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

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.

Efficacy and safety of Nafamostat mesylate in patients with endstage renal failure

BACKGROUND Recent studies on dialysis anticoagulation therapy in patients with renal failure have shown that Nafamostat mesylate,a broad-spectrum potent serine protease inhibitor,has strong anticoagulation and anti-fiber activity.AIM To evaluate the efficacy and safety of Nafamostat mesylate in patients with end-stage renal failure.METHODS Seventy-five patients with end-stage renal failure who received hemodialysis at our hospital between January 2020 and August 2021 were selected and divided into the observation group(Nafamostat mesylate for injection,n=33)and control group(heparin sodium injection,n=32).General patient data,indicators of clinical efficacy,dialyzer hemocoagulation parameters,coagulation function indices,and hemoglobin concentration and platelet count before and after treatment,and the occurrence of adverse reactions after treatment were compared between the two groups.RESULTS The two groups showed no significant differences in general patient data(P>0.05).The post-treatment effectiveness rate in the control group was lower than that in the observation group(P<0.05).The two groups showed no significant difference in the number of patients in grade I(P>0.05),while the number of patients in grade 0 was lower in the control group,and the number of patients in grades II and III was higher in the control group(P<0.05).The post-treatment prothrombin time,activated partial thromboplastin time,thrombin time,and international normalized ratio values in the control group were higher than those in the observation group,while the fibrinogen level in the control group was lower than that in the observation group(P<0.05).The two groups showed no significant difference in the platelet count and hemoglobin level before and after treatment(P>0.05).The total number of post-treatment adverse reactions in the observation group was lower than that in the control group(P<0.05).CONCLUSION Treatment of patients showing end-stage renal failure with Nafamostat mesylate can significantly improve therapeutic efficacy and has high safety and clinical value.

Comparative efficacy of traditional Chinese herbal injection for chronic renal failure:A systematic review and network meta-analysis of randomized controlled trials

Objective: To conduct a systematic review and network meta-analysis(NMA) for the comparison of the efficacy and safety of Chinese herbal injection(CHI) combined with Western medicine(WM) and WM monotherapy for chronic renal failure(CRF).Methods: Eight databases were searched from inception to August 30, 2022. Randomized controlled trials(RCTs) regarding the comparison of CHI-WM combination therapy and WM monotherapy were included. Literature search, risk-of-bias assessment, and data extraction were conducted by 2 reviewers independently. NMA was performed by Stata 14.0, R 4.0.4 software, and the latest risk of bias assessment tool 2(RoB 2).Results: A total of 53 RCTs were finally included, involving 4445 participants and 16 CHIs. RoB 2 showed that 2 of these studies had a high risk of bias. Tianqi injection(TQ) + WM was the most effective in reducing serum creatinine(Scr) level. Xingding injection(XD) + WM was the most effective in reducing blood urea nitrogen(BUN) and cystatin C(Cys C) levels. Guhong injection(GH) + WM had the highest endogenous creatinine clearance rate(Ccr). Shuxuetong injection(SXT) + WM was the most effective in improving the clinical effective rate. Danhong injection(DH) + WM resulted in the lowest 24-h urinary protein quantity(24 h-UPQ), while Danshen injection(DS) + WM led to the lowest blood uric acid(UA)level. Shenfu injection(SF) + WM was the most effective in increasing hemoglobin(Hb) level.Conclusion: CHIs-WM combination therapy is more effective than WM monotherapy in treating CRF.Considering all of the indicators, SK + WM may be the optimal treatment option for improving renal function in patients with CRF.

Effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with diabetic nephropathy and chronic renal failure

BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficacy prediction model.AIM To determine the effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with DN and chronic renal failure(CRF),and to construct an efficacy prediction model.METHODS We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022.We selected 94 patients who met the inclusion and exclusion criteria.Patients were assigned to a dialysis group(n=45)and a joint group(n=49)in relation to therapeutic regimen.The clinical efficacy of the two groups was compared after treatment.The changes in laboratory indexes after treatment were evaluated,and the two groups were compared for the incidence of adverse reactions.The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed.RESULTS The dialysis group showed a notably worse improvement in clinical efficacy than the joint group(P=0.017).After treatment,the joint group showed notably lower serum levels of serum creatinine,uric acid(UA)and blood urea nitrogen(BUN)than the dialysis group(P<0.05).After treatment,the joint group had lower serum levels of phosphorus,procollagen type I amino-terminal propeptide(PINP)and intact parathyroid hormone than the dialysis group,but a higher calcium level(P<0.001).Both groups had a similar incidence of adverse reactions(P>0.05).According to least absolute shrinkage and selection operator regression analysis,UA,BUN,phosphorus and PINP were related to treatment efficacy.According to further comparison,the non-improvement group had higher risk scores than the improvement group(P<0.0001),and the area under the curve of the risk score in efficacy prediction was 0.945.CONCLUSION For treatment of CRF and DN,combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients,with good safety.

Epidemiological and Clinical Aspects of Chronic Renal Failure in the Medical Department at the Hospital of Sikasso

Introduction: Chronic renal failure is a real public health problem because of its prevalence, the cost of its management and the high morbidity and mortality rate associated with it. The objective of this study was to determine the frequency, causes and main aggravating factors of chronic renal failure in the medical department of the hospital of Sikasso. Materials and Methods: This was a cross-sectional, retrospective, descriptive study conducted in the medical department of the Sikasso hospital from January 1, 2021 to November 30, 2022. It covered all the records of patients with chronic renal failure hospitalized in the department during this period. The MDRD formula was used to estimate the glomerular filtration rate. The KDIGO 2012 classification was used to stage CKD. Results: Of 820 patient records reviewed, we retained 197 records. The mean age of our patients was 42.25 ± 10 years. The male sex represented 114 (57.9%). The socio-economic level was considered low and precarious in 79.8% of cases. The frequency of chronic renal failure was 24%. The reason for hospitalization was mostly hyper creatinine > 185 μmol/l (92.4%). Herbal medicine was reported in 103 cases (52.3%). Medical history was hypertension 101 cases (51.3%), undocumented gastro duodenal ulcer (UGD) 14 cases (7.6%), hypertension and diabetes 11 cases (5.1%), diabetes 8 cases (4%), lower limb edema 9 cases (4.6%). Hypocalcemia was 147 cases (75.6%) with hyper phosphoremia was 153 cases (77.7%). Hemoglobin level was: <6 g/dl, 44 cases (22.3%);between 6 - 8 g/dl, 77 cases (39.1%), from 8 - 10 g/dl, 54 cases (27.4%). The etiologies of CKD were vascular nephropathy 106 cases (53.8%), interstitial nephropathy, 44 cases (22.3%), glomerular nephropathy, 33 cases (16.8%), diabetic nephropathy, 12 cases (6.1%) and polycystic kidney disease 2 (1%). CKD was classified as stage 5, 171 cases (86.8%), stage 4, 11 cases (5.6%), stage 3, 13 cases (6.6%) and stage 2, 2 cases (1%.) Dialysis was performed in 1095 (5.3%) of our patients. All these patients started dialysis with a central line. Conclusion: This study reveals the high prevalence of chronic renal failure in the department and above all the late diagnosis at very advanced stages. This imposes policies of prevention and effective management of the responsible diseases.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances

Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index(a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.

Doctor-led intensive diet education on health-related quality of life in patients with chronic renal failure and hyperphosphatemia

BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.

Detection of the Level of Urinary FPA in Chronic Nephritis with Renal Failure and Its Clinical Implication

The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.

Effects of chronic renal failure on the expression of connexin 43 in the rat＇s corpus cavernosum

Aim： To explore the mechanism of chronic renal failure （CRF）-related erectile dysfunction （ED）. Methods： CRF experimental models were established by 5/6 nephrectomy from male Sprague-Dawley rats. Both the rats from the control group （NCRF group, n = 6） and the experimental group （CRF group, n = 30） were injected with a low dose （80 μg/g） of apomorphine in the 12th week after resection surgery to measure corresponding penile erections. Western blot method was thereafter conducted to measure the expression of connexin 43 （CX43） in the rat corpus cavernosum in the 12th week after the resection surgery. Results： There was one death in the NCRF group and five in the CRF group. The penile erection ratio of the CRF group was 28% （7/25）, whereas that of the NCRF group was 100% （5/5）, which presents a significant difference between the two groups （P 〈 0.05）. In terms of penile erection frequency, the average of the CRF group was 1.0 ± 0.0, which was significantly different from that of the NCRF group （2.2 ± 0.8） （P 〈 0.05）. As for the expression of CX43 in the rat corpus cavernosum, a notable difference existed between the CRF group （0.21 ± 0.07） and the NCRF group （0.53 ± 0.27） （P 〈 0.01）. Conclusion： CRF significantly reduces the erectile function of rats. A close correlation exists between the expression of CX43 in rats＇ corpus cavernosum and CRF-related ED. （Asian J Andro12008 Mar; 10： 286-289）

Etiologies of Chronic Renal Failure in Adolescent Patients at the University Hospital of Brazzaville

Objectives:?The aim of our work was to identify the etiologies of chronic renal failure in adolescent patients.?Patients and Methods:?This is a descriptive cross-sectional retrospective study that included adolescents aged 10 to 19 years hospitalized between January 2014 and December 2017 in the department of nephrology at the?University Hospital of Brazzaville. The CRF was defined according to the ANAES criteria by an estimated glomerular filtration rate less than 60 ml/min/?1.73?m2?of body surface.?Results:?Forty cases of CRF were collected, representing a prevalence of 4.9%. The average age was 16.32 ± 3.64 years and the sex ratio was 3. The most common mode of discovery was edematous syndrome 62.5%. The most common etiology was glomerular nephropathies 60%, hereditary nephropathies 25% and malformative uropathies in 15%. Ten patients (25%) had moderate CFR at admission, 62.5% had severe CRF, 12.5% had terminal CFR?and all of them died during the year.?Conclusion:?Epidemiological data CRF in adolescent patients in developing countries are scarce and limit treatment. Glomerular pathologies represent the most frequent etiology. Early treatment of chronic renal failure in childhood and multidisciplinary collaboration between pediatrician and nephrologist are necessary.

Effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure

AIM: To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure (CRF).METHODS: Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori (H pylori) and CRF status. Groups were labeled as follows: 1a: normal renal function, H pylori negative (n = 12), 1b: normal renal function,H pylori positive (n = 11), 2a: CRF, H pylori negative (n = 10), 2b: CRF, H pylori positive (n = 11). Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation,antral biopsy specimens were taken from each patient.In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen (PCNA) labeling indexes (LI) were assessed with immunohistochemical staining method.RESULTS: For groups 1a, 1b, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5,60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22,respectively. When the one-way ANOVA test was applied,statistically significant differences were detected between the groups for both Bax LI (P = 0.004 ＜0.01) and PCNA LI (P = 0.009 ＜0.01). When groups were compared further in terms of Bax LI and PCNA LI with Tukey's HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups 1a and 2b (P = 0.006 ＜0.01).CONCLUSION: In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.

Effect of Heme Oxygenase-1 Inducer Hemin on Chronic Renal Failure Rats

Summary: The role of HO-1 inducer, hemin, in chronic renal failure (CRF) rats and its possible mechanism of action was studied. 5/6 subtotal nephrectomy was performed to establish chronic renal failure model. Rats were randomly assigned to 4 groups: sham-operated group, CRF group, ferrous gluconate group and hemin group. At the 10th week after operation, serum creatinine, BUN, RBC, HGB and HCT were measured. Renal pathologic changes were observed. RT-PCR and immunohistochemistry were used to detect the expression and distribution of HO-1. RT-PCR and radioimmunoassay was used to determine the expression of ET-1 in the kidney and plasma. The results showed that as compared with CRF group, serum creatinine and BUN in hemin group were reduced significantly and nephrogenic anemia was improved markedly. Glomerular mesangial proliferation and interstitial lesion were also ameliorated significantly. Hemin not only increased the expression of HO-1 but also reduced the expression of ET-1 in the kidney. The level of ET-1 protein in the plasma was also reduced after hemin treatment. Most of these indexes were not obviously changed in ferrous gluconate group. It was suggested that through inducing the expression of HO-1 and reducing the level of ET-1 in the kidney and plasma, hemin plays an important protective role in 5/6 subtotal nephrectomized rats.

Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)

瞄准：在小肠(SB ) 的察觉调查无线的囊内视镜检查法(WCE ) 的角色在有长期的肾衰竭(CRF ) 并且阴暗流血的病人的病理。方法：有阴暗流血的连续 CRF 病人有希望地被学习。有正常肾的功能并且阴暗流血的病人，与 WCE 在一样的时期期间调查了，被用于结果的解释。结果：十七个 CRF 病人(11 公开， 6 玄术流血) 并且 51 个病人(33 公开， 18 玄术流血) 与正常，肾的功能在这研究被注册。积极 SB 调查结果在 70.6% CRF 病人被检测(P 【 0.05 ) 。SB angiodysplasia 在 47% CRF 病人被识别。Univariate 逻辑回归为 angiodysplasia 作为一个重要预兆的因素揭示了 CRF (P 【 0.05 ) 。治疗学的措施与积极调查结果在 66% 病人被承担。结论：根据我们的初步的结果， SB angiodysplasia 与阴暗流血在 CRF 病人之中在增加的流行被发现。WCE 在胃肠的病理的诊断并且在计划适当治疗学的干预是有用的并且因此，应该在这组病人的病情的检查被包括。

Evaluation of Thyroid Hormones Levels in Libyan Patients with Chronic Renal Failure before and after Maintenance Hemodialy

Data from recent studies revealed that kidney diseases might affect the thyroid function in various ways. A variety of alterations in thyroid hormone levels and metabolism have also been reported in patients with chronic renal failure (CRF) in some studied population. In addition, it was reported that serum levels of both T3 and T4 might alter immediately after a hemodialysis (HD) treatment than before. Therefore, this study was aimed to investigate the level of triiodothyronine (T3) and thyroxine (T4) in CRF Libyan patients before and after HD. This study was carried out on 46 CRF patients (30 males and 16 females) with a mean age of 47.46 ± 15.75 years. These patients were treated at the hemodialysis unit of Educational Central Zelitin Hospital, Zelitin, Libya. None of these patients apparently have any thyroid problems and no history of drug intake that may affect thyroid function. Blood samples were taken from each patient to measure serum levels of T3 and T4, before and after HD. In addition, the effects of several variables including age, gender, body mass index (BMI), presence of both hypertension and, diabetes mellitus and duration of kidney dialysis on serum levels of T3 and T4 before and after HD were also studied. After HD, there was a statistically significant increase in the serum levels of T3, T4. The age, gender, BMI, duration of kidney dialysis and the presence of hypertension and diabetes mellitus did not have any significant effect on the serum level of T3 and T4 before and after HD. However, the serum levels of T3 and T4 were still in the normal range in these examined patients either before or after HD. From these findings, it can be concluded that these CRF patients may be in a euthyroid state, because the serum levels of T3 and T4 were in the normal range. In addition, HD was seemed to improve the T3 and T4 thyroid hormone concentrations, suggesting that HD might activate the secretion of thyroid gland and catabolism. The other variables did not play any role in thyroid hormone levels in these patients either before or after HD. It is highly recommended that large scale evaluation of thyroid hormone levels in Libyan CRF patients is performed by more patients, especially elderly patients.

Late Nephrology Case Management and Morbidity Due to Chronic Renal Failure, Case of Guinea

Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated with late nephrology case management and to describe the evolution of patients depending on the time of care nephrology. Material and Methods: It was a 5-year prospective study, observational type, going from January 1st, 2010 to December 31th, 2014. We studied all the patients hospitalized with chronic renal failure with dialysis or not and we excluded the patients hospitalized for acute renal failure. Results: The study population includes 307 men (53.4%) and 268 women (46.6%) with a sex ratio of 1.14. Age population ranged between 15 and 85 years old with a mean of 44.4 ± 16.20 years old. Their profession was distributed as follows: 220 housewives (38.3%), 181 workers (31.5%), 104 civil servants (18.1%), 56 students (9.7%) and 14 unemployed (2.4%). Patients came from all regions of the country: Conakry: 389 patients (67.6%);Lower Guinea: 82 (14.3%);Middle-Guinea: 57 (9.9%);Upper Guinea: 31 (5.4%);Guinea Forest Region: 16 (2.8%). In this study population, 48 patients were admitted in emergency (8.3%);105 were scheduled (18.3%) and 422 were referred to the nephrology department (73.4%). Reasons for the emergency admission were acute pulmonary edema in 21 patients (43.7%), decompensated anemia in 13 patients (27.1%), loss of consciousness in 9 patients (18.7%) and malignant hypertension in 5 patients (10.4%). The reference patterns was uremic syndrome in 312 patients (54.3%), followed by high blood pressure in 247 patients (42.9%), an edematous syndrome in 234 patients (40.7%), oligoanuria in 222 patients (38.6%), morphological abnormalities on the renal ultrasound in 4 patients (0.7%). The functional symptoms were vomiting in 379 patients (65.9%), followed by dyspnea in 290 patients (50.4%), headaches in 287 patients (49.9%). Among them, 121 patients could handle alone, 431 were borne by their families and 23 were indigent;181 patients had consulted before 1 month of the beginning of the signs, 238 between 1 and 2 months and 156 after 2 months;48 were admitted in emergency, 105 were programmed by the Nephrology Department and 422 were referred to the other health structures of the country. Conclusion: Several factors contributed to the delay in treatment, among which: the low socioeconomic level, the delay of the reference of the patients, the long distance of the regions, the lack of Nephrology units in the country.

Transplantation Therapy of Cats with Chronic Renal Failure

Abstract Dialysis therapy is not a radical cure of chronie renal failure in eats. while renal transplantation is the cure method, Renal transplantalion requires rigorous examinatinn of donor and receptor, and the procedure is strictly sterile. The main points of renal Iransplantalion are： renal artery and vein sutured to abdominal aorta and psterior vena tara, respectively; ureter sutured to bladder; minimizing the time of thermal isehemia. Cats should be given immunosuppressant betore lhe operation, and the drug should be administered throughout the life. Various indicators shouhl be mnnitored regularly to prevent the occurrence of immunologieal rejcetion.

Prevalence of Severe Anemia (Hb ≤ 5 g/dl) in Non-Dialyzed Chronic Renal Failure Patients in the Nephrology and Hemodialysis Department of Point G University Hospital

Introduction: Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73m2 for at least three (3) months. Anemia is one of its most common complications. Anemia increases the risk factor for cardiovascular mortality by 18% per gram of hemoglobin loss. Objectives: To determine the prevalence and characteristics of this severe anemia, to determine the indications for transfusion, the complications related to this anemia, the evolution and the prognosis of these patients. Materials and Methods: This was a descriptive study with retrospective data collection over 18 months (January 1, 2017 to June 30, 2018) that included hospitalized CRF patients. Were included, non-dialyzed chronic renal failure patients with Hb ≤ 5 g/dl hospitalized during the said period. Not included were chronic renal failure patients with an Hb level ≥ 5 g/dl, those followed up and/or hospitalized outside the study period. Results: Among 1176 patients, 26 had severe anemia (Hb level ≤ 5 g/dl) on CRF, a prevalence of 2.21%. The mean age was 40 years ± 32.62 with extremes of 15 and 67 years. Seventeen women and 9 men. The etiology of chronic renal failure (CRF) was hypertensive vascular nephropathy in 50% of cases. CRF was end-stage in 18 patients (69.2%). The mean hemoglobin level was 4.10 g/dl ± 0.64 with extremes of 2 and 5 g/dl. The anemia was microcytic hypochromic in 50% and aregenerative (96.2%). The main symptoms were asthenia in 20 cases (76.9%), dizziness in 20 cases (76.9%), exertional dyspnea in 19 cases (73.1%). Signs of cardiac decompensation (n = 12) were jugular turgor 10 cases (38.5%), hepato-jugular reflux 06 cases (23.1%), mitral insufficiency murmur 06 cases (23.1%). The main complication was left ventricular hypertrophy 17 cases (77.3%). There was no correlation between anemia and sex (p = 0.291), age (p = 0.778), malaria (p = 0.158), etiology of CRF (p = 0.26). The evolution after treatment of anemia was favorable in 19 patients (73.1%), unfavorable in 02 patients (7.7%) and 05 deaths (19.2%). The deaths were of cardiovascular cause: left ventricular insufficiency 04 cases, stroke 01 case. Conclusion: Anemia is frequent in patients with chronic renal failure and remains an important risk factor for cardiovascular disease and poor general condition.

Inflammatory status in chronic renal failure: The role of homocysteinemia and pro-inflammatory cytokines

AIM: To evaluate determinants of inflammatory markers in chronic renal failure patients according to the level of glomerular filtration rate. METHODS: One hundred fifty four patients(Age; 44 ± 06 years, male/female; 66/88) with chronic renal failure(CRF) were divided into 6 groups according to the National Kidney Foundation(NKF) classification. They included 28 primary stage renal failure patients(CRF 1), 28 moderate stage renal failure patients(CRF 2),28 severe stage renal failure patients(CRF 3), 18 endstage renal failure patients(CRF 4), 40 hemodialysis(HD) patients, and 12 peritoneal dialysis(PD) patients. Tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6) and C-reactive protein(CRP) were analyzed by immunosorbent assay kit(ELISA)(Cayman Chemical's ACETM EIA kit). Immunoassay methods were used for total homocysteine(tH cy)(fluorescence polarization immunoanalysis HPLC, Perkin Emer 200 series), transferrin(MININEPHTM human transferin kit: ZK070.R), ferritin(ADVIA Centaur) and fibrinogen analysis(ACL 200). Differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± SD.RESULTS: Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in HD(16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P < 0.001) and PD(14.04 ± 3.40 pg/m L vs 0.39 ± 0.03 pg/m L, 10.15 ± 1.66 pg/m L vs 8.20 ± 0.22 pg/m L, P < 0.001). IL-1β levels were increased in HD(9.63 ± 3.50 pg/m L vs 3.24 ± 0.10 pg/mL, P < 0.001) and CRF 4(7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/m L, P < 0.001) patients than in CRF 1 and in the other groups. Plasma t Hcy levels were higher in HD(32.27 ± 12.08 μmol/L) and PD(28.37 ± 4.98 μmol/L) patients compared to the other groups of CRF(P < 0.001). The serum CRP level was significantly increased in HD(18.17 ± 6.38 mg/L) and PD(17.97 ± 4.85 mg/L) patients compared to the other groups of CRF patients(P < 0.001). The plasma fibrinogen level was more elevated in HD(6.86 ± 1.06 g/L) and CRF 4(6.05 ± 0.57 g/L) than in the other groups(P < 0.001). Furthermore; the ferritin level was higher in HD(169.90 ± 62.16 ng/m L) and PD(90.08 ± 22.09 ng/m L) patients compared to the other groups of CRF(P < 0.001). The serum transferrin value was significantly decreased especially in PD(1.78 ± 0.21 g/L) compared to the other groups(P < 0.001). We found a negative correlationbetween glomerular filtration rate(GFR), TNF-α levels(r =-0.75, P < 0.001), and t Hcy levels(r =-0.68, P < 0.001). We observed a positive correlation between GFR and transferrin levels(r = 0.60, P < 0.001). CONCLUSION: CRF was associated with elevated inflammatory markers. The inflammation was observed at the severe stage of CRF and increases with progression of renal failure.

The Possibilities of Chronic Renal Failure Patients Contracting Occult Hepatitis B Virus Infection, Sudan

Introduction: Chronic kidney disease (CKD) is a major cause of death in sub-Saharan Africa. The effects of the CKD on the host and the continuous therapeutic measures increase the hypothesis of blood-borne diseases transmission. Objective: This study aimed to find the frequency of occult hepatitis B virus (OBI) in patients of chronic renal failure (CRF) and to study the possibilities of infection acquisition. Methods: During 2017 and 2019, two hundred CRF patients under regular haemodialysis and attending Gezira Hospital for Renal Diseases and Surgery were recruited. Plasma specimens were collected and used for detection of hepatitis B surface antigens (HbsAg), total hepatitis B core antibodies (anti-HBc) and hepatitis B virus DNA isolation. Nested PCR reaction was followed to identify HBV. Socio-clinical data for each participant was obtained. Results: Male patients represented 64% (128/200), most frequent age group was from 41 to 60 years with percentage of 56.5% (113/200), 86% (172/200) of CRF patients were received blood while 42% (84/200) get HBV vaccination. Hepatitis B core antibodies were found in 54% (108/200) of studied cases, and 22% (42/188) of tested DNA were positively amplified for target gene. Detection of Hepatitis B core antibodies was significantly associated with marital status while absence of vaccination significantly associated with the detection of both hepatitis B core antibodies and HBV DNA. Conclusion: This study found high frequency of OBI in CRF patients, to reduce the transmission of the disease, possible hypotheses should be studied, including blood transfusion, haemodialysis process and HBV vaccination status.