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1.
Nephrol Ther ; 19(2): 139-144, 2023 04 26.
Article in French | MEDLINE | ID: mdl-37098712

ABSTRACT

Introduction: Bee sting venom is generally well tolerated. However, some rare cases of massive stings can lead to anaphylactic shock and even renal failure. This observation is the illustration of a case of acute kidney injury secondary to bee stings in a 64-year-old black african subject. Case presentation: A 64-year-old man without a known medical history was referred to the emergency department of the Fousseyni Daou hospital in Kayes (Mali) for disturbed consciousness 4 hours after massive stings from a bee swarm. Renal failure with serum creatinine level at 752,2 µmol/L was documented on day 3 in a context of total anuria. The patient was transferred to a nephrology unit and biology confirmed renal failure associated with intravascular haemolysis and rhabdomyolysis. The kidneys were of normal size and well differentiated. The diagnosis of severe acute kidney injury due to massive envenomation induced by bee venom was evoked. The evolution was favourable, with normalization of renal function at D26 after 5 sessions of haemodialysis in parallel with transfusions of packed red blood cells. Conclusion: A massive bee attack should be considered a medical emergency because of the organic damage it can inflict. The renal prognosis depends on the number of stings, and especially on the delay and the quality of the treatment. Early initiation of dialysis treatment reduces mortality.


Introduction: Le venin des piqûres d'abeilles est en général bien toléré. Cependant, quelques rares cas de piqûres massives peuvent entraîner un choc anaphylactique, voire une insuffisance rénale. Cette observation est l'illustration d'un cas d'insuffisance rénale aiguë par envenimation aux piqûres d'abeilles chez un sujet noir africain de 64 ans. Présentation du cas: Un homme de 64 ans sans antécédent médical connu, est adressé aux urgences de l'hôpital Fousseyni Daou de Kayes (Mali) pour trouble de la conscience 4 heures après des piqûres massives par un essaim d'abeilles. Une insuffisance rénale à 752,2 µmol/L de créatinine est découverte à J3 dans un contexte d'anurie totale. Le patient est transféré en unité de néphrologie où la biologie confirme l'insuffisance rénale associée à une hémolyse intravasculaire et une rhabdomyolyse. Les reins étaient de taille normale et bien différenciés à l'échographie. Le diagnostic d'une insuffisance rénale aiguë sévère par envenimation massive induite par le venin d'abeille a été évoqué. L'évolution était favorable, marquée par une normalisation de la fonction rénale à J26 après cinq séances d'hémodialyse en parallèle à des transfusions de culot globulaire. Conclusion: L'attaque massive d'abeilles doit être considérée comme une urgence médicale en raison des atteintes organiques qu'elle peut entraîner. Le pronostic rénal dépend du nombre de piqûres, et surtout du délai et de la qualité de prise en charge. L'instauration rapide de l'épuration extrarénale permet de réduire la mortalité.


Subject(s)
Acute Kidney Injury , Bee Venoms , Insect Bites and Stings , Humans , Animals , Insect Bites and Stings/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Kidney , Renal Dialysis/adverse effects
2.
Nephrol Ther ; 18(6): 565-569, 2022 Nov.
Article in French | MEDLINE | ID: mdl-35915034

ABSTRACT

INTRODUCTION: Lenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically. CASE PRESENTATION: We report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy. CONCLUSION: Lenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management.


Subject(s)
Acute Kidney Injury , Multiple Myeloma , Nephritis, Interstitial , Humans , Middle Aged , Lenalidomide/adverse effects , Multiple Myeloma/drug therapy , Multiple Myeloma/complications , Multiple Myeloma/pathology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Nephritis, Interstitial/chemically induced , Nephritis, Interstitial/complications , Acute Kidney Injury/etiology
3.
Rev. int. sci. méd. (Abidj.) ; 24(1): 53-58, 2022. figures, tables
Article in French | AIM (Africa) | ID: biblio-1397175

ABSTRACT

Contexte + objectif : les signes cliniques et paracliniques en particulier radiologique ne sont pas spécifi ques d'un processus infectieux. L'objectif de cette étude était de déterminer les micro-organismes non tuberculeux en cause au cours des infections respiratoires dans le service de Néphrologie du CHU du Point G. Méthode : il s'agissait d'une étude prospective et descriptive allant du 1er janvier 2018 au 30 juin 2019, soit 18 mois. Etaient inclus, tous les patients en insuffi sance rénale chronique (IRC) souffrant d'une pneumopathie infectieuse diagnostiquée cliniquement, radiologiquement et/ou bactériologiquement. Résultats : Nous avons colligés 35 patients, 21 hommes et 14 femmes. L'âge moyen a été de 46,8 ± 13,9 ans avec des extrêmes de 23 et 76 ans. Les patients âgés de plus de 45 ans étaient majoritaires (54,3%). L'IRC était terminale chez tous nos patients avec un débit de fi ltration glomérulaire moyen de 6,7 ml/min/1,73m2. La radiographie thoracique de face a révélé une pneumopathie alvéolaire (65,7%), une pleuropneumopathie (28,6%) et une pneumopathie cavitaire (5,7%). Les bactéries non tuberculeuses retrouvées à l'examen cytobactériologique des crachats étaient : Klebsiella pneumoniae (25,7%), Escherichia coli (11,4%), Citrobacter frendii, Pseudomonas aeroginosa, Staphylococcus aureus, Candida albicans soit 5,7% pour chacune, Enterobacter clocae et Enterococcus sp avec 2,9% chacune. Quatre (11,4%) sur 35 présentaient une tuberculose dont 1 cas (2,9%) de coïnfection de germe banal. Conclusion: Le diagnostic de la tuberculose par bacilloscopie entraine des cas de méconnaissance des germes banals associés.


Context and objective. Clinical and paraclinical signs, in particular radiological signs, are not specifi c to an infectious process. The objective of this study was to determine the non-tuberculous microorganisms involved in respiratory infections in the Nephrology department of the CHU du Point G. Methods. This was a prospective and descriptive study from January 1, 2018 to June 30, 2019, (18 months). Included were all patients with chronic renal failure (CKD) suffering from an infectious pneumonia diagnosed clinically, radiologically and / or bacteriologically. Results. We collected 35 patients, 21 men and 14 women. The mean age was 46.8 ± 13.9 years with extremes of 23 and 76 years. The majority of patients over the age of 45 were 54.3%. IRC was terminal in all of our patients with an average glomerular filtration rate of 6.7 ml / min / 1.73m2. The chest chest X-ray revealed alveolar pneumonitis (65.7%), pleuropneumopathy (28.6%) and cavitary pneumonitis (5.7%). The non-tuberculous bacteria found on cytobacteriological examination of sputum were: Klebsiella pneumoniae (25.7%), Escherichia coli (11.4%), Citrobacter frendii, Pseudomonas aeroginosa, Staphylococcus aureus, Candida albicans, or 5.7% for each , Enterobacter clocae and Enterococcus sp with 2.9% each. Four (11.4%) out of 35 presented with tuberculosis, including 1 case (2.9%) of common coinfection. Conclusion. The diagnosis of tuberculosis by bacilloscopy leads to cases of ignorance of the associated banal germs.


Subject(s)
Humans , Male , Female , Pneumonia , Tuberculosis, Pulmonary , Pneumonia, Bacterial , Coinfection , Radiography, Thoracic , Nephrology
4.
Lancet Infect Dis ; 17(12): 1266-1275, 2017 12.
Article in English | MEDLINE | ID: mdl-28916443

ABSTRACT

BACKGROUND: Chloroquine was used for malaria treatment until resistant Plasmodium falciparum was identified. Because 4-aminoquinolines with modified side chains, such as AQ-13, are active against resistant parasites, we compared AQ-13 against artemether plus lumefantrine for treatment of uncomplicated P falciparum malaria. METHODS: We did a randomised, non-inferiority trial. We screened men (≥18 years) with uncomplicated malaria in Missira (northeast Mali) and Bamako (capital of Mali) for eligibility (≥2000 asexual P falciparum parasites per µL of blood). Eligible participants were randomly assigned to either the artemether plus lumefantrine group or AQ-13 group by permuting blocks of four with a random number generator. Physicians and others caring for the participants were masked, except for participants who received treatment and the research pharmacist who implemented the randomisation and provided treatment. Participants received either 80 mg of oral artemether and 480 mg of oral lumefantrine twice daily for 3 days or 638·50 mg of AQ-13 base (two oral capsules) on days 1 and 2, and 319·25 mg base (one oral capsule) on day 3. Participants were monitored for parasite clearance (50 µL blood samples twice daily at 12 h intervals until two consecutive negative samples were obtained) and interviewed for adverse events (once every day) as inpatients during week 1. During the 5-week outpatient follow-up, participants were examined for adverse events and recurrent infection twice per week. All participants were included in the intention-to-treat analysis and per-protocol analysis, except for those who dropped out in the per-protocol analysis. The composite primary outcome was clearance of asexual parasites and fever by day 7, and absence of recrudescent infection by parasites with the same molecular markers from days 8 to 42 (defined as cure). Non-inferiority was considered established if the proportion of patients who were cured was higher for artemether plus lumefantrine than for AQ-13 and the upper limit of the 95% CI was less than the non-inferiority margin of 15%. This trial is registered at ClinicalTrials.gov, number NCT01614964. FINDINGS: Between Aug 6 and Nov 18, 2013, and between Sept 18 and Nov 20, 2015, 66 Malian men with uncomplicated malaria were enrolled. 33 participants were randomly assigned to each group. There were no serious adverse events (grade 2-4) and asexual parasites were cleared by day 7 in both groups. 453 less-severe adverse events (≤grade 1) were reported: 214 in the combination group and 239 in the AQ-13 group. Two participants withdrew from the AQ-13 group after parasite clearance and three were lost to follow-up. In the artemether plus lumefantrine group, two participants had late treatment failures (same markers as original isolates). On the basis of the per-protocol analysis, the AQ-13 and artemether plus lumefantrine groups had similar proportions cured (28 [100%] of 28 vs 31 [93·9%] of 33; p=0·50) and AQ-13 was not inferior to artemether plus lumefantrine (difference -6·1%, 95% CI -14·7 to 2·4). Proportions cured were also similar between the groups in the intention-to-treat analysis (28 of 33, 84·8% for AQ-13 vs 31 of 33, 93·9% for artemether and lumefantrine; p=0·43) but the upper bound of the 95% CI exceeded the 15% non-inferiority margin (difference 9·1%, 95% CI -5·6 to 23·8). INTERPRETATION: The per-protocol analysis suggested non-inferiority of AQ-13 to artemether plus lumefantrine. By contrast, the intention-to-treat analysis, which included two participants who withdrew and three who were lost to follow-up from the AQ-13 group, did not meet the criterion for non-inferiority of AQ-13, although there were no AQ-13 treatment failures. Studies with more participants (and non-immune participants) are needed to decide whether widespread use of modified 4-aminoquinolones should be recommended. FUNDING: US Food and Drug Administration Orphan Product Development, National Institutes of Health, US Centers for Disease Control and Prevention, Burroughs-Wellcome Fund, US State Department, and WHO.


Subject(s)
Antimalarials/therapeutic use , Artemisinins/therapeutic use , Ethanolamines/therapeutic use , Fluorenes/therapeutic use , Malaria, Falciparum/drug therapy , Plasmodium falciparum , Quinolines/therapeutic use , Adolescent , Adult , Antimalarials/administration & dosage , Artemether, Lumefantrine Drug Combination , Drug Combinations , Humans , Male , Middle Aged , Quinolines/administration & dosage , Young Adult
5.
Am J Trop Med Hyg ; 94(2): 253-257, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26598570

ABSTRACT

The health-care needs and resources of disease-endemic regions such as west Africa have been a major focus during the recent Ebola outbreak. On the basis of that experience, we call attention to two priorities that have unfortunately been ignored thus far: 1) the development of clinical research facilities and 2) the training of host country investigators to ensure that the facilities and expertise necessary to evaluate candidate interventions are available on-site in endemic regions when and where they are needed. In their absence, as illustrated by the recent uncertainty about the use of antivirals and other interventions for Ebola virus disease, the only treatment available may be supportive care, case fatality rates may be unacceptably high and there may be long delays between the time potential interventions become available and it becomes clear whether those interventions are safe or effective. On the basis of our experience in Mali, we urge that the development of clinical research facilities and the training of host country investigators be prioritized in disease-endemic regions such as west Africa.


Subject(s)
Delivery of Health Care , Endemic Diseases/prevention & control , Health Personnel/education , Hemorrhagic Fever, Ebola/diagnosis , Antimalarials/therapeutic use , Antiviral Agents/therapeutic use , Health Facilities , Hemorrhagic Fever, Ebola/epidemiology , Humans , Malaria, Falciparum/epidemiology , Malaria, Falciparum/prevention & control , Mali/epidemiology
6.
Nephron Clin Pract ; 115(2): c122-32, 2010.
Article in English | MEDLINE | ID: mdl-20413991

ABSTRACT

Experts from all continents discussed the present and future of nephrology and transplantation medicine in emerging countries during a 3-day conference, supported by the World Health Organization, the International Society of Nephrology, the Transplantation Society-Global Alliance for Transplantation and the Ministry of Health of the Republic of Mali. This conference was held in Bamako, Mali on December 4-6, 2008, and focused on prevention and treatment of chronic kidney disease in emerging countries. Apart from delivering high-quality medical and scientific knowledge, the meeting was mainly a call to action for emerging countries to start chronic kidney disease prevention and screening programs, develop end-stage renal disease registries and start or further elaborate transplantation programs. International as well as regional collaborations need to be stimulated and strengthened in order to allow emerging countries to acquire the information, technology, experience and skills necessary to achieve these ambitious goals.


Subject(s)
Achievement , Developing Countries , Global Health , Kidney Transplantation/trends , Renal Insufficiency, Chronic/surgery , Humans , Kidney Transplantation/ethnology , Mali , Renal Insufficiency, Chronic/ethnology
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