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

[Knowledge, attitudes and practices related to venous thromboembolism prophylaxis in hospitalists in Lome (Togo)]. / Connaissances, attitudes et pratiques sur la prophylaxie de la maladie thromboembolique veineuse chez les praticiens hospitaliers en médecine à Lomé (Togo).

The purpose of this study was to assess the knowledge and practices related to the prevention of venous thromboembolism (VTE) in medical settings in Lome (Togo). Hospitalists in Lome are relatively well aware of the risk of VTE in patients. They report risk factors for VTE as the primary indications for thromboprophylaxis. Few physicians cited acute medical conditions among these indications.

[Epidemiologic and clinical profile of patients at their first consultation with a nephrologist in Togo]. / Profil épidémioclinique des patients en primoconsultation néphrologique au Togo.

OBJECTIVES: To determine the clinical and epidemiologic profile of the source population of the only nephrology department in Togo, to guide the development of prevention. METHODS: Prospective and descriptive cross-sectional study of all patients seen for the first time during the year 2012 in the department of nephrology and hemodialysis of the Sylvanus Olympio University Hospital in Lomé. We analyzed the following data: medical specialty of the referring medical professional, the reason for consultation (RFC), demographic information, and the initial assessment. RESULTS: In 2012, 198 new patients were seen as outpatients in nephrology; their mean age was 51 ± 18 years (16-82 years), and the sex ratio M/F 1.5. They were referred by a general practitioner in 97 cases (49%), a medical assistant in 19 (9.6%), a cardiologist in 23 (11.6%), and a nurse in 12 (6.1%); 7 (3.5%) came on their own initiative. The RFC was kidney failure for 145 patients (73.2%), nephrotic syndrome for 10 (5%), hypertension for 11 (5.6%), and polycystic kidney disease for 6 (3%). Mean serum creatinine at consultation was 90 mg/L (15-398 mg/L). Initial GFR was less than 15 mL/min for 130 patients (89.7%), between 15 and 30 mL/min for 9 (6.2%), and between 30 and 60 mL/min for 6 (4.1%). CONCLUSION: Advanced-stage kidney failure is the main reason for nephrology consultations in Togo.

[Medication adherence of 65 patients in hemodialysis in Togo]. / Observance médicamenteuse chez des hémodialysés au Togo. Étude monocentrique chez soixante-cinq sujets.

OBJECTIVE: The aim of this study was to assess adherence in people on hemodialysis and determine the factors of poor adherence. MATERIAL AND METHODS: This cross-sectional study took place throughout the month of September, 2012, in the hemodialysis center of the Sylvanus Olympio University Hospital, the only such center in Togo. RESULTS: The study included 65 patients, with a mean age of 49.5 years (range: 22 to 77 years), more often men (sex ratio: 1.82) and married (74 %). More than half (58%) had completed secondary education, while 73% belonged to the least advantaged socioeconomic class; 61 (94%) had health insurance, and 57% had been on dialysis for 1 to 4 years. The compliance rate was 11%. The main factors associated with good adherence were marital status (p = 0.0339) and the patient's general health status (p = 0.001). Treatment fatigue (p = 0.0347), forgetfulness (p = 0.0001), dosage forms and drug characteristics (p = 0.0198) were all factors of noncompliance. Therapeutic non-compliance was proportional to the number of drugs prescribed (p = 0.4263). CONCLUSION: Adherence in hemodialysis patients in Togo is very poor.

[Chronic kidney failure in Togo: clinical, laboratory, and etiological aspects]. / Insuffisance rénale chronique au Togo: aspects cliniques, paracliniques et etiologiques.

OBJECTIVES: Determine clinical, laboratory, and etiological aspects of chronic kidney failure (CKF) in Togo. PATIENTS AND METHODS: This retrospective study was focused on the 11-year period from 1st January 1995 to 31st December 2005. Review was carried out on the medical files of 398 patients hospitalized for CKF in various departments of Lomé-Tokoin University Hospital. For lack of kidney biopsy findings, nephropathy was classified on the basis of semiological criteria. RESULTS: Male predominance with a sex ratio of 1.34 was noted. Mean age was 42.6 years. Most patients presented extrarenal signs including hematological changes (94.5%), digestive tube manifestations (68.3%), and cardiovascular disease (55%). Most patients (75.5%) had end-stage disease with creatinine clearance below 10 ml/min. Ultrasound demonstrated stage III kidney damage in 42.8% of cases. Chronic glomerulonephritis (40.2%) was the main etiology, followed by chronic interstitial kidney failure (20.9%) and nephroangioscerosis (17.6%). CONCLUSION: The clinical and laboratory presentation of CKF in Togo is unremarkable but has a rich semiological background.