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

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

Ethanol extract of Abelmoschus manihot suppresses endoplasmic reticulum stress in contrast-induced nephropathy

Objective:To explore the efficacy and potential mechanisms of the ethanol extract of Abelmoschus manihot(L.)Medic in contrast-induced nephropathy(CIN).Methods:CIN rat models and human renal proximal tubular cells(HK-2)with iopromide-induced injury were employed to mimic CIN conditions.The effect of Abelmoschus manihot extract on the rat models and HK-2 cells was evaluated.In rat models,kidney function,histology,oxidative stress and apoptosis were determined.In HK-2 cells,cell viability,apoptosis,mitochondrial membrane potential,and endoplasmic reticulum stress were assessed.Results:Abelmoschus manihot extract significantly improved structural and functional impairments in the kidneys of CIN rats.Additionally,the extract effectively mitigated the decline in cellular viability and reduced iopromide-induced oxidative stress and lipid peroxidation.Mechanistic investigations revealed that Abelmoschus manihot extract prominently attenuated acute endoplasmic reticulum stress-mediated apoptosis by downregulating GRP78 and CHOP protein levels.Conclusions:Abelmoschus manihot extract can be used as a promising therapeutic and preventive agent in the treatment of CIN.

Point-of-care ultrasound in nephrology:A private practice viewpoint

Point-of-care ultrasound(POCUS)is a limited ultrasound examination performed by the clinician at the bedside,emerging as a complement to physical examination across various medical specialties.In the field of nephrology,its integration has been gradual,primarily limited to guiding procedures like temporary dialysis catheter placement or,in some cases,diagnostic kidney ultrasounds.In reality,the assessment of hemodynamic status at the bedside holds immense value for nephrologists,yet there exists limited awareness among practitioners regarding its implementation.While there is a growing trend towards incorporating multiorgan POCUS training in fellowship programs,private practice nephrologists remain relatively uninformed.This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice,demonstrating its effectiveness in diverse clinical settings,ranging from medical wards to outpatient dialysis units.Additionally,we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.

Seeing through the myths:Practical aspects of diagnostic point-ofcare ultrasound in nephrology

Point of care ultrasonography(POCUS)is emerging as an invaluable tool for guiding patient care at the bedside,providing real-time diagnostic information to clinicians.Today,POCUS is recognized as the fifth pillar of bedside clinical examination,alongside inspection,palpation,percussion,and auscultation.In spite of growing interest,the adoption of diagnostic POCUS in nephrology remains limited,and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs.Moreover,several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice.These include myths about its scope,utility,impact on patient outcomes and legal implications.In this minireview,we address some of these issues to encourage wider and proper utilization of POCUS.

Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days

Background:None of study mentioned about contrast-induced acute kidney injury(CI-AKI)in people who have received contrast agents twice within in a short period of time.This study is trying to identify the predictors.Methods:We enrolled 607 patients between Oct.2010 and Jul.2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region.The primary outcome was CI-AKI within 72 h after contrast agent exposure.Patients were divided into groups A(n=559)and group B(n=48)according to whether CI-AKI occurred after the second agent.Results:Patients in group B(CI-AKI occurred after the second agent)had a more rapid heart rate and more usage of diuretics and digitalis.In group B,CI-AKI occurred more frequently after the first agent.Multivariate logistic regression showed that diuretic(P=0.006)and intra-aortic balloon pump(IABP)usage(P=0.012)were independent predictors of CI-AKI after the first agent.Angiotensin-converting enzyme inhibitor/AngiotensinⅡreceptor antagonist(ACEI/ARB)usage(P=0.039),IABP usage(P=0.040)and CI-AKI occurring after administration of the first agent(P=0.015)were independent predictors of CI-AKI after the second.Furthermore,dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1–3 days after the first exposure than within 4–6 days(12.4%vs.5.0%,P=0.008)or≥7 days(12.4%vs.6.4%,P=0.039).Conclusions:Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent.The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure,ACEI/ARB usage,and IABP usage.More importantly,a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.

Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis

AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a randomeffects model to estimate the incidence of CIAKI.RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6%(95%CI: 4.5%-16.3%) and 0.4%(95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0%(95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1%(95%CI: 6.6%-28.4%), 10.1%(95%CI: 4.2%-18.0%), and 6.1%(95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.

First Consultation in Nephrology: Case of the Point G University Hospital (Bamako-Mali)

Understanding the first consultation of people with kidney disease seems to us to be essential to understand the attitude of the referring physician and the nephrologist. The aim was to find out to whom a patient with kidney disease should be referred in the first instance and for what reason? Hence the evaluation of the prevalence of the first consultation in the nephrology department of the Point G University Hospital in Bamako was made. Patients and Method: This was a prospective descriptive study which took place from July 2017 to June 2018 in the nephrology department of the Point G University Hospital. The study included all patients who came to the nephrology department for the first time during this period. Results: Between July 2017 and June 2018 at the nephrology and haemodialysis service of the G point University Hospital, we retained 643 out of 1031 patients who came for their first consultation, i.e. 62.36%. There were many patients aged between 41 and 50 years. The average age was 42.6 ± 5.03 years with extremes of 30 and 82 years. The sex ratio (M/F) was in favor of males, 1.14. The majority of patients were referred/evacuated from the referral health centres (57.6%). The majority of patients were referred/evacuated by general practitioners (70.5%). Cardiologists were the main specialists to refer/evacuate patients (21.2%). The main reasons for consultation that led to the first diagnostic hypotheses were: arterial hypertension for vascular nephropathy, glomerular syndrome for glomerular nephropathy, acute uraemia syndrome for acute renal failure, hydronephrosis for obstructive uropathy and finally diabetes for diabetic nephropathy. Conclusion: The first consultation in nephrology remains an important step in the management of renal disease, especially when the referral is an emergency. The percentage of referrals is dominated by general practitioners.

Does Current Nephrology Fellowship Training Affect Uti-lization of Peritoneal Dialysis in the United States?

Background: The 2010 US Renal Data System annual report revealed that peritoneal dialysis is used by only 7% of end-stage renal disease patients on chronic dialysis vs. hemodialysis which is used by 93% of such patients, despite documented benefits of peritoneal dialysis over hemodialysis in these cases. Purpose: We examined whether education of nephrology fellows contributed to underutilization of peritoneal dialysis in the US. Methods: Self-report questionnaires were administered electronically to nephrology fellowship training program directors, October 2010-March 2011 (55% response). Results: Median number of training faculty and patients/fellow were significantly lower for peritoneal-dialysis vs. hemodialysis training. Hours of didactic teaching for fellows over their 2-year training period were significantly lower for peritoneal dialysis vs. hemodialysis. Peritoneal dialysis training was 20% of total training vs. 80% for hemodialysis. Most program directors (87%) believed lack of trained faculty in peritoneal dialysis and insufficient peritoneal dialysis patient population contributed to inadequate fellows’ peritoneal dialysis training. Conclusions: Findings suggest that current nephrology fellowship training in peritoneal dialysis is inadequate and contributes to its underutilization.

Clinical audit,a valuable tool to improve quality of care:General methodology and applications in nephrology

Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing.Different tools have been developed,including incident analysis,health technology assessment and clinical audit.The clinical audit consist of measuring a clinical outcome or a process,against welldefined standards set on the principles of evidencebased medicine in order to identify the changes needed to improve the quality of care.In particular,patients suffering from chronic renal diseases,present many problems that have been set as topics for clinical audit projects,such as hypertension,anaemia and mineral metabolism management.Although the results of these studies have been encouraging,demonstrating the effectiveness of audit,overall the present evidence is not clearly in favour of clinical audit.These findings call attention to the need to further studies to validate this methodology in different operating scenarios.This review examines the principle of clinical audit,focusing on experiences performed in nephrology settings.

Result of 10 Years of Experience in Echo-Guided Kidney Biopsy Punctures in the Nephrology Department of the Martigues Hospital Center, France

Introduction: Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. Objectives: To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. Methodology: This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. Results: The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. Conclusion: Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.

Renal Failure of Lithiasis Origin: Frequency and Management in the Nephrology and Haemodialysis Department of the Point G University Hospital in 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.

Contrast Agents and Contrast-Induced Nephropathy

Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.

Restructuring nephrology services to combat COVID-19 pandemic:Report from a Middle Eastern country

Coronavirus disease 2019 has spread across the world and has been classified as a pandemic.It has overwhelmed the healthcare systems.Specifically,it has overstretched the intensive care units and renal replacement therapy services in many countries.In this paper,we discuss the reconfiguration of nephrology services in the State of Qatar during the current pandemic.We highlight the key strategies that have been implemented to ensure that renal replacement therapy capacity is not constrained in either the intensive care or ambulatory setting.Some innovative approaches for the safe delivery of ambulatory care to dialysis and kidney transplant patients are also discussed.

Contrast-induced Encephalopathy after Endovascular Embolization of an Anterior Communicating Artery Aneurysm:Case Report and Literature Review

We report a case of contrast-induced encephalopathy after endovascular embolization of an anterior communicating artery aneurysm.A 59-year-old woman was admitted to Tongliao Hospital for neurointerventional treatment due to a left anterior communicating artery aneurysm.She had a history of hypertension,which was controlled by regular medication.The contraindications were eliminated following a preoperative examination,and head computed tomography(CT)showed no abnormalities.After evaluation,interventional embolization was performed.Three hours postoperatively,the patient complained of a headache on the right side,which was accompanied by frequent nausea.Emergency head CT showed no intracranial hemorrhage,obvious brain tissue edema in the right cerebral hemisphere,blurred sulcus/gyrus,or metal artifacts(spring coils)in the left frontal lobe.The patient was diagnosed with contrast-induced encephalopathy(CIE).This patient achieved good prognosis through timely and reasonable treatment.CIE is very rare clinically,improper treatment may lead to irreversible clinical outcomes;it should cause alarm to doctors.

What is the purpose of launching the World Journal of Nephrology?

The launch of the World Journal of Nephrology(WJN) has distinct purposes. Its main purpose is to incorporate the fields of diabetes, hypertension, urology, cardiology and neurology, which are related to kidney disease, and to make all of our readers, contributors and allied health professionals feel at home with the WJN. The WJN aims to rapidly report new theories, methods and techniques for prevention, diagnosis, treatment, rehabilitation and nursing skill in the field of nephrology. The WJN will cover diagnostic imaging, disorders of kidney development, renal obstruction, atrophy and regeneration, kidney tumors, renal pharmacology and therapy, renal replacement therapies including transplantation, and Chinese herbal medicine. The WJN issues will include an editorial, frontier, invited review of articles and commentaries in addition to original articles submitted. The WJN will solicit articles from investigators in areas of diabetes and hypertension, and high priority will be given to those articles with an emphasis on the prevention of dialysis. Final decision for publication will be based on the merit of the article, language and lucidity.

Multiple Antihypertensive Therapy in Nephrology Practice

Introduction: Hypertension (HT) can be the cause or consequence of chronic kidney disease. Its management often requires a multiple therapy due to its severity. Objective: To describe the profile of patients receiving a multiple anti-hypertensive therapy in nephrology practice. Materials and Methods: This was a prospective, descriptive study conducted in the department of Nephrology, Yopougon Teaching Hospital, from January 1 to October 31, 2016. We included all patients admitted to this department who had received at least three anti-hypertensive drugs. Results: Out of a total of 625 hypertensive patients admitted over the study period, we included 120 patients on multiple therapy, i.e. a 19% prevalence. HT was essential in 60% of cases, secondary to chronic glomerulonephritis (CGN) in 25%, to diabetes in 13.3% and to polycystic kidney disease (PKD) in 1.7%. The therapy consisted of the combination of 3 antihy-pertensive drugs in 36.7% of cases, 4 drugs in 49.2% and 5 drugs in 4.2%. The antihypertensive classes used were Calcium channel blockers (CCB) in 99.2% of cases, Diuretics (D) in 87.5%, Angiotensin Converting Enzyme Inhibitors (ACEI) in 70%, Centrally acting medication (C) in 66.7%, Angiotensin Receptor Blockers (ARB) in 25.8% and Beta-blockers (β-) in 6.7%. The main combinations were CCB + D + ACEI + C in 34.2% of cases, CCB + D + ACEI in 23.3%, and CCB + D + ARB + C in 12.5%. The combinations of antihypertensive drugs varied according to the cause of HT with a non-significant difference. Patient outcome was characterized by normal blood pressure in 64.2% of cases and normal renal function in 13.3%. The mortality rate was 17.5%. In multivariate analysis, stage 5 renal disease (p = 0.001), hypertensive retinopathy (p = 0.04) and hemoglobin level < 8 g/dl (p = 0.039) were associated with mortality. Conclusion: Multiple antihypertensive therapy, which is common in nephrology, is related to the severity of HT and not to its cause. We still use centrally acting drugs in combination with the other recommended classes, so as to achieve the target blood pressure.

Precision nosology of contrast-induced acute kidney injury may have higher accuracy in predicting adverse outcomes: inspiration from the modified classification of AKI

The definition of contrast-induced acute kidney injury(CI-AKI)in most articles is a fixed(rise by 0.5 mg/dL,CIAKI-absolute)or proportionate(rise by 25%,CIAKI-relative)increase in serum creatinine concentration(SCr)above baseline(measured at hospital admission)within 48-72 hours of contrast exposure[1,2].Hence,an absolute increase in SCr≥0.5 mg/dl is equivalent to a relative increase in SCr≥25%in their protocols.However,we believe a precision nosology of CI-AKI may have higher accuracy in predicting adverse outcomes.We recommend further study conduct a sub-group analysis based on our modified classification of CI-AKI.

延伸见习在肾内科临床见习教学中的应用探索

目的:探讨延伸见习在肾内科临床见习教学中的应用效果。方法:选取在我科见习的西安医学院临床医学本科生为研究对象,对照组2016级87人采用CBL联合PBL教学法,试验组2017级61人在对照组基础上进行延伸见习,见习课程结束后进行随堂测试和问卷调查评估教学效果。结果:试验组学生随堂测试成绩为(82.74±7.69)分,对照组学生(77.70±6.61)分,差异具有统计学意义(P<0.001);试验组学生对见习课程的总体满意率为100%,对照组仅47.13%,试验组学生对见习课程的总体满意率和十分满意率均明显高于对照组(P<0.05);问卷调查显示,在激发学习兴趣、激发主动性、培养创新思维、培养临床诊疗思维、指引学习方法、提升医患沟通能力及团队协作方面,试验组得分都明显高于对照组(P<0.05)。结论:延伸见习符合未来医学教育发展方向,是值得探索的新模式。

肾内科教学中采用SHARP反馈法的效果及对教学满意度的影响

目的探析SHARP反馈法在肾内科教学中的应用效果。方法选取2021年5月至2022年5月皖南医学院弋矶山医院肾内科实习生50名,依据随机数表法分为两组,每组各25名。对照组采用传统教学方法,观察组采用SHARP反馈法。比较两组学习成绩、教学质量评分及教学满意度。结果观察组学生学习成绩、教学质量评分包括学习和学术价值、教师的情操、组织和表达、师生关系和互动、教师知识面评分高于对照组,差异有统计学意义(P<0.05),观察组教学满意度、学习能力评分包括学生临床思维、课堂氛围、自学能力、临床实践能力、表达能力及知识关联能力高于对照组,差异有统计学意义(P<0.05)。结论肾内科教学中采用SHARP反馈法教学的效果明显,可提升实习生学习成绩,为实习生提供高质量教学,同时提升实习生对教学方法的满意度,临床教学中可大力推广及应用。

基于共情表达模式的课程思政在肾内科护生教育中的应用

目的 探讨基于共情沟通模式的课程思政在肾内科护生教育中的应用效果。方法 选取我院2022年8月至2023年8月肾内科实习的142名护理实习生为研究对象,按照实习时间先后分为对照组和试验组。对照组采用常规教学模式,试验组在常规教学的基础上,采用基于共情沟通模式的课程思政教育模式。比较两组护生的理论和操作成绩、批判性思维能力测量表得分、护生临床沟通能力测评量表得分和课程思政教学效果评价。结果 试验组护生的理论和操作成绩、批判性思维能力测量表得分及护生临床沟通能力测评量表得分显著高于对照组,差异均具有统计学意义(P<0.05)。试验组护生的课程思政教学效果满意度为98.59%,显著高于对照组的88.73%,差异具有统计学意义(P<0.05)。结论 应用基于共情表达模式的课程思政教学模式能够调动护生的学习积极性,激发其学习内驱力,提高临床沟通能力,有利于护生的思想政治教育,使其更好地掌握相关理论知识和操作技能。