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.

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.

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.

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.

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.

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.

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.

Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation:A three-year follow-up

Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membranous nephropathy,who underwent treatment with prednisone and cyclosporine in 2016.In early 2017,the patient was diagnosed with a"fungal infection"and discontinued the use of cyclosporine.After one month of anti-infection therapy,a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region.The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses,multiple lung and brain lesions,and a positive culture of Nocardia in the drainage.We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole(TMP-SMX),minocycline,and voriconazole.However,the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation.During the five-month follow-up period following the discharge,the patient displayed an enhanced nutritional status and stable renal function.The focal infection ultimately resolved during the subsequent three years.Neuro-infection caused by Nocardia should be considered in immunocompromised patients,and TMP-SMX is the preferred initial therapy;however,because of the high mortality rate,a long-term combination therapy with imipenem,cefotaxime,amikacin,and TMP-SMX is suggested.

Point-of-care ultrasonography in cirrhosis-related acute kidney injury:How I do it

Discerning the etiology of acute kidney injury(AKI)in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes.The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload.In the recent past,point-of-care ultrasonography(POCUS)has emerged as a valuable adjunct to clinical assessment,offering advantages in terms of diagnostic accuracy,rapidity,cost-effectiveness,and patient satisfaction.This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI.The review distinguishes basic and advanced POCUS,emphasizing a 5-point basic POCUS protocol for efficient assessment.This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy,lung ultrasound for detecting extravascular lung water,inferior vena cava(IVC)ultrasound for estimating right atrial pressure,internal jugular vein ultrasound as an alternative to IVC assessment,and focused cardiac ultrasound for assessing left ventricular(LV)systolic function and identifying potential causes of a plethoric IVC.Advanced POCUS delves into additional Doppler parameters,including stroke volume and cardiac output,LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload.POCUS,when employed judiciously,enhances the diagnostic precision in evaluating AKI in cirrhotic patients,guiding appropriate therapeutic interventions,and minimizing the risk of fluid-related complications.

Machine learning in nephrology: scratching the surface

Machine learning shows enormous potential in facilitating decision-making regarding kidney diseases.With the development of data preservation and processing,as well as the advancement of machine learning algorithms,machine learning is expected to make remarkable breakthroughs in nephrology.Machine learning models have yielded many preliminaries to moderate and several excellent achievements in the fields,including analysis of renal pathological images,diagnosis and prognosis of chronic kidney diseases and acute kidney injury,as well as management of dialysis treatments.However,it is just scratching the surface of the field;at the same time,machine learning andits applications in renal diseases are facing a number of challenges.In this review,we discuss the application status,challenges and future prospects of machine learning in nephrology to help people further understand and improve the capacity for prediction,detection,and care quality in kidney diseases.

PRESENT STATUS OF NEPHROLOGY IN CHINA

In China,nephrology as a specialty began in 1982,and the national socicty of nephrology was established

A short history of Chinese Society of Pediatric Nephrology

It was not until 1970s that the subspecialty of pediatric nephrology was initiated on the foundation of general pediatrics in China. In 1977, Cooperation Group on Childhood Renal Diseases was organized by Prof. WANG Bao-lin （Beijing）, Prof. JIANG Xin-qiu （Nanjing） and Prof. GUO Yi-qing （Shanghai）, which was a milestone for pediatric nephrology in China.

Transcending boundaries:Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury

Acute kidney injury(AKI)is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both.In spite of thorough history-taking,physical examination,and laboratory analysis,there are limitations in the diagnostic process and clinical monitoring of AKI.Point-of-care ultrasonography(POCUS),a limited ultrasound study performed by clinicians at the bedside,has emerged as a valuable tool in different clinical settings.In this discussion,we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients.POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics,enabling formulation of individualized treatment plans.Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI,as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics.As a part of cardiorenal syndrome,the diagnosis is usually made based on history and physical examination,with findings such as jugular venous distension,a third heart sound,and vital signs as supporting findings.More recently,however,these once though objective measures have come under scrutiny for their accuracy.At the same time,bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion.In this mini-review,we will discuss some of the traditional methods used to measure venous congestion,describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation,and offer a description of venous excess ultrasound score,a relatively novel scoring technique used to objectively quantify congestion.While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements,more study is underway to solidify the role of this objective measure in daily clinical practice.

Obstructive uropathy-acute and chronic medical management

Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surgical approach.Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance.Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy.This narrative review summarises the early and long-term medical management of obstructive uropathy.

‘Children Kidney Care Centers’:Rationale,requirements and recommendations for best facilities and better future

Specialized centers are needed for nephrology and urology care of children.The justifications are the specialized nature of care needed and the growing incidence and prevalence.Children with chronic kidney disease(CKD)are at risk of morbidity,mortality,and decreased quality of life.Current pediatric practice structures are apparently poorly suited for the increasing demands of chronic disease in children.Kidney diseases account for around 8%-10%of total outpatients and 12%of admissions to the pediatric ward in hospitals.The major causes of pediatric CKD in registries are congenital anomalies of the kidney and urinary tract(around 50%),followed by inherited nephropathies and glomerulonephritis.The nephrologist’s role is important for specialized investigations and treatment.Urologist’s services are essential for the wide variety of conditions from birth to early adult age for complete cure and complementing medical management.Children have a right to treatments and to resources that are as sophisticated and advanced as those available to adults.Simple and sophisticated care for all children with ailments of the kidneys and related structures is important for ensuring‘health for all’.The availability of‘Child Kidney Care Centers’will go a long way in improving the lives of affected children.

Successful pregnancy after protective hemodialysis for chronic kidney disease: A case report

BACKGROUND Chronic kidney disease(CKD)affects almost 3%of females of child-bearing age,who have a high risk of adverse maternal and fetal outcomes.Additionally,high renal burden as a result of pregnancy may lead to deterioration of renal function.An increasing number of women with CKD stages 3 to 5 have a strong desire to conceive,and both obstetricians and nephrologists are faced with enormous challenges in terms of their treatment and management.CASE SUMMARY The case of a 35-year-old pregnant woman with a 10-year history of mild mesangial proliferative glomerulonephritis is described here.CKD progressed from stage 3 to stage 5 rapidly during pregnancy,and protective hemodialysis was started at 28 wk of gestation.Due to preeclampsia at 34 wk of gestation,cesarean section was performed and a healthy baby was delivered.Hemodialysis was discontinued at 4 wk postpartum.After 1 year of follow-up,her renal function was stable,and her baby exhibited good growth and development.CONCLUSION Protective hemodialysis during pregnancy can prolong gestational age and improve maternal and fetal outcomes in women with advanced CKD.

Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment

Accurate assessment of the hemodynamic status is vital for appropriate management of patients with critical illness.As such,there has been a constant quest for reliable and non-invasive bedside tools to assess and monitor circulatory status in order to ensure end-organ perfusion.In the recent past,point of care ultrasonography(POCUS)has emerged as a valuable adjunct to physical examination in various specialties,which basically is a clinician-performed bedside ultrasound to answer focused questions.POCUS allows visualization of the internal anatomy and flow dynamics in real time,guiding apt interventions.While both arterial(forward flow)and venous(organ outflow or afterload)limbs of hemodynamic circuit are important for tissue perfusion,the venous side remains relatively under-explored.With recent data underscoring the deleterious consequences of iatrogenic volume overload,objective evaluation of venous congestion is gaining attention.Bedside Doppler ultrasound serves this purpose and aids in diagnosing and monitoring the congestion/venous blood flow pattern.In this article,we summarize the rationale for integrating this technology into routine care of patients with volume-related disorders,discuss the normal and abnormal waveforms,limitations,and future directions.

Acute Nephronia and Renal Abscesses in Children from Quito, Ecuador

Renal abscess and nephronia are uncommon diseases in children and with unknown global prevalence. Nephronia represents an intermediate state between pyelonephritis and renal abscess. Prompt diagnosis is important to prevent morbidity and mortality (sepsis, renal injury, death). Scientific advances have made these entities more evident, although they may still be underdiagnosed. Patients with this disease require prolonged intravenous antibiotic therapy and potentially surgical resolution, mostly when their size is bigger than 3 - 5 cm when therapy with intravenous antibiotics alone fails and they are accessible to percutaneous drainage. We describe five cases of pediatric patients from four private hospitals in Quito, Ecuador followed during a one-year period. In every case, the diagnosis was suspected mostly because of persistent fever, abdominal pain, severe leukocytosis and/or elevated inflammation biomarkers. Only one of them had a previous history of urinary tract malformation while in another one malformation was revealed in his actual admission. Every case had microbiologic isolation. All of them recovered successfully. To our knowledge, in our country, there are no previous reports of these diseases in pediatric patients, and worldwide, there is scarce data. Our aim is to alert doctors who work with children to be aware of this condition.