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In general, the term "preeclampsia" refers to the presence of hypertension associated with proteinuria occurring after 20 weeks of gestation in a previously non-proteinuric and normotensive woman. A 24-year-old woman, known to be non-hypertensive, carried two pregnancies and lost two babies. In 2011, as she was carrying the third (twin) pregnancy at 17 weeks of amenorrhea, she was admitted to the hospital for an 8-kilogram excess weight gain between two antenatal visits spaced 4 weeks apart. The clinical examination revealed 140 mmHg systolic blood pressure and 80 mm Hg diastolic blood pressure. The following days, the systolic blood pressure ranged between 110 and 120 mm Hg. Furthermore, the presence of bilateral and symmetrical pitting edema of the lower limbs was reported. The laboratory assessment upon admission showed the following results, proteinuria; 3.3 g/24 h, total albumin; 1.7 g/dL, total protein; 5.4 g/dL and total calcium was 75 g/L. The test results for HIV serology, HBs antigen and HCV antibodies as well as antinuclear and native anti-DNA antibodies were negative. The treatment consisted of iron, folic acid and calcium supplementation. Cesarean section was scheduled for the 38th week. The immediate aftermath was simple. Formula feeding was recommended for the newborns and ramipril 1.25 mg was initiated in the mother once daily. The evolution was marked by a progressive reduction in proteinuria around 500 mg/24 h six months after delivery, and below 200 mg/24 h one year later. Pre-eclampsia before 20 weeks of gestation is rare. Hypertension, which is its main clinical sign, may be exceptionally absent at this stage.

Introduction: Diabetes mellitus is a disease whose prevalence has been steadily increasing worldwide. Objectives: To evaluate the prevalence of diabetic kidney disease and to identify the associated factors in type 2 diabetic patients. Material and Methods: This was a descriptive and analytical cross-sectional study. The study was conducted over a period from January to June 2016, among patients with type 2 diabetes, followed up at the Division of Diabetology of the University Hospital of Treichville, Abidjan. Results: Of 154 included patients, diabetic nephropathy (DN) was observed in 40 cases (25.9% prevalence). We observed a female predominance (sex ratio; 0.17) and the mean age of 57.7 ± 11 years. Based on the K/DOQI guidelines, half of our patients had stage 3 kidney disease. Complications such as diabetic retinopathy (100%), hypertension (HT) (75%), dyslipidemia (45%) and obesity (30%) were found. Factors such as female sex (P = 0.001; OR [95% CI] = 4.76 [1.85-12.19]), a range 55-65 years old (P = 0.010; OR [95% CI] = 2.64 [1.26-5.53]), obesity (P = 0.012; OR [95% CI] = 3.06 [1.27-7.36]), hypertension (P = 0.0001; OR [95% CI] = 4.77 [2.12-10.71]) and HbA1c Conclusion: the prevalence of diabetic kidney disease is high in our study. The associated factors are non-modifiable such as female gender and age, but also modifiable such as obesity and hypertension.

Objectives 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), hemoglobin

Resume Contexte L’insuffisance renale aigue (IRA) est frequemment associee a l’infection par le virus de l’immunodeficience humaine (VIH). Objectifs Decrire le profil de l’IRA chez les patients infectes versus non infectes par le VIH. Patients et methode Il s’agit d’une etude prospective qui s’est deroulee durant la periode de janvier 2010 a decembre 2015 dans le service de nephrologie-medecine interne D du CHU de Treichville, en Cote d’Ivoire. Resultats La prevalence de l’infection a VIH etait de 35,2 % dans la population d’IRA. L’âge moyen des patients etait de 42 ± 18 ans dans le groupe VIH positif, contre 51 ± 18 ans dans le groupe VIH negatif (p = 0,0001). Les etiologies etaient les infections dans 65,1 % dans le groupe VIH positif, contre 38,8 % dans le groupe VIH negatif (p = 0,0001) et les pertes hydriques dans 24,7 % dans le groupe VIH positif contre 7,8 % dans le groupe VIH negatif (p = 0,0001). Les facteurs tels que le stade sida (p = 0,002), le sepsis severe (p = 0,002) et la pyelonephrite aigue (p = 0,001) etaient associes a la mortalite chez les patients VIH positif, contre l’anemie severe (p = 0,0001) et le sepsis severe (p = 0,0001) dans le groupe VIH negatif. Conclusion La mortalite est identique dans les deux groupes avec des facteurs de risque differents.

Resume Le syndrome de la poche a urines violette est une affection rare, qui survient chez les patients porteurs de sondes urinaires a demeure de facon prolongee et frequemment associees a une infection urinaire. Il est caracterise par l’apparition d’une coloration violette de la sonde et/ou de la poche de recueil des urines. Nous rapportons un premier cas en Afrique de l’ouest survenu chez une patiente de 47 ans en encephalopathie uremique et porteuse d’une sonde urinaire qui a presente une coloration violette de la tubulure ainsi que de la poche a urine, associee a une infection urinaire. L’evolution a ete favorable sous une antibiotherapie. De nombreux patients beneficient de la pose de sondes urinaires pour divers motifs et la survenue de ce syndrome devrait amener l’equipe medicale a rechercher systematiquement une infection urinaire sous-jacente afin d’eviter, si possible, des bilans paracliniques couteux a nos patients generalement sans couverture medicale dans nos pays en voie de developpement.

Introduction: Numerous studies have shown that the recovery of renal function was slower and less complete in the elderly patients than in adults. Objectives: To compare the profile of acute kidney injury (AKI) of the young patients with that of the elderly patients. Patients and Methods: This is a prospective study carried out during the period from January 2010 to December 2015 in the department of Nephrology-Internal Medicine of the University hospital of Treichville. The diagnosis of AKI was retained according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: The mean age of patients was 26.8 ± 6 years in the young and 69.4 ± 7 years in the elderly. The proportion of males was 51.9% (55/106) in the young patients against 77.8% (84/108) in the elderly patients (P = 0.0001). The proportion of hypertension and diabetes in the elderly patients, respectively 30.6% and 36.1% was statistically higher than in the young patients (P = 0.001). However, human immunodeficiency virus (HIV) infection was more prevalent in the young patients (P = 0.0001). Anemia was observed in 84.9% in the young patients against 58.3% in the elderly patients (P = 0.001). It was severe in 34% among the young patients against 15.7% among the elderly patients (P = 0.002). The proportion of drug AKI was 17% in the young patients against 2.8% in the elderly patients (P = 0.0001). Malignant hypertension (P = 0.002) and urinary tract tumors (P = 0.001) were more observed in the elderly patients. Mortality was 31.1% in the young patients against 47.2% in the elderly patients (P = 0.011). Conclusion: The etiologies are the same with different proportions, except malignant hypertension observed only in the elderly patients. Mortality is higher in the elderly patients.

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.

To investigate the prognostic factors of acute kidney injury (AKI) in our daily practice.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.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), haemoglobin8 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), haemoglobin8 g/dL (OR = 6.66; 95% CI = 2.94-8.28; P0.001), AKI stage 3 (OR = 9.09; 95% CI = 4.54-16.66; P0.001) 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).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.

Introduction La maladie renale chronique (MRC) est en nette progression dans le monde, liee a l’augmentation de la prevalence de ses facteurs de risque. Patients et methodes Il s’agit d’une etude transversale descriptive realisee du 24 au 26 mai 2016 dans la commune de Yopougon et qui a concerne tout participant venant volontairement a notre centre de collecte. La MRC a ete definie par la presence d’une anomalie urinaire et/ou d’une baisse du debit de filtration glomerulaire (DFG) Resultats Nous avons collige 510 participants dont l’âge moyen etait 43 ± 14,5 ans avec une predominance feminine (sex-ratio : 201/309 = 0,65). Les comorbidites telles que l’hypertension arterielle (47,1 %), l’obesite (22,7 %), l’hypercholesterolemie (12,5 %), l’infection a VIH (7,1 %) et le diabete (3,6 %) etaient retrouvees. La prevalence de la MRC etait de 13 % selon la formule MDRD, de 11,2 % selon la formule CKD-EPI et de 23,4 % selon la formule Cockcroft–Gault. En analyse multivariee, les facteurs tels que le sexe feminin (OR = 1,15 ; IC95 % = 1,07–1,23 ; p = 0,0001), l’obesite (OR = 2,04 ; IC95 % = 1,26–3,30 ; p = 0,004) et l’hypertriglyceridemie (OR = 1,95 ; IC95 % = 1,05–3,59 ; p = 0,039) etait associes a la MRC. Discussion La prevalence de la MRC etait variable selon l’equation utilisee pour evaluer le DFG. Elle etait plus basse avec la formule CKD-EPI et plus elevee avec CG comme l’ont montre Kaze et al. au Cameroun. En considerant le DFG Conclusion L’obesite doit etre prise en charge pour la prevention de la MRC, au meme titre que les facteurs de risque habituels. La formule de CG ne devrait plus etre utiliser pour evaluer le DFG en population generale.

Resume Les infections sont frequentes chez le dialyse chronique. Notre etude a pour objectifs de decrire la prevalence et les particularites de la tuberculose chez le dialyse chronique. Il s’agit d’une etude longitudinale prospective conduite sur 21 mois portant sur des patients dialyses chroniques dont la symptomatologie clinique et paraclinique sont en faveur d’une tuberculose. Resultats Sur 118 patients hemodialyses chroniques pendant la periode d’etude, sept ont presente une tuberculose, soit une frequence de 5,9 %. Le delai moyen etait respectivement de 13,7 mois entre le debut de la dialyse et l’apparition des premiers signes de la tuberculose, et de 10,4 semaines entre les premiers signes et le debut du traitement anti-tuberculeux. Une localisation extra-pulmonaire a ete observee six fois sur sept, avec une atteinte des sereuses dans tous les cas. La sereuse la plus atteinte etait le peritoine. Conclusion La tuberculose extra-pulmonaire est caracteristique chez le dialyse chronique, ainsi que les difficultes diagnostiques, lesquelles devraient nous amener a un depistage systematique et a une chimiotherapie antituberculeuse precoce.

Infectious diseases are frequent in chronic dialysis patients. Our study had for objective to describe the prevalence and the clinical presentation of tuberculosis in the chronic dialysis patient. This observational study was conducted over a period of 21 months in chronically hemodialyzed patients.Among 118 patients chronically dialysed and during the study period, seven (5.9%) presented tuberculosis. An average lag time of 13,7 months was observed between the beginning of the dialysis and the appearance of the signs of tuberculosis, and of 10,4 weeks between the first signs and the beginning of treatment. Extrapulmonary localization was observed in six cases among seven peritoneal involvements.Extrapulmonary localisation is a characteristic of tuberculosis in the chronic dialysis patients. Systematic screening of tuberculosis is recommended in order to start chemotherapy without any delay.