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Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension continues to be a topic of debate. The objectives of this study were 1) to evaluate the performance of hemodialysis center BP measurements (routine and standardized BP measurements) in the diagnosis of ambulatory BP in chronic hemodialysis patients using 44h ambulatory BP monitoring (44h-ABPM) as the reference measurement; 2) to compare the performance of standardized and routine BP measurement; and 3) to evaluate the concordance between the values measured at the hemodialysis center and the BP values at 44h-ABPM. Methods In this 23-month case control study including 56 patients followed in the hemodialysis units of Aristide Le Dantec Hospital (HALD) and Idrissa Pouye General Hospital (HOGIP), BP was measured by 3 methods: i) an automated measurement (OMRON®) carried out by health professional called routine BP measurement (RBPM) in pre and post dialysis; ii) the mean of five automated measurements in a patient isolated in a quiet room called standardized BP measurement (SBPM) before and after dialysis; iii) 44h-ABPM with the CONTEC® device. The hypertension was defined as BP ≥ 130/80 mmHg at 44h-ABPM. Results Fifty-six (56) patients including 31 men (55%) with a mean age of 45.20 ± 13.64 years were included. Thirty-one patients (55%) were hypertensive at the 44h-ABPM. Pre-dialysis SBPM was significantly better than pre-dialysis RBPM (AUC [IC 95%], 0.881 [0.778-0.984]/0.785 [0.664-0.907], p=0.02) in detecting 44h ambulatory systolic BP (SBP) ≥ 130 mmHg. Post-dialysis SBPM was also outperformed post-dialysis RBPM (0.916 [0.843-0.988]/0.874 [0.782-0.965]) in detecting 44h ambulatory SBP ≥ 130 mmHg without statistically significant difference. Pre-dialysis SBPM outperformed pre-dialysis RBPM (0.882 [0.776-0.988]/0.878 [0.781-0.975] in detecting 44h ambulatory DBP ≥ 80 mmHg without statistically significant difference. Post-dialysis SBPM also outperformed post-dialysis RBPM (0.914 [0.832-0.996]/0.848 [0.743-0.952]) in detecting 44h ambulatory DBP ≥ 80 mmHg without statistically significant difference. Hemodialysis center measurements overestimate ambulatory BP at 44h-ABPM. Conclusion Hemodialysis center measurements overestimate ambulatory BP despite excellent performance on ROC curve analysis. SBPM performs better than RBPM and in particular in the detection of a SBP ≥ 130 mmHg in the ambulatory setting. SBPM overestimates SBP less than RBPM.

Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of haemodialysis and examined the factors associated with its use.

Nephrology was a relatively poorly known specialty in sub-Saharan Africa until the early 1980s, because of low awareness and lack of access to diagnosis and renal replacement therapies. Nephrology has seen progress on the continent despite an unfavourable economic and geopolitical environment. With a prevalence of fewer than five nephrologists per million inhabitants, the training of nephrologists, now carried out on the continent, allowed to have more than 200 specialists trained in the last decade in French-speaking sub-Saharan Africa. Clinical and basic research is developing with quality work published from the continent in major international journals. The population receiving haemodialysis remains small, between 0 and 200 per million inhabitants. Kidney transplantation, with a prevalence between 0 and 5 per million inhabitants, is only well structured in South Africa. In this context of scarce resources, a strategy based on the prevention of non-communicable diseases in general, and chronic kidney disease in particular, should be prioritised.

Late stages of CKD are characterized by significant symptom burden. This study aimed to identify subgroups within the 5-year trajectories of symptom evolution in patients with CKD and to describe associated patient characteristics and outcomes.Among 2787 participants (66% men) with eGFR60 ml/min per 1.73 mPatient mean age (±SD) at baseline was 67±13 years, and mean eGFR was 33±13 ml/min per 1.73 mThis study highlights a significant worsening of symptoms in about one third of the participants, whereas the majority reported low symptom severity throughout the study.

Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease. Surgical management occurs in severe forms and/or unresponsive medical treatment. The aim of this study was to outline the indications of parathyroidectomy and its evolution after surgical approach. It was a five-year multicenter backward study in Otorhinolaryngology Department of Fann Hospital and four dialysis centers in Dakar. We include all patients with SHPT who underwent surgery. Preoperative clinical and paraclinical parameters, clinical-biological evolution, and histology findings of the resected parathyroid specimen were collected. Out of 58 patients with hyperparathyroidism, 18 patients required parathyroidectomy, corresponding to a prevalence of 31%. Mean age of patients was 46.6 ± 15.29 years and sex ratio 0.61. Mean duration on dialysis was 44.4 ± 30 months. Ten patients (55.56%) had bone pain and nine patients (50%) had joint pain. Mean serum calcium was 97.27 ± 8.66 mg/L. Mean blood phosphorus levels were 40.47 ± 9.99 mg/L. Mean iPTH rate was 1493.22 ± 1014.93 ng/mL, with a maximum of 5000 ng/mL (77N). Mean value of 25-OH Vitamin D was 32.89 ± 16.02 ng/mL. Parathyroidectomy was indicated after failure of medical treatment with persistence of a serum intact parathyroid hormone concentration above 800 μg/mL in all patients. Subtotal parathyroidectomy (7/8) was performed in 11 patients (61.1%). Two patients (11.11%) benefited from a selective parathyroidectomy (3/4). Evolution was favorable for 13 patients, corresponding to a success rate of 72.2%. It was unfavorable in five patients including one patient with hypoparathyroidism and four patients with recurrent hyperparathyroidism. Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism in developing countries.

Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and corticosteroid resistance and the therapeutic options are numerous and have limited effectiveness. The objective of our study was to assess our practice in this lesion. Patients and Methods: We carried out a retrospective study of patients treated for primary FSGS the period January 1, 2010 to September 30, 2018. The clinical pathological, therapeutic and evolutive characteristics were studied. Results: Fifty-eight patients were included in the study. The average age was 30.74 ± 11.35 years and the sex ratio (M/F) was 2.41. Edema was found in 86.2% and hypertension in 37.9%. The average creatinine was 20.17 ± 16.06 mg/l and the average GFR according to MDRD was 82.43 ± 69.06 ml/min/1.73 m2. The average albumin level was 15.11 ± 5.78 g/l and the 24-hour proteinuria was 7.8 ± 3.79 g/24 h. Nephrotic syndrome was the main indication for renal biopsy in 84.48% and the classic form of FSGS was found in 90.9%. The average initial corticosteroid dose was 62.68 ± 10.04 mg/d and the average duration of regression was 11.78 ± 7.40 months. Forty-five patients (77.6%) were corticosensitive (27.6% complete remission and 50% partial remission). Corticosteroid resistance was observed in 19% and corticosteroid dependence in 11.1%. The proportion of relapse was 33.3% within an average of 15.4 ± 9.1 months. Cyclosporine was no longer prescribed as a second-line treatment in 8 patients. Infectious complications were more found in 19%. Two patients had progressed to ESRD and we noted 2 death cases. The male gender was correlated with the occurrence of a relapse. However, the impact of certain factors such as hypertension, proteinuria, hematuria and GFR level has not been demonstrated. Conclusion: The evolution of primary FSGS is unpredictable, often marked by relapses, hence the interest in identifying factors associated with therapeutic responses for better management.

Introduction: Senegal has pioneered the implementation of peritoneal dialysis (PD) in West Africa, practicing it since 2004. Non-infectious complications are a significant cause of failure of this technique and the transfer of patients to haemodialysis. The aim of this study was to determine the prevalence and the different types of non-infectious complications in our context. Patients and Methods: This was a 5-year, descriptive, retrospective study of patients on chronic peritoneal dialysis for more than 3 months. Results: During the study period, 75 patients were included. The prevalence of non-infectious complications was 88%, including 45.3% mechanical complications and 76% metabolic complications. Catheter migration was the most common mechanical complication (55.9%), followed by catheter blockage (23.5%). Metabolic complications were dominated by hypoalbuminemia (76.3%). Dyslipidaemia and hypokalaemia affected more than 50% of patients, occurring in 59.3% and 56.9% of cases, respectively. Conclusion: In our study, non-infectious complications related to PD were frequent and varied. They remain a significant cause of technical failure. Mechanical complications are often the cause of permanent transfer to haemodialysis.

On peut facilement remarquer, a travers l’histoire, le rapport plus ou moins direct que les ecrivains entretiennent avec les grandes crises sociales ou les revolutions. Parfois ils y prennent directement part, generalement en tant que instigateurs (on sait ce que la Revolution francaise de 1789 doit aux ecrits politiques d’un Rousseau et d’un Voltaire) ; d’autres fois ils s’en constituent en juges, postfacant ce qu’ils n’ont pas decide. En marge de ces deux categories, on peut en trouver une troisieme : des auteurs qui, en meme temps que juges, deviennent des temoins (passifs ou actifs) des evenements. Victor Hugo appartient a ce dernier lot. Contre toute attente, la figure la plus emblematique du romantisme francais place la science au cœur de son œuvre. Grand auteur du XIX e siecle, il est contemporain d’une Revolution industrielle qu’il appelle d’abord de tous ses vœux avant que sa deception s’attelle a en montrer tout le mal pour l’humanite.

Background and Aims The lethality and cost of chronic kidney disease (CKD) management are high in Senegal. The aim of this study was to evaluate the access in dialysis at Senegalese public’s hospitals. Method This was a retrospective cohort during 4 years (2014-2018) from the hemodialysis registry waiting list at Aristide Le Dantec University Hospital. This registry is composed by: a registration form (social survey and doctor's visa); a written letter addressed to hospital director and the national identity card. From this registry, telephone calls were made to collect data relating to mortality and access to dialysis. Results seven hundred fifty-one (751) files were collected. The mean age of the patients was 48.12 ± 15.28 years with a sex ratio of 1.02. The socioeconomic level was low in 85.40% (521/610) and average in 13.61% (83/610). The geographic origin was rural in 11.15%, semi-urban in 07.54% and urban in 81.31%. Ten patients (1.64%) had medical care coverage. On call, 49.70% (373/751) were died before accessing to public dialysis, 29.70% (223/751) had accessed public dialysis and 04.00% (30/751) didn’t yet need dialysis. Hundred twenty-one (16.10%) were unreachable and 0.50% (4/751) was unknown. Conclusion The lethality of CKD was high. Access to dialysis in public hospital remains problematic in Senegal despite its democratization. Additional efforts are needed for effective management of all patients at dialysis stage.

Introduction: The aims of this study were to assess the impact of isonatraemic haemodialysis on reduction of interdialytic weight gain (IDWG) and blood pressure (BP) as well as its tolerability in our study population. Methods: This crossover trial, at the Aristide Le Dantec University Hospital in Senegal, was conducted on 32 patients with kidney failure who were stable on treatment with chronic haemodialysis. In the initial “control phase”, patients had nine haemodialysis sessions with a dialysate sodium (Na+) concentration (Na+ dialysate) of 138 mmol/L. The serum Na+ set point (SP) for each patient was calculated from three predialytic mid-week values. In the second phase, the “individualized phase”, patients had nine haemodialysis sessions with Na+ dialysate equal to their SP. Results: The mean age of the patients was 55.5 ± 12.1 years, with a male/female ratio of 1.3 and the most common cause of kidney disease was hypertension (47%). Mean predialytic serum Na+ concentration was 135.8 ± 1.9 mmol/L, with a mean intra-individual coefficient of variation of 2%. Mean interdialytic weight gain (IDWG) was 1.9 kg and 1.8 kg in the control and individualized phases, respectively (P = 0.75). A reduction in postdialytic systolic blood pressure (BP) was observed during the individualized phase (P = 0.04). A similar trend was noted in pre- and intradialytic BP but this was not statistically significant. Apart from headaches, which were more common in the individualized phase (P = 0.04), isonatraemic haemodialysis was well tolerated. Conclusions: IDWG as well as pre- and intradialytic BP were unaffected by isonatraemic haemodialysis. Postdialytic BP was significantly reduced. Introduction: Les objectifs de cette étude étaient d’évaluer l’impact de l’hémodialyse isonatrémique sur la réduction de la prise de poids inter-dialytique (PPID) et de la pression artérielle (PA) ainsi que sa tolérance dans notre population d’étude. Méthodes: Cet essai croisé a été mené au centre hospitalier universitaire Aristide Le Dantec de Dakar (Sénégal) chez des patients hémodialysés chroniques. Durant la première phase dite « phase contrôle », les patients ont eu neuf séances d’hémodialyse avec une concentration de sodium dans le dialysat (Na+ dialysat) de 138 mmol/L. Le set-point (SP) de la natrémie a été calculé pour chaque patient et correspondait à la moyenne de 3 natrémies pré-dialytiques en milieu de semaine. Durant la deuxième phase dite « phase individualisée », les patients ont eu neuf séances d’hémodialyse avec du Na+ dialysat égal à leur SP. Résultats: Trente-deux patients ont été inclus. L’âge moyen était de 55,5 ± 12,1 ans avec un ratio homme/femme de 1,3 et la néphropathie initiale la plus fréquente était l’hypertensive (47%). La natrémie pré-dialytique moyenne était de 135,8 ± 1,9 mmol/L, avec un coefficient de variation intra-individuel moyen de 2 %. La PPID moyenne était de 1,9 kg et 1,8 kg dans les phases de contrôle et individualisé, respectivement (P = 0,75). Une diminution de la PA systolique post-dialytique a été observée au cours de la phase individualisée (P = 0,04). Une tendance similaire sans significativité statistique a été notée sur les PA pré- et intra-dialytiques. Hormis les céphalées, plus fréquentes pendant la phase individualisée (P = 0,04), l’hémodialyse isonatrémique a été bien tolérée. Conclusions: La PPID, les PA pré- et intra-dialytiques n’ont pas été affectées par l’hémodialyse isonatrémique. La PA post-dialytique était significativement réduite.

Les calcifications metastatiques representent une complication parfois severe de l´insuffisance renale chronique terminale. Leurs consequences cardiovasculaires ont ete associees a l´augmentation de la morbi-mortalite. Nous rapportons l´observation d´une malade presentant une hyperparathyroidie tertiaire complique de calcifications cardiovasculaires dont l´evolution a ete fatale conduisant au deces de la patiente. La prevention constitue la meilleure arme therapeutique et la parathyroidectomie (PTX) pourrait utiliser comme traitement de sauvetage.

Nephrology was a relatively poorly known specialty in sub-Saharan Africa until the early 1980s, because of low awareness and lack of access to diagnosis and renal replacement therapies. Nephrology has seen progress on the continent despite an unfavourable economic and geopolitical environment. With a prevalence of fewer than five nephrologists per million inhabitants, the training of nephrologists, now carried out on the continent, allowed to have more than 200 specialists trained in the last decade in French-speaking sub-Saharan Africa. Clinical and basic research is developing with quality work published from the continent in major international journals. The population receiving haemodialysis remains small, between 0 and 200 per million inhabitants. Kidney transplantation, with a prevalence between 0 and 5 per million inhabitants, is only well structured in South Africa. In this context of scarce resources, a strategy based on the prevention of non-communicable diseases in general, and chronic kidney disease in particular, should be prioritised.

Background: Photography is very useful in medical practice, especially in surgery. Therefore, there are a growing number of legal issues related to the use of personal data. Our aim is to assess knowledge, attitudes and practices about the use of photography in surgery in Dakar. Methods: This is a descriptive cross-sectional study involving surgeons and surgical trainees using photography in their practice in Dakar. An auto administered questionnaire was sent. The studied parameters were: the type of image and the mode of storage, the frequency of use, the advantages and disadvantages according to the user, the attitudes towards the informed consent, the respect for anonymity.Results: According to the type of pictures taken: 94.4% used it for clinical lesions; 90.3% for imaging images, 84.7% for per operative view. The type of device was a smartphone in 94.4%, a tablet in 4.2% and a digital camera in 1.4%. These images were stored on a smartphone in 77.8%, a personal computer in 76.4% and online in 19.4%. The benefits were noted in the follow-up of the patient (76.4%), in the communication between physicians (98.6%) and for a didactic purpose (79.2%). The main disadvantage was the alteration of the contact with the patient (9.2%). 30.6% say that it is not mandatory to have the patient's informed consent. 75% of those surveyed said they had faced at least once, a patient's refusal when they took pictures.Conclusion: Medical photography is really interesting in daily medical practice, especially in surgery. These results suggest misconceptions about ethical principles (informed consent, anonymity of patient and hospital). Since personal data is sensitive, medical photography must be used with caution.

Resume Objectifs Evaluer la prevalence de l’hypertrophie ventriculaire gauche (HVG) electrocardiographique et echographique ainsi que ses corollaires dans une population d’hypertendus vivant en milieu semi-rural au Senegal. Patients et methode Selon l’approche STEPS de l’organisation mondiale de la sante, nous avons mene, en novembre 2012, une enquete transversale et exhaustive chez les sujets âges d’au moins 35 ans et vivant depuis au moins 6 mois, dans la zone semi-rurale de Gueoul. Les facteurs de risque cardiovasculaire ont ete depistes et l’hypertrophie ventriculaire gauche recherchee a l’electrocardiogramme et a l’echocardiographie chez les hypertendus. Les donnees etaient analysees grâce au logiciel SPSS 18.0 et le seuil de significativite fixe pour une valeur de p Resultats Nous avons examine 1411 sujets âges en moyenne de 48,5 ± 12,7 ans. Au total, 654 sujets etaient hypertendus et une hypertrophie ventriculaire gauche a ete la recherche chez 515 sujets parmi eux. Selon l’indice de Sokolow-Lyon, 86 sujets (16,7 %) presentaient une HVG electrocardiographique, plus frequemment chez les hommes (p = 0,002). Selon l’indice de Cornell et le produit de Cornell, elle etait retrouvee respectivement chez 66 (12,8 %) et 52 sujets (10,1 %), avec une predominant feminine (p = 0,0001 ; p = 0,004). Elle etait plus frequente chez les hypertendus en grade 3 quel que soit l’indice. A l’echocardiographie, la prevalence de l’HVG selon la masse ventriculaire gauche etait de 2,5 % (13 cas), de 9,3 % (48 cas) selon la masse ventriculaire gauche indexee a la surface corporelle et de 8,2 % (42 cas) selon la masse ventriculaire gauche indexee a la taille2,7. L’HVG selon la masse ventriculaire gauche indexee a la surface corporelle etait significativement correlee a l’HVG electrocardiographique selon l’indice de Sokolow-Lyon (p Conclusion Bien que rare chez l’hypertendu senegalais vivant en milieu semi-rural, l’hypertrophie ventriculaire gauche est correlee a la severite de l’hypertension arterielle. Un depistage par l’electrocardiogramme permettra un meilleur suivi de ces hypertendus.

Introduction: Renal disease (RD) in human immunodeficiency virus (HIV) infection is a decisive turning point in the development and prognosis of this disease. In Africa, the prevalence varies between 2.5% and 48.6%. In Senegal, little data are available in the literature. The objective of our study was to describe the epidemiological, clinical, paraclinical, therapeutic and progressional aspects in patients living with HIV (PLWHIV). Patients and methods: This was a retrospective, descriptive and analytical study carried out over a 10-year period in the Department of Internal Medicine and Nephrology at the Aristide Le Dantec Hospital in Dakar, Senegal. We included all 15-year old and above PLHIV with available CD4 count and viral load. Results: Out of 248 PLHIV, 32 had kidney disease (KD), which means a hospital prevalence of 12.9%. The mean age was 51.22 ± 10 years (extremes of 36 and 77 years) with a sex ratio (male/female) of 1.28. Renal signs were dominated by glomerular nephropathy syndrome. It was present at 80%. Tubulo-interstitial nephropathy syndrome and chronic uremic syndrome accounted for 6.25% and 3.1% of cases, respectively. Renal function Impairment was present in 21 patients with 18 cases of acute kidney injury (85.7%) and 3 cases of chronic renal failure (14.3%), including 2 in stage 5 of chronic kidney disease. Renal biopsy (RB) was indicated and performed in 20 (62.5%) patients with glomerular signs in 12 patients (60%). Glomerular lesions were dominated by focal and segmental glomerulosclerosis (FSGS) in 6 cases, membraneous nephropathy (MN) in 4 cases and minimal change disease (MCD) in 2 cases. Tubulo-interstitial and vascular lesions were present in 45% and 12.5% of cases, respectively. In highly active antiretroviral therapy (HAART), 12 (37.5%) patients had total remission, 9 (28.12%) had partial remission. One (3.12%) death from severe metabolic acidosis on chronic renal failure was deplored. Conclusion: This study illustrates the high prevalence of RD in PLHIV in our exercise context.

Introduction: Idiopathic nephrotic syndrome represents 25% to 30% of glomerulonephritis in adults. These glomerulonephritides are responsible of about the half of chronic kidney failure examined as well in United States as in Europe or Africa. The aim of this study was to determine the anatomoclinic, therapeutic and progression patterns of idiopathic nephritic syndrome in Dakar. Patients and Methods: It is a retrospective ten-year study in the nephrology department of Aristide Le Dantec Hospital. Patients with idiopathic nephrotic syndrome were included. We analyzed anatomoclinic, therapeutic and progression data of idiopathic nephrotic syndrome. Results: On 202 patients with nephrotic syndrome, 156 (77%) were primitive. The mean age was 29.7 ± 12 years with a sex ratio of 2.4. Edema was found in 98 patients (62.8%) and hypertension in 63 patients (40%). The mean proteinuria was 6.8 ± 4.8 g/24h. Histologic lesions found at renal biopsy were focal segmental glomerulosclerosis in 71 patients (45.5%), minimal change disease in 68 patients (43.5%) and membranous nephropathy in 8 patients (5%). 134 patients (85.8%) received steroids alone, 12 patients (7.6%) received cyclophosphamide and 4 patients (2.5%) azathioprine in association with steroids. 44 patients (28.2%) reached remission. The factors of poor prognosis were: age, above 40 years, proteinuria above 10 g/24h, existence of renal failure at admission, absence of use of steroids therapy. Conclusion: This study shows that idiopathic nephrotic syndrome is frequent in our country with a prevalence of 77%. The most common lesion found at the renal biopsy is the focal segmental glomerulosclerosis. Remission is found only in 28% which is very low. 33% of patients progress towards chronic kidney disease due to the lack of early diagnosis and the use of traditional medicine.

Introduction Plusieurs methodes d’evaluation nutritionnelle sont disponibles. L’objectif de cette etude etait d’evaluer l’etat nutritionnel d’une population d’hemodialyses chroniques a partir de l’anthropometrie, la bioimpedance et l’albuminemie. Description Il s’agissait d’une etude transversale monocentrique observationnelle realisee en juillet 2018 au sein des deux unites d’hemodialyse du CHU/ALD, ayant inclus les patients regulierement dialyses depuis plus de 3 mois, sans antecedents d’hospitalisation au cours du mois dernier et consentant. Methodes L’evaluation nutritionnelle etait basee sur le recueil de marqueurs anthropometriques, la determination de la composition corporelle par analyse d’impedance bioelectrique (BIA) et le dosage de l’albuminemie. Resultats Il s’agissait de 68 patients (46,7 ans, 51,5 % femmes). La prevalence de la denutrition etait diversement appreciee et variait de 10,3 a 55,9 %. Elle etait de 47,1 % (IC95 % [34,8–59,6]) selon l’indice de masse corporelle (seuil de 20 kg/m2), de 25 % (IC95 % [15,3–37,0]) selon le perimetre brachial, de 10,3 % (IC95 % [4,2–20,1]) selon le pourcentage de poids ideal, de 11,8 % (IC95 % [5,2–21,9]) selon la masse grasse, de 55,9 % (IC95 % [43,3–67,9]) selon l’indice de masse maigre et de 10,3 % (IC95 % [4,2–20,1]) selon le taux d’albumine. De meme, la prevalence de l’obesite variait en fonction des criteres de diagnostic : de 8,8 % (IC95 % [−1,8 a 22,4]) en se selon l’indice de masse corporelle et de 36,8 % (IC95 % [24,7–48,9]) selon la masse grasse. Selon la BIA, les femmes hemodialysees etaient plus exposees a la malnutrition que les hommes (p Conclusion La prevalence de la malnutrition variait en fonction de la methode d’evaluation et du genre chez les patients et les femmes hemodialysees etaient plus exposees a la malnutrition que les hommes.

Background: Crescentic extra-capillary glomerulonephritis (ECGN) is a diagnostic and therapeutic emergency. In black Africans, little data are available on this lesion. This study aimed at determining the clinical/biological and evolutionary patterns of ECGN and identifying factors of poor prognosis. Methods: This was a retrospective study conducted over a period of 5 years. All patients with extra-capillary proliferation of ≥ 50% in Bowman’s space upon kidney biopsy were involved. The researchers compared 2 groups of patients: group A (patients, who fully recovered from renal function after 3 months of treatment) and group B (patients developing signs of chronic renal insufficiency) in order to identify factors responsible for a poor renal prognosis. Results: Forty cases of crescentic glomerulonephritis were found in 750 kidney biopsies, i.e. a prevalence of 5.33%. The mean age of the patients was 33.9 ± 16.65 years, with a gender ratio of 0.53. Upon admission, 85% of cases had renal insufficiency, with oligoanuria present in 62.5%. By employing light microscopy, the crescents were found to be cellular in 60%, fibro-cellular in 32.5%, and fibrous in 7.5%. The etiologies were mainly lupus in 32.5% of cases, followed by ANCA-related vasculitis in 27.5% of cases, and infectious causes in 17.5% of cases. Outside of the infectious context, basic treatment relied on immune suppression combining corticosteroids and cytotoxic drugs. The evolution was marked by transition to a chronic state in 72.7% of cases; 18.2% of patients recovered normal renal function. The factors responsible for a poor renal prognosis were oligoanuria (P = 0.0008), high creatinine level upon admission (P = 0.0001), use of hemodialysis (P = 0.0001), and evidence of fibro-cellular and fibrous crescents (P = 0.013). Conclusions: Crescentic glomerulonephritis was relatively common in the current patients. The etiology was dominated by lupus in the study’s context. This rapidly causes chronic renal failure, hence explaining the interest in early management.

Introduction: Acute coronary syndromes with persistent ST-segment elevation (STEMI) constitute a cardiologic emergency. The objectives of this study were to investigate their epidemiological, diagnostic, therapeutic, prognostic and evolutionary aspects in cardiologic environment in Dakar. Patients and methods: It was a retrospective study from January 2013 to December 2014 including patients admitted for STEMI in the cardiology unit of the General Hospital of Grand Yoff. The collected data were analyzed and significance level was selected for a value of p

Introduction La ponction-biopsie renale (PBR) est realisee dans peu de pays d’Afrique subsaharienne. Cependant dans notre pays, elle est pratiquee depuis tres longtemps avec une lecture anatomopathologique faite sur place depuis 2009. Le but de cette etude etait de determiner les indications de la PBR, et de decrire les aspects anatomopathologiques et etiologiques des nephropathies biopsiees dans un pays d’Afrique subsaharienne. Methodes Il s’agit d’une etude retrospective descriptive realisee dans un service de nephrologie d’un CHU d’Afrique Subsaharienne, sur une periode de 7 ans (1er janvier 2010 au 31 decembre 2016). Etaient inclus les patients ayant beneficie d’une PBR durant la periode d’etude. Cette PBR devait etre corticale et contenir au moins 10 glomerules. Toutes les PBR etaient echo-guidees. Resultats obtenus ou attendus Un total de 1559 PBR ont ete realisees dont 1154 interpretables. L’âge moyen des patients etait de 33,8 ± 16,6 ans. Il y avait 834 hommes pour 725 femmes, soit un sex-ratio de 1,15. Le syndrome nephrotique etait la principale indication dans 78,3 % des cas. Les lesions glomerulaires representaient 79,46 % des cas, les lesions tubulo-interstitielles 5,28 % des cas, les lesions vasculaires 9,61 % des cas, et les lesions inclassees 4,15 %. Parmi les lesions glomerulaires, la hyalinose segmentaire et focal (HSF) representait 27,48 % % des cas, la glomerulonephrite extramembraneuse (GEM) 10,68 % des cas, la lesion glomerulaire minime (LGM) 29,00 % des cas, la glomerulonephrite membranoproliferative (GNMP) 1,85 % des cas, la glomerulonephrite extracapillaire (GNEC) 4,79 % des cas, la glomerulonephrite endocapillaire 3,05 % des cas, la nephropathie a IgA 2,18 % des cas et La nephropathie lupique representait 13,74 %. Conclusion La PBR joue un role central dans l’approche nosologique, diagnostique et therapeutique en nephrologie. Dans notre contexte, les lesions glomerulaires sont dominees par la LGM et la HSF. Cette derniere est en partie due a une predisposition genetique liee a un polymorphisme et a l’existence de deux variants (G1–G2) du gene codant pour APOL1.

Introduction L’HID est definie par l’elevation de la pression arterielle (PA) de plus de 10 mm Hg en postdialyse par rapport a la periode de predialyse avec une repetition sur plusieurs seances. L’UF progressive pourrait ameliorer l’HID. L’objectif de ce travail etait d’evaluer l’efficacite de l’ultrafiltration progressive dans la prise en charge de l’HID. Methodes il s’agissait l’effet d’une ultrafiltration progressive (0,25 kg par seance chez 12 patients compares a un groupe controle de 12 patients) sur l’HID. Cet essai clinique randomise en deux groupes: groupe A interventionnel (UF, n = 12) et groupe B controle (n = 12), a ete mene chez des patients hemodialyses chronique presentant une HID. Une premiere phase de recueil transversal des PA avant et apres dialyse, durant 2 semaines, avait permis d’obtenir cette cohorte de 24 patients. Une baisse progressive du poids de base de 0,25 Kg par seance en fonction de la tolerance hemodynamique etait realisee dans le groupe A. Le critere de jugement principal, la proportion de patients ayant une disparition de l’HID, a ete evalue a la fin de la 4e et de la 8e semaine. Resultats obtenus ou attendus A la 4e semaine, l’HID etait disparue chez 83,3 % et 41,7 % des patients du groupe A et B respectivement avec un RR a 0,29; IC 95 = [0,14–0,59]; p = 0,035. A la 8e semaine, l’HID etait disparue chez 72,7 % et 66,7 % des patients du groupe A et B respectivement avec un RR a 0,76; IC 95 = [0,58–1,00]; p = 0,75. Par ailleurs la baisse du poids de base etait associee a la survenue d’effets secondaires (p = 0,0001) avec un risque relatif (RR) a 5 [1,45–7,27]. L’arret de l’UF etait necessaire chez 4 patients du groupe A (36,4 %). Conclusion L’UF progressive etait associee a une reduction significative de la prevalence de l’HID chez nos patients a la 4e semaine.

The monitoring of hypertension (HTN) in dialysis is often delicate with potentially false measurements due to the white coat effect on the one hand and masked HTN (M-HTN) on the other hand. In this population, there is much controversy over the ideal moment for taking blood pressure (BP) and the target values. An answer to these questions is given by home BP measurement that can detect white coat HTN (WC-HTN) and M-HTN. The aim of this study was to determine the respective prevalence of permanent HTN (P-HTN), WC-HTN, M-HTN, and permanently normotensive (P-NTN) in this population and to analyze the risk factors of M-HTN and WC-HTN in hemodialysis (HD) centers in sub-Saharan Africa. This was a multicenter, descriptive, and analytical cross-sectional study conducted over a period of one month and 23 days. Data collection was performed using a home BP measurement form, conventional BP measurement form, and clinical and laboratory data collection form. The study included all patients who could take their BP at home using an electronic BP machine and record results on the BP forms. All analyses were performed using the Sphinx plus software version 5. The significance level for all statistical tests was set at 5%. The mean age of patients was 45.57 years ± 14.11, with a sex ratio of 1.42. The mean duration in dialysis was 57.96 months ± 34.86. Adherence to the home BP measurement was 100% in 71.7%. P-NTN patients were 15.2% (7 patients), WC-HTN patients were 13% (6 patients), M-HTN patients were 17.5% (8 patients), and P-HTN patients were 54.3% (25 patients). A statistically significant association was observed between WC-HTN and age (P = 0.01). In this work, we noted an important proportion of M-HTN and WC-HTN. This result confirms the need for home BP measurement in the follow-up of BP in HD patients.

Introduction En Afrique subsaharienne, le syndrome nephrotique du sujet âge reste tres peu aborde dans la litterature. Les objectifs de cette etude etaient d’etablir le profil epidemiologique des sujets âges atteints de SN, identifier leurs etiologies et d’evaluer leurs traitements et leurs evolutions. Patients et methodes Il s’agissait d’une etude retrospective descriptive portant sur les sujets âges de plus de 60 ans, consultes ou hospitalises de 2009 a 2013 et chez qui le diagnostic de syndrome nephrotique avait ete retenu. Resultats Quarante cas ont ete colliges, la prevalence hospitaliere de 3,87 %. L’âge moyen etait de 65,67 ± 6,2 ans. Le sex-ratio etait de 3. L’œdeme de type renal, la proteinurie et l’insuffisance renale (IRA) representaient les principaux motifs de consultation et/ou d’hospitalisation respectivement dans 72,5 %, 45 % et 42,5 % des cas. Des signes extrarenaux etaient presents chez 20 % des patients. La proteinurie moyenne etait de 5,53 ± 3,65 g/24 h. Une IR etait presente dans 77,5 % des cas. Le DFG moyen etait de 39,07 ± 17,9 mL/min. La protidemie moyenne etait de 57,17 ± 9,2 g/L et l’albuminemie moyenne etait de 21,74 ± 5,3 g/L. Le SN etait impur chez 95 % des patients. La PBR a ete realisee chez 50 % des patients. A l’histologie, les lesions etaient dominees par la GEM (50 % des lesions primitives) et par l’amylose (35,7 % des SN secondaires). Six patients ont ete mis sous corticotherapie avec un taux de remission de 50 %, deux cas (33,3 %) de corticodependance et un cas (16,3 %) de corticoresistance. Discussion La prevalence du SN du sujet âge reste tres variable suivant les regions du monde. Ces differences sont probablement liees a la structure demographique des pays. En effet, dans les pays en voie de developpement et a forte demographie, la population est plus jeune (19 ans d’âge moyen au Senegal), contrastant avec une moyenne d’âge beaucoup plus elevee dans les pays developpes (en France, 16,2 % de la population a plus de 65 ans). Conclusion Le SN du sujet âge est une pathologie relativement frequente dans notre service pour les patients de plus de 60 ans. Les causes primitives etaient dominees par la GEM et les causes secondaires par l’amylose.

Introduction La ponction biopsie renale (PBR) est peu realisee en Afrique subsaharienne. Elle demeure encore moins pratiquee chez le sujet âge. L’objectif de notre etude etait de determiner les indications de la PBR chez le sujet âge et decrire les aspects histopathologiques des nephropathies de cette tranche d’âge. Patients et methodes Il s’agit d’une etude retrospective descriptive sur une periode de 5 ans (du 1er janvier 2011 au 31 decembre 2015). Etaient inclus les patients âges de plus de 60 ans ayant beneficie d’une PBR durant la periode d’etude. Cette PBR devait etre corticale et contenir au moins 5 glomerules. Toutes les PBR etaient echoguidees. Resultats Cinq cent quatre-vingt-dix-neuf PBR effectuees, cent cinq (105) etaient realisees chez le sujet âge, soit une prevalence hospitaliere de 17 %. Seules 75 ont eu une histologie interpretable. L’âge moyen des patients etait de 66,5 ± 5,03 ans. Avec un sex-ratio (H/F) de 2,4. Le syndrome nephrotique etait la principale indication dans 26,7 % des cas. Les lesions glomerulaires representaient 63 % des cas, les lesions tubulo-interstitielles 5,2 % des cas, les lesions vasculaires 25,36 % des cas, et les lesions inclassees 6,5 %. Parmi les lesions glomerulaires, la glomerulonephrite extra-membraneuse (GEM) representait 33,33 % des cas, la hyalinose segmentaire et focal (HSF) 30,76 % des cas, l’amylose 12,82 %, la lesion glomerulaire minime (LGM) 10,25 % des cas, la glomerulonephrite extracapillaire (GNEC) 7,69 %, la glomerulonephrite membranoproliferative (GNMP) 2,56 %, la glomerulonephrite aigue (GNA) 2,56 %. Les nephropathies etaient primitives dans 35,8 % des cas et secondaires dans 64,2 % des cas. Le myelome representait 12,4 % des nephropathies secondaires. Discussion La GEM primitive dans notre contexte representait la premiere lesion glomerulaire. Sone pourcentage etait plus eleve que celui retrouve dans une autre etude africaine (14,5 %) d’Okpechi et al. en Afrique du sud. Conclusion Nos donnees a l’instar des celles de litterature mondiale, montre que la GEM est la lesion la plus retrouvee chez le sujet âge. L’histologie pour cette tranche d’âge est souvent necessaire pour clarifier une situation clinique, confondu quelques fois avec des comorbidites et cela peut aider a adopter une strategie therapeutique appropriee.

Introduction La nephroangiosclerose (NAS) benigne constitue le retentissement de l’hypertension arterielle sur le rein. Au Senegal, l’HTA est un probleme de sante publique (24 % de la population ont une HTA selon les donnees de l’Enquete nationale STEPS 2015). L’objectif de ce travail etait de determiner les profils epidemiologique, clinique, biologique, etiologique, therapeutique et evolutif de la NAS benigne. Patients/materiels et methodes Il s’agit d’une etude retrospective sur une periode de 5 ans (2012–2016). Ont ete inclus les patients dont le diagnostic de NAS benigne a ete pose. La NAS benigne etait definie par la presence d’une HTA ancienne (> 3 ans), un DFG ≤ 60 mL/min/1,73 m2 MDRD, une hypertrophie ventriculaire gauche et/ou retinopathie hypertensive sans autres nephropathies associees. Resultats Quatre cent soixante et un (461) patients etaient inclus. La prevalence hospitaliere etait de 10,43 %. L’âge moyen etait de 56,95 ± 13,23 ans. Les hommes etaient predominants avec un sex-ratio de 1,07. L’alteration de la fonction renale etait le motif de consultation le plus frequent (84,32 % des patients). L’HTA etait de grade III a l’admission (selon OMS) chez 39 % des patients. L’uremie chronique etait retrouvee chez 21,04 % des patients a l’admission. La creatininemie moyenne etait de 66,4 ± 63,04 mg/L. Le DFG moyen (selon MDRD) etait de 22,02 mL/min/1,73 m2. Quarante-six pour cent etaient en IRC stade 5 a l’admission. L’HVG etait retrouvee chez 49,9 % des cas. La retinopathie hypertensive de stade II etait retrouvee dans 51,3 % des cas. Le schema therapeutique le plus utilise etait la bitherapie dans 50,3 % des cas. La duree moyenne du suivi des patients etait de 14,98 mois. L’evolution de la fonction renale etait favorable avec stabilisation ou amelioration du DFG chez 21,25 % des patients. Conclusion L’Afrique et en particulier le Senegal doit mettre en œuvre tous les moyens afin d’eviter de diminuer la prevalence et l’evolution de la NAS benigne vers la MRC stade 5 par la prevention et le traitement de l’hypertension arterielle.

Introduction Les nephropathies parenchymateuses representent la premiere cause d’HTA secondaire avec en tete de file les glomerulopathies. L’objectif de cette etude etait de decrire les aspects epidemiologiques, diagnostiques, therapeutiques et evolutifs de l’HTA au cours des glomerulopathies chroniques primitives. Patients/materiels et methodes Il s’agissait d’une etude retrospective descriptive et analytique de 7 ans (1er janvier 2010 au 1er janvier 2017). Etaient inclus, les patients hospitalises ou suivis en consultation pour une glomerulopathie chronique primitive associee a une HTA. Etaient exclus, ceux ayant une HTA anterieure a la glomerulopathie. Pour chaque patient inclus, nous avons recueilli les donnees epidemiologiques, cliniques, paracliniques, therapeutiques et evolutives. Resultats Durant la periode d’etude, 368 patients etaient suivis pour une glomerulopathie primitive et 172 d’entre eux presentaient une HTA, soit une prevalence d’HTA de 46 %. L’âge moyen etait de 33,9 ± 13,7 ans et le sex-ratio (H/F) de 2,07. La pression arterielle (PA) systolique moyenne etait de 158,93 ± 21,57 mmHg. La PA diastolique moyenne etait de 98,23 ± 14,8 mmHg. L’HTA etait de grade II (de l’OM) dans 36 % des cas. L’œdeme aigu du poumon a l’admission etait observe dans 38,5 % des cas. Les œdemes de type renal etaient notes dans 80,8 % des cas. La MRC etait au stade 5 a l’admission chez 45,9 % des patients. La proteinurie etait massive superieure a 3 g/24 h dans 65,2 % des cas. Le syndrome nephrotique etait note dans 62,7 % des cas. La hyalinose segmentaire et focale (HSF) etait la lesion la plus frequemment observee dans 48,7 % des cas. Les diuretiques de l’anse etaient prescrits dans 76 % des cas, les IEC dans 79 % des cas. Une bitherapie (IEC + diuretiques) etait prescrite dans 64,5 % des cas. L’evolution a 12 mois etait favorable dans 84,6 % des cas, defavorable dans 11,5 % des cas et 3,9 % des patients etaient perdus de vue. Les facteurs associes a la survenue de l’HTA etaient l’hypoalbuminemie inferieure a 30 g/L (p = 0,018). Conclusion L’HTA secondaire aux glomerulopathies chroniques primitives est frequente dans notre etude, particulierement en cas de HSF. Son controle est primordial pour ralentir la progression de la maladie renale chronique.