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Resume Introduction Le traitement du paludisme non codifie reste tres delicat dans l’insuffisance renale chronique, avec des anomalies immunitaires qui affaiblissent le sujet uremique et creent un cercle vicieux morbide. Objectif Decrire le profil de traitement du paludisme du patient presentant une insuffisance renale chronique. Methodologie Il s’agit d’une etude retrospective des patients atteints d’insuffisance renale chronique presentant un paludisme diagnostique admis dans les services de nephrologie des centres hospitaliers universitaires de Treichville et Yopougon du 1er octobre 2018 au 28 fevrier 2019 et ayant donne leur consentement eclaire verbal. Resultats Nous avons identifie 278 insuffisants renaux chroniques dont 40 (14,4 %) avaient un paludisme. L’âge moyen etait de 42 ± 13 ans, avec une predominance masculine (sex-ratio : 1,1). Les signes cliniques etaient une hyperthermie (70 %), une douleur diffuse (67,5 %) et des cephalees (37,5 %). L’insuffisance renale chronique etait decouverte au stade 5 dans 87,5 %, et 85 % ont debute la dialyse chronique a l’aide d’un catheter d’hemodialyse (94 %). Le paludisme a ete confirme par une goutte epaisse (66 %) et un Quantitative Buffy Coast Malaria Test (44 %). Il y avait une anemie severe avec un taux d’hemoglobine moyen de 7,1 ± 1,9 g/dL et une thrombocytopenie (38,4 %). Le paludisme a ete traite en premiere intention avec l’artemether (67 %) ou l’artesunate (25 %) par voie intramusculaire (67,5 %) ou intraveineuse (25 %). La duree moyenne du traitement par artemether etait de 3 jours et l’artesunate de 4,5 jours ± 1,1. Soixante-dix-huit pour cent (78 %) des patients avaient un antipaludique injectable sans relais oral. L’evolution clinique etait favorable avec 77,5 % de guerison. Le diabete etait un facteur influencant l’evolution des patients. Conclusion Cette etude revele une mauvaise utilisation des antipaludiques car les recommandations nationales pour le traitement du paludisme n’etaient pas respectees. La presence d’anemie rendrait les voies parenterales preferables.

L´hypertension artérielle maligne (HTAM) est une entité nosologique peu décrite en milieu néphrologique. L´objectif était de décrire le profil des patients présentant une HTA maligne en milieu néphrologique et identifier les facteurs pronostiques. Étude rétrospective, descriptive et analytique réalisée de janvier 2013 à décembre 2018 dans le service de néphrologie du CHU de Treichville. Le diagnostic d´HTA maligne était retenu devant une pression artérielle diastolique (PAD) ≥ 130 mmHg, une rétinopathie hypertensive au stade III ou IV selon Keith Wegener, avec une ou plusieurs autres atteintes viscérales cardiaques et/ou cérébrales et/ou rénales. Nous avons colligé 168 patients. L´âge moyen était de 41,10 ± 14,86 ans avec une prédominance masculine (sex-ratio de 1,54). Les facteurs de risque cardiovasculaire étaient l´HTA (79,20%), l´alcool (32,10%), le tabac (19,60%), la maladie rénale chronique (15,30%) et le diabète (11,30%). Ils étaient admis pour dyspnée (39,29%), poussée hypertensive (26,16%), troubles de la conscience (10 ,12%). L´examen clinique notait une anémie (82,10%), des œdèmes des membres inférieurs (63,10%), un œdème aigu du poumon (37,50%). Pour le retentissement de l´HTA, nous avons observé une insuffisance rénale (95,9%), une hypertrophie ventriculaire gauche (92,81%), un accident vasculaire cérébral (16,67%), un double retentissement cardiaque et rénal (85%). L´insuffisance rénale était chronique dans 78%. Les étiologies de l´HTAM étaient l´HTA essentielle (56,8%), la glomérulonéphrite chronique (29,8%) et le diabète (6%). L´évolution a été favorable dans 66,7% des cas et le décès constaté dans 25,6% des cas. En analyse multivariée, le taux d´urémie ≥ 2g/l [OR=5,07; IC95% = (2,39-10,75); p = 0,0001], l´hyperkaliémie [OR = 3,50; IC95% = (1,70-7,19); p = 0,001], l´hyponatrémie [OR = 2,90;IC95% = (1,40-6,03); p = 0,004], le taux d´hémoglobine < 12g/dl [OR = 5,91; IC 95% = (1,34-26,00); p = 0,019] et l´IR terminale [OR =6,06; IC95% = (2,04-18,18); p = 0,001] étaient les facteurs associés à la survenue de décès. L´HTA maligne est consécutive à une HTA mal ou non traitée. Elle touche l´adulte jeune avec des complications multiviscérales dominées dans notre contexte par l´insuffisance rénale chronique terminale (IRCT). D´où l´intérêt d´un diagnostic précoce et d´une prise en charge adéquate de toute HTA.

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.Describe the malaria treatment profile of the chronic renal failure patient with malaria.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.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.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.

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

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.

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.

En Côte d'Ivoire, la prévalence de l'infection au virus de l'immunodéficience humaine (VIH) est élevée. Tous les organes peuvent être atteints, en particulier le rein. Certaines études en Côte d'Ivoire ont retrouvé les infections opportunistes comme facteur de mauvais pronostic de l'insuffisance rénale aiguë (IRA). L'objectif de cette étude était de rechercher les éventuels autres facteurs associés à l'évolution de l'IRA chez les personnes infectées par le VIH. Une étude rétrospective, analytique, menée au Centre Hospitalier et Universitaire de Yopougon de janvier 2014 à décembre 2017. Etaient inclus tous les patients âgés de plus de 18 ans, infectés par le VIH et ayant présenté une IRA. Soixante-treize (73) patients ont été inclus, soit une prévalence de 24%. L'âge moyen des patients était de 39,32 ± 10,50 ans avec des extrêmes de 18 et 65 ans. Un sexe ratio de 1,6 en faveur des femmes. L'obésité (p=0,047; OR=8,72; IC (95%)=1,07-39,21) et le taux de CD4< 200/mm3(p=0,000; OR=58,50; IC (95%)=10,31-55,12) étaient associés à un mauvais pronostic de l'IRA. En Côte d'Ivoire, la prévalence hospitalière l'IRA au cours du VIH demeure élevée. Son évolution est défavorable avec le décès ou le passage à la chronicité. En plus de l'immunodépression profonde déjà connue comme facteur de mauvais pronostic, cette étude a montré que l'obésité était associée à une évolution défavorable de l'IRA chez les personnes vivant avec le VIH.

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.