Nephrologie & Therapeutique最新文献

Introduction

Since 2012, a deceased donor kidney transplant program exists for dialysis patients living in New-Caledonia in collaboration with Royal Prince Alfred Hospital in Sydney, Australia. This program has reduced the time spent out-of-territory for a renal transplantation and has reduced the economic burden of end stage renal disease in New-Caledonia. We have realised a photography of kidney transplants evaluation for patients in peritoneal dialysis in New-Caledonia and Wallis and Futuna. The first aim was to describe access to kidney transplants evaluation for dialysis patients. A second aim was to compare patients with a conformed kidney transplant evaluation and patients without transplant evaluation with no obvious reasons identified.

Method

All patients in peritoneal dialysis in New-Caledonia and Wallis and Futuna at the 2018, 31^st july were included. A standardised form was filled by two nephrologists. The computerised shared medical record was used to collect information. A kidney transplant evaluation was adequate for patients registered on transplant waiting list, patients with medical contraindications identified or patients with evaluation exams begun less than 6 months.

Results

In total, 61 patients were included. The average age was 62 years old. The chronic kidney disease care average time was 6.7 years and the dialysis average time was 2.0 years. Among them, 11 (18 %) were registered on the waiting list, 26 (43 %) had at least one kidney transplant medical contraindication, 3 (5 %) had begun transplant exam since less than 6 months and 21 (34 %) had no transplant exam begun or transplant exam begun since more than 6 months without medical contraindication identified. Among those 21 patients, the three most common reasons were a faulty programming transplant exam (67 %; n = 14), a remote living place (48 %; n = 10) and an intercurrent health event (29 %; n = 6). Among patients living in Noumea and suburbs, 74 % had a conformed transplant evaluation against 44 % in patients living outside Noumea and suburbs (P = 0.058). Nearly one in two patients not on the waiting list had have no information about kidney graft or the information was not recorded in the medical record.

Conclusion

This study showed two main factors of a non-conformed transplantation evaluation: living outside Noumea and suburbs and a non-efficient planning of pre-transplant assessment exams. There is also a lack of information to the patient. These risk factors for late registration and non-registration must be considered by the healthcare teams. This study will provide a point of reference to assess the impact of actions to improve access to renal transplantation deployed in New-Caledonia.

Introduction

Peripheral neuropathies, in hemodialysis patients, are frequent.

Objective

To study peripheral neuropathies in the population of chronic hemodialysis patients in Benin.

Methods

This was a descriptive and analytical cross-sectional study conducted from April 1^st to July 31^st, 2017 in the hemodialysis units of the two public dialysis centers in Benin. Recruitment was exhaustive with inclusion of all patients with hemodialysis for more than 3 months, aged at least 18 years and consenting. The diagnosis of peripheral neuropathy was based on the presence of sensory-motor and/or vegetative disorders associated with amyotrophy, abolition or reduction of osteotendinous reflexes and absence of central signs.

Results

A total of 189 hemodialysis patients were included in the two public hemodialysis centers of Benin, 180 at the CNHU-HKM and 9 at the CHUD/BA. The mean age was 50.23 ± 13.31 years with extremes from 20 to 85 years and a sex ratio of 1.59. The overall frequency of peripheral neuropathy was 59.26%, including polyneuropathies (72.32%), unifocal mononeuropathies (10.71%), polyradiculoneuropathies (9.82%), and multiple mononeuropathies (7.14%). The associated factor in multivariate analysis was socioeconomic level (P = 0.001; OR 39.41; 95% CI 4.81–322.64).

Conclusion

Peripheral neuropathy is frequent in chronic hemodialysis patients in Benin, requiring early detection and management.

Introduction

Lenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically.

Case presentation

We report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy.

Conclusion

Lenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management.

Introduction

Screening for neoplasms and vascular calcifications is a key step before kidney transplantation. American, European and French recommendations diverge on the imaging assessment to be carried out in this context.

Method

We carried out a retrospective single-center study including patients who underwent imaging for kidney transplantation between the 01/01/2011 and the 12/31/2018. The neoplastic pathologies and vascular calcifications discovered on this assessment were noted.

Results

We included 579 patients: 293 performed a thoracic CT scan, 579 an abdominopelvic CT scan. The imaging work-up revealed 5 malignant thoracic tumors, 14 malignant abdominal tumors and 140 significant calcifications of the external iliac axes. All malignant chest tumors were found in patients with estimated smoking greater than or equal to 30 PY.

Discussion

Like the American recommendations, our results are in favor of performing a chest computed tomography in patients with smoking greater than or equal to 30 PY. Contrary to American and European recommendations, our results are in favor of performing an abdominopelvic tomodensitometry in all patients.

Conclusion

Screening for vascular calcifications and neoplasms in kidney transplant candidates should include routine abdominopelvic CT and chest CT for smoking greater than or equal to 30 PY.

Leishmaniasis is a zoonosis acquired from the bite of a sandfly that introduces the amastigote forms of leishmania into the bloodstream. It is a frequent infection in the countries of the Mediterranean basin and in Tunisia, where it is rife in an endemo-epidemic mode. However, it is rare after kidney transplantation. It constitutes a challenge due to the diagnostic difficulty, the variability and the polymorphism of the clinical picture in immunocompromised patients. We report seven observations of cutaneous leishmaniasis after kidney transplantation through which we try to identify diagnostic and therapeutic difficulties.

Introduction

Urinary lithiasis is a very common condition. The morpho-constitutional analysis of urinary stones is important for etiological diagnosis. It guides the explorations and the specific management. Type IV_a2 stones are rare, have particular morphology and correspond to very targeted pathologies. We propose to report our cases of patients diagnosed with type IV_a2 urinary lithiasis.

Methods

Our retrospective work focused on three cases of patients with the morphological type of renal lithiasis IV_a2, collected between 2008 and 2020 in the Medicine A Department of Charles Nicolle Hospital in Tunis.

Results

All three patients were female; average age 37.6 years. The clinical symptomatology was identical marked by renal colic with recurrent episodes. The presence of a type IV_a2 stone, isolated or associated with other components, guided the etiological investigation to look for a secondary or primary cause of distal renal tubular acidosis. We retained the diagnosis of a primary hyperparathyroidism in one case and a primary Gougerot-Sjögren's syndrome in the second case, and probable in the last case.

Conclusion

Determination of urolithiasis nature (morphological and chemical), although carried out late, was of major interest to us and allowed us to make the diagnosis of distal tubular acidosis.

Introduction

The possibility of indirect linkage between data from the French REIN registry and data from the National Health Data System makes it possible to enhance knowledge of the care pathway of patients with severe kidney disease. Taking an interest in hospitalizations makes it possible to understand the burden of this disease, both for patients, in terms of comorbidities, complications and quality of life but also for society in terms of care load, need for organization of the care offer and costs.

Methods

Patients on dialysis in 2019 were identified from REIN. The information on hospital stays comes from an extraction of the National Health Data System linked with REIN. The hospitalization rate corresponds to the number of hospital stays over the period, relative to the number of people at risk on dialysis over the period.

Results

After excluding dialysis sessions, 36,962 patients had a hospital stay in 2019: 36,738 in medicine, surgery, obstetrics, 2863 in rehabilitation, 531 in home hospitalizations and 201 in psychiatry facilities. This represents a total of 146,743 stays, including 140,372 in medicine, surgery, obstetrics. The hospitalization rate in medicine, surgery, obstetrics is 259 stays for 100 person-years. The reasons vary according to age, type of hospitalization (with or without overnight stays) and mode of discharge (home, death or transfer). The median amounts for a stay vary from €7920 in rehabilitation to €719 in medicine, surgery, obstetrics without overnight stay. Due to the volumes, stays for cardiovascular pathology represent a high total amount over the year. Hospitalizations for infection have significant median costs.

Discussion and conclusion

The results presented in this article confirm the important place of hospitalization in the trajectory of dialysis patients. Hospitalizations in medicine, surgery, obstetrics represent 96% of hospitalizations. For the first time, this study shows the very low place of hospitalizations in psychiatry and rehabilitation facilities.