Dialysis prescription: Determinants and relationship with intradialytic complications and the dialysis dose. A prospective study

Introduction: Dialysis still remains the most common modality for the treatment of end stage kidney disease and it could be maneuvered to augment its dose, minimize complications and improve outcome. Dialysis prescription is a brief of how dialysis is to be given and involves adjustments in patients' characteristics, disease or dialytic procedure. This study aimed to assess the determinants of the prescribed dialysis and its relationship with intradialytic complications and the dialysis dose. Methods: A prospective study in which 1248 sessions for 232 consented participants with end stage kidney disease on maintenance hemodialysis were studied from 2017-2020. Biodata was taken, participants were examined and blood samples were taken to determine electrolytes, urea/creatinine and hematocrit. Pearson's correlation was used to determine the strength of association between dialysis dose and some variables. Results: Determinants of the prescribed dose were dialysis frequency (P<0.001), and predialysis systolic blood pressure (P<0.001) and packed cell volume (P<0.001). Dialysis sessions without significant intradialytic blood pressure changes were most likely to be completed, as sessions with intra-dialysis hypotension were most likely to be terminated. Participants dialyzed with high flux dialyzers, via an arterovenous fistula, higher blood flow and ultrafiltration rates had higher dialysis doses (P<0.001 in all instances). Conclusion: Higher dialysis doses were achieved with higher blood flow and ultrafiltration rates. Intradialytic hypotension was common with dialysis termination, higher blood flow and ultrafiltration rates. Intradialytic hypertension was common with low flux dialyzers. An optimized dialysis prescription is needed to deliver an adequate dialysis dose and minimize complications

Fréquence des néphropathies congénitales au Centre hospitalier universitaire de Donka à Conakry

Contexte et objectif. L'ampleur réelle des néphropathies congénitales est peu connue en Afrique et notamment en Guinée. L'objectif de cette étude était de déterminer la fréquence des néphropathies congénitales rencontrées. Méthodes. Cette étude documentaire de type descriptif sur la néphropathie congénitale, a été conduite entre les 1er janvier 2007 et 30 juin 2012, dans les services de pédiatrie et de chirurgie pédiatrique de Donka. Les paramètres d'intêret englobaient les données épidémiologiques, cliniques et paracliniques. Résultats. Parmi les 34.448 dossiers colligés, 26 présentaient une néphropathie congénitale. Il s'agissait des néphroblastomes (n=17), des syndromes de jonction pyélo-urétérale (n=6), d'une hydronéphrose sur rein multikystique gauche (n=1), d'un rein multikystique en ptose (n=1) et d'une ectopie rénale (n=1). Le sexe masculin était prépondérant (21/26) avec un sexe ratio de 4,2/1. Les enfants de 29 jours à 2 ans étaient les plus touchés. Conclusion. Les néphropathies congénitales sont paraissent moins fréquentes dans cette institution hospitalière, à cause du manque d'un plateau technique diagnostique optimal. Le diagnostic précoce des néphropathies congénitales devrait être fait dans la période prénatale ce qui permettrait une meilleure prise en charge des enfants affectés

Clinical and demographic profile of end stage kidney disease hemodialysis patients at University Teaching Hospital of Kigali

BACKGROUND: End stage kidney disease (ESKD) has become a major public health problem and is associated with considerable co-morbidity and mortality. In Rwanda, the extent and the distribution of ESKD have not been reported despite provision of dialysis services. This paper describes the clinical and demographic characteristics of ESKD patients in at a tertiary referral hospital in Rwanda. METHODS: This was a retrospective descriptive study of ESKD hemodialysis patients treated at a tertiary referral hospital from January 2014 to December 2017, start of hemodialysis services to date. Demographic and clinical data were obtained regarding all eligible patients treated. Descriptive statistics were reported using frequency and percent for categorical data; median and Interquartile range (IQR) for continuous data. Analysis of survivors versus non-survivors was performed using Chi-square test for categorical variables and Wilcoxon rank sum test for continuous, nonparametric variables. RESULTS: Over a three-year period, there were 64 patients with ESKD. Median age was 48 years (IQR: 35 to 57.5) and 42 (66%) were male. Edema (n=50, 78%) and anuria (n=40, 63%) were the most common presenting symptoms. Underlying comorbidities of ESKD included hypertension (n= 50, 78%), diabetes (n=24, 38%). Urea (n=52, 81%) and creatinine (n=57, 89%) were elevated in most patients. CONCLUSION: ESKD is a the leading cause of hemodialysis in young adults who would otherwise be contributing to the national development. It is a challenging to clearly establish etiologies as the majority present with more than one comorbidity. Hence healthcare providers should be proactive in prevention and prompt management of chronic kidney disease

Obesity and kidney disease: hidden consequences of the epidemic

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased bodyweight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long term. The incidence of obesity-related glomerulopathy has increased tenfold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating a healthy lifestyle and health policy measures that makes preventive behaviours an affordable option

Pattern and outcome of renal diseases in hospitalized children in Tikur Anbessa specialized teaching hospital, Addis Ababa, Ethiopia

Background: Renal diseases are major causes of morbidity and mortality in pediatric practice. Pediatric patients with renal disease, especially younger ones may present with nonspecific signs and symptoms unrelated to the urinary tract. Unexplained fever or failure to thrive may be the only manifestation. Most children with renal diseases in our hospital arrive very late either because of inadequate health awareness among the parents or failure of recognizing the symptoms of renal diseases at a lower health care level. This review will highlight the symptoms of renal diseases at presentation and outcomes of treatment in children in a major referral hospital.Methods: A cross-sectional retrospective chart review was done over a period of 3 years (June, 2012 to May, 2015) in 381 admitted children (Birth-17 years) at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia.Results: Out of 14521 pediatric ward admissions in the study period, kidney diseases accounted for 473 admissions in 381 children, accounting for 3.3% of all admissions. The three most common renal diseases observed were congenital anomalies of the kidney and urinary tract (CAKUT) seen in 127 children (26.8%), followed by nephrotic syndrome in 80 children 16.9% and acute glomerulonephritis in 58 children (12.2%). Other renal diseases observed were urinary tract infection 8.0%, urolithiasis 6.7%, Wilm's tumor 6.3%, acute kidney injury 4.2% and chronic kidney disease 4.0%. Other less frequently detected diseases were bladder exstrophy, lupus nephritis, Henock shonlein Purpura nephritis and prune-belly syndrome.Out of 381 children 207 (54.3%) recovered normal renal function, 20(5.2%) remained with proteinuria, 13(3.4%) progressed to chronic kidney disease and 11(2.9%) died. Sixty one nephrotic children (76.3%) achieved remission but 17 children (21.3%) remained with proteinuria; one steroid resistant child died of end stage renal disease. Ten children (2.6%) with different renal diseases were lost to follow-up and 5 (1.3%) discharged against medical advice.Conclusions: This data reflects that many of the renal diseases are preventable or potentially curable. Therefore, improvement of pediatric renal services and training of health workers would help in early detection and treatment of these conditions leading to reduction in their morbidity and mortality

The Effects of Acute Hypoglycaemia on Cognitive Function in Type 1 Diabetes : Review

Throughout life with type 1 diabetes mellitus people with the condition are exposed to multiple episodes of hypoglycaemia associated with insulin therapy. Hypoglycaemia affects several domains of cognitive function. Studies in non-diabetic adults and in people with type 1 diabetes have shown that almost all domains of cognitive function are impaired to some degree during acute hypoglycaemia; with complex tasks being more greatly affected. The specific cognitive functions of attention and memory are both profoundly impaired during hypoglycaemia. These cognitive processes are fundamental to the performance of many day to day tasks. Their impairment disrupts everyday life and raises safety concerns for the pursuit of activities such as driving. Mood and emotion are also negatively affected by hypoglycaemia; resulting in tense tiredness; while motivation is reduced; and anger may be generated in some individuals. Hypoglycaemia can cause embarrassing social situations; and may lead to chronic anxiety and depression in people with type 1 diabetes. At present few therapeutic measures can modify or ameliorate the effects of hypoglycaemia on cognitive function; so instigation of measures to prevent exposure to hypoglycaemia is of major clinical importance; while preserving good glycaemic control

High-Protein Diets and Renal Disease : is there a Relationship in People with Type 2 Diabetes? : Review

Diabetic kidney disease is the greatest cause of kidney disease worldwide and a cause of significant morbidity and mortality - in New Zealand it accounts for more than 50 of patients receiving renal dialysis. Diet and lifestyle modification are recognised as the cornerstones of management of type 2 diabetes. Dietary interventions to aid weight loss and improve glycaemic control typically increase total energy intake from protein by about 10. The effects of increased protein intake on kidney function and progression of kidney disease in type 2 diabetes has not been established. Evaluation of the literature reviewed here suggests that there is some evidence for the benefit of treating existing nephropathy with protein restriction; but no evidence that increasing protein intake in patients with microalbuminuria accelerates diabetic nephropathy; or causes it in those with normal renal function. Substituting chicken; fish and vegetable protein sources for red meat may be helpful; while retaining a focus on other aspects of a healthy diet; such as high fibre; will ensure that potential risks are minimised

Living kidney donor transplants over a 16-year period in South Africa: a single center experience

BACKGROUND:Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). The number of patients on the waiting list is increasing due to an imbalance between organ supply and demand. This has led to an increase in the number of living donor transplants in most parts of the world. The benefits to the recipients must, however, be weighed against the risks to the donors. Long-term follow-up of the donors is therefore imperative to ascertain the risks of living kidney donation.MATERIALS AND METHODS:We reviewed the records of 571 potential living kidney donors (PLDs) in Johannesburg hospital over a 16-year period between 1990 and 2005.RESULTS:There were 1030 kidney transplants during this period, with 800 cadaveric and 230 actual living donor (ALD) transplants. There were 571 PLDs; however, 341 (59.7%) withdrew or were withdrawn because of medical and non-medical reasons. Among the 230 ALDs, the mean age of the donors was 35.2 ± 8.3 years; 55% were females; 24% were Blacks. Eighty-five percent were related to the recipients while 15% were unrelated. Mean duration of follow-up was 8.6 ± 6.4 years. The pattern of post-donation follow-up was excellent in 29.7%, adequate in 34% and unacceptable/poor in 36.3%, based on the number of clinic visits post-donation. Hypertension was noted in 24% of the donors during long-term follow-up. Three of the donors also developed significant microalbuminuria.CONCLUSION:There is a need to encourage living kidney donation, especially amongst the Black populations, and to emphasize the value and significance of post-donation follow-up visits to all potential donors

Left Ventricular Diastolic Function in a Predialysis Patient Population

BACKGROUND: Diastolic dysfunction is common in chronic kidney disease (CKD) accounting for 40-66of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare findings with those of hypertensive patients with normal renal function. METHODS: Eighty-six consecutive patients with CKD were studied; comprising 43 hypertensives and 43 age- and sexmatched healthy subjects as controls. Clinical; laboratory; and echocardiographic variables were measured. RESULTS: Left ventricular diastolic dysfunction was present in 62.8of CKD patients; 79.1of hypertensive patients and 25.6of normal controls (p 0.001. There was a positive correlation between left ventricular diastolic function (LVDF) and systolic blood pressure (SBP); diastolic blood pressure (DBP); mean arterial pressure (MAP); severity of SBP; severity of DBP in CKD patients but not in hypertensive patients. There was a negative correlation between LVDF and age in CKD patients and hypertensive patients. Linear multiple regression analysis showed age as the only predictor of LVDD. CONCLUSION: There is a high prevalence of diastolic dysfunction in CKD patients at first presentation to a nephrologist in Nigeria

Lipid Profile in Sickle Cell Disease Patients with Chronic Kidney Disease

Background: Dyslipidaemia is reported to occur in patients with sickle cell disease as well as patients with chronic kidney disease irrespective of the haemoglobin genotype. This study aimed at evaluating lipid profile in subjects with sickle cell anaemia (HbSS); sickle cell trait (HbAS) and normal haemoglobin genotype (HbAA); and comparing the lipid parameters between sickle cell disease patients with and those without chronic kidney disease. Methods: A total of 66 patients with chronic kidney disease: 26 HbAA; 24 HbAS and 16 HbSS and 60 apparently healthy controls were recruited for the study. Lipoproteins; urea; creatinine; estimated glomerular filtration rate and electrolytes were determined using standard procedures in both patients and controls. Results: The mean total cholesterol; low density lipoproten cholesterol and high density lipoproten cholesterol in stable HbSS subjects were significantly lower (p

Echocardiographic Assessment of Left Atrial Size in Patients with End-Stage Renal Disease : Cardiovascular Topic

Background: Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease; silent myocardial ischaemia; complex ventricular arrhythmias; atrial fibrillation; left ventricular hypertrophy; annular mitral and aortic valve calcification; and enlargement of the left atrium; than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study; we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. Methods: We analysed data from 123 patients who were on regular haemodialysis; by means of traditional transthoracic echocardiographic examination. The usual statistical parameters; correlations and the Student's t-test were performed; with levels of significance of p 0.01 and p 0.05. Results: The most presented age group was 60 to 69 years old; with a predomination of females (56.1). We found dilated left atrium in 26.02of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Conclusion: Evaluation of left atrial size should be determined by several different measurements; and left atrial enlargement should be seen as a risk factor for advancing disease

Hemodialysis; plea of availability versus adequecy gezira experience

Objectives: This is a prospective cross sectional study carried out in Gezira Hospital for Renal Diseases and Surgery (Sudan) to assess the adequacy of hemodialysis in 206 patients with end stage kidney disease on regular hemodialysis twice per week using. Methods: Pre and post hemodialysis blood sample were obtained from the study group, spKt/V and urea reduction ratio were calculated. Results: Mean Kt/v was found to be 1.19 and urea reduction ratio was 59.55%. None of the patients in this study group achieved the National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) recommendations for adequate hemodialyis, since it requires three hemodialyis sessions per week and our patients are receiving two sessions per week. Conclusion: In order to improve the situation herewith we recommended increased number of sessions from two to three times per week and /or increase the duration of hemodialysis session, increase blood flow rate and dialysate flow rate. Moreover, decrease the number of patients on regular hemodialysis by encouraging the patients to take the other renal replacement therapy (peritoneal dialysis and renal transplantations)

Contrast Medium-induced Nephropathy. Aspects on Incidence; Consequences; Risk Factors; and Prevention

"Contrast media-induced nephropathy (CIN) is a well-known complication of radiological examinations employing iodine contrast media (I-CM). The rapid development and frequent use of coronary interventions and multi-channel detector computed tomography with concomitant administration of relatively large doses of I-CM has contributed to an increasing number of CIN cases during the last few years. Reduced renal function; especially when caused by diabetic nephropathy or renal arteriosclerosis; in combination with dehydration; congestive heart failure; hypotension; and administration of nephrotoxic drugs are risk factors for the development of CIN. When CM-based examinations cannot be replaced by other techniques in patients at risk of CIN; focus should be directed towards analysis of number and type of risk factors; adequate estimation of GFR; institution of proper preventive measures including hydration and post-procedural observation combined with surveillance of serum creatinine for 1-3 days. For the radiologist; there are several steps to consider in order to minimise the risk for CIN: use of ""low-"" or ""iso-osmolar"" I-CM and dosing the I-CM in relation to GFR and body weight being the most important as well as utilizing radiographic techniques to keep the I-CM dose in gram iodine as low as possible below the numerical value of estimated GFR. There is as yet no pharmacological prevention that has been proven to be effective."

Familial polycystic kidney disease in Nigeria: A report of two cases

A case of familial polycystic kidney disease is reported. Although isolated cases of adult polycystic kidney disease have been reported in our environment; no case to our knowledge has been reported with a familial link. Polycystic kidney disease is said to be rare in Africans. Although it commonly terminates in chronic renal failure; it hardly features in the aetiopathogenesis of end stage renal disease requiring some form of renal replacement therapy in African series. This; some workers believe may be due to misdiagnosis and under reporting. This report is to show that it may not be as rare as suspected; and that the familial link shown in the advanced countries is also applicable here. Case 1 was diagnosed in the course of evaluation of her clinical disease. Case 2; an aunt of Case 1; was diagnosed following investigation of a casual complaint of a painless abdominal mass in the wake of her senior brother's death from haemorrhagic stroke

Hypokalaemic nephropathy secondary to enterocutaneous fistula: a rare complication of abdominal hysterectomy

A case of severe hypokalaemia due to enterocutaneous fistula as a post surgical complication of total abdominal hysterectomy is described. The severity of the hypokalaemia resulted in hypokalaemic nephropathy. The polyuria, nocturia and polydipsia were all reversed with appropriate fluid and potassium replacement after the closure of the fistula

Aspects anatomopathologiques observes au cours des nephrectomies au CHU de Brazzaville (Congo)

De janvier 1990 a decembre 1993 soit en 4 ans; trente (30) pieces de nephrectomie ont ete enregistrees et examinees dans le Service d'Anatomie et de Cytologie Pathologiques; du CHU de Brazzaville. Les pathologies renales qui ont conduit a la nephrectomie frappent egalement l'homme et la femme (50 per cent de cas). Les aspects anatomo-pathologiques sont polymorphes; dominees par l'inflammation (53;4 per cent). Selon l'age; les lesions histologiques observees entre 0 et 20 ans sont dominees par le nephroblastome (9 cas) suivies des pyelonephrites (4 cas) et exceptionnellement le carcinome renal a cellules claires (1 cas). Apres 20 ans les lesions inflammatoires a type de pyelonephrites par obstruction calculeuse sont predominantes (12 cas); secondairement viennent les carcinomes renaux a cellules claires (2 cas). Les tumeurs benignes (cystadenome; lipomyofibrome) sont rares

A modality of renal substitution therapy

Dialysis is a process whereby the solute composition of a solution A; is altered by exposing solution A to a second solution B; through a semi-permeable membrane. The mechanisms of solute transport across the semipermeable membrane include diffusion and hydrostatic pressure gradient (ultra-filtration). Additionally; water movement in response to osmotic pressure gradient is also involved