[Renal involvement during monoclonal gammopathies at the teaching hospital of Yopougon in Abidjan, from 2000 to 2016]. / Manifestations Renales des Gammapathies Monoclonales au CHU de Yopougon de 2000 a 2016 : Etude Retrospective D'Une Serie de 42 cas.

BACKGROUND: Renal involvement is common during monoclonal gammopathies and their occurrence impacts the survival of the patients. Our objective was to describe the renal features during monoclonal gammopathies from 2004 to 2016 at the University Hospital of Yopougon in Abidjan. METHODS: Renal failure was defined as blood creatinine level > 20 mg/L and/or proteinuria > 500 mg/24 hours. RESULTS: We identified 42 cases of monoclonal gammopathiesincluding multiple myeloma (n=40) and monoclonal gammopathy of underdetermined significance (n=2). The rate of renal impairment was 57% (n=24) including tubular disease (n=20)and glomerular nephropathy (n=3). Two patients (one with cast nephropathy and another with Randall's disease) performed renal biopsy. The factors associated with renal impairment were mainly hyperuricemia (n=24)and hypercalcemia (n=23). Three cases were treated by hemodialysis. There were 6 (14.3%) deaths among patients with renal impairment. CONCLUSION: Tubular injury was common among patients with monoclonal gammopathy. It was associated with hypercalcemia and Hyperuricemia.

CONTEXTE: Les atteintes rénales sont fréquentes au cours des gammapathies monoclonales (GM) et leur persistance impacte la survie des patients. Notre objectif était de décrire ces atteintes observées de 2004 à 2016 au CHU de Yopougon à Abidjan. MÉTHODES: L'atteinte rénale était définie par une créatinine > 20 mg/l et ou une protéinurie > 500 mg/24 heures. RÉSULTATS: Nous avons recensé 42 cas de GM dont 40 cas de myélome multiple et 2 cas de gammapathie monoclonale de signification indéterminée. La fréquence de l'atteinte rénale était de 57% (n=24). Il s'agissait de 3 cas de néphropathie glomérulaires et 20 cas d'atteintes tubulaires. Deux patients ont bénéficié d'une ponction biopsie rénale et c'était un cas de tubulopathie myélomateuse, et un cas de maladie de Randall. Les facteurs favorisant l'atteinte rénale étaient dominée par l'hypercalcémie (23 cas) et l'hyperuricémie (24 cas). Trois cas ont été traités par hémodialyse conventionnelle. Il y eu 6 (14,3%) décès parmi les patients ayant l'atteinte rénale. CONCLUSION: l'atteinte tubulaire est plus fréquente au cours de la gammapathie monoclonale. Elle est favorisée par la prise de toxiques traditionnels, l'hypercalcémie et l'hyperuricémie.

[Purple urine-bag syndrome: A case report]. / Le syndrome de la poche à urines violette : à propos d'un cas.

Purple urine-bag syndrome is a rare condition that occurs in patients with indwelling urinary catheters carried over a long period and frequently associated with a urinary tract infection. It is characterized by the appearance of a violet coloration of the probe and/or the urine collection bag. We report the first case in West Africa that occurred in a 47-year-old woman in uremic encephalopathy and carrier of a urinary catheter, which presented a violet color of the tubing and urine-bag associated with a urinary tract infection. The outcome was favorable under antibiotic therapy. Many patients benefit from the installation of urinary catheters for various reasons and the occurrence of this syndrome should lead the medical team to systematically seek an underlying urinary tract infection to avoid if possible paraclinical assessments generally costly to our patients without medical coverage in our developing countries.

[Chronic renal failure in sickle cell disease: A retrospective analysis of 100 adults sickle cell patients from black Africa]. / Insuffisance rénale chronique au cours de la drépanocytose : une analyse rétrospective de 100 patients adultes drépanocytaires majeurs d'Afrique noire.

The prevalence of chronic renal failure (CRF) in sickle cell disease (SCD) patients could vary from one country to another depending on the modalities of management. The aim of the present study was to appreciate the epidemiology of CRF in SCD patients from black Africa in order to search for promoting factors. One hundred SCD adult patients have been considered for the study. The glomerular filtration rate (GFR) has been estimated according to the CKD-EPI formula. Three groups of patients have been identified according to the value of their GFR. The mean age of the patients was 30.84±8.26 years. Male gender has represented 51% of the study population. The mean GFR value was 175.4±86.2 mL/min/1.73 m(2). The prevalence of CRF was 11%. About 3% of them had severe CRF. Subjects with normal GFR were 20%. Subjects with glomerular hyperfiltration (HF) were 69%. By univariate analysis, when subjects with HF were compared with those presenting normal GFR, the following factors have appeared to be significantly associated: female gender (female 60.9% versus male 39.1%; P<0.01), weight <60 kg (weight <60 kg; 53.67±9.45 kg versus weight >60 kg; 59.9±9.41 kg; P<0.008), age <30 years (younger age 29.36±7.9 years versus older age 35.14±8.02 years; P<0.001), lower hemoglobin value (9.38±2,3 g/dL versus 10.33±2.61 g/dL; P<0.04). By logistic regression analysis, age <30 years (age >30 years; OR=0.12 [CI95% 0.03-04]; P<0.001), female gender (male gender; OR=0.17 [0.04-0.64]; P<0.01), weight <60 kg (weight >60 kg; OR=0.19 [CI95% 0.05-0.72]; P<0.01) were associated with HF. By univariate analysis, when subjects with CRF were compared with those presenting normal GFR, a lower hemoglobin value was significantly associated with CRF (7.92±2.7 g/dL versus 10.43±2.5 g/dL; P<0.009). There was a trend for subjects not being under maintenance therapy to more experience CRF (36.4% versus 70%; P<0.07). By logistic regression analysis, only a low hemoglobin value was associated to CRF (higher hemoglobin level; OR=0.55 [0.20-6.3]; P<0.01). In total, CRF and HF are frequent complications in SCD adult patients from black Africa.

[Growth in steroid-responsive nephrotic syndrome in Cote d'Ivoire]. / La croissance staturale des enfants ayant un syndrome néphrotique cortico-sensible en Côte d'Ivoire.

We realized one of the first observational studies in sub-Saharan Africa whose aim was to analyze the growth in steroid-responsive nephrotic syndrome. This was a retrospective study, involving 30 children followed for nephrotic syndrome in pediatric nephrology unit of the University Hospital of Yopougon (Abidjan) from 28.02.2005 to 19.12.2010. Each child was followed for two years and we are interested in demographic characteristics and the evolution of size. At the end of our study, it appears that: the mean age was 89.33 ± 43.41 months (7.44 years) with a sex ratio of 3,28. At the end of the two years of follow-up, patients had received a median dose of steroids 6151 ± 3832 mg/m(2), 9111 ± 1376 mg/m(2) and 8664 ± 5379 mg/m(2), respectively, for a relapse or no, two and at least three relapses. Fourteen patients had received vitamin D therapy and calcium. At the end of follow-up, four children had growth retardation. An average gain in Z-score was noted at the end of follow-up in girls and boys respectively +0.06 and +0.36. The growth retardation observed in our study was not associated with different growth periods (P=0.116), gender (P=0.548) and the mean Z-scores observed at the end of follow-up was not significantly different between the sexes (P=0.26). Growth retardation observed was not related to the cumulative dose administered (P=0.15), number of relapse (P=1.000).

Acute peritoneal dialysis in African pediatric area experience of pediatric nephrology unit of Yopougon University Hospital (Abidjan, Côte d'Ivoire).

INTRODUCTION: Acute kidney injury (AKI) is a diagnostic emergency threatening patients in a major way. Pediatric renal extra purification methods are limited in African countries due to the nonavailability of resources. Peritoneal dialysis (PD) seems to be the modality that is the most practiced for children with acute renal failure (ARF). METHODOLOGY: We conducted a retrospective study on 5 years of records of children from 1 month to 15 years who have suffered an ARF and benefited from PD while being treated at the pediatric nephrology unit of the Chu of Yopougon. ARF is defined as the condition that exists when the serum creatinine level is high or equal to 200 µmol/l outside any underlying uropathies. RESULTS: Out of the hospitalized 88 children for AKI, 33 were on PD. Twenty-two children have been on dialysis while 9 children had to discontinue treatment due to financial problems. The sex ratio was 0.46 and the average age was 8.1. The etiologies of the AKI were predominantly glomerular diseases (45%), malaria (31.8%), and secondary interstitial nephritis of toxic origin. The indications of the PD are anuria (31%), hyperkalemia (18%), acute edema of lung (13%), and hyperuremia (13%). Eight children had automated peritoneal dialysis, 02 children underwent manual PD, and 9 children had both methods of treatment. We recorded 31 mechanical complications and 10 infections. While 8 children died, 10 recovered from AKI. CONCLUSION: Trained surgical medical personnel and favorable economic statuses of patients are the factors that will determine the success of PD in our country.

[Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature]. / Cystite hémorragique à adénovirus chez le transplanté rénal: à propos d'un premier cas en Afrique noire survenu dans un tout débutant programme de greffe rénale et revue de la littérature.

Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently.