[Antimalaria therapy of chronic renal failure]. / Paludothérapie chez l'insuffisant rénal chronique.

INTRODUCTION: The treatment of uncoded malaria (malaria) remains very delicate in chronic renal failure which is associated with immunity abnormalities which weaken the uremic subject and create a vicious morbid circle. OBJECTIVE: Describe the malaria treatment profile of the chronic renal failure patient with malaria. METHODOLOGY: This was a retrospective study of patients with chronic renal failure presenting with diagnosed simple malaria admitted to the nephrology departments of the university hospital centers of Treichville and Yopougon from October 1, 2018 to February 28, 2019 and having given their informed consent verbal. RESULTS: We identified 278 chronic renal failure patients, 40 (14.4%) of whom had malaria. The mean age was 42±13 years with a male predominance (sex-ratio: 1.1). The clinical signs were hyperthermia (70%), diffuse pain (67.5%) and headache (37.5%). Chronic renal failure was discovered at stage 5 in 87.5% of cases and 85% started chronic dialysis using a dialysis using a hemodialysis catheter (94%). Malaria was confirmed by a thick drop (66%) and a Quantitative Buffy Coast Malaria Test (44%). There was severe anemia with an average hemoglobin level of 7.1±1.9g/dL and thrombocytopenia (38.4%). Malaria was first treated with artemether (67%) or artesunate (25%) intramuscularly (67.5%) or intravenously (25%). The average duration of treatment with artemether was 3 days and artesunate 4.5 days±1.1. Seventy-eight percent of the patients had an injectable antimalarial without oral relay. The clinical course was favorable in 77%. Diabetes was a factor influencing patient evolution. CONCLUSION: This study reveals a misuse of antimalarials because the national recommendations for the treatment of malaria were not respected. The presence of anemia would make the parenteral routes preferable.

[A study on malignant arterial hypertension: about 168 cases at the unit of nephrology-internal medecine of the University Hospital Center, Treichville, Abidjan]. / Hypertension artérielle maligne en milieu néphrologique à Abidjan: à propos de 168 cas colligés au Service de Néphrologie-Médecine Interne du Centre Hospitalier Universitaire de Treichville.

INTRODUCTION: malignant arterial hypertension (MAH) is a nosologic disorder which has not been described in Nephrology. The purpose of this study was to describe the profile of patients with MAH in the Division of Nephrology and to identify prognostic factors. METHODS: we conducted a retrospective, descriptive and analytical study from January 2013 to December 2018 in the Unit of Nephrology of the University Hospital Center in Treichville. The diagnosis of MAH was retained in patients with diastolic blood pressure (DBP) ≥ 130 mmHg, Keith Wegener grade III/IV hypertensive retinopathy, one or multiple visceral, cardiac and/or brain and/or renal diseases. RESULTS: we collected data from 168 patients. The average age of patients was 41.10 ± 14.86 years, with male predominance (sex ratio 1.54). Cardiovascular risk factors were AH (79.20%), alcohol (32.10%), tobacco (19.60%), chronic kidney disease (15.30%) and diabetes (11.30%). They were admitted with dyspnea (39.29%), hypertensive crisis (26.16%), consciousness disorders (10.12%). Clinical examination showed anemia (82.10%), lower limb edema (63.10%), acute pulmonary edema (37.50%). Arterial hypertension resulted in renal failure (95,9%), left ventricular hypertrophy (92.81%), stroke (16,67%), and cardiac and renal involvement (85%). Renal failure was chronic in 78% of cases. The causes of MAH were essential AH (56,8%), chronic glomerulonephritis (29.8%), and diabetes (6%). Outcome was favorable in 66,7% of cases and overall mortality rate was 25.6%. In multivariate analysis uremia ≥ 2g/l [OR=5,07; 95%CI = 2,39-10.75; p = 0.0001], hperkalaemia [OR = 3.50; 95% CI = 1.70 - 7.19; p = 0.001], hyponatremia [OR = 2.90; 95% CI= 1.40 - 6.03; p = 0.004], haemoglobin level < 12g/dl [OR=5,91; 95% CI=1,34-26,00; p=0,019] and end-stage renal disease [OR = 6.06; 95% CI = 2.04 - 18.18; p = 0.001] were factors associated with the occurrence of death. CONCLUSION: MAH is a consequence of poorly treated or untreated AH. It mainly affects young adults with multivisceral complications. In our Hospital, these were dominated by end-stage chronic renal disease. Hence the importance of early diagnosis and adequate management in patients with AH.

[Outcome of acute renal failure in subjects with HIV living in Abidjan, Ivory Coast over the period 1st January 2014 to 31st December 2017]. / Profil évolutif de l'insuffisance rénale aiguë chez les personnes vivant avec le VIH à Abidjan, Côte d'Ivoire du 1er janvier 2014 au 31 décembre 2017.

In Ivory Coast, the prevalence of human immunodeficiency virus (HIV) infection is high. Any organ can be affected, in particular the kidney. Some studies conducted in Ivory Coast highlighted that opportunistic infections are a poor prognostic factors for acute renal failure (ARF). The purpose of this study was to investigate the other possible factors associated with ARF outcome among subjects with HIV infection. We conducted a retrospective analytical study, at the University Hospital Center of Yopougon over the period January 2014-December 2017. All patients over the age of 18 years with HIV infection associated with ARF were enrolled. The study included 73 patients, reflecting a rate of 24%. The average age of patients was 39.32 ± 10.50 years, ranging from 18 to 65 years. Sex ratio of 1.6 favoured women. Obesity (p=0.047; OR=8.72; CI (95%)=1.07-39.21) and CD4 count < 200/mm3 (p=0.000; OR=58.50; IC (95%)=10.31-55.12) were associated with poor prognosis of ARF. In Ivory Coast, the hospital prevalence of ARF in patients with HIV is high. Unfavorable outcome included death or chronicity. In addition to deep immunosuppression already known as a poor prognostic factor, this study showed that obesity is associated with unfavorable outcome of ARF in subjects with HIV.

Mortality in the elderly with acute kidney injury in an internal medicine department in Abidjan, Cote D'Ivoire.

Acute kidney injury (AKI) in the elderly is characterized by high mortality. The objective of this study is to identify the causes of death in the elderly with AKI. This is a prospective cohort study with a descriptive purpose which was carried out during the period from January 2009 to December 2014 in the Department of Nephrology-Internal Medicine of Treichville University Hospital. The diagnosis of AKI was made on the basis of serum creatinine (SCr) values determined during hospitalization, according to KDIGO classification. Our study involved 107 elderly aged 65 and older with AKI. The hospital mortality rate was 46.7% (50/107). The average age of deceased patients was 71.8 ± 7 years with extremes of 65 and 90 years. We observed a male predominance with a sex ratio (41/9) of 4.55. AKI on admission was in Stage 1 in 16% of cases, in Stage 2 in 24%, and in Stage 3 in 60% cases. SCr was normal in 8%, the AKI was in Stage 1 in 34% (P = 0.09), Stage 2 in 18% (P = 0.001), and Stage 3 in 40% (P = 0.0001). AKI in deceased patients was organic in 36% of cases, obstructive in 30%, and functional in 6%. The etiologies of AKI were infections (46%), cancer (18%), benign tumors of the urinary tract (12%), malignant hypertension (6%), decompensated heart disease (6%), and drugs (6%). The main causes of death were sepsis (28%), cardiovascular disease (22%), severe renal failure (20%), pelvic cancers (16%), and liver failure (12%). All patients with cancer (P = 0.001) or HIV infected (P = 0.009) died. Sixty-eight percent of deaths occurred the 1st week. Death was earlier by sepsis and cardiovascular disease than by cancer. Mortality is high in the elderly. The main causes of death were sepsis, cardiovascular disease, renal failure, pelvic cancer, and liver failure.

[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.

Prevalence and risk factors of chronic kidney disease in Cote D'Ivoire: An analytic study conducted in the department of internal medicine.

Chronic kidney disease (CKD) has become a public health problem because of its increasing prevalence. The objective of this study was to describe the current profile of CKD in our working conditions. This is a descriptive retrospective study of patients admitted for CKD during the period from January 2010 to December 2014 in the Internal Medicine Department of the university hospital of Treichville in Abidjan. CKD was defined by a glomerular filtration rate below 60 mL/min lasting for at least three months. We collected 252 cases of CKD out of 3573 patients recorded during the study period, yielding a prevalence of 7%. The mean age was 39.6 ± 14 years (15-83 years). We observed a male predominance (sex ratio 1.2:1). Of the CKD patients studied, 67.1% were hypertensive, 7.9% were diabetic, and 8.7% were positive for human immunodeficiency (HIV) virus. The CKD was Stage 3 in 2.4%, Stage 4 in 3.2%, and Stage 5 in 94.4% of the patients. The etiology of CKD was hypertension in 59.9% of cases, followed by chronic glomerulonephritis (25%), HIV infection (9.1%), and diabetes (4.8%). On bivariate analysis, hypertension was the cause of CKD in 48.8% of patients under 35 years, 66.4% in patients between 35 and 64 years, and 85.4% in patients ≥65 years (P = 0.001). Chronic glomerulonephritis was the cause of CKD in 40.2% of patients under 35 years, in 14.3% between 35 and 64 years, and in 4.8% of patients ≥65 years (P = 0.0001). CKD is a common cause of hospitalization in our department. Patients generally consulted at the late stage of the disease. Risk factors are mainly hypertension, HIV infection, and diabetes.

Outcomes of acute kidney injury in a department of internal medicine in ABIDJAN (cote D'IVOIRE).

AIM: To investigate the prognostic factors of acute kidney injury (AKI) in our daily practice. METHODS: We analyzed the cohort of patients hospitalized for AKI in the period from January 2010 to December 2015 in the Department of Internal Medicine, University Hospital of Treichville. Kaplan-Meier curves were built for survival analysis. Cox regression analysis was used to identify independent predictors of mortality. RESULTS: We collected 414 cases of AKI during the study period. The mean age was 48.3 ± 16.8 years. We observed a male predominance with a sex ratio (236/178) of 1.32. In multivariate analysis, the predictive factors of death were age ≥ 65 years (HR = 2.13; 95% CI = 1.28-3.55; P = 0.004), AKI stage 3 (HR = 1.69; 95%CI = 1.13-2.50; P = 0.009), haemoglobin <8 g/dL (HR = 2.91; 95% CI = 1.79-4.72; P = 0.0001), infection (HR = 1.85; 95% CI = 1.21-2.83; P = 0.004) and drug-induced AKI (HR = 3.23; 95% CI = 1.65-6.29; P = 0.001). Factors associated with incomplete recovery or non-recovery of renal function beyond 3 months were age ≥ 65 years (OR = 4.76; 95% CI = 1.85-12.50;P = 0.001), hypertension (OR = 2.17; 95% CI = 1.07-4.34; P = 0.03), haemoglobin <8 g/dL (OR = 6.66; 95% CI = 2.94-8.28; P < 0.001), AKI stage 3 (OR = 9.09; 95% CI = 4.54-16.66; P < 0.001) malignant hypertension (OR = 5; 95% CI = 1.67-7.27; P = 0.005) and cancer (OR = 4.69; 95% CI = 2.22-6.63; P = 0.001). CONCLUSION: The aetiologies are dominated by infections. The fatality rate is high and its risk factors are advanced age, low haemoglobin level, severe AKI, infection and drug intake. Prevention is essential.

[Comparative study of community acute kidney injury in HIV infected versus non-infected persons: Experience of an internal medicine department in Abidjan (Côte d'Ivoire)]. / Étude comparative de l'insuffisance rénale aiguë communautaire chez le sujet VIH positif et le sujet VIH négatif : expérience d'un service de médecine interne à Abidjan (Côte d'Ivoire).

BACKGROUND: Acute kidney injury (AKI) is commonly associated with HIV infection. OBJECTIVES: To describe the profile of AKI in HIV infected versus non-infected persons. PATIENTS AND METHODS: This is a prospective study that was carried out during the study period from January 2010 to December 2015 in the department of nephrology-internal medicine D of Treichville University Hospital (Côte d'Ivoire). RESULTS: The prevalence of HIV infection was 35.2% in the population of AKI. The average age of patients was 42±18 years in the HIV positive group against 51±18 years in the HIV negative group (P=0.0001). Etiologies were infections in 65.1% in the HIV positive group against 38.8% in the HIV negative group (P=0.0001) and water loss in 24.7% in the HIV positive group against 7.8% in the HIV negative group (P=0.0001). Factors such as the AIDS stage (P=0.002), severe sepsis (P=0.002) and acute pyelonephritis (P=0.001) were associated with mortality in HIV positive patients against severe anemia (P=0.0001) and severe sepsis (P=0.0001) in the HIV-negative group. CONCLUSION: HIV positive patients are younger with a female predominance. The mortality rate is identical in both groups.