[Rapid decline of kidney function in diabetic patients in Lomé (Togo)]. / Déclin rapide de la fonction rénale chez les patients diabétiques à Lomé (Togo).

OBJECTIVE: To determine the hospital frequency of diabetic patients with a rapid decline in their renal function, to look for the associated factors. METHOD: Descriptive and analytical cross-sectional study carried out over 12 months (May 1, 2019 to April 31, 2020). Were included all patients aged 18 and over, having achieved at least 3 creatinine during the previous 2 years but spaced at least 6 months apart and having an eGFR calculated from their last creatinine greater than 30 mL/min by the formula of CDK-EPI. We evaluated the eGFR by the CDK-EPI formula using the calculator developed by the Poitiers University Hospital and the Inserm unit of the Francophone Diabetes Society. RESULTS: A total of 80 patients medical files were retained. The rapid decline in renal function was found in 28 patients, either a frequency of 35%. The sex ratio M/F was 1.5. The mean age was 62.93 years (range 18-85 years). Hypertension was the most common comorbidity (92.5%). The very high cardiovascular risk was predominant in 82.5% of cases. The very high renal risk was found in 20 patients, either 25%. Univariate and multivariate analysis showed that the rapid decline in renal function was associated with very high cardiovascular risk (P=0.037) and glomerular filtration rate (P˂0.001). CONCLUSION: this study showed a high hospital frequency of the rapid decline in renal function in Togo (35%). Our results have identified the very high cardiovascular risk and glomerular filtration rate as risk factors. The originality of our study was the demonstration of the high proportion of very high cardiovascular risk (82.5%) and very high renal risk (25%) in the evaluation of renal and cardiovascular risk.

[Chronic renal failure and hemodialysis in Lomé: are patients on haemodialysis and their entourage well informed?] / Insuffisance rénale chronique et hémodialyse à Lomé: l´hémodialysé et son entourage sont-ils bien informés?

End stage renal failure requires substitution therapy, including hemodialysis. Before initiation, patients and their entourage receive information on renal disease and treatment options. The purpose of this study is to assess the level of knowledge as well as the opinion of patients on haemodialysis and of their entourage on chronic kidney disease and substitution therapies. We conducted a cross-sectional descriptive study in the Department of Haemodialysis at the Sylvanus Olympio University Hospital (CHU-SO) from 29 July to 19 August 2020. The study population was composed by all the haemodialysis patients in the Department of Haemodialysis at the CHU-SO and by their accompanying persons who gave their free and informed consent. Anonymous survey was used to collect data. Data collection and statistical analysis were carried out using the Epi Info software 7.2.2.6. Eighty-one patients and 79 accompanying persons were interviewed. The average ages of patients and their accompanying persons were 49.7 years ± 13.5 and 39,6years ± 13.2 respectively. All patients knew their disease and 94% of accompanying persons were informed about their parents' disease. Hemodialysis was considered very expensive by 95.1% of patients. Patients stated that improved quality of life was the most known benefit of hemodialysis (80.2%) while 15% also thought that renal transplantation was equally effective. The majority of accompanying persons (85%) stated that hemodialysis was the best treatment. Haemodialysis education program for patients and their accompanying persons is essential to better overall management of haemodialysis patients.

[Circumstances of diagnosis of diabetes mellitus at the Sylvanus Olympio University Hospital in Lomé]. / Les modes de révélation du diabète sucré au CHU Sylvanus Olympio de Lomé.

The purpose of this study was to describe the different circumstances in which diabetes mellitus was detected in the Department of Internal Medicine at the Sylvanus Olympio University Hospital in Lomé. We conducted a retrospective and descriptive study in the Department of Internal Medicine, at the Sylvanus Olympio University Hospital in Lomé from January 2015 to December 2017. During the study period, 307 patients with diabetes mellitus were admitted to our Department, of whom 104 did not know to have diabetes. The average age of patients was 51.27 years (ranging from 20 to 90 years), the sex ratio (M/F) was 0,5. Type 2 diabetes was diagnosed in 75% of cases, type 1 in 23% of cases and secondary in 2% of cases. The discovery of diabetes was fortuitous in 11.53% of cases (n=12). Some patients had symptoms (26.92%, n=28) while others had complications (61.53%, n=64). Complications included: ketoacidosis (n=34), hyperosmolar hyperglycemic syndrome (n=3), high blood pressure (n=8), ischemic stroke (n=4), diabetic foot (n=2), diabetic nephropathy (n=2), polyneuropathy (n=1), infections (n=18, 8 with metabolic complications). This study shows that in the Department of Internal Medicine, at the Sylvanus Olympio University Hospital in Lomé, diabetes mellitus is most commonly diagnosed when patients have complications. It is essential to educate our populations about prevention and screening tests.

[Etiological and evolving profile of renal disability of children in hospital in Togo]. / Profil étiologique et évolutif de l'insuffisance rénale de l'enfant en milieu hospitalier au Togo.

OBJECTIVE: To determine the etiological and evolutionary profile of renal failure of chidren in Togo. METHODS: This is a cross-sectional study over the period of 12 months (2016-2017) including children aged 1 to 18 years hospitalized in the pediatric ward of Sylvanus Olympio university teaching hospital of Lome (Togo) for renal failure. RESULTS: Of 2374 patients hospitalized in our unit, 58 (2.4%) had renal failure. The mean age was 8.17±4 years with a sex ratio of 1.32. The average consultation time was 11.9 days. The mean duration of hospitalization was 12.7±7.7 days. Thirty-seven patients (63.8%) were referred from a peripheral center. Thirty-seven children out of 58 (63.1%) were oligoanuric. Renal failure was acute in 94.8% and chronic in 5.2%. Anemia was found in 84.4% of children. The main etiologies found were severe malaria (63.8%), glomerulonephritis (10.3%) and nephrotic syndrome (10.3%). Thirteen children (22.4%) benefited from dialysis sessions. The evolution was favorable in 79.3% of the cases. CONCLUSION: The renal failure of child is relatively common in our daily practice. The low socio-economic level and the lack of adapted equipment make the care difficult.

[Non-traumatic splenic rupture revealed by acute renal failure]. / Rupture non traumatique de la rate révélée par une insuffisance rénale aiguë.

We report a case of rupture of spontaneous subcapsular splenic hematoma caused by toxic product and revealed by acute renal failure with intravascular hemolysis.

[Life-threatening hypercalcemia and acute kidney injury induced by etanercept]. / Hypercalcémie sévère et insuffisance rénale aiguë induites par étanercept.

Drug-induced sarcoidosis-like disease is a rare, but not exceptional, side effect of anti-tumor necrosis factor (anti-TNF) agents. The organs most commonly involved are lungs, skin and lymph nodes. Kidney involvement is exceptional. Histology usually reveals non-caseating granulomas. Some of the biological features usually described in sarcoidosis are very infrequent in drug-induced granulomatosis. We report a case of sarcoid-like granulomatosis manifesting as life-threatening hypercalcemia and acute kidney injury in a woman treated with etanercept for a rheumatoid arthritis. Seven days after admission, she developed hypoxemic interstitial pneumonia with negative mycobacterial and fungal analysis. This picture suggested sarcoid-like disease induced by tumor necrosis factor blockers and prompted etanercept cessation. Kidney biopsy performed 30 days after admission revealed significant acute interstitial nephritis and intratubular calcium crystals. Staining for acid-fast bacilli and fungi was negative. Clinical picture improved gradually after etanercept withdrawal and cortisone treatment. Three weeks after admission, serum creatinine and calcium levels were normal. Clinical presentation of sarcoidosis-like disease induced by anti-tumor necrosis factor agents may be extremely variable. Our observation shows that severe, life-threatening hypercalcemia may occur. Renal involvement is very unusual. This case highlights this diagnostic difficulty and the importance of a close clinical monitoring in patients treated with these drugs. Cessation of the anti-tumor necrosis factor agent leads to resolution of this condition in most cases.