Prevalence and Etiologies of Obstructive Renal Failure in the Nephrology Department of the University Hospital Center of Point G, Bamako, Mali

Introduction: Obstructive renal failure (ORF) or obstructive uropathy is defined by the simultaneous presence of impaired renal function and urinary excretory tract dilatation on medical imaging. It accounts for 2% to 10% of the causes of acute renal failure (ARF). Objective: To determine the prevalence and etiologies of ORF in the nephrology department of the University Hospital Center of Point G. Methodology: This was a descriptive study with retrospective data collection conducted from January 1, 2017 to June 30, 2018. All patients hospitalized with renal failure due to urinary tract obstruction were included. The parameters studied were age, gender, etiology, type of renal impairment, procedures performed, surgical outcomes of the procedure, pre-and post-management creatinine levels. Information on these clinical and paraclinical variables was collected from individual hospitalization and patient follow-up records. Results: Among 1133 patients, 83 had obstructive renal failure, a prevalence of 7.32%. The sex ratio was 1.86. The mean age was 48.99 ± 6.81 years with extremes of 7 and 102 years. Signs suggestive of lower urinary tract obstruction were, in order of frequency: dysuria (50.6%), urinary burns (44.6%), urinary frequency (44.6%), pollakiuria (44.6%), macroscopic hematuria (25.3%), low back pain (21.6%), total anuria (18.1%). The etiologies were dominated by lithiasis 36 cases (43.4%), tumours 32 cases (38.55%) followed by sequelae of bilharziasis 12 cases (14.50%). Conclusion: Obstructive renal failure is becoming more and more common. The etiology is essentially of lithiasic and tumor origin. It must be treated early to allow total or partial recovery of renal function.

Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Bamako, Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. Conclusion: Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.

Interest of Beta-2-Microglobilin Plasma Assay in Iterative Haemodialysis in the Nephrology and Haemodialysis Department of University Teaching Hospital of Point G, Bamako, Mali

Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. Materials and Methods: This was a prospective and descriptive study from January 1st, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. Results: We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P < 0.001). The mortality rate was 6%. Conclusion: Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.

Diabetic Foot: Epidemiological and Clinical Aspects in the Department of Medicine and Endocrinology of the Hospital of Mali, Mali

Introduction: Diabetes is a heterogeneous group of metabolic diseases characterized by chronic hyperglycemia resulting from a defect in the secretion and/or action of insulin, diagnosed by the observation of high levels of glucose in the blood, responsible in the long term for vascular and nervous complications. The diabetic foot is the set of pathological manifestations affecting the foot in relation to the diabetic disease. Approximately 5% of diabetics present a chronic lesion of the foot. Objective: To describe the epidemiological and clinical aspects of the diabetic foot in the medicine/endocrinology department of the Mali hospital. Methodology: This was a retrospective descriptive study from November 2011 to December 2015. It focused on diabetic patients hospitalized in the department with a foot wound and aged 14 years and over. Results: The study involved 94 patients out of 828 hospitalized, a prevalence of 11.35%. Our series included 36 (38.3%) men and 58 (61.7%) women, i.e. a sex ratio of 0.61%. The mean age was 42.66 years with extremes of 14 and 81 years. Type 2 diabetes was present in 95% of the patients with a duration of evolution of more than 5 years in 60.6% of the cases. The mechanism of occurrence of the wounds was minor trauma in 54 cases (57.4%). Self-medication was the primary treatment in 70 patients (74.5%). More than 50% of the patients wore unsuitable footwear. Clinical and para-clinical examinations revealed isolated neuropathy in 37 cases (39.4%), necrotic wound in 37 cases (39.19%), poor glycemic control: HbA1c > 7% (98.9%), absence of osteitis (57.4%), normal Doppler ultrasound 45 cases (45.7%), stenosing arteriopathy 11 cases (22.3%), non-stenosing 3 cases (20.2%), germs present 56 cases (59.6%) including 21 cases (22.4%) of Staphylococcus aureus. Conclusion: Diabetes and diabetic foot constitute a real public health problem. They are responsible for dreadful and sometimes disabling complications. Its management is multidisciplinary and requires significant financial resources.

Kidney Damage during Sharp’s Syndrome: About Two Cases

Context: The coexistence in the same patient of a mixed connectivitis or Sharp’s syndrome is a rare eventuality. Objective: To underline the presence of this mixed connectivitis in our practice, whose prevalence remains unknown, particularly in Africa and more precisely in Mali. Case Presentations: We report two cases of Sharp’s syndrome in a 48-year-old man and a 40-year-old woman with impaired renal function. The picture achieved associated massive proteinuria, hypoalbuminemia, moderate renal failure and edematous syndrome in men. In women, the picture was associated with accelerated to malignant hypertension and severe renal failure. There were no osteoarticular manifestations and the diagnosis of Sharp’s syndrome was based on the presence of high levels of antibodies to U1RNP. Therapeutic management has been that of predominantly associated connective tissue disease (systemic lupus erythematosus). Conclusion: Mixed connectivitis or Sharp’s syndrome is increasingly recognized as a separate entity thanks to advances in molecular biology. Its prevalence is low in sub-Saharan African countries with renal disease that manifests itself as proteinuria or nephrotic syndrome associated with microscopic hematuria, renal failure, and hypertension. This renal impairment is more likely to occur in severe forms of the disease.