Kidney biopsy in subsaharan Africa / Ponctions biopsies rénales en Afrique subsaharienne

Materials and methods: We carried out a retrospective and descriptive study on biopsies examined between January 2015 and December 2019, in the pathological departments of University Teaching Hospital of Bouaké and Cocody-Abidjan. The KB came from four countries (Côte d'Ivoire, Togo, Guinea-Conakry and Burkina Faso). Optical microscopy and/or direct immunofluorescence techniques were used. All biopsy samples including epidemiological, clinical and pathological data and an optical microscopy and/or direct immunofluorescence study were included. The parameters studied were indications for KB, epidemiological profile, clinic, proteinuria and pathological aspects. Results: Over the study period, we collected 179 KB, i.e. 35.8 KB/year. The mean age of the patients was 32.9 ±13.8 years (range 11-70 years). The sex ratio (M/F) was 1.03. Pure nephrotic syndrome was the main indication (64.2 %, n = 115) for KB, followed by impure nephrotic syndrome (11.7 %, n = 21), acute renal failure (ARF) (7.8 %, n = 14) and rapidly progressive glomerulonephritis (RPGN) (7.8 %, n = 14). Glomerulonephritis (GN) occurred in 86 % (n = 158), vascular nephropathy in 11.7 % (n = 21) and tubulointerstitial nephritis in 2.2 % (n = 4). The nephropathies were preferentially focal segmental glomerulosclerosis (34.6 %, n = 62), nephroangiosclerosis (10.6 %, n = 19), membranous GN (10 %, n = 18), post-infectious GN (8.9 %, n = 16) and lupus GN (7.3 %, n = 13). Conclusion: The KB is an essential step in the diagnosis of nephropathies. Focal segmental glomerulosclerosis is frequent in our study. The establishment of a Kidney registry would allow better knowledge of renal pathologies in sub-Saharan Africa.

La ponction biopsie rénale (PBR) constitue une avancée notable dans la prise en charge des néphropathies. En Afrique subsaharienne, peu d'études ont été réalisées. L'objectif de notre travail était d'évaluer les indications de la PBR et de déterminer les caractéristiques épidémiologiques et histologiques des néphropathies diagnostiquées en Afrique subsaharienne. Matériels et méthodes: Nous avons mené une étude rétrospective et descriptive portant sur les PBR examinées entre janvier 2015 et décembre 2019, dans les services d'anatomie et cytologie pathologiques des CHU de Cocody-Abidjan et de Bouaké. Les PBR provenaient de quatre pays africains (Côte d'Ivoire, Togo, Guinée-Conakry et Burkina Faso). Les techniques de microscopie optique et/ou d'immunofluorescence directe ont été utilisées. Nous avons inclus l'ensemble des PBR contributives sur cette période et pour lesquelles nous disposions de données cliniques et biologiques. Les paramètres étudiés étaient les données cliniques et biologiques, l'indication de la PBR et les résultats histologiques. Résultats: Sur la période d'étude, nous avons colligé 179 PBR, soit 35,8 PBR/an. L'âge moyen des patients était de 32,9 ± 13,8 ans (extrêmes de 11 à 70 ans). Le sex ratio (H/F) était de 1,03. Le syndrome néphrotique pur était la principale indication (64,2 %, n = 115) à la réalisation d'une PBR, suivi du syndrome néphrotique impur (11,7 %, n = 21), de l'insuffisance rénale aiguë (IRA) (7,8 %, n = 14) et de la glomérulonéphrite rapidement progressive (GNRP) (7,8 %, n = 14). Les glomérulonéphrites (GN) s'observaient dans 86 % des cas (n = 158), les néphropathies vasculaires dans 11,7 % (n = 21) et les néphrites tubulo-interstitielles dans 2,2 % (n = 4). Les néphropathies les plus fréquentes étaient la hyalinose segmentaire et focale (34,6 %, n = 62), la néphroangiosclérose (10,6 %, n = 19), la GN extramembraneuse (10 %, n = 18), la GN post-infectieuse (8,9 %, n = 16) et la GN lupique (7,3 %, n = 13). Conclusion: La PBR est un geste capital pour le diagnostic des néphropathies. La hyalinose segmentaire et focale est la principale nosologie retrouvée dans notre cohorte. La mise en place d'un registre Rein permettrait une meilleure connaissance et prise en charge des pathologies rénales en Afrique subsaharienne.

Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience.

Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 µmol/L (115.18-1063.2), at 6 months was 117.20 µmol/l (95.6-139.9), at 12 months was 104.55 µmol/L (62.02-132.9), and at 24 months was 104.55 µmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.

Risk factors for chronic renal failure in Ivory Coast: a prospective study of 280 patients.

Chronic renal failure (CRF) represents the major cause of mortality in the nephrology unit in Ivory Coast because the means for appropriate management are lacking. The present study was performed to investigate the risk factors for CRF so that strategies for prevention could be elaborated. A case-control study was performed prospectively at the Yopougon Teaching Hospital in Abidjan from January 2006 to December 2006. Factors known to cause CRF were investigated in patients and controls. Their prevalence rates were compared with the general population. A total of 280 patients and 113 controls were recruited. The mean age of the patients was 37.88 ± 13.33 years and that of the controls was 41.5 ± 9.72 years. Both genders were equally represented. The main causes of CRF were chronic glomerulonephritis (47.48%), with HIV infection accounting for 15% of them, and essential hypertension (HTA) (25%). Essential HTA represented the only factor which, if untreated, inevitably leads to CRF. Thus, our study indicates that HTA is a major public health concern. All efforts should be implemented to reduce the high prevalence of HTA and the deleterious effect of this disorder in Ivory Coast.

Prevalence of acquired cystic disease in black Africans on hemodialysis in West Africa.

Acquired cystic kidney disease (ACKD) is a late manifestation of end-stage renal disease. To determine the prevalence of ACKD in black African patients on chronic hemodialysis in West Africa, we examined by ultrasonography the native kidneys of 83 patients from February to August 2002. ACKD was present in 26 patients, with estimated prevalence of 31% that was higher in males. There were 20 (77%) ACKD patients with a duration on dialysis of more than five years. The associated clinical manifestations were lumbar pain (58%), hematuria (23%) and urinary tract infection (23%). No case of renal cancer was detected during this study. We conclude that the prevalence of ACKD and its complications in black African patients on chronic hemodialysis in West Africa is high. We recommend that renal ultrasonography should be performed routinely in patients on hemodialysis for more than 5 years.