COVID-19 Infection and Acute Kidney Injury: About 43 Cases Report Collected at the Nephrology Department of the Farah Polyclinic in Abidjan

Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) during Coronavirus disease (COVID-19) in Abidjan, C?te d’Ivoire. Material and Method: This was a monocentric retrospective analytical study of all patients over 18 years of age with AKI during COVID-19 at the Farah Polyclinic in Abidjan, C?te d’Ivoire. AKI was defined and ranked according to Kidney Disease Improving Global Outcomes (KDIGO) 2012. The data were collected from the medical record and processed using RStudio. Results: Forty-three cases were collected. The average age was 58.5 12 years. The sex ratio (M/F) was 4.4. The main comorbidities were high blood pressure (60.4%) and diabetes (37.2%). AKI was at KDIGO stage 3 in 58%, KDIGO 2 in 21% and KDIGO 1 in 21%. The diagnosis of acute tubular necrosis was retained in 44.2% of patients followed by acute functional kidney injury in 32.6%. Hemodialysis was initiated in 48.8% of cases. The main indication of dialysis was anuria (46.6%). In total, 55.8% of patients died. Factors associated with death were KDIGO stage (p = 0.049), and invasive ventilation (p Conclusion: Mortality is high in patients with AKI during COVID-19 infection.

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.

Prevalence of Metabolic Syndrome and Associated Factors among Hemodialysis Patients Monitored at the National Teaching Hospital, Hubert Koutoucou Maga in 2015

Introduction: Metabolic syndrome is one of the main risk factors of cardiovascular disease among hemodialysis patients. Objective: The main objective of this study was to determine the prevalence and factors associated with metabolic syndrome among hemodialysis patients in Cotonou in 2015. Patients and methods: It was a cross-sectional, descriptive and analytical study conducted from 05th October to 02nd November 2015 at the National Teaching Hospital, Hubert Koutoucou Maga of Cotonou. All patients aged 18 years and above, regularly under hemodialysis for the past 3 months and who gave their informed consent were included in the study. Those excluded were: currently hospitalized hemodialysis patients, hemodialysis patients hospitalized in the last three months, hemodialysis patients whose general condition deteriorated or unable to answer the questionnaire. Metabolic syndrome was defined according to the International Diabetes Federation’s criteria. Factors associated with metabolic syndrome were sought using logistic regression in univariate analysis. Confidence intervals were calculated at 95% and alpha significance threshold at 5%. Outcomes: In total 165 patients were included in the study. Male predominance was observed, with 1.27 sex-ratios. Average age was 49.3 ± 12.9 years with extremes ranging from 18 to 78 years. Metabolic syndrome is observed among 46 patients undergoing hemodialysis or 27.9% prevalence rate. Factors associated with the metabolic syndrome in univariate analysis were: gender (p 0.001), age (p = 0.007), body mass index (p = 0.029) and prior diabetes history (p = 0.011). Conclusion: Metabolic syndrome is common among hemodialysis patients. Early screening and fighting against associated risk factors are very important.

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.

The COVID-19 Vaccine Acceptance in Hemodialysis Patients in Togo

Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodialysis patients in Lomé. Patients and Method: Cross-sectional study was conducted from August 1 to 31, 2021 in hemodialysis patients at the Sylvanus Olympio University Hospital to obtain their opinion on the anti-COVID-19 vaccination. Results: One hundred and twenty-three patients on regular hemodialysis were interviewed;their mean age was 45 years [37 - 55.5 years]. The average number of years patients were on dialysis was 3 years [2 - 5 years]. The general opinion on vaccination was mostly unfavorable (59.3%). Reasons given included: doubts about the quality of the vaccine (49.6%), fear of side effects (51.2%), alarming messages on social networks (36.5%) and doubts about the efficacy of the vaccines (33.3%). Only half of the patients in favor of vaccination were already vaccinated at the time of the survey. The main motivations for getting vaccinated were dominated by: fear of developing a severe form of COVID-19 if infected (32.5%), frailty due to age (19.5%) and medical history (15.4%). Social networks (72.3%), television (60.1%), family and friends (55.2%) were the main sources of information for patients about COVID-19 vaccination. Conclusion: Hemodialysis patients are mostly septic to anti-COVID-19 vaccination.

Evaluation of Glomerular Filtration Rate and Urinary Abnormalities in Children with Cancer before Chemotherapy

Introduction: Glomerular filtration is an important elimination pathway for many types of chemotherapy. Accurate estimation of glomerular filtration is essential in the management of children with cancer. Methodology: This was a prospective cross-sectional study of the descriptive type extending over a period of 6 months from July 01 to December 31, 2021 on all children with cancer followed in the pediatric hemato-oncology unit of the HND with a renal, blood and urinary assessment associated with the GFR calculated by the SCHWARTZ formula during the study period. Results: During the study period, we registered 41 new cases of cancer in the pediatric oncology unit. The age group of 0 - 5 years was the most represented, i.e. 65.85% and the average age was 5.6 ± 4 years. The most cited clinical signs were fever ie 56.10% followed by abdominal pain 34.15% and anemia 26.83%. The most represented diagnosis was Burkitt’s Lymphoma, i.e. 26.83% followed by Retinoblastoma 24.39%. Mean serum creatinine was 70.65 ± 68.93 μmol/L. In our series, patients whose normal glomerular filtration rate were more represented, i.e. 70.73% and 29.27% had an abnormal GFR with an average of 87.28 ± 70 mL/min/1.73m2. Proteinuria and leukocyturia were observed in 31.71% and 19.51% respectively. Glycosuria and hematuria with common frequencies of 2.44% of patients. Conclusion: The prevention of renal toxicity of anticancer drugs always involves the precise evaluation of renal function using the Schwartz formula in children. .

Development and application of a closed-loop medication administration system in University of Hongkong-Shenzhen Hospital

Objective： This study aimed to develop and apply a closed-loop medication administration system in a hospital in order to reduce medication administration errors （MAEs）.Methods： The study was implemented in four pilot general wards. We used a before-and-after design to collect oral medication administration times before and after the implementation of the closed-loop medication administration system, evaluated MAE alert logs after the intervention, and conducted a survey of the nurses1 satisfaction with the system in the pilot wards.Results： （a） Nursing time of oral medication administration： before the adoption of the closed-loop medication administration system, the average nursing time was 31.56 ± 10.88 minutes （n = 78）; after the adoption of the system, the time was 18.74 ± 5.60 minutes （n = 54）. Independent sample Mests showed a significant difference between two groups（t= 8.85, P 〈0.00）. （b） Degree of nurses’ satisfaction with the closed-loop medication administration system： 60.00% （n = 42） of nurses considered the system to be helpful for their work and nearly half of the nurses （47.14%, n = 33） believed that the system could facilitate clinical work and reduce workload; 51.43% {n = 36） believed that the system could reduce checking time and enhance work efficiency; 82.86% （n = 58） believed that the system was helpful in improving checking accuracy to reduce MAEs and ensure patient safety. More than 60% of the nurses considered the system to be a method that could help to track MAEs to improve nursing quality, （c） The MAE alert logs during observation period： it revealed only 27 alerts from the repeated scans of 3,428 instances of medication administration.Conclusions： The nurses were satisfied with the closed-loop medication administration system because it improved their work efficiency and reduced their workload. The current investigation was limited by time; therefore, further research is needed to more closely examine the relationship between the system and MAEs.

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.

Design and application of weight gain graphs based on Bandura’s self-efficacy theory for patients on maintenance haemodialysis

Purpose:To design interdialytic and daily weight gain graphs for patients on maintenance haemodialysis and to evaluate their effect on patient adherence to restricted fluid intake.Methods:Forty-five patients on maintenance haemodialysis were recruited from August to October 2012.The graphs were applied for 12 weeks based on Bandura’s self-efficacy theory.Adherence to restricted fluid intake,dialysis adequacy,and satisfaction were compared before and after the graphs were applied.Results:Adherence to restricted fluid intake increased from 53.3%to 91.1%;the mean rate of urea clearance(Kt/V)decreased from 1.197 to 1.311,and the qualified rate increased from 42.5%to 70%.The rate of adherence was 86.77%;acceptance and satisfaction rates were 100%.Conclusion:It is acceptable to apply the graphs clinically for subsequent effective improvement of adherence to restricted fluid intake,promoting dialysis adequacy,and increasing patient satisfaction.Therefore,clinical application of the graphs is worthwhile.

Renal Disease among HIV Positive Patients in Senegal

Introduction: Renal disease (RD) in human immunodeficiency virus (HIV) infection is a decisive turning point in the development and prognosis of this disease. In Africa, the prevalence varies between 2.5% and 48.6%. In Senegal, little data are available in the literature. The objective of our study was to describe the epidemiological, clinical, paraclinical, therapeutic and progressional aspects in patients living with HIV (PLWHIV). Patients and methods: This was a retrospective, descriptive and analytical study carried out over a 10-year period in the Department of Internal Medicine and Nephrology at the Aristide Le Dantec Hospital in Dakar, Senegal. We included all 15-year old and above PLHIV with available CD4 count and viral load. Results: Out of 248 PLHIV, 32 had kidney disease (KD), which means a hospital prevalence of 12.9%. The mean age was 51.22 ± 10 years (extremes of 36 and 77 years) with a sex ratio (male/female) of 1.28. Renal signs were dominated by glomerular nephropathy syndrome. It was present at 80%. Tubulo-interstitial nephropathy syndrome and chronic uremic syndrome accounted for 6.25% and 3.1% of cases, respectively. Renal function Impairment was present in 21 patients with 18 cases of acute kidney injury (85.7%) and 3 cases of chronic renal failure (14.3%), including 2 in stage 5 of chronic kidney disease. Renal biopsy (RB) was indicated and performed in 20 (62.5%) patients with glomerular signs in 12 patients (60%). Glomerular lesions were dominated by focal and segmental glomerulosclerosis (FSGS) in 6 cases, membraneous nephropathy (MN) in 4 cases and minimal change disease (MCD) in 2 cases. Tubulo-interstitial and vascular lesions were present in 45% and 12.5% of cases, respectively. In highly active antiretroviral therapy (HAART), 12 (37.5%) patients had total remission, 9 (28.12%) had partial remission. One (3.12%) death from severe metabolic acidosis on chronic renal failure was deplored. Conclusion: This study illustrates the high prevalence of RD in PLHIV in our exercise context.

Management and Evolution of Multiple Myeloma with Renal Failure in Developing Countries: The Case of the Sylvanus Olympio University Hospital in Lome, Togo

Background: Renal failure (RF) is a frequent complication during multiple myeloma (MM) and sometimes reveals the disease. The median survival of MM patients with RF is shorter than that of patients with myeloma without renal involvement. Although patient survival has been prolonged with the new therapies, the median survival does not exceed five to seven years. Few data on this subject are available in sub-Saharan Africa. Objectives: To describe the therapeutic management and evolution of MM with RF in a developing country like Togo. Method: This was a retrospective descriptive and analytical study which took place over a period of ten years (2010-2019) and included the records of patients with MM according to the 2009 and/or 2014 IMWG criteria, hospitalized or followed up in the nephrology and rheumatology departments of the CHU-SO with a GFR Results: During the study period, 78 patients with MM had renal failure (55.7%). Therapeutically, hygienic and dietary measures were dictated in 84.6% of cases (68 patients). Rehydration was performed in 38 cases (48.7%);alkalinization of urine in 10 cases (12.8%);use of antibiotics in 36 cases (46.2%), NSAIDs in 51 cases (65.4%);use of biphosphonates in 36 cases (46.6%). Surgical immobilization by screw-plate osteosynthesis was performed in 02 patients. Nephrologically, 8 patients underwent ESRD. The different chemotherapy protocols used were Melphalan-Prednisone in 70% of cases, Melphalan-Cyclophosphamide-Prednisone in 26.7% of cases and Cyclophosphamide-Prednisone in 3.3%. The median overall survival was 8 months. The median survival was 13 months in patients who recovered from renal failure versus 2 months in those who did not recover from renal failure (p = 0.0030). Of the 78 patients in our series, 22 patients had died (28.2%). Conclusion: Despite renal failure, the Alexanian protocol and biphosphonates are still widely used in combination with symptomatic treatment with significant results.

Sjögren’s Syndrome Revealed by Obstructive Renal Failure: A Case Report and Review of the Literature

Introduction: Primary Sjögren’s syndrome (SS) is the most common connective tissue disease after rheumatoid arthritis and affects mostly women between 30 and 40 years of age with an estimated prevalence between 0.1% and 0.6%. This observation illustrates an incidental finding of a case of SS in a young female patient in a context of obstructive renal failure (ARF) due to uterine fibroids. Observation: This was a 31-year-old woman hospitalized for anuric AKI (Acute Kidney Injury) with a creatinine level of 1247 μmol/l. Her history included sickle cell disease A/C and an unoperated uterine fibroid diagnosed 3 years ago. Approximately 2 months before her admission, her symptomatology was made of dizziness, physical asthenia, vomiting, poly-arthralgia, morning rash, pollakiuria and oral dryness. Abdominal examination showed a painless transverse mass in the pelvis. Biological examination showed a CRP (C-reactive protein) level of 488 mg/l. The cytobacteriological examination of the urine was normal and the proteinuria was 1.35 g/24 hours. The CT scan showed kidneys measuring 110 mm on the right and 113 mm on the left associated with bilateral pyelo-caliceal dilatation on a large polymyomatous uterus of interstitial and submucosal type. Immunologically, the anti-nuclear factor, the rheumatoid factor and the anti-SSA antibodies were positive. The resumption of the interrogation within the framework of the research of the subjective dry syndrome to find a notion of intermittent xerophthalmia 4 months ago. The Schirmer test was positive in the left eye. The initial management consisted of a polymyomectomy after 3 sessions of hemodialysis. Background treatment combining prednisone 5 mg/day and methotrexate 20 mg/week was started in parallel with the use of artificial tears. The evolution after twelve (12) months of treatment was favorable with a complete disappearance of the signs dry syndrome and full recovery of renal function. Conclusion: SS can have an insidious evolution and remain stable for many years, hence its fortuitous discovery in this case of obstructive ARF on uterine fibroid. In this context we insist on the interest of the immunological assessment in a patient in period of genital activity with a significant proteinuria and non-specific extrarenal signs.

Estimation of Glomerular Filtration Rate: Which Formula to Apply in G-Spot Subjects Aged 1 - 17 Years?

Introduction: Morbidity and mortality in paediatric practice is dominated in Africa by malaria, diarrhoeal diseases and acute respiratory infections. Aim: In order to evaluate the Glomerular Filtration Rate (GFR) with the formulas commonly used by medical laboratories, we proposed to undertake this study. Patients and Method: This was a descriptive, prospective and cross-sectional study conducted at the PA and KA medical biology laboratory in Bamako Hamdalaye ACI 2000 in collaboration with the medical biology and hospital hygiene laboratory service at the Point G University Hospital. Results: During the study period, we recruited 360 subjects, 189 of whom were male (52.5%) and 171 female (47.5%). The mean age was 8.75 ± 4.8 years with extremes of 1 and 17 years. Subjects aged 15 to 17 years were the most numerous. The reference means GFR of the subjects according to age was with the SCHWARTZ formula 179.16 ± 50.47 with extremes of 173.93 and 184.39;with CKD-Epi 37.63 ± 11.25 with extremes of 36.46 and 38.79;with MAYO 107.87 ± 18.11 with extremes of 105.99 and 109.75 and MDRD 350.83 ± 251.15 with extremes of 324.79 and 376.86. Conclusion: The Mayo formula showed a better distribution around the mean than other formulas for estimating the glomerular filtration rate.

Acute Renal Failure Secondary to Paracetamol Intoxication: A Case Report

Renal damage secondary to paracetamol intoxication is rare, estimated between 1% and 2% of intoxication cases. Its pathophysiology is still debated, the clinical involvement consisting in an acute tubular necrosis with a good prognosis if it is rapidly treated. Renal damage can sometimes occur without prior hepatic damage, and the onset of renal manifestations is generally between the 2nd and 7th day after taking paracetamol. If its management remains exclusively symptomatic, its late onset can sometimes lead to serious metabolic complications. It is therefore important to systematically monitor renal function following paracetamol drug intoxication. We report the case of a 60-year-old male subject hospitalized for the management of voluntary drug intoxication (VDI) with paracetamol complicated by acute hepatocellular failure and acute renal failure. His management required extrarenal purification (hemodialysis) and the evolution was favorable with recovery ad integrumof renal function. Conclusion: Although less known and of unelucidated physiopathology, nephrotoxicity secondary to voluntary drug intoxication with paracetamol is a reality and can lead in extreme cases to the use of extrarenal purification technique (hemodialysis).

Fortuitous Discovery of a Multifocal Enchondromatosis in a Case at the “Luxembourg” Hospital Center in Bamako

The aim of this study was to clarify the interest of standard radiography in the management of Ollier’s disease. Observation: Enchondromas are benign lesions that may present on imaging with nonspecific features in children, and they are relatively large lesions, with frequent endosteal erosion and rare matrix mineralization. We report a case of predominantly right-sided multifocal enchondromatosis in a 5-year-old girl with no known medical history, diagnosed fortuitously on standard radiography during a trauma assessment and confirmed by histology. No sign of pain was noted after a 6-month follow-up. But the radiographic control noted signs of diffuse osteoarthritic remodeling in the surgical areas and early fusion of the growth cartilages. Conclusion: Ollier’s disease is rare, you have to know how to think about it in the face of fortuitous discoveries, especially at an early age. Enchondromas are benign lesions that may present on imaging with nonspecific features in children. In all cases, standard radiography is essential in the diagnosis and follow-up of Ollier’s disease.

Epidemiological and Clinical Profile of Patients Undergoing Primary Nephrological Consultation at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.

Centropontine Myelinolysis after Conservative Correction of Hyponatremia: A Case Report and Review of Contributing Factors

Introduction: Centropontine myelinolysis (CPM) is a rare pathology, a delayed neurological complication corresponding to massive demyelination of the protrusion. Its exact pathogenesis is poorly understood. Rapid correction of sodium hyponatremia has been implicated as a potent causative factor. We report a case of CPM despite a priori conservative correction of hyponatremia with a favorable course in a 61-year-old alcoholic-smoker diabetic. Case Presentation: A 61-year-old man with chronic alcoholism presented to the emergency department (D0) with physical asthenia and anorexia. He was treated for severe hyponatremia at 104 mmol/L by careful rehydration with saline before being transferred to a nephrological hospital. Magnetic resonance imaging (MRI) performed at D14 for locked-in syndrome showed osmotic demyelination syndrome (Figure 1). The evolution was favorable after 3 months of rehabilitation marked by a progressive and clear improvement of clinical signs. Conclusion: This observation suggests an evaluation of the benefit/risk ratio of the short-term prognosis of profound hyponatremia with that of the metabolic stress induced by a still too rapid correction. Particular attention should be paid to diabetic patients in the context of chronic alcoholism or nutritional deficiencies.

肝脏透析的体内量化:白蛋白透析和分次血浆分离的比较

Background/Aims: Artificial liver support represents a potentially useful option for the treatment of severe liver failure. A sufficient ‘ dose’ might be crucial for such treatments to provide a survival benefit. The aim of this study was to compare in vivo efficiency and resulting delivered treatment dose of two commercially available devices that use different therapeutic principles: albumin dialysis (AD, MARS ) and fractionated plasma separation (FPS, Prometheus ). Methods: Eight patients with acute-on-chronic liver failure were treated alternately with AD and FPS. Thirty-two treatments at identical blood and dialysate flow rates were evaluated. Clearance and reduction ratio (a measure of delivered treatment dose)were compared for bilirubin subfractions, ammonia and urea. Results: FPS achieved significantly higher clearance for all measured protein-bound and water-soluble markers. This resulted in significantly higher reduction ratios for FPS compared to AD. Unconjugated bilirubin, a marker for strongly albumin-bound toxins, was influenced only by FPS. Conclusions: FPS provided a higher delivered treatment dose than a matching treatment with AD. Reduction ratios of bilirubin and urea should be reported in clinical studies on liver dialysis, since delivered dose is likely to be linked to the clinical effectiveness of extracorporeal liver support therapies.