[Non-traumatic splenic rupture revealed by acute renal failure]. / Rupture non traumatique de la rate révélée par une insuffisance rénale aiguë.

We report a case of rupture of spontaneous subcapsular splenic hematoma caused by toxic product and revealed by acute renal failure with intravascular hemolysis.

[Etiological and evolving profile of renal disability of children in hospital in Togo]. / Profil étiologique et évolutif de l'insuffisance rénale de l'enfant en milieu hospitalier au Togo.

OBJECTIVE: To determine the etiological and evolutionary profile of renal failure of chidren in Togo. METHODS: This is a cross-sectional study over the period of 12 months (2016-2017) including children aged 1 to 18 years hospitalized in the pediatric ward of Sylvanus Olympio university teaching hospital of Lome (Togo) for renal failure. RESULTS: Of 2374 patients hospitalized in our unit, 58 (2.4%) had renal failure. The mean age was 8.17±4 years with a sex ratio of 1.32. The average consultation time was 11.9 days. The mean duration of hospitalization was 12.7±7.7 days. Thirty-seven patients (63.8%) were referred from a peripheral center. Thirty-seven children out of 58 (63.1%) were oligoanuric. Renal failure was acute in 94.8% and chronic in 5.2%. Anemia was found in 84.4% of children. The main etiologies found were severe malaria (63.8%), glomerulonephritis (10.3%) and nephrotic syndrome (10.3%). Thirteen children (22.4%) benefited from dialysis sessions. The evolution was favorable in 79.3% of the cases. CONCLUSION: The renal failure of child is relatively common in our daily practice. The low socio-economic level and the lack of adapted equipment make the care difficult.

[Iatrogenic disease in the elderly: about two cases of tricyclics-induced renal failure]. / Iatrogénie médicamenteuse chez la personne âgée: à propos de deux cas d'insuffisance rénale favorisée par les tricycliques.

Prostatic hyperplasia is a common condition in people over the age of 50 and its incidence increases with age. It gives particular cause for concern when it is symptomatic. Drugs with potential adverse effects on lower urinary tract can induce symptoms. Among those, anticholinergic drugs causing primary or secondary effects, such as tricyclics, are often associated with symptoms. These are contraindicated in patients with subvesical obstruction because they can induce or worsen urinary symptoms and complications resulting from them. Renal failure having health and economic consequences on elderly subjects Who often suffer from multiple disorders is the most severe complication. We report two cases of tricyclics-related adverse effects on the urinary tract in patients with prostatic hyperplasia ranging between 80 and 92 years. Given the lack of semiologic signs, imaging techniques and bladder TC scan enabled etiological diagnosis allowing adequate management. Study results justify a systematic performace of rectal examination, bladder CT scan or even ultrasound in any elderly with acute renal failure or with a worsening of chronic renal failure based on the frequency of prostatic pathologies and polypharmacy in this age.

Quality of life of hemodialysis patients in Togo: A single-center study on 64 hemodialysis patients at the Sylvanus Olympio University Hospital in Lomé, Togo.

This study aims at assessing patients' quality of life during hemodialysis (HD) and determining influencing factors. This prospective study was conducted over a three-month period (December 1, 2012-February 28, 2013) at the Sylvanus Olympio University Hospital (CHU-SO) HD unit, the only center to provide such services in Togo. Respondents used the standard Medical Outcome Survey-Short Form 36 questionnaire. This study was conducted on 64 patients (44 males and 20 females = M/F ratio 2.2). Mean patient age was 45.51 ± 14.00 years old with the vast majority in the 16-44-year-old group (90.82%), and mean dialysis vintage was 2.84 ± 2.37 years (1 month to 9.5 years). The mean global quality of life score was 35.58 (standard deviation ± 15). Quality of life physical score and mental score were, respectively, 31.84 and 40.64. Physical limitation scores were 15.23, followed by general ill-health score 37.38 and poor physical function score 47.37. Mental limitation score was 30.20 and vitality score was 43.75. The quality of life was inversely proportional to patient age and the dialysis vintage, with female quality of life scores worse than male in all questionnaire parameters. Togolese dialysis patients suffer from poor quality of life. Factors underlying such poor quality of life include advanced age, female gender, long-standing history of dialysis, and patient profession.

[Tuberculosis among chronic hemodialysis patients in Togo: Report of 10 cases]. / Tuberculose chez les patients hémodialysés chroniques au Togo : à propos de 10 observations.

GOALS: To determine the frequency of tuberculosis among hemodialysis patients in Togo, specify its different localizations and identify its diagnostic and therapeutic difficulties. PATIENTS AND METHODS: This was a retrospective study over a period of 5 years (2010-2015). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Sylvanus-Olympio University Teaching Hospital in Lomé. The diagnosis of tuberculosis was selected on the basis of clinical and laboratory data. The specific treatment has involved the association of 4 antituberculosis, which was adapted to the renal function. RESULTS: Of 91 chronic hemodialysis patients treated in Hospital Sylvanus-Olympio hemodialysis center, 10 cases (10.9%) of tuberculosis were diagnosed. The mean age was 37.3±12.8 years, and the sex ratio was 1.5. The median time to onset of tuberculosis after initiation of hemodialysis was 16.8±9 months. Extrapulmonary sites are found in 100% of cases (5 had both peritoneal and pleural localization, only 5 had pleural localization). The tuberculin skin test was positive in 4 patients (40%). The search for Mycobacterium tuberculosis was unsuccessful in all types of samples. Tuberculosis treatment was generally tolerated. Two patients (20%) had died during treatment. CONCLUSION: Tuberculosis is relatively common in hemodialysis patients. Diagnosis is difficult and may be based on the therapeutic trial.

[Depression in patients on chronic hemodialysis at the Sylvanus Olympio University Hospital of Lomé (Togo)]. / Hémodialyse chronique et dépression au Centre Hospitalier Universitaire Sylvanus Olympio de Lomé (Togo).

INTRODUCTION: The aim of our study was to estimate the prevalence of depression and to investigate its associated risk factors in patients with chronic renal failure on hemodialysis. METHODS: We conducted a descriptive cross-sectional study in the hemodialysis unit of the Division of Nephrology at the University Hospital of Sylvanus Olympio Lomé (Togo) from 1 January 2014 to 31 December 2014. Self-evaluation Scale as calibrated using the Beck Depression Inventory in his simplified version was our screening tool. RESULTS: During the study period, 88 patients were enrolled of whom 61.4% were men with a sex ratio of 1.6. The average age was 38.80 ± 13.24 years ranging from 12 to 66 years. The majority of patients (90.9%) were workers. Arterial hypertension was the most common somatic comorbidity (45.4%) recorded. Forty-six patients (52.3%) had hemodialysis duration between 1-4 years; 68.2% of patients had depression; 47.7% of depressed patients had severe depression. The occurrence of the depression is significantly related to the hemodialysis length (p= 0,008). CONCLUSION: The management of chronic hemodialysis patient should be multidisciplinary including nephrologist and psychiatrist.

[Falls among hemodialysis patients: Incidence and risk factors]. / Chutes chez l'hémodialysé : incidence et facteurs de risque.

Falls and mineral and bones disorders are both implicated in the occurrence of pathological fractures in patients undergoing chronic dialysis. However, data on falls among this population are rare. We carried out a prospective study during four weeks and included 70 patients on chronic hemodialysis with the main objectives being to evaluate the incidence of falls and factors related to it. At the end of the four weeks, 16 patients (22.86%) fell at least once, with a total of 17 falls during 4 weeks, giving an incidence of 3.2 falls per patient/year. The mean age was 40 ± 16 years. Five patients (31.2%) had a past history of pathological fractures. Ten patients (62.5%) presented intra- and post-dialysis hypotension, six (37.5%) was diagnosed of gait disorders and two (12.5%) had sensory deficit of the lower limbs. Six patients (37.5%) presented frailty. Hypotension (P=0.004), frailty (P=0.047) and sensory deficit (P=0.049) were significantly associated with the occurrence of falls. The incidence of falls is relatively high in our hemodialysis patients and real risk factors exist. Hence, it is important to implement programs for falls prevention to reduce their incidence and impact.

[Changing c.106delG (p.Ala36fs*6) loss syndrome associated with congenital Finnish type: first case diagnosed in Togo]. / Mutation c.106delG (p.Ala36fs*6) associée au syndrome néphrotique congénital type finlandais : premier cas diagnostiqué au Togo.

OBJECTIVE: To report the first case of congenital nephrotic syndrome of the Finnish type (SNCF) in Togo associated with a new mutation of NPHS1. OBSERVATION: Our study focused on a female infant of 10months, born premature at 34weeks 6days, followed from birth to pure SNC discovered the 10th day of life. Monitoring and pregnancy outcome unremarkable. It is the third in a family of three children, the first two are killed in a similar table but not explored before 1year of age. The diagnosis is confirmed by the SNCF genetic study NPHS1 gene encoding nephrin performed in our patient and her parents showed a double mutation of which c.[106delG]+[2728T>C] and p. at the nucleotide level. [Ala36fs*6]+[Ser91OPro] at the protein level inherited from each parent. The change was made to the 10th month of death in life after sepsis in a third of cortico-resistance. CONCLUSION: The SNCF, autosomal recessive disease early, which remains a serious diagnosis, is genetic. This new mutation could she explained the severity of the SNCF in this family?