Left ventricular function as an independent prognostic factor for coronary artery bypass surgery

Background : Studies have suggested that patients with severe impairment of left ventricular function had a poor outcome following CABG surgery. Objectives: Evaluation of the role of pre-operative left ventricular function on the early post-operative mortality and morbidity following CABG. Patients and methods: This study was carried out from August 2016 to January 2017 including 40 patients undergoing CABG surgery. Patients were divided into two equal groups each containing 20 patients. Group A contained 20 patients with pre-operative ejection fraction > 50%, while group B contained 20 patients with pre-operative ejection fraction < 50%. Results: Mortality was 2 patients in group A (10%) compared to 5 patients in group B (25%) (P value = 0.031). The mean ICU stay in group A was 3.29 ± 1.49 days compared to 4.22 ± 1.98 days in group B (P value = 0.028). Pre-operative renal dysfunction improved in 2 patients (10%) from group A, compared to 1 patient (5%) in group B (P value = 0.555). Conclusion: Left ventricular function as an independent factor is a good prognostic factor regarding the early postoperative outcome in coronary artery bypass grafting including mortality, operative times, ICU stay and hospital stay

Particularités de l'amylose rénale au Togo

Objectifs :analyser la démarche diagnostique, thérapeutique, et l'évolution des trois cas d'amylose rénale diagnostiqués avec une revue de la littérature. Méthodologie : Il s'agissait d'une étude rétrospective et descriptive portant sur trois cas cliniques observés sur une période de 27 mois, avec une revue de la littérature. Résultats : Nos patients, adultes jeunes (17, 15 et 31ans) ont été tous admis pour un syndrome né-phrotique. L'examen clinique a retrouvé dans tous les cas des œdèmes des membres inférieurs de type rénaux. La biologie a retrouvé une protéinurie massive sans hématurie et une hypoprotidémie dans tous les cas et une fonction rénale préservée au début. Aucune étiologie n'a pu être trouvée pour ce syndrome néphrotique qui s'est avéré cortico-résistant dans tous les cas d'où une amylose rénale avait été suspectée. Une Biopsie des Glandes Salivaires Accessoires réalisée était en faveur d'une amyloseavec des signes d'inflammation. Le typage de l'amylose n'a pas été fait, compte tenu de la pauvreté de notre plateau technique, ce qui a empêché l'instauration d'un traitement curatif de cette pathologie. L'évolution a été marquée dans un cas par une insuffisance rénale terminale, plu-sieurs épisodes de septicémie sévère avec décès de la patiente. Dans un autre cas, nous avons as-sisté à un arrêt de grossesse. Conclusion :L'amylose rénale est une maladie rare. Son diagnostic est histologique et il faut y pen-ser devant tout syndrome néphrotique surtout ceux cortico-résistants. Son traitement doit être précoce pour éviter l'évolution vers les complications

Profil évolutif d'un cas de syndrome néphrotique infantile par mutation génétique NPHS3 à Dakar

Les auteurs rapportent un cas de syndrome néphrotique (SN) infantile génétique révélé chez un garçon à l'âge de huit mois. Il présentait un syndrome néphrotique impur avec hématurie et insuffisance rénale. Il s'agissait d'un SN corticorésistant. La biopsie rénale avait permis de noter une hyalinose segmentaire et focale (HSF) classique. L'étude génétique a permis de retrouver une mutation dans le gène NPHS3. L'évolution était marquée par une persistance de la protéinurie, un retard staturopondéral et la surve aigu du poumon (OAP) entre deux séances d'hémodialyse. Le protocole néphrectomie-dialyse-transplantation rénale aurait permis de prendre en charge cet enfant

Risk factors for chronic kidney disease among in­school adolescents in Ibadan, Southwest, Nigeria

Background: Chronic kidney disease (CKD) a common noncommunicable diseases associated with high morbidity and mortality.Epidemiology of CKD in Sub­Saharan Africa suggests high burden of CKD with early onset. The adolescent age group has been reported to be at increased risk of kidney disease arising from prevalent risky behaviors and obesity. The in­school adolescents constitute a large group of at­risk individuals that are easily accessible for screening. Objective: This study aimed to determine the prevalence of kidney CKD and its risk factors among in-school adolescents. Materials and Methods: This was a cross­sectional study of 420in­school adolescents in Ibadan, Southwest Local Government Area, Ibadan, Nigeria. A pretested questionnaire was administered to the participants selected using multistage clustered sampling technique. Anthropometric and blood pressure measurements were taken,urine samples were collected for dipstick urinalysis, while 80 participants provided blood for serum creatinine and estimated glomerular filtration rate (eGFR). Results: A total of 420 in­school adolescents participated in the study, the mean age was 14.0 ± 2.3 years and 57.4% were female. The mean body mass index, mid­upper arm circumference (MUAC), and median eGFR were 19.9 ± 3.7 kg/m2, 20.8 c ± 3.7 cm, 96.1 (36.6­156) ml/min/1.73 m2, respectively. The common risk factors for CKD were herbal consumption (59.2%),abnormal MUAC (47.1%), and truncal obesity (28.3%). Proteinuria, hematuria, and CKD were observed in 10%, 16%, and 21.3% of the participants, respectively. Excess body weight (odds ratio [OR], 5.03), abnormal MUAC (OR, 4.11), hypertension (OR, 2.51),and family history of kidney disease (OR, 1.58) were independently associated with CKD. Conclusions: CKD and its risk factors were common among in­school adolescents and the occurrence of CKD was associated with excess body weight, abnormal MUAC,hypertension, and family history of kidney disease

Fournier's gangrene: outcome analysis and prognostic factors

Background: Fournier's gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes.Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier's gangrene. Methods: A prospective hospital based observational study on 51patients with a clinical diagnosis of Fournier's gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival.Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin(p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival.Conclusion: Fournier's gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction

Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana

Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients.Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF.Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality.Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality.Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub-Saharan Africa, and call for more studies to be done in this region

Profil épidemiologique de la maladie rénale chronique dans le service de néphrologie du CNHU-HKM de Cotonou

Introduction : La maladie rénale chronique (MRC) constitue un problème majeur de santé publique. Le but de ce travail est d'étudier le profil épidémiologique de la maladie rénale chronique dans la clinique universitaire de néphrologie et d'hémodialyse du CNHU-HKM de Cotonou. Méthodes : Il s'agissait d'une étude rétrospective descriptive qui porte sur tous les patients hospitalisés ou suivis en consultation externe sur une période allant du 1er janvier 2010 au 31 décembre 2014 soit 5 ans. Etaient inclus dans l'étude, les patients des deux sexes âgés de plus de quinze (15) et présentant une MRC définie par un débit de filtration glomérulaire inferieur à 60ml/min/1,73m2 sur trois (3) mois et/ou un des marqueurs d'atteinte rénale persistant au-delà de trois (3) mois. La collecte des données a été faite par un dépouillement des dossiers à l'aide d'un questionnaire établi. Résultats : Au total 820 cas de MRC ont été retenus. La moyenne d'âge des patients était de 47 ± 15 ans. La sex-ratio était de 1,8, la profession artisanale représentait 41,2% suivis de commerçants à 29%. La MRC représentait 91% des admissions. Le stade 5 de l'insuffisance rénale chronique terminale était observé chez 78% des patients. Les principales étiologies étaient dominées par HTA 75%, diabète sucré 15% et glomérulonéphrite chronique (GNC) 4%. Conclusion : La prévalence de la MRC est très élevée dans le service. Le diagnostic précoce et la prise en charge adéquate de HTA, diabète et GNC sont nécessaires

Maladie rénale chronique: facteurs associés, étiologies, caractéristiques clinique et biologique à Lubumbashi en République Démocratique du Congo

Introduction: la maladie rénale chronique constitue un véritable problème mondial de santé publique du fait de l'augmentation de ses principaux facteurs de risque à savoir l'hypertension artérielle et le diabète sucré. Dans nos milieux à faible revenu et spécialement dans notre pays, peu d'études sont connues sur cette pathologie diagnostiquée à un stade très avancée et posant un problème de prise en charge.Méthodes: il s'agit d'une étude descriptive transversale ayant été menée durant la période allant de juillet 2014 à juillet 2015 au service de dialyse de CMDC. Ont été inclus tous les patients avec taux de filtration glomérulaire inférieur à 60ml/min/1,73 m2 ou créatinine élevée au-delà de trois mois durant notre période d'étude L'objectif de cette étude est de décrire les caractéristiques sociodémographiques, les facteurs de risque et les paramètres biologiques de patients reçus pour insuffisance rénale.Résultats: nous avons retenu 60 patients. L'âge moyen était de 51, 38+/-13, 47 ans avec la tranche d'âge la plus touchée comprise entre 50-59 ans. 51, 67% avaient un niveau d'instruction secondaire et 40% un niveau supérieur. Les facteurs de risque d'atteinte rénale étaient l' HTA 66, 64%, le diabète sucré 25%, l'usage des produits nephrotoxiques 35%, l'infection à VIH 11, 67%, l'obésité 10%, la drépanocytose 3, 3%. Le poids de naissance de naissance de nos patients ainsi que l'existence d'une maladie rénale familiale étaient des facteurs méconnus.85% de nos patients avaient un taux d'hémoglobine inférieur à 12g%.Conclusion: de cette observation, il ressort que l'âge de nos patients ne diffère pas de celui observé dans les autres milieux à revenu faible. Le niveau d'instruction de nos patients est plus élevé comparé aux autres études. Il serait mieux de développer des stratégies de dépistage précoce de la maladie rénale pour éviter d'aboutir à l'hémodialyse qui reste un traitement très onéreux

Cardiovascular risk factors among patients with chronic kidney disease attending a tertiary hospital in Uganda

Chronic kidney disease (CKD) is a risk factor for the development of cardiovascular disease; which is the primary cause of morbidity and mortality in patients with CKD. Local data about cardiovascular risk factors among CKD patients is generally scanty. Objective: To determine the prevalence of the common cardiovascular risk factors among patients with CKD attending the nephrology out-patient clinic in Mulago national referral hospital in Uganda. Methods: This was a cross-sectional study in which 217 patients with a mean age of 43 years were recruited over a period of nine months. Data on demographic characteristics; risk factors for cardiovascular disease; complete blood count; renal function tests/electrolytes; and lipid profiles were collected using a standardised questionnaire. Results: One hundred and eleven (51.2%) of the participants were male. Hypertension was reported in 90% of participants while cigarette smoking was present in 11.5%. Twenty-two participants (10.2%) were obese and 16.1% were diabetic. A total of 71.9% had a haemoglobin concentration 11 g/dl; with the prevalence of anaemia increasing with advancing renal failure (p 0.001); 44.7% were hypocalcaemic and 39.2% had hyperphosphataemia. The prevalence of abnormal calcium and phosphate levels was found to increase with declining renal function (p

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

The Prevalence of Chronic Kidney Disease in Apparently Healthy Retired Subjects in Asaba; Nigeria

Background: The prevalence of chronic kidney disease (CKD) is increasing globally. Studies on this subject; especially in the older age groups are difficult to come by in developing countries like Nigeria. Aim: The aim of this study; therefore; is to estimate the prevalence of CKD in retired and elderly Nigerian subjects. Subjects and Methods: A total of 170 retired subjects were recruited for the study. Anthropometric measurements were carried out and blood samples taken for serum urea and creatinine estimation. Estimated glomerular filtration rate (eGFR) was determined using software by Kidney Health Australia. The figures obtained thereafter were multiplied by 1.21 to accommodate for the black race. Differences between subjects were tested; using Chi-squared test for categorical data; while two tailed unpaired t-test was used for comparison of means. A significant difference was defined as (P 0.05) Results: A total of 170 subjects with age ranged between 50 and 86 years; with a mean age of 68.1 (7.7) years (95 confidence interval [CI

Nephropathie au cours d'une extravasation de produit de contraste iode : quel lien ? a propos d'un cas

Introduction. L'extravasation d'un produit de contraste injecte par voie intraveineuse est rare en pratique clinique courante. Son incidence est relativement faible. Cas clinique. Nous rapportons ici l'observation d'un adulte jeune de 40 ans; obese; qui a la suite d'une extravasation de 50 ml de produit de contraste iode dans l'avant-bras droit; a presente des reactions locoregionales immediates accompagnees d'une insuffisance renale aigue. Un traitement symptomatique institue sur la base d'une rehydratation adaptee a ameliore les signes cliniques apres 48 heures avec secondairement normalisation de la fonction renale. Conclusion. La toxicite des produits de contraste iode est connue et liee a leur osmolarite elevee et a l'importance de la quantite extravasee dans le tissu sous cutane

Nephropathie au cours d'une extravasation de produit de contraste iode : quel lien ? a propos d'un cas

Introduction. L'extravasation d'un produit de contraste injecte par voie intraveineuse est rare en pratique clinique courante. Son incidence est relativement faible. Cas clinique. Nous rapportons ici l'observation d'un adulte jeune de 40 ans; obese; qui a la suite d'une extravasation de 50 ml de produit de contraste iode dans l'avant-bras droit; a presente des reactions locoregionales immediates accompagnees d'une insuffisance renale aigue. Un traitement symptomatique institue sur la base d'une rehydratation adaptee a ameliore les signes cliniques apres 48 heures avec secondairement normalisation de la fonction renale. Conclusion. La toxicite des produits de contraste iode est connue et liee a leur osmolarite elevee et a l'importance de la quantite extravasee dans le tissu sous cutane

Hypertension; Chronic Kidney Disease; Atrial Fibrillation and the Newer Anticoagulants

Atrial fibrillation (AF) is a common clinical condition that is associated with increased morbidity and mortality that mainly relates to an embolic stroke. Dominant risk factors for AF are advanced age and hypertension in the absence of mitral valve disease.1 In turn; hypertension and ageing are determinants of the congestive heart failure; hypertension; age; diabetes mellitus; prior stroke or transient ischaemic attack or thromboembolism (CHADS2) criteria for assessing the indication for anticoagulation. In addition; they are important risk factors for chronic kidney disease (CKD). In itself; CKD is an independent risk factor for AF and a higher risk of stroke.2 It is highly likely that a practitioner will encounter older patients with AF and concomitant hypertension and CKD that require anticoagulation therapy. Thus; it is essential for the practitioner to understand the risks and benefits of anticoagulation in older patients with AF; hypertension and CKD

Electrocardiographic Abnormalities among Dialysis Naive Chronic Kidney Disease Patients in Ilorin Nigeria

Background: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD); but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation; inadequate diagnostic facilities; and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naive CKD patients. Materials and Methods: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital; Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. Results: Overall; 86of the patients had at least one form of ECG abnormality; with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6); left atrial enlargement (LAE) (21.6); combination of LVH and LAE (17.2); and ventricular premature contractions (6). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease; chronic glomerulonephritis (CGN); and diabetic nephropathy patients. Conclusion: LVH and LAE were very common ECG abnormalities in our dialysis naive CKD patients. HTN; CGN; anemia; late presentation; and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN; anemia; and underlying kidney disease; especially in resource poor nations where the burden of CKD is assuming epidemic proportion

La leucemie lymphoide, cause d'insuffisance renale chez l'adulte noir

L'insuffisance renale chronique consecutive a une leucemie myeloide est une entite nosologique rarement decrite dans la litterature chez l'Africain. L'age adulte; le syndrome metabolique; la Glomerulonephrite; le statut socioeconomique bas et le syndrome de Randal ont ete decrits comme facteurs de risque. Les auteurs presentent un patient qui a consulte pour alteration de l'etat general; sueur nocturne et adenopathie axillaire; inguinale et mediatisnale (avec antecedent de leucemie lymphoide et de dependance alcoolo-tabagique). Les investigations ont revele; en absence d'anticorps VIH une creatinemie de 220 mg/l; une proteinurie de 1+ sans hematurie ni glycosurie et une proteinurie de 24 heures a 0.14g. La biopsie renale a revele une infiltration lympho- plasmocytaire. Le diagnostic d'insuffisance renale chronique a ete evoque. En conclusion; un cas de leucemie lymphoide connu avec antecedent alcoolo-tabagique consultant pour alteration de l'etat general; adenopathies avec proteinurie meme minime; un diagnostic d'insuffisance renale chronique doit etre evoque

Insuffisance renale aigue compliquant un paludisme grave a plasmodium falciparum: prise en charge dans un milieu peu equipe

Les auteurs rapportent un cas d'insuffisance renale aigue classe F selon le critere RIFLE compliquant un paludisme grave chez un enfant de 7 ans; de sexe masculin; pris en charge dans un milieu logistiquement pauvre. La goutte epaisse etait positive avec une Hyperparasitemie a plasmodium falciparum; l'uremie a 143 mg/dl et la creatininemie a 5;0mg/dl. Par manque de dialyse; l'association furosemide a forte dose et dopamine a dose dopaminergique avait permis de controler la surcharge hydrosodee en attendant la resolution de l'insuffisance renale