The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA)/European Society of Hypertension (ESH) recommends out-of-center blood pressure measurements, self-blood pressure ...measurement or ambulatory blood pressure measurement in dialysis patients. However, the feasibility of out-of-center blood pressure measurements in routine care is not known. The objective of our study was to quantify it as "a priori" i.e. the percentage of hemodialysis to whom out-of-center blood pressure measurements can be proposed and who accept it, as "a posteriori", i.e. the percentage of out-of-center blood pressure measurements made and valid. A systematic out-of-center blood pressure measurements program was implemented from April to October 2019 in our chronic hemodialysis structures. It was proposed to each dialysis patient to carry out after education, an self-blood pressure measurement (Omron M3®), from 2 measurements, to 1 to 2minutes interval, mornings and evenings of 6days without dialysis (validity: 15 measures). Apart from arrhythmic patients, to all patients "not eligible" for self-blood pressure measurement (visually impaired, hemiplegic, neuropsychological disorders, language barrier), a 44-hour ambulatory blood pressure measurement (Microlife WatchBP 03®) was proposed separating 2 hemodialysis sessions; measures every 15minutes from 7 a.m. to 10 p.m. and 30minutes from 10 p.m. to 7 a.m. (validity: 40 measurements/day and 14/night). This is a study evaluating practices recommended for routine care in 18-year-old hemodialysis, having given their consent to the collection and analysis of the data. One hundred twenty nine patients were treated with chronic hemodialysis in our structures during the out-of-center blood pressure measurements campaign. Out-of-center blood pressure measurements could not be done in 21 patients (4 deceased, 2 transplanted and 4 absent before evaluation; 7 arrhythmics; 3 refusals and 1 multiple-disabled). Of these 108 patients (sex ratio 1.25; 69.3±13.5 years), 23 were ineligible for self-blood pressure measurement (visually impaired, neuro- and/or psychological disorders, language barrier). Due to 4 self-blood pressure measurement failures, the feasibility of the self-blood pressure measurement (n=81/129) is 62.8 % (CI95% 54.2-70.7). Of the 24 ambulatory blood pressure measurements performed (23 among those not eligible for self-blood pressure measurement and 1 failure of self-blood pressure measurement), 19 were valid. The "a posteriori" feasibility of out-of-center blood pressure measurements (n=100/129) is 77.5 % (CI95% 69.6-83.4). The feasibility of out-of-center blood pressure measurements in hemodialysis patients is good, making the application of the recommendations possible.
The prevalence of chronic renal failure (CRF) in sickle cell disease (SCD) patients could vary from one country to another depending on the modalities of management. The aim of the present study was ...to appreciate the epidemiology of CRF in SCD patients from black Africa in order to search for promoting factors. One hundred SCD adult patients have been considered for the study. The glomerular filtration rate (GFR) has been estimated according to the CKD-EPI formula. Three groups of patients have been identified according to the value of their GFR. The mean age of the patients was 30.84±8.26 years. Male gender has represented 51% of the study population. The mean GFR value was 175.4±86.2 mL/min/1.73 m(2). The prevalence of CRF was 11%. About 3% of them had severe CRF. Subjects with normal GFR were 20%. Subjects with glomerular hyperfiltration (HF) were 69%. By univariate analysis, when subjects with HF were compared with those presenting normal GFR, the following factors have appeared to be significantly associated: female gender (female 60.9% versus male 39.1%; P<0.01), weight <60 kg (weight <60 kg; 53.67±9.45 kg versus weight >60 kg; 59.9±9.41 kg; P<0.008), age <30 years (younger age 29.36±7.9 years versus older age 35.14±8.02 years; P<0.001), lower hemoglobin value (9.38±2,3 g/dL versus 10.33±2.61 g/dL; P<0.04). By logistic regression analysis, age <30 years (age >30 years; OR=0.12 CI95% 0.03-04; P<0.001), female gender (male gender; OR=0.17 0.04-0.64; P<0.01), weight <60 kg (weight >60 kg; OR=0.19 CI95% 0.05-0.72; P<0.01) were associated with HF. By univariate analysis, when subjects with CRF were compared with those presenting normal GFR, a lower hemoglobin value was significantly associated with CRF (7.92±2.7 g/dL versus 10.43±2.5 g/dL; P<0.009). There was a trend for subjects not being under maintenance therapy to more experience CRF (36.4% versus 70%; P<0.07). By logistic regression analysis, only a low hemoglobin value was associated to CRF (higher hemoglobin level; OR=0.55 0.20-6.3; P<0.01). In total, CRF and HF are frequent complications in SCD adult patients from black Africa.
Kidney transplantation from living kidney donors (LKDs) because of its good results represents a good option for the treatment of patients with the end-stage renal disease. Kidney donation is a ...relatively safe procedure according to several studies. We conducted this cross-sectional study in order to describe the demographic, clinical, and renal outcome of LKD in Côte d'Ivoire. From March to November 2014, LKD residing in Côte d'Ivoire at the time of investigation and having donated the kidney more than one year ago were considered for the study. They were evaluated through a questionnaire. Of the 29 LKD listed in Côte d'Ivoire, only 14 responded to the questionnaire. The mean age at donation was 43.29 ± 9.12 years (27-59) and 10 of the LKD were women. Eight were related to the recipients, and the remaining were spouses. Laparoscopic nephrectomy was performed in nine LKD. The left kidney was harvested in ten cases. The main motivation for donation in all donors was the desire to save a life. At the time of the survey, the average duration after the donation was 4.57 ± 2.56 years (1-8). Only five donors had a regular nephrological follow-up. Hypertension was observed in one donor, seven had significant proteinuria, and six had glomerular filtration rate <60 mL/min but >30 mL/min. Significantly higher proteinuria was noted in donors under 45 years as compared to those over 45 years (0.43 ± 0.17 g/24 h vs. 0.22 ± 0.03 g/24 h, P = 0.01). Our study suggests that renal disease in LKD in Côte d'Ivoire is low after a mean follow-up period of four years. A donor registry is essential to ensure better follow-up of donors in order to detect potential adverse effects of kidney donation in the medium as well as in the long-term.
Nephrology is a new discipline in sub-Saharan Africa. For a better management of various nephropathies, histological data are necessary in terms of diagnosis, therapy as well as prognosis. However, ...performing renal needle biopsy is very challenging. We are reporting inadequacy of human, material and financial resources for histological data collection through a case of 21-yearold patient with lymphoma complicated by acute renal failure (ARF).
The incidence of uncontrolled hypertension (HTN+) in CKD in nephrology could reflect the quality of the management of the patients in a primary care setting. The aim of the present study was to ...identify factors associated with HTN+ in CKD in order to elaborate a prevention strategy for the health professionals. A retrospective analysis of 479 incidents patients has been performed from 2012/1st to 2012/12th. Sixty-two percent had CKD HTN+. Eighty percent were at stages 4 and 5. Mean value of SBP was 166.5±32 mmHg and 96±27.3 mmHg for DBP. Mean age was 48.2±14.6 years. Mean GFR was 17.4±17.1 mL/min and no difference found between groups (17.4±17.6 mL/min in CKD HTN+ versus 17.5±16.3 mL/min in CKD HTN-, P < 0.9). Alcohol consumption was more in CKD HTN+ as compared to CKD HTN-, but not different between groups (37.2% in CKD HTN+ versus 27.6% in CKD HTN-; P < 0.09). Patients who were taking antihypertensive drugs were significantly more in the CKD HTN- than CKD HTN+ (22% in CKD HT+ versus 41.1% in CKD HTN-; P < 0.0001). Factors associated with HTN+ in CKD were antihypertensive therapy (OR = 0.39; CI 0.20-0.75; P < 0.005); alcohol (OR = 2.19; CI 1.09-4.37; P < 0.02). BP was similar in HN and non-HN patients (173.0±26.9 mmHg versus 174.7±33.7 mmHg; P = 0.75). But kidney function was a little better in HN (16.9±17.7 mL/min and 20.95±18.5 mL/min; P < 0.1). Factors associated positively with HN/HTN+ were: history of HTN and age. Factors associated negatively with HN/HTN+ were: history of diabetes and CKD stage.
L’incidence de l’hypertension artérielle non contrôlée (HTA+) au cours de la maladie rénale chronique (MRC) en néphrologie peut refléter l’efficacité ou non de la prise en charge en amont de cette ...affection. L’objectif de cette étude était d’identifier les facteurs associés à une HTA+ lors de la MRC afin de proposer une stratégie de prévention. Une étude rétrospective de 479 patients incidents admis en service de néphrologie a été réalisée de janvier à décembre 2012. Parmi les patients, 62 % avaient une MRC HTA+. Ils étaient vus à un stade tardif. La pression artérielle systolique (PAS) était de 166,5±32mmHg et la pression artérielle diastolique (PAD) de 96±27,3mmHg. L’âge moyen était de 48,2±14,6 années. Les sujets MRC HTA+ étaient significativement plus âgés (50,3±15 années contre 46,9±14,3 années ; p<0,01). Le débit de filtration glomérulaire (DFG) moyen était de 17,4±17,1 mL/min, identique entre les groupes (17,4±17,6 mL/min MRC HTA+ et 17,5±16,3 mL/min MRC HTA– ; p < 0,9). La consommation d’alcool était notable chez les MRC HTA+ (37,2 % MRC HTA+ versus 27,6 % MRC HTA– ; p < 0,09). Les sujets qui prenaient un antihypertenseur étaient en nombre significativement plus important chez les MRC HTA– (22 % MRC HTA+ et 41,1 % MRC HTA– ; p < 0,0001). Les facteurs associés à une MRC HTA+ étaient un traitement antihypertenseur et la consommation d’alcool. La pression artérielle était similaire pour les néphropathies hypertensives (HTN+) et non hypertensives (HTN–) (173,0±26,9 mmHg versus 174,7±33,7 mmHg ; p = 0,75). Mais la fonction rénale est non significativement meilleure dans les HTN+ (16,9±17,7 mL/min et 20,95±18,5 mL/min ; p < 0,1). Les antécédents d’HTA et l’âge sont positivement associés à l’HTA+ des HTN+. Les antécédents de diabète et un stade MRC sont négativement associés à l’HTA+HTN+.
The incidence of uncontrolled hypertension (HTN+) in CKD in nephrology could reflect the quality of the management of the patients in a primary care setting. The aim of the present study was to identify factors associated with HTN+ in CKD in order to elaborate a prevention strategy for the health professionals. A retrospective analysis of 479 incidents patients has been performed from 2012/1st to 2012/12th. Sixty-two percent had CKD HTN+. Eighty percent were at stages 4 and 5. Mean value of SBP was 166.5±32mmHg and 96±27.3mmHg for DBP. Mean age was 48.2±14.6years. Mean GFR was 17.4±17.1 mL/min and no difference found between groups (17.4±17.6 mL/min in CKD HTN+ versus 17.5±16.3 mL/min in CKD HTN–, P < 0.9). Alcohol consumption was more in CKD HTN+ as compared to CKD HTN–, but not different between groups (37.2% in CKD HTN+ versus 27.6% in CKD HTN–; P < 0.09). Patients who were taking antihypertensive drugs were significantly more in the CKD HTN– than CKD HTN+ (22% in CKD HT+ versus 41.1% in CKD HTN–; P < 0.0001). Factors associated with HTN+ in CKD were antihypertensive therapy (OR = 0.39; CI 0.20–0.75; P < 0.005); alcohol (OR = 2.19; CI 1.09–4.37; P < 0.02). BP was similar in HN and non-HN patients (173.0±26.9 mmHg versus 174.7±33.7 mmHg; P = 0.75). But kidney function was a little better in HN (16.9±17.7 mL/min and 20.95±18.5 mL/min; P < 0.1). Factors associated positively with HN/HTN+ were: history of HTN and age. Factors associated negatively with HN/HTN+ were: history of diabetes and CKD stage.
Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the ...past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently.
The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because ...of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.
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