to investigate associated factors. The dependent variable was DFG status: coded 1 if the GFR is less than 60 ml/min and 0 if not. Results: A total of 216 patients were included. The majority were female (54.17%). The median age of patients was 53 years [IQI = 32 - 61 years] with extremes of 15 and 96 years. 16.49% of patients had a GFR of less than 60 ml/min. In multivariate analysis the average standard of living (OR = 2.40, p = 0.0456), diabetes (OR = 2.67, p = 0.0300), hypertension (OR = 5.66, p = 0.0399), alcoholism (OR = 4.00, p = 0.0063) were the main factors in the development of an RF/HF. Conclusion: The average standard of living, diabetes, hypertension, and chronic alcoholism are the determinants of renal failure in HF.

关键词： Heart Failure Renal Failure Determinants Togo

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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 w

关键词： Chronic Renal Failure Digestive Signs Mali

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Effectiveness and Safety of Tenofovir Disoproxil Fumarate in Patients Treated for Hepatitis B in the National University Hospital of Cotonou

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Open Journal of Gastroenterology 2018年第6期8卷 213-222页

作者： Jean Sehonou Aboudou Raimi Kpossou Samuel Guido Comlan N’dehougbea Martin Sokpon Koffi Rodolph Vignon Jacques Vigan Department of Gastroenterology and Hepatology National University Hospital Center-Hubert Koutoukou Maga(CNHU-HKM)of CotonouCotonouBenin Department of nephrology-hemodialysis CNHU-HKM of CotonouCotonouBenin

Introduction: Viral hepatitis B (VHB) is a serious and global public health issue, particularly in sub-Saharan Africa where it is endemic. The objective of this work was to evaluate the effectiveness and safety of tenofovir disoproxil fumarate (TDF) in the treatment of chronic VHB in Cotonou. Methods: This was a descriptive cross-sectional study with a retrospective collection of data from January 1st, 2015 to December 31st, 2016 (24 months) and prospective from May to August 2017 (4 months). Chronic VHB patients treated with TDF for at least 6 months were included. The non-detectability of HBV DNA and the normalization of aminotransferases defined the virological and biochemical responses, respectively. The evaluation of the treatment response on liver fibrosis was done by using APRI score. Renal impairment was assessed by a reduction in glomerular filtration rate according to MDRD (Modifications of the Diet in Renal Disease) formula below 90 mL/min/1.73 m2. Results: In all, 42 patients treated with TDF were included. The average age was 46.7 ± 13.8 years. The study population was predominantly male with a sex ratio of 2.5. Among the 42 patients treated with TDF for an average of 60 weeks (24 to 96 weeks), 36 patients (85.7%) had a virological response;21 patients (50%) had a biochemical response. Virologic response was 70% at week 24 (W24), 92.6% at W48, 87.5% at W72 and 100% at W96 without significant difference between W24 and W48;between W48 and W72 then between W72 and W96. There was a regression of fibrosis and cirrhosis but not significantly. Renal involvement occurred in 3 out of 19 cases (15.8%) including a case of chronic end stage renal failure and 2 cases of mild chronic renal failure. Conclusion: The treatment with TDF is effective and globally safe in our patients with chronic viral hepatitis B in Cotonou.

关键词： Chronic Viral Hepatitis B Tenofovir Efficacy Safety Cotonou

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Epidemiology of Renal Failure in Children at the Pediatric University Hospital Charles De-Gaulle of Ouagadougou (Burkina Faso)

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Open Journal of Pediatrics 2016年第1期6卷 141-148页

作者： Coulibaly Gérard Savadogo Hamidou Bakoné B. Evariste Karambiri Adama Roger Kouéta Fla Hien Kpienoba Manan Champion Gérard Lengani Adama Yé Diarra Department of nephrology and hemodialysis University Hospital Center Yalgado Ouedraogo Ouagadougou Burkina Faso Department of Medical Pediatrics Pediatrics University Hospital Center Charles De-Gaulle Ouagadougou Burkina Faso Pediatrics nephrology Service Pediatrics Federation CHU Angers Cedex France

Objective: Renal failure (RF) is a serious condition that is still insufficiently evaluated in our context. We wanted to know its epidemiology at the Pediatrics University Hospital Center Charles De-Gaulle (PUHC-CDG) of Ouagadougou. Patients and Methods: We retrospectively studied all children aged from three to fifteen years old who were diagnosed with renal failure (RF) in the Department of Medical Pediatrics, from January 1, 2011 to December 31, 2013. RF was defined by a glomerular filtration rate (GFR) less than 80 mL/min/1.73m2, estimated by the formula of Pottel et al., which ignored the size that was rarely found in the medical records. The department constantly lacked pediatric blood pressure monitors or urinary strips. Results: In total, 119 cases of RF (3.3% of all admissions) were collected. They were about acute RFs (ARFs), chronic RFs (CRFs), and Unclassified RFs (URFs), respectively in 28.6%, 2.5% and 68.9% of cases. The overall average age of patients was 6.7 ± 3.4 years old. The average GFR was 35.2 ± 22.2 mL/min/1.73m2. The mechanism of ARF was presumed to be organic in 26 cases (76.5%). The most common presumed etiology was malaria (47.9%). Twelve patients (10.1%) died. Conclusion: RF was common at the PUHC-CDG but it was unclassified in over half of the cases. The diagnosis was based on the estimation of the GFR by Pottel et al.’s formula which was a good alternative to the Schwartz’s formula. The improvement of human and material resources would certainly help for a screening and characterization of RF at the PUHC-CDG.

关键词： Burkina Faso Epidemiology Glomerular Filtration Rate Pediatrics Renal Failure

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