Background: Detection of subclinical rejections has been a real challenge for pediatric nephrology. We hypothesized that donor-derived cell-free DNA (dd-cfDNA) in combination with serum creatinine levels and a kidney biopsy provide a “gold-standard” for clinicians so that treatment for subclinical rejection can be initiated appropriately. Design/Methods: We performed a two-year cohort study on total (n=5) pediatric patients aged 5-19 years who received kidney transplant within 2015-2019. Blood was collected for dd-cfDNA, i.e., AlloSure, at the time of scheduled surveillance visits or when clinically indicated. During the study period, serum creatinine and tacrolimus were measured as well. For diagnosing subclinical rejection, dd-cfDNA was divided into 3 groups: low dd-cfDNA <0.5%, high dd-cfDNA 0.5%-1%, very high dd-cfDNA>1%. A kidney biopsy was performed in one patient who had very high dd-cfDNA 2.3% (nl<0.2%), high serum creatinine (sCr 1.17 mg/dL, baseline 0.5 mg/dL), in the absence of tacrolimus levels. Kidney biopsy revealed acute cellular rejection (ACR) type 1A. Patient received intravenous immune globulin (IVIG) 2 g/kg x 1, IV pulses with methylprednisolone 20 mg/kg/dose x 3, followed by a steroid taper over one month. Her serum creatinine remains normal since. Whereas in the other 4 patients, dd-cfDNA did not show significant change, no subclinical rejection was observed. Conclusion: dd-cfDNA in combination with serum creatinine levels and a kidney biopsy can be considered the “gold standard” which improves early diagnostic utility for subclinical rejection.
{"title":"Role of dd-cfDNA in Detection of Subclinical Rejection in Pediatric Kidney Transplant Recipients","authors":"Mendel R, Benchimol C, W. X.","doi":"10.16966/2380-5498.238","DOIUrl":"https://doi.org/10.16966/2380-5498.238","url":null,"abstract":"Background: Detection of subclinical rejections has been a real challenge for pediatric nephrology. We hypothesized that donor-derived cell-free DNA (dd-cfDNA) in combination with serum creatinine levels and a kidney biopsy provide a “gold-standard” for clinicians so that treatment for subclinical rejection can be initiated appropriately. Design/Methods: We performed a two-year cohort study on total (n=5) pediatric patients aged 5-19 years who received kidney transplant within 2015-2019. Blood was collected for dd-cfDNA, i.e., AlloSure, at the time of scheduled surveillance visits or when clinically indicated. During the study period, serum creatinine and tacrolimus were measured as well. For diagnosing subclinical rejection, dd-cfDNA was divided into 3 groups: low dd-cfDNA <0.5%, high dd-cfDNA 0.5%-1%, very high dd-cfDNA>1%. A kidney biopsy was performed in one patient who had very high dd-cfDNA 2.3% (nl<0.2%), high serum creatinine (sCr 1.17 mg/dL, baseline 0.5 mg/dL), in the absence of tacrolimus levels. Kidney biopsy revealed acute cellular rejection (ACR) type 1A. Patient received intravenous immune globulin (IVIG) 2 g/kg x 1, IV pulses with methylprednisolone 20 mg/kg/dose x 3, followed by a steroid taper over one month. Her serum creatinine remains normal since. Whereas in the other 4 patients, dd-cfDNA did not show significant change, no subclinical rejection was observed. Conclusion: dd-cfDNA in combination with serum creatinine levels and a kidney biopsy can be considered the “gold standard” which improves early diagnostic utility for subclinical rejection.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahmoud Nb, Letaief A, Saad J, Salem Mb, Salah Mb, Hamouda M, Aloui S, Skhiri H
The first site of insertion of central venous catheters for hemodialysis is usually the right jugular vein, and in some cases we find it necessary to insert catheters into the left jugular vein. In our case, we describe the case of a patient aged 80 years, which required the placement of a tunneled catheter for hemodialysis at the level of the left jugular vein which was complicated by a malposition of the catheter at the level of the mediastinum causing a breach at the level of the left brachiocephalic venous trunk, requiring withdrawal of the catheter without incident. In order to avoid this type of complication, we recommend a chest X-ray after the insertion to verify the correct position of the catheter.
{"title":"Malposition of a Tunneled Cuffed Hemodialysis Catheter: Where Did the Catheter Go?","authors":"Mahmoud Nb, Letaief A, Saad J, Salem Mb, Salah Mb, Hamouda M, Aloui S, Skhiri H","doi":"10.16966/2380-5498.232","DOIUrl":"https://doi.org/10.16966/2380-5498.232","url":null,"abstract":"The first site of insertion of central venous catheters for hemodialysis is usually the right jugular vein, and in some cases we find it necessary to insert catheters into the left jugular vein. In our case, we describe the case of a patient aged 80 years, which required the placement of a tunneled catheter for hemodialysis at the level of the left jugular vein which was complicated by a malposition of the catheter at the level of the mediastinum causing a breach at the level of the left brachiocephalic venous trunk, requiring withdrawal of the catheter without incident. In order to avoid this type of complication, we recommend a chest X-ray after the insertion to verify the correct position of the catheter.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 61-year-old man was admitted to our hospital on September 2021 because of a three-month history of fatigue, night sweats, and weight loss. The patient had been diagnosed with organized pneumonia and was treated with methyl prednisolone at a local hospital. One week before presentation to our hospital, he had developed fever, cough, sputum and shortness of breath. Upon admission to our hospital, sputum acid-fast resistant bacteria (ARB) and urine ARB were positive and mycobacterium tuberculosis was cultured. With the diagnosis of drug-sensitive pulmonary and urinary tuberculosis, treatment consisting of isoniazid, rifampicin, ethambutol and pyrazinamide was started. After two months, his symptoms had not improved and he developed nausea and vomiting. At the next visit to our hospital, his renal function tests were further increased. He was taken for emergency dialysis. Diagnosis of interstitial nephritis was made by kidney biopsy, which was considered to have developed due to the use of rifampicin. Rifampicin was discontinued and methyl prednisolone was added. The new drug regimen was arranged as isoniazid, moxifloxacin, ethambutol, pyrazinamide and cycloserine. Cycloserine was discontinued due to tremors and prothionamide was started. When drug-induced hepatitis developed, his subsequent treatment was changed to isoniazid, levofloxacin, ethambutol, and pyrazinamide. The patient was treated with methyl prednisolone for two months. Currently, he has been taking the treatment stated above for 4 months without any problems and it is scheduled to be completed in 12 months.
{"title":"Successful Treatment of Tuberculosis Combined With Rifampicin Induced Interstitial Nephritis: A Case Report","authors":"Katran Zy, Akyıldız Ab, Babalık A","doi":"10.16966/2380-5498.235","DOIUrl":"https://doi.org/10.16966/2380-5498.235","url":null,"abstract":"A 61-year-old man was admitted to our hospital on September 2021 because of a three-month history of fatigue, night sweats, and weight loss. The patient had been diagnosed with organized pneumonia and was treated with methyl prednisolone at a local hospital. One week before presentation to our hospital, he had developed fever, cough, sputum and shortness of breath. Upon admission to our hospital, sputum acid-fast resistant bacteria (ARB) and urine ARB were positive and mycobacterium tuberculosis was cultured. With the diagnosis of drug-sensitive pulmonary and urinary tuberculosis, treatment consisting of isoniazid, rifampicin, ethambutol and pyrazinamide was started. After two months, his symptoms had not improved and he developed nausea and vomiting. At the next visit to our hospital, his renal function tests were further increased. He was taken for emergency dialysis. Diagnosis of interstitial nephritis was made by kidney biopsy, which was considered to have developed due to the use of rifampicin. Rifampicin was discontinued and methyl prednisolone was added. The new drug regimen was arranged as isoniazid, moxifloxacin, ethambutol, pyrazinamide and cycloserine. Cycloserine was discontinued due to tremors and prothionamide was started. When drug-induced hepatitis developed, his subsequent treatment was changed to isoniazid, levofloxacin, ethambutol, and pyrazinamide. The patient was treated with methyl prednisolone for two months. Currently, he has been taking the treatment stated above for 4 months without any problems and it is scheduled to be completed in 12 months.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: End-stage renal disease (ESRD) and renal replacement therapy options are associated with malnutrition, which occurs in 30-50% of patients. Suboptimal nutritional status and physical inactivity are common in peritoneal dialysis patients also and are consequences of the restrictive diet, appetite loss, and poor physical fitness. Materials and methods: This single-center observational study aimed to analyze the dietary intake, body composition, and physical activity of 19 peritoneal dialysis (PD) patients. Dietary assessment was performed with a three-day 24-hour dietary recall, while nutritional status was assessed with body composition measurements. Patients’ physical performance was assessed with a handgrip test and a sit-stand test. Each value was expressed as a percentage or mean ± SD. Continuous variables between normal values and of study values were compared using paired t-tests and Wilcoxon signed ranks test. A two-tailed P value <0.05 was considered statistically significant. Results: The mean caloric intake of the 19 patients was 1545 ± 295 kcal/day (21.4 kcal/kg BW/day), and the mean protein intake was 0.8 g/kg BW/ day. The mean value of body mass index was 24.4 ± 2.9 kg/m2 , phase angle was 5.2 ± 0.9, lean tissue index was 14.5 ± 2.8 kg/m2 and adipose tissue index was 9.3 ± 3.6 kg/m2 . The results of the handgrip test and the sit-to-stand test showed muscular weakness associated with low caloric intake. Conclusion: In our PD patients, average energy and protein intakes were inadequate according to dietary recommendations, which are related to reduce muscle strength among observed patients and a poor physical activity profile. The overall approach of nutritional counseling is necessary to improve the nutritional status of patients.
{"title":"Diet Patterns, Nutrition Status and Physical Activity in Patients on Peritoneal Dialysis","authors":"Knap B, Veceric Haler Z","doi":"10.16966/2380-5498.233","DOIUrl":"https://doi.org/10.16966/2380-5498.233","url":null,"abstract":"Background: End-stage renal disease (ESRD) and renal replacement therapy options are associated with malnutrition, which occurs in 30-50% of patients. Suboptimal nutritional status and physical inactivity are common in peritoneal dialysis patients also and are consequences of the restrictive diet, appetite loss, and poor physical fitness. Materials and methods: This single-center observational study aimed to analyze the dietary intake, body composition, and physical activity of 19 peritoneal dialysis (PD) patients. Dietary assessment was performed with a three-day 24-hour dietary recall, while nutritional status was assessed with body composition measurements. Patients’ physical performance was assessed with a handgrip test and a sit-stand test. Each value was expressed as a percentage or mean ± SD. Continuous variables between normal values and of study values were compared using paired t-tests and Wilcoxon signed ranks test. A two-tailed P value <0.05 was considered statistically significant. Results: The mean caloric intake of the 19 patients was 1545 ± 295 kcal/day (21.4 kcal/kg BW/day), and the mean protein intake was 0.8 g/kg BW/ day. The mean value of body mass index was 24.4 ± 2.9 kg/m2 , phase angle was 5.2 ± 0.9, lean tissue index was 14.5 ± 2.8 kg/m2 and adipose tissue index was 9.3 ± 3.6 kg/m2 . The results of the handgrip test and the sit-to-stand test showed muscular weakness associated with low caloric intake. Conclusion: In our PD patients, average energy and protein intakes were inadequate according to dietary recommendations, which are related to reduce muscle strength among observed patients and a poor physical activity profile. The overall approach of nutritional counseling is necessary to improve the nutritional status of patients.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahoungou Gh, E. Dt, Clauvel Niama A, Ngoma P, Gandzali-Ngabé E, Ambounou F, Ndinga B, Fouda-Embana H, Loumingou R
Objective: Evaluate the cost of CRD (Chronic Renal Disease) management at the dialysis stage, in a public hospital in Congo Brazzaville. Patient and method: It was a longitudinal and descriptive study of 7 months, which took place over the period from February 1 to August 31, 2022, in the Nephrology-Hemodialysis department of HGELBO It focused on 35 patients identified in a way exhaustive. Socio-demographic and clinical information and expenses incurred over 3 months were collected from medical records and during individual interviews using pre-established survey sheets. SPSS 22 software was used for data analysis and processing. Results: Of the 35 patients, 26 were men, i.e., a sex ratio of 2.9. The mean age was 51.2 ± 12.3 years. Only 3 patients (9%) had health insurance and 52.2% of working patients had lost their job after starting dialysis. The median monthly cost of a chronic HD patient was 630,800 CFA Francs. Direct expenses amounted to 589,367 CFA Francs, they represented 93.4% of the total cost and are dominated by the cost of dialysis consumables (56.9%). The monthly median indirect cost was evaluated at 60,000 CFA Francs and represents 9.2% of the overall cost. The average cost of an HD session was evaluated at 31,219.4 CFA Francs. The total annual cost of the patient in HD maintenance was estimated at 7,569,600 CFA Francs. Conclusion: The cost of caring for HD patients is high. The cost of managing CR at the dialysis stage is beyond the reach of most patients, so there is a need to implement strategies to prevent and manage ESRD in our setting.
{"title":"Cost of Therapeutic Care for Patients on Maintenance Hemodialysis in a Public Hospital in Congo Brazzaville in 2022","authors":"Mahoungou Gh, E. Dt, Clauvel Niama A, Ngoma P, Gandzali-Ngabé E, Ambounou F, Ndinga B, Fouda-Embana H, Loumingou R","doi":"10.16966/2380-5498.241","DOIUrl":"https://doi.org/10.16966/2380-5498.241","url":null,"abstract":"Objective: Evaluate the cost of CRD (Chronic Renal Disease) management at the dialysis stage, in a public hospital in Congo Brazzaville. Patient and method: It was a longitudinal and descriptive study of 7 months, which took place over the period from February 1 to August 31, 2022, in the Nephrology-Hemodialysis department of HGELBO It focused on 35 patients identified in a way exhaustive. Socio-demographic and clinical information and expenses incurred over 3 months were collected from medical records and during individual interviews using pre-established survey sheets. SPSS 22 software was used for data analysis and processing. Results: Of the 35 patients, 26 were men, i.e., a sex ratio of 2.9. The mean age was 51.2 ± 12.3 years. Only 3 patients (9%) had health insurance and 52.2% of working patients had lost their job after starting dialysis. The median monthly cost of a chronic HD patient was 630,800 CFA Francs. Direct expenses amounted to 589,367 CFA Francs, they represented 93.4% of the total cost and are dominated by the cost of dialysis consumables (56.9%). The monthly median indirect cost was evaluated at 60,000 CFA Francs and represents 9.2% of the overall cost. The average cost of an HD session was evaluated at 31,219.4 CFA Francs. The total annual cost of the patient in HD maintenance was estimated at 7,569,600 CFA Francs. Conclusion: The cost of caring for HD patients is high. The cost of managing CR at the dialysis stage is beyond the reach of most patients, so there is a need to implement strategies to prevent and manage ESRD in our setting.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67392052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. G, Mahamat Hissein A, Soukaya B, Hagre Youssouf D, Adneli Alliance T, A. Y, Senoussi C, Fotclossou T
Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease. After about ten years of evolution, it leads to a slow and progressive loss of kidney function eventually causing renal insufficiency and kidney failure. Few data exist on this pathology in Africa and Chad. The objective of this study was to analyze the epidemiological, diagnostic and therapeutic aspects of ADPKD. Methodology: This was a multicenter cross-sectional, descriptive and analytical study conducted over a period of 34 months in two hospitals in N’Djamena, Chad. All patients aged 15 years and above, having a family history of polycystic kidney disease, which were hospitalized or who were coming for consultation that met the unified criteria for ultrasonographic diagnoses (Ravine criteria modified by Pei) of ADPKD were included in the study. The clinical, paraclinical, therapeutic and evolutionary criteria for these patients had been studied. Results: There were a total of 26 cases of polycystic kidney disease that had a hospital prevalence of 1.16%. The average age was 42.4 years with extremes ranging from 15-70 years and a sex ratio of 1.3. The family survey had shown that parental consanguinity was present in 34.6% (n=9). The prevalence of hypertension was 53.8% (n=14). The mean serum creatinine was 45 mg/l with extremes ranging from 4.5 to 274.42 mg/l. It was noted that 65.3% (n=17) had chronic kidney disease with a GFR >30 mL/min/1.73m2 . During diagnosis 26.9% (n=7) had end-stage renal disease (ESRD), while 2 patients progressed to ESRD two years after diagnosis. One patient was hospitalized for chronic hemodialysis. No patient had received a kidney transplant and no patient had undergone a molecular biology and genetics study or had been treated with Tolvaptan. Conclusion: In Chad, the hospital prevalence of ADPKD was 1.16%, affecting young adults (average age of 42.4 years) with a male predominance. Management is usually late and remains limited to symptomatic treatment with complications such as chronic renal failure. Abbreviations: ADPKD: Autosomal Dominant Polycystic Kidney Disease, CRF: Chronic Renal Failure, ESRD: End-Stage Renal Disease, CVA: Cerebro Vascular Accident
{"title":"Autosomal Dominant Polycystic Kidney Disease: An Unknown Disease in Chad","authors":"M. G, Mahamat Hissein A, Soukaya B, Hagre Youssouf D, Adneli Alliance T, A. Y, Senoussi C, Fotclossou T","doi":"10.16966/2380-5498.234","DOIUrl":"https://doi.org/10.16966/2380-5498.234","url":null,"abstract":"Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease. After about ten years of evolution, it leads to a slow and progressive loss of kidney function eventually causing renal insufficiency and kidney failure. Few data exist on this pathology in Africa and Chad. The objective of this study was to analyze the epidemiological, diagnostic and therapeutic aspects of ADPKD. Methodology: This was a multicenter cross-sectional, descriptive and analytical study conducted over a period of 34 months in two hospitals in N’Djamena, Chad. All patients aged 15 years and above, having a family history of polycystic kidney disease, which were hospitalized or who were coming for consultation that met the unified criteria for ultrasonographic diagnoses (Ravine criteria modified by Pei) of ADPKD were included in the study. The clinical, paraclinical, therapeutic and evolutionary criteria for these patients had been studied. Results: There were a total of 26 cases of polycystic kidney disease that had a hospital prevalence of 1.16%. The average age was 42.4 years with extremes ranging from 15-70 years and a sex ratio of 1.3. The family survey had shown that parental consanguinity was present in 34.6% (n=9). The prevalence of hypertension was 53.8% (n=14). The mean serum creatinine was 45 mg/l with extremes ranging from 4.5 to 274.42 mg/l. It was noted that 65.3% (n=17) had chronic kidney disease with a GFR >30 mL/min/1.73m2 . During diagnosis 26.9% (n=7) had end-stage renal disease (ESRD), while 2 patients progressed to ESRD two years after diagnosis. One patient was hospitalized for chronic hemodialysis. No patient had received a kidney transplant and no patient had undergone a molecular biology and genetics study or had been treated with Tolvaptan. Conclusion: In Chad, the hospital prevalence of ADPKD was 1.16%, affecting young adults (average age of 42.4 years) with a male predominance. Management is usually late and remains limited to symptomatic treatment with complications such as chronic renal failure. Abbreviations: ADPKD: Autosomal Dominant Polycystic Kidney Disease, CRF: Chronic Renal Failure, ESRD: End-Stage Renal Disease, CVA: Cerebro Vascular Accident","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury (AKI) affects increasing numbers of hospitalized patients in Central Europe and in the US. Kidney replacement therapy (KRT) becomes mandatory if other strategies fail to prevent patients from systemic intoxication, resistant hyperhydration, or refractory hyperkalemia. The majority of data related to survival rates of AKI subjects that require KRT have been acquired under intensive care conditions. In the current letter to the editor we provide outcome data of all patients with in-hospital diagnosed AKI that received KRT at least once. We retrospectively assessed subjects receiving one or more individual sessions of KRT due to AKI of various etiology. Subjects were partly treated in the ICU or under non-ICU conditions. The in-hospital mortality was 35.4% complete recovery of kidney function occurred in 48.8%. In summary, the mortality of all inhospital AKI subjects is comparable to the mortality of AKI patients in the ICU. In addition, more than 50% do not recovery completely. Therefore, subjects with hospital-acquired AKI and an incident or prolonged need for KRT require the highest attention of nephrologists in general, no matter whether they received intensive care treatment or not.
{"title":"Mortality and Recovery of Kidney Function in Kidney Replacement TherapyRequiring AKI: Data from All Affected In-Hospital Subjects","authors":"Sturzebecher L, Ritter O, Patschan D","doi":"10.16966/2380-5498.236","DOIUrl":"https://doi.org/10.16966/2380-5498.236","url":null,"abstract":"Acute kidney injury (AKI) affects increasing numbers of hospitalized patients in Central Europe and in the US. Kidney replacement therapy (KRT) becomes mandatory if other strategies fail to prevent patients from systemic intoxication, resistant hyperhydration, or refractory hyperkalemia. The majority of data related to survival rates of AKI subjects that require KRT have been acquired under intensive care conditions. In the current letter to the editor we provide outcome data of all patients with in-hospital diagnosed AKI that received KRT at least once. We retrospectively assessed subjects receiving one or more individual sessions of KRT due to AKI of various etiology. Subjects were partly treated in the ICU or under non-ICU conditions. The in-hospital mortality was 35.4% complete recovery of kidney function occurred in 48.8%. In summary, the mortality of all inhospital AKI subjects is comparable to the mortality of AKI patients in the ICU. In addition, more than 50% do not recovery completely. Therefore, subjects with hospital-acquired AKI and an incident or prolonged need for KRT require the highest attention of nephrologists in general, no matter whether they received intensive care treatment or not.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Djidita Hagre Y, M. G, M. Ad, Mahamat Hissein A, Adamou Abbassi M, Senoussi C, A. Y
Introduction: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden and potentially reversible reduction in kidney function, as measured by glomerular filtration rate (GFR) affecting the exocrine functions of the kidney. It engages the short-term vital prognosis and the long-term renal function prognosis. It is an important cause of morbidity and mortality in sub-Saharan Africa. Our objective was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of acute renal failure in children at the Renaissance University Hospital Center and Mother and Child University Hospital in N’Djamena, Chad. Methodology: This was a descriptive and analytical cross-sectional study for six months from March to August 2020. All children aged 1 year to 15 years that were hospitalized in the emergency room of the Mother and Child University Hospital and went for follow-up consultations in the Nephrology and Dialysis Department of the Renaissance University Hospital Center with acute renal failure defined by the KDIGO 2012 criteria were included in the study. The data were analyzed by Excel 2019 and SPSS 18.0 with significance (p<0.05). Results: Thirty children were included in the study with a hospital prevalence of 0.56%. The mean age was 8.33 years with a sex ratio of 3.28. The average consultation time was 10.1 days. Vomiting was the main reason for consultation (46.7%). About 27% of patients had oligoanuria. There were 86% of the cases that were anemic, half of which were severe. Mean serum creatinine was 434.02 µmol/l and the mean urea level was 26.86 mmol/l. Severe malaria was the main cause of AKI (33.3%). All patients suffering from malaria received antimalarials based on artemisinin derivatives. Intermittent hemodialysis was indicated in 22 patients (73.4%). The evolution was marked by a total recovery of renal function in 20 patients, 8 deaths and 2 transitions to chronic kidney disease. Deaths were statistically related to AKI severity, age range 1-5 years, femoral catheters and infections (p<0.0000). Conclusion: Acute kidney injury is an uncommon pathology in pediatrics and in Chad. It is often linked to severe malaria and has a high mortality rate.
{"title":"Pediatric Acute Renal Failure in Chad: Epidemiological, Clinical and Evolutionary Aspects","authors":"Djidita Hagre Y, M. G, M. Ad, Mahamat Hissein A, Adamou Abbassi M, Senoussi C, A. Y","doi":"10.16966/2380-5498.240","DOIUrl":"https://doi.org/10.16966/2380-5498.240","url":null,"abstract":"Introduction: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden and potentially reversible reduction in kidney function, as measured by glomerular filtration rate (GFR) affecting the exocrine functions of the kidney. It engages the short-term vital prognosis and the long-term renal function prognosis. It is an important cause of morbidity and mortality in sub-Saharan Africa. Our objective was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of acute renal failure in children at the Renaissance University Hospital Center and Mother and Child University Hospital in N’Djamena, Chad. Methodology: This was a descriptive and analytical cross-sectional study for six months from March to August 2020. All children aged 1 year to 15 years that were hospitalized in the emergency room of the Mother and Child University Hospital and went for follow-up consultations in the Nephrology and Dialysis Department of the Renaissance University Hospital Center with acute renal failure defined by the KDIGO 2012 criteria were included in the study. The data were analyzed by Excel 2019 and SPSS 18.0 with significance (p<0.05). Results: Thirty children were included in the study with a hospital prevalence of 0.56%. The mean age was 8.33 years with a sex ratio of 3.28. The average consultation time was 10.1 days. Vomiting was the main reason for consultation (46.7%). About 27% of patients had oligoanuria. There were 86% of the cases that were anemic, half of which were severe. Mean serum creatinine was 434.02 µmol/l and the mean urea level was 26.86 mmol/l. Severe malaria was the main cause of AKI (33.3%). All patients suffering from malaria received antimalarials based on artemisinin derivatives. Intermittent hemodialysis was indicated in 22 patients (73.4%). The evolution was marked by a total recovery of renal function in 20 patients, 8 deaths and 2 transitions to chronic kidney disease. Deaths were statistically related to AKI severity, age range 1-5 years, femoral catheters and infections (p<0.0000). Conclusion: Acute kidney injury is an uncommon pathology in pediatrics and in Chad. It is often linked to severe malaria and has a high mortality rate.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67392012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Resistant arterial hypertension (RAH) is common in patients with chronic kidney disease (CKD). We aimed to study the prevalence and associated factors of RAH in patients with CKD in 2 referral hospitals in Cameroon. Material and method: This was a cross-sectional and analytical study, from December 2020 to May 2021. All consenting patients over 18 years of age with hypertension and CKD stage 2-5 ND was included. Socio demographic, clinical and biological data were collected. Patients were considered to have RAH if they were on 4 antihypertensive drugs or a patient on 3 antihypertensive drugs, including 1 diuretic who presented with office blood pressure ≥ 140/90 mmhg and BP ≥ 135/85 mmhg after home BP self-measurement. Home BP self-measurement was performed using an OMRON brand electronic BP monitor every morning and evening for three consecutive days and the average of the 18 values was calculated. Chi-2 and exact Fischer tests was used to assess the association between variables. p<0,05 was considered significant. Results: A total of 194 patients were included, with 62.89% male. The mean age was 61.89 (13.13) years; 34.54% (67/194) had CKD stage 3a, 26.80% (52/194) stage 3b, 15.46% (30/194) stage 4 and 21.13% (41/194) stage 5. Hypertension: 47.93% (93/194), diabetes: 21.65%, (42/194) and chronic glomerulonephritis: 11.34% (22/194) were the main presumed etiologies of CKD. The prevalence of RAH was 26.29% (51/194), and age >60 years (p=0,001), CKD grade 5 (p=0,000), presence of diabetes (p=0,000), dyslipidemia (p=0,006), obesity (p=0,001) and smoking (p=0,001) were associated factors. Conclusion: RAH is frequent amongst CKD patients, and it is associated with cardiovascular risk factors and severity of CKD. It is necessary to identify these patients and put measure to control BP especially in those with risk factors.
{"title":"Prevalence and Associated Factors of Resistant Hypertension among Patients with Chronic Kidney Disease: An Example from Cameroon","authors":"Patrice Hm, Danielle Mm, Sidick Ma, Ebenezer Nv, Solange Nm, Danielle Fh, Felicite K, Anastase Dt, Francois Kf, Gloria Ae","doi":"10.16966/2380-5498.224","DOIUrl":"https://doi.org/10.16966/2380-5498.224","url":null,"abstract":"Background: Resistant arterial hypertension (RAH) is common in patients with chronic kidney disease (CKD). We aimed to study the prevalence and associated factors of RAH in patients with CKD in 2 referral hospitals in Cameroon. Material and method: This was a cross-sectional and analytical study, from December 2020 to May 2021. All consenting patients over 18 years of age with hypertension and CKD stage 2-5 ND was included. Socio demographic, clinical and biological data were collected. Patients were considered to have RAH if they were on 4 antihypertensive drugs or a patient on 3 antihypertensive drugs, including 1 diuretic who presented with office blood pressure ≥ 140/90 mmhg and BP ≥ 135/85 mmhg after home BP self-measurement. Home BP self-measurement was performed using an OMRON brand electronic BP monitor every morning and evening for three consecutive days and the average of the 18 values was calculated. Chi-2 and exact Fischer tests was used to assess the association between variables. p<0,05 was considered significant. Results: A total of 194 patients were included, with 62.89% male. The mean age was 61.89 (13.13) years; 34.54% (67/194) had CKD stage 3a, 26.80% (52/194) stage 3b, 15.46% (30/194) stage 4 and 21.13% (41/194) stage 5. Hypertension: 47.93% (93/194), diabetes: 21.65%, (42/194) and chronic glomerulonephritis: 11.34% (22/194) were the main presumed etiologies of CKD. The prevalence of RAH was 26.29% (51/194), and age >60 years (p=0,001), CKD grade 5 (p=0,000), presence of diabetes (p=0,000), dyslipidemia (p=0,006), obesity (p=0,001) and smoking (p=0,001) were associated factors. Conclusion: RAH is frequent amongst CKD patients, and it is associated with cardiovascular risk factors and severity of CKD. It is necessary to identify these patients and put measure to control BP especially in those with risk factors.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrice Hm, Loic T, C. E., Vincent N, M. M, Junette M, H. F., Francois Kf
Background: Patients on maintenance hemodialysis (MHD) often depend on caregivers due functional status impairment (FSI). We evaluated the functional status of patients on MHD and the burden on their caregivers in Douala. Material and methods: A fourth month cross-sectional study including consenting adult patients on MHD in Douala general hospital and their caregivers. Functional status of patients was assessed using the overall functional status scale. A FSI score between 1-5/13 was considered moderate, and severe when above 5/13. Caregiver burden was assessed with the Zarit caregiver burden scale; a score between 21 to 40 was considered light to moderate burden, and severe if >41. Logistic regression was used to look for associated factors to FSI and caregivers burden (p <0.05). Results: In 184 patients, the mean age 47.29 (13.75) years. FSI was moderate in 60.33% (111/184) and severe in 8.69% (16/184). Caregiver burden was light to moderate in 48.91% (90/184), severe in 38.59% (71/184). Factors associated with FSI were: older patients, low patient and caregiver income, diabetes, longer duration on dialysis and being accompanied by his child. Factors associated with caregiver burden were: male gender, patient’s age ≥ 70 years, low patient’s income, inability to do shopping and laundry, age of caregiver ≥ 50 years, and caregiver being a student. Patient functional dependence increased the caregiver’s burden by 3.87 times (p=0.001). Conclusion: FSI and caregiver’s burden were relatively high with many associated factors. The caregiver burden increased with the degree of patient dependence.
{"title":"Functional Status of Patients on Maintenance Haemodialysis and Burden of Their Caregivers: An Example from a Tertiary Referenz Hospital in Cameroon","authors":"Patrice Hm, Loic T, C. E., Vincent N, M. M, Junette M, H. F., Francois Kf","doi":"10.16966/2380-5498.229","DOIUrl":"https://doi.org/10.16966/2380-5498.229","url":null,"abstract":"Background: Patients on maintenance hemodialysis (MHD) often depend on caregivers due functional status impairment (FSI). We evaluated the functional status of patients on MHD and the burden on their caregivers in Douala. Material and methods: A fourth month cross-sectional study including consenting adult patients on MHD in Douala general hospital and their caregivers. Functional status of patients was assessed using the overall functional status scale. A FSI score between 1-5/13 was considered moderate, and severe when above 5/13. Caregiver burden was assessed with the Zarit caregiver burden scale; a score between 21 to 40 was considered light to moderate burden, and severe if >41. Logistic regression was used to look for associated factors to FSI and caregivers burden (p <0.05). Results: In 184 patients, the mean age 47.29 (13.75) years. FSI was moderate in 60.33% (111/184) and severe in 8.69% (16/184). Caregiver burden was light to moderate in 48.91% (90/184), severe in 38.59% (71/184). Factors associated with FSI were: older patients, low patient and caregiver income, diabetes, longer duration on dialysis and being accompanied by his child. Factors associated with caregiver burden were: male gender, patient’s age ≥ 70 years, low patient’s income, inability to do shopping and laundry, age of caregiver ≥ 50 years, and caregiver being a student. Patient functional dependence increased the caregiver’s burden by 3.87 times (p=0.001). Conclusion: FSI and caregiver’s burden were relatively high with many associated factors. The caregiver burden increased with the degree of patient dependence.","PeriodicalId":92052,"journal":{"name":"International journal of nephrology and kidney failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67391530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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